BACKGROUND: The cause of gynecological tumors is multifactorial. Risk factors include higher BMI and lack of physical activity. Gynecological oncological diseases are associated with loss of function due to the pathophysiological effects of the disease, treatment, and also mental stress in patients. These problems lead to greater rehabilitation demand of patients. Rehabilitation aims to help the patient to achieve the best possible level of functional status, to foster independence, to improve acceptance of the disease, to improve patient fatigue and improve the quality of life of the patients It is essential to focus the rehabilitation examination on several factors associated with impaired function, such as impaired cardiovascular and pulmonary function, urinary incontinence or psychological or psychological distress. The pleiotropic effect of rehabilitation can also be used in pain relief, improvement of chemotherapy tolerance, in the treatment of lymphedema and in the improvement of pelvic floor muscle function. PURPOSE: The main aim of this paper is to summarize available options for rehabilitation after gynecological oncological diseases.

• Klíčová slova
• exercise, gynecological oncological diseases, pelvic floor, postoperative rehabilitation, preoperative rehabilitation, rehabilitation,
• MeSH
• cvičení MeSH
• gynekologická onemocnění * MeSH
• inkontinence moči * rehabilitace   MeSH
• kvalita života MeSH
• lidé MeSH
• nádory ženských pohlavních orgánů * MeSH
• pánevní dno MeSH
• terapie cvičením MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: There is a substantial variation in rates of preterm delivery between different parts of the world. The understanding of these variations, as well as the biological mechanisms behind spontaneous preterm delivery, is limited. Although the benefit of antenatal interventions has been shown to be limited, using well-known risk factors for spontaneous preterm delivery to select the correct pregnant women for targeted interventions is important from both a medical and caregiving perspective. OBJECTIVE: To provide an introduction to a substantial research area dealing with risk factors of spontaneous preterm delivery. METHODS: Risk factors in this review were classified as demographical, obstetrical, and gynecological and those related to the current pregnancy according to high-quality evidence of recent literature. RESULTS AND CONCLUSION: An introduction to a substantial research area in maternal and fetal medicine was provided that might help clinicians to better understand the risk factors related to preterm delivery and select the correct pregnant women for targeted interventions.

• Klíčová slova
• Demographical, Pregnancy complications, Risk factors, Spontaneous preterm delivery, and gynecological factors, obstetrical,
• MeSH
• lidé MeSH
• novorozenec MeSH
• předčasný porod diagnóza   etiologie   MeSH
• prenatální péče metody   MeSH
• rizikové faktory MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

A lymphocele is a cystic mass that may occur in the retroperitoneum following a systematic pelvic and/or para-aortic lymphadenectomy. Lymphoceles may be the cause of severe morbidity, or rarely mortality. Symptomatic lymphoceles manifest with pain, compression of adjacent structures, lymphoedema, deep vein thrombosis or inflammation. The morbidity associated with a symptomatic lymphocele may reduce the quality of life of a patient, as well as delay subsequent cancer treatment. The number and positivity of removed lymph nodes, surgical approach, type of tumor, radiotherapy and BMI rate are among the most discussed risk factors of lymphocele formation. The incidence of postoperative lymphocele is reported in the broad range of 1-58%; 5-18% of those who are symptomatic. Only symptomatic lymphoceles should be treated. Mini-invasive methods involving catheter drainage and sclerotization tend to prevail. Surgery either via laparoscopy or laparotomy remains an option in recurring, poorly accessible or inflammatory lymphoceles.

