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Novel treatment modalities for pelvic floor dysfunction
Macková, Kateřina ; Krofta, Ladislav (advisor) ; Džupová, Olga (referee) ; Čelko, Alexander (referee)
We aimed to test selected novel treatment modalities for pelvic floor dysfunctions and genitourinary syndrome of menopause. Both conditions are common in female, they negatively affect their quality of life, and current treatment options are not optimal. We started our research with an extensive literature search. First, we summarized the information on animal models for, and the utility they may have in the investigation of the pathophysiology of POP and novel therapies. We systematically searched 7426 articles from which 51 fulfilled the inclusion criteria. From all screened animals, only the non-human primate develops POP spontaneously, however their use is controversial. We concluded that many studies have methodological shortcomings and lack standardization in reporting outcomes. Also, several other animals can be used as a model of surgery for POP, each of them with different purposes. For our later research we chose the rat model to simulate POP repair with synthetic mesh. We also systematically reviewed the literature on the objective effects of non-ablative Er:YAG LASER on the skin and vaginal wall. We identified 7187 articles of which we included 15 in our review, including four that tested Er:YAG LASER on vaginal tissue. Er:YAG LASER energy induces measurable changes in the deeper skin...
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Multiple Sclerosis and Pregnancy
Hanulíková, Petra ; Rob, Lukáš (advisor) ; Binder, Tomáš (referee) ; Krofta, Ladislav (referee)
Introduction: Multiple sclerosis (MS) is an autoimmune disorder of the CNS that typically affects young women of childbearing age. Due to the international published data, safety for pregnant women with MS can be assumed. However, no study has been published in the Czech Republic to address the effect of MS on pregnancy and perinatal outcomes. Objective: Analysis of the clinical course of patients with MS during and after pregnancy, and perinatal outcomes in comparison with healthy pregnant women. Methods: A single centre prospective observational study in the period 2006-2015 was conducted. Complete data from 68 patients with MS were analyzed (85 deliveries) and were compared with a control cohort of 68 age- and parity - matched healthy pregnancies. Results: The comparison between relapse rate and EDSS before, during and after delivery showed no statistically significant difference (relapse in 7.4% and 9.5%, EDSS 1.27 and 1.49). Perinatal outcomes were comparable in both cohorts. The weight of newborns differed by 159 g, (p = 0.295), complications in pregnancy were represented in 16.2% in the group with MS and in 27.9% in controls (p = 0.295), caesarean section was performed in 16.2% in patients with MS and in 23.5% of controls (p = 0.629), 79.4% of patients with MS were breast-feeding. In the MS...
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Effect of hysterotomy suture techniques after cesarean on its healing
Hanáček, Jiří ; Krofta, Ladislav (advisor) ; Ľubušký, Marek (referee) ; Kacerovská Musilová, Ivana (referee)
Introduction: This prospective randomised study compared healing of the scars after cesarean section during the first postpartum year using a single or double layer suturing technique. Material and methods: Women with uncomplicated singleton pregnancies indicated for elective or acute cesarean section were randomly allocated to the uterine closure technique group. During the first postpartum year, their lower uterine segment was examined with a transvaginal ultrasound in 3 consecutive visits at 6 weeks, 6 months, and 12 months. Results: 324 women had the 12 months visit, out of these 149 underwent single layer closure of the uterine incision, 175 underwent double-layer technique. A higher proportion of the defects is seen in the single layer closure technique of suturing. Defects in the single layer group were wider (0.002) and the residual myometrial thickness in the single layer group were thinner (0.019). Women who underwent cesarean section at the stage of full cervical dilation had scars that were closer to the external cervical os (0.000). Conclusions: The findings of this study demonstrate that double layer technique with the first continuous nonlocking suture followed by a second continuous nonlocking suture is associated with better suture healing and greater residual myometrial thickness.
