[Proposal for delivery in the XXI century].
Explore the source record for details and available documents.
Delivery, Obstetric↗
Biomedical subjects
K Czajkowski
Publications and source records attributed to K Czajkowski.
What we can really expect from telemedicine in intensive diabetes treatment: results from 3-year study on type 1 pregnant diabetic women.
Existing standards of the management of the diabetic patients are not efficient enough, and further improvement is needed. The major objective of this paper is to present and discuss the therapeutic effectiveness of an intensive care telematic system designed and applied for intensive treatment of pregnant type 1 diabetic women. The developed system operates automatically, every night transferring all the data recorded during the day in the patient's glucometer memory to a central clinical unit. In order to assess the efficiency of the designed and developed system, a 3-year randomized prospective clinical trial was conducted, using the study group and the control group, each consisting of 15 pregnant type 1 diabetic women. All patients were treated by the same diabetologist. In the presented analysis, two indices calculated weekly were used for the assessment of glycemic control: MBG represents mean blood glucose level, and the universal J-index is sensitive to the glycemic level and glycemic variations. The most important results from the study concern: (a) better glycemic control in the study group in comparison with the control group during the course of treatment, as assessed by the average differences of the MBG and J indices calculated weekly (n = 24) (deltaMBG = -3.2 +/- 4.3 mg/dL, p = 0.0016, deltaJ = -1.4 +/- 2.3, p = 0.0065); (b) much more similar results in glycemic control among members of the study group compared to each other, than among members of the control group compared to each other, as indicated by significantly lower variations of the applied glycemic control indices (SDMBG: 11.9 vs. 18.7 mg/dL, p = 0.0498; SDJ: 6.5 vs. 10.9, p = 0.0318); (c) the observed tendency of a better glycemic control for patients with a lower level of intelligence (IQ < 100) supported by the telematic system in comparison with all other assessed groups of patients. The last result was not statistically significant (p > 0.05). This telematic intensive care system improved the effectiveness of diabetes treatment during pregnancy. It also allows the diabetologist's strategy to be much more precise than if it were conducted without telematic support. This telematic system is inexpensive and simple in use.
Adult↗
Teletransmission system supporting intensive insulin treatment of out-clinic type 1 diabetic pregnant women. Technical assessment during 3 years' application.
A telematic system supporting intensive insulin treatment of pregnant type 1 diabetic out-clinic patients was implemented and technical efficiency of the system was evaluated over long-term ambulatory application. The system consists of a patient teletransmission module (PTM) and a central clinical control unit (CCU). The PTM contains a one-box blood glucose meter and electronic logbook, a modem and a dial-up or cellular phone set. The CCU consists of a PC computer with a modem and DIAPRET - an original program designed to monitor the intensive insulin treatment. The system was installed in the Clinic of Gastroenterology and Metabolic Disease, MA Warsaw and was tested for 166 +/- 24 days on 15 pregnant type 1 diabetic women. Telemonitoring of the patient data was done automatically. No major technical problems with proper operation or handling of the system was noted. Total effectiveness was 69.3 +/- 13.0% and technical effectiveness 91.5 +/- 6.1%. The efficacy of the system was not significantly influenced by patient intelligence level, education level or place of residence (p < 0.05). Significant improvement of metabolic control was noted during application of the system. In conclusion, the telematic system we developed and implemented should have a positive influence on the quality of diabetes treatment during pregnancy.
Adult↗
[Initial analysis of chocolate cysts operated on by laparoscopy].
53 women with an ovarian chocolate cyst were operated in a laparoscopy. A histopathological examination showed 60.4% of endometriomas and 39.6% of hemorrhagic lutein cysts. The average age of patients with endometriomas was 33.9 while of the ones with hemorrhagic lutein cysts was 28.6. The operated patients, who were under 35 years old, could be divided into halves, one half of them had endometriomas while the other half had hemorrhagic lutein cysts. However, endometriomas appeared significantly more often in the group of operated patients who were older than 35 years old.
Adolescent↗
[The influence of chosen hormones on lipids and its correlation during normal pregnancy].
