Lipid index changes in the blood serum of patients with hyperplastic and early neoplastic lesions in the ovaries.

BACKGROUND: The authors used the lipid index (WL) to monitor lipid changes before and after surgery. The surgical operation performed was the simultaneous enucleation of a cystic tumor of the hilum ovarii in its entirety (with diagnosis of a simple cyst or teratoma adultum) in groups of 20 patients. OBJECTIVES: To compare the lipid index WL in the blood serum of patients undergoing surgery treatment at the following times: before and 7 days after surgery, and 6 and 12 months after surgery. MATERIAL AND METHODS: The research material was the blood serum of women aged about 24 years. The authors divided the patients into 3 groups: two groups of 20 women and a control group. The concentrations of the lipid parameters were measured and the lipid index WL was calculated. RESULTS: Statistically significant differences were found between the lipid index of serum from patients with diagnosed ovarian neoplasms and the index of serum from healthy subjects; differences were demonstrated in the postoperative period, particularly 6 and 12 months after surgery. CONCLUSIONS: The lipid index WL proved useful in diagnosing ovarian neoplasm (simple cysts and teratoma adultum) and in monitoring the postoperative period.

Effect of attending childbirth education classes on psychological distress in pregnant women measured by means of the General Health Questionnaire.

BACKGROUND: Pregnancy brings about many changes in a woman's life in somatic, psychological and social spheres. Therefore, many women decide to participate in childbirth education classes. The aim of study was to determine the differences in emotional distress between women who participated in childbirth education classes and these who did not. MATERIAL AND METHODS: Seventy first-time mothers after labor were examined. Based on a survey carried out, the women were divided into two equal groups. Group I consisted of women who had participated in childbirth education classes and Group II of women who had not. The data was gathered by means of the General Health Questionnaire (GHQ-12) adapted to Polish conditions. RESULTS: There were no differences either in age or in BMI rates among the examined women. The level of education and knowledge about labor was significantly higher among the participants of childbirth classes. The results of the GHQ-12 revealed that women from Group I had a better mental status than women from Group II. Significant differences were observed in terms of sleep deprivation, overcoming difficulties and in the ability to enjoy daily activities. CONCLUSIONS: Participation in childbirth classes has a significant influence on psychological well-being in pregnant women as measured by the GHQ-12.

Inability to have children caused by recurrent HELLP syndrome in early pregnancies - implications for a review of literature.

This review is inspired by a case of two pregnancies of the same patient complicated by HELLP syndrome, which suggests that there is a predisposition for the occurrence of preeclampsia and HELLP syndrome in early pregnancy. HELLP syndrome, uncommon below the 20th week and rarer still in two consecutive pregnancies, appeared in two pregnancies of the same woman. The aim of our work is to try to understand the cause of heterogeneity of HELLP syndrome and help find a way of prolonging such pregnancies. Recurrent HELLP syndrome in early pregnancy is a form of severe, fulminant preeclampsia. The preceding symptom is a surge in blood pressure. The hypertension becomes resistant to antihypertensive drugs, which indicates that preexisting hypertension is later accompanied by other factors contributing to the rise in blood pressure. Different effects of high dosage of corticosteroids on liver and platelets show that there are different factors responsible for liver damage and for thrombocytopenia. It seems that the symptoms have various origins, so the therapy with one drug only is not sufficiently effective. Nicotine analogues or a plant extract (from rootstock of Eriosema kraussianum) used by South African traditional healers for erectile dysfunction seem to give a chance of prolonging pregnancy and, consequently, having children.

Initiation of preterm labor.

Preterm births are still a major problem in obstetrics. It is estimated that preterm births occur in about 12% of all pregnancies. Due to advances in medical technology and better care of fetuses and premature babies, the preterm mortality rate has been falling (as recently as 1995 the survival rate in the US for premature infants born at 34 weeks amounted to only a fraction of the corresponding rate for those born after 37 weeks). In the US in 2005, preterm births cost society approximately $26 billion, and medical care for premature babies cost more than $51 billion. Only the richest countries can afford such costly medical care. That is why it is not only the individual aspects but also the social aspects that are important when studying preterm birth mechanisms and ways of preventing them. The existing research indicates that both spontaneous mature birth and preterm birth begin and proceed in a similar manner. This is confirmed by the similar involvement in both processes of corticotropin-releasing hormone, urocortin, extracellular stress protein HSP70 (amniotic fluid heat shock protein), prostaglandins, proinflammatory cytokines or glucocorticosteroids. Apparently, at the beginning of either a preterm birth or a term birth, there is a stimulus that ends the development of the fetus or initiates birth. This stimulus works via feedback through placental hormones and through substances present in the fetal membranes, ultimately leading to functional progesterone withdrawal (FPW), thus leaving the uterus sensitive to contractive factors.

