Evidence of a significant vitamin D deficiency among 9-13-year-old Polish children: results of a multicentre study.

PURPOSE: To evaluate the extent to which the population of Polish preadolescents is vitamin D deficient and to assess seasonal variations in vitamin D status. PARTICIPANTS AND METHODS: A total of 720 healthy children aged 9-13 years (409 girls, 311 boys) residing in 6 representative geographical locations in Poland were studied. A parental-assisted questionnaire provided data on nutritional habits, vitamin D supplements and sun exposure. Serum concentration of 25-hydroxyvitamin was determined twice, after the winter in March and after the summer in October. RESULTS: In March, vitamin D deficiency (25-50 nmol/L) was found in 64%, and severe deficiency (< 25 nmol/L) in 20.2% of children. In October, the deficiency and severe deficiency were still noticed in 25.9 and 0.1% of children, respectively. The mean serum concentration of 25-OHD was 52% higher in October (55.4 ± 14.0 nmol/L) than in March (36.4 ± 13.5 nmol/L), (p < 0.01). In children with 25-OHD < 50 nmol/L in March, their 25-OHD concentration increased by 64% through March to October (32.5 ± 8.2 vs. 53.2 ± 7.9 nmol/L, p < 0.01). An association was found between 25-OHD concentration and regular consumption of vitamin D supplements, cod-liver oil and fish. CONCLUSIONS: The majority of preadolescent Polish boys and girls show vitamin D deficiency after the winter period, although a distinct amelioration over summertime is found in this age group. There is a need to implement effective prevention and intervention strategies in the management of vitamin D deficiency among schoolchildren in Poland, with the supplementation throughout the entire year.

Hepcidin and iron status in pregnant women and full-term newborns in first days of life.

OBJECTIVES: The amount of iron is regulated by hepcidin. The aim of the study was to assess hepcidin concentrations in healthy pregnant women before delivery, in cord blood, and in 3-day-old newborns in relation to maternal and neonatal iron status. MATERIAL AND METHODS: The study group consisted of 44 mother-newborn pairs. Serum concentrations of hepcidin, ferritin, and transferrin receptor (sTfR) were assessed. RESULTS: Maternal hepcidin was significantly lower than cord blood (p < 0.001), and full-term newborn values (p < 0.001). Mothers also had the lowest ferritin and sTfR concentrations. The highest concentration of hepcidin was observed in the newborns. They had lower sTfR and higher ferritin concentrations than in cord blood (p < 0.001). Maternal ferritin correlated negatively with sTfR (R = -0.50 p = 0.005), and positively with hepcidin (R = 0.41; p = 0.005). There were no correlations between hepcidin and ferritin or sTfR concentrations in cord blood, nor between hepcidin and ferritin or sTfR concentrations in the newborns. Moreover, there were no correlations between maternal and cord blood or neonatal blood hepcidin, nor between maternal hepcidin and infant iron status. There were also no correlations between hepcidin in cord blood and hepcidin or parameters of the iron status in the children. CONCLUSIONS: It may be assumed that a relatively low concentration of hepcidin in women in late pregnancy facilitates their iron accumulation. Higher levels of hepcidin in full-term newborns than in their mothers may be the result of a relatively high level of iron from the stored supplies. Neonatal iron status was independently associated with either maternal or cord blood hepcidin.

[Indications for hospitalization of young girls and adolescent girls--clinical work-up in the selected cases]. / Wskazania ginekologiczne do hospitalizacji dziewczynek i mlodych kobiet--postepowanie w wybranych przypadkach klinicznych.

