Analysis of the results and long-term follow-up of second-look laparotomy in advanced ovarian cancer.

OBJECTIVE: The goal of the study was to analyze results of 171 second-look laparotomy and compare survival of patients with advanced ovarian cancer depending on SLL results. RESULTS: We obtained the following results: complete pathologic response (CPR)--56.2% (96 patients), microscopic disease (R(micro))--12.8% (22 patients), macroscopic disease (R(marco))--31% (53 patients). In patients with negative SLL results disease recurrence was diagnosed in 38.5%. We compared survival in separate groups of patients depending on SLL results: no difference between the CPR group and R(micro) group. Significantly longer survival of patients in the R(micro) group was found compared to patients with recurrence after negative SLL. There were no differences between the group with recurrence after negative SLL and the R(macro) group. CONCLUSIONS: An important observation is that the survival rate in patients with recurrence after negative SLL was significantly lower compared to patients with microscopic disease. The probable explanation for favorable prognosis in the group with microscopic disease was early administration of chemotherapy after SLL.

Combination of intraperitoneal hyperthermic perfusion chemotherapy (IHPC) with intraperitoneal chemotherapy as a treatment modality for persistent ovarian cancer.

Persistent minimal residual disease diagnosed after the first line of chemotherapy during second-look surgery can be an indication for intraperitoneal chemotherapy. Another treatment option is intraperitoneal hyperthermic perfusion chemotherapy (IHPC) where the drug is administrated into the peritoneal cavity with the use of extracorporeal closed circuit perfusate circulation at a temperature of 41-42 degrees C. We have started to perform, as a second-line treatment, a combination of one IHPC procedure and four cycles of standard intraperitoneal chemotherapy. In a patient who had previously undergone three different chemotherapy regimens, stabilization of the disease was achieved. In our opinion combining the IHPC procedure with intraperitoneal chemotherapy can be valuable in patients with small volume residual tumor.

Mannan-binding lectin (MBL) in women with tumours of the reproductive system.

Mannan-binding lectin (MBL) is an important factor of innate immunity contributing to the clearance of microorganisms. Recently, an antitumourigenic role of MBL has been suggested. We investigated mbl2 genotypes, MBL concentrations, and MBL-MASP-2 complex activity in patients with ovarian cancer. The expression of both mbl2 and masp-2 genes were investigated in ovarian tissue sections. Additionally, samples from patients with other malignant and benign tumours of the reproductive tract were tested. A significantly higher incidence of MBL deficiency/insufficiency-associated genotypes was found among patients with malignant disease compared to age-matched controls. Unexpectedly, no differences in median MBL level or MBL-MASP-2 complex activity were found between the groups. This was partly a reflection of higher MBL concentrations and MBL-MASP-2 activity in cancer patients compared with healthy women carrying corresponding genotypes. MBL-specific mRNA expression was detected in several normal and malignant ovarian tissues, as well as in ovarian epithelial cell lines. Intracellular staining with MBL-specific antibodies demonstrated the presence of MBL in ovarian cell lines, and in normal as well as malignant ovarian tissue sections. In contrast, MASP-2-specific mRNA expression was detected only in the ovary tissues of patients with malignant disease. No significant changes in MBL concentration during 3 months of chemotherapy were noticed. MBL was detected in ascites and in the fluid of benign ovarian cysts. Our findings may reflect anti-tumourigenic activity of MBL protein which might suggest potential therapeutic application. However, it cannot be excluded that mbl-2 mutant alleles may be in linkage disequilibrium with an unidentified tumour susceptibility gene(s).

The problem of accurate initial diagnosis of Bartholin's gland carcinoma resulting in delayed treatment and aggressive course of the disease.

Carcinoma of the Bartholin's gland is a rare lesion accounting for only 5% of all vulvar cancers. Initial diagnosis of Bartholin's gland cancer (BGC) and recurrence after primary radical surgery and adjuvant radiotherapy poses a challenge in the treatment of BGC. This case report presents a particularly aggressive course of BGC. Spontaneous rupture of the femoral artery in the postoperative period was observed. The length of the survival period from the moment of diagnosis amounted to less than 16 months. Aspects of initial diagnosis problem and treatment options in groin recurrence of vulvar carcinoma and vascular complications are discussed.

Sentinel node identification in cervical cancer patients undergoing transperitoneal radical hysterectomy: a study of 100 cases.

We investigated the feasibility of sentinel lymph node (SN) identification using radioisotopic lymphatic mapping with technetium-99m-labeled nanocolloid and blue-dye injection in 100 patients with early cervical cancer (FIGO stage IB1 in 58, IB2 in 18, and IIA in 24) undergoing radical hysterectomy with pelvic lymphadenectomy. At least one SN was found in 84% on one side and in 66% on both sides. The sentinel detection rates according to the stages were as follows: 96.6% in IB1, 66.7% in IB2, and 62.5% in IIA with at least one SN on one side, and 86.2% in IB1, 38.9% in IB2, and 37.5% in IIA with at least one SN on both sides. Successful identification of at least one SN was less likely in patients with tumors >2 cm (54% of SN) compared with those with tumors

The influence of radioisotope vehicle on breast sentinel node detection.

