[Laparoscopic findings in women with chronic pelvic pain]

OBJECTIVE

To determine the frequency and analyze the findings during laparoscopy in women with chronic pelvic pain /CPP/.

MATERIALS AND METHODS

The study was conducted in the period 01.03.2004-01.07.2007 in the Gynaecological clinic at the Department of Obstetrics and Gynaecology, MU-Pleven. Eighty-six women were consecutively admitted in the Clinic, presenting with pelvic pain with duration more than 6 months and who underwent laparoscopy in order to be diagnostically defined more accurately or operatively treated. They were classified according to their socio-demographic characteristics, reproductive history/fertility and parity/, presence of preceding operative interventions, and findings during laparoscopy.

RESULTS AND DISCUSSION

The most frequent findings in women with CPP during laparoscopy were endometriosis /56,98%/ and adhaesion syndrome /39,53%/, and with a lower frequency-pelvic varicosis /17.44%/ and Allen-Masters syndrome /24,42%/. The most common localization of endometriotic foci was on ovaries/40,7%/and plica vesicouterina /18,6 %/, and of the varicose dilated veins-along vv.ovaricae and in the basis of the broad ligaments/resp. 89,96 and 60%/.

CONCLUSION

Laparoscopy is an exceptionally valuable and useful method in diagnosing and differentiating the etiology of chronic pelvic pain symptoms, because of the frequent presence of more than one cause with pelvic localization for its appearance.

[Frequency of gynecological morbidity and chronic pelvic pain in the Gynecological Clinic, UMPHAT "Dr. G. Stransky" - Pleven]

OBJECTIVE

By setting the structure of gynaecological morbidity to determine the frequency of chronic pelvic pain /CPP/ and the most common diseases, presented with CPP.

MATERIALS AND METHODS

A prospective study was conducted in the Gynaecological Clinic at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.07.2007. During that period, 4168 women were consecutively admitted in the Clinic. The object of the study were patients with leiomyomatosis /L/, endometriosis /E/, adenomyosis /A/, pelvic congestion syndrome/PCS/, Allen-Masters syndrome/AMS/, pelvic inflammatory disease /PID/ and adhesion syndrome /AS/. They were divided in groups according to age, type of disease and presence of CPP. The following methods were used for the purpose of the study: documentary method, R-AFS classification of E, inquiry method-by a questionnaire/form/, based on instruments for pain assessment, which are accepted worldwide /visual analogue scale, etc.

RESULTS AND DISCUSSION

Among all 1357 women included in the study, the most common diseases were L, followed by E and A, and AS. Comparatively lower frequency was determined for PCS and AMS. In almost one-third of the women in the study were admitted in the Clinic for diagnostic specification or operative treatment because of CPP. The most frequently defined reason for it were E, L and AS, and in a smaller part of patients-PCS and AMS.

CONCLUSION

From the analysis we made, we concluded that CPP was very often polyetiologically determined, which was assessed by some invasive methods.

[High risk of recurrent spontaneous abortion during second trimester in women carriers of polymorphism A2 in platelet glycoprotein IIb/IIIa]

The aim of this study was to evaluate the role of polymorphism A2 (PLA2) in platelet glycoprotein IIb/IIIa (GP IIb/IIIa) in the development of recurrent spontaneous abortion (RSA)--miscarriages before 20th week of gestation (wg) of pregnancy. The carriage status of PLA2 in GP IIb/IIIa, single and in combination with FVL and FII G20210A was investigated in 56 women with recurrent miscarriages before 10 g, in 38 women with RSA from 10 to 20 wg and in 98 healthy women with at least one uncomplicated full-term pregnancy. The significant prevalence of carriage of PLA2 in GP IIb/IIIa in women with RSA in first 20 wg was found with high risk or miscarriage (OR = 4.32; 95% CI: 2.10-8.97, p < 0.0001). However, after adjustment for combined carriage of other thrombophilic factors (PLA2 and FVL or PLA2 with FII G20210A) the risk was still high (OR = 2.07; 95% CI: 0.98-4.40 p = 0.058), but not significant. The similar results (OR = 2.632; 95% CI: 1.140-6.104, p = 0.021) were found for women with recurrent miscarriages in the first 10 wg. The prevalence of PLA2 adjusted for combined carriage of other thrombophilic factors was also not significant. The carriage status of PLA2 in GP IIb/IIIa in women with RSA in the period from 10 to 20 wg was significantly higher as compared to controls (OR = 8.79; 95% CI: 3.477-22.605, p < 0.0001). The prevalence, adjusted for combined carriage of other thrombophilic factors (PLA2 with FVL or PLA2 with FII G20210A) was also significantly higher (OR: 2.990; 95% CI: 1.178-7.613, p = 0.018). These results confirm the impact of PLA2 polymorphism on RSA in the period of 10 to 20 wg, and its contribution to RSA in the first 10 wg in combination with other thrombophilic mutations. The results support the suggestion of testing women with miscarriages in first 20 wg for PLA2 carriage and application of appropriate prophylactic antiplatelet drug therapy for next planned pregnancy.

