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P Safár

Publications and source records attributed to P Safár.

11 recordsLinked to original sources
PubMed2006

[Syndrome of persistent low levels of human chorionic gonadotrophin (hCG)].

OBJECTIVE: To analyze the syndrome of persistent low levels of hCG in terms of its etiology, classification, diagnosis, and management. DESIGN: Retrospective analysis. SETTING: Center for Trophoblastic Disease in Czech Republic, Institute for Care of Mother and Child, Prague, Institute of Postgraduate medical education, IPVZ, Prague METHODS: An analysis of the syndrome of persistent low levels of hCG recorded in CTN in 29 women in the years 1979-2005 by the immunoluminesence method which can quantitatively assess variable levels of hCG in blood and urine. A comparison was made of our findings with results of a similar studies having been done in England and USA. RESULTS: Persistent low levels of hCG (PLL) can be differentiated according to cause. 1. PLL-F False positive, also known as Phantom hCG, often caused by heterogenous antibodies. 2. PLL-H Of hypophysial origin, mainly in perimenopause and menopause. 3. PLL-Q Quiescent with trophoblastic disease in history, of trophoblastic origin. 4. PLL-U Undetermined, in history without trophoblastic disease, but in the past with physiological or pathological pregnancy. Assuming also to be of trophoblastic origin. All types of PLL lead in practice to the wrong diagnosis of trophoblastic disease and to a high percentage (40-80%) of needless chemotherapy and operations. In no case of PLL did chemotherapy or operations have an effect on PLL and thus are contraindicated. PLL-Q and PLL-U require continuous clinical and laboratory monitoring and repeated examinations with sophisticated visualization methods. The percentage of developing malignant trophoblastic tumors after PLL-Q and PLL-U is unclear. Extreme incidence was established in 7-25%. PLL-Q and PLL-U are considered as a marker of persistent trophoblastic invasion. Its detection by visualization methods in any organ localization before it turns into a limited solid tumor is excluded by it microscopic dissociative structure. CONCLUSION: The syndrome of persistent low levels of hCG (PLL) lately affects all gynecological and obstetrical workplaces. According to cause it can be divided into: 1. PLL false positive, 2. PLL of hypophysial origin, 3.PLL quiescent with trophoblastic disease in the history, 4. PLL undetermined, in history without trophoblastic disease. In the last two items mentioned above we assume to be of trophoblastic origin. Their morphological base is persistent trophoblastic invasion. The syndrome of PLL often leads to the wrong diagnosis of trophoblastic disease and to needless chemotherapy and operations. In this work was described the diagnosis of PLL, its classification, cause, and management. The percentage of PLL turned into malignant trophoblastic disease is unknown and ranges from 7-25% and requires monitoring in an accredited, national center for trophoblastic disease.

Chorionic Gonadotropin↗
PubMed2006

[Guideline for gynecological malignant tumors I. Standard--a complex therapy of ovarian epithelial malignant tumors].

OBJECTIVE: Elaboration of guideline for primary and secondary treatment of ovarian cancer. DESIGN: Review, consensus between proposers and opponents. METHOD: A retrospective review of published data, analysis of Czech statistics and consensus between proposers and opponents. RESULTS: We underline importance of comprehensive approach in therapy of ovarian cancer. We notice importance of expert ultrasound and CA 125 level in diagnostic algorithm. Extension of surgery depends on result of frozen section. All departments which want to perform surgery for ovarian resistance must have possibility to do peroperative histopathology. We can perform conservative fertility sparing surgery in patient with wishing of pregnancy and low stage disease. The effort of maximal debulking with radical surgery including lymphadenectomy is the standard procedure. When we diagnose ovarian cancer during laparoscopy, we have to convert on laparotomy procedure. We define the role of the neoadjuvant chemotherapy followed by surgery after 3-4 cycles of chemotherapy. We define adequate surgery treatment, indication for adjuvant chemotherapy and indication for second line therapy. CONCLUSION: Guideline for the treatment of epithelial ovarian cancer should become directions for clinicians and others, who participate in the process of treatment of the ovarian cancer. The guidelines include all parts of the process from diagnosis, treatment to follow up. All topics of the guidelines arose from a voting of the proposers and opponents.

