Meigs' syndrome with elevated CA-125 and HE-4: a case of luteinized fibrothecoma.

Presence of fibrothecoma is not usually accompanied by elevated levels of tumor markers. In recent years, however, there have been isolated reports of fibrothecoma and Meigs' syndrome, accompanied by an increase in tumor markers. We present a case of fibrothecoma with Meigs' syndrome and elevated levels of both CA-125 (cancer antigen 125) and HE-4 (human epididymis protein 4). In this paper, we present a case of Meigs' syndrome associated with an increased CA-125 and HE-4 level due to ovarian fibrothecoma.

[Clitoromegaly--treatment with the harmonic knife (case description)]. / Przerost lechtaczki--leczenie z zastosowaniem noza harmonicznego (opis przypadku).

Clitoromegaly, state when clitoris is non-physiologically large, most frequently occurs among patients with endocrine disorders (adrenal-genital syndrome, hormonally active tumors producing androgens, the use of anabolic steroids) or genetic. Less often the clitoromegaly is idiopathic of unknown etiology. There are no fixed standards for the size of organ, but it is assumed that not being in erect clitoris due to sexual arousal has a diameter of no more than 1/2 cm. To assess the size and shape of the clitoris can be used five Prader scale. However, it is most commonly used to assess the genitals of intersex. To the Clinic of Gynecology Oncology and Gynecology reported a 33 year old female patient because of escalating discomfort in sexual life. Patient associated her discomfort with her overly enlarged and painful clitoris preventing its proper coexistence. Gynecological survey found the correct size uterus and appendages. Vestibule of the vagina and the vagina of normal length and width. Larger and smaller labia developed properly. Clitoris increased to approximately 4x2 cm, not swollen, moving, with a uniform consistency. Except clitoromegaly in initial examination no abnormalities were found. Prior to surgery the patient has identified karyotype (46 XX) and has made designation of the levels of sex hormones and sonographic examination. In conducting these studies there was no answer found for the reason of clitoromegaly, there was the idiopathic overgrowth stated. Because of the pain during cohabitation associated with clitoromegaly, the patient was classified for reducing operation of this organ. For fear of the possibility of organ dysfunction, excessive bleeding and the appearance of postoperative adhesions abandoned classical surgical technique. It was decided to use in this operation, the harmonic knife. The use of harmonic knife allows avoiding introperative bleeding and precise, a partial reduction of the clitoris to the considered correct size without damaging of the organ structures. A month after surgery, the patient started having satisfying sex without feeling any pain and preserving proper function of the clitoris.

[Ectopic and intrauterine simultaneous pregnancies--diagnostic difficulties]. / Ciaza wewnatrzmaciczna i jajowodowa--trudnosci diagnostyczne.

There are special troubles to diagnose ectopic and intrauterine simultaneous pregnancies. The intrauterine pregnancy usually releases from coexisting ectopic pregnancy diagnosis. Diagnostic difficulties were analysed.

[Three-dimensional sonoangiography in diagnostic of endometrial hyperplasia and carcinoma. An assessment of vascularization indices and endometrial volume]. / Trójwymiarowa sonoangiografia w diagnostyce rozrostów i nowotworów blony sluzowej macicy. Ocena indeksów naczyniowych oraz objetosci endometrium.

Three-dimensional sono-angiography was executed in 123 women with uterine bleedings in perimenopausal period. With the use of software for automatic measurement of volume of blocks (VOCAL, Kretztechnik, Austria) vascular indices (VI, Fl, VFI) and endometrial volume (EV) were estimated. Based on histopathological estimation of endometrium the patients were divided into the following groups: atrophic, proliferative, secretive endometrium, hyperplasia and endometrial cancer (EC). Mean EV in women with EC amounted to 16.82 ml and was significantly higher (p < 0.005) than in women with hyperplasia or without pathological changes. Mean values of vascular indices VI, Fl and VFI in the group of women with EC amounted to respectively 5.464; 25.995 and 1.898 and were also significantly higher in comparison to remaining groups of patients. The results of the investigation suggest, that three-dimensional measurement of endometrial volume with assessment of vascular indices (VI, Fl, VFI) can be valuable prognostic element improving a diagnostic precision of sonographic estimation of pathological changes of endometrium.

[Application of unabsorbable polypropylene mesh in patients with vaginal prolapse after hysterectomy]. / Zastosowanie niewchlanialnej siatki polipropylenowej u pacjentek z wypadaniem kikuta pochwy po operacjach wyciecia macicy.

