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To assess the role of elastography in preoperative ultrasound assessment of abdominal wall endometriosis (AWE) location.33 patients qualified for surgical excision of AWE were included in the study. Preoperative assessment of AWE was performed transabdominally on a Samsung Medison V20 Prestige with a transvaginal probe and Elastoscan® option. The following B-mode settings were used: focus set to the lower end of the lesion, gain adjusted to obtain best image quality, tissue harmonic imaging activated. For elastographic examinations the color map from red (soft) to purple (hard) and the alpha blend option (a blend of B-mode and elastographic image) were used. AWE location was first assessed by B-mode ultrasound as: superficial (located in SCT only; SCT visible between the fascia and the lesion; intact fascia), intermediate (located in SCT or in RAM; no subcutaneous or muscle tissue between the lesion and the fascia; fascia infiltrated); or deep (located in RAM; muscle tissue visible between the lesion and the fascia; fascia intact). Then the AWE location was assessed by alphablend elastography as: superficial (hard lesion in soft SCT; soft SCT between the fascia and the lesion; no hard areas on the fascia); intermediate (hard lesion in soft SCT or soft RAM; no soft subcutaneous or muscle tissue between the lesion and the fascia; hard areas on the fascia); or deep (hard lesion located in RAM; soft muscle tissue between the fascia and the lesion; no hard areas on the fascia). These findings were verified during surgery. The surgeons were blinded to the results of elastography. The influence of obesity on the accuracy of ultrasound and elastography in assessing the location of AWE was evaluated.During surgery superficial AWE was found in 6, intermediate in 19 and deep in 8 patients. Preoperative ultrasound assessment was correct in 33.3 % of cases, while adding the elastography option improved the accuracy of AWE location assessment to 87.9 % (p 0.05). The diagnostic accuracy of ultrasound alone, but not with the elastography option, was significantly decreased in the preoperative assessment of AWE location in overweight and obese patients. 4 patients required implantation of a mesh. In all cases the pathological examination confirmed the diagnosis of AWE.Elastography significantly improved the accuracy of ultrasound in evaluating the depth of infiltration of AWE, is not affected by increased BMI, and should be considered in patients qualified for surgical treatment of AWE.

Total antioxidative capacity (TAC), a measure of overall free-radical scavenging potential, was determined by enhanced chemiluminescence in preimplantation embryo culture medium (PECM; pre-equilibrated Ham's F-10 medium supplemented with 7.5% patient's serum). Changes were evaluated in PECM TAC following a 24 h incubation of 66 single human embryos, as was TAC of patient's serum alone. The PECM TAC averaged 8.1% of the same patient's blood serum TAC. The percentage decline of PECM TAC over an incubation period of 24 h ranged from 0.9 to 41.7%, with a median of 5.5%. The decline in PECM TAC in different embryo quality groups was also studied. Embryos were categorized as 'good', 'fair' or 'poor' according to a scoring system based on an assessment of both the morphological appearance and developmental speed of the embryos. Incubation of poor quality embryos was associated with a decline in TAC, which was significantly higher than that observed in 'good' and 'fair' embryos. The findings suggest that impaired embryo development may be associated with an increased generation of reactive oxygen species by the embryo.

