Novel Sphingolipid-Based Cancer Therapeutics in the Personalized Medicine Era

Sphingolipids are bioactive lipids that participate in a wide variety of biological mechanisms, including cell death and proliferation. The myriad of pro-death and pro-survival cellular pathways involving sphingolipids provide a plethora of opportunities for dysregulation in cancers. In recent years, modulation of these sphingolipid metabolic pathways has been in the forefront of drug discovery for cancer therapeutics. About two decades ago, researchers first showed that standard of care treatments, e.g., chemotherapeutics and radiation, modulate sphingolipid metabolism to increase endogenous ceramides, which kill cancer cells. Strikingly, resistance to these treatments has also been linked to altered sphingolipid metabolism, favoring lipid species that ultimately lead to cell survival. To this end, many inhibitors of sphingolipid metabolism have been developed to further define not only our understanding of these pathways but also to potentially serve as therapeutic interventions. Therefore, understanding how to better use these new drugs that target sphingolipid metabolism, either alone or in combination with current cancer treatments, holds great potential for cancer control. While sphingolipids in cancer have been reviewed previously (Hannun & Obeid, 2018; Lee & Kolesnick, 2017; Morad & Cabot, 2013; Newton, Lima, Maceyka, & Spiegel, 2015; Ogretmen, 2018; Ryland, Fox, Liu, Loughran, & Kester, 2011) in this chapter, we present a comprehensive review on how standard of care therapeutics affects sphingolipid metabolism, the current landscape of sphingolipid inhibitors, and the clinical utility of sphingolipid-based cancer therapeutics.

Sphingosine 1-Phosphate Lyase Enhances the Activation of IKKε To Promote Type I IFN-Mediated Innate Immune Responses to Influenza A Virus Infection

Sphingosine 1-phosphate (S1P) lyase (SPL) is an intracellular enzyme that mediates the irreversible degradation of the bioactive lipid S1P. We have previously reported that overexpressed SPL displays anti-influenza viral activity; however, the underlying mechanism is incompletely understood. In this study, we demonstrate that SPL functions as a positive regulator of IKKε to propel type I IFN-mediated innate immune responses against viral infection. Exogenous SPL expression inhibited influenza A virus replication, which correlated with an increase in type I IFN production and IFN-stimulated gene accumulation upon infection. In contrast, the lack of SPL expression led to an elevated cellular susceptibility to influenza A virus infection. In support of this, SPL-deficient cells were defective in mounting an effective IFN response when stimulated by influenza viral RNAs. SPL augmented the activation status of IKKε and enhanced the kinase-induced phosphorylation of IRF3 and the synthesis of type I IFNs. However, the S1P degradation-incompetent form of SPL also enhanced IFN responses, suggesting that SPL's pro-IFN function is independent of S1P. Biochemical analyses revealed that SPL, as well as the mutant form of SPL, interacts with IKKε. Importantly, when endogenous IKKε was downregulated using a small interfering RNA approach, SPL's anti-influenza viral activity was markedly suppressed. This indicates that IKKε is crucial for SPL-mediated inhibition of influenza virus replication. Thus, the results illustrate the functional significance of the SPL-IKKε-IFN axis during host innate immunity against viral infection.

Placental vascular endothelial growth factor expression in pregnancies complicated by type 1 diabetes

Type 1 diabetes mellitus (T1DM) is still associated with increased risk of severe maternal and foetal complications but their pathomechanism remains unclear.

OBJECTIVES

we investigated the possible role of placental vascular endothelial growth factor (VEGF) and VEGF single nucleotide polymorphisms (SNP) in foetal development in T1DM pregnancies. Sixty seven pregnant women with T1DM and singleton pregnancy were enrolled into the study. Results demonstrated higher expression of placental VEGF in women who delivered neonates with birth weight (NBW)>4000g. No such correlation was found in the overall T1DM group and in women who delivered appropriate for gestational age (AGA) and small for gestational age (SGA) newborns. We also demonstrated a significant correlation between 3(rd) trimester mean blood glucose, HbA1C and placental VEGF. No such correlation was found for the 1(st) and 2(nd) trimesters. Top placental VEGF expression and placental mass were found in women who delivered large for gestational age (LGA) newborns. We also found a statistically significant difference in homozygous and heterozygous frequency variants of VEGF SNPs in study groups. We conclude that the increased placental VEGF together with impaired metabolic control may have a role in stimulating foetal overgrowth in T1DM pregnancy.

