[The management of cervical cancer cases in pregnancy and puerperium]. / Postepowanie w przypadkach raka szyjki macicy w czasie ciazy i pologu.

UNLABELLED: Cervical cancer in women during pregnancy and puerperium is a serious diagnostic and therapeutic problem. Twelve multiparas with confirmed cervical cancer during pregnancy, delivery and puerperium were examined. The mean age of the group was 35. In two of them cervical cancer was diagnosed in the second trimester, in 5 in the third trimester and in 5 in puerperium. Clinical stage according to FIGO was as follow: Ib--9 patients, IIa--2 patients, III--1 patient. In two patients operated in the second trimester--extended hysterectomy was performed. In four women cesarean section with extended hysterectomy and lymphadenectomy was performed. Only one patient in third trimester had cesarean section and in the same time unradical hysterectomy because of bleeding. In two patients in puerperium extended hysterectomy was performed (Meigs operation). Three patients underwent only radiotherapy. All patients who were operated on underwent subsequent radiotherapy. CONCLUSIONS: Cervical cancer during pregnancy and puerperium is diagnosed very late, usually in advanced stage. It is connected with lack of clinical and cytological examination of women before pregnancy. Principles of treatment of cervical cancer in pregnancy and puerperium do not differ from those applicable in other patients.

[The analysis of the sperm parameters in view of its concentration and motility in relation to men's age and occupation]. / Analiza parametrów nasienia ze szczególnym uwzglednieniem koncentracji i ruchliwosci w stosunku do wieku i niektórych zawodów.

OBJECTIVE: To evaluate chosen sperm parameters (concentration and progressive motility) in relation to men's age and occupation. MATERIAL AND METHODS: Retrospective study of laboratory records containing semen analysis results (n = 473, 1995-1997) of patients attending local andrology lab. Linear regression analyses was applied to co-related the age of the patients with the sperm concentration and progressive motility. Mean sperm counts and percentage of motile spermatozoa were compared in the general population vs. car drivers and soldiers. RESULTS: Sperm characteristics were not associated with the age of men. No differences between the general population, drivers and soldiers were found. The values of the mean sperm counts and percentage of motilile spermatozoa were higher than the cut-off values of the WHO. CONCLUSION: The data show no evidence of deterioration in sperm quality in relation to the age and occupation of patients.

[Changes in sperm mitochondria in patients with asthenozoospermia]. / Zmiany we wstawkach plemników pacjentów z astenozoospermia.

OBJECTIVE: To evaluate functional and ultrastructural alterations of the spermatozoa midpieces in patients with asthenozoospermia and to find a correlation between the damage of the midpieces and loss of sperm motility. MATERIAL AND METHODS: Routine, morphological assessment of the midpieces stained according to the Papanicolaou method, cytochemical study of the mitochondrial activity using reaction for the diaphorase/ NADH according to the Piasecka method and electron-microscopic investigation of the midpiece structures were performed. RESULTS: The cytochemical reaction for diaphorase/NADH revealed disorders of the mitochondrial activity and subtle and drastic malformations in the spermatozoa midpieces. The unusually thickened midpieces contained the supernumerary mitochondria. In patients with severe asthenozoospermia, the damage of the accessory fibres and axonemal complex located in the midpiece, were obtained also. CONCLUSION: This study indicates that mitochondrial defects are one of the causes that may account for loss of sperm motility in the population of patients.

[Outcome of microsurgical treatment of obstructed abdominal oviducts in infertile women]. / Wyniki mikrochirurgicznego udrazniania ujsc brzusznych jajowodów u nieplodnych kobiet.

The aim of the paper was to estimate the results of microsurgical reconstruction involving the abdominal opening of the oviducts in 89 infertile women in relation to anatomical status of uterine adnexa. Following procedure, patency of abdominal openings of the oviducts documented by hysterosalpingography and/or by laparoscopic in 73.33% of the treated females. However if simultaneous supplementary (14 women) surgical connecting of impatent oviducts in isthmo-intramural segment was performed the patency restored 57.14%. Pregnancies resulting in delivery of viable infants were achieved in 30.37% and 7.14% in the studied groups respectively. The post operative effect correlated inversely with the intensity of periadnexal adhesions and the diameter of hydrosalpinx ampulla of oviducts.

[Fertility of women after microsurgical resection of intraperitoneal adhesions of uterine adnexa]. / Plodnosc kobiet po mikrochirurgicznym wycieciu sródotrzewnowych zrostów przydatków macicy.

