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.

[Prevalence of anal human papillomavirus infection among women and its relation to cervical HPV infection]. / Prevalence anální HPV infekce u zen a její vztah k cervikální HPV infekci.

OBJECTIVE: To summarize current knowledge of prevalence, duration and clearance of anal HPV infection among women and its relation to cervical HPV infection. DESIGN: Review article. SETTING: Department of Gynecology and Obstetrics, Hospital Na Bulovce and 1st Medical School of Charles University, Prague; Institute for the Care of Mother and Child, Prague; Gynecologic Oncology Center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague. RESULTS: The infection of human papillomavirus (HPV) is strongly associated with the development of anal cancer. Anal HPV infection is common and most anal HPV infections are transient. Women with cervical HPV infection, cervical dysplasia and cervical cancer are at the increased risk. Concurrent anal and cervical HPV infection is most prevalent among the youngest women. By contrast, the prevalence of anal infection alone remains relatively steady in all age groups. Compared with cervical infections, the overall distribution of HPV genotypes in the anus are more heterogeneous and include a greater proportion of nononcogenic types. A high degree of genotype-specific concordance is observed among concurrent anal and cervical infections, indicating a common source of infection. Tobacco smoking delays clearance of anal HPV. CONCLUSION: The high degree of genotype-specific concordance suggests that the cervix may be primary source and may serve as reservoir of HPV infection, too. Any type of sexual contact may be a route of transmission, history of anal intercourse is not a condition. The women with HPV related disease of low genital tract form high-risk group for acquisition of anal HPV infection and development of anal carcinoma.

Case report: pelvic actinomycosis.

A case of pelvic actinomycosis is presented. The patient is 42-year-old female with a 5 weeks history of pelvic pain. An intrauterine device (IUD) was taken out 3 weeks ago. There is a lump length 9 cm between rectus muscles. Ultrasound, magnetic resonance imaging (MRI) and histology are used to make the diagnosis. Actinomycosis can mimic the tumour disease. The definitive diagnosis requires positive anaerobic culture or histological identification of actinomyces granulas. A long lasting antibiotic therapy is performed.

[Current classification of malignant tumours in gynecological oncology--part II]. / Soucasná klasifikace zhoubných nádoru v onkogynekologii--cást II.

OBJECTIVE: Review of new staging systems for gynaecological cancers and their impact on prognosis and planning treatment. DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Radiotherapeutic Oncology, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Pathology, University Hospital Na Bulovce, Prague. RESULTS: Every staging system should have 3 basic characteristics: it must be valid, reliable, and practical. Over the years, these staging classifications--with the exception of cervical cancer and gestational trophoblastic neoplasia--have shifted from a clinical to a surgical-pathological basis. Changes based on new findings were proposed in 2008 by the FIGO Committee on Gynecologic Oncology, approved in September 2008 by the FIGO Executive Board, and published in 2009. The greatest changes were made in the new staging system for carcinoma of the vulva and others in the new staging systems for carcinoma of the cervix and carcinoma of the endometrium. A new stanging system was also created for uterina sarcomas, based on the criteria used in other soft tissue sarcomas. A clinical staging system for carcinoma of cervix continues because surgical staging cannot be employed worldwide (especially in third world countries). Stage 0 has been deleted from the staging of all tumours, since it is pre-invasive lesion and it is not an invasive tumour. In the revised staging system for carcinoma of the endometrium, four fundamental changes have occurred, which will be discussed. Carcinosarcoma is still staged identically to carcinoma of the endometrium. A completely new staging system was created for adenosarcomas, along with an almost identical staging system for leiomyosarcoma and endometrial stromal sarcoma. The staging system for carcinoma of ovary and Fallopian tube remains without changes. CONCLUSION: Since medical research and practice in the field of oncology have shown explosive growth, the staging of some of the gynaecological cancers did not give a good spread of prognostic groupings. Therefore, revised FIGO and TNM staging system has been structured to represent major prognostic factors in predicting patients' outcomes and lending order to the complex dynamic behavior of gynaecological cancers. The purpose of good staging system is to offer a classification of the extent of gynaecological cancer in order to provide a method of conveying one's clinical experience to others for the comparison of treatment methods.

