Fas-Related Apoptosis of Peritoneal Fluid Macrophages in Endometriosis Patients: Understanding the Disease.

Recent studies of the peritoneal cavity environment in endometriosis demonstrate quantitative and qualitative changes in the cells responsible for cell-mediated immunity. Such changes may have led to disturbances in the surveillance, recognition, and destruction of misplaced endometrial cells and might have, in fact, brought about the disease. The aim of the study was to assess CD95 (Fas) expression on (activated) peritoneal fluid (PF) macrophages, as well as to ascertain soluble Fas (sFas) concentration in the PF of endometriosis patients, as compared to the nonendometriotic group. The concentration of leukocytes in the PF, the percentage of cells expressing CD45+/CD14+, and the percentage of PF macrophages expressing the HLA-DR antigen were significantly higher in patients with stages I and II endometriosis. The percentage of Fas- (CD95+-) expressing macrophages was significantly higher in all stages of the disease, in comparison with controls. Moreover, the concentration of sFas in the PF of patients with moderate and severe endometriosis was significantly higher, as compared to the reference group. The high number of immune cells in PF in early stage endometriosis and their increased susceptibility to apoptosis confirm the role of the impaired peritoneal environment and immune defects in the development and progression of the disease.

Antimicrobial Resistance Patterns in Women with Positive Urine Culture: Does Menopausal Status Make a Significant Difference?

Aim. Urinary tract infection (UTI) is considered one of the most common bacterial infections in women. The aim of this study was to investigate the types of uropathogens present, as well as the degree of antimicrobial drug resistance seen among premenopausal (n = 2748) and postmenopausal (n = 1705) women with uncomplicated UTI. Methods. Urinary samples (n = 4453) collected from women with UTI were analyzed in terms of uropathogens present. These were considered as positive if bacterial growth was ≥105 colony forming units (CFUs)/mL. Susceptibility and resistance testing for commonly used antibiotics was subsequently assessed. Results. The most common uropathogens cultured from urine samples were Escherichia coli (65.5%), followed by Enterococcus faecalis (12.2%), Klebsiella pneumoniae (4.7%), and Proteus mirabilis (4.2%). The resistance to ampicillin exceeded 40%, independently of menopausal status. Of note, resistance to ciprofloxacin exceeded 25% among postmenopausal patients. Moreover, resistance of all uropathogens to commonly used antimicrobials was significantly higher in postmenopausal women. Conclusion. Due to the high resistance rate, ampicillin, ciprofloxacin, and the trimethoprim/sulfamethoxazole combination should be avoided in treating postmenopausal women affected by UTI without being indicated by initial urine culture report. Finally, cephalexin and cefuroxime are promising alternatives as initial treatment in postmenopausal women.

Assessment of Th17 lymphocytes and cytokine IL­17A in epithelial ovarian tumors.

The present study was carried out to assess the percentage of T helper 17 (Th17) lymphocytes in blood and tissue and IL-17A serum concentrations in patients with epithelial ovarian tumors. Two isoforms, IL-17A and IL-17F, as well as IL-21 and IL-22, were simultaneously investigated. The study group consisted of 60 women affected by epithelial ovarian tumors (benign, borderline and malignant) and 20 women without ovarian pathology as a control group. The evaluation of the percentage of Th17 cells secreting IL-17A, IL-17F, IL-21 and IL-22 in peripheral blood and tumor tissues was performed using flow cytometry applying a Th17 cytokine staining panel. The blood serum concentration of IL-17A was determined using ELISA. We found no statistically significant differences in the subpopulations of Th17 lymphocytes, either in peripheral blood or in ovarian tissues, following comparison of the women with and without ovarian pathology. Negative correlations were found between the percentage of CD4+/IL-21+ (rs=0.8, p=0.02) and CD4+/IL-17+ (rs=-0.78, p=0.03) in the tissue and IL-17A in blood serum in the group of patients with borderline ovarian tumors. A negative correlation was also found between IL-17A and the percentage of CD4+/IL-21+ in peripheral blood (rs=­0.48, p=0.03) in the group of patients with ovarian cancer. The increased percentage of Th17 cells in tissue was not correlated with the overall survival of the ovarian cancer patients. In conclusion, we showed that more Th17 cells secreted IL-17A and IL-21 in the tissue of borderline ovarian tumors and less IL-17A in serum. We also observed that in peripheral blood of the patients with ovarian cancer, there was a higher percentage of Th17 lymphocytes and a lower concentration of IL-17A in serum indicating a negative correlation. An increased percentage of Th17 cells in ovarian tissue does not influence the time of survival of patients with ovarian cancer.

