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"Hand-foot" syndrome is a well-documented, dermatologic reaction after several chemotherapeutic agents with wild spectrum of symptoms. To the best of our knowledge, palmar-plantar erythrodysesthesia syndrome--presented as irreversible cytotoxic side effect induced by gemcitabine alone--has not been reported so far. We present a case of a patient with a history of peripheral sensory neuropathy who developed a painless finger necrosis caused by gemcitabine used in the second-line therapy for progressive ovary cancer.

A rare case of a 22-year old patient with obstetric urethrovaginal fistula, resulting in urinary incontinence, has been reported in the following report The emphasis is put on a number of medical and social consequences related to the formation of the fistula. Authors have presented the diagnostic difficulties. The aim of the report is to draw attention to the probable complications following prolonged labour and the necessity of appropriate treatment.

A case of actinomycosis presenting as tubo-ovarian abscess, misdiagnosed as ovarian malignancy in 54-year old woman with IUD is reported. Author presents the diagnostic problems due to uncommon location, no reliable clinical manifestation and nonspecific CT imaging findings, based on current literature. Knowledge of the characteristic features may help one consider the possibility of actinomycetic infection in the differential diagnosis, in patients with a previous history of predisposing factors and treat them appropriately.

Introduction: The established of prognostics factors in ovarian cancer patients can be used to predict the outcome of the disease, and gives possibilities to identified the group of patients who must be treated more aggressive. Some authors believe that (SPF) is prognostic factor in ovarian cancer., Aim of the Study: Evaluation of prognostic significance of S phase fraction in ovarian cancer patients determined by flow cytometric (FC) analysis., Material and Methods: Percent of S phase fraction by FC was investigated in group of 102 ovarian cancer patients from freshfrozen samples. FIGO: I--18 (17.65%), II--10 (9.8%), III--66 (64.7%), IV--8 (7.85%). Histopathologic grades (G): G1--u 30 (29.5%), (G2)--43 (42.16%), G3--26 (25.5%), Gx--2.94%). Serous tumours--66 (64.7%), endometrioid--5 (14.7%), undifferentiated--10 (9.8%), mucinous--7 (6.9%), clear cell tumours--4 (3.9%). The oldest patient was 82 and the youngest 24 mean 54 years. After primary citoreductive surgery patients was treated with intravenous chemotherapy 6 cycles. Tissue was fixed in liquid nitrogen (-195 degrees C), and after different period of time prepared according Vidlov method. SPF was measured with FACScan flow cytometr (FACS-Calibur Becton-Dickinson). In statistical analysis established confidential level was 95% (p < 0.05)., Results: We excluded 7 patients from the study. Average SPF in whole group--13.0637% (0.58-57.62), average SPF in aneuploidy group--13.536% standard deviation (SD)--10.71, in diploidy group--12.365%, SD 10.63. No differentiation between groups was found p = 0.66. We did not find, in whole group a ny influence of SPF on survival p = 0.992., Conclusion: S-phase fraction has no prognostic significance in ovarian cancer.

Aim of the Study: The prognostic significance of DNA ploidy in ovarian cancer patients determined by flow cytometric analysis, in correlation with effectiveness of first line chemotherapy., Material and Methods: DNA ploidy by FC was investigated in group of 102 ovarian cancer patients from fresh frozen samples (4 patients was excluded from the study)., Results: Positive answer for first line treatment we notified in 64(62,75%) cases, lack of answer 34 (37,25%) patients. Aneuploidy was more frequent in negative group 31(91,18%), diploid tumours occurred in 3(8.82%) cases. In positive group aneuploid tumours occurred in 29(45,31%) and diploid in 35(54,69%) patients (p<0,001). Median survival in positive group--45 months, in negative group 12 months (p<0,0001). In positive group median survival in patients with aneuploid tumours--31 months, in patients with diploid tumours median survival was not reached (p=0,0102). In negative group DNA ploidy has no impact on survival (p=0,1027), Conclusions: 1. DNA ploidy determined by flow cytometry is prognostic factor in ovarian cancer patients who answered positively for first line treatment. 2. Aneuploid tumours appear much often then diploid in group of patient who did not answer for first line chemotherapy 3. Patients with diploid tumours have better prognosis. 4. Lack of positive answer for first line treatment is bad prognostic factor.

