Effect of obesity and hypothyroidism on hepcidin concentration in pregnancy - a pilot study using maternal and umbilical cord blood at delivery day.

Hepcidin is a primary regulator of iron metabolism in the human body. By promoting ferroportin degradation, hepcidin reduces intestinal iron absorption and its release from intracellular stores. In the course of pregnancy, gradually declining hepcidin concentrations encourage placental iron transfer, thereby providing the appropriate amount of iron for fetal development. Hence, we aimed to investigate changes in maternal and cord blood hepcidin and iron metabolism parameters in normal-weight (n=17) and obese (n=17) gestating women, as well as gravid women with a history of hypothyroidism following the restoration of euthyroidism (n=17). All blood samples were taken on the day of delivery, and ELISA kits were used for measurements. A significant increase in maternal hepcidin concentration was observed in obese pregnant women, compared to normal-weight controls (29.53±4.20 ng/mL vs. 25.69±5.70 ng/mL; P<0.05). However, only a slight, insignificant tendency for lower hepcidin was noted in the hypothyroid group, compared to the healthy controls (23.10±6.00 ng/mL vs. 25.69±5.70 ng/mL; P=NS). Moreover, decreased maternal free triiodothyronine, triiodothyronine, free thyroxine, and ferritin levels were revealed in the hypothyroid group, compared to the normal-weight individuals (P<0.05). Furthermore, positive correlations between maternal hepcidin and the majority of maternal thyroid hormones were found, with a most potent relation to FT3 (r=0.40; P<0.01). Interestingly, no alterations of thyroid hormones and iron metabolism parameters were noticed in cord blood in any of the subgroups. In summary, pre-pregnancy obesity is associated with elevated maternal hepcidin, albeit no signs of lowered cord blood iron status were shown. Medical history of hypothyroidism following the restoration of euthyroidism does not substantially influence maternal nor cord blood hepcidin concentration, as well as fetal iron homeostasis, even though free thyroid hormone levels correlate with maternal hepcidin.

The knowledge of risk factors and prevention of breast cancer in Polish women.

PURPOSE: Currently, breast cancer is one of the most common malignancies among women and it constitutes a significant medical, economic, and social problem. MATERIALS AND METHODS: The study was conducted in a group of 600 healthy women (aged 18 to 88 years) between September 2011 and February 2015 living in the region of Wielkopolska (Poland) in a private gynecological practice. A survey questionnaire designed specifically for purposes of the study was a tool used to conduct the study. RESULTS: With regards to risk factors for breast cancer: 93% - familial history of breast cancer, 46% - use of hormone treatment, and 40.16% - taking contraceptive pills. CONCLUSIONS: A significant component of breast cancer prevention should be providing information regarding prevention tests and increasing accessibility to medical services.

Association between polymorphisms of the DNA repair gene RAD51 and ovarian cancer.

Genetic polymorphisms in the RAD51 gene may be associated with increased cancer risk. The aim of the present study was to evaluate associations between the risk of ovarian cancer and 135G>C (rs1801320) and 172G>T (rs1801321) polymorphisms in the RAD51 gene. We analysed the distribution of genotypes and frequency of alleles of the RAD51 polymorphisms in 210 women with ovarian cancer and 210 healthy controls. Both polymorphisms were genotyped by restriction fragment length polymorphism-polymerase chain reaction (PCR-RFLP). In the present study only 135G>C polymorphism of the RAD51 gene was associated with ovarian cancer risk. The distribution of genotypes for 135G>C in ovarian cancer patients vs. controls was: 20% vs. 30% for G/G, 22% vs. 47% for G/C, and 58% vs. 23% for C/C genotype, respectively. We found evidence of an increased ovarian cancer risk in C/C homozygotes but not in heterozygotes. The 135C allele of RAD51 increased cancer risk. In the present work we demonstrated a significant positive association between the RAD51 135G>C polymorphism and ovarian carcinoma in Poland. However, this gene requires further understanding of its interaction with other genes involved in tumour development.

Comparison of one-step nucleic acid amplification (OSNA) method and routine histological investigation for intraoperative detection of lymph node metastasis in Polish women with breast cancer.

