The role of oxidative stress in female infertility and in vitro fertilization.

Infertility problem involves many couples of reproductive age. It has been estimated that in Poland 0.7-1.0 million pairs require treatment, while for more than half of them assisted reproduction is the only recommended and effective method. Infertility affects 13 to 15% of the world's population. A major concern is the age-related decline in female fertility even more that often a decision about pregnancy is taken at later age. Recent studies show that increased production of reactive oxygen species is an important factor in etiopathogenesis of pregnancy and affects female reproduction. It was found that oxidative stress may damage the oocytes and may impair their fertilization capacity. Oxidative stress may also lead to embryo fragmentation and formation of numerous developmental abnormalities, and is regarded to be one of the important reasons of spontaneous and recurrent miscarriage. Moreover, overproduction of reactive oxygen species has a significant impact on the success of in vitro fertilization (IVF).

Comparison of prognosis in patients with endometrioid endometrial cancer staged IB in FIGO 1988 and 2009 classifications.

PURPOSE: Since 2009 the new FIGO Staging System of endometrial cancer, which changed the previous FIGO 1988 Staging System, has been in use. The aim of the study was to compare prognosis in patients with endometrioid endometrial cancer at stage IB of the 2009 FIGO Staging System and of the 1988 FIGO Staging System. METHODS: We analyzed 173 patients: 108 patients (group A) at stage IB in FIGO 1988 Staging System, and 68 patients (group B) at stage IB in FIGO 2009 Staging System from 262 consecutive endometrioid endometrial cancer patients. The disease-free survival (DFS) and overall survival (OS) were compared between these groups. RESULTS: The DFS rate was 96.3 % in group A and it was 87.7 % in group B (p = 0.029). Relapses were observed in 12 patients (6.4 %) from 6 to 57 months (mean 28.1; SD = 14.6) after initial surgery, and occurred in four patients from group A (3.7 %) and eight patients from group B (12.3 %) (p = 0.032). The OS rate was 94.4 % in group A and it was 83.1 % in group B (p = 0.018). During follow-up, 17 patients (9.8 %) died: six patients from group A (5.6 %), and 11 patients from group B (16.9 %). CONCLUSIONS: Stage IB in FIGO 2009 Staging System is associated with worse prognosis compared to stage IB according to FIGO 1988 classification. There seems to be a need to use exclusively the new FIGO 2009 classification worldwide to avoid therapeutic mistakes, which can be caused by diverse nomenclature.

Comparison of FIGO 1989 and 2009 recommendations on staging of endometrial carcinoma: pathologic analysis and cervical status in 123 consecutive cases.

Incidences of endometrial carcinoma (EC) among women of Western countries is increasing, reaching a level of 18/100,000. In 2009, the International Federation of Gynecology and Obstetrics (FIGO) proposed a new staging system in EC. The purpose of this study included the evaluation of distribution of EC in categories of age, histologic grade, and surgical staging according to the 1989 and the 2009 FIGO guidelines. The original staging assessments have been updated to reflect the current staging system in 123 consecutive patients. Statistical analysis was carried out. The median age of patients was 61 years. A comparison of old and new staging systems shows that a significant number of patients moved to stage I: 78.05%, versus 56.91% based on the 1989 classification (P=0.044). The number of patients in stage II changed as well: 9.76% according to new staging system and 30.89% by definitions of FIGO 1989 (P=0.001). Of patients in stage II, 21.1% had G1 tumors according to the old versus 8.3% by the new classification (P=0.001). We have not identified any associations between the histologic status of a cervix and EC. The most common type of EC is the endometrioid subtype, found in 87.8% of patients. We have noted a significant association between the tumor grade and cervical stromal infiltration. The new classification system for EC seems to be an improved staging instrument. Having up to 80% of patients with endometrial cancer in stage I and following them, might elucidate the impact of current staging on survival and life quality.

Long-term survival of endometrioid endometrial cancer patients.

