Laparoscopic correction of isthmocele combined with ventrosuspensios of uterus.

OBJECTIVE: To describe a case history of a patient after two caesarean sections, planning another pregnancy. Due to the dehiscent lower uterine segment, surgical correction of the defect was performed. Performance followed by an unplanned pregnancy five weeks after the operation. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Hospital in Frýdek-Místek. CASE REPORT: We present a case of a 31-year-old third-graders, anamnestically after two caesarean sections, which were performed laparoscopical correction of isthmocoele in our department. Our patient was diagnosed with six weeks old intrauterine pregnancy only eleven weeks after surgery. The gravidity was successfully completed in the 38th week of pregnancy by the planned caesarean section with finding of a solid lower uterine segment. Whole duration of the pregnancy was uncomplicated. CONCLUSION: Women, after previous surgery of the uterus, are exposed to complications such as nidation disorders, placental disorders, risk of uterine rupture etc. during future pregnancy and childbirth. We want to show possible advantage of laparoscopic isthmocoele resection in combination with ventrosuspension of uterus.

Laparoscopic sacrocolpopexy using Seratex Slimsling: pilot study.

OBJECTIVE: To describe a new technique of laparoscopic sacrocolpopexy using material Seratex Slimsling. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynecology, Vyškov Hospital; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc. METHODS: Using a laparoscopically inserted Seratex Slimsling material, we performed a sacrocolpopexy in 12 patients with pelvic prolapse between November 2018 and June 2019. All patients were operated at the same workplace by the same surgeon with experience in advanced laparoscopic surgery. We monitored age, parity, BMI, previous hysterectomy, surgical time, blood loss, type of concomitant surgery, length of hospitalization and incidence of peroperative and postoperative complications in the pilot group of patients Results: Patients included in the pilot study were 53.2 ± 10.0 (34-74) years old, BMI 24.7 ± 4.2, parity 1.92 (95.7% of whom were vaginal births) and in 5 cases (41.7%) previous hysterectomy was performed. The mean duration of surgery was 58.4 ± 6.6 min in cases without hysterectomy and 102 ± 4.9 in patients with concomitant hysterectomy. The mean blood loss was 93 ± 78.8 ml and the length of hospitalization was 5.25 ± 0.72 days. There was no injury to large vessels or ureters during any operation and none of the operations was converted to laparotomy. In one case, the implant slipped from the sacrouterine ligaments area and subsequently the vaginal stump prolapse recurred three months after the primary operation. The patient was re-operated six months after the primary operation using the same technique and has been without any problems until now. In the monitored postoperative period, we did not notice any protrusion of the implant or significant dyspareunias or discomfort in any of the patients. Apart from one patient mentioned above, the method did not fail. CONCLUSION: Laparoscopy has had an irreplaceable role in gynecological surgery for pelvic prolapse since 1993. It is possible to perform laparoscopic sacrocolpopexy with high success rate nad minimal incidence of complications with the use of Seratex Slimsling.

Laparoscopic hysterosacropexy with subsequent pregnancy and delivery by cesarean section: case report with short term follow-up.

OBJECTIVE: To report a case of laparoscopic hysterosacropexy with subsequent pregnancy complicated by car accident, and terminated by cesarean section due to gestational hypertension. DESIGN: Case report and literature review. SETTING: Department of Obstetrics and Gynecology, University Hospital and Faculty of Medicine Olomouc, Palacký University. CASE REPORT: The patient is a 38 years old woman diagnosed with prolapse of the uterus POP-Q III. She had history of three spontaneous vaginal deliveries. In 2016 she underwent laparoscopic hysterosacropexy using Alyte mesh. There were no intraoperative complications, operating time was 80 min and blood loss 60 ml. Three moths after surgery patient became pregnant spontaneously. In 30th week of gestation patient had a car accident with intact pregnancy. During the third trimester patient has developed gestational hypertension which lead in 2017 to termination of pregnancy by cesarean section at 37 weeks. Mesh was found to be intact in the lower uterine segment. Follow up at 30 months after hysterosacropexy and 18 months after cesarean section revealed well supported cervix and no vaginal prolapse. CONCLUSION: Laparoscopic hysterosacropexy is feasible and safe method for treatment of the uterine prolapse. In young women it can be used to spare reproductive function.

