Biomedical subjects

M Szpakowski

Publications and source records attributed to M Szpakowski.

At least 37 records · Page 2Linked to original sources

PubMed1999

[Analysis of perinatal death at the Institute of the Health Center of the Polish mother in 1995, 1996 and 1997. The reason for making changes in the accountability for perinatal death].

Perinatal death's causes of fetuses and newborns from single and twin pregnancies delivered at the PMMHI from 1995-1997 were discussed. Data from the Pathology Department were analysed and compared to information regarding prenatal US + ECHO diagnoses coming from the Department for Diagnoses of Congenital Malformations at the PMMHI. The most frequent cause of death of fetuses and newborns from single pregnancies were congenital malformations (42%). In twins there prevailed such typical for multiple pregnancies' death causes as TTTS (27%), intrauterine demise of one of the twins (17%). Premature labor occupies the second most frequent cause of death both in single and multiple pregnancies. Most of perinatal deaths may be predicted prenatally by means of ultrasound and fetal echocardiography.

Catchment Area, Health↗

PubMed1998

[The use of maternal serum cytokines in the predicting of the efficacy of tocolytic therapy in case of the threat of preterm labor].

OBJECTIVES: The purpose of our study was to evaluate the use of maternal serum IL-8, IL-6, IFN-gamma levels in the predicting of the efficacy of tocolytic therapy in preterm labor. MATERIALS AND METHODS: We investigated prospectively the group of 47 women in singleton pregnancies with threatened preterm labor in less than 36 weeks gestation and administered tocolytic therapy. RESULTS: In 19 of them tocolysis failed (group II and they delivered premature newborns (the group I--successful tocolysis consisted of remaining 28 women). The incidence of clinical chorioamnionitis, histologic chorioamnionitis and inherited infection of newborns was significantly higher among women refractory to tocolytic therapy (10.2%, 36.8%, 26.3% versus 0%, 3.6%, 0%, respectively, p < 0.05). Maternal serum IL-8, IL-6, IFN-gamma (by means of ELISA technique) and CRP, WBC, ESR levels were measured at the admission to the study. The mean WBC, ESR and the median (range) IFN-gamma (0 (0-7.1) and 0.9 (0-10.4) pg/ml, respectively) didn't differ in both groups. The concentrations of serum IL-8, IL-6, CRP were significantly higher in the group of failed tocolysis (median (range): IL-8: 22.7 (6.3-83.2) vs 3.0 (0-26.0) pg/ml; IL-6: 7.4 (0-21.0) vs 0 (0-11.3) pg/ml; CRP: 1.8 (0.6-7.0) vs 0.6 (0.6-3.9) mg/dl; p < 0.05). Serum IL-8 determinations (definition of abnormal test: > 8 pg/ml) were found the most reliable in the prediction of tocolysis failure with a sensitivity 87.5%, specificity 81.8%, positive predictive value 77.8%, negative predictive value 90% and accuracy 84.2%. Also reliable were IL-6 determinations (IL-6 > 6 pg/ml had a sensitivity 75%, specificity 90.9%, positive predictive value 85.7%, negative predictive value 83.3% and accuracy 84.2%) and CRP determinations (CRP > 1.2 mg/dl had a sensitivity 75%, specificity 81.8%, positive predictive value 75%, negative predictive value 81.8% and accuracy 78.9%). The efficacy of IFN-gamma, WBC and ESR was significantly lower. CONCLUSIONS: Our data revealed that the maternal serum IL-8, IL-6 and CRP determinations are very useful in the predicting of the efficacy of tocolytic therapy in women with threatened preterm labor. The use of IFN-gamma, WBC, ESR was significantly lower.

Cytokines↗

PubMed1998

[The cost of laparoscopy in the diagnosis of female infertility].

