Evaluation of serum levels of soluble (s)L- and (s)P-selectins in endometrial cancer.

OBJECTIVES: A number of reports on the role of selectin in the process of carcinogenesis, at the stage of proliferation and metastasis, have been available. The aim of the study was to analyze (s)P- and (s)L-selectin serum concentrations in women with EC and to compare these concentrations to clinical/pathological parameters and disease progression using surgical-pathological staging data. MATERIAL AND METHODS: A total of 46 patients with EC and 50 healthy controls were included in the study. Serum concentrations of sL- and sP-selectins were measured in all participants. The oncologic protocol was implemented in all women from the study group. RESULTS: Significantly higher serum concentrations were found in EC women as compared to controls. No statistically significant differences were found between the concentrations of the soluble forms of selectins and the following parameters: histologic type of EC, histologic tumor differentiation, depth of myometrial infiltration, cervical involvement, distant metastases, vascular space invasion, and disease advancement. Slightly higher (s)P-selectin concentrations were observed in serous carcinoma, in women with cervical involvement, in the sera of women with vascular space invasion and with advanced stages of the disease. Slightly higher mean (s)P-selectin concentrations correlated with lower differentiation of the tumor. Slightly higher mean (s)P-selectin concentration was detected in the sera of women with lymph node metastases and with the serosal and/or adnexal involvement. The results were statistically insignificant, but they almost reached statistical significance. CONCLUSIONS: L- and P-selectins play a role in the biology of EC. The absence of an unambiguous relationship between differences in (s)L- and (s)P-selectin levels and disease advancement suggests that they do not play a vital role in tumor progression in endometrial cancer.

The analysis of vaginal hysterectomy results depending on the uterine size.

OBJECTIVES: Vaginal hysterectomy is one of the oldest but still rarely used minimally invasive techniques. Although new surgical methods making use of robots in laparoscopy have been introduced recently, when compared with vaginal hysterectomy, these approaches do not offer significant benefits for the patients and the doctors operating on them. The purpose of this study was a thorough analysis of vaginal removal of non-prolapsed uterus with benign pathology. MATERIAL AND METHODS: The analysis included data of 1148 women who underwent vaginal hysterectomy in the Clinic of Surgical, Endoscopic and Oncological Gynecology between 2002 and 2014. A group of patients operated on were assessed, and data from the surgeries were obtained paying attention to such aspects as the operating time, the evaluation of morphotic blood elements, the type of perioperative complications, and the length of postoperative hospital stay. Additionally, all vaginal hysterectomies were divided into groups and analyzed taking into consideration uterus weight. RESULTS: Vaginal hysterectomy was performed even in cases of earlier abdominal surgeries. The mean operating time was and 69.51 ± 28.32 minutes. The patients left hospital after 2.93 days on average. The mean uterus weight was 179.69 ± 113.54 g. What is important, the enlarged uterus was not a significant obstacle during the surgery. In case of heavy uteri of more than 580g, when the fundus of the uterus reached above the navel, the attention was drawn to the need for careful preparatory procedures, which reduced the number of perioperative complications and thus had a significant influence on the length of the operation (p = 0.0170). CONCLUSIONS: Vaginal hysterectomy is an operating technique which is relatively easy to perform and safe for the patients because it involves a slight decrease of morphotic blood elements and a small number of mid- and postoperative complications. Vaginal hysterectomy is not a contraindication in case of large uteri, even those of more than 1000 g; however, in such cases, a longer operating time and an increased number of perioperative complications must be taken into consideration.

Is M235T polymorphism of the angiotensinogen gene involved in the development of endometriosis?

