Angiogenic activity and IL-8 concentrations in peritoneal fluid and sera in endometriosis.

OBJECTIVES: During menstruation endometrial fragments are transported into the peritoneal cavity where they form endometriotic lesions. Angiogenesis is proposed as one of the mechanisms in endometriosis pathogenesis. The aim of the study was to determine the angiogenic activity and interleukin 8 concentrations in peritoneal fluid and sera in endometriosis. METHODS: Angiogenesis was determined in cutaneous assay in Balb/c mice; IL-8 concentrations were measured by ELISA test in sera and peritoneal fluid of 32 control and 56 endometriosis patients. Wilcoxon and Mann-Whitney tests and Spearman rank correlations were used in statistical analysis. RESULTS: Peritoneal fluid and sera from the examined group had higher angiogenic activity and interleukin 8 concentrations. There was correlation found between AFS and neovascularization induced by sera and PF of patients with peritoneal lesions. CONCLUSIONS: Angiogenesis plays an important role in pathogenesis of endometriosis. Although IL-8 takes part in neovascularization, there are other factors modulating angiogenesis in endometriosis.

Efficacy and tolerability of low-dose transdermal estrogen (Oesclim) in the treatment of menopausal symptoms.

OBJECTIVE: To establish the proportion of symptomatic postmenopausal women who can be satisfactorily maintained on a low HRT dose of 25 microg/day 17-beta-estradiol (Oesclim 25 transdermal patches), after 8 weeks of treatment. STUDY DESIGN AND PATIENTS: This was a multicenter open label non-comparative trial. Treatment was initiated with 25 microg/day dosage, which could be increased to 50pg/day if required after 8 weeks, according to clinical evaluation. Sequential treatment with an oral progestogen was also given for > or = 12 days/month in all non-hysterectomized women. The primary criterion for evaluation of efficacy was the proportion of patients who remained on Oesclim 25 after 8 weeks of treatment in comparison to patients requiring Oesclim 50. RESULTS: Sixty-two patients were included in the study and 60 were treated. 88.3% of treated patients [CI: 78.7-94.9] fulfilled the primary criterion, remaining with the Oesclim 25 dosage after 8 weeks of treatment. All clinical menopausal symptoms showed a decrease from baseline to the end of the study. The mean daily number of vasomotor symptoms decreased from 8.2 (+/- 5.6) at baseline, for the entire treated population, to 1.0 (+/- 2.2) and 1.0 (+/- 1.2) at the end of the study in patients remaining with Oesclim 25 and in those requiring Oesclim 50, respectively. At the interim visit, patients in the Oesclim 50 group had a higher number of symptoms than those maintained on Oesclim 25. The global efficacy of the treatment was evaluated as very effective/effective by 93% of all patients and very good/good by investigators for 91% of their patients. Overall 91% of all patients evaluated the global tolerability as very well/well, while investigators rated it very good/good for 97% of their patients. The vast majority of all patients (93%) were very satisfied/satisfied with the trial treatment, and 90% of them were willing to continue the study drug. CONCLUSION: Oesclim low dose (25microg) hormonal transdermal therapy was efficient in management of climacteric symptoms in this 16-week study. The good acceptance of the treatment was associated with its high efficiency and tolerability.

[Actinomyces adnexitis in a woman]. / Promienica narzadu plciowego u kobiet.

The course of actinomycetic infections in two females with IUD is presented. Both patients needed surgery. Literature review taking into a special consideration laboratory diagnosis has been performed. Infection caused by other than Actinomyces israelii species was observed.

[The results of GnRH analog treatment of endometriosis]. / Wyniki leczenia endometriozy analogami GnRH.

Our study consisted of 146 patients with endometriosis diagnosed during laparoscopy. The age of those women varied from 19 to 43. Pathological changes were classified according to Revised American Fertility Society scale. Numeric scale was also used to evaluate clinical symptoms characteristic to this disease. During the initial laparoscopy biopsies were taken, endometrial implants were coagulated, pelvic adhesions deliberated and endometriomas were enucleated or their wall cut out and coagulated. When endometriosis was histopathologically confirmed the hormonal treatment was undertaken during a period of time from 3 to 6 months depending on the severity of the disease. The patients were treated with 3.6 mg gosereline and 3.75 mg triptorelin monthly or with 400 mcg of naphareline daily. The hormonal therapy was monitored by the concentration of estradiol in blood serum. After full cycle of GnRH analogues treatment laparoscopy was repeated. The mean of The Symptom Severity Scores decreased from 7.1 to 2.1 after the treatment which is a 70% decrease. In the group of women with pain complains 96% of patients noticed improvement, in the group suffering from infertility there were 26.3% of patients who got pregnant. GnRH analogues were good tolerated by patients during the treatment.

