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Several hundred million people are infected with genital genotypes of the human papillomavirus (HPV) annually in the world. The infections transmitted mainly through sexual routes are usually asymptomatic, but can lead to the development of cervical, vulvar, vaginal, anal, penile cancers, some head and neck cancers and genital warts (condylomas). The fraction HPV-related cancers range from nearly 100% in the case of cervical cancer to several/over a dozen percent in the case of other cancers and diseases. There are no effective drugs against HPV, but prophylactic HPV vaccines are available free of charge in immunization programmes in many countries around the world. In Poland, HPV vaccinations have so far been executed out on the pocket or in free-of-charge, local-governmental prevention programs, but the vaccination coverage of the target population does not exceed 10%. From November 2021, one of the vaccines is available with a 50% reimbursement, work is underway to reimburse the next ones, and the National Oncology Strategy assumes the implementation of the HPV immunization programmes and vaccination of 60% of the teen population by 2028. Three prophylactic HPV vaccines are registered. All of them are safe and their effectiveness in the prevention of diseases caused by vaccine genotypes reaches almost 100%, provided that full post-vaccination immunity is obtained before the contact with the virus. Girls aged 11-13 are the priority target cohort for HPV vaccination in Poland. The implementation of routine, free-of-charge HPV immunization in the Preventive Immunization Program (PIP) for all adolescents should be pursued. Persons over the age of 13 may also benefit from HPV vaccination and should be vaccinated according to product specifications. In addition to free access under the PIP, the key element for the success of the implementation of HPV vaccinations in Poland will be the education of medical personnel and parents of adolescents to be vaccinated. [ABSTRACT FROM AUTHOR]

Appendicitis (APP) and gall bladder diseases (GBD) are the most frequent non-obstetric indications for urgent surgery among pregnant women. The aim was to present the diagnosis, treatment and potential complications of APP and symptomatic GBD. We searched the literature for APP and GBD during pregnancy and presented the results in the form of a review article. APP symptoms among pregnant women are comparable to these in the general population. Typical clinical symptoms are present in 50-75% of cases. Laboratory tests are useful for a differential diagnosis. The imaging of choice is an ultrasonography scan, but magnetic resonance is of the highest accuracy The final diagnosis is difficult. When the surgery is delayed, the risk of appendix perforation increases and thus complications are more frequent. GBD symptoms and signs are comparable to those in the general population. The best imaging is an ultrasonography scan, and laboratory tests are important in a jaundice differential diagnosis. In cases with symptomatic GBD, a delay in surgery is associated with an increased risk of complications (pancreatitis, abortion, intrauterine death). The treatment method of choice for APP and symptomatic GBD is surgery both laparotomy and laparoscopy (preferred), which are considered relatively safe, though laparoscopy compared to laparotomy for APP can be associated with a higher risk of abortion. Untreated or delayed APP and symptomatic GBD treatment during pregnancy increases the risk of complications, both for the woman and the fetus. Diagnosis is difficult and should be based on a multidisciplinary approach to the patient. Surgery by laparotomy or laparoscopy is relatively safe.

