miRNA profile of luminal breast cancer subtyptes in Slovak women.

OBJECTIVE: Aberrant expression of short, non-coding RNA molecules (miRNA) leads to breast cancer initiation, progression and metastasing. The miRNA expression level associates with imunohistochemical profile, histopathological parameters, clinical outcomes, prognoses and therapeutical response. The aim of this study was to analyse the whole spectrum of miRNA by microarray method and to define relevant miRNAs describing biological characteristics of luminal breast cancer subtypes. DESIGN: Cross-sectional study, basic research. SETTING: Biomedical center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia. METHODS: We analysed 16 tissue samples of Luminal A/B breast cancer types and 16 breast tissue samples without pathological findings. The microarray technology by Agilent was used to analyse 2549 miRNAs by SurePrint G3 Human miRNA kit v.21. The results were assessed by AgiMicroRNA Bioconductor library within Limma pack. RESULTS: The analyses of the lowest FDR p-value and the highest logFC value selected the oncomiR miR-182 as the most dominant with higher expression in cancer tissues than in normal tissues, followed by miR-21, miR342-3p/5p and miR-6826. The miR-4324 and cluster of miR-99a/let7c/miR-125b dominated in the group of miRNAs with lower expression in cancer tissues compared to normal tissues. CONCLUSION: The first results of this study complement biological characteristics of luminal breast cancer subptypes, represent basis for follow-up projects focused on the clarification of relevant signaling pathways and promise new and innovative breast cancer treatment based on the precise, tailored therapy by targeting specific miRNAs involved in the most important carcinogenesis mechanisms.

Circulating HPV DNA in patients with cervical precancerous lesions and cervical cancer.

OBJECTIVE: In our review article we focused on the circulating HPV DNA and its potential role in the pathogenesis of cervical cancer and in the evaluation of patients´ prognosis with cervical cancer Design: The article is a systematic review study analyzing available scientific articles focused on the circulating HPV DNA. SETTING: Clinic of Obstetrics and Gynecology, Jesenius faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia. METHODS: In our study we searched the medical database PubMed with the key words: circulating HPV DNA, cervical cancer, cervical precanceroses. The core of our work is focused on the scientific articles published in English language since year 1995. RESULTS: We identified 13 studies in PubMed database analyzing the circulating HPV DNA in the process of cervical carcinogenesis. It is clear from the results that circulating HPV DNA is a significant prognostic marker of cervical malignant diseases including the early stages. CONCLUSION: The results focused on circulating HPV DNA show the significance of molecular biology in assessing the prognosis of cervical cancer. This idea has to be supported by further relevant studies. The uniformity of studies and use of the most sophisticated methods could help to answer the question about the real role of circulating HPV DNA in the process of cervical carcinogenesis and disease progression.

Dietary phytochemicals in breast cancer research: anticancer effects and potential utility for effective chemoprevention.

Cancerous tissue transformation developing usually over years or even decades of life is a highly complex process involving strong stressors damaging DNA, chronic inflammation, comprehensive interaction between relevant molecular pathways, and cellular cross-talk within the neighboring tissues. Only the minor part of all cancer cases are caused by inborn predisposition; the absolute majority carry a sporadic character based on modifiable risk factors which play a central role in cancer prevention. Amongst most promising candidates for dietary supplements are bioactive phytochemicals demonstrating strong anticancer effects. Abundant evidence has been collected for beneficial effects of flavonoids, carotenoids, phenolic acids, and organosulfur compounds affecting a number of cancer-related pathways. Phytochemicals may positively affect processes of cell signaling, cell cycle regulation, oxidative stress response, and inflammation. They can modulate non-coding RNAs, upregulate tumor suppressive miRNAs, and downregulate oncogenic miRNAs that synergically inhibits cancer cell growth and cancer stem cell self-renewal. Potential clinical utility of the phytochemicals is discussed providing examples for chemoprevention against and therapy for human breast cancer. Expert recommendations are provided in the context of preventive medicine.

Strumal carcinoid of the ovary - report of two cases and review of literature.

