[Vulvar squamous precancerous lesions History and current state of the topic]. / Dlazdicobunecné prekancerózy vulvy Historie a soucasný stav problematiky.

This review article discribes the genesis and development of vulvar squamous precancerous lesions terminology and discusses the consensus of the International Society for the Study of Vulvovaginal Disease, the American Society for Colposcopy and Cervical Pathology, College of American Pathologists and the World Health Organization on the current terminology. The article describes the different types of vulvar squamous precancerous lesions, according to their etiology, incidence and malignant potential.

Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer.

OBJECTIVE: Evaluate prognostic significance of low volume disease detected in sentinel nodes (SN) of patients with early stages cervical cancer. Although pathologic ultrastaging of SN allows for identification of low volume disease, including micro-metastasis and isolated tumor cells (ITC), in up to 15% of cases, prognostic significance of these findings is unknown. METHODS: A total of 645 records from 8 centers were retrospectively reviewed. Enrolled in our study were patients with early-stage cervical cancer who had undergone surgical treatment including SN biopsy followed by pelvic lymphadenectomy and pathologic ultrastaging of SN. RESULTS: Macrometastasis, micrometastasis, and ITC were detected by SN ultrastaging in 14.7%, 10.1%, and 4.5% patients respectively. False negativity of SN ultrastaging reached 2.8%. The presence of ITC was not associated with significant risk, both for recurrence free survival and overall survival. Overall survival was significantly reduced in patients with macrometastasis and micrometastasis; hazard ratio for overall survival reached 6.85 (95% CI, 2.59-18.05) and 6.86 (95% CI, 2.09-22.61) respectively. Presence of micrometastasis was an independent prognostic factor for overall survival in a multivariable model. CONCLUSION: Presence of micrometastasis in SN in patients with early stage cervical cancer was associated with significant reduction of overall survival, which was equivalent to patients with macrometastasis. No prognostic significance was found for ITC. These data highlight the importance of SN biopsy and pathologic ultrastaging for the management of cervical cancer.

[Parametrial involvement in early stage cervical cancer patients with tumor less 2 cm: The myth or reality?]. / Postizení parametrií u pacientek s Casným stadiem cervikáIního karcinomu s velikostí nádoru do 2 cm: mýtus, nebo realita?

OBJECTIVE: The aim is review of studies exploring the relationship of parametrial involvement with other tumor-related factors (lymphovascular space invasion, depth of stromal invasion, status of sentinel lymph node) in early stage cervical cancer patients with tumor less than 2 cm. DESIGN: Review. SETTINGS: Department of Obstetrics and Gynaecology, University Hospital Ostrava. METHODS: Searching of the literature in database PubMed by combination of the key words: early stage, cervical cancer, parametrial involvement, parametrectomy. CONCLUSION: Based on literature review, the metastatic parametrial involvement in early-stage cervical cancer patients with tumor less than 2 cm and with other tumor-related factors is very rare. Before omitting of parametrectomy in these low-risk patients, these encouraging data must be confirmed in the prospective multicentric trials.

Gemcitabine and carboplatin treatment in patients with relapsing ovarian cancer.

Despite progress in primary treatment of patients with advanced ovarian cancer, the majority develop recurrence of the disease. A platinum salt treatment, either as monotherapy or in combination with another cytostatic agent, is indicated for patients who have relapsed 6 or more months after primary treatment and thus have platinum-sensitive relapse. Because repeated use of paclitaxel treatment may lead to substantial neurotoxicity, the combination of gemcitabine with carboplatin represents a suitable treatment option, which is widely used in common clinical practice in the Czech Republic and Slovakia. This non-interventional, prospective study observed the effectiveness and tolerability of second-line treatment with gemcitabine and carboplatin in patients with platinum-sensitive relapse of ovarian cancer in routine clinical practice. The primary endpoint was to evaluate the survival and secondary endpoints were to evaluate time to disease progression, objective tumor response rate, and treatment toxicity. Patients were enrolled to planned second-line treatment with gemcitabine and carboplatin (gemcitabine 1000 mg/m2 and carboplatin AUC 5 on Day 1, and gemcitabine 1000 mg/m2 on Day 8 of a 21-day cycle) for platinum-sensitive relapse of ovarian cancer as a part of routine clinical practice and followed for 12 months. The events (death, tumor progression), tumor response, and maximal grades of toxicity were recorded according to common clinical practice. Survival time (using Kaplan-Meier analysis) and objective tumor response rate were calculated using data forms, and a subgroup analysis was performed using log rank tests for time-to-event endpoints; p-values were also calculated. Response rates were calculated for the whole population; for the subgroups, the Fisher's exact test was performed and only p-values were calculated. Between January 2004 and June 2005, 53 patients were enrolled in the study. The median age was 57 years and 96% of patients had an Eastern Cooperative Oncology Group Performance Status (ECOG-PS) of 0 and 1 at baseline. Approximately 91% of patients were originally diagnosed with stage III or IV; 60% of patients had disease free intervals (DFIs) of 12 or more months from previous therapy, and the additional 40% less than 12 months. The 1-year survival rate was 83%. Median survival time was not determined within the 12-month period following the start of the treatment study due to the limited duration of follow-up. Objective tumour response rate was 67.3%. Most common reasons for discontinuation of therapy were "Planned treatment completed" (53%) and "Tumor progression" (11%). Most common toxicities were leukopenia, anaemia, neutropenia, and thrombocytopenia; grades 3 and 4 of these toxicity types did not exceed 30%. Febrile neutropenia was recorded in two patients. Most common non-haematological toxicities were nausea and vomiting, fatigue, and neuropathy; grades 3 and 4 of these were below 6%. Results on time to disease progression are not published due to inconsistent statistical analysis of reported data. Based on this observation from routine clinical practice, which corresponds with previously published results from controlled clinical trials, the gemcitabine and carboplatin combination seems to be a suitable therapeutic option for patients with platinum-sensitive relapse of ovarian cancer.

