Total Colectomy as a Part of Ultra-Radical Surgery for Ovarian Cancer-Short- and Long-Term Outcomes.

(1) Background: The aim of this study was to assess the outcomes for patients who underwent total colectomy (TC) as a part of surgery for ovarian cancer (OC). (2) Methods: We performed a retrospective analysis of 1636 OC patients. Residual disease (RD) was reported using Sugarbaker's completeness of cytoreduction score. (3) Results: Forty-two patients underwent TC during primary debulking surgery (PDS), and four and ten patients underwent TC during the interval debulking surgery (IDS) and secondary cytoreduction, respectively. The median overall survival (mOS) in OC patients following the PDS was 45.1 months in those with CC-0 (21%) resection, 11.1 months in those with CC-1 (45%) resection and 20.0 months in those with CC-2 (33%) resection (p = 0.28). Severe adverse events were reported in 18 patients (43%). In the IDS group, two patients survived more than 2 years after IDS and one patient died after 28.6 months. In the recurrent OC group, the mOS was 6.9 months. Patient age above 65 years was associated with a shortened overall survival (OS) and the presence of adverse events. (4) Conclusions: TC as a part of ultra-radical surgery for advanced OC results in high rates of optimal debulking. However, survival benefits were observed only in patients with no macroscopic disease.

The role of laparoscopy in the surgical treatment of endometrial cancer.

INTRODUCTION: Endometrial carcinoma is one of the most common neoplasms in gynecological oncology and the most common genital cancer in women in developed countries. The 5-year overall survival rate depends on the FIGO stage. For patients with stage I endometrial cancer it is estimated as 80%. Traditionally, the main treatment of endometrial cancer consists of total abdominal hysterectomy with bilateral salpingo-oophorectomy and, in some histological or clinical stages, with additional pelvic lymphadenectomy. The main surgical approach so far for women with endometrial cancer has been laparotomy. However, in the last decades there have been many reports stating that the survival rate in such cases is similar after laparoscopy and laparotomy. Some researchers claim that laparoscopy is as effective as laparotomy, and it might be much more precise than laparotomy thanks to its special optic system. AIM: To establish the method of choice for treatment of stage I endometrial cancer. MATERIAL AND METHODS: Comparing the preliminary results from data collected during surgical procedures performed at the First Department of Obstetrics and Gynecology of the Medical Centre of Postgraduate Education in Warsaw and the Department of Obstetrics and Gynecology of the Rural Hospital in Garwolin. RESULTS: Laparoscopy is as effective as laparotomy, and it might be much more precise than laparotomy. CONCLUSIONS: Taking into consideration all the above arguments, if an experienced endoscopic surgeon and proper laparoscopic equipment are available, laparoscopy might become the method of choice for treatment of stage I endometrial cancer.

Prolactin secretion in polycystic ovary syndrome (PCOS).

OBJECTIVES: Hyperprolactinemia and polycystic ovary syndrome (PCOS) are on the list of the most frequent causes of female infertility. Both pathologies are characterized in common by several clinical features. At the same time, there are essential discrepancies in medical literature on mutual relations between PCOS and hyperprolactinemia. The objective of our study was to answer several questions, e.g. about frequency of hyperprolactinemia in PCOS patients, typical concentrations of prolactin (Prl) in PCOS patients vs women without polycystic ovaries and/or an assessment of circadian Prl level profiles vs single Prl sampling, as regards diagnostic usefulness. METHODS: The study was retrospective analysis of medical records of female patients in whom nine (9) points daily profile of prolactinemia had been performed. RESULTS: Prl levels appeared to be slightly higher in women without PCOS but the difference did not reach a border of statistical significance. The incidence of elevated Prl concentrations in 8:00 AM and 11:00 AM samples was higher in women without PCOS than in PCOS patients (32.0% vs 16.3% - 8:00 AM, and 8.5% vs 4.6% - 11:00 AM, respectively). Also, elevated mean daily prolactinemia, assessed as area under the curve (AUC) of Prl concentrations, was more frequent in the group of women without PCOS than in those with PCOS (22.0% vs 13.9%). CONCLUSIONS: Polycystic overy syndrome is not associated with higher levels of Prl, measured in daily profiles. Hyperprolactinemia does not seem to be more frequent in PCOS women than in healthy subjects and it should not be considered as characteristic feature of PCOS - both are distinct clinical entities. Prolactin concentrations should be assessed in each woman with PCOS suspicion because of certain common clinical signs in both disorders. Every woman diagnosed with PCOS and hyperprolactinemia should further be examined in terms of the actual causes of hyperprolactinemia because the coexistence of these two disease entities - as distinct - is also possible.

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]. / Rozlegly rak sromu 2 olbrzymim guzem pochwy--opis przypadku.

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]. / Dopplerowskie cechy niedotlenienia plodu w przypadkach wspólistniejacego nadcisnienia ciazowego (GH--gestational hypertension) i wewnatrzmacicznego zahamowania wzrostu.

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]. / Ocena przeplywu krwi w testnicy srodkowej mózgu i tetnicy pepowinowej u plodów z rozpoznana pulsacja w zyle pepowinowej.

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.