Antoni Basta

Autologous muscle-derived cells for the treatment of female stress urinary incontinence: A 2-year follow-up of a polish investigation

We evaluated the safety, feasibility and initial effects of therapy with muscle‐derived cells (MDCs) for women with stress urinary incontinence (SUI).

The Obstetrical History in Patients with Pfannenstiel Scar Endometriomas – An Analysis of 81 Patients

Introduction: The participation of immune tolerance during pregnancy was suggested to be an important factor predisposing to the implantation of decidual cells after cesarean section in Pfannenstiel scar. Delivery at term is related to the termination of immune tolerance to fetal antigens that is maintained throughout pregnancy. Substantial proportion of cesarean section deliveries is performed before the onset of true term labor. The aim of this study was to analyze the clinical symptoms of spontaneous beginning of labor in pregnant women in whom cesarean sections were performed and in whom Pfannenstiel scar endometriomas were observed during follow-up. Materials and Methods: We have retrospectively analyzed 81 patients following the surgical removal of scar endometrioma after cesarean section. Obstetrical histories of cesarean sections in the number of 5,370 preceding the occurrence of the scar endometrioma were analyzed. These data were collected in six different Gynecological and Obstetrical wards in Malopolska Province in Poland. Analysis of data was started by the retrospective evaluation of regular uterine contractions, uterine cervix ripening before cesarean section and the indications for surgery. Results: In 67 women from the group of 81 patients cesarean sections were performed with unripe uterine cervix and without the presence of regular uterine contractions. Elective indications for cesarean sections were predominant in this group of women. The relative risk of scar endometriomas occurrence following cesarean sections performed before onset of labor in comparison to cesarean sections following spontaneous onset of labor was statistically significantly higher [RR = 2.16, 95% CI = 1.21–3.83; OR = 2.18, 95% CI = 1.22–3.89]. Conclusions: Cesarean section performed before spontaneous onset of labor may increase substantially the risk of occurrence of scar endometriomas.

Transrectal Ultrasound-Guided Hysteroscopic Myomectomy of Submucosal Myomas With a Varying Degree of Myometrial Penetration

STUDY OBJECTIVE To predict the 1-step complete resection rate after transrectal ultrasound-guided hysteroscopic myomectomy and to determine the usefulness of intraoperative transrectal ultrasonography (TRUS) in monitoring hysteroscopic electroresection of submucosal myomas. DESIGN Prospective cohort study (Canadian Task Force classification II-1). SETTING University hospital. PATIENTS One hundred twenty women with symptomatic (abnormal uterine bleeding or reproductive disorder), single, submucosal myomas underwent hysteroscopic electroresection. Groups 1 and 2 were monitored, respectively, with or without TRUS. Anatomical inclusion criteria were myoma ≤5 cm and myometrial free margin ≥3 mm above the myoma. INTERVENTIONS Myomas were evaluated preoperatively via sonohysterograpy and were graded according to the guidelines outlined by the European Society of Hysteroscopy (ESH), including size and myometrial free margin, and according to the STEPW (size, topography, extension, penetration, and lateral wall) classification. On the basis of sonographic findings, patients with myomas >3 cm received gonadotropin-releasing hormone therapy for 1 to 3 months. Hysteroscopic myomectomy was performed with or without TRUS guidance. At 4 to 8 weeks after the initial procedure, postoperative transvaginal ultrasonography, sonohysterography, or second-look hysteroscopy was performed. MEASUREMENTS AND MAIN RESULTS In the TRUS group, a significantly higher percentage of 1-step complete resections was observed than in the group without TRUS (91% vs 73%) (p = .02). This was associated with a statistically significant difference in the subgroups of myomas that were deeply penetrating into the myometrium (89% vs 55%) (p < .01). One-way logistic analysis of data for all treated patients indicated the use of TRUS, as well as the ESH and STEPW classifications, as significant factors influencing the 1-step complete resection. At multivariable logistic regression analysis, use of TRUS (odds ratio [OR], 2.74; p < .001), myomas graded 0 or 1 according to ESH (OR, 3.55; p < .001), and size <3 cm (OR, 2.35; p < .05) were significantly associated with 1-step complete resection (area under the curve, 0.80; p < .001). In the TRUS group there were two significant predictors: size <3 cm (OR = 5.21; p < .05) and myometrial free margin <5 mm (OR, 0.18; p < .05). CONCLUSION Intraoperative use of TRUS during hysteroscopic myomectomy increases the chance of complete 1-step removal of submucosal myomas that deeply penetrate the myometrium.

