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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....

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Case Reports 2013; 34(5): 339-342 PubMed PMID: 23922047 Citation  Keywords:  Acromegaly:complications, Adenoma:complications, Adult, Diabetes Mellitus, Humans, Magnetic Resonance Imaging, Male, Pituitary Apoplexy:complications, Pituitary Neoplasms:complications, Remission, Spontaneous, Sella Turcica:pathology,.   

OBJECTIVES: Pituitary apoplexy is a rare clinical syndrome associated with rapid enlargement of a pituitary mass. We report the initial presentation, subsequent course and outcome of an acromegalic patient who developed spontaneous remission following pituitary apoplexy with pathologic findings of tumor infarction.

CLINICAL PRESENTATION: A 38 year-old man with typical acromegalic features was referred to our hospital. He had been diabetic and hypertensive. His basal GH and IGF-1 levels were high (80 µg/L and 747 ng/mL respectively). Sella MRI showed a macroadenoma about 19×20 mm in size. He admitted to emergency department with complains of severe frontal headache accompanied by nausea and vomiting two days after MRI was taken. His neurological examination and visual field test were normal. Emergent MRI of the sella disclosed an enhancing intrasellar mass of 24×23 mm compressing the optic chiasm. The patient underwent transsphenoidal decompression of the lesion. Histological examination revealed an adenomatous tissue showing nonhemorrhagic coagulation necrosis. Before surgery, his GH levels declined to 2.72 µg/L spontaneously and after surgery he was in remission even leading to a state of growth hormone deficiency.

CONCLUSION: When apoplexy occurs in functioning adenomas, it may cause spontaneous remission. However pituitary apoplexy due to tumor infarction is very rare. Various precipitating factors have been reported in 25-30% of pituitary apoplexy patients. Diabetes mellitus and diabetic ketoacidosis are one of these. The presence of contrast media induced endothelial swelling with the result of hypoperfusion and diabetes mellitus associated vasculopathy might be a precipitating factor in this patient....

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Comparative Study 2012; 33(Suppl 3): 179-182 PubMed PMID: 23353864 Citation  Keywords:  Abnormalities, Multiple:epidemiology, Abortion, Spontaneous:epidemiology, Appetite Depressants:adverse effects, Cyclobutanes:adverse effects, Czech Republic:epidemiology, Databases, Factual:statistics & numerical data, Drug Prescriptions:statistics & nume.   

OBJECTIVES: Both, obesity as well as anorexia may be associated with infertility and other complications of pregnancy. Weight loss during pregnancy is therefore considered a risk factor. Weight loss and appetite suppressant are contraindicated during pregnancy, but the unintended exposure is probably not associated with higher risk. Our work was focused on trends in the appetite suppressants use in the Czech Republic and their embryotoxicity.

METHODS: The pregnancies exposed to various appetite suppressants were followed prospectively in the years 1997-2012. The study group was compared to the comparison group which enrolled pregnant women exposed to non-teratogenic drugs. Drugs used as appetite suppressants were sibutramine and phentermine.

RESULTS: Number of calls for this type of exposure was rare till 2005. Their number started to increase until 2009. Later, number of calls decreased because both drugs were withdrawn from the market. This finding reflects increasing tendency for the weight control in the group of fertile women in the Czech Republic. In our study, we did not reveal differences in pregnancy outcomes between study and comparison groups.

CONCLUSIONS: However, we should be aware of the increasing food supplements exposure, that could be used as alternative to the appetite suppressants. Their potential risk results from the limited or completely absent control of their origin. Some of them have probably only placebo effect, but some of them could represent the risk....

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Journal Article 2012; 33(1): 98-101 PubMed PMID: 22467119 Citation  Keywords:  Abortion, Spontaneous, Delivery, Obstetric, Humans, Premature Birth, Prospective Studies, Twins,.   

OBJECTIVE: To examine the possibility of postponement of the delivery of fetus B after preterm delivery or late abortion of fetus A in multiple pregnancy.

METHODS: Between January 2000 and September 2010, we tried to delay delivery of the second twin in 18 cases. Group A includes women that experienced a preterm premature rupture of the membranes in fetus A (PPROM), group B includes women who presented with regular uterine activity and the vaginal finding indicated unavoidable late miscarriage or preterm delivery.

RESULTS: Thirteen (72.22%) of the 18 attempts were evaluated as unsuccessful. The interval of delay of delivery of fetus B ranged between 24 and 384 hours. Five cases were successful.

CONCLUSION: Indication for applying this therapeutic procedure to a pregnant woman must be strictly selective. The procedure will be also in future more or less reserved for women in which subsequent pregnancy is for different reasons highly improbable....

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Evaluation Studies 2011; 32(Suppl 1): 53-56 PubMed PMID: 22167208 Citation  Keywords:  Abortion, Eugenic:statistics & numerical data, Abortion, Spontaneous:epidemiology, Antidepressive Agents:adverse effects, Case-Control Studies, Congenital Abnormalities:epidemiology, Czech Republic:epidemiology, Depression:drug therapy, Drug Information S.   

OBJECTIVES: Antidepressant drugs are used frequently during pregnancy. The risk assessment of SSRI exposure is still evaluated and re-opened due to studies indicating possible increase of inborn defects, neonatal abstinence syndrome and cognitive ability or behavioral defects.

