Enzymatic diagnosis of neurological risk of premature labor

The level of oxytocinase in the pregnant woman's blood is a sensitive marker of the efficiency of the hypothalamus/hypophisis/suprarenal glands in mother and fetus, as well as the quantity of hormone production, also in placenta, which determines the duration of pregnancy and the course of labor. In the study, the level of oxytocinase was measured before the labour in 485 pregnant women at risk of premature labour. After the mean duration of pregnancy of 264 +/- 12 days, 353 infants were born fully mature (group I), and 132 with the lowered maturity of 6-9 Klimek points (group II). In group II, the mean pregnancy duration (249 days), body mass (2700 g) and oxytocinase level (5.6 mumol/l/min) were significantly lower and tocolysis was necessary twice as often (41% vs. 21%). Independently of the level of newborn maturity in cases of tocolysis the mean level of oxytocinase was significantly 2.6 times lower (3 +/- 0.8 mumol/l/min) than in the other pregnant women (7.9 mumol/l/min). It proves, that low oxytocinasaemia becomes normal following the ACTH-depot therapy, which eliminates the necessity of tocolysis.     

Newborn's postnatal maturity index as the health marker of the mother

OBJECTIVES: Newborns of both high and low body weight, as well as of higher or lower gestational age and length are born within the wide range of the six weeks of the biological norm. The correlation between the fetal mass and height is high, however the correlation of those two basic features with the fetal maturity is half as high. In view of the above, in order to verify the proper time of pregnancy ending, particularly if it is an instrumental one, it is necessary to assess the newborn's maturity index, which is also an indicator of the mother's health. Consequently, the index has a prognostic value for assessment of both the mother's and the infant's morbidity. MATERIALS END METHODS: Human maturation process was evaluated by means of at least two ultrasonographic measurements of fetal parameters < or = 28th week to determine an individual birth term in 2500 cases, construed as the day when the fetus reaches full maturity to self-dependent life and the mother becomes ready for the labor. Regardless of the method of assessment, the most important criterion of the sufficient pregnancy duration is the degree of the fetal maturity assessed immediately after the labor, i.e. Klimek's score (K) during the routine neonatal evaluation accompanied by the assessment of the newborn infant's adaptive efficiency expressed in the popular Apgar score (A). RESULTS AND CONCLUSIONS: It was found that the point count in K score is a more sensitive index of the newborn infant's wellbeing than the A score. Fetal development in the mother's womb progresses according to the auxological laws, to which the K score point-count conforms, unlike the A score. This study summarizes the latest studies on this subject in infants born both from physiological and pathological labors.     

Laparoscopic management during pregnancy--own material (1996-2002)

OBJECTIVE: Utility of laparoscopic procedures in pregnant women. Is laparoscopy safe for the foetus? MATERIAL AND METHODS: Between 1996 an 2002 14 pregnant patients were admitted and laparoscopy was performed. RESULTS: In 10 cases laparoscopic cyst enucleation (6 simplex, 1 endometrial, 3 dermoidal), in 1 case myomectomy and in 2 adnexectomy was performed. There were no complications during surgery. In one case miscarriage occurred 3 weeks after laparoscopic surgery and 9 healthy babies were delivered. DISCUSSION: There is no doubt that laparoscopy is well accepted in gynecological surgery and is going to be more and more accepted in obstetrics. Due to several differences between non-pregnant and pregnant women laparoscopic procedures in pregnancy require special attention. All papers show good foetal outcome even with preterm labour. In our material all babies were born healthy. CONCLUSIONS: Laparoscopic procedures during pregnancy are feasible and safe. Nevertheless they have to be performed by experienced gynecological-surgical teams.     

