Monitoring levels of nephrotoxicity of different aminoglycosides during febrile neutropenia caused by nephrotoxic chemotherapy: a single centre study

PURPOSE

To investigate the possible existence of increased nephrotoxicity caused by once-daily aminoglycosides in febrile neutropenic patients who were previously treated with cisplatin-based nephrotoxic chemotherapy.

METHODS

Thirty-one patients with metastatic tumors received chemotherapy and, as a result, developed febrile neutropenia. Patients were stratified with regard to chemotherapy with cisplatin (n=15) or without cisplatin (n=16). Both groups received i.v. empiric antibiotic treatment which included combinations of once-daily aminoglycosides (amikacin vs. gentamicin) with beta-lactams.

RESULTS

Increased nephrotoxicity due to administered aminoglycosides appeared significantly more frequently (p<0.05) in patients who received cisplatin-based chemotherapy. Increased nephrotoxicity differed significantly between various aminoglycosides regimens (p<0.05), being greater in the gentamicin group.

CONCLUSION

These results showed that cisplatin-based chemotherapy followed by a once-daily aminoglycosides regimen caused increased renal toxicity, which was more pronounced in patients treated with gentamicin vs. those treated with amikacin.

Acute spinal cord injury in pregnancy: an illustrative case and literature review

Acute trauma is not all that uncommon in pregnancy. It accounts for 15% of non-obstetric maternal deaths. Moreover, about 15% of acute spinal cord injuries involve young women of childbearing age (Gilson et al., 1995). Most of the existing literature on spinal cord injury in pregnancy is concerned with the management of patients with pre-existing lesions; very few articles deal with acute injuries. We report the management of a case of acute spinal cord injury in the third trimester of pregnancy and review the major clinical issues associated with such cases.

Cell image area as a tool for neuronal classification

The measurement of the area of a shapeless plane region is one of the basic problems in traditional calculus. In order to calculate the 'true' area of such a region, we have superimposed a net of identical squares on this region, counted the squares containing at least one point of the region, and calculated the sum of the areas of said squares. This sum represents an approximation of the region's area. By mathematical modelling and computational techniques we have investigated the law governing the decrease of these areas with the decrease of the length of the square's side. In theory, the prediction of the 'true' area could then be performed if the side of the net's squares tend to zero. Of course, the accuracy of the calculated area strongly depends on the computational potential and the statistical possibilities. Several morphometric parameters are currently in use for the quantitative analysis of the morphology of neuronal cell images. The cell image area has not yet been used and evaluated as a classification parameter - but it has the potential to be chosen over some other alternatives due to the high mathematical accuracy at which it is defined. By adopting mathematical modelling and computational techniques we show that this parameter can lead to successful distinction between 2 types of morphologically very similar cells (large boundary neuron and large asymmetrical neuron) in the dentate nucleus of the rhesus monkey (Macaca mulatta), while some other parameters failed to achieve positive results.

[Effect of small-doses ketamine on postoperative pain management with combinations morphine/ketoprofen or lidol/ketoprofen after major gynecological surgery] [corrected]

We examine the potential beneficial effect of small-doses ketamine on postoperative pain management with combinations morphine/ketoprofen or lidol/ketoprofen after major gynecological surgery. After patient written consent, 50 healthy women, which were scheduled for abdominal gynecological surgery were randomly allocated into two groups depending of postoperative analgesic technique--morphine/ ketoprofen or lidol/ketoprofen. The quality of postoperative analgesia, total opioid consumption for the first postoperative day and unwished side effects were assessed. Demographic and surgical data were identical in the groups. Using ketamine during the anesthesia improve quality of postoperative analgesia in accordance with less opioid consumption for the combination morphine/ ketoprofen, but not for the combination lidol/ketoprofen. Adding small doses ketamine to combination morphine/ketoprofen improve postoperative analgesia; reduce morphine consumption and incidences of morphine-related side effects after major gynecological surgery.

Biweekly oxaliplatin, fluorouracil and leucovorin versus cisplatin, fluorouracil and leucovorin in patients with advanced gastric cancer

PURPOSE

To compare a bi-weekly infusion of leucovorin (LV) 5-fluorouracil (5-FU) for 2 days, plus oxaliplatin (LV5- FU2-oxaliplatin) and LV5-FU2-cisplatin (CDDP) regimens with respect to toxicity, objective response rates, time to progression (TTP) and overall survival (OS) in patients with advanced gastric cancer.

