Developmental Characteristics of the Glomerular and Tubular Portion of the Nephron in the Human Foetal Kidney Cortex: Morphometrical and Immunohistochemical Analysis.

This study aimed to morphometrically examine the development of glomeruli and tubules in the kidney cortex of human foetuses at different gestational ages (GAs). We also investigated the expression of the proliferation marker Ki-67 and apoptosis-related markers Bcl-2 and Bax during nephrogenesis using immunohistochemistry. Kidney samples from 38 human foetuses of both sexes with GA ranging from 13 to 40 weeks were analysed. The samples were divided into 7 groups based on GA, each corresponding to 1 lunar month. Foetal kidneys showed a spatiotemporal gradient of nephron differentiation with the transient stages of nephron anlage located in the nephrogenic zone and immature nephrons located in the subjacent maturation zone. In the inner cortex, nephrons establish the morphological characteristics of definitive nephrons. The average area, perimeter, and Feret's diameter of the glomeruli formed within the kidney cortex gradually decreased up to a period of 29-32 weeks of gestation and subsequently increased until a period of 37-40 weeks. There was a weak negative correlation with GA. In contrast, the areal density of glomeruli increased up to a period of 21-24 weeks and then gradually decreased until a period of 37-40 weeks, showing a moderate negative correlation with GA. The average area of renal tubules slightly decreased until a period of 21-24 weeks of gestation and then gradually increased until a period of 36-40 weeks, showing a moderate positive correlation with GA. The average areal density of renal tubules increased significantly until a period of 21-24 weeks of gestation, remained relatively constant until a period of 33-36 weeks, and then increased significantly at 36-40 weeks. There was a strong positive correlation with GA. Our results showed that Ki-67 was expressed in numerous cells of the metanephric mesenchyme, pretubular aggregates, renal vesicles, comma-shaped bodies, and early S-shaped bodies. During subsequent development and the spatial expansion of nephrons towards the mature zone, the expression of Ki-67 was markedly reduced. Similarly, Bcl-2 was strongly expressed in induced nephrogenic progenitor cells, pretubular aggregates, renal vesicles, and comma-shaped bodies. As vascularisation and maturation of the nephron proceeded, Bcl-2 staining became less intense and limited to the parietal layer of the Bowman's capsule and renal tubules. Weak Bax expression was observed in individual scattered cells within segments of the nephrons at all developmental stages. In the mature zone, more intense Bax staining was observed in the renal tubules.

Speed, Change of Direction Speed, and Lower Body Power in Young Athletes and Nonathletes According to Maturity Stage.

The aim of this study was to establish the role of maturation on the development of physical performance in adolescent athletes and nonathletes. The total studied sample consisted of 231 participants (131 athletes: 72 boys with an average chronological age of 13.53 ± 0.7 and 59 girls with an average chronological age of 11.97 ± 0.8; 100 nonathletes: 47 boys with an average chronological age of 13.73 ± 0.47 and 53 girls with an average chronological age of 11.93 ± 0.33), distributed according to their biological maturity stage (Pre-, Mid-, and Post-Peak Height Velocity [PHV]) and to their gender. The assessment of physical performance was performed using the following tests: Countermovement jump (CMJ), countermovement jump with arm swing (CMJA), squat jump (SJ), five-jump test (5JT), 5 m sprint (5 m), 10 m sprint (10 m), 20 m sprint (20 m), T-test, Zig Zag, and Slalom. The differences in athletes according to biological maturity were identified in all variables except for 5 m (p = 0.33) and Slalom (p = 0.07), while in nonathletes the differences were found in 5JT (p = 0.01), 5 m (p = 0.02), 10 m (p = 0.01), and 20 m (p = 0.01) tests. Additionally, a significant interaction of gender and biological maturity was detected for CMJ (p = 0.03), CMJA (p = 0.01), and Zig Zag (p = 0.05) in athletes. The findings of the current study confirm the importance of maturity status in the assessment of physical performance. As a consequence, a more rational selection of talented athletes could be provided, also enabling the timely development of physical performance in nonathletes as a "window of opportunity".

Acute caffeine supplementation promotes small to moderate improvements in performance tests indicative of in-game success in professional female basketball players.

