Lymph node mapping and sentinel node detection in carcinoma of the cervix, endometrium and vulva

OBJECTIVES: Validity of the sentinel node concept in patients with cervical, endometrial and vulvar cancer. MATERIAL AND METHODS: 47 cases of FIGO stage I and II cervical cancer, 33 cases of first clinical stage of endometrial cancer and 37 patients with FIGO stage I and II of vulvar cancer. In cervical and vulvar cancer preoperative lymphoscyntygraphy and intraoperative lymphatic mapping with blue dye and handheld gamma probe were performed. In patients with endometrial cancer intraoperative lymphatic mapping with blue dye injected into the cervix and into the uterine corpus subserously were done. In the last 10 cases radiolabeled nannocolloid were administered and the patients underwent preoperative lymphoscyntygraphy and intraoperative radio detection of sentinel node. Sentinel nodes were labeled as blue, radioactive, or blue/radioactive. RESULTS: In cervical cancer sensitivity of the dye and radiocolloid methods was 94%, specificity 100% and negative predictive value 97%. Out of 33 cases of endometrial cancer sentinel node was identified in 29 (87.87%) patients. None of women with histological negative sentinel node had metastases in the rest of lymph nodes resected. Sentinel node was detected in all cases of vulvar cancer. The status of sentinel nodes were representative for all lymph node resected. CONCLUSIONS: Concept of sentinel node may be applied first of all for vulvar cancer and also for cervical and endometrial cancer.     

Tissue-type plasminogen activator (T-PA) and plasminogen activator inhibitor (PAI-1) in human follicular fluid during gonadotropin-induced ovulation

OBJECTIVES: Plasminogen activators and their inhibitors have been implicated in the process of fibrinolysis, tissue remodeling, and ovulation. To evaluate the role of t-PA and PAI-1 in human ovulation, we obtained follicular fluid (FF) from preovulatory follicles of patients undergoing IVF-ET. Concentrations tPA and PAI-1 were analyzed in relation to oocyte maturation. Levels of tPA and PAI-1 obtained after COH were compared to the tPA and PAI-1 concentrations in the follicular fluid of healthy, fertile women. MATERIALS AND METHODS: FF was collected from 66 infertile patients undergoing ovulation induction using either short or long protocol. FF was obtained 36 hours after hCG (Pregnyl) administration. The control group consisted of 16 fertile women with unstimulated cycles. Concentrations of t-PA Ag and PAI-1 Ag were measured using Elisa kits (Bioopol). RESULTS: The average follicular fluid tPA concentration of patients undergoing IVF-ET treatment was significantly lower (0.039 vs 0.117 ng/mg protein; p < 0.0005), whereas PAI-1 significantly higher (3.261 vs 0.135 ng/mg; p < 0.0001) compared to the control group. Concentrations of tissue-type plasminogen activator in FF of patients with 5 or more mature oocyte were significantly lower (0.017 vs 0.056 ng/mg) and levels of PAI-1 higher (3.49 vs 2.9 ng/mg) in comparison to cases involving < 5 oocytes. CONCLUSIONS: 1. Concentration of tPA in the follicular fluid is significantly lower whereas PAI-1 level significantly higher in patients undergoing COH. 2. Follicular fluid tPA and PAI-1 concentrations may be a crucial factors reflecting oocyte maturity.     

Effect of recombinant activated factor VII (RFVIIA; NovoSeven) in a patient in haemorrhagic shock after obstetrical hysterectomy

Perinatal bleeding may lead to a fatal outcome in about 10% of cases. We present a case of a 29 year old woman in childbirth, in whom a preparation of recombinant activated factor VII (rFVIIa, NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark) was used with success to control intraoperative bleeding during haemorrhagic shock after caesarean section and obstetrical hysterectomy, in the course of the patient's third abdominal cavity revision for continuing blood loss. Administration of the preparation enabled for quick intraoperative control of haemorrhage, which allowed safe and clear identification and elimination of the cause of bleeding. No significant clotting abnormalities were noted at postoperative monitoring of the coagulation system. rFVIIa seems to be an effective alternative treatment of life-threatening haemorrhages in obstetrics, allowing for quick arrest of bleeding, and thus safe control of intraoperative local hemostasis.     

