FSH RECEPTOR AND FSH BETA CHAIN POLYMORPHISM INVOLVEMENT IN INFERTILITY AND ENDOMETRIOSIS DISEASE.

OBJECTIVES: The purpose of this study was to evaluate the association between the follicle-stimulating hormone (FSH) receptor (c.-29G>A) and FSH beta chain (c.-280G>T) polymorphisms and endometriosis in Romanian women. MATERIAL AND METHODS: We performed the polymorphic analysis of the FSH receptor gene and FSH beta chain in 44 patients with endometriosis and 34 controls. Genomic DNA was obtained from peripheral blood and polymorphisms were investigated using restriction fragment length polymorphism analysis (RFLP). RESULTS: There were no significant differences in genotype frequencies of FSH receptor gene between endometriosis patients and controls. For the heterozygous type of the FSH receptor polymorphism (c.-29G>A) we did not find a significant difference in its frequency between patients with minimal/mild and moderate/severe endometriosis (p = 0.136). Also, the FSH beta chain (c.-280G> T) polymorphism frequency was not significantly associated with the severity of endometriosis (p = 0.966). CONCLUSIONS: FSH receptor and FSH beta chain polymorphisms do not seem to influence the severity of endometriosis, but they could be correlated with female infertility (primary or secondary), therefore further studies are required to debate this topic.

PSYCHO-SOCIAL ASPECTS OF QUALITY OF LIFE IN WOMEN WITH ENDOMETRIOSIS.

OBJECTIVES: The objective of this study was to assess the impact of endometriosis on the quality of life. PATIENTS AND METHODS: Study group of 205 women, aged between 18-45 years old, hospitalized in the "Cuza-Voda" Hospital of Iasi, between 2013-2015. We used the Fertility Problem Inventory, the Endometriosis Health Profile and the Beck Depression Inventory. RESULTS: We first realized a descriptive analyses of patients' health related quality of life - 60% of women reported higher infertility distress associated with relationship issues caused by difficulties to conceive. The descriptive analysis over the quality of life in patients with endometriosis suggests that the high level of stress related factors, are: the loss over the control of the symptoms, dyspareunia and altered emotional status. Regarding the sexual aspect of life, almost a quarter of the women complained about an altered sexual status, due to both fear of failing in conceiving and dyspareunia caused by the endometriosis. The descriptive analysis over the infertility related stress suggests that the factors associated with a high level of stress are: sadness, pessimism, feeling of failure, irritability, lack of confidence, self-hatred and fatigue. CONCLUSIONS: Patients with endometriosis are dealing daily with a large spectrum of symptoms, including pain, dyspareunia, emotional instability and high levels of stress, which have a negative impact upon the quality of life, by lowering it on different levels. Also, within the present study we showed a significant presence of high infertility stress in patients of all ages that lead to depression and social anxiety.

Controversies on Transvaginal Ultrasound Screening for Endometrial Cancer in Asymptomatic Postmenopausal Women.

Endometrial cancer (EC) in postmenopausal women is usually associated with abnormal vaginal bleeding. However, asymptomatic cases of EC have been reported. The incidence of EC has been estimated to 1.3-3.05 per 1,000 screened postmenopausal asymptomatic women, the most significant ultra-sonographic feature being the thickened endometrium. We reviewed the literature on the accuracy of endometrial thickness measurement by transvaginal sonography (TVS) in predicting EC in asymptomatic postmenopausal women. The use of endometrial thickness as a sole screening test was found not to be of high predictive value and it should be combined with the evaluation of EC risk factors and followed by hysteroscopy and biopsy in suspicious cases. The lack of a universal cut-off value for endometrial thickness that could be correlated to EC is pointed out.

THE CORRELATION BETWEEN MARKERS OF SYSTEMIC INFLAMMATION AND ANGIOGENIC MARKERS IN PRE-ECLAMPSIA.

