Clinical outcomes of patients with adenocarcinoma in situ of the cervix treated by conization.

OBJECTIVE: To describe the clinical outcomes of histologically confirmed adenocarcinoma in situ (AIS) of the cervix treated with cervical conization. MATERIALS AND METHODS: A retrospective chart review of patients with histologically confirmed AIS from July 1998 to February 2011 included 52 patients. The rates of residual disease in subsequent excisions, the clinical recurrence rate, the average disease-free interval, and risk of progression to adenocarcinoma were described. The clinical outcomes of patients treated with cold knife cone (CKC) and loop electrosurgical excisional procedure (LEEP) were compared. RESULTS: Fifteen LEEPs and 37 CKC procedures were performed as initial treatment and 26 patients (50%) had positive margins. There was no significant difference in rate of positive margins between LEEP and CKC (40% vs. 54%, respectively. p = 0.55). LEEPs and CKCs resulted in similar volumes of cervical tissue resected (4.98 cm3 vs. 5.04 cm3, p = 0.40). Of patients with positive margins, ten underwent immediate hysterectomy, six underwent a second cone biopsy, seven were managed expectantly, and four were lost to follow up. Residual AIS was found in 47% (eight of 17) of repeat cone biopsy and hysterectomy specimens performed for positive cone margins. Of the 26 patients with negative cone margins, no residual or recurrent disease was found after an average follow-up of 32 months. CONCLUSIONS: A positive surgical margin was associated with residual disease in 47% of patients with AIS treated with conization. No patient with negative cone margins had recurrent or progressive disease. Cervical conization with negative margins appears to be a safe treatment option for patients with AIS but requires further investigation. CKC and LEEP were equally efficacious treatments in our study population.

PP124. Trofoblastic invasion: The role of subunits STAT1 and STAT3.

INTRODUCTION: The trophoblastic migration/invasion are controlled by cytokines and growth factors that use intracellular pathways of signal to promote the regulation of gene expression, proliferation, cells differentiation, angiogenesis and embryonic development. The most important mediator of cytokine in trophoblastic invasion is the Janus-Kinase/signal transducer and activator of transcription (JAK/STAT). STATs are amino acids, compounds of 700-850 variable long-chain with isoforms α and ß and molecular weight between 83-113kDa. The role of these factors in the pregnancy set up may contribute to adopt interventions that could contribute to prophylaxis and/or treatment of abnormalities in the course of gestation when installed early. OBJECTIVES: Search on database the role of STAT in the process of trophoblastic invasion with emphasis on subunits STAT1 and STAT3. METHODS: This is a review performed on PubMed database. Have been included Studies found from 1992 (the year of discovery of STATs) until July 2011, without language restriction. The descriptors were: "Signal transducers and activators of transcription "and" Trophoblast". In the end we excluded bibliographical review. RESULTS: Five of the six selected papers studied the role of STAT3 in the physiology of the trophoblastc invasion process. One of them, indirectly by selection process of lactobacilli of vaginal flora endogenous, during change of vaginal pH on pregnancy, altering the release of greater or lesser number of Interleukin-10 which modulates the activation JAK/STAT. Among them, one of the study refers to involvement of STAT1 in the immunomodulation of interface fetus-mother. CONCLUSION: STAT3 is directly involved in the process of trophoblast invasion either in its endometrium adherence to, angiogenesis, invasion and regulation of invasion. And STAT1 is involved in immunomodulation through its suppression by trophoblast STAT utron. Several soluble factors that are generally present in the decidua, especially hepatocyte growth factor, granulocyte macrophagocytic-colony stimulating factors, interleukin-6, interleukin-11 and inhibition leukemia factor , which have been described by using the JAK-STAT activating STAT1 and STAT3 for intracellular signaling and from this process may influence the invasion trophoblast.

PP176. SFLT-1: A possibility of precocious diagnosis of preeclampsia.

INTRODUCTION: Preeclampsia (PE) affects 5-8% of all pregnant women and can trigger a severe gestational hypertension framework and eventually develop into eclampsia and HELLP syndrome. Anticipating the damage would be important in order to establish procedures that can reduce adverse outcomes. For this reason, many researches are undertaken to identify ways to make a diagnosis of preeclampsia as early as possible. It has been highlighted in literature the study: the sFlt1 (soluble fms-like tyrosine kinase-1) has been implicated in the precocious diagnosis of pre eclampsia. The sFlt1 is an anti-angiogenic factor produced in response to oxidative stress derived from the deleterious effects of pre-eclampsia. OBJECTIVES: The objective of the study was to evaluate the role of Soluble fms-like tyrosine kinase-1 in the diagnosis of preeclampsia. METHODS: This is a review conducted in the database PubMed and Lilacs. For this purpose, we used the following MeSH, "Vascular Endothelial Growth Factor Receptor-1" OR "FLT1 protein, human" AND "Pre-Eclampsia/diagnosis" in PubMed and "Pre-eclampsia" AND "SFLT1A" in Lilacs, resulting in 84 papers. After reading the abstracts of these studies, we selected the articles analyzed taking into consideration the criteria for inclusion and exclusion. We excluded publications that were not in the period under study (2008 to July 2011) and by study design. Including only case-control, cohort and prospective observational. For a critical analysis of the material, we used the following indicators: researcher, years, central theme, participants, study design and primary outcome. RESULTS: The final results of this study were composed of seven articles and are shown for each target outcome. These vary according to gestational age at which PE is installed and the marker studied (sFlt1 alone or its relation to PlGF - sFlt1/PIGF). Six studies showed greater levels of sFlt1 for the preeclampsia groups when compared to the control group. Significantly differences in antiangiogenic factors seric levels were not found among preeclamptic and eclamptic patients. When associated with another factor, like PIGF, a greater efficacy in the diagnosis of early preeclampsia is shown. Of the studies analyzed, only one (Lynch et al) showed no significant difference between the values of sFlt-1 in groups of early PE, late PE and control for gestational ages between 10 and 15 weeks. As for the relation sFlt-1/PIGF, five studies have considered it even better for PE diagnosis when compared to sFlt-1 isolated. CONCLUSION: The dosage of sFlt1 may be a relevant resource for the early diagnosis of preeclampsia before the installation of target organ damage, especially if measured in the period between 12 and 28 weeks of gestational age. Whereas sFlt-1 manifests itself before the 20th week, that may be interesting clinical point of view since it is this phase that settles the most severe cases, when the adoption of care could prevent further risks. The relationship sFlt1/PIGF, was more appropriate than the measurement of sFlt1 alone. Additional studies are needed to: amplification of the number of women evaluated, establishing gestational age appropriate for study, serum standard and need to consider the relationship between sFlt1 and other factors pro and/or anti-angiogenic.