Four main reasons of maternal death in Poland between 1991-2000

Maternal death during pregnancy, labour and puerperium constitutes the main problem of prenatal medicine and still a major public health topic. In this work we analyses maternal deaths in Poland between 1991-2000. There were 4,404,641 live births and 462 maternal deaths. Among them there were 402 direct ("true") maternal deaths with mortality rate 9.1 per 100,000 live births and 60 indirect maternal deaths (rate 1.4). There were 218 cases of pregnancy associated deaths (rate 4.9). The main causes of direct maternal deaths were as follows: haemorrhage--33.6% (rate 3.1), sepsis--27.3% (rate 2.5), amniotic fluid embolism--22.4% (rate 2.0) and pregnancy induced hypertension 16.7% (rate 1.5). Increasing maternal age is one of important risk factor for mortality. Over 30% of direct pregnancy related deaths were noted within women above 35 years. Unsatisfactory antenatal care, management deficiency and patient's neglect were main risk factor foe fatal outcome. Practical conclusions should be issued as general rules, instructions and recommendations. Between one third to one half of the maternal deaths are considered to have been preventable.     

Congenital diaphragmatic hernia--diagnostic and therapeutic procedures

Congenital diaphragmatic hernia (CDH) is connected with a high risk of neonatal mortality and morbidity, which are caused mostly by lung hypoplasia. Frequency of these congenital malformations is 1: 2000-3000 live birth. CDH can be isolated, but in as many as 23% of cases, it co-exists with other fetal anomalies. Moreover, in 12% of cases it may be connected with genetically determined syndromes. Ultrasonographic diagnostics, especially in isolated CDH cases, is very difficult so that pregnant women must very often be admitted to perinatal 3rd references center. The first symptom to suggest CDH is polyhydramnios appearing between the 2nd and 3rd trimester of pregnancy. Appropriate prenatal diagnosis, delivery at a specialized perinatal center, and well-prepared neonatal, anaesthesiological and surgical teams significantly improve the survival rate and increase the likelihood of the proper development of newborn infants. The aim of this paper is the presentation of the case of a newborn diagnosed with intrauterine CDH who, upon delivery at 34th week of gestation, was admitted to the Department of Child Surgery, and after surgical procedures, was discharged in a healthy condition.     

Rare coexistence of phlegmonous appendicitis and tumor of a twisted left ovary

The authors present a diagnostically difficult case of a three year old girl with abdominal pain. The girl with abdominal pains, nausea, upper airways infarction and some urinary system symptoms was admitted to Children's Surgical Clinic for observation. She was given antibiotic therapy and i.v. infusions. WBC was 29.6 tys./ul and CRP 2.7 mg/dl. No other abnormalities were detected in biochemical or sonographic investigation. The girl was submitted to laparotomy because of unclear abdominal signs suggesting acute appendicitis. Phlegmonous appendicitis and twisted/rotated left ovary with multiple adhesions were found. Histopathological investigation showed teratoma of the left ovary. Postoperative course went without complication.     

Iatrogenic multiple pregnancies. Do they complicate perinatal care?

This review addresses questions related to medicosocial concerns surrounding the care of women with multiple births and their infants. Relevant articles and texts on twin and triplet pregnancies were reviewed. Population-based data were selected for inclusion whenever possible. Relevant tables were simplified from original sources. The review clarifies obstetric and perinatal questions in a manner that is helpful to clinicians and their patients.     

Distribution of high affinity choline transporter immunoreactivity in the primate central nervous system

A mouse monoclonal antibody (clone 62-2E8) raised against a human recombinant high-affinity choline transporter (CHT)-glutathione-S-transferase fusion protein was used to determine the distribution of immunoreactive profiles containing this protein in the monkey central nervous system (CNS). Within the monkey telencephalon, CHT-immunoreactive perikarya were found in the striatum, nucleus accumbens, medial septum, vertical and horizontal limb nuclei of the diagonal band, nucleus basalis complex, and the bed nucleus of the stria terminalis. Dense fiber staining was observed within the islands of Calleja, olfactory tubercle, hippocampal complex, amygdala; moderate to light fiber staining was seen in iso- and limbic cortices. CHT-containing fibers were also present in sensory and limbic thalamic nuclei, preoptic and hypothalamic areas, and the floccular lobe of the cerebellum. In the brainstem, CHT-immunoreactive profiles were observed in the pedunculopontine and dorsolateral tegmental nuclei, the Edinger-Westphal, oculomotor, trochlear, trigeminal, abducens, facial, ambiguus, dorsal vagal motor, and hypoglossal nuclei. In the spinal cord, CHT-immunoreactive ventral horn motoneurons were seen in close apposition to intensely immunoreactive C-terminals at the level of the cervical spinal cord. CHT immunostaining revealed a similar distribution of labeled profiles in the aged human brain and spinal cord. Dual fluorescent confocal microscopy revealed that the majority of CHT immunoreactive neurons contained the specific cholinergic marker, choline acetyltransferase, at all levels of the monkey CNS. The present observations indicate that the present CHT antibody labels cholinergic structures within the primate CNS and provides an additional marker for the investigation of cholinergic neuronal function in aging and disease.     

