Elastography Improves the Accuracy of Ultrasound in the Preoperative Assessment of abdominal wall endometriosis.

PURPOSE: To assess the role of elastography in preoperative ultrasound assessment of abdominal wall endometriosis (AWE) location. MATERIALS AND METHODS: 33 patients qualified for surgical excision of AWE were included in the study. Preoperative assessment of AWE was performed transabdominally on a Samsung Medison V20 Prestige with a transvaginal probe and Elastoscan® option. The following B-mode settings were used: focus set to the lower end of the lesion, gain adjusted to obtain best image quality, tissue harmonic imaging activated. For elastographic examinations the color map from red (soft) to purple (hard) and the alpha blend option (a blend of B-mode and elastographic image) were used. AWE location was first assessed by B-mode ultrasound as: superficial (located in SCT only; SCT visible between the fascia and the lesion; intact fascia), intermediate (located in SCT or in RAM; no subcutaneous or muscle tissue between the lesion and the fascia; fascia infiltrated); or deep (located in RAM; muscle tissue visible between the lesion and the fascia; fascia intact). Then the AWE location was assessed by alphablend elastography as: superficial (hard lesion in soft SCT; soft SCT between the fascia and the lesion; no hard areas on the fascia); intermediate (hard lesion in soft SCT or soft RAM; no soft subcutaneous or muscle tissue between the lesion and the fascia; hard areas on the fascia); or deep (hard lesion located in RAM; soft muscle tissue between the fascia and the lesion; no hard areas on the fascia). These findings were verified during surgery. The surgeons were blinded to the results of elastography. The influence of obesity on the accuracy of ultrasound and elastography in assessing the location of AWE was evaluated. RESULTS: During surgery superficial AWE was found in 6, intermediate in 19 and deep in 8 patients. Preoperative ultrasound assessment was correct in 33.3 % of cases, while adding the elastography option improved the accuracy of AWE location assessment to 87.9 % (p < 0.05). The diagnostic accuracy of ultrasound alone, but not with the elastography option, was significantly decreased in the preoperative assessment of AWE location in overweight and obese patients. 4 patients required implantation of a mesh. In all cases the pathological examination confirmed the diagnosis of AWE. CONCLUSION: Elastography significantly improved the accuracy of ultrasound in evaluating the depth of infiltration of AWE, is not affected by increased BMI, and should be considered in patients qualified for surgical treatment of AWE.

Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three-dimensional ultrasound: prospective observational study.

OBJECTIVE: To compare the effects of two alternative treatment options for uterine fibroids, ulipristal acetate (UPA) and uterine artery embolization (UAE), on fibroid volume and vascularity at 3-month follow-up. METHODS: Premenopausal patients with symptomatic, intramural uterine fibroids were included in this prospective case-control study. Seventeen patients who qualified for preoperative UPA treatment were pair-matched with patients of similar age (± 5 years) and fibroid volume (± 10% of volume) who qualified for UAE. Patients undergoing UPA treatment received 5 mg/24 h of oral UPA for 3 months. UAE was performed in patients bilaterally by an interventional radiologist. To estimate dominant fibroid volume, Virtual Organ Computer-aided AnaLysis (VOCAL™) was used. The VOCAL program was also used to calculate three-dimensional power Doppler vascular indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Dominant fibroid volumes and VI, FI and VFI values were assessed before commencement of UPA treatment or UAE procedure and again at 3 months afterwards. RESULTS: In both the UPA and UAE groups, fibroid volumes decreased significantly after treatment in comparison with baseline volumes obtained prior to treatment. The percentage of fibroid volume reduction after 3 months of UPA therapy (48.1%) was not significantly different from the reduction seen 3 months after the UAE procedure (47.3%). All vascular indices decreased significantly after treatment by UPA or UAE. The percentage reduction in VI and VFI 3 months after UAE (95.4% for both) was significantly greater than the percentage reduction in patients after 3 months of UPA therapy (51.5% and 62.5%, respectively); however the difference in FI reduction between treatment groups did not reach significance (54.3% for UAE and 30.9% for UPA). No significant side-effects were observed in either treatment group. CONCLUSIONS: Fibroid treatment by UPA therapy results in a decrease in fibroid volume, comparable with that after UAE, and decreases fibroid vascularization, although to a lesser extent than does UAE.