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Modern technologies in the assessment and treatment of pelvic organ prolapse - experimental and clinical studies
Urbánková, Iva ; Krofta, Ladislav (advisor) ; Mašata, Jaromír (referee) ; Kachlík, David (referee)
This project has shown that pelvic organ prolapse is linked with maternal age and delivery-related injuries. Up to every eight women may have a symptomatic prolapse already one year after their first delivery. Moreover, those with muscle injury have a higher short-term risk of pelvic organ prolapse development. To improve our knowledge we further explored the potential of an ovine model for prolapse and vaginal surgery. We showed that many anatomical and morphological features and vaginal wall changes induced by specific lifespan factors (first delivery, artificial menopause, and hormonal replacement) are similar to what is observed in women. We further used this model for testing novel implants and mesh visualization techniques. We believe that the ovine model can be used in future research on pelvic organ prolapse pathophysiology and novel treatment modalities.t
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Variation of abnormalities of foramen obturatum and retropubic space and its relation to complications of tape surgery
Hubka, Petr ; Mašata, Jaromír (advisor) ; Smetana, Karel (referee) ; Krofta, Ladislav (referee)
Introduction: The knowledge of anatomy is crucial for introduction of new surgical methods. It is also of especial use while dealing with surgical complications during surgeries with limited surgical field, where the way of approach limits the management of complications. It was assumed that common anatomical variations would influence different efficacy of surgeries and would explain potential complications. Methods: During anatomical dissections fifty female cadavers were dissected and tension-free vaginal tapes TVT-S H, TVT-S U, TVT Abbrevo and Ajust were studied. A novel descriptive system for localisation of the tape was created. During the dissection the tape was located and its localisation and fixation was described. Results: Common anatomical variation in the sample was corona mortis with frequency of 72 %. Preperitoneal fatty plug, which is recognized by some authors as the first stage of obturator hernia, was found in 40 % in obturator canal. The proper fixation of TVT-S H was achieved in 53.6 %. In 10.5 % urinary bladder was injured. In case of TVT-S U the proper fixation occurred in 63.8 %. In two cases the inserter was nearby corona mortis. Within the group of TVTO Abbrevo the tape was fixated properly into the obturator complex (consists of the obturator membrane and obturator muscles) in...
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The relationship between selected inflammation markers and markers of the endothelial dysfunction to preterm labor and fetal inflammatory response
Koucký, Michal ; Hájek, Zdeněk (advisor) ; Krofta, Ladislav (referee) ; Živný, Jan (referee)
The doctoral dissertacion is focused on the role of inflammation in the pathogenesis of preterm labor. In the first part, we describe the current view on pathophysiology of preterm labor. In the second part, we evaluated the relationship of specific markers of inflammation and endothelial dysfunction to preterm birth and fetal inflammatory response. The most important findings of our study was that we found decreased levels of MMP-2 and decreased levels of sRAGE in women with preterm labor in comparison with the control group of pregnant women. Similarly, we found decreased levels of MMP-2 in women with subsequent diagnosed fetal inflammatory response. sRAGE is currently ranked among patttern recognition receptors. In the case of sRAGE we followed the results of our pilot project, it can be assumed that the its low level are connected with tissue damage. We confirmed that it can play an important role in the pathogenesis of preterm labor. We assume abnormal regulatory mechanisms of the production of MMP-2. In both cases, however, further studies are required to elucidate the functional significance of our results.
