[Anterior colporrhaphy under local anesthesia]. / Prední posevní plastika v lokální anestezii.

OBJECTIVE: To evaluate the advantage of the usage of local anesthesia for vaginal surgery in gerontological patients. DESIGN: Prospective study. SETTING: Charles University in Prague, 1st Medical Faculty and Hospital Bulovka, Department of Obstetrics and Gynaecology, Prague. METHODS: 43 patients over 60, 4 were younger, with diagnosed descent of anterior vaginal wall G II-III according to International Continence Society classification, were included into the study. They underwent anterior vaginal wall repair in the sole local anesthesia. For the assessment of the procedure, we used anamnestic data and quality of life questionnaires Visual analogue scale, International Consultation on Incontinence Questionnaire - Short Form, Pelvic Floor Distress Inventory - 20. RESULTS: The results of used questionnaires confirmed positive results of the local anesthesia. We demonstrated statistically significant improvement of the urinary incontinence too, as well as subjective perception of the descent. CONCLUSION: Excellent subjective assessment of usage of local anesthesia showed us new operative possibility in treatment applicable in high-risk patients.

Predicting axillary sentinel node status in patients with primary breast cancer.

The aim of this study is to determine the combination of characteristics in early breast cancer that could estimate the risk of occurrence of metastatic cells in axillary sentinel lymph node(s). If we were able to reliably predict the presence or absence of axillary sentinel involvement, we could spare a considerable proportion of patients from axillary surgery without compromising therapeutic outcomes of their disease. The study is based on retrospective analysis of medical records of 170 patients diagnosed with primary breast cancer. These women underwent primary surgery of the breast and axilla in which at least one sentinel lymph node was obtained. Logistic regression has been employed to construct a model predicting axillary sentinel lymph node involvement using preoperative and postoperative tumor characteristics. Postoperative model uses tumor features obtained from definitive histology samples. Its predictive capability expressed by receiver operating characteristic curve is good, area under curve (AUC) equals to 0.78. The comparison between preoperative and postoperative results showed the only significant differences in values of histopathological grading; we have considered grading not reliably stated before surgery. In preoperative model only the characteristics available and reliably stated at the time of diagnoses were used. The predictive capability of this model is only fair when using the data available at the time of diagnosis (AUC = 0.66). We conclude, that predictive models based on postoperative values enable to reliably estimate the likelihood of occurrence of axillary sentinel node(s) metastases. This can be used in clinical practice in case surgical procedure is divided into two steps, breast surgery first and axillary surgery thereafter. Even if preoperative values were not significantly different from postoperative ones (except for grading), the preoperative model predictive capability is lower compared to postoperative values. The reason for this worse prediction was identified in imperfect preoperative diagnostic.

[Nocturnal polyuria, treatment with desmopressin]. / Lécba nocní polyurie desmopresinem.

UNLABELLED: Nonpharmacologic and especially pharmacologic treatment options are available for nocturnal polyuria. Desmopressin represents the basis of pharmacologic treatment. Desmopressin acetate is a synthetic analogue of arginine vasopressin with high affinity to V2 receptors with antidiuretic effect. It is the only medicament currently registered for antidiuretic treatment. Desmopressin has not any relevant affinity to V1 receptors, and therefore there is no hypertensive effect in contrary to natural vasopressin. Desmopressin use before a bedtime leads to reduced production of urine during a sleep, therefore time between desires to void is prolonged and number of nocturia is reduced. Clinical effect, in a meaning of reduced urine production and increased osmolality of urine, lasts approximately 8-12 hours. In the treatment of nocturnal polyuria desmopressin is used orally one hour before a bedtime. It is essential to titrate an ideal dose, the initial dose is 60 µg of MELT formula (fast melting oral formulation) and it can be increased according to the clinical effect up to the maximal recommended daily dose 240 µg. Patients treated with desmopressin should cut down a fluid intake 1 hour before and 8 hours after the use of desmopressin. Total number of adverse events connected withdesmopressin treatment in clinical studies was higher compared to placebo but the side effects were mostly mild. The most common adverse events were headaches, nausea, diarrhoea, abdominal pain, dry mouth and hyponatremia both in the short-term and long-term clinical trials. Hyponatremia was observed mainly in patients over 65 year of age. Therefore treatment with desmopressin should not be commended in patients over 65 year of age without close monitoring of the natrium level in serum and all patients should be informed about the first symptoms of hyponatremia - headache, nausea and insomnia. According to Evidence Based Medicine, the level of evidence for treatment of nocturnal polyuria with desmopressin is 1b and the grade of recommendation for treatment is A. KEYWORDS: nocturnal polyuria - treatment - desmopressin.

