Accuracy of hysterosalpingo-foam sonography in comparison to hysterosalpingo-contrast sonography with air/saline and to laparoscopy with dye.

Study question: What is the diagnostic accuracy of 2D/3D hysterosalpingo-foam sonography (HyFoSy) and 2D/3D-high-definition flow Doppler (HDF)-HyFoSy in comparison to laparoscopy with dye chromotubation (as the reference method) and 2D air/saline-enhanced hysterosalpingo-contrast sonography (HyCoSy) (as the initial index test)? Summary answer: 2D/3D-HDF-HyFoSy had the best diagnostic accuracy and was the only method that did not significantly differ from the reference method, while both 2D/3D-HyFoSy and 2D/3D-HDF-HyFoSy had significantly higher accuracy than 2D-air/saline-HyCoSy. What is known already: Previous studies on X-ray hysterosalpingography and laparoscopy and dye as the reference standard have undermined the impact of older commercial contrast agents on the accuracy of ultrasound tubal patency tests. Recently, HyFoSy was reported to have very high accuracy in a small pilot study in comparison to laparoscopy and dye, and had a very high positive predictive value (PPV) for medical tubal occlusion. A new Doppler sonographic technique, known as HDF imaging with better axial resolution, fewer blooming artifacts and higher sensitivity than color and power Doppler imaging, has been introduced. Study design, size, duration: A prospective observational study was performed on 132 women (259 Fallopian tubes) consecutively enrolled between 2013 and 2015. Participants/materials, setting, methods: This study included infertile women of reproductive age who previously had not been examined for tubal patency and who presented for the evaluation to the university hospital, private hospital and clinic at which this study was conducted. 2D-Air/saline-HyCoSy, 2D/3D-HyFoSy and 2D/3D-HDF-HyFoSy and laparoscopy were performed independently by experienced readers. During HyFoSy, the 3D mode was used for standardization of pelvic scanning and observations of contrast flow without diagnosis after volume acquisition. Sensitivity, specificity, negative and positive predictive value (NPV and PPV), negative and positive-likelihood ratio (LR- and LR+) and 95% CI were calculated. McNemar's test and relative predictive values (a comparison of NPV and PPV) were used to compare all the index tests. Main results and the role of chance: 2D-Air/saline-HyCoSy, 2D/3D-HyFoSy and 2D/3D-HDF-HyFoSy indicated that 46 (17.8%), 27 (10.4%) and 24 (9.2%) of the 259 tubes were occluded, respectively; additionally, inconclusive results were obtained for 8 (3%), 5 (1.9%) and 3 (1.2%) tubes, respectively. The reference method revealed 18 (6.9%) occluded Fallopian tubes. 2D-Air/saline-HyCoSy had a high NPV (99.5%) that was similar to that of 2D/3D-HyFoSy (99%) and 2D/3D-HDF-HyFoSy (99.6%) (P > 0.05), but had a very low PPV (30.4%). The use of 2D/3D-HyFoSy, especially 2D/3D-HDF-HyFoSy, which had a significantly higher PPV (48% and 71%, P < 0.05 and P < 0.01; respectively), resulted in fewer false positive and inconclusive findings than the use of 2D-air/saline-HyCoSy. The LR- and LR+ was 0.14 and 14.8, respectively, for 2D/3D-HyFoSy, 0.06 and 32.1, respectively, for 2D/3D-HDF-HyFoSy, and 0.08 and 6.9, respectively, for 2D-air/saline-HyCoSy. The number of inconclusive or positive results per patient was significantly fewer with 2D/3D-HyFoSy (odds ratio, OR = 0.5, CI = 0.3-0.95, P < 0.05) and 2D/3D-HDF-HyFoSy (OR = 0.4, 95% CI = 0.2-0.8, P < 0.01) than with 2D-air/saline-HyCoSy. Limitations, reasons for caution: An unselected infertile population with a low prevalence of tubal occlusion is suitable for estimating the diagnostic accuracy of imaging tests only as a screening tool. Wider implications of the findings: These findings can be used to establish a diagnostic strategy with high accuracy but minimum invasiveness and limited use of contrast agents and sophisticated technology. 2D-Air/saline-HyCoSy, which has a high NPV, is suitable as an initial test and basic screening method, but 2D/3D-HDF-HyFoSy, which has a significantly higher PPV, can be used as a standard to verify any questionable or positive results obtained with 2D HyCoSy. This strategy may signficantly reduce the need for laparoscopy as a reference standard. Study funding/competing interest(s): There was no external funding for this study, and the authors have no conflicts of interest to declare. Trial registration number: N/A.

