48-hours administration of fenoterol in spontaneous preterm labor - does it affect fetal preload?

OBJECTIVE: to investigate whether any changes in the preload index (PLI) occur within the first 48 hours of fenoterol intravenous tocolysis. MATERIAL AND METHODS: Doppler evaluation of placental and fetal circulation was performed in 36 pregnant women prior to fenoterol administration and after 24/48 hours. Measurements were obtained from a longitudinal section of the inferior vena cava (IVC) and preload index was calculated. To determine changes over time, an all study variable analysis of variance (ANOVA) for repeated measurements, followed by Tukey-Kramer's multiple comparison test was used. The effects of additional clinical covariates were checked. RESULTS: The maternal heart rate values were significantly increased after 24 hours and 48 hours in comparison to pre-treatment values. No significant changes in fetal heart rate were observed during treatment. The fetal IVC PLI values were significantly reduced after 24 hours and 48 hours of treatment. The increase in PLI values when comparing 24 and 48 hours results were not statistically significant. These observations were consistent with ANOVA post-hoc analysis. CONCLUSIONS: 48 hours intravenous administration of fenoterol appears not to alter inferior vena cava blood flow by itself. The reduction in PLI values may reflect lower fetal preload conditions during the course of successful tocolytic treatment. Therefore, Doppler IVC PLI measurement should be considered as a possible additional assessment method of effectiveness of treatment. However, other Doppler venous blood flow parameters should be assessed to confirm the results and clarify whether maternal corticosteroids administration may be interfering with the results.

48-hours administration of fenoterol in spontaneous preterm labor - Doppler blood flow assessment of placental and fetal circulation.

OBJECTIVES: The aims were to investigate whether any changes in placental and fetal circulation were observed during fenoterol tocolysis within the first 48 hours of therapy. MATERIAL AND METHODS: Doppler evaluation of placental and fetal circulation was performed prior to fenoterol administration and then after 24 and 48 hours. Maternal heart rate and pulsatility index (PI) in uterine arteries were assessed. FHR, RI and PI of umbilical artery and middle cerebral artery were measured. E/A ratio for A-V valves, the myocardial performance index (MPI) and shortening fraction (SF) were calculated for both ventricles independently. The blood flow pattern in DV was assessed using PI, S/a ratio and peak velocity index for the vein. To determine changes over time in all study variable analysis of variance (ANOVA) for repeated measurements followed by Tukey-Kramer's multiple comparison test was used. The effects of additional clinical covariates were checked. RESULTS: Uterine and fetal arterial blood flow patterns were not altered significantly during 48 hours of tocolysis. No significant changes were observed in fetal cardiac function parameters as well. The evaluation of Doppler parameters in the DV revealed a significant increase in PVIV after 48 hours. Additionally after 48 hours of successful tocolysis S/a ratio values were significantly lower. CONCLUSIONS: Short term intravenous administration of fenoterol seems not to alter uterine and fetal arterial blood flow pattern. Direct fetal cardiac function remained unaffected. However significant changes of selected Doppler parameters in DV may suggest further studies should be performed to assess more precisely fetal venous blood flow.

[Maternal hyperoxygenation test in prediction of fetal lung hypoplasia--preliminary report]. / Przydatnosc testu hiperoksygenacji w prognozowaniu hipoplazji pluc u plodów--donlesienie wstepne.

OBJECTIVES: The aim of our study was to present the detailed execution and interpretation of the hyperoxygenation test in the fetus. MATERIAL AND METHODS: This was a retrospective investigation of fetuses examined in The Department for Diagnosis and Prophylaxis of Congenital Malformations (Polish Mothers Memorial Hospital Institute and Medical University in Lodz) between January 2006 and December 2009, in whom in addition to the routine echocardiographic examination the hyperoxygenation test was performed. Indications for such an extended evaluation were suspected fetal malformations and pulmonary hypoplasia. Changes in the fetal pulmonary circulation before and after maternal exposure to hyperoxygenated air together with the newborn follow-up were analyzed. RESULTS: Clinical outcome was available for 42 of 52 cases: 16 patients died (including 11 cases with negative hyperoxygenation test), whereas 24 patients were discharged home (including 17 cases with positive hyperoxygenation test). The probability of survival for fetuses with the positive test was significantly higher than for fetuses with the negative one (p = 0.016, Fischer's exact test). CONCLUSIONS: Based on changes evoked in the fetal pulmonary circulation, the hyperoxygenation test seems helpful in predicting impaired fetal lung development Functional assessment of the fetal pulmonary circulation may be useful in predicting fetal lung hypoplasia and respiratory failure in the neonate.

