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Biomedical subjects

J Pajak

Publications and source records attributed to J Pajak.

At least 19 recordsLinked to original sources

Study on risk factors for transplacental viral infections; effect of bacterial factors and double viral infections on virus replication in placenta and amniotic membranes.

Among risk factors for vertical transmission of HIV there are listed concomitant viral and bacterial infections. Therefore the influence on the viruses replication in human placenta and amniotic membrane cultures of double viral infection with two unrelated viruses - encephalomyocarditis (EMCV) and vesicular stomatitis virus (VSV) - was studied and compared with the replication of the viruses in single virus infection (EMCV or VSV) in the same organ cultures. Additionally effect of bacterial factors - lipopolysaccharide (LPS) Escherichia coli and sonicated Treponema pallidum antigens (Tpa) - on VSV replication in the same culture system was studied and compared with VSV replication in untreated explants. Two effects were observed in double-virus infected cultures and also in bacterial factors treated cultures: inhibition and stimulation of virus replication. The kind of effect in the both cases was dependent on the presence or absence of innate antiviral immunity. In virus-sensitive organs double infected or treated with LPS or Tpa, inhibition of virus titer (2-5 log TCID(50)/ml) was observed. In the organs expressing the innate immunity, stimulation (1-4 log TCID(50)/ml) of virus replication was noticed. Contribution of endogenous TNFalpha in both reactions (stimulation and inhibition) was confirmed using antibodies against the TNF.

Amnion↗

Operative treatment of truncus arteriosus communis coexisting with tricuspid atresia.

The coexistence of tricuspid atresia and common arterial trunk is extremely rare. We present a successful three-stage surgical treatment of this defect. The first stage included disconnection of the pulmonary arteries from the common trunk, atrial septectomy and systemic-to-pulmonary shunt; the second stage, a hemi-Fontan procedure; and the third stage, a fenestrated Fontan completion. The child is now 8 years old and is developing well.

Blood Vessel Prosthesis Implantation↗

Factors influencing early outcome of Norwood procedure for hypoplastic left heart syndrome.

OBJECTIVE: [corrected] The operative outcome of the Norwood procedure for hypoplastic left heart syndrome is still not satisfactory. Conflicting reports concern factors associated with early Norwood procedure mortality and the reasons for the instability after surgery are not sufficiently understood. The purpose of this study was to determine some perioperative factors influencing early (30 days) outcome. METHODS: We retrospectively analyzed a group of 30 consecutive children with hypoplastic left heart syndrome (aged 5-39 days) who underwent Norwood procedure in 1997 and 1998. The following factors were considered and statistically analyzed: operative age, birth weight, operative weight, serum level of bilirubin, aminotransferases, creatinine, urea, arterial blood gasses, anatomic subgroups, ascending aorta and arch size, systemic to pulmonary modified right Blalock-Taussig shunt size, cardiopulmonary circulatory arrest time, cardiopulmonary bypass time, and delayed chest closure. Eighteen patients underwent hemi-Fontan procedure with one late death and the modified Fontan operation was performed in 16 of them (one late death). RESULTS: The early mortality was 37%. Seven deaths (64%) occurred during the first 24 h after operation. There was a significant difference between survivals and non-survivals in: birth weight (P=0.047), operative age (P=0.016), preoperative serum level of bilirubin (P=0.044), and cardiopulmonary circulatory arrest time (P=0.006). The other assessed factors were not found to be predictors of early mortality. All 16 survivals followed up are in New York Heart Association class I or II. CONCLUSIONS: Anatomic and functional status of the patient, as well as procedural factors are related to Norwood operation early mortality. High mortality in hypoplastic left heart syndrome after stage I surgery indicates the necessity of assessing all factors which may determine further improvement in the outcome.

Arteriovenous Shunt, Surgical↗

[Analysis of newborns' health status in twin pregnancies according to the duration of pregnancy and its delivery based on the materials of Reproduction and Obstetrics Clinic in 1995-1999].

On the ground of the analysis of 79 twin pregnancies, the valuation of newborns' condition in Apgar's scale, according to the delivery means, has been executed. The lack of differences between the mean values of the scale has been ascertained. There was no indication of any difference between the condition of the twin I and II. Furthermore, there has been executed a detailed comparative analysis of the newborns' condition in the four periods of the pregnancy duration: 23-27, 28-32, 33-37 and 38-42 weeks of gestation. It has been ascertained that the newborns delivered through the abdominal delivery were in better condition than those born in the spontaneous delivery, in the 28-32 weeks of gestation period. The use of rather intraspinal rather than general anesthesia in the 33-37 weeks period gave better results by improving the newborns' condition. Moreover, there has been stated a similar condition of the newborns delivered through either spontaneous or abdominal delivery with intraspinal anesthesia in the periods of 33-37 and 38-42 weeks of gestation.

Adult↗

[Active labor].