UNLABELLED: Pre-eclampsia is a severe multisystemic syndrome that represents a major cause of maternal, foetal and neonatal mortality and morbidity. In the study we conducted it stood out the. significant modifications of angiogenic markers in pregnant women suffering from pre-eclampsia and the existence of a correlation between C-reactive protein (CRP) and SBP, DBP and average BP. MATERIAL AND METHOD: The group included in the study consisted of 138 pregnant women hospitalized at the "Cuza-Voda" Clinical Hospital of Obstetrics and Gynaecology of Iasi, between 2012-2014, with over 20 weeks gestational age and which gave their free consent to take part in the study. RESULTS: It is confirmed the importance of determining the markers for diagnosing and monitoring hypertensive pregnant women and at the same time it was pointed out that the sFlt-1/PlGF ratio represents a good pre-eclampsia predictor. CONCLUSIONS: The results of our study confirm the importance of determining sFlt-l and PlGF as markers for diagnosing and monitoring pregnant women with HBP as well as the sFlt-l/ PlGF ratio which represents a good pre-eclampsia predictor.

Pregnancy and recurrence rates in infertile patients operated for ovarian endometriosis.

AIM: The study deals with the preoperative ultrasound diagnosis of ovarian endometriosis, postoperative ultrasound reassessment, laparoscopic surgical resolution of ovarian endometriosis, estimation of recurrence risk 12 months after surgery by ultrasound, reappearance of clinical symptoms (such as pain) or second-look laparoscopy, and pregnancy rate 2 years after surgery. MATERIAL AND METHODS: 140 patients with en- dometriosis and infertility admitted to the Iasi "Cuza-Voda" Clinical Hospital of Obstetrics and Gynecology between the years 2009-2011 were included in the study. The patients were divided into 2 groups: group 1-59 cases that refused in vitro fertilization procedures, did not afford in vitro fertilization (IVF) or had minimal endometriosis and young ages and thus a possibility of delaying treatment, and group 2--62 cases which underwent IVF procedures immediately after surgery. RESULTS: No significant differences in the chance of becoming pregnant were found between the two groups (χ2 = 2.06, p = 0.0891, 95% CI); in group 1, 11.86% pregnancies were obtained while in group 2 the pregnancy rate was 11.29%. Based on the nonparametric method of analysis of contingency tables we could estimate the odds of becoming pregnant in the study groups, obtaining an odds ratio (OR = 1.16, CI: 1.04-2.23, 95% CI). This result indicated that in group 1 the odds of becoming pregnant was not significantly higher, and the estimation was made for a confidence interval of 95%. The study had in view the assessment of pregnancies obtained in the study groups and the time interval (number of weeks) from the time of intervention until the occurrence of pregnancy. The Kaplan-Meier analysis enabled the assessment of the mean value and the median value of the number of weeks until becoming pregnant, and these values did not show significant differences (χ2 = 1.55, p = 0.212, 95% CI). CONCLUSIONS: For endometriosis associated with infertility, hormonal suppression does not improve fertility, and therefore surgery followed by controlled ovarian hyperstimulation and intrauterine insemi- nation (IUI), provided the anatomy of the pelvis is preserved in early cases or in vitro fertilization in severe cases is preferred.

Urogenital prolapse--current methods of surgical treatment.

UNLABELLED: Several combined surgical procedures have been described, but connective tissue deficiency required the use of some "prostheses" instead of conventional methods based exclusively on correction by suture. AIM: Assessment of the techniques used for the repair of stress urinary incontinence (SUI) and anterior vaginal wall prolapse, as well as the incidence of intraoperative and postoperative incidents and complications. MATERIAL AND METHOD: The study was conducted between January 2007 and December 2011 at the 1st Clinic of Obstetrics and Gynecology Iasi. The diagnosis was made on clinical criteria. Menopausal patients received estrogens prior to surgery. Vaginal meshes were used only in patients with grade III and IV cystocele. The patients were followed up at 1 1/2, 6, 12 and 36 months (first local evaluation for meshes at 2 weeks after surgery). RESULTS: During the study interval 400 patient with a mean age of 57.45 ± 5 years (range 29-81 years) were surgically treated in our clinic. Of these, 150 women underwent classic surgery, 243 women transobturator tape procedure-TOT (107 TOT alone for SUI and 136 TOT combined with classic surgery), 4 women ten- sion-free vaginal tape (TVT) procedure, and 3 patients prepubic and transobturator mesh. In 12 patients meshes with 2 or 4 arms for cystocele (7 and 5 cases, respectively) were used. Vaginal mesh extrusion was recorded in 4 patients. CONCLUSIONS: The use of prostheses allows a better standardization of procedures, shortening of surgical time and a better postoperative recovery, the patients being able to resume their normal activities.

