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Biomedical subjects

D Cibula

Publications and source records attributed to D Cibula.

At least 37 records · Page 2Linked to original sources
PubMed2003

Pregnancy outcome in women with PCOS and in controls matched by age and weight.

BACKGROUND: The aim of this study was to compare the pregnancy outcome, especially the prevalence of gestational diabetes mellitus (GDM), in a group of patients with polycystic ovary syndrome (PCOS), with a group of healthy weight-matched women. METHODS: Retrospectively, we evaluated the pregnancies of 66 women with PCOS, who had been treated for infertility and who delivered at our department. These were compared with a group of 66 age- and weight-matched controls. RESULTS: We did not find any significant differences in the prevalence of pregnancy complications such as gestational diabetes mellitus, pregnancy-induced hypertension (PIH) and premature deliveries between the group of PCOS patients and the controls. CONCLUSION: When differences in age and weight between PCOS patients and controls are negligible, PCOS is not associated with a higher risk of pregnancy complications.

Adult↗
PubMed2003

[The role apoptosis in the extent of endometriosis and its clinical symptomatology].

OBJECTIVE: To evaluate the presence and intensity of apoptosis in lesions of peritoneal endometriosis. To consider the role of different intensity of apoptosis in the progression of the disease and in the manifestation of clinical symptoms. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology and Department of Histology and Embryology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: Lesions of peritoneal endometriosis were excised at laparoscopy in women with 1st to 3rd stage of the disease. Specimens were fixed in the Karnowski solution. The presence of apoptosis was assessed immunohistochemically. RESULTS: Biopsies of peritoneal endometriosis were consecutively taken in 48 women. Altogether, 29 patients were symptomatic, and 19 did not complain of any symptoms. The average duration of symptoms was 16.6 months. The presence of apoptosis was detected in 11 out of 35 evaluated specimens. In comparing the groups with and without apoptosis, no differences were found in the stage of the disease, in the proportion of asymptomatic patients, and in the manifestation of different subjective complaints. CONCLUSIONS: The study confirmed a frequent presence of apoptosis in biopsies of peritoneal endometriosis. However, there were no relationships found between the presence of apoptosis and the stage of the disease or manifestation or character of subjective complaints.

Adult↗
PubMed2003

[Long-term follow-up after complete treatment of peritoneal endometriosis with the CO2 laser].

OBJECTIVE: To evaluate the effect of laparoscopic CO2 laser ablation of peritoneal endometriosis in the treatment of pelvic pain with a long-term follow-up. To differentiate the effect of surgery on different types of pelvic pain. DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: Patients with 1st to 3rd stage endometriosis, with manifestation of pelvic pain, and with complete excision of peritoneal endometriosis lesions, were included in the study. All visible lesions were vaporized by CO2 laser following adhesiolysis and complete visualization of the pelvis. After the procedure, patients were followed up at 6-month intervals. The severity of pelipathia, dyspareunia, dysmenorrhea, pain during micturition, and pain during defecation were monitored using a visual analog score of 10 points. RESULTS: A total of 31 patients were included in the study. After 6, 12, and 18 months after surgery, the recurrence of pelvic pain was found in 12 (39%), 15 (48%), and 19 (61%) patients, respectively. Improvement or disappearance of complaints was documented 18 months after the surgery in 11 cases of dysmenorrhea (50%), 9 cases of dyspareunia (50%), 14 cases of pelipathia (58%), 12 cases of pain during micturition (71%), and in 14 cases of pain during defecation (87.5%). The proportion of recurrences increases with the length of the interval after the procedure, mainly in dysmenorrhea and dyspareunia. CONCLUSIONS: The effect (improvement or disappearance of pelvic pain) of a complete CO2 laser ablation of peritoneal endometriosis continues 18 months after the surgery in about 40% of patients. A graduated increase in the number of recurrences is apparent during follow-up, most significantly in dysmenorrhea and dyspareunia. The effect of surgery on different types of pelvic pain varies. A small number of recurrences was found in pain during micturition and pain during defecation, on the other hand, less success was apparent in the treatment of dysmenorrhea.

