[Various approaches of endometrial preparation for frozen-thawed embryo transfer]. / Moznosti prípravy endometria ke kryoembryotransferu.

OBJECTIVE: Various approaches of endometrial preparation for frozen-thawed embryo transfer. DESIGN: Retrospective analysis. SETTING: Department of Obstetric and Gyneacology, Faculty of Medicine, Palacky University, University Hospital Olomouc. METHODS: Effectivity of frozen-thawed embryo transfers was carried out between January and August 2017 in the IVF unit at the University Hospital Olomouc. Results were compared among groups A, B, C with various approaches of endometrial preparation. Group A - natural ovulating cycle, group B - artificial cycle with oral estrogen, vaginal gestagen and group C - artificial cycle with transdermal estrogen and vaginal gestagen. One blastocyst (two blastocyst in five cycles) was transferred on day 6 post ovulation (group A) or after 6 days of using gestagens (group B, C). RESULTS: The highest pregnancy rate was observed in group C (56%), similar pregnancy rate was found in group B (52%) and the lowest was seen in group A (22%). All pregnancies in group A continued over 12 weeks, in group B continued 57 percent and in group C continued 56 percent of pregnancies. CONCLUSION: Frozen-thawed embryotransfers in natural cycles are highly time-consuming. Our study has demonstrated the lowest effectivity of frozen-embryotransfer in natural cycles. Artificial cycles managed by oral or transdermal form of estrogen have shown better results.

[Sacrospinous fixation for vaginal vault prolapse after hysterectomy sec. Miyazaki - longterm results]. / Sakrospinální fixace prolabovaného posevního pahýlu po hysterektomii sec. Miyazaki - dlouhodobé výsledky.

OBJECTIVE: To assess intra- and postoperative complications and to look for long term follow-up results in women with sacrospinous ligament fixation for vaginal vault prolapse sec. Miyazaki. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: Between January 2002 and December 2011,112 women (mean age 66.8, range 44 to 88 years) underwent vaginal unilateral sacrospinous ligament fixation sec. Miyazaki; 101 patients had prior hysterectomy. In 11 patients concomitant hysterectomy and sacrospinous ligament fixation was performed. RESULTS: All 112 patients were analysed for intra and postoperative complications. Urinary tract infection (n=6; 5.3%), hematoma (n=6; 5.3%), temporary urinary retention (n=3; 2.7%), and temporary irritation of the static nerve (n=2; 1.6%), occurred in the postoperative phase. Long term data (range from 1 month to 8 years, mean 22 months) exist for 59 patients. 56 were completely cured without any signs of urinary inkontinence and prolapse. At follow-up 3 patients (5.1%) showed recurrent vaginal vault prolapse. Recurrent cystoceles and rectoceles were found in 10 (16.9%) and one (1.6%) cases respectively. Three patiens with complete recurrence of vaginal vault prolapse successfully underwent repeated sacrospinous ligament fixation sec. Miyazaki (2 cases) or polypropylene mesh insertion (1 case). CONCLUSION: Sacrospinous ligament fixation sec. Miyazaki is an effective and safe procedure with a low recurrence and complication rate.

Prognostic importance of selected molecular immunohistochemical markers and DNA ploidy in endometrial cancer.

UNLABELLED: The aim of the study was the analysis of the new molecular genetic immunomarkers (p53, c-erbB-2, Ki 67, bcl-2) hormonal receptors (ER, PR) and ploidy disturbances and their relation to the most important prognostic factors for endometrial cancer. The study group consisted of 135 endometrial cancer patients. Biopsies of the tumours obtained at operations were routinely histopathologically examined. Subsequenly, the immunohistochemical tumour markers were determined. The same biopsies were examined by microdissection and flow cytometric ploidy analysis and karyotyping. The findings were compared with the most important prognostic factors for endometrial cancer, mainly with clinical stage of the disease and grade. RESULTS: High expression of p53, Ki 67, c-erbB-2 and low rate of progesterone receptors was found in the prognostically unfavourable group (G 3). Aneuploidy was found in 72% in the group of poorly differentiated endometrial cancers (G 3) in contrast to 27% in the group of G1 and G2 tumours, but this difference was not statistically significant. CONCLUSIONS: Identification of p53, Ki 67, c-erbB-2, PR and determination of DNA ploidy is a useful tool to specify a group of prognostically unfavourable patients.

