HE4 protein and SMRP: Potential novel biomarkers in ovarian cancer detection.

Epithelial ovarian cancer has the highest mortality of all gynecological cancers, and its progression is often without symptoms. Clinical outcome and survival may be improved if the disease is identified in the early stages. The objective of the study was to evaluate the utility of the serum biomarkers human epididymis protein 4 (HE4), soluble mesothelin-related protein (SMRP) and CA125 in the detection of ovarian cancer. In this retrospective study, the serum concentrations of CA125, HE4 protein and SMRP were measured in a cohort of 70 patients with epithelial ovarian cancer (EOC) compared with 78 healthy controls. Median serum levels of CA125 for ovarian cancer cases were 503.55±560.7 U/ml vs. 9.28±14.47 U/ml in the control group (p<0.001); for SMRP 5.13±7.64 nM vs. 1.02±0.89 nM (p<0.01); and for HE4 597.95±934.59 pM vs. 56.75±43.79 pM (p<0.001), respectively. Positive correlations between the clinical stage of EOC and CA125, HE4 and SMRP serum concentrations were found [(R=0.83; p<0.001); (R=0.64; p<0.001); (R=0.45; p<0.001), respectively]. Data analysis for the whole study group also revealed a significant correlation between plasma concentrations of CA125 and HE4 (R=0.45; p<0.001), between CA125 and SMRP (R=0.38; p<0.001) as well as HE4 and SMRP (R=0.51; p<0.001). Similar significant correlations between serum biomarker concentrations were also found in the ovarian cancer group [CA125 and HE4 (R=0.31; p<0.01); CA125 and SMRP (R=0.25; p<0.05); HE4 and SMRP (R=0.44, p<0.001), respectively]. A significant correlation was observed between the serous histological type of EOC and serum concentration of HE4 in the study group compared with other non-serous types of ovarian cancer (p<0.01). In conclusion, measuring CA125 in combination with new biomarkers such as SMRP and HE4 may improve the accuracy of ovarian cancer diagnosis, particularly in early detection of the disease.

[Predictive value of CA 125 in detection of ovarian cancer in pre- and postmenopausal patients]. / Wartosc predykcyjna stezenia CA 125 w diagnostyce raka jajmnika u kobiet przed i po menopauzie.

AIM: The aim of the study was to evaluate the usefulness of CA125 measurements in ovarian cancer diagnostics in pre- versus postmenopausal women. MATERIAL AND METHODS: The study group consisted of 99 serum specimens of women diagnosed with ovarian cancer (28 pre- and 71 postmenopausal). The control group consisted of 86 specimens collected from women without any ovarian pathology (34 pre- and 52 postmenopausal). CA 125 measurements were performed with Zymed Laboratories CA 125 ELISA Kit. Descriptive statistics, including mean values, standard deviation (SD) and 95CI of CA 125 among pre- and postmenopausal women, were calculated. The usefulness of CA 125 measurements in ovarian cancer diagnostics was assessed by calculating specificity sensitivity positive and negative predictive rates among pre- versus postmenopausal women. Statistical calculation was preformed with the use of STATISTICA 6.0 StatSoft Inc. (2001) software (wwwstatsoft. com). RESULTS: Higher CA 125 concentrations were observed in controls among pre- versus postmenopausal women (10.01 +/- 15.41; 95% CI: 4.63-15.39 IU/ml vs. 8.88 +/- 13.74; 95% CI: 5.06-12.71/U/ml, respectively NS). In contrary among women with ovarian cancer CA 125 levels were higher in postmenopausal women when compared to premenopausal (352.11 +/- 432.07; 95% CI: 184.57-519.65 vs. 541.59 +/- 547.98 95% CI: 411.89-671.29, respectively p < 0.05). In premenopausal group the CA 125 sensitivity was calculated at 64% whereas specificity 94.12% (FPR 5.9%; OR: 10.9), positive predictive value 90% and negative predictive value 94.12%. Among postmenopausal women results were as follows: sensitivity 88.73%, specificity 98.07% (FPR 1.9%, OR: 46.7), positive predictive value 98.44% and negative predictive value 86.44%. CONCLUSIONS: CA 125 measurements were more useful in the postmenopausal group. Higher CA 125 levels were observed in women with ovarian cancer diagnosis when compared to controls, in which lower CA 125 were observed. Higher sensitivity specificity and positive predictive values were observed in the postmenopausal group.

