Plasminogen Activator Inhibitor Type 1 in Blood at Onset of Chemotherapy Unfavorably Affects Survival in Primary Ovarian Cancer.

Plasminogen activator inhibitor type 1 (PAI-1) belongs to the family of the plasminogen activator system. PAI-1 stimulates fibrinolysis and also promotes tumor progression. The aim of this study was to evaluate the prognostic value of blood plasma PAI-1 content in patients with epithelial ovarian cancer who start the first-line chemotherapy. PAI-1 content was measured in the blood of 61 patients with epithelial ovarian cancer at onset of first-line chemotherapy. The patients were further stratified into the low PAI-1 group (≤20 ng/mL; 33 patients) and the high PAI-1 group (>20 ng/mL; 28 patients). We found that the greater plasma PAI-1 content was associated with a significantly lower probability of a 5-year-long survival compared to that when PAI-I content was lower (45.5% vs. 69.5%, respectively; p = 0.04). However, the risk of cancer recurrence within 5 years failed to differ appreciably. A multivariate analysis revealed that the lower PAI-1 plasma content was an independent factor of longer overall survival (death risk ratio of 0.36, 95%CI = 0.16-0.79; p < 0.01). We conclude that PAI-1 is yet another biomarker of survival in patients with ovarian cancer.

[Recurrent ovarian cancer--qualification and results of surgical treatment]. / Nawrotowy rak jajnika--kwalifikacja i wyniki leczenia operacyjnego.

INTRODUCTION: Complete tumor cytoreduction seems to be beneficial for platinum-sensitive women with recurrent ovarian cancer (ROC). Selection of patients who might have a chance for complete debulking constitutes a real challenge. Several predictive models defining a chance for complete cytoreduction and help in patient selection for surgery have been developed. OBJECTIVES: The aim of the study was to evaluate the effectiveness of selected models in one clinical center and the impact of complete resection on treatment outcome. MATERIAL AND METHODS: A total of 17 patients with ROC, diagnosed at least 6 months after first-line chemotherapy were recruited for the study. The inclusion criteria were based on the AGO-score (DESKTOP I trial). The group were retrospectively analyzed based on the predictive model International Collaborative Cohort Score (Tian- score). The end point was the percentage of complete cytoreduction. Also, postoperative complications and progression-free survival (PFS) were evaluated. RESULTS: Out of 17 patients who meet the criteria of the the AGO-score, complete debulking was achieved in 13 (76.47%) cases. Comparing the results of the Tian-score, 12 (100%) patients who were considered to be at 'low-risk of surgical failure' were debulked optimally In addition, complete debulking was achieved in 1 patient from the high-risk group. In all optimally operated patients, the number of changes detected during pre-operative imaging was ≤ 3. In 11 patients after complete cytoreduction there was another relapse. The median of PFS was 16 months. CONCLUSIONS: The applied predictive models have proven to be effective in selecting patients who will benefit from surgical treatment of ROC.

[The possibility of cardiovascular system evaluation in fetuses at 11.0 to 13.6 weeks of gestation in a reference perinatal cardiology centre]. / Mozliwosc oceny plodowego ukladu krazenia pomiedzy 11.0 a 13.6 tygodniem ciazy w referencyjnym osrodku kardiologii perinatalnej.

OBJECTIVE: To assess the possibility of foetal circulatory system evaluation between 11+0 to 13+6 weeks of gestation in a reference perinatal cardiology centre. MATERIAL AND METHODS: A prospective study was conducted between January 2004 and June 2008 in patients admitted to the reference perinatal cardiology centre for a foetal echocardiographic examination. 1170 foetuses were examined: 31 in 2004, 167 in 2005, 310 in 2006, 406 in 2007 and 262 in the first half of 2008. All foetuses had early echocardiography performed during 11-13+6 weeks of gestation, following the Foetal Medicine Foundation guidelines. The examination included: position and size of the heart, 4-chamber view and outflow tracts evaluation. The flow through ductus venosus, atrio-ventricular and arterial valves were assessed with colour and pulsed Doppler. 982 patients with confirmed normal heart anatomy in the second trimester were further analysed. RESULTS: Mean maternal age was 30 years. 237 (20%) patients were >35 years old. Mean CRL (crown rump length) was 65 mm. 4-chamber view was obtained in 933 foetuses (95%) and outflow tracts in 813 (83%) cases. Diagnostic flow through the tricuspid valve was detected in 894 (91%) foetuses. CONCLUSIONS: Early foetal echocardiography is available in a reference perinatal cardiology centre since 11th week of gestation, in most cases with transabdominal probe. Possibility of the foetal heart anatomy evaluation increases with gestational age. Only patients from the high risk group (i.e. previous child with a major cardiac defect, diabetes mellitus, monochorionic pregnancy) and foetuses with increased NT should be examined. In every case, a control echocardiographic examination in the second trimester must be performed.

[Evaluation of the embryonic and foetal heart rate at 6(+0) to 11(+6) weeks of gestation]. / Ocena rytmu serca zarodka i plodu miedzy 6(+0) a 11(+6) tygodniem ciazy.

