Biomedical subjects

P Freitag

Publications and source records attributed to P Freitag.

At least 19 recordsLinked to original sources

PubMed2006

[Radical parametrectomy in women with invasive cervix cancer after previous simple hysterectomy].

OBJECTIVE: Evaluate technique, indications and limits of surgical procedure in the treatment of cervical cancer diagnosed from uterus specimen from simple hysterectomy. DESIGN: Retrospective observational study, review of literature. SETTINGS: Department of Obstetrics and Gynecology, 1st Medical Faculty and General Faculty Hospital, Charles University, Prague, Czech Republic. METHODS: Women following radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy were enrolled to the study. In all patients unexpected invasive cervical cancer was found from the uterus specimen after simple hysterectomy. RESULTS: Together 10 patients were enrolled to the study. CIN was the indication for primary hysterectomy in all but two patients. There were two operative complications, cystostomy in both cases, treated properly during surgery. In the specimen from radical procedure residual tumor in parametria was found in 2 cases, and metastasis to pelvic nodes in 4 cases. There was no postoperative complication. Adjuvant radiotherapy was recommended in 4 patients due to positive lymph nodes, in one case due to residual tumor in parametria, and in one case for both reasons. CONCLUSIONS: Radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy should be considered as an alternative solution in patients following simple hysterectomy with unexpected finding of invasive cervical cancer. Morbidity of the procedure is higher in comparison to standard radical hysterectomy, however majority of complications are easy to repair. The most significant criteria for patient's selection for surgical approach is a depth of invasion to cervical stroma. In our group radical procedure obviated the need for radiotherapy in half of the patients.

Adult↗

PubMed2006

[Prognostic factors of ovarian cancer].

OBJECTIVE: To sum up the knowledge about prognostic factors of ovarian cancer. TYPE OF STUDY: Review article. SETTING: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague. METHODS: Compilation of data from scientific litarature. CONCLUSIONS: Prognostic factors represent a complex of information with clinical, social, histopathological, biochemical, genetic and molecular biological characteristics. They are integral part of the predictive oncology, with perspective advantage in prevention, screening, prediction, prognosis and monitoring of the tumor disease activity. The prognostic factors of ovarian cancer are discussed from several points of view in the presented review, included their possible implementation into the clinical practice.

Biomarkers, Tumor↗

PubMed2005

Rate of brain atrophy in relapsing MS decreases during treatment with IFNbeta-1a.

OBJECTIVE: To determine the time course of brain atrophy during treatment with once-weekly IM interferon beta-1a (IFNbeta-1a). METHODS: The MRI cohort (n = 386) of the European IFNbeta-1a dose comparison study in relapsing multiple sclerosis (MS) was analyzed. In addition to baseline and three annual scans, a frequent subgroup (n = 138) had two scans before treatment initiation and scans at months 4, 5, 6, 10, and 11. Brain parenchymal fraction (BPF), a normalized measure of whole-brain atrophy, and volume of Gd-enhancing lesions (T1Gd) and T2 hyperintense lesions (T2LL) were evaluated. RESULTS: BPF decrease was -0.686% (first year), -0.377% (second year), and -0.378% (third year). Analysis of the frequent subgroup showed that 68% of the first-year BPF decrease occurred during the first 4 months of treatment. This change was paralleled by a drop in T1Gd and T2LL. In the frequent subgroup, an annualized atrophy rate was determined by a regression slope for the pretreatment period and from month 4 of treatment onward. Annualized pretreatment rate (-1.06%) was significantly higher than the under-treatment rate (-0.33%). CONCLUSIONS: In the first year of treatment with anti-inflammatory agents, atrophy measurements are possibly confounded by resolution of inflammatory edema or more remote effects of previous damage to the CNS. The atrophy rate reduction observed after treatment month 4 may reflect a beneficial but partial effect of interferon beta-1a and was sustained over the 3-year study period.

Adult↗

PubMed2005

A randomized, double-blind, placebo-controlled study of oral hydrolytic enzymes in relapsing multiple sclerosis.

