Hormonal replacement therapy in women with a history of internal genital organ malignancy.

Sudden cessation of ovary activity as a result of bilateral oophorectomy or chemo- or radiotherapy in premenopausal women is linked with more serious consequences that bear no comparison to natural menopause - to name just a few: higher rate of mortality, higher rate of colorectal and lung cancer, circulatory system diseases, cognitive disorders, Parkinson's disease, psychological disorders, osteoporosis, and sexual disorders. The prolonged period of estrogens deficit in premenopausal age is connected with worsened quality of life. The progress in oncological care means that in many malignant diseases, also in the case of gynaecological malignancies, the percentage of survivors increases. This makes improving the quality of life more and more important. The purpose of this review is to establish, based on EBM data, the answer to whether replacement hormonal therapy, being the most effective treatment of menopause symptoms, can be recommended for women who have undergone bilateral oophorectomy because of gynaecological cancer. On the basis of collected data, derived from meta-analysis, and studies which have been published within the last 20 years, it seems that the use of the appropriate type of hormonal replacement therapy (HRT) in properly selected gynaecological cancer survivors (epithelial ovarian cancer - EOC, endometrial cancer, squamous cell carcinoma of the cervix) is safe and effective. It seems that benefits connected with better quality of life that stem from the use of appropriate HRT in gynaecological cancer survivors predominate the unfounded fear of disease recurrence in selected patients' groups.

Metformin paradoxically worsens insulin resistance in SHORT syndrome.

BACKGROUND: SHORT syndrome is an autosomal dominant condition associated severe insulin resistance (IR) and lipoatrophy due to post-receptor defect in insulin signaling involving phosphoinositide-3-kinase regulatory subunit 1 (PIK3R1), where no clear treatment guidelines are available. METHODS: We attempted to test the efficacy metformin in a female patient with SHORT syndrome by measuring glucose and insulin during an extended Oral Glucose Tolerance Test (OGTT) in a 21-year old patient (BMI 17.5 kg/m2), who presented for endocrine assessment with a history of amenorrhoea. RESULTS: She had lipid concentrations within the reference range, normal thyroid function tests, prolactin, gonadotropins, estradiol and androgens with Free Androgen Index 4.52. Extended Oral Glucose Tolerance Test was performed and showed severe IR. She was then started on metformin 850 mg twice a day, and had repeated OGTT. This showed dramatic worsening of glucose tolerance (e.g. glucose 96 mg/dl versus 187 mg/dl and 68 mg/dl versus 204 mg/dl at 120 and 150 min of OGTT, respectively). This was accompanied by a massive increase of already high insulin concentrations (e.g. from 488.6 to > 1000 µIU/ml, and from 246.8 to > 1000 µIU/ml at 120 and 150 min of OGTT, respectively). Insulin concentrations remained above upper assay detection limit also at 180 min of OGTT on metformin treatment (> 1000 µIU/ml versus 100.6 µIU/ml without metformin). CONCLUSIONS: Metformin treatment may paradoxically lead to deterioration of insulin resistance and to development of glucose intolerance in SHORT syndrome. Hence, metformin treatment might be potentially harmful in these patients. Though, the precise cause of such profound and paradoxical worsening of glucose tolerance post metformin remains unknown, SHORT syndrome might prove to be an interesting model to study the mechanism(s) of metformin action.

[The role of vitamin D deficiency in the etiology of polycystic ovary syndrome disorders]. / Rola niedoboru witaminy D w patofizjologii zaburzen wystepujacych w zespole policystycznych jajników.

Vitamin D deficiency connected with insufficient production in the skin and limited alimentation delivery disrupts the function of all systems of the body and increases the risk of chronic diseases. Many studies have reported associations between low serum 25-hydroxyvitamin D [25(OH)D] level and symptoms of the polycystic ovary syndrome (PCOS) - insulin resistance, hirsutism, and infertility associated with both, ovulatory disorders and abnormal endometrial receptivity. The beneficial effects of vitamin D supplementation on insulin resistance, ovarian follicles maturation, ovulation and menstrual regularity were confirmed. Due to limited evidence, the additional randomized trials are required to establish the correct dose of vitamin D and confirm the effectiveness of vitamin D treatment in PCOS disorders. However; it seems evident that correct supplementation of vitamin D is beneficial in the management of women with PCOS and low 25(OH)D serum levels, and that it could be helpful in improving the effects of PCOS treatment.

