Th1/Th2 cytokine gene polymorphisms in patients with uterine fibroid.

Uterine fibroid or leiomyoma is a frequent non-malignant tumour with unknown aetiology and pathogenesis. The aim of our study was to look for possible genetic markers which could be used as prognostic tools for evaluation of an increased risk for development of uterine fibroid. A large spectrum of Th1/Th2 cytokine gene polymorphisms in 102 patients with uterine leiomyoma was compared with 145 healthy controls. An association between polymorphisms of the IL4 gene promotor at positions -590 C/T and -33 C/T, and the risk of leiomyoma was observed. The CC genotype of IL4 -590 and at position -33 was less frequent in the patient group than in the control group (P = 0.03). Besides IL-4, we observed different genotype distribution of the TNFA gene -308 A/G. The frequency of genotype AA was higher in the younger (≤ 35 years) patient group (P = 0.02). Our study thus suggests that certain cytokine gene polymorphisms, especially of the IL4 and TNFA genes, may be associated with increased risk for development of uterine fibroid. Further investigation would be needed to elucidate the mechanisms responsible for these associations.

[Sexual functions after laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) in preoperatively asymptomatic women]. / Sexuální funkce po laparoskopicky asistované vaginální es gynek. hysterektomii (LAVH) a totální laparoskopické hysterektomii (TLH) u predoperacne asymptomatických zen.

OBJECTIVE: To find the consequences of laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for sexual functions in preoperatively asymptomatic women. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Teaching Hospital in Prague. MATERIAL AND METHODS: In 100 women without subjective complaints hysterectomy was performed for benign uterine pathology. In all the women the uterus weighted less than 250 g, there were no salpingooophorectomies and no perioperative complications. Women were alternativelly assigned for LAVH (n = 50) or TLH (n = 50). Clinical documentation and questionnaires about sexual functions were evaluated in 87 women (in 40 women after LAVH and in 47 after TLH) 18 months after surgery or later. RESULTS: According to our findings the type of surgery did not influence the frequency of sexual activity after surgery, there was no change in sexual manners using during coitus as well as no change in preferred way how to reach the sexual arousal (clitoridally, vaginally or combined). The type of surgery did not influence frequency, quality and duration of orgasm. From all the evaluated parameters there were only two significantly different: the presence of postoperative sexual activity (positive answer in all women from LAVH group and only in 85% women from TLH group, F test, p = 0.009) and the frequency of sexual satisfaction (in terms of both increase and also decrease in TLH group chi2 8,376, p = 0.015). CONCLUSION: The type of laparoscopic hysterectomy (LAVH or TLH) does not significantly affect the sexual functions (frequency of sexual satisfaction, type of sexual arousability, intensity and duration of orgasm) in preoperatively asymptomatic women.

[Etiopathogenesis of uterine fibroid: current knowledge]. / Soucasné poznatky o etiopatogenezi delozních myomu.

OBJECTIVE: To sum up the knowledge of etiology and pathogenesis of uterine fibroids. TYPE OF STUDY: Review. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University, Prague. SUBJECT OF STUDY: A summary of what is known about development of uterine fibroids. CONCLUSION: In this overview of etiology and pathogenesis of uterine fibroids we have attempted to ananlyze the literature and present prevailing evidence and opinions.

Uterine arteries doppler velocimetry provides 3-years follow up endometrial ablation outcome.

The aim of this study was to assess whether uterine artery Doppler velocimetry [pulsatility index (PI) and resistance index (RI)] and thickness of the endometrium (TE) are able to predict 3-year clinical outcome after endometrial ablation (EA) for dysfunctional uterine bleeding (DUB). This was a prospective, observational study of 29 women of whom 22 were amenorrhoeic (A) and 7 eumenorrhoeic (E) at the end of the first postoperative year. The PI, RI and TE were measured prior to and 1, 6 and 12 months after EA. Statistical analyses were performed using BMDP statistical software, discriminant analysis, ANOVA and T test. Using the calculated classification function (CF) with the three parameters PI, RI and TE measured 12 months after FEAT, we were able to accurately (100%) specify which of the women will have A or E in 3 years. The predictive value of PI, RI and TE has been confirmed clinically in a minimum 3-year follow-up of outcome (ranging from 36 to 72 months [mean 55]). All A and E women have stayed in the same group (A or E) during the minimum of 3 years. In conclusion we found that PI, RI and TE measured prior to EA cannot predict the outcome, however these measurements performed 1 year after FEAT can predict the duration of A or E in the 3-year follow up.

[Enucleation of intramural uterine fibroids in women at fertile age: midterm results of prospective clinical trials]. / Enukleace intramurálnch delozních myomu u zen ve fertilním veku: strednedobé výsledky prospektivní klinické studie.

