Bilateral serous retinal detachment in preeclampsia--a case report.

Preeclampsia is a leading cause of maternal and fetal/neonatal mortality worldwide. Serous retinal detachment is an unusual cause of visual loss in pregnancy. This is a case report of a 17-year-old patient who was admitted to the obstetric ward with symptoms of preeclampsia. The pregnancy was terminated by cesarean section at 38 gestational weeks. The patient complained of blurred vision in both eyes throughout the perinatal period. The ophthalmic examination revealed serous retinal detachment in both eyes. The optical coherence tomography demonstrated the hyporeflective area between the retinal pigment epithelium and the neurosensory retina. With blood pressure control at postpartum, there serous retinal detachment resolved spontaneously and patient's vision improved.

[B lynch suture for post partum heamorrhage due to uterine atony]. / Zastosowanie szwu lyncha typu b w leczeniu krwotoku poporodowego w przebiegu atonii macicy.

Uterine atony and concomittant massive haemorrhage is one of the most dangerous complications of labour. Conventional, conservative treatment approach comprising of oxytocics such as oxytocin, methergin or prostaglandins may fail in some cases, mandating surgical techniques, including hysterectomy. B Lynch compression uterine suture may be a safe and effective method of treatment in post partum heamorrhage and in most of cases may replace more complicated techniques. In this article, together with referring the technical aspects of this procedure, we present a case of successful treatment.

Differences in permeability of preterm and term fetal membranes to calcium ions - Preliminary report.

The metabolic activity of amniochorion contributes to the control of activation of labor-type uterine contractions. The study presents an experimental model of transport of calcium ions across the human amniochorion sampled directly after cesarean section in patients delivering both at term and prematurely. Transmembrane transport of calcium ions was lower in preterm vs. term tissue samples. The differences in permeability were most pronounced in the first 60 min of experiments. The results of the study provide evidence for the existence of an active mechanism of calcium transport which can contribute to regulating the contractility of the uterus.

Antenatal corticosteroid therapy: a comparative study of dexamethasone and betamethasone effects on fetal Doppler flow velocity waveforms.

OBJECTIVE: To compare the effects of antenatal administration of dexamethasone and betamethasone, used in two different regimens, on fetal Doppler flow velocities. STUDY DESIGN: Sixty-seven women at risk for preterm delivery received course of corticosteroids by means of a computer-generated randomization table. The Doppler examination of the pulsatility index (PI) of the umbilical artery (UA), the middle cerebral artery (MCA) and the middle cerebral artery/umbilical artery PI ratio (MCA PI/UA PI) were performed before treatment, 24 and 72 h after the first dose of corticosteroids. The SAS system was used to perform statistical analysis. RESULTS: No significant change was observed in UA PI through dexamethasone therapy. In MCA there was a significant decrease in PI at 72 h (2+/-0.43 before and 1.68+/-0.31 after, p=0.0001). Similarly a significant decrease in MCA PI/UA PI ratio was noted (2.09+/-0.51 before and 1.83+/-0.4 after, p=0.0137). No significant changes were observed in UA PI, MCA PI and MCA PI/UA PI ratio during betamethasone treatment. CONCLUSIONS: Our results indicate significant decrease in fetal middle cerebral artery impedance at 72 h after maternal administration of the first dose of dexamethasone. Effects of dexamethasone on fetal brain warrants further research.

Increased Maternal and Cord Blood Betatrophin in Gestational Diabetes.

AIM: The aim of the study was to compare maternal and cord blood levels of betatrophin--a new peptide potentially controlling beta cell growth--as well as in its mRNA expression in subcutaneous adipose tissue, visceral adipose tissue and placental tissue obtained from pregnant women with normal glucose tolerance (NGT) and gestational diabetes (GDM). METHODS: Serum betatrophin and irisin concentrations were measured by ELISA in 93 patients with GDM and 97 women with NGT between 24 and 28 week of gestation. Additionally, maternal and cord blood betatrophin and irisin, as well as their genes (C19orf80 and Fndc5) expression were evaluated in 20 patients with GDM and 20 women with NGT at term. RESULTS: In both groups, serum betatrophin concentrations were significantly higher in the patients with GDM than in the controls (1.91 [1.40-2.60] ng/ml vs 1.63 [1.21-2.22] ng/ml, p=0.03 and 3.45 [2.77-6.53] ng/ml vs 2.78 [2.16-3.65] ng/ml, p=0.03, respectively). Cord blood betatrophin levels were also higher in the GDM than in the NGT group (20.43 [12.97-28.80] ng/ml vs 15.06 [10.11-21.36] ng/ml, p=0.03). In both groups betatrophin concentrations in arterial cord blood were significantly higher than in maternal serum (p=0.0001). Serum irisin levels were significantly lower in the patients with GDM (1679 [1308-2171] ng/ml) than in the healthy women between 24 and 28 week of pregnancy (1880 [1519-2312] ng/ml, p=0.03). Both C19orf80 and Fndc5 mRNA expression in fat and placental tissue did not differ significantly between the groups studied. CONCLUSIONS: Our results suggest that an increase in maternal and cord blood betatrophin might be a compensatory mechanism for enhanced insulin demand in GDM.

