Appearance of levator ani muscle subdivision defects on level III vaginal support structures in women with and without pelvic organ prolapse: an MRI study.

INTRODUCTION AND HYPOTHESIS: Injury of the levator ani muscle (LAM) is a significant risk factor for pelvic organ prolapse (POP). The puborectalis (PRM) and pubovisceral (PVM) subdivisions are level III vaginal support structures. The null hypothesis was that there is no significant difference in patterns of LAM subdivisions in healthy nulliparous women. Secondarily, we evaluated the presence of different LAM injury in a POP-symptomatic cohort. METHODS: This retrospective magnetic resonance imaging study included: 64 nulligravidae without any pelvic floor dysfunction (PFD) and 526 women of various parity with symptomatic POP. Primary outcome was PVM and PRM morphology on the axial planes: the attachment site on the pubic bone, and the visible separation/border between the PVM and PRM. The attachment was scored as "normal" or "abnormal". The "abnormal" attachment was divided in two types: "type I"-loss of the muscle substance, but preservation of the overall muscle architecture-and "type II"-muscle detachment from the pubic bone. RESULTS: The puboanal muscle (PAM) subdivision was evaluated as a representative part of the PVM. The PAM and PRM attachments and separation were distinguished in all asymptomatic nulliparae. PAM and PRM attachments did not significantly differ. POP group characteristics were parity 1.9 ± 0.8, instrumental delivery 5.6%, hysterectomy or POP surgery 60%, all Pelvic Organ Prolapse Quantification (POP-Q) stages, LAM defect 77.6% (PRM: 77.1%; PAM: 51.3%). Type I injuries were more frequent (PRM 54.7%; PAM 53.9%) compared with type II (PRM 29.4%; PAM 42.1%). CONCLUSIONS: A LAM defect was present in 77.6% of women with symptomatic POP. In PRM and PAM subdivisions type I injury was more frequent than type II.

Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham-controlled trial.

OBJECTIVE: To describe effects of non-ablative erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser on vaginal atrophy induced by iatrogenic menopause in the ewe. DESIGN: Animal experimental, randomised, sham and estrogen-treatment controlled study with blinding for primary outcome. SETTING: KU Leuven, Belgium. SAMPLE: Twenty-four ewes. METHODS: Menopause was surgically induced, after which the ewes were randomised to three groups receiving vaginal Er:YAG laser application three times, with a 1-month interval; three sham manipulations with a 1-month interval; or estrogen replacement and sham manipulations. At given intervals, ewes were clinically examined and vaginal wall biopsies were taken. Vaginal compliance was determined by passive biomechanical testing from explants taken at autopsy. MAIN OUTCOME MEASURES: Vaginal epithelial thickness (primary), composition of the lamina propria (collagen, elastin, glycogen and vessel content), vaginal compliance, clinical signs. RESULTS: Animals exposed to Er:YAG laser application and sham manipulation, but not to estrogens, displayed a significant and comparable increase in vaginal epithelial thickness between baseline and 7 days after the third application (69% and 67%, respectively, both P < 0.0008). In laser-treated ewes, temporary vaginal discharge and limited thermal injury were observed. Estrogen-substituted ewes displayed a more prominent increase in epithelial thickness (202%; P < 0.0001) and higher vaginal compliance (P < 0.05). None of the interventions induced changes in the lamina propria. CONCLUSIONS: Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes. TWEETABLE ABSTRACT: Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes #LASER #GSM #RCT.

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.

[Selective feticide in monochorionic twin pregnancies with discordant fetal anomalies: management and outcome]. / Selektivní fetoredukce u monochoriálních gravidit komplikovaných vrozenou vývojovou vadou jednoho z plodu: management a výsledky péce.

OBJECTIVE: To analyze results and outcome after selective feticide for discordant anomalies in monochorionic twins. DESIGN: Prospective cohort study. SETTING: Fetal medicine center, Institute for the Care of Mother and Child, Praha. METHODS: Analysis of outcome of monochorionic pregnancies after intrauterine surgery for structural abnormalities between January 2013 and June 2016. RESULTS: We performed 13 intrauterine operations in monochorionic twins with structural anomalies during the period. There were 12 monochorionic diamniotic and one monochorionic monoamniotic twins. We encountered four cases of Twin Reversed Arterial Perfusion sequence (TRAP), six central nervous system lesions, two abdominal wall defects and one heterokaryotypic pregnancy with trisomy 13. In seven cases we performed bipolar cord occlusion, in four cases of TRAP sequence we performed radiofrequency ablation (RFA). We also performed laser photocoagulation of placental anastomoses in a case of gastroschisis complicated with twin-to-twin transfusion syndrome. One operation was unsuccessful for technical reasons - failing to perform amnioinfusion in a fetus with eventeration and anhydramnios. All procedures were performed in local anesthesia. Fetuses were born between 26 a 41 weeks of gestation (mean 35 weeks; 77% of fetuses were delivered after 32 weeks). Mean neonatal weight 2260 g. We encountered no intrauterine demise of a healthy fetus. CONCLUSION: Patients with discordant fetal anomalies in monochorionic twins can be offered a selective feticide via bipolar umbilical cord occlusion or radiofrequency ablation that are proven to be safe and effective.

