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Advanced cervical cancer can lead to life-threatening vaginal bleeding. Emergency uterine artery embolization (UAE) has been successfully used in such cases to achieve hemostasis. Our case demonstrates the unusual emergency use of this procedure to cease heavy hemorrhage, which led to hematometra, uterine rupture and hemoperitoneum in a patient with a large tumor in the cervical region. Vaginal bleeding was minimal in this case. The emergency UAE controlled the bleeding, and the patient was scheduled for laparotomy soon after the procedure, where a supracervical hysterectomy with bilateral salpingo-oophorectomy and the removal of blood and blood clots was performed. Since the tumor primarily involved the parametria, a sample was taken for histopathology examination with the following result: squamocellular HPV-associated cervical carcinoma. The postoperative management of the patient consisted of combined chemotherapy and radiotherapy, with no complications related to the UAE. Four months after the procedure the patient is reasonably well. Urgent surgery was not the optimal decision because of the alteration of the pelvic anatomy by the tumor, and thus the UAE enabled us to manage this life-threatening condition quickly, allowing us to best prepare the patient for further therapeutic modalities.

Hepatorenal syndrome is a severe complication of liver cirrhosis which is difficult to treat because of a very fast course and lack of adequate dosing recommendations due to the stage of the disease. In this study we aimed to refine the treatment of hepatorenal syndrome type I by modifying the dose of terlipressin, depending on the stage of acute kidney injury (AKI). Objective - to improve the treatment method of hepatorenal syndrome type I in patients with alcoholic liver cirrhosis by selecting the dose of terlipressin depending on the stage of acute kidney injury. For this study were enrolled 161 patients with diagnosis alcoholic liver cirrhosis, complicated with the hepatorenal syndrome. All patients were were randomly divided into control (group 1) (n=79) and study (group 2) (n=82) groups depending on the treatment received (terlipressin in the standard dosage or modified by the response-guided titration method). If the serum creatinine level decreased less than 25% from the baseline, the dose of terlipressin was gradually increased but did not accede 12 mg/24 hours. The stage of AKI was diagnosed using the criteria of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury, 2012. The risk of short term mortality (within the first 29 days) was prognosed by Model for End-Stage Liver Disease (MELD) score. The kidney function improved better in persons with a modified dose of terlipressin: the complete response rate in them was 81.7%. The response rate in those who received the standard treatment, was 66.7% only (p˂0.05). It was found that the effective dosage of terlipressin is 3 mg/24 for AKI stage I; 6 mg/24 - for AKI stage II; 12 mg/24 - for AKI stage III. The relapse of the disease occurred only in 23.2% patients with modified treatment against 40.1% in the control group (p˂0.05). Short term survival was also significantly higher in the study group - 54.9%, while in the control group it was 37% only (p˂0.05). Thus, correction of terlipressin dosage could improve the results of the treatment and reduce mortality in patients with hepatorenal syndrome type I.

Objective: Primary foetal cardiac tumours are rare congenital malformations. They can cause a flow obstruction, arrhythmias and can lead to cardiac failure, hydrops or death. Postnatal management is based on patient´s clinical and hemodynamic impairment., Methods: We retrospectively reviewed data from 2009-2019 from our gynaecology clinic and also data regarding postnatal follow-up from our partner paediatric institution., Results: In this period, we diagnosed six cases with foetal cardiac tumours. In four cases, multiple rhabdomyomas were present. Three patients did not have serious complications pre- or postnatally. In one case, tumours were obliterating both the inflow and the outflow of the left ventricle. The child died at three months of age. Tuberous sclerosis was confirmed in all the cases with rhabdomyomas. One child had a fibroma filling the left ventricle. Despite an uneventful prenatal period, the patient got postnatally symptomatic. Tumour was considered inoperable and the child died at the age of five months. In one case a single right ventricular unspecified tumour was diagnosed, without any complications., Conclusion: Prognosis closely depends on early diagnosis, clinical manifestations and the possibility of surgical tumour removal if necessary. In confirmed rhabdomyomas, tests for tuberous sclerosis are mandatory (Tab. 1, Fig. 2, Ref. 18). Text in PDF www.elis.sk Keywords: rhabdomyoma, fibroma, prenatal diagnosis, ultrasound, tuberous sclerosis.

