Unusual clinical tumor development in axilla.

This work describes clinical development of a sarcoma in the left axilla of a 36-year-old woman. The macroscopic picture changed from the initial inflammatory reddening to globular resistance of 2.5 cm, suggestive of an enlarged lymph node. Mammography did not reveal any associated breast disease. Colliquation found on the ultrasound images led to a biopsy, the result of which indicated only an inflammation, without any malignancy. Rapid growth of the axillar tumor to 10 cm in size within 8 weeks prompted surgery allowing proper diagnosis of a small mature-to-immature sarcoma. Special examinations performed by a histopathologist (at the Institute for Histopathology) could not establish the precise histogenesis, i.e. the tissue origin. Therefore it was necessary to remove any clinically obscuring tumor for the final proper histological diagnosis and adequate treatment of the patient.

A comparison of the incidence of early postoperative infections between patients using synthetic mesh and those undergoing traditional pelvic reconstructive surgical procedures.

New mesh-related complications such as erosion, etc., can result from abnormal postoperative healing due to surgical site infection. The aim of our study was to compare systemic inflammatory responses and the incidence of early infectious complications after reconstructive surgery using synthetic mesh and after traditional vaginal wall repair. In this prospective observational study 99 women with symptomatic pelvic organ prolapse were included; 55 women underwent traditional repair and 44 repair using mesh. After the procedure infectious complications were monitored. The patients who underwent reconstructive surgery using mesh material were more likely to have febrile morbidity in the postoperative period than the patients who had been treated with traditional repair (p=0.031); there was a higher incidence of combination febrile morbidity with elevated C-reactive protein (CRP) > 50 mg/l; p=0.046, and a higher incidence of CRP increase over 30 mg/l; p=0.005. Reconstructive procedures using synthetic mesh are accompanied by a higher incidence of early post-operative infectious complications.

[Validity of the oncological cytodiagnostics and colposcopy examination versus biopsy in cervical carcinoma prevention]. / Validita onkologické cytodiagnostiky a kolposkopie versus biopsie v prevenci rakoviny cervixu.

THE AIM OF THE STUDY: The basic praebioptic methods detecting the precancerous lesions of the uterine cervix are oncologic cytology (PAP smears) and colposcopy. However in the Czech Republic the incidence of the invasive carcinomas during the last 10 years did not considerably decrease. Therefore the goal of our study is to estimate the validity of the prebioptic methods and compare the results of praebioptic methods (procedures) versus biopsy. TYPE OF THE STUDY: Analysis of the results of the oncologic cervical cytology comparing with the results of cervical biopsies performed during the years 2002-2003 were compared to those of the year 2009. THE SUBJECT AND METHODS OF THE STUDY: evaluation of the prebioptic methods (cytology, colposcopy) versus biopsy prior and during the start of the National Screening in the Czech Republic. SETTING: 1. Centre for Gynaecological Oncological prevention, 1st Faculty of Medicine, Charles University Prague, Department of Gynaecology and Obstetrics. 2. Institute of Physiology, Department of cybernetics, 1st Faculty of Medicine, Charles University, Prague. 3. Institute of Pathology, University of Ostrava. 4. Institue for Mother and Child Care, Prague. SUMMARY: We screened the documentation related to the treatment of 423 women with cervical lesions, examined at the Oncological prevention centre of the Obstetrical and Gynaecological Department of the 1st Faculty of Medicine Charles University Prague and the General Teaching Hospital in Prague 2. Results of the oncologic cytology, colposcopy and biopsy were compared. The comparison revealed differences related to the time of examinations. During the years 2002 and 2003 the agreement between cytologic diagnosis and biopsies in the group of HSIL was 40 %. In the year 2009 the agreement between HSIL and CIN was 68% the colposcopic diagnosis of precancerous lesions with those of bioptic specimens, during the years 2002 and 2003 was 90% while in the year 2009, during the National Screening, the agreement reached 98%.

Mitochondrial metabolism - neglected link of cancer transformation and treatment.