OBJECTIVE: Strumal carcinoid (SC) is a rare ovarian germ-cell tumour, which is characterized by a mixture of thyroid tissue and carcinoid. It can be presented as a monodermal teratoma or as a part of mature cystic teratoma (dermoid cyst). DESIGN: Case report. SETTING: Department of pathology, St. Elisabeth Cancer Institute, Bratislava. METHODS AND RESULTS: Hereby the authors describe two cases of this rare tumour in clinically asymptomatic women, 46- and 52-year-old, whom tumours were diagnosed at preventive gynaecological examination. The tumours considered of solid - cystic features, measured 65×45×40 mm and 75×45×40 mm and both contained parts of SC represented by tougher yellowish gelatinous areas. In both cases, SC was a part of the mature cystic teratoma (dermoid cyst), with predominated content. Histologically, both SC had a characteristic composition of intimate mixture of mature thyroid tissue and carcinoid. Immunohistochemically, the thyroid tissue stained positively with cytokeratin7, thyroglobulin and thyroid transcription factor-1, and the carcinoid component exhibited expression of synaptophysin and chromogranin A (only in one case). Tumour cells of both components of SC were negative for calcitonin and carcinoembryonic antigen. Both tumours showed low proliferation activity expressed by Ki-67 (up to 2%). Tumours were diagnosed in stage IA, and up to now are patients without any complications associated with tumours, free of relapse for 3 years and 6 months, respectively. CONCLUSION: SC represents an interesting form of primary ovarian carcinoid, which is usually asymptomatic and when confined to ovary, mostly has benign behaviour and can be treated by simple one-sided or bilateral adnexectomy. Keywords ovary, germ cell tumours, strumal carcinoid, immunohistochemistry.

[Correlation between the incidence of PIK3CA mutations in breast cancer and histopathological characteristics of the tumor]. / Korelácia výskytu PIK3CA mutácií v karcinóme prsníka s histologickými vlastnostami nádoru.

OBJECTIVE: To determine the presence of mutations in exon 9 (encoding the helical domain) and exon 20 (encoding the kinase domain) of phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) gene in DNA obtained from paraffin embedded tissue from patients with carcinoma of the mammary gland and to correlate results with clinicopathological characteristics of cancer. DESIGN: Prospective clinical study. SETTING: Department of Molecular Biology, Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Commenius University, Martin, Slovak Republic. METHODS: In set of 95 tissue samples from patients with breast cancer, mutations in exon 9 and 20 were analysed by sequencing. We also observed the associations between mutations and histopathological characteristics of tumor. RESULTS: Overall, mutations were present in 25.3% (24/95) of PIK3CA gene, of this 14.7% (14/95) of mutations were located in exon 9 and 10.5% (10/95) of mutations were in exon 20. We detected three "hotspot" mutations, two were located in exon 9 (E542K, E545K) and the third mutation was found in exon 20 (H1047R). Mutations in exon 9 showed significant correlation with lower grade(p = 0.0074) and pN status without metastases(p = 0.0415). Mutations in exon 20 were associated with higher age of patient (p = 0.0249). The E545K mutation correlated with lower grade (p = 0.0013) and pN status (p = 0.0232) particularly; the H1047R mutation was significantly more frequent in lobular type of breast cancer (p = 0.0354). CONCLUSION: The PI3K signaling pathway plays a critical oncogenic role in the development of human breast cancer and the prevalence of its deregulation advocates its potential as a feasible therapeutic target. In our study we demonstrate a significant correlation between the presence of PIK3CA mutations and some clinicopathological characteristics of tumour. We have shown that the mutations in exon 9 of PIK3CA were associated with favourable prognostic factors. KEYWORDS: "hotspot" mutation, PIK3CA, PI3K pathway, breast cancer.

Ethnic disparities in breast cancer between Central Europe Caucasian women of Slavic origin and Middle East Turkish subjects.

