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.

[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.

[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.

[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.

[Influence of cigarette smoking on some sperm parameters in males with decreased fertility]. / Wplyw palenia tytoniu na niektóre parametry nasienia u mezczyzn o obnizonej plodnosci.

112 patients from infertile couples with diagnosed asthenospermia and oligoasthenospermia have been examined. The results have been analysed in view of smoking. An increased number of antisperm antibodies have been detected in smoking patients. No difference between the two groups examined according to WHO standards have been found.

[Symptoms of andropausal syndrome in smoking and non-smoking males]. / Wystepowanie objawów zespolu andropauzalnego wsród palacych i niepalacych.

Symptoms of andropause syndrome such as: erectile dysfunction, somatovegetative and psychic symptoms have been examined in groups of smoking and non-smoking patients between 45 and 75 years of age Tests of testosterone, prolactin and SHBG levels have been carried out. Earlier andropause, a lower level of testosterone as well as more common arterial hypertension have been found in the group of smoking patients.

[Effectiveness of passive immunisation against respiratory syncytium virus in a group of premature infants with birth weight below 1000 grams]. / Ocena skutecznosci stosowania uodpornienia biernego przeciwko wirusom syncytium nablonka oddechowego (RSV) preparatem Synagis w grupie wczesniakow z masa urodzeniowa ciala ponizej 1000 gramow.

Respiratory syncytial virus (RSV) is a major cause of respiratory tract infection during the child's first year of life. Those who survive neonatal intensive care are commonly rehospitalized. In the absence of vaccine, passive immunoprophylaxis is the preferred approach. Safety and efficacy of Palivizumab (Synagis) was proven in the Impact-RSV Trial, conducted in the USA, Canada and UK. The aim of the study was to determine efficacy of humanized monoclonal RSV antibody in prematures infants born 25-32 week gestation with weight birth below 1000 g with and without broncho-pulmonary dysplasia. We compared the hospitalization rates and morbidity between two groups of children who received palivizumab and without any protection. We confirm the efficacy and safety of Synagis. The outcome of this study supports the use of palivizumab prophylaxis in high-risk children.

[Neo-angiogenesis in immunohistochemical techniques as a prognostic factor in endometrial carcinoma]. / Immunohistochemiczna ocena neoangiogenezy jako elementu rokowniczego w raku endometrium.

OBJECTIVE: Angiogenesis in malignant tumors is a prognostic factor associated with tumor growth and metastasis. The aim of the research was: determination of the angiodensity rate in two immunohistochemical techniques, estimation of the value of the examined parameter at different stages of clinical progression and histological differentiation of endometrial carcinoma, and analysis of the obtained values as prognostic factors in the disease process. MATERIALS AND METHODS: The examination covered 86 women treated surgically for endometrial carcinoma. The preliminary histological evaluation was followed by immunohistochemical methods. The microvessels within the invasive cancer were highlighted by means of immuno-cytochemical staining to detect CD-31 and CD-105 antigen. The average value of angiodesity was estimated by means of a computer image analyser. RESULTS: The group of patients at the preinvasive stage of the disease manifested significantly statistically lower values of angiodensity. It was detected that the histological differentiation of carcinoma does not influence intensification of angiogenesis. Higher values of this parameter have an adverse influence on the survival rate. CONCLUSION: The evaluation of the angiodensity coefficient can be a helpful prognostic parameter in endometrial carcinoma.

[Clinical and cytogenetic evaluation of patients with disorders of somato-sexual development]. / Badania diagnostyczne u dziewczat i kobiet z zaburzeniami rozwoju cielesno-plciowego.

UNLABELLED: Congenital somato-sexual disturbances include wide range of classic syndromes, as well as different types of numerous or isolated developmental defects. 28 women with disorders of sexual development were clinically and cytogenetically analyzed. AIM: Clinical and cytogenetic evaluation of patients with disorders of somato-sexual development. MATERIAL AND METHODS: 28 women, 17-35 years old, were included in the study. Analysis data were performed on the basis of clinical records from Department of Obstetrics and Woman's Diseases of Medical University in Bydgoszczy. Cytogenetic investigations were carried out on standard lymphocyte culture method. RESULTS: Turner's syndrome was found in 12 women; 45, X in 7 mosaic karyotype 45, X/46, XX in 4, isochromosome i(Xq) in 1.3 women had normal, male karyotype, 46, XY. One of them had dysgenetic gonads of malignant dysplesia transformation. One patient's karyotype was 47, XXX. 12 women with gonadal dysgenesis--karyotype 46, XX. CONCLUSIONS: 1. Patients with congenital disorders of somato-sexual development are a heterogenous group. 2. Laparoscopy an effective diagnostic and treatment method in women with disorders of congenital somato-sexual development.

