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D Cibula

Publications and source records attributed to D Cibula.

At least 73 records · Page 4Linked to original sources
PubMed2000

[Initial experience with the Versapoint bipolar electrode in hysteroscopic tissue vaporization].

OBJECTIVE: To evaluate our first experience with bipolar electrode (Verspoint, Johnson&Johnson) for transcervical surgery. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology, 1st medical Faculty, Charles University, Prague. METHODS: Twenty procedures with bipolar electrode in normal saline as distension fluid were performed between September and November 1999. All 20 patients underwent office diagnostic hysteroscopy with biopsy sampling which demonstrated benign histological finding. We used Olympus operative 7 mm hysteroscope, Versapoint system with bipolar electrodes (twizle, spring, ball). In 13 cases we vaporized intrauterine polyps, in 4 cases we vaporized intrauterine submucous myoma (grade I-ESH), in 1 case we dissected intrauterine septum and in 2 cases we performed intrauterine adhesiolysis. Local anesthesia-paracervical block was employed in 50% of procedures and general anesthesia was employed in 50% of cases. RESULTS: The surgeon evaluated the degree of difficulty during the procedure as comfortable and easy to use in case of intrauterine polyp, intrauterine septum and intrauterine adhesions vaporisation, as mild difficulty in submucous myoma to 2 cm and moderate/severe difficulty in case of myoma vaporisation of more than 2 cm size. No complications were registered during or post procedure, we did not registered no sign of hyponatremia, no complains regarding pain or discomfort from patients. CONCLUSION: The advantage of Versapoint bipolar system for intrauterine operative hysteroscopy is the use of normal saline as distention fluid, which decreases pre and postoperative complications. We evaluated the vaporisation of pedunculate intrauterine pathologies up to 2 cm as comfortable and easy to use. Combined to local anesthesia it appears to be a useful system for office hysteroscopy and transcervical surgery.

Adult↗
PubMed2000

Multiple ovarian biopsy in the treatment of women with polycystic ovary syndrome (PCOS).

BACKGROUND: Ovarian electrocautery has been used with success in the treatment of PCOS women. However, unipolar coagulation carries the risk of serious injuries to pelvic organs. In an effort to avoid this potential risk, the efficacy of multiple ovarian biopsy was evaluated in our study. METHODS: Eleven PCOS patients were enrolled to the study. Four to eight biopsies were taken from both ovaries. The levels of LH, FSH, androgens and the reactivity of ACTH test were evaluated at standard intervals. The occurrence of ovulation was determined by ultrasound. RESULTS: Laparoscopy was followed by non-significant changes of endocrine parameters only. The ovulatory cycle was restored in only three women of the whole group. CONCLUSIONS: Our study did not prove the efficacy of multiple ovarian biopsy in the treatment of PCOS women. The procedure caused only minor changes in endocrine parameters and rarely restored ovulation.

17-alpha-Hydroxyprogesterone↗
PubMed2000

[[Endometrial ablation--prospective 5-year follow-up study].

OBJECTIVE: Objective of the study is to evaluate the effectiveness of endometrial ablation in patients with persistent uterine bleeding who are unresponsive to conservative therapy. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University and General Faculty Hospital in Prague, Czech Republic. METHODS: 100 women with intractable uterine bleeding were subjected to undergo endometrial ablation. 44 patients were treated preoperatively not only with danazol or progestins but also with Norethisteron acetas to stop the acute bleeding preoperatively and 65 gave no preoperative drug administration. Under appropriate anesthesia the cervix was dilated to 100 mm and the uterine cavity was distended with Purisol (Sorbitol and Manitol). Roller-ball coagulation technique combined with loop highfrequency endoresection was used in most of the patients (85 patients). The findings of small uterine myoma(s) were not consider as a contraindication of the endometrial ablation. RESULTS: At 51-2 months 42 (42%) of patients reported amenorrhea, 51 (51%) hypomenorrhea, 5 (5%) eumenorrhea and 2 (2%) nochange. The mean time to complete operation was 30 minutes (range 15-45 minutes). The procedure was completed in all 100 women and we had no serious complications. CONCLUSION: It is concluded, that endometrial ablation is safe and effective hysteroscopic procedure in the cases of abnormal uterine bleeding for women with normal uterine morfological findings or small uterine myoma(s) considering the follow up 51-2 month of the study.