The biological, cultural, behavioral and sociodemographic differences across populations modulate breast cancer profile among races or ethnics. Following this, we aimed to identify differences in breast cancer epidemiology, histopathology, and clinical presentation from representatives of central Europe (Slovakia) and Middle-East countries (Turkey) to point on ethnic disparities in cancer biology. The population based cross-sectional study analyzing 414 cases of primary breast carcinomas where 214 represented Caucasian and 200 Turkish subjects. The differences were found for age at the time of diagnosis (<0.0001), education, menopausal status (<0.001), tumor localization (<0.01), size (<0.0001), grade (<0.05) and axillary lymph node status (<0.001) between groups. Although carcinomas in Slovak subjects were of higher grade, negative axillary nodal status was more frequent finding compared to Turkish patients (50.0 vs. 41.0%). The Slovak group showed carcinomas to be more often ER positive (72.4 vs. 54.0%; <0.001), ER/PgR positive (54.6 vs. 49.0%; <0.001), of better Nottingham prognostic index (<0.001), and less frequent Her-2 positive (21.2 vs. 28.5%). Slovak population expressed significantly higher risk of non-sentinel lymph node metastases with increased tumor size, grade, vascular invasion and Her-2 positivity compared to Turkey population. The tumor size >2 cm and high tumor grade (G3) bears a risk of OR=7.62 and OR=3.10 in Slovak compared to OR=3.94 and OR=1.79 in Turkish cases, respectively.There are wide demographic and biological disparities in breast cancer between observed ethnics providing unique information for clinicians working at the level of screening or therapy in these populations.

[Recurrent subareolar non puerperal abscess of breast with fistules of lactiferous ducts (Zuskas disease)]. / Rekurentný subareolárny non- puerperálny absces prsníka s fistuláciami ductus lactiferi (Zuskas disease).

INTRODUCTION: Zuskas disease (ZD) is an illness also known as the recurrent subareolar non-puerperal abscess of breast with fistulas of lactiferous ducts or as a periductal mastitis. ZD is rare, but painful chronic disease of breast characterized by local inflammation and evacuation of viscous content from abscess around the nipple. We present a rare form of the non-puerperal mastitis in patients with recurrence of this disease and with the description of management and treatment. CONCLUSION: The treatment of ZD is often inadequate and it leads to the recurrence of ZD and retraction of the nipple. Definitive treatment of ZD is surgical excision of the fistulation, removing of whole retroareolar fibroglandular tissue, abscess cavity and ductal tissue inside the nipple, including the obstructed ducts. The ratio of patients cured by this method is high, as well as their satisfaction with the final cosmetic effect of the nipple and breast.

Impact of fetal pulse oximetry and ST analysis surveillance withdrawal on rates of obstetric surgery and frequency of low birth umbilical artery pH: a cause of rising caesarean rates?

A retrospective observational study on a sample of 13,413 deliveries analysed the effect of a withdrawal of the CTG additional diagnostic methods of fetal hypoxia (fetal pulse oximetry and ST analysis of the fetal ECG) on operative delivery rates and frequency of the umbilical arterial pH < 7.15. Following the withdrawal, obstetricians are more likely to perform caesarean sections for fetal hypoxia (OR 2.23, 95% CI 1.94-2.55, p < 0.0001) and labour dystocia (OR 1.45, 95% CI 1.18-1.77, p = 0.0003), which increases the overall caesarean rate (OR 1.49, 95% CI 1.38-1.61, p < 0.0001), although decreases the incidence of birth umbilical arterial pH < 7.15 (OR 0.43, 95% CI 0.22-0.85, p = 0.015). This also leads to the significant decline in overall frequency of instrumental vaginal deliveries (OR 0.58, 95% CI 0.48-0.71). In order to decrease the overall caesarean rate, obstetricians need to be supported by more accurate and possibly automated diagnostic tools for intrapartum fetal hypoxia.

[Expression of carbonic anhydrase IX in the breast carcinomas]. / Expresia karbonickej anhydrázy IX v karcinómoch prsníka.