This is a review of literature concerning intestinal obstruction in pregnant women. Approximately 50-90% and 30% of pregnant women, respectively suffer from nausea and vomiting, mostly during the first trimester. There is also increased risk of constipation. During the perioperative period, the administration of tocolytics should be considered only in women showing symptoms of a threatening premature delivery. Intensive hydration should be ordered to sustain uterine blood flow. The incidence of intestinal obstruction during pregnancy is estimated at 1:1500-1:66431 pregnancies and is diagnosed in II and III trimester in most cases. However, it can also occur in the I trimester (6%) or puerperium. Symptoms of intestinal obstruction in pregnancy include: abdominal pains (98%), vomiting (82%), constipation (30%). Abdominal tenderness on palpation is found in 71% and abnormal peristalsis in 55% of cases. The most common imaging examination in the diagnosis of intestinal obstruction is the abdominal X-ray. However ionizing radiation may have a harmful effect on the fetus, especially during the first trimester. X-ray is positive for intestinal obstruction in 82% of pregnant women. Ultrasonography and magnetic resonance imaging are considered safe and applicable during pregnancy. Intestinal obstruction in pregnant women is mostly caused by: adhesions (54.6%), intestinal torsion (25%), colorectal carcinoma (3.7%), hernia (1.4%), appendicitis (0.5%) and others (10%). Adhesive obstruction occurs more frequently in advanced pregnancy (6% - I trimester 28% - II trimester; 45% - III trimester 21% - puerperium). Treatment should begin with conservative procedures. Surgical treatment may be necessary in cases where the pain turns from recurrent into continuous, with tachycardia, pyrexia and a positive Blumberg sign. If symptoms of fetal anoxia are observed, a C-section should be carried out before surgical intervention. The extent of surgical intervention depends on the intraoperative evaluation. Intestinal torsion during pregnancy mostly occurs in the sigmoid colon and cecum. Small bowel torsion secondary to adhesions is diagnosed in 42% of pregnant women with intestinal obstruction. The risk of intestinal torsion is higher in the 16-20 and 32-36 weeks of pregnancy and during puerperium. Intestinal torsion results in vessel occlusion which induces more severe symptoms and makes urgent surgical intervention necessary. The overall prognosis is poor--during II and III trimester the fetal mortality rate reaches 36% and 64%, respectively while the risk of maternal death is 6%. Acute intestinal pseudoobstruction can be diagnosed during puerperium, especially following a C-section. Diagnosis is made on the basis of radiological confirmation of colon distension at the cecum as > 9cm, lack of air in the sigmoid colon and rectum, exclusion of mechanical obstruction. In most cases, the treatment is based on easing intestine gas evacuation and administering neostigmine. The authors point out the need for multi-specialty cooperation in the diagnostic-therapeutic process of pregnant women suspected with intestinal obstruction, since any delay in making a correct diagnosis increases the risk of severe complications, both for the woman and the fetus.

A case report of a woman with 90 kg ovarian tumor is presented. Paracentesis and intravenous alimentation was performed before operation. During the surgery the ovarian tumor was excised and abdominal cavity packing, followed by slow pressure decreasing, was done. Intravenous together with oral alimentation was continued after the operation. The patient was discharged on the 10th postoperative day without any complications, in a good overall condition.

Objective: The aim of this study was to analyze clinical data such as diagnosis, surgical treatment and follow-up of patients with Krukenberg tumor (KT). We also reviewed literature of the subject., Material and Methods: We retrospectively analyzes medical data of 34 patients who were operated in Gynecology Clinic of Medical University of Gdansk in years 1999-2003. The definition of KT was that of Krukenberg's., Results: The mean age of patients was 52, 23 of them were postmenopausal. Fourteen patients were diagnosed with malignant disease before surgery for ovarian tumor--11 were treated for breast cancer, 2 underwent resection of the stomach and one had rectosigmoidectomy. Before surgery a diagnosis for ovarian tumor such as ultrasonography, computer tomography and Ca125 were performed--in most cases sonography findings revealed mixed cystic and solid tumor of 320 cm in diameter; in 70% cases serum Ca125 was elevated with the highest result of 772 IU/ml. From among 20 patients who were suspected for primary ovarian cancer with no other malignant disease before surgery 9 had stomach cancer, 6 colon cancer, in 2 cases ovarian tumor was a metastasis from breast and in 1 from gall bladder; in 2 patients primary tumor was not found. The surgery performed in patients with KT was that of done for primary ovarian cancer. In 5 cased partial resection of colon was necessary. Surgical findings revealed ovarian tumor of 3-10 cm in diameter, solid and bilateral in most cases. The mean survival in our group was 4,7 months. The mean time between diagnosis of malignant disease and metastases to the ovary was 18 months. The best overall prognosis was for patients with breast cancer and the worst for cases with stomach cancer., Conclusions: There is a poor prognosis for patients with Krukenberg tumor. The diagnosis is late, in most cases during surgery for ovarian tumor. The most often site of primary malignancy was breast and stomach.

Objectives: Risk of recurrences of borderline ovarian tumors is low (7-10%) but the cases with incidence of recurrence have worse prognosis. The time between primary operation and the first diagnosis of recurrence and treatment is different., Design: The purpose of the current study was to evaluate frequency and the methods of treatment patients with recurrences of borderline ovarian tumors., Materials and Methods: The analyzing group consists of 129 patients with borderline tumors of the ovary (BTO) diagnosed and treated in Department of Gynecology between years 1978-2000., Results: In our recurrences developed in 7% of patients. The recurrences in BTO were connected with stage of BTO, types of primary operations and residual disease. Recurrences developed in 5,9% patients with stage I and in 18,1% patients with stage II/III. Similarly recurrences developed in 5,8% patients with no residual disease and in 20% patient with residual disease. A higher relapse rate was observed in patients treated conservatively but recurrences was quickly recognized and efficaciously treated. 5 years survival of patients without recurrences was 91,7% and with recurrences was 72,9%., Conclusions: 1. Risk of recurrences of BTO is low (7%) and depends on stage and residual disease. 2. Risk of recurrences is higher after primary conservative operation but long follow-up and regular gynecological examinations allows to early diagnosis and treatment of recurrences. 3. Prognosis of patients with recurrences of BTO is good. 5-years survival was 90,6% of group without and 72,9% of group with recurrences of BTO.

