Hormonalna terapia zastępcza a choroby układu sercowo-naczyniowego

The results of large randomized trials such as the Women's Health Initiative (WHI), Heart and Estrogen / Progestin Replacement Study (HERS) or Estrogen Replacement and Atherosclerosis Study (ERAS) as well as the Million Women Study (MWS) which does not meet criteria RCT, concerning, among others the impact of HRT on breast cancer risk, thromboembolism, or the aging processes in the central nervous system caused the recent big confusion in the medical community , causing distrust about the safety and advisability of HRT in menopausal women. The paper presents an overview of the available, current literature on HRT. It was found that HRT should not be used in both primary and secondary prevention of coronary heart disease Great expectations was associated with an earlier initiation of therapy, before the advent of atherosclerosis - but there is currently no conclusive data about its role in the primary prevention of coronary disease. Oral HRT increases the risk of thromboembolic events - that is why you should prefer the form of a transdermal. HRT may increase the risk of ischemic stroke (but early initiation of therapy does not increase the risk of stroke) and should not be used in the primary prevention of stroke.Wyniki dużych randomizowanych badań klinicznych, takich jak Women’s Health Initiative (WHI), Heart and Estrogen/Progestin Replacement Study (HERS), czy Estrogen Replacement and Atherosclerosis Study (ERAS), jak również niespełniającego kryterium RCT dużego badania Million Women Study (MWS), dotyczących m.in. wpływu HTZ na ryzyko raka piersi, powikłania zakrzepowo-zatorowe, czy procesy starzenia w ośrodkowym układzie nerwowym wywołały w ostatnim czasie duże zamieszanie w środowisku lekarskim, powodując nieufność, co do bezpieczeństwa i celowości stosowania HTZ u kobiet menopauzalnych. Praca przedstawia przegląd dostępnej, aktualnej literatury na ten temat. Stwierdzono, ze nie należy stosować HTZ zarówno w pierwotnej, jak i wtórnej prewencji choroby niedokrwiennej serca. Duże nadzieje wiąże się z wcześniejszym rozpoczęciem terapii, przed pojawieniem się zmian miażdżycowych – obecnie brak jest jednak jednoznacznych danych o jej roli w pierwotnej prewencji choroby niedokrwiennej. Doustna HTZ zwiększa ryzyko zdarzeń zakrzepowo-zatorowych – dlatego należy preferować formę transdermalną. HTZ może zwiększać ryzyko udaru niedokrwiennego (ale wczesne rozpoczęcie terapii nie wpływa na zwiększenie ryzyka udaru). HTZ nie należy stosować w pierwotnej prewencji udaru mózgu

Effect of pregabalin on contextual memory deficits and inflammatory state-related protein expression in streptozotocin-induced diabetic mice

Diabetes mellitus is a metabolic disease characterized by hyperglycemia due to defects in insulin secretion or its action. Complications from long-term diabetes consist of numerous biochemical, molecular, and functional tissue alterations, including inflammation, oxidative stress, and neuropathic pain. There is also a link between diabetes mellitus and vascular dementia or Alzheimer’s disease. Hence, it is important to treat diabetic complications using drugs which do not aggravate symptoms induced by the disease itself. Pregabalin is widely used for the treatment of diabetic neuropathic pain, but little is known about its impact on cognition or inflammation-related proteins in diabetic patients. Thus, this study aimed to evaluate the effect of intraperitoneal (ip) pregabalin on contextual memory and the expression of inflammatory state-related proteins in the brains of diabetic, streptozotocin (STZ)-treated mice. STZ (200 mg/kg, ip) was used to induce diabetes mellitus. To assess the impact of pregabalin (10 mg/kg) on contextual memory, a passive avoidance task was applied. Locomotor and exploratory activities in pregabalin-treated diabetic mice were assessed by using activity cages. Using Western blot analysis, the expression of cyclooxygenase-2 (COX-2), cytosolic prostaglandin E synthase (cPGES), nuclear factor (erythroid-derived 2)-like 2 (Nrf2), nuclear factor-ĸB (NF-ĸB) p50 and p65, aryl hydrocarbon receptor (AhR), as well as glucose transporter type-4 (GLUT4) was assessed in mouse brains after pregabalin treatment. Pregabalin did not aggravate STZ-induced learning deficits in vivo or influence animals’ locomotor activity. We observed significantly lower expression of COX-2, cPGES, and NF-κB p50 subunit, and higher expression of AhR and Nrf2 in the brains of pregabalin-treated mice in comparison to STZ-treated controls, which suggested immunomodulatory and anti-inflammatory effects of pregabalin. Antioxidant properties of pregabalin in the brains of diabetic animals were also demonstrated. Pregabalin does not potentiate STZ-induced cognitive decline, and it has antioxidant, immunomodulatory, and anti-inflammatory properties in mice. These results confirm the validity of its use in diabetic patients. [Figure: see text

STUMP – atypowy mięśniak macicy - mimikra guza złośliwego?