Association of the immunohistochemical detection of gamma-glutamyl transferase expression with clinicopathological findings in postmenopausal women with endometrioid adenocarcinoma of the uterus.

Gamma-glutamyl transferase (GGT) is a membrane enzyme present not only in the liver but also in healthy endometrial epithelium. Its overexpression has been demonstrated in numerous malignancies, where it exerts an anti-apoptotic effect and causes drug resistance in response to oxidation stress. Aim of the study was investigation of GGT expression in postmenopausal patients with endometrioid adenocarcinoma of the uterus (EAC). The material comprised 98 paraffin-embedded post-operative tumour samples of EAC from postmenopausal patients and a control group of 60 normal human postmenopausal endometrium samples. For immunohistochemical specimen staining, polyclonal IgG anti-GGT was used; for GGT expression measurement, a semi-quantitative method was applied. In EAC patients, 16 (16.33%) were diagnosed as stage IA, 46 (46.93%) as stage IB, 14 (14.29%) as stage II, and 22 (22.45%) as stage IIIA-C, according to the International Federation of Gynaecology and Obstetrics (FIGO) classification. Fifty-six (57.14%) patients were diagnosed with low- or moderate-grade (G1-2) disease, and 42 (42.86%) were diagnosed with high-grade (G3) disease. Cytoplasmic GGT staining was confirmed in all samples, while apical membrane GGT staining was observed only in G1-2 EAC specimens and the control group. In G3 EAC specimens, GGT cytoplasmic staining and high nuclear polymorphism areas were predominantly shown. Comparable high GGT median apical expression was confirmed in healthy endometrium (2.0, S.E.M. = 0.28) and in G1-2 EAC (2.0, S.E.M. = 0.27); however, in G3 tumours, GGT expression was significantly lower (0.0, S.E.M. = 0.07) than in healthy endometrium (P < 0.001 and P < 0.001, respectively). After stratification of the cancer cases according to FIGO staging, the lowest median apical GGT expression levels were in II EAC (0.0, S.E.M. = 0.64) tumours compared with IA (4.0, S.E.M. = 0.47) tumours, specimen and normal endometrium (2.0, S.E.M. = 2.8) (P < 0001). Stage IB EAC and IIIA-C EAC (1.0, S.E.M. = 0.16) cases showed only moderate median apical expression of GGT (1.0, S.E.M. = 0.24). We concluded that impaired GGT expression has the potential to become a valuable tool for stratifying EEC patients' prognosis and treatment planning.

The Prospective External Validation of International Ovarian Tumor Analysis (IOTA) Simple Rules in the Hands of Level I and II Examiners.

