Surgical site infections following short-term radiotherapy and total mesorectal excision: results of a randomized study examining the role of gentamicin collagen implant in rectal cancer surgery.

BACKGROUND: Despite the findings of several randomized clinical studies, the role of gentamicin collagen implant (GCI) in rectal cancer surgery is unclear. Local pelvic application of GCI following preoperative radiotherapy and total mesorectal excision (TME) was evaluated to determine the risk of surgical site infections (SSI). METHODS: In this single-center trial, 176 patients with rectal cancer after preoperative, short-term radiotherapy (5 × 5 Gy) were randomized either to the study group in which GCI was used or in the control group without GCI. Prior to surgery and intraoperatively five patients were excluded from the study. The remaining 171 patients were analyzed; 86 were in the study group and 85 in the control group. RESULTS: There were no statistically significant differences in the overall rate of early postoperative complications between the study and control group: 25.6 and 34.1 % respectively; p = 0.245, relative risk (RR) 0.750 [95 % confidence interval (CI) 0.471-1.195]. The reoperation rate was similar in both groups: 12.8 versus 9.4 %; p = 0.628; RR 1.359; (95 % CI 0.575-3.212). The total rate of SSI and organ space SSI were 22.2 and 15.8 % without differences between the study and control group. In patients without anastomotic leakage, the risk of organ space SSI was significantly reduced in patients who received GCI: 2.6 versus 13.0 %; p = 0.018. CONCLUSIONS: Application of GCI in the pelvic cavity after short-term preoperative radiotherapy and TME may reduce the risk of organ space SSI but only in the absence of anastomotic leakage.

Production of cytokines during interaction of peripheral blood mononuclear cells with autologous ovarian cancer cells or benign ovarian tumour cells.

Cytokines produced by tumour and immune cells may play a significant role in a modulation of immune cells response against tumour. We investigated an ability of peripheral blood mononuclear cells (PBMC) of patients with early and advanced stages of ovarian cancer and from non-cancer patients to produce various cytokines in the presence or absence of autologous ovarian cancer (OC) cells or benign ovarian tumour (BOT) cells. Activated PBMC of patients with advanced stage of cancer produced slight amount of interferon gamma (IFN-gamma) and what's more, the production of IFN-gamma was decreased in the presence of OC cells. PBMC of patients with ovarian cancer or benign ovarian tumour generated comparable amounts of interleukin 6 and 10 (IL-6, IL-10), and transforming growth factor beta1 (TGF-beta1). PBMC of the patients with cancer produced higher amount of tumour necrosis factor alpha (TNF-alpha) than PBMC of non-cancer patients. We demonstrated here that the reciprocal contact of OC cells from advanced cancer with autologous PBMC altered the direction of produced cytokines and leads to the down-regulation of IFN-gamma and TNF-alpha as well as to up-regulation of immunosuppressive (IL-10, TGF-beta1) and pro-inflammatory (IL-6) cytokines production.

Ovarian cancer cells modulate human blood neutrophils response to activation in vitro.

In cancer, numerous cells of both innate and adaptive immune systems are activated. Polymorphonuclear neutrophils are potent effector cells of inflammation that are an important component of tumour development and progression. The important signalling proteins that are involved in neutrophil functions are extracellular signal-regulated kinases 1/2 (ERK1/2). We investigated the reactive oxygen species (ROS) production, adhesive ability and CD11b/CD18 adhesion molecule expression on neutrophils isolated from peripheral blood of ovarian cancer patients and the in vitro response of these cells to stimuli and direct contact with ovarian cancer cells isolated from tumour. We found that functional activities of neutrophils isolated from patients with advanced stages of ovarian cancer (FIGO III/IV) were intensified in comparison to neutrophils isolated from healthy female volunteers. Neutrophils of cancer patients produce higher amounts of ROS in response to stimuli than those of control group. Unstimulated neutrophils of patients possess higher expression of CD11b/CD18 molecule that is accompanied by increased adhesive ability of these cells. Our results reveal that augmented functional activities of neutrophils may result from the intensification of ERK1/2 kinases phosphorylation. We found that interactions with ovarian cancer cells modulate neutrophil functions as a result of cell-to-cell direct contact. We conclude that ovarian cancer cells affect pro-inflammatory activities in neutrophils via influence of signalling pathways in response to stimuli. Our results suggest the possibility that neutrophils responding to contact with cancer cells contribute to the progression and metastatic potential of tumour cells.

