Jan Hendl

Laparoscopic surgery in women with endometrial cancer: the learning curve

OBJECTIVE The aim of this study was to assess the effect of increasing surgeonss experience in the laparoscopic surgery of women with endometrial cancer (EC) on the surgical outcome of these patients. STUDY DESIGN Data were obtained from a prospectively collected database of 108 patients two oncolaparoscopic centers in Czech Republic who underwent laparoscopically assisted surgical staging (LASS) from April 1996 to March 2001. Patients were arranged in chronological order and divided into three groups, based on the date of their surgery. The three groups were compared in patient characteristics and surgical outcome using one-way analysis of variance (ANOVA) and Wilcoxon rank sum test. SETTING Department of Obstetrics and Gynecology, Endoscopic Training Center, Baby Friendly Hospital Kladno, Czech Republic. RESULTS The three groups were similar in patient characteristics. Operative times for laparoscopic staging with pelvic lymphadenectomy (LN) decreased significantly from mean of 156.3 min for group 1 to 142.8 min for group 3 (P < 0.05). In cases LASS with pelvic lymphadenectomy was significant increase in the number lymph nodes harvested (12.4 for group 1, 13.9 for group 2, and 15.4 for group 3, P < 0.05). In cases LASS without lymphadenectomy was not significant difference in operating time, estimated blood loss, rate of conversion to laparotomy, operative complications, and length of hospital stay among the compared groups. The number of patients who underwent para-aortic lymphadanectomy was too small (n = 22), and their distribution was asymmetrical for comparison. CONCLUSION A learning curve is demonstrated in the LASS of women with endometrial cancer. With increasing surgeons team experience, there is significant decrease in operative time for staging with pelvic lymph node dissection and increase in the number of pelvic lymph nodes removed. The para-aortic lymphadenectomy (PALN) was found to be more challenging than pelvic lymphadenectomy.

Selected metabolic parameters and the risk for uterine fibroids

To analyze the possible association between insulin resistance and dyslipidemia with uterine fibroids, using objective metabolic measurements.

Cystatin C as a Marker of Residual Renal Function during Continuous Hemodiafiltration

Background: The level of residual renal function (RRF) has an important impact on follow-up in critically ill patients with renal failure. There is currently no clear marker of RRF. Methods: Cystatin C (cysC) concentrations were measured before and during the first 48 h of CVVHDF in 33 mechanically ventilated patients suffering from renal failure. Samples were drawn both from the ports proximal and distal to the filter. Each of the two control groups consisted of 10 patients. Results: The levels of cysC were significantly higher in the group where diuresis (Vu) remained low or decreased after 48 h of treatment (n = 21, Vu median 380 (80–935) ml/24 h, cysC range 4.44–3.42 mg/l) than in the group where Vu increased to the level of 1.5 ml·kg–1·h–1 or higher after 48 h of treatment (n = 12, Vu 4,570 (4,000–5,130) ml/24 h, cysC 3.17–2.46 mg/l, p < 0.01). Creatinine clearance taken before treatment was not different between the groups. Significant correlation between cysC levels and Vu was found (r = –0.44, p < 0.0001). CysC levels were significantly higher in non-survivors than in survivors (3.54 ± 1.38 vs. 3.07 ± 1.24, p < 0.03). Conclusion: The levels of cysC are inversely related to Vu. High levels of cysC are associated with low residual diuresis, longer duration of CVVHDF and higher intensive care unit mortality in patients treated with CVVHDF.

Relationship between Natriuretic Peptides and Residual Diuresis during Continuous Hemodiafiltration

Background: The reasons for the decrease or increase of urine output following the start of continuous venovenous hemodiafiltration (CVVHDF) have not yet been explained sufficiently. The renoprotective properties of natriuretic peptides were described. Methods: The levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured in 23 mechanically ventilated patients before and during the first 48 h of CVVHDF. Samples were drawn both from the ports proximal and distal to the filter. The results were compared between the group where daily diuresis (Vu) remained low or decreased and the group where diuresis increased to the level of 1.5 ml·kg–1·h–1 or higher after 48 h of treatment. Left ventricular dysfunction (LVD) was defined as LV ejection fraction below 40%. A control group consisted of 10 patients exposed to abdominal surgery. Results: The average AVdiff (%) of ANP and BNP on filter were insignificant. Patients with increasing diuresis (n = 12) had significantly lower levels of both ANP (p < 0.001) and BNP (p < 0.005) than the patients with decreasing diuresis (n = 11). Significant correlations were revealed for ANP and Vu (p < 0.01) and for BNP and Vu (p < 0.05). The levels of both peptides were grossly elevated in comparison to controls and were predictive of survival. The differences between cardiac and non-cardiac patients were significant both for ANP and for BNP. Conclusions: The elimination of ANP and BNP by the CVVHDF is negligible. The levels of natriuretic peptides are inversely related to Vu and predict survival. ANP and BNP levels correlate with left ventricular function even during acute renal failure and CVVHDF.

Association between serve speed and court surface in tennis

ABSTRACT The aim of the study was to determine whether the serve speed differs between Grand Slam tournaments (GSTs) played on different court surfaces. The study was carried out for both men and women (n = 70–98) who participated in four of the GSTs in 2008, 2012 and 2016 (Australian Open, French Open, Wimbledon and US Open). The following serve-speed parameters were obtained from the official GST websites: the speed of the fastest serve (FS), the average speed of the first serve in a given match (S1) and the average speed of the second serve in a given match (S2). Statistical analysis was performed using a mixed linear model procedure (NCSS 2007, Keysville, UT). FS varied irregularly, but it did not differ significantly between GSTs in the three observed years. The values of S1 and S2 for both men and women were highest in WIM in all three years, and were significantly higher than the other variables measured at the other GSTs. An association between serve speed and tennis court surface was confirmed only for S1 and S2 at fast grass court surfaces at WIM in the period 2008–2016.