Adult↗
PubMed2003

[Screening for factor V Leiden mutation in women using combined hormonal contraceptives or hormone replacement therapy].

OBJECTIVE: Analysis of the issue of screening for Factor V Leiden mutation (FVL) in users of combined oral contraceptives (COC) or hormone replacement therapy (HRT). DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Charles University and General Faculty Hospital, Prague. METHODS: Review of published facts, analysis of possibilities to screen all users or to test risk groups in the current situation in the Czech Republic. CONCLUSION: 1) Screening for FVL in all COC or HRT users is not recommended mostly for economical reasons. 2) Testing for FVL is indicated in women with a positive family history of thromboembolic disease and in obese women, if they consider COC or HRT despite our recommendation or in case there is a medical indication. 3) Deep venous thrombosis or pulmonary embolism are absolute contraindications of COC or HRT regardless of the presence of FVL.

Contraceptives, Oral, Combined↗
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

[Effect of insulin in polycystic ovary syndrome].

BACKGROUND: Polycystic ovary syndrome (PCOS) has been accompanied by insulin resistance. The aim of this study was to compare the insulin action between thin and obese women with PCOS and to analyse its relationship to serum concentration of selected hormones. METHODS AND RESULTS: Total number of 32 women with PCOS between them there were 22 thin and 10 obese subjects was examined in this study. Control group consisted of 21 nonobese healthy women. The insulin action was determined by euglycemic hyperinsulinemic clamp. Normal insulin action found in the group of thin women with PCOS was comparable with that in healthy controls whereas insulin resistance was observed in obese ones. An inverse relationship was found between insulin action and body mass index (r = 0.62, p < 0.01). By using HOMA index this relationship to BMI was on the borderline significance. No correlation was observed between insulin action and serum hormone concentrations (testosterone, androstendione, LH, FSH) but sex hormone binding globulin (SHBG) positively correlated with parameters of insulin action (r = 0.50-0.54). CONCLUSIONS: The insulin action may be normal in thin women with PCOS whereas obesity and other not yet disclosed factors influence development of insulin resistance in women with polycystic ovary syndrome.

Adult↗
PubMed2002

Neuroactive steroids, their precursors and polar conjugates during parturition and postpartum in maternal and umbilical blood: 3.3beta-hydroxy-5-ene steroids.

Five 3beta-hydroxy-5-ene steroids involved in the metabolic route from pregnenolone sulfate to dehydroepiandrosterone and its sulfate, of which three are known allosteric modulators of neurotransmitter receptors, were monitored in the serum of 20 women around parturition. In addition, their levels in maternal and umbilical serum were compared at delivery. On the basis of these data, a scheme of steroid biosynthesis in maternal organism during the critical stages around parturition is proposed. In maternal serum, all the steroids except dehydroepiandrosterone sulfate decreased during labor and even first day after delivery, although their changes were less distinct the more distant from pregnenolone sulfate (PregS) in the metabolic pathway. Calculation of product/immediate precursor ratios in maternal serum over all stages around parturition enabled identification of the respective changes in the activities of the relevant enzymes. The ratio of 17-hydroxypregnenolone/pregnenolone did not change significantly, while that of dehydroepiandrosterone/17-hydroxypregnenolone grew, indicating increased C17,20 side chain cleavage on the account of C17-hydroxylation both catalyzed by C17-hydroxylase-C17,20-lyase. As was shown by factor analysis, the changes in the maternal steroids were associated with a single common factor, which strongly correlated with all the steroids except dehydroepiandrosterone sulfate. The lack of change in the pregnenolone sulfate/pregnenolone ratio and a marked increase of the ratio dehydroepiandrosterone sulfate to unconjugated dehydroepiandrosterone indicate a different means of formation of both steroid sulfates. On the basis of these data, a scheme of steroid biosynthesis in maternal organism during the critical stages around parturition is proposed.

