[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.

[Lymphedema after vulvar cancer surgery. A prospective study]. / Lymfedémy po operacích karcinomu vulvy. Prospektivní studie.

INTRODUCTION: Prospective detection of postoperative lymphedema of the lower limbs (LLL) in patients after surgery for vulvar cancer using different examination methods and their comparison. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynecology, 2nd Medical Faculty of the Charles University and University Hospital Motol, Prague. METHODS: Totally 36 women were followed after surgery for vulvar cancer. Due to the radicality of surgery the patients were divided into conservative (sentinel lymph node biopsy) and radical (inguinofemoral lymphadenectomy) group. Lower limbs were preoperatively and 3, 6 and 12 months after surgery assessed for the presence of lymphedema by measuring of circumferences, multifrequency bioelectrical impedance analysis (MFBIA) and subjective evaluation of patients. RESULTS: The prevalence of lower limb lymphedema 12 months after surgery diagnosed by subjective evaluation reached 19,44%, by circumference measurement 38,89% and with MFBIA 66,67%. The prevalence of lymphedema after inguinofemoral lymphadenectomy diagnosed by circumference measurement was in 12 months after surgery higher (45.83%) than after the conservative surgery (25%). Risk factors were evaluated 12 months after surgery (age, BMI, adjuvant radiotherapy, type of surgery) and none of them were found to be statistically significant for the development of the lower limbs lymphedema. CONCLUSION: The prevalence of lymphedema significantly depends on the diagnostic method, because they capture lymphedema in its various stages. Due to the high sensitivity MFBIA can be used for the detection of early stages of lymphedema. Preoperative measurement of the lower limbs is important for early detection of postoperative lymphedema.

[A comparison of different types of suburethral slings in the treatment of urinary incontinence in geriatric patients]. / Srovnání ruzných typu pásek v lécbe inkontinence moci u gerontologických pacientek.

OBJECTIVE: Comparison of different types of tension free tapes in the treatment of urinary incontinence in institutionalized elderly patients. DESIGN: Prospective randomized study. SETTING: Charles University in Prague, 1st Medical Faculty and Hospital Bulovka, Department of Obstetrics and Gynaecology, Prague. METHODS: 43 patients of several gerontologic centres with prevailing stress urinary incontinence were included based on urinary dysfunction specific questionnaire (ICIQ) and cognitive functions objective estimation (MMSE). Three types of tapes, TVT-O, MiniArc and Ajust were used and patients were randomized into the groups and after an urogynaecologic examination, incl. ultrasound the operation was performed. RESULTS: The groups were - except of the age of the patients of group MiniArc - well outweighted concerning demographic parameters. High success rate of all techniques used evaluated by the QoL questionnaires was in all the groups comparable. No case of bleeding, bladder injury or postoperative pain was found. Higher frequency of OAB de novo and worsening of preexisting symptomatics could be explained by general very high prevalence of OAB in the elderly even without the operation. In whole our cohort only 1 case of failure to treat and of tape exposure was found. Our results confirming high success rate of all the types also in elderly and institutionalized patients are in consent with sporadic published data. CONCLUSION: Surgical treatment of cases of stress and mixed urinary incontinence is also in cases of elderly polymorbid nurcing facilities clients with regard to the high success rate. Secondary outcome of our report when accepting the conclusion is drop of the costs of antiincontinence pads thus having a significant economic effect.

[Prolene mesh comparing with sacrospinal fixation in the treatment of genital prolapse in women. Prospective multicentre randomized study]. / Alogenni prolenové implantáty ve srovnání se sakrospinální fixací v lécbe prolapsu; randomizovaná multicentrická prospektivní srovnávací studie.

OBJECTIVE: Polypropylene mesh in the treatment of genital prolapse in women was introduced at the turn of the millennium with the rationale of decreasing surgical invasiveness, reinforcing weak tissues and to possibly complement insufficient surgical techniques. Prospective randomized studies comparing traditional and modern operations are lacking. SUBJECT: Prospective multicentre randomized study. SETTING: Department of Obstetrics and Gynaecology, The First Faculty of Medicine, Charles University in Prague. SUBJECT AND METHOD: A prospective multicentre trial was approved by the Ministry of Health of the Czech Republic and registered with the FDA planning to recruit 500 patients with vaginal prolapse, 18 years of age and over, undergoing surgery at 5 major urogynaecologic centres. The patients were divided into three groups according to prolapse predominance. The surgical techniques used were: anterior and posterior prolift, and randomly allocated total prolift or sacrospinous fixation. The examination setup included lower urinary tract ultrasound, MRI, POP-Q assessment and QoL questionnaires before surgery and six and 24 month after the surgery. CONCLUSION: Preliminary analysis of partial data of 225 women showed an acceptable rate of complications and a better success rate in the mesh groups, whereas operation time and blood loss was lower in the classical operation group. Quality of life questionnaires documented that all the methods used have comparably good results. The surgical techniques used are acceptable methods for pelvic organ prolapse repair with low complication rates and excellent impact on the subjective perception of the patient's quality of life.

