PCOS and cancer risk.

Polycystic ovary syndrome (PCOS) affects approximately 5 to 10% of women of reproductive age. It is the most common reason of anovulation in infertile women. PCOS is accompanied by such conditions as oligo- or anovulation, hipertestosteronism, lower cell sensitivity to insulin, type II diabetes, hyperlipidemia and obesity. Each of the above-mentioned conditions is an approved risk factor proved to predispose towards cancer. However, PCOS is also a disease entity which differs in its clinical manifestation. For example not all patients suffer from obesity or hipertestosteronism related symptoms. From the analysis of literature it is possible to draw conclusions, that there is a possible correlation between PCOS and endometrial cancer, which emerges from clinical trials or research focused on molecular changes in endometrium patients with PCOS. On the other hand, correlation between PCOS and breast or ovary cancer is not so strong, in spite of single papers which are showing the link. The main problem in researching the correlation between PCOS and any cancer risk, is there is a very small group of women or the trial is imperfect (e.g. no control group). There is no meta-analysis focused on this correlation in literature. The change of criteria of PCOS in the past is also a big problem, because there was a number of definitions of PCOS, which results in inconsistent PCOS diagnoses over time. In this paper we would like to provide a description of studies that aimed at showing correlation between PCOS and cancer risk and underlying theoretical assumptions

Rola niedoboru inozytolu w patofizjologii zaburzeń występujących w zespole policystycznych jajników

Inositol acts as a second messenger in insulin signaling pathway. Literature data suggest inositol deficiency in insulin-resistant women with the polycystic ovary syndrome. Supplementation of myo-inisitol decreases insulin resistance as it works as an insulin sensitizing agent. The positive role of myo-inositol in the treatment of polycystic ovary syndrome has been of increased evidence recently. The present review presents the effects of myo-inositol on the ovarian, hormonal and metabolic parameters in women with PCOS.Inozytol jest wewnątrzkomórkowym przekaźnikiem sygnału insulinowego. Dane literaturowe dowodzą, iż u kobiet z zespołem policystycznych jajników do występowania insulinooporności przyczynia się niedobór inozytolu. Stosowanie myo-inozytolu zmniejsza insulinooporność działając jako czynnik uwrażliwiający tkanki na działanie insuliny. Szczególnie korzystne działanie tego związku wykazano w zespole policystycznych jajników. Niniejsza praca jest przeglądem danych literaturowych dotyczących wpływu myo-inositolu na parametry hormonalne, metaboliczne i funkcję jajników kobiet z PCOS

Rola metforminy w leczeniu zespołu policytycznych jajników (PCOS)

Abstract Polycystic ovarian syndrom (PCOS) affects 5% to 10% of women of reproductive age, and is the most common reason of anovulation in infertile women. It is multi-symptom disease. A drug which is used to induce ovulation in women with PCOS is clomiphene citrate. After clomiphene treatment, ovulation is achieved in 56%-73% of women. The rest of them has different level of opportunity to therapy. Clomiphene does not have influence on elementary factor in PCOS which seems to be opportunity to insulin. The drug which can have positive effect is metformin, derivative from biguanid. Its influence on percent of ovulation, pregnancy and live births was evaluated based on randomized trials. Many trials have reserched this so far, but their results are divergent. In this article, we are aiming to systemize results of randomized trials concerning the role of metformin in PCOS therapy.Streszczenie Zespół policystycznych jajników (PCOS) występuje u 5 do 10% kobiet w wieku reprodukcyjnym oraz jest najczęstsza przyczyna braku owulacji u kobiet bezpłodnych. Jest to choroba wieloobjawowa. Lekiem stosowanym w indukcji owulacji u niepłodnych kobiet z PCOS jest cytrynian klomifenu. Po zastosowaniu leku owulacja jest osiągana u 56-73% pacjentek. Pozostałe kobiety wykazują różnego stopnia oporność. Klomifen nie ma wpływu na podstawowy czynnik zespołu, jakim wydaje się być insulinooporność. Lekiem, który może mieć korzystny efekt wydaje się być metformina, pochodna biguanidu. Na podstawie badań randomizowanych oceniono jej wpływ na odsetek owulacji, ciąż oraz żywych urodzeń u kobiet z PCOS. Do tej pory opublikowano kilkadziesiąt prac badających ten wpływ. Jednakże ich wyniki są rozbieżne, przez co nasza wiedza na ten temat nie jest usystematyzowana. W naszej pracy postanowiliśmy podsumować wyniki badań dotyczących roli metforminy w leczeniu PCOS

Bilateral ectopic tubal pregnancy, following in vitro fertilisation (IVF).

