Miroslav Korbel

Expression of proliferation and apoptotic markers in human placenta during pregnancy

Trophoblast has unique properties in relation to its wide range of metabolic, endocrine and angiogenic functions. Trophoblastic cells invade endometrium and adjacent myometrium in a way that is imitated by malignant tumours. The aim of the present study was to analyse the expression of markers of proliferation and apoptosis in trophoblastic cells in normal human placenta during pregnancy. A total of 22 placentas, 12 of which were obtained from curettage and induced legal abortion and 10 placentas obtained from normal deliveries or caesarean sections were included in this study. Proliferation markers were strongly expressed in cytotrophoblast in early stages of gestation. In late term placentas, a distinct decrease in expression of these markers was observed. Syncytiotrophoblast was negative for proliferation markers in all placentas. Positive immunostaining for bcl-2, an anti-apoptotic marker, was observed only in syncytiotrophoblastic cells in first-trimester but also in third-trimester placentas. Cytotrophoblast and stromal mesenchymal cells of chorionic villi were negative for bcl-2. Expression of bcl-2 protein in syncytiotrophoblast may be one of the major factors preventing these structures from early cell death, which is indispensable for the maintenance of physiological pregnancy.

Mouth cavity base defect treated with biosynthetic graft

The use of in vitro prepared biosynthetic grafts can considerably improve the patient’s quality of life. This work reports on the use of an autologous graft prepared from a patient’s preputial cells cultivated on biodegradable polymeric membrane. Coladerm membrane is based on the chemically modified polyelectrolyte complex of atelocollagen and hyaluronan. The graft was used to cover a defect in the mouth cavity base and tongue after reconstruction surgery performed at this site in the past. The presented clinical case showed that the autologous biosynthetic graft prepared from foreskin cells can be successfully used for covering of medium-size defects in mouth cavity base resulting in the regeneration of target mouth structures with significant improvement of patient’s quality of life.

Comparison of outcomes of perinatal care in Slovakia and the UK

To investigate whether there are differences in maternal and perinatal outcomes between Slovakia and the UK, and whether any observed variations can be attributed to differences in perinatal care.

Amniotic fluid embolism--investigation of fatal cases in Slovakia in the years 2005-2010 compared with fatal cases in the United Kingdom.

BACKGROUND Amniotic fluid embolism (AFE) is a rare, often severe complication of pregnancy. The clinical diagnosis is difficult to establish and is one of exclusion. The aim of this study was to investigate 6 fatal cases of AFE in Slovakia and compare the incidence, risk factors, course, management and neonatal outcomes with fatal cases of AFE in the United Kingdom (UK). MATERIALS AND METHODS Data on fatal cases of AFE in Slovakia were analysed and compared with fatal cases in the UK in the years 2005-2010. RESULTS The incidence in Slovakia was significantly higher than in the UK from 2005-2010 (RR 5.03, 95% CI 1.98-12.75, P=0.003). However, 5/6 deaths occurred in 2009 coinciding with the H1N1 flu virus pandemic in Slovakia. There were no significant differences in the characteristics of women who died, with the exception of gestational age at delivery; significantly higher in Slovakia (median 41 versus 39 weeks, P=0.01). In Slovakia most of the cases occurred after delivery, 83.3%, compared with 52.9% in the UK. There were no significant differences in clinical signs, use of recombinant factor VIIa or performance of obstetric hysterectomy. In Slovakia 83.3% and in the UK 94.7% of infants survived, but 20% and 27.8% had some long-term sequelae. CONCLUSION AFE is now the leading cause of maternal deaths in Slovakia. However, we found no significant differences in the possible risk factors, course, management or outcomes between Slovakia and the UK. This analysis is limited by study power; we propose that establishment of a national register of cases of AFE in Slovakia would help further investigate and monitor mortality from this condition.

Classification and management of extensive obstetric perineal injuries in the Czech and Slovak Republics

To assess the classification, repair, and follow up of extensive obstetric perineal injuries in the Czech and Slovak Republics.

Doppler flow velocimetry of the umbilical artery and middle cerebral artery in pregnancies complicated by insulin-dependent diabetes mellitus

Objectives: The aim of this study was to compare changes in Doppler ultrasound studies of the fetal circulation in normal pregnancies with a group of pregnancies complicated by insulin-dependent diabetes mellitus. Study Methods: In addition to the non-stress test, fetal biophysical profile, Doppler measurements of the fetal circulation included the umbilical artery (UA) resistance index (RI) and the fetal middle cerebral artery (MCA) resistance index (RI). Altogether 86 pregnancies complicated by insulin-dependent diabetes mellitus constituted the study group. 86 uncomplicated pregnancies with a term delivery of an appropriately grown baby were used to define normal range. 23 pregnancies with diabetes mellitus type I were complicated by preeclampsia. Doppler studies of umbilical artery and fetal middle cerebral artery velocity waveforms and biophysical profile were performed at 30-40 weeks of gestation. Data were analyzed with regard to asphyxia and otherwise complicated fetal outcome. Results: Fetuses of diabetic women displayed changes in umbilical artery flow and fetal middle cerebral artery flow in 1.5 cases complicated with preeclampsia and in 4 cases with intrauterine growth retardation. Conclusions: Doppler flow velocimetry of the fetal middle cerebral artery and umbilical artery together with biophysical profile and nonstress test has a high significance in predicting adverse fetal outcome, especially in the growth-retarded fetus.