METHODS: In our study, we prospectively followed groups of pregnancies in years 2002-2009, that were exposed to SSRI. As control group we used 1) women exposed to new atypical antidepressant and anti-psychotics - APD (risperidone, mirtazapine, venlafaxine, trazodone, aripiprazole, ziprasidone, olanzapine), 2) women exposed to nonteratogenic drugs and 3) the general population according to Institute of Health Informations and Statistics (ÚZIS.) Data were analyzed using software Statistica for Windows No.5.5.

RESULTS: The total number of queries on psychotropic drugs performs in CZTIS more than 30% of all calls, constantly. We enrolled a total of 43 women exposed to SSRI and 37 women (1x twins) exposed to new psychotropic drugs (APD) in the study. Exposure to SSRI was often associated with poly-therapy. The most frequent SSRI used were citalopram and/or escitalopram (56%), and setraline (26%). Other SSRI were used sporadically. We observed significantly higher frequency of elective terminations in group of SSRI and higher frequency of abortions a prematurity in APD group. Frequency of malformations does not varied, being in all groups in expected range.

CONCLUSIONS: We confirmed that SSRI exposure during pregnancy was not associated with the higher risk of major malformation. However, number of cases was low and did not allow the statistical treatment with higher power....

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Journal Article 2005; 26(4): 342-346 PubMed PMID: 16136012 Citation  Keywords:  Abortion, Spontaneous:blood, Adrenocorticotropic Hormone:blood, Cystinyl Aminopeptidase:blood, Female, Homeostasis:physiology, Humans, Hypothalamo-Hypophyseal System:physiology, Pituitary-Adrenal System:physiology, Pregnancy, Pregnancy Trimester, First,.   

INTRODUCTION: The labor at term finishes normal pregnancy. Both labor at term and first trimester spontaneous abortion are connected with increasing cytotoxic immune response within decidua. Th1 cytokines including IL-2 and INF-gamma are able to exert an effect on HPA axis and result in ACTH secretion. Oxytocinase serum level during pregnancy rises with the fetal development and arrest of oxytocinase serum growth might indicate the its development impairment, what might result in spontaneous abortion.

MATERIAL AND METHODS: The study group consisted of 27 patients with clinical symptoms of missed abortion. A control group consisted of 89 pregnant women, who were successfully treated because of infertility. Immunoassay was used to measure ACTH plasma concentration. Oxytocinase plasma activity was established using l-cystine-di-beta-naphthylamide as a substrate.

RESULTS: In the present study, significant increase in ACTH plasma concentration was observed during first trimester of spontaneous abortion. These patients were not characterized by significant increase of oxytocinase plasma level.

CONCLUSIONS: The observed ACTH rise during spontaneous abortion might be also related to the alterations at the maternal-fetal interface and the response of HPA axis to the growing cytotoxic activity....

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Clinical Trial 2004; 25(1-2): 141-147 PubMed PMID: 15159698 Citation  Keywords:  Brain Ischemia:cerebrospinal fluid, Humans, Interleukin-1:cerebrospinal fluid, Interleukin-6:cerebrospinal fluid, Intracranial Aneurysm:cerebrospinal fluid, Rupture, Spontaneous, Subarachnoid Hemorrhage:cerebrospinal fluid, Time Factors, Vasospasm, Intrac.   

: Cytokines play a key role in mutual influence of the immunological, endocrine and CNS systems. It has been proven that proinflammatory ILs may intensify the cascade of biochemical changes in ischemic brain damage. Vasospasm, which may accompany SAH and often coexists with symptoms of DINDs, is the cause of ischemic changes in the brain. It is thought that immunological mechanisms may be one of the causes of degenerative-productive changes in vessel walls, in delayed vasospasm following SAH, which lead to substantial vasospasm and in consequence too cerebral ischemia. In the randomly selected group of patients, who underwent surgical treatment after aneurysmal SAH, we determined the concentration of IL-1 beta and IL-6 in CSF in the periods between Days 0 to 3; 4 to 7; and 8 to 15 after the occurrence of SAH. The presence and dynamics of development of vasospasm were assessed on the basis of increasing DINDs as well as CT and cerebral angiography. We examined the concentrations of ILs in CSF using radioimmunological methods, applying commercially available tests for their assessment. We found that in the period between 8 and 15 days after SAH, in increasing delayed vasospasm and DINDs, here is a statistically significant increase concentration of IL-1 beta in CSF (105.4 +/- 46.9 pg x ml-1; p<0.005), and no significant changes in patients without vasospasm and neurological deficits. On the other hand, we noted a statistically significant increase concentration of IL-6 in CSF (4802 +/- 1170 ng x ml-1; p<0.05) only in the acute phase after SAH (Days 0-3) in patients in poor clinical condition, in whom delayed vasospasm and cerebral ischemia developed later. This increase of ILs level in CSF is probably related to the intensity of the SAH, and secondarily aggravates the vasospasm and ischemic changes in the brain....

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Journal Article 2001; 22(1): 5-8 PubMed PMID: 11335873 Citation  Keywords:  Abortion, Spontaneous:prevention & control, Female, Fetal Death:prevention & control, Gestational Age, Humans, Infant Mortality, Infant, Newborn, Infant, Premature:physiology, Medical Laboratory Science:instrumentation, Obstetrics:trends, Pregnancy:physio.   

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