Psoriasis vulvae.

OBJECTIVE: Case presentation, differential dia-gnostic, possible therapeutic procedure and a brief literature report. CASE REPORT: An 84-year-old woman was repeatedly examined for chronic extended dermatologic lesion on lower abdomen, external genitals, perianal region, groin and adjacent inner thighs. CONCLUSION: Neither colposcopy with dermatovenerologic consultation, nor histopathological examination led to a precise conclusion. Only a special dermatopathologic expertise showed a dia-gnosis of inverse psoriasis with suggested therapy.

Uterine perforation during intrauterine procedures and its management.

OBJECTIVE: Uterine perforation is a potential, not rare complication of all intrauterine procedures and may be associated with injury of surrounding organs and structures. The incidence, risk factors, possible prevention, dia-gnosis, management and impact on future reproduction is reviewed here. METHODS: Systematic review of available sources on the topic was carried out using the PubMed database and textbooks of Czech authors. CONCLUSION: Some risk factors that make access to the uterine cavity difficult may be prevented, however, others remain unpreventable. For patients in whom the perforation occurred during sondage, dilatation or insertion of blunt and cold instrument, without significant bleeding and who are hemodynamically stable, observation is recommended rather than immediate abdominal exploration. The exception are young women planning pregnancy in whom endoscopic suture is indicated. Abdominal exploration is required in patients who have been injured by electrosurgical or sharp device, laser, vacuum curette, who are hemodynamically unstable or show signs of severe bleeding or visceral injury.

Current data on the efficacy of prophylactic HPV vaccination in the primary prevention of cervical lesions.

OBJECTIVE: A review of current knowledge on the efficacy of HPV (human papillomavirus) HPV vaccination against pre-cancers and cervical cancer. METHODS AND RESULTS: HPV infection is probably the most common sexually transmitted disease and the cause of approximately 5% of all human cancers. Currently, three prophylactic vaccines against HPV infection are on the market: bivalent Cervarix, quadrivalent Gardasil (formerly Silgard) and nonavalent Gardasil9. The Czech Republic is one of the countries with a national vaccination program where HPV vaccination is covered by health insurance for girls and boys aged 13-14 years. Extensive scientific data on the efficacy of the vaccines clearly demonstrate significant efficacy against the development of cervical pre-cancers for all three vaccines. According to a high-certainty evidence of the Cochrane database, the efficacy of HPV vaccines against cervical intraepithelial neoplasia grade 2 or 3 associated with HPV 16, 18 compared with placebo in girls and women aged 15-26 is 99%. There is also moderate-certainty evidence that HPV vaccines reduce the risk of adenocarcinoma in situ for approximately 90% for the same population. Initial data also demonstrate a direct impact on reducing the incidence of invasive cervical cancer in vaccinated individuals. In addition, quadrivalent and nonavalent vaccines are highly effective in preventing genital warts. CONCLUSION: All three available prophylactic vaccines show high efficacy in preventing the development of cervical lesions. Efficacy is highest against lesions caused by vaccine genotypes and the highest efficacy is achieved in the HPV naive population.

[Anogenital HPV Infection as the Potential Risk Factor for Oropharyngeal Carcinoma]. / Anogenitální HPV infekce jako potenciální rizikový faktor orofaryngeálního karcinomu.

