Immunomodulation inhibits the development of endometriosis in rats.

Endometriosis, the presence of ectopic endometrium, has an unclear etiology and is commonly associated with endocrine, genetic, and immunological imbalance. This study determined whether immunomodulation by the RESAN vaccine could alter the potentially pathogenic gene expression profiles in the cells of the eutopic endometrium in an animal model of endometriosis. Preventing these changes could inhibit the early development of the illness and support the success of surgical treatment. Wistar rats were divided into three groups: prophylaxis (vaccinated before ectopic endometrium implantation, n = 23), therapeutic (vaccinated at the time of the ectopic excision, n = 23) and control (n = 10). During the first laparotomy, autotransplantation of the endometrium to the peritoneum was performed in the prophylaxis and therapeutic groups. The second laparotomy was carried out three months later in all groups to examine endometriotic foci and adhesions. Suspected endometriosis foci were removed. Three months later, the third laparotomy was performed in all animals, followed by suspected foci excision. Fragments of the eutopic endometrium were collected from all animals during the first and third laparotomies. All samples were analysed by real-time PCR to assess the expression of Bcl2, Bax, Bax/Bcl2 ratio, Mki67, and Tert genes. Endometrial foci were found in abdominal peritoneum at the second laparotomy in 1 animal in the prophylaxis group, compared to 16 animals in the therapeutic group. The prophylaxis group showed a high expression of Bax while the therapeutic group showed high expression of Bax, Tert and Mki67 genes. Additional analysis revealed that throughout the six months of the experiment, the expression of the Bax, Tert, and Mki67 genes decreased significantly in the prophylaxis group, Mki67 gene expression decreased in the therapeutic group, and Tert, Mki67, and Bcl2 gene expression decreased in the control group. The results indicate that immunomodulation affects the balance between apoptosis and proliferation in the eutopic endometrium and may prevent the onset and recurrence of endometriosis.

An influence of immunomodulation on Th1 and Th2 immune response in endometriosis in an animal model.

AIM: To assess the role of the Th1 and Th2 cellular response in the etiology of endometriosis observed in a rat model, with the use of the RESAN immunomodulator. MATERIALS AND METHODS: A comparative analysis of cytokines in blood serum typical of Th1 (TNF-α and INF-γ ) and Th2 (IL-4, IL-6, IL-10) cell response in groups of rats, in which RESAN preparation was used as prophylaxis (Gr. I) or treatment (Gr. II) of endometriosis. RESULTS: The results indicated an increase in the level of cytokines in blood serum typical of Th2 cell response by comparing the second and third stages of the experiment in the second group of rats and a decrease in IL-4 and IL-10 between III and IV stages. There was a significant difference in cytokine levels during the third stage of the experiment by comparing I and II groups of rats. In the III group of rats, levels of IL-10 significantly increased between the II and III stages of the experiment. CONCLUSION: RESAN preparation shows Th2 cell response, inhibiting the development of endometriosis in a rat model. Due to successful prophylactic action, one may speculate that RESAN vaccine may be effective as a complementary treatment after surgical excision.

The influence of simultaneous whole body exposure to cigarette smoke and low-protein diet feeding on fertility, reproduction, and progeny of rats.

The aim of the present study was to evaluate the toxicological influence of different concentrations of tobacco smoke and low-protein diet on fertility, reproduction, and survival of offspring of Wistar female rats. We studied three generations, two litters in each. There were 192 animals in parent generation. Animals were exposed to three different concentrations of tobacco smoke that were reflected by the carbon monoxide (CO) concentration (500, 1000, and 1500 mg CO/m3 air) during 11 weeks (six before and two weeks during mating, and three weeks of pregnancy). Additionally, animals were divided into two subgroups that were fed normal or low-protein diet. In the present study, we concentrated on the indices describing the reproduction ability, fertility, and rearing of pups of mothers exposed to tobacco smoke. The parameters of newborns survival were estimated also. We concluded that neither tobacco smoke exposure nor the low-protein diet changed the duration of pregnancy. The tobacco smoke in all doses and low-protein diet had a negative influence on fertility, reproduction, and survival of newborns from exposed mothers. This influence was mainly attributed to the tobacco smoke exposure. The levels of carboxyhaemoglobin were increasing with increasing tobacco smoke concentration.

