Two oncomiRs, miR-182-5p and miR-103a-3p, Involved in Intravenous Leiomyomatosis.

Leiomyomas, also referred to as fibroids, belong to the most common type of benign tumors developing in the myometrium of the uterus. Intravenous leiomyomatosis (IVL) tends to be regarded as a rare type of uterine leiomyoma. IVL tumors are characterized by muscle cell masses developing within the uterine and extrauterine venous system. The underlying mechanism responsible for the proliferation of these lesions is still unknown. The aim of the study was to investigate the expression of the two epigenetic factors, oncomiRs miR-182-5p and miR-103a-3p, in intravenous leiomyomatosis. This study was divided into two stages: initially, miR-182-5p and miR-103a-3p expression was assessed in samples coming from intravenous leiomyomatosis localized in myometrium (group I, n = 6), intravenous leiomyomatosis beyond the uterus (group II; n = 5), and the control group, i.e., intramural leiomyomas (group III; n = 9). The expression level of miR-182-5p was significantly higher in samples coming from intravenous leiomyomatosis (group I and group II) as compared to the control group (p = 0.029 and p = 0.024, respectively). In the second part of the study, the expression levels of the studied oncomiRs were compared between seven samples delivered from one woman during a four-year observation. The long-term follow-up of one patient demonstrated significantly elevated levels of both studied oncomiRs in intravenous leiomyomatosis in comparison to intramural leiomyoma samples.

Selected environmental factors in mothers of newborns subjected to the therapeutic hypothermia - a case control study.

OBJECTIVES: Hypothermia is an established method of treating severe forms of perinatal hypoxia in newborns. Some of them develop neonatal encephalopathy, which is associated with high morbidity and mortality. Therefore, prophylaxis of this pathology is important as well as determining environmental factors in mothers of newborns affected by this pathology. The aim of the study was to assess of selected environmental factors in mothers of newborns qualified for hypothermia. MATERIAL AND METHODS: The material consisted of 102 subjects, including 51 mothers of newborns with hypoxic-ischemic encephalopathy referred for hypothermia treatment (group I) and 51 mothers of newborns without signs of hypoxia (group II). The case-control study was carried out in the third level reference centre. It is 1 of 20 centers of therapeutic hypothermia for newborn in Poland. Data was collected based on a data collection sheet. Study groups were compared in terms of demographic and environmental data. The odds ratio (OR) was determined and the logistic regression analysis of univariate and multivariate regression was used to determine the probability of the need for hypothermia in the study group. RESULTS: The groups did not differ in terms of age, BMI and place of living. The need to use hypothermia increased in pregnant women living together with their parents (OR = 6.8, 95% CI: 2.4-19.6) also in case of exposure to factors at the workplace, i.e., noise (OR = 4.1, 95% CI: 1.1-15.5). CONCLUSIONS: Based on the results of our case-control study we postulate to pay attention during preconception care to proper preparation for pregnancy especially in younger women exposed to nuisance in the work environment and at home. In this area postulated activities should include education programs, in close cooperation occupational medicine practitioners and obstetricians even before the conception as a part of pre-conception counseling. Int J Occup Med Environ Health. 2023;36(1):59-68.

Histopathological Analysis of the Effect of Photodynamic Action on Post-Chemotherapy Excised Breast Cancer Tissue.