[Bioimpedance analysis--a new method in prediction and early detection of ovarian hyperstimulation syndrome?]. / Analýza bioimpedance--nová metoda v predikci ovariálního hyperstimulacního syndromu?

OBJECTIVE: The aim of the study was to establish a new method of the multiple-frequency bioimpedance analysis (MFBIA) for patients with controlled ovarian hyperstimulation (COH) and to determine the significance of this method in prediction and early diagnosis of severe forms of ovarian hyperstimulation syndrome (OHSS). DESIGN: Prospective case control study. SETTING: Department of Obstetrics and Gynecology, 2nd Medical Faculty, Charles University and University Hospital Motol, Prague. METHODS: 53 patients were recruited into the case control study. The surface body impedances for the frequencies of the current 1, 5, 50 and 100 kHz were measured. Study group included 13 patients with developed OHSS grade III.-V. according Golans classification. The control group included 40 women undergoing COH without developed OHSS. Measurements of impedances were performed by MFBIA device. RESULTS: The decrease of the values of impedance between the day of oocyte retrieval and the day of embryotransfer significantly increases relative risk of OHSS grade III.-V. development. The best correlation was found for the frequency of 5 kHz (9.08 p<0.0001). The study suggests, the predictive value of MFBIA in OHSS development might be higher than the number of retrieved oocytes (>20 oocytes-RR 5,71). CONCLUSION: Patients in risk of OHSS development are those with decreasing impedances. The highest predictive value of OHSS development is for the impedances at frequency of 5 kHz. Greater multicenter studies should be done to confirm our preliminary results.

[Detection of postoperative lymphoedema in patients with breast cancer]. / Detekce pooperacního lymfedému u pacientek s karcinomem prsu.

OBJECTIVE: Lymphoedema is a severe postoperative complication after treatment of many malignancies. It is a pathological accumulation of extracellular water (ECW). Early diagnostic tool is needed. Multifrequency bioimpedance analysis (MFBIA) is a method for detection of changes in ECW. TYPE OF STUDY: Prospective study. SETTING: Dept. of Obstetrics and Gynaecology of the 2nd Medical Faculty, Charles University, Prague. METHODS: We measured a control group of 72 women and a group of 74 patients undergoing a breast cancer surgery during 18 month after the surgery by MFBIA and circumferency. Characteristics of the patients were recorded. The detection of lymphoedema was done using MFBIA, circumferency measurement and upon the symptoms of the patients. RESULTS: The average age in the controll and tested group was 40,1 and 58,9 years. The average size of the tumour, grade and positivity if oestrogen receptors was 15,1 mm, 2,04 and 43%. In 23 patients (21%) complete lymphadenectomy was performed, in 51 patients (79%) a detection of sentinel lymph node was performed. Lymphoedema was detected in 8 women (11%). In these patients MFBIA detected lymphoedema 9 month earlier in total than other methods. CONCLUSION: MFBIA is a low-cost and precise method for the detection od early stage postoperative lymphoedema. We recommend to incorporate MFBIA into standard dispensatory plan of every patient combined with circumferency measurement.

Lipid-protein complexes as cholesterol pronucleating agents in human bile.

Among the various substances which accelerate the formation of cholesterol crystals in cholesterol supersaturated bile are proteins obtained from the bile by affinity chromatography on con A-Sepharose. Several such con A binding proteins have been identified and shown to mediate acceleration of cholesterol crystal formation in vitro. However, the major protein fraction, which does not bind con A, has been studied rarely. Investigation of the effect of this latter bile protein fraction on cholesterol crystallization is the aim of this study. Contrary to results published to date, the con A nonbinding protein fraction exerted a higher cholesterol crystallization promoting activity than the con A binding fraction. Delipidation as well as proteolytic degradation sharply decreased the activity of both fractions. Albumin was identified as the main component of the con A nonbinding fraction. A lipid-protein complex formed from the lipid and albumin possessed a very high cholesterol crystallization promoting activity whereas albumin or the lipid alone showed much lower activity. Bivalent ions, especially Mn2+ and Ca2+, increased the promoting activity of the lipid-protein complex. Thus, albumin and other bile protein can bind noncovalently biliary lipid material and such lipid-protein complexes may act as the main cholesterol crystallization promoter in the human bile.