Prenatal and early childhood development of gut microbiota.

OBJECTIVE: Gut microbiota provide a diverse "organ" or biocenosis responsible for protection against pathogens and the development of both intestinal and immune systems. Microbiota are also responsible for the synthesis of vitamins and short-chain fatty acids, which in turn affect the host's metabolism. It was hypothesized that gut microbiota are influenced by fetal life followed by intensive development throughout the first years of life. MATERIALS AND METHODS: We analyzed the available literature (PubMed, Embase, Google Scholar) on prenatal and early childhood development of gut microbiota. RESULTS: A body of evidence suggests in utero colonization. The main factors determining gut microbiota include the type of delivery and post-natal feeding method. The composition of the intestinal flora is also influenced by fetal age at birth, antibiotic therapy, pre- and probiotic supplementation, and other environmental factors. The multifaceted nature of this process guarantees the uniqueness of its composition for each human being. CONCLUSIONS: Although the composition of intestinal microbiota is subject to continuous and dynamic changes, it seems that the perinatal period is critical for the emergence of its proper pattern, which may guarantee health or otherwise illness in adult life.

Intraepithelial neoplasia and early stage vulvar cancer. Epidemiological, clinical and virological observations.

OBJECTIVE: Evaluation of vulvar intraepithelial neoplasia (VIN) and early vulvar cancer risk factor occurrence, frequency, localization and development. STUDY DESIGN: A clinical study carried out on 293 women aged 23-76 years with VIN and vulvar cancer stage I and in a control group of 115 cytologically and colposcopically negative women. METHODS: Clinical, colposcopic and morphological evaluation of the localization of VIN and vulvar carcinoma stage I concomitant with intraepithelial neoplasia in other parts of the lower genital tract. Anamnestic inquiry regarding risk factors. In situ hybridisation technique for HPV detection. Thomson's method for blood serum vitamin A level assessment. RESULTS AND CONCLUSION: An increased frequency of VIN and Ca stage I, especially in young women, has been observed in the past 15 years. In a group of young women under 45 years of age, those lesions were multifocal in 43 cases (63.2%), and unifocal in 25 patients (36.8%). In women over 45 years of age, multifocal lesions occurred in 35 (31.8%), and unifocal in 75 patients (68.2%). HPV infections concomitant with VIN and vulvar cancer stage I occurred in 61.5% of young women and in 17.5% of older females. VIN and stage I vulvar carcinoma coexisted with cervical intraepithelial neoplasia and cervical and/or vaginal cancer in 14 women (7.9%). The risk factor for VIN and early vulvar carcinoma occurrence in young women was different than in older patients. Long-term follow-up of VIN 1 and VIN 2 showed that in over 1/3 of cases the lesions were persistent or recurred after a transient remission. Progression depended not only on dysplasia stage, but also on histological pattern.

[Incidence of precancerous states an carcinomas of the vulva in young women]. / Wystepowanie stanów przednowotworowych i nowotworów zlosliwych sromu u kobiet mlodych.

Frequency of precancerous and malignant neoplasms in young (under 45 y.) women in last 20 years has been analysed in the work. There have been analysed VIN and invasive carcinoma progression, localization, coexistence of HPV infection together with intraepithelial neoplasia within uterine cervix and vaginal mucosa. 50% increase of VIN and vulvar cancer, especially in young women during last 10 years has been found. Earlier clinical stadium of vulvar carcinoma is usually found in this group of women compared with older ones. There has been found high percent of multi-focal localization of the vulvar changes in younger patients, especially as far as VIN is concerned. It is often accompanied by HPV infection (60.5%), and rarely by dystrophic changes (20.6%). 11.8% coincidence of cervical intraepithelial neoplasia and vaginal intraepithelial neoplasia, mostly accompanied by HPV, with VIN and vulvar cancer, has also been found.

[Intrauterine pregnancy complicated by coexisting ectopic pregnancy]. / Ciaza wewnatrzmaciczna powiklana równoczesna ciaza jajowodowa.

Authors have presented the case of coexisting 11 week intrauterine and ectopic pregnancies in the 25 years old woman, which had earlier been operated on the left ovary dermoid cyst. That operation could be regarded as an ectopic pregnancy risk factor, but the suspicion of an ectopic pregnancy has been suggested only by physical examination, and sonography and laparoscopy were most important in final diagnosis. Ectopic pregnancy has been removed by laparotomy according to the progression of the disease. The case has drawn the attention to the necessity of thorough diagnosis in pregnant women particularly in those ones with lower abdominal pain in early pregnancy and with unfavorable gynaecological and obstetric past, for example appendages operation such as in our case. It was also been emphasized, that the complex diagnosing of patients with already recognized ectopic pregnancy should be proceeded. Sonography, especially the one equipped with the endovaginal probe, plays the most important part in diagnosing. In some questionable cases laparoscopy, along with diagnostical significance, also makes the surgical treatment possible.

[An enormous oviduct hematoma coexisting with a residual uterus horn in an adolescent]. / Olbrzymi krwiak jajowodu wspólistniejacy z rogiem szczatkowym macicy u nastolatki.

The case of tremendous salpinx hematoma coexisting with a residual uterus horn has been described. A menstrual blood from the little cavity of residual horn filled progressively the salpinx, which had abdominal ostium closed. A congenital malformation, in consequence of Muller tubes defective development, has been a direct cause of the disease. The ethology of the malformation has not been found. Primary diagnosis suggested an ovarian cyst or a malignant tumour. Neither physical examination nor USG made the diagnosis easier. The case has showed, how difficult the recognition of pelvic tumours in young women is. Sonography may be very helpful in diagnosing of such malformations but in early stages only.

Critical assessment of the Amerlite free T4 assay.

The measurement of serum free T4 (FT4) by analogue methods has been severely criticised because the T4 analogue binds to albumin. Amersham have recently introduced a method utilising horseradish peroxidase-labelled-T4 (HRP-T4) designed to overcome this problem and have incorporated it into the Amerlite enhanced luminescence immunoassay system. We have critically evaluated this method for its analytical and clinical validity. Experiments in which anti-albumin was added to normal serum suggested that the HRP-T4 label did not bind to endogenous albumin while the addition of albumin caused no significant change in FT4 concentration. Adding oleic acid up to 5 mmol/L to simulate increased non-esterified fatty acid concentration did not increase the apparent FT4. Serum sampled from subjects independently allocated to clinical groups were compared with an euthyroid group. The untreated hyperthyroid group values were distinctly elevated while the untreated hypothyroid group were appropriately low. Oestrogen therapy, low TBG, familial dysalbuminaemic hyperthyroxinaemia and non-thyroidal illness groups all reflected their euthyroid status, as did pregnancy samples which also showed a tendency to lower values in late pregnancy, consistent with previous observations. In conclusion, the Amerlite FT4 method appears to overcome some of the problems associated with analogue methods. A small survey showed it to be diagnostically valid in a wide variety of clinical states.

Evaluation of Ketostix for plasma acetoacetate.

Acetoacetate in plasma is measured conveniently by Ketostix (Ames, Miles Laboratories, Elkhart, IN), a reagent strip test. The color formed on the reactive tip by the acetoacetate after 15 seconds is compared with the color chart provided for quantitation. When the concentration is between 4 to 12 mmol/L, the authors recommend a reassay using a diluted sample and both results averaged. Results thus determined agreed well with those obtained by a GC method. Analyst bias in color matching is not a serious problem. Ketostix stability and user performance are discussed in relation to quality control.