Langmuir Monolayers from Substituted 5'-Phenyl-m-terphenyl Carboxylic Acids.

A series of 5'-phenyl-m-terphenyl carboxylic acid (PTCA) derivatives with methyl, chloro, and fluoro substituents at both side phenyl rings have been synthesized and characterized as Langmuir monolayers at the air/water interface. A comparative analysis, based on the surface pressure and electric surface potential measurements under a variety of experimental conditions, is complemented with BAM images. Copyright 2001 Academic Press.

Structural Modification Influences the Characteristics of Langmuir Monolayers from Aromatic Carboxylic Acids.

The molecular organization of purely aromatic, polyphenyl carboxylic acids, as Langmuir monolayers at the air/water interface, has been investigated by means of surface pressure and electric surface potential measurements upon film compression. The monolayer characteristics of the basic compound, a symmetrical triphenylbenzene (5'-phenyl-m-terphenyl) ring with a carboxylic group at the 4 position (namely 5'-phenyl-1,1' : 3',1"-terphenyl-4-carboxylic acid), are compared with those of its derivatives containing hydrophilic (nitro) or hydrophobic (phenyl) substituents. The nature of the substituent as well as its position (2' or 4') has a profound influence on the monolayer properties. The results are discussed in view of molecular orientation deduced from values of effective dipole moments. Copyright 2001 Academic Press.

Kynurenine aminotransferase I activity in human placenta.

The aim of the study was to detect and characterize placental kynurenine aminotransferase I (KAT I) activity in physiological pregnancy at term. Placental KAT I was inhibited by l -glutamine, l -tryptophan, and l -phenylalanine and reached optimum activity at pH 9.8. When pyruvate was used as a co-factor, the KAT I activity was significantly higher than the activity of this enzyme in the presence of 2-oxoglutarate. In the light of our findings placental KAT I seems to have biochemical characteristics of KAT I detected in human brain.

[Clinical features of missed abortion]. / Objawy poronienia zatrzymanego.

RATIONALE: There is no general agreement concerning the definition of missed abortion which remains one of the most commonly encountered pregnancy complication of an extremely variable clinical picture. AIM OF THIS STUDY: The analysis of the clinical symptoms of missed abortion. SETTING: Academic Medical Center. MATERIALS AND METHODS: Consecutive 50 women with non-viable pregnancy from 7 to 22 weeks, diagnosed by clinical examination, ultrasonography and serum beta-HCG evaluation were studied. RESULTS: In 92% of the missed abortion cases a vaginal spotting was observed before the diagnosis was established. The average period of the estimated retention of the products of conception was 2.8 weeks. In only one patients this period exceeded 8 weeks. The reverse correlation was established between the gravidity of a patient and the period of asymptomatic retention of the non-viable conception products in uterus. The obtained results confirm that the onset of vaginal bleeding does not reflect the moment of embryonal/fetal death.

[Influence of premature rupture of fetal membranes on kynurenic acid concentration in umbilical cord blood]. / Ocena wplywu przedwczesnego odplywania plynu owodniowego na stezenia kwasu kynureninowego we krwi pepowinowej.

The aim of the study was to evaluate the influence of premature rupture of fetal membranes on kynurenic acid (KYNA) levels in venous and arterial umbilical cord blood of neonates. Statistically significant higher concentration of KYNA in umbilical arterial and venous blood in neonates of mothers with PROM lasting longer than 11 hours was observed. Increase of KYNA concentration in blood of such babies may be one of markers of developing infection.