'In vitro' cytokine secretion by peripheral blood and decidual lymphocytes during the third trimester of normal pregnancy.

If the 'Th2 phenomenon' is dependent on trophoblastic antigens and cytokines, the profile of cytokines secreted by decidual lymphocytes (DL) should indicate stronger Th2 shift than that of peripheral blood lymphocytes (PBL). We studied spontaneous and mitogen-stimulated 'in vitro' cytokine secretion of cultured lymphocytes isolated from peripheral blood (n = 21) and decidua (n = 11) of third trimester healthy pregnant women not being in labor. The ELISA method was used for estimation of IL-2, IL-4, IL-6, IL-10, IL-12, IFN-gamma and TGF-beta. The results (given in pg/ml) were found to be statistically significant in the Mann-Whitney U-test (p < 0.05). Compared to PBL, DL produced spontaneously decreased concentrations of IL-12, IL-6, IFN-gamma and TGF-beta and upon mitogen stimulation increased quantities of IL-2, IL-4 and IL-10. It demonstrates that DL play an active role in local Th2-like immunoregulation and that their cytokine secretion pattern estimated in 'in vitro' conditions is biased towards Th2 activity more than that of PBL.

[The influence of paternal lymphocytes immunization on percentage of peripheral blood CD16+/CD56+ cells in women with primary recurrent spontaneous abortion]. / Wplyw immunizacji allogenicznymi limfocytami na odsetkowa zawartosc komórek NK we krwi obwodowej kobiet z poronieniami nawykowymi typu pierwotnego.

OBJECTIVES: Paternal lymphocytes immunization has been proposed for several years as an efficient treatment for unexplained Recurrent Spontaneous Abortion (RSA), however precise mechanism that underline the benefits of this immunotherapy is still unclear. DESIGN: The aim was to study the influence of paternal lymphocytes immunization on percentage of peripheral blood NK cells (CD16+/CD56+) in women with primary RSA of unknown etiology. MATERIALS AND METHODS: 48 patients with history of 3-5 (mean 3.3 +/- 0.7) consecutive primary RSA of unknown etiology were selected for the study. Immunotherapy with paternal lymphocytes, isolated from 100 ml of peripheral blood, was performed twice prior conception with a 4-week interval. The percentage of NK cells (CD16+/CD56+) was estimated using standard flow-cytometric immunofluorescent techniques for whole blood with one-step monoclonal anti-CD16/CD56 antibodies. Statistical analysis was performed with Wilcoxon test and the p value less than 0.05 was accepted as statistically significant. RESULTS: It was found that paternal lymphocytes immunization significantly decreases the percentage of NK cells in peripheral blood in women with RSA (23.9 +/- 8.5 vs. 16.2 +/- 7.0; p = 0.009). CONCLUSIONS: The data of the present studies suggest that paternal lymphocytes immunization modulate immunity in women with primary unexplained RSA significantly decreasing the percentage of NK cells (CD16+/CD56+) in peripheral blood.

[Maternal serum cytokines in labor, pregnancy and chorioamnionitis]. / Wyniki oznaczen wybranych cytokin w surowicy ciezarnych oraz rodzacych przedwczesnie i o czasie.

UNLABELLED: The purpose of our study was to compare maternal serum levels of interleukin-6, interleukin-8, tumor necrosis factor-alpha and interferon-gamma in gravidities, during spontaneous term and preterm labor and their relation to histologic chorioamnionitis. METHODS: We investigated 61 women: 10 in preterm labor, 36 in term labor and 15 healthy pregnant nonlabouring controls. Venous bloods for cytokines determinations were obtained during the first stage of labor and during routine screening tests. Titers of cytokines were measured by means of ELISA technique. All births after preterm deliveries were examined to establish histologic chorioamnionitis. RESULTS: Serum levels of IL-6 and IL-8 were significantly elevated both in term (mean: IL-6: 17.5 +/- 58 pg/ml; IL-8: 148 +/- 215 pg/ml) and preterm labor (IL-6: 23 +/- 44 pg/ml; IL-8: 332 +/- 389 pg/ml) when compared to nonlabouring gravidities (IL-6: 5 +/- 7 pg/ml; IL-8: 14 +/- 11 pg/ml). IL-6 and IL-8 titers were statistically similar in term and preterm labors and in patients with and without histologic chorioamnionitis. TNF-alpha and IFN-gamma were not statistically analyzed because only a few patients had detectable serum levels of these cytokines. CONCLUSION: Serum levels of IL-6 and IL-8 in both: term and preterm labor are elevated in comparison to nonlabouring gravidities. The elevated levels of these cytokines are not connected with coexisting chorioamnionitis.