The aim of the paper was to evaluate the results of microsurgical resections of periadnexal adhesions and those within the pelvis, with taking into consideration the index of intraperitoneal adhesions, coexisting endometriosis and possible adhesions within the fimbriae of oviducts with their patency being preserved. Among 40 women operated on, intrauterine pregnancy terminating in delivery occurred in 42.5% of cases, miscarriage in 7.5%, and oviductal pregnancy in 5% of cases. The highest percentage of pregnancies was obtained with the index of adhesion up to 30 points. Above that value the number of obtained pregnancies decreased dramatically. In the group of patients with coexisting endometriosis the percentage of pregnancies was 13.3%, while 33.3% were scored in the group of women, in whom resection of adhesions within fimbriae was carried out. Active endometriosis and changes within fimbriae of oviducts exert unfavourable influence effects of surgical procedure.

[Results of microsurgical treatment of non-patency involving the isthmo-intraparietal parts of oviducts in infertile women]. / Wyniki mikrochirurgicznego leczenia niedroznosci czesci ciesniowo-sródsciennej jajowodów u nieplodnych kobiet.

In years of 1984-1992 isthmic and cornual anastomosis oviducts due to their non-patency were performed in 138 woman at the Clinic of Gynaecology--OGI-PMA in Szczecin. Of the mentioned numbered of women the study covered 45 patients having been operating on, during the period from 1.07.1984 to 31.12.1992 and those full data could be collected only for the time-span of one year that followed the operation. In 41 of them cornual and in 4 isthmic anastomoses were accomplished. The operative procedures were carried out by means of magnifying glass and operative microscope. Following the excision of the non-patent part of oviduct, a splinting fibre was introduced into its lumen, whereupon end-to-end anastomosis was formed by employing PDS 7/0-8/0 sutures. Peritoneum at the site of oviductal anastomosis was stitched together with PDS 6/0 sutures. The splinting fibre remained in place till 4-6 days, after the operation. Apart from anastomosis reconstructive operations on abdominal openings of oviducts were also performed in 15 cases, and intraperitoneal adhesions of various intensity degrees were removed in 41 patients. Dextran 70, prometazine and dexamethasone were used in prophylaxis of postoperative adhesions. In 75% cases HSG examination revealed the patency of oviduct in proximal segment, while in the distal segment only in 11 patients operated on. During the period of one year after the operative procedure 14 woman became pregnant.

[Diagnostic-surgical protocol in female infertility]. / Protokól diagnostyczno-operacyjny nieplodnosci kobiecej.

Diagnostic-operative Protocol of infertility in women, elaborated and being used at the Clinic of Gynaecology--OGI--PMA obliges the operator to evaluate the anatomical status of uterus, ovaries and particularly oviducts in a concise and simultaneously precisely expressed form in points. That also permits for additional, supplementing remarks as well as for providing information on the sketch of internal genital organs. Less emphasis was focussed on the operative procedure description. Relatively much space was left therein for detailed final diagnosis and procedure type definition.

[Evaluating the possibility of performing diagnostic and operative hysteroscopy depending on the type of hysteroscopy and agent used for filling the uterine cavity]. / Ocena mozliwosci wykonania diagnostycznych i operacyjnych hysteroskopii w zaleznosci od typu hysteroskopu i zastosowanego srodka wypelniajacego jame macicy.

The aim of the paper is to present own experiences concerning diagnostic and operative hysteroscopy performed with 4 types of hysteroscopes. Flexible hysteroscope HYP 1T, rigid hysteroscope 5 mm in diameter with single flow, operative hysteroscope 8 mm in diameter with constant flow, hysteroresectoscope 9 mm in diameter with constant flow produced by Olympus; for filling the uterine cavity CO2 0.2% NaCl, 5% glucose, Purisol, Hyskon were implemented. In even case the degree of hardship of the procedure, traumatism for the patient, degree of operated-on patient's safety during the procedure, possibility of applied in the presence of bleeding, price of instrument and agents applied for filling the uterine cavity were estimated. It has been found out that the use of rigid hysteroscope 5 mm in diameter and operative hysteroscope 8 mm in diameter with constant flow and utilization of CO2 as well as Purisol and Hyskon solutions provide possibility of extensive diagnosis and therapy.

[Nineteen years of laparoscopy in the gynecology clinic IPG PAM]. / Dziewietnascie lat laparoskopii w klinice ginekologii IPG PAM.

