Occurrence of climacteric symptoms in postmenopausal women after prophylactic bilateral ovariectomy.

PURPOSE OF INVESTIGATION: To analyse the quality of life in postmenopausal women after prophylactic bilateral ovariectomy depending on the time from menopause. MATERIALS AND METHODS: The study involved 252 postmenopausal women grouped according to the time from last menstruation: one to five years (group A), five to ten years (group B), and > ten years (group C). All women were ovariectomized during laparotomy performed for benign diseases of the uterus. Climacteric symptoms were measured with the Kupperman Index one day before and three months after surgery. RESULTS: Highly significant age differences and no substantial BMI differences were demonstrated among the study groups. Before and after surgery climacteric symptoms were reported by 17.06% and 57.8% of women, respectively. After surgery, group A women significantly more often had hot flushes, sweating, nervousness, and sleep disorders, the women in group B significantly more often reported sleep disorders, nervousness, and sweating, and the women in group C significantly more often complained of nervousness. CONCLUSION: In postmenopausal women, ovaries play the most important role during the first ten years from the last menstruation.

Effect of IGF-I and TNF-α on intensification of steroid pathways in women with PCOS phenotypes are not identical. Enhancement of progesterone pathway in women with PCOS increases the concentration of TNF-α.

OBJECTIVE: The aim of this study was to determine the correlations between the concentration of tumor necrosis factor (TNF-α) and insulin-like growth factor I (IGF-I) in each woman with polycystic ovary syndrome (PCOS) phenotypes based on the levels of androgen. METHODS: Two groups of women with PCOS differing in their levels of androgens. The test group composed of 39 women with PCOS according to the Rotterdam criteria in their reproductive age. The hormonal levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid stimulating hormone (TSH), prolactin (PRL), androstenedione, testosterone (T), estradiol (E2) and sex hormone binding globulin (SHBG) were measured. Correlations analysis were performed calculating Spearman's rank correlation coefficient of hormones with relation to TNF-α and IGF-I. RESULTS: There was a medium positive correlation of IGF-1 with LH levels (p < 0.05) and negative medium correlation of TNF-α with of dehydroepiandrosterone (DHEA)-SO4 levels (p < 0.05) only in group of PCOS women with elevated androgens. CONCLUSION: Analysis of TNF-α showed that women with high testosterone negative correlation between level of TNF-α and the concentration of DHEA-SO4. Inflammatory state involving TNF-α in women with PCOS and high concentration of androgens is caused by intensified Δ4 (progesterone) pathway and omitted or limited Δ5 (dehydroepiandrosterone) pathway of testosterone biosynthesis.

Interstitial ectopic pregnancy after salpingectomy due to previous tubal pregnancy - a case report.

Ectopic pregnancy is the development of the embryo outside the uterine cavity. In recent years an increase in the incidence of ectopic pregnancies has been observed. It is mainly related to the increased number of IVF procedures. The most frequent localization is the ampulla of the fallopian tube. In cases of intramural or cornual ectopic pregnancies, many patients have a history of ectopic pregnancy on the same side or underwent partial salpingectomy in the past. Treatment of such pregnancies involves laparotomy and removal of the uterus or comu of the uterus. This case concerns a patient operated because of intramural pregnancy. She had a salpingectomy in the past because of tubal ectopic pregnancy on the same side. This case shows that even after removal of the fallopian tube there is still a risk of ectopic pregnancy in the intramural part of this tube.

Rare case of coexistence of primary ovarian carcinoid in mature teratoma with primary serous carcinoma in second ovary--a case report.

