Expression of vascular endothelial growth factor mRNA in human leiomyomas.

AIM: Growth factors play a major role in the pathogenesis of uterine myomas. The aim of this study was to evaluate vascular endothelial growth factor (VEGF) mRNA expression during leiomyoma growth at different phases of the menstrual cycle with RT-PCR. METHOD: We studied 56 patients: 43 with myomas, 13 with healthy myometriums. In patients with myomas (secretory phase), VEGF expression was 2.82 times higher than in control patients (p < 0.05). In patients with myomas (phase I), VEGF expression was 2.53 times higher (p < 0.05) than in control patients. For all patients with myomas, those who were in menopause had 1.52 times higher VEGF expression than those who menstruated. For patients with healthy myometriums, those who were in menopause had 1.97 times higher VEGF expression than those who menstruated. A comparison of all the patients in menopause revealed that VEGF expression was 2.03-fold higher in those with myomas than in those with healthy myometriums. CONCLUSION: We observed the highest VEGF mRNA expression in women with myomas who were in menopause. Among menstruating patients, VEGF expression was significantly higher in those with myomas compared to those with a healthy myometrium. This suggested that VEGF may play a significant role in the pathogenesis of uterine myomas.

Therapeutic management of acoustic neurinoma during twin pregnancy: a case report.

BACKGROUND: Acoustic neuromas belong to relatively rare illnesses in pregnant women. A gradual worsening of the symptoms presents a serious challenge for an obstetrician, neurosurgeon and anesthesiologist, who must work together to provide a successful outcome for mother and newborn. CASE: A 33-year-old woman presented with gradually progressing visual inacuity in the 30th week of pregnancy. Magnetic resonance imaging showed a vestibular acoustic neuroma of cranial nerve VII on the right side. Because of the gradual worsening of vision, a cesarean section was performed in the 33rd week of pregnancy. On the 14th postoperative day a team of neurosurgeons performed a right suboccipital craniectomy and completely removed the tumor. CONCLUSION: The treatment of acoustic neuroma depends on the general health of a patient and the length of pregnancy. It seems that the best solution is separating the child delivery and neurosurgery in time, which is not always possible. If symptoms of intracranial compression quickly worsen, an immediate intervention is often required regardless of the pregnancy stage.

TP53 status and taxane-platinum versus platinum-based therapy in ovarian cancer patients: a non-randomized retrospective study.

BACKGROUND: Taxane-platinum therapy (TP) has replaced platinum-based therapy (PC or PAC, DNA damaging chemotherapy) in the postoperative treatment of ovarian cancer patients; however, it is not always effective. TP53 protein plays a differential role in response to DNA-damaging agents and taxanes. We sought to define profiles of patients who benefit the most from TP and also of those who can be treated with PC. METHODS: We compared the effectiveness of PC/PAC (n = 253) and TP (n = 199) with respect to tumor TP53 accumulation in ovarian cancer patients with FIGO stage IIB-IV disease; this was a non-randomized retrospective study. Immunohistochemical analysis was performed on 452 archival tumors; univariate and multivariate analysis by the Cox's and logistic regression models was performed in all patients and in subgroups with [TP53(+)] and without TP53 accumulation [TP53(-)]. RESULTS: The advantage of taxane-platinum therapy over platinum-based therapy was seen in the TP53(+), and not in the TP53(-) group. In the TP53(+) group taxane-platinum therapy enhanced the probability of complete remission (p = .018), platinum sensitivity (p = .014), platinum highly sensitive response (p = .038) and longer survival (OS, p = .008). Poor tumor differentiation diminished the advantage from taxane-platinum therapy in the TP53(+) group. In the TP53(-) group PC/PAC was at least equally efficient as taxane-platinum therapy and it enhanced the chance of platinum highly sensitive response (p = .010). However, in the TP53(-) group taxane-platinum therapy possibly diminished the risk of death in patients over 53 yrs (p = .077). Among factors that positively interacted with taxane-platinum therapy in some analyses were endometrioid and clear cell type, FIGO III stage, bulky residual tumor, more advanced age of patient and moderate tumor differentiation. CONCLUSION: Our results suggest that taxane-platinum therapy is particularly justified in patients with TP53(+) tumors or older than 53 years. In the group of patients < or =53 yrs and with TP53(-) tumors platinum-based therapy is possibly equally efficient. We provide hints for planning randomized trials to verify these observations.

