Breastfeeding history and the risk of overweight and obesity in middle-aged women.

BACKGROUND: The increased metabolic activity required to sustain breastfeeding and its associated milk production helps to reduce maternal fat stores accumulated during pregnancy. This study aims to assess the association between breastfeeding duration and fatness indices in middle-aged women. METHODS: The analysis was carried out in a group of 7500 parous 55.5 ± 5.3 year old women included body mass index, body fat percentage, and waist-to-height ratio. The likelihood of excessive weight or obesity in relation to total breastfeeding time using multivariate logistic regression analyses. RESULTS: An analysis of adjusted odds ratios did not show significant associations between breastfeeding duration and the risk of excessive weight and obesity in premenopausal women. After menopause, women who gave birth to 2 children and breastfed 1-6 and > 12 months had a lower risk of abdominal obesity (OR 0.70; 95% CI 0.50-0.99; p = 0.042; and OR 0.68; 95% CI 0.47-0.98; p = 0.039). Women who gave birth to 3 or more children and breastfed for 1-6 months, also showed a lower risk of overweight (OR 0.52; 95% CI 0.27-0.99; p = 0.047), compared to those ones that have never breastfed. There was no relationship found between the duration of lactation and the risk of excessive body fat. CONCLUSION: Breastfeeding may have some beneficial, long-term effect on the risk of excessive weight and abdominal obesity in women.

Splanchnic Vein Thrombosis in Acute Pancreatitis and Its Consequences.

Splanchnic vein thrombosis (SVT) is a serious vascular complication that can occur in patients with acute pancreatitis. We assessed the incidence of SVT and its relationship with acute pancreatitis (AP) and associated complications. We carried out a retrospective analysis of medical histories from patients hospitalized with AP in a single surgical center. Histories were acquired from patients with abdominal and pelvic computed tomography scans performed between the 2nd and 3rd day of hospitalization. We assessed the impact and extent of thrombosis over the disease course. We found a strong positive correlation (Cramer's V coefficient = 0.34) between SVT and disease severity. Mortality in the study group was 7.2% (8 patients) of which 5 patients (62.5%) were diagnosed with SVT. We observed an increased incidence of death among patients with thrombosis, with results approaching significance (P = 0.056). In our study, we found that SVT has a negative effect on the course of AP and is associated with more severe disease and increased mortality.

Plasma sICAM levels during standard exercise test are higher in postmenopausal women with mixed hyperlipemia. sICAM level in postmenopausal women.

Aim: Plasma sICAM, sVCAM, endothelin- 1 (ET-1), TNF-a, its soluble receptor levels and nitric oxide production evaluation during standard exercise test in postmenopausal women with mixed hyperlipidemia. Material and methods: 35 white, normotensive, non-smoking, postmenopusal women. Group A consisted of 24 women normal plasma cholesterol and triglicerides. Group B- 11 women hypercholesterolemic and hypertrigliceridemic. Basic fasting plasma FSH, 17b- -estradiol, total cholesterol, LDL-cholesterol, triglicerides, HDL-cholesterol were measured. Standard exercise test was carried out according to Bruce protocol. During the test blood samples were taken trice (prior to, at peak exercise, at15th minute of recovery). The sICAM, sVCAM, ET-1, TNF-a, its soluble receptor and secretion of nitric oxide were measured. Statistical analysis: Fisher test and t-Welch test were used. Results: There were no differences between groups A and B in mean plasma concentrations of FSH, estradiol and HDL-cholesterol. Mean plasma total cholesterol, triglicerides and LDL-cholesterol levels were higher in group B compared to group A. Plasma levels of sICAM prior to standard exercise test, at peak exercise and at the 15th minute of recovery were significantly lower in group A compared to group B. Mean plasma sVCAM levels did no differ between groups. NO3 plasma levels was significantly higher at peak exercise in group B compared to group A. There were no significant differences between groups in regard to mean plasma NO2, endothelin-1, TNF-a, and TNF-a receptor levels. Conclusion: Plasma soluble intracellular adhesion molecules levels are higher at rest and during exercise in postmenopausal women with atherosclerosis risk factors.

