Relationship of Glucose, C-peptide, Leptin, and BDNF in Maternal and Umbilical Vein Blood in Type-1 Diabetes.

The study aimed to determine the relationship between glucose, C-peptide, brain-derived neurotrophic factor (BDNF), and leptin between mother and fetus and neonatal weight. METHODS: In the prospective observational cohort study, we included 66 women with type-1 diabetes mellitus (T1DM). According to the z-score for neonatal weight, patients were divided into healthy-weight neonates (n = 42) and overweight neonates (n = 24). The maternal blood samples were taken during pregnancy and cesarean section when the umbilical vein blood sample was also withdrawn. The maternal vein sera were analyzed for fasting glucose, C-reactive protein (CRP), leptin, BDNF, TSH, FT3, and FT4. The umbilical vein sera were analyzed for glucose, C-peptide, leptin, TSH, thyroid-stimulating protein (FT3), free thyroxine (FT4), and BDNF concentration. The neonatologist measured the skinfold thickness on the third day of neonatal life. RESULTS: A strong correlation was confirmed between maternal and umbilical vein glucose concentration and maternal glucose and C-peptide in umbilical vein blood. A negative correlation was found between the concentration of BDNF in the umbilical vein and glucose in maternal blood. A strong correlation was seen between BMI and maternal blood leptin concentration, neonatal fat body mass, and umbilical vein blood leptin concentration. Higher BMI elevated BDNF, and TSH increase the odds for overweight neonates in the first trimester of pregnancy. Maternal higher leptin concentration in the first trimester decrease the odds of overweight neonates. CONCLUSIONS: Maternal glucose concentrations affect the fetus's glucose, C-peptide, and BDNF concentrations. Leptin levels increase in maternal blood due to increased body mass index, and in the neonate, fat body mass is responsible for increased leptin concentrations.

Clear cell variant of urothelial carcinoma in urinary bladder; a clinicopathological and immunohistochemical study--a case report.

The clear cell variant urothelial carcinoma of urinary bladder is very rare and unusual neoplasm defined histologically by clear cell pattern and glycogen-rich cytoplasm. Our case of clear cell carcinoma was diagnosed with immunohistochemistry stain. A 72-year-old man, presented with painless macroscopic hematuria in November 2007. Evaluation revealed papillary tumor in urinary bladder. A transurethral resection of the bladder tumor (TUR-Bt) was performed. Histopatologic evaluation showed superficial transitional cell carcinoma and carcinoma in situ. On three month follow-up, a solitary pedunculated tumor was detected again in the left wall of the urinary bladder. A repeated transurethral resection of the bladder tumor (reTUR-Bt) was performed in February 2008. The pathological diagnosis was difficult due to diffuse clear cell appearance. Immunohistochemistry stain showed urothelial carcinoma and finally it was diagnosed as clear cell variant. Urothelial carcinoma has many variants that show a variety of appearances and characteristics. These should be well known for evaluation and optimal treatment.

Splenic rupture in pregnancy--traumatic or spontaneous event?

Splenic rupture in pregnancy or postpartum is a rare and frequently misdiagnosed occurrence. Failure to recognise it is common, and can be fatal for both mother and child. With all our highly developed diagnostic methods and equipment, aetiology of splenic ruptures in pregnancy remains a dilemma in many cases.

[Glycemic control and the risk of preeclampsia in women with gestational diabetes mellitus]. / Utjecaj regulacije glikemije na ucestalost preeklampsije u trudnica s gestacijskim dijabetesom.

INTRODUCTION: Gestational diabetes mellitus (GDM) is associated with an increased risk of preeclampsia and other complications throughout pregnancy. AIM: The aim of the study was to analyze the incidence of preeclampsia and other risk factors in GDM pregnant women. STUDY DESIGN AND METHODS: During 1992-2001 period, 472 consecutive unselected pregnancies were followed up in women with GDM. Glycemic control was assessed by HbA1c at the time of diagnosis. Preeclampsia was defined as blood pressure 140/90 mm Hg combined with albuminuria of >0.3 g/L. The occurrence of preeclampsia was also assessed in a control group comprising 324 unselected pregnant women. RESULTS: Preeclampsia developed in 14.4% of GDM women and 4.3% of controls. After adjustment by logistic regression, both fasting blood glucose (FBG) and profile blood glucose (PBG) and their changes during pregnancy remained significant predictors for preeclampsia. The odds for preeclampsia increased by a factor 1.2 for each 1 mmol/L increment in initial FBG level and PBG level, and decreased by factor 0.8 for each 1 mmol/L decrease of FBG or PBG level achieved during pregnancy. CONCLUSION: Improvement of the glycemic control during pregnancy reduces the risk of preeclampsia.