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Hysteroscopy represents a method of uterine cavity visualization, used as both a diagnostic and also a therapeutic procedure. Hysteroscopy enables diagnosis of infertility causes (uterine defects, adhesions, changes in the uterine ostium of the oviducts), precise removal of abnormal endometrium, uterine polyps, submucosal myomas and ablation or resection of pathological endometrium. Hysteroscopy or curettage of the uterine cavity are used in diagnosis and fertility-sparing therapy in women of 40 years of age or younger with atypical hyperplasia or early endometrial cancer (FIGO grade I G1) who wish to preserve their fertility. These women undergo gestagen treatment: medroxyprogesterone acetate, megestrol acetate or levonorgestrel released from an intrauterine device. Exclusion criteria for fertility-sparing treatment are as follows: clear cell carcinoma, papillary serous carcinoma, myometrial invasion or malignant changes in the adnexa and lymph nodes identified by magnetic resonance imaging. Pregnancy and delivery of a child are possible when the above criteria are adhered to, which may then be followed by appropriate oncological procedures. Clinical studies on hysteroscopy for endometrial cancer have noted cancer cell dissemination within the peritoneum. Some studies indicate, however, that the problem is controversial: a decrease in intrauterine pressure below 80, and optimally 50 mm Hg, significantly reduces this risk. [ABSTRACT FROM AUTHOR]

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Aim. The objective of the study was to evaluate the prevalence of sleep continuity disorders in women during menopausal transition, to evaluate the relationship between disturbances of sleep continuity and the severity of menopausal syndrome and the occurrence of various symptoms of this syndrome, as well as to evaluate the association between the presence of sleep disturbances and serum concentrations of gonadotropins, prolactin and sex hormones. Methods. Consecutive 140 women (mean age 54.4 ± 4.7 years) searching for the treatment in the Clinic for Gynaecological Endocrinology who reported symptoms of menopausal syndrome were investigated. The type and severity of disturbances of sleep continuity were evaluated using a survey based on the sleep related questions from Hamilton Depression Rating Scale. The severity of symptoms of menopausal syndrome was assessed using the Kupperman Index. The concentration of the following hormones in blood serum was tested: FSH, LH, 17β-estradiol, PRL, total testosterone, DHEAS and SHBG. Results. Disturbances of sleep continuity were a prevalent complaint in the studied group of women. Difficulties in falling asleep were found in 57.8% of women, difficulties in maintaining sleep in 70%, waking up too early in 60.7%. The severity of all three types of sleep continuity disturbances was related to the severity of menopausal syndrome as measured with Kupperman Index (Spearman correlation coefficient r = 0.63, r = 0.61, r = 0.52, respectively; p < 0.001). Difficulties in maintaining sleep were negatively correlated with the concentration of FSH (r = - 0.19; p < 0.05), 17β-estradiol (r = - 0.19; p < 0.05) and SHBG (r = - 0.18; p < 0.05), difficulties in falling asleep negatively correlated with the concentration of 17β-estradiol in the blood serum (r = - 0.19; p < 0.05). Conclusions. Sleep continuity disturbances are frequently reported by women during the menopausal transition. Interventions aimed at reducing the symptoms of menopausal syndrome should be considered as important action to improve sleep quality in this population of patients. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to evaluate the prevalence of sleep continuity disorders in women during menopausal transition, to evaluate the relationship between disturbances of sleep continuity and the severity of menopausal syndrome and the occurrence of various symptoms of this syndrome, as well as to evaluate the association between the presence of sleep disturbances and serum concentrations of gonadotropins, prolactin and sex hormones., Methods: Consecutive 140 women (mean age 54.4 ± 4.7 years) searching for the treatment in the Clinic for Gynaecological Endocrinology who reported symptoms of menopausal syndrome were investigated. The type and severity of disturbances of sleep continuity were evaluated using a survey based on the sleep related questions from Hamilton Depression Rating Scale. The severity of symptoms of menopausal syndrome was assessed using the Kupperman Index. The concentration of the following hormones in blood serum was tested: FSH, LH, 17β-estradiol, PRL, total testosterone, DHEAS and SHBG., Results: Disturbances of sleep continuity were a prevalent complaint in the studied group of women. Difficulties in falling asleep were found in 57.8% of women, difficulties in maintaining sleep in 70%, waking up too early in 60.7%. The severity of all three types of sleep continuity disturbances was related to the severity of menopausal syndrome as measured with Kupperman Index (Spearman correlation coefficient r = 0.63, r = 0.61, r = 0.52, respectively; p < 0.001). Difficulties in maintaining sleep were negatively correlated with the concentration of FSH (r = - 0.19; p < 0.05), 17β-estradiol (r = - 0.19; p < 0.05) and SHBG (r = - 0.18; p < 0.05), difficulties in falling asleep negatively correlated with the concentration of 17β-estradiol in the blood serum (r = - 0.19; p < 0.05)., Conclusions: Sleep continuity disturbances are frequently reported by women during the menopausal transition. Interventions aimed at reducing the symptoms of menopausal syndrome should be considered as important action to improve sleep quality in this population of patients.

