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Background/Aim: During ovarian cancer (OC) debulking surgery, the surgeon can examine the peritoneal cavity for malignant cancer cells with peritoneal washing (PW) cytology. The goal of this study was to examine the significance of peritoneal washing as a prognostic indicator for ovarian cancer patients. Patients and Methods: Information considering the prognostic factors of OC and their impact in PW’s result was collected, compared, and combined. Results: Omental metastasis, tumor type, tumor invasion, tumor size, tumor grade/ stage, tumor’s cytoreduction, and recurrence affect both the peritoneal washing result and the patient’s prognosis. The correlation that most of the above factors have with a positive PW and dismal prognosis, led us to the assumption that PW has a significance as a prognostic indicator. Conclusion: The significance of PW as a prognostic indicator remains an assumption.

Gynecological cancer is the cancer that originates in the female reproductive system. According to the anatomical location of the cancer, it is distinguished into cervical, uterine, vaginal, ovarian, and vulvar cancer. Oncogenes and tumor catalytic genes play a key role in the genesis and development of gynecological cancer. This article presents the signaling pathways and expression of oncogenes that take place in the carcinogenesis of the female reproductive system.

Evidence indicates that SARS-CoV-2 infection increases the likelihood of adverse pregnancy outcomes. Modifications in the circulatory, pulmonary, hormonal, and immunological pathways induced by pregnancy render pregnant women as a high-risk group. A growing body of research shows that SARS-CoV-2 infection during pregnancy is connected to a number of maternal complications, including pneumonia and intensive care unit (ICU) hospitalization. Miscarriages, stillbirth, preterm labor, as well as pre-eclampsia and intrauterine growth restriction are also among the most often documented fetal implications, particularly among expecting women who have significant COVID-19 symptoms, often affecting the timing and route of delivery. Thus, prevention of infection and pharmacological treatment options should aim to minimize the aforementioned risks and ameliorate maternal, obstetric and fetal/neonatal outcomes.

A 19-year-old female patient was presented to our clinic for a pregnancy follow-up during which primary toxoplasmosis infection was diagnosed. The patient was successfully treated with spiramycin and finally delivered normally a healthy boy, on term. Serological tests (ELISA) for detection of anti-toxoplasma antibodies along with ultrasonography findings on the fetus are the gold standard for the diagnosis. Spiramycin was used for embryo protection to avoid T.gondii transmission to the fetus across the placenta.

Oxidative stress may play a role in implantation failure on multiple levels. Oxidative stress is found widely in several biological systems, as well as it acts on various molecular levels with different mechanisms. It has been shown that it is rather the disequilibrium between reactive oxygen species causing oxidative stress and antioxidant mechanisms counteracting their effects, than reactive oxygen species levels themselves. Reactive oxygen species play a role in implantation and fertilisation by acting on different levels of embryo-formation and endometrial changes. Additionally, it is widely abundant in the female reproductive tract including ovaries, oocytes, tubal as well as follicular fluid. Moreover, it has been shown that male fertility is affected by reactive oxygen species by determining sperm quality. Last but not least, oxidative stress may affect IVF indirectly through its actions on peritoneal fluid. As long as research studies on elucidating the development of oxidative stress markers on patients undergoing IVF continue, ever more new possibilities emerge on predicting the pregnancy outcome.

Uterine atony is a serious obstetrical complication since it is the leading cause of postpartum hemorrhage. Postpartum hemorrhage (PPH) is one of the 5 major causes of postpartum mortality; therefore, it requires immediate medical intervention, independent of whether delivery occurs normally or with a cesarean section. While in the past years most cases of postpartum hemorrhage were caused due to uterine atony following vaginal delivery, in recent years most PPH cases indicate a significant association with cesarean delivery. There are several methods used in order to avoid such a life-threatening complication, ranging from risk assessment to prevention, and finally medical intervention and management, if such an event occurs. In this scientific paper emphasis is given on the so-called "uterotonic" agents that are currently used, including oxytocin among others. It is, therefore, important to be familiar with these agents as well as understand the physiological mechanism by which they work, since they are used in everyday practice, not only for managing but also for preventing PPH. There are several potential questions that arise from the use of such "uterotonic" agents, and most specifically of oxytocin. Maybe one of the most important issues is the determination of optimal dosing of oxytocin in order to avoid PPH after a cesarean section.

