Biomedical subjects
Publications and source records attributed to Przemysław Oszukowski.
Iniencephaly is a rare malformation characterized by the triad of occipital bone defect, cervical dysraphism and fixed retroflexion of the fetal head with poor prognosis. We present a case one of the twin with iniencephaly and congenital heart defect (common atrio-ventricular canal) with normal karyotype.
OBJECTIVE: The aim of this study was retrospective analysis of the results of pregnancies among women who had intrauterine invasive procedures (IIP)--amnioinfusion, amnioreduction, cordocentesis and shunts, based on the materials from Polish Mother's Memorial Hospital Research Institute in 2000-2003. MATERIAL AND METHODS: 320 women performed IIP: amnioinfusions due to the oligohydramnion (frequently connected with congenital fetal abnormalities) or premature rupture of membranes. Amnioreduction due to the polihydramnion (also in a twin pregnancy with TTTS syndrome). Implantation of shunts in fetal abnormalities--hydrocephalus, megabladder, CALM. Cordocentesis--diagnostic or therapeutic in a fetal immunisatio anty-Rh factor and fetal arrhythmias. RESULTS: The total percentage of pregnancy failure after IIP was 53.2%. The best results were in the groups with hydrocephalus and immunisatio anty Rh factor, the worst in the group of patients with severe oligohydramnion due to the congenital abnormalities of fetuses' kidney. The most frequent early complications after IIP were premature rupture of membranes (12.2%), fetal hypoxia (13.7%) and premature constrictions of uterus (8.4%). 21.3% of patients delivered in less than 5 days after IIP ( delivery or abortion) due to the early complications or after resolving the obstetrical situation, e.g. the genetic reason of fetal abnormalities or lethal abnormalities. More complications were connected with amnioinfusion than with amnioreduction. Cordocentesis seemed not to be connected with more often appearing of fetal hypoxia. CONCLUSION: (1) IIP are connected with a big percentage of pregnancy failure, but it is more a result of fetal serious disease than a intrauterine procedure. (2) Performing an amnioinfusion or cordocentesis in severe oligohydramnion gives a quick diagnosis of fetal potential abnormalities and makes it possible to outlook the fetal prognosis. (3) Patients should be as early as possible qualificated to IIP to avoid complications caused by the primary fetal disease. (4) Patients for IIP should be carefully selected and prepared. They need very strict observation for a fetal well-being and monitoring the infective factors after the procedure.
DESIGN: Identifying patients at risk for preterm delivery continues to be difficult. OBJECTIVES: This study aimed at evaluating fetal fibronectin concentrations in cervical secretions measured by an enzyme-linked immunosorbent assay, as a tool for of premature delivery screening in patients with preterm uterine contractions. MATERIALS AND METHODS: Symptomatic 115 women, admitted to Department of Perinatology (RIPMMH) between 24 weeks 0 days and 34 weeks 6 days, with intact amniotic membranes, single pregnancy, cervical dilatation <3 cm and with no cerclage were included. Samples of the cervical secretion were taken every week until the delivery or to hospital discharge. RESULTS: The enzyme-linked immunosorbent assays revealed sensitivity of 73.7% and specificity of 90.9%. CONCLUSIONS: This test was found to be a good tool for the prediction of premature delivery.
DESIGN: Although an association between subclinical intrauterine infection and preterm birth is well established, there is conflicting evidence regarding the benefits of antibiotic administration in women in preterm labor. OBJECTIVES: We attempted to determine the effect of antibioticotherapy in mothers on congenital neonatal infection. MATERIALS AND METHODS: The study group consisted of 1049 pregnant women with imminent preterm labor hospitalized in Clinics of The Research Institute Polish Mother's Memorial Hospital. RESULTS: 244 women delivered preterm and no significant difference in neonatal outcomes could be detected in two groups with intact membranes and preterm premature rupture of membranes. CONCLUSIONS: The results of this study do not support the routine use of antibiotic administration in women with preterm labor.