Evening not morning plasma cortisol level is higher in women with polycystic ovary syndrome.

INTRODUCTION: The aim of our study was to assess the morning and evening cortisol plasma levels in women with polycystic ovary syndrome (PCOS). MATERIAL AND METHOD: 95 patients gave their informed consent to participate in the study and were divided into 2 groups. Group A consisted of 40 PCOS patients and group B consisted of 55 women without features of PCOS. Between day 5 and 8 of the menstrual cycle, morning (7 am), fasting blood samples were taken for the assessment of luteinizng hormone (LH), follicle stimulating hormone (FSH), estradiol, cortisol, prolactin, thyreotropin (TSH), testosterone and dehydroepeiandrosterone (DHEAS). Evening (5 pm) blood samples were also taken for the evaluation of plasma cortisol level RESULTS: There were no differences in mean age, body mass index (BMI), FSH, SHBG, PRL, estradiol and TSH levels between group A and group B. Mean plasma LH level was higher in group A compared to group B (10.7 ± 6.8 IU/l vs 6.6 ± 4.5 LU/l, p < 0.02). Mean plasma testosterone and DHEAS levels were also higher in PCOS patients (3.8 ± 0.6 nmol/l vs 1.63 ± 0.6 nmol/l; 427.7 ± 162.9 vs 236.6 ± 97.8 respectively, p < 0.001). Mean evening plasma cortisol level was higher in PCOS patients (11.8 ± 4.1 ug/dl vs 4.7 ± 1.3 ug/dl, p < 0.02). Mean morning plasma cortisol levels did not differ between groups. CONCLUSION: PCOS women showed the increased evening plasma cortisol level with impacted diurnal secretion rate.

[Cyclic Cushing's Syndrome - rare or rarely recognized]. / Cykliczny zespól Cushinga - rzadki czy rzadko rozpoznawany?

Cyclic Cushing's syndrome is a type of Cushing's disease which is characterized by alternating periods of increasing and decreasing levels of cortisol in the blood. The diagnostic criteria for cyclic Cushing's syndrome are at least three periods of hypercortisolism alternating with at least two episodes of normal levels of serum cortisol concentration. The epidemiology, signs, symptoms, pathogenesis and treatment of cyclic Cushing's syndrome have been discussed.

[The disturbances of the thyroid hormone homeostasis caused by chemical substances occurring in natural environment]. / Wielopoziomowe zaklócenia homeostazy hormonów tarczycy spowodowane przez substancje chemiczne wystepujace w srodowisku naturalnym.

The thyroid is an endocrine gland synthesizing, storaging and secreting thyroxine (T4) and triiodothyronine (T3). Currently, there are more and more reports and evidences that various chemical contaminants present in the environment, mainly polychlorinated biphenyls, interfere with stages of regulation, synthesis, secretion, transport of thyroid hormones. That can have a significant negative impact on the human body's endocrine homeostasis.

Age, place of living and education influences the pregnancy universal thyroid function screening program attendance - questionnaire study.

BACKGROUND: The aim of this study was to assess attendance at the universal screening programme for thyroid function in pregnancy and attempt to evaluate the influence of age, number of past pregnancies, level of education, and place of residence on the attendance. The study was performed by means of a questionnaire. MATERIAL AND METHODS: Our study was performed on the basis of an anonymous questionnaire handed out to 543 women aged 16-45 years, on the third day of their puerperal stay in one of five obstetric wards in southern Poland. The questionnaire contained questions about participation in plasma level measurements of TSH, fT4, total T4, thyroid antibodies or thyroid ultrasound scanning at least once in pregnancy. RESULTS: The rate of attendance at any examination of thyroid function among pregnant women was 26.7%. The highest attendance rate (32.7%) was found among women living in provincial capitals or with higher education (41.3%), whereas the lowest was among women who had completed only primary school (11%) and those living in county towns (15%). The number of previous pregnancies did not influence the thyroid screening attendance. Women over 21 years of age participated in this screening programme more frequently (27.1-30%). CONCLUSION: Less than one third of pregnant women participated in the thyroid function screening. Place of living, education level, and age were the main factors influencing the attendance rate.

