Wartości SUVmax mierzone za pomocą 18F FDG PET/CT w guzie pierwotnym a cechy kliniczno-patologiczne endometrioidalnego raka endometrium

The aim: The aim of the study was to determine the value of SUVmax by PET/CT measured before surgery with special focus on FIGO stage, myometrial invasion, grading and risk stratification. Methods: A total of 90 women, aged 37-84 (mean 65.1± 9.5) with endometrial cancer (FIGO I and II) underwent 18F FDG PET/CT imaging before surgery. SUVmax of the primary tumor was assessed and compared with histological prognostic factors (FIGO stage, grading, myometrial invasion, risk group). Results: The mean SUVmax in the study group was 13.95 ± 5.49. SUVmax was significantly higher with high FIGO stage (p=0,0009), deep myometrial invasion (p=0.0005), high grade (p=0.0331) and high risk tumors (0.0007). Patients with the poor prognosis had significantly higher SUVmax values. Conclusions: The preoperative SUVmax measurements of the primary tumor of endometrial cancer may give additional clinical and prognostic information about risk factors and poor prognosis. High value of SUVmax might be useful in making noninvasive diagnoses and deciding the appropriate therapeutic strategy for patients with endometrial cancer. However, there is not enough evidence that it could in fact replace surgical staging.Nowe techniki obrazowania stwarzają możliwości przedoperacyjnej oceny rozległości procesu nowotworowego. Pozytonowa emisyjna tomografia z zastosowaniem 18F-FDG zrewolucjonizowała obrazowanie onkologiczne w ostatnich latach, odgrywając kluczową rolę w diagnostyce wielu typów nowotworów. SUVmax (maximum standardized uptake valve) mierzony za pomocą 18F-FDG PET/CT jest półilościowym parametrem specyficznym dla PET, który związany jest z agresywnym zachowaniem się nowotworu. Cel pracy: Celem pracy była ocena przydatności SUVmax określanego za pomocą PET/CT w guzie pierwotnym, który w powiązaniu z cechami klinicznymi pacjentek z rakiem endometrium mógłby mieć istotne znaczenie w ustaleniu rokowania i indywidualnego planu leczenia, dostosowanego do potrzeb poszczególnych pacjentek. Materiał i metodyka: Badaniami objęto 90 pacjentek z endometrioidalnym rakiem błony śluzowej trzonu macicy, w I i II stopniu zaawansowania klinicznego, leczonych za pomocą radykalnej operacji w Klinice Ginekologii Onkologicznej Collegium Medicum w Bydgoszczy w latach 2007–2008. Średnia wieku chorych wynosiła 65,1± 9,5 lat (37 – 84). Na podstawie cech histopatologicznych ustalono ryzyko nawrotu choroby. U wszystkich chorych przed planowaną operacją wykonano badanie PET/CT oraz określono wartości SUVmax. Wyniki: Średnia wartość SUVmax w badanej grupie wynosiła 13,95 ± 5,49. Stwierdzono wysoce istotną (p=0,0009) różnicę wyników SUVmax w zależności od stopnia zaawansowania według FIGO. Wyniki w grupie IA były niższe niż w grupach IB i II. Ponadto stwierdzono istotną (p=0,0331) różnicę wyników SUVmax w zależności od stopnia złośliwości histologicznej. Wyniki w grupie G1 były istotnie statystycznie niższe niż w grupie G3 a grupa G2 charakteryzowała się wynikami pośrednimi. Stwierdzono wysoce istotną (p=0,0005) różnicę wartości SUVmax w zależności od występowania nacieku mięśnia macicy powyżej 50%. Wnioski: Badanie PET/CT dostarcza ważnych informacji dotyczących guza pierwotnego u pacjentek z rakiem endometrium i powinno być wykonywane u chorych obciążonych, z wysokim ryzykiem powikłań okołooperacyjnych. Chociaż wysokie wartości SUVmax związane są z wysokim ryzykiem wznowy procesu, dotychczas brak jest dowodów, aby ta metoda obrazowania mogła zastąpić staging chirurgiczny w postępowaniu z pacjentkami z rakiem błony śluzowej trzonu macicy

The Role and Place of Antioxidants in the Treatment of Male Infertility Caused by Varicocele

The inability to become pregnant for at least 1 year despite regular unprotected intercourse may indicate infertility of one or both partners. This problem affects approximately 10–20% of couples worldwide, regardless of race, with male infertility reported to account for 25–60% of cases. Among the most common pathological causes of male infertility is the presence of varicocele and chronic infections of the male reproductive system. This study was performed using data collected at the Genesis Infertility Treatment Clinic, Bydgoszcz, Poland, between 1 January 2015 and 30 June 2017. A total of 163 men meeting the inclusion criteria were selected and divided into the idiopathic infertility group (78 men) and varicocele-related infertility group (85 men). All patients received treatment with a male fertility supplement containing a combination of 1725 mg of L-carnitine fumarate, 500 mg of acetyl-L-carnitine, 90 mg of vitamin C, 20 mg of coenzyme Q10, 10 mg of zinc, 200 µg of folic acid, 50 µg of selenium, and 1.5 µg of vitamin B12 (Proxeed® Plus, Sigma-Tau, Italy) twice a day for a period of 6 months from the time of the diagnosis of infertility. The treatment resulted in significant improvements in general semen parameters, particularly sperm count, sperm concentration, total motility, and progressive motility. This antioxidant therapy produced a particularly marked therapeutic benefit in patients with Grade III varicocele, with a greater improvement in progressive motility than in men with less severe or no varicocele. The use of the antioxidant preparation examined here seems reasonable in men with idiopathic infertility and as an adjuvant in those with varicocele-related infertility in whom surgical treatment has resulted in no improvement. Its use should be considered particularly in patients with Grade III varicocele who do not wish to undergo surgical treatment or in whom such a treatment is not possible for various reasons

Serum 25(OH) Vitamin D Levels in Polish Women during Pregnancies Complicated by Hypertensive Disorders and Gestational Diabetes

Background: An association between the level of vitamin D and the risk of pregnancy-related complications remains unclear. The aim of this study was to examine concentrations of 25(OH) vitamin D in Polish women with normal pregnancies and pregnancies complicated by gestational hypertension, preeclampsia or gestational diabetes mellitus (GDM). Moreover, we analyzed an association between maternal serum 25(OH)D and the risk of gestational hypertension, preeclampsia and GDM. Material and Methods: The study included 207 pregnant women, among them 171 with pregnancy-related complications: gestational hypertension (n = 45), preeclampsia (n = 23) or GDM (n = 103). The control group consisted of 36 women with normal pregnancies. Concentrations of serum 25(OH)D were measured at admission to the hospital prior to delivery Results: Patients with hypertension did not differ significantly from the controls in terms of their serum 25(OH)D concentrations (18.20 vs. 22.10 ng/mL, p = 0.15). Highly significant differences were found in 25(OH)D concentrations of women with preeclampsia and the controls (14.75 vs. 22.10 ng/mL, p = 0.0021). GDM was not associated with significant differences in 25(OH)D concentration. A low level of 25(OH)D turned out to be associated with an increased risk of preeclampsia during pregnancy on both univariate and multivariate regression analysis, and was a significant predictor of this condition on ROC (receiver operating characteristic) analysis (AUC = 0.70, p < 0.01). Conclusions: 25(OH)D deficiency is common among pregnant Polish women. Low concentrations of 25(OH)D may play a role in the etiopathogenesis of preeclampsia. Routine assessment of the 25(OH)D level during pregnancy may be crucial for the identification of women at increased risk of preeclampsia