DESIGN: 30% preterm deliveries are the consequence of preterm premature rupture of membranes. The available data suggests lack of benefit of conservative management of preterm premature rupture of membranes. OBJECTIVE: Our objective was to compare perinatal outcomes in regard to the duration of rupture of membranes and gestational ages. MATERIALS AND METHODS: 435 newborns delivered below 28 weeks of pregnancy, 28-32 weeks of pregnancy and above 32 weeks of pregnancy were studied. RESULTS: There was no significant difference in the group of newborns delivered before 33 weeks of gestation. CONCLUSION: The duration of rupture of membranes had significant on perinatal outcomes among neonates born after 33 weeks of gestation.
Doppler evaluation of the fetal venous system at present improves assessment of fetal well-being in many conditions. Actually, analysis of ductus venosus waveforms seems to be the most important. It place role in detection of genetic abnormalities (in low pregnancies), prediction of outcomes growth-restricted fetuses, assessment of severity of heart failure due to congestive heart anomalies, fetal infections, hydrops fetalis. Hepatic veins are known rather as an additional parameter (for ductus venosus) in the severely compromised fetus. Doppler evaluation of pulmonary veins may be useful in prediction of fetal lung maturity and in detection some difficult circulatory anomalies.
Pregnancy is often associated with ocular changes. Most of them are specifically associated with the pregnancy itself, rare disturb the normal visual function and are transient in nature. The ocular effects of pregnancy may be divided into physiologic changes, pathologic conditions or modifications of pre-existing conditions. Pregnancy is associated with changes in corneal sensitivity and thickness, decreased tolerance to contact lenses, decreased intraocular pressure, can affect refractive error. Pathologic conditions reported to develop during pregnancy include hypertensive and vascular disorders, central serous chorioretinopathy, uveal melanoma and others. The most significant modified pre-existing condition is diabetes mellitus. Pregnant women are at increased risk for the progression of preexisting proliferative diabetic retinopathy, and diabetic women should see an ophthalmologist before pregnancy or early in the first trimester. This review describes various ocular changes that occur during pregnancy and summarizes the ocular disturbances in these three categories.
PURPOSE: The purpose of this study was to define physiological changes in intraocular pressure during pregnancy. MATERIAL AND METHODS: 182 healthy pregnant women were examined cross-sectionally throughout the pregnancy. After measuring systolic and diastolic blood pressure full ophthalmological examination was performed (visual acuity, refractive error, intraocular pressure, slit lamp examination and fundus exam). All subjects were free from any systemic or ocular diseases. RESULTS: Intraocular pressure significantly decreased during successive stages of pregnancy. The results are presented as means SD. In the control group mean IOP was 15.6 +/- 1.81 mmHg. During first ten weeks of pregnancy mean IOP was 15.33 +/- 1.98 mmHg, between 11-20 hbd was 14.52 +/- 2.37 mmHg, between 21-30 hbd was 13.47 +/- 2.19 mmHg, and towards the end of pregnancy (31-40 hbd) was 12.5 +/- 1.96 mmHg. The mean fall of IOP during whole pregnancy was 3.1 +/- 0.38 mmHg (p < 0.001). In these subjects pregnancy decreased IOP by 19.8%. CONCLUSIONS: The study results showed a gradual, statistically significant fall of intraocular pressure during pregnancy.
