Performance of IOTA Simple Rules Risks, ADNEX Model, Subjective Assessment Compared to CA125 and HE4 with ROMA Algorithm in Discriminating between Benign, Borderline and Stage I Malignant Adnexal Lesions.

BACKGROUND: Borderline ovarian tumors (BOTs) and early clinical stage malignant adnexal masses can make sonographic diagnosis challenging, while the clinical utility of tumor markers, e.g., CA125 and HE4, or the ROMA algorithm, remains controversial in such cases. OBJECTIVE: To compare the IOTA group Simple Rules Risk (SRR), the ADNEX model and the subjective assessment (SA) with serum CA125, HE4 and the ROMA algorithm in the preoperative discrimination between benign tumors, BOTs and stage I malignant ovarian lesions (MOLs). METHODS: A multicenter retrospective study was conducted with lesions classified prospectively using subjective assessment and tumor markers with the ROMA. The SRR assessment and ADNEX risk estimation were applied retrospectively. The sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) were calculated for all tests. RESULTS: In total, 108 patients (the median age: 48 yrs, 44 postmenopausal) with 62 (79.6%) benign masses, 26 (24.1%) BOTs and 20 (18.5%) stage I MOLs were included. When comparing benign masses with combined BOTs and stage I MOLs, SA correctly identified 76% of benign masses, 69% of BOTs and 80% of stage I MOLs. Significant differences were found for the presence and size of the largest solid component (p = 0.0006), the number of papillary projections (p = 0.01), papillation contour (p = 0.008) and IOTA color score (p = 0.0009). The SRR and ADNEX models were characterized by the highest sensitivity (80% and 70%, respectively), whereas the highest specificity was found for SA (94%). The corresponding likelihood ratios were as follows: LR+ = 3.59 and LR- = 0.43 for the ADNEX; LR+ = 6.40 and LR- = 0.63 for SA and LR+ = 1.85 with LR- = 0.35 for the SRR. The sensitivity and specificity of the ROMA test were 50% and 85%, respectively, with LR+ = 3.44 and LR- = 0.58. Of all the tests, the ADNEX model had the highest diagnostic accuracy of 76%. CONCLUSIONS: This study demonstrates the limited value of diagnostics based on CA125 and HE4 serum tumor markers and the ROMA algorithm as independent modalities for the detection of BOTs and early stage adnexal malignant tumors in women. SA and IOTA methods based on ultrasound examination may present superior value over tumor marker assessment.

Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems.

BACKGROUND: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. AIM: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. MATERIAL AND METHODS: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. RESULTS: The median age was 60.3 years (range ± 10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71-0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65-0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70-0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73-0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. CONCLUSIONS: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

Sonographic Assessment of Complex Ultrasound Morphology Adnexal Tumors in Pregnant Women with the Use of IOTA Simple Rules Risk and ADNEX Scoring Systems

BACKGROUND: To evaluate the accuracy of subjective assessment (SA), the International Ovarian Tumor Analysis (IOTA) group Simple Rules Risk (SRR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model for the preoperative differentiation of adnexal masses in pregnant women. METHODS: The study population comprised 36 pregnant women (median age: 28.5 years old, range: 20-42 years old) with a mean gestation age of 13.5 (range: 8-31) weeks at diagnosis. Tumors were prospectively classified by local sonographers as probably benign or probably malignant using SA. Final tumor histological diagnosis was used as the reference standard in all cases. Logistic regression SRR and ADNEX models were used to obtain a risk score for every case. Serum CA125 and human epidydimis protein 4 (HE4) concentrations were also retrieved and the Risk of Ovarian Malignancy Algorithm (ROMA) value was calculated. The calculated predictive values included positive and negative likelihood ratios of ultrasound and biochemical tests. RESULTS: Final histology confirmed 27 benign and 9 malignant (including 2 borderline) masses. The highest sensitivity (89%) and specificity (70%) were found for the subjective tumor assessment. Although no malignancy was classified as benign using the SRR criteria (sensitivity = 100%), the specificity of this scoring system was only 37%. At the cut-off risk level of >20%, the ADNEX model had a sensitivity of 78% and a specificity of 70%. Serum levels of CA125, HE4 and the ROMA risk model correctly identified adnexal malignant tumors with a sensitivity of 67%, 25% and 25%, respectively. Corresponding specificities were 72%, 100% and 100%, respectively. The highest positive and negative likelihood ratios were found for SA (LR+ = 3.0 and LR- = 0.16, respectively). Overall diagnostic accuracy of all predictive methods used in this study were similar (range: 70-75%) except for SRR (53%). CONCLUSION: Subjective assessment remains the best predictive method in complex adnexal masses found at prenatal ultrasound in pregnant women. For less experienced sonographers, both the SRR and ADNEX scoring systems may be also used for the characterization of such tumors, while serum tumor markers CA125 and HE4, along with the ROMA algorithm appear to be less accurate.