Increased percentage of Th17 cells in peritoneal fluid is associated with severity of endometriosis.

AIM: Th17 cells are a newly discovered T helper lymphocyte subpopulation, producing interleukin IL-17. Th17 cells are present in blood and peritoneal fluid (PF) at different stages of endometriosis. We aim to establish their potential importance in the pathogenesis and clinical features of the disease. METHODS: The percentage of Th17 cells among T helper lymphocytes was determined in the PF and peripheral blood (PB) of patients with endometriosis and in the control group by flow cytometry using monoclonal antibodies: anti-CD-4-FITC, anti-CD-3-PE/Cy5, and anti-IL-17A-PE. RESULTS: Th17 percentage is increased in PF in comparison with PB in both endometriotic patients and in the control group. In severe endometriosis, the percentage of Th17 cells in PF was higher than with early (I/II stage) endometriosis. A positive correlation between the percentage of Th17 cells in PF and the white blood cell count in PB was found in patients with endometriosis. CONCLUSION: Targeting the activity of PF Th17 cells may have an influence on the proliferation of ectopic tissue and clinical manifestations of the disease.

[Umbilical cord blood as a source of nerve and stem cells]. / Krew pepowinowa jako zródlo komórek nerwowych i macierzystych.

OBJECTIVES: The aim of the study was to assess proliferative ability of the stem cells in the umbilical cord blood and their potential to differentiate in in vitro culture. MATERIAL AND METHODS: The material consisted of 14 samples of umbilical cord blood collected from the umbilical cord vein. Mononuclear cells were isolated using the method of density gradient medium. Next, CD34 cells were isolated from the interphase with the use of the VarioMACS sorter and anti-CD34 antibodies. Long-term cultures were conducted on Iscove's modified Dulbecco medium (IMDM) with addition of granulocyte-macrophage colony stimulating factor (GM-CSF) and nerve growth factor (NGF). Qualitative identification was performed using the May-Grunwald-Giemsy staining method, taking photographs with a confocal microscope, and with the immunoenzymatic method. RESULTS: In our research, CD34+ stem cells constituted 1.16% of the mononuclear cells, and after centrifugation in medium 0.37% of leukocytes in whole umbilical cord blood. Even after 60 days of culture without addition of the growth factors, CD34+ cells were present in the fraction of adherent cells. After stimulation with GM-CSF and NGF a part of the umbilical cord blood cells were transformed into nerve cells (presence of neuron-specific enolase was shown) and into cells morphologically similar to fibroblast and dendritic cells. CONCLUSIONS: After stimulation with GM-CSF and NGF cytokines, the umbilical cord blood cells proliferate in long-term medium, transform into nerve cells and into cells similar to fibroblast and dendritic cells.

Regulatory T lymphocytes and transforming growth factor beta in epithelial ovarian tumors-prognostic significance.

BACKGROUND: Regulatory T lymphocytes (Treg) are characterized by the presence of CD4+ surface antigen. Today the transcription factor FOXP3 is considered to be the most specific marker of Treg cells. The aim of the study was to estimate the percentage of Treg in peripheral blood and the tissue of the epithelial ovarian tumor and blood serum TGF-beta concentrations and relationships between them. Moreover, the aim of the study was to answer the question whether the percentage of Treg lymphocytes affects the time of survival in patients with ovarian cancer. METHODS: The patients were divided into four groups, depending on the histopathological examination result: I--a group without any pathology within the ovaries (C; n = 20), II--a group with benign tumors (B; n = 25), III - with borderline tumors (BR; n = 11), IV--a group with cancer of the ovary (M; n = 24). The percentage of Treg lymphocytes in peripheral blood and the tissue was assessed using the flow cytometry method. TGF-beta cytokine concentration was estimated with the ELISA immunoenzymatic test. Statistical analysis of the results was conducted using the computer program Statistica 10.0PL (StatSoft, Inc). RESULTS: No significant differences were found in percentages of Treg lymphocytes in peripheral blood between individual groups of patients (p = 0.11). However, we observed marked differences in the tissue of malignant and non-malignant tumors between individual groups of patients (p = 0.003). The analysis with the post hoc test revealed significantly higher TGF-beta concentration in the group of women with malignant tumors. Moreover, no relationship was found between TGF-beta concentration and the percentage of Treg cells in peripheral blood and tumors of the ovary. No correlation was found between the percentage of Treg lymphocytes in peripheral blood (p = 0.4) and the tissue of ovarian tumors (p = 0.3) and the time of survival of patients with ovarian cancer. CONCLUSIONS: The recruitment of Treg lymphocytes toward the tumor is one of the mechanisms of escape of neoplasm from the response of the immune system. The percentage of Treg lymphocytes in peripheral blood and the neoplastic tissue does not influence the time of survival of patients with ovarian cancer.

