[Evaluation of morphological activity of primary Sjogren's syndrome on bioptates of minor salivary glands]. / Otsenka morfologicheskoi aktivnosti bolezni Shegrena po bioptatam malykh slyunnykh zhelez.

BACKGROUND: The results of the morphological study of the minor salivary glands can be used to assess the activity of the primary Sjogren's syndrome and to decide on adequate therapy.The existing protocol of The Sjögren's International Clinical Collaborative Alliance (SICCA) prescribes the methodology for examining biopsy specimens for suspected Sjögren's disease, however, experts interpret data from the analysis of histological preparations differently. OBJECTIVE: To identify morphological forms of sialadenitis, as well as to determine the focus score in Russian patients based on the retrospective analysis of minor salivary glands biopsies of patients with primary Sjogren's syndrome. MATERIAL AND METHODS: Biopsies of minor salivary glands were studied in 92 patients with primary Sjogren's syndrome and 42 patients without rheumatic disease. RESULTS: Focal lymphocytic sialadenitis was detected in 69 patients with primary Sjogren's syndrome. The focus score in patients with primary Sjogren's syndrome was 7.32 (2.8-14.17). In patients without rheumatic diseases, this index was 0.48 (p<0.05). Patients with confluent lymphocytic foci need immunohistochemical examination and dynamic monitoring to exclude lymphoproliferative diseases. CONCLUSION: The index of morphological activity of sialadenitis in primary Sjogren's syndrome ranges from 2.8 to 14.17 and reflects the activity of the underlying disease.It should be taken into account in the diagnosis and prescription of adequate therapy. Further study of the correlations of morphological and clinical and laboratory parameters will lead to clarification of the criterion signs of the disease.

Clinical and functional consequences of anti-properdin autoantibodies in patients with lupus nephritis.

Properdin is the only positive regulator of the complement system. In this study, we characterize the prevalence, functional consequences and disease associations of autoantibodies against properdin in a cohort of patients with autoimmune disease systemic lupus erythematosus (SLE) suffering from lupus nephritis (LN). We detected autoantibodies against properdin in plasma of 22·5% of the LN patients (16 of 71) by enzyme-linked immunosorbent assay (ELISA). The binding of these autoantibodies to properdin was dose-dependent and was validated by surface plasmon resonance. Higher levels of anti-properdin were related to high levels of anti-dsDNA and anti-nuclear antibodies and low concentrations of C3 and C4 in patients, and also with histological signs of LN activity and chronicity. The high negative predictive value (NPV) of anti-properdin and anti-dsDNA combination suggested that patients who are negative for both anti-properdin and anti-dsDNA will not have severe nephritis. Immunoglobulin G from anti-properdin-positive patients' plasma increased the C3b deposition on late apoptotic cells by flow cytometry. Nevertheless, these IgGs did not modify substantially the binding of properdin to C3b, the C3 convertase C3bBb and the pro-convertase C3bB, evaluated by surface plasmon resonance. In conclusion, anti-properdin autoantibodies exist in LN patients. They have weak but relevant functional consequences, which could have pathological significance.

Endoluminal negative pressure therapy in colorectal anastomotic leaks.

AIM: The aim of the present work was to perform an up-to-date review of the literature on endoluminal negative pressure therapy for colorectal anastomotic leak. METHOD: An electronic search in PubMed and Google Scholar and a manual search without language restrictions were performed on 25 January 2019. Only original series reporting endoluminal negative pressure therapy in colorectal anastomotic leaks were included. The primary outcome was the success rate (complete closure of the abscess cavity). The secondary outcomes were the rates of complications and stoma closure. RESULTS: Nineteen series with a total of 295 cases were analysed. The median distance of the anastomosis from the anal verge and the size of the abscess were 5.65 cm (4.9-10) and 6.0 cm (5-8.1) respectively. In 84.5% (78%-91%) the stoma was created at the first intervention. Neoadjuvant therapy was performed in 48.6% (3%-60%). Median 7 sponges (2-34) were used with median negative pressure 150 mmHg (125-700) for a median of 31 days (14-127). The success rate was 85.4% (80%-91%) with ileostomy closure in 72.6%. Complications were observed in 19% (13%-25%): abscesses 11.5% and anastomotic stenosis 4.4%. Laparotomy was required in 15% of the complications. The stoma was the only significant predictor for the success of the therapy (0.007, SE 0.004, P = 0.040). CONCLUSIONS: The initial experience looks promising with an 85% success rate, which precludes risky re-resections with redo anastomosis or Hartmann's procedure. Despite the good initial results, definitive conclusions cannot be drawn because of the small sample size and the lack of high-quality comparative studies.