BACKGROUND: Human papillomavirus (HPV) can cause cervical, other genital, anal, head, and neck cancers. The incidence of oropharyngeal squamous cell carcinoma (OSCC), the head and neck cancer most commonly caused by HPV infection, is increasing. The prevalence of oral HPV infections is considerably lower than that of genital HPV infections; however, infection of both sites is strongly associated with sexual behavior. Although the natural histories of cervical and oral HPV infections do not markedly differ, the virus seems to rarely infect oral and genital sites simultaneously. On the other hand, the standardized incidence ratio of OSCC is higher in cervical cancer patients than in other populations. Furthermore, women with OSCC have a significantly increased risk of developing HPV-related genital cancers. Administration of the HPV vaccine to both genders will undoubtedly dramatically change the epidemiology of HPV-related cancers. AIM: This work provides an overview of the literature and estimates the risk of OSCC in women with anogenital HPV infections. CONCLUSION: The biological relationship between different HPV-infected sites might be complex; however, the increased prevalence of HPV in oral samples of women positive for anogenital HPV indicates that such infections are unlikely to be independent of one another. Sexual activity likely affects the risk of concurrent anogenital and oral coinfections. However, it is also possible that one infection site provides a reservoir that can increase the risk of autoinoculation at anatomically distant locations or that coinfections develop as a result of other factors, such as immunodeficiency. Nevertheless, women with HPV-associated malignancy undoubtedly have a higher risk of developing OSCC.Key words: human papillomavirus - HPV - genital HPV infection - oral HPV infection - oropharyngeal squamous cell carcinoma - standardized incidence ratio - head and neck cancer This article was supported by by the project UNCE 204065 of Charles University. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 26. 8. 2017Accepted: 4. 1. 2018.

[Contemporary possibilities of non-oral estrogen-progestin contraception]. / Soucasné moznosti non-orální estrogen-progestinové antikoncepce.

Besides the classic combined oral contraception (pill), there are alternative medical forms as transdermal contraception system, vaginal ring, intramuscular injections, and percutaneous gel, respectively. The mechanism of contraceptive effect is the same as well as they are the contraindications. The advantage of non-oral application is the elimination of the first-pass effect that enables reduction of doses, diminishing of undesirable side-effects and medical interactions, and only small effect on enzymatic systems associated with cytochrome P450. As the main advantage, comfort and better compliance of patients who have problems with daily use of tablets, is considered.

[The current staging for uterine body malignancies and its importance for clinical practice]. / Soucasný staging zhoubných nádoru delozního tela a jeho význam pro klinickou praxi.

Reliable staging system should facilitate prognosis assessment, decision on treatments, and evaluation of their outcomes. A good staging system must meet three basic characteristics: validity, reliability, and practicality. The purpose of such system is to offer classification of the extent and progress of gynaecological cancer that will allow the comparison of different treatment methods and the choice of optimal treatment for individual patients. The previously developed staging of gynaecological cancers has become outdated because it has not considered results of current medical research that allow refinement of prognostic subgroupings. Changes based on new findings were proposed for staging of uterine malignancies by the FIGO (The International Federation of Gynecology and Obstetrics) Committee on Gynecologic Oncology and approved by the FIGO Executive Board in 2008, and were published in 2009. Stage 0 was deleted, since it did not represent any stage of invasive tumor. Four fundamental changes were made in the staging system of endometrium carcinoma. The revised staging system for endometrium carcinoma divides patients to groups with similar prognosis; carcinosarcoma is staged identically. The novel system will facilitate exchange of relevant information between diverse oncological centers and thereby promote knowledge dissemination and stimulate research around the globe. A different staging system was proposed for adenosarcomas, leiomyosarcomas and endometrial stromal sarcomas. It is based on features used for the sarcomas of other soft tissues. The purpose of the text is to review current knowledge in this area.

The relationship between the cervical and anal HPV infection in women with cervical intraepithelial neoplasia.

