[Preoperative detection of lymph nodes by means of computer tomography in patients with endometrial carcinoma]. / Predoperacní detekce lymfatických uzlin pomocí computerové tomografie u onemocnení karcinomem endometria.

OBJECTIVE: To determine the value of computed tomography (CT) in predicting preoperatively nodal disease in patients with endometrial cancer. DESIGN: A prospective multicentric study. SETTING: Department of Obstetrics and Gynecology of the Palacky University Medical School and University Hospital, Olomouc, Obstetrical and Gynecological Departments of collaborating hospital, Czech Republic. METHODS: A total of 164 women with endometrial carcinoma that was diagnosed between 1998 and 2002 were recruited for this study. Final pathological findings were compared with those of the preoperative CT scans to assess nodal disease. RESULTS: Among 164 women who had preoperative scans and lymph node samplings, sensitivity, specificity, positive and negative predicting values of CT scans at predicting lymph node metastasis was 30, 95.5, 30 and 95.5% respectively. CONCLUSION: Routine preoperative CT scanning is a poor predictor of nodal disease in patients with endometrial cancer. Its preoperative routine use should be discouraged.

[Hysterectomy at the Olomouc Clinic 1989-2002: evolution in the indication spectrum and surgical approach]. / Hysterektomie na Olomoucké klinice v letech 1989-2002: vývoj v indikacním spektru a operacním prístupu.

OBJECTIVE: Analysis of representation in surgical approaches and techniques to hysterectomy (abdominal hysterectomy, vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy) in our clinic. The evolution of indications, diagnosis and operating approaches from 1989 to 2002 were analysed. DESIGN: Retrospective study. SETTING: Department of Obstetric and Gynecology, University Hospital, Olomouc. METHODS: Retrospective analysis of medical documentation (operating protocols). RESULTS: 3079 hysterectomies were performed in years 1989-2002. Type of hysterectomy in years 1989-1993: abdominal approach 97% (diagnosis: uterine leiomyomas 57%, malignant tumors 28%), vaginal hysterectomy 3% (diagnosis: descensus uteri only). Type of hysterectomy in years 1989-1993: abdominal approach 42% (diagnosis: malignant tumors 65%, uterine leiomyomas 28%), vaginal hysterectomy 48% (diagnosis: uterine leiomyomas 56%, descensus uteri 25%), Laparoscopically assisted vaginal hysterectomy (LAVH) 10%. CONCLUSION: Decreased number of abdominal hysterectomies in women with non oncological diagnosis since 1989 to 2002 and increase of vaginal hysterectomies and LAVH was noted. This complies with the contemporary trends of minimally invasive surgery.

[Risks in hysteroscopy in patients with endometrial carcinoma--a prospective clinical study]. / Riziko hysteroskopie u onemocnení karcinomem endometria (RHOCE)--prospektivní klinická studie.

OBJECTIVE: The evaluation of the risk of hysteroscopy (HSC) in patients with endometrial carcinoma with regard to the dissemination of disease and the deterioration of its prognosis. DESIGN: A prospective multicentric study. SETTING: Department of Obstetrics and Gynaecology and Institute of Pathology of the Palacky Univerzity Medical School and University Hospital, Olomouc; Obstetrical and Gynecological Departments of collaborating hospitals. METHODS: Two groups of patients with endometrial carcinoma were compared on the basis of cytological examinations from the peritoneal cavity. The study group (n = 156) consisted of patients whose diagnosis was made on the base of HSC and targeted biopsy. The control group (n = 71) included patients with the classical D&C. Both groups were comparable as to the distribution of clinical stages of the disease (P < 0.05). Cytological examinations were performed from the fluid obtained by the puncture of the cul de sac at the end of the HSC procedure and from the peritoneal lavage at the beginning of the following operation. Results of both groups were compared and statistically evaluated. RESULTS AND CONCLUSIONS: The comparison of the cytological findings from the punctures of the cul de sac after the HSC and from the lavages at the following operation did not show an increased penetration of malignant cells from the uterus into the abdominal cavity. Similarly, the comparison of cytological findings from the peritoneal lavages after HSC and probatory curettage did not show a statistically significant difference between both groups. We assume that HSC does not increase the risk of dissemination of tumour cells into the peritoneal cavity and does not deteriorate the prognosis of the disease.

[Risk of fluid overload syndrome during hysteroscopy procedures]. / Riziko fluid overload syndromu pri hysteroskopických výkonech.

At present increasingly liquid media are preferred to gaseous ones in hysteroscopic procedures. In operations the former media are used almost exclusively. The use of liquid media involves, however, some risks, the greatest one being the so-called fluid overload syndrome. It develops as a result of overload and upset of the milieu interior due to excessive escape of the distension medium. Medium escapes also via the oviducts into the peritoneal cavity. It is therefore necessary to adhere to safety measures which include in particular selection of a suitable medium, the time factor, correct surgical procedure and specially continuous control of consumption of the medium.

[Transcervical endoscopic ablation of the endometrium--experience with the first 31 procedures]. / Transcervikální endoskopická ablace endometria--zkusenosti z prvních 31 výkonu.

The hitherto assembled experience with and results of endometrial ablations are very good. Endoscopic ablations of the endometrium are operations which are consistent with the present trend of minimally invasive surgery, which not only various medical advantages for the patient but also considerable economic savings.

[Serum FSH and LH levels in women following surgical castration and during hormonal management of menopause symptoms]. / FSH- und LH-Spiegel im Serum von Frauen nach chirurgischer Kastration und bei hormonaler Behandlung von Ausfallsbeschwerden

Using the radioimmunological method, FSH and LH levels were determined in women immediately after surgical castration and after an elapse of 18 months to two years. A twofold increase in FSH was found already two days after castration, while an increase in LH only after six days. Increased FSH and LH levels were observed as late as after two years when upon the administraion of estrogens and androgens, the feed-back mechanism of the pituitary still plays a role. In women with pronounced menopausal disturbances the FSH and LH levels were followed up after the application of Folivirin and Agofollin-Depot over a period of two weeks. There was a constant decrease in FSH of all women immediately after the injection, while the responses in LH were subject to variation, the decreased LH levels being found in all the women only towards the end of the second week. Folivirin was found more suitable for mastering the menopausal disturbances.