Factors affecting the uterine sarcomas developement and possibilities of their clinical diagnosis.

OBJECTIVE: The main goal of this article is to summarize the known factors underlying the tumorigenesis of sarcomas and to present the limitations of clinical diagnosis. DESIGN: A review article. SETTINGS: Division of Molecular Medicine, Biomedical Center, JLF UK Martin, Slovakia; Department of Gynaecology and Obstetrics JLF UK and UNM Martin, Slovakia; Division of Oncology, Biomedical Center in Martin, JLF UK, Martin, Slovakia. METHODS: An analysis and summarisation of published studies about etiology, aberrant factors and limmitations of clinical diagnosis of uterne sarcomas. RESULTS AND CONCLUSIONS: Uterine sarcomas are heterogenous, malignant tumour types of mesenchymal origin with a very low incidence. On the other hand, sarcomas are very aggressive tumours with a poor prognosis, and a very low chance of surviving in general. The most common types of sarcomas are leiomyosarcomas, followed in percentage occurrence by endometrial stromal sarcomas and adenosarcomas. This tumour pathogenesis remains still relatively unknown. There are recognized only several predisposition factor types, and the limitated molecular-genetic aberrations associated with their occurrence. Importantly, the potential perturbation of the malignant mass during the implementation of invasive methods can be considered as the most serious risk factor. In regards to the visualization methods application, there are still limited ways of distinguishing between malignant and benign forms, especially in the case of leiomyosarcomas.

Potential of survivin for treatment of gynaecological tumour diseases.

OBJECTIVE: The main purpose of this article is to consolidate known facts about survivin, its contribution to inhibition of apoptosis, impact to tumorigenesis of gynaecological types of tumours. and possibilities of inhibition of survivin on molecular-genetic levels. DESIGN: A review article. SETTINGS: Division of Molecular Medicine, Biomedical Center in Martin, JLF UK Martin, Slovakia; Department of Gynaecology and Obstetrics JLF UK and UNM Martin, Slovakia; Division of Oncology, Biomedical Center, JLF UK Martin, Slovakia. METHODS: An analysis of the literature using database search engines focused on aberations in fuction of survivin, primarily in case of gynaecological tumours and possibilities of its inhibition. RESULTS AND CONCLUSIONS: Survivin is the smallest member of inhibitor of apoptosis (IAP) family. Despite of its size and affiliation to mentioned gene family, survivin can affect besides inhibition of apoptosis also proper process of mitosis, DNA reparation and angiogenesis. High levels of survivin expression are typical for fetal tissues during intrauterine developement. In healthy, adult tissues remain levels of survivin very low. Nonetheless, abundant expression of survivin is in many cases typical for various types of cancer, including gynaecologycal cancers Generally, it is possible to associate higher amounts of survivin with poor prognosis and resistance to chemo- or radiotherapy.

[Leiomyomas of the uterine body: Molecular-genetical aspects of formation and development]. / Leiomyómy tela maternice: Molekulárno-genetické aspekty vzniku a rozvoja.

OBJECTIVE: An overview of the molecular-genetical aspects of formation and development of leiomyomas of the uterine body. DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic. METHODS: An analysis of the literature using database search engines PubMed, Blast, Science direct and Web of Knowledge focused on tumorigenesis of leiomyoma. RESULTS: Benign uterine leiomyomas, also known as myoma, fibroids or fibromyomas are the most common tumours located in the pelvic area of women. The prevalence of this disease reaches, on the global scale, values higher than 50%, depending on the ethnicity even up to 80% of women of reproductive age. Despite such a high value, the origin of leiomyomas is still unknown. The main reason is the heterogeneity of the disease, and a number of factors that influence their development. In the case of leiomyomata occurrence, it has so far been observed several genome rearrangements and a number of aberrantly expressed genes. There are several reasons for overexpression or underexpression of a particular gene, from a point mutation in the exon region of the gene, promoter or other regulatory sequences to epigenetic modifications, most commonly the nature of methylation, or more precisely inadequate regulation short molecule miRNA. Many of these genes belong to the group of tumour-suppressor genes, or more precisely to genes, which can affect the cell cycle in a different way and thus can affect even the cell division. The aim of this work is to describe the various factors influencing the formation of leiomyomas and their impact on tumorigenesis.

