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The bachelor thesis deals with the topic "Specifics of emergencies in gynecology and obstetrics". It concists of two parts, theoretical and practical. In theoretical part, we provide information on individual emergencies in gynecology and obstetrics. We deal at emergencies, how they manifest, what the risk factors may be and what treatment is in pre-hospital emergency care. In gynecological emergencies we discuss emergencies such as ectopic pregnancy, adnexal torsion, ovarian cyst rupture, endometriosis, ovarian hyperstimulation syndrome, pelvic inflammatory disease and pathological gynecological bleeding. In obstetrics we describe hypertensive conditions in pregnancy, preeclampsia, eclampsia, HELLP syndrome, abortive birth, breech birth, umbilical cord prolapse, placental abruption, placenta previa, amniotic fluid embolism, postpartum hemorrhage and cardiopulmonary resuscitation of pregnant women. In the practical part, we present information collected from interviews with paramedics. The information collected was analysed and divided into 11 categories. The goal of thesis was - 1. To map individual emergencies in gynecology and obstetrics. 2. To map the procedures of paramedics in gynecology and obstetrics emergencies. We believe that we have succeeded in meeting our goals. The results of the research can be used to create recommended procedures in gynecological and obstetrics emergencies.

Autoři předloženého příspěvku si jako cíl stanovili provedení analýzy stávajících kritérií určených pro kvantifikované hodnocení ranivého potenciálu střel malorážových zbraňových systémů. Zde uvedená kritéria jsou chronologicky řazena s ohledem na jejich historický vývoj. Pojem ranivý potenciál je zde uveden jako fenomén spadající do oboru experimentální ranivé balistiky, který souvisí s metodami nepřímé identifikace a jejich využitím v experimentálním postřelování substitučních fyzikálních modelů, zastupujících reálné biologické objekty. Vedle analyticky odvozených hodnotících kritérií na základě vhodně zvolené fyzikální veličiny, je zde důraz položen na empirická kritéria, mající svůj základ ve výsledcích balistických experimentů. Při sestavování jednotlivých kritérií bylo nutné postupovat odděleně u střeliva určeného pro obranu (KKZ) a puškového střeliva (DKZ), a to z důvodu výrazných odlišností konstrukčních a balistických parametrů hodnoceného střeliva. The authors of this paper set the aim of the paper to perform an analysis of existing criteria for a quantified assessment of the wounding potential of small arms missiles. The criteria in the paper are arranged chronologically with regard to their historical development. The term wounding potential is presented as a phenomenon belonging to the field of experimental wounding ballistics, which is related to methods of indirect identification and their use in the experimental shooting of substitution physical models representing real biological objects. In addition to analytically derived evaluation criteria based on a suitably chosen physical quantity, emphasis is placed on empirical criteria, which are based on the results of ballistic experiments. When compiling the individual criteria, it was necessary to proceed separately for ammunition intended for defence (KKZ) and rifle ammunition (DKZ), due to significant differences in design and ballistic parameters of the evaluated ammunition.

Background: Dementia syndrome is a significant psychosocial and public health problem with important societal impact. It is important for us to learn more about methods of dementia management. Objective: To discuss principles and basic measures of psychomotor therapy in patients with dementia as well as the implementation of movement therapy and the lifestyle of patients with dementia. Methods: This research presents experience with psychomotor therapy of patients with dementia from the Centre of Gerontology - a day care unit for patients with dementia. Results: Physical activity is an important component in the management of dementia. Implementation of movement should be based on individual needs of persons with dementia and on their abilities. Individual programs and regular training have been pointed out as important principles in care and implementation of physical activity. Other physical activities could be included in the daily programme as well such as different sports and other movements if appropriate to the status of patients and advancement of the dementia syndrome. Conclusion: Regular structured physical activities should be a regular part of the daily programme in the care of patients with dementia.

The risk of osteoporotic fracture is determined collectively by bone mineral density, bone mass, architecture and properties of the mineral and organic matrix composite. Changes in these distinct aspects of quality of bone with age, estrogen deficiency, diseases leading to increased risk of fracture and differential mode of action of antiresorptive and bone anabolic treatments have to be considered in clinical therapeutic strategies. In patients at high risk of low impact fracture, sequential therapy switching to antiresorptives after patients have an adequate response to 2 years teriparatide may be the optimal strategy of long term therapy.Key words: aging - bone quality - osteoporosis - prevention - therapy.