[Analysis of delivery types in women after previous cesarean section]. / Analiza sposobu zakonczenia ciazy u kobiet po przebytym cieciu cesarskim.

OBJECTIVE: The study was undertaken to analyze the course of pregnancy and delivery in women after previous cesarean section. MATERIAL AND METHODS: The study group consisted of 1272 pregnant women after one cesarean section, who delivered at the 1st Department of Gynecology and Obstetrics, Medical University of Lodz between 1st January 2007 and 31st December 2010. RESULTS: Among patients after previous cesarean section, the most numerous group constituted women whose pregnancy was resolved with an elective repeat cesarean section, without the attempt to deliver vaginally - 58,96% whereas the remaining 41,04% of the women were qualified to make an attempt at vaginal delivery 48,28% of them succeeded to gave birth vaginally and 51,72% underwent repeat cesarean section. CONCLUSIONS: Proper qualification of patients after previous caesarean section for a natural vaginal birth allows a successful vaginal delivery. A critical analysis of the indications for surgical delivery needs to be performed in order to lower the rate of cesarean sections.

[Pregnancy and delivery in a patient with non-Hodgkin lymphoma--a case report]. / CiAza i poród u pacjentki z chloniakiem nieziarniczym--opis przypadku.

INTRODUCTION: Neoplasmatic diseases during pregnancy are relatively rare, with the incidence of approximately 1/1000 pregnancies. The symptoms of neoplasmatic processes are unspecific and often mirror physiological changes during pregnancy Chemotherapy is the main therapeutic management of non-Hodgkin lymphomas. The strategy of the treatment and its influence on the course of pregnancy remain controversial. AIM: The aim of this study was to present the case of a pregnant woman with non-Hodgkin lymphoma. CASE REPORT: We described the case of a 27-year-old pregnant nullipara with anemia, breathlessness, cough and general weakness with diagnosed diffused large B-cell lymphoma. During pregnancy the patient received six cycles of CHOP chemotherapy without any serious complications. On 37 week of gestation the caesarean section was performed. CONCLUSIONS: Coexisting non-Hodgkin lymphomas and pregnancy are seldom the case and the treatment requires complex chemotherapy.

[Concentration of selected biochemical parameters in blood of pregnant women infected by HPV 16 and 18]. / Ocena stezenia wybranych parametrów biochemicznych w surowicy kobiet ciezarnych z zakazeniem HPV 16 i 18.

UNLABELLED: Asymptomatic HPV infection in pregnant women may be connected with changes of pro-inflammatory cytokines and proteolytic enzymes which may condition the persistence of infection during pregnancy. AIM: The main aim of the study was to evaluate the concentration of interleukin-1, TNF-alpha and alpha-1 antitrypsin in pregnant women infected by oncogenic types HPV. MATERIALS AND METHOD: The study was conducted in 2008-2009 at the Department of Obstetrics and Gynecology Medical University Lodz, on pregnant women in the third trimester of pregnancy The study group consisted on 19 pregnant women HPV-16, -18 infected. The control group consisted on 34 pregnant women at the same gestational age, HPV-negative. The concentration of interleukin-1, TNF-alpha and alpha-1 antitripsin was estimated in blood. RESULTS: The results of concentration interleukin-1, TNF-alpha and alpha-1 antitrypsin were similar in both groups of pregnant women. CONCLUSIONS: High risk HPV infection has no influence on the concentration of pro- inflammatory cytokines. In HPV infection during pregnancy the anti proteolytic defense did not decrease.

[Course of pregnancy and delivery in a patient with ovarian cancer after conservative surgical treatment--case report]. / Przebieg ciazy i porodu u pacientki po leczeniu oszczedzajacym z powodu raka jajnika--opis przypadku.