There is increasing evidence that the balance of prooxidants and antioxidants within ovarian follicles may play a key role in follicle formation. The fact that more than 20% of women of reproductive age in Europe and theUnited States smoke regularly makes this an important issue, because tobacco smoke is a major source of exogenous prooxidants. Both the particulate and gas phases of cigarette smoke contain reactive oxygen species (ROS) and free radical generators. Smoking increases ROS in the circulation while depleting free radical scavengers. The goal of this study was to examine the possibility that cigarette smoking influences the redox milieu within ovarian follicles. Lipid peroxidation was studied in follicular fluid (FF) samples from 108 women less than 40 years of age who underwent in vitro fertilization (IVF) because of male or tubal factor infertility. Lipid peroxidation in FF was quantified by spectrophotometric study of thiobarbituric acid reactive substances (TBARS). Total antioxidative capacity of FF was measured by a luminolenhanced chemiluminescence method. Exposure to cigarette smoke was quantified by estimating cotinine within follicular fluid using a radioimmunoassay. Samples were taken from 72 nonsmokers, 21 passive smokers, and 15 active smokers, all of similar age. Peak serum estradiol levels and oocyte yields per cycle were significantly lower in the smokers. Age did not correlate with oxidative stress markers, but increasing exposure to tobacco smoke correlated with significantly increased TBARS in FF. There seemed to be a more than 2-fold increase in final peroxidation products in the active smokers compared with passive smokers as well as nonsmokers. Levels of cotinine in FF correlated significantly with FF TBARS values. The total antioxidative potential of FF decreased significantly as the FF content of cotinine increased. FF levels of TBARS and cotinine did not correlate with oocyte maturity. Active cigarette smoking seems to alter the balance of prooxidants and antioxidants within ovarian follicles in women having ovulation induced. In this setting, follicular cells may be exposed to peroxidative stress that is unopposed by antioxidative elements within the follicles. These findings support efforts to persuade patients scheduled for IVF-embryo transfer to stop smoking.

The paper reviews most important trends in hormonal replacement therapy which have appeared in recent years. The tailored approach to HRT, introduction of new drugs and modification of established treatment regimes are the most probable directions in which menopausal medicine would develop in the years to come.

The aim of the present study was to test the relationship between the objectively measured intrafollicular exposure to the tobacco smoke compounds and the estradiol level in the preovulatory follicular fluid. In 30 IVF-ET patients (14 smokers and 16 non-smokers) levels of cotinine (C-FF) and 17 beta-estradiol (E2-FF) were quantified in the follicular fluid by means of radioimmunoassay. In smokers (C-FF from 62.21 to 595.00 ng/ml) the mean E2-FF was 85.07 nmol/l, while in the non-smokers (C-FF from 1.20 to 15.62 ng/ml) the respective value amounted to 109.19 nmol/l. The difference was statistically significant (p = 0.005). The obtained results support the growing body of evidence that tobacco smoking negatively influences endocrine function of the Graafian follicle.

The aim of the study was to evaluate the influence of premature rupture of fetal membranes on kynurenic acid (KYNA) levels in venous and arterial umbilical cord blood of neonates. Statistically significant higher concentration of KYNA in umbilical arterial and venous blood in neonates of mothers with PROM lasting longer than 11 hours was observed. Increase of KYNA concentration in blood of such babies may be one of markers of developing infection.

In 40 premenopausal women who underwent TAHBSO serum E2 levels were measured by means of RIA in 3 time points: before the operation, in the postoperative day 2 and in the postoperative day 3. In 20 of the subjects the ERT (transdermal estradiol 0.1 g/24 h) was introduced in the 2 postoperative day. In the postoperative day 2 the average serum E2 decreased by nearly 90% as compared to the preoperative values. Twenty four hours after the application of the transdermal E2 patch, the estradiol level returned to the values insignificantly different from the preoperative ones.

In 50 women (25 smokers and 25 non-smokers), cotinine, a relatively stable metabolite of nicotine, was measured in the 3rd postpartum day in blood serum and colostrum by means of enzyme-enhanced chemiluminescence. Non-smokers had cotinine levels in serum and colostrum below 10 ng/ml. Colostrum cotinine content in smokers amounted to approximately 50% of the respective serum level and both these values were strongly positively correlated (p0.0014). Cotinine level in early breast-milk did not correlate significantly with the number of cigarettes smoked daily by a mother. Newborns breast-fed by smoking women are exposed to the tobacco smoke compounds not only by an environmental ("passive") smoking but also by the ingestion of nicotine metabolites present in mother's milk.

