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Přehledový článek o aktuálních možnostech řešení klimakterických problémů v ordinaci praktického lékaře. Klimakterium je přirozené období v životě ženy, kdy dochází k útlumu produkce estrogenů a progesteronu, které nevyžaduje zdravotní péči. Klimakterické potíže zcela přirozené nejsou, pokud ovlivňují běžný život ženy, lékař by jim měl věnovat pozornost, diagnostikovat je a léčit. Pro ordinaci praktického lékaře není primárně určená hormonální léčba. Nabízí se ale celá řada doporučení a možností alternativní léčby. V mnoha případech je nezbytná ordinace antidepresiv, hlavně u pacientek, kde se objeví úzkostná porucha, poruchy spánku nebo poruchy příjmu potravy. Důležitá je úprava životosprávy, pomáhají vitaminy a přírodní produkty s obsahem fytoestrogenů, dále rehabilitace a fyzioterapie, s použitím fyzikálních metod. Nezastupitelnou roli má trpělivý rozhovor lékaře s pacientkou, projev empatie a pochopení a zájem lékaře pacientku vyslechnout. Právě změny chování, nedostatek komunikace a pochopení rodiny a okolí často zhoršují vnímání klimakterických problémů.

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Objectives: First up to date study comparing diagnostic accuracy of ultrasound (US) and magnetic resonance (MR) using standardised IDEA group nomenclature. Methods: All patients planned for surgery for deep infiltrating endometriosis (DIE) were enrolled in the study conducted by Endometriosis Centre and Gynecologic Oncology Centre in Prague. Participants underwent preoperative staging with index tests (plane US and MR) following uniformly the IDEA group evaluation form, focusing on lesions in bladder, bowel, rectovaginal septum (RVS) and uterosacral ligaments (USLs). Sonographers and radiologists were blinded to the physical examination findings and other imaging results. Intraoperative and histopathological findings were used as a reference standard, following the same IDEA protocol. The bivariate analysis was used to compare both imaging modalities with laparoscopy. Results: From 07/2016 to 2/2018, data of 49 patients were analysed, 2 were excluded due to lack of reference standard. Results are presented in table 1. Conclusions: This is the first study up to date comparing US and MR in the assessment of deep infiltrating endometriosis following the IDEA group nomenclature. Both methods showed similarly high sensitivity and specificity, with US being better in bladder and RVS DIE detection and MR being better in USLs assessment. The assessment of DIE in USLs represented the most critical task for both modalities. OC15.02: Table 1. Results DIE site Index test Sensitivity % Specificity % PPV % NPV % Accuracy % Corre lation coefficient Bladder US 89 100 100 82 98 0.93 MR 100 95 988 100 96 0.88 Recto sigmoideum US 96 74 84 94 88 0.76 MR 96 74 84 94 88 0.76 RV septum US 67 100 100 96 96 0.8 MR 83 93 63 98 92 0.68 US ligaments US 73 66 87 58 76 0.38 MR 94 60 84 82 84 0.6 Overall assessment US 84 93 88 86 89 --MR 95 87 82 96 89 -- * This presentation is eligible for the Young Investigator award (to be presented in the closing plenary). OC15.03 Pelvic vein thrombosis and associated pelvic abnormalitiesObjectives: Venous thrombosis (VT) commonly arises from the deep veins of the lower limbs. Studies have also shown that VT can originate from ''unusual sites'' such as the pelvis but there is an overall paucity of data on how to diagnose and manage pelvic vein thrombosis (PVT). The aim of this study was to identify pelvic abnormalities that may be associated with increased risk of developing PVT. Methods: This was a prospective cross-sectional study of women who were referred to our clinic over a 16-month period. All women had a pelvic ultrasound scan which included a detailed examination of the uterus, ovaries and adnexa. In addition, pelvic blood vessels were examined using B-mode and Doppler ultrasound to search for signs of PVT. We compared the prevalence of pelvic abnormalities in women diagnosed with PVT with findings in a large group of women who were attending our general gynecology outpatient clinic.Results: A total of 50 women were diagnosed with PVT during the study period. Of these, 29 women (58%) had evidence ...