[One-Step Nucleic Acid Amplification method - what is the future of sentinel lymph node management?] / Metoda One-Step Nucleic Acid Amplification - jaká je budoucnost zpracování sentinelových uzlin?

OBJECTIVE: The article summarizes current possibilities of usage of the One-Step Nucleic Acid Amplification method (OSNA) in the perioperative management of sentinel lymph nodes in oncologic surgery. The principle of this method is the detection of cytokeratin 19 (CK19) in the lymphatic tissue as a marker of the metastatic spread. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynaecology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague; Department of Biology, Faculty of Medicine in Pilsen, Charles University, Prague; Department of Immunochemistry, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague; Sikl´s Department of Pathology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague. METHODS: The review of the literature published until the end of April 2017 available on the PubMed database was performed. The official abbreviation OSNA and the full name of the method One-Step Nucleic Acid Amplification was used for search in this database. CONCLUSION: The usage of the OSNA method with the detection of CK 19 in the sentinel lymph nodes as a marker of metastatic spread to the lymphatic tissue currently represents an acceptable form of perioperative sentinel lymph node management in patients with breast and colorectal cancer. Until now published data are pointing towards possible successful application of this method in sentinel lymph node management in patients with some other malignancies, such as thyroid carcinoma, gastric cancer, uterus cancer and head and neck cancer. More data is needed to establish this method also in those neoplasms.

[Effect of overweight on the outcome of assisted reproductive technology in infertile women]. / Vliv nadváhy na úspesnost technik asistované reprodukce u neplodných zen.

OBJECTIVE: Obesity and overweight negatively affect the ability of women to conceive naturally, contributes to the increased incidence of obstetric complications during pregnancy and affect the outcome of assisted reproduction techniques (ART). The aim of our study was to compare the results of treatment of infertilityin a group of infertile women undergoing ART, depending on the values of BMI and changes in levels of selected hormones and markers of oxidative stress in follicular fluid. DESIGN: Retrospective comparative study. SETTING: Faculty of Medicine in Pilsen, Charles University in Prague; Institute of Reproductive Medicine and Endocrinology, IVF Centers - Prof. Zech, Plzen. METHODS: The studied group consisted of 44 women (mean age of 31.9 years, SD = 4.35) treated for infertility at the Institute of Reproductive Medicine and Endocrinology - IVF Centers Prof. Zech. Women were divided into 2 groups according to BMI (37 women had normal BMI, 7 women were overweight). Prolactin, free T3 and T4 hormone, homocysteine, malondialdehyde, glutathione peroxidase, total antioxidant capacity and total protein were analyzed in the follicular fluid both groups. Only blood free samples were studied after pooling of all FF samples of each patient. RESULTS: We observed significantly lower levels of glutathion peroxidase in the group of overweight women(p = 0.0044). The pregnancy success rate with women with normal BMI and overweight women did not differ significantly from each other (p = 0.4430). CONCLUSION: Our study did not confirm the negative effect of obesity on the results of treatment of infertility, specifical-ly pregnancy rate in a group of infertile women undergoing treatment with assisted reproduction techniques.

[Analysis of point mutations in interleukin-11 gene in the population of infertile patients and fertile control women]. / Vysetrení bodových mutací v genu pro interleukin-11 v populaci neplodných zen a plodných kontrol.