The aim of this study was to determine the effect of acute caffeine supplementation on anaerobic performance in professional female basketball players. A double-blind, placebo-controlled, experimental design was used in a randomized counterbalanced manner. In separate sessions, 10 professional basketball players ingested caffeine (3 mg/kg body mass) or a placebo (dextrose: 3 mg/kg body mass) 60 min before completing countermovement jumps (CMJ) with and without arm swing, a squat jump (SJ), the Lane Agility Drill, 20-m sprints (with 5-m and 10-m split times recorded) with and without dribbling a ball, and a suicide run. Participants provided ratings of perceived exertion (RPE) and ratings of perceived performance 30 min following testing. Data analyses included the use of effect size (ES) and significance. Caffeine supplementation produced small nonsignificant (p > 0.05) increases in CMJ without arm swing (ES = 0.30), CMJ with arm swing (ES = 0.29), SJ (ES = 0.33), and the lane agility drill (ES = -0.27). Caffeine supplementation produced small to moderate significant improvements in 10-m (ES = -0.63; p = 0.05) and 20-m (ES = -0.41; p = 0.04) sprint times without dribbling. Caffeine supplementation promoted a moderate significant reduction in RPE during the test battery (ES = -1.18; p = 0.04) and a small nonsignificant improvement in perceived performance (ES = 0.23; p = 0.53). Acute caffeine supplementation may produce small to moderate improvements in key performance attributes required for basketball while reducing RPE.

Caffeine Supplementation Has No Effect on Dribbling Speed in Elite Basketball Players.

PURPOSE: To examine the effect of caffeine supplementation on dribbling speed in elite female and male basketball players. METHODS: A double-blind, counterbalanced, randomized, crossover design was utilized. Elite basketball players (n = 21; female, n = 10; male, n = 11; age = 18.3 ± 3.3 yr) completed placebo (3 mg·kg-1 of body mass of dextrose) and caffeine (3 mg·kg-1 of body mass) trials 1 week apart during the in-season phase. During each trial, players completed 20-m linear sprints with and without dribbling a basketball. Performance times were recorded at 5-m, 10-m, and 20-m splits. Dribbling speed was measured using traditional (total performance time) and novel (Dribble Deficit) methods. Dribble Deficit isolates the added time taken to complete a task when dribbling compared to a non-dribbling version of the same task. Comparisons between placebo and caffeine conditions were conducted at group and individual levels. RESULTS: Non-significant (P > 0.05), trivial-small (effect size = 0.04-0.42) differences in dribbling speed were observed between conditions. The majority (20 out of 21) of players were classified as non-responders to caffeine, with 1 player identified as a negative responder using Dribble Deficit measures. CONCLUSIONS: Results indicate caffeine offers no ergogenic benefit to dribbling speed in elite basketball players. The negative response to caffeine in one player indicates caffeine supplementation may be detrimental to dribbling speed in specific cases and emphasizes the need for individualized analyses in nutrition-based sport science research.

The Effect of Early Substitution of Subclinical Hypothyroidism on Biochemical Blood Parameters and the Quality of Life.

BACKGROUND: Subclinical hypothyroidism (SCH) is defined as high TSH and normal thyroxine. Data on the effects of early substitution by levothyroxine on psychophysical health in SCH are still not consistent enough to support its introduction. METHODS: Clinical parameters, biochemical data and quality of life (Short Form 36 questionnaire) were measured before the intervention and 3 months after the euthyroid state had been achieved in SCH patients. RESULTS: Significant reduction in body weight (p=0.030), systolic and diastolic blood pressure (p=0.024, p=0.019), homocysteine (p<0.001), leukocytes and neutrophils (p=0.011, p=0.001), INR (p=0.049), K levels (p=0.040, p=0.013), HbA1c (p=0.001), fasting insulin (p<0.001) and insulin resistance measured by HOMA index (p<0.001), lipid parameters (total cholesterol (p<0.001), LDL-cholesterol (p<0.001), triglycerides (p=0.007), apoB (p=0.022), Lp(a) (p<0.001), LDL/HDL (p=0.008), LAP (p=0.04) and apoB/apoA1 ratios (p<0.023)), TSH (p<0.001) and tAbs (p<0.001) was recorded. Frequency of fatty liver (20% to 2.9%, p=0.016), hyperlipidemia (85% to 65.7%, p=0.001) and metabolic syndrome (34.3% to 2.9%, p=0.070) significantly decreased. A statistically significant positive association was found between the average dose of levothyroxine and changes in physical functioning (r=0.391, p=0.020), vitality (r=0.393, p=0.020), mental health (r=0.374, p=0.027) and overall dimensions of mental health (r=0.376, p=0.026). With increasing doses of levothyroxine, the previously listed scores of SF 36 grew (r=0.296, p=0.084). CONCLUSIONS: Early substitution of SCH improved the many clinical and biochemical parameters related to cardiovascular risk. Quality of life was also improved, and correlated only with thyroxine doses suggesting an indirect relationship between the degree of hypothyroidism and quality of life.