The aim of the paper was the analysis of 1450 laparoscopic procedures performed in the Clinic of Gynecology--IOG PMA in Szczecin in the years from 1974 to 1992. The above number include 320 laparoscopic operations. In the analyzed three five-year periods, the number of laparoscopies increased twofold, while in the years 1989-1992 it constituted 26.8% of all the operative procedures. Indication for laparoscopy in 74.6% of cases was sterility, in 13.38% pelvic pain of undefined etiology, in 7.7% ectopic pregnancy, 1.8% oncologic indications, in 0.5% internal ones, in 0.3% sterilization and others in 1.6%. Among operative laparoscopies electrocoagulation of endometriosis was carried out in 46.6% of cases, resection of intraperitoneal adhesions in 27.5%, in the region of abdominal orifices of oviducts in 7.5%, ectopic pregnancy operations in 7.2%, excision of ovarian cysts in 6.6% as well as extirpation of myomas in 4.7%. At the analyzed period the following complications were disclosed, namely: interstitial lesion in 2 cases, hemorrhage from inferior epigastric artery in 1 and subcutaneous emphysema in 34 cases.

[Laparoscopy in the diagnosis of chronic painful disorders of the pelvis]. / Laparoskopia w diagnostyce przewleklych dolegliwosci bólowych w miednicy.

The objective of the paper was the evaluation of the results in laparoscopic examinations performed in women reporting chronic painful ailments in the pelvis. The investigation has covered 194 women in whom the laparoscopic procedure was performed by multidirectional diagnostic examinations, and the inflammatory changes had been excluded. The most frequent change recorded during laparoscopy was adhesions of the pelvic organs 103 (53.09%). In 58.63% of cases the cause of adhesions were post inflammatory states of uterine adnexa, in 24.8% the post operative procedures, in 9.2% the adhesions accompanied endometriosis, while in 7.22% the adhesions were the cause responsible for the retroflexion of uterus. In 29.38% the studied group of women was found to have a normal image of the pelvis, and in 8.76% there was a picture of congested pelvis. Laparoscopy is a valuable diagnostic examination, frequently allowing to establish the cause of chronic painful ailments in the area of pelvis, therein also some forms of functional disturbances.

[Diagnostic value of directed anamnesis and gynecologic examination with regard to HSG investigation in diagnosis of mechanical infertility in women]. / Wartosc diagnostyczna ukierunkowanego wywiadu i badania ginekologicznego w odniesieniu do badania HSG w rozpoznawaniu mechanicznej nieplodnosci u kobiet.

The aim of the work has been hysterosalpingographic estimation of oviductal patency in women with case histories encumbered or not encumbered by inflammations restricting the fertility, with taking into consideration the anatomical state of the reproductive organs being evaluated by gynaecological examination. Of 429 women covered by the study 102 out of a group of 277 with primary infertility reported adnexitis in their case histories, while 67 women out of a group of 152 with secondary infertility declared having had inflammations. In women, whose anamnesis included inflammations, uterine adnexa thickening as well as abdominal position of uterus with restricted movements appeared in the group of examined women with primary infertility (15.2%) about twofold, and in the group with secondary infertility (26.5%) over fourfold more frequently than in women with inflammatory--free case histories. The women, in whom the gynaecological examinations failed to reveal any changes in genital organs, regardless of the fact that they reported adnexitis, were found to have uni- or bilateral in patency of oviducts from 43.7% to 96.2%, mean in 53.74%, and in those with pubescent uteri on the average 53.75%, with thickened uterine adnexa--mean 64.46% with abdominal position and restricted movements of uterus on the average 74%. Oviductal in patency was recorded twofold more frequently in women, whose case histories disclosed uterine adnexitis.

[Evaluation of combined application of diazepam, fenoterol and metamizole in prevention of uterine-tubal spasm during the performance of hysterosalpingography]. / Ocena lacznego podawania diazepamu, fenoterolu i metamizolu w zapobieganiu skurczu maciczno-jajowodowego w czasie wykonywania hysterosalpingografii.