[Prognostic importance of selected molecular genetic immunohistochemical markers and DNA ploidy in endometrial cancer]. / Prognostický význam vybraných molekulárne-genetických imunohistochemických markeru a DNA ploidity u karcinomu endometria.

OBJECTIVE: The aim of the study was the analysis of the new molecular genetic immunomarkers (p53, c-erbB-2, Ki 67, bcl-2) hormonal receptors (ER, PR) and ploidy disturbances and their relation to the most important prognostic factors for endometrial cancer. DESIGN: Prospective study. SETTING: Dept. of Gynaecology and Obsterics, Laboratory of Experimental Medicine, Institute of Pathology, Institute of Molecular and Transplational Medicine, Medical Faculty and University Hospital, Olomouc. METHODS: The study group consisted of 88 endometrial cancer patients. The biopsies of the tumours obtained at operations were routinely histopathologically examined. Subsequently, the immunohistochemical tumormarkers were determined. The same biopsies were examined by microdissection and flow cytometric ploidy analysis and karyotyping. The findings were compared with the most important prognostic factors for endometrial cancer, mainly with clinical stage of the disease, grade and histopathological type. RESULTS: Aneuploidy was found in 71% in the group of poorly differentiated endometrial cancers (G3) in contrast to 47% in the group of G1 and G2 tumours. High expression of p53, Ki 67, c-erbB-2 and low rate of sex hormone receptors was found in the prognostically unfavourable group (G3). CONCLUSIONS: Aneuploidy seems to be an important prognostical factor for endometrial cancer patients. Identification of p53, Ki 67, c-erbB-2, ER a PR is a useful tool to specify a group of prognostically unfavourable patients.

[Complications of laparoscopic and laparotomic treatment of endometrial cancer]. / Komplikace laparotomické a laparoskopické lécby karcinomu endometria.

OBJECTIVE: The aim of the study is to compare advantages, disadvantages and complications of the laparoscopic and clasical laparotomic operations in the patients treated for endometrial carcinoma at our Department and to find out the optimal strategy. DESIGN: Retrospective study. SETTINGS: Department of Gynaecology and Obstetrics, Medical Faculty, Palacky University and University Hospital, Olomouc. MATERIAL AND METHODS: A total of 165 endometrial cancer patients were operated on since 2004 till 2008 at our department. The clasical laparotomic approach was used in 141 patients and 24 were operated laparoscopically. Both groups were comparable in clinical staging and other parameters. The clinical parameters compared were the frequency of inflammatory complications, urinary passage injury, blood loss, transfusions, operating time and hospital stay. RESULTS: The average operating time for laparotomic operations was 137 minutes and for the laparoscopic ones 175 minutes. The mean hospital stay after clasical operation was 7.8 days, and 6.7 days after laparoscopy. The estimated blood after clasical operation was 410 ml and 8.5% of patients received blood transfusion. Blood loss after laparoscopy was only 214 ml but 12.5% of patients necessitated blood transfusion. Complications due to infection were more often in patients with laparotomy (5.7%) while they occurred only in 4.1% after laparoscopies. The injury of the urinary tract was recorded only in 1 patient (0.7%) in the laparotomy group while it was more frequent in the laparoscopic group (2 patients i.e. 8.3%). CONCLUSIONS: The main advantage of laparoscopy at the operations of the endometrial cancer is the shorter hospital stay resulting in lower costs, less postoperative discomfort and a minimum of inflammatory complications. On the other hand there were more frequent urinary tract injuries and the operating time was usually longer at laparoscopies compared to laparotomies. Nevertheless, it seems that the use of the laparoscopic operations for endometrial cancer will probably be increasing.

[The importance of sonography and hysteroscopy at suspected findings on endometrium of menopausal women]. / Význam sonografie a hysteroskopie u suspektních nálezu na endometriu menopauzálních zen.

