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E Kucera

Publications and source records attributed to E Kucera.

At least 19 recordsLinked to original sources
PubMed2006

[Pregnancy after laparoscopic myomectomy--long-term follow up].

OBJECTIVE: Analysis of pregnancy related complications in infertile patient after laparoscopic myometomy (LM). DESIGN: Retrospective analytic study. SETTING: Institute for the Care of Mother and Child, Prague; Institute for Postgraduate Medical Education, Prague. METHODS: The study group were infertile patients referred to our department with the finding of uterine fibroid(s). In all patients LM was the method of choice. Thorough information and results from all infertile patient after LM were assessed and analysed with 18 months follow-up after surgery. RESULTS: The aim of our study was to evaluate pregnancy rate and the possible risks during pregnancy and delivery following LM. We analysed 69 patients after LM. Mean size of a fibroid was 3.3 cm and the number of removed fibroids in one patient was 1.8. The conception rate after LM was 56.5%. We didn't observe any increased incidence of fetomaternal morbidity or severe pregnancy and labour related complications. There was no uterine rupture after LM in our group. The cesarean section was rate 44.8%. CONCLUSIONS: The impact of fiborids on infertility is still controversial. LM in infertile patient is one of the most common surgical procedure. The appropriate surgical management of uterine scar is mandatory. This operation must be performed by skilled reproductive surgeon. Thorough information to the patient before and after LM is necessary. The pregnancy following LM is at high risk with increased caesarean section rate.

Adult↗
PubMed2005

[The management of uterine fibroids: Czech and Slovak Gynecologic Endoscopy Working Group (CSGE) clinical practice guidelines].

OBJECTIVE: The objective of this paper is to give a guideline to the management of uterine fibroids. DESIGN: Review. SETTING: Czech Society Gynecological Endoscopic Working Group. MATERIAL AND METHOD: The bibliographic data from Medline were reviewed from 2003-2004 using the key words: fibroid--leiomyoma--uterine artery occlusion--hysterectomy--myomectomy. CONCLUSION: The clinical guideline was prepared after the analysed data were supplied using the material and criteria of Society of Obstetricians and Gynaecologists of Canada (SOGC) for the management of uterine fibroids.

Female↗
PubMed2005

[Pregnancy complications after intrauterine hysteroscopic surgery].

OBJECTIVE: To evaluate our clinical experience of cases of pregnancy after transcervical septum resection and endometrial ablation. There are several case reports in the literature showing increase fetomaternal morbidity after intrauterine surgery. DESIGN: Analytic retrospective study. SETTING: Mother and Child Care Institute, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: There were three cases of severe complications during pregnancy after intrauterine surgery. We experienced one case of uterine rupture after transcervical septum resection in the second stage of labour. The other two cases were pregnancies after endometrial ablation and septum resection complicated with severe bleeding in the second trimester. CONCLUSION: Pregnancies after some types of intrauterine surgery (septum resection, endometrial ablation) are at high risk. They can lead to increased fetomaternal morbidity. We recommend intensive prenatal care with immediate surgical intervention when complications occur.

Adult↗
PubMed2004

[Classification of twins and their ultrasonographic diagnosis].

OBJECTIVE: Systematic classification of all forms of twins and mechanisms of twinning. DESIGN: Review of published cases. Morphogenesis based on personal experience related to human blastogenesis including observation of anterior twinning in two early human embryos. SETTING: Institute for the Care of Mother and Child, Prague, Department of Gynecology and Obstetrics, 1st Medical Faculty, Charles University, Prague, Department of Medical Genetics, Medical Faculty, Palacký University Olomouc, Institut Unica, Brno. METHODS: Analysis of cases described in literature completed by observed cases. RESULTS: Classification of twins. A) Separated twins: 1. dichorial a) monozygotic (very rare), b) dizygotic (most frequent); 2. monochorial (always monozygotic) a) diamnial, b) monoamnial. B) Conjoined twins (always monozygotic) 1. isopagi (equal conjoined twins) a) originating from peripheral fusions of two germ discs, b) originating from duplications of axial structures; 2. heteropagi (unequal conjoined twins): autosit (main twin), heterosit (parasitic twin). CONCLUSION: The developmental mechanisms of twinning are discussed, special attention is paid to equal conjoined twins and to the possibilities of their early prenatal ultrasonographic diagnostics.

Female↗
PubMed2004

[Laparoscopic myomectomy in infertile women].