INTRODUCTION: To establish risk factors for onset and progression of endometrioid endometrial cancer still remains the aim of scientists. The aim of the study was to determine disease-free survival (DFS) and overall survival (OS) in women with endometrioid endometrial cancer. MATERIAL AND METHODS: A retrospective review of 142 patients with endometrioid endometrial cancer after surgery treated with adjuvant radiotherapy and/or chemotherapy in the Regional Cancer Centre in Lodz between 2002 and 2004 was performed. Clinical and pathological data were correlated with clinical outcome and survival. RESULTS: In 3 patients (2.1%) clinical progression was diagnosed during the treatment. In 23 patients (16.7%) after primary remission, relapse was diagnosed 2-56 months after treatment. DFS and OS were 81.7% and 83.1% respectively. Better DFS significantly correlated with larger number of pregnancies (> 1), stage I of the disease and optimal surgery. Lower stage of disease, pelvic lymph node dissection, optimal surgery and depth of myometrial infiltration ≤ 50% were independent prognostic factors for better OS. CONCLUSIONS: The results of our study provided significant evidence that early detection of endometrioid endometrial cancer enables optimal surgery. It reduces the indications for adjuvant therapy in stage I of the disease, and makes the prognosis significantly better. Other clinical and pathological factors such as numerous pregnancies, pelvic lymphadenectomy, and depth of myometrial infiltration, although important, are of less significance. Further prospective, randomized studies are necessary to prove the role of these factors.

Primary uterine rhabdomyosarcoma in a patient with a history of breast cancer and gastrointestinal stromal tumor.

We describe a unique case of a 67-year-old patient with primary uterine rhabdomyosarcoma with a history of breast cancer and gastrointestinal stromal tumor of the stomach. Uterine rhabdomyosarcoma was diagnosed in our patient during adjuvant treatment of breast cancer with anastrozole. To the best of our knowledge, the development of primary uterine rhabdomyosarcoma has never been described in patients treated with anastrozole. Due to the suggested causative role of tamoxifen in the development of uterine sarcomas, it is interesting to analyze whether the new drug, anastrozole, exerts any pathogenic effect on the development of uterine sarocomas.

[Adnexal tumors after surgical treatment of colorectal cancer]. / Guzy przydatków po operacyjnym leczeniu nowotworów zlosliwych jelita grubego.

OBJECTIVE: The risk of metastatic ovarian tumor is significantly higher in case of women with a history of colorectal cancer. Additionally, the possibility of developing ovarian cancer due to congenital mutations in suppressor genes should be assessed. DESIGN: The purpose of the study was to evaluate the clinical presentation and histopathology of adnexal tumors in case of female patients with a history of colorectal adenocarcinoma. MATERIAL AND METHODS: A retrospective study on 13 women (each with a history of colorectal carcinoma, operated due to adnexal tumor between 2004 and 2007), has been conducted. Subject characteristics, ultrasound, CT, serum tumor markers levels, histopathology and findings at surgery were analyzed. RESULTS: Time distance between colorectal cancer surgery and ovarian tumor operation - measured in months -was shorter in cases of malignant neoplasms (10.13 +/- 3.98) than in benign tumors (26.2 +/- 19.37). Ultrasound examination showed solid-cystic adnexal tumors in 8 malignant cases, and ovarian cysts in 5 benign conditions. The use of ultrasound with plasma levels of CEA, CA 19.9 and CA 125 improved the validity of the preoperative differentiation of ovarian masses. Total abdominal hysterectomy with bilateral salphingo-oophorectomy was performed in eleven cases. Unilateral adnexectomy only took place in one case of benign tumor and in one case of disseminated neoplasmatic disease. CONCLUSIONS: When evaluating a patient with an adnexal tumor, a history of malignancy strongly suggests a metastatic nature. The use of ultrasound associated with plasma levels of Ca 125, Ca 19-9 and CEA, represents a useful method of preoperative assessment of ovarian tumors.

