News in the fifth edition of World Health Organization classification of testicular tumors.

BACKGROUND: The fifth edition of World Health Organization classification of urinary and male genital tumours also brought news regarding testicular tumours. In contrast to the previous editions' radical alterations, the adjustments in the fifth edition are subtle and mostly impact the terminology, categorization of some of the rare tumours and diagnostic criteria. PURPOSE: Acquainting with current terms and tumor classification, which is necessary for good clinical practice.

Oxidative stress and motility impairment in the semen of fertile males.

The aim of the study was to determine the total oxidant status (TOS) and evaluate the influence of oxidative stress on sperm quality in fertile males. The study population consisted of 55 fertile males. Based on the seminal plasma TOS value, the study subjects were divided into the two subgroups: a group with a low (TOS-L) and a high (TOS-H) value. Comparing the TOS-H group with the TOS-L group, we found poorer sperm motility in the TOS-H group. We found lower total antioxidant capacity values and lower activity levels in the majority of the determined superoxide dismutase, glutathione peroxidase, glutathione-S-transferase and glucose-6-phosphate dehydrogenase. Further, we found higher levels of copper and iron as well as lower levels of zinc in the TOS-H group. We observed lower medians of IL-2, 4, 6, 8 and INF-γ in the TOS-H group compared with the TOS-L group, whereas the medians of IL-1ß, IL-10 and IL-12 were significantly higher. In fertile males, higher oxidative stress intensity was associated with poorer semen quality and decreased antioxidant capacity in semen. These negative effects might be a result of decreased activities of antioxidant enzymes and altered levels of trace metals and cytokines.

The incidence of metabolic syndrome in obese Czech children: the importance of early detection of insulin resistance using homeostatic indexes HOMA-IR and QUICKI.

Common alimentary obesity frequently occurs on a polygenic basis as a typical lifestyle disorder in the developed countries. It is associated with characteristic complex metabolic changes, which are the cornerstones for future metabolic syndrome development. The aims of our study were 1) to determine the incidence of metabolic syndrome (based on the diagnostic criteria defined by the International Diabetes Federation for children and adolescents) in Czech obese children, 2) to evaluate the incidence of insulin resistance according to HOMA-IR and QUICKI homeostatic indexes in obese children with and without metabolic syndrome, and 3) to consider the diagnostic value of these indexes for the early detection of metabolic syndrome in obese children. We therefore performed anthropometric and laboratory examinations to determine the incidence of metabolic syndrome and insulin resistance in the group of 274 children with obesity (128 boys and 146 girls) aged 9-17 years. Metabolic syndrome was found in 102 subjects (37 %). On the other hand, the presence of insulin resistance according to QUICKI <0.357 was identified in 86 % and according to HOMA-IR >3.16 in 53 % of obese subjects. This HOMA-IR limit was exceeded by 70 % children in the MS(+) group, but only by 43 % children in the MS(-) group (p<0.0001). However, a relatively high incidence of insulin resistance in obese children without metabolic syndrome raises a question whether the existing diagnostic criteria do not falsely exclude some cases of metabolic syndrome. On the basis of our results we suggest to pay a preventive attention also to obese children with insulin resistance even if they do not fulfill the actual diagnostic criteria for metabolic syndrome.

[Preliminary results of the heparin treatment in anticardiolipin and antihistone antibodies seropositive pregnant women]. / Wstepne wyniki leczenia heparyna ciezarnych z obecnoscia przeciwcial antykardiolipinowych i antyhistonowych w surowicy krwi.

