Associations between Single Nucleotide Polymorphisms from the Genes of Chemokines and the CXCR2 Chemokine Receptor and an Increased Risk of Endometrial Cancer

Significant relationships with endometrial cancer were demonstrated, both for CCL2, CCL5, and CXCL8 chemokines and for the chemokine receptor CXCR2. The reported case-control study of genetic associations was designed to establish the role of selected single nucleotide polymorphisms (SNPs) of the CCL2, CCL5, CXCL8, and CXCR2 genes in the onset and progression of endometrial cancer. This study was conducted on 282 women, including 132 (46.8%) patients with endometrial cancer and 150 (53.2%) non-cancerous controls. The genotypes for CCL2 rs4586, CCL5 rs2107538 and rs2280789, CXCL8 rs2227532 and -738 T>A, and CXCR2 rs1126580 were determined, using PCR-RFLP assays. The AA homozygotes in CCL5 rs2107538 were associated with more than a quadruple risk of endometrial cancer (p ≤ 0.050). The GA heterozygotes in the CXCR2 SNP were associated with approximately threefold higher cancer risk (p ≤ 0.001). That association also remained significant after certain adjustments, carried out for age, diabetes mellitus, arterial hypertension, or endometrial thickness above 5 mm (p ≤ 0.050). The A-A haplotypes for the CCL5 polymorphisms and T-A-A haplotypes for the CCL2 and CCL5 SNPs were associated with about a twofold risk of endometrial cancer (p ≤ 0.050). In conclusion, CCL2 rs4586, CCL5 rs2107538 and rs2280789, and CXCR2 rs1126580 demonstrated significant associations with an increased risk of endometrial cancer.

The Utility of Rectal Water Contrast Transvaginal Ultrasound for Assessment of Deep Bowel Endometriosis

Deep infiltrating endometriosis (DIE) is characterized by the presence of endometrial tissue outside the uterine cavity that infiltrates at least 5-mm deep below the peritoneal layer. Imagining examinations are the first-choice methods to detect DIE. The aim of this study is to assess whether rectal water contrast transvaginal sonography (RWC-TVS) can be a useful tool for the estimation of the size of deep bowel endometriotic nodules. This retrospective study includes 31 patients subjected to RWC-TVS who underwent surgery due to deep bowel endometriosis between January 2021 and December 2022. Nodule dimensions measured via ultrasound were compared to those of histopathological samples taken after surgery. In total, 52% of patients had endometriosis limited only to the intestines, 19% had endometriotic nodules located at uterosacral ligaments and posterior vaginal fornix, 6% at the anterior compartment, and 13% at a different location. Additionally, 6% of patients had nodules at more than two locations. In all but one case, the intestinal nodules could be seen on RWC-TVS images. The largest nodule dimension measured via RWC-TVS and the size of the equivalent histopathological sample correlated (R = 0.406, p = 0.03). Thus, RWC-TVS allows for the detection of DIE and moderate estimation of the nodule sizes and should be practiced during a diagnostic process.

The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions

Endometriosis is a common condition associated with debilitating pelvic pain and infertility. A genome-wide association study meta-analysis, including 60,674 cases and 701,926 controls of European and East Asian descent, identified 42 genome-wide significant loci comprising 49 distinct association signals. Effect sizes were largest for stage 3/4 disease, driven by ovarian endometriosis. Identified signals explained up to 5.01% of disease variance and regulated expression or methylation of genes in endometrium and blood, many of which were associated with pain perception/maintenance (SRP14/BMF, GDAP1, MLLT10, BSN and NGF). We observed significant genetic correlations between endometriosis and 11 pain conditions, including migraine, back and multisite chronic pain (MCP), as well as inflammatory conditions, including asthma and osteoarthritis. Multitrait genetic analyses identified substantial sharing of variants associated with endometriosis and MCP/migraine. Targeted investigations of genetically regulated mechanisms shared between endometriosis and other pain conditions are needed to aid the development of new treatments and facilitate early symptomatic intervention.

Long Non-Coding RNA SNHG4 Expression in Women with Endometriosis: A Pilot Study

BACKGROUND

Endometriosis is a chronic disease of the genital organs that mainly affects women of reproductive age. The analysis of long non-coding RNA (lncRNA) in endometriosis is a novel field of science. Recently, attention has been drawn to SNHG4, which is incorrectly expressed in various human diseases, including endometriosis.

AIM

The aim of this pilot study was to analyze the expression of lncRNA small nucleolar RNA host gene 4 (SNHG4) and to investigate its significance in endometriosis.

MATERIAL AND METHODS

LncRNA SNHG4 expression was investigated in paraffin blocks in endometriosis patients (n = 100) and in endometriosis-free controls (n = 100) using a real-time PCR assay.

RESULTS

This study revealed a higher expression of SNHG4 in endometriosis patients than in controls. A statistically significant relationship between expression level and SNHG4 was found in relation to The Revised American Society for Reproductive Medicine classification of endometriosis, 1996, in the group of patients with endometriosis.

