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Z Holub

Publications and source records attributed to Z Holub.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Perioperative hemorrhage associated with laparoscopic hysterectomy: retrospective study].

OBJECTIVE: To evaluate perioperative bleeding during laparoscopic hysterectomy. DESIGN: Retrospective clinical study. SETTING: Department Gynaecology and Obstetrics, Baby Friendly Hospital Kladno, Kladno, Czech Republic. METHODS: Clinical data and cases of perioperative complications and bleeding of patients after laparoscopic hysterectomy were summarized and assessed. The primary hemostatic treatment was electrosurgery. Patients were assessed to efficacy, safety, utility and applicability of vasoconstrictive and local hemostyptic agents. RESULTS: From all laparoscopic procedure were 97.6% successfully completed. There were of nine conversions (2.4%) and twenty-six (6.9%) of severe perioperative complications. The total number of perioperative bleeding was 16 (3.7%) from 376 laparoscopic hysterectomies. The mean order of blood loss was 201.6 ml (range 50-800 ml). CONCLUSION: Clinical retrospective study demonstrates that hemorrhage during and after laparoscopic hysterectomy is most perioperative complication. The laparoscopic approach to hysterectomy appears to be safe and is seen as a good, effective procedure for women with gynaecological conditions of female pelvis organs. Laparoscopic hysterectomy could potentially decrease morbidity historically associated with hysterectomy performed abdominally. Large prospective studies are needed to evaluate the surgical trauma and optimal number of perioperative complications. In conclusion, we think the oozing from the damage tissue during laparoscopic surgery can be successfully arrested and controlled using the laparoscope to apply of local hemostyptic agent.

Adult↗
PubMed1999

[Tissue damage in alternative types of hysterectomy: prospective study].

OBJECTIVE: To assess and compare tissue damage during alternative hysterectomies. DESIGN: Prospective clinical study. SETTING: Department of Gynaecology, Endoscopic Training Centre, Kladno Hospital. METHODS: Tissue damage and perioperative parameters were assessed using the enzymatic activity of creatine kinase (CK) and C-reactive protein (CRP). Serum levels of these markers were measured in 127 women who underwent laparoscopic, abdominal and vaginal hysterectomy. RESULTS: The rare of CK activity and CRP were significantly greater in 45 patients who underwent abdominal hysterectomy compared with that in the patients who underwent laparoscopic and vaginal hysterectomies (57 and 25 patients, respectively). CONCLUSION: Clinical experience and metabolic changes indicate that the tissue damage and perioperative stress in patients undergoing laparoscopic hysterectomy is lower than in patients where an abdominal approach is used. Large prospective studies are needed to evaluate the surgical trauma and metabolic changes induced by laparoscopic hysterectomy.

Adult↗
PubMed1999

[Evaluation of the role of the HPV test in routine clinical practice: prospective study].

OBJECTIVE: To determine the incidence of papillomavirus and to asses the role a HPV DNA in screening of cervical intraepithelial neoplasia. DESIGN: Czech National Collaborative Trial. SETTING: Department of Gynaecology and Obstetrics, Kladno Hospital, Department of Microbiology, KLINLAB, Prague, outpatient clinics (Kladno, Bruntál, Unhost'). METHODS: The study group includes of 3,264 women, their cervical scrapings were sent to KLINLAB during November 1996 to June 1998, because of abnormal results of primary screening. Patients with ASCUS, AGNUS, LSIL, HSIL and/or abnormal colposcopic findings were eligible for this study. Only completely filled in records of a subgroup of 1,158 patients were assessed for sensitivity and specificity for CIN in screening methods. RESULTS: The overall sensitivity of cytology and basic colposcopy were 84.7% and 64.9% respectively. The overall sensitivity of HPV DNA testing was 66%. The sensitivity of cytology of women with minor cytological abnormities for major cervical disease (CIN 2/3 and microinvasive cancer) in this group of patients was only 35%. Combined cytology with HPV DNA test gave an increased sensitivity for major cervical disease of 83%. CONCLUSION: 153 (66.4%) of the cervical intraepithelial neoplasias grade 2/3 displayed negative and borderline or mild cytological changes. The combined use of cytology with HPV testing increased the sensitivity with a reduction of specificity. However, it is evident from these results that HPV DNA testing alone cannot be used as a diagnostic tool but could usefully improve the level of screening CIN in common clinical practice.

Adolescent↗
PubMed1999

Laparoscopic ultrasonic operative technique in surgery of women with endometrial cancer: 2 case reports.

The aim of this study was to introduce a new laparoscopic ultrasonic technique in the laparoscopy-assisted surgical staging of endometrial cancer. The entire laparoscopic phase of the laparoscopic hysterectomy and pelvic lymph node dissection was performed using a 5 mm ultrasonic scalpel and shears. Ultrasonic activated technology was easy to use and allowed the surgeon to perform laparoscopic hysterectomy and lymphadenectomy close to important pelvic structures safer than in other operative techniques. This is only a case report and a larger study to confirm the advantages of the laparoscopic operative technique in surgery of women with uterine malignancy is needed.

Adenocarcinoma↗
PubMed1999

[Laparoscopic hysterectomy using ultrasonic surgical technics: prospective study].