Low-volume metastatic nodal disease in endometrial cancer.

AIM: To review contemporary knowledge of the low volume metastatic disease in patients with endometrial cancer. TYPE OF STUDY: A literatue review. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Olomouc; Department of Clinical and Molecular Pathology, University Hospital Olomouc. INTRODUCTION: The presence of micrometastases or isolated tumor cells in the sentinel node detected by ultrastaging leads to the change of tumor stage. Low volume lymph node involvement represents up to 30% of the affected lymph nodes in patients with endometrial cancer. The enhanced sentinel lymph node investigation aims to more accurately determine the extent of illness from stage I to stage IIIC. Particularly important is the detection of low-volume metastatic nodal involvement in low-risk tumors, because compared with macrometastases, micrometastases may occure earlier in tumours with lower carcinologic aggressiveness. CONCLUSION: Detection of low volume metastatic disease decrease the false negativity of nodal involvement and is helpful for adjuvant treatment planning.

Medical ethical moral and legal aspects of Jehovah´s Witnesses operations.

OBJECTIVE: To point out principles of blood sparing surgery. Medical ethical moral and legal aspects of operations on Jehovahs Witnesses. DESIGN: Retrospective clinical study. Review of articles. SETTING: Dept. of Gynecology and Obstetrics, University Hospital, Olomouc; Dept. of Health Care Sciences, Faculty of Humanities, Tomas Bata University Zlín. MATERIALS AND METHODS: 72 Jehovahs Witnesses patients were operated on for various benign and malignant gynecological diseases since 2007-2017. All patiens were operated according to the rules of blood sparing surgery. RESULTS: There were no excesive blood loss at any of the operations. The estimated blood loss was between 10 to 550 ml. CONCLUSIONS: The main principles of blood sparing surgery should be applied not only for Jehovahs Witnesses but for all patients. Even if the blood transfusion is the last resort for excessive blood loss during complicated operations it always carries some health risks. There are also the economical aspects. Blood transfusions should be therefore used only at very rare occasions. Jehovahs Witnesses refuse blood transfusions at all even if it is the only life saving resort. Our legislation deal with this problem but there are also moral and ethical aspects. The attitude of gynecological surgeons how to solve this problem differ a great deal.

Distal vaginal agenesis.

Cíl: Popis symptomatiky, diagnostiky a operační léčby vzácné vrozené vady ženského genitálního systému - distální vaginální ageneze. Typ studie: Kazuistika. Pracoviště: Porodnicko-gynekologická klinika, FN a LF UP Olomouc; Ústav pro péči o matku a dítě, 3. lékařská fakulta UK, Praha. Vlastní pozorování: U dvou pacientek ve věku 16,5 a 15 let byla na Porodnicko-gynekologické klinice v Olomouci v letech 2018 a 2019 diagnostikována vrozená vývojová vada pochvy - distální vaginální ageneze. Byla provedena klinická a ultrazvuková diagnostika (v jednom případě magnetická rezonance pánve) a indikována operační léčba - distální kolpoplastika (kolpostomie). Závěr: Distální vaginální ageneze je ojediněle se vyskytující chirurgicky dobře léčitelná vrozená vada vývoje pochvy s dobrou prognózou. Kombinace zobrazovacích metod umožňuje přesnou diagnostiku, adekvátní terapii a stanovení prognózy.

New serum tumor markers S100, TFF3 and AIF-1 and their possible use in oncogynecology.