CONCLUSION

This pilot study has revealed that gene expression in SNHG4 plays an important role in the pathogenesis of endometriosis.

Chemokine expression in patients with ovarian cancer or benign ovarian tumors

INTRODUCTION

Chemokines play a crucial role in tumor growth and progression according to proangiogenic and immunosuppressive action. The aim of this study was to investigate the serum levels of selected chemokines in patients with ovarian cancer or benign ovarian tumors to assess their role in tumorigenesis and their potential use in preoperative diagnosis of an adnexal mass.

MATERIAL AND METHODS

The study group consisted of 59 women with ovarian cancer: 17 epithelial ovarian cancer (EOC) patients and 42 women with benign ovarian tumors. We measured in sera obtained preoperatively the level of CA125 and a panel of 5 chemokines - CX3CL1/fractalkine, CXCL1/GRO-α, CXCL12/SDF-1, CCL20/MIP-3α and IL-17F - using the chemiluminescence method with multiplexed bead based immunoassay.

RESULTS

CX3CL1 was significantly elevated in sera of advanced ovarian cancer patients compared to women with benign ovarian tumors. The significant elevation of CXCL1 was also observed (both early and advanced stages). A similar pattern was present with the standard ovarian cancer marker CA125. In our patients with endometriotic cysts CA125 levels were significantly higher than in women with other benign tumors, whereas all analyzed chemokines had similar serum titers in patients with endometriotic vs. other benign ovarian cysts.

CONCLUSIONS

CX3CL1 and CXCL1 are elevated in sera of EOC patients, which indicates their role in cancer development. Moreover, they might be useful in preoperative differential diagnosis of ovarian tumors, especially as they were not elevated in cases of endometriosis.

Is serum anti-Müllerian hormone (AMH) assay a satisfactory measure for ovarian reserve estimation? A comparison of serum and peritoneal fluid AMH levels

BACKGROUND

Clinical cases have been reported with women who got pregnant with confirmed low serum anti-Müllerian hormone (AMH) concentrations, thus demonstrating that low serum AMH concentration cut-points could be fairly specific for poor ovarian response (POR) to gonadotrophin stimulation, but not for pregnancy. That observation prompted the question whether serum AMH concentration accurately corresponded to the whole amount of AMH secreted by granulosa cells.

OBJECTIVES

To measure AMH levels in peritoneal fluid and their correlations with serum AMH concentrations.

MATERIAL AND METHODS

The reported study involved 48 female patients, aged 18-40 years, diagnosed with benign ovarian cysts and qualified for a laparoscopic cystectomy. Prior to surgery, the ovarian reserve was assessed using serum AMH concentration assay. The peritoneal fluid was also collected during the laparoscopy and AMH concentrations in peritoneal fluid were measured.

RESULTS

The AMH present in the peritoneal fluid strongly correlated with AMH levels in blood serum (r = 0.54; p < 0.001) and higher serum AMH concentrations corresponded to higher AMH concentrations in the peritoneal fluid. There was also a significant correlation between AMH levels in serum and in peritoneal fluid, collected from patients with endometrioma and other benign cysts (r = 0.61; p = 0.001 vs r = 0.43; p = 0.03).

CONCLUSIONS

The AMH is present in the peritoneal fluid and its concentrations significantly correlate with AMH levels in serum. The assessment of AMH concentration in the peritoneal fluid may be a valuable complement to the evaluation of ovarian reserve and the diagnosis of infertility after adnexal surgery.

Polymorphisms in the 3'UTR Region of ESR2 and CYP19A1 Genes in Women With Endometriosis

OBJECTIVE

ESR2 and CYP19A1 genes play a major role in the hormonal control of women with endometriosis. The aim of the study was to analyze single nucleotide polymorphisms (SNPs) in the 3'UTR region of ESR2 and CYP19A1 genes. The study aimed at localisation of new polymorphisms, the nucleotide variants of which determine the level of susceptibility to endometriosis.

STUDY DESIGN

The study included n = 200 patients: 100 with endometriosis and 100 healthy controls. The Sanger's sequencing method was applied for polymorphism analysis.

RESULTS

Statistically significant correlations were identified between new, not previously described, two SNPs of ESR2 gene and endometriosis: rs4986938 (G>A) and rs928554 (A>G). In the case of rs4986938 polymorphism, the genotype AA was found to decrease the risk of endometriosis (OR = 0.24 95 % PU 0.05-1.22, p = 0.04). Analysis of the rs928554 polymorphism revealed that the occurrence of the AG genotype reduced the risk of endometriosis (OR = 0.38 95 % PU 0.21-0.71, p = 0.002). There were no differences in the distribution of genotypes of the polymorphisms rs10046 (C>T) and rs4646 (C>A) of CYP19A1 gene between patients and control.

CONCLUSIONS

Further studies are necessary in groups with higher numbers of patients to explain whether the above-mentioned polymorphisms may be the risk factors for endometriosis.