This is a case report of a 33 year-old-woman who underwent in vitro fertilization, because of primary infertility caused by fallopian tube factor. The patient underwent three trials of frozen embryo transfers (ET-CRYO). On the 26th day after the third probe of ET-CRYO she suffered from pelvic pain and vaginal bleeding. Transvaginal ultrasonographic scan revealed bilateral tubal ectopic pregnancy without fluid in the Douglas pouch and no gestational sac in the uterus. Laparoscopic bilateral salpingectomy was performed on the next day after admission. The postoperative course was uneventful

Metabolic and hormonal effects of a combined Myo-inositol and d-chiro-inositol therapy on patients with polycystic ovary syndrome (PCOS)

Objectives: To evaluate the effects of a combined Myo-inositol (MI) and D-chiro-inositol (DCI) therapy on the hormonal and metabolic parameters of women with PCOS. Prospective clinical study. Clinical Study registration number — EUPAS25705 Material and methods: Seventy women diagnosed with PCOS according to the Rotterdam criteria were enrolled in this study. Patients received a combined therapy of one tablet that contained 550 mg of inositol (myo-inositol (MI) and D-chiro-inositol (DCI) in a ratio of 10:1) twice a day for 6 months. At each of 3 visits, the body weight, height and BMI were all recorded; and serum levels of free testosterone (fT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and glucose with insulin during standard OGTT (75 g) were measured. Also at each visit, transvaginal ultrasonography and skin condition assessments were performed. Results: Significant body weight reduction and decreases in fT, FSH, LH and insulin levels, as well as significant increase of serum SHBG concentrations were observed. Serum glucose levels during OGTT decreased after 6 months of treatment. Also, skin conditions improved after only three months of treatment. Conclusions: Combination of MI and DCI in a ratio 10:1 seems to be efficient in improving both metabolic and hormonal parameters in patients with PCOS.

Zespół policystycznych jajników (PCOS), a ryzyko występowania cukrzycy ciążowej (GDM)

Gestational diabetes mellitus (GDM) is a common complication of pregnancy. In the course of pregnancy, elevated levels of hormones and other proteins having insulin-antagonistic effects lead to higher insulin resistance in peripheral tissues, followed by hyperinsulinemia. Risk factors for the development of GDM have been well-established. However, the debate whether polycystic ovary syndrome (PCOS) may predispose to GDM continues. Patients with PCOS are often affected by obesity, dyslipidemia, hyperinsulinemia ,and tissue-specific insulin resistance. Obesity occurs in 50% of the cases, while tissue-specific insulin resistance is observed in 20-40% of the affected patients. This paper aims at systematizing risk factors that could contribute to the development of GDM, as well as reviewing literature reports and analyses on the occurrence of a potential correlation.Cukrzyca ciążowa (gestational diabetes mellitus – GDM) jest częstym stanem patologicznym wikłającym ciążę. W przebiegu ciąży dochodzi do zwiększenia stężenia w organizmie hormonów oraz innych białek o działaniu antagonistycznym w stosunku do insuliny, co prowadzi do wzrostu insulinooporności tkanek obwodowych, a następnie do hiperinsulinemii. Pomimo, że znane są czynniki ryzyka prowadzące do rozwoju GDM, od lat toczy się dyskusja czy zespół policystycznych jajników (PCOS) może predysponować do wystąpienia cukrzycy ciążowej. U pacjentek z PCOS często występuje otyłość, dyslipidemia, hiperinsulinemia oraz brak wrażliwości tkankowej na insulinę. Otyłość występuje u 50% przypadków, a brak wrażliwości na insulinę u 20-40% pacjentek. Celem poniższego opracowania jest usystematyzowanie czynników ryzyka, które mogłyby u pacjentek z PCOS prowadzić do rozwoju GDM, a także przegląd badań oraz analiz dotyczących występowania potencjalnej korelacji