PATIENTS AND METHODS

Patients received LV5-FU2- oxaliplatin (oxaliplatin 85 mg/m(2), day 1; folinic acid 200 mg/m(2), days 1-2; 5-FU 400 mg/m(2), i.v. bolus, days 1-2; 5-FU 600 mg/m(2), 22-hour continuous infusion, days 1-2) or LV5- FU2-CDDP (CDDP 50 mg/m(2), day 1; plus LV5-FU2). A total of 72 patients were enrolled into this study (36 vs. 36).

RESULTS

A total of 305 cycles were administered in the LV5-FU2-oxaliplatin arm (median 8) and 272 cycles in the LV5-FU2-CDDP arm (median 8). Grades 3-4 toxicity were as follows (LV5-FU2-oxaliplatin %/LV5-FU2-CDDP %; p<0.05): neutropenia 5/49, thrombocytopenia 2/6, anemia 6/16 nausea/vomiting 2/15, and mucositis 0/3. Response rate of LV5-FU2-oxaliplatin was 41% (partial response/PR 41%, stable disease/SD 31%, progressive disease/PD 28%; 95% confidence internal/95% CI 27-58) and of LV5-FU2-CDDP was 25% (PR 25%, SD 36%, PD 39%; 95% CI 14-41; p =0.013). The median TTP of the patients in the LV5-FU2-oxaliplatin arm was 8 months and 6 months for those in the LV5- FU2-CDDP arm (p=0.073). The median survival time of the patients in the LV5-FU2-oxaliplatin arm was 10 months and 7 months for those in the LV5-FU2-CDDP arm (p=0.003).

CONCLUSION

Our study showed that oxaliplatin may be substituted for cisplatin with LV5-FU2 with favorable safety and efficacy profile. The encouraging results from our study support the effectiveness of oxaliplatin-fluoropyrimidine- containing chemotherapy in gastric cancer and could provide a new core on which to add other agents in future investigations.

[The study of ovarian autoimmunity and ovarian reserve in women with uncertain sterility]

Ovarian autoimmunity can be induce ovarian function, which is shown clinically with premature ovarian failure, unknown sterility and unsuccessful in vitro fertilizations. Antiovarian antibodies are directed to antigens functional zones of zona pellucida and granulose cells with important part in follicle genesis and fertilization.

AIM

We have to investigate the influence of ovarian autoimmunity, antiovarian and antizona pellucida antibodies on endocrinology markers of ovarian reserve: inhibin B, FSH, LH by the women with unknown sterility.

MATERIALS AND METHODS

340 women were investigated with unknown sterility and 60 women were investigated with only one successful pregnancy at least. We investigated them for presence of antiovarian antibodies, antizona pellucida antibodies, and of course the levels of FSH, LH, inhibin B on the third day of menstrual cycle. Serological methods were used: ELISA- biochemical technique to detect the presence of antiovarian antibodies and antizona pellucida antibodies, inhibin B, FSH, LH. Statistical methods for analysis were also used.

RESULTS

In investigated group was found the presence of antiovarian antibodies in 58 women (17.05%) and in control group was not found. Antizona pellucida antibodies presence was found in 43 women (12.64%) in investigated group and in control found was not found. It was not found important difference in levels of FSH, LH, inhibin B on the third day of menstrual cycle between women with and women without antiovarian antibodies.

CONCLUSION

Antiovarian antibodies were observed only in women who have had laparoscopic ovarian drilling. The frequency of antiovarian antibodies among the Bulgarian women with unknown sterility is 17.05%. The presence of antiovarian antibodies is not associated with poor ovarian reserve as we investigated the levels of FSH, LH, inhibin B on the third day of the menstrual cycle.

[The importance of the presence of antisperm antibodies in serum and ejaculate of men with infertility]

There are multiple insults to the male genital tract that have been associated with an increased risk of antisperm antibodies (ASA) formation. The presence of ASA has been regarded as typical and specific for the immunological infertility. It has been suggested that the presence of agglutinated spermatozoa is suggestive of the existence of an immunological cause of infertility such as the existence of ASA.

AIM

The objective of this study was to determine the clinical significance of serum and seminal plasma ASA as well as whether varying degrees of sperm agglutination can be a predictive indicator of positive serum and/or seminal plasma ASA.

