High prevalence of early (1st trimester) gestational diabetes mellitus in Polish women is accompanied by marked insulin resistance - comparison to PCOS model.

INTRODUCTION: Both pregnancy and polycystic ovary syndrome (PCOS) constitute insulin-resistant states that are associated with an increased prevalence of glucose intolerance. Some women demonstrate significant insulin resistance (IR) and develop gestational diabetes (GDM) even in the 1st trimester. We compared surrogate IR indices in 1st-trimester pregnant women and in women with PCOS (Rotterdam consensus criteria). MATERIAL AND METHODS: We performed a 75-g oral glucose tolerance test (OGTT) with insulin measurements in 106 healthy 1st-trimester pregnant women at 9.9 ± 2.6 weeks of gestation and in 418 women with PCOS. We assessed IR (HOMA-IR, QUICKI, Matsuda, Belfiore, and Stumvoll indices) as well as the prevalence of GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADSPG) and World Health Organization (WHO) (1999) criteria. RESULTS: Despite having a slightly lower BMI (p = 0.027), pregnant women had either similar (QUICKI, Belfiore index, Stumvoll0-120 min) or greater IR than women with PCOS (e.g. HOMA-IR 3.85 ± 6.11 vs. 2.64 ± 2.04, p = 0.002), while only the Matsuda index demonstrated less IR in pregnant women (p = 0.003). The correlation between IR indices in pregnant women showed marked variability, ranging from r = 0.334 (HOMA-IR vs. Belfiore index) to r = -1.0 (HOMA-IR vs. QUICKI, p < 0.001). This was accompanied by a high prevalence of GDM (14.2% and 9.4%, IADPSG and WHO criteria, respectively). Women with GDM diagnosed according to IADPSG criteria demonstrated greater IR than pregnant women without GDM. In women with GDM diagnosed according to WHO (1999) criteria these differences were visible only for OGTT-derived IR indices (Belfiore, Matsuda, and Stumvoll0-120 index). CONCLUSIONS: Depending on the choice of IR indices, healthy 1st-trimester pregnant women demonstrate either similar or greater IR than women with PCOS, and this is accompanied by a high prevalence of early GDM. It remains to be established whether GDM screening should be performed in the 1st trimester.

Subclinical thyroid dysfunction in the first trimester of pregnancy: 'Disease' versus physiological (pulsatile) variation in TSH concentrations.

BACKGROUND: There is no universal consensus regarding cut-off points for TSH in pregnancy, so concentrations of 2.5 or 4.0 mIU/L were suggested for first trimester (Endocrine Society [2012] and ATA [2017] guidelines, respectively). Yet, the impact of physiological variation in TSH secretion has not been assessed. SUBJECTS AND METHODS: We assessed baseline concentrations of free T4, free T3 and TSH at 30-minute intervals (between 7.00 and 9.00 hours) in 110 healthy pregnant women, age 30.2 ± 6.0 years, 9.9 ± 2.4 weeks of gestation, and in 19 female controls, age 28.9 ± 10.7. RESULTS: Mean TSH concentrations in pregnant women were 1.62 ± 1.26 mIU/L and on average varied by 39.5% (dispersion between the highest and the lowest TSH), with no difference in TSH variation between pregnant women and controls. Taking into account the highest TSH out of five consecutive measurements, TSH >2.5 mIU/L and TSH above 4.0 mIU/L were found in 23 (20.9%) and 10 (9.1%) pregnant women, respectively. In contrast, when the lowest TSH value was considered, then concentrations of TSH >2.5 mIU/L and >4.0 mIU/L were found in 14 (12.7%) and 4 (3.6%) women, respectively. This discrepancy was even more pronounced in aTPO-negative subjects (21 [21.2%] vs 8 [8.1%] women, for TSH >2.5 mIU/L, and six [6.06%] vs one [1.01%], for TSH >4.0 mIU/L). Furthermore, either six (5.4%) or 10 (9.1%) women had TSH concentrations below 0.1 mIU/L. CONCLUSIONS: In a significant number of patients, diagnosis of subclinical thyroid dysfunction could be erroneously made not as a result of 'disease', but as a result of physiological variation in TSH concentrations.

Anti-Müllerian hormone as a marker of abortion in the first trimester of spontaneous pregnancy.