Authors described a serious, iatrogenic, vessel complications after hysterectomy for uterus sarcoma. After successful abdominal hysterectomy spontaneous rupture of right common iliac artery occurred causing massive exsanguination into intraperitoneal space. During secondary laparotomy procedure large, partial loss of arterial wall was recognized and provided with non-absorbable Prolene 4-0 suture. Subsequently, the injury was replaced by arterial artificial prosthesis gore-tec 8. Intraoperatively, ventricular fibrillation and cardiac arrest took place with subsequent acute respiratory and circulatory distress syndrome. Throughout next several days after reoperation patient was deep unconscious and hospitalized on Intensive Care Unit. She manifested symptoms of damaged extrapyramidal tracts. In spite of further unfavourable prognosis, after almost a month of respiratory therapy, she fully recovered without symptoms of brain damage and visual sequelae.

Objectives: The aim of the study was to assess procreation in group of patients who were treated by conservative operation for borderline tumors of the ovary., Design: The analysis included 42 patients conservatively operated for ovarian tumor of borderline malignancy in Department of Gynecology Medical University of Gdansk between 1978-2000. The incidence of pregnancy, age of patients, tumor pathology, type of conservative surgery and the course of pregnancy and labour were evaluated in this study., Results: In the analysis group were 36 (85.7%) stage IA, 2 (4.8%) stage IB, 3 (7.1%) stage IC and 1 (2.4%) stage III C patients. Unilateral adnexectomy was performed in 36 (85.7%) patients, 4 (9.5%) unilateral cystectomy, 2 (4.8%) bilateral cystectomy with omentectomy in one case. After conservative operation 10 (23.8%) patients were pregnant and delivered healthy children but 2 patients delivered twice and 1 third. Recurrence was observed in 2 patients in period of 27 and 50 months after operation. 5 years survival was 97.6%., Conclusions: Percentage of pregnancy after conservative treatment for borderline ovarian tumors was high (23,8%) and number of recurrences was low so conservative surgery allows young women to retain procreational potential without increasing risk of recurrence.

Aim: To estimate the diagnostic and prognostic value, pathological and clinical correlation of cancer antigen 125 (CA125) in ovarian cancer (OC). Retrospective analysis was done of 350 patients who were operated for OC in years 1990-2001 in Gynecology Clinic MU of Gdansk. We analyzed those before primary operation (PO) and second look laparotomy (SLL). Chi 2 and t-Student tests were used., Results: Before PO 18% OC patients had CA125 less than 35 and 43.8% more than 600 U/ml, for benign tumors it was 59.9 and 1.1 respectively (p < 0.001). 56.2% with complete remission and 43.8% with progress disease in SLL had normal values of antigen before the operation. There were 32 patients who had CA125 > 600 before SLL and all of those had progress disease. The positive and negative predictive value of CA125 before SLL were 0.94 and 0.56 respectively. Cytoreduction with no macroscopic disease was achieved in 45% of patients with CA125 < 600 U/ml before PO, and it was 19.2% for those with antigen > 600 (p = 0.001). We looked for differences of CA125 levels depending on clinical and pathological data. According to our results only histology (p = 0.02) and clinical stage (p = 0.02) influenced CA 125 levels., Conclusions: There is a good correlation between elevated levels of CA125 and state of the disease in SLL, and we consider SLL as obligatory to perform as there is a low negative predictive value of CA125. The CA125 before primary operation has prognostic significance to possibility of optimal cytoreduction.

Objectives: The objectives were to assess indications as well as outcome and morbidity of gastrointestinal surgery in patients with ovarian cancer., Methods: The study included 74 patients with primary ovarian cancer who had debulking surgery (bowel surgery) from 1987 to 2001., Results: In our group postoperative residual tumor was--R0 in 15 cases (20.3%) and < or = 2 cm (R2) in 33 patients (44.6%)., Conclusion: Gastrointestinal surgery is frequently indicated during operation in ovarian cancer. Gynecologic cancer surgeons should be trained accordingly.