Background. Successful diagnosis and management of cervical intraepithelial neoplasia (CIN) prevent the occurrence of invasive cervical cancer, which is one of the important indicators of the ...national health care.Methods. The retrospective analysis studies patients at Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, who had in the period from January 1996 to December 2000 cervical biopsy due to CIN suspicion, based on abnormal PAP smear test and/or abnormal colposcopy. The patients, whose CIN diagnosis was confirmed with cervical biopsy sample histology, were treated by local methods (laser vaporisation, laser conization, large loop excision of the transformation zone (LLETZ), cold-knife conization), hysterectomy or just supervised with 4–6 month PAP smear and colposcopy follow-up. Our efficiency criteria were PAP smear one year after the treatment and excised tissue histology (for local excision methods and hysterectomy). We also compared the histology of the cervical biopsy sample and the excised tissue after excision methods of treatment and hysterectomy. The sources of our database were the patients’ records.Results. The study analyses 800 patients. In 195 women (24%) CIN wasn’t confirmed by cervical biopsy sample histology. In the remaining 605 patients (76%), we diagnosed severe dysplasia (CIN III) in 332 women (55%), moderate dysplasia (CIN II) in 153 women (25%) and light dysplasia (CIN I) in 120 women (20%). CIN was most frequently diagnosed in the age between 30 and 34. CIN III was most frequently treated with cold-knife conization and CIN II with laser vaporisation. We also treated 120 patients (66%) with CIN I, mostly with laser vaporisation. There were no substantive differences in therapeutic efficacy between the methods of treatment. Besides hysterectomy, the most successful method was cold-knife conization in 96,9%, and the least successful LLETZ in 91,7%. The histology between cervical biopsy sample and excised tissue after local excision methods and hysterectomy matched in 75%.Conclusions. Considering known criteria we find local conservative methods of CIN treatment successful and having advantage compared to the other methods of CIN treatment.
SURGICAL TREATMENT OF ENDOMETRIAL CANCER Stelio Rakar; Leon Meglič; Branko Cvjetičanin ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
12/2003, Letnik:
72
Journal Article
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Background. Nowadays, endometrial cancer is the most frequent gynecologic malignancy with a relatively good prognosis. The prognosis and the quality of life of these patients can be improved ...considering the prognostic factors and more rational treatment.Methods. This retrograde analysis comprised 499 patients with endometrial cancer operated at the Department of Obstetrics and Gynecology and then irradiated at the Institute of Oncology in Ljubljana in the period 1995–1999.Results. Most patients had stage I disease (81.4%), good prognostic histological type (endometroid and adenoacanthoma in 81.3%), well- and moderately differentiated tumors (86%) and early myometrial invasion (72.4%). In the observed period we performed radical hysterectomy »old« Wertheim (Piver II) in only 8.4% of cases, in all other cases simple vaginal or abdominal hysterectomy (in 46.9% with pelvic lymphadenectomy) was done. Adjuvant irradiation was administered to 70% of patients. The analysis of 3- and 5-year survival comprises only 466 patients. The overall 5-year survival was 85.8%, in stage I cases 88.1%. There were no significant differences in survival in stage I cases regarding the type of surgery. In stage I the most important adverse prognostic factors were poor differentiation, deep myometrial invasion and serous-papillary histologic type, whereas lymph node involvement was very rare (less than 1%).Conclusions. For the choice of appropriate surgical treatment of patients with endometrial cancer it is necessary to consider the prognostic factors. In this analysis a more radical surgical procedure did not improve the survival significantly. The usefulness of limphadenectomy in stage I remains open.
Background. Traditional surgical technique applied in the treatment of endometrial carcinoma is total abdominal hysterectomy combined with bilateral salpingooophorectomy. Laparoscopic surgical ...technique, providing the possibility of simultaneous hysterectomy and lymphadenectomy through the vagina, represents the alternative to laparotomy. The objective of this analysis was to evaluate periand postoperative parameters of both techniques, and the appropriateness of the number of removed nodes.Methods. This retrospective comparative analysis involved 36 patients (Group LAVH), who underwent laparoscopic surgical treatment for stage I endometrial carcinoma in the period 1995–2003, and 24 randomly chosen patients (Group TELA), in whom the same surgical procedures were performed using abdominal approach. The data for comparison of general clinical parameters, duration of surgery, blood loss, early and late postoperative complications, duration of stay at the intensive care unit and hospital stay, were collected from the operative and anesthesiology records. Histologic findings provided histopathomorphologic data on carcinoma and the number of removed nodes. The comparison of all parameters was evaluated using Student T-test for continuous variables, and Chi-square test and Mann-Whitney test for categorical variables.Results. General clinical parameters and the patient age were evenly distributed between the groups. The same applies for the distribution of mean blood loss and early postoperative complications. Two patients, treated laparoscopically, were re-admitted to hospital for pelvic abscess. The mean duration of stay at the intensive care unit was longer in the TELA group patients (3.3 ± 1.1) than in the LAVH group patients (2.1 ± 0.45) (F = 30.41; p < 0.0001). Also, most patients from the LAVH group were discharged from hospital on day 8 after surgery (8.47 ± 2.3 days), and on day 11 in the TELA group (11.7 ± 3.4 days) (F = 17.46; p < 0.0001). In the LAVH group mean 18 ± 6 nodes were removed, and in the TELA group 14 ± 8, the difference being statistically significant (p = 0.03).Conclusions. Although this analysis was retrospective, the obtained results confirm the findings of other authors regarding the advantages offered by the laparoscopic technique, the most important being hysterectomy combined with salpingo-oophorectomy performed through the vagina, quicker postoperative recovery and satisfactory surgical staging for stage I endometrial cancer.