[Principles and limits of clinical methods in the diagnosis of fetal hypoxia]. / Princípy a limity klinických metód diagnostiky fetálnej hypoxie.

OBJECTIVE: An overview of electronic fetal monitoring methods (EFM), and an analysis of their physical and technical limits. DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic. METHODS: An analysis of the literature using database search engines PubMed, and SCOPE in the years 2000 - 2013 in field of diagnostic methods of fetal status in utero. RESULTS: The essential aim of modern perinatology is the birth of a live and healthy newborn. This aim is strongly related to the abilities of the diagnostic methods to evaluate the intrauterine fetal status and with the professional skills of obstetricians to analyze these methods accurately. Nowadays, EFM is exposed to criticism, in spite of its widespread use. It is associated with some degree of failure in terms of an over-evaluation and under-evaluation. An over-evaluation of results can lead to unnecessary, often surgical, intervention. An under-evaluation of results can lead to an adverse fetal outcome with a neurologic handicap or intrauterine death. The long-term efforts currently underway to improve the reliability of EFM still remain to show any great progress. KEYWORDS: cardiotocography, intermittent auscultation, pulse oximetry, ST analysis, fetal electrocardiography.

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.

[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.

[Hormonal treatment effectivity in hyperandrogenic syndrome]. / Efekt hormonálnej liecby hyperandrogénneho syndrómu.

OBJECTIVE: To evaluate effectiveness of hormonal treatment of hyperandrogenic syndrome (HAS). DESIGN: Prospective randomized study. SETTING: Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. METHODS: We assessed effect of one-year-long hormonal treatment on menstrual cycles (MC), clinical signs of HAS, and ultrasound finding (USG) in 90 patients with HAS. Patients were divided into three groups with 30 females: A--35 microg ethinylestradiol (EE) with 2.0 mg cyproterone acetate/day; B--30 microg EE with 2.0 mg dienogest/day; C--30 microg EE with 3.0 mg drospirenone/day. RESULTS: It was achieved a positive effect on MC regularity in every group during the first six months of treatment (p < 0.001). Signs of hirsutism, virilization, and USG finding were significantly better in group A. CONCLUSION: The most effective hormonal treatment in our study was the combination of 35 microg EE with 2.0 mg cyproterone acetate/day.

[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.

[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.

[Single umbilical artery syndrome (review and a case report)]. / Syndróm jednej umbilikálnej artérie (review a kazuistika).

OBJECTIVE: Authors present a review of epidemiology, ethiopathogenesis and current diagnostic approaches of single umbilical artery syndrome (SUA). They describe one case of SUA complicated with intrauterine growth restriction (IUGR), and possible management of risk pregnancy like that. SUBJECT: Literature review and a case report. SETTING: Department of Gynecology and Obstetrics, Jessenius Medical Faculty, Commenius University, Martin, Slovak Republic. SUBJECT AND METHOD: The observation and management of one case with SUA and IUGR. CONCLUSION: SUA is the most frequent umbilical malformation. The finding of isolated SUA does not markedly increase perinatal morbidity and mortality, but its association with other pathologies leads to higher perinatal losses. An accurate management is still unclear (invasive antenatal diagnosis, especially), but SUA diagnosis should be a reason for more strict observation, timing of delivery, appropriate mode of delivery, and/or for more prompt intervention during pregnancy and labor. An early intervention and appropriate termination of pregnancy allowed delivery of live premature newborn with good posptartal adaptation and good prognosis was delivered after early intervention in our case.

In vitro contractile response of human myometrium to oxytocin, PGF2alpha, bradykinin and ET-1.

BACKGROUND: The imbalance in the sex hormones levels is the limited factor which induces disturbances in the uterus function and elevates uterine contractile activity. OBJECTIVES: The aim of our study was to evaluate and compare the direct contractile responsiveness of myometrium to the effects of uterotonic agents--oxytocin, PG2alpha, ET-1, and bradykinin--in the strips of human non-pregnant myometrium during different phases of menstrual cycle. METHODS: Reactivity of human myometrial strips, obtained from the pre-menopausal woman undergoing total hysterectomy for benign gynaecological indications such as leiomyomas, was evaluated in vitro. RESULTS: Our results showed an increased reactivity of myometrium to contractile mediators during follicular phase of the cycle. Our findings support the idea that estrogens might have a positive influence on the expression of various types of receptors (FP, OTR, BK2R and ET(A)R) and thus promote the contractility in response to uterotonic agents. On the contrary, minimal myometrial response to oxytocin, PG2alpha, ET-1, and bradykinin were observed during luteal phase when progesterone levels are increased. CONCLUSION: Our results indicate that the contractile activity of myometrium is mostly influenced by changes in sex steroid hormones during menstrual cycle. In future, this experimental model can be used for the study of mechanism regulating myometrial smooth muscle reactivity and its pharmacological modulation (Fig. 4, Ref. 20). Full Text (Free, PDF) www.bmj.sk.

