Endometriosis: Kotarski J

Debski R, Kotarski J, Paszkowski T, Pawelczyk L, Skrzypulec V, Tomaszewski J, Anonymous00190. · No affiliation provided · Ginekol Pol. · Pubmed #19323063 No free full text.

Abstract: Recent epidemiologic studies indicate that use of combined oral contraception is associated with a increase in the incidence of cardiovascular disease (venous thromboembolism, pulmonary embolism, myocardial infarction and stroke). The risk of cardiovascular disease is strongly related to estrogen dose, progestogen type and other factors for example thrombogenic mutations and cigarette smoking among female over age 35. The progestogen only contraception is safe alternative to combined hormonal contraception. Progestogen only pill (POP) has different levels of action (local and/or central) which may vary from one drug to another. As for the cardiovascular disease risk, progestogens are not considered to be risk factors. Desogestrel containing POP is advised in the following cases: bad tolerance of exogenous oestrogens; in order to counteract an endogenous hyperoestrogenosis; medical, metabolic or cardiovascular contraindications to estroprogestogen contraception. Lastly, POP should be used as a prime contraception in some particular situations (breast feeding, endometriosis, adenomyosis, cigarette smoking, contraception for older women). These recommendations present the actual system of care in that population of women in Poland.

Polak G, Wertel I, Kozioł-Montewka M, Tarkowski R, Kotarski J. · Department of Gynecology, University School of Medicine, ul. Staszica 16, 20-081 Lublin, Poland. · Eur J Obstet Gynecol Reprod Biol. · Pubmed #12860343 No free full text.

Abstract: Changes in the peritoneal fluid (PF) environment have been implicated in the pathogenesis of endometriosis as well as in the decrease of fertility. OBJECTIVE: To evaluate the concentration of glutathione in PF of women with endometriosis. PATIENTS: Twenty-one patients with endometriosis (I or II rAFS stage, n=11; III or IV rAFS stage, n=10), and 29 patients with follicular or dermoid ovarian cysts (n=17 and n=12, respectively). RESULTS: Mean (+/-S.D.) PF glutathione concentration was 0.22+/-0.01 micromol/ml in patients with minimal or mild endometriosis, 0.21+/-0.05 micromol/ml in women with III or IV stage of the disease, 0.24 +/- 0.03 micromol/ml in women with follicle ovarian cysts, and 0.23+/-0.05 micromol/ml in patients with dermoid tumors of ovaries. No significant difference in the peritoneal glutathione level was found between the groups. CONCLUSION: These results suggest that PF glutathione is not involved in the progression of endometriosis.

Polak G, Wertel I, Tarkowski R, Morawska D, Nowakowski A, Kotarski J. · I Katedra i Klinika Ginekologii AM im Prof F Skubiszewskiego w Lublinie. · Ginekol Pol. · Pubmed #16958229 No free full text.

Abstract: Accumulating data suggests that iron homeostasis in the peritoneal cavity may be disrupted by endometriosis. Increased iron metabolism induce proinflammatory and prooxidative environment in the peritoneal fluid (PF), thus may be involved in the pathogenesis of the endometriotic disease. Ferritin, a protein consisting of 24 subunits, may represent 25% of the total iron found in the organism. The aim of the study was to estimate the levels of ferritin in peritoneal fluid of women with endometriosis. MATERIALS AND METHODS: Forty women were studied, including 15 patients with minimal/ mild endometriosis, 15 patients with moderate/ severe stage of the disease and 10 women without the disease. Ferritin concentrations were measured in the PF using a commercially available ELISA kit. RESULTS: Ferritin levels were significantly higher in PF from both women with stages I/II (p=0.003) and III/IV (p=0.0007) endometriosis as compared to the reference group. No significant difference in the PF ferritin levels was found between women with stages I/II and stages III/IV endometriotic disease (p=0.98). CONCLUSIONS: Increased ferritin levels, observed in peritoneal fluid, may reflect disrupted iron metabolism in the peritoneal cavity of endometriosis women.

