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D Tóth

Publications and source records attributed to D Tóth.

At least 19 recordsLinked to original sources
PubMed2006

[Office hysteroscopy--state of the art].

OBJECTIVE: Sum up the knowledge about office hysteroscopy. TYPE OF STUDY: Review of literature and our own 5 years of experience. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague, Prague. METHODS: Compilation of data from scientific literature and 5 years of our own experience with office hysteroscopy. CONCLUSIONS: Hysteroscopy provides optical evaluation of uterine cavity. Most of the benign intrauterine organics pathologies could be managed in an outpatient setting with a vaginoscopic approach without any anaesthesia and analgesia. Using that approach we can recommend to perform endometrial target biopsy, resection of endometrial polyps up to 1.5 cm and pedunculated submucous myomas up to 1 cm as well as resection of filmy intrauterine adhesions. Method is comfortable for well managed patients and practically complication-free.

Ambulatory Surgical Procedures↗
PubMed2006

["See and treat" hysteroscopy: limits of intrauterine pathology bulk].

OBJECTIVE: To evaluate bulk limits of intrauterine pathology for "see and treat" hysteroscopy. TYPE OF STUDY: A retrospective observational study. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague. METHODS: 200 mg of Indomethacin was administered to the patients by rectum 2 hours before procedure. "See and treat" procedures were performed with "Versascope" in awake patients without any peroperatively admistered analgesia or anaesthesia. As a "see and treat" were managed 796 endometrial polyps, 125 submucous myomas, as well as 62 cases of intrauterine synechias. CONCLUSIONS: endometrial polyps up to 1,5 cm, pedunculated submucous myomas up to 1,0 cm as well as fibroid adhesiones obliterated no more than 1/3 of uterine cavity can be managed as "see and treat" procedures with a high compliance of the patients.

Female↗
PubMed2002

[The 3mm optical system in hysteroscopy].

OBJECTIVE: To evaluate our first experience with 3 mm hysteroscope. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology, 1st medical Faculty, Charles University, Prague. METHODS: 105 hysteroscopic procedures in normal saline as distension fluid were performed between June and November 2001. We performed 60 (57.1%) diagnostic procedures and 45 (42.9%) minor surgical intrauterine interventions (mainly endometrial polyp < 2 cm resection). We used Versascope (Gynecare, Johnson & Johnson) 1.9 mm optics with 3.2 mm expandable operative sheath. All diagnostic procedures were done by minimal invasive way--using vaginoscopic approach. Main part of procedures were performed without any anaesthesia. In case of operative intervention we used Versapoint bipolar electrodes in normal saline and active outflow. RESULTS: The surgeon evaluated the intrauterine findings and the patient evaluated subjective comfort during the procedure (comfortable, uncomfortable, painful). No complications were registered during or post procedure. 83 (73%) women undergone diagnostic procedure described the procedure without discomfort, 22 (21%) women described a moderate discomfort with pressure in the lower abdomen (all undergone intrauterine surgical intervention). No patient described severe discomfort or wish to have general anesthesia. CONCLUSION: Miniaturized optical systems allows us to perform most cases of diagnostic and surgical intrauterine interventions (after proper patient selection) in an outpatient or office setting.

Female↗
PubMed2001

Aspiration cytology from the pouch of Douglas at hysteroscopy.

Eighty-seven fine needle aspiration cytological samples from 29 patients suffering from irregular perimenopausal uterine bleeding were evaluated. Aspiration cytology was performed prior to hysteroscopy, after distension of the uterine cavity and finally after uterine curettage. In this paper, cytological examination of fluid from the pelvic content in women with benign endometrial findings is compared with that of patients with adenocarcinoma. Endometrial curettage influenced the cell content of the cytologica specimens.

Adenocarcinoma↗
PubMed2000

Dihexyl sulfosuccinate biodegradation by mixed cultures.

The primary biodegradation of dihexyl sulfosuccinate has been demonstrated using two single cultures and three mixed bacterial cultures of Comamonas terrigena. Primary biodegradation was found in all variants. The highest biotransformation rate and efficiency was observed in one of the single strains. No synergistic effect on degradation was found in mixed cultures.

Biodegradation, Environmental↗
PubMed2000

Effect of starvation and chloramphenicol on acceleration of bacterial dihexyl sulfosuccinate biotransformation.

Starvation for carbon and energy sources accelerated the biotransformation of the anion-active surfactant dihexyl sulfosuccinate (DHS) by Comamonas terrigena cells. Chloramphenicol (Cm) added at different time intervals to non-starved cells inhibited the DHS transformation. The largest difference between cells treated and non-treated by Cm was observed for a 16-h-starvation period. Protein synthesis de novo during starvation enhanced the DHS biotransformation efficiency. A partial transformation of DHS in the presence of Cm indicated the constitutive character of enzymes involved in primary DHS biodegradation.

Bacterial Proteins↗
PubMed2000

[Paracervical anesthesia in hysteroscopy and transcervical surgery].