The presence of elevated titres of anticardiolipin antibodies (ACA) and antihistone antibodies (AHA) in the blood serum is considered as one of serious reasons of repeated pregnancy losses. According to some reports, heparin significantly improves live birth rates in these cases. The aim of the work is an evaluation of the results of the heparin therapy in pregnant women with elevated titres of ACA and/or AHA in blood and bad obstetric anamnesis, or after sterility treatment. Our material consisted of three groups: the first one was composed of 25 ACA- and/or AHA-seropositive pregnant women 30.0 +/- 4.1 years old with 1-5 early miscarriages in past, the second one of six seropositive patients 31.3 +/- 2.8 years old, actually pregnant after the treatment of unexplained sterility (two of them after assisted reproduction) and, finally, in the third group were placed five pregnant ACA- and AHA-seronegative pregnant women 30.8 +/- 2.2 years old with 2-4 abortions of unexplained etiology in past. The ACA IgA, IgM and IgG and AHA IgG levels in blood sera were determined by ELISA. As a positive titre ACA in the class IgA was considered > 7 APL/ml, in the class IgM > 4 MPL/ml, IgG > 7 GPL/ml and in case of AHA IgG > 25 GPL/ml. The patients were treated by heparin 7500-30,000 units daily during all the pregnancy under the control of kaolin-kephalin time. In the first group, where 53 pregnancies from 56 were miscarried (94.6%), after the heparin therapy in 10 women 9 pregnancies of 11 (81.8%) were terminated by live birth (p < 0.001). One of the patients died three days after cesarean section because of myocardial infarction, probably due to sudden stopping of heparin. In the second group three women after heparin treatment delivered live babies, but three untreated aborted. In the last group only two women treated by heparin delivered live babies and three, despite treatment, miscarried. It should be concluded, that heparin therapy in ACA- and/or AHA-positive pregnant women might be a recommended therapeutic method. In cases of antiphospholipid syndrome a special precaution should be undertaken, when stopping the heparin. It seems, that double assay of ACA and AHA in patients with conception troubles might be usefull.

[Perinatal outcome in multiple pregnancy after natural reproduction and ART techniques]. / Wyniki perinatalne w ciazy wieloplodowej po rozrodzie naturalnym i technikach ART.

In this study we analysed occurrence of multifetal pregnancy in groups of patients after natural reproduction and after using ART between 1991-1998 in clinical material. We showed the most important complications during pregnancy, occurrence of TTTS, percentage of prematurity, percentage and indications to caesarean sections. We found that above-mentioned manifestations of perinatal care were comparable with reports of Polish and foreign authors.

[Selective salpingography in cases of proximal tubal occlusion]. / Salpingografia selektywna w przypadkach niedroznosci proksymalnej jajowodów.

The technical performance and results of selective salpingography (SGS) in 28 infertile women with proximal tubal occlusion (PTO) are presented. In 50 cases of PTO, diagnosed first by hysterosalpingography (HSG) and/or laparoscopy, 14 oviducts (28%) were patent during initial HSG using the baloon catheter tightly filling the internal cervical orificium and from remaining 36 tubes 27 (75%) were successfully recanalized by SGS. Three patients after successful SGS became pregnant. One of the pregnancies was ectopic. The SGS should be widely accepted in diagnosing and treatment of PTO as a cheap, simple, noninvasive and very effective method.

[The usefulness of MESA-ICSI (microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection) in cases of obstructive azoospermia]. / Zastosowanie MESA-ICSI (microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection) w przypadkach azoospermii obstrukcyjnej.

Till the end of March 1998 first seven trials of MESA-ICSI (microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection) in the Ist Chair and Clinics of Obstetrics and Gynecology of the Silesian Medical Academy in Bytom were performed in cooperation with an urologist from the IInd Chair and Clinics of Urology in Zabrze in couples suffering from sterility caused by obstructive azoospermia. In all the cases both contraindications and conditions of MESA-ICSI were respected. Fertilization rate of the MII oocytes was on average 62% and cleavage rate of the fertilized oocytes 76.9%. After embryo transfer at least two pregnancies occurred, from them one is ongoing well. The result of the last procedure is not known yet. The data obtained permit to conclude, that MESA-ICSI makes a real chance to possess their own children by couples with sterility caused by obstructive azoospermia.

Mixed lymphocyte culture responses in rabbits undergoing corneal grafting and topical cyclosporine treatment.

