Maciej Jóźwik

Antioxidant defence of red blood cells and plasma in stored human blood

Blood collected routinely from donors, and preserved with CPDA-1 anticoagulant (citrate, phosphate, dextrose, adenine), was investigated. The concentration of reduced glutathione, and glutathione peroxidase, glutathione S-transferase, glutathione reductase, superoxide dismutase, and catalase activities in erythrocytes, as well as the total radical-trapping antioxidant parameter in plasma were determined on days 1, 3, 7, 12, 16, 20 and 25 of storage. At the end of the study, a 30% decrease in the reduced glutathione concentration (P < 0.001) and decreases in glutathione S-transferase (over 20%, P < 0.001), glutathione reductase (over 8%, P < 0.01) and superoxide dismutase (over 10%, P < 0.001) activities in erythrocytes, together with up to a 30% diminution of total antioxidant activity in plasma (P < 0.001) were noted. Thus, during blood storage, glutathione-dependent antioxidant systems in erythrocytes and antioxidant defence in plasma are depleted. From the present study, a twelve-day period can be considered a safe storage limit. The sequence of events occurring in stored blood, leading to peroxidative injury in erythrocytes, is discussed.

Fetal and maternal non-glucose carbohydrates and polyols concentrations in normal human pregnancies at term.

The objective of the present investigation was to determine fetal and maternal plasma concentrations of nonglucose carbohydrates and polyols in normal human pregnancies at term. Uncomplicated human pregnancies (n = 50) were studied at ≥37 wk gestation. Blood samples were obtained from umbilical artery, umbilical vein, and maternal peripheral blood at the time of elective cesarean section. Plasma concentrations of inositol, glycerol, erythritol, sorbitol, and mannose were determined by HPLC analysis. Differences between umbilical venous, umbilical arterial, and maternal concentration were tested by the two-tailed t test for paired samples. Correlations between umbilical and maternal concentration and between umbilical venoarterial concentration difference and umbilical arterial concentration were assessed by Pearsons correlation and multiple regression analysis. All newborns were appropriate for gestational age, and oxygenation and acid-base balance were within the normal range for all fetuses studied. For most of the polyols (inositol, sorbitol, and erythritol), the fetal concentration was significantly higher than the maternal concentration. The umbilical venoarterial concentration difference for inositol was −10.5 ± 3.6 μM, for glycerol was 10 ± 1.7 μM, for sorbitol was 3.8 ± 0.5 μM (p < 0.001), and for mannose was 7.6 ± 0.7 μM. There was a significant correlation between maternal concentration and umbilical venous concentration of mannose (UVMAN = 15.38 + 0.69 MMAN; R2 = 0.46; p < 0.001). These results indicate that in normal human pregnancies at term, inositol is produced by the fetus, sorbitol is produced by the placenta, and there is a significant umbilical uptake of mannose from the maternal circulation.

Prognosis of fertility after surgical closure of vesicouterine fistula

OBJECTIVES To evaluate fertility of women following surgical closure of vesicouterine fistula. STUDY DESIGN Long-term retrospective investigation combined with a follow-up in the setting of an academic department. Operative hospital records (15,718) were reviewed for a 12-year period. RESULTS Sixteen women with a vesicouterine fistula at reproductive age entered the study. Five pregnancies were recorded after repair, of which four resulted in a full term delivery. In comparison with the data reported to date this series showed significantly higher rates of pregnancy (31.25% vs. 9.7%; P = 0.012) and term deliveries (25% vs. 6.2%; P = 0.01). The majority of women were afraid of recurrence if pregnant again. CONCLUSIONS Fertility after repair of vesicouterine fistula can be much better than previously described.