[Parameters of peripheral whole blood neutrophil activity in women with pregnancy induced hypertension]. / Ocena niektórych parametrów aktywnosci ukladu neutrofili w pelnej krwi obwodowej ciezarnych z nadcisnieniem indukowanym ciaza.

OBJECTIVES: Pregnancy induced hypertension is believed to be a state of neutrophil overactivity, however all previous studies were done on isolated cells. DESIGN: To study neutrophil activity in whole blood of PIH women. MATERIALS AND METHODS: Neutrophil activity was estimated without isolation, in peripheral whole blood of 23 PIH women and 26 normal pregnant controls. The chemiluminescence test was performed without any stimulation and upon stimulation of neutrophils with fMLP, OZ and PMA, before and after pre-activation with TNF-alpha. The results were corrected according to the haemoglobin concentration and (%) of neutrophils. The percentage of whole blood neutrophils indicating expression of selectins CD18, CD11b, integrin CD62L and mean fluorescence intensity (MFI) of these molecules were studied on flow-cytometry. RESULTS: The study revealed that neutrophil chemiluminescence was not significantly higher in PIH women and after correction coefficient used it was even lower in PIH patients. TNF-alpha preactivation had no influence on chemiluminescence results. Expression of CD11b expressed as MFI value was significantly increased while that of CD62L, expressed as (%) of positive cells and MFI value--decreased in PIH patients. CONCLUSIONS: Changes of neutrophil CD11b and CD62 expression indicate increased activity of these cells in PIH women, however low production of reactive oxygen species estimated by corrected chemiluminescence test especially after TNF-alpha pre-activation, indicates that this form of their reactivity is rather "exhausted" during PIH.

[Decidual lymphocyte subsets in pregnant women]. / Subpopulacje limfocytów w doczesnej u ciezarnych z preeklampsja.

OBJECTIVES: Materno-foetal immunological reactions in decidua are probably one of the most important elements in pathogenesis of preeclampsia. DESIGN: To compare lymphocyte subsets isolated from decidua of preeclamptic pregnant women with lymphocyte subsets isolated from healthy pregnant women. MATERIALS AND METHODS: Preeclampsia (PE) was defined according to USA National Health Institute criteria. The study group consisted of 21 women with PE and 11 women with physiological pregnancy. All pregnancies were finished with elective cesarean sections. Exclusion criteria were: uterine contractions, infection, chorinamnionitis, diabetes mellitus and therapy with steroids less than 7 days before blood sampling. Decidual tissue was obtained by curettage of the uterine cavity. The fragments of decidua were separated from clotted blood and placed in sterile tubes with 5 ml of isotonic solution (PBS). Then the decidual tissue was mechanically fragmented, homogenized and rinsed in PBS. Routine immunofluorescent marking techniques with monoclonal antibodies were performed. Analysis was done with FACSCalibur flow-cytometer with 488 nm argon laser using CellQuest programme. The following lymphocyte subsets were estimated: CD3, CD19, CD4, CD8, CD4/CD29, CD8/CD28, CD4/CD45RA, CD4/CD45RO, CD56/CD16, CD69. The results were described as percentage of lymphocytes positive for above surface molecules. Statistical analysis was performed using t-Student and U-Mann-Whitney tests. The work was sponsored by KBN 4 P05E 118 15 grant. RESULTS: Decidua of pregnant PE women contains significantly increased percentage of CD3-/ CD56 + 16+, CD8+/CD28+ cells and decreased percentage of CD3+, CD19+, CD4+/CD29+ and CD4+/CD45RA+ compared to decidua of healthy pregnant controls. CONCLUSIONS: These changes suggest that deficiency of suppressor activity as well as aberrant immunoregulation exists in decidual tissue of PE women.

