An influence of immunomodulation on Th1 and Th2 immune response in endometriosis in an animal model.

AIM: To assess the role of the Th1 and Th2 cellular response in the etiology of endometriosis observed in a rat model, with the use of the RESAN immunomodulator. MATERIALS AND METHODS: A comparative analysis of cytokines in blood serum typical of Th1 (TNF-α and INF-γ ) and Th2 (IL-4, IL-6, IL-10) cell response in groups of rats, in which RESAN preparation was used as prophylaxis (Gr. I) or treatment (Gr. II) of endometriosis. RESULTS: The results indicated an increase in the level of cytokines in blood serum typical of Th2 cell response by comparing the second and third stages of the experiment in the second group of rats and a decrease in IL-4 and IL-10 between III and IV stages. There was a significant difference in cytokine levels during the third stage of the experiment by comparing I and II groups of rats. In the III group of rats, levels of IL-10 significantly increased between the II and III stages of the experiment. CONCLUSION: RESAN preparation shows Th2 cell response, inhibiting the development of endometriosis in a rat model. Due to successful prophylactic action, one may speculate that RESAN vaccine may be effective as a complementary treatment after surgical excision.

Bilateral androblastoma (Sertoli-stromal cell tumor) of the ovary: a rare cause of virilization in a teenager.

A case of a 17-year-old patient diagnosed with bilateral androblastoma of the ovary is presented. The patient was admitted because of secondary amenorrhea, hirsutism and acne. After clinical, ultrasonographic and hormonal examinations an androgen-producing ovarian tumor was suspected and consequently laparotomy with right ovarian tumor excision and left ovary exploration was carried out. During surgery the right ovarian tumor was excised and exploration of the left ovary revealed an ovarian tumor with a diameter of 10 mm, which was then also excised. The pathologic diagnosis was a bilateral androblastoma of the ovary measuring 40 mm x 30 mm x 20 mm in the right ovary and 10 mm in diameter in the left ovary. We concluded that androblastomas, in spite of their low incidence, are a possibility that should always be considered in women of all ages presenting with signs of virilization.

Changes in ultrasound shear wave elastography properties of normal breast during menstrual cycle.

UNLABELLED: Elastography is a novel technique capable of noninvasively assessing the elastic properties of breast tissue. Because the risk factors for breast cancer include hormonal status and proliferation, the aim of our study was to estimate the intensity of sonoelastographic changes during the menstrual cycle. METHODS: Eight women aged 20-23 years with regular menstrual cycles underwent B-mode sonography and sonoelastography (ShearWave on Aixplorer, France) on days 3, 10, 17 and 24. RESULTS: Mean values of glandular and fat tissue elasticity did not change statistically significantly during the menstrual cycle as well as glandular to fat tissue ratio. During almost the whole cycle differences between outer and inner quadrants in glandular and fat tissue were statistically significant. The lowest values of elasticity occurred on the 10th day and the highest on the 24th of the menstrual cycle. There were statistically significant differences in elasticity between inner and outer quadrants of both breasts close to day 3 and 17 of the menstrual cycle.

Use of shear wave sonoelastography in capsular contracture before and after secondary surgery: report of two cases.

We present two cases of patients undergoing secondary surgery due to Baker III and IV contracture, with detailed sonoelastography evaluation before and after the surgery. It is probably the first case where the use of sonoelastography has enabled plane colour-coded analysis of regions with different stiffness (Young moduli, kPa). The obtained results have been compared with applanation tonometry.

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.

Evaluation of soluble intracellular adhesion molecule-1 (sICAM-1) in benign and malignant ovarian masses.

PURPOSE: To evaluate serum ICAM-1 levels preoperatively in patients with ovarian masses. METHODS: Estimation by ELISA assay in 101 women with pelvic tumours and 16 healthy controls was performed. Correlations of sICAM-1 levels with CA-125, Tumour Volume Index, morphological score and pathological findings were studied. RESULTS: Fifty-one ovarian tumours were malignant, five were borderline and 45 benign. Mean levels of sICAM-1 were respectively, 311.1 +/- 182.9 ng/ml, 172.6 +/- 40.1 ng/ml, 241.8 +/- 74.1 ng/ml and 195.6 +/- 68.7 ng/ml for controls. The area under ROC curve for sICAM-1 was 0.72 (95% CI 0.58-0.82), the cut-off 250 ng/ml, corresponding to 81.3% sensitivity and 52.9% specificity. Serum ICAM-1 correlated with morphological score (r = 0.51, p < 0.001), but not with FIGO stage, tumour grade, Tumour Volume Index and CA-125. CONCLUSION: sICAM-1 concentrations are higher in patients with malignant tumours, but poorly correlate with clinical status. The clinical use alone in ovarian malignancy detection and tumour differentiation seems to have limited application. Combinations of CA-125 and sICAM-1 could improve the test characteristics.

