Grzegorz Krasomski

IL-12, IL-6 and IFN-gamma production by lymphocytes of pregnant women with rheumatoid arthritis remission during pregnancy.

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease with progressive activity. The RA remission was observed in women during pregnancy, but the mechanism responsible for remission is hypothetical only and concerns mechanisms of immune regulation such as lymphocyte subpopulations and interleukin production. AIMS: The lymphocyte subpopulations and interleukin production in vitro in a group of healthy non-pregnant women, healthy pregnant women and pregnant women suffering from RA may help towards a better understanding of regulation of the immune processes. METHODS: The investigations were performed in trimester III--2 days after delivery and 6 weeks after delivery. Peripheral blood lymphocytes were isolated on Gradisol gradient and analysed immediately or after having been cultured for 72 hours in RPMI medium supplemented with 10% FCS. The cultures were terminated after 72 h, supernatants stored at -72 degrees C for interleukin evaluation. The concentrations of IFN-gamma, IL-2, IL-6, IL-12, TNF-alpha and its soluble receptors R-I, R-II were estimated in non-stimulated and PHA (Sigma, 5 microg/ml) stimulated culture supernatants using ELISA Endogen kits according to the manufacturers instructions. RESULTS: The general pattern of T cell subpopulation distribution was similar in all analysed groups. Decreased IFN-gamma, IL-12 and increased IL-6 production by lymphocytes after PHA stimulation was found in trimester III in pregnant women with RA as compared to healthy pregnant woman. CONCLUSION: The obtained results suggest that in pregnant women with RA the TH1 cell response predominates, contrary to healthy pregnant women with TH2 type functional response. These phenomena were not observed after delivery.

Prenatally evolving ectopia cordis with successful surgical treatment.

Ectopia cordis (EC) is a rare malformation due to failure of maturation of the midline mesodermal components of the chest and abdomen. It can be defined as a complete or partial displacement of the heart outside the thoracic cavity. It comprises 0.1% of congenital heart diseases. Common cardiac anomalies associated with EC are ventricular septal defect, atrial septal defect, and tetralogy of Fallot. EC and additional anomalies usually lead to intrauterine death. The possibility and efficacy of surgery in a surviving neonate depends on the degree of EC, coexisting congenital heart defects and extracardiac malformations. We present a case of prenatally diagnosed isolated EC diagnosed in the first half of pregnancy. After counseling, the patient decided to continue her pregnancy which ended with a newborn baby discharged from the hospital after cardiac surgery performed just after elective cesarean section.

Difficulties in prenatal diagnosis of tumour in the fetal sacrococcygeal area

Prenatal ultrasound at the 20th week of gestation revealed a 3-cm tumour in the sacrococcygeal area. Initially, a sacrococcygeal teratoma was suspected on the basis of fetal ultrasonography, which revealed normal heart anatomy and an increasing tumour mass. The diagnosis was then changed to fetus in fetu or teratoma. Prenatal magnetic resonance imaging at the 34th week of pregnancy confirmed the ultrasound diagnosis. No other anomalies were found. Elective caesarean section was performed at term. The care team included a paediatric surgeon, obstetricians, neonatologists, midwives, and an anesthesiologist. A female newborn was delivered in good condition. The tumour was resected in the operating room and mature teratoma was established by histopathological evaluation. Surprisingly, agenesis of the right forearm was revealed which had not been detected prenatally, despite many examinations (both in our hospital and earlier at a primary care obstetrician office).

The impact of excessive maternal weight on the nutritional status of the fetus – the role of leptin

Introduction Assessment of leptin concentration in the blood of pregnant women (leptin concentration – Lc) and in their newborns, according to their nutritional status. Material and methods Pregnant women (n = 42) were divided into normal body mass (NBM) and excessive body mass (EBM) groups. Neonates were divided into AGA (eutrophic) and LGA (macrosomic) groups. Leptin concentraction was studied in 4 subgroups: NBM/AGA, NBM/LGA, EBM/AGA, EBM/LGA. Results Mothers: A significant correlation was found between maternal Lc and body mass index (BMI) (r = 0.75, p < 0.001). Maternal Lc was 3 times higher than neonatal Lc (p < 0.00001). The NBM mothers showed lower Lc compared to EBM mothers (p = 0.000018). Leptin concentration values in NBM/LGA and NBM/AGA mothers were similar (p = 0.6775). Newborns: Correlations were found between Lc and ponderal index (PI) (r = 0.67, p < 0.001), weight (r = 0.43, p = 0.004) and placental weight (r = 0.56, p < 0.001). Girls presented higher Lc than boys (p = 0.0338). In LGA groups, newborns born to EBM mothers presented higher Lc than those born to NBM mothers (p = 0.0013). In both AGA groups, Lc was similar (AGA/EBM vs. AGA/NBM p = 0.1619). The highest Lc and the largest placentas were found in the group of LGA newborns born to EBM mothers. Conclusions Leptin concentration positively correlates with BMI in pregnant women, with PI and female sex in newborns as well as with placental weight. The nutritional status of fetuses does not affect the Lc of their non-obese mothers. The LGA neonates born to EBM women demonstrate higher Lc than LGA neonates born to NBM mothers, whereas Lc of AGA neonates is similar regardless of the nutritional status of their mothers.

