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.

Dietary Natural Compounds and Vitamins as Potential Cofactors in Uterine Fibroids Growth and Development.

An analysis of the literature generated within the past 20 year-span concerning risks of uterine fibroids (UFs) occurrence and dietary factors was carried out. A link between Vitamin D deficiency and UFs formation is strongly indicated, making it a potent compound in leiomyoma therapy. Analogs of the 25-hydroxyvitamin D3, not susceptible to degradation by tissue 24-hydroxylase, appear to be especially promising and tend to show better therapeutic results. Although research on the role of Vitamin A in the formation of fibroids is contradictory, Vitamin A-enriched diet, as well as synthetic retinoid analogues, may be preventative or limit the growth of fibroids. Unambiguous conclusions cannot be drawn regarding Vitamin E and C supplementation, except for alpha-tocopherol. Alpha-tocopherol as a phytoestrogen taking part in the modulation of estrogen receptors (ERs) involved in UF etiology, should be particularly avoided in therapy. A diet enriched in fruits and vegetables, as sources of carotenoids, polyphenols, quercetin, and indole-3-carbinol, constitutes an easily modifiable lifestyle element with beneficial results in patients with UFs. Other natural substances, such as curcumin, can reduce the oxidative stress and protect against inflammation in leiomyoma. Although the exact effect of probiotics on uterine fibroids has not yet been thoroughly evaluated at this point, the protective role of dairy products, i.e., yogurt consumption, has been indicated. Trace elements such as selenium can also contribute to antioxidative and anti-inflammatory properties of a recommended diet. In contrast, heavy metals, endocrine disrupting chemicals, cigarette smoking, and a diet low in antioxidants and fiber were, alongside genetic predispositions, associated with UFs formation.

Assessment of the Parameters of Oxidative Stress Depending on the Metabolic and Anthropometric Status Indicators in Women with PCOS.

Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in females of reproductive age. In women with PCOS, metabolic disorders such as insulin resistance (IR), hyperinsulinemia, obesity, diabetes mellitus, and other elements of metabolic syndrome are likely to occur. Studies have shown an increase in the concentration and activity of oxidative stress (OS) markers in patients with PCOS, compared to that in unaffected women. The aim of this study was to evaluate the parameters of OS in PCOS and their activity in relation to women without menstrual disorders with a normal body weight. Then, we compared malonodialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), including overweight and obesity, hyperandrogenemia, and IR in the PCOS group. The study included 35 women aged 18-46, hospitalized for menstrual disorders in the form of infrequent menstruation. In 26 women, PCOS was diagnosed on the basis of the Rotterdam Criteria; these patients qualified for the study group. The control group (n = 21) consisted of patients without menstrual disorders and without PCOS in an ultrasound examination. Patients were diagnosed between the 2nd and 5th day of the cycle. The parameters of OS were analyzed and compared with the anthropometric parameters and the lipid profile of the patients. Enzymatic activity of GPx, CAT, SOD, and MDA levels was determined in both groups. MDA levels and CAT activity differed significantly between the groups. There was a decrease in MDA levels in the IR group and the involvement of GPx in the excess weight and obesity and IR group accompanied by an increase in hip circumference. It therefore seems that IR may be the main risk factor to exposure to OS in patients with PCOS, independent from obesity. In addition, GPx is involved in every step in the development of the pathological condition in PCOS.

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.

Nutrition Strategy and Life Style in Polycystic Ovary Syndrome-Narrative Review.

Here we present an extensive narrative review of the broadly understood modifications to the lifestyles of women with polycystic ovary syndrome (PCOS). The PubMed database was analyzed, combining PCOS entries with causes, diseases, diet supplementation, lifestyle, physical activity, and use of herbs. The metabolic pathways leading to disturbances in lipid, carbohydrate, and hormonal metabolism in targeted patients are described. The article refers to sleep disorders, changes in mental health parameters, and causes of oxidative stress and inflammation. These conditions consistently lead to the occurrence of severe diseases in patients suffering from diabetes, the fatty degeneration of internal organs, infertility, atherosclerosis, cardiovascular diseases, dysbiosis, and cancer. The modification of lifestyles, diet patterns and proper selection of nutrients, pharmacological and natural supplementation in the form of herbs, and physical activity have been proposed. The progress and consequences of PCOS are largely modifiable and depend on the patient's approach, although we have to take into account also the genetic determinants.

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 TGFß, 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.

A Properly Balanced Reduction Diet and/or Supplementation Solve the Problem with the Deficiency of These Vitamins Soluble in Water in Patients with PCOS.

