Resting membrane state as an interplay of electrogenic transporters with various pumps.

In this study, a new idea that electrogenic transporters determine cell resting state is presented. The previous assumption was that pumps, especially the sodium one, determine it. The latter meets difficulties, because it violates the law of conservation of energy; also a significant deficit of pump activity is reported. The amount of energy carried by a single ATP molecule reflects the potential of the inner mitochondrial membrane, which is about -200 mV. If pumps enforce a resting membrane potential that is more than twice smaller, then the majority of energy stored in ATP would be dissipated by each pump turning. However, this problem could be solved if control is transferred from pumps to something else, e.g., electrogenic transporters. Then pumps would transfer the energy to the ionic gradient without losses, while the cell surface membrane potential would be associated with the reversal potential of some electrogenic transporters. A minimal scheme of this type would include a sodium-calcium exchanger as well as sodium and calcium pumps. However, note that calcium channels and pumps are positioned along both intracellular organelles and the surface membrane. Therefore, the above-mentioned scheme would involve them as well as possible intercellular communications. Such schemes where various kinds of pumps are assumed to work in parallel may explain, to a great extent, the slow turning rate of the individual members. Interaction of pumps and transporters positioned at distant biological membranes with various forms of energy transfer between them may thus result in hypoxic/reperfusion injury, different kinds of muscle fatigue, and nerve-glia interactions.

[Intraamniotic infection--cause and satellite of preterm birth].

Intraamniotic infection (IAI), most commonly presented as chorioamniotitis, plays a major role in the pathogenesis of preterm birth (PTB). In this study, we sought for signs of IAI through clinical and laboratory parameters (leukocyte count, CRP concentration and IL-6 in maternal blood), and compared those to the newborns' infectious condition. Using cervical and vaginal secretion cultures, we determined the probable causing agents of IAI. We also followed up the therapeutic effect from the use of corticosteroids, tocolitics and antibiotics for the treatment of PTB. The results demonstrated that over 46% of the pregnant women with PTB presented with evidence of IAI. The best diagnostic option to detect an IAI provides maternal blood IL-6, and the combination between leukocyte count and CRP is a must for routine examinations. We did not isolate a single vaginal pathogen but a combination of harmful microbes which provided evidence of a vaginal ecosystem disorder. The combination therapy in over 50% of women had a positive effect on PTB for the period of corticosteroid prophylaxis (72 hrs). From hour 84, antibiotic therapy can no longer control IAI development.

[Role of IL-6 for the diagnosis of preterm birth].

The preterm birth (PTB) is still a problem for the modern obstetrics, with certainly unsolved questions. Mainly this is associated with the lack of chance to decrease its frequency but also due to the tendency of definite change of its structure--high level of extreme premature state. Intra uterus infection (IUI) is one of the major etiologic reasons for PTB. The early detection of IUI and the determination of the level of fetus damage are the leading therapeutic approach to PTB. The present study includes the test reliability of interleukin-6 (IL-6) to diagnose IUI and early neonatal infectivity. The groups of patients are (A) pregnant women with regular term and (B) pregnant women with PTB, both, with ruptured amniotic membrane or with intact ones. The results of their infectious parameters are determined and analyzed: Leu number, CRP and IL-6 in mother's blood and newborn's blood. It is obvious that the highest percent of IUI is detected by using the blood level of IL-6, followed by CRP and Leu number. The most significant correlation is established between PTB and pathologic levels of IL-6 in cord blood (> or = 30 pg/ml, OR-40.09). In conclusion, we could summarize that IL-6 is a reliable parameter and sign for IUI in cases with PTB. It opens the door to a potential application of its laboratory testing, thus allowing a crucial decision with problematic therapeutic cases, when discussing the PTB.

[A case of cervical myoma and pregnancy].

We are presenting a case of women in 31 gestational week of her pregnancy with prematurely ruptured membranes and 10.5 cm myoma in the vagina. The cervix was elevated with well-defined external orifice, dilated to 10.5 cm. C-section with myomectomy was performed. The myoma had penetrated in the vagina with a lot of adhesions to the rectum and cavum Douglais. The vaginal vault and the posterior cervical wall were restored with single sutures. Smooth postoperative period.

[Short term outcome after active obstetric management of very low birthweight infants].