Torcular dural sinus malformations (tDSMs) are rare congenital defects representing a complex of vascular anomalies that have been grouped in one single unit. Although the current literature suggests a generally favourable prognosis for prenatally diagnosed tDSMs, there are still only limited data and published papers on the subject. Factors resulting in an adverse outcome of the fetuses and children have to be taken into consideration to determine precisely the nature of the consultation and management. A 33-year-old primipara at 21 weeks, 5 days of gestation was referred to our clinic with the suspicion of a central nervous system (CNS) malformation of the fetus, and the diagnosis of tDSM with thrombus was made. No factors contributing to an adverse outcome such as arterialization of the lesion, ventriculomegaly or neuroparenchymal damage were present. The pregnant woman was scheduled for regular sonographic and magnetic resonance imaging (MRI) controls. In the third trimester the lesion decreased in size, which is a key imaging marker for a favourable prognosis. The child was born in term, and the latest neurological examination at the age of six weeks is without pathological findings. This case study demonstrates a prenatally diagnosed tDSM with a favourable outcome with a regression in the size of the lesion during the prenatal period.

The aim of the study is to identify topical issues of the regulatory framework and the application of legal provisions related to acquisition (collection) of samples for examination in criminal proceedings. To achieve this objective, as well as justify the results, a set of general scientific and special methods is used. The comparative legal method enables to analyze the criminal procedure legislation of Ukraine and other countries, as well as the practice of the European Court of Human Rights. The system-structural method enables to reveal the procedure for sample acquisition for examination. The technical-logical method is the basis for forming the conceptual apparatus in the framework of the subject under study. The statistical method is used in the course of summarizing and processing of the data of investigative and judicial practice. The analysis of the procedure for acquisition (collection) of samples for examination in criminal proceedings is carried out in accordance with the Criminal Procedure Code of Ukraine and international acts. The study states that the CPC of Ukraine, first, does not reveal the concept of "samples for examination," "biological samples"; second, does not fix the list of sample objects that can be obtained for comparative examination; third, does not provide the list of persons authorized to conduct this procedural action and persons, from whom they can be collected. Taking into account the study conducted, the author suggests how to improve the procedure and organization of sample acquisition for examination, as well as recommends how to resolve problematic issues arising during their collection.

Aim: To identify characteristic risk factors of preterm birth in Central and Eastern Europe and explore the differences from other developed countries., Method: Data on 33,794 term and 3867 preterm births (<37 wks.) were extracted in a retrospective study between January 1, 2007 and December 31, 2009. The study took place in 6 centers in 5 countries: Czech Republic, Hungary (two centers), Romania, Slovakia, and Ukraine. Data on historical risk factors, pregnancy complications, and special testing were gathered. Preterm birth frequencies and relevant risk factors were analyzed using Statistical Analysis System (SAS) software., Results: All the factors selected for study (history of smoking, diabetes, chronic hypertension, current diabetes, preeclampsia, progesterone use, current smoking, body mass index, iron use and anemia during pregnancy), except the history of diabetes were predictive of preterm birth across all participating European centers. Preterm birth was at least 2.4 times more likely with smoking (history or current), three times more likely with preeclampsia, 2.9 times more likely with hypertension after adjusting for other covariates. It had inverse relationship with the significant predictor body mass index, with adjusted risk ratio of 0.8 to 1.0 in three sites. Iron use and anemia, though significant predictors of preterm birth, indicated mixed patterns for relative risk ratio., Conclusion: Smoking, preeclampsia, hypertension and body mass index seem to be the foremost risk factors of preterm birth. Implications of these factors could be beneficial for design and implementation of interventions and improve the birth outcome.

Breast carcinoma is the most common cancer with high mortality caused by metastatic disease. New molecular biomarkers predicting the tumour's metastatic potential would therefore improve metastasis prevention and personalised care. The aim of the study was to investigate the relationship between DNA methylation levels in invasivity and metastasising associated genes with aberrant protein expression and also to evaluate whether a similar DNA methylation level is present in the tumour and circulating cell-free DNA for utilising plasma DNA methylation as prognostic biomarker. By using pyrosequencing, we analysed DNA methylation levels of 11 genes, namely APC, ADAM23, CXCL12, ESR1, PGR B, CDH1, RASSF1A, SYK, TIMP3, BRMS1 and SOCS1 in tumour, plasma and peripheral blood cells from 34 patients with primary breast cancer, as well as plasma and peripheral blood cells from 50 healthy controls. Simultaneously, the expression of related proteins in paraffin-embedded tumour samples was evaluated by immunohistochemistry. Statistical analysis was performed by SPSS statistics 15.0 software. Tumour DNA hypermethylation was found in most commonly methylated RASSF1A (71.9%), APC (55.9%), ADAM23 (38%) and CXCL12 (34.4%) genes with methylation levels up to 86, 86, 53 and 64 %, respectively. In tumours, significantly higher methylation levels were found in nine genes, compared with the patients´ peripheral blood cell DNA. Furthermore, in patients methylation levels in peripheral blood cell DNA were significantly higher than in controls in CXCL12, ESR1 and TIMP3 genes, but the values did not exceed 15%. On the other hand, no correlations were observed in patients between DNA methylation in tumours and cell-free plasma DNA. Moreover, in patients and controls nearly identical values of cumulative DNA methylation (43.6 % ± 20.1 vs. 43.7 % ± 15.0) were observed in plasma samples. A variable spectrum from high to none expressions presented in tumour tissues in all of the proteins evaluated, however in APC and CXCL12 genes a visible decreasing trend of mean DNA methylation level with increasing expression of the corresponding protein was observed. The DNA methylation profiles manifested in our group of breast carcinomas are cancer specific, but they are not the only cause that affects the silencing of evaluated genes and the decrease of relevant protein products. The clinical utility of DNA methylation testing in peripheral blood cell DNA for cancer diagnosis and therapy need to be further investigated.