Microbe-independent entry of oomycete RxLR effectors and fungal RxLR-like effectors into plant and animal cells is specific and reproducible

A wide diversity of pathogens and mutualists of plant and animal hosts, including oomycetes and fungi, produce effector proteins that enter the cytoplasm of host cells. A major question has been whether or not entry by these effectors can occur independently of the microbe or requires machinery provided by the microbe. Numerous publications have documented that oomycete RxLR effectors and fungal RxLR-like effectors can enter plant and animal cells independent of the microbe. A recent reexamination of whether the RxLR domain of oomycete RxLR effectors is sufficient for microbe-independent entry into host cells concluded that the RxLR domains of Phytophthora infestans Avr3a and of P. sojae Avr1b alone are NOT sufficient to enable microbe-independent entry of proteins into host and nonhost plant and animal cells. Here, we present new, more detailed data that unambiguously demonstrate that the RxLR domain of Avr1b does show efficient and specific entry into soybean root cells and also into wheat leaf cells, at levels well above background nonspecific entry. We also summarize host cell entry experiments with a wide diversity of oomycete and fungal effectors with RxLR or RxLR-like motifs that have been independently carried out by the seven different labs that coauthored this letter. Finally we discuss possible technical reasons why specific cell entry may have been not detected by Wawra et al. (2013).

Leptin gene, leptin gene polymorphisms and body weight in pregnant women with diabetes mellitus type I

There have been several genetic causes of obesity discussed by past authors, among others leptin, that have provided information regarding signaling pathways in energy expenditure in humans. Genetic variants of the leptin gene and its receptor may influence body weight.

AIM

To investigate the role of the leptin gene's polymorphism promotion region (2548 G/A) and the leptin gene receptor polymorphism (668 A/G) and its associations with body weight in pregnant women with type 1 diabetes (PGDM-1).

METHODS

78 PGDM-1 were qualified to the study group (SG) which was divided into normal and over-weight individuals according to BMI criteria. The control group (CG) consisted of first trimester healthy pregnant women with normal body weight. Genetic variants of the leptin gene and its receptor were analyzed using PCR-RFLP assays. Within the SG, the following metabolic parameters were estimated: MBG, HbA1C, insulin dose, LDL, HDL, T-CHOL, creatinine, creatinine clearance and blood pressure.

RESULTS

There was a trend found among the majority of homozygous A and G variants in LEP -2548 G/A and LEPR 668 A/G in over-weight and obese individuals in comparison to normal-weight subjects (CG). There were no specific differences found in selected first trimester metabolic parameters in relation to patients' genotypes.

The significance of C3435T point mutation of the MDR1 gene in endometrial cancer

The P-glycoprotein (P-gp) plays an important role in carcinogen distribution and is connected with cell differentiation and apoptotic processes leading to carcinogenesis. Interindividual differences in P-gp activity could modulate susceptibility to cancer development. The MDR1 gene, coding for P-gp, is highly polymorphic and some mutations modulate P-gp activity. Recently, association between the MDR1 C3435T polymorphism and the cancer susceptibility was shown. We have hypothesized that MDR1 polymorphism could influence endometrial cancer susceptibility. We have matched 198 women with endometrial cancer and 198 controls. An additional group of 488 healthy volunteers was investigated. The MDR1 C3435T polymorphism was tested by LightCycler assay. The distribution of MDR1 3435 genotypes was significantly different between cases and controls (P = 0.006). Genotypes containing at least one 3435T allele were statistically significant more frequent in the endometrial cancer group (86.8% vs 75.2%, OR 2.18, P = 0.004). Our observation suggests that MDR1 C3435T polymorphism is correlated with endometrial cancer susceptibility.

Studies on leptin and leptin receptor gene expression in myometrium and uterine myomas of gnRH analogue-treated women

AIM

To test if treatment with GnRH analogue, which leads to a significant reduction in myoma volume, changes expression of leptin genes and gene coding leptin receptor isoforms in uterine myomas and in the surrounding unaltered myometrium.