[Serum estradiol levels in early postoperative period after surgical castration--the influence of estrogen replacement therapy]. / Poziom estrogenemii we wczesnym okresie pooperacyjnym po obustronnej ooforektomii z uwzglednieniem wplywu przezskórnej estrogenowej terapii zastepczej.

In 40 premenopausal women who underwent TAH&BSO serum E2 levels were measured by means of RIA in 3 time points: before the operation, in the postoperative day 2 and in the postoperative day 3. In 20 of the subjects the ERT (transdermal estradiol 0.1 g/24 h) was introduced in the 2 postoperative day. In the postoperative day 2 the average serum E2 decreased by nearly 90% as compared to the preoperative values. Twenty four hours after the application of the transdermal E2 patch, the estradiol level returned to the values insignificantly different from the preoperative ones.

[Influence of maternal smoking on kynurenic acid concentrations in umbilical cord blood]. / Ocena wplywu palenia papierosów przez ciezarna na stezenia kwasu kynureninowego we krwi pepowinowej.

The aim of the study was to evaluate the influence of maternal smoking on kynurenic acid (KYNA) levels in venous and arterial umbilical cord blood of neonates. Statistically significant lower concentration of KYNA in umbilical arterial blood of smoking mothers neonates was observed. The lower levels of KYNA in blood may reflect the smaller resistence of neuronal tissue to damages under hypoxic-ischemic conditions in neonates affected during intrauterine life by smoking.

[Concentration of fibronectin and its possible role in unexplained infertility in relationship to testosterone, FSH and LH levels]. / Wystepowanie fibronektyny i próba oceny jej znaczenia w nieplodnosci o niewyjasnionej etiologii z uwzglednieniem wydzielania testosteronu FSH i LH.

The group of 100 men, divided into two groups according to WHO criteria concerning the spermatozoa content was evaluated. The group of 44 oligospermic and azoospermic men was compared with the control group consisting of 56 normospermic men by means of Mann-Whitney U. The statistically significant differences were established in two studied groups in such selected semen parameters like percent of pathological forms and motility of spermatozoa and volume of semen. The concentrations of fibronectin in semen plasma were different in studied groups however the difference did not reach the statistically significant level. No statistically significant Sperman's correlations were observed between the fibronectin and testosterone, FSH and LH levels in blood plasma specimens.

[Kynurenic acid concentration in blood and urine during normal pregnancy]. / Zawartosc kwasu kynureninowego we krwi i w moczu w przebiegu ciazy fizjologicznej.

OBJECTIVES: The aim of the study was to evaluate the concentrations of kynurenic acid (KYNA) in blood and urine during the normal pregnancy. MATERIALS AND METHODS: Under the study were 37 pregnant women. Level of KYNA was measured by high performance liquid chromatography (HPLC). RESULTS: The KYNA concentration in blood serum was 1.56 pmol/100 microliters and in urine -1.17 nmol/100 microliters (6.57 nmol/mg creatinine). The level of KYNA in blood serum did not correlate with the age of pregnancy. Statistically insignificant decrease of KYNA level in urine during the pregnancy was observed. CONCLUSIONS: Decreasing of KYNA level in urine during the pregnancy independently from its blood level was observed. The studies on the KYNA's role outside the central nervous system may supplement the knowledge about the changes occurring during the pregnancy.

Vasoactive effects of nicotine in human umbilical arteries.

The aim of the study was to evaluate the possible influence of cigarette smoking during pregnancy on nicotine dependent umbilical artery contraction in "in vitro" performed experimental study. The vasoconstrictive effect of nicotine was established. The study on umbilical cord artery segments from 23 nonsmokers, 6 light smokers and 8 heavy smokers failed to find the relationship between the doses of nicotine and duration and relative pressure increase of artery contractions. The arteries of heavy smokers showed the statistically significant (P less than .05) lower contraction potency in comparison with nonsmokers in the nicotine concentration of 5*10(-7) M/l. Nicotine alters the umbilical cord artery pressure "in vitro", thus when transferring to "in utero" conditions, might be one of the potent factors adversely affecting perinatal outcome.