Effect of gold adsorption on the conductive properties of cyclo-octasulfur microcrystals

The formation of gold crystallites on the surface of S8 promotes diffusion of electrons and determines the conductive properties of the shell-core nanosystems. Conducting probe atomic microscopy and four-probe resistance measurements confirmed that Au/S8 shell-core systems exhibit electrical conductivity on the micro- as well as on the nanoscale in contrast to non-covered S8 crystals, which are insulating. The conductivity of Au/S8 systems on the microscale was measured to be 10+/-1 S cm(-1). In XPS measurements, a single peak at 163.6 eV was observed for bulk S8 whereas an additional peak corresponding to a binding energy of 161.4 eV appeared for S8 adsorbed on a Au substrate. This is interpreted to mean that a chemical reaction has taken place. A process which results in adsorption of uniform gold nanolayers on needle shaped or fibrous S8 crystallites is under investigation.

[Fetal macrosomia--risks for the mother and the infant during vaginal delivery]

Fetal macrosomia represents a continuing challenge in obstetrics. The delivery of macrosomic infant has potentially serious consequences for the infant and the mother.

AIM

To determine the influence of fetal macrosomia (FM) on some of maternal and fetal complications during vaginal delivery.

MATERIALS AND METHODS

A five-year retro- and prospective study was conducted at the Department of Obstetrics and Gynecology, Medical University, Pleven (2001-2005). It included 524 vaginal deliveries: 286 cases of delivery of macrosomic infant--fetal birth weight (FBW) more than 4000 g and/or over 90-th percentile (Large for gestational age) and 238 cases of delivery of eutrophic infant at term--FBW between 10-th and 90-th percentile (Appropriate for gestational age). Analysis included: rate of episio- and perineotomy, perineal trauma, postpartum haemorrhage and fetal injury.

RESULTS

It was found significant correlation (p < 0.05) for influence of FM on the rate of episio- and perineotomy, perineal trauma and haemorrhage (chi2 = 182.10; R = 0.14), fetal injuries (chi2 = 114.52; R = 0.19).

CONCLUSION

FM is associated with a higher risk for the mother and the infant during vaginal delivery compared to infants with normal birth weight.

[Diprivan versus midazolam in combined anaesthesia with ketamin for minor gynecological surgery]

We tested the hypothesis that diprivan/ketamine (D/K) anesthesia would offer advantages compared to midazolam/ketamine (M/K) in patients undergoing minor gynecological surgery. After patient written consent, 60 healthy women, which were scheduled for elective termination of pregnancy were randomly allocated into two groups. Operating conditions, recovery, pain, postoperative nausea and vomiting (PONV) and patient's satisfaction to anesthesia were assessed. Demographic and surgical data were identical in the groups. Immediate recovery was faster with patients given diprivan than midazolam. Patients receiving M/K experienced more PONV in recovery room. D/K is preferable method of anesthesia for ultra-short gynecological procedure compared to M/K because of faster recovery and decreased incidence of PONV.

[Risk of thrombophilia in carriers of thrombophilic genetic factors in unsuccessful assisted reproduction]