OBJECTIVE: Carbonic anhydrase IX (CA IX) is one indicator of hypoxia in the tumor and its expression is associated with more aggressive forms of breast cancer. The aim of this study is to point out its own set of correlation between CA IX expression and selected morphological and biological indicators. TYPE OF STUDY: Cohort prospective study. SETTING: Department of Pathology of Slovak Medical University and St. Elisabeth Cancer Institute, Bratislava, Slovak Republic. METHODS: These were 145 cases of breast cancer aged 25 to 85 years (median 59 years) from the Register of the Institute of Pathology and Slovak Medical University and St. Elisabeth Cancer Institute in Bratislava for the period 1. 9. 2012 to 28. 2. 2013. In all cases were examined CA IX, estrogen receptor (ER), progesterone receptor (PR), HER2, p53 and Ki67 by immunohistochemistry. Typing, grading and staging of the disease were evaluated according to the classification systems currently in place. RESULTS: CA IX expression was demonstrated in 51 cases (35.2%). CA IX positivity correlated with the degree of differentiation (p = 0.0001), with ER status (p <0.0001) and PR (p <0.01) and HER2 (p <0.01) and proliferative activity as measured by Ki67 (p <0.001). HER2-positive cancers and triple-negative cancers were more frequently associated with the expression of CA IX compared with luminal subtypes (p <0.0001). The state of CA IX and age range of the tumor - pT and lymph node status - pN and p53 have not been shown statistically significant correlations. CONCLUSION: CA IX examination in breast cancer provides valuable information on the state of hypoxia in the tumor, thereby supplementing view of prognosis of the disease.

[The p16INK4A mRNA transcripts estimation in cervical smear with different degrees of cervical dysplasia]. / Stanovenie expresie p16INK4A mRNA transkriptu v steroch z krcka maternice s rôznymi stupnami cervikálnej dysplázie.

OBJECTIVE: To determine the presence of HPV infection and expression level of p16INK4A mRNA transcripts in cervical smears as adjunct biomarker in detection of cervical intraepithelial neoplasia or cancer. DESIGN: Prospective pilot clinical study assessing clinical utility and validity of ddCt method for qPCR mRNA expression of p16ink4a in comparison to immunohistochemistry. SETTING: Department of Molecular Biology, Department of Obstetrics and Gynecology, Jessenius Medical Faculty, Commenius University, Martin, Slovak Republic. METHODS: Cervical smears (OC) from patients with different cervical lesions (L-SIL, H-SIL, SCA; n=45) and from healthy controls (n=45) were tested for the presence of HPV infection and p16INK4A mRNA transcripts using relative quantification (RQ). Results were compared to H&E and IHC histological findings from biopsies (conization, hysterectomy). RESULTS: HPV 16 was the most frequent finding (53.3%) in the group of subjects with cervical dysplasia. The p16INK4A mRNA expression analysis revealed the slightly reduced expression in L-SIL group, 4-fold increased expression in H-SIL and 10-fold increase in women with SCA when compared to controls. The p16INK4A mRNA expression in OC was present in 30% of L-SIL, 75% of H-SIL and 85.7% of SCA samples, respectively. The test overall sensitivity was 81.48% (95% CI: 61.92-93.7) and specificity 60% (95% CI: 26.24- 87.84) with PPV of 84.62% and NPV of 54.55%. The likelihood ratio (LR) in case of test positivity was 2.04 and for negativity 0.31. The diagnostic accuracy of p16INK4A expression by RQ method in OC smears for prediction of p16 positivity in cervical dysplasia was 66.7% for the L-SIL lesions, 59.5% for H-SIL lesions, and 100% for SCA (r=0.9897, p<0.0913) when compared to IHC p16 positive findings in surgically treated samples. CONCLUSION: The relative quantification is able to determine the level of p16INK4A mRNA transcripts in cervical smear cells with active carcinogenesis nearly at the same level as IHC staining. The advance of biopsy sparing over IHC is qualifying this diagnostic approach for useful candidate in selective management of women with cervical dysplasia looking for cervix preservation or avoiding the unnecessary overtreatment.

Time trends in cervical cancer epidemiology in the Slovak Republic: reflection on the non-implementation of screening with international comparisons.

