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.

Level of Potassium Is Associated with Saturated Fatty Acids in Cell Membranes and Influences the Activation of the 9 and 13 HODE and 5 HETE Synthesis Pathways in PCOS

Potassium helps to maintain the water–electrolyte and acid–base balance. There is little research on the relationship between plasma fatty acids (FAs), inflammatory mediators and red blood cell potassium levels in women with polycystic ovary syndrome (PCOS). This study included 38 Caucasian women with PCOS. Potassium in the erythrocytes was determined by inductively coupled atomic plasma emission spectrometry. The FAs were analysed with gas chromatography, and liquid chromatography was used to separate the eicosanoids. The relationships between the potassium content and the amounts of fatty acids, as well as potassium and arachidonic acid (AAs) derivatives, were analysed. Significant negative correlations were found with, among others, pentadecanoic acid, palmitic acid, stearic acid and arachidic acid, whereas a positive correlation was found with neuronic acid. Positive correlations were observed with 9, 13 HODE (derivatives synthetized from linolenic acid) and 5 oxo ETE and 5 HETE (from 5 LOX pathway). Saturated fatty acids reduce the influx of potassium into the cell by destabilizing the pH of the cytosol, and thus exacerbating the inflammatory response through the activation of the AA cascade. Therefore, improving the flow of potassium inside the cell is important in the treatment of patients.

The Role of Oxidative Stress in the Risk of Cardiovascular Disease and Identification of Risk Factors Using AIP and Castelli Atherogenicity Indicators in Patients with PCOS

Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathies in females of reproductive age and may affect 5-14% of women. In women with PCO syndrome, metabolic disorders such as insulin resistance, hyperinsulinemia, obesity, diabetes mellitus, and other elements of metabolic syndrome may occur. Patients with PCOS often have overweight and obesity, especially abdominal obesity, which is one of the risk factors for developing atherosclerosis. The atherogenicity indicators of AIP (atherogenic index of plasma) and Castelli's index are used to assess the risk of developing atherosclerosis. Studies have shown an increase in the concentration and activity of oxidative stress markers in patients with PCOS compared to women without the disease. The aim of the present study was to evaluate oxidative stress parameters in patients with PCOS in relation to insulin resistance, BMI, and hyperandrogenemia and to correlate them with cardiovascular risk parameters. Conclusions: The severity of oxidative stress in women with PCOS correlates with exposure to cardiovascular diseases. The assessment of additional cardiovascular disease (CVD) parameters is useful in identifying the risk groups for cardiometabolic disease among PCOS patients. When additional risk factors such as hyperandrogenism and insulin resistance (IR) are present in patients with PCOS, it is reasonable to include preventive examinations early. It is also important to evaluate lipidograms, which will make it possible to determine indicators of atherogenicity. Patients with PCOS and IR are at particular risk for cardiovascular complications. PCOS should be considered an important risk factor for CVD, which occurs independently of the occurrence of obesity. This factor is related to the important role of insulin resistance, which occurs independently of obesity. Atherogenic factors (AIP and Castelli index) are useful additional parameters to assess the risk of cardiometabolic disease in PCOS patients, especially among groups with insulin resistance. The early detection of risk factors should be an integral part of the care of PCOS patients. In laboratory studies of women with PCOS, TG, TChol, HDL-c and LDL-c levels, and glutathione peroxidase (GPx) activity were most clearly correlated with exposure to cardiovascular disease.

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.