[Placenta endocrine function influence on fetal hypothalamo-hypophyseo-thyroid axis]. / Czynnosc endokrynna lozyska a os podwzgórzowo-przysadkowo-tarczycowa u plodu.

The conteporary views on the influence of placenta on the fetal hypothalamo-hypophyseo-thyroid axis has been given. The role of hCG, estrogens, deiodineses, transfereses and arylosulphateses has been presented. Transthyretin role has been mentioned.

[The role of thyroid antibodies in the pathogenesis of the infertility and miscarriage]. / Rola przeciwcial przeciwtarczycowych w potencjalnej przyczynie nieplodnosci i poronien.

There are discordant opinions about the influence of subclinical hypothyroidism to the fertility of the women. No unequivocal opinion has been presented concerning the purposefulness of the diagnostics process and treatment of the pregnant women with subclinical hypothyroidism. Few clinical studies suggest that there is a connection between thyroid antibodies and infertility, spontaneous miscarriages, implantation failures and fetal malformations.

Intake of iodine-containing multivitamin preparations by pregnant women from the Krakow region of Poland.

BACKGROUND: The aim of this study was to evaluate the number of women who take multivitamin formulations containing iodine. MATERIAL AND METHODS: A 34-question questionnaire was given to 500 women during their puerperal stay in two obstetrics/gynaecology wards in Krakow. RESULTS: 295 pregnant women (59%) took iodine-containing formulations. 205 pregnant women (41%) took multivitamin preparations without iodine. 49.7% of the women (91 out of 183) who inhabited rural areas and small towns were not supplemented with iodine during pregnancy. Women in Krakow took iodine-containing multivitamin formulations in 61.2% of cases. Women with primary and secondary education did not use iodine supplementation in 48.3% and 50.3% of cases respectively. Women with a university education did not use supplementation in 38.6% of cases. The prevalence of women using iodine-containing multivitamin preparation was similar in each age group. CONCLUSIONS: The promotion of iodine supplementation to pregnant women should be augmented at each level of contact with medical staff. Medical staff should be reminded about such promotion at each level of medical care and training (general practitioner, obstetrics/gynaecology specialist, endocrinologist, postgraduate training).

[The impact of polychlorinated biphenyls on placental and ovarian steroidogenesis]. / Polichlorowane bifenyle, a sterydogeneza w lozysku i jajniku.

The structure and turnover of polichlorinated biphenyls (PCB) in environment was presented. The PCB absorption and metabolism in organisms as well as the PCB induced disruption of placental and ovarian steroidogenesis were discussed.

[Influence of estradiol administration mode on plasma insulin-like growth factor-I (IGF-I) and its binding proteins 1 and 3 concentration in postmenopausal women treated with norethisterone acetate]. / Wplyw drogi podania 17beta-estradiolu na stezenie insulinopodobnego czynnika wzrostu-I (IGF-I) i jego bialek wiazacych 1 i 3 w surowicy krwi u kobiet po menopauzie stosujacych octan norethisteronu.

AIM: The aim of the present work was to assess the influence of estradiol administration mode on the plasma IGF-I, IGFBP-1, IGFBP-3 levels in postmenopausal women treated with norethisterone acetate. MATERIAL AND METHODS: 39 women were enrolled into the study Group A--14 women received transdermal 17beta-estradiol (Oesclim 50--Fournier-Solvay) combined with oral norethisterone 2.5 mg daily (Primolut-Nor--Schering), Group B--10 women on oral 2 mg 17beta-estradiol combined with oral 1 mg daily norethisterone (Kliogest--Novo-Nordisk). Control group (group C) consisted of 15 postmenopausal women who received no treatment. Basic plasma FSH, estradiol and total IGF-I, IGFBP-1 as well as IGFBP-3 levels were measured initially and at the 52nd week of the study. RESULTS: The mean plasma FSH level was reduced and mean plasma estradiol level was increased in groups A and B during hormone therapy. Mean plasma levels of total IGF-I, IGFBP-1, IGFBP-3 as well as IGFBP-3/IGF-I ratio did not changed significantly during 52 weeks of observation in groups A, B and C. The comparison of plasma IGF-I, IGFBP-1, IGFBP-3 between groups at the initial visit and after 52 weeks showed the lowest concentration f IGBP-3 in group B. Other parameters showed no differences among the three groups. CONCLUSION: Mode of administration of estradiol did not influenced the plasma levels of IGF-I, IGFBP-1, IGFBP-3 in postmenopausal women treated with norethisterone acetate.