Objective: To externally validate the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) by examiners with different levels of sonographic experience defined by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and to assess the morphological ultrasound features of the adnexal tumors classified as inconclusive based on IOTA SR. Materials and Methods: In the two-year prospective study adnexal tumors were assessed preoperatively with transvaginal ultrasound by examiners with different levels of experience (level 1- IOTA SR1, level 2-IOTA SR2). Additionally, an expert (level 3) evaluated all tumors by subjective assessment (SA). If the rules could not be applied, the tumors were considered inconclusive. The final diagnosis was based on the histopathological result of the removed mass. The diagnostic performance measures for the assessed model were sensitivity, specificity, negative (LR-) and positive(LR+) likelihood ratios, accuracy (ACC) and diagnostic odds ratio (DOR). Results: 226 women with adnexal tumors scheduled for surgery were included in the stutdy. The prevalence of malignancy was 36.3 % in the group of all studied tumors and was 52.5 % in the inconclusive group (n = 40) (p = 0.215). Fewer tumors were classified as inconclusive by level 2 examiners compared to level 1 examiners [20 (8.8 %) vs. 40 (17.7 %); p = 0.008], resulting from the discrepancy in the evaluation of acoustic shadows and the vascularization within the tumor. For level 1 examiners a diagnostic strategy using IOTA SR1 +MA (assuming malignancy when SR inconclusive) achieved a sensitivity, specificity and DOR of 96.3 %, 81.9 %, 13.624 respectively. For level 2 examiners the diagnostic strategy for IOTA SR2 +MA achieved a sensitivity, specificity and DOR of 95.1 %, 89.6 %, 137,143, respectively. Adding SA by an expert (or level 3 examiner) when IOTA SR were not applicable improved the specificity of the test and achieved a DOR of 505.137 (SR1 +SA) and 293.627 (SR2 +SA). The SA by an expert proved to have the best diagnostic performance with a DOR of 5768.857, and a sensitivity and specificity of 97.6 % and 99.3 % respectively. Within the inconclusive group the most common tumors were unilocular-solid (n-13), solid (n-8) and multilocular-solid (n-10) ones. All multilocular tumors were classified as inconclusive because of their size (≥ 100 mm) and were found to be benign by pathology. Most of the inconclusive tumors with cystic content presented low-level (43.75 %) echogenicity, followed by ground-glass (34.37 %), mixed (12.5 %) and anechoic (9.4 %). Conclusion: The study results show excellent diagnostic performance of IOTA Simple Rules followed by subjective expert assessment in inconclusive tumors irrespective of the level of experience, while subjective assessment by an expert still has the highest diagnostic odds ratio. The number of inconclusive cases seems to depend on the level of ultrasound expertise and less experienced examiners have a tendency to overestimate blood flow and a presence of acoustic shadows within the tumors. IOTA SR were not applicable either because no benign or malignant features were found or both were identified. Within inconclusive tumors the majority of cases comprise malignant masses that are either unilocular-solid, solid tumors or small multilocular-solid ones with a diameter of less than 100 mm.

Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty.