OBJECTIVES: The aim of the study was to analyze the M235T polymorphism of the angiotensinogen (AGT) gene in women with endometriosis and to identify correlations between identified genotypes and the disease progression, its stage and clinical course as well as to evaluate the prognostic value of the investigated polymorphism in patients with endometriosis treated for infertility. MATERIAL AND METHODS: The study group consisted of 241 women with minimal to severe stage of endometriosis, the control group (without endometriosis) - 127. The molecular analysis was performed by PCR-RFLP technique. RESULTS: The analysis of the frequency of genotypes and alleles of M235T polymorphism showed no significant differences between the study and the control groups and between the severity grades of the disease (p > 0.05). No such differences were reported in the case of different localizations of the disease lesions, either. Evaluation of the correlations related to pain accompanying endometriosis did not demonstrate association with any genotypes of the analyzed AGT gene poly-morphism. Comparison of the results obtained in the group in which infertility treatment was successful (n = 54) and in those who failed to conceive (n = 73) did not show the correlation between the investigated polymorphism and the effect of infertility treatment. CONCLUSIONS: M235T polymorphism of the AGT gene seems unrelated to the development or the clinical course of en-dometriosis. No prognostic value has been found of the investigated polymorphism in predicting the effects of infertility treatment in women with endometriosis.

Endometriosis and RAS system gene polymorphisms: the association of ACE A2350G polymorphism with endometriosis in Polish individuals.

To analyze the polymorphisms of angiotensin I converting enzyme (ACE) gene (insertion/deletion [I/D], A2350G) and angiotensin II type 1 receptor gene (A1166C) in women with endometriosis and to determine the correlation of the identified genotypes with the severity of the disease. Additionally, to estimate the prognostic value of the polymorphisms in patients with endometriosis treated due to infertility. The study group included 241 women, the control group (without endometriosis)-127. The molecular analysis was performed by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism technique. For I/D ACE and A1166C AT1 polymorphisms no significant differences were observed between the study and control groups and between the severity grades of the disease (p>0.05). For A2350G ACE polymorphism the frequency of genotypes for the study and control groups respectively was the following: AA-31.54%, AG-54.36%, GG-14.11% and AA-55.12%, AG-36.22%, GG-8.66% (x(2)=19.36, p<0.0001). Statistically significant differences were found between the frequency of A and G alleles between both groups (x(2)=15.16, p=0.0001), but not when individual grades of the disease severity were compared. There was no association between the investigated polymorphisms and the effect of infertility treatment. A2350G polymorphism (allele G, AG genotype) of ACE gene seems to be associated with the development of endometriosis.

Evaluation of total laparoscopic hysterectomy with lymphadenectomy in surgical treatment of endometrial cancers.

OBJECTIVES: The study was conducted to evaluate the efficacy feasibility and safety of total laparoscopic hysterectomy (TLH) with lymphadenectomy in the treatment of endometrial cancer MATERIAL AND METHODS: The retrospective study included 31 patients with endometrial cancer who underwent TLH with lymphadenectomy and 42 patients with endometrial cancer who were operated by laparotomy. In both groups the following parameters were analyzed: age, BMI, accompanying diseases, previous surgeries, parity duration of the surgery blood loss (complete blood count before and after the operation was compared), necessity of blood transfusion, length of hospital stay uterine volume, grade, stage of endometrial cancer (FIGO), and intra/ postoperative complications. RESULTS: Mean age of patients was lower in the laparoscopic group than in women operated by laparotomy: 54 and 64, respectively (p = 0.0001). There were no significant differences between both groups in BMI, uterine volume, grade, staging (FIGO), and parity The percentage of patients with accompanying chronic diseases in the TLH group was lower than in the laparotomy group: 48.39% and 83.34%, respectively (p = 0,032). There were no significant differences between both group in the history of previous laparotomies (p = 0.704). Mean duration of surgery was shorter in the case of laparotomy than in case of laparoscopy: 130.6 and 151.77, respectively (p = 0.003). Laparotomy was associated with greater blood loss during surgery Statistically significantly higher decrease in the Hb concentration and Hct values was noted in the group operated by laparotomy when compared to laparoscopy (mean values.: Hb-1.1 7 g/dl, Hct-3.49% for the TLH technique and Hb-7.8 g/dl Hct-5.47% for laparotomy; p = 0.011-Hb; p = 0.003-Hct). Mean hospital stay after laparoscopy was shorter than after laparotomy--4 and 9 days, respectively (p = 0,0001). The influence of the operational technique on the number of pelvic lymph nodes taken for histopathological examination was evaluated. No statistically significant correlation between the number of lymph nodes taken for histopathological examination during the surgery and the operational technique was noted (p = 0.083). Mean number of nodes taken for examination was 15 during the TLH surgery and 19 during laparotomy Postoperative complications were observed in 2 patients from the TLH and in 12 patients from the laparotomy groups (p = 0.038). The most statistically significantly frequent complication in the laparotomy group was postoperative wound infection: 8 (19.05%) patients. CONCLUSIONS: Total laparoscopic hysterectomy with lymphadenectomy in endometrial cancer therapy is a safe and feasible procedure. It is characterized by significantly smaller percentage of complications and shorter hospital stay This technique offers an alternative for laparotomy when it is performed by a highly experienced surgeon.

