Aromatase inhibitor therapy for endometrial stromal sarcoma - two-centre experience.

OBJECTIVES: Endocrine therapy is the recommended systemic treatment for steroid receptor positive endometrial stromal sarcoma (ESS). There is no current consensus on the optimal hormonal therapy for ESS. The literature offers several reports on advanced/recurrent/metastatic ESS patients treated with progestins, whereas data on the efficacy of aromatase inhibitors are scarce. MATERIAL AND METHODS: We retrospectively identified cases treated for ESS with aromatase inhibitors at our institutions. There were five patients with advanced or unresectable recurrent estrogen, progesterone and androgen receptor-positive ESS, treated with aromatase inhibitors: letrozole or anastrozole (at a daily dose of 2.5 mg and 1 mg, respectively), as first-line endocrine therapy in all but one case treated following progression with megestrol acetate. RESULTS: Disease stabilization was achieved in four cases (80%), including two with long-term progression-free survival for up to 10 years attained under letrozole treatment, and one case after prior progestin treatment. During therapy, no substantial toxicity was observed. CONCLUSIONS: Aromatase inhibitors as first- or second-line endocrine treatment achieve disease control in most steroid receptor positive ESS. Our series of cases is evidence of aromatase inhibitors efficacy as long-term endocrine treatment option for ESS patients.

"Niche" czyli ubytek w miejscu blizny miesniówki macicy po cieciu cesarskim - przyczyny, diagnostyka, objawy.

Niche, a newly described in the polish literature cesarean section complication, is defined as a triangular anechoic deficient of the uterine myometrium localized in the site of the scar after the incision of a typically performed low-transverse cesarean delivery. The aim of the paper is to provide an overview of the available literature on the diagnosis and symptoms of niche. Diagnostic evaluation of the niche comprises of visual diagnostic methods: transvaginal ultrasonography to localize the cesarean scar and contrast-enhanced sonography as the method of choice for measuring the depth of the niche, the residual myometrium thickness and the total myometrial thickness. The mechanisms of niche development have not yet been revealed, although, as suggested, it may be a coincidence of many factors as: closure technique, development of the lower uterine segment or location of the incision and wound healing. The symptoms related to the presence of a niche are: abnormal uterine bleeding, lower abdominal pain, infertility, urination problems and obstetrical complications which may be life-threatening for both the women and the fetus. The suggested relation between the niche and the occurrence of complications in future pregnancies, as uterine rupture and implantation of the gestational sack in the site of the diverticulum, are still unexplained.

Conservative treatment of borderline ovarian tumors: the experience of one clinical center.

OBJECTIVES: Borderline ovarian tumors have favorable survival rates, however, prognostic factors are still discussed. The aim was to investigate the outcome for women treated conservatively with respect to different tumor-dependent and tumor-independent prognostic factors. MATERIAL AND METHODS: 194 women treated surgically between years 1978 and 2007. Influence of conservative or radical surgical treatment on survival was evaluated. RESULTS: The overall 5-year survival rate was 93.1% and 96.8% respectively for radical and conservative treatment. The mean time of survival was longer in women treated conservatively (p = 0.03), but this was an outcome of their younger age; when age was eliminated as a determining factor; the type of treatment had not influenced the length of postoperative survival (p=0.57). Conservative treatment was chosen more frequently for younger women. Factors that are detrimental to survival are age, postmenopausal detection of borderline ovarian tumors, an advanced stage of progression, a bilateral localization of tumors, the occurrence of invasive peritoneal implants and a serous rather than a mucinous histological type of borderline ovarian tumor more frequently occurred in women treated radically Borderline ovarian tumors recurred in 16.7% of women after conservative treatment and in 3.5% of women after radical treatment. Of women with preserved fertility 25.7% became pregnant at least once and 21.2% of the group as a whole delivered children at term; none of the pregnancies were fertility-assisted. CONCLUSIONS: Conservative treatment does not have a deleterious effect on the prognosis of women provided that unfavorable prognostic factors are identified.

[The use of venous ports in oncological patients]. / Zastosowanie portów naczyniowych u chorych onkologicznych.

INTRODUCTION: Venous ports provide a permanent, long-lasting and easy access to the central veins. These subcutaneously inserted systems have found application in the therapy of patients with oncological and chronic illnesses, and in treatment of children with hemophilia. During a planned continuous infusion of chemotherapy they increase patient comfort, reducing the risk of local inflammatory states and moderating the risk of spilling the cytostatic agent to the perivesical compartment. MATERIAL AND METHODS: 83 patients with venous subcutaneous ports implanted between July 2006 and November 2011 were included into the study The methods of implantation and usage were presented. Length of time the port is in situ and occurrence of early and late complications was evaluated. RESULTS: The longest indwelling time for port was 1484 days, while the shortest was 70 days. In 89.9% of cases, the correct position of the port's tip was noted during a control X-ray performed after the implantation. Early complications were not observed, while late ones concerned 16.86% of patients and included: generalized bacteriemia (8.43%), local inflammation of the skin and of the subcutaneous tissue (1.2%), venous thrombosis (2.41%), migration of the catheter (1.2%), necrosis of the skin over the port's chamber (2.41%). CONCLUSION: Venous ports play an important role in the treatment of cancer patients. The placement of venous ports is a safe procedure that has a low rate of early complications. The frequency of late complications correlates with that described in the literature.

High maternal-fetal HLA eplet compatibility is associated with severe manifestation of preeclampsia.

