PCOS and cancer risk.

Polycystic ovary syndrome (PCOS) affects approximately 5 to 10% of women of reproductive age. It is the most common reason of anovulation in infertile women. PCOS is accompanied by such conditions as oligo- or anovulation, hipertestosteronism, lower cell sensitivity to insulin, type II diabetes, hyperlipidemia and obesity. Each of the above-mentioned conditions is an approved risk factor proved to predispose towards cancer. However, PCOS is also a disease entity which differs in its clinical manifestation. For example not all patients suffer from obesity or hipertestosteronism related symptoms. From the analysis of literature it is possible to draw conclusions, that there is a possible correlation between PCOS and endometrial cancer, which emerges from clinical trials or research focused on molecular changes in endometrium patients with PCOS. On the other hand, correlation between PCOS and breast or ovary cancer is not so strong, in spite of single papers which are showing the link. The main problem in researching the correlation between PCOS and any cancer risk, is there is a very small group of women or the trial is imperfect (e.g. no control group). There is no meta-analysis focused on this correlation in literature. The change of criteria of PCOS in the past is also a big problem, because there was a number of definitions of PCOS, which results in inconsistent PCOS diagnoses over time. In this paper we would like to provide a description of studies that aimed at showing correlation between PCOS and cancer risk and underlying theoretical assumptions

Zespół policystycznych jajników (PCOS), a ryzyko występowania cukrzycy ciążowej (GDM)

Gestational diabetes mellitus (GDM) is a common complication of pregnancy. In the course of pregnancy, elevated levels of hormones and other proteins having insulin-antagonistic effects lead to higher insulin resistance in peripheral tissues, followed by hyperinsulinemia. Risk factors for the development of GDM have been well-established. However, the debate whether polycystic ovary syndrome (PCOS) may predispose to GDM continues. Patients with PCOS are often affected by obesity, dyslipidemia, hyperinsulinemia ,and tissue-specific insulin resistance. Obesity occurs in 50% of the cases, while tissue-specific insulin resistance is observed in 20-40% of the affected patients. This paper aims at systematizing risk factors that could contribute to the development of GDM, as well as reviewing literature reports and analyses on the occurrence of a potential correlation.Cukrzyca ciążowa (gestational diabetes mellitus – GDM) jest częstym stanem patologicznym wikłającym ciążę. W przebiegu ciąży dochodzi do zwiększenia stężenia w organizmie hormonów oraz innych białek o działaniu antagonistycznym w stosunku do insuliny, co prowadzi do wzrostu insulinooporności tkanek obwodowych, a następnie do hiperinsulinemii. Pomimo, że znane są czynniki ryzyka prowadzące do rozwoju GDM, od lat toczy się dyskusja czy zespół policystycznych jajników (PCOS) może predysponować do wystąpienia cukrzycy ciążowej. U pacjentek z PCOS często występuje otyłość, dyslipidemia, hiperinsulinemia oraz brak wrażliwości tkankowej na insulinę. Otyłość występuje u 50% przypadków, a brak wrażliwości na insulinę u 20-40% pacjentek. Celem poniższego opracowania jest usystematyzowanie czynników ryzyka, które mogłyby u pacjentek z PCOS prowadzić do rozwoju GDM, a także przegląd badań oraz analiz dotyczących występowania potencjalnej korelacji

Bilateral ectopic tubal pregnancy, following in vitro fertilisation (IVF).

This is a case report of a 33 year-old-woman who underwent in vitro fertilization, because of primary infertility caused by fallopian tube factor. The patient underwent three trials of frozen embryo transfers (ET-CRYO). On the 26th day after the third probe of ET-CRYO she suffered from pelvic pain and vaginal bleeding. Transvaginal ultrasonographic scan revealed bilateral tubal ectopic pregnancy without fluid in the Douglas pouch and no gestational sac in the uterus. Laparoscopic bilateral salpingectomy was performed on the next day after admission. The postoperative course was uneventful

Cumulative summation test for learning curve (LC-CUSUM) in outpatient hysteroscopy

Objectives: Outpatient hysteroscopy has become an integral part of postgraduate training in gynecology. It is an operator-dependent procedure, however there are no recommendations regarding total number of performed procedures to reach proficiency. Material and methods: This study aimed to assess the learning curve (LC) using cumulative summation test for learning curve (LC-CUSUM). Results: A success rate of 97% a failure rate ≥ 10% were established to denote an adequate and an inadequate performance. A third-year trainee needed 56 procedures to reach the predefined level of performance. Conclusions: As the length of the LC for outpatient hysteroscopy seems highly variable, it is reasonable to provide tailored monitoring while training

