Search

Background Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. However, the lack of standardisation of volumetric LLL assessment hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective trial that have implications for LLL assessment standardisation. Methods In the prospective international multicentre trial SENTIX, a group of 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral sentinel lymph node biopsy was prospectively evaluated by objective LLL assessment, based on limb volume change (LVC) using circumferrential limb measurements and subjective patient-reported swelling. The assessments were conducted in six-month periods over 24 months post-surgery. Results Patient LVC substantially fluctuated in both positive and negative directions, which were comparable in frequency up to ±14% change. Thirty-eight patients experienced persistent LVC increase >10% classified as LLL, with nine months median time to onset. Some 34.2% of cases experienced onset later than one year after the surgery. Thirty-three patients (22%) experienced transient oedema characterised as LVC >10%, which resolved without intervention between two consequent follow-up visits. No significant correlation between LVC >10% and a patient-reported swelling was observed. Conclusions Given that we observed comparable fluctuations of the the lower-limb volumes after surgical treatment of cervical cancer in both positive and negative direction up to ±14%, the diagnostic threshold for LLL diagnosis based on LVC should be increased to >15% LVC. The distinction of transient oedema from persistent LLL requires repeated measurements. Also, as one-third of LLL cases are diagnosed >1-year post-surgery, a sufficient follow-up duration needs to be ensured. Patient-reported swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment. Trial registration: ClinicalTrials.gov : NCT02494063

AIMS To investigate relationships between pelvic floor muscles (PFM) and sexual function (SF) in sexually active (SA) and not-SA (NSA) women with pelvic floor disorders (PFD). METHODS In 350 women with PFD: 173 (49.4%) SA, 177 (50.6%) NSA, Pelvic Organ Prolapse (POP)-Quantification, PFM tone, and strength were evaluated. Transperineal ultrasound (TPS) measured genital hiatus (GH) diameter, bladder neck (BN) movement. Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), and Female Sexual Function Index (FSFI) were used. SA women were dichotomized according to muscle strength (weak/strong) and tone (normal/hypoactive). RESULTS FSFI scores reflected sexual dysfunction in 63.5% SA women. 32.2% partnered NSA stated PFD the reason for sexual inactivity. NSA women had higher POP stages and hypoactive PFM rates compared to SA: 72 (40.7%) vs 52 (30.1%), P = .04. TPS GH diameter did not differ between SA and NSA at rest, contraction, and did not correlate with SF. BN length was longer in SA at rest (15.0 ± 7.0 vs 13.1 ± 9.4, P = .03) and contraction (19.7 ± 7.0 vs 16.7 ± 10.2, P = .006); 30 (8.6%) subjects depressed BN during contraction. GH change at contraction correlated with Oxford Grading Scale (rps = 0.41; P

Objectives: To assess the significance of pathologic ultrastaging (PU) of sentinel (SLN) and non-sentinel (nSLN) lymph nodes (LNs) and the influence on cancer staging in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IB1 cervical cancer. Material and methods: A retrospective study was conducted with 54 patients divided into two equal-sized groups. In test group (n1), at least one SLN/patient was detected with blue dye. All excised LNs in this group were subjected to PU (4 μm slices/150 μm intervals) with hematoxylin-eosin staining and immunohistochemistry (AE1-AE3 antibodies). In none of the control group (n2) was PU performed, but in 2 patients SLN concept was performed. Patients in both groups underwent radical hysterectomy and lymphadenectomy. The effect of PU was expressed in puTNM and compared with both standard pTNM and FIGO systems. The influence of PU on patients’ disease-free survival (DFS) and overall survival (OS) was assessed using Kaplan-Meier curves. Results: In total, 516 LNs were extracted (66 SLNs, 36% bilaterally). Micrometastases (MIC) or isolated tumor cells (ITC) were detected in 34 of the 482 LNs (7.1%), including 16 MICs and 9 ITC in non-SLNs. False negative rates were: 3.7%/side-specific, and 7.4%/both sides. The use of PU resulted in stage change in 2 cases (N and M status change), FIGO stage did not changed. No PU impact on DFS or OS was observed. Conclusions: The risk of TNM stage migration in early cervical cancer is low, is more likely in inattentively evaluated patients, and has indeterminate prognostic and predictive value. Selection of cases with cT ≤ 2 cm and cN0 is sufficient to avoid the risk of improper staging.

The aim of this study was to develop a Polish language version of the short form of the Pelvic Floor Distress Inventory (PFDI-20) and to validate it in a sample of Polish-speaking women with pelvic floor disorders (PFDs). The PFDI-20 was initially translated in a stepwise fashion as guided by the International Urogynecological Association (IUGA) Translation Protocol. After initial forward translation from English to Polish, a community review process consisting of cognitive interviews and confirmation via back translation was performed. The final Polish version of the PFDI-20 was administered to Polish-speaking patients presenting with PFDs at university-based urogynecology clinics in Poland and the United States, along with a Polish version of the King’s Health Questionnaire (KHQ). Internal consistency and criterion validity were assessed. Test–retest reliability was assessed in 100 patients after 2 weeks. A total of 254 women with PFDs enrolled in this multicenter study. Complete data from 44 Polish-speaking women in the United States and 200 women in Poland were analyzed. Participants had a mean age of 60.3 ± 11.2 years and mean body mass index (BMI) 27.6 ± 4.7. Internal consistency as measured by Cronbach’s alpha was good (0.89). Criterion validity was adequate between responses on the KHQ and PFDI-20 with Pearson correlations in particular domains (0.27–0.50, P

In everyday gynecological practice, there is an unmet need to manage survivors after allogeneic hematopoietic cell transplantation (allo-HCT). The major gynecological complications include premature ovarian insufficiency (POI), chronic graft-versus-host disease (cGVHD) of the anogenital zone (cGVHDgyn), and secondary neoplasms. Aiming to assess a real-life scale of problems associated with HCT, we performed a detailed analysis of a consecutive series of females after allo-HCT who were referred for a routine gynecological evaluation. The study includes 38 females after allo-HCT in whom gynecological examination with cervical smear and USG were performed, followed by colposcopy according to NCCN guidelines. NIH scoring system was used to classify a grade of cGVHDgyn. The incidence of cGVHD was 71% whereas GVHDgyn was 29%, including 5 patients with score 3 at the time of diagnosis. The other manifestations (frequently noted) included the skin, mucosa, eyes, and liver. Menopause was diagnosed in 93% females, and in 81% of them, POI criteria were fulfilled. Ovarian function resumed in 2 cases. The rate of abnormal cytology was 26%: 4 ASCUS, 1 AGUS, 1 LSIL, 3 HSIL/ASC-H, and one cytological suspicion of cervical cancer. GVHDgyn was documented in 10 patients, and 6 of them had abnormal cervical cytology. Early topical estrogen therapy led to a significant reduction in vaginal dryness (p p p

