Glutathione Transferase P1: Potential Therapeutic Target in Ovarian Cancer

Chemotherapy resistance of ovarian cancer, regarded as the most lethal malignant gynecological disease, can be explained by several mechanisms, including increased activity of efflux transporters leading to decreased intracellular drug accumulation, increased efflux of the therapeutic agents from the cell by multidrug-resistance-associated protein (MRP1), enhanced DNA repair, altered apoptotic pathways, silencing of a number of genes, as well as drug inactivation, especially by glutathione transferase P1 (GSTP1). Indeed, GSTP1 has been recognized as the major enzyme responsible for the conversion of drugs most commonly used to treat metastatic ovarian cancer into less effective forms. Furthermore, GSTP1 may even be responsible for chemoresistance of non-GST substrate drugs by mechanisms such as interaction with efflux transporters or different signaling molecules involved in regulation of apoptosis. Recently, microRNAs (miRNAs) have been identified as important gene regulators in ovarian cancer, which are able to target GST-mediated drug metabolism in order to regulate drug resistance. So far, miR-186 and miR-133b have been associated with reduced ovarian cancer drug resistance by silencing the expression of the drug-resistance-related proteins, GSTP1 and MDR1. Unfortunately, sometimes miRNAs might even enhance the drug resistance in ovarian cancer, as shown for miR-130b. Therefore, chemoresistance in ovarian cancer treatment represents a very complex process, but strategies that influence GSTP1 expression in ovarian cancer as a therapeutic target, as well as miRNAs affecting GSTP1 expression, seem to represent promising predictors of chemotherapeutic response in ovarian cancer, while at the same time represent potential targets to overcome chemoresistance in the future.

Interobserver variability and positive predictive value for ultrasonographic BI-RADS categories requiring pathohistological evaluation

OBJECTIVE

The objective of this study was an analysis of interobserver variability and positive predictive value (PPV) for BI-RADS categories requiring pathohistological evaluation: 4A, 4B, 4C, and 5.

MATERIAL AND METHODS

Interobserver variability for each of descriptors as well as PPV for final BI-RADS categories requiring pathohistological evaluation was measured in a retrospective study which included 30 ultrasonographic reports, with pathohistological verification, randomly selected from ultrasonographic reports from Institute for Oncology and Radiology of Serbia where about 1,100 breast cancers are verified every year. Ten observers, seven gynecologists, and three radiologists, independently rated each ultrasonographic report according to the fourth edition of BI-RADS atlas. Interobserver variability was measured with k coefficient.

RESULTS

There was most conformity for a category of orientation (k = 0.79). Substantial degree of conformity was also present for both boundary (k = 0.71) and shape (k = 0.65) categories. Moderate degree of conformity was achieved for posterior features (k = 0.54) and margins (k = 0.41) descriptors, while there was poor conformity in echogenicity (k = 0.38). In case of a final score, common conformity for all BI-RADS 4A, 4B, 4C, and 5 categories was (k = 0.51); it was the greatest for category 5 (k = 0.50), and it was less for categories 4C (k = 0.37), 4B (k = 0.32), and 4A (k = 0.29).

CONCLUSIONS

Interobserver conformity for ultrasonographic descriptors and final evaluation of BI-RADS 4A, 4B, 4C, and 5 categories is good. PPV implies that not only division into categories 4 and 5, but also classification into categories 4 and subcategories 4A, 4B, and 4C are justified and clinically applicable.

Cesarean section scar pregnancy treatment--case report

This is a case report of a 36-year-old patient with an ectopic pregnancy located in the previous cesarean section scar following in vitro fertilization (IVF). The patient was treated by 50 mg of intrasacular methotrexate locally under ultrasound guidance. Transvaginal ultrasound (TVUS) confirmed that the pregnancy was no longer vital within 24 hours, dilatation and aspiration of the ovular tissue were performed after seven days and it was sent for pathohistological analysis. Eight hours after the procedure, the patient began bleeding abundantly and was consequently treated locally by 1 ml of Beriplast P Combi set, human fibrinogen, and human thrombin set (CSL Behring). After the treatment, the patient was discharged in good health, with normal laboratory values. Her menstrual period resumed 35 days after the procedure.

