Zoon vulvitis - a rare form of chronic inflammation of the vulva.

OBJECTIVE: Description of finding out rare disease Zoon vullvitis. Desing: Case report and differential diagnosis. SETTING: Department of Obstetric and Gynecology, University Hospital Ostrava. CASE REPORT: Zoon vulvitis or plasma cell vulvitis (PCV) belongs to extremely rare and often misdiagnosed inflammatory disease of the vulva. Lesions may look like shiny, sharply bordered , erythematosus patches or macular lesions. Less than 50 cases have been reported. This article is devoted to clinical findings, differential diagnosis and treatment of PCV. We present one clinical case with typical clinical and histopathological manifestations. Risk of dysplasia exists and long-term follow-up is desirable.

[Tubo-ovarian abscess in the 39th week of pregnancy (case report)]. / Tuboovariální absces ve 39. týdnu gravidity (kazuistika).

OBJECTIVE: A case of tubo-ovarian abscess in a patient with term pregnancy. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Nemocnice s poliklinikou Karviná Ráj. CASE REPORT: I hereby report a case of a patient in her 39th week of pregnancy hospitalized for abdominal pain and vomiting. Due to unclear aetiology and growing dynamics of inflammatory markers the ending of the pregnancy by induction of labour was indicated. Postpartum examination performed through computed tomography determines the cause of current problems. Conservative therapy of the diagnosed adnexal abscess, however, is insufficient. In the fourth postpartum day, the patient is indicated for surgical intervention and unilateral salpingo oophorectomy is performed. CONCLUSION: Even though rare during this period, some forms of clinical pelvic inflammatory disorders during pregnancy have to be taken into consideration. Timely and correct diagnosis combined with adequate therapy is of vital importance for reduction of perinatal and maternal mortality and morbidity.

[Folic acid and prevention of the neural tube defects]. / Kyselina listová a prevence rozstepových vad centrálního nervového systému.

OBJECTIVE: Overview of neural tube defect in relation to use of folic acid among fertile-age women. DESIGN: Review article. SETTING: Obstetrics and gynecology department OU and FN Ostrava. METHODS AND RESULTS: Neural tube defects (NTDs) are one of the most common birth defects in the Czech Republic. The relation between using of folic acid and decrease of the incidence NTDs was first described in 1965. Fertile-age women are not able to get enough folate from their diet, therefore right timing and proper dosing of folic acid is the object of numerous studies. Many countries started theirs food fortification programs because of the high percentage of unplanned pregnancies and often low compliance. CONCLUSION: The role of folic acid in prevention of NTDs is undeniable. Due to the large number of unplanned pregnancies long-term supplementation is recommended for all fertile-age women. If pregnancy is planned, the suplementation should begin at least one month before pregnancy. In both cases it is necessary to continue until the end of the week of 12. dosage should be individualized according to risk.

[Systemic enzyme therapy in the treatment of recurrent vulvovaginal candidiasis]. / Systémová enzymoterapie v lécbe recidivující vulvovaginální kandidózy.

