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The lateral support of the vaginal wall depends on the integrity of the paravaginal section of the visceral pelvic fascia, levator ani, and their connection. Various defects of the muscle and fascia can result in identical clinical findings-ie, the descent of the lateral vaginal sulcus. In this study, we created a realistic scheme for classifying paravaginal defects, based on the complex relationship of the pelvic fascia with the levator ani. Surgical observations, cadaver examinations, and a complex magnetic resonance imaging (MRI)-based 3-dimensional (3D) model were used to analyze the spatial relationships of normal and defective anatomy of the female pelvic floor. Descent of the lateral vaginal sulcus can result from a defect in the paravaginal visceral pelvic fascia, levator ani, or both. The fascial defect can be partial or complete, and the muscle defect can vary in location. A detailed illustrated classification is presented. We present a new model of the pathology that underlies a common clinical finding.

This study seeks to assess the effects of forceps-assisted delivery on the levator hiatus. Seventy-six women were investigated 12 months after forceps-assisted delivery. Introital three-/four-dimensional ultrasound measured volumes at rest and during the Valsalva maneuver. Morphological parameters analyzed were angle gamma, hiatal area, pubovisceral angle, and continuity between the muscle and pelvic sidewall. Avulsion was diagnosed by loss of continuity. Forty-eight women had avulsion injuries, 23 had bilateral, and 25 had unilateral. Bilateral avulsion increased hiatal area during straining and at rest and was associated with changes in bladder neck position at rest. Unilateral avulsion injury was associated with a higher pubovisceral angle on the side of the avulsion. Forceps-assisted vaginal delivery is associated with levator ani injury. Avulsion of the pubovisceral muscle seems more common after forceps delivery than after spontaneous vaginal delivery. Avulsion alters hiatal shape and area and influences the position and mobility of the anterior compartment.

Zusammenfassung In der vorliegenden Mitteilung erganzen Verff. die fruheren Ergebnisse ihrer Befunde der keratinophilen Pilze vom kubanischen Boden. Sie widmen eine grose Aufmerksamkeit zwei Gruppen von Isolaten, die sie auf Grund ihrer morphophysiologischen Eigenschaften als Chrysosporium indicum-ahnliche Pilze und Ch. evolceanui identifizieren. Sie unterstutzen die Auffassung, das diese Pilze von der Gattung Trichophyton in die Gattung Chrysosporium umzureihen sind. Die Befunde der beiden Arten dieser keratinophilen Pilze werden durch Angaben uber deren Okologie und geographische Verbreitung erganzt. Resumen En la presente comunicacion los autores completan los resultados de sus anteriores hallazgos de hongos queratinofilos del suelo cubano. Dedican especial atencion a dos grupos de hongos aislados, que por sus caracteristicas morfologicas son identificados como Chrysosporium evolceanui y hongos similares al Ch. indicum. Sostienen que deben excluirse estos del genero Trichophyton para incluirlos dentro del genero Chrysosporium. Se completa la informacion sobre el hallazgo de estas dos formas de hongos queratinofilos con datos referentes a su ecologia y distribucion geografica. Wir sind Herren Dr. R. Evolceanu (Central Dermato-Venerologic, Bucuresti) und Dr. H. S. Randhawa (Vallabhai Patel Chest Institute, University of Delhi) fur gefl. Gewahrung der Kulturen zum Vergleich zu einem besonderen Dank verpflichtet.

Zusammenfassung Verff. beschreiben einen suspekten Fall von ursprunglich psoriasisartiger, spater sich ekzematos verandernder lokalisierter Haut-Chromomykose. Sie begrunden die Diagnose-stellung durch das Ergebnis der mykologischen Untersuchung, und zwar durch den mikro-skopischen Befund von typischen fumagoiden Zellen in den Hautschuppen sowie durch die Isolierung des Pilzes Hormodendrum cladosporioides (Fresenius) Saccardo in der Reinkultur. Verff. unterstreichen die Notwendigkeit, der Diagnostik der Haut-Chromomykose auch in Mitteleuropa die notige Aufmerksamkeit zuzuwenden. Resumen Los autores describen un caso sospechoso de cromomicosis cutanea localizada, que al comienzo presentaba un aspecto psoriatico tomando luego un aspecto eczematoso. Funda-mentan el diagnostico con el resultado de la investigacion micologica: hallazgo micros-copico de upicas celulas fumagoides en las escamas cutaneas y el aislamiento del hongo Hormodendrum cladosporioides (Fresenius) Saccardo en cultivo puro. Los autores, subrayan la necesidad de dispensarle al diagnostico de la cromomicosis, tambien en Europa central, mayor importancia.

