Biomedical subjects

M Kudela

Publications and source records attributed to M Kudela.

At least 19 recordsLinked to original sources

PubMed2006

[Development of incidence of post-dural puncture headache in patients undergoing caesarean section in spinal anaesthesia at the Department of Obstetrics and Gynecology in Olomouc during 2003-2004].

BACKGROUND: Paper gives the analyse of the incidence of post-dural puncture headache in patients undergoing caesarean section in spinal anaesthesia at the Department of Obstetrics and Gynecology in Olomouc in 2003-2004. METHODS AND RESULTS: Post-dural puncture headache following caesarean section in spinal anaesthesia in 2003 was retrospectively analysed. Subsequently, measures to reduce the incidence of this complication (use of Whitacre and Atra ucan needles) were implemented. 2004 patients were followed prospectively. 54 caesarean sections - 16.3% (54/331) were performed in spinal anaesthesia in 2003. Following needles were used to establish spinal blockade: Quincke 22G - 35.2% (19/54), Quincke 25G - 50% (27/54), Atraucan 26G - 14.8% (8/54). Post-dural puncture headache occurred in 9 cases - 16.6% (9/54) (22G - 7x, 25G - 2x), the onset of symptoms occurred after 24 to 65 hours after the spinal blockade (mean 41.7). It was necessary to perform epidural blood patch (EBP) in 7 cases - 77% (7/9) - 12.9% (7/54) (22G - 5x, 25G - 2x). Epidural blood patch (EBP) was performed after 7 to 45 hours after the onset of symptoms (median 28.4). The age of patients at the time of delivery ranged between 22 to 43 years (median 34.5). 36 caesarean sections - 8.4% (36/426) were performed in spinal anaesthesia in 2004. Following needles were used to establish spinal blockade: Whitacre 27G - 63,9% (23/36), Atraucan 26G - 13,9% (5/3), Quincke 25G - 11,1 (4/36), Quincke 22G - 11,1% (4/36). Post-dural puncture headache (PDPH) occurred in 3 cases - 8.3 (3/36) (25G - 1x, 22G - 2x), the onset of symptoms occurred after 24 to 54 hours after spinal blockade (median 36.0). It was not necessary to perform epidural blood patch. The age of patients at the time of delivery ranged between 22 to 39 years (median 28.5). CONCLUSIONS: Incidence of post-dural puncture headache (PDPH) is significantly higher in pregnant women and in puerperal period compared to general population. The use of appropriate needles for spinal blockade and adequate level of anaesthesiologist's skills lead to lower incidence of post-dural puncture headache (PDPH) after caesarean section performed in spinal anaesthesia.

Adult↗

PubMed2006

[Prevention of Rh (D) alloimmunization in Rh (D) negative women in pregnancy and after birth of Rh (D) positive infant].

OBJECTIVE: The objective of this review was to assess the effects of antenatal anti-D immunoglobulin on the incidence of Rhesus D alloimmunization when given to Rh-negative women without anti-D antibodies and assess the effects of giving anti-D to Rhesus negative women, with no anti-D antibodies, who had given birth to a Rhesus positive infant. DESIGN: A review article. SETTING: Department of Obstetrics and Gynecology, Department of Medical Genetics and Fetal Medicine, University Hospital, Olomouc, Ministry of Health, Czech Republic. SUBJECT AND METHOD: We searched the Cochrane Pregnancy and Childbirth Group trials register, refence lists of relevant articles and bibliographies. CONCLUSION: The risk of Rhesus D alloimmunization during or immediately after a first pregnancy is about 1%. Administration of 100 microg (500 IU) anti-D to women in their first pregnancy can reduce this risk to about 0.2% without, to date, any adverse effects. Anti-D, given within 72 hours after childbirth, reduces the risk of RhD alloimmunization in Rhesus negative women who have given birth to a Rhesus positive infant. However the evidence on the optimal dose is limited.

Female↗

PubMed2006

[Sentinel lymph node detection using 99mTc-nanocolloid in endometrial cancer].

