Threshold values of maternal blood glucose in early diabetic pregnancy--prediction of fetal malformations.

BACKGROUND: The prevention of congenital malformations in the newborns of diabetic mothers still constitutes one of the main problems in this group of patients. AIM: The aim of this study was to analyze the prevalence of fetal malformations in diabetic pregnancies, as well as detection of the cut-off points for the first-trimester glycemia levels, relating to diabetes-induced fetal malformations. METHODS: The data for analysis were collected retrospectively from the case histories of diabetic pregnant women and their newborns, treated in our departments. For the evaluation of maternal diabetes control, the whole-day glycemia profiles as well as glycated hemoglobin (HbA1C) levels were registered. To establish the glucose cut-off values for malformations, we have used receiver operating characteristic (ROC) curves for fasting, 1-hr, and 2-hr postprandial glucose levels. To determine how metabolic control influences the risk of giving birth to a malformed infant, we followed 198 newborns of diabetic mothers and 4700 infants born of healthy mothers (control group). RESULTS: We detected malformations in the infants of 8.6% (n = 17) of diabetic mothers and 3.8% of the control (odds ratio: 2.35, 95% CI = 1.40-3.96). We compared this group of diabetic patients to another diabetic pregnancy group, analyzed over a period of 1988-93 (n = 209), in which 13 newborns (6.2%) manifested congenital malformations (odds ratio: 1.41, 95% CI = 0.67-2.99) (the difference was statistically insignificant). HbA1C level during organogenesis was not significantly higher in women whose infants were malformed. We proved, however, that the risk of malformations was higher, when HbA1C value exceeded 9.3%. The malformation rate in diabetes classes D-H (according to White) was higher than in classes B and C, but the difference was not significant. A wide spectrum of anomalies has been observed in the newborns of diabetic mothers. CONCLUSIONS: Our results confirm the view that diabetic pregnancy, despite the improved metabolic control, is still a strong risk factor for alterations in fetal development, particularly in patients with a tendency to brittle glycemia during first trimester of pregnancy. It seems that keeping fasting glucose levels in first trimester below 5.8 mmol/l and postprandial glucose levels below 9.1 mmol/l can contribute to decreasing number of fetal malformations in pregestational diabetes mellitus (PGDM) pregnancy. The ROC curves appear to be useful and adequate tool for the analysis of factors influencing fetal development in diabetic pregnancy.

[Addition for treatment of orbital complications in paranasal sinuses diseases]. / Przyczynek do leczenia zatokopochodnych powiklan oczodolowych.

During the years 1990-92 three patients with dynamically developing paranasal sinuses infections and orbital complications were treated in ENT Department of Medical Academy in Cracow. In two cases sinuses were early opened and drained, resulting in improvement in local and main status of the patients. Delayed surgical treatment in third patient caused visual loss in ipsilateral side. Indications for sinuses opening were based on the CT examination.

[Exposure to beta-naphthylamine in the Polish industry]. / Narazenie na beta-naftyloamine w polskim przemysle.

Data on occupational exposure to beta-naphthylamine obtained from Departments of Occupational Hygiene in Sanitary-Epidemiological Stations have been verified. The verification implied that this compound may occur in air only at the production of phenyl-beta-naphthylamine and in few research laboratories where exposure bears no industrial nature. The exposure to beta-naphthylamine at the production of phenyl-beta-naphthylamine was evaluated. The studies demonstrated that beta-naphthylamine occurs in air only at scaling of phenyl-beta-naphthylamine and its concentration does not exceed 0.0024 mg/m3.

[Evaluation of occupational exposure to tetrachloroethylene (PER) in a dry cleaning business]. / Ocena narazenia zawodowego na czterochloroetylen (PER) w pralniach chemicznych.

In eleven chemical laundries, occupational exposure to perchloroethylene (PER) has been evaluated. The examinations have been carried out with the personal dosimetry technique and involved 99 workers, performing different occupational tasks. Exposure of a magnitude varying with particular occupational groups have been indicated by 253 personal measurements taken. Most exposed to PER have been machine set operators and maintenance technicians. Time-weighted average (8h) concentrations of PER in the breathing zone were, on average, 142 mg/m3 in the machine set operators and 91.8 mg/m3 in maintenance technicians groups.

Experimental studies on the chronic toxic effects of vinyl chloride in rats.

Male rats were exposed to vinyl chloride at the concentrations of 50, 500, and 20 000 ppm, 5 hours daily, 5 days a week for 10 months. Morphological lesions in the liver and the testes detected by light and electron microscope and depression in body weight increase intensified with the duration of exposure. Increased relative weights of some organs and slight hematological and biochemical changes in blood during the course of the experiment were also observed. Some toxic effects including morphological liver injuries arose at the smallest exposure level, i. e., 50 ppm. Assuming 50 ppm as the threshold concentration for rats, the 5 ppm level has been estimated as the safe exposure limit in industry in relation to systemic effects of vinyl chloride.

Urinary excretion of thiodiglycollic acid and hepatic content of free thiols in rats at different levels of exposure to vinyl chloride.

In order to assess the process of oxidation and conjugation involved in biotransformation of vinyl chloride (VC), rats were exposed to 50, 200, 500, 1000 and 20,000 ppm inhaled VC. The rate of urinary excretion of thiodiglycollic acid (TDGA) after exposure to each investigated concentration of VC depends on the activity of microsomal monooxygenase. In general, higher levels of TDGA in urine were reflected by a more significant depression of non-protein sulfhydryl content in the liver of rats, whereas no changes were observed in those with inhibited activity of microsomal monooxygenase and depressed urinary levels of TDGA. The significance of alcohol dehydrogenase in the metabolism of low concentrations of VC has not been confirmed. Metabolism of VC in the range of 50--2 000 ppm is mediated by microsomal monooxygenase followed by conjugation with thiols.