Ceska Gynekologie-Czech Gynaecology最新文献

{"title":"Comparative analysis of the histological architecture of ovarian tissue following slow-freezing cryopreservation.","authors":"Veronika Hončová, Jan Vodička, Zuzana Slobodová, Radovan Pilka","doi":"10.48095/cccg2025349","DOIUrl":"https://doi.org/10.48095/cccg2025349","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to validate the methodology of ovarian tissue cryopreservation using the slow freezing technique as a fertility preservation approach and to assess its potential implementation in clinical practice at the Assisted Reproduction Centre of the University Hospital Olomouc. In parallel, the technical procedure of cryopreservation was optimized and standardized.</p><p><strong>Materials and methods: </strong>The study was conducted between April 2022 and December 2024 at the Department of Obstetrics and Gynecology, University Hospital Olomouc, and included six transgender patients aged 19-25 years who underwent laparoscopic hysterectomy with bilateral adnexectomy as part of gender-affirming surgery. Ovarian tissue obtained during the procedure was immediately processed and cryopreserved using the slow freezing method at the Assisted Reproduction Centre of the University Hospital Olomouc. Histopathological evaluation of the ovarian tissue was performed both prior to cryopreservation and after thawing at the Department of Clinical and Molecular Pathology.</p><p><strong>Results: </strong>Morphological assessment of the ovarian tissue after cryopreservation confirmed preservation of structural characteristics of follicles and stromal components, without signs of significant degeneration.</p><p><strong>Conclusion: </strong>The results confirm that the applied slow freezing protocol for ovarian tissue cryopreservation is appropriate and sufficiently gentle for clinical use. This method represents a reliable option for fertility preservation in patients undergoing gonadectomy, with potential applications in subsequent autologous transplantation or in vitro follicle culture.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 5","pages":"349-359"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted cesarean scar defect repair.","authors":"E Dosedla, Z Ballová","doi":"10.48095/cccg2025339","DOIUrl":"10.48095/cccg2025339","url":null,"abstract":"<p><p>The rising global incidence of cesarean deliveries has led to a marked increase in associated obstetric and gynecological complications, notably the cesarean scar defect. Clinical management decisions are predominantly guided by patient-reported symptoms, reproductive goals, and individual anatomical considerations. The literature currently lacks definitive guidelines recommending a singular optimal approach. The recent advent and incremental adoption of robotic surgery has introduced a promising new technique, characterized by enhanced surgical precision, improved visualization, reduced morbidity, and rapid patient recovery. Ultimately, embracing robotic-assisted surgery for cesarean scar defect repair represents a critical advancement in gynecological surgery.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 4","pages":"339-342"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative pressure wound therapy in gynecologic oncology - current knowledge and clinical applications.","authors":"Klára Balcárová, Petra Bretová, Munachiso Iheme Ndukwe, Daniel Leško, Martin Štěpán, Jiří Špaček","doi":"10.48095/cccg2025495","DOIUrl":"https://doi.org/10.48095/cccg2025495","url":null,"abstract":"<p><p>Negative pressure wound therapy is a modern and effective method for the prevention and treatment of postoperative wound healing complications, with growing applications in gynecology, especially in gynecologic oncology. Its mechanism of action includes enhanced drainage, reduction of edema, promotion of angiogenesis, and stimulation of granulation tissue formation, ultimately contributing to faster healing and a lower risk of infection, seroma, and wound dehiscence. Negative pressure wound therapy has been shown to be effective in the therapeutic management of complex, infected, or dehiscent wounds following gynecologic-oncologic surgery. Recent studies also suggest that its prophylactic application to primarily closed incisions after laparotomy or vulvectomy may significantly reduce surgical complications, shorten hospitalization, and accelerate recovery, which is particularly important in patients scheduled for adjuvant therapy. However, because most available evidence is based on retrospective studies, further prospective randomized trials are needed to confirm the role of this method in both therapeutic and prophylactic use and to guide its integration into standard perioperative care in gynecologic oncology.