Thyroid dysfunction during severe ovarian hyperstimulation syndrome. A case report.

Thyroid disorders, both in women who wish to conceive and in gravidas, has become a topic of much interest to numerous researchers. Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening condition among women undergoing controlled ovarian hyperstimulation (COH). We present a case of thyroid dysfunction in severe OHSS in a patient diagnosed with subclinical hypothyroidism before COH. The dose of L-thyroxine (L-T4) was increased before the procedure in order to reach TSH levels below 2.5 mU/L, and from day 1 of the stimulation the dose of L-T4 was increased by 33%. The patient remained clinically and biochemically euthyroid until day 8 after the embriotransfer (ET). Then, the woman developed severe OHSS, with fluid in the pleural and peritoneal cavity and laboratory evidence of severe OHSS. Laboratory thyroid function tests revealed overt hypothyroidism. L-T4 dose was not increased due to serious clinical condition of the patient. Iodine supplementation was initiated instead. After the symptoms subsided, a period of clinical and laboratory euthyroid state was observed, followed by gestational hyperthyroidism. The L-T4 dose was reduced and iodine supplementation was temporarily ceased. The thyroid function stabilized, while maintaining the L-T4 and iodine supplementation, at 20 weeks of gestation. The patient gave birth by a caesarean section at 37 weeks of gestation and returned to the pre-pregnancy dose of L-T4. To the best of our knowledge, this has been the first report about a patient with thyroid dysfunction in severe OHSS in the Polish literature. On the basis of the presented case and a review of the literature on thyroid dysfunction in women undergoing COH and OHSS, we conclude that clinical signs and biochemical parameters need to be taken into consideration while making therapeutic decision in women with thyroid dysfunction in the course of OHSS. Also, further studies are necessary to elucidate the matter.

Predictive value of HPV DNA in lymph nodes in surgically treated cervical carcinoma patients--a prospective study.

OBJECTIVE: High-risk types of HPV are etiological factors in cervical cancer. Lymph node involvement in cervical cancer patients reduces 5-year survival rates by 25-60%. However, the influence on survival of HPV DNA positivity in histopathologically negative lymph nodes remains unresolved. METHODS: The study included 116 of 148 patients who underwent Piver type III radical hysterectomy and pelvic lymphadenectomy and who showed HPV DNA positivity in the primary lesion. Lymph node tissues were tested for the presence of HPV DNA, using a PCR technique. RESULTS: We found the presence of HPV DNA sequences in lymph nodes dissected intraoperatively in 81 (69.83%) cases. In analysis, we compared patients from 3 groups: HPV- and metastatic-negative (LN HPV-M-); HPV-positive metastatic-negative (LN HPV+M-); and metastatic-positive (LN M+). We discovered that survival in groups LN M+ and LN HPV+M- did not differ statistically (p=0.37). However, the survival periods in these two groups differed when compared with LN HPV-M- patients (p<0.001). Using Cox's proportional hazards model, we found that the presence of lymph node HPV DNA, and FIGO stage, and primary lesion volume were independent parameters correlating with survival and mortality risk. CONCLUSION: We conclude that the presence of HPV DNA in lymph nodes is an early sign of metastasis and should be treated as such in prognostic outlook and planning the therapeutic strategy.

Doppler evaluation of external iliac vein hemodynamic changes caused by lymphocele after lymphadenectomy for cervical cancer.

PURPOSE: To use Doppler sonography to assess the hemodynamic changes in the external iliac vein (EIV) compressed by a pelvic lymphocele after pelvic lymphadenectomy in patients with cervical cancer. MATERIALS AND METHODS: Postoperative gray-scale and Doppler sonographic examinations were performed in 71 women after pelvic lymphadenectomy. Twenty healthy women served as controls. When present, the lymphocele was graded on a scale of 1 to 4 based on the percentage of the circumference of iliac vessels in contact with the lymphocele (ie, circumferential contiguity) (grade 1, 0-24%; grade 2, 25-49%; grade 3, 50-74%; grade 4, 75-100%), and in 3 groups according to its maximum diameter (group A, 1-40 mm; group B, 41-60 mm; group C, >60 mm). EIV velocity was measured, and waveform modulation by respiratory movements was analyzed. RESULTS: There were 40 lymphoceles in 22 patients. The mean (+/-SD) EIV velocity was 24.5 +/- 14.8 cm/s in the control group, 38.2 +/- 5.9 cm/s in group 1, 69.2 +/- 29.4 cm/s in group 2, 105.75 +/- 12.36 cm/s in group 3, and 139.5 +/- 33.79 cm/s in group 4. Spontaneous EIV blood flow could not be detected in 2 cases in the later group. EIV flow modulation was significantly lower in patients with greater lymphocele contiguity or diameter. CONCLUSIONS: Post-pelvic lymphadenectomy causes EIV extrinsic compression that results in upstream blood stasis, potentially increasing the risk for deep vein thrombosis.

[Clinical analysis of patients with Krukenberg tumor of the ovary]. / Analiza kliniczna chorych z guzem Krukenberga na materiale wlasnym oraz przeglad literatury.

