Karolina Chmaj-Wierzchowska

Endometriosis prophylaxis and treatment with the newly developed xenogenic immunomodulator RESAN in an animal model

OBJECTIVE The objective was to assess the effectiveness of the newly developed immunomodulator RESAN in the prophylaxis and treatment of endometriosis induced in rats. STUDY DESIGN The study was performed on 58 Wistar rats. Twelve weeks before endometriosis induction, the RESAN vaccine was administered to 24 rats (100 mg i.m. and 100 mg s.c.). Endometriosis induction was performed in 48 rats, which were divided into two groups: group I, the prophylaxis group, consisting of 24 previously vaccinated rats; and group II, the treatment group, comprising the other 24 rats, which had not been vaccinated. The graft (4 mm x 4 mm) of endometrium was attached to the parietal peritoneum. A sham operation was performed in 10 rats (group III). After 3 months, a second laparotomy was performed in all animals, and endometriotic foci were excised when present. RESAN was administered to the group II animals. After an additional 3 months, a third laparotomy was performed in all animals of the three groups. RESULTS Positive, histologically confirmed endometriosis was found in 4.3% of the animals in group I and in 69.6% of group II rats (p<0.0001). Macroscopic assessment revealed endometriosis in 21.7% and 91.3% of animals in groups I and II, respectively (p<0.0001). At final laparotomy, 3 months after excision of the previously suspected foci, no signs of endometriosis were found according to both macroscopic assessment and histological examination. During the second laparotomy intraperitoneal adhesions were present in 13.0% of the animals in group I and in 61.0% of those in group II. No adhesions were present in group III. At the final laparotomy, the adhesions were present in only three of the animals in group II (p<0.0009). CONCLUSIONS RESAN seems to be effective in both the prophylaxis and treatment of endometriosis, as well as in the prophylaxis of adhesions. Histological confirmation of endometriosis should be mandatory.

Knowledge assessment of women living in the Wielkopolska region concerning risk factors for cervical cancer.

Introduction Cervical cancer (CC) is a malignant tumor which for many years has been a serious epidemiological problem in Poland. This issue is important because CC is the second most common type of malignant tumor, after breast cancer, and the second most common cause of death among women. The aim of this study was to assess the knowledge and awareness of women living in the Wielkopolska region (Gniezno district) of risk factors for cervical cancer. Material and methods The study used the diagnostic poll method, based on a previously developed survey questionnaire. The study was carried out between March and April 2013. The study group consisted of 100 women, involving schoolgirls from the secondary school in Gniezno (Group I), workers (doctors, nurses and midwives) of two outpatient clinics in the Gniezno district (Group II) and patients of the same clinics (Group III). Results According to the respondents, the main cause of CC is human papillomavirus (Group II – 36%) and genetic predisposition (Group III – 35%). It is alarming that 26% of women did not know the risk factors for CC. Conclusions It is necessary to improve health education, especially concerning the main factors affecting the development of CC, in order to reduce the morbidity and mortality rates related to this cancer.

Threatened preterm labour – analysis of the cytokine profile and progesterone treatment efficiency

Abstract Objective: Preterm labour is defined as the onset of labour between weeks 23 and before 37 of gestation. The purpose of this study was to compare the cytokine profile in the blood serum of patients experiencing threatened premature labour, along with the time of delivery and the foetus body mass at birth. Methods: The study included 89 women hospitalised at the Obstetrics and Gynaecology Clinical Hospital in the period 2011–2013. Group 1 comprised 31 patients diagnosed with threatened preterm labour, prior to tocolytic treatment. Group 2 comprised 32 patients with tocolytic treatment. Group 3 constituted the control group. Results: Groups 1, 2 and 3 differed considerably in terms of the week of delivery of pregnancy (p = 0.006). Analogous results were obtained by analysing the body mass at birth, where a statistically significant difference in body mass at birth was found between Groups 1, 2 and 3 (p  < 0.001). Our analysis focussed on the cytokine profile of the women included in the study, but no considerable changes in cytokine concentration were observed. Conclusions: No statistically significant differences were found in the cytokine profile among those patients in normally progressing pregnancy or in threatened preterm labour. No suitability of progesterone treatment in threatened preterm labour was observed.