Při zvýšené fyzické zátěži člověk nadýchá větší množství vzduchu včetně škodlivin a jiným způsobem než v klidovém režimu. Prostředí tělocvičen je v mnoha ohledech náchylné k vysokým koncentracím aerosolu (PM), který se v nich kumuluje a během tělesné výchovy (TV) se pohybem a činností cvičících resuspenduje. Koncentrace PM (především jeho hrubé frakce) se tak podle množství cvičenců a charakteru činnosti při cvičení výrazně zvyšují. Cílem naší studie bylo odhadnout expozici aerosolu za podmínek zvýšené ventilace u 32 cvičících dětí (18 dívek – 10 až 14 let a 14 chlapců – 10 až 13 let) na pražských základních školách.Ke zjištění plicní ventilace jsme použili nepřímou metodu přepočtu srdeční frekvence (SF) na minutovou plicní ventilaci (VE) pomocí exponenciální regresní křivky. Provedli jsme laboratorní zátěžové vyšetření vybrané skupiny žáků a měření SF pomocí sport-testerů v průběhu hodiny TV. Výsledky klidových a zátěžových hodnot ventilace jsme porovnávali s hodnotami hmotnostních koncentrací aerosolu, které jsme v tělocvičně měřili kontinuálně fotometrem DustTrak a nízkoobjemovým kaskádovým impaktorem.Výsledky ukázaly, že průměrný násobek plicní ventilace během cvičební jednotky dosáhl u sledované skupiny 3,8 násobku, oproti klidovým hodnotám. Průměrná SF respondentů za měřenou cvičební dobu byla 150,6 tepů·min-1. a vypočtená x̄ VE 24,4 l·min-1. Hodnoty násobku ventilace jednotlivých cvičenců za cvičební jednotku významně korelují (r = 0,78) s průměrnými hodnotami SF za stejnou dobu. Koncentrace aerosolu dosahovaly v měřených hodinách TV u PM2,5 22,4 až 24,4 [μg·m-3] a PM10 60,14 až 101,12 [μg·m-3]. Pokud by respondenti zvýšili ventilaci na vypočtený 3,8 násobek klidové hodnoty, jejich expozice PM by přesahovala limity hygienických požadavků pro školní prostředí dané dokumenty WHO. Ze 112 sledovaných dnů na třech pražských základních školách za výše uvedených podmínek násobku plicní ventilace bylo nadlimitních 89% dnů v tělocvičnách a 46% dnů venku.Při zvýšené fyzické zátěži mohou odpovídat inhalační expozice stavům s nadlimitními koncentracemi škodlivin. V souvislosti s uvedenými poznatky lze doporučit, aby čistotě školního prostředí, kde dochází k vyšší fyzické zátěži, byla věnována větší péče, než místům, kde jsou žáci relativně v klidu., The greater the physical activity, the greater the amount of air, including pollutants, are inhaled compared to when resting. The school gym environment is in many aspects predisposed to high amounts of aerosol (particulate matter – PM) concentrations, which are cumulated in gyms and re-suspended by exercising pupils during physical education (PE) lessons. PM concentrations (mainly its coarse particles) distinctly rise according to the number of people exercising and the type of activity. The aim of our study was to estimate the aerosol exposure for 32 children exercising with increased ventilation in Prague primary school gyms (18 girls - 10 to 14 years and 14 boys - 10 to 13 years).The indirect method of transferring heart rate (HR) to minute ventilation (VE) through the exponential regression curve was used to measure pulmonary ventilation. HR was measured by sport-testers during PE lessons. Results of rest and ventilation load values were compared with the values of aerosol weight concentrations, measured continually by a photometer Dust Track and by the Personal Cascade Impactor Sampler.Results have shown that the average VE multiple during exercising reached 3.8 times in the observed group. The average HR of respondents in the measured exercise unit was 150.6 beats·min-1 and the estimated x̄ VE 24.4 litres·min-1. VE multiple values of individual pupils in an exercise unit correlate significantly (r = 0.78) with average HR values in the time unit. Aerosol concentrations reached in measured PE lessons from PM2.5 22.4 to 24.4 [μg·m-3] and from PM10 60.14 to 101.12 [μg·m-3]. If the tested pupils raised their ventilation to the estimated 3.8 times their resting value, exposure to PM would exceed the sanitary limits set by WHO guidelines for school environments. Out of 112 observed days, in three Prague primary schools, 89% of days in school gyms and 46% of days outdoors were over the limit (under the above stated conditions of VE multiple).The study results indicate that during increased physical load inhalation exposure exceeds pollutant limit concentrations. We recommend that indoor areas, in which pupils exercise, should be cleaned with more care than places in which pupils stay in rest.

