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Objective: To assess the total antioxidant potential of women with endometriosis-associated infertility, women with idiopathic infertility, and fertile controls., Design: Retrospective study., Setting: University medical hospital., Patient(s): Sixty-five women admitted for diagnostic laparoscopy., Main Outcome Measures: Peritoneal fluid samples were analyzed for superoxide dismutase activity and total antioxidant status on spectrophotometry, glutathione peroxidase activity on enzyme-linked immunosorbent assay, and lipid peroxides levels on colorimetry., Result(s): Mean activity of superoxide dismutase, glutathione peroxidase, and total antioxidant status was lowest and lipid peroxide level was highest among infertile patients with endometriosis. Women with idiopathic infertility, in contrast, had the highest superoxide dismutase, glutathione peroxidase, and total antioxidant status activity and the lowest lipid peroxide level., Conclusion(s): High antioxidant potential is not a contributing factor in women with idiopathic infertility. Low total antioxidant status and low activity of antioxidant enzymes in the peritoneal fluid of infertile women with endometriosis probably do not influence fertility in these women, but these factors may play a role in the development of the disease.

Objectives: The only possibility to diagnose peritoneal endometriosis is laparoscopy or laparotomy with tissue sampling for histology. Women with impalpable endometriosis not visible on ultrasound suffering from infertility or teenagers with pelvic pain, where endometriosis may also be expected, would greatly benefit from an inoperative diagnostic method. A sure and comfortable method of assessing the effectiveness of endometriosis treatment does not exist. The aim of the study was description of the alpha 3 beta 1, alpha 4 beta 1 integrins and beta 1 chain expression in endometrial biopsies in women suffering from endometriosis., Material and Methods: Laparoscopy and hysteroscopy was performed in 32 patients because of infertility (n = 23) and/or pelvic pain (n = 11). For histochemical stainings of endometrial biopsy primary and secondary mouse antibodies to human integrins alpha 3 beta 1, alpha 4 beta 1 and beta 1 chain were used (DAKO)., Results: In 17 women peritoneal endometriosis was diagnosed by biopsy at the time of laparoscopy. An alpha 3 beta 1 integrin was more common in the glandular epithelium of women with endometriosis and beta 1 subunit was less frequently observed in the stroma of the endometriosis group than in women without endometriosis. The differences were statistically significant., Conclusion: The selected integrins do not yet allow finding a pattern characteristic for endometriosis.

Objectives: Endometriosis is characterised as a presence of proliferating endometrial fragments growing outside uterus. Despite many investigations we still do not understand why in some women sheded endometrium implants itself into peritoneum and grows, and in the others does not. It is possible that apoptotic status of endometrial fragments implanted into peritoneum is responsible for endometriosis growth as well as the treatment results. Cellular apoptosis is characterised morphologically by cell shrinkage, nuclear pyknosis, chromatin condensation, and blebbing of the plasma membrane., Material and Methods: The study was performed on 28 mature Wistar rats. We studied endometria of rats after induction of endometriosis in peritoneal cavity., Results: The only difference was found in endometrial glands. In animals with successful endometriosis implantation apoptosis indices in endometrial glands obtained during second laparotomy were lower than in the endometriosis free animals (p < 0.05).

Mechanism of etiopathogenesis of pregnancy induced hypertension (PIH), including preeclampsia, are still not completely discovered. Among many hypotheses concerning this subject very important is the theory which emphasizes the role of hyperlipidemia and oxidative stress in the pathophysiology of PIH. The study, based on literature, describes mechanisms by which hyperlipidemia and oxidative stress induce preeclampsia. The article stresses correlations between two pathogenetic factors and gives information about prophylaxis and new method of treatment of PIH.

In the therapeutic process the means of communication between a physician and a patient and the interactions between them constitute an important element of medical procedures. The gynecologist and obstetrician accompany women from their births till late old age. The aim of the study was to describe from the psychological point of view certain situations arising in everyday work in Gynecological-Obstetrical Hospital: motherhood, the place of a newborn and his/her parents in the Neonatal Ward, gynecological surgery, climacteric and senium.

