Tomasz Opala

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.

Multifactorial analysis of risk factors for reduced bone mineral density among postmenopausal women

Introduction The study aimed to determine the risk factors for reduced bone mineral density (BMD) among postmenopausal women. Material and methods Two hundred and fifty-three postmenopausal women were included to the study. The study group consisted of 85 women with osteoporosis (mean age: 59.9 years) and 168 with osteopenia (mean age: 57.8 years). Patients were assigned to groups according to their BMD measured in the lumbar spine, hip and femoral neck by dual X-ray absorptiometry. Bone formation was assessed by measuring serum osteocalcin and bone resorption by measuring serum C-terminal type I α-collagen chain telopeptide. Results Multiple regression analysis for lumbar spine showed association of age (p = 0.001), parental history of fracture (p = 0.05), use of hormone replacement therapy (p = 0.034), bisphosphonates therapy (p < 0.001), calcium and vitamin D supplements therapy (p = 0.001), oestradiol level (p = 0.007) and body mass index (p < 0.001). Multiple regression analysis for femoral neck and hip total showed association of age (p = 0.001), parental history of fracture (p = 0.049), use of bisphosphonates (p < 0.03)) use of calcium and vitamin D supplements (p = 0.039), oestradiol level (p = 0.047). All the variables together explain 40.4% of variance in BMD for the lumbar spine and 25.6% of variance in BMD for femoral neck and hip total. Conclusions The present study demonstrated correlations between the variables and BMD, which are known and widely described in the literature. Osteoporosis and osteopenia in Polish subjects appear to be associated with several known risk factors that are well described in the literature.

Quality of life in postmenopausal women with reduced bone mineral density: psychometric evaluation of the Polish version of QUALEFFO-41.

Introduction Evaluation of the quality of life of patients with osteoporosis concerns the physical, emotional, social and pain quality of life domains. The aim of the research was to describe the psychometric properties of the Polish version of QUALEFFO-41 in 253 Polish postmenopausal women with osteopenia or osteoporosis and in 132 postmenopausal women with normal BMD. Material and methods The internal reliability of QUALEFFO-41 was studied using Cronbach’s alpha coefficient. The reproducibility of the QUALEFFO-41 scales was assessed using Pearson’s correlation. The capacity of questions to discriminate between women with reduced bone mineral density (BMD) and normal subjects was assessed by conditional logistic regression to derive an odds ratio with 95% confidence intervals. The discriminative power, which measures the ability of the questionnaire to discriminate between patients, was assessed by clinical validity. Additionally, receiver operating characteristic (ROC) curves were constructed to assess the ability of QUALEFFO-41. Results Cronbach’s α coefficient reflecting the reliability and repeatability of the instrument for all domains was satisfactory. Results of scores for domains of QUALEFFO-41 and the score for total QUALEFFO-41 demonstrate a significant difference (p < 0.001) among all groups; only in the case of the pain domain was there a significant difference at the level of p < 0.01 between normal subjects and osteoporotic patients. Receiver operating characteristic curve analysis demonstrated a good discriminating capacity of individual domains and total QUALEFFO-41 score. Conclusions The Polish version of QUALEFFO-41 can be used among patients with reduced BMD compared to normal subjects, independently of vertebral fractures, as it is coherent and discriminates well between women with reduced BMD and normal subjects.

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.

The role of ghrelin, leptin and insulin in foetal development

INTRODUCTION AND OBJECTIVE The growing epidemic of childhood obesity has forced scientists to search for methods to prevent feeding disorders. Increasing interest in appetite regulating hormones has revealed their influence on energy homeostasis after birth or even in utero. STATE OF KNOWLEDGE The presence of ghrelin in the stomach of human foetuses and the distinctive production in the pancreas of neonates suggests the role of ghrelin in pre- and post-natal development. The neonatal period appears to be a critical time for the formation of adipose tissue-hypothalamus circuits, thus the amount of adipocytes in foetal life may be a major regulator of food intake. Insulins orexigenic effect in the arcuate nucleus of the hypothalamus can be a major modulator of foetal development. OBJECTIVE This review, based on available literature, aims to analyses the role of appetite regulating hormones in foetal development. SUMMARY Different concentrations of hormones, such as ghrelin, leptin and insulin during foetal life raises the question whether or not they can be modulated, thereby avoiding obesity before birth. Children with pancreas agenesis showed smaller body size at birth, which emphasises the probable role of insulin in foetal growth. Study of sheep foetuses with IUGR confirmed these finding. Appetite-regulating hormones show different roles in foetal development and seem to be essential in the perinatal period.

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.