The aim of this study was to evaluate an association of carrier status of common inherited thrombophilic genetic mutations and implantation failure after assisted reproduction (ART): IVF and ICSI. Sixty seven women with failure of embryo implantation and ninety six controls--women without obstetric complication were investigated for carriage of factor V Leiden (FVL), G20210A prothrombin gene mutation, genetic variant C677T in methylentetrahydrofolate reductase gene (MTHFR) and polymorphism A2 in platelet glycoprotein IIb/IIIa (GIPr IIb/IIIa). A significantly higher prevalence of polymorphism A2 in GIPr IIb/IIIa was found in women with implantation failure in ART compared to controls (respectively 26.1% and 12.5%; OR: 2.571, 95% CI: 1.066-6.258, p = 0.033). A higher but not significant prevalence of G20210A prothrombin gene mutation carriage was found inpatients compared to controls (respectively 5.8% and 3.13%, OR: 1.968, 95% CI 0.356-11.539). The carriage of FVL was a little but not significantly higher in controls. The carriage of genetic variant C677T in MTHFR was the same in both groups. These data suggest that polymorphism A2 in GIPr IIb/IIIa and G20210A prothrombin gene mutation could be play a role in the etiology of IVF failures and the carriers of GIPr IIb/IIIa A1/A2 and G20210A prothrombin gene mutation are at higher risk of implantation failure and not successful ART outcome. The carriage of these two genetic defects should be investigated in women undergoing IVF and the antithrombotic or anticoagulant prophylaxis should be indicated for carriers of these two factors.

[Genetic variant C677T in the MTHFR in women with recurrent early fetal loss]

The aim of this study was to evaluate correlation of carrier status for thrombophilic gene mutation--C677T in the methylenetetrahydrofolate reductase (MTHFR) and recurrent early pregnancy loss. Recently inherited thrombophilia was discussed as a predisposed factor for early recurrent fetal loss (ERFL). We investigated carrier status for C677T genetic variant in 54 women with ERFL before 10 week of gestation and 67 women with one or more successful pregnancy. It was found significant prevalence of C677T genetic variant in MTHFR in women with ERFL compared with controls (p = 0.005). The significant high prevalence of C677T genetic variant in women with ERFL suggests that thrombophilia have an increased risk of early pregnancy loss and possibly, although the definition of the magnitude of risk will require prospective longitudinal studies.

[Immunological aspects of postoperative analgesia after abdominal hysterectomy]

BACKGROUND

Prostaglandins modulate cytokine release though increases in cAMP, regulating interleukin-6 and interleukin-10. Ketoprofen inhibits cyclo-oxygenase activity and hence prostaglandin production.

AIM

We hypothesized that ketoprofen would affect release of IL-6 and IL-10 and modulate the immune response.

METHOD

We have evaluated 40 women, divided into four groups by the model of postoperative pain treatment: control group (only opioid) and experimental group (combination of i.v. ketoprofen and opioid). Serum IL-6 and IL-10 were measured before surgery, 24 and 72 hours after skin incision. Due to days in hospital we detected temperature and severe complications.

RESULTS

IL-6 increased at 24h and normalized at 72h. In contrast IL-10 did not change significantly.

CONCLUSION

The two models of postoperative analgesia have both modulated immune response after abdominal hysterectomy in same way.

[Manganese and selenium content in plasma of women with uterine myoma]

OBJECTIVE OF THE STUDY

To determine plasma concentration of manganese and selenium in women with uterine fibroids.

MATERIALS AND METHODS

The study included 22 women with uterine fibroids (group A) and a control group of 25 women (group B). Flame atomic-absorbable spectrometry was used for the purpose of the study. The patients were admitted in the Clinic of Gynaecology of UMPHAT "Dr. G. Stransky" in the period 01.01.2007-01.07.2007.

RESULTS AND DISCUSSION

No significant difference was found between the plasma concentrations of manganese in group A and B. Selenium plasma concentration of group A was determined as significantly lower in comparison with that of group B. The obtained results can serve as a precondition for investigations on a larger scale.

[Comparison and analysis of pain profiles in women with endometriosis and pelvic congestion syndrome--part II]

PURPOSE OF THE STUDY

To compare and analyze the pain profiles of patients with endometriosis /E/, adenomyosis /A/, and pelvic congestion syndrome /PCS/ in order to specify the factors that make closer the profiles of these conditions, and the factors, that make the differences between them clearer.

MATERIALS AND METHODS

A prospective study was conducted in the Clinic of Gynaecology, Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006. It included 98 patients consequently admitted in the Clinic--66 patients suspected of or with proven E, and 32 patients with PCS. For the purpose of the study the following methods were used: pain chart, visual-analogue scale /VAS/, monthly pain calendar, documentary method, R-AFS classification of endometriosis and inquiry method.

