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Biomedical subjects

Z Holub

Publications and source records attributed to Z Holub.

At least 55 records · Page 3Linked to original sources
PubMed2001

[Laparoscopic-assisted myomectomy--surgical technique and indications].

OBJECTIVE: To analyze perioperative outcomes of laparoscopically assisted myomectomy. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynaecology, Endoscopic Training Centre, Hospital Kladno, Czech Republic. MATERIAL AND METHODS: Eight consecutive women with fibromyoma were treated by laparoscopic assisted myomectomy. Laparoscopic surgery was performed based on size of fibromyoma over 6 cm. RESULTS: The application of the operative technique of laparoscopically assisted myomectomy was effective in all out exception. In the studied group the mean operative time and the mean of weight of the specimen were 76 min (range 50-90) and 151.7 g (range 45-220), respectively. In one patient the relaparoscopy for bleeding was necessary. CONCLUSION: Laparoscopic assisted surgery is feasible in women with fibromyoma and may also be considered for myomectomy.

Adult↗
PubMed2000

Comparison of two procedures for laparovaginal hysterectomy: a randomized trial.

OBJECTIVE: To compare peroperative parameters of two variants of a laparovaginal hysterectomy in surgical management of gynecological conditions. METHODS: A prospective randomized study of 70 laparovaginal hysterectomies performed by the same two surgeons for disease of female pelvic organs. The following criteria were studied: indication for surgery, previous surgery, duration of the procedure, recovery, hospital stay, blood loss, tissue damage markers, hysterectomy proportions and complication incidence. Statistical analysis was performed using the non-parametric chi(2)-test and non-parametric Fischer's exact probability test when appropriate, with a level of significance P=0.05. RESULTS: Totals of 38 (54.3%) laparoscopy-assisted vaginal and 31 (45.7%) vaginally assisted laparoscopic hysterectomies were performed for fibroma as the main indication. Conversion to laparotomy was applied in only one patient. The VALH group (P=0.01) showed both fewer procedures and shorter hospital stay with insignificant blood loss. CONCLUSION: The two variants of a laparovaginal hysterectomy appear to be safe and appropriate, effective procedures for women with gynecological conditions. Furthermore, vaginally assisted laparoscopic hysterectomy has been shown to be superior to laparoscopy-assisted vaginal hysterectomy in terms of shorter operating time and greater palliative effect upon the complex of uterosacral ligaments. Laparoscopic surgery can alter the relationship between vaginal and abdominal hysterectomy.

Adult↗
PubMed2000

Laparoscopic surgery in obese women with endometrial cancer.

STUDY OBJECTIVE: To analyze perioperative and postoperative outcomes of laparoscopic treatment of endometrial cancer in two groups of women of different weight. DESIGN: Prospective, multicenter clinical study (Canadian Task Force classification II-1). SETTING: Three laparoscopic oncology centers. PATIENTS: Sixty-five consecutive women with endometrial cancer, of whom 32 were not obese (weight <81. 7 kg) and 33 were obese (weight (3)81.7 kg, body mass index 30-40). INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Three patients (1 nonobese, 2 obese) in whom laparoscopy was converted to laparotomy were removed from data analysis. Laparoscopy in the remaining 62 (94.38%) was completed successfully. Hysterectomy and pelvic and paraaortic lymphadenectomies were performed based on tumor grade and depth of myometrial invasion. In both groups, 28 women underwent pelvic lymphadenectomy and 21 paraaortic lymph node dissection or sampling. Eight patients had metastases in pelvic or paraaortic nodes. Deep myometrial invasion over 50% was present in five obese and two nonobese women. Mean operating time was 166 and 172 minutes, respectively. The rate of major complications and conversions was higher in the obese group (8 vs 5). CONCLUSION: Laparoscopic surgery is feasible in obese women and may also be considered for endometrial cancer, which typically occurs in obese women.

Body Mass Index↗
PubMed2000

[Hormone replacement therapy in women with surgical treatment of endometriosis and adenomyosis: prospective and follow-up study. Part I].