Sentinel lymph node (SLN) biopsy is a part of the staging procedure in breast cancer patients. Intraoperative molecular analysis for SLN metastases using the one-step nucleic acid amplification (OSNA) method based on reverse-transcription loop-mediated amplification (RT-LAMP) has already been validated in breast cancer. In this study, we compare the intraoperative OSNA method to our routine histological investigation. To evaluate the performance of OSNA in comparison to histology, analysis of 74 SLN from 60 breast cancer patients was conducted with both methods. Of the 22 histologically positive samples, 14 were attributed to macrometastases (++) in the OSNA-CK19 assay and 8 to micrometastases (+). Two samples negative in histopathology were positive in the OSNA method (micrometastases +). Our results show that OSNA is an excellent method for the detection of metastases in lymph nodes and can be applied as an intraoperative diagnostic approach. Intraoperative molecular analysis for SLN metastases using the OSNA method reduces the number of admission days and duration of surgery. To our knowledge this is the first study referring to Polish women.

Efficiency of postoperative pain management after gynecologic oncological surgeries with the use of morphine + acetaminophen + ketoprofen versus morphine + metamizol + ketoprofen.

Surgical treatment used in gynecological oncology involves acute postoperative pain which requires efficient treatment. This study covered a group of 128 patients who were randomly divided into two groups. In the postoperative period patients in group I were administered morphine subcutaneously, acetaminophen intravenously and naproxen per rectum. The pain intensity level was checked by means of the pain intensity numeric rating scale (NRS). In the instances of pain rated at 5 or more, patients were additionally administered ketoprofen intravenously. Patients in group II were administered morphine, naproxen, and metamizole instead of acetaminophen and ketoprofen additionally. In group I after the administration of morphine and acetaminophen 22 patients (34.37%) needed additional doses of ketoprofen. In group II 33 women (51.56%) required ketoprofen after the administration of morphine and metamizole (N1 = 22 vs N2 = 33, p < 0.05). The use of metamizol with morphine (without ketoprofen) gave worse analgesic results than acetaminophen with morphine, but the combination of morphine, acetaminophen and ketoprofen or morphine, metamizol and ketoprofen gave satisfactory analgesic results.

Difficulties in diagnosing and treating phyllodes tumor of the breast--case report.

A phyllodes tumor is a rare breast neoplasm, and in the majority of cases is benign. Its diagnosis is difficult because many characteristics of this neoplasm are also typical for other changes within the breast, especially for fibroadenoma. Palpable examination and imaging diagnostics are obviously very important in the process of establishing a diagnosis. However, histopathological examination is the most important one. Currently, the treatment process boils down to surgical removal of this tumor. It is essential to keep a sufficient margin of healthy tissues, which reduces the risk of local recurrence. In the described case the patient was admitted to hospital due to single tumors in both breasts. Mammosonography allowed us to pre-exclude changes of a malignant character. The right breast tumor was removed during mammotomy. Histopathological examination showed a phyllodes tumor, which is why the mass on the other side was removed surgically. In the period of an 18-month-observation no local recurrence was revealed.

Evaluation of preoperative diagnosis with results of histopathological examinations of ovarian tumors in women of reproductive age.

Ovarian tumors are the most frequent lesions encountered by gynecologists. Ovarian carcinoma most often develops asymptomatically and until now no sufficient screening diagnostic methods have been developed, which is why various diagnostic methods are being tried concurrently to increase diagnostic sensitivity. The aim of this paper was to evaluate the compliance of the preoperative diagnoses with the results of histopathological examinations of ovarian tumors and to determine the usefulness of simultaneous application of gynecological, ultrasonographic, and Doppler examinations together with determination of CA-125 antigen in the diagnostic process of ovarian tumors. The study comprised a group of 250 women in reproductive age who were operated on for tumors of the ovary. Results of histopathological examinations were compared with the preoperative diagnosis based on the above-mentioned examinations and prognostic indicators: sensitivity, specificity, negative and positive prediction value as well as accuracy were determined. The results showed that combining the four diagnostic methods is a useful research panel in the preoperative diagnostic process of ovarian tumors and makes selecting the appropriate procedure and surgical treatment viable.

Clinical usefulness of evaluation of quality parameters of blood flow: pulsation index and resistance index in the uterine arteries in the initial differential diagnostics of pathology within the endometrium.

Detection of neoplastic changes in the pelvis minor in early stages is a critical prognostic factor for patients suffering from uterine carcinoma. Due to the problem presented, the evaluation of clinical usefulness of ultrasonographic examination including color Doppler in the process of detecting pathologic changes within the endometrium was the main aim of this paper. Quality parameters of blood flow in the uterine arteries, such as the pulsation index (PI) and resistance index (RI) were evaluated. A group of 100 female patients diagnosed with and treated for abnormal genital bleeding in the Clinic of Gynecological Surgery, Gynecological-Obstetrics Clinical Hospital, Poznan University of Medical Sciences from December 2005 until January 2007 constituted the subjects for this work. Analyzing patients with pathology of the endometrium, we obtained lower values of quality parameters of blood flow in the terine arteries in comparison to the control group. Reduction of the resistance and pulsation indexes of the uterine arteries may be useful elements in the process of differentiating pathological changes within the endometrium.

