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Biomedical subjects

Marek Klimek

Publications and source records attributed to Marek Klimek.

30 records · Page 2Linked to original sources
PubMed2005

[Thrombophilia in pregnancy and its influence on venous thromboembolism and recurrent miscarriages].

Thrombophilia can be defined as a predisposition to thrombosis. Inherited or acquired thrombophilias have been associated with venous thromboembolism and recurrent pregnancy loss. Abnormalities in haemostasis that are associated with clinical thrombophilia include heritable defects, such as mutation in genes encoding antithrombin III, protein C and S, prothrombin, factor V, hyperhomocysteinemia or acquired defects such as antiphospholipids. Women with thrombophilic tendency have an increased risk of other vascular pregnancy complications such as premature placental abruption and intrauterine growth retardation. In this paper there are different types of thrombophilias described. It is suggested that women with personal or family history of venous thromboembolism or recurrent fetal loss should be screened to improve pregnancy outcome.

Abortion, Habitual↗
PubMed2005

The level of maternal immune tolerance and fetal maturity.

OBJECTIVES: Fetal maturity does not seem to be directly connected with the phenomenon of immune tolerance during pregnancy although the fetal maturation influences the process of initiation of the labor at term finishing the immune tolerance during pregnancy. CAP and RCAS1 are expressed by the trophoblast cells and afterwards by the placenta, these proteins are able to modulate the maternal immune response. MATERIALS AND METHODS: 160 patients were randomly selected to our study. The patients were divided into two groups using K score according to the newborn's maturity: maturated and not fully maturated. Within the groups of matured and not fully matured newborns the subgroups were selected according to the type of the labor: spontaneous or induced. The oxytocinase plasma activity was established in plasma samples obtained from pregnant women a few days before delivery. The placental RCAS1 relative amount was assessed by Western blot analysis. RESULTS: The differences in oxytocinase plasma level with respect to the fetal maturity were identified in our study however no RCAS1 expression changes were found regarding the fetal maturation. We determined the alterations in RCAS1 expression with respect to the occurrence of clinical symptoms of the spontaneous beginning of the labor in maturated and not-fully maturated groups of newborns. CONCLUSIONS: Oxytocinase seems to be a useful marker of normal fetal development. The assessment of RCAS1 in placenta directly after delivery appears to indicate the level of maternal immune tolerance during the labor initiation. The level of the immune tolerance at the moment of the delivery drops independently of the fetal maturity.

Actins↗
PubMed2005

Cycle dependent expression of endometrial metallothionein.

OBJECTIVES: Molecular changes observed in endometrium with respect to menstrual cycle changes seem to be crucial for the reproductive function. Accumulation of cytotoxic cells increases the exposure of endometrial cells to apoptosis. Protection against apoptosis may be reached by endometrial cells by self molecular regulation. Metallothionein was suggested to participate in this process. The aim of our study was to evaluate endometrial MT immunoreactivity with respect to the menstrual cycle phases. MATERIALS AND METHODS: MT expression was assessed using immunohistochemistry method in 47 endometrial tissue samples derived from randomly selected patients with respect to the menstrual cycle phases--proliferative and secretory with distinguishing early, mid and late subphases in each. RESULTS: MT expression changes were observed respectively to hormonal fluctuations with the highest level during mid secretory phase and its respective decrease during the early, late secretory and mid proliferative menstrual cycle phases. The lowest MT immunoreactivity level was disclosed during early proliferative phase. CONCLUSION: Significant differences in MT expression observed in endometrium with respect to menstrual cycle changes might suggest MT participation in endometrial cells protection against apoptosis.

Adult↗
PubMed2005

[Premenstrual syndrome--current approach].

Premenstrual syndrome (PMS) affects 3-5% of women. It still remains controversial in diagnosis and treatment. Dynamic progress in neuroendocrinology in recent years led to PMS etiology explanation. It also influenced therapeutic approach. According to Wang et al. neuroactive steroids and their imbalance evoke PMS symptoms. That theory introduced other therapeutic interventions restoring neuroendorine balance. The newer antidepresants demonstrated excellent efficacy in treatment of somatic and emotional PMS symptoms. PMS is a typical object of contemporary studies on therapeutic efficacy according to evidence based medicine.

Female↗
PubMed2003

[Laparoscopic management during pregnancy--own material (1996-2002)].