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 6","pages":"495-502"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of selected immunohistochemical and clinical-pathological markers on the prognosis of patients with malignant uterine tumors.","authors":"Petra Herboltová, Petra Ovesná, Klára Dvořáková, Tibor Focko, Radovan Kaštan, Petr Stráník, Vendula Smoligová, Jan Kosťun, Jiří Presl","doi":"10.48095/cccg2025425","DOIUrl":"https://doi.org/10.48095/cccg2025425","url":null,"abstract":"<p><strong>Introduction: </strong>Endometrial carcinoma is the most common gynecological malignancy in developed countries, and its incidence has been increasing in recent decades. The prognosis of patients depends on a combination of clinical-pathological characteristics, and more recently, molecular indicators. The aim of this study was to analyze the influence of the selected prognostic markers - immunohistochemical (L1CAM, ER, PR) and classical (FIGO stage, grade, myometrial invasion, lymph node involvement, distant metastases) - on the survival of patients with endometrial carcinoma.</p><p><strong>Materials and methods: </strong>A retrospective evaluation was performed on 143 women with histologically confirmed endometrial cancer treated between 2014 and 2018. All patients underwent primary surgical treatment. Resected specimens were subjected to immunohistochemical analysis of L1CAM, ER, and PR. Data were statistically processed using a Kaplan-Meier analysis and the Cox proportional hazards model, adjusted to age.</p><p><strong>Results: </strong>L1CAM expression was detected in 14% of patients and was associated with shortened survival (HR ≈ 3.9). ER and PR positivity (89% and 85%, resp.) correlated with a more favorable prognosis (HR for ER positivity 0.21; PR 0.23). Classical factors such as higher grade, advanced FIGO stage, cervical and lymphovascular invasion, or presence in nodes were statistically associated with worse survival. An interesting finding was a significantly better prognosis in asymptomatic patients - the presence of symptoms increased the risk of death up to fourfold.</p><p><strong>Conclusion: </strong>L1CAM positivity and loss of hormone receptors are significant adverse prognostic factors. Their inclusion in routine immunohistochemical panel testing improves risk stratification and treatment personalization, which at the time of publication of this paper is already included in the updated ESGO-ESTRO-ESP 2025 guidelines. At the same time, it has been shown that the absence of symptoms at diagnosis is a favorable survival indicator. The results support further research into prognostic markers and their integration into clinical decision-making algorithms.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 6","pages":"425-434"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical placental site nodule detected via hysteroscopy - first case report from Brazil.","authors":"Antônio Braga, Gabriela Paiva, Lilian Padron, Aretha Nobre, Juliana Soares Pereira, Gustavo Yano Callado, Joffre Amim Junior, Sue Yazaki Sun, Edward Araujo Júnior, Jorge Rezende-Filho, Neil Horowitz, Ross Berkowitz","doi":"10.48095/cccg2025479","DOIUrl":"10.48095/cccg2025479","url":null,"abstract":"<p><p>Atypical placental site nodule (APSN) is a rare form of gestational trophoblastic disease (GTD) originating from the proliferation of intermediate trophoblasts, with uncertain clinical behavior. It is considered a potential precursor to rare forms of gestational trophoblastic neoplasia (GTN), such as placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). This report describes the first Brazilian case of APSN diagnosed via hysteroscopy in a 43-year-old woman following miscarriage. Histopathological analysis revealed a circumscribed, hyalinized aggregate of intermediate trophoblasts with nuclear atypia, positive immunostaining for PLAP and p63, and a Ki-67 index > 5%. The patient declined hysterectomy, opting for conservative management with close monitoring. After 12 months of follow-up, no progression was observed. This case emphasizes the diagnostic challenges of APSN, given its subtle presentation and overlap with benign placental site nodules or even PSTT/ETT. Hysteroscopy proved valuable for both diagnosis and fertility-preserving management. Although hysterectomy remains the definitive treatment in many cases, individualized approaches balancing oncologic safety and reproductive goals are increasingly considered. Long-term clinical vigilance is essential, as APSN may precede aggressive GTN forms. Multicenter studies and registries are urgently needed to establish evidence-based guidelines for the diagnosis, treatment, and follow-up of this rare lesion, improving patient outcomes in these uncommon forms of GTD.