Ovarian function in female survivors after multimodal Ewing sarcoma therapy.

BACKGROUND: With advances in cancer care, more young women with Ewing sarcoma (ES) survive after treatment. Thus, we sought to analyze the ovarian function in prepubertal, pubertal and postpubertal females and young women receiving multimodal therapy for ES, and to identify patients at risk of infertility on whom fertility preservation would be indicated. PROCEDURES: Twenty-seven female survivors of ES were included in this retrospective multiinstitutional study. Patients were classified into four groups according to the treatment received: chemotherapy (CHT) without pelvic radiation (pRT), chemotherapy and pRT, CHT and autologous hematopoietic cell stem rescue (aHSCT) without pRT, and CHT + pRT + aHSCT. The ovarian function and fertility outcomes were analyzed. RESULTS: At a median follow-up of 5.7 years from diagnosis, and at median age at follow-up of 16.3 years, 67% of the survivors had premature ovarian insufficiency, including all patients receiving pelvic RT and 87.5% of patients who underwent aHSCT, independent of chemoprotection. Thirty-seven percent of patients had a clinical syndrome of premature menopause. The relative risk (RR) of premature ovarian insufficiency of a survivor was 3.9 (p 0.03) for pRT, and 2.4 (p 0.07) for aHSCT. On multivariate analysis, radiation therapy was a significant predictor of higher risk of premature ovarian insufficiency over chemotherapy alone. CONCLUSIONS: A large proportion of women receiving multimodal therapy for ES develop premature ovarian insufficiency. Patients and guardians should be informed about the reproductive potential and strategies for preservation of ovarian function should be considered individually. Pediatr Blood Cancer 2015;62:341-345. © 2014 Wiley Periodicals, Inc.

[Levels of immunoreactive cytokines in serum of women with preeclampsia or severe pregnancy hypertension]. / Stezenie immunoreaktywnych cytokin w surowicy krwi u kobiet ze stanem przed- rzucawkowym i ciezka postacia nadcisnienia ciazowego.

OBJECTIVE: The purpose of the study was to compare concentrations of inflammatory and Th1/Th2 cytokines in serum obtained from women with preeclampsia or severe pregnancy hypertension versus normotensive controls. MATERIAL AND METHODS: The study group consisted of 34 pregnant women with hypertension over 140/90mmHg and proteinuria over 0.3 g/day or severe pregnancy hypertension. 16 healthy pregnant women comprised the control group. The concentration of IL-2, IL-4, IL-6, IL-10, TNFalpha and IFNgamma was measured with Cytometric Bead Array Human Th1/Th2 Cytokine Kit II (Becton Dickinson). U-Mann Whitney test was used for the comparison of the results. RESULTS: We found statistically significantly increased concentrations of IFNgamma: 8.4 +/- 5.3 pg/ml vs. 4.2 +/- 3.2 pg/ml (p = 0.02), TNFalpha: 1.5 +/- 0.7 pg/ml vs. 0.7 +/- 0.3 pg/ml (p = 0.04) and IL-2: 1.3-0.6 pg/ml vs. 0.6 +/- 0.4 pg/ml (p = 0.01) in the studied group. The level of IL-6 35.5 +/- 21.0 pg/ml vs. 19.8 +/- 12.3 pg/ml was also increased but the difference did not reach statistical significance. Concentrations of IL-4 and IL- 10 were similar in both groups. CONCLUSION: Increased concentrations of Th1 cytokines (IFNgamma, IL-2) in the serum of women with preeclampsia suggests an exaggerated cytotoxic activity of blood in this pathology accompanied by an increase in the levels of inflammatory cytokines TNFalpha and IL-6.

[Chlamydia trachomatis infection in sexually active teenagers]. / Zakazenie Chlamydia trachomatis u aktywnych seksualnie nastolatek.