[The results of five years follow-up prospective study of vaginal prolapse repaired by prolift total mesh surgery or sacrospinous fixation]. / Resení sestupu trí kompartmentu pomocí syntetického implantátu a sakrospinózní fixace: kohortová prospektivní studie s délkou follow-up peti let.

OBJECTIVE: The aim of the study is to compare the results of five years follow-up prospective study of vaginal prolapse repaired by prolift total mesh surgery or sacrospinous fixation. STUDY DESIGN: A single-center prospective, cohort study, in patients with defect grade II and more by POP-Q. SETTING: The Institute for the Care of Mather and Child; 3rd Medical Faculty Charles university, Prague. METHODS: Comparison of the preoperative state and the five years after the operation according POP Q, ICIQ-SF, PISQ 12, VAS. Comparison of intraoperative and postoperative complications. RESULTS: The study was attended by 142 patients; 75 patients underwent surgery Prolift Total and 67 patients sacrospinous fixation by Amreich Richter. On clinical examination at 5-year follow-up, we observed 15 (20.0%) case of anatomical failure in the Prolift group and 30 (44.8%) in the SSF group. Anatomic failure was defined clinically as Ba, C or Bp at the hymen or below. In assessing the overall condition before and five years after surgery using a VAS occurred in patients in the cohort Prolift Total decrease to 2.9 (± 1.9) from the original 7.8 (± 1.8). VAS in SSF group decreased after 5 years to 4.2 (± 2.7) of the original 7.8 (± 1.4). Values ICIQ-SF, analyzing the state of voiding PT group showed a decline from the original 6.7 (± 6.9) to 5.5 (± 5.3). A similar trend was evident even after the SSF. Parameters questionnaire PISQ-12 showed a positive increase from the original 28.6 (± 9.5) to 31.8 (± 7.9) points. PISQ-12 was improved from 28.7 (± 9.8) to 32.2 (± 7.5). CONCLUSION: Recurrences were observed more frequently in patients after sacrospinous fixation, while the quality of life questionnaires yielded comparable postoperative results. Quantity of intraoperative complications is low and both groups do not differ.

[Reconstruction of the posterior and central compartment with the Prolift Posterior: cohort study with a 5-year follow-up]. / Rekonstrukce defektu zadního a stredního kompartmentu pomocí kotveného implantátu Prolift Posterior: kohortová studie s petiletým follow-up.

OBJECTIVE: To analyse the results of the long-term prospective follow-up study of vaginal prolapse reconstructed using a Prolift Posterior. STUDY DESIGN: Prospective, cohort study. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Over a 5-year period (I/2006 - XII/2011) we prospectively followed a cohort of patients with posterior vaginal wall defect who underwent surgical reconstruction using a monofilament polypropylene implant Prolift Posterior (Gynecare, Ethicon, Inc., Piscataway, NJ, USA). Patients were invited for review at six weeks, three months, six months, 12 months and then yearly up to five years. Postoperative follow-up included the clinical examination and subjective evaluation using VAS, PISQ 12 and ICIQ SF. RESULTS: One hundred twenty-four women were included in the study, of which 14 (11.3%) had no prolapse surgery in their health history. There were no concomitant vaginal procedures such as hysterectomy or another implant surgery. The average operation time and blood loss were 64.25 min (min. 10, max. 205 min) and 115 ml (min. 10 ml, max. 1000 ml), respectively. Only one patient had a blood loss 1000 ml. There were no injuries of the urinary bladder or intestines during the needle insertion of the mesh. In the five-year period, the recurrence of posterior vaginal wall defect was observed in 4 cases (3.3%). The average time to the posterior vaginal wall recurrence prolapse was 19.5 months (min. 6, max. 36). De novo prolapse in the anterior compartment was observed in 25 patients (20.5%). CONCLUSION: In this prospective single centre study, we observed anatomical improvement in the implanted compartment with low recurrence rate. During five years follow-up period there was de novo anterior vaginal wall defect observed in 20.5% cases. The question of implant employment in urogynecology remain to be answered, however, our results show that implants have their position in reconstructive surgery.