STUDY QUESTION: Can morphologic measurements (width, length and surface area) of the uterine septum predict healing-dependent abnormal anatomic results [ARs; residual septum (RS) and intrauterine adhesions in other locations (IUA-OLs)] after complete hysteroscopic metroplasty (HM)? SUMMARY ANSWER: Significant predictors of ARs are the septal width and, to a lesser extent, septal surface area. WHAT IS KNOWN ALREADY: Anatomic results after hysteroscopic metroplasty have very large variation. A RS >1 cm and IUA-OLs can aggravate reproductive outcomes, resulting in the need for reoperation. New criteria for diagnosing a uterine septum according to the European Society of Human Reproduction and Embryology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE) have been suggested (ESHRE-ESGE criteria). Autocross-linked hyaluronic acid gel (autocross-linked polysaccharide) has an antiadhesive effect. STUDY DESIGN, SIZE, DURATION: A prospective, observational cohort study was performed with 96 women consecutively enrolled between 2007 and 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women who had uterine septum and previous miscarriage or infertility presented for evaluation at a university hospital, private hospital or private medical center were included. Preoperative septal width, length and surface area were determined with three-dimensional sonohysterography. Women were treated by hysteroscopy in a standardized manner with three- or four-dimensional transrectal ultrasound guidance (complete resection). Patients received either no adhesion barrier (49 patients) or adhesion barrier with autocross-linked polysaccharide (47 patients). Anatomic results were assessed with three-dimensional sonohysterography and second-look hysteroscopy. Healing-dependent ARs were reported using both American Society of Reproductive Medicine (ASRM) criterion of RS length >1 cm (ASRM>1 cm criterion) and ESHRE-ESGE criteria. Univariate and multivariate logistic regression were used to identify predictors of RS, IUA-OLs and ARs. MAIN RESULTS AND ROLE OF CHANCE: In patients who had no adhesion barrier, ARs were diagnosed in 11 of 49 patients (23%) using the ASRM > 1 cm criterion and in 20 of 49 patients (41%) using the ESHRE-ESGE criteria for RS [odds ratio (OR)ESHRE-ESGE:ASRM, 2.4, P = 0.05]. In the patients who had autocross-linked polysaccharide, ARsASRM > 1 cm were diagnosed in 2 of 47 patients (4%) and ARsESHRE-ESGE in 4 of 47 patients (9%). RSESHRE-ESGE was diagnosed significantly more often than RSASRM > 1 cm 19 of 96 (20%) versus 5 of 96 (5%) in all patients (ORESHRE-ESGE:ASRM > 1 cm = 4.5, P < 0.01). In patients who had no adhesion barrier, logistic regression with ASRM > 1 cm and ESHRE-ESGE criteria showed that the width and surface area were predictors of ARs. Models adjusted by patient group confirmed the significance of width as a predictor of ARsASRM > 1 cm [OR for width, 3.5 (P < 0.01); OR for group, 0.22 (P < 0.01)], width as a predictor of ARsESHRE-ESGE [OR for width, 2.2 (P < 0.01); OR for group, 0.26 (P < 0.01)] and surface area as a predictor of ARsASRM > 1 cm [OR for surface area, 1.5 (P < 0.01)]; OR for group, 0.32 (P < 0.01). In patients who had autocross-linked polysaccharide, these predictors were not significant. Receiver-operating characteristic curves showed cutoff values for ARsASRM > 1 cm (septal width, 3.42 cm; septal surface area, 4.68cm²) and ARsESHRE-ESGE (septal width, 3.42 cm; septal surface area, 3.51cm²). LIMITATIONS AND REASONS FOR CAUTION: Patients were enrolled in the adhesion barrier group in a time-dependent, consecutive and non-randomized manner. WIDER IMPLICATIONS OF THE FINDINGS: A wide septum and large surface area may be indications for adhesion barrier. The use of autocross-linked polysaccharide reduces the risk of ARs. The ESHRE-ESGE criteria may cause greater frequency of recognition of RS than the ASRM > 1 cm criterion, which could result in more frequent reoperations with use of the ESHRE-ESGE criteria, possibly without any significant effect on reproductive performance. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by Jagiellonian University (grant no. K/ZDS/003821). The authors have no competing interest to declare.

Validation of the Polish version of the EORTC QLQ-CX24 module for the assessment of health-related quality of life in women with cervical cancer.

The aim of our study was to undertake a prospective validation study of the Polish version of the EORTC cervical cancer (EORTC QLQ-CX24) module used alongside the EORTC core measure. The translated module was pilot-tested according to the established EORTC guidelines. Patients with histological confirmation of cervical cancer were eligible for the study. All patients filled out the Polish version of the EORTC QLQ-CX24 module in addition to EORTC QLQ-C30 and a demographic questionnaire. Standardised validity and reliability analyses were performed. One hundred and seventy-one patients were enrolled into the study, mean age ± SD: 52.1 ± 9.6. Cronbach alpha coefficients, range 0.81-0.88, showed positive internal consistency. Re-test was undertaken with 40 patients (23.4%). Interclass correlations for the EORTC QLQ-CX24 ranged from 0.85 to 0.89 and proved appropriate test-retest reliability. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. Concluding, the Polish version of the EORTC QLQ-CX24 module is a reliable and valid tool for measuring HRQoL in patients with cervical cancer. It can be fully recommended for use in clinical and epidemiological settings in the Polish population.

Use of contraception by women treated with leflunomide due to rheumatic arthritis.