A rare case of life-threatening extra-peritoneal bleeding a.

INTRODUCTION: Although inguinal hernia repair is a routine procedure and frequently performed as one-day surgery, we should be particularly aware of the possible complications, which could be life-threatening if not recognized in due course. CASE REPORT: We report a case of life-threatening extra-peritoneal bleeding after open inguinal hernia repair requiring damage control surgery. DISCUSSION: Several vessels can be responsible for massive extraperitoneal bleeding - external iliac vessels, lower epigastric artery, crema steric vessels and corona mortis. Although damage control surgery was developed to treat the severe trauma, it can also be a life-saving maneuver in cases as the presented one. Hemodynamic instability with distended abdomen is a primary indication for laparotomy, but in some cases the contrast CT provides valuable information about the location and the size of hematoma and can guide the operative approach - midline laparotomy or revision of the wound as in our case. To the best of our knowledge, this is the first reported case of life-threatening retroperitoneal bleeding after open inguinal hernia repair. The present case is a good example for the application of damage control in pathology considered as one-day surgery. CONCLUSIONS: Although casuistic, the life-threatening bleeding after open hernia repair should be suspected. The prompt surgical response with damage control can be life-saving maneuver even in the routine hernia surgery. Detailed knowledge of the anatomy and carefull dissection are required to avoid this kind of complications.

Clinical Case of Parvovirus B19 Infection in Pregnant Woman with Β-Thalassemia in Bulgaria.

A pregnant 30-year-old female in the 34th gestational week was admitted at University "Maichin Dom" Hospital prior to childbirth. The patient is diagnosed with ß-thalassemia. During laboratory screening hemoglobin of 98 g/L was established. Blood smear shows mild microcytic hypochromic anemia: RBC 5.15 x 1012/L, HGB 98 g/L, MCV 65.8 fL, MCH 19.4 pg, MCHC 295 g/L. Serum iron concentration is 12.9 µmol/L and ferritin 17.5 µg/L. For the delivery process cesium was considered. Two days after procedure a rash presented on face, hands and breasts. Although the mother was positive for parvovirus B19 infection, the baby was negative. This was confirmed by se-rological and molecular investigations. We discovered only the mother's B19V IgG antibodies in the newborn. In connection to the main disease, namely ß-thalassemia, acute virus infection could cause aplastic crisis. After consultation with a hematologist, serum hepcidin concentration (an iron homeostasis regulator) was quantified: 19.4 µg/L. ELISA test was used to prove B19V IgM antibodies in the mother. PCR analysis shows the presence of B19V DNA. During infection, inflammatory cytokines increase hepcidin secretion, leading to iron deposition into cells.

[NEW APPROACH IN DIAGNOSTIC ALGORITHM OF AN INFECTIOUS AGENTS (PARVOVIRUS B19 AND CHLAMYDIA TRACHOMATIS) INVOLVED IN THE DEVELOPMENT OF PATHOLOGICAL PREGNANCY].

