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Case Reports 2015; 36(3): 241-242 PubMed PMID: 26313390 Citation  Keywords:  Cesarean Section:methods, Female, Humans, Pregnancy, Pregnancy Complications:pathology, Torsion Abnormality:pathology, Uterine Diseases:pathology,.   

: This paper describes a case of uterine torsion not only around the long, but also the horizontal axis, diagnosed post-operatively. The patient was 28-years-old, II/I in the 34th week of her gravidity. She was admitted due to amniotic fluid leak. Due to unsuccessful delivery induction using prostaglandins, a caesarean section was indicated to end the gravidity. Uterine torsion 180° around the longitudinal axis and 90° around the transversal axis was diagnosed during the surgery. The uterine wound was treated in accordance with guidelines and the patient was dismissed in a good condition. Control hysteroscopy and laparoscopy done after a time interval showed problem-free healing of the wound in the posterior uterine wall....

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Journal Article 2015; 36(3): 209-213 PubMed PMID: 26313385 Citation  Keywords:  Adult, Evidence-Based Medicine:methods, Female, Fertilization in Vitro:methods, Humans, Infertility, Female:therapy, Ovarian Reserve:physiology, Pregnancy,.   

: Despite the vast experience in controlled ovarian hyperstimulation, there are still women who respond poorly to gonadotropins, which results in few oocytes at retrieval, reduced number of embryos for transfer and consequently unsatisfactory pregnancy rates. Although such patients are quite common in IVF practice, the exact prevalence of so-called "poor responders" is difficult to estimate due to the variety of applied definitions. The urgent need for an internationally accepted definition of poor ovarian response (POR) was addressed by an ESHRE Workshop held in Bologna in 2010, where the consensus was reached and criteria were finally established. The application of this uniform definition may allow a correct estimate of POR prevalence and, what is more important, designing proper trials to assess and finally compare the interventions used in POR patients. The article describes the possible physiology of POR and patient characteristics, mentions risk factors and laboratory tests of decreased ovarian reserve. Finally it reviews the possible management of POR with different stimulation protocols in the light of EBM. Basing on published meta-analyses, various additional alternatives (such as estradiol priming, the addition of rLH, growth hormone, androgens and androgen-modulating agents, aspirin) are also summarized. Despite the two decades of trying, there is still no consensus on what is best for POR. No single treatment can be recommended over another, as the evidence for all of them is insufficient. It is obvious that interventions used in POR require properly designed large randomized studies, because until now there is no evidence-based treatment for that particular group of patients....

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Journal Article 2015; 36(2): 143-147 PubMed PMID: 26071583 Citation  Keywords:  Animals, Brain:metabolism, Environment, Male, Pituitary Adenylate Cyclase-Activating Polypeptide:metabolism, Radioimmunoassay, Rats, Rats, Wistar,.   

OBJECTIVE: Pituitary adenylate cyclase activating polypeptide (PACAP) is a pleiotropic and multifunctional neuropeptide, widely distributed throughout the body. It is involved in the regulation of various physiological and pathophysiological processes. Numerous studies have shown that PACAP is involved in the development of the central nervous system and has neuroprotective effects. Environmental enrichment is also protective in various injuries, partially through involvement of trophic factors. The interaction between PACAP levels in the brain and environmental effects has not been studied yet. The aim of the present study was to investigate whether environmental enrichment influences PACAP levels of different brain areas in rats.

METHODS: Wistar rats were exposed to enriched environment in adulthood for 3 weeks. PACAP27- and PACAP38-like immunoreactivities were measured with a specific and sensitive radioimmunoassay in homogenates of different brain areas: brainstem, cerebellum, diencephalon and telencephalon.

RESULTS: We found that levels of both PACAP27- and PACAP38-like immunoreactivities showed significant increases in most brain areas after a 3-week-long exposure to enriched conditions. Thus, similarly to several other CNS injuries, enriched environment induced elevation in PACAP levels.

CONCLUSION: As PACAP has strong neuroprotective effects, the elevation observed after exposure to enriched environment is suggested to play a role in the protective effects of such an environment as part of the endogenous neuroprotective machinery in adult rats....

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Case Reports 2015; 36(2): 119-123 PubMed PMID: 26071578 Citation  Keywords:  Adrenal Insufficiency:chemically induced, Adult, Female, Hashimoto Disease:chemically induced, Human Growth Hormone:adverse effects, Humans, Polyendocrinopathies, Autoimmune:chemically induced, Turner Syndrome:drug therapy, Young Adult,.   

