Five-year disease-free survival in FIGO IA stage endometrial cancer patients: Tertiary institution experience in a developing country.

Purpose: Endometrial cancer is characterized as histopathological, molecular, genetic, biological, and very diverse group of malignancies. Due to the need to precisely define the indications for adjuvant treatment in recent years, there has been a division made according to risk groups based on prognostic factors, which identify patients at risk for disease relapse, who may benefit from adjuvant therapy. The aim of this research was to examine the clinical and morphological factors that influence disease-free survival (DFS) and overall survival (OS) in patients with FIGO IA stage endometrial cancer. Material and methods: A retrospective clinical study was conducted, primarily based on the identification of factors that influence five-year DFS and OS. The study integrated data of FIGO IA stage endometrial cancer patients, who presented to gynecological oncology board for the first time after operative treatment, from January 1, 2016 to January 1, 2022. Adjuvant radiotherapy was applied to patients with an initially higher risk of disease progression. Length of survival was analyzed using Kaplan-Meier method, while log-rank test was used to assess differences between groups. Results: The results show that 5-year OS for 93 patients was 89.2% and DFS was 88.2%. Application of adjuvant brachytherapy, number of deliveries, MRI staging, type of institution where the surgery was performed influenced DFS. Pathohistological characteristics of tumor indicated a statistically significant impact on DFS. Conclusions: Application of adjuvant brachytherapy in high-intermediate and high-risk patients contributes to DFS increase. Moreover, the existence of a pre-operative MRI assessment of the stage of disease as well as the type of healthcare provided by an institution where the surgery was performed, significantly affect DFS.

Zuclopenthixol decanoate in pregnancy: successful outcomes in two consecutive offsprings of the same mother.

INTRODUCTION: Almost all individual antipsychotics are classified into the intermediate pregnancy risk category as no or limited data exist about human pregnancy outcomes. We presented the case of zuclopenthixol decanoate using in two successive pregnancies of the same woman, which had not been published in the available peer-reviewed literature. CASE REPORT: A middle-age female subject who suffered from schizophrenia received zuclopenthixol decanoate injection during her two consecutive pregnancies. About four and a half months before diagnosis of the first pregnancy (to approximately 3.5 years after psychosis emergence), zuclopenthixol decanoate (400 mg every other week, im injection) was introduced to the treatment protocol (due to previous non-compliance with haloperidol and risperidone). A significant clinical improvement was achieved and the dose during pregnancy was reduced to 200 mg once monthly and maintained to date. In both pregnancies the women gave birth to healthy girls who have been developing normally until now, at their ages of 6 months and of 3.5 years. During pregnancy and after giving birth to children the mothers' psychiatric status and her social functioning were significantly improved and are still stable. Close monitoring of the mother's health, a multidisciplinary approach to both her treatment and the monitoring of pregnancies as well as the complete compliance with the prescribed drug protocol were likely to be crucial for the therapeutic success. CONCLUSION: A favorable outcome of the present case suggests that the zuclopenthixol decanoate is a rational therapeutic option for pregnant women suffering from psychosis when the expected benefit exceed the potential risk, but a definitive evidence for its safety requires large, controlled studies.

Significance of pregnancy-associated plasma protein A (PAPP-A) concentration determination in the assessment of final outcome of pregnancy.

BACKGROUND/AIM: Pregnancy-associated plasma protein A (PAPP-A) is high molecular matrix metalloproteinase originally isolated in the serum of pregnant women. The aim of this study was to analyze the values of concentration of PAPP-A in assessment of progress and outcome of pregnancy in pregnant women diagnosed with threatening preterm delivery, preeclampsia and fetal growth restriction in relation to physiological pregnancy of the same gestational age. METHODS: The study included 60 pregnant women that were divided into three groups according to gestational age and the diagnosis of imminent premature birth upon reception, preeclampsia and fetal growth restriction as follows: the group I from 28 to 32 weeks of gestation, a total of 25 pregnant women, the group II from 33 to 36 weeks of gestation, a total of 23 pregnant women, and the group III from 37 to 41 weeks of gestation, a total of 12 pregnant women. The control group consisted of 60 pregnant women without complications of pregnancy that were identically divided into three groups according to gestational age as in the sample. We performed quantitative determination of PAPP-A from the venous blood of patients by using commercial tests of the company Diagnostics Product Corporation (DPC), Los Angeles, California, USA. RESULTS: There was a statistically significant difference in PAPP-A values in the examined groups in all gestational ages (p < 0.01). The value of the PAPP-A concentration in different gestational ages with equal statistical significance indicated the possibility of complications, which was examined during pregnancy in relation to the control group of pregnant women with physiological pregnancies. This study confirmed that there was a statistically significant difference in fetal body weight at birth (p < 0.05), Apgar score in 5 min after birth (p < 0.05), and gestational age at birth (p < 0.05), as parameters of the outcome of pregnancy course, between the examined groups of pregnant women in relation to the value of PAPP-A concentration. The age of pregnant women was not statistically different in the examined groups (p > 0.05). CONCLUSION: Differences in PAPP-A concentration should point out to the obstetrician the need for more intensive antepartum fetal surveillance in order to increase the chances of favorable perinatal outcome, regardless gestational age.

