Ceska Gynekologie-Czech Gynaecology最新文献

Hidradenitis suppurativa is a chronic immune-mediated inflammatory disease that is manifested by formation of painful nodules, abscesses and suppurating fistulas, primarily in the intertriginous spaces. This painful, often under-diagnosed disease affects much more women. They are also exposed to certain specific challenges in the management of this disease, especially during menstruation or pregnancy. The treatment requires the interdisciplinary cooperation of a dermatologist, gynaecologist, obstetrician and last but not least an algesiologist and psychotherapist. Above all, early and correct diagnosis, initiation of therapy in the early stages of the disease, is a key, which also plays a fundamental role in controlling inflammatory activity, preventing complications and further prognosis.

Prehabilitation is a set of interventions aimed at increasing the patient's endurance and functional capacity before a planned stressful event (oncogynaecological surgery). Currently, prehabilitation is based on three main modalities which are: physiotherapy, nutritional support and psychological support, with others gradually being added. In studies published to date, a positive effect of combined preoperative intervention on the patient's postoperative recovery reduces the risk of perioperative and postoperative complications, shortening the hospital stay. This directly reduces the costs associated with cancer treatment.

The narrative review article is focused on the strengths and limitations of modern imaging methods in the preoperative differential diagnosis of uterine mesenchymal tumours. In order to tailor the surgical procedures, imaging methods, namely ultrasound and magnetic resonance imaging (MRI), should be taken into account as well as clinical symptoms, age, and fertility plans. On ultrasound scans, uterine sarcomas have the appearance of large, usually solitary tumours of non-homogenous structure with irregular cysts, ill-defined outline borders (interrupted capsule), absence of calcifications with acoustic shadowing, and moderate to rich internal vascularisation. Rapid growth between follow-ups or atypical growth in peri- or post-menopause is also a sign of malignancy. On MRI, uterine sarcomas are characterized by irregular borders, hyperintense areas on T1-weighted and T2- weighted images, and central non-enhancing necrotic areas. On diffusion-weighted imaging (DWI/MRI), sarcomas exhibit markedly restricted diffusion but there is a significant overlap with some variants of fibroids. Core-needle or hysteroscopic biopsy can be used preoperatively if suspicious features are detected on ultrasound or MRI scans, particularly before myomectomy if fertility preservation is required or when conservative management is considered in asymptomatic women. Other imaging methods, such as positron emission tomography fused with CT (PET-CT) or computed tomography (CT) have limited role to distinguish uterine sarcomas from myomas and are suitable only for staging purposes. The importance of tumour markers including lactate dehydrogenase in preoperative work-up have not been verified yet. Conclusion: Uterine sarcomas can be distinguished from much more common myomas based on a combination of malignant features on ultrasound or MR imaging. In these suspicious cases the type and extent of surgery should be adjusted, avoiding intraperitoneal morcellation, which could lead to iatrogenic tumour spread and worsening of the patient's prognosis.

Venous thromboembolism is a multifactorial dis ease and major cause of morbidity and mortality. Absolute risk of venous thromboembolism is less than 1 per 10,000 per year in women of reproductive age. Hormonal contraception is a common risk situation for venous thromboembolism in this part of the population. The risk of venous thrombosis depends on many factors, mainly female characteristics and also the type of contraception. Hematologists can help with the choice of contraception in females with inherited thrombophilia and females experiencing thrombosis. Intrauterine devices with levonorgestrel seem to be the best option in these settings.

Recent literature sources suggest that 15-20% of all malignant diseases have a viral aetiology. About 5% of these are caused by the human papillomavirus. The presence of papillomavirus is one of the strongest risk factors for development of a cervical pre-cancerous lesion and subsequent cervical cancer. The presented review provides a brief summary and characterisation of risk factors that influence spontaneous and post-interventional regression and persistence of papillomavirus in the cervical area.

Objective: The aim of this study is to investigate the relationship between endometriosis and the vaspin RS2236242 gene polymorphism.

Materials and methods: This prospective cross-sectional case-control study included patients with grade 4 endometriosis and a healthy control group. Vaspin RS2236242 gene polymorphism was evaluated in these study groups.

Results: Thirty eight endometriosis individuals and 17 women from the control group in the study. The group of individuals with endometriosis exhibited similar characteristics to the control group in terms of sex, body mass index (BMI), and age (control mean age: 29.6 ± 4.62 years; BMI: 24.02 kg/m2; endometriosis mean age: 30.4 ± 5.01 years; BMI: 23.63 kg/m2). According to the statistical analysis, there was a significant difference in the genotype distribution of the vaspin RS2236242 polymorphism between people with endometriosis and controls (P = 0.027). Also, the AT genotype was more likely to cause endometriosis than the OR: 2.474 (95% Cl 0.668-9.169) genotypewhen we looked at the genotypes' relative risk ratio for endometriosis. Significant differences were observed in total AT and TT genotype frequencies between cases and controls (OR = 2.31; 95% CI 0.86-0.92; P = 0.03). AT and TT genotypes were associated with endometriosis risk.

Conclusion: A significant association was observed between vaspin RS2274907 A/T polymorphism and the probability of developing endometriosis.

