Effects of environmental pollution with aromatic hydrocarbons on endocrine and metabolic functions of the human placenta.

INTRODUCTION: Phenol and 1-hydroxypyrene are biological markers of exposure to polycyclic aromatic hydrocarbons (PAH) that have certain negative effects on parenchymal organs such as the human placenta. The literature presents only few reports regarding the effects of elevated PAH levels on the functions of the human placenta. OBJECTIVE: The aim of the work is to assess the effects of elevated PAH levels in excreted urine on the endocrine and metabolic functions of the human placenta obtained from a normal pregnancy. MATERIAL AND METHODS: Tissue material from 50 afterbirths from Plock constituted a study group, whereas 50 afterbirths from Kutno constituted a control group. Immunohistochemical reactions with the peroxidase method using LSAB kits (DAKO, Denmark) were performed. The extent and intensity of reactions were analysed. The levels of phenols and 1-hydroxypyrene in the excreted urine of pregnant women (undergoing delivery) were detected using gas chromatography and colorimetry. The statistical analysis used the PQStat v.1.6.2 software; moreover, t-student and chi-square tests were used. Differences were considered to be significant at the significance level of 95% (p<0.05). RESULTS: The levels of phenol and 1-hydroxypyrene in the excreted urine were demonstrated to be statistically significantly higher in patients living in the area of Plock. Statistically lower expression of placental glutathione transferase and lower immunohistochemical demonstration of the placental phosphatase activity were observed in placentas from Plock. It has been demonstrated that the expression of the oestrogen receptor activity and placental gonadotropin is significantly higher in placentas from areas not contaminated with aromatic hydrocarbons (Kutno). CONCLUSIONS: The course of pregnancy in the environment with elevated levels of aromatic hydrocarbons leads to impaired placental functioning and reduced endocrine and metabolic activity of the placenta.

The duration of pregnancy in ecologically-challenged area. The effects of environmental pollution with aromatic hydrocarbons on the angiogenesis and elements of the mesenchymal tissue of the human placenta.

INTRODUCTION: The literature presents only few reports regarding the effects of elevated levels of aromatic hydrocarbons (AH) on the functions of the human placenta. The effects of environmental contamination with AH (including phenol and 1-hydroxypyrene) have certain negative effects on parenchymal organs such as human placenta. OBJECTIVE: The paper aimed to assess the effects of elevated levels of AH on the placental angiogenesis and elements of the mesenchymal tissue of the placenta. MATERIAL AND METHODS: Tissue material from 50 afterbirths from Plock constituted a study group, whereas 50 afterbirths from Kutno constituted a control group. Immunohistochemical reactions with the peroxidase method using LSAB kits (DAKO) were performed. The extent and intensity of reactions were analysed. The levels of phenols and 1-hydroxypyrene in the excreted urine of pregnant women (undergoing delivery) were detected using gas chromatography and colorimetry. RESULTS: The levels of phenol and 1-hydroxypyrene in the excreted urine were demonstrated to be statistically significantly higher in patients living in the area of Plock. Statistically significantly higher expression of antibodies indicating placental angiogenesis was observed in the placentas in the Plock group (p < 0.01). Moreover, lower expression of vimentin indicating reactions with proteins in mesenchymal cells was observed in the Kutno group (p < 0.01). CONCLUSIONS: Pregnancy in the environment with elevated levels of aromatic hydrocarbons has detrimental effects on the human placenta. The foetus is protected by activation of adaptation and compensation mechanisms that are manifested as significant angiogenesis and greater development and differentiation of mesenchymal cells compared to the control group.

Cell-free fetal DNA testing in prenatal diagnosis: Recommendations of the Polish Gynecological Society and the Polish Human Genetics Society.

This paper contains a joint position of the Polish Gynecological Society and Polish Human Genetics Society on the cell-free fetal DNA testing in prenatal diagnosis. We present situations where the cell-free fetal DNA testing should be applied and cases in which performing of the test is not useful. We indicate what diagnostic steps should be performed before the test and how the test results should be interpreted and followed.