UNLABELLED: Increased survival in infants weighing less than 1500g (VLBW) in recent decades is largely due to active perinatal management and intensive neonatal care. AIMS: To analyze the relationship between antenatal corticosteroid (ACS) administration, mode of delivery and the short term outcome in VLBW infants. METHODS: A total of 563 neonates weighing < 1500 g was studied between 01.01.2008 and 30.06.2010, distributed according the outcome into 3 groups: 330 healthy, 150 with chronic morbidities (bronchopulmonary dysplasia - supplemental O2 at 28 days, intraventricular hemorrhage gr.Ill-IV or cystic periventricular leucomalacia, retinopathy of prematurity gr.llI-V), 83 died. Mode of delivery, ACS and their influence on the outcome were evaluated by multinomial logistic regression analysis and the relative risk was calculated for each of them (OR). The ACS course was taken for completed if applicated in the 7 days before delivery. RESULTS: Lack of ACS significantly increased the risk of severe morbidities or death compared to the complete course: OR 2.6 and 4.9 respectively (p < 0.001). A higher risk was found comparing incomplete to complete course too: morbidities OR 2,3 (p = 0.01), death OR 3,1 (p = 0.01). Incomplete ACS did not improved outcome significantly. Mode of delivery didn't affected significantly the risk of morbidities. The relative risk of death was lower in neonates delivered by cesarean section compared with vaginal breech delivery (OR 0.2, p = 0.005) but higher compared with vaginal vertex delivery (OR 2.1, p = 0,004). In this study we didn't analyze the indications for cesarean section, some of which were due to fetal distress and could influence the outcome. CONCLUSION: The active obstetric management for VLBW infants reduces the risk of death and survival with morbidities. The main protective factor is the complete ACS course.

[Congenital rhabdomyoma--prenatal diagnosis with three-dimensional ultrasound of two cases with different pregnancy outcome].

Congenital rhabdomyoma is the most common benign tumor of the fetal heart. Usually it occurs as a single or multiple lesions located within the ventricles and it is often associated with tuberous sclerosis after birth. We present two cases of congenital rhabdomyoma diagnosed in the third trimester with three-dimensional (3D) ultrasound. Both cases had different pregnancy outcome.

[Finding a developing intrauterine infection in preterm birth by using classic and modern infection indices].

A significant part of preterm births (PTB) are due to a developing intrauterine infection (IUI). This infection is often of subclinical nature, and its diagnosis is mainly based on laboratory measurements. The objective of our study was to compare the diagnostic potential of classic (clinical picture, leukocyte count, CRP) and modern (IL-6) indices of an infectious and inflammatory process. We found the established clinical symptoms of IUI in 4.2% of the women with PTB, and if symptoms such as subfebrile body temperature (37'-37.5 degrees C), and mother's pulse of 90-100 beats/minute are taken into consideration, then with them this infection were diagnosed 23% of the women with PTB. Based on reference values of blood markers, the following incidence rates of infection were established for the studied pregnant women: increased Leu--26.7% for PTB, and 3% for the full-term birth group; based on increased CRP--51.7% for PTB, and no available data on infection for the control group; based on IL-6 over 11 pg/ml--66.7% for the PTB group, and 16.7% for the full-term women. Laboratory markers have the following sensitivity, specificity and accuracy in finding an intrauterine infection (histologically confirmed): for Leu--93.3%, 25%, and 47.8%, respectively; for CRP--100%, 53.4%, and 69.3%; and IL-6--90%, 70%, and 76.7%, respectively. Obtained results demonstrate that clinical symptoms are rarely indicative of IUI. Of all laboratory measurements, IL-6 has the best diagnostic profile, followed by CRP and leukocyte count.

[Caesarean section by vertical incision of lower uterine segment].

OBJECTIVES: The aim of the study is to analyze the use of vertical incision of the lower uterine segment when performing Caesarean section (CS). MATERIAL AND METHODS: The study includes 89 pregnant women who delivered by CS. The main group includes 40 cases with vertical incision in lower uterine segment (preliminary intention, but final decision made during surgery) and controls--49 cases with transversal incision of lower uterus segment with difficulties/complications of fetus extraction (30 with uterine lacerations and 19 with T-form incision). The mean gestational age in the main group is 32 g.w. (range 26-39) vs. 31 in control group (27-39). RESULTS. Vertical incision of the uterus is performed in 57.5% due to prematurity and lack of enough space for transversal incision (lower uterine segment not yet formed), in 25 % the cause is situs transverses of the foetus and the rest of the cases are related with technical difficulties in isthmicotransversal approach (myoma praevia, anomalies of the uterus, adhesions of the omentum). C.S. is performed for mean 66 min. in the main group vs. 74 min. with controls (p < 0.05). Time to extraction of the foetus is less than a minute in main group vs more than a minute with controls. No lacerations are found with vertical incision of uterus. Blood loss in main group is 664 ml, vs. 884 ml in control group (p < 0.05). Mean values of pH from umbilical artery of the newborn is 7.257 in main group vs. 7.19 in controls (p < 0.05), resp. Apgar scores atb 5-th min. is 7 vs 6. CONCLUSIONS. Vertical incision of lower uterine segment before the formation of the latter, with situs transversus of the foetus and difficult approach renders the option for less lacerations intra operationem, less birth trauma with better final outcome for the newborn.