[VEGF concentration in peritoneal fluid of patients with endometriosis]. / Stezenie VEGF (czynnik wzrostu sródblonka naczyniowego) w plynie otrzewnowym kobiet z endometrioza.

The theory of Sampson that endometrial cells and fragments desquamated during the menstrual period are transported through fallopian tubes into the peritoneal cavity where they implant, proliferate and develop into endometriotic lesions is generally accepted. There is increasing evidence that immunological mechanisms play a role in the pathogenesis and pathophysiology of endometriosis. Excessive endometrial angiogenesis is proposed as an important mechanism in the pathogenesis of endometriosis. Evidence is reviewed for the hypothesis that the endometrium of women with endometriosis has an increased capacity to proliferate, implant and grow in the peritoneal cavity. From the known angiogenic factors, vascular endothelial growth factor (VEGF) has emerged as a pivotally important regulator of normal angiogenesis and pathological neovascularization. In present study we evaluated the concentrations of VEGF in peritoneal fluid of patients with endometriosis and showed no correlation between AFS score and VEGF concentration in peritoneal and in ovarian endometriosis. Above results do not confirm former observations indicating the role of VEGF in endometriosis pathogenesis.

[Analysis of hormone profile in women during the pre- and postmenopausal period using hormone replacement therapy, and analysis of the mammography image in these women]. / Analiza profilu hormonalnego u kobiet w okresie przed- i pomenopauzalnym stosujacych hormonalna terapie zastepcza, oraz analiza obrazu mammograficznego u tych kobiet.

The hormonal profile and mammography results were analysed in 120 women in premenopause (group A) and 130 in postmenopausal period (group B). The analysis developed biphasic menstrual cycle, with high progesterone levels in the second cycle's period in 57 subjects (group A--mean P concentration--53.7 nmol/ml), and elevated E2 levels in monophasic cycle in 63 subjects (group A2--man E2 205.4 pg/dl). In case of post-menopausal women mean E2 level during therapy was 104.6 pg/dl. In examined group 8 subject have been undergoing hormonal replacement therapy for 1-3 years, 30 of them for 5 years, 20 more than 5 years. In mammography in one case from group A1 with high progesterone concentration abnormally opaqueness has been observed. Histological examination confirmed incidence of cancer cells. No other changes have been observed. High serum progesterone concentration in pre-menopausal women increase risk of cancer.

Aerodiol versus the transdermal route: perspectives for patient preference.

OBJECTIVE: to compare the efficacy, tolerability and user preference of Aerodiol intranasal and transdermal patch administration of 17 beta-estradiol for climacteric symptoms. METHODS: an open-label, multicenter, crossover trial in which recently postmenopausal women were randomized to receive either Aerodiol 300 microg daily (n=176), or transdermal 17 beta-estradiol (reservoir patches delivering 50 microg/day), 2 patches per week (n=185), for 12 weeks, followed by 4 weeks of the alternative treatment. Efficacy was assessed primarily by the Kupperman index at the end of each treatment period. User satisfaction was assessed by questionnaire at weeks 12 and 16, and at week 16 the women chose which treatment they preferred to use for a further 40-week period. RESULTS: Aerodiol and transdermal patch therapy produced marked and similar reductions in the Kupperman index and the incidence of hot flushes at weeks 12 and 16. The reduction in the Kupperman index at week 12 was statistically equivalent for the two treatments. The tolerability of both treatments was good, with similar numbers of emergent adverse events reported in both groups. The incidence of moderate or severe mastalgia, however, was significantly lower with Aerodiol (P=0.02). Significantly more women chose to continue treatment with Aerodiol than with the transdermal patch (66 vs. 34%, P<0.001). When all women had experienced both treatments, reported levels of satisfaction were significantly higher with Aerodiol than with transdermal therapy (P<0.001 for all six categories assessed). CONCLUSIONS: Aerodiol and transdermal patch treatments were of similar efficacy and tolerability. Levels of user preference and satisfaction, however, were higher with Aerodiol, which should contribute towards good long-term compliance with this therapy.

[Bacterial and fungal vaginal infections--immunologic and clinical aspects]. / Bakteryjne i grzybicze stany zapalne pochwy--aspekt immunologiczny i kliniczny.