Misoprostol and dinoprostone therapy for labor induction: a Doppler comparison of uterine and fetal hemodynamic effects.

OBJECTIVE: To compare the effect of misoprostol (PGE(1)) versus dinoprostone (PGE(2)) on blood flow in uteroplacental circulation during labor induction. STUDY DESIGN: Eighty-four women with indications for induction of labor were assigned to receive either misoprostol 50 microg per vagina every 4 h as needed or 0.5 mg doses of dinoprostone given intra-cervically every 6 h by means of a randomization table generated by computer. Doppler velocimetry of umbilical, uterine and arcuate arteries was performed immediately before and 2-3 h after the administration of misoprostol or dinoprostone. The SAS system was used to perform statistical analysis. RESULTS: There were no significant changes of pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) ratio in umbilical arteries after both prostaglandin compounds. Vaginal application of misoprostol significantly increased all ratios in arcuate artery and S/D ratio in uterine artery. Intra-cervically dinoprostone significantly increased PI, RI and S/D ratio in arcuate and uterine arteries. CONCLUSIONS: Our results indicate that vaginal misoprostol and cervical dinoprostone administration increases uteroplacental resistance but does not affect umbilical blood flow. Misoprostol would be as safe and effective agent as dinoprostone for cervical ripening and labor induction.

[Evaluation of serum sICAM-1 and sVCAM-1 concentration in patient at risk of preterm delivery]. / Ocena stezen czastek adhezyjnych sICAM-1 i sVCAM-1 w surowicy krwi pacjentek z zagrazajacym porodem przedwczesnym.

Aim of the study was to assess the serum adhesion molecules concentration in patients at risk of preterm labour. Sixty-three patients were divided into two groups basing on cervical evaluation (Bishop's score > or = 6 and < 6). The assessment of sICAM-1 and sVCAM-1 levels in serum were carried out by immunoenzymatic ELISA test utilizing monoclonal antibodies (moAb) against human sICAM-1 and sVCAM-1 (ELISA system, R&Q, USA). Among the patients at risk of preterm labour and Bishop's score > or = 6 statistically higher serum levels of sICAM-1 were found. There were no statistically significant differences in sVCAM-1 levels between examined groups. We conclude that serum sICAM-1 determination might improve the prediction of preterm birth.

[Lamellar body count and interleukin-6 levels in women with preterm labor]. / Ciala lamelarne i interleukina-6 w diagnostyce porodu przedwczesnego.

Our purpose was to investigate the amniotic fluid lamellar body count and interleukin-6 levels in women with preterm labor. The study was carried out on 50 amniotic fluid collections obtained by amniocentesis or during cesarean delivery. Concentration of lamellar body (CL) and interleukin-6 (IL-6) were performed. We found significantly lower lamellar body count values in women at risk of preterm delivery before 34 weeks' gestation and elevated amniotic fluid IL-6 concentration (CL--20.81 +/- 6.73 x 103/ul, IL-6--318.3 +/- 18.7 pg/ml) when compared with pregnancies at term (CL--77.1 +/- 28 x 103/ul, IL-6--142 +/- 15.3 pg/ml).

[Higher percentages of T regulatory cells in children at risk for developing type 1 diabetes mellitus]. / Podwyzszone odsetki limfocytów T regulatorowych u dzieci z grupy ryzyka zachorowania na cukrzyce typu 1.