Cervical cancer is a serious public health problem with high geographical variations in incidence, mainly due to historical patterns of risk factors and the influence of screening activities. To reduce both cervical cancer incidence and mortality is the primary objective of organized screening and annual reports of high quality utilising accepted interventional measures. Currently, the time-trends in overall incidence and mortality from cervical cancer in the Slovak Republic are implacable. The high incidence values of this condition that have stabilized long term without any signs of a significant decrease rank us among the "developing countries" in Europe. Moreover, the continuing low accessibility of vaccinations for the population lowers the potential effect of an improvement in the incidence of pre-malignant lesions of cervical cancer. Without a basic analysis of the cervical cancer epidemiological data it is not possible to discover the causes of this unfavorable situation and thus condition changes at the level of screening and early diagnostics.Following this, we aimed to analyse the incidence and mortality of cervical cancer over the period 1968-2006 and to point out the necessity for the early introduction of interventional measures in accordance with organized screening in the Slovak Republic.There was recorded a stabilized trend in incidence with an estimated average annual change -0.008/100.000 (95% CI = -0.048 to 0,032, p =0.689) and a moderately increasing trend in mortality with average annual increase 0.049/100,000 (95% CI = 0.033 to 0.065, p < 0.0001). In 2003-2006, the cumulative risk of disease (0-74 years) averaged 1.5 %, the cumulative risk of death reached 0.5%. The analyses of clinical stages during the period 1978-2003 showed that the number of cases in clinical stage I increased, the stage II rate declined, and the numbers of cases in stages III and IV were still high with, moreover, a rising tendency. In comparison with other European countries these trends are unfavorable and our results have confirmed the necessity of an immediate introduction of organized screening in the SR.

[Dehiscence of laparotomy after hysterectomy - wound management]. / Dehiscencia laparotómie po hysterektómii - manazment hojenia rany.

Authors of the paper present prospective case report about nursing process and healing of extensive dehiscence of middle lower laparotomy wound in patient after surgical procedure for endometrial carcinoma. The aim of the paper is to describe, analyse and evaluate the process of complicated postoperative wound healing using negative pressure and moist therapy. They emphasize importance of cooperation between particular departments in complicated postoperative wound therapy management. They point out using new and easily available techniques and methods, risk factors elimination and maintenance of the factors that have a positive influence on wound healing.Key words: postoperative wound dehiscence, negative pressure wound therapy, moist therapy, case report.

[Acatholytic variant of squamous carcinoma of the breast. A case report and review of literature]. / Akantolytický variant skvamózneho karcinómu prsnej zl'azy. Kazuistika a prehl'ad literatúry.

The acantholytic variant of squamous carcinoma (ASC) represents a rare type of metaplastic breast carcinoma with typical occurrence of pseudoglandular and pseudovascular structures, arising as a result of cohesion loss between the neoplastic cells. Up to the present, there have been only 10 cases of mammary ASC described in the English written literature. The authors present a case of a 57-year-old woman with a large (6 x 7 cm) suspicious lump on ultrasonography in her right breast treated by mastectomy with an ipsilateral axillary lymph node dissection due to histologically verified ASC. Additional postoperative staging computer tomography revealed metastatic foci in the left lungs, thus calling for adjuvant chemotherapy for the patient. Six months after setting the diagnosis, the patient is alive with a partial therapeutic response. In the differential diagnosis of ASC it is important to exclude angiosarcoma, phyllodes tumor and metastatic sarcomas to the breast. The useful tools for differentiation between the above-mentioned entities are extensive bioptic examination and detailed immunohistochemical staining, enabling the pathologist to exclude the endothelial lineage (using CD31 and CD34) and to verify the epithelial origin through the detection of cytokeratins (spectra of high-molecular weight cytokeratins). Furthermore, the ASC shows positive immunohistochemical staining for markers of the myoepithelial differentiation, e.g. cytokeratin 14, CD10 and p63, suggesting an immature cell population with basaloid features. In conclusion, as ASC is an aggressive subtype of the breast carcinoma with a poor prognosis, the correct diagnosis set by the pathologist is of great importance on the therapeutic management in affected patients.

[Methylation of selected tumor-supressor genes in benign and malignant ovarian tumors]. / Metylácia vybraných tumor-supresorických génov v benígnych a malígnych ovariálnych nádoroch.