OBJECTIVE: The interleukin-11 (IL-11) is one of the most important signaling factors in the process of decidua-lization and embryo-maternal cross talk during the embryo implantation. We investigated the prevalence of the IL-11 gene point variants in the population of infertile women and fertile control subjects. DESIGN: A cohort study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital of Charles University, Pilsen. SUBJECTS AND METHODS: The population to screen consisted of 354 infertile women. The control population was comprised of 195 healthy fertile subjects. For the mutational analysis, the temperature gradient gel electrophoresis (TGGE) and direct sequencing had been used. The groups of fertile controls and infertile patients were compared for statistically significant difference using the Fisher´s 2 by 2 Exact test. RESULTS: Thirteen potentially functional IL-11 gene variants, the G to A transversions at the position 3651 (G3651A) leading to the arginin to histidin exchange on the position 113 (R113H) were detected in the group of infertile women. No mutations were identified in the control group, which means that the frequency of functionally relevant mutations of the IL-11 gene in infertile women is significantly enhanced in comparison with controls (p = 0.01, Fisher´s 2 by 2 Exact test). CONCLUSION: The results prove the presence of the potentially functionally relevant IL-11 gene variants in the population of infertile women. The presence of variants does not have to lead directly to decrease fertility but may contribute to the dysbalance of cytokine milieu which is needed for the decidualization as well as subsequent embryo implantation. Even thought IL-11 gene variants occur infrequently, their impact on molecular events during early phases of pregnancy should be further elucidated.

[Czech registry of complications in gynecological laparoscopy - the on-line data collection]. / Národní registr komplikací gynekologické laparoskopie CR -první zkusenosti s elektronickým sberem dat a vize do budoucna.

OBJECTIVE: To survey the performance of laparoscopically assisted vaginal hysterectomy (LAVH) and other gynecologic laparoscopic operations performed in the Czech Republic. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Departments of gynecology in the Czech Republic. METHODS: Two paper questionnaires were sent to 120 clinics performing laparoscopic gynecologic operations in the past, the data have been collected via web application since 2013. RESULTS: Process of transition from paper questionnaires to electronic forms was realized without complications. Number of clinics that responded was the highest during 5 last years. Number of reported gynecologic laparoscopic operations in 2013 was the second highest since the establishment of the Registry. CONCLUSION: Unchanged trend of decrease in number of abdominal hysterectomy. Latest data shows the possibility of vaginal hysterectomy renaissance.

[Doctors specialty training in obstetrics and gynecology at university medical schools: 2012-2013]. / Specializacní vzdelávání v gynekologii a porodnictví na lékarských fakultách: 2012-2013.

OBJECTIVE: The paper addresses transfer of doctors specialty training from the national Institute of postgraduate medical education (IPVZ) to University Medical Schools (UMS) with the special focus to Obstetrics and Gynecology (OG). METHODS: The National Specialty Board (NSB) has been established. NSB tasks include definition of inclusion criteria and process of specialty choice at UMS. In OG specialty there are defined mid-term and final postgraduate training courses and other requirements for final specialty exam (FSE) - in particular trainees scientific work and surgery done with the supervision of NTB member. The system of FSE, its content, application, reimbursement and mechanisms are described in details. RESULTS: In the whole country in 2012 there have been done 864 FSE in all basic medical specialties, which took place at seven UMS. Autumn semester terms has been utilized significantly more than spring terms (57% vs. 43%). There have been differences in the numbers of specialties and also numbers of candidates in each specialty among different UMS. In total 94% of applicants succeed in the FSE. In 2012 within OG specialty training there has been held 56 FSE - 24 exams on five UMS in spring term and 32 (57%) exams only on two UMS in autumn term. In the spring 2013 FSE were organized on 1st LF UK in Prague with 23 applicants, from which 22 successfully passed. During autumn 2013 the FSE in OG will be held on LF UP in Olomouc with 44 applicants for final postgraduate training course and 39 candidates for FSE. CONCLUSION: Within OG specialty the transfer of doctors specialty training from IPVZ to UMS has been successfully managed. The NSB in OG specialty closely cooperates with past IPVZ and the Accreditation Commission of the Czech Ministry of Health. Thus continuity, quality and continuous enhancement of specialty training program in OG in Czech Republic is assured.

[HE4 a biomarker of ovarian cancer]. / HE4 - biomarker ovariálního karcinomu.

