Renal cell carcinoma in pregnancy: a case report.

Renal cell carcinoma is seen most frequently after childbearing years, but occasionally is diagnosed in pregnancy. The pregnancy demands special considerations in terms of the diagnostic evaluation and management. A case of a patient with renal cell carcinoma diagnosed in the first trimester of pregnancy, which suddenly enlarged at the end of the second trimester, is presented. She underwent radical nephrectomy after delivery. Since the mother's welfare is the primary concern, surgical management should not be delayed.

[Strength required for mobilization of reconstructed flexor tendons in the front paw of the dog].

Adhesions of tendons with surrounding tissue, especially in zone II, are frequent complication at the reconstruction of flexor tendons of the hand. Through knowing of biomechanical incidents between the reconstructed flexor tendon and the surrounding tissue we get significant data for post-operative procedures, and that improves the opportunity for obtaining good functional results. By successive loading of operated flexor digitorum profundus in the experimental animals - dogs, medium values of force necessary for mobilization of tendons obtained on 3. post-operative day are 0 = +/- 3.36 N, 5. day 0 = +/- 6.85 N, 10. day 0 = +/- 9.58 N and 15. day 0 = +/- 10.19 N. It can be concluded that peritendon adhesions occur between 3 and 5 post-operative day. In time, the adhesions get stronger and block the movements of the tendon, and growing force is necessary for their mobilization.

Solitary ovarian mass: a case of metastatic malignant melanoma.

Malignant melanoma involving the ovaries is rare and in most cases metastatic in origin. We present a case of ovarian malignant melanoma presenting as a large adnexal mass in a patient with no previous history of malignant melanoma.

Leiomyoma of the uterus and retroperitoneal angioleiomyoma: case report.

Retroperitoneal angioleiomyoma is a benign mesenchymal neoplasm that is composed of smooth muscle cells and thick-walled vessels. In a 36-year-old patient a retrouterine and retroperitoneal tumor, 70 x 65 x 50 mm in size, was discovered during a surgical procedure due to uterine myoma. The tumor had a soft consistency and was completely removed. Histopathology showed features of angioleiomyoma. Angioleiomyoma is a rare benign entity; hence a benign course and good prognosis are expected.

Treatment for infertility and risk of invasive epithelial ovarian cancer--a case report.

A 30-year-old women was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia in April 2004 with the following diagnosis: adnexal mass soon after in vitro fertilization. Her history revealed salpingo-oophorectomy for mucinous cystadenofibroma of the left ovary eight years before and cystectomy of the right ovary three years before. At admission, the most remarkable findings were high temperature and elevated white blood cells with erythrocyte sedimentation rate. After the antibiotic treatment, laparatomy was performed and a multilocular right adnexal tumor was found. The right salpingo-oophorectomy was performed and pathological diagnosis was mucinous ovarian adenocarcinoma. Two weeks later, radical surgery was carried out and chemotherapy was applied. There is an urgent need for clear interpretation of the link between ovarian stimulation and ovarian cancer. An association between ovarian stimulation treatment and ovarian cancer has still not been completely proven.

Paget's disease of the vulva--a review of our experience.

OBJECTIVE: The aim of our study was to review our experience with Paget's disease of the vulvar relative to initial examination, treatment and oncological outcome. METHODS: Ten women with extramammary Paget's diseases of the vulva were treated during the 10-year period. The charts of these patients were reviewed and data were collected regarding patient demographics, symptoms, previous Paget's disease, surgical treatments and time to recurrence. RESULTS: Eight women (80%) were treated with wide local excision or partial vulvectomy, and two patients (20%) required radical resection for invasive adenocarcinoma. The group of women who had invasive diseases also underwent inquinofemoral lymphadenectomy and no lymphatic metastases were noted. Three women (30%) experienced recurrence. The mean time to relapse was 30 months (range 3-88 months). CONCLUSION: Recurrence is very common and long-term monitoring is recommended with careful examination of any abnormal vulvar lesion.

The application of collagen sheet in open wound healing*.

