[Effect of TFX preparation on the course of pregnancy in rabbits with experimental antiphospholipid syndrome]. / Wplyw preparatu TFX na przebieg ciazy u królic z doswiadczalnie wywolanym zespolem antyfosfolipidowym.

Recurrent thrombo-embolic episodes and pregnancy loss, thrombocytopenia and the presence of antiphospholipid antibodies, first described in 1983 by Hughes and defined by Harris in 1987, are characteristic of the primary antiphospholipid syndrome (APS). APS is the cause of obstetrical problems in the form of recurrent miscarriages, intrauterine fetal death or growth retardation, and EPH gestosis. Clinical symptoms described above are probably mediated by antiphospholipid antibodies which interact with endothelial and trophoblastic cells, blood platelets, embryonic tissue cells, as well as with coagulation factors and proteins involved in the coagulation cascade or in antibody binding. Management of APS includes antiaggregation, anticoagulation, immunosuppression, and intravenous administration of gamma globulins. Successful treatment is not always the case and search for more efficient therapies continues. The importance of animal experiments led to the design at the Department of Pathology of Pregnancy and Labour of an APS model in pregnant and nonpregnant rabbits. As Turowski et al. have confirmed the immunomodulating action of TFX in rabbits, it seemed justified to examine the properties of this preparation in pregnant rabbits with experimentally induced APS. The material consisted of 30 pregnant New Zealand rabbits, divided into the following groups: I--10 pregnant rabbits (and 63 fetuses) treated intradermally twice weekly since the 10th day of pregnancy with cardiolipin together with adjuvant; I-K--5 pregnant rabbits (and 17 fetuses) treated with cardiolipin and adjuvant in the same manner as group I and additionally with intramuscular injections of 0.9% NaCl on the 20th, 21st, and 22nd day; I-T--10 pregnant rabbits (and 66 fetuses) treated with cardiolipin with adjuvant in the same manner as group I and additionally with intramuscular injections of 10 mg/day of TFX (Jelfa, Poland) on the 20th, 21st, and 22nd day of pregnancy; K--5 pregnant rabbits (and 27 fetuses) treated with injections of 0.9% NaCl twice weekly. Blood samples for laboratory analysis were collected by cardiac puncture before immunization (sample I) and on the day of caesarean section (sample II). Platelet counts and APTT tests were done. Numbers of live and dead newborns, resorbed fetuses, body mass, newborn viability and survival rates were recorded. TFX administered to pregnant rabbits with experimentally induced antiphospholipid syndrome increased the number of live newborns, reduced the incidence of fetal resorption, increased the viability and survival rate of newborn rabbits. The beneficial effect of TFX on APTT and platelet count was revealed, such that these parameters remained within the normal range despite immunization. Morphological changes observed in the placenta were not specific.

Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study.

BACKGROUND: Echinacea products are among the most popular phytomedicines on the North American market. Since at least half of all pregnancies are unplanned, many women inadvertently use echinacea in their first trimester. Presently, there is a paucity of information regarding the gestational safety of this herb. The primary objective of this study was to evaluate the safety of echinacea in pregnancy when used for upper respiratory tract ailments. PATIENTS AND METHODS: The study group consisted of women who were prospectively followed up after contacting the Motherisk Program regarding the gestational use of echinacea. This cohort was disease-matched to women exposed to nonteratogenic agents by maternal age, alcohol, and cigarette use. Rates of major and minor malformations between the groups were compared. RESULTS: A total of 206 women were enrolled in the study group after using echinacea products during pregnancy; 112 women used the herb in the first trimester. There were a total of 195 live births, including 3 sets of twins, 13 spontaneous abortions, and 1 therapeutic abortion. Six major malformations were reported, including 1 chromosomal abnormality, and 4 of these malformations occurred with echinacea exposure in the first trimester. In the control group, there were 206 women with 198 live births, 7 spontaneous abortions, and 1 therapeutic abortion. Seven major malformations were reported. There were no statistical differences between the study and control groups for any of the end points analyzed. CONCLUSIONS: This first prospective study suggests that gestational use of echinacea during organogenesis is not associated with an increased risk for major malformations.

High levels of IL-17 in rheumatoid arthritis patients: IL-15 triggers in vitro IL-17 production via cyclosporin A-sensitive mechanism.

