Ceska Gynekologie-Czech Gynaecology最新文献

Gonadotropin-releasing hormone pulsatility is under the influence of hypothalamic neuropeptides, especially neurons expressing kisspeptin, neurokinin B, and dynorphin. These hypothalamic cells are called KNDy neurons. By integrating hormonal and environmental stimuli in the brain, they modulate the effects on neuropeptide release and control the frequency and amplitude of pulses. The relationship between KNDy neurons and gonadal hormones is essential for the initiation of puberty, regulation of the menstrual cycle, and reproduction. Steroid hormones have a feedback effect on the modulation of the activity of KNDy neurons, as their membrane and cell nucleus express receptors for estradiol, progesterone, and testosterone. Recent research suggests a close relationship with the pathophysiology of infertility, pathological pregnancy, menstrual cycle disorders, polycystic ovary syndrome, endometriosis, and vasomotor symptoms in perimenopause.

Heteropagus or parasitic conjoined twins represent an extremely rare anomaly, occurring in approximately 1 in 1 million cases. This condition is characterized by the presence of a parasitic twin with significant congenital abnormalities attached to an otherwise typically healthy fetus. The well-developed twin is known as the "autosite" or "host," while the severely affected fetus is termed the "parasite." Survival of the defective twin depends on the cardiovascular system of the second, relatively normal fetus. We present the case of a 27-year-old primigravida in her 14th week of pregnancy with ultrasound findings indicating parasitic conjoined twins, specifically omphalopagus.

To summarize current knowledge on the use of sclerotherapy in the treatment of endometriomas and its effect on ovarian reserve. Endometriosis affects 10-15% of women of reproductive age. The presence and treatment of endometriomas influence ovarian reserve, and therefore the conception possibilities of patients. The management is further complicated by frequent recurrences. All standard surgical methods lead to a reduction in ovarian reserve. Current clinical research is focused on developing methods that minimize the reduction of ovarian reserve. Ethanol sclerotherapy is a relatively new alternative to the currently used surgical methods, mainly extirpation. It is not yet a standard procedure. This article aims to summarize the current knowledge regarding the use of sclerotherapy in the treatment of endometriomas and its effect on ovarian reserve. The studies included in this review article are based on PubMed and Scopus databases. According to published works, sclerotherapy is a relatively simple method that allows treating endometriomas without surgery and general anaesthesia if performed under ultrasound guidance. It has a similar recurrence rate as laparoscopic extirpation and does not lead to a greater reduction in ovarian reserve compared to the latter. Sclerotherapy can be performed trans-vaginally, trans-abdominally, or laparoscopically. This paper summarizes the current knowledge on the impact of sclerotherapy on ovarian reserve.

Objective: Phoenixin has endothelial protective and anti-inflammatory properties, but has been associated with the development of hypertension. Given that endothelial dysfunction plays a significant role in the pathophysiology of preeclampsia, we aimed to investigate the serum levels of phoenixin-14 and phoenixin-20 in pregnant women diagnosed with preeclampsia.

Materials and methods: In this cross-sectional case-control study, 45 pregnant women diagnosed with preeclampsia comprised the preeclampsia group, while 45 healthy pregnant women, matched to the preeclampsia group by age, body mass index, and gestational age, served as the control group. Commercial kits were used to analyze phoenixin-14 and phoenixin-20 levels in serum samples.

Results: Serum phoenixin-14 level was 390.3 pg/mL in the preeclampsia group and 393.2 pg/mL in the control group (P = 0.434). While the serum phoenixin-20 level was 346.6 pg/mL in the preeclampsia group, it was 379.9 pg/mL in the control group (P = 0.278). When the preeclampsia group was divided into subgroups according to the severity of the disease and the onset of the disease and compared with the control group, no significant difference was found between the groups regarding serum phoenixin-14 and phoenixin-20 levels.