Adult↗
PubMed2000

[Liver function tests during administration of triphasic contraceptives containing Norgestimate].

OBJECTIVE: To evaluate serum levels of liver enzymes and bilirubin before and after six cycles of use of a triphasic oral contraceptive containing 35 micrograms of ethinylestradiol and 180/215/250 micrograms of norgestimate (Pramino, Janssen-Cilag). DESIGN: A prospective, open-label, non-comparative, multicentric phase IV study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University, Prague. METHOD: Before the start and after six cycles of Pramino use, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GMT), and bilirubin were determined in women. As the analyses were performed in different laboratories, the evaluation involved: 1. Subgroups of women examined in laboratories with the same reference range; 2. A group of women examined in laboratories with the upper reference range within the mean +/- SD interval; 3. Percentage variations of the measured values from a concrete upper reference limit. RESULTS: When evaluating subgroups of women from laboratories with the same standards, significant decreases in AST and bilirubin were seen in some subgroups, a rise in GMT in one subgroup; the other changes were non-significant. When assessing the entire group and percentage variations from standard, a mild rise in GMT was again seen; however, the values remain deep within the normal range. Values above the upper reference limit at the start of the study either do not change significantly throughout the study, or they normalize spontaneously. CONCLUSION: No clinically significant changes in liver function tests occurred in users of a triphasic oral contraceptive containing norgestimate along with 35 micrograms EE over a period of six cycles of use. The results, as judged by their dynamics, suggest liver function tests are not a useful tool for routine monitoring a healthy combined oral contraceptive user.

Contraceptives, Oral, Combined↗
PubMed1999

[Endometrial ablation: prospective 3-year follow-up study].

INTRODUCTION: Patients with persistent uterine bleeding not responsive to conservative therapy may in selected cases opt for endometrial ablation rather than hysterectomy. METHODS: 50 women with intractable uterine bleeding were subjected to endometrial ablation. 26 patients were treated preoperatively with danazole 200 to 400 mg/day for 4 weeks, 4 received progestins, 5 norethisteron acetas to stop the acute preoperative bleeding and 15 were not given preoperative treatment. Under anaesthesia the cervix was dilated to 10 mm and the uterine cavity was distended with Purisol (sorbitol and mannitol). Roller-ball coagulation technique combined with loop resection was used in 32 patients, resection using the electrosurgical loop in 17 and coagulation with roller ball in 1 patient respectively. The endometrium of the internal os of the uterus was resected in 16 cases. The findings of small uterine myoma(s) were not considered a contraindication of endometrial ablation. RESULTS: Patients' satisfaction with the effect of treatment was recorded in 48 cases (96%). After 35--5 months 22 (44%) patients reported amenorrhea, 24 (48%) hypomenorrhea, 3 (6%) eumenorrhea and 1 (2%) no change. The mean time of operation was 25 minutes (range 15-40 minutes). The procedure was completed in all 50 women and we had no serious complications. DISCUSSION: There was some evidence of superior health related quality of life among hysterectomy patients reported in literature. The rate of secondary hysterectomy was 10% because of associated lesions: myoma with adenomyosis in 50% of the cases, so that the procedure in cases of myoma(s) is questionable. This is the reason why it is necessary to make a careful selection of patients who are to be treated by this metod in order to avoid complications and secondary hysterectomy. CONCLUSION: It is concluded, that endometrial ablation is a safe and effective hysteroscopic procedure in cases of abnormal uterine bleeding in women with normal uterine morphological findings or small uterine myoma(s).