Carcinoma↗
PubMed2004

[Malignant trophoblastic tumors (MTT) treated in the years 1955-2004 in trophoblastic disease center in the Czech Republic (TDC-CZ): clinical-pathological features, curability, typing, pathogenesis].

OBJECTIVE: Clinical- pathological features, typing, curability and pathogenesis of malignant tumors of trophoblast (MTT). DESIGN: A retrospective analysis. SETTING: Trophoblastic Disease Center in the Czech Republic (TDC-CZ), Mother and Child Care Institute, 3rd Medical Faculty, Charles University, Prague. METHODS: Revision of 379 MITT cases treated at TDC-CZ and comparison of their histological picture with developmental stages of orthologic trophoblast from the standpoint of MTT typing and pathogenesis. The determination of curability of different histological types and risk stages (RS) used in TDC-CZ and a comparison with RS axccording to FIGO, WHO and NIH. Differentiation of undifferentiated choriocarcinoma (CH-Und) alias Epitheloid Trophoblastic Tumor (ETT) from the given cohort of MIT and establishment of its clinical and biological properties, curability and formal pathogenesis. RESULTS: Three hundred and seventy nine MTT cases were classified into 5 histological types onthe basis of analogy with developmental stages of 7 to 14 days old trophoblast. 1: typical "classical" choriocarcinoma - No Special Type (CH-NST), which forms more than 80% of MTT. Moreover, the degree of differentiation of tumorous trophoblast and its prevailing (cytological) type made it possible to define other 4 types, i.e.: 2: CH-syncytio-trophoblastic (CH-Syn), representing 3.8%; 3: CH-cytotrophoblastic CH-Cyt with 3.3%; 4: CH-dissociated (CH-Dis), representing 6%; 5: CH-undifferentiated (CH-Und) with 6.8%. Mortality due to MIT of all mentioned types reached 94% until 1963, decreased to 43% until 1980 and has been 5.8% in the period of 1981-2004. In the latter period of time (1981-2004), mortality due to CH-Cyt proved to be 40%, that due to CH-Dis being 11%, and CH-Und 18%, though. Mortality of s.c. Placental Site Trophoblastic Tumor, which includes our CH-Cyt and CH-Dis therefore forms 21.4%. We have been using four RS in TDC-CZ. The following outline includes only the main features: 1st RT includes CH-NST < 30mm limited to uterus in connection with mole. 2nd RS includes CH-NST > 30mm after birth. 3rd RS includes CH-NST with multiple metastases outside GIT and CNS and MTT with the CH-Cyt, Dis, Und component < 75%. 4th RS includes CH-NST with metastases in CNS or GIT. MTT with CH-Cyt Dis, Ned component < 75% with metasteses and MTT with the same components > 75% In the last 23 years 1st RS and 2nd RS includes 85 % of all MTT in the TDC-CZ and curability is 100%. In the 3rd RS curability decreases to 64.3% and decreases to 55.6% in the 4th RS. According to FIGO classification the 1st RS forms 48%, 2nd RT represents 17% and 100% curability applies for both of them. 3rd a RS includes 20% of 100% curability, 3rd bc RS forms 10% with 67% curability and 4th abc RS includes 5 % with 50% curability. In using the WHO classification with four RS, their percentage representation is similar to our classification with similar curability; nevertheless the 1st RS and 2nd RS did not detect almost 8% of MTT, which ended with exitus. 