Markers of Inflammation and Vascular Parameters in Selective Progesterone Receptor Modulator (Ulipristal Acetate)-Treated Uterine Fibroids

The exact mechanism of selective progesterone receptor modulator action in leiomyoma still challenges researchers. The aim of the study was to assess the effects of ulipristal acetate (UPA) on immunoexpression of inflammatory markers and vascularization in fibroids. UPA-treated patients were divided into three groups: (1) good response (≥25% reduction in volume of fibroid), (2) weak response (insignificant volume reduction), (3) and no response to treatment (no decrease or increase in fibroid volume). The percentage of TGFβ, IL6, IL10, CD117, and CD68-positive cells were significantly lower in the group with a good response to treatment vs. the control group. Moreover, the percentage of IL10 and CD68-positive cells in the group with a good response to treatment were also significantly lower compared to the no response group. Additionally, a significant decrease in the percentage of IL10-positive cells was found in the good response group vs. the weak response group. There were no statistical differences in the percentage of TNFα-positive cells and vessel parameters between all compared groups. The results of the study indicate that a good response to UPA treatment may be associated with a decrease of inflammatory markers, but it does not influence myoma vascularization.

Evaluation of the Diagnostic Accuracy of the Interview and Physical Examination in the Diagnosis of Endometriosis as the Cause of Chronic Pelvic Pain

Background: Chronic pelvic pain affects approximately 15% of reproductive age women. It is mainly caused by adhesions (20–40%). Despite CPP being the main symptom of endometriosis, the disease is confirmed by laparoscopy only in 12–18% of cases. The aim of this study was to evaluate the results of laparoscopy in women with CCP and to assess the sensitivity and specificity of elements of an interview and clinical examination. Materials and methods: The study included 148 women with CPP. Each patient underwent laparoscopy. In laparoscopy, the presence of endometriosis and/or peritoneal adhesions was confirmed. Then, the sensitivity and specificity and the positive and negative predictive value of endometriosis symptoms or abnormalities in the gynecological examination were statistically calculated. Results: After previous surgery, adhesions were found in almost half (47%) of patients. In patients without a history of surgery, adhesions were diagnosed in 6.34% of patients. Endometriosis without coexisting adhesions was more often diagnosed in women without previous surgery (34.9%), compared to 10.58% in the group with a history of surgery (p < 0.05). Conclusions: Intraperitoneal adhesions are most common in women after pelvic surgery and with chronic ailments. The best results for sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of endometriosis are found in women with irregular menstruations during which the pain increases. Laparoscopy still remains the primary diagnostic and therapeutic method for these women.

[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.

[How to reduce the failure rate in surgical treatment of stress urinary incontinence]

Urinary incontinence (UI) is one of the most common chronic diseases in women, occurring in all age groups. UI is found in 20-60% of the female population and is considered as a social disease. We use conservative and surgical methods to treat stress urinary incontinence. Conseravtive treatment is the first line therapy. In case of severe symptoms of SUI, in patients with urethral sphincter insufficiency and prolaps conservative treatment is not effective. Currently, the most common are used slings: TVT and TOT as well as Burch operations. Therapeutic success depends on many elements, such as proper qualification for surgery, proper pre and postoperative procedure, correct surgical technique and operator's experience. Pelvic ultrasound plays a major role in urogynecology both in qualification for surgery and in postoperative control.

Predictive Factors of Response to Selective Progesterone Receptor Modulator (Ulipristal Acetate) in the Pharmacological Treatment of Uterine Fibroids

Background: Selective progesterone receptor modulator ulipristal acetate (UPA) is a drug used in management of symptomatic myomas. It was observed that the response to UPA treatment in uterine myomas varied amongst patients. An attempt was thus made at establishing predictive factors conducive to better reaction to treatment with UPA. The aim of this study was to assess the efficacy of UPA treatment in women with myomas, depending on pretreatment myomas’ volume, number of myomas, age of patients, estrogenic status of women, and pretreatment blood flow in uterine arteries. Materials and methods: The study included patients with one to four myomas. The UPA treatment was a preparation stage for surgical treatment in all patients. The study group was divided into the subgroups according to pretreatment myomas’ volume, number of myomas, age of patients, estrogenic status of women, and pretreatment blood flow in uterine arteries. Results: A better effect of reduction in size of myomas after UPA treatment was noted when pretreatment myomas’ volume was lower than 30 cm³. A significant reduction in fibroids’ size was observed after UPA therapy independently of the number of myomas and age of patients. A good response after the UPA therapy was observed when pretreatment estradiol concentration was below 50 pg/mL and when uterine artery resistance index (RI) was above 0.8. Conclusions: Our research demonstrates that treatment with ulipristal acetate is an efficient method in preoperative preparation of patients with uterine fibroids. The most important factor of positive response to UPA therapy is myoma volume. The number of myomas and patient’s age do not interfere with effects of UPA therapy. Pretreatment estradiol concentration is significant, yet secondary for the effects of therapy. The UPA therapy has no impact on blood flow in the uterine arteries and no adverse influence on estradiol concentrations.

