Systemic treatment of colorectal cancer in Serbia: what have we done and what can we offer in the new century?

The treatment of patients with metastatic colorectal cancer (mCRC) has changed dramatically over recent years in Serbia. The more optimal use of 5-fluorouracil (5-FU) in association with leucovorin (LV), the development of new drugs such as oxaliplatin and irinotecan and of the oral fluoropyrimidines, such as capecitabine, have increased therapeutic options and to the improved outcome of patients with mCRC. Throughout our 10-years published papers in international journals, we presented development of chemotherapy for mCRC and improvement in treatment outcome in Serbia. It is shown that combination therapy with 5-FU/LV and oxaliplatin or irinotecan is more active than 5-FU/LV in first line treatment of mCRC. Sequential therapy with FOLFIRI+FOLFOX was the most efficacious combination in comparison to any other 2 drugs combinations. The combination protocols in second line were superior to mono irinotecan and equal to LV5FU2 in terms of time to progression. The oral fluoropyrimidines seems to have an activity comparable to that of i.v. 5-FU/LV. New agents acting on novel targets are under development. Angiogenesis inhibitors, epidermal growth factor inhibitors, COX-2 inhibitors and farnesyl transferase inhibitors might play a role in the future in the treatment of CRC. We will present our first experience with bevacizumab, vascular endothelial growth factor inhibitor.

Radical radiotherapy for localized prostate cancer in elderly

BACKGROUND

Prostate cancer is an age related neoplasm, with high incidence in the group of elderly man. The correct management must to be balanced between the benefits of the treatment and its disadvantages. Radiotherapy as definitive treatment is commonly reserved for older patients and patients with high surgical risk and is widely used as a treatment of choice.

AIM

The aim of this study was to determine the role of radical radiotherapy for localized prostate carcinoma in patients 70 years age or older concerning treatment morbidity, local control, disease free and overall survival.

MATERIAL AND METHODS

A clinical prospective non-randomized study was performed including 103 elderly patients with an age 70 or above, between January 1991 and April 2005, at the Institute for Oncology and Radiology of Serbia. Median age of patients was 74,89 years (range 70- 80 years). Stage distribution was as follows: stage A--3 patients (2.9%), stage B--69 patients (67%) and stage C--31 patients (30.1%). Out of 103 patients, initial PSA value was noted in 87 patients. The mean value of initial PSA was 18,06 ng/ml. Radical radiotherapy was conducted on megavoltage linear accelerators with high energy photons (10, 18 MeV) and total tumor dose of 65 Gy.

RESULTS

Low grade acute complications were registered in 70 patients (65%). Mean follow up time was 40, 13 months. The disease outcome at the last follow up show that 79 patients (76.7%) had no evidence of disease and 24 patients (23.3%) relapsed. Overall survival rates were 65, 29% and 44, 52% and disease free survival 66, 59% and 63, 26% at 5 and 10 years. Disease specific survival was at 5 and 10 years 73,32% and 65, 42% respectively. Late sequelas (gradus I and II) are registered in 22 patients (21.36%), out of 103.

CONCLUSION

Radical radiotherapy for localized carcinoma of the prostate is effective treatment option in elderly patients with good local control, present treatment tolerance providing good quality of life and long-term cure.

[Enteral versus parenteral administration of a single dose of profenid after gynecological laparoscopy]

The aim of our study is to compare analgesic effect of single dose Profenid (Sanofi-Aventis)--100 mg administered per rectum or intravenously in woman endured gynecological laparoscopy (LS). We have evaluated 40 woman (divided into two groups each one of 20) sustained planned laparoscopy in department of gynaecology. The effect of administered Profenid over the postoperative pain has been estimated after standard general anaesthesia due to different objective and subjective parameters. As a result of our study we consider that postoperative analgesia with Profenid applied intravenously or by suppository is effective enough method for postoperative analgesia after laparoscopy in gynecology.

Radiotherapy in prostate cancer treatment

Prostate cancer is a complex disease, with many controversial aspects of management in almost all stages of disease. The natural history of this tumor is variable and is influenced by multiple prognostic factors. Radical prostatectomy and radiotherapy are standard treatment options for disease limited to the prostate. The data in literature does not provide clear- cut evidence for the superiority of any treatment. Neo- adjuvant or adjuvant hormonal therapy improves local control and survival in locally advanced disease. The patients treated with radiotherapy would have a relatively long life expectancy, not great risk factors for radiation toxicity and a preference for radiotherapy. The advantages of radiotherapy are that it has a significant potential for cure, it is well tolerated in the majority of men especially when the modern techniques of conformal radiotherapy and intensity modulated therapy are used and it is non-invasive therapeutic options with no anesthesia risk. Expected complications like radiation cystitis, impotence and proctitis are registered in about 1% of patients.

