The role of sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial and cervical cancer.

INTRODUCTION: Endometrial and cervical carcinoma are common neoplasms in gynecological oncology. The prognosis and treatment depend on the stage of the cancer according to the FIGO staging system. Stage IAl may be treated by hysterectomy or even local surgical procedures. For Stage IA2, radical hysterectomy and lymphadenectomy must be performed. Lymph node metastasis is an important prognostic factor in both cancers, however lymphadenectomy is associated with long-term complications. Thanks to the sentinel lymph node biopsy (SLNB), we can more accurately discover the staging of the primary tumor, and in case of sentinel lymph node (SLN) negative patients, can resign regional lymphadenectomy. Some researchers claim that new techniques such as indocyanine green (ICG) and endoscopic near-infrared fluorescence imaging for sentinel node mapping can be used instead of the traditional techniques. AIM: To establish the role of sentinel node mapping technique in endometrial and cervical cancer. MATERIAL AND METHODS: A retrospective study of medical records of five patients with cervical cancer (first group) Stage I and nine patients (second group) who underwent laparoscopic radical hysterectomy and SLNB or group of lymph nodes. These procedures were performed at Gynecology Department of the District Hospital in Garwolin. RESULTS: All lymph nodes were clear of metastases. All patients after histopathological diagnosis were finally referred to the Cancer Centre and Institute of Oncology due to consultation or for further treatment. CONCLUSION: Based on the present first results and literature review, intracervical ICG injection with fluorescence imaging seems to be the best SLN mapping technique, because of its simplicity, safety, and overall lower cost. More data is required to determine if the nodes identified with this technique are able to predict metastatic disease.

Anti-Co(a) implicated in severe haemolytic disease of the foetus and newborn.

The Colton (Co(a)) antigen is of high frequency; its incidence in Caucasians is about 99.8%. Reports on haemolytic transfusion reactions and haemolytic disease of the foetus/newborn (HDFN) due to anti-Co(a) are rare. We report a severe HDFN due to anti-Co(a). The first child of the mother was healthy. The second died a few hours after delivery because of hydrops fetalis, likely due to HDFN; anti-Co(a) in the maternal serum, the father typed as Co(a+). The third pregnancy was followed up by the measurements of anti-Co(a) titre (additional antibodies were excluded), its functional activity by the chemiluminescence test (CLT) and the Doppler flow in the middle cerebral artery of the foetus. Increased values of antibody titre up to 128, the CLT to 30% and multiplex of median of the peak systolic velocity to 1.71 indicated haemolytic disease and the necessity for an intrauterine transfusion. The foetus received the maternal red blood cells (RBCs). Delivery had to be by Caesarean section for obstetrical reasons at 34-week gestation. The newborn (anti-Co(a) on red cells and in plasma, the rise of the bilirubin concentration up to 333 micromol L(-1)) had four exchange transfusions: the first of maternal RBCs, the remaining of donor's Co(a+) cells and one top-up transfusion. The baby was discharged in good health. Anti-Co(a) was responsible for severe HDFN. Proper monitoring during pregnancy and antenatal and post-natal therapy were successful. This is the second severe published HDFN due to anti-Co(a).

In vitro evaluation of the effect of aortic compliance on pediatric intra-aortic balloon pumping.

OBJECTIVES: To evaluate the effect of aortic compliance on pediatric intra-aortic balloon pumping (IABP). DESIGN: In vitro study using a mechanical model of the pediatric left heart circulation. SETTING: Cardiovascular fluid dynamics research laboratory. SUBJECT: Pulsatile flow system simulating the pediatric left heart circulation and two different aortas with compliances comparable to those of the pediatric aorta (0.12 and 0.07 mL/mm Hg). INTERVENTIONS: Measurements were made at a baseline peak aortic flow of 4 L/min, at simulated shock (1.7 L/min), and with 1:1 IABP (rates, 130 and 150 bpm; balloon volumes, 2.5 and 5.0 mL). MEASUREMENTS AND MAIN RESULTS: Peak flow rates were measured in the ascending aorta, coronary arterial system, and brachiocephalic arterial systems. Aortic pressure was measured in the ascending aorta. For both aortas (0.12 and 0.07 mL/mm Hg), IABP resulted in diastolic augmentation (38 +/- 8 and 43 +/- 16 mm Hg) and afterload reduction (4 +/- 2 and 6 +/- 3 mm Hg). For both aortas, compared to shock, IABP resulted in significant increases in coronary arterial and brachiocephalic arterial flow and aortic pressure for both aortas. Aortic flow significantly increased only in the less-compliant aorta. CONCLUSIONS: In a laboratory model of pediatric left heart circulation, IABP results in diastolic augmentation, afterload reduction, and improved hemodynamics, even in aortas of greater compliance.