Conclusion: In this study, serum levels of phoenixin-14 and phoenixin-20 were similar in both the preeclampsia and control groups. Although the sample size is too small to draw a definitive conclusion, findings suggest that phoenixin-14 and phoenixin-20 do not play a role in the pathophysiology of preeclampsia.

Caesarean scar pregnancy is a rare form of ectopic pregnancy. It can be reliably diagnosed through transvaginal ultrasonography, typically during the 1st or early 2nd trimester. While one-third of patients remain asymptomatic, others may develop severe complications. The most common symptoms are vaginal bleeding and abdominal pain, with rare cases involving uterine rupture or the development of placenta accreta spectrum. Caesarean scar pregnancy is associated with a risk of various complications and poses a risk factor for future pregnancies. In many cases, surgical intervention cannot be avoided. Treatment options include surgical management or medical therapy. In some cases, an expectant management approach may be chosen. No single treatment method has yet been definitively established as sufficiently rapid, safe, and effective. This case report presents a patient with twin pregnancy in a caesarean scar, in whom a conservative approach was chosen due to the low gestational age. Additionally, we provide a literature review of the current therapeutic options for managing this challenging condition.

Endometriosis affects approximately 10% of women of fertile age and its deep infiltrating form causes serious consequences for fertility, clinical problems depending on which organs are affected (urinary and digestive tract) and causes serious pain which seriously impairs quality of life. Resection of the affected tissue tend to be complex and often require multidisciplinary approach. Resection in the field of severe deep infiltrating endometriosis is complicated by the difficulty of resection line identification. Although we are able to perform most of the resections laparoscopically, there is still significant risk of intra and postoperative complications, the most serious of which is the formation of rectovaginal fistulas. Identification of boundaries of the endometrial nodule and preservation of tissue vitality is crucial in resection procedures. Endometriotic nodules, based on the pathogenesis of the lesion, have various vascularity and therefore different perfusion patterns. According to nature of tissue and the degree of vascularization, most deep infiltrating nodules have rather hypoperfusion pattern. A substance that would be able to guide the resection by live monitoring of the tissue perfusion, could have useful therapeutic applications. Such substance could be the fluorescent dye indocyanine green. With resection guidance by fluorescence dye, we could be able of pathogenesis oriented management of the disease and therefore perform more gentle tissue preparation, with less collateral damage, reduction of intra and postoperative complications, and thus improvement of the quality of life of patients in terms of pain, risk of recurrence, and preservation of fertility.

Objective: Overview of the possibilities of using non-medical occupational therapy in oncogynecology, description of the role of an occupational therapist in prehabilitation, and evaluation of data from a pilot study.

Methods: The study cohort consisted of 18 patients enrolled between November 2023 and October 2024. The prospective study was conducted over a period of nine months. Patients were admitted for a 3-week intensive multimodal prehabilitation program scheduled on a 4/7 basis prior to elective surgery for primary or recurrent malignant ovarian, endometrial, or cervical cancer. In addition to the physicians, patients received prehabilitation by a physiotherapist, psychologist, nutritionist, and occupational therapist. Clinical work of the occupational therapist was measured upon examination and subsequent therapy in the areas of cognitive function, fine motor skills of the upper limbs, self-sufficiency, and quality of life. The occupational therapist applied selected functional tests and questionnaires (MKF classification, Hand grip test, MoCA test, 5× Sit-to-Stand test, WHODAS 2.0) to determine the effect of the rehabilitation intervention.

Results and conclusions: Important indicators were selected functional abilities that have a significant impact on the quality of life of patients. The results of functional tests showed a significant improvement of key parameters due to intensive prehabilitation, confirming the essential role of occupational therapist intervention in oncogynecological prehabilitation.