UNLABELLED: Viral infections during pregnancy, along with some form of accompanying pregnancy diseases such as diabetes, cardiovascular, gastrointestinal, kidney and others, are a major cause of arising complications and mortality of mother and fetus. AIM: To improved the laboratory diagnostic approach in the study of women with pathological pregnancy, including improve treatment and prognostic character of the outcome of pregnancy, with the inclusion of two infectious agent parvovirus B19 and Chlamydia trachomatis. To determine types of anemia in pregnant women with parvovirus B19 and Chlamydia trachomatis infection and to select the correct therapeutic approach. MATERIALS AND METHODS: A total 36 serum samples from pregnant women with anemia (n = 22), nonimmune hydrops fetalis (n = 8) and fetal ascites (n = 6) were tested. The study included three newborns (n = 3), tested on the occasion of a possible maternal-fetal infections. The serological (indirect ELISA tests) and molecular (B19V-PCR test) methods were used. In anemic pregnant women were evaluated iron homeostasis parameters with CLIA, AAS and NEPH methods. RESULTS: In 6/36 (16.66%) patients B19V-IgM positive result was detected. Among the study patients with anemia, non-immune hydrops fetalis and fetal ascites incidence of proven B19V-IgM antibodies was 18.18% (4/22), 12.5% (1/8) and 16.66% (1/6), respectively. Protective B19-IgG antibodies in 25/39 (64.10%) samples were found. A positive PCR signal was showed in all patients with positive B19V-IgM, and 1 patient with anemia and positive B19V-IgG result. The three newborns were positive for B19V-IgG antibodies (maternal) and negative for acute viral infection. Present Chlamydia trachomatis infection in 6/36 (16.66%) and past infection in 5/36 (13.89%) patients was demonstrated. The anemia was evaluated as iron-deficiency according to low hepcidin levels 2.54 ± 0.4 µg/I compared to pregnant control group which included women without anemia 25.9 ± 2.8 µg/I. CONCLUSION: In view of the varied transmission B19V and the wide range of complications arising as a result of chlamydia, screening for these viral agents of pregnant women and women of childbearing age is an important approach for monitoring of pregnancy.

[SERUM HEPCIDIN LEVELS IN ENDOMETRIOSIS].

OBJECTIVE: Endometriosis is a benign disease, which ranks third in mortality from gynecological morbidity after inflammatory conditions and myoma. We tried to evaluate serum iron and hepcidin levels and seek their connection with the development of endometriosis. METHODS: For quantification of serum hepcidin we use ELISA method. 53 women were included, average age 25.4 ± 4.3. They were divided into two groups--women with endometriosis (EM) and a control group. Samples were taken at the University hospital "Maichin dom" for a period of one year. We measure serum iron, ferritin and calculate transferrin saturation. We use the Pearson's correlation and Student's t-test for evaluating of statistical significance. RESULTS: We found statistically significant differences in serum hepcidin levels in the groups included: women with endometriosis have higher concentrations 64.3 ± 7.8 µg/L compared to the control group 19.4 ± 4.1 µg/L (r = -0.201, P < 0.001). Serum ferritin levels showed significant differences between the two groups in EM 17.9 ± 8.4 ng/ml vs control 79.5 ± 14.6 ng/ml (r = -0.249, P < 0.001). Statistically significant difference was found in serum iron levels: in EM 21.9 ± 3.2 µmol/L compared to 13.5 ± 1.9 µmol/L in the control group (P < 0.001). CONCLUSION: Our results support the idea that iron overload and increased serum levels of hepcidin plays an important role in the pathogenesis of endometriosis.

[Curare-Like Camphor Derivatives and Their Biological Activity].

The synthesis and evaluation of muscle relaxant activity of series of dimeric camphor derivatives are described. Compounds in which the quaternary nitrogen atoms are separated by aromatic chain exhibited the highest efficiency as muscle relaxant. It was shown the screening of a charged atom and counter-ion does not have a significant role on the activity of the studied agents.

Preanalysis in Serum Hepcidin Measurement.