C-reactive protein as the indicator of severity in ovarian hyperstimulation syndrome.

BACKGROUND: To establish correlations between laboratory findings and clinical symptoms of moderate and severe ovarian hyperstimulation syndrome (OHSS). DESIGN: A retrospective study. SETTING: Department of obstetrics and gynecology, public clinical hospital. PATIENTS: Nineteen women admitted to the public hospital with a diagnosis of OHSS. The procedure of controlled ovarian stimulation (COH) was performed in the private assisted reproductive technology centre. METHODS: Blood samples were collected, ultrasound examination of ovaries, abdominal circumference measurement were performed, intravenous crystalloids, plasma expanders such colloids and albumin were given. Correlations between mean laboratory results (haematocrit, c-reactive protein (CRP), white blood count, serum protein, serum albumin), ovarian size in ultrasound examination, abdominal circumference, and amount of albumin and hydroxyethyl starch transfused to the patient were assessed. RESULTS: Significant correlation was observed between CRP concentration and abdominal circumference measured when the patient was admitted to the department, between CRP concentration and ovarian size measured during ultrasound examination at admission and between CRP concentration and body weight. CONCLUSIONS: CRP can be a potential candidate to an indicator of OHSS severity.

Bilateral ectopic tubal pregnancy, following in vitro fertilisation (IVF).

This is a case report of a 33 year-old-woman who underwent in vitro fertilization, because of primary infertility caused by fallopian tube factor. The patient underwent three trials of frozen embryo transfers (ET-CRYO). On the 26th day after the third probe of ET-CRYO she suffered from pelvic pain and vaginal bleeding. Transvaginal ultrasonographic scan revealed bilateral tubal ectopic pregnancy without fluid in the Douglas pouch and no gestational sac in the uterus. Laparoscopic bilateral salpingectomy was performed on the next day after admission. The postoperative course was uneventful.

Prenatal diagnosis of an atrioventricular canal in a foetus with deletion of chromosome 8 (pter-->p21).

Congenital heart malformations, detected during a pregnancy, are associated in 20-48% of cases with a chromosomal aberration. In the following study we have reported the deletion of chromosome 8 (pter-->p21), diagnosed prenatally at 22 weeks of gestation, because of a visible defect in the upper part of the interventricular septum and a partial defect of the atrial septum. The atria and the ventricles were joined with a common central valve. The cordocentesis was performed and karyotype: 46, XX ish del(8)(wcp8x2) was detected. Because of the persistent bradycardia of the foetus, indicating a danger of intrauterine asphyxia of the foetus, as well as features of premature placental detachment, the caesarean section was performed at 27 weeks of gestation. The patient gave birth to a daughter weighing 960 g. The child died in the 4th hour of her life. On the basis of the present observation it is safe to say that when an AV-canal defect is diagnosed prenatally, special attention must be paid to the detection of chromosomal abnormalities and amniocentesis or cordocentesis should be performed to assess the state of affairs.

[Dysfunctional uterine bleeding--diagnostics and treatment]. / Czynnosciowe krwawienia maciczne--diagnostyka i leczenie.

Dysfunctional uterine bleeding (DUB) occurs frequently in women at the reproductive age and is unrelated to structural uterine abnormalities. It significantly impairs the quality of life for many otherwise healthy women. Evaluation of patients with abnormal uterine bleeding and identification of those with DUB is based on medical records, physical examination, laboratory tests, uterine imaging and endometrial sampling. Surgical treatment options include hysterectomy and conservative surgery (endometrial resection or ablation). Medical therapy, with the avoidance of possibly unnecessary surgery, is an attractive treatment option. However, there is considerable variation in practice and lack of consensus regarding the most effective therapy.

Ovarian tissue preservation, present and clinical perspectives.

Ovarian tissue preservation and transplantation are intended for women undergoing aggressive regimens of chemical and/or radiological therapy, bone marrow transplantation or stem cell transplantation. Main indications for the procedure are neoplastic diseases and autoimmune disorders. The first live human birth after ovarian tissue autotransplantation was successfully done in 2002. Cryopreserved ovarian tissue can be autografted either orthotopically or heterotopically. Neovascularization of the implanted tissue is essential for the procedure. Vascular transplantation seems to be the best approach for avoiding follicular loss and extending the lifespan of the ovarian grafts. The procedure, regardless of whether ortho- or heterotopic, is connected with a risk of reimplantation of neoplastic cells. This can be minimized by multiple ovary biopsies, thorough histological examination and molecular genetic techniques. Introducing ovarian tissue transplantation into clinical practice requires many problems to be solved. Standardization of the freeze-thaw protocol is one of the most important issues. Solving the problem of transient graft ischemia is also essential. Eventually, the future safety of the method requires the development of efficient tests to detect the presence of neoplastic cells in the transplanted tissue.