INTRODUCTION: The natural history of type 1 diabetes is concerned with the appearance of autoantibodies against antigens of pancreatic beta cells. The last decade revealed some evidence of the participation of T regulatory lymphocytes - cells which suppress immune response - in the pathogenesis of type 1 diabetes and prediabetes. AIM OF THE STUDY: was the assessment of T regulatory cells in the blood of children at risk for developing type 1 the diabetes mellitus. MATERIAL AND METHODS: 85 subjects, siblings of children with type 1 diabetes, were enrolled into the study. The presence of anti-GAD65 antibodies was assessed. With the use of flow cytometry the following cell subpopulations were noted: CD4+, CD4+CD25high and CD4+CD25highCD127low with the coexpression of: CD28, CD45RO, CD54, CD62L and CD134 molecules. RESULTS: We did not observe any differences in white blood cell count, lymphocyte (including CD4+) count and the percentage between the examined and control groups. We noted higher percentages of T regulatory cells: CD4+CD25high, CD4+CD127low and CD4+CD25highCD127low in children with the presence of anti-GAD65 antibodies as compared to the control children. CONCLUSION: Higher percentages of T regulatory cells in the blood of children with the presence of anti-GAD65 antibodies may suggest an intensive regulatory response present in patients at risk for developing type 1 diabetes.

[Do the regulatory T cells play a role in the pathogenesis and therapy of type 1 diabetes?]. / Czy limfocyty T regulatorowe odgrywaja role w patogenezie i leczeniu cukrzycy typu 1?

In the paper the current knowledge concerning the role of T regulatory cells in the pathogenesis and modern therapy of diabetes type 1 is discussed. Type 1 diabetes is one of the most well-known autoimmunological diseases. In its pathogenesis the destruction of pancreatic beta cells by autoreactive T lymphocytes plays the main role. It is considered that in the autoimmunologic reaction participate the disturbances in the number/function of T regulatory cells - responsible for the inhibition of hyperreactive immune response. According to the newest data the regulatory cells possess CD4+/ CD25++/CD127 low phenotype. Results concerning the role of T regulatory cells in the pathogenesis of diabetes are diverse, further both the experimental and clinical studies are required including the use of those cells in immunotherapy. Most authors observed the lack of number and/or function of T regulatory cells in type 1 diabetes. Among produced cytokines most valuable is TGF-p. Important disturbances in this field were also observed in the patients' families including the carriers of high-risk group genes. There are also ideas to use T regulatory cells in the prevention and therapy of diabetes. Some reports noted the role of T regulatory cells in the response to novel immunotherapies in diabetes like the use of TNF-a, anti-CD3 antibodies or dendritic cells inducing pancreatic islet tolerance. It is possible that further research will allow to use the immunotherapy including T regulatory cells in type 1 diabetes.

Lower percentages of T regulatory cells in children with type 1 diabetes - preliminary report.

INTRODUCTION: Type 1 diabetes (T1D) isa well-known autoimmune disease, however there are still some processes in its pathogenesis to be elucidated. In the last few years the role of T regulatory cells in the pathogenesis of T1D has been investigated. The aim of study was to determine the percentages and numbers of T regulatory cells in the peripheral blood of children with type 1 diabetes. MATERIAL AND METHODS: A total of 25 children with newly diagnosed type 1 diabetes were studied, and compared to the control group consisted of 30 healthy children with no signs of autoimmune, chronic, inflammatory, neoplastic disease, and no evidence of T1D in their families. Flow cytometric analysis ofT-cell subpopulations was performed using the following markers: anti-CD3, anti-CD4, anti-CD25, and anti-CD127 (IL-7R). RESULTS: In the group of children with type 1 diabetes we noted statistically significant lower percentages of T regulatory cells, i.e., CD4+CD25 high and CD4+CD127 low comparing to the control children. There were no differences in other assessed parameters: white blood cell count, lymphocytes, CD4+ and CD4+CD25 high CD127 low cells (percentage and count). We did not find the correlation between patients' age and any of analysed parameters. CONCLUSIONS: Our results suggest the lower percentages of Tregs in children with T1D, however those data need to be confirmed in a larger cohort of patients and complemented with functional studies, e.g. at mRNA level. In our opinion T regulatory cells could be excellent candidates for cell therapy in newly diagnosed type 1 diabetic children.

Diminished expression of ICOS, GITR and CTLA-4 at the mRNA level in T regulatory cells of children with newly diagnosed type 1 diabetes.

