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The article presents the provisions currently in force in Polish legislation regarding legal termination of pregnancy. In particular, it refers to the premise of a psychiatrist's decision that the health of a pregnant woman is at risk. Under Polish law, termination of pregnancy is generally prohibited and penalized. However, there are two exceptions to this prohibition. Such a procedure is permitted if: the pregnancy poses a threat to the life or health of the pregnant woman, or if there is a reasonable suspicion that the pregnancy was the result of a prohibited act. The text presents an overview of the relevant regulations and tips on their interpretation and application in everyday medical practice. This issue is particularly important for psychiatrists consulting maternity wards. In addition, the most important mental disorders related to pregnancy and childbirth are described. The clinical features and prevalence of perinatal mood disorders and psychoses are presented. The issue of suicide among pregnant and postpartum patients was also discussed. A sample certificate template was proposed, and guidelines were discussed as to what information and conclusions should be included in the opinion of a psychiatrist.

The Aim of the Study: was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw., Material and Methods: Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival., Results: The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations., Conclusions: Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

Background: A contracture of the shoulder joint in the course of perinatal brachial plexus palsy significantly affects the function of the upper limb as a whole. The aim of this paper is to present the authors' experience in surgical procedures carried out to improve shoulder joint function impaired as a result of perinatal brachial plexus palsy and evaluate the treatment outcomes., Material and Methods: The study involved 36 patients who underwent 37 tenomyoplastic procedures (subscapular release, teres major transfer, transfer of a portion of the trapezius). Pre- and postoperative shoulder joint function was assessed with the Gilbert scale., Results: Surgical release of the subscapular muscle improved shoulder function in all patients, usually by 1 degree in the Gilbert scale. Teres major transfer improved shoulder function in all 4 patients (grade IV - 3 children, grade V - 1 child). One patient benefited from tenomyoplasty involving the trapezius., Conclusions: 1. Indications for tenomyoplasty procedures in the region of the shoulder joint may be present both in children who had previously undergone microsurgery and in those in whom rehabilitation had led to a good outcome of perinatal brachial plexus palsy. 2. The fact that most patients improved following tenomyoplastic procedures justifies their advisability. A visible functional improvement of the upper limb can be achieved with a relatively low risk of complications.

Aim: The aim of the study was to present the case of a patient with psychotic disorders, o most probably connected with persistent mephedrone use., Method: The analysis of the clinical case and medical documentation., Results: The presented patient had used mephedrone regularly (few times a week) for four months. Because of delusions of reference, delusions of persecution, agitation and anxiety, she required psychiatric hospitalisation. During the first hospitalisation she denied using legal highs, she was diagnosed as having schizophrenia and treated with olanzapine. After discharge, she didn't stop to use legal highs and psychotic symptoms occurred once again. The patient needed another hospitalisation. Despite the fact that antipsychotic treatment wasn't administered, the symptoms resolved. Nevertheless, somnolence, apathy and social isolation were observed., Conclusions: Recently legal highs are very popular, especially among adolescents and young adults. That is the reason why physicians have become more anxious because there is little information about their contents. In most of them, synthetic or botanical substances are included. In clinical practice not only somatic but also psychiatric complications connected with legal high use are observed. It is difficult to verify why this patient developed psychotic symptoms after recurrent intoxication. It is possible that she has an individual predisposition to develop psychosis. In this case, we have no information about previous features of ultra high risk state in this patient.

Background and Purpose: The authors report their experience in surgical treatment of preganglionic injuries in perinatal brachial plexus palsies., Material and Methods: Clinical material consisted of 16 children, of both sexes, aged from 2.5 to 33 months (mean 6.2 months), treated surgically between 1994 and 2006. The clinical view of the injury and location of preganglionic lesions was analysed and the description of the performed microsurgical techniques is provided. Control clinical examinations included a group of 14 children. The shortest postoperative observation period was 3 years. The currently accepted scales of evaluation of function of particular joints of the upper limb were used., Results: The following outcome was noted after surgical treatment of perinatal brachial plexus palsies with signs of pre- and postganglionic injuries: good shoulder function in 6 cases, and average in 2 others; good elbow function in 4 cases, and average in 7 patients; functional position of the forearm in 9 cases, and good range of pronation and supination in 1 patient; useful function of wrist (flexion/extension) in 4 cases; good motor hand function in 3 cases, and fair in 6 patients., Conclusions: In preganglionic perinatal brachial plexus injuries located in the upper-middle part, spinal nerve C7 roots avulsion is the most frequently observed, and in the lower part of the brachial plexus, spinal nerve C8 roots avulsion is the most frequently observed. In preganglionic injuries of the brachial plexus, the number of avulsed spinal nerves has an influence on technical possibilities of performing reconstruction procedures, and then the results of the surgical treatment.