OBJECTIVE: The aim of this study was to evaluate the feasibility of pre-operative lymphoscintigraphy and radio-guided surgery in endometrial cancer patients after intramyometrial administration of labelled colloid. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology of the Palacký University Medical School and University Hospital, Olomouc, Czech Republic. PATIENTS AND METHODS: Between April 2002 and March 2005, thirty three patients with endometrial cancer received pre-operatively 50 MBq of 99mTc-nanocolloid. The radiopharmaceutical agent was administered by a 25 Gauge needle transcervically into the myometrium. Subsequently, series of static lymphoscintigrams were made 20 to 90 min after injection. Two hours after injection the surgery started. Twenty eight patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Five patients were scheduled for laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Paraaortal lymphadenectomy was performed in 11 cases. A gamma detecting probe was used to locate radioactive lymph nodes during operation. Each hot lymph node was removed separately. RESULTS: Sentinel lymph nodes (SLN) were identified in 26 (79%) of 33 patients. The mean number of sentinel nodes detected was 2.9 (range 1-10). Seventy two (15.3%) of 472 nodes obtained in total, were identified as radioactive-colloid positive. Histopathological analysis revealed five (7%) of 72 lymphonodes to be positive of metastases. Sentinel nodes in paraaortic area were identified in 11 (33%) patients. No false negative sentinel lymphonodes were observed. CONCLUSION: The preoperative lymphoscintigraphy and intraoperative gamma probe guided biopsy may be useful in identifying sentinel nodes in endometrial cancer. No false negative sentinel lymphonodes were observed if representative SLNs were diagnosed with tumor.

Adenocarcinoma↗

PubMed2006

[Etiopathogenesis of the prolapsed vaginal vault after hysterectomy].

OBJECTIVE: To determine the main etiopathogenic factors which may participate in the development of vaginal prolapse after hysterectomy. DESIGN: A retrospective study. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of the Palacký University and University Hospital, Olomouc. METHODS: The analysis of relevant factors which can participate in the origin and development of vaginal prolapse was carried out on the group of 51 patients treated for vaginal prolapse after hysterectomy performed in the years 2002 to 2005. The data were retrieved retrospectively from medical documentation and appended by the information obtained from questionnaires send to the patients. RESULTS: Factors participating in the development of vaginal prolapse can be divided into 3 groups: 1. Mistakes in surgical technique and complications in the post-operative period, 2. inherited qualities of patients, and 3. impact of adverse external factors. CONCLUSIONS: Several factors are involved in the etiopathogenesis of vaginal prolapse, the most important of which are the inherited qualities of patients, incorrect surgical technique and adverse outcome in the post-operative period.

Adult↗

PubMed2006

[Molecular prognostic factors and pathogenesis of endometrial cancer].

OBJECTIVE: To evaluate the importance of molecular markers for prognosis and pathogenesis of endometrial carcinoma. DESIGN: A review article. SETTING: Department of Medical Genetics and Fetal Medicine, University Hospital, Olomouc, Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: This article reviews the current knowledge of the molecular changes in the development of endometrial cancer, and their possible importance for the patient's prognosis. CONCLUSION: The new molecular biomarkers are apparently going to play a significant role in the management of endometrial carcinoma treatment in the near future.

Biomarkers, Tumor↗

PubMed2006

[Preoperative assessment of myometrial invasion in endometrial cancer patients by ultrasonography and magnetic resonance imaging (MRI)].

OBJECTIVE: To compare the accuracy of transvaginal sonography and magnetic rezonance imaging (MRI) in determining the depth of myometrial invasion in proven cases of endometrial cancer. DESIGN: A prospective study. SETTING: Department of Obstetrics and Gynecology, Department of Medical Genetics and Fetal Medicine, Department of Radiology, University Hospital, Olomouc. METHODS: Fifty five patients diagnosed as having FIGO stage I endometrial carcinoma were evaluated preoperatively by transvaginal ultrasound; 44 cases of the same group were also evaluated by magnetic resonance imaging (MRI). The degree of invasion evaluated by transvaginal sonography and by MRI was compared to the pathological specimens. RESULTS: Transvaginal sonography was successful in evaluating myometrial invasion in 44 of 55 cases (accuracy 80%, sensitivity 80%, specificity 88%, positive predictive value 77%, negative predictive value 87%). Evaluation with MRI was accurate in 37 of 44 cases (accuracy 84%, sensitivity 84%, specificity 91%, positive predictive value 81%, negative predictive value 91%). CONCLUSION: Although MRI is superior to transvaginal sonography in evaluating myometrial invasion, it is expensive and time consuming, and would not be suitable as a screening test for depth of invasion. On the other hand, transvaginal sonography is relatively low-cost technique, which can be easily performed and repeated. However, it requires more operator experience than MRI in order to achieve high accuracy.

Carcinoma↗

PubMed2005

[MMP-26 mRNA and estrogen receptor alpha co-expression in normal and pathological endometrium].