OBJECTIVE: To determine whether the initiation of estrogen replacement therapy (ERT) in the postoperative period increases the incidence of symptom recurrence following laparoscopic hysterectomy (LH) and/without bilateral salpingo-oophorectomy (BSO) for the treatment of endometriosis and adenomyosis. DESIGN: Prospective partially randomized patient preference follow up trial (PRPPT). SETTING: Department of Gynaecology, Endoscopic Training Centre, Kladno Hospital. METHODS: Chart review of 286 consecutive patients who underwent LH and/or without BSO for endometriosis or adenomyosis between April 1994 and June 1999 and who subsequently received ERT. The methods of second phase of trial was prepared. The symptoms of recurrence in patients who started ERT after surgery and in those who did not start ERT (control group) will be compared and adjusted. RESULTS: Seventy-three percent had preoperative pelvic pain. One hundred thirty two women (46.2%) had only endometriosis. Of the cases of endometriosis, 35.4% was stage I and 64.4% was stage II.-IV. One hundred fifty four women had adenomyosis, 60 with endometriosis. CONCLUSION: In the first phase of follow study the collection of clinical data was performed. Preliminary results from the PRPPT demonstrate that laparoscopic approach to surgery for endometriosis increased significantly the number of this disease.

Endometriosis↗
PubMed2000

[Statistics for physicians--part I].

Authors present a series of papers describing basic statistical methods used in biomedical research and publications. Part one deals with parameters of description statistics.

Statistics as Topic↗
PubMed2000

[Statistics for physicians--part II].

Authors present a series of papers describing basic statistical methods used in biomedical research and publications. Part two deals with the normal distribution and logarithmic transformation of data together with the simple strategy for data description in groups of different type of data distribution.

Statistics as Topic↗
PubMed2000

Hemostasis using tissue glue in laparoscopy: discussion and review.

OBJECTIVES: To discuss the usefulness of tissue glue and TachoComb (TC), a new hemostyptic agent which combines the advantages of two reliable hemostyptic products-collagen fleece and fibrin glue in local hemostasis during laparoscopy. SETTING: Department of Gynecology and Obstetrics, Endoscopic Training Centre, Hospital Kladno. DESIGN: Review. METHODS: Analysis of literary and clinical data. RESULTS: In recent years, collagen fibers, gelatin sponges, oxidized cellulose and fibrin glue has been developed, which are now widely used in postoperative hemostasis in laparoscopy. An efficient use of these preparations shortens the duration of intervention procedures and reduces patient strain. CONCLUSIONS: Clinical studies demonstrate that hemorrhage from damage tissue important pelvic structures can be successfully arrested and controlled using the laparoscope to apply tissue glue. At Czech study, sixteen patients have been effective treated with collagen-fibrin agent during laparoscopic operations. The elimination of hemorrhages after primary laparoscopic electrosurgery and the effectiveness of this drug have been successfully tested.

Aprotinin↗
PubMed2000

[Statistics for physicians--part III].

Authors present a series of papers describing basic statistical methods used in biomedical research and publications. Part three deals with statistical hypotheses, type I and type II errors, one-sided or two-sided tests. Finally, the most frequent types of testing the differences are described.

Statistics as Topic↗
PubMed2000

Does hysterectomy without salpingo-oophorectomy influence the reoperation rate for adnexal pathology? A retrospective study.

OBJECTIVE: The aim of this study was to assess if the abdominal, vaginal and laparoscopic approach to hysterectomy can affect the incidence of ovarian or adnexal pathology after hysterectomy without salpingo-oophorectomy. METHODS: In this study 17 cases out of 617 hysterectomies were found to have development of adnexal pathology; reoperation rate was 2.75%. RESULTS: The reoperation rate was significantly different (p < 0.006) in the observed approaches to hysterectomy (TAH 5.67%, VH 0.69%, LH 3.18%). The greatest difference was found between the abdominal and vaginal groups. CONCLUSION: Our study results have sufficiently shown that the relationship of a number of factors (age, primary histologic findings, smaller peritoneal trauma) had an important impact on a significant difference in reoperation rate between vaginal, laparoscopic and namely abdominal hysterectomies in female patients with preserved adnexa.

Adult↗
PubMed2000

[Clinical problems and complications in laparoscopic access].