Female↗
PubMed2002

Insulin sensitivity in non-obese women with polycystic ovary syndrome during treatment with oral contraceptives containing low-androgenic progestin.

BACKGROUND: Combined oral contraceptives (COC) effectively suppress hyperandrogenism in women with polycystic ovary syndrome (PCOS), though deterioration of insulin sensitivity during treatment is assumed. The study aim was to investigate insulin action and androgen production during treatment with COC containing low-androgenic progestin. METHODS: A total of 13 PCOS women and nine controls was enrolled into the study. Only non-obese women with a body mass index (BMI) <or=30 kg/m(2) were included. Hyperinsulinaemic euglycaemic clamp techniques were performed before and after 6 months of treatment with a monophasic COC containing norgestimate. RESULTS: Anthropometric parameters [BMI, waist:hip ratio (WHR)] remained unaltered during the study in both groups. No deterioration in glucose disposal rate (M), insulin sensitivity index (ISI) or metabolic clearance rate of glucose (MCRG) was observed during treatment in PCOS subjects. Fasting glucose decreased significantly (P < 0.01), but fasting insulin remained unchanged. Significant decreases in concentrations of testosterone (P < 0.001), androstenedione (P < 0.01) and dihydroepiandrosterone (DHEA) (P < 0.001), a decrease in the free androgen index, and an increase in concentrations of sex hormone-binding globulin were found in PCOS subjects. CONCLUSIONS: The norgestimate-containing COC significantly decreased androgen production and concentrations of free androgens, without reducing insulin sensitivity in non-obese PCOS subjects.

Adult↗
PubMed2002

Prediction of insulin sensitivity in nonobese women with polycystic ovary syndrome.

UNLABELLED: Insulin resistance is a frequent (although not constant) abnormality in both obese and nonobese women with polycystic ovary syndrome (PCOS). It plays a key role in the predisposition to type 2 diabetes, which is the most important health consequence of the syndrome. Identification of patients with insulin resistance is significant both for follow-up and for therapeutic reasons. The aim of the study was to evaluate the relationships between insulin sensitivity, measured by euglycemic clamp, and both endocrine and metabolic indices and to identify the best model for predicting insulin sensitivity. A total of 41 nonobese women fulfilling the diagnostic criteria for PCOS were enrolled in the study. None of the androgens correlated with the insulin sensitivity index. All clamp parameters correlated with SHBG, triglycerides, and body mass index, although no correlation was found with waist to hip ratio or waist circumference. The close relationship between insulin sensitivity and SHBG was documented by factor analysis and by its presence in all prediction models as the most significant (or even the single) predictor of the insulin sensitivity index. IN CONCLUSION: 1) a decreased level of SHBG can be used as a single reliable parameter in the prediction of insulin sensitivity in nonobese women with PCOS; and 2) waist to hip ratio, waist circumference, and androgen concentrations have no predictive value.

Adult↗
PubMed2001

[Effect of long-term treatment with metformin on steroid levels and parameters of insulin resistance in women with polycystic ovary syndrome].

