The Significance of Ultrasound Prenatal Diagnosis in Optimal Therapy of the Newborn Based on a Case of Pulmonary Sequestrati

Abstract: Pulmonary sequestration is a rare congenital lesion in which nonfunctional lung tissue lacks connection with the tracheobronchial tree and receives systemic blood supply. It can be accompanied by free fluid in the pleura, lung hypoplasia, circulatory insufficiency, polyhydramnios or even hydrops fetalis. For this reason early and accurate diagnosis is required. We present a case of a fetus which developed hydrothorax in the 31st week of gestation. Ultrasonographic examination revealed a hyperechogenic mass in his chest that was classified as pulmonary sequestration. Thoracocentesis was performed twice (in 33th and 35th week of gestation) and preterm labor took place, due to preterm premature rupture of membranes, in 35+5 week of pregnancy. The newborn presented respiratory distress and was admitted to the Neonatal Intensive Care Unit (NICU). The postnatal diagnosis of the lesion was difficult and it took several days to confirm the prenatal finding. We emphasize the importance of cooperation between obstetricians and neonatologists, that consist of complete visualization of the fetal anatomy, proper classification of the anomalies and successful final management not only during pregnancy but also after the delivery. Read full text »

Recurrence of Triple Negative Breast Cancer in a 34-year Old Female Patient During the Second Pregnancy – A Case Report

Abstract: A 34-year-old female patient at 36th week of her second pregnancy was admitted to the 1stDepartment of Obstetrics and Gynecology, Medical University of Warsaw. She had a cesarean section at 32nd week of her first multiple pregnancy in 2010. She had a history of bilateral mastectomy [a right breast in 2012, partially left breast (without neoplasia) in 2013] because of carcinoma mammae – ER (-) PGR (-), HER 2 (1) according to Ventana (negative status). In the current pregnancy a cervical cerclage and pessary were inserted at 14th and 17th week of gestation, respectively. At 36 weeks she started suffering from increasing pain in the lumbar part of spine, unresponsive to medication . Due to pain and limited mobility she was qualified for an operative delivery under general anesthesia – a baby boy of 3310g was born in good general condition. However, the pain did not regress after the delivery. In addition, pain of lower limbs appeared. 20 days after cesarean section PET – CT was performed: metabolically active metastases were found in bones, lymph nodes (chest, abdomen, neck), in the right lung and pleura and the liver – breast cancer recurrence. Additional X-ray of the right femur revealed a large metastasis requiring surgical treatment. The patient was referred for systemic treatment with a poor prognosis. She died 5 months after delivery. Read full text »

Mesothelin as a New Diagnostic Marker for Ovarian Cancer

Abstract: Ovarian cancer (OC) is the most aggressive of all gynecological cancers. The disease is most frequently diagnosed at a very advanced stage, because the tumor is asymptomatic for a long time. Even then, the signs are not specific. Researchers are still looking for markers which detect OC at the early stage. Mesothelin is expected to become such marker in the future. This protein exhibits high specificity to ovarian cancer and according to clinical trials could be detected in urine, serum and ascites. Nevertheless, its accurate function in the body remains unknown. It is presumed that mesothelin is involved in the pathogenesis of ascites and tumor cell migration. Evaluation of this new molecule in women may be a chance to increase overall survival and decrease mortality rate among ovarian cancer patients. Read full text »

Pregnancy In Liver Recipients – Management And Outcome. Review.

Abstract: Possession of the offspring and experiencing maternity is desired by many women, including solid-organ transplant recipients. The number of women post liver transplantation (LT) in reproductive age in the USA is approximately 14 000 and raises up to 500 more new cases each year. Moreover, 1/3 of LTs is performed in women of reproductive age. It is necessary to emphasize that pregnancy after LT is a high risk pregnancy, yet it does not increase the risk of graft rejection. In 2017 the first case of woman giving birth to a healthy child after ABO-incompatible LT was described. A period of 1-2 years between LT and conception is considered safe. Complications of pregnancy such as increased risk of hypertension, preeclampsia or gestational diabetes are more frequent among liver recipients than in general population. Increased risk of low birth weight, preterm birth and graft rejection were reported if the conceiving took place within the first year after transplantation. Choosing the right lifestyle, contraceptives and preventing drug interactions are pivotal tasks for the gynaecologist at the time. Management of patients wishing to become pregnant after LT should be based on the lowest effective dose of immunosuppressant. Calcineurin inhibitors and glucocorticosteroids are currently recommended in this group of patients. Read full text »

Uterus Transplantation As A New Method In Uterine – Factor Infertility (UFI)

Abstract: Approximately 0.2 % of women suffer from absolute uterine infertility. There used to be no existing treatment for this condition. However, up till now, a total of sixteen cases of human uterus transplantation have been reported worldwide. It seems that the procedure is to become the method of choice in the treatment of women with UFI. We introduce a review which summarizes current experience in this field, with long-term patient analysis included. It also covers such important issues as potential risks for both involved parties and immunosuppressive therapy during pregnancy Read full text »

Assessment Of The Incidence Of Transplant Renal Artery Stenosis (Tras) In The Early Post-transplantation Period