Analysis of preoperative blood platelet parameters in terms of diversity of epithelial ovarian cancer

Smouldering inflammation, thrombocytosis, and platelet hyper-reactivity are linked to malignancy. The relationships between preoperative diagnostic blood morphology parameters and cancer have been the focus of much interest, because some of these parameters are correlated with advanced cancer stages and poor patient survival rates. This study aimed to perform an observational, retrospective analysis of the intradiversity of blood platelet parameters in patients with different International Federation of Gynaecology and Obstetrics (FIGO) stages and different histological types of epithelial ovarian carcinomas (EOC), and also an analysis of the overall survival rate.In all, 94 EOC patients were included in this analysis (23 mucinous, 33 serous, 20 undifferentiated, 14 endometrioid, and 4 clear cell carcinoma cases). Peripheral blood samples were collected and analyzed before drug or surgical treatment.The platelet-to-neutrophil ratio (PNR) was related to the histological type of EOC, particularly mucinous carcinoma. In patients with mucinous cancer, the PNR was significantly lower compared with patients with nonmucinous cancer, and this parameter distinguished between mucinous and nonmucinous groups of patients (area under receiver-operating characteristic [ROC] curve 0.721 ± .056; sensitivity 82.6%; specificity 61%; P < .001; ROC analysis), regardless of the FIGO stage. Moreover, elevated PNR values were correlated with lower survival rate of EOC patients.The reduced PNR, similar to the lower level of cancer antigen 125, is characteristic for mucinous ovarian carcinoma patients. Moreover, elevated PNR index might correlate with poor survival of patients.

[The statement of Polish Society's Experts Group concerning diagnostics and methods of endometriosis treatment]

Endometriosis is defined by endometrial glands and stroma outside of the endometrial cavity Three types of endometriosis have been described: peritoneal endometriosis, ovarian endometriosis and deep infiltrating endometriosis. Endometriosis afflicts 6-15% of women population. It occurs mainly in the group of women in reproductive age, but also in the group of minors and approximately 3% of women after menopause. Within the group of women suffering from infertility the frequency of endometriosis increased to 35-50% of cases. Endometriosis is associated with pain symptoms which can bear the character of pain occurring periodically and altering into constant pain, dysmenorrhea, dyspareunia, dysuria and dyschezia. The correlation between the stage of endometriosis and intensity of pain symptoms not always has to be proportionate. Laparoscopy can be perceived as a standard procedure in endometriosis diagnostics as it allows simultaneous treatment. Profound interview as well as visual diagnostics (USG, MRI) should precede laparoscopy Treatment of endometriosis can be divided into pharmacological and surgical treatment, which can be invasive or non-invasive. The type of treatment depends on patient's age and her procreation plans, occurring ailments and endometriosis type. Important role is played by adjuvant treatment such as appropriate diet and lifestyle. Treatment of advanced endometriosis should be conducted in reference centres that are appointed with adequate equipment and have the possibility of interdisciplinary treatment. Presented standards can digest and outline the order of proceedings both in diagnostics and endometriosis treatment. The research group believes that the above compilation will facilitate undertaking appropriate decision in diagnosis and treatment of the disease, which will subsequently contribute to therapeutic success.

[Single nucleotide polymorphisms of VEGF gene in endometriosis]

Endometriosis is a common gynaecological disease of unknown etiology. Angiogenesis appears to be one of the processes involved in its pathogenesis. Angiogenic factors VEGF level is increased in patients with endometriosis. Studies have shown that endometriosis maybe associated with VEGF single nucleotide polymorphism (SNP) polymorphisms. Results from studies that assayed VEGF polymorphism in endometriosis are reviewed. Data in the literature suggest that VEGF SNPs such as: -460C/T +405G/C and 936C/T seem to be a risk factor for endometriosis.

135G>C and 172G>T polymorphism in the 5' untranslated region of RAD51 and sporadic endometrial cancer risk in Polish women

BACKGROUND

Despite advanced diagnostic and therapeutic procedures, endometrial cancer (EC) is still responsible for high morbidity and mortality of women. The genetic variability in RAD51 may contribute to the appearance and progression of various cancers including EC.

AIM

We investigated the association of polymorphisms in the DNA repair genes RAD51 135G>C and 172G>T with endometrial cancer risk.

MATERIAL AND METHODS

The genotypes of RAD51 135G>C and 172G>T polymorphism were determined by PCR-RFLP methods in endometrial tissue of 240 cancer subjects and 240 healthy subjects who served as controls.

RESULTS

In the present work we demonstrated a significant positive association between the RAD51 C/C genotype and endometrial carcinoma, with an adjusted odds ratio (OR) of 13.0 (p < 0.0001). The distribution of genotypes for 135G>C SNP in endometrial cancer patients vs. controls was: 10% vs. 27% for GG, 13% vs. 58% for GC and 77% vs. 15% for CC genotype, respectively. Variant 135C allele of RAD51 increased the cancer risk (OR = 1.81; 95% CI 0.11-2.93, p = 0.022). The higher risk of EC occurrence was associated with the combined C135C-G172T genotype (OR = 7.69; 95% CI 3.45-17.12).