BACKGROUND: Insulin resistance is probably the key factor in the pathogenesis of polycystic ovary syndrome, and thus insulin sensitization can be a beneficial treatment. We tried to investigate effects of long-term therapy with metformin in polycystic ovary syndrome on steroid levels, ovarian steroidogenesis and on insulin resistance and secretion. We also tried to find predictors of the successful therapy (in terms of improvement of menstrual cyclicity). METHODS AND RESULTS: 24 oligo/amenorhoeic women with polycystic ovary syndrome were included into the study. Basal blood samples were taken for the determination of testosterone, estradiol, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone-sulphate, 17OH progesterone, 17OH pregnenonole, sex-hormone binding globulin and cortisol. Gonadoliberin (GnRH) analogue test was performed with estimation of the same steroids and LH. Oral glucose tolerance test was done with dextrose, and with estimation of glucose, insulin, and C peptide. HOMA model assessment was used for calculation of insulin resistance and insulin secretion. All examinations were done before and after 27 +/- 4 weeks (average +/- standard deviation) of therapy with metformin 1000 mg/day. Significant improvement in menstrual cyclicity was observed in 58% of women. No significant change in basal steroid levels was found. A trend towards decline in insulin resistance and secretion was detected. Significant decrease in the mean stimulated testosterone level (from 1.74 to 1.54 nmol/l, 95% CI 1.42-2.08 and 1.21-1.87; p < 0.05), 17OH progesterone level (from 3.32 to 2.37, 95% CI 1.42-2.08 and 1.21-1.87; p < 0.05), LH (from 9.1 to 4.8 IU/l, 95% CI 6.4-12.8 and 3.4-6.8; p < 0.05), and estradiol level (from 0.91 to 0.43 nmol/l, 95% CI 0.69-1.19 and 0.38-0.65; p < 0.01) were detected. The best prediction of the improvement in menstrual cyclicity after metformin was achieved with the combination of basal 17OH progesterone, androstendione, testosterone and SHBG. This model correctly classified 86.7% of subjects. CONCLUSIONS: Long-term therapy with metformin led to the improvement in menstrual cyclicity, without significant change in basal steroid levels or parameters of insulin resistance.

17-alpha-Hydroxypregnenolone↗
PubMed2001

[Can hormonal contraceptives affect plasma levels of IGF-1 and IGFBP-1 in slim women with polycystic ovary syndrome?].

BACKGROUND: Polycystic ovary syndrome (PCOS) represents a frequent endocrinopathy among fertile women. Ethiopathogenesis of the syndrome is multifactorial and it is a subject of scientific discussions. Considered is the possibility of intraovarial IGF system disorder affecting maturation of ovarial folicles. The aim of our work was to determine effects of peroral contraceptives with low-androgen progestin on IGF system in PCOS patients and healthy woman controls. METHODS AND RESULTS: 14 patients fulfilling diagnostic criteria of PCOS and 7 healthy controls were included into the study. All persons were examined before and after six months lasting administration of monophasic estrogen-progesteron contraceptive therapy with 35 micrograms of ethinylestradiol per day and 250 micrograms of low-androgen progestin norgestimate per day. In PCOS patients low increase of basal insulinemia levels occurred (16.3 +/- 4.8 vs. 20.8 +/- 4.8 mU.l-1, p < 0.05). IGF-1 serum levels were not influenced (230 +/- 70 vs. 235 +/- 112 pg.ml-1, n.s.), IGFBP-1 serum concentration significantly increased (46.3 +/- 24.1 vs. 75.6 +/- 24.0 pg.ml-1, p < 0.001). Insulinemia in healthy women also slightly increased (15.9 +/- 4.0 vs. 18.4 +/- 4.0 pg.ml-1, p < 0.05). IGF-1 serum concentration significantly increased (140 +/- 65 vs. 241 +/- 89 pg.ml-1, p < 0.001). IGFBP-1 was also higher (45.0 +/- 19.19 vs. 80.0 +/- 15.6 pg.ml-1, p < 0.001). Influence of the hormonal contraception on the followed parameters was estimated using Wilcoxon's test. While BP-1 increase was significant in both groups, the increase of IGF-1 was significant only in healthy controls. CONCLUSIONS: Increased levels of IGFBP-1 were found in both studied groups of women. Women with PCOS had higher serum levels of IGF-1 before the therapy and the treatment did not influence it. Contrary to it, in healthy women the increased value was observed. Explanation of that finding will become the aim of our next study.

Body Mass Index↗
PubMed2001

Neuroactive steroids, their precursors and polar conjugates during parturition and postpartum in maternal blood: 2. Time profiles of pregnanolone isomers.