Rzadki przypadek wznowy PEComa (Perivascular Epithelioid Cell Tumor). Przypadek kliniczny i przegląd piśmiennictwa

Perivascular epithelioid cell tumor (PEC-oma) is a rare mesenchymal neoplasm. Literature reports more than 100 cases of PEC-oma, a third of which is of uterine or uterine retroperitoneum origin. The case of a 59-year-old woman presented here is, to the best of our knowledge, the first described fast uterine PEC-oma recurrence of the tumor of the gastrointestinal tract origin. In this text the authors also present literature review concerning this rare female tumor.Perivascular epithelioid cell tumor (PEComa), są bardzo rzadkimi guzami pochodzenia mezenchymalnego. Do dnia dzisiejszego odnotowano w piśmiennictwie ponad 100 przypadków PEComa, z czego mniej więcej 1/3 występowała w macicy lub pokrywającej ją otrzewnej (retroperitoneum). Prezentowany przypadek 59 letniej pacjentki jest według nas pierwszym przedstawiającym szybką wznowę zmiany o typie PEComa zlokalizowaną w obrębie macicy o pierwotnym punkcie wyjścia z przewodu pokarmowego. W poniższym tekście przedstawiamy także przegląd piśmiennictwa dotyczący tego rzadkiego guza kobiecego narządu rodnego

Risk factors for cesarean section after using the Foley catheter for labor induction

Objective: The aim of the study was to investigate the value of the Bishop score and ultrasound examination of the cervix in predicting the success of labor induction with the use of the Foley catheter determined by the mode of delivery. Material and methods: Foley catheter induction of labor was performed in 135 pregnancies between 38 to 42 weeks gestation. The study group was divided into two groups, depending of the mode of delivery: vaginal vs. cesarean. Results: The Bishop score was significantly higher in the vaginal delivery group when compared to the caesarean section group (5.2; 95%CI: 4.4 – 6.2 vs. 3.9; 95%CI: 2.8-4.9). Cervical length was not statistically significantly different between the two groups. Multivariate logistic regression showed that patient-specific risk for caesarean section decreases with increasing maternal age and the Bishop score (Detection Rate [DR] of 52% at fixed False Positive Rate [FPR] of 10%). Conclusions: Failure of labor induction with the use of the Foley catheter can be predicted by maternal age and pre-induction Bishop score

Skuteczność i tolerancja morfiny podawanej dożylnie metodą PCA (analgezja kontrolowana przez pacjenta) u pacjentek po cięciach cesarskich)

Objectives: The aim of the study was to evaluate analgesic efficacy and tolerability of patient-controlled analgesia (PCA) with intravenous morphine. Material and methods: Our observational study included 50 women who underwent a Misgav-Ladach or modified Misgav-Ladach cesarean section. Automated PCA infusion device (Medima S-PCA Syringe Pump, Medima, Krakow, Poland) was used for postoperative pain control. Time of morphine administration or initiation of intravenous patient-controlled analgesia (IV PCA) with morphine was recorded, as well as post-operative pain at rest assessed by a visual analogue scale (VAS). All patients were followed up for 24 hours after discharge from the operating room, taking into account patient records, worst pain score at rest, number of IV PCA attempts, and drug consumption. Results: Median of total morphine doses used during the postoperative period was 42.9mg (IQR 35.6–48.5), with median infusion time of 687.0 min. (IQR 531.0–757.5). Pain severity and total drug consumption improved after the first 3 hours following cesarean delivery (pCel pracy: Celem badania była ocena skuteczności leczenia bólu morfiną podawaną dożylnie metodą PCA oraz jej tolerancji u pacjentek po cięciach cesarskich. Materiał i metodyka: Do badania włączono 50 pacjentek, które przeszły cięcie cesarskie sposobem Misgav- Ladah lub jego modyfikację. Do pooperacyjnego zwalczania bólu użyto morfiny podawanej w automatycznej pompie infuzyjnej (Medima S-PCA Syringe, Medima, Kraków, Polska). Moment podłączenia morfiny i.v. w pompie PCA, czas podaży leku oraz pooperacyjną ocenę bólu przy użyciu wizualnej analogowej skali wzrokowej (VAS) były odnotowywane. Wszystkie pacjentki były pod obserwacją przez 24 godziny od zakończenia cięcia cesarskiego a w dokumentacji odnotowywano największy ból w spoczynku, liczbę prób podaży leku przez pacjentkę oraz ogólną ilość podanego analgetyku. Wyniki: Mediana całkowitej podanej dawki morfiny w okresie pooperacyjnym wyniosła 42,9mcg (IQR-rozstęp kwartylny – 35,6-48,5), mediana czasu podaży dożylnej wyniósł 687,0 min. Nasilenie bólu oraz dawka podanej morfiny zmniejszyły się po 3 godzinach od cięcia cesarskiego (