RESULTS AND DISCUSSION

The object of interest in this study were the pain profiles of E, A and PCS, and the dependence and association of severity of manifestation of the particular components of the pelvic pain syndrome /dysmenorrhoea, dyspareunia, postcoital ache, etc./ of the conditions mentioned above, on: stage of endometriosis, localization of endometriotic foci, diameter of maximal dilation and location of varicosely altered pelvic veins in women with PCS. It was found that the intensity and specificity of component demonstration of pelvic pain syndrome of women with endometriosis were not dependent on the stage of the disease, but on location of endometriotic lesions. In patients with PCS the severity and specific character of chronic pain syndrome were dependent on diameter of maximal dilation and site of varicose pelvic veins. According to its characteristics, pain profile of women A takes a specific place between the peculiar profiles of patients with E and PCS.

[Comparison and analysis of pain profiles of women with endometriosis and pelvic congestion syndrome--part I]

Pain is a general symptom in the clinical evolution of endometriosis /E/, particularly of adenomyosis /A/, and pelvic congestion syndrome /PCS/-conditions with different incidence and contingent of women with specific characteristics.

PURPOSE OF THE STUDY

To build up and compare the pain profiles of patients with E, A, and PCS by the use of quantitative and qualitative characteristics.

MATERIALS AND METHODS

A prospective study was conducted in the Clinic of Gynaecology, Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006. It included 98 patients--66 consequently admitted in the Clinic patients /for diagnostic specification or operative treatment/, suspected of or with proven E, and 32 patients with PCS. For the purpose of the study the following methods were used: pain chart, visual-analogue scale /VAS/, monthly pain calendar, documentary method, R-AFS classification of endometriosis and inquiry method.

RESULTS AND DISCUSSION

It was made a specification of and comparison between qualitative, quantitative and topical characteristics of chronic pelvic pain syndrome of women with E, A and PCS. Factors that aggravate and alleviate pain symptomatic were determined and the most frequent additional symptoms besides pain were pointed out. Discriminating between pain profiles of patients with E, A and PCS contributes to more precise differential-diagnostic specification together with other diagnostic means.

Folinic acid modulated bolus 5-FU or infusional 5-FU for adjuvant treatment of patients of UICC stage III colon cancer: Preliminary analysis of the PETACC-2-study

3563

Background: Patients with stage III colon cancer have a high risk for recurrence. Infusional 5-FU may be more active than bolus application. Methods: From 01/1997 to 03/2004 a total of 1601 patients with UICC stage III colon cancer were randomized to receive the Mayo-Clinic regimen or infusional 5-FU either the weekly high dose AIO regimen, the bi-weekly LV5FU2 regimen or the Spanish weekly high dose TTD-regime. The major aim of this study was to demonstrate a difference of 7 % in the 5 year survival rate in favour of the infusional arm for which a total of 424 events were required. Results: After a median follow-up of 31 months 478 events have occurred. 804 patients received the standard arm and 797 the experimental arm (AIO N=331, EORTC N=92, FFCD N=211, TTD N=163). The median age was 64 years; patients were well distributed according to TNM-category (T3 73 vs. 75%, T4 17 vs. 16%, N2 31 vs. 34%), vascular and lymphatic invasion and grading. The bolus regimen induced a higher rate of grade 3 or 4 leukopenia (7.1% versus 2.0%), stomatitis grade 3 or 4 (9.8% versus 3.3%) or diarrhea grade 3 or 4 (16% vs. 15%). Hand-Foot-Syndrome was more frequent in the experimental arm (4.4% versus 0.4%). There was no difference in the recurrence free survival at 5 years (57% versus 56%; hazard ratio 1.00, 95% CI, 0.84 to 1.21; P=0.9) or overall survival at 5 years 71% versus 72%; hazard ratio 0.91, 95% CI, 0.71 to 1.16; P=0.44). Conclusions: Infusional 5-FU does not improve RFS or overall survival of stage III colon cancer compared to the Mayo regimen but is less toxic. Supported by Deutsche Krebshilfe

No significant financial relationships to disclose.

[Terminated pregnancy following prenatal diagnosis of congenital anomalies--a part of register of congenital anomalies]

The most of European registries of congenital anomalies (CA) collected information of CA in livebirths, stillbirths and terminated pregnancies following prenatal/ultrasound diagnosis.