DESIGN: The aim of the study was to estimate the usefulness of laparoscopy in diagnostics of women's infertility. MATERIALS AND METHODS: This study is a retrospective review of the notes of 133 infertile women who had undergone laparoscopic procedures--in 88 (66.2%) patients the reason of their infertility was unknown (study group I) and in 45 (33.8%) pelvic pathology (PCO syndrome-37 cases, endometriosis-6 cases and tubal inpatency-2 cases) was supposed (study group II). RESULTS: In 96 (72.2%) patients (in 51 from group I and in 45 from group II) pelvic pathology was estimated (p < 0.0001 in comparison with diagnostic estimation before laparoscopy). Most frequent pathology in women with unexplained infertility was seen: endometriosis, adhesions and tubal inpatency. During laparoscopy procedure we changed totally preoperative diagnosis in 43.6% patients (58 cases--51 from group I and 7 from group II) and in 9.8% women additional pelvic abnormalities were detected. CONCLUSION: In authors opinion the laparoscopic procedure is very helpful in infertile women and ought to be included in diagnostic standard in cases of unexplained infertility.

Adult↗

PubMed1998

[Maternal serum cytokines concentrations during normal pregnancy and labor].

OBJECTIVES: The purpose of our study was to determine maternal serum concentrations of IL-8, IL-6, IFN-gamma during normal pregnancy and labor. MATERIALS AND METHODS: Maternal serum IL-8, IL-6 and IFN-gamma levels were measured by means of ELISA technique in 41 healthy pregnant women in 22-42 week gestation and 15 healthy women in labor at term. All newborns and afterbirths had no signs of infection. RESULTS: IL-8 values for pregnant women ranged from 1.98 to 35.2 pg/ml with the median value 10.24 pg/ml, and the 95th percentile 24.5 pg/ml. IL-8 values for women in labor at term ranged from 3.96 to 54.8 pg/ml with the median 10.4 pg/ml. No statistically significant changes in serum IL-8 concentration were observed during pregnancy or in labor. Serum IL-6 concentrations in pregnant women ranged from 0 to 21.7 pg/ml with the median value 0 pg/ml, and the 95th percentile 15.5 pg/ml. Serum IL-6 concentrations in women in labor at term were significantly higher (p < 0.05): ranged from 0 to 39.2 pg/ml with the median 10.1 pg/ml and 95-th percentile 33.5 pg/ml. Maternal serum IFN-gamma concentrations in pregnant women ranged from 0 to 9.8 pg/ml with the median value 3.9 pg/ml, the 95th percentile 9.2 pg/ml and didn't differ during labor at term: range from 0 to 14.5 pg/ml, median 1.9 pg/ml. CONCLUSIONS: Our data revealed that maternal serum IL-8 concentrations didn't changed during the course of pregnancy and in labor. Women in labor had significantly elevated serum IL-6 concentrations compared to those in pregnancy. We didn't observed such changes in serum IFN-gamma levels.

Adult↗

PubMed1998

[Aberration of somatic karyotype in normozoospermic males from infertile couples].

During the complex investigation of couple infertility, a group of 40 normozoospermic males having low density of semen was selected. Cytogenetic analysis revealed 2 cases of somatic karyotype aberrations: 47,XYY and 46,XY,t(14;19), and 2 cases of chromosomal polymorphisms: 46,XYq+ i 46,XY,14p+. In the article the mechanism of fertility disturbances evoked by these findings is discussed in aspects of the function of spermatozoa and its genetic material content.

Adult↗

PubMed1998

[Intrauterine infections. I. The role of C-reactive protein, white blood cell count and erythrocyte sedimentation rate in pregnant women in the detection of intrauterine infection after preliminary rupture of membranes].

