Menopausal Review

Online ISSN: 1643-8876
Publications
Article
A decade after the presentation of the first results of the WHI study, medical experts are still discussing the interpretation of detailed results and the balance between the benefits and risks of hormone replacement therapy (HRT) in women after the menopause. There is a consensus that systemic HRT for relatively healthy women up to the age of 59 and/or within 10 years of the menopause is the best treatment of vasomotor symptoms, improves quality of life and does not increase the risk of coronary heart disease. There is no doubt that HRT requires an individual approach. The decision on the type of therapy, the route of administration and the dose of estrogen, should be based on the assessment of all menopausal symptoms, priorities of the woman, her age, time since the menopause, risk factors for cardiovascular diseases and risk of breast cancer. Regarding the differences between both arms of the WHI study it is accepted that the only purpose of concomitant progestagen is to protect endometrium in women with an intact uterus. The risk of venous thromboembolism and ischemic stroke is low, it depends on the route of administration, the age and body mass index. The risk of breast cancer increases after 5 years of estrogen-progestagen therapy, but in the case of estrogen alone there is no increase after 7 years of therapy. Studies on the understanding of that phenomenon are continued. Local administration of estrogen is a safe and effective treatment of symptoms of genitourinary atrophy, independent of the woman's age. A new updated recommendation about HRT use should be a result of reanalysis of all the data and this essential discussion.
 
Article
Introduction: Abdominal-pelvic mass, ascites and pleural effusion are suggestive of malignant metastatic ovarian cancer. This triad is also present in a rare benign condition called Meigs syndrome. Rarely this condition is associated with an increased CA 125 level. Case report: A 62-year-old woman with a history of abdominal pain underwent an ultrasound (US) examination and a chest X-ray. The imaging revealed the presence of a large pelvic mass and ascites with a monolateral pleural effusion and a high level of the tumor marker CA 125. The patient underwent a total abdominal hysterectomy, salpingoophorectomy, removal of the pelvic mass, pelvic lymphadenectomy and peritoneal biopsies. The histology showed an ovarian fibrothecoma. Discussion: The US analysis according to international ovarian tumor analysis simple rules revealed "inconclusive results"; the logistic regression model LR2 and Adnex suggested a high risk of malignancy. The presence of ascites and the size of the lesion associated with a high level of CA 125 affected the correct assessment of the risk of malignancy, exposing the patient to overtreatment. Conclusions: Meigs syndrome is characterized by the resolution of symptoms after surgical removal of the pelvic mass. However, it mimics the clinical picture of a malignant metastatic ovarian cancer. Clinicians have to exclude ovarian cancer and recognize the syndrome to reduce inappropriate procedures.
 
Article
Presence of fibrothecoma is not usually accompanied by elevated levels of tumor markers. In recent years, however, there have been isolated reports of fibrothecoma and Meigs’ syndrome, accompanied by an increase in tumor markers. We present a case of fibrothecoma with Meigs’ syndrome and elevated levels of both CA-125 (cancer antigen 125) and HE-4 (human epididymis protein 4). In this paper, we present a case of Meigs’ syndrome associated with an increased CA-125 and HE-4 level due to ovarian fibrothecoma.
 
Article
Abdominal and pelvic pain with an associated pelvic mass is a very common emergency situation. There is always a management dilemma for most emergency physicians regarding these patients. A 46-year-old postmenopausal woman was admitted to our emergency department (ED) with complaints of massive abdominal distention. Abdominal and pelvis magnetic resonance imaging (MRI) was performed, which revealed a huge pelvic abdominal mass. All tumor markers were within normal limits. However, the ovarian cancer antigen (CA 125) level was elevated. As there was a strong suspicion of malignancy, the patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Her final histopathology report was suggestive of uterine leiomyoma. Uterine leiomyomas are the most common benign uterine tumors in women. Surgical treatment is the gold standard, especially for older women with severe symptoms and no desire for future fertility. Although the combination of a pelvic tumor and a high-level of CA 125 arouses suspicion of gynecological malignancy, other benign conditions should always be considered in the differential diagnosis. There is limited evidence to support an association between elevated CA 125 levels and uterine fibroids so far. However, conditions such as the coexistence of adenomyosis and tumor size can affect the level of this marker in uterine fibroids.
 
Article
A 46-year-old woman presented to the emergency department with abdominal pain and abnormal uterine bleeding over the last year. She had a history of failed cyclic progesterone with tranexamic acid over the last 3 months to control her bleeding attacks. She had a tender pelvi-abdominal mass of 28 weeks' gestation size. Therapeutic curettage was performed, followed by correction of her iron deficiency anemia with intravenous iron. The trans-abdominal ultrasound of the pelvi-abdominal mass showed asymmetrical myometrial thickening, predominantly its anterior wall, with myometrial hyperechoic regions surrounded by hypoechoic areas suggestive of adenomyosis uterus for magnetic resonance imaging (MRI) evaluation. The MRI evaluation confirmed the diagnosis of adenomyosis uterus and showed diffuse asymmetrical uterine adenomyosis, predominantly its anterior myometrial wall, with an ill-defined endo-myometrial junction. Total abdominal hysterectomy with bilateral salpingectomy and bilateral ovarian conservation was performed after departmental approval and the patient's consent. The routine pre-operative investigations were completely normal except the cancer antigen (CA-125) which was unexpectedly high (1658 and 1046 IU/ml repeated twice two days apart). The histological examination of the surgical removed uterus confirmed the diagnosis of adenomyosis uterus and the pre-operative high CA-125 decreased to 22 IU/ml (normal range 0-35 IU/ml) one week after surgery. Conclusions: Unexpectedly high CA-125 over 1000 IU/ml can be seen in benign gynecologic conditions such as severe adenomyosis. The high CA-125 level is positively correlated to the uterine size in severe adenomyosis.
 
Article
Low-dose oral MHT combining 1 mg oestradiol (E(2)) and 2 mg drospirenone (DRSP) is effective in alleviating climacteric and urogenital symptoms, prevents endometrial hyperplasia, reduces the risk of osteoporosis, and has a positive influence on lipid profile, carbohydrate metabolism, arterial pressure and female quality of life. This safe type of MHT can be a drug of first choice for the big group of women after menopause.
 