Zusammenfassung Die Ergebnisse von dermatologisdien Untersuchungen der Menschen, verschiedener Tiere, des Bodens in Ostbohmen in den letzten 20 Jahren sind dargelegt. Die Zusammen-setzung der identifizierten Dermatophytenflora ist diskutiert. Nach den Autoren ist jedes Gebiet im gewissen Zeitraum fur die Existenz von nur bestimmten Dermatophytenarten geeignet. Wahrscheinlich wirkt ein Komplex von verschiedenen Bedingungen auf die auf dem Gebiet anwesende, sowie auf importierte Dermatophyten im Sinne der Selektion. Erstmalig fur Mitteleuropa wurde bei Vogeln Trichophyton georgiae festgestellt.

Objective The endopelvic fascia is a confluent suspensory apparatus of the female pelvic organs. The aim of the study was to construct a three-dimensional model of the endopelvic fascia, defining its shape and its connections to the surrounding parietal structures. Methods We created a three-dimensional multiple-source computer model to simultaneously visualize and analyze all the structures within the female pelvic floor. This model integrates data from magnetic resonance imaging of 15 nulliparas under age 30 with no symptoms of pelvic floor dysfunction. The model also includes data from direct observation in the dissection laboratory and in surgical rooms, together with the relevant scientific literature. Results The endopelvic fascia has the shape of a semifrontally oriented septum, which surrounds the vagina and part of the uterine cervix and divides the pelvic floor into the anterior and posterior compartments. This confluent septum has specific connections to the pubic bone, anterior perineal membrane, perineal body, and superior fascia of the levator ani muscle. Additionally, the uterosacral part of the septum has three subdivisions- the "vascular part," the "neural part," and the true uterosacral ligament. Each of these subdivisions has a different physical link to the parietal structures. Three-dimensional illustrations and schemes were created to facilitate the understanding of the anatomy of these complex structures. Conclusion Connecting descriptions of the geometry of the organs visible by magnetic resonance imaging with descriptions of their individual connections to the endopelvic fascia gave us unique information about the three-dimensional representation of the anatomy of the female lesser pelvis. The endopelvic fascia divides the lesser pelvis in a manner that is similar to the way the urorectal septum divides the embryonic cloaca.

Objective. This study compares several parameters of sexual life and course of labor in women with planned and unplanned pregnancy.Methods. 339 primiparas participated in our study; they filled in a questionnaire concerning their sexual life during pregnancy on the second or third day after the delivery. One question also stressed planning of pregnancy. 246 women (i.e., 72.6%) indicated planned pregnancy, 93 pregnancies (i.e., 27.4%) were not planned.Results. Significant decrease of coital activity and number of orgasms and increase of sexual dysfunctions were observed in the whole study group during pregnancy. Significant differences between women with planned and unplanned pregnancy were observed only in frequency of vaginal dryness and pelvic pain.Conclusions. According to the results of this study, unplanned pregnancy has no adverse effect on parameters of the labor. The equal rate of partner's presence at delivery shows a high involvement of the partners of unmarried women.

