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Biomedical subjects

M Otcenásek

Publications and source records attributed to M Otcenásek.

At least 19 recordsLinked to original sources
PubMed2006

[Birth injury of the puborectalis muscle--3D ultrasound evaluation].

OBJECTIVE: Evaluation of the influence of vaginal childbirth on the integrity of the puborectalis muscle with the help of real-time 3D ultrasound. DESIGN: Prospective pilot study. SETTING: Institute for Care for Mother and Child, Prague, Czech Republic. MATERIAL AND METHODS: We examined 20 primigravid women in the third trimester and on the third day after vaginal delivery. The transperineal 3D ultrasound examination was performed and the data were evaluated afterwards in the 4D view software. The VCI (Volume Contrast Imaging) mode with slice thickness 3 millimeters was used for analysis. We evaluated the integrity of the puborectalis muscle on both sides, the quality of the images and the presence of hematomas. RESULTS: The examination before delivery did not show any abnormal anatomy of the examined region. We found four (20%) unilateral defects and one (5%) bilateral puborectalis avulsion after the delivery. The bilateral defect was after the forceps delivery, the other defects occurred after normal uncomplicated vaginal deliveries, where only left mediolateral episiotomy was performed and the birth weight did not exceed 3700 g. In our series, 25% of women suffered an injury of a major muscle of pelvic floor. No defect was diagnosed during the delivery and did not show any connection with the episiotomy. CONCLUSIONS: 3D ultrasound can detect major birth trauma to the puborectalis muscle. The puborectalis muscle avulsion is usually not recognized during the delivery and does not cause immediate problem to the patient.

Female↗
PubMed2006

[Possibilities of using ultrasound in the diagnosis of descended posterior compartment of female pelvic floor].

OBJECTIVE: Find out the features of descending posterior vaginal wall using ultrasonography and set the objective diagnostic criteria. DESIGN: Prospective comparative study. SETTING: Department of Obstetrics and Gynaecology, Teaching Hospital Bulovka, First Medical Faculty, Charles University in Prague. METHODS: We included 39 attendants, 19 with clinicaly proven descent of posterior vaginal wall; 20 as a negative control group. We observed the ultrasonographical features of descending posterior vaginal wall according to the horisontal line crossing the inferior margin of pubic bone (PM) and central anorectal angle (PARA) at rest and during Valsalva manoevre with and without intrarectal application of sonographic yelly. Student's t-Test was used for statistical evaluation. RESULTS: We proved the statisticaly significant increase in the distances PM and PM' in the group of females suffering from the descent compared to the group of healthy women. Values of PARA were also signifinatly hightened in the group of patients with the descent compared to healthy females. CONCLUSIONS: The ultrasonographical evaluation of descending posterior vaginal wall appears to be promising chance in diagnostics of female's pelvic floor pathology.

Adult↗
PubMed2004

[The hiatus urogenitalis and its dorsal component--its importance in urinary and fecal continence in women].

OBJECTIVE: Numerous anatomical studies over the last years resulted in a principal shift in the view of the area of female pelvic floor. These studies also deal with the area of posterior compartment, i.e. a region which used to be of little interest to urogynecologists. This article presents a brief outline of anatomical and physiological knowledge as well as a brief survey of most important methods of examination and basic clinical symptoms associated with disorders of posterior part of hiatus urogenitalis. The presently accepted concept of a complex approach to disorders of female pelvic floor will probably require increased interest in this area among urogynecologists. The article is aimed at summarizing elementary knowledge necessary for adequate clinical care of patients suffering from disorder in posterior compartment function. SUBJECT: Review article. SETTING: Department of Gynecology and Obstetric, Faculty Hospital Na Bulovce, 1st Medical Faculty, Prague, Czech Republic.

Defecation↗
PubMed2003

Primary cutaneous Absidia corymbifera infection in a premature newborn.

