Association of FcRn expression with lung abnormalities and IVIG catabolism in patients with common variable immunodeficiency.

The neonatal Fc receptor (FcRn) acts as a key regulator of IgG homeostasis and is an important sensor of luminal infection. We analyzed the influence of FcRn expression on disease phenotype and the catabolism of therapeutically administered intravenous immunoglobulins (IVIG) in 28 patients with common variable immunodeficiency (CVID). Patients with generalized bronchiectasis and fibrosis had lower levels of FCRN mRNA compared to patients without these complications (P=0.027 and P=0.041, respectively). Moreover, FCRN mRNA levels correlated negatively with the extent of bronchiectasis and the rate of IgG decline after infusion of IVIG (P=0.027 and P=0.045, respectively). No relationship of FCRN expression with age at disease onset, age at diagnosis, diagnostic delay, IgG levels or frequency of infections before or during replacement immunoglobulin treatment, the presence of lung functional abnormalities, chronic diarrhea, granulomas, lymphadenopathy, splenomegaly or autoimmune phenomena was observed. Our results showed that FcRn might play a role in the development of lung structural abnormalities and in the catabolism of IVIG in patients with CVID.

No association of FCRN promoter VNTR polymorphism with the rate of maternal-fetal IgG transfer.

The neonatal Fc receptor (FcRn) plays a critical role in maternal-fetal IgG transfer. Recently, a functionally active promoter polymorphism in the FCRN gene, represented by variable number of tandem repeats (VNTR), has been described. We analysed 103 single fetal samples and 103 paired maternal and fetal samples collected from umbilical cord blood of full-term neonates born from the 38th to the 41st week of pregnancy and detected no significant influence of maternal FCRN VNTR genotype on maternal IgG levels or of fetal FCRN VNTR genotype on fetal IgG levels or the fetal/maternal IgG ratio.

[Common variable immunodeficiency in pregnancy (set of case reports)]. / Bezný variabilní imunodeficit v tehotenství (soubor kazuistik).

Common variable immunodeficiency (CVID) is the most prevalent symptomatic primary immunodeficiency, which is characterized by impaired antibody responses. It's manifestation includes mainly severe and recurrent bacterial infections affecting predominantly upper and lower respiratory tract. Because of the improved standard of hypogammaglobulinemic patients many affected females become pregnant. When a woman treated for CVID gets pregnant the adequate treatment is necessary not only to protect patient from infections, but also to allow suffitient transfer of IgG through the placenta to supply the fetus and consequently the newborn. Regular periodic replacement therapy with intravenous immunoglobulins (IVIG) is applied in pregnant women as well as in other hypogammaglobulinemic patients. Regimen of IVIG administration must be modified in order to reach satisfactory IgG levels in the newborns' blood. Here we present a set of case reports of five pregnant women with CVID treated by immunoglobulins during pregnancy. In all cases labor was induced in term after the last IVIG infusion. The mode of delivery depended on the obstetric indication. All pregnancies resulted in healthy newborns.

[Evaluation of the ectopic pregnancies developed after in vitro fertilisation in the Center of Assisted Reproduction CAR 01 Brno between 1988-2006]. / Incidence ektopické gravidity po technikách in vitro fertilizace ve dvacetiletém klinickém materiálu Centra asistované reprodukce CAR 01 LF MU a FN Brno.

OBJECTIVE: To review prevalence and management of ectopic and heterotopic pregnancies developed after in vitro fertilisation and embryotranfer in the Center of Assisted Reproduction CAR 01 LF MU a FN Brno in a 20-year period. An analysis of their management and therapy. DESIGN: A retrospective analysis. SETTING: Obstetrics and Gyneacology Department, University Hospital Brno. METHODS: The collection of 1487 pregnancies arisen after IVF/ET cycles accomplished in the period of 1988-2006 in the Center of Assisted Reproduction CAR 01 Brno, in which the prevalence and the therapy of extrauterine and heterotopic pregnancies was observed. Also the therapeutic procedures of ectopic pregnancies and developement of heterotopic pregnancies were analysed. RESULTS: In the follow-up file the numbers of ectopic pregnancies was 84 from 1487 (5.65%) clinical pregnancies. Heterotopic pregnancy occured in seven cases (0.47%). Both ectopic and heterotopic pregnancy rate is higher than in a common population. From the seven heterotopic pregnancies two resulted in the delivery of the intrauterine pregnancy. From the total number of 84 ectopic pregnancies 68 (88.10%) resulted in laparoscpic salpingectomy as the therapy, only nine of them (11.90%) were treated conservatively with the tube preservation. CONCLUSION: Evaluation of the ectopic and heterotopic rate prevalence after assisted conception treatment in the Centre of Assisted Reproduction CAR 01 Brno in the period of 1988 - 2006 shows higher appearance of these complications in pregnancies, which origin is in IVF and ET as an infertility treatment.

[Role of ST-analysis of fetal ECG in intrapartal fetus monitoring with presumed growth retardation]. / Význam ST-analýzy fetálního EKG pri intrapartálním monitorování plodu s predpokládanou rustovou retardací.