Mutations in rhodopsin gene (
) are a frequent cause of retinitis pigmentosa (RP) and less often, congenital stationary night blindness (CSNB). Mutation p.G90D has previously been associated with ...CSNB based on the examination of one family. This study screened 60 patients. Out of these 60 patients, 32 were affected and a full characterization was conducted in 15 patients. We described the clinical characteristics of these 15 patients (12 male, median age 42 years, range 8-71) from three families including visual field (Campus Goldmann), fundus autofluorescence (FAF), optical coherence tomography (OCT) and electrophysiology. Phenotypes were classified into four categories: CSNB (
= 3, 20%) sector RP (
= 3, 20%), pericentral RP (
= 1, 6.7%) and classic RP (
= 8, 53.3% (8/15)). The phenotypes were not associated with family, sex or age (Kruskal-Wallis,
> 0.05), however, cystoid macular edema (CME) was observed only in one family. Among the subjects reporting nyctalopia, 69% (22/32) were male. The clinical characteristics of the largest p.G90D cohort so far showed a large frequency of progressive retinal degeneration with 53.3% developing RP, contrary to the previous report.
It has been suggested that iron metabolism may be involved in the pathogenesis of atherothrombotic cerebral infarction (ACI). The C282Y and H63D mutations in the hemochromatosis (HFE) gene are ...associated with increased serum iron levels and net iron accumulation. The aim of this study was to test the hypothesis that the C282Y and H63D mutations in the HFE gene are risk factors for ACI in a Slovene population.
The C282Y and H63D HFE gene mutations were tested in 96 Caucasian patients who had suffered an acute cerebral infarction, later confirmed as ACI, and 115 control subjects. Genotypes were determined by electrophoresis of the DNA digestion products from RsaI (C282Y) and MboI (H63D).
We failed to demonstrate that the C282Y and H63D mutations were risk factors for ACI in Caucasians. The percentage of C282Y and H63D genotypes (dominant model) in ACI-cases (C282Y: 7.3%, n=7; H63D: 28.1%, n=27) did not differ significantly (P=0.9 and P=0.7 respectively) from that of the controls (C282Y: 7.0%, n=8; H63D: 26.1%, n=30). Logistic regression analysis revealed that arterial hypertension, diabetes, and cigarette smoking are independent risk factors for ACI, whereas the C282Y and H63D HFE gene mutations are not.
We provided evidence that the C282Y and H63D HFE gene mutations were not risk factors for ACI in this Slovene population.
The angiotensin-converting enzyme (ACE) is a rate-limiting enzyme in the renin angiotensin system, the enzyme is involved in the vascular remodelling and atherosclerosis. Its significance in ...pathogenesis of ischemic cerebrovascular insults (CVI) is not known. We analysed 124 Slovenian patients with CVI and compared them with 161 healthy controls for I/D polymorphism. Under a recessive model (chi2 = 1.76, p= 0.1, OR = 1.40, 95% CI: 0.85 ~~ 2.34) we found no significant difference in I/D genotypes between patients with CVI and controls. This study shows that in a group of Slovenian CVI patients the DD genotype is not an important risk factor for the development of stroke.
The angiotensin-converting enzyme (ACE) is a rate-limiting enzyme in the renin angiotensin system, the enzyme is involved in the vascular remodelling and atherosclerosis. Its significance in ...pathogenesis of ischemic cerebrovascular insults (CVI) is not known. We analysed 124 Slovenian patients with CVI and compared them with 161 healthy controls for I/D polymorphism. Under a recessive model (χ
= 1.76, p= 0.1, OR = 1.40, 95% CI: 0.85 - 2.34) we found no significant difference in I/D genotypes between patients with CVI and controls. This study shows that in a group of Slovenian CVI patients the DD genotype is not an important risk factor for the development of stroke.
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