[Clinical study of perinatal hysterectomy between 2000-2011 in the clinic of obstetrics, gynecological diseases and oncological gynecology in Bydgoszcz]. / Analiza kliniczna okoloporodowego wyciecia macicy w latach 2000-2011 w Klinice Poloznictwa, Chorób Kobiecych i Ginekologii Onkologicznej w Bydgoszczy.

INTRODUCTION: Perinatal hysterectomy (PH) is usually a life-saving procedure, which is performed after all conservative treatment options fail. The PH frequency rate ranges from 0.04 to 0.23%. The most frequent indications for this procedure include: abnormal placental implantation, placenta previa, uterine rupture and uterine atony OBJECTIVE: Clinical study of perinatal hysterectomy cases taking into consideration the frequency indications, complications and risk factors related to this procedure. MATERIALS AND METHODS: The study included 16 women who underwent perinatal hysterectomy at the Department and Clinic of Obstetrics and Gynecological Diseases between 2000-2011. The following data were collected from medical records: course of pregnancy labor and puerperium. The profile of the study group was conducted in terms of: maternal age, parity gestation length, history of caesarean sections and gynecological operations. The following factors were studied: the termination of pregnancy, indications for caesarean section, hysterectomy-related complications and indications, neonatal birth weight and Apgar score. The statistical analysis was performed using Statistica 9.1 by StatSoft. Data are expressed as the arithmetic mean and standard deviation (SD). RESULTS: Sixteen perinatal hysterectomy procedures were performed, accounting for 0.066% of the overall number of labors. Average maternal age and pregnancy length were 31.6 years [SD+/-6.3] and 36.1 weeks of gestation [SD+/-3.4], respectively PH was more frequently performed among multiparous women (81.25%) and after caesarean sections (87.5%). Fetal asphyxia was the most frequent indication for caesarean section (35.7%). Fourteen percent of all indications accounted for the lack of consent from a pregnant woman to make an attempt at spontaneous vaginal delivery after previous c-section. Fifty percent of the women from the study group had a previous caesarean section, whereas 25% had more than one prior c-section. Between 2009-2011, as compared to previous years, the highest percentage of hysterectomies (80%) was reported in pregnant women after a previous caesarean section. The most frequent indication for hysterectomy included abnormal placental implantation (43.75%) diagnosed more often in patients with a history of caesarean section (57%). Among PH complications, a hemorrhagic shock was reported in 37.4% and bladder injury in 18.7% of the women. Every patient required a transfusion of erythrocyte concentrate, 4.7 units [SD+/-3.5] on average. Twenty-five percent of the neonates were born in poor condition with an Apgar score of 1-3. In case of all women, the therapy required cooperation of different specialists including obstetricians, anesthesiologists, urologists, surgeons and general practitioners. CONCLUSIONS: 1. Current and previous caesarean section constitutes a risk factor for perinatal hysterectomy 2. Placental pathology is the most frequent indication for perinatal hysterectomy 3. The growing number of caesarean sections should encourage obstetricians to conduct a more careful analysis of indications.

[Comparison of VEGF, IL-8 and beta-FGF concentrations in the serum and ascites of patients with ovarian cancer]. / Porównanie stezen VEGF, IL-8 oraz beta-FGF w surowicy krwi i plynie otrzewnowym u pacjentek leczonych z powodu raka jajnika.

Epithelial ovarian cancer is the leading cause of cancer death from gynecological malignancies. Angiogenesis is considered essential for tumor growth and the development of metastases. VEGF, IL-8, beta-FGF are potent angiostimulatory molecules and their expression has been demonstrated in many solid tumors, including ovarian cancer. The aim of this study was to compare the levels of VEGF, IL-8 and beta-FGF in the serum and ascites of patients with ovarian cancer VEGF, IL-8, beta-FGF concentrations were measured by ELISA (Quantikine R&D). The median VEGF, IL-8 and beta-FGF levels were significantly higher in the ascites than sera of ovarian cancer patient. VEGF, IL-8, beta-FGF levels in ascites might be regarded as an additional tool in the diagnosis of ovarian cancer.

[Retrospective analysis of ocular disorders and frequency of cesarean sections for ocular indications in 2000-2008--our own experience]. / Retrospektywna analiza patolog i narz du wzroku i czestosci ciec cesarskich ze wskazan okulistycznych w latach 2000-2008 w materiale wlasnym.