The aim of this paper is describe the application of desamidated collagen as a biomaterial in order to evaluate the utility of collagen, particularly as a drug delivery device, as a haemostat, and as a wound cover. We also evaluated the utility of vitamin A, vitamin C, 50% glucose, and gentamicin locally applied onto the open wound. Any biomaterial should ensure non-toxicity to the biological environment where it is applied. We point out the utility of vitamin A, vitamin C, 50% glucose, and gentamicin locally applied onto the open wound with a biological covering. Collagen sheet is becoming evident in our ongoing studies. We are convinced that collagen sheets are very useful in first- and second-degree burns. The cost factor comes down and the pain associated with dressing can be avoided. Especially in children it is very useful since the trauma of dressing can be avoided.

Plasmapheresis combined with somatostatin is a successful treatment of porphyrias.

During acute attacks of hepatic porphyria, levels of polypeptides, vasoactive intestinal peptides, neurotensin, substance P, pancreatic polypeptide, gastrin releasing polypeptide, gastrin, and motilin increased in the circulation while the clinical symptoms were evident. However, somatostatin decrease was not detected. Somatostatin belongs to a group of regulatory peptides that antagonize the action of endogenous steroid hormones, and decreasing their bioavailability decreases the rate of synthesis of delta-aminolevulinate synthase, alpha-aminolevunilic acid (ALA), and polypeptides. Plasma exchange was conducted in courses for 2 consecutive days every 28 days (total of 6 courses), removing more than 100% of the patient plasma each time. Between the 2 courses of plasmapheresis, subcutaneous injections of somatostatin (100-500 mcg) were administered. A lasting disappearance of pain and complete remission were obtained in all 7 patients treated. Plasmapheresis combined with somatostatin may be considered as a treatment of porphyria exacerbation.

Polypeptide levels increase during acute onset of hepatic porphyrias.

Hepatic porphyrias are characterized by neurological symptoms manifested by abdominal pain, neuropathies and mental aberrations. Porphyrins are ubiquitous and essential biochemical constituents of living beings acting as mediators of oxidation reaction in the metabolism of the steroid, drugs, environmental chemicals or as a mean of exchanging gases, such as oxygen and carbon dioxide between the environment and the tissue of the body using endogenous polypeptide properties. The different porphyrins arising from the arrangement of normal heme synthesis are characterized by an accumulation and excretion of specific intermediate porphyrins and/or of precursors exerting toxic effect, initiating cascades of generations of polypeptides, neurotransmitters and gut-brain axis peptide responsible for the symptoms of clinical status. We studied polypeptide levels in 27 patients (19 females, 8 males) presenting acute attack of hepatic porphyria: 2 with ALA dehydratase-deficient porphyria; 9 with acute intermittent porphyria; 12 with porphyria cutanea tarda and 4 with variegate porphyria. During acute attacks of porphyria, polypeptides were found to be constantly increased: vasoactive intestinal polypeptide (VIP); neurotensin (NT); substance P; pancreatic polypeptide; gastrin-releasing peptide; gastrin and motilin. Administration of the somatostatin (antagonizing polypeptide), which was undetectable or low before treatment, apparently alleviated the acute symptomatology. Elevated levels of polypeptides, at least partly, contribute to appearance of acute symptoms in porphyria patients.

[Effect of opioids and gamma-aminobutyric acid on ovulation]. / Uticaj opioida i gama-aminobuterne kiseline na ovulaciju.