Cel pracy: Praca opisuje diagnostykę ultrasonograficzną oraz postępowanie w unikalnej, rzadkiej postaci mięśniaków, jaką jest ich atypowa odmiana. Atypowy mięśniak macicy zgodnie z definicją wg WHO nie może być jednoznacznie zakwalifikowany ani jako zmiana łagodna ani złośliwa. Atypowe mięśniaki macicy charakteryzują się umiarkowaną lub wysoką liczbą wielopostaciowych, atypowych komórek nowotworowych z małą liczbą podziałów mitotycznych i brakiem martwicy skrzepowej w obrębie guza. Mają one niski wskaźnik pozamacicznych, wewnątrzbrzusznych nawrotów i znikome ryzyko przerzutów odległych. Występują bardzo rzadko, dlatego stanowią wyzwanie diagnostyczne dla ginekologa-położnika, a pewne rozpoznanie można postawić tylko na podstawie badania histopatologicznego. W prezentowanej pracy przedstawiamy przypadek pacjentki, u której w dnie macicy stwierdzono echo o średnicy 92 mm o niejednorodnej echogeniczności z widocznymi polami bezechowymi, a zastosowanie kodowania przepływu krwi w technice HD doppler wykazało bogatą waskularyzację zarówno obwodowo, jak i centralnie w obrębie guza. W skali wg Exacoustos waskularyzację obwodową oceniono na 4/4 pkt, centralną na 4/4 pkt. Oceniana zmiana w macicy spełniała kryteria wysokiego prawdopodobieństwa zmiany złośliwej, tj. skala naczyniowa 8 pkt (power doppler ≥7 pkt.), zmiana lita, wielkość powyżej 8 cm. Oceniono również prędkość przepływu krwi w naczyniach guza oraz opór naczyniowy ( PSV – 5,76 cm/s, ED – 3,16 cm/s, RI – 0,45, S/D – 1,82). Analizowany przepływ krwi w guzie miał charakter niskooporowy. Wykonano histerektomię brzuszną z przydatkami, z doraźnym badaniem histopatologicznym, które potwierdziło obecność zmiany o charakterze mięśniaka. Guz był miękki, barwy żółtej, z rozproszoną atypią małego i średniego stopnia w badaniu mikroskopowym. Martwicy ani figur podziału mitotycznego nie stwierdzono. Obraz odpowiadał mięśniakowi atypowemu (ang. atypical leiomyoma of low risk of reccurence). Atypowe mięśniaki macicy stanowią rzadkość w onkologii ginekologicznej i nie cechują się charakterystycznym przebiegiem klinicznym. Ponadto nie wykazują typowych cech w badaniach obrazowych, w tym w diagnostyce ultrasonograficznej. Niekiedy ze względu na obraz ultrasonograficzny należy różnicować je z mięsakami. Ze względu na niejednoznaczne cechy histologiczne konieczne jest wykluczenie procesu złośliwego.This study describes the ultrasound diagnostic process and management in a patient with a unique, rare form of fibroids, i.e. the atypical variant. According to the WHO definition, an atypical uterine myoma cannot be histologically unambiguously diagnosed as benign or malignant. Atypical leiomyomas are characterized by moderate or high quantity of pleomorphic atypical tumor cells, with a small number of mitotic divisions and lack of coagulative necrosis in the tumor. They have a low rate of extrauterine, intraabdominal recurrence, with a negligible risk for distant metastases. Due to the fact the atypical variant of leiomyomas is very rare, it presents a significant diagnostic challenge for obstetricians. The most reliable diagnosis can be made only on the basis of the histopathological examination. In this paper, we present a case of a patient in whom an echo with the diameter of 92 mm and a heterogeneous echogenicity with visible anechoic fields were discovered in the uterine fundus. HD color Doppler demonstrated high vascularization within the tumor, peripherally as well as centrally. The peripheral and central vascularization was rated at 4/4 points on a scale by Exacoustos. The tumor in the uterus met the criteria of high probability of malignancy i.e. 8 points on the vascular scale (power Doppler scale ≥ 7 pts.), solid tumor and a size over 8 cm. Blood flow velocity and vascular resistance in the tumor vessels were evaluated (PSV - 5.76 cm/s, ED - 3.16 cm/s, RI - 0.45 S / D - 1.82). Blood flow in the tumor presented low resistance. Hysterectomy without oophorectomy, with an intraoperative histopathological examination, was performed, and a fibroid was confirmed. The tumor was soft, yellow, with small and medium level of dispersed atypia in microscopic examination. There was no necrosis or mitotic figures. The histopathological image confirmed the atypical leiomyoma of low risk of recurrence. Atypical fibroids are rare in gynecological oncology and they do not have the characteristic clinical course. Furthermore, they do not show the typical characteristics during imaging studies, including ultrasound screening, Sometimes, due to the sonographic image, they should be differentiated from sarcomas. Also, it is necessary to exclude malignancy because of their ambiguous histological characteristics