BACKGROUND: Hepcidin is a 25-amino peptide hormone that regulates iron homeostasis. Its serum quantification helps to provide the right therapeutic choice in iron-deficiency anemia and anemia in chronic diseases. Diurnal levels of serum iron might affect hepcidin secretion during the day. Blood collection time is an important part of the preanalytical phase of its quantification. METHODS: During the period 2013 - 2014, we collected blood samples for serum hepcidin quantification in 100 healthy controls. The samples were collected in vacuettes with serum separator gel at three different times during the day: 07:30 - 08:30, 12:00 - 13:00, and 16:00 - 17:00 hours. Hepcidin levels were measured with an ELISA method. RESULTS: We found a significant difference in serum hepcidin levels during the chosen three blood taking times. The normal range for Bulgarian population is 3.05 µg/L - 37.75 µg/L. The measured levels were: at 07:30 - 08:30 hours 12.2 µg/L (5.5 µg/L - 23.6 µg/L), 12:00 - 13:00 hours 14.1 µg/L (7.1 µg/L - 27.2 µg/L), and 16:00 - 17:00 hours 16.5 µtg/L (9.9 µg/L - 29.6 µpg/L) 10.7 < r < 1.0; p < 0.5 between 07:30 - 08:30 and 12:00 - 13:00 hours and p < 0.05 between 07:30 - 08:30 hours and 16:00 - 17:00 hours and 12:00 - 13:00 hours and 16:00 - 17:00 hours]. No significant differences were found for transferrin saturation between measured groups [0.1 < r < 0.3; p > 0.5]. CONCLUSIONS: In order to obtain the most correct results for serum hepcidin quantification (especially in border to referent range levels) in the preanalytical phase, it is important to consider the time of blood sampling.

Association of rs172378 C1q gene cluster polymorphism with lupus nephritis in Bulgarian patients.

INTRODUCTION: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can affect substantially any organ in the body. One of its most severe manifestations is lupus nephritis. Hereditary C1q deficiency is strongly related to SLE but there are very few and inconsistent studies exploring the single nucleotide polymorphisms (SNPs) of the C1q gene cluster in relation to the pathogenesis of SLE. In the present study we evaluated the possible association of gene variants in complement C1q gene cluster with susceptibility to lupus nephritis in a Bulgarian population, focusing on five previously associated with SLE SNPs in other populations. MATERIALS AND METHODS: Thirty-eight patients with lupus nephritis and 185 healthy controls, all from Bulgaria, were genotyped for the five C1q SNPs, rs587585, rs292001, rs172378, rs294179 and rs631090, by quantitive real-time PCR methods. We also determined C1q serum levels of C1q and haemolytic activity of C1q in relation to C1q genotypes. RESULTS: Lupus nephritis patients and healthy controls had statistically similar frequencies of genotypes and alleles of rs587585, rs292001, rs294179 and rs631090 SNPs. Nevertheless, minor G allele in rs172378 was significantly overrepresented in lupus nephritis patients when compared with healthy controls (36% vs. 23%, odds ratio = 1.80, 95% confidence interval = 1.06-3.06, p = 0.029). The SNP rs292001 showed a trend towards lower serum C1q levels in healthy controls. Two SNPs - rs294179 and rs292001 - were in a linkage disequilibrium in patients and healthy controls with different power (healthy controls: r (2 )= 0.6526, D' = 0.842; lupus nephritis patients: r (2 )= 0.491, D' = 0.686). The haplotype C-A-A-T-T in the patient group was associated with lupus nephritis: 7.7% vs. 0.8%, odds ratio = 10.81, 95% confidence interval = 1.45-80.57, p = 0.002. CONCLUSIONS: These results support the implication of the G allele in rs172378 as a risk factor for lupus nephritis in a homozygous status, at least for a Bulgarian population.

[OPERATIONAL EXPERIENCE FOR THE PROGRAM FOR THE FORMATION OF HEALTHY LIFESTYLE SKILLS AMONG SCHOOLCHILDREN].

In the paper there are presented data concerning the experience of the implementation of educational programs for schoolchildren "Being healthy is fashionable ". The program has been tested in the territory of the Penza Region. The awareness of students about the factors affecting health was shown to increase by 15,8% over three years of the realization of the program. The number of students taking systematic participation in sports competitions has increased by 3.8%, going in for various sports and physical exercises in sports sections and circles has increased by 2.6%. The prevalence of regular smoking among schoolchildren decreased by 4.1%.