Metabolic and hormonal effects of a combined Myo-inositol and d-chiro-inositol therapy on patients with polycystic ovary syndrome (PCOS)

Objectives: To evaluate the effects of a combined Myo-inositol (MI) and D-chiro-inositol (DCI) therapy on the hormonal and metabolic parameters of women with PCOS. Prospective clinical study. Clinical Study registration number — EUPAS25705 Material and methods: Seventy women diagnosed with PCOS according to the Rotterdam criteria were enrolled in this study. Patients received a combined therapy of one tablet that contained 550 mg of inositol (myo-inositol (MI) and D-chiro-inositol (DCI) in a ratio of 10:1) twice a day for 6 months. At each of 3 visits, the body weight, height and BMI were all recorded; and serum levels of free testosterone (fT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and glucose with insulin during standard OGTT (75 g) were measured. Also at each visit, transvaginal ultrasonography and skin condition assessments were performed. Results: Significant body weight reduction and decreases in fT, FSH, LH and insulin levels, as well as significant increase of serum SHBG concentrations were observed. Serum glucose levels during OGTT decreased after 6 months of treatment. Also, skin conditions improved after only three months of treatment. Conclusions: Combination of MI and DCI in a ratio 10:1 seems to be efficient in improving both metabolic and hormonal parameters in patients with PCOS.

Zinc protoporphyrin IX, a heme oxygenase-1 inhibitor, demonstrates potent antitumor effects but is unable to potentiate antitumor effects of chemotherapeutics in mice

<p>Abstract</p> <p>Background</p> <p>HO-1 participates in the degradation of heme. Its products can exert unique cytoprotective effects. Numerous tumors express high levels of HO-1 indicating that this enzyme might be a potential therapeutic target. In this study we decided to evaluate potential cytostatic/cytotoxic effects of zinc protoporphyrin IX (Zn(II)PPIX), a selective HO-1 inhibitor and to evaluate its antitumor activity in combination with chemotherapeutics.</p> <p>Methods</p> <p>Cytostatic/cytotoxic effects of Zn(II)PPIX were evaluated with crystal violet staining and clonogenic assay. Western blotting was used for the evaluation of protein expression. Flow cytometry was used to evaluate the influence of Zn(II)PPIX on the induction of apoptosis and generation of reactive oxygen species. Knock-down of HO-1 expression was achieved with siRNA. Antitumor effects of Zn(II)PPIX alone or in combination with chemotherapeutics were measured in transplantation tumor models.</p> <p>Results</p> <p>Zn(II)PPIX induced significant accumulation of reactive oxygen species in tumor cells. This effect was partly reversed by administration of exogenous bilirubin. Moreover, Zn(II)PPIX exerted potent cytostatic/cytotoxic effects against human and murine tumor cell lines. Despite a significant time and dose-dependent decrease in cyclin D expression in Zn(II)PPIX-treated cells no accumulation of tumor cells in G1 phase of the cell cycle was observed. However, incubation of C-26 cells with Zn(II)PPIX increased the percentage of cells in sub-G1 phase of the cells cycle. Flow cytometry studies with propidium iodide and annexin V staining as well as detection of cleaved caspase 3 by Western blotting revealed that Zn(II)PPIX can induce apoptosis of tumor cells. B16F10 melanoma cells overexpressing HO-1 and transplanted into syngeneic mice were resistant to either Zn(II)PPIX or antitumor effects of cisplatin. Zn(II)PPIX was unable to potentiate antitumor effects of 5-fluorouracil, cisplatin or doxorubicin in three different tumor models, but significantly potentiated toxicity of 5-FU and cisplatin.</p> <p>Conclusion</p> <p>Inhibition of HO-1 exerts antitumor effects but should not be used to potentiate antitumor effects of cancer chemotherapeutics unless procedures of selective tumor targeting of HO-1 inhibitors are developed.</p

Statins Impair Antitumor Effects of Rituximab by Inducing Conformational Changes of CD20

Jakub Golab and colleagues found that statins significantly decrease rituximab-mediated complement-dependent cytotoxicity and antibody-dependent cellular cytotoxicity against B cell lymphoma cells