UNLABELLED: The purpose of our study was to analyze the efficacy of serum C-reactive protein (CRP), white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) serial evaluations in the prediction of chorioamnionitis in cases of premature rupture of membranes (PROM). MATERIALS AND METHODS: A group of 80 patients with PROM before 35 weeks' gestation were evaluated prospectively and managed expectantly. We applied the expectant management with the permanent use of tocolysis, antibiotics, steroids, amnioinfusions of artificial amniotic fluid and intravaginal chemotherapeutics. Patients were monitored with frequent vital signs, fetal heart rate evaluation and everyday blood tests as follows: CRP, WBC and ESR. All afterbirths were examined to establish the presence of histologic chorioamnionitis (gold standard of intrauterine infection). RESULTS: 59 (73.7%) patients had significant chorioamnionitis on histopathology and only 15 of them had clinical chorioamnionitis. Serum CRP serial determinations (definition of abnormal tests: 1) > 1.2 mg/dl; 2) > 2.0 mg/dl; 3) > 1.2 mg/dl and increasing in two consecutive days) were found the most reliable with a sensitivity 1) 91.5%; 2) 85%; 3) 88%, specificity 57%; 76%; 86%, positive predictive value 86%; 90%; 94.5%, negative predictive value 70.5%; 64%; 72% and accuracy 82.5%; 82.5%; 87.5% respectively. The efficacy of WBC (abnormal tests: > 12500/mm3; > 15000/mm3; > 12500/mm3 and increasing in two consecutive days) and ESR (abnormal tests: > 60 mm/h; > 60 mm/h and increasing in two consecutive days) serial evaluations was significantly lower. Moreover, in cases of chorioamnionitis CRP increased above the upper limit of normal 3 days earlier than WBC or ESR. CONCLUSIONS: CRP was found the most reliable indicator of histologic chorioamnionitis and indicated the presence of intrauterine infection earlier than WBC or ESR.

Adult↗

PubMed1998

[Intrauterine infection. II. The effect of intravenous dexamethasone on the results of C-reactive protein, white blood cell count and erythrocyte sedimentation rate during the expectant management of premature rupture of membranes].

UNLABELLED: The purpose of this study was to evaluate the influence of dexamethasone administration on selected markers of infection during the expectant management of premature rupture of membranes (PROM). MATERIALS AND METHODS: A group of 80 patients with PROM before 35 weeks' gestation were evaluated prospectively and managed expectantly. All patients were managed in the hospital. All pregnancies had ultrasonographic evaluations to confirm gestational age, rule out lethal anomalies, and document oligohydramnios. We applied the expectant management with the permanent use of tocolysis, antibiotics, steroids (4 mg of dexamethasone every 8 hr for 2 days, every week), amnioinfusions of artificial amniotic fluid and intravaginal chemotherapeutics. Patients were monitored with frequent vital signs, fetal heart rate evaluation and everyday blood tests as follows: C-reactive protein (CRP), white blood cell count (WBC) and erythrocyte sedimentation rate (ESR). After completing 25 weeks antenatal fetal surveillance included a nonstress test at least once a day. All afterbirths were examined to establish the presence of histologic chorioamnionitis. In order to eliminate the influence of intrauterine infection we analyzed only the results obtained of patients without histologic chorioamnionitis (n = 24). RESULTS: WBC raised significantly in the first day of steroidotherapy (mean: 14,895/mm3), was elevated in the second day (15,716/mm3) and the day after (15,100/mm3), and decreased to the normal limit in the second day after steroids (12,316/mm3); p < 0.001. There were no statistically significant differences in the results of CRP and ESR connected with the administration of dexamethasone. CONCLUSIONS: Dexamethasone administration caused the independent of infection and temporary elevation of WBC. We did not observe such influence on the results of CRP and ESR.

Adult↗

PubMed1998

Immunological characteristics of nonpregnant women with unexplained recurrent spontaneous abortion who underwent paternal lymphocytes immunization.

