Increase of nuclear expression of metallothionein I/II in neoplastic transformation of the endomnetrium.

OBJECTIVES: The aim of our study was to investigate the expression of epidermal growth factor receptor (EGFR), metallothionein (MT) 1/11, and Ki-67 antigen in endometrial cancer We analyzed cytoplasmic (cMT) and nuclear (nMT) metallothionein fractions separately Moreover we evaluated the relationships between expressions of the above mentioned proteins and compared them with clinicopathologic data. MATERIAL AND METHODS: The study material included paraffin-embedded endometrial cancer samples from 84 patients. The control group consisted of 52 non-neoplastic endometrium samples. Immunohistochemical reactions were performed using monoclonal antibodies against EGFR, MT 1/11 and Ki-67. Expression intensity of the tested proteins was assessed by computer image analysis software. Chi-square, Spearman's correlation, Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis with Statistica 8.0 PL. RESULTS: Strong expression of nMT was revealed in endometrial cancer cells in relation to benign hyperplasia (p<0.0017) and normal cells (p<0.001) of the endometrium. Statistically significant but weaker expressions in analogous relationships were observed for cMT Moreover higher grade of histological malignancy G was positively associated with increased expression of nMT (p=0.009). CONCLUSIONS: Expression of nMT remains in distinct correlation with neoplastic transformation of the endometrium and histologic grades. Our results clearly indicate a need for further research on metallothionein expression in tumor cells.

A successful cesarean section in a pregnant woman with A (H1N1) influenza requiring ECMO support.

A 24-year-old pregnant woman (29.4 weeks of gestation) with A (H1N1) influenza-associated adult respiratory distress syndrome was admitted to the intensive care unit. The patient was connected to femoral-jugular veno-venous extracorporeal membrane oxygenation (ECMO) 8 hours after admission. On the 7(th) day of ECMO support, due to the increasing threat to the life of the mother and the fetus, a decision was made to carry out a cesarean section (CS) without discontinuing the ECMO support. The CS was performed uneventfully under general anesthesia, 5 hours after the discontinuation of heparin infusion. A live, premature 1200 g female neonate was delivered. No complications occurred in the perioperative period. On the 17(th) day, the patient was successfully weaned off the ECMO and discharged 10 days later. The newborn was discharged from the hospital in good health 41 days after the delivery.

Analysis of the concentrations of interleukin 18 in amniotic fluid in the second and the third trimesters of pregnancy.

BACKGROUND: Interleukin 18 (IL-18) is a glycoprotein produced by macrophages. IL-18 influences different populations of T lymphocytes and NK cells and stimulates the production of INF-gamma by these cells. IL-18 induces both Th1 and Th2 response. That is why IL-18 is a unique cytokine. OBJECTIVES: The aim of work was to examine the concentration of interleukin 18 in amniotic fluid in the 2nd and the 3rd trimesters of physiological pregnancies. MATERIAL AND METHODS: 74 pregnant women were qualified to take part in the studies. The amniotic fluid samples by amniocentesis were taken from the patients. Two groups were distinguished among the examined patients: group I - 45 pregnant women qualified for genetic amniocentesis between the 15th and 19th week of pregnancy. All findings of the cytogenetic tests were normal. Group II: 29 pregnant women in their 3rd trimester were qualified for diagnostic amniocentesis in order to determine the biological maturity of the fetuses. The concentration of IL-18 was marked with the immunoenzymatic method ELISA with the use of the kit produced by the MBL company. Method sensitivity was < 12.5 pg/mL. RESULTS: In the 2nd trimester of pregnancy the average concentration of IL-18 in the amniotic fluid was 454.69 pg/mL and in the 3rd trimester was 71.73 pg/mL. The obtained data proved that the average concentration of IL-18 in the 2nd trimester was significantly higher than in the 3rd trimester. The obtained differences in the findings were statistically significant (p < 0.05). CONCLUSIONS: The presence and high levels of IL-18 in the amniotic fluid in the 2nd trimester of pregnancy indicate an early process of initiation of immunological mechanisms by the fetus. An average concentration of IL-18 in the amniotic fluid was significantly higher in the 2nd trimester of pregnancy than in the 3rd trimester, which may indicate the influential role of IL-18 on the development of the immune response in the fetus in this period of gestation.

Second-trimester IL-15 and IL-18 levels in the amniotic fluid of fetuses with normal karyotypes and with chromosome abnormalities.

