Uterine adenomyosis: pathogenesis, diagnostics, symptomatology and treatment.

OBJECTIVE: To summarize the current knowledge about pathogenesis, diagnostics, symptomatology and the treatment of adenomysis. DESIGN: Review article. SETTING: The Centre of Assisted Reproduction, ISCARE I.V.F., Prague. METHODS: Analysis of literature and current studies. RESULTS: This article reviews etiology, diagnostics and classification of adenomyosis, medical and surgical management options and the fertility implication of adenomyosis. CONCLUSION: Uterine adenomyosis is characterized by the presence of endometrial glands in myometrium and usually manifests by pelvic pain, abnormal uterine bleeding or infertility. Although adenomyosis and endometriosis share a number of features, they are considered to be two different entities. Recent improvements of imaging techniques such as transvaginal ultrasound and magnetic resonance imaging have affected the detection of adenomyosis. Adenomyosis has a negative impact on IVF results.

Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer.

OBJECTIVE: Evaluate prognostic significance of low volume disease detected in sentinel nodes (SN) of patients with early stages cervical cancer. Although pathologic ultrastaging of SN allows for identification of low volume disease, including micro-metastasis and isolated tumor cells (ITC), in up to 15% of cases, prognostic significance of these findings is unknown. METHODS: A total of 645 records from 8 centers were retrospectively reviewed. Enrolled in our study were patients with early-stage cervical cancer who had undergone surgical treatment including SN biopsy followed by pelvic lymphadenectomy and pathologic ultrastaging of SN. RESULTS: Macrometastasis, micrometastasis, and ITC were detected by SN ultrastaging in 14.7%, 10.1%, and 4.5% patients respectively. False negativity of SN ultrastaging reached 2.8%. The presence of ITC was not associated with significant risk, both for recurrence free survival and overall survival. Overall survival was significantly reduced in patients with macrometastasis and micrometastasis; hazard ratio for overall survival reached 6.85 (95% CI, 2.59-18.05) and 6.86 (95% CI, 2.09-22.61) respectively. Presence of micrometastasis was an independent prognostic factor for overall survival in a multivariable model. CONCLUSION: Presence of micrometastasis in SN in patients with early stage cervical cancer was associated with significant reduction of overall survival, which was equivalent to patients with macrometastasis. No prognostic significance was found for ITC. These data highlight the importance of SN biopsy and pathologic ultrastaging for the management of cervical cancer.

[Threatening uterine rupture in pregnancy after previous laparoscopic myoma enucleation. Case report]. / Hrozící delozní ruptura v gravidite po predchozí laparoskopické enukleaci myomu. Kazuistika.

OBJECTIVE: To evaluate the negative effect of uterine myoma enucleation forcompact structure of the uterus. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Pronatal Sanatoruim, Prague METHODS: In this study, the authors analyze their experience of the course of pregnancy in a patient who had uterine myoma enucleation with penetration to the uterine cavity and large coagulation. The pregnancy was terminated by caesarean section for the indication of prior uterine surgery and the risk of uterine rupture in 38 week of pregnancy. CONCLUSION: This case report demonstrates the risk of uterine rupture in pregnancy after laparoscopy myoma enucleation.

[Proteomics and its importance for gynecological oncology]. / Proteomics a jeho význam pro gynekologickou onkologii.

OBJECTIVE: Analysis of contemporary knowledge of proteomics and its aplication in diagnostics of ovarian cancer and other malignant tumours. DESIGN: Review article. SETTING: Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, Prague. METHOD: An overview of published data. CONCLUSION: Proteomics deals with the analysis of proteins present in the organism in normal and pathologic conditions. Protein expression is characteristic of particular types of cells and tissues. The main improvement of protein analysis in clinical practice is early diagnostics of oncological diseases and specification of prognosis.