Tumor budding index and microvessel density assessment in patients with endometrial cancer: A pilot study.

The present study aimed to analyze the association between tumor budding index (TBI) and microvessel density (MVD) and selected clinicopathological features in female patients with endometrial cancer (EC). The present study included 137 patients, of whom 117 had endometrial endometrioid cancer and 3 had non-endometrioid EC (NEEC). Additionally, 8 cases of simple endometrial hyperplasia and 9 cases of atypical endometrial hyperplasia were included in the present study. Patient age, menopausal status, tumor histological type, grade and International Federation of Gynecologists and Obstetricians (FIGO) clinical stage were investigated. Immunohistochemistry was utilized to detect MVD using a CD34 antibody, and a laminin-5γ2 antibody was used for TBI assessment. In nonmalignant endometrial lesions, the TBI was significantly lower than that in patients with EC and NEEC (P=0.002). Significant differences in median TBI (MD-TBI) were also observed between patients with low-grade EC (MD-TBI, 4.5) and high-grade EC (MD-TBI, 16.2; P=0.01). Age, body mass index and tumor FIGO stage were not indicated to be associated with the MD-TBI. Premenopausal patients with EC had lower MD-TBI values than postmenopausal patients (0.3 vs. 11.1; P<0.005). The median MVD-CD34 in the study group was 19 (range, 13-29). Significant differences in MVD-CD34 were observed between malignant and nonmalignant endometrial lesions (P=0.01). Histological grade was markedly associated with tumor MVD-CD34 (P=0.001). The MVD was higher in high-grade cancer (G3; MVD-CD34, 24.9) than in grade G1 and G2 lesions (MVD-CD34, 14 and 18.6, respectively; P=0.01). FIGO clinical stage was not associated with MVD-CD34 in low and high stage lesions (MD, 18.4 for FIGO stage I/II; MD, 17.6 for FIGO stage III/IV; P=0.2). High MVD was markedly associated with high MD-TBI (P=0.0002). In conclusion, TBI could be a valuable indicator of tumor aggressiveness in patients with EC. The presence of the tumor budding phenomenon with increased MVD may have the potential to further refine clinical management decisions when endometrial malignancy is detected.

[Breasts self examination - everything we want you to know about it - survey study].

OBJECTIVE: Introduction: Breasts self examination is first line prevention in case of breast cancer. It is cheap, it is easy and it can save your life. That is why it is so important that every woman and even man know how to do it. The aim: To estimate the level of knowledge about breasts self examination among women and also among people connected with medicine. PATIENTS AND METHODS: Materials and methods: The data were gathered through the internet questionnaire, which contained of 14 questions. There were 204 respondents : 53% women and 47% men. Among them there were 93% people related with medicine. Average age was 23,5 years. The participation was voluntary and annonymous. RESULTS: Results: Among female respondents 57% admit doing breasts self examination, however only 23% of them do that regularly every month. Also only 36% of the respondents know how to do proper examination. When asked if they ever had their breasts examined by the doctor, only 20% replied positively. We also prepared questions for people connected with medical field: we asked them if doing breasts examination for the patient they would feel confident (61% replied negatively.) and also if they had a chance to do breasts examination during studies most of them replied negatively. CONCLUSION: Conclusions: To conclude, even among women connected with medical field the knowledge is not enough, which is the most concerning since they should educate others and diagnose concerning symptoms. We should put more afford to break the tabu and pay more attention to breast examination.

[Public knowledge of the infertility and legal aspects of infertility treatment in Poland].