Difficulties in the diagnosis of ovarian carcinoma: case report of squamous cell ovarian carcinoma in a 26-year-old woman.

A 26-year-old woman who was admitted to the Gynecology Department with abdominal pain was later diagnosed with a multi-chamber tumor in the left ovary. Neoplastic markers were within normal limits. It was proposed that the patient should be operated on in order to remove the tumor, and a left salpingo-oophorectomy was performed. During the intraoperative histopathological examination, the tumor was described as being benign. However, in the final histopathological examination, a malignant neoplasm, a squamous cell carcinoma (G-2) of the ovary (pT1a), was found. It was decided that a hysterectomy and a right salpingo-oophorectomy should be performed. No other neoplastic foci were found in the postoperational material. The patient is currently undergoing periodic control examinations.

Vaginal hysterectomy aided with surgery by the abdominal approach as a method of hysterectomy with salpingo-oophorectomy due to endometrial carcinoma in a woman with morbid obesity. Case report.

The most important risk factors of endometrial carcinoma are fat consumption, obesity (BMI > or = 25 kg/m2) and use of unbalanced estrogen therapy. Other factors include lack of physical activity, a high-calorie diet, arterial blood pressure above 140/90 mmHg and high concentrations of glucose in the blood. The basic treatment in cases of endometrial carcinoma is surgery including hysterectomy with salpingo-oophorectomy and complete interoperational assessment of the development degree of the disease. Basic operational treatment is difficult as far as obese women are concerned (BMI > or = 50 kg/m2). This is linked with poor access to operated tissues and limited visibility, mainly in the area of the bottom of the pelvis minor. Our 69-year-old patient was admitted to and operated on at the Gynecological Department due to endometrial carcinoma. Because of her giant obesity, BMI - 51.30 kg/m2, surgery by the abdominal approach was very difficult to perform, so vaginal hysterectomy with salpingo-oophorectomy was carried out.

Analysis of odds ratio of increased relative risk of developing breast cancer in different groups of women.

Taking into account the large number and variety of factors of breast cancer there is constant need and necessity to monitor the risk of developing the disease. It is important to take preventive actions--health education concerning lifestyle and possible ways to modify unhealthy aspects. Quantitive assessment of risk of developing invasive breast carcinoma can be performed using the Gail model (GM). This method is designed to estimate relative and cumulative risk during the entire lifetime or at a certain age of a patient, considering risk factors. It is possible to identify women with increased risk of breast carcinoma and to choose a proper diagnostic path. The purpose of this study was to estimate the relative risk (RR) and to analyze the odds ratio (OR) of increased risk of developing breast cancer. The participants in the study were healthy women with no focal changes in mammary glands and women with diagnosed malignant or benign breast neoplasms. The total number of participants was 555 females aged 35-70 years. The study was carried on in the Great Poland and Lubuskie provinces between 2005 and 2006. High 5-year relative risk of developing breast cancer assessed by the Gail method, proved that this method was a useful tool in confronting reality. In classification of women to a group of increased risk of breast carcinoma, apart from assessment by the Gail method, factors like: BMI, education, medical interventions in puerperium and number of cases of familial invasive cancers should be taken into account.

Women's lifestyle and the risk of breast tumors.

The first behavioral aspect of mankind that has been commonly acknowledged as one of the main reasons for neoplasms is lifestyle. The specified lifestyle determines the exposure to the variety of carcinogens, whose crucial role in carcinogenesis is doubtless. The purpose of this study was to analyze women's lifestyle and its influence on the risk of developing breast cancer and benign tumors. The participants of the study were healthy women with no changes in mammary glands and women with diagnosed breast cancer or benign tumor. The total number of participants was 555 females aged 35-70 years. Every patient voluntarily filled in an anonymous questionnaire consisting of questions about socioeconomic conditions, number of cigarettes/daily, alcohol consumption, and physical activity. Proper education concerning a healthy lifestyle can positively contribute to a reduction in breast cancer. A high value of BMI, especially in the postmenopausal period, is a negative predictive factor increasing the risk of breast cancer. Physical activity decreases the risk of breast cancer. No such relation concerning smoking cigarettes has been proven.

Past obstetric history and risk of malignant breast neoplasms.

