Urinary incontinence in women as a health and social problem.

PURPOSE: Urinary incontinence is a disease due to which women have suffered for many centuries. But there is some optimistic side to the problem, too; such illnesses can be treated and prevented. The aim of the work was to evaluate the frequency of occurring such cases among women and to evaluate the chosen risk factors influencing this illness. MATERIAL AND METHODS: Results of studies carried through on 160 women in 2000 and 2001 at the 2nd Gynaecological Medical University of Lódz were presented here. RESULTS: A high frequency of urinary incontinence among the tested group was found. Almost every five respondent claimed to hale had symptoms that would prove this illness. CONCLUSIONS: Risk factors of occurrence of urinary incontinence among the patients were: birthweight over 4000 g, gynaecological or urological operations, big body mass and physical work were significant.

[Current opinions on immunological processes in rheumatoid arthritis during pregnancy]. / Wspólczesne poglady na przebieg procesów immunologicznych w reumatoidalnym zapaleniu stawów u kobiet w ciazy.

The essential in pathogenesis of RA is induction of incorrect immunological response against synovial and connective tissue antigens, which depends of CD4+ T-cells activation by specific antigen. This stimulation leads to releasing Th1 lymphokines. The most important cytokine is TNF-alpha. An increased level of TNF-alpha, IL-1, IL-6, GM-CSF, IL-8 was observed in patients with RA. PDGF, FGF, TGF, C-X-C a chemokines (IL-GRO-alpha, ENA78) and CCb chemokines (RANTES, MCP1 MIP1 alpha) are also involved in synovial hyperplasia in RA. During a pregnancy a clinical improvement in women with RA is frequent. The reason of this fact is probably connected with Th2 predominance (IL-4, IL-10) caused by presence of fetal tissues. Specific, cell-mediated immunity is suppressed and changed to Th2 by progesterone and PGE2. During a pregnancy a higher sensitivity of lymphocytes to progesterone was found. Progesterone stimulates T cells to PIBF production, which decreases NK activity. Th2 cytokines (Il-6, IL-10, IL-13, TGF) are expressed on decidua and inhibit secretion of Th1 cytokines (IL-2, INF gamma, TNF-alpha, IL-1 alpha, IL-1 beta). Immunosuppression caused by pregnancy probably decreases inflammatory and destructive reactions in tissues women with RA. The first attack of this disease frequently observed during puerperium is connected with a high level of prolactin and a low of estrogens, which causes a increased release of IL-2 and has a main influence on initiation and increasing of inflammatory process in RA.

[Parameters of peripheral whole blood neutrophil activity in women with pregnancy induced hypertension]. / Ocena niektórych parametrów aktywnosci ukladu neutrofili w pelnej krwi obwodowej ciezarnych z nadcisnieniem indukowanym ciaza.

OBJECTIVES: Pregnancy induced hypertension is believed to be a state of neutrophil overactivity, however all previous studies were done on isolated cells. DESIGN: To study neutrophil activity in whole blood of PIH women. MATERIALS AND METHODS: Neutrophil activity was estimated without isolation, in peripheral whole blood of 23 PIH women and 26 normal pregnant controls. The chemiluminescence test was performed without any stimulation and upon stimulation of neutrophils with fMLP, OZ and PMA, before and after pre-activation with TNF-alpha. The results were corrected according to the haemoglobin concentration and (%) of neutrophils. The percentage of whole blood neutrophils indicating expression of selectins CD18, CD11b, integrin CD62L and mean fluorescence intensity (MFI) of these molecules were studied on flow-cytometry. RESULTS: The study revealed that neutrophil chemiluminescence was not significantly higher in PIH women and after correction coefficient used it was even lower in PIH patients. TNF-alpha preactivation had no influence on chemiluminescence results. Expression of CD11b expressed as MFI value was significantly increased while that of CD62L, expressed as (%) of positive cells and MFI value--decreased in PIH patients. CONCLUSIONS: Changes of neutrophil CD11b and CD62 expression indicate increased activity of these cells in PIH women, however low production of reactive oxygen species estimated by corrected chemiluminescence test especially after TNF-alpha pre-activation, indicates that this form of their reactivity is rather "exhausted" during PIH.