CONCLUSION

The results indicated that the polymorphism 135G>C of the RAD51 gene may be positively associated with endometrial carcinoma in the Polish population. Further studies, conducted on a larger group, are required to clarify this point.

Single nucleotide polymorphism in DNA base excision repair genes XRCC1 and hOGG1 and the risk of endometrial carcinoma in the Polish population

BACKGROUND

Polymorphisms in the human oxoguanine glycosylase 1 ( hOGG1 ) and X-ray repair cross-complementing 1 ( XRCC1 ) genes have been extensively studied in the association with various human cancers such as endometrial cancer.

MATERIAL AND METHODS

The genotype analysis of hOGG1 Ser326Cys and XRCC1 Arg399Gln gene polymorphisms for 150 endometrial cancer patients and 150 controls of cancer-free subjects, in the Polish population, were performed using PCR-based restriction fragment length polymorphism (PCR-RFLP).

RESULTS

Although there were no significant (p > 0.05) differences in the frequencies of genotypes or alleles of hOGG1 genes between patients and controls, the frequency of the XRCC1 399Gln allele was significantly greater in endometrial cancer patients compared with controls (p = 0.033) with an odds ratio of 1.39 (95% confidence interval 0.99 to 1.95). The distributions of genotypes and alleles of the genes hOGG1 and XRCC1 were not significantly associated with different grades of endometrial cancer (p > 0.05).

CONCLUSION

In conclusion, these findings indicated that XRCC1 Arg399Gln polymorphism may be a genetic determinant for developing endometrial cancer. The hOGG1 Ser326Cys may not play an important role in susceptibility to endometrial cancer in Polish women.

[Comparative analysis of abnormal Pap smear and the results of histopathological examination of specimens from the cervix of the programme in-depth diagnosis cervical cancer conducted at the of Operational Gynecology Department ICZMP in Lodz]

INTRODUCTION

Cervical Cancer Screening Program has been operational in Poland for over four years. Colposcopy and guided biopsy methods constitute an essential part of population-based screening, enable stating right diagnosis and planning treatment procedures.

AIM

The aim of the following study was to analyse the diagnostic acuity of cyto- and histopathological examination.

RESULTS

We examined 510 patients with the following result of cytological smear: ASCUS--265 women (51.96%), LSIL--167 cases (35.75%), HSIL--78 women (15.29%). Complete agreement between cytological smear and guided biopsy histopathology was observed among 81.13% cases of ASCUS, in 88.02% of women with LSIL and in 76.92% cases with the diagnosis of HSIL. As with cytology-biopsy comparisons, discordant cases were significantly more frequent in the group with stated HSIL than among patients with the diagnosis of ASCUS or LSIL (p<0.001).

CONCLUSIONS

1. High cyto-histopathological accordance (82%) has been obtained, what is comparable with the data in literature. 2. The highest cyto- histopathological compatibility was obtained in the group of patients with LSIL--over 88%, and the lowest in the group of patients with HSIL--less than 77%. 3. Failure to confirm the histopathological diagnosis of cytological HSIL requires further molecular and morphological evaluation.

Expression of estrogen and progesterone receptor genes in endometrium, myometrium and vagina of postmenopausal women treated with estriol

CONTEXT AND OBJECTIVE

Estriol is an estrogen with considerably weaker stimulatory effects on endometrial proliferation than estradiol. A study was conducted to determine the level of estrogen receptors (ERs) and progesterone receptors (PRs) in women who received 14-day vaginal estriol therapy, compared with those who did not receive this therapy. ER and PR gene expression was analyzed in the endometrium, myometrium and vagina of postmenopausal women treated with estriol.

DESIGN AND SETTING

Analytical cross-sectional study, at the Research Institute of the Polish Mothers' Memorial Hospital, Lodz, Poland.

METHODS

Twenty-seven postmenopausal women (57-74 years of age) were included in the study. All of them were waiting for per vaginam hysterectomy or plastic surgery on the vagina and perineum because of uterine prolapse. ER and PR gene expression was determined by means of the technique of reverse transcription polymerase chain reaction (RT-PCR).

RESULTS

In the estriol-treated patients, in comparison with the control group, a significant increase in ER gene expression was observed in the endometrium and vagina, while enhanced PR gene expression was found in the endometrium. However, under histological examination of the endometrium, estrogen stimulation of low and medium degree was diagnosed for 21.4% and 14.3% of the estriol-treated women, respectively.

CONCLUSION

The results obtained suggest that the women who received 14 days of treatment with vaginal estriol had higher ER and PR mRNA levels. No difference between these groups regarding endometrial proliferation was observed.

[Laparoscopic dissection of uterine artery and coagulation utero-ovarian ligament for the treatment of symptomatic myomas]

OBJECTIVES

Our purpose was to evaluate the effects and safety of laparoscopic dissection of the uterine artery and coagulation of the utero-ovarian ligament in treating symptomatic myomas.