The cardiovascular diseases (CVDs) developing as the result of atherosclerosis are among the most frequent causes of morbidity and mortality within the Czech Republic and elsewhere. Genetic predisposition for cardiovascular diseases is amplified in the presence of routine risk factors which can be influenced. Our aim was to establish whether the level of the risk factors for ICHS already differs in the population of healthy descendants of the patients after early myocardial infarction, as opposed to the control group of examined individuals.We approached adult children (n = 127; age 28.7 ± 6.5 years) of the patients with early manifestation of ICHS, who were examined within the study EUROASPIRE IV. The examination of both the descendants and the control group (n = 199; age 28.9 ± 5.3 years) focused on identifying the risk factors for ICHS.Descendants presented arterial hypertension more often (18.9 vs 8.0 %, p = 0.003) and there were more smokers among them compared to the control group (37 vs 24.1 %, p = 0.01). The levels of triglycerides (1.13 vs 0.99 mmol/l, p = 0.05) and LDL-cholesterol (2.7 vs 2.45 mmol/l, p = 0.01) were higher in the descendant group, HDL-cholesterol was similar in both groups (1.6 vs 1.67 mmol/l, p = 0.17). Increased fasting glycemia occurred more frequent in the descendant group (5.5 vs 1.5 %, p = 0.05). None of the examined participants met the criteria for the diagnosis of diabetes mellitus. Aortic stiffness was higher in the descendant group as opposed to the control group (6.2 vs 5.8 m/s, p = 0.001). The total calculated cardiovascular risk based on the SCORE system was also higher in the descendant group as compared to the control group - the current risk related to the age of 40 years: 0.35 (0.19-0.64) vs 0.20 (0.13-0.47), p0.0001 and the risk related to the age of 60 years: 3.35 (2.23-5.36) vs 2.40 (1.58-4.11), p0.0001.The population of the descendants includes, based on our results, a greater number of smokers and hypertensive patients. They also have higher levels of LDL-cholesterol, triglycerides and impaired fasting glycemia more frequently. Unfavourable genetic predisposition along with unfitting lifestyle contributes to a higher likelihood of accumulation of risk factors, and therefore to a higher risk of a cardiovascular disease manifestation. In practice we should try, with regard to these predisposed individuals, to lower their cardiovascular risk and implement a healthy lifestyle.Key words: atherosclerosis - cardiovascular disease - lifestyle - myocardial infarction - primary prevention - risk factors for CVD.

Primary testicular lymphoma (PTL) is a rare form of extranodal lymphoma and accounts for approximately 1 to 2 % of all non-Hodgkins lymphoma and 5 % of testicular malignancies. PTL typically affects patients older than 60 years. The most common clinical symptom is painless scrotal swelling. The ultrasound of testicles followed by orchiectomy and histological and imunohistochemical examinations are the most important tools for diagnostic assessment. Diffuse large B cell lymphoma (DLBCL) is the most common histological type of PTL. Orchiectomy is an important part of the treatment, which includes the combination of systemic imunochemotherapy and prophylactic modalities such as radiotherapy of contralateral testis and central nervous system (CNS) prophylaxis. This combined treatment approach improved the outcome of patients with PTL, however, the high frequency of extranodal relapses including CNS involvement represents a significant problem. The prognosis of PTL still remains less favorable in comparison to the some subtypes of non-Hodgkins lymphomas.Key words: central nervous system lymphoma involvement prophylaxis - primary testicular lymphoma - prognosis - radiotherapy - relapse.

Early diagnosis of the appendiceal carcinoid during first trimester of pregnancy.Case report.Department of Obstetrics and Gynaecology, Merciful Brothers Hospital, Brno.Own observation, review of literature.In case of unclear clinical or intraoperative finding, the appendectomy may reveal a serious disease. Thorough examination of the appendix should be a part of every gynaecological operation.