Polak G, Wertel I, Tarkowski R, Morawska D, Kotarski J. · 1st Department of Gynecology, University School of Medicine, Lublin, Poland. <> · Eur J Obstet Gynecol Reprod Biol. · Pubmed #16644090 No free full text.

Abstract: OBJECTIVE: The aim of the study was to evaluate for the presence of lactoferrin (LTF) in peritoneal fluid (PF) of women with and without endometriosis. PATIENTS: Seventy-eight women were studied, including 49 women with endometriosis and, as a reference group, 29 patients with functional follicle ovarian cysts. RESULTS: Lactoferrin levels were detectable in all peritoneal fluid samples. Women with minimal endometriosis had lower PF lactoferrin concentrations compared to both patients with high revised American Fertility Society classification scores and women with follicle ovarian cysts. No significant difference in the peritoneal LTF levels was found between patients with stage II endometriosis, stage III or IV endometriotic disease and women with functional cysts of ovaries. CONCLUSIONS: Owing to its antibacterial properties lactoferrin is probably an important defense factor in the peritoneal cavity, however its role in the pathogenesis of endometriosis remains enigmatic.

Wertel I, Gogacz M, Polak G, Jakowicki J, Kotarski J. · 1st Department of Gynecology, University School of Medicine, ul. Staszica 16, 20-081 Lublin, Poland. · Eur J Obstet Gynecol Reprod Biol. · Pubmed #15808381 No free full text.

Abstract: OBJECTIVE: Changes in peritoneal fluid (PF) composition may affect fertilization as well as early embryonic development. Leptin, an adipocyte hormone, has been shown to act as a link between adipose tissue and the reproductive system. Therefore, we decided to assess peritoneal and serum leptin levels in infertile endometriotic patients. PATIENTS: Seventy-two women were studied, including 30 fertile and 18 infertile women with ovarian endometriotic cysts and, as a reference group, 24 patients with unexplained infertility. RESULTS: No significant difference in the peritoneal and leptin levels was found between the studied groups. Significantly higher PF leptin concentration was observed in patients with stages III and IV of endometriosis as compared to those with minimal stage of the disease. In fertile patients with endometriosis a positive correlation has been found between PF and serum leptin concentrations. CONCLUSIONS: No differences in peritoneal or serum leptin levels between infertile and fertile women with endometriosis suggest that this cytokine is not involved in pathophysiology of endometriosis-related infertility.

Pietura R, Janczarek M, Bednarek W, Kotarski J, Szczerbo-Trojanowska M. · Zakładu Radiologii Zabiegowej i Neuroradiologii AM w Lublinie. · Ginekol Pol. · Pubmed #15029748 No free full text.

Abstract: THE AIM: Of the study was to evaluate utility of magnetic resonance (MR) in the assessment of the women who fulfilled inclusion criteria for uterine artery embolisation as a symptomatic leiomyoma treatment and outcome of procedures. MATERIALS AND METHODS: MR examination was performed in 220 patients. Uterine artery embolizations were performed in 170 patients. RESULTS: The reasons for disqualification were: no correlation between symptoms and size an position of leiomyoma--61%, adenomyosis--20%. In MR imaging dominant leiomyoma volumes were diminished by 59.6% (p < 0.05) over a period of 3 months. CONCLUSIONS: MR is the method of choice in the assessment of women referred to uterine artery embolisation as a symptomatic leiomyoma treatment. MR imaging is effective and objective method of evaluation outcomes of uterine embolisation.

Polak G, Kozioł-Montewka M, Tarkowski R, Kotarski J. · I Katedry i Kliniki Ginekołogii AM w Lublinie. · Ginekol Pol. · Pubmed #14674157 No free full text.

