Quality of Life in Female Patients with Overactive Bladder after Botulinum Toxin Treatment

BACKGROUND

Manifestations of OAB can considerably diminish the quality of life. Botulinum toxin has emerged as a valuable treatment option in diseases whose symptoms cannot be controlled adequately with other available therapies. The aim of the present study was to compare the subjective quality of life of patients with OAB before the injection of botulinum toxin and three and six months after the intervention.

METHODS

This study was based on a diagnostic survey with three validated questionnaires, ICIQ-OAB, ICIQ-OABqol, and ICIQ-LUTSqol, and an additional questionnaire developed by the authors to collect sociodemographic characteristics and selected medical data.

RESULTS

This study demonstrated significant differences between pre-treatment scores and those at three and six months post injection. At three and six months after the intervention, mean scores for all three instruments (ICIQ-OAB, ICIQ-OABqol, ICIQ-LUTSqol) were significantly lower than the respective pre-treatment values, implying a significant attenuation of OAB symptoms and their lower impact on the quality of life. However, the severity of OAB symptoms and their impact on the quality of life at six months post intervention were significantly higher than at three months, except for the social interaction domain.

CONCLUSIONS

Botulinum toxin is an effective treatment for OAB.

Lymphangioleiomyomatosis with Tuberous Sclerosis Complex-A Case Study

Lymphangioleiomyomatosis (LAM) is characterized by lung cysts that cause lung deterioration, changes in the lymphatic system, and tumors in the kidneys. It mainly affects women of reproductive age and is a progressive disease. LAM can occur as an isolated disease or coexist with tuberous sclerosis (TSC). The source of LAM cells is unknown. Patients with confirmed LAM should be treated with an mTOR inhibitor, sirolimus, or everolimus. We present a case of LAM with TSC in a patient whose symptoms, including those in the lymph nodes and chyaloperitoneum, mainly concern the abdominal cavity.

Influence of hsCRP Parameter on the Occurrence of Metabolic Syndrome in Patients with Polycystic Ovary Syndrome

PCOS (polycystic ovary syndrome) is a common endocrine disorder that affects 8-13% of women of reproductive age. Increased body weight and insulin resistance may be associated with chronic inflammation, which increases the risk of cardiovascular complications. CRP (C-reactive protein) tests may be use to assess persistent inflammation. Elevated CRP levels may be associated with insulin resistance and type 2 diabetes. Determination of hsCRP, highly sensitive C-reactive protein, can be used to assess cardiovascular risk in women with PCOS. In this study, 120 women between the ages of 18 and 42 were divided into two groups: patients with polycystic ovary syndrome (n = 80) and regular menstruating women in whom PCOS was excluded (n = 40). Lipid and carbohydrate metabolism parameters and hsCRP levels were assessed, followed by receiver operating characteristic (ROC) analysis for hsCRP, where metabolic syndrome was the dependent variable. For hsCRP, the cutoff point was 1.44 (mg/dL). Sensitivity for the cutoff point was 0.913 and specificity was 0.691. The area under the curve (AUC) was 0.851 (p < 0.000). The closer the AUC value is to unity, the better the predictive ability of the studied variable. There was also a statistically significant correlation between hsCRP levels and the presence of metabolic syndrome.

Influence of Vitamin D on the Incidence of Metabolic Syndrome and Hormonal Balance in Patients with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder that affects 8-13% of women of reproductive age. It is one of the most common causes of infertility and is associated with hyperandrogenism in the form of hirsutism and acne, non-ovulatory cycles, and characteristic ovarian morphology. The available research on serum vitamin D deficiency in patients with PCOS and the appropriateness of vitamin D supplementation in this group of women is inconclusive, so we decided to investigate the influence of vitamin D on the incidence of metabolic syndrome and hormonal balance in patients with polycystic ovary syndrome. The study comprised 120 women aged between 18 and 42 years, who were divided into two groups: a group with diagnosed polycystic ovary syndrome (PCOS) and a group of regularly menstruating women without features of androgenisation, in whom polycystic ovary syndrome was excluded. Each patient underwent a history and physical examination, including a gynecological examination, anthropometric measurements were taken, including height, weight, waist, and hip circumference, and blood pressure was measured using the Korotkow method. In the female patients, the following parameters were also determined from the blood: follicle-stimulating hormone (FSH), luteinizing hormone (LH), oestradiol, TSH, ft4, prolactin (PRL), total testosterone, DHEASO4, 17-hydroxyprogesterone (17-OHP), sex-hormone-binding globulin (SHBG), androstendione, 25(OH) vitamin D3 metabolite. The majority of the patients with polycystic ovary syndrome were found to have deficient or suboptimal serum vitamin D levels, and the effects of vitamin D on the SHBG levels and free-androgen indices in these patients was examined. The effects of vitamin D on the incidence of metabolic syndrome and BMI, waist-to-hip ratio, waist circumference, and blood pressure in patients with polycystic ovary syndrome were also found.

Influence of Muscle Mass and Strength on Bone Mineralisation with Consideration of Sclerostin Concentration

Osteoporosis is a disease characterised by a reduction in bone strength due to increased porosity and impaired mineralisation. In our study, we investigated whether muscle strength and mass exert a significant effect on bone mineral density in young adult women. We also tested whether sclerostin can be used as an indicator in the assessment of bone mineralisation. The study included 111 patients. All patients had their bone mineral density determined in the L1-L4 section of the lumbar spine and in the whole skeleton. The parameters of fat mass (FM), lean body mass (LBM) and visceral fat mass (VF) were also determined. Metabolic activity of osteocytes was assessed by measuring the serum sclerostin concentration. There was a statistically significant association of both hands' muscle strength with all parameters expressing bone mineralisation. A statistically significant relationship was also obtained between BMD L1-L4 and the body mass components (FM, LBM). Sclerostin levels in the study did not differ between groups with normal and reduced bone mineral density. Muscle strength assessment may be a potential exponent of reduced bone mineral density, also used clinically in young adult women. The utility of sclerostin in the clinical assessment of bone mineralisation has not been demonstrated.

Associations of Hormonal and Metabolic Parameters with Bone Mineralization in Young Adult Females

Osteoporosis is characterized by impaired bone mineralization and microarchitecture. An important protective factor is a high peak bone mass (PBM), attained in the second and third decade of life. The aim of the study was to evaluate the effect of hormonal and metabolic parameters on bone mineralization in young adult female patients. A total of 111 participants qualified for the study. Bone mineral density of the lumbar spine (L1-L4) and whole skeleton was measured using dual-energy X-ray absorptiometry (DXA). Hormonal parameters were determined: the concentrations of androstendione, dihydroepiandrosterone sulphate, testosterone, sex hormone binding protein, 17-OH-progesterone, folliculotropic hormone, estradiol, thyrotropic hormone, free thyroxine and cortisol. Metabolic parameters were also examined. The study showed a statistically significant correlation between bone mineral density and estradiol concentration and a negative relationship between cortisol concentration and the bone mineral density (BMD) Z-score of the lumbar spine. Sclerostin measurements taken during this study were not related to bone mineral density. It has been shown that the concentration of the hormones tested, even within the reference range, may affect bone mineralization. We suggest observing the follow-up of the menstrual cycles, as well as analyzing the results of test patients in an annual examination system. However, each clinical case should be considered individually. The sclerostin test is currently not useful in the clinical evaluation of bone mineralization in young adult women.

