Bilateral double-layered patella in a patient with advanced knee osteoarthritis.

Double layered patella (DLP) is a rare anomaly of the patella that may go undiagnosed, especially in patients with progressive knee dysfunction and early degenerative changes. Clinical symptoms such as motion-dependent pain and anterior knee pain most typically occur in adolescents or young adults; however, gradually increasing pain and early generalised degenerative changes have also been seen in patients over 40 years old. Diagnosis of DLP could be difficult, especially in cases with coexisting arthrosis. DLP is considered to be pathognomonic for the diagnosis of multiple epiphyseal dysplasia and usually coexists with other anomalies seen in this syndrome, such as hip dysplasia. In extremely rare cases, DLP can occur as a solitary disorder. The prevalence of such cases, however, is unknown, and they could be easily misdiagnosed. Computed tomography and magnetic resonance imaging are the most sensitive radiological methods used in DLP diagnosis. This case report presents a case of a bilateral DLP incidentally found in a 47-year-old patient with advanced arthritis referred for arthroplasty because of increasing symptoms of knee joint failure with no other abnormalities recorded. An important goal of our case study is to raise the awareness of this abnormality with radiologists and orthopaedic surgeons.

Coronary artery fistulas morphology in coronary computed tomography angiography.

BACKGROUND: The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula's morphology and other cardiac functional findings and clinical data. MATERIALS AND METHODS: A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals. RESULTS: Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients. CONCLUSIONS: Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.

Prevalence of Chlamydia trachomatis and herpes simplex virus 2 in cervical carcinoma associated with human papillomavirus detected in paraffin-sectioned samples.

PURPOSE: The aim of the study was to evaluate the frequency of occurrence of HPV and co-infection: Chlamydia (C.) trachomatis and HSV-2 in cervical cancer. MATERIAL AND METHODS: The study group consisted of 570 paraffin-sectioned samples of patients with cervical cancer. In order to identify viral and bacterial DNA in DNA isolated from archival, postoperative material, PCR analysis was performed using starters complementary to various types of HPV, HSV-2 and C. trachomatis. RESULTS: In patients with squamous cell cervical cancer the presence of 33 types of HPV was found in 90% (468/520). HPV 16 infections occurred in 69.4% (325/468), while HPV 18 infections were present in 30.5% (143/468) of cases. In the control group C. trachomatis and HSV-2 were observed in four cases (4/50), which constitute 8.0%. In the tissue sections from patients with squamous cell cervical carcinoma, C. trachomatis was identified in 26% (135/520) and HSV-2 in 28% (145/520). In the group of patients with adenocarcinoma C. trachomatis infections were found in 24% (12/50) and herpes virus was identified in 30% (15/50). Statistically significantly higher frequency of occurrence of HSV-2 and C. trachomatis was observed in paraffin-sectioned samples for patients with invasive cervical cancer compared to the control group, without neoplastic lesions (p < 0.05). No correlation was found between frequency of occurrence of HPV and C. trachomatis and of HPV and HSV-2 detected in paraffin-sectioned samples for cervical carcinoma.

A rare case of pregnancy and delivery of a healthy neonate by a woman with microprolactinoma and review of the literature.

A rare case of a term-pregnancy and delivery in a patient with microprolactinoma is presented. The patient had been treated with bromocriptine since she was 17 due to primary amenorrhea for 60 months with short intervals. Pharmacological tests with dopamine antagonists and X-ray diagnostics revealed the presence of microprolactinoma. The patient was constantly under specialist endocrinological care and the level of prolactin in her blood serum was continuously being monitored. After getting pregnant she was placed under strict gynecological scrutiny with special attention devoted to the developing fetus and possible congenital defects. The patient continued receiving bromocriptine therapy up to the 16th week of pregnancy. In the course of pregnancy in the 26th week, a circular suture was placed on the uterine cervix due to symptoms of isthmus-cervical insufficiency. In the 38th week of pregnancy a cesarean (C) section was performed and a healthy child in good general condition (Apgar score 10) was born. The child weighed 2,900 grams.

Influence of magnesium sulphate and isradipine on human placental cotyledon fetal vessels in vitro.

