http://www.ginekolpol.comTable of contents Volume 81, 2010 Number 02.en-usCopyright 2010 by the Ginekologia Polskahttp://www.ginekolpol.com/rssIndexCopernicus Journal Management System RSS GENERATORwebmaster@www.ginekolpol.com (ADM)Fri, 05 Feb 2010 00:00:00 ESThttp://www.ginekolpol.com/abstracted.php?icid=905106&level=5Summary Intrahepatic cholestasis occurs most frequently in the third trimester of pregnancy. It is characterized by elevated concentrations of liver enzymes and bile acids. The main aim of the study was to analyze the changes of concentration in biochemical indicators of cholestasis during the treatment. Material and methods: The study was conducted in the group of 38 women with diagnosed intrahepatic cholestasis in pregnancy and hospitalized in Medical University Lodz, High Risk Pregnancy Clinic in 2007-2008. Treatment constituted UDCA in 750mg per 24h and Essentiale Forte 3 times a day. The concentrations in serum of AspAt, AlAt, ALP, GGTP, bile acids and bilirubin were estimated before and after 7 and 15 days of the treatment. Results: Mean concentration of AlAt was 262±16.26 U/L, AspAt 146±141.17 U/L, ALP 189±60.64 U/L, bile acids 28.6±15μmol/L, GGTP 31.5±28.15U/L but only in 28,9%was elevated. After 7 days the decrease of mean concentrations of AlAt (165±126.7 U/L) and AspAt (85±59.62 U/L) was observed. The concentration of ALP was similar to the previous results (190±71.94 U/L). After 15 days mean values of AlAt and AspAt decreased to 119±103.56 U/L and 65±46.12 U/L (p<0.001), No changes in ALP concentration were found. The concentration of bile acids decreased after 15 days to17±15μmol/L. Conclusions: The applied treatment decreased the concentration of most of biochemical markers of cholestasis. To reach the normal values of concentration of biochemical markers of cholestasis a 15-day treatment is necessary. Maria Brzozowska, Urszula Kowalska-Koprek, Agata Karowicz-Bilińska Original articlehttp://www.ginekolpol.com/abstracted.php?icid=905106&level=5http://www.ginekolpol.com/abstracted.php?icid=905107&level=5Abstract Aim: The study aimed at: 1. analysis of the relationship between Doppler flow in the selected maternal and fetal vessels and the risk of adverse perinatal outcome (APO); 2. multivariate logistic regression model for the assessment the risk of APA. Material and methods: The study population covered 216 pregnant women from Lodz and Kalisz between 2003-2006. Results: In univariate logistic regression model PI_UA significantly influenced the risk of APO. That risk was increasing 1.2 times, if the PI_UA value was 1/10th higher than the measured unit. Abnormal cardiotocography (CTG) pattern was related to 12-times higher risk of APO. In cases of abnormal PI_MCA, the risk of APO was 2.5 times higher than when PI_MCA was within the normal range. Abnormal PI_UA was related to 11.5-times higher risk of APO. Similarly, when PIV_DV was abnormal, the risk of APO was 2.3-times higher. Low birth weight (LBW) was connected with the 6-times higher risk of APO. In multivariate logistic regression model, CTG and LBW were the risk factors significantly associated with APA. Abnormal CTG pattern was related to more than 6-times higher increase of the risk of APO, however LBW with nearly 4-times higher risk of APO. Conclusion: Abnormal values of PI in UA and in MCA, abnormal flow in DV, and abnormal CTG pattern, as well as low birth weight, had significant influence on the risk of APO. In multivariate analysis only abnormal CTG and low birth weight were the significant factors of APO. Jarosław Hajdo, Jan Wilczyński, Wiesław Szymczak, Dorota Nowakowska Original articlehttp://www.ginekolpol.com/abstracted.php?icid=905107&level=5http://www.ginekolpol.com/abstracted.php?icid=905108&level=5Abstract Aim: Cervical ripening is the main factor of success in the induction of labor. The aim of the study was to compare predictive value of digital examination (Bishop’s score) and ultrasound evaluation for labor induction success. Material and methods: The study was carried out in the Fetal Medicine Department of Medical University of Lodz between 2006-2009. 101 pregnant women comprised the study group. Results: Comparing the subgroups with successful and unsuccessful labor induction, the main differences were observed in the entire Bishop’s score (7.21 versus 5.4 points; p<0.001). Ultrasound measurements demonstrated significant differences in the cervical diameter (55.5 vs. 51.6mm; p<0.01) and internal os (8.64 vs. 3.28mm; p<0.001). We noticed a significant correlation between the outcome of the labor induction and the shape of the canal (p<0.001), as well as the posterior cervical angle (p<0.001). Ultrasound measurements of the internal os width (p<0.001; cut-off point: 4.5mm), the length (p<0.001; cut-off point: 23.5mm) and shape of the cervical canal (p<0.001; Y shape in 36.21%), were significant independent factors in the prediction of labor induction. Following the Bishop’s score model, we created a similar score for the ultrasound measurements (total -10 points). The entire