Importance of addition of HPV DNA testing to the cytology based cervical cancer screening and triage of findings with p16/Ki67 immunocytochemistry staining in 35 and 45 years old women LIBUSE trial data analysis.

OBJECTIVE: The study evaluates results of 2-years follow-up of patients in ages 35-36 and 45-46, who are participating in the project LIBUSE, that deals with efficacy of HPV DNA and Pap smear co-testing and p16/Ki67 dual staining in the Czech national cervical screening. DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynecology, General University Hospital and 1st Medical Faculty, Charles University, Prague. MATERIALS AND METHODS: Out of all women enrolled in the project LIBUSE only those who were at the beginning of the study 35-36 and 45-46 years old were sellected. Conventional Pap smear and HPV DNA test (Cobas 4800, Roche Diagnostics) had been collected at the baseline. Women were stratified according to their results in the three risk groups: 1. low-risk, 2. high-risk and 3. intermediate risk, who subsequently underwent p16/Ki67 dual staining. All high-risk patients and those with positive result of dual staing were refered to the expert colposcopy. The cases with biopsy proven precancers or cancers were considered as „positive findings“. RESULTS: Altogether 352 women meet the age requirements. In 26 (7.6%) women had been proven HPV DNA positivity and out of the them 9 cases were HPV 16/18 positive. Severe cytological abnormality was found only in one patient (0.3%), who was simultaneously HPV positive. Ten women (2.8%) were classified as high-risk and directly refered to colposcopy. Another 18 patients underwent p16/Ki67 dual staining and 4 positive cases were refered to colposcopy too. After one year further 9 patients were classified as intermediate risk and 6 more were identified after two years of follow-up. Within two years 9 more patient were refered to colposcopy. After the entire period of follow-up in 10 patients biopsy confirmed precancer lesions, none of them had invasive cancer. CONCLUSIONS: Addition of HPV DNA testing with selective HPV 16/18 genotyping to the cytology based screening significantly increases sensitivity and safety of our cervical screening program.

First-trimester screening for preeclampsia.

DESIGN: Review article. SETTING: Department of Clinical Biochemistry, University Hospital Olomouc; Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc; The Institute for the Care of Mother and Child and 3rd Faculty of Medicine Charles University, Prague; G-CENTRUM Olomouc, Olomouc; Genetika Plzeň, Pilsen. Methods, results: Preeclampsia (PE) is a multisystem disorder complicating pregnancy. It is the leading cause of maternal and perinatal mortality and morbidity worldwide. Recent studies have shown that high-risk pregnant women may benefit from low-dose acetylsalicylic acid early therapy in prevention of the development of severe forms of the disease. The risk group of pregnant women should be identified in 11-13 gestational week for effective prevention. The only procedure validated in many studies for performing PE screening with sufficient diagnostic accuracy in the first trimester of pregnancy is given by The Fetal Medicine Foundation (FMF) and has been adopted and published in a new recommendation by The International Federation of Gynecology and Obstetrics (FIGO). CONCLUSION: This article summarizes the recent findings and recommendation for performing screening of preeclampsia in 1st trimester of pregnancy and how to prevent the development of severe forms of PE by low-dose acetylsalicylic acid therapy.

A comparison of bleeding patterns and cycle control using two transdermal contraceptive systems: a multicenter, open-label, randomized study.

