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Biomedical subjects

L Rob

Publications and source records attributed to L Rob.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Prevalence of the female urinary incontinence. Results from a questionnaire study].

OBJECTIVE: To evaluate the prevalence of urinary incontinence in patients of gynecological practise aged 31-60. DESIGN: Prospective questionnaire study. SETTING: Obstetric and Gynecologic Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. METHODS: Questionnaire study of 561 women aged 31-60 examined with gynecological problems (not for the symptoms of urinary incontinence) from November 2001 till October 2002 in standard gynecological practise. The questionnaire included history, evaluation of urinary continence, lasting of the symptoms, body mass index, obesity, age, parity. Stress, urgent and mixed incontinence and influence on the sexual life were also evaluated. Cochran Mantel-Haenszel test and chi2 test were used for the statistical analysis. RESULTS: The incontinence rate in the group of 533 evaluated patients (95% completed questionnaires from 561) of gynecological practise was 23.8%. 81.1% of incontinent patients in the study suffered from stress urinary incontinence. For an easy survey and analysis the patients were divided into three age groups (31-40, 41-50, 51-60). Prevalence of the urinary incontinence rised with age. Statistically significant lower prevalence of urinary incontinence was in the age group 31-40 (p<0.0005). Influence of parity on the prevalence of incontinence was statistically significant only in the age group 31-40 (p=0.002). Obesity had no statistical impact on prevalence of urinary incontinence (p=0.79). 5.5% of incontinent women suffered from negative effect of urinary incontinence on sexuality; the differencies among the age groups were not statistically significant. CONCLUSIONS: The results of the study show high prevalence of urinary incontinence in population of healthy women of gynecological practise. Low interest for the treatment is in contrast with high prevalence of this symptom. Higher quality of the enlightenment with attention to the prevention and therapy of urinary incontinence in population is the way how to improve quality of lives of the afflicted women.

Adult↗
PubMed2004

[Immunotherapy--perspectives in therapy of ovarian carcinomas].

OBJECTIVE: To summarise recent knowledge and clinical studies of immunotherapy in the treatment of malignant ovarian epithelial tumors. DESIGN: A literature review. SETTING: Department of Gynecology and Obstetrics, Charles University Prague, 2nd Medical Faculty, University Hospital Motol. Department of Immunology Charles University Prague, 2nd Medical Faculty, University Hospital Motol. ABSTRACT: Combination of surgery and chemotherapy has been the usual standard of therapeutic protocols in ovarian cancer patients. However, this therapy is still not sufficient to eliminate all of the tumour cells. Immunotherapy seems to be an effective approach in combination with surgery and chemotherapy. Immunotherapy includes three types of strategies: cytokine therapy, monoclonal antibody therapy and vaccine therapy, especially vaccines with dendritic cells. All of them are shortly reviewed in this article. IFNalpha, IFNgamma, IL-2, GM-CSF are examples of cytokine therapy. Representatives of monoclonal antibody therapy include trastuzumab (monoclonal antibody against HER-2/neu peptide, MAb B.43.13 (antibody against CA 125), or radiolabeled antibody--pemtumomab (90Yttrium-CC49). Cancer vaccination is used in experiments because it should be effective in presenting tumour cells as foreign cells to effector cells of the immune system. Otherwise, tumour cells are not usually recognised by the immune system as dangerous cells. The efficiency of immunotherapy depends on tumor size and previous therapy. It seems to be effective in potentiation of primary chemotherapy or as a consolidation treatment of minimal residual disease. Immunotherapy is still at the experimental level, but in the future it could be a useful part of protocols for the treatment of ovarian cancer.

Antibodies, Monoclonal↗
PubMed2004

[Guideline for gynecological malignant tumors--primary complex therapy in operable stages of malignant tumors of uterus cervix].

OBJECTIVE: Elaboration of guideline for primary treatment of operable cervical cancer. DESIGN: Review, consensus between proposers and opponents. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague, 2nd Medical Faculty and Faculty Hospital Motol. METHOD: A retrospective review of published data, analysis of Czech statistics and consensus between proposers and opponents. RESULTS: Team work is essential in the diagnostic and therapeutic procedure. For the preoperative diagnostic management it is possible to perform magnetic resonance volumometry. For the treatment of early stage cervical cancer it is possible to perform sentinel lymph node mapping (SLNM) by patent blau and 99mTc together with frozen section. SLNM does not substitute systematic pelvic lymphadenectomy. For the treatment of IB2 stage cervical cancer, an alternative for primary surgery or chemoradiotherapy is neoadjuvant chemotherapy, followed by radical surgery. In other topics only minor changes were made from the 1998 guideline. CONCLUSION: The guideline for cervical cancer treatment should represent directions for clinicians and others, who participate in the process of the treatment of cervical cancer. The guidelines include all parts of the process (from diagnosis to follow up). It originated from the consensus between proposers and opponents: we voted about all parts of guideline.

