Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No clinical or radiological signs of secondary tethering were observed. Neurological examination at 11 months postdelivery revealed cranial nerves without any signs of damage, axial hypotonia, decreased muscle tone in the lower extremities, and absent pathological reflexes. Motor development was slightly retarded. Complete untethering of the neural structures should always be performed, regardless of the surgical approach, as it is the only course of action that lowers the risk for developing secondary TSC.

Artykuł jest dostępny na zasadzie dozwolonego użytku osobistego. Dalsze rozpowszechnianie (w tym druk i umieszczanie w sieci) jest zabronione i stanowi poważne naruszenie przepisów prawa autorskiego oraz grozi sankcjami prawnymi.

Objectives: Vulvar lichen sclerosus is chronic and difficult to treat disorder, which often is recurrent and leads to multiple complications. The limited efficacy of pharmacologic treatment directed the search for new therapies including use of CO 2 laser. The aim of the study was to provide rationale for the use of CO 2 laser in treatment of vulvar lichen sclerosus.Material and methods: Two patients with diagnosed LS were recruited for the study. Vulvar biopsies were taken taken before CO 2 laser application and then 3 months later. We assessed the following genes: COL1A,

Vulvar lichen sclerosus (VLS) belongs to the group of autoimmune, chronic inflammatory skin disorders and is most frequent in females after their 50s. This disease might lead to vulvar scarring, sexual dysfunction and neoplasm transformation. For that reason, treatment of VLS is still considered an important clinical issue from the borderline of gynaecology and dermatology. Classical treatment includes the use of corticosteroids, which help to relieve symptoms, prevent further scarring of the vulva, reduce inflammation and reduce the risk of malignant transformation. Due to the resistance of some patients to local treatment and its complications, however, the use of fractional CO2 lasers in the treatment of VLS has been proposed.A 41-year-old female patient presented to a gynaecologist with symptoms such as itching, burning, and cracking of the vulva skin. A tissue sample was taken from the affected area and a histopathological examination confirmed the initial diagnosis. Treatment with topical glucocorticosteroids was applied, but no improvement was noticed. For that reason, a CO2 fractional laser was applied to the therapy with complementary treatment in the form of topical glucocorticosteroids. After 1.5 years, regression of lesions on the skin of the vulva was observed. This case report highlight the effectiveness of fractioned CO2 laser in the treatment of VLS resistant to glucocorticosteroid monotherapy.

Objectives: Heat shock proteins (HSPs) are proteins involved in protein folding and maturation. HSP expression is induced by heat shock or other stressors including cellular damage and hypoxia. The major groups, which are classified based on their molecular weight, include HSP27, HSP40, HSP60, HSP70, HSP90, and large HSP (HSP110 and glucose-regulated protein 170). The comparison of heat shock proteins and TP53 expression is yet not well studied in both vulval lichen sclerosus and lichen planus. Our aim was to assess the HSP and TP53 gene expression in women suffering from LS or LP and compare it within these groups and also healthy controls. Material and methods:The inclusion criteria were willingness to donate vulval biopsies, not currently or in the prior two weeks received any local nor systemic treatment for vulval disorder, age > 18 years old. The exclusion criteria were lack of consent, current vaginal infection confirmed with microbiological studies, current local or systemic treatment for vulval disease. 45 consecutive women were recruited into the study. All appropriate vulval samples were process by genetic analysis. Results:The mean expression (± SD) of HPSA1A for controls was 5.52 ± 3.18, for LS was 7.44 ± 2.16 and for LP was 7.89 ± 2.48. The mean expression (± SD) of HPSA1B for controls was 6.54 ± 3.41, for LS was 9.94 ± 6.88 and for LP was 9.43 ± 2.31. The mean expression (± SD) of TP53 for controls was 9.11 ± 1.14, for LS was 9.94 ± 1.27 and for LP was 10.41 ± 2.00. HSPA1A expression was 3,8 higher in women with lichen sclerosus than in control group.Conclusions: Heat shock protein-70 is more often expressed in LS than in healthy controls. HSP-70 not only supports tumor growth and metastasis, but on the other hand mat help to develop immune-driven treatment strategies.