OBJECTIVE(S): To investigate the bleeding pattern and cycle control parameters of a contraceptive patch containing 0.55 mg ethinyl estradiol (EE) and 2.1 mg gestodene (GSD) compared with a patch containing 0.6 mg EE and 6 mg norelgestromin (NGMN). STUDY DESIGN: In this phase III, open-label, randomized, parallel-group trial, healthy women aged 18-35 years (smokers aged 18-30 years) received either the EE/GSD patch (n=200) or the EE/NGMN patch (n=198). Treatment consisted of one patch per week for 3 weeks followed by a 7-day, patch-free interval for seven cycles. Bleeding control was assessed in two 90-day reference periods. RESULTS: In reference period 1, mean number of bleeding/spotting days was comparable across treatment groups (p>0.05). However, in reference period 2, there were fewer bleeding/spotting days in the EE/GSD patch group (15.7 versus 18.4; p<0.0001). Mean number of bleeding/spotting episodes was comparable across groups for both reference periods, but bleeding/spotting episodes were shorter for the EE/GSD patch than the EE/NGMN patch during reference period 1 (5.13 days versus 5.53 days, respectively; p<0.05) and reference period 2 (5.07 versus 5.66; p=0.0001). Both treatment groups showed a similar frequency of withdrawal bleeding episodes; however, across all seven cycles, the length of these episodes was consistently shorter with the EE/GSD patch (p<0.01). There were no notable treatment differences in intracyclic bleeding. CONCLUSION(S): Bleeding pattern and cycle control achieved with the EE/GSD patch was similar to that of the EE/NGMN patch. IMPLICATIONS STATEMENT: The paper presents data on the bleeding pattern and cycle control parameters of an investigational transdermal contraceptive patch containing EE and GSD compared with an approved contraceptive patch containing EE and NGMN. This descriptive study found that bleeding patterns associated with the EE/GSD patch were similar to those of an EE/NGMN patch providing higher EE exposure.

[Systemic enzyme therapy in the treatment of recurrent vulvovaginal candidiasis]. / Systémová enzymoterapie v lécbe recidivující vulvovaginální kandidózy.

OBJECTIVE: Phase I: A prospective evaluation of long-term systemic enzyme therapy (Wobenzym; WE) effects on the frequency of recurrent vulvovaginal candidiasis (RVVC) episodes. Phase II: A retrospective analysis of possible positive effects remaining in the next 3 years. TRIAL DESIGN: Original work - pilot project consisting of prospective phase I and retrospective phase II trials. METHODS: Composition of animal and plant proteo-lytic enzymes (WE) is a common component in the treatment of chronic or recurrent inflammatory diseases and has been also shown to have immunomodulatory effects. Project involving 7 gynecology practices has been started in 2005 - 2007 to evaluate the effectiveness of WE in the complex treatment of RVVC. The trial involved 62 women with at least 4 microscopically confirmed episodes of RVVC in the last 12 months (year 1; 4-9 episodes, mean 4.4 episodes per patient-year). From the beginning of the trial, participants took WE in the dose of 2× 8 tbl/day for 10 weeks and were monitored for 12 months (year +1). All infections of RVVC were treated according to usual practice of the particular gynecologist. The number of RVVC episodes during the year -1 was compared to the number of RVVC during the year +1. To evaluate possible long-term effects of the WE treatment, retrospective analysis of the data from 3 years following the phase I (year +2, +3, +4) was performed. Complete data for 54 women were collected (87.1% of the former group of patients). All data were processed with regular statistics methods. RESULTS: Mean number of RVVC in the year +1 has decreased from 4.4 to 0.5 per patient-year (i.e. by 88.5%; p < 0.001). All women experienced an improvement, 63% of them experienced no recurrence. The lower incidence of RVVC remained also for the phase II (year +2: 0.91; year +3: 0.57; year +4: 0.52 episodes of RVVC per patient-year). The difference, as compared to the mean incidence of RVVC before the treatment (year -1), remains significant (p < 0.001) although women, who became pregnant during the trial, were not excluded from the observed population. If only non-pregnant women were analyzed (41 women), the mean incidence of RVVC was even lower (year +2: 0.69; year +3: 0.39; year +4: 0.44 episodes of RVVC per patient-year). CONCLUSION: 10 weeks of systemic enzyme therapy (WE) in women with RVVC significantly reduced recurrence of this disease not only for the first year following the treatment, but also for the next 3 years. An explanation of the basis for this effect needs further research.

[Epidemiology and management of thyroid disorders in pregnancy]. / Epidemiologie a management poruch stítné zlázy v tehotenství

