Premature ovarian insufficiency: the context of long-term effects.

PURPOSE: Premature ovarian insufficiency (POI) is defined as the cessation of the ovarian function before the age of 40 years. POI aetiology may be related to iatrogenic or endogenous factors and in many cases remains unclear. The aim of this review was to characterize the long-term consequences of POI. METHODS: The available literature regarding the long-term consequences of POI from MEDLINE has been reviewed. RESULTS: Lack of ovarian steroids synthesis has serious consequences for women's health. The short-term effects are similar to spontaneous menopause and refer mainly to the climacteric syndrome. In a longer perspective, POI affects a variety of aspects. It obviously and drastically reduces the chances for spontaneous pregnancies. Oestrogen loss leads also to urogenital atrophy. The most common urogenital symptoms include vaginal dryness, vaginal irritation and itching. The urogenital atrophy and hypoestrogenism interferes also with sexual functioning. Patients with POI are threatened by a decrease in bone mineral density (BMD). POI women also experience psychological distress and some studies have shown an increased risk of neurodegenerating diseases. Overall, POI women have a shortened life expectancy, mainly due to cardiovascular disease. Some studies have reported a reduced risk of breast cancer in this group of patients. CONCLUSIONS: In conclusion there are several well-characterized health risks in POI women. With every patient, an individualized approach is required to properly recognize and prevent these risks.

System for objective assessment of fetal activity.

Fetal activity is an important indicator of fetal well-being. It is proposed to assess this activity using the pulsed wave Doppler method to collect fetal activity data and dedicated software for on-line processing. The system, addressed to 3rd trimester pregnancies, provides information on presence of pseudobreathing, the heart rate trace, the fetal movement trace, the movement velocity spectrogram, histograms of the velocity and acceleration of both the body movements and pseudobreathing, parameters of these histograms (mean values, standard deviations, shape descriptors), and cumulative counts of the velocity histograms. These parameters form the feature vector of the fetal activity. The system was validated by simultaneous echographic and cardiotocographic recordings and during oxytocin challenge tests. Feature vectors obtained from 1h recordings in 61 pregnancies were submitted to multivariate analysis of variance. Activity patterns of physiological cases and "borderline pathologies" were discriminated using reduced feature vectors, containing cumulative counts of velocity histograms.

Automatic detection of ultrasonic Doppler signal episodes resulting from fetal breathing movements.

A method for automatic detection of fetal breathing movements has been proposed, based on the time-frequency structure of the corresponding continuous wave ultrasonic Doppler signals. The method uses spectral analysis of the envelope of the directional Doppler signal and cross-correlation analysis of both directional envelopes. Detection rule comprises the following criteria: presence of the peak in the envelope spectrum and of the adequate signal level in the frequency range corresponding to the fetal breathing rhythm, the peak value and the position limits of the peak of the cross-correlation coefficient of the both directional envelopes. The effect of the criteria setting on the rule performance and the tradeoff between the specificity and sensitivity was investigated. The rule is most sensitive to the threshold value of the cross-correlation coefficient of the envelopes. The limits of the position of this peak are crucial for the distinction between the breathing episodes and hiccups. The optimal settings of the criteria, resulting in average sensitivity and specificity exceeding, respectively, 0.70 and 0.80, are proposed.

Alpha-hydroxybutyrate dehydrogenase activity in intrahepatic cholestasis of pregnancy.

OBJECTIVES: Intrahepatic cholestasis of pregnancy (ICP) is associated with increased perinatal mortality and morbidity. Alpha-hydroxybutyrate dehydrogenase (alpha-HBDH) is an enzyme that originates in the cytoplasm of hepatocytes and can be detected in the serum. The aim of this study was to determine the characteristics of alpha-HBDH activity in ICP. METHODS: The study included 100 women in their third trimester of pregnancy, 58 of whom had ICP (the study group) and 42 were healthy (the control group); another group, 26 nonpregnant women, was also analyzed to follow changes in alpha-HBDH activity during pregnancy. The concentrations or activity of fractionated bilirubin; bile acids; total alkaline phosphatase; alanine and aspartate aminotransferases; total high-density and low-density lipoprotein cholesterol; triglycerides; total protein; and alpha-HBDH were assessed. RESULTS: The activity of serum alpha-HBDH is increased during the third trimester of pregnancies complicated by ICP, and it correlates positively with total and direct bilirubin concentration and total alkaline phosphatase activity. CONCLUSIONS: Alpha-hydroxybutyrate dehydrogenase serum activity seems to be another biochemical parameter useful in the assessment of ICP severity.

Calcium-phosphorus-magnesium homeostasis in pregnant women after renal transplantation.