Involvement in Tumorigenesis and Clinical Significance of CXCL1 in Reproductive Cancers: Breast Cancer, Cervical Cancer, Endometrial Cancer, Ovarian Cancer and Prostate Cancer

C-X-C motif chemokine ligand 1 (CXCL1) is a member of the CXC chemokine subfamily and a ligand for CXCR2. Its main function in the immune system is the chemoattraction of neutrophils. However, there is a lack of comprehensive reviews summarizing the significance of CXCL1 in cancer processes. To fill this gap, this work describes the clinical significance and participation of CXCL1 in cancer processes in the most important reproductive cancers: breast cancer, cervical cancer, endometrial cancer, ovarian cancer, and prostate cancer. The focus is on both clinical aspects and the significance of CXCL1 in molecular cancer processes. We describe the association of CXCL1 with clinical features of tumors, including prognosis, ER, PR and HER2 status, and TNM stage. We present the molecular contribution of CXCL1 to chemoresistance and radioresistance in selected tumors and its influence on the proliferation, migration, and invasion of tumor cells. Additionally, we present the impact of CXCL1 on the microenvironment of reproductive cancers, including its effect on angiogenesis, recruitment, and function of cancer-associated cells (macrophages, neutrophils, MDSC, and T_reg). The article concludes by summarizing the significance of introducing drugs targeting CXCL1. This paper also discusses the significance of ACKR1/DARC in reproductive cancers.

Metabolic and Dietary Factors in Acne Vulgaris and Evaluation of the Acne Vulgaris Treatment with Oral Contraceptive-Based Therapies in Young Adult Women

The etiopathogenesis of acne is complex, as several endo- and exogenous factors that affect the sebaceous-hair unit are involved in the development of acne lesions. The main aim of the study was to evaluate selected metabolic parameters before treatment. Another goal of the study was to determine the correlation between selected metabolic and dietary parameters and the severity of acne before treatment. The third objective was to assess the severity of acne before and after treatment, considering the type of treatment used. The final objective was to assess the relationship between the difference in acne severity before and after treatment, considering the type of treatment used and factors of dairy or sweets intake. 168 women participated in the study. The patients belonged to two groups: the study group (99 patients with acne vulgaris) and the control group (69 patients without skin lesions). The study group was divided into subgroups according to the treatment used: contraceptive preparation, contraceptive preparation and cyproterone acetate, and contraceptive preparation and isotretinoin preparation. We found that LDL levels and consumption of sweets correlated with acne severity. The mainstay of acne treatment is contraceptive treatment (ethinylestradiol and drospirenone). The effectiveness of the three contraceptive-based treatments was confirmed by observing the severity of acne. There were no significant correlations between the difference in acne severity before and after treatment with the three treatments and factors of dairy or sweet consumption.

Late Diagnosis of Swyer Syndrome in a Patient with Bilateral Germ Cell Tumor Treated with a Contraceptive Due to Primary Amenorrhea

Swyer syndrome is a special form of DSD (disorders of sex development), so-called pure gonadal dysgenesis with a karyotype 46, XY and a female phenotype. One of the most important problems in patients with DSD is the risk of gonadal tumors. We present a case of a 26-year-old patient with Swyer syndrome. The patient had primary amenorrhea and no puberty characteristics. In ultrasound imaging in the vicinity of the uterus, there were two homogeneous structures. A genetic diagnosis was also performed, which showed karyotype 46, XY. The patient underwent a bilateral gonadectomy. Histopathological examination revealed the presence of dysgerminoma in both dysgenetic gonads. The follow-up of five years now did not show any changes suspected of invasion. We concluded that the primary amenorrhea, along with the absence of development of sexual characteristics, should prompt an expanded diagnosis for disorders of sex development. Gonadal dysgerminoma should be suspected even in the absence of tumor features on ultrasound and blood laboratory tests. Early prophylactic gonadectomy could protect patients from developing tumors in dysgenetic gonads.

Quality of life in patients with overactive bladder following botulinum toxin treatment: a preliminary report

OBJECTIVES

The aim of the present study was to compare the subjective quality of life in patients with overactive bladder (OAB) prior to intravesical botulinum toxin injection and three and six months thereafter.

MATERIAL AND METHODS

The study included 50 women diagnosed with OAB refractory to oral pharmacotherapy. The respondents completed four questionnaires, ICIQ-OAB, ICIQ-OABqol, ICIQ-LUTSqol and a dedicated clinicodemographic survey.

RESULTS

Intravesical injection of botulinum toxin A contributed to the attenuation of OAB-related ailments and resultant improvement of the quality of life. The ICIQ-OAB scores at three and six months post-injection were significantly lower than at the baseline (p < 0.001), implying that the treatment reduced the severity of OAB manifestations. OAB ailments had, without a doubt, a detrimental effect on the quality of life, as shown by high ICIQ-OABqol and ICIQ-LUTSqol scores before the treatment. Administration of botulinum toxin A was associated with a significant decrease in scores for all domains of the ICIQ-OABqol and ICIQ-LUTSqol scales (p < 0.001).

CONCLUSIONS

Botulinum toxin is an effective treatment option in patients with OAB who failed to respond to anticholinergic therapy. Botulinum toxin injections contributed to a significant improvement in the quality of life during a six-month follow-up.

Estrogen and Progesterone Receptor Immunoexpression in Fallopian Tubes among Postmenopausal Women Based on Time since the Last Menstrual Period

Existing data on the expression of estrogen receptor (ERα) and progesterone receptor (PR) in fallopian tubes in postmenopausal women are mostly inconclusive. Therefore, we assessed ERα and PR immunoexpression in the oviducts of these women. One hundred postmenopausal women were divided into three groups based on time elapsed since the last menstrual period: (A) 1–5 years, (B) 6–10 years, and (C) ≥11 years. In all groups, both in the glandular epithelium and stroma of the ampulla and isthmus of the oviduct, immunolocalization of ERα and PR were noted. The glandular epithelium of the ampulla showed a higher percentage of PR-positive cells than the isthmus in each group. Regarding ERα, there were no significant differences. In the glandular epithelium in both the ampulla and isthmus, the percentage of ERα- and PR-positive cells was significantly higher than that in the stroma in each study group and higher in the A group than in the C group. In conclusion, in postmenopausal women, time elapsed since the last menstrual period in the fallopian tubes was positively correlated with the following: (1) the epithelium showed vacuolation of cytoplasm with greater frequency, (2) the proportion of ciliated cells decreased, and (3) the percentage of ERα- and PR-positive cells also decreased. The obtained results indicate a significant decrease in ERα and PR expression depending on the time that has elapsed since the last menstruation, which is undoubtedly related to the loss of the reproductive function of the patients.

National and regional trends in the prevalence of polycystic ovary syndrome since 1990 within Europe: the modeled estimates from the Global Burden of Disease Study 2016

INTRODUCTION

The exact prevalence of polycystic ovary syndrome (PCOS) is difficult to assess due to the clinical heterogeneity of this condition, the lack of a universal definition as well as the lack of studies comparing differences within and between ethnic groups across geographical regions.

MATERIAL AND METHODS

Using a modeling approach, we analyzed the data from Global Burden of Disease Study 2016 and extracted the national and regional estimates on PCOS prevalence since 1990 in females aged 15-49 years by country and three major European regions: Western, Central, and Eastern.

RESULTS

The average prevalence of PCOS in Europe was 276.4 cases per 100,000 (95% uncertainty interval (UI): 207.8-363.2). The estimates varied markedly across countries and regions, with the highest rates per 100,000 in the Czech Republic (460.6) and the lowest in Sweden (34.10); other Nordic countries, Germany, and the UK had relatively low rates as well. The rates in Central and Eastern Europe were more than three times higher than those in Western countries. They were comparable among Eastern countries, ranging from 406.4 in Lithuania to 443.1 in Russia. Within Central Europe, PCOS prevalence was lowest in Turkey and Albania, while in the majority of the remaining countries, the prevalence ranged between 420 and 440 per 100,000. Between 1990 and 2016, the rates across European regions were relatively stable.