OBJECTIVE: Evaluation of laparoscopic myomectomy in infertile patient. DESIGN: Literary review. SETTING: Institute for the Care of Mother and Child, Prague, Institute for Postgraduate Medical Education, Prague. METHODS: Information and results of laparoscopic myomectomy in infertile patient were assessed and analysed. RESULTS: Laparoscopic myomectomy in infertile patient is one of the most common surgical procedures. There are several complications after this procedure--adhesion formation, bleeding and uterine rupture during following pregnancy. The incidence of adhesion formation after laparoscopic myomectomy especially in case of intramural and deep subserosal fibroids of posterior uterine wall is high, almost in 60-90%. The uterine rupture following myomectomy represents only 2% of all uterine ruptures in pregnancy. CONCLUSIONS: The laparoscopic approach in uterine fibroids treatment has been clearly established. The appropriate surgical management of uterine defect is mandatory. This approach is the best prevention of postoperative complications--adhaesions and uterine rupture.

Female↗
PubMed2004

[Laparoscopic ovariopexy--modality of ovarian endometriosis treatment].

OBJECTIVE: Case report of a successful treatment of ovarian endometriosis by laparoscopic ovariopexy in infertile women. DESIGN: Case report. SETTING: Institute for the Care of Mother and Child, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: Conservative treatment of ovarian endometriosis is often complicated by postoperative periadnexal adhaesions which may result in pelvic pain or ongoing infertility. Temporary laparoscopic ovarian suspension--ovariopexis is a very effective method in postoperative adhaesion prevention and in the treatment of ovarian endometriosis in infertile patient. We observed successful cases of laparoscopic treatment of ovarian endometriosis. CONCLUSION: Laparoscopic ovariopexis is a simple and effective method for treatment of ovarian endometriosis and prevention of extensive periadnexal adhaesions.

Adult↗
PubMed2004

[Immunopathological and histopathological aspects of ectopic implantation with possible effect on fertility disorders].

OBJECTIVE: To evaluate leucocytic infiltration of fetomaternal interface in ectopic pregnancy and to evaluate the changes in cell immunity against trophoblast (AT-CMI) in women with extrauterine pregnancy (GEU) in their medical history. To assess the effect of these factors on possible fertility disorders in a woman. DESIGN: A retrospective study. SETTING: Mother and Child Care Institute, Prague. METHODS: In most of the patients, we addressed GEU through laparoscopy. The tube was extirpated in toto and immediately fixed in Baker's solution. Thereafter, it was prepared in a dissection microscope and then processed in a standard way. In order to identify the intensity of AT-CMI, we used the leucocyte migration inhibition test. The cytotrophoblastic cell line JAR was used as an antigen. The degree of inhibition of the migration was monitored by means of a computer image analyser. Inhibition of migration below 75% was rated as favourable. RESULTS: We monitored the presence of inflammatory infiltrate in the place of implantation and correlated the findings with the hCG levels and the presence of the foetal ovum or its part in the tube. In 28 patients (23.5%) of the total number of 119 patients in the group, we observed an inflammatory infiltrate in the place of implantation. In these patients, the hCG levels were lower and in 17 of them (60.7%) we did not prove the presence of a foetal ovum or its parts. In women with GEU in their medical history, the AT-CMI positivity was established in 61.1% of the women 1 year after surgery, in 56.8% of the women 1-3 years after surgery and in 41.2% of the women 3 years after surgery. CONCLUSION: Ectopic pregnancy involves a pathological fetomaternal interface. The leucocytic infiltrate in the area of implantation may be of secondary character and may cause gradual destruction of the ectopically positioned product of conception. The results of our study indicate a possible participation of the increased AT-CMI in the destruction of the ectopically located trophoblast. Persisting anti-trophoblast immunity may influence the occurrence and course of further gravidities.

Cell Migration Inhibition↗
PubMed2003

[Ventral prolapse of the embryo: case report].

OBJECTIVE: A pathologic human embryo 3 mm long affected by a "ventral prolaps" was present in a product of conception implanted within the Fallopian tube. The gestational age was 7 weeks. The malformation was characterized by a deep protrusion of the embryonal body (containing the medullary tube and the notochord adherent to the ceiling of the yolk sac) through the umbilical ring of the germ disc delineated by ectoderm covered mesenchymal streaks with primordia of the umbilical veins. Similar two affected embryos were depicted by Kollmann in his Handatlas in 1907, but were considered normal. DESIGN: Case report. SETTING: Institute for the Care of Mother and Child, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: Implanted product of conception found within the Fallopian tube exhibited a characteristic embryonic defect described as the "ventral prolaps". CONCLUSION: Ventral prolaps of the embryo represents a characteristic embryonal malformation of unknown developmental significance.

Embryo, Mammalian↗
PubMed2003

[Distension media in hysteroscopy--use and complications].

OBJECTIVE: Review of distending media used in hysteroscopic surgery. TYPE OF STUDY: Overview. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Analysis of data from the literature. RESULTS: The author reviewed the use of distending media in hysteroscopic surgery with most serious complication--fluid overload syndrome. CONCLUSION: Fluid overload syndromee is a very dangerous and often underestimated complication during hysteroscopic surgery which needs immediate and appropriate management.