[Comparison of the frequency of selected gynecologic operations conducted as laparotomy and laparoscopy during 1993-1997]. / Porównanie czestosci przeprowadzania wybranych typow operacji ginekologicznych na drodze laparotomii i laparoskopii w latach 1993-1997.

UNLABELLED: The aim of the study was to compare frequency of four gynecological operations: myomectomy, tubal surgery, cystectomy and operative management of ectopic pregnancy, performed by laparotomy or laparoscopy, by the same team of surgeons. In the years 1994-1997 in Division of Reproduction Poznan University Medical School 647 cystectomies, 208 myomectomies, 68 tuboplasties and 50 surgical treatments of ectopic pregnancy were done. Among 973 operations--684 (70.3%) were performed by laparoscopy. There was a gradual tendency in increasing endoscopic procedures. Comparing the year 1994 and 1997 percentage of operations performed by laparoscopy significantly changed: In tuboplasty from 83% to 95%, cystectomy from 35.9% to 80.3%, ectopic pregnancy from 61.5% to 91.7% and myomectomy from 52.7% to 61.5%. Patient hospital stay decreased significantly after laparoscopic procedures (from 5.1 days to 3.25 days). During the study period open surgery followed laparoscopy only in 8 cases (1.1%) because of complications or technical difficulties. CONCLUSION: 1. Operative laparoscopy is a safe and effective procedure, in many cases replacing open surgery. 2. Shortening of hospital stay and recovery period after laparoscopy is one of the main advantages of this method of treatment.

Endometrial receptivity: expression of alpha3beta1, alpha4beta1 and alphaVbeta1 endometrial integrins in women with impaired fertility.

Advances in immunohistochemical methods with the specificity of poly- and monoclonal antibodies allow the description of the endometrial receptivity, which is characterized by the ability of secretion of phase specific proteins and glikoproteins by epithelial and stromal cells. We studied the differences in the expression of alpha3beta1, alpha4beta1 and alphaVbeta1 integrins in endometrium of women with recurrent miscarriages and women with unexplained infertility. The endometrial tissue was collected during hysteroscopy performed between 7th and 9th day after ovulation. The immunohistochemical evaluation of alpha3beta1, alpha4beta1 and alphaVbeta1 integrin expression was determined in all endometrial biopsies. Staining intensity of alpha3beta1 in glandular epithelium and endometrial stroma was similar in both groups. In women with recurrent miscarriages we noted a lower concentrations of the alpha4beta1 and alphaVbeta1 integrins during the midluteal phase than in women with unexplained infertility. Moreover, integrins alpha4beta1 and alphaVbeta1 were expressed more frequently in glandular epithelium and endometrial stroma of women with unexplained infertility than those of women with recurrent miscarriages. However, alphaV(2)1 staining in endometrial stroma was stronger than that of alpha4beta1. It can be concluded, that these integrins may play an important role in the implantation process.

[Microbiological flora cultured from peritoneal fluid of women in reproductive age]. / Flora mikrobiologiczna izolowana z plynu otrzewnowego u kobiet w wieku rozrodczym.

The aim of the study was to assess the presence of the microbes in peritoneal fluid of women in reproductive age. An investigation was performed on the group of 144 women operated laparoscopically in Division of Reproduction. The bacteria were cultured from 77 fluids (53.5%). The most common bacteria were: Staphylococcus epidermidis (34.1%) and Propionibacterium acnes (19.3%). In our group of patients 88 strains of bacteria were isolated. Sensitivity to antibiotics differed in many points. This situation does not allow to prepare any universal scheme of antibiotic therapy. We stress the necessity of assessing the type of bacteria and antibiotic resistance before the treatment get started. It seems to be especially important in pelvic pain syndrome and in pelvic inflammatory disease when operative procedure is necessary for bacteria isolation.

[Laparoscopic myomectomy]. / Laparoskopowe leczenie miesniaków macicy.