• MeSH
• kvalita života MeSH
• laparoskopie MeSH
• laparotomie metody   MeSH
• lidé MeSH
• lymfadenektomie škodlivé účinky   MeSH
• lymfokela epidemiologie   etiologie   terapie   MeSH
• nádory ženských pohlavních orgánů patologie   MeSH
• pooperační komplikace epidemiologie   terapie   MeSH
• prevalence MeSH
• recidiva MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

The venous thromboembolism is a serious disease, but it is possible to some extend eliminate it by properthromboprophylaxis. The recommendations in gynecology result from guidelines not only in surgery and the internal medicine, but also from specific gynecologic conditions. The early and frequent mobilization is recommended for minor gynecological surgery and laparoscopic procedures. For major gynecological surgery and laparoscopic procedures in whom additional VTE risk factors are present, low molecular weight heparin is indicated. In major gynecological surgery for malignancy, low molecular heparin is needed in dose at least 4,000 antiXa IU. The prolonged prophylaxis for 28 days is also suitable in this setting.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• fibrinolytika terapeutické užití   MeSH
• gynekologické chirurgické výkony škodlivé účinky   MeSH
• lidé MeSH
• rizikové faktory MeSH
• tromboembolie etiologie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• antikoagulancia MeSH
• fibrinolytika MeSH

OBJECTIVE: To identify the incidence of asymptomatic and symptomatic (i.e., causing pain, hydronephrosis, venous thrombosis, acute lymphedema of the lower or urinary urgency) lymphoceles, as well as risk factors for their development, through a prospective study of patients undergoing sole pelvic or combined pelvic and paraaortic lymphadenectomy for gynecological cancer. METHODS: Patients with endometrial, ovarian or cervical cancer scheduled for sole pelvic or combined pelvic and paraaortic lymphadenectomy as a primary surgical treatment or salvage surgery for recurrence were enrolled at single institution from February 2006 to November 2010 and prospectively followed up with ultrasound. RESULTS: Of 800 patients who underwent sole pelvic or combined pelvic and paraaortic lymphadenectomy for gynecological cancer, the overall incidence of lymphoceles was 20.2%, with symptomatic lymphoceles occurring in 5.8% of all patients. Lymphoceles are predominantly located on the left pelvic side wall. Lymphadenectomy in ovarian cancer, a higher number of lymph nodes obtained (>27), and radical hysterectomy in cervical cancer were found to be independent risk factors for the development of symptomatic lymphoceles. CONCLUSIONS: The overall incidence of lymphocele development after lymphadenectomy for gynecological cancer remains high. However, the majority of lymphoceles are only incidental finding without clinical impact. A symptomatic lymphocele is an uncommon event, occurring in only 5.8% of patients. Symptomatic lymphoceles tend to develop earlier than asymptomatic. Although such risk factors are hard to avoid, patients known to be at an increased risk of developing symptomatic lymphoceles can be counseled appropriately and followed up for specific symptoms relating to lymphocele development.

• Klíčová slova
• Lymphocele, Paraaortic lymphadenectomy, Pelvic lymphadenectomy, Radical hysterectomy,
• MeSH
• dospělí MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru chirurgie   MeSH
• lymfadenektomie škodlivé účinky   statistika a číselné údaje   MeSH
• lymfokela epidemiologie   MeSH
• mladý dospělý MeSH
• nádory ženských pohlavních orgánů chirurgie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