Angiotensin II (Ang II) evoked secretion of the human placental lactogen (HPL) in intrauterine growth retardation: examination of the relationship with Ang II receptor type 1 (AT1) expression.

Angiotensin II (Ang II) and its hemodynamic effects on placental vasculature mediated via Ang II receptor type 1 (AT1) may play significant role in intrauterine growth retardation (IUGR). Placental lactogen (HPL) production directly reflects placental function. We compared influence of Ang II on HPL production in normal and IUGR-complicated pregnancies and correlated this phenomenon with AT1 expression. Basal and Ang II-evoked HPL secretion was examined in perfused placental lobules using ELISA. After immunostaining of placental sections, AT1 expression was estimated using quantitative morphometry. Ang II increased HPL secretion. Ang II-evoked increase in HPL concentration in the perfusion fluid was 27.36+/-6.4 (%, +/-SEM) lower in IUGR (p<0.05) compared to normal-course pregnancies. AT1 expression was significantly decreased in IUGR and was 78.12+/-8.2 (%, +/-SEM) of the mean value of controls. Demonstrating that Ang II-evoked secretion of HPL in preeclampsia-free IUGR is decreased and correlates with down-regulated expression of AT1, we present a new approach to the pathophysiology of IUGR.

[Myocardial infarction in the peripartum period in a 42-year-old multipara with normal coronary arteries]. / Ostry zawal serca w okresie okoloporodowym -- opis przypadku 42-letniej wieloródki ze zdrowymi naczyniami wiencowymi.

Acute myocardial infarction (AMI) during pregnancy and puerperium is very rare. With a growing number of older women giving birth, AMI may become more common complication of pregnancy. We present a 42-year-old multipara with coagulation disorders in pregnancy who suffered from AMI in the peripartum period, documented by ECG, cardiac markers and echocardiography, with normal coronary arteries on angiogram. In conclusion, AMI in pregnancy may be different entity than AMI complicating coronary artery disease. It seems that the main causes of AMI in this population may not be atherosclerotic plaques, but reversible factors, i.e. vessel spasm or coagulation disorders. This may explain why in our patient symptoms of AMI were dramatic in spite of a small area of necrosis and normal coronary angiograms.

[Value of fine needle aspiration biopsy in cervical cancer]. / Ocena wartosci celowanej cienkoiglowej punkcji przymacicz u pacjentek operowanych z powodu raka szyjki macicy.

UNLABELLED: Correct staging qualification, especially evaluation of parametrium is very useful in choosing of adequate method of treatment, and thereby in patients' survival. OBJECTIVE: The aim of study was estimation of the value of fine needle aspiration biopsy in transvaginal ultrasonography assistant in preoperative assessment of parametria in cervical cancer. We compared parametrial infiltration before treatment and to verified and confirmed staging in cervical cancer postoperatively by histopathology. MATERIAL AND METHOD: 64 women with cervical cancer in stage Ib, were included in the study. Assessment of parametrial invasion before treatment was performed by fine needle aspiration biopsy in endovaginal ultrasound assistants. The sonographic evaluation of parametria was performed by Siemens Sonoline Versa Pro with transvaginal 7 MHz mechanical transducer with the biopsy guide 14 cm long. All of patients with cervical cancer in stage Ib were operated on Wertheim-Meigs hysterectomy. The preoperative findings were compared with data obtained by histopathology findings. There were evaluated sensitivity, specificity and diagnostic accuracy of this method. RESULTS: Accuracy of fine needle aspiration biopsy of parametrial involvement was 89%, sensitivity-70%, specificity-92.6%, PPV-63.6%, NPV-94.3%. CONCLUSIONS: Transvaginal ultrasonography is superior to routine clinical examination in the assessment of parametria. Sensitivity of fine needle biopsy with ultrasound assistance is higher then of gynecological examination and ultrasound alone. Correct preoperative diagnosis may improve staging, treatment and indirectly, survival patients with cervical cancer.

[Comparison of cerclage and cerclage pessary in the treatment of pregnant women with incompetent cervix and threatened preterm delivery]. / Porównanie skutecznosci leczenia szwem szyjkowym oraz pessarium kolnierzowym szyjki macicy u ciezarnych z niewydolnoscia ciesniowo-szyjkowa i zagrazajacym porodem przedwczesnym.

