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Objectives: Controlled ovarian hyperstimulation is an important step in infertility treatment. In some cases, however, ovar-ian hyperstimulation syndrome (OHSS) can occur. In its severe forms, ascites is likely to develop, associated with dyspnea. The aim of this study was to explore the usefulness of Ascites Index (AsI), a new tool for quantitative determination of ascites in patients with OHSS, to obtain data for planning further trials., Material and Methods: Twelve patients with OHSS and ascites were included in the study. All patients were admitted to the hospital because of abdominal pain and dyspnea due to increasing ascites. Ultrasound measurements of ascites extent were performed in four external quadrants of the abdomen. Pockets of free fluid were measured. The obtained values were totaled, forming the Ascites Index (AsI), similarly to the amniotic fluid index. Because of dyspnea, paracentesis was performed in all cases., Results: Median AsI at which patients reported dyspnea was 29.0 cm (range 21.6-38.6 cm). At AsI values less than 21.6 cm, no dyspnea was observed in any of the 12 studied patients. To avoid complications, 2000 mL of ascitic fluid was collected in each patient. After paracentesis, range of AsI decreased to 12.1-14.5 cm., Conclusions: The proposed AsI seems to be a promising tool for estimating and monitoring the ascites extent in OHSS. It can be estimated using basic ultrasound equipment. AsI requires further studies for standardization and transferability to other causes of ascites.

Adrenocortical carcinoma is a rare tumour with high malignancy and poor prognosis. This tumour is rarely diagnosed in the reproductive age. Complete surgical resection is the only curative treatment for adrenal cancer in all stages. After surgery adjuvant chemotherapy is required. Mitotane is the most important drug in adrenal cancer chemotherapy. Mitotane's mode of action is not entirely explained. Animal studies have shown that the substance exerts a direct cytotoxic effect on the cells of the adrenal cortex. This activity is selective, progressive and affects only the zona reticularis and fasciculata of the adrenal cortex. Mitotane inhibits cortisol synthesis by disrupting the chain of cholesterol. It has been suggested, that mitotane also affects the peripheral metabolism of steroids, especially of transcortin (CBG). This results in an increase of CBG blood concentration and a reduction of the amount of free hormones.

Genital psoriasis is a variety of autoimmune dermatological disease - psoriasis with relapsing-remitting course, which can have an onset in all age groups. It is most often diagnosed at an advanced stage. Genital psoriasis is considered an embar-rassing condition and is often misjudged as a sexually transmitted disease or allergic reaction due to low social awareness of the disease. The manifestations of genital psoriasis may differ from typical genital dermatoses and with symptoms such as itch, erythroderma and vaginal discharge may mimic other diseases at an early stage. The diagnosis and treatment of genital psoriasis may be difficult and often requires a multidisciplinary approach. The aim of this article is to present the literature review of genital psoriasis concentrating on the clinical presentation, treatment and influence on the quality of patients' life and sexual activity disorders.

Objectives: The aim of the study was to estimate the potential value of elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length for prediction of preterm delivery (PTD)., Material and Methods: This prospective observational study included 109 patients with cervical length of ≤ 25 mm at 18-22 weeks scan. Stiffness of the internal cervical os was assessed by elastography. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard), and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. The following outcome measures were analyzed: percentage of PTDs in various categories of elastographic cervical assessment, sensitivity specificity negative predictive value (NPV), and positive predictive value (PPV) of elastography in predicting PTDs. Additionally ROC curves were constructed for elastography and cervical length for predicting PTDs., Results: Forty-five cases of PTDs (< 37 weeks of pregnancy) were found in the studied population. The number of PTDs was significantly higher in the red group, than in the blue and purple groups. The sensitivity specificity NPV and PPV for the assessment of both, red and yellow internal os for predicting preterm delivery were 82.2%, 75.0%, 84.0% and 72.5% respectively The cut-off value for elastography suggested inclusion of both, red and yellow (warm) colors as predictors of PTD., Conclusions: Elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length may be useful in predicting PTD.

