Pregnancy associated with melanoma and fetal anomalies: a case report and review of literature.

The estimated incidence of melanoma complicating pregnancy has ranged from 0.1 to 2.8 per 1,000 pregnancies. Here the Authors present a case of a 40-year-old pregnant woman, who was admitted to the Clinic of Obstetrics and Gynaecology in 26 weeks of gestation, with diagnosis of melanoma and suspected with fetal anomaly, as possible bowel obstruction, and polyhydraminos. The melanoma was asported with a wide local excision under local anesthesia. Histological evaluation revealed melanoma Stage Ib (Clark IV, Breslow thickness 1.2 mm, pT2a). Lymph node sonography of neck, axilla, inguinum, abdomen, and pelvis as well as chest radiography did not demonstrate any evidence of metastatic disease. After vaginal delivery at 37 weeks of gestation, the female preterm hypotrophic newborn was transferred to the Institute for Neonatology and underwent resection of duodenojejunal atresia with tapering duodenoplasty and duodenojejunal termino-terminal anastomoses due to intestinal obstruction. No evidence of the melanoma was found in the placenta. Two years later the child was healthy and the mother was disease-free.

Comparison of electrolytic status (Na+, K+, Ca2+, Mg2+) in preterm and term deliveries.

PURPOSE OF INVESTIGATION: The objective of this study was to evaluate the electrolytic status of Na+, K+, Ca+, and Mg2+ in serum and red blood cells in idiopathic preterm and term deliveries. METHODS: The study included 105 pregnant women diagnosed with idiopathic premature delivery (study group) and 36 pregnant women with physiologically term delivery (controls). Samples of mother's blood were collected and analyzed for the level of electrolytes in the serum/plasma and red blood cells. RESULTS: Measured values of magnesium in red blood cells in the study group were far lower than physiological values, intracellular calcium levels were higher in the study group compared to levels measured in the controls. Sodium concentrations in cells were significantly lower in subjects with premature delivery. CONCLUSION: The magnesium intracellular level is the best representative value of magnesium in the body.

Prediction of fetal macrosomia with ultrasound parameters and maternal glycemic controls in gestational diabetes mellitus.

PURPOSE OF INVESTIGATION: Evaluation of ultrasound measurements of fetal adipose subcutaneous tissue (ASCT), abdominal circumference (AC), liver length (LL), and amniotic fluid index (AFI) in prediction of fetal macrosomia (FM) and gestational diabetes mellitus (GDM). MATERIALS AND METHODS: In a prospective clinical trial, 280 pregnant women underwent 100 g oral glucose tolerance test (oGTT) at 28th week of gestation (wg) and measurements ofAC, LL, AFI, and ASCT at 32nd, 34th, 36th, and 38th wg. RESULTS: For GDM, the best sensitivity was achieved by ACST at 32nd and 34th wg, the best specificity by LL at 32nd wg (90.6%), the best area under the curve (AUC) by LL at 34th wg (0.944). For FM the best sensitivity was achieved by AC at 32th, 34th, 36th, and 38th wg and by ASCT at 34th wg (94.2%), and the best AUC at 38th wg for AC (0.974). CONCLUSION: Ultrasound parameters of glycemic control were good predictors of FM and GDM.

Postmenopausal palpable ovary and ovarian cancer.

INTRODUCTION: Ultrasound (US) examination is a much more reliable method for evaluation of potential ovarian cancer risk than gynecologic palpation. The aim of our study was to analyze the US characteristics of patients with palpable ovaries in light of potential for malignancy. PATIENTS AND METHODS: We analyzed 70 women ten years after menopause without increased CA 125 values. They underwent clinical and US exams (abdominal and transvaginal ultrasound), with special emphasis on US Doppler exam. RESULTS: Bimanuel gynecological examination showed palpable ovaries in 14 patients (palpable ovary group), and the remaining 56 patients were defined as the control group. US showed increased dimensions of palpable ovaries. Atypical follicular activity, deviation from verticalization, atypical ovaries and hyperechogenic punctations classified under germ cell cysts occurred statistically significantly more often in the palpable ovary group. Doppler flow showed pathological vascularization in five patients with palpable ovaries and the estrogen level was increased. After four to six months in these five patients we found a mild increase of estrogen levels and higher Doppler abnormality. Six months later, two patients had irregular bleeding and underwent surgical treatment. CONCLUSION: Every adnexal mass after menopausis demands special attention. Bimanuel gynecological exams should be used liberally. It is necessary to follow the dimensions of the ovary, describe the echostructure, as well as the edges of the ovary and other anatomical structures. Doppler flow measurement and estrogen levels are predictive and give more information. Controls should be in three to six month intervals in order to make a decision for surgical treatment.