Female↗
PubMed2004

[Guideline for gynecological malignant tumors 2004--primary complex therapy in operable stages of malignant tumors of vulva].

OBJECTIVE: Elaboration of guideline for primary treatment of operable vulvar cancer. DESIGN: Review, consensus between proposers and opponents. SETTING: Department of Obstetrics and Gynecology, 2nd Medical Faculty Charles University and Faculty Hospital Motol, Prague. METHOD: A retrospective review of published data, analysis of Czech statistics and consensus between proposers and opponents. RESULTS: Guideline for the diagnosis remain the same as in the proposal from 1998. We elaborated practically new guideline for surgical treatment. Wide excision or simplex vulvectomy is adequate only for stage la without angioinvasion, free margins have to be 5 mm. Standard surgical procedure is radical vulvectomy with inquinofemoral lymphadenectomy in stage 1a with angioinvasion, 1b and 2. In laterally localised lesions it is possible to perform hemivulvectomy or radical excision with inquinofemoral lymphadenectomy. Free margins have to be more than 8 mm. An alternative procedure in internally high-risk patients is sentinel node detection with radical vulvectomy (hemivulvectomy). Sentinel node detection has to by performed by combined method of blue dye and radiocoloid Tc 99 simultaneously. Bilateral inquinofemoral lymphadenectomy is indicated in case of positive sentinel node. Primary radiotherapy is indicated in higher stages, in stage 3 we can perform an exenteration with the agreement of patient. CONCLUSION: Guideline for the treatment of vulva cancer should be directions for clinicians and others, who participate in the process of treatment of the vulva cancer. Guidelines include all parts of the process (from diagnosis to follow up). All topics of the guidelines were arise from a voting of the proposers and opponents.

Combined Modality Therapy↗
PubMed2003

[Malignant tumors of the female genitalia in childhood--yesterday, today and tomorrow].

Genital tumors in children and adolescents represent 1.5 to 2.0% of al malignancies in these age groups. Organ incidence differs from that in adult women. In children and in young adolescents non-epithelial gynaecological tumors predominate, while carcinomas are rare and their incidence rises with the age of girls. Malignant tumors of the external genital are very rare (sarcomas of the soft tissues). Malignancies of vagina are represented by the embryogenic rabdomyosarcoma, yolk sack tumor and tumor of pale cells or vaginal adenocarcinoma. All these tumors are highly malignant. Cytostatics are used as the basic therapy and only later the less radical surgery is recommended. Radiotherapy is used in chemoresistant tumors. Vaginal bleeding of the premenarcheal girl is an early symptom and requires immediate examination, including vaginoscopy. Tumors of uterus in childhood do not occur and they are rare in postmenarcheal girls. Ovarian tumors represent about 1.5% of all tumors in childhood and adolescence and about 95% of all gynaecologic tumors. They differ in types from those of adults: Epithelial tumors (carcinomas) do not occur in childhood, germinal and gonadal stromal tumors are typical in this age. Mature differentiated teratomas are usually benign and the less differentiated they are, the worse biological effect they have (not mature or mixed teratomas). It seems that nowadays the proportion of immature and mixed teratomas has been rising. Dysgerminom occurs more frequently in Y-chromosome karyotypes. It has malignant progression with early propagation along lymph vessels into the lymph nodes. Beside ovarectomy, also lymphadenectomy at the affected side is performed and the treatment proceeds with chemotherapy. For the prognostic reasons, immunological examinations, DNA ploidity identification and other tests are recommended. Gonadal stromal tumors are always unilateral, malignant, and frequently hormonally active, but they usually have a good prognosis. In order to preserve fertility of the young girl with ovarian tumors, uterus should be spared as well as the macroscopically healthy contra-lateral ovarium. To protect gonad from the adverse effects of oncological treatment, pharmacologically induced regression to premenarcheal stadium has been tested. Present development of paediatric and adolescent gynaecology is aimed to preserve for patients with tumors all prospects of future pregnancy, either in the natural way or using methods of assisted reproduction with a donated oocyte. Complex treatment of gonadal malignancies in childhood in future will be aimed not only at the lifesaving but also at the preservation of the highest possible quality of life, including the motherhood.

Adolescent↗
PubMed2003

[The Barnett-Macku method of anterior colporrhaphy in the prevention and treatment of urinary stress incontinence in women with cystocele].

