Insulin resistance as estimated by the homeostatic method at diagnosis of gestational diabetes: estimation of disease severity and therapeutic needs in a population-based study.

BACKGROUND: Chronic insulin resistance, exacerbated in the course of pregnancy, is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). We hypothesise that the degree of insulin resistance, assessed at diagnosis of GDM, is a parameter of its pathophysiologic heterogeneity and/or severity. Thus, it offers potential to open new avenues for the personalization of therapy in affected women. METHODS: 1254 Polish Caucasian women with GDM were recruited into the study. The following parameters were assessed in the course of the study: body mass index (BMI), parity, weight gain during pregnancy, glycated haemoglobin, glucose level during an oral glucose tolerance test (OGTT), insulin, insulin resistance and insulin secretion. The severity of GDM was assessed based on insulin use and daily insulin dose during gestation. In order to evaluate insulin secretion and insulin resistance the homeostatic method was used (HOMA-B and HOMA-IR, respectively). We compared all the metabolic parameters and methods of treatment of GDM in women subdivided by quartiles of insulin resistance. RESULTS: The HOMA-IR in the whole population ranged from 0.34 to 20.39. The BMI, fasting insulin, fasting glucose and insulin dose per day increased along with increasing quartiles (HOMA-IR > 1.29). We observed a decrease of HOMA-B in the third quartile (1.92-2.89) compared with the first quartile (0.34-1.29). Insulin treatment was associated with HOMA-IR (<1.29 vs. >2.89), OR: 3.37, fasting glucose (≤6.11 vs. >6.11 mmol/dl), OR: 2.61, age (≤30 vs. >30 y. o.), OR: 1.54, and BMI (<25 vs. ≥25 kg/m2), OR: 1.45. Maximum insulin dose was associated with HOMA-IR, OR: 2.00, after adjustment for family history of diabetes, and 2-h OGTT glucose. CONCLUSION: Insulin resistance assessed by the HOMA index at diagnosis is associated with the severity and pathophysiological heterogeneity of GDM. A HOMA-IR >1.29 points to the major role of insulin resistance, indicating the need for a treatment aimed at improving tissue sensitivity to insulin. A HOMA-IR 1.29-2.89 suggests reduced insulin secretion, which is an indication for the introduction of insulin therapy. A HOMA-IR >2.89 indicates insufficient compensation for insulin resistance, which suggests the need for a treatment aimed at improving susceptibility of tissues to insulin combined with insulin therapy.

The immunohistochemical analysis of RCAS1, HLA-G, and B7H4-positive macrophages in partial and complete hydatidiform mole in both applied therapeutic surgery and surgery followed by chemotherapy.

INTRODUCTION: The suppressive microenvironment developing around the implantating ovum in normal pregnant women may correlate with the development in cancer patients of a suppressive microenvironment of neoplasmatic cells derived from trophoblasts, such as occurs in molar lesions. Macrophages are suitable candidates for mediating not only the balance of the maternal defensive immune responses to external antigens, but also a tolerance to tumor cells. The aim of our study has been to gain information about the expression of RCAS1, B7H4, and HLA-G within the macrophages present in the microenvironment of the molar lesion. METHODS: We analyzed the immunoreactivity of such antigens as B7H4, RCAS1, and HLA-G on the macrophages present in tissue samples derived from patients on whom curettage was performed after a diagnosis of molar pregnancy. These patients were then divided into two subgroups according to whether or not they required chemotherapy after the surgical procedure. RESULTS: We observed a statistically significant increase in the RCAS1-positive macrophage infiltration within the microenvironment of the molar lesions in patients with partial hydatidiform mole in comparison with those patients who exhibited complete hydatidiform mole. There were no such differences, however, in the infiltration of HLA-G- and B7H4-positive macrophages between the two groups of patients. Additionally, we showed that RCAS1- and HLA-G-positive macrophages are more distinct in those cases of complete molar pregnancy where chemotherapy was necessary after surgical treatment while no such differences with respect to B7H4-positive macrophages were observed. CONCLUSION: The immune-suppressive endometrial microenvironment represented by suppressive macrophages may have an influence on the clinical course of hydatidiform mole.