Surgical treatment of ovarian cancer and early detection of venous thromboembolism.

INTRODUCTION: Deep vein thrombosis (DVT) is present in 10.6% patients after operative treatment for ovarian malignancy. We undertook the present study to find the risk factors for venous thromboembolism (VTE) after surgical treatment for ovarian cancer and to clarify the prognostic value of D-dimer and a positive PTP test (Wells score) in these patients. MATERIAL AND METHODS: A total of 31 consecutive patients with histologically confirmed ovarian cancer after surgery, clinically suspicious for DVT were followed from January 2006 to December 2008. All patients were operatively treated at the Clinical Center of Serbia. Study variables included age, cardiovascular disease, FIGO stage, histology, BMI, presence of massive ascites and tumor size, D-dimer level and Wells score. All patients were postoperatively administered anticoagulant therapy. RESULTS: DVT was found in nine of 31 patients (29.0%). High BMI and presence of massive ascites were significantly associated with DVT. D-dimer (DD) levels were high in 27 of out 31 patients (87.1%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 100, 18.2, 33.3 and 100%. Results of the PTP test (according to Wells score) was positive in 20 out of 31 patients (64.5%). PTP score was not significantly different in patients with or without VTE (p = 0.606). Sensitivity, specificity, PPV and NPV were 66.7, 36.4, 30.0 and 72.7%, respectively. CONCLUSION: Incidence of VTE after gynecological operations for ovarian cancer in our study was similar to other investigators. Obesity and the massive ascites are statistically significant risk factors. Measurement of DD level and ultrasonography could become the standard in predicting VTE in ovarian cancer surgery. The use of Wells score is not satisfying in these patients. Prediction of VTE after gynecological surgery needs further confirmation in randomized controlled trials.

Is insulin-dependent diabetes and obesity a predisposition for endometrial and pancreatic carcinoma?

Among 178 patients operated for endometrial carcinoma during a five-year period, 17 were re-operated at the Institute of Surgery (9.5%) because of pancreatic head carcinoma. The frequency of insulin-dependent diabetes was pointed out in patients-- 28% of those who were first diagnosed with endometrial carcinoma. Moreover in the same group diagnosed with endometrial carcinoma, we found 17 to have pancreatic carcinoma, and among those there were 12 cases that had diabetes (70.58%).

Bone metastasis arising from a polyp of the cervix as the first symptom in generalized multi-organ adenocarcinoma.

Our patient was a 40-year-old female with a positive familial history for malignancies but no chronic diseases. After two vaginal deliveries without any reported difficulties, the patient had no intermenstrual bleeding, postcoital bleeding, leucorrhea or hypermenorrhea, abnormal vaginal bleeding, or postmenstrual bleeding, except during the past five-year period when a polyp-like change in the cervix was found. There was no indication for polypectomy, considering the fact that the patient had no symptoms, had an iodine positive Schiller test, as well as regular cytological smears on Papanicolaou testing. It is noteworthy that the patient had no symptoms until changes in the stool and painful sensation in the hip area. The patient was subjected to extensive surgery by a team composed of a gynecologist, surgeon and orthopedist. During Werthaim-Meigs surgery, four positive glandules and cervical adenocarcinoma Stage II were found. The colon was removed, as a right hemicolectomy, as well as the iliac bone upper segment. Unfortunately, considering the changes in the tissue of the colon and cervix, we considered the condition to be "generalized" adenocarcinoma.

Ovulation stimulation after treatment for a molar pregnancy for or against?