Objectives: The Aim: The aim of the study was to evaluate the effectiveness, safety and clinical outcomes of endovascular embolisation of pelvic congestion syndrome (PCS)., Material and Methods: This prospective, observational study carried out between January and May of 2014 encompassed 24 female patients aged 22-44 years (average - 31 years) diagnosed with PCS. Diagnosis of PCS was established by medical history physical examination, transvaginal Doppler ultrasound examination and confirmed by MRI. The patients were qualified for phlebography and ovarian vein embolization with 0.035" detachable coils and/or microcoils. Pelvic pain scores were assessed before and 3 months after the procedure with the visual analog scale (VAS; 0 - no pain, 10 - unbearable pain)., Results: Embolisation procedures were performed in 23 out of 24 patients. Nineteen patients underwent unilateral and 4 patients bilateral embolisation of the ovarian vein. In one case, safe and selective vessel catheterization was not possible due to the anatomical variant of venous flow. Nineteen patients underwent unilateral embolisation of the left ovarian vein. Four patients had the left and right ovarian veins embolized; in one of them, the internal iliac vein was additionally closed (the two-stage procedure). The technical success rate was 96%. Procedures lasted 23-78 minutes (32 minutes on average). An average of 40 ml of contrast was administered during the procedures. The total mean radiation dose at the reference point was 389 mGy (from 127 mGy to 1112 mGy). A decrease in pelvic pain intensity according to VAS was considered a clinical success. The median VAS pelvic pain score before the procedure was 8. Three months after the procedure median pelvic pain score decreased to 1 (p < 0.001). In two cases, the ovarian vein was injured and the contrast medium extravasated, which was clinically insignificant. In one case, a small injection site haematoma developed., Conclusion: Embolisation is a minimally invasive, effective and safe method of treatment for PCS. The cooperation between gynaecologists and interventional radiologists is essential for successful outcomes.

Introduction: Uterine anomalies may lead to infertility recurrent miscarriage, preterm labour intrauterine growth restriction and post-partum haemorrhage. Infertility and recurrent miscarriage are relatively common problems in the female population. Diagnostic algorithms in such cases include the evaluation of uterine anatomy Magnetic resonance imaging (MRI) is the most accurate technique for visualizing the female genitourinary tract anatomy but as it is expensive and not readily available, it is not useful in everyday practice. Hysterosalpingography (HSG) is a frequently performed procedure that plays an important role in evaluating the uterus and fallopian tubes. The most typical indication for HSG is infertility and recurrent miscarriage, which are common problems in the female population. However this procedure is invasive, exposes the patient to ionizing radiation, carries a risk of complications and does not show the external contour of the uterus, which is essential for differentiating uterine anomalies. Three dimensional transvaginal ultrasound (3D TV USG) is a noninvasive and quick, imaging method that may be used in diagnosing uterine anomalies. This method allows evaluate the external contours of the uterus, making it comparable to MRI., Objective and Methods: In this study we discuss the advantages and disadvantages of HSG and 3D TV USG in diagnosing uterine anomalies. Additionally we present the results of HSG and 3D TV USG of 155 patients referred to our Department because of infertility and/or suspected uterine anomalies., Results: After performing HSG, in the studied group 118 patients were diagnosed with a normal uterus, 4 with unicornuate (including 1 patient with an unicornuate uterus, with rudimentary horn), and 6 with didelphys uterus. In 22 cases, due to the lack of evaluation of external contour of the uterus, we could not differentiate arcuate, septate and bicornuate uterus. After performing 3D TV USG we confirmed the HSG diagnosis and precise differentiated 22 disputable cases. 8 with arcuate, 11 with septate (2 complete and 9 partial) and 3 with complete bicornuate uterus. In 5 patients, severe pain and lack of cooperation during HSG made the acquisition of diagnostic X-ray images impossible. In these cases 3D TV USG allowed the anatomic assessment of the uterus, a normal uterus was found in all of them. All uterine anomalies were then confirmed by hysteroscopy and/or laparoscopy, Conclusions: Basing on a review of the literature and our results, we conclude that HSG is not the optimal method for diagnosing uterine anomalies, while 3D TV USG can accurately show the uterus anomalies and may become an alternative method to MRI.

The aim of the study was to present clinical issues concerning uterine artery embolization (UAE) in women with uterine fibromas. In order to ensure high clinical efficiency of UAE and prevent subsequent complications, it is necessary to carefully select patients eligible for the procedure. Patients with intramural fibromas, who do not plan to conceive, are the best candidates for the procedure. Fibroma necrosis, with following infection, and premature ovarian failure remain to be the most common complications after UAE. UAE may cause amenorrhea and increase FSH levels, what is typical for menopause. Thus, it may be responsible for problems with conception as well as optimal development of a pregnancy. It may also cause premature, iatrogenic menopause. This complication significantly more frequently occurs in women over the age of 45 as compared to younger patients. UAE is considered as an alternative therapeutic procedure, available to women who do not desire the surgery or wish to preserve the uterus. Patients subject to this procedure should be informed about the possible side effects.