OBJECTIVE: To assess anti-Müllerian hormone (AMH) levels as a marker of early abortion in the first trimester among women younger than 35 years. METHODS: Prospective study of women aged 18-34 years with a spontaneous pregnancy at less than 12.6 gestational weeks in Lódz, Poland, between January 2017 and November 2018. Cases of anembryonic abortion and assisted conception were excluded. Blood samples were collected and assayed for serum AMH levels. Data were compared between women with an embryo with no cardiac activity by ultrasound (n=30) and those with a normal embryo (n=33) by using Statistica12 software. RESULTS: The 10th and 90th percentiles of serum AMH concentration among control women were used to identify a reference AMH range (1.1-4.5 ng/mL). Risk of pregnancy loss in the first trimester was found to be higher for both low AMH (<1.1 ng/mL; relative risk [RR], 3.66; 95% confidence interval [CI], 2.1-6.4; P<0.001) and high AMH (>4.5 ng/mL; RR, 3.0; 95% CI, 1.61-5.59; P<0.001). CONCLUSIONS: Both very low and very high AMH concentrations were found to significantly increase the risk of abortion in the first trimester of pregnancy. Serum AMH might be a valuable marker to predict the risk of early abortion.

The change in groin pain perception after transabdominal preperitoneal inguinal hernia repair with glue fixation: a prospective trial of a single surgeon's experience.

BACKGROUND: Although inguinal hernia is one of the most common conditions requiring surgical treatment, no reliable information is available on the quality of life of patients with inguinal hernias before surgery. Additionally, patients with intense inguinal pain prior to surgery are more susceptible to postoperative chronic pain. In such cases, less invasive laparoscopic techniques can be used, allowing atraumatic mesh fixation to reduce postoperative pain. The aim of the study was to determine, whether these treatments for patients with preoperative pain would minimize upsetting experiences after surgery. MATERIALS AND METHODS: Data were gathered prospectively from the National Hernia Repair Register for 146 patients who underwent TAPP repairs in the general surgery department (2013-2016). The demographic data were recorded, the pain intensity was determined and patients described the occurrence of pain during ten everyday activities. RESULTS: The average surgery time was 56.4 min. The follow-up was 23.4 months. The pain before surgery was 4.28 and 12 months after surgery 0.38 (p < 0.001). Pain intensity before surgery was scored as 4.1, 4.3, and 4.9 among patients who had a hernia < 12 months, > 1 year, and > 5 years, respectively (p = 0.028). Twelve months after surgery, the pain was 0.26, 0.34, and 0.40 (p = 0.037), respectively. Patients < 40 years experienced pain before the surgery more often. The intensity of pre-/postoperative pain was significantly higher < 40 years (4.9/0.63) than > 60 years (3.8/0.29). CONCLUSIONS: TAPP inguinal hernia repair with glue fixation significantly decreased the frequency and intensity of the pain compared to that experienced preoperatively. After TAPP repair, the influence of pain on basic everyday activities is substantially lower. Patients under 40 years of age experience frequent and intense pre- and postoperative pain. A longer hernia duration prior to surgery causes increased pre- and postoperative pain.

Outcomes of bridging versus mesh augmentation in laparoscopic repair of small and medium midline ventral hernias.

BACKGROUND: Bridging of the hernia defect in laparoscopic repair (sIPOM) technique does not fully restore the abdominal wall function. Closure of hernia defect in IPOM-plus technique leads to the restoration of abdominal wall function and improved long-term treatment outcomes. Against the expectations, the studies confirm the formation of intraabdominal adhesions to the mesh. Regardless of the above, the search of the proper technique for mesh implantation and fixation is still ongoing. There have also been attempts to identify groups of patients who may still benefit from IPOM procedure. MATERIALS AND METHODS: Patients with midline abdominal wall hernias up to 10 cm wide were enrolled in the study except for subxiphoid and suprapubic hernias. Between 2011 and 2014 we performed 82 hernia repairs using the laparoscopic technique with Physiomesh. Patients were divided into sIPOM and IPOM-plus groups. The study included 44M and 38F patients aged 27-84 years. After 12-months and again in August 2015 a survey was posted to all patients with questions regarding potential recurrence. RESULTS: After 12 months, eight patients (20 %) in sIPOM group reported subjectively perceived recurrence and none in IPOM-plus group (p = 0.002). Six patients (14.3 %) in sIPOM group reported suspected recurrence, as compared to three patients (7.1 %) in IPOM-plus group (p = 0.13). These patients were invited for a follow-up physical examination and sonography. Eventually, four cases of hernia recurrence were confirmed in sIPOM group (10 %) and none in IPOM-plus group (p = 0.018). Other patients presented with mesh bulging. CONCLUSIONS: Laparoscopic ventral hernia repair is generally safe and is associated with the low recurrence rate. Closure of fascial defects before mesh insertion offers better treatment outcomes. Non-closure of fascial defects with only bridging of the hernia defect (sIPOM) causes more frequent recurrence and bulging. As a result, patient satisfaction with treatment is lower, and they are concerned about hernia recurrence.

