http://www.ginekolpol.comTable of contents Volume 81, 2010 Number 06.en-usCopyright 2010 by the Ginekologia Polskahttp://www.ginekolpol.com/rssIndexCopernicus Journal Management System RSS GENERATORwebmaster@www.ginekolpol.com (ADM)Thu, 10 Jun 2010 00:00:00 ESThttp://www.ginekolpol.com/abstracted.php?icid=912833&level=5Summary Introduction: HOXA genes are receptivity markers and their altered expression can help identify women with implantation defect. Objectives: The purpose of this study was to examine the expression pattern of HOXA11 and expression and localization of its protein product in the endometrium of women with endometriosis, idiopathic infertility and normal fertile patients during different phases of the menstrual cycle. Material and methods: We evaluated HOXA11 mRNA level in the endometrium from endometriosis (n=36), idiopathic infertility (n=48) and fertile patients (n=30) during a menstrual cycle. The amounts of mRNA were determined by real-time quantitative PCR. Using the immunohistochemical techniques we compared the localization of HOXA11 protein in the proliferative, early secretory and midsecretory endometrium in all of the studied groups. Endometrial biopsy was performed by pipelle or during hysteroscopy. Results: We observed statistically significantly elevated HOXA11 transcripts levels in the midsecretory phase in both, the idiopathic infertility and the fertile control groups (p<0.05). Patients with endometriosis had low HOXA11 transcript level in the implantation window. Normal fertile patients showed statistically significantly decreased (p=0.003) HOXA11 mRNA level in the proliferative phase and statistically significantly increased level (p=0.018) in midsecretory phase, comparing to endometriosis patients. HOXA11 protein were localized in the nuclei of the endometrial stromal cells whereas the cytoplasm of these cells did not stain. Conclusion: Our results suggest that altered HOXA11 gene expression in the endometrium during a menstrual cycle may be a common phenomenon among patients with endometriosis and may cause infertility in this group of patients. Further research should explain the mechanism of altered expression of HOXA11 gene. Małgorzata Szczepańska, Przemysław Wirstlein, Jana Maria Skrzypczak Original articlehttp://www.ginekolpol.com/abstracted.php?icid=912833&level=5http://www.ginekolpol.com/abstracted.php?icid=912835&level=5Streszczenie Wstęp: Angiogeneza ma istotne znaczenie we wzroście raka endometrium. Naczyniowo-śródbłonkowy czynnik wzrostu (VEGF) jest kluczowym mediatorem angiogenezy. Cel pracy: W pracy oceniono wartość prognostyczną VEGF i jego receptorów w endometrioidalnym raku endometrium. Materiał i metody: Przeprowadzono immunohistochemiczną ocenę ekspresji VEGF i VEGFR w 84 preparatach uzyskanych od chorych leczonych operacyjnie. Wyniki: Wśród 84 raków intensywnie dodatnią ekspresję VEGF obserwowano w 35 (42%) przypadków. Intensywnie dodatnią ekspresję VEGFR-1 stwierdzono w 33% a VEGFR-2 w 15% przypadków. Wykazano istotny statystycznie związek pomiędzy stopniem zaawansowania klinicznego a nadekspresją VEGF i VEGFR-1 (p=0,027 i p=0,004 ). Ponadto, stwierdzono znamienny statystycznie związek pomiędzy nadekspresją VEGF i VEGFR-1 a zróżnicowaniem histologicznym (p<0,001 i p<0,001). Pięcioletni czas przeżycia wolny od choroby (DFS) pacjentek, u których wykazano nadekspresję VEGF i VEGFR-1 był statystycznie znamiennie krótszy niż tych, u których ekspresji nie wykazano lub była ona słaba (p<0,001). Wnioski: Immunohistochemiczna ocena ekspresji VEGF i VEGFR-1 może być przydatna w prognozowaniu pięcioletniego czasu przeżycia wolnego od choroby w raku endometrioidalnym. Bożena Dobrzycka, Sławomir Jerzy Terlikowski, Marcin Kwiatkowski, Magdalena Grabowicz, Maciej Kinalski, Lech Chyczewski Original articlehttp://www.ginekolpol.com/abstracted.php?icid=912835&level=5http://www.ginekolpol.com/abstracted.php?icid=912837&level=5Summary Introduction: Biophysics and molecular biology are disciplines dynamically entering the area of cervical cancer prevention. The combined test, comprising optoelectronic and molecular diagnostics, may play a significant role in the decrease of cervical cancer incidence and mortality. Objective: Assessment of the combined test usefulness – optoelectronic method and HPV test for the presence of oncogenic HPV types, in the detection of cervical intraepithelial neoplasia and cervical cancer . Material and method: From August 2006 to October 2008 the study included 250 patients from the Laboratory of Pathophysiology of Uterine Cervix in Gynecology and Obstetrics Clinical Hospital of Karol Marcinkowski University of Medical Sciences. The patients underwent the following diagnostic tests: optoelectronic method, PCR test for the presence of DNA HPV HR, colposcopic examination and histopathologic biopsy. Results: Sensitivity of the