[Nocturia, incidence, ethiology, diagnostics]. / Epidemiologie, etiologie a diagnostika nykturie.

Nocturia is the complaint that the individual has to wake at night one or more times to void, according to the International Continence Society definition from the ICS Standardisation of Terminology Report 2002. As the nocturia definition is complicated there are also other slightly modified definitions. It is currently not absolutely clear if prevalence or incidence is more important for epidemiology evaluation of nocturia. Nocturia is a variable symptom and its presence in individuals is reversible therefore it is very difficult to obtain reliable incidence data. Nocturia prevalence varies remarkably in different studies according to evaluation methodology, nocturia definition, methods of data collection and characteristics of evaluated population. There are not enough studies, especially demographic ones, evaluating lower urinary tract symptoms and/or nocturia in males and females. There is relatively large number of comparative studies confirming strong correlation between aging and prevalence of nocturia. Prevalence of two or more voids per night in individuals in their twenties varies between 5-15 %, it progresses with age, and in the seventh decade of life ranges between 35-50 %. Prevalence evaluated by gender is higher among younger women compared to older women and older men compared to younger men. Currently there are only limited sources of data regarding nocturia incidence. Incidence of nocturia (two or more voids per night) in a population older than 60 years is 213 new cases/1000 persons/1 year in two year observation. Incidence of two or more voids per night is 75 new cases/1000 male/1 year in five year observation and 126 new cases/1000 male/1 year in ten year observation in male population. Incidence of nocturia rises significantly with age. Incidence of two or more voids per night increases by 2,7 % in the population of women after child birth during 5 year follow up and by 5,9 % during 12 year follow up. Incidence of nocturia newly diagnosed in a pregnancy drops down by 98% in 3 month after the child birth. The incidence data indicate that incidence of nocturia rises with age and probability of nocturia relief decreases with age. Incidence of mild nocturia is higher compared to incidence of severe nocturia and significant relief of nocturia in women after child birth is very inconsistent compared to increase of other lower urinary tract symptoms. Ethiology of nocturia might be polyuria, nocturnal polyuria or reduced bladder capacity. Nocturia and its ethiology can be determined in most cases with simple and commonly used investigative methods on the out-patients bases. The diagnostic algorithm should lead to verification of nocturia and identifying its cause because treatment of nocturia differs remarkably according to the etiology.

[A comparison of different types of suburethral slings in the treatment of urinary incontinence in geriatric patients]. / Srovnání ruzných typu pásek v lécbe inkontinence moci u gerontologických pacientek.