The somatotropic axis in postmenopausal women during six month of transdermal continuous 17beta-estradiol administration combined with oral medroxyprogesterone.

AIM: The evaluation of the influence of continuous transdermal estradiol supplementation combined with oral medroxyprogesterone on the somatotropic axis in postmenopausal women. MATERIAL AND METHODS: 25 women completed the study Group A--13 women received transdermal 17beta-estradiol (Oesclim 50 - Fournier-Solvay) combined with oral 5 mg daily medroxyprogesterone (Gestomikron - Adamed). Group B--12 women without treatment. Basic plasma FSH, estradiol, glucose, insulin, SHBG, hGH, total and free IGF-I, IGFBP-1 as well as IGFBP-3 were measured initially and at the 12th and 24th week of the study. RESULTS: The mean plasma FSH level was reduced and mean plasma estradiol level was increased in group A during estradiol supplementation. Mean plasma level of free IGF-I and free to total IGF-I ratio were increased in group A during 24 weeks of hormone therapy. In the control group (group B) there was the significant increase in mean plasma IGFBP-3 level. Other parameters showed no significant changes in the control group. CONCLUSION: The administration of transdermal 17beta-estradiol combined with oral medroxyprogesterone increases the IGF-I bioavailability. However this influence do not exceed the physiologial level of IGF-I bioavailability.

Overexpression of P53 protein and local hGH, IGF-I, IGFBP-3, IGFBP-2 and PRL secretion by human breast cancer explants.

BACKGROUND: Insulin-like growth factor-I (IGF-I) in concert with insulin-like binding protein 3 (IGFBP-3), insulin-like binding protein 2 (IGFBP-2), human growth hormone (GH) and P53 protein is involved in autocrine/paracrine growth signaling pathways as an adaptive response to environmental stimuli. OBJECTIVE: The study evaluated the local secretion of PRL, hGH, IGF-I, IGFBP-2 and IGFBP-3 by breast cancer tissue explants in relation to the overexpression of P53 protein in breast cancer tissue. MATERIALS AND METHODS: Breast cancer explants were obtained during radical mastectomies. The overexpression of P53 protein was assessed immunohistochemically using monoclonal antibody (DAKO, Anti-Human P53 protein, clone DO-7); the results of the reaction were stratified into 5 groups. The lack of P53 protein overexpression was defined as 0% of cells that overexpressed P53 protein. IGF-I, IGFBP-3, IGFBP-2, and hGH levels were measured with RIA kits, and prolactin was measured with the MEIA kit. RESULTS: The local secretion of hGH by tumour explants - presenting a positive immunohistochemical reaction (IHCR) to the product of P53 gene - was twice as high as those with no IHCR to product of P53 gene; the opposite was noted in the case of IGF-I, IGFBP-2 and IGFBP-3 secretion. In both cases, the level of hGH, IGF-I and IGFBP-3 secretion did not correlate with the ratio of cells overexpressing P53 protein. There was a significant decrease in local, basic IGFBP-2 secretion along with an increased ratio of cells with positive IHCR to product of P53 gene. Furthermore, local PRL secretion was not correlated with the ratio of cells overexpressing P53 protein in breast cancer tissue. Prolactin also exerts no influence on IGF-I secretion. CONCLUSION: Our results may suggest the presence of local hGH/IGF-I feedback in breast tissue as well as the possibility of P53/hGH/IGF-I/IGFBP-3 but not P53/PRL/IGF-I axis.

Bimodal influence of plasma estradiol on relation between insulin-like growth factor-I (IGF-I) and estradiol in women.

