Primary small cell ovarian cancer of pulmonary type: A case report.

BackgroundPrimary small cell ovarian cancer of pulmonary type (SCCOPT) is a rare aggressive ovarian tumour with an incidence of Case presentationWe report a case of a 77-year old Caucasian woman who presented initially with a one-week history of abdominal discomfort with raised inflammatory markers and Ca125 of 50 μ/ml. Calcium levels were normal. She underwent primary debulking surgery, and histology showed a tumour comprising areas of classical small-cell carcinoma morphology. 6 cycles of adjuvant chemotherapy with carboplatin was offered. Relapsed/progressive disease was noted after 3 months of chemotherapy and patient died 7 months after treatment completion.ConclusionsSCCOPT is a rare aggressive malignancy with majority of the women having an overall survival of 2 years. There is no clear consensus for the diagnosis and optimal treatment

Association of human adiponectin, placental growth factor and annexin A5 levels in the second trimester amniotic fluid with intrauterine growth restriction

Objective: We investigated the association between second trimester amniotic fluid levels of Annexin A5, Human Adiponectin (HA) and Placental Growth Factor (PLGF) in Small for Gestational Age (SGA) and Large for Gestational Age (LGA) fetuses when compared with Appropriate for Gestational Age (AGA) fetuses.Study design: Samples of second trimester amniotic fluid were collected with amniocentesis at 15 to 22 week of gestation in 300 pregnant women. 78 amniotic fluid samples were selected (n=78). Annexin A5, Human Adiponectin and Placental Growth Factor levels were determined with enzyme-linked immunosorbent assay (ELISA) in IUGR (n=21), in LGA fetuses (n=13) and AGA fetuses (n=44) that consisted our study group. Results: Adiponectin and PLGF levels were detectable in AF. Median (25th-75th percentile) adiponectin levels were 16.1 (10.9-32.3) ng/ml in SGA, 19.5 (15.1-30.9) ng/ml in AGA, and 18.2 (14.7-30.8) ng/ml in LGA fetuses. Median (25th-75th percentile) PLGF levels were 24.2 (19.9-34.9) pg/nl in SGA, 26.4 (20.9-33.8) pg/ml in AGA and 33.5 (21.8-40.4) pg/ml in LGA fetuses. The differences were not statistically significant. Nevertheless, indication of differentiation of levels existed when SGA and LGA fetuses in the extremes of distribution were considered. Specifically, very severely SGA fetuses (≤2.5th percentile) tended to have high levels of adiponectin and reduced levels of PLGF in AF. Conclusion: The study suggests a possible relationship between16adiponectin and PLGF in amniotic fluid in fetal growth deviations, such as IUGR and LGA fetuses. These results could be explained by the growth promoting effect of HA and PLGF through the metabolic route and the vascular integrity of the placenta respectively. A better understanding of these disorders may provide new prospects for control interventions to be initiated earlier in pregnancy.Στόχος: Ο σκοπός της παρούσας μελέτης ήταν να διαπιστωθεί αν τα επίπεδα των Human Adiponectin (HA), Placental Growth Factor (PLGF) και Annexin Α5 σε δείγματα αμνιακού υγρού από το δεύτερο τρίμηνο της κύησης συνδέονται με τον ενδομήτριο περιορισμό της ανάπτυξης του εμβρύου (IUGR).Σχεδιασμός μελέτης: Δείγματα αμνιακού υγρού από το δεύτερο τρίμηνο της κύησης συλλέχθηκαν με αμνιοπαρακέντηση κατά τις 15-22 εβδομάδες της κύησης από 300 έγκυες γυναίκες. H Human Adiponectin, o PLGF και η Annexin Α5 προσδιορίστηκαν με τη μέθοδο ELISA σε 21 IUGR, σε 13 LGA έμβρυα και 44 AGA έμβρυα που αποτελούσαν την ομάδα ελέγχου. Αποτελέσματα: H adiponectin και ο PLGF ανιχνεύθηκαν στο ΑΥ. Η διάμεση συγκέντρωση της adiponectin (25η–75η εκατοστιαία θέση), ήταν 16.1 (10.9-32.3) ng/ml στα IUGR, 19.5 (15.1-30.9) ng/ml στα AGA και 18.2 (14.7-30.8) ng/ml στα LGA. Η διάμεση συγκέντρωση του PLGF (25η–75η εκατοστιαία θέση), ήταν 24.2 (19.9–34.9) pg/ml στα IUGR, 26.4 (20.9–33.8) pg/ml στα AGA και 33.5 (21.8-40.4) pg/ml στα LGA. Οι διαφορές δεν ήταν στατιστικά σημαντικές. Παρ 'όλα αυτά, υπάρχει ένδειξη της διαφοροποίησης των συγκεντρώσεων στα IUGR και LGA έμβρυα που βρίσκονται στις ακραίες εκατοστιαίες θέσεις της κατανομής. Η Annexin Α5 δεν ανιχνεύτηκε στα δείγματα αμνιακού υγρού.Συμπέρασμα: Η μελέτη υποδεικνύει την πιθανή σχέση της adiponectin και του PLGF στο αμνιακό υγρό σε παρεκκλίσεις της εμβρυικής ανάπτυξης,14όπως τα IUGR και LGA έμβρυα. Η καλύτερη κατανόηση των εν λόγω διαταραχών μπορεί να προσφέρει νέες προοπτικές για παρεμβάσεις ελέγχου που θα ξεκινήσουν νωρίτερα στην κύηση

Novel Medical Therapy of Cesarean Scar Pregnancy With a Viable Embryo Combining Multidose Methotrexate and Mifepristone A Case Report

