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Uzel R, Rezar R, Bruno RR, Wernly S, Jung C, Delle Karth G, Datz C, Hoppichler F, Wernly B. Frailty as a predictor of mortality and readmission rate in secondary mitral regurgitation. Wien Klin Wochenschr 2023; 135:696-702. [PMID: 36633679 PMCID: PMC9836337 DOI: 10.1007/s00508-022-02138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/24/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Selection in patients with functional mitral regurgitation (MR) to identify responders to interventions is challenging. In these patients, frailty might be used as a multidimensional parameter to summarize the resilience to stressors. Our objective was to evaluate frailty as a predictor of outcome in patients with moderate to severe secondary MR. METHODS We conducted a single-center retrospective observational cohort study and included 239 patients with moderate to severe secondary MR aged 65 years or older between 2014 and 2020. Echocardiography was performed at baseline; frailty was evaluated using the clinical frailty scale (CFS). The combined primary endpoint was hospitalization for heart failure and all-cause mortality. RESULTS A total of 53% (127) of all patients were classified as CFS 4 (living with mild frailty) or higher. Frail patients had a higher risk for the combined endpoint (hazard ratio, HR 3.70, 95% confidence interval, CI 2.12-6.47; p < 0.001), 1‑year mortality (HR 5.94, 95% CI 1.76-20.08; p < 0.001) even after adjustment for EuroSCORE2. The CFS was predictive for the combined endpoint (AUC 0.69, 95% CI 0.62-0.75) and outperformed EuroSCORE2 (AUC 0.54, 95% CI 0.46-0.62; p = 0.01). In sensitivity analyses, we found that frailty was associated with adverse outcomes at least in trend in all subgroups. CONCLUSION For older, medically treated patients with moderate to severe secondary mitral regurgitation, frailty is an independent predictor for the occurrence of death and heart failure-related readmission within 1 year and outperformed the EuroSCORE2. Frailty should be assessed routinely in patients with heart failure to guide clinical decision making for mitral valve interventions or conservative treatment.
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Affiliation(s)
- Robert Uzel
- Department of Internal Medicine, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020, Salzburg, Austria.
- Department of Cardiology, Klinik Floridsdorf, Brünner Str. 68, 1210, Vienna, Austria.
| | - Richard Rezar
- Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstr. 37, 5110, Oberndorf, Austria
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Georg Delle Karth
- Department of Cardiology, Klinik Floridsdorf, Brünner Str. 68, 1210, Vienna, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstr. 37, 5110, Oberndorf, Austria
| | - Friedrich Hoppichler
- Department of Internal Medicine, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020, Salzburg, Austria
- Special Institute for Preventive Cardiology and Nutrition, SIPCAN-Initiative für ein gesundes Leben, Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstr. 37, 5110, Oberndorf, Austria
- Institute of general practice, family medicine and preventive medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
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Bruno RR, Uzel R, Spieker M, Datz C, Oehler D, Bönner F, Kelm M, Hoppichler F, Jung C, Wernly B. The impact of gender and frailty on the outcome of older patients with functional mitral regurgitation. ESC Heart Fail 2023; 10:2948-2954. [PMID: 37489061 PMCID: PMC10567657 DOI: 10.1002/ehf2.14478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
AIMS Functional mitral regurgitation (MR) is the second most common valvular heart disease worldwide and is increasing with age. The present study investigates the gender distribution and 1 year prognosis of older patients (≥65 years) with pharmacologically treated MR in a real-world population with moderate to severe functional MR. METHODS AND RESULTS This a single-centre retrospective observational cohort study and included 243 medically treated patients with moderate to severe MR from 2014 to 2020. Echocardiography was performed at baseline. The combined endpoint was hospitalization due to heart failure and all-cause death. There were more female than male patients (42% vs. 58%) without differences regarding age (81 ± 7 years in males vs. 82 ± 8 years in females, P = 0.24). Heart failure symptoms were distributed equally in both groups. Almost half of the patients evidenced a high EuroSCORE II (41%/42%). Atrial fibrillation was frequent, affecting 65% male