UNLABELLED: Neurons secreting gonadotropin-releasing hormone (GnRH) contain receptors of gamma-aminobutyric acid (GABA), glutamate, fibroblast-growth factor, prolactin, beta-adrenergic receptor and dopamine receptor. Oestrogens and opioid peptides have a very important influence on gonadotropin secretion, but have no their own receptors in GnRH neurons. The role and interaction between gamma-aminobutyric acid and opioids in the inhibition of ovulation were studied, using valproate (GABA agonist) and naloxone (opioid antagonist) SUBJECT AND METHOD: Groups: postmenopausal women (50), postmenopausal women on oestrogen replacement therapy, consisting of 200 mcg/day transdermally oestrogen for one month (50), and women in luteal phase of their regular menstrual cycle (50). Thirty women from each group were studied after placebo (1st day) administration, and after 300, 600 or 1200 mg of valproate (2nd day). Gonadotropins and prolactin were measured in the same way, at intervals of 24 h, on the placebo day, and on the 2nd day. The interaction between naloxone and valproate was tested in 20 women from each group; day 1-placebo; day 2-naloxon (infusion-1.6 mg/h for 6 h); day 3-naloxon infusion, preceded by 1200 mg of valproate. RESULTS: Valproate. The concentration of luteinizing hormone (LH) was significantly decreased after the administration of valproate in postmenopausal women (up to 20%) and to women in luteal phase of the cycle (up to 80%). In substituted postmenopausal women there was no change in LH concentration after valproate administration. Naloxon. Naloxon infusion had no effect on LH concentration in postmenopausal women, and was significantly increased in mean serum LH in substituted postmenopausal women (52%) and in women in luteal phase of the cycle (27%). Valproate and naloxon. In women with a high oestrogen concentrations (substituted postmenopausal women) opioid blockade with naloxon (situation analogous to preovulatory phase of the cycle) contributed to the appearance of inhibitory influence of valproate on LH secretion (29.2 IU/L-after naloxone infusion; 13.2 IU/L-after administration of valproate and naloxone). In this group of patients there was no effect of valproate on LH previous secretion. CONCLUSION: GABA may have a significant role in the inhibition of ovulation because of its inhibitory role in LH secretion in the situations when oestrogen secretion is high, and opioid concentration is low.

[The polycystic ovary syndrome associated with ovarian tumor]. / Udruzenost sindroma policisticnih jajnika i tumora jajnika.

Case report of a girl with PCOD (polycystic ovarian disease) and Sertoli-Leydig ovarian tumour. A sixteen-year old girl was clinically, endocrinologically, echosonographically and laparoscopically examined, and polycystic ovarian disease was diagnosed. After a two-year period she was reexamined: normal adrenal function was confirmed and left ovarian tumour was discovered echosonographically. Therefore, she was operated on and adnexectomy of the left ovarian tumour and biopsy of the right ovary were done. The histopathologic analysis revealed the Sertoli-Leydig tumour of the left ovary and polycystic degeneration of the right ovary. In conclusion, because of the greater frequency of ovarian tumours in women with PCOD, the permanent follow-up of women with PCOD is necessary.

The effect of short- vs. long-term platelet-activating factor exposure on mouse preimplantation embryo development.

Preimplantation mouse embryos (n = 1540) were cultured in the presence of platelet-activating factor (PAF) (10(-7)- 10(-14) mol/l) to the hatched blastocyst stage. A dose-dependent negative correlation (-0.75783) relationship between blastocysts and the concentration of PAF was statistically significantly different (p < 0.001). Long-term but not short-term PAF exposure is detrimental to preimplantation Swiss Webster mouse embryos. Short-term PAF (10(-9) mol/l) exposure was found significantly (p < 0.05) to reduce blastocoel diameter. The effect of PAF during preimplantation development may be genotype dependent and be affected by the culture conditions.

Plasmapheresis combined with interferon: an effective therapy for multiple sclerosis.

The rationale for the use of interferon (IFN) in the treatment of multiple sclerosis (MS) is based on its recognized antiviral and immunomodulating actions. The pathogenesis of MS is believed to be due to an immunologic response in a genetically predisposed individual, localized within the central nervous system white matter, and triggered by exposure to an environmental agent such as a virus. Based on our personal experience we find that the efficacy of IFN therapy is hampered in MS patients by the presence of an interferon inhibitor factor (IIF) in the patients' sera which we have isolated and characterized. When plasmapheresis (PP) was done on 24 MS patients with intermittent 3-day administration of IFN-alpha and human leukocyte IFN, marked increase of IFN in 18 patients and modest increase in three patients correlated with clinical improvement. Three clinical nonresponders showed no increase in IFN levels following therapy. The ability to remove IIF and lymphokine inhibitor factor (LIF) by PP may explain the successful treatment of our patients. We describe the evaluation of helper T cells, suppressor T cells, HLADR antigen, natural killer cells, and monocyte/macrophage cell populations by flow cytometry before and after PP. A significant increase in these immune-competent cells correlated with marked improvement in Kurtzke disability status scale in 13 patients, while eight stabilized. Patients showing progression of the disease either showed decrease or no change in these parameters after therapy. Encouraging results from this pilot study suggest that PP combined with immunomodulatory regimens of IFN may be an effective therapy for MS.