Many studies indicate hormonal disorders as a crucial reason for breast pathology. They are also probably responsible for the development of benign neoplasms and play a role in the origin and development of breast carcinoma. Although the mammary gland is under the influence of many steroid and peptide hormones such as thyroid hormones, prolactin, growth hormone, glucocorticosteroids, it is estrogen that plays an important role in the development of breast cancer. The purpose of the study was to analyze the obstetrical past of patients and the potential influence on the risk of developing malignant breast neoplasms. The participants in the study were healthy women with no changes in mammary glands (control group) and women with diagnosed malignant or benign breast neoplasms (study group). The total number of participants was 555 females aged 35-70 years. The study was carried out in the Greater Poland and Lubuskie province between 2005 and 2006. Hormonal disorders in childhood and puberty symptoms of early menarche play a crucial role in increasing the risk of malignant breast neoplasms. In women who experienced one or more miscarriages the risk of malignant breast neoplasms is significantly increased. On the basis of our study we calculated the odds ratio (OR) of malignant breast neoplasms among women who during lactation experienced problems needing medical intervention (OR = 2.25; 95% CI, 1.20-4.19) in comparison to women who experienced no problems).

Efficacy of 12 weeks supplementation of a botanical extract-based weight loss formula on body weight, body composition and blood chemistry in healthy, overweight subjects--a randomised double-blind placebo-controlled clinical trial.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of composite extracts in reducing weight, as the main outcome measure. Secondary measures of the study were body composition change. DESIGN: Randomised, double blind, placebo-controlled clinical trial. SETTING: Tertiary university clinic. SUBJECTS: hundred and five subjects, 5 of them withdrawn consent, 2 drop-outs not related to study preparation. INTERVENTION: two tablet per meal concept supposed to generate a "psychological" therapy-like approach during 12 weeks supported by measured physical activity. The tablets 1 (one hour before meals, comprises extracts of Asparagus, Green tea, Black tea, Guarana, Mate and Kidney beans) and 2 (taken half an hour after meals, comprises extracts of Kidney bean pods, Garcinia cambogia, and Chromium yeast) are taken twice daily with two main meals. RESULTS: A significant change of the Body Composition Improvement Index (BCI) was observed in the active extract group compared to placebo (p = 0.012). Weight, BMI, waist-to-hip ratio was not statistically different between groups. Body fat loss was greater in active group (p = 0.011) compared to placebo. A weight loss parameter corrected for exercise was introduced and found to be higher in active group (p = 0.046) than in placebo, meaning that the formula was more efficacious, due to a concurrently performed exercise program--a recommended strategy for life style modification. CONCLUSIONS: A significant change of the Body Composition Improvement Index and the decrease in body fat was statistically significant in active extract subjects compared to placebo. A change in some outcome measures like: weight, BMI failed to produce significant difference between groups.

Evaluation of soluble tumour necrosis factor alpha receptors p55 and p75 in ovarian cancer patients.

PURPOSE: Evaluation of serum TNFalpha receptor 1 (p55) and 2 (p75) concentrations preoperatively in patients with ovarian masses. METHODS: Estimation by ELISA assay in 51 women with ovarian cancer and 16 healthy controls. Mean values and correlations with CA-125, tumour volume index, morphological score, pathological finding and cytoreduction were estimated. RESULTS: Mean concentrations of p55 and p75 in cancer patients were 2006 +/- 1030 pg/ml and 2849 +/- 1092 pg/ml, respectively, whereby for controls 1323 +/- 291 pg/ml and 2386 +/- 475 pg/ml, respectively. The area under the ROC curve for CA-125, p55 and p75 for cancer (FIGO Stages I-IV) were: 0.85 (95% CI 0.75-0.92), 0.73 (95% CI 0.60-0.83) and 0.65 (95% CI 0.50-0.77), respectively. Serum p55 correlated with morphological ultrasound score and CA-125 but not with FIGO stage, tumour grade or tumour volume index. No correlations of p75 with these parameters were observed. CONCLUSION: Estimation of p55 and p75 provide little information in ovarian cancer patients and have poor detecting power.

Serum tumor necrosis factor alpha receptors p55/p75 ratio and ovarian cancer detection.

OBJECTIVE: Early ovarian cancer detection is still very difficult and patients are mostly in advanced stages, with obvious influence on poor prognosis. METHOD: Fifty-one ovarian cancer patients and 16 healthy controls had the serum concentrations of TNF alpha receptor p55, p75 and CA-125 measured prospectively and preoperatively. RESULT: Mean concentrations of TNF alpha receptor p55, p75 and CA-125 in patients with ovarian cancer were higher than in controls. The ratios of p55 and p75 receptor in ovarian cancer and controls were 0.73+/-0.38 and 0.55+/-0.06 respectively. The areas under ROC curve in detecting malignancy (all FIGO stages) were 0.73, 0.65, 0.88 and 0.85 for p55, p75, p55/p75 ratio and CA-125 respectively. The areas under ROC curve in detecting stage I of ovarian cancer were 0.52, 0.60, 0.84 and 0.66 for p55, p75, p55/p75 ratio and CA-125 respectively. CONCLUSION: Serum TNF alpha p55/p75 ratio showed promising value in ovarian cancer detection.