Prevention and treatment of infertility remains a priority for developed countries where a large proportion of women undergo in vitro fertilization (IVF) after ovarian stimulation. Latest data suggest that, in the USA alone, almost eight million women of fertile age will have sought medical advice for fertility problems by 2025. However, over the last years, attention has been increasingly focused, and questions have risen, on the long-term health effects in women who underwent assisted reproductive technologies (ARTs). Since the emergence of ART, reports highlight a possible connection of ovarian stimulation and several types of gynaecological cancer, including ovarian, endometrial and cervical types, but due to limited scientific evidence, such a speculation is still under investigation. The objective of this review is to summarize the latest data of ovarian hyperstimulation and IVF, associated with the risk of gynecological tract cancer development.

Cancer is a medical condition which has a molecular basis. Proto-oncogenes are the first regulatory factors of this biological process. They act in transmitting signals, resulting as growth factors. Modifications of these genes, called oncogenes, lead to the appearance of cancer cells. The activation process leading to proto-oncogenes are chromosomal translocation, point mutation, and gene amplification. Concerning the clonal theory of oncogenesis, it is believed that a tumor starts from a cell. Furthermore, there is close association between tumor development and inhibition of apoptosis or programmed cell death, providing cell immortality. Angiogenesis and angiogenic factors found to be expressed in tumors and may play a key role in tumor formation and development. Tumor-suppressor genes block the growth of cancer and contribute to the normal development of cells. This article highlights the evidence that neoplasms develop as the after-effect of the increase of acquired and physical genetic variations in proto-oncogenes and tumor-suppressor genes; these form a target group in the cells of neoplasms. Tumor formation and development are characterized by individual processes, working synergistically, and an understanding of each individual process may provide a better basis for further anticancer research.

Endometrial cancer is the most common gynecologic malignancy. The mainstay of treatment for endometrial cancer is total hysterectomy with bilateral salpingo-oophorectomy. Radiation and chemotherapy accompanied with progestins can also play a significant role in treatment. Lower urinary tract symptoms (LUTS) following therapy for endometrial cancer are an extremely difficult and challenging condition that deteriorates patients' quality of life. Current literature remains rather scarce regarding LUTS after therapy for endometrial cancer. This review aimed to investigate the incidence of LUTS in endometrial cancer treatment.

Objective:Treating burn patients in the battlefield is one of the biggest challenges that military doctors and medical personnel can face. Wound patterns have been changed over time due to the introduction of new weapons, and many different aspects play a major role in the management of those burns nowadays. There is a potential gap in care of burn patients in war zones.Methods:A thorough literature search in PubMed, scientific journals, and Internet sites was conducted in regard to burn patients and trauma in war zones.Results:It is crucial for military surgeons to be able to stabilize burn patients during wartime conflicts, especially those patients who suffer from extreme burn injuries, as specialized treatment should be given. Medical personnel should be aware of all medication types used, the ways to minimize the risk of bacterial infection, and the ways to keep the injured safe.Conclusions:Injured civilians with burn trauma in the field of battle are deserving care, and special recognition should be given to the non-governmental organizations (NGOs) that strive to ease human suffering in war zones. Proper management of burn patients in war zones is crucial, and military medical staff and NGOs can play a key role in that purpose.

Molecular biology of cancer cell is a domain of medical science that is rapidly growing in our days. Knowing the ways and paths that cancer cells follow is crucial to the prevention of cancer itself. Central role to these paths, concerning the cell cycle and the process of apoptosis, has the protein p53. The whole mechanism of the cell cycle is activated by the action of various mitogens, such as growth factors, hormones and cytokines. Carcinogenesis involves alterations of genes (proto-oncogenes and tumor suppressor genes), which encode proteins of the signal transduction. Many of the damages that lead to carcinogenesis may be due to the lack of repressive signals for cell division, but also to the absence of the sensitivity of cells to repressive signals. The cell has mechanisms of receiving apoptotic-antitumor signals and mechanisms of execution of these instructions. A percentage of cancers (4-8%) are etiologically linked to germ (stem) cells mutations and occur at an increased frequency in families (hereditary cancers). Substantial progress in understanding the mechanisms of carcinogenesis, filtration and metastasis of cancer has highlighted the key role of specific genes, primarily oncogenes and tumor suppressor genes.