OBJECTIVE: To review a literature about possible new blood serum gynecologic tumor markers, S100 proteins family, trefoil factor 3 and AIF-1. DESIGN: Literature review. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Palacky University and University Hospital in Olomouc. METHODS: Literature review of articles published in PubMed database till January 2019. RESULTS: The association of S100A2, S100A4, S100A6, S100A7, S100A8, S100A9 and S100A11 with breast carcinoma has been demonstrated in the literature. The association of S100A2, S100A4, S100A6, S100A7A, S100A10, S100A14, S100A16, S100B, S100P (up-regulation associated with a lower survival) and S100A1, S100A13, S100A5, S100A13 and S100G proteins (up-regulation associated with a better survival) have been demonstrated in ovarian cancer patients. Cervical carcinoma has been shown to be associated with the S100A9 protein. TFF3 association with endometrial cancer, breast cancer (worse prognosis) and ovarian cancer (better prognosis) has been demonstrated. AIF-1 has been shown to increase expression in cervical cancer. CONCLUSION: Tumor markers can be a very useful tool for patient management when used appropriately. Further research in this area and the search for new tumor markers, including S100, TFF3 and AIF-1, are needed. In future studies, scientists should focus not only on one time point, but assess the trend of the tumor markers for a specific time axis.

Uterine microbiome and endometrial receptivity.

OBJECTIVE: Structure and correct function of endometrium is necessary for embryo implantation, pregnancy development and childbirth. It is a result of many factors - anatomical and histological structure, hormonal effects and signalling pathways at the molecular genetic level. A little known phenomenon is the presence of microorganisms on the endometrium. Traditionally, the uterine cavity was considered sterile, but new findings have been changing this view fundamentally. The aim of this work is to present new findings on endometrial microbiome and its importance for embryo implantation and development. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno; Department of Obstetrics and Gynecology, University Hospital Faculty of Medicine, Palacky University Olomouc. METHODS: PubMed was searched for articles in English indexed until 30th June 2018 with terms of „uterine microbiome analysis“ and „endometrial receptivity“. RESULTS: The vital information on bacterial colonization of endometrium brought new diagnostic methods for their detection based on ribosomal RNA analysis in 16S subunit, which are capable of detection and exact identification of bacteria that cannot be detected by classical cultivation methods. The endometrial microbiome is assumed to modulate the function of endometrial cells and local immunity system, it prevents growth of pathogenic microorganisms by its presence and production of protective substances. CONCLUSION: Endometrial microbiome seems to be important factor of endometrial receptivity.

Sakrospinous fixation sec. Miyazaki - complications and long-term results.

OBJECTIVE: To evaluate preoperative, perioperative and postoperative data, complications and results in long-term follow-up at patients who underwent Miyazaki´s sacrospinous suspension between January 2002 and December 2018. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc. METHODS: The evaluation of results of 240 patients who underwent Myiazaki sacrospinous suspension for vaginal prolaps between January 2002 and December 2018. RESULTS: The mean age of patients operated between 2014-2018 was higher than the mean age of all patients. Perioperative and early postoperative complications were analysed in six tables and two graphs. The most common complications were transient urinary retention (5.24%), urinary tract infection (3.80%) and pelvic hematoma (7.14%). In the long-term follow-up (131 patients over 24 months) the recurrence of apical defect was recorded at 12 (9.16%), cystocele at 26 (19.85%) and rectocele/enterocele at 3 (2.29%) patients. Patients with recurrence of vaginal vault prolapse underwent Miyazaki´s sacrospinous resuspension in four, transvaginal mesh insertion in three and sacropexy in five cases. CONCLUSION: Miyazakis sacrospinous suspension is an effective and safe method how to correct vaginal apical prolapse. The introduction of new surgical methods probably explains the shift of the age of the patients to the older ones in the last years. The most frequent early postoperative complications were urinary tract infections and pelvic hematomas. In the long-term follow up they were the recurrences of the prolaps of the anterior compartment. Total recurent apical vaginal prolaps was recorded at 12 patients (9.16%.).

Prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient.

OBJECTIVE: To describe a case report with prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc; Department of Radiology, University Hospital, Olomouc; Department of Health Care Sciencies, Bata University, Zlín. CASE REPORT: We describe case report with prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient in attempt to decrease the risk of heavy peroperative bleeding. Twenty eight years old primigravida underwent prophylactic internal iliac artery balloon catheterization with interventional radiology preoperatively. Two 6-Fr balloon catheters transfemorally bilaterally up to internal iliac artery with position a “cross over“ were introduced, according to Seldingers standard technique. The procedure was without complications, estimated blood loss was 500 ml. CONCLUSION: Prophylactic placement of intravascular balloon catheters is a feasible treatment for Jehova´s Witnesses patients in efforts to decrease the risk of heavy bleeding during cesarean section.