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.

[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.

Interstitial ectopic pregnancy after salpingectomy due to previous tubal pregnancy - a case report

Ectopic pregnancy is the development of the embryo outside the uterine cavity. In recent years an increase in the incidence of ectopic pregnancies has been observed. It is mainly related to the increased number of IVF procedures. The most frequent localization is the ampulla of the fallopian tube. In cases of intramural or cornual ectopic pregnancies, many patients have a history of ectopic pregnancy on the same side or underwent partial salpingectomy in the past. Treatment of such pregnancies involves laparotomy and removal of the uterus or comu of the uterus. This case concerns a patient operated because of intramural pregnancy. She had a salpingectomy in the past because of tubal ectopic pregnancy on the same side. This case shows that even after removal of the fallopian tube there is still a risk of ectopic pregnancy in the intramural part of this tube.

[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.

Pulmonary benign metastasizing leiomyoma from the uterine leiomyoma: a case report

BACKGROUND

Benign metastasizing leiomyoma (BML) is a rare condition described as multiple well-differentiated leiomyomas at sites distant from the uterus. Apart from lungs it has also been reported in lymph nodes, heart, brain, bone, skin, eye and spinal cord. We present a case of pulmonary benign metastasizing leiomyoma in a female patient admitted to our hospital with suspicion of left adnexal tumor.

CASE REPORT

A 45-year-old woman was referred to our hospital with suspicion of left adnexal tumor. The control transvaginal ultrasound examination performed at admission to the Gynecological Department excluded adnexal neoplasm. However, a large amount of fluid within the Douglas pouch raised the oncological concern. The patient underwent myomectomy in 2005. In the same year she was diagnosed with multiple lung nodules and underwent pulmonary wedge resection with the diagnosis of pulmonary benign metastasizing leiomyoma being stated. The decision of reevaluation of the specimen, control CT and puncture of the Douglas pouch fluid was made. Computed tomography performed at the Department of Diagnostic Imaging and Interventional Radiology of the Pomeranian Medical University Hospital revealed multiple, bilateral nodules. The microscopic examination of the samples confirmed the initial diagnosis of benign metastasizing leiomyoma with no evidence of neoplastic cells within the fluid.

CONCLUSIONS

Pulmonary benign metastasizing leiomyoma is a rare entity. However, it should be always taken into consideration in women with a previous or coincident history of uterine leiomyoma, especially when no evidence of other malignancy is present.

[Urinary stress incontinence - one of basic diseases of modern society]

One of the most common women's chronic diseases is urine incontinence (UI). Currently considered to be a social disease of women in all age groups. The etiology of urine incontinence is multifactorial and the most common is stress urinary incontinence (SUI). UI is a interdisciplinary problem, lying in the sphere of interests of different specialties. According to the recommendations of the Polish Gynecological Society IU diagnostics can be divided into a preliminary stage and specialized stage. Initial diagnosis should start by gathering medical history and it can be completed by quality of life questionnaire. Today, one of the non-invasive diagnostic methods is the ultrasound study. In a situation where diagnosis can not be placed or when surgical treatment is needed, the patient should have urodynamic study. Conservative methods and surgery are used in the treatment of SUI. Conservative procedure should be the first choice in patients with symptoms of IU. Over 200 types of various operations have been described in the history of the surgical treatment of SUI. Until now the most common are: Burch colposuspension, TVT and TOT and implantation of an artificial sphincter.