OBJECTIVE: To evaluate the usefullness of examination of methylation status of selected tumor-supressor genes in early diagnosis of ovarian cancer. DESIGN: Prospective clinical study. SETTING: Department of Gynecology and Obstetrics, Department of Molecular Biology, Jessenius Medical Faculty, Commenius University, Martin, Slovak Republic. METHODS: In this study we analyzed hypermethylation of 5 genes RASSF1A, GSTP, E-cadherin, p16 and APC in ovarian tumor samples from 34 patients - 13 patients with epithelial ovarian cancer, 2 patients with border-line ovarian tumors, 12 patients with benign lesions of ovaries and 7 patients with healthy ovarian tissue. The methylation status of promoter region of tumor-supressor genes was determined by Methylation Specific Polymerase Chain Reaction (MSP) using a nested two-step approach with bisulfite modified DNA template and specific primers. RESULTS: Gene methylation analysis revealed hypermethylation of gene RASSF1A (46%) and GSTP (8%) only in malignant ovarian tissue samples. Ecad, p16 and APC genes were methylated both in maignant and benign tissue samples. Methylation positivity in observed genes was present independently to all clinical stages of ovarian cancer and to tumor grades. However, there was observed a trend of increased number and selective involvement of methylated genes with increasing disease stages. Furthermore, there was no association between positive methylation status and histological subtypes of ovarian carcinomas. CONCLUSION: RASSF1A and GSTP promoter methylation positivity is associated with ovarian cancer. The revealed gene-selective methylation positivity and the increased number of methylated genes with advancing disease stages could be considered as a useful molecular marker for early detection of ovarian cancer. However, there is need to find diagnostic approach of specifically and frequently methylated genes to determining a methylation phenotype for early detection of ovarian malignancies.

[Biophysical methods in diagnosis of intrapartal fetal hypoxia]. / Biofyzikálne metódy diagnostiky intrapartálnej fetálnej hypoxie.

OBJECTIVE: To evaluate validity of biophysical diagnostic methods of fetal hypoxia. DESIGN: A case-control study. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. METHODS: We divided the patients according to pH in umbilical artery (UA) < 7.15 into two groups: controls (n = 36), and studied (n = 31), retrospectively. We performed continuous simultaneous fetal monitoring with cardiotocography (CTG), fetal pulse oxymetry (IFPO), and ST segment analysis of fetal electrocardiogram (STAN). STATISTICS: histograms, Kolmogorov-Smirnovov test, Mann-Whitney test, Spearman's rho; statistical significance: p < 0.05, Receiver Operating Characteristic curves, Area Under the Curve. RESULTS: The most frequent was intermediary CTG pattern (n = 32; 47.76%). Non-reassuring IFPO was in 22 cases (32.86%), and ST events were present in 4 cases (5.97%). CTG validity in prediction of pH in UA < 7.15: sensitivity 80.0%, specificity 50.0%, positive predictive value (PPV) 22.1%, and negative predictive value (NPV) 93.4%, respectively; IFPO sensitivity was 76.3%, specificity 71.4%, PPV 32.2%, and NPV was 94.4%. Validity of STAN was not significant, because of low frequency of ST events in our study. Satisfactory accuracy (AUC > 0.8) had combined continuous monitoring with CTG, IFPO and STAN. Good accuracy (AUC > 0.7) had CTG by itself, and combined monitoring with IFPO and STAN, respectively. IFPO by itself had only sufficient accuracy (AUC > 0.6). CONCLUSION: The most valid method of fetal wellbeing objectification is combined simultaneous monitoring with CTG, IFPO and STAN. Our results support the effort in the development of integrated sensor for CTG, IFPO, and STAN.

[Perinatal indicators of the Zilina region in Slovak Republic during the period 2000-2009]. / Perinatologické výstupy Zilinského kraja Slovenskej republiky za 10roné obdobie (2000-2009).