The role of leptin in human reproduction

The article reviews the current literature about leptin, a hormone produced mainly in the adipose tissue, in terms of its role in reproduction. The structure of leptin, its biological activity as well as its influence on secretion of their hormones has been discussed. The leptin concentrations during the ovulatory cycle, pregnancy puerperium and assisted reproduction have been presented. It has been suggested that leptin may have an advantageous effect not only on oocyte and zygote development in the early stages, but also on the process of implantation and therefore its evaluation may be useful for the clinical determination of embryo quality in IVF-ET program.     

Change in otosclerosis presentation over two decades

Presentation of otosclerosis in eighties and nineties was compared on the basis of analysis of patients' documentation. A group I of 80 patients treated in 1980-1990 and a group II of 148 patients treated in 1991-2000 were compared with regard to sex, age, incidence of oval window obliteration and bilateral disease. Bone conduction and air conduction threshold and air-bone gap were also compared. There was no difference between two groups regarding sex, age and bone conduction threshold. Oval window obliteration was found in 8 (10%) patients of group I and in 7 (4.7%) patients of group II and the difference was not significant. Bilateral otosclerosis was diagnosed in 77 (96.3%) patients of group I and in 121 (81.8%) patients of group II and the difference was significant (p < 0.01). Air conduction threshold and air-bone gap in patients treated in nineties were significantly smaller than in eighties (p < 0.001). In the last decade patients with otosclerosis presented with smaller hearing loss, smaller air-bone gap and had bilateral disease less frequently than patients in eighties.     

Captopril and enalapril improve cognition and depressed mood in hypertensive patients

In this study, we evaluate the effects of two angiotensin converting enzyme inhibitors (ACEIs), captopril and enalapril given chronically as antihypertensive treatment, on certain cognitive and emotional processes in humans. Thirty-nine subjects with mild to moderate hypertension and fifteen normotensive controls were divided into four groups consisting of normotensive and hypertensive subjects taking captopril, enalapril, or no medication at all. The Rey Auditory Verbal Learning Test and the Wechsler Memory Scale were used to evaluate their cognitive functioning. Mood changes in all subjects were assessed using the Beck Depression Inventory and the Hopkins Symptom Check- list (HSC). Results: Untreated hypertensive patients scored lower than normotensive controls in cognitive tests and significantly worse in cumulative recall (P < 0.05) and paired words association (P < 0.01). When compared with normotensive subjects, untreated hypertensive patients also scored significantly higher on the depression with anxiety subscale in HSC (P < 0.05). No significant influence of hypertension was found in any other examined aspect of cognition and mood. In most cases captopril improved and enalapril reversed the adverse memory effects of hypertension. High arterial blood pressure is significantly associated with an impairment of cognition and the occurrence of depression with anxiety in humans. Enalapril and, to a lesser extent, captopril reversed these deficits.     

Selected risk factors of ischemic heart disease in Polish seafarers. Preliminary report

Cardiovascular diseases are a serious health problem for seafarers. Work-related exposures, their diet and limited physical exercise during work at sea are contributing factors for the development of ischemic heart disease (IHD) in this group of workers. The objective of the present study was determination of incidence of selected risk factors of IHD, such as overweight and obesity, tobacco smoking, arterial hypertension, type 2 diabetes mellitus, dyslipidaemia, and elevated serum concentration of uric acid. A survey was conducted in 1998-2001 among 715 Polish seafarers examined at the Institute of Maritime and Tropical Medicine in Gdynia. One or more of the above risk factors were detected in 593 examined persons (82.9%). A single risk factor was present in 30.5% of the study population, two factors in 50.3% three factors in 13.2%, while four or more risk factors were present in 6% of examined seafarers. The authors suggest that, during the periodic medical examinations, physicians should advice seafarers about prevention of cardiovascular disease, and those of them in whom three or more risk factors of IHD are detected, should be referred to cardiological consultation comprising the assessment of coronary performance (exercise test).