Bacterial and fungal vaginal infections seem to be one of the most important problem in clinical gynaecology, because of their very often incidence and recurrence. One of the most important factor that implicates those epidemiological facts is local immunological response. Present paper summarises immunological mechanisms involved in antimicrobial response, and current knowledge on diagnosis and treatment of bacterial and fungal vaginal infections.

[Patient's preferences concerning the course of labor]. / Preferencje kobiet dotyczace przebiegu porodu.

OBJECTIVE: Much concern is being focused on the improvement of perinatal care standards in recent time. Not only the safety of woman and newborn, but also the comfort and individual preferences should to be considered. The aim of this study was to assess of expectations and requirements of the delivering women in relation to the course of labor and usage of the most common procedures in clinical practice. MATERIAL AND METHODS: 47 women who delivered in Obstetrical Word in Puck were questionnaire. Mean gestational age was 39 +/- 1.5 hbd. 47% of women were nulliparous, 53% were multiparous. The following variables were analyzed: the presence of medical staff and family at delivery, possibility of the delivery position choice, use of auxiliary devices, a friendly atmosphere during delivery, use of analgesia and labor induction, episiotomy and ante-partum preparation, cesarean section on request, attendance to labor school. Mann-Whitney, Pearson and Yule tests were used for statistical analysis. RESULTS: 25% of women, mainly younger gravidae, attended the labor school. The midwife was considered the most important person at delivery. The presence of family member(s) was important for highly-educated women. The possibility to choose the delivery position and to walk during the 1st stage of labor was important for 73% of respondents. The majority of women who had attended the labor school avoided the horizontal position. Over 60% of patients accepted the usage of labor induction. A vast majority of women were against antepartum perineal shaving and episiotomy. Better-educated women preferred water delivery. 69% of the studied women would like to listen to the music at the delivery room. Cesarean section on request was supported by 11% of women. CONCLUSIONS: The tendency to promote modern delivery methods and active participation in labor leading is noticed. The significant influence of labor school on women's knowledge and their preferences was found.

[Water birth in the parturients' estimation]. / Poród w wodzie w ocenie rodzacych kobiet.

OBJECTIVES: The purpose of the study was to characterise a group of women who decided for under water birth and to show an influence of warm water on their psychosomatic reactions. MATERIALS AND METHODS: The results of the inquiry conducted among 45 women bathed during first stage of normal labour and delivery under water were analysed. The demographic data, water birth knowledge and psychosomatic reactions were studied traditional. The age, education, obstetric history of the women was compared with a group of 45 women who gave birth in a way. RESULTS: The average age of women in labour under water was 25.6 years and no significant difference to control group (25 years) was found. The most common in our research group was secondary education (62%), after that elementary (20%) and university education (18%). Worse educated women were more rarely decided for water birth (20% in research group vs 41% in control; p < 0.05). A midwife was the most important source of information about warm tub bath during delivery, especially among worse educated women (67%). Concerning reactions after entering the pool, in 69% cases decrease of labour pain and in 64% decrease of spasm pains was observed. In 58% cases the time of delivery was advanced, only in 13% it lasted longer after going into the warm tub. Immersion in the pool was sensed in a positive way by all the parturients. The women described appeasement (78%), relaxation (67%), better opportunities for mid-spasm rest (67%). The water tub bath during delivery was estimated good by all of the women. 76% of the group gave 5 points in 1 to 5 scale. As many as 87% of women wish they born another baby in a water. CONCLUSIONS: A midwife has an essential role in information and making a decision of water birth. Entering the pool causes subjective decrease of labour pain and advance of delivery. Women very good estimate birth in water.

[The influence of water immersion on the course of labor]. / Wplyw immersji wodnej na przebieg porodu.

OBJECTIVE: The aim of this study was to examine the influence of water immersion on the course of labor. MATERIAL AND METHODS: The study group consisted of 109 women, who have delivered in water in Obstetrical Ward in Puck from 1998 to 2000. 110 women composed control group. Mean patients' age in study and control group was respectively 26.40 +/- 4.33 and 26.72 +/- 5.82 years (ns). Gestational age was 40.69 +/- 5.91 and 39.71 +/- 2.03 weeks (ns). The duration of labor stages, time from membranes rupture to delivery, birthweight and newborns condition, frequency of episiotomy and perineum injuries as well as necessity of labor stimulants use were analyzed. Particular parameters were also assessed regarding to parity. The differences were determined using T-test. RESULTS: Mean duration of 1st labor stage was 319 min in study group and 375 min in control group (p < 0.02). The 2nd and 3rd labor stages did not differ significantly. II labor stage in nulliparous and I stage in multiparous were shorter in study group (respectively 34.41 vs. 45.5 min; p < 0.02 and 258.23 vs. 329.83 min; p < 0.02). The episiotomy was less frequent in study group (p < 0.01), whereas perineum injuries in control one (p < 0.05). Use of oxytocin was comparable between both groups. 97% of newborns from study group and 93% from control group, they were in good condition (ns). CONCLUSIONS: The profitable influence of water immersion to short 1st labor stage was noted. There were no differences in newborns' condition. The water birth is a safe method of labor in patients with physiological pregnancy.