Prenatal diagnosis of gonosomal anomalies: limitations of the FISH method and genetic counseling difficulties in 15 cases.

UNLABELLED: Prenatal diagnosis (PD) by FISH or cell culture is today an important tool for the prevention of chromosomal anomalies. A difficult issue is prenatal detection of gonosomal anomalies. Most gonosomal anomalies neither affect life expectancy nor cause psychomotor retardation, but sexualization disorders and the lack of reproductive potential are a constant finding. AIM: This study aimed at identifying the medical problems the specialists and the parental couple are faced with at the time of the diagnosis of fetal gonosomal anomalies. MATERIAL AND METHODS: This retrospective study (2004-2012) was conducted in the Prenatal Genetic Diagnosis Department of "CuzaVoda" Maternity by FISH technique in 1685 pregnancies. The AneuVysion probes were used for identifying and enumerating chromosomes 13, 18, 21, X, and Y via fluorescence in situ hybridization (FISH) in interphase nuclei obtained from amniotic fluid. RESULTS: Fifteen fetuses were selected in which we were faced with difficulties interpreting the number of gonosomes: monosomy X (5 cases), pseudomosaicism XX/XY (3), trisomy XXY (3 cases), trisomy XYY (1 case), 45,X/46.XX mosaicism (1 case) and triploidy XXX (2 cases). Later, by repeating the analysis, 2 cases with pseudomosaicism XX/XY were excluded. A case highlighting the limitations of the FISH test was that of a fetus in which the FISH test revealed trisomy XXY, while postnatal karyotyping showed a six cell line mosaicism (marker and ring X chromosomes). CONCLUSIONS: All parental couples received nondirective genetic counseling, respecting the individuals' dignity and rights of self-determination. Parents received information on the natural course of the disease, treatment options, and psychological support and were involved in their child's recovery.

The value of PAX8 and WT1 molecules in ovarian cancer diagnosis.

PAX8 and WT1 are transcription factors, each of them with distinct roles in organogenesis, morphogenesis, cell growth, and differentiation. Recently, their expression was also confirmed in a variety of malignancies, being included in the antibodies panel recommended for the female genital tract pathology. The aim of our study was to evaluate PAX8 and WT1 in different types of ovarian cancer (OC) with focus on (i) the completion of evidences of the Müllerian origin and (ii) the establishment of primary ovarian tumor status vs. metastasis. The study group consisted of 86 cases, with histopathological diagnosis covering the main subtypes of OC (low- and high-grade serous, low- and high-grade endometrioid, clear cell, mucinous, malignant Brenner tumor, malignant mixed Müllerian tumor, undifferentiated, and borderline). The investigation was based on immunohistochemical examination, performed by using specific antibodies applied on blocks obtained through Tissue MicroArray technique, and interpreted by scores assessing the nuclear positivity of tumoral cells. One case was not valuable due to technical difficulties. PAX8 expression was positive in 70 (81.39%) cases, the remaining 15 (17.44%) negative cases suggesting a non-Müllerian origin. WT1 expression was positive in 61 (71%) cases, mainly expressed in serous carcinoma, regardless of their differentiation degree, and negative in 24 (27%) cases. Our study provide supplementary evidences to support the association of PAX8 and WT1 immunostaining in the investigation of the complex biology of OC, PAX8 confirming the ovarian primary and WT1 allowing the refinement of the diagnosis in phenotype overlapping cases.