Sentinel node in gynaecological oncology

Summary Background The concept of sentinel node biopsy has been widely invastigated in various malignant tumoures and has become a standard method in such neoplastic diseases as penile cancer or melanoma. In tumours, where the lymphatic flow is more complicated and difficult to analyze, this concept still needs to be verified. Aim The aim of this paper is to present the validity of the above concept in sentinel node detection in vulvar, cervical and endometrial cancers. Materials/Methods Sentinel node detection was performed in 127 women with gynaecological malignances; 39 patients with vulvar cancer, 52 patients with cervical cancer and 36 patients with endometrial cancer. In sentinel node detection we used radioisotopes and a dye technique. After sentinel node dissection, in all cases, radical surgery with systemic lymphadenectomy was performed. The number and localization of the nodes classified as sentinel nodes were analyzed. Results The identification rate for sentinel node detection was 97.4% in vulvar cancer, 96.2% in cervical cancer and 88.9% in endometrial cancer. The sensitivity in this procedures was 100.0% in vulvar cancer, 94.0% in cervical cancer and 87.9% in endometrial cancer. Negative predictive value was 96.2% for vulvar cancer, 97.0% for cervical cancer and 100.0% for endometrial cancer. Conclusions The concept of sentinel node detection in gynaecological malignances requires more clinical date for its validation, but outcomes in vulvar cancer seem to be potentially most promising.

Quality of life assessment in female patients 2 and 4 years after muscle-derived cell transplants for stress urinary incontinence treatment

INTRODUCTION Regenerative medicine for the treatment of urinary incontinence has become a popular area of focus in the search for therapies for this disease. The paper focused on womens quality of life assessment who were subjected to transplantation of MDSC (autologous muscle derived stem cells) to the urethral sphincter. METHODS The procedure was conducted in 16 female patients who completed the observation stage. Assessment of quality of life before and after the treatment (two and four years post-operation) was conducted based on the validated I-QOL questionnaire (the Polish language version). RESULTS The questionnaire study showed that autologous cell therapy significantly improves quality of life in female patients suffering from stress urinary incontinence (SUI). The total I-QOL score increased from 49 (SD ± 7.7) before therapy to 77 (SD ± 5.4) two years post-operation. Four years after the procedure, quality of life remained at a higher level than before therapy, although quality of life decreased by several points when compared with the results from the two-year follow-up - 63 (SD ± 7.2). Patients reported significantly less concern related to their ability to reach the toilet to avoid incontinence, improved sleep at night, a higher level of satisfaction with life, and more satisfaction with their sexual lives (p<0.05). CONCLUSION The MDSC injection procedure for SUI treatment has significant improved quality of life in the majority of our patients in 2 and 4 year follow-up.

DFF45 expression in ovarian endometriomas

OBJECTIVE Endometriosis, defined as a spread of endometrium outside the uterus cavity, affects up to 30% women of reproductive age, with the ovaries being its most common localization. In the ectopic lesions, endometrial cells show abnormal proliferation and impaired apoptosis. The DNA destruction during apoptosis is a direct result of activation of the DFF40/DFF45 complex. DFF40 (DNA fragmentation factor of 40 kDa) is responsible for direct DNA fragmentation while DFF45 (DNA fragmentation factor of 45 kDa) acts not only as a DFF40 inhibitor, but also as its chaperone. Therefore, the presence of DFF45 is required for proper DFF40 synthesis. The aim of this study was to determine the DFF45 level in human ovarian endometriosis. STUDY DESIGN The endometriosis samples were collected from 43 affected women, while the 81 normal endometrial specimens were obtained from the control group. Western blot and immunohistochemistry tests were used to determine the DFF45 level in examined tissues. RESULTS The expression of DFF45 in normal human endometrium and ovarian endometriosis was confirmed using both the Western blot and the immunohistochemistry tests. In normal eutopic proliferatory endometrium, a lower DFF45 expression was observed compared with secretory endometrium, while no cyclic changes in DFF45 expression were observed in the ovarian endometriomas. In the normal eutopic endometrium, stronger DFF45 staining was noted in the endometrial glands in comparison to the stroma, irrespective of menstrual cycle phase. However, in the ovarian endometriosis no difference between the glandular layer and stroma in DFF45 immunoreactivity was appreciated. The lowest level of DFF45 was observed in ovarian endometriosis when compared with both normal eutopic proliferatory and secretory endometria using the Western blot and immunohistochemistry analysis. CONCLUSIONS A decreased level of DFF45 observed in ovarian endometriosis may be a part of an apoptosis-resistant mechanism enhancing the disease progression.

Ten years of anti-HPV vaccinations: what do we know?