Article
Objective: Sex hormones can affect the activity of immune cells, particularly lymphocytes and monocytes. The aim of the study was to investigate the activity of peripheral blood mononuclear cells (PBMC) after stimulation of progesterone and 17 beta-estradiol. The indicator of PBMC activity was the concentration of transforming growth factor-beta (TGF-beta) produced by those cells. It is an important factor involved in the regulation and course of the menstrual cycle and implantation Materials and methods: Material for the study comprised peripheral blood mononuclear cells isolated from the blood of 10 donors. The resulting cells were cultured for 48 h in the medium and in medium supplemented with different concentrations (1 ng/ml and 5 ng/ml and 10 ng/ml), progesterone and 17 beta-estradiol. Concentration of TGF-beta in the supernatant of PBMC culture was determined by ELISA immunoassay. Results: The analysis of results showed that after stimulation of both progesterone and 17 beta-estradiol, the secretory activity of PBMC was changed. With increasing concentrations of progesterone, the concentration of TGF-beta 2 was significantly higher as compared to unstimulated cultures (p < 0.0001). In contrast, significantly increased secretion of the parameter by PBMC was observed after stimulation of cells of 17 beta-estradiol at a concentration of 5 ng/ml (p < 0.0001). Conclusions: Progesterone and 17 beta-estradiol have effects on PBMC activity. Increased activity of these cells is observed after stimulation of higher levels of hormones, which greatly influences the secretion of TGF-beta.
 
Article
Introduction: The activities of daily living (ADLs) are a set of basic skills necessary for self-care. The in�ability of elderly people to perform ADLs leads to dependence, insecure conditions, and poor quality of life. The COVID-19 pandemic has affected all aspects of the daily life of the elderly. This study aimed to determine the factors associated with ADLs among elderly people during the COVID-19 pandemic using structural equation modelling/path analysis. Material and methods: It was a descriptive-analytical study which had conducted on 487 elderly people who were selected randomly to participate in the study. Data collection tools included a demographic informa�tion questionnaire, an activities of daily living questionnaire, a knee pain and personal performance question�naire Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and the falls efficacy scale, which were completed by interview and self-report methods. SPSS-22 and AMOS software were used for data analysis. Results: Two structures of the fear of falling (FOF) and knee pain and personal performance questionnaire WOMAC had a significant role in explaining the ADL variance among the studied elderly people (p < 0.001, root mean square error of approximation = 0.063). These variables explained 64% of the ADL variance. Conclusions: The structures of this model (FOF and WOMAC) can be used as a reference framework to de�sign effective interventions for improving ADLs among elderly people during the COVID-19 epidemic. It is also recommended that a multi-component program be provided, which includes exercise and psychological strate�gies for this population during the COVID-19 pandemic through online videos, distance health programs, etc. Key words: elderly, activities of daily living (ADLs), risk factors, fear of falling (FOF), COVID-19.
 
Article
Introduction: Isolation and self-quarantine can expose individuals, particularly older people, to cognitive and physical decline. Due to a reduction in their musculoskeletal and neural flexibility, older adults are more likely to be affected by quarantine limitations. This study aimed to investigate the effect of self-quarantine on cognitive and balance performance of older women during the COVID-19 outbreak. Material and methods: In a convenience sampling method, a total of 75 older adult women were recruited in this ex post facto study. The mini-mental state exam, single leg stance test, and timed up and go test were used to assess cognitive functions, static, and dynamic balance, respectively. Fall risk was measured by the Johns Hopkins assessment tool. Evaluations were performed before and after 7 months of quarantine due to the COVID-19 outbreak (November 2019 – June 2020), in which volunteers were at the lowest level of physical and social interaction. Results: No significant difference was observed in the mean static balance performance of the older adult women between the baseline and quarantine phases [p = 0.095, t (df) = –1.69]. The dynamic balance perfor�mance [p < 0.001, t (df) = 5.6] and cognitive status (p < 0.001, t = –7.4) decreased and the fall rate increased [p < 0.001, t (df) = 7.35] after 7 months of quarantine. Conclusions: It seems that self-quarantine can cause a decline in cognitive functions and dynamic balance performance of older women. It implies that the decrease in social interactions and physical activities caused by the limitations of self-quarantine put individuals at greater risk of cognitive impairment and increase their falling rate by impairing dynamic balance. Key words: cognitive performance, balance performance, older adults, women.
 
Article
Introduction: Since 2009 the new FIGO Staging System of endometrial cancer, which changed the previous FIGO 1988 Staging System, has been present. Unfortunately, parallel use of both classifications is observed. Aim of study: to assess whether parallel use of the 2009 and the 1988 FIGO staging systems can cause significant therapeutic mistakes in patients with endometrioid endometrial cancer. Material and methods: We analysed 262 patients with endometrioid endometrial cancer. The endometrial cancers were staged in both classifications. We analysed possible therapeutic mistakes caused by diverse nomenclature. Results: The patients at low risk, intermediate risk, and high risk for relapse were presented in: 110 (41.6%), 109 (42.0%) and 43 (16.4%) cases, respectively. The possibility of inappropriate qualification for adjuvant treatment occurred in 102 patients (38.9%) if they were staged in the FIGO 1988 classification and interpreted as the FIGO 2009 classification, and similarly, in 65 patients (24.8%) if they were staged in the FIGO 2009 classification and interpreted as the FIGO 1988 classification. The risk of a decision mistake in terms of the adjuvant treatment due to diverse nomenclature was observed commonly in 167 patients (63.7%). Conclusions: The common use of both FIGO staging systems for endometrioid endometrial cancer can cause significant therapeutic mistakes in terms of the adjuvant treatment. There is a need to use only the new FIGO 2009 Staging System for endometrial cancer and stop using the FIGO 1988 Staging System to avoid therapeutic mistakes.
 
Article
Introduction: Laparoscopic surgery has evolved very quickly and nowadays plays an important role in contemporary gynecology. This technique presents many advantages over traditional laparotomy, including smaller surgical stress against tissues, reduced postoperative pain, better cosmetic effect and shorter hospital stay as well as recovery period. Objective: The aim of the study was to analyze intraoperative and postoperative complications due to laparoscopic procedures performed in the Department of Gynecological Surgery of "Polish Mother's Health Center" Research Institute. Material and methods: We have analyzed hospital charts of 1359 patients who had been treated with laparoscopy in 1991-2010. The following parameters were evaluated: indications to laparoscopic surgery, type of procedures, intraoperative and postoperative complications. Results: In 1991-2010, a total number of 1359 laparoscopies were performed in the Department of Gynecological Surgery of "Polish Mother's Health Center" Research Institute. Most of laparoscopic operations were performed due to benign ovarian tumors (487-35.8%). The other indications were: infertility, endometriosis, extrauterine pregnancy, uterine myoma, sactosalpinx. The most common laparoscopic procedures were: chromosalpingoscopy (33.8%), excision of the ovarian tumor (25.2%), adnexectomy (9.4%). Because of technical dificulties or complications, laparoscopy turned into laparotomy in 47 cases (3.5%). The intraoperative complications occurred in 21 cases (1.5%). They were: bleeding into the abdominal cavity - in 10 cases, pneumatosis of the retroperitoneal space - 3 cases, injury of the colon - 1 case, injury of the small intestine - 1 case, injury of the urinary bladder - 1 case, injury of the uterus - 1 case, technical problems - 4 cases. Postoperative complications were found in 119 cases (8.76%) with fever being the most frequent one - 103 cases. Conclusions: 1. Laparoscopy is a safe and useful alternative technique compared to laparotomy for treatment of some gynecological pathology. Improvement of surgical skills of the medical team resulted in more common use of this procedure for both diagnostic and therapeutic purposes. 2. In the study period, we noticed a decreasing number of intraoperative and postoperative complications, which is comparable to that described by other centers.
 
