Umbilical cord blood gas content, postnatal state of neonates, and lactation after caesarean and natural childbirth.

In recent years the number of Caesarean sections (C-section) has been rapidly increasing. One of the reasons behind this is the fact that the scope of indications for these operations is still widening. The purpose of this article was to present a comparative analysis of the umbilical cord blood gas content, the state of infants, assessed by the Apgar score, and the course of lactation after elective C-sections or natural childbirth. We found that PO2 in the cord blood after natural delivery was appreciably higher than that after C-section. The neonates delivered in a natural way also had an appreciably better Apgar score compared with those after C-section. Compared to mothers who delivered their babies in a natural way, it takes a longer time for C-sectioned women to commence breastfeeding. We conclude that a lower PO2 level in the umbilical cord blood in women subjected to C-section may stem from breathing disorders in neonates at the time of delivery. The way of ending pregnancy has an apparent influence on adaptive abilities of infants to live outside mother's womb.

P21WAF1, P27KIP1, TP53 and C-MYC analysis in 204 ovarian carcinomas treated with platinum-based regimens.

BACKGROUND: The prognostic and predictive value of cell cycle regulatory proteins in ovarian cancer has not been established. We evaluated the clinical and biological significance of P21(WAF1), P27(KIP1), C-MYC, TP53 and Ki67 expressions in ovarian cancer patients. MATERIALS AND METHODS: Immunohistochemical analysis was performed on 204 ovarian carcinomas of International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IV treated with platinum-based chemotherapy. Multivariate analysis with Cox and logistic regression models was performed in the whole group, and in the TP53-negative and TP53-positive subgroups. RESULTS: High P21(WAF1) labeling index (LI) was an independent positive predictor of platinum-sensitive response (P = 0.02). Overall survival was positively influenced by P21(WAF1) LI (P = 0.02) or by P21(WAF1) plus P27(KIP1) LI (P = 0.004) in the TP53-negative group only. Ki67 LI showed borderline association with disease-free survival (P = 0.05). Growth fraction was negatively associated with P21(WAF1) and P27(KIP1) indices in the TP53-negative group (P = 0.023 and 0.008, respectively), and these associations were borderline or lost in the TP53-positive group. Endometrioid and clear cell carcinomas differed from other carcinomas by having a low incidence of TP53 accumulation, a high incidence of C-MYC overexpression (70%) and a low median Ki67 LI (all with P <0.001). CONCLUSIONS: We have shown an independent predictive value of P21(WAF1) LI in ovarian carcinoma patients. The prognostic value of P21(WAF1) and P21(WAF1) plus P27(KIP1) LI was determined by TP53 status. A high frequency of C-MYC overexpression in endometrioid and clear cell carcinomas may suggest its role in the development of these tumor types.

Evaluation of clinical significance of TP53, BCL-2, BAX and MEK1 expression in 229 ovarian carcinomas treated with platinum-based regimen.

In cell line studies, BCL-2, BAX, as well as novel MEK1 protein levels have strong influence on ovarian cancer response to cisplatin-based chemotherapy. However, such associations have not been demonstrated clinically. We evaluated prognostic/predictive significance of these proteins with regard to TP53 status. Immunohistochemical analysis was performed on 229 ovarian carcinomas FIGO stage IIB-IV treated with platinum-based chemotherapy; the results were analysed by the Cox and logistic regression models. Clinical parameters (residual tumour size, patient age, FIGO stage) were the only indicators of overall survival (OS) and the strongest predictors of complete remission (CR). On the other hand, BAX expression was the strongest (P=0.005) or the only (in FIGO IIIC, P=0.02) prognostic indicator of disease-free survival (DFS) in the TP53(+) group. TP53(+) and TP53(-) ovarian carcinomas differed in clinical and molecular prognostic and predictive factors. Another novel finding is that CR was negatively influenced by high BAX expression in all patients group (P=0.047) and by BCL2 expression in the TP53(-) group (P=0.05). High MEK1 expression was associated with endometrioid and clear cell carcinomas (P=0.049); its loss was found with advancing FIGO stage (P=0.002). Our results suggest that binomial TP53 status divides ovarian carcinomas into two biologically distinct groups. BAX expression is an important factor of DFS in the TP53(+) group. BCL-2 and BAX, but not MEK1 expressions have predictive value in ovarian cancer patients treated with platinum-based chemotherapy.

