Biomedical subjects

N Jancárková

Publications and source records attributed to N Jancárková.

14 recordsLinked to original sources

PubMed2006

[Radical parametrectomy in women with invasive cervix cancer after previous simple hysterectomy].

OBJECTIVE: Evaluate technique, indications and limits of surgical procedure in the treatment of cervical cancer diagnosed from uterus specimen from simple hysterectomy. DESIGN: Retrospective observational study, review of literature. SETTINGS: Department of Obstetrics and Gynecology, 1st Medical Faculty and General Faculty Hospital, Charles University, Prague, Czech Republic. METHODS: Women following radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy were enrolled to the study. In all patients unexpected invasive cervical cancer was found from the uterus specimen after simple hysterectomy. RESULTS: Together 10 patients were enrolled to the study. CIN was the indication for primary hysterectomy in all but two patients. There were two operative complications, cystostomy in both cases, treated properly during surgery. In the specimen from radical procedure residual tumor in parametria was found in 2 cases, and metastasis to pelvic nodes in 4 cases. There was no postoperative complication. Adjuvant radiotherapy was recommended in 4 patients due to positive lymph nodes, in one case due to residual tumor in parametria, and in one case for both reasons. CONCLUSIONS: Radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy should be considered as an alternative solution in patients following simple hysterectomy with unexpected finding of invasive cervical cancer. Morbidity of the procedure is higher in comparison to standard radical hysterectomy, however majority of complications are easy to repair. The most significant criteria for patient's selection for surgical approach is a depth of invasion to cervical stroma. In our group radical procedure obviated the need for radiotherapy in half of the patients.

Adult↗

PubMed2006

[Prognostic factors of ovarian cancer].

OBJECTIVE: To sum up the knowledge about prognostic factors of ovarian cancer. TYPE OF STUDY: Review article. SETTING: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague. METHODS: Compilation of data from scientific litarature. CONCLUSIONS: Prognostic factors represent a complex of information with clinical, social, histopathological, biochemical, genetic and molecular biological characteristics. They are integral part of the predictive oncology, with perspective advantage in prevention, screening, prediction, prognosis and monitoring of the tumor disease activity. The prognostic factors of ovarian cancer are discussed from several points of view in the presented review, included their possible implementation into the clinical practice.

Biomarkers, Tumor↗

PubMed2005

[Pelvic exenteration].

OBJECTIVE: Review of literature concerning pelvic exenterative procedures. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSION: Pelvic exenterations are standard procedures in oncogynecology which have no alternative in certain indications. The most frequent indications are recurrences or progressions of cervical, vulva or vaginal cancers. Exenterative procedures might be used in primary treatment in some cases of locally advanced tumors. Mortality of current procedures reaches 5% to 10%, early and late postoperative morbidity is frequent (40-60%). Recently explorative laparoscopy is used in preoperative staging to decrease the number of aborted procedures due to distant metastasis or pelvic tumor inoperability. The procedure with high morbidity, causing impairment of quality of life, is justified due to good follow-up results--5-years overall survival is about 50-60%. It should be emphasized that with no treatment in these patients median of survival reaches about 6 months.

Female↗

PubMed2005

[Possibilities of increased radicality in pelvic exenteration].

OBJECTIVE: Review of advanced radicality in pelvic exenterations. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, General Faculty Hospital and Ist Medical Faculty of the Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSIONS: More extensive radicality in pelvic exenterations make possible to use surgical treatment in some cases of lateral recurrences or central recurrences with the attachment to the pelvic side wall. One possible technique is a combination of en bloc exenteration with pelvic bone resection, most frequently sacrum. Experiences in gynecological tumours are so far limited. Laterally extended resection was described in lateral infrailiac pelvic wall recurrences. The only one presented paper related to laterally extended procedures showed a reasonable overall survival of patients; however follow-up is limited.

Female↗

PubMed2005

[Genetic aspects of malignant epithelial ovarian tumours].

OBJECTIVE: To sum up the knowledge about genetic aspects of ovarian cancer. TYPE OF STUDY: Review article. SETTING: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague, Prague. METHODS: Compilation of data from scientific literature. CONCLUSIONS: Ovarian cancer represents the most lethal malignancy among gynecological tumours. Etiology is still largely unknown. Multistep process, with accumulation of genetic alterations concerning factors with key role in cell regulation - oncogenes, tumor-supressor genes and mismatch-repair genes is supposed. Cytogenetic and molecular-genetic characteristics, in correlation with other molecular-biological parameters extend information of carcinogenesis. The final aim is to create a predictive model for clinical use.

Carcinoma↗

PubMed2004

[Hereditary predisposition for the development of breast and ovarian carcinoma].

Part of breast and ovarian cancer cases develops on the hereditary predisposition, i.e. mutation in one of predisposing genes. Although this proportion is relatively small, 5-10% of all breast and ovarian carcinomas, it represents a group with clearly defined etiologic factor. Predictive analysis of unaffected family members allows to identify individuals at high risk of cancer and to include them into the programme of primary and secondary cancer prevention. Following article presents basic review of the hereditary predisposition to breast and ovarian cancer focusing especially on BRCA1 and BRCA2 genes, which are responsible for almost three-quarters of those hereditary tumours.

