[Adrenocortical oncocytoma presenting as Cushing´s syndrome in pregnancy with spontaneous postpartum uterine rupture]. / Adrenokortikální onkocytom jako raritní prícina Cushingova syndromu v gravidite a následná delozní ruptura po porodu.

OBJECTIVE: The description of rare case of the Cushings syndrome in pregnancy resulting in the spontaneous rupture of uterus. DESIGNS: A case report. SETTING: Department of Gynecology and Obstetrics, 1st Medical Faculty of Charles University and Hospital Na Bulovce. CASE REPORT: The authors report the case of a 33 year old woman, who was admitted to the clinic in 30th week of pregnancy for elevated blood pressure and hypokalemia. Arterial hypertension was corrected with the combination of Vasocardin and Dopegyt. In 36th week of pregnancy the patient was admitted to the hospital with premature rupture of membranes. In less than sixteen hours the patient spontaneously gave birth to a healthy girl. Subsequently the patient suffered from abdominal pain. CT scan showed haemoperitoneum and a right adrenal mass and the surgical revision was performed. During the surgery uterine rupture was identified and the patient uderwent abdominal hysterectomy. Based on the endocrinological examination the diagnosis of Cushings syndrome was made. Three months after the delivery she underwent laparoscopic right adrenalectomy. Histological examination revealed adrenocortical oncocytoma. CONCLUSION: Cushings syndrome is rare in pregnancy and misdiagnosis is common. Symptoms mimic pregnancy complications. The disease is often diagnosed with delay even after delivery. The sonography and magnetic resonance are dominant imaging methods. Laboratory diagnosis is difficult due to pregnancy related changes. In spite of rarity of Cushings syndrome in pregnancy we should think about it in terms of the differential diagnosis of hypertension, diabetes, dysbalance of mineralogram and typical cushingoid habitus.

[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.

[The 2-dose schedule of HPV vaccines in young adolescents]. / Dvoudávkové ockovací schéma HPV vakcín u mladých adolescentu

OBJECTIVE: To summarize new knowledge about the 2-dose HPV vaccine schedule in young adolescents. DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University and Hospital Na Bulovce in Prague; Oncogynaecological Center, First Faculty of Medicine, Charles University and General University Hospital in Prague. RESULTS: The goal of immunization programs in many countries is the prevention of cervical cancer using either the bivalent or the quadrivalent HPV vaccine. The vaccines, which were designed to prevent cervical cancer outcomes in adults, need to be administered before the onset of sexual activity. Since the HPV vaccines are among the most expensive of all the widely recommended vaccines, limited financial resources restrain the HPV vaccination in some countries around the word. Higher immunogenicity of both HPV vaccines in young adolescents, as well as potential cost savings, have prompted discussions about the efficacy of the 2-dose HPV vaccine schedule. Results of the immunobridging studies showed that two doses of the bivalent and the quadrivalent HPV vaccine in young girls induced geometric mean antibody titers that were non-inferior to geometric mean antibody titers elicited in older girls and women with three doses of the same vaccine. Non-inferiority for HPV-16, -18, -31 and -45 was obtained for the 2-dose of the bivalent HPV vaccine in girls 9-14 years old in the period of 48 months and for HPV-6, -11, -16 and -18 for the 2-dose of the quadrivalent HPV vaccine in girls 9-13 years old in the period of 36 months. CONCLUSION: These results indicate that the bivalent and the quadrivalent vaccine HPV vaccine applied in 2 doses has sufficient immunogenity in young girls.