Article
Introduction: Tumor progression is associated with the function of the immune system. Recent studies have shown that indoleamine 2,3-dioxygenase (IDO) is one of the molecules involved in tumor-induced immunosuppression. IDO probably induces tumor progression through inhibiting NK cells and T lymphocytes activity. Aim of the study: The aim of our study was to assess indoleamine 2,3-dioxygenase at the mRNA level in ovarian serous and endometrial adenocarcinoma. Material and methods: Forty patients (15 before and 25 after menopause) operated due to advanced ovarian carcinoma were recruited. mRNA expression of IDO was assessed by means of real-time PCR. The control group was represented by normal ovary tissue. Results: Indoleamine 2,3-dioxygenase was expressed at the mRNA level in all ovarian cancer patients. It was significantly higher (p < 0.005) in cancer tissue than in healthy controls (RQ = 0.040). The expression of IDO in serous ovarian cancer (RQ = 0.319) was significantly higher (p = 0.02) compared with the expression in endometrioid cancer (RQ = 0.091). The expression of IDO in ovarian cancer patients with clinical stage III was higher than in patients with clinical stage II, but this difference did not reach statistical significance. There was no statistically important difference between the expression of IDO in ovarian cancer patients in relation to grading and menopausal status. Conclusions: IDO positive expression is different among the histological types.
 
Article
Breast cancer is the most common malignant tumour among women. About 15,000 new cases of breast cancer are diagnosed and more than 5,000 women die in Poland every year. The aim of this study was to analyse the incidence and mortality rate of breast cancer among women in Poland in the years 2001-2010. Analysed data concerning the incidence of and mortality from cancer among women were obtained from the National Cancer Registry. The number of new cases reported in 2010 exceeded that reported in 2001 by 3,666. The mortality from breast cancer among women increased by 15.1% by 2009, to subsequently drop by 0.3% in 2010. The standardized incidence rate increased by 7.4 and the standardized mortality rate fell by 1.3 in 2001-2010. In the years 2001-2010 the incidence of breast cancer in women in Poland rose by 30.3%, with an increase of 7.4 in the incidence rate. The highest rise in the incidence and mortality of women due to breast cancer in Poland is reported in the Lodz voivodeship. In the years 2001-2009 the number of women's deaths due to breast cancer increased slightly, while the mortality rate dropped.
 
Article
Aim of the study: Laparoscopy is one of the most common diagnostic and therapeutic procedures in gynecology, allowing for an accurate macroscopic evaluation of abdominal and pelvic cavity with minimal invasiveness. The most common indications for gynecological laparoscopy are infertility, diagnosis and treatment of pelvic pain, ectopic pregnancy, endometriosis, adnexal inflammation, benign adnexal tumors and cysts. The aim of this study was retrospective evaluation of the causes of conversion to laparotomy procedures performed in the Department of Gynecology, Institute of Polish Mother's Memorial Hospital in the years 2006-2012. Material and methods: The study involved 906 patients hospitalized in the Department of Gynecology ICZMP in Lodz between 2006 and 2012, who had undergone laparoscopic surgery. An analysis of 42 case records of patients in whom laparoscopy was performed initially, and then conversion to laparotomy occurred. Results: 906 laparoscopies were performed in the Department of Gynecology in the years 2006-2012. A detailed analysis of the indications for endoscopic surgery that ended in conversion to laparotomy was performed. Of all endoscopic procedures performed, in 42 cases (4.6%) the need for conversion from laparoscopy to laparotomy occurred. The most common cause was massive adhesions - in 21 cases (50%). Heavy bleeding was the reason for conversion to laparotomy in 5 patients (12%). Technical difficulties in performing laparoscopic surgery occurred in 4 women (9.5%), and difficulty to produce pneumoperitoneum in 2. In 4 patients during surgery there was damage to the intestines. The diagnosis of-ovarian cancer established intraoperatively resulted in the completion of the surgery by laparotomy in 2 cases (4.8%). In other 2 patients, tumor location and its size (in both cases, tumor diameter greater than 10 cm) led to the completion of the procedure in a classical way. Conclusions: Laparoscopy is a common and generally acceptable medical diagnostic method used in the Department of Gynecology, Institute of Polish Mother's Health Center. As with any surgical intervention, however, it involves a risk of complications, the proportion of which leads to the need for conversion to laparotomy.
 
Article
In this article some up-to-date information on transdermal hormone therapy is presented. Lack of first-pass effect, therapeutic efficacy and safety make transdermal MHT a therapy of the first choice for many menopausal subjects.
 
Article
Zespół Ekspertów Polskiego Towarzystwa Menopauzyi Andropauzy na posiedzeniu 23.04.2010 r. dokonał przegląduliteratury przedmiotu z ostatnich 3 lat dotyczącejterapii hormonalnej okresu menopauzalnego (menopausalhormone therapy – MHT), koncentrując się szczególniena aspektach praktycznych prowadzenia tej terapiiw świetle Evidence Based Medicine. Niniejsze stanowiskoPTMA jest uaktualnieniem poprzedniego z 2007 r.
 
Article
Bornstein et al. developed a classification which was endorsed by the Congress of the International Federation for Cervical Pathology and Colposcopy (IFCPC) held in Rio de Janeiro on 5 July 2011. The classification accepted at the Congress is aimed at considerable facilitation of efficient clinical management. The IFCPC 2011 classification of the colposcopic images, which does not change basic colposcopic definitions, is composed of two parts: a general one and a detailed one. In the general part, attention is focused on the degree to which the inspected colposcopic image is suitable for evaluation, how extensive the inspected lesion of the cervix is and whether it is visible in full or only partially. In the detailed part, the observed colposcopic images are divided into normal and abnormal ones (from an oncological point of view), implying cervical carcinoma and others. The classification distinguishes two grades of epithelial anomalies: grade 1 - low grade (low grade squamous intraepithelial lesion - LG SIL) and grade 2 - high grade (high grade squamous intraepithelial lesion - HG SIL). The basis for categorizing the epithelial lesions observed in colposcopy to the appropriate grade of the anomaly is above all the outcome of acetic acid test. The classification also clearly defines other criteria that allow to categorize the observed colposcopic images to either of the mentioned groups. In many women, as years go on following menopause, the epithelium is getting thinner and its surface is becoming more and more sleek and smooth. A thin atrophic squamous epithelium is penetrating into a cervical canal and then the border of the squamocolumnar junction occurs deeply in the canal. It is necessary, according to suggestions of Carcopino et al., to collect a cytological swab from the interior of the canal or curette carefully the canal and perform a histopathological assessment of the collected material. An addendum containing the abnormal epithelial lesions of the uterine cervix is attached to the IFCPC 2011 classification of colposcopic images. It refers to the procedures of collecting tissue material from the cervix. The addendum defines also the sizes of collected tissue samples.
 
