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Biomedical subjects

M Halaska

Publications and source records attributed to M Halaska.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Treatment of urinary stress incontinence in women with a periurethral implant].

OBJECTIVE: The aim of this article is the comprehensive information about different bulking substances and their use for the treatment of genuine stress urinary incontinence in women. DESIGN: The review summarizes various materials used for this purpose, methods of their application, possible complications and results of clinical studies of implants. SETTING: Department of Obstetrics and Gynaecology of Charles University and Faculty Hospital Bulovka takes part in the development of the new metacrylate of Czech origin. SUBJECT AND METHOD: Current scientific literature as listed in the article. CONCLUSION: Implants seem to be a useful alternative method in the treatment of the genuine stress incontinence in women.

Adipose Tissue↗
PubMed2002

[Hydrogen expandable implants in the treatment of stress incontinence in women--a pilot study].

OBJECTIVE: The aim of the study was to evaluate the use of new-type implants for the treatment of female urinary stress incontinence. The patients with intrinsic sphincter deficiency were also included, the other were after previous surgery for GSI. DESIGN: Original article. SETTING: Departments of Obstetrics and Gynaecology, Faculty Hospital Na Bulovce and General Faculty Hospital, 1. Faculty of Medicine, Charles University, Prague, Institute of Macromolecular Chemistry, Czech Academy of Science, Prague. METHODS: We operated 9 patients, two of them with type III (McGuire) urinary stress incontinence the rest after operations for GSI in general anesthesia. Six to nine hydrogel swelling implants were introduced into the submucosa of proximal urethra under the transrectal ultrasound guidance. We evaluated the effect 6 to 9 months after the operation. RESULTS: Two patient were dry (negative stress-test and pad-weight test), one patient had substantial improvement, 4 had mild improvement and 2 did not notice any change. We found de novo urge symptoms in four patients, two of them were of the motor type. CONCLUSION: The new type of implants reached the success rate of other currently used materials. The improvement of stress incontinence was on the cost of de novo urge symptoms in some patients. The urgency was successfully managed with spasmolytic drugs.

Female↗
PubMed2002

[Photodynamic therapy of benign viral vulvar lesions].

OBJECTIVE: The aim of the study was to evaluate the use of the photodynamic effect in the treatment of genital warts in women. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology, Hospital Na Bulovce, 1st Faculty of Medicine, Charles University, Prague. METHODS: Twenty-five women with genital warts (HPV infection), which were verified by biopsy, were involved into the study. The affected area was treated by ten milligrams of the 5-aminolevulinic acid in three milliliters of gel for 8 hours. Red light with the 630 nanometers wavelength was applied for 15 minutes, with calculated energy intake 30 J/cm2. RESULTS: All women were free of symptoms and had negative colposcopy in the followed period of 3 to 12 months. On average 3.8 sessions were necessary to reach the remission. It was possible to repeat the session after two weeks time. During the application of light, 17 (68%) of the patients felt either no or slight burning sensation, 6 (24%) had unpleasant but bearable sensation and 2 patients had to be treated in short intravenous anesthesia. CONCLUSION: Photodynamic therapy (PDT) is a promising modality in the treatment of HPV vulvar lesions and can be considered to be a method of choice.

Adolescent↗
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

Ultrasound imaging of the lower urinary system in women after Burch colposuspension.

OBJECTIVE: Most of the relevant surgical procedures employed in the management of genuine stress urinary incontinence (GSI) involve the technique of bladder neck elevation. The appropriate level of suspension is an important (but frequently overlooked) consideration as the clinical consequences of over-correction of the posterior angle are voiding dysfunction and urgency symptoms. The aim of our study was to compare ultrasound characteristics in women with GSI with those of women before and after Burch colposuspension. The findings of our study should have implications for GSI management. DESIGN: Prospective randomized clinical study at the Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. METHODS: Seventy women with previously untreated GSI (preoperative group) and 52 women (42 of whom had been in the preoperative group) who were studied 3-12 months after receiving Burch colposuspension (postoperative group) took part in the study. The standard transperineal and introital ultrasound scans were performed. The mobility of the bladder neck was assessed transperineally with a curved array probe after instillation of 300 mL of saline. The bladder was then evacuated and the thickness of the urinary bladder wall in the sagittal plane in defined regions (base, vertex and anterior wall) was measured. RESULTS: We found significant differences in bladder neck position, mobility, and in bladder wall thickness. Where symptoms of urgency occurred, the average bladder wall thickness was > 5 mm, the gamma angle < 40 degrees, and lower bladder neck mobility was evident. CONCLUSION: These findings supported our hypothesis that signs of urgency follow over-elevation of the bladder neck. These results helped us significantly to refine our GSI management.

