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Background/Aim. Cyclooxygenase (COX) or prostaglandin H2 synthase is the first enzyme that catalyzes the first two steps in the biosynthesis of prostaglandins from arachidonic acid. The aim of the study was to determine the expression level of COX-2 in patients with cervical cancer and compare it with that in the control group with no cervical pathology. Methods. The study included 76 patients divided into two groups: the control group - 30 patients without histopathological changes and the group A - 46 patients with cervical cancer, FIGO stage IB-IIA. Histopathological and immunohistochemical analyses were performed in these two groups of patients. Results. In the control group, the expression of COX-2 was not confirmed compared to the group A of 26 (56.52%) patients. The expression of COX-2 showed a statistically significant difference in the presence of lymphocytic stromal infiltration (p = 0.0053). The expression of COX-2 was more pronounced in the stromal tissue without lymphocytic infiltration (80% vs 20%). Conclusion. A higher expression of COX-2 in cervical carcinoma without stromal lymphocytic infiltration suggests a possible paradoxical effect of COX-2 in immunosuppression. Frequent COX- 2 expression in the subgroup with poor prognostic histological parameters in the group A indicates the importance of COX-2 expression in the carcinogenesis of cervical cancer.

Background: To determine the level of knowledge among women about factors responsible for the development of cervix carcinoma and the necessity of education and health promotion. Methods: Three groups of women were interviewed according to measuring instruments by the specially created questionnaire for this research. The statistically significant difference in answers was determined by the ANOVA test. Results: In most of the investigated factors (7 of 11) statistically significant differences in answers were observed among the groups. Only six participants in all groups indicated human papillomavirus as the factor responsible for the development of cervix carcinoma. Conclusion: In all three groups of the interviewed women, bacterial and viral causes of the disease were highly ranked in comparison to other risk factors. Only a small number of participants indicated human papillomavirus as an etiological factor. There is need to improve the knowledge about risk factors through health promotion and health education in order to change the epidemiological situation concerning cervical carcinoma.

BACKGROUND: Identification of reliable predictors of axillary lymph node metastases (ALNM) may be useful in selecting appropriate management for patients with T1-size breast cancer. This study was undertaken to determine the association between ALNM and several variables, including age, tumor size, grade, estrogen receptor status, progesterone receptor status, p53 and c-erbB2 protein expression, and Ki-67 proliferative index. METHODS: In a retrospective study, 74 patients with pT1b and pT1c ductal invasive breast carcinoma and with known nodal status were analyzed. The size of the infiltrating tumor was microscopically evaluated. The histological grading was performed using the modified criteria of Bloom and Richardson, as described by Elston and Ellis. The immunophenotype of the tumor was determined as: the expression of estrogen (ER) and progesterone (PR) receptors, p53, c-erbB2 and Ki-67. The patients were grouped by age as follows: 70 years old. RESULTS: Twenty six patients (35%) were node positive. Tumor size was related directly to nodal positivity. Nodal positivity was significantly related to negative PR status, p53 protein overexpression and high Ki-67 index (p

Background/Aim. The most common secondary manifestations of menopause are clinical manifestations of estrogen deficiency. They could be early and late. The aim of this study was to compare manifestations of somatic disturbances in early postmenopause in women after physiological and surgical menopause. Methods. This prospective study included 60 women, age 41-55 years, divided into two groups: physiological (30 of them) and surgically induced menopause. For every subject a special evidence list, consisting of the disease history questions, physical and gynecology examination as well as dates about physiological variables (arterial tension, height, weight, and body-mass index) and laboratory examination was formed. The values of arterial blood pressure, body height, body mass, body mass index (BMI), and lipid status were determined and gynecological examinations were performed in each patient. Results. The most frequent symptoms in both groups were vasomotor ones. Headache was the more intensive sign in the group after induced menopause. Extra systolic heart excursion was a common symptom in both study groups. Arterial tension, regardless of the type of menopause, was in the physiological range. The frequent organic signs of menopause, more intensive in the group after induced menopause, were genitourinary and skin atrophy. An analysis of the BMI showed that the women in both groups were obese (BMI > 25). The lipids analysis confirmed the predomination of hyperlipoproteinemia type IIa in the group with physiologic menopause and type IIb after induced menopause. Conclusion. The dominant signs of menopausal syndrome were vasomotor and bone-joint symptoms, more frequent in the group after induced menopause. There were no statistically significant differences between the study groups according to the genitourinary atrophy and other signs of aging. Menopausal hormonal changes, regardless of the way of menopause developing, increase the risk for hyperlipoproteinemia. The frequency of somatic signs in early post menopause is typically higher after induced menopause. More intensive follow-up in patients after surgical removing of the ovaria is necessary in order to improve the quality of life in these patients.

