[(Un)Forgotten Neugebauer-Le Fort operation. Paramedian closure of the vagina--safe and effective surgical procedure for treating of pelvic organ prolapse in older women]. / (Nie) Zapomniana operacja Neugebauera-Le Forta. Posrodkowe zamkniecie pochwy-bezpieczna i skuteczna procedurar zabiegowego leczenia wypadania narzadu plciowego u starszych kobiet.

OBJECTIVES: The aim of the study is to present data concerning Neugebauer-Le Fort operations performed at the Gynecologic Oncology Clinic, Polish Mother's Health Center Research Institute in Lodz between 2000-2009, including the effects of the surgeries on improving quality of life. MATERIAL AND METHODS: Our research included all patients (90 women) operated due to total pelvic organ prolapse (stage IV of POP-Q) in Gynecologic Oncology Clinic. The data was collected retrospectively from medical records. Results of the treatment were evaluated based upon surveys and control checkups. The p-value of 0.05 was considered statistically significant. RESULTS: Mean patient age was 76.5 years. The analysis of medical records showed that 35% of the subjects had a BMI index >30. Out of 90 patients, 53%, 30% and 4% of the women had 2, 3, and 4 natural deliveries, respectively whereas 16% had forceps delivery Of the 65 operated patients, in more than 92% all the symptoms connected with pelvic organ prolapse disappeared. Problems with the urinary tract (urinary incontinence 'de novo', urinary tract infections) emerged in 13% and constipation in 5% of the women. As far as improved quality of life after the surgery is concerned, 93% of the subjects answered 4 and 5 (in a scale from 1 to 5). CONCLUSIONS: Neugebauer-Le Fort surgery is characterized by high effectiveness both, in objective research and subjective ratings of the operated patients. A high safety profile constitutes a great advantage of the surgery as was confirmed in our study In carefully selected group of patients with stage IV of POP-Q, Neugebauer-Le Fort surgery is a safe and effective procedure.

Interdisciplinary treatment of the patient with adenoid cystic carcinoma of the Bartholin's gland resulting in 15 years' survival: a case report and review of literature.

Carcinoma of the Bartholin's gland is very rare, comprises below 2% of Bartholin's gland lesions and adenoid cystic carcinoma (ADC) is one of the most uncommon variants and accounts for 10-15% of Bartholin's gland malignancies. There is no consensus on treatment of ADC of the Bartholin's gland: reported cases were treated with local excision or vulvectomy with or without lymphadenectomy followed or not by radiotherapy. The survival of patients varies significantly, so we present a case of interdisciplinary treatment of ADC resulting in 15 years' survival. The patient was initially treated with local excision, but the margins were not clear. Then vulvectomy, inguinal lymphadenectomy and adjuvant brachytherapy were performed resulting in 7 years free of the disease. Relapses were excised by abdominoperineal amputation of the rectum and distal part of the vagina with sigmoideostomy, excisions of local recurrences in vagina and metastasectomy of isolated lung metastases. The patient died manifesting multiple lung metastases 15 years after the initial diagnosis. Based on our experience and world literature, in cases of adenoid cystic carcinoma of the Bartholin's gland, vulvectomy with or without lymphadenectomy should be considered as a treatment of choice and in patients with positive margin, surgery should be extended by adjuvant radiotherapy.

Classical radical hysterectomy and nerve-sparing radical hysterectomy in the treatment of cervical cancer.

AIM OF THE STUDY: To compare Piver III radical hysterectomy (RH) with nerve-sparing radical hysterectomy (NSRH) for cervical cancer patients in terms of postoperative physiology of pelvic autonomic nerves and perioperative complications. MATERIAL AND METHODS: Seventy-three consecutive patients with invasive cervical cancer underwent RH (53 cases) or NSRH (20 cases) from 2001 to 2012 at the Department of Gynecology and Gynecologic Oncology of Polish Mother's Memorial Hospital - Research Institute in Lódz. RESULTS: Compared with patients treated with RH, patients who underwent NSRH presented no significant difference in terms of operative time (146 vs. 143 minutes, p > 0.05), blood loss and hospital stay (9.2 vs. 7.5 days, p > 0.05). A positive surgical margin was found in 6 cases of RH. No serious surgical complications were found in the NSRH group, while there were 4 cases in the RH group. CONCLUSIONS: Nerve-sparing radical hysterectomy is safe and feasible surgical management for cervical cancer patients, which should improve the physiology of the pelvic autonomic nerve system postoperatively. The technique is relatively new and its oncologic efficiency has not been fully established yet, moreover it requires sophisticated anatomical knowledge and high operative skills.