T regulatory lymphocytes in patients with endometriosis.

The present study aimed to investigate the presence of T regulatory cells (Tregs) in the peripheral blood (PB) and peritoneal fluid (PF) in females with endometriosis. The present study included 42 patients who underwent laparoscopy between 2010 and 2011. Flow cytometry was used to determine the percentage of Tregs in the PF and PB of the patients. No significant difference was observed in the percentage of Tregs in the patients in the endometriosis group compared with those in the control group in the PF (9.1±5.4 vs. 9.1±3.8%) or the PB (6.5±3.2 vs. 6.5±3.7%). However, the percentage of Tregs was found to be higher in the PF compared with the PB in the patients in the endometriosis and control groups, but significance was found only in those in the control group. Furthermore, no significant difference was observed in the Treg concentration in the patients with early stage (I/II) endometriosis compared with those with late stage (III/IV) endometriosis. Moreover, no significant correlation was found between the percentage of Tregs and the white blood cell count, lymphocyte count or CA125 concentration in the patients. These findings suggest that the local host­defense mechanism is deficient in patients with endometriosis, thus endometriosis should not be treated as an autoimmune condition.

Tape fixation: an important surgical step to improve success rate of anti-incontinence surgery.

PURPOSE: Mid urethral slings are effective surgical treatment for stress urinary incontinence. However, 5% to 20% of patients still experience surgical failure with clinically significant recurrent or persistent stress urinary incontinence. Since a subset of these failures may be caused by improper tape position, we elucidated whether additional paraurethral fixation of a tape to prevent displacement during tensioning could improve the transobturator sling outcome. MATERIALS AND METHODS: The study was done in 463 patients with stress urinary incontinence who were randomly allocated to treatment with a standard transobturator intravaginal monofilament sling procedure (232) or to an intravaginal transobturator monofilament sling with additional 2-point tape fixation (231). Another 2 absorbable sutures parallel to the urethra were added to fix the tape and prevent displacement during tape tensioning. Outcome was assessed by a cough test and a 1-hour pad test at 12 months. RESULTS: Clinical efficacy of the procedure with fixation was significantly higher with 195 women (95.12%) cured or improved compared to the 199 (88.73%) cured or improved with the standard sling (chi-square 5.71, p = 0.0169). There was no increase in intraoperative or postoperative complications. Also, among patients with intrinsic sphincter deficiency we noted a significantly better outcome in the fixation group than in the control group, that is 39 of 41 patients (95.1%) cured or improved vs 31 of 42 (73.8%) (chi-square 10.65, p = 0.0011). CONCLUSIONS: Tape fixation significantly increases the clinical efficacy of the transobturator sling, especially in patients with intrinsic sphincter deficiency.

Body mass index does not influence the outcome of anti-incontinence surgery among women whereas menopausal status and ageing do: a randomised trial.

INTRODUCTION AND HYPOTHESIS: A few series comparing the clinical efficacy of midurethral slings in obese and postmenopausal patients are available. The aim of the study was to assess clinical efficacy of suburethral tape operations for the surgical treatment of female stress urinary incontinence (SUI) stratified by obesity, menopause and ageing. METHODS: Five hundred thirty-seven patients underwent either retropubic or transobturator sling procedure. Patients were randomly allocated into two study groups in a ratio of 1:1. After 18 months, 398 women were available for a follow-up efficacy evaluation. RESULTS: The clinical effectiveness of surgical SUI treatment did not depend on patients' body mass index (BMI) and type of midurethral sling, but menopausal status and ageing significantly influenced the outcome of the surgery. CONCLUSIONS: We found that BMI does not influence the clinical effectiveness of SUI treatment, whereas both menopause and ageing had a detrimental influence on the final outcome of the surgery.

