Solid papillary carcinoma of the breast with neuroendocrine features in a pregnant woman: a case report.

Solid papillary carcinoma, a special form of breast carcinoma with neuroendocrine differentiation, usually presents in women aged 60 years or more. (Koern 2010). According to our best knowledge, we present the second case of such a tumor in pregnant women.

[Prenatal ACTH-depot therapy]. / Prenatalna terapia ACTH-depot.

ACTH-depot therapy is one of the therapeutic methods in threatening abortion or premature labor, introduced by Prof. R. Klimek in the 60-ies of the last century. Administration of syntetic ACTH is the method of first choice in treatment of neuroendocrinologically complicated pregnancy, safe for mother as for infant. The first trials of application of this method disclosed good results determined by very high birth rate of at term pregnancies (96%) and delivery of live infants, in comparison to 18.5% or 37% supported pregnancies treated conservatively, in the same group of women previously. Because hypothalamic hormones induce synthesis of enzyme-oxytocinase, it becomes possible to observe the development of pregnancy in women treated with ACTH-depot by CAP-level determination. In women with hypothalamic hypofunction, level of oxytocinase is low, increasing slowly, sometimes even its decrease is observed. Current multiple ACTH-depot doses: 0.5 mg i.m. are routinely used, instead of hitherto applied series of 3 injections in the second and third trimester. Number of doses depend on: levels of oxyto-cinase, rate of its increase, reactivity of patient and progression of pregnancy. Administration of ACTH-depot seems to be more beneficial than aministration of corticoids, because this hormone does not cross the placenta, but increases the production of endogenic hormones. Unwelcome symptoms of ACTH-depot treatment are similar to those observed in course of the corticold therapy, but they are less expressed. Development of features connected with hypercatabolism of proteins like: muscular atrophy, striae and osteoporotic changes, are not observed. Only single therapy with ACTH-depot causes regression of clinical symptoms of threatening premature labor, without necessity of tocolitic treatment. Thanks to steroidogenesis, normalisation of the number of preterm labors and respiratory disorders decreases.

The molecular changes during placental detachment.

OBJECTIVES: RCAS1 is a membrane protein that plays a role in the maintenance of maternal immune tolerance during pregnancy. The work presented here demonstrates the results of RCAS1 expression in placenta in cases of placental abruption and patients with retained placental tissue during the third stage of labor. STUDY DESIGN: The placenta tissue samples were obtained during vaginal and cesarean delivery (derived from 117 pregnancies). Pregnant women were divided into four groups according to the onset of labor and the time of placental detachment in term labors. The samples were analyzed by the Western blot method. Statistical analysis was performed using the Shapiro-Wilk procedure. The Mann-Whitney test and Student's t-test were applied to compare the differences between parametric data. RESULTS: The average relative amount of RCAS1 observed in those patients with retained placental tissue was statistically significantly higher than in the patients with placental abruption. CONCLUSION: The differences observed in placental RCAS1 levels confirm the participation of this protein in the inhibition of maternal immune response during gestation. The present results also indicate that RCAS1 participates in the changes in the maternal immune system that take place during parturition and reinforce its potential involvement in the mechanism of placental abruption.

[Enzymatic diagnostics in obstetrics and gynecology. Part I]. / Enzymatyczna diagnostyka w poloznictwie i ginekologii. Czesc I.

The object of this paper is to highlight the importance of enzymatic diagnostics in obstetrics and gynecology. Enzymatic diagnostics through the assessment of oxytocinase allows to monitor the pregnancy and predict the delivery. Oxytocinase and its isoenzymes reflect the present state of the mother, the fetus and the placenta. The constant increase of oxytocinase in maternal blood up to the time of delivery and its appropriate level indicates the proper development of pregnancy. Low lewel and above all decrease in level instead of the normal constant increase precedes by several weeks clinical symptoms of abortions and preterm deliveries. Maternal blood levels of cystine-amino-peptidases (CAP1 and CAP2) show high correlation with the fetal and placental mass as well as fetal maturity. The levels of oxytocinase allow to objectivize the duration of pregnancy and to reduce induced and operative deliveries.