Clinical and hormonal features of women with polycystic ovary syndrome living in rural and urban areas

Introduction Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies among women at reproductive age, but its pathology remains unknown. From epidemiological studies it is known that endogenous, mainly genetic and exogenous, environmental factors are of importance. Objective The aim of the study was to compare the phenotype of women diagnosed with PCOS from urban and rural areas of Poland. According to the knowledge of the authors, this is first such study. Material and Methods The retrospective study included 3,877 PCOS patients: 2511 women living in cities and 1,366 village inhabitants, aged between 18 – 45 years. Clinical data, including medical history, body mass, height and hirsutism severity was obtained from each patient. Hormones were also tested in each patient: follicle stimulating hormone, luteinizing hormone, prolactin, estradiol [E2], testosterone, dehydroepiandrosterone sulphate [DHEAS], thyroid stimulating hormone, free thyroxin, insulin [INS], 17 hydroxyprogesterone, cortisol [CORT]) and metabolic (75g oral glucose tolerance test, Chol – total cholesterol, HDL-C – high density lipoprotein cholesterol, LDL-C low density lipoprotein cholesterol, and the TG (triglicerides) profile. Results PCOS women from urban areas had a higher mean serum concentration of E2 in comparison to the inhabitants of rural areas. Women from cities had a lower mean level of DHEAS, CORT, and INS measured in the morning than rural residents. Insulin-resistance, using homeostasis model assessment, was more pronounced among women from villages. The prevalence of menstrual disorders, in general, was higher in PCOS women living in rural comparing to urban areas. Conclusions The clinical and biochemical indices differed significantly between women diagnosed with PCOS living in cities and villages. In general in Poland, the PCOS phenotype is more severe in women living in rural areas. This study shows that different living conditions significantly affect the PCOS phenotype

Clinical and hormonal features of women with polycystic ovary syndrome living in rural and urban areas

Introduction Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies among women at reproductive age, but its pathology remains unknown. From epidemiological studies it is known that endogenous, mainly genetic and exogenous, environmental factors are of importance. Objective The aim of the study was to compare the phenotype of women diagnosed with PCOS from urban and rural areas of Poland. According to the knowledge of the authors, this is first such study. Material and Methods The retrospective study included 3,877 PCOS patients: 2511 women living in cities and 1,366 village inhabitants, aged between 18 – 45 years. Clinical data, including medical history, body mass, height and hirsutism severity was obtained from each patient. Hormones were also tested in each patient: follicle stimulating hormone, luteinizing hormone, prolactin, estradiol [E2], testosterone, dehydroepiandrosterone sulphate [DHEAS], thyroid stimulating hormone, free thyroxin, insulin [INS], 17 hydroxyprogesterone, cortisol [CORT]) and metabolic (75g oral glucose tolerance test, Chol – total cholesterol, HDL-C – high density lipoprotein cholesterol, LDL-C low density lipoprotein cholesterol, and the TG (triglicerides) profile. Results PCOS women from urban areas had a higher mean serum concentration of E2 in comparison to the inhabitants of rural areas. Women from cities had a lower mean level of DHEAS, CORT, and INS measured in the morning than rural residents. Insulin-resistance, using homeostasis model assessment, was more pronounced among women from villages. The prevalence of menstrual disorders, in general, was higher in PCOS women living in rural comparing to urban areas. Conclusions The clinical and biochemical indices differed significantly between women diagnosed with PCOS living in cities and villages. In general in Poland, the PCOS phenotype is more severe in women living in rural areas. This study shows that different living conditions significantly affect the PCOS phenotype