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The article presents analysis on the results of 171 second-look laparotomy (SLL) and equate survival of patients having advanced ovarian cancer. The study reveals that the survival rate in patients having recurrence after negative SLL was importantly lower equated to patients with microscopic disease. It shows that probable explanation for encouraging prognosis in the group having microscopic disease was early medication of chemotherapy after SLL.

Purpose: Since angiogenesis plays an important role in the pathogenesis of ovarian cancer the aim of the study was to compare the expression of the most relevant angiogenesis-related genes in serous ovarian cancer samples. Genes were divided into 5 subgroups according to their angiogenic potential: growth factors and their receptors; cytokines/chemokines; adhesion molecules and other matrix related proteins; transcriptions factors and signaling molecules; morphogenic factors, and angiogenesis inhibitors., Materials/methods: Twenty-nine patients were involved in the study: 20 with serous ovarian cancer and 9 healthy controls. All neoplasms were confirmed by histopathological examination. Healthy ovarian control samples were obtained from women diagnosed with fibroids and had previously scheduled operations. Real-time PCR gene arrays were used to examine the expression of 84 human angiogenesis-related genes and expression of selected proteins was assessed with ELISA., Results: Significantly higher expressions of 46 genes were found in the ovarian cancer group compared to the healthy control group. By the use of ELISA we confirmed the expression of three proteins i.e.: angiopoietin-2, angiopoietin-like protein 3, and angiopoietin receptor 2. Only angiopoietin-2 and angiopoietin receptor 2 showed significant differences between ovarian cancer and healthy controls., Conclusions: Changes in the expression of selected genes associated with angiogenesis may add new information to the pathogenesis of ovarian cancer. Although the angiopoietin-2 signaling pathway may play an important role in neovascularization in ovarian cancer, the role of angiopoietin-like protein 3 is yet to be established., (Copyright © 2017 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.)

Purpose: To determine the complication rate associated with using a single-lumen intravenous access port with a silicone catheter of 9-10Fr size in the intraperitoneal treatment, including hyperthermic intraperitoneal chemotherapy, in ovarian cancer., Patients/methods: We reviewed 27 patients who had subcutaneous venous access ports placed for the administration of IP chemotherapy. With four patients, the catheter was implanted during a hyperthermic intraperitoneal chemotherapy-related laparotomy using the closed technique. Each case was categorized as to the number of cycles of IP therapy received., Results: Seven catheter-related complications were noted. These were divided into two categories: six malfunctions (24%) and one infection (4%). Overall, of the patients who had IP catheters placed and received IP chemotherapy, 13 (54.2%) were able to complete the six regimens. Among the four (14.8%) patients who had the catheters planted directly following the HIPEC, one experienced a catheter leak, one an infection and one concluded the treatment successfully; one is still being treated., Conclusions: A subcutaneous single-lumen intravenous access port with a silicone catheter of a large size (9-10Fr) is related to a lower rate of catheter-related complications than previously reported open-ended Tenckhoff catheter treatment. An additional advantage is the possibility of removing the catheter as an office procedure under local anesthesia. Intraperitoneal chemotherapy following a HIPEC procedure may cause increased occurrence of catheter-related complications. As of 2010 we have been using silicone subcutaneous catheters in our center., (Copyright © 2015 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Objective: In 2009, International Federation of Gynecology and Obstetrics (FIGO) modified staging of vulvar cancer-the prognostic significance of the new classification relative to the prior system as well as to the commonly recognized prognostic factors has not been assessed. The aim of this study was to test prognostic ability of 2009 staging in a cohort of uniformly treated and staged cases with long-term follow-up., Methods: Pathologic characteristics were obtained by blind review of the original tissue samples. 76 patients who qualified for surgery on the basis of the same criteria, with full clinical history, were included in the study. The histological analyses were performed on 76 and 35 paraffin-embedded tissue samples from primary tumors and lymph nodes, respectively. Survival analyses included the Kaplan-Meier method, log-rank test and Cox proportional hazards model., Results: Univariate analysis has demonstrated that age (p = 0.0170), lymph node metastasis (p = 0.0393), tumor grade (p = 0.0086) and FIGO1994 stage (p = 0.001) were the significant prognostic factors for overall survival. Multivariate analysis has demonstrated that growing age (HR 2.25, 95 % CI 0.79-3.71, p = 0.0321), tumor grade (G1 vs. G2 and G3) (HR 1-3.11, 95 % CI 1.6-4.62, p = 0.0057) and FIGO1994 stage (HR 1.78, 95 % CI 0.55-3.01, p = 0.0061) are independent prognostic factors with respect to overall survival., Conclusions: The results indicate the prognostic advantage of the 1994 FIGO staging as it has become an independent prognostic factor in contrast to the new FIGO system. This should be tested in future larger cohort studies. Differentiation grade turned out to be a very valuable independent prognostic factor and should be incorporated as a routine component of the histopathologic reports in vulvar cancer.