In the paper we underlined the benefits of the labour in the vertical position in contrast to many disadvantages of parturition in recumbent or semi-recumbent position. These not natural positions are the consequences of the development of obstetrics manoeuvres as late as 200 years ago. In our opinion there is the necessity of the changing our minds on pros and cons of horizontal position during labour.

Female↗

[Analysis of twin pregnancies on the ground of women hospitalized in the Department of Reproduction and Obstetrics Medical University in Wrocław in 1995-1999].

The aim of this study was the general valuation of the course and the delivery means of the twin pregnancies. The research material composed of 83 from among 5540 pregnant women hospitalized in the Department of Reproduction and Obstetrics Medical University of Wrocław in the years 1995-1999. The mean body mass values and the condition of the newborns have been analyzed on the ground of Apgar's scale, according to the date of delivery. In the period between 23 and 42 week of pregnancy a very high correlation between fetus' body mass and a high correlation between Apgar's scale and the pregnancy's duration has been ascertained. These values have also been estimated in particular periods: 23-27, 28-32, 33-37 and 38-42 weeks of gestation. Statistical analysis didn't indicate any difference between the mean values of Apgar's scale of the newborns from the periods of 33-37 and 38-42 weeks of gestation. There was no evidence of differences either in Apgar's scale values or in the twins' I and II body masses, as well in the whole examined group as in particular periods.

Adult↗

[Simplified cesarean section technique in the author's version].

The paper contains the description of the modification of simplified method for caesarean section, based on the Joel-Cohen and Misgav Ladach method. Advantages of the simplified methods are described on the basis of the cited papers. Following stages of procedure are described in details.

Cesarean Section↗

[Analysis of bacterial flora in the uterine cervix in women during preterm labor].

The aim of this study was to estimate type and frequency the bacterial flora of uterine cervix of female in case of preterm labor. There were analyzed 153 uterine cervix swabs of women before 37 weeks of pregnancy. It has been shown that the main etiologic factors of infestations were Escherichia coli and Staphylococcus epidermidis. Positive results of bacterial investigation has been occurred more frequently in multiparas with precocious ammonirrhea.

Cervix Uteri↗

[HELLP syndrome: problems in diagnosis and treatment illustrated on the basis of the fully symptomatic case].

HELLP syndrome is a serious complication of Pregnancy-Induced Hypertension (PIH) which is very dangerous for the mother and her foetus. The prognosis depends on early diagnosis and correct treatment. The etiopathogenesis of the syndrome is still investigated but remains unclear. Taking as an example the precisely monitored, fully symptomatic case of the HELLP syndrome, we present review of modern opinions on pathogenesis, recognition and treatment.

Adult↗

[Operative outcome in children with total anomalous pulmonary venous connection].

The authors present their experience in surgical treatment of children with total anomalous pulmonary venous connection. A retrospective analysis was carried out in 42 patients operated on in the years 1979-1999. The group included 30 boys aged 7 days to 7 years (mean 170 +/- 480 days) and 12 girls aged 14 days to 7 months (mean 86 +/- 80 days). Diagnostic studies allowed to determine that 24 patients (57%) had supracardiac type (type I), nine (21%)--cardiac (type II), five (12%)--infracardiac (type III) and four (10%)--mixed (type IV). The diagnosis was based on clinical examinations and echocardiography, supplemented in 17 patients (40%) by hemodynamic studies and angiocardiography. Preoperative pulmonary hypertension was noted in 34 children (81%), including 15 patients (36%) diagnosed by hemodynamic studies and 19 children (45%) by echocardiography. All children were operated on in deep hypothermia with circulatory arrest. In the early postoperative period (30 days), seven children (17%) died, while four more (9.5%) died in the latter period. The former were characterized by significantly lower birth weight values (p = 0.023). The total mortality rate was higher in children with type II and III anomalies. No statistically significant association was found between preoperative pulmonary hypertension and early mortality. Thirty-one children (74%) remain in late follow-up. All of them are in NYHA (New York Heart Association) class I and develop normally. Total anomalous pulmonary venous connection is a rare congenital anomaly that can be fully repaired with improving early and late results.

Angiography↗

[Results of surgical treatment of congenital heart defects in infants below 2500 grams].