[Prenatal evaluation of fetal lung maturity by determination of phosphatidylglycerol (PG) concentration in amniotic fluid]. / Prenatalna ocena dojrzalosci pluc plodu poprzez oznaczanie stezenia fosfatydyloglicerolu (PG) w plynie owodniowym.

Phosphatidylglycerol (PG) is considered to be the most important phospholipid of lung surfactant, responsible for its biological activity. The aim of the study was to investigate the predictive value of phosphatidylglycerol (PG) concentration in amniotic fluid in prediction of neonatal lung maturity. The study was carried out on 180 pregnant women, chosen by random selection, hospitalized in Polish Mother's Health Centre Hospital in the period from 15.06.1994 to 31.12.1995. 223 samples of amniotic fluid were tested--phosphatidylglycerol (PG) concentration was assayed by immunological test Amnio Stat FLM. In the study value PG < or = 0.2 microgram/ml was found in 110 (49.3%) samples of amniotic fluid, PG = 0.5 microgram/ml in 57 (25.6%) and PG > or = 2.0 micrograms/ml in 56 (25.1%). In our research predictive value of PG in relation to clinical lung maturity of neonates was verified. It turned out that PG concentration in amniotic fluid < or = 0.2 microgram/ml indicates a possibility of RDS occurring in neonates born before 72 hours of performed determination. Concentration PG in amniotic fluid PG > or = 2.0 micrograms/ml corresponds to complete clinical lung maturity of neonates with predictive value 98%.

[Diagnostic significance of index alpha-amylase/glucose in amniotic fluid in prediction of fetal maturity]. / Znaczenie indeksu alpha-amylaza/glukoza w plynie owodniowym w prognozowaniu dojrzalosci plodu.

An increase in alpha-amylase activity with parallel decrease in glucose concentration in amniotic fluid is observed during pregnancy. This interdependence is a theoretical basis for using an alpha-amylase/glucose index in fetal maturity evaluation. The aim of the study was to investigate usefulness of the alpha-amylase/glucose index in amniotic fluid in prenatal fetal maturity diagnosis. The study was carried out on 180 pregnant women, chosen by random selection, hospitalized in Polish Mother's Health Centre Hospital in the period from 15.06.1994 to 31.12.1995. 223 samples of amniotic fluid were tested for glucose concentration and alpha-amylase activity. It was found that the alpha-amylase/glucose < 6.0 index indicates a possibility of RDS occurring in neonates born before 72 hours of performed determination. The alpha-amylase/glucose > or = 6.0 index has high diagnostic value (95.8%) in prenatal prediction of fetal lung maturity.

[Alpha-amylase/glucose index in amniotic fluid as a new method in prenatal assessment of fetal maturity]. / Indeks alpha-amylaza/glukoza w plynie owodniowym jako nowa metoda prenatalnej oceny dojrzalosci plodu.

Prenatal diagnosis of amniotic fluid enables fetal maturity evaluation, particularly that of fetal lungs. The aim of the study is to evaluate the diagnostic value of on alpha-amylase/glucose index in amniotic fluid in comparison to routinely performed tests, used for prenatal fetal lung maturity evaluation, particularly in respect of PG concentration, whose predictive value is almost 100%. The study was carried out on 180 pregnant women, chosen by random selection, hospitalized in Polish Mother's Health Centre Hospital in the period from 15.06.1994 to 31.12.1995. 223 samples of amniotic fluid were tested- in all samples following assays and tests were performed: bubble stability test (BST), optical density, orange cells test, phosphatidylglycerol concentration (PG), glucose concentration, alpha-amylase activity urea and creatinine concentration. The alpha-amylase/glucose index in amniotic fluid is statistically significant with PG concentration. The value of the alpha-amylase/glucose index is < 6.0 when amniotic fluid assay indicates fetal immaturity, but when amniotic fluid assay indicates fetal maturity, its value is 36.0. The evaluation of fetal lung maturity on the basis of the alpha-amylase/glucose index multiply decreases the cost of examinations. Authors make a suggestion to implement this method in all hospital departments of the country.

