Premature rupture of membranes before 34 weeks of pregnancy as a medical problem

Pęknięcie błon płodowych przed 37 tygodniem ciąży zdarza się u 2-3% ciężarnych i jest główną przyczyną przedwczesnych porodów. W każdym przypadku bardzo komplikuje to dalsze prowadzenie ciąży. Skala problemów jest tym większa im wcześniejszy jest wiek ciążowy. Praca podsumowuje współczesną wiedzę na temat epidemiologii, diagnostyki, monitorowania i dostępnych metod leczenia oraz wyników leczenia tego poważnego powikłania.Rupture of membranes before 37 weeks of pregnancy occurs in 2-3% of all pregnant women and is the leading cause of premature birth. It always significantly complicates the course of pregnancy. The scale of the problem increases with decreasing gestational age. This paper summarizes the current state of knowledge on epidemiology, diagnosis, monitoring, available methods of treatment, and the outcome of this serious complication

Sperm DNA adducts impair fertilization during ICSI but not during IVF.

Many studies emphasize the influence of the status of spermatozoal nucleus on fertilization, mainly with regard to DNA fragmentation. This study was undertaken to analyze the influence of DNA adducts content in spermatozoa on fertilization during assisted reproduction. Ovarian hyperstimulation, oocyte retrieval and laboratory work-up in 61 IVF (in vitro fertilization) and 118 ICSI (intracytoplasmic sperm injection) first cycles were performed according to the same protocol. Semen analysis was made according to WHO Manual (1999). DNA adducts assay in spermatozoa was performed by 32Ppostlabeling method. In total 331 fertilizable oocytes were obtained during IVF and 659 during ICSI. Both groups differed significantly by sperm count, motility and morphology but not by the concentration of DNA adducts in spermatozoa (0.0306 +/- 0.0217 in IVF versus 0.0373 +/- 0.0321 in ICSI). The fertilization rate during IVF was significantly influenced by sperm count (p=0.0002) and motility (p=0.0037) but not by DNA adducts concentration (p=0.30528), whereas during ICSI was positively influenced by sperm motility (p=0.04669) and negatively by DNA adducts concentration (p=0.00796). DNA adducts concentration in spermatozoa significantly negatively influences fertilization rate during ICSI, but not during IVF

Ekspresja TGF-β w raku sromu

Vulvar cancer accounts for about 3-5% of all female genital carcinomas. TGF-β protein is a member of a superfamily of cytokines that regulate cell functions. A correlation between this protein and many neoplastic processes was reported. Objectives: In our study we analyzed TGF-β expression in vulvar tumor among patients with diagnosed squamous cell carcinoma (with and without inguinal nodes metastases). Material and methods: Paraffin embedded blocks obtained from vulvar tissues and inguinal nodes (from 31 patients with vulvar carcinoma FIGO II-IV) were prepared. Next, the hematoxylin and eosin staining was performed. Monoclonal antibody NCL-TGF-β was used for immunohistochemical tests. Results: Higher expression of TGF-β in cancer cells corresponds to more advanced cancer stages (FIGO). A positive correlation between TGF-β and metastases, as well as a number of inguinal nodes metastases was observed. The ratio between the number of stained cells in vulvar tumor and of inflammatory cells proved to be higher in FIGO stage III than IV. Possibly, TGF-β increase in vulvar tumor contributes to the breakdown of immunological processes limiting cancer progression. Higher TGF-β expression leads to metastasis in regional lymphatic nodes. Conclusions: TGF-β overproduction is observed in vulvar neoplastic processes. In early stages of carcinogenesis TGF-β inhibits cancer cell proliferation, but in more advanced stages it accelerates cancer progression by inhibiting the immunological response.Rak sromu stanowi 3-5% wszystkich nowotworów narządu płciowego kobiety. TGF-β jest białkiem z rodziny cytokin biorących udział w regulowaniu cyklu komórkowego. W licznych pracach wykazano związek tego białka z procesem nowotworowym. Cel pracy: W badaniu przeprowadzono ocenę ekspresji TGF-β w tkankach guza sromu w grupie pacjentek z potwierdzonym histopatologicznie rakiem płaskonabłonkowym (z obecnymi lub brakiem przerzutów do węzłów chłonnych). Materiał i metody: Przygotowano bloczki parafinowe z tkanek guza sromu oraz węzłów chłonnych (w grupie 31 pacjentek z rakiem sromu FIGO II-IV). Nastepnie, po zastosowaniu barwienia hematoksylina-eozyna, przeprowadzono badanie przy użyciu monoklonarnego przeciwciała NCL-TGF-β. Wyniki: Zaobserwowano, że wraz z zaawansowaniem procesu nowotworowego (wg skali FIGO) wzrasta ekspresja TGF-β. Istnieje dodatnia korelacja pomiędzy TGF-β a obecnością przerzutów w węzłach chłonnych pachwinowych. Wykazano, że stosunek liczby wybarwionych komórek w tkance guza sromu do liczby komórek zapalnych jest większy w stopniu III niż w stopniu IV. Prawdopodobnie wzrost TGF-β przyczynia się do załamania procesów immunologicznych ograniczających progresję choroby nowotworowej. Wyższa ekspresja TGF-β prowadzi do rozwoju przerzutów w regionalnych węzłach chłonnych. Wnioski: W przypadkach nowotworu sromu obserwuje się zwiększoną produkcję TGF-β. We wczesnych stadiach choroby nowotworowej TGF-β wpływa hamująco na proliferację komórek nowotworowych, natomiast w stadiach bardziej zaawansowanych przyspiesza postęp choroby poprzez hamowanie odpowiedzi immunologicznej