3rd RS according to FIGO is overestimated in view of 100% curability and the abc degree in 1st and 2nd RS are only of theoretical significance and irrelevant for the choice of treatment. The closest results comparable with our classification were those of NIH. A very careful clinical-pathological analysis of 25 CH-Und-ETT, detected among 379 MTT revealed that CH-Und-ETT is anaggressive malignant form of CH, which is best derived from undifferentiated 7-8 days old trophoblast. It is insidious for its seemingly primary extragenital symptomatology in seven out of 25 cases, low hCG values and poor sensitivity to chemotherapy. CONCLUSION: 1) The comparison of histological pictures of 379 MTT with developmental stages of orthologic trophoblast of 7-14 days old embryo was the basis for classification of 5 types of choriocarcinoma (CH): 1. Differentiated CH "No Special Type" (CH-NST), 2. Syncytiotrophoblastic CH (CH-Syn), 3. Cytotrophoblastic CH (CH-Cyt), 4. Dissociated CH (CH-Dis), and 5. Non-differentiated CH (CH-Und); 2) We have determined their percentual (and absolute) occurrence in the group of 379 MTT treated in CTN in the years 1955-2004. 3) We have described biological properties of individual types of CH and established the way they influence curability. 4) Four degrees of risk (RS) were specified in relation to 7 types of risk factors observed (1. size of tumor, 2. type of preceding pregnancy, 3. interval from pregnancy to the diagnosis, 4. histological type of CH, 5. number of metastases, 6. localization of metastases, 7. values of hCG). It has become obvious how RS influenced curability of CH (1st and 2nd RS forms 85% of all CH's and their curability is 100% (!), 3rd and 4th RS are represented in 15% and their curability is 64% in the 3rd RS and 55% in the 4th RS. 6) The curability reached in CTN was compared with that determined according to FIGO, WHO and NIH, respectively. The results proved to be similar, but in case of FIGO the 3rd degree was overestimated and the degrees abc in the 1st and 2nd RS were of theoretical importance only, therefore being of no values for the choice of treatment. Low and medium score according to WHO did not detect 8% of women who had died. The CH curability according to RS, having been recommended by NIH and used in the American Centers was virtually the same as our results. 7) It has been proved that the histological type of CH significantly influenced the determination of RS in the given patient. 8) CH-Und-ETT represents the least differentiated form of MTT, in other words choriocarcinoma. This is associated with a low production of HCG, mostly between 10(1) and 10(3) mIU/ml. 9) Pathogenesis of CH-Und ETT-ETT we derive from the earliest, undifferentiated stage of orthological trophoblast. The origin from the differentiated intermediate trophoblast chorion leeve we considerei improbable. 10) There are continuous transitions from CH-Und-ETT and PSTT to CH-NST, representing an analogy to grading in other malignant epithelial tumors.