The Association of Prenatal Tocolysis and Breastfeeding Duration.

BACKGROUND: To date there are no clinical studies analyzing potential effects of tocolytics on breastfeeding duration in humans. OBJECTIVES: The purpose of this study was to evaluate the association between beta 2 agonists prescribed for tocolysis during pregnancy and breastfeeding duration. METHODS: We conducted a cross-sectional questionnaire study of 114 mothers and filled in the questionnaire developed to directly address the goals of the study. RESULTS: There was a statistically significant difference between breastfeeding duration of mothers who were on tocolytics during pregnancy versus those who were not prescribed tocolytics (9.5 ± 5.7 months versus 4.5 ± 2.1 months) p < 0.001. In addition, hypogalactia was statistically significantly more prevalent in mothers with positive history versus mothers with negative history of tocolytic usage p < 0.001. CONCLUSION: The results of our study indicate that tocolytic treatment in pregnancy is associated with shorter breastfeeding duration and hypogalactia.

Preeclampsia with and without intrauterine growth restriction-Two pathogenetically different entities?

OBJECTIVE: The objective of this study is to determine the differences in histopathological features of basal decidua and placenta in cases of preeclampsia with or without fetal intrauterine growth restriction (IUGR). METHODS: A prospective case-control study included a study group consisting of 30 pregnant women with preeclampsia completed by cesarean section (CS), in 19 of whom preeclampsia was associated with IUGR, and in 11 it was not. The control group consisted of 20 healthy pregnant women delivered by elective CS. Placentas and samples of placental bed obtained during CS were histopathologically (HP) analyzed after hematoxylin-eosin staining and immunohistochemical labeling of Cytokeratin 7 (CK7) trophoblastic cells in decidua. RESULTS: Regarding the HP changes in the spiral arteries in preeclampsia, the most frequent features were inadequate transformation of spiral arteries with poor trophoblastic invasion (70.0%) and fibrinoid necrosis of the media (66.7%), and rarely acute atherosis (33.3%) and thrombosis (30.0%). Villous hypermaturity was more frequently found in placentas of patients with preeclampsia with IUGR (p < 0.05), while there were no differences between subgroups of preeclampsia with and without IUGR regarding some of HP alterations of placental bed. CONCLUSION: Alterations of the placental bed in terms of decidual vasculopathy are more the characteristics of the preeclampsia itself than IUGR, while changes in placental villi primarily follow the presence of IUGR, which could indicate that preeclampsia with and without IUGR are two pathogenetically different entities.

Morphometric analysis of somatotropic cells of the adenohypophysis and muscle fibers of the psoas muscle in the process of aging in humans.

