Diagnosing and management of iatrogenic moderate and severe ovarian hyperstymulation syndrome (OHSS) in clinical material.

Severe ovarian hyperstymulation syndrome is a rare but potentially life-threatening complication in patients undergoing assisted reproductive techniques (ART). The pathogenesis of this condition is likely to be multifactorial. The aim of the retrospective study was to present management in moderate and severe iatrogenic ovarian hyperstymulation syndrome (OHSS) in clinical material. The study group was 19 women, admitted to the Department of Obstetrics and Gynecology in Central Clinical Hospital of Ministry of Interior and Administration in Warsaw from large outpatient infertility center "Novum" in Warsaw with moderate and severe OHSS between 14.07.2004 and 8.11.2005. Laboratory tests and ultrasound examination of the ovarian size and ascites were performed, abdominal circumference was measured. Patients were treated with rehydration with intravenous crystalloids and colloids, diuretics, antibiotics, anticoagulants and ultrasound-guided paracentesis if symptoms of ascites become severe (ascites causes pain and compromised pulmonary function). Oral intake of water was restricted, monitoring of fluid intake and output, and daily monitoring of body weight was performed. During treatment controlled laboratory tests were done. In one patient occurred intra-abdominal hemorrhage from ovarian rupture and laparotomy with oophorectomy was performed. The ovarian hyperstimulation syndrome is still a difficult diagnostic and therapeutic problem and more studies are required to elucidate pathophysiology of OHSS. Because of still unknown etiology treatment is empirical and in most of cases bases on experience of medical team. Thus, the management in individual patients varies according to the severity of ovarian hyperstymulation syndrome and its complications

Study on changing patterns of reproductive behaviours due to maternal features and place of residence in Poland during 1995-2014

Introduction The sharp decline in the total fertility rate in Poland coincided with broader socio-economic changes, which resulted in its reduction to the lowest level observed among the countries of Central and Eastern Europe. Objective. The aim of the study was to investigate and evaluate the changing patterns of reproductive behaviour in rural and urban areas, depending on the demographic and socio-economic features in Poland. Material and Methods Information about live births in Poland in the years 1995–2014 were obtained from the Central Statistical Office. Registered cases of live births in rural and urban areas were analyzed considering the maternal features (age, marital status, main source of income). To evaluate the changes in fertility and comparisons between rural and urban areas, Joinpoint Regresssion was used. Results In 1995–2014, a shift in the age of highest fertility from 20–24 years to 25–29 years was observed. This occurred at the same time as a reduction in the fertility rate per 1,000 women aged 15–29 years, more pronounced in rural areas (95.8 to 60.0) than in urban areas (63.4 to 51.5), while in women aged 30–49 years, a faster increase in fertility was observed in urban areas (16.4 to 32.0) than in rural areas (27.5–29.2). Fertility trends between rural and urban areas differed significantly. A significant increase in live births for employed mothers was shown mainly in 2005–2009; later, the growth rate in rural areas was slower and in urban areas the growth trend stopped. Conclusions The postponement of births and reduction of fertility in women aged 15–29 requires active measures aimed at creating favourable conditions for achieving economic independence for the younger generation, as well as combining work with raising children, especially in rural areas. Abbreviations APC – annual percentage change; AAPC – average annual percentage change; CSO – Central Statistical Office; TFR – total fertility rat

Zaburzenia w białkach kardiomiocytu przyczyną niewydolności serca

Niewydolność serca nadal stanowi znaczący problem kliniczny i ekonomiczny związany z bardzo dużą zachorowalnością i śmiertelnością. Niewydolność serca mogą wywoływać znane czynniki, prowadzące do powstania kardiomiopatii wtórnej lub czynniki nieznane, powodujące kardiomiopatię pierwotną. Dzięki rozwojowi techniki molekularnej możliwe staje się określenie przyczyn kardiomiopatii dotychczas określanych mianem pierwotnych. Jedną z takich przyczyn są zaburzenia w obrębie białek kardiomiocytu, tworzących błonę komórkową (sarkoglikany, dystrofina), cytoszkielet (desmina, tubulina) czy sarkomer (aktyna, miozyna, troponina I, T, C)

