SEMA3B but Not CUL1 as Marker for Pre-Eclampsia Progression

@#Background: An imbalance between pro- and anti-angiogenic factors contributes to impaired trophoblast invasion during pregnancy, leading to failure of uterine spiral artery remodeling, blood vessel ischemia, and pre-eclampsia (PE). Anti-angiogenic semaphorin 3B (SEMA3B) and pro-angiogenic cullin 1 (CUL1) are expressed in both the placenta and maternal blood. The present study investigated correlations between serum and placental SEMA3B as well as CUL1 levels in late-onset PE. Methods: This cross-sectional study included 50 patients with late-onset (≥ 32 weeks gestation) PE. Maternal serum was obtained before delivery, and placentas were obtained immediately after delivery. SEMA3B and CUL1 levels were evaluated by ELISA. Results were statistically analysed by Spearman correlation test, with a P < 0.05 considered statistically significant. Results: While elevated serum SEMA3B levels significantly correlated with increased placental SEMA3B levels in late-onset PE (R = 0.620, P = 0.000), alteration of serum CUL1 levels did not correlate with alteration of placental CUL1. Conclusion: Alteration of circulating maternal SEMA3B, but not CUL1, levels can potentially be used to monitor PE progression during pregnancy.

VEGF-C level as a predictor of pelvic lymph node metastases of cervical cancer at early stage.

Aim Vascular endothelial growth factor (VEGF) works to stimulate angiogenesis and lymphogenesis which is one of the factors in the metastasis process. This study aimed to identify whether VEGF level could be used to predict metastasis into pelvic lymph node of stage IB-IIA cervical cancer. Methods The study was case control study, a case (cervical cancer metastasis into pelvic lymph node), a control (cervical cancer without metastasis). Independent variables included primary lesion size, histological type, grade of cell differentiation, lymph vascular space involvement, and VEGF level. Dependent variable was metastasis into pelvic lymph node. Results Based on cut-off point, VEGF-C serum level, i.e., 10,066.90 pg/ml, 11/47 patients or 23.41%, had the level above that value, and 10/11 of the group of patient or 90.91% were found to develop metastasis into pelvic lymph node. Sensitivity of the examination of VEGF-C level in relation to the risk for the incidence of lymph node in this study was 71.43%, with a specifi city of 96.97%, positive predictive value (PPV) of 90.91%, and negative predictive value (NPV) of 88.89%. Conclusion VEGF-C level in the serum could be used to predict lymph node metastasis of stage IB-IIA cervical cancer, with a sensitivity of 71.43% and specifi city of 96.97%.

Study on retinol binding protein (RBP) receptor in hydatidiform mole trophoblastic cells.

Hydatidiform mole is an abnormal pregnancy characterized by the proliferation of cytotrophoblastic, syncytiotrophoblastic, and intermediate trophoblastic cells in histological specimens. Vitamin A plays a role in controlling cell proliferation, and decrease in vitamin A level will cause an uncontrollable proliferation. To date, it is not known whether there is a relationship between vitamin A deficiency and hydatidiform mole. This study aimed to demonstrate the presence of retinol binding protein (RBP) receptors in the hydatidiform mole trophoblastic cells, that would provide explanation on the relationship of vitamin A and hydatidiform mole. The study was a descriptive study. The specimens of the study were paraffin blocks of hydatidiform mole made in 2005, and the examinations were performed by indirect immunohistochemistry. We examined the distribution of the cells showing expression of RBP receptor, the strength of expression, and location of the expression. As many as 21 specimens were collected, and the distributions of RBP receptor expression in hydatidiform mole trophoblastic cells ranged from moderate to dense. The expression in syncytiotrophoblastic cells was stronger than that in cytotrophoblastic cells. Furthermore, the expressions were found in the cell membranes and cytoplasm.

Survival rate and prognostic factors in advanced cervical cancer patients accompanied by renal impairment.

The objective of this study was to obtain information on the survival rate of advanced cervical cancer patients with renal impairment (ACCRI) and its prognostic factors. In addition, it is hoped that by this method the scoring system for predicting the death of ACCRI patients hopetully could be obtained. Design of the study used was retrospective cohort study. Data collected were retrieved from medical records of ACCRI patients from 1 January 1998 to 31 December 2003 at Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, with a total sample of 70 cases. The results of the study showed that mean survival of all ACCRI patients was 8.2 months, mean survival at sixth month was 39%, and mean survival at one year was 3.2%. Median survival was 5.3 months. Prognostic factors affecting the survival of ACCRI patients included histopathological type (adenosquamous cell and cell differentiation), cortical thickness of the kidney less than 1 cm, and nephrostomy.

Presurgical cytologic diagnostic test of uterine cavity in ovarian malignant tumor.

