Recommendations of the Group of Experts of the Polish Society of Gynecologists and Obstetricians in the field of gynecological and obstetric care of young women with physical and intellectual disabilities.

The recommendations present the current knowledge and procedures, which can be modified and changed in some cases, after careful analysis of a given clinical situation, which in the future may become the basis for their modification and updating.

Association of leptin with inflammatory cytokines and lymphocyte subpopulations in peritoneal fluid of patients with endometriosis.

INTRODUCTION: Endometriosis is a common, complex and chronic disease related to ectopic implantation and growth of endometrial tissue that may manifest by pelvic inflammatory reactions, chronic pelvic pain and subfertility. Endometriosis may be associated with increased peritoneal fluid leptin levels. Leptin is known to exert immunomodulatory effects; however, an association between leptin and inflammatory reactions in endometriosis has not been documented. Therefore, the aim of this study was to investigate a relationship between leptin concentrations in peritoneal fluid and the levels of peritoneal fluid inflammatory cytokines and mononuclear leukocyte subpopulations. MATERIALS AND METHODS: Peritoneal fluid was aspirated by laparoscopy from 46 women in whom endometriosis had been confirmed by clinical and histopathological examinations and from 10 control women qualified for ART in whom pelvic pathology has been excluded. Concentrations of leptin and inflammatory cytokines (IL-1beta, IL-6, IFN-gamma and TNF) in peritoneal fluid were evaluated by specific ELISAs. Percentage of peritoneal leukocyte subpopulations (CD3+, CD4+, CD8+ and CD14+) was analyzed by FACS using specific monoclonal antibodies. RESULTS: Leptin concentrations in peritoneal fluid correlated negatively with concentrations of IL-1beta and IFN-gamma (r(s)=-0.38, p=0.01 and r(s)=-0.31, p=0.03, respectively) and correlated positively with the percentage of CD3+ pan-T cells (r(s)=0.69, p=0.009) and CD4+ T helper cells (r(s)=0.74, p=0.036). CONCLUSIONS: Increased leptin levels in peritoneal fluid from endometriosis patients may affect local inflammatory/immune reactions, especially infiltration of CD4+ T helper cells. Thus, leptin may play an important role in the immunopathogenesis of endometriosis.

A relationship between increased peritoneal leptin levels and infertility in endometriosis.

Endometriosis is a common, complex and chronic disease related to ectopic implantation and growth of endometrial tissue that may manifest by pelvic pain, and accounts for over 20% of all cases of infertility in women. Endometriosis may be associated with increased levels of leptin in peritoneal fluid. However, the association of leptin with infertility has not been definitely documented. Therefore, the aim of the present study was to search for a relationship between concentrations of peritoneal-fluid leptin and patients' clinical status. The study included 56 patients being diagnosed for infertility and/or pelvic pain. Peritoneal fluid was aspirated during routine laparoscopic examination. Concentrations of leptin in peritoneal fluid were evaluated by a specific enzyme-linked immunosorbent assay. The results revealed that the levels of peritoneal-fluid leptin did not correlate with different stage of endometriosis. However, they correlated with body mass index. Leptin levels were significantly higher in infertile patients than in patients with pelvic pain (p = 0.0023 by Mann-Whitney U test or p = 0.0045 by analysis of variance). It may suggest that increased leptin levels in the peritoneal fluid may play a role in pathogenesis of infertility.

[Present conceptions of etiopathogenesis of polycystic ovary syndrome]. / Wspólczesne koncepcje etiopatogenezy zespolu policystycznych jajników.

Polycystic ovary syndrome is one of the most common endocrinopathies, occurring in women in reproductive ages. Despite a long history of studies on PCOS, its etiology is still unknown and the very definition remains controversial. This paper presents the most modern concepts which explain the pathophysiology of PCOS, concentrating on a gonadotropic-ovarian and an insulin-dependent model, the roles of a inflammatory state, an endothelium injury and an oxidative stress in PCOS development, as well as postulated genetic mechanisms. The hypo-thetical model of PCOS etiopathogenesis is proposed on the base of the discussed partial concepts.

