Prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient.

OBJECTIVE: To describe a case report with prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc; Department of Radiology, University Hospital, Olomouc; Department of Health Care Sciencies, Bata University, Zlín. CASE REPORT: We describe case report with prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient in attempt to decrease the risk of heavy peroperative bleeding. Twenty eight years old primigravida underwent prophylactic internal iliac artery balloon catheterization with interventional radiology preoperatively. Two 6-Fr balloon catheters transfemorally bilaterally up to internal iliac artery with position a “cross over“ were introduced, according to Seldingers standard technique. The procedure was without complications, estimated blood loss was 500 ml. CONCLUSION: Prophylactic placement of intravascular balloon catheters is a feasible treatment for Jehova´s Witnesses patients in efforts to decrease the risk of heavy bleeding during cesarean section.

Medical ethical moral and legal aspects of Jehovah´s Witnesses operations.

OBJECTIVE: To point out principles of blood sparing surgery. Medical ethical moral and legal aspects of operations on Jehovahs Witnesses. DESIGN: Retrospective clinical study. Review of articles. SETTING: Dept. of Gynecology and Obstetrics, University Hospital, Olomouc; Dept. of Health Care Sciences, Faculty of Humanities, Tomas Bata University Zlín. MATERIALS AND METHODS: 72 Jehovahs Witnesses patients were operated on for various benign and malignant gynecological diseases since 2007-2017. All patiens were operated according to the rules of blood sparing surgery. RESULTS: There were no excesive blood loss at any of the operations. The estimated blood loss was between 10 to 550 ml. CONCLUSIONS: The main principles of blood sparing surgery should be applied not only for Jehovahs Witnesses but for all patients. Even if the blood transfusion is the last resort for excessive blood loss during complicated operations it always carries some health risks. There are also the economical aspects. Blood transfusions should be therefore used only at very rare occasions. Jehovahs Witnesses refuse blood transfusions at all even if it is the only life saving resort. Our legislation deal with this problem but there are also moral and ethical aspects. The attitude of gynecological surgeons how to solve this problem differ a great deal.

Sakrospinous fixation sec. Miyazaki - complications and long-term results.

OBJECTIVE: To evaluate preoperative, perioperative and postoperative data, complications and results in long-term follow-up at patients who underwent Miyazaki´s sacrospinous suspension between January 2002 and December 2018. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc. METHODS: The evaluation of results of 240 patients who underwent Myiazaki sacrospinous suspension for vaginal prolaps between January 2002 and December 2018. RESULTS: The mean age of patients operated between 2014-2018 was higher than the mean age of all patients. Perioperative and early postoperative complications were analysed in six tables and two graphs. The most common complications were transient urinary retention (5.24%), urinary tract infection (3.80%) and pelvic hematoma (7.14%). In the long-term follow-up (131 patients over 24 months) the recurrence of apical defect was recorded at 12 (9.16%), cystocele at 26 (19.85%) and rectocele/enterocele at 3 (2.29%) patients. Patients with recurrence of vaginal vault prolapse underwent Miyazaki´s sacrospinous resuspension in four, transvaginal mesh insertion in three and sacropexy in five cases. CONCLUSION: Miyazakis sacrospinous suspension is an effective and safe method how to correct vaginal apical prolapse. The introduction of new surgical methods probably explains the shift of the age of the patients to the older ones in the last years. The most frequent early postoperative complications were urinary tract infections and pelvic hematomas. In the long-term follow up they were the recurrences of the prolaps of the anterior compartment. Total recurent apical vaginal prolaps was recorded at 12 patients (9.16%.).

[Comparison of vaginal use of micronized progesterone for the luteal support. Randomized study comparison of Utrogestan and Crinone 8]. / Srovnání vaginálního uzití mikronizovaného progesteronu k luteální podpore. Randomizovaná studie porovnávající Utrogestan a Crinone 8.

OBJECTIVE: The study was focused on comparison of efficiency, safety and tolerance of vaginal use of micronized progesterone in preparations Utrogestan and Crinone 8%. DESIGN: Prospective randomized study. SETTING: Department of Gynecology and Obstetric, University Hospital, Olomouc, Faculty of Medicine and Dentistry, Palacky University, Olomouc. MATERIAL AND METHODOLOGY: Into a prospective randomized study was, after calculation of 80% of the power of the study, α = 0,05, included 111 women in age between 18-40 with a basal value FSH < 10 IU/l and a normal finding in uteral cavity. After evaluation of efficiency of both preparations there was selected a fertilization rate, an implantation rate, a pregnancy rate and a take-home baby rate. Comparison of tolerance was made from evaluation of 21 parameters which were obtained through a questionnaire. RESULTS: There were not been proven any significant differences in efficiency between both preparations. Crinone 8% was in patients better tolerated. CONCLUSION: Luteal support within the IVF/ICSI-ET remains an integral part of the treatment. According to the outcomes of the study it seems to be more suitable to use a vaginal gel for the luteal support with micronized progesterone.

