[The place of laparoscopy in gynecological practice--useful technique for diagnostic and treatment of infertility and endometriosis]. / Miejsce laparoskopii w praktyce ginekologicznej--metoda z wyboru w diagnostyce i leczeniu nieplodnosci i endometriozy.

OBJECTIVE: The objective was to evaluate indications for laparoscopy performed in Department of Gynecological Surgery of Polish Mother's Memorial Research Institute. MATERIALS AND METHODS: We have analyzed hospital charts of 342 patients who had been treated with laparoscopy in 1991-1999. RESULTS: During last years a progressive frequency in performing laparoscopic procedures has been noted (4.7% of all surgical treatment in 1991-93, 6.4% in 1994-96, 16.3% in 1997-99, and 25.2% in 1999). An increased percentage of operative laparoscopic procedures has also been observed (11.9% in 1991-93 vs 59.8% in 1994-96 vs 86.9% in 1997-99). The major indication for performing laparoscopy was: infertility (145--42.4%), endometriosis (90--26.4%) and benign ovarian tumors. Most of laparoscopic operations were performed due to benign pathological changes found in adnexa (218--68.6%). Laparoscopy has been recently introduced in surgical treatment of uterine myoma (enucleation, laparoscopically assisted vaginal hysterectomy-LAVH) and diagnosis of ovarian carcinoma. Complications were found in 19 (5.5%) cases: 11 cases (3.2%) intraoperative and 8 (2.3%) cases postoperative. Bleeding from abdominal wall vessels was the most often intraoperative complications, whereas an infection was the most common postoperative one. Because of complications laparoscopy turned into laparotomy in four cases. CONCLUSION: Laparoscopy is a safe and useful technique for treatment some gynecological pathology (especially infertility and endometriosis) with a small number of complications.

[Serum cytokines in patients with ovarian cancer and benign ovarian cysts]. / Wyniki oznaczen wybranych cytokin w surowicy chorych na raka jajnika lub lagodne torbiele jajników.

UNLABELLED: The aim of our study was to evaluate serum interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) as tumor markers--study based on the data about tumor cytokines production and tumor-host interactions. METHODS: We investigated 48 women: 17 with ovarian cancer untreated before, 16 with benign ovarian cysts and 15 healthy controls. Venous blood for cytokines determinations were obtained before operations and during routine screening tests. Titers of cytokines were measured by means of ELISA technique. RESULTS: In the control group the upper limit of normal IL-6 titers (95th percentile) was 5.5 pg/ml; the mean IL-8 concentration was 9.6 +/- 15.1 pg/ml and the upper limit of normal was 37 pg/ml; serum TNF-alpha and IFN-gamma were not detectable. In patients with benign ovarian cysts the levels of all investigated cytokines didn't differ significantly from healthy controls. Women with ovarian cancer had significantly higher serum IL-8 levels (mean: 290.5 +/- 351 pg/ml) than healthy controls or women with benign ovarian cysts; 88% of them had IL-8 titers above the normal. The IL-6 titers in ovarian cancer were also higher but didn't reach statistical significance, 53% of them had IL-8 titers above the normal. TNF-alpha and IFN-gamma levels in ovarian cancer were similar to patients with benign ovarian cysts. CONCLUSION: Serum IL-8 levels in patients with ovarian cancer were significantly higher when compared to healthy controls and benign ovarian cysts and in almost 90% of ovarian cancers the titers of IL-8 were increased. Additionally, 53% of women with ovarian cancer had elevated serum IL-6 levels.

[Laparoscopy and laparotomy in the operative treatment of ovarian cysts]. / Leczenie operacyjne lagodnych guzów jajnika: laparotomia i laparoskopia.

OBJECTIVES: The purpose of our study was to compare operative procedures, histologic types of tumours, and intra- and postoperative complications of patients operated for benign ovarian cysts by laparotomy or laparoscopy. MATERIALS AND METHODS: 257 patients with different types of ovarian cysts underwent operations by laparoscopy (51 cases) or laparotomy (206 cases). Careful selection for operative treatment was made on the basis of clinical findings, ultrasound scans (using colour Doppler), patient's age and history. Operative laparoscopies were performed in patients with "unsuspected" ovarian cysts with diameter < or = 8 cm. During every operation, a histologic examination of tumour was performed. RESULTS: In 42 patients the cysts were found in both ovaries. Remaining 215 women had unilateral ovarian tumours. Adnexectomy was carried out in 142 cases, cystectomy in 131, ovariectomy in 18, and aspiration and electrocoagulation of ovarian cysts in 8 cases. The most common laparoscopic procedures were cystectomy (41) and aspiration and electrocoagulation of ovarian cysts (8); while by laparotomy: adnexectomy (142) and cystectomy (131); p < 0.0001. The histopathological assessment showed as follows: serous cysts in 98 cases, dermoid cysts in 75, endometrial cysts in 63, mucous cyst in 23, and others (mainly haemorrhagic, functional cysts and fibrothecomas) in 40 cases. The incidence of operative complications (3/257--all due to insufficient hemostasis) and postoperative complications (infection--7/257, anaemia--4/257, peritonitis--1/257) was rather low and similar in patients operated by laparoscopy and laparotomy. Patients were generally discharged from the hospital on the fourth (median) postoperative day after laparoscopies and the seventh (median) day after laparotomies (p < 0.0005). CONCLUSIONS: Operative treatment of ovarian benign cysts is connected with a very low risk for intra- and postoperative complications. The operative laparoscopy brings better cosmetic effects and seems to be safe and effective method of treatment of ovarian benign cysts.