score of the ultrasound measurements with the cut-off value: 4.5 points, was found to be a significant factor (p<0.001) predicting the success of labor induction. Conclusion: The ultrasound evaluation of the cervix demonstrates significantly better predictive value in the prognosis of labor induction comparing to the Bishop’s score. Piotr Sieroszewski, Renata Banach Original articlehttp://www.ginekolpol.com/abstracted.php?icid=905108&level=5http://www.ginekolpol.com/abstracted.php?icid=905109&level=5Abstract Objective: The aim of the study was to evaluate the relationship between serum free and total PSA and histopathological findings in women with fibrocystic mastopathy. Material and methods: 176 women with fibrocystic breast disease, aged 18 to 45 years. - group I: comprised 114 patients with cysts <10mm in diameter - group II: comprised 62 women with cysts >10mm in diameter The control group consisted of 46 healthy women aged 18 - 45 years who had no breast pathology. Total PSA (PSA-T) and free PSA (PSA-Free) were measured by an ultra-sensitive fluoroimmunometric DELFIA assay (Prostatus PSA Free/Total Wallac, Turku, Finland). The detection limit for PSA was 0.01 ng/ml. Endometrial samples have been obtained with Pipelle probe between 22 and 24 days of the menstrual cycle. Results: In the control group secretory endometrium was more frequently detected than in the mastopathy group (chi2=11,15, p=0.01). Proliferatory (chi2=8.27, p=0.004) and presecretory endometrium (chi2=4.61, p=0.03) were more frequently detected in the mastopathy group than in controls. We did not find statistically significant relationship between the mean PSA concentrations between the groups in relation to histopathological findings. Conclusions: No relationships between free and total PSA measured in the follicular phase of the menstrual cycle and endometrial findings were detected in our study. Further research is required to evaluate the relationship between PSA and endometrial findings. Stanisław Radowicki, Michał Kunicki Original articlehttp://www.ginekolpol.com/abstracted.php?icid=905109&level=5http://www.ginekolpol.com/abstracted.php?icid=905112&level=5Abstract Objectives: Evaluation of partner relationships in menopausal period. Material and Methods: A questionnaire study was performed in a group of 67 women (age: 45-55 years) and their partners. The inclusion criteria were: presence of climacteric symptoms, stable partnership, consent to research. 40 women and their spouses were included into the final study group. The investigative tool was based on 3 scales: Marriage Bond Scale (SWM); Scale of Attractiveness (SKAT); GREEN Scale evaluating intensification of menopausal symptoms and a set of additional questions concerning socio-demographical data, marital sexuality and substitute hormonal therapy. Results: Mean age of respondents was 52 years. Most of the women demonstrated an amenorrhea (90%). Climacteric symptoms such as: hot flush, stress, depressive moods (87.5% each), musculoarticular pain (80%) occurred in various degree. 97.5% of women did not use a substitute hormonal treatment. The mean result of SWM for women and their partners scored 237 which is 79% of the total value. A correlation between exacerbation of menopausal signs and SWM score was not found. The co-attractiveness ratio counted on the basis of SKAT scale scored 30 points on average, which constitutes 74% of the maximum. Approximately 58% of the men accepted symptoms related to menopause in their partners; they tolerated changes appearing in the climacteric period, however, 100% of men did not talk about menopausal problems with their partners and did not support them in this difficult time. Conclusions: Men find their partners attractive in the perimenopausal period, accepting their partners and problems related to menopause. Most of the male respondents understand changes occurring in their partners, however, they do not help them to deal with them. Rafał Szpak, Wiesław Folwarczny, Agnieszka Drozdzol, Adam Szuścik, Agnieszka Skrzypulec, Violetta Skrzypulec Original articlehttp://www.ginekolpol.com/abstracted.php?icid=905112&level=5http://www.ginekolpol.com/abstracted.php?icid=905117&level=5Summary The most important benefit of tocolysis is a 48-hour prolongation of gestational age in order to administer corticosteroids to reduce perinatal mortality and morbidity, as well as, if necessary, to gain time for “in utero” transfer to a tertiary centre with neonatal facilities. The tocolytic agents used in clinical practice can be grouped into six classes, namely: calcium channel blockers, betamimetics, magnesium sulfate, cyclooxygenase inhibitors, oxytocin receptor antagonists and nitric oxide donors. The use of them should be individualized and based on tocolytic effectiveness, safety, gestational age as well as maternal, fetal and neonatal outcomes. Data from clinical trials suggests that nifedipine appears to be the drug of first choice in the management of preterm labor. Żaneta Kimber-Trojnar, Bożena Leszczyńska-Gorzelak, Beata