Case-Control Studies↗
PubMed2001

[Psychology of urinary incontinence. I. Comparison of women with urgent and stress incontinence before initiation of therapy].

OBJECTIVE OF STUDY: Comparison of psychological characteristics of untreated female patients with urgent and stress urinary incontinence. DESIGN: First stage of a perspective comparative study. SETTING: Gynaecological and Obstetric Department of the Municipal Hospital Neratovice, Urogynaecological out-patient dept. of the Institute for Mother and Child in Prague-Podolí, the Urogynaecological out-patient dept. of the Gynaecological and Obstetric Clinic of the First Medical Faculty Charles University and General Faculty Hospital Prague. METHODS: The study compares a group of 54 patients with stress incontinence and a group of 16 patients with urgent incontinence. Before the onset of therapy the patients were examined by a series of psychodiagnostic tests: MMPI/100 (Minnesota Multiphasic Personality Inventory, abridged version), STAI (State-Trait Anxiety Inventory), SCL-90 (Symptom Check List), Lüscher's colour test, guided interview. For statistical evaluation the sign test and t-test were used. RESULTS: In the MMPI/100 and SCL-90 questionnaires a significant difference was found, i.e. a greater psychopathology in women with urgent incontinence (in both instances p < 0.01). The two groups did not differ in any single scale. STAI and the interview did not reveal any significant differences with the exception of greater importance of sexual contact in women with urgent incontinence (p < 0.05). CONCLUSION: In the group of women with urgent incontinence a higher non-specific psychopathology was proved as compared with women with stress incontinence.

Adult↗
PubMed2001

[Magnetic resonance in urogynecology].

OBJECTIVE: The aim of the study was to review the use of the MRI in urogynaecology and to describe an original method for the construction of 3D computer models of pelvic floor. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynaecology, Institute of Sexuology, 1st Faculty of Medicine, Charles University, Prague, Department of Radiodiagnostics, Charles University, Hradec Králové. METHODS: A review of the use of the MRI in urogynaecology was made. A new method was introduced for creation of computer 3D models of female pelvis based on the data obtained by the MRI. RESULTS: Five complex computer models of the female pelvic organs and pelvic floor were created. Many so far estimated details were visualized. CONCLUSION: The use of MRI in urogynaecology can bring important data about the functional anatomy of female pelvic floor.

Computer Simulation↗
PubMed2000

Efficacy and cardiac safety of propiverine in elderly patients - a double-blind, placebo-controlled clinical study.

The study investigated the efficacy and cardiac safety of propiverine in the elderly, because the induction of life-threatening ventricular arrhythmia has been reported for some drugs prescribed in the therapy of urinary incontinence. Ninety-eight patients (21 male, 77 female; 67.7+/-6.3 years of age) suffering from urgency, urge incontinence or mixed urge-stress incontinence were included in the double-blind, multicentre, placebo-controlled, randomized study. After a 2-week placebo run-in period, the patients received propiverine (15 mg t.i.d.) or placebo (t.i.d.) for 4 weeks. Before (V1, V2) and during the treatment period (V3, V4), standard ECGs and 24-hour long-term ECGs were recorded. Propiverine caused a significant reduction of the micturition frequency (V2: 8.7+/-4.2, V4: 6.5+/-3.2 ml; p< or =0.01), reflected in a significant increase in the average micturition volume (V2: 163.5+/-65.9, V4: 216.3+/-101.5 ml; p< or =0.01) and a significant decrease in episodes of incontinence (-54%; p = 0.048). These findings were confirmed by the overall assessment at V4, in which approximately 90% of patients under propiverine either had no urge incontinence or urge symptoms, or showed improvement. Resting and ambulatory electrocardiograms indicated no significant changes. Neither the frequency-corrected Q-T interval nor other cardiac parameters were relevantly altered. The frequency of cardiac events (Lown classes IVa/b) was random, revealing no difference between placebo and propiverine. The incidence of adverse events was very low (2% dryness of the mouth under propiverine) and confirmed by the findings from the quality of life questionnaires. A favourable benefit-risk ratio without the induction of any cardiac arrhythmia in the treatment of elderly patients suffering from urgency, urge incontinence or combined urge-stress incontinence is therefore proven for propiverine.

Age Factors↗
PubMed2000

[Suspension of the lower third of the urethra in ambulatory practice--minimally invasive treatment of urinary stress incontinence--technique and initial experience].