[Gynecologic endoscopy in the greater region of Poland during 1988-1998]. / Endoskopia ginekologiczna w województwie wielkopolskim w latach 1988-1998.

The aim of the study was to analyze the state and development of the gynaecological endoscopy in the Wielkopolska region in years 1988-1998. The questionnaire included gynaecological and obstetrical departments of 31 hospitals: 1 academic center, 5 former regional hospitals and 25 small hospitals. At the end of 1998 35.5% of departments were equipped with laparoscopes and 9.7% with histeroscopes. There was an increase in the laparoscopic procedures from 151 to 832 estimated in these years, as well as from 181 to 314 hysteroscopies. The detailed analysis of procedures and dynamic of its increase according to the type of hospital is presented. The experience of the staff was also analyzed. We demonstrated the insufficient equipment in the region, in spite of the right tendencies in the spectrum of the endoscopic procedures and the experience of the physicians who perform laparoscopy and hysteroscopy.

[Pathologies observed in barium enema examination in patients with gynecological disorders]. / Zmiany obserwowane we wlewie kontrastowym jelita grubego u pacjentek ze schorzeniami ginekologicznymi.

The aim of our study was to analyse retrospectively 171 patients with gynaecological diseases, who have undergone barium enema examination in Third Teaching Hospital in Poznan between 1992 and 1998. 79 patients were diagnosed with ovarian tumours, in 24 cases their colon was dislocated. Stenosis was detected in 20 women and in five situations inflammatory changes of the colon were present. Malignant infiltration of large intestine was suspected in ten patients. The second group included 24 women diagnosed with tubo-ovarian abscesses and adnexitis. Three of them had dislocated colons. Stenosis of large bowel was detected in 11 patients and inflammatory changes in 8. In the next group of 35 patients' myoma uteri, myometrial endometriosis and carcinoma of colli uteri were detected. Barium enema examination revealed that 10 women had dislocated colons. In the third group stenosis was detected in eight cases, two patients had radiological signs of cancer infiltration and twice inflammatory changes of the large bowel were present. Frequency of radiological changes in barium enema examination was evaluated in the aforementioned groups. Results were compared with group of 33 patients treated for endocrinological disorders, sterility and minor pelvis pain syndrome. Frequency of dislocation of colon was compared with size of changes of ovaries measured during ultrasound examination. Our results showed that barium enema is still an important supplementary examination, which can give a great deal of beneficial information concerning the clinical condition of the patient. This procedure is useful before surgical intervention especially in cases of suspected ovarian cancer. We must underline that the same or similar information can be obtained using other methods without such radiation exposure.

[Comparison of the frequency of selected gynecologic operations conducted as laparotomy and laparoscopy during 1993-1997]. / Porównanie czestosci przeprowadzania wybranych typow operacji ginekologicznych na drodze laparotomii i laparoskopii w latach 1993-1997.

UNLABELLED: The aim of the study was to compare frequency of four gynecological operations: myomectomy, tubal surgery, cystectomy and operative management of ectopic pregnancy, performed by laparotomy or laparoscopy, by the same team of surgeons. In the years 1994-1997 in Division of Reproduction Poznan University Medical School 647 cystectomies, 208 myomectomies, 68 tuboplasties and 50 surgical treatments of ectopic pregnancy were done. Among 973 operations--684 (70.3%) were performed by laparoscopy. There was a gradual tendency in increasing endoscopic procedures. Comparing the year 1994 and 1997 percentage of operations performed by laparoscopy significantly changed: In tuboplasty from 83% to 95%, cystectomy from 35.9% to 80.3%, ectopic pregnancy from 61.5% to 91.7% and myomectomy from 52.7% to 61.5%. Patient hospital stay decreased significantly after laparoscopic procedures (from 5.1 days to 3.25 days). During the study period open surgery followed laparoscopy only in 8 cases (1.1%) because of complications or technical difficulties. CONCLUSION: 1. Operative laparoscopy is a safe and effective procedure, in many cases replacing open surgery. 2. Shortening of hospital stay and recovery period after laparoscopy is one of the main advantages of this method of treatment.