Newborn outcome after assisted reproductive technology: experiences and reflections from Poland

In spite of much ethical uncertainty and wide variations in obstetric and neonatal outcomes reported in the literature, we have studied the outcome of Polish newborns after assisted reproductive technology (ART). In all of our patients, both obstetrics and neonatal care were performed in the Level Three Center in Poznan, Poland. A total of 45 and 82 newborns were analyzed from the ART and the control group, respectively. We analyzed gestational age, birth weight, Apgar score, duration of hospitalization, newborn mortality, and congenital malformations. We found a far higher rate of mothers over 35 years and with university education in ART compared to controls. The incidence of cesarean section and birth weight <1,500 g was much higher in ART. Newborn mortality was much higher among ART newborns compared to controls and was related to premature delivery of triplet pregnancy. The most important factor resulting in high neonatal mortality in our study group was multiple pregnancy. We consider the lack of regulation in Poland concerning the number of replaced embryos as a main factor influencing newborns' outcome after ART.     

Usefulness a buccal flaps for reconstruction tissue defects after operations cancers lip and nose

The aim of this study was to describe methods in tissue reconstruction deficiences after operations due to upper and lower lip and nose cancer with using full thickness (musculomucosal cutaneus flap) and incomplete buccal flap (musculocutaneus). Flaps were collected bilaterally and sutured in the middle of the lips. Their usefulness was confirmed especially in total lip reconstruction.     

Carbon cage used for anterior lumbar interbody fusion: a case report

Two cases of patients with lumbar discopathy who underwent anterior lumbar interbody fusion (ALIF) were described. The authors stress the advantages and disadvantages of this kind of stabilization.     

Investigation of local reaction of muscular tissue after injection of polyvinylpyrrolidone preparation

Natural preparations for replenishing of hyaluronic acid of zoogenous origin used till now, are characterized with quit low biocompatibility and also too short effect of their action. Recently worked out synthetic polyvinylpyrrolidone preparation PVP, contains modification constituting internally netting of microgels to improve polymer bioresistance. The introduce modification can, however influence PVP biocompatibility after deposition into tissues of the living organism. The aim of research was evaluation of the local reaction of muscular tissue after PVP infection. The results of research concerned a control group where normal saline was used for infections. The research was carried out on 18 Wistar rats and included macroscopic and histologic observations made in the 3rd, 5th, 7th, 14th and 30th day after PVP injection into thigh muscle. The local reaction of muscular tissue was macroscopically characterized with inflammatory reaction till the 7th day after PVP injection, in later terms the observed changes disappeared. Microscopic research showed that PVP till the 7th day after PVP injection caused rather strong diffuse non-specific inflammatory process, yet without essential participation of neutrophils leading to producing of loose intra-muscular. Connective tissue in a later term. The carried out tests showed presence of PVP in muscular tissue till the 30th day after injection.     

Tissue reaction after injection of polyvinylpyrrolidone (PVP) preparation into knee joint. Experiment

Internally netted miscogelatinated preparation on the basis of polyvinylpyrrolidone PVP desioned for viscosuplementation of joint fluid was worked out. Netted structure of microgel grains presents larger resistance to the degrading action of free radicals than analogical linear polymer chains. Application of zoogeous preparations of hyaluronic acid results in short-term effects of their usage in evoking reaction foreign protein. Replenishment of joint fluid with preparation with higher biostability from biocompatible synthetic polymer-polyvinylpyrrolidone could improve the function of synovial through restoration of its proper viscosity and protection of the joint for a longer period of time. The aim of the experiment was determination of bioresistance and reaction of microgel PVP on the tissues of synovial joint. The tests were carried out on 10 white New Zealand rabbits after injection PVP into the knee joint for 3, 7, 14 and 30 days and submitted to macroscopic and histological evaluation. The results of tests were compared with the data obtained after injection of normal saline. Macroscopically, there were no changes in the limits of articular capsule and cartilage; there was only slight and enlargement of synovial membrane in the first 7 days after PVP injection. In histological tests it was observed that reaction in the knee joint after PVP injection was characterised it single inflammatory chains without essential participation of neutrophils observed only in synovial membrane and limited to places were tested preparation was seen. Microgel PVP was present in diverticula of synovial membrane to 30th day after injection.     