OBJECTIVE: To examine the expression pattern of matrix metalloproteinase-26 (MMP-26) mRNA and estrogen receptor-alpha (ER alpha) in normal, hyperplastic, premalignant and malignant endometrial tissue. DESIGN: Experimental study. SETTING: Department of Obstetrics and Gynecology of the Palacky University Medical School and University Hospital, Olomouc, Czech Republic, Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden, Atherosclerosis Research Unit, King Gustav V Research Institute, Karolinska Hospital, Stockholm, Sweden. METHODS: We studied MMP-26 mRNA and ER alpha in 36 normal, 7 hyperplastic, 6 premalignant and 19 malignant endometrial samples. Based on histological examination, all normal specimens were classified according to an ideal 28 day menstrual cycle as early, mid, and late proliferative phase, early, mid and late secretory phase and menstrual phase. Samples with hyperplasia were classified as simple or complex. Premalignant samples were represented by complex hyperplasia with atypia. Malignant samples were histologically classified as well, intermediately and poorly differentiated, respectively. Specimens were analyzed using in situ hybridization and real time PCR. ER alpha was localized by immunohistochemistry. RESULTS: Epithelial MMP-26 mRNA expression was highest in the early secretory phase and in endometrial hyperplasia. Expression levels were low in the late secretory and menstrual phase and in malignant samples decreased gradually with dedifferentiation. Expression pattern of MMP-26 mRNA in normal, hyperplastic, premalignant and malignant endometrial tissue strongly co-variated with that of ER alpha. CONCLUSION: Co-expression of MMP-26 and ER alpha in normal and pathological endometrial tissue suggests possible regulation of MMP-26 gene by estrogen.

Adult↗

PubMed2005

[Premature separation of the placenta--etiology and risk factors].

OBJECTIVE: Placental abruption complicates approximately 1% of all pregnancies and remains a significant cause of both maternal and fetal morbidity and mortality. Several risk factors are associated with this complications, but a clear causal relation is diffucult to establish. THE AIM OF THE STUDY: The aim of the study was to determine and identify risk factors for placental abruption. DESIGN: Retrospective cohort study. SETTING: Dept. of Obstetrics and Gynaecology, Medical Faculty of Palacký University, Olomouc. SUBJECT AND METHOD: Retrospectively gathered cohort of 180 women was compared to 198 healthy women. We have focused on anthropometric, sociodemographic, behavioral, obstetric and fetal parameters. Statistical evaluation was done by Statsoft, Inc. (2001) Statistika CZ (Software system data analysis), version 6. RESULTS: The incidence of the placental abruption was 0.89%. We have confirmed the following risk factors as statistically significant (p values are given): Low-degree education (0.00002), prepregnancy weight of the mother (0.00), weight gain in pregnancy (0.00), higher parity (0.0272), smoking (0.03847), preeclampsia (0.00889), chorioamnionitis (0.00), premature rupture of membranes (0.00), recurrent spontaneous abortions (0.00), positive family history of deep venous thrombosis (0.0007) and intrauterine growth retardation (0.0386). CONCLUSION: Placental abruption has a large number of potential risk factors. The true biological cause and its etiopathogenic role is still to be elucidated.

Abruptio Placentae↗

PubMed2005

[Histological grade in management of carcinoma of endometrium].

OBJECTIVE: To correlate histological differentiation of endometrial cancer assessed from material obtained at diagnostic operation (hysteroscopy and targeted biopsy or curettage) and definitive radical surgical treatment. DESIGN: A prospective multicentric study. SETTING: Department of Obstetrics and Gynaecology, Institute of Pathology, Palacký University Medical School and University Hospital, Olomouc. MATERIAL AND METHODS: 237 patients with endometrial adenocarcinoma diagnosed between 1997-2001 were enrolled into this study. Histopathologic differentiation of tumoral tissue obtained at diagnostic and definitive radical operation were compared. RESULTS: Discrepancies in histopathologic differentiation of tumoral tissue obtained at diagnostic and definitive operation were found to be present in 42.2% of grade 1 (G1), 34.8% of grade 2 (G2), and 25.6% of grade 3 (G3) samples. When divided into subgroups, we observed discrepancies in 37.1% of G1, 31.5% of G2, and 26.7% of G3 tumors diagnosed at hysteroscopy and targeted biopsy. In patients with D&C the discrepancies were present in 53.1% of G1, 41.4% of G2, and 23.1% of G3 tumors. CONCLUSIONS: Low correlation between histopathologic differentiation of tumoral tissue obtained at diagnostic and definitive surgery supports the necessity of surgical staging in all patients with endometrial cancer. Primary radiotherapy should be reserved only for patients, in which the surgery is contraindicated.

Adenocarcinoma↗

PubMed2004

[Hysterectomy at the Olomouc Clinic 1989-2002: evolution in the indication spectrum and surgical approach].