The aim of this research was to quantify changes of the adenohypophyseal somatotropes and types 1 and 2 muscle fibers with aging, as well as to establish mutual interactions and correlations with age. Material was samples of hypophysis and psoas major muscle of 27 cadavers of both genders, aged from 30 to 90 years. Adenohypophyseal and psoas major tissue sections were immunohistochemically processed and stained by anti-human growth hormone and anti-fast myosin antibodies, respectively. Morphometric analysis was performed by ImageJ. Results of morphometric analysis showed a significant increase in the somatotrope area, and significant decrease in somatotrope volume density and nucleocytoplasmic ratio with age. Cross-sectional areas of types 1 and 2, and volume density of type 2 muscle fibers decreased significantly with age. One Way ANOVA showed that the latter cited changes in the somatotropes and types 1 and 2 muscle fibers mostly become significant after the age of 70. Significant positive correlation was observed between the area of the somatotropes and volume density of type 2 muscle fibers. A significant negative correlation was detected between the nucleocytoplasmic ratio of the somatotropes and cross-sectional areas of types 1 and 2 muscle fibers. So, it can be concluded that after the age of 70, there is significant loss of the anterior pituitary's somatotropes associated with hypertrophy and possible functional decline of the remained cells. Age-related changes in the somatotropes are correlated with the simultaneous atrophy of type 1, as well as with the atrophy and loss of type 2 muscle fibers.

In vitro fertilization outcome in women with endometriosis & previous ovarian surgery.

BACKGROUND & OBJECTIVES: Women with endometriosis often need in vitro fertilization (IVF) to concieve. There are conflicting data on the results of IVF in patients with endometriosis. This study was undertaken to elucidate the influence of endometriosis on IVF outcome to give the best counselling for infertile patient with this problem. METHODS: The outcome measures in 78 patients with surgically confirmed endometriosis were compared with 157 patients with tubal factor infertility, all of whom have undergone IVF. The groups were matched for age and follicle stimulating hormone (FSH) levels. Outcome measures included number of follicles, number of oocytes, peak oestradiol (E2) concentrations and mean number of ampoules of gonadotropins. Cumulative pregnancy, miscarriage and live birth rates were calculated in both the groups. RESULTS: Higher cancelation rates, higher total gonadotropin requirements, lower peak E2 levels and lower oocyte yield were found in women with endometriosis and previous surgery compared with those with tubal factor infertility. However, no differences were found in fertilization, implantation, pregnancy, miscarriage, multiple births and delivery rates between the endometriosis and tubal factor infertility groups. INTERPRETATION & CONCLUSIONS: The present findings showed that women with endometriosis and previous surgery responded less well to gonadotropins during ovarian stimulation and hence the cost of treatment to achieve pregnancy was higher in this group compared with those with tubal factor infertility. However, the outcome of IVF treatment in patients with endometriosis was as good as in women with tubal factor infertility.

Morphometric analysis of connective tissue sheaths of sural nerve in diabetic and nondiabetic patients.

One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of disease, various layers of nerve may be affected. Our aim was to investigate influence of diabetes on the epineurial, perineurial, and endoneurial connective tissue sheaths. The study included 15 samples of sural nerve divided into three groups: diabetic group, peripheral vascular disease group, and control group. After morphological analysis, morphometric parameters were determined for each case using ImageJ software. Compared to the control group, the diabetic cases had significantly higher perineurial index (P < 0.05) and endoneurial connective tissue percentage (P < 0.01). The diabetic group showed significantly higher epineurial area (P < 0.01), as well as percentage of endoneurial connective tissue (P < 0.01), in relation to the peripheral vascular disease group. It is obvious that hyperglycemia and ischemia present in diabetes lead to substantial changes in connective tissue sheaths of nerve, particularly in peri- and endoneurium. Perineurial thickening and significant endoneurial fibrosis may impair the balance of endoneurial homeostasis and regenerative ability of the nerve fibers. Future investigations should focus on studying the components of extracellular matrix of connective tissue sheaths in diabetic nerves.

Stages of endometriosis: does it affect in vitro fertilization outcome.

