Niedobór czynnika XI jako problem kliniczny podczas porodu – opis przypadku

Hereditary factor XI deficiency has been a mystery since its discovery in 1953. The most common mild symptoms in patients with the most severe form do not match the abnormalities in standard clotting tests. The contribution of factor XI to hemostasis is not adequately assessed in modern clinical laboratories. How does factor XI deficiency contribute to changes in blood clotting patterns, what is the genetics of this condition, and the relationship between its deficiency and bleeding? A new approach of gynecologists to childbirth in patients with factor XI deficiency. This article describes the case of a pregnant woman with hemophilia C.Dziedziczny niedobór czynnika XI jest zagadką od jego odkrycia w 1953 roku. Najczęściej występujące łagodne objawy u pacjentów z najcięższą postacią nie pasują do nieprawidłowości w standardowych testach krzepnięcia. Udział czynnika XI w hemostazie nie jest odpowiednio oceniany w nowoczesnych laboratoriach klinicznych. W jaki sposób niedobór czynnika XI przyczynia się do zmian w modelach krzepnięcia krwi, jaka jest genetyka w tym schorzeniu, związek jego niedoboru z krwawieniem? Nowe podejście ginekologów do porodu u pacjentek z niedoborem czynnika XI. Artykuł przedstawia opis przypadku ciężarnej z hemofilią C

Complicated colonic diverticulitis at 34 weeks gestation

Peritonitis is a set of symptoms of varying etiology, usually with an accompanying infection, systemic and local changes within the peritoneal cavity. Colonic diseases, especially colon perforation, are one of the most common causes of peritonitis. The course of the disease may be turbulent due to sudden perforation. In case of limited peritonitis the disease is not as acute as the perforation hole is small and it can be sealed by the omentum and internal organs. Abdominal pain is usually located around the source of infection and is less severe. A 38-year-old patient at 34 weeks gestation was hospitalized in the obstetric-gynecological ward of the Health Care Center with a diagnosis of preterm delivery, urinary infection and renal colic. Due to increasing peritoneal symptoms and deteriorating general condition of the patient, a decision to perform immediately exploratory laparotomy combined with the Cesarean section was made. The surgeon indicated a place in the left mesogastrium that could correspond with a drained interintestinal abscess and also found a large amount of fibrin in the lower floor of the peritoneal cavity. The initial point of the abscess remained unknown and the patient received total parenteral nutrition for 10 days. On 5 postoperative day the drain was removed from the peritoneal cavity and since day 10 patient health was steadily improving. Bacteriological cultures revealed abundant growth of E. coli that showed sensitivity to the used antibiotics. On 22 postoperative day the patient and her child were discharged home in good condition. Five months later, the patient was admitted to the surgical ward with acute abdominal pain with the diagnosis of an abscess in her left mesogastric and subgastric area, perforation of sigmoid diverticulum and fecal fistula. Our case illustrates great difficulties in diagnosing diseases of the abdominal cavity during pregnancy because causes and symptoms may be typical of this condition, as well as of unrelated diseases, including: kidney problems, appendicitis, cholecystitis and bowel disease. Examination of the pregnant patient presents a challenge and the symptoms are uncharacteristic. Tension of the abdominal wall, as well as the muscles of the digestive and urinary tract are reduced and the topography of the internal organs changes during pregnancy. The interpretation of laboratory tests becomes more difficult. In our case, the initial local peritonitis, caused by microperforation of the diverticulum, ran a latent course and was masked by both pregnancy and renal colic symptoms, consequently leading to diffuse peritonitis. The presented case demonstrates the importance of the problem and forces obstetricians to be more vigilant in determining the diagnosis and decision-making, because of its meaning for the health and even the life of the patient and her child

Limitations of insulin resistance assessment in polycystic ovary syndrome

Background: Though insulin resistance (IR) is common in polycystic ovary syndrome (PCOS), there is no agreement as to what surrogate method of assessment of IR is most reliable. Subjects and methods: In 478 women with PCOS, we compared methods based on fasting insulin and either fasting glucose (HOMA-IR and QUICKI) or triglycerides (McAuley Index) with IR indices derived from glucose and insulin during OGTT (Belfiore, Matsuda and Stumvoll indices). Results: There was a strong correlation between IR indices derived from fasting values HOMA-IR/QUICKI, r = −0.999, HOMA-IR/McAuley index, r = −0.849 and between all OGTT-derived IR indices (e.g. r = −0.876, for IRI/Matsuda, r = −0.808, for IRI/Stumvoll, and r = 0.947, for Matsuda/Stumvoll index, P 75th percentile had IRI value also above 75th percentile. There was a significant, but weak correlation of all IR indices with testosterone concentrations. Conclusions: Significant number of women with PCOS can be classified as being either insulin sensitive or insulin resistant depending on the method applied, as correlation between various IR indices is highly variable. Clinical application of surrogate indices for assessment of IR in PCOS must be therefore viewed with an extreme caution