Prostate specific antigen (PSA) in diagnosis of polycystic ovarian syndrome - a new insight.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder and cause of androgen excess in women. Prostate specific antigen (PSA) could be a new marker of hyperandrogenism in PCOS. OBJECTIVE: The aim of the study was to assess the concentration PSA (total PSA - TPSA and free PSA - fPSA) in 165 patients with PCOS and 40 healthy female controls, the relationship between PSA (TPSA and fPSA) and hormonal parameters and to determine the performance of PSA in diagnosis of PCOS. RESULTS: Total PSA was higher in PCOS group versus controls. The fPSA was below the lower detection levels among all patients. The median value of FAI was 4.31 in PCOS patients versus 1.79 in controls, p < 0.001. There was a correlation of TPSA and tT (r= 0.173, p = 0.027) and TPSA and FAI (r = 0.2603, p = 0.001). AUC for FAI was 82.1%, threshold 2.56 nmol/l, for tT AUC 80.5%, threshold 0.54 ng/ml, for TPSA AUC 66.3%, threshold 0.005 ng/ml. The ROC analysis for A AUC 62.7%, threshold 3.95 ng/ml. CONCLUSION: PCOS women have higher serum concentration of TPSA than controls. TPSA positively correlate with T and FAI, which is the best marker for hyperandrogenic states and has better accuracy for tT and total PSA serum levels in diagnostic of PCOS.

Serum leptin concentration in women of reproductive age with euthyroid autoimmune thyroiditis.

INTRODUCTION: Autoimmune thyroid disease (AITD) with elevated anti-thyroid peroxidase antibody (aTPO) levels appears in 12-25% of all women, apart from thyroid dysfunction. High titers of aTPO are more common in women with polycystic ovary syndrome and endometriosis. Elevated aTPO has been associated with infertility and poorer quality of life among euthyroid women, and may be related to other factors. OBJECTIVES: The aim of the study was to measure differences in serum leptin concentration between AITD+ and AITD- patients. Setting, patients and main outcome measures: The sample was comprised of 74 women who were hospitalized in the Department of Gynecological Endocrinology, Medical University of Warsaw. Data collected included age, body mass index (BMI), and serum aTPO, serum thyroid stimulating hormone (TSH), serum fT4, serum follitropin (FSH), serum estradiol and serum leptin. AITD positive status was defined as serum aTPO greater than 5.6 mIU/ml. RESULTS: Serum leptin concentrations were significantly higher in AITD+ patients compared to AITD- patients (17.13 ng/ml [SD 7.66] versus 12.78 ng/ml [SD 7.28]; p < 0.05). No differences by AITD status were found in age, BMI, TSH, FSH, estradiol and fT4. CONCLUSIONS: Serum leptin concentrations were higher in patients with AITD than in patients without AITD.

Depression in relation to biochemical parameters and age in women with polycystic ovary syndrome.

OBJECTIVE: The phenotype of women with PCOS changes with age. The study was aimed to address whether changes in biochemical parameters associated with age of the patients correlate with depression severity measured with the use of screening tools. STUDY DESIGN: This was a single center observational study. Women with PCOS meeting the Rotterdam criteria for PCOS were recruited. Hormonal and clinical parameters including symptoms of hyperandrogenism, age, BMI, androgen and blood lipids were analyzed in 60 patients (median age 27, median BMI 23 kg/m(2)) together with evaluation of depressive symptoms with the use Beck Depression Inventory, Patient Health Questionnaire-Nine Item (PHQ-9), Quick Inventory of Depressive Symptomatology-Self Report 16 Item (QIDS-SR16). RESULTS: The prevalence of depression was equal 22-33% depending on the questionnaire. The older women tended to present significantly higher BMI, SBP, waist circumference and lower androstenedione and DHEAS values than the younger group of patients. The prevalence of depression was higher in the group of older patients, however without statistical significance. Among the cohort of older patients (age ≥ 27 years, n = 29) significant correlates of depression included: nonHDL, LDL, HDL, total cholesterol (p < 0.05), even after controlling for BMI. In the younger study cohort (age < 27, n = 28) the only significant correlates included BMI and waist circumference. CONCLUSION: Women with PCOS reporting depressive symptoms present higher levels of androgens and blood lipids. Clinicians treating women with PCOS should be aware that this group of patients is at increased risk of depression irrespectively of age and phenotype.