Vaginal hysterectomy vs. laparoscopically assisted vaginal hysterectomy in women with symptomatic uterine leiomyomas: a retrospective study.

INTRODUCTION: Uterine leiomyomas are the most common benign tumors of the female reproductive system. Although the majority of myomas are asymptomatic, some patients have symptoms or signs of varying degrees and require a hysterectomy. THE AIM OF THE STUDY: The aim of the study was to compare the clinical results of two minimally invasive hysterectomy techniques: vaginal hysterectomy (VH) and laparoscopically assisted vaginal hysterectomy (LAVH). MATERIAL AND METHODS: A retrospective, observational study was performed at a tertiary care center: the Gynecology and Gynecologic Oncology Department, Polish Mother's Memorial Hospital Research Institute. The study period was from January 2003 to December 2012. A total of 159 women underwent either vaginal hysterectomy (VH, n = 120) or laparoscopically assisted vaginal hysterectomy (LAVH, n = 39) for symptomatic uterine myomas. Outcome measures, including past medical history, blood loss, major complications, operating time and discharge time were assessed and compared between the studied groups. Statistical analysis was performed using Student t-test, U-Mann Whitney test, χ(2) test and Yates'χ(2) test. P < 0.05 was considered statistically significant. RESULTS: There were no differences in patients' mean age. Parity was significantly higher in the VH group (VH 1.9 ± 0.7 vs. LAVH 1.5 ± 0.8; p = 0.008). No difference was found in the mean ± standard deviation (SD) uterine volume between vaginal hysterectomy and LAVH groups (179 ± 89 vs. 199 ± 88 cm(3)), respectively. The mean operative time was significantly longer for the LAVH group (83 ± 29 vs. 131 ± 30 min; p = 0.0001). The intraoperative blood loss (VH 1.3 ± 1.1 vs. LAVH 1.4 ± 0.9 g/dl; p = 0.2) and the rate of intra- and postoperative complications were similar in both groups studied. The mean discharge time was longer for LAVH than for VH (VH 4.2 ± 1.2 vs. LAVH 5.3 ± 1.3 days, p = 0.0001). CONCLUSIONS: Laparoscopically assisted vaginal hysterectomy and VH are safe hysterectomy techniques for women with the myomatous uterus. Concerning the LAVH, the abdominal-pelvic exploration and the ability to perform adnexectomy safely represent the major advantages comparing with VH. Vaginal hysterectomy had a shorter operating time and the mild blood loss making it a suitable method of hysterectomy for cases in which the shortest duration of surgery and anesthesia is preferable.

[Salpingotomy vs salpingectomy--a comparison of women's fertility after surgical treatment of tubal ectopic pregnancy during a 24-month follow-up study]. / Salpingotomia vs salpingektomia--porównanie plodnosci kobiet po operacyjnym leczeniu jajowodowej ciazy ektopowej, 24-miesieczne badanie obserwacyjne.