Carbon Dioxide↗
PubMed2002

The detection of HPV DNA improves the recognition of cervical intraepithelial lesions.

UNLABELLED: Reasons that influence the efficacy of cervical cancer screening are failure to screen all women at risk, as well as inherent technical limitations of the conventional cervical smear. HPV DNA testing is a supplementary, objective test less independent on sampling failure. The aim of this study was to compare results of HPV DNA screening to cytological smears (CS) and histological diagnosis. From January 1995 to January 1999, cytological smears, cells for HPV DNA analysis and cervical biopsies were obtained from 280 women included in this study. STATISTICAL METHODS: Fisher's exact test (2x2 contingency tables, P<0.01), Pearson Chi-square, P< 0.05, Spearman's rank correlation R. Sixty patients (21.4%) tested positive for low-risk (LR-HPV), 227 (81.1%) positive for high-risk HPV (HR-HPV). The CS proved to be a strong predictor for the histological diagnosis, reaching a sensitivity of 93.4%, a specificity of 65.8% and a positive predictive value (PPV) of 77.4%. By combining cytology and HPV DNA testing, the sensitivity could be considerably enhanced (99.0%), though at a price of loss in specificity (30.1%). HPV DNA testing, available as a commercially standardized product, leads to a significant rise in sensitivity when used as an additional diagnostic tool to cytological screening methods and thus contributes to reduce the incidence of cervical carcinomas.

Adolescent↗
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↗
PubMed2001

Is high-risk human papillomavirus infection associated with cervical intraepithelial neoplasia eliminated after conization by large-loop excision of the transformation zone?

OBJECTIVE: To investigate whether high-risk HPV infection associated with cervical intraepithelial neoplasia (CIN) was successfully eliminated after electrosurgical conization by large-loop excision of the transformation zone (LLETZ). STUDY DESIGN: 142 women, who were admitted for conization of CIN 1-3 were recruited into a prospective follow-up study of HPV infection, including cervical sampling for HPV DNA before, and then 3, 6 and 12 months after surgery. We examined whether there were any differences in the rate of HPV DNA positivity after LLETZ between specific risk groups, such as patients with primary (i.e. before surgical treatment) high-risk HPV infection, CIN of different grades, and positive margins. RESULTS: We did not detect statistically significant differences between specific risk groups. According to the assay used (hybrid capture II) at the last follow-up visit 94% of primarily infected patients were completely free from infection with high-risk HPV types, while 6% had persisting HPV infection. CONCLUSIONS: With a detection limit of 5000 genomes/ml HPV DNA the hybrid capture II results revealed, that after electrosurgical removal of CIN in 94% of patients testing positive for high-risk HPV DNA prior to surgery were negative 12 months post-surgery.

Cervix Uteri↗
PubMed2001

High-dose versus low-dose rate brachytherapy in definitive radiotherapy of cervical cancer.

BACKGROUND: To retrospectively compare the clinical outcome in cervical cancer patients treated by external irradiation and intracavitary high-dose rate (HDR) brachytherapy with iridium 192 versus low-dose rate (LDR) brachytherapy with radium 226 or caesium 139. METHODS: 450 LDR patients were treated from 1982 to 1986 and compared with 189 HDR patients treated from 1993 to 1999. Cobalt (CO) 60 treatment was replaced in the HDR group by modern megavoltage photon radiotherapy (Linac 25 MV). Brachytherapy was given in either 2 or 3 LDR radium 226 implants for the earlier patient cohort, and 3-6 HDR iridium 192 implants for the latter cohort. The primary endpoint assessed was the 3-year overall survival. RESULTS: The median duration of follow-up was 70 months (range, 2-108 months) in the LDR group and 34 months (range, 4-69 months) in the HDR group. Actuarial overall 3-year survival after conventional LDR brachytherapy was 51.3%, versus 58.2% after HDR brachytherapy. No difference in 3-year survivors was seen in the small groups of stage I (68.3% vs. 84.6%) and stage IV (23.1% vs. 37.5%) patients. In stage II and III and in the overall group there were statistically significantly more 3-year survivors in the HDR group (58.1% vs. 78.9%, p < 0.001 in stage II; 37.3% vs. 53.8%, p < 0.01 in stage III; and 46.7% vs. 67.2%, p < 0.001 in the total group). Retrospectively assessed complication rates in the former LDR group were 3.8% for irreversible side effects, and 13.3% for chronic radiation damage. In the HDR group the actuarial late complication rates for grades 3 and 4 were 2.9% for the bladder, 4.0% for the bowel, and 6.1% for the rectum. CONCLUSION: In our preliminary experience, HDR brachytherapy combined with external beam radiation produced similar and even better survival rates compared with the LDR series. HDR brachytherapy combined with external beam radiation is an efficient method for the treatment of cervical cancer and adverse side effects are comparable.