Introduction: Until now, it is still true that late detection of ovarian cancer is a major cause of its poor prognosis. So far, no sufficiently sensitive and specific marker or combination of markers and imaging methods has been identified that would unambiguously allow the detection of early potentially highly-curable stages and furthermore prebioptically differentiate a group of poorly distinguishable benign lesions from malignant tumours on ultrasound. In a retrospective study design, serum levels of vascular endothelial growth factor D (VEGF-D) were investigated. VEGF-D is related to tumour-induced angiogenesis, lymphangiogenesis, and vascular remodelling with the effect of facilitating metastasis and improved oxygen and nutrient distribution into tumour tissue. On the other hand, the lymphatic network serves as a barrier against tumour dissemination and is a transport system for immune-active elements in suppressing tumorigenesis. The aim of this study was to investigate that there is a difference in serum VEGF-D levels in a group of patients with malignant tumours, benign ovarian lesions, and healthy controls without pathological findings in the adnexa.

Methods: 162 sera collected preoperatively and preserved by a freezing process in a biobank in 2022-2023 were retrospectively evaluated. The test set was stratified on the basis of histopathological results of the adnexal examination into the malignant tumour group (N = 54), benign lesion group (N = 47), and healthy control group (N = 61). Descriptive statistical analysis methods were used for the statistical evaluation of the parameters. Nonparametric tests were used to compare serum VEGF-D levels. All analyses were considered at a significance level of 5%. Serum VEGF-D was analysed by ELISA Quantikine® Human VEGF D R&D Systems and values were read spectrophotometrically on a TECAN reader.

Results: The result of the comparison of descriptive statistical parameters was statistically significant (P = 0.00067) for the difference between serum VEGF-D levels in the set of benign lesions and malignant tumours. Furthermore, there was a statistically significant difference between the values of patients with malignant tumours and healthy controls (P = 0.0008). No statistically significant difference was found between the values of patients with benign lesions and healthy controls (P = 0.4308). Compared to the conventional marker CA125, pathologically elevated serum CA125 levels correlated with low serum VEGF-D levels in patients with malignant tumours. The same concordance was observed in comparison with the HE4 marker: high serum HE4 levels were accompanied by low VEGF-D levels in the group of patients with malignant tumours; moreover, the dot plot clearly stratified the group of patients with malignant tumours from the group of benign lesions and healthy controls.

Conclusion: In view of the results obtained,

Objective: The aim of this study was to validate the methodology of ovarian tissue cryopreservation using the slow freezing technique as a fertility preservation approach and to assess its potential implementation in clinical practice at the Assisted Reproduction Centre of the University Hospital Olomouc. In parallel, the technical procedure of cryopreservation was optimized and standardized.

Materials and methods: The study was conducted between April 2022 and December 2024 at the Department of Obstetrics and Gynecology, University Hospital Olomouc, and included six transgender patients aged 19-25 years who underwent laparoscopic hysterectomy with bilateral adnexectomy as part of gender-affirming surgery. Ovarian tissue obtained during the procedure was immediately processed and cryopreserved using the slow freezing method at the Assisted Reproduction Centre of the University Hospital Olomouc. Histopathological evaluation of the ovarian tissue was performed both prior to cryopreservation and after thawing at the Department of Clinical and Molecular Pathology.

Results: Morphological assessment of the ovarian tissue after cryopreservation confirmed preservation of structural characteristics of follicles and stromal components, without signs of significant degeneration.

Conclusion: The results confirm that the applied slow freezing protocol for ovarian tissue cryopreservation is appropriate and sufficiently gentle for clinical use. This method represents a reliable option for fertility preservation in patients undergoing gonadectomy, with potential applications in subsequent autologous transplantation or in vitro follicle culture.

The rising global incidence of cesarean deliveries has led to a marked increase in associated obstetric and gynecological complications, notably the cesarean scar defect. Clinical management decisions are predominantly guided by patient-reported symptoms, reproductive goals, and individual anatomical considerations. The literature currently lacks definitive guidelines recommending a singular optimal approach. The recent advent and incremental adoption of robotic surgery has introduced a promising new technique, characterized by enhanced surgical precision, improved visualization, reduced morbidity, and rapid patient recovery. Ultimately, embracing robotic-assisted surgery for cesarean scar defect repair represents a critical advancement in gynecological surgery.