METHODS

Using RT-PCR, expression of leptin genes and leptin receptor genes was studied in myomas and in the surrounding myometrium in women with uterine myomas, untreated or treated with GnRH analogue. In the randomly selected cases presence of leptin protein and of leptin receptor proteins was examined also by Western blotting.

RESULTS

Expression of leptin genes was demonstrated both in myomas and in the surrounding myometrium, and a similar pattern of expression was found for leptin receptor isoforms. The results of RT-PCR were confirmed by Western blotting, which documented the identical distribution of leptin proteins and leptin receptor proteins in studied tissues. Treatment with GnRH analogue had no effect on the expression pattern of studied genes.

CONCLUSION

The results of the present study on the administration of GnRH analogue to females with myomas suggest that no direct or immediate inter-relationship exists between expression of leptin genes in uterine myomas on one hand and estrogen, progesterone and leptin levels in the blood on the other. Expression seems to be of a more durable nature but factors that induce such expression remain unknown.

Further studies on leptin and leptin receptor expression in myometrium and uterine myomas

AIM

Examination of the potential role of leptin in the development of uterine myomas. Expression of the leptin gene and leptin receptor gene was tested in the myometrium of healthy women, and in myomas and the surrounding myometrium of women with benign tumors.

METHODS

Using RT-PCR, expression of the leptin gene and leptin receptor gene were studied in myomas and in the surrounding myometrium in 30 women with uterine myomas at various phases of the menstrual cycle, and in the myometrium of ten women in a control group. Presence of leptin gene proteins and leptin receptor gene proteins in the women was also examined by Western blotting.

RESULTS

Using RT-PCR, expression of the leptin gene was demonstrated both in myomas and in the surrounding myometrium. In contrast, expression of the gene could not be detected in the myometrium of healthy women. The results were confirmed by Western blotting, which documented the identical distribution of leptin proteins and leptin receptor proteins in studied tissues.

CONCLUSION

Demonstration of the expression of leptin genes and leptin proteins in uterine myomas and in the surrounding myometrium, and their absence in the myometrium of healthy women suggests the involvement of leptin in the development of uterine myomas.

Uncommon case of a foreign body ingestion with consecutive small-bowel obstruction in a child

A 12-year-old boy with Lennox syndrome presented with an acute abdomen and a history of progressive abdominal pain and vomiting over 3 weeks. The uncommon finding in this case was a foreign body detected in a lower loop of the jejunum causing radiological and clinical signs of jejunitis/ileitis. The foreign body had to be removed surgically and turned out to be a hard (originally soft) plastic part of a towel rack.

The role of leptin in breast cancer

Leptin, the protein hormone produced mainly by adipocytes, placenta and mammary epithelium plays a significant role in, e.g., control of metabolism, reproductive processes, immune processes, angiogenesis, haemopoiesis and oxidation of lipids. Since some authors link leptin to mechanisms of mammary cancer development, the clinical data has been screened to allow evaluation of the hypothesis.

Evaluation of soluble intracellular adhesion molecule-1 (sICAM-1) in benign and malignant ovarian masses

PURPOSE

To evaluate serum ICAM-1 levels preoperatively in patients with ovarian masses.

METHODS

Estimation by ELISA assay in 101 women with pelvic tumours and 16 healthy controls was performed. Correlations of sICAM-1 levels with CA-125, Tumour Volume Index, morphological score and pathological findings were studied.

RESULTS

Fifty-one ovarian tumours were malignant, five were borderline and 45 benign. Mean levels of sICAM-1 were respectively, 311.1 +/- 182.9 ng/ml, 172.6 +/- 40.1 ng/ml, 241.8 +/- 74.1 ng/ml and 195.6 +/- 68.7 ng/ml for controls. The area under ROC curve for sICAM-1 was 0.72 (95% CI 0.58-0.82), the cut-off 250 ng/ml, corresponding to 81.3% sensitivity and 52.9% specificity. Serum ICAM-1 correlated with morphological score (r = 0.51, p < 0.001), but not with FIGO stage, tumour grade, Tumour Volume Index and CA-125.

