The role of sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial and cervical cancer

INTRODUCTION

Endometrial and cervical carcinoma are common neoplasms in gynecological oncology. The prognosis and treatment depend on the stage of the cancer according to the FIGO staging system. Stage IAl may be treated by hysterectomy or even local surgical procedures. For Stage IA2, radical hysterectomy and lymphadenectomy must be performed. Lymph node metastasis is an important prognostic factor in both cancers, however lymphadenectomy is associated with long-term complications. Thanks to the sentinel lymph node biopsy (SLNB), we can more accurately discover the staging of the primary tumor, and in case of sentinel lymph node (SLN) negative patients, can resign regional lymphadenectomy. Some researchers claim that new techniques such as indocyanine green (ICG) and endoscopic near-infrared fluorescence imaging for sentinel node mapping can be used instead of the traditional techniques.

AIM

To establish the role of sentinel node mapping technique in endometrial and cervical cancer.

MATERIAL AND METHODS

A retrospective study of medical records of five patients with cervical cancer (first group) Stage I and nine patients (second group) who underwent laparoscopic radical hysterectomy and SLNB or group of lymph nodes. These procedures were performed at Gynecology Department of the District Hospital in Garwolin.

RESULTS

All lymph nodes were clear of metastases. All patients after histopathological diagnosis were finally referred to the Cancer Centre and Institute of Oncology due to consultation or for further treatment.

CONCLUSION

Based on the present first results and literature review, intracervical ICG injection with fluorescence imaging seems to be the best SLN mapping technique, because of its simplicity, safety, and overall lower cost. More data is required to determine if the nodes identified with this technique are able to predict metastatic disease.

Laparoscopic abdominal cervical cerclage before conception--case report

Cervical incompetence is characterized by painless cervical dilation in the second or early in the third trimester with prolapsed membranes and expulsion of an immature fetus. Cervical cerclage performed during pregnancy is a typical and effective treatment of cervical incompetence. In case of previously failed cervical cerclages or other cervix malformations the procedure of abdominal cerclage in prepregnancy period can be considered as an option to help keep a pregnancy. In the following work we present two cases in which laparoscopic abdominal cervical cerclage was performed before conception. Laparoscopic cervical cerclage is a less invasive technique with acceptable outcome, that could replace the traditional laparotomy technique.

[Extensive vulva cancer with enormous tumor of the vagina]

The following is a case report documenting a 53-year old patient with extremely advanced vulva cancer (stage IV). The patient needed urgent operative treatment because of massive bleeding from large tumor located inside and out of the vagina. The prime step was to stop tumor hemorrhage, perform cystotomy and decompression of the urinary bladder and exteriorization of artificial anus. Second operation was a conventional oncologic procedure, which contained: radical vulectomy, hysterosalpingo-oophorectomy, cystectomy with excision of the urethra, the excision of almost the entire vagina, lymphadnectomy of the left inguinal lymph nodes and iliac lymph nodes. In spite of the surgical treatment, the patient died at the fourth day after the second operation.

[Doppler assessment of the fetal asphyxia in pregnancies complicated by gestational hypertension and intrauterine growth retardation]

OBJECTIVES

Gestational hypertension is associated with a high morbidity for both mother and fetus. Doppler ultrasound has allowed the fetal circulation to be examined. Now it is possible to monitor the response of the fetal circulation to hypoxia.

DESIGN

The aim of this study was to determine flow patterns in fetal circulation from pregnancies complicated by gestational hypertension and intrauterine growth restriction.

MATERIALS AND METHODS

The investigation included 23 fetuses with signs of the gestational hypertension and intrauterine growth restriction. We evaluated cerebral-placental ratio (CPR) and pulsation index (PI) in the middle cerebral artery (MCA) and the umbilical artery (UA). We also evaluated flows in umbilical vein.

RESULTS

We observed abnormal flow pattern in all cases of analyzing fetuses. The most common abnormal flow was vein pulsation (48%).

CONCLUSIONS

All analyzing fetuses shown signs of the hypoxia. Present of the umbilical vein pulsation or decompensate of the brain sparing effect is closely related o increased perinatal mortality.

[Assessment of blood flow in the middle cerebral artery and the umbilical artery in fetuses with umbilical venous pulsations]

OBJECTIVES

Umbilical venous pulsation is an important sign of hemodynamic compromise, especially during fetal heart failure and asphyxia.

DESIGN

The aim of this study was to determine of the blow flow in the middle cerebral artery and the umbilical artery in fetuses with umbilical venous pulsations.

MATERIALS AND METHODS

The investigation included 18 fetuses with signs of the intrauterine growth restriction and umbilical venous pulsations after 28th weeks of gestation. We evaluated cerebral-placental ratio (CPR) and pulsation index (PI) in the middle cerebral artery (MCA) and the umbilical artery (UA).

RESULTS

We observed brain sparring effect in all cases of analyzing fetuses. There were 77,8% of abnormal flow pattern in umbilical artery. 13 fetuses had a single pulsation pattern in umbilical vein and another 5 had double pulsation pattern.