Article
Having thoroughly reviewed the literature on this topic, Members of the Management of the Polish Menopause and Andropause Society present up-to-date recommendations concerning menopausal hormone therapy (MHT).
 
Reproducibility of histological findings in EIN, EWG, and WHO systems regarding complexity of divisions into categories 
Article
Endometrial hyperplasia (EH) is a pathological condition characterised by hyperplastic changes in endometrial glandular and stromal structures lining the uterine cavity. Endometrial hyperplasia, particularly with atypia, is a significant clinical concern because it can be a precursor of endometrial cancer. Accurate diagnosis of precancerous lesions of the endometrium and exclusion of coexisting endometrial carcinomas are absolutely required for the optimal management of patients. The classification of endometrial hyperplasia has had numerous terminology. According to the classification of WHO94, based on glandular complexity and nuclear atypia, EH is divided into four groups: non-atypical endometrial hyperplasia (simple, complex) and atypical endometrial hyperplasia (simple, complex). Estimated risk of progression of atypical hyperplasia to endometrial cancer is 8-29%. The American College of Obstetricians and Gynaecologists and the Society of Gynaecological Oncology states that endometrial intraepithelial neoplasia (EIN) classification is superior to the World Health Organisation (WHO 94) classification for histology of endometrial hyperplasia. However, the WHO classification system remains the most commonly used and reported in existing literature. The new classification, WHO 2014, accepted by the International Society of Gynaecological Pathologists, divided hyperplasia into two groups: benign hyperplasia and atypical hyperplasia/endometrial intraepithelial neoplasia (EIN). The WHO 2014 schema is more likely to successfully identify precancerous lesions than the WHO94 classification.
 
Article
The term 'male menopause' was first used in 1944 to describe various complaints of ageing men which at least partially mirrored the climacteric symptoms in women. Continuous research resulted in the evolution of opinions about the nature of these complaints, from the clinical syndrome, diagnosed with the use of disease-targeted questionnaires, to a well-defined clinical and biochemical syndrome. The pathophysiological causes - gonad ageing (with a compensatory rise in luteinizing hormone), age-related increase in serum sex hormone-binding globulin (SHBG) levels, the role of visceral adipose tissue as a place for aromatization of androgen to estrogen, and lower sensitivity of testosterone receptors - have been described. However, no consensus was reached as far as the definition, incidence, treatment, and especially testosterone therapy, are concerned. Our review presents the current standpoints, indicating the predictive role of late-onset hypogonadism (LOH) in evaluating male health as well as the current literature reports on the risks and benefits of using testosterone therapy.
 
Transperineal examination in the midsagittal plane 
Transvaginal examination with the biplane electronic probe (linear perpendicular arrays used) in a patient after suburethral sling procedure. Some subtle structures of the urethral complex can be distinguished 
Patient after posterior vaginal mesh. Posterior compartment examined with transvaginal biplane electronic probe (linear perpendicular arrays used) 
Article
The role of ultrasound imaging in urogynecology is not clearly defined. Despite significant developments in visualization techniques and interpretation of images, pelvic ultrasound is still more a tool for research than for clinical practice. Structures of the lower genitourinary tract and pelvic floor can be visualized from different approaches: transperineal, introital, transvaginal, abdominal or endoanal. According to contemporary guidelines and recommendations, the role of ultrasound in urogynecology is limited to the measurement of post-void residue. However, in many instances, including planning and audit of surgical procedures, management of recurrences or complications, ultrasound may be proposed as the initial examination of choice. Ultrasound may be used for assessment of bladder neck mobility before anti-incontinence procedures. On rare occasions it is helpful in recognition of pathologies mimicking vaginal prolapse such as vaginal cyst, urethral diverticula or rectal intussusception. In patients subjected to suburethral slings, causes of surgery failure or postsurgical voiding dysfunctions can be revealed by imaging. Many reports link the location of a tape close to the bladder neck to unfavorable outcomes of sling surgery. Some postoperative complications, such as urinary retention, mesh malposition, hematoma, or urinary tract injury, can be diagnosed by ultrasound. On the other hand, the clinical value of some applications of ultrasound in urogynecology, for example measurement of the bladder wall thickness as a marker of detrusor overactivity, has not been proved.
 
Article
Uterine fibroids are considered to be the most common benign tumours in females. The vast majority of these tumours are incidental findings and do not require any treatment. Symptomatic fibroids, with ailments such as abnormal uterine bleeding, dysmenorrhoea, pelvic pain, impaired urination, bowel dysfunction, infertility, and recurrent pregnancy loss, are indicated for medical treatment. Surgery remains a first-line treatment of symptomatic uterine fibroids; however, minimally invasive techniques and pharmacological management have become more available and popular. Among minimally invasive techniques uterine artery embolization (UAE) is the most well-established uterine preserving treatment. UAE was first introduced in obstetrics and gynaecology in 1987 and since then many studies have shown the safety and efficacy of UAE in fibroid treatment with low rates of complications. In this review we present a novel approach to UAE, which reflects the current state of knowledge based on recent clinical trials and long-term post-procedural follow-up.
 
Article
Vulvovaginal atrophy accompanied by lower urinary tract dysfunction related to low levels of estrogen and androgens is labeled as genitourinary syndrome of menopause (GSM). Although this condition affects most postmenopausal women worldwide, it seems to be underdiagnosed and undertreated. Women should be properly advised to choose an adequate treatment modality to improve their quality of life, sexual relationships and social activity. The aim of this article to is increase knowledge of GSM. The current treatment options, both hormonal and non-hormonal, are reviewed. Topical estrogen therapy still remains the gold standard, but the demand for individually tailored therapy is growing. New treatment modalities are continuously included in clinical practice. They should consider the whole personality of a woman as well as cultural and social factors. Further studies on GSM and on the effectiveness of various treatment options are necessary to achieve this purpose.
 
Article
Septic shock is a rare but dramatic complication in obstetrics with a high mortality rate. In the course of this condition, cardiovascular failure, severe hypotension and multiorgan dysfunction are observed. Usually, septic shock is also associated with disturbed coagulation. In our report, we present a case of septic shock caused by Escherichia coli after spontaneous abortion in the 21st gestational week of pregnancy in a 40-year-old woman. During intensive care, besides broad-spectrum antibiotics, hysterectomy was performed and activated protein C was administered. In our opinion, this treatment modality significantly improved the outcome in our patient.
 