GnRH Antagonist IVF Protocol in PCOS.

The aim of the present study was to compare the GnRH agonist long protocol with the flexible GnRH antagonist protocol in infertile PCOS women undergoing COS in terms of clinical pregnancy rate (CPR), with special reference to the incidence of OHSS. Materials and Methods. The study was conducted at the Hospital Obstetrics and Gynecology Cuza Voda Iasi and Fertility Reproductive Medical Center Omini Clinic Iasi from June 1, 2010, to September 31, 2012. PCOS as defined by the Rotterdam 2003 consensus, i.e. presence of two of the following three features: presence of oligo- and/ or anovulation, clinical and/or biochemical signs of hyperandrogenism, polycystic ovaries and exclusion of other endocrinopathies. Results. No differences were observed in clinical pregnancy rate (CPR) in the agonist and antagonist protocols, respectively. Incidence of OHSS was lower in the antagonist compared with agonist group (4% versus 28%). Duration of stimulation (13,80 + 1,4 vs 11,85 + 2,4 p < 0,001) and total gonadotrophin required (2435,5 + 884,5 versus 2005, 5 + 545,5 IU p < 0.003) were also lower in the antagonist compared with agonist protocol. Conclusions. The current study suggests that the flexible GnRH antagonist protocol is associated with a similar ongoing pregnancy rate, lower incidence of OHSS grade II, lower gonadotrophin requirement and shorter duration of stimulation, compared with GnRH agonist. The GnRH antagonist might be the treatment choice for patients with PCOS undergoing IVF.

[Performance of different methods of estimating risk screening for chromosomal anomalies]. / Performanta diferitelor metode de screening in primul trimestru de sarcina privind estimarea riscului pentru anomaliile cromozomiale.

UNLABELLED: In the last 10 years, several studies have been carried out on additional ultrasound markers in the first trimester of pregnancy in order to improve detection rate of fetal numerical chromosome abnormalities (aneuploidy) and to reduce the rate of false-positive diagnosis. The purpose of this study was to evaluate the performance of various recommendations for which amniocentesis was performed followed by FISH testing in the diagnosis of aneuploidy. These evaluations were conducted in order to determine whether ultrasound aspects are associated with fetal aneuploidy and to estimate the risk level of individual markers using probability estimation analysis. MATERIAL AND METHODS: The study has been carried out at the Clinical Hospital of Obstetrics and Gynecology "CuzaVoda" Iasi, at the Laboratory of cytogenetic--prenatal diagnosis, during January 2004-December 2011, on a target group of 1406 pregnant women. As part of this study, 1411 amniocentesis were performed. RESULTS: increased efficiency of screening for fetal aneuploidy in the first trimester of pregnancy is obtained through combined method (maternal age over 35 years, increased nuchal translucency and the presence of double test risk) which has 100% detection rate and a rate false-positive result of 0%. The efficiency of this method is provided also by the relatively high risk (RR = 17.2) and its specificity (Sp = 100%). Making the assessment following the study false positive rate, it appears that a good method of risk assessment for aneuploidy is the combined evaluation of increased nuchal translucency (NT) with maternal age over 35 years (specificity 99.5%, a detection rate of 40% false positive rate of 0.45% and a relative risk of 7.09 for the presence of aneuploidy). CONCLUSIONS: The achievement of a correct prenatal diagnosis and the increase of the method efficiency, requires a correct selection of cases with aneuploidy risk assessment, based on the results of ultrasound and biochemical (double test risk) investigations correlated with advanced maternal age or previous presence of aneuploidy of children (Down syndrome, Edwards syndrome, Patau syndrome, Klinefelter syndrome and triplo X).

Management of borderline ovarian tumors.