Abstract: Changes in the peritoneal fluid environment have been implicated in the pathogenesis of endometriosis as well as in the decrease of fertility. Tumor necrosis factor alpha (TNF alpha) and interferon gamma (IFN gamma) play a critical role in the generation of the immune response, leading to the enhanced proinflammatory cytokines and free radicals production. MATERIALS AND METHODS: 59 women were studied, including 24 patients with unexplained infertility, 10 infertile women with endometriosis (Io or IIo rAFS), 11 patients with PCOS and 14 patients with tubal occlusion. TNF alpha and IFN gamma concentrations were measured in the PF using commercially available ELISA kits. RESULTS: Peritoneal fluid IFN gamma concentrations did not differ significantly between the studied groups. TNF alpha levels were significantly (p = 0.02) higher in the PF of endometriotic patients compared to women with tubal infertility. The positive correlation (R = 0.83; p < 0.01) has been found between TNF alpha and IFN gamma levels. CONCLUSIONS: Increased PF TNF alpha levels observed in patients with endometriosis may play a role in activation of peritoneal macrophages. Positive correlation between TNF alpha and IFN gamma suggests their synergistic stimulatory effect on the immunocompetent PF cells.

Tarkowski R, Kotarski J, Polak G, Wojcierowski J. · Kliniki Ginekologii Operacyjnej I Katedry Połoznictwa i Chorób Kobiecych SPSK I AM w Lublinie. · Ginekol Pol. · Pubmed #11883311 No free full text.

Abstract: The survivin gene encoding a novel inhibitor of apoptosis protein (IAP) is located on chromosome (17q25). It is expressed during development and in human cancer in vivo. Endometriosis in cicatrix after cesarean section represents the only localization of endometriotic implant which etiology is known. It is believed that during the surgical procedure when the uterine cavity is open there is a high risk of decidualized endometrium implantation. The aim of the study was to estimate the expression of the survivin mRNA in the scar endometriosis after cesarean section (n = 6) and perineum endometriosis (n = 2) and in normal human endometrium (n = 12, reference group) using reverse transcribed-polymerase chain reaction (RT-PCR). METHODS: Total cellular RNA was isolated from the tissues using TriReagent according to the manufacturer's protocol. Total cellular mRNA was transcribed into cDNA with reverse transcriptase (RT) then the survivin gene fragment (430 bp) was amplified with PCR using specific primers. The products of the PCR reaction were separated on 2% agarose gel. The survivin gene was expressed in 4 of 6 cases of scar endometriosis after cesarean section and in 2/2 cases of perineum endometriosis. In all cases of normal endometrium we found the expression of survivin with a peak in the late proliferative phase. The antiapoptosis function of this gene product may play an important role in the endometriotic implant growth promotion.

Polak G, Kozioł-Montewka M, Tarkowski R, Kotarski J. · I Katedry i Kliniki Ginekologii Operacyjnej AM w Lublinie. · Ginekol Pol. · Pubmed #11883271 No free full text.

Abstract: OBJECTIVES: To investigate the possible role of oxidative stress in the pathogenesis of female infertility, we examined the peritoneal fluid (PF) and plasma lipid peroxides levels in infertile women. MATERIALS AND METHODS: 4-hydroxynonenal (4-HNE) and malonyldialdehyde (MDA) concentrations were measured in peritoneal fluid and plasma samples obtained from: 10 infertile women with minimal and mild endometriosis, 24 patients with unexplained infertility, 11 women with PCOS and 14 patients with tubal infertility. RESULTS: PF lipid peroxides level was significantly higher in women with idiopathic infertility compared to other groups. Plasma 4-HNE and MDA concentrations did not differ significantly between the infertile groups. No significant difference or relationship was observed between peritoneal fluid and plasma lipid peroxides levels. CONCLUSIONS: Increased free radicals activity in the peritoneal fluid environment may be the factor responsible for some cases of "unexplained infertility".