Objectives: The objective of this study was to verify the correlation between prognostic factors, positive or negative second look laparotomy (SLL) and 5-year survival in patients with ovarian cancer., Material: Between 1984 and 1993, 178 patients after primary surgery and first-line chemotherapy with complete clinical response underwent second look laparotomy. The correlation between clinical stage and grade of cancers, residual disease, age of patients in two group of patients: with positive and negative second look laparotomy were evaluated., Results: 95 patients (53%) had positive SLL. The 5-years survival in this group was only 20%. Adverse prognostic factors were: advanced primary stage (IV-0% of 5-years survival), low grade of differentiation (9.1% of 5-years survival) and residual disease > 2cm (9.4% of 5-years survival). The 5-year survival in group with negative SLL was 78.3%. The analysed prognostic factors in this group were insignificant in predicting 5-year survival., Conclusions: This study confirms that the SLL can provide an important prognostic evaluation in patients without evidence of disease and allows surgical cytoreduction in group with positive SLL (more than 50% of patients). The analyzed prognostic factors in group with negative SLL were insignificant in predicting 5-year survival. The multicenter research for new prognostic factors in this group are required.

Objective: The purpose of this study was to present twinning rates and to compare patients with multiple pregnancy delivered at Gynaecology and Obstetrics Department of Medical University of Gdansk in 1981-1990 and 1991-2000., Material and Methods: A retrospective study of 523 twin births was performed. The analysis concerned: maternal age, place of living, education, parity, using of assisted reproductive techniques., Results: The incidence of twin pregnancy was 1.0%. The percentage of twin deliveries in 1981-1990 was 0.84% and in 1991-2000: 1.28%. The number of twin pregnancies depending on maternal age in two periods was analysed. The statistically significant differences were observed in maternal age interval 21-25 years (32.4% in 1981-1990 versus 20.8% in 1991-2000, p=0.01) and in age interval < 20 years (3.5% in 1981-1990 versus 8.8% in 1991-2000, p=0.009). There were 3.2% patients with multiple pregnancy treated due to infertility in 1981-1990 and 7.4% in 1991-2000 (p=0.04)., Conclusions: We observed the increase in twinning rates in our department. The mean age of patients with multiple pregnancy increased. We noticed the increase in number of iatrogenic multiple pregnancies.

A case of vesicouterine fistula diagnosed in 40-year old woman who underwent cesarean section 18 years earlier was presented. The clinical features, etiologic factors, diagnostic procedures and treatment modalities were discussed in relation to the case and others reported in the literature. The gift of contrast by catheter to bladder allowed to visualize the fistula.

A case of clarocellular ovarian cancer in 27-year old woman is reported. Authors present the diagnostic and management problems, their experience and the review of current literature. The place of laparoscopy in management of malignant ovarian tumors is discussed.

Objectives: From a theoretical viewpoint, intraperitoneal therapy (i.p.) in-patients with ovarian cancer, a malignancy, which remains mainly, confined to the peritoneal cavity is logical. Intraperitoneal catheters have moved to the forefront as a delivery system in cancer treatment. Authors have described complications during the placement, usage, and evacuation of Tenckhoff catheters., Material and Methods: From January 1996 to January 2003, 118 patients with recurrent or persistent ovarian cancer, after surgery and first line chemotherapy, have had catheter insertion, but only 91 have had catheter evacuation: because of: not complete therapy (21 patients). Three patients died during i.p. therapy, Four times intraperitoneal catheter has spontaneously fold out., Results: During insertion total number of complications reached (7.63%)--6 bowel incision, 1 bladder incision, 1 hernia of the linea alba, 1 incision of bowel and bladder. During catheter evacuation total number of complications was 9 (7.63%), 8 bowel incisions, 1 hernia of the linea alba. Complications connected with catheter function: only 10 patients required cessation of chemotherapy prior to its expected completion because of following reasons: 2 fistula of the catheter to vagina, 2 fistulas to bowel, in four cases intraperitoneal catheter has spontaneously fold out due to abscess (two after citostatics flow under the skin, and two without clear reason probably because of not proper fixation) one because of abscess in peritoneal cavity, and problems with citostatics inflow, one because of subileus., Conclusion: 1 Surgical complications occurring during IPC are not dangerous for patients. 2 IPC is valid and safety way of treatment ovarian cancer patients. 3 The frequency of complications occurring during insertion of Tenckhoff catheter depends on the way of placement. 4 We do not noticed connections between frequency of complications and sum of insertion made by the surgeon.

Unlabelled: Acute myocardial infarction during pregnancy is a very rare event. It occurs from 1 per 10,000 to 1 per 30,000 deliveries. Diagnosis of myocardial ischaemia is difficult because of typical complaints in pregnancy such as breathlessness and pain in chest. Its first recognisable symptom is very often loss of consciousness and cardiac death. We present the case of a 36-year-old woman with cardiac arrest in the second trimester of pregnancy. The defibrillation was applied four times with power ranging from 150 J to 200 J. Acute myocardial infarction was diagnosed on the basis of biochemical and electrocardiological examinations. Pharmacological treatment consisted of adrenalin, lidocaine, dopamine, heparin, insulin and cordarone. Uncomplicated pregnancy and delivery by caesarean section is described. A review of literature follows., Conclusion: Although myocardial infarction is a rare complication of pregnancy, it always should be taken in consideration, especially in case of multipara older than 32, suffered from hypercholesterolemia or diabetes, treated with beta-mimetics or ergot alkaloid.