The aim of the study was to compare the serum laminin levels in patients with threatened abortion and healthy gravidae with uncomplicated pregnancy.Twenty five pregnant women with menstrual arrest period ranging from 7 to 22 weeks, presenting with symptoms of threatened abortion (TA), were included into the study. Control group consisted of 25 healthy gravidae with uneventful course of pregnancy matched for the gestational age. Blood serum laminin was quantified by means of ELISA method using commercially available kits.Average serum laminin levels (S-L) measured in gravidae with threatened abortion was significantly higher than that of the control group. In patient with sonographically diagnosed trophoblast ablation the serum laminin was significantly elevated in comparison with the remaining patients of TA group, who had no sonographic abnormalities found. The patients with favorable outcome had mean serum laminin significantly lower than that of the patients with subsequent pregnancy loss.The observed difference in serum laminin level between patients with TA and patients with uncomplicated pregnancy seems to result from the release of laminin from trophoblast in cases when the integrity of the decidual/conceptual interface is disintegrated. This hypothesis is further supported by the finding of the high S-L in patients with the ablation of trophoblast. The obtained results suggest the prognostic value of S-L measurements in patients with imminent abortion.

To evaluate in the standardized conditions the thermal emission by normal uterine cervix and vulva.Infrared telethermography (ITT) was used to examine vulva and uterine cervix in 32 women aged 24-54 years without colposcopic and cytologic abnormalities.The measured temperatures differed between different topographic points of vulva and uterine vaginal portio. The inter-individual variability of temperatures determined at the same vulvar structures was relatively low.The obtained results constitute a basis for further studies on thermovisual definition of therapeutic targets in cases of vulvar and cervical lesions.

The aim of the study was to evaluate the blood serum/follicular fluid gradient for cotinine levels in the IVF patients with different levels of the tobacco smoke exposure.Cotinine levels were measured by means of the double antibody RIA in blood serum (S) and preovulatory follicular fluid (FF) of 45 IVF patients undergoing standard controlled ovarian hyperstimulation. Self reported smoking status was used for grouping purposes.Mean (range) cotinine concentrations (in ng/ml) in follicular fluid of nonsmokers (n = 10), passive smokers (n = 25) and active smokers (n = 10) were 3.71 (1.20-15.62), 29.65 (20.91-45.75) and 285.69 (62.21-595.00), respectively. The differences were highly significant (p0.001). No significant gradient of cotinine concentrations was found between blood serum and follicular fluid. Cotinine levels in serum and follicular fluid were strongly correlated (rs = 0.892; p0.001). The S/FF ratio for cotinine levels did not depend on the follicle's size or serum cotinine.Cotinine easily crosses the blood/follicle barrier.

Total antioxidative capacity (TAC), a measure of overall free-radical scavenging potential, was determined by enhanced chemiluminescence in preimplantation embryo culture medium (PECM; pre-equilibrated Ham's F-10 medium supplemented with 7.5% patient's serum). Changes were evaluated in PECM TAC following a 24 h incubation of 66 single human embryos, as was TAC of patient's serum alone. The PECM TAC averaged 8.1% of the same patient's blood serum TAC. The percentage decline of PECM TAC over an incubation period of 24 h ranged from 0.9 to 41.7%, with a median of 5.5%. The decline in PECM TAC in different embryo quality groups was also studied. Embryos were categorized as 'good', 'fair' or 'poor' according to a scoring system based on an assessment of both the morphological appearance and developmental speed of the embryos. Incubation of poor quality embryos was associated with a decline in TAC, which was significantly higher than that observed in 'good' and 'fair' embryos. The findings suggest that impaired embryo development may be associated with an increased generation of reactive oxygen species by the embryo.