Effect of estrogen/progesterone hormone replacement therapy on natural killer cell cytotoxicity and immunoregulatory cytokine release by peripheral blood mononuclear cells of postmenopausal women.

Sex steroids are known to affect immune responses; however, information on immunomodulatory effects of estrogen/progesterone hormone replacement therapy (HRT) is still limited. Therefore, the present study aimed to investigate the effect of estrogen/medroxyprogesterone HRT on natural killer (NK) cell cytotoxicity and immunoregulatory cytokine (IL-2, IL-4 and IFN-gamma) release by phytohemaglutinin (PHA)-stimulated peripheral blood mononuclear cells (PBMC) from 15 selected healthy postmenopausal women. NK cell cytotoxicity, cytokine production and serum levels of 17beta-estradiol (E2), progesterone (P) and FSH were tested in each patient before and after 90-days HRT. NK cell cytotoxicity was tested by (51)Cr-release assay using K562 erythroleukemic cells as target. Specific cytokine production and serum hormone levels were evaluated by enzyme-linked immunosorbent assay (ELISA) and immunochemiluminescent assays, respectively. HRT resulted in a significant decrease of Kupperman index, an increase of E2 and a decrease of FSH levels. These changes were associated with a significant decrease of NK cell cytotoxicity, IL-2 and IFN-gamma production. The levels of IL-4 production remained unchanged. Changes of NK cell cytotoxicity and cytokine release in individual patients did not correlate with changes of serum sex hormone levels. Nevertheless, the present results imply strongly that estrogen/progesterone HRT may affect cell-mediated immunity, thus being a potential factor influencing development and course of autoimmune disorders and neoplastic diseases.

Reprint of 'A nonlinear parameterization of multivariate electrohysterographical signals'.

Electrohysterography is a technique which measures a bioelectrical activity of a uterus. This paper presents an application of a nonlinear parameterization of multivariate electrohysterographical signals for a uterine activity assessment to improve unsatisfactory a labor prediction accuracy by methods published in literature. A multivariate sample entropy used for differentiated 4-channel electrohysterographical signals, general Spearman's correlation and a combined index being the sum of them, were tested. These nonlinear measures use joint information contained in a multivariate signal. The results confirm that the combined index provides the best assessment of uterine contractions: 87% sensitivity and 50% specificity of labor prediction in the studied data. These results should be verified in a prospective study.

[Mean arterial blood flow depends on the intensity of thyrotoxicosis in patients with Graves' disease]. / U chorych z nadczynnoscia tarczycy w przebiegu choroby Gravesa-Basedowa wielkosc przeplywu krwi zalezy od stopnia nasilenia nadczynnosci tarczycy.

UNLABELLED: Thyrotoxicosis leads to profound changes in the cardiovascular system. AIM: Using a new non-invasive ultrasonic system VED elaborated by Powalowski et al., we aimed to assess whether arterial blood flow is related to the intensity of thyrotoxicosis in patients with Graves' disease. MATERIAL AND METHODS: We compared two groups: hyperthyroid (Graves' group n=25, mean age=31+/-8 years) and euthyroid (control group n=23, mean age 30+/-7 years). Mean arterial blood flow (Q) was determined in the common carotid artery on the basis of ultrasound continuous wave Doppler and echo examinations. RESULTS: Q was significantly higher in the Graves'group: 11.52+/-4.36 vs 8.33+/-2.02 10(-6) m3/s, p<0.00003. There was positive correlation between Q and blood concentrations of thyroid hormone in the Graves' group (rS=0.5372, p<0.00001 for Q and fT3; rS=0.4087, p<0.005 for Q and fT4). No correlation between Q and age nor Q and lipid parameters (total cholesterol, HDL-cholesterol nor LDL-cholesterol) were found in the Graves' group. CONCLUSION: In thyrotoxic patients with Graves' disease there is not only a qualitative but also a quantitative relationship between thyroid hormone and blood flow in the common carotid artery.