Oral administration of hydrolytic enzymes (HE), such as bromelain, trypsin and rutosid, may have beneficial effects on the clinical course of neurological symptoms related to multiple sclerosis (MS). This is supported by a complete protection by HE from experimental allergic encephalomyelitis, an animal model related to MS. Three hundred and one patients with relapsing MS were enrolled in a double-blind, placebo-controlled trial. No treatment effect between the placebo and the HE groups was found either for clinical or MRI parameters.

Administration, Oral↗

PubMed2005

[Pelvic exenteration].

OBJECTIVE: Review of literature concerning pelvic exenterative procedures. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSION: Pelvic exenterations are standard procedures in oncogynecology which have no alternative in certain indications. The most frequent indications are recurrences or progressions of cervical, vulva or vaginal cancers. Exenterative procedures might be used in primary treatment in some cases of locally advanced tumors. Mortality of current procedures reaches 5% to 10%, early and late postoperative morbidity is frequent (40-60%). Recently explorative laparoscopy is used in preoperative staging to decrease the number of aborted procedures due to distant metastasis or pelvic tumor inoperability. The procedure with high morbidity, causing impairment of quality of life, is justified due to good follow-up results--5-years overall survival is about 50-60%. It should be emphasized that with no treatment in these patients median of survival reaches about 6 months.

Female↗

PubMed2005

[Possibilities of increased radicality in pelvic exenteration].

OBJECTIVE: Review of advanced radicality in pelvic exenterations. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, General Faculty Hospital and Ist Medical Faculty of the Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSIONS: More extensive radicality in pelvic exenterations make possible to use surgical treatment in some cases of lateral recurrences or central recurrences with the attachment to the pelvic side wall. One possible technique is a combination of en bloc exenteration with pelvic bone resection, most frequently sacrum. Experiences in gynecological tumours are so far limited. Laterally extended resection was described in lateral infrailiac pelvic wall recurrences. The only one presented paper related to laterally extended procedures showed a reasonable overall survival of patients; however follow-up is limited.

Female↗

PubMed2005

[Abdominal radical trachelectomy--technique and experience].

OBJECTIVE: Discussion of current experiences with abdominal radical trachelectomy in the treatment of early stages of cervical cancer in fertile women. DESIGN: Case-reports. SETTING: Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague. METHODS: Presentation of 4 cases of abdominal radical trachelectomy and pelvic lymphadenectomy. Discussion with published data. RESULTS: Three cases of open abdominal and one case of laparoscopic abdominal radical trachelectomies together with pelvic lymphadenectomies are presented. All procedures were indicated for cervical cancer stages IA2-IB1. Frozen section of pelvic nodes and a slice of upper margin of cervix revealed no metastasis or infiltration. In total 22-43 pelvic nodes were removed, being negative in all cases. Operative time ranged between 148 and 270 min. in laparotomy and 250 min. in laparoscopy. Blood loss reached 350-3500 ml. There were no intraoperative complications, postoperatively one case of bladder atony was treated by suprapubic drainage for 30 days, one case of ileus was managed pharmacologically. Vaginal suture healed properly in all cases. No complications occurred within limited follow-up of 1-5 months. CONCLUSION: Abdominal radical trachelectomy with pelvic lymphadenectomy is a rational alternative in the treatment of stages IA2-IIA cervical cancer in women of fertile age. Standard radicality in parametria resection and easy incorporation into armamentarium of oncogynecological centers are main advantages of such approach. Laparotomy can be avoided using laparoscopy.

Adult↗

PubMed2005

[Reconstruction procedures following pelvic exenterations].

OBJECTIVE: Review of reconstruction procedures following pelvic exenterations. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Department of Urology, 1st Department of Surgery, Faculty Teaching Hospital and 1st Medical Faculty of the Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSIONS: Reconstruction procedures are important part of pelvic exenterations. The procedures are crucial for following quality of life. Currently the most frequently used techniques for isolated pelvic floor support are omental flaps (carpets), for combined reconstruction of pelvic floor and vagina TRAM (transverse rectus abdominis musculocutaneus flap). Reconstructions prolong operation time; however they are accompanied with low morbidity and some techniques decrease total morbidity of exenterative procedure. Total and posterior exenterations require sigmoideostomy in vast majority of cases. Low rectal anastomosis might be used in cases of supralevator procedures. They cause high morbidity especially in patients following radiotherapy. In these patients temporary diverting colostomy is being recommended. A bowel segment is usually used for urinary diversion following total or anterior exenteration. Golden standard remain the incontinent ureteroenterostomies using ileum or colon transversum. Currently continent diversions are considered more often due to encouraging results and good quality of life. Heterotopic diversions, with continent conduit and cutaneous stoma, are frequently used. Risk of serious complications, especially fistulas and stoma stenosis, after all types of diversions is possible to reduce by using appropriate bowel segment not handicapped by previous radiotherapy.