Article
Introduction: About 13% of Polish women die every year because of breast cancer. The treatment of breast cancer is becoming increasingly less invasive but it is still long-lasting and causes a lot of side effects. Today, in the case of some women, if there are no contraindications, it is possible to perform breast reconstruction. Aim of the study: The purpose of the research was to determine whether there are differences in the assessment of the quality of life among women after mastectomy and breast reconstruction. Material and methods: The research covered a group of 241 women from oncology hospitals in Lublin. 55.19% (n = 133) of them had mastectomy, while 44.81% (n = 108) had breast reconstruction. During the research, the following questionnaires were used - EORTC QLQ-C30 and QLQ-BR23. Statistical analyses were conducted based on STATISTICA 8.0 Program, assuming a significance level of p < 0.05. Results: The research shows that breast reconstruction has a significant positive effect on the assessment of the quality of life of women in the physical, emotional and social sphere, while it has no effect on the cognitive sphere. Conclusions: The quality of life of women after breast reconstruction in most dimensions is assessed higher than in the case of women after mastectomy. If women knew that the treatment is now less invasive, it would probably contribute to a higher number of women deciding to undergo oncological treatment.
 
Article
Background: More attention is being paid lately to polycystic ovary syndrome (PCOS) not only in the aspect of fertility but also according to long-term metabolic and cardiovascular abnormalities. Observations of women with PCOS show that the occurrence of blood hypertension is more frequent after the menopause. There are few articles concerning the predictable symptoms of blood hypertension. It seems that twenty-four hour blood pressure monitoring and assessment of changes of diurnal rhythm could be useful in this group of patients. Aim of the study: The purpose of this study was to assess diurnal changes of blood pressure in women with polycystic ovary syndrome. Material and methods: 26 women with PCOS diagnosed according to Rotterdam consensus criteria and Androgen Excess Society (AES) criteria were included in our study. The mean age of the examined women was 29.5 years and the mean BMI (body mass index) was 24.7 kg/m2. The control group consisted of 12 age-matched women, without PCOS. Twenty-four hour Holter monitoring of ambulatory blood pressure was performed during normal daily activity in all patients. Halberg's cosinor method was used to analyse daily biorhythm. Results: Results show the diurnal changes of systolic blood pressure in the preclinical phase in 30% and diastolic in 15% of PCOS women. In this group no physiological decrease of blood pressure at night time was observed.
 
Cardiotocography during admission
Article
There are many reasons for sterility, and uterine malformations are of the greatest concern. Among uterine disorders, myomas play a significant role and are present in 27% of infertile women. The occurrence of myomas is frequent – 20-40% in women of reproductive age. Thus, for those infertile patients surgical treatment may be needed to preserve an opportunity to conceive. This case report refers to an uterine rupture at 28 weeks of gestation after laparoscopic myomectomy (3 months before conceiving). The myomectomy was conducted correctly and two layers of sutures on the myometrium were performed. The purpose of the myomectomy in a young woman should be well considered. In cases of infertility, removal of the lesions is usually necessary to give the patient a chance of pregnancy. At the same time, the risk of uterine rupture is increased. There are some suggestions referring to myomectomy to reduce the risk of uterine rupture in a subsequent pregnancy. It seems that the method of sewing the uterine closure is crucial. For example, multilayer uterine stitches, preservation of the endometrial cavity, and avoidance of using electrosurgery to prevent devascularization (to avoid haematoma formation) should be taken into consideration to prevent weakness of the wall of the uterus. Uterine scars differ histologically and biochemically.
 
Article
Male breast cancer (MBC) is a rare disease that occurs in ~0.2% of all neoplasms among men. The risk of developing MBC is higher in men with a BRCA2 genetic mutation (7%). The aim of this study was to evaluate the association between c.2808_2811del ACAA (p.Ala938Profs) BRCA2 mutation in MBC and clinicopathological factors. A 75-year-old patient was admitted to the Genetic Outpatient Clinic with a diagnosis of right breast cancer and with a family history of cancer (two daughters who were diagnosed with breast cancer at ages 46 and 38 years). Postoperative histopathological examination revealed tumor type pT2 N1a Mx, NST NG-3 G-3, Ki-67 (75%), HER2 (+), ER (+++), PR (+++), invasive carcinoma and luminal B subtype. The complete coding sequences of the BRCA1 and BRCA2 genes were analyzed for genomic DNA material using next generation sequencing on the Ion Torrent platform. The c.2808_2811delACAA (p.Ala938Profs) mutation was observed in the BRCA2 gene. The presence of the c.2808_2811delACAA (p.Ala938Profs) mutation in the BRCA2 gene was confirmed using the Sanger method. The same BRCA2 gene mutation was reported in one of the patient's daughters. The detected mutation causes the frameshift mutation, resulting in the creation of an additional translation termination codon and the synthesis of an abnormal protein. This mutation was associated with a later age of disease, a higher histological degree, a higher mitotic index, a positive steroid receptor status and the luminal B subtype HER2- breast cancer.
 
Primer sequences for each of the genes in the studied groups
Article
Introduction: Heart disease risk rises with age. However, women's symptoms become more pronounced following the onset of menopause. The aim of the present study was to evaluate the effects of six weeks of combined resistance-endurance (RE) training on microRNA-29 expression in the heart of ovariectomised rats. Material and methods: Thirty female Wistar rats were divided into three groups: 1) sham (SHAM); 2) ovariectomy (OVX); and 3) OVX with RE training (OVX + RE). The effects of these treatments on cardiac microRNA-29 expression were measured using real-time PCR. Data were analysed using a 2 × 3 ANOVA and Tukey post-hoc comparisons and presented as mean ±SEM. Results: Ovariectomy resulted in a significant down-regulation in the heart microRNA-29 gene expression of OVX (0.265 ±0.031 fold changes), OVX + RE (0.699 ±0.038 fold changes) in animals vs. sham animals (1 ±0 fold changes; all, p < 0.05) following six weeks of treatment. However, microRNA-29 expression in the OVX + RE group was significantly greater than in the OVX group (p < 0.05). Conclusions: Our findings suggest that the six weeks of regular RE training attenuate the reduction in heart muscle microRNA-29 expression observed in ovariectomised rates. If our findings carry over to humans, such an exercise regimen could be beneficial to the cardiovascular disease risk in women during menopause.
 