The aim of this review is to provide a general historical and contemporary perspective on the implementation and use of robot-assisted laparoscopy in gynecology as well as the experience gained to date.Robotic-assisted laparoscopic surgeries in gynecology include benign hysterectomy, myomectomy, radical hysterectomy, lymph node dissections or sacrocolpopexies. Robot-assisted gynecologic surgery is often associated with longer operating room time but generally similar clinical outcomes, decreased blood loss and shorter hospital stay when compared to open or laparoscopic surgery.Robotic surgery is associated with a shorter learning curve and has allowed a larger number of gynecologists to master complex laparoscopic procedures. Robot-assisted surgery offers all the benefits of minimally invasive surgery, making them accessible to a much broader spectrum of patients.Key words: robotic surgery - gynecology hysterectomy - da Vinci laparoscopy.

Translation and validation of the EORTC QLQ-CX24 questionnaire on quality of life into the Czech language and literature.Prospective study.Dept. of Obstetrics and Gynaecology, 2nd Medical Faculty, Charles University and Faculty Hospital Motol, Prague.In concordance with the EORTC guidelines a questionaire for patients with cervical cancer was translated and validated. A group of 14 women who underwent the treatment for cervical cancer filled in the questionaire. T-test was used for the evaluation of the patient's characteristics and the differences in quality of life.We present a Czech version of the questionaire EORTC QLQ-CX24 and the description how to evaulate it. In comparison of the two treatment groups no statistically significant differences have been found.EORTC QLQ-CX24 is an internationally accepted questionnaire focused on patients with cervical cancer which should be incorporated into the projects dealing with women undergoing treatment for this disease.

To point out the latest trends in the surgical training that need to be implemented in Slovak and Czech Republic, not only in gynecology and obstetrics but also in all surgical specialties.Review article.Department of Obstetrics and Gynecology, Faculty Hospital Nitra and Constantine the Philosopher University Nitra.Analysis of the database Medline 1979-2010 with the searching words education, competency, surgeon.The development of high-technologies, mainly minimally invasive surgery, working-hours shortage and public medical awareness are the factors that have major influence on the education of surgeons. Subspecialization, shortage of learning curve and higher safety of surgical procedures are the key elements of the surgical training.

The objective of this article is to review the recent adoption, experience, and applications of robot-assisted laparoscopy in gynecologic surgery.Review article.Department of gynekology and obstetrics, University hospital and Medical faculty Palacky University, Olomouc.Review of literature and our initial experience with robotic surgery.Robotic-assisted laparoscopic surgeries in gynecology include benign hysterectomy, myomectomy, tubal reanastomoses, radical hysterectomy, lymph node dissections, and sacrocolpopexies. Robot-assisted gynecologic surgery is often associated with longer operating room time but generally similar clinical outcomes, decreased blood loss, and shorter hospital stay when compared to open or laparoscopic surgery. We comment on our first 37 robot assisted procedures.Well-designed, prospective studies with well-defined clinical, long-term outcomes, including complications, cost, pain, return to normal activity, and quality of life, are needed to fully assess the value of this new technology.

Problem of mycoses in gynecology is considered very frequent and yeasts are traditionally described as most common cause of vulvovaginal disorders. While acute disorders can be promptly cured in most cases, there is a group of women suffering from those repeatedly. Following article refers to a group of patients in long-term follow-up and shows realistic possibilities of diagnostics, available to out-patient gynecologist. Preliminary results of our pilot project do not confirm yeasts have to be the primary etiologic factor, nevertheless it is logical to be in search of them in these patients.

This article is meant to be a complement to the new statement "Assisted vaginal delivery" of the Section of perinatal and fetomaternal medicine (SPFM) of the Czech Society of Gynecology and Obstetrics ČLS JEP, which is also published in this issue of Czech gynecology. The new statement has been formed as a synthesis of two previous separate statements of the SPFM "Vacuumextraction" and "Forceps delivery" and has also been updated based on new scientific knowledge. This review publication summarizes latest knowledge on vacuumextraction and forceps delivery and adds comments to certain points from the statement.A review of the literature.