and 64% female patients (P = 0.89). There were no differences regarding medical treatment. In both genders, two-thirds of the patients displayed MR grade II° (71% (72), and 69% (97)), and one-third showed MR grade III° (29% (30) vs. 31% (44), respectively, P = 0.76). Although males had larger left ventricular end-diastolic diameter, lower ejection fraction (39% (16) vs. 48% (14), P < 0.001), and more dilated left atria. After 1 year, genders did not differ regarding the combined primary endpoint of hospitalization due to heart failure and all-cause mortality (32% (33) for males vs. 29% (41) for females, P = 0.61). One-year mortality was low and equal in both cohorts (11% in males and 9% in females, P = 0.69). In univariate Cox regression proportion hazard model, being female was not associated with the primary endpoint (hazard ratio 0.87 (95% confidence interval 0.55 to 1.37), P = 0.54). Multivariable adjustment for EuroSCORE II and frailty did not result in a significant change regarding the impact of the female gender. CONCLUSIONS Despite better left ventricular systolic function, mortality in medically treated older female patients suffering from functional mitral regurgitation is not lower than in males. In this real-world cohort, frailty was a stronger predictor of clinical outcome than gender.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of MedicineHeinrich‐Heine‐University DuesseldorfDuesseldorfGermany
| | - Robert Uzel
- Department of Internal MedicineSaint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private UniversitySalzburgAustria
| | - Maximilian Spieker
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of MedicineHeinrich‐Heine‐University DuesseldorfDuesseldorfGermany
| | - Christian Datz
- Department of Internal MedicineTeaching Hospital of the Paracelsus Medical University Salzburg, General Hospital OberndorfOberndorfAustria
| | - Daniel Oehler
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of MedicineHeinrich‐Heine‐University DuesseldorfDuesseldorfGermany
| | - Florian Bönner
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of MedicineHeinrich‐Heine‐University DuesseldorfDuesseldorfGermany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of MedicineHeinrich‐Heine‐University DuesseldorfDuesseldorfGermany
- CARIDCardiovascular Research Institute DuesseldorfDüsseldorfGermany
| | - Friedrich Hoppichler
- Department of Internal MedicineSaint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private UniversitySalzburgAustria
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of MedicineHeinrich‐Heine‐University DuesseldorfDuesseldorfGermany
| | - Bernhard Wernly
- Department of Internal MedicineTeaching Hospital of the Paracelsus Medical University Salzburg, General Hospital OberndorfOberndorfAustria
- Institute of General Practice, Family Medicine and Preventive MedicineParacelsus Medical UniversitySalzburgAustria
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Uzel R, Bruno RR, Jung C, Lang C, Hoi H, Grünbart M, Datz C, Hoppichler F, Wernly B. Clinical Impact of ACE-I/ARB for Conservatively Treated Patients with Moderate to Severe Mitral Regurgitation: A Single Center Observational Study. J Cardiovasc Dev Dis 2023; 10:jcdd10040177. [PMID: 37103056 PMCID: PMC10142284 DOI: 10.3390/jcdd10040177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
(1) Background: Mitral regurgitation (MR) is associated with increased mortality and frequent hospital admissions. Although mitral valve intervention offers improved clinical outcomes for MR, it is not feasible in many cases. Moreover, conservative therapeutic opportunities remain limited. The aim of this study was to evaluate the impact of ACE inhibitors and angiotensin receptor blockers (ACE-I/ARB) on elderly patients with moderate-to-severe MR and mildly reduced to preserved ejection fraction. (2) Methods: In total, 176 patients were included in our hypothesis-generating, single-center observational study. Hospitalization for heart failure and all-cause death have been defined as the combined 1-year primary endpoint. (3) Results: Patients treated with ACE-I/ARB showed a lower risk for the combined endpoint of death and heart failure-related readmission (HR 0.52 95%CI 0.27-0.99; p = 0.046), even after adjustment for EUROScoreII and frailty (HR 0.52 95%CI 0.27-0.99; p = 0.049) (4) Conclusions: The use of an ACE-I/ARB in patients with moderate-to-severe MR and preserved to mildly reduced left-ventricular ejection fraction (LVEF) significantly associates with improved clinical outcome and might be indicated as a valuable therapeutic option in conservatively treated patients.