OBJECTIVE: The aim of the study was the assessment of calcium-phosphorus-magnesium homeostasis in pregnant women after renal transplantation. METHODS: The study covered 64 pregnant women in the third trimester of gestation including: 33 women after renal transplantation (the study group) and 31 healthy pregnant women (the control group). Women from both groups were at the similar age: 30.8+/-4.7 vs. 31.3+/-5.0 years (NS) and at the same gestational age 34.8+/-2.4 vs. 35.3+/-2.6 weeks (NS). The mean body mass index (BMI) in the women from the study group before pregnancy was 21.49+/-2.81 vs. 22.1+/-3.02 in the control group (NS), BMI before delivery was 25.43+/-3.05 vs. 26.0+/-3.35 (NS), the percentage of the BMI increase during pregnancy was 18.7+/-7.68 vs. 17.65+/-7.13 (NS) and BMI increase during gestation was 3.93+/-1.56 vs. 3.90+/-1.54, respectively (NS). Arterial blood pressure at the time of blood samples collection for biochemical tests was 151.4+/-26.8/92.5+/-16.9 in women from the study group comparing to 115.0+/-6.0/68.0+/-7.0 mmHg (P<0.001) in the patients from the control group. The maximal blood pressure during pregnancy was 169.2+/-20.7/102.7+/-14.0 vs. 118.0+/-7.0/70.0+/-8.0 mmHg (P<0.001), respectively. We estimated serum levels of: total Ca, ionized Ca(2+), inorganic phosphorus (P(i)), Mg, total protein, albumin and blood morphology. Moreover, urine levels of Ca, P(i), Mg and protein were assessed. RESULTS: The pregnant women after renal transplantation presented increases in serum concentrations of total Ca (2.54+/-0.20 vs. 2.16+/-0.10 mmol/l; P<0.001) and ionized Ca(2+) (1.322+/-0.104 vs. 1.12+/-0.07 mmol/l; P<0.001) and the decrease in P(i) level (1.013+/-0.211 vs. 1.10+/-0.16 mmol/l; P<0.05), total protein (59.3+/-7.0 vs. 65+/-5 g/l; P<0.001) and albumin (461.6+/-65.65 vs. 493.2+/-59 micromol/l; P<0.05). Moreover, in the study group drop in red blood cells count to 3.71+/-0.56 vs. 4.01+/-0.35 x 10(12)/l (P<0.02) in the control group was detected. Despite increased volume of 24-h urine collection in the kidney recipients we observed significantly decreased urine 24-h calcium excretion 2.47+/-0.92 vs. 6.72+/-3.49 mmol (P<0.001) and simultaneous increase in urine Mg excretion 3.422+/-1.025 vs. 2.18+/-0.52 mmol/24 h (P<0.001). There was no difference in urine 24-h P(i) excretion between the study and the control group. The pregnant renal transplant recipients presented proteinuria of 1.19+/-1.9 g/24 h. CONCLUSIONS: Women after kidney grafting present vital aberrations in calcium-phosphorus-magnesium homeostasis during pregnancy. The most significant changes are associated with calcium metabolism (high increase in serum Ca levels and impairment of renal elimination of calcium). The observed changes may be influenced by the doses of immunosuppressive agents and disturbed renal function.

[Initial analysis of chocolate cysts operated on by laparoscopy]. / Wstepna analiza torbieli czekoladowych operowanych laparoskopowo.

53 women with an ovarian chocolate cyst were operated in a laparoscopy. A histopathological examination showed 60.4% of endometriomas and 39.6% of hemorrhagic lutein cysts. The average age of patients with endometriomas was 33.9 while of the ones with hemorrhagic lutein cysts was 28.6. The operated patients, who were under 35 years old, could be divided into halves, one half of them had endometriomas while the other half had hemorrhagic lutein cysts. However, endometriomas appeared significantly more often in the group of operated patients who were older than 35 years old.

Teletransmission system supporting intensive insulin treatment of out-clinic type 1 diabetic pregnant women. Technical assessment during 3 years' application.

A telematic system supporting intensive insulin treatment of pregnant type 1 diabetic out-clinic patients was implemented and technical efficiency of the system was evaluated over long-term ambulatory application. The system consists of a patient teletransmission module (PTM) and a central clinical control unit (CCU). The PTM contains a one-box blood glucose meter and electronic logbook, a modem and a dial-up or cellular phone set. The CCU consists of a PC computer with a modem and DIAPRET - an original program designed to monitor the intensive insulin treatment. The system was installed in the Clinic of Gastroenterology and Metabolic Disease, MA Warsaw and was tested for 166 +/- 24 days on 15 pregnant type 1 diabetic women. Telemonitoring of the patient data was done automatically. No major technical problems with proper operation or handling of the system was noted. Total effectiveness was 69.3 +/- 13.0% and technical effectiveness 91.5 +/- 6.1%. The efficacy of the system was not significantly influenced by patient intelligence level, education level or place of residence (p < 0.05). Significant improvement of metabolic control was noted during application of the system. In conclusion, the telematic system we developed and implemented should have a positive influence on the quality of diabetes treatment during pregnancy.

[The influence of chosen hormones on lipids and its correlation during normal pregnancy]. / Wplyw niektórych hormonów na lipidy oraz ich korelacja podczas przebiegu prawidlowej ciazy.