[The place of laparoscopy in gynecological practice--useful technique for diagnostic and treatment of infertility and endometriosis]. / Miejsce laparoskopii w praktyce ginekologicznej--metoda z wyboru w diagnostyce i leczeniu nieplodnosci i endometriozy.

OBJECTIVE: The objective was to evaluate indications for laparoscopy performed in Department of Gynecological Surgery of Polish Mother's Memorial Research Institute. MATERIALS AND METHODS: We have analyzed hospital charts of 342 patients who had been treated with laparoscopy in 1991-1999. RESULTS: During last years a progressive frequency in performing laparoscopic procedures has been noted (4.7% of all surgical treatment in 1991-93, 6.4% in 1994-96, 16.3% in 1997-99, and 25.2% in 1999). An increased percentage of operative laparoscopic procedures has also been observed (11.9% in 1991-93 vs 59.8% in 1994-96 vs 86.9% in 1997-99). The major indication for performing laparoscopy was: infertility (145--42.4%), endometriosis (90--26.4%) and benign ovarian tumors. Most of laparoscopic operations were performed due to benign pathological changes found in adnexa (218--68.6%). Laparoscopy has been recently introduced in surgical treatment of uterine myoma (enucleation, laparoscopically assisted vaginal hysterectomy-LAVH) and diagnosis of ovarian carcinoma. Complications were found in 19 (5.5%) cases: 11 cases (3.2%) intraoperative and 8 (2.3%) cases postoperative. Bleeding from abdominal wall vessels was the most often intraoperative complications, whereas an infection was the most common postoperative one. Because of complications laparoscopy turned into laparotomy in four cases. CONCLUSION: Laparoscopy is a safe and useful technique for treatment some gynecological pathology (especially infertility and endometriosis) with a small number of complications.

[Serum cytokines in patients with ovarian cancer and benign ovarian cysts]. / Wyniki oznaczen wybranych cytokin w surowicy chorych na raka jajnika lub lagodne torbiele jajników.

UNLABELLED: The aim of our study was to evaluate serum interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) as tumor markers--study based on the data about tumor cytokines production and tumor-host interactions. METHODS: We investigated 48 women: 17 with ovarian cancer untreated before, 16 with benign ovarian cysts and 15 healthy controls. Venous blood for cytokines determinations were obtained before operations and during routine screening tests. Titers of cytokines were measured by means of ELISA technique. RESULTS: In the control group the upper limit of normal IL-6 titers (95th percentile) was 5.5 pg/ml; the mean IL-8 concentration was 9.6 +/- 15.1 pg/ml and the upper limit of normal was 37 pg/ml; serum TNF-alpha and IFN-gamma were not detectable. In patients with benign ovarian cysts the levels of all investigated cytokines didn't differ significantly from healthy controls. Women with ovarian cancer had significantly higher serum IL-8 levels (mean: 290.5 +/- 351 pg/ml) than healthy controls or women with benign ovarian cysts; 88% of them had IL-8 titers above the normal. The IL-6 titers in ovarian cancer were also higher but didn't reach statistical significance, 53% of them had IL-8 titers above the normal. TNF-alpha and IFN-gamma levels in ovarian cancer were similar to patients with benign ovarian cysts. CONCLUSION: Serum IL-8 levels in patients with ovarian cancer were significantly higher when compared to healthy controls and benign ovarian cysts and in almost 90% of ovarian cancers the titers of IL-8 were increased. Additionally, 53% of women with ovarian cancer had elevated serum IL-6 levels.

[Analysis of urinary tract injury during gynecological surgery performed with preoperative ureter catheterization or intraoperative ureter control]. / Analiza czestosci wystepowania uszkodzen ukladu moczowego w czasie wybranych operacji ginekologicznych po zastosowaniu przedoperacyjnego cewnikowania moczowodów oraz sródoperacyjnego ustalania ich umiejscowienia.