Carcinoma of the Bartholin gland is rate, comprising less then 1% of female genital tract neoplasms. We present the case of 52-year-old female with Bartholin gland carcinoma, discuss the therapeutic problems and review the data from the world literature.

Objectives: From a theoretical viewpoint, intraperitoneal therapy in patients with ovarian cancer, a malignancy, which remains mainly confined to the peritoneal cavity is logical. Intraperitoneal catheters have moved to the forefront as a delivery system in cancer treatment., Design: The authors sought to evaluate effects of intraperitoneal chemotherapy (IPC) as a second line therapy for ovarian cancer patients., Material and Methods: From January 1996 to January 2002, 92 patients with recurrent or persistent cancer, after surgery, and first line chemotherapy, were treated with intraperitoneal chemotherapy as a second-line treatment. Only 74 were included in the study, due to incomplete of therapy (6 patients), spontaneous fold-out of catheter (3 patients), five patients were treated because of some other kind of carcinomas, three patients passed away during therapy because of independent reasons, and weren't be verified and a patient who had wrong pathological diagnosis in SLL., Results: The three year survival in the whole group reached 58.62% for patients who responded to the first line chemotherapy, or when the debulking surgery was completed, which was a significant improvement in survival. There was a significant improvement in survival for patients with residual tumor < 5 mm compared with the whole group, and especially with these, whose residual tumors were greater then 5 mm., Conclusions: 1. Survival was increased for patients who had a positive response to the first line intravenous chemotherapy, or had complete a debulking surgery 2. The response for IPC depends on the size of residual disease. 3. Intraperitoneal chemotherapy improves survival in ovarian cancer.

Objectives: From a theoretical viewpoint, the use of intraperitoneal therapy (i.p.) in patients with ovarian cancer (a malignancy, which remains mainly confined to the peritoneal cavity) is logical. Intraperitoneal catheters have moved to the forefront as a delivery system in cancer treatment. Authors described complications during the placement, usage, and evacuation of Tenckhoff catheters. Some of them report much too high number of surgery complications connected with i.p., Design: We report a number of complications connected with insertions, functions, and evacuations of Tenckhoffa catheter., Material and Methods: From January 1996 to January 2002, 92 patients with recurrent or persistent ovarian cancer, after surgery and first line chemotherapy, have had catheter insertion performed, but only 79 have had performed catheter evacuation: because of: not complete therapy (7 patients), three patients died during i.p. therapy, in three cases intraperitoneal catheter has spontaneously fold out., Results: During insertion total number of complications 9(9.78%), 6 bowel incision, 1 bladder incision, 1 hernia of the linea alba, 1 incision of bowel and bladder. During catheter evacuation total number of complications 9 (11.39%), 8 bowel incisions 1 hernia of the linea alba. Complications connected with catheter function: only 8 of 92 (8.70%) required cessation of chemotherapy prior to its expected completion, 2 fistula of the catheter to vagina, 2 fistulas to bowel, in two cases intraperitoneal catheter has spontaneously fold out due to abscess, one after citostatics flow under the skin, one because of abscess in peritoneal cavity, and problems with citostatics inflow one because of subileus., Conclusion: The surgical complications occurring during IPC are not dangerous for patients. IPC is valid and safe way of treatment patients with ovarian cancer. The frequency of complications occurring during insertion of Tenckhoff catheter depends on the way of placement.

Objectives: The study aimed to compare the effect of second line intravenous and intraperitoneal chemotherapy on physical and psychological aspects of quality of life in patients with advanced ovarian cancer., Materials and Methods: Quality of life was measured with EORTC QLQ-C30 (version 3.0) questionnaire. 42 sample patients with histologically confirmed diagnosis of advanced epithelial ovarian cancer treated with second line intravenous or intraperitoneal chemotherapy were included in the study., Results: Higher score of global quality of life and less side-effects of chemotherapy were observed in the group of patients treated with intraperitoneal chemotherapy. In this group constipation and dyspnoea were less common., Conclusion: Intraperitoneal chemotherapy has less negative influence on quality of life than intravenous drug delivery.

Objectives: The authors sought to evaluate how FIGO stage in cervical cancer depends on frequency of gynaecological control., Material and Methods: From March 2000 to January 2001, 74 patients with cervical cancer were treated in 2-nd Dept. of Obstetrics and Gynaecology Medical University of Gdańsk. The authors analysed frequency of gynaecological control, although patients age, number of delivery, socio-economic status, living place., Results: The median interval, from last gynaecological examination to cervical cancer diagnosis was 8.6 year (1-26), number of delivery: 0-0.5%, 1-10%, 2-21%, 3-21%, 10-1%, 67% patients lived in town and 32.4% in villages., Conclusion: Women from Gdańsk area who developed cervical cancer were not gynaecological controlled from 1 to 26 year (median--8.6). Authors noticed that FIGO stage of ovarian cancer depends seriously on interval between last gynaecological control and cervical cancer diagnosis. The old, not working, and those who live in villages in Gdańsk area have an especially low level of health education.