The purpose of this study was to analyze the immunological characteristics of nonpregnant women with recurrent spontaneous abortions (RSA) of unknown etiology. We analyzed how differences of the immunological state of individual groups of women with RSA and various types of RSA (primary vs. secondary aborters) might influence on results of paternal lymphocytes immunization. In this prospective study the immunological characteristics of 117 nonpregnant women with unexplained RSA in comparison to 44 healthy, nonpregnant multigravid women, were analyzed. The following immunological parameters were studied: peripheral blood lymphocyte subpopulations (CD3+, CD4+, CD8+, CD3+/HLA-DR+), lymphocyte proliferative response to phytohaemaglutynin (PHA) and allogenic lymphocytes (in mixed lymphocyte reaction--MLR), the effect of women's sera on MLR, neutrophil chemiluminescence and anticardiolipin (ACA) as well as antinuclear (ANA) antibodies titers. We found that in nonpregnant RSA women the CD8+ lymphocytes percentage was lower (20.2% vs. 23.9%) and the CD4+/CD8+ ratio higher (2.37 vs. 1.9) as compared to the controls. In comparison with normal multigravidas in recurrent aborters an absence of serum factors suppressing MLR (blocking antibodies) and a high incidence of autoantibodies was observed (ACA: 53.8% vs. 9.1%; ANA: 42.7% vs. 6.8%). The pregnancy success ratio was significantly lower for alloimmunized women with medium/high titers of ACA than for those without ACA (64% vs. 96%, p < 0.001). It was proved there were no significant differences in the estimated immunological parameters between groups of women suffering from either primary or secondary abortions. It was also shown that there is an equally high efficiency of paternal lymphocyte immunization in preventing future abortions both in primary (88%) and secondary (86%) aborters. In conclusion it can be assumed that considering the immunological conditions of nonpregnant women with recurrent spontaneous abortion of unexplained etiology differ from healthy and fertile women. These differences are mainly connected to the humoral immunity and manifested in absence of blocking antibodies in sera of women with RSA and in frequent occurrence of antinuclear and anticardiolipin antibodies. Among autoantibodies, only ACA at medium and high levels are the ones that can negatively influence on the pregnancy outcome in women with RSA who underwent paternal lymphocytes immunization. The clinical classification of women with RSA into primary and the secondary aborters is reflected neither in immunological results nor in efficacy of paternal lymphocytes immunization.

Abortion, Habitual↗

PubMed1997

Clinical and immunological condition of newborns of mothers treated for recurrent spontaneous abortions with paternal lymphocytes immunization.

OBJECTIVE: The aim of this study was to evaluate the clinical condition at birth and some laboratory parameters in newborns of mothers treated for recurrent spontaneous abortion (RSA) of unknown etiology with paternal lymphocytes immunization. STUDY DESIGN: The study comprised 104 newborns delivered by 102 women with RSA, who underwent alloimmunization and 90 randomly chosen control newborns. The following parameters were analysed in two groups of newborns: general condition at birth, physical development, course of adaptation period, values of hematological and immunological (percentage of CD3, CD4, CD8, CD19 and CD3/CD25 lymphocytes, chemiluminescence of neutrophils at rest and stimulated with opsonized zymosane) parameters in umbilical arterial blood. RESULTS: No statistically significant differences were noted between the two groups of newborns as to the duration of pregnancy, birth weight, general condition at birth, occurrence of complications in the adaptation period and values of studied hematological and immunological parameters. CONCLUSION: These results suggest that immunization with paternal lymphocytes in women with RSA of unknown etiology not only creates better prognosis for the outcome of the pregnancy, but is also safe for the fetus and the newborn.

Abortion, Habitual↗

PubMed1997

[Efficiency of paternal lymphocyte immunization in prevention of unexplained recurrent spontaneous abortion. I. Clinical prognostic factors].

Prognostic value of some clinical factors on the course of subsequent pregnancy in 117 women with unexplained recurrent spontaneous abortion undergoing immunization with paternal lymphocytes were evaluated in the study. The results allow to conclude that high efficiency of alloimmunization in preventing consecutive abortions (87.2% in our own study) does not seem to depend significantly on: the woman's and her partner's age, number, type (primary vs. secondary), and time of previous miscarriages, coexistence of subfertility, time from immunization to the fertilization and the number of lymphocytes used for the procedure (as far as it concerns the number of lymphocytes isolated from 100 ml of blood). In our results, alloimmunization is most effective in preventing a missed abortion (in comparison with "live" spontaneous abortion).