[Changes in uterine myoma dimentions during pregnancy].

The purpose of this study is to follow up the changes in the myoma dimentions during pregnancy (1st, 2nd and 3rd trimester). The study is prospective and includes 90 pregnant women with myoma during the period 2002-2006. If more than one myoma was diagnosed, the largest one was considered to be representative. Our data show that the combination of myoma and pregnancy is more frequent with women over the age of 30 and it is more frequent with nullipares (63.2%). Single myomas were more frequent with 58%, 48% of the myomas were intramural and 62% were located in the uterine corpus. Our study shows that during the first trimester there is no change in the myomas dimentions in 35%-43% of the cases and during the second trimester there is no change of the myona dimentions in 50% of the cases. During the third trimester there are only 5% of the myomas that change their dimentions. We conclude, that the myomas, that enlarge during the first trimester, usually enlarge during the second trimester as well. We found no decrease of the myoma dimentions during the third trimester.

[Treatment of preterm delivery with calcium channel blockers--Nifedipine].

AIM: To assess the feasibility of the calcium antagonist Nifedipine as an oral tocolytic for the treatment of preterm labor. METHODS: Thirty-seven pregnant women in preterm labor participated in a prospective longitudinal study. Inclusion criteria were: gestational age between 24 and 32 weeks gestation; uterine contractions in 30 min interval; lack of cervical dilatation and lack of contraindications for tocolysis. In all cases the calcium antagonist Nifedipine was used in dosage 4 x 10 mg per os. The clinical response to tocolysis, gestational age at delivery and potential side effects were analyzed. RESULTS: Forty-one pregnant women participated in the study. Two were lost for follow up and another two cases were excluded because myoma uteri was diagnosed. Thirty-seven pregnancies were finally analyzed. In five of them maternal contractions persisted despite of treatment which necessitated parenteral tocolysis. In two of these five cases the pregnancy was terminated (1--spontalneous abortion in 26 w.g., 1--preterm delivery at 32 w.g.). The other 32 pregnancies were delivered at term without any side effects attributed the treatment. CONCLUSION: Nifedipine is an effective oral tocolytic and a rational alternative to other tocolytic agents in the management of preterm labour.

[Congenital cystic adenomatoid malformation of the lung--report of two cases].

Congenital cystic adenomatoid malformation (CCAML) is a rare anomaly of the fetal lung which can be diagnosed prenatally by ultrasound. We present two cases of CCAML with different pregnancy outcome diagnosed at 17 and 24 weeks gestation, respectively, and discuss the major aspects of the obstetrical and therapeutical management.

[Magnetic resonance imaging--diagnosis and differential diagnosis of tumor formations (cyst) in the abdomen cavity during pregnancy].

The existence of tumor formations with unidentified origin in the abdomen cavity of the pregnant can cause serious problems during the operative intervention. It is critical to find the organ origin of the existing formation and it's relations with the neighboring organs. In the following article we present some of the capabilities of the magnetic resonance tomography as a complementally to the existing in the clinical practice classical and special methods for diagnosis and differential diagnosis of tumor formations in the abdomen cavity during pregnancy. MRI locates precisely the organ origin, the type and the size of the cyst formation, furthermore it helps to determine in detail the access point, the type and size of the operative intervention. The technique is harmless concerning the pregnancy and the development of a normal, healthy fetus.

[Pregnancy after treatment of primary sterility with zoladex in patient with essential thrombocytopenia].

We have a patient with essential /idiopathic/ thrombocitopeny and primary sterility, who becomes pregnant after medical and operative treatment. With the beginning of the menarche her menstrual cycle goes irregular with menstrual bleeding duration from 8 to 20 days, cystic ovaries, non-ovulation cycles, trombocytopeny and anemia. A laparotomy was performed twice, because of the existence of hemoperitoneum, caused by a rupture of the corpus luteum. After achieving a amenorrhoea with Zoladex treatment, a splenectomia was performed. As a result we observe a physiological recovery of the menstrual cycle, the ovulation cycle and the pregnancy. The patient's hematology and hemostaseology statuses went back to normal.