OBJECTIVE: Our purpose was to compare the efficacy of low calorie diet and low calorie diet applied together with acupuncture in treatment of obesity in peri- and postmenopausal women. MATERIALS AND METHODS: Sixty nine obese peri- and postmenopausal women qualified for hormone replacement therapy were divided into two groups. Women from the first group (n = 33) during six months used a low calorie slimming diet: 1000 kcal below daily energy requirement (1200-1500 kcal per day on the average), 5-6 meals a day, consisted of proteins in 10-15%, fat in 25% and carbohydrates in 60-65%. The second group (n = 36) during this period had the same kind of diet as well as one cycle of six-week acupuncture procedures. Each cycle consisted of 12 procedures (2 per week). Following acupuncture points were applied: -GV 20 (Baihui), CV 12 (Zhongwan), ST 36 (Zusanli), ST 21 (Liangmen), ST 25 (Tianshu), LIV3 (Taichong), LIV 13 (Zhangen), P 6 (Neiguan), H 7 (Shenmen); auriculotherapy--55 (Shenmen), 87 (Stomach). RESULTS: In the first group on the low calorie slimming diet mean body weight decreased from 85.48 +/- 8.48 kg to 77.07 +/- 7.7 kg (BMI dropped from 33.23 +/- 1.90 kg/m2 to 29.95 +/- 1.66 kg/m2) during six-week period (p < 0.001). In the second group (acupuncture together with a low calorie diet) decreased mean body weight from 85.5 +/- 5.99 kg to 72.68 +/- 6.06 kg (BMI dropped from 33.54 +/- 1.77 kg/m2 to 28.51 +/- 2.00 kg/m2) at the same time (p < 0.001). The mean drop of body weight as well as BMI was significantly higher in the group treated with acupuncture and slimming diet (12.81 +/- 2.85 kg and 5.03 +/- 1.08 kg/m2) than in the low calorie diet group (8.41 +/- 2.02 kg and 3.28 +/- 0.78 kg/m2); p < 0.01. CONCLUSIONS: 1. Our results testify to the higher efficacy of the complex low calorie diet and acupuncture treatment in comparison to the low calorie therapy in the lowering of BMI and body weight. 2. Acupuncture seems to be an additional useful healing method in treatment of menopausal obesity.
UNLABELLED: There was done 8525 sonographical and echocardiographical examinations in 1994-2002 in the Department for Diagnosis and Prophylaxis of Fetal Malformation (DDPFM) of Institute of Polish Mother's Memorial Hospital. In 22 cases (0.25%) bilateral renal agenesis (BRA) was diagnosed. Till year 1999 the examinations were performed on Acuson 182 XP an since year 2000 on Philips HDI 5000 with Power Doppler. In 6 cases (27%) the suspicion of BRA were diagnosed in others places and in 16 cases (73%) in DDPFM. The average age of pregnant was 25.5 (+/- 4.8) and the average fetal age during first examination at DDPFM 27 weeks and 2 days (+/- 5 days). 83% of pregnant were from low risk group. The ahydramnion was the most frequent diagnosed anomaly (11 cases) and intrauterine growth retardation (IUGR) (4 cases). Till year 1999 BRA was diagnosed based on indirect syndromes: lack of visualization of kidney, the absence of bladder, no improvement after diagnostic amnioinfusion. Since year 2000 BRA was diagnosed based on indirect syndromes and lack of visualization of kidney artery in Power Doppler. In 16 fetuses there were not abnormality in echocardiographical examination. In 5 cases pericardial effusion were diagnosed. In 5 cases cardiomegaly and in 3 cases hypertrophy of heart were diagnosed. Among 22 pregnancies there where 8 (36%) intrauterine deaths, 1 (5%) fetus was born before 32nd week of gestation and 13 (59%) died after birth. 12 (55%) fetuses were delivered in I PMMH and 10 (45%) cases in others hospitals. In 15 (68%) cases there were vaginal delivery and 7 (32%) cesarean sections. The average birth weight was 1530 grams and Apgar score in 19 newborns was 0-1. CONCLUSIONS: 1. Bilateral renal agenesis is a lethal malformation, which can be suspected during screening obstetrical examination (ahydramnion, IUGR), but it needs confirmation by genetical ultrasound and echocardiographical examination. 2. The mean technique during examination for BRA is Power Doppler.
OBJECTIVES AND DESIGN: The aim of this study was retrospective analysis of ultrasound and echocardiographic examinations in fetuses with diagnosis of posterior urethral valve, at the referral center from the database of our unit in 8 years (1994-2002). RESULTS AND CONCLUSIONS: Among 8525 ultrasound and echocardiography examination performed in the Department of the Diagnosis and Prophylaxis of Congenital Malformation Institute Polish "Mother's Memorial Hospital" the diagnosis of fetal posterior urethral valve was established in 22 cases. The frequency of premature deliveries was 80% among fetuses with PUV. Over 54% of all fetuses with PUV demonstrated functional abnormalities in circulatory system. 40% of all diagnosed fetuses with PUV survived longer then 6 months after delivery. 80% of all fetuses with PUV and functional abnormalities in echocardiographic examination died while only 20% of all fetuses with PUV without any abnormalities in circulatory system. Echocardiographic examination can be helpful in forecasting in utero and post delivery course of fetuses/neonates with PUV diagnosis.