Recent data suggest that IL-15 plays an important role in the pathogenesis of rheumatoid arthritis. In the present study, we hypothesized that elevated in the joints of rheumatoid arthritis, but not osteoarthritis, patients, IL-15 may exert its proinflammatory properties via the induction of IL-17, a cytokine known to stimulate synoviocytes to release several mediators of inflammation including IL-6, IL-8, GM-CSF and PGE2. To test this hypothesis, we first measured the levels of IL-17 and IL-15 using specific ELISA and found that synovial fluids of patients with rheumatoid arthritis, but not with osteoarthritis, contain high levels of these cytokines. A strong correlation between IL-15 and IL-17 levels in synovial fluids was observed. Among tested factors, LPS and TNF-alpha failed, IL-15 and IL-2 were equipotent, and PMA + ionomycin was far more efficient in the induction of IL-17 secretion by PBMCs isolated from healthy blood donors. Interestingly, synovial fluid cells, in contrast to PBMCs isolated from patients with rheumatoid arthritis, but not osteoarthritis, respond to PMA + ionomycin with much lower, comparable to IL-15-triggered IL-17 secretion. Moreover, PMA + ionomycin-triggered IL-17 secretion is completely or partially blocked in the presence of low doses of cyclosporin A or high doses of methylprednisolone, respectively. IL-15-triggered IL-17 secretion by PBMCs was completely inhibited by these drugs. Thus, our results suggest for the first time that IL-15 may represent a physiological trigger that via cyclosporin A and steroid sensitive pathways leads to the overproduction of IL-17 in the joints of rheumatoid arthritis patients.

Cryotherapy in the treatment of rheumatic disease.

Cryotherapy is the application of a temperature lower than -100 C to the outer surface of the body, for a period of 2-3 minutes, in order to evoke and make use of physiological reactions to cold. The body's positive response to cryotherapy is a supportive factor in the treatment of the underlying disease and facilitates kinseitherapy.
Low temperatures, obtained by injecting air chilled with liquid nitrogen vapor, can be applied either locally, on selected parts of the locomotor apparatus, or generally, on the entire body (in a cryosauna or cryochamber). The best therapeutic effects are obtained by applying cryotherapy twice a day, with at least a 3-hour interval between procedures. Kinesitherapy is necessarily applied after each cryotherapy session. This form of treatment should be continued for 2 to 6 weeks, depending on the patient's individual needs.
Cryotherapy reduces pain and edema, relaxes skeletal muscles, and increases the range motion in the treated area, which makes it possible to conduct exercises increasing muscle strength. Thus cryotherapy would seem to meet all requirements for use in the rehabilitation of patients with rheumatic diseases.
Cryotherapy requires little time to apply, is well tolerated by patients, and leads to rapid improvement of the patient's status after application. The relatively small number of contraindications makes cryotherapy a method of choice for broad application in the treatment of rheumatic diseases.

Low temperatures in post-operative knee rehabilitation in rheumatoid arthritis patients.

Low temperatures were applied (in addition to kinesitherapy), in the form of injected air cooled to -75 C and CO2, to 22 patients (34 knees) recovering from total knee alloplasty or synovectomy. Each procedure lasted 5-7 minutes. The control group consisted o 22 patients (34 knees) treated with kinesitherapy only.
The range of active and passive flexion and extension in the operated knee joint was tested twice, once before the experiment began and once after the third week. During this period the subjective feeling of pain was also observed.
The results were analyzed statistically using the t-Student test. Upon comparison of the results obtained by patients from both tested groups, it can be stated that the addition of low temperatures to the program of post-operative rehabilitation of the knee enables:
- faster and more effective pain relief;
- faster increase in the range of movement, especially flexion, in the operated knees.
These results justify the conclusion that this method should be recommended in rehabilitation of the knee after surgery.

[Clinical usefulness of color doppler flow examination during treatment of gestational trophoblastic disease]. / Ocena przydatnosci klinicznej badan przeplywów naczyniowych z uzyciem kolorowego Dopplera u chorych leczonych z powodu ciazowej choroby trofoblastycznej.

Neovascularisation is the integral part of tumor development. Presence and type of pathological vascularisation can be used in therapy monitoring and follow up. The value of beta HCG and pulsatility index (PI) and resistance index (RI) in 14 women treated for nonmetastatic persistent trophoblastic disease (NMTD) were been compared. There was statistical, significant correlation between dropped BHCG level and increased value of RI. No correlation between BHCG blood concentration and values of PI was observed. In summary it should be stated that color Doppler ultrasonography is useful method in monitoring patients with NMTD.

DNA ploidy as a prognostic factor in patients with ovarian carcinoma.

The aim of this work was to establish the dependence between survival and time to progression and the factor which is considered as risk factor i.e. type of DNA ploidy. The DNA ploidy was evaluated in 33 cases of ovary carcinoma selected from 314 cases. The statistically significant difference between the 5 years survivals in patients with DNA aneuploidy and patients with DNA diploidy was observed (13.6% vs 60.9%). What was also found out, was the statistically significant difference between the 5 years survivals without the progression of disease in patients with DNA aneuploidy and patients with DNA diploidy (13.6% vs 55.9%).

[Analgetic treatment and rehabilitation in osteoporosis]. / Postepowanie przeciwbólowe i rehabilitacja w osteoporozie.