HPV infection in etiology of uterine cervix cancer

Abstract Uterine cervical cancer may be the direct result of persistent HPV infection. The DNA analysis shows over 200 HPV types. The natural history of uterine cervix cancer is a constantly progressing process, from low pathology changes, through medium to major pathology changes, including microinvasion and invasive carcinoma. The population studies show that over 20% of women at the moment of examination is infected with HPV. The study of cervical cancer tissue revealed the HPV in the DNA, whereas the serological study revealed the presence of specific antibodies to HPV capsid antigens in most women (in USA the number amounts up to 70%). The serological conversion after HPV infection is not a common process. Therefore, the naturally infected women, still do not have enough antibodies and they are at the risk of infection, just as seronegative women. The vaccination of women between the ages of 15 and 25, causes the increase of the number of antibodies, several times higher than in the case of naturally acquired ones. The positive results of HPV examination is not a contraindication to vaccination. However, in case of vaccinated women, the negative test for 14 oncogenic HPV types has an overwhelmingly negative predictive value. Independent of the presence or absence of HPV infection, it is essential to continue cytological. The vaccination does not protect patients from all oncogenic HPV types. Cytological screening enables doctors to recognize cervical pathology at the early stage and introduce a proper treatment

Cyklopia – przegląd literatury i opis przypadku

Abstract Cyclopia is a deformation of the facial skeleton with one eye orbit formed in the place where both eyes should be present. As a result of hypoplasia there is absence (hypothesized loss) of central nervous system structures. Teratogenic factors leading to the occurrence of this anomaly may include irregular cholesterol biosynthesis, viruses, alcohol intake and maternal diabetes. Many authors suggest genetic etiology of this illness. The following work presents a case of a female patient whose fetus was diagnosed with multiple defects, among others with cyclopia. After pharmacological induction of labor, a male fetus with vital signs was born but died after two hours. As far as cyclopia is concerned, special attention should be paid to proper diagnosis of this pathology at an earliest possible stage of fetal life. Early ultrasound diagnostics of this anomaly must be emphasized most strongly, leading to the conclusion that patients suspected of fetal facial skeleton defects should be referred to medical centers which are qualified in prenatal examinations.Streszczenie Cyklopia to deformacja twarzoczaszki, na którą składa się obecność jednego oczodołu w miejscu, gdzie prawidłowo formują się oczy. W wyniku niedorozwoju dochodzi do utraty struktur ośrodkowego układu nerwowego w linii środkowej. Czynnikami teratogennymi doprowadzającymi do powstania tej nieprawidłowości mogą być: nieprawidłowa biosynteza cholesterolu, wirusy, alkohol i cukrzyca u matki. Wielu autorów wskazuje także na etiologię genetyczną tego schorzenia. Opisaliśmy przypadek ciężarnej, której płód cierpiał zespół wad wrodzonych, m.in. cyklopię. Po farmakologicznej indukcji porodu urodził się płód płci męskiej, który zmarł po dwóch godzinach życia. Należy zwrócić szczególną uwagę na odpowiednią diagnostykę tej patologii w możliwie najwcześniejszym etapie życia płodowego. Największy nacisk należy położyć na wczesną diagnostykę ultrasonograficzną tej nieprawidłowości, stąd wniosek o konieczności kierowania pacjentek podejrzanych o wady twarzoczaszki do ośrodków wykwalifikowanych w badaniach prenatalnych