[Anatomical and functional effect of laparoscopic Vecchietti operation]. / Efekt anatomiczny i czynnosciowy laparoskopowej operacji sposobem Vecchiettiego.

OBJECTIVE: To evaluate surgical: anatomical and functional effect of the laparoscopic Vecchietti procedure to treat women with vaginal agenesis. METHODS: Retrospective analysis of 10 patients operated in the II-nd Department of Gynecology Medical University of Lublin, Poland. The length of vagina and macroscopic evaluation of it structure was assessed in each case. Sexually active women for more than 6 months answered the BISF-W questionnaire (Brief Index of Sexual Functioning for Women). The results were analyzed comparing health age-matched controls. RESULTS: The mean age of operated women was 22.8-4.5 year whereas in the control group 22.9 +/- 3.3 year. In two operated patients the small areas of granulation were found in the vagina: in one woman on the side wall of vagina in the other in the apex. The mean length of neo-vagina was 8 +/- 2.1 cm, whereas in the control group 10 +/- 1.0 cm. The difference was statistically significant (U Mann-Whitney test, p = 0.013). BISF-W scores were comparable in both groups. CONCLUSION: The laparoscopic Vecchietti operation allows to create shorter vagina in comparison to health women but the sexual life of this patients is as satisfying as the normal controls.

The clinical effectiveness of retropubic (IVS-02) and transobturator (IVS-04) midurethral slings: randomized trial.

BACKGROUND: Few series comparing the clinical efficacy of retropubic slings versus transobturator slings for the treatment of female stress urinary incontinence (SUI) are available. OBJECTIVE: To compare clinical efficacy of retropubic tape operations and transobturator suburethral tape operations for the surgical treatment of female SUI. DESIGN, SETTING, AND PARTICIPANTS: From January 2003 to December 2005, 611 patients underwent clinical and urodynamic evaluation before surgical treatment for SUI. Patients with advanced urogenital prolapse (pelvic organ prolapse-quantification scale [POP-Q] scale grade >1) were excluded, and 537 patients were included in this study. After 18 mo, 398 women were available for follow-up efficacy evaluation at a tertiary academic center. INTERVENTION: All patients underwent either a retropubic sling procedure or a transobturator sling procedure. Patients were randomly allocated into two study groups at a ratio of 1:1. MEASUREMENTS: After 18 mo all enrolled patients were clinically checked for clinical efficacy of both procedures. RESULTS AND LIMITATIONS: Demographic and urodynamic parameters of patients were similar in both groups. No bladder injury occurred in the transobturator sling group (IVS-04), whereas 13 intraoperational bladder perforations (6.5%) occurred in the retropubic sling group (IVS-02) (p<0.001). The tape erosion rate was <2.5% in both groups (p=0.7). After 18 mo, 398 patients (201 in the IVS-02 group and 197 in the IVS-04 group) were evaluated in terms of clinical efficacy of the procedures. We found out that there was no statistically significant difference in clinical efficacy between these two procedures (chi(2)=1.88, p=0.39). In the IVS-02 group, 75.1% of patients (n=151) remained dry (cured), 16.9% of patients (n=34) reported significant improvement, and 8.0% of patients (n=16) were considered as failures. In the IVS-04 group, 74.1% of patients (n=146) remained dry, 14.2% of patients (n=28) reported significant improvement, and 11.7% (n=23) were considered as failures. CONCLUSIONS: Based on an 18-mo follow-up, the efficacies of both techniques are comparable; however, the retropubic route appears to be more efficient in the intrinsic sphincter deficiency (ISD) group.

Do preoperative cytokine levels offer a prognostic factor for polypropylene mesh erosion after suburethral sling surgery for stress urinary incontinence?