UNLABELLED: 1. Evaluation of frequency of cesarean sections for ocular indications. 2. Analysis of ophthalmological disorders as indications for cesarean section. MATERIAL AND METHODS: 4895 cesarean sections were performed (100 due to ocular indications) in the Department of Obstetrics, Female Pathology and Oncological Gynecology between 2000 and 2008. Medical documentation was analyzed. RESULTS: Among 4895 patients undergoing cesarean sections, 100 (2.04%) presented a written certification from an ophthalmologist suggesting this way of delivery. The frequency of c-sections due to ocular indications continued to increase between 2000-2005 and has been in decline since 2006. The most common ophthalmological disorders included myopia (57%), retinopathy (20%), glaucoma (5%), imminent retinal detachment (4%) and past retinal detachment (3%). In 45% of patients an eye pathology was the only reason for a cesarean section. CONCLUSION: 1. The frequency of cesarean sections due to ocular reasons in our material was 0.7%- 3.44%, average 2.04%. 2. Since 2006 the number of ocular indications for cesarean section has been decreasing. Nevertheless, it remains to be twice as high as in 2000. 3. The most common eye disorders leading to cesarean section were myopia and retinopathy 4. In almost half of the patients the decision to conduct a cesarean section was based solely on ophthalmological indications.

[History of cigarette smoking. The effect of tobacco smoking on women's health]. / Nikotynizm--rys historyczny. Uzaleznienie od nikotyny a zdrowie kobiety.

History of cigarette smoking started on XV century, when Columb imported tobacco to Europe. Popular using of tobacco we are indebted Jaen Nicot Villeman, the name of nicotine originate from his surname. Tobacco first was exploited like a drug, however now it is a very harmful stimulant. Cigarette smoking is still an actual problem and increased risk of many diseases. Very toxic components of smoke get inside all the organs and upsetting their activities and proper running of the life processes. It is common knowledge that smoking badly influences women's health. Nicotine makes the negative influence on function of ovaries metabolism of hormones and state of osseous tissue. Maternal smoking during pregnancy is associated with obstetrical and pediatrician complication with fetus, newborn and child. The aim of the article is to summarize the role of tobacco smoking on women's health.

Coagulation and fibrinolysis variables in pregnant women with type 1 diabetes mellitus.

BACKGROUND: Many studies have reported changes in the hemostatic system in patients with type 1 diabetes in whom coagulation processes predominate over fibrinolytic activity. The aim of this study was to assess some of the hemostatic variables during pregnancy women with in type 1 diabetes. MATERIAL/METHODS: The current study included 31 pregnant diabetic women and 24 healthy pregnant women. At 12, 24, and 36 weeks of gestation, we determined blood concentrations of the following: platelet count, fibrinogen, tissue plasminogen activator antigen, and plasminogen activator inhibitor-1. RESULTS: When we compared pregnant diabetic women in the third trimester with those in the first trimester, we observed a statistically significant decrease in the platelet count (172.0+/-9.0 vs 200.6+/-9.8 G/L, P<0.05) and a statistically significant increase in the levels of fibrinogen (3.5+/-0.2 vs 2.9+/-0.2 g/L, P<0.05), tissue plasminogen activator antigen (14.9+/-2.2 vs 4.7+/-0.6 ng/mL, P<0.001), and plasminogen activator inhibitor-1 (17.2+/-2.8 vs 4.0+/-1.0 IU/mL, P<0.001). Similar fibrinogen, tissue plasminogen activator: A, and plasminogen activator inhibitor-1 changes were observed in pregnant women (3.8+/-0.3 vs 2.9+/-0.2 g/L, P<0.05; 7.7+/-0.9 vs 5.2+/-0.3 ng/mL, P<0.05; and 17.6+/-2.1 vs 5.1+/-1.1 IU/mL, P<0.05, respectively). Tissue plasminogen activator antigen was the only variable to significantly increase during the third trimester in pregnant diabetic women with microangiopathy compared with women without microangiopathy (21.0+/-3.2 vs 8.4+/-1.7 ng/mL, P<0.01). CONCLUSIONS: (1) In patients with type 1 diabetes without microangiopathy and with good metabolic control, fibrinogen and tissue plasminogen activator antigen concentrations and changes in the activity of plasminogen activator inhibitor-1 are similar to those found in patients with a normal pregnancy; (2) the marked decrease in platelet count in patients with type 1 diabetes during pregnancy may be an additional source of plasminogen activator inhibitor-1; and (3) during pregnancy, diabetic microangiopathy leads to a greater increase of tissue plasminogen activator antigen concentration as a marker of endothelial cell injury.