Partial Denervation of the Pelvic Floor during Term Vaginal Delivery

Modern obstetrics has entered the new millennium with a number of unresolved clinical problems. One of them is partial denervation of the pelvic floor at term vaginal delivery. Numerous studies from various countries suggest the universal nature of this problem and point to its long-term sequelae, which can include stress urinary incontinence, fecal and flatus incontinence, as well as pelvic organ prolapse. However, for at least two reasons this negative impact of childbirth on the pelvic floor has not been widely recognized. The first is the fact that normal pregnancy predisposes to stress incontinence, which is the second most common urinary complaint in pregnant women after frequency. As demonstrated by urodynamic studies [1], the gradual increase in the intravesical pressure as pregnancy advances is not parallelled by an increase in the intraurethral pressure. This finding is well supported by epidemiological data. For instance, in 1981 Iosif [2] presented an account of the occurrence of urinary incontinence during pregnancy and after birth based on a sample of 1400 Swedish women. In 5% of subjects, stress urinary incontinence appeared at the beginning of pregnancy and continued throughout. In 11% it appeared in the latter half of pregnancy and continued during the puerperium, and in 4% it appeared in close relation to labor. In later work by Dimpfl et al. [3], as many as 53% of 290 women who had delivered vaginally complained of losing urine at straining during pregnancy. In 8% the symptom persisted postpartum, and 6% developed permanent incontinence. Of note, out of 60 women delivered by cesarean section, half experienced stress incontinence in pregnancy, yet none reported the symptom postpartum [3]. These two studies point to the important observation that in the majority of gravidae stress incontinence resolves spontaneously during the puerperium, when pregnancy-associated changes regress. In contrast, in those women in whom the incontinence appears or worsens after birth, this disorder is not mild and transient but marked and chronic. The explanation for this changed outcome is revealed by two recent prospective studies comparing antepartum and postpartum pudendal nerve conduction. These studies demonstrated that the causative factor of denervation acts during the period of delivery, and specifically in the second stage of labor [4,5], whereas throughout pregnancy the nerve’s conduction is minimally affected [5]. Clearly, there is a relationship of this denervation with the period of maximal distension, or overstretching, of soft tissues of the birth canal, including the muscles of the pelvic floor. However, the origin of the injury seems to be neurogenic, rather than muscular. This is due to the discrepancy between the capacities of the nerve and the skeletal muscle to withstand distension. Nerves of the pelvic floor muscles can be elongated for 6%–22% of their initial length before direct damage occurs [6]. In contrast, human skeletal muscles are known to sustain distensions of up to 200% of their initial length [7]. In the absence of apparent morphologic defects, such as muscular tearing, bleeding or hematoma, the denervation of the pelvic floor at birth is frequently subclinical, which is the second reason for the lack of common recognition of the occurrence of this denervation. The pelvic floor is innervated by the pudendal nerve and, notably, the intrapartum injury can take place throughout the nerve’s course, i.e. from the origins of the main trunk to the terminal branches, such as the perineal nerve [8]. So far, the following mechanisms have been implicated [9]: (1) denervation at the neuromuscular junction; (2) overstretching of the nerve trunk; (3) compromise of the lumbo-sacral plexus; (4) temporary Int Urogynecol J (2001) 12:81–82 2001 Springer-Verlag London Limited International Urogynecology Journal

An Open Multicenter Study of Clinical Efficacy and Safety of Urolastic, an Injectable Implant for the Treatment of Stress Urinary Incontinence: One-Year Observation

The prevalence of stress urinary incontinence rises and affects up to 30% of women after 50 years of age. Midurethral slings are currently the mainstay of surgical anti-incontinence therapy. Some patients experience recurrent SUI (RSUI) which is defined as a failure of anti-incontinence surgery after a period of time or persistence of SUI after the procedure aimed at correcting it. The urethral bulking agent application decreases invasiveness of treatment and meets patients requirements. The objective of this study was to assess the safety and clinical efficacy of Urolastic injection. One hundred and five patients with SUI (including 91 patients with RSUI) were treated with Urolastic in three tertiary gynecological clinics. The efficacy of the procedure was assessed objectively at each follow-up visit by means of cough test and a standard 1-hour pad test. Objective success rate after 12 months after primary procedure in RSUI patients was found in 59.3% of patients. In 14 patients with primary SUI improvement after 1 year was found in 71.4% of patients. Although cure rates after MUS are up to 90% there is still place for less invasive treatment option like periurethral injection of bulking agents, especially in patients with previous SUI surgical management.

Human breast milk sugars and polyols over the first 10 puerperium days.

The transition from colostrum to mature breast milk during early puerperium is associated with significant concentration changes of numerous compounds. However, it is not known whether the free sugars, aminohexoses, and polyols are affected. Therefore, in this study, we aimed to determine their concentrations in human colostrum and milk during the first 10 days postpartum.

