[Qualitative blood flow parameters in the spiral artery and progesterone concentration in pregnancy complicated by threatened abortion]. / Jakosciowe parametry przeplywu krwi w tetnicach spiralnych a stezenie progesteronu w surowicy krwi u ciezarnych zagrozonych poronieniem.

OBJECTIVES: The aim of the study was to determine the values of i.e. resistance index (RI) and pulsatility index (PI) in the spiral arteries and to evaluate the maternal serum concentration of progesterone trying to find correlation between these parameters in the group of patients in early pregnancy complicated by threatened abortion. STUDY METHODS: We have analysed 30 pregnant women between 5th and 12th weeks of pregnancy with the symptoms of vaginal bleeding & lower abdominal pains diagnosed as threatened abortion. In all patients transvaginal ultrasound examination with pulse color Doppler was performed. The RI and PI values were calculated for blood flow velocity waveforms obtained from the spiral arteries. The concentration of progesterone in maternal serum was evaluated by Microparticle Enzyme Immunoassay. The correlation between analysed parameters and pregnancy duration was examined with use of linear correlation by Pearson. The correlation between Doppler and biochemical parameters were analysed with use of rang correlation method by Spearman. RESULTS: Thirty flow velocity waveforms from spiral arteries were analysed and blood flow indices were calculated. We have found statistically significant negative correlation between the values of both blood flow parameters (RI & PI) and successive weeks of pregnancy (p < 0.001) and statistically significant positive correlation between maternal serum concentration of progesterone and pregnancy duration (p < 0.05). In the tested group in 40% of patients the level of progesterone was abnormal. We have not find any correlation between serum progesterone concentration and doppler parameters in our study. CONCLUSIONS: There is observed the characteristic drop of resistance to the blood flow in the vessels of the uteroplacental circulation in the successive weeks of early pregnancy in patients with threatened abortion similar to normal early pregnancies. Lack of correlation between maternal serum concentration of progesterone and blood flow parameters indicates that other hormonal factors play major role in the regulation of the blood flow in these vessels in early pregnancy. Only the combination of Doppler blood flow analysis in spiral arteries and progesterone evaluation in the maternal serum performed in first trimester may be useful for the intensive fetal monitoring of high risk pregnancies.

[The evaluation of the efficiency of treatment in ectopic pregnancy with the application of various surgical procedures]. / Ocena skutecznosci leczenia ciazy ektopowej z zastosowaniem róznych metod operacyjnych.

In our study we analyzed 54 women with confirmed diagnosis of ectopic pregnancy, in whom two different surgical approaches were performed. There were 40 salpingotomies and 14 salpingectomies. The dynamics of the decrease of beta hCG serum level were assessed. The beta hCG levels not greater than 5 mIU/ml (2nd IS) were the markers of the recovery. Similar therapeutic effect was obtained in both testing group. The normalisation of the beta hCG serum level was observed after 19th and 21st days after salpingectomy and salpingotomy, respectively.

[Primary and secondary ovarian hypoplasia]. / Pierwotny i wtórny niedorozwój jajników.

In 98 young women with lack of maturity, with menstrual disturbances and with insufficiency of the primary and secondary sexual signs an the basis of clinical and hormonal investigations in 61.2% the primary and in 38.8% the secondary ovarian hypoplasia was established. This allowed in spite of great clinical resemblance of the investigated persons to the proper diagnosis and to the choice of the suitable therapy.

[New aspects in diagnosis and therapy of Turner's syndrome]. / Nowe aspekty w rozpoznawaniu i leczeniu zespolu Turnera.

In the last 35 years we noticed 91 cases of Turner's syndrome. To the obligatory symptoms of the syndrome belong primary amenorrhoea, sexual infantilism, elevated values only of FSH and very reduced levels of estrogens, chromosomal aberrations in karyotype, most often 45, X and presence of streak gonads. The facultative symptoms of the syndrome belong short stature (94.5% of patients), presence of congenital defects (short webbed neck in 44.4%) and sterility (98.9%). Therapy above 15 years excepting to cause the menstrual cycles have to development the second sexual symptoms by giving enough large doses of oestrogens and gestagens. The best effects we obtain nearly in 100% in the development of breasts, in slowly growth of sexual hair and in the growth of the stature which does not cross the height of 150 cm and only in six patients attained in average 152.5 cm.

[New aspects of diagnosing and treating pure gonadal dysgenesis 46XY and 46XX]. / Nowe aspekty w rozpoznawaniu i leczeniu czystej dysgenezji gonad 46XY i 46 XX.

Among 67 women with pure gonadal dysgenesis, karyotype 46XY was found in 46 and karyotype 46XX in 21 (26.3% of all intersexual subjects). Karyotype 46XY was either of pure type or mosaicism 45,X/46,XY (10.9%). Primary amenorrhea, underdevelopment of mammary glands and lack or poor development of pubic hair were the main complaints of the patients. In gonadal dysgenesis 46XY mammary glands were developed in 21.8% and pubic hair in 26% suggesting the presence within the gonads of the hormonally active tumor or the state after hormonal treatment. The patients with gonadal dysgenesis 46XX had lowered levels of estrogens and elevated levels of FSH and LH. Karyotype 46XY was not associated with evident changes in hormonal levels. Estrogens were both low and normal, and FSH was elevated (21.5 + 16.6 ug/ml) or normal (3.2-5.0 ng/ml). Total testosterone values were normal or slightly elevated. Such situation can be explained by the presence in some patients of tumors secreting either estrogens or androgens. Taeniform character of gonads was observed by ultrasonography whenever the presence of gonadal tumor was excluded. Histology of specimens taken from gonads or tumors demonstrated the presence of dysgerminoma or gonadoblastoma type of malignancy in 53.1%, foci or proliferation of the Leydig cells in 31.3% and typical morphology of residual gonads without germinal cells only in 12.5%. The differentiation between pure gonadal dysgenesis 46XX and primary ovarian insufficiency is required whenever no characteristic pattern emerges from clinical, hormonal, cytogenetic or ultrasonographic examination. Diagnosis of pure gonadal dysgenesis 46XX can be finally confirmed by the absence of gonocytes in the residual gonad. Besides of removal of gonads or tumors by surgery, the treatment of patients with 46XY karyotype consists in cyclic administration of estrogens and progestagens restoring menstruation and bringing development of secondary sex attributes.