Abortion, Habitual↗

PubMed1997

[Efficiency of lymphocyte immunization by the partner in prevention of unexplained recurrent spontaneous abortion. II. Immunologic prognostic factors].

The prognostic value of some immunological parameters on the course of subsequent pregnancy in 117 women with recurrent spontaneous abortion of unknown etiology subjected to paternal lymphocytes immunization, were estimated. We conclude that neither antinuclear (ANA) nor low titers of anticardiolipin antibodies (ACA), nor mixed lymphocyte reaction--blocking antibodies (MLR-BAbs) have any significant influence on alloimmunization efficiency. However medium or high ACA titers significantly diminish changes for successful alloimmunization and are connected with most complications of subsequent pregnancy.

Abortion, Habitual↗

PubMed1997

[Immunologic characteristics women with recurrent spontaneous abortion of unknown etiology. I. Cellular immune response].

The purpose of this study was to analyze the cellular immune response of women with recurrent spontaneous abortion (RSA) of unknown etiology. The study group was consisted of 117 nonpregnant women with RSA and 44 healthy, nonpregnant multigravidas (as a control). The following immunological parameters were analyzed in peripheral blood of two groups of women: percentage of CD3+, CD4+, CD8+, CD3+/HLA-DR+ and CD16+/CD56+ cells, lymphocyte proliferative response to mitogen and allogenic, and chemiluminescence of neutrophils. The results show that nonpregnant women with RSA of unknown etiology differ in some parameters of immune response form controls. The changes of peripherial blood T lymphocytes subpopulation were observed, consisted on lower CD8+ percentage and higher CD4+ to CD8+ T cells ratio, but lymphocytes and neutrophils activity seems to be unchanged. It seems, that among couples experiencing RSA of unknown etiology higher evidence of the same HLA antigents is not observed, when compared with couples of normal fertility.

Abortion, Habitual↗

PubMed1997

[Immunologic characteristics of women recurrent spontaneous abortion of unknown etiology. II. Characterization of humoral immunology].

The purpose of this study was to analyze the humoral immune response of non-pregnant women with unexplained recurrent spontaneous abortion (RSA). The study group was consisted of 117 nonpregnant women with RSA and 44 healthy, non-pregnant multigravidas (as a control). The following immunological parameters were analyzed in peripheral blood of two groups of women: the effect of autologous sera on proliferation of lymphocytes stimulated with phytohemagglutinin (PHA) or paternal lymphocytes (in mixed lymphocyte reaction--MLR), incidence of MLR-blocking antibodies (MLR-BAbs) incidence of antinuclear and anticardiolipin antibodies. The results show that women with RSA of unknown etiology differ in some parameters of immune response--higher incidence of antinuclear and anticardiolipin antibodies, absence of serum factors suppressing lymphocyte proliferation in response to PHA and paternal alloantigens--in comparison with nonpregnant normal multigravidas.

Abortion, Habitual↗

PubMed1997

CD3-/HLA-DR+, CD3+/HLA-DR+ cell levels and PHA stimulation of lymphocytes obtained from women with recurrent spontaneous abortions and subjected to partner's lymphocyte immunization.

It is assumed that 80% of recurrent spontaneous abortions (RSA) of unknown etiology are of immunological origin. The proposed experimental treatment of those patients could be immunization with paternal lymphocytes, though the exact mechanism through which this therapy exerts its effect is still unknown. Some authors suggest that lymphocyte alloimmunization alters the number and activity of particular subpopulations of peripheral blood lymphocytes. The aim of this study was to evaluate the proliferative O activity of lymphocytes stimulated with phytohemagglutinin (PHA) and the percentage of peripheral lymphocytes carrying CD3+/HLA-DR+ and CD3-/HLA-DR+ markers, present in 32 selected for this study RSA women subjected to paternal lymphocytes' alloimmunization performed prior to conception and in early pregnancy. We conclude that, the post-immunization changes seem to have different quantitative and qualitative character comparing to those seen in normal pregnancy. They seem to avert unfavourable immunological phenomena observed in RSA women, allowing for successful continuation of pregnancy.

