Dynamics of cervical langerhans cell counts in the course of HPV-positive CIN treatment with the use of human recombinant interferon gamma.

OBJECTIVES: Langerhans cells play a pivotal role as professional antigens presenting cells in cervical epithelium, thus changes in their density or/and function may profoundly influence the proper activation of the afferent arm of immune response in cases of HPV-related intraepithelial lesions. AIM OF THE STUDY: Assessment of intraepithelial Langerhans cell count changes in CIN I/CIN II after human recombinant interferon gamma (IFNgamma) application and correlation with clinical outcome. MATERIAL & METHODS: The present study is a part of prospective trial on IFNgamma application in the treatment of CIN I/CINII associated with high-risk HPV infection. Seventeen subjects underwent uniform IFNgamma treatment (four intracervical injections in a two-day interval for a total dose of 6,000,000 IU). Langerhans cells were stained within cervical punch biopsy specimens with the use of polyclonal anti-S-100 antibody according to the three-step indirect peroxidase protocol, and their mean count calculated for the following groups: before IFNgamma treatment launching, immediately after completion of the treatment, and after two months of follow-up. RESULTS: The analysis revealed a rapid and significant increase in Lagerhans' cell count immediately after treatment completion (21.17/mm2 and 25.94/mm2, respectively, at p = 0.019) which further increased in the group of complete response (in 9 subjects; 32.22/mm2). After transient elevation of the Langerhans' cell count it returned to a level even lower than initially in the non-responder group (4 subjects; 20.25/mm2). CONCLUSION: Our data strongly support the observation from static studies suggesting that regression of HPV-related cervical lesions is associated with increased density of epithelial Langerhans cells.

Recombinant human interferon gamma in the treatment of cervical intraepithelial neoplasia (CIN) associated with human papillomavirus (HPV) infection.

Human papillomavirus (HPV) proteins E6 & E7 are considered to be the constitutively expressed neoantigens in a vast majority of cervical squamous intraepithelial lesions and cancers. Data available from in-vitro, animal, and small clinical trials suggest that the immunological properties of interferon gamma might enhance early viral protein presentation, thus stimulating a cytotoxic response. In order to study this effect in vivo we undertook a trial in which 20 women with a definite diagnosis of cervical intraepithelial neoplasia (CIN) grade I or II with coexistent high-risk HPV infection (detected by the Hybrid Capture System) underwent four months observation followed by intracervical administration of INFgamma in cases without spontaneous regression (17 cases). Human recombinant interferon gamma 1-b (Imukin) was administered intracervically four times in equal doses in two-day intervals to a total dose of 6,000,000 IU. The results of therapy were verified by punch biopsy evaluation and HPV-DNA testing two months after completion, and revealed a complete response in nine women (complete regression of CIN and remission of HPV infection in 53% of treated cases) and partial response in four cases (lower grade of CIN or/and remission of HPV infection--23.5%). The differences between spontaneous (before treatment) and treatment-related regressions were significant at p < 0.05. We conclude that in selected cases (mainly young women who have not completed their procreation and are compliant with the therapy) a conservative approach to CIN management with intracervical IFNgamma injections seems to be a valuable method.

[Glutathione peroxidase activity in normal and preeclamptic placentas]. / Aktywnosc peroksydazy glutationowej w lozyskach z ciazy prawidlowej i powiklanej preeklampsja.

OBJECTIVE: The decrease of placental glutathione peroxidase (GSH-Px) activity may lead to exacerbation of lipid peroxidation in preeclamptic placentas. DESIGN: The aim of the study was the determination of GSH-Px activity in placentas from normal and preeclamptic pregnancies (with and without intrauterine growth retardation-IUGR). MATERIALS AND METHODS: The investigations comprised placentas obtained immediately after delivery from 24 normal pregnancies (group K), 26 pregnancies complicated by severe preeclampsia-PE (group PE) and 23 pregnancies complicated by severe PE and IUGR (group PEI). The activity of GSH-Px was determined using a spectrophotometric method and expressed as IU/g protein. Comparative analysis was performed using u Mann-Whitney test. RESULTS: Mean activity of GSH-Px (MGSH-Px) in the PEI group--5.38 +/- 1.59 (M +/- SD), was significantly lower (p < 0.001) as compared to MGSH-Px in the group K (7.22 +/- 1.21). MGSH-Px in the PE group (6.47 +/- 1.31) was lower than MGSH-Px in the group K, but this difference was not statistically significant (p > 0.05). MGSH-Px in the group PEI was significantly lower (p = 0.023) as compared to MGSH-Px in the PE group. CONCLUSIONS: The activity of GSH-Px is decreased in placentas from pregnancies complicated by severe PE and IUGR. Received results may indicate that the decrease of placental GSH-Px activity may be involved in pathogenesis of IUGR in preeclamptic pregnancies.