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.

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.

Laparoscopic Coagulation of Uterine Myomas With the Use of a Unipolar Electrode

The aim of this study was to evaluate the effectiveness of a laparoscopic myolysis with the use of a unipolar electrode. Forty-six patients, 25 to 52 years old with symptomatic myomas (menometrorrhagia or/and pelvic pain) were included in the study. A transvaginal ultrasound showed 1 or 2 intramural or/and subserosal leiomyomata of 1 to 4.5 cm in diameter. Patients were selected to undergo a laparoscopic coagulation of myomas. Subsequently, they were followed-up 6 months after the treatment. Symptoms reduction and myoma size reduction were evaluated. In addition, all the patients underwent transvaginal Doppler ultrasounds to assess the blood flow in the uterine arteries. In the study group, the disappearance of myomas was observed in 52.2% of patients 6 months after the therapy. In other patients, the mean myoma shrinkage amounted to 76%. The myoma-volume reduction was correlated with an increase in the resistance index (P=0.02) and the pulsatility index (P=0.11) of the right and left uterine arteries.

[Ovarian androgenesis in women after menopause]

Menopause state doesn't mean total ovarian failure. Function of stromal cells is maintained and steroids, especially androgens, are produced. The role of androgenesis after menopause is important because of general androgens activity and their influence on some symptoms characteristic for perimenopausal period. From the other side, these hormones are necessary for the proper quality of life connected with bone mass density, libido, mood and physical activity. Knowledge of postmenopausal ovarian androgenesis and its influence on total androgens level is still not completed. On the basis of result of immunohistochemical assays it was found, that T and A postmenopausal production is depended on: hyperplasia of stromal tissue, receptors of Gn-FSH and Gn-LH, steroids receptors: ER, PR and AR, enzymes: P-140 aromatase, 3-beta HSD, 17-beta HSD activity. But influence the estrogen replacement therapy on these factors is still unknown.

[Bilateral ovarian lipid cell tumor: a case of androgenization in women]

Lipid cell tumors are a very small group of ovarian neoplasms. Especially rare they occur simultaneous in the both ovaries. They are connected with symptoms of virilisation and increased androgens serum concentration. This report describe a case of 34-years old woman with a symptoms of a quickly increased hirsutism and ascites. These symptoms were connected with recurrence of a lipid cell tumor in a left ovary after 4 years from ovariectomy on the other side. The diagnostic and therapeutic management in the regional hospital, where the first ovariectomy was performed, was not correct. Young women should be treated in a special gynecology departments, where pathological intraoperative diagnosis of the second ovary is possible. Quickly diagnosis and surgical treatment allowed to cure the patient. Follow-up examinations after 5 months showed symptoms resolved and normalization of serum androgens concentration. Diagnosis of these ovarian tumors is difficult but we should think about it in every case of androgenization. Analysis of the symptoms and quickly diagnosis gives a chance of entire treatment.

[The value of ultrasonography in diagnosis of atypical endometrial hyperplasia in postmenopausal women]

There is no agreement if an incorrect endometrial ultrasound image without clinical symptoms or postmenopausal bleeding despite normal ultrasound results are the indications for histopathological diagnosis of endometrium to exclude its pathological hyperplasia.

OBJECTIVES

The aim of the study was a comparison the compatibility of ultrasound results with histopathological examination of uterine scrapings in postmenopausal women.

MATERIAL AND METHODS

The study included 659 postmenopausal women aged 41-85 (mean 61.5). They were divided into three groups. The first one counted 186 women (28.22%) with metrorrhagia and normal endometrial ultrasound image. The second one counted 293 women (44.46%) with only changes in ultrasound examination and the third one counted 180 women (27.31%) with metrorrhagia and incorrect ultrasound image of endometrium. As an incorrect ultrasound images the endometrial thickness above 5 mm, especially with non-homogenous structure, polyps and fluid in uterine cavity, were assumed. Each examined women had a D&C with consecutive histopathological evaluation of the tissue material.