INTRODUCTION: Ectopic pregnancy (EP) is usually located in the Fallopian tube and it has a significant adverse effect on womens fertility Three types of EP treatment include: expectant, medical, and surgical radical (salpingectomy) or conservative (salpingotomy) management. OBJECTIVES: The aim of the study was to compare women's fertility after surgical radical or conservative treatment of tubal ectopic pregnancy MATERIALS AND METHODS: Out of the 58 patients operated because of tubal EP pregnancy 22 underwent laparoscopic salpingotomy (group 1) and 36 laparoscopic salpingectomy (group 2). EP-related data were obtained from medical documentation (the symptoms, diagnostic tests, EP risk factors, medical reproductive and surgical history clinical status during EP surgery). Follow-up data were collected by means of a telephone interview. The survey included questions focused on women's fertility during a 24-month period following the surgical treatment of EP (conception, subsequent intrauterine pregnancies and ectopic pregnancy). RESULTS: A 24-month follow-up period revealed that the cumulative intrauterine pregnancy rate was higher in group 1 (salpingotomy) as compared to group 2 (salpingectomy), i.e. 50% vs. 41.5%, respectively. Tubal EP returned in 13.6% cases (group 1) vs. 19.4% (group 2). All submitted results are statistically insignificant. CONCLUSIONS: Our findings are consistent with the literature which reports a trend of higher odds for intrauterine pregnancy after salpingotomy for surgical treatment of EP as compared to salpingectomy Moreover the risk for recurrent tubal EP is comparable for both methods. Regardless, the decision about the operating range in case of EP always depends on the actual clinical state of the patient.

Proinflammatory and immunosuppressive serum, ascites and cyst fluid cytokines in patients with early and advanced ovarian cancer and benign ovarian tumors.

OBJECTIVE: To analyze the profiles of interleukin-2 (IL-2), IL-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-alpha), transforming growth factor-beta1 (TGF-beta1) and interferon-gamma (IFN-gamma) in serum and the tumor microenvironment (cyst fluid, ascites) in women with ovarian cancer or benign ovarian tumors to find the differences in their immunological status. We also estimated serum cytokines as biomarkers to distinguish preoperatively between malignant or benign character of tumors. DESIGN: Prospective study. SETTING: Tertiary referral hospital. POPULATION: 51 women with epithelial ovarian cancer, 26 with benign ovarian tumors of epithelial origin and 21 healthy controls. METHODS: The levels of cytokines were measured using ELISA sets. RESULTS: We did not found differences in the levels of IFN-gamma, TNF-alpha and IL-2 in all fluids isolated from patients with malignant or benign tumors. Women with advanced cancer had significantly higher serum IL-6, IL-10 and TGF-beta1 levels than women with early stages or benign tumors. Moreover, women with very advanced cancer in whom the optimal cytoreduction was disabled had the highest serum levels of IL-10, TGF-beta1 and IL-8. The concentrations of IL-6 and IL-8 were higher in ascites of cancer patients than in ascites of women with benign tumors. The areas under curves constructed for the selected cutoff serum cytokines levels (AUC-ROC) showed good predictive values for IL-6 (0.87), IL-10 (0.836) and IL-8 (0.797). CONCLUSIONS: Our results indicate on intensified inflammatory process in women with ovarian cancer (accompanied by their immunosuppression). Preoperative analysis of serum IL-6, IL-10 and IL-8 may improve the differential diagnosis of ovarian tumors.

[Peritonitis caused by a giant trichobezoar ventriculi--a case report]. / Objawy ostrego brzucha wywolane bezoarem zoladka--opis przypadku.

Bezoars are the most common foreign bodies of gastrointestinal tract. They contain swallowed hair, different fibres, seeds, nut shells, sweets or drugs. Clinical manifestations vary, depending on the location and size of bezoar, from "no symptoms" to "acute abdomen" syndrome. In this case report, the authors describe a giant trichobezoar from the stomach of an 18-year-old girl, who had been admitted to the gynecological department with syndromes suggesting an ovarian cyst torsion. The preoperative diagnosis was not confirmed and a giant trichobezoar was found and removed during the surgery.

[The rare case of erosive lichen planus with large leasions in vulvar area and vagina]. / Rzadki przypadek liszaja plaskiego nadzerkowego z rozleglymi zmianami w obrebie sromu i pochwy.

The main aim of our paper was to point out the rare localization of erosive lichen planus in vulvar region and vagina. Moreover, these untreated lesions may be the starting point of squamous cell carcinoma.

[Laparoscopy or laparotomy in the treatment of ovarian teratomas?]. / Laparoskopia czy laparotomia w leczeniu potworniaków jajnika?