An ectopic pregnancy is defined as cesarean scar pregnancy (CSP) when the products of conception are implanted within the myometrium in the area of a cesarean section scar. CSP can be a life-threatening condition and to date there is no clear consensus for CSP management. A medical approach joining high treatment rates with fertility preservation could be a safer and less invasive method of therapy.We present a case of CSP with a viable embryo that was successfully treated with a novel medical therapy combining multidose methotrexate (MTX) and mifepristone.No further additional invasive procedure was required since pregnancy products were dissolved and no major complications were experienced.Multidose MTX and mifepristone can be considered a safe and effective treatment for CSP

A randomized controlled trial for cervical priming using vaginal misoprostol prior to hysteroscopy in women who have only undergone cesarean section

To evaluate the efficacy of misoprostol administrated vaginally on cervical priming and its complications prior to diagnostic or operative hysteroscopy in women who have undergone at least one cesarean section and who have never delivered vaginally before and/or had other transcervical procedure. A total of 55 patients undergoing hysteroscopy for various intra-uterine lesions were included in this study and were randomly allocated to two groups finally. Thirty patients in the study group were given 200 mu g misoprostol vaginally 12 h before the procedure, whereas 25 patients in the control group did not receive any cervical priming. The countered outcome included the cervical width detected with Hegar dilatators and complication rates. Mean cervical width was greater in the study group (6.6 +/- A 1.3) than in the control group (5.1 +/- A 0.9). Complications and failure rates were lower in the study group. Application of 200 mu g misoprostol vaginally 12 h before hysteroscopy softens the cervix, reduces cervical resistance and consequently the need for cervical dilatation, with only mild side effects

Placental growth factor (PlGF): a key to optimizing fetal growth

The needs of the uterus and the fetus for the provision of nutrients and oxygen, supplied by the blood flow, are understandably extremely high, with the circulatory system playing the most important role in this action. Abnormal vascular growth and transformation that create a high vessel resistance network have been associated with various pregnancy pathologies, including miscarriage, small for gestational age (SGA) fetuses with or without preeclampsia and intrauterine growth restriction (IUGR). Placental growth factor (PlGF) has a major role in vasculogenesis and angiogenesis in human placenta. Low concentrations of PlGF and high concentrations of its inhibitor-soluble Fms-like tyrosine kinase-1 (sFlt-1) are linked with impaired angiogenesis and placental development, leading to the above pregnancy complications. The activity of vascular endothelial growth factor (VEGF), which is the most potent of all angiogenic mediators, is partly modulated by PlGF. Although the mechanisms via which PlGF exerts its various effects are still under investigation, we herein discuss the known actions exerted by this major mediator together with its results on fetal growth

Effect of High-Risk Human Papillomavirus but Normal Cytology at Test of Cure on Achieving Colposcopy Standards

Acknowledgements: We thank Sister Christine Godley for helping with data collection. Declaration of Interests: The authors have no conflicts of interest to declare. Funding: None.Peer reviewedPostprin

Ovarian Tissue Cryopreservation in Children and Adolescents

Cancer during childhood and adolescence remains a major public health issue, affecting a significant portion of this age group. Although newer anti-cancer treatments have improved survival rates, this comes at a cost in terms of gonadotoxic effects. As a result, the preservation of fertility is important. Ovarian tissue cryopreservation, one of the newest methods, has some advantages, especially for prepubertal patients: no need for ovarian stimulation, thus, no further risk for estrogen-sensitive cancer types, and preservation of more and better-quality primordial follicles of the ovarian cortex. The most frequent indications include treatment with alkylating agents, ovarian-focused radiotherapy, leukemias, lymphomas, brain and neurological tumors, as well as Turner syndrome and benign hemoglobinopathies. An expected survival exceeding 5 years, the absence of systematic disease and an overall risk of premature ovarian insufficiency over 50% are among the criteria that need to be fulfilled in order for a patient to undertake this method. Orthotopic transplantation is more frequently used, since it can allow both live birth and the recovery of endocrine function. Reimplantation of malignant cells is always a major risk and should always be taken into consideration. Histological analysis, as well as immunohistochemical and molecular methods, are needed in order to improve the search for malignant cells before transplantation. Ovarian tissue cryopreservation appears to be a method with specific benefits, indications and risks which can be an important tool in terms of preserving fertility in younger women

The impact of Mayer–Rokitansky–Küster–Hauser Syndrome on Psychology, Quality of Life, and Sexual Life of Patients: A Systematic Review

Background: Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is a rare congenital syndrome characterized by uterovaginal agenesis. Most patients are diagnosed during adolescence, when body image and sexual identity are shaped. Our main objective was to investigate how MRKH syndrome affects psychology, quality of life (QoL), and the sexual life of patients compared with non-affected individuals. Methods: Original peer-reviewed research papers examining psychological outcomes, QoL, and sexual function of MRKH patients were searched in PubMed. Titles, abstracts, and full text from potentially eligible records were reviewed by two independent reviewers. Case reports and papers published not in English were excluded. Results: Our search identified 63 records, of which 20 were included: 10 examined psychological and psychosocial outcomes, 14 examined sexual function outcomes, and 6 examined QoL outcomes. Results may be affected by selection bias and confounding due to differences between MRKH patients and controls. Conclusions: MRKH could be associated with a higher prevalence of anxiety and depression symptoms and social insecurity compared with women of a similar age without the condition. MRKH could also be associated with greater pain and discomfort during sexual intercourse and limitations in arousal, lubrication, and orgasm. MRKH patients more commonly experience impairment of mental-health-related QoL, but physical-health-related QoL is not affected