DESIGN: To analyze urinary tract injuries during gynecological surgery performed with preoperative ureter catheterization or intraoperative ureter control. MATERIAL AND METHODS: Retrospective analysis of 1986 chosen gynecological operations performed between 1990-1998 in Dept. of Gynecological Surgery Polish Mother's Health Center Institute. RESULTS: The overall frequency of urinary injuries was 2.15%. It was less during gynecological surgery performed with ureter catheterization compared to intraoperative ureter control only (ureter: 0.30% vs. 0.55%, p = 0.22; urinary bladder: 0.40% vs. 0.90%, p < 0.05). CONCLUSION: 1/ urinary injury was twice as frequent during ureter control than during ureter catheterization, 2/ urinary injury was the most frequent complication during hysterectomy with adnexa, 3/ the results of our analysis should be treated as a vote "for" ureter catheterization before gynecological surgery.

[Colposuspension during abdominal hysterectomy--own modification]. / Wlasna modyfikacja podwieszania pochwy w czasie zabiegu usuniecia macicy droga brzuszna.

OBJECTIVES: The aim of our study was to evaluate the clinical effectiveness of own modification of colposuspension using the musculofascial flap during abdominal hysterectomy. MATERIAL AND METHODS: The study group consisted of 57 patients operated on uterine and/or vaginal prolapse; 45 of them had also others pelvic gynecological disorders. Prolapsed or lowered vaginal walls were corrected by colposuspension or cervical suspension using musculofascial flap (made of the rectus abdominis muscle sheet and pyramidal muscle). The flap was sharply separated from the anterior wall of rectus abdominis muscle sheet going up from pyramidal muscle to umbilical region where it ended. Its end was sutured to vaginal vault and uterosacral ligaments. This gave a flattening of rectovaginal pouch and shortage of rectovaginal distance. RESULTS: The incidence of usual complaints as: hypogastric pain, uterine/vaginal prolapse feeling and vaginal dryness was significantly decreased after the operation. The quality of sexual functions was also improved. The incidence of urine incontinence and polyuria didn't change after the operation. CONCLUSION: The own modification of colposuspension during abdominal hysterectomy is an effective method of treatment in cases of uterine/vaginal prolapse with other pelvic gynecological disorders.

[Antiphospholipid autoantibodies in women treated for infertility]. / Wystepowanie autoprzeciwcial antyfosfolipidowych u kobiet leczonych z powodu nieplodnosci.

OBJECTIVE: To evaluate an occurrence of selected antiphospholipid antibodies (APL) in infertility women. STUDY DESIGN: An enzyme-linked immunoabsorbent assay (ELISA) has been used to determine a titre of anticardiolipin antibodies (ACA). APTT (activated partial thromboplastin time) and PT (prothrombin time) measurements and direct commercial assay have been also used to study occurrence of LAC (lupus anticoagulant antibodies). The group of 268 observed women has been divided into five subgroups according to the cause of infertility: I-endometriosis, II-tubal occlusion caused by others diseases than endometriosis, III-occurrence of antisperm antibodies (ASA), IV-polycystic ovariorum syndrome (PCOS) and V-unexplained etiology. Results have been compared to 44 healthy controls. RESULTS: Occurrence of ACA has been found statistically more often in patients suffering from infertility than in controls (17.9% vs 4.5%, p < 0.05). Moreover ACA have been statistically more often observed in patients with endometriosis (21 from 44, 47.7%). ACA were more common in patients with other cause of infertility (except PCOS) compared to controls, though statistically this was not significant. Frequency of ACA was also more common than LAC (17.9% vs 13.6%). Compared to controls LAC tests were more often positive in infertile women with endometriosis (I), tubal occlusion (II) and with the occurrence of antisperm antibodies (III) but results were not statistically significant. CONCLUSIONS: Antiphospholipid antibodies are observed more often in patients suffering from infertility compared to women with a regular fertility. This suggests a role of APL in etiology of infertility. The occurrence of anticardiolipin antibodies in almost every second woman suffering from endometriosis suggests existing of autoimmunologic disturbances in this disease.

[Laparoscopy and laparotomy in the operative treatment of ovarian cysts]. / Leczenie operacyjne lagodnych guzów jajnika: laparotomia i laparoskopia.

