The clinical evidence and the role of imiquimod in the extramammary Paget disease

Extramammary Paget disease is a rare disease. Different treatment options are used for its management, among them treatment with imiquimod. Our aim is to clarify the efficacy and safety of the use of topical imiquimod cream in the treatment of extramammary Paget disease.In this article the current literature in Pubmed and Scopus on this topic is reviewed.According to the literature the topical use of imiquimod can be used as first-line treatment in different dosages and durations with excellent results, reaching a 87.5% cure rate with rare complications. The available evidence is currently limited to case reports and a single case series, but is definitely in favor of imiquimod use as an alternative treatment for extramammary Paget disease.</p

GRIGORIS LAMBRAKIS (1912-1963) – A GREEK OBSTETRICIAN AND WORLD RENOWNED ACTIVIST

Grigoris Lambrakis was a Greek politician, doctor, athlete, and faculty member of the Medical School of Athens University. As an athlete, Lambrakis held the Greek record for long jump for twenty-three years and he also won several gold medals in the Balkan Athletic Games. Lambrakis received an excellent medical education. As lecturer at the University of Athens, Lambrakis became a pioneer of Gynecological Endocrinology. His philanthropy was always evident during his medical career, but he also consistently attended international pacifist meetings and demonstrations. His medical work, and his performance as lecturer of Obstetrics and Gynaecology, have been neglected, if not overshadowed, by his political career. Lambrakis is recognized worldwide as a martyr for peace. The aim in this essay is to present his life, and especially to elucidate his medical achievements.Grigoris Lambrakis bio je grčki političar, liječnik, sportaš i član Medicinskog fakulteta Sveučilišta u Ateni. Kao sportaš, Lambrakis je držao grčki rekord u skoku u dalj tijekom dvadeset i tri godine, a osvojio je i nekoliko zlatnih medalja na Balkanskim atletskim igrama. Imao je izvrsno medicinsko obrazovanje. Kao predavač na Atenskom sveučilištu, Lambrakis je postao pionirom ginekološke endokrinologije. U njegovoj se liječničkoj karijeri očitovala njegova dobrohotnost. Također, neprestano je prisustvovao međunarodnim pacifističkim susretima i prosvjedima. Njegova je politička karijera zasjenila njegov medicinski rad i sveučilišni rad predavača opstetricije i ginekologije. Lambrakis je svjetski poznat kao mučenik za mir. Cilj je ovog izlaganja predstaviti njegov život, a posebice pojasniti njegova medicinska postignuća

Molecular Mechanisms of Preeclampsia

Preeclampsia is one of the leading causes of maternal morbidity/mortality. The pathogenesis of preeclampsia is still under investigation. The aim of this paper is to present the molecular mechanisms implicating in the pathway leading to preeclampsia

The Role of 3-Dimensional Power Doppler Imaging in the Assessment of Ovarian Teratoma in Pregnancy: A Case Report

Background. Conventional sonography is the primary imaging tool for these pregnant women who present with an ovarian teratoma. In some cases, however, sonography diagnosis is difficult. We report a case of ovarian teratoma during pregnancy diagnosed by three-dimensional Power Doppler. The cyst was removed via laparotomy without fetal or maternal complications. Three-dimensional ultrasound with multiplanar view can better discriminate a benign ovarian teratoma from complex ovarian lesions or malignant tumors. Its role is significant especially during pregnancy as it may assist in determining which patients are requiring surgery and which are not. The results of three-dimensional sonography and magnetic resonance (MR) were equal but the role of MR imaging is limited in early pregnancy. Conclusions. Three-dimensional technique is a reliable diagnostic modality for preoperative assessment of an ovarian teratoma as it can be performed during the first trimester of pregnancy

Maternal Serum Levels of TNF-Alpha and IL-6 Long after Delivery in Preeclamptic and Normotensive Pregnant Women

