Destructive methods in uterine bleeding outpatient treatment

Wprowadzenie w latach 80. ubiegłego stulecia ablacji jako nowej techniki leczenia zachowawczego krwawień macicznych spowodowanych nieprawidłowym rozrostem endometrium znacząco ograniczyło odsetek histerektomii wykonywanych z tego powodu. Metoda ta zyskuje coraz więcej zwolenników. Ablacja endometrium przy użyciu histeroskopii dotyczy trzech sposobów usuwania endometrium, które są określane jako techniki pierwszej generacji. Są to: przezszyjkowa resekcja endometrium, destrukcja endometrium elektrodą obrotową i destrukcja endometrium przy użyciu lasera. W oparciu o materiał własny histeroskopowej ablacji endometrium, obejmujący 876 przypadków histeroskopowej resekcji endometrium i 51 przypadków destrukcji endometrium przy użyciu elektrody obrotowej, przedstawiono doświadczenia i obserwacje oraz skuteczność tych zabiegów. W latach 90. ubiegłego stulecia zaczęto wprowadzać metody wykorzystujące różne rodzaje energii do destrukcji endometrium, określane jako techniki ablacji drugiej generacji. Są to: termiczne balony śródmaciczne (system therma choice), metoda wodno-termiczna (system hydroterm), wieloelektrodowy system balonowy, metoda mikrofalowa, krioablacja endometrium oraz endometrialna wewnątrzmaciczna terapia laserowa. Warunkiem stosowania tych metod jest wykluczenie atypii endometrium i możliwość następowej kontroli lekarskiej. Najbardziej powszechną metodą ablacji endometrium drugiej generacji jest system therma choice. Mimo że najskuteczniejszą metodą jest histeroskopowa resekcja endometrium, to jednak techniki destrukcyjne są łatwiejsze do wykonania, mniej inwazyjne i powodują mniejszą liczbę powikłań.Introduction of the ablation, in the 1980s, as a new technique of conservative management of metrorrhagia due to endometrial hyperplasia has significantly decreased the percentage of hysterectomies and is gaining more attention. Endometrial ablation with the use of hysteroscopy refers to three methods of endometrial removal, which are defined as the first generation techniques. This group comprises transcervical endometrial resection, endometrial destruction with the revolving electrode and the laser endometrial destruction. Based on our own hysteroscopic endometrial ablation material, which comprises 876 cases of hysteroscopic endometrial resection and 51 cases of endometrial destruction by the revolving electrode, our observations, experience and the efficacy of these procedures have been discussed. In the 1990s new methods using different types of energy for endometrial destruction, known as the second generation techniques, were introduced. This group consists of thermal intracavitary balloons (ThermaChoice System), hydro-thermic method (Hydrotherm System), multielectrode balloon system, microwave method, endometrial cryoablation and endometrial intrauterine laser therapy. These methods may be used provided that endometrial atypia had been excluded and a regular follow-up is possible. The most common method of endometrial ablation is one of the second generation techniques: ThermaChoice System. Although hysteroscopic endometrial resection is the most efficient method, the destructive methods are less invasive, easier to perform and involve fewer complications

Efficient myoblast expansion for regenerative medicine use

Cellular therapy using expanded autologous myoblasts is a treatment modality for a variety of diseases. In the present study, we compared the commercial skeletal muscle cell growth medium-2 (SKGM-2) with a medium designed by our group for the expansion of skeletal myoblasts. The use of an in-house medium [DMEM/F12 medium supplemented with EGF, bFGF, HGF, insulin and dexamethasone (DFEFH)] resulted in a greater number of myoblast colonies (>50%) and a 3-, 4- and 9-fold higher proliferation rate, eventually resulting in a 3-, 7- and 87-fold greater number of cells at the 1st, 2nd and 3rd passage, respectively, compared with the cells grown in SKGM-2 medium. The average CD56 expression level was higher in the myoblasts cultured in DFEFH than in those culturd in SKGM-2 medium. At the 3rd passage, lower expression levels of myostatin and considerably higher expression levels of myogenin were observed in the cells that were grown in DFEFH medium. The results of our study indicated that myoblasts cultured in both medium types displayed fusogenic potential at the 3rd passage. Furthermore, it was shown that cells cultured in DFEFH medium created myotubes with a considerably higher number of nuclei. Additionally, we observed that the fusion potential of the cells markedly decreased with the subsequent passages and that the morphology of the myoblasts differed between the 2 cultured media. Our data demonstrate that culture in the DFEFH medium leads to an approximately 90-fold greater number of myoblasts, with improved morphology and greater fusion potential, compared with culture in the commercial SKGM-2 medium