Diagnosing and management of iatrogenic moderate and severe ovarian hyperstymulation syndrome (OHSS) in clinical material.

Severe ovarian hyperstymulation syndrome is a rare but potentially life-threatening complication in patients undergoing assisted reproductive techniques (ART). The pathogenesis of this condition is likely to be multifactorial. The aim of the retrospective study was to present management in moderate and severe iatrogenic ovarian hyperstymulation syndrome (OHSS) in clinical material. The study group was 19 women, admitted to the Department of Obstetrics and Gynecology in Central Clinical Hospital of Ministry of Interior and Administration in Warsaw from large outpatient infertility center "Novum" in Warsaw with moderate and severe OHSS between 14.07.2004 and 8.11.2005. Laboratory tests and ultrasound examination of the ovarian size and ascites were performed, abdominal circumference was measured. Patients were treated with rehydration with intravenous crystalloids and colloids, diuretics, antibiotics, anticoagulants and ultrasound-guided paracentesis if symptoms of ascites become severe (ascites causes pain and compromised pulmonary function). Oral intake of water was restricted, monitoring of fluid intake and output, and daily monitoring of body weight was performed. During treatment controlled laboratory tests were done. In one patient occurred intra-abdominal hemorrhage from ovarian rupture and laparotomy with oophorectomy was performed. The ovarian hyperstimulation syndrome is still a difficult diagnostic and therapeutic problem and more studies are required to elucidate pathophysiology of OHSS. Because of still unknown etiology treatment is empirical and in most of cases bases on experience of medical team. Thus, the management in individual patients varies according to the severity of ovarian hyperstymulation syndrome and its complications.

[The ovarian hyperstimulation syndrome--diagnostic criteria, management procedures]. / Zespól hyperstymulacji jajników--kryteria rozpoznania, sposoby postepowania.

The ovarian hyperstimulation syndrome (OHSS) is still a difficult diagnostic and therapeutic problem. OHSS is associated with significant hypertrophy of the ovaries associated with the loss of the intravascular fluid to the third space which results in hypovolaemia, oliguria, electrolyte imbalance, and a rise in haematocrit. The endogenous OHSS is rare. Most often OHSS appears as a complication of induction of ovulation. The fundamental issue in pathophysiology of OHSS is an increase of capillary permeability which results in the leakage of fluid to the third space. The vascular endothelial growth factor--VEGF--is considered to be the factor directly responsible for the processes involved. The most common are the mild and moderate forms of the syndrome. The severe form of OHSS is a life-threatening condition. The following symptoms may be present: ascites, pleural and pericardial effusion, oliguria, dyspnoea with tachypnoe, tachycardia, adult respiratory distress syndrome, renal failure, venous thrombosis, ischaemic stroke, haemorrhage from a ruptured ovary. Therapy should be based on the correction of hypovolaemia, hypotension and oliguria. Antithrombotic prophylaxis is an integral part of the OHSS management. Some interesting attempts have been undertaken to re-infuse the protein-rich ascites fluid directly to the systemic circulation, so called continuous auto-transfusion system of the ascites (CATSA).

[Risk factors for gestational trophoblastic tumors following complete hydatidiform mole]. / Czynniki ryzyka rozwoju nowotworów trofoblastu po zasniadzie groniastym calkowitym.

OBJECTIVES: The aim of our study was to determine the factors associated with higher incidence of trophoblastic tumours following complete hydatidiform mole. MATERIAL AND METHODS: Epidemiological and clinical factors were studied in eighty five patients with complete hydatidiform mole evacuated from 1973 to 1997 in Department of Obstetrics and Gynecology Medical University of Gdansk. Univariate and multivariate analysis were used to study of group. RESULTS AND CONCLUSIONS: In the analysis of 85 patients we found three prognostically independent factors that were associated with higher incidence of trophoblastic tumours after the complete hydatidiform mole: pre-evacuation hCG level, presence of prominent theca lutein cysts (greater than 6 cm in diameter) and molar pregnancy in the patient's past history. Persistent vomiting was a symptom of lower significance as a risk factor of trophoblastic tumour.