Colostomy↗

PubMed2005

[Genetic aspects of malignant epithelial ovarian tumours].

OBJECTIVE: To sum up the knowledge about genetic aspects of ovarian cancer. TYPE OF STUDY: Review article. SETTING: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague, Prague. METHODS: Compilation of data from scientific literature. CONCLUSIONS: Ovarian cancer represents the most lethal malignancy among gynecological tumours. Etiology is still largely unknown. Multistep process, with accumulation of genetic alterations concerning factors with key role in cell regulation - oncogenes, tumor-supressor genes and mismatch-repair genes is supposed. Cytogenetic and molecular-genetic characteristics, in correlation with other molecular-biological parameters extend information of carcinogenesis. The final aim is to create a predictive model for clinical use.

Carcinoma↗

PubMed2004

[Prophylactic adnexectomy].

OBJECTIVE: Analysis of the issue of prophylactic bilateral salpingo-oophorectomy (BSO): a) during pelvic surgery for benign diagnosis; b) in women with hereditary risk of ovarian cancer. DESIGN: Review article. SETTING: Department of Obstetric and Gynecology, Charles University. METHODS: Critical review of published data. CONCLUSION: During pelvic surgery for benign diagnosis a prophylactic BSO is indicated of the age over 45, in younger women an individual approach is required, considering many aspects, including history of ovarian and breast cancer. Another indication for BSO is an increased risk of familial ovarian cancer. The surgery significantly diminished the risk of epithelial cancer of ovary, fallopian tube, and simultaneously the risk of breast cancer. There is a continuing increased risk of peritoneal cancer following the surgery. Bilateral oophorectomy together with bilateral salpingectomy is recommended. The age limit for surgery is about 35 years after careful consideration of individual risk, reproductive plans, type of mutation and age at malignant disease manifestation in previous generation. Potential alternative for women who do not accept prophylactic surgery is tubal ligation. Screening of risk group or chemoprevention by oral contraceptives are not equivalent alternatives to prophylactic surgery.

Fallopian Tubes↗

PubMed2004

[Borderline ovarian tumors--10-year clinical series and literature review].

OBJECTIVE: Analysis of 10-year clinical series of borderline ovarian tumors (BLT) and literature review. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. METHODS: Analysis of 38 patients from years 1994-2003 regarding age, histological types, tumor duplicities, role of frozen section, Ca125 levels, operation methods, adjuvant treatment, relaps occurrence, follow-up and survival. RESULTS: Median follow-up was 18.5 months (3-122), median age 51 (16-78). HISTOLOGY: 23 serous, 12 mucinous (1 microinvasion), 2 cystadenofibromas and 1 endosalpingiosis. 26 patients of stage IA, 3 of IB, 6 of IC, 1 of IIA, 1 of IIC and 1 IIIB. 3 cases were underestimated by frozen section. 6 tumor duplicities were revealed. Ca125 marker was elevated in 10/23 (43.5%) cases. 12 patients underwent conservative surgery, 3 of them with complete staging including lymphadenectomy. 26 patients had radical operation, 9 of them with full staging. No one lymphonode was positive. 7 patients had primary laparoscopic approach, 6 had more than one operation. Adjuvant chemotherapy was indicated in 3 cases: PTX-CBDCA (IC and IIC) and CBDCA-CFA (IC). 4 patients were lost of evidence. 2/34 evaluated patients (5.9%) had a frank carcinoma recurrence after 3 and 7 years. Both relapsed patients and all 34 evaluable patients live without evidence of disease at present. Our results as well as literature date generate some controversies. Do we need staging lymphadenectomy in all cases (inclusive T1a)? Which parameters identify high-risk group and which patients will benefit from adjuvant (and which one) therapy? Are there not recurrencies of BLT rather second primary malignancies? CONCLUSION: In spite of 2 recurrences in a group of 34 evaluated cases all patients live without evidence of disease at present. Some management questions are therefore raised.