Osteoporosis seems to be a component of body aging process. Through the years, muscles, ligaments, and fasciae loose their natural elasticity; degenerative changes form in joints; also, mechanical resistance of bones reduces. Involutive changes in central nervous system (CNS) cause disturbances in reciprocal transmission of impulses between CNS and muscles. This changes normal motion pattern, leading, consequently, to lasting stress of ligaments, muscles, joints and bones, what becomes a source of strong nociceptive impulses. One of first symptoms of this is pain, localized particularly in spine region. Pain is another cause of increased, abnormal tension of muscles and, thus, of their stress. Proper treatment of above situation must be necessarily consisted of simultaneous analgesia, correcting of muscle tension and relaxation. Therefore, guideline for the rehabilitation program needs to be supported by thorough clinical, biomechanical, roentgenographic and densitometrical case analysis. Rehabilitation works as prophylactics of formation and fixing of deformities. Therefore, this must be aimed to: pain relief, maintaining of proper patient's stance, rebuilding of normal muscle force, maintaining of normal motion range and increasing of daily motion activity, what would stimulate skeletal system. For practical reasons, forming of dysfunctions in motion system in course of osteoporosis is classified into three stages--I--early, II--advanced osteoporosis and III--late.

[Cryotherapy in osteoporosis]. / Krioterapia w osteoporozie.

Cryotherapy is use of temperature lower than -100 degrees C onto body surface, for 2-3 minutes, in aim to cause physiological reactions for cold and to use such adapting reactions. Organism's positive response to cryotherapy supports treatment of basic disease and facilitates kinesitherapy. Low temperature may be obtained by use of air flow cooled with liquid nitrogen; this could be applied either locally, over chosen part of the body, or generally, over the whole body, in cryosauna or in cryochamber. The most efficiently is applying cryotherapy twice a day, with at least 3 hours interval. Kinesitherapy is necessarily used after each cryotherapy session. Whole treatment takes 2 to 6 weeks, depending on patient's needs. Cryotherapy reduces pain and swellings, causes skeletal muscles relaxation and increase of their force, also, motion range in treated joints increases. Thus, cryotherapy seems to fulfill all necessary conditions for rehabilitation in osteoporosis. Cryotherapy represents numerous advantages: it takes short time for applying, being well tolerated by patient, also patient's status improves quickly. In addition, contraindications against cryotherapy are rare. All this makes cryotherapy a method for a broad use in prophylactics and treatment of osteoporosis.

Is laparotomy for staging early ovarian cancer an absolute necessity?

STUDY OBJECTIVE: To demonstrate that palpation of the omentum, mesentery, and intestine can be omitted from the laparoscopic staging of stage I carcinoma of the ovary. DESIGN: Retrospective analysis of 223 women with stages III and IV ovarian cancer treated by laparotomy. SETTING: Gynecological Oncology Clinic, M. Sklodowska-Curie Memorial Cancer Institute of Oncology, Warsaw, Poland. INTERVENTIONS: Observation of macroscopic spread of tumor to areas accessible to laparoscopic inspection versus spread to areas inaccessible to laparoscopic evaluation. MEASUREMENTS AND MAIN RESULTS: Macroscopically detectable disease in the areas easily accessible to laparoscopic inspection was present in all cases of metastases to the mesentery, omentum, or intestine. CONCLUSION: The diagnosis of FIGO stage I ovarian cancer can be made with confidence if laparoscopic inspection of certain areas reveals no evidence of metastases.

The management of granulosa-cell tumors of the ovary based on long-term follow up.

The results of treatment in 130 cases of GCT of the ovary treated in the Institute of Oncology in Warsaw and followed up from 5 to 40 years were analysed with respect to the methods of therapy and age of the patients. The highest 5-year survival rate (86%) was obtained by combination of radical surgery with external irradiation. Such treatment also resulted in the lowest percentage of early and late failures of the treatment (17%). Conservative surgery, applied in the Ist stage of GCT resulted in 69% of 5-year survivals and gave young women a chance of procreation; however, the majority (69%) of patients who underwent this treatment sooner or later developed a recurrence leading, in consequence, to death.

Clinical analysis and evaluation of the results of adjuvant treatment (radiotherapy and chemotherapy) in ovarian carcinoma.

The present study was carried out on the material of 486 ovarian cancer patients who received radiotherapy and chemotherapy as adjuvant treatment at the Oncological Gynaecology Clinic at the Maria Sklodowska-Curie Cancer Center-Institute of Oncology in Warsaw in the period 1979-1985, following primary surgery. The clinical stage of disease advancement was determined on the basis of surgery protocols and histological examinations. Radiotherapy was the treatment of choice in patients in stages I and II. Irradiation was applied to the pelvis minor and para aortal nodes (in patients at stage Ia) or to fields covering the entire abdominal cavity (other patients at stage I and II). Chemotherapy was given to stage III and IV patients multi-drug therapy, usually including Cisplatin, Adriamycin, and Cyclophosphamide, or with one drug (monochemotherapy) with the alhylating agents. The largest group of patients under study were women with ovarian cancer in stage I (38.8%), the smallest group consisted of patients in stage IV (8.5%). Patients in stage III represented 37.5% of all the material. Patients aged 50-64 years were most frequently treated (47.3%), the least frequent group were the patients aged over 65 (13.2%). The predominating histological diagnosis was serous cancer type (48.7%), clear-cell cancer was detected least frequently (13.2%). Among all the patients treated 35.4% survived 5 years after treatment, 69% in stage I, 43.8% in stage II, 8.8% in stage III, and 2.5% in stage IV.