Use of Tc99m-nanocolloid for sentinel nodes identification in cervical cancer

BACKGROUND: The initial draining lymph node for a primary tumor is referred to as the “sentinel” node. Firstly adopted in the management of patients with cutaneous melanoma and breast cancer, it is now widely tested in cervical cancer. In patients with cervical cancer, lymph node status is the most important prognostic factor for survival. In patients with cervical cancer FIGO stage I and II pelvic lymph node metastases are expected in 0–16 and 24.5-31% and para-aortic lymph node metastases are expected in 0–22 and 11–19% of patients. The removal of pelvic and para-aortic lymph nodes is essential for assessing the biology of the disease. Lymphoscintigraphy enables the visualisation of lymphatic drainage patterns from a great variety of tumour sites prior to surgery. Therefore, the current procedure is to perform the pre-operative mapping of sentinel nodes by static and/or dynamic lymphoscintigraphy, followed by in vivo identification using a gamma detection probe and selective surgical resection. MATERIAL AND METHODS: Between 2001–2003, 37 patients with cervical cancer FIGO stage I-IIa were seemed to be qualified to undergo lymphoscintigraphy. The day before surgery 99mTc-nanocolloid (100 MBq; 0.5–1.0 ml in volume) was applied in each quadrant of the cervix or around the tumor. The static scintigraphic scans were performed after 2 hours p.i. using a dual-head large-field-of-view Siemens gamma-camera equipped with high resolution collimators. SNs were identified intra-operatively using a handheld gamma detection probe (Navigator GPS-Tyco) and intra-operative lymphatic mapping with blue dye. After a resection of the SNs, a standard radical hysterectomy with pelvic and low para-aortic lymph node dissection was performed. Tumor characteristics were compared with sentinel node detection and with the histopathological and immunohistochemical results. RESULTS: The scintigraphy showed a focal uptake in 35 of the 37 patients. In all women one or more sentinel lymph nodes were identified intra-operatively. Of them, 24 patients had those located bilaterally. Histologically positive SNs were found in 5 women (13.5%). CONCLUSIONS: A combination pre-operatively administered radioactively labelled albumin with blue dye allows the successful detection of SN in patient with cervical cancer. This technique will result in a real advance in the less aggressive management of patients with early stage cervical cancer. Sentinel lymph node status may be representative of the pelvic lymph nodes status in cervical cancer and thus could provide important information for further treatment

Use of Tc99m-nanocolloid for sentinel node identification in cervical cancer

BACKGROUND: The initial draining lymph node for a primary tumor is referred to as the “sentinel” node. Firstly adopted in the management of patients with cutaneous melanoma and breast cancer, it is now widely tested in cervical cancer. In patients with cervical cancer, lymph node status is the most important prognostic factor for survival. In patients with cervical cancer FIGO stage I and II pelvic lymph node metastases are expected in 0–16 and 24.5-31% and para-aortic lymph node metastases are expected in 0–22 and 11–19% of patients. The removal of pelvic and para-aortic lymph nodes is essential for assessing the biology of the disease. Lymphoscintigraphy enables the visualisation of lymphatic drainage patterns from a great variety of tumour sites prior to surgery. Therefore, the current procedure is to perform the pre-operative mapping of sentinel nodes by static and/or dynamic lymphoscintigraphy, followed by in vivo identification using a gamma detection probe and selective surgical resection. MATERIAL AND METHODS: Between 2001–2003, 37 patients with cervical cancer FIGO stage I-IIa were seemed to be qualified to undergo lymphoscintigraphy. The day before surgery 99mTc-nanocolloid (100 MBq; 0.5–1.0 ml in volume) was applied in each quadrant of the cervix or around the tumor. The static scintigraphic scans were performed after 2 hours p.i. using a dual-head large-field-of-view Siemens gamma-camera equipped with high resolution collimators. SNs were identified intra-operatively using a handheld gamma detection probe (Navigator GPS-Tyco) and intra-operative lymphatic mapping with blue dye. After a resection of the SNs, a standard radical hysterectomy with pelvic and low para-aortic lymph node dissection was performed. Tumor characteristics were compared with sentinel node detection and with the histopathological and immunohistochemical results. RESULTS: The scintigraphy showed a focal uptake in 35 of the 37 patients. In all women one or more sentinel lymph nodes were identified intra-operatively. Of them, 24 patients had those located bilaterally. Histologically positive SNs were found in 5 women (13.5%). CONCLUSIONS: A combination pre-operatively administered radioactively labelled albumin with blue dye allows the successful detection of SN in patient with cervical cancer. This technique will result in a real advance in the less aggressive management of patients with early stage cervical cancer. Sentinel lymph node status may be representative of the pelvic lymph nodes status in cervical cancer and thus could provide important information for further treatment