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Affiliation(s)
- Robert Uzel
- Department of Internal Medicine, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020 Salzburg, Austria
- Department of Cardiology, Klinik Floridsdorf, Brünner Straße 68, 1210 Vienna, Austria
| | - Raphael R Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Christian Lang
- Department of Pulmonology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Hannes Hoi
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020 Salzburg, Austria
| | - Martin Grünbart
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020 Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstraße 37, 5110 Oberndorf, Austria
| | - Friedrich Hoppichler
- Department of Internal Medicine, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020 Salzburg, Austria
- Special Institute for Preventive Cardiology and Nutrition, SIPCAN-Initiative für ein gesundes Leben, 5020 Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstraße 37, 5110 Oberndorf, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
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Cepický P, Cibula D, Dvorák V, Fait T, Hlavácková O, Líbalová Z, Kostál M, Nový J, Rokyta Z, Unzeitig V, Uzel R. [Recommendations for the levonorgestrel intrauterine system (LNG-IUS). 2006]. Ceska Gynekol 2007; 72:149-50. [PMID: 17639740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- P Cepický
- Gynekologicko-porodnická ambulance LEVRET s.r.o., Praha
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Cepický P, Cibula D, Dvorák K, Dvorák V, Fait T, Fanta M, Koryntová D, Kost'ál M, Líbalová Z, Rokyta Z, Uzel R. [Guideline recommendations for gestagen contraception. 2006]. Ceska Gynekol 2006; 71:421-3. [PMID: 17131931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- P Cepický
- Gynekologicko-porodnická ambulance LEVRET s.r.o, Praha
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Cepický P, Holub Z, Horejsí J, Rokyta Z, Uzel R. [Postcoital contraception]. Ceska Gynekol 2001; 66:378-80. [PMID: 11732240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- P Cepický
- Gynekologicko-porodnická ambulance LEVRET s.r.o., Praha
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Cepický P, Cibula D, Dvorák K, Dvorák V, Holub Z, Horejsí J, Kopecký P, Rokyta Z, Unzeitig V, Uzel R, Zivný J. [Recommendations for prescribing postcoital contraceptives]. Ceska Gynekol 2001; 66:381-2. [PMID: 11732241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- P Cepický
- Gynekologicko-porodnická ambulance LEVRET s.r.o., Praha
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Cepický P, Dvorák K, Holub Z, Uzel R. [Combined oral contraceptives with extremely low doses of estrogen (15 micrograms in a single tablet)]. Ceska Gynekol 2001; 66:297-9. [PMID: 11569429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- P Cepický
- Ustav pro péci o matku a dítĕ, Praha
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Cepický P, Dvorák K, Dvorák V, Fait T, Holub Z, Horejsí J, Líbalová Z, Lippert P, Rokyta Z, Skrivánek A, Srácek J, Unzeitig V, Uzel R, Zivný J. [Recommendations for prescription of intrauterine contraception]. Ceska Gynekol 2001; 66:190-2. [PMID: 11464379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- P Cepický
- Gynekologická ordinace LEVRET s.r.o., Praha
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Cepický P, Cibula D, Dvorák K, Dvorák V, Horejsí J, Kostál M, Malík V, Paseka J, Rokyta Z, Unzeitig V, Uzel R, Zeman S, Zivný J. [Recommendations for prescribing combined oral contraceptives]. Ceska Gynekol 2000; 65:279-82. [PMID: 11039237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- P Cepický
- Gynekologická ambulance LEVRET s.r.o., Praha
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Uzel R. Sex education in the Czech Republic. Med Law 1999; 18:313-314. [PMID: 10536396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- R Uzel
- Czech Family Planning Association (SPRSV), Prague
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Uzel R. [Family planning and the law]. Ceska Gynekol 1997; 62 Suppl:84-5. [PMID: 9634283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Okkan S, Atkovar G, Sahinler I, Turkan S, Uzel R. A randomised study of ornidazole as a radiosensitiser in carcinoma of the cervix: long term results. Br J Cancer Suppl 1996; 27:S282-6. [PMID: 8763898 PMCID: PMC2149986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This paper presents long-term results of a randomised study of ornidazole as a radiosensitiser in locally advanced carcinoma of the cervix. A total of 76 patients were randomised and followed-up with a median of 85 months. All patients were treated with external and intracavitary irradiation. The 10 year actuarial local control rate was 61% in patients receiving ornidazole, compared with 50% for placebo group. This difference was not statistically significant. Ten year actuarial overall and disease-free survival rates were also similar in the two treatment groups. Although, when analysed by stage, there was a significant advantage in the local control (54% vs 15%; P = 0.044) and disease-free survival rates (37% vs 8%; P = 0.047) in ornidazole group for stage IIIB cases, its implication is obscure because of the small number of patients. In this study moderate and severe complication rates were found to be 30%. These results suggest that ornidazole seems to have relatively weak sensitisation and it may show a possibility of a marginal benefit with unconventional irradiation using relatively large radiation doses. However, the results are insufficient for a real gain in the probability of local tumour control and survival.
