ASSESSMENT OF EFFECTIVENESS OF ANTI-RECURRENT AND HORMONAL THERAPY IN WOMEN WITH UTERINE FIBROIDS IN PREGRAVIDAL PREPARATION

Aim. This study was designed to evaluate the effectiveness of sequential prescription of drugs for anti-recurrent therapy of the uterine fibroids (UF) and combined oral contraceptives (COC) in pregravidal preparation.Materials and methods.There was conducted a prospective, nonrandomized and controlled cohort study of 150 women with UF who are planning a pregnancy after the organ-preserving treatment of uterine fibroids by means of myomectomy with laparoscopic access and pregravidal preparation. The immunohistochemical (IHC) study of the intensity expression of Ki 67, p53, Bcl-2 was performed for the differential diagnosis of reactive proliferation from dysplasia in the distant fibroid node and the selection of anti-recurrent therapy.Results. The duration of the UF disease does not depend on the intensity of expression of p53, Ki-67 or Bcl-2, the level of expression of the progesterone receptors in the distant fibroid node. A negative average correlation between the level of hemoglobin before myomectomy, the duration of the disease (r = -0.3867) and the number of nodes (r = -0.5389) was revealed. After the end of the anti-recurrent treatment in women who underwent organ- preserving treatment of uterine fibroids, the prescription of COC is connected with a further decrease in the size of fibroid nodes remaining after myomectomy from 15.81±0.22 mm to 8.94±0.45 mm (p<0.05), the number of fibroid nodes from 2.25±0.08 to 0.91±0.06 (р<0.05).Conclusion.The combination of anti-recurrent therapy with the subsequent prescription of the COC for prevention of the UF growth in women planning a pregnancy after myomectomy with endoscopic access is highly effective.

Isolated lip involvement in psoriasis: an uncommon aspect of a common dermatologic condition

Introduction: Psoriasis is a chronic inflammatory skin disease that typically affects the extremities, trunk, scalp, and nails. Psoriatic cheilitis as an exclusive presentation is very rare and to our knowledge, only 6 cases have been reported to date. The absence of cutaneous lesions causes diagnostic difficulties that can result in misdiagnosis and inadequate treatment. Observation: We reported the case of a 21-year-old woman with a seven years history of scaly plaques of the vermillion of the lips as the only disease manifestation. Her cheilitis was associated with significant psychiatric morbidity. Oral biopsy showed a psoriasiform pattern. Local applications of betamethasone was proposed. Discussion: Although lip psoriasis is extremely rare, it can be the sole presentation of psoriasis even in the absence of accompanying skin lesions, other oral manifestations or a family history of psoriasis. Conclusion: Lip psoriasis should be considered in the differential diagnosis of chronic or recurrent treatment-resistant labial lesions.

Contemporaneous biopsy and laser interstitial thermal therapy for two treatment-refractory brain metastases

Recurrent treatment-refractory brain metastases can be treated with modern adjuvant therapies such as laser interstitial thermal therapy (LITT). Since previously radiated lesions may be indolent (treatment effect) or recurrent tumor, histological confirmation may be helpful. The authors present the utility of contemporaneous biopsy and LITT using intraoperative O-arm navigation in a patient who presented with multiple refractory metastases. The authors demonstrate the utility of O-arm navigation to confirm intraoperative biopsy and LITT placement. Concurrent stereotactic biopsy and LITT may be a safe and efficacious method for both the diagnosis and treatment of deep lesions that are unamenable to standard adjuvant treatment modalities.The video can be found here: https://youtu.be/SUY-qiahMyo.