OBJECTIVE: The aim of the study was to analyze the clinical reasons for hospitalization due to gynecological causes of adolescent girls and young women. METHODS: We reviewed clinical data on reasons for hospitalization, treatment methods, and histopathological diagnosis in adolescent girls and young women hospitalized at the Second Department of Gynecology Medical University of Lublin, between January 2003 and December 2012. Methods of conservative or surgical treatment, as well as their clinical effectiveness, have been discussed. RESULTS: Over the analyzed period of time, we identified 334 patients at the age between 8 and 20 years, which accounted for 1.61% of all hospitalized women during that time. Rating these patients by age, we found the following: 1 patient < 9 years old, 2 patients aged 10-11 years, 38 patients aged 12-14 years, 128 patients aged 15-17 years and 165 patients aged 17-19 years old. The main clinical reasons for hospitalization of adolescents and young women due to gynecological causes were: ovarian cysts (138 cases; 41.3%), menstrual disorders (46 cases; 13.7%), pregnancy complications (35 cases; 10.5%), and congenital Müllerian anomalies (33 cases; 9.9%). The remaining patients (24.6%) were admitted due to suspicion of ovarian cyst (22 cases; 6.6%), cervical erosion (15 cases; 4.5%), juvenile metrorrhagia (15 cases; 4.5%), and vulvar diseases (8 cases; 2.4%). CONCLUSIONS: Adolescent girls and young women are rarely admitted to gynecological departments. Nevertheless, they present a clinical challenge. Proper diagnosis using advanced visualization methods, along with modern pharmacotherapy accounts for the final therapeutic success.

[The new era in the pharmacological treatment of overactive bladder (OAB): mirabegron--a new selective beta3agonist]. / Nowa era w farmakologicznym leczeniu pecherza nadreaktywnego (OAB): mirabegron--selektywny agonista receptora beta3.

Overactive bladder is defined by ICS as urgency frequency and nocturia, with or without urgency urinary incontinence in the absence of urinary tract infection, or other obvious causative pathology Lower urinary tract symptoms (LUTS) are highly prevalent, especially in aging populations. Epidemiological studies reported LUTS in 62% of men and 67% of women, rising to 81% and 79%, respectively in adults over 60 years old. However the actual burden of LUTS remains relatively unrecognized. LUTS, mainly due to considerable distress including almost all aspects of social functioning, impact on sleep and mental health, may significantly affect quality of life. Management of LUTS including OAB has undergone dramatic changes since 1972, when the first antimuscarinic drug-oxybutynin, was introduced into clinical practice. In the last two decades, six new antimuscarinic drugs entered OAB field and this was accompanied by introduction of botulinum toxin into clinical practice in patients resistant to or not compliant with antimuscarinics. Nowadays, it is recognized that OAB is progressive, age-related and non sex-specific condition with most patients experiencing a combination of storage, voiding and post-micturition symptoms. In 2013, the next step was taken, with new therapeutic options for OAB, enabling an even more patient-tailored approach. This was possible for both, male and female OAB sufferers with new class of oral 3 adrenoreceptor agonist (mirabegron). This drug, by stimulation of 3-adrenoceptors, couples via Gs proteins to adenylyl cyclase, what results in an increase of intracellular cAMP levels and a subsequent activation of cAMP-dependent protein kinase A, which then phosphorylates myosin light chain kinase responsible for inhibition of calcium-calmodulin dependent interaction of myosin with actin. Moreover the cAMP increase also leads to the reduction of cytoplasmic Ca2+ concentration by removal of calcium ions from cytoplasm. These both actions result in a significant increase in the storage bladder capacity and by this interval between micturitions is prolonged. Mirabegron was evaluated in three 12-week, double blind, randomized, placebo controlled, parallel-group, multicenter clinical trials in OAB patients with symptoms of urge urinary incontinence, urgency and frequency - study 046, 047 and 074. It should be pointed out that efficacy of mirabegron was maintained through the entire 12-month period in phase Ill long-term study Discoveries on the physiology of the normal bladder and on the pathophysiology underlying OAB have led to the development of new treatment options for OAB. Pharmacological management of OAB should be tailored to patient's characteristics. New and recent options of pharmacological treatment have undoubtedly expanded treatment possibilities, what should allow physicians to select the optimal treatment for each patient.

[The influence of mesh pelvic floor reconstructive surgery on OAB symptoms]. / Wplyw operacji naprawczych zaburzen statyki narzadu rodnego na redukcje objawów zespolu pecherza nadreaktywnego.

