Neonatal outcomes for women diagnosed with cancer during pregnancy - single-center study.

Pregnancy complicated by cancer is one of the most serious challenges of modern perinatology. The increasing number of cancers diagnosed and treated during pregnancy requires a multidisciplinary approach to optimize the treatment of the person who is pregnant and deliver a healthy child. The aim of the study is to analyze the course of the neonatal period in children of mothers suffering from cancer during pregnancy, treated in a specialist hospital for women and children. Being diagnosed with cancer during pregnancy significantly increases the risk of premature delivery, prematurity and intrauterine growth restriction. Our own observations show no significant differences during the neonatal period in children of mothers suffering from a malignant tumor during pregnancy compared to children of healthy mothers. This applies to both full-term and premature babies. Modern treatment of malignant tumors during pregnancy seems to be safe for the fetus and newborn. It is optimal to conduct oncological, obstetric and neonatological treatment in one center. It seems advisable to conduct long-term follow-up observations in children of pregnant people with cancer. Since the described groups of patients and their newborns are small and heterogeneous, in order to develop appropriate standards, it is recommended to report these cases to central registers.

Comparative Genomic Hybridization to Microarrays in Fetuses with High-Risk Prenatal Indications: Polish Experience with 7400 Pregnancies.

The aim of this study was to determine the suitability of the comparative genomic hybridization to microarray (aCGH) technique for prenatal diagnosis, but also to assess the frequency of chromosomal aberrations that may lead to fetal malformations but are not included in the diagnostic report. We present the results of the aCGH in a cohort of 7400 prenatal cases, indicated for invasive testing due to ultrasound abnormalities, high-risk for serum screening, thickened nuchal translucency, family history of genetic abnormalities or congenital abnormalities, and advanced maternal age (AMA). The overall chromosomal aberration detection rate was 27.2% (2010/7400), including 71.2% (1431/2010) of numerical aberrations and 28.8% (579/2010) of structural aberrations. Additionally, the detection rate of clinically significant copy number variants (CNVs) was 6.8% (505/7400) and 0.7% (57/7400) for variants of unknown clinical significance. The detection rate of clinically significant submicroscopic CNVs was 7.9% (334/4204) for fetuses with structural anomalies, 5.4% (18/336) in AMA, 3.1% (22/713) in the group of abnormal serum screening and 6.1% (131/2147) in other indications. Using the aCGH method, it was possible to assess the frequency of pathogenic chromosomal aberrations, of likely pathogenic and of uncertain clinical significance, in the groups of cases with different indications for an invasive test.

Treatment of very large cranial defects with individually shaped polypropylene polyester knitwear prostheses: a series of 11 cases.

BACKGROUND: Very large cranial defects are not very common in neurosurgical practice and there is not any widely acknowledged standard of their treatment. One of the useful methods in such cases is individual forming of polypropylene-polyester knitwear. Such material was used in the past but before 2008 it was available only as standardized plates. Currently, it can be also produced as individually-shaped implants. The authors give their definition of very large cranial defects and present their experience with this cranioplastic method in such defects. METHODS: The authors collected data on 11 cases of patients with very large cranial defects, from a total of 156 cases, operated on in 5 Polish neurosurgical departments. The necessary implants were prepared for individual patients according to the data provided by a computed tomography examination and with the use of computer aided machining. RESULTS: All defects were larger than 120 cm2 (129 to 178 cm2) and exceeded 1/4 of the calvaria area. Patients were operated between 2008 to 2012. In all patients, a very good aesthetic result and correct skull reconstruction was achieved. The follow-up time in all cases exceeded 1 year and reached 4 years in one case. No complications were observed. CONCLUSIONS: Individually pre-shaped polypropylene-polyester knitwear prostheses are a good alternative to the existing cranioplasty methods, particularly in very large cranial defects.

[Chronic cerebrospinal venous insufficiency--pathophysiology and treament]. / Przewlekla mózgowo-rdzeniowa niewydolnosc zylna--patofizjologia i leczenie.

