Cushing's syndrome in pregnancy: a case report and mini review of the literature.

Adrenal diseases in pregnant women are diagnosed relatively rarely. The main cause of hypercortisolemia during pregnancy is Cushing's syndrome related to adrenal adenoma. It is important to diagnose Cushing's syndrome in pregnant women because it can lead to significant maternal and foetal complications and morbidity. However, due to physiological endocrine changes and symptoms in pregnant women the diagnosis of this disorder can be a challenge. One current case describes a 38-year-old pregnant woman with hypertension, oedema and an adrenal tumour. At the beginning, Conn syndrome was suspected, but after careful analysis Cushing's syndrome (with an adenoma of the right adrenal gland) was diagnosed. After delivery and 5 weeks of pharmacological treatment the patient underwent right side adrenalectomy by laparoscopy.

Blood velocity in the fetal vein of Galen and the outcome of high-risk pregnancy.

BACKGROUND: Pulsation in the flow velocity waveform in the umbilical vein is related to perinatal mortality but the flow velocity waveform in the fetal vein of Galen is normally even and without fluctuation. OBJECTIVES: To establish whether blood flow velocity pulsations in the vein of Galen in high-risk pregnancies are related to outcome. STUDY DESIGN: The vein of Galen was located by colour Doppler ultrasound in 102 pregnancies complicated by severe pregnancy-induced hypertension. The blood velocity waveform was recorded by pulsed Doppler within 2 days of delivery and the presence pulsations related to pregnancy outcome, including emergency operative intervention and neonatal distress. Umbilical artery and vein and uterine artery blood flow velocity waveform were also recorded at the same time. The clinicians managing the women were unaware of the venous flow results. RESULTS: Pulsation were present in the vein of Galen in 68 cases and in the umbilical vein in 21. Both were significantly related to adverse outcome. Pulsations in the vein of Galen were seen in all seven perinatal deaths. CONCLUSIONS: Since umbilical venous pulsation are a late sign of fetal compromise, and pulsations in the vein of Galen seem to appear earlier, thus being an intermediate sign of fetal compromise that might be of great value for fetal surveillance.

[Statistical methods applied in retrospective risk assessment of endometrial adenocarcinoma occurrence]. / Metody statystyczne stosowane w retrospektywnej ocenie ryzyka wystapienia raka blony sluzowej macicy.

A retrospective study about frequency of occurrence of endometrial adenocarcinoma in postmenopausal women which are associated with diabetes mellitus, overweight and hypertension was performed. The aim of the study was to have risk factors for carcinoma of endometrium estimated. The nonparametric statistics such as: 2 x 2 table chi 2/Phi2 test, observed versus expected chi 2 test and estimation of relative risk were applicable. A retrospective study (from 1991 to 1993) of 2887 patients of Institute of Obstetrics and Gynecology University School of Poznan with pathological sign and symptoms was performed.

[Fetal pulse oximetry in second stage of labor]. / Zastosowanie pulsoksymetrii plodowej w II okresie porodu.

OBJECTIVE: To compare the mean values of fetal oxygen saturation with fetal heart rate pattern in the second stage of labor (Melchior classification) MATERIAL AND METHODS: The study included 30 parturients in gestational age 37-41 weeks. Fetal oxygen saturation was recorded and averaged over the last 30 min of the second stage of labor Simultaneously, fetal heart rate and uterine contractions were monitoring. Fetal heart rate patterns were assessed according to Melchior's classification. At birth, the cord acid-base parameter (pH) was calculated. RESULTS: The lowest value of fetal oxygen saturation over the last 30 min of labor was 10%, the highest 60%, and the mean value 39.1 +/- 12.5%. Statistically, significant correlation between the mean value of oxygen saturation over the last 30 min of labor and pH arterial values (n = 25, p = 0.004, r = 0.42) was found. There was no statistically significant correlation between fetal oxygen saturation and pH venous values (n = 24, p. = 0.006, r = 0.49), but trend towards significance could be observed. Statistical analysis revealed that arterial pH was significantly correlated to Melchior's classification. The lowest pH and FSpO2 values coexisted with type 3 and 4 of FHR patterns according to Melchior's classification. CONCLUSIONS: The mean values of fetal oxygen saturation over the last 30 min of labor significantly correlate with arterial pH values. These values correlate with FHR abnormalities according to Melchior's classification. Fetal pulse oximetry seems to be an important, additional method assessing fetal well-being in the second stage of labor.

[Spectral analysis of fetal heart rate variability]. / Analiza spektralna zmiennosci czynnosci serca plodu.

