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Biomedical subjects

Z Holub

Publications and source records attributed to Z Holub.

At least 19 recordsLinked to original sources
PubMed2006

[Serum amyloid A as an effective marker for the assessment of surgical trauma and risk of post-operative complications].

OBJECTIVE: To analyze relations among acute phase reactants in a group of 40 women operated for uterine myom by laparoscopy and open surgery. DESIGN: Prospective study. METHODS: Plasma concentrations of C-reactive protein (CRP), serum amyloid A (SAA) and interleukin 6 (IL-6) were measured together with leukocytes in blood before operation, 24 and 72 hours post operation, respectively. RESULTS: Leukocytes and IL-6 displayed minimal response and decreased quickly after operation to preoperative levels. Concentrations of CRP and SAA remained increased after operation. There were no relationships between leukocytes and acute phase reactants. Normal leukocytes 72 hours post operation were found in 1/3 of women with increased at least one acute phase reactants and in 1/4 of women with increased at least two markers. Typ of surgery, surgical stress and length of surgery were related to the concentration of CRP, IL-6 and SAA. CONCLUSION: Changes in SAA 24 hours after operation are similar to CRP and IL-6. Surgical stress, length of operation and possible risk 72 hours after operation are best predicted by CRP and SAA (at that time IL-6 and leukocytes are practically normal). Maximal increase was found for SAA concentrations. Thus SAA seems to be suitable marker of early postoperative complications.

Acute-Phase Reaction↗
PubMed2005

Pregnancy outcomes and deliveries following laparoscopic transsection of uterine vessels: a pilot study.

OBJECTIVE: To assess pregnancy outcomes and deliveries after laparoscopic uterine artery transsection (LTUV) in symptomatic women with fibroids. SETTING: Department of Obstetrics and Gynecology, Endoscopic Training Center, Baby Friendly Hospital, Kladno, Czech Republic. DESIGN: One hundred and fifty three patients underwent laparoscopic transsection of uterine vessels during a 4-year period. RESULTS: Nine of the 21 women desiring pregnancy conceived spontaneously and one after anovulation treatment. The average age of the women was 32.4 years, and the range was 26-39 years. Two women had vaginal delivery at term and one delivered vaginally at 31 weeks secondary to premature preterm rupture of membrane (PROM). Four others delivered at term by cesarean section. One woman with placenta previa was delivered by cesarean section 3 weeks before term. Mean birth weight was 3199 g (range 1710-3910 g). One spontaneous abortion was reported in the first trimester of pregnancy. One case of undesired pregnancy occurred. An extrauterine pregnancy was reported in this woman. CONCLUSION: LTUV is a minimally invasive operative procedure, that preserves the uterus and ovarian blood supply and allows for the achievement of pregnancy in women with symptomatic fibroids. Fetal growth and umbilical Doppler findings remained normal in all cases. An increased risk for preterm delivery and cesarean section was found in this small series.

Adult↗
PubMed2005

Laparoscopic uterine artery dissection in an undiagnosed endometrial stromal sarcoma. Case report.

We present a case of a 24-year-old woman, gravida 0, with menometrorrhagia and pelvic pain. A uterine hemorrhagic fibroid was diagnosed after ultrasound and magnetic resonance imaging (MRI). The endometrial biopsy was negative for malignancy. Laparoscopic sentinel lymph node sampling, lavage, and myometrial biopsy with negative results were performed before dissection of the uterine vessels. The final diagnosis of endometrial stromal sarcoma was made by myomectomy and hysterectomy one year later. This case should demonstrate the difficulty of making the right diagnosis of sarcoma before laparoscopic dissection of uterine vessels in patients with symptomatic fibroids.

Adult↗
PubMed2005

[Successful treatment of severe post-partum bleeding after caesarean section using recombinant activated factor VII].

OBJECTIVE: To present a case report of severe post-partum bleeding after caesarean section and successful using recombinant factor VIIa. SETTING: Department Obstetrics and Gynecology, Regional Hospital, Kladno, Czech Republic. CASE REPORT: A 28-year old nullipara presented with major post-partum bleeding after caesarean section due to uterine atony. The patient developed hemorrhagic shock, associated with disseminated intravascular coagulation (DIC). Treatment with uterotonics drug, prostaglandins, hysterectomy and packing of the pelvis failed to control diffuse pelvic and vaginal bleeding. Recombinant factor VIIa (2.4 mg intravenous injection) was given as a final attempt to control the bleeding before relaparotomy and ligation hypogastric artery. The response to treatment was rapid, with control of the bleeding and resolution of the coagulopathy. CONCLUSION: This case suggests a potential role of recombination factor VIIa in the treatment of severe post-partum bleeding associated with DIC.

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

[Immune, inflammatory and hormonal changes in connection with laparoscopic surgery].

OBJECTIVE: Analysis of the issue of laparoscopy on the intra and post-operative immune changes. SUBJECT: Review article. SETTING: Department of Obstetrics and Gynecology, Regional Hospital Kladno. SUBJECT AND METHOD: Review of published facts with regard to impact laparoscopic surgery on immune function. CONCLUSION: The impact of surgery on the intra and post-operative immune, hormonal and inflammatory response is significantly less after laparoscopy than with an open approach.

Acute-Phase Reaction↗
PubMed2005

[Fistula as a complication of pelvic actinomycosis--two case reports].