Adolescent↗

PubMed2004

[Proteomics and its importance for gynecological oncology].

OBJECTIVE: Analysis of contemporary knowledge of proteomics and its aplication in diagnostics of ovarian cancer and other malignant tumours. DESIGN: Review article. SETTING: Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, Prague. METHOD: An overview of published data. CONCLUSION: Proteomics deals with the analysis of proteins present in the organism in normal and pathologic conditions. Protein expression is characteristic of particular types of cells and tissues. The main improvement of protein analysis in clinical practice is early diagnostics of oncological diseases and specification of prognosis.

Biomarkers, Tumor↗

PubMed2004

[Initial experience in exenteration interventions in the pelvis].

OBJECTIVE: Discussion of experiences with pelvic exenterations. DESIGN: Case-report. SETTING: Department of Obstetrics and Gynecology, Department of Urology, Department of Surgery, Department of Pathology, Department of Clinical Oncology, General Teaching Hospital and Ist Medical Faculty of the Charles University, Prague, Czech Republic. METHODS: Presentation of 4 cases of pelvic exenterations. Discussion with published data. RESULTS: Altogether four cases of pelvic exenterations are presented, one case of supralevator total exenteration for recurrent cervical cancer, one case of infralevator total exenteration for recurrent vaginal cancer, one case of supralevator anterior exenteration in the treatment of locally advanced cancer of urinary bladder, and one case of supralevator posterior exenteration for recurrent vaginal cancer.

Adult↗

PubMed2003

[Detection and occurrence of BRCA 1 gene mutation in patients with carcinoma of the breast and ovary].

OBJECTIVE: The article presents a review of basic information on incidence and detection of BRCA 1 and BRCA 2 genes mutations. Results of investigation in a group of women with ovarian and breast cancer are presented. DESIGN: Retrospective clinical-laboratory study and review. SETTING: Department of Gynaecology and Obstetrics, 1st Medical Faculty of Charles University, Prague, Apolinárská 18, Czech Republic. MATERIAL AND METHODS: Investigated group consisted of 16 persons--12 patients with ovarian or breast cancer and 4 healthy relatives of a woman--breast cancer patient and a carrier of BRCA 1 gene mutation. Protein truncation test (PTT) was performed in order to detect BRCA 1 gene mutation. This test detects mutations leading to premature termination of protein synthesis. Truncated proteins are easily discriminated from full size. RESULTS: Three BRCA 1 gene alterations were identified in the investigated group of women suffering from ovarian or breast cancer. One asymptomatic person--carrier of BRCA 1 gene mutation--was identified in this study. She was daughter of a woman, a carrier of BRCA 1 gene mutation, with early onset of breast cancer and positive family history. CONCLUSIONS: BRCA 1 and BRCA 2 gene mutations are of particular importance in the increasing risk of ovarian cancer and early onset of breast cancer as well as some other malignancies. Genetic testing and counselling including investigation of some other genetic and environmental factors, related to cancer risk, may be of clinical significance in patients with increased risk of certain malignancies.

Adult↗

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

Local injection of the 90Y-labelled peptidic vector DOTATOC to control gliomas of WHO grades II and III: an extended pilot study.

We have previously presented preliminary observations on targeting somatostatin receptor-positive malignant gliomas of all grades by local injection of the radiolabelled peptidic vector 90Y-DOTATOC. We now report on our more thorough clinical experience with this novel compound, focussing on low-grade and anaplastic gliomas. Small peptidic vectors have the potential to target invisible infiltrative disease within normal surrounding brain tissue, thereby opening a window of opportunity for early intervention. Five progressive gliomas of WHO grades II and III and five extensively debulked low-grade gliomas were treated with varying fractions of 90Y-DOTATOC. The vectors were locally injected into the resection cavity or into solid tumour. The activity per single injection ranged from 555 to 1,875 MBq, and the cumulative activity from 555 to 7,030 MBq, according to tumour volumes and eloquence of the affected brain area, yielding dose estimates from 76+/-15 to 312+/-62 Gy. Response was assessed by the clinical status, by steroid dependence and, every 4-6 months, by magnetic resonance imaging and fluorine-18 fluorodeoxyglucose positron emission tomography. In the five progressive gliomas, lasting responses were obtained for at least 13-45 months without the need for steroids. Radiopeptide brachytherapy had been the only modality applied to counter tumour progression. Interestingly, we observed the slow transformation of a solid, primarily inoperable anaplastic astrocytoma into a resectable multi-cystic lesion 2 years after radiopeptide brachytherapy. Based on these observations, we also assessed the feasibility of local radiotherapy following extensive debulking, which was well tolerated. Targeted beta-particle irradiation based on diffusible small peptidic vectors appears to be a promising modality for the treatment of malignant gliomas.