CONCLUSIONS

The coexistence of umbilical vein pulsation and abnormal flow pattern in umbilical artery is closely related to increased perinatal mortality.

[Administration of natural anthocyanins derived from chokeberry (aronia melanocarpa) extract in the treatment of oligospermia in males with enhanced autoantibodies to oxidized low density lipoproteins (oLAB). The impact on fructose levels]

PURPOSE

To determinate the influence of anthocyanins from chokeberry on the generation of serous autoantibodies to oxidized low density lipoproteins (oLAB) and fructose levels in semen of males with oligospermia.

MATERIAL AND METHODS

Study group consisted of 38 males with oligospermia of who were randomly divided into 2 subgroups: in 22 subjects anthocyanins were administered, while 16 men were on placebo; control group consisted of 25 healthy male volunteers. We examined the level of oxidative stress measured by serum concentration of oLAB, together with fructose levels in semen.

RESULTS

In the anthocyanin group oLAB titres decreased from 1103 +/- 34 mU/ml before treatment to 742 +/- 24 mU/ml (1st month) and 724 +/- 23 mU/ml (2nd month), p < 0.01. In the placebo group oLAB titres were as follows--1094 +/- 21 mU/ml before treatment, 1114 +/- 36 mU/ml (1st month) and 1117 +/- 33 mU/ml (2nd month), p > 0.05; oLAB tires in the control group: 601 +/- 40 mU/ml before treatment, 609 +/- 38 mU/ml (1st month) and 609 +/- 38 mU/ml (2nd month), p > 0.05. In the anthocyanin group fructose levels in semen increased from 850 +/- 42 mg/ml before treatment to 1121 +/- 26* mg/ml (1st month) and 1230 +/- 27* mg/ml (2nd month), p < 0.05. In the placebo group fructose levels were as follows--832 +/- 36 mg/ml before treatment, 845 +/- 33 mg/ml (1st month) and 841 +/- 35 mg/ml (2nd month), p > 0.05; fructose levels in the control group: 1376 +/- 40 mg/ml before treatment, 1376 +/- 40 mg/ml (1st month) and 1388 +/- 37 mg/ml (2nd month), p > 0.05.

CONCLUSIONS

1. Our results indicate that natural antioxidants (anthocyanins) can be useful in controlling of oxidative stress in males with oligospermia. 2. Anthocyanins from aronia melanocarpa induce enhanced levels of fructose in semen of males with oligospermia.

[Oxidative stress in pregnancies complicated by gestational hypertension (GH), effect of oxidized serum lipoproteins (O-LDL)--the role of antio-LDL antibodies]

OBJECTIVE

To explain correlations between metabolism of serous oxidized lipoproteins, their influence on placental function in pregnancies complicated by GH and intrauterine asphyxia.

MATERIALS AND METHODS

The group of 233 pregnant women characterised by gestational age between 32-40 weeks were divided into two sub-groups: the study group of 105 women with GH and the control group of 128 healthy pregnant women. In all the subjects doppler flows in umbilical and middle brain artery as well as the serum levels of anti o-LDL antibodies (oLAB) were measured.

RESULTS

In the study group mean PI values in middle brain artery equal 1.62 +/- 0.41 while in the control group 0.91 +/- 0.16 (p < 0.01), with oLAB values 1133 +/- 24 for the study group and 619 +/- 15 for the controls. Having analysed vascular flows in umbilical artery, mean PI values of 1.41 +/- 0.36 for the study group and 0.63 +/- 0.12 for the control group were obtained, (p < 0.01). The levels of oLAB in these groups were as follows: 1019 +/- 18 for the study group and 600 +/- 12 for the controls.

CONCLUSIONS

1. In pregnancies complicated by GH an intensified oxidative stress was observed as determined by increased levels of anti o-LDL antibodies (oLAB). 2. Pulsatility indices in umbilical and middle brain artery exhibited enhanced values in pregnancies complicated by GH.

[Evaluation of coagulation and fibrinolysis systems in women at peri- and postmenopausal age qualified for hormone replacement therapy]

OBJECTIVE

The aim of the study was to evaluate coagulation and fibrinolysis systems in peri- and postmenopausal women who were qualified for hormone replacement therapy.

MATERIALS AND METHODS

In sixty eight peri- and postmenopausal women qualified for hormone replacement therapy under study some coagulation and fibrinolysis parameters were measured in serum--platelet count, prothrombin time, prothrombin ratio, INR, APTT, thrombin time (TT), fibrinogen, D-dimers, TAT, factor VII, activity of antithrombin III, activity of protein C and protein S, PAI-1 and t-PA concentration. Controls were 26 healthy, reproductive women.

RESULTS

Out of fifteen examined coagulation and fibrinolysis parameters in six cases there were statistically significant differences between menopausal women and controls:--APTT and TT were shortened (but within normal range) in menopausal group than in controls;--concentration of fibrinogen in menopausal group (also within normal range) was higher than in controls;--activity of factor VII was risen (and outside normal range) in the examined group in comparison to the controls;--activity of protein S was lower in menopausal than in reproductive women;--also concentration of t-PA was lower in the examined group.