Increased systemic vascular resistance and blood pressure during pregnancy may be due to impaired prostacycline PGI(2)-thromboxan (TX) A(2) balance. The aim of the study was to compare the influence of magnesium sulphate and isradipine on the placental vascular resistance induced by stable thromboxan A(2) analogue U 46619 in experimental bilateral perfusion of the human placental cotyledon. The research used the experimental model described by Schneider et al. [Am. J. Obstet. Gynecol. 114 (1972) 822]. The control group consisted of six placental lobule perfusions lasting 120 min each. Constant increase in perfusion pressure of mean value 185% of the initial pressure was obtained from about the 60th min of the experiment and maintained till the end. Having obtained constant increase in perfusion pressure from the 60th min of the experiment, magnesium sulphate and isradipine were administered along with thromboxan A(2) analogue U 46619 into the fetal circulation. Both drugs lowered perfusion pressure, experimentally increased by thromboxan A(2) analogue U 46619. The onset of magnesium sulphate activity was quicker than isradipine. According to the results of our in vitro study, magnesium sulphate and isradipine may have a beneficial effect on vascular resistance of cotyledon vessels in PIH in vivo, too.

[Management and outcome of preterm labor in department of obstetrics and pathology of pregnancy school of medicine in Lublin]. / Metody rozwiazania porodów przedwczesnyciw materiale Kliniki Poloznictwa i Patologii Ciazy AM w Lublinie.

OBJECTIVES: We present data of three years experience of management and outcome of preterm labour. MATERIALS AND METHODS: The study comprised 335 pregnant women with preterm labour. We analyzed the pharmacological therapy and way of labour. There were two groups of patients: I group--180 patients who had cesarean delivery, II group--155 patients who had vaginal delivery. RESULTS: It has been found 7.54% more cesarean delivery than vaginal delivery of preterm labour.

[PCR and Digene Hybride Capture System I in identification of human papillomavirus]. / Zastosowanie metody PCR oraz Digene Hybride Capture System I do identyfikacji DNA wirusów Papilloma.

We have analyzed and compared two different systems used in identification of DNA HPV. 100 samples obtained from patients with I degree and II degree Papanicolaou smears and 200 from patients with cervical intraepithelial neoplasia were analyzed. The obtained data indicate higher sensitivity of the PCR method compared to Digene Hybride Capture System.

[Management and outcome of pregnancy in women with hypothyroidism--case report]. / Ciaza i poród u kobiety z wrodzona niedoczynnoscia tarczycy--opis przypadku.

We analysed the influence of congenital hypothyroidism, diagnosed in the third year of life, on the outcome of pregnancy. We observed the physiological progress of pregnancy and normal development of the foetus. We delivered newborn by caesarean section. We did not observe any disadvantageous influence of congenital hypothyroidism in the mother on newborn status. We analysed the pharmacological substitution and its influence on pregnancy outcome.

[Influence of captopril on hemodynamics of human placenta in vitro]. / Wplyw kaptoprilu na hemodynamike lozyska ludzkiego in vitro.

OBJECTIVES: Captopril, an agiotensin converting enzyme inhibitor (ACEI) is widely used drug in antihypertensive treatment. After maternal therapy with ACEI several adverse effects on fetus and neonate have been described but the patomechanism is not well known. DESIGN: The purpose of the study was to determine the effects of varying Captopril concentrations on the perfusion pressure in fetal vessels in the in vitro placental double-sided perfusion model. MATERIALS AND METHODS: Human placental cotyledons from term normal pregnancies were perfused with 100 ng/ml and 1000 ng/ml of Captopril. The perfusion pressure in fetal circuit in every 30 minutes of 3-hours experiment was measured. RESULTS: The highest mean perfusion pressure in fetal circuit was observed in placentas perfused with Captopril in the dose of 100 ng/ml, whereas Captopril in the dose of 1000 ng/ml significantly decreased perfusion pressure after 180 minutes of the experiment. CONCLUSION: The decrease in perfusion pressure in fetal vessels after relative high dose of Captopril may indicate its direct or indirect influence on capillaries.

[Analysis of twin pregnancies in material from the Department of Obstetrics and Pathology of Pregnancy in Lublin from 1991-1998]. / Analiza ciaz blizniaczych w materiale Kliniki Poloznictwa i Patologii Ciazy AM w Lublinie w latach 1991-1998.

The course of multiple pregnancies and multiple fetus labor were analyzed in 111 women delivered in the Department of Obstetrics, School of Medicine in Lublin in the years 1991-1998. It has been found that the most frequent patients were those aged 25-29 coming from the cities and after the infertility treatment. The aim of this research was to characterize twin pregnant patients, and present the outcome of multiple pregnancy. The studies were performed on 67 women from the cities and 44 women from the villages. It is significant that almost 55% pregnant women underwent the cesarean section and their average birth weight was 2490 g. These results indicate that multiple pregnancy is in high risk pregnancy.