Physical processes in living cells were not taken into consideration among the essentials of biological activity, regardless of the fact that they establish a state far from thermodynamic equilibrium. In biological system chemical energy is transformed into the work of physical forces for various biological functions. The energy transformation pathway is very likely connected with generation of the endogenous electrodynamic field as suggested by experimentally proved electrodynamic activity of biological systems connected with mitochondrial and microtubule functions. Besides production of ATP and GTP (adenosine and guanosine triphosphate) mitochondria form a proton space charge layer, strong static electric field, and water ordering around them in cytosol - that are necessary conditions for generation of coherent electrodynamic field by microtubules. Electrodynamic forces are of a long-range nature in comparison with bond and cohesive forces. Mitochondrial dysfunction leads to disturbances of the electromagnetic field; its power and coherence may be diminished, and frequency spectrum altered. Consequently, defective electrodynamic interaction forces between cancer and healthy cells may result in local invasion of cancer cells. Further deformation of interaction forces connected with experimentally disclosed spatial disarrangement of the cytoskeleton and disordered electrodynamic field condition metastatic process. Cancer therapeutic strategy targeting mitochondria may restore normal physiological functions of mitochondria and open the apoptotic pathway. Apoptosis of too much damaged cancer cells was observed. Considerable experience with DCA (dichloroacetate) cancer treatment in humans was accumulated. Clinical trials should assess DCA therapeutic potential and collect data for development of novel more effective drugs for mitochondrial restoration of various cancers.

[Invasive cervical cancer incidence in the span from the preventive check-up to the national screening programing in the Czech Republic]. / Invazivní karcinom cervixu od depistázních akcí k národnímu screeningu v Ceské republice.

OBJECTIVE: Former Czechoslovakia was the first European country in which the gynecological cytodiagnosticts was used for checking-up the cervix malignancy, in the years 1947-1957. The preventive measures in woman population together with building up the centres for gynekological oncological prevention result in the cervical cancer incidence lowering, as it is documented by national registry data. The cervical cancer incidence rate was 19.2/100 000 in the year 2008, that is the third endplace on the European scale. How to go positively forward? SETTING: 1st Faculty of medicine, Charles University Prague and General Teaching Hospital Prague. STUDY DESIGN: Analytical study od the incidence during the historical way up to now. Validity of the data should bring the strategy of solution. METHODS: The collected data od the cervical cancer incidence provided by national registry of the CR from the span 1960 to 2008 enabled to evaluate the effectivity od prevention measures used. RESULTS: The incidence rate od cervical cancer was 30/100 000 women before the prevention check-up started. the diagnosis was based cytology. The incidence of cervical cancer lowered to 22/100 000 in the year 1970. The establishment of the centres for oncological gynekological prevention ("COP") led up to the futher dropping up of cervical cancer incidence (20,7/100 000) the activity of the "COP" was based on the gynekologists having the II. degree certificate of the line, colposcopy skill, on cytolaboratory. The continuing education of cytotechnologists started in the year 1991 and it has influenced positively the cervical cancer incidence - its rate was below 20/100 000 -in the year 2008. the data analyses have shown, that the west regions of the CR (Karlovy Vary, Ustí nad Labem) have high incidence steadely respectively. The graph of incidence of age groups of women has 3 peaks: In the age 35-39, 55-59 and 75-80. The whole Moravia region reached the lowest cervical cancer incidence 15,2/100 000, which is lower then the world incidence standard. The Czech part of the republic has shown 20,7/100 000 in the average in the year 2008.

[Doc. MUDr. Antonín Cernoch and his original technical surgery modifications]. / Vzpomínky na docenta MUDr. Antonína Cernocha v jeho originálních operacních postupech.

Antonin Cernoch an outstanding gynaecologic surgeon, was head of the Czech institute for postgraduate medical education in the years 1960 - 1970. His important surgical work exhibited many stimulating ideas for contemporary gynaecology and obstetrics. The Cernoch's original modifications of surgical repairs of uterine cervix are presented in this article and are very important ideas for surgical practice. The original procedures repair damaged uterine cervix together with adjoining tissue as well as surgical removing advanced malignant ovarian tissue are documented in pictures. The effective treatment was used in more than 400 causes. Both, excellent surgery strategy and experience of doc. MUDr. A. Cernoch is of practical importance for gynaecologic surgeons.

[Prevention of the invasion of malignant cells of gynecologic tumors during surgery]. / Prevence invaze maligních bunek pri gynekologických operacích nádoru.