BACKGROUND: The prevalence of Chlamydia trachomatis infections among Polish teenagers remains unknown. Sexually active teenagers are exposed at sexually transmitted infections, including Chlamydia trachomatis (CT). Most infections are asymptomatic and, therefore, untreated. Early detection and treatment of cervical chlamydial infections may prevent pelvic inflammatory diseases and prevent later infertility. AIM: to determine the prevalance and risk factors of Chlamydia trachomatis infections among sexually active female teenager. MATERIALS AND METHODS: 243 sexually active girls, 16-19 year-olds, attending the outpatient clinic were enrolled in this study between 2005-2007. The participants filled in a questionnaire containing such information as age, purpose of visit, level of education, age at the first intercourse, number of sexual partners, number of current partners (in the past 3 months), contraceptive methods, use of condoms, past history of STD and obstetric history at the first visit. Pelvic examination was performed to check the following: vaginal discharge, presence of abnormalites of the cervix (ectopy, erythema, tenderness of uterine and adnexal) and to take a Pap smear and a cervical swab for Chlamydia trachomatis. Cervical swabs for Chlamydia trachomatis were tested by polymerase chain reaction (PCR). RESULTS: The prevalence of CT genital infection in the studied group was 2,9%. Adolescent females infected by CT less frequently admitted to the use of condom and more often did not use any contraception at all, in comparison with the girls without CT genital infections (29% and 57% vs. 37% and 19%). There were statistically significant differences in the results of the abnormal Pap smears (ASCUS, LGSIL) between the two groups.

Chlamydia trachomatis infection in pregnant women hospitalised in the Institute of Mother and Child in Warsaw, Poland.

UNLABELLED: Chlamydia trachomatis infection is the most common sexually transmitted disease. It concerns both epidemiologists and clinicians as it is often asymptomatic and can cause permanent sequelae. Chlamydia trachomatis infection in women causes nongonococcal cervicitis, endometritis, urethritis, inflammation of the Bartholin's gland, acute and chronic pelvic inflammatory disease, Fitz-Hugh-Curtis syndrome and can lead to Fallopian tube obstruction, infertility and ectopic pregnancy. During pregnancy it can cause chorioamnionitis, premature rupture of membranes, premature delivery, intrauterine growth restriction, low birth weight. post partum endometritis and also infection in the newborn. AIM: To assess the prevalence and to describe risk factors (behavioural and clinical) of genital infection caused by Chlamydia trachomatis in the population of pregnant women attending the Obstetrics Clinic at the Institute of Mother and Child and to study the impact of this infections of pregnancy outcome. METHODS: We have tested 80 pregnant women attending the clinic of obstetrics and gynaecology of the Mother and Child Institute in Warsaw: The presence of C. trachomatis in cervical swabs was assessed using the Polymerase Chain reaction (PCR). RESULTS: We found two cases of C. trachomatis infection, which represents 2.5% of the tested population. CONCLUSIONS: controversial data on the prevalence of C. trachomatis in pregnant women and its influence on pregnancy duration justify further investigations despite the observed law prevalence in this study. This will allow to determine the role and usefulness of routine screening for C. trachomatis in pregnant women in Poland.

Chlamydia trachomatis infection in sexually active adolescents and young women.