Novel markers in the diagnostics of endometriomas: Urocortin, ghrelin, and leptin or leukocytes, fibrinogen, and CA-125?

OBJECTIVE CA-125 protein is used as a marker in clinical practice for the diagnosis of endometriomas. The aim of this study was to determine whether endometriomas are accompanied by an increased level of urocortin, ghrelin, and leptin, as well as the increased parameters of blood cell count, fibrinogen, and CA-125. MATERIALS AND METHODS The study included 86 women aged 18-38 years who had been treated laparoscopically for lesions in the adnexa with the characteristics of endometriomas and mature teratoma, during the period September 2009 to November 2012. The statistical analysis was performed using the nonparametric Mann-Whitney U test and the Spearman rank correlation coefficients (p ≤ 0.05). RESULTS The medians were 105.31 pg/mL versus 120.84 pg/mL for urocortin, 7.16 pg/mL versus 9.13 pg/mL for leptin and 584.33 pg/mL versus 657.82 pg/mL for ghrelin (p > 0.05), respectively. Analyzing the parameters of blood cell count, statistically significant differences were shown in the respective groups for leucocyte level (5.35 × 10(9)/L vs. 6.7 × 10(9)/L; p = 0.029), fibrinogen level (3.12 mg% vs. 2.57 mg%; p = 0.001), and CA-125 (36.50 U/mL vs. 15.08 U/mL; p = 0.001). CONCLUSION In conclusion, the prognostic values for CA-125, leukocytes, and fibrinogen may prove a very useful tool for the diagnosis of lesions in the adnexa of the type endometriomas.

I What Do We Know About Hysterectomy

A total hysterectomy is the most common type of gynecologic surgery and may be performed to treat many diseases that affect the uterus including: abnormal uterine bleeding, uterine fibroids, endometriosis and chronic pelvic pain, anatomic uterine defects, uterine prolapse and cancer (Reich, 2003). Based on German studies from 2005 and 2006 (overall 305 015 hysterectomies performed during the study period) the hysterectomy rate for benign diseases of the genital tract among women aged 20 or older (3.6 out of 1000 women) was higher than in Sweden but lower than in the US or Australia (Gupta, 2006, Stang 2011). The United States still has the highest incidence of hysterectomy, with about 550 000 women undergoing this operation annually, at a cost of more than

Maternal health-related behaviours during pregnancy: a critical public health issue

5 billion. The rate of this procedure in the USA is 5.4/1000 women, whereas in Italy it is 3.7/1000 and in Norway only 1.2/1000 women (Manyonda, 2003).

Modifiable lifestyle factors and ovarian cancer incidence in women

Abstract Aim: The aim of the study was to investigate the health-related behaviours of pregnant women. Maternal health-related habits, use of psychoactive medicines, diet, prevention of neural tube defects, oral cavity hygiene, chronic diseases and physical activity were analysed in a group of pregnant women attending antenatal classes. Methods: Hundred pregnant women recruited from various antenatal classes in Poznań, Poland, were investigated using a questionnaire based on the Pregnancy Risk Assessment Monitoring System. Results: The results showed that 29% of pregnancies were unplanned. In women with higher education, 62% reported that they were taking folic acid supplements during pregnancy, in contrast with 35% women with a lower level of education (p = .012). The study showed that 24% of women were exposed to second-hand smoke during pregnancy, and this was more common among younger study participants (p = .038). Nine percentage of women admitted drinking alcohol during pregnancy. Pre-pregnancy alcohol consumption was more frequent among women with higher education (p = .011). Only 46.7% of women informed their dentist about their pregnancy, and these were more often older participants (p = .023). Conclusion: The study found low maternal awareness regarding health-related behaviours, which presents a serious challenge to public health care in Poland. Pregnant women and those who wish to conceive need to be educated effectively about preventive measures in order to maintain optimal maternal and reproductive health, as well as normal fetal development.