OBJECTIVE: Verification of the importance of determination of HE4 and calculation of ROMA index for increasing the efficiency of diagnosis of ovarian cancer in a population of Czech women. DESIGN: Prospective study. SETTING: Department of Gynaecology and Obstetrics, Faculty Hospital in Pilsen. METHODS: In the period from 06/24/2010 to 12/01/2011 was at the Department of Gynaecology and Obstetrics, University Hospital Pilsen examined 552 patients with abnormalities in the pelvis. Patients were divided into two groups. There were 30 women with histologically confirmed malignant ovarian tumors. Another 522 women had benign findings. According to the levels of FSH were women in both groups divided into premenopausal and postmenopausal. At all women were measured CA 125, HE4 and FSH. HE4 and CA125 were determined using the chemiluminescent device Architect 1000 (Abbott, USA), FSH chemiluminescent method on the device DXI 800 (Beckman Coulter, USA). At all premenopausal women was calculated ROMA1 index and at all postmenopausal women ROMA2 index. SAS statistical software 9.2 were used for all statistical calculations. RESULTS: The highest diagnostic efficiency was achieved by a combination of HE4 and CA125 markers with the calculation ROMA2 index for postmenopausal women. In determining of menopausal status according to the values of FSH cut-off for menopause 40 IU/L and cut-off at 26.4% for ROMA2 reaches ROMA2 sensitivity of 92.3%, specificity of 88.5% and PV- of 99.3%. If we reduce the cut-off for laboratory diagnosis of menopause using FSH at 22 IU/L, and cut-off for ROMA2 was 26.3% reaches ROMA2 sensitivity of 95.2%, specificity of 87.8% and PV- of 99.5%. CONCLUSION: HE4 in combination with CA125 and current ROMA index calculation is a suitable methodology to improve the detection of ovarian cancer.

[Comparison of selective oxidative stress parameters in the follicular fluid of infertile women and healthy fertile oocyte donors]. / Srovnání vybraných parametru oxidacního stresu ve folikulární tekutine u zen s poruchou plodnosti a u zdravých fertilních dárkyn oocytu

OBJECTIVE: Follicular fluid (FF) affects oocyte development and disruption of its homeostasis has a crucial effect on egg developmental potential. The aim of this study was to compare the levels of selected oxidative stress markers in the FF of women with impaired fertility and healthy fertile oocytes donors. DESIGN: A retrospective comparative study. SETTING: Faculty of Medicine in Pilsen, Charles University in Prague; Institute of Reproductive Medicine and Endocrinology, IVF Center Prof. Zech, Pilsen. METHODS: Levels of homocysteine (Hcy), malondialdehyde (MDA), glutathione peroxidase (GPx), total antioxidant capacity (AOK) and total protein (CB) were analyzed in the FF. We have analysed FF of 146 women - 74 infertile patients (mean age 31 years, SD = 4.65) and 72 healthy fertile oocyte donors (mean age 26 years, SD = 4.44). Only blood free samples were studied after pooling of all FF samples each patient. RESULTS: The study showed a statistically significantly higher Hcy levels (p < 0.0001) in the FF of healthy fertile women compared with impaired fertility group both - comparing the two groups regardless the age and in groups of the same age range (for the age group between 20 to 29 years isp = 0.0002, for the age group between 30 to 39 years is p < 0.0001). When divided into above age ranges we found statistically significantly higher levels of MDA in the control group aged 20 to 29 years compared to same age infertile patients (p = 0.0374) and statistically significantly higher AOK in infertile women between 30 to 39 years of age compared to same age control group (p = 0.0458). CONCLUSION: The presence or on the contrary the absence of prooxidant parameters in the FF has an important role in the ability of conception and subsequent embryo development.

[Perineal audit: reasons for more than one thousand episiotomies]. / Perineální audit: duvody pro více nez 1000 epiziotomií.