Adult↗
PubMed1999

[Rational laparoscopic intervention in laparoscopically-assisted vaginal hysterectomy (LAVH): prospective study].

INTRODUCTION: Despite evidence that the vaginal route of surgery is associated with fewer complications and faster recovery, more than two-thirds of hysterectomies are performed abdominally. Diagnostic and operative laparoscopy leads to an increasing number of hysterectomies performed vaginally, although laparoscopy may lead to serious complications. The object of the study was to evaluate the rational share of laparoscopy during laparoscopically assisted vaginal hysterectomy. METHOD: 100 consecutive women subjected to hysterectomy were indicated for laparoscopically assisted vaginal hysterectomy. The procedures were performed by the same surgical team experienced in laparoscopy and vaginal route hysterectomy which evaluated the rational share of laparoscopy during laparoscopically assisted vaginal hysterectomy. The mean age of the patients was 48.1 years (range 34-71 years). 7 were nulliparae. 69 patients were indicated for operation due to myomas, 20 for the previous operation in the pelvic area, 6 for adnexal cystic masses, 5 for the associated indications. At the same time bilateral adenexectomy was performed in 74 patients. Uterine descensus was diagnosed in 9 patients preoperatively and the operations for stress urine incontinence were performed in 7 cases (Kelly-Stoeckel 4 and Pereyra 3 respectively). Ovarian vessels were coagulated by bipolar coagulation during laparoscopy and uterine vessels were ligated by the vaginal route. RESULTS: The uterus was extripated electively by the abdominal route in 2 patients after diagnostic laparoscopy (unfavourabl localised intraligamentous myoma, distended bowels after using Tractrium by the anestesiologist). Hysterectomy by the vaginal route was completed in 98 patients. The mean operation time was 80 minutes (range 55-180 minutes) and the mean operation time of the laparoscopic part of the operation was 35 minutes (range 25-45 minutes). The estimated blood loss was 300 ml (range 100-550 ml). In 2 patients lysis of dense pelvic adhesions during the laparoscopic part caused that the vaginal part of surgery was safe. 10 complications were encountered postoperatively (3 cases of bleeding from the vaginal vault and 1 from ovarian vessels respectively, 3 cases of pelvic inflammatory disease, 2 injuries of the urinary bladder were recognized and treated peroperatively and 1 case of stress urinary incontinence 10 weeks after hysterectomy). DISCUSSION: According to the literature a different extent of surgical laparoscopy in vaginal hysterectomy is possible. Nulliparity or uterine myomas are no contraindications for vaginal hysterectomy. The main contribution of surgical laparoscopy for vaginal hysterectomy consists in lysis of dense adhesions in the pelvic area and in evaluating or operating adnexal cystic masses. Other indications are controversial because of prolonging the operative time and general risks of diagnostic and surgical laparoscopy. CONCLUSION: The main contribution of laparoscopy for the purposes of vaginal hysterectomy remains the assessment and treatment of dense pelvic adhesions or adnexal pathology rather than hysterectomy itself. Bipolar coagulation of ovarian vessels decreases the blood loss in cases of enucleation of morcellation of myoma(s) during the vaginal part of the operation.

Adult↗
PubMed1999

[Importance of operative hysteroscopy in the treatment of intrauterine pathology: method of first choice].

OBJECTIVE: To demonstrate the possibilities of hysteroscopic procedures and transcervical surgery in the management of intrauterine pathology. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of General Medicine and General Faculty Hospital, Prague, Apolinárská 18, Czech Republic. METHODS: Retrospective analysis of hysteroscopic procedures. RESULTS: In the period 1994-1998 we performed 1410 hysteroscopic procedures. We registered an increase of operative hysteroscopic procedures--from 6.8% in 1995 to 24.5% in 1998. We registered 4 perioperative complications--in 1 case "fluid overload syndrome", in 2 cases perforation of the posterior vaginal fornix during dilatation of the cervix after its conisation and in 1 case perforation of the anterior uterine wall. These complications were not treated by any further major surgical intervention. In 91.3% we were able to solve the intrauterine pathology immediately in a one-step hysteroscopic procedure. CONCLUSIONS: Our results are positive and demonstrate the role and advantages of operative hysteroscopy in the management of intrauterine pathology.