OBJECTIVE: Determine the incidence of asymptomatic decrease of thyroid function at pregnant women in the first trimester of pregnancy in the Olomouc region. MATERIAL AND METHODS: The authors examined 461 women in the first trimester of pregnancy. There was measured serum concentrations of thyrotropin (TSH), free thyroxine (FT4) and thyroidperoxidaseantibody (TPOAb). RESULTS: TSH concentration > 2.5 mIU/l was in 21% women (96/461). Reduction of FT4 < 9.8 pmol/l was found in 15 of the 96 women screened with a TSH greater than 2.5 mU/l. For women with TSH 2.5 mU/l, however, was found reduction of the FT4 < 9.8 pmol/l in 11 cases. TSH concentration > 3 mIU/l was found in 14% women (64/461). Reduction of FT4 < 9.8 pmol/l was found in 13 of the 64 women screened with a TSH greater than 3 mU/l. TSH concentration> 3.5 mIU/l in 10% of women (45/461). Reduction of FT4 <9.8 pmol/l was found in 11 of 45 examined women with TSH greater than 3.5 mU/l. TSH concentration > 4 mIU/l in 8% of women (35/461). Reduction of FT4 < 9.8 pmol/l was found in 10 of35 examined women with TSH greater than 4 mU/l. TPOAb was raised over 20 kU/l in 17% of women (78/461). CONCLUSIONS: Asymptomatic decrease of thyroid function was during direct examination in the first trimester of pregnancy diagnosed at more than 8% of pregnant women. Untreated decreased of thyroid function at mothers may have a negative impact on the course of pregnancy, as well as on fetal development, especially in the psychomotoric area. The presence of TPOAb indicate an increased risk of developing thyroid fictional disorders in pregnancy or postpartum thyroiditis. TSH in pregnancy may be affected by elevated levels of hCG and may slightly decrease because hCG and TSH have a common alpha subunit. Discussed the specific standards for TSH in pregnant and implementation of systematic screening for women in early pregnancy or before planned conception. Perspective, however, we see in tests of thyroid function already in preconception period.

[Disorders of the thyroid gland in pregnancy]. / Poruchy funkce stítné zlázy v tehotenství

Functional disorder of the thyroid gland affects individuals of all ages. Incidence and nature of the disease is influenced by supplying iodine, genetic and immunological factors and other external effects. Increased function occurs in 1-2% of the adult population, reduced function in the younger population diagnosed in about 5%, in women aged over 50 years we have been at 10-15%. The incidence of thyroid diseases is higher in women than in men (5-8:1) and significantly increases with age. Approximately as common as overt forms of thyroid disease are their subclinical forms. Thyroid disease, especially asymptomatic reduction of function for direct examination is diagnosed up to 5% of pregnant women. Untreated decreased thyroid function of mothers may have significant negative impact on the course of pregnancy, as well as on fetal development, especially in the psychomotoric area. Women with the presence of antithyroid antibodies are at risk of pregnancy deepening malfunctions and/or postpartum thyroiditis. Czech Endocrinological Society currently pursuing a systematic screening of other risk population groups, including notably the pregnant and nursing women, women in old age and ill with some other disease or treatment with certain drugs.

[Epidemiology of genital warts in female population of Czech Republic]. / Epidemiologie genitálních bradavic mezi zenami v Ceské republice.

OBJECTIVE: The aim of study was to evaluate prevalence of genital warts in Czech Republic. SUBJECT: Multicentric prospective observation study. SETTING: HPV College. METHODS: During 6 month (February 2010 - July 2010) 20 private gynaecological centers in all Czech Republic were counting up the number of genital warts cases. Risk factors, therapy and knowledges about genital warts were evaluated. RESULTS: There were 637 patients with genital warts in cohort of 70 980 patients. The prevalence of genital warts was 0.89%. The most frequent risk factor was cigarette smoking in 37%. Main strategy for treatment were podophyllin local application and cold knife excision. CONCLUSION: The prevalence of genital warts in our study has shown importance for its prevention by rules of safety sex and HPV vaccination against HPV type 6 and 11.

Adenoid basal epithelioma of the uterine cervix in 21-year-old patient. Report of a case with histologic and immunohistochemical study.

A case of adenoid basal epithelioma (ABE) of the uterine cervix in 21-year-old woman is reported. The patient's age appears to be lowest among cases of ABE reported to date. The tumor showed typical histologic features of ABE and was associated with CIN3. In addition, rare tumor cells had surface cilia-appearing structures suggesting tubal differentiation. Immunohistochemically, the tumor was reactive for p63, CD10, ER, PR, p16 and bcl-2, and negative for CEA. Thus, the immunophenotype also suggests possible partial tuboendometrioid differentiation in the glandular component of the lesion. It further indicates, along with finding of associated CIN, a role of oncogenic HPV in pathogenesis of ABE.