OBJECTIVE: Women with endometriosis often need in vitro fertilization (IVF) to conceive. There are conflicting data on the results of IVF in patients with endometriosis. The present study was undertaken to investigate whether or not the stage of endometriosis affects the IVF outcome in order to give the best patient counseling MATERIALS AND METHODS: We compared IVF outcome measures between 40 patients with surgically confirmed minimal and mild endometriosis (American Society for Reproductive Medicine Stage I/II) and 38 patients with moderate and severe endometriosis (Stage III/IV). Each group was also compared with a control group of 157 patients with tubal factor infertility. Outcome measures included number of follicles, number of oocytes, mean number of ampoules of gonadotropins, cumulative pregnancy, and live birth rates RESULTS: Higher cancelation rates, higher total gonadotropin requirements, and lower oocyte yield were found in women with endometriosis Stage III and IV compared with both the Stage I/II and control groups. The fertilization rate was higher in Stage III/IV endometriosis compared to Stage I/II. Clinical pregnancy and live birth rates were comparable between patients with endometriosis Stage I/II and control group, whereas they were significantly lower in patients with endometriosis Stage III/IV compared to other two groups. CONCLUSION: The American Society for Reproductive Medicine classification of endometriosis is useful in predicting IVF outcome. Advanced endometriosis means a worse prognosis for IVF treatment compared to milder stages or tubal factor infertility. The decreased fertilization rate in Stage I/II endometriosis might be a cause of subfertility in these women, as a result of a hostile environment caused by the disease.

The role of hysteroscopy in diagnosis and treatment of postmenopausal bleeding.

BACKGROUND/AIM: Abnormal uterine bleeding is the most common problem which brings woman to the gynecologist during the postmenopausal period. The aim of this study was to define the significance of hysteroscopy as a diagnostic procedure for the evaluation of patients with postmenopausal bleeding, as well as to define it as a surgical procedure by which the cause of bleeding can be treated in most cases in the same sitting. METHODS: The study involved 148 female patients referred to the Clinic for Gynecology and Obstetrics in Nis for postmenopausal bleeding in the period of 12 months. Hysteroscopy with endometrial biopsy were performed in all the patients. Biopsy materials were directed to histological examination, and the hysteroscopic and histological findings were compared afterwards. Polyps and submucous miomas were hysteroscopically removed in the same sitting and also directed to histological examination. RESULTS: The success rate of the method was 95.1%, while complications occurred in 1.37% of the cases. The hysteroscopic findings were normal in almost 30% of the cases, and the most common pathological finding was endometrial polyp. The sensitivity of hysteroscopy in the detection of intrauterine pathology was 100%, the specificity 81%, the positive predictive value 92% and the negative predictive value 100%. In 69.7% of the patients the cause of bleeding was hysteroscopically removed. Hysteroscopy was performed in 58.1% of the patients in the same sitting, and in 11.6% of the patients after obtaining histological findings. CONCLUSION: Hysteroscopy is a safe, highly sensitive diagnostic procedure, thus being an ideal method for evaluation of patients with postmenopausal bleeding. The application of hysteroscopy with endometrial biopsy leads to accurate diagnosis. An adequate diagnosis is crucial for the selection of relevant treatment of postmenopausal bleeding and avoidance of unnecessary major surgical procedures. Except for being a diagnostic method hysteroscopy, is also an outpatient minimally invasive surgical procedure for treating the cause of bleeding in the majority of cases in the same sitting.

Morphological and biomechanical features of the temporomandibular joint disc: an overview of recent findings.

The temporomandibular joint is a type of synovial joint with unique structure and function. Between the mandibular condyle and the mandibular fossa there is a dense fibrocartilaginous oval articular disc, temporomandibular joint disc. This disc serves as a nonossified bone, thus permitting the complex movements of the joint, and plays a major role in jaw function by providing stress distribution and lubrication in the temporomandibular joint. Pathological mechanical loads are one of the principal causes of temporomandibular joint disc displacement. There is a high frequency of temporomandibular joint disc disorders and treatment options are very limited. For this reason, it is necessary to examine possible alternatives to current treatment options like physiotherapy, drugs, splints or surgical techniques. Recent discoveries in the field of structure and functions of temporomandibular joint disc have created the need for their particular systematization, all in order to create an implant that would be used to replace the damaged disc and be more similar to the natural one. There is a need to more fully meet the morphology and biomechanical properties of the temporomandibular joint disc, and using tissue engineering, make a substitute for it, as faithful as possible, in a case where the natural TMJ disc is damaged so much that the normal function of the joint can be preserved only through implanted disc. Therefore, the aim of this paper was to describe morphology and structure, as well as biomechanical properties of the TMJ disc, in light of the possible applications of this knowledge for the purposes of tissue engineering.

Postpartum HELLP syndrome--the case of lost battle.