Photochemiluminescent detection of antiradical activity. VII. Comparison with a modified method of thermo-initiated free radical generation with chemiluminescent detection

The method of photosensitized chemiluminescence (PCL) allows the quantification of water- and lipid-soluble antioxidants and activity of superoxide dismutase (SOD) in the same measuring system. However, it needs a special device, which we have described in a previous paper in this series. Another method suitable for the assay of water- and lipid-soluble antioxidants is the thermo-initiated decay of azo-compounds combined with the measurement of O2 consumption (Niki, 1985; Wayner et al., 1985). Its long duration and the complicated measuring procedure is not acceptable for routine medical applications. We show that a modification using CL detection of free radicals with luminol, has results comparable with PCL for the determination of non-enzymic water- and lipid-soluble antioxidants, SOD activity and oxidative modification of proteins. In contrast to PCL, it is possible to use any luminometer with a heatable measuring cell and to investigate coloured samples. While the new method has an overall higher sensitivity and is scalable to microtitre plates, PCL measurements can be made at different pH. The advantages and analytical information content of certain components of the integral antioxidative capacity of blood plasma are discussed in comparison with other methods.

[Correlation between receptive wall analysis of benign ovarial cysts and their clinical conduct]

The biological behaviour (conduct) of benign ovarial cysts is interesting due to their comparatively high frequency of appearance and clinical manifestation. (During the last five years their frequency is between 62%-65% of the gynaecological surgical interventions). With this current survey the authors try to set up a target for research study of the wall receptive status of benign ovarial cysts. This study should be treated as a start up point rendering a prognosis for their eventual biological development.

MATERIALS AND METHODS

An immunohistochemical survey was carried on with 50 patients who have already reached the surgical treatment in retrospective order for the period 2001-2003 (three years' period). The survey search is in direction receptive analysis of Estrogene /E2/ and Progesterone /P/ wall receptor in the ovarial cyst. A perspective observation was also carried on (control group of 50 cases) of hormonal-gestagene treatment of the benign ovarial cystogenesis. It appears to be the necessary prove material for hormonal receptors' participation in the cyst wall as an active factor for its development and involution.

RESULTS

In the basic group /surgical treatment/ it was stated: In 39 patients--E2/-/, P/-/; in 4 patients--E2/+/, P/+/ In 5 patients--E2/+/, P/-/; in 2 patients--E2/-/, P/+/

CONCLUSION

The executed retrospective analysis demonstrates statistical importance in receptor competency lack in the wall of benign ovarial cysts as the probable grounds for them not being influenced during the conservative treatment method. This method led to the surgical elimination of the cyst. The statistical reliability, connected with the receptor E2 participation in the therapeutic behaviour of the benign ovarial cysts, is not stated. The final conclusions acquired from the executed research work would be a discussion issue after the correlative aspects in the prospective group are surveyed. The benign ovarial cysts' hormonal profile would be taken into consideration also.

[Administration of Perfalgan (paracetamol) for postoperative analgesia in obstetrics and gynaecology]

The aim of our study is to determine the quality of postoperative analgesia by using of Perfalgan (injectable paracetamol)--alone or in combination with other analgesics for different operations in obstetric and gynecology. We have evaluated 60 women, divided into four groups each one of 15 according to the kind of surgical intervention: section cesarean, laparoscopy, laparohysterectomy or cystectomy. The effect of administered Perfalgan over postoperative pain was estimated by different objective and subjective parameters after standard general anesthesia. As a result of our study we consider that postoperative analgesia with Perfalgan is suitable enough after section cesarean and laparoscopy. As a component of multimodal analgesic combination it gives a good quality of postoperative pain relief in condition of laparohysterectomy or cystectomy. It is very important that this is without any adverse effects.