Background/Aim. Most human cancers, including breast one, increase in frequency with aging. The aim of this study was to explore the hypothesis that aging also alters breast cancer biology. Methods. The study included 120 women with primary invasive ductal carcinoma of the breast. We correlated the patients age and diagnosis with the commonly used clinical, pathological factors and newer tumor biomarkers. Immunohistochemical staining was conducted for p53, c-erbB-2, Ki-67, estrogen (ER), progesterone (PR) receptors, and angiogenesis. Results. In our study, the patients with axillary lymph node metastases and negative steroid hormone receptors (ER and PR) were significantly younger than the patients with nodal involvement and positive hormone receptors. There was also a significant association between the patients age, diagnosis and angiogenesis. No association was found between the patients age and tumor size, histological grade, p53, c-erbB-2, and Ki-67. Conclusion. The results of our study supported only partially the hypothesis that the breast cancer biology is significantly affected by a patient's age.

The sense of smell is the least examined of all senses. The significance of the organs of smell is in their influence on the mental state as well as on the vegetative, visceral and sexual functions. The objective of this experiment was to define the influence of sex on the olfactory function. It was performed on 120 subjects (60 females and 60 males) divided into three age groups (20 - 30; 31 - 40; 41 - 50 years of age). The experiment was carried out by the Fortunato-Niccolini olfactometric method using six odorous experimental substances: A - anethol, PH - phenyl-ethyl-alcohol, C citral, M - menthol, V- vanillin and P - pyridine, the thresholds of perception (TP) and identification (TI) being defined for each odorous substance. The examined females had slightly lower thresholds of perception (TP) and identification (TI) in relation to the males of the same age group. However, the differences were not statistically significant except for the group of subjects between 41 and 50 years of age where the females, being in the pre-menopause, had significantly better olfactory functions. The results can be explained by the weakening of the olfactory power as a result of ageing in both sexes, however, the females still experienced the protective role of sex hormones.

BACKGROUND: Superficially invasive neoplasias of the uterine cervix are a matter of controversy in terms of their definition, prognostic factors and selection of treatment to minimize the risk of recurrences. METHODS: Forty-three women with invasive cervical carcinoma, operated from 1993 to 2003, were postoperatively staged as IA cervical carcinoma. There were 28 patients who were submitted to class III radical hysterectomy, 9 patients to class II hysterectomy, 2 patients to class I hysterectomy, and 2 patients to abdominal trachelectomy and pelvic lymph node dissection. Mean age of patients was 44 years (range, 27-64 years). RESULTS: Twenty-three patients (56.1%) were stage with IA1 and 18 (43.9%) with stage IA2 disease according to the 1995 FIGO classification. Tumor histology revealed squamous cell carcinoma in 38 (92.6%) cases, adenocarcinoma in 2 (4.8%) cases and glassy cell carcinoma in 1 (2.4%). The average number of examined lymph nodes was 17.4 (2-53). Lymphovascular space invasion was identified in 3 patients. None of the 41 patients had metastasis to the pelvic lymph nodes or developed recurrence of disease. CONCLUSION: The results suggest that patients with cervical cancer stage IA1 have an extremely low risk of pelvic lymph node metastasis and an excellent prognosis, so nonradical management that excludes pelvic lymph node dissection could be as effective as radical surgery in these patients. Stage IA2 invasive squamous carcinoma of the cervix should be treated with radical hysterectomy with lymph node dissection considering the presence of risk factors. The treatment should be individualized and based on an exhaustive pathological evaluation of an adequate cone biopsy specimen.