[The statement of Polish Society's Experts Group concerning diagnostics and methods of endometriosis treatment]. / Stanowisko Zespolu Ekspertów Polskiego Towarzystwa Ginekologicznego dotyczace diagnostyki i metod leczenia endometriozy.

Endometriosis is defined by endometrial glands and stroma outside of the endometrial cavity Three types of endometriosis have been described: peritoneal endometriosis, ovarian endometriosis and deep infiltrating endometriosis. Endometriosis afflicts 6-15% of women population. It occurs mainly in the group of women in reproductive age, but also in the group of minors and approximately 3% of women after menopause. Within the group of women suffering from infertility the frequency of endometriosis increased to 35-50% of cases. Endometriosis is associated with pain symptoms which can bear the character of pain occurring periodically and altering into constant pain, dysmenorrhea, dyspareunia, dysuria and dyschezia. The correlation between the stage of endometriosis and intensity of pain symptoms not always has to be proportionate. Laparoscopy can be perceived as a standard procedure in endometriosis diagnostics as it allows simultaneous treatment. Profound interview as well as visual diagnostics (USG, MRI) should precede laparoscopy Treatment of endometriosis can be divided into pharmacological and surgical treatment, which can be invasive or non-invasive. The type of treatment depends on patient's age and her procreation plans, occurring ailments and endometriosis type. Important role is played by adjuvant treatment such as appropriate diet and lifestyle. Treatment of advanced endometriosis should be conducted in reference centres that are appointed with adequate equipment and have the possibility of interdisciplinary treatment. Presented standards can digest and outline the order of proceedings both in diagnostics and endometriosis treatment. The research group believes that the above compilation will facilitate undertaking appropriate decision in diagnosis and treatment of the disease, which will subsequently contribute to therapeutic success.

[Management of thyroid diseases during pregnancy]. / Postepowanie w chorobach tarczycy u kobiet w ciazy.

The management of thyroid disorders during pregnancy is one of the most frequently disputed problems in modern endocrinology. It is widely known that thyroid dysfunction may result in subfertility, and, if inadequately treated during pregnancy, may cause obstetrical complications and influence fetal development. The 2007 Endocrine Society Practice Guideline endorsed with the participation of the Latino America Thyroid Association, the American Thyroid Association, the Asia and Oceania Thyroid Association and the European Thyroid Association, greatly contributed towards uniformity of the management of thyroid disorders during pregnancy and postpartum. Despite the tremendous progress in knowledge on the mutual influence of pregnancy and thyroid in health and disease, there are still important areas of uncertainty. There have been at least a few important studies published in the last 3 years, which influenced the thyroidal care of the expecting mother. It should also be remembered that guidelines may not always be universally applied in all populations with different ethnical, socio-economical, nutritional (including iodine intake) background or exposed to different iodine prophylaxis models. The Task Force for development of guidelines for thyroid dysfunction management in pregnant women was established in 2008. The expert group has recognized the following tasks: development of the coherent model of the management of thyroid dysfunction in pregnant women, identification of the group of women at risk of thyroid dysfunction, who may require endocrine care in the preconception period, during pregnancy and postpartum - that is in other words, the development of Polish recommendations for targeted thyroid disorder case finding during pregnancy, and the development of Polish trimester-specific reference values of thyroid hormones. Comprehensive Polish guidelines developed by the Task Force are to systematize the management of the thyroid disorders in pregnant women in Poland.

The somatotropic axis in postmenopausal women during six month of transdermal continuous 17beta-estradiol administration combined with oral medroxyprogesterone.

