Ljiljana Mirkovic

Fertility sparing therapy for metastatic gestational trophoblastic disease in young patients.

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Lipids and Adipokines in Cord Blood and at 72 h in Discordant Dichorionic Twins

ABSTRACT Background: Intrauterine growth restriction (IUGR) is a risk factor for developing metabolic syndrome later in life. We explored whether adipokine concentrations in cord blood (CB) and on day 3 (D3) were related to impaired fetal growth and lipids in IUGR twins. Patients and methods: Thirty-six discordant (birth weight [BW] discordance ≥20% calculated in relation to the heavier co-twins) and 42 concordant (BW discordance ≤ 10%) twin pairs were included. Results: In IUGR twins, both adiponectin/BW and triglyceride (TG) levels were significantly higher, while total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol were lower in CB. On D3, both leptin and HDL-C levels were significantly lower and TG levels were significantly higher in IUGR twins. In the discordant group, the alterations in lipids were not related to any adipokine. Conclusions: IUGR is related to lower leptin level and proatherogenic lipid profile (higher TG and lower HDL-C), which are not influenced by adipokine at birth.

Leptin and adiponectin levels in discordant dichorionic twins at 72 hours of age-associations with anthropometric parameters and insulin resistance.

Abstract Background: Insulin resistance (IR) in adults has been associated with intrauterine growth restriction (IUGR). Leptin and adiponectin correlations with anthropometric parameters and IR at 72 h in discordant twins were tested. Methods: We included 24 discordant (birth weight discordance ≥20% in relation to the heavier cotwin) and 30 concordant (birth weight discordance ≤10%) twins. Results: A correlation between leptin (but not adiponectin) level and birth weight (BW), birth length and head circumference in IUGR twins was recorded (p<0.05). Insulin sensitivity (IS) and homeostatic model assessment (HOMA)-IR in IUGR twins were similar to appropriate-for-gestational-age cotwins and unrelated to adipokines. In IUGR twins, adiponectin and insulin associated positively. In larger concordant twins’ leptin level correlated with HOMA-IR and insulin. Conclusions: Leptin, but not adiponectin, levels correlate positively with anthropometric parameters in IUGR twins. IR in IUGR twins is unrelated to adipokines in the first few days of life.

Molar and Trophoblastic Disease

Gestational trophoblastic disease (GTD) has been known for over 2400 years and, in the last century, Dr. Ober was one of the first to compose a review of GTD history [1]. Hippocrates (460–370 AD) first described the hydatidiform mole as the “dropsy of the uterus.” In 600 AD, Aetius of Armida (502–575 AD) described a uterus “filled with bladder-like objects,” probably referring to a molar tissue. Velpeau and Boivin recognized hydatids as cystic dilations of chorionic villi in 1827. Marchand, in 1895, proved these tumors to be the sequelae of pregnancy, abortion, or hydatidiform mole and described the proliferation of the syncytium and cytotrophoblast [2]. Finally, Fels, Ernhart, Reossler, and Zondek proved the presence of high levels of gonadotropic hormone in the urine of patients with GTD [3].