Jaundice is a rare symptom of the HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) and is diagnosed in only 5% of the patients with this condition. However jaundice is related with sever presentation of the disease and associated with higher mortality The aim of this paper was to present a case of 24-year-old patient with jaundice as the first symptom of severe HELLP syndrome. A review of the literature about symptoms and treatment of HELLP syndrome and differential diagnosis of jaundice in pregnancy was done as well.

Objectives: The main aim of our study was to determine the features of the greatest importance in the prognosis of the functional nature of ovarian cysts, as well as the evaluation of the role of morphological index and CA 125 in the diagnosis of functional ovarian cysts., Material and Methods: 187 premenopausal women with ovarian tumor (between the ages of 13 and 52) were enrolled in the study. Each patient underwent transvaginal ultrasonography and the morphology of the tumor was assessed on the basis of morphological index. The level of CA 125 was measured. The patients were divided into two groups: 1) patients with functional cyst, 2) patients with non-functional cyst. The study was performed between the years 2003-2006., Results: Functional ovarian cysts in ultrasonography included: unilocular with smooth internal wall, anechoic, without solid elements and with a thin wall of the structure (< 3 mm). They were usually unilateral and ascites was rarely present. The morphological index (SM) achieved the highest accuracy (71.6%) at the cut-off level of > or = 5. The area under ROC curve for SM was 0.834. The level of CA 125 did not differ significantly between the analyzed groups., Conclusions: Tumors with 5 points or less in morphological index estimation may be safely observed during 2 or 3 menstruation cycles, as their spontaneous regression is anticipated. Assessment of CA 125 concentration is a test with low clinical usefulness and marginal statistical significance.

Overview: Preoperative differential diagnosis of adnexal masses has been a challenge for researchers for years. Prediction of tumor malignancy is essential for selection of optimal treatment with lowest risk for patient. Assessment of various tumor vascularization attributes, using color Doppler semi-quantitative analysis, can be helpful for malignancy differentiation., Objectives: To assess value of selected vascularization attributes of adnexal masses in preoperative prediction of tumor malignancy., Materials and Methods: This study included 521 women diagnosed and treated for adnexal masses (181 malignant and 340 benign) in Obstetrics and Gynecology Hospital of University of Medical Sciences in Poznan between 1994 and 2004. All of them underwent color Doppler examination using Aloka 2000 and 5500 devices (vaginal probes 5,0-6,5 MHz, abdominal probes 3,5-5 MHz) with evaluation of such attributes as: vessels count, localization and structure; semi-quantitative scale was also constructed basing on these parameters., Results: There was a significantly higher number of vessels (cut-off value=4; p < 0.0001), central vessels localization (p < 0.0001) and irregular structure of vessels (p < 0.0001) in patients with confirmed malignant tumor. Constructed semi-quantitative Doppler scale resulted in highest diagnostic accuracy (cut-off value = 3; p < 0.0001)., Conclusions: Central vessels localization was the single most significant attribute in tumor malignancy differentiation. Constructed semi-quantitative Doppler scale resulted in highest diagnostic accuracy and can be a useful tool in preoperative prediction of tumormalignancy.