[Ovarian cancer. I. Epidemiology, symptoms, FIGO staging]. / Rak jajnika w materiale Kliniki Chirurgii Ginekologicznej Instytutu CZMP. I. Epidemiologia, objawy, stopnie zaawansowania.

OBJECTIVES: The purpose of our study was to analyse the epidemiological data, signs and symptoms, FIGO staging in patients operated for the first time for ovarian cancer. MATERIALS AND METHODS: A retrospective review of patients' charts with ovarian cancer operated at the Department of Gynaecological Surgery of Polish Mother's Memorial Hospital-Research Institute in 1990-1999 was conducted. We analysed the data of women operated for the first time for this disease. FIGO staging was performed due to operational and histologic findings. RESULTS: Between January 1990 and December 1999, 107 patients were operated for the first time for ovarian cancer. The mean patients' age was 54 years (range: 25-82); 31.8% of patients were aged from 41 to 50 years, 24.8% 51-60, 27.1% 61-70%, 7.5% above 70 years, and 9.3% were below 40 years. The main symptoms were: abdominal pain (61.7%), increasing abdominal circumference (35.5%), urination and bowel problems (14.0%), weight loss (8.4%), dyspeptic problems (7.5%), slightly elevated temperature (4.7%) and abnormal vaginal bleeding (3.7%). No symptoms were reported by 16.8% of patients (frequency similar in I/II and III/IV stage by FIGO). There were no statistical differences in the incidence of reported symptoms in I/II vs III/IV FIGO stage. FIGO staging was as follows: I--13.1%, II--14.95%, III--59.8%, IV--12.15%. CONCLUSIONS: Our data showed that ovarian cancer is very rare below the age of 40 and above 70 years. There is a great need to improve screening for ovarian cancer because the development of the disease is clinically silent or nonspecific and almost 70% of patients with ovarian cancer is diagnosed in the late stages of illness.

[Ovarian cancer. II. Procedures, histology, and complications]. / Rak jajnika w materiale Kliniki Chirurgii Ginekologicznej Instytutu CZMP. II. Operacje pierwotne, histopatologia, powiklania.

OBJECTIVES: The purpose of our study was to analyse the operative procedures and complications in patients operated for the first time for ovarian cancer. MATERIALS AND METHODS: A retrospective review of patients' charts with ovarian cancer operated at the Department of Gynaecological Surgery of Polish Mother's Memorial Hospital-Research Institute in 1990-1999 was conducted. We analysed the data of women operated for the first time for this disease. In every case we tried to perform radical operation consisted of hysterectomy with bilateral adnexectomy, omentectomy, appendectomy (if needed), and additionally optimal debulking in advanced cancer. RESULTS: Between January 1990 and December 1999, 107 patients were operated for the first time for ovarian cancer. FIGO staging was as follows: I--13.1%, II--14.95%, III--59.8%, IV--12.15%. The most frequent findings on histology were serous (39.3%), endometrioid (26.2%), undifferentiated (11.2%) and clear cell cancers (10.7%). In 60.7% of cases we performed hysterectomy with bilateral adnexectomy, in 15.0% bilateral adnexectomy, in 4.7% of patients cytoreductive tumorectomy, and in 19.6% of cases only excisions for histology were taken. 69.0% of patients underwent also omentectomy and 42.6% appendectomy. In 58.9% of patients we performed radical operation; its incidence significantly decreased with the increase of FIGO staging: I--100%, II--87.5%, III--51.6%, IV--15.4% (p < 0.0005). We noted 5 cases of intraoperative complications, all in patients with the stage III, connected with intestinal or urinary bladder lesions. The most common postoperative complication was anaemia (23.4%) and fever (4.7%). Four patients died in 8-27 postoperative day due to circulatory insufficiency. CONCLUSIONS: The most common was serous and endometrioid ovarian cancer. The great majority of patients was diagnosed to late and operated in III and IV stage of the disease, but in almost 60% of cases radical operation was performed.

[The evaluation of blood flow in uterine arteries in girls with polycystic ovary syndrome by transvaginal color Doppler ultrasonography]. / Ocena przeplywu krwi w tetnicach macicznych u dziewczat z zespolem policystycznych jajników przy wykorzystaniu ultrasonografii przezpochwowej z "kolorowym" Dopplerem.