OBJECTIVE: The use of the harmonic scalpel and Laparosonic Coagulating Shears (LCS) for laparoscopic hysterectomy (LH) was evaluated in thirty six women with other gynaecological conditions. DESIGN: Prospective clinical study. SETTING: Department Gynaecology and Obstetrics, Endoscopic Training Centre, Baby Friendly Hospital Kladno, Kladno, Czech Republic. METHODS: Clinical data and cases of hysterectomy performed via ultrasonic operative laparoscopy were summarized and assessed. The primary hemostatic treatment was harmonic scalpel and LCS. Patients were assessed to efficacy, safety, utility and applicability of laparosonic operative technique. RESULTS: From all laparoscopic procedure were 91.6% successfully completed. There were three cases which were finished electrosurgically. The mean order of total operating time was 86.03 min and the mean order of blood loss was 170 ml (range 50-400 ml). There were no major complications, only one case of postoperative bleeding from vaginal cuff. CONCLUSION: Clinical prospective study demonstrates that ultrasonic activated technology in laparoscopic hysterectomy is easy to use, cost effective, and affords the surgeon a greater margin of safety. The harmonic scalpel produces surgical incision with concomitant hemostasis. This is only a preliminary report, and further randomised study is needed.

Adult↗
PubMed1999

[The definition of laparoscopic hysterectomy].

OBJECTIVE: To define laparoscopic hysterectomy. DESIGN: Short review. SETTING: Departments Gynaecology, Kladno Hospital and Na Homolce Hospital, Prague. METHOD: A retrospective study and analyse of literature and information database (Medline 1994-1998). CONCLUSION: We suggest nomenclature and LH classification for the Czech Endoscopic Society, which will bases on the guidelines published by Nezhat et al. and defined especially two forms of laparoscopic assisted vaginal hysterectomy (superior and inferior type).

Female↗
PubMed1998

A comparison of laparoscopic surgery with open procedure in endometrial cancer.

BACKGROUND: Laparoscopic hysterectomy and lymph node dissection have lately been reported as an alternative to an abdominal open procedure for the treatment of malignant gynaecological conditions. The laparoscopic operative technique has been evaluated and compared as to whether it is a safe, feasible and effective procedure. SUBJECTS: The study includes 78 women with indications for surgery for endometrial cancer stage I. A retrospective comparative study was undertaken at Baby Friendly Hospital, Kladno, in which 11 patients treated laparoscopically were compared with 26 patients treated by the open procedure of lymphadenectomy. We evaluated differences in the peri-and postoperative outcomes. RESULTS: All 11 procedures were successfully completed. The mean operating time was 153 min, and mean blood loss was 130 ml. The median hospital stay was 4.7 days. There were no major complications. CONCLUSIONS: Laparoscopic hysterectomy and lymphadenectomy seem to be the procedures which result in a shorter hospital stay and rapid recovery. This approach could potentially decrease morbidity historically associated with hysterectomy and lymphadenectomy performed abdominally. Only prospective randomised studies will be able to demonstrate the ability of operative laparoscopy to improve contemporary management of endometrial cancer.

Endometrial Neoplasms↗
PubMed1997

[The role of laparoscopic hysterectomy in the surgical treatment of premalignant and malignant diseases of the uterine cervix and uterus].

Laparoscopic hysterectomy is a suitable surgical method in women with premalignant changes of the uterine cervix and in premalignant and malignant endometrial diseases in a selected group of women with low or medium risk. The authors consider laparoscopic lymph-adenectomy in patients with endometrial carcinoma as technically feasible, provided careful selection and indication are made. Careful preoperative examination by biopsy, hybridization probes, tumour markers, sonography, computed tomography or magnetic resonance are essential. A minimal invasive approach can be applied not only in benign diseases of organs of the lasser pelvis. Favourable convalescence parameters are the reason for integration of surgical laparoscopy with gynaecological oncology. Multicentric control studies are needed which will provide evidence that endoscopy can improve the results of hitherto used surgical treatment. Training of the modern surgeon in the sphere of gynaecological oncology involves mastering of surgical techniques of open radical operations as well as perfect endoscopic surgery and strategy.

Adult↗
PubMed1997

[Comparative study of three alternative surgical techniques for hysterectomy].

In conjunction with the introduction of laparoscopic hysterectomy into wider clinical practice significant changes take place in the evaluation of medical and economic aspects of alternate surgical techniques. In the investigated group the advantages of a minimally invasive and vaginal approach in the evaluation of perioperative parameters and time of convalescence were confirmed. Laparoscopically assisted vaginal hysterectomy by the simple coagulation technique reduces considerably the costs of the operation. Costs can be markedly cut by reducing the number of days in hospital and by an earlier return to work. After systemic problems associated with funding of the health services will be resolved it will be useful to implement further extensive prospective studies. The results of these studies along with medical findings can participate in a significant way to an optimal ratio of different alternate surgical techniques of hysterectomy.

Convalescence↗
PubMed1996

[Experimental cross-bow injury].

A high of easily obtainable cross-bows was pointed out in an experiment. In the same time, an experience from foreign papers was verified that injuries caused by arrows with a head for target shooting can imitate the gun shot injuries. Because of their rate increasing in connection with accesibility of cross-bows these injuries need to be recognized and described more precisely. They are not mentioned in the Czech literature in spite of the fact that there were two recent cases of injuries in attempts of murder.

Adult↗
PubMed1996

[Present trends in surgical treatment of endometrial carcinoma].

Contemporary trends in the treatment of endometrial carcinoma are in favour of radical surgery, in particular when prognostic factors signalize possible failure of standard surgical treatment. When selecting a suitable operation it is important to respect the patient's general health status, age and anatomical conditions. High-standard evaluation of prognostic factors, proper surgical technique and tactics are further basic prerequisites of successful treatment.

Aged↗