Neurologic manifestations of hypereosinophilic syndrome--review of the literature.

Hypereosinophilic syndrome is a rare disorder of the hematopoietic system. The disease is characterized by continuously high number of eosinophils (>1.5 x 10(9)/L) for more than six months. Other possible causes of hypereosinophilia, such as allergic and parasitic diseases, malignant disease, Churg-Strauss disease and infection should be eliminated. The most common manifestations of hypereosinophilic syndrome are pulmonary, skin, gastrointestinal, cardiac difficulties and neurologic lesions. Numerous neurologic lesions have been described, in particular of the central and peripheral nervous systems. Review of the literature revealed the following to have been recorded so far: mononeuritis multiplex, sensory polyneuropathy, radiculopathy, myalgia, myositis and perimyositis, neuropathy, ataxia, paraplegia, ophthalmologic abnormalities, optic neuritis, hemiplegia-hemiparesis, spasmodic quadriplegia, seizures, meningitis, cerebral infarction, organic psychosyndrome, other mental changes, stroke, temporal arteritis, leptomeningeal dissemination, memory deficits and dysarthria.

Predictive value of fetal nuchal translucency.

AIM: To determine the predictive value of fetal nuchal translucency (NT) measurements in the detection of chromosomopathy. METHODS: The investigation of NT included 317 pregnant women with singleton pregnancies of gestational age of 11 to 14 weeks with pathological karyotype. The control group consisted of pregnant women whose amniocentesis findings indicated a normal fetal karyotype. RESULTS: The median value of NT in the control group was 1.92 +/- 0.39 mm, and in the group with pathological fetus karyotype findings it was 2.49 +/- 0.37 mm (p < 0.05). The median value of crown-rump length was 64.83 +/- 8.23 mm and 60.12 +/- 8.48 mm in the control group and in the group with pathological karyotype, respectively. The gestational age in the control group was 87.10 +/- 87.10 days, while in the pathological group it was 85.69 +/- 3.98 days, which indicated the homogeneity of the investigated sample (p > 0.05). The probability for a patient with negative NT findings to be healthy was 1.0, NT sensitivity as a marker for chromosomopathy was 1.0. The rate of false positive findings was 0.026. The specificity of NT as a marker for chromosomopathy was 0.97. CONCLUSION: Normal NT findings could be considered reliable ultrasonographic markers in the assessment of the absence of chromosomopathy. Pathological findings, given the low positive predictive value of NT must be interpreted in the context of other prenatal tests before the pregnant woman is advised to undergo invasive prenatal diagnosis.

Anticardiolipin antibodies in pathogenesis of infertility.