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Affiliation(s)
- S Okkan
- Department of Radiation Oncology, Cerrahpasa Medical Faculty, University of Istanbul, Turkey
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Atkovar G, Ozşahin M, Koca S, Sahinler I, Okkan S, Uzel R. Postoperative radiotherapy in carcinoma of the cervix: treatment results and prognostic factors. Radiother Oncol 1995; 35:198-205. [PMID: 7480822 DOI: 10.1016/0167-8140(95)01570-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In order to assess the role of postoperative radiotherapy and prognostic factors, 126 patients who were treated with radiotherapy after surgery for clinical early-stage carcinoma of the cervix were reviewed. All patients received external pelvic radiotherapy and 37 patients were treated with additional vaginal cuff irradiation. The 5-year overall survival, disease-free survival and locoregional control rates were 71.1, 69.9 and 78.1%, respectively. The 5-year disease-free survival rates were 40% for grade 3 vs. 75.4% for grade 1 tumours (p = 0.05), 76.5% for pathological stage IB versus 54.1% for pathological stage IIA (p = 0.04), 36.6% for node-positive patients versus 82.5% for node-negative patients (p = 0.0017), 54% for full thickness cervical invasion versus 100% superficial cervical invasion (p = 0.01), 34.8% for positive margins versus 78.1 for negative margins (p < 0.0001). After a multivariate analysis, tumour grade (p = 0.026) and presence of positive margins (p = 0.006) were found to independently influence the outcome. Grade II and III complication rate was 5.5% in all patients. In conclusion, postoperative radiotherapy should be used in patients treated with simple hysterectomy as well as those treated with radical hysterectomy with unfavorable pathological findings.
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Affiliation(s)
- G Atkovar
- Department of Radiation Oncology, Cerrahpaşa Faculty of Medicine, Istanbul University, Türkiye
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Visser A, Uzel R, Ketting E, Bruyniks N, Oddens B. Practice, attitudes and knowledge of Czech and Slovak gynaecologists concerning contraception. Plan Parent Eur 1994; 23:19-23. [PMID: 12288984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Uzel R, Wynnyczuk V. Private fee no barrier to family planning in the Czech Republic. Plan Parent Eur 1994; 23:10-1. [PMID: 12288979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Abstract
A survey was held among 155 gynecologists of the former Czech and Slovak Federal Republic (CSFR) who visited a national gynecological congress. The sample was fairly comparable to the total group of Czech and Slovak gynecologists concerning sex, age and county. Questions were asked on personal and professional characteristics, experience with the provision of contraception, attitudes toward family planning and knowledge about contraception. Almost all gynecologists rejected abortion as a birth control method and mentioned the lack of sex education, non-use of contraception and the widespread use of traditional contraceptive methods as main reasons for the high prevalence of abortion. About 60% of the physicians thought that at least some women would rather have an abortion than use contraception. According to the physicians, special family planning services should be developed and delivered by gynecologists. Opinions on proper services for teenagers varied. Only a few physicians felt that patients should pay the full price of contraceptives. Physicians' knowledge about the pill was found to be insufficient. The physicians overestimated the knowledge of their female patients about the pill. Apart from books and journals, colleagues and pharmaceutical firms were reported as important information sources. Overall, the present survey showed that introduction of well structured pre- and postgraduate courses in family planning should be encouraged.
