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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.

Intratumor heterogeneity implies heterogeneous protein function, facilitating tumor adaptation which results in therapeutic failure. We hypothesized that tumor heterogeneity at protein level may influence the course of the disease. As a single biopsy might not represent the full biologic complexity of the tumor, we have analyzed immunohistochemically four different cores obtained from each primary tumor within the cohort of 364 patients with endometrial cancer (EC). The following proteins were examined: estrogen receptor 1 (ESR1), progesterone receptor, epidermal growth factor receptor, v-erb-b2 erythroblastic leukemia viral oncogene homolog 2, receptor tyrosine-protein kinase erbB-3, v-erb-b2 avian erythroblastic leukemia viral oncogene homolog 4, phosphatidylinositol-4,5-bisphosphate 3-kinase, phosphorylated v-akt murine thymoma viral oncogene homolog 1, v-myc avian myelocytomatosis viral oncogene homolog, DNA topoisomerase II alpha 170 kDa (TOP2A), cyclin-dependent kinase inhibitor 2A (CDKN2A), tumor protein p53, RAD21 homolog, S. pombe, and runt-related transcription factor 1. Particularly strong correlation was found between TOP2A and CDKN2A heterogeneity and higher stage of the disease (P = .0002 and P = .0003, respectively). Most correlations with clinicopathologic data were observed for ESR1 heterogeneity that correlated with non-endometrioid carcinomas (P=.02), higher stage (P=.005), grade (P=.01), and the presence of metastases (P = .01). Thirty-nine (11.0%) patients were classified as “globally heterogeneous”. Cumulative tumor heterogeneity strongly correlated with the presence of metastases, higher stage, and higher grade of the disease (all P b .05). It also carried negative prognostic value (P=.0008). We show that the degree of heterogeneity in EC might serve as a clinically valid molecular marker.

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 aim of this cross-sectional study was to determine the cutoff scores for sexual dysfunction in disease-specific Pelvic Organ Prolapse/Incontinence Sexual Questionnaire&mdash, IUGA Revised (PISQ-IR) for women with pelvic floor disorders (PFD). Medical history and urogynecological data of 521 women with PFD were collected. The subjects provided information about their sexual activity and completed Female Sexual Function Index (FSFI) and PISQ-IR questionnaires. Sexually active (SA) women were further analyzed and categorized using their FSFI scores: &lt, 26.55&mdash, sexual dysfunction, &gt, no sexual dysfunction. Receiver operating characteristics (ROC) curve tested how well PISQ-IR allowed to discriminate between patients with and without sexual disorders. Area under curve (AUC) was calculated to measure the PISQ-IR Summary Score efficiency in the prediction. The cutoff values which minimalize (1-specifity) and maximize sensitivity were selected. In the analyzed cohort, 250 (48%) women were SA and a total of 226 SA were recruited for the study: 143 (63.3%) with &lt, 26.55 FSFI and 83 (36.7%) with &gt, 26.55 FSFI (response rate: 90.4%). Using ROC curve analysis, PISQ-IR Summary Score of 2.68 was determined to be the optimal cutoff for distinguishing between dysfunctional and nondysfunctional women (AUC = 0.85), allowing to diagnose sexual dysfunction in SA women with PFD, with 90% sensitivity and 71% specificity.

We report a case of a 74-year-old female, who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy due to a solid-cystic tumor of the right ovary. The histopathological diagnosis revealed a borderline Brenner tumor (BBT). After 25 disease-free months the patient was admitted to a hospital because of a tumor in the postoperative scar of the abdominal wall, later diagnosed as infiltrating Brenner tumor consistent with ovarian borderline lesion. The tumor in the postoperative scar was therefore diagnosed as BBT. The article presents results of literature search on BBT in order to find characteristic features of this very rare ovarian tumor. To the best of our knowledge, this is the first report of subcutaneous recurrence of Brenner ovary tumor of low malignant potential.