Interaction of drugs used in gynecology and urology and their management Author: Kupka Vojtěch Tutor: PharmDr. Martin Doseděl Ph.D., Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Introduction: Drug interactions represent a serious health problem and they cause adverse drug effects and toxicity of drugs. Objectives: The goal of the thesis was to create an overview of possible drug interactions with drugs used in gynecological and urological practice. Methodology: From a theroretical introduction was selected registred drugs to 1 st January 2015 by State Institute for Drug Controle. Information about drug interactions were collected and collated from databases Vademecum Infopharm and Micromedex. From database Micromedex, the drug interactions were selected with quality of documentation "excellent" or "good". Pubmed database (www.pubmed.gov) with entering key words "basic drug", "drug interaction" and "interactive drug" was applied to create a current information. To complement the information was also gathered from magazines Practical Pharmacy and Clinical Pharmacology and Pharmacy. In case of not finding relevant information was drawn from the summary information of medicine (SPC). Results: The results were categorized into a research...

INTRODUCTION The nationwide Colorectal Cancer Screening Programme was introduced in the Czech Republic in 2000. The aim of this article is to describe the employment of faecal occult blood tests (FOBTs) by the Czech population within the screening programme, and to provide information on the latest results of the programme. MATERIAL AND METHODS Data on the development of the colorectal cancer (CRC) burden in the Czech population is obtained from the Czech National Cancer Registry, a database required by the Czech law that has been collecting comprehensive data on cancer patients since 1977. Data on FOBT employment can be obtained from health care payers, and was provided by the Czech National Reference Centre. RESULTS Around 8,000 patients are diagnosed with colorectal cancer in the Czech Republic each year, and the number of CRC deaths is about 4,000. Despite the ongoing screening programme, significant improvements in the proportional representation of cancer stages (i.e., improvements in early detection of CRC cases) have yet to be seen. Although the number of FOBTs performed in the Czech Republic has significantly grown in the long term (which is accompanied by an increase in coverage by this screening test), the total coverage of the Czech population aged over 50 was only 25.5% in 2012. The Olomouc Region, the Zlin region, and the Usti nad Labem region had the highest coverage rates by CRC screening based on FOBT (over 28%), while the Capital of Prague had the lowest coverage rate (18%). Since 2008, FOBT positivity rates have seen a continuous and significant increase, reaching 6.9% in 2012. Between 13 to 14% of FOBTs in women are performed by practical gynaecologists. CONCLUSION Despite a significant increase in the participation rate in recent years, which was partially improved by the involvement of practical gynaecologists, the programme unfortunately still covers only a quarter of the eligible population. Implementation of effective measures aimed at getting people interested in preventive examinations (including the recently introduced programme of personalized invitations) is therefore essential; otherwise, the screening programme will not be successful on the population level.

Preinvasive lesion of the uterine cervix can give rise to cervical cancer. High-risk human papillomaviruses with high oncogenic potential are considered to be the main etiopathological factors with interaction of other risk factors (recurrent inflammation of the cervix, injury of the cervix, immunosuppressive conditions, sexual promiscuity, etc.). Early dia-gnosis of these changes at regular gynecological examinations and adequate treatment can prevent of malignant transformation. Organized cervical screening and implementation of nationwide vaccination against human papillomavirus promises to reduce the incidence of cervical cancer.

Preinvasive lesions of the endometrium are histopathological and molecular alterations related to high-risk of uterine carcinoma development. Incidence has increasing tendency. Atypical endometrial hyperplasia is the preinvasive lesion of type I endometrial carcinoma, developing under a hyperestrogenic background. Carcinoma in situ of the endometrium is considered to be precursor lesion of type II endometrial carcinoma, first of all uterine serous carcinoma. Hysterectomy and bilateral oophorectomy is the main therapeutical modality in both preinvasive lesions of the endometrium. The hormonal therapy with progestogens is the possibility of fertility sparing approach in treatment of histological findings of atypical endometrial hyperplasia in young women. Even though preinvasive lesions of the endometrium are clearly defined, the possibilities of endometrial cancer screening are markedly limited.