Objectives: The aim of the study was the measurement of blood flow in uterine arteries and endometrial vessels in women with postmenopausal bleeding using "power" angio Doppler technique, Materials and Methods: 256 patients diagnosed and treated because of postmenopausal bleeding participated in this study. Using doppler technique blood flow indices: pulsatility index (PI), resistance index (RI) and time average maximal velocity were measured., Results: Neovascular arteries in endometrium were found in 87,7% patients with endometrial carcinoma, 21,9% cases of endometrial hyperplasia and in 5,7% women with normal endometrium. A significantly lower PI and RI in endometrial vessels and uterine arteries were obtained in endometrial cancer cases than in patients with endometrial hyperplasia. TAMXV measured in endometrial vessels and uterine arteries was significantly higher in patients with endometrial cancer when compared to the patients with endometrial hyperplasia., Conclusions: Transvaginal ultrasonography with the "power" angio Doppler is a valuable diagnostic method in cases of early endometrial pathologies. The measurement of blood flow indices in endometrial vessels and uterine arteries is useful to differentiate benign and malignant endometrial pathologies.

Unlabelled: THE OBJECTIVES: The aim of this study was to evaluate the clinical value of blood flow indicies for differentiating between benign and malignant ovarian tumours., Materials and Methods: Realisation of the aim was based on the analysis of examinations' results of 686 ovarian tumors. For each recorded blood flow wave the followind parameters of examined tumor vessels were analysed: pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), time-averaged maximum velocity (TAMXV) and maximum and diastolic velocity (MEDV). Apart from conditional probabilities we also presented assessing areas under the ROC curves, which introducted information over practical usefulness of each test., Results: Vascular perfusion was observed in 100% of malignant tumors and 92% of non-malignant tumors. In group of patients with malignant tumors PI and RI were significantly lower; and PSV, TAMXV and MEDV were higher than in group with non-malignant tumors. (p<0.05), Conclusions: Transvaginal ultrasonography with the Doppler technique is valuable diagnostic method in preoperative differentiation of tumor malignancies. The best predictive value in analysed group was observed for PI (AUROC=o.87) and MEDV (AUROC=0.86). Similar correlation was observed for premenopausal patients. In group of postmenopausal patients the best predictive value was for RI (AUROC=0.90) and MEDV (AUROC=0.88).

Objectives: The purpose of the study was to evaluate the helpfulness of sonomorphological index in preoperative diagnosis of ovarian tumours., Material and Method: 686 patients diagnosed and treated because of adnexal tumours were analyzed. At the admission day the patient underwent an ultrasonographical examination that stated morphology of tumour using the sonomorphological index (SM)., Results: The sonomorphological index demonstrated high prognostic values: accuracy - 80.6%; sensivity - 86.7%; specifity - 77.0%. During the study, histopathological types of ovarian tumours with the lowest prognostic values were appointed. Among malignant tumours the lowest sensitivity of the test corresponded with: dysgerminoma and folliculoma. Among benign tumours the lowest helpfulness in preoperative diagnosis of ovarian tumours the sonomorphological index demonstrated in following histopathological types: mucinouse cystadenoma and adult teratoma. Particular histopathological diagnosis is the tubo-ovarian abscess--all analyzed cases had a false positive result in the test., Conclusions: In all histopathological types of malignant and benign tumours mentioned above, the use of the sonomorphological index require caution. To increase accuracy of preoperative diagnosis based on ultrasonographical examination, additional Doppler examination and also biochemical markers concentration should be considered.

Objectives: The purpose of this study was to analyse prevalence of so called classical risk factors for VV in patients with this entity., Materials and Methods: Study consisted of three parts. In the first part the prevalence of risk factors in 130 men and 360 women with VV was compared. In the second part the prevalence of risk factor in 360 women with VV and 162 without VV was compared. In the third part the prevalence of risk factors in pregnant women with and without VV was compared. The age of patients in all groups was comparable. The results were statistically analyzed., Results: There were no differences in prevalence of classical risk factors between men and women with VV. In non pregnant women positive family history (OR 2,27, p=0,018) and previous pregnancies (OR 2,05, p=0,046) were associated with presence of VV. Premenstrual aching of lower extremities and obesity were at the border of statistical significance, OR and p, 1,9 and 0,062 and 1,4 and 0,071, respectively. As many as 47% of pregnant women had VV. Positive family history (OR 2,27, p=0,018), previous pregnancies (OR 2,56, p=0,011) and premenstrual aching of lower extremities (OR 2,03, p=0,021) were associated with presence of VV. Remaining, so called classical risk factors such as oral contraceptive, working in a sitting or standing position or constipations were not associated with occurrence of VV., Conclusions: In conclusion, positive family history and previous pregnancies seem to be principal risk factors for VV in women.