HER-2 [Ile655Val] polymorphism in association with breast cancer risk: a population-based case-control study in Slovakia.

Breast cancer belongs to the most frequent types of cancer affecting women and it occurs at any age. Around 1600-1800 women are getting ill annually in the Slovak republic. One of the most important factors in connection with cancer genesis refers to changes in specific genes. HER-2 proto-oncogene belongs to low penetrating genes, which increase susceptibility to breast cancer genesis. Clinical studies demonstrated an association between polymorphism at codon 655 of this gene and increased risk for breast cancer development. The aim of this case-control based prospective study was to determine the distribution of HER-2 genotype and its association with risk factors of breast cancer in the population of women in Slovak republic. HER-2 genotypes were determined with PCR-RFLP method. The DNA was isolated from white blood cell nuclei. The frequency of Val allele in the cancer group was 29.79% and was higher than in the control group 15.84% (p<0.05). The presence of the heterozygote (Ile/Val) genotype was identified in 46.81% of patients in the case group and in 28.33% in healthy individuals, and the homozygote (Val/Val) genotype in 6.38% and 1.67, respectively (p<0.01). The risk of breast cancer development for carriers of one valine (Val) allele in genotype was two-times lower (OR=2.47) than for carriers of two Val alleles (OR=5.73) (p<0.05). Risk of cancer genesis for Val allele carriers was higher in multiparas (OR=2.90), among women with positive family history of breast cancer (OR=5.0), BMI>24 (kg/m2), and late menopause (OR=1.5). Contraceptives in anamnesis contrariwise showed tend to decrease the risk in Val allele carriers (OR=0.3). In conclusion, this study revealed relatively high frequency of the Val allele among the women population of the Slovak republic. Ile655Val polymorphism of HER-2 gene was associated with a statistically significantly increased risk of breast cancer all above in homozygotes for Val allele.

Uterine activity and ductus venosus flow velocity patterns during the first stage of labor.

OBJECTIVE: To analyze the effects of uterine contractions on ductus venosus (DV) pulsatility during the first stage of labor. METHODS: Twenty healthy women were examined. Measurements were taken at three stages of cervical dilatation (<4 cm, 4-7 cm and >or=8 cm) during and between contractions. Peak velocity during ventricular systole (S) and atrial contraction (A), pulsatility index for veins (DV PIV), ductus venosus index (DVI) and the S/A ratio were measured. RESULTS: The DV was observed successfully in 16 cases. The mean S velocity did not change significantly (64 cm/s during and 65 cm/s between contractions). The mean A velocity decreased significantly from 35 cm/s measured between contractions to 29 cm/s during contractions (P<0.0001). The mean DV PIV and DVI were significantly higher during contractions (0.72 and 0.55) than between contractions (0.57 and 0.45) (P<0.0001). There were no significant differences in means between stages of cervical dilatation. CONCLUSION: Significant differences during and between uterine contractions can be observed in DV pulsatility during normal labor.

[Velocimetry of the ductus venosus in the first stage of labor]. / Cirkulácia v ductus venosus pocas prvej doby pôrodnej.

OBJECTIVE: To assess feasibility and physiological variation of fetal ductus venosus Doppler velocimetry during the first stage of labor between uterine contractions. STUDY DESIGN: A prospective cross-sectional study including 23 healthy women with low-risk pregnancies. Maximum velocities during ventricular systole (S) and atrial contraction (A) were recorded in the ductus venosus between contractions. Pulsatility index for veins (DV PIV) and the ductus venosus index (DVI) were also calculated. SETTING: Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University, Martin. RESULTS: Acceptable ductus venosus waveforms were acquired in 19 fetuses (83%). The mean +/- SD values of the ductus venosus index and the pulsatility index were 0.46 +/- 0.07 (95% CI: 0.42-0.49) and 0.57 +/- 0.12 (95% CI: 0.51-0.63), respectively. The mean +/- SD values of maximum velocities during ventricular systole (S) and atrial contraction (A) were 65 +/- 8 cm/s and 35 +/- 5 cm/s, respectively. CONCLUSION: Ductus venosus blood flow velocities can be assessed during labor. This calls for an extension of the detection possibilities of intrauterine fetal status and gives an idea to establish reference ranges for these circulation parameters during labor in the future.