CONCLUSION

sICAM-1 concentrations are higher in patients with malignant tumours, but poorly correlate with clinical status. The clinical use alone in ovarian malignancy detection and tumour differentiation seems to have limited application. Combinations of CA-125 and sICAM-1 could improve the test characteristics.

[Polymorphism of gene angiotensin converting enzyme in pregnancy induced hypertension]

In the recent years genetic background of pregnancy induced hypertension (PIH) are intensively investigated. Genetically determined differences in activity of renin-angiotensin system (RAS) are of importance to hypertension susceptibility. The insertion/deletion (I/D) polymorphism of angiotensin I converting enzyme (ACE) was suggested to play an important role in the aetiology of idiopathic hypertension. We have tested if this polymorphism could be associated with PIH. ACE polymorphism was investigated in 87 pregnant women with PIH and in 110 healthy pregnant women (control group). Investigation was performed by polymerase chain reaction (PCR). We have amplified genomic DNA excteracted by phenol-chloroform method from blood leucocytes. We have detected overrepresentation of the I allele in the PIH group (47.2% and 41.4% in PIH and controls, respectively). ACE genotype frequency in control group was in agreement with expected values, according to Hardy-Weinberg law, but in the PIH group the obtained values were different from expected. This observation confirmed the possible role of I allele in aetiology of PIH, and we believe that continuation of this investigation is necessary.

[Triplet gestation--analysis of pregnancy course, delivery and neonatal outcome, based on personal material]

Triplet gestation appears in 0.1-0.3% of all pregnancies and it is high risk pregnancy for mother and foetus. It appears more frequently in Afroamerican women, rarely in Japan women. In multifetal pregnancy early prenatal diagnosis and management are very important.

AIM

Analysing course of pregnancy, way of delivery, condition of newborns, influence of environmental factors, and concomitant diseases in triplets gestation.

MATERIAL

30 women treated between 1989-1998, in Division of Perinatology, University of Medical Sciences in Poznań, Poland.

RESULTS

21 pregnancies were ended by caesarean section, 9 by vaginal delivery. Apgar score for II and III foetus decreases significantly. pH value of umbilical artery was without significant differences.

CONCLUSIONS

Almost all triplets have ended preterm. Route of delivery of triplets have to be considered individually. Environment factors could play an important role in multifetal pregnancy.

[Cesarean section for the second twin during the course of delivering twins]

We have analysed 6 cases of twin pregnancies with vertex presentation of the first foetus. In this cases after delivery of the first twin by vaginal route caesarean, section was made. Caesarean section of the second twin was made because of: transversal presentation with fetal distress syndrom (four cases), umbilical cord drop (one case), and premature placenta ablation (one case). We have determined acid base balance and Apgar score. We have noted worse results for the second twin, independently too of the time between deliveries both twins. Caesarean section of the second twin is the rarely clinical situation, but in motivated situation is accepted and reasonable solution.

[Analysis of interleukin-6 serum concentration in trophoblastic tumors prognosis]

OBJECTIVES

Our purpose was to estimate the prognosis based on Il-6 concentration in cases of trophoblastic tumors.

MATERIALS AND METHODS

The study population was 65 women suffering from hydatiform mola or choriocarcinoma. We divided them into two groups: 30 patients who required only operative management and 35 patients who required operative procedures and additional chemotherapy. The observation period was 6 months. Blood samples were collected every 4 weeks. Concentration of Il-6 was measured in ELISA assay.

RESULTS

The serum Il-6 concentration was significantly higher in cases of trophoblastic diseases than in the group of healthy women and higher in patients who required chemotherapy after operation (451.0 +/- 88.5 pg/ml), than in patients treated only surgically (257.1 +/- 77.1 pg/ml).

CONCLUSIONS

Patients with hydatiform mola and choriocarcinoma reveal higher concentration of Il-6 than healthy women. It is associated with disease prognosis and allows to determine at the time of establishing a diagnosis, whether a patient can be treated only surgically or requires an additional chemotherapy.

