Jacek Zamłyński

Comparison of prenatal and postnatal treatments of spina bifida in Poland – a non-randomized, single-center study

Abstract Objective: The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally. Methods: The study group (SG) comprised 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study. Results: High incidence of prelabor rupture of membranes (24 (52.2%), CI: 3.74 (1.69–8.26) (p < 0.001) was noted in the group of prenatal surgeries as compared to controls. The need for ventriculoperitoneal shunt implantation was statistically significantly lower (p < 0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI: 0.35 (0.16–0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the SG (2 (11.1%) CI: 1.86 (1.00–3.48) p < 0.05) are able to walk independently. Conclusions: Prenatal MMC closure significantly lowers further adverse evolution of the II CM. Further studies are needed, especially on preventive measures for preterm labor and iatrogenic preterm prelabor rupture of membranes (iPPRM) in the postoperative course of IUMR.

Concentrations of antibodies against heat shock protein 27 in the sera of women with ovarian carcinoma.

Introduction: Heat shock proteins (Hsp) are highly expressed in many malignant human tumors, including tumors of the genital tract. One of the Hsps strongly associated with the process of cancerogenesis is Hsp27. The presence of Hsp27 and anti-Hsp27 in the sera of patients with ovarian carcinoma is still a new research field, and papers contain contradictory results. The aim of this work was to study the concentrations of anti-Hsp27 immunoglobulin G antibodies in the sera of women with ovarian cancer at different clinical stages and with different histopathological types of this cancer. Methods: Serum samples from 158 patients with ovarian carcinoma and 80 healthy women were investigated. The concentrations of anti-Hsp27 antibodies were determined by the enzyme-linked immunosorbent assay technique. Results: The mean concentration of anti-Hsp27 antibodies in the patients with ovarian carcinoma was significantly higher than that in the control group. Analysis in relation to the stage of clinical progression showed that the less advanced the cancerogenesis process, the higher the concentration of the anti-Hsp27 antibodies is. The mean concentrations of the anti-Hsp27 antibodies in the patients with ovarian carcinoma were not significantly different in relation to the histological type of the cancer. The use of chemotherapy as a primary anticancer treatment in ovarian carcinoma did not cause a significant decrease in the concentration of anti-Hsp27 antibodies. Conclusions: An immunological response to Hsp27 is increased in women with ovarian carcinoma. Although the diagnostic concentrations of anti-Hsp27 antibodies have not been precisely defined yet, we believe that this may be a helpful diagnostic parameter particularly to detect early stages of clinical advancement of the disease.

Galanin concentrations in maternal circulation, amniotic fluid and umbilical cord blood during term labor: Relationship with maternal body mass and neonatal birth weight

Background. Galanin is a hypothalamic regulatory peptide involved in the regulation of appetite. It is synthesized by the nervous system, anterior pituitary gland, adrenal medulla, pancreas, intestine and placenta. Placental secretion of galanin has until now only been investigated in animals. Additionally, galanin concentration has not been assessed in umbilical cord blood and amniotic fluid. Patients and methods. Galanin concentrations were measured in maternal circulation before term delivery, in cord blood and in amniotic fluid of 45 healthy pregnant women (gestational age 38 – 40 gestational weeks). The control group consisted of 26 normally menstruating healthy women. Results. Plasma galanin concentrations were found to be similar in pregnant healthy women before term delivery (20.8 ± 1.9 pg/ml) and non-pregnant women (19.0 ± 1.7 pg/ml). Galanin concentration in umbilical cord blood (26.5 ± 2.2 pg/ml) was significantly higher (p < 0.05) than in maternal circulation. Galanin concentration in amniotic fluid (20.4 ± 1.0 pg/ml) was similar to that observed in maternal plasma, but significantly (p < 0.01) lower than in umbilical cord blood. A significant correlation was found between maternal body mass index and plasma galanin concentration (τ = 0.246; p < 0.05) and between birth weight and cord blood galanin concentration (τ = 0.345; p = 0.01). There was no significant correlation between placental mass and cord blood galanin concentration (τ = 0.124; p = 0.26). Conclusions. Plasma galanin concentration in pregnant women before term delivery is similar to that in non-pregnant women. The fetus rather than the placenta is the source of the high galanin concentration in umbilical cord blood. The role of galanin in the regulation of newborn weight is uncertain.

Current views on fetal surgical treatment of myelomeningocele — the Management of Myelomeningocele Study (MOMS) trial and Polish clinical experience

Myelomeningocele (MMC) is the most frequent congenital defect of the central nervous system for which there is no satisfactory alternative to postnatal treatment. On the contrary prenatal MMC surgery is conducting before birth and is aimed at protecting from Chiari II malformation. The main goal of fetal MMC repair is to improve development and life quality of children with Chiari II malformation. Management of Myelomeningocele Study (MOMS) which was published in 2011 clearly confirmed effectiveness of prenatal surgery. In this paper we compare MOMS results with our own clinical experience. Thanks to high effectiveness and significant improvement in safety of maternal-fetal surgery prenatal MMC surgery become a new standard of treatment.

Chronic urticaria and irregular menstrual cycle: A case report of effective therapy with oral contraception

Abstract It has been reported that urticaria may be associated with some conditions characterized by sex hormone changes. The case presented concerns a 19-year-old patient who had severe symptoms of chronic urticaria for 3 years, concomitant with an irregular menstrual cycle and functional ovarian cysts. After a laparoscopic ovarian cystectomy the patient was treated with hormonal contraceptives. After 3 weeks the symptoms of urticaria withdrew. The patient continues to receive oral contraceptive treatment, has regular menstruation and shows no symptoms of urticaria. A diagnosis with an urticaria origin should take into consideration any changes in hormone balance as one of the possible reasons for the disease. In such cases, treatment with sex hormones may positively influence the course of the illness.