There are several methods for diagnosing ovarian carcinoma, such as gynecological examination, ultrasonographic examination, and tumor marker examination. However, all these combinations have not yielded high specificity antl sensitivity results. For this reason, it is necessary to perform other examinations to enhance both specificity and sensitivity, and one of them which is of interest to be studied is cytological examination of uterine cavity. By cytological examination of uterine cavity, it is hope that malignant cells originating from ovarian malignant tumor can be found. Discovery of ovarian malignant cells is possible because of peristaltic mechanism in the fallopian tube and negative pressure from uterine cavity, that makes possible the transportation of ovarian malignant cells into uterine cavity through the tube. The objective of this study is to understand the sensitiviry and specificity of cytological examination of uterine cavity in detecting ovarian malignancy. This stucty was a diagnostic test with histological examination as the gold standard, to understand sensitivity, specificity, positive prediction value, and negative prediction value of cytological examination of uterine cavity. A total of 30 cases were included in the study. A nurnber of factors enhanced positive results in cytology of uterine cavity. Those factors were stage and ascites. The more advanced the stage, the greater the positive results, and the presence of ascites increased positive results. On diagnostic test, sensitivity of uterine cavity cytology was 48%, specificity 60, positive predictive value 85.7%, and negative predictive value 18.8% respectively. In conclusion, cytological examination of uterine cavity could be used as one of the methods in assistirtg the diagnosis of ovarian carcinoma.

Diagnostic test of endometrial cytobrush in cases of perimenopausal and postmenopausal hemorrhage.

Perimenopausal menopausal hemorrhage can be due to by a variety of causative factors. One of its dangerous causes is atypical hyperplasia and endometrial carcinoma. There are a number of risk factors for the occurrence of endometrial carcinoma. The group that has this risk belongs to high-risk group. In this high-risk group, it is necessary to have a method to identify the changes in endometrial abnormality. One of the alternatives is the examination of endometrial cytology. The objective of this study was to evaluate the sensitivity, specificity and correlation test between endometrial cytology and endometrial histology. This study was a diagnostic test of cytological examination of the endometrium as compared with endometrial histology. Endometrial cytology was performed with a modification of cytubrush and IUD shell. Specimen was dissolved into the centrifuged NaCl, and its deposits were then processed for cytological examination with Papanicolaou and Giemsa staining. After the taking of cytology, the process was continued with curettage of the endometrium, and the specimens were processed for cytological examination. Both of them were examined by anatomic pathologist. Statistical analysis used diagnostic test using histological examination of curetage specimens as gold standard. During the period of study 45 study samples were collected, among which 12 (26.66%) were endometrial adenocarcinoma, 6 (13.33%) with atypical hyperplasia, 11 (24.44%) with non-atypical hyperplasia, 15 (33.33%) were samples without abnormality, and one sample with endometritis. Actual correlation value was 57.8%, correlation because of possibility 3.38%, and correlation not because of possibility 54.42%, potential correlation not because of possibility 96.62%, and Kappa value 0.56. It was concluded that cytological examination of the endometriurn with cytobrush could be employed as a screening method in the abnormalities of endometrial thickness, with sensitivity of 62.5% and specificity of 62.2%.

Clinical-pathologic factors, as predictor of lymph nodes metastasis in cervical cancer stage IB and IIA.

The aim of this study was to identify possible predictor factors of lymph node metastases in patients with cervical cancer stage IB and IIA. Study was conducted between May 1996 and December 2001. There were 183 patients of cervical cancer with FIGO Stage IB and IIA who were underwent radical hysterectomy and lymphadenectomy. From those 158 patients could be evaluated, consisting 43 patients with node metastases 115 patients without metastases. Research design was case control study. Case was patients with node metastases and control was those without node metastases. Multivariate analysis was made after bivariate analysis. On bivariate analysis age < 39 years, diameter of lesion > 4 cm, stage IIA > 4 cm, histopathology moderate and poor differentiation, blood and lymphatic vessel invasion were independent variables for node metastases with p value ≤ 0.05. However, on multivariate analysis younger age, parity ≥ 4, diameter of lesion, histopathology adenosquamous, and lymph vascular invasion (+) as independent factors for node metastases with p value ≤ 0.05. Conclusion: Younger age, parity ≥ 4, stage IIA > 4 cm, diameter of lesion, histopathology adenosquamous, and lymph vascular invasion (+) were risk factors for node metastases and can be used as predictors.

Surgical management of stage I and II vulvar cancer:The role of the separated incision.

Vulvar cancer is a gynecological cancer whose incidence rate is relatively low. Patients generally were admitted at advanced stage, and radiation therapy at advanced stage does not provide favorable prognosis. Two main modalities in the treatment of vulvar cancer are surgery and radiation therapy. However, radiation can be performed in early stage vulvar cancer but surgery is thought to have more benefits, such as in side effect on the ovary/ reproductive function disorder, patient's hygiene factor, and the ease in performing therapy if recurrence occurs. There are various techniques of vulvar cancer surgery, such as radical vulvectomy with butterfly incision (RVBI) and radical vulvectomy with separated incision (RVSI). The objective of this study was to identify the benefits of radical vulvectomy with separated incision in comparison with radical vulvectomy with butterfly incision in terms of the length of surgery, wound recovery, infection incidence, length of hospital stay. This study was a clinical trial performed during the period of 1990-2000. Fifteen cases of vulvar cancer were found and underwent surgery. Fourteen cases were at stage II and 14 cases were histologically defined as squamous-cell carcinoma and 1 case was adenocarcinoma. The average length of surgery in RVSI was 168 minutes, this was shorter than that in VRBI which reached an average of 275 minutes. The incidence of infection in RVSI group was 3 of 11 cases (27.27%), while in RVBI group all cases had infection in surgical wound. Failure of surgical wound approximation was 1 of 12 cases (9.99%), while in RVBI all cases experienced the failure such that cosmetic surgery was required. Length of postoperative care in RVSI group was 12.3 days, while in RVBI 21.5 days. Thus, complications in VRBI were lower, and length of surgery and length of postoperative care were shorter.