OBJECTIVE: The aim of the article is the presentation of a new, mini-invasive method for the treatment of urethral incompetence in women--TVT (tension-free vaginal tape). DESIGN AND SETTING: The design was a prospective comparison of the first 10 patients at the Department of Obstetrics and Gynaecology of the 1st Medical Faculty and General Faculty Hospital in Prague where urethral incompetence = genuine stress incontinence regardless of their history was diagnosed consecutively. METHODS: We present the technique of the operation, examination procedure including the application of dynamic magnetic resonance before and after operation at rest and under Valsalva, the subjective and objective outcome in the analyzed group. We compare also the parameters of urethrovesical junction mobility in the MR image and discuss their importance for the new continence mechanism in the TVT method. RESULTS: All patients are 10-18 months after the operation continent. The functional morphology of the lower urinary tract and of the pelvic floor on the MR image after TVT did not reveal any relevant changes in bladder neck dynamic mobility. CONCLUSION: The experience of other authors concerning possible complications, postoperative care and results are evaluated; they are without exception positive.

Ambulatory Surgical Procedures↗
PubMed2000

[The effect of bladder filling on changes in ultrasonography parameters of the lower urinary tract in women with urinary stress incontinence].

OBJECTIVE OF THE STUDY: Was to evaluate the effect of filling the bladder on position and mobility of UV junction, and to determine other possible changes of measured ultrasound parameters of the lower urinary tract in relation to filling of the bladder. TYPE OF STUDY: Prospective randomized clinical study. NAME AND ADDRESS OF THE WORKPLACE: Department of Gynaecology--Obstetrics, 1st Faculty of Medicine of Charles University and VFN in Prague. METHODOLOGY: 20 women were included in our study with proved stress incontinence of urine ("GSI"). Their average age was 46 years, average weight 70 kg, average parity 1.57. Perineal and introital ultrasound examination was performed in a supine position, using Acuson 128 XP 10 equipment, a convex probe of 5 MHz frequency and a vaginal probe of 7.0 MHz. Position and mobility of UVJ was monitored based on the following parameters: angle gamma, abscissas p, h, x, y. Bladder filling was 300 ml, 200 ml and empty bladder. RESULTS: Statistically significant differences were observed in UVJ mobility during contractions of pelvic floor muscles between measurements, when the bladder contained 300 ml of liquid, or was empty (p = 0.00983). UV-junction of and empty bladder is higher during a contraction, and the mobility is greater (p = 0.006). Distances x, y, p in case of an empty bladder are shorter during contraction and the gamma angle is smaller (p = 0.01). The thickness of the bladder wall was greater in an empty bladder (p = 0.01). Changes in area and thickness of the urethral sphincter were not significant. CONCLUSIONS: Based on our preliminary results we can state that a bladder filling of 300 ml is not significant for evaluation of UV-junction mobility. Rather the opposite; a higher mobility of UV-junction was observed with an empty bladder. Monitoring of the inner orifice of the urethra with an empty bladder presents a slight problem. To evaluate vesicalisation of the proximal urethra and to confirm insufficiency of the inner sphincter (ISD), a filling in the bladder is necessary. The thickness of the bladder wall is measured with an empty bladder.

Female↗
PubMed2000

[Ultrasonography of the funneling of the urethra].

OBJECTIVE: The objective of the study was to evaluate possibilities of using contrast substances during transperineal urogenital ultrasound examination. DESIGN: Prospective, pilot study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University, Prague. METHODS: 28 women with stress of incontinence were included in the study. For all women, position and mobility of the bladder neck and funneling of urethra was evaluated by transperineal ultrasound examination, and, subsequently, by ultrasound contrast substance examination. Both examinations were compared. During the Valsalva manoeuvre, the contrast substance enters the proximal urethra and allows a more exact diagnosis of urethra funneling than in the case of examination without the use of contrast substance. When using contrast substance, funneling was diagnosed in 25 patients compared to 7 patients subjected to common transperineal examination. CONCLUSION: Using contrast substance significantly improves visualisation of urethra funneling and opens new possibilities in diagnosing stress incontinence.

Contrast Media↗
PubMed2000

[Ultrasonic evaluation of paravaginal defects before and after surgical treatment in women with urinary stress incontinence].