[Total laparoscopic radical hysterectomy and bilateral pelvic lymphadenectomy of cervical cancer stage IB--case report]. / Calkowita laparoskopowa radykalna histerektomia z obustronna limfadenektomia miednicza w leczeniu raka szyjki macicy w stadium IB--opis przypadku.

OBJECTIVE: Clinical application of minimally invasive surgical techniques in gynecology continuous to increase steadily. Laparoscopic surgery has widely replaced open surgical technique in many routine cases. This method is obviously less traumatic and painful, requires a shorter hospital stay and recovery time. The aim of the study is to present the first operation of total laparoscopic radical hysterectomy and bilateral pelvic lymphadenectomy of cervical cancer. PATIENT AND METHOD: A 44-year-old woman was admitted to hospital for surgery due to cervical cancer stage IB1. The patient body mass index was 23.7. She was qualified for total laparoscopic radical hysterectomy (Piver type III) and bilateral pelvic lymphadenectomy. Three 5-mm trocars and 0-degree optic laparoscopic camera were used. We also used other instruments such as two atraumatic grasping forceps, a monopolar hook, Thermostapler forceps (EMED) with bipolar vessel sealing system and bipolar scissors BiSect (ERBE) for cutting, coagulation and preparation. RESULTS: The operating time was 220 minutes. Blood loss was 100 ml. The Hb drop was 1.5 g/dl. No intraoperative or postoperative complications occurred. The postoperative hospital stay was 3 days. Final histopathologic test revealed carcinoma planoepitheliale invasivum colli uteri with negative margins of vaginal cuffs. 1 out of the 15 lymph nodes identified in the removed tissue was positive for malignancy. CONCLUSION: Total laparoscopic radical hysterectomy with bilateral pelvic lymphadenectomy is a safe, effective and minimally invasive technique of diagnosis and treatment in an early stage of cervical cancer. This technique requires further evidence and evaluation before its widespread use.

ACE I/D polymorphism in Polish patients with endometriosis.

OBJECTIVES: To analyse I/D polymorphism of ACE gene in women with diagnosed endometriosis and to determine the correlation of the identified genotypes with the stage of the disease and its clinical picture. MATERIAL AND METHODS: The analysis of ACE I/D gene polymorphism was performed in a group of 121 women with endometriosis and in the control group of 122 women. In the study group the stage of the disease, number of pathological foci, occurrence of chronic pain in pelvis minor and infertility were taken into consideration. RESULTS: In the study group the following distribution was found of ACE gene genotypes: II-25.62%, ID-47.93%, DD--26.45%, whereas in the control group: II--35.25%, ID--41.80%, DD--22.95%. The comparison of the frequency of analysed genotypes and alleles between the study and control groups did not demonstrate statistically significant differences (p > 0.05). Similarly no correlation was found for these parameters when the four stages of the disease acc. to rAFS (p > 0.05) were compared. In the study group the frequency was compared of the analysed ACE gene genotypes and alleles in women with infertility (n = 59) and in fertile women (n = 62). The comparison of these parameters did not demonstrate statistically significant differences between the analysed groups (p > 0.05). The frequency of genotype II was 17.07%, ID--46.34% and DD--36.59% in women with endometriosis complaining of pain (n=41). In the group of women with endometriosis without pain the frequency of the investigated genotypes (II, ID, DD) was respectively: 26.53%, 59.18%, 14.29%. DD genotype and D allele were more frequent in patients with pain complaints (p < 0.05). CONCLUSION: In analysed population no association was found of ACE I/D polymorphism and the prevalence of endometriosis, its stages or the number of disease foci. However the association of DD genotype and D allele with the occurrence of pain within pelvis minor in women with endometriosis was found.