Search NEL Online

Journal Article 2014; 35(8): 718-723 PubMed PMID: 25702301 Citation  Keywords:  Adult, Cesarean Section:adverse effects, Decision Making, Elective Surgical Procedures:adverse effects, Female, Humans, Obstetric Labor Complications:epidemiology, Pregnancy, Pregnancy Outcome:epidemiology, Retrospective Studies, Vaginal Birth after Cesar.   

OBJECTIVE: A retrospective analysis of the course of labour in patients after one caesarean section (CS) and of factors influencing successful attempt of vaginal birth after caesarean (VBAC).

DESIGN: A group of 296 patients after one CS was divided into: group G1 (206 patients) - elective CS, group G2 (90) - VBAC attempt, and G2 to: G2a (35) - VBAC and G2b (55) - CS after an unsuccessful VB attempt. A comparative analysis between the groups and logistic regression analysis of factors influencing a successful VBAC was made.

RESULTS: There were no differences regarding age, BMI, weight gain during pregnancy or gestational age between groups G1 and G2, as well as G2a and G2b. G2a patients had more often already given VB previously (28.6% vs 10.9%; p=0.03). The most frequent indication for a repeat elective CS was the lack of informed consent for VBAC (29.13% of all indications). The mean neonatal birthweight was highest in G1 (3 410 g), and in G2b higher than in G2a (3 275 g vs 3 098 g; p=0.009). There were no differences in newborns' general condition between the group. There were no cases of uterine rupture and 4 cases of uterine scar dehiscence in G1 and 1 in G2. Of all the analysed factors only spontaneous delivery onset (OR 7.78) and previous vaginal birth after the caesarean (OR 1.99) or before the caesarean (OR 2.03) had significant influence on successful VBAC trial.

CONCLUSION: The right classification of patients is a significant factor having effect on the success of a VB attempt after CS....

Read abstract  Full text PDF

Journal Article 2014; 35(8): 711-717 PubMed PMID: 25702300 Citation  Keywords:  Adult, Antidepressive Agents:therapeutic use, Anxiety Disorders:drug therapy, Combined Modality Therapy, Depressive Disorder:drug therapy, Female, Humans, Male, Middle Aged, Psychotherapy:methods, Self Concept, Social Stigma, Treatment Outcome,.   

OBJECTIVE: Many psychiatric patients suffer from self-stigma. One consequence of these internalized prejudices is decreased treatment efficacy. Much has been written about the effects of self-stigma in patients with severe mental disorders. However, individuals with minor psychiatric disorders also suffer from self-stigma. It is therefore necessary to explore the effect of self-stigma on treatment efficacy of neurotic patients.

METHOD: Aim of out study was to investigate relationship between self-stigma, severity of symptoms, and presence of comorbidit disorder and treatment outcome in neurotic patients. Patients were treated by combined psycho and pharmacotherapy. Level of self-stigma was measured by Internalized Stigma Of Mental Illness scale. Severity of anxiety and depressive symptoms was assed by Beck Anxiety Inventory, Beck Depressive Inventory and Clinical Global Impression Scale.

RESULTS: Level of self-stigma was significantly correlated with the levels of anxiety, depression and global evalutions of a mental state on the beginnig of the therapy. Up to our results patients with higher level of self-stigmatization had lower improvement after combined treatmet in respect to perceived anxiety symptoms.

CONCLUSION: Self-stigma seems to be an important factor influencing efficacy of combined treatment. More researches focused on self-stigmatization should be done to find an optimal therapeutic strategy for patients with higher level of self-stigmatization....

Read abstract  Full text PDF

Journal Article 2014; 35(5): 367-372 PubMed PMID: 25275261 Citation  Keywords:  Adult, Apgar Score, Female, Humans, Infant, Newborn, Poland, Pregnancy, Pregnancy Outcome, Prenatal Exposure Delayed Effects:drug therapy, Vitamin D:administration & dosage, Vitamin D Deficiency:drug therapy, Vitamins:administration & dosage, Young Adult,.   

OBJECTIVE: Pregnancy increases the demand for vitamins, including vitamin D. Data on effects of vitamin D deficiency for pregnant woman and fetus available in Poland are scarce. The aim of this study was to evaluate vitamin D3 concentration in pregnant women and its influence on pregnancy course, health of pregnant women and their offspring.