Background: Restless legs syndrome (RLS) is a frequent neurological disorder which predominantly affects women. Pregnancy is one of the most common conditions leading to secondary RLS. Severe symptoms of RLS may lead to complications of pregnancy and/or labor. The aim of this study was to determine the prevalence and characteristics of RLS in pregnant women., Methods: Women in the third trimester of gravidity filled out a simple questionnaire based on the official diagnostic criteria for RLS. Positive responders were interviewed in order to further characterize their symptoms. Afterwards information on changes in frequency and/or intensity of the symptoms after delivery was obtained by a telephone follow-up. All data were statistically analysed., Results: A total of 300 questionnaires were completed. All 94 RLS-positives met the four diagnostic criteria (31.33%). There was no difference in age, body mass index, or the number of previous pregnancies between RLS-positives and RLS-negatives, but weight gain during pregnancy was significantly higher in RLS-positives. More than 30% of positives had clinically significant symptoms, and 50% reported sleep disturbances. Almost 75% of the cases of RLS were secondary, i.e., symptoms occurred only during pregnancy (with a peak in the third trimester). More complications of pregnancy or labor occurred in women with RLS, but this was only marginally significant., Conclusions: Our study confirmed the relatively high prevalence of RLS in pregnant women compared with the general population. Although almost three-fourths of the symptoms were only transient throughout pregnancy, the impact of the severe symptoms and sleep deprivation on the course of pregnancy and delivery was not negligible. Early detection and adequate treatment of severe RLS are necessary to prevent maternal discomfort and possible health risks. The questionnaire method is a simple, reliable diagnostic tool.

The prothrombotic effect of malignant diseases on organism is commonly known. We review the documentation of the Medical Department in Liptovsky Mikulas filed in years 1996-2002 (15,512 patients). 120 patients suffered from significantly coinciding acute myocardial infarction and malignant diseases (p = 0.05). In 17 of them the correlation was possible; in 38 it was probable. Most common were the tumours of digestive organs, uropoetic system and oncohematological diseases. The acute myocardial infarction usually preceded the diagnosis of malignant diseases. Under certain conditions, e.g. under that of paraneoplastic syndrome, some acute myocardial infarctions can serve as a hint that it is necessary to assume and solve also possible presence of occult malignancies (Fig. 1, Re of 46).

Postoperative results of 113 unilateral and 77 bilateral extracapsular cataract extractions (EC-CEs) in dogs were evaluated retrospectively. Restoration or improvement of functional vision was achieved in 79.6% of the eyes in dogs with unilateral extraction and 85.7% of the eyes in dogs with bilateral extractions at weeks 4 to 6. Complications occurring 6 weeks to 9 months after lens extraction lessened the surgical success rate in both groups. Twenty-six percent of the dogs in which bilateral lens removal was performed suffered complications resulting in surgical failure in one eye. When using the criterion that one or both treated eyes had functional vision, a short-term success rate of 98.7% was found for bilateral extractions.

Intramuscular injections of the title drug in a dose of 5 mg/kg (5% of the LD50) during 10 days produced in the liver and blood serum of white rats a decrease in the activity of glucokinase, succinate dehydrogenase, glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase, glutathione reductase, ATPase and ceruloplasmin. The urea content in total phospholipids rose, whereas the content of triglycerides and hexosamine diminished. Ten and 20 days after the drug was discontinued the majority of these characteristics returned to normal. The activity of glucosophosphate isomerase, transketolase, glucose-6-phosphatase, fructose-1,6-diphosphatase and lactate dehydrogenase as well as the content of total cholesterol, free fatty acids, tyrosine, hydroxyproline, total protein, RNA and DNA remained unchanged.

The suggested method consists in incubation of the homogenate of the tissue under study with a solution of 0.5% p-phenylene diamine hydrochloride. The forming stained products of the reaction are extracted with butanol. The extracts obtained is photometered at a wave of 582 nm. The activity of ceruloplasmin is expressed by arbitrary units per 1 mg of protein.