Background and objectives: Breast cancer is the most commonly diagnosed cancer in women and its mortality is increasing. Therefore, research to improve treatment is of paramount importance. One method of treatment is photodynamic therapy. Photodynamic therapy selectively stimulates apoptosis in photosensitizer-treated neoplastic breast cells as a result of cytotoxic singlet oxygen generation via collisions between triplet excited state photosensitizer and triplet ground state oxygen upon tissue irradiation. The aim of this study was to evaluate the effects of photodynamic action on cancerous breast tissue samples as a model of photodynamic therapy. Materials and Methods: Breast cancer tissue samples were obtained from post-operative material and the patterns of histopathological changes in breast cancer tissue before and after photodynamic action on post-chemotherapy tissue were evaluated. Excised tissue samples were obtained from 48 female breast cancer patients who had previously undergone chemotherapy. Breast cancer tissues for this study were taken from macroscopically visible tumors larger than 10 mm. Histopathological analysis was performed to evaluate any morphological changes prior to and after photodynamic action on the post-chemotherapy tissue samples. Eighteen breast cancer tissue samples were analyzed before chemotherapy, fifteen after chemotherapy, and fifteen samples were analyzed after chemotherapy and application of photodynamic action. The photosensitizer Rose Bengal was applied to the samples subjected to photodynamic action. Results: Photodynamic action on post-chemotherapy neoplastic tissue showed histological changes under a light microscope. The results showed that morphological changes in breast cancer tissues after chemotherapy and photodynamic action were dependent on the concentration of Rose Bengal. In all cases, follow-up imaging showed tumor shrinkage of an average of 35% from baseline size. Conclusions: Histopathological examination revealed photosensitizer-concentration-dependent changes after photodynamic action in excised post-chemotherapy tissue. The effects of photodynamic action observed in this study suggest that the application of photodynamic therapy after chemotherapy can aid in breast cancer cell eradication.

The Diagnosis of Perineural Invasion: A Crucial Factor in Novel Algorithm of Coexistence of Conventional and Nerve-Sparing Radical Hysterectomy.

Nerve-sparing radical hysterectomy (NSRH) was introduced to mitigate adverse effects associated with conventional radical hysterectomy (CRH) in cervical cancer. However, the introduction of NSRH was compromised by possible existence of perineural invasion (PNI). Additionally, the coexistence of NSRH and CRH is currently the fact. The aim of the study was to review the literature and attempt to construct a novel and preliminary PNI diagnostic algorithm that would establish the coexistence of NSRH and CRH in one system of early-stage cervical cancer (ESCC) surgical treatment. This algorithm takes into account the PNI risk factors and current and future diagnostic methods such as imaging and biopsy.

Spectroscopic evaluation of carcinogenesis in endometrial cancer.

Carcinogenesis is a multifaceted process of cancer formation. The transformation of normal cells into cancerous ones may be difficult to determine at a very early stage. Therefore, methods enabling identification of initial changes caused by cancer require novel approaches. Although physical spectroscopic methods such as FT-Raman and Fourier Transform InfraRed (FTIR) are used to detect chemical changes in cancer tissues, their potential has not been investigated with respect to carcinogenesis. The study aimed to evaluate the usefulness of FT-Raman and FTIR spectroscopy as diagnostic methods of endometrial cancer carcinogenesis. The results indicated development of endometrial cancer was accompanied with chemical changes in nucleic acid, amide I and lipids in Raman spectra. FTIR spectra showed that tissues with development of carcinogenesis were characterized by changes in carbohydrates and amides vibrations. Principal component analysis and hierarchical cluster analysis of Raman spectra demonstrated similarity of tissues with cancer cells and lesions considered precursor of cancer (complex atypical hyperplasia), however they differed from the control samples. Pearson correlation test showed correlation between cancer and complex atypical hyperplasia tissues and between non-cancerous tissue samples. The results of the study indicate that Raman spectroscopy is more effective in assessing the development of carcinogenesis in endometrial cancer than FTIR.

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with laparoscopic surgical mode.