RESULTS

The endometrial cancer was the most frequent in the third group--in 29 examined women (16.11%) and was significantly rare in the first and second groups: 9 women (4.84%) and 2 women (0.68%), respectively. The most frequent (in 19 from 107 women--17.75%) the cancer was recognized in cases of endometrial hyperplasia, especially when ultrasound image of endometrium was non-homogenous and irregular, and the rarest was in the cases of affirmed fluid in uterine cavity (1 from 22 examined women--4.5%).

CONCLUSIONS

The endometrial cancer is the frequent in women with postmenopausal bleeding and endometrial hypertrophy in ultrasound examination, especially when endometrial image is non-homogenous and irregular. However, the rarest endometrial cancers were affirmed in postmenopausal women with ultrasound image of fluid in uterine cavity with thin endometrium.

[Analysis of risk factors for ectopic pregnancy in own material in the years 1993-2002]

The ectopic pregnancy is still a life-threatening condition. The risk factors for ectopic pregnancy are divided into four groups: 1) mechanic factors, 2) tubal dysfunction, 3) assisted reproductive techniques (ART) and 4) hormonal factors.

MATERIAL AND METHODS

On basis of the analysis of medical documentation we determined the risk factors for ectopic pregnancy in 214 patients (aged 18-44, mean 32 +/- 9 years) hospitalized in Department of Reproductive Medicine and Gynecology of Pomeranian Medical University between 1993 and 2002. The control group composed 215 patients admitted to the hospital outpatient clinic in the years 1993-2002.

RESULTS

The risk factors for ectopic pregnancy evaluated in each group of patients were: history of adnexitis, surgical procedures (appendectomy, tubal microsurgery, ovarian cystectomy, adnexectomy, myomectomy, cesarean section, previous conservative surgical treatment of ectopic pregnancy, salpingectomy), appendicitis complicated by peritonitis, endometriosis, conservative treatment of ectopic pregnancy, insertion of IUD, ovarian induction or IVF procedure, uterine defects and smoking. In the examined group 104 patients had a history of surgery (48.5%) compare to 40 patients in the control group (18.6%). Difference between groups is significant p = 0,034. In 40 cases out of 104 (18.6%) surgical operations were done two and more times. Statistics proves that surgical procedures in the past occurred significantly more frequently in the studied than in control group. The most frequent operations were: conservative surgical treatment of ectopic pregnancy (p = 0.000), tubal microsurgery (p = 0.0016), ovarian cystectomy (p = 0.013) and salpingectomy (p = 0.047). Appendectomies or myomectomies in the past did not increase the risk of ectopic pregnancy. Additionally, in the examined group there were more cases of MTX (Methotrexate) therapy applied in the past because of ectopic pregnancy (p = 0.000), more smoking (p = 0.0001) and more adnexitis in the past (p = 0.013). Treated endometriosis in the past, artificial reproductive techniques (ART), peritonitis, IUD application and uterine defects were no important risk factors for ectopic pregnancy.

CONCLUSIONS

The main risk factors for ectopic pregnancy are: history of surgical procedures, especially conservative surgical treatment of ectopic pregnancy and tubal microsurgery. Appendectomy or myomectomy do not increase this risk. The other important risk factors for ectopic pregnancy are: conservative treatment of ectopic pregnancy in the past and smoking. Adnexitis is another risk factor for ectopic pregnancy.