The paper addresses transfer of doctors specialty training from the national Institute of postgraduate medical education (IPVZ) to University Medical Schools (UMS) with the special focus to Obstetrics and Gynecology (OG).The National Specialty Board (NSB) has been established. NSB tasks include definition of inclusion criteria and process of specialty choice at UMS. In OG specialty there are defined mid-term and final postgraduate training courses and other requirements for final specialty exam (FSE) - in particular trainees scientific work and surgery done with the supervision of NTB member. The system of FSE, its content, application, reimbursement and mechanisms are described in details.In the whole country in 2012 there have been done 864 FSE in all basic medical specialties, which took place at seven UMS. Autumn semester terms has been utilized significantly more than spring terms (57% vs. 43%). There have been differences in the numbers of specialties and also numbers of candidates in each specialty among different UMS. In total 94% of applicants succeed in the FSE. In 2012 within OG specialty training there has been held 56 FSE - 24 exams on five UMS in spring term and 32 (57%) exams only on two UMS in autumn term. In the spring 2013 FSE were organized on 1st LF UK in Prague with 23 applicants, from which 22 successfully passed. During autumn 2013 the FSE in OG will be held on LF UP in Olomouc with 44 applicants for final postgraduate training course and 39 candidates for FSE.Within OG specialty the transfer of doctors specialty training from IPVZ to UMS has been successfully managed. The NSB in OG specialty closely cooperates with past IPVZ and the Accreditation Commission of the Czech Ministry of Health. Thus continuity, quality and continuous enhancement of specialty training program in OG in Czech Republic is assured.

This paper presents the current status and rules for the laboratory staff activities and their competences in the centers of assisted reproduction. The rules were processed by the members of the Association of Reproductive Embryology (ARE) committee under the current legislation. Committee members of the Czech Sterility and Assisted Reproduction Society and Czech Gynecology and Obstetric Society approved these rules as obligatory for assisted reproduction centres in Czech Republic.

3Patologicko-anatomicke odděleni 1. LF UK a Nemocnice Na Bulovce, Praha 4 Onkogynekologicke centrum, Gynekologicko-porodnicka klinika 1. LF UK a VFN v Praze Souhrn Východiska: Přehled změněneho stagingu karcinomu vulvy, vysvětleni změn a jejich vlivu na prognozu onemocněni. Cil: Spolehlivý stagingový system by měl umožnit odhad prognozy onemocněni, planovat lecbu a informovat o jejim výsledku. Dobrý stagingový system by měl mit tři zakladni charakteristiky – odůvodněnost na zakladě poznatků mediciny založene na důkazech, důvěryhodnost a prakticnost. Na zakladě nových poznatků byly výborem Mezinarodni federace gynekologie a porodnictvi – FIGO (FIGO Committee on Gynecologic Oncology) v zaři 2008 navrženy, odsouhlaseny a o rok později i publikovany změny ve stagingu karcinomu vulvy. Stadium 0 bylo zruseno, protože odpovida prekanceroze. Stadium IA zůstalo beze změny a stadia I a II byla sloucena. Do stagingu byl zahrnut pocet a morfologie postižených lymfatických uzlin, nikoliv vsak jejich bilateralni postiženi. Zavěr: Ucelem dobreho stagingoveho systemu je poskytnout klasifi kaci siřeni zhoubneho nadoru vychazejici z klinicke zkusenosti, aby bylo možno srovnat ucinnost různých modalit lecby. Výsledkem lekařskeho výzkumu na poli onkologie bylo zastarani ně kte rých klasifi kacnich systemů v onkogynekologii, ktere přestaly shrnovat skupiny onemocněni se stejnou prognozou. Přepracovaný staging karcinomu vulvy rozděluje pacienty do skupin s podobnou prognozou. Tim umožňuje relevantni výměnu informaci mezi onkologickými centry a přispiva k poznavani a výzkumu malignit v rozlisných castech světa. Summary Background: Review of revised staging system for vulva, explaining the changes of staging and their impact on the prognosis of disease is presented. Aim: The main objectives of a reliable staging system include an assessment of prognosis, planning treatment, and the evaluation of their outcomes. A good staging system must meet three basic characteristics: validity, reliability and practicality. Since medical research and practice in the fi eld of oncology have shown explosive growth, the staging of vulvar cancer and some other cancers did not give a good spread of prognostic groupings. Changes based on new fi ndings were proposed in 2008 by the FIGO Committee on Gynecologic Oncology, approved, and published a year later the changes in the staging system for carcinoma of the vulva. Stage 0 was deleted, since it represents pre-invasive lesion. Stage IA remained unchanged and stage I and II were combined. The number and morphology of the involved nodes were taken into account, and the bilaterality of positive nodes has been discounted. Conclusion: The purpose of a good staging system is to off er a classifi cation of the extent of gynecological cancer, in order to provide a method of conveying one‘s clinical experience to others for the comparison of diff erent treatment methods. As a result of the explosion of medical research in the fi eld of oncology, the staging of some of the gynecological cancers became outdated and did not give a good spread of prognostic groupings. According to the revised staging for carcimona of the vulva, patients are divided to groups with similar prognosis. Therefore, exchange of relevant information between oncological centers is facilitated, thus disseminating knowledge and stimulating research in other parts of the world.