Multiple sclerosis (sclerosis multiplex--SM) is a chronic nervous sytem disease, which through formation of demyenilisation focus in the central nervous system leads to deterioration of its various functions. In the consequence it may cause invalidity of patient. Etiology of this disease is still unknown. In this article authors describe theory of Chronic Cerebrospinal Venous Insufficiency as a possible cause of multiple sclerosis and methods of treatment of this pathology, with all doubts and controversies connected with this method. Autors also present an experimental treatment of Chronic Cerebrospinal Venous Insufficiency in patients with multiple sclerosis, which is being performed as a scientific program to evaluate neurological outcomes of endovasculat treatment of CCSVI.

Reconstruction of cranial defects with individually formed cranial prostheses made of polypropylene polyester knitwear: an analysis of 48 consecutive patients.

This article presents a new method of cranioplasty in which polypropylene polyester knitwear was used as the filling material. The basis for prosthesis shaping was a three-dimensional model of the defect made according to the patient's CT scans. Previously, such material has never been a subject of computer-aided design and computer-aided manufacturing (CAD/CAM) individual forming. The process of the prosthesis design included CT bone scans and mold preparation for each patient. Such prostheses were implanted in 48 patients with cranial defects. The total number of prostheses applied was 51. The follow-up time was at least 6 months up to 36 months. The group of treated patients is described here, and sample pictures are shown to illustrate the results. The smallest defect had a size of 15 cm(2); the biggest, 178 cm(2). The coverage and the aesthetic results were very good in all cases. Two patients had postoperative complications. The cranioplastic solution described here is a valuable addition to the existing reconstructive methods, because of the low cost of the implant, the ease of its adjustment to the shape of the defect, and the short time of preparation.

Postural balance in the early post-operative period in patients with intervertebral disk disease following surgery.

BACKGROUND: The authors assumed that advanced lumbar disk disease contributes to disorders of body balance and asymmetry of foot pressure force on the ground. Surgery improves biomechanical relations in the lumbar spine, thus decreasing the disturbance of postural balance and foot load. MATERIAL AND METHODS: The study was carried out among 40 patients treated in Military Clinical Hospital in Wroclaw due to a herniated nucleus pulposus in the lumbar region of the spine. Patients were examined prior to lumbar intervertebral disc surgery and 3 days following the procedure. A PEL 38 MEDICAPTEURS platform was used to measure foot pressure forces on the ground. RESULTS: Examinations of body posture balance based on plumb line tests before the operation indicated transposition of pelvis both to the left and the right side. The correct position of the pelvis was reported only in 25% of the patients. Examinations of lower limb load indicated asymmetry in the distribution of foot pressure forces on the ground. CONCLUSIONS: Herniated disk disease in the lumbar spine causes disturbances of body posture balance, such as transposition of pelvis to the left or right and asymmetry of foot pressure forces on the ground due to pain radiating to one of the lower limbs. Surgery for herniated disk reduces the abnormal position of the pelvis and alleviates the pain, but it does not improve the lower limb load disorders.

[Effect of maternal smoking on concentrations of the pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of chorionic gonadotropin (beta hCG) in the first trimester of pregnancy]. / Wplyw palenia tytoniu na stezenie osoczowego bialka ciazowego A (PAPP-A) i wolnej podjednostki beta gonadotropiny kosmówkowej (beta hCG) u kobiet w pierwszym trymestrze ciazy.

A combination of maternal serum levels of free beta human chorionic gonadotropin (free beta hCG) and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal transluency thickness (fetal NT) has been shown to be an effective approach to screening for fetal trisomies in the first trimestr of pregnancy. A maternal smoking habit is known to influence these serum markers in singleton pregnancies however it has not been yet completely explained. The aim of this study was the investigation of PAPP-A and beta hCG concentrations in smoking women in the first trimester of pregnancy. The study comprised 215 women between 11th and 14th weeks of gestation: 135 cigarette smokers (age range 19-43 years) and 80 nonsmokers (age range 21-42 years). Only normal singleton pregnancies were included. Smoking women were divided into two groups: 75 women smoking during all along the first trimester and 60 women, who stopped smoking before 6 week of gestation. Maternal serum levels of PAPP-A and beta hCG were measured with the KRYPTOR rapid random-access immunoassay analyser (Brahms GmbH, Germany) using time-resolved amplified cryptate emission technology (TRACE). Combinated fetal nuchal translucency (NT), maternal age and biochemical risk estimates were calculated using the Fetal Medicine Foundation risk algorithm. We observed the lower of PAPP-A median values in both smoking groups by about 20% than in nonsmokers (0.86 MoM; 0.84 MoM versus 1.04 MoM; p < 0.01). We also indicated the lower values of beta hCG in smoking women in comparison to the nonsmoking controls, but this difference was not statistically significant. The concentrations of PAPP-A as well as beta hCG were similar in both groups of smoking women. Further studies will be continued to assessment of smoking influence before conception on maternal serum PAPP-A and beta hCG in the first trimester of pregnancy.

