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The influence of reduced radicality of oncosurgical treatment on urogenital tract morbidity
Chmel, Roman ; Rob, Lukáš (advisor) ; Halaška, Michael (referee) ; Mlynček, Miloš (referee) ; Roztočil, Aleš (referee)
Cervical cancer is the fourth most common gynecological malignancy in Czech Republic. The incidence of cervical cancer in 2008 was 19.2/100000 (1021 women) and mortality reached 6/100000. Both radiotherapy and surgery have comparable results in the treatment of cervical cancer but surgical treatment is still the favoured modality especially in young female. Very succesful curability of early stages of this disease (88-97 %) based on individualized therapy currently leads to emphasize the quality of life increasing of treated women. Morbidity related to the treatment is connected with radicality of surgery. The dominant objective of the submitted study was prospective detection of preoperative and postoperative control over the micturition and urinary continence in 142 evaluated women who underwent nerve-sparing radical abdominal hysterectomy type C1, less radical surgery - laparoscopic pelvic lymphadenectomy and laparoscopic assisted vaginal hysterectomy type A or less radical fertility sparing surgery - laparoscopic pelvic lymphadenectomy and simple trachelectomy. Postoperative morbidity is connected with both pelvic lymphadenectomy and resection of the paracervix and proximal part of vagina with hypogastric nerve and inferior hypogastric plexus injury. The lower urinary tract function before and after the...
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Importance and methods of sentinel nodes identification in endometrial cancer
Hrehorčák, Martin ; Rob, Lukáš (advisor) ; Roztočil, Aleš (referee) ; Špaček, Jiří (referee) ; Masák, Ladislav (referee)
STRUCTURED ABSTRAKT Title: Importance and methods of sentinel nodes identification in endometrial cancer Author: Martin Hrehorčák Objective: To evaluace the results of tree different protocols of sentinel node identification in endometrial cancer. Design: Prospective observational study. Setting: Department of Obstetrics and Gyneacology, Charles University, 2nd Medical Faculty, University Hospital Motol, Prague, Czech republic. Methods: 141 women with verified endometrial cancer were included into the study. 10 subjects were excluded due to the duplicity with another malignit tumour, extrauterine spread and non- endometroid type of the tumour. Three different protocols for sentinel lymph node detection were described: Tc99 was applied hysteroscopically peritumorous in 22 women. Subserous peritumorous application of the radiocolloid and patent blue dye was performed in 66 women. Subserous diffuse injection of this combination to eight sites was performed in 43 subjects. Results: 2220 lymph nodes were harvested in 131 women, average 16.9 per subject. 215 sentinel lymph nodes in 91 women were obtained, average 2.36 per subject. Detection rate was 69.46. 63.4% sentinel nodes were identified in the external iliac area, 17.8% in supraobturator area, 8.9% in common iliac area, 4.25% in medial part of lateral...
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The Significance of Ultrasound Examination in the Management of Experimental Uterine transplantation
Matěcha, Jan ; Chmel, Roman (advisor) ; Zikán, Michal (referee) ; Roztočil, Aleš (referee)
The significance of ultrasound examination in the management of experimental uterine transplantation Abstract Uterine transplantation (UTx) represents a new experimental method of treatment of absolute uterine factor infertility (AUFI), which includes inability to conceive and deliver as a result of absence of the uterus. This can be congenital (Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS)) or acquired (after hysterectomy, severe congenital uterine malformations). For a woman affected this way is the uterine transplantation the only way to give birth to a child by herself. This is a very sophisticated and invasive procedure for the treatment of sterility with promising results, but the woman - recipient of the uterus - is burdened by at least three abdominal surgeries (transplantation, Caesarean section, explantation), in vitro fertilization and by the need to use immunosuppressive therapy. The dissertation summarizes current knowledge on this issue from the perspective of a gynecologist-obstetrician, who regularly examined by ultrasound or gynecologically participants in the Czech uterine transplant study in 2016-2019, which was carried out on the basis of a cooperation agreement between two Prague hospitals - IKEM and FN Motol. The set contains data on ten patients with a transplanted uterus, five from...