: Autoimmune polyglandular syndrome is a constellation of signs and symptoms of simultaneous insufficiencies of several endocrine glands. Autoimmune polyglandular syndrome type 2 (APS 2) may be diagnosed when the adrenocortical insufficiency is associated with an autoimmune thyroid disease (Hashimoto's thyroiditis or Graves' disease), and/or insulin-dependent diabetes mellitus. Turner syndrome is the most common chromosomal disorder in females, caused by complete or partial X chromosome monosomy. We present the case of a 20-year-old woman with Turner syndrome, in whom APS 2 (Hashimoto's thyroiditis and adrenocortical insufficiency) has been diagnosed after introduction of recombinant human growth hormone (rhGH) therapy. In Turner syndrome, examination of the patient must regularly be conducted in order to diagnose a possible onset of autoimmune diseases; respective treatment must be applied as soon as the diagnosis is established. In particular, therapy of rhGH, used for short stature treatment, may be a trigger factor of adrenal insufficiency. The cortisol level in blood should be assessed before rhGH administration and carefully monitored during the therapy, especially in case of autoimmune thyroid disease coexistence....

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Journal Article 2015; 36(2): 101-105 PubMed PMID: 26071574 Citation  Keywords:  Adult, Diabetes, Gestational:pathology, Female, Humans, Placenta:pathology, Pregnancy,.   

: Nowadays, the continuous rise of maternal obesity is followed by increased gestational diabetes mellitus incidence. GDM is associated with adverse fetal and neonatal outcome that often presents with macrosomia, birth trauma, neonatal hypoglycemia, and respiratory distress syndrome. Inclusion of GDM into 'the great obstetrical syndromes' emphasizes the role of the placenta in interactions of the maternal and fetal unit. The placenta acts as a natural selective barrier between maternal and fetal blood circulations. Placenta is sensitive to the hyperglycemic milieu and responses with adaptive changes of the structure and function. Alteration of the placental development and subsequent vascular dysfunction are presented in 6 out of 7 women with all ranges of diabetic severity. Most placentas from GDM pregnancies present typical histological findings such as villous immaturity, villous fibrinoid necrosis, chorangiosis, and increased angiogenesis. The type of dysfunction depends on how early in pregnancy glycaemia disorders occurred. Generally, if impaired glucose metabolism is diagnosed in the early pregnancy, mainly structural dysfunctions are observed. GDM that is detected in late gestation affects placental function to a greater extent. Moreover many studies suggest that diabetic placental changes are associated with inflammation and oxidative stress that can lead to the chronic fetal hypoxia. This article aims to review particular changes of the development, anatomy and function of the placenta in the environment of abnormal glucose metabolism which can establish the maternal-placental-fetal interface dysfunction as a potential source of adverse pregnancy outcomes. A detailed sequence of events that leads from hyperglycemia to placental dysfunction and subsequent pregnancy complications may become an important issue for further studies....

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Journal Article 2015; 36(1): 53-58 PubMed PMID: 25789595 Citation  Keywords:  Adult, Circadian Rhythm, Comorbidity, Female, Humans, Hyperprolactinemia:blood, Polycystic Ovary Syndrome:blood, Prolactin:blood, Retrospective Studies, Young Adult,.   

OBJECTIVES: Hyperprolactinemia and polycystic ovary syndrome (PCOS) are on the list of the most frequent causes of female infertility. Both pathologies are characterized in common by several clinical features. At the same time, there are essential discrepancies in medical literature on mutual relations between PCOS and hyperprolactinemia. The objective of our study was to answer several questions, e.g. about frequency of hyperprolactinemia in PCOS patients, typical concentrations of prolactin (Prl) in PCOS patients vs women without polycystic ovaries and/or an assessment of circadian Prl level profiles vs single Prl sampling, as regards diagnostic usefulness.

METHODS: The study was retrospective analysis of medical records of female patients in whom nine (9) points daily profile of prolactinemia had been performed.

RESULTS: Prl levels appeared to be slightly higher in women without PCOS but the difference did not reach a border of statistical significance. The incidence of elevated Prl concentrations in 8:00 AM and 11:00 AM samples was higher in women without PCOS than in PCOS patients (32.0% vs 16.3% - 8:00 AM, and 8.5% vs 4.6% - 11:00 AM, respectively). Also, elevated mean daily prolactinemia, assessed as area under the curve (AUC) of Prl concentrations, was more frequent in the group of women without PCOS than in those with PCOS (22.0% vs 13.9%).

