Ovarian reserve assessment in women with different stages of pelvic endometriosis

Introduction: Endometriosis is defined as the appearance of ectopic endometrial cells outside the uterine cavity. Ectopic cells demonstrate functional similarity to eutopic cells, but structural and molecular differences are significant and manifest themselves in gene expression of the metalloproteinase genes, integrin or the Bcl-2 gene. Pelvic pain remains to be the main symptom of the disease. Endometriosis may cause dysfunction of the reproductive system and lead to infertility. Pathogenesis of infertility in endometriosis is based on its influence on the hormonal, biochemical and immunological changes in the eutopic endometrium, as well as structural damages of the ovaries and the fallopian tubes. Objectives: The aim of the study was to assess the ovarian reserve in patients with endometriosis. Material and methods: A total of 39 patients (aged 22-34 years) with different stages of endometrial changes were recruited for the study. The number of antral follicles was rated by vaginal ultrasonography and the level of FSH was measured between days 1-3 of the menstrual cycle. The stage of the disease was established after laparoscopy with the rASRM scale. Results:No statistically significant correlation between the number of follicles(AFC), the level of FSH and the stage of endometriosis was found. Conclusions: Evaluation of the number of antral follicles and measurements of the FSH level do not allow to predict the ovarian reserve in women with endometriosis

Cardiac sympathetic hyperactivity in chronic kidney disease — a comparison between haemodialysis and peritoneal dialysis patients

BACKGROUND: The effect of renal replacement therapy on cardiac sympathetic function in patients with chronic kidney disease has not yet been completely elucidated. The aim of this study was to evaluate the impact of renal replacement therapy on the activity of cardiac sympathetic nervous system. MATERIAL AND METHODS: Thirty-four patients with chronic kidney disease were studied: 14 patients (6 men, mean age 48 ± 11 years) were receiving peritoneal dialysis (PD) and 20 patients (20 men, mean age 52 ± 10 years) were receiving haemodialysis (HD). Patients with diabetes and heart failure were excluded from the study. All patients underwent resting gated myocardial perfusion and 123I-mIBG myocardial scintigraphy from which early and late heart to mediastinum ratios (HRM) and myocardial washout rate (WR) values were calculated. RESULTS: PD and HD patients did not differ with respect to left ventricular ejection fraction (52 ± 9% vs. 57 ± 7%) and summed rest score (3.8 ± 2.4 vs. 3.5 ± 0.3). Similarly, early (1.89 ± 0.23 vs. 1.87 ± 0.27) and late (1.76 ± 0.47 vs. 1.74 ± 0.25) HMR, and washout rate (35.5 ± 15.8% vs. 31.3 ± 9.4%) were not significantly different between the two groups of patients. CONCLUSIONS: These results suggest that the applied method of renal replacement therapy has no significant influence on global activity of cardiac sympathetic nervous system

Early fetal cardiac scan as an element of the sonographic first-trimester screening

Early fetal cardiac scan (EFCS) is becoming an increasingly common element of the first trimester ultrasound screening carried out at 11-14 gestational weeks. It offers the first possibility to detect congenital heart defects (CHD) or, in ambiguous cases, to identify those pregnancies where a more detailed cardiac scan would be required later in pregnancy. The size of the fetal heart at the end of the first trimester and the associated relatively low image resolution make it impossible to capture all cardiac data to inform the ultimate picture. However, even at this stage, cues of anatomical and functional abnormalities can be picked up, which suggest not only a CHD, but also a likelihood of cardiovascular symptoms typical of genetic disorders. EFCS should focus on cardiac position, atrioventricular (AV) connections, AV valve function, initial assessment of ventriculo-arterial (VA) connections and the presence of red flag signs in the three vessel and trachea view (3VTV). Proper use of color Doppler mapping makes it possible to overcome the low resolution of B-mode to a certain extent. Here we present our long-term experience in EFCS

Ciąża w bliźnie po cięciu cesarskim

Pregnancy in the uterine scare after previous caesarean section is the rarest type of ectopic pregnancy. Due to the possibility of life-threatening complications, cesarean scar pregnancy (CSP) needs rapid and proper diagnosis and management. Hereby we present 3 cases of women with CSP, diagnosed and treated at the Department of Gynecology and Obstetrics of Jagiellonian University Medical College, in Krakow, in 2013, as well as literature review.Ciąża w bliźnie po cięciu cesarskim stanowi najrzadszą postać ciąży pozamacicznej. Ze względu na ryzyko wystąpienia zagrażających życiu powikłań wymaga sprawnego rozpoznania oraz leczenia. Poniżej prezentujemy 3 przypadki pacjentek z ciążą w bliźnie po cięciu cesarskim leczonych w Klinice Ginekologii SU w Krakowie w 2013 roku oraz przegląd piśmiennictwa