OBJECTIVES

to assess terminated pregnancies after prenatal/ ultrasound diagnosis of CA as a part of register of CA performed in University Hospital-Pleven. Among 21 202 births monitored during the study period (1996-2005), 679 CA were detected. The total prevalence of CA was 32/ 1000 births. The outcome of pregnancy for all cases of selected CA by register was 620 livebirths (91.3%), 36 stillbirths (5.3%), 23 terminated pregnancies (TP) (3.4%). The percentage of pregnancy termination was higher in the case of isolated anomalies, mainly lethal and CA associated with a low survival rate (61%), than with multiple ones. The most common CA detected after prenatal/ ultrasound diagnosis were neural tube defects (NTD) - the main reason for TP (52% of cases). The low proportion of these CA in TP (1/3) compared to their proportion in livebirths (50%) demonstrated an insufficiency of prenatal diagnosis of NTD as a part of register of CA performed in University Hospital-Pleven. Prenatal diagnosis of CA allows an early genetic counseling of mother presenting information on neonatal prognosis and recurrence risk for subsequent pregnancies. It helps family to take an adequate decision for termination of pregnancy with bad prognosis about heavy fetal CA.

[Pain profile of women with endometriosis and chronic pelvic pain-determining factors and significance]

PURPOSE OF THE STUDY

To determine the severity of the separate components of chronic pelvic pain syndrome/dysmenorrhoea, dyspareunia, dysuria, dyschezia ,etc/ in the different stages of the disease and according to the localization of endometriotic lesions. To determine to what extent the severity of the separate chronic pain components correlates with stage of the disease and localization of endometriomas.

MATERIALS AND METHODS

The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004 - 01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, type of the disease - internal or external genital endometriosis, adenomyosis, stage of the disease, localization of endometriotic lesions. The following methods were used for the purpose of the study: visual analogue scale, documentary method, R-AFS classification of E, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide.

RESULTS AND DISCUSSION

The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. When the mean value of pain assessment was reported, there was noted a non-correspondence between severity of pain and stage of the disease. It was found no significant correlation between the extent of manifestation of the separate components of the pain syndrome according to the stage of the disease. The severity of the separate components of the pain syndrome was determined according to the localization of the E-lesions. Statistically significant correlation was found between the extent of manifestation of dyspareunia, postcoital ache and dyschezia, and the localization of the E- lesions /p<0,05/ and that correlation was strongly supported in cases of adenomyosis and the components mentioned above. Statistically significant differences were found between the extent of manifestation of the relevant component of the chronic pain syndrome and some of the localization of E foci.

CONCLUSION

It was established a correlation between localization of E lesions and the severity of the separate components of the chronic pain syndrome. No correlation was found between the extent of pain manifestation, when assessed in total and in each pain component, and the stage of endometriosis.

[Modern aspects of perioperative analgesia by using nonsteroidal anti-inflammatory drugs in gynecology (Part II)]

It is an actual problem how to treat acute postoperative pain by using nonsteroidal anti-inflammatory drugs. Modern concepts for perioperative administration of these drugs are very important for the usual practice. The possibilities for optimal application of nonselective or selective COX-2 inhibitors are examined in this review.

[Modern aspects of perioperative analgesia by using nonsteroidal anti-inflammatory drugs in gynecology (Part I)]

It is an actual problem how to treat acute postoperative pain by using nonsteroidal anti-inflammatory drugs. Modern concepts for perioperative administration of these drugs are very important for the usual practice. The possibilities for optimal application of nonselective or selective COX-2 inhibitors are examined in this review.

[Endometriosis and chronic pelvic pain]

Endometriosis /E/ is a frequently met disease in women in reproductive age. One of its most typical clinical manifestations is chronic pelvic pain /CPP/ and as components of the chronic pain syndrome- dysmenorrhoea, dyspareunia, intermenstrual pain, and sometimes dyschezia and dysuria.

PURPOSE OF THE STUDY

To build up pain profile of patients with E by using quantitative and qualitative characteristics.

MATERIALS AND METHODS

The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, body mass index, blood group affiliation, stage of the disease, etc. The following methods were used for the purpose of the study: pain map, monthly pain calendar, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide; documentary method, R-AFS classification of E. Factors that provoke appearance and manifestation of pain, and factors that alleviate pain were studied too.

RESULTS AND DISCUSSION

The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. They corroborated the hypothesis for typical pain profile of women with E.

CONCLUSION

The building up of pain profile in total with other diagnostic methods /ultrasonography, magnetic resonance imaging/ has a determining role in the further diagnostic and therapeutic management of women with E and CPP. Pain profile can also be used as an assessment tool of conducted treatment /conservative or surgical/.