UNLABELLED: Cervical incompetence is one of the causes of preterm delivery. Ultrasound examination of the cervix has given the evidence that cervical shortening, dilatation of internal cervical os and funneling observed long before term are the warning signs of preterm delivery. Early diagnosis and treatment may serve better outcome. Cerclage, which has been employed for more than 50 years is a traumatic procedure, furthermore requiring anaesthesia. Cerclage pessary can be a safe alternative to cerclage. This method seems to be less invasive. The aim of the study was to compare the effectiveness of the two methods employed in gravid patients between 22 and 27 completed weeks of pregnancy with clinically and ultrasonographically confirmed shortening of the cervix. MATERIAL AND METHODS: We analysed 57 patients, 22 treated with McDonald cerclage procedure and 35 with pessary. The primary outcome measure was prolongation of pregnancy--mean 13.4 weeks and 12.1 weeks for cerclage and pessary respectively (p = 0.06). There were no significant differences regarding the mode of delivery, rate of prematurity, mean birthweight and Apgar score. CONCLUSIONS: Cerclage and cerclage pessary are equally effective methods of prolongation of pregnancy in gravid patients with incompetent cervix and threatened preterm labor. The choice of the method does not affect the mode of delivery as well as neonatal outcome.

Technetium-99m MIBI imaging in diagnosis of pelvic and abdominal masses in patients with suspected gynaecological malignancy.

BACKGROUND: The aim of this study was to determine the diagnostic value of (99m)Tc MIBI planar dynamic scintigraphy in the diagnosis of gynaecological malignancies and to determine if it has a greater diagnostic accuracy than conventional ultrasound technique (US). MATERIAL AND METHODS: A prospective trial was performed to assess the accuracy of (99m)Tc MIBI scintigraphy and ultrasound in 93 female patients (mean age 50, SD 16; range 17-82 years). Three readers assessed all the imaging independently and this was compared with histological examination in 89 cases and by clinical follow-up and correlative imaging for a minimum of 6 months in 4 patients. RESULTS: There were 37 patients with cancer of gynaecological origin. There were in addition 56 benign lesions within the pelvis. (99m)Tc MIBI identified correctly 29 of the 37 malignant tumours localised within the pelvis and also correctly identified 21 of 23 metastases within the abdomen. Conventional US identified correctly 35 of the 37 tumours in the pelvis and 16 sites of metastases within the abdomen. The sensitivity and specificity of tumour detection within the pelvis for (99m)Tc MIBI were as follows: 78% and 70%; and for metastases within the abdomen 91% and 90%. The results of ultrasound for tumour detection within the pelvis: the sensitivity and specificity were 95% and 79% and for abdominal metastases 70% and 97%. Analysis of the index area under a receiver operator characteristic (ROC) curve in scintigraphy did not show a significant difference between both techniques in the diagnosis of pelvic lesions. There was however a significant increase in the sensitivity of scintigraphy (99m)Tc MIBI over US in metastases detection within the abdomen. CONCLUSIONS: (99m)Tc MIBI cannot be recommended for the imaging of pelvic cancer alone, but it may be helpful in the identification of intra-abdominal spread of ovarian carcinoma and appears to offer significant advantages over ultrasound.

[The effectiveness of photodynamic diagnosis method in diagnosis of cervical lesions]. / Ocena wydolnosci metody fotodynamicznej--PDD w rozpoznawaniu zmian na tarczy czesci pochwowej szyjki macicy--doniesienie wstepne.

OBJECTIVES: The aim of this study was to evaluate Photodynamic Diagnosis (PDD) effectiveness among patients with cervical lesions and comparison to effectiveness of colposcopy. MATERIAL AND METHODS: 68 patients with cervical lesions underwent cytologic examination, colposcopy and PDD which were followed by histologic examination. RESULTS: In 41 patients with Pap smear gr. II or IV the result of Pap smear, colposcopy, PDD and histologic result were correlated. Among 27 patients with Pap smear gr. III the conformity of the final pathologic result with colposcopic examination was 55.6% and positive fluorescent effect during PDD was 63% in patients with Pap smear gr. III. CONCLUSION: The efficacy, specificity and sensitivity of PDD are similar to those of colposcopy in diagnosis of Pap smear gr. III patients.