Breast Neoplasms↗

PubMed2004

[Prophylactic adnexectomy].

OBJECTIVE: Analysis of the issue of prophylactic bilateral salpingo-oophorectomy (BSO): a) during pelvic surgery for benign diagnosis; b) in women with hereditary risk of ovarian cancer. DESIGN: Review article. SETTING: Department of Obstetric and Gynecology, Charles University. METHODS: Critical review of published data. CONCLUSION: During pelvic surgery for benign diagnosis a prophylactic BSO is indicated of the age over 45, in younger women an individual approach is required, considering many aspects, including history of ovarian and breast cancer. Another indication for BSO is an increased risk of familial ovarian cancer. The surgery significantly diminished the risk of epithelial cancer of ovary, fallopian tube, and simultaneously the risk of breast cancer. There is a continuing increased risk of peritoneal cancer following the surgery. Bilateral oophorectomy together with bilateral salpingectomy is recommended. The age limit for surgery is about 35 years after careful consideration of individual risk, reproductive plans, type of mutation and age at malignant disease manifestation in previous generation. Potential alternative for women who do not accept prophylactic surgery is tubal ligation. Screening of risk group or chemoprevention by oral contraceptives are not equivalent alternatives to prophylactic surgery.

Fallopian Tubes↗

PubMed2004

[Borderline ovarian tumors--10-year clinical series and literature review].

OBJECTIVE: Analysis of 10-year clinical series of borderline ovarian tumors (BLT) and literature review. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: Analysis of 38 patients from years 1994-2003 regarding age, histological types, tumor duplicities, role of frozen section, Ca125 levels, operation methods, adjuvant treatment, relaps occurrence, follow-up and survival. RESULTS: Median follow-up was 18.5 months (3-122), median age 51 (16-78). HISTOLOGY: 23 serous, 12 mucinous (1 microinvasion), 2 cystadenofibromas and 1 endosalpingiosis. 26 patients of stage IA, 3 of IB, 6 of IC, 1 of IIA, 1 of IIC and 1 IIIB. 3 cases were underestimated by frozen section. 6 tumor duplicities were revealed. Ca125 marker was elevated in 10/23 (43.5%) cases. 12 patients underwent conservative surgery, 3 of them with complete staging including lymphadenectomy. 26 patients had radical operation, 9 of them with full staging. No one lymphonode was positive. 7 patients had primary laparoscopic approach, 6 had more than one operation. Adjuvant chemotherapy was indicated in 3 cases: PTX-CBDCA (IC and IIC) and CBDCA-CFA (IC). 4 patients were lost of evidence. 2/34 evaluated patients (5.9%) had a frank carcinoma recurrence after 3 and 7 years. Both relapsed patients and all 34 evaluable patients live without evidence of disease at present. Our results as well as literature date generate some controversies. Do we need staging lymphadenectomy in all cases (inclusive T1a)? Which parameters identify high-risk group and which patients will benefit from adjuvant (and which one) therapy? Are there not recurrencies of BLT rather second primary malignancies? CONCLUSION: In spite of 2 recurrences in a group of 34 evaluated cases all patients live without evidence of disease at present. Some management questions are therefore raised.

Adolescent↗

PubMed2003

[Detection and occurrence of BRCA 1 gene mutation in patients with carcinoma of the breast and ovary].

OBJECTIVE: The article presents a review of basic information on incidence and detection of BRCA 1 and BRCA 2 genes mutations. Results of investigation in a group of women with ovarian and breast cancer are presented. DESIGN: Retrospective clinical-laboratory study and review. SETTING: Department of Gynaecology and Obstetrics, 1st Medical Faculty of Charles University, Prague, Apolinárská 18, Czech Republic. MATERIAL AND METHODS: Investigated group consisted of 16 persons--12 patients with ovarian or breast cancer and 4 healthy relatives of a woman--breast cancer patient and a carrier of BRCA 1 gene mutation. Protein truncation test (PTT) was performed in order to detect BRCA 1 gene mutation. This test detects mutations leading to premature termination of protein synthesis. Truncated proteins are easily discriminated from full size. RESULTS: Three BRCA 1 gene alterations were identified in the investigated group of women suffering from ovarian or breast cancer. One asymptomatic person--carrier of BRCA 1 gene mutation--was identified in this study. She was daughter of a woman, a carrier of BRCA 1 gene mutation, with early onset of breast cancer and positive family history. CONCLUSIONS: BRCA 1 and BRCA 2 gene mutations are of particular importance in the increasing risk of ovarian cancer and early onset of breast cancer as well as some other malignancies. Genetic testing and counselling including investigation of some other genetic and environmental factors, related to cancer risk, may be of clinical significance in patients with increased risk of certain malignancies.

Adult↗

PubMed2003

[Antiemetics in gynecologic oncology].