Objective The aim of our study was to analyze whether transabdominal and introital sonography can identify paravaginal defects and to determine changes that occur following paravaginal defect repair and Burch colposuspension. Methods Twenty women with genuine stress incontinence took part in this prospective study. The mobility of the bladder neck was assessed transperineally with a curved array probe following instillation of 300 mL saline. The same probe was used transabdominally to determine the presence of paravaginal defects. Introital examination using a transvaginal probe was then performed to determine the presence of paravaginal defects. The same measurements were performed following Burch colposuspension and paravaginal defect repair. Results There were significant differences in bladder neck position and mobility before and after surgical intervention. In 18 women before surgery, transabdominal ultrasound identified unilateral or bilateral paravaginal defects. Eight unilateral defects were found on the right side but only two were found on the left side. In eight women, the defect was bilateral. The introital approach obtained similar results apart from in two patients with a bilateral defect in whom it indicated a unilateral right defect. Between the first and second weeks following the operation transabdominal ultrasound found no paravaginal defects in 16 women and introital ultrasound found no paravaginal defects in 18 women. We were unable to visualize the region of the paravaginal defect in two women using transabdominal ultrasound because the abdominal wall was edematous after surgery. Five to 6 weeks after the operation, our results were confirmed by abdominal and introital ultrasound in all cases. No paravaginal defects were found in any of the patients after paravaginal defect repair. Conclusion Our clinical study suggests that ultrasound scanning should be performed to confirm the presence of paravaginal defects and that paravaginal defect repair may be added to Burch colposuspension for the treatment of genuine stress incontinence, as an operation to correct cystourethrocele and the posterior urethrovesical angle.

The aim of this study is to determine the combination of characteristics in early breast cancer that could estimate the risk of occurrence of metastatic cells in axillary sentinel lymph node(s). If we were able to reliably predict the presence or absence of axillary sentinel involvement, we could spare a considerable proportion of patients from axillary surgery without compromising therapeutic outcomes of their disease. The study is based on retrospective analysis of medical records of 170 patients diagnosed with primary breast cancer. These women underwent primary surgery of the breast and axilla in which at least one sentinel lymph node was obtained. Logistic regression has been employed to construct a model predicting axillary sentinel lymph node involvement using preoperative and postoperative tumor characteristics. Postoperative model uses tumor features obtained from definitive histology samples. Its predictive capability expressed by receiver operating characteristic curve is good, area under curve (AUC) equals to 0.78. The comparison between preoperative and postoperative results showed the only significant differences in values of histopathological grading; we have considered grading not reliably stated before surgery. In preoperative model only the characteristics available and reliably stated at the time of diagnoses were used. The predictive capability of this model is only fair when using the data available at the time of diagnosis (AUC = 0.66). We conclude, that predictive models based on postoperative values enable to reliably estimate the likelihood of occurrence of axillary sentinel node(s) metastases. This can be used in clinical practice in case surgical procedure is divided into two steps, breast surgery first and axillary surgery thereafter. Even if preoperative values were not significantly different from postoperative ones (except for grading), the preoperative model predictive capability is lower compared to postoperative values. The reason for this worse prediction was identified in imperfect preoperative diagnostic.

An unusual case of a primary cutaneous Absidia corymbifera infection in a premature twin successfully treated with low doses of intravenous amphotericin B and topical natamycin is described. Epidemiological and therapeutical aspects of the case are discussed and in vitro antifungal susceptibility data are presented.

Introduction Pelvic ring injuries rank among the most serious skeletal injuries. According to published data, pelvic fractures constitute 3–8% of all fractures. There has been a threefold increase in the number of these fractures over the last 10 years. A significant factor determining the choice of the therapeutic procedure, timing and sequence of individual steps, and also the prognosis of the patient with a fractured pelvis, are associated injuries defined as injuries to the organs and anatomical structures found in the pelvic region. Published data describes the incidence of injury to neurogenic structures as ranging between 9 and 21%, to the urogenital tract between 5 and 11%, to the gastrointestinal tract in 3–17% and to the gynecologic organs up to 1%. The pathway of the pudendal nerve may be affected in types B and C fractures where the root fibers emerge from the foramina sacralia and plexus sacralis is formed, on the one hand, and in types A, B and C fractures during the nerve's course alongside the inferior pubic ramus. Materials and methods In order to determine the frequency of potential injury to the pudendal nerve, a set of 225 pelvic fractures treated between 2007 and 2009 was assessed; 38 fixed hemipelves were also used to study the length of the course of the pudendal nerve alongside the inferior pubic ramus, on the one hand, and the distances from the symphysis pubica at the crossing of the branches of the n. pudendus – n. dorsalis penis and the branches for the muscles of the diaphragma urogenitale on the other hand. Conclusion The work elucidated the selected distances and discuss their possible clinical relevance for evaluation of the seriousness of pelvic fractures from the perspective of late sequelae in the region innervated by the pudendal nerve.