OBJECTIVE: To compare the influence of low and normal endogenous estradiol concentration on circulating hGH, IGF-I and IGFBP-3 levels as well as on mutual correlations of these parameters. PATIENTS: 45 women (age 30.7 ± 9.0 years, BMI 25.7 ± 8.0) divided into group A - 15 hypoestrogenic women and group B - 30 normoestrogenic controls. Neither of the women was menopausal nor hyperprolactinemic. METHODS: Blood sample was taken at the standard conditions prior to the initiation of hormonal supplementation therapy in group A and at the day 3-5 of menstrual cycle in group B. Serum hGH, IGF-I, IGFBP-3, insulin, testosterone, sex hormone binding globulin (SHBG) dihydroepiandrosterone sulphate (DHEAS) and LH as well as prolactin (PRL), FSH and estradiol levels were measured by standard RIA kits. RESULTS: Mean IGF-1, LH, FSH, testosterone and estradiol and PRL plasma levels were lower in group A compared to group B. There were no significant differences in mean SHBG, insulin and DHEAS levels. There were also no differences in mean: age, body mass, BMI as well as percentage of each BMI range between groups. Regardless the estradiol level the IGF-I/age link was found in both groups. A IGF-I/IGFBP-3 relation was found in both groups. IGF-I/estradiol link was seen only in group A. In group B hGH/SHBG link was found, in group A this relation was indirect. A link between hGH and testosterone levels was found only in group B. SHBG was related in group B to IGFBP-3, testosterone and to DHEAS. Insulin/IGFBP-3 link was seen in group B. The stepwise multiple regression revealed DHEAS and LH as predictors of IGF-I level in group A, while in group B none of the parameters predicted IGF-I level. The results of the same analysis in case of hGH are as follows: in group A hGH level was predicted by estradiol and SHBG. In group B none of factors predicted hGH levels. CONCLUSION: Estradiol plasma level is correlated to circulating IGF-I, albeit the relation seems to be biphasic.

[Retrospective hormonal analysis of incidentally discovered and operated adrenal tumors for subclinical Cushing's syndrome]. / Retrospektywna analiza hormonalna przypadkowo wykrytych i zoperowanych guzów nadnercza pod katem subklinicznego zespólu Cushinga.

In the last twenty years the introduction of new imaging techniques has caused increasing incidence of accidental detection of adrenal tumors, which are usually mild and in most cases are hormonally inactive adenomas. Among hormonal disorders in patients with adrenal incidentalomas the hypercortisolism is often described, which, if not treated properly, leads to multiple organ complications, and further to the patient's death. The aim of the study was the retrospective analysis of the group of patients with adrenal incidentaloma, verified by histopathology for assessment of subclinical Cushing's syndrome. Among the group of 225 patients: 62 men and 163 women with incidentally detected adrenal tumors in age from 19 to 81 years diagnosed and treated in the Department of Clinical Endocrinology, University Hospital in Krakow, 59 patients was sent to surgery: 15 men and 42 women. Two groups of patients were analysed, divided on the basis of histopathological examination result. Group A consisted of patients with adrenal cortical adenoma: 38 people (11 men and 27 women). In group B there were people with so-called other hormonal inactive adrenal tumors - 17 people (4 men and 13 women). The average age of the patients in group A was 52.05 +/- 11.52 years, in group B 51.44 +/- 14.14 years. In group A the mean morning level of cortisol was 18.23 +/- 6.42 ug/dl and did not differ statistically significantly from the results of group B (mean morning cortisol level of 15.86 +/- 4.6 ug/dl). However a significantly higher nocturnal cortisol levels in the blood serum of patients with group A versus group B was observed (6.78 +/- 5.65 ug/dl vs. 3.57 +/- 1.77 ug/dl). There was no cortisol diurnal rhythm disorders in group B, while in group A slightly disrupted cortisol diurnal rhythm was found in 17 people. Mean values of 24-hour urine 17-OHCS and free cortisol were statistically higher in group A than in group B, although mean values remained within normal limits. In 24 patients from group A where abnormalities in the screening test with 1 mg DXA were found, a test with 2 and 8 mg was performed, which showed incomplete suppression of the excretion of steroid metabolites in the urine after administration of 8 mg in 17 subjects, and 3 of the total absence of suppression. In group B in 4 people there was no suppression in 1 mg of DXA test, while the suppression test with 8 mg of DXA was normal. A detailed analysis of the clinical signs, meticulously carried out and repeated hormonal diagnosis with the use of functional tests should be focused on the detection of subclinical hormonal disorders, which is crucial in preventing organ damage and making a decision of the right treatment of the patient, which is surgical.