Bilateral aggressive malignant granulosa cell tumour with essentially different immunophenotypes in primary and metastatic lesions comprising predominantly sarcomatoid and fibrothecomatous patterns - looking for prognostic markers: a case report.

We present an unusual case of a young woman with rare bilateral, very aggressive ovarian granulosa cell tumour (GCT), comprised of granulosa, sarcomatoid and fibrothecomatous fields with significantly different immunostaining of primary and metastatic tumours showing stronger WT1, Bcl2, fascin and EGFR expression in metastases. Despite radical surgery and chemotherapy the tumour recurred rapidly and the patient died 16 months later. Such results clearly demonstrate the usefulness of immunostaining for the above markers as prognostic/predictive factors and the need for careful assessment of the immunoprofile of both primary and metastatic tumours, which can be useful for therapy and follow-up planning in GCT cases.

Multiple skin metastases to vulva from carcinoma of the cervical stump.

UNLABELLED: Metastases to the skin occur rarely in the cervical carcinoma, even in terminal stage of the disease. The frequency of metastasis is estimated from 0.01% to 2%. The presence of metastasis suggests generalized dissemination of the disease and reflects a rapidly progressive process that appear in the final stage of the disease. CASE: We present a case of skin metastases in patients with squamous cell carcinoma of the cervical stump after the previous supracervical hysterectomy for benign disease of the uterus. The extensive skin changes on vulva and perineum occurred after radical trachelectomy and external radiation therapy. Patient received HDR brachytherapy for recurrent lesions, but the effect of treatment was poor and she died of progressive disease. CONCLUSION: As far as we know this is the first case report of squamous cell carcinoma in the cervical stump metastasizing to skin. Palliative brachytherapy has a limited role in controlling symptoms. Skin metastases indicate an aggressive and progressive process.

[Tobacco smoking and HPV infection]. / Palenie tytoniu a zakazenie HPV.

Cervical cancer is one of the most common neoplasm in women in Poland. Etiopathogenesis of this neoplasm is mainly related to HPV infections. The persistent HPV infection is an important but not the only one sufficient factor in neoplastic transformation. The additional factors include tobacco smoking. Nowadays, prophylactic programs are conducted as cytologic screening, sexual education as well as decreased tobacco smoking. The aim of the present paper was the evaluation of correlation of number of smoked cigarettes and duration of smoking habit with histopathological changes uterine cervix. From 143 women operated due to gynecological problems there were selected 21 cases (medium age 44 years) with cervical cancer. In 5 women preoperative brachytherapy was done. E used immunohistochemical methods (with LSAB system) for evaluation of presence of L1 protein of HPV. The correlation between the stage of neoplasm and presence of viral protein was impossible as clinical records missed the information on tobacco smoking. In conclusion we would like to stress that evaluation of the possible role of proved and possible neoplastic factors needs a preparation of proper databases.

[The impact of illness on the emotional life of women united in "the amazons" clubs after breast cancer surgery]. / Wplyw choroby na zycie emocjonalne kobiet po operacji raka piersi zrzeszonych w klubach "amazonka".

INTRODUCTION: Breast cancer is the most frequent malignant tumor diagnosed among women in Poland and in the world. Among the consequences of the disease are disorders in the woman's physical, mental, and social sphere of functioning. MATERIAL AND METHODS: We enrolled 102 women aged 29-56 years from three Amazons Clubs (mastectomy support groups) in Bydgoszcz, Koszalin, and Bialogard. A questionnaire was prepared addressing demographics and the emotional state of women. RESULTS: Most of the women participating in our study completed university education, had a white-collar job, and resided in a city. The disease completely changed the life of 24 women (23%) and some aspects of life of 59 women (58%). The disease inflicted changes in the life of 62 (61%) women, with 32 women (31%) continuously worrying about their future. Sadness and fear were frequent reactions to the diagnosis in 42 women (45%) but only 7 women (7%) felt depressed or indifferent to the diagnosis. 42 women (46%) presented a very optimistic attitude to the disease and 36 women (39%) were determined to combat the disease. The disease had no influence on the life of 19 women (19%). The most frequent state after treatment was impatience, feeling of kindness, and irritability (32%). CONCLUSIONS: The disease had a negative influence on the emotional state of women after mastectomy. An optimistic attitude was observed in almost half of the women. Married women and women living in complete families were quicker in accepting changes which occurred in their life.