Hepatotoxic effects of fenofibrate in spontaneously hypertensive rats expressing human C-reactive protein.

Dyslipidemia and inflammation play an important role in the pathogenesis of cardiovascular and liver disease. Fenofibrate has a well-known efficacy to reduce cholesterol and triglycerides. Combination with statins can ameliorate hypolipidemic and anti-inflammatory effects of fibrates. In the current study, we tested the anti-inflammatory and metabolic effects of fenofibrate alone and in combination with rosuvastatin in a model of inflammation and metabolic syndrome, using spontaneously hypertensive rats expressing the human C-reactive protein transgene (SHR-CRP transgenic rats). SHR-CRP rats treated with fenofibrate alone (100 mg/kg body weight) or in combination with rosuvastatin (20 mg/kg body weight) vs. SHR-CRP untreated controls showed increased levels of proinflammatory marker IL6, increased concentrations of ALT, AST and ALP, increased oxidative stress in the liver and necrotic changes of the liver. In addition, SHR-CRP rats treated with fenofibrate, or with fenofibrate combined with rosuvastatin vs. untreated controls, exhibited increased serum triglycerides and reduced HDL cholesterol, as well as reduced hepatic triglyceride, cholesterol and glycogen concentrations. These findings suggest that in the presence of high levels of human CRP, fenofibrate can induce liver damage even in combination with rosuvastatin. Accordingly, these results caution against the possible hepatotoxic effects of fenofibrate in patients with high levels of CRP.

[Robot assisted endometrial cancer staging - evaluation the first 100 operations and comparing the first andthe last 30 operations]. / Robotem asistovaný staging karcinomu endometria - vyhodnocení prvních 100 operací a srovnání prvních a posledních 30 operací.

OBJECTIVE: To describe and evaluate our experience with robotically assisted laparoscopic staging of endometrial cancer in first hundred cases as compared with the first and last 30 cases of patients staged by this method. DESIGN: Comparative retrospective study. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic. Institute of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic. METHODS: The robotic centre at the Faculty Hospital in Olomouc was opened in August 2009 which enabled to perform robotically assisted laparoscopic staging of endometrial cancer. Retrospectively we evaluated the first hundred patients with the early stage of endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic/paraaortic lymphadenectomy using four-armed da Vinci S HD surgical robotic system. In the second stage of the evaluation we compared the first and the last 30 cases operated by the above mentioned minimally invasive approach. All cases were performed by two surgeons (P.R., D.P.), within the same institution in the course of learning this technique. Age, body mass index (BMI), clinical stage of disease, length of operation, nodal yield, blood loss, the pre-operative and post-operative hemoglobin concentration difference and operating complications were documented and compared. RESULTS: The first hundred patients were operated by the above mentioned minimally invasive method between September 2009 nad June 2014. All patients were between 33 and 85 years of age. The average age of the entire group of patients was 65 years of age, the average BMI reached 31.0 (ranging from 18.0 to 49.0), the operating times median was 206 minutes. The estimated median of blood loss was 100 ml. The conversion of robotic surgery to a laparotomy was recordedin 6 cases. When comparing the first and the last30 operated patients there was observed a statistically significant increase in BMI in the group of the last30 operations (29.5 vs. 33.0, p = 0.004) and there was a decrease in the number of conversions from 4 to 1.In particular, however, there was a statistically significant increase in the total number of the obtained lymph nodes in the group of the last 30 vs. the first30 patients (27 vs. 17), and the increase in the number of removed pelvic lymph nodes (21 vs. 17) and the paraaortic nodes (4 vs. 0). CONCLUSION: The robotically assisted laparoscopic staging is one of several possible surgical approaches in the treatment of patients with endometrial cancer and it can be performed adequately in this way. According to the results from our patients group it is a surgical modality with significantly low blood loss, safe even for patients with high BMI and age. The increasing erudition of the surgeon is linked to the shortening of the operating time, reducing the number of conversions and the higher yield of lymph nodes and a reduction in blood loss which was reflected in particular in the comparison of the pre-operative and post-operative hemoglobin difference.