The role of mesenchymal-epithelial transition in endometrial function and receptivity.

OBJECTIVE: During reproductive age of a woman, endometrium undergoes frequent stuctural and functional changes. Abilities of regeneration, remodelation and differentiation are precondition of endometrial receptivity and implantation and development of an embryo. These processes are conditioned by mutual transformation between mesenchymal and epithelial fenotype of endometrial cells: epithelial-mesenchymal transition (EMT) and mesenchymal-epithelial transition (MET). The aim of this study is to present contemporary knowledge of transformation between epithelial and mesenchymal endometrial cells and its influence on human fertility. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk university and University Hospital Brno; Department of Obstetrics and Gynecology, University Hospital Faculty of Medicine, Palacky University, Olomouc. METHODS: PubMed was searched for articles in English indexed until February 2019 with terms of „endometrial receptivity“, „embryo implantation“, „endometrial regeneration“, „mesenchymal-epithelial transition/transformation“. RESULTS: It has been proved, that mesenchymal stromal cells participate on regeneration of not only the endometrial stroma, but also of the epithelium. During endometrial decidualisation under influence of ovarian steroids, the MET is under way. Stromal fibroblasts gain the morfological and functional properties of epithelial cells. During implantaion of an embryo, the trofoblast interacts with decidualised endometrium. Epithelial cells transform into mesenchymal (EMT), which mediate the growth of trofoblast. CONCLUSION: Mutual transformation between stromal and epithelial cells in essential for normal function of endometrium and implantation and development of an embryo.

Robotic paraaortic lymphadenectomy in oncogynecology. Double side docking of daVinci S system increases the success rates of high paraaortic lymph node dissection in endometrial cancer.

OBJECTIVE: To present an overview of minimally invasive approaches to suprapelvic lymphadenectomy and compare two different methods of staging robotic transperitoneal paraaortic lymphadenectomies in patients with early stages of endometrial cancer. DESIGN: Retrospective study and literature review. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc. METHODS: In this retrospective study we enrolled 70 patients with early stages of endometrial cancer undergoing staging robotic surgery at the Department of Obstetrics and Gynecology, University Hospital Olomouc from January 2016 to March 2018. Primary systematic pelvic and paraaortic lymphadenectomy was suggested in all patients. In 39 out of 70 patients single docking was used for robotic staging surgery, whereas in 28 patients the procedure was done using double side docking approach. Number of patients with total and infra-renal suprapelvic lymphadenectomy, number of para-aortic lymphonodes retrieved and the rate of lymphadenectomy complications were compared. RESULTS: Robotic surgery was performed in 67 (96%) out of 70 patients. In three cases (0,4%) laparoscopy was converted to laparotomy. Single side docking was used in 39 cases (58%), whereas in 28 patients (42%) double side docking was used. Paraaortic lymhadenectomy was performed in 45 cases (67%). In 16 patients (24%) the upper limit of the left renal wein was reached. Upper limit of paraaortic lymphadenectomy was above inferior mesenteric artery but did not reach left renal vein in 19 cases (28%). Inferior mesenteric represented upper limit of paraaortic lymphadenectomy in 10 patients (15%). Number of paraaortic lymphonodes retrived (4,9 ± 3,3 vs 3,7 ± 4,9, p = 0,028) as well as number of paraaortic lymphadenectomies with upper limit at the left renal vein (p < 0,0001) was higher in double side docking cases. Complication rates were low in both groups and the differences were not significant. CONCLUSION: Number of lymphonodes retrieved as well as the number of paraaortic lymphadenectomy cases with upper limit at the left renal vein was higher in double side docking group. Operating time, complication and conversion rates were low without differences between both groups.

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.

Late morbidity in cesarean section scar syndrome.