Abstract: Transplant renal artery stenosis (TRAS) affects 1-23% of recipients and accounts for about 75% of all post- transplantation vascular complications. Objective: The purpose of the work was to evaluate the incidence of TRAS in the period up to 6 months after kidney transplantation and analysis of selected stenosis risk factors in a group of patients transplanted in the Clinic of General and Transplantation Surgery of the Institute of Transplantology of the Medical University of Warsaw. Material and methods: A retrospective analysis of a group of 334 patients treated in the period from January 2014 to December 2015 was performed. The cases of patients in whom a≥50% stenosis of artery lumen was described on imaging studies within 6 months after transplantation were evaluated and selected stenosis risk factors were analysed. Results: The incidence of TRAS in the study (7.2%) is comparable to the results of other centres in Poland and abroad. No statistically significant relationships were found in the TRAS vs. non-TRAS groups for the studied risk factors (p>0.05). In the TRAS CD vs. LD groups, the value of the Phi index (φ=0.318) for the parameter of multiple renal arteries is of note. Conclusions: Multiple renal arteries may represent an important indicator in the diagnosis for TRAS. Read full text »

Obesity and Metabolic Syndrome

Abstract: Obesity is a state of the body, when the amount of energy delivered from food exceeds its consumption by the body. The concept of metabolic syndrome (MS) is determined by the coexistence of the clinical condition with connects risk factors for cardiovascular disease of atherosclerotic character and type 2 diabetes. Metabolic syndrome consists of: increased waist circumference, fasting blood glucose, hyperinsulinemia, lipid disorders, including reduced HDL cholesterol, hypertension, proinflammatory and prothrombotic states. The etiology of metabolic syndrome can be related to two reasons: “adipose-centric” and “diabetes-centric”. The basis of all these metabolic changes is an increased fat mass, a fundamental element of the pathogenesis of insulin resistance. Lack of physical activity, caloric and highly processed diet are not without significance for the development of MS. The paper discusses the influence of adipose tissue in the development of metabolic syndrome and the common denominator that links obesity to insulin resistance, which results in inflammation. In addition, the indicators reveal the prevalence of obesity and metabolic syndrome in Poland and in the world on the basis of the available literature. Additionally, the principles of dietary treatment and its importance in reducing the risk of cardio – vascular patients with metabolic syndrome are discussed. Data from studies conducted around the world confirm that we are dealing with an epidemic of the XXI century in the form of obesity and its complications, including metabolic syndrome. Read full text »

Nasal Septum Deviation In Children – Clinical Presentation And Methods Of Treatment. A Review.

Abstract: The deviation of nasal septum is a common deformity observed in children, with an increasing tendency in older age groups. It can be both, symptomatic and asymptomatic, depending on its size, location and other personal anatomical characteristics; on the other hand it may be an inborn feature or originate from a trauma. Due to the children’s growing process they stand for an exceptional population. Continuous development of the nasomaxillary complex leads to changes in the facial proportions, which may then result in the enhancement of persisting deformities or affect other structures. It has also been questioned for many years, how the proper approach towards such cases should look like and whether it should require an immediate (after trauma or after diagnosis) surgery or pre-planned postponed procedure until the growth ceases or the symptoms are unbearable. In our review we tried to analyse this issue and find the most optimal up-to-date solution to this problem. We also concentrated on clinical manifestation in order to answer the question about the correlation between the deviation and rhinosinusitis. Read full text »

Diabetic Retinopathy – Risk Factors, Pathogenesis, Diagnosis And Treatment

Abstract: Diabetic retinopathy (DR) or diabetic eye disease, is the major long-term complication of diabetes and main cause of vision impairment and vision loss. Major risk factors of the disease are the diabetes duration and glycemia (hyperglycemia and glycemic variations). One can also distinguish high blood-pressure, lipid disorders, pregnancy and puberty, age at diagnosis, ethnicity and genetic disorders among others. Diabetic retinopathy develops as a consequence of long-term accumulation of damage of retinal vessels. Its most advanced, proliferative stage leads to complications that are a direct cause of vision impairment or vision loss. The mechanism of this pathology includes macular oedema, vitreous hemorrhage, neovascular glaucoma and tractional retinal detachment by fibrovascular proliferations. Diabetic eye disease remains asymptomatic at the primary stages. In more advanced phases gradual vision acuity impairment is reported. In some cases, type 2 diabetes is diagnosed at the same moment as diabetic eye disease, which threatening with blindness. Running screening tests (fundus photography) allow to detect early, asymptomatic disease’s stages. Most frequently used diagnostics method to recognize DR ad hoc is direct ophthalmoscopy. Other useful methods are optical coherence tomography (OCT) and fluorescent angiography among others. Regular routine tests play a crucial role in DR diagnose. Pregnant women should be treated with special attention. The most substantial form of treatment and/or prevent from progress is intensification of metabolic control, minimalization of glucose fluctuations and achieve the normoglycemia. Laser coagulation and vitrectomy are also recommended, bearing in mind that their early performance gives better results. Intravitreal application of vascular endothelial growth factor (VEGF) antagonists and steroids has a positive impact on macular oedema. Read full text »

Carcinosarcoma Of The Uterus In A 30-year Old Patient – A Case Report

Abstract: Uterine carcinosarcoma is a very rare type of cancer. In most common cases it has poor prognosis, because it is discovered at an advanced stage. There is no specific test for this type of malignant neoplasm. We present an unusual case of uterine carcinosarcoma in a young patient. It was diagnosed accidentally after the pathological result of a cytological smear. The described case points at the usefulness of prophylactic examinations, as different types of malignancies can be detected in asymptomatic stages. Read full text »