Hysteroscopic evaluation of the uterine cavity in postmenopausal women with uterine bleeding

Postmenopausal uterine bleeding is the most characteristic and frequent endometrial adenocarcinoma symptom. Patient with uterine bleeding appeared at least 12 months after the last menstruation needs diagnostic management before initiation of any treatment. OBJECTIVES: Evaluation of hysteroscopy for the recognition of pathologies causing postmenopausal uterine bleeding. MATERIALS AND METHODS: Seventy-nine women aged 48-80 without hormonal replacement therapy hospitalized in the 1st Department of Gynecology and Gynecological Oncology of the Medical University of ?ód? between 1998-2002 because of postmenopausal uterine bleeding were included in the study. In each case diagnostic hysteroscopy with visualisation of the uterine cavity was performed and then histopathologic biopsy by a curretage was taken. Hysteroscopic images were analyzed and compared with the histopathological results. RESULTS: 2 women had the oncologically suspected hysteroscopic images. In both cases endometrial adenocarcinoma was histopathologically confirmed. Among 5 patients with hysteroscopic images suggesting non-malignant endometrial proliferation 4 cases of endometrial hyperplasia were found. 11 times hysteroscopic visualisation of endometrial polyps enabled their complete deletion. In 8 cases intrauterine adhesions were found and dissected: 11 patients presented submucous myomas during hysteroscopy. In 3 cases visualisation of the uterine cavity was not possible because of technical failure. Any patient with absence of hysteroscopically found uterine abnormalities had a poor histopathological result. CONCLUSIONS: Hysteroscopic investigation in postmenopausal women with uterine bleeding reduce the risk of false negative histopathological result. Hysteroscopy is useful method of the uterine cavity visualisation. Thanks to localization and elimination of the pathologies like endometrial polyps and intrauterine adhesions the repeated bleeding and the second time admission of the patient for the same reason can be avoided.     

Comparison of assessing the patency of the Fallopian tubes during laparoscopy and during hysterosalpingography on television in infertile women with endometriosis

OBJECTIVES: Sterility become nowadays not only medical, but as well socio-economic problem. One of its major causes is endometriosis. Recurrent adnexitis--one of the most common symptoms of endometriosis might be the cause of fallopian tubes occlusion. The hysterosalpingography (HSG) can be helpful to diagnose this tubal pathology. DESIGN: To compare the assessment of fallopian tubes patency during HSG with the results of laparoscopy in infertile women with endometriosis. MATERIAL AND METHODS: 331 women with endometriosis who were diagnosed during laparoscopy examination between 1998-2002 due to sterility. The presence of endometriosis was confirmed during laparoscopy. In each patient the control of the patency of both fallopian tubes was performed. These data were confirmed with those from HSG performed during follicular phase on the television path. The absence of the contrast passage through fallopian tubes as well as the only trace contrast passage into abdominal cavity were classified as tubal obstruction. RESULTS: In patients during the HSG physiological uterine shape and size in 91.3%, the bicornis uterus in 6.6%, and the unicornis uterus in 2.1% were observed. During laparoscopy we diagnosed the physiological uterine shape and size in 88.8%, the bicornis uterus in 8.2%, and the unicornis uterus in 3.0%. The diagnostic compatibility of these both examinations was 90.6%. In HSG the correct anatomical course of both fallopian tubes without occlusions in 51.7%, the only unilateral patency in 36.7%, and bilateral occlusions in 11.6% were found. During laparoscopy we diagnosed the anatomical course of both fallopian tubes without occlusions in 36.7%, the only unilateral patency in 33.3%, and bilateral occlusions in 30.0%. The diagnostic compatibility of these both examinations was 49.6% for both fallopian tubes, and 34.2% for the only one fallopian tube. In 16.2% both results were incompatible. CONCLUSIONS: The incorrect contrast passage through the fallopian tubes and its increased pressure during HSG in women with the characteristic history and clinical symptoms can suggest endometriosis. In these cases laparoscopy is necessary as the additional examination in the diagnostics of fallopian tubes patency, but the only objective method in diagnosis of endometriosis.     

Success of laparoscopic ovarian wedge resection is related to obesity,lipid profile,and insulin levels

OBJECTIVE: To evaluate the effects of laparoscopic ovarian wedge resection on hormonal and metabolic parameters of polycystic ovary syndrome (PCOS) and to compare profiles of women who achieved pregnancy with those who did not. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Thirty-three women with PCOS. INTERVENTION(S): Laparoscopic ovarian wedge resection using harmonic scalpel. MAIN OUTCOME MEASURE(S): Pregnancy; levels of testosterone, DHEAS, gonadotropins, sex hormone-binding globulin (SHBG), and glucose and insulin during 2-hour glucose tolerance test; lipid profile; body mass index; and waist-to-hip ratio. RESULT(S): Twenty-two women (67%) achieved clinical pregnancy within the mean of 4.9 months after surgery. Baseline parameters of women who became pregnant differed from those who did not: those who became pregnant were less obese, had lower levels of total cholesterol, low-density lipoprotein, and triglycerides; higher levels of SHBG; lower levels of fasting insulin; lower insulin area under the curve; and higher insulin sensitivity index. Subjects not pregnant by 12 weeks after surgery underwent repeat endocrine and metabolic evaluations. In these women, wedge resection was followed by declines in testosterone, LH, and insulin sensitivity index. Wedge resection had no significant effect on SHBG, DHEAS, or lipid profile. CONCLUSION(S): Laparoscopic wedge resections are associated with the highest pregnancy rates among less obese subjects with favorable lipid profiles and lower insulin. In this study, the postoperative decline of serum testosterone and LH is not attributable to improvement of insulin sensitivity.