A total of 46 premenopausal patients treated with leflunomide (LMF) for rheumatic arthritis (RA) and 107 women of reproductive age free from chronic diseases were investigated to evaluate methods of contraception. Among 31 LMF-treated women using contraception, 48.4% chose oestrogen-progesterone hormonal contraception (E-PHC); 16.1% condoms; 3.2% had an intrauterine device and 32.0% preferred natural methods. These methods differed significantly from women in the control group, who mostly used condoms (56.8%) and E-PHC (35.3%) and rarely, natural methods (3.95%) or progesterone injections (3.95%). As many as 32.6% LMF-treated patients did not use any method of birth control. The choice of contraception among RA patients with LFM therapy was significantly dependent on the experience with methods used prior to the LFM therapy introduction (p < 0.001). Compared with women free from chronic diseases, LMF-treated patients use E-PHC significantly more often but still as many as 33% do not use any contraceptive method, despite strong recommendations.

Arterial supply and venous drainage of the choroid plexus of the human lateral ventricle in the prenatal period as revealed by vascular corrosion casts and SEM.

The topography of the arterial supply and venous drainage was visualised by corrosion casting and scanning electron microscopy in the human foetal (20 weeks) choroid plexus of the lateral ventricle. Although secondary villi were not yet present at that developmental stage, the topography of the large arteries and veins almost fully corresponded to that described in adult individuals. The only major difference observed was a lack of the typical tortuosity of the lateral branch of the anterior choroidal artery and of the superior choroidal vein, which probably develops during further expansion of the vascular system associated with the formation of secondary villi.

The microvascular architecture of the choroid plexus in fetal human brain lateral ventricle: a scanning electron microscopy study of corrosion casts.

The microvascular architecture of developing lateral ventricle choroid plexus was investigated by corrosion casting and scanning electron microscopy in human fetuses aged 20 gestational weeks. The areas with different microvascular patterns corresponded to the particular parts of the mature plexus: anterior part, glomus, posterior part, the villous fringe and the free margin. In the posterior part, densely packed parallel arterioles and venules were surrounded by sheath-like capillary networks. Other areas contained compact capillary plexuses of the primary villi: the most prominent, protruding basket- and leaf-shaped plexuses were observed in the villous fringe, whilst less numerous and smaller plexuses occurred in the anterior part and glomus. The capillaries of the plexuses had a large diameter and sinusoidal dilations, and showed the presence of occasional short, blind sprouts indicative of angiogenesis. Short anastomoses between arterioles supplying the plexuses and venules draining them were only rarely observed. In the upper area of the choroid plexus, the superior choroidal vein was surrounded by a capillary network forming small, glomerular or rosette-shapes plexuses. The free margin of the choroid plexus was characterized by flat, multiple, arcade-like capillary loops. The general vascular architecture of the human choroid plexus at 20 gestational weeks seems to be similar to that of postnatal/mature plexus, still lacking, however, the complex vascular plexuses of the secondary villi.

[Changes in ovaries after hysterectomy]. / Zmiany zachodzace w jajnikach po usunieciu macicy.

Although simple hysterectomy is one of the most frequent gynecological operations, there is still the lack of clear criterions to the procedure with macroscopic unchanged ovaries in perimenopausal term. The aim of study was to examine setting changes in ovaries after hysterectomy. The study included 40 women aged between 40 and 49 years, who underwent hysterectomy due to myoma, leaving their bilateral changes in ovaries connected with age two study groups were distinguished, the first group included 21 patients aged 40-44 years and the second one--19 patients aged 45-49 years. The occurring of pathological changes in remaining ovaries and changes in ovaries function were estimated. The period of observation lasted two years. The function of ovaries was observed by estimation of FSH and of E2 and of total volume of ovaries before operations and after 6, 12, 24 months following hysterectomy. The results of observation were compared with similar marks of female patients with intact uterus and were exactly in the same age group. Pathological changes of uterine appendages as ovary cyst that needed a repeat operation was in 1 patient-(2.5%) The fundamental statistical differences in level of FSH and of E2, volume of ovaries between examined and controlled groups were not important. Also the trends in changes of the level of these parameters taking place during the observation in both study groups were not statistically significant. On the basis of the examinations it can be stated that the hysterectomy in the group of women at the age 40-49--doesn't have an influence on function of remaining ovaries. The decision how to treat the ovaries in case of hysterectomy should take into consideration the results of an interview and individual patient's preferences.