BACKGROUND: The prevalence of Chlamydia trachomatis infections among Polish teenagers is unknown. Sexually active adolescents are at a greater risk for sexually transmitted infections, including Chlamydia trachomatis (ChT). Most inflections are asymptomatic and therefore untreated. Early detection and treatment of cervical chlamydial infections can prevent pelvic inflammatory disease and has a strong protective effect against infertility. AIM: To determine the prevalence and risk factors of Chlamydia trachomatis infections among sexually active female adolescents attending the outpatient gynaecological clinic of the Institute of Mother and Child in Warsaw. MATERIALS AND METHODS: 249 sexually active girls, 16-19 years old, attending the outpatient clinic of the Institute of Mother and Child in Warsaw were enrolled in this study from December 2002 to May 2004, The participants filled out a questionnaire containing informations on age, purpose of the visit, level of education, age of the first intercourse, number of lifetime sexual partners, number of current partners (in the last 3 months), number of sexual partners in the past (patients' partner), contraceptive methods, use of condoms at the first and the last intercourse, past history of STD and obstetric history at first visit. Pelvic examination was done for the following reasons: checking vaginal discharge, presence of abnormalities of the cervix such as ectopy, erythroplakia and uterine tenderness and taking a Pap smear and a cervical swab for Chlamydia trachomatis detection. Cervical swabs for Chlamydia trachomatis were tested by Polymerase Chain Reaction (PCR). RESULTS: The prevalence of ChT genital infection in the studied group was 3.2%. Adolescent females infected by ChT less frequently reported the use of condom and more often did not use any contraception in comparison with the girls without ChT genital infections (42.8% and 42.8% vs. 49% and 12.8%), The existence of other STDs was more frequently noted in adolescents with Chlamydial infection in comparison to healthy girls (14.2% vs. 8.3%). There were no statistically significant differences in results of the Pap smears and the incidence of cervical ectopy between the two groups.

[Case report of 18 weeks delayed delivery of the second twin after the miscarriage of the first fetus at the 17th week of pregnancy]. / Poród odroczony o 18 tygodni po wczesniejszym poronieniu pierwszego z blizniat.

Delayed delivery of the second twin after the miscarriage of the first foetus is very rare. Delayed second-twin delivery gives the opportunity for corticoid and antibiotics administration--procedures that decrease the infant morbidity and mortality. We report a case of the second twin's retention after miscarriage of the first at 17th week of pregnancy. The delay time was of 126 days (18 weeks). Pregnancy like this is at increased risk for all maternal complications, in particular intrauterine infection. Parents consent have to be obtained after informing them about advantages and risk of such procedure. The patient was treated with tocolysis, antibiotics, corticosteroids but not previous cervix cerclage has been performed. On regards of our experience and the data from literature we conclude that when observing fetal status and maternal condition, it is possible to delay the second twin's delivery long time after the miscarriage or birth of the first one thus giving the chance to the second twin to grow more mature. The main problem is imminent infection which defines the prognosis. Cerclage does not seem to be essential for better outcome.

[Four main reasons of maternal death in Poland between 1991-2000]. / Zgony matek w Polsce w latach 1991-2000 wg czterech glównych przyczyn.

Maternal death during pregnancy, labour and puerperium constitutes the main problem of prenatal medicine and still a major public health topic. In this work we analyses maternal deaths in Poland between 1991-2000. There were 4,404,641 live births and 462 maternal deaths. Among them there were 402 direct ("true") maternal deaths with mortality rate 9.1 per 100,000 live births and 60 indirect maternal deaths (rate 1.4). There were 218 cases of pregnancy associated deaths (rate 4.9). The main causes of direct maternal deaths were as follows: haemorrhage--33.6% (rate 3.1), sepsis--27.3% (rate 2.5), amniotic fluid embolism--22.4% (rate 2.0) and pregnancy induced hypertension 16.7% (rate 1.5). Increasing maternal age is one of important risk factor for mortality. Over 30% of direct pregnancy related deaths were noted within women above 35 years. Unsatisfactory antenatal care, management deficiency and patient's neglect were main risk factor foe fatal outcome. Practical conclusions should be issued as general rules, instructions and recommendations. Between one third to one half of the maternal deaths are considered to have been preventable.

[Demographic and socioeconomic risk factors of preterm delivery]. / Wiek matki, wyksztalcenie, jakosc opieki polozniczej w czasie ciazy, a ryzyko wystapienia porodu przedwczesnego.

Preterm labour is the main reason of fetal and neonatal deaths. The pathology and etiology of preterm labour are still unknown. The aim of this study was to estimate the demographic and socioeconomic risk factors of premature labour. The study was carried out on 158 pregnant women with preterm labour and rupture of membranes and 120 women with preterm without ruptured membranes. This study determine that age (both young and advanced), low education level, and absent or late prenatal medical care have association with the risk of preterm delivery.