OBJECTIVE: The aim of this study was to analyze clinical data such as diagnosis, surgical treatment and follow-up of patients with Krukenberg tumor (KT). We also reviewed literature of the subject. MATERIAL AND METHODS: We retrospectively analyzes medical data of 34 patients who were operated in Gynecology Clinic of Medical University of Gdansk in years 1999-2003. The definition of KT was that of Krukenberg's. RESULTS: The mean age of patients was 52, 23 of them were postmenopausal. Fourteen patients were diagnosed with malignant disease before surgery for ovarian tumor--11 were treated for breast cancer, 2 underwent resection of the stomach and one had rectosigmoidectomy. Before surgery a diagnosis for ovarian tumor such as ultrasonography, computer tomography and Ca125 were performed--in most cases sonography findings revealed mixed cystic and solid tumor of 320 cm in diameter; in 70% cases serum Ca125 was elevated with the highest result of 772 IU/ml. From among 20 patients who were suspected for primary ovarian cancer with no other malignant disease before surgery 9 had stomach cancer, 6 colon cancer, in 2 cases ovarian tumor was a metastasis from breast and in 1 from gall bladder; in 2 patients primary tumor was not found. The surgery performed in patients with KT was that of done for primary ovarian cancer. In 5 cased partial resection of colon was necessary. Surgical findings revealed ovarian tumor of 3-10 cm in diameter, solid and bilateral in most cases. The mean survival in our group was 4,7 months. The mean time between diagnosis of malignant disease and metastases to the ovary was 18 months. The best overall prognosis was for patients with breast cancer and the worst for cases with stomach cancer. CONCLUSIONS: There is a poor prognosis for patients with Krukenberg tumor. The diagnosis is late, in most cases during surgery for ovarian tumor. The most often site of primary malignancy was breast and stomach.

Evaluation of Fas gene promoter polymorphism in cervical cancer patients.

Transduction of signalling through Fas receptor has been implicated in physiological regulation of apoptosis process as well as pathogenesis of various human diseases. The gene encoding Fas receptor contains single nucleotide polymorphism at -670 position, which influences the expression by different transcriptional efficiency of this gene. The aim of this study was to determine the distribution of -670 A/G Fas gene promoter polymorphism in cervical cancer patients and healthy control group in Poland in order to evaluate the potential association between Fas genotype and cervical carcinogenesis. Our results do not confirm the hypothesis that AA genotype in Fas gene promoter may be engaged in the development of cervical neoplasia.

[Surgical complications in patients treated for invasive cervical cancer]. / Powiklania chirurgicznego leczenia chorych z inwazyjnym rakiem szyjki macicy.

OBJECTIVES: The aim of this study was to analyse, retrospectively, complications of therapy of 898 patients suffered from invasive cervical carcinoma. All patients have undergone radical surgical treatment in Gynaecological Department of Medical University of Gdansk between 1972 and 2000. MATERIALS AND METHODS: Patients were divided into four groups according to clinical examination (FIGO staging from 1985). Group Ia consisted of 27 (3%) patients; Ib consisted of 711 (79%) patients; IIa consisted of 133 (15%) patients and IIb consisted of 27 (3%) patients. 85 (9.5%) patients ware older than 60. In all cases radical abdominal hysterectomy and pelvic lymph nodes dissection was applied. RESULTS: Intraoperative complications ware observed in 66 (7.3%) patients. Among them 2 (0.2%) patients ware died, 29 (3.2%) patients had massive hemorrhage and 37 (4.1%) patients had local organs damage as bladder, rectum or ureter wall. During the postoperative period 11 (1.2%) patients ware died. There ware observed ureterovaginal fistula in 25 (2.7%) cases and vesicovaginal fistula in 9 (1.0%) cases. CONCLUSION: Radical surgical treatment of invasive cervical carcinoma performed in our department is relatively safe procedure. Results showed above are similar to the results from leading oncology centers.

[Action of galanin on smooth muscle strips isolated from rat and human uterus]. / Dzialanie galaniny na miesnie gladkie macicy.

OBJECTIVE: Galanin (Gal), a 29 amino-acid, peptide was isolated from porcine intestine extracts. Gal and its receptors are widely distributed in central and peripheral nervous systems, urogenital and gastrointestinal tracts of several mammalian species including the human. The study was undertaken to characterise the effects of Gal on uterus smooth muscle. MATERIAL AND METHODS: Smooth muscle strips were isolated from human uterus excised in perimenopausal age because of fibroids and prolapse. Another strips were taken from the uterus of a pregnant female rat a week before delivery. Muscle strips were suspended in the organ bath. Their spontaneous contractions and responses to Gal and oxytocin were recorded isometricaly. The changes in frequency and amplitude of smooth muscle contraction were analysed. RESULTS: Characteristics of smooth muscle stripes isolated from human uterus did not changed in the presence of Gal in concentration of 300 nM. Spontaneous contractions of smooth muscle stripes from the uterus of pregnant female rat were not affected in the presence of Gal in the concentration showed above, furthermore Gal did not alter contractions provoked by oxytocin. CONCLUSIONS: Gal has no influence on uterus smooth muscle function within perimenopausal age and the second half of pregnancy. The study does not exclude possibilities of Gal influence in other sex hormones profiles e.g. in young women or during labour.

[Acute myocardial infarction during the second trimester of pregnancy]. / Zawal miesnia sercowego w drugim trymestrze ciazy.

UNLABELLED: Acute myocardial infarction during pregnancy is a very rare event. It occurs from 1 per 10,000 to 1 per 30,000 deliveries. Diagnosis of myocardial ischaemia is difficult because of typical complaints in pregnancy such as breathlessness and pain in chest. Its first recognisable symptom is very often loss of consciousness and cardiac death. We present the case of a 36-year-old woman with cardiac arrest in the second trimester of pregnancy. The defibrillation was applied four times with power ranging from 150 J to 200 J. Acute myocardial infarction was diagnosed on the basis of biochemical and electrocardiological examinations. Pharmacological treatment consisted of adrenalin, lidocaine, dopamine, heparin, insulin and cordarone. Uncomplicated pregnancy and delivery by caesarean section is described. A review of literature follows. CONCLUSION: Although myocardial infarction is a rare complication of pregnancy, it always should be taken in consideration, especially in case of multipara older than 32, suffered from hypercholesterolemia or diabetes, treated with beta-mimetics or ergot alkaloid.