OBJECTIVE: Comparison of different types of tension free tapes in the treatment of urinary incontinence in institutionalized elderly patients. DESIGN: Prospective randomized study. SETTING: Charles University in Prague, 1st Medical Faculty and Hospital Bulovka, Department of Obstetrics and Gynaecology, Prague. METHODS: 43 patients of several gerontologic centres with prevailing stress urinary incontinence were included based on urinary dysfunction specific questionnaire (ICIQ) and cognitive functions objective estimation (MMSE). Three types of tapes, TVT-O, MiniArc and Ajust were used and patients were randomized into the groups and after an urogynaecologic examination, incl. ultrasound the operation was performed. RESULTS: The groups were - except of the age of the patients of group MiniArc - well outweighted concerning demographic parameters. High success rate of all techniques used evaluated by the QoL questionnaires was in all the groups comparable. No case of bleeding, bladder injury or postoperative pain was found. Higher frequency of OAB de novo and worsening of preexisting symptomatics could be explained by general very high prevalence of OAB in the elderly even without the operation. In whole our cohort only 1 case of failure to treat and of tape exposure was found. Our results confirming high success rate of all the types also in elderly and institutionalized patients are in consent with sporadic published data. CONCLUSION: Surgical treatment of cases of stress and mixed urinary incontinence is also in cases of elderly polymorbid nurcing facilities clients with regard to the high success rate. Secondary outcome of our report when accepting the conclusion is drop of the costs of antiincontinence pads thus having a significant economic effect.

[A delay in the HELLP syndrome diagnosis]. / Opozdení diagnózy HELLP syndromu.

HELLP syndrome is a serious obstetrical complication that tends to occur in the second half of pregnancy that complicates six promiles of pregnancies. The term HELLP syndrome is derived from the beginning letters of the English words indicating laboratory changes, which is occurs as a specific illness in pregnancy. There is hemolysis, elevated liver enzymes and a decreased platelet count. It can present itself with preeclampsia or without it. The most serious complications are disseminated intravascular coagulation, liver rupture or various organ failures. The pathogenesis at the moment is not completely known. The basic approach to care is delivery at the earliest possible term. HELLP syndrome generally arises in the second or third trimester of pregnancy, but can also occur after delivery. It has typical signs, which can also arise due to other liver diseases, but more frequently in diseases of the gall bladder, which in pregnancy given the physiological changes in the body of the pregnant women is also predisposed. In this context, woman with this problem can seek out other physicians than obstetricians. In our case, we wanted to refer to the needs of early diagnosis of this frequently diagnosed illness, since in the case of late diagnosis and a woman not sent to the obstetrical department can lead to a serious life threatening state for the mother and child.

[Uterine rupture in pregnancy--case study]. / Ruptury delohy v tehotenství--kazuistiky.

OBJECTIVE: Analysis of two cases uterine rupture following caesarian section. SUBJECT: Two case studies. SETTING: Gynecological obstetrics clinic, First Medical Faculty and Faculty Hospital Bulovka, Prague. SUBJECT AND METHODS: The authors in their article describe two cases of rupture of the uterus in pregnancy prior to delivery. In both cases there was a history of cervicocorporal caesarian section. CONCLUSION: In the first case the patient was admitted from her home with bleeding, and signed a nonconsent form. The second case concerned a hospitalized patient, in which the first signs of uterine rupture were indicated by fetal heart rate. Both women underwent hysterectomy, paradoxically, in the first case the child was saved and discharged home in good health.

[Analysis of the set of pregnancy women with asthma bronchiale]. / Analýza souboru rodicek s asthma bronchiale.

OBJECTIVE: The set of pregnant females suffering from bronchial asthma-retrospective analysis. TYPE OF STUDY: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, University Hospital Na Bulovce, First Medical Faculty, Charles University in Prague, Czech Republic. SUBJECT AND METHOD: Our set consists of pregnant women suffering from bronchial asthma and attending our Antenatal Clinic & delivering at our Maternity Hospital from January 2008 through December 2009. Retrospective analysis of the set based on the medical records was performed. RESULTS: 80 females suffering from bronchial asthma gave birth at our Hospital during the studied time span, i.e., 1.7% of all deliveries at our Maternity Hospital. In 4 females (i.e. 5%) the asthma attack was observed during the pregnancy. 33% of all females suffering from bronchial asthma did not require any bronchodilator medication, 22% were just on betamimetics, 23% required inhalational betamimetics with intermittent inhalational corticosteroid and 21% use both regularly. Perorally corticosteroids or leukotrien inhibitors were not used at all. There was no negative influence on subjective felling of the female during her pregnancy and labor in 71% of cases. 24% of all females suffering from bronchial asthma delivered by Caesarean Section but just in two of them it was indicated due to the bronchial asthma itself. We observed no case of IUGR or congenital defect. No change in the length of the hospital stay in comparison to the other females was shown. CONCLUSION: The nowadays standard treatment of bronchial asthma during pregnancy is based on local inhalative bronchodilator and anti-inflammatory medication. Pregnant females are usually well compensated, and thus their perinatal outcome shows no difference compared to the healthy population.