IL-12, IL-6 and IFN-gamma production by lymphocytes of pregnant women with rheumatoid arthritis remission during pregnancy.

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease with progressive activity. The RA remission was observed in women during pregnancy, but the mechanism responsible for remission is hypothetical only and concerns mechanisms of immune regulation such as lymphocyte subpopulations and interleukin production. AIMS: The lymphocyte subpopulations and interleukin production in vitro in a group of healthy non-pregnant women, healthy pregnant women and pregnant women suffering from RA may help towards a better understanding of regulation of the immune processes. METHODS: The investigations were performed in trimester III--2 days after delivery and 6 weeks after delivery. Peripheral blood lymphocytes were isolated on Gradisol gradient and analysed immediately or after having been cultured for 72 hours in RPMI medium supplemented with 10% FCS. The cultures were terminated after 72 h, supernatants stored at -72 degrees C for interleukin evaluation. The concentrations of IFN-gamma, IL-2, IL-6, IL-12, TNF-alpha and its soluble receptors R-I, R-II were estimated in non-stimulated and PHA (Sigma, 5 microg/ml) stimulated culture supernatants using ELISA Endogen kits according to the manufacturer's instructions. RESULTS: The general pattern of T cell subpopulation distribution was similar in all analysed groups. Decreased IFN-gamma, IL-12 and increased IL-6 production by lymphocytes after PHA stimulation was found in trimester III in pregnant women with RA as compared to healthy pregnant woman. CONCLUSION: The obtained results suggest that in pregnant women with RA the TH1 cell response predominates, contrary to healthy pregnant women with TH2 type functional response. These phenomena were not observed after delivery.

[Twin pregnancy complicated by intrauterine death of one twin]. / Ciaza blizniacza powiklana obumarciem wewnatrzmacicznym jednego plodu.

In twin pregnancies single intrauterine death of one fetus is associated with significant morbidity and mortality of the surviving infant. The aims of our retrospective study were to review conditions of twin pregnancies complicated with SIUD in Polish Mother's Memorial Hospital in Lódz between 1989-1999 and to assess the fetal outcome when conservative management had undergone. In this study we reviewed 30 twin gestations involving the intrauterine death of one fetus. The incidence of preterm delivery among pregnancies with fetal death was 83.3%; Caesarean section was the method of delivery in 53.3% cases. Monochorionic placentation was found in 60%. Conservative management until there is no risk for the fetus is apt.

[Risk of preterm birth in twin pregnancy]. / Ryzyko porodu przedwczesnego w ciazy blizniaczej.

The aim of the study was to analyze the selected risk factors in twin pregnancies. Retrospective analysis was carried out in the Research Institute Polish Mother's Memorial Hospital (ICZMP) in Lodz and covered data from the period of time between 1989-1999. Out of 38,066 deliveries which had place in the ICZMP 538 twin pregnancies were enrolled in the study. We evaluated usual risk factors for preterm birth such as body mass index, short cervical length, beta-mimetics admission, presence of bleeding and contractions as well as socio-demographical characteristics such as age, parity, martial status and educational level. Univariate analysis and ?2 test were preformed. Odds ratios and 95% confidence intervals were calculated. For multivariate analysis logistic regression model was used. Most of the risk factors for preterm birth were not significantly associated with spontaneous preterm birth of twins.

[Analysis of perinatal death at the Institute of the Health Center of the Polish mother in 1995, 1996 and 1997. The reason for making changes in the accountability for perinatal death]. / Analiza zgonów w okresie perinatalnym w Instytucie Centrum Zdrowia Matki Polki w latach 1995, 1996 I 1997. Przyczynek do koniecznosci wprowadzenia zmian w sprawozdawczosci na temat umieralnosci okoloporodowej.