OBJECTIVE: To assess power spectral densities and power spectrum of FHR variability in two categories of fetal activity, quiescence and breathing movements, in pregnancies complicated by diabetes mellitus or intrauterine growth retardation. MATERIAL AND METHODS: The study group included 70 women, 35 in uncomplicated pregnancies and 35 with above-mentioned complications. The spectral analysis of FHR variability in fetal quiescence or breathing activity was performed. The power spectrum was analyzed at frequencies 0-1.0 Hz. Successively, the power spectral density was calculated. It has been presented the plots of spectral densities of beat-to-beat variabilities well during breathing episodes as "no breathing". Subsequently, the power spectra were calculated in both analyzed activities and groups. RESULTS: The highest values of power spectral densities (0.118 +/- 0.025) at 0.6-0.8 Hz were found in uncomplicated pregnancies. In pregnancies complicated by diabetes mellitus (0.048 +/- 0.049) or IUGR (0.042 +/- 0.041) these values were statistically significantly. At 0.6 Hz and 0.8 Hz power spectra of FHR variability were lower in quiescence comparing to breathing activity, as well in uncomplicated as complicated pregnancies. At these frequencies power spectra during breathing movements were significantly lower in complicated pregnancies comparing to uncomplicated. COMMENTS: The results of this study confirm the usefulness of spectral analysis in the assessment of FHR variability. The observed disturbances may reflect an abnormal fetal reactivity. The evaluation of breathing and cardiovascular systems interaction allows to study indirectly the central nervous system that coordinates both activities.

[Evaluation of fetal breathing movements in prognosis of preterm labor]. / Ocena aktywnosci oddechowej plodu w prognozowaniu porodu przedwczesnego.

The relationship between fetal breathing activity and preterm labor among patients with signs of preterm labor has been analyzed. The assessment concerned pregnant women admitted to the hospital because of regular uterine contractions, uterine contractility and bleeding or premature rupture of membranes. It has been found the significant correlation between the absence of fetal breathing movements and preterm labor.

[Twin-to-twin transfusion syndrome--case report]. / Zespól transfuzji plodowo-plodowej--opis przypadku.

Authors described a case of twin-to-twin transfusion syndrome that did not comply with a classic definition of syndrome. It has been presented possibilities of ultrasound screening regarding to Doppler blood flow velocimetry. It has been also shown the usefulness of these methods in the monitoring and assessment of fetal status. This is an example of Doppler blood flow velocimetry applying that yields information concerning fetal condition. This method seems to be very useful in these situations when fetal heart rate monitoring is difficult or even inapplicable.

[Fetal breathing movements and onset of delivery at term]. / Ruchy oddechowe plodu a czas wystapienia porodu w ciazy donoszonej.

It has been studied the relation between fetal breathing activity and labor among 216 patients in uncomplicated pregnancies at term. It has been also described the value of fetal breathing movements in the evaluation of fetal well-being. Among patients where fetal breathing movements were absent 81.9% women delivered within 3 days since ultrasonographic examination. And among patients with visible fetal breathing activity only 25.0% delivered within this period. The analysis of newborn condition based on Apgar score in pregnant women with or without fetal breathing movements showed no significant statistical differences. The absence of fetal breathing movements has no prognostic value concerning the evaluation of fetal well-being in antepartum period. The cessation of fetal breathing activity facilitates to prognose the time of labor in mature pregnancies.

[Analysis of selected parameters of maternal and fetal status during stimulation of fetal lung maturation]. / Analiza wybranych parametrów stanu ciezarnej i plodu w trakcie stymulacji dojrzewania ukladu oddechowego.

At patients threatened with premature childbirth the influence of glicocorticoids on short and tong-term fetal heart rate variability and the occurrence of respiratory arrhythmia was evaluated. It has been ascertained statistical significant lowering of the incidence of fetal respiratory arrhythmia and short-term variability. Described changes had a temporary character and surrendered of normalization in the course 72 of hours after last use of glicocorticoids. The influence of glicocorticoids on select biochemical and biophysical parameters of state pregnant women was also studied. One specified occurrence of incidental symptoms in road drove of therapy. Pregnant women in road of treatment glicocorticoids have also observed a temporary weakness of feeling of fetal movements.

[Lung hypoplasia and the application of Doppler ultrasonography in the assessment of fetal pulmonary circulation]. / Hipoplazja pluc a mozliwosci zastosowania technik dopplerowskich w ocenie plodowego krazenia plucnego.