CONCLUSIONS

We found highly variable national and regional prevalence of PCOS among European females. Our estimates encourage the search at the population level for new environmental and genetic determinants of PCOS.

[Probiotics intake as gut-microbiota modulating therapy in an interdisciplinary aspect]

The gut microbiota was defined as one of the endocrine organs. It consists of many various microorganisms with huge metabolic potential. An imbalance of the gut microbiota was assessed as one of risk factors for various metabolic, infectious, and inflammatory disorders, but also stress-related disorders. Link between the gut microbiological environment and the development of such pathologies as: metabolic syndrome, diabetes, obesity, inflammatory bowel disease, colorectal cancer, depression, anxiety disorders, attention deficit hyperactivity disorder or PCO syndrome has been proven. Diet with probiotics intake could be effective in the prevention and treatment of many diseases and associated metabolic disorders. Increasing the amount of "beneficial" gut microbiota may favorably affect the functioning of the whole organism. Treatment options for specific diseases must be compliant with the guidelines of recommendations for these disorders. However, probiotic supplementation can positively strengthen the results of this treatment. It is recognized that probiotics, by increasing beneficial intestinal microflora, inhibit development of pathogens and change metabolic and enzymatic activity. It reduces inflammation and positively regulates immunologic activity of intestines. On the base of conducted studies beneficial effects of probiotic supplementation in patients with metabolic, endocrine and mental disorders were noted. Prebiotics and probiotics influence on modification of gastrointestinal microflora. Changes of gut microbiota, by diet with probiotics intake, cause the maintenance of gut epithelial barrier integrity and may be useful in prevention and treatment of many diseases and concomitant metabolic disorders. It may have potential implications for protection against adverse, long-term health consequences of these disorders.

Treatment of ovarian endometrial cysts in the context of recurrence and fertility

An approach to ovarian endometrial cysts has changed considerably during recent years, especially in regard to treatment of recurrent endometriosis, fertility sparing and infertility management. Surgical treatment is the primary therapeutic option. The most efficient types of treatment are radical procedures involving adhesiolysis, removal of the cyst along with its capsule and any remaining endometriotic foci. However, small asymptomatic cysts should not be treated surgically, especially in patients older than 35 years. Surgical treatment can be considered in infertile women and those who failed to get pregnant despite 1-1.5 years of trials, as well as in cases in which in vitro fertilization is not an option. Also large cysts, with more than 4 cm in diameter, should be treated surgically due to the risk of their rupture or torsion. The most efficient preventive measure for recurrent ovarian endometriosis is unilateral oophorectomy with sparing the contralateral ovary. Such a procedure should be considered in women who are no longer interested in childbearing or present with another endometriotic cyst in the same ovary. The role of pharmacotherapy is fairly limited; it should be considered in patients in whom diffuse endometriosis is associated with pain. Therapeutic agents from the following groups can be used: estrogen-progestin preparation, gestagens, including progesteronereleasing intrauterine systems and gonadotropin-releasing hormone agonists. Women with infertility should get pregnant as soon as possible, and in patients who failed to get pregnant and/or are older than 35 years, in vitro fertilization should be the treatment of choice.

Assessment of ovarian reserve as an indicator of fertility and health consequences in patients with chronic kidney disease stages 3-4

The aim of the study was to evaluate whether ovarian reserve depends on chronic kidney disease. Twenty-four patients, 23-45 years with chronic kidney disease (CKD) stages 3-4 were included in the study. All the patients underwent transvaginal ultrasounds to assess antral follicle count (AFC) and ovarian volume. The serum samples were obtained on days 3-5 of the menstrual cycle from all participants for anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH), and estradiol (E2) levels. On the base of the study, it was concluded that the most sensitive parameters of ovarian reserve are AMH and AFC. AMH levels and number of antral follicles in both ovaries were statistically significantly lower in the group of patients with CKD than in control ones. But there were no significant differences in the ovarian volumes (right and left ovary), FSH and E2 levels between study and control groups. Ovarian reserve is not dependent on the duration of CKD and hormonal parameters of ovarian reserve like FSH and estradiol (E2) are not dependent on the presence or absence of proteinuria in patients with CKD, but the most sensitive parameter - AMH is significantly lower in patients with CKD and proteinuria.

[Polycystic ovary syndrome - current state of knowledge]

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder, affecting 5-10% women of reproductive age. It is one of the most common causes of functional infertility and a clinical problem that can be faced by doctors of many specialities. PCOS is characterized by hyperandrogenism, oligoovulations and metabolic disorders. ESHRE/ASRM (2003) or AES (2006) criteria are used to diagnose a patient with polycystic ovary syndrome. Although a lot of studies are carried out, ethiology and pathogenesis of PCOS is still not clear. The treatment must be long-term, causal and depending on the patient's expectations. The fundamental part of the therapy are lifestyle modifications and weight loss. Losing as little as 5% of body mass increases frequency of ovulations, chances of pregnancy and improves hormonal profile. First-line therapy is clomiphene citrate and for hyperandrogenism reduction combined oral contraceptive pill is frequently used. Metformin, not only improves carbohydrate metabolism, but also increases ovulations' frequency and chances of pregnancy. Metabolic syndrome, diabetes mellitus type 2, hypertension and higher risk of endometrial cancer are characteristic for patients with PCOS.

Influence of Pb and Cd levels in whole blood of postmenopausal women on the incidence of anxiety and depressive symptoms

INTRODUCTION

To-date, the influence of heavy metals such as Pb or Cd on mental functioning, and especially on the occurrence of depressive and anxiety-related disorders, has not been well understood.

OBJECTIVES

1) Assessment of Pb and Cd levels in whole blood of postmenopausal women. 2) Assessment of the severity of anxiety and depressive symptoms depending on Pb and Cd levels in whole blood of postmenopausal women.

MATERIAL AND METHODS

The survey-based study involved 198 healthy postmenopausal women from West Pomeranian province in Poland. It was performed using the Primary Care Evaluation of Mental Disorders (PRIME-MD), Beck's Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI). The second part of the study was based on biochemical analysis of the levels of heavy metals (Pb, Cd).

RESULTS

The mean level of Pb was 19.85 ± 8.99 µg/l and Cd 0.87±0.98 µg/l; these levels were within normal ranges. Analysis of the mean levels of Pb and Cd in whole blood of postmenopausal women in relation to the severity of depressive symptoms did not reveal statistically significant differences. Correlation analysis demonstrated a statistically significant (p<0.05) negative correlation (-0.22) between the level of Pb and the severity of anxiety as a state. Correlations between the levels of Pb and Cd and the severity of anxiety as a trait were not statistically significant.

CONCLUSIONS

The mean Pb and Cd levels in whole blood of healthy postmenopausal women did not exceed acceptable limits. The study did not confirm a relationship between the levels of selected heavy metals and the severity of anxiety and depressive symptoms in healthy women. However, there was a relationship between the level of Pb and the severity of anxiety as a state.