OBJECTIVES: The aim of the research was to assess whether all reasons of NIHF were leading to the same poor outcome. MATERIALS AND METHODS: The material of the research study consisted of 192 fetuses with follow up from 230 fetuses with NIHF who had echocardiography and detailed sonography between 1992 and 2002. RESULTS: The most common anomalies associated with NIHF were cardiological anomalies n = 71 (30.8). The remain extracardiac causes of NIHF were: so called "other structural defects" n = 24 (10.4%), infections (without myocarditis) n = 24 (10.4%), multiple structural defects n = 20 (8.7%), urogenital defects n = 17 (7.4%), pulmonary anomalies n = 17 (7.4%), gastrointestinal anomalies n = 12 (5.2%), chromosomal defects n = 8 (3.5%), mirror syndrome n = 2 (0.9%) and idiopathic n = 35 (15.3%). In the group of NIHF 102 fetuses (44.3%) presented echocardiographic signs of congestive heart failure which statistically increased mortality ratio. In the group of fetuses with NIHF follow up was established in 192 (83.4%) fetuses/newborns; there were n = 139 (72.4%) demise and n = 53 (27.6%) alive. Therapy in utero was applied to 28 cases. In this group 13 fetuses/newborns (46.4%) survived. CONCLUSIONS: Multiple structural anomalies and cardiological anomalies causing NIHF are connected with poor prognosis for fetus or neonate. Congestive heart failure coexisting with NIHF (in our series in about 44%) significantly increased mortality ratio what point the special role of fetal echocardiography. Relatively better prognosis was observed possible in cases with NIHF without structural anomalies and mild intensify or due to infection but without cardiac anomalies. In selected fetuses therapy in utero may increase the survival ratio.
UNLABELLED: There is still an urgent need for obstetricians to develop new, noninvasive, accurate methods of diagnosing preterm labor. The purpose of this study was to evaluation of maternal serum corticotropin-releasing factor concentrations and its concentration with onset of labor. The analysis was undertaken of women hospitalized in Research Institute Polish Mother's Memorial Hospital-Clinical of Perinatology (2001-2002) year with pregnancy between 16 to 35 weeks. All pregnancies were singleton gestation free of medical complications but with threatened labor. Maternal peripheral blood samples were obtained from antecubital vein during the first day of hospitalization. The control group consisted of 77 pregnant who delivered term infants whose growth was appropriate for gestational age. The study group consisted of pregnant women who gave preterm delivery. The serum CRF concentrations were measured using EIA method. Maternal serum CRF concentration in control group was 7.28 +/- 1.92 ng/ml. The material was obtained in 26.2 +/- 4.5 week of gestation. CRF concentration in studied group was 6.37 +/- 1.86 ng/ml +/- and the serum was obtained in 24.3 +/- 4.9 ng/ml weeks of gestation. The results were paradoxically significantly higher in control group. CONCLUSIONS: Our results were not in agreement with the findings of other investigators.