OBJECTIVE: Phase I: A prospective evaluation of long-term systemic enzyme therapy (Wobenzym; WE) effects on the frequency of recurrent vulvovaginal candidiasis (RVVC) episodes. Phase II: A retrospective analysis of possible positive effects remaining in the next 3 years. TRIAL DESIGN: Original work - pilot project consisting of prospective phase I and retrospective phase II trials. METHODS: Composition of animal and plant proteo-lytic enzymes (WE) is a common component in the treatment of chronic or recurrent inflammatory diseases and has been also shown to have immunomodulatory effects. Project involving 7 gynecology practices has been started in 2005 - 2007 to evaluate the effectiveness of WE in the complex treatment of RVVC. The trial involved 62 women with at least 4 microscopically confirmed episodes of RVVC in the last 12 months (year 1; 4-9 episodes, mean 4.4 episodes per patient-year). From the beginning of the trial, participants took WE in the dose of 2× 8 tbl/day for 10 weeks and were monitored for 12 months (year +1). All infections of RVVC were treated according to usual practice of the particular gynecologist. The number of RVVC episodes during the year -1 was compared to the number of RVVC during the year +1. To evaluate possible long-term effects of the WE treatment, retrospective analysis of the data from 3 years following the phase I (year +2, +3, +4) was performed. Complete data for 54 women were collected (87.1% of the former group of patients). All data were processed with regular statistics methods. RESULTS: Mean number of RVVC in the year +1 has decreased from 4.4 to 0.5 per patient-year (i.e. by 88.5%; p < 0.001). All women experienced an improvement, 63% of them experienced no recurrence. The lower incidence of RVVC remained also for the phase II (year +2: 0.91; year +3: 0.57; year +4: 0.52 episodes of RVVC per patient-year). The difference, as compared to the mean incidence of RVVC before the treatment (year -1), remains significant (p < 0.001) although women, who became pregnant during the trial, were not excluded from the observed population. If only non-pregnant women were analyzed (41 women), the mean incidence of RVVC was even lower (year +2: 0.69; year +3: 0.39; year +4: 0.44 episodes of RVVC per patient-year). CONCLUSION: 10 weeks of systemic enzyme therapy (WE) in women with RVVC significantly reduced recurrence of this disease not only for the first year following the treatment, but also for the next 3 years. An explanation of the basis for this effect needs further research.

[Incidence of infection of newborns of GBS positive mothers in relation to peripartal antibiotic prophylaxis or mode of delivery]. / Výskyt infekcie u novorodencov SAG pozitívnych matiek v závislosti na peripartálnej antibiotickej profylaxii a spôsobe pôrodu.

OBJECTIVE: To evaluate the effectiveness of antibiotic prophylaxis given to GBS positive women in time of delivery on incidence of infection of their newborns. To find whether is the infection of the newborn correlated with the mode of delivery or with the length of PROM. DESIGN: Prospective cohort study. STUDY SAMPLE: Of all 6415 live born newborns born in between May 2010 to April 2011 at Faculty hospital Brno we selected only those whose mothers had positive GBS vaginal cultivation at time of delivery, which meant 1115 newborns. METHODS: We compared the incidence of complications resulting from infection between the newborns divided into groups based on time of administration of antibiotic prophylaxis (adequate, inadequate, none) or by mode of delivery (vaginal, cesarean without PROM, cesarean with PROM). RESULTS: In our 1115 newborns peripartal antibiotic prophylaxis was given adequately in 355 (31.84%) cases, inadequately in 609 (54.62%) cases, none was given in 151 (13.54%) cases. Vaginal delivery was in 869 (77,94%) cases, cesarean delivery with PROM in 146 (13.09%) cases, cesarean delivery without PROM in 100 (8.97%) cases. Complications due to infection was seen in 14 (1.26%) newborns, cultivation confirmation as GBS was in 2 (0.18%) newborns. There were no deaths of newborns according to the infection caused by GBS. CONCLUSION: Due to small amount of cases with GBS infection within our group we could not statistically prove the effect of antibiotic prophylaxis, nor could we associate our results with specific mode of delivery. The results seen in our study show an incidence of early-onset sepsis (regardless of agent) 2.18/1000 live born; invasive GBS sepsis: 0.31/1000 live born; GBS colonization of pregnant women 17.4%.

[Survey of contraceptive behaviour and attitude of Czech women towards different types of contraception]. / Antikoncepcní chování ceských zen: Výsledky národního výzkumu.

OBJECTIVE: Survey of contraceptive behaviour and attitude of Czech women towards different types of contraception. DESIGN: Representative survey. METHODS: Anonymous questionnaire survey of the sample of 1011 Czech women aged from 15 to 50. RESULTS: More than half of the women of our sample used some form of contraception during their first sexual intercourse. Most of the women used condom (41%), only a small part used hormonal contraception or withdrawal. Eighty percent of Czech women use some form of contraception with their stable partner, most often hormonal contraception (51%). One sixth of Czech women use condom. Using contraception is influenced mostly by age and religious belief: younger respondents show more responsible contraceptive behaviour at their first sexual intercourse, they use hormonal contraception with their stable partner more often. Furthermore, atheists protect themselves by some form of contraception more often than believers. The most used form is hormonal contraception. CONCLUSION: Czech women show responsible contraceptive behaviour during their heterosexual intercourse. There is a significant increase of using hormonal contraception.