OBJECTIVES: The working hypothesis was that pelvic organs prolapse can induce overactive bladder symptoms. Therefore, restoration of pelvic anatomy with accompanying proper urodynamic parameters (cystometric volume, micturition volume, uroflow) should resolve OAB (Overactive Bladder) symptoms. MATERIALS AND METHODS: Forty eight women, aged 51-77 years (mean 62.4±7.32), with stage II, III or IV prolapse (POP-Q scale) were included into the study. Patients with LUTS (Lower Urinary Tract Symtoms--inflammation, infection, pain) were excluded. Each patient underwent clinical evaluation and full urodynamic examination (cystometry and uroflowmetry MMS Libra +). Depending on the type of the anatomical defect on the POP-Q scale--anterior defect, posterior defect or both anterior and posterior--a repair using polypropylene monofilament mesh was performed (TVM anterior, TVM posterior or TVM Total). Patients were asked to complete King's Health questionnaire before and after the reconstructive surgery. Statistical analysis was performed using Kolmogorov-Smirnov and U Mann-Whitney tests. RESULTS: Overactive bladder symptoms were diagnosed in 27 patients. Detrusor overactivity was found in 10 patients. In 17 patients, out of 27 with OAB before surgery overactivity symptoms completely resolved after the surgery (63%). On the other hand, post-op de novo OAB symptoms appeared in 2 patients (4.1%). Half of the patients with OAB symptoms after surgery had detrusor overactivity before mesh repair while only 30% of patients without OAB symptoms after surgery had DO (Detrusor Overactivity) before the surgical procedure. Micturition volume in group of patients with OAB significantly increased after the surgery (293.78 ml vs. 364.15 ml; p=0.006). Maximal cystometric capacity in patients with overactive bladder also significantly increased after the surgery (318.78 ml vs. 407 ml; p=0.0001). Quality of life measured by King's questionnaire improved in the group of patients with resolution of OAB symptoms in such domains as: Incontinence Impact, Role Limitations and Sleep/emotions, p<0.05. CONCLUSIONS: Correction of pelvic organ prolapse stage II, III and IV in patients with OAB symptoms leads to an improvement in bladder conditions in half of the patients. Such treatment also resulted in symptom resolution of detrusor overactivity ascertained in urodynamic studies. Overactive bladder syndrome with DO was more resistant to surgical treatment as compared to OAB without DO. Quality of life improved in patients who did not present with OAB bladder symptoms after the mesh surgery. Restoration of proper anatomy might also cure or improve bladder symptoms in patients with OAB symptoms, coexisting with advanced pelvic organ prolapse.

[Clinical effectiveness of transobturator midurethral sling (T-sling) with additional 2-point tape fixation performed on an outpatient and inpatient basis]. / Ocena efektywnosci klinicznej operacji typu T-Sling z fiksacja tasmy wykonywanej w ramach procedury jednodniowej i standardowej.

INTRODUCTION: Nowadays, mid-urethral slings are considered the gold standard in surgical treatment of female stress urinary incontinence (SUI). Traditionally this technique has been followed by short inpatient hospitalization and convalescence. From the perspective of both, the patient and the physician, this technique has become increasingly popular due to very high clinical effectiveness and fast recovery ' OBJECTIVES: The aim of the study was to compare the efficacy and safety of transobturator monofilament sling (T-sling-Hernia Mesh, Italy) with additional 2-point tape fixation in the treatment of SUI in women operated on an inpatient and outpatient basis. MATERIAL AND METHODS: A total of 200 women with stress urinary incontinence were included into the study Clinical diagnosis was based on detailed medical history voiding diary gynecological examination, and positive cough test. Exclusion criteria were as follows: previous urogynecologic surgery detrusor overactivity on urodynamics and advanced urogenital prolapse (pelvic organ prolapse-quantification [POP-Q] scale grades--II, III, IV). In both groups the surgery was performed by two (TR; A W) surgeons. Using identical surgical technique, all patients had a monofilament tape inserted at the mid-urethra with 2 absorbable sutures parallel to the urethra in order to fix the tape and prevent its displacement during tape tensioning. Patients were discharged home after the first spontaneous voiding (outpatient group) or 2 days (inpatient group) postoperatively After 12 months, 192 patients (99 in outpatient and 93 in inpatient group) were available for assessment of clinical effectiveness of surgery Success was defined as lack of any leakage during cough stress test. The subjective cure rate was determined by Sandvik scale also after 12 months. Statistical analysis was performed with Statistica 7.1 pl and Mann-Whitney U and Chl tests were used. P-level of < or = 0.05 was considered as statistically significant. RESULTS: There were no differences in demographical data of patients from both groups. The only difference between the two groups concerned the body mass index (mean 26.6 +/- 3.9 vs. 28.67 +/- 3.99; p<0.001) and age (50.48 +/- 9.71 vs. 61.7 +/- 9.2; p<0.001) in the outpatient versus inpatient group, respectively There was no significant difference between the two groups in terms of the overall patients satisfaction and cure rate after the 12-month follow-up (chi2=4.039, p=0.133). CONCLUSIONS: Proper surgical technique but not length of hospitalization is the main factor determining the effectiveness of surgical treatment of SUI. Tape fixation is a simple surgical maneuver that ensures proper sling placement at mid-urethra and does not markedly increase procedure duration or cost of the treatment. Outpatient surgery for SUI using transobturator mid-urethral sling ensures the same cure and satisfaction rates as inpatient orocedure. allowing to reduce the cost of the treatment without compromising clinical effectiveness.