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 6","pages":"479-485"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HLA-C and KIR interactions as a possible cause of reproductive failures.","authors":"Eva Šťastná, Hana Višňová","doi":"10.48095/cccg2025435","DOIUrl":"https://doi.org/10.48095/cccg2025435","url":null,"abstract":"<p><strong>Objective: </strong>Despite advancements in assisted reproduction, the cause of up to 50% of cases of idiopathic fertility disorders remains unclear. The immune system, particularly the interaction between human leukocyte antigen-C (HLA-C) molecules on the trophoblast and killer-cell immunoglobulin-like receptors (KIR) on uterine natural killer (NK) cells, plays a crucial role in implantation and placental development. The aim of this analysis was to evaluate our experience with testing KIR/HLA-C compatibility and its potential role in personalizing infertility treatment.</p><p><strong>Methods: </strong>This is an interventional study examining the success of therapy in 23 couples who underwent infertility treatment with donated gametes between 1/2023 and 12/2024, with additional consideration of KIR/HLA-C compatibility between the recipient and the donor. For better homogeneity of the sample, patients in the intervention group were divided into two subgroups. The first subgroup consisted of 14 couples undergoing their first therapy with donated gametes. The second subgroup consisted of 9 couples with a history of repeated unsuccessful embryo transfers from donated gametes. A control group of 320 single embryo transfers with donated gametes from couples treated using standard methods between 1/2023 and 12/2024 was used for comparison.</p><p><strong>Results: </strong>In both intervention subgroups, success rates were comparable. Clinical pregnancy was achieved in 62.5% and 63.6%, resp., which exceeded the average success rate of 55.2% in the control group.</p><p><strong>Conclusion: </strong>The high number of achieved clinical pregnancies in a prognostically unfavorable group, burdened by repeated unsuccessful embryo transfers, appears to be a therapeutic success. It is important to bear in mind the low number of evaluated transfers; however, this result suggests that testing KIR/HLA-C compatibility between the recipient and the donor and taking it into account when selecting a donor may significantly increase the success of therapy in indicated cases.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 6","pages":"435-441"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative analgesia in breast cancer surgeries - anesthetic techniques and the role of cytokines.","authors":"Paula Borela Perfeito Abud, Flora Margarida Barra Bizinoto, Natália Nunes Santos, Letícia Tereza Dornelas de Melo, Rafaela Barcelos Andrade, Bruno Henrique Gomes Parizzi, Millena Prata Jammal, Douglas Côbo Micheli, Eddie Fernando Candido Murta, Rosekeila Simões Nomelini","doi":"10.48095/cccg2025447","DOIUrl":"10.48095/cccg2025447","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the relationships between postoperative pain and anesthetic technique and analgesic use, to compare preoperative and postoperative serum cytokine levels, and to determine the influence of the anesthetic technique on these levels in patients undergoing breast cancer surgery.</p><p><strong>Materials and methods: </strong>Thirty-six patients undergoing oncological breast surgery were allocated to general anesthesia only (G; N = 20) and general anesthesia with erector spinae plane block (ESPB, E; N = 16) groups. Postoperative pain intensity was evaluated using a visual analogue scale at three periods (M): 2, 24, and 48 hours after the end of surgery (M2, M24, and M48, resp.). Blood was collected preoperatively, before the induction of general anesthesia (M0), and at M24 and M48. Plasma interleukin (IL) -1, IL-8, and tumor necrosis factor-α (TNF-α) levels were determined by enzyme-linked immunosorbent assay. Associations between categorical variables were evaluated using the Fisher's exact test. Pain scores and cytokine levels were compared between groups G and E and between patients undergoing mastectomy and quadrantectomy using repeated-measures analysis of variance. The significance level adopted for all tests was 5.0%.</p><p><strong>Results: </strong>Moderate to severe pain was more frequent in group G than in group E at M24 (P = 0.016). The IL-8 level was lower in group E than in group G (P = 0.029). In the whole cohort, TNF-α level was reduced at M48 (P = 0.010), IL-8 level was reduced at M24 (P < 0.001), and IL-1 level was increased at M48 (P < 0.001).</p><p><strong>Conclusions: </strong>ESPB is an effective alternative in cases with contraindications or technical difficulties with other anesthetic techniques, such as epidurals. Its use could improve women's quality of life and health after breast cancer surgery.