Using a vascularized cornea rabbit model closely resembling human high-risk keratoplasty, corneal allografts were performed on three groups of animals that were paired and tested preoperatively by mixed lymphocyte cultures (MLCs). The three groups were group A, unmodified controls with clear corneas; group B, untreated animals with vascularized corneas; and group C, animals treated with topical cyclosporine (CSA) with vascularized corneas. The MLC results were expressed as stimulation indices (SIs) and divided into low (SI < or = 20) and high (SI > 20) responders and were correlated with final outcome of grafts using survival analysis estimates. In group A, five of 13 (38.5%) grafts rejected, the chance of failure depending on the degree of MLC mismatch between donor and recipient (p = 0.02). All allografts in group B rejected regardless of the degree of mismatch. In group C, seven of 12 (58.3%) grafts rejected, indicating that topical CSA significantly improved survival (p = 0.003) compared with group B. Grafts with mild degrees of MLC mismatch (low responders) survived better (p = 0.0003) than did higher degrees of MLC mismatch (high responders), all of which rejected despite treatment. Our results indicate that both corneal vascularization and the degree of donor-recipient matching play important roles in determining corneal graft survival.

[Laparoscopy in clinical practice. I. Indications]. / Laparoskopia w praktyce klinicznej. I. Wskazania.

In the paper the authors analyzed indications to 1527 laparoscopies. The most frequent indications were: sterility (72.2%) and suspicions of adnexal tumours or extrauterine gravidity (14.1%). In 173 diagnostically difficult cases laparotomy was avoided. In these cases laparoscopy allowed to exclude the pelvic pathology or to quality to laparoscopic operation of ovarian cysts and intact tubal pregnancy. Diagnostic and operative laparoscopy give the possibility of quick diagnosis in diagnostically difficult cases and enables avoidance of laparotomy in many cases.

[Laparoscopy in clinical practice. II. Usefulness in diagnosis of sterility]. / Laparoskopia w praktyce klinicznej. II. Przydatnosc w diagnostyce nieplodnosci.

The paper presents results of 1099 laparoscopies performed in sterility. Laparoscopy was made in the second phase of the menstrual cycle, 5 to 7 days after probable ovulation, as a last stage in diagnosis of sterility. Normal state of genital organs and minor pelvis was noted in 20.9% of investigated patients. In the remaining more than one etiologic factor was found, which may influence the sterility. The authors concluded, laparoscopy is valuable, accessory method in the diagnosis of sterility, which enables sometimes to find the etiologic factor in patients with "unexplained infertility".

[Laparoscopy in clinical practice. III. Complications]. / Laparoskopia w praktyce klinicznej. III. Powiklania.

In the paper authors made analysis of complications, which have appeared among 1527 laparoscopies. The authors noted complications in 14 cases (0.91%) among the whole laparoscopic interventions. The most frequent complication was subcutaneous oedema, which was noted in 7 cases (0.46%). Injury of internal organs was noted in 6 cases (0.39%) and cardiac arrest in 1 case (0.06%). In author's opinion laparoscopy carry a small risk of complications.

[Modern methods of treating ectopic pregnancy using surgical laparoscopic methods]. / Wspólczesne metody leczenia ciazy ektopowej technika laparoskopii operacyjnej.

The authors present modern methods of radical treatment of tubal pregnancy by the endoscopic technique. The methods are presented of conservative and radical treatment of tubal pregnancy by laparoscopy.

[Use of laparoscopy in gynecology]. / Zastosowanie laparoskopii w ginekologii.

Paper concerns 1822 performed laparoscopies. The most frequent indications to laparoscopy were: sterility, adnexal mass, tubal pregnancy and pelvic pain syndrome. In 80% cases of sterility we found pathologic findings, which could be the cause of sterility. adnexal mass, tubal pregnancy and pelvic pain syndrome. In 80% cases of sterility we found pathologic findings, which could be the cause of sterility. In 75% of cases we confirmed adnexal mass, which were operated by laparoscopy or by laparotomy. In 17 cases we confirmed unruptured tubal pregnancy, which were conservatively operated by laparoscopy or by laparotomy. Laparoscopy is useful method in gynecology, especially in diagnostically difficult cases of gynecologic disease.

[Laparoscopic surgery in gynecologic practice]. / Chirurgiczne zabiegi laparoskopowe w praktyce ginekologicznej.

Paper concerns 293 laparoscopic operations. The most frequent types of laparoscopic operations in presented material were: adhesion lysis in minor pelvis (33.8% cases), cystectomy and cyst-ovariectomy (27.6%) and electrocoagulation of ovarian capsule. Operative laparoscopy because of small injury is useful method in the treatment some gynecological disease.

