Sonoelastography in the evaluation of capsule formation after breast augmentation - preliminary results from a follow-up study.

INTRODUCTION: There are many indications for breast augmentation, including reconstruction after mastectomy, correction of congenital disorders and cosmetic procedures. The most frequent local complication of this surgery is capsule formation due to fibrosis. The aim of the study was to assess the usefulness of sonoelastography in the evaluation of capsule formation around silicone implants. MATERIAL AND METHODS: The study group included 13 patients aged 20 to 41, who underwent breast augmentation with silicone implants. Their 26 breasts were examined before surgery, 7 and 14 days and a minimum of 8.5 months after surgery. The breast stiffness was assessed with tonometry and shear wave elastography to evaluate elasticity of the breast tissue and capsule formation after surgery. RESULTS: We assessed the correlation between capsular elasticity measured at successive visits and the Baker scale. There were no significant relationships between any pairs of variables (p > 0.05). We also analyzed the correlation between the time of the follow-up and changes in the tissue elasticity of every region - no significant relationship was found. The greatest decrease in pericapsular elasticity was established in lower and inner quadrants. Moreover, there was a significant difference between the elasticity of the tissue before and 1 week after surgery (p < 0.05) and no significant changes in the elasticity before surgery and at the end of the follow-up. CONCLUSIONS: Sonoelastography is precise in evaluation of capsule formation after breast augmentation. It may show changes that cannot be assessed using palpation.

Recurrent fetal complex ovarian cysts with rupture followed by simple cyst in the neonatal period with no adverse sequelae.

Fetal ovarian cysts are the most frequent type of abdominal tumors in female fetuses with prenatal detection rate of more than 30%. The etiology of fetal ovarian cysts is unclear, but hormonal stimulation as well as presence of maternal diabetes, hypothyroidism, Rh iso-immune hemolytic disease and toxemia has been generally considered responsible for the disease. Complications of fetal ovarian cysts include compression of other viscera, cyst rupture, hemorrhage and, most frequently, ovarian torsion with consequent loss of the ovary. Management is controversial with several options described in the literature, including watchful expectancy, antenatal aspiration of simple cysts to prevent torsion and ovarian loss and finally, resection of all complex cysts in the neonatal period. To date, no case report has described recurrent complex cysts with rupture in the fetal period and recurrence of simple cyst in neonatal period. By presenting this case, we wanted to show that surgical intervention in case of prenatally diagnosed fetal ovarian cyst should be considered postnatally and only in symptomatic or complicated cases.

[Human papilloma virus genotyping in women with abnormal cytology]. / Ocena genotypów wirusów brodawczaka ludzkiego u kobiet z nieprawidlowa cytologia.

OBJECTIVE: To assess presence of HPV infection and identification of the most common HPV types in patients with abnormal cytology based on the Bethesda system (atypical squamous cells). MATERIAL AND METHOD: 81 women with abnormal cytology based on the Bethesda system (atypical squamous cells) were qualified for the study. Material was taken from the cervical canal, the vaginal portion of the cervix and the vagina onto a liquid medium to detect HPV DNA and genotyping of 19 most common oncogenic types of high and medium risk was performed with the Papillomastrip method and for HPV types 6 and 11 with the PCR method. RESULTS: HPV was detected in 53 out of 81 examined women, which accounted for 66%. The most common HPV types were: 6/11 - 23 cases (43% of women with infection), 16 - 23 cases (43% of women with infection), 18 and 33 with 9 cases each (17% of women with infection). Coexistence of 6/11 with 16 or 18 - 13 concerned 15 patients (28% of women with infection) and presence of HPV 16 or 18 was detected in 28 cases (53% of women with infection). Positive HPV type contained in the quadrivalent vaccine against human papillomavirus 6/11 and 16 or 18 was detected in 38 patients (72% of women with infection). 40% of HPV positive women were infected with only one type of the virus, 26%--with two types and 23% with three types. CONCLUSION: In 81 women with abnormal cytology based on the Bethesda system (atypical squamous cells) within 66% of HPV positive results the most common were type 6/11 (of low oncogenic potential but responsible for anogenital warts) and type 16 of high oncogenic potential.

Knowledge assessment of women living in the Wielkopolska region concerning risk factors for cervical cancer.