Supplementary ultrasonometry of the fetus in evaluation of gestational age

The terminology quoted in the leaflet "Ultrasonometry of foetus in evaluation of gestational age" could change the diagnostic and therapeutic procedures in obstetrics from the point of view of only one out of many methods of imaging. The object of the study was to complement the "standards for eleven measurements pertinent to evaluation of pregnancy age and well-being of the foetus", in order to use them in compliance with the laws of auxology with recognize the priority of developmental age over the postmenstrual calendar age. Foetus is not a statistical patient, but an individual one, and it is not clinically important that, e.g. 15% of children are born at the foetal age of 38 or 41 weeks, but whether the examined foetus is born in either of the two weeks. Our complementation should be convincing about the great significance of ultrasonometry not of the foetus (as in the title of the publication in question), but of the foetuses in evaluation of their average gestational age, and about the necessity of reformulation of the published ultrasonomatric standarda, so as to render them clinically useful in regard of the foetuses of various gestational maturation rate.     

Prognostic factors in treatment of neoplasms as the dissipative structures

The aim of the study is to define the systemic prognostic factors in the neoplasm according to thermodynamic theory of cancer a the self-organising dissipative structure. As the local, so called "specific" factors seem to be not adequate one should look for more general ones. It is shown, that such general factors as hormonal state of women' organism, preterm births, lactation, infertility treatment are important.     

Clinical method of newborn's maturity evaluation according to R. Klimek's index

The object of the study was to evaluate R. Klimek's new simple clinical method of computing newborn's maturity index (K) without having to use the computer-aided method or understand the basics of the quantum mechanics or theory of relativity, which gave rise to the modern definition of maturity. The study was based on the material of 1000 successive newborns delivered in the Clinic of Gynecology and Obstetrics of the Jagiellonian University. Their maturity was determined routinely in BK scale, and confirmed by means of computer-aided method of birth term prognosis. Posture, angle of the elbow, pulling an elbow to the middle line of the body, breast appearance, presence of lanugo and plantar creases were evaluated by means of K index with points from 0 to 2. Newborns' maturity index K was 9.2 +/- 1.9 points (range 2-12). 2.6% newborns were immature and one third of them (0.8%) were born with the gestational age < 37 weeks, 28 of which (77%) had correct K index > or = 6 points. There is a high, statistically significant correlation between maturity assessed in Ballard-Klimek scale and K index (r = 0.61, t = 24.78).     

Pancreatic exocrine secretions as a source of luminal polyamines in pigs

The goal of the present study was twofold: (1) to detect the possible storage of dietary polyamines (PAs) in various tissues and (2) to investigate the role of dietary PAs in the differentiation of the pig intestinal epithelium. A first experimental series was designed to assess the accumulation of either milk PAs (mostly spermidine) or orally administered spermine (SPM) in piglet red blood cells (RBCs) and plasma, a preliminary stage in their distribution to growing and storage organs. Though PA concentrations of piglet RBCs and plasma were generally significantly higher than their sow counterparts, our experimental conditions failed to demonstrate that this increase could stem from ingested PAs. A second experimental series dealt with the determination of disaccharidase specific activities in proximal and distal parts of piglet gut on the 26th and 29th days after birth (preweaning time). In agreement with observations made previously on rat pups, we observed an increase in maltase specific activity (SA) at the end of the suckling period (the observed increase in sucrase SA was not significant). However, orally administered SPM did not affect this activity. Compared to the constant protein concentrations observed in both parts of the gut, the pancreatic protein content decreased sharply between the 26th and 29th postnatal days. At the same time pancreatic concentrations of spermidine (SPD) also decreased, suggesting that some pancreatic PAs were released as the organ secreted its proteins. In accordance with this hypothesis, we recorded SPM and SPD in pancreatic juice. The increases in PA concentrations seemed to follow the protein secretion pattern (i.e. PA concentrations reached a maximal value when the protein concentration was highest). The presence of PAs in pancreatic juice could be indicative of a control mechanism exerted by the pancreas on PA-induced growth and differentiation of porcine intestinal epithelium.     

