Badanie prospektywne zale˝noÊci pomi´dzy poziomem wolnego insulinopodobnego czynnika wzrostu (IGF-1) w surowicy krwi a zaawansowaniem nowotworu u pacjentek z rakiem endometrium

Abstract Introduction: Endometrial carcinoma is a common malignancy of the female genital tract. There is a strong correlation between myometrial invasion and clinical prognosis. Increasing myometrial penetration is associated with an increasing risk of pelvic and para-aortic lymph node metastasis, adnexal metastasis, positive peritoneal cytology, local vault recurrence, and hematogenous spread. The causal role for Insulin-like growth factor-1 and insulin in endometrial carcinogenesis is well supported and insulin and IGF system have mitogenic and antiapoptotic activity. Endometrial cancer cell lines express high-affinity insulin receptors, consistent with there being a direct biological effect of insulin and IGF system on the growth and myometrial invasion of endometrial cancer cells. Material and methods: Patients with endometrial carcinoma have been divided into three groups: tumor confined to the endometrium (stage IA, n:24), endometrial carcinoma with a minimal invasion (less than 50% of the myometrium; stage IB, n:32), and the control group (n:40). Demographic factors, estradiol and free IGF-1 plasma levels have been compared in all groups. Results: Lower Free IGF-1 plasma levels were found in patients with myometrial invasion when compared to the patients without myometrial invasion. Conclusions: In the following work we have presented the current understanding of endometrial carcinoma, association between free IGF-1 plasma levels and myometrial invasion in patients with endometrial adenocarcinoma in terms of management and survival.Streszczenie Wstęp: Rak trzonu macicy jest częstym nowotworem narządu rodnego. Istnieje zależność pomiędzy stopniem naciekania macicy a rokowaniem. Wraz z zaawansowaniem nacieku na ścianę mięśniową macicy wzrasta ryzyko wystąpienia przerzutów do węzłów chłonnych miednicy i okołoaortalych, nacieku na przydatki, wznów w obrębie sklepienia pochwy, obecności komórek nowotworowych w badaniach cytologicznych płynu z jamy otrzewnowej oraz rozsiewu komórek nowotworowych za pośrednictwem krwi. Insulina i insulinopodobny czynnik wzrostu (IGF-1) pobudzają komórki do rozrostu, mają właściwości antyapoptotyczne oraz są znanymi czynnikami ryzyka raka trzonu macicy. Jednocześnie komórki nowotworowe wywodzące się z endometrium wykazują wysoką ekspresję receptorów o silnym powinowactwie wobec insuliny. Materiał i metodyka: Pacjentki z rakiem endometrium podzielono na 3 grupy: chore z rakiem ograniczonym do endometrium (n:24), następnie pacjentki, u których naciek nie przekraczał 1 grubości ściany mięśniowej (n:32) i grupę kontrolną (n:40). U pacjentek analizowano czynniki demograficzne, badano poziom estradiolu i IGF-1 w surowicy krwi. Wyniki: Poziomy IGF-1 w surowicy krwi były niższe u pacjentek z obecnym naciekiem ściany mięśniowej w porównaniu z chorymi z naciekiem ograniczonym do endometrium. Wnioski: Przedstawiliśmy obecną wiedzę na temat raka trzonu macicy, zależności pomiędzy poziomem wolnego IGF-1 w surowicy krwi a stopniem naciekania na ścianę endometrium u pacjentek z rakiem endometrium, pod kątem postępowania i przeżycia chorych

Computed tomography as a predictor of the extent of the disease and surgical outcomes in ovarian cancer

Objectives: The aim of the present study is to determine the predictive value of Computed Tomography (CT), alone or in combination with serum CA-125 levels, for preoperative staging, detection of the extent of the disease, and surgical complications in patients with ovarian carcinoma. Material and methods: One hundred and fourteen patients diagnosed with ovarian carcinoma following an exploratory laparotomy with a preoperative CT scan, performed between January 2007 and June 2013, were enrolled in the study. Preoperative CT and intraoperative surgical findings were compared using 14 parameters and predictions of CT for gas­trointestinal, genitourinary, and cardiovascular complications. All radiological features and clinical characteristics were analyzed statistically. Results: CT and surgical findings correlated (sensitivity/ specificity) as follows: uterine and tubal spread (66%/89%), cervical involvement (100%/80%), peritoneal nodulesincreased density-carcinomatosis (57%/93%), omental involvement (68%/95%), retroperitoneal involvement (25%/84%), ascites (85%/87%), perirectal and perivesical fat plan obliteration (43%/94%), liver metastasis (50%/91%), small and large bowel involvement (47%/95%), adnexal mass (94%/70%), and other metastases (47%/86%). Also, CT findings were found to be statistically insignificant for prediction of mesenteric involvement, bladder metastasis, and diaphragmatic involvement. The overall CT sensitivity and specificity at detecting intraoperative findings was 91% and 71%, respectively. We found a statistically significant correlation between intestinal involvement on CT and the necessity of additional surgical procedures. Conclusions: CT is a widely used imaging method in the preoperative evaluation of ovarian cancer. However, its predictive value, sensitivity and specificity differ, depending on the anatomical region

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

The prevalence and causes of sexual problems among premenopausal turkish women

Introduction. Sexual dysfunction in females is an important public health problem worldwide. It is suggested that sexual problems among women are more common than the number of diagnosed female sexual dysfunction (FSD) cases indicates

Post hysterectomy occurrence of endometrial adenocarcinoma in association with granulosa cell tumour: a case report

[No abstract available

The impact of uterine adenomyosis on the histopathological risk factors and survival in patients with endometrial adenocarcinoma

