Comparison of two therapeutic protocols in patients with antiphospholipid antibodies and recurrent miscarriages

AIM: To compare the effects of two therapeutic protocols for the patients with recurrent miscarriages associated with the presence of antiphospholipid (anticardiolipin) antibodies. METHODS: A prospective observational study included 20 patients with antiphospholipid antibodies in the first group who received low-molecular heparin and aspirin. The second group of 20 patients, in addition to this therapy, received immunotherapy (intravenous immunoglobulin). Aspirin was administered at the time of a positive pregnancy test, and low-molecular heparin not before the fetal heart activity registration by ultrasound. Intravenous immunoglobulin was given prior to the conception or at the beginning of the pregnancy. We compared these groups according to the pregnancy outcomes and the occurrence of complications during pregnancy, using standard statistical tests. RESULTS: The rate of positive gestational outcome in the patients treated with aspirin and low-molecular heparin was 85% (17/20), and in the second group it was 90% (18/20). There was no significant difference in pregnancy outcomes between these groups (p > 0.05), except for the occurence of preeclampsia and thrombocytopenia, which were recorded only in the aspirin and low-molecular heparin group, but with no statistical significance (p > 0.05) compared to the second group, which received immunoglobulin additionally. CONCLUSION: There was no significant difference (p > 0.05) in pregnancy outcomes between the two studied therapeutic protocols, but the therapy with aspirin and low-molecular heparin was cheaper and easier to apply than the therapy with immunoglobulins. The results of our study confirmed that the final pathogenic mechanisms in recurrent fetal miscarriages were inflammation and thrombosis of the uteroplacental blood vessels.     

Pericardial Disease in Pregnancy

Background: There is no evidence that pregnancy affects susceptibility to pericardial disease. However, when such a condition occurs, its proper diagnosis and management may be crucial for the outcome of the pregnancy. Incidence and Diagnosis: Hydropericardium is the most frequent form of pericardial involvement in pregnancy. It is typically a small, clinically silent pericardial effusion present in the third trimester in approximately 40% of healthy pregnant women. Small amounts of fetal pericardial fluid (< 2 mm in echocardiography, in diastole) can be detected after 20 weeks of gestation. Larger effusions should raise clinical concern for hydrops fetalis, Rh disease, hypoalbuminemia, and infectious or autoimmune disorder. Wide varieties of etiologic forms of pericardial diseases occur sporadically in pregnant women. Significant symptoms, electrocardiographic changes, or physiologic impairment warrant hospitalization. Treatment: Most pericardial disorders are managed during pregnancy as in nonpregnant patients (i.e., nonsteroidal antiinflammatory drugs for acute, antibiotics and drainage for purulent pericarditis, and corticosteroids for systemic autoimmune disorders). However, colchicine is contraindicated in pregnancy, and pericardiocentesis should be performed only for very large effusions causing clinical signs of cardiac tamponade or if presence of suppurative, tuberculous or neoplastic pericardial effusion is suspected. Echocardiographic guidance of pericardiocentesis is preferred to fluoroscopic guidance in order to avoid fetal X-ray exposure. Pericardiectomy should be reserved for significant pericardial constriction and resistant bacterial infections. Delivery of normal infants in term after pericardiocentesis or pericardiectomy is expected, whenever natural history of causative disease allows. Pericardiectomy itself is not a contraindication for subsequent successful pregnancies. Zusammenfassung. Hintergrund: Hinweise dafür, dass eine Schwangerschaft zur Entstehung von Perikarderkrankungen prädisponiert oder deren Ausbildung beeinflusst, gibt es nicht. Wenn aber während der Schwangerschaft eine Perikarderkrankung auftritt, sind eine schnelle Diagnose und die richtige Behandlung von großer Bedeutung. Inzidenz und Diagnose: Die häufigste Form eines Perikardergusses während der Schwangerschaft ist das "Hydroperikard". Es handelt sich typischerweise um das Auftreten eines kleinen, klinisch nicht relevanten Perikardergusses im dritten Trimenon der Schwangerschaft. Bei ca. 40% aller gesunden Schwangeren ist ein solcher minimaler Erguss nachweisbar. In der 20. Schwangerschaftswoche kann auch bei den Feten ein kleiner Perikarderguss nachgewiesen werden, der in der fetalen Echokardiographie eine Separation von < 2 mm zeigen sollte. Größere Ergüsse sind meist das erste klinische Zeichen für einen Hydrops fetalis, eine Rhesus-Blutgruppenunverträglichkeit, eine Hypoalbuminämie bzw. infektiöse oder autoimmune Erkrankungen des Fetus und/oder der Mutter. Die Ätiologie der Perikarderkrankungen der Mutter während der Schwangerschaft ist vielfältig, wobei die akute virale Perikarditis und Perikardergüsse im Rahmen systemischer autoimmuner Erkrankungen die häufigsten Ursachen darstellen. Selten findet man auch Perikardergüsse bei Schwangeren im Rahmen von Tumorerkrankungen oder einer Tuberkulose. Wenn starke präkordiale Schmerzen, Veränderungen im EKG und eine deutliche Beeinträchtigung der Belastungsfähigkeit auftreten, ist eine Klinikeinweisung unumgänglich. Therapie: Die meisten Perikarderkrankungen bei Schwangeren werden behandelt wie die von Nichtschwangeren, d.h. mit nichtsteroidalen antiinflammatorischen Medikamenten bei akuter Perikarditis, mit Antibiotika und ggf. einer Drainage bei eitrigen Perikardergüssen bzw. der Gabe von Kortikosteroiden bei autoimmunen Systemerkrankungen. Die Gabe von Colchicin ist während der Schwangerschaft kontraindiziert. Eine Perikardpunktion wird nur bei großen Perikardergüssen mit den klinischen Zeichen einer akuten Tamponade bzw. bei Verdacht auf Tuberkulose, infektiösen Erguss oder Tumorerkrankung durchzuführen sein. In diesen wenigen Fällen ist eine echokardiographisch gesteuerte Punktion angebracht, um eine Strahlenbelastung des Ungeborenen zu vermeiden. Eine Perikardektomie sollte nur bei perikardialer Konstriktion und schwerer bakterieller Infektion durchgeführt werden. Die Prozeduren Perikardpunktion und Perikardektomie allein haben, vom Interventions- bzw. Operationsrisiko abgesehen, keinen negativen, sondern eher einen günstigen prognostischen Einfluss auf die Schwangerschaft. Es gibt bislang keine ausreichenden Daten dafür, dass eine Perikardergussbildung in einer vorausgegangenen Schwangerschaft bei erneuter Gravidität zu einem Rezidiv führt. Liegen gleichzeitig allerdings eine linksventrikuläre Dilatation und Dysfunktion vor, ist, wie im Beitrag "Schwangerschaft und Kardiomyopathie" ausgeführt, nach den Empfehlungen der European Society of Cardiology (ESC) von einer erneuten Schwangerschaft abzuraten.     