Polycystic ovary syndrome (PCOS) is an increasingly common problem for women in the reproductive age throughout the entire world. A reduction diet with a low glycaemic index (GI) has proved to support the treatment of PCOS. The aim of the study was to analyse the influence of the diet on the level of vitamins soluble in water. The study included 55 women, 40 of which suffered from PCOS (identified by means of the Rotterdam Criteria) and 15 healthy women of the Caucasian race. The level of vitamins before and after the dietary intervention was measured. The diet was a reduction diet with a reduced glycaemic index (GI). Biochemical analyses were made on the basis of liquid chromatography-Infinity 1260 Binary liquid chromatography (LC) Agilent Technology. The level of vitamins in the serum was analysed together with the consumption before and after the dietary intervention. A higher level of vitamin C in the plasma was observed before and after the dietary intervention in the PCOS group in comparison to the control group despite the lower intake of this vitamin in the PCOS group. The remaining vitamins were at a comparable or lower level (B1, B3, B5, B6 and B12). After the dietary intervention, only B1 and B9 were at a clearly lower level (a trend of p = 0.093 and p = 0.085). A properly balanced reduction diet with reduced GI improves the supply of vitamins in women with PCOS. An additional recommendation should be the additional supplementation of B1, niacinamide and the combination of folates with inositol. The level of vitamin C in the plasma may not be a good marker of its supply in the PCOS group.

Markers of Cellular Proliferation, Apoptosis, Estrogen/Progesterone Receptor Expression and Fibrosis in Selective Progesterone Receptor Modulator (Ulipristal Acetate)-Treated Uterine Fibroids.

There appear to be very few data on the exact mechanisms of a selective progesterone receptor modulator action in myomas. The aim of the study was to assess the effects of ulipristal acetate (UPA) on fibroids, especially on estrogen receptor (ER) and progesterone receptor (PR) immunoexpression, proliferation, apoptosis and tissue fibrosis, and to compare the above parameters in untreated (surgical attention only) and UPA-treated leiomyomas. UPA-treated patients were divided into three groups: (1) good response (≥25% reduction in volume of fibroid), (2) weak response (insignificant volume reduction) and (3) no response to treatment (no decrease or increase in fibroid volume). The study observed a significant decrease in the percentage of collagen volume fraction and ER and PR immunoexpression in the good response group, in the percentage of proliferating cell nuclear antigen (PCNA)- and Ki67-positive cells in the groups with good and weak reactions vs. control group; significantly higher apoptotic index (terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL)-positive cells) in the good reaction group vs. control group. The results of the study indicate that a good response to UPA, manifested by a volume reduction of myoma, may be associated with a decrease in fibrosis, ER/PR and PCNA and Ki67 immunoexpression and an increase in cell apoptosis within the myoma.

[How to reduce the failure rate in surgical treatment of stress urinary incontinence]. / Jak ograniczyc odsetek niepowodzen w operacyjnym leczeniu wysilkowego nietrzymania moczu.

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.

[Probiotics intake as gut-microbiota modulating therapy in an interdisciplinary aspect]. / Rola probiotyków jako modulatora regulacji zaburzen mikroflory jelitowej w podejsciu interdyscyplinarnym.

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.

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.

The Influence of Cigarette Smoke Exposure on the Copper Concentration in the Serum Depending on the Use of Menopausal Hormone Therapy.

This study evaluated the effect of menopausal hormone therapy (MHT) on serum concentration of copper in postmenopausal women depending on passive or active exposure to tobacco smoke or lack thereof. The study included healthy postmenopausal women aged 42-69 years, who used (n = 76) or did not use (n = 76) MHT. Salivary cotinine and serum copper concentrations were determined in all the study subjects. Salivary cotinine exceeded 14 ng/ml in 14 women from the MHT group (18.5%) and in 16 controls (21.1%). Up to 41 (27%) study subjects had serum copper above the upper normal limit (1.17 mg/l). No correlation was found between salivary cotinine and serum copper in women with cotinine concentrations <14 ng/ml, and these two parameters correlated weakly in subjects with cotinine >14 ng/ml. Salivary concentration of cotinine increased with serum copper level in the MHT group, but not in the controls; smokers using MHT presented with significantly higher serum copper than nonsmokers. These findings imply that MHT does not affect serum concentration of copper in women who are not exposed to tobacco smoke. However, MHT seems to contribute to unfavorable increase in serum copper in passive and active smokers.

[New methods of uterine fibroids treatment]. / Nowe metody leczenia miesniaków macicy.

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.