[Serum angiogenin concentration in women with adnexal tumors]. / Stezenia angiogeniny u kobiet z guzami przydatkowymi.

Angiogenesis is essential for most solid tumor growth and dissemination. Angiogenin (ANG), a potent new blood vessel formation stimulator may be a potential biomarker of ovarian malignancies. We have analyzed serum concentration of this polypeptide and CA-125 in 78 women with operated because of adnexal tumors. Sixty-five tumors were benign and 13 were malignant. Mean serum concentration of ANG in women with benign tumors and with ovarian cancer 410.8 pg/ml (range: 98.3-956.3 pg/ml) and 469.1 pg/ml (range: 65.3-1103.0 pg/ml), respectively. There were no significant differences in ANG concentrations between the groups, also we have not found any correlation with serum CA-125 levels assayed preoperatively. We conclude that serum angiogenin levels are not a useful predictor of ovarian malignant tumors.

[Surgical approach in cases of adnexal pathology in adolescents and young women]. / Postepowanie operacyjne w przypadkach patologii przydatków dziewczat i mlodych kobiet.

Retrospective analysis comprised 108 cases of adnexal pathology found at laparotomy in the group of adolescents and young women up to the age of 25. The most common condition necessitating the laparotomy was hemorrhagic corpus luteum (24% of cases). Adnexal cysts of different but benign histological structure had been found in 30.5% of cases. Malignant germ cell tumors (6 cases--dysgerminoma and teratoma immaturum) all of which at Ia stage at the time of laparotomy, had been treated conservatively with unilateral salpingo-oophorectomy. Authors suggest that the conservative approach should be applied in most cases of adolescents' adnexal pathology.

[Endometriosis in adolescents and young women. Can we afford to delay the diagnosis?]. / Endometrioza u dziewczat i mlodych kobiet. Czy mozemy zwlekac z diagnostyka?

Retrospective analysis performed on medical records of 129 adolescents and young women treated surgically at I Dept. of Surgical Gynaecology during the nine years period (1989-1998) revealed 22 cases (17%) of endometriosis. Main indication for surgical intervention, apart from dysmenorrhoea and cyclic abdominal pain, had been the presence of endometriod cyst, as disclosed by ultrasound investigation (66%). Despite of negative result of imaging or clinical examination subjective complaints necessitated laparotomy in 27% of cases. According to American Fertility Society endometriosis classification, 17% subjects presented endometriosis in I stage, 17%--in stage II and remaining 66%--endometrioid cysts with stage III. Authors conclude, that in cases with persistent abdominal pain, not responding to conventional therapy, diagnostic laparoscopy/laparotomy in young women should not be delayed, unless endometriosis is suspected.

[Color and power doppler ultrasonographic measurement of the uterine blood flow in subfertile women with unstimulated cycles]. / Ocena przeplywu naczyniowego wewnatrz i wokól blony sluzowej macicy kobiet z obnizona plodnoscia przy zastosowaniu sonoangiografii z kolorowym i "power" Dopplerem.

We have assessed the usefulness of color and power Doppler velocimetry in uterine and radial arteries in a group of subfertile women who were referred for infertility treatment. The study group comprised of 44 women monitored at 7-10th, 11-14th and 15-18th day of unstimulated cycle. The control group comprised of 14 women who were monitored for the intrauterine insemination due to male factor and who had normal pelvis on laparoscopy and ovulatory cycles. Following study groups were evaluated: 11 women with endometriosis, 10 women with tubal factor, 12 patients with anovulatory cycles and 11 women with unexplained infertility. We have found a significant increase in uterine artery PI in early luteal phase of the cycle in women with endometriosis, with tubal factor and with unexplained infertility. Elevated uterine artery PI was also found in women with anovulatory cycles between 7th and 10th day of the study. Using power Doppler sonography we were able to detect subendometrial blood flow in 92% of control women and in 75% to 91% of patients in other studied groups. Significant increase in radial artery PI was found between 15th and 18th day of cycle in women with unexplained infertility and with anovulatory cycles. The present results suggest that increased impedance to blood flow may be regarded as possible cause of infertility. Larger studies with comparison to conception rates are needed to validate clinically this hypothesis.