OBJECTIVE: In experiments performed on Vistar rats with Walker tumors, F. Luksch observed transfer of malignant cells during different manipulations into the blood circulation of the animals. During gynecologic surgery of a choriocarcinoma and of an ovarian carcinoma Luksch and Cernoch prooved trace of malignant cells within the blood circulation related to the manipulation of tumors during surgery. Therefore, as prevention of the metastazing of tumor cells, they proposed to ligate ampular portions of oviducts and hypogastric vessels as the first step of the radical surgeries. METHODS: Our observation is based on radical surgeries of 42 patients with cervical uterine carcinomas at the stage II.a (T2, N0, M0). In the first group 13 cases the ligature of oviducts and hypogastric vessels was performed at the start of the surgery. In the second group of 29 patients were operated without ligatures. RESULTS: After five years in the group of 13 ligated patients 10 patients (77%) survived. In the group of 29 unligated patients only 7 (24%) were alive. The results proove substantial differences. CONCLUSION: Although the members are small, there is doubt, that the ligation of oviducts and hypogastric vessels prior radical surgeries in patients affected by malignant gynecologic tumors substantially reduces metastazing of malignant cells nad improve the five years survival of surgically treated patients with gynecologic malignant tumors.

Cell-mediated immunity in cervical cancer evolution.

Cell-mediated immunity (CMI) response to different antigens was examined in healthy women, in patients with cervical precancerous lesions, and in patients with cervical cancer. Cervical lesions were diagnosed by cytological (PAP) smears, from examination by colposcopy, and from "punch" biopsy material by histology. CMI response is related to specific processes in healthy and cancer cells. CMI was investigated by leukocyte adherence inhibition (LAI) assay using specific antigen (prepared from cervical carcinoma tissue) and non specific antigen (prepared from blood of mice infected by LDH--lactate dehydrogenase--virus). The CMI responses of healthy women and cancer patients to the antigens used are different: the majority of T lymphocytes display adherence and non adherence, respectively (but the CMI responses elicited by the antigens are not equal and small quantitative differences are observed). Regardless of the CIN (cervical intraepithelial neoplasia) grades, CMI responses correspond either to healthy women or to cervical carcinoma patients (at about similar ratio of cases in all the CIN groups). Effect of non specific antigen suggests that cervical carcinoma transformation may be connected with reduction of mitochondrial activity similar to processes in LDH virus infection.

Maternal hyperphenylalaninemias in healthy Czech population of pregnant women: 30 years experience with screening, prevention and treatment.

INTRODUCTION: The increased level of phenylalanine (Phe) in maternal blood--hyperphenylalaninemia (mHPA) has a detrimental effect on the early development of healthy foetus (1965). The toxic effect causes spontaneous abortion or retards intrauterine growth, skeletal malformation, cardiac anomalies can appear. However the most frequent are microcephaly, mental retardation and hypotrophy. PATIENTS AND METHODS: Simultaneously with the introduction of obligatory "Newborn Screening Program" in CR also the facultative screening for mHPA was introduced ("Maternal Hyperphenylalaninemia Preventive Screening Program"). Since 1975 till now 222,990 healthy pregnant women (16-47 yrs) from city Prague and its area (cca 2 mil. inh.) have been screened for increased Phe in blood by Efron's chromatographic screening test (1964); Phe cut off value: 240 micromol/l. Nonfasting venous blood has been taken in 2nd-3rd month of pregnancy during the first antenatal visit. All positive cases have been verified with quantitative Phe estimation on amino acid analyzer incl. pterines analysis in urine. For differentiation of detected mHPAs the Güttler's scheme (1980) has been used. Mutations for Phe-hydroxylase gene analyzed by restriction enzyme digestion after Guldberg (1994). RESULTS: The average incidence of mHPA detected at the beginning of pregnancy was found 1:8675. The major part (65.3%) of all detected mHPA belongs to mild or moderate form of phenylketonuria (PKU) with most frequent PAH gene mutations R408W, Y414C, IVS11 nt8g-a, R158Q, IVS12ntlg-a and R261Q. 19.2% corresponds to atypical or classical PKU with prevailing mutation R408W. Only in 15.3% were detected non-PKU (persistent HPA) with mutations R408W, Y414C, IVS12ntlg-a, IV11nt8g-a and A403V. 28 offsprings born from pregnancies on low-phenylalanine diet (LPD) introduced at least 2 months before the conception and during the whole pregnancy show normal psychomotoric development. In 7 offsprings without LPD or after delayed introducing or on PLD or badly monitored showed malformations (microcephaly, hypotrophy, skeletal malformations) or died. DISCUSSION: Relatively high incidence of mHPA detected in healthy population of pregnant women of Prague area differs from findings of Buist (1989) or Levy (1994) from American pregnant women screened for mHPA from umbilical blood. We consider that screening performed at the beginning of pregnancy from nonfasting venous blood is more effective compared to umbilical blood from two reasons: the Phe level in maternal blood is increased during first trimester of pregnancy due to succing effect of placenta in comparison to decreased Phe level at the end of labour. Umbilical blood for screening of mHPA is not quite suitable to detect the atypical or mild forms of Phe disturbances which prevailed in our Slavonic population of pregnant women. (Tab. 5, Fig. 7, Ref. 16.)