OBJECTIVE: To provide health care providers, patients, and the general public the improvements and objective data outcomes in perinatal health care indicators for the Zilina district, northern part of Slovak republic. SETTING: Martin perinatology center (Department of Gynecology and Obstetrics, Department of Neonatology, Jessenius Medical Faculty, Commenius University, Martin, Slovak Republic). SUBJECT AND METHOD: Retrospective analysis of selected main perinatal outcomes for the period of 10 years (last decade) in the Zilina region. The comparison between the regional data and similar ones retrieved for the Slovak republic. RESULTS: During the analyzed period we have observed a significant decrease in perinatal mortality (PM) with lowest rate of 3.1 per thousand in year 2009 with the 4.13 per thousand decade average. The more favorable trend in PM drop was observed when analyzed separately from congenital disorders, which when compared to national rate decreased by 2.9 per thousand and by 1 per thousand when compared to crude PM in Zilina region for the year 2009. Furthermore, the sophisticated clinical management and improved technical equipment led to the decrease in other main perinatal indicators (e.g. decade average of frequency drop in preterm labors to 5.4%; early neonatal mortality to 2.14 per thousand; stillbirth rate drop to 0.327 per thousand, decrease in neonatal asfyxia rate with pH <7.15 to 0.01% in 2009 with decade average of 0.08% and increased proportion of in-utero transports with 5-years average of 90.9%). Contrary to that, there was revealed a doubling effect of cesarean section rate per observed period (15.7% vs. 32.9%). CONCLUSIONS: Our results showed that the symbiosis in organization of health care, basic and applied clinical research together with improved technical equipment and introducing the WHO guidelines into the obstetrical praxis has prepared the clinical background which led to the immense improvement in the perinatal outcomes in the northern part of Slovakia during the last decade.

[Angiolipoleiomyoma of the uterus. Case report and literature review]. / Angiolipoleiomyóm maternice. Kazuistika a prehl'ad literatúry.

OBJECTIVE: The rare case presentation of angiolipoleiomyoma (ALLM) of the uterus with review of diagnostic and discriminative information for this entity. SUBJECT: Case report with review of the literature. SETTING: Department of Pathology and Obstetrics and Gynecology at Jessenius Medical Faculty in Martin. CONCLUSION: The ALLM of the uterus is rare benign mixed mesenchyme tumor consisting of smooth muscle bundles, foci of mature fat tissue and abnormal vessels. The presented case is describing a 53-year-old women hysterectomized for multiple uterine myoma of which two showed the histological signs of ALLM. On imunohistochemical profile are these tumors negative for melanocytic features, e.g. HMB-45, what distinguishes them from angiomyolipomas, which are currently categorized into so called PEComas - tumors originating from perivascular epithelial cells.

Hypermethylation of the GSTP1 promoter region in breast cancer is associated with prognostic clinicopathological parameters.

UNLABELLED: Breast cancer is one of the most common cancer affecting women and the recent research is focused on identifying new genetic and epigenetic prognostic and predictive factors. Glutathione S-transferase P1 (GSTP1) is abiotransformation enzyme expressed in normal breast epithelial cells which can be epigenetically inactivated in breast cancer. We have shown, that application of nested two-stage methylation-specific PCR (MSP) is asuitable method for analysis of epigenetically silenced GSTP1 in formalin-fixed paraffin-embedded (FFPE) tissues from breast cancer patients. Of 45 breast tumors, 11 (24, 4%) were found to have methylated GSTP 1promoter region. We were able to demonstrate the correlation between the hypermethylation of the GSTP1 promoter region and histological grade of the tumor (p KEYWORDS: breast cancer, prognostic factors, hypermethylation, GSTP1, methylation-specific PCR.

[Semiquantitative analysis of mRNA aromatase expression in eutopic endometrium as a diagnostic marker of endometriosis and estrogen dependent diseases]. / Semikvantitatívna analýza expresie mRNA aromatázy v eutopickom endometriu ako diagnostický marker endometriózy a estrogéndependentných ochorení.