OBJECTIVES: The aim of our study was clinical analysis of the factors influencing on laparoscopic myomectomy. STUDY DESIGN: Retrospective analysis of the operative protocols. MATERIAL AND METHODS: Two hundred nineteen women had laparoscopy because of unexplained infertility (n = 109) unexplained infertility and myomas (n = 41), myomas (n = 36), endometriosis suspicion (n = 20) ovarian cyst (n = 9) or pelvic pain syndrome (n = 4). RESULTS: Among 299 myomas 186 were extirpated during laparoscopy. In 39 cases suturing of the myometrium was necessary. Electrocautery was performed in 27 cases and laser-vaporisation in 8. In 28 women the operation was postponed because of small myomas and mainly poor operative technique (beginning of the learning curve). In two of them second laparoscopy was performed after GnRH therapy. An analysis of the factors which enable laparoscopic myomectomy was performed. The most important factors are: size and number of the myomas, localization in the myometrium, experienced hands and operative room equipment. CONCLUSIONS: Uterine myomas are one of the indications to operative laparoscopy. Meticulous analysis of the operative conditions as well as the assessment of the team experience should always precede laparoscopy.

The experimental investigations of the toxic influence of tobacco smoke affecting progeny during pregnancy.

1. Tobacco smoke contains around 4000 substances, most of which are described as toxic, and they may have an influence on the development of progeny. 2. The present studies concentrate on the measurement and calculation of indices describing the new-born's survival, rearing of pups, weight of foetuses, young animals, placenta and females in relation to different doses of tobacco smoke (carbon monoxide levels). The morphological studies of placenta, foetal and newborn lungs were done as a supplement. Biochemical placenta study was also done. 3. The results of the experiment proved that some indices for animals in groups which were passively exposed to the highest concentrations of tobacco smoke were lower, others fluctuated (4 day, 12 day and total survival) and some did not reveal any changes (rearing). Direct correlation between maternal passive exposure to tobacco smoke and the presence of acute respiratory distress syndrome symptoms in new-borns was observed. A decrease of body weight of pregnant females passively exposed to tobacco smoke was also observed. An increase of placenta-foetal factor was found. A decrease of rat weight was observed after passive exposure to tobacco smoke. 4. We concluded that there is correlation between passive exposition to tobacco smoke during pregnancy and delayed lung maturation in the offspring. Exposure of the pregnant rats to cigarette smoke increases the activity of isocitric and glucose-6-phosphate dehydrogenases in placenta.

[Bacterial flora of genital organs in women treated for infertility]. / Flora bakteryjna narzadów plciowych kobiet leczonych z powodu nieplodnosci.

Bacterial flora in 72 women suffering from infertility was assessed. The medium age of women was 28.9 years (22-37) and the duration of infertility-5.5 years (2-15). Cultures were taken during laparoscopy (65) or microsurgery (7) from vagina, cervical canal and the fallopian tubes. Specific cultures for anaerobic and aerobic bacteria, N. gonorrhoeae, C. Trachomatis and Mycoplasma hominis were taken. In the specimens from fallopian tubes 21 species of bacteria were cultured. The most often coagulase-negative staphylococci (54.3%) as well as aerobic and anaerobic Gram-positive bacilli were found (23.9%). In conclusion we think that the proper preparation of patients in the preoperative period decreases significantly the number of isolated species of bacteria. Also the profile of cultured species differs from that found in women from western populations, especially from United States and Sweden.

[Usefulness of counting leukocytes and round cells in determination of bacterial infection of semen in infertile men]. / Przydatnosc oznaczania leukocytów i komórek okraglych w okresleniu zakazenia bakteryjnego nasienia nieplodnych mezczyzn.

The authors measured efficiency of the determination of bacterial infection from the semen of infertile men. They compared the correlation of counts of bacteria with white blood cells (peroxidase method) and round cells in ejaculate. Seminal white blood cells counts (more than 1 x 10(5)/ml) correlated well with bacteriospermia (more than 1000 cells/ml), R = 0.4741, p = 0.0007. Determination of round cells in semen has no clinical value in prediction of seminal infection, R = 0.0153, p = 0.6022.

[Examination of 17 beta-estradiol and progesterone levels in peritoneal fluid and blood serum of women with endometriosis]. / Badanie stezenia 17 beta-estradiolu i progesteronu w plynie otrzewnowym i surowicy krwi kobiet z endometrioza.