[Complications of endoscopy in gynecology]. / Powiklania zabiegów endoskopowych w ginekologii.

The paper concerns the complications which appeared during 1822 laparoscopies and 141 hysteroscopies. The overall percentage of complications in presented material was 0.82% for laparoscopy and 2.8% for hysteroscopy. The most frequent complication during performance of laparoscopy was subcutaneous emphysema (8 cases). The most frequent complication during hysteroscopy was uterine wall perforation, which appeared in 3 cases during incision of dense and massive intrauterine adhesions. All patients with complications of gynecologic endoscopy recovered well.

[Use of diagnostic and operative hysteroscopy in clinical practice]. / Zastosowanie histeroskopii diagnostycznej i operacyjnej w praktyce klinicznej.

In the paper authors present indications and results of 141 hysteroscopies. The most frequent indications were: sterility, Asherman syndrome suspected, infertility and abnormal uterine bleeding. 55 diagnostic and 86 operative hysteroscopies were performed. In sterility and infertility group of patients were present 49.6% pathological findings of uterine cavity, between them the most frequent were: uterine septa and intrauterine adhesions. In the remaining cases the intrauterine pathology were present in 75.8% cases, between of them the most frequent were intrauterine adhesions and endometrial hyperplasia. Hysteroscopy should be the method of choice in some cases of gynecological pathology.

[Treatment of tubal pregnancy laparoscopically]. / Leczenie ciazy jajowodowej technika laparoskopii operacyjnej.

Five cases of unruptured tubal pregnancy treated laparoscopically are described. Basing on the clinical evaluation of them we concluded, that selected cases of unruptured tubal pregnancy may be successfully treated using the laparoscopic technics. The use of this technics is less traumatic for patient, shorted the time of her stay in the hospital and lower the costs of therapy.

Collection and cryopreservation of human stem and progenitor cells for bone marrow transplantation.

Bone marrow collection was undertaken from human organ donors (Group 1: n = 7) to develop a closed-system single-step technique for stem and progenitor cell enrichment, using the Cobe 2997 continuous-flow blood-cell separator. The effects of programmed freezing, storage in liquid nitrogen, and thawing were then defined using these grafts. Once standardised, this method was extended to autografting following cryopreservation of a comparable fraction (Group 2: n = 8) and then to allogeneic transplantation after ex vivo exposure to the lytic monoclonal antibody. Campath-1 IgM and human complement, but without cryopreservation (Group 3; n = 9). The median number of mononuclear cells harvested was 5.0 x 10(6)/mL (n = 24), and this was not significantly different in the three groups. The ex vivo graft, composing marrow rich anticoagulated whole blood, was recirculated in the separator at a flow rate of 60 mL/minute, with a centrifuge speed of 1,100 r.p.m., and the mononuclear cell fractions were collected at the rate of 1.5 mL/minute. The average procedure time from formation of the interface in the single disposable channel to achievement of the final volume was 90 minutes. The mean recovery of the mononuclear cells was 101.4% (SD 38.0) and the GM:CFUc was 91% (SD 43.86). These figures were not significantly influenced by subsequent cryopreservation (Group 1; n = 7 and Group 2; n = 8) or following exposure to the monoclonal antibody. Campath-1 IgM (Group 3; n = 9).(ABSTRACT TRUNCATED AT 250 WORDS)

[Laparoscopy in the differential diagnosis of causes of female infertility. I. Significance of the presence of ovulation stigma]. / Laparoskopia w diagnostyce róznicowej przyczyn nieplodnosci kobiecej. Cz. I Znaczenie obecnosci znamienia poowulacyjnego.

104 laparoscopy were performed in infertile women. Apart from the routine evaluation of organs of pelvis small the particular attention was drown to the presence of stigma on the surface of corpus luteum. The sigma was present in 41 cases (39.42%). It was shown that the presence of the stigma allows to recognize the examined infertile women as on ovulating one. It was also stated that the evaluation of the presence of the stigma is an important method in diagnosis of ovulation, particularly in the so-called unexplained infertility.