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The Use of Immune Markers in the Managament of Preterm Birth
Korečko, Vladimír ; Novotný, Zdeněk (advisor) ; Roztočil, Aleš (referee) ; Měchurová, Alena (referee)
Structured summary Aim of the study: To compare the diagnostic reliability, accuracy, and safety of amniocentesis and amniotic fluid Interleukin-6 testing in the diagnosis of intrauterine inflammation of patients with preterm premature rupture of membranes. Type of study: Prospective cohort study Name and location of study site: Department of Gynaecology and Obstetrics, Faculty of Medicine, Charles University in Pilsen Set and methodology: We prospectively examined patients with pPROM between the 23rd and 34th week of gestation in 2014 - 2017. All of them underwent amniocentesis and determination of IL-6 levels in amniotic fluid, leukocytes and bacteria in amniotic fluid as well as maternal blood examination for inflammation parameters. The results were compared to histological examination of the placenta after delivery for the presence of chorioamnionitis. Based on the values mentioned above the sensitivity, specificity, negative and positive predictive value, false positive and negative predictive value and accuracy of the test were determined together with an assessment of statistical significance. Furthermore, the feasibility and incidence of perioperative complications as well as the risk of secondary infection when pregnancy continued were evaluated by serial aniocenteses at weekly intervals. The...
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Delivery and the Pelvic Floor
Kališ, Vladimír ; Rokyta, Zdeněk (advisor) ; Martan, Alois (referee) ; Roztočil, Aleš (referee)
Vaginal Birth in Primiparas and Anal Incontinence Objective: An investigation of incidence and degree of anal incontinence after vaginal delivery among primiparas and characterizing of the risk factors Design: Prospective observational study Setting: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Pilsen, the Czech Republic Methods: 346 primiparas after consecutive vaginal delivery between 2000 and 2001 were included. All delivered in lithotomy position. Questionnaires were sent few days after delivery and then 2 and 6-9 months later. Analysis of returned questionnaires. 28 obstetric parameteres assessed. Results: 46.5% women responded. 23 women registered leakage of flatus before delivery. Two months postpartum 1 (0.6%) patient reported fecal incontinence and 22 (14.3%) flatus incontinence de novo or impaired already present incontinence. 6-9 months after delivery the same patient (0.6%) reported fecal incontinence and 16 women (10.4%) incontinence of flatus. 10 of them felt impaired quality of life. Anal incontinence gradually improved during the time (in 76%). Risk factors of developing (worsening) of anal incontinence were antenatal anal incontinence (in two months period) and women weight (or BMI) meassured at 6-9 months after birth. None of nine patients after forceps...
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Obstetric interventions and pelvic floor disorders
Rušavý, Zdeněk ; Kališ, Vladimír (advisor) ; Roztočil, Aleš (referee) ; Mašata, Jaromír (referee)
Obstetric interventions and pelvic floor disorders - Abstract One of the principal objectives of obstetric interventions in the second stage of labor is prevention of pelvic floor trauma and associated pelvic floor disorders. The most commonly used and also most frequently discussed interventions are manual perineal protection and episiotomy. The majority of pelvic floor disorders are of subjective nature. Therefore, tools for objectification and severity quantification of these disorders are the key to reliable comparison and identification of the most effective interventions. The aim of the dissertation was to find the most effective modification of manual perineal protection, to compare two frequently used types of episiotomy regarding all pelvic floor disorders and finally to find a consensus on the most suitable instrument for anal incontinence severity assessment. Our studies concerning manual perineal protection experimentally described the direction and extent of perineal deformation during vaginal delivery. The subsequent studies on biomechanical model demonstrated that the most effective method of manual perineal protection in peak perineal strain reduction is when the fingers are placed on the perineum 6 cm laterally and 2 cm ventrally from the posterior commissure at both sides and are...
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The Utilization of the Molecular-Biology Method One-Step Nucleic Acid Amplification (OSNA) for Examination of Sentinel Lymph Nodes in Endometrial Cancer Patients
Kosťun, Jan ; Presl, Jiří (advisor) ; Fínek, Jindřich (referee) ; Roztočil, Aleš (referee)
Hypothesis The One-Step Nucleic Acid Amplification method could represent an effective intraoperative tool for detection of metastatic involvement of lymphatic nodes on the level of ultrastaging in endometrial cancer patients. Objective Utilization of the One-Step Nucleic Acid Amplification (OSNA) molecular biology method for the detection of the micrometastatic and macrometastatic involvement of sentinel lymph nodes in endometrial cancer patients. The objective is a comparison with the conclusion of the histopathological ultrastaging of sentinel lymph nodes and a description of the clinical consequences of this method. Methods Patients indicated for the surgical treatment of endometrial cancer underwent the detection of sentinel lymph nodes that was executed using the intracervical application of a tracer. Nodes larger than 5 mm were cut into sections 2 mm thick parallel to the short axis of the node. Odd sections were examined using the OSNA method, while even ones were examined by hematoxylin and eosin (H&E) and immunohistochemical examination to detect cytokeratin 19 antibody (IHC CK19) based on an ultrastaging-relevant protocol. Nodes of the size of 5 mm and smaller were divided into halves along the longitudinal axis with one half being examined using the OSNA method and the other half by...