OBJECTIVE: The aim of our study was to analyze whether transabdominal and introital ultrasonography can accurately identify paravaginal defect associated with GSI (Genuine stress urinary incontinence) and to determine the changes after paravaginal defect repair. DESIGN: Prospective randomised clinical study. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. METHODS: Sixteen women with GSI, who had previously not undergone anti-incontinence surgery were involved. Their average age was 52 years, average weight 71 kg and average parity 2.0. Within vaginal examination our attention was focussed on the diminution of sulsus superioris vaginae during Valsalva maneuver. The bladder of a patient in supine position was filled with 300 ml of sterile saline. Than a 5 MHz curved array probe was used to assess the bladder neck mobility from the perineal approach, and the same probe was used from the abdominal approach to determine paravaginal defect and subsequently a vaginal probe from introital approach was used for the rest of the examination. After Burch colposuspension and paravaginal defect repair US scanning was performed 6 till 8 days and 5 or 6 weeks after operation. RESULTS: We found significant differences in bladder neck position and mobility before and after the operation. In women with symptoms of GSI we found from abdominal approach unilateral or bilateral paravaginal defect in fifteen women. Unilateral defect was found on the right side six times and on the left side only once. In eight women the defect was bilateral. The introital approach obtained similar results, only in two patients with bilateral defect the examination concluded unilateral right defect. After the operation we did not find PVD in patients after paravaginal defect repair. We obtained worse results from vaginal examination, where preoperatively PVD was correctly determined (sensitivity) only in 82.6%. CONCLUSION: From our preliminary results we can suggest performing US scanning to conform paravaginal defect before anti-incontinence surgery and possibly adding to the Burch colposuspension paravaginal defect repair to correct cystourethrocele.

Female↗
PubMed2000

[The suspensory system of the vagina--present views].

OBJECTIVE: To describe vaginal support levels according to the DeLancey's classification, their appearance in transversal magnetic resonance images and clinical categories caused by their defects. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University, Prague; Department of Radiodiagnostics, Charles University, Medical Faculty in Hradec Králové. METHODS: A review of literature, examinations of female pelvis with magnetic resonance imaging (MRI) and 3 dimensional computer reconstructions were made. RESULTS: We performed 20 MRI studies and 5 computer spatial reconstructions of female pelvis. Selected results of a review of literature and our MRI examinations were correlated with various types of vaginal descensus. CONCLUSIONS: The questions about the supporting structures of female vagina are still not fully answered. Great advance was achieved by some recent pathological studies and by the introduction of modern magnetic resonance units in this field. The DeLancey's classification goes well in accord with clinical examination, imaging methods and cadaver studies.

Female↗
PubMed1999

A placebo-controlled, multicentre study comparing the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence.

OBJECTIVE: To assess the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence in a randomized, double-blind placebo-controlled clinical trial. PATIENTS AND METHODS: In all, 366 patients (149 on propiverine, 145 oxybutynin and 72 placebo, ratio 2:2:1) with urgency and urge incontinence were recruited in 32 study centres. Propiverine (group 1, 15 mg three times daily), oxybutynin (group 2, 5 mg twice daily) or placebo (group 3) were administered for 4 weeks, using the double-dummy technique. The dosages were selected specifically to compare the tolerability profile of propiverine with the commonly used therapeutic dosage of oxybutynin. Tolerability was assessed by directly questioning the patients about adverse events at four visits (V-1 before and V0 after a 1-week 'washout' period, V1 after 1 week and V4 after 4 weeks of treatment) during a 5-week surveillance period, and by tolerability ratings of the physicians. Efficacy was assessed using urodynamics at V0 and V4, evaluating the cystometric bladder capacity at maximal and first desire to void, and postvoid residual urine, according to the criteria of the International Continence Society. Additionally, a voiding protocol, overall assessment of clinical symptomatology and efficacy ratings by the physicians were documented. RESULTS: A remarkably high percentage of adverse events was reported in the washout period (VO: 13%, 16% and 18% in groups 1-3, respectively). At V4, the clinically most relevant symptom (dry mouth) occurred in 53% of patients in group 1, in 67% of group 2 and in 28% of group 3. Furthermore, dry mouth was less severe in group 1 than group 2. In contrast to groups 2 and 3, only patients in group 1 showed increasing tolerability during the treatment (from V1 to V4). These tolerability results were further supported by the overall tolerability assessment ('very good' or 'good' tolerability in 67% of group 1, in 59% of group 2 and in 83% of group 3). The urodynamic assessment of efficacy (comparing V0 and V4) showed a statistically significant increase in the mean (sd) maximal cystometric bladder capacity in group 1, being 222 (77) mL at V0 and 311 (125) mL at V4, an increase of 89 (108) mL, and in group 2, at 226 (75) mL and 322 (123) mL, an increase of 96 (106) mL, compared with group 3, at 211 (77) mL and 263 (93) mL, an increase of only 52 (92) mL. The cystometric bladder capacity at first desire to void also increased in group 1 (93 to 160 mL) and group 2 (89 to 160 mL), whereas in group 3 there were only minor changes (93 to 120 mL). Changes in the residual urine volume within and between the treatment groups were minimal and clinically irrelevant. The overall assessment of efficacy showed significant differences between the drugs when compared with placebo. CONCLUSION: Propiverine is a safe and effective drug in the treatment of urgency and urge incontinence; it is as effective as oxybutynin, but the incidence of dry mouth and its severity is less with propiverine than with oxybutynin. The availability of alternative pharmacotherapeutics such as propiverine should reduce the therapeutic failure rate and improves the success rate in the treatment of patients suffering from urgency and urge incontinence.