OBJECTIVE: To evaluate the efficacity of local-paracervical anaesthesia in hysteroscopy and transcervical surgery. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology, 1st medical Faculty, Charles University, Prague. METHODS: In 1998 we performed 144 hysteroscopic procedures under local anaesthesia--paracervical block. In 47 (32.6%) cases we performed transcervical surgery. As anaesthetic agent we used bupivacain (0.25%, Marcain, Astra) combined with an intravenous sedative--midazolam (Dormicum, Hoffman-LaRoche). RESULTS: In 130 (90.2%) cases patients evaluated the procedure as comfortable, in 7 (4.86%) cases the procedure caused discomfort and in 7 (4.86%) cases we used general anaesthesia. CONCLUSION: Paracervical anaesthesia is a safe method for hysteroscopy and transcervical surgery due to its minimal invasivity.

Anesthesia, Local↗
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

[[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

[Ambulatory hysteroscopy--a new trend in the diagnosis and treatment of intrauterine pathology].

OBJECTIVE: An analysis of ambulatory hysteroscopic procedures. DESIGN: Retrospective study. SETTING: Dept. of Obstetrics and Gynecology of the 1st Faculty of Medicine, Charles University and the General Faculty Hospital, Apolinárská 18, Prague 2, Czech Republic. METHODS: The sample consists of 225 patients who underwent ambulatory hysteroscopy, during the period between September 1999 to February 2000. The sample makes up 46.3% of the total number of hysteroscopies performed during that period. The procedures were performed under a paracervical block, only rarely in combination with analgesic sedation. RESULTS: Indications for the procedure were most often abnormal uterine bleeding peri- or postmenopausally, 51.2%, abnormal ultrasound findings in 9.8%, and endometrial polyps in 1.8%. In only 23.11% of cases, hysteroscopy was performed in the frame of TCS (transcervical surgery), the remaining procedures were diagnostic. The paracervical block was a great benefit to the comfort of the ambulatory procedures. In 93%, the procedure was evaluated as comfortable, in 4.8% there was discomfort, and in only 2.2% general anesthesia was used due to significant pain. We did not observe any early or late complications. CONCLUSION: Hysteroscopy can be performed as an ambulatory procedure, assuming quality equipment, an experienced surgeon, and properly administered local anesthesia. Our results demonstrate that hysteroscopy is not only a diagnostic procedure, but can be used for certain procedures in the area of TCS (with low or intermediate level of difficulty).

Ambulatory Surgical Procedures↗
PubMed2000

[Surgical treatment of duodenal perforation].

Duodenal ulcer can be cured successfully by the eradication of Helicobacter pylori (H. p.) and administration of anti-acid secretory drugs, however, from among the complications of duodenal ulcer, perforation with unchanged incidence continues to need an urgent operation. The authors examined the case histories, results of preoperative examinations, data of operations, and postoperative events of 175 patients hospitalized for perforation of duodenal ulcer in the past five years. The average age of the 38 women was more than 20 years greater than that of the 137 men. The time between the appearance of the serious symptoms and the operation exceeds 24 hours in 31 patients. There was serious preoperative general condition (ASA IV. and V.) in 13.7% of the cases. In the last year infection with H. p. was proved with Pylori Screen II (Orion Diagnostica) serological examination in 22 patients. Closure of the perforation was made in open fashion in 155 (average operative time: 54.1 min.), laparoscopically in 7 (average operative time: 117.9 min.) and gastric resection was necessary in 12 patients (average operative time: 154.6 min.). In 20.4% of the survivors a complication was observed. All of the 18 non-survivors (10.3%) were operated on in poor condition and beyond recovery. Seven patients operated on laparoscopically experienced undisturbed recovery, and stayed in the hospital the shortest time (average: 5.4 days). In the authors opinion the preoperative knowledge of H. p. infection influences the method of the operation of choice, and they recommend the laparoscopic access in elected cases.

Aged↗
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

[Cesarean section and perinatal mortality 1993-1996 in a regional perinatology center].

During the period between 1993-96 the authors made at the Second Gynaecological and Obstetric Clinic 1099 caesarean sections. The investigated group was subjected to frequency analysis. The relationship with perinatal mortality and early neonatal mortality was assessed. In a group of 287 caesarean sections in 1996 the authors analyzed indication spectra and maternal morbidity. The results were compared with data in the literature. From the assembled data ensues that although the rate of caesarean sections practically does not change, perinatal mortality decreased significantly. This positive result is due mainly to better perinatal and neonatological care. In the indications for caesarean section the authors did not reveal statistically significant deviations from nationwide average figures.

Cesarean Section↗
PubMed1999

Video-choledochoscopy in bile duct surgery.

The authors report on common bile duct explorations performed in 92 patients and in one patient laparoscopically. In their practice usually ERCP and EST were attempted first when bile duct stones were suspected. Open choledochotomy was performed when the endoscopic approach was unsuccessful, or a stone was detected during selective intraoperative cholangiography. In 16 cases intraoperative video-choledochoscopy was performed. The thing that increased the average operating time by 47 minutes. In 4 patients in this group residual stones were detected postoperatively, presumably because of the inexperience of the surgeons with the use of the choledochoscope. Postoperative cholangiography raised the suspicion of a residual stone altogether in 8 cases. Postoperative ERCP was negative in 2 instances, EST and stone extraction were successful in 3 patients, but unsuccessful in 3 patients. In these last cases a successful reoperation was made in one, ESWL and dissolution therapy were performed in two patients. The authors advise to learn the technique of laparoscopic removal of the bile duct stones and the application of guide-wire, Dormia basket, Fogarty balloon catheter, and balloon dilatator. According to the data of the literature, the one stage laparoscopic procedure is successful in most of the patients, more comfortable, and cost saving.

Adolescent↗