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.

We report the use of SPECT/CT in sentinel lymph node biopsy in endometrial cancer. The patient was a 54-year-old woman with the diagnosis of endometrial adnenocarcinoma, grade 2. Preoperative MRI and transvaginal ultrasound scans revealed tumor infiltrating more than 50% of the myometrium. The patient was qualified for total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic/paraaortic lymphadenectomy. Before the surgery, 2 cervical injections of the (99m)Tc-labeled nanocolloid (0.5 mCi) were administered and the SPECT/CT was performed using a standard dual-head gamma camera and a 6-slice spiral CT component.

Chemioterapia dootrzewnowa (IPC) jest rodzajem leczenia uzupelniającego. Stosuje sie ją najcześciej po zabiegucytoredukcji nowotworu zlośliwego. Jej początki siegają lat 50., kiedy to zaczeto ją stosowac w przypadku rozsiewunowotworowego w jamie brzusznej. Wspolcześnie stanowi ona jedną z opcji leczniczych w przypadkach wielunowotworow. W artykule skoncentrowano sie na kluczowych zagadnieniach dotyczących IPC oraz dootrzewnowejchemioterapii środoperacyjnej w hipertermii (HIPEC) w raku jajnika. Przedstawiono aktualny stan wiedzy na temat IPCi HIPEC w tym nowotworze. Omowiono zagadnienia takie jak czas zastosowania IPC, uzasadnienie jej uzycia, roznicew stosunku do chemioterapii dozylnej (IVC), podano korzyści i wady, w tym omowiono skutecznośc, toksycznośc,kwalifi kacje do terapii oraz wymogi stawiane wobec ośrodka przeprowadzającego taką procedure medyczną. Zwroconotakze uwage na kwestie fi nansowe związane z IPC i HIPEC.

The aim of the study was to compare the results of single-photon emission computed tomography-computed tomography (SPECT-CT) with those of intraoperative gamma probe detection and assess the clinical utility of SPECT-CT for sentinel lymph node biopsy in endometrial cancer.We investigated 70 patients with endometrial cancer who underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node biopsy (routine pelvic and para-aortic lymphadenectomy was additionally performed in high-risk patients). Tc-99m radiocolloid albumin was injected into the cervix and a blue dye was injected superficially into the fundus.SPECT-CT revealed hot spots in 64 patients (91.4%). The detection rates were 97.1 and 94.3% using the combined technique and the hand-held gamma probe, respectively. In 19 cases (27.1%) 35 hot spots detected on SPECT-CT were not diagnosed as sentinel lymph nodes (SLNs) during surgery. In each patient with undetected hot spots located in the common iliac or para-aortic regions, hot SLNs were found during surgery in the obturator or external iliac region. In addition, SPECT-CT had detected 88.9% of the SLNs found during surgery. With respect to the 13 cases not detected on SPECT-CT, the hot SLNs had very low activity. Using the combined method, 95.1% of SLNs were found in typical locations (external iliac or obturator nodes). There were two metastatic nodes: one in SLN and one in nonsentinel node.SPECT-CT yields a high SLN detection rate; however, there is significant discrepancy in comparison with intraoperative findings, which limits its clinical utility. In addition, in the majority of cases SLNs are found in typical areas, which means that they can be reliably detected using an intraoperative gamma probe.

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.

AIMS To compare quality of life (QoL) in women with urinary incontinence (UI) using continence pads during the day versus all day and night; to identify risk factors for a 24-hour pad use; to calculate quality-adjusted life years (QALY). METHODS A cross-sectional study in 331 women with lower urinary tract symptoms referred to urogynaecologic examination was conducted. Main outcome measures were the scores of King's Health Questionnaire (KHQ), clinical data, and KHQ-derived utility values. RESULTS A total of 270 women with UI were recruited: 176 (57.3%) using continence pads only during the day (group I) and 94 (30.6%) for 24 hours (group II). The groups did not differ in terms of age, menopause, parity, type of UI, stage of POP-Q, and percentage of sexually active subjects. Group II had significantly higher body mass index (BMI) and lower education than group I (P

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.