OBJECTIVES: The purpose of our study was to compare operative procedures, histologic types of tumours, and intra- and postoperative complications of patients operated for benign ovarian cysts by laparotomy or laparoscopy. MATERIALS AND METHODS: 257 patients with different types of ovarian cysts underwent operations by laparoscopy (51 cases) or laparotomy (206 cases). Careful selection for operative treatment was made on the basis of clinical findings, ultrasound scans (using colour Doppler), patient's age and history. Operative laparoscopies were performed in patients with "unsuspected" ovarian cysts with diameter < or = 8 cm. During every operation, a histologic examination of tumour was performed. RESULTS: In 42 patients the cysts were found in both ovaries. Remaining 215 women had unilateral ovarian tumours. Adnexectomy was carried out in 142 cases, cystectomy in 131, ovariectomy in 18, and aspiration and electrocoagulation of ovarian cysts in 8 cases. The most common laparoscopic procedures were cystectomy (41) and aspiration and electrocoagulation of ovarian cysts (8); while by laparotomy: adnexectomy (142) and cystectomy (131); p < 0.0001. The histopathological assessment showed as follows: serous cysts in 98 cases, dermoid cysts in 75, endometrial cysts in 63, mucous cyst in 23, and others (mainly haemorrhagic, functional cysts and fibrothecomas) in 40 cases. The incidence of operative complications (3/257--all due to insufficient hemostasis) and postoperative complications (infection--7/257, anaemia--4/257, peritonitis--1/257) was rather low and similar in patients operated by laparoscopy and laparotomy. Patients were generally discharged from the hospital on the fourth (median) postoperative day after laparoscopies and the seventh (median) day after laparotomies (p < 0.0005). CONCLUSIONS: Operative treatment of ovarian benign cysts is connected with a very low risk for intra- and postoperative complications. The operative laparoscopy brings better cosmetic effects and seems to be safe and effective method of treatment of ovarian benign cysts.

[Ovarian cancer. I. Epidemiology, symptoms, FIGO staging]. / Rak jajnika w materiale Kliniki Chirurgii Ginekologicznej Instytutu CZMP. I. Epidemiologia, objawy, stopnie zaawansowania.

OBJECTIVES: The purpose of our study was to analyse the epidemiological data, signs and symptoms, FIGO staging in patients operated for the first time for ovarian cancer. MATERIALS AND METHODS: A retrospective review of patients' charts with ovarian cancer operated at the Department of Gynaecological Surgery of Polish Mother's Memorial Hospital-Research Institute in 1990-1999 was conducted. We analysed the data of women operated for the first time for this disease. FIGO staging was performed due to operational and histologic findings. RESULTS: Between January 1990 and December 1999, 107 patients were operated for the first time for ovarian cancer. The mean patients' age was 54 years (range: 25-82); 31.8% of patients were aged from 41 to 50 years, 24.8% 51-60, 27.1% 61-70%, 7.5% above 70 years, and 9.3% were below 40 years. The main symptoms were: abdominal pain (61.7%), increasing abdominal circumference (35.5%), urination and bowel problems (14.0%), weight loss (8.4%), dyspeptic problems (7.5%), slightly elevated temperature (4.7%) and abnormal vaginal bleeding (3.7%). No symptoms were reported by 16.8% of patients (frequency similar in I/II and III/IV stage by FIGO). There were no statistical differences in the incidence of reported symptoms in I/II vs III/IV FIGO stage. FIGO staging was as follows: I--13.1%, II--14.95%, III--59.8%, IV--12.15%. CONCLUSIONS: Our data showed that ovarian cancer is very rare below the age of 40 and above 70 years. There is a great need to improve screening for ovarian cancer because the development of the disease is clinically silent or nonspecific and almost 70% of patients with ovarian cancer is diagnosed in the late stages of illness.

[Ovarian cancer. II. Procedures, histology, and complications]. / Rak jajnika w materiale Kliniki Chirurgii Ginekologicznej Instytutu CZMP. II. Operacje pierwotne, histopatologia, powiklania.