OBJECTIVES: Obesity has been suggested to have a negative influence on procedural outcomes of endometrial cancer laparoscopic treatment. Obesity and other possible risk factors of laparoscopic endometrial cancer treatment has not been precisely described in the literature. The aim of the study is to determine the factors that have the greatest influence on the course of laparoscopic surgery for endometrial cancer, with particular emphasis on the influence of obesity. MATERIAL AND METHODS: The study included 75 females who were treated for endometrial cancer by laparoscopic surgery. Preoperative body-mass index (BMI), waist circumference(WC), waist to hip ratio(WHR), and selected anatomical indices were measured. The duration of surgery and hospitalization stay, loss of hemoglobin, and procedural-related complications served as parameters of in-hospital outcomes. RESULTS: Multiple linear regression analysis indicate the body mass as most sensitive parameter of obesity which influence in-hospital outcomes in patients treated with laparoscopic procedure. Procedural-related complications occurred in the group of patients with significantly greater WC and BMI. Multiple linear regression indicates also histological grading (G1-G3), external conjugate, intertrochanteric distance as significant risk factors. The multiple linear regression analysis confirmed also that implementation of sentinel lymph node procedure is related with decreased hemoglobin loss in patients with cancer of endometrium compare to lymphadenectomy without sentinel node biopsy(Est.: 0.488; 95% CI: 0.083-0.892, p = 0.018). CONCLUSIONS: The most sensitive risk factor of in-hospital outcomes in laparoscopic treatment of endometrial cancer is body mass. The implementation of the sentinel node procedure is associated with reduced surgery time and reduced hemoglobin loss.

Simultaneous FTIR and Raman Spectroscopy in Endometrial Atypical Hyperplasia and Cancer.

Currently, endometrial carcinoma (EC) is the most common genital cancer in high-income countries. Some types of endometrial hyperplasia (EH) may be progressing to this malignancy. The diagnosis of EC and EH is based on time consuming histopathology evaluation, which is subjective and causes discrepancies in reassessment. Therefore, there is a need to create methods of objective evaluation allowing the diagnosis of early changes. The study aimed to simultaneously asses Fourier Transform Infrared (FTIR) and Raman spectroscopy combined with multidimensional analysis to identify the tissues of endometrial cancer, atypical hyperplasia and the normal control group, and differentiate them. The results of FTIR and Raman spectroscopy revealed quantitative and qualitative changes in the nucleic acid and protein in the groups of cancer and atypical hyperplasia, in comparison with the control group. Changes in the lipid region were also observed in Raman spectra. Pearson correlation coefficient demonstrated a statistically significant correlation between Raman spectra for the cancer and atypical hyperplasia groups (0.747, p < 0.05) and for atypical hyperplasia and the controls (0.507, p < 0.05), while FTIR spectra demonstrated a statistically significant positive correlation for the same group as in Raman data and for the control and cancer groups (0.966, p < 0.05). To summarize, the method of spectroscopy enables differentiation of atypical hyperplasia and endometrial cancer tissues from the physiological endometrial tissue.

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with traditional surgical mode.

OBJECTIVES: Abdominal obesity is a risk factor for endometrial cancer. The negative impact of individual parameters of obesity on the procedural effects of endometrial cancer surgical treatment has been suggested. The aim of the current study was to estimate the relationship of particular parameters of obesity and in-hospital outcomes in patients treated surgically due to endometrial cancer. MATERIAL AND METHODS: The study included 70 women treated surgically for endometrial cancer. Pre-operatively, mass, body mass index (BMI), waist circumference, waist-hip ratio and selected anatomical indices were measured. The duration of surgery, hospitalisation, and the loss of haemoglobin served as parameters of in-hospital procedure success. Also, procedural-related complications were estimated. RESULTS: There were 37 (52.8%) obese females in the current study. They were obese patients presenting more advanced clinical stages of endometrial cancer before operation. The duration of operation (94.9 ± 21.6 min. vs. 76.1 ± 13.5 min., p < 0.0001), hospitalisation (12.4 ± 3.4 days vs. 10 ± 2.3 days, p = 0.0009) and haemoglobin loss (2.5 ± 0.9 g/dL vs. 1.9 ± 0.8 g/dL, p = 0.004) were significantly greater in obese patients. Multivariate analysis, among the independent predictors of the duration of operation, has confirmed the correlation between BMI, waist circumference and weight and the duration of hospitalisation. Waist and hip circumference and BMI coupled with external conjugate dimension and intertrochanteric distance have been linked with haemoglobin loss. The strongest correlation for the duration of operation, hospitalisation and haemoglobin loss was noticed for waist circumference (r = 0.7, r = 0.57 and r = 0.59). CONCLUSIONS: Waist circumference and BMI are strong predictors of in-hospital outcomes among patients with endometrial cancer treated via traditional surgical operation.