OBJECTIVE: Introduction: The awareness of infertility is limited in Polish society despite the fact that this problem affects around one million couples in our country. Some of them decide to undergo specialistic treatment. Issues pertaining techniques of contributed reproduction are strictly regulated by Polish law. PATIENTS AND METHODS: Material and methods: The study was conducted among the residents of Lublin in the period from October 1, 2017 to May 1, 2018. The research tool was an original, anonymous questionnaire containing 24 questions. The study group consisted of 164 people. Statistical analysis was performed using T-student test for non-parametric variables. RESULTS: Results: The majority of the examined group were people who worked the medical profession (71%). It is significant that as much as 79.3% of respondents are religious. Only 8,5% of respondents know that the Polish law on infertility treatment is regulated in Act on the treatment of infertility of 25 June 2015. Almost half of the respondents (44.2%) answered correctly to the question regarding the treatment of infertility according to the binding Act. Only 28,5% of respondents were able to give the definition of embryo included in the Act. Moreover, almost all respondents (92.1%) never met with lectures about legal aspects in the treatment of infertility. Half of the respondents (47.3%) correctly indicated the most common cause of female infertility, the reason of men infertility was correctly indicated more respondents (65.5%). CONCLUSION: Conclusions: The respondents knowledge of infertility is more extensive than their knowledge of the legal regulations about infertility treatment. Respondents asked about regulations included in the Act on the treatment of infertility of June 25, 2015 mostly did not answer questions or gave wrong answers. The respondents whose field of study was related to medicine gave more correct answers compared to people who study non-medical fields. Practicing Catholic (45%) more often gave wrong answers.

Prognostic significance of TEM7 and nestin expression in women with advanced high grade serous ovarian cancer.

OBJECTIVES: Tumor endothelial marker 7 (TEM7) and nestin have been proposed to be new candidates for neoangiogenesis assessment. Nestin is also cancer stem cells marker in various malignant tumors. AIMS: To investigate the expression of TEM7, nestin and nestin-related microvessel density (MVD) in high-grade serous ovarian cancer samples and to study their correlation with overall survival (OS) and disease-free survival (DFS) times. MATERIAL AND METHODS: Tumor samples obtained from 70 women with FIGO IIIc/IV ovarian serous cancer were studied with immunohistochemistry. RESULTS: Patients median age was 54 yrs (range: 29-72 years), 86% died of the disease with median OS = 28.5 months and median DFS = 10 months (3 years DFS = 19%; 5 years. DFS = 13.8%). High nestin expression was found in 16 (23%) patients with 3 years and 5 years OS of 14% and 0%. In low-nestin expression group OS and DFS were 42% and 25%, respectively. Median nestin-MVD (16, range:12-23) was not correlated with cancer cells nestin expression and with both DFS and OS. High TEM7 expression was found in 29 women (41%) of whom 21 (72%) died of the disease. A 5-year OS in these women was 27% as compared to 8% in low TEM7 expression group, but TEM7 presence had no association with nestin, nestin-MVD and both OS and DFS. CONCLUSIONS: Nestin as a marker of cancer stem cells may assist in the prediction of OS and DFS in women with high grade serous ovarian cancer. Nestin may also be considered a novel therapeutic target for antiangiogenic agents.

[testicles self examination - knowledge and abilities - survey study].

OBJECTIVE: Introduction: Testicle cancer is a common malignant cancer among young men (20 to 44 years). In 90% of cases we can feel nodule or change of consistency, which means during testicles self examination we can quickly discover cancer. The aim: To estimate the level of knowledge about testicles self examination among men and also medical stuff and students. PATIENTS AND METHODS: Materials and methods: We gathered the data through the internet questionnaire, which contained of 13 questions. There were 204 respondents (53% women and 47% men). 93% were related with medicine. Average age was 23,5 years old. The participation in the study was voluntary and annonymous. RESULTS: Results: Only 41% of our respondents perform self examination. When asked if They every had Their testicles checked by a doctor only 33% responded positively. Most of the respondents almost correctly point out symtpoms and risk factors of testicles cancer. Only 22% of medical related respondents feel confident while performing testicles examination with the patient and just 12% of them had a chance to do it during studies. We also asked our respondents if They have ever seen a social campaign about priopriate testicles self exmiantion and 80% of them respondet negatively. CONCLUSION: Conclusions: The level of education about testicles examination is on low level. Men are usually aware of the risk, but They neglect it. In most cases doctors do not examine testicles and are not confident about it. We have to put more concern to that case.