Advances in immunohistochemical methods with the specificity of poly- and monoclonal antibodies allow the description of the endometrial receptivity, which is characterized by the ability of secretion of phase specific proteins and glikoproteins by epithelial and stromal cells. We studied the differences in the expression of alpha3beta1, alpha4beta1 and alphaVbeta1 integrins in endometrium of women with recurrent miscarriages and women with unexplained infertility. The endometrial tissue was collected during hysteroscopy performed between 7th and 9th day after ovulation. The immunohistochemical evaluation of alpha3beta1, alpha4beta1 and alphaVbeta1 integrin expression was determined in all endometrial biopsies. Staining intensity of alpha3beta1 in glandular epithelium and endometrial stroma was similar in both groups. In women with recurrent miscarriages we noted a lower concentrations of the alpha4beta1 and alphaVbeta1 integrins during the midluteal phase than in women with unexplained infertility. Moreover, integrins alpha4beta1 and alphaVbeta1 were expressed more frequently in glandular epithelium and endometrial stroma of women with unexplained infertility than those of women with recurrent miscarriages. However, alphaV(2)1 staining in endometrial stroma was stronger than that of alpha4beta1. It can be concluded, that these integrins may play an important role in the implantation process.

We studied levels of IL-12 in peritoneal fluid and serum in patients with minimal, advanced and recurrent endometriosis compared to women without endometriotic lesions in pelvis minor. The aim of the study was to determine whether level of IL-12 detected in peritoneal fluid or serum changes with grading of severity of endometriosis. To assess IL-12 levels immunosorbent ELISA was used. There were no statistically significant differences in IL-12 levels in peritoneal fluid nor in serum in any of studied groups. There was higher concentration (without statistical significance) of IL-12 in peritoneal fluid of healthy women compared to women with endometriosis.

Unlabelled: The aim of the study was to compare frequency of four gynecological operations: myomectomy, tubal surgery, cystectomy and operative management of ectopic pregnancy, performed by laparotomy or laparoscopy, by the same team of surgeons. In the years 1994-1997 in Division of Reproduction Poznań University Medical School 647 cystectomies, 208 myomectomies, 68 tuboplasties and 50 surgical treatments of ectopic pregnancy were done. Among 973 operations--684 (70.3%) were performed by laparoscopy. There was a gradual tendency in increasing endoscopic procedures. Comparing the year 1994 and 1997 percentage of operations performed by laparoscopy significantly changed: In tuboplasty from 83% to 95%, cystectomy from 35.9% to 80.3%, ectopic pregnancy from 61.5% to 91.7% and myomectomy from 52.7% to 61.5%. Patient hospital stay decreased significantly after laparoscopic procedures (from 5.1 days to 3.25 days). During the study period open surgery followed laparoscopy only in 8 cases (1.1%) because of complications or technical difficulties., Conclusion: 1. Operative laparoscopy is a safe and effective procedure, in many cases replacing open surgery. 2. Shortening of hospital stay and recovery period after laparoscopy is one of the main advantages of this method of treatment.

The aim of the study was to assess the presence of the microbes in peritoneal fluid of women in reproductive age. An investigation was performed on the group of 144 women operated laparoscopically in Division of Reproduction. The bacteria were cultured from 77 fluids (53.5%). The most common bacteria were: Staphylococcus epidermidis (34.1%) and Propionibacterium acnes (19.3%). In our group of patients 88 strains of bacteria were isolated. Sensitivity to antibiotics differed in many points. This situation does not allow to prepare any universal scheme of antibiotic therapy. We stress the necessity of assessing the type of bacteria and antibiotic resistance before the treatment get started. It seems to be especially important in pelvic pain syndrome and in pelvic inflammatory disease when operative procedure is necessary for bacteria isolation.

Objectives: The aim of our study was clinical analysis of the factors influencing on laparoscopic myomectomy., Study Design: Retrospective analysis of the operative protocols., Material and Methods: Two hundred nineteen women had laparoscopy because of unexplained infertility (n = 109) unexplained infertility and myomas (n = 41), myomas (n = 36), endometriosis suspicion (n = 20) ovarian cyst (n = 9) or pelvic pain syndrome (n = 4)., Results: Among 299 myomas 186 were extirpated during laparoscopy. In 39 cases suturing of the myometrium was necessary. Electrocautery was performed in 27 cases and laser-vaporisation in 8. In 28 women the operation was postponed because of small myomas and mainly poor operative technique (beginning of the learning curve). In two of them second laparoscopy was performed after GnRH therapy. An analysis of the factors which enable laparoscopic myomectomy was performed. The most important factors are: size and number of the myomas, localization in the myometrium, experienced hands and operative room equipment., Conclusions: Uterine myomas are one of the indications to operative laparoscopy. Meticulous analysis of the operative conditions as well as the assessment of the team experience should always precede laparoscopy.