Przezkroczowa ultrasonograficzna diagnostyka zaburzeń statyki narządu rodnego i nietrzymania moczu

The examination standards developed so far, including the analysis of the quantitative parameters, greatly minimize the potential subjectivity of the assessment of the existing disorders. Apart from its low costs, the main value of the sonographic examination of the pelvic floor is the possibility to dynamically assess the changes in statics which take place during functional testing. Not only does it have a cognitive significance, but also it allows to adjust the scope of the surgical correction to the existing damages. Thus, indirectly, it can contribute to the reduction of a number of subsequent remedial surgeries. Three-dimensional sonography allows to thoroughly examine the construction and functioning of the anal levators and to detect their possible damage. It is the trauma to these muscles - occurring, among others, during childbirth - that is one of the major causes of pelvic organs descent and prolapse in women. Sonographic examination also enables to visualize the artificial material, the use of which is increasingly frequent in the surgical treatment of pelvic organs prolapse. The remedial kits currently in use are not visible in classic X-ray examinations and CT, however, they can be easily visualized by means of a sonographic test. This way it is possible to locate the positioned tapes or meshes and to establish their orientation towards the urethra, the bladder and the anus. It is also possible to observe the complications (e.g. hematomas) following the surgical procedures via the transvaginal access. Transperineal sonography is a relatively inexpensive method that may be performed in almost every ultrasonographic laboratory. Its value, approaching the MRI diagnostic value in the assessment of the pelvic floor defects and its low cost, place ultrasonography on the first place among the methods of imaging the pelvic and uro-genital diaphragm. The results of diagnostics of pelvic organs prolapse obtained by placing the sonographic head on the patient’s perineum may also help in establishing the changes of the support apparatus for the uterus and the vagina, bladder, urethra and perineum during functional testing and, thus, to verify the clinically established degree of the prolapse. It seems, also, that this method may be used during peri-urethral injections of specific substances and postapplication follow-up, an increasingly frequently employed method of urinary incontinence treatment.Postęp technologiczny jaki dokonuje się w konstrukcji aparatów ultrasonograficznych i coraz powszechniejszy do nich dostęp sprawia, że zakres diagnostycznego zastosowania badania ultrasonograficznego znacznie się poszerza. Dotyczy to także zaburzeń statyki narządu rodnego. Aktualnie stosowane w codziennej praktyce położniczo-ginekologicznej zestawy ultrasonograficzne, pozwalają uzyskać wgląd w struktury tworzące dno żeńskiej miednicy mniejszej, a uzyskane obrazy mogą stanowić wartościowe uzupełnienie badania fizykalnego. Aplikacja głowicy ultrasonograficznej na krocze pacjentki umożliwia wizualizację trzech kompartmentów żeńskiej miednicy mniejszej. Po zamrożeniu obrazu można dokonać oceny położenia struktur anatomicznych w stosunku do kości i wyznaczonych płaszczyzn , ustalić wzajemne odległości oraz zmierzyć odpowiednie kąty. Najwięcej informacji uzyskuje się w ten sposób w zakresie kompartmentu przedniego, którego uszkodzenia często łączą się z nietrzymaniem moczu. Wypracowane do tej pory standardy badania obejmujące także analizę parametrów ilościowych, w znacznym stopniu minimalizują subiektywność oceny istniejących zaburzeń. Istotną wartością ultrasonografii dna miednicy mniejszej oprócz niewysokich kosztów jest możliwość dynamicznej oceny zmian statyki do jakich dochodzi podczas testów czynnościowych. Ma to nie tylko znaczenie poznawcze lecz także pozwala na dostosowanie zakresu korekcji chirurgicznej do istniejących uszkodzeń. W sposób pośredni może więc przyczynić się do zmniejszenia ilości kolejnych operacji naprawczych. Ultrasonografia trójwymiarowa umożliwia z kolei dokładne prześledzenie budowy i funkcji mięśni dźwigaczy odbytu oraz detekcję ich ewentualnych uszkodzeń. To właśnie urazy tych mięśni do których dochodzi np. podczas porodu są jedną z głównych przyczyn obniżenia i wypadania narządu rodnego u kobiet. W badaniu ultrasonograficznym można również dokonać wizualizacji materiału sztucznego, który jest stosowany coraz częściej w chirurgicznym leczeniu zaburzeń statyki