Zespół Sweeta — etiopatogeneza, obraz kliniczny, diagnostyka, leczenie

Zespół Sweeta jest rzadko występującym schorzeniem o charakterze zapalnym, należącym do grupy dermatoz neutrofilowych. Charakteryzuje się nagłym występowaniem zmian skórnych o charakterze grudek, guzków, blaszek z towarzyszącą gorączką i leukocytozą. Zazwyczaj wyróżnia się następujące podtypy zespołu: klasyczny, związany z nowotworami i indukowany przez leki. Etiopatogeneza zespołu Sweeta pozostaje niejasna. Zespół bywa poprzedzony infekcją układu oddechowego, układu pokarmowego, szczepieniem bądź współwystępuje z chorobą nowotworową, chorobą zapalną lub ciążą. Dla zespołu Sweeta charakterystyczna jest dobra odpowiedź na leczenie ogólne preparatami glikokortykosteroidowymi i szybkie ustępowanie wykwitów. Średnio u jednej trzeciej pacjentów zmiany nawracają. Słowa kluczowe: ostra gorączkowa dermatoza neutrofilowa, dermatozy neutrofilowe, zespół Sweet

Zaburzenia w białkach kardiomiocytu przyczyną niewydolności serca

Niewydolność serca nadal stanowi znaczący problem kliniczny i ekonomiczny związany z bardzo dużą zachorowalnością i śmiertelnością. Niewydolność serca mogą wywoływać znane czynniki, prowadzące do powstania kardiomiopatii wtórnej lub czynniki nieznane, powodujące kardiomiopatię pierwotną. Dzięki rozwojowi techniki molekularnej możliwe staje się określenie przyczyn kardiomiopatii dotychczas określanych mianem pierwotnych. Jedną z takich przyczyn są zaburzenia w obrębie białek kardiomiocytu, tworzących błonę komórkową (sarkoglikany, dystrofina), cytoszkielet (desmina, tubulina) czy sarkomer (aktyna, miozyna, troponina I, T, C)

Wartość tomografii komputerowej i rezonansu magnetycznego w diagnostyce zmian w centralnym układzie nerwowym u pacjentów z twardziną układową

Background: Systemic sclerosis is an autoimmune connective tissue disease characterized by vascular abnormalities and fibrotic changes in skin and internal organs. The aim of the study was to investigate involvement of the central nervous system in systemic sclerosis and the value of computed tomography (CT) and magnetic resonance imaging (MRI) in evaluation of central nervous system involvement in systemic sclerosis. Material/Methods: 26 patients with neuropsychiatric symptoms in the course of systemic sclerosis were investigated for central nervous system abnormalities by computed tomography (CT) and magnetic resonance imaging (MRI). Results: Among these 26 symptomatic patients lesions in brain MRI and CT examinations were present in 54% and in 50% patients respectively. Most common findings (in 46% of all patients), were symptoms of cortical and subcortical atrophy, seen in both, MRI and CT. Single and multiple focal lesions, predominantly in the white matter, were detected by MRI significantly more frequently as compared to CT (62% and 15% patients respectively). Presence of brain atrophy and focal lesions in CT and MR correlated with disease duration (both p<0,0001), extent of skin involvement (p<0,01) and presence of pulmonary fibrosis in the course of the systemic sclerosis (p=0.001). Conclusions: These data indicate that brain involvement is common in patients with severe systemic sclerosis. MRI shows significantly higher th an CT sensitivity in detection focal brain lesions in these patients

Vascular changes in autoimmunological connective tissue diseases

Vascular complications due to systemic connective tissue diseases pose a very difficult clinical problem. Due to the nature and location of the lesions, they very often prevent revascularization procedures and the conservative treatment is usually insufficient, which leads to a growth in the degree of ischemia and the need to amputate the limb. The authors clearly show the clinical picture of the most common diseases in this group — systemic lupus erythomatosus, systemic scleroderma, dermatomyositis, mixed connective tissue disease and Sjögren’s syndrome

Raynaud’s phenomenon — the clinical picture, treatment and diagnostics

Raynaud’s phenomenon is the triphasic phenomenon which consists of sudden paling of distal parts of the body with the following cyanosis and occurance of erythema in the third stage. This phenomenon is a result of peripheral microcirculation disorder and usually appears after exposure to cold. If the RP is a primary, idiopathic (not associated with other diseases) then the other name for this condition is Raynaud’s disease (80% of RP cases). If the RP is secondary to other medical conditions such as connective tissue disorders, arterial alterations etc., then Raynaud’s syndrome is diagnosed and that is why further diagnostics is required in every case of RP