Biomedical subjects
Publications and source records attributed to J Pajak.
Abnormal origin of the coronary artery in children with hypoplastic left heart syndrome is an extremely rare defect. We describe a newborn with concomitant hypoplastic left heart syndrome and abnormal origin of the left coronary artery arising from the right pulmonary artery. A Norwood procedure and direct reimplantation of the left coronary artery to the ascending aorta was performed.
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.
OBJECTIVE: The aim of this study was to assess the usefulness of the assessment of cervical length and and measurement of fetal fibronectin level in cervical secretion of pregnant women in prophylaxis of premature deliveries. MATERIAL AND METHODS: 78 pregnant women hospitalized in Department of Fertility and Obstetrics, University School of Medicine Wrocław. They were divided into III groups: Group I-13 pregnant women who had premature delivery and the time between examination and delivery was no longer than 24 hours. Group II-20 women who had premature delivery, and the time between examination and delivery was longer than 24 hours. Group III-pregnant who delivered at term (control group). Between the 25th and the 34th week of pregnancy presence of fetal fibronectin in cervical secretion and ultrasonographic assessment of cervical length were done. RESULTS: Significantly higher percentage of women with presence of fibronectin in cervical secretion and significantly shorter length of cervical length was stated in 13 pregnant women who delivered prematurely, between the 28th and 35th week of pregnancy comparing with other groups. In group II pregnant women delivered between the 28th and 35th week of pregnancy, and the time between examination and delivery was from 3 days to 4 weeks. In this group in 75% examined women fibronectin was present in cervical secretion. Significant was that cervical length in 14 of this group of women (70%) was no longer than 20 mm and in the rest was between 20-30 mm, moreover in no cases was longer than 30 mm. In group III only in 7% women presence of fibronectin in cervical secretion was stated and only in two cases (4%) cervical length was shorter than 20 mm, both of them delivered in 38th week of pregnancy. CONCLUSIONS: 1. Examination of fetal fibronectin in cervical secretion allows precisely estimate the risk of premature delivery. 2. Cervical length shorter then 20 mm collerates with the presence of fetal fibronectin in cervical secretion and with increased risk of premature delivery.
OBJECTIVES: To evaluate the relation among the concentration of selected air pollution and seminal parameters, examined from 1977 to 2000. DESIGN: Semen analysis and air pollution results were retrospectively evaluated. MATERIALS AND METHODS: We have analysed semiograms from 1363 men from infertile couples inhabiting Lower Silesia. Seminal volume, sperm concentration, percentage of pathologic sperms were measured in all men. Estimation of mean seminal volume, total sperm number, sperm motility, and percentage of pathologic sperms per year was performed. Average values for NO2, CO, SO2 and dust concentrations during the study were taken from official sources. RESULTS AND CONCLUSIONS: We showed the statistically significant increase in the percentage of pathological sperms (R2 = 0.9, p < 0.05), the slight increase in the semen volume(R2 = 0.4, p < 0.05). The total sperm count in the semen samples revealed a slight increase (R2 = 0.25, p < 0.05). The sperm concentrations and the percentage of motile sperms remained relatively stable and relatively constant. Statistically important decrease in NO2 (R2 = 0.85, p < 0.05), SO2 (R2 = 0.96, p < 0.05) and dust concentration (R2 = 0.89, p < 0.05) and no change in CO concentration was revealed. There is no correlation among concentrations of dust, NO2, SO2, CO and the increase in percentage of pathologic sperms.
OBJECTIVES: Estimation of the long term prophylactic or therapeutic application of low molecular weight heparin (LMWH) on the platelets count, and incidence bleedings during pregnancy, delivery and puerperium in the women with varices of lower extremities and past thrombophlebitis of lower extremities. MATERIAL AND METHODS: 5212 pregnant, women in labour and in puerperium divided into 4 groups.; 142 women with varices and thrombophlebitis of lower extremities (group I); 10 with past thrombophlebitis of lower extremities (group II); 15 with thrombophlebitis in current pregnancy; 5045 without vascular complications (group IV--control). In group I during pregnancy compression therapy was applied (stockings) and low molecular weight heparins (LMWH) in course of puerperium. In group II during the 1st trimester of pregnancy and in labour the same heparin doses were administered, while the doses were increased in the 2nd and 3rd trimester. In group III, when thrombophlebitis was stated non-steroid anti-inflammatory drugs and LMWH were administered. In all cases treated with heparin both number of platelets and incidents of bleedings from genitourinary tract were observed. Presence of embolic complications was also noted. RESULTS: No cases of decrease platelets number or bleedings from genitourinary tract were observed in group I-III during administering of LMWH. In women in group II where prophylactic with LMWH was applied no incidences of recurrent thrombophlebitis during pregnancy and puerperium were observed. In group I-III all newborns were born in good condition and no complications were observed. Average blood loss during both labour and cesarean section, among women in group I-III was not significantly different comparing with control group. No incidences of pulmonary artery embolism or decrease number of platelets were observed. CONCLUSIONS: 1. The long term prophylactic or therapeutical administration of LMWH in the women with varices of lower extremities or thrombophlebitis has no influence on the platelets count and incidence of bleedings from genitourinary tract during pregnancy or increase of blood loss during labour and puerperium. 2. In the women with past thrombophlebitis of the lower extremities after application of LMWH during pregnancy there were no recurrence observed.