Breast cancer characteristics obtained at the time of diagnosis are important for setting the basic strategy of the treatment. Reliability of preoperative investigation differs for various features of the disease. The aim of this study was to ascertain the agreements and differences between preoperative and postoperative values. This retrospective study analyzed the results of 617 women with primary surgery of the breast and axilla. Cohen's kappa coefficient has been employed to measure the degree of agreement between preoperative and postoperative values. Substantial or “almost perfect” agreement has been documented for the histological type of the tumors, their histopathological grade, proliferation index Ki67, as well as for estrogen, progesterone, and HER-2/neu receptors. Substantial differences exist between preoperative and postoperative diagnoses of invasiveness of the tumor, determination of the size of the tumors, and the number of tumor foci. Preoperative imaging and clinical examination of lymph nodes exhibited unacceptably high false negative rates. Heterogeneity of breast cancer cell population, methodology of histology examinations, and insufficient imaging of lymph nodes are the major limitations precluding satisfactory accuracy of preoperative diagnosis. Preoperatively diagnosed in situ carcinomas, as well as multifocal lesions, were the most often sources of diagnostic failures.

The aim of this study was to evaluate the effectiveness of and morbidity associated with the tension-free vaginal tape-secur (TVT-S) procedure in women with stress urinary incontinence (SUI). We performed a prospective trial, examining 86 women with primary SUI. Eighty-two patients had a 1-year follow-up (dropout rate = 4.6%). The preoperative evaluation included urinalysis, urodynamic studies, and validated questionnaires. The 1-year outcome evaluation also included a 1-h pad testing. At the 1-year follow-up, 43 (52.4%) women were objectively cured, and 14 (17.1%) women were objectively improved. Subjectively, 49 (59.7%) patients did not experience urine loss, and 18 (22.2%) women improved in this respect. Postoperative de novo urge incontinence symptoms developed in 24.4% (n = 20) of patients. Vaginal defect healing occurred in 6.1% (n = 5) of patients, and one (1.2%) case of urethral erosion was reported. Objective and subjective cure rates following TVT-S are inferior to other tape procedures.

A study was conducted to compare the efficacy and complications of TVT and TVT-O.This study is a prospective randomized trial involving 300 women with primary SUI; 149 received TVT, and 151 patients were treated with TVT-O. At the 1 year follow-up, 141 TVT patients and 147 TVT-O patients (dropout, 5.3% and 2.6%) were evaluated using urodynamic studies, validated questionnaires, and a 1-h pad test.The mean operating time was shorter in the TVT-O group (p0.001). Urinary retention was not significantly different (p0.05). Inner thigh discomfort was reported by 5.4% of TVT-O patients. In the TVT and the TVT-O groups, respectively, 90.1% and 88.4% women were objectively cured. The satisfaction with the surgical outcome reflects the significant decrease in the questionnaire mean symptom scores in both groups. Postoperative de novo urgency was significantly more common in the TVT-O patients (p = 0.015).The groups showed comparable objective and subjective cure rates.