OBJECTIVES: Lipids and hormones levels in nonpregnant and pregnant with uneventful gestation (from I, II, III trimester) were estimated and its correlation was evaluated. METHODS: The study group consisted of 219 women: 49 nonpregnant and 170 pregnant women (35 in I trimester, 35 in II and 100 in III trimester of gestation). All subjects were healthy. Following parameters were measured in blood serum: total lipids, LDL total fraction, (beta-lipoproteids), cholesterol both total and free, HDL cholesterol, LDL cholesterol. Percentage of free cholesterol contained on total cholesterol was evaluated. HPL and estrogens levels were estimated. RESULTS: Serum levels of total lipids, phosphlipids, triglicerides, total fraction of LDL and its contains of cholesterol increase with gestational age (p < 0.001). During pregnancy positive correlation between estrogens, HPL and triglycerides was also observed (p < 0.001). Additionally in II trimester positive correlation of total cholesterol, phospholipids and HPL was noted (respectively r = 0.469 p < 0.001 and r = 0.452 p < 0.01). CONCLUSIONS: In case of women with uneventful pregnancy positive correlation between estrogens and total lipids, total fractions LDL and triglycerides was stated. Also positive correlation among lipids parameters and HPL concentration was noted. No correlation between HPL and free cholesterol, LDL, HDL cholesterol nor between estrogens and total cholesterol, free cholesterol and LDL cholesterol was found. Lipids status in case of nonpregnant women is multihormonaly influenced.
Age Factors↗
[Diagnostic values of lactate dehydrogenase (LDH), creatine kinase (CK) and gamma-glutamyltransferase (gamma-GT) examinations in the course of intrahepatic cholestasis in pregnancy].
OBJECTIVE: The activity of LDH, CK and gamma-GT in blood serum of women with intrahepatic cholestasis in pregnancy was investigated. Diagnosis of intrahepatic cholestasis was based on anamnesis, clinical examination and laboratory tests. METHODS: 41 women with intrahepatic cholestasis (the study group) and 30 healthy women (the control group) entered the study. All women were in the third trimester of pregnancy. The prevalence rate of intrahepatic cholestasis in pregnancy in our Department is 1%. All women of the study group presented an intensive pruritus and had negative hepatitis B antigen. They also presented negative results of laboratory tests, clinical examination and anamnesis concerning other hepatitis. RESULTS: There was no significant difference in mean gestational age between study and control group (35.1 +/- 2.8 vs 36.0 +/- 3.0 weeks). The results of biochemical tests in study vs control group: 1) total bilirubin 33.3 +/- 18.8 vs 8.55 +/- 3.4 mumol/L; p < 0.001, 2) direct bilirubin 25.6 +/- 14.2 vs 1.7 +/- 1.7 mumol/L; p < 0.001, 3) indirect bilirubin 7.7 +/- 2.22 vs 8.5 +/- 3.4 mumol/L; NS, 4) alkaline phosphatase (AP) 168.4 +/- 61.2 vs 96.8 +/- 14.9 IU/L; p < 0.001, 5) heat-stable AP 99.8 +/- 38.7 vs 64.1 +/- 20.9 IU/L; p < 0.001, 6) bile acid 28.6 +/- 20.0 vs 4.5 +/- 1.5 mumol/L; p < 0.001, 7) AlAT 158 +/- 00 vs 5 +/- 3 IU/L; p < 0.001, 8) AspAT 97 +/- 31 vs 8 +/- 3 IU/L; p < 0.001, 9) de Ritis ratio AspAT/AlAT 0.61 +/- 0.31 vs 1.6 +/- 0.4; p < 0.001, 10) total protein 61.8 +/- 5.6 vs 66.0 +/- 6.0 G/L; p < 0.001, 11) albumine 450 +/- 34.8 vs 484.0 +/- 37.7 mumol/L, 12) Fe++ 26.0 +/- 3.8 vs 12.71 +/- 2.15 mumol/L; p < 0.001, 13) total cholesterol 8.81 +/- 1.87 vs 6.68 +/- 1.04 mmol/L; p < 0.001, total LDL 6.80 +/- 1.57 vs 4.80 +/- 0.81 G/L; p < 0.001, 15) LDH 211 +/- 48 vs 134 +/- 33 UI/L; p < 0.001, 16) CK 51.0 +/- 33 vs 45 +/- 14 UI/L; NS, 17) gamma-GT 49 +/- 22 vs 23 +/- 8 UI/L; p < 0.001. CONCLUSIONS: An increase of LDH is related to the significant impairment of hepatocytes. An increase of gamma-GT confirms the retention of bile in intrahepatic ducts. CK does not present prognostic value in intrahepatic cholestasis in pregnancy.