Bleeding from endometrial and vaginal malignant tumors treated with activated recombinant factor VII.

The authors report two cases of successful employment of human recombinant activated factor VII in gynecological oncological patients (endometrial cancer and vaginal sarcoma) without pre-existing coagulopathy. They conclude that recombinant factor VIIa may be an important and effective drug in severe bleeding in gynecological oncology.

[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.

[Coexistence of female sexual organ malformation and urinary tract anomalies]. / Wspólwystepowanie wad zenskich narzadów plciowych z anomaliami rozwojowymi ukladu moczowego.

OBJECTIVES: The aim of the study was to estimate the correlation between sexual organs and urinary tract malformation. MATERIALS AND METHODS: The retrospective analysis of clinical data obtained from 50 patients with sexual organs anomalies diagnosed in the Academic Gynaecological Centre between 1992-1999 was performed. RESULTS: Material included 24 patients with the Meyer-Rokitansky-Küster-Hauser syndrome and 26 with other sexual organs' malformations. Frequency of urinary tract anomalies was 42%, 11 patients with Meyer-Rokitansky-Küster-Hauser syndrome and 11 with other malformations. The gravity of urinary tract anomalies showed no statistical significant difference dependent on the type and symmetry of genital malformation. Urinary tract anomalies were more frequent in cases of asymmetric genital malformation and the difference was statistically significant. CONCLUSIONS: Intravenous urography proofed to be more sensitive than ultrasonography in diagnosing urinary tract anomalies.

[Treatment of condylomata acuminata of the male reproductive organs with CO2 laser under colposcopic control]. / Leczenie klykcin konczystych meskich narzadów plciowych laserem CO2 pod kontrola kolposkopowa.

The first results of laser therapy in treatment of condylomata acuminata of male reproductive organs are reported. Between November 1991 and December 1993 in Department of Reproduction, Institute of Gynecology and Obstetrics, Karol Marcinkowski University School of Medical Sciences, Poznan in nine patients with condylomatous changes of reproductive organs CO2-laser therapy under colposcopic control was done. In 7 of them the healing was achieved. In two patients second laser therapy was done. All patients are still under control in Department of Reproduction and there was no recurrence diagnosed.

[Use of CO2 laser in the treatment of condylomata acuminata of the anogenital region in pregnant women]. / Zastosowanie lasera CO2 w leczeniu klykcin konczystych narzadów plciowych i okolicy odbytu u kobiet ciezarnych.

The first results of treatment of condylomata acuminata of anogenital region in 11 pregnant women were presented. The analysis were made in Department of Reproduction, Institute of Gynecology and Obstetrics, Academy of Medicine, Poznan. All patients were treated between 28 and 35 week of pregnancy. After first laser-therapy the healing achieved in 9 women. The second lasertherapy was required in 2 patients. It was done after 3 weeks. Complete destruction of pathological changes was obtained. All women had vaginal delivery and no complications (connected with HPV infection) in their newborns were found. The authors said that CO2-lasertherapy under colposcopic control is a reliable method for treatment of condylomata acuminata in pregnant women.

[Prognostic value of vaginal ultrasound with color Doppler in differentiating the malignancy of ovarian tumors]. / Wartosc prognostyczna ultrasonografii dopochwowej z kolorowym Dopplerem w róznicowaniu charakteru zlosliwosci guzów jajnika.

The authors presented results of research on pathological vascularization in ovarian tumors by Doppler's method. 60 records of blood flow were analysed to estimate: pulsation index (PI) and resistance index (RI). Among benign ovarian tumors (26 cases) PI was 1.82 +/- 0.93 and RI 0.93 +/- 0.36. On the contrary, for malignant neoplasms (11 cases) the blood flow was low resistance PI: 0.89 +/- 0.38 and RI: 0.44 +/- 0.19.

[Point CO2 laser vaporization in treatment of superficial endometriosis of the uterine cervix]. / Waporyzacja punktowa laserem CO2 w leczeniu endometriozy powierzchownej szyjki macicy.

The study showed the treatment of superficial endometriosis of the uterine cervix in 54 women between November 1991 and January 1994. After first vaporisation 43 patients were cured successfully. In 8 cases vaporisation should be repeated and in 3 women the operation should be performed for the third time. All patients are still under control in our department and there is no recurrence observed.