OBJECTIVE: To establish the normal range of embryonic heart rate (EHR) and foetal heart rate (FHR) at 6(+0) to 11(+6) weeks of gestation, to evaluate the risk of pregnancy loss depending on EHR and FHR values and to establish if checking of FHR with the use of M-mode method is possible in different levels obstetric departments. MATERIAL AND METHODS: Transvaginal or transabdominal ultrasound using M-mode in 255 singleton pregnancies. Maternal age varied between 16 and 44 years (mean 29 +/- 5 years). There were 67% primigravidas. Gestational week was established on the basis of CRL measurements. Demographic factors, obstetrical history and follow-up were collected. Data was statistically reviewed. RESULTS: FHR varied between 47 and 192 bpm (mean 154 +/- 26 bpm). At 6 weeks, mean EHR was 116 +/- 21 bpm, then slowly increased, reaching mean 172 +/- 9 bpm at 10 weeks. At 11 weeks the mean FHR achieved the level of 165 +/- 7 bpm. The difference was statistically significant. The r-correlation ratio between FHR and the gestational week was 0.58. In case of 7 embryos (2.75%) at 6.1 to 8.1 weeks of gestation slow FHR was noted (< 100 bpm). The scan performed 7-10 days later revealed miscarriages in all cases. CONCLUSIONS: EHR and FHR in the first trimester depends on gestational week. It increases since 6 to 9 weeks and decreases after 10 weeks. The highest values of FHR are observed between 9 and 10 weeks of gestation. The risk of early pregnancy loss increases significantly in case of detecting slow FHR. FHR can be checked by M-mode methods using any kind of ultrasound machine.

Prognostic value of tissue plasminogen activator (tPA) in patients with epithelial ovarian cancer undergoing chemotherapy.

OBJECTIVES: Tissue plasminogen activator (tPA) is a key enzyme for fibrin degradation and the proteolytic defense against formation of the thrombotic endothelial deposits. tPA is involved in carcinogenesis but its exact role in tumor biology is not very well understood and a prognostic value of tPA remains ambiguous in different cancers. The aim of the study was to assess the prognostic value of plasma tPA in patients with epithelial ovarian cancer (EOC) in the course of the first line chemotherapy. MATERIAL AND METHODS: the study covered 60 patients with EOC who underwent the 1st line chemotherapy. Plasma tPA was assessed at onset, after 3 and 6 cycles of chemotherapy. The groups were stratified according to tPA level at onset of chemotherapy (low tPA group < 6.5 mg/L, N = 37 and high tPA group > 6.5 mg/L, N = 23). Survival analysis was repeated for the cut-off of tPA level at 6.5 mg/L and 5.1 mg/L after 3 and 6 cycles. RESULTS: Only subjects with tPA > 6.5 mg/L at onset of chemotherapy had a significantly lower probability of a 5-year survival (34.8% vs. 72.7%, P < 0.006) and lower chance for disease free survival within 5 years (39.3% vs. 72.7%, P < 0.014). tPA < 6.5 mg/L plasma level evaluated at onset of chemotherapy was an independent marker of better overall survival (RR = 0.44, 95%CI = 0.19-0.98) but not disease-free survival. CONCLUSIONS: Plasma tPA may serve as a marker of survival if assessed at onset of the first line chemotherapy in patients with ovarian cancer.

[The possibility of evaluation of the myocardial performance index in fetuses at 11,0 to 13,6 week of gestation]. / Moiliwosci oceny skurczowo-rozkurczowej funkcji miesnia sercowego u plodów miedzy 11,0 a 13,6 tygodniem ciazy.

OBJECTIVES: To assess myocardial performance index (Tei index) for left and right ventricle in fetuses at 11.0 to 13.6 week of gestation. MATERIAL AND METHODS: Flow velocity waveforms of mitral, tricuspid, aortic and pulmonary valves were obtained. The Tei index for the left ventricle (Tei LV) was calculated in 55, and for the right ventricle (Tei RV) in 27 fetuses. RESULTS: The value of Tei LV ranged from 0.28 to 0.59, mean 0.41 +/- 0.08, and for Tei RV from 0.23 to 0.56, mean 0.37 +/- 0.11. There was no statistically important correlation either between Tei index and both ventricles or gestational age and fetal heart rate. The possibility to measure Tei index increased with the progress of the pregnancy. There remains a significant correlation between Tei LV and Tei RV values. CONCLUSIONS: Tei index may be useful for the assessment of fetal myocardial performance in the first trimester of pregnancy. Tei index is independent of gestational age and fetal heart rate. It is easier to measure the Tei index for the left ventricle than for the right one.

Results of Further Diagnostic Procedures Among Patients with Cytological Characteristics of Minor Changes on Pap Smears.