PATIENTS AND METHODS: The study included 102 healthy pregnant women, aged 21 to 40 years, mean 30.5±4.9 years. Women were divided into three groups based on 25(OH)D serum concentration in the third trimester of pregnancy: Group I - with sufficient 25(OH)D serum concentration (>30 ng/ml), Group II - with vitamin D3 insufficiency (20-30 ng/ml), Group III - with serious vitamin D deficiency (<20 ng/ml).

RESULTS: Optimal vitamin D concentrations were found only in 31.2% of women, however in winter months only in 16%. Bacterial vaginosis was significantly more common in women with vitamin D deficiency and insufficiency (p<0.05). In contrast, there were no relations between vitamin D status and the incidence of gestational diabetes, preeclampsia, mode of delivery and size of newborns. A relationship between vitamin D deficiency and insufficiency during pregnancy and subsequent incidence of respiratory infections in children (p<0.05) was demonstrated.

CONCLUSIONS: 1. The current model of vitamin D supplementation in pregnant women in Poland is insufficient, particularly in winter. 2. Vitamin D deficiency in pregnant women fosters development of bacterial vaginosis during pregnancy and recurrent respiratory infections in children, suggestive of the role of vitamin D in prevention of infections....

Read abstract  Full text PDF

Journal Article 2014; 35(4): 285-289 PubMed PMID: 25038607 Citation  Keywords:  Aged, Aged, 80 and over, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Radiosurgery, Treatment Outcome, Trigeminal Nerve:pathology, Trigeminal Neuralgia:etiology,.   

OBJECTIVES: The etiology of classic trigeminal neuralgia (CTN) is still under debate and, together with neurovascular compression (NVC), other anatomical abnormalities have been considered, including differences of trigeminal nerve (TN) volume.

DESIGN: We evaluated the volumes of affected and non-affected nerves and the presence and type of NVC in large group of 84 CTN subjects prior to gamma knife treatment (GKS) on MR images. Correlation between affected nerve volume and NVC, treatment outcome and demographic characteristics were explored.

RESULTS: NVC was detected in 71% of affected nerves, 52% of non-affected nerves, and in 31% of subjects bilaterally. Lower trigeminal nerve volume was detected on the affected side (p<0.001, affected mean 34.9 mm3 ± 14.4 SD, non-affected mean 41.9 mm3 ± 17.7 SD), however, no correlation between affected nerve volume and the presence and type NVC, treatment outcome or demographic data was detected.

CONCLUSION: Our results suggest that NVC may trigger CTN in susceptible subjects but is not a reliable disease marker. Lower trigeminal nerve volume appears to manifest independently of NVC, and may represent nerve asymmetry rather than atrophy. No correlation between volumetry and clinical data was detected including treatment outcome after GKS....

Read abstract  Full text PDF

Case Reports 2014; 35(4): 249-251 PubMed PMID: 25038605 Citation  Keywords:  Aged, Blindness:etiology, Breast Neoplasms:pathology, Choroid Neoplasms:complications, Fatal Outcome, Female, Humans, Multiple Organ Failure:etiology, Neoplasm Metastasis:pathology,.   

: Intraocular choroidal metastasis is a very rare cause of blindness. Carcinoma of breast is the most common primary malignancy the accounts for choroidal metastasis in females. Other primary neoplasms which can uncommonly metastasize to the choroid are gastrointestinal tract, thyroid, pancreas, prostate and testis. Metastatic neoplasm to the eye outnumbers the primary tumors such as retinoblastoma and malignant melanoma. We present a case of sudden loss of vision due to breast cancer metastasis to the eyeball. The interval between the diagnosis of the primary tumor and the choroidal metastasis was 4 years.

...

Read abstract  Full text PDF

Case Reports 2014; 35(4): 262-264 PubMed PMID: 25038597 Citation  Keywords:  Adult, Female, Humans, Laparoscopy, Magnetic Resonance Imaging, Myoma:pathology, Pregnancy, Pregnancy Complications:etiology, Treatment Outcome, Uterine Neoplasms:pathology,.   