Human papillomavirus (HPV) is one of the most important carcinogens in humans. Vaccines against HPV are now considered the first anti-cancer vaccinations. Since 2007, in many developed countries, there have been recommendations present for preventive vaccines against HPV. At present, the degree of implementation of these recommendations depends on a number of country-specific factors such as the health care system organization or the ways of funding. HPV vaccines are primarily to prevent the development of cervical cancer and other genital cancers. Therefore, only their long-term effectiveness can be measured, when a correspondingly large cohort of vaccinated teenagers reaches the age of the greatest incidence of these cancers. However, great care should be taken in assessing the results of vaccinations due to the possibility of misinterpretation and possible erroneous data. Undoubtedly, teenagers are the target population of HPV vaccines. However, vaccinating young sexually active women is also justified from an individual point of view. A 9-valent vaccine has been registered in the USA and in Europe – including Poland – as one of the three preventive vaccines. It is recommended to vaccinate women between 13 and 26 and men between 13 and 21, previously unvaccinated. It is also recommended to vaccinate men aged 26 years or less who have sexual relations with other men and people with reduced immunity, including HIV-positive people who have not been vaccinated previously.

Efficient myoblast expansion for regenerative medicine use

Cellular therapy using expanded autologous myoblasts is a treatment modality for a variety of diseases. In the present study, we compared the commercial skeletal muscle cell growth medium-2 (SKGM-2) with a medium designed by our group for the expansion of skeletal myoblasts. The use of an in-house medium [DMEM/F12 medium supplemented with EGF, bFGF, HGF, insulin and dexamethasone (DFEFH)] resulted in a greater number of myoblast colonies (>50%) and a 3-, 4- and 9-fold higher proliferation rate, eventually resulting in a 3-, 7- and 87-fold greater number of cells at the 1st, 2nd and 3rd passage, respectively, compared with the cells grown in SKGM-2 medium. The average CD56 expression level was higher in the myoblasts cultured in DFEFH than in those culturd in SKGM-2 medium. At the 3rd passage, lower expression levels of myostatin and considerably higher expression levels of myogenin were observed in the cells that were grown in DFEFH medium. The results of our study indicated that myoblasts cultured in both medium types displayed fusogenic potential at the 3rd passage. Furthermore, it was shown that cells cultured in DFEFH medium created myotubes with a considerably higher number of nuclei. Additionally, we observed that the fusion potential of the cells markedly decreased with the subsequent passages and that the morphology of the myoblasts differed between the 2 cultured media. Our data demonstrate that culture in the DFEFH medium leads to an approximately 90-fold greater number of myoblasts, with improved morphology and greater fusion potential, compared with culture in the commercial SKGM-2 medium.

Operative procedures supported with robotics systems and available endoscope procedures in operative gynecology

Abstract Minimally invasive surgery revolutionized operative procedures in the last 20 years. Much of the progress in minimally invasive surgery can be attributed to the development of robot-based systems. The most apparent changes are found in laparoscopy procedures. Procedures in which only small skin incisions are made have revolutionized operating theaters. The learning curve, although long in itself, allows for the development of procedures with reduced perioperative risk (i.e., bleeding, pain) or shorter postoperative period. Convalescence after endoscopy procedures is significantly shorter compared with classic laparotomy. However, certain limitations apply to laparoscopy. Apart from the long learning curve, movements executed with long and rigid tools cannot strictly translate the precision of an operator’s hand. The body position of the surgeon is often forced by the reach of the endoscope instrument. It is related to a significant physical load of personnel, especially during long operating procedures. For this reason, some therapeutic procedures are still executed using the laparotomy approach.

OC08.04: The assessment of myoma distance from perimetrium in qualification to hysteroscopic myomectomy; a comparative study of SIS with constant pressure

Objectives: To document by transvaginal ultrasound how varies the distance between the submucous fibroids and the uterine serosa (myoma free margin or MFM) during resectoscopic myomectomy. Methods: We enrolled all patients with a hysteroscopically diagnosed G2 submucous fibroid undergoing a cold loop resectoscopic procedure from January to November 2009. MFM was evaluated by TVU pre-operatively (T0) and during the procedure. MFM was sonographically assessed after distension of the cavity for resectoscopic myomectomy (T1), after the beginning of myoma’s slicing (T2), during enucleation (T3) and at the end of the procedure (T4). Results: Overall, 10 patients were included in our study. The procedure was successfully performed without complications in all cases. The mean MFM at T0 was 6.58 ± 2.6 mm. This measurement decreased significantly at T1, but underwent progressive increase at steps T2 and T3. After complete enucleation of the fibroid (T4) the mean distance between the fovea and uterine serosa was 7.5 mm greater in comparison with preoperative MFM. Conclusions: MFM is a dynamic parameter and may considerably increase during hysteroscopic myomectomy. On this basis, even G2 submucous fibroids which appear very close to serosa on preoperative TVU may be eligible for resectopic removal.