UNLABELLED: Borderline ovarian tumors are an intermediate stage between benign cystadenomas and adenocarcinomas. AIM: The paper evaluates the management of borderline ovarian tumors (BOTs) in the patients admitted and treated in our clinic in the interval January 2003 - June 2011. MATERIAL AND METHODS: The observation sheets and pathology results of 264 patients with malignant ovarian tumors were analyzed. RESULTS: Of the 264 malignant ovarian tumors 74 (28.03%) were low malignant potential. Patients with BOT were aged 18-72 years (mean 46 +/- 6.2 years) and those with invasive tumors 14-83 years (mean 53 +/- 9.8 years). 92.18% were in stage 1. Sixty tumors were graded G1. 53.52 % of the tumors were over 10 cm (maximum 30 cm) in size. The histological types were: serous - 35 cases, mucinous - 19 cases, mixed (serous and mucinous) - 8 cases, and endometrioid - 2 cases. Fifteen patients presented intraepithelial carcinoma and 11 noninvasive implants into the peritoneal cavity. Five women had recurrences. CONCLUSIONS: Ovarian borderline tumors with histological characteristics of carcinoma, but with good behavior are now with better defined histological features. The biggest challenge in the management of women with these tumors is to identify the subset that will behave in a malignant fashion and to develop effective treatment for them.

Methods for estimating "dry weight" in hemodialysis patients.

The correct estimation on dry weight is very important in providing effective and safe hemodialysis to end stage renal disease patients. Optimal fluid removal with minimal adverse reactions from the treatment is one goal of hemodialysis treatment. The aim of this article is to discuss different methods of assessing dry weight and to determine their role in the complex fluid management of end-stage renal disease patient. Recent literature describes various methods of determining optimal hydration state, including clinical or paraclinical methods. Each of these methods has their benefits and limitations. Despite the large number of studies conducted on new technologies for determining dry weight, there is a lack of larger, randomized controlled trials to support these methods. Although the successful use of different methods of dry weight assessment is not supported yet by large clinical trials, some evidence is starting to link the use of some methods to improved outcomes (morbidity, mortality) in this population.

[Incidence of congenital malformations in the Iasi "Cuza Voda" Maternity Hospital]. / Cercetari privind incidenta malformatiilor congenitale în Spitalul Clinic "Cuza Voda" Iasi.

AIM: To update the data on the incidence of congenital malformations in our area and emphasize the importance of prenatal diagnosis. MATERIAL AND METHODS: The study was conducted over a period of ten years and included 2211 cases with congenital malformations. Such parameters as the incidence of malformations over these years, gestational age at the moment of diagnosis, and mortality from congenital malformations were followed. Statistical and graphical data were processed with the help of SPSS 16.0 and MS Excel software. RESULTS: The total prevalence of malformations was 3.52%, comparable with the data in the literature. Over this period a number of 262 cases (11.8%) ended in spontaneous miscarriage or termination of pregnancy for fetal abnormalities. A significant percentage of these pregnant women gave birth to their child, many of them dying shortafter. CONCLUSIONS: Congenital malformations remain the leading cause of mortality in neonates. In Romania, the advanced techniques of prenatal diagnosis being used only in specialized centers, and a large number of cases may escape early diagnosis. This study underlines the importance of a correct assessment of fetuses so that the discovery of fetal abnormalities at birth not to be a surprise.

[Assessment of the congenital syphilis prevention programs]. / Evaluari asupra programelor de preventie a sifilisului congenital.