Adult↗
The biochemical functions of the renal tubules and glomeruli in the course of intrahepatic cholestasis in pregnancy.
Biochemical functions of kidney glomeruli and tubules were estimated in pregnancy complicated by cholestasis. The investigated group consisted of 72 women with pregnancy complicated by cholestasis and 30 healthy pregnant patients as a control group. Biochemical assays were performed for the deamination of amino acids, carbonic acid dissociation and creatinine metabolism. Statistical analysis was carried out using the t-test and P<0.05 was considered to be significant. In diurnal urine samples collected from pregnant patients with cholestasis, decreased concentrations of NH4+ (42.0+/-8.9 versus 50.3+/-7.6 mmol/24 h), H+ (19.0+/-7.0 versus 25.0+/-5.0 mmol/24 h), creatinine (1.15+/-0.2 versus 1.43+/-0.3 mmol/24 h) as well as lower levels of creatinine clearance (89.0+/-23.0 versus 135.0+/-30.0 ml/min) and normal levels of potassium and sodium were observed. Serum creatinine and uric acid concentrations were elevated (86.6+/-7.07 versus 66.3+/-4.42 micromol/l and 32.1+/-8.3 versus 19.0+/-3.57 micromol/l). Diurnal urine volume was lower in patients with cholestasis than in the control group (995+/-313 versus 1264+/-426 ml/24 h). Disturbances of biochemical functions of kidney glomeruli and tubules, regarding creatinine metabolism and deamination of amino acids, and dissociation of carbonic acid, were seen in patients with cholestasis during pregnancy.
Adult↗
[Results of the activity of Jose Carreras Memorial Cord Blood Bank in Warsaw].
Following the first successful cord blood transplantation in 1988, several hundreds of patients were treated using same protocol. The main limitation of the wide use of cord blood as a source of haematopoietic cells is the number of available units of this tissue. To make possible selection of HLA-matched cells for individual patient, several thousands of cord blood samples must be collected and stored in liquid nitrogen. The network of cooperating cord blood banks with join accessible database is necessary. In this paper the activity of Jose Carreras memorial Cord Blood Bank established in Warsaw was described. Since the middle of January the collection of cord blood units for clinical purposes was started. During first three months 80 samples of cord blood was collected. Collections were obtained from normal full-term deliveries after the third stage of labour. For the banking the collection over 60 ml or contain over 4 x 10(8) of mononuclear cells were qualified. Whole blood samples and plasma samples obtained following volume reduction were used for HLA and bacteriology tests. After volume reduction the number of nucleated cells (WBC), mononuclear cells (MNC) and hematopoietic cells (CD34+) were evaluated. After processing the cord blood samples were frozen using control freezer and were stored in liquid nitrogen storage tanks. According to results of cord blood transplantation hundred percent of banked samples are suitable for recipients weighing 10 kg and only 7 percent for these weighing 50 kg.
Blood Banks↗
[Comparison of the selected methods of cord processing for transplantation purposes].
Human umbilical cord blood (UCB) has been successfully used as a source of allogeneic hematopoietic cells for transplantation. Banking of the UCB requires its volume reduction to decrease storage space, costs and volume of infused DMSO. In order to select an optimal method for volume reduction we compared several methods of cord blood processing, namely buffy coat centrifugation, red cell lysis, hydroxyethyl starch (HES)-, methylcellulose- and gelatin-sedimentations. The viability of cells and the recoveries of total white blood cells, mononuclear cells and CD34+ cells was evaluated. We also compared the efficacy of red cells depletion from the original UCB sample. Buffy coat centrifugation, red cell lysis, HES, gelatin or methylcellulose resulted in high mononuclear cell recoveries, whereas high hematopoietic cell recovery was observed only after HES sedimentation and buffy coat processing. The HES sedimentation procedure compared to buffy coat processing is more time and labor consuming and resulted in higher red blood cell and platelets depletion. Both methods can be recommended as a method at choice for the umbilical cord blood processing before banking.