Introduction and hypothesis To assess the impact of coital incontinence (CI) on health-related quality of life (HRQoL) and quality of sexual function (QSF) in women with urodynamic stress urinary incontinence (SUI). Methods Women were recruited for this cross-sectional study from among 289 patients with lower urinary tract symptoms, underwent clinical and urodynamic evaluation. Of these 289 women, 127 sexually active women with SUI completed the King’s Health Questionnaire (KHQ) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), of whom 97 were enrolled for the study. The study group comprised 53 women with CI occurring ‘sometimes’, ‘usually’ or ‘always’, and the control group comprised 44 women without CI. Total and individual domain scores were evaluated. Results CI was reported by 65.35 % of the women. The frequency of CI was correlated with lower educational level and higher body mass index (r = 0.22 and r = 0.23, respectively; p = 0.01). The KHQ results showed significantly lower HRQoL in women with CI in all domains (p

Cel: Nierodztwo jest jednym z najwazniejszych czynnikow ryzyka rozwoju raka blony śluzowej trzonu macicy. Wciąz trwają rozwazania, czy wielorodztwo implikuje bardziej korzystny przebieg choroby i wyzsze wspolczynniki calkowitego przezycia chorych. Celem pracy jest ocena wplywu rodności na calkowite przezycie kobiet w Polsce z rakiem blony śluzowej trzonu macicy. Material i metody: Retrospektywna analiza wplywu rodności na wspolczynniki przezycia zostala przeprowadzona u 810 kobiet leczonych operacyjnie z powodu raka blony śluzowej trzonu macicy w ośrodku referencyjnym ginekologii onkologicznej. Wyniki: Wykazano, ze wyzsza rodnośc jest związana z istotnie nizszym wspolczynnikiem calkowitego przezycia chorych (p=0.03). Rodnośc okazala sie byc niezaleznym czynnikiem przezycia chorych (HR 1.9). Wielokrotne wielorodki byly starsze w chwili zabiegu operacyjnego, stwierdzano u nich cześciej glebokie naciekanie mieśniowki macicy i cześciej naciek podścieliska szyjki macicy oraz wyzsze stopnie zaawansowania nowotworu (wylącznie w klasyfikacji FIGO z 1988 roku). Grupa wielokrotnych wielorodek charakteryzowala sie znacząco nizszym wspolczynnikiem nawrotow choroby. Kobiety te statystycznie cześciej cechowalo posiadanie nizszego wyksztalcenia, cześciej rowniez stwierdzano u nich obecnośc chorob towarzyszących w tym rowniez wystepowanie innych nowotworow zlośliwych. W grupie tej jednakze rzadziej wystepowaly nowotwor piersi i jelita grubego niz u pozostalych kobiet. Wnioski: Wielorodztwo okazuje sie byc niekorzystnym czynnikiem prognostycznym przezycia u Polek. Niekorzystne rokowanie w raku blony śluzowej trzonu macicy w tej grupie jest mniej związane z nierodztwem a zdecydowanie bardziej związane z interakcją niekorzystnych czynnikow ryzyka i negatywnych czynnikow prognostycznych, ktore tworzą sprzyjające okoliczności i środowisko dla wzrostu nowotworu.

The aim of the study was to develop a Polish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) to evaluate sexual function in patients with stress urinary incontinence (SUI) and pelvic organ prolapse (POP) versus a control group. Before the validation study, a pilot study of the Polish version of the PISQ was performed in 22 women with pelvic floor dysfunctions. The respondents completed the questionnaire at recruitment and 2 weeks later. Test–retest reliability and internal consistency were determined. The validation study was performed in 249 sexually active women (123 with urodynamic SUI and POP; 126 healthy controls). The study group reported urinary incontinence (UI) at the urogynecological ambulatory clinic, where they underwent urogynecological and urodynamic examinations. All participants completed the questionnaire. PISQ results from both groups were compared and correlated with those of the King’s Health Questionnaire (KHQ) and patient age. Test–retest reliability was good according to Pearson’s correlation coefficient (r = 0.89, p

ObjectivesSentinel lymph node biopsy (SLNB) can identify patients with nodal metastases who are eligible for tailored treatment. The aim of study was to compare the SLN detection rates using cervical and subserosal administration of 2 tracers.ResultsIn group 1 (82 patients), SLNB was performed using radiocolloid injected to the cervix and blue dye administered to the fundus. In group 2, blue dye was injected to cervix and fundus (106 patients). Only SLNB was performed in 128 (68.1%) women. In the remaining 60 (31.9%) patients, pelvic/para-aortic lymphadenectomy together with SLNB was performed. Groups 1 and 2 did not differ with regard to the frequencies of SLNB and lymphadenectomy. The detection rate for both groups was 90.9%. Bilateral detection was achieved in 72.5%. Para-aortic SLNs were found in 9.6%. Detection rates in groups 1 and 2 were 95.1% and 87.7% (P= 0.065). In comparison of cervical administration of radioisotope and subserosal injection of blue dye in group 1, we found a significant difference for total SLN detection (91.5% vs 74.4%,P< 0.05) and no significant difference for bilateral detection (73.3% vs 59.1%,P= 0.776). We did not find differences in the para-aortic SLN detection rates achieved after administration of a radiotracer and injection of a blue dye (4.9% vs 9.8%,P= 0.184). Eighteen patients (9.6%) presented with nodal disease, including 15 women with SLN involvement. The false-negative rate, calculated for patients subjected to lymphadenectomy, was 12.5% (1/8); using the SLNB surgical algorithm, it was 10% (1/10).ConclusionsCervical administration of a tracer, especially radioisotope, results in high SLN detection rates. In turn, the subserosal injection can be used only as an adjuvant method for SLNB. Low para-aortic SLN detection rates observed after cervical administration of a tracer do not seem to be a serious limitation of this technique.