Female↗
PubMed1999

[Prediction of increased levels of androgen in women with acne vulgaris using ultrasound and clinical parameters].

OBJECTIVE: The aim of our study was to identify clinical parameters characterizing women with acne whose dermatological problems are due to increased androgen production. Identification of these parameters would allow to indicate endocrinological examination in only a proportion of women with acne vulgaris. PATIENTS AND METHODS: A total of 54 women with acne vulgaris resistant to local treatment were enrolled in the study. The following clinical parameters were monitored: hirsutism (Ferriman-Gallway score), severity of acne, association of the severity of acne with the menstrual cycle, beginning of manifestations of acne, regularity of the menstrual cycle, presence of alopecia, age at menarche, body weight, BMI and ultrasound investigation of the ovaries. In the standard phase of the cycle, blood was collected to determine the levels of the following hormones: LH, FSH, PRL, TSH, testosterone, androstenedione, DHEA, DHEAS, SHGB. Wilcoxon's robust non-parametric paired test was employed for statistical data analysis. RESULTS: Overall, 33 (61%) women showed increased levels of at least one androgen. An irregular cycle was found in 21 (39%) women, acne severity was associated with the menstrual cycle in 16 (30%) women, 48 (89%) women had acne from menarche, 19 (35%) women had hirsutism; an ultrasound finding of polycystic ovaries was revealed in 32 (59%) women. No significant differences were found between a sub-group of women with levels of at least one androgen above the upper reference limit and the other women in the following variables: age, weight, BMI, age at menarche, ultrasound finding of polycystic ovaries, manifestation of acne from menarche, irregular cycle, hirsutism. The two groups were not different in the severity of acne. Deterioration of acne depending on the menstrual cycle was more often present in women with normal androgen levels. By contrast, a regular menstrual cycle was found to be more frequent in women with raised androgen levels, although the difference was not statistically significant. CONCLUSIONS: Clinical parameters had no association with androgen overproduction. Evaluation of clinical parameters, including severity of acne, does not allow to refer only a proportion of women with acne resistant to local treatment for endocrinological examination.

Acne Vulgaris↗
PubMed1999

[Clinical study of a triphasic contraceptive preparation (Norgestimate 180/215/250 micrograms + ethinylestradiol 35 micrograms) in a population of Czech women].

OBJECTIVE: To assess the efficacy, acceptability and safety of triphasic oral contraceptive pill containing norgestimate 180/215/250 micrograms and ethinylestradiol 35 micrograms. DESIGN AND SETTING: Prospective, open-label, non-comparative, multicenter study in 409 centers in the Czech Republic. METHODS: Body weight, blood pressure, bleeding pattern, headaches, nausea, breast tenderness, acne, pregnancies and side effects were monitored before the start of the treatment, after three and six cycles of oral contraceptive use. Liver function tests were carried out before and after the treatment. RESULTS: Evaluating 26,432 cycles in 4,720 women the theoretical Pearl index was 0.15. There were no significant changes in body weight (61.45 kg before vs 61.58 kg after the treatment). There were clinically significant changes neither in the blood pressure nor in the liver function tests. Evaluating the bleeding pattern there were similar incidences of irregular bleeding/spotting before the treatment and up to the third treatment cycle (16.15%, resp. 17.86%); then the incidence dropped down (8.41% after the third cycle). Amenorhea was very rare (0.41% resp. 0.35% up to, resp. after the third cycle). Decreasing incidences compared to pretreatment state were observed for headache, breast tenderness and acne. The effect on acne was remarkable (28.3% of women complaining of acne before the treatment vs 6.51% after the six treatment cycles). There were no serious adverse events observed during this study. CONCLUSION: Triphasic oral contraceptive pill containing norgestimate and ethinylestradiol proved in a large multicenter study high both efficacy and acceptability.

