Cíl práce: Popsat případ akutního infarktu myokardu v graviditě u ženy s abúzem drog. Typ studie: Kazuistika. Název a sídlo pracoviště: Gynekologicko-porodnické oddělení, Thomayerova nemocnice, Praha. Metodika: Vlastní pozorování. Závěr: Akutní infarkt myokardu v graviditě patří k neočekávaným porodnickým komplikacím. Jeho následky mohou být fatální pro matku i plod, avšak při správném managementu vedení porodu a léčby můžeme morbiditu i mortalitu obou snížit na minimum.

Objective: To describe hear-attack on crystal meth addicted pregnant woman. Design: Case report. Conclusion: Acute heart-attack during pregnancy means unexpected obstetric complication. The consequences could be fatal for the mother and the fetus. Although good delivery management and treatment could reduce morbidity and mortality to a minimum.

• Keywords
• infarkt myokardu, gravidita, abúzus drog, fetus mortuus, hysterektomie, císařský řez, heart-attack, myocardial infarction, pregnancy, drug use, stillbirth, hysterectomy, caesarean section,
• MeSH
• Angiography methods   MeSH
• Cesarean Section MeSH
• Adult MeSH
• Echocardiography utilization   MeSH
• Myocardial Infarction * etiology   therapy   MeSH
• Pregnancy Complications, Cardiovascular * diagnosis   therapy   MeSH
• Pregnancy Complications MeSH
• Humans MeSH
• Substance-Related Disorders MeSH
• Pregnancy MeSH
• Delivery, Obstetric methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

I.Objective: To compare invasiveness, clinical effectiveness, frequency of complications, and especially reproductive and perinatal outcomes of the two occlussive methods of uterine fibroids treatment using prospective, controlled, non randomized study.II.Methods: In symptomatic women <40 years of age wishing to preserve fertility with intramural fibroid > 4cm in unfavorable location for myomectomy or with more than 2 fibroids > 2cm radiological or laparoscopic occlusion of uterine arteries will be performed. III.Follow-up: Except clinical and ultrasound evaluation (every 6 months) the results of MRI, hysteroscopy, blood count, ovarian reserve and myoma-related symptoms after 6 months will be compared with the initial state. Reproductive results of patients will be monitored in detail. IV.Importance: To contribute to optimal approach in young patients with fibroids, not suitable for surgical ablative therapy. To compare effectiveness and safety of ischemizing methods in selected group of patients.

I. Cíl: v rámci prospektivní, kontrolované, nerandomizované klinické studie porovnat invazivitu, morbiditu, klinickou efektivitu a frekvenci komplikací dvou okluzivních způsobů léčby děložních myomů s důrazem na výsledky reprodukční a perinatální. II. Metodika: Symptomatické ženy < 40 let, s přáním zachování fertility a nálezem intramurálního myomu > 4cm v rizikové lokalizaci pro enukleaci nebo s nálezem více než 2 myomů > 2cm podstoupí radiologickou nebo laparoskopickou okluzi děložních tepen. III.Follow-up: Kromě klinického a ultrazvukového sledování (á 6 měsíců) budou po 6 měsících s výchozím stavem porovnány výsledky MRI, hysteroskopie, krevního obrazu, ovariální rezervy a intenzita obtíží. Podrobně budou zaznamenávány výsledky reprodukční. IV. Význam projektu: Přispět ke stanovení optimálního terapeutického postupu u mladších žen s objemnými myomy, nevhodnými k resekční léčbě chirurgické. Porovnat a ověřit efektivitu a bezpečnost ischemizujích metod u selektované skupiny pacientek.

• MeSH
• Uterine Artery Embolization MeSH
• Laparoscopy methods   utilization   MeSH
• Myoma therapy   MeSH
• Embolization, Therapeutic MeSH
• Vascular Surgical Procedures MeSH
• Treatment Outcome MeSH
• Fertility Preservation MeSH

• Conspectus
• Gynekologie. Porodnictví
• NML Fields
• gynekologie a porodnictví
• NML Publication type
• závěrečné zprávy o řešení grantu IGA MZ ČR

• MeSH
• Obstetric Labor Complications MeSH
• Contraindications, Procedure MeSH
• Blood Transfusion * methods   standards   MeSH
• Humans MeSH
• Postpartum Hemorrhage diagnosis   therapy   MeSH
• Pregnancy MeSH
• Erythrocyte Transfusion standards   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH

The purpose of this study was to compare the midterm results of a radiological and surgical approach to uterine fibroids. One hundred twenty-one women with reproductive plans who presented with an intramural fibroid(s) larger than 4 cm were randomly selected for either uterine artery embolization (UAE) or myomectomy. We compared the efficacy and safety of the two procedures and their impact on patient fertility. Fifty-eight embolizations and 63 myomectomies (42 laparoscopic, 21 open) were performed. One hundred eighteen patients have finished at least a 12-month follow-up; the mean follow-up in the entire study population was 24.9 months. Embolized patients underwent a significantly shorter procedure and required a shorter hospital stay and recovery period. They also presented with a lower CRP concentration on the second day after the procedure (p < 0.0001 for all parameters). There were no significant differences between the two groups in the rate of technical success, symptomatic effectiveness, postprocedural follicle stimulating hormone levels, number of reinterventions for fibroid recurrence or regrowth, or complication rates. Forty women after myomectomy and 26 after UAE have tried to conceive, and of these we registered 50 gestations in 45 women. There were more pregnancies (33) and labors (19) and fewer abortions (6) after surgery than after embolization (17 pregnancies, 5 labors, 9 abortions) (p < 0.05). Obstetrical and perinatal results were similar in both groups, possibly due to the low number of labors after UAE to date. We conclude that UAE is less invasive and as symptomatically effective and safe as myomectomy, but myomectomy appears to have superior reproductive outcomes in the first 2 years after treatment.

• MeSH
• Adult MeSH
• Fertility MeSH
• Financing, Organized MeSH
• Gynecologic Surgical Procedures MeSH
• Ultrasonography, Interventional methods   MeSH
• Leiomyoma surgery   therapy   MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Uterine Neoplasms surgery   therapy   MeSH
• Follow-Up Studies MeSH
• Postoperative Complications MeSH
• Prospective Studies MeSH
• Surveys and Questionnaires MeSH
• Reoperation MeSH
• Risk MeSH
• Pregnancy MeSH
• Embolization, Therapeutic adverse effects   MeSH
• Pregnancy Outcome MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

• MeSH
• Uterine Hemorrhage etiology   surgery   MeSH
• Adult MeSH
• Endometrium surgery   physiopathology   MeSH
• Financing, Organized MeSH
• Outcome Assessment, Health Care methods   utilization   MeSH
• Hysteroscopy methods   utilization   MeSH
• Humans MeSH
• Prospective Studies MeSH
• Flowmeters utilization   MeSH
• Blood Flow Velocity MeSH
• Statistics as Topic methods   MeSH
• Endometrial Ablation Techniques MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH

AIM: Uterine artery embolization for fibroids is a controversial issue for women with incomplete reproductive plans. Ovarian failure and uterine infection are the most dreaded complications of this procedure. The purpose of the present study was to assess the types and the frequency of intrauterine abnormalities and the histological features of the endometrium after embolization. METHODS: Uterine artery embolization was performed on 51 women (average age 34.5 years) with intramural fibroid/s larger than 4 cm. Hysteroscopy and endometrial biopsy was performed from 3 to 9 months later in the luteal phase of the cycle. RESULTS: Despite all women having no major symptoms prior to hysteroscopy, only 19 (37%) had completely normal hysteroscopic findings. There was intrauterine protrusion of fibroid/s in 19 cases (37%), yellowish coloration of the endometrium in 14 (28%), intrauterine or cervical adhesions in seven (14%), and communication between the myoma and the uterine cavity in five cases (10%). A normal, functional endometrium was histologically verified in 44 women of 49 (90%) who could be evaluated. Regressive changes (necrosis or hyalinization) of leiomyoma or of indefinite origin were found in 17 patients and embolization particles in five, including one patient with microspheres inside the endometrial vessel. No case of Asherman syndrome or endometrial atrophy was observed. CONCLUSION: The frequency of abnormal hysteroscopic findings after embolization is surprisingly high. The clinical significance, reversibility, and impact on fertility of abnormal hysteroscopic findings after embolization remain unclear. Regardless, hysteroscopy should be strongly recommended to all patients after uterine fibroid embolization, prior to conception.

• MeSH
• Adult MeSH
• Financing, Organized MeSH
• Hysteroscopy MeSH
• Leiomyoma therapy   MeSH
• Humans MeSH
• Uterine Neoplasms pathology   therapy   MeSH
• Prospective Studies MeSH
• Embolization, Therapeutic adverse effects   MeSH
• Uterus pathology   MeSH
• Age Factors MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Clinical Trial MeSH

Objective: To compare invasivity, safety and effectiveness of 2 different methods of uterine fibroids treatment, especially their impact on reproductive and perinatal outcomes. Design: prospective, randomized, controlled clinical trial. Methods: 70 pregnancy planning women under the age of 40 with significant intramural myoma (? 4cm) will be randomly devided into group E (they undergo selective uterine artery embolization) and group M (laparoscopic ro open myomectomy). Follow-up: Dynamics of pelvic ultrasound picture, ovarian endocrin functions and myoma-related symptoms will be ealuated regularly up to 6 months. 6-12 months posproceduraly women could start to conceive. Fertility outcomes will be followed for 2 years. Project importance: Finding out the optimal therapeutic algorhytm for pregnancy planning women with uterine fibroids. According to the scientific evidence this serious topic remains unsolved so far.