[Current classification of malignant tumours in gynecological oncology--part I]. / Soucasná klasifikace zhoubných nádoru v onkogynekologii--cást I.

OBJECTIVE: Review of new staging systems for gynaecological cancers and their impact on prognosis and planning treatment. DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague. Department of Radiotherapeutic Oncology, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague. Department of Pathology, University Hospital Na Bulovce, Prague. RESULTS: The main objectives of any good staging system--essential to an evidence-based approach to cancer--include planning treatment, providing an assessement of prognosis and the evaluation of the results of treatment. With this approach, the exchange of relevant information between oncological centers is facilitated, thus disseminating knowledge and stimulating research in other parts of the world. A good staging system must have three basic characteristics: validity, reliability, and practicality. The first staging system for gynaecological cancers appeared around the turn of the 20th century and was applied to carcinoma of the cervix uteri. Classifications for the other gynaecological malignancies were not created until the 1950s. Over the years, these staging classifications--with the exception of cervical cancer and gestational trophoblastic neoplasia--have shifted from a clinical to a surgical-pathological basis. Some changes, brought about through new findings, were approved by the FIGO in 2008 and published in 2009. The greatest changes were made in the new staging system for carcinoma of the vulva, while others were made in the new staging systems for carcinoma of the cervix and carcinoma of the endometrium. A new stanging system was also created for uterine sarcomas, based on the criteria used in other soft tissue sarcomas. CONCLUSION: As a result of the explosion of medical research in the field of oncology, the staging of some of the gynaecological cancers became outdated and did not give a good spread of prognostic groupings. Therefore, revised FIGO and TNM staging system has been structured to represent major prognostic factors in predicting patients' outcomes and lending order to the complex dynamic behavior of gynaecological cancers. The purpose of a good staging system is to offer a classification of the extent of gynaecological cancer, in order to provide a method of conveying one's clinical experience to others for the comparison of different treatment methods.

[Characteristics and prognosis of malignant disease of the breast in women of very low age]. / Vlastnosti a prognóza zhoubného onemocnení prsu u zen velmi nízkého veku.

OBJECTIVE: This study aims to describe characteristics of malignant diseases of the breast in women of very low age (thus with breast cancer diagnosed before 35th year of age) and compare those characteristics with the phenotype of "average" breast cancer in Czech female population. METHODS: 98 women diagnosed with breast cancer before the age of 35 and treated between 2001 and 2010 in private medical center Medicon Praha s.r.o, were enrolled to this retrospective study. The control group of 100 women was constituted by random choice from patients older than 35 years at the time of diagnosis treated in the same time period. RESULTS: Size of the tumors at presentation were similar in both study groups. Tumors in younger group exhibited higher proliferative activity, higher grade and lower count of estrogen receptors. On the contrary, in the group of older women was significantly higher percentage of lobular type of cancer and also the proportion of in situ carcinomas. The number of multifocal tumors, positivity of HER-2/neu and progesterone receptors were all without statistically significant difference. In younger women neoadjuvant chemotherapy has been used more frequently. Prognosis of the disease did not differ in both groups. CONCLUSION: Tumors diagnosed in women younger than 35 years can be considered more aggressive. However, using adequate treatment makes the prognosis comparable in both age groups.

[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.

[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.

[Detection of postoperative lymphoedema in patients with breast cancer]. / Detekce pooperacního lymfedému u pacientek s karcinomem prsu.

OBJECTIVE: Lymphoedema is a severe postoperative complication after treatment of many malignancies. It is a pathological accumulation of extracellular water (ECW). Early diagnostic tool is needed. Multifrequency bioimpedance analysis (MFBIA) is a method for detection of changes in ECW. TYPE OF STUDY: Prospective study. SETTING: Dept. of Obstetrics and Gynaecology of the 2nd Medical Faculty, Charles University, Prague. METHODS: We measured a control group of 72 women and a group of 74 patients undergoing a breast cancer surgery during 18 month after the surgery by MFBIA and circumferency. Characteristics of the patients were recorded. The detection of lymphoedema was done using MFBIA, circumferency measurement and upon the symptoms of the patients. RESULTS: The average age in the controll and tested group was 40,1 and 58,9 years. The average size of the tumour, grade and positivity if oestrogen receptors was 15,1 mm, 2,04 and 43%. In 23 patients (21%) complete lymphadenectomy was performed, in 51 patients (79%) a detection of sentinel lymph node was performed. Lymphoedema was detected in 8 women (11%). In these patients MFBIA detected lymphoedema 9 month earlier in total than other methods. CONCLUSION: MFBIA is a low-cost and precise method for the detection od early stage postoperative lymphoedema. We recommend to incorporate MFBIA into standard dispensatory plan of every patient combined with circumferency measurement.