[An evolution in the conduct for ectopic pregnancy in gynecological clinic, "UMBAL - D-r G. Stranski", Pleven for 7 years' period]

AIM

The aim of the present study is to show the evolution of the conduct for ectopic pregnancy for 7 years' period after introduction in gynecological practice of contemporary diagnostic and therapeutic methods for ectopic pregnancy. For the fulfillment of this aim was made a prospective study for 7 years' period of the patients with diagnosis "Ectopic pregnancy", treated in Gynecological clinic of "UMBAL - D-r G. Stranski" EAD, Pleven.

MATERIALS AND METHODS

The objects of observation were 198 women with diagnosis: "Ectopic pregnancy". There were used the following methods: clinical, technical devices, statistical methods.

RESULTS

The authors analyze the results of the use of laparoscopy, conventional surgery and application of Methotrexate describing the indications and the risk for the patient.

CONCLUSION

The authors emphasized the advantages of the gynecological laparoscopy for precise diagnosis and contemporary treatment of the intact ectopic pregnancy.

[Usage of the new parenteral selective cox-2 inhibitor dynastat in the gynecologic practice]

A follow-up of 180 women was carried out. The patients having endured different gynecological operations (laparoscopy, laparohysterectomy, etc.) were divided into two main groups: half of them were treated with Dynastat (new selective COX-2 inhibitor) and the others were treated with Profenid (conventional nonsteroidal anti-inflammatory drug). The groups were compared by the quality of the achieved analgesia and appeared side effects, especially postoperative nausea and vomiting. These parameters were assessed by both medics and patients. In conclusion we accept that the new COX-2 selective inhibitor Dynastat does not have advantages over traditional nonsteroidal anti-inflammatory drug as Profenid especially for postoperative nausea and vomiting and quality of analgesia.

Histopathology of residual rectal carcinoma following preoperative radiochemotherapy

Preoperative radiotherapy with (CRT) or without chemotherapy (RT) in the management of patients with locally advanced rectal carcinoma is increasingly accepted as therapeutic modality to reduce local recurrence and improve survival, decrease tumor size and/or stage, has less toxicity compared to postoperative therapy, improves sphincter preservation and the ability to perform a curative resection. In a brief review of literature we discussed the possible prognostic role of most important pathologic parameters and their clinical implications. At present, predictive value of tumor response to neoadjuvant therapy remains uncertain, whether evaluated as five-point histological tumor regression grade (TRG) or recently proposed three-point rectal cancer regression grade (RCRG). However, most reports emphasize reduced local reccurence rates and disease-free survival advantage in patients with complete tumour regression or tumour down-staging, occuring in up to 20% and 60% of cases, respectively. Patients with advanced post-treatment tumour stage (ypT3/4), positive lymph nodes (ypN1/2), vascular invasion, positive circumferential resection margin, clearance < 2mm, or absence of tumor regression are shown to have poor clinical outcome. Among CRT-induced morphological features, only "fibrotic-type" stromal response with minimal inflammatory infiltrates and absence of surface ulceration are correlated to recurrence-free survival. Preliminary unpublished results of a pilot study from our multidisciplinary prospective trial relate to correlation of histopathologic parameters and morphologic changes to rectal cancer regression grade (RCRG). Therefore, we studied 22 consecutive patients, mean age 56 (range 23-69) years, with transmural cT3/4 stage and were subgrouped as follows: RCRG-1 (7 patients, 31.8%), RCRG-2 (9 patients, 40.,9%) and RCRG-3 (6 patients, 27,2%). In addition, 14 patients (63%) showed tumour downstaging and only 1 patient (4.5%) nodal down-staging after ypTNM restaging. There was the predominance of fibrotic-type stroma (16 patients, 72.8%) versus fibro-inflammatory response (6 patients, 27.2%), frequent tumoral necrosis (13 patients, 59%) but infrequent surface ulceration (5 patients, 22.7%) and peritumoural eosinophylic infiltration as well as endocrine cell differentiation (4 patients, 18%). The second aim of our study was to investigate determinants of radiosensitivity, i.e. the relationship between proliferative activity indices (Ki-67 and PCNA) as well as the induction of apoptosis (p53) and the tumour regression (RCRG) after neoadjuvant CRT. The interaction between Ki-67 and PCNA immunoexpression levels and the benefit of CRT was significant for Ki-67 (p = 0.03), but not for PCNA (p = 0.08) and p53 levels (p = 0.4). In a conclusion, high percentage of Ki-67-positive tumor cells in the preoperative biopsy predicts an decreased treatment response after preoperative CRT of rectal cancer. However, long-term follow-up and large studies are necessary to establish the value of regression grade and the need for its prediction by reliable biological markers.