OBJECTIVE: Bacterial vaginosis of pregnant woman is an important factor of appearance of the PROM in result of intrauterine infections on every stage of pregnancy. Frequency exist of intrauterine infection evaluate from 1 to 10% pregnancies. Clinical chorio-amnionitis complicates 1-5% of term pregnancies, but nearly 25% of preterm deliveries and really increase morbidity and mortality of newborns and they are also a reason of mothers morbidity. A condition of recognition the intrauterine infections is ascertainment of infection factor risk of mother and appearance of clinic symptoms of newborns. The aim of this work was a valuation of dependence between bacterial flora taken from cervics uteri of pregnant woman with PROM who gave birth with preterm below 32 weeks and a presence of clinic and laboratory symptoms of infections and the presence of bacterial flora in blood culture of the newborns. MATERIAL AND METHODS: 37 pregnant women at the age from 20 to 43 hospitalized in Department Perinatology ICZMP between 1999-2001 because of PROM and a threat of preterm labor at the fetal age from 24 to 32 weeks were taken by an analysis. The average time of amniotic liquid outflowing before the labor was 11.1 days +/- 8.63, average length persistence of pregnancy was 27.6 hbd +/- 1.85, average born mass was 1029 g +/- 187.5. Laboratory factors and clinics symptoms chorionamnionitis, bacteriology cultures of swabs from cervics uteri and information of the labor of pregnant women were analyzed. Diagnostics of newborns contained: making of blood cultures and skin, nose, throat, urine cultures, estimation WBC and level CRP, estimation of lungs X-ray. RESULTS: In result of bacteriology cultures from cervics uteri of mothers gained bacteria of frequent occurrence: Staphylococcus epiderm.--27%, E. coli--19%, Streptococcus gr. B--10.8%, Enterococcus foecalis--8.1%. In result of bacteriology cultures of newborns blood gained bacteria of frequent occurrence: Staphylococcus epiderm.--13.5%, Staphylococcus haemolitycus--10.8%, Klebsiella pneumoniae--10.8%, Pseudomonas aeruginosa--8.1%. In 97.3% cases at newborns appeared inborn infections in a shape of pneumonia confirmed by X-ray. Confirmation of intrauterine infection in histopathology examination of the placenta in a shape of chorionamnionitis was shown in 25 cases, in other words in 67.5%. Positive results of pathogenic bacteriology flora cultures taken from cervics uteri was in 50% pregnant woman, however in 43% of newborns bacteriology cultures of the blood were positive. In none of the analyzed preterm labor cases with PROM bacterial flora from positive cultures taken from cervics uteri of mothers did not correlate with bacterial flora found in blood cultures of newborns. CONCLUSIONS: On a base of analyzed values PROM of mothers with bacterial vaginosis is the important factor risk of the evolution of intrauterine infections of newborns, besides did not ascertain the dependence between the values of bacteriology cultures taken from cervics uteri of mothers and the values of bacteriology cultures of the newborns blood with clinic symptoms of intrauterine infection.
Antenatal medical care is one of the most important factors bearing an influence on the course of pregnancy and labour. The study group comprised 7307 pregnant patients who delivered in the regional Hospital in Brzezin. The women not taking advantage of antenatal care constituted 3.4% of all pregnant patients, those who had visited the gynaecological outpatient department less than 4 times during the pregnancy--15.4%, and those who had had 4 to 7 visits--57%, and 8 visits or more--23.8%. In 52.2% of cases antenatal care started early. During the period 1987-1998 antenatal medical care systematically improved. The number of women seeking the doctor's advice early in their pregnancy and complying with the check-up schedules to at least satisfactory degree increased. The risk of late or insufficient compliance with antenatal care requirements was higher among the patients below 20 and over 34, singles, those with the fourth or subsequent pregnancy, and those who had completed elementary or vocational education.
The aim of the study was to evaluate the usefulness of skin glue--Dermabond in wound repair after laparoscopy intervention. It is a new adhesive with the physical properties that differ from other cyanoacrylate adhesives and give a significantly greater tensile strength. It was proved to have similar cosmetic results in the repair of lacerations and incisions when compared with those closed with monofilament sutures. Octylcyanoacrylate tissue adhesive has been approved for clinical use by the Health Protection Branch of Health Canada and has been approved for clinical trials by the U.S. Food and Drug Administration. The study was conducted on thirty women with use of skin glue in wound closure after laparoscopy. Thirty-five patients served as controls whose skin was closed with a monofilament suture by standard sterile techniques. We estimated local tissue reaction, way of healing and cosmetic results. There was no difference in healing found in this study between the two examined groups. The only significant correlation outcome measures was in a very good cosmetic effect in the group where skin glue (p = 0.0231) was applied. The authors suggest high usefulness of Dermabond glue in good wound closure and correct healing.