Background and Objectives: Hydatid disease (HD) remains a significant public health issue causing morbidity and mortality in many Mediterranean countries. Material and Methods: The present cohort study included 50 consecutive patients with liver hydatid disease who underwent surgery in a tertiary University Hospital. A total of 18 patients (36%) had a case of complicated HD, including simple communication of the cyst with the biliary tree (6 cases), rupture of the cyst into the biliary tree (6 cases), presence of a bronco-biliary fistula (2 cases), rupture of the cyst in the peritoneal cavity (2 cases), and rupture of the cyst and formation of a hepatic abscess (2 cases). Endoscopic retrograde cholangiopancreatography (ERCP) was pre-operatively performed on six patients. Results: The main clinical symptom presented was right upper quadrant pain in 16 patients (88%), which was associated with high fever (&gt, 39 °C) in 14 patients (78%). C-reactive protein (CRP) was the primary indicator of a complicated HD (p = 0.003), however, it was only elevated in 67% of cases. CRP was a more sensitive indicator of a rupture in the biliary tree cyst (p = 0.02). Computer tomography (CT) detected more cases (44%) of a complicated HD than ultrasonography (US) (25%), however, the difference was not statistically significant. Conclusions: For prevention and control of HD, a high suspicion of the disease leading to early referral to specialized centers, mainly in endemic areas, is required. Prior to surgical or percutaneous intervention, a combination of imaging and laboratory findings are essential in diagnosing a complicated case and avoiding unnecessary interventions.

Background/Aim: We aimed to evaluate the safety and efficacy of sealing primary upper gastrointestinal (GI) perforations with a collagen patch coated with fibrin glue (Tachosil(®)). Materials and Methods: Thirty New Zealand rabbits were used in this study. An iatrogenic gastric perforation was created, and primary repair was performed on the control group. Tachosil(®), without suturing the deficit, was used in the intervention group. Results: Leakage was observed in 3 (20%) and 2 rabbits (13.3%) in the control and intervention group, respectively; however, the difference was not statistically significant (p=0.62). Moreover, adhesions formed in 10/15 and all rabbits in the intervention and control group, respectively (p=0.014); however, based on the Zuhlke adhesion’s classification, there was no statistically significant difference between the two groups. Conclusion: A collagen patch coated with fibrin glue is not a replacement but can be considered a safe option for the reinforcement of suturing, preventing leakages in the upper GI tract.

Breast cancer represents one of the three most common gynecological cancers, with each subtype having distinct risk profile and treatment strategies. Optimal therapy for each case depends not only on tumor subtype and cancer stage, but also on patient preferences. Thus, the final therapeutic choice seems complicated to be reached. In addition, frequent relapses and the aesthetic effects have led to the search for more effective and less invasive methods. Surgical interventions have become less complex and new hormonal and chemotherapeutic drugs are established, that promise great results, either combined to surgical treatment or used exclusively. Luteolin is a representative of natural flavonoid that has proven to modulate various signaling pathways involved in cancer development. Recent data demonstrate that luteolin induces apoptotic cell death via antioxidant activity, acting as an anticancer agent against various types of human malignancies including breast cancer. The aim of this review is to summarize latest data considering the therapeutic role of luteolin in breast cancer.

Fallopian tube cancer is an extremely rare gynecological condition, accounting for just 1 to 2% of all female tract malignancies. The mean age of diagnosis is similar to that of ovarian cancer, between 60 and 75 years, but it can affect a wide spectrum of ages. Advanced age and family history of ovarian and breast cancer are the main risk factors, since they are associated with increased incidence of this uncommon entity. In this study, we report a rare case of an elderly, 89-year-old patient that presented to our clinic due to vaginal bleeding.

The Notch signaling pathway regulates the development of embryonic and tissue homeostasis of various types of cells. It also controls cell proliferation, variation, fate and cell death because it emits short-range messages to nearby cells. The pathway plays an important role in the pathophysiology of various malignancies, controlling cancer creation. It also limits cancer development by adjusting preserved angiogenesis and cellular programs. One of the Notch signaling ligands (in mammals) is Delta-like ligand 4 (Dll4), which plays a significant role in the overall malignancies’ advancement. Particularly, sequencing Notch gene mutations, including those of Dll4, have been detected in many types of cancers portraying information on the growth of particular gynecological types of tumors. The current research article examines the background theory that implies the ability of Dll4 in the development of endometrial and other cancer types, and the probable therapeutic results of Dll4 inhibition.