Ocena jakości życia kobiet w 2 i 4 lat po transplantacji komórek pochodzących z mięśni w leczeniu wysiłkowego nietrzymania moczu

Introduction: Regenerative medicine for the treatment of urinary incontinence has become a popular area of focus in the search for therapies for this disease. The paper focused on women’s quality of life assessment who were subjected to transplantation of MDSC (autologous muscle derived stem cells) to the urethral sphincter. Methods: The procedure was conducted in 16 female patients who completed the observation stage. Assessment of quality of life before and after the treatment (two and four years post-operation) was conducted based on the validated I-QOL questionnaire (the Polish language version). Results: The questionnaire study showed that autologous cell therapy significantly improves quality of life in female patients suffering from stress urinary incontinence (SUI). The total I-QOL score increased from 49 (SD ± 7.7) before therapy to 77 (SD ± 5.4) two years post-operation. Four years after the procedure, quality of life remained at a higher level than before therapy, although quality of life decreased by several points when compared with the results from the two-year follow-up – 63 (SD ± 7.2). Patients reported significantly less concern related to their ability to reach the toilet to avoid incontinence, improved sleep at night, a higher level of satisfaction with life, and more satisfaction with their sexual lives (p<0.05). Conclusion: The MDSC injection procedure for SUI treatment has significant improved quality of life in the majority of our patients in 2 and 4 year follow-up  Cel pracy: Medycyna regeneracyjna w leczeniu nietrzymania moczu stała się popularnym obszarem zainteresowania w poszukiwaniu metod leczenia tej choroby. Celem niniejszej pracy była ocena jakości życia u kobiet poddanych transplantacji autologicznych dojrzałych komórek pochodzących z mięśni (MDSC) do zwieracza cewki moczowej. Materiał i metody: Badanie zostało przeprowadzone w grupie 16 pacjentek, które ukończyły etap obserwacji. Do oceny jakości życia przed i po leczeniu (w dwa i cztery lata po zabiegu) wykorzystano kwestionariusz I-QOL (polska wersja językowa). Wyniki: Badania ankietowe wykazało, że terapia z wykorzystaniem autologicznych komórek mięśniowych w znacznym stopniu poprawia jakość życia pacjentek cierpiących z powodu wysiłkowego nietrzymania moczu (WNM). Całkowity wynik I-QOL wzrósł z 49 ± 7,7 (SD) przed leczeniem do 77 (SD ± 5,4) dwa lata po zabiegu. Cztery lata po zabiegu, jakość życia pozostał na poziomie wyższym niż przed leczeniem, chociaż zmniejszyła się o kilka punktów w porównaniu z wynikami z dwóch lat obserwacji - 63 (SD ± 7,2). Pacjentki zgłaszały znacznie mniej objawów związanych z ich możliwością dotarcia do toalety, wyższy poziom zadowolenia z życia i więcej satysfakcji z życia seksualnego (p <0,05). Wnioski: Zastosowana procedura MDSC do leczenia wysiłkowego nietrzymania moczu skutecznie poprawiła jakość życia u większości analizowanych pacjentek po 2 i 4 latach od zbiegu.

Influence of vaginal biocoenosis on the presence of persistent atypical squamous cells and atypical glandular cells in Pap smear – a 3-year study

Abstract Aim of the study: the evaluation of influence of abnormal vaginal biocoenosis on presence and maintenance ASC and AGC in Pap smears. Methods: The study group consisted of 242 non-pregnant women (25-65 years of age): 207 women (4.96%) with atypical sqamous cells and 35 (0.7%) with atypical glandular cells. In all women the vaginal flora was assessed by Nugent scale. Results: Vaginal flora was normal in 157 (75.8%) and pathological in 50 (24.1%) women with ASC. In the ASC subgroup, the highest proportion of physiological vaginal flora was observed in 151 patients (77.4%) with ASC-US, in comparison to 44 (22.6%) with ASC-H, in which the percentage of women with normal or abnormal flora was the same (50%vs 50%). This difference was statistically significant. In case of AGC, vaginal culture was physiological in 23 (65.7%) women, and in 12 (34.3%) abnormal vaginal flora with features of the inflammation. The statistically significant influence of abnormal vaginal flora on the presence of atypical endometrial and endocervical cells was not observed. Conclusions: We did not observed any influence of abnormal vaginal flora on the presence, regression and progression of ASC and AGC