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Modern technologies in the assessment and treatment of pelvic organ prolapse - experimental and clinical studies
Urbánková, Iva ; Krofta, Ladislav (advisor) ; Mašata, Jaromír (referee) ; Kachlík, David (referee)
This project has shown that pelvic organ prolapse is linked with maternal age and delivery-related injuries. Up to every eight women may have a symptomatic prolapse already one year after their first delivery. Moreover, those with muscle injury have a higher short-term risk of pelvic organ prolapse development. To improve our knowledge we further explored the potential of an ovine model for prolapse and vaginal surgery. We showed that many anatomical and morphological features and vaginal wall changes induced by specific lifespan factors (first delivery, artificial menopause, and hormonal replacement) are similar to what is observed in women. We further used this model for testing novel implants and mesh visualization techniques. We believe that the ovine model can be used in future research on pelvic organ prolapse pathophysiology and novel treatment modalities.t
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Variation of abnormalities of foramen obturatum and retropubic space and its relation to complications of tape surgery
Hubka, Petr ; Mašata, Jaromír (advisor) ; Smetana, Karel (referee) ; Krofta, Ladislav (referee)
Introduction: The knowledge of anatomy is crucial for introduction of new surgical methods. It is also of especial use while dealing with surgical complications during surgeries with limited surgical field, where the way of approach limits the management of complications. It was assumed that common anatomical variations would influence different efficacy of surgeries and would explain potential complications. Methods: During anatomical dissections fifty female cadavers were dissected and tension-free vaginal tapes TVT-S H, TVT-S U, TVT Abbrevo and Ajust were studied. A novel descriptive system for localisation of the tape was created. During the dissection the tape was located and its localisation and fixation was described. Results: Common anatomical variation in the sample was corona mortis with frequency of 72 %. Preperitoneal fatty plug, which is recognized by some authors as the first stage of obturator hernia, was found in 40 % in obturator canal. The proper fixation of TVT-S H was achieved in 53.6 %. In 10.5 % urinary bladder was injured. In case of TVT-S U the proper fixation occurred in 63.8 %. In two cases the inserter was nearby corona mortis. Within the group of TVTO Abbrevo the tape was fixated properly into the obturator complex (consists of the obturator membrane and obturator muscles) in...
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The relationship between selected inflammation markers and markers of the endothelial dysfunction to preterm labor and fetal inflammatory response
Koucký, Michal ; Hájek, Zdeněk (advisor) ; Krofta, Ladislav (referee) ; Živný, Jan (referee)
The doctoral dissertacion is focused on the role of inflammation in the pathogenesis of preterm labor. In the first part, we describe the current view on pathophysiology of preterm labor. In the second part, we evaluated the relationship of specific markers of inflammation and endothelial dysfunction to preterm birth and fetal inflammatory response. The most important findings of our study was that we found decreased levels of MMP-2 and decreased levels of sRAGE in women with preterm labor in comparison with the control group of pregnant women. Similarly, we found decreased levels of MMP-2 in women with subsequent diagnosed fetal inflammatory response. sRAGE is currently ranked among patttern recognition receptors. In the case of sRAGE we followed the results of our pilot project, it can be assumed that the its low level are connected with tissue damage. We confirmed that it can play an important role in the pathogenesis of preterm labor. We assume abnormal regulatory mechanisms of the production of MMP-2. In both cases, however, further studies are required to elucidate the functional significance of our results.
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Detection of fetal abnormalities in the I. trimester of pregnancy
Pošarová, Alena ; Krofta, Ladislav (advisor)
The topic of his thesis detection of fetuses with congenital abnormalities in I. trimester of gestation , I chose based on their interest in this issue. 5 As the name suggests, the work itself , try the following pages briefly summarize methods of prenatal diagnostics with a focus on the first trimester . It medical discipline , which in recent decades has undergone dynamic development , related to the development of technical background , in particular ultrasonic techniques and laboratory methods. Birth of a child victim severe mental retardation significantly affect the future the whole family. 's why I consider it necessary to possible future parents should all available information , and hence to make responsible decisions about their future life and the life of his child . Contribution of early diagnosis of congenital defects is therefore invaluable especially for expectant parents and their chances of a healthy baby. It is also about move diagnosis of chromosomal aberrations and eventual termination pregnancy in the earliest possible stages due to mental and health impact of a pregnant woman . When drafting diplomky I , among others, drew from the grant MD . Ladislav Krofta from the years 1999-2002, and 2005 - 2007 , which are listed in literature.
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