The case of a 29-year-old patient who underwent invitro fertilization due to secondary sterility, after a spontaneous but molar pregnancy, is described. Afterwards there was no spontaneous conception for five years. With the couple's consent, we decided to perform in vitro fertilization, i.e., ovulation induction and the ICSI (intracytoplasmic sperm injection) method.

Different medicaments in fetus maturation--corticosteroid usage.

OBJECTIVE: The object of work is pointing out the significance of improvement highly risk pregnancies by applying artificial fetal lungs maturation in relation to expected outcomes without adequate therapy. METHODS: We analyzed fetal lung maturation by using lecithin and sphingomyelin ratio in embryo fluid received by foam test. We examined successfulness of artificial fetal lungs maturation by applying corticosteroids to the embryo in a group of patients with serious form of growth retardation (group A), then to the mother (group B) and by inducing partial mild form of asphyxia with oxytocin infusion (group C). RESULTS: The success of the method is shown by the success of finished pregnancies. We followed the difference between expected and actual term of delivery. CONCLUSION: Artificial fetal lungs maturation by applying fetal corticosteroids efficiently increases the creation of lecithin and sphingomyelin and enables life of neonate even in period up to 30th week of gestation.

Cerebrovascular diseases during pregnancy and puerperium.

OBJECTIVE: We have studied 37 women with all forms of cerebrovascular diseases. Our aim was to study the etiology, clinical manifestations and prognosis of such conditions during pregnancy or puerperium. METHODS: We analyzed the most common causes of cerebrovascular diseases during the given period. RESULTS: The most common causes of cerebrovascular diseases during pregnancy or puerperium are hematological coagulation disorders, cardio embolism and eclampsia, whereas other causes ara rarer. CONCLUSIONS: The incidence of cerebrovascular diseases during pregnancy or puerperium is 11%. Cerebrovascular diseases are more frequent in puerperium than during pregnancy, being 1.8:1. Etiology remains undetermined in 35% of the cases.

Uterine sarcoma diagnosed during colon surgery--a complete precise diagnosis.

Uterine sarcomas are very rare tumors with the greatest malignant potential of all uterine tumors, and they differ significantly from endometrial carcinoma by their specific course, propagation and prognosis. A 54-year-old patient, after three vaginal deliveries and negative personal and family history, as well as regular cycles, presented with secondary problems related to occasional constipation with sporadic diarrhea and bloody stools. Colonoscopy revealed a colon tumor.

[The role of myomectomy in female infertility].

The aim was to examine which is the role of myoma in women infertility. We analyzed 100 patients with infertility that underwent classic abdominal myomesctomy from 2000. to 2003. year. Frequency of conception was 46%. Most patients were over 30-years-old. Conception happened in 80% patients aged 30-39 years. In 69,6% patients with secundar infertility happened conception. Pregnancies occured more often in infertility shorter than 36 months, in front wall myoma and in intramural-subserose or subserose type. In 11 patients with intramural-submucose myomas, uteral cave was opened and only two of them got pregnant. Recidives of myoma happened in 18%, and postoperative adhesions in 29% of pacients. Age, duration of pre-operative infertility and characteristics of myoma did not have statistically significant influence on the conception. Miomectomy is the important method in treatment of infertility, especially if the other possible causes were excluded.

[Radical treachelectomy in treatment of early stages of cervical cancer].

The aim of the study was to determine if radical trachelectomy with pelvic lymphonodectomy could be a method for treatment of early cervical cancer to preserve fertility. We examined 12 patients who were operatively treated from 1996. to 2006. year. Diagnostic method for cervical cancer was histologic examination, cone or biopsy. Histologic condition was planocelular carcinoma well differented. Two of the patients had Ia1 stage, seven had Ia2, and three of them had Ib1. We performed abdominal radical trachelectomy with pelvic lymphonodectomy. Resectional edges were patohistologically analyzed ex tempore, as well as lymphonodi, selectively. According to ex tempore analysis we determined if the radical trachelectomy should be done. In one patient resectional edges were positive, so she underwent radical hysterectomy. Postoperatively we found a positive lymphonodus in one patient, so we continued radiation therapy. In two-year follow-up period we did not find any sign of residual cancer. We concluded that radical trachelectomy with pelvic lymphonodectomy could be appropriate method for treatment of early stage cervical cancer.