MATERIAL AND METHODS

We studied 40 women, aged 31 to 50, with symptomatic uterine fibroids undergoing laparoscopic dissection of the uterine artery and coagulation of the utero-ovarian ligament Ultrasound examination of uterus and dominant fibroid were performed. Their volume reduction was measured. Clinical response was evaluated according to questionnaire assessing the level of menstrual bleeding, pain and urgency.

RESULTS

There were no complications during operations. Within 6 months after the surgery the mean uterus volume was reduced by 22% and mean volume of dominant fibroid was reduced by 51%. Six months after the surgery menstrual bleeding was reduced in case of 34/38 patients (85%), completed pain relief has been observed in case of 19/25 patients (76%). In case of 11/15 (73%) patients, a regression of urgency has been observed.

CONCLUSIONS

Laparoscopic dissection of the uterine artery and coagulation of the utero-ovarian ligament is a safe and effective method of treating symptomatic myomas. It is an alternative to hysterectomy, especially for women who wish to preserve their uterus.

[The risk of endometrial cancer appearance and CYP19 and COMT gene polymorphism]

THE AIM

Women with high circulating estrogens concentration have increase risk of breast, endometrium and ovarian cancer, thus it is important to identify factors, including environmental and genetic variability that may be alter estrogen concentration.

MATERIAL AND METHODS

In the present work the distribution of genotypes and frequencies of alleles of the T/C polymorphism of CYP19 and G/A polymorphism of COMT gene in subjects with endometrial cancer were investigated. Paraffin embedded tumour tissues was obtained from 151 postmenopausal women with endometrial cancer. The polymorphism's were determined by PCR-RFLP methods.

RESULTS

The distribution of the genotypes of the T/C and G/A polymorphism in both control and patients did not differ significantly (p > 0.05) from those predicted by the Hardy-Weinberg distribution. Additionally, there were no significant differences (p > 0.05) in genotype distributions and allele frequencies between subgroups assigned to histological stage.

CONCLUSION

The results suggest that the CYP19 and COMT polymorphism may not be linked with appearance and development of endometrial cancer but further research, conducted on larger population, are needed to clarify this point.

The polymorphisms of the CYP17 and CYP19 genes in endometrial cancer patients

Endogenous estrogen exposure is an important determinant of endometrial cancer risk. The CYP 17 and CYP 19 genes encode 17alphahydroxylase/17,20-lyase and aromatase, respectively, both involved in sex hormone synthesis. The genes CYP17 and CYP19 are polymorphic and gene variability could contribute to the level of protein biosynthesis. In the present work the distribution of genotypes and frequency of alleles of the C/T polymorphism in promoter region of CYP17 and G/A polymorphism at position Val80 in CYP19 in subjects with endometrial cancer were investigated. Paraffin embedded tumor tissues were obtained from 100 women with endometrial cancer. DNA from normal endometrial tissue (n=106) served as control. The polymorphisms were determined by PCR-RFLP. The distribution of the genotypes of the C/T polymorphism of CYP17 and G/A polymorphism of CYP19 in both control and patients did not differ significantly (p>0.05) from those predicted by the Hardy-Weinberg distribution. There were no significant differences (p>0.05) in genotype distributions and allele frequencies between subgroups assigned to histological stage. The results suggest that the C/T polymorphism of CYP17 gene as well as G/A polymorphism of CYP19 may not be linked with appearance and development of endometrial cancer.

[Perspectives of endometriosis treatment]

In recent years a dynamic development of research on endometriosis has been observed. Complex and not definitively recognized etiopathogenesis, impedes diagnostic progress and effective treatment. Frequent incidence of endometriosis in reproductive age and high percentage of the illness in the group of patients with infertility, both determine the importance of that issue. The article below presents the latest lines of research on efficient therapeutical scheme, covering reproductive abilities. Attempts of implementation of aromatase inhibitors, selective estrogen receptor modulators, immunomodulators and antiinflammatory agents have been described. Considering groups of medicines mentioned in the article, the outcome of examination using aromatase inhibitors, immunomodulators mainly IL-2, INF-alpha-2b, as well as antiinflammatory agents--recombinant human TNF binding protein-1, seem to be most encouraging. Part of the survey was conducted on animal models therefore it requires verification of usefulness and effectiveness on people. The results are very promising, they set the trend of future research aimed at application of modern and efficient treatment of endometriosis.

[Effect of combined surgical and pharmacologic treatment on peripheral blood cytokine concentrations in women with endometriosis]

Endometriosis is a disease causing the growth of endometrial tissue outside its proper localisation. The frequency of this disease occurrence is estimated for about 10% of women at reproductive age. More and more often scientific studies reveal the key role of immunological disorders as the factor contributing to the development of endometriosis. Investigators pay their attention not only on the composition of immunological cells, but on the amount and proportion of their products, including cytokines, as well. Aim of the study was the evaluation of cytokine generation by peripheral blood lymphocytes derived from women with endometriosis, as well as the estimation of combined surgical and pharmacological treatment influence on this production.