Ovarian tissue cryopresevation as a perspective for fertility preservation

Urodzenie dziecka w 2004 roku przez pacjentkę, u której z powodu choroby nowotworowej w okresie remisji przeszczepiono własną tkankę jajnikową, stanowi przełom w badaniach nad zachowaniem płodności po leczeniu przeciwnowotworowym. Jest ono wynikiem ponad 50-letnich badań nad tym zagadnieniem. Co prawda krioprezerwacja i przeszczepianie tkanki jajnikowej nadal stanowią metodę eksperymentalną, konieczne są szczególnie szersze badania nad ryzykiem reimplantacji komórek nowotworowych pacjentkom w okresie remisji choroby, jednak jest to niezwykle istotny krok w staraniach nad przywróceniem płodności tej grupie pacjentek. W poniższej pracy przedstawiono ogólną zasadę krioprezerwacji tkanki jajnikowej oraz dotychczasowe osiągnięcia w tej dziedzinie.In 2004 the first livebirth after cryopreserved ovarian tissue transplantation has been reported which is a turning point in fertility preservation after anticancer treatment and a result of almost 50 years of research. However transplantation of cryopreserved ovary is still experimental method and further study needs to be done on the risk of cancer cell reimplantation, this method is very promising for cancer patients who wants to preserve fertility after cancer treatment. This is a review of methods used for cryopreserved ovarian tissu

Rzadki przypadek wznowy PEComa (Perivascular Epithelioid Cell Tumor). Przypadek kliniczny i przegląd piśmiennictwa

Perivascular epithelioid cell tumor (PEC-oma) is a rare mesenchymal neoplasm. Literature reports more than 100 cases of PEC-oma, a third of which is of uterine or uterine retroperitoneum origin. The case of a 59-year-old woman presented here is, to the best of our knowledge, the first described fast uterine PEC-oma recurrence of the tumor of the gastrointestinal tract origin. In this text the authors also present literature review concerning this rare female tumor.Perivascular epithelioid cell tumor (PEComa), są bardzo rzadkimi guzami pochodzenia mezenchymalnego. Do dnia dzisiejszego odnotowano w piśmiennictwie ponad 100 przypadków PEComa, z czego mniej więcej 1/3 występowała w macicy lub pokrywającej ją otrzewnej (retroperitoneum). Prezentowany przypadek 59 letniej pacjentki jest według nas pierwszym przedstawiającym szybką wznowę zmiany o typie PEComa zlokalizowaną w obrębie macicy o pierwotnym punkcie wyjścia z przewodu pokarmowego. W poniższym tekście przedstawiamy także przegląd piśmiennictwa dotyczący tego rzadkiego guza kobiecego narządu rodnego

Cumulative summation test for learning curve (LC-CUSUM) in outpatient hysteroscopy

Objectives: Outpatient hysteroscopy has become an integral part of postgraduate training in gynecology. It is an operator-dependent procedure, however there are no recommendations regarding total number of performed procedures to reach proficiency. Material and methods: This study aimed to assess the learning curve (LC) using cumulative summation test for learning curve (LC-CUSUM). Results: A success rate of 97% a failure rate ≥ 10% were established to denote an adequate and an inadequate performance. A third-year trainee needed 56 procedures to reach the predefined level of performance. Conclusions: As the length of the LC for outpatient hysteroscopy seems highly variable, it is reasonable to provide tailored monitoring while training

Perinatal outcome analysis of twin pregnancies at the Department of Obstetrics and Gynecology Central Clinical Hospital of Ministry of Interior and Administration in Warsaw in the years 2005-2006.

A group of 59 twin pregnant women who gave birth at the Department of Obstetrics and Gynecology Central Clinical Hospital of Ministry of Interior and Administration in Warsaw in the years 2005-2006. The patients have been divided into four groups: spontaneous twin pregnant women (n=16), twin pregnant women after in- vitro fertilization (IVF) (n=11), twin pregnant women after in-vitro fertilization with intracytoplasmic sperm injection (ICSI) (n=29) and twin pregnant women after ICSI and transfer of frozen embryos (n=3). In one case intrauterine death of one of twins in the 34th week of gestation has been noticed. The cause of the death was umbilical cord wrapped around his neck. The gestation was ended with cesarean section and Apgar score of the second twin was 8 in the fifth minute. In one case there was an urgent indication for a cesarean delivery of children with a very low birth weight (because of intrauterine infection, preterm labor in progress) and in three cases at least one of twins with a low birth weight. Among the group 19 women (32%) have given birth prematurely. The Apgar score in the first, third and fifth minute has been statistically significant and inversely proportional dependent only on the gestational age. There were no differences in birth weight among study groups regardless the way of conception. Only two spontaneous twin pregnant patients have had a vaginal labor. By the remaining 57 patients there has been an elective cesarean section in thirty five cases and there has been an urgent indication for cesarean section in twenty two cases