[Gestational hypertension (GH) and a1166c polymorphism of angiotensin II type 1 receptor]

INTRODUCTION

Recent studies have suggested an association between genetic background of renin-angiotensin system (RAS) and the pathogenesis of pregnancy induced hypertension (PIH). However, the role of the gene coding for angiotensin II receptor (AT1) polymorphism in PIH is not fully understood, thus the aim of the present study was to determine the frequency of A1166C mutation in women with gestational hypertension (GH) and to establish the role of this polymorphism on the susceptibility to the PIH development.

PATIENTS & METHODS

We have analysed 88 women with PIH and 113 healthy pregnant women as a controls. Genomic DNA was extracted from leucocytes using polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP).

RESULTS

We have detected overrepresentation of mutated homozygous genotypes in the PIH group (11.4% in the PIH versus 2.7% in the controls). Homozygous wild-type genotypes were underrepresented in the PIH group (48.9% in PIH and 56.6% in controls). The frequency of heterozygotes was similar in both groups. Statistically significant overrepresentation of allele with mutation in the PIH group (31.3% in the women with PIH, and 23.0% in the controls) (O.R. = 1.5, p = 0.04) was observed.

CONCLUSION

We suggest that presence of A1166C mutation is a risk factor for the development of PIH.

[Chorion carcinoma: failure of treatment]

Between 1986-1998 in University Oncology Gynecology Department in Poznan, Poland were treated 23 women with choriocarcinoma. Despite of intensive chemotherapy 3 women were dead. In the report we present the history of this choriocarcinomas making effect to answer why our therapy was ineffective.

[Gestational trophoblastic disease: the epidemiological analysis of 342 cases]

Between 1987-1996 dates were collected to assess frequency and risk factors for gestational trophoblastic disease in a case-control study of 342 women with trophoblastic tumors and 342 pregnant women admitted for deliveries or spontaneous abortion to University Hospitals in Poznan, Poland. Were analyzed the age of women obstetric history, place of live and repeat appearance of hydatidiform mole. The risk of trophoblastic disease increased with increase in maternal age and above third pregnancy. The risk independent of living in town or in the country. The second and more incident of hydatidiform mole was associated with greater risk of malignant sequele. The study of the pregnancy of gestational trophoblastic disease was led in Great Poland in the support on the date from all pathologic centres in this region and public demographic office. The frequently of hydatidiform mole was between 1987-1996 2.32 per 100,000 women, and 0.76 for 1000 live birth (1 HM for 1315 live birth). The frequently of choriocarcinoma was 0.08 per 100,000 women (and 0.38 per 10,000 live birth (1 CHA per 26,315 live birth).

[Glycoforms of alpha-1-acid glycoprotein in trophoblastic tumors prognosis]

OBJECTIVES

Our purpose was to define the pattern of AGP glycolysation and concentration in cases of trophoblastic tumors.

MATERIALS AND METHODS

The study population was 65 women suffering from hydatiform mola or choriocarcinoma. We divided them into two groups: 30 patients who required only operative management and 35 patients who required operative procedures and additional chemiotherapy. The observation period was 6 months. Blood samples were collected every 4 weeks. Concentration of AGP was measured in radial immunodyfusion. Glycolysation pattern was defined in Concanavalin A crossed affinoimmunoelectroforetic analysis.

RESULTS

The serum AGP concentration was significantly higher in patients treated only surgically (1026.1 +/- 241.0 mg/l) than in patients who required chemotherapy after operation (740.3 +/- 103.0 mg/l). AGP microheterogeneity was represented by 2 to 4 glycoforms.

CONCLUSIONS

Patients with hydatiform molar and choriocarcinoma reveal characteristic changes in concentration and microheterogeneity of AGP, which are associated with disease prognosis. They allow to determine at the time of establishing a diagnosis, whether a patient can be treated only surgically or with additional chemotherapy.

