Acute appendicitis during pregnancy

W latach 2000–2006 w II Klinice Chirurgii Ogólnej CMUJ w Krakowie leczono z powodu ostrego zapalenia wyrostka robaczkowego 4 ciężarne — wszystkie metodą laparoskopową. Omówiono trudności diagnostyczne oraz wynikające z tego różnice w poszczególnych trymestrach ciąży. Przedstawiono własne doświadczenia i możliwości zastosowania appendektomii laparoskopowej. Oceniono również wpływ leczenia operacyjnego na dalszy przebieg ciąży oraz rozwój płodu. Nie stwierdzono powikłań wynikających z zastosowanej metody leczenia. Wszystkie ciąże zostały zakończone o czasie: 3 siłami natury, 1 przez cięcie cesarskie z przyczyny położniczej. Wycięcie zmienionego zapalnie wyrostka robaczkowego metodą laparoskopową u kobiet w każdym trymestrze ciąży jest metodą bezpieczną zarówno dla matki, jak i dla płodu.Between 2000–2006, in the 2nd Department of Surgery at the Medical College of the Jagiellonian University, we performed 4 laparoscopic appendectomies in pregnant patients with acute appendicitis. Diagnostic difficulties in relation to the progression of pregnancy are discussed. Our own experience and the use of laparoscopic technique are also presented. We have evaluated the possible influence of operative management on the further development of the fetus. There were no complications related to the operative procedure. All pregnancies developed normally until delivery, which were either natural (3 patients) or cesarean (1 patient, due to obstetrical indications). We conclude, therefore, that laparoscopic appendectomy seems to be a safe approach both for mother and baby during any trimester of pregnancy

The effect of TCDD dioxin on the rat liver in biochemical and histological assessment

Eighteen male Wistar rats were divided into 3 groups of 6 animals each. Two groups received different intraperitoneal doses of TCDD (0.75 and 8 μg) in DMSO solution and the third group (control) received only DMSO on days 0, 7 and 14. On day 21 the animals were sacrificed, and then blood tests, pathological examination and CYP1A1 activity measurement were performed. In rats that received a high dose of dioxin (8 μg) hepatic lobules revealed parenchymal degeneration and vacuolization of hepatocytes was observed, and also an increased CYP reaction was found in central parts of lobules, around the central vein. The reaction in control and low dose groups was weak. The resorufin level was significantly (P<0.05) higher in the group receiving a low dose of dioxin as compared to the control group. The study confirmed that TCDD damages the rat liver in a dose-dependent manner. Administration of high TCDD doses causing major liver damage also damaged CYP1A1 (based on higher resorufin levels in epiluminescence). TCDD activates CYP1A1, which was confirmed by increased immunohistochemical reactivity of central areas of hepatic lobules

Acute appendicitis during pregnancy

W latach 2000&#8211;2006 w II Klinice Chirurgii Ogólnej CMUJ w Krakowie leczono z powodu ostrego zapalenia wyrostka robaczkowego 4 ciężarne - wszystkie metodą laparoskopową. Omówiono trudności diagnostyczne oraz wynikające z tego różnice w poszczególnych trymestrach ciąży. Przedstawiono własne doświadczenia i możliwości zastosowania appendektomii laparoskopowej. Oceniono również wpływ leczenia operacyjnego na dalszy przebieg ciąży oraz rozwój płodu. Nie stwierdzono powikłań wynikających z zastosowanej metody leczenia. Wszystkie ciąże zostały zakończone o czasie: 3 siłami natury, 1 przez cięcie cesarskie z przyczyny położniczej. Wycięcie zmienionego zapalnie wyrostka robaczkowego metodą laparoskopową u kobiet w każdym trymestrze ciąży jest metodą bezpieczną zarówno dla matki, jak i dla płodu.Between 2000-2006, in the 2nd, Department of Surgery at the Medical College of the Jagiellonian University, we performed 4 laparoscopic appendectomies in pregnant patients with acute appendicitis. Diagnostic difficulties in relation to the progression of pregnancy are discussed. Our own experience and the use of laparoscopic technique are also presented. We have evaluated the possible influence of operative management on the further development of the fetus. There were no complications related to the operative procedure. All pregnancies developed normally until delivery, which were either natural (3 patients) or cesarean (1 patient, due to obstetrical indications). We conclude, therefore, that laparoscopic appendectomy seems to be a safe approach both for mother and baby during any trimester of pregnancy

Markers of oxidative stress in pregnancies complicated by pregnancy induced hypertension and intrahepatic cholestasis

Abstract Objective: The aim of the study was to investigate levels of superoxide dismutase (CuZnSOD-1), catalase (CAT), glutathione peroxidase (GPx) and malonodialdehyde (MDA) in groups of pregnant women with pregnancy induced hypertension (PIH), hypertension recognized before pregnancy (HA) or intrahepatic cholestasis. Material and methods: 33 women with PIH, 6 with HA and 12 with cholestasis were compared with 33 healthy pregnant women. Levels of enzymes were assessed in blood samples. Methods of delivery and obstetric results were presented. Results: SOD and GPx levels did not differ significantly in any of the investigated groups. A tendency for lower mean levels of CAT in the group of PIH women, and a higher level of MDA in the group of women with HA has been noted. The mean CAT level was significantly lower in PIH and HA patients delivered instantaneously due to the risk of eclampsia. All mean levels of enzymes in the group of women with cholestasis were similar to the ones in the group of healthy women. Patients with PIH and HA gave birth more often by cesarean section, but the overall condition of the newborns was satisfactory. Conclusions: There is no substantial evidence that the level of oxidative enzymes in a blood sample can be an indicator of oxidative stress in pregnant women with PIH, HA or cholestasis. Although CAT levels were lower in PIH and HA women who had cesarean section due to the risk of eclampsia, there was no correlation between these enzyme levels and the clinical outcome of patients or the condition of the newborns

Rheological properties of erythrocytes in patients infected with Clostridium difficile

Clostridium difficile infection (CDI) is a bacterial infection of the digestive tract. Acute infections are accompanied by increased risk for venous thromboembolism (VTE). To date, there have been no studies of the rheological properties of blood during the course of digestive tract infections. The aim of our study was to examine the effects of CDI on red blood cell (RBC) rheology, specifically RBC deformability, RBC aggregation, and plasma viscosity. In addition, the activity of glucose 6 phosphate dehydrogenase (G6PD) and acetylcholinesterase (AChE) in RBC was studied. Our study group included 20 patients with CDI, 20 healthy persons comprised the control group. We examined the effects of CDI on the rheology of RBCs, their deformability and aggregation, using a Laser–assisted Optical Rotational Cell Analyzer (LORCA). Plasma viscosity was determined using a capillary tube plasma viscosymeter. Moreover, we estimated the activity of AChE and G6PD in RBC using spectrophotometric method. A statistically significant increase was found in the aggregation index, viscosity and activity of G6PD whereas the amount of time to reach half of maximum aggregation (t½) and the amplitude of aggregation (AMP) both showed statistically significantly decreases among patients with CDI compared to the control group. We also observed that the Elongation Index (EI) was decreased when shear stress values were low, between 0.3 Pa and 0.58 Pa, whereas EI was increased for shear stress in the range of 1.13 - 59.97 Pa. These observations were statistically significant. We report for the first time that acute infection of the gastrointestinal tract with Clostridium difficile is associated with abnormalities in rheological properties of blood, increased serum viscosity as well as increased aggregation of RBCs, which correlated with severity of inflammation. These abnormalities may be an additional mechanism causing increased incidence of VTE in CDI