OBJECTIVE: The aim of this study was to evaluate of blood flow in uterine arteries in girls with PCOS and to determine whether uterine blood flow variations are associated with endocrine findings typical of PCOS. METHODS: Seventy two girls with clinical, endocrinologic and ultrasonographic features of PCOS (mean age 18.8 +/- 1.3 years) were examined. The control subject consisted of twenty girls with regular, ovulation cycles. None of these girls had received hormonal treatment for at least 6 months before the study. Pelvic ultrasound examination was made in each patient with Acuson 128 XP/10 with the 4/5/7 MHz transvaginal transducer. Examination was performed in early follicular phase. Blood flow was made in each patient in the ascending branches of uterine arteries. Index values pulsatility index (PI) and resistance index (RI) were used for the purpose of better comparison of the data. Associations between values of PI and RI and hormones (testosterone, luteinizing hormone) were examined. RESULTS: No significant differences between PI and RI of the left and right uterine artery was observed. PI in PCOS girls was mean 3.19 +/- 0.52 ranged from 2.1 to 4.3, in control girls PI was mean 2.33 +/- 0.36 ranged from 1.6 to 3.1. The PI was positively correlated (r = 0.435, p < 0.01) with testosterone and PI was positively correlated (r = 0.450, p < 0.001) with LH. The RI in PCOS patients was mean 0.87 +/- 0.04 ranged from 0.74 to 0.93, in control girls 0.72-0.87, mean 0.80 +/- 0.04. The RI was positively correlated (r = 0.466, p < 0.001) with testosterone and RI was positively correlated (r = 0.492, p < 0.001) with LH. CONCLUSIONS: The elevated uterine artery resistance was observed in girls with PCOS.

[Intrauterine infections. I. The role of C-reactive protein, white blood cell count and erythrocyte sedimentation rate in pregnant women in the detection of intrauterine infection after preliminary rupture of membranes]. / Infekcje wewnatrzmaciczne. I. Przydatnosc oznaczen bialka C-reaktywnego, calkowitej liczby leukocytów i odczynu opadania krwinek we krwi ciezarnych w rozpoznawaniu infekcji wewnatrzmacicznej po przedwczesnym peknieciu blon plodowych.

UNLABELLED: The purpose of our study was to analyze the efficacy of serum C-reactive protein (CRP), white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) serial evaluations in the prediction of chorioamnionitis in cases of premature rupture of membranes (PROM). MATERIALS AND METHODS: A group of 80 patients with PROM before 35 weeks' gestation were evaluated prospectively and managed expectantly. We applied the expectant management with the permanent use of tocolysis, antibiotics, steroids, amnioinfusions of artificial amniotic fluid and intravaginal chemotherapeutics. Patients were monitored with frequent vital signs, fetal heart rate evaluation and everyday blood tests as follows: CRP, WBC and ESR. All afterbirths were examined to establish the presence of histologic chorioamnionitis (gold standard of intrauterine infection). RESULTS: 59 (73.7%) patients had significant chorioamnionitis on histopathology and only 15 of them had clinical chorioamnionitis. Serum CRP serial determinations (definition of abnormal tests: 1) > 1.2 mg/dl; 2) > 2.0 mg/dl; 3) > 1.2 mg/dl and increasing in two consecutive days) were found the most reliable with a sensitivity 1) 91.5%; 2) 85%; 3) 88%, specificity 57%; 76%; 86%, positive predictive value 86%; 90%; 94.5%, negative predictive value 70.5%; 64%; 72% and accuracy 82.5%; 82.5%; 87.5% respectively. The efficacy of WBC (abnormal tests: > 12500/mm3; > 15000/mm3; > 12500/mm3 and increasing in two consecutive days) and ESR (abnormal tests: > 60 mm/h; > 60 mm/h and increasing in two consecutive days) serial evaluations was significantly lower. Moreover, in cases of chorioamnionitis CRP increased above the upper limit of normal 3 days earlier than WBC or ESR. CONCLUSIONS: CRP was found the most reliable indicator of histologic chorioamnionitis and indicated the presence of intrauterine infection earlier than WBC or ESR.

[Asymptomatic bacteriuria in pregnant women with insulin-dependent diabetes]. / Bezobjawowy bakteriomocz u ciezarnych z cukrzyca insulinozalezna.

Results of studies of the urinary tract of 43 pregnant women with insulin-dependent diabetes have been presented. No clinical symptoms of infection of this system were observed in particular trimesters of pregnancy. It was found that, despite the lack of symptoms of the urinary tract infection, the infection as such did occur-most frequently in the 2nd trimester. The most common bacteria in pregnant women with insulin-dependent diabetes (lasting over 10 years) were Staphylococcus epidermidis and Staphylococcus saprophiticus.