AIM: The evaluation of the influence of continuous transdermal estradiol supplementation combined with oral medroxyprogesterone on the somatotropic axis in postmenopausal women. MATERIAL AND METHODS: 25 women completed the study Group A--13 women received transdermal 17beta-estradiol (Oesclim 50 - Fournier-Solvay) combined with oral 5 mg daily medroxyprogesterone (Gestomikron - Adamed). Group B--12 women without treatment. Basic plasma FSH, estradiol, glucose, insulin, SHBG, hGH, total and free IGF-I, IGFBP-1 as well as IGFBP-3 were measured initially and at the 12th and 24th week of the study. RESULTS: The mean plasma FSH level was reduced and mean plasma estradiol level was increased in group A during estradiol supplementation. Mean plasma level of free IGF-I and free to total IGF-I ratio were increased in group A during 24 weeks of hormone therapy. In the control group (group B) there was the significant increase in mean plasma IGFBP-3 level. Other parameters showed no significant changes in the control group. CONCLUSION: The administration of transdermal 17beta-estradiol combined with oral medroxyprogesterone increases the IGF-I bioavailability. However this influence do not exceed the physiologial level of IGF-I bioavailability.

[Influence of estradiol administration mode on plasma insulin-like growth factor-I (IGF-I) and its binding proteins 1 and 3 concentration in postmenopausal women treated with norethisterone acetate]. / Wplyw drogi podania 17beta-estradiolu na stezenie insulinopodobnego czynnika wzrostu-I (IGF-I) i jego bialek wiazacych 1 i 3 w surowicy krwi u kobiet po menopauzie stosujacych octan norethisteronu.

AIM: The aim of the present work was to assess the influence of estradiol administration mode on the plasma IGF-I, IGFBP-1, IGFBP-3 levels in postmenopausal women treated with norethisterone acetate. MATERIAL AND METHODS: 39 women were enrolled into the study Group A--14 women received transdermal 17beta-estradiol (Oesclim 50--Fournier-Solvay) combined with oral norethisterone 2.5 mg daily (Primolut-Nor--Schering), Group B--10 women on oral 2 mg 17beta-estradiol combined with oral 1 mg daily norethisterone (Kliogest--Novo-Nordisk). Control group (group C) consisted of 15 postmenopausal women who received no treatment. Basic plasma FSH, estradiol and total IGF-I, IGFBP-1 as well as IGFBP-3 levels were measured initially and at the 52nd week of the study. RESULTS: The mean plasma FSH level was reduced and mean plasma estradiol level was increased in groups A and B during hormone therapy. Mean plasma levels of total IGF-I, IGFBP-1, IGFBP-3 as well as IGFBP-3/IGF-I ratio did not changed significantly during 52 weeks of observation in groups A, B and C. The comparison of plasma IGF-I, IGFBP-1, IGFBP-3 between groups at the initial visit and after 52 weeks showed the lowest concentration f IGBP-3 in group B. Other parameters showed no differences among the three groups. CONCLUSION: Mode of administration of estradiol did not influenced the plasma levels of IGF-I, IGFBP-1, IGFBP-3 in postmenopausal women treated with norethisterone acetate.

A molecular and cytogenetic investigation of FMR1 gene premutations in Polish patients with primary ovarian insufficiency.

OBJECTIVE: The aim of this study was to determine the prevalence of premutations in the FMR1 gene that cause primary ovarian insufficiency (POI) in a group of affected women. STUDY DESIGN: Forty DNA samples were purified from peripheral blood collected from women with ovarian failure who were under 40 years of age. A routine cytogenetic test was performed to eliminate chromosomal aberrations as the cause of POI. The DNA was analysed by polymerase chain reaction (PCR) with primers specific to the FMR1 gene region. The PCR products were then separated in denaturing polyacrylamide gels using an ABI Prism 377 sequencer. RESULTS: Cytogenetic analysis of the samples revealed two X/autosome translocations. DNA analysis identified FMR1 gene premutations in three patients. The frequency of X/autosome translocations in the studied group was 2/40 (5.0%), and the frequency of FMR1 gene premutations was 3/38 cases (7.9%). Thus, genetic tests allowed for the identification of POI in five (12.5%) out of 40 women. CONCLUSION: FMR1 gene premutation is a common genetic cause of POI.

Bimodal influence of plasma estradiol on relation between insulin-like growth factor-I (IGF-I) and estradiol in women.