[Extraperitoneal inguinal endometriosis]. / Zaotrzewnowa endometrioza w dole pachwinowym.

The case report of the very rare, extraperitoneal endometriosis in the inguinal localisation in 40-year-old woman. Clinical diagnosis was confirmed by histological examination of the removed endometriotic focus. The main patient's complain was the pain in the groin during menses often accompanied with the feeling of dumbness of the ipsilateral leg. During menses the palpable tumor enlarged and was painful. The surgical excision of the tumor with broad margins is the best method of treatment. In differential diagnosis one should consider entrapped inguinal hernia as well as displaced ovary.

[E-cadherin in the serum and the peritoneal fluid of women with endometriosis]. / E-kadheryna w surowicy i plynie otrzewnowym kobiet z endometrioza.

Endometriosis, a disease of unclear etiopathogenesis, is a quite common problem in gynecology. It is thought that the retrograde flow of the menstrual debris to the peritoneal cavity plays an important role in the origin of endometriosis but the mechanism of endometrial cells implantation remains unknown. Recently many centers have reported the importance of adhesion molecules in this process. We studied the concentrations of E-cadherin in the serum and the peritoneal fluid of women with endometriosis. Our results show a significant decrease of E-cadherin concentrations in sera and peritoneal fluids in women with endometriosis. We suggest that screening the level of E-caherin may be useful in the monitoring the therapy of endometriosis.

[VEGF, TNF-alpha and IL-6 in the peritoneal fluid of women with unexplained infertility]. / VEGF, TNF-alpha i IL-6 w plynie otrzewnowym kobiet z nieplodnoscia niejasnego pochodzenia.

Unexplained infertility is an important problem in diagnosis and therapy in everyday gynecologist's practice. Looking for possible reasons of the unexplained infertility we studied the concentrations of selected cytokines (VEGF, TNF-alpha and IL-6) in the peritoneal fluid of women suffering from the unexplained infertility. We compared the results in the studied group with the control group and with the patients with endometriosis. Immunological disorders of the peritoneal fluid in endometriosis are thought to take part in its pathomechanism. Our results suggest that the levels of one of the main factors of endothelium proliferation (VEGF) in the peritoneal fluid from women with unexplained infertility and women with endometriosis are comparable. Concentration IL-6 and TNF-alpha in the peritoneal fluid in case of unexplained infertility and control group was lower than in the endometriosis patients.

[Markers of coagulation and fibrinolysis in peripheral blood and in blood collected pouch of Douglas in patients with ectopic pregnancy]. / Uklad krzepniecia i fibrynolizy krwi obwodowej i pobranej z zatoki Douglasa u kobiet z ciaza ektopowa.

In cases of ectopic pregnancy a blood collected in a pouch of Douglas is a nonclotting one. It contains no fibrinogen, prothrombin, factor V and VII, plasminogen and monomers of fibrin, however concentration of D-dimers is very high. Is this solely an effect of independently occurring fibrinolysis or does coagulation accompany this process? The definite answer can not be given. Coagulation and fibrinolysis markers obtained at the same time from peripheral veins were normal.

Factors influencing period of time between negative second-look laparotomy and ovarian carcinoma recurrence. Multicenter study in Poland.

OBJECTIVE: The aim of our study was to evaluate factors such as primary clinical stage, presence of ascites, serum CA 125 antigen level, histological type of ovarian cancer, cell differentiation and number of chemotherapy cycles influencing the time of recurrence after negative second-look operations. MATERIAL AND METHODS: Having observed complete clinical remission in 356 patients with ovarian cancer, second-look laparotomy was performed. In 180 patients complete pathologic remission was detected and in 73 recurrence was observed. Correlation analysis between time of recurrence and the above-mentioned prognostic factors was carried out by means of the Mann-Whitney and Kruskal-Wallis tests. RESULTS: The time from the second-look operation till diagnosis of relapse ranged from 7 to 36 months (average 21 months). The statistical analysis showed a correlation between the presence of ascites, increased serum CA 125 antigen level, the administration of six chemotherapy courses and the time of recurrence. In all those cases relapse occurred earlier than in patients without ascites, with normal CA 125 antigen levels and after ten courses of chemotherapy. CONCLUSION: Our findings suggest that the stage of clinical advancement and histologic grading do not influence the time of recurrence. The presence of ascites, increased serum CA 125 antigen level and the administration of fewer chemotherapy courses (6 versus 10) after primary surgery affects the earlier relapse of disease.