Unexpected rapid maternal death after delivery due to HELLP syndrome is rarely encountered and may become the subject of forensic expertise. Unexpectedness, suddenness, and fulminant course of this syndrome as well as absence of classical signs of pre-eclampsia can confuse physicians and lead to diagnostic delay. A definitive post-mortem diagnosis of HELLP syndrome in questionable cases of maternal death should be based on accepted laboratory criteria and characteristic histopathological alterations. We present a case of acute postpartum HELLP syndrome complicated by disseminated intravascular coagulation and acute renal failure which caused rapid maternal death only 20 hours after a caesarean section following an uncomplicated pregnancy.

[Pregnancy after conservative surgical treatment of ovarial mucinous adenocarcinoma].

BACKGROUND: Epithelial ovarian cancer (EOC) accounts for 25% of all malignancies in the female genital tract and it is the most common cause of death among women who develop gynecologic malignancies. According to recent reports at least 20% of EOC are diagnosed at stage I of the disease. Because women tend to give birth to their first child at an older age, and due to the usage of more sensitive diagnostic procedures, the diagnosis of EOC during reproductive age has become more frequent. Therefore, the demand for fertility-sparing surgery in early-stage of EOC is increased. CASE REPORT: We presented the case of accomplished reproduction at 41 after the conservative treatment of mucinous ovarian cancer. In the absence of a complete surgical staging, her decision was to spare her fertility capacities opposed to the treatment recommendations of the oncological council. The bottom-line of this report was to give its contribution to the ongoing controversies in the decision to recommend the conservative surgical treatment of the EOC and also to reveal the need of reconsideration of the necessity of a complete surgical staging in patients with stage I of mucinous ovarian cancer. CONCLUSION: The profile of EOC cases in which a conservative surgical approach is the appropriate one has not yet been defined. Correct surgical staging is still an indispensable guideline for that kind of clinical decision. In the case of stage I of mucinous ovarian cancer with the low tumor grade, the necessity of a complete surgical staging should be reconsidered.

[Fetal multicystic kidney disease--outcome and follow up].

INTRODUCTION: Congenital fetal anomalies are the great problem and one of the main causes of increased perinatal mortality and morbidity. The aim of this study is to determine the outcome of prenataly detected multicystic dysplastic kidney and to point to the necessity of postnatal diagnostic procedures. MATERIAL AND METHODS: The retrospective-prospective study encompasses 38 cases of the prenatally diagnosed unilateral fetal multicystic dysplastic kidney. The associated anomalies were revealed either by autopsy findings when the pregnancy was terminated, or when the pregnancy continued, by clinical and operative findings the newborns. RESULTS: The autopsy finding revealed bilateral multicystic displastic kidney or unilateral mylticystic displastic kidney and the agenesis of the contralateral kidney. The postnatal evaluation of the newborns with unilateral multicistic disease revealed that 84.3% of them had some concomitant anomaly of the urinary tract, most of them had an anomaly of the contralateral kidney (31.4%). The surgery was performed in 73.6% of children, in 17% of children the kidney function deteriorated after the surgery. CONCLUSION: The findings of bilateral multicystic kidney disease and unilateral multicystic kidney disease and amnion are the indication to terminate the pregnancy. The finding of an isolated unilateral multicystic dysplastic kidney require thorough examination, both prenatally and postnatally. We propose obligatory serial prenatal ultrasound examinations, followed by postnatal ultrasound, isotope scan, and urinary cystourethography.

[Perinatal outcome of growth restricted fetus with absent end-diastolic umbilical blood flow--case report].

INTRODUCTION: Absent or reversed end-diastolic blood flow in the umbilical artery is usually associated with poor perinatal outcome and high perinatal mortality rate. CASE REPORT: We present the case of a pregnant woman with absent end-diastolic blood flow in the umbilical artery in the 27th week of pregnancy with initial restriction of fetal growth. Allthough it was more and more obvious that the fetal growth was hindered, the Doppler, cardiotocographic and biophysical parameters did not get any worse as the pregnancy developed. The full fetal maturation was reached after the intense monitoring of the fetal condition and the pregnancy was terminated in the 37th week by elective Cesarean section. CONCLUSION: The basic purpose of prenatal fetal monitoring in the situation of hindered fetal growth with chronic hypoxia is to predict the phase of decompensation and to terminate pregnancy before it is developed. The major problem is in great individual variations at the moment of development of decompensation phase, so the major obstetric aim in the monitoring of the fetus hindered in growth is to determine the optimal time and way of delivery.