BACKGROUND: Little is known about the behavior of interleukin 15 (IL-15) and 18 (IL-18) in the amniotic fluid in the second trimester of gestations complicated by chromosomal defects in the fetus. Likewise, it has not yet been established whether a fetus with chromosome abnormalities creates its immunity mechanisms in the same way as a fetus with a normal karyotype. OBJECTIVES: The aim of this work was to assess the concentration of IL-15 and IL-18 in the amniotic fluid in the second trimester of gestation in fetuses with normal karyotypes and with chromosome abnormalities. MATERIAL AND METHODS: The material consisted of 51 samples of amniotic fluid obtained from genetic amniocenteses carried out between the 15th and the 19th weeks of gestation. On the basis of cytogenetic screening, two groups were singled out: Group I--45 fetuses with normal karyotypes, and Group II--6 fetuses with abnormal karyotypes. The concentrations of IL-15 and IL-18 in the amniotic fluid were assessed with ready-made assays and analyzed, and the results from both groups were compared. RESULTS: The differences between the IL-15 levels in the amniotic fluid from Groups I and II proved to be statistically insignificant (p = 0.054). However, the average IL-18 levels in the amniotic fluid of the fetuses with normal karyotypes were significantly higher than in the amniotic fluid of the fetuses with chromosome abnormalities (p = 0.032). CONCLUSIONS: Some defense mechanisms in the second trimester of gestation in fetuses with chromosome abnormalities may develop in a different way than in fetuses with normal karyotypes.

Analysis of the concentrations of interleukin 15 in amniotic fluid in the second and the third trimesters of pregnancy.

BACKGROUND: Cytokines play an essential role in the regulation of immunological responses. Interleukin 15 (IL-15) is a glycoprotein secreted primarily by macrophages and monocytes. IL-15 plays a key role in the immunological response of the cellular type. OBJECTIVES: The objective of this study was to evaluate changes in the concentration of interleukin 15 in amniotic fluid in the second and the third trimesters ofa normal pregnancy. MATERIAL AND METHODS: The study included 74 pregnant women who were subjected to a diagnostic amniocentesis in order to extract amniotic fluid samples. The patients were divided into two groups: group I - 45 pregnant women in the 2nd trimester, subjected to genetic amniocentesis during the 15th through 19th weeks. The results of the cytogenetic tests were found to be normal in all the fetuses. Group II: 29 pregnant women in their 3rd trimester, were subjected to amniocentesis in order to determine the biological maturity of the fetuses. The concentration of IL-15 was marked with the ELISA method using a kit made by the R&D company. Method sensitivity was > 2 pg/ml. RESULTS: The average concentration of IL-15 in the amniotic fluid of 2nd trimester pregnancies was 6.54 pg/ ml, whereas in the 3rd trimester it rose to 18.62 pg/ml. Discrepancies were found to be statistically significant (p < 0.05). CONCLUSIONS: The presence of IL-15 in the amniotic fluid in the second trimester of gestation indicates an early activation of the fetus's defensive mechanisms. An average concentration of IL-15 in the amniotic fluid is significantly higher in the third trimester of pregnancy than in the second trimester, which can mean about the development of the immune response in the fetus.

[Assessment of cell proliferation based on group analysis of Ki-67 index in serous ovarian cancers]. / Ocena aktywnosci proliferacyjnej komórek na podstawie calosciowej analizy indeksu Ki-67 w rakach surowiczych jajnika.

OBJECTIVES: Ovarian neoplasms are very important problems in medicine, because they account for 23% of all female genital neoplasms, and they are the cause of 47% deaths among women suffering from cancers of the female reproductive organs. Growth of the neoplasms depends on the speed of cells' reproduction. Monoclonal antibody Ki-67 detects specific antigen--nonhistonic protein of cellular nucleus, which is characteristic for dividing cells. It gives the possibility of using Ki-67 to establish proliferating index, especially in intensely proliferating neoplasm tissues. PURPOSE: The aim of the study was the evaluation of clinical parameters compared with histological and laboratory findings in serous carcinomas. The research analysed the level of proliferating index Ki-67 in patients with ovarian cancers and in control group. MATERIALS: The material used consisted of 41 cases of serous ovarian cancer. For clinical examinations we chose only patients who underwent primary surgical operation. The control group for Ki-67 levels were 15 patients with benign serous ovarian adenomas. METHODS: For showing Ki-67 reacting antigen in paraffin samples of ovarian cancer we used DAKO Serum (Rabbit Anti Human Ki-67 Antigen N 1574 LSAB). Tissue proliferation activity called proliferation index--IP Ki-67 was measured as a proportion of numbers of cells reacting with antigen to the total number of cells in the sample. RESULTS: Mean level of IP Ki-67 in examined group was 29.01%, compared to 5.84% in the control group and that was statistically significantly higher (p<0.05). CONCLUSIONS: The analysis of cells' proliferative activity differentiates benign adenomas from ovarian serous carcinomas. But I didn't find this kind of correlation among analysed clinical and laboratory parameters and the level of Ki-67 index in ovarian serous cancers.