Peritoneal washing cytology on fluid hysteroscopy and after curettage in women with endometrial carcinoma.

OBJECTIVE: To assess the influence of fluid hysteroscopy with target biopsy of the endometrium and the influence of added curettage on the results of peritoneal washing cytology (PWC) in endometrial carcinoma. STUDY DESIGN: In 42 women at risk of endometrial carcinoma, we performed fluid hysteroscopy with target biopsy of the endometrium and curettage. Evaluation of PWC of the pouch of Douglas was performed three times during the procedure: prior to hysteroscopy, after fluid hysteroscopy with target biopsy and after curettage. RESULTS: On cytologic slides from peritoneal washings in 11 patients with carcinoma of the endometrium, malignant endometrial cells were found after curettage in 72.7%. There was no statistically significant difference in PWC prior to hysteroscopy (two women, 20%) or after hysteroscopy with target biopsy (three women, 30%). There was a statistically significant difference (.05 level) in positive PWC after hysteroscopy with target biopsy (three women, 33.3%) and after curettage (eight women, 88.9%). CONCLUSION: Slides from carcinoma of the endometrium in PWC do not deteriorate after hysteroscopy with target biopsy of the endometrium, but tumor cells will appear in the pouch of Douglas after curettage.

Incidence of cervical carcinoma in the Czech Republic.

OBJECTIVE: To analyze the incidence of cervical cancer in the Czech Republic. STUDY DESIGN: Investigation of the cause of the unfavorable level of cervical cancer through incidence and laboratory performance. RESULTS: Repeatedly modified screening program measures did not lower the incidence significantly. The incidence in various regions of the Czech Republic differed without fully correlating with patients' life situations. There has been an important shift in incidence toward teenagers and the elderly. Analysis of laboratory work showed that it is necessary to educate smear takers/clinicians and ensure their cooperation with cytology laboratories. CONCLUSION: The various types of screening programs did not lower the cervical carcinoma incidence. It is essential to provide adequate cytologic smears and sufficient laboratory personnel for their proper evaluation.

[Factors which affect cytodiagnosis in gynecology]. / Faktory, které ovlivnují gynekologickou cytodiagnostiku.

The incidence of invasive carcinoma of the cervix in the Czech Republic is higher than in Western Europe. The only effective test for early discovery of the precancerous lesions is cytodiagnostics--"PAP" smears. The study points to preventing mistakes in the cytodiagnostic process and stresses quality control according to the International Academy of Cytology (I.A.C.) and the European Federation of Cytological Societies (E.F.C.S.).

Aspiration cytology from the pouch of Douglas at hysteroscopy.

Eighty-seven fine needle aspiration cytological samples from 29 patients suffering from irregular perimenopausal uterine bleeding were evaluated. Aspiration cytology was performed prior to hysteroscopy, after distension of the uterine cavity and finally after uterine curettage. In this paper, cytological examination of fluid from the pelvic content in women with benign endometrial findings is compared with that of patients with adenocarcinoma. Endometrial curettage influenced the cell content of the cytologica specimens.

Cytologic detection of cervical and endometrial carcinoma with other genital tract involvement.