OBJECTIVE: To determine clinical benefits of mRNA aromatase expression in entopic endometrium as a diagnostic marker of endometriosis. DESIGN: Prospective clinical trial. SETTING: Department of Obstetrics and Gynaecology of Jessenius Medical Faculty and Faculty Hospital, Martin. METHODS: The expression of mRNA aromatase of eutopic endometrium was determined among women who underwent laparoscopy or laparotomy due to pelvic pain, infertility or benign pelvic tumor. Endometriosis was confirmed histologicaly and classified by rAFS. RESULTS: On the basis of entering criteria 23 women were enrolled in this study and divided into two subgroups: 12 endometriotic and 11 without endometriosis. Sensitivity of aromatase expression was 75% and specificity 54.5% at the cut-off value of at least minimal aromatase activity. By the presence of estrogen-dependent diseases- endometriosis, myomas or endometrial hyperplasia 18 women were compared to 5 disease free women. In this case, sensitivity of aromatase expression was 72.2 and specificity 80%. CONCLUSION: Aromatase expression in eutopic endometrium is a good diagnostic marker for endometriosis.

[Validity of hysteroscopy in clinical setting: single centre analysis of 605 consecutive hysteroscopies]. / Opodstatnenost' hysteroskopie v klinickej praxi analýza 605 výkonov jedného centra.

OBJECTIVE: Hysteroscopy represent standard diagnostic and therapeutic method in the treatment of endometrial pathology, where patient selection for this procedure depends in majority on preoperative uterine ultrasound scan. Hysteroscopy can be used for removal of polyps or myomas, endometrial tumor resection, synechiolysis, sterilisation or removal of remnants from pregnancy. Hysteroscopic surgery can be also an option for patients who wish to preserve the uterus for the treatment of recurrent bleeding. We aimed to evaluate the validity, complication rate and accuracy of hysteroscopy in correlation with preoperative ultrasound and postoperative histopathological findings. SETTING: Department of Gynecology and Obstetrics, Jessenius Medical Faculty, Commenius University, Martin, Slovak Republic. SUBJECT AND METHOD: Retrospective analysis of hysteroscopies for period of 24 months. RESULTS: During study period a total of 605 hysteroscopies were performed. In three (0.5%) cases we did not acquired sufficient bioptic material required for histopathological diagnosis, thus only 602 cases were included in the final analyses. The most frequent indication for hysteroscopy was history of postmenopausal bleeding (35.88%), followed by endometrial polyp (30.9%), hyperplasia (28.24%), cervical polyp (2.32%), corpus alienum in the uterus (1.66%) and fertility disorders (1%). Multifactorial analysis of hysteroscopy, ultrasound and histopathological findings revealed 69.41% sensitivity rate for ultrasound finding of endometrial hyperplasia, 48.16% sensitivity rate for submucous myoma and 81.72% sensitivity for endometrial polyp. The last group of patients showed the highest correlation rate (r)=0.41, p<0.01. The false pozitivity of preoperative ultrasound was 30.59%, 51.84% and 18.28% for mentioned groups, respectively. The association between hysteroscopic and histopathological results showed a 97.1% agreement in patients with endometrial polyp and 89.3% agreement for cases with endometrial hyperplasia (p<0.05). In 66.45% was hysteroscopy associated with biopsy or curretage. The causally surgery (tumor or endometrium ablation, myoma or septum resection) was performed in 27.9% and in 5.65% others types of intrauterine hysteroscopic sugery were done. Out of all surgical procedures polyp ablation represented 63.2%, resection of submucous fibroids 21.2%, endometrial resection or ablation 7.2% and 8.4% others procedures. In studied population we diagnosed 18 (3%) cases of endometrial carcinoma (13 cases associated with hyperplasia, 5 with polyp). Complication rate was 0.66%. Diagnostic hysteroscopic procedures were associated with a significantly lower complication rate (0.19%) than operative procedures (0.82%; p<0.05). The most frequent surgical complication was perforation of the uterine cavity (three cases 0.50%), followed by fluid overload syndrome (0.17%). CONCLUSION: Hysteroscopy is safe diagnostic and operative method with high sensitivity, particularly for endometrial polyps. The validity of sonography in case of hyperplasia prior surgery could be improved by control uterine ultrasound scan reflecting cycle phase one-two days before surgery.