In search of the ideal patient for the intragastric balloon - short- and long-term results in 70 obese patients.

INTRODUCTION: Treating concomitant diseases in obese patients generates costs which are twice as high as the costs of the therapies in individuals with a normal weight. The conservative management of obesity involving lifestyle and dietary modifications and medical treatment shows only short-term efficacy and carries a 90% risk of recurrence. The intragastric balloon causes a permanent feeling of satiety, thus reducing the amount of food consumed by the patient. AIM: To assess the early and long-term effect of intragastric balloon treatment in obese patients. MATERIAL AND METHODS: In 2012, we performed 75 intragastric balloon procedures in obese patients. A total of 70 patients were enrolled in the study. The balloon was removed at 6 months. The patients were interviewed 2 years after removal. RESULTS: Upon balloon removal, mean total weight loss (TWL) was 15.9 kg, and excess weight loss (EWL) was 41 ±19.6% (p < 0.001). Only one patient was classified as a non-respondent. Satisfactory results (> 10% TWL) were achieved in all other patients. The mean body mass index (BMI) reduction was 5.8 kg/m(2) (15.5%) (p < 0.001). Two years later 45 patients still maintained reduced weight, 7 returned to baseline body weight, whereas 18 subjects experienced a full yo-yo effect (mean gain of 2.7 kg). During 2 years following the balloon removal, mean total weight increased by 10.9 kg, and mean BMI increased by 3.9 kg/m(2) (12.5%). A satisfactory effect (> 10% TWL) was achieved in only 19 patients. CONCLUSIONS: Obesity management with the intragastric balloon is a safe treatment method, which effectively induces weight loss. Poor tolerance and lack of response occurring in some individuals should be taken into consideration. The best results are achieved in women with class 1 obesity.

Tolerance of intragastric balloon and patient's satisfaction in obesity treatment.

INTRODUCTION: The dietary management of obesity is associated with a high failure rate. Methods which enable the long-term reduction of food intake have been developed. Patients treated with an intragastric balloon may experience some unwanted symptoms during therapy. The severity of these symptoms may result in poor tolerance of treatment, while patients who do not experience these symptoms may refuse to follow dietary modifications. In these cases, weight reduction at the end of treatment may be below expectations. AIM: To assess the tolerance of intragastric balloon treatment in obese patients as well as their satisfaction with this treatment. MATERIAL AND METHODS: Fifty-seven gastric balloon procedures were performed in 51 females and 6 males aged 17 to 65 years (39.5 ±10.7 years). Baseline weight was 104 ±14.5 kg (78-140 kg), body mass index 37.2 ±4.1 kg/m(2) (29.8-48.1 kg/m(2)), mean excess body weight 41.2 ±11.5 kg (20.4-63.1 kg). The balloon was filled with 669 ±25.8 ml of saline solution (550-700 ml). Upon balloon removal 6 months later, the patients completed a 12-question survey. RESULTS: We obtained 57 surveys. The most common symptoms included vomiting, heartburn, abdominal pain and others. Twenty-two patients reported > 2 symptoms. Two patients were symptom-free. The mean duration of symptoms was 24.8 days. Patients reported better control of hypertension, diabetes and resolution of obstructive sleep apnoea and joint symptoms. Only 14 patients did not observe any significant improvement in their bodily function. Fifty-four patients expressed satisfaction after treatment, 6 patients were dissatisfied with the weight loss, and 5 patients would not opt for balloon re-treatment. CONCLUSIONS: The balloon treatment is a safe and well-tolerated therapy with a low complication rate.