Paweł Rzymski

Impact of heavy metals on the female reproductive system.

INTRODUCTION It has been recognized that environmental pollution can affect the quality of health of the human population. Heavy metals are among the group of highly emitted contaminants and their adverse effect of living organisms has been widely studied in recent decades. Lifestyle and quality of the ambient environment are among these factors which can mainly contribute to the heavy metals exposure in humans. OBJECTIVE A review of literature linking heavy metals and the female reproductive system and description of the possible associations with emission and exposure of heavy metals and impairments of female reproductive system according to current knowledge. RESULTS The potential health disorders caused by chronic or acute heavy metals toxicity include immunodeficiency, osteoporosis, neurodegeneration and organ failures. Potential linkages of heavy metals concentration found in different human organs and blood with oestrogen-dependent diseases such as breast cancer, endometrial cancer, endometriosis and spontaneous abortions, as well as pre-term deliveries, stillbirths and hypotrophy, have also been reported. CONCLUSIONS Environmental deterioration can lead to the elevated risk of human exposure to heavy metals, and consequently, health implications including disturbances in reproduction. It is therefore important to continue the investigations on metal-induced mechanisms of fertility impairment on the genetic, epigenetic and biochemical level.

Anaphylactic reaction to methylene blue dye after laparoscopic chromopertubation.

A 25-year-old infertile woman was admitted to our department with occluded right Fallopian tube and left sactosalpinx. Diagnostic hysteroscopy (Wolf, Knittlingen, Germany) showed a normal, follicular-phase endometrium with a small endometrial polyp in the uterine fundus. Electroresection of the polyp was performed with no complication or excessive bleeding. After hysteroscopy, a laparoscopic examination was performed (Aesculap, Tuttlingen, Germany). It revealed adenomyosis of the uterus, small patches of pelvic endometriosis, and endometriosis of the right ovary. Electrocoagulation of the right ovarian endometriosis was performed. Chromopertubation with methylene blue (Patenblau V; Guerbet, Roissy, France) showed bilateral tubal dilatation and occlusion. Bilateral salpingoneostomy was performed successfully, with no complication or bleeding. Tubal patency was checked with repeated chromopertubation. The total amount of methylene blue used was 20 mg of dye diluted in 100 ml of

Factors influencing breast elasticity measured by the ultrasound Shear Wave elastography – preliminary results

Introduction Many physiological changes of breast elasticity depend on the age, hormonal status, menstrual cycle and many others. The aim of this study was to evaluate viscoelastic properties of normal breast tissues in a large group of women and to search for factors which play a role in its mechanical properties. Material and methods 101 women aged 18-74 years who underwent B-mode sonography and additionally sonoelastography. We measured viscoelasticity in 8 quadrants by a share wave ultrasonic device estimating Young modules in regions of interest. Results Mean elasticity measured in all 8 scans in glandular and fatty tissue were 11.28 ±5.79 kPa (0.1-46.26 kPa) and 9.24 ±4.48 kPa (0.1-29.78 kPa), respectively. The correlation between age and mean elasticity of glandular tissue was Rs = 0.27 (p = 0.007). The correlation between glandular tissue elasticity heterogeneity and breast mastalgia measured by VAS was Rs = –0.23 (p = 0.241). Fat tissue elasticity correlated with duration of lactation was Rs = 0.21 (p = 0.01). Conclusions There are several parameters influencing breast viscoelasticity measured by share wave sonoelastography. Glandular tissue elasticity correlates positively with age, fatty tissue elasticity correlates positively with duration of lactation and heterogeneity of the elasticity map of glandular tissue correlates with breast pain and fat tissue with BMI.

Metal status in human endometrium: Relation to cigarette smoking and histological lesions

Human endometrium is a thick, blood vessel-rich, glandular tissue which undergoes cyclic changes and is potentially sensitive to the various endogenous and exogenous compounds supplied via the hematogenous route. As recently indicated, several metals including Cd, Pb, Cr and Ni represent an emerging class of potential metalloestrogens and can be implicated in alterations of the female reproductive system including endometriosis and cancer. In the present study, we investigated the content of five metals: Cd, Cr, Ni, Pb and Zn in 25 samples of human endometrium collected from Polish females undergoing diagnostic or therapeutic curettage of the uterine cavity. The overall mean metal concentration (analyzed using microwave induced plasma atomic emission spectrometry MIP-OES) decreased in the following order: Cr>Pb>Zn>Ni>Cd. For the first time it was demonstrated that cigarette smoking significantly increases the endometrial content of Cd and Pb. Concentration of these metals was also positively correlated with years of smoking and the number of smoked cigarettes. Tissue samples with recognized histologic lesions (simple hyperplasia, polyposis and atrophy) were characterized by a 2-fold higher Cd level. No relation between the age of the women and metal content was found. Our study shows that human endometrium can be a potential target of metal accumulation within the human body. Quantitative analyses of endometrial metal content could serve as an additional indicator of potential impairments of the menstrual cycle and fertility.

Serum tumor necrosis factor alpha receptors p55/p75 ratio and ovarian cancer detection

Early ovarian cancer detection is still very difficult and patients are mostly in advanced stages, with obvious influence on poor prognosis.

Use of shear wave sonoelastography in capsular contracture before and after secondary surgery: report of two cases.

We present two cases of patients undergoing secondary surgery due to Baker III and IV contracture, with detailed sonoelastography evaluation before and after the surgery. It is probably the first case where the use of sonoelastography has enabled plane colour-coded analysis of regions with different stiffness (Young moduli, kPa). The obtained results have been compared with applanation tonometry.