Multiple carpometacarpal dislocations with a simultaneous fracture of the hamate represent less than 1% of all injuries to the hand and wrist regions, with a scarcity of published cases. These injuries usually require a great force, and diagnosis can be missed or delayed because of the high likelihood of other severe concomitant injuries. We report a case of acute closed dislocation of the third through fifth carpometacarpal joints and an associated fracture of the hamate in a military paratrooper. The injury was caused by a wrong landing technique during parachuting. The patient was managed with primary surgical repair, and after a six-month follow-up, he has excellent functional results. The fact that both this clinical entity and the mechanism of injury are very unusual a high index of suspicion is needed, especially for orthopedic surgeons working in military hospitals. Additionally, given that there is a paucity of published cases and optional treatment is controversial, this study corroborates the superiority of surgical repair in a long-term basis.

Echogenic intracardiac focus (EIF) constitutes a finding in the ultrasound study that indicates an area which is echogenically bright in the fetal heart and is as bright as the bone that moves synchronically to the atrioventricular valves. Microcalcifications of the papillary muscles or chordae tendinae are being represented by this echogenicity and are mostly present in the left ventricle (90% of cases). EIF appears usually at the ultrasound that is realized in the mid-trimester in a percentage that reaches 3.5% in euploid fetuses and 15% to 30% in fetuses with trisomy 21. In the current paper, the rare and curious case of a 21-year-old primigravida woman is described, who presented for ultrasound scan at the 12th week of gestation. The scan revealed the presence of EIF, which is very rare, as it is well-known that it usually appears in the second trimester of pregnancy. Counseling and debriefing for dismissing parents’ anxiety is necessary as well as further examinations, because EIF has low sensitivity. This specific case report could constitute a beginning in the research of whether investigating EIF in the first trimester of pregnancy is possible and which are the benefits of its detection for the mother, the fetus and the whole family, in clinical practice.

Endometrial cancer is the most common gynecologic malignancy. The mainstay of treatment for endometrial cancer is total hysterectomy with bilateral salpingo-oophorectomy. Radiation and chemotherapy accompanied with progestins can also play a significant role in treatment. Lower urinary tract symptoms (LUTS) following therapy for endometrial cancer are an extremely difficult and challenging condition that deteriorates patients' quality of life. Current literature remains rather scarce regarding LUTS after therapy for endometrial cancer. This review aimed to investigate the incidence of LUTS in endometrial cancer treatment.

Gastrointestinal stromal tumors (GISTs) of the large intestine are extremely rare entities that constitute approximately 5% of the reported GISTs and approximately 0.1% of all cancers of colon and rectum. Almost 85-95% of GISTs contain a mutation in the c-kit tyrosine kinase and positive expression of the CD117 antigen (c-KIT). About 5% of GISTs appear to be c-kit-negative and usually have a mutation on the platelet-derived growth factor receptor-a (PDGFR-a). Compared to other GISTs, GISTs of the colon demonstrate different prevalence, incidence between various population subgroups, clinical appearance, molecular biology, treatment and prognosis. These parameters differ further depending on the GISTs primary site (colon, rectum or anus). The aim of this article was to review the current literature of those rare tumors.

Heterotopic pregnancy (HP) is defined as the simultaneous occurrence of an intrauterine and extrauterine gestation. Risk factors contributing to this condition are similar to those which contribute to ectopic pregnancy. While a triple heterotopic gestation through natural conception is uncommon, here we present the case of a patient with spontaneous intrauterine twins and a concurrent tubal extrauterine gestation, where the patient also had systemic lupus erythematosus. During the seventh week of gestation, the patient presented with acute abdomen signs and hemodynamic instability; a decision was taken to perform an emergency laparotomy. Haemoperitoneum, a total torsion of the right ovary with salpinx, a ruptured tubal pregnancy and subsequent necrosis were found intraoperatively. The patient was discharged on the sixth postoperative day and monitored throughout her whole pregnancy, with the intrauterine pregnancy progressing uneventfully. Two healthy neonates were delivered by cesarean section at 36 weeks of gestation. In conclusion, physicians treating women of reproductive age should be aware of possible HP, even in the absence of risk factors., Highlights • Spontaneous heterotopic pregnancy (HP) occurs in approximately 2.3% of all cases of HP • Risk factors include assisted reproduction techniques and pelvic inflammatory disease • The probability of an ovarian pregnancy accompanied by an intrauterine pregnancy, comprises 2.3% of all cases of HP • Surgical intervention plays a key role in the management of HP, with laparoscopic salpingectomy being the gold-standard procedure