[Meningiomas of the anterior cranial fossa: clinical and radiological presentation--report of 2 cases]. / Masywne oponiaki przedniego dolu czaszki: prezentacja kliniczna i obraz radiologiczny --opis dwóch przypadków.

We reported two cases of the anterior cranial fossa meningiomas: cerebral falx meningioma and recurrence of olfactory groove meningioma. Since the tumors grow very slowly, they remain clinically undetectable during the early stages and can reach a very large size. Clinical manifestations are caused by pression of meningiomas on adjacent structures. The authors present possibilities of radiological examinations of intracranial tumors and treatment management. In the described cases meningiomas were diagnosed in CT examination with the use of angio option and reconstruction RT3D and MPR.

[Conjoined twins--diagnostic problems, difficult decisions in choosing the most optimal management in one of the rarest pathologies of pregnancy]. / Bliznieta niecalkowicie rozdzielone--problemy diagnostyczne i terapeutyczne.

Conjoined twins are the rarest type of monozygotic, monochorionic, monoamniotic twins--incidence about 1:50000 - 1:100000. A conjoined twin pregnancy is a very special pathology in obstetrics and usually ends prematurely. 40% of twins are stillborn, while 35% die within 24 hours after delivery. The development of ultrasonography and in the last years also MRI, allows earlier detection and diagnosis of fetal malformation and enables precise evaluation of the anatomy, type of malformation and how the twins are conjoined. Chances of survival and way of delivery depends on the degree of fusion of the organs and possibilities of surgical separation. Obstetric care for a women with conjoined twins does not differ from that in a normal twin pregnancy, but the newborns require special medical care after delivery. We would like to stress the diagnostic problems and the difficult decisions that we encountered. The degree of conjoinment in this case excluded surgical separation of the twins. A multidisciplinary team of experts decided to end the pregnancy at 31 wks by cesarean section. Delivery at a later term could increase the risk of uterine rupture and surgical complications.

[Preterm delivery by cesarean section in patient with polycythemia vera]. / Przedwczesne ukonczenie ciazy cieciem cesarskim u pacjentki z czerwienica prawdziwa.

Polycythemia vera is a myeloproliferative disease most commonly diagnosed in male 60-70 years old patients. It is associated with a higher risk of thrombosis and bleeding. It is very rarely diagnosed in young patients, and thus only few cases of pregnant women have been reported in the literature. These reports show that polycythemia vera may have a detrimental effect on outcome of the pregnancy (PIH, spontaneous miscarriages, preterm delivery, and stillbirth). We report a 33-year-old woman with polycythemia vera who underwent caesarean delivery in 34 weeks gestation. This case demonstrates fully successful result of our intensive perinatal care.

Vertebroplasty with methacrylate bone cement and radiotherapy in the treatment of spinal metastases with epidural spinal cord compression. Preliminary report.

Background. The choice of treatment method for metastases to the spine remains an unresolved and controversial question. The major complication in disseminated neoplastic disease compression of the spine and nervous elements. Vertebroplasty performed jointly with palliative radiotherapy has been proposed as a procedure to treat metastases complicated by cancer infiltrations in the vicinity of the spine. Material and methods. We examined 21 patients treated since May 2004. Vertebroplasty was performed by surgery using acrylic cement, followed by palliative radiotherapy. Results. Outcome was assessed by clinical examination, neurological evaluation, and other methods, such as X-ray, CT scan, and MRI. All patients showed prompt relief of pain and substantial improvement in mobility. No complications or side effects were observed in connection with the joint palliative treatment. Conclusions. Vertebroplasty is an effective method and works to help stabilize spinal fractures. Satisfactory results were obtained using palliative treatment. The use of acrylic cement made it possible to perform radiotherapy safely with an optimum margin of healthy tissues, which enhances treatment. These initial results point to the need for further clinical collaboration between neurosurgeon and radiotherapist.