Design: The authors sought to evaluate risk factors of patients with ovarian cancer treated with intraperitoneal cisplatin based chemotherapy (IPC)., Material and Methods: From January 1996 to December 1998, 24 patients with recurrent or persistent ovarian cancer were treated. We divide them in two groups first beneath 65 year old (19 patients), second above 65 year (5 patients), and in three groups with residual microscopic diseases, residual below 0.5 cm, and between 0.5 and 2 cm in the time of the beginning of treatment with IPC. We also estimate stage (FIGO) as a risk factor., Results: In the first group the study showed (CRP) among 9 patients (SD) among 2 patients PD in among patients. In the second group CRP were observed among 2 patients PD among 2 patients, and SD 1 patient., Conclusion: IPC is the valuable method of second line chemotherapy for ovarian cancer. Age is not a risk factor in IPC. IPC prolongs survival in ovarian cancer patients, progression free survival, and gives only slightly adverse effects.

There are reports of rare cases of malignant schwannoma of the small bowel, ovary or urinary bladder. We report a case of malignant schwannoma found in peritoneum without any other localisation in 66-year-old woman. The first diagnosis was tumor of right ovary. Laparotomy was performed and a big, solid tumor of urinary bladder involving the small bowel was found. There were some small tumors in peritoneum and parametrium. All the tumors were removed. The histological changes of the small lesions were described as malignant schwannoma. The mass in urinary bladder and small bowel was found to be of an inflammatory origin. The cases described by other authors suggest, that the diagnosis of malignant schwannoma in pelvis minoris is very difficult. Surgery is an adequate way of final diagnosis and management.

Objectives: The aim of this study was to analyse the group of patients with borderline ovarian tumours., Design: The analysis included 114 patients, operated for ovarian tumours of borderline malignancy in the Gynaecological Department of Medical University of Gdańsk between 1978-1997. The study takes into account comparison of: age of patients, obstetrical past, clinical signs and symptoms, clinical stage (according to FIGO), type of surgery, tumour pathology, post surgical treatment. Furthermore, long-term follow up was assessed., Results: Middle age in the group was 48 years, main symptoms: pain of lower part of abdomen (47%) and ascites (26%). 92% of tumours were recognised in stage I (FIGO). 44.7% of the tumours were histological serous, 36% were mucinous. All patients were treated by surgery and 12% received additional treatment. Mean follow up was 104 months (1-247). 9.6% of the patients died because of main disease, next ten persons for reasons not connected with the main disease. 5 year survival rate was 91.2%, 10-year 84.2%., Conclusions: 1. Borderline ovarian tumours are most frequently recognised in stage I. 2. Serous and mucinous borderline ovarian are dominant. 3. Type of surgery is dependent on age of patients, obstetrical past, clinical stage and tumour pathology. 4. Prognosis in borderline ovarian tumours is excellent.

Design: The aim of the study was to describe pregnancies, deliveries, and puerperal times, and to compare them with the reached scientific communications., Material and Methods: Four pregnancies in women with the hypothyroidism were described. All cases were taken from the group of twenty pregnancies (18 women) who were treated because of thyroid gland diseases in our clinic., Results: We found that every infant was born in good condition, deliveries and childbeds were uncomplicated., Conclusions: Our notices are similar to new scientific communications, that hypothyroidism coexists with pregnancy much often then everybody, till now, suspected and infants have not so often congenital defects.

We report two cases of pregnancy in patients with multiple sclerosis. Both of women were primigravidas. In both cases pregnancy were ended by cesarean section: in first case due to obstetric indications, in second due to neurological indications. Our experience and a review of current literature are presented.

Design: The aim of our study was to describe a course of pregnancy, delivery and puerperal time in women hospitalized in our Clinic during their pregnancies because of hyperthyroidism., Materials and Methods: Sixteen case reports (thirteen pregnant women) were retrospectively analysed. Our study embrace data from the recent ten years., Results: In all cases pregnancies, deliveries and puerperal time proceeded without any serious complications. Infants were delivered in good condition and no congenital defects were reported., Conclusions: 1. A proper treatment of hyperthyroidism in a pregnant woman determines the correct course of pregnancy, delivery and puerperal time. 2. We have not found any congenital defects, hypotrophy cases and infants' death reports in our material. 3. Hyperthyroidism in pregnancy does not determine cesarean section as a way of delivery.