OBJECTIVES Borderline ovarian tumors have favorable survival rates, however, prognostic factors are still discussed. The aim was to investigate the outcome for women treated conservatively with respect to different tumor-dependent and tumor-independent prognostic factors. MATERIAL AND METHODS 194 women treated surgically between years 1978 and 2007. Influence of conservative or radical surgical treatment on survival was evaluated. RESULTS The overall 5-year survival rate was 93.1% and 96.8% respectively for radical and conservative treatment. The mean time of survival was longer in women treated conservatively (p = 0.03), but this was an outcome of their younger age; when age was eliminated as a determining factor; the type of treatment had not influenced the length of postoperative survival (p=0.57). Conservative treatment was chosen more frequently for younger women. Factors that are detrimental to survival are age, postmenopausal detection of borderline ovarian tumors, an advanced stage of progression, a bilateral localization of tumors, the occurrence of invasive peritoneal implants and a serous rather than a mucinous histological type of borderline ovarian tumor more frequently occurred in women treated radically Borderline ovarian tumors recurred in 16.7% of women after conservative treatment and in 3.5% of women after radical treatment. Of women with preserved fertility 25.7% became pregnant at least once and 21.2% of the group as a whole delivered children at term; none of the pregnancies were fertility-assisted. CONCLUSIONS Conservative treatment does not have a deleterious effect on the prognosis of women provided that unfavorable prognostic factors are identified.

Background: Detection of micrometastases in sentinel lymph nodes (SLN) extends our knowledge of lymphatic spread in endometrial cancer, although its clinical significance has not yet been confirmed. Objectives: The aim of study was to determine the incidence of SLN micrometastases and to analyze the association between micrometastases and disease relapse. Material and methods: Fifty-four patients with endometrioid endometrial cancer underwent routine surgical therapy and sentinel lymph node biopsy (SLNB). SLNB was performed using two techniques: cervical injection of 99mTc-labelled albumin or blue dye and fundal injection of blue dye. SLNs were subjected to ultrastaging with immunohistochemistry (AE1/AE3, 150μm). Results: At least one SLN was detected in 51 patients (94.4%) and bilateral SLN detection was achieved in 80.4%. Nodal macrometastases were found in 3 patients (6.3%). SLNB enabled us to detect nodal macrometastases in 2 out of those 3 patients. In the third case, detection of SLN micrometastasis allowed to correctly determine the nodal status, thus avoiding the false negative result of SLNB. In 48 patients with detected 184 SLNs, there were 4 patients (8.3%) with micrometastases and 4 (8.3%) with ITC foci. No significant associations between the presence of risk factors (grade, myometrial invasion, cervical invasion, lymphovascular space invasion) and incidence of micrometastases and/or ITC foci in SLNs were found. Conclusions: Detection of micrometastases may result in lower false-negative rate, thus increasing SLNB safety.

Mannose-Binding Lectin (MBL) is a serum pattern recognition molecule, able to activate complement in association with MASP proteases. Serum levels of MBL and MASP-2, activities of MBL–MASP complexes, single nucleotide polymorphisms of the MBL2 and MASP2 genes and/or their specific mRNA expression in ovarian sections were investigated in 128 patients suffering from primary ovarian cancer (OC) and compared with 197 controls (C), encompassing both patients with benign ovarian tumours (n = 123) and others with no ovarian pathology (n = 74). MBL deficiency-associated genotypes were more common among OC patients than among controls. The O/O group of genotypes was associated with ovarian cancer (OR 3.5, p = 0.02). In A/A homozygotes, MBL concentrations and activities were elevated in the OC group and correlated with C-reactive protein. Moreover, high MBL serum levels were associated with more advanced disease stage. No differences in distribution of the MASP2 +359 A>G (D120G) SNP or MASP-2 serum levels were found between cancer patients and their controls. However, the highest frequency of the A/G (MASP2) and LXA/O or O/O (MBL2) genotypes was found among OC patients with tumours of G1–2 grade (well/moderately differentiated). Furthermore, MBL deficiency-associated genotypes predicted prolonged survival. None of the parameters investigated correlated with CA125 antigen or patients’ age. The local expression of MBL2 and MASP2 genes was higher in women with ovarian cancer compared with controls. It is concluded that the expression of MBL and MASP-2 is altered in ovarian cancer, possibly indicating involvement of the lectin pathway of complement activation in the disease. Electronic supplementary material The online version of this article (doi:10.1007/s00262-014-1579-y) contains supplementary material, which is available to authorized users.

The molecular background of endometrial cancer (EC) has not been fully elucidated. In the present study, we developed a quantitative PCR (qPCR) platform to examine the gene dosages of the potential molecular markers MGB1, TOP2A, ERBB1-4, MYC, CCND1, ESR1 and PI3K. The platform was applied in samples collected from 157 EC patients (stage I-IV) to verify its clinical utility and to examine the diagnostic and prognostic significance of the analysed biomarkers. The gene dosage pattern of the ERBB family and its downstream effectors PI3K and MYC showed particularly strong correlations with clinicopathological data. The ERBB PI3K/Akt pathway was upregulated in 31 (20%) of 156 cases. Activation of the ERBB PI3K/Akt pathway was positively correlated with a higher stage (p=0.001), higher grade (p=0.001), histological type II disease (p=0.0003) and metastases (p=0.02). The implemented hierarchical clustering revealed that cluster 2 was characterised by high copy numbers of the studied genes. Cluster 2 was associated with shorter overall survival (p=0.05). The platform was found to be a fast and simple method for direct analysis of the genes involved in uterine carcinogenesis, making it feasible for EC biology characterisation.

To analyze sexual behavior and the use of contraception among young women in Poland.Cross-sectional study.1,478 young women in higher (78.9%) and secondary (21.1%) education.Gdansk region in Poland.The data were gathered between September and December 2008 by the use of a questionnaire prepared for the purpose of this study, completed anonymously and in person by the young women.Sexual activity had been initiated by 67.2% of the women studied at a mean age of 18.7 years (±1.97). Assessment was made of changes in their contraceptive practice between the time of sexual initiation and later sexual activity. Since their first experience of intercourse 67.0% did not change their contraceptive methods. As many as 40.1% continued using either low effective methods or no contraception. Early sexual initiation was linked to a significantly lower likelihood of highly effective contraception, more frequent unprotected sexual intercourse and more sexual partners (p0.05). Over half of women assigned to a 'high-risk' group with regard to the chance of unintended pregnancy and sexually transmitted infection, declared that their behavior did not carry any risk, similar (p0.05) to those who did not have a history of hazardous behavior.Sexual behavior differentiates Polish women from the women in Western Europe. Despite the welcome tendency toward choosing reliable contraceptives, use of appropriate contraception is still insufficient.