UNLABELLED: The Romanian program for the management and screening of syphilis includes the recording, follow-up, and antenatal care of pregnant women. It aims at testing all pregnant women for syphilis with the help of VDLR (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin) tests, and in the women with positive tests to confirm the results by treponemal tests (treponemal antibodies): THPA (Treponema Pallidum Hemagglutination), FTA-Abs (Fluorescent Treponemal Antibody with Absorption), ELISA-Captia-IgM, and Western Blotting-IgM. In the pregnant women with positive tests two doses of 2.4 million units of penicillin G benzathine were administered at 5 days interval. These pregnant women are in the evidence of a specialist (obstetrician, dermatologist), and District Department of Public Health, and required to come for another serology test in 3 months. In case they still test positive, the same treatment is applied at the beginning of the third trimester of pregnancy. AIM: To assess the outcome of congenital syphilis prevention programs in lasi, Romania. MATERIAL AND METHODS: In the interval 2005-2011, in the Iasi town, 84 RPR positive pregnant women were recorded. There was no significant difference in the number of pregnant women residing in urban as compared to rural areas. Most of these women were from poor social environments and had a low level of education. The diagnosis of acquired syphilis was made by serological tests as most pregnant women presented in the period of syphilis latency, being asymptomatic. All pregnant women followed the treatment, and were tested periodically. Ultrasound examination was normal in all women (no changes suggestive of fetal malformations). RESULTS: Free clinical, laboratory, and ultrasound investigations, history taking, psychological assessment, sex education, rapid identification of contacts of known patients, follow-up of the interaction between health care providers and syphilitic pregnant women, booklets, and leaflets altogether made that in the last 3 years (2008-2010) no new case of congenital syphilis to be reported in the study area. CONCLUSIONS: Encouraging women to attend antenatal care early in their pregnancy is essential, this way all pregnancy-related problems (syphilis included) could be managed.

[Diagnostic problems in fetal echocardiographic examination. Observations on a lot of study during 2005-2010]. / Probleme de diagnostic în examinarea ecocardiografica fetalaa. Observatii pe un lot de studiu in perioada 2005-2010.

UNLABELLED: Echocardiography is the key diagnostic method in the diagnostics of structural heart pathologies. AIM: To underline some possible situations that may cause errors in ultrasound examination of the fetal heart. MATERIAL AND METHOD: We examined a number of 39,370 fetuses along a period of six years. The ultrasound scan was performed according with international standards of basic and extended cardiac scan. RESULTS: 442 of them (1.12%) were diagnosed with cardiac malformations. CONCLUSION: Ultrasound examination errors can cause false positive, false negative or incomplete diagnosis. Limitations in fetal echocardiography are related to the examiner experience to do an accurate diagnosis. The difficulty of assessing complex congenital heart lesion is increased. The unsatisfactory study should be repeated and sometimes the exact diagnosis requires sequential procedures. The aim is to define fetal heart anatomy and adise the family, in collaboration with neonatologist. The final results ia an optimal behavior for the fetus and newborn.

[Chromosomal evaluation in couples with reproductive disorders--retrospective study of a selected group of 266 couples]. / Evaluarea cromozomiala a cuplurilor cu tulburari de reproducere--studiu retrospectiv pe un lot selectionat de 266 cupluri.

UNLABELLED: Reproductive Disorders (RD), manifested by the biological inability to conceive (primary sterility) or inability to carry a pregnancy to full-term (infertility), affect 10-15% of reproductive-aged couples. The genetic etiology of RD is represented, in the majority of cases, by the chromosomal abnormalities. AIM: To retrospectively analyze the karyotype results in a selected group of couples with RD. MATERIAL AND METHOD: The present study was performed in 266 couples with RD: 80 (30.07%) with primary sterility (ST), 149 (56.01%) with Recurrent Spontaneous Abortions (RSA) and 37 (13.90%) with Stillborn Children (SC). A GTG-banded karyotype was performed on both partners of each couple. RESULTS: We identified a chromosomal abnormality in 43 individuals (16.16%): 20 cases (7.51%) with ST, 13 cases (4.88%) with RSA and 10 cases (3.75%) with SC. The affected partner was female in 23 cases (8.64%) and male in 20 cases (7.51%). A X chromosome (numerical or structural) abnormality was detected in 18 cases (6.76%), most frequent X chromosome monosomy mosaicism in female and trisomy XXY in male; a balanced structural chromosomal abnormality (BSC) was detected in 23 couples (8.64%); in other two males with ST, the karyotype result was 46,XX. CONCLUSIONS: The results of our study are similar to other reported studies and underline the major etiologic role of chromosomal abnormalities in RD and the importance of chromosomal analysis for the etiologic diagnosis and genetic counseling of these patients.