Searching for the relationship between the parameters of metabolic syndrome and the rs17782313 (T>C) polymorphism of the MC4R gene in postmenopausal women

Metabolic syndrome (MS) is widespread in the human population, and its incidence is continuously increasing, generating serious health problems. The purpose of this study was to find the relationship between the parameters of MS and the melanocortin type 4 receptor (MC4R) gene polymorphism in postmenopausal women. The study involved 344 healthy Polish women, who had their last menstrual cycle 1 year ago or earlier. The study included blood analysis, survey, and body measurements. The mean age was 58.5±6.6 years. An increased body mass index was observed in 65.7% and abdominal obesity in 80.3% of the study population. MS was diagnosed in 40.7% of all participants, including 39.3% of women with the T/T genotype and 44.7% of those with the C/X genotype (χ² test; P>0.05). A logistic regression model showed that the probability of MS was higher in patients with the C/X genotype (odds ratio =1.25) (χ² test; P>0.05). The study concluded that MS is a very common condition among postmenopausal women. The C/X genotype of the MC4R gene seems to predispose postmenopausal women to developing some MS symptoms.

Analysis of Relations Between the Level of Mg, Zn, Ca, Cu, and Fe and Depressiveness in Postmenopausal Women

Numerous observations suggest a possible connection between the levels of Mg, Zn, Fe, and Zn and the incidence of depressive symptoms. Depression is two to three times more common in women than in men. The menopausal period is extremely conducive to depressive disorders. The aim of this study was to assess the severity of depressive symptoms in postmenopausal women depending on the levels of Mg, Zn, Ca, Cu, and Fe. The study included 198 healthy postmenopausal women at the average age of 56.26 ± 5.55 years. In the first part of the study, standardized research tools were used, namely the Primary Care Evaluation of Mental Disorders (PRIME-MD) and the Beck Depression Inventory (BDI). The second part involved biochemical analysis of Mg, Zn, Ca, Cu, and Fe levels in blood serum. The lowest Cu levels were observed in women without depressive symptoms (1.07 ± 0.22 mg/l) and the highest in those with severe depressive symptoms (1.19 ± 0.17 mg/l), (p ≤ 0.05). The lowest Mg levels were observed in women with depressive symptoms (14.28 ± 2.13 mg/l), and the highest in women without depressive symptoms (16.30 ± 3.51 mg/l), (p ≤ 0.05). The average serum Mg levels (15.75 ± 3.23 mg/l) decreased compared to the reference values (18.77-24 mg/l). What is striking is a potential relation between the levels of Mg and Cu and depressiveness. Our results indicate to a higher vulnerability to depression in a group of women with lower levels of Mg and higher levels of Cu.

Occurrence of climacteric symptoms in postmenopausal women after prophylactic bilateral ovariectomy

PURPOSE OF INVESTIGATION

To analyse the quality of life in postmenopausal women after prophylactic bilateral ovariectomy depending on the time from menopause.

MATERIALS AND METHODS

The study involved 252 postmenopausal women grouped according to the time from last menstruation: one to five years (group A), five to ten years (group B), and > ten years (group C). All women were ovariectomized during laparotomy performed for benign diseases of the uterus. Climacteric symptoms were measured with the Kupperman Index one day before and three months after surgery.

RESULTS

Highly significant age differences and no substantial BMI differences were demonstrated among the study groups. Before and after surgery climacteric symptoms were reported by 17.06% and 57.8% of women, respectively. After surgery, group A women significantly more often had hot flushes, sweating, nervousness, and sleep disorders, the women in group B significantly more often reported sleep disorders, nervousness, and sweating, and the women in group C significantly more often complained of nervousness.

CONCLUSION

In postmenopausal women, ovaries play the most important role during the first ten years from the last menstruation.

Cardiovascular system diseases in patients with polycystic ovary syndrome - the role of inflammation process in this pathology and possibility of early diagnosis and prevention

Polycystic ovary syndrome is a disorder which affects 5-10% of women in reproductive age. PCOS is a cause of hyperandrogenism, menstrual disorders and infertility. The most common clinical symptoms are hirsutism, acne and obesity. Patients often suffer from metabolic disorders: insulin resistance, hyperinsulinemia, dislipidemia, leading to atherosclerosis and others irregularities of the metabolic syndrome. Patients are in the high risk group for cardiovascular diseases (CVD) development because of the metabolic abnormalities. Obesity is observed in 35-60% of women with PCOS. Lean women with PCOS are also exposed to a greater risk of glucose intolerance development and abnormalities in lipid profile than women without PCOS with comparable BMI. Adipocytes are the source of many compounds of the paracrine and endocrine activity. Some of them are also markers and mediators of inflammation. Increased levels of proinflammatory cytokines in blood can promote atherosclerosis and cardiovascular disease. Markers: IL-18, TNF, IL-6 and hs-CRP are often elevated in patients with polycystic ovary syndrome. An increase in inflammatory markers may be an early indicator of the risk of developing insulin resistance and atherosclerosis, and may become a useful prognostic and therapeutic tool for monitoring patients with PCOS: lean and those with overweight and obesity. Assessment of the concentrations of inflammatory markers may become a very useful test in evaluating the risk of developing atherosclerosis and cardiovascular disease, long before their clinical manifestation. It will also allow for the appropriate prophylaxis.

[New methods of uterine fibroids treatment]

Uterine fibroids are the most common benign tumors of the uterus. Their main symptoms are prolonged menstrual bleeding, leading over time to a secondary anemia, bleeding and spotting between periods, pelvic pain and infertility. It is recognized that fibroids are the most common indication for surgery in gynecology. Currently radical surgical treatment of fibroids is abandon. Ulipristalu acetate is used in pharmacological treatment. This medicine reduces the growth of fibroids. New non-invasive technique is also MR-guided focused ultrasound surgery using thermal tissue destruction by focusing ultrasound beam. Ability to avoid the often crippling surgery makes conservative methods increasingly popular.

The role of serological testing for Chlamydia trachomatis in differential diagnosis of pelvic pain

INTRODUCTION

Pelvic pain is typically associated with pelvic inflammatory disease (PID). The most common cause of PID is Chlamydia trachomatis. The aim of this study was to verify the role of serological testing for Chlamydia trachomatis in patients with suspected PID.

MATERIALS AND METHOD

The retrospective study included 185 patients with pelvic pain hospitalized at the Department of Obstetrics and Gynecology in 2003 and 2004. Titers of anti-Chlamydia trachomatisIgG and IgA were measured by means ELISA immunoassays. Erythrocyte sedimentation rate (ESR), serum concentration of C-reactive protein (CRP) and leukocyte count (WBC) were also determined. Final diagnosis was established on the basis of laparoscopic examination.

RESULTS

The presence of anti-Chlamydia trachomatis antibodies correlated significantly with abnormal values of ESR, WBC and CRP. The most common laparoscopic pathology were pelvic adhesions, typically found in women with elevated titers of anti-Chlamydia trachomatis IgG. Cconclusion. Serological examination for Chlamydia trachomatis is helpful in evaluation of patients with suspected PID. Elevated titers of anti-Chlamydia trachomatis antibodies are frequently associated with laparoscopic evidence of pelvic adhesions and inflammation.

[Role of office hysteroscopy in the diagnosis and treatment of uterine pathology]

Nowadays endoscopic techniques are one of the basic diagnostic and operative methods in gynecology. Laparoscopy and hysteroscopy are the most popular of them. Office hysteroscopy is a modern diagnostic and therapeutic method feasible in an outpatient room because no necessity of anesthesia. It is the first-line procedure in the infertility diagnosis and treatment of uterine pathology such as polyps, submucosal fibroids and adhesions. Limitation of this method is the cervical canal atresia. Contraindications to it are: pregnancy, uterine bleeding, active inflammation of pelvic organs, cervical cancer. Due to the high sensitivity and specificity, simplicity of execution and no need for patient hospitalization, office hysteroscopy becomes important diagnostic and therapeutic procedure in uterine pathologies.