Gogacz M, Polak G, Jakowicki J, Kotarski J. · Second Department of Gynaecological Surgery, University School of Medicine, Jaczewskiego 8, 20-954 Lublin, Poland. · J Reprod Immunol. · Pubmed #11543854 No free full text.

Abstract: Leptin may play a role in the regulation of menstrual cycle acting either directly on ovaries or at the level of the hypothalamic-pituitary axis. Peritoneal fluid is a biologically active environment that influences ovarian function but, on the other hand, concentration of many substances in peritoneal fluid can reflect the functional status of ovaries. In our study, we estimated leptin concentration in peritoneal fluid in relation to serum leptin concentration in infertile patients. A study group consisted of 31 infertile patients that underwent laparoscopy. In 15 patients, laparoscopy did not solve the problem and they were grouped as unexplained infertility, in eight patients we found endometriosis and eight patients were diagnosed as polycystic ovary syndrome (PCOS). We found significantly higher peritoneal fluid leptin concentrations in patients with unexplained infertility and endometriosis compared to those with PCOS. The plasma leptin concentration did not differ between the groups studied. There was no correlation between peritoneal fluid and plasma leptin concentrations in any patient group. Taking into account our results, the role of leptin in reproduction should be emphasized but further investigation is needed to determine its mechanism of action.

Polak G, Kozioł-Montewka M, Niedźwiadek J, Tarkowski R, Sidor-Wójtowicz A, Kotarski J. · Katedry i Zakładu Mikrobiologii Lekarskiej AM w Lublinie. · Ginekol Pol. · Pubmed #11526787 No free full text.

Abstract: OBJECTIVES: To assess the concentrations of tumor necrosis factor alpha (TNF-alpha), interferon gamma (IFN-gamma) and lipid peroxides (the marker of free radicals activity) in peritoneal fluid (PF) of infertile women with minimal and mild endometriosis. MATERIALS AND METHODS: 19 women were studied, including 9 infertile women with minimal or mild endometriosis and 10 patients with tubal occlusion (the reference group). Lipid peroxides (malonyldialdehyde and 4-hydroxynonenal), TNF-alpha and IFN-gamma concentrations were measured in the PF using commercially available kits. RESULTS: Concentration of IFN-gamma was detectable in PF of 7 (77.8%) women with endometriosis and in PF from 3 (30%) patients with tubal occlusion. Neither TNF-alpha or lipid peroxides PF concentration differed significantly (p < 0.05) between the groups. In the group with endometriosis we have found a positive correlation (R = 0.77, p = 0.04) between the concentrations of TNF-alpha and IFN-gamma. CONCLUSIONS: Our results suggest that oxidative stress in the PF doesn't appear to play a role in endometriosis-associated infertility.

Gogacz M, Jakowicki J, Kotarski J. · Kliniki Ginekologii Operacyjnej II Katedry Połoznictwa i Chorób Kobiecych Akademii Medycznej w Lublinie. · Ginekol Pol. · Pubmed #11526784 No free full text.

Abstract: Phagocytic activity of macrophages isolated from peritoneal fluid (PF) was estimated using flow cytometry. Study group consists of 28 patients with endometriosis and 19 patients with benign noninflammatory tumour of adnex(is) served as reference group. Macrophages were processed in two ways: fresh cells were obtained from women with endometriosis (n = 7) and reference group (n = 10) and frozen cells derived from patients with endometriosis (n = 21) and reference group (n = 9). Phagocytic activity of macrophages was measured against opsonized and conjugated with FITC E. coli. It is worth to notify that phagocytosis was determined in PF environment in the study. Percentage of phagocytosing fresh macrophages did not differ (p = 0.05) between subjected groups of patients and was respectively 64.3% +/- 17.3% vs 49.0 +/- 4.0%. Phagocytic activity of frozen macrophages derived from patients with endometriosis was significantly higher (p < 0.02) in comparison to reference group (14.3 +/- 9.1% vs 5.2 +/- 2.8%).