Brachytherapy↗
PubMed2001

Bcl-2 expression as a novel immunohistochemical marker for ruptured tubal ectopic pregnancy.

Programmed cell death by apoptosis occurs in fetal and maternal tissues during early pregnancy and plays an important role during implantation, decidualization, and in fetal development. In the regulation of apoptosis, bcl-2 is one of the central controlling genes, and acts by protecting the cell against apoptosis. It is postulated that invasiveness of ectopic trophoblast towards and through the muscularis zone of the tubal wall consequently leading to tubal rupture might be due to disturbed regulation of apoptosis. By means of immunohistochemistry and a computerized image analysis, bcl-2 immunostaining was localized and quantified in 36 randomly selected paraffin-embedded ectopic trophoblast tissue specimens collected from women undergoing surgery for ruptured (n = 18) and non-ruptured (n = 18) tubal ectopic pregnancies. Immunostaining was found in the villi syncytiotrophoblast in all patients, while the percentage of positive bcl-2 immunostained area (%PA) (P = 0.0009) and staining intensity (P = 0.0042) were consistently greater in the group of ruptured ectopic pregnancies. Including the variables %PA and saturation into a logistic regression model for a probability threshold of 0.5 (<0.5 = non-ruptured ectopic pregnancy, >0.5 = ruptured ectopic pregnancy) to identify tubal rupture, a sensitivity and specificity of 94.4% were found. It is suggested that elevated bcl-2 immunostaining in the syncytiotrophoblast layer reflects unlimited cell survival of ectopic trophoblast and could lead to the establishment of a circulating marker for tubal rupture.

Adult↗
PubMed2001

Radiotherapy alone for invasive vaginal cancer: outcome with intracavitary high dose rate brachytherapy versus conventional low dose rate brachytherapy.

PURPOSE: Our aim was to compare the role of remote afterloaded high-dose-rate brachytherapy (HDRB) with traditional low-dose-rate brachytherapy (LDRB) for patients with invasive primary vaginal carcinoma. METHODS: The study group comprised 190 patients with invasive carcinoma of the vagina. The patients were staged according to the International Federation of Gynecology and Obstetrics (FIGO) staging system. Eighty patients were treated with intracavitary high-dose rate iridium 192 brachytherapy with or without external beam therapy. These patients are compared with a historical group of 110 patients treated with intracavitary low-dose-rate radium 226 or cesium 137 brachytherapy with or without external beam therapy. RESULTS: No significant differences were found for stages, tumor grade or location between the two groups. Crude 5-year survival for all patients was 41% in the former LDRB group, 81% in stage I and 43% in stage II. Overall actuarial 3-year survival and disease-specific survival rates for all patients in the HDRB series were 51% and 66%, respectively. Disease-specific 3-year survival attained 83% in stage I and 66% in stage II. There were no significant differences in local and distant recurrences between the treatment modalities. The comparison of treatments with or without external beam radiation and of complications showed no significant differences between the HDRB and LDRB series. CONCLUSION: With HDRB and its advantages of decreased radiation exposure and patient immobilization and precise positioning, treatment results to be obtained are at least similar to traditional LDRB for primary vaginal cancer.

Adult↗
PubMed2001

[Ovarian implantation of the embryo in IVF and ET--early mole with proliferative trophoblast].

OBJECTIVE: Case report of a very rare case of ovarian implantation after IVF and ET treated by laparoscopy. DESIGN: Case report. SETTING: Institute for the Care of Mother and Child, Prenatal Diagnostic Centre and Trophoblastic Disease Centre, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: We observed implanted product of conception found within the ovarian stroma 35 days after ET. At laparoscopy, the genital sac appeared as an inconspicious haemorrhagic cyst, 2 cm in diameter. After dissection, in the intact sac appeared amorphous 2 mm embryo and 3 mm yolk sac. The trophoblast of the anchoring chorionic villi exhibited marked hyperproliferation and was classified as a proliferating mole. CONCLUSION: The intact early product of conception exhibited trophoblastic hyperplasia.

Adult↗
PubMed2001

[Ectopic omental pregnancy--laparoscopic diagnosis and therapy].

OBJECTIVE: Description of a very rare case of primary omental pregnancy. DESIGN: Case report. SETTING: Institute for the Care of Mother and Child, Prenatal Diagnostic Centre, Prague, Institute for Postgraduate Medical Education, Prague. SUBJECT AND METHOD: Implanted product of spontaneous conception was found in the omentum. The gestational sac on omentum had the appearance of a haemorrhagic tumor 2 cm in diameter. CONCLUSION: After dissection, an intact embryo of 7 mm with a 4 mm yolk sac was discovered.

Adult↗