Objective To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. Design Case control national study. Setting Polish Center of the European Competence Network on Mastocytosis (ECNM). Population or sample 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999-2014, before becoming pregnant. Methods Prospective analysis outcomes of pregnancies and deliveries. Main outcome measures Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Red Espanola de Mastocitosis (REMA), Spain. Results All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies). Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%). None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during pregnancy and puerperium. Conclusions There is no contraindication to pregnancy when mastocystosis-related pathologies are under appropriate medical control.

Background Urinary incontinence (UI) in women is a chronic disorder which has a negative impact on health-related quality of life. Only 45 % of the affected individuals report the problem with continence to their doctor. The aim of the study was to assess the duration of stress urinary incontinence (SUI), time from disease onset to the first medical consultation and in-depth diagnosis, as well as the need for using continence pads in various grades of SUI. Methods We conducted a cross-sectional study in women who presented at the urogynecologic ambulatory center and reported urinary incontinence. A total of 420 subjects were interviewed and underwent urogynecologic and urodynamic examinations. A group of 147 patients with urodynamic SUI was enrolled in the study. Results All women were graded according to the Stamey severity score: grade 1 – 56 (38.1 %), grade 2 – 68 (46.3 %), and grade 3 – 23 (15.6 %). Mean time elapsed between disease onset and presentation at the urogynecologic ambulatory center was 17.4 ± 11.8 years (grades 1, 2 and 3 for 11.6 ± 11.8, 14.9 ± 10.8, and 22.2 ± 12.1 years, respectively; p = 0.0002). Patients with SUI started perceiving their condition as a problem 4.7 ± 5.4 years before referral to urodynamics; 58.3 % of the SUI patients reported their problems with continence to a physician. Average time between the onset of UI symptoms and seeking medical help was 13.28 ± 12.3 years. Mean duration of using continence pads during the day was 4.2, 5.4 and 10.2 years in grades 1, 2 and 3, respectively (p = 0.0002). The number of patients using continence pads in and outside the home, as compared to outside only, was: grade 1 – 44.6 % vs. 28.6 %, grade 2 – 77.6 % vs. 13.4 %, and grade 3 – 86.4 % vs. 9.1 % (p = 0.004). Mean use of continence pads at night was 3.3, 6.1, and 9.1 years in grades 1, 2 and 3, respectively. The differences were not statistically significant. Protective continence products were used at night by 26.7 % of the SUI patients: 16.1 %, 25 % and 59.1 % in grades 1, 2 and 3, respectively (p = 0.004). Conclusions Women with SUI delay seeking medical help for over a decade. The severity of SUI is associated with duration and increased use of continence pads.

The aim the study was to compare two groups of endometrial cancer patients (below and above 45 years of age) in the aspect of clinicopathological and molecular data.The study encompassed 456 primary tumour samples retrospectively collected from a cohort of endometrial cancer patients, primarily treated by surgery Molecular analysis covered: copy number variations of 10 genes (TOP2A, ERBB1, ERBB2, ERBB3, ERBB4, MYC, CCND1, ESR1, PIK3CA, RAD21) analyzed by quantitative PCR; mRNA expression of 6 genes (SCGB2A2, RAD27, RUNX1, SNAI1, SNAI2, PROM1) analyzed with the use of reverse transcription quantitative PCR; protein expression analysis of 8 markers (PGR, ESR1; ERBB1, ERBB2, ERBB3, ERBB4, TOP2A, pAKT1) performed with the use of immunohistochemistry.The younger group of patients was characterized by less frequent hypertension (p0.00007), less frequent myometrial infiltration (p=0.002) and longer overall survival (p=0.003). Apart from RAD21 gene aberrations, which were more frequent in younger patients (p=0.02), the study revealed no statistically significant differences between the groups.The study showed no molecular differences in the profile of younger and older endometrial cancer patients. Data on both the prognostic and predictive significance of RAD21 in endometrial cancer are still insufficient. The clinical profile of younger patients with endometrial carcinoma was slightly better when compared to elderly patients. Younger patients were characterized by longer overall survival.

Background: Lymph node (LN) micrometastatic disease has come to prominence since ultrastaging was shown to improve the quality of LN procedures in epithelial cancers. The aim of the study was to evaluate the feasibility and diagnostic usefulness of detecting micrometastases in sentinel (SLN) and non-sentinel LNs (nSLN) in cervical cancer. Material and methods: Twelve consecutive patients with cervical cancer stages IA to IIA, classified according to the Union for International Cancer Control (UICC) and divided into two groups: A (7) and B (5), with and without SLN procedure with methylene blue dye, who underwent radical hysterectomy and lymph nodes removal, were recruited for the study. All LNs were evaluated in hematoxylin-eosin (HE) staining and immunohistochemically (IHC) in ultrastaging with anti-cytokeratin AE1/AE3 antibodies. A detailed analysis was performed with regard to the technical and histopathological aspects of the procedure. Results: More LNs could be extracted and studied in group A as compared to group B (210 vs. 70, mean 30 vs. 14, respectively, p

Epithelial-mesenchymal transition (EMT) and cancer stem cells (CSCs) are presumed to be key conditions for malignancy. Data concerning their role in endometrial cancer (EC) are scarce. We aimed to investigate the possible link between EMT and CSCs markers in EC samples.The study encompassed 156 primary tumour samples. Using RT-qPCR, we analyzed the expression of EMT-related genes, SNAIL and SLUG, and the CSCs marker CD133.SNAIL and SLUG correlated with each other (R=0.33; p=0.00003). All the studied genes were expressed in both normal and malignant endometrial tissue. Decreased SNAIL expression was found to correlate with post-menopausal status (p=0.002). Decreased SLUG expression was associated with shorter overall survival (p=0.01).SLUG expression could serve as a prognostic factor in EC. No correlation between the expression of EMT and CSCs markers was found, suggesting there to be no association between the EMT and CSC phenotype in endometrial cancer.

Ficolins are serum pattern recognition molecules. They have opsonic properties and are able to activate complement via the lectin pathway. This paper reports investigations concerning ficolin-2 and ficolin-3 in ovarian cancer (OC). Their serum levels, single nucleotide polymorphisms of the corresponding FCN2 and FCN3 genes and specific mRNA expression in ovarian sections were investigated in 128 patients suffering from primary OC and 197 controls operated on for reasons other than malignancies. The latter consisted of two reference groups: those with benign tumours (n = 123) and those with normal ovaries (NO) (n = 74). Serum ficolin-2 and ficolin-3 concentrations were higher among patients with malignant disease when compared with either of the reference groups. A significant correlation between ficolin-2 and ficolin-3 concentrations was found, while no correlations with CA125 antigen or CRP were observed. No differences in the frequency of single nucleotide polymorphisms at sites −64, −4 (promoter), +6359, or +6424 (exon 8) (FCN2 gene) nor in the frame-shift mutation 1637delC (FCN3 gene) were found between investigated groups. In contrast to serum concentrations, the expression of FCN2 gene (reported for the first time in ovarian sections) was significantly lower in women with OC in comparison with patients with NO but not with benign ovarian tumours. In case of FCN3 gene, its expression levels in OC group inversely correlated with serum ficolin-3 and were lower in comparison with controls. Electronic supplementary material The online version of this article (doi:10.1007/s00262-013-1445-3) contains supplementary material, which is available to authorized users.