[Gynecological laparscopy, endometriosis and sterility]

The authors presented the importance of the gynecological laparoscopy for diagnosis of the external genital endometriosis in its different forms. In the last 20 years, it was seen that laparoscopy is not only the basic method for diagnostics but also for the surgical treatment of the endometriosis. Thirty to fifty percent of the females with endometriosis in reproductive age have available sterility. The authors presented the cases, which have been laparoscopically proven for endometriosis and sterility for 7 years' period in Gynecological clinic in MBAL-Pleven and the results from the treatment with analog of the Gonadoliberins (Zoladex).

[Use of low molecular weight heparin (Clexane) together with selective COX-2 inhibitor (Dynastat--once or twice per day)]

A follow-up of forty women was carried out. The patients having endured a gynecological operation (laparohysterectomy) were divided into two groups: group A--treated with Dynastat (40 mg/24h) and group B--treated with Dynastat (80mg/24h) which was combined in both groups with Clexane. The hematological and hemostatic parameters were evaluated during the early postoperative period--the first 24 hours. The women were followed until they were discharged from hospital. No significant changes of these laboratory parameters were noticed and the clinical stability of the patients in both groups was unaffected. The results showed that Dynastat/Clexane combination could be applied in the clinical practice as it proved great extend of safety for usage after gynecological operations.

[Risk factors for fetal macrosomia]

AIM

To determine the influence of some of the risk factors on fetal macrosomia.

MATERIALS AND METHODS

A retrospective study was provided at the Department of Obstetrics and Gynecology, Medical University, Pleven, from January, 1, 2001 to December, 31, 2002 over 625 deliveries: 225 cases of fetal macrosomia--fetal birth weight (FBW) more than 4000 g and/or over 90. percentile (macrosomic group--MG) and 400 cases of singleton term newborns--with FBW between 10. and 90. percentile (nonmacrosomic group--NMG). Analysis included influence of: maternal age, height, prepregnant weight, BMI, weight gain and weight before delivery, previous delivery of macrosomic infant, maternal diabetes mellitus, fetal sex and gestational age.

RESULTS

A comparative analysis of data for both of groups was performed. It was found significant correlation (p = 0.001) for influence of maternal age (r = 0.34); height (r = 0.33); prepregnant weight (r = 0.42); BMI (r = 0.32); weight before delivery (r = 0.49); weight gain (r = 0.34); previous delivery of macrosomic infant (r = 0.41); maternal diabetes mellitus (r = 0.54); fetal sex (r = 0.37) and gestational age (r = 0.39). Correlations are different in both of groups.

CONCLUSION

Positive correlations between analysed factors and delivering of macrosomic infants and differences in both of groups suggest that analysed factors can't explain completely fetal macrosomia.

[Treatment of tubal pregnancy with methotrexate in gynecological clinic of MBAL-Pleven during five year period]

The authors presented a short survey for application of Methotrexate for treatment of intact ectopic pregnancy and its usage in Gynecological clinic of MBAL-Pleven during the last five years. There was made a prospective study, and for the studied five years' period in the clinic there were treated 149 women with ectopic pregnancy, 33 of which were hospitalized with intact tubal pregnancy. Methotrexate was used by plan for 6 patients as for 3 of them the treatment was successful. The authors also described two of these cases according to the diagnosis, way and usage period of the cytostatic and the result from the disorder. In conclusion there was emphasized that the treatment of intact tubal pregnancy with Methotrexate has a place in gynecological practice in view of the fact that it decreased physical pain, psycho-emotional stress and bed staying of the patient, but the cases must be strongly selected.

[Diagnostic approach to Allen-Masters syndrome]

In the basic appearance of chronic pelvic pain /CPP/, it is often found the symptomatology of Allen-Masters syndrome /AMS/, especially having in mind pelvic congestion syndrome /PCS/.

PURPOSE OF INVESTIGATION

To determine the diagnostic approach to AMS on the basis of CPP and factors conducive to development of AMS.

METHODS AND MATERIALS

A nine-year retro- and prospective study (in the period 1996-2004) was conducted in Gynaecological Clinic at the Department of Obstetrics and Gynaecology, Medical University - Pleven. Forty patients with verified AMS were included in it. A documentary and inquiry methods were used for the investigation purposes. The following conducive factors were studied: age, body mass index /BMI/, blood group belonging, deliveries, including that of macrosomic foetuses, abortions and other gynaecologic interventions. It was rendered an account of the beginning of CPP, its qualitative and quantitative characteristics, localization and irradiation, its dynamics according to menstrual cycle and day. Excel and Statgraphics plus for Windows were used for the statistical processing of the data obtained from the investigation.