[Current views on treatment of the ovarian granulosa-cell tumor]. / Aktualne poglady dotyczace leczenia chorych z bloniakiem ziarnistym jajnika.

The granulosa-cell tumor (folliculoma) is a rare type of ovarian neoplasm, accounting for 5% of all cases. It is the most common type of sex cord-stromal tumors, diagnosed in 70% of cases. The granulosa-cell tumor is a hormone active one, originating from granulosa cells which produce estradiol. Overproduction of estradiol is helpful in the diagnosis of the tumor because of its numerous symptoms. There are two types of folliculoma: juvenile (5%) and adult (95%). The juvenile type is mostly recognized (90%) in FIGO I stage and has a better prognosis. Operation is often a sufficient way of treatment in this group. Tumors in higher stages are more aggressive and must be treated further. The adult folliculoma is more aggressive in its nature. Patients with the disease diagnosed in higher stages must be treated by adjuvant radiotherapy or chemotherapy. Recurrence appears often many years after the treatment and has high mortality. Many old (platinum) and new (taxans) agents are active when used in treatment of this type of tumor. Randomized study must be made to establish standard therapy of granulosa-cell tumor. Currently, the most frequent way of treatment is chemotherapy with BEP (Blemycyna, Etopozyd, Cisplatyna).

[Pelvic actynomycosis as the result of a long standing use of an intrauterine device. Case report]. / Promienica miednicy mniejszej zwiazana z dlugoletnim stosowaniem wkladki wewnatrzmacicznej. Opis przypadku.

The aim of the study was to introduce a case of a 49-year-old woman who had been using an intrauterine contraceptive device for 20 years. The pelvic actynomycosis in her case led to sepsis and consequently to her death. Colonisation Actinomyces israeli in women using IUD may amount up to even 20%, however infections occur very seldom. Following the recommended time of IUD usage, cytology and early start of antibiotic therapy may protect patients against the Actinomyces infection.

[Problems in diagnosing breast cancer in women younger than 25 years old]. / Trudnosci diagnostyczne w rozpoznawaniu raka piersi u kobiet ponizej 25 roku zycia.

OBJECTIVES: There are several challenges in the diagnosis of breast cancer in young women. Special consideration must be given to the woman's fertility and body image issues, but the difficulty in distinguishing benign from malignant lesions in this group of patients still exists. The aim of our study was to show five cases of breast cancer in young women. MATERIALS AND METHODS: Based on 5 cases of breast cancer in women younger than 25, several methods used in diagnosis in this group of patients were discussed. The role of USG and BAC was analyzed. Moreover, a significant role of RM and PET was emphasized. RESULTS: Diagnosing and treatment of young patients with breast cancer should be performed in specialized oncological centers experienced in dealing with breast cancer in very young women. CONCLUSIONS: 1. Because of the possibility of breast cancer in women under 25 years old, each case of breast tumor should be precisely diagnosed, especially by ultrasonography and biopsy (BAC) 2. Each case suspected of breast cancer in young women should be diagnosed in highly equipped and specialized medical center.

[The value of FDG PET/CT, ultrasound and CT in diagnosing recurrent ovarian carcinoma]. / Ocena czulosci, swoistosci i dokladnosci diagnostycznej pozytonowej tomografii emisyjnej, ultrasonografii i tomografii komputerowej w diagnostyce nawrotu choroby u pacjentek leczonych z powodu raka jajnika.