[Pro-health prevention in perimenopausal women with regard to estrogen treatment]

According to the latest demographic forecast in Poland is observed the progressive aging of the population with growing population of perimenopausal women. This is a special time in woman's life, in which there are many metabolic changes, neurovegetative symptoms and mental changes. All of them are connected with decreased concentration of sex hormones. Very important in this period are health behaviors, including healthy lifestyle, regular exercises and proper diet. Highly effective in removing menopausal symptoms is hormone replacement therapy. It also prevents the effects of metabolic disorders. This therapy is primary prevention of cardiovascular diseases and osteoporosis, depression, Alzheimer's and Parkinson's disease and urogenital atrophy. It also has to delay the process of aging. Clinical studies of HERS, WHI and MWS caused extreme caution in the use of hormone replacement therapy and distrust for this therapy between doctors and their patients. It is therefore important to establish priorities for action and individualized therapy, depending on the indications and contraindications for its use.

[Influence of Selected Reproductive Factors and Smoking on Age at Menopause]

Introduction: Early menopause may be associated with serious health risks resulting from, for example, decreased oestrogen levels. This may occur despite hormone replacement therapy. Aim: The aim of this study was the determination of the effect of selected reproductive factors and smoking on age at the onset of menopause in women from Szczecin and surrounding areas. Material and Methods: 305 women after natural menopause were asked to complete a questionnaire, and blood samples were collected from them to test for the levels of follicle stimulating hormone (FSH) and oestradiol (E2). Results: Smoking women experienced menopause on average more than a year earlier than non-smokers, but this difference was not statistically significant. There was no statistically significant effect of age at menarche or first birth on age at the last menstrual period. Conclusions: Age at menarche and first birth were not related to age at menopause. In smoking women, menopause occurred earlier but the difference was not statistically significant.

Rare case of coexistence of primary ovarian carcinoid in mature teratoma with primary serous carcinoma in second ovary--a case report

Ovarian malignant tumours are mostly ovarian cancers. The most frequent ovarian benign lesions are mature teratomas. A very rare ovarian neoplasm is carcinoid. It mostly occurs as a component of mature teratoma, what causes rare diagnosis before surgery. Study presents the case of patient with primary ovarian carcinoid in mature teratoma of one ovary, co-existing with primary epithelial carcinoma of another ovary. Surgical treatment of carcinoid involves adnexectomy or hysterectomy with adnexa and removal of great omenturn, followed by chemotherapy and radiotherapy. In young women with early-stage tumours, treatment can be limited to adnexectomy followed by close monitoring. In the presented case, management associated with the diagnosis of ovarian carcinoid, resulted in the detection of early-stage ovarian epithelial cancer. This case seems to confirm the recommendations to take tissue samples from the other ovary for histopathological evaluation in cases of ovarian unilateral benign tumours.

Immunoexpression of aromatase cytochrome P450 and 17β-hydroxysteroid dehydrogenase in women's ovaries after menopause

Background

Menopause results in a lack of regular menstrual cycles, leading to the reduction of estrogen production. On the other hand, ovarian androgen synthesis is still present at reduced levels and requires expression of several steroidogenic enzymes.

Methods

This study was performed on 104 postmenopausal women hospitalized due to uterine leiomyomas, endometriosis, and/or a prolapsed uterus. Patients were divided into three groups depending on the time from menopause. Group A patients experienced menopause 1–5 years before enrollment in the study (42 women). Group B included women who had their last menstruation 5–10 years before the study (40 women). Group C consisted of 22 women who were more than 10 years past menopause. Hysterectomy or removal of the uterine corpus with adnexa was performed during laparotomy. We evaluated the expression of aromatase cytochrome P450 (CYP 19) and 17β-hydroxysteroid dehydrogenase (17β HSD) by employing immunohistochemistry.

Results

Activity of 17β-HSD and CYP19 was demonstrated in the cytoplasm of stromal cells of postmenopausal ovaries, epithelium cells coating the ovaries, vascular endothelial cells, and epithelial inclusion cysts. However, overall expression of both 17β-HSD and CYP 19 decreased with time after menopause.

Conclusion

Demonstration of the activity of the key enzymes of ovarian steroidogenesis, CYP 19 and 17β-HSD, confirms steroidogenic activity in the ovaries of postmenopausal women. Nevertheless, ovarian steroidogenic activity decreases with time, and its significant decrease occurs 10 years after menopause.

The severity of depressive symptoms vs. serum Mg and Zn levels in postmenopausal women

The aim of this study was to assess the severity of depressive symptoms in postmenopausal women, depending on serum Mg and Zn levels. The study involved 171 postmenopausal women from Poland, who were not using menopausal hormone therapy (MHT). The intensity of depressive symptoms was evaluated using a standard research technique, the Beck Depression Inventory (BDI). The plasma Mg and Zn concentrations were measured. Depressive symptoms of different severity levels were diagnosed in 36.8 % of the women. The mean serum Mg level was 1.53 ± 0.28 mg/dL, and Zn level was 72 ±14 μg/dL. The women with higher serum Mg and Zn levels had less depressive symptoms, and this observation is a precious information which can be used when planning depressive disorder prevention programmes.

[Chronic inflammation and metabolic syndrome in comparison with other signs belonging to the image of polycystic ovary syndrome]

Polycystic ovary syndrome (PCOS) is a disorder which concern even 5-10% of women in reproductive age. PCOS is a cause of hyperandrogenism and menstrual disorders with chronic anovulation. The most common clinical symptoms observed in PCOS are hirsutism, acne and obesity. Patients with PCOS often suffer from metabolic disorders like insulin resistance, hyperinsulinemia, dyslipidemia, arteriosclerosis and other abnormalities of the metabolic syndrome. 35 to 60% of women with PCOS are obese and about 50% of them have insulin resistance and hyperinsulinemia. The pathogenesis of atherosclerosis emphasizes the role of inflammatory processes. There are a number of markers of the inflammation process. They are also observed in PCOS and may indicate an increased risk of cardiovascular disease in women. More than 46% of women with PCOS can be diagnosed with metabolic syndrome. Because of the fact that patients with PCOS are at higher risk group of the earlier development of complications such as diabetes t 2, atherosclerosis, hypertension and cardiovascular system diseases, it is important to carry out metabolic disorders diagnosis in every patient with PCOS. It will help to estimate the risk of complications and allow for the implementation of prevention or treatment of metabolic diseases belonging to the image of PCOS.

Insulin resistance assessment in patients with polycystic ovary syndrome using different diagnostic criteria--impact of metformin treatment

INTRODUCTION AND OBJECTIVE

Polycystic ovary syndrome (PCOS) is one of the most frequent reasons for anovulation in infertile women. It can affect 5%-10% of women of reproductive age. One of the important factors associated with the typical clinical signs and hormonal disorders could be insulin resistance and hyperinsulinaemia. The primary objective of this study was to assess the prevalence of insulin resistance in PCOS women. The secondary objective was to evaluate changes in body mass index (BMI), waist-to-hip ratio (WHR), and insulin sensitivity after 3 months of metformin therapy.

MATERIALS AND METHODS

68 patients were enrolled in the study. In all participants fasting and 2-h post-load glucose and insulin levels, WHR and BMI were evaluated before and after metformin (2 x 850 mg) therapy. Insulin resistance was assessed using G0/I0, G120/I120, and HOMA-IR indexes.

RESULTS

Before the treatment, insulin resistance was observed in 26% patients according to HOMA-IR, and in 16% or 28% according to G0/I0 or G120/I120, respectively. Metformin therapy was associated with improvement in insulin sensitivity in HOMA-IR and G120/I120 defined insulin resistant patients.

CONCLUSIONS

The percentage of insulin resistant PCOS patients differed depending on the method applied. It is necessary to find a single most useful method to measure insulin resistance. Metformin treatment significantly improves insulin sensitivity in insulin resistant patients.