[Analysis of prognostic factors for the extent of vascularity of serous ovarian cancer on the basis of CD34 antigen expression]. / Analiza wartosci rokowniczej poziomu unaczynienia raka surowiczego jajnika na podstawie oceny ekspresji antygenu CD34.

OBJECTIVES: Ovarian neoplasms are very important problem in medicine, because they account for 23% of all female genital neoplasms, and they are the cause of 47% deaths among women suffering from gynecological cancers. Progression of neoplasmatic disease depends also on dynamism of angiogenesis, because better oxygen and nutrition substances supply increase tumor growth. To increase the tumor volume of 1 mm3, the development of new vessels is needed, and that also increases the risk of distant metastases. AIM: The aim of the study was the evaluation of clinical parameters compared with histological and laboratory findings in serous carcinomas. The research analyzed of angiogenesis level (antigen CD34) in patients with ovarian cancers and in control group. MATERIALS AND METHODS: The material consisted of 41 cases of serous ovarian cancer. For clinical examinations we chose only patients who underwent primary surgical operation. The control group for CD34 levels were 15 patients with benign serous adenomas. The microscopic (200x) evaluation of blood vessel in paraffin samples were made by showing the reaction of endothelial CD34 antigen with DAKO serum (Monoclonal Mouse Anti Human CD34 class 1-N 1574 LSAB). RESULTS: The level of statistical significance for grading and total vessels' area was p = 0.01 (G1--0.037 mm2, G2--0.019 mm2, G3--0.015 mm2). No difference in vascularity was observed at the level of total vascularisation of serous ovarian cancers (0.021 mm2) and in benign serous adenomas (0.023 mm2). CONCLUSIONS: Among analysed clinical and laboratory parameters only histological grade (G) correlates significantly with the level of vascularisation of ovarian serous cancers.

[Analysis of labor methods after cesarean sections in the last 50 years]. / Analiza sposobów ukonczenia ciazy po przebytych cieciach cesarskich w ostatnim piecdziesiecioleciu.

The aim of the work was to analyze the incidence and changes in the labors after previous cesarean section in the last 50 years. The study was conducted on the basis of the labors documented in our Clinic between 1946 and 1996 year. Cesarean sections are more and more frequent in these years and the amount of the patients with previous cesarian section elevates. We observed the increase rate of repeat cesarean delivery in comparison to vaginal birth after cesarean section. The trial of vaginal labor after cesarean section is usually successful in young patients (under 25 years old), repeat cesareans is mainly observed in patients older than 35. The permanent decrease in the incidence of instrumental deliveries in comparison with cesarean section was observed. The trial of vaginal labor after cesarean section, after exclusion of contraindicatins, should be routine procedure decreasing the amount of cesarean sections.

[Antibiotic prophylaxis after abdominal hysterectomy--comparative analysis of two treatment patterns]. / Profilaktyczna antybiotykoterapia stosowana podczas zabiegu histerektomii brzusznej--analiza porównawcza dwóch schematów postepowania.

OBJECTIVES: The aim of the study was to evaluate the efficacy of antibiotic prophylaxis after abdominal hysterectomy. Additionally we compared costs of the treatment patterns and the periods of hospitalization. MATERIALS AND METHODS: We studied 70 cases of women operated in I Obstetrics and Gynaecology Clinic in Wroclaw without serious internal diseases, divided in two groups: on the basis of the treatment patterns. RESULTS: We showed that: Antibiotic prophylaxis decreases the risk of infectious complications after surgery in patients with abdominal hysterectomy. We did not observe any essential therapeutic differences between short-term monotherapy and longterm combined antibiotic treatment in perioperative prophylaxis. CONCLUSIONS: Monotherapy should be a method of choice in antibiotic perioperative prophylaxis. Monotherapy essentially reduces the cost of surgery procedure.

[Etiology and diagnostic problems in pregnant women with uterine myomas]. / Etiopatogeneza i implikacje terapeutyczne wynikajace z problemu ciazy powiklanej wystepowaniem miesniakow macicy.

