Follow-up after primary therapy of malignant epithelial ovarian tumors.

Follow-up after finishing the primary therapy has become a routine aimed to an early detection of relapse, decreasing the mortality and improving the quality of patient's life. Main aim of the follow-up is to prolong the life of the patient. No prospective randomized study confirming the scientific character of such aims has been published, so far. Opinions on benefit from the follow-up are conflicting. It is supposed, that early relapse detection can contribute to prolonged survival and on the other hand, there are opinions, that regular medical examinations can postpone relapse detection in symptomatic patients. Patients after treatment of an early stage should be followed up in regular intervals according to the presented scheme. Patients in advanced stages of the disease should be treated in a principally different way, based on free access to post primary treatment care. Quality of life has to be emphasized. The main purpose of the follow-up is to detect relapse during the time, when it is curable. When this condition has been fulfilled, the follow- up can have medical and economic relevance. Optimal screening is based on results from prospective randomized studies which objectively compare different models of the follow-up. Routine intensive follow-up might not be cost-effective and might substantially raise patient's anxiety at the same time. Patient education regarding early symptoms of relapse and free access could represent a cost-effective model. In order to decide between minimal and intensive follow-up, needs of all three participating members: patients, doctors and healthcare system have to be taken into account (Tab. 1, Ref. 105).

[Spontaneous rupture of uterine vessels during pregnancy in a patient with previous endometriosis]. / Spontánna ruptúra uterinných ciev pocas gravidity u pacientky s predchádzajúcou endometriózou.

Spontaneous rupture of the utero-ovarian vessels during pregnancy is a rare condition that can be life-threatening. Endometriosis is one of the factors associated with this complication of the pregnancy. Location of the pain as well as the course of this complication can simulate various diseases that must be dealt with. We describe the case associated with haemoperitoneum and hemorrhagic shock.

[Peripartum hysterectomy--an audit in Slovakia in 2007]. / Peripartálne hysterektómie--audit na Slovensku v roku 2007.

OBJECTIVE: An audit was performed to assess the number, indications and complications of peripartum hysterectomy at the departments of obstetrics/gynecology in Slovakia in 2007. DESIGN: Observational descriptive study. SETTING: Department of Obstetrics and Gynecology, Faculty Hospital Nitra and Constantine the Philosopher University Nitra. METHOD: An official questionnaire of Slovak Society of Obstetrics and Gynecology was sent to all 63 departments of obstetrics/gynecology to find the number of peripartum hysterectomy performed in the year 2007. Differences between intrapartum and postpartum cases were compared. RESULTS: 44 from 63 institutions responded to the survey (response rate 69.8%). There were 38,485 deliveries and 24 cases of peripartum hysterectomies. The incidence of peripartum hysterectomy was 0.62/1000 deliveries, 1 case occurred in 1604 deliveries. 16 (66.7%) patients had a total abdominal hysterectomy with the remaining 8 (33.3%) having a sub-total hysterectomy. All operations were emergent. 18 procedures were performed during delivery and 6 in the postpartum period. Hypogastric artery ligation before hysterectomy were performed on 2 patients in the postpartum group. 20 of 24 (83.3%) patients delivered by cesarean section, three (12.5%) by spontaneous vaginal delivery and one (4.2%) with vaccumextraction. The indications for emergency peripartum hysterectomy were: placenta praevia 6 cases (25%), placental abruption with disseminated intravascular coagulation 6 (25%), placenta accreta 3 (12.5%), uterine atony 3 (12.5%), uterine rupture 3 (12.5%) and retroperitoneal haematoma 3 (12.5%). The youngest patient was 15 year-old, the oldest one was 39. After hysterectomy 10 (41.7%) women were admitted to the intensive care unit. There was no maternal mortality, but five newborns died due to perinatal asphyxia. There were more blood transfusions in the group of postpartum hysterectomies in comparison with intrapartum cases (4.0 +/- 1.3 transfusion units vs 9.1 +/- 3.5, p < 0.05), as well as the longer hospital stay (10.3 +/- s4.2 days vs. 19.1 +/- 5.3, p < 0.05). CONCLUSIONS: Peripartal hysterectomy is a dramatic but a life saving procedure. It is usually associated with significant maternal and fetal morbidity and mortality. Every obstetric service should have access to a surgical team capable of performing emergency peripartal hysterectomy.