Choriocarcinoma↗
PubMed2003

[Undifferentiated choriocarcinoma--epithelioid trophoblastic tumors treated at the Center for Trophoblastic Diseases in the Czech Republic 1955-2003].

OBJECTIVE: The clinical-pathological picture, pathogenesis, biological behavior and therapy of epithelioid trophoblastic tumor (ETT) alias undifferentiated choriocarcinoma (CH-Ned). DESIGN: A retrospective analysis. SETTING: Trophoblastic Disease Center in the Czech Republic (TDC-CZ), Department of Gynecology and Obstetrics, 3rd Medical Faculty, Charles University, Institute for the Care of Mother and Child, Prague. METHODS: The identification of all tumors complying with histopathological criteria of ETT-CHNed among 372 malignant tumors of trophoblast (MTT), treated at TDC-CZ in the years 1955-2003. Their morphological analysis was done from the standpoint of formal pathogenesis, correlation with clinical picture, laboratory and therapeutic results. RESULTS: Among 372 malignant tumors of trophoblast (MTT) we detected 25 ETT-CHNed. The size of the tumor was in the range of 15 to 45 mm except two cases. One tumor diffusely infiltrated thyroid gland and clinically imitated struma. In the other case a massive dissemination of ETT-CHNed in the lungs was supposed to be tuberculosis. The tumor in the uterus and metastases was predominantly of solid character, not infrequently with necroses and haemorrhages. The microscopic analysis revealed larger irregular cells with frequent mitoses, resembling eight-day orthologic trophoblast. There were also infrequent elements of cyto-intermediate and syncytium-trophoblastic character. The mitotic index (3-7), proliferation markers (20%), inhibitin alpha, hCG and PLAP with histological picture suggest a specific form of MTT or choriocarcinoma. The age of the female patients was in the range of 22 to 43 years. In 18 cases (72%) the tumor displayed gynecological symptomatology, in 7 cases (28%) a non-gynecological one (pulmonary 3 times, thyroid once, CNS once, GIT once, mamma once). In the case history there was delivery in 10 cases, abortion in eight, mola hydatiosa completa twice, anamnesis was uncertain once and extra-uterine pregnancy was suspected also once. The interval between pregnancy and established diagnosis was in the range of one to 64 months. The ETT-CHNed diagnosis was established 18 times from curettage of endometrium, six times from biopsies of organs considered as primary localization of the tumor and once during post mortem examination. The hCG values upon admission were in the range of 10(1) to 10(3) mIU/ml in connection with a small number of differentiated syncitium-trophoblastic cells. In the first period (1955-1963) before introduction of chemotherapy all five patients died (100%) in the range of 4 months to 3 years. In the second period (1964-1980), hysterectomy with subsequent monochemotherapy resulted in permanent remission (20 years) in four women out of nine (44%). In the third period (1981-2003), hysterectomy with subsequent polychemotherapy resulted in complete remission from two to 18 years in 9 out of 11 women (82%), while in two cases with absent ETT-CHNed in uterus the intervention was limited to tumor extirpation in the lung or mamma with subsequent treatment with chemotherapy. CONCLUSION: The revision of 372 MTT treated in TDC-CZ (1955-2003) uncovered 25 ETT-CHNed. Their clinical-pathological analysis revealed that ETT-CHNed is a malignant tumor, which is not less aggressive than choriocarcinoma (CH-NST). It becomes manifest by frequent metastases, often with absent demonstrable tumor in the uterus. It represents a less differentiated form of MTT, becoming manifest in a low production of hCG. It can be derived by formal pathogenetics from non-differentiated earliest orthologic trophoblast. There are differentiated transitions between ETT-CHNed and CH-NST, which are analogous to grading of other malignant epithelial tumors. Hysterectomy with subsequent intensive chemotherapy decreased the original 100% mortality in the years 1955-1963 to 18.1% in the years 1980-2003.

Adult↗
PubMed2002

[Proliferating mole in menopause imitating choriocarcinoma recurrence--case report].

OBJECTIVE: To show the possibility of new invasive mole arising after 2 years of menopause, after choriocarcinoma cured by chemotherapy 5 years ago. SETTING: Trofoblastic disease center (TDC), Prague, Institution for care of mother and child, Prague. CASE REPORT: Patient 50-years-old with choriocarcinoma, in consequence to invasive mole, was cured by chemotheraphy. After 5 years of clinical and laboratory remission and after two years of menopause new pregnancy with invasive mole arised imitating relapse of choriocarcinoma.

Choriocarcinoma↗
PubMed2000

[Cervical carcinoma during pregnancy].

OBJECTIVE: To evaluate management and outcome of pregnant women with cervical carcinoma. DESIGN: Retrospective clinical study. SETTING: Institute for Mother and Child Care, Prague, Czech Republic. METHODS: Clinical data of pregnant women suffering from cervical carcinoma were summarized and assessed. The primary treatment was radical hysterectomy and pelvic lymphadenectomy including the foetus in utero in the first and early second trimester and caesarean section and radical surgery after viability of the foetus has been reached. Patients were assessed with regard to the stage of the disease and the stage of pregnancy. RESULTS: In this retrospective study we discuss 8 cases of cervical cancer diagnosed during pregnancy. According to the TNM classification 3 patients were in stage Ib1, 3 patients in stage Ib2, one patient in stage IIa and one patient in stage IIb. With the exception of one patient in stage IIb all cases were operable with no complication after radical surgery. After a follow-up of at least 12 months we are convinced that pregnancy has no negative effect on the prognosis of cervical cancer.

Adult↗
PubMed1996

[Ultrasonographic hysterosalpingography].

The objective of the investigation was to compare US hysterosalpingography with methods currently used to examine tubal patency, i.e. hysterosalpingography and laparoscopy with chromoperturbation. The examination was made in 39 women with the diagnosis of primary or secondary sterility. Consistent with data in the literature, the authors proved a high concordance (86.8%) with reference methods. US HSG is an ambulatory minimally-invasive method of examination of the uterine cavity and patency of the oviducts, which is well tolerated by patients.

Adult↗