[Surgical treatment of ovarian tumors in girls in the materials of the 2nd Department and Gynecological Clinic of the Medical Academy in Wroclaw]. / Leczenie operacyjne guzów jajnika u dziewczat na materiale II Katedry i Kliniki Ginekologii AM we Wroclawiu.

Between 1987 and 1998 44 young women (average age 17.4) were operated for ovarian tumours at the 2nd Clinic and Department of Academy of Medicine in Wroclaw. Bilateral changes were observed in 6 patients. In one case a malignant tumour was diagnosed. The most frequent benign tumours were teratoma adultum (30%) and cystis paraovarialis (22%) the type of surgical intervention depended on the size of the tumour and on the degree of destruction of the ovarian tissue. Since 1995 the clinic carries out surgical laparoscopy particularly prefened modality in case of young women. During that time, 16 of 21 patients aged up to 21, had their ovarian tumours enucleated by means of the laparoscopic method.

[Surgical treatment in a case of partial vaginal obliteration coexisting with hematometra, hematocolpos and other congenital defects]. / Postepowanie chirurgiczne w przypadku czesciowego braku pochwy wspólistniejacego z haematometra i haematocolpos oraz innymi wadami rozwojowymi.

A case history of 12 years old girl with transverse vaginal septum occurring with hematometra, hematocolpos and other congenital defects is presented. Operation was carried out twice because of vaginal prosthetic appliance after the first operation. The reoperation was done 6 months after the previous one and artificial vagina recanalised.

[Gonadal dysgenesis in own material]. / Dysgenezja gonad w materiale wlasnym.

Eleven patients with Turner syndrome and 6 with pure gonadal dysgenesis were examined. Diagnosis was made on the base of clinical and cytogenetic examination. All patients had primary amenorrhea and underdevelopment of primary, secondary and tertiary sexual features. Hormonal estimations revealed elevated FSH serum concentration in women with Turner syndrome and with pure gonadal dysgenesis (46, XY) vs. to patients with 46, XX. Estradiol and Progesterone levels were low in all cases. All women were treated with estrogens and progestational agents in sequential manner with good results. We did not observe significant phenotypic differences between patients with monosomie X and patients with structural abnormalities within chromosome X and mosaicism.

Epidermal growth factor receptor and c-erbB-2 oncoproteins in tissue and tumor effusion cells of histopathologically different ovarian neoplasms.

The overexpression of two growth factor receptors - epidermal growth factor receptor (EGFR) and c-erbB-2 - was evaluated immunohistochemically in malignant and benign ovarian neoplasms, considering the stage of the disease and histology of tumors. The comparison of EGFR and c-erbB-2 reactivity in tissue sections and respective cyst and/or ascitic fluid cells was also performed. c-erbB-2 expression was detected in 44.4% of ovarian carcinomas, and in benign neoplasms there was no evidence of its staining, while EGFR reactivity was found both in malignant (58.7%) and benign (50%) tumors. Significant heterogeneity of staining was observed, however, the relationship between EGFR and c-erbB-2 expression in tissue sections and cyst and/or ascitic fluid cells in individual patients was evident. The expression of both growth factor receptors was not correlated with histopathological subtypes of ovarian neoplasms. The c-erbB-2 oncoprotein was detected more frequently in III/IV than in I/II stages according to the criteria of the International Federation of Gynecology and Obstetrics (FIGO) and the EGFR expression was independent of the clinical advancement of the disease. The coexpression of c-erbB-2 and EGFR was shown in 32% of ovarian carcinomas, and it dominated in cases with FIGO stages III/IV. Our results indicate that the increase of the EGFR expression appears to be associated with early stages of ovarian tumorigenesis, and the enhancement of c-erbB-2 reactivity may cooperate with EGFR activation in the development and progression of ovarian carcinomas.