Cíl: porovnat invazivitu, bezpečnost a efektivitu dvou různých způsobů léčby děložních myomů, zejména pak jejich vliv na reprodukční a perinatální výsledky. Design: prospektivní, randomizovaná, kontrolovaná klinická studie. Metodika: 70 žen do 40 let věku, aktuálně plánujících graviditu, s nálezem intramurálního myomu (> 4cm) bude náhodně rozděleno na skupinu E (podstoupí selektivní embolizaci děložních tepen) a skupinu M (laparoskopickou či otevřenou myomektomii). Follow-up: Po dobu 6 měsíců bude pravidelně sledován vývoj UZ nálezu v malé pánvi, endokrinní funkce ovárií a specifických symptomů. Po 6-12 měsících od výkonu bude ženám doporučeno otěhotnět; celková doba sledování reprodukčích výsledků bude 2 roky. Význam projektu: Nalezení optimálního terapeutického postupu u žen s děložními myomy, které plánují těhotenství. Dle dosavadních vědeckých poznatků zůstává tato závažná problematika dosud nevyřešená.

• MeSH
• Gynecologic Surgical Procedures MeSH
• Laparoscopy MeSH
• Myoma surgery   therapy   MeSH
• Uterine Neoplasms therapy   MeSH
• Pregnancy MeSH
• Embolization, Therapeutic MeSH
• Check Tag
• Pregnancy MeSH

• Conspectus
• Gynekologie. Porodnictví
• NML Fields
• gynekologie a porodnictví
• gynekologie a porodnictví
• reprodukční lékařství
• NML Publication type
• závěrečné zprávy o řešení grantu IGA MZ ČR

Uterine artery embolization (UAE) is an effective and accepted treatment option for symptomatic uterine leiomyoma. Between 2000 and 2005, 91 women were treated using this method, and were prospectively followed at our institution. Twenty of them subsequently underwent surgery. One of these patients was subjected to four surgical procedures. We describe the pathological findings of 23 surgical specimens obtained from these 20 patients. The embolic material used consisted of tris-acryl gelatin microspheres (TGMS) in 15 patients (18 surgical specimens), polyvinyl alcohol particles (PVA) in three patients, and a combination of PVA and TGMS in two patients. Histologically, of the 23 specimens examined, 20 were diagnosed as leiomyomas, and three as adenomyosis. Particles used for embolization were found in all but three specimens. Necrosis was present in 15 of 20 leiomyoma specimens. Hyaline necrosis was found in 12 specimens, coagulative necrosis in one case, and a combination of hyaline and coagulative or suppurative necrosis in two cases. The foci of adenomyosis remained unaltered.

• MeSH
• Arteries MeSH
• Adult MeSH
• Endometriosis pathology   therapy   MeSH
• Financing, Organized MeSH
• Leiomyoma pathology   therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Uterine Neoplasms pathology   therapy   MeSH
• Necrosis MeSH
• Polyvinyl Alcohol therapeutic use   MeSH
• Prospective Studies MeSH
• Embolization, Therapeutic MeSH
• Uterus blood supply   pathology   MeSH
• Treatment Outcome MeSH
• Gelatin therapeutic use   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Clinical Trial MeSH

OBJECTIVE: To compare the clinical results of surgical and endovascular treatment of uterine myomas in young women. STUDY DESIGN: In a university-affiliated, tertiary care center a prospective trial was conducted. Sixty-three women, wishing to retain fertility, with intramural fibroid(s) larger than 4 cm, were randomly selected either for uterine artery embolization or myomectomy. Invasiveness, efficacy, and complications of both procedures were compared. RESULTS: Thirty embolizations and 33 myomectomies (15 laparoscopic, 18 open) were performed. The mean follow-up was 17 months. In embolized patients, there was a significantly shorter procedure length (p<0.0001), hospital stay (p<0.001) and disability period (p<0.0001), lower CRP (p<0.001) and higher hemoglobin (p<0.0001) concentrations the 2nd day after procedure. But there was a higher incidence of re-interventions (p<0.01) and a lower rate of total symptomatic relief (p<0.1). The groups did not significantly differ in: technical success rate, febrile morbidity, FSH levels 6 months after the procedure, and complication rates. CONCLUSIONS: Although the reproductive outcomes of uterine artery embolization and myomectomy cannot be evaluated at the moment, our first results indicate that both methods are clinically successful in the majority of cases and are not connected with significant number of serious complications.