Natural history of leiomyomas beyond the uterus.

RATIONALE: Most leiomyomas are located in the uterus. Leiomyomas are rarely found outside the uterus and classified as leiomyoma beyond the uterus (LBU). This group consists of disseminated peritoneal leiomyomatosis, benign metastasizing leiomyoma, intravenous leiomyomatosis, parasite leiomyoma located in the broad ligament and retroperitoneal space. The descriptions of the patients who suffer from these types of leiomyomas are presented mainly in case reports. PATIENT CONCERNS: A 34-year-old multiparous woman was operated on multiple recurrent uterine leiomyoma in parametrium. At one time, 32 leiomyomas were removed. Thirteen months following it, in next laparotomy, 132 leiomyomas were excised. Histologically, both were intravenous leiomyomas (IVLs). DIAGNOSIS AND INTERVENTIONS: In follow-up, computed tomography (CT) and magnetic resonance imaging scans were performed to look for next recurrent leiomyoma. Accidentally, the mass was found in inferior vena cava which was diagnosed as intravenous vena cava leiomyoma. The mass was removed and the final diagnosis of intravenous myoma was confirmed in histopathology. OUTCOMES: CT scan performed 3 months after the surgery for leiomyoma in vena cava revealed no pathology. Next 10 months' follow-up was uneventful. LESSONS: The recurrent multiple uterine leiomyoma precede LBU. The uterine leiomyoma spreads intravenously route to parametria as parasite leiomyoma, then to vena cava. It has to be taken into account in follow-up.

[The prophylactic operational model integrated with occupational healthcare - Prophylactic of some types of cancers among women]. / Model dzialan profilaktycznych zintegrowany z opieka profilaktyczna nad pracownikami ­ zapobieganie niektórym typom nowotworów wsród kobiet.

Periodical medical examinations are mandatory for employees in Poland. This rule makes a unique opportunity during occupational health services for implementation of prophylactic activities focused on early diagnosis of various diseases, including cancers. Epidemiological data about cancers is alarming and what is more, further increase in development of cancers is being predicted in population overall. The highest incidence of cancers in the case of Polish women belongs to breast cancer (21.7% of diagnosed cancers in general), while the morbidity rate for uterine cancer, ovarian cancer and cervical cancer amounts to 7.4%, 4.7% and 3.5%, respectively. The aim of this study was to elaborate an algorithm of prophylactic activities integrated with the occupational healthcare system, based on medical literature review and guidelines concerning prophylaxis of selected cancers. Polish cancers' prophylaxis programs related to risk factors were presented in this publication and practical indications for occupational healthcare physicians were worked out. Med Pr 2018;69(4):439-455.

Benign metastasizing leiomyoma: A review of current literature in respect to the time and type of previous gynecological surgery.