OBJECTIVE: Evaluation of the role of ST analysis of fetus ECG for early detection of developing acute hypoxia in the course of delivery of fetuses with presumed growth retardation. A comparison with present way of intrapartal fetus monitoring. Impact on the number of surgical births for indications of threatening fetus hypoxia. Influence of the method on perinatal results and postnatal adaptation of the newborns. TYPE OF STUDY: A prospective study. SETTING: Gynecology-Obstetrics Clinic, Masaryk University and Teaching Hospital Brno. METHOD: Forty seven women with a growth retardation of the fetus diagnosed before delivery who gave birth in the Teaching Hospital in Brno during 2003-2005 and intrapartal ST analysis of fetus ECG was subsequently used, were enrolled into this prospective study (group A). The control group consisted of 87 deliveries taking place in the same period of time and concerning women with fetuses suffering from growth retardation and monitored by standard methods (group B). The standard methods included cardiotocography (CTG), supplemented with pulse oximetry (IFPO) if needed. The diagnosis of intrauterine fetus growth retardation was established on the basis of the results of repeated prepartal ultrasound fetus biometry with estimation of the mass, which corresponded to a group below 10 percentile for the given gestational age. The numbers of vaginal deliveries and surgically treated delivery due to threatening fetus hypoxia (Cesarean section, forceps delivery) were recorded. The authors evaluated postpartal pH from umbilical artery, independently for the group of values of pH < 7.00, the group of pH 7.00-0.10 and pH 7.10 or more. The values of Apgar score were evaluated for the first, fifth and tenth minute, respectively. The neonatologist followed the duration of stay of the newborn at the Newborn Intensive Care Unit, the Intermediate Care Unit, total duration of hospitalization, the occurrence of sepsis in the early newbotn period, the occurrence of hyperbilirubinemia, and the conclusion of neurological examination. All the results were evaluated statistically by the chi2 test, Kruskal-Wallis test or the Anova method. RESULTS: There was no statistically significantly difference in the number of delivery ended by surgery for threatening fetus hypoxia (p = 0.856) or the detection rate of intrapartal hypoxia according to pH values of umbilical blood divided into the three groups (p = 0.657, p = 0.958, p = 0.730, respectively). The values of Apgar score differed in favor of the group A significantly only in the first minute at the level of 5% opf significance (p = 0.018). The values of Apgar score in the fifth and tenth minute did not show any significant difference (P = 0301 and p = 0313, respectively). There was no statistically significant difference in neonatological results between the group A and B. CONCLUSION: The use of ST analysis of fetal ECG in the course of delivery of fetuses with presumed intrauterine growth retardation did not show any significant difference from the presently used methods (CTG supplemented with IFPO if needed). In using the method there was not any effect on the number of surgically treated deliveries for indications of threatening acute fetus hypoxia or perinatal results and postnatal adaptation of the newborns.

[ST analysis of fetal ECG in premature deliveries during 30th-36th week of pregnancy]. / ST analýza fetálního EKG u predcasných porodu ve 30.-36. týdnu tehotenství.

OBJECTIVE: To determine the possibilities of ST analysis of fetal ECG (STAN) in premature deliveries between 30th to 36th week of pregnancy. To compare the results of a group of premature deliveries monitored by ST analysis with a control group of premature deliveries monitored by means of cardiotocography (CTG) and intrapartum fetal pulse oxymetry (IFPO). TYPE OF STUDY: A prospective study. SETTING: Department of Gynecology-Obstetrics, Masaryk University and Faculty Hospital Brno. METHODS: The authors evaluated 39 women with premature delivery between 30th and 36th week of pregnancy from a total cohort of 239 high-risk pregnant women, who had been monitored by means of ST analysis of fetal ECG. The control group included 229 pregnant women who gave birth between 30th and 36th week of pregnancy under the monitoring with CTG and IFPO. The allocation into individual groups was at random order. The authors evaluated the duration and way of termination of delivery, pH in arterial umbilical blood, Apgar score in the first, fifth and tenth minute, total duration of hospitalization, necessity and duration of stay at the Neonatologic Intensive Care Unit, Intermediatry Intensive Care Unit, the presence of sepsis, hyperbilirubinemia and neurological state of the newborn. The statistical analysis was performed by means of the Fisher's exact test, Kruskal-Wallis test, chi2 test and the parametric test Anova. RESULTS: Almost none of the observed parameters in both categories of premature deliveries (STAN vs. CTG+IFPO) exhibited a statistically significant difference except a mild neurological affection of the newborn. In the group of premature deliveries monitored by ST analysis there are only 33.3% of newborns with signs of light neurological damage as compared with the control group, where 56.3% subjects were so affected (p<0.01). CONCLUSION: It has become obvious that the ST analysis of fetal ECG in premature deliveries between 30th and 36th week of pregnancy provides the same results as the so far used monitoring by CTG and IFPO. In the group of premature deliveries monitored by the ST analysis, there were significantly less frequent neurological disturbances.