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Affiliation(s)
- A P Visser
- International Health Foundation, Brussels, Belgium
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Ketting E, Visser AP, Uzel R, Lehert P. Oral contraception in the former Czech and Slovak Federal Republic: attitudes and use. Adv Contracept 1993; 9:141-52. [PMID: 8237567 DOI: 10.1007/bf01990145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This paper presents and discusses data on oral contraception from a national representative survey (n = 1072) on knowledge, attitudes and practice with regard to contraceptive use in the Czech and Slovak Federal Republic (CSFR). Only 7% of the women at risk of unplanned pregnancy used the pill. The low rate of use seems to be due to the general negative image of oral contraception, reinforced by the experiences of past users and opinions expressed by relative, friends, doctors, and the media. In particular, perceived psychological disadvantages have an important bearing on the decision not to use the method, whereas perceived advantages have hardly any impact. It is likely that this negative image is closely linked with the types of oral contraceptives that have been available in the country and also with the limited choice. Second- and third-generation oral contraceptives have only very recently become available. It is recommended that balanced information on the advantages and disadvantages of oral contraception be made available to doctors and to the general public on a large scale and through a variety of channels.
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Affiliation(s)
- E Ketting
- Netherlands Institute of Social Sexological Research (NISSO), Utrecht
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Podrouzek P, Cepický P, Uzel R, Nejedlý B. [Relation between diet and certain types of diseases in nations with high living standards--hormonal and biochemical mechanisms]. Cesk Gynekol 1992; 57:234-9. [PMID: 1423713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Uzel R, Presl J. [Favorable effects of oral steroidal contraceptives]. Cas Lek Cesk 1991; 130:539-42. [PMID: 1764716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In addition to preventing pregnancy which in the wider sense of the word implies prevention of all complications of gestation, incl. extrauterine pregnancy, the use of steroid contraceptives has a favourable effect on some other diseases which are not directly associated with gestation. The authors give an account of all diseases where the use of steroid contraceptives may act as a preventive factor as regards the incidence of these disease and/or their intensity. This action is frequently omitted in the professional and lay press. The authors also draw attention to the advantages of modern steroid contraceptives with a minimal dose of oestrogens and on gestagens of the third generation.
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Affiliation(s)
- R Uzel
- Ustav pro péci o matku a dítĕ, Praha-Podoli
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Uzel R. [The position of the highest court in Czechoslovakia regarding an interesting paternity dispute]. Cesk Gynekol 1991; 56:72-3. [PMID: 2044170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R Uzel
- Ustav pro péci o matku a dítĕ Praha Podolí
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Cepický P, Bucek S, Königová R, Stroufová A, Uzel R. [FSH, LH, prolactin, estradiol and progesterone after burn injuries in premenopausal and postmenopausal women]. CESKOSLOVENSKA GYNEKOLOGIE 1990; 55:641-4. [PMID: 2093446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors examined 49 women who suffered severe burns and had to be hospitalized. Thirteen of these women were postmenopausal, 35 premenopausal and in one women, incipient pregnancy was revealed. In 14 women repeatedly FSH, LH oestradiol, progesterone and prolactin were assessed in serum by RIA. The group of premenopausal and postmenopausal women did not differ as to the levels of oestradiol, progesterone and prolactin. The gonadotropin levels in postmenopausal women were somewhat higher but the difference was significant only in FSH. The mean levels of the investigated hormones in premenopausal and postmenopausal women were: FSH 7.98 and 21.56 mIU/ml resp. oestradiol 151.88 and 183 micrograms/ml) resp. These differences cannot be explained by possible differences in the extent of burns or the time when the serum sample was taken. The authors interpret the results to the effect that the adrenals and steroid hormones produced by them resp. have a central position in the dysfunction of the pituitary-ovarian axis. These hormones influence by a backfeed mechanism the secretion of pituitary gonadotropins. This is consistent with data in the literature dealing with burns in men.