Gynecological surgery is considered to be clear with possible contamination by gram-positive cocci from the skin, gram-negatives from the perineum or groins or polymicrobial biocenosis from vagina, depending on the surgical approach. Antibiotical prophylaxy enforces the natural mechanisms of immunity and helps to exclude present infection. There were presented many studies comparing useful effect of prophylaxis in gynecological surgery. The benefits of antibiotical prophylaxy before IUD insertion, before the cervical surgery and before hysteroscopies were not verified. On the other hand the prophylaxy of vaginal surgery including vaginal hysterectomy decreases the number of postoperative febrile complications. The positive influence of prophylaxis before the simple laparoscopy and laparoscopy without bowel injury or the opening of the vagina was not evidently verified. In abdominal hysterectomy the antibiotical prophylaxy decreases the incidence of postoperative complications significantly. The administration of 2 g of cefazolin can be recommended. In procedures taking more than 3 hours the repeated administration of cefazolin is suitable. New urogynecological procedures, using mesh implants, were not sufficiently evaluated as for postoperative infections and the posible antibiotical effect. The presence of implant in possibly non sterile area should be considered as high risc of postoperative complications.

Overactive bladder (OAB) presents one of the most frequent medical problems among the current adult population, with a significant impact on the quality of life of the affected patients. A questionnaire survey was carried out in 2006, with the aim to assess the level of knowledge regarding the problem of OAB among gynaecologists and urologists in the Czech republic, as well as to evaluate the currently applied methods of OAB diagnostics and treatment. The aim of this work was to perform a repeated survey after five years, and to evaluate, whether there have been any changes achieved in the monitored parameters.A total of 290 respondents (181 gynaecologists, 109 urologists) were included in the survey in 2006; the study group in 2011 included a total of 285 respondents (180 gynaecologists, 105 urologists). The questionnaire used for the survey in 2011 was identical to the document utilized in the initial survey performed five years ago, with minimal changes. The anonymous questionnaire was designed as "multiple-choice", i.e. with a possible selection from proposed answers; the questions were targeted at the topics of definition, diagnostics and therapy of OAB. The obtained results were processed with the methods of descriptive statistics; the concordance of proportions was evaluated with the Fishers exact test.A total of 114 gynaecologists (63.3%), and 65 urologists (61.9%) were able to determine the correct definition of OAB, which presents a significant increase when compared to 2006 (p0.0001). The most frequently applied methods of OAB diagnostics were patient history (gynaecologists: 97.8% in 2011 vs. 96.5% in 2006, urologists: 99.0% in 2011 vs. 99.0% in 2006), local examination (gynaecologists: 57.8% vs. 76.4%, urologists: 86.7% vs. 87.2%), bladder diaries (gynaecologists: 62.8% vs. 40.3%, urologists: 79.0% vs. 60.5%), and urine examination (gynaecologists: 71.1% vs. 82.3%, urologists: 96.2% vs. 97.1%). Anticholinergic medication is the first-choice in the OAB treatment in our conditions, which has been confirmed by 146 (81.1%) gynaecologists, and 89 (84.4%) urologists. In cases when the physicians use anticholinergic medication for the treatment of OAB, the first-choice medication is trospium, among both gynaecologists and urologists. In case of failure of the first-choice treatment, twenty-six (14.4%) gynaecologists from the addressed respondents try to continue with a treatment according to their own decision, 154 (85.6%) gynaecologists refer the patient to a specialist. Similarly, a total of 90 (85.7%) urologists try to manage the further course of treatment by their own means, 15 urologists (14.3%) refer the patient to a specialist.The level of understanding and awareness about the problem of OAB among the Czech gynaecologists and urologists has significantly improved during the past five years. The applied diagnostic and treatment methods for OAB are being harmonized with the International Continence Society (ICS) recommendations. Taking into consideration the prevalence of OAB among the population, it is desirable to increase the number of clinical departments who deal with the problem of OAB in a complex manner. The remaining significant task lies in the improvement of foreknowledge about the current possibilities and effectiveness of the OAB treatment among the patient population.