Four molecular subtypes have lately been established in endometrial cancer basing on estrogen receptor (ER), progesterone receptor (PR) and HER2 status: ER+/PR+/HER2+, ER+/PR+/HER2-, ER-/PR-/HER2+ and ER-/PR-/HER2-. The subtypes have shown diversity in terms of prognosis, clinicopathological and molecular characteristics, with ER+/PR+/HER2- and ER-/PR-/HER2+ group exhibiting exceptionally benign and aggressive behavior, respectively. We have further characterized the subtypes in the context of pathways known to drive endometrial carcinogenesis: phosphatidylinositol 3-kinase (PI3K)-AKT pathway (ERBB/PI3K pathway), TP53 system, and the mismatch repair (MMR) mechanism. Analysis of tumor heterogeneity was also included. ER+/PR+/HER2+ was characterized by active ERBB/PI3K pathway occurring in 58% of cases. Subtype ER-/PR-/HER2+ was characterized by the most frequent TP53 mutations (83% of cases). Triple negative phenotype utterly lacked active ERBB/PI3K pathway. Analyzed major pathways rarely correlated with clinicopathologial data but mutated TP53 and retained MMR did correlate with shorter overall survival (both P

Only approximately 50% of all familial breast cancers can be explained by known genetic factors, including mutations in BRCA1 and BRCA2. One of the most extensively studied candidates for breast and/or ovarian cancer susceptibility is BARD1. Although it was suggested that large mutations may contribute substantially to the deleterious variants of BARD1, no systematic study of the large mutations in BARD1 has been performed. To further elucidate the role of large mutations in BARD1, we designed a multiplex ligation-dependent probe amplification (MLPA) assay and performed an analysis of 504 women with a familial breast and/or ovarian cancer and 313 patients with ovarian cancer. The investigation did not reveal any large mutations in the BARD1 gene. Although the analysis was not focused on identification of small mutations, we detected seven deleterious or potentially deleterious point mutations, which contribute substantially to the total number of BARD1 mutations detected so far. In conclusion, although we cannot exclude the presence of large mutations in BARD1, our study indicates that such mutations do not contribute substantially to the risk of breast and/or ovarian cancer. However, it has to be noted that our results may be specific to the Polish population.

This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.

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.

Individualization of treatment on the basis of in vitro chemosensitivity testing constitutes one of the aims of contemporary oncology Although previous studies report advantages resulting from chemosensitivity laboratory tests, the issue remains an area of interest. The aim of this study was to discuss chemosensitivity assay methods of ovarian cancer cells. ATP-TCA (ATP-based tumor chemosensitivity assay) is the most investigated chemosensitivity test in ovarian cancer with well-documented efficacy Potentially it is possible to use the xCELLigence system to evaluate chemosensitivity of ovarian cancer cells by measuring their colony volume but application of this method remains in the experimental phase. Optimization of ovarian cancer treatment would improve chemotherapy results, thus increasing the overall survival, improving the quality of patient life, decreasing chemotherapy-related toxicity and resulting in economic benefits owing to better drug use.

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.

In most cancers of epithelial origin, metastases to the lymph nodes constitute the most important prognostic factor and are predictive of the results of the surgical and adjuvant therapies. Data on the lymph node status allows to design an appropriate treatment plan. Despite advances in gynecologic oncology, the importance of lymph node micrometastases in cervical cancer, especially in nonsentinel lymph nodes which are detected by ultrastaging, has not been fully elucidated. The purpose of the article is to familiarize the reader with the state of current knowledge on cervical cancer micrometastases. The authors attempt to answer the question about the benefits of lymph node assessment in the search for micrometastases in cervical cancer, as well as to address emerging doubts.

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.