[Transvaginal ultrasonography and diagnostic hysteroscopy in infertile women]. / Znaczenie ultrasonografii przezpochwowej i histeroskopii w diagnostyce nieplodnosci kobiecej.

Sensibility and specificity of transvaginal ultrasonography and diagnostic hysteroscopy were compared in 211 infertile women. Examinations were performed between 1996-2000 in I-st Department of Obstetrics and Gynecology Warsaw Medical University--Poland. Comparing results we concluded high compatibility of transvaginal ultrasound and hysteroscopic examinations. In the future--as we suppose--the number of diagnostic hysteroscopies in infertile women will decrease and will be at least partially replaced by transvaginal ultrasound as less invasive and less expensive method.

Diagnosis and treatment of sigmoidal endometriosis--a case report.

Intestinal endometriosis is a rare but clinically significant complication. The most commonly involved sites are the rectosigmoid (up to 73%) and rectovaginal septum (13%). A case of a 53-year-old woman with intestinal endometriosis located in the sigmoid colon is presented with symptoms of pelvic pain and rectal bleeding. The diagnosis was established by means of colonoscopy which was performed 3 times before laparotomy. Bowel resection and pathologic study are necessary to relieve the symptoms and avoid neglecting a malignant tumor or other lesions. The postoperative course was uneventful and the patient was discharged after 13 days.

[Computer-assisted analysis of cardiotocographic recordings in the course of fetal hemolytic disease]. / Komputerowa analiza zapisów kardiotokograficznych w ciazy powiklanej choroba hemolityczna plodu.

OBJECTIVES: The aim of this study was to assess the usefulness of computerized cardiotocography in the diagnostics of fetal hemolytic disease. STUDY DESIGN: 50 invasive diagnostic and therapeutic procedures proceeded by computer assisted CTG recording were analysed. The values of particular parameters of CTG were compared with adequate values obtained in uncomplicated pregnancy. The correlation between both cardiotocographic and hematological parameters was estimated. The common relationship between all analyzed features was examined using multidimensional analysis of variancy. RESULTS: The most significant correlation was determined in case of short-term variation and hematocrite of fetal blood. The five-feature algorhythm, containing short- and long-term variation, number of accelerations, fetal movements and gestational age, was established for the prognosing of the most probable level of fetal hematocrite. CONCLUSION: Computerized cardiotocography seems to be the useful diagnostic method which enable to decrease the number of invasive intrauterine procedures in case of fetal hemolytic disease.

Freeze-drying of Aegyptianella pullorum.

Heparinized whole blood, parasitized with Aegyptianella pullorum, was collected from 2 fowls. Buffered lactose peptone (BLP) was added v/v as a stabilizer and the mixture lyophilized in 2 ml aliquots after rapid or slow freezing. At different stages during the freeze-drying process, as well as after lyophilization and reconstitution with 1.8 ml of sterile water, samples were taken and injected into pullets. Infectivity was maintained throughout. However, the prepatent period was lengthened after freezing and particularly after lyophilization when there was some loss of viability.

Broiler pulmonary hypertension syndrome. I. Increased right ventricular mass in broilers experimentally infected with Aegyptianella pullorum.

Infection with the obligatory intra-erythrocytic anaplasma-like rickettsia Aegyptianella pullorum in 4-week-old broilers at a moderate altitude of 1,200 m produced a significant increase in the mean relative right ventricular (RV) mass (RV: TV) from 0.23 in the controls to 0.31 in the infected group. This was accompanied by an increase in the number of birds suffering from severe RV hypertrophy from 14.3% in the controls to 50% in the infected group. Pulmonary hypertension and subsequent RV hypertrophy could have been caused by the severe anaemia experienced in the course of the infection or by metabolic or biochemical action of A. pullorum. As the agent does not occur on commercial broiler farms, it cannot play a practical role in the broiler ascites syndrome.