[Microbiological evaluation of the effectiveness of gynalgin in the treatment of vaginitis]. / Ocena mikrobiologiczna skutecznosci Gynalginu w zapaleniach pochwy u kobiet.

The microbiological effectiveness of the preparation Gynalgin produced by POLFA Pharmaceutical Works in Rzeszów was assessed in cases of vulvovaginitis in 55 patients with clinically diagnosed inflammatory conditions of the lower genital tract, who were given Gynalgin tablets in 10-day courses. Vaginal smears were examined three times for the presence of bacteria, fungi and trichomonas vaginalis (before and immediately after the treatment, and two weeks later). In the initial examination in five vaginal smears mixed bacterial flora was found, in 6 smears trichomonas was present, in 4--bacteria and fungi, and in one--trichomonas and fungi. After the treatment in control examinations I and II the number of the isolated bacterial strains was lower, trichomonas was no longer present, and the number of fungi was reduced evidently. In the light of these microbiological examinations Gynalgin was found to exert a strong fungicidal, bactericidal and antitrichomonal activity, and the results of laboratory investigations agreed with those of clinical trials of Gynalgin effectiveness.

Essential metal and immunoglobulin levels in women and neonates with PROM.

The aim of the study was to evaluate the essential metals' levels in the blood of both mothers and neonates with premature rupture of the fetal membranes and to examine the changes produced by PROM in immunoglobulins' concentrations. Metals' levels in blood samples were determined by atomic absorption spectrophotometry, while the quantitative estimation of the immune proteins in both maternal and umbilical blood sera was performed by a single radial immunodiffusion. Zinc level in blood samples of mothers from the examined group was significant lower than this one evaluated in controls while the other concentrations of metals did not differ significant. We found the significant higher level of cord blood IgA in neonates from PROM+ group comparing with the PROM- group. Low zinc level in maternal blood which was found in examined PROM+ group might suggest that it constitutes one of the causes leading premature rupture of the fetal membranes. The response of the humoral immune system in PROM+ neonates seems to be stimulated by the premature rupture of the fetal membranes.

Intrapartum levels of trace metals in maternal blood in relation to umbilical cord blood values: lead, iron, copper, zinc.

The study was designed to measure the gradients of lead, iron, copper and zinc from maternal blood to cord blood in pregnant urban and rural women. The concentrations of iron, copper, zinc and lead were measured by means of atomic absorption spectometry (AAS) in whole blood of 100 normal parturients and 92 of their neonates. Levels of lead in cord blood were not significantly different from those in maternal blood. This ratio was associated with similar iron and zinc ratios. Neonatal birth weight was negatively correlated with maternal copper levels, whereas cord blood zinc values positively correlated with placental weight. Rural women showed higher maternal to cord blood lead ratios than urban women. The implications of these findings are discussed.

Hair trace metal concentration of pregnant women at term in comparison with blood and milk levels.

The concentrations of Fe, Cu, Zn and Pb were determined by means of AAS in the scalp hair (SH) and pubic hair (PH) as well as in maternal blood (MB), breast milk (BM) and cord blood (CB) taken from 104 pregnant women and their neonates. SH values of all studied metals correlated with strong statistical significance with their PH levels. Significant correlations were found between maternal Fe-PH and neonatal body length (r = 0.271) as well as between Fe-SH and placental weight (r = 0.168). The age of examined women was found to correlate negatively with Cu-SH values as well as with Zn-SH (P less than 0.05). The inverse relationship between Zn-PH and the parity of examined women was established to be statistically significant (P less than 0.001). The usefulness of hair analyses in assessing trace metal status of a pregnant woman is discussed.