OBJECTIVE: Utility of laparoscopic procedures in pregnant women. Is laparoscopy safe for the foetus? MATERIAL AND METHODS: Between 1996 an 2002 14 pregnant patients were admitted and laparoscopy was performed. RESULTS: In 10 cases laparoscopic cyst enucleation (6 simplex, 1 endometrial, 3 dermoidal), in 1 case myomectomy and in 2 adnexectomy was performed. There were no complications during surgery. In one case miscarriage occurred 3 weeks after laparoscopic surgery and 9 healthy babies were delivered. DISCUSSION: There is no doubt that laparoscopy is well accepted in gynecological surgery and is going to be more and more accepted in obstetrics. Due to several differences between non-pregnant and pregnant women laparoscopic procedures in pregnancy require special attention. All papers show good foetal outcome even with preterm labour. In our material all babies were born healthy. CONCLUSIONS: Laparoscopic procedures during pregnancy are feasible and safe. Nevertheless they have to be performed by experienced gynecological-surgical teams.

Adult↗
PubMed2003

[Enzymatic diagnosis of neurological risk of premature labor].

The level of oxytocinase in the pregnant woman's blood is a sensitive marker of the efficiency of the hypothalamus/hypophisis/suprarenal glands in mother and fetus, as well as the quantity of hormone production, also in placenta, which determines the duration of pregnancy and the course of labor. In the study, the level of oxytocinase was measured before the labour in 485 pregnant women at risk of premature labour. After the mean duration of pregnancy of 264 +/- 12 days, 353 infants were born fully mature (group I), and 132 with the lowered maturity of 6-9 Klimek points (group II). In group II, the mean pregnancy duration (249 days), body mass (2700 g) and oxytocinase level (5.6 mumol/l/min) were significantly lower and tocolysis was necessary twice as often (41% vs. 21%). Independently of the level of newborn maturity in cases of tocolysis the mean level of oxytocinase was significantly 2.6 times lower (3 +/- 0.8 mumol/l/min) than in the other pregnant women (7.9 mumol/l/min). It proves, that low oxytocinasaemia becomes normal following the ACTH-depot therapy, which eliminates the necessity of tocolysis.

Adrenocorticotropic Hormone↗
PubMed2003

Comparative analysis of RCAS1 level in neoplasms and placenta.

The tumor associated antigen RCAS1 (receptor-binding cancer antigen expressed on SiSo cells) expressed with high frequency in various cancer and trophoblast cells, inhibits growth of estrogen receptor-expressing cells and induces apoptosis. Because previous reports demonstrated RCAS1 presence only by non-quantitative immunocytochemistry methods, we decided to use a Western blotting with anti-RCAS1 monoclonal antibodies for estimation of the relative content of the tumor-associated antigen. One hundred tissue samples were assayed (neoplasms, chronic inflammatory diseases, healthy tissues, trophoblasts and placentas at term). RCAS1 was present in all neoplastic, placental and trophoblast tissue samples and its level in malignant samples was statistically significantly higher than in benign neoplasms. The amount of RCAS1 in chronic inflammations was also significantly increased in immune mediated diseases, like allergic nasal polyps and sarcoidosis. The RCAS1 protein was not revealed in healthy mucous membrane and in muscle tissues. The presented results suggest that RCAS1 might play an important role in tumor escape from host immunological surveillance and carry weight in the down regulation of the maternal immune response, thereby maintaining pregnancy.

Antigens, Neoplasm↗
PubMed2003

[Pregnancy duration and mode of delivery in patients with cardiac insufficiency on the material of Jagiellonian University OB/GYN Clinic in the years between 1986-1999].

OBJECTIVES: Recent progress in cardiology and cardiac surgery lead many patients with cardiac disease in the procreative age. DESIGN: To asses the influence of cardiac disease on pregnancy and delivery. MATERIAL AND METHODS: 232 subjects with congenital and acquired cardiac anomalies, hospitalized in the Jagiellonian University OB/GYN Clinic between 1986-1999. Patients were divided according to NYHA classification depending on kind and grade of cardiovascular insufficiency. Acquired data were compared with data in the control group consisted of 424 subjects without any complications during pregnancy and delivery. RESULTS: We proved shortening of the pregnancy duration in more advanced NYHA classes. Percentage shave of preterm deliveries in 3rd and 4th class was 31.15%, what equals to 3 times preterm delivery rate in the control group. Preterm delivery rate in groups of NYHA I and II was similar to the rate in the control group. Acquired data reveal extremely high cesarean section rate in the material of patients with cardiac anomalies. Cesarean section rate in the group of NYHA I and II was 3 times higher (30%) than in control group (rate of 10%). NYHA III and IV groups has a cesarean section rate of 93%. Vaginal delivery rate in the NYHA I and II groups equals to 58.5%, what is 10 times higher than in NYHA III and IV groups (equals to 6.6%). CONCLUSIONS: 1. Pregnancy duration depends on cardiovascular sufficiency and is significantly shorten in NYHA III and IV groups. 2. Extremely high cesarean section rate in the analyzed group is due to decreased cardiac sufficiency.