[Smoking amongst women arriving at an outpatient clinic in hospital. Nicotine addiction versus disorders in the menstrual cycle]. / Palenie papierosów wsród kobiet zglaszajacych sie do Przyklinicznej Poradni dla Kobiet. Nikotynizm a zaburzenia cyklu miesiaczkowego.

It is common knowledge that smoking badly influences women's health. Nicotine addiction does not only increase the risk of cancerous diseases, blood circulation and coronary system disorders as well as osteoporosis, but also it can cause disorders of the menstrual cycle, infertility and earlier menopause. One hundred and seven patients took part in the research and attended the women's clinic (Clinic "K"). On the basis of the questionnaire, some data was assessed: demographic data, frequency and type of menstrual cycle disorders, fertility and age of menopause occurrence. A group of smoking women (36.05%) was distinguished and non-smoking women (63.95%). A higher percentage of menstrual cycle disorders was noticed in a group of smoking women (p < 0.05). The most frequent symptoms were painful period, painful breasts and premenstrual tension. No significantly statistical difference was stated in frequency of menstrual cycle depending on the amount of smoked cigarettes and addiction duration. The main decisive factor of giving up smoking is the awareness of the harmfulness of nicotine addiction.

[Heterogeneity of insulin resistance level in gestational diabetes mellitus. Therapeutic implications]. / Zróznicowanie nasilenia insulino- opornosci w cukrzycy ciezarnych. Implikacje terapeutyczne.

OBJECTIVE: The evaluation of insulin resistance (IR) level in population of women with gestational diabetes(GDM) and its relation to treatment of GDM. MATERIALS AND METHODS: 657 GDM women, aged 17-45, treated between the years 2003 and 2005, in Bydgoszcz were studied. Age, pregravid body mass index(BMI), weight gain during pregnancy at the GDM diagnosis, week of GDM diagnosis, week of the beginning of insulin therapy and daily doses of insulin were assessed in the whole population. Daily doses of insulin were evaluated as minimal doses needed at the initial phase of GDM therapy and as maximal doses during gestation. IR was evaluated at the GDM diagnosis, with the use of homeostasis model assessment (HOMA-IR), based on fasting glucose and insulin concentration. RESULTS: 47% women were classified as low HOMA-IR(<2) subpopulation, 50% as intermediate HOMA-IR(2-10) subpopulation, 3% as high HOMA-IR(10-46)subpopulation. Subpopulation with intermediate HOMA-IR had higher BMI, higher weight gain and blood glucose at 0 OGTT compared to subpopulation with low HOMA-IR but lower insulin concentration compared to high HOMA-IR subpopulation. Women in high HOMA-IR subpopulation and in intermediate HOMA-IR subpopulation were twice as often treated with insulin, compared to low HOMA-IR group, accordingly, 58%, 42%, 24%. Daily insulin doses, assessed both minimal and maximal doses, were increasing parallel to HOMA-IR in whole population, accordingly, minimal doses of insulin, 16.0 = -12.7 vs 18.4 vs 20.8 vs 30.8 +/- 30.3 and maximal doses of insulin, accordingly, 39.0 +/- 322.4 vs 50.9 +/- 42.4 vs 70.3 +/- 30.3. CONCLUSION: The studied population of women consisted mainly of subpopulation with low or intermediate HOMA-IR value, in rare cases, of high HOMA-IR value. Our results suggest that adipose tissue is particularly associated with insulin resistance level in subpopulation with intermediate HOMA-IR. Both, frequency of insulin therapy and daily insulin doses are associated with insulin resistance level at the GDM diagnosis.

[Maternal smoking: effect on neonatal's health]. / Zjawisko nikotynizmu wsród ciezarnych. Palenie papierosów w ciazy a stan noworodka.