[Benefits and the accuracy of the intra-operative frozen section at suspected ovarian tumours]. / Prínos a validita peroperacní frozen section u suspektních ovariálních tumoru.

OBJECTIVE: To assess benefits and the accuracy of the intra-operative frozen section for the operative strategy at suspected ovarian tumours. TYPE OF STUDY: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc. MATERIALS AND METHODS: Intraoperative frozen section and final histopathology were compared in 53 patients who underwent operative treatment for suspected ovarian neoplazma. The accuracy of the frozen section findings was evaluated according to the histopatological type of tumours and categories - benign, malignant and borderline tumours. CONCLUSION: In accordance with literature reports a good reliability of the frozen section as for the sensitivity, specificity, positive and negative predictive values were proved. The majority of errors occured in diagnosing mucinous and borderline tumours.

[Psychosomatic aspects and antipsychotics medication in ethiopathogenesis of endometrial carcinoma]. / Psychosomatické aspekty a lécba psychofarmaky v etiopatogenezi karcinomu endometria.

OBJECTIVE: To assess possible role of psychosomatic aspects and antipsychotic medical treatment in ethio-pathogenesis of endometrial cancer. DESIGN: Prospective study and revue of literature. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University Hospital, Olomouc; Department of Health Care Science, Faculty of Humanities, Tomas Bata University in Zlín. METHODS: A case-control study was conducted on 40 patients who underwent surgical treatment for histopathologicly confirmed diagnosis of endometrial cancer. Patients on admition were examined by means of the standardised Minnesota personality inventory MMPI-2. Antipsychotic medical treatment in patients history was recorded. RESULTS: Our study confirmed signinicantly increas in the scale of depression, anxiety, psychastenia, social introversion, low self-respect, A-type behaviour and hostility. On the other hand there were no changes in the scale of hysteria and lie. A possible role of antipsychotics is discussed. KEYWORDS: endometrial carcinoma, psychosomatic aspects, antipsychotics medication.

Emergence patterns and ecological associations of some haematophagous blackfly species along an oligotrophic hydrosystem.

Emergence patterns of blackflies (Diptera: Simuliidae) were investigated for 2 years at nine sites in the Plitvice Lakes area of Croatia, using pyramid-type traps. A total of 38 012 specimens representing 10 haematophagous species were collected. The dominant species was Simulium angustipes Edwards, 1915, a vector transmitting avian trypanosomes. Water temperature, alkalinity, conductivity and habitat type represented the factors with the greatest degree of influence on blackfly species composition, structure and distribution along a longitudinal gradient of this oligotrophic karstic hydrosystem. Simulium angustipes was highly associated with lake outlets. The blackfly communities at all sites were dominated by species typical of the rhithral zone, but there was a shift in species composition along a longitudinal gradient from the hypocrenal-epirhithral to the epirhithral-metarhithral zone. Multiple generations per year were detected in S. angustipes, whereas in Simulium costatum Friederichs, 1920, the number of generations differed between sites with constant and those with variable water temperature.

[Gynaecological surgery of Jehovah´s Witnesses]. / Chirurgická lécba gynekologických onemocnení u Svedkyn Jehovových.

OBJECTIVE: To present experience with surgical treatment of various gynaecological diseases in patients belonging to the Church of Jehova´s Witness. DESIGNE: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Palacky University Olomouc, Institute of Health Care Studies, Faculty of Humanity Studies, Thomas Bata University, Zlín. METHODS AND RESULTS: The study included 24 patients belonging to the Church of Jehova´s Witness who reject blood tranfusion. The operations in these patients were performed for malignant as well as nonmalignant gynaecological disorders which could not be treated by conservative therapeutic procedures. The operation records were analysed and evaluated according to a set of criteria including the type of surgical procedure, estimated amount of blood loss, postoperative complications and the outcome of surgical treatment. CONCLUSION: Jehovas´s Witnesses represent a risk group of patients considering their refusal of blood transfusion. The indication for the operation and its performing is responsible decision which always inherits a certain degrese of risk. On the other hand, when adhering to the principles of bloodless surgery, the therapeutic results are very good and in the properly indicated cases the scope of risk is acceptable.