Assessment of Pain and Stress Intensity among Women with Ovarian Endometriomas versus Teratomas

INTRODUCTION A correct diet plays an important role in the prevention of malignant tumours. The risk of the disease may be reduced by introducing a number of changes to the daily diet. The most important changes concern the amount of fat in the diet, dietary fibre, antioxidants in the food and the reduction of substances having a significant impact on the development of malignant tumours. OBJECTIVE The aim of the study is to analyse the role of selected modifiable lifestyle factors affecting the development of ovarian cancer. MATERIAL AND METHODS The study covered healthy women and women with diagnosed ovarian cancer. A total of 850 women aged between 21-84 were studied. The study included women visiting the Gynaecology and Obstetrics Hospital of the University of Medical Sciences in Poznan, Poland, between 2011-2013. Patients recognized with malignant ovarian cancer were qualified into the study based on the histopathological examination of the material obtained during surgery. RESULTS Respondents who consumed fruit and vegetables several times a week have the odds ratio OR = 0.29 level; 95% CI 0.04-2.01 (p =.2085), compared to women not consuming fruit and vegetables at all. Consumption of 100 g of French fries and potato chips several times a week, results in a 2-fold increase in ovarian cancer. The OR for this group of women amounts to 2.06; 95% CI 0.53-7.99 (p=.2966). CONCLUSIONS A diet rich in fruit and vegetables, including bulb vegetables, and grain products containing whole grains, should be introduced. It is recommended that the consumption of popular fast foods be eliminated.

The role of chemokine and non-chemokine factors in pain-related complaints in patients with endometrial cysts.

Endometriosis is a painful condition characterized by chronic pain that is periodic in nature, and intense perimenstrual symptoms. The pain associated with this condition is believed to be inflammatory in nature, in contrast with the pain due to mass effect caused by other gynecological lesions such as teratomas. The authors of this article aimed to compare pain intensity and pain-related distress among women with either an ovarian teratoma or endometrioma discovered on surgery.

Life style and risk of development of breast and ovarian cancer.

OBJECTIVES Endometriosis is a chronic disease manifested as peritoneal endometrial implants and adhesions, as well as endometrial cysts, with pain as the dominant component. THE AIM The aim of the study was to evaluate the role of chemokine (MCP-1, MCP-2, MIP-1, MIP-1 and RANTES) and non-chemokine (urocortin, ghrelin, and leptin) factors in the intensity of pelvic pain in women with endometrial cysts. MATERIAL AND METHODS A total of 86 women, aged 18-38, treated laparoscopically between September 2009 and November 2012, due to adnexal changes, i.e. endometrial cysts and mature teratomas, were recruited for the study. On a numeric rating scale, i.e. PSS (Pain Sensation Scale--according to Johnson), the patients rated pain intensity. The level of pain-related stress was investigated with the Pain Distress Scale (PDS, according to Johnson). RESULTS Medians for MCP-1, MCP-2, MIP-1, MIP-1 and RANTES concentrations were not statistically significantly different. The respondents rated pain intensity during menses as 6 and 3 points in the E and T groups, respectively (6 vs. 3 points; p=0.001). Statistically significant differences were also observed for pain intensity during work (apart from menses), (2 vs. 2 points, p=0,014) and during sexual intercourse (apart from menses) (3 vs. 1 points, p=0.006). Pain-related stress levels were higher in the T group as compared to the E group (3 vs. 5 points; p=0.007). CONCLUSIONS It seems safe to conclude that chemokines and leptin may play a significant role in the occurrence of pain complaints among women with endometrial cysts. Further research might result in implementation of new treatment methods for pain management, especially in terms of pharmacotherapy.