We present a review of our recent experience of operating on infants below 2500 g suffering from congenital heart disease. A retrospective review was performed in 73 children who had undergone cardiac operations at our institution from 1990 to 1999. There were 43 (59%) females and 30 (41%) males; the mean age at operation was 28 days (range 4 to 92). The mean gestational age was 34.7 weeks (range 24 to 41), mean birth weight--1899 g (range 700 to 2450) and mean weight at operation--2013 g (range 640 to 2500). Cardiac diagnoses included patent ductus arteriosus (PDA) (N = 21, 28.7%), ventricular septal defect (VSD) (N = 9, 12.3%), transposition of great arteries (TGA) (N = 10, 13.7%), tetralogy of Fallot (TOF) (N = 7, 9.6%), double-outlet right ventricle (DORV) (N = 4, 5.5%), truncus arteriosus communis (TAC) (N = 4, 5.5%), hypoplastic left heart syndrome (HLHS) (N = 4, 5.5%), coarctation of aorta (CoAo) (N = 6, 8.2%), total anomalous pulmonary venous return (TAPVR) (N = 2, 2.7%), aortic stenosis (AoVS) (N = 3, 4.1%), interrupted aortic arch (IAA) (N = 1, 1.4%), pulmonary atresia (PA) (N = 1, 1.4%) and common atrioventricular canal (CAVC) (N = 1, 1.4%). Hospital mortality was 16.4%. There were 6 early deaths (8.2%) and 6 late deaths (8.2%). A higher mortality rate was noted in premature children and in children who had undergone palliative procedures. At a 1-116-month follow-up (mean 39 months), of 57 (93.4%) patients, 46 (80.7%) were in NYHA class I and 11 (19.3%) in NYHA class II. In conclusion the authors believe that early intervention can be performed in infants below 2500 g, and the associated mortality and morbidity rates are low.

Female↗

[Assessment of the effectiveness of using low molecular weight heparin in the prophylaxis of venous thrombo-embolic diseases in obstetrics].

OBJECTIVES: Assessment of the effectiveness of using low molecular weight heparin in the prophylaxis of venous thrombo-embolic diseases in pregnant women, parturients and puerperants. MATERIAL AND METHODS: 14,106 female patients were retrospectively analysed in the period between 1990-1999. The patients were divided into 4 groups: I--142 pregnant patients with crural varices, II--10 pregnant patients who had suffered from deep venous thrombosis, III--5 patients with implanted artificial cardiac valves, IV--13,949 patients without any risk factors. In the patients in groups I-III low molecular weight heparin was used prophylactically. RESULTS: In the studied groups no cases of pulmonary embolism were observed. Superficial venous thrombosis occurred in 10 women (3 in group I and 7 in group IV). Deep venous thrombosis occurred in 5 patients (2 in group I and 3 in group IV). In patients who received low molecular weight heparin over a long period of time, no excessive bleeding during delivery was observed. Other complications in the form of osteoporosis and thrombocytopenia were also not observed. CONCLUSIONS: 1. Administering of low molecular weight heparin during pregnancy, labour and puerperium has no influence on the increase of maternal et fetal complications. 2. Administering of low molecular weight heparin in pregnant women, in labour and in puerperium with increase risk of thrombo-embolic disease allows to avoid pulmonary arteries embolism. 3. Pregnant women and women in puerperium with increased risk of venous thrombo-embolic disease should be under control of experienced obstetrician in cooperation with vascular surgeon and hematologist.

Adult↗

[Changes in morphological picture of the semen in the group of men from infertile couples in the Lower Silesia in 1977-1993].

OBJECTIVES: To reveal the trends of the particular semen parameters changes during the 17 years period. DESIGN: Semen analysis results were retrospectively evaluated. MATERIALS AND METHODS: We have analysed semiograms from 618 men from infertile couples in 1977-1993. Regression analysis of the results from years of observation was performed. RESULTS AND CONCLUSIONS: We showed the statistically important increase in the percentage of pathological sperms (R2 = 0.89, p < 0.0001), the slight increase in the semen volume (R2 = 0.30, p < 0.02). The total sperm count in the semen samples revealed a slight increase (R2 = 0.33, p < 0.02). The sperm concentrations and the percentage of the motile sperms remained relatively stable and relatively constant.

Adult↗

[Amniocentesis and amniotic infusion: benefits and risks].

The introduction of the amnioinfusion technic in the treatment of chosen complications of pregnancy, requires an easy access to the amniotic cavity. Catheterisation of the amniotic cavity requires the skilled technic, and is not associated with the rise of the obstetrics complications.

Amniocentesis↗

[Usefulness of ultrasonographic measurement for fetal sacrum length in assessment of gestational age in physiologic pregnancy].

Assessment of gestational age is one of the most important aims of ultrasonography in obstetrics. As pregnancy progresses, influences of factors which makes the growth of the fetuses different, cumulates. It has been revealed that the earlier in pregnancy ultrasound examination was performed, the better precision in the assessment of gestational age was obtained. The best precision is encountered when Crown-rump length is measured between 7-9 weeks of gestation. Until the end of the half of pregnancy, biparietal measurement allows for better assessment of gestational age than the date of the last menstrual period. As pregnancy progresses the variability of the measurements increases, reaching 7 week variation at term. The aim of this study is the assessment of fetal sacral length ultrasonographic measurements in the calculation of gestational age. The investigated group consists of 453 pregnant women between 16-41 weeks of physiological gestation.

Adult↗