The purpose of this study was to evaluate the follicular fluid selenium status of in vitro fertilization patients in relation to their individual characteristics and treatment outcome. A total of 135 samples of follicular fluid were collected from 112 patients during transvaginal oocyte retrieval. Selenium levels and glutathione peroxidase (GSHPx) activity were measured in follicular fluid (FF) and blood serum. A selenium dependent GSHPx activity in follicular fluid has been demonstrated. Patients with unexplained infertility had significantly decreased follicular selenium levels as compared with those with tubal infertility or male factor. The mean GSHPx activity in follicles yielding oocytes which were subsequently fertilized exceeded that of the follicles with non-fertilized oocytes. Tobacco smoking resulted in significantly diminished follicular GSHPx activity. The Se/GSHPx pattern of the FF seems to be significant for the evaluation of the follicular milieu.

The recent obstetric literature reports on various applications of amnioinfusion that have been used in an attempt to improve maternal and neonatal outcome. This paper reviews the indications, techniques, clinical benefits and hazards associated with the use of this procedure.

A case is presented of successful pregnancy in a patient with acute renal failure superimposed on chronic controlled renal failure. The cause which led to development of acute renal failure were severe water-electrolyte equilibrium disturbances due to diarrhoea. Appropriately conducted conservative treatment in the period of oliguria, and early institution of treatment with repeated haemodialysis (taking into account the minimal fluctuations of body fluids, and adequate heparinization) were decisive for successful outcome of pregnancy in this patient.

The results were subjected to analysis of USG examination of 11 patients with tubal pregnancy, verifying the found echographic anomalies with the intraoperative assessment done shortly after the USG examination. Of greatest usefulness for the preoperative diagnosis of tubal pregnancy is, according to the authors' opinion, coexistence of the following sonographic signs: enlargement of the uterus without echographic sing of pregnancy in the uterine cavity;-a mass of irregular outline, cystic-solid appearance, and axial dimension of above 50 mm, situated near the uterus;-fluid in the Douglas pouch. The experience of the authors shows that ultrasonography is a valuable supplementation of clinical examination and laboratory analysis in the diagnosis of tubal pregnancy, on condition of using objective criteria for sonogram interpretation.

The microbiological effectiveness of the preparation Gynalgin produced by POLFA Pharmaceutical Works in Rzeszów was assessed in cases of vulvovaginitis in 55 patients with clinically diagnosed inflammatory conditions of the lower genital tract, who were given Gynalgin tablets in 10-day courses. Vaginal smears were examined three times for the presence of bacteria, fungi and trichomonas vaginalis (before and immediately after the treatment, and two weeks later). In the initial examination in five vaginal smears mixed bacterial flora was found, in 6 smears trichomonas was present, in 4--bacteria and fungi, and in one--trichomonas and fungi. After the treatment in control examinations I and II the number of the isolated bacterial strains was lower, trichomonas was no longer present, and the number of fungi was reduced evidently. In the light of these microbiological examinations Gynalgin was found to exert a strong fungicidal, bactericidal and antitrichomonal activity, and the results of laboratory investigations agreed with those of clinical trials of Gynalgin effectiveness.

The concentrations of magnesium, iron, copper and zinc were determined by atomic absorption spectrometry in the colostrum of 5 women in puerperium after delivery by Cesarean section. The samples of colostrum were obtained for examination between 11 and 12 hours on puerperium days from 4th to 7th. A significant rise of the concentration between these days was noted only in the case of iron (p less than 0.05). The differences in the levels of other metals over time period were random. The daily supply of these elements with milk to the breast-fed newborn increased evidently in that time period. Statistically significant differences were noted between days 4 and 6 (p less than 0.05) and the successive days (p less than 0.01). The daily supply of magnesium estimated on the 8th day of puerperium was not exceeding 50% of the lower limit of the recommended daily supply of this metal for newborns and infants. The contents of iron and copper in the daily portion of colostrum were at the borderline of the recommended values, and only in the case of zinc they fell within the range of these values.