When polypropylene meshes are used in reconstructive urogynecological surgery, the erosion rates vary from 3.3% to 14% and causative factors for such erosions are still unknown in many cases. Therefore, the aim of our study was to establish the role of immunologic factors in the process of polypropylene tapes erosions after suburethral sling procedures. Serum concentrations of tumor necrosis factor alpha, interleukin (IL)-2, IL-4, IL-5, IL-10, and interferon (IFN)-gamma were estimated in 123 patients suffering from stress urinary incontinence preoperatively and during 12 months follow-up using Human Th1/Th2 Cytokine Cytometric Bead Array I kit. The same immunological assessment was performed in each case of detected tape erosion. Statistical calculation was performed using UNIVARIATE, CORR, and NPAR1WAY procedures from Statistical Analysis System. The unpaired Student's t test, nonparametric Mann-Whitney U test, and Wilcoxon tests were used. Preoperative IFN-gamma concentration was significantly higher in women with subsequent polypropylene mesh erosion when compared to women with successful outcome (p < 0.05). Th1 cytokine profile may be related to the risk of the vaginal erosions following placement of polypropylene meshes. The way to lower erosion rate may involve exclusion of the patients immunologically prone to synthetic material erosion. The factor which can help to select such patients could be preoperative level of IFN-gamma.

[Rho kinase--a new target for pharmacological treatment of an overactive bladder]. / Kinaza Rho--nowy cel dla leczenia farmakologicznego pecherza nadreaktywnego.

Rho kinase plays a key role in the regulation of smooth muscles contraction, including those of the urinary bladder detrusor. Rho kinase pathway modulates the level of phosphorylation of the myosin light chain, mainly through the inhibition of myosin phosphatase. Recent experimental data indicate that its role might be exacerbated in local and systemic pathological conditions which affect the bladder. It seems that Rho kinase inhibitors, such as Y27632, may turn out to be an effective group of drugs in pharmacotheraphy of an overactive bladder (OAB), which will influence the storage phase of the micturition cycle, without interfering with the physiological voiding.

[Expression of tumor necrosis factor-alpha (TNF-alpha) on peritoneal fluid mononuclear cells in women with endometriosis]. / Ekspresja receptorów dla czynnika martwicy guza-alpha (TNF-alpha) na jednojadrzastych komórkach immunokompetentnych plynu otrzewnowego u kobiet z endometrioza.

OBJECTIVES: Tumor necrosis factor-alpha (TNF-alpha) plays a key role in the processes underlying the development of pelvic endometriosis. TNF-alpha acts on target cells via two receptors: TNFR1(p55) and TNFR2(p75). Depending on cell type and its activation state, ligand binding to TNF-alpha may induce activation and proliferation of the cells or promote apoptosis. The aim of our study has been to evaluate the expression of TNFR1 and TNFR2 on peritoneal fluid macrophages and T lymphocytes derived from women with endometriosis. MATERIAL AND METHODS: The study group consisted of 22 patients with endometriosis (stage I and II rAFS). 14 patients with benign, non-inflammatory ovarian tumors composed the reference group. Mononuclear cells have been isolated from peritoneal fluid, obtained during laparoscopy. The expression of TNFR1 and TNFR2 proteins has been evaluated by means of flow cytometry, using monoclonal antibodies against CD120a, CD120b, CD3 and CD14. RESULTS: The percentage of peritoneal fluid macrophages revealing the expression of TNFR1 and TNFR2 proteins has been higher in patients with endometriosis, in comparison with control group (22.6+/-5.3% vs. 6.8+/-1,8%; p=0.03 and 29.3+/-2.3% vs. 8.8+/-1.8%; p=0.01, respectively). The percentage of T lymphocytes with the expression of TNFR1 and TNFR2 has been similar in endometriosis and control group. CONCLUSION: Higher percentage of peritoneal fluid macrophages expressing TNFR1 and TNFR2 proteins in endometriosis suggests dependence of these cells on TNF-alpha stimulation. Changes in TNF receptors distribution on PF macrophages, but not lymphocyte, may play its role in the pathogenesis of endometriosis.

Changing trends in the surgical treatment of female stress urinary incontinence--twenty two years observation.

