Zastosowanie elastografii w przewidywaniu porodu przedwczesnego u pacjentek z krótką szyjką macicy stwierdzoną między 18-22 tygodniem ciąży: prospektywne badanie obserwacyjne

Objectives: The aim of the study was to estimate the potential value of elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length for prediction of preterm delivery (PTD). Material and methods: This prospective observational study included 109 patients with cervical length of ≤25 mm at 18-22 weeks scan. Stiffness of the internal cervical os was assessed by elastography. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard), and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. The following outcome measures were analyzed: percentage of PTDs in various categories of elastographic cervical assessment, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of elastography in predicting PTDs. Additionally, ROC curves were constructed for elastography and cervical length for predicting PTDs. Results: Forty-five cases of PTDs (Cel: Ocena znaczenia elastograficznej oceny ujścia wewnętrznego szyjki macicy w przewidywaniu porodu przedwczesnego (PTD) u pacjentek z krótką szyjką macicy stwierdzoną w 18-22 tygodniu ciąży. Materiał i metody: Prospektywne badanie obserwacyjne obejmujące 109 pacjentek z długością szyjki macicy ≤25 mm stwierdzoną w 18-22 tygodniu ciąży. Elastograficznie oceniano twardość ujścia wewnętrznego szyjki macicy z użyciem następującej skali kolorów: czerwone (miękkie); żółte (średnio miękkie); niebieskie (średnio twarde); fioletowe (twarde). W przypadku uwidocznienia dwóch kolorów w okolicy ujścia wewnętrznego wybierano opcję bardziej miękką. Analizowano następujące zmienne: odsetek PTD w poszczególnych kategoriach twardości ujścia wewnętrznego oraz czułość, swoistość, ujemną i dodatnią wartość predykcyjną (NPV i PPV) elastografii w przewidywaniu PTD. Ponadto wyznaczono krzywe ROC dla elastografii i długości szyjki macicy w przewidywaniu PTD. Wyniki: W badanej populacji wystąpiło 45 PTD

Use of a levonorgestrel-releasing intrauterine device for menorrhagia treatment during adjuvant therapy of adrenocortical carcinoma with mitotane

Adrenocortical carcinoma is a rare tumour with high malignancy and poor prognosis. This tumour is rarely diagnosed in the reproductive age. Complete surgical resection is the only curative treatment for adrenal cancer in all stages. After surgery adjuvant chemotherapy is required. Mitotane is the most important drug in adrenal cancer chemotherapy. Mitotane’s mode of action is not entirely explained. Animal studies have shown that the substance exerts a direct cytotoxic effect on the cells of the adrenal cortex. This activity is selective, progressive and affects only the zona reticularis and fasciculata of the adrenal cortex. Mitotane inhibits cortisol synthesis by disrupting the chain of cholesterol. It has been suggested, that mitotane also affects the peripheral metabolism of steroids, especially of transcortin (CBG). This results in an increase of CBG blood concentration and a reduction of the amount of free hormones

Links in the functional diversity between soil microorganisms and plant communities during natural succession in coal mine spoil heaps

The successful establishment of vegetation, soil development and biogeochemical cycling during the restoration process of mine tailings requires a diverse and metabolically active microbial communities. The objective of this study was to test whether there is any link between the functional groups of both the dominant plant species and soil microbial communities on unreclaimed coal mine spoil heaps of different age located in the Silesian Upland (Poland). At each sampling site the dominant plant species were recorded and characterised based on their Raunkiaer’s life form, socio-ecological group and their potential to form mycorrhiza. The functional diversity of the plantassociated microbial communities was assessed using the microbial carbon-utilisation guilds generated using the Biolog method. We observed no differences in the microbial functional diversity, but a gradual increase in the plant functional diversity with the age of the heap. Our results indicate that trees, plants with the potential to form ectomycorrhiza, and deciduous plants strongly affected the carbon-utilisation profiles. The mean proportion of microbe guilds in dominant plant patches accounts for 60 % of the variance while the soil physicochemical parameters explained only 30 % of the variance. This suggest that in post-industrial habitats the biotic features of the soil substratum are more important for the vegetation development than the abiotic parameters