OBJECTIVE: To evaluate the reliability of vaginal sonography and hysteroscopy based on the histopathologic finding in menopausal women. To compare the findings in a group of asymptomatic women with the findings in patients with a clinical symptomatology of endometrial disease. DESIGN: A retrospective study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: Diagnostic hysteroscopy with targeted biopsy was performed in 186 menopausal women who were referred to our department either on the basis of clinical symptoms or only on the basis of a suspected ultrasound finding. The ultrasound and hysteroscopic findings were compared with the final histopathologic diagnosis and their reliability was evaluated. The findings were evaluated separately for asymptomatic and symptomatic patients. RESULTS: In all asymptomatic and in 88% symptomatic patients vaginal sonography showed endometrial thickness higher than 5 mm. In 10 patients (14%) sonographic finding suggested possibility of a malignant process. The most frequent finding at hysteroscopy was endometrial polyp, which was found in more than a half of asymptomatic women. In two patients (5%) hysteroscopic findings were suspected for malignancy. Histopathologic examination confirmed malignant tumour in 6 patients (7%). Accordance with the histopathologic finding was more often seen in hysteroscopy than in vaginal sonography. CONCLUSION: The main advantage of vaginal sonography in menopausal women is a relatively easy detection of suspicious findings on the endometrium, especially in asymptomatic patients. Hysteroscopy, on the contrary, enables to visualize the endometrial cavity and mainly the targeted biopsy. Even if the number of malignant endometrial diseases is not high (6% in asymptomatic patients) the combination of vaginal sonography and hysteroscopy is optimal for the detection of pathological findings on the endometrium.

[Etiopathogenesis of the prolapsed vaginal vault after hysterectomy]. / Etiopatogeneze prolapsu pochvy po hysterektomii.

OBJECTIVE: To determine the main etiopathogenic factors which may participate in the development of vaginal prolapse after hysterectomy. DESIGN: A retrospective study. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of the Palacký University and University Hospital, Olomouc. METHODS: The analysis of relevant factors which can participate in the origin and development of vaginal prolapse was carried out on the group of 51 patients treated for vaginal prolapse after hysterectomy performed in the years 2002 to 2005. The data were retrieved retrospectively from medical documentation and appended by the information obtained from questionnaires send to the patients. RESULTS: Factors participating in the development of vaginal prolapse can be divided into 3 groups: 1. Mistakes in surgical technique and complications in the post-operative period, 2. inherited qualities of patients, and 3. impact of adverse external factors. CONCLUSIONS: Several factors are involved in the etiopathogenesis of vaginal prolapse, the most important of which are the inherited qualities of patients, incorrect surgical technique and adverse outcome in the post-operative period.

[Rescue cerclage in the treatment of cervical insufficiency]. / Záchranné cerkláze v lécbe cervikální insuficience.