OBJECTIVES: Vaginal prolapse is one of delayed complications of hysterectomy. DESIGN: The aim of this work is estimation of efficiency of the application of unabsorbable polypropylene mesh in patients with vaginal prolapse after a prior operation of hysterectomy. MATERIALS AND METHODS: In the work the authors have described the operation procedure. It was performed in 6 women aged 49-73. Patients were inspected in 1, 3 and 6 months after the operation. RESULTS: The authors have estimated anatomical relations and postsurgical complications. CONCLUSION: The operation with the use of unabsorbable polypropylene mesh is an easy and efficient method of treatment of vaginal prolapse in patients after hysterectomy.

Successful treatment with recombinant factor VIIa for intractable bleeding at pelvic surgery.

BACKGROUND: Postoperative bleeding may be complicated by failure to identify the site of bleeding, multiple bleeding points, and persistent hemorrhage despite surgical intervention. CASE: Activated recombinant factor VII was used successfully in a patient with life-threatening postsurgical bleeding after resection of two large extraperitoneal pelvic sarcomas. CONCLUSION: In severe hemorrhage, hemostasis can be achieved with activated recombinant factor VII.

[Three dimensional sonography in the endometrial volume measurement in women with perimenopausal irregular uterine bleeding]. / Zastosowanie trójwymiarowej ultrasonografii w ocenie objetosci blony sluzowej macicy u kobiet z krwawieniami z jamy macicy.

OBJECTIVES: Evaluation of the role of three-dimensional (3D) ultrasonographic measurement of the endometrium volume in perimenopausal women with irregular uterine bleeding. MATERIAL AND METHODS: We have assessed 45 women (23 postmenopausal) with 3D transvaginal probe and automatic volume measurement (VOCAL) software using Voluson V730 scanner (Kretztechnik, Austria). Additionally, doppler blood flow indices PI, RI and PSV in uterine artery as well as endometrial thickness were measured. All ultrasound data were verified by histology of the endometrial specimens removed during D&C or hysterectomy. RESULTS: The age of the study group ranged between 43-70 years (median 53 years). The mean volume of endometrium in women with endometrial cancer was 19.9 +/- 7.5 ml. The mean volumes measured in women with endometrial hyperplasia and normal endometrium were 12.2 +/- 7.9 ml and 7.4 +/- 4.8 ml, respectively. There was a significant difference in endometrial volume between each pair of study groups (P < 0.05). Moreover, significant differences were found in mean endometrial thickness between endometrial cancer and benign but not in hyperplastic endometrium. In contrast, there were no significant differences in study groups in mean values of Doppler blood flow indices measured in uterine artery. CONCLUSION: We conclude that 3D sonography and automatic volume measurement might be used better to characterize endometrial changes in women with perimenopausal bleeding.

[Sonoangiography and logistic regression analysis in the preoperative differentiation of ovarian tumors]. / Sonoangiografia i zastosowanie logistycznej analizy regresji w przedoperacyjnej charakterystyce guzów jajnika.

OBJECTIVE: To apply logistic regression analysis for several clinical and sonographic data for the construction of a predictive model that could be helpful in the preoperative differentiation of adnexal masses. MATERIALS AND METHODS: Two hundred and eight women with tumors thought to be of adnexal origin were examined preoperatively. Initial analysis included age and menopausal status, ultrasound derived morphological features of adnexal masses (unilateral/bilateral tumors, papillae, septae, tumor size and volume) as well as color Doppler criteria such as PI, RI, Peak Systolic Velocity, PSV assessment. In all examinations we used B&K 2002 ADI (Denmark) and Kretz Voluson V730 (Austria) scanners with transvaginal probes 5-9 MHz. Stepwise logistic regression analysis was used to construct a predictive model that would allow probability of malignancy calculation for individual patient. RESULTS: There were 159 benign and 49 malignant masses. Seven cancers were in FIGO stage one. Statistical analysis revealed that only 5 of initially tested 14 variables had significant influence on the regression equation. These were: age, bilateral mass, presence of septa > 3 mm, papillary projections > 3 mm in the tumor wall and subjective color scale assessment according to Timmerman et al. (1999). Sensitivity and specificity at the 50% probability level of malignancy in the studied tumor were 77.5% and 96.8%, respectively. When 25% cut-off probability level was used, sensitivity increased to 87.7% and specificity dropped to 89.9%. Prospective testing in a new group of 30 patients (5 ovarian cancers) gave sensitivity of 80% and specificity of 100%. CONCLUSIONS: The use of logistic regression analysis can help in modeling clinical and sonographic data. Our model had better predictive value than individual tests and allowed to calculate true probability figure of ovarian malignancy for any given patient with adnexal mass.