[Pathological parameters of endometrial cancer and presence of metastases in pelvic lymph nodes]. / Patomorfologiczne cechy raka endometrium, a obecnosc przerzutów w wezlach chlonnych miednicznych.

Endometrial cancer has become a more frequent neoplasm of the female genital tract. The role of lymphadenectomy in surgical treatment of this neoplasm has not been finally defined. The aim of the study was to determine relationship between pathological parameters of endometrial cancer and presence of metastases in pelvic lymph nodes. Forty one patients with endometrial cancer were treated by extended hysterectomy with pelvic lymphadenectomy. The precise Fisher test and logistic regression test were applied in the analysis of relationship. An intrinsic connection between presence of metastases in pelvic lymph nodes and cancer grade, depth of myometrium infiltration depth and infiltration of vascular spaces was found. On the other hand, histological type of neoplasm and characteristic of its growth does not seem to have connection with presence of metastases in pelvic lymph nodes. Pelvic lymphadenectomy seems to give profound information of of process advancement and indications for supplementary treatment.

[Data from our recent trials with tension-free vaginal tape (TVT) procedure for surgical treatment of genuine urinary stress incontinence]. / Wstepne wyniki zastosowania techniki TVT (tension-free vaginal tape) w leczeniu wysilkowego nietrzymania moczu.

UNLABELLED: There exist many surgical procedure for the treatment of urinary incontinence. Most of them require relatively extensive surgery and several days hospitalization. The advantage of tension-free vaginal tape procedure is a possibility to be performed on an ambulatory basis and under local anesthesia. OBJECTIVES: The aim of the study was to evaluate the results and morbidity of TVT procedure in genuine urinary stress incontinence. MATERIAL AND METHODS: The study group consists of 26 women, aged 39-69, suffering from genuine stress incontinence class I to III according to Stamey classification. The operation was carried out under epidural anesthesia. The procedure was performed as described by Ulmsten at al. The period of follow-up ranged from 3 to 20 month. RESULTS: The mean time of procedure was 26 minutes (range 18-43). The stay in hospital in 23 patient (88.46%) did not exceed 2 days. Three patients experienced urinary retention lasting four days requiring catheterization. No patients had bladder perforations or severe blood loss. No evidence of defect healing or rejection of the tape was found. Twenty four patients (92.31%) of patients were completely cured, 2 patients (7.69%) had considerably improved urinary continence. CONCLUSIONS: Our early study indicate that TVT procedure is effective and safe method of the surgical treatment of urinary stress incontinence in women.

Colposcopy and microcolpohysteroscopy qualification for large loop excision of the transformation zone (LLETZ) in the management of cervical intraepithelial neoplasia.

OBJECTIVE: Large loop excision of the transformation zone is more and more often used as a treatment for cervical intraepithelial neoplasia. There is still debate as to whether this method should be performed in cases when the lesion extends into the cervical canal. Some colposcopists consider loop excision equal to cone biopsy, while others confine its application to satisfactory colposcopy findings. The purpose of the study was to compare the effectiveness and morbidity of LLETZ performed due to CIN in patients with and without extension of the lesion into the cervical canal. DESIGN: Prospective study of 143 women treated by LLETZ due to cervical intraepithelial neoplasia. METHODS: A series of 143 patients cytologically and colposcopically suspected of cervical intraepithelial neoplasia received outpatient treatment by large loop excision of the transformation zone (LLETZ). Microcolpohysteroscopy examinations of the cervix were performed on all patients. Depending on the involvement of the endocervix the material was divided into two groups. Group A comprised 83 women with a colposcopically visible upper margin of the lesion. Group B consisted of 60 patients with the lesion ranging in the endocervix, but not exceeding 10 mm from the external os. Chi square analyses of indication, morbidity and recurrence of the lesions in the two groups were done. Results were considered significant at p less than 0.05. RESULTS: Minimal thermal damage of excised tissue did not interfere with histological examination in either group. In 139 cases (97.20%) histology examination confirmed the presence of CIN. There were no significant differences between the two treatment groups with respect to mean age, mean parity and indications for LLETZ. The women in the group with an entirely visible lesion experienced less perioperative blood loss. There was no significant difference in secondary haemorrhage, infection, stenosis, incomplete excision of the lesion, visibility of neosquamocolumnar junction and residual disease between the two groups. CONCLUSIONS: On the basis of the results obtained it can be stated that LLETZ performed with colposcopic guidance complemented by microcolpohysteroscopy constitutes a valuable method in the treatment of CIN and it may in selected cases replace cone biopsy.