Ascites Index — a novel technique to evaluate ascites in ovarian hyperstimulation syndrome: a concept-proof study

 Objectives: Controlled ovarian hyperstimulation is an important step in infertility treatment. In some cases, however, ovar­ian hyperstimulation syndrome (OHSS) can occur. In its severe forms, ascites is likely to develop, associated with dyspnea. The aim of this study was to explore the usefulness of Ascites Index (AsI), a new tool for quantitative determination of ascites in patients with OHSS, to obtain data for planning further trials. Material and methods: Twelve patients with OHSS and ascites were included in the study. All patients were admitted to the hospital because of abdominal pain and dyspnea due to increasing ascites. Ultrasound measurements of ascites extent were performed in four external quadrants of the abdomen. Pockets of free fluid were measured. The obtained values were totaled, forming the Ascites Index (AsI), similarly to the amniotic fluid index. Because of dyspnea, paracentesis was performed in all cases. Results: Median AsI at which patients reported dyspnea was 29.0 cm (range 21.6–38.6 cm). At AsI values less than 21.6 cm, no dyspnea was observed in any of the 12 studied patients. To avoid complications, 2000 mL of ascitic fluid was collected in each patient. After paracentesis, range of AsI decreased to 12.1–14.5 cm. Conclusions: The proposed AsI seems to be a promising tool for estimating and monitoring the ascites extent in OHSS. It can be estimated using basic ultrasound equipment. AsI requires further studies for standardization and transferability to other causes of ascites

The relationship between successional vascular plant assemblages and associated microbial communities on coal mine spoil heaps [streszczenie]

The aim of the study was to investigate relationships between vascular plant species and associated soil microbial properties at various stages of vegetation development on unclaimed hard coal mine spoil heaps in Upper Silesia (south Poland). The spontaneous vegetation, soil chemistry as well as the activity and structure of microbial communities were recorded on this specific habitat. The colliery heaps were divided into four age classes and plant species composition and cover abundance were recorded on the established plots (2x2m) (Fragment tekstu)

Usefulness of three dimensional transvaginal ultrasonography and hysterosalpingography in diagnosing uterine anomalies

Objective and methods: In this study we discuss the advantages and disadvantages of HSG and 3D TV USG in diagnosing uterine anomalies. Additionally we present the results of HSG and 3D TV USG of 155 patients referred to our Department because of infertility and/or suspected uterine anomalies. Results: After performing HSG, in the studied group 118 patients were diagnosed with a normal uterus, 4 with unicornuate (including 1 patient with an unicornuate uterus, with rudimentary horn), and 6 with didelphys uterus. In 22 cases, due to the lack of evaluation of external contour of the uterus, we could not differentiate arcuate, septate and bicornuate uterus. After performing 3D TV USG we confirmed the HSG diagnosis and precise differentiated 22 disputable cases: 8 with arcuate, 11 with septate (2 complete and 9 partial) and 3 with complete bicornuate uterus. In 5 patients, severe pain and lack of cooperation during HSG made the acquisition of diagnostic X-ray images impossible. In these cases 3D TV USG allowed the anatomic assessment of the uterus, a normal uterus was found in all of them. All uterine anomalies were then confirmed by hysteroscopy and/or laparoscopy. for diagnosing uterine anomalies, while 3D TV USG can accurately show the uterus anomalies and may become an alternative method to MRI

Ocena skuteczności wewnątrznaczyniowej metody embolizacji w leczeniu zespołu przekrwienia biernego miednicy - badania wstępne