[Lymphatic mapping in cervical cancer]. / Lymfatické mapování u karcinomu cípku delozního.

BACKGROUND AND AIMS: The aim of the study is to analyze the feasibility of intraoperative sentinel lymph nodes (SLN) detection using gamma detection probe and blue dye in patients with cervical cancer. DESIGN AND SUBJECTS: Prospective clinical study. 106 patients with cervical cancer were included into the study in the period from May 2004 to November 2006. METHODS AND RESULTS: Patients were divided into three groups according to the tumor volume. Lymphoscintigraphy was performed following an injection of 99m Tc-labeled nanocolloid and intraoperatively the SLN were identified visually after marking of lymphatic vessels with blue dye and further detected using a handheld gamma detection probe. The SLN were histologically and immunohistochemically analyzed. Total number of 309 SLN with an average of 2.9 per patient were identified. The SLN detection rate was 94.3% per patient, 84.4 % per side, and depended on the tumor volume. Metastatic disease was detected in 39 patients (36.8%) and micrometastatic disease in 15 patients (14.2%). Sensitivity and negative predictive value calculated were 93.9% and 98.0%, false negative rate reached 5.1. CONCLUSIONS: Intraoperative detection of SLN using combination of technecium-99-labeled nanocolloid and blue dye represents a feasible, safe and accurate technique to identify lymphatic spreading in stages IA2-IB1 of cervical cancer.

[Sentinel node detection in early stage of cervical carcinoma using 99mTc-nanocolloid and blue dye]. / Detekce sentinelové uzliny u casných stadií cervikálního karcinomu kombinovanou metodou s uzitím nanokoloidu technecia Tc99 a patentní modri.

OBJECTIVE: The aim of the study was to analyse the feasibility of intraoperative sentinel lymph nodes (SLN) detection using gamma detection probe and blue dye in patients undergoing radical hysterectomy for treatment of early stage of cervical cancer. DESIGN: Prospective case observational study. METHODS: In the period from May 2004 to February 2006 77 patients with early stage of cervical cancer who underwent a radical surgery were included into the study. Patients were divided into three groups according to the tumour volume. First group consists of patients FIGO IA2 and FIGO IB1 with tumour diameter less than 2 cm, second group tumours FIGO IB1 with tumour diameter more than 2 cm and third group stadium IB2. SLN was detected by blue dye and Tc99. Preoperative lymphoscintigraphy was done after Tc99 colloid injection, intraoperative detection was performed by visual observation and by hand-held gamma-detection probe. SLN were histologically and immunohistochemically analysed. RESULTS: A total number of 2764 lymph nodes with an average 36 and 202 SLN with an average 2.6 were identified. The SLN detection rate was 94.8% per patient and 85.1% for the side of dissection and depends on the tumor volume. SLN were identified in obturator area in 48%, in external iliac area in 15%, in common iliac and internal iliac both in 9%, in interiliac region in 8%, in praesacral region in 6% and in parametrial area in 5%. Metastatic disease was detected in 31 patients (40.2%), metastatic involvement of SLN only in 12 patients (15.6%). False negative rate was 2.6%, sensitivity and negative predictive value calculated by patient were 923% and 95.7%. CONCLUSIONS: Intraoperative lymphatic mapping using combination of technecium-99-labeled nanocolloid and blue dye are feasible, safe and accurate techniques to identified SLN in early stage of cervical cancer.