Nicotine-induced endocytosis of amiloride-sensitive sodium channels in human nasal epithelium

In previous studies we developed and introduced a method to examine the transport mechanisms of ions in primary cell cultures of human nasal epithelium. In the current study, substances, especially nicotine, that influence these mechanisms are investigated. Specimens of nasal and paranasal epithelium of patients treated by endonasal surgery because of chronic sinusitis (n = 217) were used as primary cell cultures. Cell cultures of smokers (n = 83) and non-smokers (n = 134) were differentiated. Transepithelial Ussing chamber measurements were performed to examine sodium channel functions and to evaluate the influence of nicotine. These examinations were accompanied by simultaneous continuous capacitance measurements. Whereas transepithelial parameters, such as short-circuit current, (Isc), potential (Vt) and resistance (Rt), in tissues derived from smokers and non-smokers showed no difference, the transepithelial conductance was reduced immediately in cell cultures with apical application of nicotine (2 mM). This decrease was accompanied by a marked reduction of epithelial surface area. In the presence of nicotine, amiloride (100 microM) completely lost its inhibitory capacity. Amiloride-insensitive sodium channels were unaffected by nicotine, as proved by Na+ substitution. Furthermore, the Na+ channel blocker was accompanied by an increase in intracellular Ca2+. We conclude that the nicotine-induced increase in intracellular calcium (Ca2+) has stimulated Ca2+-dependent protein kinase (PKC). PKC promotes endocytosis removing amiloride-sensitive Na+ channels from the cell membrane into the cell by means of vesicular transport.     

Die Anwendung von humanisierten Anti-Immunoglobulin-E-Antikörpern

Omalizumab is a humanized monoclonal anti-IgE antibody developed for the treatment of allergic diseases. It has demonstrated good efficacy in patients with intermittent and persisting allergic rhinitis and in patients with moderate-to-severe allergic asthma. Omalizumab results in a marked lowering of free IgE in serum and down-regulation of IgE receptors on circulating basophils. In addition, it reduces the inflow of eosinophils into nasal and bronchial tissue and the number of IgE-positive mast cells in the bronchial mucosa. Omalizumab treatment has also been shown to be associated with down-regulation of IgE receptors on circulating dendritic cells, suggesting that blocking IgE may also inhibit chronic aspects of allergic inflammation involving T cell-activation. Patients’ clinical symptoms are attenuated and their quality of life improved by anti-IgE treatment with omalizumab; other medications effective in symptomatic treatment are therefore less necessary. Omalizumab’s broad spectrum of efficacy emphasizes the central role of IgE in the allergic-inflammatory cascade. Further areas of applications in ENT medicine could be anticipated in other IgE-related illnesses, such as allergic rhinitis, food allergies, laryingitis and chronic allergy-related rhinosinusitis.     

Insulin receptor substrate-1 is over-expressed in glycogenotic but not in amphophilic preneoplastic hepatic foci induced in rats by N-nitrosomorpholine and dehydroepiandrosterone.

Insulin receptor substrate-1 (IRS-1) is over-expressed in preneoplastic glycogenotic hepatic foci (GSF) and is gradually down-regulated during progression of these lesions, via mixed cell foci (MCF), to the basophilic neoplastic phenotype. The aim of the present study was to investigate the effect of dehydroepiandrosterone (DHEA), a weak hepatocarcinogen and tumour enhancer, on IRS-1 expression. Hepatocellular lesions were induced by N-nitrosomorpholine followed by DHEA. Under these conditions, many glycogen-poor amphophilic (APF) and intermediate cell foci (ICF) appear, in addition to GSF and MCF. IRS-1 was over-expressed in 215 out of 295 GSF, in 50 out of 53 MCF and in a glycogen-rich mixed cell adenoma. IRS-1 expression was not shown in 147 APF, 51 ICF and 5 amphophilic hepatocellular adenomas, and 3 out of 5 hepatocellular carcinomas showed a weak IRS-1 expression. The results suggest a close association of IRS-1 over-expression with the glycogenotic hepatocellular phenotype. The modulation and enhancement of tumour progression by DHEA is associated with a shift from glycogenosis to amphophilia and basophilia, and a down-regulation of IRS-1 expression.