Hormone concentrations in the homogenates of ovarian tissue and blood serum in postmenopausal women not using hormone therapy

Ovaries in postmenopausal women synthesize steroids, mostly androgens. Removal of the ovaries after menopause may be reflected by menopausal symptoms and arterial hypertension observed during postoperative period, along with a significantly increased risk of death due to cardiovascular complications. It is not understood if the clinical consequences of gonad removal at different time points after menopause are similar. The aim of this study was to evaluate ovarian steroidogenesis and consequently to define the role of the ovaries in postmenopausal women depending on the time after menopause. Concentrations of hormones were determined in ovarian homogenates and serum of postmenopausal women. This study included 207 postmenopausal women. They were divided into groups depending on the time after menopause. All participants had laparotomic removal of the ovaries. Concentrations of estradiol, testosterone and androstenedione were measured in ovarian homogenate and serum. The study revealed that ovarian homogenate and serum concentrations of estradiol, testosterone and androstenedione were the highest in women up to 5 years after menopause and since then significantly decreased. This study showed that testosterone, androstenedione and estradiol are synthesized in the postmenopausal ovaries. The peak synthesis of these hormones occurs up to 5 years after menopause and significantly decreases thereafter.

Analysis of pituitary gonadotropin concentration in blood serum and immunolocalization and immunoexpression of follicle stimulating hormone and luteinising hormone receptors in ovaries of postmenopausal women

The participation of gonadotropins in ovarian carcinogenesis is well known and is supported by studies with inhibition of pituitary gonadotropin secretion, which results in a diminished risk of cancer. However, there are few data on localization and expression of Follicle Stimulating Hormone and Luteinising Hormone Receptors (FSHR and LHR) in ovaries of healthy postmenopausal women, and their correlation with FSH and LH concentration in blood serum is unknown. The aim of our study was to analyze gonadotropin concentration in blood serum and the expression of FSHR and LHR in ovaries of 207 postmenopausal women. Patients included in the study were divided into three groups depending on the number of years since menopause. We analyzed the concentration of FSH and LH in blood serum and the expression of FSHR and LHR in ovaries. Ovaries of postmenopausal women showed numerous morphological changes in the cortex and medulla when compared to the structure of ovaries of women at reproductive age. In all groups of patients clefts in the surface epithelium and epithelial inclusion cysts were found. The concentration of FSH and LH in the blood serum of women studied increased significantly with time from menopause. Significant differences between analyzed menopausal groups were found. The highest FSH and LH concentration in blood serum were found in women with the longest period of time from menopause. Quantitatively similar expression of FSHR and LHR was found in ovarian surface epithelial cells, in epithelial inclusion cysts and in the connective tissue cells of ovarian stroma. The intensity of the immunohistochemical reaction decreased with time from menopause and with age.

Immunohistochemical analysis of steroid receptors in ovaries of postmenopausal women--effects of aging and hormone status

Current knowledge on immunolocalization and immunoexpression of steroid hormone receptors, especially estrogen receptor alpha (ER-alpha), progesterone receptor (PR) and androgen receptor (AR) in normal ovaries in postmenopausal women is not complete. The recognition of localization of these receptors in postmenopausal women is crucial, as many of these women receive estro-progestagene therapy, and its participation in the pathogenesis of ovarian cancer should be carefully studied. In our paper we present the results of immunohistochemical studies performed on samples from 100 post-menopausal women (aged: 48 to 60 years) who did not use hormonal therapy. The ovaries were removed during elective operation due to uterine leiomyoma, endometriosis and/or prolapsed uterine. PR, ER-alpha and AR were detected in the normal ovaries of postmenopausal women in stroma and in ovarian surface epithelium, as well as in its invagination and in epithelial inclusion cysts. The expression of PR and AR did not change, while the expression of ER-alpha decreased in time from menopause, and it was also detected in patients more than 10 years after menopause. Women older than 60 were not included in the study. The concentration of selected hormones was measured in the serum. The immunohistochemical expression of PR and AR were similar in all examined patients and did not correlate with FSH, LH, T, A, DHEAS concentrations in serum, while immunohistochemical expression of ER-alpha correlated with FSH, LH, T, A, DHEAS concentrations in serum. The significant correlation of decreasing expression of ER-alpha in normal ovarian tissue and decreasing concentrations of T, A and DHEAS in serum were found, as well as increasing serum concentrations of FSH and LH.

[The results of surgical treatment urinary stress incontinence of Burch and TVT methods independent of position of pelvic organ]

Urinary incontinence is a social disease. In age-various women groups it appears in abort 15-30%. After menopause urinary incontinence frequency increases to 40%. In most cares stress urinary incontinence (SUI) demands surgical treatment. There are many treatment opinions, but there is no 100% effective method.

AIM OF THE STUDY

In this research two surgical treatment methods (Burch suspension vs tension-free vaginal tape - TVT method) for urinary incontinence were compared.

MATERIAL AND METHODS

The study was undertaken in 295 women. After carefully diagnostic (interview, ultrasound, assessment of risk factors) of SUI patients were qualified to Burch suspension or TVT method. Effects were assessed after 24 postoperative months.

RESULTS

Total lost of complaints was obtained in 65% after TVT In case of retroflexio of uterus percent of recoveries was lower--about 30%, independently on a type of operation. Even small agree of cervical descent get worse a treatment effects. Clinical effects were confirmed by ultrasound (angle between urethra and bladder, distance between symphysis and urethra before and treatment).

CONCLUSIONS

Result of surgical treatment of urinary incontinence is about 65% of improvement regardless of surgical method. Retroflexio of uterus and cervical descent make this result even worse.

The bone mass density in postmenopausal women using hormonal replacement therapy in relation to polymorphism in vitamin D receptor and estrogen receptor genes

The aims of the study were as follows: (1) To identify the differences in spinal body mass density (BMD) in relation to polymorphism in vitamin D receptor (VDR) and estrogen receptor-alpha (ERalpha) genes in untreated women with postmenopausal osteoporosis. (2) To assess the efficacy of treatment in women with postmenopausal osteoporosis in relation to polymorphism in VDR and ERalpha genes. (3) To find the estradiol concentration necessary to protect bone tissue in patients with a given polymorphism in VDR and ERalpha genes.

METHODS

The study included 44 postmenopausal women with primary osteoporosis who used cyclic hormonal replacement therapy (HRT) for a year. The polymorphism of ERalpha and VDR genes were evaluated. We also determined the age, body mass index and spinal BMD before and after 12 months of administration the HRT.

RESULTS

We found a significant spinal BMD increase, what is connected with ERalpha genotype and both VDR and ERalpha genes. There is no such a correlation observed in polymorphism of VDR gene.

CONCLUSIONS

(1) There is no relationship between VDR and ERalpha genes polymorphism and the stage of osteoporosis related to the spinal BMD value before treatment. (2) The XX, PP or Bb markers or only X, P, B alleles are connected with a significant decrease of treatment efficacy. (3) Estradiol serum concentration before and during HRT is not dependent on the polymorphism of VDR and ERalpha genes.