Own experience in surgical treatment of the pineal region and midbrain tumors via the infratentorial approach

Nine cases of tumours located in the pineal and midbrain region in adults operated on between November 1998 and July 2002 in Dept. of Neurosurgery, Central Military Hospital in Warsaw are reported. The patients (2 men and 7 women) were aged from 27 and 69 years (mean age 43.6 years). Their main initial symptoms were caused by hydrocephalus. The histopathological examination revealed anaplastic pinealoma in 2 cases, and pineocytoma, pineal cyst, mesencephalic glial cyst, protoplasmatic astrocytoma, epidermoid cyst, unclear glial scar, and papillary ependymoma in single cases. Five patients had been treated, usually elsewhere, with shunt implantation prior to the surgery. Occipito-suboccipital osteoplastic craniotomy was performed in each case and tumours were totally removed microsurgically via the infratentorial epicerebellar approach. In one case a part of the glial periaqueductal tumour was resected additionally via the fourth ventricle and aqueduct in one stage. Postoperative haematomas in the third and fourth ventricle were found in 2 cases. Main complaints after the surgery included transient diplopia. All the patients improved significantly and resumed their previous life activities. Follow-up ranged from 3 to 44 months. Three patients with pineal tumours and one with a small postoperative ependymoma recurrence were irradiated after the surgery. One patient had been irradiated prior to surgery. Very good results of the surgical treatment of tumours in this area suggest that such patients should be referred earlier to one stage surgical management, as the procedure is easier to perform and shunt implantation may be avoided.     

The assessment of development of binding antibodies to interferon beta during interferon beta 1a treatment of multiple sclerosis

The importance of binding antibodies (BAb) that develop during the treatment of multiple sclerosis with interferon beta has not been fully explained yet. However, they are generally regarded as one of factors that may diminish treatment efficacy. The aim of the study was to evaluate firstly, BAb occurrence in interferon beta 1-a (IFN beta 1-a)-treated MS patients and secondly, BAb impact on clinical efficacy of this medication. In the 36-month study participants were 21 patients with relapsing-remitting multiple sclerosis, RR-MS, (14 women, 7 men, aged 29.6 +/- 8.5). All the patients were receiving intramuscular IFN beta-1a (Avonex) for 24 months, in the dose of 30 micrograms per week. Clinical parameters and serum BAb levels (the EIA method) were estimated every 3 months. Two control groups, examined only once, included 20 RR-MS patients without IFN-beta therapy and 20 healthy volunteers. While before treatment a high BAb level was found in 2 patients (9.5%), at 6 months of treatment it was found in 8 patients (38.1%). A similar number of patients with high BAb levels was seen throughout the study during the IFN-beta treatment. On therapy completion serum BAb levels decreased very rapidly. After 2 years of treatment, disability as measured by the EDSS scale was more pronounced in patients with serum BAb, but the differences were statistically not significant. No statistically significant relationship was found either between elevated BAb levels and the number of relapses during the IFN-beta treatment (including relapses that required steroid therapy).     

Tuberculosis of the central nervous system: case reports

Tuberculosis of the central nervous system possess a serious clinical and radiological problem, since early treatment of this condition is crucial for the patient's life, and tuberculous process in the CNS may mimic many other pathologies. In this paper three cases of tuberculous process difficult to diagnose are presented. In all the cases early treatment could be started due to MRI findings suggesting tuberculous etiology. The authors emphasize the importance of presumptive radiological diagnosis in reducing the morbidity and mortality rates due to CNS tuberculosis.     

Neuroimaging in a chronic demyelination process following tick-borne encephalomyelitis

We present a case of a 17-year-old female patient with a tick-borne neuroinfection. Tick-borne encephalitis is a viral disease of the CNS. Tick-borne encephalitis is usually of diphasic type, with partial epileptic seizures. No such symptoms were observed in this case. Since areas of demyelination could be seen on CT and MRI scans, immunological etiology should be taken into consideration. The correct diagnosis was established on the basis of serological examination and neuroimaging findings.