Introduction: Venous ports provide a permanent, long-lasting and easy access to the central veins. These subcutaneously inserted systems have found application in the therapy of patients with oncological and chronic illnesses, and in treatment of children with hemophilia. During a planned continuous infusion of chemotherapy they increase patient comfort, reducing the risk of local inflammatory states and moderating the risk of spilling the cytostatic agent to the perivesical compartment. Material and methods: 83 patients with venous subcutaneous ports implanted between July 2006 and November 2011 were included into the study. The methods of implantation and usage were presented. Length of time the port is in situ and occurrence of early and late complications was evaluated. Results: The longest indwelling time for port was 1484 days, while the shortest was 70 days. In 89.9% of cases, the correct position of the port’s tip was noted during a control X-ray performed after the implantation. Early complications were not observed, while late ones concerned 16.86% of patients and included: generalized bacteriemia (8.43%), local inflammation of the skin and of the subcutaneous tissue (1.2%), venous thrombosis (2.41%), migration of the catheter (1.2%), necrosis of the skin over the port’s chamber (2.41%). Conclusion: Venous ports play an important role in the treatment of cancer patients. The placement of venous ports is a safe procedure that has a low rate of early complications. The frequency of late complications correlates with that described in the literature.

UNLABELLED The curriculum of the Medical Faculty is a result of a compromise between the need to upgrade and extend the material and the immutability of study duration. In result of reduction of time for acquisition of basic practical skills. THE AIM OF THE STUDY was to evaluate the current curriculum by students and answer the question: What are the students' expectations of teaching surgery? and to compare the opinion in two academic centers in Poland. MATERIAL AND METHODS The survey embraced 85 students of the Medical Faculty of IV (25.9%), V (22.35%) and VI (51.75%) year of the Medical University of Gdansk and VI year students of the Pomeranian University of Szczecin (PUM--34%). Students completed a 19-item questionnaire, send by e-mail. Questions were closed (yes / no or grades 1-5) with the option of opinion adding to each item. The Statistica (version 9) package for calculations was used. Differences with p

The sentinel lymph node (SLN) biopsy is a solution for decreasing the extent of surgery with a significant reduction of the incidence of complications without influencing treatment results.We performed the sentinel lymph node procedure in 24 women with vulvar cancer. In 14 cases, only the blue dye technique was applied, and in 10 cases (99m)Tc-labelled nanocolloid with blue dye was administered simultaneously. The extent of the surgery included radical vulvectomy in 23 patients and a wide local excision in 1 patient. In 15 patients unilateral inguinofemoral lymphadenectomy was performed and in 9 cases bilateral lymphadenectomy. The total number of operated groins was 39.SLNs were detected in 34/39 of operated groins (87.2%). In 4 cases (16.6%) tumour metastases to the lymph nodes were found. In total, 10 metastatic lymph nodes were detected in 9 sentinel-nodes and in 1 non-sentinel node. In three patients the nodal metastases were found only in the sentinel nodes. In one patient the metastases were found in the contralateral groin in two SLNs. There were no false negative sentinel lymph nodes. With the sole use of blue dye, SLNs were found in 79.5% of groins. The additional administration of the radiocolloid improved SLN detection to 88.9% of groins.The parallel use of the (⁹⁹m)Tc labelled radiocolloid and blue dye enables high sentinel node detection rates by adequately trained surgeons.

Gestational hypertension is a recognized risk factor for the development of complications during pregnancy. The present study retrospectively assessed the respective values of blood pressure components derived from conventional and 24-h recordings (ABPM) as predictors of premature delivery in women with gestational hypertension based on office readings from 26th week of gestation onwards. Blood pressures were measured conventionally and over 24 h. Standard medical and obstetric history, and standard laboratory work-up were taken into account. The mean (+/- standard deviation, SD) age of 123 women was 29 +/- 6 years. Current pregnancy was, on average, the second. The conventional systolic (SBP)/diastolic (DBP) blood pressure averaged 140 +/- 19/92 +/- 14 mmHg, and pulse pressure (PP) and mean arterial pressure (MBP) averaged 48 +/- 10 and 108 +/- 15 mmHg. The corresponding values derived from ABPM were 135 +/- 16/90 +/- 11, 47 +/- 9 and 105 +/- 12 mmHg. The 24-h blood pressures had better prognostic value than the conventional blood pressures. The 24-h SBP predicted risk of premature delivery and was inversely related to the duration of pregnancy and birth weight. After the exclusion of 41 women with white-coat hypertension, the highest predictive value was associated with PP. PP wider by 1SD was associated with 66% higher risk of premature delivery, and was associated with shortening of pregnancy by 2 weeks and 400 g lower birth weight, even after adjustment for SBP. In conclusion, ABPM is superior to conventional blood pressure measurements in predicting adverse outcome of pregnancy. Twenty-four-hour PP, of all classic indices, seems to be most closely related to increase of that risk.

Congenital heart malformations, detected during a pregnancy, are associated in 20-48% of cases with a chromosomal aberration. In the following study we have reported the deletion of chromosome 8 (pter--p21), diagnosed prenatally at 22 weeks of gestation, because of a visible defect in the upper part of the interventricular septum and a partial defect of the atrial septum. The atria and the ventricles were joined with a common central valve. The cordocentesis was performed and karyotype: 46, XX ish del(8)(wcp8x2) was detected. Because of the persistent bradycardia of the foetus, indicating a danger of intrauterine asphyxia of the foetus, as well as features of premature placental detachment, the caesarean section was performed at 27 weeks of gestation. The patient gave birth to a daughter weighing 960 g. The child died in the 4th hour of her life. On the basis of the present observation it is safe to say that when an AV-canal defect is diagnosed prenatally, special attention must be paid to the detection of chromosomal abnormalities and amniocentesis or cordocentesis should be performed to assess the state of affairs.