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The role of sentinel lymph node biopsy in the management of patients with early-stage cervical cancer
Kocián, Roman ; Cibula, David (advisor) ; Roztočil, Aleš (referee) ; Špaček, Jiří (referee)
The sentinel lymph node biopsy is part of recommended surgical staging guidelines in patients with early stages of cervical cancer. High success rates of bilateral detection of SLN are achieved in sites with adequate experience with this procedure. The sentinel lymph node biopsy without systematic pelvic lymph node dissection is currently considered inadequate procedure for stages IB to IIA of the disease. One of the benefits of sentinel lymph node detection is extensive histopathological examination using the ultrastaging protocol enabling detection of small metastases (i.e. micrometastases). At the moment, there is lack of evidence about oncological safety of sentinel lymph node biopsy which might replace systematic lymph node dissection in the future. Prognostic significance of micrometastases is also controversial due to the lack of data about their potential presence in non-sentinel lymph nodes in cases with negative sentinel lymph nodes. This dissertation deals with the concept of sentinel lymph node biopsy in the cervical cancer and focuses on several topics. We have shown that the presence of micrometastasis is associated with significant negative impact on patients' prognosis on the largest retrospective cohort of patients ever published. Only 67% of patients with micrometastasis have...
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Antibiotic prophylaxis of extensive obstetric perineal injuries repair
Menzlová, Erika ; Záhumenský, Jozef (advisor) ; Procházka, Martin (referee) ; Roztočil, Aleš (referee)
Objective Our aim was to compare two regimens of antibiotic prophylaxis at the time of repair of obstetric anal sphincter injury. Benefit of long regimen of antibiotic prophylaxis in comparison with short regimen of antibiotic administration haven't been till now proven. Material and Methods Women who gave vaginal birth in department of gynaecology and obstetrics of the First Faculty of Medicine of Charles University and Hospital Bulovka from 1.1.2008 to 30.6.2013 and who sustained third - or fourth - degree perineal tears have been enrolled in our trial. All women who fulfilled trial criteria received at the time of repair antibiotic prophylaxis which was cefuroxim (second - generation cephalosporin). This antibiotic has good sensitivity to vaginal gram-positive flora and to rectal gram-negative microorganisms too. Suture technique and following postpartum care have been standardized. All enrolled women were checked 2 weeks and 3 months after delivery. We evaluated subjective and objective parameters of healing of the obstetric perineal injury and 3 months postpartum we looked for symptomps regarding anal incontinence. The Manchester questionnaire was used for evaluation of anal incontince occurance. Results Incidence of third - and fourth - degree perineal tears was 1,4 % during period of our...
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The Utilization of the Molecular-Biology Method One-Step Nucleic Acid Amplification (OSNA) for Examination of Sentinel Lymph Nodes in Endometrial Cancer Patients
Kosťun, Jan ; Presl, Jiří (advisor) ; Fínek, Jindřich (referee) ; Roztočil, Aleš (referee)
Hypothesis The One-Step Nucleic Acid Amplification method could represent an effective intraoperative tool for detection of metastatic involvement of lymphatic nodes on the level of ultrastaging in endometrial cancer patients. Objective Utilization of the One-Step Nucleic Acid Amplification (OSNA) molecular biology method for the detection of the micrometastatic and macrometastatic involvement of sentinel lymph nodes in endometrial cancer patients. The objective is a comparison with the conclusion of the histopathological ultrastaging of sentinel lymph nodes and a description of the clinical consequences of this method. Methods Patients indicated for the surgical treatment of endometrial cancer underwent the detection of sentinel lymph nodes that was executed using the intracervical application of a tracer. Nodes larger than 5 mm were cut into sections 2 mm thick parallel to the short axis of the node. Odd sections were examined using the OSNA method, while even ones were examined by hematoxylin and eosin (H&E) and immunohistochemical examination to detect cytokeratin 19 antibody (IHC CK19) based on an ultrastaging-relevant protocol. Nodes of the size of 5 mm and smaller were divided into halves along the longitudinal axis with one half being examined using the OSNA method and the other half by...
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