OBJECTIVE: Analysis of representation in surgical approaches and techniques to hysterectomy (abdominal hysterectomy, vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy) in our clinic. The evolution of indications, diagnosis and operating approaches from 1989 to 2002 were analysed. DESIGN: Retrospective study. SETTING: Department of Obstetric and Gynecology, University Hospital, Olomouc. METHODS: Retrospective analysis of medical documentation (operating protocols). RESULTS: 3079 hysterectomies were performed in years 1989-2002. Type of hysterectomy in years 1989-1993: abdominal approach 97% (diagnosis: uterine leiomyomas 57%, malignant tumors 28%), vaginal hysterectomy 3% (diagnosis: descensus uteri only). Type of hysterectomy in years 1989-1993: abdominal approach 42% (diagnosis: malignant tumors 65%, uterine leiomyomas 28%), vaginal hysterectomy 48% (diagnosis: uterine leiomyomas 56%, descensus uteri 25%), Laparoscopically assisted vaginal hysterectomy (LAVH) 10%. CONCLUSION: Decreased number of abdominal hysterectomies in women with non oncological diagnosis since 1989 to 2002 and increase of vaginal hysterectomies and LAVH was noted. This complies with the contemporary trends of minimally invasive surgery.

Czech Republic↗

PubMed2004

[Preoperative detection of lymph nodes by means of computer tomography in patients with endometrial carcinoma].

OBJECTIVE: To determine the value of computed tomography (CT) in predicting preoperatively nodal disease in patients with endometrial cancer. DESIGN: A prospective multicentric study. SETTING: Department of Obstetrics and Gynecology of the Palacky University Medical School and University Hospital, Olomouc, Obstetrical and Gynecological Departments of collaborating hospital, Czech Republic. METHODS: A total of 164 women with endometrial carcinoma that was diagnosed between 1998 and 2002 were recruited for this study. Final pathological findings were compared with those of the preoperative CT scans to assess nodal disease. RESULTS: Among 164 women who had preoperative scans and lymph node samplings, sensitivity, specificity, positive and negative predicting values of CT scans at predicting lymph node metastasis was 30, 95.5, 30 and 95.5% respectively. CONCLUSION: Routine preoperative CT scanning is a poor predictor of nodal disease in patients with endometrial cancer. Its preoperative routine use should be discouraged.

Adult↗

PubMed2004

[Novel matrix metalloproteinases in cycling endometrium].

OBJECTIVE: To examine the expression pattern of some novel matrix metalloproteinases (MMPs) in cycling endometrium. DESIGN: Experimental study. SETTING: Department of Obstetrics and Gynecology of the Palacky University Medical School and University Hospital, Olomouc, Czech Republic, Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden. METHODS: We studied MMP-12, -16, -17, -19 and -26 mRNA in 39 normal endometrial samples obtained across the menstrual cycle. Based on histological examination, all specimens were classified according to an ideal 28 day menstrual cycle as early (n=8), mid (n=6) and late (n=7) proliferative phase, early (n=4), mid (n=4) and late (n=8) secretory phase and menstrual (n=3) phase. Cycle variation was examined in frozen samples using in situ hybridization. RESULTS: Three distinct pattern of MMP mRNA expression were detected in cycling endometrium. MMP-12 was expressed predominantly in perimenstrual period, MMP-16, -17 and 19 were expressed throughout the cycle and MMP-26 was found to be maximal in periovulatory period. CONCLUSION: Different endometrial expression patterns of novel MMPs during menstrual cycle may indicate their specific roles for menstruation, endometrial growth and remodelling and implantation.

Adult↗

PubMed2004

[The effectiveness and complications of ovarian transposition in young women with cervical cancer].

OBJECTIVE: To discuss the indications, effectiveness, and complications of ovarian transposition before pelvic irradiation for cervical cancer. DESIGN: A review article. SETTING: Department of Obstetric and Gynecology, University Hospital, Olomouc. SUBJECT AND METHOD: A review from literature and bibliographic databases. CONCLUSION: Ovarian transposition gives an option for preserving ovarian function in patients treated by radiosurgical combination. In young women preservation of ovarian function by means of ovarian transposition brings them some positive benefits compared to conventional HRT. The main risk of ovarian transposition--a possibility of ovarian or distant metastasis--increases particularly depending on clinical stage and histopathological type of the tumor. However the risk of ovarian metastasis is very low for patients with squamosus cell carcinoma of the cervix in stages IA-B.

Adult↗

PubMed2004

[Posthumous sperm procurement and use--ethical and legal dilemmas].