The demand for genetic amniocentesis in case of young pregnant women has significantly increased due to various new indications. Moreover, nowadays a growing number of women agedor =35, who required genetic amniocentesis, get pregnant The aim of the following study has been to compare the course of the pregnancy, the delivery and the condition of the newborn in two groups of patients: 18-34 years old andor =35 years old.783 women underwent the procedure of amniocentesis at the Department of Obstetrics of Medical University of Gdansk in 1996-2003. A group of 540 women, who answered the questionnaire about the course of the pregnancy and the delivery after the procedure, has been isolated.Fetal loss occurred in 2 cases (1.6%) in the group of the younger women and in 8 cases (0.8%) in the group ofor =35 year-olds (p=0.84). There was no statistically significant difference between younger and older patients when comparing complications after the procedure in the first three weeks following amniocentesis: spotting, bleeding, leakage of amniotic fluid. Frequency of late complications such as gestational diabetes mellitus, pregnancy induced hypertension and urinary tract infections were comparable in both age groups women. Cesarean section has been more frequently performed in case of the older women than in the group of younger patients, with statistical difference p=0.003. In most cases (33.9%) it has been an elective cesarean section, performed due to advanced maternal age rather than any obstetric cause. Frequency of pneumonia and the number of respiratory infections in the newborns have been comparable in both groups.Prenatal invasive diagnosis has no influence on frequency of complications during pregnancy and delivery in the group of women less than 35 years old and more than 35 years old.

The risk of fetal loss after amniocentesis is 0.2-1%. The aim of the study was to compare the course of pregnancy and delivery and the state of the newborn in patients after genetic amniocentesis and in the control group.783 patients who underwent amniocentesis at the Department of Obstetrics of Medical University of Gdansk in 1996-2003 and 221 women who did not undergo amniocentesis.Fetal loss occurred in 8 pregnancies (3.8%) after amniocentesis and in 12 (5.4%) p=0.37 in the control group. There was no significant statistical difference between the amniocentesis group and the control group comparing complications during pregnancy such as gestational diabetes mellitus, pregnancy induced hypertension, urinary tract infections. Cesarean section was more often performed in the amniocentesis group than in the control group, statistical difference p=0.003. Most often (28.09%) there was an elective cesarean section because of advanced maternal age without any obstetrician cause. The frequency of pneumonia, respiratory infections and congenital malformations in the first weeks of life was more frequent in the amniocetesis group.Invasive prenatal diagnosis has no influence of the frequency of complications during pregnancy and delivery.

According to recommendations, the sentinel node (SN) procedure results causes of less radical treatment and reduction of morbidity.The aim of this study was to determine the feasibility of sentinel lymph node identification using radioisotopic lymphatic mapping with technetium-99m labelled nanocolloid and blue dye injection in patients with early-stage cervical cancer.100 patients with FIGO stage from IB1 to IIA primary carcinoma undergoing radical hysterectomy with pelvic lymphadenectomy have been investigated.84% of the patients have been diagnosed with at least one-sided SN and 66% of them with two-sided SN. The sentinel detection rates, depending on the stages, were as following: 181-96.6%, IB12-66.7%, IIA-62.5%. Successful identification of SN was less likely in patients with tumors2cm (54% of SN) compared with those with tumorsor = 2cm (96% of SN). The false negative rate for the SN procedure was 3% (3/100). In all false negative SNs the primary cervical tumor was above 2cm and there was an isthmus infiltration. SN detection had 86.4% sensitivity, 100% specificity, and 95.3% negative predictive value.Sentinel node mapping method for cervical cancer patients undergoing primary surgical therapy is a feasible option. The sentinel node detection rate is relatively high and depends on FIGO stage and the tumor size. The appliance of SN into cervical cancer procedures allows us to refrain from a surgery in favor of radiochemiotherapy, seems to be the right course of action in deciding treatment and may result in fewer postoperative complications rate.

BACKGROUND The authors report on the development and validation of a cervical cancer module for the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life (QoL) questionnaire (QLQ), which was designed to assess disease-specific and treatment-specific aspects of QoL in patients with cervical cancer. METHODS The cervical cancer module (EORTC QLQ-CX24) was developed in a multicultural, multidisciplinary setting to supplement the EORTC QLQ-C30 core questionnaire. The QLQ-C30 and the cervical cancer module were administered to 346 patients with cervical cancer who underwent radical hysterectomy and received radiotherapy and chemotherapy. Psychometric analyses were performed by using data from 2 independent samples. RESULTS The QLQ-CX24 consists of 3 multiitem scales and 5 single-item scales. Multitrait scaling analyses revealed high internal consistencies for the subscales with Cronbach α coefficients ranging from .72 to .87 (Symptom Experience, .72; Body Image, .86; Sexual/Vaginal Functioning, .87). Convergent and discriminant validity were fulfilled with scaling errors below 3%. The QLQ-CX24 was capable of discriminating between clinical subgroups. All items exhibited good compliance with

The purpose of this study was to investigate the operative time, surgical complications and patient outcomes of the TOT surgery performed by an experienced surgeon compared to those performed by a senior resident under proper supervision by a senior surgeon.A prospective, open label, randomized study was conducted at the department of urogynecology of the Ministry of Health Ankara Etlik Maternity and Women's Health Teaching Research Hospital between June 2003-June 2004. The study included 60 women who had stress urinary incontinence. Patients were randomly allocated to either the TOT surgery performed by an experienced surgeon group (Group 1, n=30) or the TOT surgery performed by a senior resident under proper supervision by a senior surgeon group (Group 2, n=30). The operative time, intraoperative and postoperative complications, intraoperative blood loss and the effectivity of the TOT procedure were recorded by a senior surgeon who did not participate to the operation.The study was completed by 55 women. Baseline characteristics were comparable between the two groups. The mean operative time was significantly long in Group 2 compared with Group 1 (27 min [15-48]; 13 min [7-22], respectively). There was no difference between the Groups 1 and 2 in terms of the intraoperative and postoperative complications. No bladder injury was noted in Group 1. One bladder injury was observed in Group 2 and the bladder was repaired in the usual form by the assisting senior surgeon. Urinary retention was observed in two patients in Group 2 and the tapes were cut 7 days after the operation. Both of the patients have been dry since the intervention. The mean follow up period was 30 months. After the follow up period, there were no statistically significant differences in terms of cure, partial recovery and failure between two groups.There is no difference in the outcome when TOT is performed by residents under proper supervision.