Ammonia concentration in human preovulatory ovarian follicles

OBJECTIVES To determine ammonia concentrations in both the direct environment of the oocyte, ovarian follicular fluid, and peripheral blood. STUDY DESIGN Samples of preovulatory follicular fluid and antecubital venous blood were obtained from 23 randomly selected women attending an in vitro fertilization program in an academic department. Ammonia concentrations were measured using the indophenol method. RESULTS In every patient examined, the ratio of ammonia concentration in follicular fluid to that in blood exceeded 1.0. Mean ammonia concentration in follicular fluid (38.01+/-2.61 microM) was significantly higher than that in blood (22.70+/-1.35 microM; P<0.001 paired Students t test). CONCLUSIONS There is an ammonia gradient from follicular fluid to blood. The human preovulatory oocyte grows in an environment of a moderately increased ammonia concentration. This study suggests that the preovulatory follicle is a source of ammonia production.

Surface antigen expression on peripheral blood monocytes in women with gynecologic malignancies.

BackgroundOf many specialized blood cells, monocytes are gaining increasing attention for their role in neoplastic disorders. The purpose of the present investigation was to determine the expression of selected peripheral blood monocyte surface antigens in cases of cervical, endometrial, and ovarian cancers. In addition, our aim was to validate the diagnostic value of two artificial coefficients recently proposed for the diagnosis of gynecologic malignancies: Neutrophil to Lymphocyte Ratio (NLR), and Multiplication of Neutrophil and Monocyte Counts (MNM).MethodsWe studied 69 white Caucasian women with histopathologic confirmation of endometrial (N = 42), cervical (N = 13), and ovarian (N = 14) cancers. Reference Group I were women suspected of cancer but histologically nullified (N = 20), and Group II were healthy blood donors (N = 23). Expression of CD11a, CD11b, CD11c, CD16, CD54 (ICAM-1), CD62 L (L-selectin), CD64, and HLA-DR was measured with immunofluorescence in a flow cytometer.ResultsCD54 expression increased by ≥35.6% (p < 0.001) whilst HLA-DR decreased by ≥10.8% (p < 0.001) in all cancer subgroups and Group I as compared to blood donors. A correlation (p < 0.05) between CD54 and CD62 L was stronger in all cancers studied than in healthy subjects. There was no difference in the NLR values between any of these subgroups. Moreover, we observed an increase in MNM parameter in cases of cervical and endometrial cancer and in the Reference Group I.ConclusionsIn the studied gynecologic malignancies, CD54 expression on peripheral blood monocytes is enhanced, indicating a higher transmigrational potential present in such patients, and HLA-DR expression diminished, indicating a decreased readiness of the immune system to recognize foreign antigens. The more pronounced correlation for the expression of CD54 and CD62 L in cancer suggests that monocytes uptake from the bloodstream and their local adhesion increase the pool of tumor-associated macrophages. This study challenged the suggested credibility and usefulness of the artificial parameters of MNM and NLR for the differential diagnosis of gynecologic malignancies.

Maternal and fetal blood ammonia concentrations in normal term human pregnancies.

Background: The current evidence on the primary source of ammonia production in the human fetoplacental unit is potentially misleading. Objective: The aim of the present investigation was to determine the concentration of ammonia in human maternal and fetal blood at birth and to compare them with published data in late gestation sheep. Methods: In 12 normal human pregnancies, umbilical arterial and venous and maternal venous blood was sampled, and whole blood ammonia concentrations were measured. Data from 12 pregnant sheep and fetuses from our previous studies were utilized for comparison. Results: The human fetus at delivery has higher concentrations of ammonia (60–80 µM) than the late gestation fetal lamb (25–35 µM). In the human, the arterial umbilical ammonia concentration exceeds the venous umbilical concentration, indicating a net ammonia production by fetal tissues. In sheep, the venous umbilical ammonia concentration exceeds the arterial umbilical concentration, indicating the net placental ammonia production. Conclusions: In contrast to fetal lambs, human fetuses exhibit a net production of ammonia, which may reflect differences in biologic state or a species difference.

Giant Vulvar Lipoma in an Adolescent Girl: A Case Study and Literature Review

A rare case of a giant vulvar lipoma that developed in an adolescent is presented. A review of the world literature of 15 cases that occurred prior to adulthood confirmed that they tend to occur on the right side of the vulva.