The efficacy and safety of leflunomide in patients with active rheumatoid arthritis.

OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of leflunomide in patients with active rheumatoid arthritis (RA). MATERIAL AND METHODS: The study included 100 patients (88 women and 12 men) with rheumatoid arthritis (RA). The mean age was 46.5 years and the mean duration of the disease was 10.3 years. The inclusion criteria were a Disease Activity Score (DAS28) of over 3.2, and contraindications to methotrexate or failure of treatment with methotrexate for at least 3 months. The patients that were enrolled in the study had developed lesions of various grades according to the Steinbrocker Radiological Classification. Leflunomide was administered at a dose of 20 mg per day for the whole observation period. During the monitoring appointments the duration of morning stiffness, pain and disease activity were evaluated on a visual analogue scale (VAS), as well as the number of tender and swollen joints and the DAS28 score. In compliance with the leflunomide therapy protocol, the following control tests were performed: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hematology, creatinine and liver function tests. Safety assessment included monitoring of adverse events and laboratory test results. RESULTS: During the one-year monitoring period significant improvements were noted in 68% of the patients, expressed as a decrease of 1.2 or more in their DAS28 scores. DAS28 > 0 < 1.2 was achieved in a further 18% of the patients. No improvement was reported by 14% of the subjects. In one year of treatment leflunomide was effective in 74% of the patients with active RA. The most marked clinical improvement in the DAS28 index was noted between the third and sixth months of treatment. In the next six months ESR, CRP and DAS28 scores continued to decline steadily, but the differences were not as clear as those recorded in the previous time period. CONCLUSIONS: The most commonly observed adverse events were related to the gastrointestinal tract (i.e. diarrhea and periodic increases in liver function tests), and reported hair loss. Mild to moderate adverse events were observed in 19% of the patients; they resolved spontaneously or in response to medication, and were not a reason for discontinuing therapy in any of the cases.

Depression in women aged 75-89--predisposing factors and preventive measures.

BACKGROUND: There are analyses showing the relationship between low and irregular physical activity and the risk of more frequent occurrences of depression symptoms in the future. There are studies that do not prove the connection between those two dependencies. OBJECTIVES: The aim of this study was to find the relationship between physical activity before menopause and the occurrence of depression in senium. MATERIAL AND METHODS: The study was comprised of 200 randomly selected women, aged 75-89 years, who were treated in the local department of general surgery and oncology from January to June 2009. The study used a 15-point Geriatric Depression Scale which is an integral part of the EASY care (Polish version 1999-2002) questionnaire to assess emotional efficiency, and the Questionnaire Survey for Research on Physical Activity in Older People which contains 8 questions. The results were statistically analyzed using a Student's test and basic probabilities calculations. RESULTS: The probability of depression in women aged 75-89 is 0.8. Increased physical activity in pre-menopausal women neither affects the level of depression, nor prevents it (p < 0.1). Depression was more common in people living alone, in which case the probability is 0.85. Postmenopausal women enjoy a beneficial impact on physical activity in the following areas: previous activity (p < 0.001), family support (p < 0.0001), GP support (p < 0.001), and television education (p < 0.001). CONCLUSIONS: Depression among elderly women is very common. In this study, depression was found in 80% of senior women. There is a relationship between depression and physical activity. Increased physical activity in premenopausal women neither affects the level of depression, nor prevents it. There was no correlation between age, weight, education, place of residence and depression. Depression was more common in people living alone.

[Fear-driven cesarean section on request]. / Zadanie ciecia cesarskiego podyktowane strachem przed bólem porodowym.