OBJECTIVE: To compare the influence of low and normal endogenous estradiol concentration on circulating hGH, IGF-I and IGFBP-3 levels as well as on mutual correlations of these parameters. PATIENTS: 45 women (age 30.7 ± 9.0 years, BMI 25.7 ± 8.0) divided into group A - 15 hypoestrogenic women and group B - 30 normoestrogenic controls. Neither of the women was menopausal nor hyperprolactinemic. METHODS: Blood sample was taken at the standard conditions prior to the initiation of hormonal supplementation therapy in group A and at the day 3-5 of menstrual cycle in group B. Serum hGH, IGF-I, IGFBP-3, insulin, testosterone, sex hormone binding globulin (SHBG) dihydroepiandrosterone sulphate (DHEAS) and LH as well as prolactin (PRL), FSH and estradiol levels were measured by standard RIA kits. RESULTS: Mean IGF-1, LH, FSH, testosterone and estradiol and PRL plasma levels were lower in group A compared to group B. There were no significant differences in mean SHBG, insulin and DHEAS levels. There were also no differences in mean: age, body mass, BMI as well as percentage of each BMI range between groups. Regardless the estradiol level the IGF-I/age link was found in both groups. A IGF-I/IGFBP-3 relation was found in both groups. IGF-I/estradiol link was seen only in group A. In group B hGH/SHBG link was found, in group A this relation was indirect. A link between hGH and testosterone levels was found only in group B. SHBG was related in group B to IGFBP-3, testosterone and to DHEAS. Insulin/IGFBP-3 link was seen in group B. The stepwise multiple regression revealed DHEAS and LH as predictors of IGF-I level in group A, while in group B none of the parameters predicted IGF-I level. The results of the same analysis in case of hGH are as follows: in group A hGH level was predicted by estradiol and SHBG. In group B none of factors predicted hGH levels. CONCLUSION: Estradiol plasma level is correlated to circulating IGF-I, albeit the relation seems to be biphasic.

[Androgen and 17-hydroxyprogesterone concentrations in blood serum versus menstrual patterns in women with polycystic ovary syndrome (PCOS)]. / Stezenie hormonów androgennych oraz 17-hydroksyprogesteronu w surowicy krwi a wzorzec miesiaczkowania u pacjentek z zespolem policystycznych jajników.

THE AIM OF THE STUDY: to evaluate correlation between androgen and 17-hydroxyprogetserone concentrations in blood serum and menstrual patterns of women with polycystic ovary syndrome. MATERIAL AND METHODS: 227 patients with polycystic ovarian syndrome (PCOS), aged 18 to 35 years, hospitalized at the Department of Gynecological Endocrinology All patients with PCOS presented clinical and biochemical evidence of hyperandrogenism with oligoovulation and/or ultrasonographic appearance of polycystic ovaries. PCOS was diagnosed according to the Rotterdam Criteria after excluding reasons such as: congenital adrenal hyperplasia, adrenal and ovarian tumors, hyperprolactinemia and hypo- hyperthyreosis. The following hormone concentrations were measured in each patient: total testosterone (TT), androstendione (A), dehydroepiandrosterone sulphate (DHEAS) and 17-hydroxyprogesterone (17-OHP). The patients were divided into 4 groups: I--eumenorrhoeic (n = 66), II--polymenorrhoeic (n = 32), III--oligomenorrhoeic (n = 93), IV--with secondary amenorrhea (n = 36). The control group consisted of 40 patients with normal regular menstrual cycles and no clinical/biochemical sings of hyperandrogenism. Statistical analysis was performed using one-way Anova and NIR test. P < 0.05 were considered to be statistically significant. RESULTS: The mean TT concentrations were as follows: Group I-- 0.91 +/- 0.56 ng/ml, II--0.91 +/- 0.22, III--0.91 +/- 0.48, IV--1.66 +/- 1.78 ng/ml; Androstendione: I-- 3.34 +/- 1.32, II--2.77+/- 0.75 ng/ml, III--3.28 +/- 1.00 ng/ml, IV--4.29 +/- 2.18 ng/ ml, 17-OHP: I--1.08 +/- 1.61 ng/ml, II-- 0.89 +/- 0.62ng/ml, III--0.94 +/ - 0.37 ng/ml; IV--1.68 +/-1.28 ng/ml and DHEAS: I--5.69 +/- 2.49 micromol/, II-- 6.11 +/- 3.11 micromol/l, III--6.04 +/- 3.00 micromol/l, IV-- 6.12 +/- 3.25 micromol/l respectively. The hormone concentrations in the control group were as follows: TT--0.58 +/- 0.35 ng/ml, A--2.33 +/- 0.52 ng/ml, 17-OHP--0.67 +/- 0.30 ng/ml, DHEAS--5.24 +/- 2.33 micromol/I. We found significantly higher TT A, 17-OHP concentrations in all PCOS subgroups than in the healthy subjects (p < 0.05). The PCOS group analysis revealed that all the mentioned hormone concentrations were significantly higher in women with secondary amenorrhea (group IV) than in the remaining 3 groups (p < 0.05). We found no significant difference in DHEAS concentrations between the study and the control group. CONCLUSIONS: Higher total testosterone, androstendione and 17-hydroxyprogesterone concentrations, longer menstrual cycles in women with PCOS.