The influence of maternal smoking on the higher miscarriage rate, premature births and premature detachment of the placenta was proved in numerous so far undertaken medical researches. Apart from that smoking has an influence on fetal developmental retardation, low birth weight as well as the baby's abnormal development. The investigated population comprised of 100 healthy women that gave birth to their children after the 37th week of pregnancy and their newborns. The pregnant women's morphology parameters, the newborns' health (after the third minute of life according to the Apgar's scale) and the birth weight were assessed. The results achieved were analysed taking into consideration the problem of maternal smoking. The lower Apgar's notes as well as lower birth weight of the newborns whose mothers used to smoke during pregnancy were observed. The fact of being pregnant is the most significant argument for women to give up or diminish the habit of smoking.

Effect of ciclesonide and fluticasone on exhaled nitric oxide in patients with mild allergic asthma.

Ciclesonide is a novel, lung-activated, inhaled corticosteroid with once-daily efficacy and potent anti-inflammatory activity. The aim of the study was to compare the effect of ciclesonide and fluticasone propionate on exhaled nitric oxide (FENO), pulmonary function, and other parameters used in clinical evaluation of patients with mild allergic asthma. The study indicates that ciclesonide (in a daily dose of either 80 or 160 microg) induces both a faster and stronger decrease of FENO in comparison with fluticasone (100 microg twice daily). In both groups of patients treated with ciclesonide, the highest decrease in FENO levels was observed after 2 weeks of treatment. In the group of patients treated with fluticasone, this maximum effect was not observed till 8 weeks. An improvement in spirometric indices was observed in all groups studied. Statistical differences between the groups were not found; however, there was a trend toward higher increase in the group receiving 160 microg of ciclesonide. In all groups studied we observed clinical improvement (asthmatic symptoms and consumption of rescue medication were reduced), but there were no significant differences between these groups. Our results indicate that ciclesonide, compared with fluticasone, has stronger anti-inflammatory activity in patients with mild allergic asthma.

[Insulin resistance in pregnant type 1 diabetic female. Case report]. / Insulinoopornosc u ciezarnej z cukrzyca typu 1--opis przypadku.

Insulin resistance may coexist with diabetes type 1 and make treatment of diabetes difficult. Case of 24-year-old type 1 diabetic female with insulin resistance features prior to pregnancy is reported. Exacerbating of insulin resistance during pregnancy was manifested by difficulties to overcome excessive weight gain and necessity to initiate treatment with high doses of insulin. The treatment was based on diet with progressive caloric restriction to 800 kcal/day in 35 week of pregnancy. That diet was continued till the delivery in 37 week. The fast acting analog insulin (Humalog) and long acting insulin (Humulin U) were used in treatment of diabetes. Treatment with low calorie diet did not cause negative effects on diabetic female metabolism and on the neonate state.

[Insulin secretion at the diagnosis of gestational diabetes is lower in multiparas than in primiparas]. / Sekrecja insuliny przy rozpoznaniu cukrzycy ciezarnych jest mniejsza u wieloródek niz u pierwiastek.

UNLABELLED: Gestational diabetes mellitus (GDM) has heterogeneous ethiopathogenesis, pathophysiology and clinical features. OBJECTIVES: The aim of the study was to evaluate some of anthropometric parameters, clinical features and indices of insulin resistance and beta cell function in GDM women in first pregnancy and in GDM women in third and following pregnancies. MATERIAL AND METHODS: 877 GDM women, aged 18-48 years were studied. Both groups were compared according to age, BMI before pregnancy, week of GDM diagnosis, weight gain during pregnancy, fasting blood glucose, fasting serum insulin level, HbA1c, insulin resistance and beta-cell function indices. All parameters except BMI were evaluated at GDM diagnosis. RESULTS: Multiparas were older, with higher BMI and lower beta-cell function indices. CONCLUSION: At the moment of GDM diagnosis, insulin secretion evaluated by HOMA indices are lower in multiparas in comparison to primaparas.

[Relationship between doppler velocimetry at middle cerebral artery and umbilical artery and status of newborn after delivery]. / Analiza zaleznosci miedzy dopplerowskimi parametrami przeplywu krwi w tetnicy srodkowej mózgu i tetnicy pepowinowej a stanem noworodka po urodzeniu.