[Assessment of routine surveillance of patients after primary treatment for cervical cancer in stage I. and II.: retrospective analysis]. / Zhodnotenie rutinného sledovania pacientok po primárnej liecbe pre karcinóm krcka maternice v I. a II. stádiu: retrospektívna analýza.

OBJECTIVE: Evaluate the monitoring and diagnosis of recurrence after primary treatment for cervical cancer. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology Faculty Hospital and Constantine the Philosopher University Nitra. METHODS: We retrospectively analyzed 199 patients who have undergone surgical treatment for cervical cancer between 2000 and 2008 at the Faculty Hospital Nitra and they received chemoradioterapy after evaluation of risk factors. Monitoring after primary treatment consisted of general physical examination, gynecological examination, vaginal and abdominal ultrasonography, chest X-ray and determining the level of SCCA. The examinations were performed by gynecologist and clinical oncologist. We compared the survival of patients with symptomatic and asymptomatic recurrences. RESULTS: The recurrence after 6 months post primary therapy were identified in 17 cases. At the time recurrence diagnosis 3 patients were asymptomatic and 14 were symptomatic. Recurrences all 3 asymptomatic patients were detected during regular examinations. Asymptomatic and symptomatic patients had similar survival. CONCLUSION: Regular monitoring of patients after primary treatment of cervical cancer in the rigid intervals and diagnosis of recurrence in the asymptomatic stage does not improve survival compared with symptomatic patients. It is necessary to re-evaluate the algorithm of follow-up not only in terms of survival but also in terms of economic consequences.

[Education of gynecologic surgeons]. / Výchova gynekologických operatérov.

OBJECTIVE: To point out the latest trends in the surgical training that need to be implemented in Slovak and Czech Republic, not only in gynecology and obstetrics but also in all surgical specialties. SUBJECT: Review article. SETTING: Department of Obstetrics and Gynecology, Faculty Hospital Nitra and Constantine the Philosopher University Nitra. METHODS: Analysis of the database Medline 1979-2010 with the searching words education, competency, surgeon. CONCLUSION: The development of high-technologies, mainly minimally invasive surgery, working-hours shortage and public medical awareness are the factors that have major influence on the education of surgeons. Subspecialization, shortage of learning curve and higher safety of surgical procedures are the key elements of the surgical training.

[Fitz-Hugh-Curtis syndrome: a case report]. / Fitz-Hugh-Curtis syndróm: kazuistika.

Fitz-Hugh-Curtis syndrome (FHCS) is a liver inflammation associated with pelvic inflammatory disease (PID). It is usually associated with a sharp pain in the right upper quadrant at the rib margin. Chlamydia trachomatis and Neisseria gonorrhoeae are thought to be primary causative agents of FHCS. Location of pain as well as the course FHCS can simulate various diseases which is necessary in the differential diagnosis of abdominal pain thinking. In the case report we describe the occurrence of a typical syndrome in an association with PID.

Prognostic factors in women 45 years of age or younger with endometrial cancer.

The purpose of this study was to conduct a clinical and pathologic review of endometrial cancers diagnosed in women aged younger than 45 years to better identify the prognostic factors for this subgroup of women. We retrospectively evaluated the clinical history, treatment, and follow-up of patients with histologically confirmed endometrial cancer treated in Faculty Hospital Nitra, Slovakia from 1993 to 2003. Data were abstracted regarding tumor histology, grade, age, parity, stage, diabetes, use of oral contraceptives, body mass index (BMI), and survival. One hundred seventy-three patients with endometrioid histology were divided into two groups: younger group (age 45, n = 153). Patients with high-risk histology (clear cell or serous papillary) were excluded from the study. Twenty patients less than or equal to 45 years of age received treatment for endometrial cancer: stage I, 16 (80%); stage II, 2 (10%); stage III, 1 (5%); and stage IV, 1 (5%). Tumors were well differentiated in 12 (60%), moderately differentiated in 6 (30%), and poorly differentiated in 2 (10%). Age ranged from 28 to 45 years (mean 37), with mean BMI 35.8 +/- 9.4. At the end of study period, 17 (85%) were alive with no evidence of disease and 3 (15%) had died of recurrent disease. We conclude that patients less than or equal to 45 years of age have better survival compared to older patients. Deeper myometrial invasion was significantly associated with age greater than 45 years. Majority of young patients with endometrial cancer were obese and nulliparous.