[Pharmacotherapy for pelvic endometriosis in women]

Pelvic endometriosis in women is a very common disease. The incidence of this condition in Poland in reproductive age women is about 7-15%, and as much as 50% of cases is diagnosed in patients with co-existing infertility and/or pain and adhesion of a true pelvis. The choice of a therapeutic method depends on the patient's age, stage of the disease, desire for pregnancy, the presence of adhesion, focus localization and a reaction to previous treatment. Currently, the most popular is surgical treatment sometimes followed by pharmacotherapy. Pharmacological treatment includes hormone therapy and symptomatic treatment, also the use of painkillers. Hormonal agents are administered to suppress ovarian activity and cause atrophy of ectopic foci of endometrium. At present, post-surgical pharmacotherapy for endometriosis uses mainly such hormones as: the Combined Oral Contraceptive Pill (COCP), progestagens, danazol, GnRh (gonadotropin-releasing hormone) analogues, aromatase inhibitors and other less common drugs. Also other therapeutic procedures are recommended in endometriosis treatment, procedures which support and in certain clinical situations even replace classical pharmacological methods. Some of them are immunotherapy and a diet rich in isoflavones, organic compounds which modulate estrogen receptor activity. Numerous clinical trials proved that preoperative pharmacotherapy does not improve treatment results and is not applicable to endometriomas in women. On the other hand, postoperative pharmacotherapy still ignites controversy. As maintained by the most recent literature, in the case of mild endometriosis (clinical Stage I and II according to the American Society for Reproductive Medicine) endometrial ablation has better effects than observation only, however postoperative pharmacotherapy does not improve the results of treatment. In more severe cases (clinical Stage III and IV), the best results are achieved by the combined treatment. Nevertheless, no randomized research has been carried out on a wide scale in this group of patients.

[Epidemiology and treatment for urinary incontinence and pelvic organ prolapse in women]

Urinary incontinence (UI) is defined as uncontrolled urine leakage through an urethra. At present, the following types of UI can be specified: stress incontinence (SI), urge incontinence (UI), mixed incontinence (MI), overflow incontinence (OI) in which the bladder becomes too full because it cannot be fully emptied, and functional incontinence (FI). Incontinence is one of the most common chronic diseases in women and is found in 17-60% of the whole population. In most patients, SI is combined with pelvic organ prolapse. The basic risk factors mentioned as contributing to these two conditions are obstetrical past and gynaecological history and atrophic changes in the urogenital area. There are also a number of diseases related to the increase in intra-abdominal pressure, such as obesity chronic constipation and diseases associated with persistent cough. Other factors leading to pelvic organ prolapse include hard physical work, some professional sports, connective tissue disorders, neuropathy and disturbed innervation of the pelvic floor. To deal with stress incontinence (SI), conservative and surgical treatment is employed. In the first degree intensity, it is mainly physiotherapy, electrical stimulation of the pelvic floor muscles, lifestyle modification and reduction of body mass. When the SI symptoms are more severe, surgical treatment is usually preferred. From among many methods, these presently used are Burch and sling operations. On the other hand, surgical treatment for pelvic organ prolapse involves colpoperineoplasty with the use of polypropylene mesh (Prolift), colporrhaphy by double TOT approach method, median colporrhaphy, Cooper's ligament or sacrospinous ligament colpopexy, and attachment of the uterus to the sacrum. The results of surgical treatment depend on co-occurrence of risk factors, the surgical method chosen, the lapse of time from the surgery and the type of the applied biomedical material.

Human postmenopausal ovary--hormonally inactive fibrous connective tissue or more?

The ovary undergoes several changes after the menopause. In this period, the main structural changes in both the cortex and medulla were observed. In the cortex, they included: 1) reduction of its thickness; 2) epithelial inclusions forming cysts; 3) blurring the line between medulla and cortex; 4) reduction of follicles number; 5) tendency to fragmentation of corpora albicantia; 6) surface epithelium invaginations. Whereas the changes in the medulla included: 1) fibrosis and scars in stroma; 2) architectonical changes in blood vessels with hyalinization of walls and constriction of lumen. The loss of follicles and several changes in the ovary are due to apoptotic processes. Despite age related atrophic changes, the postmenopausal ovary is not devoid of hormonal activity. Our results are coherent with the reports of other researchers, and reveal that postmenopausal ovary produces trace quantities of steroid hormones, mainly androgens, and confirm the presence of steroid receptors and activity of main enzymes involved in steroidogenesis process.

[Comparative analysis of the effects of iodine prophylaxis in children and adolescents from the region of Szczecin]

The research on iodine metabolism carried out in the '80s and '90s of the twentieth century revealed moderate iodine deficiency in the area of the whole Poland. These results contributed to the introduction of the populational iodine prophylaxis programme consisting in the obligatory iodizing of kitchen salt. In 2002-2003, the research was conducted in the region of Szczecin, the aim of which was to assess the efficiency of this model of iodine prophylaxis. As it was observed, the incidence of goitre among children considerably reduced, however, determination of ioduria (iodine level in the urine) proved that slight iodine deficiency was still present. The aim of our research was the renewed assessment of iodine prophylaxis results in the randomly chosen group of children and adolescents from the region of Szczecin.

MATERIAL AND METHODS

The study was undertaken in the 2006. In random selected groups of children and adolescents in Szczecin region. The patients administered vitamins or minerals enriched with iodine were excluded from a study. The study included 314 persons aged 13 to 16 years, 151 boys (48%) and 163 girls (52%). Iodine excretion with urine was determined on the basis of catalytic Sandell-Kolthoff reaction. Radioimmunometric and radioimmunological methods were used for the determination of thyrotropin (TSH) and free thyroxine (FT) concentrations. Collected data were then analyzed using sophisticated computer-based statistic program.

RESULTS

In the research conducted in 2002-2003, median urinary iodine concentration was 81.6 microg/l, and the percentage of children with abnormal ioduria excedeed 65%, where slight iodine deficiency (50-100 microg/l) was observed in 43% of children, medium (20-49 microg/l)--in 19%, and serious iodine deficiency (< 20 microg/l) was found in--4.4%. At present, median iodine concentration increased up to 108.1 microg/l, and the proportion of children showing normal ioduria is 58.4% including 5% with urinary iodine concentration exceeding 200 microg/l. The percentage of children with slight and medium iodine deficiency considerably reduced to 21.9% and 10,4% respectively, but the proportion of children with serious deficiency of this element increased (up to 9%). According to the results from 2002-2003, serum concentration of free thyroxine was 14.58 pmol/l, and thyrotropin--2.0 microU/ml. In our results, significantly higher median FT4 concentration (17.54 pmol/l) as well as insignificant increase in median TSH concentration (to 2.1 microU/ml) were observed. Similarly to the previous research, no correlation was found between ioduria and hormone levels. Neither considerable differences in urinary iodine concentrations nor in serum hormone levels were observed between sexes.

CONCLUSIONS

(1) Proper median urinary iodine concentration and satisfactory proportion of people with normal ioduria are an important result of the currently conducted iodine prophylaxis programme in the region of Szczecin. (2) The rising percentage of individuals with high urinary iodine concentrations suggests that there is the necessity for extended research on the assessment of incidence of autoimmune thyroid diseases.

[Changes of the localization and function of estrogen receptor alpha in the ovaries of postmenopausal women comparing to those of reproductive-age]

The distribution of estrogen receptors in the ovaries of postmenopausal women is a very up-to-date subject in the aspect of advantages and complications of estrogen replacement therapy and the risk of estrogen-dependent neoplasms of reproductive organs. Both ovarian structure and immunolocalization of estrogen receptor alpha (ERalpha) in postmenopausal women are substantially different than they are in women at the reproductive-age. The most important changes in the ovarian structure after menopause include a blurring of the line between medulla and cortex, the reduction of cortex thickness, formation of epithelial inclusion cysts, reduction of follicle number, tendency to fragmentation of corpora albicantia, and stromal invaginations of the surface epithelium. In the ovaries of reproductive-age women, ERalpha is observed in stroma, in protective, granular and interstitial cells as well as corpus luteum lutein cells. After menopause it is found in the cells of stroma, inclusion cysts and the ovarian surface epithelium (OSE). Particularly vital change in the structure of postmenopausal women's ovaries in the aspect of the development of estrogen-dependent neoplasms is associated with the occurrence of epithelial inclusion cysts and the presence of ERalpha in their epithelium. 90% of ovarian epithelial neoplasms, and especially serous cancers, are known to develop from epithelial cysts and (or) in OSE. On the other hand, finding ERalpha in the ovarian stroma and in luteal and paraluteal cells of the corpus luteum, especially in perimenopausal women, proves the auto- and (or) paracrine regulation of these cells; it is also an evidence for steroidogenic activity in the ovary.