OBJECTIVES: Aim of research was estimation of correlation between doppler parameters and fetal state after delivery. MATERIAL AND METHODS: One hundred fifty-one pregnancies treated in Dept. of Obstetrics and Gynecology of Medical Academy in Bydgoszcz was investigated between 1998-2002. Pregnancies were estimated between 27 and 43 Hbd. Ultrasound examination using pulse and color Doppler was performed (ACUSON XP 128) and PI, RI, S/D, MCA, UA were estimated. DESIGN: Following doppler parameters were analyzed: pulsatile index (PI), resistance index (RI) and systolic/diastolic ratio (S/D) in middle cerebral artery (MCA) and in umbilical cord artery (UA). The newborn children were estimated by Apgar score in first minute of life (AP1). Correlation between amount of amniotic fluid index (AFI) and newborn state in first minute after delivery was investigated too. RESULTS: There were following correlations in this investigation: (1) negative between UA PI and AP1 (-0.26); (2) negative between UA RI and AP1 (-0.23); (3) negative between UAS/D and AP1 (-0.16); (4) negative between AFI and API (-0.06); (5) lack of statistical correlation between MCA PI, MCA RI, MCA S/D and AP1. We considered following covariancies: (1) negative between AFI and AP1 (-1.03); (2) negative between UA S/D and AP1 (-0.42); (3) negative between UA PI and AP1 (-0.23); (4) negative between UA RI and AP1 (-0.09). CONCLUSIONS: We concluded that Doppler investigations by measure of parameters of blood flow in umbilical cord artery (PI, RI, S/D) can be predictive to fetal threat and useful in estimation of newborn state.

[Outcome of non-pharmacologic treatment in a gestational diabetic woman with high insulin resistance HOMA-IR index and allergy to human insulin. Case report]. / Skutecznosc leczenia niefarmakologicznego cukrzycy ciezarnych u pacjentki z wysokim wskaznikiem insulinoopornosci HOMA-IR uczulonej na preparaty insuliny ludzkiej.

Gestational diabetes is a syndrome of significant pathophysiological and clinical heterogeneity. This type of diabetes mellitus can be treated with diet, exercise and insulin in cases of unsatisfactory results of nonpharmacologic treatment. It has been reported the case of a 28-year -old female with gestational diabetes treated with high doses of insulin (128 U/per day) on four injections regimens. During the therapy allergic type III reactions to human insulin preparations (Ultratard HM, Actrapid HM Humulin U, Humulin R, Humalog) has been occurred at the injection site. The insulin was omitted. We applied diet modification and 15-30 minutes walking before meals till the afternoon with god metabolic control. High insulin resistance index HOMA-IR, type 2 diabetes history in both parents god metabolic control of nonpharmacologic treatment, and impaired glucose tolerance after post-partum may suggest, the early stage of diabetes type 2 in presented case.

[Ectopic cervical pregnancy terminating in the birth of a live 1800 g infant]. / Ciaza ektopqwa szyjkowa zakonczona urodzeniem zywego 1800 g dziecka.

We present here a case of ectopic cervical pregnancy terminated in the birth of a live 1800 g infant, whose further development takes normal course. Wrong evaluation of the place of the developing pregnancy resulted in its growth up to 34th week. Finally, the placement of pregnancy was established after delivering the woman with a caesarean section, on the basis of macro and microscopic evaluation of the removed uterus. Extraordinary series of circumstances enabled such a long development of ectopic cervical pregnancy, on a scale unprecedented in literature. Ways of dealing with cervical pregnancy, which seriously endangers health and life of the patient, were also recalled.

[Assessment of selected factors influencing birthweight in pregnant women with gestational diabetes mellitus]. / Analiza wybranych parametrów wplywajacych na mase ciala noworodka u kobiet z cukrzyca ciezarnych.

OBJECTIVES: Giving birth to a chi;d with an excessive brithweight is one of the most common neonate complications observed in the pregnant women with gestation diabetes (GDM). DESIGN: The aim of the study was an evaluation of selected factors affecting birthweight in the GDM. MATERIALS AND METHODS: Data from 867 pregnant women were analysed. The influence of: age, height, place of living and mother's educational background and BMI before pregnancy and weight gain during pregnancy and also HbA1c, triglycerides (TG) and total cholesterol (TC) values in the 3rd term of pregnancy (T3) were determined. The TC and TG were assessed by the enzymatic method by means of the Bio Merieux firm set--France, HbA1c by means of the immunoturbidimetric method using the Roche firm sets--France. RESULTS: Statistically significant birthweight differences were affirmed according to: mother's height (respectively the groups: < or = 155 vs 156-169 vs > or = 170 cm), BMI before pregnancy (< 25 vs 25-29.9 vs > or = 30 kg/m2), weight gain in pregnancy (< 12 vs > or = 12 kg), TG (< 2.7 vs > 2.7 mmol/l) and HbA1c in T3. No influence of mother's age, her place of living, educational background, HbA1c at admission and TC values in T3 on the neonates birthweight was observed. CONCLUSIONS: The anthropometric and environmental factors (mother's height, weight, weight gain in pregnancy) have a more significant influence on the neonates birthweight of the mothers with GDM, than social-demographic factors (age, educational background, place of living), the way of treatment of GDM and TC in T3. The TG level in T3, beside HbA1c is an independent, prognostic factor of birthweight in GDM.