Diabetes mellitus is one of the most common chronic diseases in children. T regulatory cells (Tregs) modulate response to autoantigens and probably play a role in pathogenesis of type 1 diabetes (T1DM). The aim of the present study was the assessment of T regulatory cells including their percentages and expression of critical genes in these cells in children with newly diagnosed type 1 diabetes. The examined group consisted of 50 children with T1DM. A flow cytometric analysis of T-cell subpopulations was performed using the following markers: anti-CD4, anti-CD25 and anti-CD127 (=IL-7R). Additionally, T regulatory cells were isolated for assessment of mRNA levels for chosen genes with the real-time RT-PCR technique. The percentages of CD4(+)CD25(high)CD127(dim/-) were very low and did not differ between T1DM and control children. We did not observe any statistically significant differences between healthy and diabetic children in mRNA expression for FoxP3, IL-7R (CD127), IL-8RA, IL-10RA, IL-12A, IL-2RA (CD25), IL-21, STAT1, STAT3, SOCS2, SOCS3, TGF-beta1-R1, TGF-beta-R2 and TBX-21 genes. Interestingly the mRNA level for CTLA-4, ICOS1, IL-23, IL-27, SMAD3 and GITR were lower in Treg cells of children with diabetes compared to the control patients. No disturbances in the percentages of T regulatory cells in patients with diabetes but diminished expression of some elements important in Treg function could be the result of an immunologic imbalance accompanying the onset of the diabetes. The results of our study should be used in future research in the field of immunotherapy in pediatric diabetes.

[Identification of the CD40 (CD154) ligand expression on the surface of conglomerate platelet-monocyte in children with the metabolic syndrome]. / Identyfikacja ekspresji liganda CD40 (CD154) na powierzchni konglomeratu plytka-monocyt u dzieci z zespolem metabolicznym.

INTRODUCTION: The increased expression of the transmembrane protein CD40 on macrophages, endothelium, smooth muscle cells, platelet-monocyte conglomerate is connected with an enlarged risk of the occurrence of diseases of the cardiovascular system in the metabolic syndrome. THE AIM OF THE STUDY: was to establish whether metabolic syndrome in children can already be a precursor of cardiovascular diseases. MATERIAL AND METHODS: The study was carried out on 35 children aged 10-18 years with the metabolic syndrome recognized according to the National Cholesterol Educational Program Adult Treatment Panel III (ATP III) criteria. The control group consisted of 26 healthy children without risk factors. In the examined children we evaluated BMI, the blood pressure, lipids, hsCRP, and the HOMA index. The analysis of the expression CD 40L (CD154) was performed with a three-color flow cytometer. The identification surrendered 104 cells. Statistical analysis was performed with use of U-Mann-Whitney test, for correlation analysis we used Spearman and Pearson tests. RESULTS: We observed an elevated expression of CD40 ligand on the surface on platelet-monocyte conglomerate in patients with the metabolic syndrome compared to healthy children (12.7 vs. 4.95%, p=0.0036). In addition, we found a statistically significant correlation between the expression of the CD40L and HOMA index (r = -0.33, p<0.028). CONCLUSIONS: Enlarged expression of the transmembrane protein CD40L not only initiates and influences the progression of the atherosclerosis, but modulates the architecture of atherosclerotic plaque as well.

The effect of relcovaptan (SR 49059), an orally active vasopressin V1a receptor antagonist, on uterine contractions in preterm labor.

Relcovaptan (SR 49059) is a non-peptide, orally active vasopressin V1a receptor inhibitor. The effect on uterine contractions in 18 women with preterm labor in pregnancy weeks 32-36 was assessed in a double-blind investigation. The inclusion criterion was at least four regular uterine contractions over 30 min as measured by external tocodynamometry. Twelve patients received at random a single oral dose of 400 mg relcovaptan and six received placebo, and contractions were monitored up to 6 h thereafter. Rescue medication (beta-adrenoceptor-stimulating drug) was allowed after 2 h. Before drug administration a mean (+/- SE) of 8.2 +/- 1.4 and 9.7 +/- 1.6 contractions/30 min were recorded in the relcovaptan- and placebo-treated groups, respectively. In the former group, the frequency of uterine contractions started to decrease within the first half hour, and 1.5-2 h after dosing it was steady at 3.2 +/- 0.9 contractions/30 min. Correspondingly, after placebo, 7.8 +/- 2.2 contractions/30 min were recorded, a statistically significant difference (p = 0.017). The activity in the relcovaptan-treated women remained low, whereas in the placebo group inhibited uterine contractions were observed only in women receiving 'rescue' tocolytic treatment. It is concluded that relcovaptan inhibits preterm labor.