MATERIAL AND METHODS

The study group consisted of 72 patients treated in Surgical Gynecology Department of Polish Mother Health Centre Research Institute in Lodz, in years 1998-2002. Endometriosis was diagnosed during laparoscopy or laparotomy in 60 of them. The diagnosis was confirmed in histopathological examination. 14 of those patients were qualified to 6 months long Zoladex therapy (AstraZeneca), following the operation. Zoladex was used in a dose of 3.6 mg per month. Evaluation of the cytokine generation was performed before the treatment and repeated after the full therapy. 12 women with no signs of endometriosis lesions existence were the comparison group. Immunofluorescence method ELISA and ENDOGEN commercial kits were used for evaluating the cytokine concentration levels.

RESULTS

Significant decrease in IFN-gamma generation (p < 0.05) by peripheral blood lymphocytes was noted in women with endometriosis before the treatment as compared to women without this disease. Therapy caused its increase and the difference was statistically significant. Significantly higher levels of the IL-4 generation after PHA stimulation were also observed in women with endometriosis then in women from the comparative group. The therapy of endometriosis caused the decrease in IL-4 production, but the differences were not statistically significant (p < 0.05). Significant differences in IL-4 generation after the treatment as compared to the values noted before the treatment were observed only after using conkanavaline A as the lymphocyte stimulator. Generation levels of IL-2, IL-10 and IL-12 did not vary significantly after the combined surgical and pharmacological treatment of endometriosis.

CONCLUSIONS

1. Significant decrease in IFN-gamma concentration was shown in patients with endometriosis, which proves the role of this cytokine in the pathogenesis of this disease. 2. Combined surgical and pharmacological treatment causes the increase in IFN-gamma production by peripheral blood lymphocytes.

[TVT tape usage in the treatment of stress urinary incontinence]

Stress urinary incontinence is one of the most common gynecological complains. The frequency of its occurrence is from 12 to 25 and even 60%. It is most often observed in patients after menopause, but in a few percent is also found in twenty and thirty years old women. During several years of searching the effective methods of stress urinary incontinence treatment, many operative techniques have been worked out, but none of them became a perfect one. The operation with the use of TVT tape is one of the newest methods of the stress urinary incontinence treatment. The aim of our study was the attempt of the estimation the TVT operation effectiveness in the treatment of stress urinary incontinence in women treated in Surgical Gynecology Department of Polish Mother Health Centre Research Institute in years 2000-2002. Performed analysis of 60 patients at the age between 38 and 76 years revealed that stress urinary incontinence symptoms regressed after TVT operation, as evaluated 7 days after the procedure. In 51.7% of patients anterior colpoplasty or colpoperineoplasty was performed simultaneously to TVT operation. Control studies were performed a month and six months after the operation. Recurrence of the symptoms was observed in 11.7% of the patients. Revealed data let us show that the efficacy of this procedure is very high and reaches 88.3%.

[Innate immunity participation in the pathogenesis of endometriosis]

Endometriosis is a serious clinical problem among the women treated because of gynecological reasons. The frequency of its occurrence is estimated for 10-15% of all women at reproductive age.

AIM

This study evaluates the chosen phenomenons participating in innate immunity and their role in the pathogenesis of endometriosis.

MATERIALS AND METHODS

42 patients aged 22 to 39 years old treated in Surgical Gynecology Department of Polish Mother Health Centre Research Institute were the study group. Comparative group consisted of 22 age-matched women with no clinical complains. We evaluated production of reactive oxygen intermediates by peripheral blood neutrophils in both groups of women (both spontaneous and stimulated with fMLP) using the chemiluminescence test. We used neutrophils, both resting and previously preactivated with TNF-alpha. The activity of C3 and C4 complement components and total antioxidant status were also measured.

RESULTS

Showed that the chemiluminescence values were higher in patients with endometriosis than in comparative group. Preactivation of neutrophils with the use of TNF-alpha was significantly weakened. Both C3 and C4 complement components revealed higher activity in women with endometriosis as compared to those without this disease. Total antioxidant status values were significantly lower in patients with endometriosis than in women from the comparative group.

CONCLUSION

Innate immunity may play a significant role in the pathogenesis of endometriosis due to changes in its components activity that are observed in the course of this disease.

Detection and analysis of apoptosis in breast and ovarian cancer subjects--genetic studies

Apoptotic cell death plays a central role in the pathogenesis and disease progression of cancer as well as in the response to treatment. In the present work we investigated the association between the presence of apoptotic peripheral blood cells in breast and ovarian cancer progression. Apoptosis was analysed in blood cells of breast (n=82) and ovarian cancer patients (n=79). Blood samples from age matched healthy women served as control (n=70). The apoptotic peripheral blood cells were detected by agarose gel electrophoresis. The apoptotic cells were identified in 83% (68/82) of the breast cancers and in 65% of ovarian cancer patients (51/79). The number of positive samples was significantly higher among cancer samples than among control samples (p<0.05). Additionally, there were significant differences (p<0.05) in the presence of apoptosis between subgroups assigned to histological stage. The high frequency of apoptotic peripheral blood cells in breast and ovarian tumours suggests a potential role of apoptosis in cancer appearance and/or progression.