[Knowledge of Czech and Romanian women about STIs. Representative survey]. / Informovanost ceských a rumunských zen o problematice pohlavne prenosných nemocí: Výsledky reprezentativních výzkumu.

OBJECTIVE: Survey of knowledge of Czech and Romanian women about STIs and their perception of sources of the information. DESIGN: Representative survey. METHODS: Anonymous questionnare survey of the sample of 1011 Czech and 1001 Romanian women aged 15 to 50. RESULTS: The doctor or the psychologist is considered to be the most reliable source of information about STIs, the Czech women prefer information from books and papers, Romanian women consider the close persons to be more better source of information than Czech women. The Czech women know better the realy effective methods of STI prevention and situations which are risky from the possible HIV/AIDS infection, Romanian ones more often believe in non effective methods of prevention and more often are afraid of situations, which are not dangerous and more often were not able to answer the questions at all. CONCLUSION: Romanian women have worse konwledge in the area of STIs than Czech ones. They are also more credulous to information from different sources, especially to those provided by experts or by close persons.

[Attitudes of Czech women toward induced abortions]. / Interrupcní chování a postoje k umelému prerusení tehotenství u ceských zen: výsledky národního výzkumu.

OBJECTIVE: Survey of attitudes of Czech women toward abortions. DESIGN: Representative survey. METHODS: Anonymous questionnare survey of the sample of 1011 Czech women aged 15 to 50. RESULTS: Number of induced abortions significantly increases with age; women with one or more children frequently undergo induced abortion; women using hormonal contraception have significantly less incidence of induced abortion in their case history; independently of age or place of residence Czech women have liberal attitudes towards the possibility for induced abortion, whereas the religious beliefs significantly increase the restrictive attitudes towards induced abortion. CONCLUSION: In spite of the very liberal attitudes of Czech women toward induced abortions their number is constantly decreasing--probably as a result of the increasing number of hormonal contraception users.

[Pre-eclampsia from the perspective of inter-professional collaboration]. / Preeklampsie z hlediska mezioborové spolupráce.

Preeclampsia-eclampsia is a syndrome which covers the area of influence belonging to gynecologists-obstetricians. However the internists, especially those who work as consultants in obstetric departments, are interested in diagnostics and therapy of this problem as well. Though internists working in the outdoor-departments do not face the problems of preeclampsia so often, it will be usefull to inform them about the latest trends in diagnostics and therapy ofthis syndrome, which may be very risky in pregnancy. The physicians in general (except the gynecologists) consider preeclampsia mostely as one form of hypertension that appears sometimes during gravidity and they do not realy appreciate the complex danger ofthis illness for the both, mother and child. The objective ofthis paper is to inform the general medical public, especially the internists and general practitioners about the modern view ofthe main problems of preeclampsia e.g. the pathogenesis, diagnostics and the up to day therapy of this high risky syndrome joined with pregnancy.

[Vaginal bacteriology in women with use of sanitary towels and tampons during menstruation]. / Bakteriologie pochvy u uzivatelek menstruacních vlozek a tamponu.

PURPOSE OF STUDY: Clinical study of peri-menstrual changes of vaginal environment in healthy fertile women after long-term use of sanitary towels (group A) or vaginal tampons (group B). TYPE OF STUDY: Prospective study. SEAT OF SITE: Centre of Outpatient Gynaecology Brno, Dept. of Obstetrics and Gynaecology, Masaryk Univesrity Brno. MATERIALS AND METHODS: The group consisted of 100 females with regular menstrual cycle without clinical and microbiological signs of vaginal inflammation or dysmicrobia for three months. In the perimenstrual period samples were taken three times from the ventral vaginal arch and sent for culture examination. A selected group of the females was also subject to culture examination of samples taken from the vulva 0.5 cm under the posterior comisure. RESULTS: Occurrence of ten most common bacteria and yeasts before beginning of menstruation was comparable in both groups. In the course of menstrual bleeding reproduction of bacteria in group B was lower and the vaginal environment return to normal after menstruation end was quicker in the same group. Significant differences between the two groups also included a higher occurrence of peptostreptococci, E. coli and enterococci during and after menstruation in group A women. CONCLUSION: Regular use of vaginal tampons during menstruation does not represent increased risk of disruption of the vaginal environment, effusions or recurring sexually transmitted infections.