[Is diagnostic curettage sufficient prior to endometrial ablation? Case of an early stage endometrial cancer]. / Je diagnostická kyretáz pred abláciou endometria dostacujúca? Prípad vcasného endometrálneho karcinómu.

OBJECTIVE: To demonstrate a case of unrecognized endometrial cancer at endometrial ablation. SUBJECT: Case report. SETTING: Department of Obstetrics and Gynaecology and Department of Pathology, Jessenius Faculty Hospital, Martin, Slovakia. SUBJECT AND METHOD: Authors describe a case of an early endometrial cancer diagnosed from material obtained by bipolar loop electrode during endometrial ablation. CONCLUSION: Authors poing out insufficiency of curettage as a method of endometrial biopsy prior to ablation. Using of the loop electrode may minimize the incidence of unrecognized malignancies.

[Laparoscopy in chronic pelvic pain--a prospective clinical study]. / Laparoskopia pri chronickej panvovej bolesti--prospektívna klinická stúdia.

OBJECTIVE: The aim of this study was to analyze the incidence, causes and management in women with chronic pelvic pain and to evaluate the role of laparoscopy. DESIGN: A prospective non-randomized clinical trial on 86 women with chronic pelvic pain. SETTING: Clinic of Gynecology and Obstetrics, JMF CU Martin, Slovak Republic. METHODS: A prospective clinical trial was performed on 86 patients with chronic pelvic pain, who have undergone laparoscopy from March 2003 to March 2004. Only patients with a pain history of at least 6 month were enrolled into this trial. Specific patient's history characteristics, laparoscopic and cytologic findings were reviewed and analyzed (pain interval, organic findings, preoperative ultrasound examination, previous surgical intervention, oral contraceptive usage, patient's medical history, menstrual cycle regularity, age, presence of dysmenorrhea). In all women, laparoscopy was performed under general anesthesia. RESULTS: During the study we have performed 309 diagnostic laparoscopic examinations, from which 86 (27.8%) were done due to chronic pelvic pain. The mean patient's age was 35.8 years (19-56). The mean parity was 1.6, ranging from 0-5. Pelvic organ pathology was present in 88.4% of the patients. The most frequent finding was endometriosis (31.4%). According to revised criteria of the American Fertility Society the presence of first, second, third and fourth stage of endometriosis was 55.6, 25.9, 11.1 and 7.4%, respectively. The most frequent occurrence of endometriotic lesions were on ligamenta sacrouterina (21.4%) and plica vesicouterina (19.0%). Pelvic adhesions, myomas, pelvic varicosities and chronic inflammatory process were present in 25.6, 15.1, 9.3 and 3.5% of the cases, respectively. No somatic origin of pain was identified at laparoscopy in 11.6% of patients. Preoperative ultrasonic examination with pelvic pathology findings were performed in 36 patients, and laparoscopy correlated with ultrasonographic findings in 31 (86.1%) cases. The average pain duration was 11.5 months (6-28) with the majority among women with history of previous surgical intervention (48.8%) and parturated women. Presence of pain was most common among women after 31 years of age. Predominantly, cytology examination of biological materials (peritoneal fluid, cyst fluid) revealed an increased histiocytic reaction in coincidence with chronic inflammation process in 31.6%. CONCLUSION: Invasive laparoscopy in chronic pelvic pain pertains to one of the most important examination procedures for its high specificity and sensitivity. Laparoscopy can reveal organic causes of pelvic pathology in 60% of cases with the possibility of following treatment. Our combined effort should stop the progression of such pathology leading to possible morphologic, functional and psychological alteration, especially among young women in fertile age. Today, endometriosis still remains the main cause of chronic pelvic pain in high percentage rate.

[TNF-alpha serum levels in women with endometriosis: prospective clinical study]. / Sérové hladiny TNF-alpha u zien s endometriózou: prospektivna klinická studia.