Does a midurethral sling inserted at the time of pelvic organ prolapse mesh surgery increase the rate of de novo OAB? A prospective longitudinal study.

OBJECTIVES: Approximately 20% of women suffer from pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Furthermore, POP and overactive bladder (OAB) symptoms often coexist. Midurethral slings and mesh surgeries are both considered to be risk factors for de novo OAB symptoms. The aim of our study was to determine whether simultaneous midurethral sling insertion at the time of pelvic organ prolapse mesh surgery further increases the risk of de novo OAB. MATERIALS AND METHODS: The study group consisted of 234 women who underwent surgery in our department between August 2007 and October 2009 (114 patients underwent surgery because of coexisting POP and SUI, and 120 underwent surgery because POP alone). The patients were evaluated at follow-up visits scheduled after 6-8 weeks and after 12 months. All women underwent surgery using the Gynecare Prolift Pelvic Floor Repair System, whereas in women with additional overt or occult SUI after restoration of the pelvic anatomy monofilament midurethral slings were simultaneously inserted. The chi-squared test was used to compare the study groups. RESULTS: De novo OAB symptoms were significantly more pronounced among women in the Prolift only surgery group (23.3%) compared to the Prolift with IVS04M group (10.5%; p = 0.0093). CONCLUSIONS: Midurethral sling insertion at the time of pelvic organ prolapse surgery significantly decreases the rate of postoperative de novo OAB symptoms. The lack of anatomical success of the mesh-based reconstructive surgery is a risk factor for the development of de novo OAB symptoms.

Iron deficiency, iron deficiency anaemia and anaemia of inflammation - an overview.

Iron is an essential trace element for various cellular proteins and for biological processes in all cells. Severe iron deficiency (ID) impairs haem synthesis, reduces erythropoiesis and causes iron deficiency anaemia (IDA). Iron restriction in anaemia of inflammation is mainly due to retention of iron in macrophages. This condition is known as 'functional iron deficiency'. A review of studies performed in Europe shows that the prevalence of ID and IDA in young children varies by region. It is more common in eastern than western European countries. This overview summarises information on the need for iron supplementation in children, and the current understanding of the regulatory mechanisms of iron homeostasis and ironrestricted erythropoiesis. The causes of anaemia during infection and the usefulness of classical and new indicators to distinguish absolute from functional iron deficiency are discussed.

The polymorphisms of the MMP-1 and the MMP-3 genes and the risk of pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: To investigate the associations between single nucleotide polymorphism (SNP) type 1G/2G at position -1607/-1608 of the matrix metalloproteinase (MMP)-1 gene and SNP type 5A/6A at position -1612/-1617 of the MMP-3 gene and the development of pelvic organ prolapse (POP) in women. METHODS: 133 patients with symptomatic POP were included in the study group. The control group consisted of 132 women with a normal pelvic floor. 1G/2G MMP-1 and 5A/6A MMP-3 SNPs were determined by polymerase chain reaction (PCR) and restriction fragments length polymorphism analysis. RESULTS: When estimated individually none of the investigated SNPs were associated with POP. The combined MMP-1/MMP-3 SNP analysis showed that the following polymorphic pairs were overrepresented in women with POP: 1G/2G -5A/6A, 2G/2G -5A/6A, 2G/2G -5A/5A, 1G/1G -6A/6A, p=0.005. CONCLUSIONS: The combined effect of -1607/-1608 MMP-1 and -1612/-1617 MMP-3 SNPs may contribute to the development of POP in some women.