Sun behaviour patterns and perception of illness among melanoma patients

Background Melanoma is one of the most aggressive skin tumours for which the major risk factor is ultraviolet radiation. Sun protection is extremely important, especially for melanoma patients who, once diagnosed with melanoma, have 500 times greater chance of developing another melanoma than the general population. Objective In this study, we examined the perception of melanoma and attitudes towards sun protection among melanoma patients and compared their results with the patients suffering from other dermatological disorders. Methods In total, 240 participants were included in the study: 120 patients suffering from melanoma and 120 participants in the control group. The Sun Behaviour Patterns Questionnaire and the Brief Illness Perceptions Questionnaire were used in this study to assess sun behaviours and perception of melanoma. Results Melanoma patients have negative attitude towards sunbathing: 57% avoid sunbathing and 27% spend time in the sun only during swimming, otherwise seeking shade, whereas participants in the control group have more positive attitude towards sunbathing. Results indicate very short time of using sunscreen protection during the year and very small number of people using adequate SPF value, in both melanoma and control group. Conclusion Participants in control group perceive melanoma as a more serious illness than patients who think that melanoma has mild symptoms, is easy to cure and control, has moderate consequences and lasts relatively long. Both melanoma patients and participants in the control group show relatively good sun behaviour patterns and slightly negative attitudes towards sun protection.     

Respiratory gases and acid base parameter of the fetus during the second and third trimester

Respiratory gases and acid base parameters were determined in the samples of fetal blood collected by cordocentesis from 70 patients with normal course of pregnancy, between 18th and 38th gestational week. The mean pH value was 7.386 +/- 0.05; partial pCO2 pressure -4.819 +/- 1.464 kPa; O2-5.712 +/- 1.24 kPa; bicarbonate 21.528 +/- 0.494 mMol/l; base excess -2.284 +/- 0.647 mMol/l and saturation 74.86 +/- 13%. Statistically significant negative correlation between gestational age and pH (r = 0.841, p less than 0.01) and partial O2 pressure (r = -0.961, p less than 0.01) was revealed. Partial CO2 pressure correlated significantly with gestational age (r = 0.923, p less than 0.01). The values of bicarbonate and base excess do not change significantly during gestation. Our own standards of examined parameters were formed.     