[Insertion-deletion polymorphism in the gene for angiotensin-converning enzyme (I/D ACE) in pregnant women with gestational diabetes]. / Inzercne-delecní polymorfismus v genu pro angiotensin-konvertující enzym (I/D ACE) u tehotných s gestacním diabetem.

AIM OF THE STUDY: The aim of the study was to investigate possible associations of the Angiotensin-converting enzyme insertion/deletion (I/D ACE) polymorphism with gestational diabetes mellitus occurrence. METHODS: Number of 53 healthy pregnant women (controls) and 48 women with gestational diabetes mellitus were included in the study. The woman patients were hospitalised in the Clinic of Obstetrics and Gynaecology, Masaryk University Affiliated hospital Brno during the period 10/2004 - 10/2005. In all cases there was the spontaneous one baby pregnancy. The procedure was obtaining the peripheral blood samples from women of those two groups and isolation of their DNA using standard technique with the use of proteinase K. I/D ACE genotype of each person was determined using allele specific primers. RESULTS: We did not prove significant association neither of the genotype distribution (P(g)) P(g) = 0.115 nor allele frequency (P(a)) P(a) = 0.873 between controls and women with gestational diabetes mellitus. The significant differences of genotype distributions (P(g) = 0.03) were observed in women with two and more labours in anamnesis. Borderline significant differences of genotype distributions (P(g) = 0.08) were found in women with one and more abortions in anamnesis. CONCLUSIONS: According to our results the variability in ACE gene can be taken as factor contributing to manifestation of gestational diabetes mellitus. According to results of our study I/D ACE polymorphism can't be taken as genetic marker of gestational diabetes mellitus.

[Antithrombotic prophylaxis and treatment in thrombophilic disorders in gynaecology and obstetrics]. / Návrh antitrombotické profylaxe a péce o trombofilní stavy v gynekologii a porodnictví.

Pregnancy and puerperium are physiological thrombophilic condition and risk of venous thromboembolism in pregnancy is 4 - 6 fold higher. This risk is further increased in the presence of the additional risk factors. Inherited thrombophilia is well-defined risk factor for VTE in pregnancy and also can be the risk for obstetrics complications. So that early diagnostic of inherited thrombophilia can result in the decrease of risk of VTE and the obstetrics complications.

[Infection with Chlamydophila pneumoniae as a cause of female infertility of tubal origin?]. / Infekce Chlamydophila pneumoniae jako prícina neplodnosti zen tubárního puvodu?

OBJECTIVE: A contribution to the role of Chlamydophila pneumoniae in women from the IVF program. DESIGN: A serological study proving the antibodies against the antigens of Chlamydophila pneumoniae (C. pneumoniae) and Chlamydia trachomatis (C. trachomatis) in women from the IVF program suffering from different factor of infertility. SETTING: Veterinary Research Institute, Brno. METHODS: The complement fixation test with chlamydial antigen and ELISA tests proving IgA and IgG antibodies against genus-specific antigen (cLPS) and species-specific chlamydial major outer membrane protein (cMOMP) of C. trachomatis and C. pneumoniae in the blood serum of 32 females being in the fertilization program due the tubal factor infertility have been estimated and the results compared with those obtained in 26 females being in the fertilization program due the ovarian factor and in 42 female with andrological factor, respectively. RESULTS: The frequency of positive complement fixation test proved in the group of women with tubal factor infertility was significantly higher than in the groups with ovarial and andrological factor, respectively. The number of the strongly positive reactions (with high titres) in the group with tubal factor infertility was higher than in two remaining groups. The occurrence of species-specific IgG antibodies (anti-C. trachomatis) and chlamydia genus-specific IgA antibodies proved by means of ELISA in the group with tubal factor was statistically more frequent. The difference of the species-specific anti-C. pneumoniae antibodies in all three groups examined was not significant. The simultaneous occurrence of species-specific antibodies against anti-C. pneumoniae and C. trachomatis in the group with tubal factor was higher than in other groups (in comparing with the group with andrological factor statistically significant). CONCLUSION: The opinion of the authors being in agreement with the view of most specialists is that the most important agent in the pathogenesis of tubal factor fertility is C. trachomatis. C. pneumoniae is above all a respiratory pathogen with a high prevalence and its impact for fertility disorders may be in the synergismus with C. trachomatis. The serological examination of both chlamydial infections should be a standard part of diagnostic algorithm.