Increasing importance is given to the clinical significance of the new formation of vessels (angiogenesis) in the course of physiological inflammatory and neoplastic processes. Angiogenesis is best studied in the growth of malignant tumors, since cancer may be regarded as the most important angiogenesis-dependent disease. Vascular endothelial cell proliferation, migration, and capillary formation are stimulated by angiogenic growth factors, which include the proteins vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor, and eicosanoids synthesized from n-6 fatty acids. Angiogenesis plays an important role in physiological proliferation of the endometrium and formation of corpus luteum in the second half of menstrual cycle. The present study showed that microvessel counts affect prognosis of patients with endometrial cancer. Analysis of angiogenesis in endometrial cancer may be a useful biologic parameter and additional study of neovascularization is required. Tumor angiogenesis is regulated by the balance of stimulators (e.g., VEGF, bFGF) and inhibitors of angiogenesis (e.g., angiostatin, endostatin, angiostatic steroids). Measuring angiogenesis (blood vessel density) and/or its main regulators such as VEGF and bFGF in solid tumors, or the levels of these growth factors in the serum or urine provides new and sensitive markers for tumor progression, metastasis and prognosis.

Borderline ovarian tumors are classified between benign cystadenoma and malignant cystadenocarcinoma. They are characterized as malignant tumors by histopathological features, which make them different from the benign ones. These tumors are commonly diagnosed at the early disease stage. The treatment of these tumors is surgical. The prognosis depends on the stage of disease and histopahtological types. We present 10 patients operated at the Institute of Oncology Sremska Kamenica because of malignant tumors with low malignant oncogenic potential in the period between 2000 and 2005. All patients had surgical treatment with ex tempore diagnostics, hysterectomy and adnexectomy with total omentectomy, or unilaterals adnexectomy. All patients had negative cytoanalytic findings of the small pelvis. Histopathological findings are necessary to confirm the diagnosis of disease. In young patients who had no children fertility can be preserved.

Introduction: A definitive diagnosis of cervical intraepithelial neoplasia (CIN) is confirmed after histopathological (HP) examination of the tissue obtained through the biopsy. The aim of this study was to compare histopathological results obtained with punch biopsy and results obtained through one of the excisional techniques., Material and Methods: We analysed histology results of 130 patients referred to our institution with abnormal smear. Punch biopsy was performed after colposcopic examination in all patients before one of the excision methods. Excision methods performed were: large loop excision of transformation zone (LLETZ), radio-frequency knife conisation or cold knife conisation. Based on the histopathological examination of the punch biopsy specimen or excisional specimen diagnosis of CIN was established., Results: CIN and invasive cancer were the most common diagnoses in the 31-40 age group at 45.4% (59/130). Discrepancies in the histological diagnosis between punch biopsy and excisional biopsy was identified in 58.5% (76/130) of the patients. In 6% of the of the cases the biopsy did not detect an invasive carcinoma., Conclusion: The most frequent discrepancies between punch biopsy and excisional biopsy were in the group of patients with a higher grade cervical dysplasia. Mild dysplastic changes diagnosed through punch biopsy, require a more conservative approach, as the majority of this group had negative specimens on the cone after excision, especially in the younger population. It is advisable that the patients above 30 years of age and a higher grade dysplasia in the biopsy specimen, should undergo one of the excisional techniques as a diagnostic/therapeutic method of treatment.

Cervical cancer still remains one of the major problems in developing countries. The last decade of 20th century has seen a trend towards more conservative surgical approaches in the treatment of early-stage disease in young patients. The trend of delaying childbearing, nowadays, increases preservation of fertility, and reproductive function is a major concern when counseling these young women with regard to the effects of treatment for cervical cancer. Radical trachelectomy, either with abdominal or vaginal surgical approach, showed promise as treatment option in young patients with early cervical cancer. The basic principle of such a surgical approach is an operation aiming at preserving the uterine body and removing the cervix, parametrium, with bilateral pelvic lymphadenectomy, and creating a utero-vaginal anastomosis, either laparoscopically or by laparotomy. Both surgical approaches are evaluated after a search of the relevant literature in Pub Med or Medline.