Intraepithelial neoplasia and early stage vulvar cancer. Epidemiological, clinical and virological observations.

OBJECTIVE: Evaluation of vulvar intraepithelial neoplasia (VIN) and early vulvar cancer risk factor occurrence, frequency, localization and development. STUDY DESIGN: A clinical study carried out on 293 women aged 23-76 years with VIN and vulvar cancer stage I and in a control group of 115 cytologically and colposcopically negative women. METHODS: Clinical, colposcopic and morphological evaluation of the localization of VIN and vulvar carcinoma stage I concomitant with intraepithelial neoplasia in other parts of the lower genital tract. Anamnestic inquiry regarding risk factors. In situ hybridisation technique for HPV detection. Thomson's method for blood serum vitamin A level assessment. RESULTS AND CONCLUSION: An increased frequency of VIN and Ca stage I, especially in young women, has been observed in the past 15 years. In a group of young women under 45 years of age, those lesions were multifocal in 43 cases (63.2%), and unifocal in 25 patients (36.8%). In women over 45 years of age, multifocal lesions occurred in 35 (31.8%), and unifocal in 75 patients (68.2%). HPV infections concomitant with VIN and vulvar cancer stage I occurred in 61.5% of young women and in 17.5% of older females. VIN and stage I vulvar carcinoma coexisted with cervical intraepithelial neoplasia and cervical and/or vaginal cancer in 14 women (7.9%). The risk factor for VIN and early vulvar carcinoma occurrence in young women was different than in older patients. Long-term follow-up of VIN 1 and VIN 2 showed that in over 1/3 of cases the lesions were persistent or recurred after a transient remission. Progression depended not only on dysplasia stage, but also on histological pattern.

[Colposcopic verification of cytologic smears containing atypical squamous cells of undetermined significance]. / Kolposkopowa weryfikacja rozmazów cytologicznych z obecnoscia atypowych komórek plaskonablonkowych o nieokreslonym znaczeniu.

The aim of the study was the estimation of significance of smears containing Atypical Squamous Cells of Undetermined Significance (ASCUS) and presentation the own management of that cases. The study group consisted of 73 non-pregnant women (aged from 21 to 54 years) with ASCUS. The control group included 113 non-pregnant patients (aged between 20 and 57 years) with unsuspected cytology findings. Chi square test and Fisher test were used to compare the colposcopy findings in the two groups. Colposcopic pictures indicating a presence of dysplasia were significantly more often in study group. 14 cases (19.18%) of mild dysplasia and 8 cases (10.96%) of moderate and severe dysplasia were found in the group of patients with ASCUS. During the 18 month follow-up of the remaining patients in that group persistence of ASCUS was found in 2 cases (3.92%), progression to mild and moderate dysplasia was observed in 6 women (11.76%). Regression to normal smear occurred in 43 women (84.31%). Progression to dysplasia referred to women with suspected colposcopy findings. Until further research resolve all the questions regarding ASCUS smears or new more precise diagnostic methods are invented, colposcopy remains the method of choice in verification of ASCUS smears. Colposcopy together with cytology is the optimal mode of observation of such patients.

[The value of micro-colpo-hysterectomy in the diagnosis and therapeutic evaluation of squamous intraepithelial lesions]. / Wartosc mikrokolpohisteroskopii w diagnostyce i kwalifikacji terapeutycznej zmian sródnablonkowych szyjki macicy.