[Gynecological aspects of allogenic stem cell transplantation--incidence, risk factors and preventive strategies--description of two clinical cases and literature review]. / Ginekologiczne problemy zwiazane z transplantacja szpiku--czestosc wystepowania, czynniki ryzyka i zalecenia lecznicze--opis dwóch przypadków i przeglad literatury.

Vaginal graft-versus-host disease (GVHD) is a rather common and underreported complication of allergenic stem cell transplantation. It occurs in approximately 25% of all women undergoing hematopoietic stem cell transplantation. In severe manifestation, GVHD might cause complete obliteration of the vagina which requires surgical intervention. In this paper we described 2 cases with complete obliteration of the vagina. We present a case report of 2 women (both 38 years old) diagnosed with complete vaginal obliteration after myeloablative chemotherapy and bone marrow transplant. Both patients were operated at the Second Department of Gynecology Lublin. During the operation we reconstructed the entire vaginal length using either sharp or blunt dissection until the cervix was visualized. Immediately after the reconstruction, we placed a phantom within the vaginal canal for 7 days in order to separate the vaginal wall and prevent the formation of new adhesions. Both patients received antibiotic prophylaxis for 5 days, as well as ointment with Cyclosporine twice a day since postoperative day 2, and 50 microg estrogen transdermal patch every 4 days. The patients were discharged from the hospital on postoperative day 7 and were recommended to use cyclosporine ointment twice a day and intra-vaginal tablets with Estrogen every 3 days. After 6 weeks a follow up revealed complete healing of the vaginal canal and both patients resumed uneventful sexual intercourses. A literature review of preventive strategies for vaginal GVHD was also presented.

The clinical efficacy and safety of outside-in transobturator sling with additional paraurethral fixation - The prospective longitudinal study.

Stress urinary incontinence (SUI) is a common condition that affect 30-40% of women in their lifetime. Midurethral slings (MUS) either suprapubic or transobturator can be safely used in the surgical treatment of SUI. The aim of this study was to collect clinical long-term data regarding safety and performance of transobturator sling with an additional tape fixation in women with urinary incontinence. This prospective longitudinal study was conducted on a group of 2086 female patients diagnosed with stress urinary incontinence. Follow up visits where scheduled 6 weeks, 6 and 12 months after surgery followed by annual checking when possible. Patients underwent transobturator sling procedure from 01.01.2011 to 31.12.2021. All patients had a monofilament tape inserted at the mid-urethra using outside-in technique (TOT) with 2 absorbable sutures parallel to the urethra. Success of surgery was defined as lack of any leakage during cough stress test whereas the subjective cure rate was determined by Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF). 87% of patients who were operated at least 10 years before assessment reported ICIQ -SF < 6. Main postoperative complications were storage symptoms - de novo urgency and voiding difficulties. TOT is safe and highly effective surgical treatment for (SUI) in a long-term observation.

[Overactive bladder--a new insight into the pathogenesis of its idiopathic form]. / Pecherz nadreaktywny--nowe spojrzenie na etiopatogeneze idiopatycznej postaci tego schorzenia.