Time profiles of the pregnanolone isomers epipregnanolone (3 beta-hydroxy-5 beta-pregnan-20-one), allopregnanolone (3 alpha-hydroxy-5 alpha-pregnan-20-one), pregnanolone (3 alpha-hydroxy-5 beta-pregnan-20-one), and isopregnanolone (3 beta-hydroxy-5 alpha-pregnan-20-one) were measured around parturition and in the postpartum period in the serum of 13 and three women with subarachnoidal and epidural analgesia, respectively. In addition, the levels of polar conjugates of all pregnanolone isomers were followed during parturition. GC/MS analysis was used for the measurement of steroid levels. Changes in concentrations of free steroids exhibited a similar pattern, with a fall primarily within the first hour after delivery. The decrease in conjugated steroids was shifted to the interval within the first hour and first day after delivery, and the changes were more pronounced. The time profile of the conjugated/free steroid ratio exhibited a significant decrease within the first hour and the first day after delivery in all of the isomers investigated. A decrease was also observed in the ratio of 3 alpha/3 beta-isomers and 5 alpha/5 beta-isomers around parturition. The possible physiological consequences of the findings are indicated.

Adult↗
PubMed2001

Does obesity diminish the positive effect of oral contraceptive treatment on hyperandrogenism in women with polycystic ovarian syndrome?

Polycystic ovarian syndrome (PCOS) is an obvious indication for long-term treatment. Combined oral contraceptives (COC) remain the first choice for the treatment of hyperandrogenism in most patients. However, differences in endocrine and metabolic parameters between obese and lean patients have been postulated. This is the first study evaluating the effect of COC treatment in obese versus non-obese PCOS patients. In total, 28 lean [body mass index (BMI) <25 kg/m(2))] and 15 obese (BMI >30 kg/m(2)) women patients were enrolled in the study. The concentrations of androgens, sex hormone-binding globulin (SHBG) and lipids were measured before and after 6 months of treatment with COC containing low-androgenic progestins. Clinical androgenic symptoms were monitored. There was a lower concentration of SHBG in obese patients, but there were no differences in androgen concentrations between both groups before the study. Highly significant changes in concentrations of testosterone (P < 0.001), androstenedione (P < 0.0001), SHBG (P < 0.001) and LH (P = 0.01) were demonstrated in lean patients, with only less significant changes in SHBG (P < 0.01) and testosterone (P < 0.05) in obese patients during the study. Clinical androgenic symptoms improved significantly (P = 0.05) only in the group of lean women. No reduction in low-density lipoprotein-cholesterol/high-density lipoprotein-cholesterol ratio was observed in either group. In conclusion, the positive effect of COC treatment on androgen production, serum androgen binding capacity, and clinical androgenic symptoms was negatively influenced by an increased BMI.

Acne Vulgaris↗
PubMed2001

Exploratory biochemical data analysis: a comparison of two sample means and diagnostic displays.

The occurrence of acne in women with hyperandrogenemia is well known; a question remains, however, as to whether a further positive relationship can be detected between the intensity of acne and the levels of testosterone, androgen precursors and sex hormone binding globulin (SHBG). A procedure of interactive data analysis extracting relevant information from original data was applied. Exploratory data analysis (EDA) identifies basic statistical features and patterns of data using a variety of diagnostic displays. The need for this step is particularly acute in biochemical and clinical data, the distribution of which is mostly non-Gaussian and often corrupted by the outliers. The omission of EDA can lead to incorrect results and false conclusions. In the EDA (i) several graphical tools for summarizing data are applied, (ii) the peculiarities of a sample distribution are investigated, (iii) a construction of distribution is carried out, (iv) a graphical comparison of the sample distribution with selected theoretical distributions is employed. The proposed procedure is illustrated by typical case study in the evaluation of differences between mean values of serum levels of testosterone, androgen precursors and SHBG in a group of patients with mild and severe forms of acne. A knowledge of the interval estimate of the mean value in both groups enables their comparison at the chosen probability level. As will be apparent from the evaluation of inter-group SHBG differences, an incorrect approach to the determination of group mean values could result in a complete misinterpretation of the data. The results indicate that androgens are not significantly related to the intensity of acne, and that SHBG is higher in patients with more severe forms of acne.

Acne Vulgaris↗