OBJECTIVES: The purpose of our study was to analyse the operative procedures and complications in patients operated for the first time for ovarian cancer. MATERIALS AND METHODS: A retrospective review of patients' charts with ovarian cancer operated at the Department of Gynaecological Surgery of Polish Mother's Memorial Hospital-Research Institute in 1990-1999 was conducted. We analysed the data of women operated for the first time for this disease. In every case we tried to perform radical operation consisted of hysterectomy with bilateral adnexectomy, omentectomy, appendectomy (if needed), and additionally optimal debulking in advanced cancer. RESULTS: Between January 1990 and December 1999, 107 patients were operated for the first time for ovarian cancer. FIGO staging was as follows: I--13.1%, II--14.95%, III--59.8%, IV--12.15%. The most frequent findings on histology were serous (39.3%), endometrioid (26.2%), undifferentiated (11.2%) and clear cell cancers (10.7%). In 60.7% of cases we performed hysterectomy with bilateral adnexectomy, in 15.0% bilateral adnexectomy, in 4.7% of patients cytoreductive tumorectomy, and in 19.6% of cases only excisions for histology were taken. 69.0% of patients underwent also omentectomy and 42.6% appendectomy. In 58.9% of patients we performed radical operation; its incidence significantly decreased with the increase of FIGO staging: I--100%, II--87.5%, III--51.6%, IV--15.4% (p < 0.0005). We noted 5 cases of intraoperative complications, all in patients with the stage III, connected with intestinal or urinary bladder lesions. The most common postoperative complication was anaemia (23.4%) and fever (4.7%). Four patients died in 8-27 postoperative day due to circulatory insufficiency. CONCLUSIONS: The most common was serous and endometrioid ovarian cancer. The great majority of patients was diagnosed to late and operated in III and IV stage of the disease, but in almost 60% of cases radical operation was performed.

[The role of peripheral blood lymphocyte subpopulations in differentiation between preeclampsia and transient hypertension]. / Znaczenie oznaczen subpopulacji limfocytów krwi obwodowej w róznicowaniu pomiedzy preeklampsja a nadcisnieniem przemijajacym w ciazy.

OBJECTIVES: Hypertension is the most frequent complication of pregnancy after 24th week of gestation, occurring in 8% of pregnancies and being the main cause of perinatal mortality and morbidity. It is classified as preeclampsia (PE) or transient hypertension (TH). According to some statements PE and TH are distinct syndromes of different pathogenesis. There are even opinions emphasizing that in most cases TH is in fact undiagnosed chronic hypertension. The role of immunological system in pathogenesis of PE is well known but the hypothesis that immunological events are engaged in pathogenesis of chronic hypertension has not been proved so far. Assuming that TH is closer in its pathogenesis to chronic hypertension than to PE it would be possible to differentiate between TH and PE using some immunological tests. If PE and TH are the same, the differences would be insignificant. DESIGN: The aim of this study was to check the hypothesis that peripheral blood lymphocyte subsets analysis is an useful tool in differentiation between PE and TH and confirmation of their distinct origin. MATERIALS AND METHODS: The study groups consisted of 19 pregnant women with PE (mean age 25.5 +/- 2.5 years, mean gestational age 32.5 +/- 2.5 weeks, 84.2% primiparae) and 14 pregnant women with TH (mean age 27.0 +/- 3.0 years, mean gestational age 33.5 +/- 3.0 weeks, 100% primiparae) diagnosed between 30-37 week of gestation. All women were matched according to gestational age and race. They had no renal diseases or chronic hypertension prior to pregnancy neither had any features of them during the study. Exclusion criteria were: uterine contractions, infection and therapy with steroids before blood sampling. PE and TH were defined according to USA National Health Institute criteria. Peripheral blood was obtained by venipuncture. Standard immunofluorescent marking techniques for whole blood with one-step monoclonal antibodies were performed. Lymphocyte subsets (CD19+, CD3+, CD4+, CD8+, CD3-/CD16+/CD56+, CD3+/CD16+/CD56+, CD8+/CD28+, CD4+/CD45RA+, CD4+/CD45RO+, CD3+/CD69+) analysis was done with flow-cytometer FACSCalibur with 488 nm argon laser. The lymphocyte cells region was chosen with LeucoGATE and analysis performed with SimulSET v.3.1 programme. Statistical analysis was based on Student T test. RESULTS: The differences in peripheral blood lymphocyte subsets composition between PE and TH were insignificant. CONCLUSION: Is that on the basis of peripheral blood lymphocyte subsets analysis PE and TH despite different clinical symptoms seem to have common pathogenesis. However there is possibility that changes observed in peripheral blood are not significantly different in PE and TH because of their low importance for immunopathogenesis.