Rationale for the Study: Diagnosis of the uterine cervix lesions remains a key element of the women's health care especially in the context of the cervical carcinoma prophylaxis. The infrared mapping constitutes a new generation biophysical diagnostic method of potential application in medicine., Objective: The study was planned to analyze uterine cervix thermograms in both physiology and pathology of this organ. An attempt was made to establish the standard thermographic pattern of the portion., Material and Methods: The study population consisted of 51 women aged from 20 do 70 years. In total, 109 thermographic patterns were analyzed by the computer processing of the thermovision data. In order to establish a physiologic standard, 14 thermograms of the normal cervix were analyzed in detail. Furthermore, thermograms of such cervical lesions as endocervical polyp (3 patients), erosion (PAP II) (11 cases), CIN I-III (9 patients) and invasive cancer (6 patients) were studied. The diagnosis was based on clinical, cytologic and colposcopic criteria as well as on the pathology report. The infrared camera AGEMA AGA-880 and the specialized software was used. The measurements were done in a standardized climatic environment., Results: Comparisons between the studied groups revealed significant differences between invasive cervical cancer and benign lesions or healthy cervix. Significant were also differences in mean temperature and highest temperature for all the studied groups. The difference in mean whole portion temperature between the normal cervix and invasive planoepithelial cancer amounted to 1.4 degrees C while in comparison to other lesions it did not exceed 0.5 degree C. Statistical analysis of the averaged profiles of cervical temperatures has also shown significant differences between invasive cancer and the remaining groups--by 1.5 degrees C in average. Strong interrelationships (p < 0.001) were found among the single results of thermography measurements within all the groups. The thermographic profiles of all 14 thermograms of normal portion did not exceed the two standard deviations range of the established standard with the mean temperature of 36.56 degrees +/- 0.56 degree C., Conclusions: 1. The established thermographic mapping patterns of the normal cervix may form a basis for the future evaluation of the diagnostic application of computer thermography in gynecology. 2. Statistically significant differences were found in thermographic profiles of the portion between the normal cervix and such cervical lesions as endocervical polyp, erosion (PAP II), CIN and invasive cancer. 3. Invasive cervical cancer reveals thermographic pattern of relatively high specificity within the analyzed cervical lesions.

In 45 gravidae (below 24 weeks) fetal fibronectin (fF) was measured in cervico-vaginal discharge and plasma fibronectin (pF) was evaluated in venous blood. Twenty women had cervical incompetence (CI) diagnosed and 25 healthy gravidae served as a control. The fF level in patients with CI (0.073 +/- 0.014 mg/ml) was significantly (p < 0.01) higher than that found in the control group (0.058 +/- 0.011 mg/ml). The same was true for pF (p < 0.001). A diagnostic value of fibronectin levels in patients suspected of cervical incompetence is suggested.

Serum laminin (sL--by means of ELISA method) was evaluated in 17 patients with tubal pregnancy (TP) and 25 healthy control subjects. In patients with ruptured TP sL was significantly elevated as compared to both the controls and the patients with unruptured TP (p < 0.001). The obtained results suggest the usefulness of sL measurements in clinical management of patients with symptoms of ectopic pregnancy.

Unlabelled: The aim of the study was to compare the serum laminin levels in patients with threatened abortion and healthy gravidae with uncomplicated pregnancy., Material and Methods: 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., Results: 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., Conclusions: 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.

Recent studies emphasise an important role of immunological mechanisms in pregnancy maintenance. Antiphospholipid antibody syndrome is responsible for 5-15% of recurrent pregnancy loss. Authors describe a successful pregnancy outcome after aspirin and heparin therapy in 26 years old woman with three previous pregnancy losses, with positive anticardiolipin antibodies and increased number of NK cells.

Studied were 25 healthy gravidae in the first or second trimester of pregnancy and 28 women with threatened abortion (TA). Plasma fibronectin (pFN) was assayed in maternal blood serum and the fetal fibronectin (fFN) was quantified in cervico-vaginal secretion. Patients with imminent abortion had significantly elevated levels of both pFN and fFN as compared with women with uncomplicated pregnancy. Within the TA group of patients, vaginal bleeding and/or trophoblast was associated with significant increase in fibronectin levels.

There were 30 infertile women with insufficient luteal phase of the cycle under the study. The hyperprolactinemia was diagnosed in 14 from 30 infertile women. In women with normal cycles the ovulation occurred in 18 day of the cycle. During the treatment with Bromocorn it was observed earlier, independently from the prolactin level in blood serum. The luteal phase of the cycle in controls lasted for 9.9 +/- 0.2 days and 11.8 +/- 0.5 days in women after one cycle with Bromocorn and 12.3 +/- 0.2 days after two cycles with Bromocorn. Duration of the cycles in these three studied groups differed statistically significantly (p < 0.001). In women treated with Bromocorn the second cycle phase lasted longer than 11 day and the differences in progesterone and LH levels in the middle of the cycle and at the end of the luteal phase were insignificant. The obtained results show, that Bromocorn could be a suitable method of treatment in the luteal phase insufficiency.

Studied were 25 healthy gravidae in the first or second trimester of pregnancy. Plasma fibronectin (pFN) was assayed in maternal blood serum and the fetal fibronectin (fFN) was quantified in cervico-vaginal secretion. The highest level of fFN was found in the cervico-vaginal secretion of the 1st trimester gravidae while the pFN levels gradually raised to reach its peak between 21 and 24 gestational weeks.