["Learning curve" robotic radical hysterectomy compared to standardized laparoscopy assisted radical vaginal and open radical hysterectomy]. / Robotem asistovaná radikální hysterektomie ve fázi "learning curve" a její srovnání se standardní laparoskopicky asistovanou radikální vaginální a otevrenou radikální hysterektomií

OBJECTIVE: To compare intraoperative, pathologic and postoperative outcomes of "learning curve" robotic radical hysterectomy (RRH) with laparoscopy assisted radical vaginal hysterectomy (LARVH) and abdominal radical hysterectomy (ARH) in patients with early stage cervical carcinoma. DESIGN: Comparative study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: The first twenty patients with cervical cancer stages IA2-IIA underwent RRH and were compared with previous twenty LARVH and ARH cases. The procedures were performed at University Hospital Olomouc, Czech Republic between 2004 and 2011. RESULTS: There were no differences between groups for age, body mass index, tumor histology, number of nodes removed or preoperative hemoglobin levels. The median theatre time in the learning period for the robot procedure was reduced from 400 min to less than 223 min and compared well to the 215 min for an open procedure. We found differences between the pre- and postoperative hemoglobin levels (RRH, 14.9 ±7 .6; LARVH, 23.0 ± 8.5; ARH, 28.0 ± 12.4). This difference was statistically significant in favor of RRH group ( p= 0.0012). Mean length of stay was significantly shorter for the RRH group (7.2 versus 8.8 days,p = 0.0005). Mean pelvic lymph node count was similar in the three groups. None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative complications between the two groups were not significant. CONCLUSION: Based on our experience, robotic radical hysterectomy showed better results than traditional laparoscopically assisted radical vaginal hysterectomy in early stage cervical carcinoma cases. Introduction of this new technique requires a learning curve of less than 20 cases that will reduce the operating time to a level comparable to open surger.

[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.

[Objective assessment of the tissue trauma in surgery of endometrial cancer]. / Moznosti objektivizace tkánového traumatu u operací pro karcinom endometria.

OBJECTIVE: To review the current possibilities of objective assessment of tissue trauma in surgical treatment of endometrial cancer. TYPE OF STUDY: Review article. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc. MATERIAL AND METHODS: After critical evaluation of relevant contemporary literature, selected methods of the objective estimation of the extent of tissue trauma are presented. The aim of their choice was to find methods objectivly assessing the extent of tissue trauma in connection with using different types of surgical procedures in endometrial cancer treatment. CONCLUSION: The following clinical and biochemical markers - VAS, KO, CRP, IL-6, neopterin, kynurenin, retinol, α-tocoferol and citrulin seem to be best suitable for the assessment of surgical trauma. These markers should objectivly evaluate the peroperative burden in different types of surgical procedures used for treatment of endometrial cancer.

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.

Repeated chemosensitivity testing in patients with epithelial ovarian carcinoma.

Epithelial ovarian carcinoma (EOC) is a highly chemosensitive tumor, but most patients with advanced EOC initially responding to first-line chemotherapy will eventually relapse. Chemosensitivity testing may offer an opportunity for the optimal selection of chemotherapeutic agents for individual patients. In the present retrospective analysis we have examined the changes in chemosensitivity profiles during the course of the disease. Chemosensitivity was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test. Two or more samples at least 14 days apart were obtained from 34 patients with ovarian cancer. Chemoresistance increased significantly at the second measurement only for paclitaxel and carboplatin, the most frequently used cytotoxic drugs. No significant difference compared to baseline was observed at subsequent measurements for any other cytotoxic agent studied, although a non-significant trend for increased chemoresistance was observed. In conclusion, in the present cohort only paclitaxel and carboplatin chemosensitivity changed significantly, although to a limited extent, during the course of the disease. In contrast to a limited increase of paclitaxel and carboplatin chemoresistance, no significant changes were observed for other cytotoxic agents examined. The present data indicate that chemoresistance increases, to a modest extent, against the drug most frequently used, but remains relatively stable during the course of disease, especially for agents that are not used in the therapeutic regimen.

Immunohistochemical evaluation and lymph node metastasis in surgically staged endometrial carcinoma.

OBJECTIVE: To assess the expression of immunohistochemical markers in surgically staged endometrial cancer patients. METHODS: We studied 107 cases of primary untreated endometrial carcinoma in which the p53, bcl-2, her-2/neu, Ki-67, estrogen receptor (ER) and progesterone receptor (PR) antigens were investigated by an immunohistochemical method. In the last 50 consecutive patients immunoreactivity for MMP-7 and MMP-26 was assessed as well. We evaluated the correlations among the immunohistochemical staining assessed by histoscore, and the age, grading, depth of invasion, stage of the neoplasia and extrauterine disease. RESULTS: Mean age was 65 years (range 34-88). All patients were submitted to total abdominal or modified radical vaginal hysterectomy plus bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy; p53, bcl-2, her-2/neu, Ki-67, MMP-7, MMP-26, estrogen and progesterone receptors were positive in 36 (43%), 71 (86%), 13 (16%), 80 (96%), 65 (78%), 80 (96%), 61 (73%) and 71 (86%) patients, respectively. p53 overexpression was found to be related to poor grade of differentiation and deep myometrial invasion. Immunostaining for ER was inversely related to the histopathological differentiation of the tumors. Decreased expression of PR was related to advanced stage, poor histopathologic differentiation and extrauterine spread of disease. CONCLUSION: The overexpression of p53 seems to indicate more malignant phenotype, while PR expression correlates with parameters of better clinical outcome.