OBJECTIVES: Lipids and hormones levels in nonpregnant and pregnant with uneventful gestation (from I, II, III trimester) were estimated and its correlation was evaluated. METHODS: The study group consisted of 219 women: 49 nonpregnant and 170 pregnant women (35 in I trimester, 35 in II and 100 in III trimester of gestation). All subjects were healthy. Following parameters were measured in blood serum: total lipids, LDL total fraction, (beta-lipoproteids), cholesterol both total and free, HDL cholesterol, LDL cholesterol. Percentage of free cholesterol contained on total cholesterol was evaluated. HPL and estrogens levels were estimated. RESULTS: Serum levels of total lipids, phosphlipids, triglicerides, total fraction of LDL and its contains of cholesterol increase with gestational age (p < 0.001). During pregnancy positive correlation between estrogens, HPL and triglycerides was also observed (p < 0.001). Additionally in II trimester positive correlation of total cholesterol, phospholipids and HPL was noted (respectively r = 0.469 p < 0.001 and r = 0.452 p < 0.01). CONCLUSIONS: In case of women with uneventful pregnancy positive correlation between estrogens and total lipids, total fractions LDL and triglycerides was stated. Also positive correlation among lipids parameters and HPL concentration was noted. No correlation between HPL and free cholesterol, LDL, HDL cholesterol nor between estrogens and total cholesterol, free cholesterol and LDL cholesterol was found. Lipids status in case of nonpregnant women is multihormonaly influenced.

[Diagnostic values of lactate dehydrogenase (LDH), creatine kinase (CK) and gamma-glutamyltransferase (gamma-GT) examinations in the course of intrahepatic cholestasis in pregnancy]. / Wartosc diagnostyczna oznaczenia aktywnosci dehydrogenazy mleczanowej (LDH), kinazy kreatynowej (CK) i gamma-glutamylotransferazy (g-GT) podczas wewnatrzwatrobowej cholestazy ciezarnych.

OBJECTIVE: The activity of LDH, CK and gamma-GT in blood serum of women with intrahepatic cholestasis in pregnancy was investigated. Diagnosis of intrahepatic cholestasis was based on anamnesis, clinical examination and laboratory tests. METHODS: 41 women with intrahepatic cholestasis (the study group) and 30 healthy women (the control group) entered the study. All women were in the third trimester of pregnancy. The prevalence rate of intrahepatic cholestasis in pregnancy in our Department is 1%. All women of the study group presented an intensive pruritus and had negative hepatitis B antigen. They also presented negative results of laboratory tests, clinical examination and anamnesis concerning other hepatitis. RESULTS: There was no significant difference in mean gestational age between study and control group (35.1 +/- 2.8 vs 36.0 +/- 3.0 weeks). The results of biochemical tests in study vs control group: 1) total bilirubin 33.3 +/- 18.8 vs 8.55 +/- 3.4 mumol/L; p < 0.001, 2) direct bilirubin 25.6 +/- 14.2 vs 1.7 +/- 1.7 mumol/L; p < 0.001, 3) indirect bilirubin 7.7 +/- 2.22 vs 8.5 +/- 3.4 mumol/L; NS, 4) alkaline phosphatase (AP) 168.4 +/- 61.2 vs 96.8 +/- 14.9 IU/L; p < 0.001, 5) heat-stable AP 99.8 +/- 38.7 vs 64.1 +/- 20.9 IU/L; p < 0.001, 6) bile acid 28.6 +/- 20.0 vs 4.5 +/- 1.5 mumol/L; p < 0.001, 7) AlAT 158 +/- 00 vs 5 +/- 3 IU/L; p < 0.001, 8) AspAT 97 +/- 31 vs 8 +/- 3 IU/L; p < 0.001, 9) de Ritis ratio AspAT/AlAT 0.61 +/- 0.31 vs 1.6 +/- 0.4; p < 0.001, 10) total protein 61.8 +/- 5.6 vs 66.0 +/- 6.0 G/L; p < 0.001, 11) albumine 450 +/- 34.8 vs 484.0 +/- 37.7 mumol/L, 12) Fe++ 26.0 +/- 3.8 vs 12.71 +/- 2.15 mumol/L; p < 0.001, 13) total cholesterol 8.81 +/- 1.87 vs 6.68 +/- 1.04 mmol/L; p < 0.001, total LDL 6.80 +/- 1.57 vs 4.80 +/- 0.81 G/L; p < 0.001, 15) LDH 211 +/- 48 vs 134 +/- 33 UI/L; p < 0.001, 16) CK 51.0 +/- 33 vs 45 +/- 14 UI/L; NS, 17) gamma-GT 49 +/- 22 vs 23 +/- 8 UI/L; p < 0.001. CONCLUSIONS: An increase of LDH is related to the significant impairment of hepatocytes. An increase of gamma-GT confirms the retention of bile in intrahepatic ducts. CK does not present prognostic value in intrahepatic cholestasis in pregnancy.