Article
Aim: Polymorphisms in the promoter region of metallothionein genes resulting in variation of heavy metal detoxification may be associated with cancer risk. In the present work A/G (-5) polymorphism in the promoter region of the metallothionein 2A gene (MT-2A) in ductal carcinoma of the breast was investigated. Material and methods: Genomic DNA isolated from 75 breast cancer patients and 100 volunteers was used to genotype MT-2A A/G (-5). Polymorphism was determined by automated DNA sequencer ABI PRISM 377. GeneScan Analysis Software ver. 3.7 and DNA Sequencing Analysis Software ver. 3.4.1 was used for interpretation of results. Results: The distribution of the genotypes of the A/G (-5) polymorphism in the promoter region of MT-2A in both controls and patients did not differ significantly (p>0.05) from those predicted by the Hardy-Weinberg distribution. There were no significant differences (p>0.05) in genotype distributions or allele frequencies between subgroups assigned to different Bloom-Richardson grading. Conclusions: The results suggest that the A/G (-5) polymorphism in the promoter region of the MT-2A gene may not be linked with neoplastic transformation of breast ductal carcinoma.
 
Article
Inerleukin-6 is a pleiotropic cytokine with multidirectional influence on the cells of both innate and adaptive immune system. The main role of IL-6 is to initiate and regulate acute inflammatory response and adaptive immunity. It has a number of physiological effects. Overproduction of IL-6 causes a change from acute to chronic inflammation. Its higher concentration may initiate premature occurrence of preterm uterine contractions. Preterm delivery is the main reason for perinatal mortality and morbidity of neonates. Pro-inflammatory cytokines, mainly IL-1 and IL-6, which stimulate prostaglandin production are considered to be crucial reasons for preterm delivery.
 
Article
Women in the twenty-first century play a more active role in social and working life. They strive to achieve an adequate education and material status and postpone motherhood. Therefore more and more women over 35 years of age become mothers. Thanks to techniques of assisted reproduction it is possible. However, we have to keep in mind that pregnancy in mature women is not so risky because of the age, but may be associated with various complications. In pregnant women over the age of 35 there are statistically more cases of intrauterine fetal death, miscarriage, genetic defects, hypertension, gestational diabetes and preterm deliveries. These pregnancies are usually completed by caesarean section because of elective indications. Children of women over the age of 35 are usually born in a good condition, as measured both on the Apgar scale and by the cord blood pH. Despite the fact that pregnancy in mature women can cause medical complications such as hypertension or gestational diabetes, with properly conducted perinatal care it does not raise any reservations and, what is more, the results are comparable with younger women.
 
Serum level of CCL20/MIP-3α
Serum levels of CCL20/MIP-3α in endometriosis subgroups [pg/ml]
Article
Introduction: Endometriosis is a chronic disease defined by the presence of uterine mucosa outside the uterine cavity. Abnormal levels of cytokines, growth factors, adhesion molecules and metalloproteinases have been found in patients with endometriosis. A review of the literature revealed no papers on CCL20 serum levels in women with endometriosis. Material and methods: The study included 32 women who underwent laparoscopy in the Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland. Patients were divided into 2 groups: the study and control group. The study group was divided into three subgroups according to endometriosis form. Twenty patients were included in the study group and 12 patients acted as controls. CCL20 concentrations value were determined using a quantitative sandwich ELISA kit (R&D Systems). Results were statistically analyzed by SPSS STATISTICS 24.0.0 software. A significance level of 0.05 was used. Results: The mean serum level of CCL20 in the study group was 7.4 pg/ml. In controls the mean value was 10.95 pg/ml. The concentration of CCL20 was statistically significantly lower in the study group than in controls (p = 0.004). Within the study group the highest values were reported in patients with endometrial ovarian cysts (8.55 pg/ml), intermediate in the DIE subgroup (8.24 pg/ml) and the lowest in patients with peritoneal endometriosis (6.74 pg/ml). Differences between subgroups were not statistically significant (p = 0.385). Conclusions: Our study revealed statistically significantly decreased CCL20 serum levels in women with endometriosis. No significant differences of CCL20 serum levels between patients with different forms of endometriosis were observed.
 
Article
Aim: To assess correlation between endometrial thickness, Doppler blood flow indices and 3D in women with endometrial hyperplasia (EH) or endometrial cancer (EC). Material and methods: We studied a group of 80 women in whom 55 cases of EC and 25 cases of EH were found. In all cases a transvaginal 6-9 MHZ probe and a Kretz Voluson 730 (Austria) equipment were used. Clinical data such as menopausal status, age, were compared with tumor histological grade, FIGO stage and preoperative sonography. Sonographical criteria included endometrial thickness and volume, Doppler blood flow indices PI, RI and PSV studied in the uterine artery as well as 3D vascularity and blood flow indices VI, FI and VFI. Results: Endometrial thickness and volume were significantly different in groups with EH and EC (p=0.0004 and p=0.02, respectively). Menopausal status, histological grade and FIGO stage were correlated with endometrial thickness (p=0.02; p=0.03; p=0.04, respectively) but not with endometrial volume. Medians of VI FI i VFI were significantly different in both groups with EH and EC (p=0.009, p=0.05 and p=0.009, respectively). Menopausal status and clinical stage of EC were significantly correlated with VI: p=0.003; FI: p=0.02 VFI: p=0.03. Also, positive and significant correlations between 2D blod flow indices and 3D vascularity and flow indices were found (p>0.02). Conclusions: Doppler assessment of vascularity and flow may be used as additional criteria allowing for better preoperative discrimination of endometrial hyperplasia and cancer. Low risk of malignancy based of sonographic and sonoangiographic criteria could safely exlude some patients from invasive procedures such as unnecessary endometrial biopsy.
 
Article
Uterine fibroids are considered to be the most frequent female benign tumours. The most common reported symptoms of fibroids are heavy menstrual bleeding and painful menstruation, pelvic pain, urinary problems, constipation, as well as infertility and recurrent pregnancy loss. The mainstay of fibroid treatment is surgery, but nowadays minimally-invasive techniques are growing in popularity. Vascularity of fibroids may play a role in the outcome of these techniques, which is why it is important to find an objective, reproducible technique to measure the vascularization before and after the procedure. The 3D Power Doppler vascular indices (3DPDVI) allow objective assessment of vascularization in the entire volume of the tumour. Initially this technique was mostly used in experimental imaging phantoms, but recently many studies focus on the clinical utility of this technique. Power Doppler allows to obtain information on vascularity in the area of interest, while 3DPDVI can be objectively calculated by the Virtual Organ Computer-Aided AnaLysis (VOCAL™) software. 3DPDVI showed high reproducibility in most of the studies. This technique has an important role in monitoring the outcome of minimally invasive procedures in fibroid treatment, because they affect vascularity of the tumours. Although there are some limitations of 3DPDVI, it seems that their application may be an effective tool in objective assessment of vascularity of fibroids. However further studies are required to consolidate the usage of 3DPDVI in clinical practice.
 