BACKGROUND: More than 90% of cases of anal cancers are caused by high-risk human papillomavirus (HR HPV) infection and a history of cervical intraepithelial neoplasia (CIN) is established as possible risk factor. OBJECTIVES: To demonstrate relationship between anal and cervical HPV infection in women with different grades of CIN and microinvasive cervical cancer. STUDY DESIGN: A total of 272 women were enrolled in the study. The study group included 172 women who underwent conization for high-grade CIN or microinvasive cervical cancer. The control group consisted of 100 women with non-neoplastic gynecologic diseases or biopsy-confirmed CIN 1. All participants completed a questionnaire detailing their medical history and sexual risk factors and were subjected to anal and cervical HPV genotyping using Cobas and Lynear array HPV test. RESULTS: Cervical, anal, and concurrent cervical and anal HPV infections were detected in 82.6%, 48.3% and 42.4% of women in the study group, and in 28.0%, 26.0% and 8.0% of women in the control group, respectively. The prevalence of the HR HPV genotypes was higher in the study group and significantly increased with the severity of cervical lesion. Concurrent infections of the cervix and anus occurred 5.3-fold more often in the study group than in the control group. Any contact with the anus was the only significant risk factor for development of concurrent HPV infection. CONCLUSIONS: Concurrent anal and cervical HR HPV infection was found in nearly half of women with CIN 2+. The dominant genotype found in both anatomical locations was HPV 16. Any frequency and any type of contact with the anus were shown as the most important risk factor for concurrent HPV infection.

[Perspectives of male contraception]. / Perspektivy muzské antikoncepce.

The principle of suppressive methods of male contraception is to repress the sperm production and its functions by hormonal, chemical, physical, immunological or other ways. Of hormonal methods, the most perspective seems to be the steroid blockade of spermatogenesis. In horizon of ten years, it might be expected that the first male hormonal contraception will be available in form of injections or implants, however the "male pill" will not become a reality in the near future. Blockade of calcium channels by means of pharmacological inhibitors seems to be another promising mechanism of sperm functions inhibition. Based on the results of research of last two decades, the method of "reversible vasectomy" might be accessible, too.

[Significance of human papillomavirus infections]. / Význam infekcí zpusobených lidskými papilomaviry.

Human papillomavirus is one of the most frequent sexually transmitted diseases; more than three quarters of sexually active population are infected during their lifetime. Most of papillomavirus infections clear spontaneously, however persistent high-risk human papillomavirus 16 and 18 are responsible for over 70% of all cases of cervical cancer and related to a major part of cancers in the vulva, vagina, penis, anal region, and oropharynx. It is estimated that approximately 5.2% of all cancers are associated with oncogenic human papillomavirus infection.

[Sexually transmitted infections and spermicides]. / Sexuálne prenosné infekce a spermicidy.

Incidence of sexually transmitted infections (diseases) has been already increasing again for more than one decade; the world number of 125-340 millions of new cases a year is estimated. Fifteen thousands of new HIV-positive persons daily present a substantial contribution to the total amount. Besides an increasing number of unplanned pregnancies, the huge spreading of sexually transmitted infections predominantly of the second generation is the main reason for a renewed interest in search of local contraceptives, i.e. spermicides. An urgent need for a new, non-detergent, synthetic or natural spermicide emerged to replace the traditional nonoxynol-9. New preparation of microbicidal spermicide should offer dual protection against both unplanned conception and sexually transmitted infections.

Comparison of labor course and women's sexuality in planned and unplanned pregnancy.

OBJECTIVE: This study compares several parameters of sexual life and course of labor in women with planned and unplanned pregnancy. METHODS: 339 primiparas participated in our study; they filled in a questionnaire concerning their sexual life during pregnancy on the second or third day after the delivery. One question also stressed planning of pregnancy. 246 women (i.e., 72.6%) indicated planned pregnancy, 93 pregnancies (i.e., 27.4%) were not planned. RESULTS: Significant decrease of coital activity and number of orgasms and increase of sexual dysfunctions were observed in the whole study group during pregnancy. Significant differences between women with planned and unplanned pregnancy were observed only in frequency of vaginal dryness and pelvic pain. CONCLUSIONS: According to the results of this study, unplanned pregnancy has no adverse effect on parameters of the labor. The equal rate of partner's presence at delivery shows a high involvement of the partners of unmarried women.

Could a man be affected with carcinoma of cervix?--The first case of cervical carcinoma in trans-sexual person (FtM)--case report.

The article presents an unique case of trans-sexual person (FtM) with histological finding of pre-invasive cervical carcinoma after performed hysterectomy.