The aim of this work was to evaluate the concentration of granulocyte-macrophage colony stimulating factor (GM-CSF), IL-1 beta IL-6 and TNF alpha in follicular fluid obtained from mature oocytes during in vitro fertilization scheme and to determine a correlation between GM-CSF concentration and the analyzed cytokines. Material consisted of 36 samples of follicular fluid which were divided into two groups: the first one--17 samples of follicular fluid obtained from follicles with successful oocyte fertilization and cleavage and the second one--19 samples of follicular fluid with unsuccessful fertilization. The concentration of GM-CSF as well as IL-6, IL-1 beta and TNF alpha in follicular fluid was evaluated by using the ELISA immunosorbent assays. The mean concentration of GM-CSF, IL-6, IL-1 beta was similar in both groups, however, the frequency of occurrence of these parameters as well as coexistence of GM-CSF with analyzed cytokines were higher in the second group i.e. in the follicular fluid with unsuccessful fertilization. We found a positive correlation between concentration of GM-CSF and IL-6 in follicular fluid of all samples. The authors suggested that activation of macrophages to an increased release of GM-CSF during disturbance of oocyte's maturation might implicate a relation between immune and endocrine systems with cytokine mediation.

The aim of the study was evaluation of presence of the antibodies against theca of the oocyte in peritoneal effusion and in serum in fertile and infertile women with minimal endometriosis in luteal phase of the menstrual cycle. Antibodies were measured by means of ELISA method. Median of the antibodies against theca was three-fold higher in peritoneal effusion in infertile women. No differences were stated in serum.

The object of the study was the morphology and steroidogenesis of cultured granulosa cells obtained from 6 women aged 28-39 years who, because of Ib cervix carcinoma, were treated with ionizing radiation and later underwent surgery. It was observed that the granulosa cells were viable, had strong proliferative ability, and formed a monolayer on day 2 of culture. Contrary to our expectations, these cells produced larger amounts of steroids in culture than the control cells harvested from normal ovaries in late follicular phase. It was also found that the cells treated with ionizing radiation responded to exogenous gonadotropins with higher production of progesterone and estradiol than the controls. It is concluded that the increase in metabolic activity by granulosa cells from ovaries which had been indirectly affected by ionizing radiation is manifested by the stimulating influence of radiation on steroidogenesis.

Authors have presented and assessment of estradiol and progesterone levels in peritoneal fluid and blood serum in women with endometriosis. Peritoneal fluid was collected during laparoscopy performed in luteal phase of the cycle. In this cycle ovulation was controlled in all women. An ovulation was confirmed ultrasonographically and laparoscopically in 45% of women with endometriosis and in 80% of that without the illness. Progesterone concentration in peritoneal fluid in women with endometriosis was significantly lower to the control (p < 0.01).

An analysis of the peritoneal fluid in women with endometriosis was undertaken. Peritoneal fluid was collected during laparoscopy from the Douglas pouch. The quantity, color of the fluid as well as macrophages number, concentration and activity were assessed. Conclusion is that no one of the listed parameters of peritoneal fluid could be considered as an endometriosis marker.

The hysteroscopic evaluation of uterine openings in 23 sterile women was described. The attention was paid to morphological features of obliterated uterine openings. The hysteroscopic examination of structural changes located in uterine openings seems to be a reliable method for evaluation of potency of oviducts. This procedure may help in choosing the proper way of therapy--microsurgery or IVF.

Endoscopic examination was made in 20 sterile women. Particular attention was drawn to the mechanism of uterine openings of the oviductus, viewed by hysteroscopy. Clinical condition end the flux of contrast via abdominal part of oviductus evaluated using laparoscopic technique. The hysteroscopic picture of valvular mechanisms is reliable element for evaluation of potency of oviductus. Combined laparoscopy and hysteroscopy brings a lot of information concerning the structure and function of oviductus.

Authors have presented long-term results of microsurgical treatment of female infertility. Operations of the abdominal ostium were successful in 28% (home taken baby), what is similar to the results presented in the literature. Poor outcome of the other types of the microsurgical operations was analysed. Comparison of the microsurgery with the different methods of the assisted medical procreation was performed (e.g. IVF-ET and GIFT), showing the advantages of the latest.

