IntroductionUterine leiomyomas are the most common benign tumors of the female reproductive system. Although the majority of myomas are asymptomatic, some patients have symptoms or signs of varying degrees and require a hysterectomy.The aim of the studyThe aim of the study was to compare the clinical results of two minimally invasive hysterectomy techniques: vaginal hysterectomy (VH) and laparoscopically assisted vaginal hysterectomy (LAVH).Material and methodsA retrospective, observational study was performed at a tertiary care center: the Gynecology and Gynecologic Oncology Department, Polish Mother's Memorial Hospital Research Institute. The study period was from January 2003 to December 2012. A total of 159 women underwent either vaginal hysterectomy (VH, n = 120) or laparoscopically assisted vaginal hysterectomy (LAVH, n = 39) for symptomatic uterine myomas. Outcome measures, including past medical history, blood loss, major complications, operating time and discharge time were assessed and compared between the studied groups. Statistical analysis was performed using Student t-test, U-Mann Whitney test, χ2 test and Yates‘χ2 test. P < 0.05 was considered statistically significant.ResultsThere were no differences in patients’ mean age. Parity was significantly higher in the VH group (VH 1.9 ± 0.7 vs. LAVH 1.5 ± 0.8; p = 0.008). No difference was found in the mean ± standard deviation (SD) uterine volume between vaginal hysterectomy and LAVH groups (179 ± 89 vs. 199 ± 88 cm3), respectively. The mean operative time was significantly longer for the LAVH group (83 ± 29 vs. 131 ± 30 min; p = 0.0001). The intraoperative blood loss (VH 1.3 ± 1.1 vs. LAVH 1.4 ± 0.9 g/dl; p = 0.2) and the rate of intra- and postoperative complications were similar in both groups studied. The mean discharge time was longer for LAVH than for VH (VH 4.2 ± 1.2 vs. LAVH 5.3 ± 1.3 days, p = 0.0001).ConclusionsLaparoscopically assisted vaginal hysterectomy and VH are safe hysterectomy techniques for women with the myomatous uterus. Concerning the LAVH, the abdominal-pelvic exploration and the ability to perform adnexectomy safely represent the major advantages comparing with VH. Vaginal hysterectomy had a shorter operating time and the mild blood loss making it a suitable method of hysterectomy for cases in which the shortest duration of surgery and anesthesia is preferable.

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Neoplastic diseases together with cardiovascular diseases are the most frequent causes of death in the Polish population. Cancers of reproductive organs with breast cancer are responsible for the highest morbidity and mortality in women suffering from neoplasm diseases. Asymptomatic dynamics of the development of a neoplasm and no deviations from the normal level of laboratory results contribute to the fact that malignant diseases are diagnosed too late. The aim of modern medicine is to diagnose cancer at the earliest stage, however, there is no sufficiently sensitive and specific biomarker which can be used for diagnostic, prognostic and therapeutic purposes.Cellular interactions play the main role in the development, angiogenesis and invasiveness of a tumor. Recent research suggests the possibility of microvesicles (MVs) involvement in communication between cells. The MVs ability to fuse with various cells is used in cell-to-cell contact. Microvesicles cargo may include growth factors, their receptors, protease, adhesion molecules, signaling molecules and the sequence of DNA, mRNA, and micro-RNA. Larger quantities of MVs released from neoplastic cells affect both the local environment and systematic range causing metastases and progression. The research on molecular mechanisms of MVs’ release and the presence of characteristic oncogenes in blood of patients with neoplasms is being carried out. Confirmation of MVs presence in patients’ serum can potentially serve as useful information for therapeutic purposes and as the biomarker of a neoplastic disease.

WstępChoć szczyt zachorowań na raka szyjki macicy przypada na okres oko³omenopauzalny, z uwagi na wciąż niedoskonały system profilaktyki pierwotnej i wtórnej oraz brak świadomości zdrowotnej pacjentek nowotwór ten wykrywany jest coraz częściej u m³odszych kobiet, często w związku z opieką przedporodową. Czę-stość występowania raka szyjki macicy w ciąży wynosi 1/1200 do 1/10 000. Postępowanie lecznicze w raku szyjki macicy wzbudza wiele kontrowersji, szczególnie natury etycznej, wobec istniejącej sprzeczności interesów matki i p³odu. Różne są zatem podejścia do problemu ze strony onkologów, po³ożników i samych rodziców. Decyzja o sposobie leczenia musi być uzależniona od stopnia zaawansowania i typu nowotworu, wielkości ciąży i stanowiska pacjentki. Zwykle decyzja o podtrzymaniu ciąży jest podejmowana, gdy do wykrycia nowotworu dochodzi w III trymestrze. W II trymestrze dopuszcza się postępowanie wyczekujące w wybranych przypadkach, do czasu aż p³ód osiągnie zdolność przeżycia. Najnowsze doniesienia wskazują na możliwość zastosowania chemioterapii w II trymestrze, w celu zahamowania wzrostu guza do czasu osiągnięcia dojrza³ości wewnątrzmacicznej p³odu. W I trymestrze priorytetowe wydaje się leczenie nowotworu, nawet jeśli oznacza to obumarcie p³odu i zakończenie możliwości rozrodu. StreszczeniePostępowanie lecznicze w raku szyjki macicy zdiagnozowanym w ciąży wzbudza wiele kontrowersji, szczególnie natury etycznej, wobec istniejącej sprzeczności interesów matki i p³odu. Przedstawiono opis przypadków dwóch pacjentek operowanych w Klinice Ginekologii z Pododdzia³em Onkologii Ginekologicznej Instytutu Centrum Zdrowia Matki Polki w 2011 r. z powodu źle rokującego inwazyjnego raka szyjki macicy zdiagnozowanego w czasie ciąży. Celem pracy jest przedstawienie obecnych możliwości leczenia ciężarnych z rozpoznanym w czasie ciąży źle rokującym rakiem szyjki macicy.Słowa kluczowe: rak szyjki macicy, ciąża. SummaryThe therapeutic approach in cervical cancer diagnosed during pregnancy is ethically controversial due to a conflict of interest between the mother and the fetus. We present cases of two pregnant patients with invasive cervical cancer who underwent radical surgery in the Department of Gynecology and Oncology at the Polish Mother's Institute in 2011. The aim of this study is to present the mainstay of treatment of pregnant patients with poor prognosis cervical cancer diagnosed in gestation.

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