Circulating HPV DNA in patients with cervical precancerous lesions and cervical cancer.

OBJECTIVE: In our review article we focused on the circulating HPV DNA and its potential role in the pathogenesis of cervical cancer and in the evaluation of patients´ prognosis with cervical cancer Design: The article is a systematic review study analyzing available scientific articles focused on the circulating HPV DNA. SETTING: Clinic of Obstetrics and Gynecology, Jesenius faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia. METHODS: In our study we searched the medical database PubMed with the key words: circulating HPV DNA, cervical cancer, cervical precanceroses. The core of our work is focused on the scientific articles published in English language since year 1995. RESULTS: We identified 13 studies in PubMed database analyzing the circulating HPV DNA in the process of cervical carcinogenesis. It is clear from the results that circulating HPV DNA is a significant prognostic marker of cervical malignant diseases including the early stages. CONCLUSION: The results focused on circulating HPV DNA show the significance of molecular biology in assessing the prognosis of cervical cancer. This idea has to be supported by further relevant studies. The uniformity of studies and use of the most sophisticated methods could help to answer the question about the real role of circulating HPV DNA in the process of cervical carcinogenesis and disease progression.

Potential of survivin for treatment of gynaecological tumour diseases.

OBJECTIVE: The main purpose of this article is to consolidate known facts about survivin, its contribution to inhibition of apoptosis, impact to tumorigenesis of gynaecological types of tumours. and possibilities of inhibition of survivin on molecular-genetic levels. DESIGN: A review article. SETTINGS: Division of Molecular Medicine, Biomedical Center in Martin, JLF UK Martin, Slovakia; Department of Gynaecology and Obstetrics JLF UK and UNM Martin, Slovakia; Division of Oncology, Biomedical Center, JLF UK Martin, Slovakia. METHODS: An analysis of the literature using database search engines focused on aberations in fuction of survivin, primarily in case of gynaecological tumours and possibilities of its inhibition. RESULTS AND CONCLUSIONS: Survivin is the smallest member of inhibitor of apoptosis (IAP) family. Despite of its size and affiliation to mentioned gene family, survivin can affect besides inhibition of apoptosis also proper process of mitosis, DNA reparation and angiogenesis. High levels of survivin expression are typical for fetal tissues during intrauterine developement. In healthy, adult tissues remain levels of survivin very low. Nonetheless, abundant expression of survivin is in many cases typical for various types of cancer, including gynaecologycal cancers Generally, it is possible to associate higher amounts of survivin with poor prognosis and resistance to chemo- or radiotherapy.

Perivascular epithelioid cell tumors of the uterine cervix.

The World Health Organization (WHO) defines PEComas as mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular cells. Uterus is the most common site of a subgroup of PEComas not otherwise specified(NOS). PEComas of the uterine cervix are extremely rare, and only thirteen cases have been described in the English literature to date. In this review, we summarize the available data concerning diagnostics, immunohistochemical analysis, genetics and treatment of cervical PEComas. Radical hysterectomy with bilateral salpingooophorectomy is the best surgical approach available. Adjuvant therapy in its present form is not efficient. Therefore, further studies are needed to evaluate the newest treatment strategies.

Determination of malignant potential of cervical intraepithelial neoplasia.

Basic diagnostic procedures in cervical cancer screening are able to set the diagnosis but they do not provide any information about the biological nature and behavior of lesions. The causal link of HPV infection and cervical cancer and discoveries of complex interactions between host and HPV genome opened new possibilities in molecular diagnostics. HPV DNA analysis, determination of viral load, detection of E6 and E7 mRNA transcripts, identifying of methylation profiles, genomic changes, miRNAs, and telomerase activity should be the right choice for exact diagnostics and prediction of behavior of premalignant lesions of the cervix. These findings set a completely new light not only in diagnostic but also in management and treatment of cervical dysplasia and cervical cancer.

[Breech presentation - an analysis of results in one perinatal center]. / Poloha plodu koncom panvovým - analýza výsledkov jedného perinatologického centra.

OBJECTIVE: A retrospective analysis of medical records during years 2007-2011 considers maternal and fetal outcome in patients with breech presentation terminated by vaginal delivery versus caesarean section (CS). DESIGN: Retrospective analysis. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. METHODS: Authors devided patients with breech presentation of fetus (n = 299) to groups of single pregnancies terminated in term (n = 197), before term (n = 67) and to group of multiple pregnancies (n = 35). All groups were devided according to the way of termination of pregnancy by vaginal delivery, by acute CS and by planned CS. Main followed parameters: parity, gestational week, Apgar score, birth weight, birth length, fetal gender, indications for CS, mortality and neonatal morbidity, umbilical artery pH, convulsions, admit to neonatal intensive care unit, intubation of neonate, intracranial bleeding, cervical spine and peripheral nerve injuries. RESULTS: Total cohort of breech deliveries was 299. In the group of single pregnancies in term was 19.8% terminated by vaginal delivery (n = 39), 32.5% deliveries by acute CS (n = 64). The most common indication was fetal hypoxia (43.8%). By planned CS was terminated 47.7% deliveries (n = 94). The most common indication for CS was footling presentation (54.3%). Severe neonatal morbidity was rare and without significant difference according to the type of termination of pregnancy. Neonatal outcome was comparable in the group of preterm deliveries(n = 67) terminated by vaginal delivery or by CS. All neonatal deaths were associated with extreme prematurity and not with type of termination of gravidity. CONCLUSION: Clinical outcomes between vaginal breech deliveries and breech deliveries terminated by CS in term in singleton pregnancies were not significant different. Mortality of neonates delivered by preterm delivery was associated with severe prematurity.