Antigens, CD34↗
[Results of screening tests for gestational diabetes mellitus at Medical University in Warsaw].
Our purpose was to determine the incidence of screening for gestational diabetes among the population of women delivering at I and II Departments of the First Faculty of Medical University in Warsaw. A retrospective review of 647 pregnancies was performed. The incidence of gestational diabetes mellitus screening was determined and the rate of occurrence of GDM analyzed. 310 (48%) pregnancies were screened for gestational diabetes mellitus with a 1-hour, 50 gm oral glucose challenge test. 49 (16.07%) of the screens had positive results at a plasma glucose level of > 139 mg/dl. Two-hour 75 gm oral glucose tolerance tests (according to the 1994 World Health Organization panel recommendations) were performed on screen-positive women, eleven of whom (22.45%) were diagnosed with gestational diabetes mellitus. Despite of positive oral 50 gm glucose test, (plasma glucose level 140-179 mg/l) 15 women (30%) haven't had the 75 gm oral glucose test. The incidence of GDM among analyzed population is 4% and when GDM screening is carried out, exceeds 7%. Early gestational glucose screening, if performed, may be beneficial in detecting gestational diabetes. Consideration should be given to fulfill it more frequently and for sure, repeat glucose testing in patients with positive one-hour screening tests.
Academic Medical Centers↗
[Risk factors for gestational diabetes mellitus and results of glucose tolerance tests].
The authors made an effort to verify the connection between the presence of risk factors for GDM and results of screening and diagnostic tests. Study group consisted 302 patients. Gestational diabetes was more frequently diagnosed when an excessive maternal weight and family history of diabetes occurred. Among women with gestational diabetes recognised on the basis of the tests results (screening or diagnostic), 1/3 of patients had no evidence of any risk factor. There is no correlation between the number of risk factors and the occurrence of gestational diabetes. The risk factors were present in half of the investigated patients.
Adult↗
[Pregnancy in women with diabetes complicated by nephropathy and proliferative retinopathy].
Nephropathy and proliferative retinopathy are widely known as the most serious complications of diabetes. In the paper the analysis of the course of pregnancy, labour and neonatal complications among mothers with White class F, R, FR and T was made. The study group consisted of 44 patients. Primary hypertension was observed in 17 (38.6%) patients. The percentage of complications both maternal and neonatal was very high. Among maternal complications were pregnancy induced hypertension (43.2%), urinary tract infections (36%), anaemia (22.7%), threatened preterm labor (13.6%). Nearly 50% of patients has diurnal proteinuria in nearly 50% of patients exceed 3 g. In the opinion of the authors there is a strong need to establish the national supraregional centers designed specially to deal with the problems of pregnant women with diabetic nephropathy and retinopathy.
Adult↗
[Influence of intelligence level of the type I diabetic patients handling hi-tech glycemia monitoring system on the effectiveness of intensive insulin treatment].
An intensive care system designed and developed in IBBE PAS allows for electronic storage and automatic transmission of BG values and other parameters directly from a patient's BG meter and electronic logbook (Glucometer M+ Bayer) to central clinical computer by telematic connection. Despite effort made to keep the system as simple as possible, its proper handling still requires some additional skills from the patient. Thus, effectiveness of the intensive insulin treatment supported by the system may be influenced by the patient's intelligence level. The aim of this work was to evaluate influence of the intelligence level of type 1 diabetic patients equipped with designed system on effectiveness of a long-term intensive insulin treatment. The study group consisted of 17 type 1 diabetic pregnant women randomly divided in two sub-groups. Eight patients used the transmission system and the remaining 9 patients were treated classically. Patient's intelligence level was assessed according Wechsler scale. Analysis of variance indicated that intelligence level did not influence significantly on average result of the treatment (p > 0.05) in whole study group and in both subgroups. Generally, in patients with lower (93 +/- 2.0) and higher (114.1 +/- 1.2) intelligence level glycemic control indices were found to be similar and did not differ significantly. Performed analysis indicated that the designed system could be properly handled by diabetic patients within wide range of intelligence level. However, despite not statistically significant influence of the patients intelligence level on obtained glycemic control, tendency was observed to obtain better average long-term glycemic control in patients with lower intelligence level using telematic data transmission in comparison with the patients treated in classical way (SDWG = 7.0 +/- 0.4 vs. 8.1 +/- 1.0 mmol/l and J = 30.3 +/- 4.4 vs. 39.0 +/- 12.2).