OBJECTIVES: The aim of this study was to analyze the changing trends in surgical treatment of female urinary incontinence (UI). MATERIAL AND METHODS: Medical records of all women admitted to II Department of Gynecology from 1985 to 2006 were analyzed in order to find out how the female SUI treatment changed over these years. RESULTS: During analyzed time 36819 patients were hospitalized in our Department and 77.6% (28568) of them were operated because of various indications. The number of SUI surgeries among all hospitalized women steadily rose from 1.93% in 1985 to 10.96% in 2006 reaching maximum in 2005 (13.73%). Clinical effectiveness of SUI surgeries markedly improved from 35% for anterior colporrhaphy to almost 90 % for suburethral slings. CONCLUSIONS: Introduction into clinical practice modern suburethral slings improved clinical efficacy of SUI treatment. The percentage of women admitted and treated surgically because of SUI steadily increased over the last years.

Relationship between estrogen receptor-alpha polymorphism and serum levels of vascular cell adhesion molecule-1, intercellular adhesion molecule-1, C-reactive protein and homocysteine in postmenopausal women.

BACKGROUND AND AIM: Genetic variation in the estrogen receptor-gene (ERalpha) may influence the risk of cardiovascular diseases in postmenopausal women. This effect, at least in part, may be dependent on the decrease in expression of injury and inflammatory markers in the vascular wall. The aim of the present study was to evaluate the relationship between ERalpha PvuII and XbaI polymorphisms and serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), C-reactive protein (CRP) and homocysteine in postmenopausal women. SUBJECTS AND METHODS: Subjects of the study were 64 postmenopausal women. PvuII and XbaI ERalpha gene polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: Mean sVCAM-1 level was significantly higher in pp homozygotes in comparison with PP homozygotes and Pp heterozygotes, as well as higher in xx homozygotes in comparison with XX homozygotes and Xx heterozygotes. Levels of sVCAM-1 were also significantly higher in women with px haplotype compared with PX and Px haplotypes. There were no relationships between investigated genotypes or haplotypes and levels of sICAM-1, CRP and homocysteine. CONCLUSION: The results of our study suggest that genetic variation in ER gene may influence blood levels of VCAM-1 in women after the menopause.

[The prospective comparison of the clinical effectiveness and the complication rate of retropubic (IVS-02) and transobturator (IVS-04) midurethral slings in the treatment of female stress urinary incontinence]. / Prospektywne badanie porównujace efektywnosc kliniczna i czestosc wystepowania powiklan sród- i poopera- cyjnych slingu zalonowego (IVS-02) i slingu przezzaslonowego (IVS-04) zastosowanych w leczeniu wysilkowego nietrzymania moczu u kobiet.

UNLABELLED: The prospective comparison of the clinical effectiveness and the complication rate of retropubic (IVS-02) and transobturator (IVS-04) midurethral slings in the treatment of female stress urinary incontinence. OBJECTIVES: The purpose of this study was the prospective comparison of clinical efficacy and safety of retropubic (IVS-02) and transobturator suburethral tape techniques (IVS-04) in the treatment of female stress urinary incontinence. MATERIAL AND METHODS: From January 2003 to June 2004, 145 patients with uro-dynamically proven stress urinary incontinence underwent surgical treatment (IVS-02 or IVS-04). During pretreatment work-up, all patients had under-gone full clinical and urodynamic evaluation. Patients with mixed, urge incontinence and the advanced urogenital prolapse (POPQ scale > 2) were excluded from the study. RESULTS: Patients clinical characteristics and urodynamic parameters were comparable between the analyzed groups. At one year follow-up, 122 patients (61 in each group) were evaluated in terms of clinical efficacy of the procedure. The total cure (78.7% in IVS-02 vs 70.5% in IVS-04), the improvement (14.7% vs 21.3%) and the failure rates (6.6% vs 8.2%) were similar in both analyzed groups, chi2 = 0.58; (p = 0.75). CONCLUSIONS: The transobturator route for the treatment of stress urinary incontinence appears to be as effective as the retropubic one at one year follow-up. Moreover, the shorter operation time and no need to perform cystoscopy during the surgery make the transoburator route a very attractive alternative to retropubic approach.

[Tape erosion--local process or general reaction of the organism. The erosion rate and localization of implanted polypropylene tape in female pelvis]. / Czy erozja tasmy polipropylenowej jest reakcja miejscowa, czy ogólnoustrojowa organizmu kobiety oraz czy wystapienie tego zjawiska zalezy od miejsca implantacji tasmy w miednicy mniejszej?