[Effect of family history and clinical features of metabolic syndrome on certain anthropometric, clinical, biochemical, metabolical parameters and the method of diabetes treatment in women with gestational diabetes]. / Wplyw obciazenia rodzinnego wykladnikami klinicznymi zespolu metabolicznego na wybrane parametry antropometryczne, kliniczne, biochemiczne, metaboliczne oraz na metode leczenia cukrzycy u pacjentek z cukrzyca ciezarnych.

UNLABELLED: Etiopathogenesis of gestational diabetes mellitus (GDM) is still unknown. It has been suggested, that GDM may be a clinical feature of the Metabolic Syndrome (MS). The aim of the study was to asses the effects of parents history of MS clinical features (diabetes mellitus type 2, obesity, arterial hypertension) on certain anthropometric measures, clinical, biochemical and metabolic parameters and on the method of GDM treatment. 156 GDM women aged from 19 to 43 years (mean +/- SD:29.7 +/- 5.8 years) were included in this study. They were divided into two groups, 73 women with positive family history and 83 with negative family history. These groups were compared with regard to age, time of diagnosis of GDM, BMI before pregnancy, increase of weight during pregnancy, fasting glycaemia, fasting insulinaemia, HBA1c, HOMA indices of insulin resistance and method of GDM treatment with regard to maximal doses of insulin used during pregnancy. All parameters except BMI were assessed at the diagnosis of GDM. Gestational diabetics with positive family history of MS clinical features were older (mean +/- SD:30.7 +/- 6.4 vs 28.9 +/- 5.2 years) and have a greater BMI before pregnancy (26.34 +/- 6.12 vs 23.31 +/- 4.7 kg/m2) with GDM diagnosed earlier (29.3 +/- 3.5 vs 30.7 +/- 3.4 week) than in the gestational diabetics with negative family history. There were not significant differences between groups in fasting glycaemia, fasting insulinaemia, increase in weight during pregnancy at GDM diagnosis, HbA1c, HOMA-IR and maximal dose of insulin during pregnancy. There were significant positive correlation between age and BMI in women without family between age and BMI in positive family history group. In both groups were not correlations between age, time of GDM diagnosis and BMI. In positive family history 52% of women were treated with insulin during pregnancy. In negative family history 37% of women were treated with insulin. CONCLUSION: positive one or both parents history of MS clinical features (diabetes mellitus type 2, obesity, arterial hypertension) my be predisposing cause of greater BMI before pregnancy, earlier diagnosis of GDM and more frequently insulin treatment during pregnancy comparing with gestational diabetics with negative family history of analyzed MS clinical features.

[Insulin Lispro as an alternative for insulin Humulin U in the treatment of an obese gestational diabetic woman with allergy to Humulin U. Case report]. / Insulina Lispro jako alternatywny preparat w leczeniu Humulina U otylej kobiety z cukrzyca ciezarnych uczulonej na Humulin U. Opis przypadku.

It has been reported the case of 32-year-old obese gestational diabetic woman, treated with Humulin U and Humalog from 28 week of gestation. Seventeen days after initiation of insulin Humulin U the woman developed allergic type I cutaneous changes. During the few minutes following injection of Humulin U, the local wheal-flare reactions accompanied by itching has been occurred. These symptoms have been disappeared after a few hours. Insulin Humulin U was discontinued (18 j). Glycemia were monitored every 1-2 hours between 8 pm-6 am. Glycemia were in normal range between 8 pm. till 5 am. We have observed increase of glycemia to 6.34 mmol/l between 5 am.-6 am. The therapy was converted to Humalog injected at 5 30 am with glycemic control one hour later. The glycemic control was very good till next dose of Humalog before breakfast. The doses of Humalog were systematically increased at 5.30 am depend on glycemia at 6.30 with highest doses in 37 week of pregnancy (30 j with 180 j a day). The good glycemic control was maintained till delivery (38 week of pregnancy). That method of therapy was good tolerated and was not strenuous in spite of necessity of early awakening. We suggest that in obese gestational diabetics ultra-short insulin preparation, analog of short acting human insulin (Humalog), injected at 5.30 am might be considered as a therapeutic alteration for long acting insulin injected at evening. This observation may be interesting especially in situations in which long acting insulin injected at evening must be discontinued.