Adult↗

PubMed2002

[Vulvar carcinoma--retrospective study of 47 cases (epidemiology, etiology and long-term results].

OBJECTIVE: To evaluate the incidence of vulvar carcinoma, epidemiological signs and therapeutic results in patients with vulvar malignancies during the stated time period. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague. METHOD: An analysis of the available clinical documentation of the patients of the oncological outpatient service of the Department of Obstetrics and Gynaecology. RESULTS: Vulvar carcinoma represents 4% of all malignant tumours of female genital tract. It concerns predominantly elder women (the average age is 74.2 years). The overall 5-year survival, with no regard to the stage of the disease, is 39.1% in our group. This low figure is due to the high age of the group and to the inappropriate therapeutic approach owed to the internal comorbidity, advanced age and the fact that the majority of cases are diagnosed in advanced stage. CONCLUSION: In spite of good access, the introduction of screening program is unlikely due to the age distribution, biological behaviour and difficulties in diagnostic of premalignant lesions. With regard to the increasing incidence of in situ carcinoma whose ethiopathogenesis is affected by HPV infection, it is necessary to pay more attention to vulva lesions in terms of an early histopathological verification. The treatment of the external genital tract malignancies should be concentrated to the centers with the greatest experience of their management.

Adult↗

PubMed2002

[Complications of axillary dissection in breast carcinoma ].

OBJECTIVE: The objective of the work was to evaluate the incidence and type of postoperative complications after radical exenteration of the axilla in conjunction with an implemented surgical operation. DESIGN: Retrospective clinical study. SETTING: Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital Prague, Apolinárská 18, Prague. METHOD: The authors made a retrospective analysis of postoperative complications in 116 selected patients, who underwent partial breast surgery or ablation of the breast with dissection of the axilla at the Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital in Prague in 1994-2000 on account of breast cancer stage I and II according to FIGO. The group comprised patients where radiotherapy or chemotherapy of the axilla was not used. The patients were at least 12 months after operation without signs of locoregional relapse of the disease and in the dissected axillary tissue at least 10 lymph nodes were found. The operations were implemented by nine different surgeons. Early (infection, seroma, haematoma) as well as late (oedema, paraesthesia, stiffness, pain, weakness of the upper extremity) complications were also evaluated. The authors compared the incidence of complaints in relation to age, the number of dissected nodes and extent of the breast surgery. The statistical significance of the phenomena was evaluated by Fisher's exact test. RESULTS: At least one complication was recorded in 65% of the patients. In early complications (haematoma, infection, seroma) neither the correlation with the patient's age nor with the number of removed nodes was significant. There was a statistically significant relationship (P < 0.05) between the incidence of infection and the extent of the breast surgery which probably was associated with the wound area. As to late complications (oedema, paraesthesia, stiffness, pain and weakness of the upper extremity) a significant relationship was found with lower painfulness in patients above 55 years (P < 0.05) and lower sensation of weakness and paraesthesias in patients with partial breast operations (P < 0.05). The more frequent complaints of younger patients were probably due to their greater everyday physical activity as compared with older women. The higher number of subjective complications in patients after ablation of the breast is explained not only by the size of the wound area but also by psychosocial reasons. CONCLUSION: Dissection of the axilla is part of standard surgical treatment of breast cancer. The surgical operation without radio- or chemotherapy is associated in 65% cases with long-term morbidity of the patients. With regard to the shift of diagnosis of breast cancer to earlier stages it is important to seek a less invasive staging method which will reduce the patient's morbidity. The sentinel node biopsy method seems perspective.

Aged↗