Quantification of human polyomavirus JC in brain tissue and cerebrospinal fluid of patients with progressive multifocal leukoencephalopathy by competitive PCR

Activation of human polyomavirus JC (JCV) infection is the cause of the central nervous system (CNS) disease progressive multifocal leukoencephalopathy (PML). Previous studies with uncontrolled quantification systems suggested that the virus load in the CNS correlates with the state of disease and might reflect therapeutic effects. Therefore the aim of this study was the development of a competitive system with standard PCR techniques that allowed rapid detection of JCV subtypes, simultaneous differentiation of the two human polyomaviruses JCV and BKV and absolute quantification of the virus burden in initial diagnosis and progressive disease states. Subtype- and species-specificity of the PCR was achieved with the development of a degenerative PCR primer pair that detected JCV DNA in a range regularly found in PML samples, but did not amplify BKV DNA. The accuracy of the system was evaluated by quantification of known amounts of cloned JCV DNA with a competitive JCV-specific template that exhibited a comparable amplification rate to that of the native product. The calibration study demonstrated a linear correlation over a wide range of DNA concentrations on the background of buffer or JCV-negative diagnostic samples. The reliability of the system for PML diagnosis was analysed by calibration and determination of the virus burden in tissue and cerebrospinal fluid (CSF) of 11 PML patients confirming the accuracy in both types of samples under diagnostic conditions. Comparison of the JCV DNA concentration in tissue and CSF by a tightly controlled quantification technique revealed for the first time differences in a range of about four orders of magnitude and a variable virus load in CSF samples taken at comparable states of disease. This pointed to an individual course of virus shedding and demonstrates that a controlled competitive PCR system of high accuracy is essential for reliable quantification of virus DNA either in initial diagnosis, in progressive disease or for the evaluation of therapeutic effects.

[Ectopic cervical pregnancy--conservative treatment with methotrexate]

Ectopic pregnancy regardless its localization always remains difficult diagnostic and therapeutical problem. Special attention is paid to cervical pregnancy because of its rare incidence and poor prognosis (even in this day and age maternal death rate is 40-45%). In this paper there has been reported the case of 38 years old patient, admitted to Dept of Gynecological Oncology with suspicion of alive cervical pregnancy. Diagnostic procedures have been described as well as positive results of conservative treatment with Methotrexate (under careful monitoring--ultrasound, beta hCG levels). Also there has been presented detailed description of endocervix curettage after fetal death confirmed ultrasonographically. Current conservative therapy methods for cervical pregnancy have been discussed.

[Iatrogenic esophageal perforation-- severe complication in the care of premature infants]

Two preterm neonates were referred to our institution, one with suspected oesophageal atresia and one with the definite diagnosis of oesophageal atresia for further treatment. Diagnostic procedures identified an iatrogenic perforation of the oesophagus which was caused by a feeding tube in both patients. The treatment was based on broad-spectrum antibiotic therapy and parenteral nutrition. The perforations healed without long term sequelae.

Cocaine differentially regulates activator protein-1 mRNA levels and DNA-binding complexes in the rat striatum and cerebellum

Cocaine is a psychomotor stimulant that exerts many of its behavioral and physiological effects through alteration of catecholamine reuptake systems. One early cellular response to cocaine administration is a brain region-specific alteration in the transcriptional pattern of immediate early genes belonging to the Fos/Jun family of nucleotide sequence-specific [activator protein-1 (AP-1)] DNA-binding proteins. The work described here compares cocaine-induced transcriptional regulation of immediate early gene mRNA levels, as well as AP-1 DNA-binding activity, within the striatum and cerebellum. In the striatum, acute cocaine administration increases cellular levels of c-fos and jun-B mRNA, whereas transcriptional effects in the cerebellum are limited to c-fos mRNA. After chronic cocaine treatment a desensitization of c-fos mRNA induction is observed in the striatum, with sensitization of the same transcriptional effect occurring in the cerebellum. Pharmacological studies further reveal that the dopamine D1, dopamine D2, gamma-aminobutyric acid type B, and N-methyl-D-aspartate receptor systems mediate the effects of cocaine on cerebellar neurons, whereas striatal effects are modulated through D1 and N-methyl-D-aspartate receptors. Gel retention analysis using antibodies to the various Fos and Jun proteins was used to characterize cocaine-dependent alterations in the composition of striatal and cerebellar AP-1 DNA-binding complexes. In striatum, cocaine increases the relative levels of c-Fos, Fos-B, Jun-B, and Jun-D proteins that bind the AP-1 DNA sequence element, whereas in the cerebellum only c-Fos and Jun-D binding activities are increased. These data suggest two possible neuroanatomical sites where tolerance and sensitization to cocaine can be examined at the genomic level.