[Plasma D-dimer levels in preeclampsia].

Preeclampsia is a multifactorial disease characterized by hypertension and proteinuria after 20 weeks of gestation of the pregnancy. Preeclampsia is characterized by the deposition of fibrin in the walls of small blood vessels. D-dimer was used as a marker for degradation/synthesis of fibrin in vivo. D-dimer has emerged as a useful indicator in the diagnosis of thrombotic conditions because its plasma concentration has a high predictive value for the assessment of venous thromboembolism. The purpose of this study was to evaluate plasma levels of D-dimer and preeclampsia compared to normal pregnancy occurs. We found that elevated levels of D-dimer is associated with the development of preeclampsia in the third trimester of pregnancy compared with normal pregnancy occurs. Preliminary findings highlight the need for further in-depth studies during pregnancy in order to fully clarify the diagnostic/prognostic role of D-dimer preeclampsia.

Recent trends in the epidemiology of shigellosis in Israel.

We provide an update on the epidemiology of shigellosis in Israel using data generated by a sentinel laboratory-based surveillance network for the period 1998-2012. The average annual incidence of culture-proven shigellosis was 97/100 000. We estimated that each case of shigellosis accounted for 25 cases in the community indicating the high burden of disease. Orthodox Jewish communities, living in highly crowded conditions and with a high number of children aged <5 years were the epicentre of country-wide biennial propagated epidemics of S. sonnei shigellosis. S. flexneri was the leading Shigella serogroup in Israeli Arabs. S. flexneri 2a and S. flexneri 6 alternated as the most common serotypes. Both S. sonnei and S. flexneri isolates showed high rates of resistance to ampicillin and trimethoprim/sulfamethoxazole and very low rates of resistance to quinolones and third-generation cephalosporins. Shigellosis due to S. sonnei conferred 81% (95% confidence interval 69-89) protection against the homologous Shigella serotype when epidemic exposure re-occurred 2 years later. These data are of value in the process of Shigella vaccine development.

[PlGF and sFlt-1--diagnostic significance in preeclampsia prediction in pregnant women with gestational and chronic hypertension].

Preeclampsia (PE) is characterized with hypertension and proteinuria after 20 gestational weeks. and is the major reason for maternal and fetal mortality during pregnancy. Etiology of PE is still unclear. Clinical manifestation is connected to high levels of circulated anti-angiogenic proteins such as soluble Fms-like tyrosine kinase 1 (sFlt1) and soluble endolgin (sEng). Furthermore PE leads to low serum levels of Placental growth factor (PIGF). The change of these serum levels appears before clinical manifestation, which makes them useful for screening of pregnant women with high risk of PE. This opportunity for prediction of PE would significantly lower the mortality caused by PE. We measure serum sFlt-1 and PIGF levels in pregnant women with normal and pathological pregnancy including gestational and chronic hypertension without PE. Population included 23 pregnant women during a period of two years. Comparison between the groups was made with parametric Student's test. A level of p < 0.05 was accepted as statistically significant. Eight women were with PE (one of them with chronic hypertension). Six pregnant women were with isolated hypertension (four with chronic and 2 with gestational hypertension). Nine pregnant women were with normal pregnancy. Serum sFlt-1 and PIGF levels showed significant differences in pregnant women in between 25th and 28th gestational weeks: a) for sFlt-1--in PE (4859.88 pg/ml) and normal pregnancy (3125.53 pg/ml)--p = 0.0002 or isolated hypertension (2791.40 pg/ml)--p = 0.0054 and b) for PIGF--in PE (206.63 pg/ml) and normal pregnancy (667.87 pg/ml)--p = 0.0011 or isolated hypertension (560.20 pg/ml)--p =0.0125. Our study shows that serum sFlt-1 and PIGF levels significantly changes during pregnancy and before clinical manifestation of PE (minimum in 15.5 gestational weeks).