The vascular endothelial growth factor (VEGF) family and VEGF receptors (VEGFR) play an essential role in angiogenesis and lymphangiogenesis. The aim of this study was to clarify the prognostic significance of VEGFR expression in ovarian carcinoma. Levels of VEGFR-2 and VEGFR-3 tissue expression in human ovarian tumours were assayed by immunoblotting and the correlations between analysed factors and clinicopathological features were examined. Tissue samples consisted of 42 benign and 10 borderline (low malignant potential - LMP) tumours, 76 ovarian carcinomas, 8 Krukenberg tumours and 32 normal ovarian tissues. The highest relative level of VEGFR-2 was detected in cases with at the early stages of cancer development. The highest level of VEGFR-3 was detected advanced cancer stages and those with Krukenberg tumours. Overexpression of VEGFR-3 was found to correlate with the debulking status (p = 0.02) and positive response to chemotherapy (p = 0.04). A statistically significant longer progression free survival (PFS) was observed in women with a low than with a high expression of VEGFR-3 (p = 0.01). Increased levels of VEGFR-2 expression at the early stages of ovarian cancer may indicate the significance of neoangiogenesis at these stages. Overexpression of VEGFR-3 reflects the aggressiveness of ovarian carcinoma spread and has a predictive value for identifying high-risk patients with poor prognosis.

The aim of this study was to selectively profile the activation status of mammalian target of rapamycin (mTOR)-associated oncogenes and tumor suppressor genes (TSGs) in ovarian cancer specimens, healthy ovaries and benign ovarian tumors, including endometrial cysts. We used a novel type of microfluidic gene array to examine the expression of 15 human tumor suppressors and oncogenes in ovarian cancer specimens of 53 patients, benign ovarian cysts of 29 women (endometrial and simple) and 11 healthy ovaries of individuals in whom the material was obtained during total hysterectomies performed because of fibroid changes. The array was custom-designed to include the following genes: NF1, RHEB, mTOR1, AKT-1, PTEN, TSC1, TSC2, KRAS, RPS6KB1, 4EBP1, TP53, EIF4E, STK11, PIK3CA and BECN1. Confirmatory immunohistochemical detection was performed for a group of selected proteins. Particularly significant differences were observed as to the expression of PTEN (p < 0.0001), TP53 (p = 0.0003), PIK3CA (p = 0.0003) and BECN1 (p = 0.0014) which were shown to be downregulated in cancer patients when compared to healthy ovaries and benign ovarian cysts (endometrial and simple). These markers did not show association with grade or stage of the tumor. Immunohistochemistry showed that PTEN, TP53, PIK3CA and BECN1 proteins are expressed in ovarian cancer. Our results indicate that there are significant differences in the expression of some of the mTOR-related tumor suppressors and oncogenes which could be associated with the pathogenesis of ovarian cancer.

Objective: Maspin is a member of the serine protease inhibitor superfamily. Experimental studies revealed that maspin suppresses tumor growth, angiogenesis, invasion and metastasis. We examined maspin expression in human ovarian tumors and relation between maspin expression and clinicopathological features as well as the role of maspin in predicting clinical outcome in patients with ovarian cancer., Methods: Tissue samples consisted of 42 benign tumors, 10 borderline (LMP) tumors, 76 ovarian carcinomas, 8 Krukenberg tumors and 32 normal tissues. Immunoblot analysis was performed to evaluate the relative expression of maspin/beta-actin., Results: Relative maspin level was significantly higher in patients with LMP tumors (median 0.74) and early stages ovarian cancers (median 0.46) when compared with healthy tissues (median 0.03), those with benign (median 0.23) and metastatic tumors (median 0.22). Overexpression of maspin was found to correlate with the early stage of the disease (p=0.001), non-serous subtype of ovarian cancer (p=0.03) and positive response to chemotherapy (p=0.02). A statistically significant longer PFS was seen in women with high as compared with low expression of maspin (p=0.03)., Conclusions: Maspin is upregulated in borderline tumors and the early stages of ovarian carcinoma and then significantly downregulated with malignant transformation. High expression may paradoxically promote the invasion and metastasis of ovarian carcinomas. Our study revealed that maspin expression could play an important role in predicting the results of treatment of ovarian cancer patients.