OBJECTIVE: To summarize recent knowledge on ethiology, diagnostic management and treatment possibilities of cesarean section scar syndrome (isthmocoele). DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, Faculty Hospital and Palacky University, Olomouc; Department of Gynaecology and Obstetrics, Vítkovická nemocnice, Ostrava-Vítkovice. METHODS: A literature review of published data on cesarean section scar syndrome (isthmocoele). RESULTS: Cesarean section scar syndrome may be associated with subsequent complications including postmenstrual spotting or bleeding, dysmenorrhoea, abdominal pain, dyspareunia, infertility, scar pregnancy, a morbidly adherent placenta, scar dehiscence or rupture in later pregnancy. Ethiopathogenesis of isthmocoele remains poorly understood. Magnetic resonance, sonohysterography and transvaginal ultrasound are the gold standard imaging techniques for diagnosis. Surgical treatment is still controversial but should be offered to symptomatic women. CONCLUSIONS: Given the association between an isth-mocoele and gynaecological symptoms, obstetric complications and infertility, it is important to focus on preventive strategies of its development.

Consecutive intrapartum uterine rupture following endoscopic resection of deep rectovaginal and bladder endometriosis.

OBJECTIVE: To present case report of patient with repeted endoscopic resections of deep infiltrating endometriosis (DIE) to demonstrate its possible risks for subsequent delivery. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, Central Moravian Hospital Trust, Member of Agel holding, Prostějov, Czech Republic; Department of Obstetrics and Gynecology, Vyškov Hospital, Czech Republic; Department of Pathology, Vyškov Hospital, Czech Republic; Department of Pathology, University Hospital Brno, Medical faculty, Masaryk University Brno, Czech Republic; Department of Obstetrics and Gynecology, Palacky University, Faculty of Medicine and Dentistry, Olomouc, Czech Republic. METHODS AND RESULTS: We are presenting a case of 29 years old patient with multiple laparoscopic surgery for deep infiltrating endometriosis (DIE). At the same time, new risks are posed to the delivery process like a severe injuries of the uterine attachment aparate, vagina, parametria with the risk of developing life threatening bleeding. These case we presented here demonstrates the emergence of new risks and complications for another pregnancy with such women. CONCLUSION: Our case report demonstrates new possible obstetric risk factors as consequence of increasing radicality in surgical treatment of DIE.

Robot assisted laparoscopic abdominal cerclage: two case reports.

OBJECTIVE: In this work we report the first use of robot-assisted preconceptual abdominal cerclage in the Czech Republic with subsequent live birth. We present two patients with a history of late pregnancy losses (late miscarriage) who underwent robotic abdominal cerclage. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký Univesity, Olomouc. METHODS: The da Vinci S surgical system was used for the robot-assisted abdominal cerclage. RESULTS: One robot-assisted laparoscopic transabdominal cerclage patient delivered at term a live infant and the second patient currently undergoes infertility treatment with in vitro fertilization. CONCLUSION: Robotic abdominal cerclage is a relatively new minimally invasive method for treatment of cervical insufficiency. This technique provides 3D visualization and better instrumentation than the conventional laparoscopic approach.

Implantation and diagnostics of endometrial receptivity.

OBJECTIVE: Literature review of endometrial receptivity in embryo implantation and its diagnostic possibilities. DESIGN: Literature review. SETTING: Department of Obstetrics and Gynecology, University Hospital, Faculty of Medicine, Palacky University, Olomouc; Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc. RESULTS: Endometrial tissue is very dynamic, undergoing cyclic proliferation, differentiation and cell transportation, especially of immune system cells under the influence of circulating estradiol and progesterone. Endometrial remodelling during embryo implantation is controlled by decidual cells senescence and effectivity of their immunologic destruction. Endometrial receptivity can be assessed by transcriptomic profiling of endometrial biopsy using ERA system or proteomic analysis of either endometrial secretome or cervical mucus by gel electrophoresis (DIGE) or mass spectrometry (MS). CONCLUSION: With respect to recent discoveries in endometrial physiology and molecular biology, clinical application of proteomic approaches in research of potential biomarkers of endometrial receptivity could be of interest.

[Various approaches of endometrial preparation for frozen-thawed embryo transfer]. / Moznosti prípravy endometria ke kryoembryotransferu.