OBJECTIVE: To evaluate the effectiveness of the cervical cerclage in the five year period on pregnancy outcome. The primary outcomes of interest was effectiveness of rescue cerclage in prolongation of pregnancy. STUDY DESIGN: Retrospective study. SETTING: Gynaecological and Obstetric Clinic Medical Faculty Palacky University and Faculty Hospital Olomouc. METHODS: In the retrospective analysis of maternal and newborn records in the five year period from 1. 1. 2000 to 31. 12. 2004 we identified three groups of indications for operative cervical closure: elective--on the basis of history without objective evidence of cervical change, emergency cerclage--with objective manifestation of cervical insufficiency and rescue cerclage of a widely dilated cervix with prolapsed unruptured membranes. RESULTS: A total of 50 patients underwent cerclage during the period from 1. 1. 2000 to 31. 12. 2004 between 12 and 30 weeks of gestation. The prevalence of operative intervention was 0.6% of all mothers. All patients had similar management (hospitalization, bed rest, antibiotics and tocolysis treatment). Cervical cerclage was done by the McDonald technique with single or double stich or Mersilene tape. Fourteen patients (28%) had rescue operations, 28 (56%) emergency and 8 (16 %) elective cerclage. In all groups there was no significant difference in the sociodemographic characteristics (age, BMI, education, number of previous pregnancies and parity). Also no significant difference we found in pregnancy complications. Only smoking in the pregnancy was a significant risk factor associated with rescue cerclage, relative risk = 3.30 (95% CI 1.57-6.96, P = 0.0272183). Critical gestational age 32nd week achieved 6 rescue cerclage subjects (42.9%), significantly less as for emergency cerclage subjects (85.7%), (P = 0.0089396) and elective ones (87.5%). Mean length of interval from cerclage to delivery was significantly shorter after rescue cerclage, 42.7 +/- 35.8 days, median 24, range (3-126) compared to emergency cerclage patients, 72.0 +/- 28.4 median 72, range (14-130), (P = 0.006247). Interval from cerclage to delivery in elective operation was 118 +/- 59.1, median 109, range (32-188), (P = 0.049818). Survival analysis also confirmed significantly shorter interval from cerclage to delivery in the rescue cerclage compared to other acute intervention. Log Rank test = 23.6205 (P = 0.000000), Wilcoxon = 20.299 (P = 0.000000). Newborn dates corresponds with earlies termination of pregnancy in rescue cerclage subjects, with mean gestational age at time of delivery 29.5 +/- 6.0 weeks, median 28, range (20-41), after emergency cerclage 35.4 +/- 3.4, median 37, range (26-41), (P = 0.000592). The mean gestational age at delivery after elective cerclage was 34.8 +/- 5.0, median 35, range, (25-41). There was no significant difference in hospitalization time between groups. Three fetal losses of extremly low birth weight babies were in rescue subjects, one abortion at 20 weeks gestation, fetal weight 260 grams with marked acute chorioamnionitis. Interval from cerclage to abortion was 24 days. Two female fetuses (twins) 530 anad 550 grams died early in life after caesarean section for placental abruption 34 days after the cerclage. CONCLUSION: Rescue cerclage occurs in 28% of all cervical closure. In comparison with other indications they have significantly worse outcomes in prolongation of pregnancy. Obviously, because they are extreme events of cervical insufficiency. Fetal losses were nevertheless minimal and connected with intrauterine infection and placental abruption. In combination with antibiotics and tocolysis rescue cerclage gives hopes that they can help in pregnancy prolongation.

[Uterine myomatosis--abdominal hysterectomy, vaginal hysterectomy or laparoscopic-assisted vaginal hysterectomy?]. / Delozní myomatóza--AHY, VHY nebo LAVHY?

OBJECTIVE: To evaluate the way of the surgical treatment of uterine fibroids in two 5 year long periods. In the first period (1987-1991) the operative procedures--hysterectomies--were performed usually by the classical abdominal approach. In the second period (1997-2001) the modern trend of minimal invasive surgery was applied. Through analysis of three surgical procedures used (AHY, VHY, LAVHY) the conclusions concerning the advantages, disadvantages and correct indications for the selection of hysterectomy in cases of uterine fibroids are presented. STUDY DESIGN: Retrospective study. STUDY SETTING: Department of Obstetrics and Gynecology, Medical Faculty and University Hospital, Palacký University, Olomouc. METHODS: The total of 1172 patients (604 in the first period and 568 in the second period) were operated by abdominal hysterectomy (AHY), vaginal hysterectomy (VHY) or laparoscopically assisted vaginal hysterectomy (LAVHY). The factors influencing the mode of hysterectomy (body mass, weight of uterus, parity, adnexal finding, previous surgery) were analyzed. The type of anesthesia and per and postoperation complications (blood loss, conversion of vaginal to abdominal approach, inflammatory complications and administration of antibiotics) were also evaluated. RESULTS: Each of the chosen surgical procedures has advantages and disadvantages. Abdominal hysterectomy as the most invasive procedure is indicated only in extremely unfavourable findings. The least invasive procedure is VHY, which therefore is the optimal solution for the patient. LAVHY represents the operation which combines advantages of both AHY and VHY and fulfills also the criteria for minimal invasive surgery. CONCLUSION: The choice of the optimal surgical procedure in patients with uterine fibroids depends on the complex assessment of the preoperative finding, the technical possibilities of the setting and the experience of the surgeon. The goal is to chose the safest but at the same time least invasive surgical procedure.