Ocular cicatricial pemphigoid associated with hyperproliferation of the conjunctival epithelium

We determined the mitotic rate, measured by evaluating uptake of tritiated thymidine autoradiographically, and the frequency of goblet cells in conjunctival epithelial biopsy specimens from nine normal subjects and from 11 patients (seven women and four men ranging in age from 50 to 80 years) with ocular cicatricial pemphigoid. The mitotic rate of patients with the disease was significantly higher than that of normal subjects, 7.2 +/- 2.2 vs 1.6 +/- 0.2 labeled cells per 100 basal epithelial cells (P less than .01). The goblet cell frequency, however, was significantly less in patients than in normal subjects. This suggests that ocular cicatricial pemphigoid is associated with hyperproliferation of the conjunctival epithelium, with a concurrent failure of normal conjunctival differentiation.     

Cytological detection of lymphoma in Douglas aspirate

Except in primary effusion lymphoma (PEL), serous effusions with lymphomatous cells in non-Hodgkin lymphoma (NHL) are not frequently seen as first manifestation of disease. In NHL lymphoplasmacytic lymphoma (LPL) the spleen, lymph nodes, and bone marrow are frequently sites of disease and this type of NHL is usually associated with a serum paraprotein of IgM type accompanied by the clinical syndrome of Waldenstr?m macroglobulinemia. Our patient with NHL LPL type presented in this report had less frequently seen involvement of gastrointestinal tract and clinically was first manifested as effusion in Douglas space. Cytological evaluation as well immunoanalyses of effusion in such cases is essential, and various ancillary studies, because of differential diagnostic problems of lymphomas in serous effusions, first include reactive lymphocytoses and small round-cell tumors (SRCT). In our patient, cytology of effusion revealed cytomorphologically atypical lymphomatous cells with plasmocytoid differentiation. Immunocytochemical and flow cytometry analysis confirmed lymphoid cell differentiation and pathohistological diagnosis of CD20(+) LPL was set after pathohistological analysis of resected ileum.     

Acute effects of smoking and food consumption on breath condensate pH in healthy adults

Acute effects of food and cigarette consumption on exhaled breath condensate (EBC) acidity are insufficiently explored. The study aimed to evaluate potential changes in EBC pH within 2 hours following cigarette or food consumption. In 15 healthy smokers, samples were obtained after 10 hours of abstinence from smoking and then 15, 30, 60, and 120 minutes after smoking 1 cigarette. In 19 healthy nonsmoking adults, EBC samples were obtained in the morning after an overnight fast, and then 30, 60, and 120 minutes following standardized breakfast. Smoking of 1 cigarette after overnight tobacco abstinence induced significant increase in EBC pH during the 2-hour observation period, for approximately 0.60 logarithmic units (repeated-measures analysis of variance [ANOVA], P < .0001). The average presmoking pH value in smokers (7.00 ± 0.50) was significantly lower than average value in nonsmokers (7.62 ± 0.31; P = .0001). No effect of food consumption was found. These results show that cigarette smoking acutely increases EBC pH in healthy smokers. Smoking status and abstinence from smoking before EBC sampling seems to be important in studies evaluating EBC pH and should be standardized or at least stated in the methodology. Acute effects of food were not found under described study conditions in healthy adults.     

Simultaneous preparation of four cell type enriched glial cultures from rat cerebral cortex

Summary We have developed a procedure for the stimultaneous isolation of 95 to 98% homogeneous populations of four glial cell types from a heterogeneous cell suspension derived from one pool of neonatal rat cerebral cortices. The method is based on four known differences between microglia, astrocyte types 1 and 2, and oligodendrocytes: a) timing of differentiation and preservation of this schedule in dissociated cell cultures; b) adhesion strength; c) cell size; and d) nutritional requirements. The advantages of this procedure over current methods include: a) cultures remain pure approximately 2 wk longer; b) cultures of type 2 astrocytes are approximately 25% more pure; c) direct comparisons of these cell types are made possible during development and/or in maturity under a variety of heritable and other perturbations; d) biochemical analyses of the interactive and individual properties of glial cells are facilitated; and e) animal lives are conserved. The method may prove particularly valuable in human brain research where supply of tissue is both sporadic and limited.