[New Single-Incision Sling System MiniArc in treatment of the female stress urinary incontinence]. / První zkusenosti s novou minipáskou k lécbe stresové inkontinence moci u zen--MiniArc.

OBJECTIVE: The aim of this paper is to introduce the new Single-Incision Sling System MiniArc in treatment of the female stress urinary incontinence. SUBJECT: Prospective follow up. SETTING: Department of Obstetrics and Gynaecology, The First Faculty of Medicine, Charles University in Prague. SUBJECT AND METHOD: Prospective follow up of the first set of 38 patients treated with the new method MiniArc. CONCLUSION: We performed initial 38 cases of MiniArc under the local anesthesia. There was neither the complication during procedure, nor during the early postoperative period. No patient required urine derivation. Late postoperative period showed neither obstruction, nor ,,de novo urgency". One asymptomatic sub-urethral tape protrusion into the vagina was found. No late postoperative pain occurred. Subjective cure rate was investigated in 33 ladies with follow up from 6 weeks through 19 months. 23 females declared full dryness (i.e., 76.7%), 6 patients were very satisfied and declared improvement of more than 70% (i. e. 20.0%); thus we obtained efficacy in 29 cases of 30 (i. e. 96.7%). We have not seen any vanishing of the sling effect. Based on our initial experience we judge the new single incision tape as very promising.

[Registry of the urogynaecologic procedures involving implant in the Czech Republic during the year 2007]. / Registr urogynekologických výkonu s implantáty v Ceské republice za rok 2007.

OBJECTIVE: The aim of this paper is to report the outcomes of the registry of the urogynaecologic procedures involving implant in the Czech Republic during the year 2007. SUBJECT: Retrospective registry analysis. SETTING: Czech Urogynaecological Association, Prague. SUBJECT AND METHOD: We performed a retrospective analysis of all urogynaecologic procedures involving implant registered in the Czech Registry during the year 2007. CONCLUSION: We report the results of 2557 urogynaecologic procedures involving implant from the 33 referring centres from the Czech Republic. 2232 (87%) implants were intended to treat the stress urinary incontinence and 325 (13%) were used to treat the pelvic organ prolapse. Intraoperative complications were reported in 36 (1.41%) cases, early postoperative complications intervened in 117 cases (4.58%) and the late complications were found in 121 females (4.73%).

[Prolene mesh comparing with sacrospinal fixation in the treatment of genital prolapse in women. Prospective multicentre randomized study]. / Alogenni prolenové implantáty ve srovnání se sakrospinální fixací v lécbe prolapsu; randomizovaná multicentrická prospektivní srovnávací studie.

OBJECTIVE: Polypropylene mesh in the treatment of genital prolapse in women was introduced at the turn of the millennium with the rationale of decreasing surgical invasiveness, reinforcing weak tissues and to possibly complement insufficient surgical techniques. Prospective randomized studies comparing traditional and modern operations are lacking. SUBJECT: Prospective multicentre randomized study. SETTING: Department of Obstetrics and Gynaecology, The First Faculty of Medicine, Charles University in Prague. SUBJECT AND METHOD: A prospective multicentre trial was approved by the Ministry of Health of the Czech Republic and registered with the FDA planning to recruit 500 patients with vaginal prolapse, 18 years of age and over, undergoing surgery at 5 major urogynaecologic centres. The patients were divided into three groups according to prolapse predominance. The surgical techniques used were: anterior and posterior prolift, and randomly allocated total prolift or sacrospinous fixation. The examination setup included lower urinary tract ultrasound, MRI, POP-Q assessment and QoL questionnaires before surgery and six and 24 month after the surgery. CONCLUSION: Preliminary analysis of partial data of 225 women showed an acceptable rate of complications and a better success rate in the mesh groups, whereas operation time and blood loss was lower in the classical operation group. Quality of life questionnaires documented that all the methods used have comparably good results. The surgical techniques used are acceptable methods for pelvic organ prolapse repair with low complication rates and excellent impact on the subjective perception of the patient's quality of life.