On the basis of two cases we discuss the important issues regarding the sentinel lymph node detection biopsy (SLNB) in endometrial cancer with combined cervical administration of the radiocolloid and the subserosal blue dye injection. The first patient (endometrioid adenocarcinoma G2, invasion50% myometrium) had 4 SLNs detected. Three were both hot and blue (detected on SPECT-CT). The fourth, paraaortic SLN was blue only. None of the lymph nodes contained metatstases. The second patient (endometrioid adenocarcinoma G1, invasion50% myometrium) had 4 SLNs detected. Three were blue (but two of them had also very low radioactivity). The fourth SLN was hot only. Blue only node contained macrometastasis. In the past patients underwent cervical amputation. Diverse distribution of each tracer confirms the advantages of the combined tracers administration in SLNB. The radiotracer is the crucial component--uptake was present in 6 of 8 SLNs. Although the blue dye is more a complimentary method, its suberosal injection significantly increases the safety of the SLNB procedure. In the first case we have detected blue only SLN in paraaortic region which otherwise would be missed using the cervical approach only. More importantly in the second case the tracer uptake was very limited due to the previous surgery and the blue dye administration allowed correct SLNs detection (including the metastatic node). Presented clinical cases confirms that the combined cervical and subserosal tracers administration together with preoperative SPECT-CT constitute an optimal SLN detection method and correctly provides information about the regional lymph node status.

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.

Cohesins and cohesin-regulated genes are deregulated in numerous types of human cancer. However, data concerning their status and role in endometrial cancer are scarce. This study aimed to determine the clinical significance of double-strand-break repair protein rad21 homolog (RAD21) and runt-related transcription factor 1 (RUNX1) gene dosage and mRNA expression in endometrial cancer. RAD21 is a component of the cohesin complex, crucial for chromosome segregation and DNA repair. RUNX1 is the transcription factor implicated in RAD21 regulation. The study group included 144 endometrial cancer patients. RAD21 and RUNX1 expression profiles were measured by reverse-transcription quantitative PCR. RAD21 gene dosage was determined by quantitative PCR. RAD21 gene dosage was associated with RAD21 mRNA expression (ϱ=0.22; p=0.009). Furthermore, RAD21 expression strongly correlated with RUNX1 expression (ϱ=0.43; p

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 aim of the study was to prove the possibility of elastography application in the assessment of the indications for dilatation and curettage (DC) of the uterine cavity in patients with wide endometrium found in transvaginal ultrasound examination.Analyzed group consisted of 25 perimenopausal women admitted for DC due to the suspicion of endometrial hypertrophy. In all the patients transvaginal ultrasound examination in B-mode and elastography by the use of ElastoScan software were performed. Endometrium was described by Elastography Index (EI) presented in previous publications. The results were compared to the pathological results from DC.Statistical analysis revealed significant difference of elastography image of endometrium described by EI between patients with normal or atrophic endometrium confirmed by pathological examination and women with abnormal findings--endometrial cancer hypertrophy or polyp (chi2 Pearson test; p=0.00005). EI in the group with normal endometrium was 0 or 1 point and in the group with endometrial pathology was from 2 to 4 points. No patient with EI for endometrium above 1 point had normal or atrophic endometrium and no woman with EI 0 or 1 had any pathologic finding.Elastography as a new diagnostic technique in gynecology seems to be a valuable tool differentiating endometrial pathologies from normal or atrophic endometrium in perimenopausal women with endometrium thickness above 5 mm in transvaginal ultrasound examination.

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.