OBJECTIVE: The authors present a survey of available pharmacological possibilities of treatment of nausea and vomiting aimed at their application in oncological therapy of gynecological neoplastic diseases. TYPE OF THE STUDY: A review article. NAME AND ADDRESS OF THE INSTITUTION: Gynecological-Obstetrical Clinic, First Medical Faculty, Charles University and General Faculty Hospital, Praha. SUBJECT AND METHOD OF THE STUDY: A survey of published data from the Czech and foreign professional literature. CONCLUSION: 5-HT3 receptor antagonists take up the most important position in the antiemetic treatment of oncological patients. They efficiently prevent and treat vomiting induced by anticancer drugs with high and very high emetogenic effect. They have been used as monotherapy or in combination with corticoids. In the treatment of nausea and vomiting or vomiting induced by anticancer drugs with medium or light emetogenic effect, antiemetic preparations from the corticoid series and dopamine receptor antagonists may be recommended. In the treatment of anticipation vomiting, benzodiazepines are indicated for their anxiolytic and psychosedative influence.

Antiemetics↗

PubMed2002

[Vulvar carcinoma--retrospective study of 47 cases (epidemiology, etiology and long-term results].

OBJECTIVE: To evaluate the incidence of vulvar carcinoma, epidemiological signs and therapeutic results in patients with vulvar malignancies during the stated time period. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague. METHOD: An analysis of the available clinical documentation of the patients of the oncological outpatient service of the Department of Obstetrics and Gynaecology. RESULTS: Vulvar carcinoma represents 4% of all malignant tumours of female genital tract. It concerns predominantly elder women (the average age is 74.2 years). The overall 5-year survival, with no regard to the stage of the disease, is 39.1% in our group. This low figure is due to the high age of the group and to the inappropriate therapeutic approach owed to the internal comorbidity, advanced age and the fact that the majority of cases are diagnosed in advanced stage. CONCLUSION: In spite of good access, the introduction of screening program is unlikely due to the age distribution, biological behaviour and difficulties in diagnostic of premalignant lesions. With regard to the increasing incidence of in situ carcinoma whose ethiopathogenesis is affected by HPV infection, it is necessary to pay more attention to vulva lesions in terms of an early histopathological verification. The treatment of the external genital tract malignancies should be concentrated to the centers with the greatest experience of their management.

Adult↗

PubMed2000

[Granulosa cell tumor--clinical group and literature review].

OBJECTIVE: To present a review of literature and to analyse a clinical retrospective series of patients with granulosa cell tumor. DESIGN: Retrospective study and review. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Prague, Czech Republic. METHODS: Retrospective analysis of age, stage, surgery, radiotherapy and chemotherapy, survival curve, number of recurrences and time to recurrence. Literature and information database (Medline 1997-1999) review. RESULTS: In a group of 43 patients the median of age was 53.5 years. 83.7% of cases were in a stage I. There were two duplicate tumors in a series. Conservative surgery was performed in 9/43 cases, 5 of them were reoperated on. The most frequent chemotherapy regimens were platinum-cyclophoshamide and BEP (bleomycin, etoposide, platinum). The 5-year overall survival was 86% and specific survival 90.7%. There were 3/43 recurrences, median time to recurrence was 22 months. CONCLUSION: A good prognosis of a patient with granulosa cell tumor requires a precise histopathologic examination, an adequate surgery and a comprehensive clinical analysis of a case to evaluate an indication of adjuvant therapy. Concentration of patients in oncogynaecological centres is advisable. A careful follow-up because of a risk of late recurrences is necessary.

Female↗

PubMed2000

[Teratogens during pregnancy].

OBJECTIVE: To sum up the knowledge of the influence of substances in the external environment on the development of the human embryo/fetus during exposure at various periods of intrauterine life. TYPE OF STUDY: Summary. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University, Prague. METHODS: Compilation of data from scientific literature. RESULTS: An overview of the main groups of teratogenic substances among the physical, chemical, biological and metabolic teratogens. Their relationship to morphological malformations, anomalies and functional defects are described. CONCLUSION: A summary of the principles/basics of care of a pregnant woman using medication before or during pregnancy and the possibility of evaluating the individual reproductive risk during preconception and prenatal exposure to teratogenic substances.

Abnormalities, Drug-Induced↗

PubMed2000

[Gynecologic operations in patients after kidney and liver transplantation--case report].

OBJECTIVE: To give an overview of the complications associated with the post-transplantation period which thus presents an increased risk for subsequent gynecological surgery and also for the postoperative period. To determine the criteria and conditions under which these operations may be performed with relative safety. TYPE OF STUDY: Case report. SUBJECT OF STUDY: Described surgical treatment of gynecological diseases in three patients after liver and kidney transplantation. CONCLUSION: A summary of the principles/basics of patient care after surgery for gynecological indications with a prior organ transplant in ther patient's history. These patients should undergo surgery in hospitals with a high quality of professional care as well as high quality equipment and cooperation among the specialists from the various medical fields involved.

Adult↗