UNLABELLED: The diagnosis of recurrent ovarian cancer can be complicated and variable sensitivities, specificities and accuracies have been reported for integrated positron emission tomography and computed tomography (PET/CT). The aim of the study was to evaluate the sensitivity, specificity and accuracy of PET/CT, ultrasound and CT in the diagnosing recurrent ovarian cancer. MATERIALS AND METHODS: 27 women in the follow-up after cytoreductive surgery and chemotherapy of ovarian cancer, underwent ultrasound, CT and PET/CT to assess for possible recurrence. RESULTS: Recurrence of ovarian cancer was detected in 22 patients (laparotomy or cytology of ascites or pleural effusion). 5 disease-free patients were followed-up for 8-14 months. FDG-PET, ultrasound and CT had sensitivities of 81,82%, 45,45%, 55.56%, specificities of 60%, 60%, 60% and accuracies 77,78%, 48,15%, 52,17% respectively. CONCLUSIONS: 1. FDG PET/CT is a useful technique to in diagnosing recurrent ovarian cancer. 2. PET/CT depicts/detects recurrent ovarian cancer with higher diagnostic accuracy comparing to the standard imaging and provides the chance to detect disease at an earlier stage during follow-up.

[Role of Ca-125 in the differential diagnosis of adnexal mass in breast cancer patients]. / Rola markera Ca-125 w monitorowaniu chorych z rozpoznanym guzem przydatkow po przebytym leczeniu raka piersi.

OBJECTIVES: Serum CA-125 is of value in differential diagnosis of benign and malignant adnexal masses, especially in postmenopausal women. In ovarian cancer preoperative CA-125 levels are related to tumor stage, histologic grade, but are not an independent prognostic factor. DESIGN: The aim of our study was to determine CA-125 serum level in women with ovarian tumor treated previously because of breast cancer. MATERIALS AND METHODS: Due to our research, we examined 51 women operated on for adnexal masses in the Department of Oncological Gynaecology in Bydgoszcz, 1996 - 2002. All those patients were treated because of breast cancer previously. RESULTS: In 19 women (37,3%) benign ovarian tumors were found, in 4 cases (7,8) - primary ovarian cancer whereas in 28 patients (54,9%) breast cancer metastases were detected. Based on CA-125 levels before surgery, correlation between CA-125 concentration and malignant histologic type was observed. CONCLUSIONS: 1. Higher CA-125 serum levels were found in a group of patients with metastatic adnexal masses compared to primary ovarian cancer. 2. In a group of women with breast cancer and ovarian tumor, metastatic adnexal masses were observed in more than 50% of cases.

[Breast conserving treatment in patients with early detection of breast cancer]. / Leczenie oszczedzajace chorych z wczesnymi postaciami raka piersi z uwzglednieniem zmian wykrytych w badaniach profilaktycznych.

OBJECTIVES: Kujawsko-pomorskie province is a region with high morbidity and death-rate from breast cancer. One method of detected less advanced forms of breast cancer and increased number of patients with BCT having prophylactic medical examination. DESIGN: The aim of the study was the treatment evaluation of patients with noninvasive and invasive cancer treated with BCT, screening-detected and non-screening detected. MATERIALS AND METHODS: Prophylactic mammography for breast cancer was taken in three medical centers. First one so called "mobile" was localized in the health service center, second one in the bus with the mammography reaching distant areas and third one was performing examinations locally. There were 63401 people examined for breast cancer (age 35 -79), detected 288 breast cancers (0.54% of examined population). 260 of them were operated on. 1149 breast cancers were detected in non-screening group. The number of detected noninvasive cancers, their sizes and methods of treatment were analysed. RESULTS: Twelve of 260 (4,62%) cancers detected in screening patients were carcinoma noninvasive and 34 invasive cancers treated with BCT. In non-screening patients 20 carcinoma noninvasive and 104 invasive cancers were found and treated with BCT The number of patients with noninvasive and invasive cancers treated with BCT in prophylactic group is statistically higher. Sizes and clinical stages of malignant tumours detected in both groups were not different CONCLUSIONS: 1. Prophylactic breast cancer examinations increase the number of noninvasive cancers. 2. Breast cancer prophylactic examinations increase the number of patients treated with BCT.

