Determinants of favourable neonatal outcome after premature rupture of membranes (PROM) before 24 weeks of pregnancy--review of the literature and a case report.

OBJECTIVES: Premature rupture of the membranes (PROM) in pregnancy refers to rupture of membranes of the amniotic sac and chorion. The aim of the study was to review the literature and analyze the course of pregnancy (primipara) complicated by the premature rupture of the membranes, and consequent loss of amniotic fluid after 19 weeks of gestation. STUDY DESIGN: A 27-year old primiparous patient was admitted to the Gynaecology and Obstetrics University Hospital in Poznan on 9 December 2010, due to suspected premature rupture of the membranes. On presentation, foetal development was at 19 weeks gestation. Standard clinical investigations included ultrasonography, amniotic fluid index measurements and laboratory blood tests. RESULTS: Ultrasonography confirmed the size of the foetus to be normal for the gestational age. However, no amniotic fluid pockets were visible and the amniotic fluid index was 0 cm. The patient was hospitalized on multiple occasions and as a result a decision was made to end the pregnancy prematurely by means of a caesarean section at 32 weeks of gestation. Longer-term observation of the newborn indicated that one year following delivery, the development of the baby was normal, and thus far no neurological injuries or complications have been observed. CONCLUSION: The pregnancy was ultimately successfully completed with the delivery of a healthy newborn at 32 weeks of gestation. A regime involving rigorous bed rest and antibiotic administration can positively extend the duration of pregnancies complicated by premature rupture of the membranes.

Leiomyoma cellulare in the broad ligament of the uterus--case report and review of literature.

UNLABELLED: Myomas are most often benign tumours of the female genital tract. Uterine fibroids are the most common myomas, while uterine cervix and intraligamentary ones are statistically less frequent. The most common histopathological form is the leiomyoma and the least common is the cellular leiomyoma (< 5%). OBJECTIVES: As emphasized in the introduction, interlamellar parametrial cellular leiomyomas are extremely rare. Leiomyoma cellulare in the broad ligament of the uterus is the first case of that, therefore, the following situation deserves a short analysis and publication. MATERIAL AND METHODS: A 29-year-old patient was admitted to the Obstetrics and Gynaecology Clinic in Poznan due to a diagnosed lesion in the broad ligament of the uterus, possibly a myoma of the female genital tract. Cancer Antigen (CA) 125 level was 10.14 U/ml, beta sub-unit of human chorionic gonadotropin (beta- HOG) was 0.1 mIU/ml, acute-phase protein was (CRP) 0.09 mg/l. The technique of laparoscopic myomectomy by enucleation of a 6-cm in diameter myoma was used after preparation of the right parametrium tissue. The patient left the hospital on the second postoperative day in good overall condition. RESULTS: Histopathology revealed leiomyoma cellulare oedematosum. CONCLUSIONS: The above description of CL in the broad ligament of the uterus is a highly unique case and thus, deserves some attention, a short analysis.

[The use of therapeutic whole body cooling in treating hypoxic-ischemic encephalopathy in the newborn--the first case in Poland]. / Pierwszy przypadek w Polsce zastosowania hipotermii leczniczej calego ciala w leczeniu encefalopatii niedotlenieniowo--niedokrwiennei u noworodka.

Hypoxic-ischemic encephalopathy (ENN) concerns neonates born after 35 completed weeks of gestation. The incidence rate has been shown to be 1-6/1000 births and can lead to significant permanent neurological damage, cerebral palsy and even death. Until the whole body cooling and selective brain cooling methods have been accepted, the treatment of children with ENN was only symptomatic. The article describes the first case of ENN neonatal treatment with the whole body hypothermia in Poland, which took place at the Department of Neonatology Poznan University of Medical Sciences. Currently both methods--whole body hypothermia and selective brain cooling--offer a chance for a normal neurological development and a better life for children born with ENN. Both methods are accessible in a few centers in Poland.

Do soluble p55 and p75 TNF-α receptor concentrations play a role in women with primary sterility?

INTRODUCTION: In modern medicine the cause of infertility is believed to be immune mechanism disorders as well as immune over-reactivity. The objective of this thesis is to evaluate the diagnostic usefulness of measuring the concentration of soluble TNF-α receptors p55 and p75 in women with primary infertility. MATERIAL AND METHODS: EXAMINATION SUBJECTS: 41 female patients with primary sterility in the period January-September 2005. The control group consisted of 13 female patients. For identification of soluble receptors' p55 and p75 TNF-α concentration was used commercial ELISA kits. Quantitative in vitro method of hormone identification in blood serum of plasma (ECLIA) has been used to estimate hormone concentration. Results have been analyzed with Student's t-test, Wilcoxon's test, Fisher's exact test and Spearman's test. P value<0.05 was considered significant. RESULTS: There is no significant statistical relation between concentration of soluble p55 and p75 TNF-α receptors and age, BMI index, or length of periods. In the case of soluble p75 TNF-α receptor a statistical correlation with length of period was found (p = 0.004). From the statistical point of view, the most advantageous relation was found in the case of p75 TNF-α soluble receptor and thickness of endometrium (p = 0.007) as well as the correlation of p55/p75 soluble receptors (p = 0.05). The statistical analysis of correlations between TNFR1 and TNFR2 receptors and concentration of hormones FSH, LH, PRL, E2 and testosterone showed no dependence of TNFR1 and TNFR2 receptor concentrations and concentrations of examined hormones. Statistical analysis of relations of TNFR1/TNFR2 receptor concentrations revealed a significant correlation between these receptors and concentration of LH (p = 0.05). CONCLUSIONS: The correlation between endometrium thickness, size of dominating vesicle and concentration of LH compared to concentrations of soluble TNF-α?receptors p55 and p75 and their ratio might condition the time of survival of the vesicle or lead to excessive expression of its atresion-leading conditions.