[Prevalence of depressive disorders among perimenopausal women seeking gynecological services]. / Rozpowszechnienie zaburzen depresyjnych wsród kobiet w wieku okolomenopauzalnym zglaszajacych sie do lekarzy ginekologów.

AIM: The aim of the study was to evaluate the prevalence of depressive disorders in perimenopausal women reporting to gynecologists and to assess a possibility of screening and diagnosing depression in gynecological practice. METHOD: The study entailed 2262 female patients of the age of 45-55 attending 120 gynecologists in Poland. Patients were first asked to fill in the Beck's Depression Inventory and next examined by their gynecologists to verify the presence of the basic symptoms of depressive episode according to ICD-10 diagnostic criteria. Patients who obtained 12 points or more in BDI total score were referred for a psychiatric consultation, including the MINI questionnaire. The study was monitored by 'Servier Polska'. RESULTS: 32.5% of women aged 45-55 years visiting gynecologists scored 12 points or more on the BDI scale. Patients with high BDI scores reported long-lasting somatic and emotional symptoms associated with menopause more frequently than patients with low BDI scores. Women with high BDI scores also more frequently experienced gynecological surgery in the past, more frequently attended gynecological clinics, and reported more peri- and postmatal mood disorders. 57% of patients did not visit psychiatrists. Depressive disorders were diagnosed in 76% of patients who came for the psychiatric evaluation. CONCLUSIONS: The study suggests that more than 19% of perimenopausal women attending their gynecologists suffer from depressive disorders. Gynecologists in Poland can diagnose depression accurately and start pharmacological treatment of the disorder in half of the patients.

[Microvessel density index as a prognostic factor in a low histological differentiation stage of endometrial carcinoma]. / Przydatnosc oznaczania gestosci naczyniowej jako czynnika rokowniczego w rakach trzonu macicy o niskim stopniu zróznicowania.

OBJECTIVE: Angiogenesis in malignant tumors is a prognostic factor associated with tumor growth and metastasis. Studies of angiogenesis in breast, prostate and lung cancer showed that neovascularisation correlates with likelihood of metastasis and recurrence. Our study was to evaluate microvessel density as a prognostic factor in endometrial cancer. METHODS: Between 1995-1999, 58 women were treated for endometrial carcinoma. The primary treatment consisted of total abdominal hysterectomy, bilateral salpingoophorectomy and pelvic lymphadenectomy. The microscopic examination of paraffin blocks showed the areas of the deepest myometrial invasion. The microvessels within the invasive cancer were highlighted by means of immuno-cytochemical staining to detect CD-31 antigen. RESULTS: Microvessel count was related to likelihood of recurrence. We found statistically significant differences between patients who died after operation and patients with nonrecurrence process. All patients were in the same stage and grade of endometrial carcinoma. CONCLUSION: Microvessel density index seems to be an important factor for planing postoperation treatment in endometrial carcinoma.

[Evaluation of selected risk factors in patients operated for uterine body carcinoma]. / Ocena wybranych czynników rokowniczych u kobiet operowanych z powodu raka trzonu macicy.

OBJECTIVES: Uterus body carcinoma ranks among to the most common malignant neoplasms. It is of special interest what kind of factor influences on the survival span of treated patients. DESIGN: Evaluation of selected risk factors such as: age, obesity, clinical stage, type and histologic differentiation and proliferation depths on the 5-year survival span. MATERIALS AND METHODS: /Due to our research we analyzed 280 endometrium samples of patients with the diagnosis of endometrial cancer, who*.../ Analysis was made on the group of 280 endometrium carcinoma patients, who were operated in the Department of Obstetrics and Women Diseases, University School of Medicine in Bydgoszcz in 1982-2000 period, 221 of the total number of patients (78.8%) were in the cancer stage I, while 33 (11.9%) in stage II, followed by 26 (9.3%) in stage III. RESULTS: The highest percentage of 5-year survival time was observed in the group of patients under age of 50. In patients with the clinical stage I and proliferation depths under 1/2 of myometrum the percentage of 5-year survival time was 91%. Adenocarcinoma was the most common type of cancer and also with the best prognosis (81% of 5-year survival). Neither histologic differentiation G1 nor G2 have an influence on the survival time of operated patients. CONCLUSIONS: 1. The proliferation depths, histologic type of the endometrial carcinoma and clinical stage are the major prognostic factors for the uterus body carcinoma. 2. Endometrial carcinoma in the group of patients under age of 50 is connected with the higher percentage of five-year survival time.