Objectives To compare the clinical results of three minimally invasive hysterectomy techniques: vaginal hysterectomy (VH), laparoscopically assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH). Study design A prospective, randomized study was performed at a tertiary care center between March 2004 and October 2005. A total of 125 women indicated to undergo hysterectomy for benign uterine disease were randomly assigned to three different groups (40 VH, 44 LAVH, and 41 TLH). Outcome measures, including operating time, blood loss, rate of complications, inflammatory response, febrile morbidity, consumption of analgesics, and length of hospital stay, were assessed and compared between groups. Results Vaginal hysterectomy had the shortest operating time (66 min) and smallest drop in hemoglobin. However, there were technical problems with salpingo-oophorectomy from the vaginal approach (3/20 cases) and this group had a significantly higher rate of febrile complications (20%) compared to LAVH (2.3%) and TLH (7.3%). The increase in inflammatory markers was higher in vaginal hysterectomy patients. Laparoscopically assisted vaginal hysterectomy had an acceptable operating time (85 min), a low complication rate, lack of severe post-operative complications, and the lowest consumption of analgesics. However, it had the highest blood loss. Total laparoscopic hysterectomy had the longest operating time (111 min) and severe complications occurred only in this group. Conversions to another hysterectomy method occurred in all three groups, most of these conversions were to LAVH. Conclusions Based on our results, in women with non-malignant disease of the uterus, LAVH and VH seem to be the preferred hysterectomy techniques for general gynecological surgeons. Vaginal hysterectomy had the shortest operating time and least drop in hemoglobin, making it a suitable method for women for whom the shortest duration of surgery and anesthesia is optimal. LAVH is a versatile procedure, combining the advantages of both the vaginal and laparoscopic approach, and is preferable in cases when oophorectomy is required. Total laparoscopic hysterectomy did not appear to offer any significant benefits over the other two methods and should be strictly indicated in women where neither VH nor LAVH are feasible and should only be performed by very experienced laparoscopists.

Objectives Obstetric trauma to the puborectal muscle seems to be an important cause of pelvic floor dysfunction in women. Due to the complicated three-dimensional (3D) arrangement of the pelvic structures, two-dimensional images are not sufficient to demonstrate its relationships in a complex fashion. Thus, we aimed to create a 3D computer model to visualize the normal female pelvic floor anatomy and to compare this with the anatomy after bilateral avulsion of the puborectal muscle following delivery. Methods We created two 3D computer models of the female pelvic floor, one of a healthy nulliparous woman and the other of a woman with bilateral puborectal muscle avulsion after vaginal delivery. The data for the models were obtained from magnetic resonance imaging examinations and the following structures were depicted: pelvic bones, puborectal muscle, internal obturator muscle, urethra, urinary bladder, vagina and rectum. The models were compared. Results The models allowed us to demonstrate in three dimensions changes in the puborectal muscle after avulsion. Its relations to the bone, internal obturator muscle, perineal membrane and the deep part of the external anal sphincter were modeled and differences from the normal non-injured anatomy were demonstrated. Avulsion altered the support to the whole endopelvic fascia and destabilized both the anterior and the posterior vaginal walls. Conclusions The use of 3D technology including modeling allows for the acquisition of new knowledge and aids in the understanding of both normal and pathological pelvic anatomy. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

After intraperitoneal inoculation ofE. crescens to nine species of wild small mammals, six species of rodents (Apodemus flavicollis, A. sylvaticus, Clethrionomys glareolus, Microtus agrestis, M. arvalis, Mus musculus) developed generalized adiaspiromycosis. The course of experimental infection corresponded to the infections of laboratory animals provoked in the same manner of inoculation. The authors studied the affliction of individual organs, the dynamics of growth of adiaspores in the organs of the abdominal cavity and in the lungs and followed up morphological changes in the adiaspores. In fresh cover glass preparations, the presence of manifestations was demonstrated justifying considerations on the capacity of multiplication of the adiaspiromycosis agent in the host organism.

The authors report on adiaspiromycosis of a fox (Vulpes vulpes) caused by Emmonsia parva. Species diagnosis was made on the basis of dimensions of the fungus found in the lungs of the animal, the histopathological picture of tissue changes and the properties of the isolated culture. The identification of the fungus was also confirmed by experimental infection. The differential diagnosis of the agent of adiaspiromycosis is discussed by experimental infection. The differential diagnosed of the agent of adiaspiromycosis is discussed and attention is called to confusion of the species. E. crescens and E. parva in the past. The finding represents the first case of adiaspiromycosis due to E. parva in Europe.