Tumour infiltrating right ureter, PET-CT scan of the pelvis
Tumour infiltrating right ureter, PET-CT scan of the pelvis
The ports' location for pelvic urological operations
Article
The paper describes a case of a 61-year-old woman with recurrent epithelial ovarian cancer infiltrating the ureter treated with 3D laparoscopy as a tertiary cytoreductive surgery (TCR). In addition, a mini-review of the literature concerning TCR is presented.
 
Article
Cornual pregnancy is a rarely occurring variant of ectopic pregnancy with often unspecific symptoms, what makes the diagnosis very difficult. Its early detection is a key factor for using less invasive treatment and preserving fertility. The article presents a case of a 41-year-old nullipara in her fourth pregnancy, after unilateral resection of adnexa because of the tubal pregnancy, with the diagnosis of the cornual pregnancy. She was treated laparoscopically, i.e. the cornual resection was performed. The postoperative period was uneventful. Early diagnosis and treatment made it possible to minimize the risk connected with this life-threatening entity.
 
Article
Introduction: Health is a value that has the strongest impact on the living situation of the Poles. It is often equated with good quality of life. Aim of the study: To assess the subjective sense of health of Polish female physicians in the perimenopausal age range and to examine the impact of selected sociodemographic and lifestyle-related variables on the subjective sense of health. Materials and methods: The study involved 221 working female physicians certified in a specialty. Median age was 50.57 +/- 2.97 years. The Subjective Health Profile (SHP) instrument and a self-developed questionnaire were used. Results: Most of respondents reported health-enhancing behaviours, as well as good physical, mental and social functioning. The study demonstrated a statistically significant relationship between the global subjective sense of health and: having children, frequency of physical activity, satisfaction with physical appearance, regularity of eating meals, mood and suicidal thoughts. Conclusions: Polish female physicians in the age range of 45-55 years have a subjective sense of good health status which is favoured by health-enhancing behaviours and mental well-being.
 
Article
Introduction : Contemporary people do not follow the civilisation development in every life domain, their lifestyle is not always healthy. Self-efficacy is the factor that plays an important role in undertaking actions towards struggling with the disease. The aim of the study was to determine the relationship between the general self-efficacy level and health behaviours as well as chosen sociodemographic features in women over the age of 45 years who have undergone osteoporosis treatment. Material and methods : The study comprised 151 women over the age of 45 years. The research was conducted in 2016 in health care centres in Lublin, a city in south-eastern Poland. The Generalised Self-Efficacy Scale (GSES) by R. Schwarzer, M. Jerusalem and Z. Juczyński and an original questionnaire were used as research tools. The obtained material was subjected to descriptive and statistical analysis. 2 test, Kruskal-Wallis test, Mann-Whitney Test and Spearman’s rank correlation coefficient were all applied. Results : The analysis of obtained results showed that as much as 73.5% of the respondents showed very low and low generalised self-efficacy level. On the other hand, only 22.5% of the examined were characterised by high and very high generalised self-efficacy level. The longer the duration of osteoporosis treatment (rho = 0.251; p = 0.002) and the better the self-estimation of health status (rho = 0.473; p = 0.000), the higher the respondents’ generalised self-efficacy level. The women’s self-efficacy level declined with increasing ailments (rho = –0.190; p = 0.019). Conclusions : The generalized self-efficacy level and the health behaviours are not satisfactory.
 
Change in attitudes towards menopause (MRQ scores) over time in group S (S t1 vs. S t1 -significant) and group C (C t1 vs. C t2 -non-significant).
Article
Objectives: Psychological interventions are effective ways to modify experience of menopause. They provide evidence-based data on menopausal transition and develop skills for symptoms' management. The designed intervention programme included information on hormonal mechanisms, symptoms and the impact of menopause on health, and offered exercises aimed at recognition of bodily sensations and their control. A study was conducted to evaluate its effects. Design: Cross-sectional, with two-week follow-up. Material and methods: Women aged 48-54 yrs were recruited at meetings of non-governmental organizations and divided into 2 groups (study, n = 30 and control, n = 30). Participants filled in (time 1): demographic questionnaire, Menopause Symptoms List (MSL), Type D Personality Questionnaire (DS-14), Menopause Representation Questionnaire (MRQ). At time 2 (2 weeks after the intervention) all women filled in MSL and MRQ. The study group evaluated the intervention immediately after it and 2 weeks later. Results: The study group reported a significant (p < 0.001) decrease in intensity and frequency of vasomotor and psychological symptoms, and a decrease in intensity of somatic symptoms; more positive attitudes towards menopause (p < 0.001) were expressed. In both groups, a significant correlation was found for frequency and intensity of all types of symptoms and DS-14 scores (p < 0.001). Positive opinions on the workshop increased with the time. Conclusions: The findings indicate the potential to change experiences by the designed psychological intervention. A relatively short follow-up requires cautious interpretation of the effects of the programme.
 
Article
The etiology of pseudomyxoma peritonei is unknown. There are several study reporting pseudomyxoma peritonei associated with the tumors of abdominal cavity, especially related with appendix at/or ovary. We reported case of pseudomyxoma peritonei associated with cystadenoma appendix and granulose cell tumor of the ovary in 54-year-old woman. Ultrasound showed a cystic tumor with solid area of the right ovary, size 9 cm. The tumor marker (Ca 125) was within the normal limit. Laparotomy was performed during which the following structures were diagnosed: normal size uterine body, bilaterally enlarged ovaries with the presence of mucinous cysts on their surface, 8 cm diameter tumor infiltrating appendix, in greater omentum presence of tumor like mucosal structures. Ascites was not present. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and appendectomy. The histopathological examination was describe pseudomyxoma peritonei, cystadenoma mucinosum of the appendix and granulose cell tumor of the right ovary. This case represented FIGO stage I. Pseudomyxoma peritonei may occur in patients with appendiceal mucoceles and ovarian tumor.
 
Article
Mucosal melanoma is a rare malignant tumor - 0.5-2% of all melanomas, which is not included in TNM classification. Among head and neck localisation, it arise most frequently in the nose and paranasal sinuses, oral cavity, nasopharynx and middle ear. According to this untypical place of melanoma, aggressive behavior and nonspecific symptoms the stage of investigation in this cases is usually late. Surgical resection with appropriate margin of normal mucosa in this localization is difficult, so the prognosis is poor. We report a case of primary melanoma of the middle ear in 58-year-old woman admitted to Otolaryngology Department of the Medical University of Łódź. On admission the patient presented left ear tinnitus and hypoacussis with serosanguineous exudate.
 