Ovarian malignant tumours are mostly ovarian cancers. The most frequent ovarian benign lesions are mature teratomas. A very rare ovarian neoplasm is carcinoid. It mostly occurs as a component of mature teratoma, what causes rare diagnosis before surgery. Study presents the case of patient with primary ovarian carcinoid in mature teratoma of one ovary, co-existing with primary epithelial carcinoma of another ovary. Surgical treatment of carcinoid involves adnexectomy or hysterectomy with adnexa and removal of great omenturn, followed by chemotherapy and radiotherapy. In young women with early-stage tumours, treatment can be limited to adnexectomy followed by close monitoring. In the presented case, management associated with the diagnosis of ovarian carcinoid, resulted in the detection of early-stage ovarian epithelial cancer. This case seems to confirm the recommendations to take tissue samples from the other ovary for histopathological evaluation in cases of ovarian unilateral benign tumours.

Analysis of pituitary gonadotropin concentration in blood serum and immunolocalization and immunoexpression of follicle stimulating hormone and luteinising hormone receptors in ovaries of postmenopausal women.

The participation of gonadotropins in ovarian carcinogenesis is well known and is supported by studies with inhibition of pituitary gonadotropin secretion, which results in a diminished risk of cancer. However, there are few data on localization and expression of Follicle Stimulating Hormone and Luteinising Hormone Receptors (FSHR and LHR) in ovaries of healthy postmenopausal women, and their correlation with FSH and LH concentration in blood serum is unknown. The aim of our study was to analyze gonadotropin concentration in blood serum and the expression of FSHR and LHR in ovaries of 207 postmenopausal women. Patients included in the study were divided into three groups depending on the number of years since menopause. We analyzed the concentration of FSH and LH in blood serum and the expression of FSHR and LHR in ovaries. Ovaries of postmenopausal women showed numerous morphological changes in the cortex and medulla when compared to the structure of ovaries of women at reproductive age. In all groups of patients clefts in the surface epithelium and epithelial inclusion cysts were found. The concentration of FSH and LH in the blood serum of women studied increased significantly with time from menopause. Significant differences between analyzed menopausal groups were found. The highest FSH and LH concentration in blood serum were found in women with the longest period of time from menopause. Quantitatively similar expression of FSHR and LHR was found in ovarian surface epithelial cells, in epithelial inclusion cysts and in the connective tissue cells of ovarian stroma. The intensity of the immunohistochemical reaction decreased with time from menopause and with age.

Immunohistochemical analysis of steroid receptors in ovaries of postmenopausal women--effects of aging and hormone status.

Current knowledge on immunolocalization and immunoexpression of steroid hormone receptors, especially estrogen receptor alpha (ER-alpha), progesterone receptor (PR) and androgen receptor (AR) in normal ovaries in postmenopausal women is not complete. The recognition of localization of these receptors in postmenopausal women is crucial, as many of these women receive estro-progestagene therapy, and its participation in the pathogenesis of ovarian cancer should be carefully studied. In our paper we present the results of immunohistochemical studies performed on samples from 100 post-menopausal women (aged: 48 to 60 years) who did not use hormonal therapy. The ovaries were removed during elective operation due to uterine leiomyoma, endometriosis and/or prolapsed uterine. PR, ER-alpha and AR were detected in the normal ovaries of postmenopausal women in stroma and in ovarian surface epithelium, as well as in its invagination and in epithelial inclusion cysts. The expression of PR and AR did not change, while the expression of ER-alpha decreased in time from menopause, and it was also detected in patients more than 10 years after menopause. Women older than 60 were not included in the study. The concentration of selected hormones was measured in the serum. The immunohistochemical expression of PR and AR were similar in all examined patients and did not correlate with FSH, LH, T, A, DHEAS concentrations in serum, while immunohistochemical expression of ER-alpha correlated with FSH, LH, T, A, DHEAS concentrations in serum. The significant correlation of decreasing expression of ER-alpha in normal ovarian tissue and decreasing concentrations of T, A and DHEAS in serum were found, as well as increasing serum concentrations of FSH and LH.

Human postmenopausal ovary--hormonally inactive fibrous connective tissue or more?