Błaszkowska I, Roliński J, Gogacz M, Jakowicki J, Kotarski J. · I Katedry Połoznictwa i Chorób Kobiecych Akademii Medycznej w Lublinie. · Ginekol Pol. · Pubmed #11526783 No free full text.

Abstract: Dendritic cells represent discrete leukocyte subpopulation of specialist or "professional" antigen-presenting cells (APC). They play a crucial role in the activation of naive T cells "in vivo" They have monocyte/macrophages origin. There are no data in literature on the presence of dendritic cells derived from peritoneal fluid monocytes/macrophages. In our study we tried to culture PF macrophages from patients who undergone surgery so that to obtain dendritic cells. PF was aspirated during laparoscopy from patients with endometriosis, unexplained infertility or benign noninflammatory ovarian tumor. Peritoneal macrophages were isolated using adherence method then were cultured and stimulated with GM-CSF and IL-4. Phenotype of cultured cell was estimated using flow cytometry after incubation with monoclonal antibodies CD45/14, CD 40/HLA-DR, CD28/3, CD3/40L, CD25/5 and CD69/HLA-DR. Morphology of cultured cells was confirmed microscopically after May-Grunvald-Giemsa staining. PF leukocytes concentration varied from 1.2 x 10(6) cells/mm3 to 22.6 x 10(6) cells/mm3. Cultured monocytes/macrophages from PF had morphology typical for dendritic cells. We also found that only dendritic cells from patients with endometriosis had higher expression HLA-DR antigen (93.6% of cells) and low expression of CD40 (2.7% of cells) on their surface in comparison to reference group. It is worthy to notify that dendritic cells from patients with endometriosis expressed also CD25 antigen characteristic for T leukocytes. To our data it is the first report in literature on dendritic cells obtained from PF macrophages.

Polak G, Kozioł-Montewka M, Gogacz M, Błaszkowska I, Kotarski J. · Department of Medical Microbiology, University School of Medicine, ul. Lubartowska 85, 20-123 Lublin, Poland. · Eur J Obstet Gynecol Reprod Biol. · Pubmed #11165736 No free full text.

Abstract: OBJECTIVE: To determine whether impairment of the antioxidant systems of peritoneal fluid might be a factor responsible for infertility. STUDY DESIGN: Total antioxidant status was measured in peritoneal fluid obtained from 18 infertile women suffering from minimal or mild endometriosis, 23 patients with unexplained infertility, 12 women with tubal infertility and 13 fertile women. RESULTS: Total antioxidant status was significantly lower in peritoneal fluid from women with unexplained infertility (0.49+/-0.21 mmol/l) compared to both fertile patients (0.67+/-0.24 mmol/l, P=0.02) and women with tubal infertility (0.76+/-0.26 mmol/l, P=0.001). Peritoneal fluid total antioxidant status did not differ significantly between patients with endometriosis (0.61+/-0.2 mmol/l), tubal infertility and the fertile group (P>0.05). CONCLUSIONS: Our results suggest that low antioxidant status in peritoneal fluid may play a role in the pathogenesis of infertility.

Polak G, Kozioł-Montewka M, Tarkowski R, Morawska D, Kotarski J. · Katedry i Zakładu Mikrobiologii Lekarskiej AM w Lublinie. · Ginekol Pol. · Pubmed #11082967 No free full text.

Abstract: OBJECTIVES: To assess the concentration of Plasma Glutathione Peroxidase (plGPx) in the peritoneal fluid (PF) of patients with unexplained infertility and infertile women with minimal and mild endometriosis. MATERIALS AND METHODS: 33 women were studied, including 8 infertile women with minimal or mild endometriosis, 15 patients with unexplained infertility and 10 patients with tubal occlusion (a reference group). Concentration of plGPx was measured in the PF using a commercially available ELISA kit (Oxis Inc.). RESULTS: The plGPx concentration was significantly (p = 0.04) lower in PF from women with unexplained infertility (846 +/- 177 ng/ml) compared to the reference group (1023 +/- 238 ng/ml), but did not differ significantly (p = 0.25) between women with endometriosis (918 +/- 81 ng/ml) and patients with tubal infertility. CONCLUSIONS: Our results suggest that low peritoneal plGPx concentration may play a role in the pathogenesis of infertility.