[The postnatal condition evaluation of preterm infants]. / Ocena stanu noworodków urodzonych przedwczesnie.

OBJECTIVE: The aim of the study was to compare general postnatal condition of preterm infants delivered by caesarean section or born vaginally. MATERIAL AND METHODS: The study group consisted of 605 premature newborns delivered in Obstetrics and Gynaecology Clinic of Medical University of Warsaw in 1995-2000. The newborns were divided into two groups. There were 280 prematures delivered by caesarean section in the first group and 325 ones were born vaginally in the second group. RESULTS: The first day mortality rate in infants born vaginally was 6.8% comparing with 2.8% in ones delivered by caesarean section. CONCLUSIONS: In the study group the percentage of neonatal severe condition was similar in both groups but mortality rate in the first day of life was slightly higher in infants born vaginally.

[Analysis of the postnatal condition and mortality of neonates with extremely low birth weight]. / Analiza umieralnosci poporodowej, stanu pourodzeniowego oraz przyczyny zgonów noworodków z ekstremalnie niska urodzeniowa masa ciala.

OBJECTIVE: The aim of this study was to analyze the postnatal condition and mortality of neonates with extremely low birth weight. MATERIALS AND METHODS: The study group consisted of 35 neonates delivered in the 1st Dept of Ob/Gyn. Medical University of Warsaw in the period of 1996-2000. The group was divided into two classes depending on the birth weight. There were newborns weighted 500-750 g in the first class and 751-1000 g in the second one. Newborns condition in the 1st minute of life was assessed with Apgar score. The rate of mortality up to the 7th day of life as well as the causes of deaths was analyzed. CONCLUSIONS: Postnatal mortality rate of premature newborns extremely low birth weight is still very high, especially in case of newborns below 750 g. Respiratory distress syndrome and intracranial hemorrhage are the most common causes of demise of those newborns.

[Preterm deliveries of extremely low birth babies--analysis of the course of pregnancy, labour and neonatal outcome]. / Porody przedwczesne noworodków ze skrajnie niska masa urodzeniowa ciala--analiza przebiegu ciazy, porodu oraz stanu pourodzeniowego noworodka.

OBJECTIVE: Preterm delivery of baby with extremely low birth weight (ELBW) is an important problem in contemporary perinatology and a major reason of perinatal mortality. A great development of neonatal intensive care that has occurred over the last few years has resulted in the decrease of perinatal mortality rate. The aim of the study is to analyse the course of pregnancy, labour and neonatal outcome in the group of patients who delivered ELBW children. MATERIALS AND METHODS: In 1st Obstetric and Gynaecology Department Clinic of Medical University of Warsaw, 6982 deliveries were conducted from 1996 to 2000. Among them there were 589 preterm ones. As a result 44 women delivered ELBW children. These 44 deliveries were divided into three groups according to the reasons: Idiopathic preterm contractility-24 patients PROM with intrauterine infection or threatening infection-14 Induction of delivery because of lethal foetal defects and direct foetal distress-6. RESULTS: The most common reasons for deliveries of ELBW children were hypertension and ascending infections. CONCLUSIONS: A great number of mothers who delivered ELBW children had low socioeconomic status. In most cases pregnancy was unplanned and body mass index of the mothers was below 19. Almost all these newborns were severely depressed and delivery was often complicated. It is important to conduct labour in a careful way to avoid tissue injuries.

[Pregnancy delivery and newborn in female kidney recipients]. / Ocena przebiegu ciazy i porodu oraz stanu noworodków u pacjentek po transplantacji nerki.