The ovary undergoes several changes after the menopause. In this period, the main structural changes in both the cortex and medulla were observed. In the cortex, they included: 1) reduction of its thickness; 2) epithelial inclusions forming cysts; 3) blurring the line between medulla and cortex; 4) reduction of follicles number; 5) tendency to fragmentation of corpora albicantia; 6) surface epithelium invaginations. Whereas the changes in the medulla included: 1) fibrosis and scars in stroma; 2) architectonical changes in blood vessels with hyalinization of walls and constriction of lumen. The loss of follicles and several changes in the ovary are due to apoptotic processes. Despite age related atrophic changes, the postmenopausal ovary is not devoid of hormonal activity. Our results are coherent with the reports of other researchers, and reveal that postmenopausal ovary produces trace quantities of steroid hormones, mainly androgens, and confirm the presence of steroid receptors and activity of main enzymes involved in steroidogenesis process.

Flow cytometry application in the assessment of sperm DNA integrity of men with asthenozoospermia.

Sperm genomic integrity and ultrastructural features of ejaculated spermatozoa contributing to the assessment of gamete fertility potential in patients with asthenozoospermia are discussed. The proportion of TUNEL-positive cells was significantly higher in the semen of patients with low sperm motility (n=40; p<0.01) as compared to men with normal sperm motility (n=54). Sperm DNA fragmentation negatively correlated (n=94) with sperm motility, sperm concentration, and integrity of the sperm cellular membrane (HOS-test). Two categories of patients were distinguished: (1) patients (23 out of 94 subjects) with < or = 4% of TUNEL-positive cells and (2) patients (71 subjects) with 4% of TUNEL-positive cells. A significant difference was noted in the sperm motility and HOS-test results between patients from both groups. Large numbers of immature spermatozoa with extensive cytoplasmic retention, ultrastructural chromatin and midpiece abnormalities, and conglomerates containing sperm fragments were present more frequently in the semen of asthenozoospermic subjects with >4% of TUNEL-positive sperm cells. Low sperm motility seems to be accompanied by serious defects of gamete chromatin expressed as diminished sperm genomic integrity and abnormal DNA condensation and by defects of sperm midpiece. These abnormalities may reflect developmental failure during the spermatogenic remodeling process. The DNA fragmentation test may be considered as an additional assay for the evaluation of spermatozoa beside standard analysis and taken together with electron microscopy may help to determine the actual number of "healthy" spermatozoa thereby playing an important role during diagnosis and treatment of male infertility.

[The relationship between intraperitoneal adhesion index and anatomical status of oviductal ampullary mucosa in patients with distal tubal occlusion]. / Zwizek miedzy wskaznikiem zrostów wewnatrzotrzewnowych a stanem anatomicznym banki jajowodów niedroznych w ujsciu brzusznym.

OBJECTIVES: An effort was made to verify co-relation between intraperitoneal adhesions and anatomy of oviductal mucosa of infertile women with distal tubal occlusion. MATERIALS AND METHODS: The study comprised 25 infertile women with distal tubal occlusion. The patients were allocated into 3 groups: A--11 women with the history of pelvic inflammatory disease (PID); B--9 patients with previous gynecological abdominal surgery; and C--5 women without PID nor surgery. Intraperitoneal adhesion index as well as oviductal mucosa were evaluated during laparoscopy and salpingoscopy. RESULTS: Women with the history of PID presented strong co-relation between intraperitoneal adhesions and anatomical abnormalities of the tubal mucosa with distal tubal occlusion. The co-relation was stronger then in women with previous abdominal surgery. Following the evaluation of the fallopian tubes, 5 out of 11 patients with history of PID, 6 of 9 women with history of previous surgery and all 5 without any risk factors were qualified for microsurgical reconstructive treatment. The remaining patients were sent for in vitro fertilization and embryo transfer.

A case of voluminous diarrhoea with hypokalaemic acidosis.

We describe a patient presenting with voluminous diarrhoea, hypokalaemic acidosis and hypercalcaemia who was found to have a vasoactive intestinal polypeptide-producing tumour. His diarrhoea was initially mild and intermittent requiring no medical attention.