Case-Control Studies↗
PubMed2003

[Management of analysis in case of ectopic pregnancy--own material].

INTRODUCTION: Apart from increasing frequency of ectopic pregnancy occurrence during recent years there is still a need to diagnose and treat these pathology as early as possible. Delay in diagnosing subsequently cause severe threat to patients life. Recognition improvement means equally decrease in mortality connected to ectopic pregnancy. AIM: The aim of the study was diagnosis and treatment efficiency evaluation in cases of ectopic pregnancy. MATERIAL AND METHODS: In this paper 68 cases of women hospitalised between May 1999 and September 2002 in our Clinic with suspicion of ectopic pregnancy were analysed. Diagnostic procedures included clinical examination, biochemical assessment of beta HCG level, sonography and diagnostic laparoscopy. Therapeutic management included salpingotomy with evacuation of gestational sac, salpingectomy and uterine cornu excision. RESULTS: In 11 cases the presence of pregnancy was excluded according to non-invasive diagnostics. Laparotomy was performed in two cases. Laparoscopy was performed in 50 cases what equals to 73% of all subjects. Laparoscopy was negative in 7 cases. Misdiagnosis resulted from pathologies in adnexal area. The most frequent ectopic pregnancy localisation was oviduct, one case of cervical and one intramural localisation was diagnosed. In one case two salpingostomies were performed in two years apart period. CONCLUSIONS: Complex diagnostic management is the only diagnostic way in case of ectopic pregnancy. Any confusion should be solved by immediate invasive diagnostics. In our opinion the most efficient method in ectopic pregnancy diagnosing and treatment is early laparoscopy.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed2002

Synchronous serrated adenoma of the appendix and high-grade ovarian carcinoma: a case demonstrating different origin of the two neoplasms.

Association of mucinous adenomas of the appendix and mucinous ovarian tumors is well known. The origin of the ovarian tumor (metastasis from the appendix vs independent primary) is still debated. Serrated adenoma is a rare neoplasm of the distal gastrointestinal tract, and its precancerous role in the colorectum was recently postulated. A 74-year-old patient was subjected to hysterectomy with routine appendectomy due to a 17-cm tumor of her right ovary. Histological examination revealed a high-grade ovarian adenocarcinoma with peritoneal involvement. The appendix, grossly unremarkable, harbored a serrated adenoma with no evidence of invasion or malignant transformation. Immunohistochemical examination revealed CD7+, CK20-phenotype of the ovarian and reverse (CK7-, CK20+) phenotype of the appendiceal tumor. Microsatellite analysis demonstrated microsatellite instability (MSI-high) within the serrated adenoma (4/5 markers with positive amplification) and no MSI (0/6 amplified markers) in the samples from the ovarian carcinoma, its metastases and the uninvolved uterine cervix. There were also differences in LOH pattern between the ovarian adenocarcinoma and the serrated adenoma. The findings suggest two independent primaries with profound differences in tumorigenetic pathways of both lesions. To the best of our knowledge this is the first report of synchronous serrated adenoma of the appendix and ovarian carcinoma.

Adenocarcinoma↗
PubMedDate not supplied

A case of left interstitial pregnancy after left adnexectomy--why surgical management?

Interstitial pregnancy is a rare condition of tubal pregnancy with a mortality rate of 2-2.5% [4] that can easily be misdiagnosed. The prevalence of interstitial pregnancy is 0.8% in normal population and it increased during the past few decades due to reproduction techniques development even up to 11% in groups of women after in vitro fertilization. A comprehensive MEDLINE and OLDMEDLINE search covering years 1950-2005 using query terms "interstitial", "pregnancy" and "adnexectomy" identified only 10 cases reported in worldwide literature. The first treatment of interstitial pregnancy used to be a resection of the uterus body via laparotomy. Along with the evolution of sensitive biochemical assays, imaging technologies and the development of operative techniques, the management of interstitial pregnancy became less invasive. We report a case of spontaneous left interstitial pregnancy after left adnexectomy due to left ovarian tumor of borderline malignancy.

Adnexa Uteri↗