Colorectal screening program in the Czech republic in 2011 offers faecal occult blood test (FOBT) yearly in the age of 50-54. Patient over 55 years of age chooses either a FOBT once in 2 years or primary screening colonoscopy once in 10 years without using FOBT. There are different types of FOBT in our screening program: quaiac tests, immunochemical tests unquantitative and quantitative tests. The role of general practitioners was enhanced by participation of the gynecologists in the colorectal cancer screening program due to low compliance of population. Alternative ways of distribution of FOBT to the patients are being considered as well.Participation of general gynecologists in the Czech colorectal cancer screening program is connected with a great expectation. We would like to achieve such compliance in colorectal cancer screening as there is in the screening of gynecological tumors. Using a right method of screening could play an important role in this process.

Identifikační záznam: ŠEBESTOVÁ, Marcela. Náhlé příhody břišní v gynekologii pohledem sestry v intenzivní péči. [Acute Severe Abdominal Pain in Gynaecology from the Point of View of a Nurse in the Intensive Care Unit]. Praha, 2011. 68 s., 10 příl. Diplomová práce (Mgr.). Univerzita Karlova v Praze, 1. lékařská fakulta, Ústav teorie a praxe v ošetřovatelství. Vedoucí práce Mgr. Kulhavá, Miluše. Abstrakt Diplomová práce je zaměřena na náhlé příhody břišní v gynekologii pohledem sestry intenzivní péče. Teoretická část je věnována anatomii a fyziologii ženského reprodukčního systému. Velkou část práce zaujímají náhlé příhody břišní v gynekologii a to především mimoděložní těhotenství, tedy stav, se kterým se může setkat každá žena ve svém reprodukčním období. Empirická část práce je věnována kvalitativnímu výzkumu se zaměřením na zjištění spokojenosti respondentek s poskytovanou ošetřovatelskou péčí po operaci mimoděložního těhotenství. Pohled na hospitalizaci ze strany pacientek je velice cenný, protože dokládá výsledky zdravotnické, v tomto případě ošetřovatelské práce jinak, než běžné statistiky. Výzkumný soubor je tvořen pěti ženami v reprodukčním věku, které byly hospitalizovány na gynekologicko-porodnické klinice s diagnózou ektopická gravidita. Práce shromažďuje co nejvíce informací o mimoděložním...

Christian Gerhard Leopold was one of the most important gynecologists and obstetricians at the end of the 19th century. He is mainly remembered for the eponymous "Leopold's grips" (Leopold-Handgriffe) which are used to determine the position of the fetus within the uterus. He was a student of Carl Siegmund Franz Credé, taught midwifery at the Frauenklinik in Leipzig, and was appointed as an associate professor at Leipzig University in 1883. Afterwards, he succeeded Franz von Winckel as the director of the Royal Gynecological Infirmary in Dresden. In the journal "Archiv für Gynäkologie" he published the four classic "Leopold's grips". A third grip or maneuver known as "Pawlik's grip" is still used by obstetricians today, though some, especially abroad, favored and recommended the two-handed approach. Leopold himself oriented strictly on the external investigation of the pregnant to reduce the danger of infection. His main domain was the prevention of the puerperal fever.

Antonin Cernoch an outstanding gynaecologic surgeon, was head of the Czech institute for postgraduate medical education in the years 1960 - 1970. His important surgical work exhibited many stimulating ideas for contemporary gynaecology and obstetrics. The Cernoch's original modifications of surgical repairs of uterine cervix are presented in this article and are very important ideas for surgical practice. The original procedures repair damaged uterine cervix together with adjoining tissue as well as surgical removing advanced malignant ovarian tissue are documented in pictures. The effective treatment was used in more than 400 causes. Both, excellent surgery strategy and experience of doc. MUDr. A. Cernoch is of practical importance for gynaecologic surgeons.