[Comparison of platelet activation and procoagulant activity of blood cells in healthy pregnant women and EPH-gestosis patients]. / Porównanie wybranych parametrów koagulologicznych oraz stanu pobudzenia krwinek plytkowych u ciezarnych kobiet z ciaza fizjologiczna i powiklana gestoza EPH.

OBJECTIVES: EPH-gestosis is one of the most frequent complications of pregnancy, labour and puerperium. Despite its unknown ethiology, many authors suggest a vital role played by platelets as an ethiopathogenic factor. The aim of this study was to observe the level of platelets activation in EPH-gestosis subjects. STUDY DESIGN: Platelets activation level has been observed in 16 EPH-gestosis third semester pregnant women and 14 normotensive third semester pregnant controls. Platelets double-labeled with monoclonal antibodies and a flow cytometer have been used in assessment of platelet activation level. Anti-P-selectin (GMP 140- Granule Membrane Protein) has been used as a marker of the platelet released reaction. Fibrinogen, D-dimers, antithrombin and thrombin-antithrombin complexes levels have been analyzed. RESULTS: An increased platelet activation (p < 0.005) as well as the increased level of thrombin-antithrombin (p < 0.005) in pregnant EPH-gestosis women comparing to control group, has been observed in the study. CONCLUSIONS: A state of hypercoaguability and enhanced platelet activation in pregnant EPH-gestosis women have been observed.

[The influence of paternal lymphocyte immunization on the balance of Th1/Th2 type reactivity in women with unexplained recurrent spontaneous abortion]. / Wplyw immunizacji limfocytami partnera na równowage odpowiedzi immunologicznej typu Th1/Th2 u kobiet z poronieniami nawykowymi o nieustalonej etiologii.

OBJECTIVES: Paternal lymphocyte immunization has been proposed as an efficient treatment for unexplained recurrent spontaneous abortion (RSA), however precise mechanism that underlie the benefits of this immunotherapy are still unclear. It was proposed that successful pregnancy is reminiscent of T helper 2 (Th2)--dominant situation but unsuccessful pregnancy is a Th1-type situation. The aim of the study was the evaluation of influence of paternal lymphocyte immunization on the balance of Th1/Th2--type reactivity in women with unexplained recurrent spontaneous abortion. MATERIAL AND METHODS: 8 patients with a history of 3 or more consecutive primary spontaneous abortions of unknown etiology and no positive autoimmune factors were selected for the study. Immunization with paternal lymphocytes, obtained from 100 ml of peripheral blood, was performed twice prior conception with a 4-week interval. The following immunological parameters were studied: peripheral blood T lymphocyte subpopulations (CD3, CD4, CD8) and secretion of the Th1-type cytokines (IL-2, IFN-gamma), Th2-type cytokines (IL-6) and TGF-beta 1 by phytohaemaglutinin-stimulated peripheral blood lymphocytes. Evaluation of immunity parameters were performed before and 2 weeks after immunotherapy. RESULTS: It was found that paternal lymphocytes immunization significantly increase the percentage of CD4 T lymphocytes (37.11 +/- 7.65 vs. 41.38 +/- 5.57, p = 0.007). Immunotherapy also leads to a significant enhancement in Th2-type cytokines (IL-6) secretion (22,677 +/- 17,907 mg/ml vs. 44,550 +/- 15,907 mg/ml, p = 0.008) and a significant decreasing in Th1-type cytokines (IL-2) secretion (6.50 +/- 5.98 mg/ml vs. 0.00 +/- 0.00 mg/ml, p = 0.0179). CONCLUSIONS: The data of the present studies suggest that paternal lymphocytes immunization modulate of immunity in women with unexplained recurrent spontaneous abortion. Our studies indicate a shift in the balance fo cytokine profiles away from Th1-type reactivity to a Th2-type reactivity after immunotherapy.