OBJECTIVE: The evaluation of the success rate in prevention and treatment of stress incontinence in patients with cystocele operated by Barnett-Macku modification of anterior colporrhaphy. DESIGN: Retrospective clinical trial. SETTING: Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. METHODS: Comparative questionnaire study of 41 patients operated between 1998 and 2000 for cystocele by Barnett-Macku modification of anterior colporrhaphy and the control group of 75 patients operated by Stoeckel modification. Preoperative examination included history, gynecological examination and evaluation of urinary continence. Body mass index, obesity, age, parity and hormonal status were recorded in the time of surgery. Stress and urge incontinence, lower urinary tract infections, hormonal therapy, recurrency of the prolapse and quality of life improvement were evaluated in follow-up. Yes-no logistic regression test and chi 2 test were used for the statistical analysis. RESULTS: In the group of patients operated for cystocele by Barnett-Macku modification of anterior colporrhaphy statistically significant higher success rate in the prevention and treatment of concomitant stress urinary incontinence was demonstrated. Prophylactic effect of the procedure was also documented by the fact that no one stress incontinent woman after surgery appeared in this group. CONCLUSION: Barnett-Macku modification of anterior colporrhaphy is reliable and successful contribution into the register of reconstructive vaginal operations primary for the treatment of cystocele and secondary for the prevention of latent and treatment of concomitant stress incontinence.

Aged↗
PubMed2002

[What can we expect of raloxifene in the treatment of postmenopausal osteoporosis--views of a gynecologist].

OBJECTIVE: Evaluation of positive properties and side effects of raloxifene treatment with respect to its potential use as agent to improve women's health and quality of life in postmenopausal years. DESIGN: A review article. SETTING: Obstetrics and Gynaecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. SUBJECT: Estrogen use may protect against osteoporosis and cardiovascular disease, but may increase the risk of breast cancer in long-term treated women and also may increase the risk of irregular uterine bleeding (in combination with gestagen in non-hysterectomized women) in perimenopause and postmenopause. Drugs with tissue-specific estrogenic effects are termed selective estrogen receptor modulators (SERM). Tamoxifen is the first SERM successfully used in the prevention and treatment of breast cancer. Another SERM raloxifene is widely used in the prevention and treatment of postmenopausal osteoporosis, especially in women without climacteric complaints. Therapy with raloxifene increases bone mineral density, lowers serum concentrations of total and low-density lipoprotein cholesterol, and does not stimulate endometrium and breast. Evaluation of another potential positive effects (reducing size of uterine leiomyomas, etc.) warrants further investigation. CONCLUSION: Raloxifene can be used in postmenopausal women free of climacteric symptoms for the prevention and treatment of postmenopausal osteoporosis with no increased risk of thrombosis and with the advantage of positive side effects during the treatment.

Estrogen Replacement Therapy↗
PubMed2002

[Hormone replacement therapy, proliferation in the breast and risk of carcinoma].

OBJECTIVE: The objective of the study was to investigate the changes of histopathological and immunohistochemical parameters of breast tissue among the HRT users. DESIGN: Prospective, pilot study. SETTING: Departments of Gynecology and Obstetrics, Pathology and Radiology of the 2nd Medical School, Charles University and the Teaching Hospital Motol, Praha 5, Czech Republic. METHODS: The samples of breast issue were obtained by core cut biopsy and during the breast surgery procedures in the study group of HRT users (no = 48) and in the control group of women without HRT (n = 22). Proliferation index (Ki-67), expression of ERB2 oncoprotein and hormonal receptors (ER, PR) were examined in the breast tissue in addition to routine histopathological examinations. RESULTS: We did not record increasing frequency of proliferative and precancerous lesions in the group of HRT users. Ki-67 expression was very low both in HRT users and in the control group of women. The values of estrogen receptors expression in breast tissue samples of women with HRT were similar to the findings in the normal breast. The values of progesterone receptor expression were higher among the HRT users then non-users, but it can be considered as a normal response of breast tissue to hormonal influence. Expression of ERB protein in HRT users was similar to that found in non-users. CONCLUSION: The findings indicate that HRT has not increased the proliferation rate of the breast tissue in our study group, so this mechanism certainly does not increase the risk of breast cancer.

Aged↗
PubMed2001

[Regression of hCG in various types of molar pregnancies--clinical course and prognosis].

