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Background: Carboplatin remains a first-line agent in the management of epithelial ovarian cancer (EOC). Unfortunately, platinum-resistant disease ultimately occurs in most patients. Using a novel EOC cell line with acquired resistance to carboplatin: PEO1CarbR, genome-wide micro-array profiling identified the cyclin-dependent kinase inhibitor p57(Kip2) as specifically downregulated in carboplatin resistance. Presently, we describe confirmation of these preliminary data with a variety of approaches.Methods: Cytotoxicity testing (MTT) and cell cycle blockade assessed drug responsiveness. Methylation specific PCR and pyrosequencing identified sites of promoter methylation in p57(Kip2). siRNA to p57(Kip2) was used to look at the changes in apoptosis of carboplatin treated EOC cells. EOC tissues (20 cases) were assessed for mRNA levels of p57(Kip2).Results: Carboplatin resistance was reversed using 5-aza-cytidine in vitro. Promoter methylation sites and preferential sensitivity to seliciclib were seen in PEO1CarbR cells. Silencing p57(Kip)2 decreased the apoptotic response to the effects of platinum but produced sensitisation to seliciclib. EOC biopsies indicated an association of high levels of p57(Kip2)mRNA with complete responses to chemotherapy and improved outcome.Conclusion: We conclude that p57(Kip2) is a candidate biomarker of platinum sensitivity/resistance in EOC and such cases may show preferential response to the cyclin-dependent kinase inhibitor seliciclib. [ABSTRACT FROM AUTHOR]

Background:Carboplatin remains a first-line agent in the management of epithelial ovarian cancer (EOC). Unfortunately, platinum-resistant disease ultimately occurs in most patients. Using a novel EOC cell line with acquired resistance to carboplatin: PEO1CarbR, genome-wide micro-array profiling identified the cyclin-dependent kinase inhibitor p57Kip2 as specifically downregulated in carboplatin resistance. Presently, we describe confirmation of these preliminary data with a variety of approaches.Methods:Cytotoxicity testing (MTT) and cell cycle blockade assessed drug responsiveness. Methylation specific PCR and pyrosequencing identified sites of promoter methylation in p57Kip2. siRNA to p57Kip2 was used to look at the changes in apoptosis of carboplatin treated EOC cells. EOC tissues (20 cases) were assessed for mRNA levels of p57Kip2.Results:Carboplatin resistance was reversed using 5-aza-cytidine in vitro. Promoter methylation sites and preferential sensitivity to seliciclib were seen in PEO1CarbR cells. Silencing p57Kip2 decreased the apoptotic response to the effects of platinum but produced sensitisation to seliciclib. EOC biopsies indicated an association of high levels of p57Kip2mRNA with complete responses to chemotherapy and improved outcome.Conclusion:We conclude that p57Kip2 is a candidate biomarker of platinum sensitivity/resistance in EOC and such cases may show preferential response to the cyclin-dependent kinase inhibitor seliciclib. [ABSTRACT FROM AUTHOR]

We evaluated the effectiveness and safety of Quixil® in gynaecological oncology with a prospective observational study over 11 months in a gynaecological oncology centre. Quixil® was opportunistically used when conventional haemostatic techniques failed, in 35 laparotomies and four laparoscopies. A total of 26 operations were performed for malignant disease and 13 for benign indications. Demographic, intraoperative and postoperative data were collected. Haemostasis was accomplished within 5 min from sealant application. No hypersensitivity reactions were noted. Bowel recovery and postoperative pain were usual. In the laparotomy group, the mean hospital stay was 11 days and mean operating time, 164 min. In the laparoscopy group, the mean hospital stay was 3 days and mean operating time 165 min. In both groups, the incidence of complications and recurrence rates were in line with the expected population rates of these treated patients. We conclude that Quixil® is an efficient, safe and effective haemostatic agent, which has a role to play in gynaecological surgery for benign and malignant disease. [ABSTRACT FROM AUTHOR]

Objective: The new guidelines of the British Society of Colposcopy and Cervical Pathology suggest that women should be offered colposcopy after only one mildly dyskaryotic smear. This is expected to generate increased workload for the colposcopy clinics, at least in the short term. The main objective of this study was to estimate the incidence of high-grade cervical intraepithelial neoplasia (CIN) in women with mildly dyskaryotic smears and investigate whether there is any variation in different age groups. The rationale was to determine whether we could reduce the burden on colposcopy services by prioritizing the mild dyskaryotic referrals by age, as we hypothesized that high-grade CIN is less frequent in younger women. Methods: The study sample included all women who were referred for colposcopy with a cervical smear suggesting mild dyskaryosis (with or without koilocytosis) from April 2000 to March 2003. Results: We studied 510 women. They were divided into three age groups (<20, 20–25 and >25 years). The overall prevalence of high-grade CIN (CIN II and III) was 28.7%.The positive predictive value of a mildly dyskaryotic smear for high-grade CIN was similar in all groups. Conclusions: Our results show that we are not in a position to prioritize our referrals by age group and reduce the initial pressure for colposcopies. We are also concerned that with the implementation of the new guidelines, a significant number of women <25 years will be carrying high-grade CIN for more than 5 years before they are first screened. [ABSTRACT FROM AUTHOR]