A retrospective cohort study was performed on patients diagnosed with endometrial adenocarcinoma (EC) during a 9-year period to investigate the impact of co-existing adenomyosis on patients with EC. Group A included women with EC and adenomyosis and Group B EC cases without the presence of adenomyosis. Group A was more likely to have early-stage disease, tumours without deep myometrial invasion, low-grade tumours and tumours with negative lymphovascular space invasion when compared to Group B (p = 0.012, p = 0.004, p 0.001, p = 0.02). There were no statistically significant difference between Group A and Group B for lymph node metastasis (p = 0.064). There was no significant relation between the adenomyosis and survival outcomes in the multivariant analysis (p = 0.437). As a conclusion, patients with adenomyosis were more likely to accompany good histopathologic prognostic factors. Multivariate analysis showed no significant effect of adenomyosis on recurrence and survival parameters.IMPACT STATEMENTWhat is already known on this subject? Adenomyosis is one of the most common accompanying benign histopathological findings of type 1 endometrial carcinomas (EC). Adenomyosis comprises some characteristics similar to malignant tumours, such as invasion, abnormal tissue growth and angiogenesis. Despite concerns have arisen due to both their high incidence and similar molecular links, the possible relation between EC and adenomyosis is still not well grounded. What the results of this study add? We presented a 9-year period retrospective cohort of a tertiary referring single centre and evaluated the prognostic effect of adenomyosis in patients with EC as well as the survival outcomes of these patients. The co-occurrence of adenomyosis was more likely to accompany early-stage (stages 1–2) disease, low-grade tumours (grades 1–2) and tumours with negative LVSI in patients with EC. However, multivariate and survival analysis showed no significant effect of adenomyosis on recurrence and survival parameters. What the implications are of these findings for clinical practice and/or further research? Based on these findings, we suggest that the presence of adenomyosis should not be considered as a prognostic factor in EC. Our results support the overriding opinion about the prognostic value of co-occurrence of adenomyosis and EC. However, further studies exploring the molecular and genomic markers in these two groups are needed to uncover the exact relation of adenomyosis on the prognosis of EC. © 2022 Informa UK Limited, trading as Taylor ; Francis Group

Does cervicovaginal cytology have a role in the diagnosis and surveillance of endometrial adenocarcinoma?

Objective: To examine the role of cervicovaginal cytology in diagnoses and surveillance of the patients with endometrial carcinoma (EC). Methods: Patients who underwent EC surgery that included a follow-up were reviewed retrospectively. The cohort was limited to the patients who had an available cervical cytology result within 12 months before the primary surgery took place. The glandular abnormalities were classified in the following subclassifications: “atypical glandular cells” (AGC)-not otherwise specified (NOS), AGC-favor neoplasia, endocervical AIS, and adenocarcinoma. Results: A total of 411 patients were eligible for the study. The cervical cytology was found to be normal and recorded as negative for intraepithelial lesion or malignancy in 368 (89.5%) patients. In 43 (10.5%) patients, cervical cytology was interpreted as: AGC-NOS (n = 11), AGC-FN (n = 7), adenocarcinoma (n = 20), malignant epithelial tumor (n = 3), and squamous carcinoma (n = 2). During the follow-up, recurrence was observed in 53 (12.9%) patients. Among six isolated vaginal cuff recurrences, two of the cases presented with malignant cytology, and the additional four cases were suspected during clinical examination. Among women with recurrence (n = 53), there were malignant cytological findings in four of the patients. In the whole population (n = 411), there were four other abnormal cytological findings detected within the surveillance. These four cytology results were nonmalignant and no recurrence was identified. Conclusion: There is no significant clinical advantage of cervicovaginal cytology testing before diagnosis or during the surveillance of EC. © 2020 Wiley Periodicals, Inc

Uterine Papilla Serous Carcinoma

Introduction: Uterine Papillary Serous Carcinoma (UPSC) is a prototype of Type II Endometrial Cancers (EC) and represents 5-10% of all EC. It is clinically aggressive and responsible for over 50% of relapses and deaths in EC patients.Aim: To investigate factors affecting the overall survival in patients with UPSC.Materials and Methods: Forty-three women treated for UPSC between January 2006 and October 2015 were analysed retrospectively. Subjects were included if histology revealed a minimum of 10% component of serous carcinoma. Patients who required neoadjuvant therapy were excluded. All women underwent surgical treatment with at least total hysterectomy and bilateral salpingo-oophorectomy. The effect of age, tumour size, myometrial invasion, presence of malignant peritoneal cytology, lymph node metastasis, presence of the tumour outside the uterus and in the upper abdomen on the survival were investigated. The Kaplan-Meier method was used for survival analysis. Univariate analysis was used to evaluate the importance of each parameter and log rank test was used for significance. Significant parameters were analysed by multivariate Cox regression.Results: Forty-three patients diagnosed and treated for UPSC were analysed. Out of them, 38 (88.4%) underwent surgical staging. Relapse and disease progression despite therapy was observed in 9 (20.9%) cases. The overall survival was estimated to be 46.5%.Conclusion: The present study demonstrated that myometrial invasion, lymphovascular space involvement, and presence of a tumour in the upper abdomen were statistically significant parameters affecting the overall survival in UPSC patients

Paraganglioma of the cauda equina: A highly vascular tumour

WOS: 000286124000024PubMed ID: 20637630Paragangliomas uncommonly occur in the cauda equina region. This type of tumour may be misdiagnosed pre-operatively as a neurinoma or an ependymoma. Paragangliomas are highly vascular tumours. We report three patients with paraganglioma of the cauda equina. The first patient had many dilated vessels resembling an arteriovenous malformation, which were seen during surgery. The second patient had a post-operative haemorrhage without any residual tumour. The third patient had a selective angiogram with dense tumour staining. (c) 2010 Elsevier Ltd. All rights reserved