[Immunohistochemical markers expression in hysteroscopy and hysterectomy specimens from endometrial cancer patients: comparison]. / Porovnání exprese imunohistochemických markeru ve vzorcích z hysteroskopie a hysterektomie u pacientek s karcinomem endometria.

OBJECTIVE: To assess the immunohistochemical expression of p53, bcl-2, c-erbB-2, Ki-67, estrogen (ER) and progesterone receptors (PR), MMP-7, MMP-26 in samplex from diagnostic hysteroscopy and therapeutic hysterectomy in endometrial cancer patients. DESIGN: Experimental prospective study. SETTING: Department of Obstetrics and Gynecology, Institute of Human Genetics, Department of Pathology, Palacky University Medical School and University Hospital, Olomouc. METHODS: We studied 43 cases of primary untreated endometrial carcinoma in which the grade and immunomarkers assessed by histoscore were investigated in specimens obtained at hysteroscopy and hysterectomy. RESULTS: Based on hysterosopy, 31 (72.1%) patients were classified as G1, G2 7 (16.3%) and G3 5 (11.6%) respective. In grade 1 the concordance rate was 77.4% of cases, in grade 2 it was in 14.3% of cases and in grade 3 it was in 80.0% of cases. In hysterosocpy samples the p53 expression was found in 23 (53.5%), bcl-2 in 37 (86.0%), c-erbB-2 in 20 (46.5%), Ki-67 in 29 (67.4%), ER in 37 (86.0%), PR in 36 (83.7%), MMP-7 in 25 (58.1%) and MMP-26 in 23 (53.5%) cases. Expression in hysterectomy specimens was p53 positive in 13 (30.2%), bcl-2 positive in 33 (76.7%), c-erbB-2 positive in 24 (55.8%), Ki-67 positive in 25 (58.1%), ER positive in 36 (83.7%), PR positive in 40 (93.0%), MMP-7 positive in 27 (62.8%) and MMP-26 positive in 23 (53.5%) of total 43 cases. CONCLUSION: We found high concordance in expression of p53, bcl-2, PR and MMP-7 in hysteroscopy and hysterectomy samples which could be of importance for therapeutic algorithm in endometrial cancer patients.

[Prognostic significance of clinic pathological and selected immunohistochemical factors in endometrial cancer]. / Prognostický význam klinickopatologických a vybraných imunohistochemických faktoru u karcinomu endometria.

OBJECTIVE: To assess the immunohistochemical expression of p53, bcl-2, c-erbB-2, Ki-67, estrogen (ER) and progesterone (PR) receptors in endometrial cancer patients. To assess the relation between steroid receptors positivity and other markers. To evaluate the prognostic significance of clinicopathologic and immunohistochemical markers on patient disease free survival. DESIGN: Experimental prospective study. SETTING: Department of Obstetrics and Gynaecology, Institute of Human Genetics, Department of Pathology, Department of Biophysics, Palacky University Medical School and University Hospital, Olomouc. METHODS: We studied 144 cases of primary untreated endometrial carcinoma in which the p53, bcl-2, c-erbB-2, Ki-67, ER and PR antigens were investigated with the use of an immunohistochemical method. In a group of 122 patients we assessed disease free survival (DFS) in relation to clinicopathologic and immunohistochemical factors. RESULTS: From the total group of 144 patients, 122 were included for survival analysis. We found 15 (12.3%) patients with recurrence of the disease. Mean age was 64,5 (34-88) years. Immunohistologic expression was p53 positive in 29 (23.8%), bcl-2 positive in 87 (71.3%), c-erbB-2 positive in 34 (27.9%), Ki-67 positive in 56 (45.9%), ER positive in 97 (79.5%) and PR positive in 106 (86.9%) of cases. In the survival analysis significantly shorter DFS was present in tumours with poor differentiation (G3), deep myometrial invasion (M2) and positive lymphoinvasion (N). CONCLUSION: Only poor differentiation (G3) and deep myometrial invasion (M2) are significant independent factors for the length of DFS.