Urinary incontinence in a group of primiparous women in the Czech Republic.

BACKGROUND/AIM: Not only the process of childbirth itself, but also processes during pregnancy seem to be strongly associated with urinary incontinence (UI). According to some epidemiological studies, UI during pregnancy occurs in 23-70% of the pregnant women. These studies also documented some risk factors (e.g., race, age, or body mass index). The aim of our study was to explore the prevalence of UI during pregnancy in the Czech Republic. METHODS: 474 primiparas who gave birth at our maternity ward from June 14, 2004, through January 31, 2005, received a questionnaire. The questionnaire concentrated on the occurrence and presentation of UI before and during pregnancy. RESULTS: 339 women (72%) completed the questionnaire. UI and the length of pregnancy are significantly related. We found a baseline UI prevalence before pregnancy of 17%, but before delivery one of 64%. We did not find any statistically significant relation between the prevalence of UI during pregnancy and body mass index before pregnancy as well as before delivery, weight gain during pregnancy, age, and birth weight. CONCLUSION: Our results show that pregnancy is a risk factor for the development of UI.

[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.

[Breast cancer cell populations and its changes relation to therapy]. / Populace bunek karcinomu prsu a její zmeny v závislosti na protinádorové lécbe.

This review summarizes the data from published studies that dealt with observation of various bioparameters changes in cancer population dependant on used therapy. Critically evaluating these studies and looking for relations among separate results we are trying to estimate prognostic value of these parameters (likelihood of recurrence, overall survival, ...) and also their value for prediction of tumor response to cytostatic, hormonal or other treatment. The aim is selection of such tumor population characteristics the testing of them would enable better patient stratification in postoperative adjuvant systemic therapy.

[The hiatus urogenitalis and its dorsal component--its importance in urinary and fecal continence in women]. / Hiatus urogenitalis a jeho dorzální soucást--význam pro kontinenci moci a stolice u zen.

OBJECTIVE: Numerous anatomical studies over the last years resulted in a principal shift in the view of the area of female pelvic floor. These studies also deal with the area of posterior compartment, i.e. a region which used to be of little interest to urogynecologists. This article presents a brief outline of anatomical and physiological knowledge as well as a brief survey of most important methods of examination and basic clinical symptoms associated with disorders of posterior part of hiatus urogenitalis. The presently accepted concept of a complex approach to disorders of female pelvic floor will probably require increased interest in this area among urogynecologists. The article is aimed at summarizing elementary knowledge necessary for adequate clinical care of patients suffering from disorder in posterior compartment function. SUBJECT: Review article. SETTING: Department of Gynecology and Obstetric, Faculty Hospital Na Bulovce, 1st Medical Faculty, Prague, Czech Republic.

[Hydrogen expandable implants in the treatment of stress incontinence in women--a pilot study]. / Pouzití hydrogelových bobtnavých implantátu v lécbe stresové inkontinence moci u zen--pilotní studie.

OBJECTIVE: The aim of the study was to evaluate the use of new-type implants for the treatment of female urinary stress incontinence. The patients with intrinsic sphincter deficiency were also included, the other were after previous surgery for GSI. DESIGN: Original article. SETTING: Departments of Obstetrics and Gynaecology, Faculty Hospital Na Bulovce and General Faculty Hospital, 1. Faculty of Medicine, Charles University, Prague, Institute of Macromolecular Chemistry, Czech Academy of Science, Prague. METHODS: We operated 9 patients, two of them with type III (McGuire) urinary stress incontinence the rest after operations for GSI in general anesthesia. Six to nine hydrogel swelling implants were introduced into the submucosa of proximal urethra under the transrectal ultrasound guidance. We evaluated the effect 6 to 9 months after the operation. RESULTS: Two patient were dry (negative stress-test and pad-weight test), one patient had substantial improvement, 4 had mild improvement and 2 did not notice any change. We found de novo urge symptoms in four patients, two of them were of the motor type. CONCLUSION: The new type of implants reached the success rate of other currently used materials. The improvement of stress incontinence was on the cost of de novo urge symptoms in some patients. The urgency was successfully managed with spasmolytic drugs.