Introduction: Preeclampsia is responsible for more than 70 000 and 500 000 maternal and fetal deaths, respectively each year. Incomplete remodelling of the spiral arteries in placenta is the most accepted theory of preeclampsia pathogenesis. However, the process is complexed with immunological background, as pregnancy resembles allograft transplantation. Fetus expresses human leukocyte antigens (HLA) inherited from both parents, thus is semiallogeneic to the maternal immune system. Therefore, induction of fetal tolerance is crucial for physiological outcome of pregnancy. Noteworthy, the immunogenicity of discordant HLA antigens is determined by functional epitopes called eplets, which are continuous and discontinuous short sequences of amino acids. This way various HLA molecules may express the same eplet and some HLA incompatibilities can be more immunogenic due to different eplet combination. Therefore, we hypothesized that maternal- fetal HLA incompatibility may be involved in the pathogenesis of gestational hypertension and its progression to preeclampsia. We also aimed to test if particular maternal-fetal eplet mismatches are more prone for induction of anti- fetal HLA antibodies in gestational hypertension and preeclampsia. Methods: High resolution next-generation sequencing of HLA-A, -B, -C, -DQB1 and -DRB1 antigens was performed in mothers and children from physiological pregnancies (12 pairs) and from pregnancies complicated with gestational hypertension (22 pairs) and preeclampsia (27 pairs). In the next step HLA eplet identification and analysis of HLA eplet incompatibilities was performed with in silico approach HLAMatchmaker algorithm. Simultaneously maternal sera were screened for anti-fetal HLA class I, class II and anti-MICA antibodies with Luminex, and data were analyzed with HLA-Fusion software. Results: We observed that high HLA-C, -B, and DQB1 maternal-fetal eplet compatibility was associated with severe preeclampsia (PE) manifestation. Both quantity and quality of HLA epletmismatches affected the severity of PE. Mismatches in HLA-B eplets: 65QIA+76ESN, 70IAO, 180E, HLA-C eplets: 193PL3, 267QE, and HLA-DRB1 eplet: 16Y were associated with a mild outcome of preeclampsia if the complication occurred. Conclusions: High HLA-C, HLA-DQB1 and HLA-B eplet compatibility between mother and child is associated with severe manifestation of preeclampsia. Both quantity and quality of maternal-fetal HLA eplet mismatches affects severity of preeclampsia.

Sexual behavior and contraception among young Polish women.

OBJECTIVE: To analyze sexual behavior and the use of contraception among young women in Poland. DESIGN: Cross-sectional study. POPULATION: 1,478 young women in higher (78.9%) and secondary (21.1%) education. SETTING: Gdansk region in Poland. METHODS: The data were gathered between September and December 2008 by the use of a questionnaire prepared for the purpose of this study, completed anonymously and in person by the young women. RESULTS: Sexual activity had been initiated by 67.2% of the women studied at a mean age of 18.7 years (±1.97). Assessment was made of changes in their contraceptive practice between the time of sexual initiation and later sexual activity. Since their first experience of intercourse 67.0% did not change their contraceptive methods. As many as 40.1% continued using either low effective methods or no contraception. Early sexual initiation was linked to a significantly lower likelihood of highly effective contraception, more frequent unprotected sexual intercourse and more sexual partners (p < 0.05). Over half of women assigned to a 'high-risk' group with regard to the chance of unintended pregnancy and sexually transmitted infection, declared that their behavior did not carry any risk, similar (p > 0.05) to those who did not have a history of hazardous behavior. CONCLUSION: Sexual behavior differentiates Polish women from the women in Western Europe. Despite the welcome tendency toward choosing reliable contraceptives, use of appropriate contraception is still insufficient.

Hysteroscopy in the treatment of uterine cesarean section scar diverticulum: A systematic review.

The aim of this paper is to review and to analyze the results of previous studies dealing with hysteroscopic treatment of postcesarean scar defects. A systematic review of publications indexed in MEDLINE/PubMed database identified a total of 11 studies dealing with resectoscopic treatment of postcesarean scar defect. The review was conducted in line with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and the PRISMA statement. In only few studies, patients were qualified for hysteroscopic surgery based on the measurement of the defect depth and thickness of residual myometrium above the pouch. Two principal techniques were used for the hysteroscopic treatment: resection of one edge of the scar diverticulum, and resection of the inferior and superior edges of the defect. Additionally, most authors performed electrocauterization of the niche bottom. Resectoscopic treatment turned out to be highly effective in the case of women with AUB. No complications of the hysteroscopic procedure have been reported. Methodological value of the reviewed studies was relatively low due to non-unified selection/verification criteria and incomplete, non-systematic postoperative assessment. In conclusion, hysteroscopic treatment seems to be a promising option in the management of postcesarean scar defects, but still further research is needed on the problem in question.

Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM).

OBJECTIVE: To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. DESIGN: Case control national study. SETTING: Polish Center of the European Competence Network on Mastocytosis (ECNM). POPULATION OR SAMPLE: 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999-2014, before becoming pregnant. METHODS: Prospective analysis outcomes of pregnancies and deliveries. MAIN OUTCOME MEASURES: Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Red Espanola de Mastocitosis (REMA), Spain. RESULTS: All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies). Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%). None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during pregnancy and puerperium. CONCLUSIONS: There is no contraindication to pregnancy when mastocystosis-related pathologies are under appropriate medical control.

Nutrition and pregnancy after bariatric surgery.

Obesity is an escalating problem in all age groups and it is observed to be more common in females than males. About 25% of women meet the criteria of obesity and one-third of them are in the reproductive age. Because morbid obesity requiring surgical treatment is observed with increasing frequency, surgeons and gynecologists are undergoing new challenges. It is not only a matter of women's health and their quality of life but also proper development of the fetus, which should be a concern during bariatric treatment. Therefore complex perinatal care has to be provided for morbid obesity patients. The paper reviews pregnancy and fertility issues in bariatric surgery patients.