To analyze the major complications after exenteration of gynecological and rectal malignancies.Twenty-two patients with gynecological malignancy and 6 with rectal malignancy underwent pelvic exenteration (PE) between 1996 and 2005. PE was performed for primary malignancy in 71.4% of cases (vulvar cancer in 13, cancer rectal in 5, cervical cancer in 1 and Bartholin's gland cancer in 1 cases respectively and recurrent malignancy in 28.6% of cases (cervical cancer in 5, ovarian cancer in 1, uterine sarcoma in 1 and rectal cancer in 1 cases respectively). Posterior PE, total PE and anterior PE were most often performed.Major complications in the operative field involving the urinary tract infection or the wound dehiscence occurred in 12 patients (42.9%). Early complications included massive bleeding from the sacral plexus, adult respiratory distress syndrome (ARDS), thrombophlebitis, acute renal failure, urinary bladder dysfunction, ureter damage, re-operation and pulmonary embolus. Urinary incontinence was observed in 2 women as a late complication. In 1 patient a nephrostomy was performed in 1 patient due to extensive hydronephrosis and 1 patient had complications connected with the gastrointestinal tract. The mortality rate was 7%, of which inter-operative mortality accounted for 3.5%. Major complications often occurred in advanced primary vulvar cancer affecting those with recurrent malignancies.PE is more beneficial to patients with primary vulvar and rectal cancer than to those with recurrent cancer. Knowledge of the inherent complications and morbidity of PE is essential.

In vulvar cancer, in a large portion of patients with early stages of the disease, the inguinal lymphadenectomy not only does not influence the overall survival and recurrence rate but may increase the incidence of complications. Sentinel lymph node (SN) detection is a promising technique for detecting groin lymph nodes, which may in future lead to less extensive use of surgical treatment. The aim of the study was to evaluate the feasibility of the sentinel node detection technique in patients with vulvar cancer.Between the years 2003 and 2005, we performed intraoperative lymphatic mapping on 10 patients with planoepithelial vulvar cancer. In eight cases, vulvar lesion was localized centrally, around the clitoris. The extent of the surgery included radical vulvectomy with bilateral inguinal lymphadenectomy in nine cases and unilateral inguinal lymphadenectomy in one case. For the lymphatic mapping, we employed two detection methods: (99m)Tc-labelled radiocolloid (activity 35-70 MBq) and blue dye (3-5 ml). Both techniques were used in six cases (60%), blue dye only in three cases and radiocolloid only in one case.In each patient, we detected at least one sentinel lymph node. Sentinel nodes were localized in 14 of 19 operated groins (73.7%); a total of 25 SNs in all. The mean number of SNs for one groin was 1.78. Nodal metastases were found in four cases. In three cases, metastases were detected only in the SN. In one patient, two SNs with metastases were found in one groin and in the contralateral groin (without any SN) there was one unchanged node, which transpired to be metastatic. This can be explained by a complete overgrowth of neoplasm in the lymph node resulting in lymph flow stasis and disabling tracer uptake. In five cases, an SN was found only in one groin ó the first case is described above, in the second case the vulvar tumor was localized laterally, opposite to the groin without any SN. In the remaining three cases, we have used only one method of SN detection.Lymphatic mapping in vulvar cancer based on the combined detection technique is a highly accurate method after adequate training of the surgeons.

The pelvic exenteration is a method of treatment in cases of recurrence or locally advanced gynecological tumors without distance metastases. The total pelvic exenteration has been used as salvage therapy especially for advanced gynecological malignancy.The aim of study was to analyse the group of women who underwent pelvic exenteration.A series of 13 patients who underwent pelvic exenteration for advanced vulvar cancer at the Department of Gynecology, Medical University of Gdańsk Poland between 1996-2003 was retrospectively reviewed.The more often performed exenteration in patients with vulvar cancer was posterior pelvic exenteration in 11 cases, total pelvic exenteration in 2 cases. The mean age at diagnosis was 56 years. The estimated blood transfusion due to operation ranged from 300 ml to 3580 ml with a mean of 1200 ml. The operating time ranged from 4 hours to 7 hours 30 minutes with a mean of 6 hours and 5 minutes. Patients stayed in hospital from 14 to 54 days after operation with a mean 33 days. The overall complication rate after pelvic exenteration was 61.5% with 8 of the 13 patients. Three times it was infection, six times wound dehiscence, in 1 case it was: ARDS, thrombophlebitis, ureter damage. There was no late complication.Pelvic exenteration offers the last chance for some women with gynecological malignancy.

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.

Radical hysterectomy has traditionally been the treatment of choice for early invasive cervical carcinoma. Validation of the sentinel lymph node concept in gynaecology has led to less radical surgery. If preservation of fertility is an issue, then radical trachelectomy is an accepted approach.A 29-year-old female presented with stage IB1 cervical cancer was treated by radical vaginal trachelectomy and pelvic lymphadenectomy as definitive treatment. Two obturator nodes visualised on lymphoscintigraphy and one parametrial not visualized on lymphoscintigraphy were "hot" and blue during surgery, and identified as sentinel nodes. All 18 nodes were non-metastatic.Preoperative lymphoscintigraphy is a useful tool in the preoperative localisation of sentinel lymph nodes, and should be undertaken in cases of early invasive cervical carcinoma where a radical trachelectomy is performed to preserve fertility.

Sexual life after supracervical or total hysterectomy is still controversial.The aim of study was to compare the impact of hysterectomy on frequency and quality of a woman's sexual life in women after supracervical vs total hysterectomy with nonmalignant conditions.A total of 539 women after total hysterectomy performed in Department of Gynecology in Gdansk and 65 women after supracervical hysterectomy operated in the hospital in Kartuzy in 1990-2000 were interviewed about symptoms as well as advantages and disadvantages after hysterectomy.There was no statistical difference between those groups comparing: sexual desire, dyspareunia, frequency of sexual relation, orgasm, vaginal dryness after operation.Total hysterectomy is recommended in benign conditions of uterine because of risk of cancer in the cervical stump after supracervical hysterectomy.

During pregnancy increased incidence of maternal cardiac arrhythmias is observed. We reported a 31 year old primipara after two incidents of cardiac arrest due to ventricular fibrillation during pregnancy at 10th and 16th week of gestation. The implantable cardioverter defibrillator was implanted at the 19th week of gestation. There was no complication after ICD implantation. A healthy child was born by cesarean section at 38th week of gestation.