[The results of cytogenetic investigations in 107 couples with recurrent spontaneous abortions from Pomerania-Kujawy region of Poland]. / Wyniki badan cytogenetycznych u 107 par z regionu kujawsko-pomorskiego z nawracajacymi poronieniami samoistnymi.

About 10-15% of clinically diagnosed pregnancies end by spontaneous abortion. One of the causes of recurrent abortions is the presence of chromosome aberrations in a parent. The paper presents the results of cytogenetic investigations in 107 couples referred to genetic council clinic because of at least 2 spontaneous abortions. Cytogenetic analysis was performed on peripheral blood lymphocytes after standard 72h PHA-stimulated culture. At least 20 GTG- and CBG-banded metaphases were analyzed in each patient. Fluorescence in situ hybridization technique was used as to precisely define cytogenetic results. Chromosome aberrations were found in 7 couples (6.54%), exclusively in women. Numerical aberration (47,XXX) was present in 1 woman, and balanced structural aberrations in 6 (5.61%). In 3 of them balanced translocations were disclosed: t(7; 19)(p13;p13.3), t(8;16)(q24;q22), and t(3;8)(q21;p21), in 2--inversions: inv(2)(p25q31), inv(17)(p12p13.3), and in 1--der(20). Pericentric inversion of chromosome 9 was found in 3 men. The analysis of nongenetic factors showed that neither age, nor congenital anomalies of uterus could be an important factor causing abortions in analyzed couples with aberrations. However, infections and muta- or teratogenic exposure could contribute to loss of pregnancies in some cases. Authors conclude that karyotype analysis should be an integral part of diagnostics in couples with recurrent abortions.

Differentiating between benign and malignant adnexal lesions with contrast-enhanced transvaginal ultrasonography.

OBJECTIVE: To analyze the relationship between contrast kinetics in tumorous vessels and lesion histologic type in an attempt to differentiate between malignant and benign disease. METHODS: In a single-center prospective study, patients who had been referred for elective surgery because of a diagnosis of unilateral and/or bilateral adnexal masses were enrolled at Dr Jan Biziel University Hospital, Bydgoszcz, Poland, between January 2012 and September 2013. Participants underwent contrast-enhanced ultrasonography examination (CEUS). Contrast kinetics were obtained and compared with the neovascularization of the tumor. Accuracy, and positive and negative predictive values were calculated. RESULTS: Among 160 enrolled patients, 84 underwent CEUS examination and 51 lesions were studied. Baseline and maximum color Doppler intensities were significantly higher in malignant than in benign tumors (P < 0.001 for both). Similarly, the absolute and relative increases in color Doppler intensity were significantly higher in malignant tumors (P < 0.001). The estimated positive predictive value was 97.1%, the negative predictive value was 100%, and the accuracy was 100%. Peak enhanced intensity of fractional color Doppler Area and area under the time-intensity curve (S-parameter) correlated significantly with the histology of the lesion (P < 0.001). Probability curves demonstrated that higher S-parameter values were correlated with a higher risk of malignancy. CONCLUSION: Transvaginal CEUS is a reliable and reproducible way to differentiate between benign and malignant adnexal lesions.

[The role of leptin in human reproduction]. / Rola leptyny w rozrodczosci u ludzi.

The article reviews the current literature about leptin, a hormone produced mainly in the adipose tissue, in terms of its role in reproduction. The structure of leptin, its biological activity as well as its influence on secretion of their hormones has been discussed. The leptin concentrations during the ovulatory cycle, pregnancy puerperium and assisted reproduction have been presented. It has been suggested that leptin may have an advantageous effect not only on oocyte and zygote development in the early stages, but also on the process of implantation and therefore its evaluation may be useful for the clinical determination of embryo quality in IVF-ET program.