[Preterm labor and IUGR rates in patients with cardiac anomalies in the material of the Pregnancy Pathology Unit at the Jagiellonian University OB/GYN Department between 1986-1999]. / Czestosc porodów przedwczesnych i hipotrofii w grupie pacjentek z wadami serca w materiale Oddzialu Patologii Ciazy Katedry Ginekologii i Poloznictwa Collegium Medicum Uniwersytetu Jagiellonskiego w latach 1986-1999.

INTRODUCTION: Advance in medicine in general caused more and more women with cardiac defects reach reproductive age. AIM: Analysis of kind and advance of cardiac disease influence on preterm labour and IUGR rates. MATERIAL AND METHODS: A prospective study on 232 pregnant patients with cardiac malformations, who were hospitalised in Pathology of Pregnancy Unit of OB./ GYN Jagiellonian University Clinic was performed between 1986-1999. Acquired data were compared with results obtained from control group of 424 pregnant patients with physiological course of pregnancy. RESULTS: Results prove of shorter pregnancy duration in patients with higher NYHA classes. Preterm labour rate in patients of NYHA III and IV equals to 31.15% and is 3 times higher than in control group. Patients of NYHA I and II revealed comparable gestational age with control group. CONCLUSIONS: Worse obstetric outcome is characteristic for 3rd and 4th NYHA classes. Intrauterine growth retardation in patients with cardiac malformations occurs after 34 week of pregnancy.

[The frequency of micronuclei in lymphocytes from cord blood as a marker of exposure to mutagenic factors]. / Czestosc wystepowania mikrojader w limfocytach krwi pepowinowej jako wskaznik narazenia na czynniki mutagenne.

The aim of the study was a preliminary recognition of effect of mutagenic factors which passed through placenta and influenced cells of the foetus during third trimester of the pregnancy. The research group of being studied was 31 newborns, born at the Department of Gynaecology and Infertility of Jagiellonian University Medical College in Kraków, and their mothers. The neonates (cord blood) and mothers (peripheral blood) were examined for presence of micronuclei (MN) in cultured lymphocytes by using the whole blood method. Significant difference between mother's and neonate's frequencies of micronuclei indicates on less exposure to genotoxic factors of neonates.

[Cardiac diseases and pregnancy]. / Choroby serca a ciaza.

Physiological maternal changes during pregnancy and cardiac disease symptoms are described. Prediction of good fetal outcome and delivery in the pregnant patient suffering from cardiac disease requires accurate assessment of cardiac disease advancement, its type and severity, frequent follow-up and immediate intervention in any case of worsening. Concerning chances and risks further influence of pregnancy and delivery on cardiac disease in the mother should be included.

[Pregnancy duration and mode of delivery in patients with cardiac insufficiency on the material of Jagiellonian University OB/GYN Clinic in the years between 1986-1999]. / Czas trwania ciazy i sposób rozwiazania w grupie pacjentek z wadami serca w materiale Kliniki Ginekologii i Poloznictwa Colegium Medicum Uniwersytetu Jagiellonskiego.

OBJECTIVES: Recent progress in cardiology and cardiac surgery lead many patients with cardiac disease in the procreative age. DESIGN: To asses the influence of cardiac disease on pregnancy and delivery. MATERIAL AND METHODS: 232 subjects with congenital and acquired cardiac anomalies, hospitalized in the Jagiellonian University OB/GYN Clinic between 1986-1999. Patients were divided according to NYHA classification depending on kind and grade of cardiovascular insufficiency. Acquired data were compared with data in the control group consisted of 424 subjects without any complications during pregnancy and delivery. RESULTS: We proved shortening of the pregnancy duration in more advanced NYHA classes. Percentage shave of preterm deliveries in 3rd and 4th class was 31.15%, what equals to 3 times preterm delivery rate in the control group. Preterm delivery rate in groups of NYHA I and II was similar to the rate in the control group. Acquired data reveal extremely high cesarean section rate in the material of patients with cardiac anomalies. Cesarean section rate in the group of NYHA I and II was 3 times higher (30%) than in control group (rate of 10%). NYHA III and IV groups has a cesarean section rate of 93%. Vaginal delivery rate in the NYHA I and II groups equals to 58.5%, what is 10 times higher than in NYHA III and IV groups (equals to 6.6%). CONCLUSIONS: 1. Pregnancy duration depends on cardiovascular sufficiency and is significantly shorten in NYHA III and IV groups. 2. Extremely high cesarean section rate in the analyzed group is due to decreased cardiac sufficiency.