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Affiliation(s)
- P Cepický
- Ustav pro péci o matku a dítĕ, Praha-Podolí
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23
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Uzel R, Cepický P, Podrouzek P. [Aphrodisiacs in gynecology]. Cesk Gynekol 1990; 55:525-30. [PMID: 2225107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R Uzel
- Ustav pro péci o matku a dítĕ, Praha-Podolí
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24
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Uzel R, Cepický P. [Is tubal sterilization harmful to the health of women?]. Cesk Gynekol 1990; 55:385-9. [PMID: 2204490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R Uzel
- Ustav pro péci o matku a dítĕ, Praha-Podolí
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25
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Uzel R. [Do our gynecologists suffer from the "burn out" syndrome?]. Cesk Gynekol 1990; 55:391-4. [PMID: 2397515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- R Uzel
- Ustav pro péci o matku a dítĕ, Praha-Podolí
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26
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Uzel R. [Küster or Küstner?]. Cesk Gynekol 1990; 55:150-1. [PMID: 2188744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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27
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Uzel R, Grumlík R, Uhlír F. [Labor in a drunk mother--fatal risk for the neonate]. Cesk Gynekol 1990; 55:132-4. [PMID: 2344634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- R Uzel
- Ustav pro péci o matku a dítĕ, Praha-Podolí
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28
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Uzel R, Bendová M, Cepický P, Chvála V, Kot'átková I, Pecená M. [Quo usque tandem? (An attempt to end the discussion on the presence of the father during labor)]. Cesk Gynekol 1989; 54:375-8. [PMID: 2791012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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29
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Yildiz I, Ulukutlu L, Büyükünal C, Ober A, Aksoy F, Yeker D, Uzel R, Danişmend N, Okkan S, Oz F. Wilms' tumor: prognostic factors and survival. Chemioterapia 1987; 6:140-3. [PMID: 3036380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A statistical analysis of 38 cases of Wilms' tumor treated and followed by the Pediatric Oncology Group of Cerrahpaşa Medical Faculty, from 1977 to 1984, is presented. The two-year survival rate was 67% and the five-year survival rate was found to be 63%. There was a strong correlation between the stage and age of the patients and prognosis. The median age was 16 months in stages I and II of the disease and the two-year survival rate was 87%. The median age was found to be 5 years in advanced stages and the survival rate at 2 years was 43%. No correlation was found between survival and initial symptoms of the tumor or its localization. The effects of histological grade on prognosis of disease were also investigated.
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30
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Uzel R. [How can we improve health education in our profession?]. Cesk Gynekol 1987; 52:81-3. [PMID: 3581200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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31
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Okkan S, Yazici Z, Uzel R, Akçasu A, Turkan S, Hacibekiroğlu M, Olgun P, Egehan I. Use of ornidazole in fractionated radiotherapy: dose tolerance, serum and tumour tissue concentration. Radiother Oncol 1986; 5:295-301. [PMID: 3523636 DOI: 10.1016/s0167-8140(86)80178-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Sensitizing and neurotoxic effect of ornidazole, was tested in a double-blind randomized study in patients with carcinoma of the cervix and larynx. Ornidazole or placebo were given orally, two times weekly, for 3 weeks. Dose was 2.5 g/m2 for each administration. Total dose given was 15 g/m2. Radiation therapy was given 3 h after the drug administration. Ornidazole was well tolerated in the majority of the patients. No neurotoxic side effects, such as peripheral neuropathy or convulsion, were observed with a total dose of up to 30 g. Dizziness, somnolence and nausea were the prominent acute side effects, seen mostly (70%) in women. In the placebo group this rate was 17% (p less than 0.01). No important side effect was observed in men receiving ornidazole. Serum concentration of ornidazole reached the maximum level in 2-4 h after oral administration and ranged (23 patients) from 65.1 to 139.8 micrograms/ml. Mean half-life was 15.6 +/- 2.8 h. Peak concentration in tumour tissue was achieved 1-3 h after the administration, ranging from 13.0 to 78.0 micrograms/g. Tumour concentration of ornidazole ranged from 14 to 93% of the serum concentration at the time of irradiation.
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Uzel R, Závada M, Safarcík K. [Use of lisuride in the treatment of anovulatory disorders with prolactinemia]. Cesk Gynekol 1984; 49:186-90. [PMID: 6722915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
In this study the sensitizing effect of ornidazole is investigated in vivo. The selected test system is the acute killing effect of radiation within 4-6 days after abdominal irradiation ranging from 9 to 24 Gy, in groups of C57 black mice. Ornidazole is given intraperitoneally in 500 mg/kg, 100 mg/kg, 20 mg/kg doses prior to irradiation of animals breathing air, oxygen or nitrogen. A decrease of LD50 dose is observed from 24.39 +/- 5.66 to 16.38 +/- 1.86 and 18.04 +/- 2.48 Gy, respectively, in nitrogen breathing animals. No sensitizing effect was observed in doses of 20 mg/kg. Enhancement Ratio (ER) was found to be 1.48 +/- 0.25 and 1.35 +/- 0.27; relative sensitizing efficiency (RSE) was 40% and 29% respectively. No sensitizing effect was observed in animals irradiated in oxic conditions. These results showed that ornidazole (Ro-7-0207) has a sensitizing effect on hypoxic cells in vivo. It is worthwhile to try this drug in a clinical study.