Adult↗
Second trimester calcium-phosphorus-magnesium homeostasis in women with threatened preterm delivery.
OBJECTIVE: The effect of threatened preterm delivery on calcium, phosphorus, magnesium homeostasis in the second trimester of pregnancy was investigated. METHODS: Serum concentrations of total and ionized calcium, inorganic phosphorus, magnesium, total protein, albumin, total estrogens and human placental lactogen were determined in women with threatened preterm delivery at 23-28 weeks of gestation (the studied group) and in women with uncomplicated pregnancy of the same duration (the control group). Additionally activities of total alkaline phosphatase and heat-stable alkaline phosphatase fraction were measured. RESULTS: Patients of the studied group compared to the control group showed decreased concentration of total calcium (2.15 +/- 0.073 vs. 2.25 +/- 0.11 mmol/l, P < 0.001), inorganic phosphorus (1.21 +/- 0.26 vs. 1.34 +/- 0.22 mmol/l, P < 0.01) and magnesium (0.63 +/- 0.053 vs. 0.71 +/- 0.12 mmol/l, P < 0.001), total protein (64.0 +/- 5.4 vs. 68.6 + 1.0 g/l, P < 0.001), albumin (546.3 +/- 55.1 vs. 579.6 +/- 49.3 micromol/l, P < 0.003) and placental lactogen (3664 +/- 1806 vs. 4651 +/- 1858 ng/ml, P < 0.02); they also demonstrated decreased activity of total alkaline phosphatase (42.17 +/- 16.99 vs. 50.66 +/- 6.56 IU/l, P < 0.001) and its heat stable fraction (22.65 +/- 7.89 vs. 31.89 +/- 9.09 IU/l, P < 0.001). Patients of the studied group showed normal values of ionized calcium and total estrogens. CONCLUSIONS: Premature uterine contractility in women in the second trimester is accompanied by lowered serum concentrations of total calcium, inorganic phosphorus, magnesium, total protein and albumin. There is also decreased activity of total alkaline phosphatase, its heat-stable fraction and placental lactogen which may have diagnostic value. Premature uterine contractility in women in the second trimester may be related to the disturbances of calcium-phosphorus-magnesium homeostasis and calcium supplementation should be considered.
Calcium↗
Calcium-phosphorus-magnesium homeostasis in women with threatened preterm delivery.
OBJECTIVE: The effect of threatened preterm delivery on calcium, phosphorus, magnesium homeostasis in the third trimester of pregnancy was investigated. METHODS: Serum concentrations of total and ionized calcium, inorganic phosphorus, magnesium, total protein, albumin, total estrogens and human placental lactogen were determined in women with threatened preterm delivery at 29-36 weeks of gestation (the studied group) and in women with uncomplicated pregnancy of the same duration (the control group). Additionally, activities of total alkaline phosphatase and heat-stable alkaline phosphatase fraction were measured. RESULTS: Patients of the studied group compared to the control group showed decreased concentration of total calcium (2.17 +/- 0.09 vs. 2.28 +/- 0.13 mmol/l, P < 0.0005), inorganic phosphorus (1.13 /- 0.27 vs. 1.32 +/- 0.23 mmol/l, P < 0.001) and magnesium (0.64 +/- 0.07 vs. 0.70 +/- 0.10 mmol/l, P < 0.003); they also demonstrated decreased activity of total alkaline phosphatase (70.8 +/- 23.2 vs. 81.9 +/- 14.9 IU/l, P < 0.01) and its heat-stable fraction (30.2 +/- 15.6 vs. 59.6 +/- 14.9 IU/l, P < 0.001). In the studied group no difference was found in concentrations of investigated ions and enzymes between women who delivered at term and women who delivered prematurely. Patients with threatened preterm delivery showed serum deficiency of total calcium, phosphorus and magnesium which might be related to premature uterine contractility but does not predict premature labor by week 36 of gestation (66% of patients delivered at term). CONCLUSION: The deficiency of minerals and lowered activity of total alkaline phosphatase is observed in women with threatened preterm delivery. Laboratory tests of calcium-phosphorus-magnesium homeostatsis have limited predictive value in regard to the term of delivery in women with threatened preterm delivery.