INTRODUCTION: Benign metastasizing leiomyoma (BML) is a rare disorder that affects women with a history of uterine leiomyoma, which is found to metastasise within extrauterine sites. The aetiology of BML remains unexplained. Because BML is rare, and most publications contain descriptions of single cases, no statistically determined time relations were found between the primary and secondary surgeries, which may have aetiological implications. OBJECTIVES: To determine age before BML surgery, age during diagnosis of BML, type of prior surgery, and location of metastasis based on the literature. METHODS: A systematic review of four databases (Medline/PubMed, Embase, Web of Science, and Cochrane) covering articles published from 1 January 1965 to 10 April 2016. The inclusion criteria were full-text articles in English and articles containing case reports. Articles in languages other than English (39), articles containing incomplete data (14), i.e. no information regarding the time of surgery and/or the site of metastasis, articles bereft of case studies (25), and articles with access only to summaries, without access to the complete text (10) were excluded. Of 321 titles identified, only 126 articles met the aforementioned criteria. RESULTS AND CONCLUSIONS: The mean age during primary surgery and BML diagnosis was 38.5 years and 47.3 years, respectively. The most common surgery was total hysterectomy. The most frequent site of metastasis was the lungs; other organs were affected less frequently.The site of metastases and their number were not related to the longer time span between the patient's initial surgery and occurrence of metastasis. The analysed data, such as the age during primary surgery, age during BML diagnosis, site and type of metastasis, do not provide us a clear answer. Thus, BML pathogenesis is most probably complex in nature and requires further multidirectional research.

Primary vaginal squamous cell carcinoma with bladder involvement in uterine prolapsed patient: Case report.

RATIONALE: Primary vaginal squamous cell carcinoma (SCC) is a rare disease. Primary SCC in prolapsed vagina is extremely rare. In the presented case additional bladder involvement was found. PATIENTS CONCERNS: Primary vaginal SCC may be misinterpreted as decubitus in prolapsed vagina and it may delay proper diagnosis and treatment. DIAGNOSES: Diagnosis was confirmed by the vaginal ulceration biopsy and cystoscopic biopsy of the involved bladder. INTERVENTIONS: In the case presented percutaneous nephrostomy was the only possible treatment of hydronephrosis. OUTCOMES: In advanced primary SCC (Figo IVA) with nodal involvement palliative treatment is only option. LESSONS: Primary SCC mimicking decubitus which appeared in prolapsed vagina, may be accompanied by bladder involvement.

Evaluation of the hospital environment for women with endometrial cancer.

INTRODUCTION AND OBJECTIVES: The aim of the study was describe the factors determining the evaluation of the hospital environment, especially satisfaction with care and individual needs of cancer patients. MATERIAL AND METHODS: The study comprised 80 women with endometrial cancer diagnosed and treated surgery in the Clinic of Gynaecology and Obstetrics in Rzeszow, Poland, between 2011-2012. The study used 3 questionnaires: the Goals Attainment Scaling (GAS) questionnaires, and questionnaires developed by the EORTC Quality of Life group, i.e. the QLQ C-30 (general module) and the In- PATSAT-32. RESULTS: Respondents indicated 36 goals/expectations and the most common (over 50%) concerned the normal course of the post-operative period. The overall index of all goals which were met was 7.0 points. General quality of life reported by respondents before surgery was at a medium level (52.3+16.8%). Emotional functioning received the lowest scores (61.0+18.8%). Most respondents assessed manual skills of hospital doctors and nurses as the best in the In-PATSAT 32 scale i.e. 69.9±14.7% and 67.3±16.1%, respectively. The worst ratings concerned access to hospital from the outside (50.8±16.9%) and easy orientation inside the buildings (55.9±16.0%). CONCLUSIONS: Analysis of correlations between GAS and the In-PATSAT32 scales proved that they cannot be used interchangeably since they measure different aspects of a patient's satisfaction with hospital care. For this reason, the application of idiographic and nomothetic tests among cancer patients is helpful for evaluation of the hospital environment.

Benign metastasizing leiomyoma in triple location: lungs, parametria and appendix.

