Uterine rupture during pregnancy.

OBJECTIVE: A review of contemporary knowledge about uterine rupture during pregnancy, followed by a case-report of a patient with uterine rupture during pregnancy without an uterine scar. DESIGN: Review and case report. SETTING: Clinic of Obstetrics and Gynecology, University Hospital, Hradec Králové; Department of Gynecology and Obstetrics, Hospital Náchod. CASE REPORT: We present a case of an uterine rupture of a uterus without a scar from previous surgery. A patient in 33. week of pregnancy with stillborn fetus was administred to our hospital. While inducing the labor, the patient showed signes of shock, fetus was no longer present in uterus. An C-section was performed, but the stillborn baby was placed in abdominal cavity, with an abrupted placenta. Large uterine rupture was spotted, therefore a hysterectomy was performed. CONCLUSION: Uterine rupture during pregnancy is an urgent state. The incidency of uterine rupture is rising accordingly with the growing number of C-sections. However, it is important to include uterine rupture into differential diagnostics also in cases with other risk factors. The key to successful diagnosis is ultrasound examination and correct evaluation of clinical state, other imaging methods are less suitable because of time delay. Together with the change of major cause of uterine rupture, the approach to treatment has changed as well. If possible, a uterus-saving procedure is preferred. The aim of this case-report is presentation of a rare case of uterine rupture in an scar-free uterus. It also shows how troublesome diagnostics of uterine ruptures can be.

[Endovascular treatment of obstetric hemorrhage]. / Endovaskulární lécba krvácení v souvislostis porodem a tehotenstvím.

PURPOSE: To evaluate effectiveness and safety of hypogastric artery branches embolization in the treatment of postpartum hemorrhage, hemorrhage associated with cesarean section and termination of pregnancy. MATERIALS AND METHODS: All women with intractable bleeding and who were treated by embolization, were included from the period between 1996 to 2010. The retrospective study included 16 women of mean age 30.5 years. RESULTS: Intractable hemorrhage related to regular delivery occurred 7 times, five times after cesarean section and four times after termination of pregnancy. Seven women (44%) were in hemorrhagic shock during therapeutic embolization. Extravazation was angiographically proved in 50% cases. Embolization was successful in hemorrhage control in 87,5% of women, in two women embolization was repeated for persistent bleeding. There were 21 additional surgical procedures performed in 13 women before embolization including 2 hysterectomies. Two hysterectomies were done after embolization because of infection. In remaining 3 women embolization was done as a primary method of bleeding control. No patient died. In the group of 10 women with maximally 1 surgery before embolization length of hospital stay was 10.1 days in average, while in a group of six women having 2 to 3 surgeries before embolization the hospital stay was 21.2 days in average (p = 0.03). CONCLUSION: Embolization of hypogastric arteries decreases length of hospital stay in patients with obstetric hemorrhage and should be done soon if routine methods of bleeding control fail.

[Appendiceal mucocele in differential diagnosis of tumors in pelvic region]. / Mukokéla apendixu v diferenciální diagnóze tumoru malé pánve.

OBJECTIVE: To report two cases of appendiceal mucocele in patients with suspected gynecological pathology. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of Charles University and Faculty Hospital Hradec Králové. SUBJECT AND METHOD: We report two cases of appendiceal mucocele diagnosed and treated at our department. CONCLUSION: Appendiceal mucocele is a rare pathology, characterized by abnormal accumulation of mucous in appendix lumen. It is four times more common in females with a mean age of about 55 years. The pathogenesis could be neoplastic or non-neoplastic. Appendiceal mucocele with its anatomic location must be considered in terms of differential diagnosis of masses in pelvic region. Preoperative diagnosis is important, alerting the surgeon of an unintended rupture during surgery and avoiding the development of pseudomyxoma peritonei. US and CT were reported to be valuable.

[NGAL--neutrophil gelatinase associated lipocalin in biochemistry, physiology and clinical praxis]. / NGAL-neutrofilní, s gelatinázou asociovaný lipokalin v biochemii, fyziologii a klinické praxi.

Neutrophil gelatinase associated lipocalin belongs to a family of small proteins, lipocalins, engaged in the transmembrane transportation of lipophylic substances. Originally isolated from specific granules of neutrophils, it was later located in bone marrow cells as well as lung, bronchial and colon epithelial cells. The expression of neutrophil lipocalin in epithelial cells and in body fluids considerably augments during the occurrence of inflammations and some cancers. A modulation of immunity response was thus suggested to be the main function of neutrophil lipocalin as well as the bacteriostatic effect originating from competition between neutrophil lipocalin and bacteria for siderophoric iron. Forming protective complexes with gelatinase B, the neutrophil lipocalin is implicated in regulatory processes of physiological and pathological rebuilding of tissues, mainly in the angiogenesis. The determination of neutrophil lipocalin levels in body fluids able to discriminate between bacterial and viral infections provides a powerful diagnostic tool. The examination of neutrophil lipocalin in the sera and urine of patients at risk of renal failure offers a very early marker of this acute state. Neutrophil lipocalin represents a sensitive non-invasive marker of renal ischemia and in patients with cystic fibrosis the marker of acute pulmonary exacerbation. Discussions have been conducted regarding the role of neutrophil lipocalin as an early marker of pancreatic cancer or of neutrophilic activation in severe cases of bowel diseases.