Epidemiological data shows that 9 millions of Poles are in smokers group, 43% of them are women. Smoking has significant negative impact on different fields of female sexual and reproductive life, like menstrual cycle, fertility, gynecological cancers and early menopause. Smoking during pregnancy is an important cause of ill health for both mother and foetus-it increases risk of placental complications, pregnancy induced hypertension, reduced fetal growth and perinatal death. Many of adverse effects of smoking is at least partially reversible after stopping smoking, so large public information campaigns can be useful for increasing women awareness of smoking hazards. Gynecologist, as a first contact specialist, has a responsibility to provide accurate information on the risks smoking poses both to the health of the smoker and to give clear, firm advice to stop smoking and offer suitable support.

Objectives: Overexpression of intracellular adhesion molecule-I (ICAM-1) was observed in many benign and malignant tumors. The aim of our study was to evaluate its serum concentrations as well as CA-125 in women with benign ovarian tumors., Materials and Methods: Forty-five women treated surgically because of benign ovarian mass., Results: Mean concentrations of sICAM-1 in benign tumors was 241.8+/-74.1 ng/ml and 195.6+/-68.7 ng/ml in healthy controls. No correlations between sICAM-1 concentrations and leukocyte count, tumor volume, BMI and obstetrical history. Efficiency in tumor differentiation was higher for CA-125 than sICAM-1 (area under Receiver Operating Characteristic curve 0.78 and 0.63 respectively). We observed higher sICAM-1 concentrations in fibrothecomas and lower in endometrial and dermoid cysts., Conclusions: Serum ICAM-1 concentrations correlate with some histological types of benign tumors, but not with tumor volume. Levels of CA-125 are more effective than ICAM-1 in ovarian tumors differentiation.

Unlabelled: Ultrasound examination with the use of the transvaginal probe is extremely important among early detection methods of the ovarian tumors. Application of the Doppler's technique makes it possible to evaluate vascularity of the tumors in the light of malignancy prognosis., Aim: Evaluation of predictive value of the suggested Doppler's Scale (DS.) detecting preoperative degree of the ovarian tumor malignancy., Patients and Methods: The analyses involved data obtained in evaluation of 464 ovarian tumors of women treated in Gynecology and Obstetric Clinical Hospital of the Karol Marcinkowski University of Medical Sciences, Poznan, Poland in the years 1994-2002. As a result of histopathological examination, 165 patients had a malignant ovarian tumor detected, and other 299 were found to suffer from a benign tumor. Predictive values among the scrutinized group of women were also analyzed in respect of their menopausal status by determining appropriate values for women before and after menopause. The obtained data allowed to draw ROC curves and to compare diagnostic value of the suggested scale for the groups of patients under the scrutiny. Evaluation involved: number of vessels, their location and arrangement, shape of velocity waves as well as presence of the protodiastolic notch in the arterial vessels of the tumor. Each of the mentioned features could acquire a point-value of 0 or 1., Results: A cut-off point for the suggested Doppler's evaluation scale of the ovarian tumors vascularity was determined at the level of 4. The following predictive values were obtained: [table: see text], Conclusions: Tumor features analyses as a result of ultrasound Doppler's evaluation enables precise prognosis of the malignancy degree. The suggested point-scale concerning the most significant elements of the Doppler's half-amount analyses facilitates precise determination of the malignancy degree of the ovarian tumors and enables selection of the most effective of therapeutic treatment. The technique is a precious supportive tool in the preoperative detection of the ovarian tumors malignancy.

Overview: Abnormal uterine bleeding is a common gynecological symptom. The curettage can asses only 50-60% of endometrium surface, thereby leaving some changes unrevealed. Sonohysterography (SHG), which combines the distention of the uterine cavity trough saline solution and ultrasound examination, allows a more exact evaluation of uterine cavity abnormalities., Objectives: To assess the value of sonohysterography in the diagnosis and management of abnormal uterine bleeding., Materials and Methods: 67 women with abnormal uterine bleeding and uterine cavity abnormalities confirmed by transvaginal ultrasound were examined with sonohysterography., Results: Sonohysterography revealed 21 cases of submucous myomas, 22 endometrial polyps and 24 cases of endometrial hyperplasia. All patients underwent diagnostic hysteroscopy to verify the results. The sensitivity and specificity for sonohysterography were both 93%. The positive and negative predictive values were 96% and 93%, respectively., Conclusions: Sonohysterography is a sensitive and specific method for diagnosis of abnormal uterine bleeding. It allows faster and less invasive diagnosis. Given the low costs of examination sonhysterography can be used as an ambulatory procedure reducing delay of treatment.