In the last few years cytokines have been shown to be the most important local cell signaling molecules, strongly involved in the pathogenesis of the overactive bladder symptoms. Proper bladder function is dependent on gap junction activity The main gap junction proteins which can be found in bladder smooth muscle are Connexin 43 (Cx43) and Connexin 45 (Cx45). Experimental studies focused on the influence of Basic Fibroblast Growth Factor on Connexin expression in bladder smooth muscle cells have shown an increased expression of Cx43, contrary to Cx45. Elevated level of Connexin 43 leads to overactivity of muscle fibers. It was also proved that expression of these proteins in tissues is modulated by cytokines. Regulation of the Cx43 promoter depends on an activating factor 1 (AP-1), cyclic monophosphate (cAMP) and retinoid concentration as well. AP-1 is induced by extracellular-signal-regulated kinases (ERK 1/2) through the activation of basic fibroblast growth factor (bFGF). Recent studies revealed that cytokine-induced modulation of gap junction plays an important role in the pathogenesis of OAB, whereas activation of sympathetic fibers via beta adrenoreceptors (beta-AR) causes relaxation of the bladder The beta-3 adrenoreceptors are divided into beta-1, beta-2, beta-3 subtypes. beta-3 adrenoreceptors have been found in fat and smooth muscle tissue. Density of beta-3 AR is very high in urinary bladder detrusor Activation of beta-3 AR leads to the relaxation of smooth muscle fibers during the filling phase and is cAMP-dependent. Missense mutation of this receptor subtype in the human bladder leading to the substitution of Tryptophan (Trp) by Arginine (Arg), occurs in about one-third of the world's population. Studies have shown that about 50% of women with Trp 64 Arg polymorphism have OAB symptoms. Higher concentration of beta3-AR with Trp 64 Arg polymorphism in bladders of women with diagnosed OAB is probably associated with a lower level of cAMP and weaker relaxation of the bladder smooth muscle. The role of the muscarinic receptors (M1-M5) in the pathogenesis of OAB has been widely described. Unfortunately due to lack of selective muscarinic ligands, the function of each subtype of the receptor has not been fully elucidated yet. A mouse model lacking one or more muscarinic receptors types has been constructed recently Animals were used to assess the real influence of various muscarinic receptors on bladder function. Studies have confirmed the importance of these receptors in the function of the urinary tract, offering a new insight in their mutual interactions and pathogenesis of OAB. Better understanding of these and new mechanisms may improve the process of diagnosis and treatment of the disease in the near future.

[Nerve growth factor as a biomarker in the diagnosis and treatment of overactive bladder (OAB)]. / Czynnik wzrostu nerwów (NGF) jako biomarker w diagnostyce i terapii peccherza nadreaktywnego (OAB).

Nerve growth factor is a complex regulator of neural plasticity along the micturition pathways. The aim of this review is to summarize the current evidence for a role of NGF in urinary bladder function both in experimental and clinical settings. There is bulk of strong evidence that experimental administration of NGF elicits the symptoms of increased sensation, urgency and bladder hyperreflexia which strongly resemble overactive bladder syndrome (OAB) and interstitial cystitis/painful bladder syndrome (IC/PBS). Therefore in human studies there are attempts to employ urinary NGF levels as a diagnostic marker in various forms of OAB and IC/PBS. It has been shown that urinary NGF levels are correlated with severity of OAB symptoms and in patients successfully treated with antimuscarinics agents or detrusor botulinum toxin injection, urinary NGF levels decrease significantly in association with reduction of urgency severity

[Local estrogen therapy--clinical implications--2012 update]. / Lokalna terapia estrogenowa--implikacje kliniczne--2012 update.

