[Placental mesenchymal dysplasia]. / Mezenkhimal'naia displaziia platsenty.

OBJECTIVE: To carry out a clinical and morphological analysis of 6 cases of placental mesenchymal dysplasia (PMD) that is not associated with Beckwith-Wiedemann syndrome. MATERIAL AND METHODS: Medical records, placental macroscopic and microscopic changes, histochemical (MSB staining) and immunohistochemical studies of placental tissue with antibodies against p57, CD34, smooth muscle actin, desmin, and Ki-67 were analyzed. RESULTS: Vascular anomalies in the chorionic plate and stem villi, the increased size and edema of the stem villi during normal formation of the terminal branches of the villous tree, the lack of proliferation of villous trophoblast were the typical signs of PMD and were noted in all cases. Comparison of the results of ultrasonography with the morphological pattern of the disease suggested that there were ultrasound signs that were typical of PMD. The characteristics of the course and outcomes of pregnancy in PMD were given. The features of morphological changes in the presence of PMD concurrent with preeclampsia were found. Significant variability in p57 expression in PMD was shown and variants of changes given. There were no substantial features of the expression of desmin and smooth muscle actin in PMD. CONCLUSION: MDP has typical morphological and ultrasound signs. The significant variability in the levels of chorionic gonadotropin and alpha-fetoprotein and in the expression of p57 does not allow their use in the differential diagnosis of PMD. The high incidence of thrombotic events in the intervillous space and fetal vessels, as well as intrauterine growth restriction, intrauterine hypoxia, and an impaired neonatal adaptation period in PMD should be taken into account when determining the management tactics for female patients and newborns.

[INFECTIOUS ENDOCARDITIS IN PREGNANT WOMEN].

A case of primary infectious endocarditis with the lesion of mitral valve in a pregnant woman is reported The diseases was caused by meticillin-resistant Staphylococcus aureus. Special attention is given to inefficiency of beta-lactame antibiotics against this infection and beneficial effect of daptomycin therapy. This observation confirms literature data about high frequency of thromboembolic complications of S aureus-induced infectious endocarditis due to the production of various coagulases and von Willebrand factor-binding protein by these microorganisms. An increase of coagulation caused by S. aureus is mediated through activation of prothrombin, factor XIII, and fibrin-binding fibronectin. It requires prescription of direct thrombin inhibitor pradax that proved to yield good results in the treatment of our patient. It is concluded that infectious endocarditis in pregnant women is characterized by an atypical clinical picture due to impaired immunity associated with rapid progression of the process after delivery, high frequency of thromboembolic and DIC syndromes.

[Peculiarities of pregnancy management after multiple stenting of coronary arteries].

This paper describes the strategy for pregnancy and labour management in women with the history of myocardial infarction after multiple stenting of coronary arteries using stents with cytostatic coating. The authors discuss a broad range of diseases underlying coronary lesions in young pregnant women receiving antiaggregation therapy. Neither multiple stenting nor intake of aspirin and ticlopid provoked teratogenic effect.

[Perinatal outcomes in pregnant women with diabetes mellitus and different level of autoantibodies to insulin and its receptors].

The levels of idiotypic (AB1) and antiidiotypic (AB2) antibodies were investigated in pregnants (n = 248) suffer from diabetes. It was proved that AB2 to insulin conditionally can be regards as antibodies to insulin receptor. It was shown that condition of newborns much depends on levels of these antibodies and their proportion. Condition of newborns from women with isolated high levels of AB1 to insulin was much better in comparison with ones from mothers with isolated high levels of AB2 to insulin. Conception about mechanisms of acting of AB1 and AB2 to insulin on fetus was represented.

[The course of the diabetes type I in pregnants with different levels of antibodies to insulin].

The course of the diabetes type I at pregnants (n=120) with different levels of idiotypic (ABI) and antiidiotypic (AB2) antibodies to insulin was investigated. It is known that AB2 to insulin can interact with insulin receptor. It was shown that changes of levels AB1 and AB2 to insulin are often observed at pregnants suffered from diabetes type I. Isolated high levels of AB1 to insulin is relatively good prognostic sign of the course of the diabetes type I at pregnants. On the contrary, isolated high levels of AB2 to insulin lead to decompensation of the diabetes type I and deep glycohemia. High levels of AB1 and AB2 to insulin together lead to unstable course of the diabetes type I. The same situation is observed in case of abnormal low levels AB1 and AB2 to insulin, taking into consideration that serum of health people contains the certain level of autoantibodies (AB1 and AB2) to insulin. The conclusion about significance of detection AB1 and AB2 to insulin during pregnancy of patients with diabetes type I was made.

Possible mechanisms of diabetic fetopathy.

By using immunoaffine chromatography and ELISA it was found that 30-35% polyclonal of anti-insulin antibodies (AB1) in sera of diabetes patients has bound with high-affinity to Nerve Growth Factor (NGF). This indicates the presence of common epitop(s) in both molecules and could be a reason for NGF deprivation during formation of the nervous system in fetuses of diabetic pregnant women. Patient sera also usually characterized by elevated level of antiidiotypic antibodies (AIAb2) which interact with membrane insulin receptors, and may induce the general metabolic disturbances in fetus and newborns from diabetic mothers, fatal sometimes. High levels of anti-insulin/NGF Ab1 may bind excess of AIAb2 and prevents the insulin receptors dysfunction (typical for newborns in satisfactory health state). On the other hand--children with elevated levels of Ab1 at age 1-3 years often revealed clinical signs of neuropathology.