Adhesive bowel strangulation after caesarean section, the rare puerperal complication.

Caesarean section is the most frequent abdominal operation carried out in obstetric practice. Parturients undergoing this operation are still exposed to a substantial rate of short- and long-term complications. The incidence of re-laparotomy after caesarean section is 0.12-0.70%. The most common indication for re-laparotomy is intra-abdominal bleeding, uterine atony, eventration, haematoma in the muscle and intra-abdominal abscesses. We present the case report of an unusual life-threatening complication of caesarean section that led to re-laparotomy. Caesarean section rate has been continually increasing globally in the last few decades, thus we also have to take into account unusual complications e.g. intestinal complication.

[Sexual assault in the woman]. / Sexuální násilí na zenách.

OBJECTIVE: Retrospective analysis of the population of women examined for suspicion of sexual assault to compare the situation in the Czech Republic with the world's published works. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty of Charles University and the Faculty Hospital Na Bulovce Prague. METHODS: Retrospective analysis of medical reports for all women examined for suspicion of sexual violence during the period from January 2007 to December 2008. RESULTS: During observed period 37 women were examined, average age of examined women was 26.2 years, range 15-51 years, 76% of females younger than 29 years, 16% of examined women were from abroad. We have found no differences in occurrence throughout the year. In 3 cases there were more aggressors, in 30% of cases the alleged perpetrator was a known person or relative. In 54% of cases completed vaginal intercourse with ejaculation allegedly took place. We detected one case of forced oral sex and one case of forced anal sex. In 19% touching was involved. 22% of women did not know whether coitus really occurred--in 14% the alleged victim was under the influence of alcohol, in 3 cases under the influence of drugs, including one case of drinking an unknown substance in a beverage. Obvious signs of violence were found in 27% of cases, of which mostly in the face (14%), the extremities (8%) and only in two cases on the genitals (5%). No woman did require medical treatment of injuries. CONCLUSION: Our experience is similar to the published world data. In our group there were more strangers among the perpetrators. We did not record any use of a weapon in the enforcement of sexual contact. It is necessary to examine the alleged victims whole body thoroughly, signs of violence were more frequent in extragenital localization.

[Abortion induction in IInd trimester]. / Indukce potratu ve II. trimestru na Gynekologicko porodnické klinice FN na Bulovce.

STUDY AIM: Analysis of the set of women that underwent the termination of pregnancy in IInd trimester at the OBGYN clinic, Teaching Hospital Na Bulovce at interval of years 2006-2007. We appreciated the effect of method and compared with references in the literature. TYPE STUDY: Retrospective descriptive study. SEATTING: OBGYN clinic of the 1st faculty of Charles University, teaching hospital Na Bulovce, Prague. METHOD: Retrospective analysis of the set of women that underwent termination of pregnancy in the IInd trimester. Data are obtained from medical documentation and statistically processed. The analysis treats with 50 cases, in all of them, cervix was prepared with hydrophile dilators. In 37 cases were subsequently handed up prostaglandins intraamnially, in two cases generally intravenously, in two cases vaginally and 9 pregnancies were finished directly by dilatation and curettage without endeavour about expulsion. RESULTS: From 37 women after intraamnial administration of prostaglandins, 35 (94.6%) aborted successfully. Average time from amniocentesis to expulsion was 13 hours 45 minutes, 23 women aborted to 24 hours (62.2%). Undesirable effects were present in 12 cases (32.4%). CONCLUSION: Our record of local intraamnial administration of prostaglandins appears to be effective method. On the other hand, other methods are described in recent literature, which appear to be more efficient and have smaller occurrence of adverse effects.