Tarkowski R, Skrzypczak M, Winiarczyk S, Kotarski J, Jakowicki JA, Jakimiuk AJ. · Kliniki Ginekologii Operacyjnej AM w Lublinie. · Ginekol Pol. · Pubmed #10842913 No free full text.

Abstract: Aromatase (P450AROM) is the enzyme complex with converts testosterone to estradiol and androstendione to estrone. This enzyme was detected in various normal tissues and uterine pathology such as uterine myoma, endometrial cancer and endometriosis. The aim of the study was to estimate expression of P450AROM messenger ribonucleic acid (mRNA) in normal, hyperplastic and malignant endometrium, and the ability to convert androstenedione to estrone by endometrial cancer tissue. Normal endometrium was obtained from 16 (12 proliferative phase, 4 secretory phase) regularly cycling women after hysterectomy for myomas, hyperplastic endometrium (n = 5) and endometrial cancer (n = 5) from postmenopausal women. The ability to convert androstenedione to estrone was estimated in 16 cases of endometrial cancer in postmenopausal women. P450AROM mRNA was measured by a quantitative assay based on reverse transcribing the mRNA into cDNA with reverse transcriptase (RT) then amplification of the cDNA using the polymerase chain reaction (PCR). The mean (+/- SEM) expression of aromatase gene in proliferative endometrium was 84.4 +/- 14.0 pg mRNA/microgram DNA and in secretory endometrium 200.3 +/- 87.8 pg mRNA/microgram DNA. The mean (+/- SEM) P450AROM mRNA expression in endometrial hyperplasia was 92.9 +/- 17.8 pg mRNA/microgram DNA, in endometrial cancer was 14.3 +/- 7.7 pg mRNA/microgram DNA. Androstenedione to estrone conversion in endometrial cancer tissue culture was 252.5 +/- 91 fmol/g tissue/h. Our data confirm that human normal, hyperplastic and malignant endometrium do express P450AROM mRNA and that aromatase activity is present in endometrial cancer tissue.

Polak G, Rola R, Gogacz M, Kozioł-Montewka M, Kotarski J. · Katedry i Zakładu Mikrobiologii Lekarskiej AM w Lublinie. · Ginekol Pol. · Pubmed #10390915 No free full text.

Abstract: OBJECTIVE: To estimate the concentration of malonyldialdehyde (MDA) and total antioxidant status in the peritoneal fluid (PF) of patients with unexplained infertility (UI) and infertile women with minimal and mild endometriosis. MATERIALS AND METHODS: PF was obtained during laparoscopy from 8 women with UI, 12 infertile women with endometriosis (I degree and II degrees rAFS) and 10 women with benign noninflammatory ovarian tumours. All laparoscopies were performed in the follicular phase of the cycle. MDA concentration was measured according to Ledwozyw method, TAS was measured spectrophotometrically using RANDOX diagnostic reagent system. RESULTS: We found significantly higher concentration of MDA in PF from both patients with UI (p = 0.03) and with endometriosis (p = 0.046) compared to the control group. TAS was significantly (p = 0.027) higher in PF of women with UI but did not differ significantly (p = 0.49) between patients with endometriosis and controls. CONCLUSIONS: Our results show that an imbalance between lipid peroxides and the antioxidant system in PF environment may be one of the main factors responsible for the UI. In the group with endometriosis a marginally significant difference in MDA levels, no significant differences in TAS and data from the literature, suggest that accelerated lipid peroxidation in PF doesn't appear to play a role in the endometriosis associated infertility.