INTRODUCTION: Cervical cancer (CC) is a malignant tumor which for many years has been a serious epidemiological problem in Poland. This issue is important because CC is the second most common type of malignant tumor, after breast cancer, and the second most common cause of death among women. The aim of this study was to assess the knowledge and awareness of women living in the Wielkopolska region (Gniezno district) of risk factors for cervical cancer. MATERIAL AND METHODS: The study used the diagnostic poll method, based on a previously developed survey questionnaire. The study was carried out between March and April 2013. The study group consisted of 100 women, involving schoolgirls from the secondary school in Gniezno (Group I), workers (doctors, nurses and midwives) of two outpatient clinics in the Gniezno district (Group II) and patients of the same clinics (Group III). RESULTS: According to the respondents, the main cause of CC is human papillomavirus (Group II - 36%) and genetic predisposition (Group III - 35%). It is alarming that 26% of women did not know the risk factors for CC. CONCLUSIONS: It is necessary to improve health education, especially concerning the main factors affecting the development of CC, in order to reduce the morbidity and mortality rates related to this cancer.

Impact of heavy metals on the female reproductive system.

INTRODUCTION: It has been recognized that environmental pollution can affect the quality of health of the human population. Heavy metals are among the group of highly emitted contaminants and their adverse effect of living organisms has been widely studied in recent decades. Lifestyle and quality of the ambient environment are among these factors which can mainly contribute to the heavy metals exposure in humans. OBJECTIVE: A review of literature linking heavy metals and the female reproductive system and description of the possible associations with emission and exposure of heavy metals and impairments of female reproductive system according to current knowledge. RESULTS: The potential health disorders caused by chronic or acute heavy metals toxicity include immunodeficiency, osteoporosis, neurodegeneration and organ failures. Potential linkages of heavy metals concentration found in different human organs and blood with oestrogen-dependent diseases such as breast cancer, endometrial cancer, endometriosis and spontaneous abortions, as well as pre-term deliveries, stillbirths and hypotrophy, have also been reported. CONCLUSIONS: Environmental deterioration can lead to the elevated risk of human exposure to heavy metals, and consequently, health implications including disturbances in reproduction. It is therefore important to continue the investigations on metal-induced mechanisms of fertility impairment on the genetic, epigenetic and biochemical level.

[Chromosomal aberrations--the cause of spontaneous abortions]. / Aberracje chromosomowe jako przyczyna poronien samoistnych.

UNLABELLED: The genetic factor remains the most frequent cause of spontaneous abortions. Examination of the fetal tissue from spontaneous miscarriages shows that 75% of them were caused by abnormal karyotype. Other reasons, albeit rare, included submicroscopic genomic rearrangements, monogenic diseases, and polygenic inheritance disorders of the embryo. OBJECTIVE: The aim of the study was to analyze the incidence of chromosomal aberrations in material from the miscarriage. MATERIAL AND METHODS: The study included 47 samples of miscarriage material from 47 women. Fluorescent hybridization in-situ (FISH) was used for genetic examination. RESULTS: Chromosomal abnormalities were diagnosed in 72% of the samples, with trisomy 21 (25.5%), trisomy 16 (17%), and trisomy 18 (12.8%) as the most common. An abnormal number of copies of chromosome 18, 21, 22, indicating the coexistence of trisomy 18, 21, 22, was detected in 1 patient. It was another miscarriage in case of 14 subjects (29.8%). CONCLUSIONS: Chromosomal aberrations were diagnosed in the majority of fetal tissue samples from spontaneous miscarriages. More than one chromosomal aberration in a single embryo is an extremely rare occurrence. Miscarriage due to chromosomal aberrations occurred in the vast majority of women > 35 years of age.

Assessment of pain and stress intensity among women with ovarian endometriomas versus teratomas.