[The effectiveness of low-calorie diet or diet with acupuncture treatment in obese peri- and postmenopausal women]

OBJECTIVE

Our purpose was to compare the efficacy of low calorie diet and low calorie diet applied together with acupuncture in treatment of obesity in peri- and postmenopausal women.

MATERIALS AND METHODS

Sixty nine obese peri- and postmenopausal women qualified for hormone replacement therapy were divided into two groups. Women from the first group (n = 33) during six months used a low calorie slimming diet: 1000 kcal below daily energy requirement (1200-1500 kcal per day on the average), 5-6 meals a day, consisted of proteins in 10-15%, fat in 25% and carbohydrates in 60-65%. The second group (n = 36) during this period had the same kind of diet as well as one cycle of six-week acupuncture procedures. Each cycle consisted of 12 procedures (2 per week). Following acupuncture points were applied: -GV 20 (Baihui), CV 12 (Zhongwan), ST 36 (Zusanli), ST 21 (Liangmen), ST 25 (Tianshu), LIV3 (Taichong), LIV 13 (Zhangen), P 6 (Neiguan), H 7 (Shenmen); auriculotherapy--55 (Shenmen), 87 (Stomach).

RESULTS

In the first group on the low calorie slimming diet mean body weight decreased from 85.48 +/- 8.48 kg to 77.07 +/- 7.7 kg (BMI dropped from 33.23 +/- 1.90 kg/m2 to 29.95 +/- 1.66 kg/m2) during six-week period (p < 0.001). In the second group (acupuncture together with a low calorie diet) decreased mean body weight from 85.5 +/- 5.99 kg to 72.68 +/- 6.06 kg (BMI dropped from 33.54 +/- 1.77 kg/m2 to 28.51 +/- 2.00 kg/m2) at the same time (p < 0.001). The mean drop of body weight as well as BMI was significantly higher in the group treated with acupuncture and slimming diet (12.81 +/- 2.85 kg and 5.03 +/- 1.08 kg/m2) than in the low calorie diet group (8.41 +/- 2.02 kg and 3.28 +/- 0.78 kg/m2); p < 0.01.

CONCLUSIONS

1. Our results testify to the higher efficacy of the complex low calorie diet and acupuncture treatment in comparison to the low calorie therapy in the lowering of BMI and body weight. 2. Acupuncture seems to be an additional useful healing method in treatment of menopausal obesity.

Laparoscopically assisted vaginal hysterectomy with bilateral salpingo-oophorectomy due to endometrial cancer in a heart transplant recipient. A case report

INTRODUCTION

Transplant recipients have a higher incidence of cancer compared with the general population. This increased risk is related to the intensity and chronicity of immunosuppression that these patients receive. In this report, we present a case of a heart transplant woman with endometrial cancer who was diagnosed six months after transplantation.

CASE REPORT

A 49-year-old woman who had undergone a heart transplant was referred to our department in May 2002 for final treatment. The diagnosis of endometrial cancer was established on the basis of the histopathology findings of the fractional curettage. Her heart transplant had occurred six months before, as a result of idiopathic restrictive cardiomyopathy. The patient received triple immunosuppression with cyclosporin, azathioprine and prednisone and she displayed no signs of acute graft rejection features. Laparoscopically assisted vaginal hysterectomy with adnexa was performed without any complications. Duration of surgery was 85 minutes. The patient was operated on under general anesthesia and intraabdominal pressure was automatically maintained at 10 mmHg with a carbon dioxide insufflator (AESCULAP, Germany). Immunosuppressive therapy was continued without modification. The postoperative course was uncomplicated in our patient. No significant changes in heart rate or blood pressure were observed. The patient was discharged from the hospital on the 11th postoperative day. Microscopic appearance revealed Stage I endometrial cancer. The patient is in good physical condition with normal heart performance and without disease recurrence.

CONCLUSION

In our opinion LAVH was a justifiable form of surgical management in the treatment of a heart transplant recipient with an early-stage endometrial cancer.

PCR analysis of matrix metalloproteinase 3 (MMP-3) gene promoter polymorphism in ovarian cancer

Matrix metalloproteinases (MMPs) are proteolytic enzymes capable of degrading extracellular matrix. Their role has been emphasized in tumor invasion, metastasis and tumor-induced angiogenesis. The gene encoding MMP-3 is polymorphic and an insertion (6A)/deletion (5A) polymorphism (5A/6A polymorphism) in the MMP-3 gene may have functional significance in the regulation of its expression. In the present work the distribution of genotypes and frequency of alleles of the 5A/6A polymorphism in subjects with ovarian cancer were investigated. Paraffin embedded tumor tissues were obtained from 118 postmenopausal women with node-negative and node-positive ovarian cancer. The 5A/6A polymorphism was determined by PCR amplification using the allele specific primers. The distribution of the genotypes of the 5A/6A polymorphism in both control and study patients did not differ significantly (p>0.05) from those predicted by the Hardy-Weinberg distribution. There were no significant differences (p>0.05) in genotype distributions and allele frequencies between subgroups assigned to histological stage. The results suggest that the 5A/6A polymorphism of MMP-3 gene may not be linked with appearance and/or progression of ovarian cancer.