[Prenatal ultrasonographic diagnosis of congenital epulis--two case reports and literature review]. / Prenatalna diagnostyka guzów jamy ustnej--opis dwóch przypadków oraz przeglad pismiennictwa.

The following work presents prenatal ultrasonographic examination of two rare fetal cases of epulis, among 13 792 fetuses referred to our unit due to suspected fetal anomalies by obstetricians (estimated prevalence 1/7000 among fetuses with different anomalies). Sonographic differential diagnosis, value of fetal nasal amniotic fluid flow assessment by color Doppler and the probability of EXIT procedure have been described.

[Electrogastrography in various clinical forms of functional dyspepsia]. / Elektrogastrografia w róznych postaciach klinicznych dyspepsji czynnosciowej.

Electrogastrography (EGG) is simple, noninvasive, painless and repeatable method of assessment of gastric myoelectrical activity. By means of cutaneous electrodes placed on the abdomen skin we can record and then using computer evaluate the slow waves of the stomach and this is one of the methods for the assessment of gastric myoelectrical activity that makes its possible to draw inferences about gastric motility. The pathogenesis of functional dyspepsia is still not clear, but the disorders of the motility and myoelectrical activity of the stomach probably play here very important role. AIM OF OUR STUDY: To evaluate gastric myoelectrical activity in patients suffering from functional dyspepsia (FD) and to answer the question if there are some differences between two clinical forms of the functional dyspepsia. MATERIAL AND METHODS: A group of 60 patients diagnosed with functional dyspepsia, aged 18-65 years (x = 34.8, SD = +/-12.1), and a reference group of 30 healthy volunteers aged 18-65 years (x = 38.2, SD = +/- 18.4) were tested. Dyspepsia was diagnosed on the basis of a detailed medical history taken according to the Roman Criteria III. A half of the patients with functional dyspepsia,. i.e., 30 persons tested, was composed of the patients with postprandial distress syndrome (PDS), whereas the other half (30 patients) included the patients with epigastric pain syndrome (EPS). The occurrence of Helicobacter pylori was excluded by a 13C-urea breath test and a urease test performed during gastroscopy. Cutaneous electrogastrography was recorded by electrodes placed on the abdomen skin for six hours. After an hour of recording of the gastric myoelectrical activity in patients on an empty stomach a solid or liquid test meal was served. Test meals, both solid and liquid, were of approximately the same energy value of about 300 kcal. RESULTS: In the patients with functional dyspepsia gastric myoelectrical disorders occur with dominating dysrhythmia (p < 0.001), especially bradygastria, both in the record on an empty stomach and after a meal. The EGG records were different in the two forms of dyspepsia: in the group of patients with postprandial distress syndrome (PDS) there was statistically significant larger number of tachygastria both in the total record period (t = 2.719; p < 0.01) and after a meal (t = 2.164; p < 0.05) than in the group of patients with epigastric pain syndrome (EPS). CONCLUSIONS. (1) In the patients with functional dyspepsia gastric myoelectrical disorders occur with dominating dysrhythmia, especially bradygastria. (2) The EGG records are different in the two clinical forms of dyspepsia and this may be used for differential diagnostics of this disease: in epigastric pain syndrome bradygastria prevails whereas in postprandial distress syndrome bradygastria is dominant and an essential proportion of tachygastria is observed.

[Diaphragmatic hernia in reference hospital ICZMP--diagnostic problems and outcome]. / Problemy diagnostyczne i losy plodów z przepuklina przeponowa w osrodku referencyjnym ICZMP w latach 1994-2006.