[Synechia vulvae infantum--incidence on Department of Obstetric/Gynaecology, Teaching Hospital Na Bulovce, the First Medical Faculty of Charles University in Prague, Czech Republic from 2001 through 2005]. / Synechia vulvae infantum--výskyt na Gynekologicko-porodnické klinice 1. LF UK a FN na Bulovce v období let 2001 az 2005.

OBJECTIVE: The aim of this study is to discuss incidence and treatment of synechia vulvae at our Institute in the five years period. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics/Gynaecology, Teaching Hospital Na Bulovce, the First Medical Faculty of Charles University in Prague. METHODS: We performed a retrospective analysis of our set of patients treated at our Institute from 2001 through 2005. We assessed age, type of synechia, symptoms and treatment. RESULTS: We treated 108 cases of synechia vulvae in 83 patients, 16 cases were relapsing. Most patients were in the group of less than 3 years of age. Almost 64% of all cases were incidental findings of paediatrician. Our set comprised of posterior fusion (79% of patients), subtotal posterior fusion (14%) and the rest was anterior or middle fusion. 87% of all labial fusions were disintegrated without any need of anaesthesia. CONCLUSION: Our results confirmed high prevalence of posterior labial fusion; most of our cases were treated without any need of anaesthesia.

[Choroid plexus cysts and risk of trisomy 18. Modifications regarding maternal age and markers]. / Cysty choroidálního plexu a riziko trizomie 18. Modifikace ve vztahu k veku a markerum.

OBJECTIVE: Our aim was to evaluate the risk of chromosomal abnormalities esp. trisomy 18, associated with isolated choroid plexus cyst(s) in pregnant women undergoing second-trimester ultrasonographic examination. DESIGN: A review article. SETTING: OBGYN clinic of the 1st faculty of medicine, Prague, Teaching hospital Bulovka. SUBJECT: Choroid plexus cyst(s) (CPC) are more common in fetuses with chromosomal aneuploidies, particularly trisomy 18. Although it is accepted that the risk of karyotypic abnormality justifies amniocentesis in the case of other associated abnormalities are present, disagreement continues as to the risk of trisomy 18 in a fetus with an isolated choroid plexus cyst. We evaluated additional consideration of maternal age and multiple-marker screening for chromosomal aneuploidy in the assessment of risk. CASE REPORT: We report a trisomy 18 case that was diagnosed on the basis of CPC detection by ultrasound, NMR, and further amniocentesis. CONCLUSION: It is well accepted that choroid plexus cyst(s) in association with other congenital anomalies warrant amniocentesis to determine fetal karyotype. The presence of isolated CPC varies around 1% in general population, but around 30% in fetuses with trisomy 18 where the prevalence is 3 per 10,000 pregnancies. Metaanalyses reported incidence of trisomy 18 of 1 in 374 in fetuses with isolated CPC. These risks do not exceed the 1:200 risk of pregnancy loss after amniocentesis and also the 1:270 risk of Down syndrome (DS) in a 35-year-old woman, but exceeds the risk for DS of a 37-year-old woman. Thus these findings suggest that amniocentesis should not be offered to pregnant women in the presence of isolated fetal choroid plexus cyst(s), but in the absence of other pathologies. Amniocentesis is then justified only in the patient with advanced maternal age.

[Deliveries out of medical facilities]. / Porody mimo zdravotnická zarízení.