Analysis of cervicovaginal fluid in the diagnosis of premature rupture of membranes

Abstract Premature rupture of membranes (PROM) complicates approximately 8% of all pregnancies, however in 3% of the cases the membrane rupture occurs before 37 weeks of gestation (preterm PROM – PPROM). The consequences of such an early loss of amniotic fluid are very serious. Serious complications and mortality of neonates born prematurely due to PPROM is very high and inversely proportional to gestational age. The diagnosis of PROM is based on medical history and physical examination. In case of doubt, a test determining the pH of vaginal secretions and ultrasonography with assessment of amniotic fluid index may be applied. In difficult cases vaginal fluid diagnostic markers are very helpful. Proposed markers include: beta-human chorionic gonadotropin (beta-HCG), placental alpha-microglobulin-1 (PAMG-1), insulin-like growth factor binding protein-1 (IGFBP-1) and alpha-fetoprotein (AFP). Other markers were also proposed, namely interleukin 6 (IL-6), prolactin, creatinine and lactates. Several tests for the analysis of cervico-vaginal secretions are already commercially available. In Poland various tests based on the analysis of vaginal pH and a test Actim Prom® based on the analysis of IGFBP-1 are available. In clinical practice, approximately 10% of cases of PROM require additional confirmation, which can be difficult, especially in the outpatient setting. Various types of bedside tests, the so-called point-of-care testing – POCT. are increasingly used in contemporary medical practice. Their implementation does not require a laboratory, specialized equipment or trained personnel. This paper presents only those markers that either are already used in the diagnosis of PROM in the form of POCT testing, or could be relatively easily adapted for this purpose

Presence of human papilloma virus in Caucasian women living in the central Europe diagnosed with vulvar intraepithelial neoplasia

Objectives: The role of human papilloma virus (HPV) in the development of cancerous states of female reproductive tracthas been widely debated. However, the information about presence of HPV in the Caucasian women living in the centralEurope diagnosed with vulvar intraepithelial neoplasia (VIN) is missing. So far, no recommendation was made to completeHPV detection in time of vulvar biopsy or after the results of positive VIN are obtained. We aimed to assess the presence ofHPV in women with vulvar intraepithelial neoplasia diagnosed at the Department of Gynecology, Obstetrics and OncologicalGynecology in Bytom, Poland.Material and methods: The retrospective examination of 120 consecutive vulvar biopsies obtained from women withpersistent vulvar itching was done. Only patients with diagnosis of VIN were included in the further analysis. HPV DNAwas detected using HPV Linear Array Genotyping Test including 14 HPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56,58, 59, 66, 68).Results: Out of 120 vulvar samples retrieved, 18 women were positive for VIN, including15 usual VIN (uVIN) and three differentiatedtype (dVIN ). 10 samples were eligible for DNA detection. HPV DNA was found in two women with uVIN (HPV16 and 51).Conclusions: It is advisable to recommend HPV genotyping in women with VIN, regardless of their age and histologic type.The incidence of HPV infection in Caucasian women from the central Europe with VIN should be further studied

The Polish Society of Gynecologists and Obstetricians statement on surgery in gynecology during the COVID-19 pandemic

The publication presents recommendations on the performance of surgical procedures in gynecology during the COVID-19 pandemic. The recommendations were prepared by the Polish Society of Gynecologists and Obstetricians, based oncurrent knowledge of SARS CoV-2. These recommendations contain the latest guidelines of scientific societies related tothe subject of operational procedures