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Uzel R, Srácek J. [Initial success at the semen cryobank in Ostrava]. Cesk Gynekol 1982; 47:582-4. [PMID: 7139744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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35
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Srácek J, Uzel R, Honĕk L. [Aspiration of uterine contents using the Vakutage apparatus]. Cesk Gynekol 1982; 47:367-70. [PMID: 7105211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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36
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Kraus I, Horský A, Presl J, Hrádek D, Petr J, Kümmel M, Uzel R. [Combined treatment of idiopathic dysmenorrhoea by acetylsalicylic acid and guaiphenezine (author's transl)]. Cesk Gynekol 1981; 46:601-5. [PMID: 6118209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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37
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Presl J, Uzel R, Pasek J, Horský A, Kümmel M, Kraus I, Vanata J. [Indometacin therapy for idiopathic dysmenorrhea (author's transl)]. Cesk Gynekol 1979; 44:244-8. [PMID: 376156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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38
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Honĕk L, Uzel R, Fialová L, Srácek J. [The use of a fresh-water weed Chlorella vulgaris for the treatment of the cervix after kryo-surgical interventions (author's transl)]. Cesk Gynekol 1978; 43:271-3. [PMID: 667982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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39
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Srácek J, Uzel R, Fukalová D. [Some legal problems associated with family planning (author's transl)]. Cesk Gynekol 1975; 40:715-6. [PMID: 1204025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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40
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Fukalová D, Uzel R. [The attitude of women to anticonception after arteficial interruption of gravidity (author's transl)]. Cesk Gynekol 1975; 40:680-1. [PMID: 1192525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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41
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Uzel R. [Modern treatment of anovulatory cycle in the surgery of the health community gynaecologist (author's transl)]. Cesk Gynekol 1975; 40:570-1. [PMID: 1192496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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42
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Strácek J, Uzel R. [The secondary amenorrhoea -- may be treated by regulation menstruation in our conditions (author's transl)]. Cesk Gynekol 1975; 40:510-1. [PMID: 1175232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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43
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Uzel R, Srácek J. [Acute rupture of granulocellular tumour (author's transl)]. Cesk Gynekol 1974; 39:709. [PMID: 4452089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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44
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Uzel R. [Influence of balneotherapy upon functional sexual disorders in women (author's transl)]. Cesk Gynekol 1974; 39:222-3. [PMID: 4476246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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45
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Uzel R. [Effect of balneary vaginal procedures on pH changes of the vaginal fluids]. Fysiatr Revmatol Vestn 1973; 51:40-5. [PMID: 4734557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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46
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Dohnálek J, Eysselt M, Kolárová O, Stanícek J, Uzel R. [Detoxificating function of the liver following gynecologic operations. Study on glucuronidation using o-iodine-benzoic acid (OIBS- 131 I)]. Zentralbl Gynakol 1972; 94:801-5. [PMID: 5053123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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47
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Uzel R. [Relation between application of vaginal mud tampons and the incidence of trichomoniasis]. Cesk Gynekol 1972; 37:172-4. [PMID: 5023535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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48
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Bártová D, Kolárová O, Uzel R, Spott J, Jicínská V. [Sex life during pregnancy]. Cesk Gynekol 1969; 34:560-2. [PMID: 5360754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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49
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Stanícek J, Fejt J, Uzel R. [Importance of the 3H thymidine test for the classification of precancerous conditions of the uterine cervix]. Cesk Gynekol 1969; 34:353-5. [PMID: 5800086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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50
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Cernoch B, Salanský I, Uzel R. [Changes of electric excitability in the Head zones in parturient women]. Cas Lek Cesk 1969; 108:864-6. [PMID: 5794992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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