[Diagnostic difficulties in recognizing of pheochromocytoma]. / Trudnosci diagnostyczne w rozpoznawaniu guza chromochlonnego nadnercza.

Pheochromocytoma (PH) is a tumour of chromaffin cells of the sympathetic nervous system and its clinical symptoms are associated with excessive production and release of catecholamines. The main criterion for clinical diagnosis of PH is finding increased concentrations of catecholamines or their metabolites in serum and/or urine. The largest diagnostic and therapeutic problems are patients with slightly elevated levels of methoxycatecholamines in serum and/ or urine. Aim of this study was to determine the cut-off point for elevated methoxycatecholamine in the collection of daily urine, which would give the basis for determining the reasonable recommendations of the biochemical criteria for diagnosis of PH. Retrospectively we analysed the results of 45 patients sent to laparoscopic adrenalectomy to the Department of General Surgery II with the preoperative diagnosis of pheochromocytoma. The diagnosis of pheochromocytoma was based on the finding of elevated 24-hour urine methoxycatecholamines. Based on the results of the histopathological examination patients were divided into two groups. Group 1 included 27 patients (14 women and 13 men) with histopathologically confirmed pheochromocytoma of adrenal gland. Group 2 consisted of 18 patients (11 women and 7 men), in which histopathological examination did not confirm the presence of pheochromocytoma. Mean age of patients in group 1: 46.8 +/- 14.4 years, in group 2: 55.7 +/- 13.7 years. Hypertension was diagnosed in 77.8% of those with group 1 and 94.4% from group 2. Based on the analyzed results of the CT, we found that the average tumor size in group 1 (4.2 +/- 1.9 cm) was statistically higher than in group 2 (2.9 +/- 1.1 cm). The average concentration of normetanephrine (NMN) in 24-hour urine in group 1 was statistically significantly higher than in group 2 (2,686 +/- 870.4 vs. 2375.1 +/- 754 mg/24h), as well as the average concentration of metanephrine (MN) (2533.4 +/- 3269.3 +/- 491.6 vs. 371.5 mg/24 hrs), and the sum of both methoxycatecholamines (NMN + MN) (5219.3 +/- 5190.6 vs. 1241.8 +/- 1202.2). The highest sensitivity in diagnosing pheochromocytoma with the rate of 81.5% was obtained for the sum of normetanephrine and metanephrine in 24-hour urine, while the sensivity for levels of each methoxycatecholamine separately was similar (63%). The highest specificity in the exclusion of PH was shown for 24-hour urine metanephrine (94.4%). The highest positive predictive value was found for the level of metanephrine in 24-hour urine (94.4%). The diagnostic cutoff concentrations of NMN, MN and NMN + MN for the diagnosis of pheochromocytoma were set. For the 24-hour urine NMN- cut-off > 1500 ug/24 h, for MN > 700 ug/24h and for NMN + MN > 1350 ug/24h. Shown above cut-off levels of methoxycatecholamines urine concentration will allow to pose a more accurate preoperative diagnosis of PH.

[The impact of polichlorinated biphenyls on neoplastic processes]. / Wplyw polichlorowanych bifenyli na procesy nowotworzenia.

The structure and turnover of polichlorinated biphenyls (PCB) in environment was presented. The PCB absorption and metabolism in organisms as well as the PCB influence on neoplastic process.

[The incidence of neoplasm in women using contraceptives]. / Czestosc nowotworów u kobiet stosujacych doustne srodki antykoncepcyjne.

Contraceptive is an important issue of women's life. In the present times there are many methods to prevent unwanted pregnancy. Each of them has its advantages and disadvantages and an appropriate choice of the method determines its promotion high efficiency and comfort its application. Today there is no method of contraception, which would not be charged some risk for the application. Following the review will allow literature to analyze impact of the various methods for the development of cancer control means diseases which may constitute a serious threat to health and life women.