Recommendations of the Polish Gynecological Society concerning child sexual abuse.

The World Health Organisation defines child sexual abuse as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person. It is estimated that in the world on average one in 3-4 women and one in 6-10 men were victims of sexual abuse in childhood. In Poland, according to the estimates of the Child's Rights Protection Committee, approximately 20% of girls and 5-6% of boys under the age of 15 years has suffered sexual abuse. In 2007 there was an increase in violence victims in all age categories, but the most alarming data concerned minors under 13 years. Girls fall victim to sexual abuse three times more frequently than boys. Sexual abuse of boys frequently involves violence. Data show that there are fewer women than men who execute such actions against a minor. Most victims (49-84%) know the perpetrator, and approximately 14-20% of acts of violence take place within the family. This article presents recommendations of the Polish Gynecological Society concerning procedures in cases of suspected sexual abuse of children.

[Recommendations of prophylaxis of vitamin D deficiency in Poland (2009)]. / Zalecenia dotyczace profilaktyki niedoborów witaminy D w polsce (2009).

Adequate vitamin D intake and its status as well outdoor physical activity are important not only for normal bone development and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. National Consultants and experts in this field established the Polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women based on current literature review. Taking into consideration pleyotropic vitamin D action and safety aspects serum 25-hydroxyvitamin D (25-OHD) level of 20-60 ng/ml (50-750 nmol/l) in children and 30-80 ng/ml (75-200 nmol/I) in adults is considered as optimal. Sunlight exposure inducing vitamin D production in the skin is main endogen source of vitamin D in the body but sunscreens may reduce skin synthesis by 90%. In Poland, skin synthesis is effective only from April to September so other sources of vitamin D such as diet and supplements play an important role. All newborns should be supplemented with 400 IU/d of vitamin D beginning from the first few days of life and continue during infancy. In formula fed infants vitamin D intake from the diet should be taken into account. In preterm infants higher total vitamin D intake (400-800 IU/day) is recommended till 40 weeks post conception. Total vitamin D intake in children and adolescents required from all sources (diet and/or supplements) should be 400 IU/d between October and March and throughout the whole year in case of inadequate vitamin D skin synthesis during the summer months. In overweight/obese children supplementation with higher dosage of vitamin D up to 800-1000 IU/d should be considered. Adults require 800-1000 IU/d of vitamin D. In pregnant and lactating women such supplementation is recommended in case of inadequate intake from diet and/or skin synthesis supplementation. Monitoring of serum 25-OHD level to define optimal dosage should be considered.

[Prophylaxis of vitamin D deficiency--Polish recommendations 2009]. / Polskie zalecenia dotyczace profilaktyki niedoborów witaminy D--2009.

Appropriate state procurement system for vitamin D is important not only for the proper functioning of the skeletal, maintaining calcium and phosphorus homeostasis, but also for a number of other organs and tissues in our body. In connection with the change in lifestyle including dietary habits change, the widespread use of UV filters and less outdoor activity, observed an increase in the percentage of vitamin D deficiency, both in population and developmental age and adults. Based on the results of recent scientific research team of experts provides recommendations for preventive Polish supply of vitamin D in infants, children, adolescents and adults, including pregnant women and nursing mothers.