OBJECTIVES: The aim of the study was to analyze US/ECHO examinations in fetuses with diaphragmatic hernia (DH) diagnosed and treated in our institution from 1994-2006, and their follow-up. MATERIAL AND METHODS: Retrospective analysis of the data base from Department for Diagnoses & Prevention of Fetal Malformations, Research Institute of the Polish Mother's Memorial Hospital: 14,481 fetal echo/ultrasound examinations in 10,077 fetuses have been analyzed to retrieve 115 fetuses with DH. RESULTS: The mean gestational age at the targeted US/ECHO examination was 30 wks. There were 8 terminations of pregnancies (at mean 21 wks), 6 intrauterine demises, 60 neonatal deaths after delivery (in 1-3rd day of postnatal life), 8 deaths after surgery, 19 neonates were discharged home and in 14 cases the follow-up could not be monitored. The most common anomalies accompanying DH have been central nervous system anomalies (20%), polyhydramnion (16%) and cong heart defects (10%). In this subgroup, there was 100% mortality. Isolated DH has been diagnosed in every third case. In this subgroup, 27 neonates had undergone surgery and the survival rate was 70%, however since 2004 there was not a single death on record. CONCLUSIONS: Late gestational age of US/ECHO examinations in our tertiary center suggests that DH has been relatively difficult to detect during ultrasound screening. DH and the other structural malformations have been a lethal disease in our series in 100%. Isolated DH was much less frequent and was present in every third case (29%), and in this group the survival rate was 70%, regardless of the way of the delivery (CS or Vaginal).

[The influence of melatonin on concentration of nitric oxide metabolites in gastric juice in subjects with functional dyspepsia]. / Wplyw melatoniny na stezenie metabolitów tlenku azotu w soku zoladkowym u osób z dyspepsja czynnosciowa.

UNLABELLED: The pathogenesis of functional dyspepsia is very complicated and its etiology is still not clear. One of the supposed pathophysiological mechanisms is the deficiency of melatonin. The deficiency of melatonin leads to increase the oxide reactive form's concentration as nitric oxide metabolites and to decrease of antyoxidative enzymes activity. This last factor seems to be very important in correct digestive tract function. The aim of our study was answer the question if is the difference between NO metabolites concentraction in gastric juice in patients with functional dyspepsia and in healthy subjects and wheather the treatment with melatonin plays the role in normal digestive tract function. MATERIAL AND METHODS: The study included 60 subjects between of 18 to 48 years with diagnosed functional dyspepsia (according to the Rome III Criteria). The study group was divided into two subgroups: group I--30 subjects with Epigastric Pain Syndrome-EPS and group II--30 subjects with Postprandial Disorders Syndrome-PDS. Control group comprised 25 healthy subjects (without any clinical or morphological symptoms of digestive tract disease). In each patient the gastroscopy was performed. During gastroscopy 5 ml gastric juice was collected. The juice was centrifuged for 15 min (4500 rotations). The undiluted supernatant was frozen in the temperature -70 degrees C. The concentration of nitric oxide metabolites in gastric juice was determined with spectrophotometric based on ELISA test (540 nm wavelength) using a microplates reader (Multiscan, Labsystems). In patients with functional dyspepsja the investigations were performer twice before and after 6 weeks treatment with melatonin. Melatonin was applied in dose 5 mg daily, in the evening. RESULTS: The concentration of nitric oxide metabolites in gastric juice in healthy subjects was 6.81 +/- 2.23 microM. In patients with functional dyspepsia was significantly higher; in patients with Epigastric Pain Syndrome--10.99 +/- 2.46 microM (p < 0.05), in patients with Postprandial Disorders Syndrome--9.28 +/- 2.18 microM (p < 0.05). After treatment with melatonin the concentration of nitric oxide metabolites in gastric juice in both groups decreased and were 8.21 +/- 1.83 microM in patients with Epigastric Pain Syndrome and 6.93 +/- 1.61 microM in patients with Postprandial Disorders Syndrome. CONCLUSIONS: In patients with functional dyspepsia the concentration of nitric oxide metabolites in gastric juice was significantly higher than in control group. After treatment with melatonin the concentration of nitric oxide metabolites in gastric juice in both groups decreased--in patients with Epigastric Pain Syndrome as well as in patients with Postprandial Disorders Syndrome. The treatment with melatonin seems to be suitable in combined therapy of functional dyspepsia.

[Secretion of serotonin and melatonin in patients with functional dyspepsia]. / Wydzielanie serotoniny i melatoniny u osáb z dyspepsja czynnosciowa.