Postoperative complications--massive transfusions in radical malignant gynecological surgeries.

At the Institute of Gynecology and Obstetrics we examined 24 women who were radically operated on and received massive transfusions during the intraoperative and postoperative period. Twelve developed massive transfusion complications such as urticaria, fever, and respiratory insufficiency known as TRALI (transfusion-related acute lung injury).

Increased AFP as an indicator of ovarian carcinoma and fetal kidney carcinoma--case report.

We examined a young primipara with increased alpha-fetoprotein (AFP) values and cystic tumefaction of the right ovary. Having in mind a mild decrease in ovarian artery resistance index (RI) and suspected findings of fetal kidney, this situation was delicate due to its double pathology which was later confirmed. Wilms' tumor is the most common urogenital tumor in childhood, and it is detectable in the prenatal period by ultrasound examination. In utero kidney biopsy confirms diagnosis and facilitates decisions concerning the course of pregnancy. Relative risk of intervention limits this diagnostic procedure for indicated cases.

Cervical and duodenal polyps and their malignant alterations--case report.

During routine examination of a 32-year-old patient, a cervical polyp was found and CIN III was confirmed by biopsy. After performing colposcopy, biopsy and establishing CIN III as well as performing gastroscopy where a duodenal polyp was found, thorough diagnostic exams and therapy were carried out. Complete duodenal resection and conization were performed. The medical board decided that neither further radiation nor chemotherapy was needed.

Leiomyoma of the uterus and retroperitoneal angioleiomyoma: case report.

Retroperitoneal angioleiomyoma is a benign mesenchymal neoplasm that is composed of smooth muscle cells and thick-walled vessels. In a 36-year-old patient a retrouterine and retroperitoneal tumor, 70 x 65 x 50 mm in size, was discovered during a surgical procedure due to uterine myoma. The tumor had a soft consistency and was completely removed. Histopathology showed features of angioleiomyoma. Angioleiomyoma is a rare benign entity; hence a benign course and good prognosis are expected.

Treatment for infertility and risk of invasive epithelial ovarian cancer--a case report.

A 30-year-old women was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia in April 2004 with the following diagnosis: adnexal mass soon after in vitro fertilization. Her history revealed salpingo-oophorectomy for mucinous cystadenofibroma of the left ovary eight years before and cystectomy of the right ovary three years before. At admission, the most remarkable findings were high temperature and elevated white blood cells with erythrocyte sedimentation rate. After the antibiotic treatment, laparatomy was performed and a multilocular right adnexal tumor was found. The right salpingo-oophorectomy was performed and pathological diagnosis was mucinous ovarian adenocarcinoma. Two weeks later, radical surgery was carried out and chemotherapy was applied. There is an urgent need for clear interpretation of the link between ovarian stimulation and ovarian cancer. An association between ovarian stimulation treatment and ovarian cancer has still not been completely proven.

Endometrial carcinoma and hormonal disturbances in middle-aged women--an overview.

Endometrial hyperplasias and endometrial adenocarcinomas present a morphological continuity. In 1,150 cases of patients admitted to two hospitals over the past two years with diagnosed irregular bleeding, suspected ultrasonography findings and positive family history, we performed, not only hormonal examinations, but also fractioned explorative curettage after receiving patient consent.

Solitary ovarian metastasis from cutaneous melanoma--case report.

A 47-year-old patient with two previous deliveries and three deliberate abortions was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia with the diagnosis of a uterine myoma and left adnexal mass. Five years previously, she had undergone excision of a malignant melanoma from her left leg. Pelvic exemination disclosed a left adnexal solid mass measuring about 100 x 80 x 80 mm and enlarged uterus 120 x 50 mm in size with myomatosus nodes on the posterior wall. After ultrasound and computed tomography examination, the patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, intracolic omentectomy and selective pelvic lymphonodectomy. The final histopathological diagnosis was metastatic amelanotic malignant melanoma of the left ovary and uterine myomas. After surgery the patient was transferred to the Institute of Oncology and Radiology where she received chemotherapy.