Objectives: The Aim: The aim of the study was to evaluate the effectiveness, safety and clinical outcomes of endovascular embolisation of pelvic congestion syndrome (PCS). Material and methods: This prospective, observational study carried out between January and May of 2014 encompassed 24 female patients aged 22-44 years (average - 31 years) diagnosed with PCS. Diagnosis of PCS was established by medical history, physical examination, transvaginal Doppler ultrasound examination and confirmed by MRI. The patients were qualified for phlebography and ovarian vein embolization with 0.035” detachable coils and/or microcoils. Pelvic pain scores were assessed before and 3 months after the procedure with the visual analog scale (VAS; 0 – no pain, 10 – unbearable pain). Results: Embolisation procedures were performed in 23 out of 24 patients. Nineteen patients underwent unilateral and 4 patients bilateral embolisation of the ovarian vein. In one case, safe and selective vessel catheterization was not possible due to the anatomical variant of venous flow. Nineteen patients underwent unilateral embolisation of the left ovarian vein. Four patients had the left and right ovarian veins embolized; in one of them, the internal iliac vein was additionally closed (the two-stage procedure). The technical success rate was 96%. Procedures lasted 23-78 minutes (32 minutes on average). An average of 40 ml of contrast was administered during the procedures. The total mean radiation dose at the reference point was 389 mGy (from 127 mGy to 1112 mGy). A decrease in pelvic pain intensity according to VAS was considered a clinical success. The median VAS pelvic pain score before the procedure was 8. Three months after the procedure median pelvic pain score decreased to 1 (p < 0.001). In two cases, the ovarian vein was injured and the contrast medium extravasated, which was clinically insignificant. In one case, a small injection site haematoma developed. Conclusion: Embolisation is a minimally invasive, effective and safe method of treatment for PCS. The cooperation between gynaecologists and interventional radiologists is essential for successful outcomes.Cel pracy: Celem badania była ocena skuteczności, bezpieczeństwa i wyniku klinicznego przeznaczyniowej embolizacji zespołu przekrwienia biernego miednicy. Materiał i metody: W prospektywnym, obserwacyjnym badaniu od stycznia do maja 2014 do zabiegu embolizacji PCS zakwalifikowano 24 chore, w wieku od 22 do 44 lat (średnio 31). Diagnozę postawiono na podstawie objawów klinicznych, badania fizykalnego, przezpochwowego USG Doppler i/lub MRI. Pacjentki zakwalifikowano do badania czynnościowego układu żylnego, flebografii i ewentualnej embolizacji żył jajnikowych przy użyciu spiral. Ocenianio średnie nasilenie dolegliwości bólowych miednicy w wizualnej skali analogowej VAS przed i 3 miesiące po zabiegu embolizacji. Wyniki: Zabieg wykonano u 23 z 24 chorych. U 19 chorych wykonano jednostronną embolizację lewej żyły jajnikowej. U 4 pacjentek wykonano embolizację lewej i prawej żyły jajnikowej. Sukces techniczny wyniósł 96 %. Procedury trwały od 23 do 78 min (średnio 32 minuty). W czasie zabiegu podano średnio 40 ml kontrastu. Łączna średnia dawka promieniowania w punkcie referencyjnym wyniosła 389 mGy. Za sukces kliniczny uznano zmniejszenie stopnia natężenia bólu w miednicy mierzonej w skali VAS. Średni ból miednicy w skali VAS przed zabiegiem wynosił 8 pkt. Trzy miesiące po zabiegu ból miednicy w skali VAS zmniejszył się do 1 (p < 0.001). W dwóch przypadkach doszło do wynaczynienia środka cieniującego bez znaczenia klinicznego. Wnioski: Embolizacja w leczeniu PCS jest małoinwazyjną, skuteczną i bezpieczną metodą leczenia. Współpraca ginekologa i radiologia zabiegowego odgrywa tutaj kluczową rolę

Uterine artery embolization using gelatin sponge particles performed due to massive vaginal bleeding caused by ectopic pregnancy within a cesarean scar: a case study

A pregnancy located within a cesarean scar is the rarest form of ectopic pregnancy. We present a case of a 34-year-old woman with a history of one cesarean section (gravida 2, para 1) admitted to the hospital at 9 weeks of gestation due to vaginal bleeding, initially diagnosed as a missed abortion. During the hospitalization spontaneous abortion took place, and the patient was qualified for dilatation and curettage. After the procedure massive vaginal bleeding occurred, a cesarean scar pregnancy was diagnosed, and uterine artery embolization (UAE) using gelatin sponge particles was performed. The treatment was successful. Our case shows that UAE might be a life-saving procedure in cesarean scar pregnancy hemorrhages. Absorbable properties of gelatin sponge particles reduce the risk of adverse effect on fertility