BACKGROUND: Mature cystic teratomas (dermoid cyst), are the most common germ cell tumours of the ovary in women of reproductive age. They are usually asymptomatic until they reach considerable size. Frequently, ultrasonography is diagnostic. MATERIALS AND METHODS: 81 patients who had surgery in 3rd Departament of Gynecology and Obstetrics, University of Medicine, Lódz, from 2000 to 2005 for benign cystic teratomas were analyzed. RESULTS: 86 teratomas were removed from 81 patients. 31 patients had surgery via laparoscopy and 50 via laparotomy. The mean age was found to be 34,5 years. 39 patients were asymptomatic. The tumours diameter ranged from 1 to 19 cm. In 46 cases there were cystectomies performed sparing fragments of healthy ovarian tissue, in 24 cases ovariectomies and in 11 panhysterectomies were made. All removed lesions histologically appeared benign cystis ovarian teratomas without any signs of malignancy. CONCLUSIONS: The teratomas are composed of mature tissues derived from the three germ cell layers. In our study histologic examination revealed 16 cases of neurogenic tissue. One of the possibility of ovarian teratoma's treatment is operative laparoscopy. When the laparoscopy is not possible or inadvisable, the laparotomy is still irreplaceable.

[Is MDR 1 gene a key to successful chemotherapy?]. / Czy gen MDR1 jest kluczem do skutecznej chemioterapii?

Pharmacogenetics achievements concerning the problem of multidrug resistance in chemotherapy started to be more frequently used in contemporary oncology to improve the treatment efficacy by individual approach to the patient. Disturbed trans-membrane transport of chemotherapeutics is one of the most important mechanisms of chemo-resistance, which seems to depend on the drug resistance genes expression (MRP1, LRP, BCRP). Between them, polymorphisms of MDR1 gene coding trans-membrane transport glicoprotein P-gp have been reported to affect the outcome of therapy, and was studied for different drugs-digoxin, fexofenadine, etoposid, vincristine, vinblastine, athracyclines and taxans. It seems that genotyping of multidrug resistance genes and identifying specific haplotypes can become an important tool in predicting individual sensibility to chemotherapy.

[Laparoscopic treatment of benign ovarian tumors]. / Laparoskopowe operacje lagodnych guzów jajnika.

BACKGROUND: laparoscopic surgery is one of the most common procedures performed in the presence of benign ovarian tumor. THE AIM OF THE STUDY: The purpose of our study was to analyze clinical findings, operative procedures, size and histopathologic type of tumors, time of hospitalization and surgical complications. MATERIAL AND METHODS: 102 female patients operated for benign adnexal masses by laparoscopic approach, in 3rd Department of Gynecology and Obstetrics, University of Medicine, Lódz, between 2001-2004. RESULTS: the most frequent laparoscopic procedure was excision of the tumor (59.8%), and the most common histopathologic type was teratoma adultum (25%), endometroid cyst (21.1%) and serous cyst (20.2%), of 5-7 cm median size. The majority of operated women (75.5%) were under 40 years of age. No intraoperative complications were noted. Postoperatively 1 patient presented with bleeding and was re-operated, 1 had hernia in the place of trocar installation, 5 had rised temperature (complication rate 6.9%). CONCLUSIONS: in the case of benign ovarian tumor laparoscopy is recommended procedure due to sparing ovarian function by small tissue traumatisation, shorter time of hospitalization, faster return to the health and low risk of complications. Because of the possibility of encountering an unexpected ovarian malignancy, the laparoscopy should be executed only in the centers where the intraoperative histopathologic examination is a routine procedure.

Lymphocyte subset distribution and cytokine secretion in third trimester decidua in normal pregnancy and preeclampsia.