CONCLUSIONS: Polycystic overy syndrome is not associated with higher levels of Prl, measured in daily profiles. Hyperprolactinemia does not seem to be more frequent in PCOS women than in healthy subjects and it should not be considered as characteristic feature of PCOS - both are distinct clinical entities. Prolactin concentrations should be assessed in each woman with PCOS suspicion because of certain common clinical signs in both disorders. Every woman diagnosed with PCOS and hyperprolactinemia should further be examined in terms of the actual causes of hyperprolactinemia because the coexistence of these two disease entities - as distinct - is also possible....

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Journal Article 2015; 36(1): 31-40 PubMed PMID: 25789594 Citation  Keywords:  Adult, Aged, Double-Blind Method, Female, Folic Acid:metabolism, Healthy Volunteers, Homocysteine:metabolism, Humans, Lipid Peroxidation:drug effects, Male, Middle Aged, Neuroprotective Agents:administration & dosage, Pyridoxine:metabolism, Superoxide Dis.   

OBJECTIVES: Neurotoxic metabolites and oxidative and nitrosative stress reactions play a crucial role in the pathways leading to neuronal cell death and neurodegeneration. The bioavailability of the many antioxidant ingredients a vitamin and trace element composition was investigated, to reveal the neuroprotective (preventive) potential of the composition.

METHODS: We recruited 159 healthy volunteers, assigned them randomly and double blind to a placebo and verum group. Physicians excluded volunteers with severe chronic diseases or interfeering medications. 142 participants finished the six month trial. Laboratory parameters were determined 1) before participation, and 2) after three and 3) six months. We confirmed the bioavailability of ingredients, and determined metabolic parameters associated with the integrity of the blood brain barrier, mitochondrial deficiency (Q 10), neurodegeneration (homocystein), and antioxidative capacity (e.g. lipidperoxidation), and superoxiddismutase activity.

RESULTS: Starting from baseleine, after three months neuroprotective ingredients increased within their physiological borders, folic acid (p<0.003), pyridoxin (p<0.001), cobalamin (p=0.001), and the fat soluble vitamin tocopherol (p<0.001). In parallel, homocytein decreased after 3 and 6 months (p<0.001, and p<0.025, respectively). Other paramters like zinc reacted slower, significant changes were observed only after 6 months.

CONCLUSION: The observed metabolic changes and alteration of the oxidative status after 3 and six month of regular intake underlines the compositions' potential to ameliorate neurodegenerative processes. We conclude that the subsitution of vitamins and trace-elements with natural source in a proper manner may be effective for neuroprotection in healthy population....

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Journal Article 2015; 36(1): 84-90 PubMed PMID: 25789589 Citation  Keywords:  Adult, Estradiol:blood, Female, Follicle Stimulating Hormone:blood, Humans, Hydrocortisone:blood, Light, Luteinizing Hormone:blood, Melatonin:secretion, Menstrual Cycle:blood, Progesterone:blood, Prolactin:blood, Young Adult,.   

OBJECTIVE: Light is known to stimulate reproductive function in women. We here investigated the immediate effect of light on reproductive hormones, addressing the role of blue-sensitive (~480 nm) melanopsin-based photoreception mediating the non-visual effects of light.

METHODS: Sixteen healthy women attended the Institute at ~07:25 (shortly after waking; sunglasses worn) twice in 2-3 days in April-May, within days 4-10 of their menstrual cycle. During one session, a broad-spectrum white-appearing light with a superimposed peak at 469 nm was presented against 5-10 lux background; during the other session, short-spectrum red light peaked at 651 nm with similar irradiance level (~7.0 W/m², corresponds to ~1200 lux) was used. Venous blood was taken at 0, 22 and 44 minutes of light exposure to measure concentrations of follicle-stimulating hormone (FSH), luteinising hormone (LH), prolactin, estradiol, progesterone and cortisol, and saliva was sampled to measure melatonin as a recognised indicator of the spectral-specific action of light.

RESULTS: Melatonin values, as expected, were lower with white vs. red light (p=0.014), with the greatest difference at 22 minutes. Of the other hormones, only FSH concentrations differed significantly: they were mildly higher at white vs. red light (again, at 22 minutes; p=0.030; statistical analysis adjusted for menstrual cycle day and posture change [pre-sampling time seated]).

CONCLUSION: Moderately bright blue-enhanced white light, compared to matched-by-irradiance red light, transiently (within 22 minutes) and mildly stimulated morning secretion of follicle-stimulating hormone in women in mid-to-late follicular phase of their menstrual cycle suggesting a direct functional link between the light and reproductive system....

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