[Enhanced molecular techniques for the diagnosis of human papillomavirus infections]. / Optimizarea unor tehnici de biologie moleculara pentru diagnosticul infectiilor cu virusuri papilloma umane.

OBJECTIVES: optimisation of Real Time PCR technique for quantifying oncogenic types 16 and 18 of Human Papilloma Viruses, genotyped through classic PCR, followed by hybridisation. MATERIAL AND METHOD: DNA/ HPV was purified with High Pure PCR Template Preparation kit (ROCHE DIAGNOSTICS), genotyping was performed with Linear Array HPV Genotyping (ROCHE DIAGNOSTICS) and PCR reaction was realized with ABI 9700 Gold Plate System. Absolute quantification of HPV 16 and 18 was performed with Path-HPV16/18 Real-time PCR detection kit for Human Papillomavirus, 2 x Precision Mastermix kits (PrimerDesign), and the instrument used was MX3000P STRATAGENE. RESULTS: I. HPV genotyping was optimised through testing of 12 cervical samples, collected from patients who have signed the informed consent approved by the local Bioethical Committee. Among the tested samples, 5 were negative for any HPV type, 3 patients had unique infections with oncogenic HPV type, and 2 patients had multiple infections, with oncogenic and non-oncogenic HPV types. Negative and positive controls were validated, identical as the internal control - beta globin gene. II. Absolute quantification for HPV 16 and 18 were performed on two samples tested by the previous method. The number of viral copies was determined using the standard curves procedure, whose parameters values were between the accepted limits. CONCLUSIONS: We fulfilled the quality criteria for both techniques: genotyping assay and viral load quantification by Real Time PCR. This allows us to start the study for monitoring persistent infections with HPV 16 and HPV 18.

The endovaginal ultrasound finding of a thin and regular endometrium is uncommon in endometrial cancer.

AIM: To present the clinical and ultrasound features in patients with endometrial cancer in whom the endometrial thickness was less that 5 mm. METHOD: Retrospective study on 263 patients with endometrial carcinoma in whom the ultrasound evaluation of the endometrium was performed. The features noticed in the patients with endometrial thickness below 5 mm are presented. RESULTS: In 249 (94.68%) of our patients with endometrial carcinoma the mean endometrial thickness was 15 mm. In 14 patients (5.32%), in whom biopsy was performed prior to ultrasound examination, endometrial thickness was less than 5 mm. CONCLUSIONS: A thin and regular endometrium (below 5 mm) rules out an endometrial carcinoma provided that no biopsy has been performed within 3 months before ultrasound examination.

[Controversies regarding intraperitoneal chemotherapy for advanced ovarian cancer]. / Controverse privind chimioterapia intraperitoneala in cancerele ovariene avansate.

Ovarian cancer is unique among solid tumors in its propensity to remain localized in the peritoneal cavity for much of its natural history. There is now a growing body of clinical data demonstrating a survival advantage for patients with advanced stages of ovarian cancer treated by intraperitoneal (i.p.) chemotherapy compared with standard intravenous (i.v.) treatment route. Cytotoxic agents administered directly into the peritoneal cavity, however, have limited potential for penetrating bulky tumor masses. On the basis of the results of three randomized, phase III clinical trials, i.p. chemotherapy has now been shown to be superior to standard i.v. chemotherapy in the primary setting of chemotherapeutic management of advanced epithelial ovarian cancer, with small residual volume after surgery. Despite the fact that i.p. chemotherapy has been shown to determine an improvement in survival, many investigators feel that the formidable toxicity, complexity, and quality of life alterations associated with i.p. therapy make it mandatory that it should be compared prospectively to a less toxic and more convenient regimen of i.v. carboplatin/paclitaxel. The barriers to implementing this treatment into clinical practice appear to be toxicity concerns, and a lack of technical expertise with the peritoneal infusion devices. It is critically important to state that a large body of exiting data revels this is a management approach that can be administered safely, but not in routine oncology practice, outside the setting of a clinical trial or tertiary medical center.