OBJECTIVES: Authors present different aspects of coexistence of uterine myomas with pregnancy. In the article special attention was given to etiology, complications and practical methods of treating pregnant women. DESIGN: The occurrence of uterine myomas is connected with the period of hormonal activity of the ovaries, so with the female reproductive age. Uterine myomas are tumors whose actions are dependent on hormonal action of estrogens which are often characterized by acceleration of growth especially in the first trimester of pregnancy. The dynamics of uterine myomas is specifically different and independent of neither the original size nor localisation of the myomas. During the antenatal period together with the involutional changes of the uterine muscle there is an observed decrease in the size of the myomas. MATERIALS: Based on literature, the effect of uterine myomas on fertility of women, pregnancy follow-up, development of foetus and occurrence of perinatal complications was analysed. The diagnostic methods as well as procedures underwent analysis depending on the localisation of the changes. The effect of nonpharmacological and surgical therapy were compared in pregnant women and those planning to conceive. CONCLUSION: In modern obstetrics, pregnancy complications as a result of uterine myomas is still actual and there is a lot of controversy on this topic. This is because up until now, there is no generalised opinion on therapeutic procedures and ways of resolving pregnancy complicated by the presence of uterine myomas.

[Using of Therma-Choice system in treatment of metrorrhagia in case of porphyria]. / Therma-Choice w leczeniu krwawien z macicy w przypadku porfirii.

The authors present the use of Uterine Balloon Therapy in the long term metrorrhagia resistant to conservative treatment, in the case of porphyria. The method was used on a 44 year old female, suffering from acute intermittent liver porphyria for 9 years.

[Nucleolus organizer regions (agnors) and Ki-67 antigens expression from the cervix and cervical canal smears with respect to changes in ascus and AGUS (atypical cells of undetermined significance) according to Bethesda Cytological System of Classification]. / Regiony organizatorów jaderkowych (AgNORs) i ekspresja antygenu K167 w rozmazach z czesci pochwowej i kanalu szyjki macicy w odniesieniu do zmian typu ASCUS i AGUS wg systemu klasyfikacji cytologicznej Bethesda.

OBJECTIVES: The cytologic report written by a cytopathologist on the basis of smears from the cervix and cervical canal ought to give detailed and worthwhile information which allows making appropriate diagnostic and therapeutic decisions. The diagnosis of atypical cells of unspecified importance (ASCUS and AGUS) ought to have clinicians to carry out further diagnostic histopathologic procedures in order to explain the pathologic character of processes going on in the female reproductive organ. This is because such pathological states may as well spell could mean reactive, preinvasive as neoplastic changes of invasive character. DESIGN: This problem has led to carry out a research in order to examine the proliferative potential of cells in cytological smears (Ki-67, AgNORs) and to answer whether this potential allows us to qualify atypical cells as changes of reactive or neoplastic type. MATERIALS: In our study there were estimated 97 cases of cytological smears from the cervix and cervical canal. In this paper, immunohistochemical methods, and staining techniques developed by Ploton et al. in the detection of AgNORs and in the examination of Ki-67 antigen were used. CONCLUSIONS: 1. The average number of AgNORs in cell nucleus was highest in ASCUS cells and exceedingly higher in CIN 1 and CIN 3.2. The areal ratio of AgNORs to that of the cell nucleus was highest in HSIL and cancer cells, least in ASCUS. 3. In ASCUS and LSIL, AgNORs were minute and scattered whereas they were large and centrally located in HSIL and cancer cells. RESULTS: We found that analysis of AgNORs makes easier the differentiation of ASCUS and LSIL cells from HSIL and neoplastic ones according to the classification system of Bethesda.

Gliomatosis peritonei with mature teratoma of the ovary.

We report a case of menstrual mature teratoma of ovary with implants of glial tissue in peritoneum and its adnexa. After resection of the tumour and omentum laparoscopic examination was performed and revealed reduction, fibrosis of glial implants and massive cellular reaction.

[Urethral obstruction caused by endometriosis]. / Niedroznosc moczowodu w przebiegu endometriozy.

Two cases of unilateral urethral obstruction caused by endometriosis were reported. Two patients aged 48 and 35 years old were fully diagnosed with above mentioned abnormalities prior to a surgical operation. During the surgical operations the initial diagnosis was confirmed macroscopically, followed by the surgical amputation of the urethral parts pathologically changed. The anastomosis of urethra was finally performed after confirmation that the remaining parts were macroscopically unchanged. Histopathological examinations confirmed the initial diagnosis. After the surgical operation both patients were subjected to hormonal treatment attaining full recovery. The above presented cases--urethral endometriosis is one of rare complications caused by endometriosis. Proper and early diagnosis, followed by an effective treatment is important in obviating grievous consequences e.g. total renal failure.