[Abdominal Burkitt lymphoma mimicking the ovarian cancer. Case report and review of the literature]. / Postac brzuszna chloniaka Burkitta o obrazie klinicznym raka jajnika. Opis przypadku i przeglad pismiennictwa.

UNLABELLED: Primary Burkitt lymphoma is a lymphoblastic B-cell malignant tumor with very aggressive course. Its abdominal form involving internal genital organs is very rare. CASE: We report the case of 27-year-old woman treated for abdominal Burkitt lymphoma. The patient presented bilateral ovarian tumors with ascites, pain and elevated CA 125 over 900 IU/ml. During laparotomy an advanced neoplasmatic disease involving internal genital organs has been diagnosed. Bilateral salphingo-oophorectomy and omentectomy have been performed. Additionally, the neoplasmatic tumor from ileo-coecal region has been ressected in order to prevent ileus. Pathologic examination has revealed an abdominal Burkitt lymphoma. After surgery, polychemotherapy has been administered (COP followed by CODOX-M+IVAC). The patient, 36 months after surgical treatment, remains under the control of our Department. No signs of recurrence have been detected so far. CONCLUSIONS: The presence of primary abdominal Burkitt lymphoma may include clinical and laboratory findings suggesting the presence of ovarian cancer. Chemotherapy appears to be an essential therapeutic management for all forms of Burkitt lymphoma. Clinically advanced Burkitt lymphoma may be successfully managed with chemotherapy.

[Krukenberg tumor - common problem of gynecologists, surgeons oncologists and pathologists. Report of three cases and review of the literature]. / Guz krukenberga--problem interdyscyplinarny. Opis trzech przypadków klinicznych i przeglad pismiennictwa.

Ovarian cancer constitutes one of the most frequent malignant tumours in the female population not only in Poland. The screening of this tumour type is unsolved. The tumours are usually diagnosed in the advanced stage, thus the survival rate are usually poor. Their histopathological appearance has a wide variety, with the occurrence of numerous metastatic forms. Among the metastatic tumours, the primary tumours of the digestive tract occur the most frequently. They are known as the Krukenberg tumours. In these cases the choice of treatment is more difficult and prognosis is also worse in most cases with fatal outcome in one year. Early diagnosis and complete resection is the only possible hope. In this paper authors present three cases of Krukenberg tumour with nonspecific symptoms, difficulties during diagnostics, late beginning of treatment and poor prognosis.

[Routine episiotomy in modern obstetrics. Is it necessary?]. / Naciecie krocza w nowoczesnym poloznictwie. Koniecznosc czy przyzwyczajenie?

The study presents a literature review on the benefits and risk of the routine episiotomy during the second stage of labour. Perineal trauma complications as well as perinatal outcomes are discussed. The risk of stress incontinence and sexual dysfunction are described. New techniques for improve of perinatal outcomes and prevention of post partum incontinence are described. Routine episiotomy gives poor effects in many cases. Perineal massage during pregnancy, waterbirth, are most interesting methods to avoid routine episiotomy and improve the quality of life in post partum women.

[Uterine leiomyomas: A prenatal diagnosis group study]. / Miesniaki macicy u ciezarnych w przypadkach diagnostyki prenatalnej.

OBJECTIVE: To evaluate uterine myomas among pregnant women underwent prenatal diagnosis procedures and to relate these findings to failures of AC, CVS or Triple Test. METHODS: 223 pregnancies were analyzed. There were 178 AC cases, 22 cases of transabdominal CVS and 23 cases of the false positive Triple Test result. RESULTS: Uterine leiomyomas were detected in 12.5% of pregnancies. AC as well as CVS failures were described due to myomas. Myomas were detected in 13% of the false positive triple test result. CONCLUSIONS: The prevalence of leiomyomas among prenatal diagnosis group of women was 12.5%--more frequent, comparing to the epidemiological studies (0.1-3.9%). AC as well as CVS failures occurred due to myomas. Feto-placental unit flow failures in myoma cases are suspected reason of the false positive triple test results.