[Fetal ventriculomegaly secondary to germinal matrix hemorrhage--case report]. / Wentrikulomegalia w nastepstwie przebytego krwawienia do istoty zarodkowej mózgu plodu--opis przypadku.

A germinal matrix is an area of the fetal brain where neuroblasts proliferate till the 20th week of gestation after which their migration takes place. Germinal matrix hemorrhage (GMH) is a frequent cause of fetal ventriculomegaly or hydrocephalus, yet the pathophysiological conditions of GMH remain unclear. A case of fetal ventriculomegaly resulting from GMH has been reported in the article. A prenatal ultrasonographic examination (US) carried out in the 30th week of gestation revealed enlarged ventricles. Utero magnetic resonance imaging (MRI) performed in the 34th week of gestation demonstrated asymetric ventriculomegaly and the changes suggesting the occurance of GMH and ependymal intraventricular hemorrhage. Fetal ventriculomegaly and hydrocephalus are commonly detected by ultrasonographic examination, but it is often difficult to determine the causes of the diseases by US. In these cases MRI allows to establish the final diagnosis.

[Peritoneal tuberculosis mimicking ovarian cancer--diagnostic difficulties. Two cases reports]. / Gruzlica otrzewnej czy rak jajnika--trudnosci diagnostyczne. Opisy dwóch przypadków.

Tuberculosis, and specially its extrapulmonary location still causes diagnostic difficulties. In 2007, in Poland 7.3% of newly registered cases of tuberculosis in Poland were located extrapulmonary. Peritoneal tuberculosis is often wrongly diagnosed as an ovarian cancer, it is due to similar symptoms like abdominal pain, abdominopelvic masses, ascites and elevated serum CA-125. Two patients who were admitted to our department with suspicion of ovarian cancer are presented. Subjective symptoms suggested the ovarian cancer, elevated levels of CA-125, chest x-rays without abnormal findings or with minimal fibrotic changes and uncharacteristic results of additional investigations were disclosed. A diagnostic laparoscopy was made to establish the diagnosis. Because of clinical and operative picture suggesting ovarian cancer in both cases resections were performed. The procedure consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy. Biopsy specimens were taken up and verified histopathologically. The peritoneal tuberculosis was recognized in both cases.

Allergen immunotherapy in intermittent allergic rhinitis reduces the intracellular expression of IL-4 by CD8+ T cells.

BACKGROUND: T helper subset dysregulation is evident in allergic disorders. The role of T cytotoxic subsets is less understood. We investigated whether allergen immunotherapy in intermittent allergic rhinitis influences the intracellular expression of IL-4 and IFN-gamma by CD3+CD8(-) and CD3+CD8+ cells. METHODS: Nineteen adult patients with intermittent allergic rhinitis were evaluated before the pollen season, and then after one preseasonal course of subcutaneous allergen immunotherapy. Twelve healthy nonatopic patients matched for age and sex served as controls. Intracellular expression of IFN-gamma and IL-4 by CD3+CD8(-) (Th1 and Th2, respectively) and CD3+CD8+ (Tc1 and Tc2, respectively) was estimated by flow cytometry in peripheral blood cells after stimulation with PMA and ionomycin. RESULTS: Before immunotherapy the percentages of Th1, Th2, Tc1 and Tc2 did not significantly differ between the patients and the controls. After immunotherapy the percentage of Tc2 was lower in the rhinitic patients than in the controls (0.38% vs. 0.45%, p=0.04). The percentage of Tc2 cells decreased significantly after immunotherapy in the intermittent allergic rhinitis group (0.64% vs. 0.38%, p=0.02) with tendency to decrease in ratios of Tc2/Tc1 (p=0.059) and with no changes in ratios of Th2/Th1. The percentages of Th1, Th2 and Tc1 were comparable before and after immunotherapy within the rhinitic patient group. CONCLUSIONS: The preseasonal allergen subcutaneous immunotherapy applied to intermittent allergic rhinitis patients suppressed the percentage of IL-4 producing CD3+CD8+ cells. Decreased number of CD3+CD8+IL-4+ cells may participate in the regulatory mechanisms of immunotherapy.

Pruritic urticarial papules and plaques of pregnancy.

Pruritic urticarial papules and plaques of pregnancy (PUPPP) are among the most common pruritic dermatoses observed in pregnant women. PUPPP appears most frequently in the third trimester, in primigravidas, and in multiple gestation pregnancies. The eruption of changes occurs initially on the abdomen and extends over the thighs, legs, back, buttocks, arms, and breasts. Skin changes typical for PUPPP are erythematous, urticarial plaques, and papules. Rash regression is usually observed within 6 weeks postpartum. Immunologic mechanisms, hormonal abnormalities, and abdominal skin distension have been suggested as etiologic mechanisms. PUPPP is thought to be harmless for the mother and fetus and usually requires intervention only for symptom relief. In some cases, laboratory investigation, histologic examination, and immunologic study should be performed to exclude more serious disorders of pregnancy, such as herpes gestationis or intrahepatic cholestasis of pregnancy. This article reviews the epidemiology, clinical manifestation, etiology, differential diagnosis, and treatment of PUPPP.