Adolescent↗
PubMed1999

[Hysteroscopic resection of submucosal myomas in abnormal uterine bleeding: results of a 4-year prospective study].

OBJECTIVE: The evaluation of the effect of transcervical resection of submucous myoma/s in patients with abnormal uterine bleeding. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University and General Faculty Hospital in Prague, Czech Republic. METHODS: 45 patients with resected submucous myoma/s within the period 1995-1998 were selected. Patients in whom resection of myoma was combined with endometrial ablation were excluded. The average age of the cohort was 43 years (29-53). In 37 patients (82%) therapeutical curettage was performed for severe bleeding in the past (3 procedures on average, interval 1-7). In 16 patients (36%) transfusion was administered in the treatment of anaemia secondary to abnormal uterine bleeding in the past. Hysteroscopy, ultrasound scan or both techniques were used to diagnose and classify myomas. In 39 patients 1 myoma was resected, in 6 patients 2 myomas. In 12 (27%) patients myoma of 0., in 29 (64%) of I. and in 4 (9%) of II. has been diagnosed according to the ESH classification. In case of several myomas, the classification was based on the one of the highest degree. Surgery was performed in the early proliferative phase of the menstrual cycle. Purisol (sorbitol and mannitol) was used as a distension medium. Myomas were resected using loop high frequency electroendoresection technique. In 3 (7%) patients myomas of ESH II. were resected in more steps--in 2 cases (5%) in 2 steps and in 1 case (2%) in 3 steps. In patients with myomas classified as a 0. and I., only the character of menstrual cycle has been monitored after surgery. Ultrasound investigation was performed in patients with myomas of II. 3 months after surgery. RESULTS: The bleeding was controlled in terms of eumenorrhoea or hypomenorrhoea in all 45 patients (100%). Ultrasound investigation showed no residual myoma in any of 4 patients after resection of II. myoma. One case fluid overload syndrome of minor degree was documented as the only complication. CONCLUSION: Hysteroscopic high frequency endorsection is a safe and effective method and method of choice in the treatment of submucous myomas in patients with abnormal uterine bleeding. The high success rate in our cohort is certainly influenced by the number of patients included and by the length of follow-up.

Adult↗
PubMed1995

[Fetal fibronectin in cervico-vaginal secretions--an indicator of incipient premature labor using a membrane immunoassay].

The objective of the investigation was to test the presence of foetal fibronectin in the cervicovaginal secretion in symptomatic pregnancies and assess the possible prediction of imminent premature delivery. Prospectively 84 pregnant women were examined who were admitted to hospital with symptoms of imminent premature delivery between the 24th and 34th week of pregnancy (more than 20 contractions per day or a cervical score higher than the critical value for the given week of gestation). The secretion was collected by means of a dacron brush from the posterior labium of the portio vaginalis uteri and examined by a single-use kit FFN (Fetal Fibronectin Membrane Immunoassay, Adeza Co.). From the total of 84 specimens of secretions examined for the presence of foetal fibronectin 32 were positive and 52 negative. Of 32 pregnant women with a positive test 19 women delivered within two weeks, 13 were discharged and the deliveries took place after the 36th week of pregnancy. In the group of 52 women with a negative result of the test 50 women were discharged and the deliveries occurred after the 36th week of gestation; only two women who remained in hospital had premature deliveries within two weeks after collection of the specimen. In no patient discharged from hospital delivery occurred before the end of the 36th week of gestation. The finding of positive foetal fibronectin can be interpreted only as an increased risk of premature delivery (positive predictive value 59.4%). A negative test has a better predictive value. If the test is negative, there is a 96.1% probability that premature delivery will not occur (negative predictive value).

Cervix Uteri↗