AIM: To analyze reasons for episiotomy use in vaginal delivery among obstetricians and midwives. Consecutively, to indentify disputable indications for its use based on published research in order to facilitate the decrease in frequency of this operation, while preserving high quality of obstetrical care. METHODS: Reasons for mediolateral episiotomy use were recorded by obstetricians and midwives after each vaginal delivery with episiotomy at the Ob&Gyn Department of the Charles University Hospital in Pilsen in the period of February 2006 - June 2007. The main reason and all reasons for episiotomy use were evaluated separately. RESULTS: The reason for episiotomy use was recorded in 1069 cases (93%) out of a total of 1150 vaginal deliveries, in which mediolateral episiotomy was performed (42% of all vaginal deliveries). The most common group of main reasons for episiotomy use was a concern about postpartum pelvic floor functional impairment (624, 58% of episiotomies), especially a rigid, non-elastic perineum (401, 37%). Fetal distress (181, 17%) and abnormalities of the expulsive forces/uncooperative parturient (109, 10%) followed. When evaluating all (including secondary) reasons, the most common groups of reasons for episiotomy use were the effort of pelvic floor functionality preservation (871, 50%), abnormalities of the expulsive forces/uncooperative parturient (354, 20%) and fetal distress (253, 15%). When evaluating episiotomies performed by obstetricians and midwives separately, the concern about postpartum pelvic floor functionality prevailed in midwives (81% vs. 39% of episiotomies performed primarily for this reason). Conversely, the obstetricians performed episiotomy more frequently for fetal distress (28% vs. 4%). CONCLUSION: In view of the fact that midwives attend only physiological deliveries in our department, the spectrum of reasons for episiotomy use among midwives is narrower and the concern about postpartum pelvic floor functionality dominates. Currently, the concern about postpartum pelvic floor functionality should not be considered a legitimate indication for episiotomy use. The fact that 624 (58%) episiotomies were performed for this reason represents a significant reserve for a decrease in the frequency of episiotomy use. The reduction should be possible primarily among midwives (81% of all main reasons for episiotomy use in the midwive group, i.e. 37% of all episiotomies performed). The analysis of reasons for episiotomy use is an important step in reduction of episiotomy rates while preserving or improving the standard of treatment provided.

History of incidence of autoimmune and oncological diseases in identical female twins.

PROBLEM: The aim of study was to investigate identical female twins born in 1977 suffered from autoimmune diseases (twin A - Sjogren's syndrome, and twin B - systemic lupus erythematosus). METHOD OF STUDY: It was refer retrospective analysis of both sisters suffered beside autoimmune alterations (Sjogren's syndrome and systemic lupus erythematosus) also from gynecological diseases (twin A - praecancerosis of cervix uteri, twin B - carcinoma vaginae). RESULTS: Relationships between disease activities and severities in the female twins were similar and the treatments were directed according to clinical symptoms and laboratory results. Dramatic change, unfortunately, occurred with twin B. The reason may be the association between SLE activity (lupus nephritis), hematological complication (leukopenia) and oncological vaginal recidivation. CONCLUSION: Association between autoimmune disease and gynecological cancer (or praecancerosis) is major risk than without immunology deviation. Twin A is periodically gynecologically observed.

Leukaemia inhibitory factor (LIF) gene mutations in women diagnosed with unexplained infertility and endometriosis have a negative impact on the IVF outcome. A pilot study.

The frequency of functionally relevant mutations of the leukaemia inhibitory factor (LIF) gene in infertile women is significantly enhanced in comparison with fertile controls. The objective of this retrospective cohort study was to evaluate the impact of LIF gene mutations on the outcome of the treatment in women with various causes of infertility. Fifteen infertile women with the G to A transition at position 3400 leading to the valine to methionine exchange at codon 64 were analysed. Group A was made up of women with diagnoses that are frequently accompanied by changes in humoral as well as cell-mediated immunity - idiopathic infertility and endometriosis (N = 7). Group B consisted of patients with polycystic ovary syndrome (PCOS), andrological factor, tubal factor and hyperprolactinaemia (N = 8). The control group comprised 136 infertile women with no LIF gene mutation diagnosed with idiopathic infertility and endometriosis (N = 37) (group C) and patients with PCOS, tubal and andrological factor (N = 99) (group D). Seven of the mutation-positive patients were successfully treated by in vitro fertilization (IVF), but nobody in this group was diagnosed with idiopathic infertility and only one with endometriosis, which means that there is a statistically significant difference in the pregnancy rates between groups A and B (P = 0.01, Fisher's 2 by 2 exact test) but no statistically significant difference when comparing patients with the LIF gene mutation (group A+B) to no LIF gene mutation (group C+D). The results suggest that in mutation-positive women the idiopathic infertility and endometriosis have a negative impact on the outcome of IVF treatment.