OBJECTIVE: To evaluate spontaneous regression curves of hCG serum positivity in patients with surgically treated molar pregnancies. Comparison of complete, partial and invasive mole. The study should result in optimalisation of follow up criteria of molar pregnancies in respect to their potential malignant change. DESIGN: Retrospective comparative clinical study. SETTING: Obst. Gyn. Dpt., Oncogynecology div., 2nd Medical Faculty, FNM, Charles University Prague, Pathology Dpt., 2nd Medical Faculty, Institute of Biology and Medical Genetics. METHODS: Evaluation of spontaneous regression curves of serum hCG levels in 104 molar pregnancies. 46 patients with partial hydatiform mole, 48 patients with complete hydatiform mole, 10 patients with invasive mole. Serum hCG levels were detected by radioimunoassay (RIA) in the first period and imunochemoluminisent assay (LIA) in the second period. Regression curves of hCG positivity in particular moles were statistically evaluated by Fischer test and t-test. RESULTS: There is statistically significant difference in spontaneous regression of hCG positivity in different types of molar pregnancies. Recommended criteria for gestational trofoblastic disease (GTD) diagnosis and follow up are fully applicable in clinical practice. There is exception in partial hydatiform moles, where plateau in hCG regression does not necessarily implicate chemotherapy in patient with good compliance. CONCLUSION: Early diagnosis of GTD predominantly due to the widespread use of ultrasonography changes classical clinical features of molar pregnancies. Spontaneous regression in hCG positivity in serum is more rapid in patients with partial hydatiform mole, slower in complete hydatiform mole and invasive mole. There is no significant change in malignant potential regarding early detection and treatment.

Chorionic Gonadotropin↗
PubMed1999

Human papillomavirus genotype spectrum in Czech women: correlation of HPV DNA presence with antibodies against HPV-16, 18, and 33 virus-like particles.

Because the biological spectrum of human papillomavirus (HPV) genotypes present in cervical cancer lesions varies according to the geographical region studied, and because little genotype information is available for Central and Eastern European countries, we studied the endemic HPV-genotype spectrum in cervical samples collected from women visiting gynaecological departments of selected hospitals in the Czech Republic. In a series of 389 samples, 171 (44.0%) were positive for HPV DNA using a consensus-primer polymerase chain reaction (PCR). Genotyping of the HPV PCR products was done using dot-blot hybridisation with type-specific oligonucleotide probes and thermocycle DNA sequencing. Twenty-two different HPV types were detected, HPV-16 being the most prevalent type irrespective of severity of the lesions (55.0%). Multiple HPV types were found in 16.4% of our HPV-DNA-positive samples. The prevalence of HPV infection was 23.0% in women with normal findings and 59.4% in patients with cervical neoplasia, and increased significantly with the severity of the disease: 52.9% in low-grade lesions, 58.0% in high-grade lesions, and 73.5% in cervical carcinomas (P for trend < .00001). In the sera of 191 subjects, 89 with normal findings and 102 with different forms of cervical neoplasia, the prevalence of HPV-specific IgG antibodies was tested by an enzyme-linked immunosorbent assay (ELISA) using virus-like particles (VLPs) of HPV-16, -18, and -33. Antibodies were significantly more prevalent in HPV-DNA-positive than in HPV-DNA-negative women and there was no association with age. In agreement with the results of HPV genotyping, antibodies reactive with HPV-16 VLPs were the most frequent and, moreover, their prevalence increased with the cervical lesion severity. About half of the subjects with smears in which either HPV-16 or HPV-33 DNA had been detected possessed antibodies reactive with homotypic VLPs. With HPV-18-DNA-positive subjects, however, fewer than 25% displayed homotypic antibodies. In general, subjects older than 30 years of age had antibodies reactive to HPV-specific VLPs more often than subjects younger than 30 years of age. In women with benign findings, the seropositivity to HPV-16, -18, and -33 VLPs increased with age, whereas in women with cervical neoplasia the seropositivity decreased with age.

Adult↗
PubMed1999

The frequency of HLA-DRB1 and -DQB1 alleles in cervical cancer cases in the Czech Republic.

The distribution of HLA class II DRB1 and DQB1 alleles in cervical carcinoma patients was compared with the frequency of these alleles found in healthy population living in the Czech Republic. The RFLP analysis and PCR-SSP were used for DNA typing. Although the differences in the frequency of DRB1*03, DQB1*02 and DQB1*0303 alleles between the cases and the controls were rather large, corrected P values did not reach significance.

Adult↗
PubMed1997

[Squamous intraepithelial lesions in young female university students].

The authors investigated the frequency of squamous intraepithelial lesions (SIL) in young women, in particular university students with special attention to morphological signs of the presence of human papilloma virus (HPV) in SIL low grade-SIL, LG-HPV. As compared with data in the world literature, they revealed a significantly lower rate of SIL LG, HPV-2.81% as compared with 5.5% reported in WHO studies of young women. The authors analyzed the biological behaviour of SIL, LG-HPV. As compared with data in the literature on known values of spontaneous regression which are 50-62% in the course of three years, they demonstrated during a time interval from 3 months to 2 years spontaneous regression in 39.1%. Further possibilities of regression in a longer time interval are expected in the group of clinically latent cytologically persistent LG lesions (18.1%) and in the group of patients which after termination of their studies were lost from the records (24.3%). During the investigated time interval no case of progression to a higher grade lesion was recorded. The authors reflect on diagnostic and therapeutic procedures with regard to the application of results of HPV typing.

Adolescent↗