The purpose of this study was to determine the negative effects (cryodamage) on human spermatozoa after freeze-thawing and to determine whether freeze-thawing of spermatozoa with a programmed slow freezer is better than freezing with liquid nitrogen vapour (rapid freezing) with regard to alterations in sperm chromatin and morphology in semen from fertile (donor) and subfertile, IVF/ICSI, patients. Ninety-five semen samples were obtained either from patients attending our IVF unit for treatment (n=34) or from donors (n=25) with proven fertility and normal sperm quality according to WHO guidelines. Each semen sample was divided into two parts after liquefaction and addition of the cryoprotectant. The first part was frozen using a programmed biological freezer and the second part was frozen by means of liquid nitrogen vapour. Smears were made before the freezing and after the thawing procedure to assess morphology (strict criteria) and chromatin condensation (Acridine Orange test). The mean percentage of chromatin condensed spermatozoa in the samples from donors (control group) was 92.4 +/- 8.4% before freezing and this decreased significantly (p < 0.0001) to 88.7 +/- 11.2% after freeze-thawing with the computerized slow-stage freezer and to 87.2 +/- 12.3% after using static liquid nitrogen vapour (p < 0.001). The corresponding values for semen obtained from patients was 78.9 +/- 10.3% before freezing which decreased to 70.7 +/- 10.8 and 68.5 +/- 14.8%, respectively (p < 0.001). On the other hand, the mean percentage of normal sperm morphology in the control group decreased from 26.3 +/- 7.5% before freezing to 22.1 +/- 6.4% (p < 0.0001) after thawing with the computerized slow-stage freezer and to 22.2 +/- 6.6% (p < 0.0001) after the use of static liquid nitrogen vapour. In the patient group, the mean percentage of normal morphology decreased from 11.7 +/- 6.1% after freezing with the biological freezer to 9.3 +/- 5.6% and to 8.0 +/- 4.9% after freezing with static liquid nitrogen vapour. This study demonstrates that chromatin packaging and morphology of human spermatozoa decrease significantly after the freeze-thawing procedure, not only after the use of static liquid nitrogen vapour but also after the use of a computerized slow-stage freezer. However, the chromatin of semen samples with normal semen parameters (donor sperm) withstand the freeze-thaw injury better than those with low quality semen samples. Therefore, the computerized slow stage freezer could be recommended for freezing of human spermatozoa, especially for subnormal semen samples, for example, ICSI and ICSI/TESE candidates and from patients with testicular tumours or Hodgkin's disease, in order to avoid further damage to the sperm chromatin structure.

Reports about uterine rupture in pregnancy subsequent to previous laparoscopic surgery are not frequent. This may be due to the lack of long term follow up of patients who had undergone this surgery rather than the rarity of this complication. A case of uterine rupture subsequent to laparoscopic myomectomy is reported. An increasing rate of the occurrence of this complication is reviewed in current literature, thus reiterating the need for more stringent selection criteria for patients who benefit from this surgical technique.

A case i s pr esented of pr egnancy and del i ver y of tr i pl ets fol l ow i ng i ntr acytopl asmi c sper m i njecti on (I CSI) ther apy. A l though the outcome w as sati sfactor y, w i th the bi r th of nor mal chi l dr en fr ee fr om any mal for mati on, most of the obstetr i c and par ti cul ar l y the neonatal compl i cati ons that can be associated with this therapy are illustrated in this case. In addition, from point of view of medi cal costs, concer ns ar e r ai sed about the cur r ent pol i cy of mul ti pl e embr yo tr ansfer w hi ch i s di r ectl y r esponsi bl e for the hi gh r ate of mul ti pl e gestati ons obser ved i n the I VF/I CSI pr ogr amme. The author s consequentl y r ecommend a pol i cy of tr ansferring not more than two embryos per tr eatment cycl e. Twin Research (2000) 3, 76-79.