Background: Ectopic pregnancy is the leading cause of gestation-related deaths during the first trimester. Cervical twin heterotopic pregnancies, when ectopic, constitute a small and rare part of gynecological surgery. Case Presentation: A 30-year-old pregnant woman (gravida 3, para 2) presented with mild pain in the lower abdomen and traces of bleeding per vaginum for three days. Transvaginal ultrasonography revealed a balloon-shaped cervical canal with a visible gestational sac measuring 3.5 × 3.9 cm. A second gestational sac was seen in the uterine cavity. The measurements of the gestational sacs corresponded to 7 + 4 weeks’ pregnancy. A decision for medical abortion with mifepristone and misoprostol was made. However, due to an incomplete abortion and continuous bleeding, a curettage was performed. Conclusions: Spontaneous heterotopic pregnancy with the ectopic pregnancy located in the cervix is an extremely rare clinical condition requiring urgent treatment in order to reduce maternal mortality and morbidity and preserve fertility.

Diagnosis and treatment of liver hydatid cysts may be challenging. Many surgical techniques have been proposed for the treatment of liver hydatid cysts, but the problem of the residual cavity still remains controversial and challenging, especially in giant liver hydatid cysts which are rare entities that have not been widely described in the literature so far. Capitonnage, external tube drainage and omentoplasty are the most commonly used techniques. Herein, we report the case of a 70-year-old man with a mild upper quadrant pain that proved to have a giant liver hydatid cyst, 21*14 cm2, occupying the entire right lobe of the liver. We describe a successful surgical approach with cyst unroofing and careful evacuation of the multiple daughter cysts by aspiration, and the effective management of the residual cavity by the combination of all three aforementioned techniques.

This article investigates the possibility and the extent of breast cancer rates being higher in European and Asian countries that have been damaged by warfare or nuclear accidents and the use of chemical weapons in relation to the rest of the countries in those two continents. After a literature review, although there are gaps in the local reports of the responsible bodies as well as many economic, geopolitical, cultural and time constraints, the rates of breast cancer incidence and mortality of the citizens of those areas are significant and have been increasing over time, especially in people of older ages, who were exposed to various disease factors at each specific period of time.

People in their everyday lives are exposed to radiation. Natural radiation is emitted from space, subsoil, and various materials which contain radioactive materials. Humans are also exposed to radiation from medical and industrial applications that use radioactive sources with artificial radioactive materials. Such radioactive sources may nevertheless get out of the control system and become orphan sources. Because these radiation sources are usually contained within metal shields such as lead and iron, the shields can end up as scrap metal being used in the metallurgical industry as raw material. Incidents have been recorded around the world, and several are reported in the literature and described here, where orphan sources have caused direct radiation exposure and/or environmental and personal contamination when the sources leaked. Timely and prompt recognition of an orphan radioactive source or device is crucial in order to minimize the radiological risk and its implications for the general population.

BACKGROUND/AIM Obstructive uropathy is defined the clinical entity that is characterized by changing the structural and functional feature of the urinary system due to interruption of normal urinary runoff. Gynecological benignities could rarely cause obstructive uropathy. Material and Methods: In this study the incidence and the severity of obstructive uropathy caused by gynecological benignities, was investigated. Additionally, we examined the spectrum of the contigent therapeutical procedures, in order to contend with this severe clinical entity, as well as the dangerous for life complication of urosepsis. Results: Gynecological benignities can cause obstructive uropathy. These conditions are rarely faced, composing a challenging problem for physicians. In the spectrum of these conditions are included adnexal masses, leiomyomas, pelvic inflammatory disease and endometriosis. Conclusions: Obstructive uropathy due to gynecological benignities is a very rare, difficult and challenging condition and physicians should always consider the existence of uropathy in such cases.

The idea of damage control (DC) is grounded on a sequential therapeutic strategy that supports physiological restoration over anatomic repair in critically injured patients. This concept is firstly described as damage control surgery (DCS) for war-wounded patients with abdominal exsanguinating trauma. The goal was to avoid prolonged operative times and prevent the outset of the lethal cycle of hypothermia, acidosis and coagulopathy. Damage control orthopedics (DCO) is also based on this concept and it is applied in the treatment of some polytrauma patients with pelvic and long bones fractures as to avoid the "second hit" of a lengthy definitive operation and eliminate initial morbidity and mortality. It is in favor of primary fracture stabilization utilizing provisional external fixation. When the patient is in stable condition, conversion to definitive open reduction and intramedullary nailing can be done. This stepwise approach should be considered as a part of the resuscitation process, and it follows the saying "do no further harm".