: Patients with infertility commonly undergo various diagnostic and therapeutic procedures that may affect the future course of the pregnancy. In this presented case a female patient with infertility has been subjected to laparoscopic myomectomy and chromoscopy of the fallopian tubes, as it turned out later, 4 days after spontaneous conception. Due to severe pain in the 19th week of pregnancy the uterus area with the scar resulted from the removed myoma was visualised by magnetic resonance imaging (MRI). The MRI showed an active red degeneration in one of the myomas. At the same time the thickness of the uterus wall in previous myomectomy area was normal. The control MRI performed in the 36th week of pregnancy showed a hyaline degeneration of the myoma, underlying its dynamic refraction. The MRI approach enabled a non-invasive treatment and delivery in term....

Read abstract  Full text PDF

Journal Article 2014; 35(4): 322-326 PubMed PMID: 25038595 Citation  Keywords:  Abortion, Spontaneous:blood, Adult, Age Factors, Anti-Mullerian Hormone:blood, Antibodies:blood, Biomarkers:blood, Female, Humans, Infertility, Female:blood, Insulin:blood, Predictive Value of Tests, Pregnancy, Pregnancy Outcome, Thyroid Hormones:immunolo.   

OBJECTIVE: This study was conducted to determine serum anti-Müllerian hormone (AMH) concentration influence on pregnancy outcome.

STUDY DESIGN: In this study we investigated sixty one infertile women (aged 27 to 44 years) who were diagnosed and treated between 2011 and 2013. We determine ovarian reserve measured by AMH concentration. Patients were divided in three groups according to their serum AMH concentration (<1 ng/ml; 1-2.5 ng/ml; >2.5 ng/ml respectively). We investigated the relationship between clinical pregnancy rate and AMH concentration. In addition, anti-thyroid antibodies (anti-TG and/or anti-TPO) positivity and insulin concentration were correlated with AMH level and pregnancy outcome in the study groups.

RESULTS: We found no statistical differences between AMH concentration regarding number of pregnancies (42.3%; 41.1 %; 38.9% respectively in study groups; p>0.05). The miscarriage rate was highest in women with AMH>2.5 ng/mL (27.3%, 0%, 86% respectively in study groups; p>0.05). We found that anti-thyroid positivity is more frequent in women with lower AMH concentration (23.1%; 11.7%; 5.5% respectively; p>0.05) and patients with lower serum AMH had higher serum insulin concentration (p<0.05).

CONCLUSIONS: It seems that AMH concentration might not reflect oocyte quality and the chance of pregnancy, but increased AMH concentration may be associated with negative pregnancy outcome. Moreover, it cannot be excluded that presence of anti-thyroid antibodies and increased insulin serum concentration may be connected to diminished ovarian reserve measured by AMH concentration....

Read abstract  Full text PDF

Case Reports 2014; 35(4): 257-261 PubMed PMID: 25038593 Citation  Keywords:  Cysts:etiology, Growth Hormone:blood, Growth Hormone-Secreting Pituitary Adenoma:complications, Humans, Kidney:pathology, Liver:pathology, Male, Middle Aged, Neurosurgical Procedures, Sphenoid Bone:surgery, Treatment Outcome,.   

: Growth-hormone staining pituitary adenoma is a popular disease of the central nervous system. We noticed some patients have accompanying cystic disorders. Several cases of concomitant growth-hormone (GH)-staining pituitary adenoma and other cystic changes have been reported but with no further investigation. We report a case of adult growth-hormone staining pituitary adenoma with accompanying polycystic changes of multiple systems, as well as hypertension and nephrolithiasis. Preoperative clinical assessment revealed intrasellar tumor, multinodular thyroid disorder, renal cysts, and hepatic cysts, with increased serum growth-hormone level and normal thyroid hormone level. The total tumor resection was performed via endoscopic transsphenoidal approach. The pathologic analysis reported growth-hormone staining pituitary adenoma. The postoperative course was uneventful. The endocrine testing was normal soon after the operation and the patient remained well for a follow-up period of eight months. This is the fifth report about simultaneous growth-hormone staining pituitary adenoma and polycystic changes of the kidneys and the liver. With review of the literature we speculate that the abnormal growth hormone secretion of the pituitary adenoma may arouse sequential cystic changes of multiple systems through some IGF-I involved pathways....

Read abstract  Full text PDF