OBJECTIVE: During the past few years a great development of clinical transplantology has taken place. Organ transplantation permits the best and quickest biological, clinical and social rehabilitation of patients. The subsidence of hormonal disturbances, which are responsible for irregular ovarian cycles and ovulation, has been observed among women with stable graft function. Such patients often become capable of conceiving and possessing offspring. With an increasing frequency of such occurrences, the pregnancy and delivery in the female transplant recipients is now becoming one of the major problem of contemporary perinatology. The aim of this study was to summarize our experience with the pregnancy, delivery and the state of newborn in female kidney transplant recipients. MATERIALS AND METHODS: 25 female kidney-transplant recipients who became pregnant were observed during pregnancy. The age of the patient was between 23 and 38 years. 32 pregnancies were followed up. The duration and complications of pregnancy, mode of delivery and newborns condition were analyzed. RESULTS: Miscarriages were observed in 47% of cases. Among patients who got birth, premature delivery was observed in 53%. Two stillbirths took place. 91% neonates were born in good condition. Preterm delivery occurred in 53%. Average birth weight was lower then observed at healthy pregnant women. No congenital defects were observed. CONCLUSIONS: In kidney transplant recipients who became pregnant the increased incidence of spontaneous abortion and preterm delivery was observed. Newborns delivered by those patients had decreased birth weight. No congenital defects were noted among those babies.

[Transvaginal ultrasonography and diagnostic hysteroscopy in infertile women]. / Znaczenie ultrasonografii przezpochwowej i histeroskopii w diagnostyce nieplodnosci kobiecej.

Sensibility and specificity of transvaginal ultrasonography and diagnostic hysteroscopy were compared in 211 infertile women. Examinations were performed between 1996-2000 in I-st Department of Obstetrics and Gynecology Warsaw Medical University--Poland. Comparing results we concluded high compatibility of transvaginal ultrasound and hysteroscopic examinations. In the future--as we suppose--the number of diagnostic hysteroscopies in infertile women will decrease and will be at least partially replaced by transvaginal ultrasound as less invasive and less expensive method.

[Semen parameters in secondary infertile couples]. / Analiza parametrów nasienia we wtórnej nieplodnosci malzenskiej.

OBJECTIVE: The aim of this study was to evaluate sperm values in the group of secondary infertile couples. MATERIAL AND METHODS: The material of the study included 35 couples with abortion in anamnesis, 12 couples with delivery in past and 11 couples conceive and deliver during studies. Sperm analysis was performed according to the WHO guidelines. RESULTS: Men from couples with abortion in past had significantly higher sperm concentration compare to couples with delivery in past. In other parameters there was no significant differences observed. CONCLUSION: Sperm concentration can be important factor in secondary infertility.

[Effects of oral administration of estrogen replacement therapy in surgical menopause]. / Wczesna pooperacyjna doustna estrogenoterapia zastepcza u pacjentek po usunieciu macicy z przydatkami.

OBJECTIVE: The aim of this study was to analyze effects of oral administration of conjugated estrogens in women after surgical menopause. MATERIAL AND METHODS: A prospective study that included 41 women after hysterectomy with bilateral oophorectomy, was performed. All patients received conjugated estrogens (Premarin) 0.625 mg daily from second or third days after surgery. Plasma level of estradiol, FSH and several homeostatic parameters were evaluated before and after 2, 5 days and 6 weeks of hormone therapy. The symptoms of climacteric syndrome were estimated based on the scale of Kuppermann. RESULTS: A decrease in plasma estradiol levels in early postoperative days and an increase up to 100 pg/ml in estradiol concentration after 6 weeks of estrogen therapy were observed. Changes in platelet number, plasma concentration of coagulation factors were transient and there were no significant thrombophilic effects after 6 weeks of Premarin administration. CONCLUSIONS: The postoperative oral administration of conjugated estrogens did not cause thromboembolic complications among women after surgical menopause. Early beginning of estrogen replacement therapy after hysterectomy may prevent symptoms of climacteric syndrome occurrence.

[The atherogenic lipid profile parameters and fibrinogen serum concentration in climacteric women under various routes of hormone replacement therapy administration]. / Ocena stezenia aterogennych czynników lipidowych i fibrynogenu w surowicy kobiet stosujacych rózne formy hormonalnej terapii zastepczej w okresie klimakterium.

OBJECTIVES: Influence of various routes of HTR on atherogenic lipid profile parameters and serum fibrinogen concentration was investigated. DESIGN: In 85 women in four groups receiving HRT transvaginally, transdermally, orally and intramuscularly, the total cholesterol, HDL-cholesterol, triglycerides, apoB, apoA, LpA and fibrinogen serum concentration was assessed before treatment and after six month. RESULTS: Most of tested parameters: total cholesterol, LpAI, apoB, LDL cholesterol, non HDL cholesterol, changed favorably (lowered concentration) in group using HRT orally and intramuscularly. CONCLUSION: Orally and intramuscularly route of administration HRT have better cardioprotective effects.