Atypical polypoid adenomyoma mixed with endometrioid carcinoma: a case report

The following is a description of an extremely rare tumor of the uterus, malignant atypical polypoid adenomyoma (APA), admixed with well-differentiated endometroid carcinoma, in a 29-year-old patient previously treated for sterility in whom, due to the existence of a ten-millimeter sessile tumor on the uterine corpus, verified by transvaginal ultrasonography (TVUS), a hysteroscopic resection of the anomaly was performed. The patient underwent all requisite examinations and was referred to the malignant diseases panel for an examination and a decision on further treatment. As the patient wished to preserve fertility, the authors decided to continue performing regular controls at intervals of two to three months. The first subsequent control called for a TVUS examination or one using another imaging method, with a multiple endometrial biopsy with curettage of the endocervix. The results of the first examination promised that fertility could be preserved. Therapy with medroxyprogesterone acetate (MPA) in daily dosages of 200 to 500 mg was advised, which the patient intentionally did not take. A spontaneous desired pregnancy was verified following the first control.

Carney complex and teratoma maturum ovarii--a case report

This is a case report of an extremely rare Carney complex (CNC) syndrome in a 17-year-old patient. After the decision made by a team of cancer specialists, the patient was admitted to the hospital for surgery because of adnexal tumor associated with ascites and increased Ca 125 tumor marker level. The patient underwent cardiac surgery twice. Adnexal mass and ascites, revealed by transvaginal ultrasound (TVUS) and confirmed by magnetic resonance imagings (MRI), indicated the malignant alteration. Surgery was performed and surgical pathological staging was refined according to the FIGO guideline and included a staging laparotomy. After surgery, general condition of the patient was good, without ascites and pain, with Ca 125 marker levels within reference ranges.

[Multifoetal pregnancies complicated by reversed arterial perfusion: report of four cases]

INTRODUCTION

Twin reversed arterial perfusion syndrome (TRAP) or acardiac anomaly presents a rare and severe complication affecting monochorionic multiple pregnancies occurring in 1 per 35,000 pregnancies or 1 per 100 of monozygotic twins. We report four cases of multiple pregnancies with TRAP diagnosed over the last 2 years, which were under check-up and treatment during the entire pregnancy course finalized by delivery.

OUTLINE OF CASES

In two cases pregnancies were trigeminal, and other two geminal, with acardia of one foetus, by anceps type in three and acephalus in one. Expectant management was initially done in all cases. The relation of acardiac and donor abdominal circumference was below 50% and negative signs of the donor's cardiac failure were detected in two cases, so that expectative management was continued until delivery. Due to obstetric indications, a cesarean section was performed on the 33rd and 34th gestational week, and healthy newborns were delivered. Another two acardiac twins had abdominal circumference ratio between the acardiac fetus and the donor of over 50%, and signs of congestive heart failure in the donor, which indicated invasive therapeutic procedure with absolute alcohol chemisclerosis; it was done by alcohol injection into the acardiac abdominal aorta which interrupted the retrograde blood-flow into the acardiac umbilicus. In the first case a successful intervention was performed at 29th gestational week, but after 12 hours distress signs were registered. The delivery was finalized by a cesarean section, and a live donor was delivered. In the second case the intervention was successfully done at the 20th gestational week, and after 96 hours from the intervention lethal ending of the donor was registered.

CONCLUSION

Bearing in mind that the occurrence of TRAP is rare, it is necessary to sum-up experiences from a larger number of centres to determine efficient therapeutic procedure.

Early dumping syndrome and reflux esophagitis prevention with pouch reconstruction

BACKGROUND

Total gastrectomy causes numerous disorders, such as reflux esophagitis, dumping syndrome, malabsorption, and malnutrition. To minimize the consequences, different variants of reconstruction are performed. The aim of our study is the comparison of two reconstructive methods: the standard Roux-en-Y and a new modality of pouch interposition, preduodenal-pouch interposition. This study aims to investigate the advantage of bile reflux prevention and to reduce symptoms of dumping syndrome after 3- and 6-mo follow-up.

MATERIALS AND METHODS

A total of 60 patients were divided in two groups: (A) 30 patients with Roux-en-Y reconstruction, and (B) 30 patients with the preduodenal-pouch (PDP) type of reconstruction. Endoscopic examination and endoluminal jejunal limb pressure measurements were performed. Scintigraphic measurements of half-emptying time were performed to evaluate meal elimination in the context of reflux esophagitis and early dumping syndrome. The Japan Society of Gastrointestinal Surgery has provided guidelines with which to classify the symptoms of early dumping syndrome. Patients were followed up for periods of 3 and 6 mo after the surgery.