[Estimated results of prophylactic physical examinations detecting cervical cancer in Center of Oncology in Bydgoszcz in years 2001-2003]. / Ocena wyników badan profilaktycznych w kierunku raka szyjki macicy w Centrum Onkologii w Bydgoszczy w latach 2001-2003.

OBJECTIVES: Kujawsko-pomorskie province is a region with high morbidity and death-rate from uterine cervix cancer. One of the methods of improve this situation is to perform prophylactic physical examinations to find the least advanced stages as possible. DESIGN: The aim of the study was to estimate the results of prophylactic physical examinations for cervical cancer that took place in Center of Oncology in Bydgoszcz between 2001-2003. MATERIALS AND METHODS: Pap Smear with prophylactic examination for breast cancer were taken in 3 medical centers. First on, according to called "mobile", was localized in the health service center, second one in the bus with the mammography, reaching distant areas and third one was performing examinations locally. Cytologic examinations were rated Bethesda system and according to Papanicolau. There were 28372 women examined (age 30-60). 8996 medical examinations were performed by "mobile" device, 6726 in the second center and 12650 locally. 8237 examinations were performed in 2001 year, 9444 in 2002, and 10691 in 2003. RESULTS: Among all the Pap Smears the results were as following: I group--14267, II group--14017, III group--73, IV group--13, V group--2.43 (0.15%)intraepithelial dysplasia was found in them CIN I--23 (0.08%), CIN II--10 (0.035%), CIN III--10 (0.35%).21 (0.1%) cervical cancers were detected, 12 of them were praeinvasive cancers. 0.31% of the all Pap Smears were abnormal. CONCLUSIONS: (1) The number of abnormal Pap Smears and severe dysplastic lesions proves the usefulness of the prophylactic physical examinations. (2) The above programme shows the that the access to oncological care for women living in rural areas, has a social aspect and should have affect the health awareness of the potential patients.

[Tissue-type plasminogen activator (T-PA) and plasminogen activator inhibitor (PAI-1) in human follicular fluid during gonadotropin-induced ovulation]. / Stezenie tkankowego aktywatora plazminogenu i inhibitora aktywatorów plazminogenu typu 1 w plynie pecherzykowym u pacjentek leczonych metodami wspomaganego rozrodu.

OBJECTIVES: Plasminogen activators and their inhibitors have been implicated in the process of fibrinolysis, tissue remodeling, and ovulation. To evaluate the role of t-PA and PAI-1 in human ovulation, we obtained follicular fluid (FF) from preovulatory follicles of patients undergoing IVF-ET. Concentrations tPA and PAI-1 were analyzed in relation to oocyte maturation. Levels of tPA and PAI-1 obtained after COH were compared to the tPA and PAI-1 concentrations in the follicular fluid of healthy, fertile women. MATERIALS AND METHODS: FF was collected from 66 infertile patients undergoing ovulation induction using either short or long protocol. FF was obtained 36 hours after hCG (Pregnyl) administration. The control group consisted of 16 fertile women with unstimulated cycles. Concentrations of t-PA Ag and PAI-1 Ag were measured using Elisa kits (Bioopol). RESULTS: The average follicular fluid tPA concentration of patients undergoing IVF-ET treatment was significantly lower (0.039 vs 0.117 ng/mg protein; p < 0.0005), whereas PAI-1 significantly higher (3.261 vs 0.135 ng/mg; p < 0.0001) compared to the control group. Concentrations of tissue-type plasminogen activator in FF of patients with 5 or more mature oocyte were significantly lower (0.017 vs 0.056 ng/mg) and levels of PAI-1 higher (3.49 vs 2.9 ng/mg) in comparison to cases involving < 5 oocytes. CONCLUSIONS: 1. Concentration of tPA in the follicular fluid is significantly lower whereas PAI-1 level significantly higher in patients undergoing COH. 2. Follicular fluid tPA and PAI-1 concentrations may be a crucial factors reflecting oocyte maturity.