BACKGROUND: Atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) are the two most common results of positive Pap smears. AIM: The aim of this study was to compare the management of patients with ASCUS and LSIL. PATIENTS AND METHODS: All procedures were performed between 2003 and 2014 in an outpatient clinic affiliated to a tertiary referral center, and included Pap smears, colposcopy, histology and invasive treatment. RESULTS: There were 131 patients in the ASCUS group and 84 in the LSIL group. Further negative cytological results were obtained more frequently among the ASCUS group than the LSIL group [relative risk (RR)=1.18, 95% confidence interval (CI)=1.33-2.40; p<0.001]. Histological results revealed higher occurrence of cervical intraepithelial neoplasia grade III or invasive squamous cancer in the LSIL group than the ASCUS group [RR=6.8 (95% CI=0.95-144.63), p=0.033]. Patients from the LSIL group more frequently required invasive treatment [RR=2.53, 95% CI=1.40-4.67, p=0.001]. CONCLUSION: Diagnosis of ASCUS is associated with more frequent cases of total remission in follow-up Pap smears and requires for less-invasive management.

[Curettage immediately after delivery]. / Instrumentalna kontrola jamy macicy bezposrednio po porodzie.

The purpose of the study was to compare indications for curettage directly after delivery with histologic findings. Only in 51% there was a histologic confirmation of placental or membrane tissue. Residences indications of the suspected retained placenta were wrong in 70% cases. The curetting of 75% of the patients experiencing post partum bleeding revealed no fragments of placental or membrane tissue.

[Genetic amniocentesis in the II Department of Obstetrics and Gynecology of the Medical University of Warsaw]. / Ocena wyników amniopunkcji genetycznych w materiale II Kliniki Poloznictwa i Ginekologii AM w Warszawie.

OBJECTIVE: Characteristic of patients, indications, outcomes and complications of genetic amniocentesis. MATERIAL AND METHODS: Retrospective analysis of 420 women who underwent genetics amniocentesis from January 1999 to 2001. It was done by ultrasound-guided insertion of a 22-gauge needle from 12 to 19 week's gestation. From 9 ml to 24 ml of amniotic fluid were removed for cytogenic analysis. RESULTS: The mean maternal age was 37.6 +/- 4 years. The mean gestational age of amniocentesis was 14.2 +/- 1.2 weeks. 416 (99%) women were in singleton pregnancy, 3 (0.7%) in twin pregnancy and one (0.2%) in triplet pregnancy. The most common indication for amniocentesis was maternal age over 35 years (366 cases - 87%). Chromosomal abnormalities were identified in 23 cases (5.5%). Any neural tube defects were observed. In 6 (1.4%) cases the cell culture of amniotic fluid was unsuccessful and procedure was repeated. 2 (0.4%) women lost pregnancy during 7 days after procedure. 4 patients (0.9%) had amniotic fluid leakage, of which no ended in fetal loss. 1 (0.2%) had pain in hypogastrium after amniocentesis, all delivered at term. CONCLUSIONS: The pregnancy loss rate in women who underwent genetics amniocentesis was 0.4%. The most common indication for genetic amniocentesis was maternal age over 35 years. Chromosomal abnormalities were detected in 5.4% of the fetuses.

[Effectiveness of cervical cerclage and pessary in the treatment of isthmo-cervical insufficiency]. / Ocena porównawcza skutecznosci szwu szyjkowego i pessarium w leczeniu niewydolnosci ciesniowo-szyjkowej w ciazy.

The aim of this study was comparison of gestation, labour, puerperium and condition of newborns in women with cervical incompetence treated with cerclage or pessary. The interval from treatment to delivery was longer in women with pessary. In women who had cervical cerclage tocolysis was applied more frequently. Among patients with pessary kolpitis was found more often. Gestational age at delivery, the way of a labour, condition of newborns and complications during puerperium didn't differ significantly between both groups.

[Sexuality in pregnant women]. / Seksualizm kobiet w ciazy.

The aim of the study was to evaluate the effects of pregnancy on women's sexuality. The studies were conducted using questionnaires to interview 120 women from 35 weeks' of gestation or just after the delivery. There were no medical contraindications for sexual intercourse in pregnancy in this group. More than half of respondents reported a decrease in libido during gestation. A reduction in coital frequency, oral intercourse, gratification of coitus, caress of breasts or genitals and erotic dreams occurred during pregnancy. Lateral position was mainly used during coitus in pregnancy. Most of women didn't discuss the problems of sexual activity in pregnancy with their obstetricians.

[Genetic amniocentesis--characteristic of patients, indications, outcomes, complications]. / Amniopunkcja genetyczna--charakterystyka pacjentek, wskazania, wyniki, powiklania.

The indications, outcomes and complications of genetic amniocentesis in a group of 358 women were undeped. The most frequent indication for amniocentesis was maternal age over 35 years. Chromosomal abnormalities were identified in 21 cases (5.8%)--most of them were chromosomal inversions. There were no neural tube defects. In 6 (1.6%) cases the cell culture of amniotic fluid was unsuccessful. The level of alpha-fetoprotein was lower in fetuses with chromosomal abnormalities. 2 (0.5%) patients lost pregnancy after procedure, 4 (1.1%) had amniotic fluid leakage and 1 (0.2%) had pain in hypogastrium after amniocentesis.