combined test for low-grade intraepithelial changes in the area of squamous epithelium (CIN 1) was 81%, while for high-grade changes (CIN 2, CIN 3) and carcinoma planoepitheliale together with adenocarcinoma was 100%. Conclusions: Optoelectronic and molecular diagnostics methods are useful in detecting neoplastic cervical changes. Both methods may become a key diagnostic tool of basic and advanced level of cervical screening. The advantage of the combined optoelectronic method and molecular diagnostics method over prevention based on cytodiagnostics and colposcopy has its source in the possibility of test automation and standardization. Dominik Pruski, Witold Kędzia, Marcin Przybylski, Agata Józefiak, Maciej Purol, Marek Spaczyński Original articlehttp://www.ginekolpol.com/abstracted.php?icid=912837&level=5http://www.ginekolpol.com/abstracted.php?icid=912838&level=5Summary Objectives: The aim of the study was to evaluate the expression of tumor necrosis factors -α and β (TNF), their receptor and content in human uterine leiomyomas at various stages of tumor growth. Material and Methods: Studies were performed on human myometrium and uterine leiomyomas of various weights (small: less than 10g and large: more than 100g). Presence of both growth factors and their receptor was detected by Western Immunoblotting technique. The content of TNF-α was evaluated by immunoenzymatic method (ELISA). Results: Changes in the expression of tumor necrosis factors and their receptor and difference in content of TNF-α during the tumor growth were found. Conclusions: Myometrium conversion into leiomyoma and an increase in its mass is accompanied by changes in the expression and contents TNF and TNF RI. Małgorzata Wolańska, Ewelina Taudul, Emilia Bańkowska-Gruszczyn, Maciej Kinalski Original articlehttp://www.ginekolpol.com/abstracted.php?icid=912838&level=5http://www.ginekolpol.com/abstracted.php?icid=912840&level=5Summary Objective: To evaluate morphological markers of inflammation in afterbirth tissue from idiopathic premature labors, with regard to symptoms of infection in newborns. Material and methods: Study group: 83 afterbirth specimens from spontaneous labors between 22 and 37 weeks gestation. Control group: 30 afterbirth specimens from physiological labors. The histopathological examination included evaluation of placenta with umbilical membranes and umbilical cords from the abovementioned labors; next the results were juxtaposed with the incidence of neonatal infections. The evaluation covered sensitivity, specificity, as well as the positive and negative predicative value of morphological markers in afterbirth infection as a diagnostic test for predicting the incidence of neonatal infections. Results: 1. Morphological markers of afterbirth inflammation were reported in 28.9% of women giving premature birth (p<0.05). 2. Features of afterbirth inflammation were most frequently observed in the fetal membranes, and in the fetal membranes and placenta. 3. Premature disruption of the fetal membranes occurred in 66.7% of women with morphological markers of afterbirth inflammation and in 23.7% of women giving premature birth with no features of afterbirth inflammation (p<0.05). 4. Neonatal infection was reported in 75% of labors with morphological markers of afterbirth inflammation and in 5.1% of labors with no features of afterbirth inflammation (p<0.05). 5. Usefulness of confirming afterbirth inflammation for diagnosing neonatal infections: sensitivity 85.7%, specificity 90.3%, positive predicative value 75%, negative predicative value 94.9%. Conclusion: 1. Afterbirth inflammation occurs in 28.9% of all premature labors; however, the percentage differs depending on gestational age, from 84.2 % in week 22-28 to 4.9% in week 33-37 of gestation. 2. Afterbirth inflammatory changes were reported in 2/3 of premature labors with premature disruption of the fetal membranes. 3. Identification of morphological markers of afterbirth inflammation has high sensitivity (85.7%) and specificity (90.3%) in predicting neonatal infections. Grzegorz Raba, Jan Kotarski Original articlehttp://www.ginekolpol.com/abstracted.php?icid=912840&level=5http://www.ginekolpol.com/abstracted.php?icid=912842&level=5Abstract Physical activity during pregnancy, active preparation for the delivery and rehabilitation after delivery are factors that can influence the quality of life of a woman at those stages of life. Treatment and prevention of leg edemas decreases the risk of hospitalization. Kinezytherapy helps pregnant women to prevent obesity and stay in good physical condition. Physiological changes in skeleton and muscle system may be the reason of pain during pregnancy and physiotherapy may effectively prevent it. Preparation for the delivery by physical activity, kinezytheraphy and respiratory exercises increase awareness and help a