OBJECTIVES: Our study was aimed to reveal whether the tape rejection is associated with increase in serum C-reactive protein level and to assess if localization of implanted polypropylene tape predisposes to its rejection. MATERIAL AND METHODS: Between January 2002 and June 2005, 780 women with SUI or pelvic organ prolapse underwent retropubic sling procedure--IVS 02 (n = 379) or transobturator suburethral tape--IVS 04 (n = 283) or posterior IVS operation (n = 118). IVS multifilament tape (Tyco Healthcare) was used in all surgeries. The same antibiotic prophylaxis and disinfected procedure were applied in all cases. Follow-up visits were performed 4-6 weeks after the operation and next were scheduled every 3 months during first year after surgery and every 6 months in the years to follow. Blood to CRP level analysis (ELISA method) was collected form all patients with mesh erosion without any concomitant inflammatory or immunologic diseases. RESULTS: Until January 2006 we have observed 28 cases of tape rejection: 5 after posterior IVS operation, 14 after IVS 02 and 9 after IVS 04. The chi-square test revealed no statistically significant differences between these groups. Ten women with mesh rejection were completely asymptomatic, two had fever and abscessi. Also, four women had pyogenic discharge from the skin or the vagina. Ten women complained of dyspareunia, vaginal bleeding and irritating voiding. We have found CRP values normal in all cases beside woman with fever and abscesi two. CONCLUSIONS: The process of mesh erosion in most cases is limited to local cellular response. The tape rejection rate is not associated with the localization of the implant in female pelvis.

Prevalence of estrogen receptor alpha PvuII and XbaI polymorphism in population of Polish postmenopausal women.

Numerous data indicate that polymorphism of estrogen receptor alpha (ERalpha) may predict lipid levels, lipid response to hormone replacement therapy (HRT), myocardial infarction risk, bone fracture risk, bone mineral density (BMD) and changes in BMD over time. In this study we aimed to evaluate distribution of ERalpha PvuII and XbaI genotypes in population of Polish postmenopausal women qualified to different protocols of HRT. Subject of the study were 64 consecutive postmenopausal women aged from 45 to 65 years (mean 56.6) assigned to HRT. ERalpha PvuII and XbaI polymorphism was determined by PCR-restriction fragment length polymorphism (RFLP). The absence of PvuII and XbaI restriction sites were indicated by "P" and "X" and presence by "p" and "x", respectively. PvuII genotype was distributed as follows: PP 17.2% (n=11), Pp 50% (n=32), pp 32.83% (n=21). Frequency of XbaI genotype was: XX 6.25% (n=4), Xx 34.4% (n=22), xx 59.4% (n=38). Four haplotypes with following frequencies were recognized: PX 17.3%, px 47.4%, Px 24.4% and pX 10.9%. Prevalence of estrogen receptor alpha PvuII and XbaI polymorphisms in Polish women is similar to previously studied population.

An alpha-1 chain of type I collagen Sp1-binding site polymorphism in women suffering from stress urinary incontinence.

OBJECTIVE: We examined the possible influence of G-->T substitution in transcription factor Sp1-binding site in the gene encoding alpha-1 chain of type I collagen on the risk of stress urinary incontinence. STUDY DESIGN: The study group consisted of 50 women reporting symptoms of stress urinary incontinence. Fifty control subjects were treated for benign gynecological conditions other then stress urinary incontinence. DNA was obtained from peripheral blood leukocytes. The fragment of the first intron of the gene encoding the alpha-1 chain of type I collagen containing the Sp1-binding site was amplified by polymerase chain reaction. The analysis of restriction fragment length polymorphism was performed. RESULTS: We found association between the GT and TT genotype and stress urinary incontinence (P = .019). The odds ratio for developing stress urinary incontinence is 4.98 (95% confidence interval 1.97 to 12.56) in subjects presenting the GT genotype and 2.23 (95% confidence interval 0.69 to 7.25) for the TT genotype. CONCLUSION: The G-T polymorphism at the Sp1 binding site of the gene encoding alpha-1 chain of type 1 collagen is associated with increased risk of stress urinary incontinence in women.