OBJECTIVES: To compare labour induction intervals between vaginal misoprostol and intravenous oxytocin as well as side effects of induction in post term pregnancies with intact membranes. METHODS: One hundred women were retrospectively selected to two groups treated with vaginal misoprostol 50 micrograms every 12 hours as needed to maximum 150 micrograms and treated with intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Statistical analysis was performed by t-Student test. RESULTS: Maternal age, parity, gestation were similar. There was a statistically important difference in labour induction intervals between the two groups. The mean time +/- SD to vaginal delivery in misoprostol group was 20.6 +/- 15.2 hours compared with 11.23 +/- 7.4 hours with oxytocin (p = 0.0396). Induction of labour failed in 12% and 32% in misoprostol and oxytocin treated group. Pethidine consumption in oxytocin treated group was higher (41 mg vs 89 mg, p = 0.04). Episodes of vomiting were more frequent in misoprostol treated group (22% vs 6%). There were no episodes of uterine hyperstimulation in both groups. CONCLUSIONS: Oxytocin stimulation resulted in a shorter induction to delivery interval. In misoprostol group induction failed in only 12% whereas in oxytocin group in 32%. There were no serious side effects in both groups. In misoprostol treated group patients required less analgetics then in oxytocin treated group.
OBJECTIVES: To estimate the usefulness of hysteroscopy (HSC) and hysterosalpingography (HSG) examination on a retrospective study. DESIGN: Canulisation and morphology of ovarian tube detected during HSG and reactivity of uterine tubal ostia observed in HSC were compared. MATERIAL AND METHODS: The results of HSG and HSC examination performed on 125 young infertile women whom the tubal uterine factor of infertility was suspected were analyzed 250 ovarian tubes, after previous selection were taken into consideration. The analysis had a retrospective character. RESULTS: The analyzed group of women were divided into 3 group which differed from each other in reactivate of uterine ostia of the ovarian tubes. The first group first with correct reactivity of tubal ostia was the largest. The authors observed canulisation, which was the best in the first group and morphologic changes in the internal structure of the ovarian tubes. The highest percentage of these changes were observed in group three with unreactive uterine ostia. CONCLUSIONS: The HSG and HSC examination are supplementary examinations. The use of both methods together increases their diagnostic value and gives a more correct estimation of tubal status.
Retroperitoneal fibrosis (Ormond's disease) is rare chronic inflammatory process, that can occur at any age. It is characterised by development of periaortic fibrous mass leading to progressive obstruction of vessels around the abdominal aorta and ureters. In the one third of cases we can find the causes of disease. There are ergotamine abuse, radiation, retroperitoneal surgery or hemorrhage, urine extravasation and response to different cancers. The other cases are idiopathic disease. We report a case of prostate cancer with unique course. The first manifestations of disease were diffuse peritoneal fibrosis and ureteral obstruction leading to bilateral hydronephrosis. Clinical course and histopathology showed idiopathic Ormond's fibrosis. Patient received oral immunosuppressive treatment (prednisolone 1 mg/kg/day + azathioprine 1 mg/kg/day), followed by intravenous methylprednisolone puls (2 g). Treatment also consisted of DJ-stent placement on the left side. On the right side we were unable to overcome the obstruction of ureter. Because of persistent renal failure, thrombocytopenia, DIC and progressive lower back pain we did control MR and CT scan. The CT scans showed multiple osteolytic bone metastases in vertebral column (the sizes of them were between a few millimetres and 1.5 centimetre). Patient died due to renal failure and haemorrhagic diathesis in the course of disseminated cancer of unknown origin. The postmortem examination revealed diffuse peritoneal infiltration surrounding the ureters, intramural ventricular metastases, pulmonary metastases and vertebral metastases. The prostate was only slightly enlarged. Histological and immunohistochemical examinations of prostate showed primary low-differentiated prostate carcinoma (CK/+/, PAP/+/, PSA/+/). Peritoneal, ventricular and bone infiltrations also were metastases from low-differentiated carcinoma of prostate origin (CK/+/, PAP/+/, PSA/-/).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.