AIM OF STUDY: Analysis of reasons and risks of planned and unplanned deliveries out of medical facilities. TYPE OF STUDY: Review of literature and casuistry. NAME AND SITE OF DEPARTMENT: Department of Obstetrics and Gynaecology, Teaching Hospital Na Bulovce, 1st Faculty of Medicine, Charles University in Prague. MATERIAL AND METHOD: Authors of this paper are discussing published evidences concerning the reasons and the risks of planned and unplanned deliveries out of the medical facilities. They are pointing out at the activities of some independently practising midwives, who systematically encourage females against medically conducted deliveries during their prenatal courses, thus obtaining clients for home deliveries. At the end of the paper the authors present three casuistries from their own practice to document the outcomes of disinformation and prenatal courses guided in a wrong way. CONCLUSION: According to the results of foreign studies and own experience home deliveries are accompanied by senseless risks for mother and child. Dubitable benefits of the home surroundings cannot counterbalance these risks. Prenatally purposely misinformed woman and her partner often threaten themselves and their arriving child during labour with senseless risks.

[Possibilities of using ultrasound in the diagnosis of descended posterior compartment of female pelvic floor]. / Moznosti vyuzití ultrazvuku prfi diagnostice descenzu zadního kompartmentu zenského páinevního dna.

OBJECTIVE: Find out the features of descending posterior vaginal wall using ultrasonography and set the objective diagnostic criteria. DESIGN: Prospective comparative study. SETTING: Department of Obstetrics and Gynaecology, Teaching Hospital Bulovka, First Medical Faculty, Charles University in Prague. METHODS: We included 39 attendants, 19 with clinicaly proven descent of posterior vaginal wall; 20 as a negative control group. We observed the ultrasonographical features of descending posterior vaginal wall according to the horisontal line crossing the inferior margin of pubic bone (PM) and central anorectal angle (PARA) at rest and during Valsalva manoevre with and without intrarectal application of sonographic yelly. Student's t-Test was used for statistical evaluation. RESULTS: We proved the statisticaly significant increase in the distances PM and PM' in the group of females suffering from the descent compared to the group of healthy women. Values of PARA were also signifinatly hightened in the group of patients with the descent compared to healthy females. CONCLUSIONS: The ultrasonographical evaluation of descending posterior vaginal wall appears to be promising chance in diagnostics of female's pelvic floor pathology.

[A survey of surgical techniques used for the correction of statics disorders of pelvic floor]. / Prehled operacních technik uzívaných ke korekci poruch statiky pánevního dna.

OBJECTIVE: To present an overview of current procedures used in female pelvic floor reconstructive surgery. SUBJECT: Review article. SETTING: Teaching Hospital Bulovka, 1st Faculty of Medicine, Charles University, Prague. SUBJECT AND METHOD: Pelvic organ prolapse (POP) in women including associated disorders belong to the top problems in current urogynecology. During the last decade a substantial progress in elucidation of detail morphology and function of each pelvic floor compartments had been made. These new findings could be rapidly implemented into clinical medicine, mainly as application of new mesh implants. The results of reconstructive operations are variable, one of the reason is the existence of many operation techniques. This review article represents a short overview of those methods. CONCLUSION: Wide range of current operation procedures must be re-evaluated respecting the existence of new techniques based on recent anatomical studies.

[Methods of assisted reproduction in HIV positive patients]. / Metody asistované reprodukce u HIV pozitivních pacientu.

AIM OF THE STUDY: Analysis of treatment possibilities of infertility in HIV positive patients and solution of child desire in discordant pairs. Authors also present their own case. TYPE OF STUDY: Literature review and two case report. NAME AND SETTING OF DEPARTMENT: Department of Obstetrics and Gynaecology, The First Medical Faculty of Charles University in Prague. MATERIALS AND METHODS: Review of papers published on risk of HIV transmission during sexual intercourse, fertility of HIV positive patients and possible solution of their child desire. Summary of papers published on safety and effectivity of artificial insemination and IVF ET in HIV discordant pairp. Analysis of our own cases of artificial insemination in pairs of HIV negative female and HIV positive male. CONCLUSION: Artificial insemination seems to be safe, relatively cheap and effective solution of child desire in HIV discordant pair.