The evaluation of sexual life after hysterectomy is still controversial.The aim of the study was to analyse the impact of hysterectomy on frequency and quality of the woman's sexual life.The total of 539 women operated in II Department of Obstetrics and Gynecology in 1990-2000 were interviewed about symptoms as well as advantages and disadvantages after abdominal hysterectomy.Sexual desire after operation decreased. The rate of dyspareunia dropped. Frequency of sexual intercourse and orgasm decreased non-significantly. The percentage of women non reporting vaginal dryness decreased significantly from 18.5% to 37.3% after hysterectomy.Sexual activity overall improved after hysterectomy.

In a pregnancy complicated with hypertension, blood flow analysis in the artery allows us to foresee threat to the fetus. Abnormal blood flow in umbilical artery makes it possible to discover vascular changes in the placenta which can endanger the life of the fetus. DESIGN IN THIS STUDY: I tried to find possible correlations between quality indices of blood flow in the foetal umbilical artery evaluated in Doppler USG in pregnancies complicated with hypertension and parameters of low molecular exchange.53 pregnancies complicated with hypertension were selected for evaluation. On basis of the result of umbilical artery flow, patients were divided into two groups: first group of 35 patients with normal values of foeto-placental flow, the second--18 patients with abnormal results of foeto-placental flow out of whom 2 were diagnosed with absence of end-diastolic blood flow. The number of epithelial plates, the number of epithelial plates in 1 mm2 and number of vessels in terminal villi were counted. The area, perimeter and diameters of terminal villi, length, thickness and area of thin epithelial plate, area of the blood vessel were estimated.The morphometric analysis indicates that the quality of the foeto-placental blood flow in pregnant women with hypertension results in parameters of the filtration area in terminal villi. In cases of complicated foeto-placental blood flow, thicker blood-placental barrier i.e. epithelial plate was found.The results of our study indicate that the quality of feto-placental flow in pregnant women with hypertension results in parameters of the filtration area in terminal villi. In cases of complicated feto-placental blood flow a thicker blood-placental barrier i.e. epithelial plate was found.

About 10% women have hypertension in pregnancy. It is a serious threat to their health. It is considered one of the most important reasons for perinatal mortality foetuses and newborns.The study deals with morphometric analysis of the blood-placental barrier in pregnant women with hypertension.The study group consisted of 105 pregnant women who gave birth in the Institute of Gynaecology and Obstetrics of Medical University of Gdańsk in 1995-1999. Patients were divided into two groups: first group (control) of 52 patients with uncomplicated pregnancies, the second -53 patients with pregnancies complicated with hypertension. The number of epithelial plates in 1 mm2 and the number of vessels in terminal villi were counted. The area, perimeter and diameters of terminal villi, length, thickness and area of thin epithelial plate, area of the blood vessel were estimated.There was observed difference in the essential parameters for low-molecular metabolic exchange in placenta. The epithelial plate in pregnancy complicated with hypertension was thicker and shorter in relation to villi's circumference and its number in 1 villi and in 1 mm2 smaller. It decreases the exchange surface in plate in 40% in relation to the control group.It is important that terminal villi reveal morphometric features of placenta on earlier stages (of pregnancy), i.e. a lower number of epithelial plates in terminal villi, a lower number of plates in 1 mm2 and the presence of short and thicker plates on the outer edges of villi.

Intestinal operations in advanced ovarian carcinoma due to intestinal obstruction are still controversial.The aim of study was to analyse the efficacy of intestinal operation and making anus praeter in the patient with advanced ovarian carcinoma.A total of 497 patient with ovarian carcinoma were operated in II Department of Obstetrics and Gynecology in 1990-2001. 66 patients with advanced ovarian cancer were analysed with a view to interventions for intestinal obstruction and making the anus praeter.In the group of 497 patients with ovarian carcinoma there were a operations of making anus praeter in 66 cases (13.28%). It was performed during first operation in 40.9%, during SLO in 22.72%, TLO in 16.67% and following operations in 19.70%. In 5 cases (7.58%) there was a liquidatio of anus praeter after an average 8.8 months after intestinal operation.Surgical intervention can be of value in removing life-threatening intestinal obstruction and to achieving longer survival with a possibility of receiving a further antineoplastic therapy.

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

The report of case in which bleeding from the anterior abdominal wall vessels occurred after the trocar insertion through the umbilicus. Directly after trocar removing there was insignificant bleeding from the trocar incision. Despite initial hemostasis with a suture ligation a postoperative blood loss and peritonitis syndrome necessitated transfusion and diagnostic laparoscopy. No vessel injury was localised during the subsequent laparoscopy. The bleeding originated from the trocar incision--a small artery was injured. The hemostasis suture was fastened. The reported case is a unique example of a laparoscopic complication. The umbilicus seemed to be a very safe localisation for the first trocar insertion--there are no reports of appearance of abdominal vessels within the umbilicus. Besides the suture ligation usually ensures an effective hemostasis--the diagnostic laparoscopy or laparotomy is are performed in exceptional situations.

The aim of our study was to established possible a correlation between Holter blood pressure measurements and BP levels measured incidentally by the medical personnel. We also tried to evaluate usefulness of ABPM in monitoring intensification of the hypertension.The research was performed on 57 pregnant women where pregnancies were complicated by hypertension (PIH or chronic hypertension). All patients were divided into four groups conforming with JNC VI protocol according to BP level measured in the time of the admission to hospital. Therefore circadian blood pressure profile was done by using ABPM SpaceLab device. After that BP load indicator was estimated in each group to assess intensification of the disease. However, we compared those results between groups by using t-Student test (p0.05).We qualified 22 patients to group 0 with SBP = 129,45 + 6.31 mmHg and DBP = 80.59 + 5.45 mmHg in the time of admission. There were 21 pregnant women with mild hypertension (group I SBP = 144,14 + 7.32 mmHg, DBP = 93.14 + 4.52 mmHg), moderate (group II, N = 8 with SBP = 153,88 + 5.54 mmHg and DBP = 101,34 + 3.78 mmHg) and severe hypertension (group III, N = 6 with SBP = 175,83 + 33.23 mmHg, DBP = 121 + 11.92 mmHg). BP load value measured in group 0 was 14.57 + 21.3% of SBP and 13.92 + 22.99% of DBP inappropriate results. In group I was found SBP 24.91 + 30.3%, DBP 23.12 + 26.01%, group II SBP 38.11 + 33.66%, DBP 26.31 + 22.75% and in group III SBP 59.3 + 38.76% and DBP 61.37 + 35.72%, respectively.Only between the group with normal blood pressure and the group with severe hypertension the obtained results were statistically significant (p0.05). We've also found a statistical correlation between BP values measured in the time of admission to the hospital and BP load indices in each group.