Tyrimo tikslasPalyginti krūtį tausojančias operacijas: periareolinę naviką adaptuojančią mastopeksiją su įprasta pusmėnuline segmentektomija, nustatyti ypatumus, metodų pranašumus ir trūkumus, pasirenkant kurį nors operacijos metodą.Tyrimo metodaiAtlikta retrospektyvioji analizė pacienčių, operuotų „Ammerland“ klinikų Krūties centre Vesterštėdėje (Vokietija) 2008–2009 m. dėl pirminio krūties vėžio, atliekant pusmėnulinę segmentektomiją (n = 136) bei periareolinę naviką adaptuojančią mastopeksiją (n = 131). Abiejų operacijų metodikos buvo nagrinėjamos atsižvelgiant į įvairius kriterijus: naviko ir krūties dydį, kūno masės indeksą, rezektato svorį ir kitus. Duomenys nagrinėti naudojant Stjudento t bei chi kvadrato (χ2) testus, Pearsono koreliaciją ir Kendallo tau-b (r), kai p < 0,05.RezultataiPašalinto audinio svoris (36,96 g ± 20,68 vs. 53,13 g ± 33,03, p = 0,0001, p < 0,05) ir naviko skerspjūvis (17,63 mm ± 11,94 vs. 25,77 mm ± 17,25, p = 0,0001, p < 0,05) buvo didesni pacienčių, kurioms buvo atlikta naviką adaptuojanti mastopeksija. Mažesnes krūtis turinčios moterys buvo dažniau operuojamos naudojant mastopeksijos metodiką, p = 0,008, p < 0,05.Pakartotinių operacijų skaičius (apie 30 %, p = 0,351) ir naviko atstumas iki rezektato kraštų abiejose grupėse nesiskyrė (segmentektomija – 5,52 mm ± 2,59, mastopeksija – 5,88 mm ± 2,87, p = 0,377). Operacijos laikas buvo 1,7 karto ilgesnis mastopeksijos grupėje (113,4 min. ± 29,42 vs. 67,61 min. ± 26, p = 0,001, p < 0,05). Komplikacijų skaičius abiejų operacijų grupėse nesiskyrė, p = 0,34.IšvadaTaikant naviką adaptuojančių periareoliarinės mastopeksijos operacijų metodiką, galima pašalinti didesnius navikus nei įprastos pusmėnulinės segmentektomijos būdu. Mastopeksija taip pat gali būti taikoma moterims, turinčioms mažesnį kūno masės indeksą bei mažesnes krūtis.Reikšminiai žodžiai: krūtį tausojanti operacija (KTO), onkoplastinė chirurgija, naviką adaptuojanti mastopeksija.Comparison of tumor-adapted mastopexy with semilunar segmentectomy – monocentric study ObjectiveTumor-adapted periareolar mastopexy is a breast-conserving oncoplastic surgery method in the breast cancer treatment. The aim of this study was a comparison of breast-conserving surgeries, tumor-adapted periareolar mastopexy vs. the usual semilunar segmentectomy, determination of characteristic properties, advantages and disadvantages when choosing one or another surgery method.MethodsData on patients from 2008–2009 were retrospectively examined. All patients underwent surgery for primary breast carcinoma by semilunar segmentectomy (n = 136) or by pariareolar tumor-adapted mastopexy (n = 131) at the Breast Center of the Ammerland Clinic in Westerstede, Germany. Both surgical techniques were analyzed on various criteria, such as tumor / breast-relation, BMI, resection weight, etc. The data analysis was performed using Student’s t-test or the Chi-square (χ2) test, the correlation by Pearson and Kendall’s Tau-b (r) when p < 0.05.ResultsThe removed tissue weight (36.96 ± 20.68 g vs. 53.13 ± 33.03 g, p = 0.0001, p < 0.05) and the diameter of the tumor (17.63 ± 11.94 mm vs. 25.77 ± 17.25 mm, p = 0.0001, p < 0.05) were larger in the tumor-adapted mastopexy patient group than in the semilunar segmentectomy group. For women with small breasts, mastopexy was used more frequently, p = 0.008, p < 0.05.The number of secondary surgeries (both groups about 30 perc., (p = 0.351) and the distance between the tumor and the resection margin were the same for both surgical procedures (segmentectomy – 5.52 ± 2.59 mm and mastopexy – 5.88 ± 2.87 mm, p = 0.377). The duration of surgery was 1.7 times longer in mastopexy than in the other technique (113.4 ± 29.42 min vs. 67.61 ± 26 min, p = 0.001, p < 0.05). The complication rate was the same in both methods, p = 0.34.ConclusionPeriareolar tumor-adapted mastopexy allows removing larger tumors than the semicircular segmentectomy. Mastopexy can be indicated for women with a lower BMI and smaller breasts.Key words: breast-conserving surgery (BCS), oncoplastic surgery, tumor-adapted mastopexy.

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