Benign metastasizing leiomyoma (BML) usually are situated in one organ, most often in lungs. BML patients typically have a history of uterine leiomyoma treated with hysterectomy, myomectomy or subtotal hysterectomy. The aim of the study was to present the case of a 53-year-old woman with triple location in the lungs, parametria and appendix. She had undergone a myomectomy 26 years earlier. In 2015, she was admitted to the surgical department because of abdominal pain, whereupon a cholecystectomy was performed. CT scans showed pelvic mass with pulmonary metastasis. Upon discharge the patient was referred to the Gynecology Clinic, where a laparotomy was performed. The intraoperative findings were: 1) uterus with multiple leiomyomas, 2) four tumors in the parametria, 3) tumor connected to the appendix. A subtotal hysterectomy, with a bilateral salpingo-oophorectomy, removal of the tumors from the parametria and appendectomy was performed. Pathology confirmed the diagnosis based on morphology and immunohistochemical staining (strongly positive for estrogen receptors and SMA, while Ki67 was very low, below 1%). Upon postoperative recovery, the patient was referred to the Thoracic Surgery Department. During the thoracotomy, multiple nodes, surrounded by lung parenchyma, were revealed. Wedge resection was performed, for localized pulmonary lesions, and sent for pathological examination. The final pathological diagnosis was benign metastasizing leiomyomatosis. In conclusion, the triple location of BML could possibly be a result of a parallel different metastasizing mechanism, although it is impossible to exclude one mechanism, which may be the cause of the metastases in three locations.

Opinions and attitudes of parturients, midwives, and obstetricians about Caesarean section in the provinces of Podkarpackie, Poland, and Ivano-Frankivsk, Ukraine.

INTRODUCTION AND OBJECTIVE: Present the opinions of parturients, midwives, and obstetricians concerning CS in the provinces of Podkarpackie (Poland) and Ivano-Frankivsk (Ukraine). MATERIAL AND METHODS: An anonymous questionnaire for parturients (n=1,295), midwives (n=47) and obstetricians (n=78), assessing demographics, knowledge and attitudes concerning CS, was distributed in 13 hospitals. In addition to measured anxiety among parturients, we also used the State-Trait Anxiety Inventory (STAI). RESULTS: Differences between the subgroups concerned respondents' ages and place of residence (p=0.0000). Parturients from Poland more often accepted the possibility of vaginal delivery after previous CS (p=0.0000), they more often believed that free access to epidural analgesia and the presence of a chosen partner in the delivery room would decrease the CS rate (p=0.0000). Polish midwives more rarely accept the idea of CS on maternal request (p=0.0012) and were convinced that free access to epidural analgesia could decrease the rate of CS (p=0.0479). In Poland parturients more often accepted CS on maternal request than obstetricians and midwives (p=0.0000). In Ukrainian population midwives and obstetricians more often accepted possibility of natural delivery after previous CS (p=0.0010). According connected with delivery in Poland parturients returned lower scores on the A-State scale (p=0.0000), but higher scores on the A-Trait scale (p=0.0067). CONCLUSIONS: There are some differences in Polish and Ukrainian obstetricians, midwives and parturients in respect of: - vaginal delivery after CS, - epidural analgesia, - CS on request, - anxiety connected with labour. The above may to some extend explain the difference in Cs rate in two countries.

Two techniques of pyramidalis muscle dissection in Pfannenstiel incision for cesarean section.

OBJECTIVES: The aim of the study was to compare two techniques of pyramidalis muscle dissection during cesarean section. MATERIAL AND METHODS: A total of 108 patients undergoing a cesarean section were randomly allocated to group I (N = 57), with the pyramidalis muscle left attached to the rectus muscles, and group II (N = 51), with preservation of the connection between the pyramidalis muscle and the rectus sheath. RESULTS: There were no statistically significant differences between the groups regarding surgery duration, blood loss and postoperative pain. After three months, patients from group II more frequently reported paresthesia in the scar region (47.1 vs. 28.1%; p = 0.041), but their self-assessment of the abdominal appearance and presence of the bulging below the wound were comparable with group I. CONCLUSIONS: None of the two techniques of pyramidalis muscle dissection appear to be superior to the other. The technique leaving the pyramidalis muscle attached to the fascia gave more frequent paresthesia during a 3-month follow-up.

Assessment of selected perioperative parameters in patients undergoing laparoscopic and abdominal supracervical hysterectomy.