Zinc concentrations were measured by atomic absorption spectrometry in whole blood, scalp hair, pubic hair, and colostrum from patients at term with and without premature rupture of membranes (PROM). A maternal zinc index was established for each patient, expressed as an average ranking of the four determinations. The mean +/- SD value of the maternal zinc index in patients with PROM was significantly lower than in patients without this complication (4.33 +/- 1.18 versus 5.97 +/- 1.39, respectively; P = .0002). The inverse relationship between maternal zinc index and parity was statistically significant (r = -0.61; P = .04). These results suggest that the subnormal tissue zinc content in pregnancy may play a role as a causative factor in PROM at term.

The concentrations of p,p'-isomers of DDT, DDE, and DDD, and alpha, beta, and gamma isomers of hexachlorohexane (HCH), hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs) were determined by means of gas-liquid chromatography in 3/4 postpartum day colostrum of 54 normal women. The milk levels of t-DDT, t-HCH, HCB, and PCBs correlated significantly with one another. The contents in milk of all the studied organohalides significantly increased with maternal age. The average daily intakes of t-DDT and PCBs were estimated for the studied neonates. Values exceeding the Acceptable Daily Intake values (ADIs) recommended by the WHO for t-DDT and PCBs were found for 70.4% and 24.1% of subjects, respectively. The present study confirms the trends in organohalogen residues of human milk observed by us in the studied region's inhabitants during the 17 years of monitoring (1970-1987), i.e., a consistent decline in t-DDT levels and an increase in PCB content in the present decade as compared to the 1970s. In conclusion, despite legal restrictions in their usage, the contamination with organohalides persist in human milk at a level that may result in neonatal alimentary exposure exceeding the recommended daily intakes.

The concentrations of Fe, Cu, Zn and Pb were determined by means of AAS in the scalp hair (SH) and pubic hair (PH) as well as in maternal blood (MB), breast milk (BM) and cord blood (CB) taken from 104 pregnant women and their neonates. SH values of all studied metals correlated with strong statistical significance with their PH levels. Significant correlations were found between maternal Fe-PH and neonatal body length (r = 0.271) as well as between Fe-SH and placental weight (r = 0.168). The age of examined women was found to correlate negatively with Cu-SH values as well as with Zn-SH (P less than 0.05). The inverse relationship between Zn-PH and the parity of examined women was established to be statistically significant (P less than 0.001). The usefulness of hair analyses in assessing trace metal status of a pregnant woman is discussed.

The study was designed to measure the gradients of lead, iron, copper and zinc from maternal blood to cord blood in pregnant urban and rural women. The concentrations of iron, copper, zinc and lead were measured by means of atomic absorption spectometry (AAS) in whole blood of 100 normal parturients and 92 of their neonates. Levels of lead in cord blood were not significantly different from those in maternal blood. This ratio was associated with similar iron and zinc ratios. Neonatal birth weight was negatively correlated with maternal copper levels, whereas cord blood zinc values positively correlated with placental weight. Rural women showed higher maternal to cord blood lead ratios than urban women. The implications of these findings are discussed.

The concentrations of cadmium, lead and total mercury were determined by atomic absorption spectrometry in maternal blood and umbilical cord blood collected during the III-rd stage of term delivery from 56 mother-neonate pairs. Cadmium and mercury levels measured on both sides of placenta did not differ significantly while lead levels in maternal blood were significantly higher than its cord blood values. In all three metals studied, the concentrations in maternal blood strongly correlated with the corresponding cord blood values. A significant, positive correlation was established between the parity of the examined women and the umbilical cord blood contents of lead and mercury. The obtained results support the opinion that human placenta does not form an effective barrier to toxic metal intake by the fetus.

The concentration of Alpha-1-Antitrypsin (A-1-AT) in the blood serum was measured by single radial immunodiffusion in 21 healthy women in reproductive age. Simultaneously the whole blood levels of cadmium, lead, copper and zinc were determined by atomic absorption spectrometry. Serum A-1-AT correlated significantly with blood copper (r = 0.55, p less than 0.01). The importance of quantitative relations between "acute phase reactants" in blood serum and the blood trace metals is discussed from the point of view of reproductive medicine.