[Application of skin glue in wound repair after laparoscopy]

The aim of the study was to evaluate the usefulness of skin glue--Dermabond in wound repair after laparoscopy intervention. It is a new adhesive with the physical properties that differ from other cyanoacrylate adhesives and give a significantly greater tensile strength. It was proved to have similar cosmetic results in the repair of lacerations and incisions when compared with those closed with monofilament sutures. Octylcyanoacrylate tissue adhesive has been approved for clinical use by the Health Protection Branch of Health Canada and has been approved for clinical trials by the U.S. Food and Drug Administration. The study was conducted on thirty women with use of skin glue in wound closure after laparoscopy. Thirty-five patients served as controls whose skin was closed with a monofilament suture by standard sterile techniques. We estimated local tissue reaction, way of healing and cosmetic results. There was no difference in healing found in this study between the two examined groups. The only significant correlation outcome measures was in a very good cosmetic effect in the group where skin glue (p = 0.0231) was applied. The authors suggest high usefulness of Dermabond glue in good wound closure and correct healing.

[Laparoscopic cystectomy during pregnancy--a case report]

We present z case report of a pregnant patient in whom a laparoscopic cystectomy was performed at 11 weeks' gestation. Included in the report is the diagnostic work-up, pharmacotherapy, review of laparoscopic technique employed as well as the course of pregnancy, labor and delivery and postpartum.

[Laparoscopy in pregnant women]

In the study current opinions of performing laparoscopy in pregnant women suffering from some either acute abdominal diseases or adnexal pathology have been presented. Based on the latest literature, intra- and postoperative complications of laparoscopy have been analyzed by the authors. Both advantages and disadvantages of laparoscopy in pregnancy have been estimated.

[Evaluation of peripheral blood neutrophils activity in women with endometriosis]

Authors evaluated the neutrophils ability of creating reactive oxygen intermediates (ROI) in peripheral blood of 14 patients with endometriosis. These tests were performed using the chemiluminescence method. Enhanced ROI production and in vivo priming phenomenon of neutrophils in endometriosis were reported. The observed increase in oxygen activity of neutrophils was statistically significant only in reaction with the use of fMLP. However performed neutrophils preactivation with TNF-alpha followed by the chemiluminescence test revealed the occurrence of in vivo neutrophil activation in women with endometriosis. Reported data confirm the existence of local inflammatory reaction in the course of endometriosis.

[Evaluation of the generation of interleukin-10 by peripheral blood lymphocytes in women with endometriosis]

The aim of study was the evaluation of generating the IL-10 by peripheral blood lymphocytes in women with endometriosis according to the stage of of the disease. Cytokine was estimated by immunoenzymatic method Elisa. The generation of IL-10 by peripheral blood lymphocytes was lower in patients with all stages of endometriosis than in control group. Decreased IL-10 generating observed in our study was not statistically significant, but it may correlate with disorders of immunological cell response. It may also play a role in a development and progression of endometriosis.

[The diagnostic value of endometrial sampling with Endorette]

The usefulness of Medscand Endorette endometrial sampling was evaluated. The analysis was based on 142 cases with medical indications for endometrial biopsy. 122 women were successfully sampled. Only in 9 cases (6.3%) the collected endometrium was insufficient. Medscand Endorette seems to be a useful tool for the collection of endometrial samples, mainly in outpatients.

[Early primary abdominal pregnancy treated by laparoscopy]

Our study describes abdominal pregnancy in 28-years old woman. Patient was admitted to Gynecological Surgery Department of Polish Mother's Memorial Hospital in Lódź with lasting for a few hours strong abdominal pain. We carried out detailed diagnostics, that showed the main importance of beta-human chronic gonadotropin level monitoring and helpful role of the ultrasonography study in abdominal pregnancy diagnosis. This woman was treated by laparoscopy that surely confirmed the diagnosis and allowed for total cure.

[Modern methods of early diagnosis and treatment of ectopic-oviduct pregnancy]

Medical documentation of 80 women operated on because of ectopic pregnancy between the years 1991-1992 was analyzed. Methods of early diagnosis and ways of surgical approaches were discussed. Authors of this article give priority to controlling beta sub-unit HCG acc. to Romero, to ultrasonographic vaginal probe examination and to diagnostic laparoscopy. Early surgical intervention increases the chances to maintain woman's fertility. All procedures on women with ectopic--oviduct pregnancy should be sparing, depending on the ward equipment and personnel training and should be performed by the means of operative laparoscopy method.