BACKGROUND: In recent years, numerous studies have considered endometriosis to be a subclinical, local inflammatory process in the pelvic peritoneum, the main symptom of which is pain. OBJECTIVES: To assess pain intensity and pain-related stress in women with ovarian endometriomas versus teratomas. METHODS: In total, 860 women (18 to 38 years of age) treated laparoscopically for lesions in the adnexa between September 2006 and November 2013 were included in the present study. After an intraoperative review of their histopathological lesions, the patients were divided into two study groups: group E (n=480), with histopathologically confirmed ovarian endometriomas; and group T (n=380), after laparoscopic treatment of ovarian teratomas. A questionnaire was generated for the study and completed by each group. Statistical analysis was performed using the Mann-Whitney U test (P≤0.05). RESULTS: Median pain scores for group E versus group T were as follows: pain during menstruation, 6 versus 3 (P=0.001); pain outside of menstruation (in professional life), 2 versus 2 (P=0.014); and pain during sexual intercourse, 3 versus 1 (P=0.006). Pain-related stress scores were higher in group T versus group E (5 versus 3; P=0.007). CONCLUSION: Ovarian endometriomas caused more pain than ovarian teratomas, likely due to the endometrial tissue component and not a mass effect. The assessment of pain and pain-related stress associated with the pelvis minor showed a high level of pain intensity and lower level of pain-related stress among patients with ovarian endometriomas.

Novel markers in the diagnostics of endometriomas: Urocortin, ghrelin, and leptin or leukocytes, fibrinogen, and CA-125?

OBJECTIVE: CA-125 protein is used as a marker in clinical practice for the diagnosis of endometriomas. The aim of this study was to determine whether endometriomas are accompanied by an increased level of urocortin, ghrelin, and leptin, as well as the increased parameters of blood cell count, fibrinogen, and CA-125. MATERIALS AND METHODS: The study included 86 women aged 18-38 years who had been treated laparoscopically for lesions in the adnexa with the characteristics of endometriomas and mature teratoma, during the period September 2009 to November 2012. The statistical analysis was performed using the nonparametric Mann-Whitney U test and the Spearman rank correlation coefficients (p ≤ 0.05). RESULTS: The medians were 105.31 pg/mL versus 120.84 pg/mL for urocortin, 7.16 pg/mL versus 9.13 pg/mL for leptin and 584.33 pg/mL versus 657.82 pg/mL for ghrelin (p > 0.05), respectively. Analyzing the parameters of blood cell count, statistically significant differences were shown in the respective groups for leucocyte level (5.35 × 10(9)/L vs. 6.7 × 10(9)/L; p = 0.029), fibrinogen level (3.12 mg% vs. 2.57 mg%; p = 0.001), and CA-125 (36.50 U/mL vs. 15.08 U/mL; p = 0.001). CONCLUSION: In conclusion, the prognostic values for CA-125, leukocytes, and fibrinogen may prove a very useful tool for the diagnosis of lesions in the adnexa of the type endometriomas.

The interaction between menstrual cycle, Tumour Necrosis Factor alpha receptors and sex hormones in healthy non-obese women--results from an observational study.

There is growing evidence that TNF-alpha and its two receptors play an important role in hormonal regulation, metabolism, inflammation and cancer. The biological effects of TNF-alpha are mediated by two receptors, p55 and p75. The aim of this study was to analyze serum concentrations of p55 and p75 and hormonal status in healthy women during the normal menstrual cycle. Eight women aged 20-22 with regular menstrual cycles were scheduled for examination on 3(rd) , 8(th) , 14(th) and 25(th) day of their menstrual cycle. We only observed a positive correlation of p75 subunit with prolactin level (correlation coefficient 0.417; p=0.0116) and negative correlation with insulin level (correlation coefficient -0.35; p=0.032) and HOMAIR insulin resistance index correlation coefficient 0.39; p=0.0185). Furthermore, a negative correlation of p55/p75 ratio with prolactin (correlation coefficient -0.42; p=0.0101) and a positive correlations of p55/p75 ratio with insulin level (correlation coefficient 0.43; p=0.008) and HOMAIR insulin resistance factor correlation coefficient 0.45; p=0.0065) were found.

Emotional changes occurring in women in pregnancy, parturition and lying-in period according to factors exerting an effect on a woman during the peripartum period.