[External cephalic version at term]. / Obrót zewnetrzny plodu w ciazy donoszonej.

About 3 - 4 % of all pregnancies reach term with a foetus in the breech presentation. Because of higher risk of complications for mother and foetus during the vaginal breech birth, only 50% of patients try to deliver vaginally - at the end 40 - 70% of labours are finished by caesarean section. In other cases planned caesarean sections are performed, and finally 10 - 20% of patients with breech presentation at term deliver vaginally. Prenatal mortality and serious complications after breech vaginal birth are 5% and after planned caesarean section 1.6%. This is the reason why the caesarean section is chosen as a final way of delivery with breech presentation. At present, after a period of increasing percentage of caesarean section one can observe a tendency to decrease this number. One of the procedures performed to decrease the number of complications and cost of perinatal management is external cephalic version (ECV). An indication to ECV is breech presentation at term, while there is no contraindication to ECV. Multiple pregnancy, significant third - trimester bleeding, uteroplacental insufficiency, IUGR, oligohydramnion, PROM, PIH, nonreassuring foetal monitoring patterns and all contraindications to vaginal birth are concerned to execute ECV. The real number of patients with breech presentation at term, after ECV, is according to the literature about 1 - 1.5%. The risk of serious complications during ECV, which are the indications for urgent caesarean section, is 1 - 3%. The risk of intrauterine death of foetus after ECV is about 0.0001%. According to the literature it appears that ECV at term seems to be useful and it is safe both for the mother and the foetus and helps to avoid a significant number of caesarean sections.

[Fibrinolytic therapy of pulmonary embolism in pregnant women]. / Fibrynolityczne leczenie zatorowosci plucnej w ciazy -- wspólczesne poglady.

Fibrinolytic therapy has an established position in the treatment of pulmonary embolism. Its use has proven to decrease patients' mortality. However, in pregnant women such treatment is considered risky, due to possible fatal haemorrhagic events. In spite of such disadvantages, fibrinolytic therapy has been used in pregnant women with good results: from definite improvement of clinical status to complete recovery. No severe haemorrhagic events were observed in these cases and overall mortality was significantly decreased. These findings show that the use of fibrinolytic therapy in emergency situations is an efficient and safe method, when applied in accordance with standard procedures. In this publication we present the general review of current knowledge regarding the use of fibrinolytic therapy in pregnant women.

[Intraamniotic surfactant supply as RDS prevention]. / Doowodniowe podanie surfaktantu jako profilaktyka zespolu zaburzen oddychania--doniesienie wstepne.

The importance of steroids given antenatally to the mothers in prevention of the respiratory distress syndrome (RDS) is unquestionable. Also intra tracheal surfactant application in newborn is proven method of prevention and treatment of RDS. However both options have some limitations and new methods useful in prevention of RDS are still needed. The aim of the study was to evaluate the efficiency and safety of the procedure of the intraamniotic surfactant supply as RDS prevention. Natural surfactant (Alveofact - Boehringer Ingelheim) has been given to 15 women at 24-32 weeks of pregnancy, two hours before expected childbirth (mainly cesarean section). To 8 of these women corticosteroids have been earlier administered. Just before surfactant injection amniotic liquid samples were taken to confirm lung immaturity and the patients were administered Aminophilline intravenously to provoke fetal breathing movements. Surfactant has been administered through the needle under direct ultrasound guidance into the amniotic cavity as close as possible to the fetal mouth and nose. Patients with the evidence of chorionamnionitis and fetal malformations were excluded from the study. No complications were observed during and after the procedure. None of the newborns had symptoms of severe asphyxia, the birth weight comprised between 670-1650 g (mean 1207). There was radiological evidence of RDS in two newborns and in 7 mechanical ventilation was needed. Of 15 newborns 13 survived (86.6%). There was no need for postpartum surfactant therapy in any case. Some authors expressed their view that this method is promising and further studies are desirable. In our study surfactant has been injected into the amniotic cavity shortly before childbirth, and Aminophilline has been administered intravenously in order to provoke fetal breathing movements before surfactant injection. The safety of the procedure was confirmed and the results of intraamniotic surfactant supply seems to be favourable to newborns. Small number of cases does not allow to draw any far-reaching conclusions. Still our preliminary results are encouraging and the study should be continued.