[Intrauterine therapy with levonorgestrel releasing IUD of women with hypermenorrhea secondary to uterine fibroids]. / Wewnatrzmaciczna terapia levonorgestrelem obfitych miesiaczek spowodowanych miesniakami macicy--doniesienie wstepne.

OBJECTIVES: The aim of the study was to evaluate the effectiveness of Mirena IUD (Schering) treatment in women with severe menstrual bleedings secondary to uterine fibroids. MATERIAL AND METHODS: The study comprised 12 women in the age of 30 to 43 years (average 36.4) with uterine fibroids and severe menstrual bleedings. Eight patients developed anemia with hemoglobin levels below 12 g/dL. All women were treated with the levonorgestrel releasing IUD. Half of the group was observed for 6, and the remaining women for 12 months. Intensity of menstrual bleedings was evaluated prior and after the treatment. US evaluation comprised measurements of endometrium and the fibroids. RESULTS: No early complications were observed following the insertion of the IUD. Six weeks following the insertion, one patient had persisted menstrual bleedings and was operated, the remaining 11 noted decrease in the intensity of menstruation. After twelve weeks 3 out of 6 women with intramural fibroids developed ammenorrhea, the remaining 3 had scanty menstrual bleedings. Hemoglobin levels were normal in 11 women already 6 months after the insertion of IUD. Post treatment US revealed endometrium thickness of no more then 4 mm, and no change in the fibroids volume. CONCLUSION: Insertion of levonorgestrel releasing Mirena IUD (Schering) reduces intensity of menstrual bleedings secondary to uterine fibroids.

[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.

[Results of treating endometriosis with infertility using operative laparoscopy]. / Wyniki leczenia endometriozy wspólistniejacej z nieplodnoscia przy zastosowaniu laparoskopii operacyjnej.

In the work, the efficiency of treating endometriosis by hormonal as well as combined methods, and employing the operative laparoscopy was evaluated. The study involved 89 infertile women with endometriosis being of various grade of advancement. Sixty women underwent combined treatment according to Samm, the remaining 29 were given hormonal therapy with Danazol and Orgametril preparations. After combined treatment full recovery was obtained in 26.7% of cases, improvement in 40%, but after the use of preparations Orgametril, Organon or Danazol, Winthrop, complete cure was reached in 12.8% of cases, improvement in 31%. Only 8 women became pregnant after combined therapy. Complete recovery concerned mainly less advanced endometriosis, particularly following the combined treatment according to Semm. Early laparoscopic diagnosis increases the chance of curing endometriosis and fertility associated with it.

[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.

Clinical prognostic indices of fatality in elderly patients admitted to hospital with acute pneumonia.

Acute pneumonia in the elderly is a common and serious condition. The importance of key clinical features and physical signs presenting to the junior hospital doctor was prospectively assessed in 100 consecutive patients admitted acutely to two hospitals. The most significant finding is that elderly patients with pneumonia who are found to be acutely confused at the time of presentation or who gave a previous history of chronic brain failure are much more likely to die than others. Thus such patients should be assessed with particular attention to the early diagnosis and vigorous treatment of pneumonia.

[The influence of individual and total lifted objects on the equilibrium of the uterus]. / Wplyw masy jednostkowej i sumarycznej podnoszonych przedmiotów na statyke macicy.

Analysed were the dependencies between the single and total weight of lifted objects and disturbed equilibrium of working women's uterus. The examined population covered 167 women working in standing position, lifting objects of different single and total mass during their workday. The analysis involved: workers' age, type of menstruation, childbirth, urine incontinence and equilibrium of the uterus and vagina. The percentage of women with the descent of uterus and vagina, uterus displacement and effort urine incontinence was found to increase with age, length of employment and number of deliveries, particularly high percentage being the one relating to women lifting, just once, heavy objects. No correlation was found between the incidence rate of the health disturbances and the total weight of the objects lifted during the workday.