Objectives: Human papillomavirus (HPV) is one of the main causes of cervical neoplasia. There is now consistent evidence that Human Papillomavirus (HPV) has a causal role in the etiology of cervical cancer and that sexual habits and reproductive/hormonal factors are associated with the risk of invasive cervical cancer. In our investigation we estimated the frequency of HPV infection in uterine cervix in women gathered in perimenopausal and postmenopausal groups., Materials and Methods: We screened 90 women in western Poland to obtain cytological smears, and tested all smears for 33 types of HPV with a polymerase chain reaction-based system. All women were classified according to age into three groups., Results: HPV infections peaked in the group of 45 to 49 year old (48.5% using universal starters) and decreased in 56 year or olders (26.1% using universal starters) with predominantly non-cancer-associated types of HPV and uncharacterized HPV types., Conclusions: We confirm the decline of HPV infection with age. But note increased prevalence after menopause, which could be related to a second peak of HSILs, an observation that warrants further investigation. At least 80% of HPVs involved in cervical carcinogenesis in this population have been characterized. Polyvalent vaccines including the main cancer-associated HPV types may be able to prevent most cases of cervical disease in this region.

Objectives: Today's diagnostics and differentiation of ovarian tumour is not efficient enough. Wide spreading tumour immunology of neoplasm presents an opportunity to determine new markers and mechanisms useful for diagnostic and discrimination. The aim of our study was to evaluate concentration of soluble intracellular adhesion molecule-1 (sICAM-1) with CA-125 in ovarian cancer., Material and Method: Serum of 40 patients undergoing surgical treatment, 32 with ovarian cancer and 8 with benign tumours. Concentration of markers was determined immunoenzymatically., Results: Concentration of sICAM-1 correlated moderately with FIGO stage, tumour volume and CA-125. Mean concentrations between analysed groups were different, but not statistically significant. Determination of sICAM-1 together with CA-125 increased discrimination power of the test., Conclusions: Determination of sICAM-1 alone seems to have limited application. Addition of this test to CA-125 could improve value of the diagnostic process.

Objectives: Irritation of lower urinary tract--bladder and urethra--is seen as a common risk factor for radiotherapy treatment. Is it possible to reduce miction disorders and urinary incontinence?, Design: Functional assessment of the lower urinary tract in women treated with surgery and radiotherapy., Materials and Methods: Authors evaluated 25 patients diagnosed with uterus neck cancer treated with surgery or radiotherapy during 1998-2001. Urodynamic assessment was based on uroflowmetry, residual urine volume measurement and cystometry results., Results: Lower urinary tract ailments were present in all 25 patients, in 2 of them they were only temporary--during recovery after surgery. During miction symptoms were reported by 23 patients, 20 patients reported symptoms between mictions. During and after treatment all patients reported the increase in symptoms and changes of urodynamics parameters., Conclusions: Function of the lower urinary tract are disturbed whilst radiotherapy treatment of uterus neck cancer. Functional diagnostics is important in oncological treatment design and should be evaluated separately for each patients.

Unlabelled: Tamoxifen is one of most common drugs for breast cancer therapy. But its weak estrogenic activity in endometrium can be the source of different abnormalities including even endometrial cancer., Objectives: The aim of this clinical trial was to compare ultrasound scan results, hysteroscopy and pathomorphological findings of tamoxifen treated patients with breast cancer who complained of bleeding., Materials and Methods: Analyzed group consisted of 10 patients treated for abnormal endometrium during breast cancer tamoxifen therapy., Results: Among 10 examined women 7 presented no pathological changes, there was 1 case of simple benign hypertrophy and 2 cases of endometrial polyps., Conclusions: There is no exact correlation between ultrasound scan results and pathomorphological findings in patients treated with tamoxifen for of breast cancer. Transvaginal ultrasound examination is not efficient screening test for endometrial abnormalities during tamoxifen therapy.