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 6","pages":"447-456"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laser therapy for type III fetal congenital cystic adenomatoid malformation.","authors":"J B Dantas, C Longo, M Saito, E Araujo Júnior","doi":"10.48095/cccg2025315","DOIUrl":"10.48095/cccg2025315","url":null,"abstract":"<p><p>Congenital cystic adenomatoid malformation (CCAM) is a rare developmental anomaly of the fetal lung that can lead to severe respiratory distress in the neonatal period. Type III CCAM, characterized by solid, microcystic lesions, often poses diagnostic and therapeutic challenges, especially in progressive cases. We report a rare case of antenatal laser therapy used to treat a fetus diagnosed with type III CCAM. Despite two cycles of corticosteroid therapy, the lesion showed no significant regression, leading to the decision to perform ultrasound-guided intrauterine laser ablation. The procedure resulted in a reduction in lesion size, normalization of the fetal cardiac axis, and a favorable perinatal outcome, with the newborn discharged 5 days after birth in stable condition. This case highlights the potential role of fetal laser therapy as a less invasive and effective alternative to surgical excision for selected cases of progressive type III CCAM. Further studies are needed to validate the safety, efficacy, and long-term outcomes of this approach.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 4","pages":"315-319"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of a modified CMT+ for assessing pelvic floor muscle contraction in pregnancy.","authors":"S H Stensgaard, K M Bek, K M Ismail","doi":"10.48095/cccg2025293","DOIUrl":"https://doi.org/10.48095/cccg2025293","url":null,"abstract":"<p><strong>Objective: </strong>The ability to locate pelvic floor muscles (PFM) is essential for the effectiveness of pelvic floor muscle training programs. The aim of this study was to investigate the accuracy of a modified coccygeal movement test that incorporates an objective assessment of abdominal muscle co-activation (CMT+) (Index test) compared to transabdominal ultrasound (TAU) scanning (Gold standard) in diagnosing accurate PFM contraction.</p><p><strong>Methods: </strong>Pregnant women attending the hospital for a routine in the middle 2nd trimester scan who are able to understand the study rationale and information were considered eligible for inclusion. TAUs were performed by one out of two trained operators. CMT+ was performed by an experienced physiotherapist. The CMT+ assessor and participants were blind to the TAU result.</p><p><strong>Results: </strong>A total of 117 participants were recruited into the study with a mean BMI of 30.86 kg/m² (4.5) and 23.16 kg/m² (3.7), resp. CMT+ (Index test) correctly identified 5 out of the 9 participants who were not able to contract and 107 out of the 108 who were able to contract their PFM resp. (sensitivity = 55.6%, specificity = 99.1%, positive predictive value = 83.3% and negative predictive value = 96.4%; LR+ = 60 and LR- = 0.45).</p><p><strong>Conclusion: </strong>CMT+ is an easy to perform test with high specificity and negative predictive value that has the additional benefit of assessing any concomitant abdominal muscle co-activation. Therefore, CMT+ is a potentially useful initial screening test to identify those who cannot perform a correct pelvic floor muscle contraction, and would benefit from specialized assessment and structured training.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 4","pages":"293-298"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of tru-cut bio psy in the management of myometrial lesions.","authors":"A Richtárová, K Hlinecká, Z Lisá, V Lukavec, V Vaisová, M Mára","doi":"10.48095/cccg2025328","DOIUrl":"https://doi.org/10.48095/cccg2025328","url":null,"abstract":"<p><p>The aim of this article was to summarize current knowledge regarding ultrasound-guided tru-cut biopsy, with a focus on its applicability in preoperative diagnosis of myometrial lesions. Tru-cut biopsy is used in gynecologic oncology for the management of pelvic and abdominal tumors; however, its application in the diagnostic algorithm for uterine tumors has been validated by only a limited number of studies. Nevertheless, this literature review highlights that tru-cut biopsy of uterine smooth muscle lesions demonstrates high sample adequacy for histological examination, diagnostic accuracy, and a low complication rate. Leiomyomas are among the most common benign uterine tumors, whereas uterine sarcomas are rare and aggressive malignancies. Symptoms of these conditions do not differ significantly. Their differentiation relies on imaging methods such as ultrasonography and magnetic resonance imaging. However, distinguishing between benign and malignant tumors remains challenging, as criteria for differentiating benign and malignant lesions using these imaging methods have not yet been sufficiently validated. Incorporating tru-cut biopsy into the standard diagnostic algorithm for uterine tumors could provide valuable insights into the oncological nature of atypical tumors on ultrasonography or magnetic resonance imaging, leading to optimized and personalized treatment strategies for each patient.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 4","pages":"328-332"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}