INTRODUCTION: Subtotal hysterectomy is a method of treatment of patients with mild changes in the uterine body. Laparoscopic methods are increasingly used in surgical gynaecology. One of the limitations of laparoscopy is the proper level of operating surgeon's training, which may be assessed with the use of the learning curve. The aim of the study was to compare data regarding the perioperative period in patients who underwent subtotal hysterectomy with the two methods, and to establish a learning curve for laparoscopic subtotal hysterectomy. MATERIAL AND METHODS: One hundred and twenty-seven patients qualified for subtotal hysterectomy due to mild disturbances in the uterine body participated in the study. The study was conducted at the Clinical Department of Gynaecology and Obstetrics of Fryderyk Chopin Provincial Specialist Hospital in Rzeszów in 2012-2013. RESULTS: The time of laparoscopic subtotal hysterectomy is longer than that of the classical surgical procedure. Uterine myomas are the main indication for subtotal hysterectomy. Laparoscopic operation results in lower blood loss compared to the classical surgical method. The mean age of the patients operated due to mild changes in the uterine body is similar in both groups. Patients who are obese or have undergone Caesarean sections are more frequently qualified for the classical surgery. The study revealed a reduction in time of laparoscopic subtotal hysterectomy by ca. 31 minutes (33%). CONCLUSIONS: Laparoscopic subtotal hysterectomy is a method chosen by operating surgeons for patients with a lower perioperative risk. The period of the study made it possible to determine a learning curve for laparoscopic subtotal hysterectomy.

Intracranial hematoma as the cause of headache after subarachnoid anesthesia for cesarean section--a case report.

BACKGROUND: Intracranial subdural hematoma is an exceptionally rare but life-threating complication of epidural and spinal anesthesia. The diagnosis is rather difficult because the initial symptoms mimic post-dural puncture headache. CASE REPORT: A 33-year-old primipara was admitted to the hospital at 38 weeks gestation for a cesarean section due to premature rupture of membranes and meconium stained amniotic fluid. During the procedure a single puncture between L2 and L3 vertebrae was made with the use of a 26-gauge, pencil-point needle. The amount of 2.8 ml of analgesic solution was administered in order to obtain subarachnoid analgesia at the level of Th4 and Th5 vertebrae. Postpartum recovery was uneventful for the first two days. On the third day the patient developed strong headache in the forehead area and tinnitus. An anesthesiologist diagnosed post-dural puncture headache (PDPH). The patient received 1 g of Paracetamol every 6 hours intravenously together with 3000 ml of crystalloid solution for 24 hours. As a result, the patient recovered and was discharged home with her infant. Five days later the patient presented at the neurology clinic because of strong and chronic temporal lobe headache. No other complaints were reported. Upon admission, the patient had a head CT followed by an MRI examination, which revealed cranial hematomas localized bilaterally in the area of the frontal, temporal and parietal lobes, spreading from the cranial vault to the skull base. The width of the hematomas was: 3-4 mm on the left and 5-6 mm on the right side. Hematomas infiltrated the anterior part of the medial longitudinal fissure. Magnetic resonance angiography showed normal images of the arteries, veins, and the dural venous sinuses. No vascular malformations, which may be a source of intracranial hemorrhage, were found. Other tests showed normal results. Patient condition during hospitalization was stable. Conservative treatment was implemented, i.e. fluids administered intravenously anti-edematous drugs, analgesic medications and bed rest. All pain complaints subsided and a control CT scan showed that hematomas evolved as expected i.e. their HU density decreased. About 6 weeks later the patient had a CT head scan, performed in outpatient settings, which showed complete absorption of extravasated blood. CONCLUSION: The presented case shows headaches in obstetric patients require thorough diagnostic examinations and appropriate management. In addition to the most typical PDPH, it may be the first sign of life-threatening intracranial pathology

Perineural space invasion in cervical cancer (FIGO IB1-IIB) accompanied by high-risk factors for recurrence.