[Sheep as an experimental model in the reaserch of effects of pregnancy, delivery and surgical procedures on the pelvic floor]. / Ovce jako experimentální model pro studium vlivu tehotenství, porodu a operacních technik na pánevní dno.

OBJECTIVE: A short literature review of ewe as an experimental model in research of effects of pregnancy, delivery and urogynecological surgical procedures on the pelvic floor. DESIGN: Literature overview. SETTING: Institute for the Care of Mother and Child, Third Faculty of Medicine, Prague. METHODS: This is an overview of recent literature on experiments using ewes as a model for biomechanical and morphological changes of the vagina induced by pregnancy, delivery and transvaginal graft implantation. RESULTS AND CONCLUSION: The ovine pelvic floor and vagina have comparable morphology to human. Its biomechanical and biochemical properties get changed during the pregnancy and postpartum similarly to clinical findings. Sheep could be used for testing of urogynaecological implants vaginally and simultaneously implanted in the abdominal wall to provide better understanding of anatomical environment differences. The size of the ovine vagina gives the opportunity to perform comprehensive biomechanical, histological and biochemical testing. Experiments and observation may improve our understanding of pathology and physiology of vaginal wall changes induced by hormones, prolapse or surgery.

[Diagnosis and management in women with lower urinary tract symptoms (LUTS) after burch colposuspension]. / Management mikcních obtízí u pacientek po antiinkontinentním chirurgickém výkonu bez vyuzití syntetického materiálu na dolních cestách mocových.

OBJECTIVE: To demonstrate the significance of introital ultrasound of the lower urinary tract in the diagnostic algorithm in patients with lower urinary tract symptoms (LUTS) after Burch colposuspension. METHODS: Twenty six women with voiding dysfunction directly associated with prior anti-incontinence surgery (Burch colposuspension) were included in the study (Group A). The control group (Group B) consisted of twenty eight women after Burch colposuspension with a good clinical result without LUTS. Introital ultrasound was performed at rest and at maximum voluntary contraction to measure the monitored parameters (angle alpha: the inclination angle of the urethra, angle beta: the posterior urethrovesical angle, angle gamma: the angle between the axis of the symphysis and the line segment connecting the region of the internal urethral orifice and the lower margin of the symphysis, distance H: the distance between the internal urethral orifice and the horizontal axis running through the bottom edge of the symphysis, distance p: the distance between the internal urethral orifice and the lower margin of the symphysis). RESULTS: Significant differences were found in bladder neck position and mobility between those women with LUTS and control group. At a 5% confidence interval, both groups differ in mean values of the angles alpha, beta a gamma, and in the mean values of segments p and H on straining. Ventral displacement of the bladder neck (characterized by angles alpha and gamma) at rest and during straining was present in all women in group A. The difference was statistically significant (p=0,001). Angle beta also demonstrates abnormal position and minimal mobility of the bladder neck in group A. As a result of bladder neck disclocation in the ventral direction, at rest, this parameter shows significantly lower values in comparison with group B. This difference is more apparent on Valsalva, where as a result of minimal mobility of the bladder neck. This parameter has even lower values in group A in comparison with group B. The bladder neck in patients with LUTS after Burch colposuspension shows not only ventral displacement of the bladder neck but also a significant reduction in dorsocaudal movement during straining. CONCLUSION: In women with LUTS after Burch colposuspension, atypical changes in the position and mobility of urethra can be demonstrated when compared with women who underwent successful surgery for incontinence.

[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.

[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.

[New diagnostic approach to different hydatidiform mole types, hydropic abortions and relevant clinical management]. / Nové diagnosticki prístupy k ruzným typum hydatidózních mol, hydropickým abortum a príslusné klinické postupy.

OBJECTIVE: To describe new diagnostic approach to complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion. TYPE OF STUDY: Original research. SETTING: Trophoblastic Disease Center in the Czech Republic (TDC-CZ), Institute for the Care of Mother and Child, Prague. METHODS: Our study consists of 1321 partial hydatidiform moles, 805 complete hydatidiform moles, 524 proliferative moles, and over 2500 hydropic abortuses diagnosed and treated at theTDC-CZ, besides which 2896 of these lesions were examined at the TDC-CZ by referral. The material was examined by routine histopathological methods, which in selected cases was supplemented by immunohistological examination and correlated with cytogenetic and molecular genetic results and clinical features. RESULTS: The study describes the diagnostic procedures enabling the differential diagnosis between mature complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion. Fourteen histological parameters have been defined which are most common, individually or in combination, in various types of hydatidiform moles and hydropic abortions. Warning is given to errors in histological diagnosis correlated with cytogenetic and molecular genetic results. Proposed reliable method of eliminating the influence of these errors on the possible development of trophoblastic disease. CONCLUSION: The study describes differential diagnosis of complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole, hydropic abortion and relevant clinical management.