[Usefulness of clinical evaluation for the level of CA-125 antigen and ultrasonographic color Doppler examination in diagnosis of ovarian tumor]. / Przydatnosc kliniczna oceny poziomu antygenu CA-125 i badania ultrasonograficznego z kolorowym Dopplerem w diagnostyce raka jajnika.

The objective of our study was to evaluate the predictive value of serum CA-125 levels and transvaginal ultrasound with color Doppler flow mapping (RI) in patients with benign and malignant ovarian tumors. The retrospective analysis included 78 women in whom 92 tumors were detected. Eleven patients had ovarian carcinoma (a total of 16 tumors). Predictive values were compared for tumor morphology, lowest resistive index (RI) < 0.40 and CA-125 > 35 IU/ml. Sensitivity, specificity, positive and negative predictive values in differentiating malignancy were highest for RI (94%, 87% 87% and 94%, respectively). Morphological criteria or CA-125 levels alone had lower predictive accuracy. Combining of the correctly identified all of the malignancies. It is concluded that preoperative transvaginal ultrasound with color Doppler flow mapping is valuable tool in the assessment of adnexal tumors and can be of assistance in prediction of ovarian cancer.

[Beeswax pessary in conservative treatment of uterine prolapse]. / Hysterofor woskowy w zachowawczym leczeniu wypadania macicy.

The own method of uterine prolapse treatment with the use of beeswax pessary is presented. The described method is applied in cases where general health conditions do not allow to perform the surgery. The study revealed that the beeswax is a good material to make a vaginal pessary. It's great plasticity allows individual modelling in compliance with anatomical conditions of treated patient. That provides the proper stability of uterine position. The risk of possible urinary stress incontinence due to uterine reposition is also diminished.

[Endometriosis in clinical materials from the years 1981-1990]. / Endometrioza w materiale klinicznym w latach 1981-1990.

In the group of 213 women with diagnosed endometriosis, after the histological analysis of the samples obtained during surgical procedure the following factors have been determined: the character and frequency of complaints, prevalence of the disease depending on the age of patients, it's localisation, coexistence with the neoplasms of the genital tract, indications for the surgical treatment and it's type. Taking into account the difficulties in diagnosing endometriosis, it's occurrence in young women and the possibility of malignant transformation along with the coexistence with malignant neoplasms of genital tract, we are convinced that the surgical intervention should be undertaken in order to achieve the better cure rate as well as to improve the accuracy of diagnosis.

[An evaluation of agreement between cytologic, colposcopic and histologic results in neoplasms of the uterine neck]. / Ocena zgodnosci wyników badan cytologicznych, kolposkopowych i histologicznych w sródnablonkowej neoplazji szyjki macicy.

There was carried out a retrospective analysis of cytologic, and colposcopic examination results in a group of 748 women with diagnosed cervical intraepithelial neoplasia (CIN) basing on histologic examinations of topical biopsy samples. In the CIN III group, in addition, results of preoperative histologic examinations were compared with those of postoperative histologic examinations. The examinations showed that a complex CIN diagnosis, including cytologic and colposcopic examination combined with taking topical biopsy samples achieves high accuracy and makes surgical conization a safe medical procedure in such cases. Histologic examination of the postoperative material determines further (follow-up) procedures.

[Local coagulation confined to the uterus and adnexa--case description]. / Lokalne wykrzepianie w obszarze narzadu rodnego--opis przypadku.

The seldom occurring local intravascular coagulation confined to the uterus and adnexa is described. The authors give attention on diagnostic difficulties in described case.

[Personal observations concerning surgical treatment of urinary stress incontinence in women]. / Wlasne spostrzezenia dotyczace operacyjnego leczenia wysilkowego nietrzymania moczu u kobiet.

Own observations concerning surgical treatment of urinary stress incontinence based upon the clinical follow-up of 82 treated women are presented. Depending on the method of surgical treatment, patients with urinary stress incontinence have been divided into 3 groups: I group-(42 women), where retropubic colpo-uretero-pexy has been performed following the rules previously suggested by Tanagho, Sprogis et al., with 92.8% of positive result, II group-(34 women), where Mieszczerski or Fothergill type of surgery has been performed, with 88.2% of positive results, and III group-(6 women), where vaginal vault has been suspended to the musculo-fascial flap, with positive results in all treated patients. The obtained results suggest that in every case of urinary stress incontinence the conservative approach should be the primary strategy of treatment. Analysis of the results revealed that retropubic colpo-uretero-pexy was an effective surgical method of urinary stress incontinence treatment in women with no cystocele and with proper uterine statics. In patients with correct uterine statics but with coexisting cystocoele, even of a minor grade, retropubical kolpouretropexy should be joined with the surgery from a vaginal access.