AIM: To assess the relationship between carrier molecule size and time elapsing between marker injection and sentinel node(s) biopsy in patients with breast cancer. MATERIAL: The study performed on 122 women, in whom the sentinel node(s) was identified according to the procedure described below. In Group I (n=72 patients), SN identification was done with radioisotope marker of 400-3000 nm molecule size (tin colloid). In Group II (n=50 patients) radioisotope marker of <100 nm molecule size (colloidal albumin) was used. METHODS: All the patients of both groups received the markers with a single-point, intradermal, periareolar injection. Four hours after the injection (Group I - surgery in the next day) or immediately before the surgery (in this same day) (Group II), stationary lymphoscintigraphy was performed. RESULTS: Mean numbers of sentinel nodes identified with the radioisotope method in Groups I and II were 1.22 and 1.48, respectively. The difference was statistically significant (p<0.01). CONCLUSIONS: There is a relationship between the radioisotope marker molecule size and the injection-to-intra-operative evaluation time. Administration of small molecule size radioisotope marker several hours prior to the planned surgery appears to be the optimum procedure in this method of SN identification in patients with breast cancer.

The role of pelvic exenteration for treatment of pelvic malignancy--a nine-year experience.

Pelvic exenteration offers the last chance for some women with gynecological and rectal malignancy. A series of 23 patients who underwent pelvic exenteration for local advanced gynecological and rectal malignancies between 1996 and 2004 were retrospectively reviewed. The exenteration was performed because of vulvar cancer in 14 patients and other pelvic malignancies in nine cases: rectal cancer in four cases, in three cases cervical cancer, in one case ovarian cancer and in one case uterine sarcoma. Nine patients developed major complications of the operative field involving the urinary tract or the wound. Early complications included massive bleeding from the sacral plexus in two cases (one patient died during surgery), acute respiratory distress syndrome (ARDS) in one case and thrombophlebitis in one case. Urinary incontinence was observed in two women as a late complication. Only one patient had a complication connected with the gastrointestinal tract. Twenty-two patients were followed-up. In the group of patients with vulvar cancer five women died after 4-29 months because of recurrence of disease. The nine surviving patients are still being followed-up and are without disease; survival time ranges from 6-74 months. In the group of patients with other malignancies four women died.

Management of massive presacral pelvic bleeding in patients with gynecological malignances: review of the literature.

Hemorrhage has always been a significant potential complication in the field of gynecological oncology. Throughout the years, a variety of medical and surgical modalities aimed at controlling pelvic hemorrhage have been developed. Most recently, these have focused on attempting to decrease the morbidity associated with pelvic bleeding. The effectiveness of and the complications involved in controlling massive hemorrhage by the preemptive method of vascular clamping of the aorta, intraoperative methods, such as the local application of procoagulants and of prolonged compression (pelvic gauze packing, plastic wrapped gauze packing, autograft tissue compression and balloon compression) have all been reviewed. Surgeons are able to acquaint themselves with the choice of methods that can be employed during massive pelvic bleeding resulting from procedures on gynecological malignancies.

Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration--a case report and review of the literature.

This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdansk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.

Acute renal failure after anterior pelvic exenteration: a case report and review of the literature.

This is a report of a case of advanced cervical carcinoma in a 34-year-old woman treated with anterior pelvic exenteration at the Department of Gynecology of the Medical University in Gdansk. Despite annual gynecological check-ups, the patient presented with profuse bleeding from the genital tract. IVa cervical carcinoma according to the International Federation of Gynecology and Obstetrics (FIGO) staging was diagnosed. A vesicovaginal fistula was confirmed. In the postoperative period acute renal failure occurred. Twenty-four days after the operation when normal renal parameters had been restored, the patient was transferred to the Department of Radiotherapy for supplementary treatment. Pelvic exenteration offers the last chance for some women with gynecological malignancy and can provide a good chance of long-term survival in carefully selected patients with gynecological cancer.

[A clinical analysis of fetoplacental blood flow in prognosis of fetal emergency in pregnancies complicated by hypertension]. / Kliniczna ocena jakosci przeplywu plodowo-lozyskowego w prognozowaniu zagrozenia plodu w ciazach powiklanych nadcisnieniem tetniczym.