Aim. To evaluate maternal TNF-alpha and IL-6 plasma levels in normotensive pregnant women, women with preeclampsia, and to examine the temporal changes in their levels from theantepartum to the postpartum period correlated with the regression of preeclampsia. Method. A prospective study was performed in the 2nd Department of Obstetrics and Gynecology, University of Athens. Blood samples were obtained: (1) antepartum at the time of clinical diagnosis of the syndrome, 2. 12-14 weeks postpartum. Results. No statistically significant differences were found in IL-6 levels, whereas a difference was found in TNF-alpha levels between preeclamptic and controls in antepartum period (0.80 pg/ml versus 0.60 pg/ml, P : .04). Long after delivery, TNF-alpha levels were significantly higher in preeclamptic compared to normotensive controls (0.86 pg/ml versus 0.60 pg/ml, P : .004). No difference was observed in TNF-alpha before and after delivery in both groups. No difference was noticed in IL-6 levels in women of normotensive group long after delivery compared to that before delivery. Long after delivery IL-6 levels were statistically significant higher in preeclamptic women compared to normal controls (3.53 ± 0.52 pg/ml versus 1.69 ± 0.48 pg/ml, P : .02). Conclusion. Preeclamptic women remain under a status of increased inflammatory stress up to 12-14 weeks postpartum despite the fact that all the other signs of preeclampsia are resolved

Congenital Cystic Adenomatoid Malformation: Is There a Need for Pregnancy Termination?

Aim. Congenital cystic adenomatoid lung malformation is a rare unilateral dysplasia of the lung. Three pathologic types are described in the literature: type I with cysts >2 cm, type II with cysts <1 cm, and type III with microcysts. The aim of this paper is to present a case of a fetus with congenital cystic adenomatoid lung malformation and discuss the necessity for pregnancy termination according to its prognosis and future mortality. Case. A 36-year-old pregnant woman (para: 1, gravida: 1) presented in our department for anatomy ultrasound screening at 20 + 1 weeks of gestation. The ultrasound detected a cystic adenomatoid right lung malformation measuring 1.45 × 1.67 cm which caused mediastinal shift of the heart and the lung to the left side. Other findings were cysts of the choroid plexus and echogenic intracardiac foci. The parents after genetic counseling decided pregnancy termination. The pregnant received cabergoline for ablactation. Conclusion. Congenital cystic adenomatoid lung malformation has different prognosis according to the type (69% in type I, 0% in types II and III). Fetal hydrops, cardiac and skeletal anomalies, Potter's syndrome, and gastrointestinal atresia are common cofindings. Genetic counseling is necessary, and pregnancy termination is proposed to the cases with poor prognosis

Vulvar Merkel Carcinoma: A Case Report

This is a new case of Merkel cell carcinoma of the vulva. It is a rare neuroendocrine carcinoma with an aggressive behavior. Because of its rarity in this location, it is not clear whether it behaves differently from the usual neuroendocrine carcinomas of the skin. A case of a 63-year-old patient with vulvar Merkel carcinoma is presented. The clinical presentation, microscopic and immunohistochemical features, and treatment are discussed

Robotic Management of Fibroids: Discussion of Use, Criteria and Advantages

Fibroids are the most common benign tumors affecting fertility and quality of life. Different methods either definitive or fertility sparing are used for their management by using open, laparoscopic and robotic techniques. This is a narrative review presenting the role and the advantages of robotic surgery in fibroids (myomectomies or hysterectomies). Such a management is effective, safe and feasible in hands of well-trained teams even for multiple, large or deep located fibroids.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site

RAZVOJ ROBOTA KROZ POVIJEST DO „DA VINCIJEVOG ROBOTA“

Da Vinci robot is increasingly used for operations adding the advantages of robots to the favor of medicine. This is a historical article with the aim to present the evolution of robots in the medical area from the time of ancient myths to Renaissance and finally to the current revolutionary applications. We endeavored to collect several elegant narratives on the topic. The use of imagination could help the reader to find similarities. A trip from the Greek myths of Hephaestus through Aristotle and Leonardo Da Vinci to the robots of Karel Capek and Isaac Asimov and finally the invention of the medical robots is presented.Da Vincijev robot se sve više koristi za operacije iskorištavajući prednosti robota u korist medicine. Ovo je povijesni članak u kojemu je cilj predstaviti evoluciju robota u medicini od vremena drevnih mitova do renesanse i konačno do sadašnjih revolucionarnih aplikacija. Nastojali smo prikupiti nekoliko elegantnih priča na tu temu. Korištenje imaginacije može pomoći čitatelju pronaći sličnosti. Predstavljeno je putovanje od grčkih mitova o Hefestu preko Aristotela i Leonarda da Vincija do robota Karela Čapeka i Isaaca Asimova te konačno izuma medicinskih robota