Authors have presented and assessment of estradiol and progesterone levels in peritoneal fluid and blood serum in women with endometriosis. Peritoneal fluid was collected during laparoscopy performed in luteal phase of the cycle. In this cycle ovulation was controlled in all women. An ovulation was confirmed ultrasonographically and laparoscopically in 45% of women with endometriosis and in 80% of that without the illness. Progesterone concentration in peritoneal fluid in women with endometriosis was significantly lower to the control (p < 0.01).

[Evaluation of peritoneal fluid in women with endometriosis]. / Ocena plynu otrzewnowego u kobiet z endometrioza.

An analysis of the peritoneal fluid in women with endometriosis was undertaken. Peritoneal fluid was collected during laparoscopy from the Douglas pouch. The quantity, color of the fluid as well as macrophages number, concentration and activity were assessed. Conclusion is that no one of the listed parameters of peritoneal fluid could be considered as an endometriosis marker.

[Evaluation of the clinical value in doing complex analysis of blood flow velocity parameters of the umbilical artery for determining prognosis of fetal status]. / Ocena wartosci klinicznej kompleksowej analizy parametrów przeplywu krwi w tetnicy pepowinowej w prognozowaniu stanu plodu.

Complex analysis of the clinical value of the doppler flow indices was undertaken. A/B, RI and PI were compared separately and in different combinations with fetal status and neonate's condition. Statistical analysis revealed that complex and detailed analysis of few quality indices is of greater clinical value and increases sensitivity, specificity and positive predictive value of the doppler technique in the sense of prognosis of fetal distress and neonate's condition.

[Doppler evaluation of blood flow in the umbilical artery when confronted with morphologic changes in human placenta of pregnancy complicated by diabetes]. / Dopplerowska ocena przeplywu krwi w tetnicy pepowinowej w konfrontacji ze zmianami morfologicznymi w lozysku ludzkim w ciazy powiklanej cukrzyca.

Doppler ultrasound velocimetry in umbilical artery was performed in 23 pregnant women in different classes of the diabetes. Results obtained were compared with the afterbirths' morphology. Strict correlation was found between arteries obliteration in the placenta and vascular resistance in higher classes of the diabetes. Normal structure of the villi with signs of their morphological maturity has basic influence on proper umbilical artery flow maintenance.

[Evaluation of fallopian tube function after microsurgical treatment]. / Ocena funkcji jajowodów po leczeniu mikrochirurgicznym.

Authors have presented long-term results of microsurgical treatment of female infertility. Operations of the abdominal ostium were successful in 28% (home taken baby), what is similar to the results presented in the literature. Poor outcome of the other types of the microsurgical operations was analysed. Comparison of the microsurgery with the different methods of the assisted medical procreation was performed (e.g. IVF-ET and GIFT), showing the advantages of the latest.

[Laparoscopy in diagnosing and treating endometriosis]. / Laparoskopia w rozpoznaniu i leczeniu endometriozy.

Clinical study in 98 women with genital endometriosis was performed. In 33 patient endometriosis was treated by operative laparoscopy-electrocauterization of foci in 20 women, ovarian cyst resection in 9 and cyst extrication in 4. In 10 cases laparoscopy was followed by laparotomy. Very high correlation between endometriosis and infertility was found (71.4%). Very few patients conceived till now (28.57%). Searching in the time of laparoscopy very subtle foci of endometriosis was stressed.

[Laparoscopy in diagnosis and treatment of polycystic ovaries]. / Laparoskopia w rozpoznawaniu i leczeniu zespolu policystycznych jajników.

Value of the laparoscopy in diagnostic process and treatment of the polycystic ovaries was analysed. Authors have presented changes in the procedure which occurred after developing new technologies. The first results of the operative laparoscopy, with use of monopolar cauterization are described.

[Laparoscopy followed by laparotomy]. / Laparoskopia zakonczona laparotomia.

Authors have presented 45 clinical situations where laparoscopy was followed by laparotomy. Pre- and intraoperative diagnosis was analyzed. Dense adhesions were the most common indication to perform laparotomy (43%).