[Potential for diagnosis in preeclampsia].

Preeclampsia (PE) is characterized with hypertension and proteinuria after 20 gestational weeks and is the major reason for maternal and fetal mortality during pregnancy. Etiology of PE is still unclear. Cliniical manifestation is connected to high levels of circulated anti-angiogenic proteins such as soluble Fms-,like tyrosine kinase 1 (sFlt1) and soluble endolgin (sEng). Furthermore PE leads to low serum levels of Placental growth factor (PIGF). The change of these serum levels appears before clinical manifestation, which makes them useful for screening of pregnant women with high risk of PE. This opportunity for prediction of PE would significantly lower the mortality caused by PE. We measure serum sFlt-1 and PIGF levels in pregnant women with normal and pathological pregnancy, including gestational and chronic hypertension without PE. Population included 40 pregnant women during a period of two years. Comparison between the groups was made with parametric Student's test. A level of p < 0.05 was accepted as statistically significant. Ten women were with PE. Fifteen pregnant women were with chronic kidney disease without hypertension. Fifteen pregnant women were with normal pregnancy (control group). Serum sFlt-1 and PIGF levels showed significant differences in pregnant women with PE compared to control group and CKD patients: a) for sFlt-1--in PE (4971.25 pg/ml) and normal pregnancy (3125.53 pg/ml)--p < 0.005 or CKD (3145.80 pg/ml)--p = 0.0032 and b) for PIGF--in PE (206.63 pg/ml) and normal pregnancy (667.87 pg/ml)--p = 0.0011 or CKD (643.13 pg/ml)--p = 0.003. Our study shows that angiogenic factors may aid in differentiating between PE caused by angiogenic imbalance and by renal function worsening.

Asymmetric dimethylarginine (ADMA) and soluble vascular cell adhesion molecule 1(sVCAM-1) as circulating markers for endothelial dysfunction in patients with pheochromocytoma.

BACKGROUND: Endothelial dysfunction is a common feature of hypertension and is associated with reduced nitric oxide bioavailability. The endogenous inhibitor of nitric oxide syntase, asymmetric dimethylarginine (ADMA), and soluble adhesion molecules such as vascular cell adhesion molecule 1 (sVCAM-1) have been established as markers of endothelial dysfunction in a number of pathologic conditions including essential hypertension. There is little information, however, about these markers in endocrine hypertension. OBJECTIVE: To investigate the levels of circulating ADMA and sVCAM-1 in patients with pheochromocytoma. PATIENTS AND METHODS: Serum ADMA and sVCAM-1 concentrations were assayed by ELISA technique in 18 patients with pheochromocytoma, 18 patients with essential hypertension (EH) and 18 healthy subjects serving as a control group. RESULTS: ADMA and sVCAM-1 levels were significantly elevated in pheochromocytoma patients compared to normotensive healthy controls (0.479 ± 0.072 vs. 0.433 ± 0.054 µmol/l, p=0.037 and 690 ± 181 vs. 577 ± 108 ng/ml, p=0.03, respectively). Patients with EH also had higher ADMA concentrations than the control group, but the difference was not significant (0.476 ± 0.075 vs. 0.433 ± 0.054 µmol/l, p=0.06). No associations were found between the levels of ADMA, sVCAM-1 and some potential risk factors for endothelial dysfunction. CONCLUSION: Endothelial function is impaired in patients with pheochromocytoma as indicated by the elevated circulating levels of ADMA and sVCAM-1. The lack of association of these markers with cateholamines, glucose and lipid abnormalities together with their comparable levels in EH patients suggests that endothelial dysfunction is most likely related to hypertension itself.

Macroprolactinemia in patients with prolactinomas: prevalence and clinical significance.