Mig-7 expression and vasculogenic mimicry in malignant ovarian tumors.

OBJECTIVES: To investigate the possible association of vasculogenic mimicry (VM), VE-cadherin and MIG-7 expression with clinicopathological features of women with malignant ovarian masses. MATERIAL AND METHODS: VM was studied with the PAS reaction and VE-cadherin was assessed with immunohistochemistry in 108 women with malignant ovarian tumors. Additionally, quantitative expression of MIG-7 mRNA was performed in 52 ovarian cancers with qRT-PCR. RESULTS: VM was found in 48/108 cases (44%), more often in higher FIGO stage tumors (83% cases; 40 vs. 8; p = 0.01). High expression of VE-cadherin was present in 37% of all ovarian masses. Ovarian tumors without VM more often expressed low levels of VE-cadherin than tumors where VM was found (37.6% vs.14.6%). No expression or very low expression of MIG-7 mRNA was found in all normal ovarian tissues and in 32 cancer samples. Median RQ of MIG-7 mRNA in tumor samples was higher than in normal ovarian tissue (RQ = 0.29 vs. RQ = 0.05, respectively; p < 0.005) and higher than in non-malignant ovarian masses (0.98 vs. 0.05 respectively; p = 0.03). Expression of MIG-7 mRNA was significantly correlated with VM (p = 0.039). In tumors with PAS-positive structures median RQ MIG-7 mRNA was higher than in tumors with PAS-negative findings (1.89 vs. 0.13 respectively). VE-cadherin expression was more frequently found in tumors where MIG-7 mRNA was present (p = 0.004). CONCLUSIONS: Vasculogenic mimicry exists in malignant ovarian tumors and advanced clinical stages of malignancy are accompanied by a high incidence of VM formation. MIG-7 mRNA and VE-cadherin expression may serve as additional molecular markers of VM in ovarian malignancies.

Diagnostic hysteroscopy and the risk of malignant cells intraabdominal spread in women with endometrial cancer.

Although hysteroscopy is currently the undisputed gold standard for the examination of the uterine cavity in women with suspected endometrial cancer, it remains controversial as a procedure that can enhance metastasis spread. Endometrial cancer cells may shed during hysteroscopy and be passively transported with fluid flow into the peritoneal cavity. The paper presents the review of current knowledge regarding the risk of neoplasm metastases in women who had diagnostic hysteroscopy and the conditions that have to be met for the procedure to be safe. We searched PubMed, Ovid, Medline and Scopus databases for data published in the years 1985-2017. The following browsing criteria, the "MeSH headings": hysteroscopy, endometrial cancer, intraperitoneal or metastatic spread were used to find relevant papers. Based on the current data analysis we conclude that (1.) diagnostic hysteroscopy performed in women with endometrial cancer, especially in its early stages, is a very useful, efficient and safe diagnostic method and (2.) the distension media used for endoscopic procedures in the uterine cavity must be strictly controlled for relatively low pressures to prevent the increase in risk of endometrial cancer intraperitoneal spread.

Proliferation and maturation of intratumoral blood vessels in women with malignant ovarian tumors assessed with cancer stem cells marker nestin and platelet derived growth factor PDGF-B.