Atypical cyst of the right ductus hepaticus.

Cystic dilatation is a rare disease of extra- or intra-hepatic bile ducts. According to the literature it is an disorder accompanying other diseases rather than an independent diagnosis. In the case of smaller dimensions it is often found by coincidence because of its asymptomatic course of development. Mostly it manifests itself through abdominal pain or icterus. The authors show a case report of 14-months old patient with the finding of a cyst in the right ductus hepaticus with extraordinary dimensions (Fig. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk

[Lymphatic mapping and detection of sentinel node in early stages of cervical carcinoma]. / Lymfatické mapováni a detekce sentinelové uzliny u casných stadií cervikálního karcinomu.

OBJECTIVE: The aim of the study was to analyse two methods of intraoperative sentinel node detection using blue dye and blue dye with Tc99 labeled tracer in early stage of the cervical cancer. DESIGN: Prospective case observational study. SETTING: Department of Obstetrics and Gynecology, University Hospital Ostrava. METHODS: From May 2004 to September 2005, 49 patients with cervical cancer who underwent a radical surgery were included into the study. Sentinel lymph node was detected using blue dye in the first group of 23 patients and by blue dye with Tc99 in the second group of 26 patients. Intraoperative sentinel node detection was performed by visual aspection in the first group, and by visual aspection and by hand-held gamma-probe in the second group. RESULTS: Patients were divided according to stage of the disease into three subgroups FIGO IA2, FIGO IB1 and FIGO IB2. A total number of 1561 lymph node with an average 32 and 94 SLN with an average 1.9 were identified. The specific detection rate per site was 63% in the first group and 80.8% in the second group respectively. Metastatic disease was detected in 26 patients (41%) and metastatic involvement of SLN only in 11 patients (17.4%). Sensitivity and negative predictive value were 100% in both groups, false negativity was 0%. CONCLUSION: Detection of SLN by combination of blue dye and Tc99 labeled tracer has a higher detection rate of SLN than detection by blue dye alone.

[Giant benign mucinous cystadenoma of both ovaries in early puerperium: case report and review of literature]. / Obrovský benigní mucinózní kystadenom obou ovarií v casném puerperiu: Popis prípadu a prehled literatury.

OBJECTIVE: A case report of giant bilateral benign cystadenoma after vaginal delivery. DESIGN: Case report. SETTINGS: Department of Obstetrics and Gynaecology, University Hospital Ostrava. SUBJECT OF STUDY: A 35-year-old woman twelve days after vaginal delivery was presented with symptoms of an acute abdomen. On ultrasonographic examination, the presence of a cyst filling the complete abdominal cavity. Bilateral cystic mass measuring 25 x 30 cm was removed by laparotomy. Subsequent histological examination revealed a benign mucinous cystadenoma. CONCLUSION: A case of giant mucinous cystadenoma is presented with clinical and pathological details. An ovarian cystadenoma was the cause of an acute abdomen in puerperium and led to clinical and therapeutic disconcerment.

[Hormone replacement therapy and ovarian tumors]. / Hormonální substitucní terapie a nádory ovaria.

OBJECTIVE: Analysis of risk and protective factors and hormone replacement therapy in the aethiology and pathogenesis of ovarian cancer. The role of hormone replacement therapy in the complex treatment in women with ovarian cancer is discussed. DESIGN: Reviewed article. SETTING: Department of Obstetrics and Gynaecology, University Hospital Ostrava. METHODS: Analysis of epidemiological studies. CONCLUSION: The role of hormone replacement therapy as a risk factor of ovarian cancer has not been confirmed. Hormone replacement therapy as a part of supportive and symptomatic therapy has been acceptable in a great deal of patients with ovarian cancer.

[Radical surgical therapy and role of adjuvant chemotherapy in ovarian tumors of borderline malignancy]. / Radikalita chirurgické lécby a postavení adjuvantní chemoterapie u nádoru ovaria hranicní malignity.