BACKGROUND: Data on the prevalence of macroprolactinemia in patients with prolactinomas is quite limited as the presence of high-molecular prolactin forms is suspected mainly in subjects with mild hyperprolactinemia and negative pituitary imaging. OBJECTIVE: The main objective of this observational case-control study was to assess the prevalence and clinical significance of macroprolactinemia among patients with prolactinomas. METHODS: The study population consisted of 239 subjects: 131 prolactinoma patients and 108 sex-, age- and ethnicity- matched healthy controls. Macroprolactinemia was defined by a PRL recovery after PEG precipitation of<40%. RESULTS: The prevalence of macroprolactinemia among newly diagnosed prolactinoma patients did not differ statistically from the prevalence in the control group (3.5 vs. 3.7%; p=1.000) but was lower although non-significantly than the subgroup of patients treated with dopamine agonists (DA) (3.5 vs.10.8%; p=0.072). Significant association between disruptions of ovarian function and serum levels of the monomeric as well as high-molecular prolactin isoform was found. CONCLUSIONS: In few cases, the presence of typical hyperprolactinemia-related clinical symptoms and their disappearance after treatment with DA suggests biological activity of macroprolactin comparable with that of monomeric prolactin isoform. Decrease of macroprolactin levels after DA treatment could suggest tumoral origin of the high-molecular isoform in these rare cases. Although macroprolactinemia is considered a benign condition, pituitary imaging, DA treatment, and prolonged follow-up may be necessary in certain cases. An individualized approach to the management of patients with macroprolactinemia should be applied.

[HE4 and CA125 in ovarian cancer].

INTRODUCTION: Ovarian cancer is forth reason that causes mortality in women all over the world. In Europe the death is 3.6 up to 9.3 in 100000 women. HE4 is a newly, more specific diagnostic marker for ovarian cancer. Human epididimis protein 4 (HE4) belongs to a group with four disulfide core proteins. It is first identified in the epithelium of distal epididimis and thought to be a protease inhibitor that took part in sperm maturation. HE4 is expressed from ovarian cancer cells. METHODS: Measurement of HE4 is uncompetitive immunoassay, based on direct sandwich technique. It uses monoclonal antibodies, against specific molecule epitopes, coated onto the microstrips. After the incubation, enzyme-linked monoclonal antibodies are added; a substrate reagent solution leads to a color reaction, which intensity is proportionate to the amount of HE4 present in the samples. RESULTS: For a 12 months period we measure 50 patients doubt about ovarian cancer (with formation in pelvis). We include a control group from 50 patients with no ultrasonographic or laboratory evidences of ovarian cancer. The age was between 25 and 60. The middle age for patients with carcinoma was higher compared to those without tumor process (respectively 51.1 to 46.7; p = 0.018). From the group with doubt for an ovarian cancer 40 cases were with EOC, 9 with benignant tumors (ovarian cysts), 1 with no deviation from the normal ovarian tissue. From the patients with EOC--32 cases were with serous tumor, 7 with mucinous, 1 were undifferentiated. CONCLUSION: HE4 is more specific marker to be used for early diagnosis of ovarian cancer. It's frequently using will decrease mortality of this social disease.

[Early detection of possibilities for preeclampsia using VEGF1 and other serum analysis].

INTRODUCTION: The aim of our study is to establish an interaction between serum VEGF1 levels and possibilities of early detection of preeclampsia. METHODS: For a period of three months we follow up 17 patients with preeclampsia in second trimester by measuring serum levels of VEGF1, PIGF and Inhibin A. A correlation between them was determined. RESULTS: During our study we investigate 17 patients with preeclampsia and 35 as a control group. Significant differences between serum levels in too groups were established. Serum levels for VEGF1 above 158.5 pg/ml; Inhibin A above 98.50 ng/ml; PIGF levels above 30.01 pg/ml shows a diagnostic sensitivity 88.895 and diagnostic specificity 97.06% in prediction of preeclampsia. CONCLUSION: Measurement of serum VEGF1, PIGF and Inhibin A levels are suitable for early prediction of possibilities for preeclampsia in second trimester. These results are the basis for further studies in this field.