OBJECTIVE: To investigate the possibility of a correct cytologic diagnosis of cervical and endometrial carcinoma with other genital organ involvement. STUDY DESIGN: From uteri removed during hysterectomy due to cervical (33 cases) and endometrial (44 cases) cancer, samples were taken by cytobrush or spatula from the ectocervix, endocervix and endometrium of uteri opened longitudinally. Smears and cytosediments were stained by the Papanicolaou polychrome method. Moreover, acid beta-galactosidase activity was demonstrated in serial cytosediments by the indigogenic method of Lojda. From quenched tissue samples taken from the same sites as those for cytology, a series of cryostat sections was prepared and stained by hematoxylin and eosin or azure A, or subjected to the reaction for acid beta-galactosidase. RESULTS: In 17 of 33 patients with cervical cancer, the same type of cancer was also found in smears of the endocervix and endometrium. In six patients the type of cancer was different. Of 44 patients with endometrial cancer, 16 had an endocervical malignancy of the same type. In seven cases the type of cancer was different. The reaction for acid beta-galactosidase helped in the differentiation between squamous (negative reaction in cancer cells) and cylindrocellular (positive reaction) cancer in cytologic preparations. CONCLUSION: Before treatment, it is necessary to determine if there is involvement of the endocervix in endometrial cancer and of the endometrium in cervical cancer. Routine cytologic examination supplemented by the reaction for acid beta-galactosidase proved to be useful for this purpose.

Terminology. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: Differences in type, structure, quality of health care systems and availability of resources influence reporting systems. In most countries, individual systems have a long history of usage that might preclude adoption of a uniform terminology worldwide. CONSENSUS POSITION: It is desirable but unrealistic at this time to aim for a unified terminology worldwide. It should be the stated objective of the International Academy of Cytology to serve as an umbrella organization for various terminologies and enhance mutual understanding and cooperation. Translation tables of equivalent terms have been created to allow increased communication. Consensus has been achieved in defining essential elements required of any terminology system: (1) the report must be text based: numerical Papanicolaou class designations alone are inadequate; (2) an assessment of the adequacy of the sample should be included; and (3) the diagnosis must address the primary purpose of cervical cytology: to indicate the presence or absence of epithelial abnormalities. Incorporating additional elements within a terminology system may be more or less appropriate, depending on the setting in which the system is used. ONGOING ISSUES: Despite the cited problems in adopting a uniform terminology worldwide, a single system would have many advantages in terms of communication and research and may be a long-term goal worth pursuing. Countries are invited to present their individual national terminology systems and participate in an ongoing dialogue, critically evaluating the advantages and disadvantages of all systems.

[Recent history of the 2d Gynecology-Obstetrical Clinic of the 1st Medical School of Charles University (1945-1995)]. / Novodobá historie II. Gynekologicko-porodnické kliniky 1. LF UK (období 1945-1995).

In 1995 75 years had elapsed since the time when the decision to found the Second Department of Obstetrics and Gynaecology was made by the Medical Faculty. An Institution arose which trained a great many qualified medical workers, midwives, students, and specialist obstetricians-gynaecologists. In the present article we should like to remember the teachers who have taken over the style of work from their predecessors and educated their pupils in the love and devotion to their discipline. In the last 50 years five Heads of the Department worked in the Second Department of Gynaecology and Obstetrics. Each of them made part of the history of the Department and imprinted there his or her characteristic image. Our wish is to acquaint you with the message of the predecessors as well as with the contemporary history and development of the Department in the field of education, research, and therapeutics.

[Difficulties in cytological diagnosis of changes in the endocervix]. / Obtíze cytologické diagnostiky zmen v endocervixu.

1. Cytological diagnosis of changes of the cylindrical epithelium in the endocervix has not been elaborated in such detail as the cytodiagnosis of squamous epithelium of the ectocervix. 2. The original proposal and experience of Vooijs of 1995 for the classification of incipient endocervical lesions corresponds best to histological practice. 3. Cytodiagnosis of endocervical changes will be more accurate if we use for evaluation the cellular pattern from the endocervix, demonstrated on the plates. 4. If we find any cellular abnormalities of the cylindrical epithelium, we recommend a procedure as used in lesions of squamous epithelium a) Low-grade abnormalities should be followed up primarily by cytological methods. If the lesion persists or progresses, histological examination is indicated. Examination of an endocervical lesion is usually not accessible to colposcopy. b) High-grade abnormalities and in particular those with the above described architecture, should be subjected to histological examination. 5. In mixed cylindrical and squamous lesions the procedure depends on the more serious lesion. In mixed lesions or suspected mixed lesions it is an advantage to use histochemical examination for betagalactosidase, the method described by Lojda, which differentiates safely the squamous and cylindrical component and in particular its tendency of malignant reversal.