[Ultrasonographic evaluation of yolk sac in early pregnancy]

Ultrasound diagnosis of yolk sac in early pregnancy. In cross-sectional study pregnant patients were analyzed by means of endovaginal ultrasound. Yolk sac diameter was analyzed to assess its growth in early pregnancy. Linear growth of sac diameter was observed (at 31 day of the cycle 0.4 mm at 72nd day of the cycle 4.8 mm).

[Transvaginal ultrasound in evaluation of the uterine cervix during pregnancy]

127 pregnant patients between 20 and 37 week of gestation were studied. Cervical estimation was done by using transvaginal ultrasonography. An accurate estimation was possible in all investigation patients. Statistically significant distinctions in uterine cervical length during pregnancy progress were noticed (p < 0.05). However, differences in cervical with were not perceived (p = 0.3). Interdependence of the duration of pregnancy upon the cervical length and width were calculated. Obtained findings could be applicable in preterm labor prognosis.

[Levels of thyroid hormones during pregnancy and in the perinatal period. II. Levels of iodothyronine in blood serum during cesarean section and puerperium]

Analysis of T4, T3 and rT3 concentration in blood serum of 27 women during and after caesarean section was performed. Estimation of hormones using RIA was done. Changes of levels of analysed hormones differed from this found during normal delivery. Periferral conversion of T4 is discussed as a potential source of different levels of T3 and rT3.

[Thyroid hormone levels during pregnancy, labor and puerperium]

Concentration of thyroxine triiodothyronine and reverse-triiodothyronine in serum blood of 30 pregnant women were estimated, like a longitudinal study from 5 to 41 week of pregnancy. Significant increase of concentration of all hormones was observed. We presented also estimation of iodothyronines in blood serum in labor and non-complicated puerperium. We found increase of T3 concentration immediately after delivery, and decrease of level of all hormones in puerperium.

Aneurysmal bone cyst in early childhood. Ultrasound findings

A 1-year-old child with an aneurysmal bone cyst in the scapula is presented. The sonographic examination showed a cystic formation with intraosseal fluid levels that shifted after repositioning of the child. Similar findings have been reported on CT scans and it is suggested that shifting fluid levels are an indicative feature of aneurysmal bone cyst.

Pseudotumoral cystitis

Pseudotumoral cystitis is an unusual lesion and since it may be confused with rhabdomyosarcoma, knowledge of its existence is important. We report eight cases.

Constitutional delay of growth and adolescence. Results of short-term and long-term treatment with GH

During recent years numerous reports on the favourable results of short-term trials with GH in patients with constitutional delay of growth and adolescence (CDGA) have been published, but it has been unclear whether such treatment affects final height. In the present study, the results of long-term therapy with GH in replacement doses have been evaluated in 15 patients who were treated with GH for several years (three years on average). At the start of treatment, 10 of the children were prepubertal and 5 were in puberty. All patients were followed up until final height was reached. Mean final height of the 13 male patients was 170.0 +/- 4.4 cm, i.e. -1.58 SDS. In the two female patients, final height was 150.0 cm (-3.5 SDS) and 164.0 cm (-0.8 SDS), respectively. Adult height of the patients lagged behind target height by 5.4 +/- 3.2 cm (mean +/- SD). Measured adult height corresponded to adult height as predicted prior to treatment. In conclusion, GH treatment of patients with CDGA did not increase final height.

Elevation of maternal serum myoglobin concentrations during delivery

Serum myoglobin was determined by radioimmunoassay in 32 women immediately after delivery, in the umbilical cord blood of 30 newborn infants, in 18 women in the third trimester of pregnancy and in 24 healthy non-pregnant women. In maternal blood following delivery there was a 3 to 10 fold rise in serum myoglobin concentration (mean +/- SD = 117.2 +/- 82.5 ng/ml). On the other hand, in umbilical cord blood and in late pregnancy, serum myoglobin concentrations did not differ from those in healthy non-pregnant women (mean +/- SD = 23.6 ng/ml).