pregnant woman to participated more actively in the act of the delivery. Agata Karowicz-Bilińska, Anita Sikora, Dorota Estemberg, Maria Brzozowska, Marlena Berner-Trąbska, Ewa Kuś, Urszula Kowalska-Koprek Review articlehttp://www.ginekolpol.com/abstracted.php?icid=912842&level=5http://www.ginekolpol.com/abstracted.php?icid=912843&level=5Abstract Advances in cancer treatment of young patients have resulted in markedly improved survival rates and quality of life. However, infertility remains to be one of adverse effects of anticancer therapy. Female patients who receive high-dose abdominal and/or pelvic irradiation or chemotherapy based on alkylating agents are at highest risk of developing ovarian failure. Among women whose fertility was not impaired during oncologic treatment, there is a significantly increased number of premature labors. High-dose irradiation also predisposes to low-birthweight infants. Neither chemotherapy nor radiotherapy increase a risk of congenital malformations. Anna Markowska, Monika Pawłowska, Janina Markowska, Maria Litwiniuk, Radosław Mądry, Darah Dilmaghani-Tabriz Review articlehttp://www.ginekolpol.com/abstracted.php?icid=912843&level=5http://www.ginekolpol.com/abstracted.php?icid=912845&level=5Abstract Objectives: Clinical evaluation of Latzko operation in primary and recurrent vesicovaginal fistulas and an update on current therapeutical strategy. Material and methods: Evaluation of clinical efficacy has been performed in a group of 5 patients with confirmed vesicovaginal fistulas and in 1 woman with urethrovaginal fistula. Prior to the operation, four patients had undergone eight fistula operations in our department with unsuccessful outcome. Results: Fistula closure by Latzko operation has been achieved in 5 patients, including one patient who had surgery treatment repeated 3 months after the primary fistula operation. In total, additional Martius flap has been introduced twice. In patient, where fistula has been operated after 45 days since primary TVM and IVSO4 surgery, closure therapy failed. Conclusions: Surgical treatment by vaginal approach offers great therapeutical efficacy in the primary and recurrent vesicovaginal fistulas, even in cases when previous abdominal surgical treatment had failed. Tomasz Rechberger, Krzysztof Postawski, Katarzyna Romanek, Aleksandra Bartuzi Case reporthttp://www.ginekolpol.com/abstracted.php?icid=912845&level=5http://www.ginekolpol.com/abstracted.php?icid=912846&level=5Summary Androgen insensitivity syndrome (AIS, Morris syndrome) is an X-linked recessive disorder of sexual development caused by the mutation of the androgen receptor coding gene (locus Xq11-q12). We present a case of a 17-year-old girl diagnosed because of primary amenorrhea. Her cytogenetic analysis revealed the kariotype of 46, XY. Clinical examinations, based on the Quigley’s scale, showed features of complete AIS. Hormonal tests brought the following results: FSH – 2.81mIU/ml, LH – 13.88mIU/ml. Testosterone value met the norm for a male individual in reproductive age (7.97ng/ml). Family anamnesis revealed no episodes of genetic diseases. Due to the risk of neoplasia, the diagnosis was an indication for surgical gonads removal, which was performed laparoscopically. Histopathologic examination showed tubular adenoma with immature seminiferous tubules without spermatogenesis, and serous cysts. Patient was discharged on the next day after the operation in good general condition, and estrogen therapy was prescribed. Conclusion: Laparoscopy is an effective method in AIS treatment. Piotr Jędrzejczak, Monika Serdyńska-Szuster, Katarzyna Wachowiak-Ochmańska, Marcin Szuster, Joanna Talarczyk, Piotr Jasiński, Leszek Pawelczyk Case reporthttp://www.ginekolpol.com/abstracted.php?icid=912846&level=5http://www.ginekolpol.com/abstracted.php?icid=912847&level=5Abstract The following work presents prenatal ultrasonographic examination of two rare fetal cases of epulis, among 13 792 fetuses referred to our unit due to suspected fetal anomalies by obstetricians (estimated prevalence 1/7000 among fetuses with different anomalies). Sonographic differential diagnosis, value of fetal nasal amniotic fluid flow assessment by color Doppler and the probability of EXIT procedure have been described. Sebastian Foryś, Jan Krajewski, Grzegorz Krasomski, Andrzej Makowski, Andrzej Zieliński, Andrzej Kulig, Maria Respondek-Liberska Case reporthttp://www.ginekolpol.com/abstracted.php?icid=912847&level=5http://www.ginekolpol.com/abstracted.php?icid=912848&level=5ArrayEditorialhttp://www.ginekolpol.com/abstracted.php?icid=912848&level=5http://www.ginekolpol.com/abstracted.php?icid=912849&level=5ArrayOtherhttp://www.ginekolpol.com/abstracted.php?icid=912849&level=5http://www.ginekolpol.com/abstracted.php?icid=912850&level=5ArrayOtherhttp://www.ginekolpol.com/abstracted.php?icid=912850&level=5