Delayed interval delivery in a quintuplet pregnancy.

We present a case report of delayed delivery of a quintuplet pregnancy. The pregnancy resulted from intrauterine insemination following hormonal treatment. This case may represent the first report of quintuplets delivered using the technique of delayed interval delivery. Three separate spontaneous labours and one Caesarean section for two fetuses took place between the 24th and 32nd weeks of pregnancy. The delay between the first and the last delivery was 61 days. Only a boy, born fourth, survived.

Changes in the concentrations of receptors of insulin-like growth factor-I, epithelial growth factor, oestrogens and progestagens in adenomyosis foci, endometrium and myometrium of women during menstrual cycle.

Concentrations of receptors of insulin-like growth factor-I (IGF-I-R), epithelial growth factor (EGF-R), oestrogen (ER), and progesterone (PR) in the adenomyosis foci, endometrium and myometrium of women during the menstrual cycle were studied. Cell membrane levels of IGF-I-R and EGF-R, cytosol and nuclear oestrogen (ERc and ERn, respectively) and cytosol progesterone (PRc) receptors were assayed in 37 samples of adenomyosis foci, 46 of endometrium and 50 of myometrium using the radioligand method. It was found that concentrations of ER and PR in all studied tissues were significantly higher in the proliferative phase than in the secretory phases. In the endometrium a similar difference concerned only the ERn but not the ERc. Adenomyosis foci as compared to endometrium and myometrium showed the highest ERn and PRc concentrations during the proliferative and secretory phase. Adenomyosis foci and myometrium contained significantly higher concentrations of IGF-I-R in the proliferative phase than in the secretory phase. In the endometrium a menstrual cycle-related difference in concentration of IGF-I-R was not significant. In the endometrium however the concentration of EGF-R was over twice as high in the proliferative phase than in the secretory phase. No significant difference in the concentrations of EGF-R in adenomyosis foci and in myometrium during the menstrual cycle was noted. The findings show that changes in regulation of the concentrations of IGF-I-R, EGF-R, ER and PR in the uterus of women during menstrual cycles are related to the tissular localization of these receptors.

[Mycoplasma hominis and Ureaplasma urealyticum of cervical canal and in the pouch of Douglas in infertile women: a preliminary report]. / Mycoplasma hominis i Ureaplasma urealyticum w kanale szyjki macicy i w zatoce Douglasa u nieplodnych kobiet-doniesienie wstepne.

Detection of Mycoplasma hominis and Ureaplasma urealyticum in the samples obtained from the cervical canal of the uterus and from the pouch of Douglas in 71 women in whom underwent diagnostic and operative laparoscopy is presented. Ureaplasma urealyticum in 33 cases diagnosed for infertility was present in 6 (18.2%) patients. In cervical canal and the pouch of Douglas in 5 and 2 women respectively. In 1 (3.0%) woman Ureaplasma urealyticum was present in both places. In the women from the control group U. urealyticum was detected in 6 (15.5%) cases only in cervical canal. Mycoplasma hominis was present only in cervical canal more frequently in the control group 4 (cases) than among infertile women 1 (3.0%).

[Chlamydia trachomatis in cervical canal and in the pouch of Douglas in infertile women]. / Chlamydia trachomatis w kanale szyjki macicy i w zatoce Douglasa u nieplodnych kobiet.

The results of microbiological examination of samples from cervical canal of the uterus and from pouch of Douglas in 71 women who underwent diagnostic and operative laparoscopy is presented. In 33 cases diagnosed because of infertility Chlamydia trachomatis was present in 2 (6.1%) women and in one woman both in cervical canal and pouch of Douglas. In second woman only in cervical canal Chlamydia trachomatis was present. There was not statistically significant correlation between control and study groups.