Abortion, Habitual↗

PubMed1996

[C-reactive protein in normal pregnancy].

Serum C-reactive protein levels (CRP) were measured by means of the immunoturbidimetric assay technique in 33 healthy pregnant women (38-42 week of gestation) and 32 healthy women in labour at term. CRP values for pregnant women ranged from 0.15 to 1.5 mg/dl with the median value 0.2 mg/dl. The 95th percentile for CRP in these pregnant women was 1.2 mg/dl. CRP values for women in labour at term ranged from 0.15 to 2.7 mg/dl. The median CRP value for these women was 0.8 mg/dl; the 95th percentile was 1.9 mg/dl. CRP values for women in labour at term were significantly higher than CRP values for pregnant women (p < 0.001). C-reactive protein levels in normal pregnancies appear to be higher than standardized values for nonpregnant individuals, and CRP values are further elevated in labour.

C-Reactive Protein↗

PubMed1996

[Analysis of the questionnaire for prenatal ultrasonography in women delivering at the Polish Mother's Memorial Hospital in the year 1995].

After delivery at the Polish Mother's Memorial Hospital, Lódź Poland (PMMH), 1658 women were asked to fulfill the questionnaire regarding US studies during their pregnancy. At least one US study had 94% (1559) of pregnant women, 6% (99) had none. Three-US studies (the optimal number recommended by the authors) had 26%, 2-US studies had 33%, 1-US studies had 22%. Our data confirm that the series of 3-US studies during the low risk pregnancy, as it is recommended in most European countries needs further promotion and implementation in Poland. In our center, in the majority of cases, 4 or more US studies were performed in high risk pregnancies.

Female↗

PubMed1995

[Occurrence of antinuclear antibodies in women with endometriosis and unexplained infertility].

The relationship between female infertility, endometriosis and antinuclear antibodies (ANA) in the blood of women without clinical symptoms of autoimmune disease is described. ANA in the titre of 1:40 and more, was detected in 63% women with endometriosis, 70.4% women with idiopathic infertility, 3.3% women with hypothalamic-pituitary dysfunction and 5.6% healthy nonpregnant women. The occurrance of ANA in endometriosis and idiopathic infertility was more frequently connected with negative postkoital test and the number of spontaneous abortions. We suggest, that (auto)immunological mechanisms play an important role in endometriosis and unexplained infertility.

Abortion, Spontaneous↗

PubMed1994

T lymphocyte subpopulations and lymphocyte proliferative activity in normal and pre-eclamptic pregnancy.

The purpose of this study was to assess whether any changes occur in the cellular immunity in normal and pre-eclamptic pregnancy. T lymphocyte subpopulations and the lymphocyte proliferative responses to mitogens (PHA, Con A, PWM) in the fetal calf serum were examined in normal pregnant and pre-eclamptic primiparas in the third trimester of pregnancy. In normal pregnancy the absolute and percentage numbers of CD3+ and CD4+ T cells were significantly lower and the CD4+/CD8+ ratio almost halved, in comparison with non-pregnant subjects. In the pre-eclamptic women a decreased absolute and percentage content of CD8+ T cells and increased percentage of CD3+ and CD4+ lymphocytes were found--in comparison with the normal pregnant women--which led to an almost 2.5-fold increase of the CD4+/CD8+ ratio. No disorders were found in the lymphocyte proliferative responses to mitogens in either normal or pre-eclamptic pregnancy. We conclude that despite the shifts among T lymphocyte subsets, mitogen-induced lymphocyte proliferation presents its functional stability and unchanged reactivity in normal and pre-eclamptic pregnancy.

CD3 Complex↗