DESIGN: The aim of our study was a clinical analysis of fetoplacental blood flow in prevision of fetal hypoxia in pregnancy complicated by a hypertension. MATERIALS AND METHODS: Between 1995-1997 105 pregnant women delivered in 2nd Dept. Of Gynecology and Obstetrics Medical University of Gdansk. They were divided into two groups: 53 patients with hypertension and control group of 52 pregnant women. In all cases a doppler umbilical blood flow was estimated using 5 MHz Convex sounder. RESULTS: In a group of pregnant women with hypertension abnormal results of doppler fetoplacental blood flow were found. Twice more often a caesarean section was made because of fetal emergency symptoms. CONCLUSIONS: The results of fetoplacental blood flow are one of more important prognostic factors in pregnancies complicated by a hypertension.

[Hypertension in pregnancy, which resulted from intrauterine insemination]. / Nadcisnienie w ciazy powstalej w wyniku inseminacji domacicznej.

The authors present an analysis of 117 pregnancies after intrauterine insemination (AIH) to indicate presence of disease during this period. We found out only 2.6% of EPH-gestosis among treated women, which means that frequency of PIH after AIH is lower then in natural population. Propriate decisions concerning pregnancies and positive relation of women to keep pregnancy have an essential value. We have not obtained any statistically significant differences between natural and after AIH evaluation of pregnancy.

[Morphometric analysis of the human placenta in physiologic term pregnancy]. / Morfometria lozyska ludzkiego w ciazy fizjologicznej, donoszonej.

Thirty placentas (after physiological deliveries of full term pregnancies) were morphometrically examined. Computer aided analysis of microscopic picture was used in those examinations. Measurements of terminal villi and epithelial plates were underwent. The efficiency of measuring methods was confirmed in morphometric examinations. The area of metabolic transport in placental plates was estimated to 1,222 m2. The results of measurements may constitute the basis for further examinations on morphology placenta.

[Management of breech delivery and its influence on the newborn]. / Sposób postepowania a stan i losy noworodków z porodów w polozeniumiednicowym plodu.

Authors analyse the newborns general well-being after the breech delivery in the two-years periods in 1983-84 and 1993-94. During this period of time the routine delivery by the caesarean section in primiparas was introduced. The statistically significant improvement in the general state on newborns measured by the Apgar score was observed in primiparas. All other data were comparatively similar.

[Forceps delivery--obstetric indications and outcome]. / Operacja kleszczowa--wskazania i wyniki poloznicze.

Authors analysed 170 forceps delivery in comparison to the control group of normal vaginal delivery. We analysed mothers age, obstetrical history, gestational age and duration of labour as well as traumatization, loss of blood and hospitalisation time. Analysed concerned as well the newborns state in the Apgar score its delivery way and newborn injuries. The most frequent indication for the forceps delivery was the imminent foetal asphyxia. The second stage of delivery lasted significantly longer, the blood lost was greater and the hospitalisation prolonged. Newborns presented poorer after-delivery condition measured in the Apgar score.

[Conjoined twins--diagnostic and therapeutic strategies]. / Bliznieta nierozdzielone--strategia diagnostyczno--terapeutyczna.

The authors have analysed three cases of twin pregnancies complicated by the conjoined of the fetuses. Based on own experience and informations from the literature the general diagnostic and therapeutic strategy of dealing with this condition has been purposed.

GnRH analogs in treating uterine leiomyomata and endometriosis.

The results of hormonal examinations, measurements of dimensions of the uterus and leiomyomas, body weight, and also frequency of incurred climacteric signs in patients treated with Decapeptyl Depot 3.75 mg for three months are reported. Subjects consisted of 12 women, among whom nine were treated for leiomyomas and four for endometriosis (one patient also had leiomyomas). Based on examinations carried out, the biggest decrease of the uterus and leiomyomas was 13-17% observed just after two doses of analog, though after the end of treatment the dimensions of the uterus slowly increased. Therefore, 2-month therapy could be used successfully as preparation for further conservative surgical treatment. Significant increase of body weight in treated patients was not observed. In women with endometriosis pain symptoms in the hypogastric area and dyspareunia regressed during treatment and at the end were not observed. The disadvantages of therapy with Decapeptyl Depot 3.75 was the rapid occurrence of symptoms--climacteric signs, especially hot flashes--which were badly tolerated by patients. All these symptoms almost totally regressed one month after ending therapy.

[Comparison of Doppler examination results for utero-placental blood flow and plate-villous index--morphologic determinant of placental barrier in pregnant patients with diabetes]. / Porównanie wyników badan Dopplerowskich przeplywu maciczno-lozyskowego i wskaznika plytkowo-kosmkowego--morfologicznego wykladnika bariery lozyskowej u pacjentek ciezarnych z cukrzyca.

The resistance index (RI) of the uteroplacental blood flow of both uterine arteries was evaluated in diabetic women in the perinatal period. Consecutively morphometric examination of placenta was proceeded after the delivery and the average number of epithelial plates in villi was calculated (so called "plate-villous index"). The correlation between the uterine arteries' blood flows and the plate-villous indices was calculated since the number of the epithelial plates determines the placenta barrier. There was poor correlation found between resistance indices and the average number of epithelial plates.