[Treatment of urinary stress incontinence in women with a periurethral implant]. / Lécba stresové inkontinence moci u zen pomocí periuretrálních implantátu.

OBJECTIVE: The aim of this article is the comprehensive information about different bulking substances and their use for the treatment of genuine stress urinary incontinence in women. DESIGN: The review summarizes various materials used for this purpose, methods of their application, possible complications and results of clinical studies of implants. SETTING: Department of Obstetrics and Gynaecology of Charles University and Faculty Hospital Bulovka takes part in the development of the new metacrylate of Czech origin. SUBJECT AND METHOD: Current scientific literature as listed in the article. CONCLUSION: Implants seem to be a useful alternative method in the treatment of the genuine stress incontinence in women.

[Perinatal outcome of twin pregnancies after fertilization in vitro and after spontaneous conception]. / Perinatální výsledky dvojcetných tehotenství po IVF a po spontánní koncepci.

OBJECTIVE: To compare the obstetric outcome of twin pregnancies after IVF with spontaneously conceived twins and thus determine whether IVF twins require greater care. TYPE OF STUDY: A retrospective study. SETTING: The Department of Obstetrics and Gynaecology, 1st Faculty of Medicine of Charles University, Prague. METHODS: Statistical evaluation of obstetric outcome between the group of 46 twin pregnancies after IVF and 85 spontaneously conceived twins. We evaluated the following parameters: signs of abortion and premature delivery, bleeding in pregnancy, premature rupture of membranes, performed cerclage, incidence of praeclampsia, gestational diabetes mellitus and hepatopathy of the mother. Pathological ultrasound findings were also evaluated--disturbances in foetal growth and the amount of amniotic fluid. In these parameters we also evaluated the time of the first signs of their development. Further, we evaluated the type of delivery, the gestational age at delivery, birth weight, birth weight discordance and perinatal mortality. RESULTS: We found statistically significant differences in the method of delivery--more cesarean sections in the IVF group (71.7%) than in spontaneous ones (44.7%). Another difference was the gestational age at which cerclage were performed--earlier in the IVF group (average 22.8 weeks) than in spontaneous ones (average 25.7 weeks). In the other evaluated parameters we did not find any statistically significant differences between the two groups. CONCLUSION: In our retrospective analysis of twin pregnancies, deliveries and neonatal outcome, except for the method of delivery and time of performing cerclage, we did not find any important significant differences between the IVF and spontaneously conceived twins. However, it is necessary to remember the generally worse obstetric outcome of twin compared to singleton pregnancies.

Arthroscopic irrigation and debridement of infected total knee arthroplasty: report of two cases.

Various methods have been described for the treatment of the acutely infected total knee arthroplasty. These include antibiotic suppression, open debridement and irrigation, exchange arthroplasty, resection arthroplasty, arthrodesis, and amputation. A method not frequently reported is arthroscopic irrigation and debridement. Two cases of acutely infected total knee arthroplasty treated with arthroscopic irrigation and debridement are presented. In both cases there was a benign postoperative course averaging five months. Both infections were secondary to hematogenous seeding from a distant focus of infection. The patients presented within approximately 12 h after the onset of knee symptoms and were taken for arthroscopic irrigation and debridement within 12 h after presentation. Gram-positive organisms sensitive to the antibiotics being used were cultured in both. Postoperative knee function and range of motion returned rapidly and disability was minimal. At average 30-month follow-up both patients were pain free, had full activity of daily living, and had no clinical or radiographic evidence of infection. Arthroscopic irrigation and debridement appears to be an effective method of treatment in select cases of infected total knee arthroplasty.