The paper presents a review of literature concerning the use of Doppler technique in the evaluation of pulmonary blood flow. Especially, it is important to monitor the development of lung in suspicion of lung hypoplasia that closely correlates with abnormal development of pulmonary vessels. In the literature there are single reports pointing on its usefulness in the detection of lethal lung hypoplasia. It has been suggested that this technique may provide valuable information of the development of vascular bed in lung. Recent data concerning Doppler blood flow velocimetry in hypoplastic lung stimulate to further studies suggesting their significant value in the diagnosis and distinguishing the lethal form of pulmonary hypoplasia.

[Usefulness of transcutaneous measurements of bilirubin in infants with jaundice]. / Przydatnosc przezskórnych pomiarów bilirubiny u noworodków z zóltaczka.

Traditionally, in neonatal jaundice, diagnosis is based on repetitive serum bilirubin measurements. The aim of this study was to analyse clinical usefulness of transcutaneous bilirubinometry as a noninvasive screening test in evaluating neonatal jaundice. The material consisted of 106 full-term infants in which 130 meter readings were performed. A Minolta/Air Shields Jaundice Meter 101 was used. Meter readings were compared with serum bilirubin measurements from these infants (correlation ratio was 0.56). After analysing the clinical data, the conclusion was, that transcutaneous bilirubinometer is a useful instrument for assessing neonatal jaundice for clinical purposes. The bilirubinometer can effectively identify infants whose degree of jaundice the need for serum bilirubin determination and can prevent unnecessary repetitive blood sampling in infants not requiring serum bilirubin determination.

[Intrauterine therapy of obstructive uropathy--case report]. / Terapia wewnatrzmaciczna uropatii zaporowej--opis przypadku.

The use of vesicoamniotic shunt in the case of obstructive uropathy was described. On the base of ultrasound screening it has been diagnosed urethral obstruction. This abnormality of urinary tract was found in male fetus. It has been diagnosed the posterior urethral valve. Qualification to intrauterine therapy was based on normal parameters of renal function. Under ultrasound guidance the vesicoamniotic shunt was installed. The normal drenage was observed within 6 weeks, until it was dislocated. In 36th week of gestation the cesarean section was performed. The indications were signs of urethral obstruction. The boy was born in whom posterior urethral valves were recognized. He was born in good condition without any biochemical features of renal damage as well as signs of hypoplastic lung.

[Analysis of pulmonary venous blood flow in growth retarded fetuses above 30 weeks of gestation]. / Ocena przeplywu krwi w zylach plucnych plodu po 30 tygodniu ciazy powiklanej wewnatrzmacicznym ograniczeniem wzrostu plodu.

Abnormal spectra of blood flow are observed in many fetal vessels in pregnancy complicated by intrauterine growth restriction. Redistribution of blood flow to the most important organs causes a diminished perfusion of the others. The disturbances of lung perfusion in utero are related to abnormal growth and development of the fetal lung. The aim of this study was to describe blood flow velocity waveforms in fetal pulmonary veins in normally grown and growth restricted fetuses above 30 weeks of gestation. Doppler studies were performed in 53 normally grown and 39 growth restricted fetuses. The subjects of analysis were: peak systolic (VS), peak diastolic (VD), end-diastolic (VA), and pulsatility index for veins (PIV). Analysis was performed for two gestational intervals: 31-36, 37-41 wks. The pulmonary venous flow in growth retarded fetuses demonstrates the similar pattern to that observed in normally grown fetuses above 30 weeks of gestation. There were no statistically significant differences between normally grown and growth restricted fetuses in all analyzed indices in both gestational intervals.

[The use of color Doppler ultrasonography in the diagnosis of benign breast tumors]. / Zastosowanie techniki koloroweo Dopplera w diagnostyce Lagodnych schorzen gruczolu sutkowego.

The paper describes Color Doppler Velocity (CDV) technique with clinical implications in examinations of patients with benign breast lesions. Results suggest that CDV might be useful in differentiation of the breast lesions in routine clinical work.

[Evaluation of the clinical value in doing complex analysis of blood flow velocity parameters of the umbilical artery for determining prognosis of fetal status]. / Ocena wartosci klinicznej kompleksowej analizy parametrów przeplywu krwi w tetnicy pepowinowej w prognozowaniu stanu plodu.

Complex analysis of the clinical value of the doppler flow indices was undertaken. A/B, RI and PI were compared separately and in different combinations with fetal status and neonate's condition. Statistical analysis revealed that complex and detailed analysis of few quality indices is of greater clinical value and increases sensitivity, specificity and positive predictive value of the doppler technique in the sense of prognosis of fetal distress and neonate's condition.

[Evaluation of ambroxol given prenatally and postnatally on gas exchange in the newborn with respiratory distress syndrome]. / Ocena wplywu ambroksolu podawanego prenatalnie i pourodzeniowo na wymiane gazowa u noworodka z zespolem zaburzen oddychania.