[Vascular complications of laparoscopic operations in gynaecology]. / Poranení velkých cév v gynekologické endoskopii.

OBJECTIVE: To provide information about vascular complications of laparoscopic operations in gynaecology. TYPE OF STUDY: Literature review and case reports. SETTING: Department of Gynaecology and Obstetrics, Medical faculty, Charles University, Pilsen. METHODS: Review of literature concerning vascular complications during laparoscopic operations in gynecology and case reports to illustrate the topic. CONCLUSION: Laparoscopic operations are benefiting for patiens. Vascular complications are rare, but their progression is often fatal even for young patients. When such complications occur, their quick treatment is crucial and co-operation with a anaesthesiologist and vascular surgeon is needed.

[How can the haematopoietic stem cells from the umbilical cord blood be de-differentiated in vitro? Our first results using the co-cultivation systems]. / Jak dediferencovat hematopoetické kmenové bunky z umbilikální krve in vitro? Nase první výsledky s pouzitím kokultivacních systému.

OBJECTIVE: Aim of this study was to de-differentiate the haematopoietic stem cells (HSCs) that originated from the umbilical cord blood. One of the ways to do it is to use a co-cultivation system. DESIGN: Prospective experimental study. SETTING: Laboratory study - Institute of reproductive medicine and endocrinology, Pilsen. METHODS: HSCs were co-cultivated with mouse embryonic stem cells (mESC) with and without feeder cells. After co-cultivation HSCs were analyzed using flow-cytometry for presence of haematopoietic markers (CD34, CD45, CD133) and using immunohistochemistry for presence of embryonic stem cell markers (SSEA-4, Tra-1-60, Tra-1-81). RESULTS: No de-differentiation was detectable in any our experiment, only the intensity of the HSC cell markers decreased. CONCLUSION: We suppose that there were two major reasons for the experiment failure: there was no direct cell to cell contact and there was a mixture of cell types that originated from two different species. To reach our goal of in vitro de-differentiation we will need to change our strategy towards a pure human culture system without any animal additives and with cell to cell contact.

[Are the antibodies against laminin-1 the signifikant marker of decreased fertility in women?]. / Jsou protilátky proti lamininu-1 významným markerem snízené plodnosti u zen?

OBJECTIVE: Study of antibodies against laminin-1 in IgG in patients with habitual abortion. DESIGN: Prospective study. METHODS: Commercial ELISA method for detection of IgG antibodies against laminin-1 in ovulatory cervical mucus, in sera in women with repeated spontaneous abortions, in sera in patients during spontaneous miscarriages. RESULTS: Positive levels of antibodies against laminine-1 in IgG in sera were found in patients during spontaneous abortions, as to ovulatory mucus of infertile women in time out of pregnancy, we did not find any positivity, only in one serum sample in patient with three pregnancy losses in her history. CONCLUSION: Antibodies against adhesive molecule as laminin-1 presents, can participate during diagnosis of repated spontaneous miscarriages in context of neuro-endocrinne-immune dysregulation, which is not seen during physiological pregnancy.

[Evaluation of the development of laparoscopically-assisted vaginal hysterectomy in the Czech Republic over the last 10 years based on the data of the National Registry of Gynecology Laparoscopy Complications]. / Hodnocení vývoje laparoskopicky asistované vaginální hysterektomie v CR za posledních 10 let na základe dat z Národního registru komplikací gynekologické laparoskopie.