A nonlinear parameterization of multivariate electrohysterographical signals.

Electrohysterography is a technique which measures a bioelectrical activity of a uterus. This paper presents an application of a nonlinear parameterization of multivariate electrohysterographical signals for a uterine activity assessment to improve unsatisfactory a labor prediction accuracy by methods published in the literature. A multivariate sample entropy used for differentiated 4-channel electrohysterographical signals, general Spearman׳s correlation and a combined index being the sum of them, were tested. These nonlinear measures use joint information contained in a multivariate signal. The results confirm that the combined index provides the best assessment of uterine contractions: 87% sensitivity and 50% specificity of labor prediction in the studied data. These results should be verified in a prospective study.

[Immunologic and genetic aspects of endometriosis physiopathology]. / Immunologiczne i genetyczne aspekty patofizjologii endometriozy.

This article reviews the pathological mechanism of endometriosis. We concentrate on immunological and genetical factors which play a role in the developing of endometriosis. We present the possible network of interactions between immune cells, hormones and matrix metalloproteases system in the ectopic endometrial tissue.

Increased levels of human neutrophil peptides 1, 2, and 3 in peritoneal fluid of patients with endometriosis: association with neutrophils, T cells and IL-8.

Endometriosis is a common gynaecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. This disease is associated with pelvic inflammation and displays some features of autoimmune disorder. Human neutrophil peptides 1, 2, and 3 (HNP 1-3) belonging to α-defensin family play a crucial role in innate immunity against infections and may exert immunoregulatory effects. They may play a role in various inflammatory reactions; however, their role in endometriosis has not been studied. Therefore, the aim of the present study was to evaluate HNP 1-3 in the peritoneal fluid of 67 patients with endometriosis and 16 healthy control women in relation to peritoneal leukocyte subpopulations (neutrophils, T cells, and macrophages) and inflammatory cytokines (IL-6 and IL-8). HNP 1-3, IL-6 and IL-8 were evaluated in the peritoneal fluid by specific enzyme-linked immunosorbent assays (ELISA), and peritoneal leukocyte subpopulations were evaluated by flow cytometry. We found that the levels of HNP 1-3 were significantly increased in the peritoneal fluid of endometriosis patients, compared with control women, and correlated with severity of the disease. Endometriosis was also associated with increased concentrations of peritoneal neutrophils. In endometriosis the levels of HNP 1-3 strongly correlated with concentrations of neutrophils, T cells and IL-8. HNP 1-3 levels were not associated with peritoneal IL-6 or macrophages. These data suggest that HNP 1-3 and neutrophils might play a role in immunopathogenesis of endometriosis and may be worth evaluating as targets for anti-endometriosis therapy.

Relationship between serum progesterone and tumor necrosis factor production in postmenopausal women undergoing estrogen/medroxyprogesterone therapy.

Changes in tumor necrosis factor (TNF) production by lipopolysaccharide-stimulated peripheral blood mononuclear cells significantly correlated with serum P levels in postmenopausal women subjected to estrogen/medroxyprogesterone therapy. This may suggest that low physiologic or hormone therapy-related changes of serum P in healthy postmenopausal women may affect an ability of peripheral blood mononuclear leukocytes to produce TNF, thus having an impact on a variety of TNF-dependent physiologic and pathologic phenomena.

Elevated ghrelin levels in the peritoneal fluid of patients with endometriosis: associations with vascular endothelial growth factor (VEGF) and inflammatory cytokines.