Marciniak, Jacek Bartosiewicz, Jan Oleszczuk Review articlehttp://www.ginekolpol.com/abstracted.php?icid=905117&level=5http://www.ginekolpol.com/abstracted.php?icid=905120&level=5Summary Over three decades of experience enabled contemporary medicine to develop an advanced and highly efficient assisted reproductive technology (ART). Currently, we are witnesses to a nationwide debate in Poland concerning recommendation and law regulations for ART. This article expresses an opinion of medicine doctors who are specialists in the field of reproductive medicine in Poland. The authors expain why infertility is a wide and important socio-economic problem and why legislative proposals of the consevative members of the Polish Parliament expose patients to lower pregnancy rate, higher procedure cost and higher risk of complications. Authors also make analysis of different law regulations in Europe, concluding that the efficient ART model should limit the number of transferred embryos, allow cryopreservation of the embryos and impose the obligation to use the frozen embryos. Rafał Kurzawa, Waldemar Kuczyński, Leszek Pawelczyk, Sławomir Wołczyński Review articlehttp://www.ginekolpol.com/abstracted.php?icid=905120&level=5http://www.ginekolpol.com/abstracted.php?icid=905123&level=5Abstract Hormonally active, associated with pregnancy ovarian tumors can cause some diagnostic and therapeutic problems. In the following work we present a 28-year-old primigravida in the 21st week of pregnancy who was admitted to hospital with acute abdominal pain and virilizing symptoms. Bilateral luteinized thecoma of a considerable size, secreting testosterone, was diagnosed and the woman received surgical treatment. During the operation a rupture of the left tumor was discovered. Bilateral adnexectomy was performed. After the operation the symptoms subsided. The pregnancy continued until 38 weeks gestation. A normal female fetus without virilizing symptoms was delivered by caesarean section. Małgorzata Kogut, Jarosław Janeczko, Małgorzata Trzcińska, Marek Grzywa Case reporthttp://www.ginekolpol.com/abstracted.php?icid=905123&level=5http://www.ginekolpol.com/abstracted.php?icid=905126&level=5Abstract Ebstein’s malformation is a rare congenital cardiac defect characterized by an abnormal formation and /or displacement of the leaflets of the tricuspid valve. Prognosis for a neonate is poor in case of cardiomegaly, due to coexistence of lung hypoplasia. This paper presents a case of a fetus with Ebstein’s malformation with massive cardiomegaly (HA/CA = 0.62) in a 27-year-old patient in her first pregnancy. The cardiac defect was diagnosed in the 22nd week of pregnancy. Due to the fact that the patient decided to continue her pregnancy, and taking into consideration single reports of transplacental Digoxin therapy, an attempt to apply Digoxin therapy was made. The mother and the fetus were monitored in two centers, in Rzeszów and in Łódź. In the course of a 12-week transplacental therapy, 8 fetal echocardiography examinations were performed and the following parameters improved: HA/CA (0.62-0.5), CVPS (5/10-7/10) SF RA (0%-11%), SF RV (18%-28%). There was also a conversion of the oxygen test from negative to positive, which seems to document that prevention of the lung hypoplasia was achieved. The neonate died on the 8th day of postnatal life before a cardiac surgery attempt. Jacek Śliwa, Maria Respondek-Liberska, Iwona Maroszyńska, Grzegorz Krasomski Case reporthttp://www.ginekolpol.com/abstracted.php?icid=905126&level=5http://www.ginekolpol.com/abstracted.php?icid=905129&level=5Streszczenie Rak szyjki macicy niezwykle rzadko daje przerzuty do skóry nawet w wysokich stopniach zaawansowania klinicznego. Przedstawiono przypadek chorej z rakiem płaskonabłonkowym w kikucie szyjki macicy poddanej radykalnemu leczeniu chirurgicznemu i następowej radioterapii. Po upływie 2 miesięcy od zakończenia terapii u pacjentki stwierdzono obecność przerzutów do skóry sromu i krocza. Chorą leczono brachyterapią HDR nie uzyskując zadowalających efektów. Zgodnie z naszą wiedzą jest to pierwszy opis przerzutów raka w kikucie szyjki macicy do skóry. Zastosowanie brachyterapii ma ograniczone zastosowanie w leczeniu przerzutów do skóry. Obecność przerzutów do skóry wskazuje na agresywny i postępujący przebieg raka szyjki macicy. Marek Grabiec, Małgorzata Walentowicz, Andrzej Marszałek Case reporthttp://www.ginekolpol.com/abstracted.php?icid=905129&level=5http://www.ginekolpol.com/abstracted.php?icid=905131&level=5ArrayEditorialhttp://www.ginekolpol.com/abstracted.php?icid=905131&level=5http://www.ginekolpol.com/abstracted.php?icid=905134&level=5Abstract Adequate vitamin D intake and its status are important not only for bone health and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. Basing on current literature review and opinions of National Consultants and experts in the field, polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women have been established. ArrayEditorialhttp://www.ginekolpol.com/abstracted.php?icid=905134&level=5