[Treatment of life-threatening bleeding in obstetrics and gynaecology --NovoSeven (recombinant factor VIIa)].

The study offers the results from the application of recombinant factor VIIa (NovoSeven) in 19 patients with obstetric or gynaecological problems showing severe haemorrhage of non-surgical origin, which could not be controlled by standard therapy (surgery and resuscitation). Haematological and haemostaseological values as well as final outcome are being monitored. The role of the drug and its special indications in complex urgent treatment of life-threatening bleeding are being discussed. Conclusions. The use of NovoSeven (recombinant factor Vlla) on time and when indicated guarantees rapid and effective haemostasis. Thus laparotomy or relaparotomy can be avoided. If no effect is observed after the application of NovoSeven indicates bleeding from a major blood vessel, demanding laparotomy and surgery. The use of the drug leads to reducing the incidence of blood derivatives transfusions and (being a recombinant product)--no risk of transmissive infections.

[Localization of leiomyoma with respect to the placenta--factor for complications during pregnancy?].

We are presenting two cases of pregnant women with leiomyoma of the uterus, diagnosed antepartum. In both cases the patients were admitted on an emergency basis due to premature uterine contractions. In both cases preterm hemorrhage and fetal malpresentations were observed. The complications of pregnancy in both of the cases were primarily based on the location of the leiomyoma with respect to the placenta--intramural or submucosal disposition of the leiomyoma, retroplacentarily situated.

[Fetal ovarian cyst--possible modalities for subsequent follow up and management].

We present a case report of a fetal ovarian cyst (d - 40/50 MM), which was diagnosed at 30 weeks of gestation [w.g.] and removed by laparotomy after a Cesarean section performed at term. The possible modalities for subsequent follow up and management are discussed.

[Optimization of prenatal screening for group B streptococcus].

The prophylaxis of endogen B streptococcal infections (GBS are part of the normal flora of the gastrointestinal and genital tract) in the presence of predisposed conditions for development of experience for every delivery (tissues' damage, time of delivery, loss of blood, obstetrics manipulations) has been a complicated objective. In the University Hospital of Obstet. Gynecol. "Maichin dom" have been delivered annually on the average 0,6-0,9/1000 born alive with GBS sepsis. The medium Granada shortens the duration for detection of GBS by 24 hours. On entrance of a pregnant woman the direct inoculations of cervico-vaginal secretions and the fast positive reactions of GBS can assist the therapeutical behavior of the mother as well as the newborn.

[Endometriosis during postmenopausal period--probable causes for its origin and development]. / Endometrioza v postmenopauzalnata vuzrast--veroiatni prichini za vuznikvane i razvitie na zaboliavaneto.

A very rare--casuistic--case of endometriosis is presented, which appeared ten years after surgical menopause (hysterectomy and ovariectomy) without concomitant use of hormone replacement therapy or phytoestrogens. The possibilities of endogenous production and exogenous supply of estrogens in the female organism are discussed as well as the possible causes of proliferation of endometrial lesions during postmenopausal period. When menopause is induced by surgery (a stress for the organism) without exogenous supply of estrogens (HRT, phytoestrogens, xenoestrogens) the production of suprarenal hormones, including androgens, increases. The peripheral conversion of androgens into estrogens in fat tissue is increased and implanted during hysterectomy endometrial lesions in vagina walls are stimulated.

[Submucosal isthmicocervical myoma--problems of diagnosis, labor and puerperium]. / Submukozna istmikotservikalna mioma--problemi na diagnozata, razhdaneto i puerperiuma.

A case of submucosal isthmicocervical myoma, 85 mm in diameter, diagnosed for first time during CS. The neonate is with atrophy of left m. sternocleidomastoideus and facial asymmetry due to impression in the left temporoparietal region, without neurological impairment. Multiple ultrasound examinations were done but the fibroids vas not diagnosed. During one examination we presume that the fibroid was mistaken for the head because the BPD was in great discrepancy with other ultrasound parameters of the fetus. During the operation OICC was not found that is why the dilatation was made through the vagina. A myomectomy was not made during the operation. Because of the pressure and the deformation of the cervical canal from the myoma a drain was inserted through the canal to facilitate the evacuation of the lochia. The post operative period passed without any complications, the drainage was taken off on the 7th post operative day and the patient was discharged on the 8th day.