160 newborns were observed to compare the influence of combine treatment with ambroxol (Lasolvan-Boehringer Ingelheim) (antenatal and postnatal) versus postnatal administration of this drug on gas exchange and reduction of ventilatory settings in newborns with RDS. In 53% of cases the preparation was given both: pre- and postnatal and 47% of newborns were treated only postnatal. The results of stimulation of lung maturity "before and after" versus "after" delivery were better in the first group, however in some parameters we did not found statistical differences.

[Comparison of mortality and morbidity in newborns treated with ambroxol prenatally and postnatally]. / Porównanie smiertelnosci i zachorowalnosci noworodków leczonych Ambroksolem prenatalnie i pourodzeniowo.

The effect of Ambroksol given pre- and postnatal on infant mortality and morbidity was performed. In particular we found a statistically significant differences in reduction of mortality in the group A treated with Ambroksol pre- and postnatal vs. group B treated only postnatal. The other parameters of morbidity had no significantly importance but sepsis, which was more often diagnosed in group A than in group B (17.5% vs. 11.1%). We connect this fact with higher frequency of PROM in the group A.

[Evaluation of using the B-mode color system in sonomammography with computer analysis of images compared with conventional gray scale modalities]. / Ocena zastosowania systemu B-mode color w sonomammografii wraz z komputerowa analiza obrazów uzyskiwanych w tym systemie w porównaniu z konwencjonalna skala szarosci.

The paper describes B-mode color and B-tag modalities with clinical implications in breast examinations. New color techniques show increased sensitivity of the human eye to color pictures compared to gray scale levels. Computer analysis of pictures obtained in color mode and gray scale supports these findings.

[Predictive value of absent or reverse end-diastolic blood flow in the umbilical artery in the diagnosis of fetal distress]. / Wartosc prognostyczna zaniku lub odwrócenia koncowo-rozkurczowego przeplywu krwi w tetnicy pepowinowej w diagnostyce zagrozenia plodu.

To examine the significance of the absence of reverse of end-diastolic (ARED) velocity in umbilical artery, outcome of pregnancy in 24 women with this complication was evaluated. Acute or chronic hypoxia was evident in 87.5% fetuses with ARED. Such situation is a definable high-risk state that demands intensive surveillance.

Diazepam and its metabolites in the mothers' and newborns' hair as a biomarker of prenatal exposure.

UNLABELLED: Pregnant women are exposed to benzodiazepines for therapeutic purposes during gestation. The goal of this study was to evaluate prenatal exposure to benzodiazepines. Time of exposure during course of pregnancy is a significant aspect of fetal exposure to drugs. Benzodiazepine concentration assay in hair of mothers and newborns exposed prenatally to these drugs was performed in the studies. Development, validation and evaluation of benzodiazepine determination method in mothers and their newborns enables assessment of health risks for the child and implementation of adequate therapeutic procedures. We used A LC-ESI-MS/MS method that allowed determination of diazepam (the main benzodiazepine used by pregnant women was diazepam) and its metabolites (nordazepam, oxazepam) in hair of mothers and newborns. LOQ 10 pg/mg of hair was used in the study. RESULTS: concentration of nordazepam was higher than parent drug (diazepam) and higher in newborns' hair when compared to mothers'. The mean concentrations of diazepam in mothers' hair were 31.6±36.0 and 34.1±42.4 pg/mg in the second and third trimester of pregnancy respectively. The mean concentration of diazepam in newborns' hair was higher and reached levels of 53.3±36.5 pg/mg. The mean concentration of nordazepam in the mothers' hair corresponding to the second and third trimester was 52.9±48.1 and 89.9±122.8 pg/mg, respectively. Nordazepam in the newborns' hair was detected at the mean level of 108.1±144.2 pg/mg. It was concluded that diazepam and nordazepam are permanently incorporated into the hair structure. Presence of diazepam and its metabolites in newborn's hair confirms that these benzodiazepines permeate placental barrier. Segmental analysis of mothers' hair enabled the assessment of drug administration time. Diazepam and its metabolites determined in hair of newborns may serve as biomarkers of prenatal exposure to these drugs. The performed LC-MS/MS analysis was accurate enough to determine even low concentrations of benzodiazepines, at the level of few pg/mg of hair. Levels of diazepam detected in hair of newborns were higher than levels determined in mothers. This may confirm the fact, that fetus's ability to metabolize diazepam is scarce. Nordazepam was found in higher concentrations in hair of newborns than in hair of mothers, which may suggest that it is cumulated in child's organism. Other metabolites of diazepam--oxazepam and temazepam--were detected in very few cases, in low concentrations.