OBJECTIVES: Platelet-derived growth factor B (PDGF-B) and nestin have been suggested to be useful in the assessment of neoangiogenesis in malignant ovarian masses. We aimed to investigate a possible association of these markers with newly formed microcapillaries and perivascular cells in ovarian tumors. MATERIAL AND METHODS: Microvessel density (MVD) and pericytes were studied in 82 women with ovarian neoplasms, including 7 benign cysts, 7 borderline masses, 64 epithelial ovarian cancers and 4 other malignant ovarian tumors. Immunohistochemical staining included antibodies to CD34, PDGF-B and nestin. RESULTS: Median values of CD34-positive and nestin-positive MVD were: 24,5 (range:17-32) and 21 (range: 12-31), respectively. No significant correlation between intratumoral CD-34 positive MVD and nestin-positive MVD was found. Benign and borderline lesions more frequently than malignant tumors displayed low or medium values of nestin-positive MVD (p = 0.01). Histological grading of malignant tumors was associated with nestin-positive MVD (p = 0.01). Nestin expression in tumor cells was not correlated with tumor grade or histological subtype. PDGF-B expression was found in tumor microves-sels in 72% of cases (59/82). High expression of PDGF in pericapillary cells was strongly associated with high expression of this marker in cancer cells (p = 0.007). Significant correlations between PDGF-B and nestin expression in malignant tumor microvessels were also found (p = 0.04). Nestin and PDGF-B expressions were strongly associated with high grade tumors when compared to low grade or benign masses. CONCLUSIONS: We conclude that the assessment of PDGF-B and nestin-positive MVD could be used to identify only highly active, angiogenic malignant ovarian masses, where tumor vasculature is formed.

The use of sonographic subjective tumor assessment, IOTA logistic regression model 1, IOTA Simple Rules and GI-RADS system in the preoperative prediction of malignancy in women with adnexal masses.

BACKGROUND: Sonography based methods with various tumor markers are currently used to discriminate the type of adnexal masses. OBJECTIVE: To compare the predictive value of selected sonography-based models along with subjective assessment in ovarian cancer prediction. MATERIAL AND METHODS: We analyzed data of 271 women operated because of adnexal masses. All masses were verified by histological examination. Preoperative sonography was performed in all patients and various predictive models includ¬ing IOTA group logistic regression model LR1 (LR1), IOTA simple ultrasound-based rules by IOTA (SR), GI-RADS and risk of malignancy index (RMI3) were used. ROC curves were constructed and respective AUC's with 95% CI's were compared. RESULTS: Of 271 masses 78 proved to be malignant including 6 borderline tumors. LR1 had sensitivity of 91.0%, specificity of 91.2%, AUC = 0.95 (95% CI: 0.92-0.98). Sensitivity for GI-RADS for 271 patients was 88.5% with specificity of 85% and AUC = 0.91 (95% CI: 0.88-0.95). Subjective assessment yielded sensitivity and specificity of 85.9% and 96.9%, respectively with AUC = 0.97 (95% CI: 0.94-0.99). SR were applicable in 236 masses and had sensitivity of 90.6% with specificity of 95.3% and AUC = 0.93 (95% CI 0.89-0.97). RMI3 was calculated only in 104 women who had CA125 available and had sensitivity of 55.3%, specificity of 94% and AUC = 0.85 (95% CI: 0.77-0.93). CONCLUSIONS: Although subjective assessment by the ultrasound expert remains the best current method of adnexal tumors preoperative discrimination, the simplicity and high predictive value favor the IOTA SR method, and when not applicable, the IOTA LR1 or GI-RADS models to be primarily and effectively used.

[What do we konw about the Zika virus?]

Zika virus (HIV) was first identified in 1947 and upto 2007 the infections in humans have been reported sporadically. Currently, the World Health Organization warns that the rapid spread of the virus Zika in both Americas and an increase in the number of children born with microcephaly in these regions begins to be a serious epidemiological problem. Known ways of spreading this RNA virus of the Flaviviridae family is: with blood, sexual, vertical and even breast feeding. Currently used diagnostic tests are not entirely perfect, as they can detect infections by other viruses in this group but they are available in Poland. The treatment of clinical sings of ZIKV as unusual, flu-like symptoms is symptomatic. Unfortunately, the most dangerous consequences of infection tend to be: a statement of microcephaly in children of mothers bitten by the mosquitoes in the areas of epidemy of Zika and symptoms of Guillain-Barre syndrome. For this reason, doctors of all specialties should have current knowledge of the diagnosis, prevention, treatment and consequences of this infection.