BACKGROUND: Excessive Th1 activity in peripheral blood plays a probable role in the pathogenesis of preeclampsia. The aim of the study was to investigate whether disturbed local immune reactions are also present in decidua. METHODS: Flow cytometric analysis of CD3, CD19, CD56/CD16, CD4, CD8, CD4/CD29, CD4/CD45RA, CD4/CD45RO, CD8/CD28, CD3/CD69 lymphocyte subsets isolated from third trimester decidua of pregnants with preeclampsia (n=21) and pregnant controls (n=11) subjected to elective caesarean sections. Spontaneous and phytohemaglutynine stimulated "in vitro" secretion of IL-2, IL-4, IL-6, IL-10, IL-12, IFN-gamma and TGF-beta by decidual lymphocytes was studied by ELISA. For the statistical significance of differences between the groups the U Mann-Whitney test was performed (confidence interval P<0.05). RESULTS: Preeclamptic patients were characterized with an increased percentage of the CD3-/CD56+CD16+, CD8+/CD28+ and decreased percentage of CD3+, CD19+, CD4+/CD45RA+ lymphocytes. The profile of secreted cytokines shifts in favor of Th1 activity (extremely high IFN-gamma and low IL-6 and IL-10 secretion). Decidual IL-12 secretion in preeclamptic patients is decreased compared to controls. CONCLUSION: Changes in NK and T lymphocyte subsets followed with Th1 cytokine IFN-gamma over-activity, could affect local immunoregulatory mechanisms in third trimester decidua of preeclamptic patients.

Expression of intercellular adhesion molecule-1 on the surface of peripheral blood and decidual lymphocytes of women with pregnancy-induced hypertension.

OBJECTIVE: If overexpression of intercellular adhesion molecule-1 (CD54) on lymphocytes exists it could have important implications for the pathophysiology of pregnancy-induced hypertension (PIH). STUDY DESIGN: CD54 "in vitro" expression (described as (%) of CD54+cells and CD54 mean fluorescence intensity, MFI) on the peripheral blood and decidual lymphocytes of pregnant with pre-eclampsia (PE) (n=16), transient hypertension (TH) (n=12), and controls (n=9). RESULTS: The percent (%) of CD54+peripheral blood lymphocytes, CD54 MFI on them and CD54 MFI on decidual lymphocytes were increased especially in PE. During PE the (%) of CD54 decidual lymphocytes correlated negatively with platelet count. In TH the positive correlation between the blood pressure and the (%) of CD54 peripheral blood lymphocytes as well as CD54 MFI on decidual lymphocytes were found. CONCLUSIONS: (1) PIH, especially PE, is accompanied by overexpression of intercellular adhesion molecule-1 (ICAM-1) on peripheral blood and decidual lymphocytes studied "in vitro", (2) Some of the parameters studied seem to correlate with clinical markers of PIH intensity but this fact needs further investigations using larger subject groups.

[Immunophysiology of normal pregnancy. Part I. Immunoregulatory mechanisms inside the maternal-fetal interface]. / Immunofizjologia ciazy prawidlowej. Czesc I. Mechanizmy immunoregulacyjne w obrebie styku matczyno-plodowego.

Contemporary opinions concerning the function of decidual NK cells, T and B lymphocytes as well as macrophages and neutrophils in normal pregnancy were presented in the paper. Maintenance of proper Th1/Th2 balance concerning cytokines produced by trophoblast, decidua and decidual infiltrating immunological cells was also precisely described.

[Cervical carcinoma and pregnancy--guidelines for the diagnosis and treatment: a proposal]. / Propozycja wytycznych postepowania diagnostyczno-terapeutycznego w przebiegu raka szyjki macicy u kobiet ciezarnych.

The paper presents a proposal of guidelines for diagnosis and management of cervical carcinoma associated with pregnancy based on the analysis of contemporary references regarding the topic.

[Ovarian tumors in pregnancy--proposals of diagnosis and treatment]. / Nowotwory jajnika u kobiet ciezarnych--propozycje postepowania diagnostyczno-terapeutycznego.

We present the review of the literature and the proposals of the exact diagnosing and therapy of the ovarian tumors complicating pregnancy. The incidence of ovarian tumors in pregnant women is estimated on 1/1000 deliveries. The coexistence of an ovarian tumor with pregnancy presents problems to both the clinician (obstetrician, oncologist) and the patient. Depending of the increasing uterus during pregnancy, the appropriate diagnosis of adnexal mass is based on the initial pelvic and ultrasound examination. Most of ovarian tumors in pregnant women are asymptomatic and when they are unsuspicious simple cysts or cystic teratomas the conservative management is recommended. In cases of complex masses and/or torsion, rupture, hemorrhage the surgical intervention by laparotomy (in some cases laparoscopy) is required. The possibility of malignancy and its therapeutic implications (hysterectomy, salpingo-oophorectomy, delay to delivery) must be discussed with the patient and her family (the lives of two human beings together are affected).