RESULTS

Major conducive factors to AMS are BMI, number of pregnancies (deliveries and abortions), weight/ body mass of baby born. CPP is clinically manifested with dysmenorrhoea, dyspareunia and postcoital ache.

CONCLUSION

The determined specific pain profile and the presence of proved etiological factors, parallel with laparoscopic method, are auspicious means for diagnosing AMS.

[Effect of intravenous gamma-globulin therapy on lymphocyte population in pregnant women with antiphospholipid antibodies]

The aim of the study was to establish the distribution of the lymphocyte populations in peripheral blood in pregnant women with antiphospholipid antibodies (aPL) and a history of recurrent pregnancy loss as well as to make a study on the influence of the intravenous IgG-treatment (IVIg) on the levels of antibodies and peripheral lymphocytes.

MATERIALS AND METHODS

14 pregnant women were investigated. The latter had two or more recurrent abortions and positive aPL--anticardiolipin (aCL) and/or anti-beta 2-Glycoprotein I (anti-beta 2-GPI). The lymphocyte populations were examined, using a flowcytometric method in peripheral blood before 6-7th gestational week and on the 10-14 day after the second IVIg infusion. 10 pregnant women wer used as controls who had no aPL antibodies and no pregnancy loss.

RESULTS

13 out of 14 pregnancies were successful Lymphocyte populations of the examined patients before the first infusion compared to the controls showed statistically significant differences for: T-lymphocyted Th(reduced) and CD3-CD56 + NK (increased) Significant increase after therapy was noticed for the levels of T-lymphocytes, and Th while the NK-cell populations were significantly reduced.

CONCLUSIONS

aPL-positive pregnancies most probably were associated with elevated and activated peripheral NK-cell subpopulations. The low doses of IVIg successfully reduce the levels of aPL, as well as peripheral CD3-CD56 + NK cells.

[Fetal macrosomia: mode of delivery]

This study was provided among 1847 deliveries from January, 1 to December, 31, 2003. The aim of the study was to examine the correlation between antenatal diagnosis "fetal macrosomia" and the mode of delivery. We found that among the cases with birth weight > or = 4000 g and antenatal diagnosis "fetal macrosomia" the rate of cesarean section was fourfold higher than among the cases without such a diagnosis. There weren't statistically significant correlation between the cases with antenatal diagnosis "fetal macrosomia " and the cases with estimated birth weight < or = 3999g in reference to the mother's age and weight, parity, fundal height and abdominal circumference. There are insignificant differences between both of groups in reference to gestacional age and birth.

[Gynecological laparoscopy and Mayer-Rokitansky-Kuster-Hauser syndrome (report of three cases)]

The syndrome is described in 1838 and it is named after the four authors. It includes combined agenesis of uterus, cervix and the upper 2/3 of the vagina, but the fallopiantubes and ovaries are normally presented. Expect abnormalities of the female reproductive system there are abnormality of the kidneys, vertebral bodies and loss of hearing. The authors of the present publication describe in details etiology, pathogenesis, clinical presentation, differential diagnosis and therapeutic methods for syndrome's treatment. There are presented three clinical cases, which are by laparoscopy proved. In conclusion it is indicated the importance of the gynecological laparoscopy like a modern method for diagnosis of the congenital anomalies of the female genital tract leading to primary amenorrhea.

[Leiomyomatosis and chronic pelvic pain]

Leiomyomatosis is one of the major gynaecological diseases, which cause the onset of chronic pelvic pain /CPP/.

PURPOSE OF THE STUDY

To build up a pain profile of patients with leiomyoma by the use of quantitative and qualitative characteristics.

METHODS AND MATERIALS

The study was conducted through the period of 01.01.2004-01.07.2004 in the Clinic of Gynaecology of the Department of Obstetrics and Gynaecology, Medical University-Pleven. During that period 94 patients with leiomyomatosis were admitted in the clinic, and they filled in an inquiry form, containing also a pain calendar and pain map. Clinical and pathohistological data, verifying type, localization and clinical manifestation were used too.