OBJECTIVE: To survey the performance of laparoscopically assisted vaginal hysterectomy (LAVH) and other gynecologic laparoscopic operations performed in the Czech Republic. This series covers a period of 10 years, in which 23889 LAVH was performed. DESIGN: Retrospective study (Canadian Task Force classification II-3). METHODS: Two questionnaires were sent each year to more then one hundred of clinics performing laparoscopic gynecologic operations. RESULTS: In 2005, 52% of clinics responded with a total of 4062 LAVH operations. The most frequently reported indication for LAVH in 2005 were uterus myomatosus (58%), uterine bleeding (18%) and adnexectomy (9%). The overall complication rate in 2005 during LAVH was 6.,9% (n = 280), the rate of complications requiring laparotomy was 3.9% (n = 161). Increased experience with LAVH over last 10 years has had two consequences: a significant drop in the number of complications (14.7% in 1996 and 6.9% in 2005) and a drop in the mean time of duration of an operation (101 minutes in 1996 and 82 minutes in 2005). CONCLUSION: LAVH is replacing abdominal hysterectomy, which means significantly less discomfort and shorter hospital stay for patients.

Association of the leukemia inhibitory factor gene mutation and the antiphospholipid antibodies in the peripheral blood of infertile women.

To characterize the impact of the potentially functional mutation--the G to A transition at the position 3400 of the leukemia inhibitory factor (LIF; a pluripotent cytokine that plays a central role in the control of the embryo implantation) gene that leads to the exchange of valine with methionine at codon 64 we evaluated the association of the LIF gene mutation and the levels of antiphospolipid antibodies (aPLs) in the peripheral blood of infertile women (the aPLs examination was part of our routine immunological test during the infertility check-up). Eight infertile mutation-positive women were diagnosed with idiopathic infertility (n=5) and endometriosis (n=3) and their levels of aPLs in serum were compared with 115 infertile women without any LIF gene mutation. Enzyme-linked immunosorbent assay was used for the detection of seven antiphospholipid antibodies; the results were statistically assessed by the Fisher's 2 by 2 exact test to evaluate the association of the LIF gene mutations and aPLs in serum of infertile patients. The presence of aPLs was significantly higher in our study group (100%) than in 30% of aPLs-positives in control infertile patients (p = 0.0035) which indicates that the aPLs are elevated in women with LIF gene mutations.

[The impact of total abdominal and laparoscopically assisted vaginal hysterectomy on the development of urine incontinence]. / Vliv abdominální a laparoskopicky asistované vaginální gynek hysterektomie na mocovou inkontinenci.

OBJECTIVE: Evaluation of mutual relationship between different types of hysterectomy and urine incontinence. DESIGN: Retrospective comparative questionnaire study. SETTING: Department of Gynaecology and Obstetrics, Charles University and University Hospital Pilsen. METHODS: Questionnaire study of women which underwent total abdominal hysterectomy (TAH) or laparoscopically assisted vaginal hysterectomy (LAVH) for nonmalignant disease without prolapse between January 2001 and March 2003. RESULTS: The questionnare was sent to 286 patients who underwent the operation. 188 (67.6%) were completed and returned. 111 patients were after TAH and 77 after LAVH. 115 patients had no symptoms of incontinence preoperatively. In this group we revealed 20 (17%) patients with SUI a 5 (4%) patients with symptoms of urge incontinence after the operation. In the group of 73 patients with some type of UI preoperatively, 38 women registered improvement and 8 patients were permanently impaired after hysterectomy. SUMMARY: After hysterectomy, the continence status is often amended (both either positively or negatively). However, there was no difference between both types of operation. If woman had some type of incontinence preoperatively, this type of incontinence was not worsened after the operation. Contrary-wise, these women often registered improvement of their type of incontinence. Age, BMI and number of deliveries were not found statistically significant.