RESULTS

Our study groups did not differ with regard to the level of reflux esophagitis (P = 0.688). Average values of pressure at 10 and 15 cm below the esophago-jejunal junction were significantly lower in the PDP group (P < 0.001). Elimination of the test meal between two groups was not significant (P = 0.222). Evaluation of early dumping syndrome symptoms revealed a significant reduction among PDP patients after 3 and 6 mo.

CONCLUSION

Our study showed significant superiority of the new pouch reconstruction over the standard Roux-en-Y approach in the treatment of early dumping syndrome.

Primary fallopian tube carcinoma in a 51-year-old postmenopausal woman--case report

The case of a 51-year-old woman with a primary carcinoma of the left fallopian tube is presented. Laparotomy performed for an ovarian tumour revealed that the patient had normal ovaries, but a left fallopian tube was dilated and filled with a tumour mass. Histopathological examination revealed primary adenosquamous cell carcinoma of the fallopian tube.

Pregnancy using gonadotropins and performing intrauterine insemination in a woman with hypogonadotropic hypogonadism

Hypogonadotropic hypogonadism is one of the causes of infertility. In women with hypogonadotropic hypogonadism both follicle-stimulating hormone and luteinizing hormone are required to induce optimal follicular growth and steroidogenesis. We described a case of singleton pregnancy in a 38-year-old patient, presenting with primary hypogonadotropic amenorrhea and empty sella syndrome, treated with human menopausal gonadotropins and performing intrauterine insemination in first attempt. This therapy led to maturation of two follicles and one of them was fertilized. A singleton pregnancy ensued and a normal infant was delivered by cesarean section.

[Cervical maturation using Prepidil gel in pregnancy termination in primigravidas]

The study investigated the possibility of pharmacological servical ripening induced by Dinoprostone (Prepidil Gel--Upjohn Co) prior to therapeutic abortion in primigravida. The study concerned patients-volunteers choosen by random. 73 patients were divided into two groups with the same average age, term of gestation, cervix consistency and passage through the cervical canal before the application of gel. In the first group therapeutic abortion was carried out 6 hours after the application of gle into cervical canal, and in the second group--4 hours after the gel application. Cervical maturation, testified by its consistency and spontaneous cervical ripening, was equal in both groups (average delta Hegar I was 7.32 and delta Hegar II--7.02), and it enabled medical procedure only with the local anaesthesia with 2% hylocein in 82% ob pregnant women. In a fifth of patients ob both groups it was necessary to do additional mechanical dilatation, which was easily performed due to the already soft cervix; these patients were also administered 1 ampulla ob Fortral I.V. In both groups during the action of Dinoprostone there were no significant changes either in blood pressure or in body temperature. More expressed uterine activity, followed by initial and incompleted abortions, were more frequent in patients of the first group (3529%) than in those from the second group (17.95%) in which only contractions occurred (33.33%). The rate of gastrointestinal side effects was 29.41% in the first group and 41.03% in the second group. There was no uterine complication during the activity of Dinoprostone as well as during and after medical procedure.

[Growth of the fetal cerebellum in normal pregnancy]

An ultrasonographic study was carried out in 203 physiological pregnancies whose menstrual gestational age (MGA) was between 20 and 40 weeks. The following biometric parameters were determined: transversal cerebellar diameter (TCD), biparietal diameter (BPD), occipito-frontal diameter (OFD) and head circumference (HC). The data analysis gave the optimal mathematical models with the following relations: 1) TCD/MGA (R2 = 0.904; SD = 2.6 mm); 2) MGA/TCD (R2 = 0.924; SD = 1.7 wks); 3) BPD/TCD (R2 = 0.914; SD = 4.3 mm); 4) HC/TCD (R2 = 0.919; SD = 14.3 mm), which are graphically and tabularly presented. Also the variability in the determination of MGA from TCD is calculated before 26 weeks (2 SD = 2.6 wks) and after 26 weeks (2 SD = 3.5 wks). TCD can be practically applied in cases where it is difficult or impossible to measure BPD, or in cases where it is unsuitable because of the expressed moulding of the head, since the cerebellum is not liable to changes in forms and its size is in correlation with MGA and BPD. The use of TCD is also important in the detection of congenital malformations which are manifested in the posterior cranial fossa. The potential importance of TCD in the diagnosis of the fetal intrauterine growth retardation is based on the assumption that the cerebellum is not liable, or at least not considerably liable, for growth retardation.