Value of the laparoscopy in diagnostic process and treatment of the polycystic ovaries was analysed. Authors have presented changes in the procedure which occurred after developing new technologies. The first results of the operative laparoscopy, with use of monopolar cauterization are described.

Authors have presented 45 clinical situations where laparoscopy was followed by laparotomy. Pre- and intraoperative diagnosis was analyzed. Dense adhesions were the most common indication to perform laparotomy (43%).

Clinical study in 98 women with genital endometriosis was performed. In 33 patient endometriosis was treated by operative laparoscopy-electrocauterization of foci in 20 women, ovarian cyst resection in 9 and cyst extrication in 4. In 10 cases laparoscopy was followed by laparotomy. Very high correlation between endometriosis and infertility was found (71.4%). Very few patients conceived till now (28.57%). Searching in the time of laparoscopy very subtle foci of endometriosis was stressed.

Angiomas and aneurysms of the intracranial space which are associated with an increase in pressure show a considerably worse prognosis than such diseases without an intracranial pressure increase do. In the connection, the occurrence of choked disks and haemorrhages in the fundus of the eye, are of particular importance. Paresis of the eye muscle are less important because in view of the neighbourhood relations they may also occur without an intracranial pressure increase ( paralytical type). Choked disks do not occur very frequently and are almost exclusively found in subarachnoid haemorrhages (apoplectic type).

A report is given on 113 tumours of the 4th ventricle in children (up to the age of 18 years) observed among a total of 1028 cerebellar operations. Of these, 87 (= 77%) tumours were exclusively tumours of the 4th ventricle, in 26 cases the tumour also encroached on adjacent structures (cerebellar hemisphere and vermis, pons and Medulla oblongata). Medulloblastomas were predominant (55%), they mainly occurred in school age. Leading clinical symptom of the tumours of the 4th ventricle - especially in child age - is the increase in intracranial pressure which can often be demonstrated radiologically in this age group. Besides there are coordination disturbances and disturbances of the cerebral nerves; relatively frequently one sees a "vermis syndrome". The initial symptoms, which are in most cases non-characteristic (nausea, headache, also ataxia), are more often than not misinterpreted. Surgically treatment aims at a radical removal of the tumour whenever of possible, which is frequently problematic in children, and the restoration of the pathways the cerebrospinal fluid. Microsurgical techniques clearly contributed to a decrease in the mortality rate which, however, still is very high. This stresses the importance of an improvement of early recognition of these tumours.

Among 210 patients operated on because of processes of the ventricles I to III in the years 1953 to 1983 a continuous outpatient after-treatment was carried out in 64 patients. Departing from the histological findings and differentiation according to the results obtained after tumour extirpation or palliative interventions, the subjective complaints, the residual neurological symptoms as well as the possibilities and limits of occupational and social rehabilitation are discussed.

Within a period of 35 years a total of 570 spinal tumours included 77 intramedullary gliomas (44 astrocytomas and 33 ependymomas including those located in the conuscada region). Initial symptoms, neurological findings at the time of the admittance to the clinic as well as results of the operation are presented. The importance of an early diagnosis is pointed out.

From a total of 1,028 infratentorial tumours operated on at the Neurosurgical Hospital of the Section Medicine of the Karl-Marx University Leipzig in the last 30 years, 167 tumours in the region of the 4th ventrical have been selected. Their statistical processing was carried out with respect to specific localisation, average age, kind of tumour, sex, clinical findings, duration of case history, application of instrumental diagnostic procedures and radicality of operation, success and failure. Some fundamental conclussions are drawn. A subdivision in detail will be contained in the following articles based on this material.

Germ cells development at particular stages of gonad differentiation during the period of fetal intrauterine life were investigated. The study was performed on 101 ovaries obtained from 76 fetuses and neonates. The earliest ovary obtained was from a 12-week old fetus, the oldest one was from a full-term fetus. The examination of germ cells was based on the analysis of the morphology and enzymatic activity. The morphology of the cells was studied by the use of light and electromicroscopy. In germ cells development three forms were distinguished: gonocytes, oogonia and oocytes. Gonocytes were observed in all the ovaries analyzed. They were found mostly among cells covering the gonad. Basing on the difference in their size, shape of nucleus and cytoplasm gonocytes were divided into older ones and younger ones. In the ovaries of fetuses, as early as the 14th week of the intrauterine life, oogonia were observed. Their fairly regular shape, abundance of cytoplasm and large nucleus, often with nucleolus, made their observation possible even in light microscopy. In the cytoplasm of regularly differentiating oogonia organelles were more numerous than in gonocytes. Oocytes constituted a more differentiated form of germ cells. In comparison to the cells surrounding them, they had a larger size, were rounded in shape and had a centrally located nucleus. In the cytoplasm separated into the surrounding space was observed. In a large number of different germ cells signs of degeneration were found. The study has confirmed that irrespective of the duration of pregnancy, all forms of germ cells are present in the fetal ovaries and that the differentiation continues throughout the whole period of intrauterine life.