BACKGROUND: Perineural space invasion (PSI) represents a poor prognostic factor in various carcinomas. Studies on PSI in cervical cancer patients are scarce and report discrepant results regarding its incidence and prognostic value. AIMS: The aim of the following study was to evaluate the occurrence rate and prognostic significance of parametrial PSI in patients cervical cancer (FIGO IB1-IIB), accompanied by high-risk factors for recurrence. MATERIALS AND METHODS: We reviewed clinical records and pathology slides of patients with cervical cancer after radical hysterectomy. Only patients with at least one of following factors: Depth of invasion of ≥15 mm, parametrial and lymph node involvement, were enrolled in the study. RESULTS: A total of 50 patients fulfilled the above mentioned criteria. Parametrial PSI was found in 9 (18%) patients (Group I), whereas the remaining 41 (82%) subjects constituted group II. The presence of PSI proved to correlate with the depth of invasion of ≥15 mm (P=0.006) and tumor size of ≥40 mm (P=0.01), as well as a more advanced stage of the disease (P=0.04). No statistically significant differences in recurrence-free survival rate between the two groups were observed. CONCLUSIONS: We were able to correlate parametrial PSI with the depth of invasion, tumor size and more advanced stage of the disease in early-stage cervical cancer with high-risk of recurrence. No association with a worse prognosis was observed.

The analysis of metallothionein immunoreactivity in stromal fibroblasts and macrophages in cases of uterine cervical carcinoma with respect to both the local and distant spread of the disease.

PROBLEM: The tumor microenvironment is made up of tissue that is responsible for the growth and progression of the tumor as well as its ability to initiate metastases. The cancer cells on the front of the tumor together with the macrophages and fibroblasts help to constitute the aggressive phenotype of the tumor. The presence of this aggressive phenotype is indicated by the local infiltration of cancer cells and by the development of lymph node metastases. In cases of uterine cancer, the extent of the local and distant spread of the disease is crucial for determining the type of therapeutic strategy to be applied - surgery alone, surgery followed by radio-chemotherapy, or radio-chemotherapy alone. In the interest of trying to improve the patient's quality of life, different studies supporting the therapeutic model of surgery alone have been conducted. While the cancer cells on the tumor front together with the macrophages and the fibroblasts help to constitute the aggressive phenotype of the tumor, metallothionein (MT) has been shown to have both pro-proliferative and anti-apoptotic activities and to participate in microenvironment remodeling. The aim of the current study was to determine the levels of MT immunoreactivity in the uterine cervical cancer cells as well as in the stromal fibroblasts and macrophages of the tumor microenvironment with respect to the depth of the local invasion and the extent of the distant metastases, so that its potential predictive value as a therapeutic strategy for cervical cancer can be ascertained. METHODS: We determined the levels of immunoreactivity of MT in a total of 57 carcinoma tissue samples (in the tumor front, in its central part, and in the macrophages and fibroblasts present within the tumor microenvironment). The patients from whom the samples derived were divided into groups with respect to the presence of lymph node metastases (distant spread) and to the depth of invasion (local spread) in relation to the FIGO stage. RESULTS: Metallothionein immunoreactivity was observed in uterine cervical cancer cells; it was also identified in the fibroblasts and macrophages found within the microenvironments of the tumors of patients suffering from the disease. The MT immunoreactivity level significantly increased within the whole cancer nest in relation to the FIGO stage (intensity of the local spread of the disease). Similarly, the infiltration of MT-positive CAFs and TAMs statistically significantly increased in relation to the FIGO stage. CONCLUSION: The level of MT immunoreactivity found in the fibroblasts and macrophages within the tumor microenvironment seems to be indicative of the intensity of the remodeled cervical tumor microenvironment, and this in turn may be related to the local advancement of the disease. Moreover, it appears that the intensity of the metallothionein immunoreactivity in the immunoreactivity profile of the cervical tumor may be linked to both the depth of the local invasion and the extent of the distant advancement of the disease.