[Activation of the ribosomal gene during blast transformation of human lymphocytes]. / Aktivace ribozomálního genu v prubehu blastické transformace lidských lymfocytu.

BACKGROUND: Natural lectin, phytohemagglutinin, initiates the transformation of normally quiescent T lymphocytes into proliferating lymphoblast-like cells. Recently we have shown that the transformation is accompanied by strong promotion of ribosomal RNA synthesis and by phosphorylation of its activator, initiating factor UBF, both culminating in a synthetic phase of the first cell division cycle. In contrast we have revealed that the UBF gene was activated and its transcription culminated in the early G1 phase. We examined three possible delaying mechanisms: the kinetics of unwinding of rDNA chromatin, the kinetics of transcription of genes coding for the second initiating factor, SL1 complex, and the kinetics of the translation of UBF protein product. METHODS AND RESULTS: Up to 48 hrs following the addition of phytohemagglutinin to the growth medium, we monitored structural changes in the rDNA chromatin using indirect antiUBF immunofluorescence. The data indicated an increased number of separated transcriptional units during the G1 phase of the first cycle. In a time interval of up to 70 hrs we measured the mRNA levels of four constituents of SL1 complex: TAF110, TAF63, TAF48 and TBP using the RT-PCR method. We found a close correlation between the kinetics of the transcription of UBF and SL1 genes and the maximal rate in the early G1 phase. Using metabolic labelling with 35S methionine/cysteine we monitored the translation of UBF protein in PHA stimulated lymphocytes. The data suggested that UBF translation, starting in the S phase, paralleled chromosomal DNA replication. CONCLUSIONS: During the transformation of normal T lymphocytes into proliferating blast-like cells, the multicopy rDNA gene unwinds in the G1 phase of the first cycle forming individual transcriptional units. Genes coding for factors which initiate synthesis of ribosomal precursors are activated in the early G1 phase. The G1 synthesis of ribosomal RNA is accelerated by phosphorylation of the hypophosphorylated UBF pool. As blastic transformation develops UBF translation is triggered in the S phase and neosynthesized UBF, activated by phosphorylation, pushes the synthesis of ribosomal precursors to maximal efficiency. The process of blastic transformation interferes throughout the entire prolonged G1 phase of the first cell division cycle.

The Ewing tumor family of peripheral primitive neuroectodermal tumors expresses human gastrin-releasing peptide.

The Ewing tumor family of peripheral primitive neuroectodermal tumors (pPNETs) are characterized by chromosomal translocations leading to EWS-ETS gene fusions. These hybrid genes express chimeric proteins that are thought to act as aberrant transcription factors. We therefore used differential display-PCR to compare gene expression patterns in pPNET cell lines with those of other small round cell tumors (SRCTs) of childhood. This technique detected differential expression of sequences corresponding to human gastrin-releasing peptide (GRP) in pPNET cell lines but not in other SRCT cell lines. Subsequent Northern and reverse transcription-PCR analysis of SRCT cell lines confirmed GRP positivity in all pPNET lines tested. Of primary tumors tested by reverse transcription-PCR, GRP expression was found in 7 (44%) of 16 pPNETs but in no other primary SRCTs examined. Expression of the GRP receptor gene was demonstrable in 55% of pPNET cell lines and 25% of primary pPNET tumors but also in several other SRCTs. Radioimmunoassays and immunohistochemistry confirmed expression of bioactive GRP peptide in pPNET cell lines and primary tumors, respectively. Moreover, in vitro growth of a pPNET cell line was slowed by treatment with a GRP receptor antagonist and accelerated by a GRP receptor agonist. GRP is a known autocrine growth factor in small cell lung cancer and other neuroendocrine tumors. Its expression in pPNETs provides further evidence for a neuroectodermal histogenesis of these tumors and suggests that autocrine growth of this family of tumors may be at least partially regulated by GRP.

Early gene expression of both RNA polymerase I transcription factors UBF1 and UBF2 precedes ribosomal RNA synthesis during lymphocyte mitogenic stimulation.