The aim of this study was to assess the incidence and risk factors of pelvic fractures as a result of radiation therapy in women with gynecological cancer. We retrospectively reviewed 3530 female patients treated at our institute between 1980 and 1998 with megavoltage radiation with or without brachytherapy for cancer in the pelvic area. Eligible were patients with vulvar, vaginal, cervical, endometrial, and fallopian tube cancer. Median follow-up was 88 months (range 0-240). Emphasis was put on treatment-related and patient-related risk factors. Of the eligible 3155 patients, 15 developed symptomatic bone fracture caused by osteoradionecrosis, which makes an overall incidence of 0.44% The diagnosis was based on anamnesis, clinical course, and X-ray or computed tomography images. Median time of onset was 44 months (range 6-197). All patients had pain as the first symptom. The only independent predictive factor for developing osteoradionecrosis seemed to be preexistent osteoporosis. Other risk factors that are related to osteoporosis include higher age, postmenopausal status, or steroid treatment. We did not find any significant treatment-related predictive factor for pelvic osteoradionecrosis. Patients with osteoporosis are probably at the highest risk for developing osteoradionecrotic fractures after pelvic radiotherapy. More studies are needed to find out other endogenous predictive factors.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• fraktury kostí diagnostické zobrazování   etiologie   MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory ženských pohlavních orgánů radioterapie   MeSH
• následné studie MeSH
• osteoradionekróza diagnostické zobrazování   etiologie   MeSH
• pánevní kosti diagnostické zobrazování   účinky záření   MeSH
• počítačová rentgenová tomografie MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Malignant tumors may contribute to host response that involves both the adaptive and innate immune systems. Among other biochemical indicators of systemic immune and inflammatory activity, activation of macrophages by interferon-gamma induces a marked increase in the production of neopterin. Neopterin production by activated macrophages is also associated with tryptophan degradation. In addition to tumors of other primary locations, increased urinary and serum neopterin concentrations have been reported in patients with gynecological cancers, including epithelial ovarian carcinoma, cervical carcinoma, endometrial carcinoma, uterine sarcomas, and vulvar carcinoma, but not in women with benign neoplasms or precancerous disorders. Increased neopterin concentrations have been associated with poor prognosis. Elevated levels of neopterin have also been observed in the tumor microenvironment. Systemic (urinary or serum) or local (ascitic fluid) neopterin concentrations increased after therapeutic administration of cytokines. Elevated neopterin concentrations have been associated with anemia of chronic disease and increased urinary zinc loss in patients with gynecological malignancy. Elevated neopterin has also been connected with depressed function of peripheral blood lymphocytes and a decrease in CD4+ T-cell numbers.

• MeSH
• analýza přežití MeSH
• biologické markery analýza   MeSH
• dospělí MeSH
• imunoterapie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory děložního čípku imunologie   mortalita   patologie   MeSH
• nádory endometria imunologie   mortalita   patologie   MeSH
• nádory vaječníků imunologie   mortalita   patologie   MeSH
• nádory ženských pohlavních orgánů imunologie   mortalita   patologie   terapie   MeSH
• neopterin analýza   metabolismus   MeSH
• prognóza MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• staging nádorů MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery MeSH
• neopterin MeSH

BACKGROUND: A good educational climate/environment in the workplace is essential for developing high-quality medical (sub)specialists. These data are lacking for gynecological oncology training. OBJECTIVE: This study aims to evaluate the educational climate in gynecological oncology training throughout Europe and the factors affecting it. METHODS: A Web-based anonymous survey sent to ENYGO (European Network of Young Gynecological Oncologists) members/trainees to assess gynecological oncology training. This included sociodemographic information, details regarding training posts, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1-5 Likert scale) to assess the educational climate. The χ test was used for evaluating categorical variables, and the Mann-Whitney U (nonparametric) test was used for continuous variables between 2 independent groups. Cronbach α assessed the questionnaire reliability. Multivariable linear regression assessed the effect of variables on D-RECT outcome subscales. RESULTS: One hundred nineteen gynecological oncological fellows responded. The D-RECT questionnaire was extremely reliable for assessing the educational environment in gynecological oncology (subscales' Cronbach α, 0.82-0.96). Overall, trainees do not seem to receive adequate/effective constructive feedback during training. The overall educational climate (supervision, coaching/assessment, feedback, teamwork, interconsultant relationships, formal education, role of the tutor, patient handover, and overall consultant's attitude) was significantly better (P = 0.001) in centers providing accredited training in comparison with centers without such accreditation. Multivariable regression indicated the main factors independently associated with a better educational climate were presence of an accredited training post and total years of training. CONCLUSIONS: This study emphasizes the need for better feedback mechanisms and the importance of accreditation of centers for training in gynecological oncology to ensure training within higher quality clinical learning climates.