An unusual case of a primary cutaneous Absidia corymbifera infection in a premature twin successfully treated with low doses of intravenous amphotericin B and topical natamycin is described. Epidemiological and therapeutical aspects of the case are discussed and in vitro antifungal susceptibility data are presented.

Absidia↗
PubMed2002

Ultrasound imaging of paravaginal defects in women with stress incontinence before and after paravaginal defect repair.

OBJECTIVE: The aim of our study was to analyze whether transabdominal and introital sonography can identify paravaginal defects and to determine changes that occur following paravaginal defect repair and Burch colposuspension. METHODS: Twenty women with genuine stress incontinence took part in this prospective study. The mobility of the bladder neck was assessed transperineally with a curved array probe following instillation of 300 mL saline. The same probe was used transabdominally to determine the presence of paravaginal defects. Introital examination using a transvaginal probe was then performed to determine the presence of paravaginal defects. The same measurements were performed following Burch colposuspension and paravaginal defect repair. RESULTS: There were significant differences in bladder neck position and mobility before and after surgical intervention. In 18 women before surgery, transabdominal ultrasound identified unilateral or bilateral paravaginal defects. Eight unilateral defects were found on the right side but only two were found on the left side. In eight women, the defect was bilateral. The introital approach obtained similar results apart from in two patients with a bilateral defect in whom it indicated a unilateral right defect. Between the first and second weeks following the operation transabdominal ultrasound found no paravaginal defects in 16 women and introital ultrasound found no paravaginal defects in 18 women. We were unable to visualize the region of the paravaginal defect in two women using transabdominal ultrasound because the abdominal wall was edematous after surgery. Five to 6 weeks after the operation, our results were confirmed by abdominal and introital ultrasound in all cases. No paravaginal defects were found in any of the patients after paravaginal defect repair. CONCLUSION: Our clinical study suggests that ultrasound scanning should be performed to confirm the presence of paravaginal defects and that paravaginal defect repair may be added to Burch colposuspension for the treatment of genuine stress incontinence, as an operation to correct cystourethrocele and the posterior urethrovesical angle.

Female↗
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↗
PubMed2001

Case report. Disseminated infection of Blastoschizomyces capitatus in a patient with acute myelocytic leukaemia.

Blastoschizomyces capitatus infection in a 48-year-old man with acute myelocytic leukaemia is reported. A multiorgan involvement and fulminant course of the fungal infection resulted in the patient's death despite fluconazole prophylaxis, therapy with amphotericin B and administration of granulocyte colony-stimulating factor. Predisposing factors to the infection, clinical relevance of surveillance strains and in vitro antifungal susceptibility testing are discussed.

Amphotericin B↗
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

[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

[Filamentous fungal infections in man. Alphabetical overview of mycotic agents with data on their systematic classification and on the localization of individual diseases].

The authors present a survey of filamentous microscopic fungi causing human mycoses. The outline is based on an alphabetical list of genera and their classification into higher taxonomic categories, i.e. orders, classes and divisions. The name of a relevant mycosis is followed by enumeration of the individual species and localizations of diseases produced by a given agent. To facilitate orientation in the system of myco-pathologically important agents, examples of classification of individual genera are presented in the text in a hierarchical arrangement of higher taxonomic categories.

Fungi↗
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↗
PubMed1998

[Candida krusei (Castellani) Berkhout--a potential pathogen with growing importance].

The authors collect information on the biological properties, ecology and pathogenicity of Candida krusei. They give a list of forms of diseases caused by this yeast and a profile of its sensitivity to antimycotics. They point out the difference between C. krusei and species of C. albicans and analyze the factors enabling its propagation. In their opinion, the resistance of this yeast to fluconazole is the main cause of the increased number of colonizations and infections produced by C. krusei. The population of C. krusei resistant to fluconazole is selected from other, sensitive species of the genus Candida primarily in hospitalized patients. Though there is no consensus of opinion at present on the influence of fluconazole on the yeast spectrum, the authors suppose this systemic antimycotic plays a distinct role in the growing importance of C. krusei.

Antifungal Agents↗