Tubal abortion is characterized by the extrusion of the foetus into the abdominal (peritoneal) cavity. It can either be a complete extrusion or incomplete with residual tissue remaining in the fallopian tube. It is a type of ectopic pregnancy that is difficult to determine the exact incidence of tubal pregnancies. Identifying cases of tubal abortions is crucial for individualized care since it can lead to a more conservative treatment approach. The diagnosis should be based on ultrasound imaging, b-hCG levels and visual conformation during exploratory surgery, either open or laparoscopic. The article describes the case of a 30-year old patient who presented with lower abdominal pain and was admitted for a suspected ectopic pregnancy. Ultrasound imaging showed a mass resembling a tubal pregnancy next to the uterus with b-hCG levels of 111.8 U/L. During laparoscopic surgery, a tubal abortion was detected in the pouch of Douglas (Rectouterine pouch). This finding led us to preserve both fallopian tubes. Histopathology confirmed our clinical findings. A conservative approach can be sufficient in case of tubal abortions, which can lead to preserved fertility and tubal functions.

Aim: The effect of platelet-rich autoplasma on endometrial thickness and receptor sensitivity to estrogen and progesterone.

Materials and methods: This prospective clinical study included 200 patients. The participants in the study were divided into two groups. The first control group received hormone replacement therapy (HRT). The second study group received an intrauterine infusion of platelet-rich autoplasma (PRP group). On the 19th day of the menstrual cycle, an ultrasound examination was performed to assess endometrial thickness, as well as an immunohistochemical analysis to determine receptor sensitivity to estrogen and progesterone.

Results: In the course of the study, we found that the use of platelet-rich autoplasma increased the thickness of the endometrium by 0.85 mm; the average thickness of the endometrium in the group who received PRP therapy was 8.25 (8.25-8.61)  mm; and in the group of patients who only received HRT, it was 7.40 (7.34-7.65)  mm. The sensitivity of receptors to estrogen in the experimental group increased by 3.5, in the experimental group it was 75.00 (71.43-74.22), and in the control group it was 71.50 (67.05-70.85). The sensitivity of receptors to progesterone also increased by 9.0, in the experimental group it was 95.0 (91.4-93.8), and in the control group it was 86.0 (83.47-86.27).

Conclusion: Due to the action of platelet factors, PRP therapy has a positive effect on the endometrium, increasing its thickness and improving its receptivity. Therefore, it can be concluded that this method can find great practical application to improve the outcomes of assisted reproductive technology programs.

Objective: In this study, we aimed to evaluate the diagnostic value of the HALP score, serum uric acid value, and uric acid-creatinine ratio, which are inflammatory markers, in the diagnosis of preeclampsia (PE).

Materials and methods: One hundred sixty-six pregnant women who met the inclusion and exclusion criteria were included in the study. They were divided into two groups: 81 pregnant women diagnosed with PE (PE group) and 85 pregnant women with healthy pregnancies (control group). Demographic and obstetric stories of the groups; weeks of pregnancy at diagnosis; hematological and biochemical parameters; hemoglobin, albumin, lymphocyte, and platelet (HALP) score and serum uric acid-creatinine ratio (sUA/sCr); and the results of the newborns were recorded and compared between groups.

Results: There was no significant difference between the groups in terms of age, gravidity, parity, and body mass index (P values = 0.533, 0.188, 0.085, 0.915, resp.). Mean gestational age, mean birth weight, 1st and 5th minute Apgar scores, and mean umbilical cord pH values were lower in the PE group compared to the control group (P values = 0.0001 for all). Percentage of NICU admissions was higher in the PE group (P = 0.0001). HALP score of the PE group was significantly lower than the control group (2.2 vs. 3.2; P = 0.0001). Uric acid and sUA/sCr ratios were significantly higher in the PE group compared to the control group (for uric acid, 6.2 ± 1.7 vs. 4.5 ± 1.2; P = 0.0001; for sUA/sCr, 12.0 ± 4.0 vs. 9.9 ± 3.1; P = 0.0001). In diagnosing PE, serum uric acid had a sensitivity of 82.7% at values of 4.7 and above, 58% sensitivity at values of sUA/sCr ratio of 10.9 and above, and 3.7% sensitivity at HALP score values of 6.6 and above (P values = 0.0001, 0.001, 0.001, resp.).

Conclusion: In our study, we found that the HALP score in PE was significantly lower than in healthy controls, and the uric acid value and sUA/sCr ratios were significantly higher. Diagnostic value of the serum uric acid value and then the sUA/sCr ratio were higher in PE. However, we found that the HALP score was insufficient for diagnosing PE.

Objective: In laparoscopic surgery, initial entry into the abdomen becomes more risky in patients with a history of abdominal surgery. In such cases, initial entry is usually performed with a Veress needle via Palmer's point (PP). However, it is associated with an increased failure rate, especially in obese patients. On the other hand, direct trocar entry is a convenient and safe technique with a low failed entry rate. Direct trocar entry via PP may be the preferred approach for initial abdominal entry in patients with a history of abdominopelvic surgery.

Materials and methods: The present study included 438 patients with a previous history of abdominopelvic surgery undergoing laparoscopic gynecological surgery, during which two different entry techniques via PP were tested.

Results: There were 88 patients (20.1%) in the Veress needle group and 350 patients (79.9%) in the direct trocar group. The time to create a pneumoperitoneum was significantly shorter in the direct trocar group (P < 0.001). Successful entry was achieved at the initial attempt in 78 patients (88.6%) from the Veress needle group and in 347 patients (99.1%) from the direct trocar group (P = 0.012). Minor complication rates were similar in both groups. However, one major complication was observed in the direct trocar group, while no major complications were noted in the Veress needle group.

Conclusion: Provided that the basic surgical principles are respected, direct trocar entry technique via PP is a safe, effective, and fast initial entry approach into the abdomen and may be preferred in patients with previous abdominopelvic surgery.