[Skret sieci wiekszej jako przyczyna dolegliwosci bólowych miednicy mniejszej u pacjentki po cieciu cesarskim - trudnosci diagnostyczne]. / Skret sieci wiekszej jako przyczyna dolegliwosci bólowych miednicy mniejszej u pacjentki po cieciu cesarskim - trudnosci diagnostyczne

Spontaneous torsion of the greater omentum is a rare cause of the acute abdomen or pain complaints of the pelvis minor. It can imitate an severe inflammatory conditions rolling in the peritoneal cavity like e.g. appendicitis. At the work a case of omental torsion at the patient after the caesarean section with pain problems in the right iliac fossa was presented. Problems of the preoperative diagnostic testing and a possible differential diagnosis were discussed.

[What do we konw about the Zika virus?]

Zika virus (HIV) was first identified in 1947 and upto 2007 the infections in humans have been reported sporadically. Currently, the World Health Organization warns that the rapid spread of the virus Zika in both Americas and an increase in the number of children born with microcephaly in these regions begins to be a serious epidemiological problem. Known ways of spreading this RNA virus of the Flaviviridae family is: with blood, sexual, vertical and even breast feeding. Currently used diagnostic tests are not entirely perfect, as they can detect infections by other viruses in this group but they are available in Poland. The treatment of clinical sings of ZIKV as unusual, flu-like symptoms is symptomatic. Unfortunately, the most dangerous consequences of infection tend to be: a statement of microcephaly in children of mothers bitten by the mosquitoes in the areas of epidemy of Zika and symptoms of Guillain-Barre syndrome. For this reason, doctors of all specialties should have current knowledge of the diagnosis, prevention, treatment and consequences of this infection.

[Assessment of the angle between puborectal muscles in women with and without stress urinary incontinence in three-dimensional sonograph]. / Ocena kata miedzy miesniami lonowo-odbytniczymi u kobiet z nietrzymaniem moczu i bez niego z zastosowaniem trójwymiarowej ultrasonografii.

UNLABELLED: Contemporary care of the woman, especially in the postmenopausal period is based not only on gynaecological periodic inspections, but also on the routine evaluation of the pelvis minorwith the ultrasound examination. Based on this examination we can manytimes initially diversify causes of wrong manifestations, so like, e.g., urinary incontinence, of social pathologies coming into existence in the result rolling within the pelvis minor. Urinary incontinence is a complaint which is changing the quality of life. Three-dimensional sonography (3D USG) supplies us more information than traditional two-dimensional sonography. It let us to make dynamic representation of examining structures and let us to observe them in any angle we need. The best way for sonographic examination of lower pelvis minor is translabial sonography, because it doesn't change mutual relationship of any parts in lower pelvic area, just like transrectal ortransvaginal probes can make. For good treatment of symptoms of urinary incontinence we have to perform not only functional examination of lower urinary tract, but also make very accurate rate of the static of female genital organs and pelvic floor. BACKGROUND: The aim of study was to rate the angle between both puborectal muscles measurements using translabial three-dimensional sonography in women with stress urinary incontinence without descension of the female genital tract. MATERIAL AND METHODS: Studied group included 100 patients who were examined with GE Kretz Voluson 730 (GE, Austria) scaner equipped 6-9 MHztranslabial probe. First group with stress urinary incontinence comprised 50 women in the mean age 56.22 (+/- 10.43) years old and the second without symptoms--50 women in the mean age 49.0 (+/- 13.22) years old. All cases of urinary stress incontinence in first group was confirm with urodynamic examination. Women in both groups were in similar body mass index, means (+/-SD): 26.88 (+/- 2.02) and 26.20 (+/- 4.14), respectively. Menopausal status in both groups was not statistically significant and aggregate 7.21 (+/- 8.71) in group of women with stress urinary incontinence and 4.70 (+/- 6.32) in group of women without symptoms. Means (+/- SD) quantity of deliveries was significantly higher in group of women with stress urinary incontinence than in control group and amount to 2.40 (+/- 1.03) and 1.56 (+/- 1.34), respectively. In all cases 3D USG coronal view of pelvic diaphragm was obtained and the angle between both puborectal muscles were measured. All women had about 200 ml urine in the bladder. RESULTS: Means (+/-SD) of this angle in these groups were 65.48 +/- 9.22 and 58.64 +/- 9.17 degrees, respectively. The differences between both groups in all measurements were statistically significant (p<0.0015). CONCLUSION: Stated during translabial three-dimensional ultrasound examination considerably different values of the angle between puborectal muscles at women with and without the urinary incontinence can be more helpful in a accurate diagnosing of the type of the urinary incontinence.