[Surgically induced ovulation in the treatment of sterility due to polycystic ovary syndrome and the course of present pregnancies and deliveries]. / Chirurgiczna indukcja owulacji w leczeniu nieplodnosci spowodowanej Zespolem Policystycznych Jajników oraz przebieg zaistnialych ciaz i porodów.

DESIGN: 64 women, with PCOS underwent treatment by bilateral ovarian wedge resection, during laparotomy, or by tunica albuginea electrocauterisation under laparoscopic control were examined. RESULTS: In treated women 2 losses of obtained 25 pregnancies were observed. After bilateral ovarian wedge resection were observed 17 pregnancies (50%), and after laparoscopic ovulation induction were observed 8 pregnancies (27%). One pregnancy was unsuccessfully terminated by premature labor, three pregnancies were terminated by caesarean section. CONCLUSION: Abortion rates and rates of pathology of delivery in women with PCOS is not elevated compared with that of non-PCOS subjects.

[The concentration of exfoliative adhesion molecules (ICAM-1 and E-Selectin) in serum and peritoneal fluid of women with endometriosis]. / Stezenie zluszczonych molekul adhezyjnych (ICAM-1 i E-Selektyny) w surowicy i plynie otrzewnowym u kobiet z endometrioza. Doniesienie wstepne.

It is commonly known that retrograde transport of exfoliative fragments of endometrium to peritoneal cavity during the menstruation is an important factor of the ethiopathogenesis of endometriosis. The mechanism of inplantation of endometrial cells to peritoneal sites still remains unclear. Adhesions molecules are suggested to take part in this process. In our study we tried to establish the concentration of the adhesion molecules (ICAM-1 and E-Selectin) in the sera and peritoneal fluids of women with endometriosis in comparison to the control group. These concentrations were significantly higher in the sera of all patients. We did not find any significant differences between two examined groups although further studies should be carried out.

[Cytotoxic activity of NK cells in the presence of the peritoneal fluid fro women with unexplained infertility and with endometriosis related infertility]. / Aktywnosc cytotoksyczna komórek NK w obecnosci plynu otrzewnowego pobranego od kobiet z nieplodnoscia niejasnego pochodzenia oraz z nieplodnoscia zwiazana z endometrioza.

We examined peritoneal fluid obtained during laparoscopy in the aspect of its influence on cytotoxic activity of NK cells. We showed significant suppression of this activity in women with unexplained infertility. The suppression of NK activity was also present in women fertile and infertile both, with severe endometriosis. These results may indicate the immunological disorders in unexplained infertility and in endometriosis-related infertility.

p53, c-erbB-2 and p21ras expression in tumor effusion cells of patients with histopathologically different ovarian neoplasms.

The overexpression of p53, c-erbB-2 and p21ras gene products was evaluated immunohistochemically in ovarian carcinomas, borderline, and benign neoplasms. All studies were performed on cytospin preparations of cyst and/or ascitic fluid cells and mutual relations between oncoproteins were analysed. p53 and c-erbB-2 immunostaining was observed in 50% and 48.5% of ovarian carcinomas and in 30% and 35% of ovarian borderline tumors respectively, however in the last group the intensity and percentage of stained cells were considerably lower. In ovarian benign neoplasms there was no evidence of p53 and/or c-erbB-2 expression. The trend for serous carcinoma to have a higher p53 and c-erbB-2 expression than endometrioid and mucinous carcinomas was observed. p53 and c-erbB-2 oncoproteins were detected more frequently in the III/IV than in the I/II stages of the disease. The expression of p21ras was detected in 91% of malignant, 65% of borderline and 50% of benign neoplasms. p21ras reactivity was independent of the histopathological structure of ovarian carcinomas and it was comparable in I/II and III/IV FIGO stages. Our results indicate that p21ras overexpression appears to be an early genetic alteration in ovarian tumorigenesis, followed by the appearance of p53 and c-erbB-2 oncoproteins. It is likely that enhanced p53 and c-erbB-2 expression may cooperate with ras gene activation to produce a particularly aggressive phenotype. Our study supports the concept that development of ovarian carcinoma is the end result of a complex multistep process involving the complementary action of different cancer causing genes.