Perinatal death's causes of fetuses and newborns from single and twin pregnancies delivered at the PMMHI from 1995-1997 were discussed. Data from the Pathology Department were analysed and compared to information regarding prenatal US + ECHO diagnoses coming from the Department for Diagnoses of Congenital Malformations at the PMMHI. The most frequent cause of death of fetuses and newborns from single pregnancies were congenital malformations (42%). In twins there prevailed such typical for multiple pregnancies' death causes as TTTS (27%), intrauterine demise of one of the twins (17%). Premature labor occupies the second most frequent cause of death both in single and multiple pregnancies. Most of perinatal deaths may be predicted prenatally by means of ultrasound and fetal echocardiography.

Selenium levels, thiobarbituric acid-reactive substance concentrations and glutathione peroxidase activity in the blood of women with gestosis and imminent premature labour.

The aim of the study was to investigate antioxidant status, monitored by selenium and thiobarbituric acid-reactive substance concentrations in blood plasma, and glutathione peroxidase activity in erythrocytes and blood plasma in women with gestosis (n = 26), imminent premature labour (n = 48) and normal pregnancy (n = 23) during 19-38 weeks of pregnancy. Selenium concentrations in blood plasma were significantly higher in women with pathological pregnancies than in normal (45.5 +/- 10.5 micrograms l-1, p < 0.01 and 44.1 +/- 11.6 micrograms l-1, p < 0.05 vs. 38.6 +/- 8.3 micrograms l-1, respectively). In all groups of pregnant women Se concentrations were extremely low as compared with non-pregnant females. Glutathione peroxidase (GSH-Px) activity in blood plasma was significantly higher in complicated pregnancies than in healthy ones. There were no significant differences in thiobarbituric acid-reactive substance concentrations between all groups of pregnant women. Statistically significant correlations were found between blood plasma Se concentrations and GSH-Px activity in healthy pregnant (r = 0.53, p < 0.01), imminent premature labour (r = 0.39, p < 0.01), and non-pregnant females (r = 0.56, p < 0.001).

[Contemporary views on estrogen replacement therapy. II. Hormonal therapy in women with imminent ischemic heart disease]. / Wspólczesne poglady na stosowanie estrogenowej terapii zastepczej. II. Terapia hormonalna u kobiet zagrozonych choroba niedokrwienna serca.

The frequence of ischemic heart disease occurring increases 2-3 fold in postmenopausal period. It is a result of serum lipid profile changes. Estrogenotherapy restores correct lipid relations and protect coronary vessels in this way, preventing stenocardia and cardiac infarcts. Divergent opinions coexist with including progestogens to estrogen replacement therapy. However a view that well selected doses and kind of hormone effectively enhance serum HDL level, begins to prevail.

[Contemporary views on use of estrogen replacement therapy in postmenopausal women. I. Hormone therapy in women with menopausal osteoporosis]. / Wspólczesne poglady na stosowanie estrogenowej terapii zastepczej u kobiet po menopauzie. I. Terapia hormonalna u kobiet zagrozonych osteoporoza.

Osteoporosis is a great problem in postmenopausal women. It begins 4--5 years after a last period and appears in clinical form in about 25-44% women. Basic irregularity is osteopenia as a result of bone resorption superiority. Many observations lead to conclusion that postmenopausal osteoporosis follows estrogens deficiency, that play a substantial role in bone metabolism. Estrogen therapy reverses a process of osteoporosis. Periodic treatment, with use of progestogens, should be performed, under condition of close endometrium and breast control. Progestogens also increase, depending on dose and kind of hormone, mechanisms preventing bone mass lost.

[The influence of perinatal asphyxia on the occurrence of respiratory distress syndrome in preterm labor]. / Wplyw zamartwicy okoloporodowej w porodach przedwczesnych na wystepowanie zespolu niewydolnosci oddechowej noworodkow.

During the period 1985-1992, the influence of perinatal asphyxia on the frequency of RDS was investigated in preterm neonates. Two thousand one hundred and sixty-eight premature infants born alive without congenital malformations weighing from 900 g to 2500 g were in the investigated group. The frequency of the occurrence of RDS and its most severe form--hyaline membrane disease (HMD)--was evaluated depending on state at birth in the first and fifth minute of life. The clinical diagnosis of HMD was verified during the postmortem examination. The state at birth was evaluated using Apgar score. In the statistical analysis, the F-Snedecor variance test was used. During this study, the influence of perinatal asphyxia on the occurrence of RDS, and particularly its most severe form--HMD, was evaluated.