OBJECTIVE: To analyse entry-related laparoscopic technique and complications. DESIGN: Literary review. SETTING: Department Gynaecology and Obstetrics, Endoscopic Training Centre, Hospital Kladno. METHOD: Peri- and postoperative complications of laparoscopic entry were assessed and analysed from database Medline and Current Contents. RESULTS: There is helpful to classify intra-abdominal entry complications occurring after laparoscopy into the two types (type I and II). The risk of bowel damage, calculated from analysed studies was 0.4/1,000 and for major vessel injuries the risk was 0.2/1,000. CONCLUSION: The need to perforate the abdominal wall to perform laparoscopic intraabdominal surgery will probably always be associated with risk of damaging structures beneath. With good techniques and appropriate case selection, this risk of such complications should be occure less than 1 per 1,000 laparoscopies. None of the existing techniques or technologies completely eliminate the risk of type II damage.

Abdominal Injuries↗
PubMed1999

Evaluation of perioperative stress after laparoscopic and abdominal hysterectomy in premalignant and malignant disease of the uterine cervix and corpus.

OBJECTIVE: To compare the differences in laparoscopic and abdominal hysterectomy in surgery of premalignant and malignant uterine disease. DESIGN: Prospective study. SETTING: Baby Friendly Hospital, Kladno, Czech Republic. SUBJECT: A total 32 patients underwent hysterectomies for premalignant and malignant uterine conditions. INTERVENTIONS: Patients were assigned to either laparoscopic-assisted vaginal hysterectomy or total abdominal hysterectomy (LAVH), with bilateral salpingo-oophorectomy and lymph node dissection. MEASURES: Clinical data and value of total creatine kinase and C-reactive protein were measured. RESULTS: All 32 procedures were successfully completed. There were no major complications. Mean order of CRP concentrations was significantly lower (p = 0.001) in patients with LAHV. Mean order of total CK activities was also significantly lower in these patients (p = 0.003) and the median hospital stay was 4.1 days (p = 0.05). CONCLUSIONS: Laparoscopic procedures were followed by shorter hospital stays and the proposed evaluation of tissue damage using serum enzymes and proteins demonstrates that the laparoscopic approach to hysterectomy and accessory procedures has considerable importance in decreasing perioperative patient stress. The presented results are supported by clinical experience and should have a decisive impact on the chosen approach to the course and duration of convalescence in patients undergoing a hysterectomy in premalignant and malignant disease of the uterine cervix and corpus.

C-Reactive Protein↗
PubMed1999

The role of laparoscopic hysterectomy and lymph node dissection in treatment of endometrial cancer.

BACKGROUND: The development of new diagnostic and surgical methods has brought a differentiated approach to surgery of endometrial cancer. The aim of this study was to verify the peri-and postoperative differences between laparoscopic and open procedure and prepare protocol for a second phase follow-up multicentric study. METHODS: The study includes 133 women with indications for surgery of endometrial cancer. A prospective multicentric study was undertaken at four centres in the Czech Republic. We evaluated differences in the peri-and postoperative outcomes. Sixty-eight patients treated laparoscopically were compared with 65 patients treated by an open procedure of hysterectomy and lymphadenectomy. RESULTS: Three patients with conversion were withdrawn from the study and another 65 patients (97%) from the laparoscopic group successfully completed the procedures. Laparoscopic and abdominal hysterectomy with lymphadenectomy were performed based on the grade of the tumor and depth of myometrial invasion. Out of both groups, 75 patients underwent pelvic lymphadenectomy and 21 women underwent para-aortic lymph node dissection or sampling. Eleven patients had metastases in the pelvic or para-aortic nodes (11.7% versus 4.7% in the open procedure group). Deep myoinvasion over 50% was more frequently present in the group of abdominally-treated women. The rate of major complications (18 versus 14 cases) was higher in the laparoscopic group, but more wound infections were seen in the open procedure group. CONCLUSION: The study illustrates that the laparoscopic approach to surgery is feasible and it also may be considered for endometrial cancer which typically occurs in at risk and obese women. Recovery time is reduced by avoiding an abdominal incision. Laparoscopic surgery was performed successfully in 65 women and in 8 cases (11.7%) malignant spread outside to the regional lymph nodes was found. However, the selection of patients for laparoscopy should be done considering optimal benefit and safety.

Adult↗