INTRODUCTION: Pregnancy, parturition and childcare, which are important moments in a woman's life, are connected with many emotional states of a future mother, a pregnant woman and a lying-in woman. The perinatal period is the time when the risk of psychological disorders in a pregnant woman may increase by even several times. Objective. The objective of the study was recognition of the main emotional and psychological changes in pregnant women, those in labour and lying-in, according to the factors occurring during the peripartum period. MATERIAL AND METHOD: The study was conducted in the form of a survey and covered a group of 108 mothers who were hospitalized in gynaecological-obstetric and obstetric wards in the Karol Marcinkowski Gynaecological-Obstetric University Hospital in Poznan. RESULTS: There are a number of factors which may exert a negative effect on the emotions of women in pregnancy, parturition, and during lying-in. The study showed that there is a close relationship between the occurrence of these factors and emotional states of the mothers after giving birth. CONCLUSION: Special attention should be given to women in whom already during pregnancy factors arise which may have a negative impact on their mental state. Emotions during pregnancy, parturition and lying-in are often quite extreme, and achieve a high intensity, as well being very variable within a short period of time.

[Fetal Escobar syndrome--a case report]. / Zespól Escobara u plodu--opis przypadku.

The Escobar variant of multiple pterygium syndrome (MPS) is a rare, autosomal recessive disorder which may lead to many serious or even lethal fetal abnormalities. MPS is characterized by pterygia, arthrogryposis (joint contractures), and intrauterine growth restriction (IUGR). In the case described below, increased fetal nuchal translucency was the first abnormality diagnosed already in the first trimester of pregnancy. Other symptoms of the disease were found during the second trimester of pregnancy using ultrasonography examination. Also, genetic amniocentesis revealed no genetic disorders and the Escobar syndrome was diagnosed post mortem. Parental and maternal genetic examinations were performed and allowed for early prenatal diagnostics in the next pregnancy resulting in the birth of a healthy newborn.

[Breast elastography--new diagnostic quality or technologic bubble]. / Elastografia gruczolu piersiowego--nowa jakosc w diagnostyce czy technologiczna banka mydlana.

Breast elastography consist of static and dynamic method. The paper deals with morphologic characterization of breast lesions and typical symptoms like: mass ventralisation, size change, switch-off sign and posterior boundary imaging. The recent studies of dynamic elastography implementation into breast cancer screening are presented. In the shear wave elastography red colour, irregular shape or maximum stiffnes above 160kPa the upgrade from BIRADS 3 to 4a should be made. If the lesion is homogenous, blue and with stiffness < 80kPa them safe downgrade to BIRADS 3 could be considered.

Endometriosis in a post-laparoscopic scar--case report and literature review.

Endometriosis is an estrogen-dependent, chronic disease consisting in implantation and hyperplasia of the endometrium outside of the uterine cavity Endometriosis in post-laparoscopic scars applies to approx. 0.5-7% of the extraorganic locations of the disease. The purpose of the paper was to describe medical management and literature review for endometriosis in a post-laparoscopic scar. Two lesions located near the insertion site for the lower trocars were removed along with the border of healthy tissue. At the time of publication of this paper the patient did not report any complaints. In conclusion, each limited lesion in the subcutaneous tissue, with pain intensifying during menstruation, should suggest an initial diagnosis of scar endometriosis, regardless of patient age and type of surgery

Practical aspects of change management at the Obstetrics and Gynecology Clinic at the University Hospital of Medical Sciences in Poznan, Poland.

INTRODUCTION AND OBJECTIVES: Recent changes to the Polish healthcare system have forced healthcare managers and administrators to implement modern instruments for strategic and operations management. The main aim of the study was to analyze the effect of managerial decisions in the area of human resources, resulting from the adopted restructuring program, on the economic situation of the OGCH, PUMS. MATERIAL AND METHODS: The research material comprised of secondary sources on finance, accounting and human resources data: financial statements, analysis of costs incurred by individual hospital departments, reports on the implementation of NHF contracts for providing health services and on hospital workforce at the time of the study, as well as the results of patient satisfaction survey at the OGCH, PUMS. RESULTS: After implementation of the restructuring program all clinics apart from one - Surgical Gynecology Clinic - reached better beds occupancy rates in 2012 as compared to 2009, as well as significantly improved profit/per hospital bed. Over the course of three years, since the launch of the hospital restructuring program, a significant (20%) increase in the revenues from selling healthcare services and a simultaneous decrease (2%) of the operating cost was observed. CONCLUSIONS: Inclusion of department heads into the decision making processes of managerial accounting seems to be necessary to improve the overall financial condition of a hospital. However, it requires a more flexible hospital structure, what can be achieved by implementing a divisional organizational structure, which grants individual organizational units a certain autonomy in the process of making medical-financial decisions.