PATIENTS AND METHODS

100 infertile and 30 fertile men were tested for ASA in seminal plasma and serum. The evaluation of patients included complete history, physical examination, scrotal ultrasound and semen analysis. ASA in serum and seminal plasma were tested by ELISA (Biosource, Belgium) and results were compared with the data of the semen analysis.

RESULTS

44 (44%) of the patients tested positive for ASA in seminal plasma, 9 of them had positive serum ASA. In the control group, seminal plasma ASA were not detected and two men (6.7%) tested positive for serum ASA. Correlation was established between seminal plasma ASA and two of the semen analysis markers: agglutination and increased viscosity.

CONCLUSION

ASA in seminal plasma are much more predictive than ASA in serum and have major role in the pathogenesis and diagnostics of male infertility.

[Therapeutical management of the most frequent gynaecological diseases and chronic pelvic pain in the Gynaecological Clinic, UMPHAT "Dr. G. Stransky"-Pleven in the period 2004-2007]

OBJECTIVE

To determine the trend in application of the basic therapeutical procedures in the most common gynaecological diseases combined or not with chronic pelvic pain /CPP/.

MATERIALS AND METHODS

In the prospective study conducted in the Gynaecological Clinic at the Department of Obstetrics and Gynaecology, MU-Pleven in the period 01.03.2004-01.07.2007, 1356 women with leiomyomatosis /L/, endometriosis /E/, adenomyosis /A/, pelvic congestion syndrome /PCS/, Allen-Masters syndrome /AMS/, pelvic inflammatory disease /PID/ and adhaesion syndrome /AS/, were included in it. They were grouped according to their age, type of disease, presence of CPP, type of therapeutical procedure and histological verification of the condition. For the purpose of the study the following methods were used: documentary method, R-AFS classification of E, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, accepted worldwide.

RESULTS AND DISCUSSION

The highest frequency was determined for L, E and A, and AS. In the majority of the total number of consecutively admitted patients with those diseases an operative intervention was done, and almost one-sixth of women underwent conservative treatment. The same trend was observed in patients with chronic pain symptomatic, regarding their operative and conservative management. Histological verification of the condition was closely related with etiological reason and diagnostic approach.

CONCLUSION

A balance between conservative and operative treatment should be set in the basis of therapeutical management, consistent with modern diagnostic procedures. Determination of the trend in treatment of women with CPP will lead to falling off of indiscriminate application of operative methods prior to exact diagnostic specification and setting of multidisciplinary approach. That will serve as a background for the future conduct to that group of patients.

[Chronic pelvic pain and combined oral hormonal contraception]

PURPOSE OF THE STUDY

To determine the frequency of usage of combined oral hormonal contraception/COHC/ and its efficiency in women with chronic pelvic pain/CPP/.

MATERIALS AND METHODS

Three-hundred and seventy, consecutively admitted in the Clinic women with CPP, were included in the study. They were divided into 2 groups--group A/n = 80/--women that had used COHC, and group B/n = 290/--women that had not used COHC in order to cope with pain symptomatic. The patients from the both groups were compared according to their socio-demographic, menstrual and reproductive characteristics, type of disease, duration of CPP assessment of pain intensity and McGill pain indices, subjective rating of efficiency of the used COHC by the means of 5-rate scale in diseases, manifested with chronic pain symptomatic/leiomyoma /L/ endometriosis/E, pelvic congestion syndrome/PCS/, adhaesion syndrome/AS, Allen-Masters syndrome and other gynaecologic pathology/OGP/--chronic pelvic inflammatory disease/ CPID/, ovarian cysts /OC/, etc./.

RESULTS AND DISCUSSION

Duration of CPP /in months/ was comparatively longer in group A /50,74 +/- 10,33/in comparison wit group B/41,38 +/- 5,97/. No significant difference was found in quantitative pain assessment, but in group A higher values of all pain indices/sensory, affective, total pain rating index/and of evaluative overall pain intensity of total pain experience were set, compared with those of group B. It was ascertained a bigger number of types of used medicines in group A/analgesics, spasmolytics, gestagenes and GnRH-agonists/. Efficiency of COHC was assessed by the patients in the range "good-/basically/very good-excellent", and that was well demonstrated by women with L, E, AS and OGP/CPID, etc./.

CONCLUSION

COHC was administered to patients with more heavily demonstrated chronic pelvic pain symptomatic, that required combination of more than two medicines in order to obtain a better therapeutic effect. Diseases, manifesting with CPP like E, L and OGP/CPID, OC, AS, etc/are of great priority in treatment with COHC.

[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.