[Laparoscopy in pregnant women]. / Laparoskopia u kobiet ciezarnych.

In the study current opinions of performing laparoscopy in pregnant women suffering from some either acute abdominal diseases or adnexal pathology have been presented. Based on the latest literature, intra- and postoperative complications of laparoscopy have been analyzed by the authors. Both advantages and disadvantages of laparoscopy in pregnancy have been estimated.

[Influence of paternal lymphocyte immunization on the selected subpopulations of peripheral blood lymphocytes in women with recurrent spontaneous abortions of unknown etiology]. / Ocena wplywu immunizacji limfocytami meza na wybrane subpopulacje limfocytów u kobiet z nawracajacymi poronieniami o nieustalonej etiologii.

UNLABELLED: The aim of the study was to evaluate the influence of alloimmunization on the composition of PBL subpopulations in women with recurrent spontaneous abortions (RSA) of unknown etiology. MATERIAL AND METHODS: 25 women with history of 3-6 consecutive RSA were selected for this study. Immunization with paternal lymphocytes, isolated from 100 ml of peripheral blood, was performed two times before conception (4-weeks interval). The following parameters were studied: (%) of peripheral T CD3+, T CD4+, T CD8+, T CD4+/CD45-RO+, T CD4+/CD29+, T CD8+/CD45-RO+, BCD19+ and NK CD16+/CD56+ lymphocytes; (%) of T CD3+ cells with markers of early (CD69+) and late activation (HLA-DR+) and presenting with IL-2 receptors (CD25+); the influence of alloimmunization on the expression of CD69+ receptors on cultured T CD3+ lymphocytes activated by PHA (CD3+/CD69+/FCS). RESULTS: The (%) of T CD3+ (61.0% vs. 68.6%), T CD4+ (37.4% vs. 45.3%) cells as well as T CD4+/T CD8+ ratio (1.3 vs. 1.0) significantly increased, whereas the (%) of T CD8+ (41.3% vs. 32.5%) and NK CD16+/CD56+ cells (23.9% vs. 16.2%) decreased after alloimmunization. The procedure didn't influence the (%) of T CD4+/CD45-RO+, T CD4+/CD29+, T CD8+/CD45-RO+ and BCD19+ lymphocytes. We observed significant increase of the (%) of T CD3+/CD69+ (4.4% vs. 7.3%) and T CD3+/CD25+ (5.8% vs. 10.9%) cells after immunotherapy. Moreover we observed the significant increase of the CD69+ expression on T CD3+ cells activated by PHA (CD3+/CD69+/FCS) (42.1 vs. 47.1%). CONCLUSIONS: Our study suggests that alloimmunization of women with RSA of unknown etiology results in increase of T lymphocytes' activity and a shift of the immune balance towards T helper and T supressor lymphocytes.

[Ovarian tumors in the reproductive age group]. / Guzy jajników u kobiet w okresie rozrodczym.

OBJECTIVES: Analysis of the type and localization of the ovarian tumors in the reproductive age group of women. MATERIALS AND METHODS: The study group consisted of all women operated on Gynecologic Surgery Department of Polish Mothers's Memorial Hospital-Research Institute due to ovarian tumors in 1996-99. As the reproductive age we defined 18-39 year, when the majority of deliveries occurs. RESULTS: We analyzed 326 patients operated on the ovarian tumors. In 60 cases (18.4%) we noticed ovarian malignant tumors, in 7 (2.1%) borderline tumors and in 259 (79.5%) benign cysts. In the reproductive age (130 women) the incidence of ovarian malignancies was significantly lower (4.6%), higher for benign tumors (93.1%) and constant for borderline malignancy (2.3%), p < 0.005. The most common malignancy among all patients was epithelial cancer--83.4% (germ cell and metastatic--8.3%, both), but in the reproductive age group (6 cases) germ cell tumors were the majority--66.8% (epithelial and metastatic--16.6%, both), p < 0.005. In women aged 18-39 yr. with ovarian malignancies 4 of them had I stage of the disease and 2 were in the stage III. 121 women in the reproductive age were operated on the benign ovarian tumors; 107 (88.4%) had unilateral cysts and 14 (11.6%) had tumors in both ovaries. On histology we revealed 31.1% of endometrioid cysts, 28.9%--teratomas, 19.3%--serous, 3.7%--mucinous and others (hemorrhagic, functional, sex cord, inflammatory) in the remaining 17%. CONCLUSION: In the reproductive age ovarian tumors are mainly unilateral benign cysts. Only a few of ovarian tumors were malignant but the majority of them were in the early stage of the disease.