Serum magnesium concentration in drug-addicted patients

Drug addiction is a complex problem which leads to many somatic, psychic and social diseases. It is accompanied by the disturbed metabolism of various macro and micronutrients. The aim of this study was to assess serum magnesium concentration in drug-addicted patients and analyze whether Human Immunodeficiency Virus (HIV) infection and methadone treatment affect the level of serum magnesium in these patients. The examination was conducted in a group of 83 people - patients of Szczecin-Zdroje Psychiatric Hospital (Poland). They were 21 to 49 years old, and the mean age was 32 +/- 7 years. The control group consisted of 81 healthy individuals. Flame atomic-absorption spectrometry method was used to determine the magnesium concentration. The total serum magnesium concentration was calculated for the whole patient group, subgroups of women and men, a subgroup of people infected with HIV, and a subgroup receiving methadone substitution treatment. How magnesium behaves depending on age and addiction period, was checked. The mean concentration of magnesium in blood serum of the patients examined was 0.57 mmol/L, which was significantly lower than in the control group. In the subgroup of men it was 0.57 mmol/L, and in the subgroup of women - 0.55 mmol/L; the differences were not statistically significant. In the patient group nobody had the appropriate magnesium concentration in blood serum. No significant correlation was found between the magnesium concentration, age of the patients and addiction period. In the subgroup of seropositive people the mean concentration of magnesium was 0.55 mmol/L, and in the subgroup of non-infected patients - 0.58 mmol/L; the difference was not statistically significant. The mean concentration of magnesium in the subgroup treated with methadone was 0.59 mmol/L, and in the subgroup not involved in this type of therapy - 0.55 mmol/L; it was not a statistically significant difference.

Flow cytometry application in the assessment of sperm DNA integrity of men with asthenozoospermia

Sperm genomic integrity and ultrastructural features of ejaculated spermatozoa contributing to the assessment of gamete fertility potential in patients with asthenozoospermia are discussed. The proportion of TUNEL-positive cells was significantly higher in the semen of patients with low sperm motility (n=40; p<0.01) as compared to men with normal sperm motility (n=54). Sperm DNA fragmentation negatively correlated (n=94) with sperm motility, sperm concentration, and integrity of the sperm cellular membrane (HOS-test). Two categories of patients were distinguished: (1) patients (23 out of 94 subjects) with < or = 4% of TUNEL-positive cells and (2) patients (71 subjects) with 4% of TUNEL-positive cells. A significant difference was noted in the sperm motility and HOS-test results between patients from both groups. Large numbers of immature spermatozoa with extensive cytoplasmic retention, ultrastructural chromatin and midpiece abnormalities, and conglomerates containing sperm fragments were present more frequently in the semen of asthenozoospermic subjects with >4% of TUNEL-positive sperm cells. Low sperm motility seems to be accompanied by serious defects of gamete chromatin expressed as diminished sperm genomic integrity and abnormal DNA condensation and by defects of sperm midpiece. These abnormalities may reflect developmental failure during the spermatogenic remodeling process. The DNA fragmentation test may be considered as an additional assay for the evaluation of spermatozoa beside standard analysis and taken together with electron microscopy may help to determine the actual number of "healthy" spermatozoa thereby playing an important role during diagnosis and treatment of male infertility.

The localization of estrogen receptor alpha and its function in the ovaries of postmenopausal women

The localization of estrogen receptor alpha (ERalpha) in the ovaries of postmenopausal women is a very up-to-date topic in the aspect of using estrogens therapy in the clinical situations of different type. In ovaries of reproductive age women ERalpha is present in ovary stroma, theca and granulosa cells, ovary surface epithelium (OSE) and in corpus luteum. The ovaries of postmenopausal women are smaller than those of women at the reproductive age, the division into cortex and medulla gets blurred, the ovaries have no follicles any longer, and the stroma is mainly composed of fibrous connective tissue, corpora albicantia, nerves, and blood and lymphatic vessels. The aim of our study was to investigate the immunolocalization and immunoexpression of ERalpha in the ovaries of postmenopausal women. The study involved 50 postmenopausal women who had their ovaries removed by laparotomy due to non-neoplastic diseases of the uterus. The women were divided into 3 groups (A, B, and C) depending on the time that had passed since the last menstruation. Group A consisted of women who had their last menstruation no more than 5 years earlier, in group B menopause occurred 5 to 10 years earlier, group C was composed of patients who had the last menstruation over 10 years earlier. In all the patients concentrations of follicle stimulating hormone (FSH), luteinizing stimulating hormone (LH), estradiol (E2), testosterone (T), androstendione (A) and dehydroepiandrosterone sulphate (DHEAS) in blood plasma were measured. Ovarian tissue was obtained during surgery. For morphological studies, ovaries were fixed in Bouin;s solution and 4% formalin and embedded in paraffin. Morphological analysis was carried out after hematoxylin-eosin (HE) staining. Comparing to groups A and B, the ovaries in group C contained a small number of corpora albicantia located in the medullary part as well as thinned blood vessels and few lymphatic vessels and nerves. For immunoohistochemical expression of ERalpha paraffin-embedded specimens fixed in 4% buffered formalin were used. The sections were next incubated with monoclonal mouse anti-human ERalpha antibody (N 1575 Dako, Denmark). Immunohistochemical nuclear expression of ERalpha in OSE, in epithelial inclusion cysts, in stroma, and in group A also cytoplasmic expression of ERalpha in luteal and paraluteal cells of disappearing corpus luteum were revealed. Immunohistochemical expression of ERalpha seems to decrease in the ovaries of women after menopause.

Apoptosis in ovarian cells in postmenopausal women

Apoptosis is a natural process which accompanies human ovary from the moment of birth until old age. While it is a well-known process at the reproductive age, it still needs to be thoroughly examined when referring to the postmenopausal age. The study involved 30 postmenopausal women who had their ovaries removed by laparotomy due to nonneoplastic diseases of the uterus. The women were divided into 3 groups depending on the time that had passed since the last menstruation. Group A consisted of women who had their last menstruation no more than 5 years earlier. In group B menopause occurred 5 to 10 years earlier. Group C was composed of patients who had the last menstruation over 10 years earlier. In all the patients concentrations of follitropin (FSH) and estradiol (E2) in blood plasma were measured. Ovarian tissue was obtained during surgery. For morphological studies, ovaries were fixed in Bouin's solution and 4% formalin and embedded in paraffin. Morphological analysis was carried out after hematoxylin-eosin (H-E) staining. For histochemical detection of apoptotic cells (in situ localization of fragment DNA), the TUNEL method was used. The expression of caspase-3 positive cells was determined immunohistochemically in paraffin-embedded specimens. Comparing to groups A and B, the ovaries in group C contained small number of corpora albicantia located in the medullary part as well as thinned blood vessels and few lymphatic vessels and nerves. In contrast to group A where the number of TUNEL-positive cells was high and caspase-3 expression was observed, no TUNEL-positive nuclei and caspase-3 expression were found in the examined ovaries of group C women.