UNLABELLED: Traditionally, women gave birth surrounded by other, experienced women. Modern women not only require continuous support during labor, but they also want to have a part in decision-taking. That is why some of them, regardless of how much or how little medical knowledge they have, want to decide about the way of birth on their own. The aim of this study was to find the underlying cause of the growing percentage of cesarean sections and cesarean sections on request and to find an answer to the question of what can be done to reduce that number. MATERIAL AND METHODS: A survey was conducted among 100 nulliparas between 38 and 40 week of pregnancy who were determined to give birth in a natural way, and among 50 nulliparas, in the same gestational age, who requested cesarean section. RESULTS: The analysis of our survey shows that request for cesarean section in 12% of cases resulted from fear of labor pain, more than before were declared 2%. After they were informed about methods of reducing labor pain and guaranteed that those methods would be available, as many as 52% of pregnant women who had previously requested cesarean section changed their mind and wanted to give birth in a natural way (this could reduce cesarean section rate about 52%, p<0.05), and 42% (of the total) wanted to have epidural anesthesia. CONCLUSIONS: Better access of pregnant women to information about pharmacological and non-pharmacological methods of reducing labor pain, coupled with the availability of those methods, can reduce the number of cesarean sections on request even by half. In the group of pregnant women determined to have cesarean section, one in four would give it up if they had access to epidural anesthesia, and one in ten if they had access to non-pharmacological methods of reducing labor pain (mainly acupuncture).

HELLP syndrome in pregnancies below 26th week.

OBJECTIVE: To test the hypothesis that HELLP syndrome may be more likely to develop earlier, if a pregnant woman has aPL antibodies, and to observe clinical and laboratory factors preceding the occurrence of HELLP syndrome. MATERIALS AND METHODS: The study consisted in retrospective analysis, with updated verification, of HELLP syndrome in pregnancies below 26th week in our clinic in the years 1992-2010. RESULTS: HELLP syndrome, if it occurred before the 26th week, occurred only in women with preeclampsia superimposed on chronic hypertension and in women with aPL antibodies. HELLP syndrome with aPL antibodies occurred with low level of platelets (mean 35.5 × 10(9)/L), lower level of AT III (mean 71.3%), lymphopenia, higher CRP (mean 9.1) and pale infarct of placenta (100%). The occurrence of HELLP syndrome was always preceded by surges in blood pressure resistant to antihypertensive drugs. CONCLUSION: HELLP syndrome in early pregnancy may indicate the presence of aPL antibodies. It may also be a clinical symptom of APS. A surge in blood pressure is a clinical forerunner of the coming HELLP syndrome. HELLP syndrome in women with APS is characterized by low level of platelets.

[Lipid index (WL) in the blood serum of women undergoing surgery in the perimenopausal age]. / Wartosc wskaznika lipidowego w surowicy krwi kobiet poddanych operacjom ginekologicznym w okresie okolomenopauzalnym.

OBJECTIVES: In the blood serum from women divided into 4 groups (healthy women aged 24 and 45 years and patients after the gynaecological surgery with sparing or radical resection of uterus) the lipids index (WL) was determined. MATERIAL AND METHODS: The WL index expresses the correlations among the HDL, LDL, triglycerides and A1 and B apolipoproteins. In the perimenopausal period in women the decrease in the lipids index WL was observed comparing to the women at age of 25. RESULTS: During the diseases indicated the necessity of gynecological surgery in women in the perimenopausal period further decrease in the lipids index WL was noticed. Contrary to the sparing operation, surgical intervention with radical resection of uterus causes the following WL decrease observed in 3rd month after it. CONCLUSION: It may suggest that these differences have hormonal background.

[Urethral obstruction caused by endometriosis]. / Niedroznosc moczowodu w przebiegu endometriozy.

Two cases of unilateral urethral obstruction caused by endometriosis were reported. Two patients aged 48 and 35 years old were fully diagnosed with above mentioned abnormalities prior to a surgical operation. During the surgical operations the initial diagnosis was confirmed macroscopically, followed by the surgical amputation of the urethral parts pathologically changed. The anastomosis of urethra was finally performed after confirmation that the remaining parts were macroscopically unchanged. Histopathological examinations confirmed the initial diagnosis. After the surgical operation both patients were subjected to hormonal treatment attaining full recovery. The above presented cases--urethral endometriosis is one of rare complications caused by endometriosis. Proper and early diagnosis, followed by an effective treatment is important in obviating grievous consequences e.g. total renal failure.