[The management of uterine fibroids: Czech and Slovak Gynecologic Endoscopy Working Group (CSGE) clinical practice guidelines]. / Management delozních myomu: CSGE doporucení k provádení spráivné klinické praxe.

OBJECTIVE: The objective of this paper is to give a guideline to the management of uterine fibroids. DESIGN: Review. SETTING: Czech Society Gynecological Endoscopic Working Group. MATERIAL AND METHOD: The bibliographic data from Medline were reviewed from 2003-2004 using the key words: fibroid--leiomyoma--uterine artery occlusion--hysterectomy--myomectomy. CONCLUSION: The clinical guideline was prepared after the analysed data were supplied using the material and criteria of Society of Obstetricians and Gynaecologists of Canada (SOGC) for the management of uterine fibroids.

Markers of oxidative stress in diabetic mothers and their infants during delivery.

Oxidative stress is probably a pathophysiological process leading to disadvantageous outcomes in diabetic pregnancies. We aimed to map a complex of potential markers of oxidative stress in this condition. Diabetic mothers had significantly higher concentrations of thiobarbituric acid reactive substances in the plasma [TBARS] both before (p<0.0001) and after (p<0.001) delivery and also their newborns showed higher values of TBARS (p<0.0001) in comparison with the control group. Diabetic mothers also showed lower concentrations of reduced glutathione in erythrocytes [GSH] both before (p<0.05) and after (p<0.01) delivery and their infants also had lower levels of GSH (p<0.0001). We found a lower total antioxidative capacity of plasma [AOC] before delivery (p<0.05) in the diabetic group in comparison with the control group. Newborns of diabetic mothers had higher plasmatic concentrations of apolipoproteine B [apo B] (p<0.05), higher erythrocyte glutathione peroxidase [GPx] activity (p<0.05) and lower pH (p<0.001) in the umbilical cord blood, when compared with infants of control non-diabetic mothers. We conclude that pregestational and gestational diabetes mellitus represent increased oxidative stress for both mother and her infant. TBARS in plasma are a valuable marker of oxidative stress in this condition. Disruption of glutathione peroxidase/glutathione pattern can be involved in pathophysiology of enhanced oxidative stress in diabetic pregnancies.

[Molecular diagnosis in pancreatic carcinoma]. / Príspevek k molekulární diagnostice pankreatického karcinomu.

Present diagnostic possibilities virtually do not make it possible to diagnose early stages of pancreatic cancer. Likewise, it is very difficult to differentiate between pancreatic cancer and chronic pancreatitis. The methods of visualization are insufficiently sensitive and the determination of certain genes could enrich our diagnostic opportunities. Considerable attention in this direction has been devoted to the determination and evaluation of the presence of oncogene K-ras. Our initial experience with the determination of K-ras in preparations from patients with pancreatic cancer or with chronic pancreatitis confirmed that K-ras in an oncomarker associated with adenocarcinoma of pancreas, whereas in patients with chronic pancreatitis it occurs in about 10% of the examined samples.

[Endometrial ablation and resection techniques]. / Techniky ablace a resekce endometria.

OBJECTIVE: To summarize all currently used and experimental, hysteroscopic and non-hysteroscopic methods of endometrial ablation and resection, their indications, operation techniques, and treatment results. DESIGN: Literary review. SETTING: Department of Obstetrics and Gynecology, Medical Faculty and Faculty Hospital, Charles university, Capkovo námestí 1, Plzen, Czech Republic. METHODS: Analysis of the literature (textbooks, medical journals, database Medline, Current Contents, Embase, PubMed). RESULTS AND CONCLUSION: Endometrial ablation and resection play an important role in the treatment of dysfunctional uterine bleeding. Hysteroscopic methods visualize the uterine cavity and enable to treat lesions in it at the same time. Non-hysteroscopic methods are less invasive for the patient and comfortable for the surgeon. Both groups of methods have similar treatment results.