Whether or not to perform early or late amniocentesis remains questionable due to higher fetal loss and the rate of talipes equinovarus after early amniocentesis.We have compared the course of pregnancy, delivery and the condition of the newborns in patients after early and late amniocentesis in the group of women who had undergone amniocentesis in the Department of Obstetrics of Medical University of Gdansk between the years 1996-2003.Early amniocentesis was performed in 302 patients (55.9%), late amniocentesis in 302 patients (44.1%). Fetal loss occurred in 8 pregnancies (2.6%) after early amniocentesis and in 2 cases (0.8%) after late amniocentesis (P = 0.10). There was no statistically significant difference between early and late amniocentesis, comparing complications following the procedure in the first 3 weeks after amniocentesis: lower abdominal pain, spotting, bleeding, leakage of amniotic fluid. Mean duration of pregnancy in patients after early amniocentesis was 38.5 +/- 3.9 and 38.4 +/- 3.3 weeks in late amniocentesis group. There was no statistically significant difference between these groups in the type of delivery and premature delivery rate. Frequency of pneumonia and the respiratory infections in newborns were comparable in two groups (6.8% vs. 4.8%). There was only one case of talipes equnovarus in a fetus after late amniocentesis and one case of congenital dysplasia of the hip in a fetus after late amniocentesis, too. There were not any such defects in a group after early amniocentesis.The type of amniocentesis--early or late--has not got any influence on the frequency of complicattions after amniocentesis.

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.

This is a report of two cases of haemorrhage after pelvic exenteration in patients with vulvar cancer and cervical cancer treated by temporary pelvic packing at the Department of Gynaecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 and 48 hours. There were no major postoperative complications in both cases and one wound dehiscence. Both patients recovered after surgery. In cases with severe intraoperative haemorrhage, intraabdominal packing can be effective mode of treatment, especially in bleeding which originates from the sacral venous plexus.

Carcinoma of the Bartholin's gland is a rare lesion accounting for only 5% of all vulvar cancers. Initial diagnosis of Bartholin's gland cancer (BGC) and recurrence after primary radical surgery and adjuvant radiotherapy poses a challenge in the treatment of BGC. This case report presents a particularly aggressive course of BGC. Spontaneous rupture of the femoral artery in the postoperative period was observed. The length of the survival period from the moment of diagnosis amounted to less than 16 months. Aspects of initial diagnosis problem and treatment options in groin recurrence of vulvar carcinoma and vascular complications are discussed.

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.

Sentinel node (SN) scintigraphy for cervical and vulvar cancer guides the gynaecological oncologist in finding the metastatic lymph nodes during lymphadenectomy. The role of the surgical gamma probe in the sentinel node concept in gynaecological oncology is to localise (SN) both intra-operatively and transcutaneously. Intra-operative hand-held collimated gamma probes are increasingly used for detection of the sentinel lymph node.A comparative evaluation of hand held gamma probes: Neoprobe 1,500, Europrobe, Gamma Finder, Gamma Ray Prospector GRP1 and GPR2 was performed using different detection methods. Laboratory tests were performed in which sensitivity, spatial resolution and angular sensitivity were evaluated.The results for each gamma probe were summarised and discussed.Awareness of a gamma probeís capabilities and limitations should be considered in the appropriate selection of a device.

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.

Aim To assess the relationship between carrier molecule size and time elapsing between marker injection and sentinel node(s) biopsy in patients with breast cancer. Material The study performed on 122 women, in whom the sentinel node(s) was identified according to the procedure described below. In Group I ( n = 72 patients), SN identification was done with radioisotope marker of 400–3000 nm molecule size (tin colloid). In Group II ( n = 50 patients) radioisotope marker of Methods All the patients of both groups received the markers with a single-point, intradermal, periareolar injection. Four hours after the injection (Group I – surgery in the next day) or immediately before the surgery (in this same day) (Group II), stationary lymphoscintigraphy was performed. Results Mean numbers of sentinel nodes identified with the radioisotope method in Groups I and II were 1.22 and 1.48, respectively. The difference was statistically significant ( p Conclusions There is a relationship between the radioisotope marker molecule size and the injection-to-intra-operative evaluation time. Administration of small molecule size radioisotope marker several hours prior to the planned surgery appears to be the optimum procedure in this method of SN identification in patients with breast cancer.

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.