Ten women underwent obstetric hysterectomy at St George's Hospital, London between 1992 and 1998, with an apparent seven-fold increase in incidence in recent years. All hysterectomies were performed as emergency procedures, with massive postpartum haemorrhage being the major indication for operation in nine cases. Abnormal placentation was the single commonest cause, seven cases being associated with previous caesarean section. There were no maternal or fetal mortalities, but major surgical complications, including urinary tract and vascular injury occurred in one case. In view of the increasing risk of obstetric hysterectomy following previous caesarean section, high risk cases associated with abnormal placentation may be identified using ultrasound, allowing appropriate pre-operative counselling regarding the risk of peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the magnitude of the morbidity following radical surgery for early stage cervical cancer. We performed a retrospective survey of all women who had undergone a radical hysterectomy and lymphadenectomy between the months of July 1995 and December 1996 inclusive at either the Royal Marsden or St George's Hospital (n =38), using a detailed questionnaire on bladder, ano-rectal and sexual function, both before and after treatment. Sixteen women (44.4%) received adjuvant radiotherapy. The mean interval between surgery and inquiry was 16.4% months (range 8-25 months). The mean age at the time of surgery was 40.5 years. Thirty-six out of 38 women contacted responded (94.7%). Overall 33 women (91.7%) reported new bladder, ano-rectal or sexual symptoms. Complaints of urinary incontinence, particularly of urge incontinence, and of voiding difficulties increased significantly after surgery (P <0.05). However, only 5.3% of women had sought treatment. Tenesmus increased significantly (P <0.05), while increases in diarrhoea and faecal incontinence were not statistically significant (P =0.051). Although 12.9% of women stated an improvement in their sex lives, 54.8% thought that their sex life was worse after treatment, and 12.9% of women had ceased sexual activity altogether. Of women of childbearing age 53.8% felt adversely affected by their loss of fertility. Bladder, ano-rectal and sexual symptoms are very common following radical hysterectomy for cervical cancer, with adverse effect on quality of life, and persist into the second year after treatment. [ABSTRACT FROM AUTHOR]

Sister Mary Joseph's nodule metastasis is a rather rare finding. The primary malignancy in women is usually ovarian, endometrial, gastric, or pancreatobiliary tree cancer. We present a case of an 87-year-old patient with Sister Mary Joseph's nodule metastasis caused by a primary peritoneal malignancy. Through a literature search, we also discuss the pathophysiology, diagnostic approach, management, and prognosis of such a condition. [ABSTRACT FROM AUTHOR]

We report a case of inadvertent insertion of a 14-Fr Foley's catheter through the orifice of one branch of a previously unrecognised duplex ureter. The unintentional insertion of the catheter occurred at urethral catheterisation during laparotomy for gynaecological malignancy and lead to false intraoperative identification of the female anatomy and injury to the ureter. Postoperatively, cystoscopy and intravenous urography confirmed the existence of a duplex ureter on the affected side. [ABSTRACT FROM AUTHOR]

The article presents case studies of patients who have undergone secondary cytoreductive surgery involving liver resection due to late recurrence of ovarian granulosa cell tumours (GCT). All the patients had primary surgery ten years before the recurrence and with liver resection, significant improvements in their health conditions were recorded. The pathophysiology of GCTs and the role of surgical resection of hepatic metastases for patients with long survival rates are also discussed.

A letter to the editor is presented in response to the article "Laparoscopic radical abdominal trachelectomy for the management of stage IB1 cervical cancer at 14 weeks' gestation: case report and review of the literature" in issue number 122.

A letter to the editor is presented in response to the article "assisted radical vaginal hysterectomy versus radical abdominal hysterectomy?a randomised phase II trial: perioperative outcomes and surgicopathological measurements," by Naik R and colleagues in the previous issue.

The article presents a case study of a 56-year-old woman who was taken in a gynaecological oncology outpatient clinic for follow-up arrangements. Findings reveal that she performed self-surgical approach of draining malignant ascites through a razor and a plain plastic drinking straw. It notes that no signs of infection, abdominal injury and haemorrhage were depicted.

The article presents a case study of a 75-year-old woman who was admitted to the Accident and Emergency Department in Great Britain due to abdominal distension and pain caused by advanced ovarian carcinoma. Physicians have performed hemostatic and Floseal sealants to assess gynecological malignancy. It found that basic fibroblastic growth factor (bFGF), angiogenin (ANG) and vascular endothelial growth factor (VEGF) can lead an increase tissue vascularity to the disease.

Granulosa cell tumours of the ovary are rare. They are considered low-grade malignant cancers and infrequently metastasise to the liver. We present our experience of a case with a grade 1, stage 1 granulosa cell tumour of the ovary that systemically recurred 15 years following surgical resection. The patient went on to have a debulking hepatic resection 21 years following initial surgery despite a 6-year-long palliative diagnosis. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A letter to the editor and its reply regarding the article Economic evaluation of robot-assisted hysterectomy: A cost-minimization analysis, published in a previous issue is presented.