The EEG findings in 177 patients with mainly malignant tumours in the region of the ventricles I-III have been evaluated. The changes were dependent upon the size of the tumours and the kind and direction of their infiltration growth into the paraventricular structure. In case of purely intraventricular spreading of the disturbance of the cerebral fluid circulation normal curves were found. In processes of the third ventricle we found to a greater extent theta-delta paroxysms whereas tumours in lateral ventricles rather caused localised disturbances in the sense of focal findings. Tumours with a growth in a basal direction frequently showed sw-patterns or steep waves. General changes only occurred in an advanced stage of the disease as an expression of the intracranial increase of the pressure.

When hypophyseal tumours are present, eye symptoms are the leading signs; they indicate, however, an advanced tumour stage. On the basis of 274 histologically verified hypophyseal adenomas, pre- and postoperative ophthalmological findings were analysed. Disturbances of the visual acuity were found preoperatively in 85.4 per cent, scotomas in 86.1 per cent and an optical nerve atrophy in 67.2 per cent of the patients. After neurosurgical intervention, 41.8 per cent of the examined patients showed an improvement of the visual acuity and 59.2 per cent a regression of the scotomas. Optical nerve atrophy was found in 78.1 per cent which was a higher percentage than before the operation. Disturbances of the visual acuity or scotomas that have persisted for a prolonged period of time show, just as optical nerve atrophy, a more unfavourable prognosis. So it had to be the aim of a neurosurgical treatment to diagnose the pituitary adenoma at an early time in order to improve the chances of a success. Eosinophilic hypophyseal adenomas are more easily recognisable, because of acromegalia being present in almost all cases. Ophthalmologically, they show less scotomas since they reach the dimensions of the chromophobic or mixed type adenomas only rarely. When blindness has developed, the situation is very serious since only in exceptional cases a recovery of sight is possible.

Tumours in the region of the Foramen magnum are rare (34 cases among more than 1000 infratentorial and 400 spinal tumours). The clinical symptoms can be guiding but they sometimes involve differential-diagnostic difficulties. In dependence upon the starting point and the direction of the development, cerebellar signs or transverse paralysis in the cervical region of the medulla are in the fore. In most cases, supplementary examinations are indispensable (X-ray examinations of the skull and the cervical vertebral column, ventriculography and CT). Angiography is of lesser importance. The anatomical relations of the tumour to its environment not only form the clinical picture, but also bring about therapeutical problems. The use of microsurgical methods has improved the prognosis a little, but nevertheless these disease pictures should be considered to be very serious.

The ophthalmological findings obtained in 254 patients with space occupying processes of the lateral and third ventricles are analysed. Visual disturbances (78%), defects of the visual field (69%), findings of the fundus of the eye (67%) and motility restrictions (24%) were identified. Only in eight per cent the findings of the eye-ground no particular findings were observed. As was expected, signs of cerebral compression were frequently found. Postoperative improvements were found in the choked papilla and motility restrictions were seen where as defects of the visual field and a decrease of the visual acuity were in most cases unchanged or had even increased.

Within 30 years, 1028 operations because of cerebellar tumours have been carried out at the Neurosurgical University Hospital in Leipzig. Of these, 167 were related to tumours within the 4th ventricle or encroaching a little outside of it. In the group of the adults (from the 18th year), 54 observations were made. These patients are subdivided according to histology (ependymomas in the first place), according to clinical findings (high values of cerebral pressure symptoms), according to the duration of the case history in dependence upon histology (long duration of angioblastomas and ependymomas), according to the possibilities of radicality (somewhat below the values in child age), the condition at discharge (better than in child age) and the cause of death (absolute predominance of central causes). A comparison is made with the results obtained with the studied patients in child age. Subsequently, the operation tactics of the Leipzig hospital is dealt with and the respective value of microneurosurgery carried out 10 years before is emphasised. A striking improvement for benign tumours can now only be achieved by a considerably improved early diagnosis.