RESULTS AND DISCUSSION

Forty-eight /51.1%/ of 94 patients with leiomyomatosis admitted in the clinic had been experiencing CPP. CPP had been the reason for diagnosing leiomyomas. A dependency was determined between quantitative value of CPP and: localization of leiomyomas, presence of another accompanying myoma gynaecological pathology, body mass index, histological changes, time of the onset of CPP, chronological appearance according to day and menstrual cycle. Pain qualitative characteristics were mainly defined by localization of leiomyomas, histological changes in them and eventually a presence of another accompanying myoma gynaecological pathology.

CONCLUSION

Building up a specific for leiomyomatosis pain profile helps to provide a faster and more accurate diagnostic assessment and therapeutic management.

[Indications for third and more than three cesarean sections--analysis and pattern of practice]

PURPOSE OF THE STUDY

Authors aimed to analyse indications for third and more than three times cesarean sections (c. s.), as well as, to make an assessment of the adequacy of the taken decisions.

METHODS AND MATERIALS

It was conducted a retrospective study for third and more than three times cesarean, including period 1991-2003 in the Department of Obstetrics and Gynaecology, Medical University, Pleven. During that time 28645 births has taken place, 2971 of which are by cesarean section. 2,5% from the last, has been third and more than three times cesarean. Using expert judging, indications for the last were divided into three groups-right, disputable and wrong.

RESULTS

In the cases with only one mentioned indication "Re-re c.s." 37,8% (28 patients), ratio between right, disputable and wrong was 2:1:1 and the same ratio in the cases with indication "Re-re c.s.+ other indications" 58,1% (43 patients), was 5:1:1. In 4,3% of the cases (3 patients) no indication "Re-re c.s." was mentioned.

CONCLUSION

Reduction of third and more than three times cesarean can be achieved by more careful judgement of indications in second, "disputable", group and erradication of the "wrong", which most commonly are jatrogenic reasons. This will result in diminishing the increasing frequency of abdominal births, as well as, preventing possible complications for mother, connected with operation.

[Profenid or veral for the postoperative analgesia in gynaecology]

We present our results for study and assessment of efficacy in accordance with postoperative analgesia with single dose Profenid (ketoprofen) or Veral (diclofenac) administrated per rectum. We studied 60 patients divided in two groups--group 1 (analgesia with Profenid) and group 2 (analgesia with Veral). All patients received standard endotracheal anesthesia for elective gynaecologic operations. We have assessed quality of the postoperative analgesia by: Ta--time of analgesia (time for first want of analgesics by patient), VRS (verbal rating score), VAS (visual analogue score), PONV (postoperative nausea and vomiting) and sedation rate.

[Antibiotic prophylaxis on treatment outcome after gynecologic surgery]

The aim of our study is to estimate advantages and disadvantages of some antibacterial drugs which were used for prevention from infections in the early postoperative period. Our study is retrospective and involved all women which were undergoing different operations in department of gynaecology for the period January 2000 until June 2004. Due to a large number of patients and long period of time which were evaluated our study shows assume data for efficacy of different antibacterial drugs and drug combination when we using them for prevention. It is very interesting for the authors result about relationship between price-efficacy-durance ot hospital being.

[Iron-deficiency anaemia in everyday gynaecological practice]

INTRODUCTION

Iron-deficiency anaemia /IDA/ is of utmost significance to clinical practice. Chronic haemorrhages from the genital tract are the major etiological factor for its appearance in 60-70% of the patients. Abnormal genital bleeding for the specialist in Obstetrics and gynaecology and IDA for the haematologist are frequently met problems in their everyday practice, which require detailed examination, good colaboration and synchronization between the work of both specialists.

PURPOSE

Diagnosing and etiological treatment of IDA of gynaecologic origin by mutual timely and adequate co-operation of gynaecologist and haematologist.

MATERIALS AND METHODS

Clinical survey based on the algorithm worked out. Its everyday application started in July-August 2001 and till today /30.04.2003/ 253 cases with IDA in the Department of Gynaecology are taken in. A record of proceedings was made for every patient and that helped the further diagnostic and therapeutic activity and respective data processing.

RESULTS AND DISCUSSION

The data and results obtained verify the achievement of final diagnostic specification of IDA, the role of the algorithm as a stepping-stone to its etiological treatment, complete and durable correction of iron deficiency.