UNLABELLED: It was confirmed that enterochromaffin cells (EC) in the digestive system are a source of serotonin and melatonin. Both hormones possess an important, but opposed, influence on secretory and motoric function of gut. The aim of our study was to evaluate fasting secretion of serotonin and melatonin in patients with functional dyspepsia. Material and methods. 25 healthy subjects (K, group I), 25 patients with epigastric pain syndrome (EPS, group II) and 25 patients with postprandial distress syndrome (PDS, group III), aged 18-50 years, were included in this study. Diagnosis of functional dyspepsia was established according to the Rome Criteria III. Organic diseases of gut, H. pylori infection and another disorders were excluded. Seven days before the examinations the patients were told to abstain from drugs intake and equal diet was applied. On the day of investigation the subjects remained in a red-light room at night and received standard liquid diet (Nutridrink, 4 x 200 ml, 1800 kcal). Blood samples were taken for examination at 8 am on the subsequent day and serum was frozen in -80 degrees C. The concentration of serotonin and melatonin was measured by ELSA, using antibodies from IBL (catalogue no. RE 59121, RE 54021). RESULTS: The mean concentration of serotonin in group I (K) was 162.9 +/- 49.1 ng/ml, in group II (EPS)--225.8 +/- 111.3 ng/ml (p < 0.05) and in group III (PDS)--152.7 +/- 83.2 ng/ml (p > 0.05). The concentration of melatonin was in group I--7.3 +/- 4.0 pg/ml, in group II 8.7 +/- 8.0 (p > 0.05) and in group III 14.3 +/- 10.1 (p < 0.01). CONCLUSIONS: During fasting time secretion of serotonin is higher in patients with EPS, and similarly higher secretion of melatonin in patients with PDS, compared to healthy subjects.

[Bilateral renal agenesis at the Department for Diagnosis and Prophylaxis of Fetal Malformation at the Institute Polish Mother's Memorial Hospital with fetal echocardiography in years 1994-2002]. / Agenezja nerek w materiale Zakladu Diagnostyki i Profilaktyki Wad Wrodzonych I "CZMP" z uwzglednieniem badan serca plodów w latach 1994-2002.

UNLABELLED: There was done 8525 sonographical and echocardiographical examinations in 1994-2002 in the Department for Diagnosis and Prophylaxis of Fetal Malformation (DDPFM) of Institute of Polish Mother's Memorial Hospital. In 22 cases (0.25%) bilateral renal agenesis (BRA) was diagnosed. Till year 1999 the examinations were performed on Acuson 182 XP an since year 2000 on Philips HDI 5000 with Power Doppler. In 6 cases (27%) the suspicion of BRA were diagnosed in others places and in 16 cases (73%) in DDPFM. The average age of pregnant was 25.5 (+/- 4.8) and the average fetal age during first examination at DDPFM 27 weeks and 2 days (+/- 5 days). 83% of pregnant were from low risk group. The ahydramnion was the most frequent diagnosed anomaly (11 cases) and intrauterine growth retardation (IUGR) (4 cases). Till year 1999 BRA was diagnosed based on indirect syndromes: lack of visualization of kidney, the absence of bladder, no improvement after diagnostic amnioinfusion. Since year 2000 BRA was diagnosed based on indirect syndromes and lack of visualization of kidney artery in Power Doppler. In 16 fetuses there were not abnormality in echocardiographical examination. In 5 cases pericardial effusion were diagnosed. In 5 cases cardiomegaly and in 3 cases hypertrophy of heart were diagnosed. Among 22 pregnancies there where 8 (36%) intrauterine deaths, 1 (5%) fetus was born before 32nd week of gestation and 13 (59%) died after birth. 12 (55%) fetuses were delivered in I PMMH and 10 (45%) cases in others hospitals. In 15 (68%) cases there were vaginal delivery and 7 (32%) cesarean sections. The average birth weight was 1530 grams and Apgar score in 19 newborns was 0-1. CONCLUSIONS: 1. Bilateral renal agenesis is a lethal malformation, which can be suspected during screening obstetrical examination (ahydramnion, IUGR), but it needs confirmation by genetical ultrasound and echocardiographical examination. 2. The mean technique during examination for BRA is Power Doppler.