OBJECTIVE: To present a review of bioethical discussion and recommendations concerning posthumous sperm procurement and postmortem parenthood. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Masaryk University, Brno, Department of Obstetrics and Gynecology, Palacky University, Olomouc. SUBJECT AND METHOD: Literature search in Database of Abstracts of Reviews of the Evidence (DARE) and MEDLINEplus. Posthumous sperm procurement and cryopreservation must be performed within 36 hours after death. To established appropriate medical practice, it is important to consider all stakeholders in the decision-making process: the deceased, the requesting party, the child, the physician and the society. There are only few legislative measures concerning postmortem parenthood and posthumous sperm procurement. The essential elements for postmortem reproduction are: judicial order, ethics committee approval, bereavement period of at least 6 month before use. CONCLUSION: Posthumous sperm procurement is fraught with ethical and legal implications. All stakeholder should be considered. Society for reproductive medicine should prepare acceptable standard protocol.

Cryopreservation↗

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

[MMP-26 expression in endometrial explants treated with estradiol and progesterone].

OBJECTIVE: To examine possible estrogen dependent endometrial expression of MMP-26 in vitro. DESIGN: Experimental study. SETTING: Department of Obstetrics and Gynecology of the Palacky University Medical School and University Hospital, Olomouc, Czech Republic, Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden. METHODS: We studied MMP-26 mRNA in 14 normal endometrial samples obtained from the proliferative phase of the menstrual cycle. Samples were cultured for five days either with estradiol alone or in combination with progesterone. Samples cultured with ethanol represented control groups. MMP-26 mRNA expression was examined in frozen samples using in situ hybridization. Immunohistochemistry was used to study the presence of estrogen and progesterone receptors in endometrial explants. RESULTS: MMP-26 mRNA expression was highest in fresh (non cultured) samples. Signal intensity decreased during the first two days of culture and was negligable in the following days. Nuclear intensity for estrogen and progesterone receptor was high after five days of culture. CONCLUSION: We did not find MMP-26 mRNA in vitro expression to be directly estrogen dependent.

Adult↗

PubMed2004

[Endometrial expression profiles of mRNA for selected matrix metalloproteinases and tissue inhibitor of metalloproteinases-1].

OBJECTIVE: To examine the endometrial expression pattern of messenger RNA (mRNA) for selected matrix metalloproteinases (MMP) and tissue inhibitor of metalloproteinases-1 (TIMP-1). DESIGN: Experimental study. SETTING: Department of Obstetrics and gynecology of the Palacky University Medical School and University Hospital, Olomouc, Czech Republic, Department of Obsterics and Gynecology, University Hospital, Luna, Sweden. METHODS: We studied MMP-1, -3, -7, -10, -11, -12, -13, -14, -16, -26 and TIMP-1 mRNA in 39 normal endometrial samples obtained across the menstrual cycle. Based on histological examination, all specimens were classified according to an ideal 28 day menstrual cycle as early (n=8), mid (n=6) and late (n=7) proliferative phase, early (n=4), mid (n=4) and late (n=8) secretory phase and menstrual (n=3) phase. mRNA extracted from frozen tissue samples was quantitated using real time PCR. RESULTS: Four distinct patterns of MMP mRNA expression were detected in cycling endometrium. MMP-1, -3, -10, and -12 were expressed predominantly in perimenstrual period, MMP-7 and -11 had highest levels in proliferative phase, MMP-13, -14 and -16 were expressed throughout the cycle and MMP-26 was found to be maximal in periovulatory period. Levels of TIMP-1 mRNA remained unchanged during the cycle. CONCLUSION: The specific endometrial expression profiles of MMPs during menstrual cycle point to their specific biologic roles during the cycle. MMP-26 exhibits a unique expression pattern.

Adult↗

PubMed2004

[Sacrospinous fixation of the prolapsed vagina after the Miyazaki hysterectomy procedure].

OBJECTIVE: Implementation of a new surgical method for treatment of vaginal prolapse after hysterectomy. DESIGN: The description of a new surgical method. The results in the first 16 patients. SETTING: Department of Obstetric and Gynecology, Medical Faculty of the Palacký University and University Hospital, Olomouc. METHODS: The description of a new surgical method, pointing out the advantages and possibilities of the use in clinical practice. Presentation of the results in the group of 16 patients treated. CONCLUSIONS: Sacrospinous fixation of vaginal prolapse after hysterectomy sec. Miyazaki is a modification of sacrospinous fixation sec. Amreich-Richter. Contrary to the classical procedure this new method has several advantages. It makes easier the exact placement of the stitches to the sacrospinous ligament which decreases the danger of bleeding often substantially complicating the classical procedure. The procedure requires a special instrument, namely the so called Miyazaki hook. The results in the first 16 patients operated on by this method are presented.

Female↗