Aljosa Mandic

Radical abdominal trachelectomy in the 19th gestation week in patients with early invasive cervical carcinoma: case study and overview of literature

Treating pregnant patients with a verified malignant disease represents a great clinical problem. Pregnancy-associated invasive cervical cancer is usually diagnosed at an early stage (approximately 70%). A 27-year-old patient was given the diagnosis of a pathohistologically verified cervical carcinoma, International Federation of Gynecology and Obstetrics stage IB1, in the 17th gestational week (GW). A radical abdominal trachelectomy was performed in the 19th GW. The patient was undergoing regular examinations at our institute of oncology while the Clinic of Gynecology and Obstetrics in Novi Sad, Serbia, monitored the pregnancy. In 36th GW, the patient had a cesarean section, with no visible traces of relapse, with good postoperative recovery and normal results in the newborn. The patient was discharged on the fifth postoperative day and advised to have her condition monitored at our institute of oncology. One year after radical trachelectomy, the patient is in the 15th GW of a new pregnancy with a normal Papanicolaou smear result.

Comparsion the histopathological findings after cervical biopsy and excisional procedures.

INTRODUCTIONnA definitive diagnosis of cervical intraepithelial neoplasia (CIN) is confirmed after histopathological (HP) examination of the tissue obtained through the biopsy. The aim of this study was to compare histopathological results obtained with punch biopsy and results obtained through one of the excisional techniques.nnnMATERIAL AND METHODSnWe analysed histology results of 130 patients referred to our institution with abnormal smear. Punch biopsy was performed after colposcopic examination in all patients before one of the excision methods. Excision methods performed were: large loop excision of transformation zone (LLETZ), radio-frequency knife conisation or cold knife conisation. Based on the histopathological examination of the punch biopsy specimen or excisional specimen diagnosis of CIN was established.nnnRESULTSnCIN and invasive cancer were the most common diagnoses in the 31-40 age group at 45.4% (59/130). Discrepancies in the histological diagnosis between punch biopsy and excisional biopsy was identified in 58.5% (76/130) of the patients. In 6% of the of the cases the biopsy did not detect an invasive carcinoma.nnnCONCLUSIONnThe most frequent discrepancies between punch biopsy and excisional biopsy were in the group of patients with a higher grade cervical dysplasia. Mild dysplastic changes diagnosed through punch biopsy, require a more conservative approach, as the majority of this group had negative specimens on the cone after excision, especially in the younger population. It is advisable that the patients above 30 years of age and a higher grade dysplasia in the biopsy specimen, should undergo one of the excisional techniques as a diagnostic/therapeutic method of treatment.

Knowledge of HPV infection and Pap testing among young women in Serbia.

⁎ Corresponding author. Clinic of Oncological Surgery, Oncology Institute of Vojvodina, Institutski put 4, 21204 Sremska Kamenica, Serbia. Tel.: +381 214805548; fax: +381 21613741. E-mail address: aljosa.m@eunet.rs (A. Mandic). The high incidence rate of cervical cancer in Serbia highlights the need for a more detailed overview of this issue than has already been undertaken nationally [1]. National screening programs for the early detection of cervical carcinoma have not been implemented in the Serbian health system, so additional effort should be made within the healthcare and education systems to inform the population about the importance of regular gynecologic examinations and the risk factors that can lead to the development of cervical cancer. The principal aim of the present study was to assess the extent to which young women in the province of Vojvodina, Serbia, were informed about human papillomavirus (HPV) infection as a risk factor for the development of precancerous/cancerous lesions of the cervix and about the importance of the Papanicolaou (Pap) test and gynecologic examinations in identifying such lesions. The present study was performed between November 1 and December 20, 2009. It involved 361 women aged 17–27 years, who were divided into 3 groups: group A, comprising 117 final-year secondary school students from the grammar and medical schools in Sombor, Serbia (aged 17–19 years [mean, 17.9 years]); group B, comprising 128 students from the Faculty of Medicine at the University of Novi Sad, Novi Sad, Serbia (aged 19–27 years [mean, 22.8 years]); and group C, comprising 116 students from other faculties at the university (aged 19–27 years [mean, 20.8 years]). All participants completed an anonymous survey of 15 questions, includingquestions about age, sexual activity, knowledge of the Pap test, and knowledge of HPV infection as a risk factor for the development of precancerous/cancerous lesions of the cervix (Table 1). Ethics approval was not required, and informed consent was not needed because of the anonymous nature of the survey. Statistical analysis (Fisher exact test) was performed using STATISTICA version 9.0 (University of Novi Sad, Novi Sad, Serbia). Pb0.05 was considered to be statistically significant. The results of the survey indicated that 46 (39.3%) women in group A, 15 (11.7%) women in group B, and 23 (19.8%) women in group C had not engaged in sexual intercourse, and that 35 (29.9%) women in group A, 19 (14.8%) women in group B, and 15 (12.9%) women in group C had first engaged in sexual intercourse between the ages of 15 and 16 years. Of thewomenwhowere sexually active, themajority (56/71 [78.9%] in groupA, 88/113 [77.9%] in groupB, and78/93 [83.9%] in groupC)used condoms for protection against sexually transmitted diseases. Correct answers about the area from which smears are taken for cytopathologic analysis were given by 103 (88.0%) women in group A, 126 (98.4%)women in groupB, and101(87.1%)women in groupC.All of the women in group A, 127 (99.2%) women in group B, and 111 (95.7%) women in group C agreed that the Pap test is an important diagnostic tool in the prevention of cervical cancer. Of the 121 women in groups B and C who were older than 21 years of age, 44/69 (63.8%) in group B and 24/52 (46.2%) in group C had undergoneaPap test; this differencewas statistically significant (Pb0.05). Young sexually active womens knowledge of the necessity for regular Pap testing was high in all 3 groups in the present study; however, there was a significant difference between the women in groups A/B and those in group C in terms of knowledge of HPV (Pb0.001). University medical students (group B) knew much more about HPV as a sexually transmitted infection than did secondaryschool students (group A) and university students from other faculties (group C) (P=0.001). Compared with group B, a lower proportion of women in groups A and C knew about men being significant transmitters of the HPV infection and about the HPV vaccine. In the present study, knowledge of HPV as a risk factor for the development of precancerous/cancerous lesions of the cervix was similar to results obtained in other studies [2–4]. The implementation of a healthcare and education program in Serbia is an ideal basis from which to raise awareness among the general population of the need for a national screening program for the early detection of cervical carcinoma. The need for academically educated women to be further educated about HPV (as indicated by the present study) indirectly suggests a requirement for better medical education among the general population. This would significantly raise the efficiency of screening programs, which must be implemented in the Serbian national health system as soon as possible.

Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

The aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. This prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. The secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side effects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p<0.001) and resumption of dietary intake was achieved earlier (p<0.001) in TEA group. Intensity of pain during the first 3 postoperative days was significantly lower at rest, on coughing and during mobilization (p<0.001), and mobilization was much more effi cient (p<0.005) in TEA than in IV-PCA group. Satisfaction scores were better in TEA group (p<0.001). Nausea, sedation and postoperative delirium occurred less frequently in TEA group (p<0.05, p<0.001 and p<0.05, respectively). TEA demonstrated significantly better effectiveness than IV-PCA after open colorectal cancer surgery and had a positive impact on bowel function, dietary intake, patient satisfaction and early mobilization. The results of this study demonstrated the importance of implementation of TEA as a preferred method for postoperative pain control after major open colorectal surgery.

Preoperative evaluation of uterine isthmus-cervical infiltration in patient with cervical cancer using nuclear magnetic resonance

www.onk.ns.ac.rs/Archive Vol 21, No. 3-4, December 2013 INTRODUCTION Cervical carcinoma represents one of the major problems in developing countries where the cervical population-screening program is still not developed (1). Approximately 45% of surgically treated stage IB cancers occur in women under the age of 40 years (2). However, in developed countries, screening enables the detection of cancer in its early phase, which suggests a new approach in comprehension and surgical treatment of early invasive cervical carcinoma. Radical trachelectomy is a surgical method, together with the pelvic lymphadenectomy, for treating invasive forms of cervical carcinoma in its early stage in women who are in their fertile ages and who want to keep their reproductive function (3-8). The general eligibility criteria for radical trachelectomy include the following: women less than 40 years of age who have a strong desire to preserve fertility, no clinical evidence of impaired fertility, lesion size less than 2 cm, International Federation of Gynecology and Obstetrics (FIGO) stages IA –IB-1, no involvement of the upper endocervical canal, and negative regional lymph nodes (9). The absence of metastatic disease in lymph nodes and parametrial involvement allow continuation of the procedure. Another crucial point of the procedure is the level where the cervix has to be incised. In the preservation of uterine corpus in fertility-sparing surgery, the most important factor is the absence of internal uterine ostium or uterine corpus tumor infiltration (10). When computed tomography (CT) and NMR are compared, NMR is signifycantly more accurate in the evaluation of tumor volume, local tumor stage, and parametrial invasion due to its distinctive tissue contrast and multiplanar capability (11). Cervical tumor is best shown in T2W sequence, which gives the most evident difference between normal structures in the body and cervix of the uterus. The same sequence is determined by the integrity of the stromal ring and its deficiency is explained by the penetration of the tumor to the parametrium. The aim was to evaluate the accuracy of NMR in detection of infiltration of uterine isthmus-cervical part in cervical cancer patients without fertility preservation.

P1076 Radical abdominal trachelectomy as surgical approach towards fertile capacity preservation in young female patients with early invasive cervical carcinoma - our experience

2. To determine the relationship between Highly active antiretroviral therapy (HAART) and cervical SIL among HIV positive women. Materials and Methods: It was a cross-sectional study in which 219 HIV positive women attending mildmay centre, an HIV care centre in Uganda underwent papsmears as part of routine care. Slides were analyzed by a cyto-pathologist at Makerere University medical school. Medical history was taken and records checked for the most recent CD4 count, and whether or not the women were on HAART. Results were analyzed using SPSS version 12. Results: 1. Out of 219 women, 88 (40.2%) had SIL. 35 (39.8%) had Low SIL, 21(23.9%) had ASCUS, 3 (3.4%) had ASC-H, and 28(31.8%) had HSIL. 1 woman had invasive cancer and 1 had an inadequate smear. 2. 110(50.2%) of the women were on HAART. And out of these 44 (40%) had SIL. Of those not on HAART, 43 (39.4%) had SIL. The average CD4 count was 366 cells/ul, and the average age was 34.8 yrs. The relationship between not being on HAART and having a SIL was not significant with a p-value of 1.023 and 95% C.I (0.596–1.758). Conclusions: 1. The prevalence of cervical squamous intra-epithelial lesions among HIV positive women was 40.2%. 2. There was no significant relationship between not being on HAART and having SIL. Cervical cancer prevention should be part of HIV care given the high prevalence of SIL among these women. Though HAART did not appear protective against SIL in this study, a bigger study exploring impact of HAART on cervical SIL is recommended.