[The effect of hemodialysis on the virgin CD45RA+, CD45RO- and memory CD45RO+, CD45RA- lymphocyte count in patients with chronic renal failure]

The hallmark of immunological memory is a quick and effective response to a repeated antigen exposure. Virgin lymphocytes, with their surface receptors CD45RA+, CD45RO- are produced in primary lymphatic organs, then migrating to secondary lymphatic structures. Memory lymphocytes CD45RO+, CD45RA- produced in these organs migrate to non-lymphatic organs--a possible location of inflammatory process, thus enabling the immunological system to eliminate effectively the same antigen, when repeatedly present. The aim of the study was 1) to test the influence of hemodialysis on the number of virgin lymphocytes and/or memory lymphocytes; 2) whether such impact (if any) depends on the type of dialysis membrane used (cuprophan or polysulphon), 3) if the effect is different in patients with or without diabetes. Overall number of virgin T helper lymphocytes CD45RA+CD4+ was significantly lower in patients with end-stage renal disease, while the number of total CD45RO+, CD45RA- memory lymphocytes was significantly greater among patients with diabetic nephropathy, compared to normal control subjects. After 15 minutes of hemodialysis, number of virgin lymphocytes CD45RA+, CD45RO- (p < 0.001, p < 0.01) and their subclasses, as well as memory lymphocytes CD45RO+, CD45RA- were significantly decreased. After 15 minutes of hemodialysis with polysulphon membrane, the decrease in T virgin cytotoxic, B virgin CD45RA+CD4-, T memory cytotoxic as well as B memory CD45RO+CD4- lymphocytes was significantly lower, when compared with cuprophan membrane (p < 0.02). Among patients treated with cuprophan hemodialysis, the decrease of T helper memory CD45RO+CD4+ lymphocytes was significantly lower in patients with diabetic nephropathy, than in non-diabetic patients.

CONCLUSIONS

In all patients with end-stage renal disease, the impact of hemodialysis on the number of memory lymphocytes CD45RO+, CD45RA-, as well as virgin lymphocytes CD45RA+, CD45RO- was shown, but the effect was less profound during hemodialysis with polysulphon membrane, compared to cuprophan. The presence of diabetic nephropathy effects the hemodialysis-induced changes in the number of T memory helper CD45RO+ CD45RO+CD4+ lymphocytes, with no impact on other subclasses of the examined cells.

[Sinus-related intracranial complications]

The authors report a case of cavernous sinus thrombosis of paranasal sinus origin. Such complication developed in a case of chronic exacerbated sinusitis and blockade of sinus orifices by polyps. Timely and effective surgical intervention combined with medical treatment achieved complete remission even of the complications of cavernous sinus thrombosis.

[Effect of hemodialysis with cuprophane and polysulfone membranes on counts of leukocytes, granulocytes, monocytes, lymphocytes and lymphocyte subsets]

In patients with chronic renal failure treated with haemodialysis many disorders of specific and unspecific immunity were observed. Several different parameters such as direct interaction with dialyzer membrane, hypersensitivity to components within the membrane, complement activation, or presence of endotoxins in the dialysis fluid or water supply can activate the immune system during haemodialysis and cause immunity disorders. This study aimed to compare the biocompatibility of two different dialysis membranes on the ground of the influence on the counts of immunity cells in the first hour of haemodialysis when the interaction between blood and membrane were the greatest. In 18 patients with CRF granulocytes, monocytes, lymphocytes B and T, T4 and T8 cells were counted just before haemodialysis, 15 minutes and 60 minutes after the start of haemodialysis. In all patients the investigation was done first using the cuprophane dialysis membrane and then using polysulfone dialysis membrane. The cell populations were differentiated by flow cytometry on Fascan using the conjugated monoclonal antibodies. During the first 15 minutes of haemodialysis with cuprophane membrane the amount of all investigated cells populations decreased significantly. With polysulfone membrane only monocytes decreased significantly in the first 15 minutes of haemodialysis. These results indicate that the polysulfone membrane is more biocompatible than the cuprophane one and suggest that using the biocompatible membranes some disorders of immunity system in this patients can be prevented.