Purpose: Cervical cancer is the leading cause of death in women with gynecological cancers in Vojvodina. Serbia currently holds the leading place in Europe regarding the incidence of cervical carcinoma and comes second in terms of mortality., Methods: Data were retrieved from the Register for malignant neoplasms of the Institute of Oncology Vojvodina for the period 2001-2007. The patients were divided in 3 groups according to the stage of disease based on the FIGO classification for cervical cancer. Data were analysed using linear trend and t-test., Results: The linear trend of the number of registered cases in the group of stage I-IIA patients during 7 years showed no significant change in the prevalence of the disease. In the group of women diagnosed with stage IIB no statistical difference regarding either a rising or a decreasing trend was observed. The observed trend in an advanced disease stage (III and IV) showed a slight decrease in the number of patients, but without statistical significance., Conclusion: The linear trend of the number of patients with cervical carcinoma during a 7-year period points to the fact that the number of newly detected cases of advanced disease stages did not decrease significantly despite the affordable and simple methods of early detection. This result underlines the importance of implementation of a National screening programme in the general population for early detection of cervical neoplasms. The excellent results of National screening programmes in other European countries lend support to this approach.

Treating pregnant patients with a verified malignant disease represents a great clinical problem. Pregnancy-associated invasive cervical cancer is usually diagnosed at an early stage (approximately 70%). A 27-year-old patient was given the diagnosis of a pathohistologically verified cervical carcinoma, International Federation of Gynecology and Obstetrics stage IB1, in the 17th gestational week (GW). A radical abdominal trachelectomy was performed in the 19th GW. The patient was undergoing regular examinations at our institute of oncology while the Clinic of Gynecology and Obstetrics in Novi Sad, Serbia, monitored the pregnancy. In 36th GW, the patient had a cesarean section, with no visible traces of relapse, with good postoperative recovery and normal results in the newborn. The patient was discharged on the fifth postoperative day and advised to have her condition monitored at our institute of oncology. One year after radical trachelectomy, the patient is in the 15th GW of a new pregnancy with a normal Papanicolaou smear result.

Purpose: In 90% of all endometrial cancers vaginal bleeding is the leading clinical symptom. Nowadays, scoring systems have become acceptable in medicine as less invasive, adequate, diagnostic methods. The main goal of this study was to examine the clinical-sonographic scoring system as a noninvasive diagnostic method for endometrial cancer., Patients and Methods: The study included 122 patients with postmenopausal bleeding (PMB). Transvaginal sonography was performed before curettage. Patients were divided in two groups (A and B). In group A included were patients without endometrial malignancy and in group B were patients with endometrial cancer. A clinical-sonographic scoring system named ONCO 1 was created. Each patient got her own score based on anamnesis, clinical examination, and transvaginal ultrasonography. Evaluations of the clinical-sonographic scoring system were performed by using the test for diagnostic accuracy and receiver operating characteristic (ROC) curve., Results: Patients with endometrial cancer were older (median age in group B 64.49 years vs. 58.81 in group A), the length of corpus uteri was longer (6.41 cm in group B vs. 5.25 cm in group A), and the postmenopausal period was longer (13.67 years median in group B vs. 9.11 in group A). All parameters were statistically significant. The average value of clinical-sonographic scoring system ONCO 1 in group A was 7.13, +/-3.07 SD and in group B it was 9.14, +/-2.32 SD. The difference was statistically significant., Conclusion: Postmenopausal bleeding caused by endometrial cancer is usually diagnosed in older patients. It was possible to distinguish high-risk patients with neoplasia from those with benign changes of the endometrium using the clinical-sonographic systems ONCO 1. Nevertheless, histopathological examination is still unavoidable for the final diagnosis of endometrial cancer.

Purpose: To determine the financial impact of four potential solutions to reduce the financial burden of medical education: reducing medical school tuition, decreasing medical school duration, increasing residency compensation, and decreasing residency duration., Method: The four proposed remedies were compared to the current medical education system using net present value, a standard financial metric, which calculates financial impact in today's dollars. Medical school tuition and duration, residency stipends and duration, and physician salaries for general internists and internal medicine subspecialists were modeled based on historical data and current requirements., Results: Decreasing medical school duration by one year had the greatest financial benefit for future physicians and ranged from 160,000 US dollars to 230,000 US dollars in today's dollars. Reducing residency duration for medicine subspecialists by one year generated a financial benefit of 170,000 US dollars. Increasing residency compensation to that of a first-year physician assistant resulted in a financial benefit of between 60,000 US dollars and 100,000 US dollars. Reducing medical school tuition by 25% had the smallest financial impact, 30,000 US dollars in today's dollars., Conclusions: Decreasing the duration of medical education offers the greatest potential for reducing the financial burden of medical education. In many cases, the benefit in current dollars to a prospective physician exceeds 100,000 US dollars. This solution warrants further investigation.