Phytohaemagglutinin stimulates lymphoid cells to initiate active cell division which is tightly coordinated with transcription of ribosomal RNA genes. Nuclear Run-On assays demonstrated that treatment of peripheral blood lymphocytes with PHA (10 microg/ml) resulted in maximal rRNA synthesis after 64 hrs. In contrast, mRNA levels for upstream binding factor (UBF)1 and UBF2, as measured by reverse transcriptase-polymerase chain reaction (RT-PCR) and Southern blotting, increased relatively rapidly within 3 to 6 hrs. and remained elevated for at least the next 60 hrs. We further showed that exponentially growing cells of promyelocytic leukemia line HL-60 contained the same amounts of UBF1 and UBF2 mRNAs as phytohaemagglutinin (PHA)-stimulated lymphocytes for 6 hrs. Growth arrest of HL-60 cells, caused by 10 nM phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced monocytic/macrophage-like differentiation for 72 hrs., has been accompanied by a 50% decrease in UBF1/2 mRNAs expression. The lowest concentrations of UBF1/2 mRNAs were revealed in non-dividing terminally differentiated granulocytes. Regardless the activity of RNA polymerase I transcription and cell division rate, UBF1 mRNA levels prevailed over UBF2 mRNA levels in all human blood cell populations tested. Our results suggest that UBF gene expression is an important regulatory mechanism involved in the acceleration and possibly deceleration of rDNA transcription observed during mitogenic stimulation and inhibition of blood cells.

Granulocytic protein p25 is a DNA-binding subunit of protein M(r) = 50,000: subcellular localization, cell and species specificity.

We have previously reported the presence and isolation of the novel protein M(r) = 25,000 (p25) from human granulocytes. In this study, the protein p25 was characterized by its: (a) ability to bind DNA, (b) subunit association, (c) partial protein sequencing, (d) subcellular localization, (e) cellular and species specificity and (f) stability in the presence of released granulocytic proteinases. For the detection of p25 in various extracts, fractions and types of human or animal hematopoietic cells, SDS-PAGE/Western blotting and immunohistochemical staining were used. The protein p25 was subjected to N-terminal amino acid sequence analysis. Protein p25-DNA interactions were monitored using Southwestern blotting. Selective inhibition of granulocytic proteinases was performed. Granulocytic protein p25 was found to be a product of oxidative cleavage of disulfide bridges in the p50 dimer. It was shown that neither protein p50 nor the p25 subunit is a degradation product of a protein of higher molecular weight. The N-terminal amino acid sequence of p25 was: RLNYNKPHAA. Binding capacity for double stranded DNA without significant sequence specificity was revealed and nuclear localization of some fraction of p50 dimer was established. The data concerning the cell and species specificity demonstrated that the protein is expressed only in normal human granulocytes. In summary, protein p25 originates from splitting of the p50 dimer. This subunit shows no identity with proteins already sequenced. DNA-binding of p25 is not sequence specific. It is concluded that the protein p50 is localized in the nuclei and cytoplasmic granules of mature human polymorphonuclear leukocytes or granulocytes of species high on the evolutionary tree. The functions of this protein remain to be determined.

Differential expression of nuclear HMG1, HMG2 proteins and H1(zero) histone in various blood cells.

Changes in the levels of chromosomal high-mobility group proteins HMG1, HMG2 and histone H1 zero were investigated in blood cells of various types, proliferation activity and stage of differentiation. The relative amounts of proteins HMG1, HMG2 and histone H1 zero were evaluated densitometrically by SDS-PAGE of 5 per cent w/v perchloric acid extracts of blood cells. Concerning the HMG1 and HMG2, the main conclusions were: the expression of these HMG proteins was higher in malignant cells, namely leukemia cell lines, then in lymphocytes or granulocytes and the distribution of HMG1 and HMG2 was highly cell-specific. In comparison with lymphoid cells, the levels of HMG1/2 were higher in myeloid cells. The results revealed that in myeloid cells HMG2 prevails over HMG1. There was no direct correlation between HMG1/2 expression and proliferation activity. The levels of HMG1/2 did not depend on the transcription of chromatin either. However, there was some connection between irreversibly differentiated nonproliferating cells and a loss of HMG1/2 proteins. Reversibly differentiated leukemic cells retain their HMG1/2 levels. Similarly to HMG1/2,H1 zero showed a strong cell specificity. The level of H1 zero was different in the various blood cell types. As compared with lymphoid cells, the level of H1 zero was several-fold higher in myeloid cells, regardless of whether they were normal or malignant. Moreover, there was an accumulation of H1 zero in differentiating HL-60 cells accompanied by only a slight decline in cell proliferation; this agrees with the idea that H1 zero expression is not directly associated with the inhibition of cell growth. Rather higher expression of H1 zero is related to changes during cell differentiation.

[Binding of butocin to serum proteins (author's transl)]. / Die Bindung von Butocin an Serumeiweisskörper.

The binding of N-[-5-(6-purinylthio)-valeryl]-glycin ethylester (butocin, PVG) to serum proteins and pure human albumin was studied using the method of equilibrium dialysis. Its binding to protein in sera diluted 1:1 of 10 patients with malignant disease averaged 48.4 +/- 7.07%. At the butocin concentration of 20 micrograms/ml an average of 36% of butocin were bound to pure albumin. Only a small portion was bound to globulin fractions. Measurements of the saturation curve showed butocin to be bound to albumin molecule by one binding centre with a microscopic association constant kappa = 1.7 . 10(3) mol/l.