Endometrial and cervical cancer: incidence and mortality among women in the Lodz region

Introduction By the early 21st century the most common cancer of female genitals in Poland was cervical cancer. Now endometrial cancer ranks first. The aim of this study was to analyse the incidence and mortality of endometrial and cervical cancer among women in the Lodz region. Material and methods Data on the incidence and mortality of endometrial and cervical cancer among inhabitants of the Lodz region were obtained from the National Cancer Registry and Bulletin of Cancer Cases in the Lodz region. The analysis covered ten consecutive years beginning in 2001. Results The number of new cases reported in 2010 exceeded that observed in 2001 by 181. The standardized incidence rate of endometrial cancer increased by 6.3, while the standardized incidence rate of cervical cancer decreased by 1.4. Conclusions In the years 2001-2010, the incidence of endometrial cancer increased by 88.3% and that of cervical cancer decreased by 6.5% among inhabitants of the Lodz region. In the years 2001-2010, mortality of endometrial cancer increased by 24.5% and that of cervical cancer decreased by 12.6%. In 2010, the highest crude incidence rates in the Lodz region of both endometrial and cervical cancer at 39.1 were recorded in the district town of Piotrków.

Incidence of and mortality from breast cancer among women in Poland in the years 2001-2010

Introduction Breast cancer is the most common malignant tumour among women. About 15,000 new cases of breast cancer are diagnosed and more than 5,000 women die in Poland every year. The aim of this study was to analyse the incidence and mortality rate of breast cancer among women in Poland in the years 2001-2010. Material and methods Analysed data concerning the incidence of and mortality from cancer among women were obtained from the National Cancer Registry. Results The number of new cases reported in 2010 exceeded that reported in 2001 by 3,666. The mortality from breast cancer among women increased by 15.1% by 2009, to subsequently drop by 0.3% in 2010. The standardized incidence rate increased by 7.4 and the standardized mortality rate fell by 1.3 in 2001-2010. Conclusions In the years 2001-2010 the incidence of breast cancer in women in Poland rose by 30.3%, with an increase of 7.4 in the incidence rate. The highest rise in the incidence and mortality of women due to breast cancer in Poland is reported in the Lodz voivodeship. In the years 2001-2009 the number of womens deaths due to breast cancer increased slightly, while the mortality rate dropped.

P23.03: Monochorionicity as a risk factor for neonatal outcome

Objectives: To prospectively evaluate the role of ultrasound imaging in counselling patients with adnexal masses. Methods: From September 2011 to February 2012, we evaluated 65 consecutive patients with adnexal masses. The ultrasound features analyzed for the masses were: number, side and dimension, anatomic origin, tenderness and type of tumour (unilocularmultilocular, simple-solid), number of locules, internal cyst wall (regular, irregular, papillary projections), internal septa (completeincomplete), echogenicity, presence of acoustic shadows or ovarian crescent sign, colour Doppler score, presence of ascites or free fluid in the Pouch of Douglas. CA-125 level was measured. Timing, type of intervention and possible referral to an oncological Unit was decided upon imaging characteristics. 62 patients underwent laparoscopy for removal of the mass in our Unit, three patients were sent to referral oncological centre. The surgical specimens were analyzed for histological diagnosis. Results: The mean age of the patients was 44.7 ± 14.6 years, eighteen patients (12%) were post-menopausal. Three patients were pregnant: one with an adnexal mass suspected of borderline ovarian cancer and two with ovarian torsion. The adnexal masses were unilateral in 59 patients and bilateral in six. The dominant mass had a mean largest diameter of 64.2 ± 23.8 mm. The histological diagnosis were: endometryoma (27%), mature teratoma (14%), mucinous/serous cystoadenoma (22%), parasalpyngeal cyst (7%), salpingitis (6%), ovarian torsion (6%), ovarian cancer (1%), others (17%). The subjective assessment of the gynaecologist was benign in 64 cases (90%) and borderline in 7 cases (10%) with a negative predictive value of 100% and specificity of 90%. Conclusions: In a university non-oncological unit, it is feasible to manage the majority of adnexal masses. Our ultrasound based triage avoids work overload of oncological referral centres, were it is mandatory to refer those patients with a high suspicious of malignancy.

P14.04: Perinatal outcome in monochorionic versus dichorionic twin pregnancies

Objectives: To determine the impact of first trimester crown to rump length (CRL) discordance in first trimester dichorionic diamniotic twins (DCDA) on neonatal outcomes. Methods: This is a prospective observational study of cohort of DCDA twin pregnancy over a period of eighteen months at a tertiary referral centre. During this period, 168 DCDA twin pregnancies were confirmed to have a viable twin pregnancy at 10–14 weeks scan for dating by crown rump length (CRL) and determine chorionicity. Outcome of pregnancies with CRL discordance of more than 10% were reviewed for variables including gestational age at delivery, mode of delivery, stillbirths, neonatal deaths and neonatal admissions. Results: Twenty two (13%) pregnancies had CRL discordance of > 10%. The mean gestational age at delivery was 36 + 6 (±,1.98) weeks’ gestation. Fourteen (63%) had delivery by caesarean section. Seven babies (16%) of the 22 pairs were admitted to the neonatal unit after birth. In six of the pairs (22%) the CRL discrepancy was > 20% and in this group there were two stillbirths. One fetus died at 32 weeks gestation and other had Inencephaly and died at 34 weeks gestation. Further four babies (33%) were admitted to the neonatal unit immediately after birth. Conclusions: In DCDA twin pregnancies, CRL discordance of more than 20% is associated with increased risk of stillbirth and admission to neonatal unit.

OP21.04: Obstetrical outcome in 80 pregnancies with prenatally diagnosed hypoplastic left heart syndrome (HLHS) at a referral center

A. Levey1, L. L. Simpson2,3, C. S. Kleinman1,3, J. Glickstein1,3, S. M. Levasseur1,3, I. Williams1,3 1Pediatrics, Division of Pediatric Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA; 2Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA; 3The Center for Prenatal Pediatrics, Morgan Stanley Children’s Hospital of New York, New York, NY, USA