[Rectal duplication cyst--case report]. / Cystická duplikatura rekta--kazuistika.

OBJECTIVE: The authors demonstrate a rare case of duplication anomaly of the rectum. DESIGN: Case report. SETTING: Institute for the Care of Mother and Child, Prague. SUBJECT AND METHOD: We present a rare case of cystic rectal duplication in adult, completely removed and histologically confirmed. A literature review was summarized. CONCLUSION: The case was complicated by delay in diagnosis, multiple operations, and by the association with endometriosis, as well. Mentioned anomaly is published in the Czech literature for the very first time.

[Histological differential diagnosis of hydatidiform moles and hydropic abortions]. / Histologická diferenciální diagnostika hydatidózních mol a hydropických abortu.

OBJECTIVE: To describe the diagnostic methods enabling histological differential diagnosis of complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion. METHODS: Our study consists of 1321 partial hydatidiform moles, 805 complete hydatidiform moles, 524 proliferative moles, and over 2500 hydropic abortuses diagnosed and treated at the Trophoblastic Disease Center in the Czech Republic (TDC-CZ), Institute for the Care of Mother and Child, plus 2896 of these lesions examined at the TDC-CZ by referral. The material was examined by routine histopathological methods, which in selected cases were supplemented by immunohistological examination and correlated with cytogenetic and molecular genetic results and clinical features. RESULTS: The study describes the diagnostic procedures enabling differential diagnosis between mature complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion. Fourteen histological parameters have been defined which are most common, individually or in combination, in various types of hydatidiform moles and hydropic abortions. Warning is given to errors in histological diagnosis, correlated with cytogenetic and molecular genetic results. We propose a reliable method of eliminating the influence of these errors on the possible development of trophoblastic disease. CONCLUSION: The study describes a histological differential diagnosis of complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion.

[Persistent trophoblastic disease in Trophoblastic Disease Center in the Czech Republic in 1955--2007]. / Perzistující trofoblastická nemoc v Centru pro trofoblastickou nemoc v CR v letech 1955--2007.

OBJECTIVE: To define persistent trophoblastic disease as a clinical entity of gestational trophoblastic disease. To describe its classification, treatment and follow-up. TYPE OF STUDY: Retrospective analysis. SETTING: Trophoblastic Disease Center (TDC) in the Czech Republic TDC-CZ, Institute for the Care of Mother and Child, Prague. METHODS: This study analyzes data from the Trophoblastic Disease Center consisting of 396 choriocarcinomas, 512 proliferative moles, 798 complete hydatid moles, 1299 partial hydatid moles, and 2105 persistent trophoblastic invasions treated at the TDC up to the year 2007. The study includes also 2615 cases of trophoblastic disease which documented by gynecologists and pathologists of the Czech Republic and registered in the TDC-CZ. RESULTS: Persistent trophoblastic disease was defined and described in detail as follows: 1. Differentiating autothonic hCG, produced by the gestational trophoblast, from so-called "phantom hCG," hypophyseal hCG and hCG during PLL-Q and PLL-U syndrome. 2. Evaluating the level and length of persistence of hCG relevant for the diagnosis of persistent trophoblastic disease. 3. Identifying three types of persistent trophoblastic disease: A. Non-metastatic B. Metastatic low-risk C. Metastatic high-risk 4. Described treatment, indications, and choice of various chemotherapeutic protocols in individual types of persistent trophoblastic disease as well as its follow-up. CONCLUSION: This study enables the differentiation of persistent trophoblastic disease in general gynecologic and obstetric clinical practice, by evaluating the presence, level, and length of persistence of hCG, and thus allowing for timely referral of the patient to the Trophoblastic Disease Center in the Czech Republic.

[Cesarean scar ectopic pregnancy]. / Ektopická gravidita v jizve po císarském rezu.