[Gynecologic laparoscopy and Swyer syndrome (two additional cases)]

The syndrome belongs to the group of the congenital abnormalities and is also known as syndrome of the pure gonadal dysgenesis with the presence of medullar elements. The girls with the Swyer syndrome are characterized by the presence of the male karyotype--46,XY and they are sex-chromatin negative. The authors of this publication describe in details etiology, pathogenesis, clinical presentation, differential diagnosis and therapeutic methods for syndrome's treatment. There are presented and two clinical cases, proved by chromosome analysis and verified by laparoscopy. It is about the significance of gynecologic laparoscopy for precise diagnostics in congenital anomalies of the genital system.

Choriocarcinoma presenting with upper gastrointestinal bleeding and intussusception

Choriocarcinomas are rare genital tract tumours, which can present with extragenital symptoms and signs. We report on an 18-year-old nulliparous woman presenting with jejunal choriocarcinoma. An outline of the diagnostic difficulties and different manifestations of extragenital choriocarcinoma is given. A high index of suspicion should be maintained and a multi-disciplinary approach is mandatory.

[Effect of some factors on obstetrical care of women with previous cesarean section]

Considering obstetrical management we should have always in mind advantages and disadvantages of vaginal birth after cesarean (VBAC) and elective cesarean section after a previous one, financial part of the elected mode of delivery in the particular case, psychological aspect of the matter (especially after an unsuccessful trial of labour--TOL) and not on the last position-patient's right to choose the way how to deliver. We performed an inquiry of 3-year-period and 50 women with a prior cesarean section, by which we studied the factors contributed in different extent to the choice of the following approach to delivery: patient's preliminary choice, the impact of medical staff during pregnancy and when entering the Department of Obstetrics, the impact of non-medical persons, complications after the previous cesarean section, patient's acquaintance with complications and consequences associated with the operative mode of delivery, as well as doctor's personal attitude to the different modes of delivery. The aim of our research is to show that by careful selection (according to the established indices) of women, who have a high probability (more than 80%) to deliver their babies vaginally and offering adequate information by educational literature and including the woman in the decision making process, the patient resistance to vaginal delivery will be reduced. In this way, the growing rate of cesarean section will be decreased by increasing the number of VBAC--undoubtedly one of the most important issue in modern obstetrics.

[The impact of some factors on obstetrical management in women with previous cesarean section]

Considering obstetrical management we should have always in mind advantages and disadvantages of vaginal birth after cesarean (VBAC) and elective cesarean section after a previous one, financial part of the elected mode of delivery in the particular case, psychological aspect of the matter (especially after an unsuccessful trial of labour--TOL) and not on the last position-patient's right to choose the way how to deliver. We performed an inquiry of 3-year-period and 50 women with a prior cesarean section, by which we studied the factors contributed in different extent to the choice of the following approach to delivery: patient's preliminary choice, the impact of medical staff during pregnancy and when entering the Department of Obstetrics, the impact of non-medical persons, complications after the previous cesarean section, patient's acquaintance with complications and consequences associated with the operative mode of delivery, as well as doctor's personal attitude to the different modes of delivery. The aim of our research is to show that by careful selection (according to the established indices) of women, who have a high probability (more than 80%) to deliver their babies vaginally and offering adequate information by educational literature and including the woman in the decision making process, the growing rate of cesarean section will be decreased by increasing the number of VBAC--undoubtedly one of the most important issue in modern obstetrics.

[Role of antiphospholipid antibodies in 147 patients with spontaneous abortions and stillbirths: a retrospective and prospective analysis]

Antiphospholipid antibodies (aPL) are a family of autoantibodies including lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and ect. That appear to react with negatively charged phospholipids. These antibodies induce thrombosis and pregnancy complications including recurrent spontaneous abortions (RSA), recurrent stillbirth (SB), preeclampsia and intra-uterine growth retardation, although their exact pathogenic mechanisms remain poorly defined. The aim of this study was to investigate the frequency and the role of a aPL women with a history of RSA and SB due to positive aPL. The study included 147 women with a history of RSA and 48 women with a history of SB and to investigate the histological changes in the heams and stillborn fetuses in aCL positive women. We established that: 1, aCL were significantly increased in 62.2% (n = 92) in women with history of RSA and in 71% (n = 34) in women with history of SB; 2. aTr antibodies were positive in 22.7% (n = 5) in women with history of SB; 3. Tr activation status was increased in 77.3% (n = 17) in women with history of SB.

CONCLUSION

The investigation of aPL in women with history of RSA and SB provides new insights into the disease and offers promise for prophylaxis and treatment in subsequent pregnancies.