OBJECTIVE: To determine serum levels of TNF-alpha (tumor necrosis factor alpha) as a prediction of endometriosis. DESIGN: Prospective clinical case control study. SETTING: Department of Obstetrics and Gynaecology and Department of Pathology, Jessenius Faculty Hospital, Kollarova 2, Martin, Slovakia. METHODS: The serum TNF-alpha was determined in women who underwent laparoscopy or laparotomy due to pelvic pain, infertility, dysmenorea or pelvic tumor. Endometriosis was confirmed histologically and classified by rAFS. RESULTS: On the basis of entering criteria 65 women were enrolled in this study. In 61 cases serum level of TNF-alpha was evaluated. The average serum level of TNF-alpha in the endometriotic group was 73.847 pg/ml (n=30) and without endometriosis was 21.089 pg/ml (n=31). We have found a significant statistical difference between the above mentioned groups in the medium levels of TNF-alpha (p<0.0001). We did not find statistical significance between TNF-alpha levels and in the group of women with endometriosis in relation to the stage of the disease (I.-II., III.-IV., adenomyosis). At a cut-off level of TNF-alpha 30 pg/ml there was a 63.33% sensitivity, 77.42% specificity, a positive prediction value 73.07%, and 68.57% of negative predictive value. CONCLUSION: TNF-alpha serum levels are good diagnostic markers of endometriosis in the spectrum of noninvasive methods.

[Morbidity after cesarean section]. / Morbidita pacientok po cisárskom reze.

OBJECTIVE: To determine the frequency, spectrum of indications and complications and maternal morbidity rate connected with Caesarean sections as the most frequent mode of operative delivery. DESIGN: Retrospective, epidemiologic and comparative clinical study. SETTING: Department of Obstetrics and Gynecology, Jessenius Medical Faculty, Comenius University, Martin, Slovak Republic. METHODS: The authors retrospectively analyzed clinical data during a ten-years period. The number of deliveries, premature deliveries, frequency of Caesarean section, indications and maternal morbidity rate were determined. Further, a special attention was paid to premature deliveries and the related frequency of Caesarean sections and maternal morbidity rate in this group. In addition, the effectiveness of a complex pre-operative management was evaluated. RESULTS: The evidence shows that the natality rate is decreasing and the incidence of premature deliveries is increasing. The frequency of Caesarean sections is relatively stable with lower morbidity rate in the group of premature Caesarean deliveries. The positive effect of antibiotics, heparin and anti-aspiration medication within a complex pre-operative management was proved to decrease the frequency and severity of complications. CONCLUSIONS: The maternal morbidity rate following Caesarean delivery is relatively low, owing to the use of prophylaxis. However, it is vital to keep to the indications for Caesarean termination of the pregnancy, because there is still substantial mortality rate connected with it.

[Cushing's syndrome in pregnancy]. / Cushingov syndróm v gravidite.

Active Cushing's syndrome during pregnancy is a rare phenomenon which was so far described in the literature only in 85 women. The authors give an account of a patient who developed Cushing's syndrome during pregnancy and who was delivered during the eighth month of a healthy foetus by caesarean section, afterwards the hypercortisolism associated with hyperaldosteronism was treated by dextrolateral adrenalectomy. In the removed adrenal gland was a cortical adenoma made up of clear cells and cells reminding of the zona glomerulosa. Subsequently the authors summarize data from the literature on the prevalence of different pathogenetic forms of Cushing's syndrome in pregnant women, on the influence of hypercortisolism on mother and foetus, on the optimal diagnosis and therapy of this syndrome during pregnancy.

[Diagnosis of malignant ovarian tumors using color Doppler sonography]. / Diagnostika malígnych ovariálnych nádorov pomocou color Dopplersonografie.

In a prospective investigation the authors followed the circulation in 32 patients with ovarian tumours before operation. They examined the RI using colour Doppler sonography. Based on histological examination the authors divided the patients into groups with malignant and benign tumours resp. The peripheral resistance and RI in the group of patients with malignant tumours was 0.35 +/- 0.03, i.e. significantly lower than in the group with benign tumours, 0.65 +/- 0.08 (p < 0.001). In none of the patients with malignant tumours the RI was higher than 0.50. The authors recommend this method as a screening examination for early detection of malignant ovarian tumours.