• MeSH
• Length of Stay MeSH
• Adult MeSH
• Fertility MeSH
• Financing, Organized MeSH
• Gynecologic Surgical Procedures methods   MeSH
• Laparoscopy MeSH
• Leiomyoma surgery   pathology   therapy   MeSH
• Humans MeSH
• Myometrium surgery   MeSH
• Uterine Neoplasms surgery   pathology   therapy   MeSH
• Postoperative Complications MeSH
• Prospective Studies MeSH
• Embolization, Therapeutic methods   MeSH
• Uterus blood supply   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Randomized Controlled Trial MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic MeSH

Cíl studie: Analyzovat klinické a reprodukční výsledky pacientek po laparoskopické (LM) nebo otevřené (OM) myomektomii. Typ studie: Prospektivní klinická studie. Název a sídlo pracoviště: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha. Metodika: Ženy mladší 40 let, s intramurálním myomem ≥ 4 cm, byly indikovány k myomektomii. Při laparoskopickém nálezu 1–2 myomů < 8 cm bylo přistoupeno k LM; u ostatních k OM. Pacientky byly sledovány v šestiměsíčních intervalech. Výsledky: Od ledna 2002 do dubna 2005 jsme provedli 80 myomektomií a enukleovali 121 myomů. Průměrný věk žen byl 33,5 roku, průměrná velikost dominantního myomu byla 56 mm. Celkem 38 % žen bylo sterilních, střední délka follow-up byla 15,6 měsíce. V 56 případech (70 %) byla provedena LM. Z 24 OM bylo 18 elektivních a 6 konvertovaných z laparoskopie. V 18 případech předcházel myomu ischemizující výkon (embolizace či laparoskopická disekce děložních tepen nebo myolýza). Ve skupině s LM byla signifikantně nižší krevní ztráta, nižší počet leukocytů a koncentrace CRP 2. pooperační den, kratší doba hospitalizace i interval mezi operací a koncepcí a nižší frekvence časných komplikací než u pacientek s OM. Symptomy plně odezněly u 76 % žen. Z 38 pacientek, které již usilovaly o těhotenství, jich otěhotnělo 20 (22 gravidit): 9 porodů (2 předčasné; 3 spontánní, 6 operačních), 6 potratů, 1 ektopické a 6 právě probíhajících těhotenství. Závěr: Enukleace intramurálních myomů je, v rukou endoskopicky erudovaných operatérů, bezpečným, symptomaticky efektivním a většinou málo invazivním výkonem s dobrou reprodukční prognózou.

Objective: To analyze clinical and reproductive outcomes of patients after laparoscopic (LM) or open (OM) myomectomy. Design: Prospective clinical trial. Setting: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague. Methods: Women under the age of 40 with intramural fibroid larger than 4 cm were indicated for myomectomy. LM was performed when laparoscopy revealed solitary or 2 fibroids smaller than 8 cm; otherwise the OM was carried out. The patients were followed at 6 months intervals. Results: 80 myomectomies with extirpation of 121 myomas was performed from January 2002 to April 2005. The average age was 33.5 years, average size of dominant fibroid 56 mm. 38% of women suffered from infertility; the mean follow-up was 15.6 months. We performed LM in 56 cases (70%). From 24 open procedures 18 were elective and 6 converted from laparoscopy. In 18 patients some of the fibroid – ischemization procedures (uterine arteries embolization or laparoscopic dissection, or laparoscopic myolysis) preceded myomectomy. In the group with LM there was significantly lower periprocedural blood loss, lower count of leucocytes and CRP concentration the 2nd day after surgery, shorter stay in the hospital, shorter interval between surgery and conception, and lower incidence of early complications than in women with OM. Fibroid related symptoms fully disappeared in 76% of patients. 20 women from 38 that have already tried to conceive have achieved 22 gestations so far: 9 deliveries (2 preterm; 3 vaginal, 6 Cesarean), 6 miscarriages, 1 ectopic and 6 ongoing pregnancies at the moment. Conclusion: In the hands of surgeons experienced in operative laparoscopy the enucleation of intramural uterine fibroids is safe, symptomatically effective, mostly low invasive procedure with good reproductive prognosis.

• MeSH
• Biomedical Research MeSH
• Research Support as Topic MeSH
• Gynecologic Surgical Procedures methods   statistics & numerical data   MeSH
• Hysteroscopy utilization   MeSH
• Laparoscopy methods   statistics & numerical data   utilization   MeSH
• Humans MeSH
• Myoma surgery   MeSH
• Genital Neoplasms, Female surgery   MeSH
• Prospective Studies MeSH
• Surveys and Questionnaires utilization   MeSH
• Reproductive Medicine MeSH
• Second-Look Surgery utilization   MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Geographicals
• Czech Republic MeSH