Eighty-one women (45 dentists and 36 dental assistants) occupationally exposed to metallic mercury underwent a toxicoclinical examination. Total mercury lebels (TMLs) were determined in scalp and pubic hair by cold vapour AAS. Furthermore a detailed questionnaire study was made concerning adverse reproductive events. TMLs in the hair of the exposed women examined exceeded significantly those determined in the hair of 34 controls not exposed to mercury. All exposed women had continued working during pregnancy. There was a significant, positive association between TMLs in the hair of exposed women and the occurrence of reproductive failures in their history. The relation between TMLs in the scalp hair and the prevalence of menstrual cycle disorders was statistically significant. These findings indicate that dental work could be another occupational hazard with respect to reproductive processes.

The concentration of cadmium was measured by flame atomic absorption spectrometry in colostrum samples obtained from 110 women on the 4th postpartum day. Detectable amounts of cadmium were found in 95% of the examined samples and the geometric mean of the determined values was 0.002 mg/kg. In 3 cases (2.7%, the examined neonates received via mother’s milk an amount of cadmium exceeding the maximum daily intake level for this metal. Maternal age, parity and place of residence did not affect the determined cadmium levels of milk. Cadmium content in the early human milk of current smokers did not differ significantly from that of nonsmoking mothers.

Total mercury levels (TML) were determined in 141 samples of maternal head and pubic hair and neonatal scalp hair. The mean mercury contents of maternal head and pubic hair were 1.88 and 1.10 mg kg-1, respectively, while the mean TML of neonatal hair was 0.11 mg kg-1. A statistically significant correlation was found between TMLs in neonatal and maternal hair. Significant inverse correlation was observed between the mercury concentration in the hair of a newborn and its birth weight. Reported findings provide evidence that the neonatal scalp hair mercury level may be a useful indicator of intrauterine exposure to mercury.

Human milk nitrates and nitrites were assayed colorimetrically. Colostrum samples were collected on the 3rd postpartum day from 59 women inhabiting Puławy region and being potentially exposed to nitrogen compounds emitted from the industrial sources. Thirty five Lublin inhabitants serving as a control group were matched in age, parity and duration of pregnancy. Geometric mean value of nitrates and nitrites concentration in the human milk being 2.83 mg/L and 0.46 mg/L, respectively were higher in the examined group than those in the control group /2.76 mg/L and 0.32 mg/L/ but difference was statistically insignificant. Ratio of nitrates and nitrites in the examined samples was 7.38 on the average and the concentration of those compounds was related statistically significantly /p less than 0.001/. The average daily intake of nitrates and nitrites by the breast-fed neonates was 0.12 mg/kg body weight and 0.02 mg/kg body weight, respectively. These values did not exceed corresponding ADI recommended by the Joint Expert Committee of FAO/WHO in none case. Significantly positive correlation of examined mothers' age and parity with nitrates content in their colostrum was seen. In view of the obtained results is may be assumed that the examined colostrum samples contain low amounts of both nitrates and nitrites.

Total mercury levels were determined by cold vapour atomic absorption spectrometry in early breast-milk obtained from 93 healthy mothers inhabiting three regions of Poland e.g. the Lublin region, the Podlasie region and the Chorzow region; the last being one of the greatest heavy-industry centers in Europe. The estimated daily mercury ingestion by a 4-days-old neonate via mothers milk was the highest in the Chorzow region (0.62 ± 0.27 μg/kg b.wt.), where in one third of the cases the ADI treshold of WHO was exceeded. The study documents the efficient transfer of environmental mercury to nursing neonate. Due to the considerable develomental toxicity of this metal, lactating women with known, high mercury exposure should be warned.