Alkaline Phosphatase↗
[Evaluation of the intrauterine fetus in hypertension--biochemical assessment of amniotic fluid. IV. Ions].
Sixty two samples of amniotic fluid, collected by ultrasound guided amniocentesis, were submitted to biochemical investigation including 31 samples from women with pregnancy complicated by hypertension (studied group) and 31 samples deriving from healthy pregnant women (control group with). Both investigated and control groups consisted of pregnant women with the same gestational age of 37 +/- 2 weeks (34-40 weeks). The following ions were measured: NH4+, K+, Na+, Cl-, Mg++, total Ca, Ca++ and inorganic phosphorus (Pi). The ionic composition of amniotic fluid deriving from women with pregnancy complicated by hypertension was normal. The regular concentration of NH4+ ions in amniotic fluids of a studied group may suggest kidneys of the fetuses in pregnancy complicated by hypertension were as mature as in the normal pregnancy within the same gestational age.
Adult↗
[Calcium-phosphorus-magnesium homeostasis in women with threatened abortion].
One hundred twenty eight women were submitted to research including: 38 healthy not pregnant women, 40 healthy women in the first trimester of uncomplicated pregnancy (6-15 weeks) and 50 pregnant women with symptoms of threatened abortion (6-15 weeks). The following parameters were measured in serum: total Ca, Ca++, ionised inorganic phosphorus (Pi), magnesium (Mg), total protein and albumin and also total alkaline phosphatase activity (APt). Micromethods generally accepted in clinical laboratories were used. The study showed symptoms of threatened abortion are related to decreased concentrations of Pi, Mg, total protein and albumin and reduced activity of APt. Women who did not underwent miscarriage showed significantly higher Pi concentration compared to those who lost pregnancy, what might be of prognostic value. Threatened abortion was not considered to alter calcium homeostasis.
Abortion, Threatened↗
[Calcium, phosphorus and magnesium in pregnant women with primary hypertension].
Sixty five women were in the third trimester of pregnancy (29-40 weeks of gestation) submitted to the study including 35 with primary hypertension (the studied group) and 30 healthy (control group). The following parameters were measured in blood serum and urine from 24 hrs, collection: total Ca and Ca++, inorganic phosphorus (Pi) and magnesium. Generally accepted micromethods were used; Ca++ was measured using AVL type 9140 analyser. Women of the studied group presented mean blood pressure 164 +/- 14/106 +/- 9.7 mm Hg and did not have proteinuria and oedema. They presented decreased concentrations of total Ca (p < 0.004) and ionised Ca++ (p < 0.004), and an increase of Pi (p < 0.002) in blood serum. No differences in magnesium concentrations were found. Distinct decrease of calcium excretion in urine was found in hypertensive women (4.50 +/- 2.76 vs 6.60 +/- 3.4 mmol/24 hrs, p < 0.024). No alterations in phosphorus and magnesium urine excretion were observed in women with hypertension (women of both groups had the same volume of 24 urine). Our study concludes the main alterations in calcium-phosphorus-magnesium homeostasis in pregnant women with primary hypertension are the calcium homeostasis alterations. Phosphorus homeostasis is less affected while magnesium distribution does not change. Hypocalciuria might be related to impaired glomerular filtration in this pathology in pregnancy. Hypocalciuria and lowered serum concentrations of total Ca and ionised Ca++ might prove general deficiency of this element in pregnancy complicated by primary hypertension.
Calcium↗