OBJECTIVE: Evaluation of the benefit of the radical surgical therapy in the assessment of prognostic factors and indication of adjuvant therapy in patients with borderline tumors of ovary. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Ostrava. METHODS: The group consists of 26 patients operated on our department, 12 of which underwent restaging operation after insufficient primary surgery in different hospital and 14 underwent primary surgery in our department. The average age was 42.9 years. RESULTS: Radical surgery with regional lymphadenectomy was performed in 18 cases (69%) and non-radical in 8 cases (31%). In 7 patients (27%) fertility preservation operation was done. According to histological results 19 tumors (73%) were of serous type, 7 being of mucinous type (27%). There were no other histological types in our group. The lymphnodes were positive in 4 cases (22%) out of 18. Eight patients were indicated for adjuvant chemotherapy (31%), 4 of them for regional lymphnodes positivity, 2 for peritoneal implants, 1 patient for tumor residuum. The last case was a patient with tumor duplicity of a borderline tumor of ovary stage FIGO IIC and corporal carcinoma stage FIGO IB. We had one case of recurrence after fertility preservation surgery. There was no case of pregnancy yet. CONCLUSIONS: Borderline tumors of ovary have good prognosis and low recurrence rate. In spite of that, there exists a group of women with higher risk of recurrence and disease progression which can be fatal. These patients may benefit from adjuvant therapy, which is indicated after evaluation of risk factors ideally acquired from the radical surgery.

[Human papillomavirus infection and cervical intraepithelial neoplasia]. / HPV infekce a cervikální intraepiteliální neoplázie.

OBJECTIVE: To determine the presence of high-risk, oncogenic types of HPV infection (HR HPV) and the presence of HPV 16 and 18 in various degrees of cervical and intraepithelial neoplasia. TYPE OF THE STUDY: A retrospective study. NAME AND ADDRESS OF THE INSTITUTION: Obstetrical-Gynecological Clinic, Faculty Hospital, Ostrava. METHODS: The study included 205 female patients indicated for conization due to cervical intraepithelial neoplasia. The conization was preceded by extended colposcopy, cytological samplings, HPV DNA test and a directed biopsy. HR HPV was examined in all patients, HPV 18 and 16, respectively, in 98 (48%) patients. Based on severity of histopathological findings the patients were divided into three groups, examined for positivity of oncogenic HPV types and the high risk HPV 18 and HPV 18 types, respectively. RESULTS: The histopathological findings from a total number of 205 conuses included five (2%) benign lesions, 85 (41%) CIN1, 77 (38%) CIN 2 and 38 (19%) CIN 3. Altogether the HR HPV was demonstrated in 143 (70%) patients. In patients with the benign lesion no HPV infection was detected. In patients with the CIN 1 finding the HR HPV infection was detected in 35 (41%) cases, in patients with CIN 2 in 70 (91%) cases and in patients with CIN 3 in 38 (100%) cases. HPV 16 was diagnosed in patients with the CIN 1 finding in 9 (23%) cases, HPV 16 in 5 (6%) cases and both types of the virus were present in two (2%) cases. In CIN 2, HPV 16 was positive in 17 (43%) and HPV 18 in 6 (8%) cases. In patients with CIN 3, HPV 18 was detected in 9 (53%) and HPV 18 in 2 (5%) patients. In all the women who underwent conization, HPV 16 infection was demonstrated in 17% and HPV 18 in 6% patients. In 19% of patients, the infection by at least one type of the virus was present and in two % both types of the virus were present. CONCLUSION: The presence of HR HPV rises with increasing severity of cervical intraepithelial neoplasia, HR HPV being detected in all cases suffering from CIN 3. The highest risk type HPV 16 was present with increasing rate in relation to the severity of cervical intraepithelial neoplasia, whereas no such trend was present in case of HPV 18.

[Care of the aged population]. / Problematika starostlivosti o starých obcanov.

Topical problems in the care of geriatric patients are presented. Qualified estimations suggest that subjects above 60 years of age represent more than one half of the daily clientele of a district physician. The basic characteristics of elderly people are their fragility, readily attained decompensation and diminished adaptability. Their hospitalization is thus demanding and involves risks. Geriatric patients require comprehensive care. Treatment without removing their social fears and psychic anxiety does not yield adequate effect. Active involvement of relatives into the program of care may prove a beneficial contribution. The main aim is to provide comprehensive health and social care primarily at the patient's home. (Ref. 10.)

Gastropleural fistula: an unusual cause of intractable postoperative nausea and vomiting.

Gastropleural fistula is an uncommon finding (1). Gastropleural fistulae have been reported after pulmonary resection (1), perforated paraesophageal hernia (2), perforated malignant gastric ulcer at the fundus, and gastric bypass operation for morbid obesity. We present a case of gastropleural fistula that resulted acutely from intractable postoperative nausea and vomiting after ambulatory knee arthroscopic surgery under general anesthesia.