The in vitro antifungal activity of Amphotericin B on a strain of Emmonsia crescens Emmons et Jellison, isolated in Czechoslovakia, has been studied. Minimal inhibitory concentration (MIC) in liquid medium was estimated and the diffusion plate technique was used. With aleuriospores as inoculum, MIC of the mycelial and adiasporic form of the fungus was 4 µg./ml.; it was 8 µg./ml. with adiaspores as inoculum. The inhibitory capacity of amphotericin B, determined by the diffusion method, was expressed by a regression equation which represents regression of the growth inhibition on antibiotic concentration.

In laboratory mice weighing about 25 g, with experimental infection of adiaspiromycosis, total inhibition of development of the parasitic phase of the agent of this mycosis is induced with Fungizone — Squibb in daily intraperitoneal administration of 0.03 mg (dissolved in 0.1 ml of isotonic saline). In autopsies carried out 10th, 20th and 30th day after an intraperitoneal inoculation of 1 ml suspension of the mycelial phase of two Czechoslovak isolates ofEmmonsia crescensEmmons &Jellison 1960, no elements of the parasitic phase — adiaspores were found in the organs of the treated mice. In control groups of the untreated mice, experimental infection developed which was demonstrated by macro- and microscopical controls of organs and by a successful recovery of the agent.

In this work the dynamics of growth and development of E. crescens adiaspores is described. The authors ascertained the budding as a form of multiplication of these elements. The differences between the growth speed of adiaspores in vitro and in vivo were established. The adiaspores germinate if the incubation temperature is lowered to 25° C and new adiaspores develop from the germ tubes after retransfer. The influence of passaging in vitro on the growth of adiaspores in cultures is evaluated in the work as well.

A 3-year study has been made of the seasonal incidence of Emmonsia crescens adiaspores in the lungs of small wild living mammals in two localities in East and South Bohemia. The definite spring peak of adiaspiromycosis has been noted and the finding supports a hypothesis of the seasonal phase alternation and circulation of E. crescens in nature.

In a collection of rodents from one locality a remarkable irregularity of monthly incidence of lung adiaspores was observed. The highest frequency of infection was ascertained in animals captured in April and May. The authors consider this phenomenon to be important for the elucidation of the life cycle ofEmmonsia crescens in nature.

Clotrimazole, econazole, ketoconazole and miconazole inhibited the growth of Emmonsia crescens and E. parva in vitro. Clotrimazole and econazole gave particularly low minimal inhibitory concentrations against the mycelial phase of the fungi, and minimal fungicidal concentrations of all four antifungals were about 2 to 4 times higher than the minimal inhibitory concentration. The adiasporic developmental phases of E. crescens and E. parva were slightly more sensitive to all the imidazole antifungals than the mycelial phases.

Studies were made of the occurrence of keratinophilic fungi in the nests of birds in Czechoslovakia. Sixty nests of 22 bird species with different nesting bionomics were investigated. A total of 11 species of keratinophilic fungi was isolated, Trichophyton terrestre and Chrysosporium keratinophilum occurring most frequently. Although the series of nests examined included many species the small numbers of nests of individual bird species did not permit more general ecological conclusions to be made.

The first identification of adiaspiromycosis (haplomycosis) in Czechoslovakia is reported. Altogether 28 of 1465 small mammals trapped in 1963 and 1964 were found to be infected (Apodemus flavicollis, A. sylvaticus, Clethrionomys glareolus, Microtus arvalis). Typical spherules were identified microscopically in formalinized lungs (chlorallactophenol) and histological sections (haematoxylin-eosin).

About 300 specimens (skin scales) obtained from human lesions which previously yielded dermatophytic fungi ( Trichophyton rubrum, T verrucosum, T mentagrophytes , and T mentagrophytes var interdigitale ) have been newly examined by cultivation. After 6 to 66 months storage in cork-stoppered glass tubes at room temperature these specimens have been recultured on Sabouraud glucose agar medium. The greatest viability has been shown by T verrucosum (growth after 20 months storage). T mentagrophytes has been reisolated after up to 15 months, T mentagrophytes var interdigitale after nine months, and T rubrum after seven months. None of these dermatophytes was able to grow after a period of storage longer than 20 months.