Elevation of serum CA 125 and D-dimer levels associated with rupture of ovarian endometrioma.

BACKGROUND: Patients with endometriosis rarely have a serum CA 125 concentration >100 IU/mL. A raised plasma level of D-dimer indicates active fibrinolysis, either secondary to clot formation or primarily activated. This condition is seldom diagnosed in patients with endometriosis. CASE REPORT: A 53-year-old woman was referred to our institution for acute abdominal pain. Laparoscopic surgery revealed a large ovarian cyst with rupture on the left side. Preoperative laboratory tests detected high serum CA 125 and D-dimer levels. Adnexectomy was performed, resulting in a sharp decrease in serum CA 125 and D-dimer concentration. We describe the clinical course of the patient. CONCLUSION: Rupture of a large ovarian endometrioma can lead to a high serum concentration of CA 125, a condition which, in addition to the detected pelvic mass, may mimic a malignant process. The increased D-dimer plasma level indicated that a ruptured endometriotic cyst can induce coagulation reactions.

[The use of recombinant factor VIIa on the therapy of massive bleeding after cesarean section]. / Pouzitie rekombinantného faktora VIIa na liecbu masívneho krvácania po cisárskom reze.

OBJECTIVE: To present a case report of severe post-partum bleeding after caesarean section and successful treatment using recombinant factor VIIa. SETTING: Obstetrics and Gynecology Department, Faculty Hospital, Nitra, Slovak Republic. CASE REPORT: A 29-year old secundigravida presented with major post-partum bleeding after caesarean section due to uterine atony. The patient developed hemorrhagic shock, associated with disseminated intravascular coagulation (DIC). Treatment with uterotonic drugs, prostaglandins and hysterectomy failed to control diffuse bleeding. Recombinant factor VIIa (90 microg/kg intravenous injection) was given as a final attempt to control the bleeding. The response to treatment was rapid, with control of the bleeding and resolution of the coagulopathy. CONCLUSION: This case suggests a potential role of recombination factor VIIa in the treatment of severe post-partum bleeding associated with DIC.

Surgical management of endometrial cancer in Slovak Republic.

AIM: To evaluate the routine surgical treatment of endometrial cancer in Slovak Republic in relation to current international recommendations. METHODS: A retrospective study based on a questionnaire was undertaken. Data on surgical and post-operative adjuvant therapy of endometrial cancer patients in Slovakia in 2001 were collected, assessed and validated for good clinical practice. RESULTS: We presented data of 298 cases of endometrial adenocarcinoma from 48 of 66 Slovak gynecologic departments. Laparotomy with hysterectomy and bilateral salpingo-oophorectomy was performed in 280/298 patients. Peritoneal washings were examined in 41/298 cases. Lymphadenectomy (pelvic and/or para-aortic) was performed in 52/298 of the women. Malignancy remained undiagnosed in 29/298 of the cases until it was detected by histological investigation of extirpated uterus. CONCLUSION: The study demonstrates that surgical management of endometrial cancer is far from optimal. It seems necessary to restrict treatment to the centres with gynecologic oncologists trained in pelvic surgery.

Peritoneal cytology in endometrial cancer.

The results as well as prognostic interpretation of peritoneal washing cytology in endometrial cancer cases is still controversial. The incidence rate of positive cytology varies widely and the clinical significance of the positive results, especially in patients with early stage of endometrial cancer remains also controversial. Prognostic significance of malignant peritoneal cytology in endometrial cancer patients in comparison with those with ovarian cancer has been less well defined. At present, positive peritoneal cytology is not a negative prognostic factor itself, but it enhance other negative prognostic indicators. Literature regarding the significance of peritoneal cytology in endometrial cancer was reviewed in order to draw conclusions for possible therapeutic implications in patients with positive cytologic findings.