Ovarian cancer is most often recognized in women at a menopausal age. It rarely appears in young women, however it can coexists with pregnancy or even precede their reproductive activity. Therefore, the exists a risk that the advancement of the illness or the course of treatment will prevent them from having children. The aim of the study is to describe and present the case of a 30-year-old patient treated conservatively for the cancer of the ovary, the course of pregnancy and the way of delivery.

[The assessment of leptin concentration and Vascular Endothelial Growth Factor (VEGF) in relation to the body mass index since 20th week of pregnancy]. / Ocena stezenia leptyny oraz sródblonkowo- naczyniowego czynnika wzrostu od 20 tygodnia ciazy, w zaleznosci od wskaznika masy ciala.

UNLABELLED: High body mass index and obesity in pregnancy signify an increased obstetrical risk. Obesity before pregnancy qualifies a patient into the group that demands more attention from the obstetrician. Leptin and VEGF are among numerous factors that influence the pregnancy course and outcome. MATERIAL AND METHOD: The study was conducted in a group of pregnant women from 20-24 weeks of gestation in High Risk Pregnancy Clinic, Medical University Lodz, between 2005-2007. The study group consisted of 30 pregnant women with BMI > or =30 and the control group consisted of 25 pregnant women at the same gestational age and BMI < or =25. Concentrations of leptin and VEGF were measured in venous blood every 4 weeks. RESULTS: More body mass gain during pregnancy was observed in the group of women with BMI > or =30 when compared to the group of BMI < or =25. Mean value of leptin was higher in the group of obese women. No difference was found in leptin concentration measured every 4 weeks. The correlation between leptin concentration and BMI was found in the group of obese women. The concentration of VEGF was higher in controls than in the group of obese women. The mean concentration of VEGF measured every 4 weeks in both groups was similar. The highest values of VEGF were found in 20-24 and 30-34 weeks of pregnancy in women with normal BMI. CONCLUSIONS: 1. The synthesis of leptin depends on body mass, not the duration of pregnancy. 2. Obesity in pregnancy is connected with decreased VEGF synthesis.

[Obstetric hysterectomy in a patient with uterine myoma of uterus duplex--case report]. / Histerektomia poloznicza u pacjentki z miesniakiem macicy podwójnej--opis przypadku.

A case of a 43-year-old multipara in 36th week of pregnancy with a duplicate uterus and uterine myoma with 15 centimeters diameter has been presented in the article. The aim of the study was to present her obstetric history, course of pregnancy and delivery mode.

HLHS--congenital heart defect in High Risk Pregnancy Unit in 2001-2007.

BACKGROUND: HLHS (hypoplastic left heart syndrome) is a serious congenital heart defect. In neonates with congenital heart disease HLHS accounts for nearly 25% of neonatal deaths. The etiology of HLHS is unknown. At present we expect to have those cases diagnosed in the second trimester of pregnancy. AIM: The main aim was to find the rate and outcome of the congenital heart defect--left heart hypoplasia (HLHS). MATERIAL AND METHODS: All cases of this heart defect found in the High Risk Pregnancy Clinic in 2001-2007 were presented. Twice the congenital malformation was diagnosed after delivery and once during pregnancy--in the second trimester. All babies were delivered between 38 and 39 weeks of pregnancy, one by the spontaneous normal delivery, one by elective caesarean section and one by emergency caesarean section because of fetal distress during the delivery. All of the newborns were transported to the Pediatric Cardio surgery Unit of M.U. and operated in first weeks after delivery. RESULTS: In two cases the operation was complicated and children died due to the cardiac arrest. One of the babies died before surgical correction. Two of the women, whose babies died after the operation gave birth to healthy newborns with no cardiac abnormalities. CONCLUSION: The HLHS is the most serious heart congenital malformation diagnosed often after the delivery because of lack of sufficient diagnostic system in healthy women. The prognosis for the children is bad, but the chance of giving birth to healthy children in the future is good.