The comparison of changes in levels of antibodies against heat shock proteins 60 (HSP60) between examined groups 
Article
Introduction: In current literature, the immune-inflammatory theory of atherosclerosis is widely discussed. The role of how heat shock proteins 60 (HSP60) lead to the development of the atheromatous plaque is especially underlined. The aim of the study is to estimate the influence of three hormonal protocols on behavior of antibodies against HSP60. It determines the state of endothelium in postmenopausal women. Material and methods: The study was carried out on 90 women between 2007 and 2012. All the women were in their menopausal age (51 ± 3 years), from the south region of Poland, with a follicle stimulating hormone (FSH) level above 25 mIU/ml, and with menopausal symptoms disturbing their normal daily activity. The study was done for a period of 6 months. Three groups of 30 randomized patients were formed. In the first group we used transdermal estrogen therapy in a 37.5 µg/24 h dose combined with a 10 mg dose of dydrogesterone. In the second group we applied transdermal estrogen therapy in a 50 µg/24 h dose with 2.5 mg of oral medroxyprogesterone. In both these groups, gestagens were administered continuously. In the third group, we prescribed continuous, oral, low-dose combined estrogen-gestagen therapy with 1 mg of ethinyl estradiol and 0.5 mg of norethisterone acetate. The control group consisted of 30 volunteers who were also from the south region of Poland, in good health, with menopausal symptoms, no menstrual period for the last 12 months, selected considering their age and weight, with an FSH level above 25 mIU/ml and with normal levels of thyroid stimulating hormone (TSH) and prolactin. All patients treated and in the control group were seronegative to Chlamydia pneumonia for the entire duration of the study. In the analysis conducted, nonparametric tests were used (Mann-Whitney U test, Wilcoxon test, Kruskal-Wallis test - ANOVA). Results: After 6 months of hormonal therapy, we found that all schemes of treatment promote a significant reduction in antibodies against HSP60 in all treated groups vs. the control group. Conclusions: All of the investigated estrogen protocols have a favorable impact on the blood level of HSP60 antibodies in early postmenopausal women who have no cardiovascular risk factors. It triggers a better condition of endothelium.
 
Article
Melanoma of the vulva comprises around 3-4% of all melanoma cases in women, very rarely appearing before the age of 50. It belongs to the group of rare tumours in this location, comprising 8-10% of vulva tumours, and the estimated frequency of vulvar melanoma occurrence is 0.10/100 000 women-years. Among the factors that can predispose to developing melanoma of the vulva, we can distinguish chronic inflammatory diseases, virus infections (including HPV virus), factors causing vulva irritation and genetic susceptibility. The majority of melanomas of the vulva develop "de novo", but they can also develop on the basis of previously existing pigmentary birthmarks. Most frequently, during physical examination pigmentary changes in the area of the vulva are found. However, in around 30% of cases melanoma does not have pigmentary traits. The depth of infiltration (invasion) is the crucial prognostic histological factor in melanoma. The treatment is based on surgery, the extent of which depends on the stage of tumour advancement. Supplemental treatment makes use of interleukin-2, interferon alpha, dacarbazine or paclitaxel with cisplatin or carboplatin. The case of a 64-year-old female patient with melanoma of the vulva area, who despite surgical treatment based on partial excision of the vulva with lymph glands and keeping a margin of healthy tissues, as well as supplemental therapy with interferon alpha, and who after a year was diagnosed with reoccurrence of the tumour in the area of the distal part of the urethra, is presented below. Continuation of the treatment is based on surgical excision of the front part of the vulva together with the distal part of the urethra and adjuvant chemotherapy treatment according to the docetaxel/carboplatin combination.
 
Article
A comparative analysis of diet and nutritional status of 183 women aged 30-64 years taking the hormone therapy and the control group taking no hormones was performed. Material and methods: Patients were divided into two groups: a group receiving hormones (HRT - 54 women) and a control group not receiving hormones (K - 129 women). The diet was assessed by interview concerning the last 24 hours. Anthropometric measurements were carried out in accordance with the WHO guidelines, while body composition was assessed by bioelectrical impedance (BIA). Results: We found a statistically significant higher percentage of lean body mass in women with HRT and not statistically significant lower body weight, BMI and waist and hips. In this group of women, a significantly higher intake of riboflavin, folate, and a smaller percentage share of energy from carbohydrates were found. Conclusions: Results of the survey indicate a beneficial effect of the hormone therapy on the body composition and basic anthropometric measurements.
 
Article
Objective: The aim of the study was to report clinical characteristics, risk factors for perioperative complications, types of surgery performed, and perioperative morbidity in women over 70 years old who underwent gynaecologic surgery. Material and methods: Among 326 women operated on in the Clinical Department of Obstetrics and Gynaecology in Rzeszów from May to August 2008 a group of 30 patients over 70 years old was selected. 8 of them were disqualified from surgery because of high risk. Results: In this group of patients the most common indications were endometrial, ovarian and vulvar cancer and pelvic organ prolapse. The most common coexisting general diseases were arterial hypertension, myocardial ischaemic disease, diabetes and varicosis. The usual preoperative time of hospitalization was 8 days and postoperative 5-6 days. In almost all patients the postoperative decrease of haemoglobin concentration was 1 g%. Conclusions: Advanced age of patients is a challenge to the gynaecological surgeon. The surgery and perioperative care must be individualized.
 
Article
Objectives: The objective of the study was to evaluate the tolerance of radical radiotherapy in patients with cancer of the corpus uteri, aged 70 years and older. Materials and methods: The analysis is based on 94 patients with cancer of the corpus uteri. There were 94 women aged 70-85 years (median 74 years) treated using radical radiotherapy in the Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch in Poland during 2008 to October 2010. Acute treatment toxicity was assessed using the EORTC/RTOG scale. The skin reaction, the digestive system reaction and urinary tract reaction were analysed. Results: The most frequent early acute post-radiation reaction was bowel reaction (74.5%) in comparison with skin (24.5%) and urinary bladder (15.96%) reactions. A severe bowel reaction, adynamic ileus, was observed in 4 patients. There were no severe reactions of the urinary bladder. Benign reactions of the bladder were observed in 15 patients (15.96%). Severe skin reactions in 1 (1.06%) patient and benign reaction in 22 (23.4%) were observed. In the majority of patients there were no skin reaction (75.5%). Conclusion: Radical radiotherapy in senile patients with cancer of the corpus uteri is combined with higher frequency of early acute toxicity, but still remains a safe and well-tolerated method of treatment.
 
Top-cited authors
Paweł Miotła
  • Medical University of Lublin
Grzegorz Jakiel
  • Centrum Medyczne Ksztalcenia Podyplomowego
Jacek Wilczynski
  • Instytut Centrum Zdrowia Matki Polki
Małgorzata Maria Gietka-Czernel
  • Centrum Medyczne Ksztalcenia Podyplomowego
Jarosław Kozakowski
  • Centrum Medyczne Ksztalcenia Podyplomowego