CONCLUSIONS

1. Differences in the values of coagulation and fibrinolytic parameters between the menopausal and reproductive groups of women may testify to the increased risk of thrombus formation in women at peri- and postmenopausal age. 2. Impaired fibrinolysis (low t-PA, high PAI-1) together with the rise in activity of factor VII can contribute to the development of ischaemic heart disease in menopausal women.

[Fetal fibronectin as a predictor of preterm delivery in patients with preterm contractions and cervical changes]

OBJECTIVE

The purpose of the study was to assess the clinical value of fetal fibronectin assay in the group of women presenting with preterm contractions and cervical changes.

STUDY DESIGN

We prospectively evaluated 82 patients between 23-34 weeks of gestation presenting with signs and symptoms of preterm labor, intact membranes and cervical dilatation < 3 cm. In all cases cervico-vaginal samples were collected and assayed for the presence of fetal fibronectin. The primary outcome was delivery < or = 28 days from examination.

RESULTS

The rate of preterm delivery (< 37 weeks) was 25.6% (21/82) and 17.1% (14/82) of the patients delivered < or = 28 days from the examination. The mean Bishop score was significantly higher in patients delivered < 28 days (5.9 +/- 1.2 vs 4.7 +/- 1.4; p = 0.004). Positive result of fFN (> 0.05 mg/ml) was found in 71.4% of patients that were delivered < or = 28 days and in 7.4% delivered > 28 days (p < 0.001). For predicting delivery < or = 28 days the positive fFN testing had sensitivity of 71.4%, specificity of 92.7%, PPV of 66.7% and NPV of 94%. The cutoff value for Bishop's score > or = 5 had sensitivity of 85.7% and specificity of 48.5%. Performing fFN testing only in patients with Bishop score > or = 5 resulted in the sensitivity of 71.4%, specificity of 95.6%, PPV of 76.9% and NPV of 94.2%.

CONCLUSIONS

Fetal fibronectin is a very good predictor of imminent preterm delivery. It needs further research whether performing of the fFN assay can be limited only to the patients with the estimated Bishop's score > or = 5.

[Administration of natural anthocyanins derived from chokeberry retardation of idiopathic and preeclamptic origin. Influence on metabolism of plasma oxidized lipoproteins: the role of autoantibodies to oxidized low density lipoproteins]

PURPOSE

To determinate the influence of anthocyanins from chokeberry on the generation of autoantibodies to oxidized low density lipoproteins (oLAB) in pregnancies complicated by intrauterine growth retardation (IUGR).

MATERIAL AND METHODS

Study group consisted of 105 pregnant women (on the turn of II trimester according to LMP) with IUGR (sonographic examination results below 5th percentile for real gestational age) who were randomly divided into 2 groups: in 50 anthocyanins were administered, 55 women were on placebo; control group--60 healthy pregnant women. We examined the level of oxidative stress measured by serum concentration of autoantibodies to oxidized low density lipoproteins (oLAB).

RESULTS

In the anthocyanin group oLAB titres decreased from 1104 +/- 41 mU/ml before treatment to 752 +/- 36 mU/ml (1st month) and 726 +/- 35 mU/ml (2nd month), p < 0.01. In the placebo group oLAB titres were of slightly increasing trend--1089 +/- 37 mU/ml before treatment, 1092 +/- 42 mU/ml (1st month) and 1115 +/- 43 mU/ml (2nd month), p > 0.05; oLAB tires in the control group: 601 +/- 49 mU/ml before treatment, 606 +/- 45 mU/ml (1st month) and 614 +/- 43 mU/ml (2nd month), p > 0.05.

CONCLUSIONS

Our results indicate that natural antioxidants (anthocyanins) can be useful in controlling of oxidative stress during pregnancies complicated by IUGR.

[Comparative analysis of modification of Misgav-Ladach and Pfannenstiel methods for cesarean section in the material of Fetal-Maternal Clinical Department PMMH-RI between 1994-1999]

PURPOSE

Comparative analysis of own modification of Misgav-Ladach (mML) and Pfannenstiel methods for caesarean section in the material of Fetal-Maternal Medicine Clinical Department PMMH-RI between 1994-99.

MATERIAL AND METHODS

Study group consists of 242 patients. In all women from this group we performed caesarean section using Misgav-Ladach method. Among all patients from control group counting 285 women we performed caesarean section applying Pfannenstiel method. To analyse clinical postoperative course in both groups we took account several parameters.

RESULTS

Statistical analysis revealed that most of clinical postoperative course parameters was significantly better values in the study group we performed caesarean section using Misgav-Ladach method.

CONCLUSIONS

The benefits of Misgav-Ladach method, with less pain post-operatively and quicker recovery, are all a by-product of doing the least harm during surgery and removing every unnecessary step. This method is appealing for its simplicity, ease of execution and its time-saving advantage.