OBJECTIVE: To analyze clinical and reproductive outcomes of patients after laparoscopic (LM) or open (OM) myomectomy. DESIGN: Prospective clinical trial. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague. METHODS: Women under the age of 40 with intramural fibroid larger than 4 cm were indicated for myomectomy. LM was performed when laparoscopy revealed solitary or 2 fibroids smaller than 8 cm; otherwise the OM was carried out. The patients were followed at 6 months intervals. RESULTS: 80 myomectomies with extirpation of 121 myomas was performed from January 2002 to April 2005. The average age was 33.5 years, average size of dominant fibroid 56 mm. 38% of women suffered from infertility; the mean follow-up was 15.6 months. We performed LM in 56 cases (70%). From 24 open procedures 18 were elective and 6 converted from laparoscopy. In 18 patients some of the fibroid--ischemization procedures (uterine arteries embolization or laparoscopic dissection, or laparoscopic myolysis) preceded myomectomy. In the group with LM there was significantly lower peri-procedural blood loss, lower count of leucocytes and CRP concentration the 2nd day after surgery, shorter stay in the hospital, shorter interval between surgery and conception, and lower incidence of early complications than in women with OM. Fibroid related symptoms fully disappeared in 76% of patients. 20 women from 38 that have already tried to conceive have achieved 22 gestations so far: 9 deliveries (2 preterm; 3 vaginal, 6 Cesarean), 6 miscarriages, 1 ectopic and 6 ongoing pregnancies at the moment. CONCLUSION: In the hands of surgeons experienced in operative laparoscopy the enucleation of intramural uterine fibroids is safe, symptomatically effective, mostly low invasive procedure with good reproductive prognosis.

[The May-Hegglin anomaly in pregnancy. 2 case reports]. / May-Hegglinova anomálie v tehotenství. 2 kazuistiky.

TYPE OF STUDY: Case report. SETTING: Obstetrics and Gynecology Department, 2nd Medical Faculty Charles University and Faculty Hospital Motol, Department of Hematology and blood transfusion, Obstetrics and Gynecology Department, 1st Medical Faculty Charles University and General Faculty Hospital, Prague. METHODS: The authors present two cases of pregnant women with May-Hegglin anomaly. This rare hereditary trombocytopenia is characterized with the presence of megathrombocytes and typical basophilie inclusions (Dahli's inclusions) in granulocyte cytoplasma in blood count. Clinically, there are possible haemmorrhagic manifestations in this anomaly [13]. The course of pregnancy was uncomplicated in both cases. The values of thrombocytes fluctuated between 22-34 x 10(9)/l and 17-27 x 10(9)/l respectively. The response on the corticosteroid administration was minimal. The pregnancy was terminated with caesarean section in general anesthesia in both cases. The indication in the first case was, after the neonatologist consultation with hematologist on duty, the anomaly itself. In the second case it was primarily decided to conduct the labor vaginally. It was necessary to start the induction of labor for the development preeclamptic signs. This prostaglandin induction was unsuccessful and therefor was the labor also terminated with s.c. Both delivered neonates were in good condition without clinical or lab signs of the disease. The neonate in the second case was of borderline trophicity. The s.c. were secured with transfusions of thrombocytes and carried out without any complications in both cases. The blood losses were 400 and 700 ml without necessity of erythrocyte transfusions. The postoperative course was also uncomplicated in both cases. Both women with their children were released from hospital on the 6th postoperative day. CONCLUSION: There are about 20 published papers of authors describing pregnancy with this rare anomaly. The efforts of haemmorrhage are very rare, the course of pregnancy is usually not disturbed [7, 8, 9, 11]. Some authors alert on possible higher risk intrauterine growth restriction [4]. The risk of fetal hemorrhage is from all available, data also small and there is no need of prenatal invasive investigation (cordocentesis) [11]. The mode of delivery depends only on the obstetrics and indications, vaginal labor is not associated with higher risk for the fetus [2, 3, 5, 6, 10]. The treatment with corticosteroids or immunoglobulins in cases when the clinical symptomatology appear is only little effective, administration of thrombocytes transfusions are useful [8, 9]. When the anesthesia is necessary, general anesthesia is preferred because of higher risk of local haemmorrhage complications in cases of epidural or spinal analgesia [10, 14].

[Impaired development of uteroplacental circulation]. / Poruchy vývoje uteroplacentární cirkulace.

OBJECTIVE: To sum up the knowledge of uteroplacental circulation, their dysfunction and etiology and pathogenesis of preeclampsia. TYPE OF STUDY: Review. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University, Prague, Institut of Pathological Physiology, 1st Faculty of Medicine, Charles University, Prague. SUBJECT OF STUDY: A summary of what is known about development of uteroplacental circulation predispose women to the development of preeclampsia and IUGR but the etiology of preeclampsia is still unknown.

[Massive pulmonary embolism after delivery by cesarean section]. / Masivní plicní embolie po porodu císarským rezem.

OBJECTIVE: To give an overview of the preventive and therapeutic measures in thromboembolic disease in association with pregnancy and delivery. SUBJECT: Case report. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague. SUBJECT AND METHOD: The surgical treatment of massive pulmonary embolism in a patient after delivery by caesarean section. CONCLUSION: Surgical embolectomy still has its place in the treatment of pulmonary embolism in the early phase of critical cases, when thrombolysis is contraindicated, and mechanical disintegration with the catheter is unsuccessful. In such cases it is the only one possibility of saving the patient. However, prevention of thromboembolic disease remains of primary importance.