BACKGROUND/AIM: Antiphospholipid syndrome (APS) is an autoimmune disorder clinically characterized by arterial or venous thrombosis and/or specific obstetric complications and presence of antiphospholipid antibodies (aPL) in the serum. It occurs in 0.3% of pregnant women, while 1% of them have two spontaneous abortions. The aim of this study was to analyze the frequency of biphospholipid antibodies in pregnant women with recurrent spontaneous abortions. METHODS: We analyzed 60 pregnant women who had two or more recurrent miscarriages. The control group included 60 healthy pregnant women. We analyzed titres of anticardiolipin (aCL) IgG and/or IgM with high titres (> 20 U/mL), lupus anticoagulant (LAC) antibodies and anti-beta-2 glycoprotein (b2-GP1) IgG as well as parameters of coagulation status of pregnant women. RESULTS: Analyzing Spearman's rank correlation coefficient in a group of affected patients, we noticed a slightly positive correlation of lupus anticoagulants (LAC) with aCL antibodies of both classes, while the correlation with b2GP1 IgG was negative. Both classes of aCL antibodies and anti-b2GP1 IgG were in a discrete positive correlation with the given variables. In the control group, there was a lack of consistency in correlation of the study variables with LAC-aCl IgG, compared to the affected patients, and there was a standard negative coefficient of correlation with anti-b2GP1 IgG. The correlation ratio of anti-b2GP1 IgG was negative for all studied test parameters. Analysis of hemostatic parameters showed a statistically significant difference in the concentration of fibrinogen (p < 0.01) and thrombocyte count (p < 0.05) between the study and the control group of pregnant women. Lower mean values of fibrinogen (2.90 +/- 0.45 g/L) and lower thrombocyte count [(179.20 +/- 6.00) x 10(9)] were found in the study group of pregnant women with secondary infertility compared to the mean values of fibrinogen (3.60 +/- 0.55 g/L) and thrombocyte count [(236.05 +/- 5.10) x 10(9)] in the control group. Activated partial thromboplastin time and prothrombin time were statistically significantly prolonged (p < 0.05) in pregnant women with spontaneous abortions compared to controls, suggest anticoagulant activity. CONCLUSION: In pregnant women with spontaneous abortions compared to healthy pregnant women slightly positive correlation of LAC with aCL antibodies of both classes, as well as a positive correlation of aCL antibodies with anti-b2GP1 IgG exist. On the other hand, hemostatic parameters values suggest an anticoagulatnt status in the blood of pregnant women with spontaneous abortions.

Correlation between serum biochemical markers and early amniocentesis in diagnosis of congenital fetal anomalies.

A combined test performed at the 12th week of gestation enables us to classify the pregnancy as high risk (risk higher than 1:300) or low risk (risk lower than 1:300) for congenital foetal anomalies, with great accuracy of 85 - 90%. According to the available data, the frequency of false positive results is estimated at around 5%. The objective of the study was to examine possible correlation between the serum marker values and amniocentesis results in prenatal diagnostics of congenital foetal anomalies. The study included 745 pregnant women monitored by the Genetic Counselling Service of the Clinic of Gynaecology and Obstetrics of the Clinics Centre Kragujevac. The subjects were included in the study under condition that CRL (embryonic crown-rump length) was from 45 to 84 mm and that the gestational age was at 11-13+6 weeks. Free beta HCG and PAPP-A were determined from venous blood using commercial DPS-USA tests. Tests were based on the analytic principle of the immuno-chemiluminescence technique and were performed by application of the automatic Immulite 2000 analyzer by DPC-USA. The foetal nuchal translucency thickness (NT) and CRL were measured by Colour Doppler. The chromosome identification was performed after a certain number of cell divisions by stopping the cell division in metaphase of mitosis when the chromosomes were the most distinguishable. The foetal karyotype was prepared using G bands. In the total sample of pregnant women (n=745), there were six cases of pathological foetal karyotype. A statistical paradox in the frequency of congenital foetal anomalies in favour of younger population was noticed. A high coefficient of Spearman's rank correlation suggests great importance of the combined test in the detection of congenital foetal anomalies (p<0,05). A high consistency was also proved for components of biochemical screening and ultrasonographic markers. The combined test, as a method of prenatal screening in the first trimester of pregnancy, if used at 11 - 13+6 weeks' gestation and for CRL of 45-84 mm, has a great importance in the detection of congenital foetal anomalies.

Effect of a low-dose ethinylestradiol and gestodene in combination on the frequency of micronuclei in human peripheral blood lymphocytes of healthy women in vivo.

BACKGROUND: Since most oral hormonal contraceptives contain a fixed combination of ethinylestradiol and gestodene as an estrogenic/progestogenic component, we decided to evaluate the possible mutagenic effect of a low-dose contraceptive pills containing 20 microg ethinylestradiol and 75 microg gestodene. METHODS: A total of 30 healthy women received hormonal contraception during six consecutive menstrual cycles. A single daily dose was 20 microg ethinylestradiol and 75 microg gestodene. The pills were taken orally in a monthly cycle of 3 weeks on and 1 week off. In the investigation of the mutagenic effect of these contraceptive pills in vivo, the cytokinesis block micronucleus (CBMN) test was used, and the frequency of micronuclei (MN) in peripheral blood lymphocytes was determined. RESULTS: Average MN frequency in women before therapy was 7.40 +/- 0.75 MN/1000 analyzed cells, and after therapy was 7.37 +/- 0.59 MN/1000 analyzed cells (p > 0.05). CONCLUSION: Our data suggest that oral contraception with 20 microg ethinylestradiol and 75 microg gestodene in combination during six consecutive menstrual cycles does not induce micronuclei in peripheral blood lymphocytes of women.