[Expression of intercellular adhesion molecule-1 (ICAM-1) on the surface of peripheral blood lymphocytes of pregnant women with pregnancy-induced hypertension]. / Wystepowanie miedzykomórkowej czastki adhezyjnej-1 (ICAM-1) na powierzchni limfocytów krwi obwodowej ciezarnych z nadcisnieniem indukowanym ciaza.

OBJECTIVES: Intercellular adhesion molecule-1 (ICAM-1, CD54) is involved in process of leukocytes adhesion to endothelium as well as in their migration to surrounding tissues. There is much evidence that pregnancy-induced hypertension (PIH) presents a state of endothelial destruction mediated partially by increased ICAM-1 expression on endothelial cells and neutrofils. DESIGN: The aim of this study was to evaluate the expression of ICAM-1 (CD54) molecule on the peripheral blood lymphocytes of pregnant women with PIH studied "in vitro". MATERIALS AND METHODS: Preeclampsia (PE) and transient hypertension (TH) were defined according to USA National Health Institute criteria. The study group consisted of 16 women with preeclampsia (PE), 12 women with transient hypertension (TH) and 9 women with physiological pregnancy. The group of 8 nonpregnant women served as controls. Exclusion criteria were: uterine contractions, infection and steroid therapy before blood sampling. Peripheral blood was obtained by venipuncture. Lymphocytes were isolated and cultured by using standard procedures. Mitogenic doses of phytohaemaglutynin (PHA) were added to each culture. Immunofluorescent marking techniques with anty-CD54 one-step monoclonal antibodies were performed. Analysis was made with FACSCalibur flow-cytometer with 488 nm argon laser using CellQuest programme. The results were described as the percentage of CD54+ lymphocytes and MFI index corresponding density of CD54 molecules on the lymphocyte surface. Statistical analysis was performed using t-Student and U-Mann-Whitney tests. The work was sponsored by KBN 4 P05E 118,15 grant. RESULTS: The percentage of CD54+ lymphocytes in physiological pregnancy compared to nonpregnant women did not differ significantly (56.9 +/- 20.8% vs. 57.2 +/- 14.0%, p = 0.97). The MFI value was increased in pregnant women but in comparison with nonpregnant women did not reach statistical significance (34.7 +/- 35.7 vs. 17.8 +/- 4.3, p = 0.20). The percentage of CD54+ lymphocytes in TH group compared to normal pregnant women did not differ significantly (52.2 +/- 18.6% vs. 56.9 +/- 20.8%, p = 0.58) but MFI value was significantly increased (100.6 +/- 81.5 vs. 34.7 +/- 35.7). In PE group compared to normal pregnant women the percentage of CD54+ lymphocytes as well as MFI value were significantly increased (CD54+: 70.8 +/- 12.9% vs. 56.9 +/- 20.8%, p < 0.05; MFI: 170.8 +/- 91.7 vs. 34.7 +/- 35.7, p < 0.0005). CONCLUSIONS: 1/expression of ICAM-1 molecule on peripheral blood lymphocytes studied "in vitro" during normal pregnancy is not different in comparison to the nonpregnant state, but 2/ in pregnancy complicated with PIH is significantly increased, especially in PE, 3/described changes are a sign of the lymphocyte activation and may be responsible for endothelial destruction observed in PIH.