OBJECTIVE: To study ghrelin concentrations in the peritoneal fluid of women with endometriosis and of control women without pelvic pathology and its associations with the levels of proinflammatory cytokines and vascular endothelial growth factor (VEGF). DESIGN: Case-control study. SETTING: University research institution and hospital. PATIENT(S): Forty-six nonobese women with laparoscopically and histopathologically confirmed endometriosis and 20 control women without pelvic pathology. INTERVENTION(S): Peritoneal fluid was aspirated during routine diagnostic laparoscopic examination. MAIN OUTCOME MEASURE(S): Concentrations of ghrelin and inflammatory cytokines (interleukin [IL]-1 beta, IL-6, tumor necrosis factor [TNF], and VEGF) in the peritoneal fluid were evaluated by specific enzyme immunoassay and enzyme-linked immunosorbent assays, respectively. RESULT(S): Ghrelin concentrations in the peritoneal fluid of women with endometriosis were significantly increased as compared with control subjects. Peritoneal ghrelin levels in patients with endometriosis were strongly positively associated with VEGF (r(s) = 0.625). There was no correlation between ghrelin and IL-1 beta, IL-6, or TNF. CONCLUSION(S): The results of the present study show that endometriosis is associated with increased peritoneal ghrelin levels. The association between ghrelin and endometriotic lesion vascularization remains to be elucidated.

[In patients with Graves' disease signal-averaged P wave duration positively correlates with the degree of thyrotoxicosis]. / W chorobie Gravesa i Basedowa czas trwania usrednionego zalamka P wykazuje dodatnia korelacje ze stopniem nadczynnosci tarczycy.

Coexistence of the goitre, proptosis and palpitations was observed in XIX century for the first time. Sinus tachyarytmias and atrial fibrillation are typical cardiac symptoms of hyperthyroidism. Atrial fibrillation occurs more often in patients with toxic goiter than in young patients with Grave's disease. These findings suggest that causes of atrial fibrillation might be multifactorial in the elderly. The aims of our study were to evaluate correlations between the parameters of atrial signal averaged ECG (SAECG) and the serum concentration of thyroid free hormones. 25 patient with untreated Grave's disease (G-B) (age 29,6 +/- 9,0 y.o.) and 26 control patients (age 29,3 +/- 6,9 y.o.) were enrolled to our study. None of them had history of atrial fibrillation what was confirmed by 24-hour ECG Holter monitoring. The serum fT3, fT4, TSH were determined in the venous blood by the immunoenzymatic method. Atrial SAECG recording with filtration by zero phase Butterworth filter (45-150 Hz) was done in all subjects. The duration of atrial vector magnitude (hfP) and root meat square of terminal 20ms of atrial vector magnitude (RMS20) were analysed. There were no significant differences in values of SAECG parameters (hfP, RMS20) between investigated groups. The positive correlation between hfP and serum fT3 concentration in group G-B was observed (Spearman's correlation coefficient R = 0.462, p < 0.02). No significant correlations were found between RMS20 and serum fT3 in G-B group and between hfP or RMS 20 and serum fT3 in group K. These findings suggest that occurrence of atrial fibrillation in patients with Grave's disease depends not only on hyperthyroidism but on serum concentration of fT3 also.

Susceptibility to ovarian endometriosis in Polish population is not associated with HLA-DRB1 alleles.

BACKGROUND: Endometriosis is associated with inflammatory autoimmune reactions; however, aetiopathogenesis of the disease is still poorly understood. While autoimmune disorders are often associated with particular HLA alleles, the possible involvement of HLA in the aetiopathogenesis of endometriosis is still a subject of controversy. The aim of the study was to examine the distribution of HLA-DRB1 alleles in women with endometriosis. To ensure homogeneity of the studied group, only women with ovarian endometrial cysts were included. METHODS: The study included 65 Polish patients of Caucasian origin in whom ovarian endometriosis had been confirmed by laparoscopic and histopathological examinations. HLA-DRB1 alleles were typed using a reverse slot blot method. A frequency of particular HLA-DRB1 alleles in patients was compared with that of a control group of 700 unrelated ethnically matched individuals as well as 193 age-matched women without endometriosis. RESULTS: No statistically significant differences were found in the distribution of HLA-DRB1 alleles in patients with ovarian endometriosis as compared with control populations. CONCLUSIONS: The results of the present study show that ovarian endometriosis is not associated with particular HLA-DRB1 allele(s). This may suggest that aetiology of this form of endometriosis may be not primarily associated with class II HLA-mediated autoimmune reactions.