The role of ghrelin, leptin and insulin in foetal development.

INTRODUCTION AND OBJECTIVE: The growing epidemic of childhood obesity has forced scientists to search for methods to prevent feeding disorders. Increasing interest in appetite regulating hormones has revealed their influence on energy homeostasis after birth or even in utero. STATE OF KNOWLEDGE: The presence of ghrelin in the stomach of human foetuses and the distinctive production in the pancreas of neonates suggests the role of ghrelin in pre- and post-natal development. The neonatal period appears to be a critical time for the formation of adipose tissue-hypothalamus circuits, thus the amount of adipocytes in foetal life may be a major regulator of food intake. Insulin's orexigenic effect in the arcuate nucleus of the hypothalamus can be a major modulator of foetal development. OBJECTIVE: This review, based on available literature, aims to analyses the role of appetite regulating hormones in foetal development. SUMMARY: Different concentrations of hormones, such as ghrelin, leptin and insulin during foetal life raises the question whether or not they can be modulated, thereby avoiding obesity before birth. Children with pancreas agenesis showed smaller body size at birth, which emphasises the probable role of insulin in foetal growth. Study of sheep foetuses with IUGR confirmed these finding. Appetite-regulating hormones show different roles in foetal development and seem to be essential in the perinatal period.

Material awareness on natural feeding.

INTRODUCTION: Natural breastfeeding is the only proper way to feed newborns and infants because it ensures their proper development. Breastfeeding enhances health and protects against the development of many diseases in childhood and adulthood. The primary benefits of breastfeeding include reduced incidences of infection in the respiratory system as well as a reduction in gastrointestinal and systemic infections. The benefits of breastfeeding also include decreased inflammation and improved immunity to disease in the infant. Further benefits of breastfeeding are reduced incidences of type 1 diabetes, Crohn's disease, and rheumatoid arthritis. OBJECTIVE: The aim of the study was to assess the degree of knowledge on maternal breastfeeding among current expecting mothers. MATERIALS AND METHOD: The study comprtisded 147 mothers hospitalized in the Gynecology-Obstetrics Hospital University of Medical Sciences in Poznan, Poland, during late July - August 2012. RESULTS: For 139 (93.88%) of the surveyed women, breastfeeding was a priority regarding the health of the child. Respondents most often used professional literature in order to gain knowledge about breastfeeding (63.27%). The least popular way of acquiring knowledge was through the media (27.21%). CONCLUSIONS: Analysis of the collected material on the surveyed women showed that women have a diverse range of knowledge about breastfeeding. Currently, breastfeeding is required to be promoted and supported by midwives, paediatricians and other health professionals.

Metal status in human endometrium: relation to cigarette smoking and histological lesions.

Human endometrium is a thick, blood vessel-rich, glandular tissue which undergoes cyclic changes and is potentially sensitive to the various endogenous and exogenous compounds supplied via the hematogenous route. As recently indicated, several metals including Cd, Pb, Cr and Ni represent an emerging class of potential metalloestrogens and can be implicated in alterations of the female reproductive system including endometriosis and cancer. In the present study, we investigated the content of five metals: Cd, Cr, Ni, Pb and Zn in 25 samples of human endometrium collected from Polish females undergoing diagnostic or therapeutic curettage of the uterine cavity. The overall mean metal concentration (analyzed using microwave induced plasma atomic emission spectrometry MIP-OES) decreased in the following order: Cr>Pb>Zn>Ni>Cd. For the first time it was demonstrated that cigarette smoking significantly increases the endometrial content of Cd and Pb. Concentration of these metals was also positively correlated with years of smoking and the number of smoked cigarettes. Tissue samples with recognized histologic lesions (simple hyperplasia, polyposis and atrophy) were characterized by a 2-fold higher Cd level. No relation between the age of the women and metal content was found. Our study shows that human endometrium can be a potential target of metal accumulation within the human body. Quantitative analyses of endometrial metal content could serve as an additional indicator of potential impairments of the menstrual cycle and fertility.