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

Objective: To report the results of ovarian cancer treatment, where a regimen of intravenous cyclophosphamide followed by intraperitoneal cisplatin or carboplatin was administered as second line treatment., Design: Retrospective observational study on 198 women with stage I-IV histologically documented epithelial ovarian cancer after one or more prior regimens of chemotherapy., Setting: University tertiary referral clinic, Gdansk, Poland., Methods: The study group was recruited from among 593 ovarian cancer patients treated between January 1996 and December 2006. Conditions of inclusion for intraperitoneal treatment were: relapse or recurrence of disease after surgery followed by first line treatment. Recurrences were confirmed through re-staging laparotomy or second-look laparotomy. Patients received 90 mg/m(2) cisplatin, or carboplatin AUC 6 intraperitoneally and cyclophosphamide 750 mg/m(2) intravenously. Four or six courses were planned for each patient., Main Outcome Measures: Response to treatment defined as complete or partial response, or progressive disease, and survival rates., Results: There were 67 (34%) with complete and 61 (31%) with partial response, while 69 (35%) developed progressive disease. Median survival from the initiation of intraperitoneal chemotherapy (IP) was 51 months and significantly longer for patients who received four cycles of IP: 78 months vs. 20 months for patients who received six intraperitoneal cycles., Conclusions: IP can be used in second line treatment of ovarian cancer, but six treatment cycles appear associated with worse results compared to four.

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

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

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

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

Background: The clinical relevance of BRCA1/2 alterations in ovarian carcinoma patients is debatable. Our aim was to determine factors influencing the risk of recurrence and death in ovarian carcinoma patients with BRCA pathogenic and unclassified variant mutations., Methods: A consecutive series of 205 women with primary ovarian carcinoma were screened for mutations in BRCA1 and BRCA2 genes using a conformational sensitive gel electrophoresis and direct sequencing. Data regarding medical and familial history were collected using questionnaires. Clinical and pathologic data were extracted from medical records., Results: Unclassified variant mutations in BRCA1 or BRCA2 genes were found in 16 (8%) patients, and BRCA1 pathogenic mutations were found in 18 (9%) patients. No pathogenic mutation was found in BRCA2 gene. Multivariate analysis showed that BRCA1 pathogenic mutation was an independent predictor of reduced risk of relapse and death (Hazard ratios [HR] 0.52 [confidence interval {CI} 0.28-0.98] and 0.38 [CI 0.10-0.96], respectively). Unclassified variant mutation did not affect recurrence and survival (HR 0.84 [CI 0.43-1.66] and 0.94 [CI 0.48-1.82], respectively). Other factors associated with reduced risk of relapse and death were complete pathologic remission at second-look laparotomy and family history of breast and ovarian carcinoma, respectively. Recurrence and death outcomes among unclassified variant mutation carriers did not differ significantly from those in sporadic cases., Conclusions: Patients with BRCA1 pathogenic mutation seem to have reduced risk of recurrence and death. These results should be interpreted with caution as they may be influenced by more intensive treatment, better response to cisplatin, and younger age of mutation carriers. Clinical relevance of BRCA1/2 unclassified variant mutations warrants further studies.

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

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

The objective of this study was to determine the prevalence of BRCA1 and BRCA2 gene mutations in unselected ovarian cancer patients, and to analyse clinical and pathological features of ovarian cancer unclassified variant mutation carriers in comparison with BRCA1 pathogenic mutation carriers and sporadic cases. A consecutive sample of 205 women with primary ovarian cancer was screened for mutations in the BRCA1 and BRCA2 genes using a direct test for small deletions and insertions, conformational sensitive gel electrophoresis and direct sequencing. Data regarding medical and familial history were collected using questionnaires. Clinical and pathological data were extracted from medical records. Unclassified variants and polymorphic mutations accounted for 8% (n = 16) and 6% (n = 13) of all cases, respectively. BRCA1 pathogenic mutations were found in 18 (9%) patients. None were found in BRCA2. The mean age of onset for BRCA1-associated tumours was 43.1 years (standard deviation (SD: 7.3) whereas in the patients with an unclassified variant, polymorphism, or no detectable gene changes, the mean age of onset ranged from 49.5-56.4 years. The most significant predictors for pathogenic or unclassified variant changes in BRCA1 in ovarian cancer patients were a younger age of onset and a history of hyperthyroidism and infertility. Except for infertility and hyperthyroidism, unclassified variant-linked ovarian tumours share features with sporadic tumours rather than with BRCA1 pathogenic mutations.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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