Benzilates↗
PubMed1999

Treatment of cyclical mastalgia with a solution containing a Vitex agnus castus extract: results of a placebo-controlled double-blind study.

In a placebo-controlled, randomized, double-blind study the efficacy of a Vitex agnus castus extract-containing solution (VACS) was investigated in patients suffering from cyclical mastalgia. Patients had mastalgia on at least 5 days in the pre-treatment cycle. During this cycle and during treatment (3 cycles; 2 x 30 drops/day), the intensity of mastalgia was recorded once per cycle using a visual analogue scale (VAS). After one/two treatment cycles, the mean decrease in pain intensity (mm, VAS) was 21.4 mm /33.7 mm in women taking VACS (n=48) and 10.6 mm/20.3 mm with placebo (n=49). The differences of the VAS-values for VACS were significantly greater than those with placebo (p=0.018; p=0.006). After three cycles, the mean VAS-score reduction for women taking VACS was 34.3 mm, a reduction of 'borderline significance' (p=0.064) on statistical testing compared with placebo (25.7 mm). There was no difference in the frequency of adverse events between both groups (VACS: n=5; placebo : n=4). VACS appears effective and was well tolerated and further evaluation of this agent in the treatment of cyclical mastalgia is warranted.

Clinical Trial↗
PubMed1999

[Ultrasound imaging of the lower urinary tract in post-menopausal women with urinary stress or combined type of incontinence before and after intravaginal administration of estriol].

The finding that climacteric symptoms are caused mainly by a decline of the oestrogen level and that their development can practically always be prevented by long-term local or general oestrogen treatment was a great asset to the treatment of this problem. Oestriol, a less effective natural oestrogen, has a favourable effect on urogenital tissues without stimulating the endometrium [2]. The objective of the present investigation was to analyze ultrasonographic parameters of the lower urinary tract in women after the menopause with the stress or mixed type of urinary incontinence before and after two-month local oestriol treatment (Ovestin). The trial comprised 40 women with confirmed stress (GSI) or the mixed type of urinary incontinence. The group with GSI comprised 124 patients and the group suffering from the mixed type of incontinence comprised 26 women. The type of incontinence was assessed by urogynaecological examination. This was followed by transperineal and introital ultrasound examination of patients in a supine position by means of an Acuson 128 XP10 apparatus using a convex probe with a frequency of 5 MHz and a vaginal probe with a frequency of 7.0 MHz. Assessment of the position and mobility of the urethrovesical junction was implemented by the transperineal route using a convex probe and filling the bladder with 300 ml. After urination followed assessment of the urethral sphincter by the introital route in a vertical plane whereby the authors followed the anterior and posterior surface of the rhabdosphincter, and in a horizontal plane its left and right surface (10). The authors assessed also in both planes the maximal thickness of the sphincter. In the vertical plane and in a proximal position in relation to the urethra they evaluated the vascular supply qunatitatively (minimal-1 to very abundant-4) and also the arterial flow-the pulsatile index PI was investigated as well as the resistance index RI. In the vertical plane 1 cm from the urethrovesical junction the authors assessed the thickness of the urethral mucosa; at the same level they evaluated the thickness of the urinary bladder wall; the anterior wall, the vertex and the area of the trigone. They assessed also the thickness of pelvic floor muscles. The assessments were made before and after two-month intravaginal oestriol administration (Ovestin crm)-two weeks 0.5 mg/day and then 0.5 mg twice a week. After treatment no statistically significant differences in thickness and areas of the urethral sphincter were found nor in the thickness of the pelvic floor muscles before and after oestriol administration. Statistically significant differences were recorded in the mobility of the urethrovesical junction and there was a significant increase in the thickness of the urethral mucosa and a more abundant vascularization was recorded during the quantitative evaluation and evaluation of PI. In women with the mixed type of incontinence after oestrogen treatment a decline in the thickness of the urinary bladder was found. Ultrasound examination of the lower urinary tract before and after oestriol treatment (Ovestin crm) is a useful supplement of common examination methods and it confirms its favourable therapeutic effect when administered by the intravaginal route.

Administration, Intravaginal↗