Is the shear wave sonographic elastography correlated with pain after breast augmentation with silicone implants an indication of inflammatory activity? A preliminary report

Introduction Formation of a capsule is a natural inflammatory response to a foreign body such as a breast implant. Breast capsular contracture is the most severe complication of implant surgery. Aim To evaluate breast tissues and the periprosthetic reaction with sonoelastography. Material and methods Nineteen patients aged 20-41 underwent breast augmentation with silicone-filled implants. Their 38 breasts were evaluated before surgery, and 7 and 14 days after surgery. Whole breast stiffness was measured by applanation tonometry. Patients underwent shear wave elastography and Youngs moduli of breast tissues and the periprosthetic capsule were estimated. During surgery patients underwent standard anaesthesia and were released home 2 days later after removal of drainage. Each day, patients completed the pain visual analogue scale questionnaire separately for left and right breasts. Results Applanation tonometry did not correlate with any parameter. In shear wave elastography we observed statistically significant changes in elasticity of all breast tissues with the highest values on day 7 after surgery and decreasing on day 14. The correlations between pain and capsule elasticity in lower quadrants measured were significant between days 4 and 10, whereas correlations of pain with applanation tonometry were insignificant. Glandular tissue elasticity in lower quadrants did not correlate with pain, whereas in upper quadrants there was a significant correlation on days 6-10. Fatty tissue, muscle and thoracic fascia elasticity did not correlate with breast pain. Breast implant volume correlated with pain only shortly after surgery, but did not correlate with any sonoelastographic parameters. Conclusions Breast pain correlates strongly with periprosthetic stiffness in elastography 4 to 10 days after breast augmentation, suggesting the possible role of an inflammatory reaction.

Identification of toxic metals in human embryonic tissues

Introduction The cause of a significant number of miscarriages remains unexplained. There is a need to identify the potential role of environmental, dietary and lifestyle factors in the risk of pregnancy loss. The present study was the first to investigate the content of miscarried embryonic material with respect to eight metals (aluminium, cadmium, chromium, copper, manganese, nickel, lead and zinc). Material and methods Embryonic tissue samples (n = 20) were obtained from women undergoing misoprostol-induced removal of the embryo between the 6th and 9th week of gestation. The content of metals was analyzed using microwave-induced nitrogen plasma atomic emission spectrometry. Based on a short questionnaire, the smoking habits, dietary patterns and place of living of the investigated women were determined. Results The general mean content of metals (μg/g) decreased in the order copper (33.9) > manganese (24.7) > chromium (13.6) > zinc (13.3) > aluminium (6.5) > nickel (3.0) > lead (2.9) > cadmium (2.5). Profoundly increased concentrations (p < 0.05) of the toxic elements aluminium (over 5-fold), cadmium (over 2-fold) and lead (over 2-fold) were observed in samples obtained from former smoking women. The miscarried material in urban populations also revealed higher levels of cadmium (over 1.5-fold) and lead (over 2-fold) compared to that obtained from women living in rural areas (p < 0.05). No associations with age or diet were found (p > 0.05). Conclusions This study identified increased levels of aluminum, cadmium and lead in miscarried embryonic material and suggests some causative factors.

Influence of sex hormones in women on breast elasticity measured by shear wave sonoelastography--a cross-sectional study.

The physiology of breast depends on age, hormonal status, menstrual cycle, lactation, and others. The aim of our study was to evaluate correlations between hormonal status and breast glandular and fat tissue elasticity in healthy women. We examined 77 women aged 20–55 with shear wave sonoelastography and estimated their hormonal levels. There were no important correlations between breast elasticity, follicle-stimulating hormone (FSH), estrogen, prolactine, and thyroid hormones (p > 0.05). Androgens negatively influenced glandular to fat elasticity ratio (Rs = −0.25, p < 0.005). Luteinizing hormone to FSH ratio correlated positively with glandular and fat elasticity, especially in outer-upper quadrant (Rs = 0.24, p = 0.003).

Correlation between insulin resistance and breast elasticity heterogeneity measured by shear wave elastography in premenopausal women - a pilot study

Introduction Recent studies have demonstrated a strong correlation between obesity, insulin resistance, increased insulin and insulin-like growth factor levels and the risk of breast cancer. Our study was aimed at exploring correlations between glucose, insulin, insulin resistance, obesity and quantitatively estimated breast elasticity in healthy women. Material and methods The pilot study included 37 premenopausal women aged 22-45 years who underwent B-mode sonography and real-time shear wave elastography. Blood was collected for fasting insulin and glucose, and HOMA insulin resistance index was calculated. Results The mean elasticity of glandular and fatty tissue measured in both breasts was 12.5 ±3.5 kPa and 10.9 ±3.7 kPa respectively. Insulin levels did not correlate with glandular tissue elasticity (Rs=–0.23, p=0.15), but nearly correlated with fat tissue elasticity (Rs=–0.30, p=0.06), in outer quadrants significantly (Rs=–0.38, p=0.02). Interestingly, a strong correlation of insulin and insulin resistance with elasticity heterogeneity was found in fatty tissue (Rs=–0.59, p<0.001 and Rs=–0.60, p<0.001 respectively). The heterogeneity of fatty tissue but not glandular elasticity also correlated with body mass index. Conclusions Insulin levels and insulin resistance correlate with breast fat tissue heterogeneity, but their role in breast pathology remains unclear.