In the years from 1989 to 1991 HSG examination was carried out in 502 infertile women. Two hours before the examination 5 mg of diazepam and 5 mg of fenoterol were orally administered, and 30 minutes prior to the procedure 2.5 mg of metamizole were given intramuscularly. The examined population of women was found to have normal patency of oviducts in 412 (82.07%) women, 48 (9.56%) had uni- or bilateral impatency of abdominal openings, in 16 (3.19%) there was uni- and in 19 (3.78%) bilateral +impatency of oviducts in uterine segments, while in 7 (1.39%) alternating impatency was disclosed. Of 502 women in 109 patients laparoscopy and chromotubation were performed during a period from 2 to 16 months after HSG examinations. In 30 (93.7%) out of 32 women with impatency of oviducts in the proximal segment, the diagnosis was confirmed. The administered drugs effectively prevent uterine-tubal spasms occurring at the time HSG is being accomplished.

[Developmental anomalies of the uterus in a population of 3000 women with various causes of infertility]. / Wady rozwojowe macicy w zbiorowosci 3000 kobiet z rózna przyczyna nieplodnosci.

In the years from 1979 to 1991 a population of 3000 women with various causes of infertility was found to have in 13.34% developmental anomalies of uteri. As many as 9.27% consisted of saddle uteri, 2.67% bicornous, in 0.37% there was partial, and in 0.13% complete septum, in 0.57% unicornous and in 0.33% double. The diagnosis of developmental anomalies involving uterus was based mainly on HSG, laparoscopic and hysteroscopic examinations.

[Effect of hydrotubation on the anatomical state of oviducts in women with mechanical infertility]. / Wplyw hydrotubacji na stan anatomiczny jajowodów u kobiet z nieplodnoscia mechaniczna.

The aim of the paper was to evaluate the anatomical state of uterine adnexa in women operated on due to mechanical infertility. Hydrotubation were previously applied in 31 women stemming from various centres in the country, while in 31 such a treatment was not performed at all. The mentioned groups of women were encumbered, to a similar degree, with a risk factor of infertility, except for the duration of sterility, which in those treated by hydrotubation lasted on the average 2 years longer. From 5 to 50 hydrotubations were carried out, most frequently in series of 5 procedures. It was reported by the women that 8 of them after hydrotubation experienced hypogastric pain persisting for some days, and in 6 there was acute adnexitis. Destructive changes in uterine adnexa, being estimated during the reconstructive operation, were decidedly more advanced in women treated by hydrotubation. That was expressed mainly by frequent appearance of lytic adhesions as well as by more advanced fibrosis of oviducts, particularly that of endosalpinx. Unchanged oviducts, after their release from adhesions, also appeared less frequently.

[Widely available cytological examinations and detectability of cervical dysplasia and carcinoma]. / Szeroko dostepne badania cytologiczne a wykrywalnosc dysplazji i raka szyjki macicy.

The system of cervical carcinoma prophylaxis introduced in 1974 in the Province of Szczecin based on obligatory obtaining of cytological smears at least one in a year from each woman coming for gynaecological examination and obligatory presentation of the result of this examination by each woman going for sanatorium treatment was analysed. In the years 1974-1986 the number of cytological examinations was systematically increasing, reached recently over 100 thousand, and covered about 30% of the female population aged over 19 years. With increasing number of cytological examinations there was a rise in the detectability of dysplasia and a tendency was noted also recently for reduced incidence of cervical carcinoma. The indices of morbidity and mortality were unchanged.

[Comparative evaluation of the incidence of premature labor among female workers in plants with different work profiles]. / Ocena porównawcza czestosci wystepowania porodów przedwczesnych u kobiet zatrudnionych w zakladach o róznym profilu pracy.

The incidence rate of premature births has been studied in 777 women employed at a chemical plant, 1430 women working in clothing industry, and 805 port women-workers. In the mentioned groups 35,41 and women, respectively, had undergone premature births. This constituted 4.5, 2.87 and 3.85%. However, in women who had delivered, these percentages have gone up to 5.55, 4.18 and 5.24. With reference to the first as well as the second findings the above differences are statistically insignificant. In the test plants no workplaces exposing to a greater risk manifested by frequent premature births have been disclosed. In all the three plants the first premature birth was recorded almost at the same rate in women who previously had no pregnancy or delivered on time, while the subsequent premature births and most frequently been directly preceded by a premature delivery. Spontaneous abortion preceded the premature births over five, and the pregnancy interruption procedure over six times less frequently than the normal parturition. The direct and most often conjectural causes of premature births mentioned by the examined subjects include: premature flow of the amniotic fluid, physical effort disconnected with the work performed, serological incompatibility involving Rh factor, psychic trauma and gestosis.