[Evidence of antibodies against the chlamydial heat shock protein (cHSP60) in women from "in vitro" fertilization program]. / Prukaz protilátek proti proteinu tepelného soku chlamydií (cHSP60) u zen zarazených do in vitro fertilizacního programu.

OBJECTIVE: A contribution to the role of chlamydial heat shock protein in women from the IVF program. DESIGN: A serological study proving the antibodies against the chlamydial heat shock protein. SETTING: Veterinary Research Institute, Brno, Department of Clinical Microbiology, and Centrum of Reproductive Medicine, Faculty Hospital Brno. METHODS: The IgG antibodies against the chlamydial heat shock protein (cHSP60) and the IgA and IgG antibodies against species specific chlamydial major outer membrane protein (cMOMP) of Chlamydia trachomatis (C. trachomatis) and Chlamydophila pneumoniae (C. pneumoniae) in the blood serum of 70 females being in the fertilization program due to fertility disorders (Group 1) have been estimated and the results compared with those obtained in 50 females suffering from pelvic inflammation disease (PID) (Group 2) and in 51 female blood donors (Group 3) respectively. RESULTS: The anti-cHSP60 antibodies have been ascertained as follows: in 26 women from the first group (37.1%), in 16 of the second group (32.0%) and in 12 (23.5%) of female blood donors. The anti cHSP60-antibody-occurrence and mean index of positivity as well, found in the groups examined, was statistically insignificant. Similarly no difference has been found in the occurrence of the species specific anti-cMOMP antibodies C. trachomatis and C. pneumoniae in the groups examined. The anti-cMOMP antibodies against C. trachomatis and simultaneously against C. pneumoniae have been detected in 21 from 171 women of all groups (12.3%), only against C. trachomatis in 9 (5.3%) and against C. pneumoniae in 73 of them (42.7%). There was considerably higher occurrence of the specific antibodies against C. trachomatis in women with a positive finding of antibodies against the cHSP60, especially in women suffering from gynecological disorders, than in women without such antibodies. CONCLUSION: C. trachomatis has a significant impact on the production of antibodies against the cHSP60. This fact can be documented by considerably higher occurrence of the specific antibodies against C. trachomatis in women with a positive finding of antibodies against the cHSP60, than in women without such antibodies. Preceding infection C. trachomatis and following sensitization with chlamydial heat shock protein indicate an unfavourable prognosis of the reproductive outcome and impairs the perspective of a successful in vitro fertilization. The proof of antibodies against the chlamydial HSP60 can be recommended as a further auxiliary criterion in women suffering from fertility disorders.

[Screening for factor V Leiden mutation in women using combined hormonal contraceptives or hormone replacement therapy]. / Vysetrování leidenské mutace (FVL--Leidenská mutace faktoru V) u zen v souvislosti s uzíváním kombinované hormonální kontracepce nebo hormonální substitucní lécby.

OBJECTIVE: Analysis of the issue of screening for Factor V Leiden mutation (FVL) in users of combined oral contraceptives (COC) or hormone replacement therapy (HRT). DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Charles University and General Faculty Hospital, Prague. METHODS: Review of published facts, analysis of possibilities to screen all users or to test risk groups in the current situation in the Czech Republic. CONCLUSION: 1) Screening for FVL in all COC or HRT users is not recommended mostly for economical reasons. 2) Testing for FVL is indicated in women with a positive family history of thromboembolic disease and in obese women, if they consider COC or HRT despite our recommendation or in case there is a medical indication. 3) Deep venous thrombosis or pulmonary embolism are absolute contraindications of COC or HRT regardless of the presence of FVL.