OBJECTIVE: Various approaches of endometrial preparation for frozen-thawed embryo transfer. DESIGN: Retrospective analysis. SETTING: Department of Obstetric and Gyneacology, Faculty of Medicine, Palacky University, University Hospital Olomouc. METHODS: Effectivity of frozen-thawed embryo transfers was carried out between January and August 2017 in the IVF unit at the University Hospital Olomouc. Results were compared among groups A, B, C with various approaches of endometrial preparation. Group A - natural ovulating cycle, group B - artificial cycle with oral estrogen, vaginal gestagen and group C - artificial cycle with transdermal estrogen and vaginal gestagen. One blastocyst (two blastocyst in five cycles) was transferred on day 6 post ovulation (group A) or after 6 days of using gestagens (group B, C). RESULTS: The highest pregnancy rate was observed in group C (56%), similar pregnancy rate was found in group B (52%) and the lowest was seen in group A (22%). All pregnancies in group A continued over 12 weeks, in group B continued 57 percent and in group C continued 56 percent of pregnancies. CONCLUSION: Frozen-thawed embryotransfers in natural cycles are highly time-consuming. Our study has demonstrated the lowest effectivity of frozen-embryotransfer in natural cycles. Artificial cycles managed by oral or transdermal form of estrogen have shown better results.

[Elevated levels of TFF3 in endometrial cancer patients]. / Zvýsení hladin TFF3 u zen s karcinomem endometria.

AIM: Trefoil peptides are a family of small proteins that are expressed in a site-specific fashion by certain epithelial tissues. These peptides might be used as markers for neoplastic uterine disease. DESIGN: Experimental study. SETTING: Department of Obstetrics and Gynaecology, University Hospital, Medical Faculty, Palacký University, Olomouc; Department of Laboratory Biochemistry, Central Moravian Hospital Trust, Member of Agel holding, Prostejov. METHODS: During the time period from 2012 to 2015 eighty-nine women underwent hysteroscopy and endometrial biopsy for postmenopausal bleeding. Fifty three patients, at the age of (mean ± standard deviation) 63,4 ± 9,5 (33-80) years were diagnosed with endometrial cancer, six patients at the age of 62,9 ± 6,4 (55-74) years were diagnosed with endometrial hyperplasia and thirty patients at the age of 63,3 ± 9,3 (48-62) years diagnosed with endometrial atrophy represented control group. At the day of surgery the venous blood was sampled and subsequently examined for the levels of TFF1, TFF2 and TFF3. RESULTS: TFF3 levels were significantly higher in patients with endometrial carcinoma but not in endometrial hyperplasia subgroup. The levels of TFF1 and TFF2 were not different in selected histopathological subgroups. CONCLUSION: We have shown elevated levels of TFF3 but not of TFF1 and TFF2 in patients with endometrial cancer. TFF1, TFF2 and TFF3 levels were not elevated in patients with endometrial hyperplasia.

[Uterine inversion]. / Inverze delohy.

AIM: Summarize the literature on the inversion of the uterus. DESIGN: A review article. SETTING: Department of Obstetrics and Gynecology, SZZ Krnov, Department of Obstetrics and Gynecology, University Hospital, Palacky University, Olomouc. METHOD: Literature review was conducted using the following key words. There were included articles published in English since 1980, from which relevant data were obtained. RESULTS: In the literature the general occurrence is broad, ranging from 1:27 000 in the UK to 1:1739 in the US, where it varies greatly according to geographic location. The uterine inversion can be generally classified according to the period from birth to diagnosis, in relation to pregnancy or by anatomical degree of prolapse. From 1887 to 2006 there were only 150 cases of uterine inversion in non puerperal women recorded. In the vast majority the incidence was observed in women older than 45 years. 85% of uterine inversion was caused by benign pathology, only 15% was associated with cancer. Treatment consists of repositioning of the uterus, to which can be used in noninvasive and invasive techniques. CONCLUSION: Inversion of the uterus is a very serious and fortunately relatively rare complication in the third stage of labor, but also in non-puerperal women. This is the situation with high maternal morbidity and mortality rates, at which it can easily cause life-threatening hemorrhage, disseminated intravascular coagulation and the development of hemorrhagic and neurogenic shock. In most of cases there are no risk factor.