OBJECTIVE: To present our clinical experience with cases of ectopic implantation in the uterine scar of a prior cesarean section and to analyse current articles with this topic. The authors experienced two cases of cesarean scar pregnancy with different clinical management and outcome. DESIGN: Review article, case report. SETTING: Institute for the Care of Mother and Child, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: We experienced two cases of cesarean scar pregnancy during the year 2006. Missed abortion in the 12th week of pregnancy was diagnosed in the first patient. During instrumental evacuation of the uterine cavity in the district hospital severe bleeding occured. After transfer to our department abdominal hysterectomy was performed. In the second case early ultrasonographic diagnosis of ectopic nidation was completed. Hysteroscopic evaluation of gestational sac with subsequent instrumental evacuation with ultrasonographic assistance was performed as a fertility saving operation. Subsequent systemic application of methotrexate was indicated after surgery. CONCLUSION: Cesarean scar pregnancy occurs in 1/800 - 1/2216 normal pregnancies. Early sonographic diagnosis enables surgical or medicamentous treatment preserving the fertility of the patient. Late or absent diagnosis of pathological implantation can cause severe uterine bleeding. Treatment options preserving fertility can not be used and hysterectomy is then the only life saving procedure.

Congenital diaphragmatic hernia: onset of respiratory distress and size of the defect: analysis of the outcome in 104 neonates.

The purpose of this study was to evaluate the outcome in neonates with congenital diaphragmatic hernia (CDH) either presenting within the first 24 h of life or diagnosed prenatally. The study was particularly focused on the time of onset of respiratory distress and on the use of the Gore-Tex (GT) patch for diaphragmatic reconstruction. Records of 104 neonates with CDH were retrospectively reviewed. The data were analyzed by ANOVA, Kruskal-Wallis test or chi (2) test as appropriate. The result showed that the overall survival rate was 73.1% (76/104). Survival of operated neonates was 91.6% (76/83). Postnatally diagnosed neonates with the onset of respiratory distress within the first minute of life survived in 67%, with the onset between 2 and 10 min survived in 89%, whilst neonates with the onset of respiratory distress after l0 min survived in 100% (P = 0.007). Birth weight, gestational age, time of onset of respiratory distress and Apgar score significantly differed between survivors and nonsurvivors. Primary closure of the diaphragmatic defect was performed in 62 patients while the GT patch was used in 21 patients. The survival of patients with a large defect treated with a GT patch was lower (76.2 vs. 96.8%, P = 0.003). There was only one case of recurrence in our series with the GT patch. Survival depends on the time of onset of respiratory distress and size of the defect, both of which correlate with the degree of pulmonary hypoplasia. The term high-risk CDH is appropriate only for children with respiratory distress within the first 10 min of life and those diagnosed prenatally. The GT patch is a suitable material for the diaphragmatic reconstruction; we suppose that the recurrence is caused by incorrect attachment of the patch to the thoracic wall.

[Tumoriform endometriosis of the urinary bladder in advanced pregnancy]. / Tumoriformní endometrióza mocového mechýre v pokrocilém tehotenství.

A case of tumoriform endometriosis of urinary bladder immitating a tumor of the bladder during the first pregnancy of a 25-year-old patient was successfully treated by partial cystectomy allowing continuation of the pregnancy, a normal term delivery and after 5 months a second pregnancy with term delivery.

[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.

[Pregnancy complications after intrauterine hysteroscopic surgery]. / Tehotenské komplikace po intrauterinní hysteroskopické chirurgii.

OBJECTIVE: To evaluate our clinical experience of cases of pregnancy after transcervical septum resection and endometrial ablation. There are several case reports in the literature showing increase fetomaternal morbidity after intrauterine surgery. DESIGN: Analytic retrospective study. SETTING: Mother and Child Care Institute, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: There were three cases of severe complications during pregnancy after intrauterine surgery. We experienced one case of uterine rupture after transcervical septum resection in the second stage of labour. The other two cases were pregnancies after endometrial ablation and septum resection complicated with severe bleeding in the second trimester. CONCLUSION: Pregnancies after some types of intrauterine surgery (septum resection, endometrial ablation) are at high risk. They can lead to increased fetomaternal morbidity. We recommend intensive prenatal care with immediate surgical intervention when complications occur.

[Endometriosis imitating bladder tumor in 2nd trimester of pregnancy]. / Endometrióa imitující nádor mocového mechýre ve II. trimestru tehotenství.

OBJECTIVE: Case presentation of bladder endometriosis during 2nd trimester imitating urinary bladder tumour. SETTING: Mother and Child Care Institute, Prague. III. Medical School of Charles University, Prague. CASE REPORT: 25-years old patient, 2nd trimester of first pregnancy. TREATMENT: Partial bladder cystectomy. RESULT: Complete recovery succeded by term delivery. CONCLUSION: Tumouriform endometriosis of urinary bladder successfully treated by partial cystectomy allowing normal term delivery.