[Kell immunization--a case report]. / Kell imunizacija--prikaz slucaja.

INTRODUCTION: The frequency of occurrence of RhD alloimmunization, due to preventive protocols, is decreased in our country, but more often there are other antigens that emerge as a cause of hemolytic disease of fetus. The most prominent is Kell antigen, which promotes specific course of disease based on an innate pathogenetic mechanism. Anti-Kell antibody production is, just as in other atypical antibodies, provoked with transfusion of incompatible blood. Except for the immune-mediated hemolysis, anti-Kell antibodies can also inhibit the function of progenitor (erytroid and megakariocyte) cell lines. CASE REPORT: We present the case of G1P1 woman in whom a distinct fetal hydrops was sonographically detected in the 28th week of pregnancy. The results of immunological tests undoubtedly pointed to Kell immunization (anti-Kell antibody titer was more than 1:32), and antenatal tests for evaluation of fetal condition (Doppler ultrasound and CTG) clearly showed the severe form of hemolytic disease. We concluded that the fetus was in a hopeless, terminal stage of the disease, and then decided to terminate the pregnancy. CONCLUSION: The only clinical approach to a problem of Kell alloimunization is active one. Early cordocentesis is recommended as the optimal method for evaluation of fetal condition. The clinical outcome of the fetus will strictly depend on a timely intrauterine transfusion (IUT) procedure. Prophylaxis emerges as a crucial factor in prevention of Kell-alloimmunization. It is to be considered that all females in childhood and throughout the reproductive period should take only K1-negative blood transfusion in order to decrease the incidence of Kell-alloimmunization.

[Association of fetal unilateral multicystic kidney disease with other urinary tract anomalies]. / Udruzenost unilateralne multicisticne displazije bubrega fetusa sa drugim anomalijama urinarnog sistema.

BACKGROUND/AIM: Multicystic dysplastic kidney represents a disorder in the fetus development presented prenatally of postnatally, this deserving special attention due to a risk of additional anomalies in children with this disorder. The aim of this study was to determine the incidence and type of common anomalies of the urinary system in the prenatal diagnosis of unilateral multicystic dysplastic kidney, and point out the necessity of postnatal diagnostic procedures in order to evaluate the state of the urinary system. METHODS: This retrospective-prospective study encompassed 38 cases of prenatally diagnosed unilateral fetal multicystic dysplastic kidney, presented to the Council for Fetal Anomalies from the Institute for Gynecology and Obstetrics of the Clinical Centre of Serbia and the University Children's Clinic within a three-year period. Associated anomalies were revealed by autopsy findings when pregnancy was terminated, ie resumed with clinical and operative findings of born children. RESULTS: In every case of terminated pregnancy and death after birth the autopsy revealed additional renal or exstrarenal anomaly which were not prenataly detected. Postnatal evaluation of survived children with unilateral multicistic disease revealed that 31.4% of them have an anomaly of the contralateral kidney, 26.3% anomaly of the ipsilateral side, 13.2% anomaly of the lower portions of the urinary system and the same percent an additional extrarenal anomaly. The surgery was performed in 73.6% of children, more than half of the interventions were related to extrarenal anomaly. In 17% of children the kidney function was deteriorated after surgery. CONCLUSION: Children suffering from unilateral multicystic dysplastic kidney have a greater chance of exhibiting an anomaly of the contralateral kidney and the urinary system in general. Therefore, they require thorough examination, both prenatally and postnatally. We propose obligatory serial professional prenatal ultrasound examinations, followed by postnatal ultrasound, isotope scan, and we especially emphasize the need for performing urinary cystouretherography, bearing in mind the high incidence of the vesicoureteral reflux of the contralateral kidney. In addition to nephrectomy, cytoscopy and colposcopy also need to be performed for the purpose of discovering possible hidden anomalies of the urogenital system.