With increasing longevity in Poland, women can now expect to live around 40% of their lives after menopause, and there is a growing desire for older women to preserve their vitality sexual function and quality of life. The most common urogenital symptoms associated with menopause are dryness, followed by irritation or itching, and discharge, with a substantial number of post-menopausal women also being affected by dysuria. These symptoms are the result of vaginal atrophy which is in turn caused by reduced transudation through the vaginal epithelium and reduced cervical gland secretions resulting from post-menopausal estrogen depletion. Vaginal atrophy generally occurs 4-5 years after the last menstrual period and progressively increases in prevalence in the subsequent years. Importantly vaginal atrophy is strongly associated with sexual dysfunction, and lower urinary tract symptoms, such as frequency urgency nocturia and dysuria, as well as incontinence and recurrent infection are reported more frequently in the presence of vaginal atrophy Those symptoms, apart from being bothersome for the patients also negatively impact their quality of life. Consequently before irreversible changes occur, early detection and treatment of vaginal atrophy should be implemented. Estrogen therapy is the most commonly prescribed treatment. Estrogens restore the cytology pH and vascularity of the vagina, resulting in symptom resolution for the majority of treated women. Because vaginal atrophy symptoms tend to occur later than vasomotor symptoms, many women do not necessarily require or wish to take systemic estrogen treatment if their symptoms are restricted to the urogenital tract. Vaginal estrogen products deliver estrogen locally to vaginal tissues with little or no systemic absorption and provide an effective alternative to systemic estrogen therapy for these women. Various vaginal estrogen preparations such as conjugated equine estrogens, estradiol and estriol vaginal creams, a sustained-release intra-vaginal estradiol ring and a low-dose estradiol and estriol tablets are useful therapeutic options in the treatment of this condition. Moreover; a low dose treatment with a minimised systemic absorption rate may be considered in women with a history of breast cancer and associated severe vulvovaginal atrophy. It should be mentioned that vaginal lubricants once applied on a regular basis may also be effective in alleviating the symptoms of vaginal atrophy and should be offered to women wishing to avoid the use of local vaginal estrogen preparations and in cases where local estrogen therapy is contraindicated. Vaginal dehydroepiandrosterone (DHEA), vaginal testosterone, and tissue selective estrogen complexes are new, emerging therapies; however more clinical studies are necessary to confirm their efficacy and safety in the treatment of postmenopausal vulvovaginal atrophy.

[Exposure to carbon monoxide toxicity as a cause for hospitalization of patients in the Children's Clinical Hospital in Lublin in the years 2006-2012]. / Narazenie na toksyczne dzialanie tlenku wegla jako przyczyna hospitalizacji pacjentów w Dzieciecym Szpitalu Klinicznym w Lublinie w latach 2006-2012.

Exposure to carbon monoxide (CO) accounts for a frequent cause for patient hospitalization in the Children's Clinical Hospital (DSK). The most common source of exposure includes the use of defective heating appliances operating on gas or coal and less frequently the fire toxic fumes. The purpose of the present study was to estimate the number of hospitalized patients in DSK in Lublin between the years 2006-2012 according to age, sex, urban-rural residence, season, carboxyheamoglobin (COHb) levels and hospitalization period. The subjects were assigned to three age groups: I - neonates and infants, II - children from 1 to 6 years of age, III - children aged between 7 to 17 years. In total 99 patients (50 female, 49 male) were admitted to hospital on account of carbon monoxide intoxication. Children aged 6 years and above constituted the most numerous age group. Furthermore 1 neonate and 5 infants (6.1%) and 43 children aged 1 to 6 years (43.4%) were hospitalized. The intoxications were visibly season-related. The highest frequency of CO poisoning lasted from October until March. The largest incidence was recorded in December and January. The majority of the children were urban residents - 67%, 33% were from rural areas. Carboxyhaemoglobin levels upon admission ranged from 0 to 26.7%. The average hospitalization lasted 2.4 days. Carbon monoxide intoxication remains a pressing health concern. The awareness of CO intoxication hazards among general public, application of appropriate first aid techniques, identification of clinical symptoms and treatment methods present the opportunity to save lives and reduce the long-term effects of CO poisoning.

C-type natriuretic peptide and its contribution to bone growth.

INTRODUCTION AND OBJECTIVE: The expression of the C-type natriuretic peptide (CNP) gene has been detected in the growth cartilage of the long bones and vertebrae. This article provides an overview of the role of CNP in bone growth and presents the results of the authors' research on the concentration of the NTproCNP and its relationship with growth velocity and bone markers in healthy school-age children. MATERIAL AND METHODS: The study involved 75 girls and 59 boys aged from 9.0-11.8 years (mean 10.29±0.74). Body weight, height and lower limb length were measured, and blood samples were collected twice at six-month intervals. In the first serum sample, the concentrations of NTproCNP, C-terminal propeptide type I (CICP), C-terminal telopeptide type I collagen (ICTP) osteocalcin (OC) and bone-specific alkaline phosphatase (BAP) were determined. In the second sample, NTproCNP concentration was assessed. RESULTS: During the six-month follow-up period, the increase in body height and weight of girls was greater than boys (p<0.000; p=0.003, respectively). While during the first examination the concentration of NTproCNP in girls and boys was similar, during the second examination it was higher in girls than in boys (p=0.04). Weak positive correlations between the increase in body height and NTproCNP, CICP, BAP as well as OC were found. There were no correlations between NTproCNP and the bone markers. CONCLUSIONS: The results suggest that NTproCNP concentration depends on growth velocity in children. There is increasing evidence that a better knowledge of CNP biology contributes to a better understanding of bone growth mechanisms.