[Ultrasonography in the diagnostics of reasons for the urinary incontinence at the postmenopausal woman. Part II--Three-dimensional ultrasonography]. / Ultrasonografia w diagnostyce przyczyn nietrzymania moczu u kobiet po menopauzie. Czesc II--Ultrasonografia trójwymiarowa.

In this article a new abilities of lower urinary tract diagnosis in three-dimensional sonography were shown. The examination's components, which allow us to estimate anatomical changes in patients with urinary incontinence were described.

[Clitoromegaly--treatment with the harmonic knife (case description)]. / Przerost lechtaczki--leczenie z zastosowaniem noza harmonicznego (opis przypadku).

Clitoromegaly, state when clitoris is non-physiologically large, most frequently occurs among patients with endocrine disorders (adrenal-genital syndrome, hormonally active tumors producing androgens, the use of anabolic steroids) or genetic. Less often the clitoromegaly is idiopathic of unknown etiology. There are no fixed standards for the size of organ, but it is assumed that not being in erect clitoris due to sexual arousal has a diameter of no more than 1/2 cm. To assess the size and shape of the clitoris can be used five Prader scale. However, it is most commonly used to assess the genitals of intersex. To the Clinic of Gynecology Oncology and Gynecology reported a 33 year old female patient because of escalating discomfort in sexual life. Patient associated her discomfort with her overly enlarged and painful clitoris preventing its proper coexistence. Gynecological survey found the correct size uterus and appendages. Vestibule of the vagina and the vagina of normal length and width. Larger and smaller labia developed properly. Clitoris increased to approximately 4x2 cm, not swollen, moving, with a uniform consistency. Except clitoromegaly in initial examination no abnormalities were found. Prior to surgery the patient has identified karyotype (46 XX) and has made designation of the levels of sex hormones and sonographic examination. In conducting these studies there was no answer found for the reason of clitoromegaly, there was the idiopathic overgrowth stated. Because of the pain during cohabitation associated with clitoromegaly, the patient was classified for reducing operation of this organ. For fear of the possibility of organ dysfunction, excessive bleeding and the appearance of postoperative adhesions abandoned classical surgical technique. It was decided to use in this operation, the harmonic knife. The use of harmonic knife allows avoiding introperative bleeding and precise, a partial reduction of the clitoris to the considered correct size without damaging of the organ structures. A month after surgery, the patient started having satisfying sex without feeling any pain and preserving proper function of the clitoris.

The influence of age and gender on antioxidant enzyme activities in humans and laboratory animals.

Antioxidative/oxidative balance is one of the important factors for homeostasis. Antioxidative systems which protect from peroxidative damage are supposed to be under the influence of steroid hormones. The implications of this influence are age and gender as well as tissue dependent alterations in antioxidative enzyme activities. Apart from hormonal influence, antioxidative enzymes require the presence of microelements in their active centers as well as concerted action of non enzymatic antioxidants which support enzymes in their scavenging action. The aim of this review is to analyze and compare existing knowledge about the changes in activity of antioxidant enzymes in human and animal females and males of different age. Evidence as regards participation of oxidative stress in senescence are specific diseases which, to some extent, are gender dependent and appear more frequently in males or females. Several experiments in laboratory animals revealed that changes in enzyme activities are reflected in histopathological pictures of cells. The alterations observed during perimenopausal period provide with additional evidence of the participation of steroid hormones in the regulation of antioxidative system activity. Moreover, estrogens themselves exhibit antioxidative activity which is receptor independent. In conclusion, apart from genetic-related influences, also diet and style of life may have an impact on the antioxidative system which requires appropriate supplementation in microelements and vitamins for its effective function of scavenging excess of free radicals.

[Urgent urinary incontinence--preliminary diagnostics and pharmacological treatment]. / Naglace nietrzymanie moczu--wstepna diagnostyka i leczenie farmakologiczne.

In this paper authors describe classification, preliminary diagnosis of urinary incontinence. They also show ways of pharmacological therapy and kinds of available medicines, which are administer in treatment of women with urinary incontinence symptoms of neurologic descent and overactive bladder.