[Twin pregnancy with intrauterine death of one fetus]. / Ciaza blizniacza z obumarlym wewnatrzmacicznie jednym plodem.

A case of twin pregnancy with congenital malformations and intrauterine death of one fetus in the 27th week of pregnancy has been discussed. The pregnancy was continued with special care of the mother and the alive fetus. During all stay of the pregnant in the clinic no coagulation disturbances were observed. In the 33rd week of pregnancy spontaneous labour occurred, which was conducted by vaginal delivery. Simultaneously a macerated dead fetus and an alive premature newborn were born. The alive one was charged home in good condition in the 38th day of staying in the Neonatal Ward.

[Method of delivery and obstetric records of premature labour in material from the Polish Mother's Health Center Memorial Hospital]. / Sposób zakonczenia ciazy a wyniki poloznicze w porodach przedwczesnych w materiale Centrum Zdrowia Matki Polki.

526 premature labours between the 28th and the 36th week of pregnancy were recorded at the Polish Mother's Health Centre Memorial Hospital during the period between April 1989 to September 1991. The mortality rates of newborns were analysed in the group of vaginal and abdominal delivery in the following pregnancy stages: the 28th--the 31st week, the 32nd--the 34th week, the 35th--the 36th week. 23 pregnant delivered abdominally by rapid indications were excluded from the study. In this group cesarean section was caused by placental complications or severe gestosis. This group, as a group of a high obstetric risk, was directly incomparable with vaginal delivery group, that of a low obstetric risk. Newborns with congenital malformations were also excluded from the study. Our analysis allows to assume that cesarean section, when applied in the premature labour between the 32nd and the 34th week of pregnancy, gives much better chances for newborn's survival than vaginal delivery.

[Malignant melanoma coexisting with pregnancy]. / Czerniak zlosliwy wspólistniejacy z ciaza.

An extremely rare case of melanoma amelanoticum coexisting with pregnancy has been discussed. Pregnant A. Ch., age 42, was admitted to the Polish Mother's Health Centre Memorial Hospital on the 22nd of August, 1990 with a diagnosis of the 5th pregnancy, the 2nd delivery, the 30th week of gestation, state after cesarean section. Suspected malignant melanoma. Stomach ulceration. Thrombophlebitis of left lower extremity. General condition--medium hard. For the last three days she did not report fetal movements, fetal heartbeat was not detected either. Us examination confirmed fetal death. On the 24th of August, 1990, spontaneous vaginal delivery terminated the pregnancy, giving a dead, macerated female fetus, body weight of 1500 g. On the 3rd day after delivery the patient died with growing circulation-respiratory insufficiency. Autopsy revealed melanoma malignum amelanoticum disseminatum. Neither an autopsy of the fetus nor histopathological examinations of the secundines were performed for the advanced maceration. The coexistence of pregnancy with malignant melanoma in this case brought a tragic end both for the mother and the fetus.

[Usefulness of biochemical studies in EPH gestosis]. / Ocena przydatnosci badan biochemicznych w EPH-gestozie.

EPH-gestosis, especially its serious clinical complications, poses a high threat for the mother and fetus. The aetiology of this condition has not yet been completely explained. During gestosis the kidneys are most frequently involved, although other organs show changes also. The consequence of renal changes is reduction of renal blood flow and glomerular filtration rate. The studied group comprised 96 women with gestosis with at least two signs treated at the Department of Pathological Pregnancy, WAM in the years 1986-1988. The control group included 52 healthy pregnant women. Serum levels were determined of urea, creatinine-uric acid and protein. The obtained results were subjected to statistical analysis by Student's t test, accepting p less than 0.05 as statistically significant. In the group with EPH-gestosis, as compared to the control group, the uric acid level was significantly raised, while that of protein in the serum was slightly decreased. The levels of creatinine and urea were not significantly different between these groups. The raised serum uric acid level in gestosis cases was correlated with a higher frequency of instrumental labours and worse condition of the newborns at birth.