[Amniotic fluid index during labor in women with EPH gestosis]. / Indeks plynu owodniowego u rodzacych z gestoza EPH.

Intrapartal cardiotocographic disturbances of fetal heart rate patterns, the way of delivery and the neonate state have been analyzed in the group of 61 women in labor with pregnancy complicated by EPH gestosis. The results have been compared with pre-labor values of amniotic fluid index (AFI) in that group. In the group of 30 women in labor with AFI < or = 5 cm the analysis revealed the higher prevalence of non stress test reactivity losses, severe variable decelerations, late decelerations, cesarean sections and lower birth weight in comparison with the group of 31 women in labor with AFI > 5 cm. The study revealed that pre-labor AFI value estimation is usefull in predicting possibilities of fetal compromise during labor in women with pregnancies complicated by EPH gestosis.

The effect of Salbupart on the value of placental perfusion pressure in extracorporeal experiment.

The purpose of the study was determination of the perfusion pressure as an expression of the resistance of placental vascular bed after administration of various doses of Salbupart. In a series of 29 experiments with extracorporeal perfusion of the fetal part of the placental from spontaneous labours after physiological pregnancy it was observed that the medicament given in one dose reduced the vascular resistance in the afterbirth. A beneficial spasmolytic effect of Salbupart may be expected in certain cases of pathological pregnancy associated with increased resting tonus of the placental vessels. The pharmacological management for stimulation of placental adenyl cyclase may be treated as supplementation of deficient endogenous catecholamines enhancing the adaptation mechanisms of the fetus and placenta.

[The value of ultrasound examination for diagnosing postmenopausal metrorrhagia]. / Przydatnosc badania ultrasonograficznego dla diagnostyki krwawien po menopauzie.

The results of transvaginal ultrasound diagnostic assessment of endometrium were compared with histopathological examination of endometrium by following diagnostic abrasion on examined group of 54 postmenopausal women. The method seems to be useful for diagnosis of postmenopausal metrorrhagia, when the "safe" thickness of endometrium layer is taken as 5 mm. It occurs in effect of our study the transvaginal ultrasound examination may decrease the number of subsequent diagnostic abrasions in those cases.

[Influence of betamethasone on glucose consumption in the human placenta perfused in vitro]. / Badania nad wplywem betametazonu na zuzycie glukozy w warunkach perfuzji pozaustrojowej lozyska ludzkiego.

The study was carried out on 48 human placentas perfused in vitro. Betamethasone was administered into the arterial systems in the following single doses: 0.4 mg, 2 mg and 10 mg. The authors found a highly significant or statistically insignificant decreased glucose consumption after administering each dose of betamethasone and at all times of the experiment. The phenomenon of a decrease in glucose consumption was attributed to an increased gluconeogenesis and releasing glucose from placental glycogen. The action of betamethasone consisting in supplying an increased amount of glucose is of great importance in the process of maturing fetal lungs in the uterus and in states threatening the fetus.

[Influence of betamethasone on the vascular resistance in human placenta perfused in vitro]. / Wplyw betametazonu na opór naczyniowy lozyska ludzkiego perfundowanego in vitro.

The study was carried out on 48 human placentas perfused in vitro. Betamethasone was administered into the arterial system in the following single doses: 0.4 mg, 2 mg, 10 mg. It was found that betamethasone decreases the pressure of perfusion in different ways depending on the dose. A statistically significant decrease in perfusion pressure was observed in 30th minute of the experiment after administering 2 mg while a dose of 10 mg induced a significant perfusion pressure in 30th and 60th minute of the experiment. The relaxation of the blood vessels of the placenta under the influence of betamethasone was attributed to the action of dopamine on the dopaminergic receptors of the vessels and glucocorticoids modifying this action. The results of the experiments point to a positive action of betamethasone on the blood vessels of human placenta.

[Consumption of glucose under the influence of propranolol in human placentas perfused in vitro]. / Zuzycie glukozy pod wplywem propranololu w lozyskach ludzkich perfundowanych in vitro.

The consumption of glucose under the influence of various doses of propranolol in human placentas perfused in vitro was evaluated every 30 minutes during a two-hour perfusion. In the experiment the authors did not find a significant influence of propranolol on the level of the glucose consumption. The authors found a fourfold differentiation of glucose consumption between particular placentas. In the experiment these values differed from 2.63 mumol/g/h to 10.27 mumol/g/h.