OBJECTIVE: The presentation of two unusual cases of pelvic actinomycosis. SUBJECT: Case reports. SETTINGS: Department of Obstetrics and Gynecology, Hospital Kladno. SUBJECT AND METHOD: The observation of two cases of pelvic actinomycosis. These cases were complicated by the abdominal wall fistula in one case and vaginal fistula in the other. CONCLUSION: Actinomycosis is a chronic disease with tendency to progress per continuitatem into neighbouring tissues and with tendency to formation of fistulas. Two less common localisations of progress of the disease are described; it means the abdominal wall and vagina. In spite of a more advanced stadium, if adequately treated, a recovery ad integrum is common.

Abdominal Wall↗
PubMed2004

Midterm follow-up study of laparoscopic dissection of uterine vessels for surgical treatment of symptomatic fibroids.

BACKGROUND: This study aimed to assess laparoscopic dissection of uterine vessels (LDUV) for symptomatic fibroids in women. METHODS: A total of 69 women entered the study between March 2000 and June 2003. In this case series, 68 consecutive women underwent LDUV using ultrasonically activated sheers or electrosurgery for the treatment of fibroids over 3 years (median follow-up period, 14.5 months). Ultrasound or magnetic resonance imaging was carried out 3, 6, 12, 24, and 36 months after treatment. The tissue markers, gonadotropin, and estrogen levels were studied postoperatively. RESULTS: Almost all the patients (98.5%) had a successful LDUV with a low rate (7.3%) of postoperative complications. The time of surgery ranged from 15 to 50 min (mean, 30.8 min). The blood loss was minimal (mean, 14.7 ml), and the hospital stay was 2.4 days. Symptom improvement (menorrhagia or dysmenorrhoea) was 93.2%, and the average reduction in the dominant myoma was 57.8% during a follow-up period longer than 12 months. All the patients with anemia had normal red cell counts after 3 months. CONCLUSIONS: Uterine volume and the dominant fibroid were significantly reduced and symptoms were improved by LDUV. The laparoscopic procedure is associated with insignificant tissue damage and normal gonadotropin and estrogen levels.

Adult↗
PubMed2004

Uterine necrosis after laparoscopic uterine vessel dissection for symptomatic fibroid--a case report.

Laparoscopic dissection of uterine vessels is a new minimally invasive method to treat symptomatic fibroids. A potential complication of uterine artery dissection is uterine necrosis. A woman with a large intramural fibroid underwent laparoscopic dissection of the uterine vessels using ultrasonic activated shears and three months later developed focal uterine necrosis requiring exploratory laparotomy and supracervical hysterectomy. Although uterine artery coagulation and dissection are procedures with a low reported rate of complications, uterine fibroid or focal uterine necrosis can occur.

Adult↗
PubMed2003

Short-term results from laparoscopic dissection of uterine vessels in women with symptomatic fibroids.

OBJECTIVE: To assess the outcome, tissue trauma, clinical improvement and the reduction in size of fibroid following laparoscopic dissection of uterine vessels (LDUV). SETTING: Department of Obstetrics and Gynaecology, Endoscopic Training Centre, Baby Friendly Hospital, Kladno, Czech Republic. DESIGN: An uncontrolled case series of 17 consecutive women who underwent LDUV using ultrasonically activated shears for the treatment of fibroids over two years. Ultrasound imaging was carried out before and three and six months following treatment. The tissue markers (C-reactive protein (CRP), Interleukin-6 (IL-6), Creatin kinase (CK) and white blood cell count) were studied preoperatively, on the first and third postoperative day. RESULTS: All patients underwent successful LDUV without intraoperative complications. Tissue markers results show that the LDUV performed using ultrasonically activated shears is associated with insignificant tissue damage. Time of surgery ranged from 30 to 50min (mean 39min). Mean blood loss was less than 30ml and mean hospital stay was 2.3 days. Three and six months after surgery, respectively, average reduction in uterine volume was 23.6 and 36.8% and average reduction in dominant fibroid was 28.6 and 56.8%. 94.1% of women had improvement in menorrhagia or dysmenorrhoea, and 91.6% had improvement in bulk-related symptoms or pelvic pain six months after treatment. CONCLUSION: Uterine volume and dominant fibroid were reduced and symptoms were improved by LDUV. The procedure of laparoscopic dissection of uterine vessels can be completed within 30-40min with only minimal blood loss and short hospital stay if performed by experienced laparoscopists.

Abdominal Pain↗
PubMed2003

The role of laparoscopy in the surgical treatment of endometrial cancer.

OBJECTIVES: Endometrial cancer is the most common gynaecological cancer. Surgical treatment has traditionally been done by laparotomy, however the laparoscopic approach has gained wider acceptance by gynecologic surgeons. Whether in combination with laparoscopic-assisted or laparoscopic hysterectomy, laparoscopic staging, including lymph-node dissection, is a major component in the treatment of patients with early endometrial cancer. It remains to be proven if these techniques are associated with the greatest benefit. METHODS: Substantial recent studies on the topic of surgical laparoscopic treatment of endometrial cancer were identified from Medline. RESULTS AND DISCUSSION: Laparoscopically assisted surgical staging (LASS) has been reported in several case series totaling more than 600 cases. CONCLUSION: The report illustrates that laparoscopically assisted surgical staging of endometrial cancer is safe as an open procedure. The laparoscopic approach may also be considered for endometrial malignancy which typically occurs in obese and elderly high-risk women.

Cost-Benefit Analysis↗