• MeSH
• akreditace * MeSH
• dospělí MeSH
• gynekologie výchova   MeSH
• kontinuální vzdělávání lékařů MeSH
• kurzy a stáže v nemocnici * MeSH
• lékařská onkologie výchova   MeSH
• lidé MeSH
• následné studie MeSH
• pracoviště MeSH
• průzkumy a dotazníky MeSH
• stipendia * MeSH
• studenti lékařství psychologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

OBJECTIVES: To evaluate risk factors associated with the local recurrence of invasive squamous cell vulvar cancer in patient group with tumor-free pathological margins. MATERIAL AND METHODS: This is a retrospective analysis of 47 patients who underwent surgical treatment at University Hospital Brno, the Czech Republic between 2007 and 2014. 24 patients were classified as IB stage and three as II stage. A further 20 patients representing stage III showed the metastatic involvement of regional lymph nodes. Seven prognostic factors were analyzed in relation to local tumour recurrence: tumour size, margin distance, depth of invasion, lymphovascular space involvement (LVSI), midline involvement, metastatic lymph nodes and FIGO stage. RESULTS: All prognostic factors were found to be statistically significant with respect to the risk of local recurrence. The highest risk of local recurrence was observed for the depth of invasion > 5 mm (HR, 12.42 [95% CI; 3.44-44.84]) and for the presence of LVSI (HR, 10.83 [95% CI; 3.87-30.28]). The study also established a clear difference in the risk of local recurrence between patient groups with resection margin < 8 vs. ≥ 8 mm (HR, 4.91 [95% CI; 1.73-13.93; p = 0.003]. CONCLUSIONS: Tumour-free pathological margin of ≥ 8 mm is a major prognostic factor of local recurrence which can be influenced by the surgeon. A perfect knowledge of the extent of the disease prior to surgery supports adequately radical surgical trends. The emphasis is given on adequate radicality as well as on the reduction of overtreatment without worse-ning prognosis by simultaneously preserving the quality of life.

• Klíčová slova
• local recurrence, squamous cell vulvar cancer, surgical treatment, tumour-free pathological margins,
• MeSH
• časové faktory MeSH
• dospělí MeSH
• gynekologické chirurgické výkony * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru * MeSH
• lymfadenektomie MeSH
• lymfatické metastázy MeSH
• nádory vulvy patologie   chirurgie   MeSH
• resekční okraje * MeSH
• retrospektivní studie MeSH
• reziduální nádor MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spinocelulární karcinom sekundární   chirurgie   MeSH
• staging nádorů MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

The aim of the study was to estimate genetic alterations detected in ovarian and cervical cancer cells, in correlation with other available parameters of a histopathological and clinical character and to find the important associations and differences of both these tumor sites with diverse impacts on the cancer's prognosis. Sixty patients presenting with ovarian cancer and twenty patients manifesting cervical cancer were included in the study. The histological type and grade, MIB-1 and p53 were estimated. For genetic testing, both conventional and molecular methods were applied. The results were subjected to statistical evaluation, using analysis of variances and I2 test. Ovarian cancer patients with extensive chromosomal rearrangements were assessed to be significantly younger. The typical findings, different in ovarian and cervical cancer cells have been found, including some less frequent findings (deletion of 22q in 36% of all ovarian cancer samples, as well as amplifications of chromosome 2 and deletions of chromosome 10, 11p and 21q in cervical cancer cells). The expression of proliferation marker MIB-1 was observed to be significantly higher in women with a high p53 HSCORE. The significant importance of genetic alterations and the activity of proliferative markers, including common correlations with an unfavorable outcome with respect to ovarian tumors in younger women were found. Key words: chromosomal rearrangements, genetic alterations, ovarian cancer, cervical cancer, prognostic significance.

• MeSH
• chromozomální aberace * MeSH
• dospělí MeSH
• karyotypizace MeSH
• lidé středního věku MeSH
• lidé MeSH
• mutace MeSH
• nádorové biomarkery analýza   MeSH
• nádory děložního čípku genetika   MeSH
• nádory vaječníků genetika   MeSH
• prognóza MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• nádorové biomarkery MeSH