Simultaneous application of cytology, colposcopy and colposcopically directed punch biopsy is acknowledged diagnostic procedure in squamous intraepithelial lesions (SIL) and cervical cancer, but not in every case it allows for precise estimation and localisation of the lesion. The aim of the study was evaluation of the value of microcolpohysteroscopy (MCH) in diagnostics and therapeutical qualification of SIL. The study group comprised 86 women cytologically suspected for SIL. Sensitivity, specificity, positive and negative predictive values of MCH in detection of SIL were calculated. The estimation of the value of MCH in therapeutical qualification was based on therapy effects of SIL performed according microcolpohysteroscopy evaluation of the cervix. In cases of low-grade SIL the sensitivity of MCH reached 0.73, the specificity 0.5, positive predictive value was 0.85 and negative predictive value was 0.33. For high-grade SIL and cervical cancer the values were 0.98, 0.33, 0.95 and 0.5 respectively. Totally, for all lesions of SIL type and cervical cancer sensitivity of MCH reached 0.94, specificity 0.75, positive predictive value was 0.99, and negative predictive value was 0.38. The high value of microcolpohysteroscopy in evaluation of the cervix made possible to optimize the treatment mode and adequately employ of minimal invasive therapeutic methods.

Extraorganic vascular system of adrenal glands in human fetuses.

The injection method was used to study the origin and variability of the blood vessels forming the extraorganic vascular system of the adrenal glands. Studies were carried out on 40 human fetuses of a crown-rump length between 113 and 280 mm (14 to 28 weeks of fetal age). It was proved that the arterial blood supply during the fetal period is extremely variable in both the origin and the number of adrenal arteries, as well as in the asymmetry of the blood supply between the left and right adrenal glands. The three main origins of the suprarenal arteries are from the inferior phrenic artery, the abdominal aorta and the renal artery. The inferior phrenic artery is the main one supplying the suprarenal glands during the fetal period. A characteristic feature of the extraorganic venous system in fetal adrenal glands is the constant presence of the adrenal vein, including number, orifice and the main tributaries.

[Coexistence of endometrioid ovarian tumor and squamous cell carcinoma of the cervix]. / Wspólistnienie endometrioidalnego raka jajnika z rakiem plaskonablonkowym szyjki macicy.

A case of the coexistence of the endometrioid ovary carcinoma and frank cervical carcinoma was shown. The diagnostic procedure, surgery and complementary therapy were described. On the basis of the follow-up of the patient it seams that the coexistence of these carcinomas neither accelerate the development of disease nor make worse the prognosis.

Vascular architecture of the human fetal adrenal gland: a SEM study of corrosion casts.

The vascular architecture of adrenal glands was investigated in human fetuses aged from 16 to 24 weeks, using microcorrosion casts and scanning electron microscopy. The fetal adrenals showed an arrangement of blood vessels remarkably similar to that described in adult glands. There was a clear centripetal pattern from superficial arteries and their branches, via irregular capillaries of the subcapsular plexus and definitive cortex, and then via the radial sinusoids and venous sinuses of the fetal cortex, to the central vein. Rare medullary arterioles traversed the cortex to break up into small local capillary networks in the central region of the gland. Some superficial capillaries were drained by occasional subcapsular veins. No portal system was observed in the fetal adrenals.

The posterior gastric and superior polar arteries in human fetuses.

In 67 human fetuses 127-285 mm of crown-rump length (15 to 28 weeks of fetal age), the variability of the posterior gastric artery (PGA) and superior polar artery (SPA) was investigated. The vascular bed was injected with colored acrylic emulsion, and diaphanisation in methyl salicylate, taken from tissue blocks. The arteries were found in 62 fetuses (92.5%). In 40 cases (59.7%) only PGA, in 17 cases (25.3%) only SPA, and in 5 cases (7.5%) both arteries were observed. They usually originated from the pancreatic portion of the lienal artery or rarely from its terminal branches. PGA supplied part of the posterior wall of the stomach and in 4.5% it supplied also the posterior wall of the abdominal portion of the esophagus. SPA supplied the superior end of the spleen and through 1-3 branches it supplied the posterior wall of the fundus of the stomach.