Femistina versus Canephron as a prevention of urinary tract infections after midurethral sling surgery - Non-inferiority study.

OBJECTIVE: Urinary tract infection (UTI) is relatively common post-operative complication following midurethral sling placement (MUS), even in cases where intraoperative antibiotic prophylaxis was given. The primary aim of this study was to investigate the non-inferiority of Femistina as compared with Canephron in reducing symptomatic UTI in first six months following surgery. STUDY DESIGN: A sample size of 144 patients per group was established, to provide at least 90% power to demonstrate the non-inferiority of phytodrug Femistina versus Canephron as a prevention of post-MUS urinary tract infection. RESULTS: Women suffering from stress urinary incontinence and mixed urinary incontinence (MUI) with predominant SUI symptoms as confirmed by urodymamics (n = 320) were randomized in a 1:1 ratio to Femistina (40 mg, oral, twice daily for 20 days) or Canephron (3 × 5 ml taken orally-three times daily for 4 weeks). Both groups were homogenous for age, type of operation (only TOT outside-in) and severity of illness as indicated by ICIQ-SF questionnaire. We found that symptoms of UTI were significantly lower in patients receiving Femistina. During first 6 months after surgery UTI was confirmed in only 10 patients receiving Femistina (6,25%) when compared to 25 (15,63%) subjects receiving Canephron, p < 0.007. CONCLUSION: Femistina is not inferior to Canephron in preventing lower urinary tract infection after midurethral sling surgery.

[Congenital anomalies of the female reproductive tract--diagnosis and management]. / Wady wrodzone ukladu moczowo-plciowego u kobiet-diagnostyka i postepowanie.

The aim of this review was to discuss the putative etiology of Müllerian duct anomalies and to present the current diagnostic strategy and therapy Congenital defects of the female reproductive tract result from failure in the proper embryological development and fusion of the Müllerian ducts. Their causative factors are not fully understood yet. Clinical symptoms, if any appear usually during adolescence or early adulthood, and in some cases might affect the reproductive outcome. Imaging techniques such as hysterosalpingography ultrasonography and magnetic resonance are mainstay for the diagnosis. The classification system of these anomalies facilitates the decision about therapy and prognosis, however individual approach in every case is strongly recommended.

[Tethered vagina syndrome after classical anterior colporrhaphy]. / Zespól zbliznowacialej pochwy jako powiklanie po klasycznej plastyce pochwy.

We presented etiology symptomatology and diagnosis of the tethered vagina syndrome. Detailed information concerning pharmacological and surgical treatment was given. Surgical method of vaginal anatomy restoration using Martius flap technique was described in patients with tethered vagina syndrome after classical anterior colporrhaphy. We paid special attention to a particular type of genital fibrosis such as labial fusion in girls.

[Intracrinology and dehydroepiandrosterone--a new perspective for the use of androgens in hormone replacement therapy in postmenopausal women]. / Intrakrynologia a dehydroepiandrosteron --nowe spojrzenie na terapeutyczne zastosowanie androgenów w terapii substytucyjnej u kobiet w okresie menopauzy.

During menopausal transition not only ovarian production of estrogens but also marked decrease of adrenal androgen production are observed Decreased secretion of adrenal DHEA and DHEA-S result in reduction of peripheral conversion of these steroids into active estrogens and androgens. Intracrinology describes the biosynthesis of active steroids in peripheral target tissues in which the action of theses steroids takes place, without release into the extracellular space or general circulation. DHEA administration to postmenopausal women significantly increases bone mineral density decreases insulin resistance and amount of fat tissue and exerts an estrogenic effect on vaginal cytology in the absence of endometrial stimulation. Moreover animal experiments proved that DHEA suppresses the growth of breast cancer which is yet another reason to consider this steroid as a part of hormone replacement therapy in women.