Unlabelled: Growth hormone deficiency is connected with the premature development of the cardiovascular system diseases, increased mortality due to the circulatory system diseases and the early development of atherosclerosis. An increased concentration of homocysteine is recognized as an independent risk factor of atherosclerosis and thrombosis. The aim of our study was to evaluate the effect of substitution rhGH therapy on homocysteine concentration in children and adolescents with growth hormone deficiency. The study included patients with growth hormone deficiency diagnosed recently and qualified for rhGH replacement therapy. A total of 25 patients (10 girls and 15 boys) aged 8.1-16.9 years (mean 13.3+/-1.8 years), height 1.15-1.61 m (mean 1.4+/-0.1 m), body area 0.84-1.47 m(2) (mean 1.14+/-0.18 m(2)) were examined. Twenty two healthy and slim children (11 girls and 11 boys) aged 6.6-16 years (mean 12.6+/-2.7 years), height 1.33-1.8 m (mean 1.58+/-0.16), body area 0.93-1.8 m(2) (mean 1.38+/-0.3 m(2)) with a family history without atherosclerosis and cardiovascular diseases constituted controls. Homocysteine concentration was determined by means of immunoenzymatic method using Axis R Homocysteine kits of BioRad firm. Homocysteine concentration in children with GH deficiency did not differ significantly in comparison with controls (8.53+/-2.38 vs 8.48+/-2.13 mg/dl). After a year-rh GH therapy, mean homocysteine concentration was significantly lower than in controls (7.52+/-2.12 vs 8.48+/-2.13 mg/dl p<0.05). A significant decrease in homocysteine concentration after GH therapy was proved in comparison with the initial values in this group (7.52+/-2.12 vs 8.53+/-2.28 mg/dl)., Conclusions: 1. rhGH replacement therapy causes a significant decrease in homocysteine concentration in children with GH deficiency. 2. Homocysteine concentration in children with GH deficiency is one of the factors inducing vessel endothelial damage and further biological consequences.

Unlabelled: A total of 25 patients (10 girls and 15 boys) aged 8.1-16.9 years (mean 13.3+/-1.8 years), height 1.15-1.61 m (mean 1.4+/-0.1 m), body area 0.84-1.47 m2 (mean 1.14+/-0.18 m2) were examined in our study. After 12-month--rhGH therapy, 23 children (9 girls and 14 boys) were re-evaluated. Twenty two healthy and slim children (11 girls and 11 boys) aged 6.6-16 years (mean 12,6+/-2.7 years), height 1.33-1.8 m (mean 1.58+/-0.16), body area 0.93-1.8 m2 (mean 1.38+/-0.3 m2) with a family history without atherosclerosis and cardiovascular diseases constituted controls. Mass and function of LV were evaluated by means of M-mode and 2D echocardiography and the Doppler method with simultaneous 2D picture recording. Systolic function parameters (SF and EF) were normal in each patient before therapy. LV systolic fraction (SF) equaled on average 35.4+/-4.5 % in the examined group and 36.7+/-3.9 % in controls. LV ejection fraction (EF) was on average 65.1+/-5.9 % in the examined group and 67.9+/-6.4 % in controls. The differences noted were not statistically significant. After a year-rhGH therapy, SF and EF were within a normal range in each patient. SF was on average 35.9+/-3.6% in the examined group and 36.7+/-3.9% in controls. EF was on average 65.7+/-4.6% in the examined group and 67.9+/-6.4% in controls. The differences were not statistically significant. SF and EF did not differ before and after rhGH therapy. LV mass indexed by body superficial area (LVA/BSA) equaled 68.3+/-18.6 g/m2 before therapy and did not differ significantly in comparison with controls (68.2+/-15.5 g/m2). After a year-GH therapy, LV/BSA was significantly higher when compared to LV/BSA mass before therapy (78.2+/-14.9 g/m2 vs 68.3+/-18 6 g/m2, p<0.05). After a year-GH therapy LV/BSA mass was significantly higher in comparison with LV/BSA mass before therapy (78.2+/-14.9 g/m2 vs 68.3+/-18.6 g/m2, p< 0.05). Before therapy, IVRT parameter was found significantly extended in comparison with controls (70.8+/-14.2 vs 64.1+/-8.5 ms, p<0.05). Other parameters characterising LV diastolic function were not significantly different between the groups. After a year-GH therapy, IVRT parameter was still extended in comparison with controls (72.3+/-9.2 vs 64.1+/-8.5 ms, p<0.05). No significant differences were observed with regard to IVRT before and after therapy., Conclusion: 1. A significant extension of isovolumetric relaxation time (IVRT) was proved in children with GH deficiency, which may suggest an impaired diastolic function of the heart left ventricle. 2. 12-month-rhGH replacement therapy causes an increase in the left ventricle mass when compared to the values before therapy, whereas isovolumetric relaxation time remains still longer. 3. Children with GH deficiency should have their circulatory system monitored to observe the dynamics of the left ventricle functional disorders.

Unlabelled: The aims of the study were to compare atherosclerosis risk factors in obese, hypertensive and diabetic children with positive and negative family history (FH) of cardiovascular disease (CVD) and to find which of the new atherosclerosis risk factors may be of clinical value in predicting future cardiovascular events. A total of 285 children and adolescents were divided into groups: obese, obese and hypertensive, hypertensive, and diabetic. Each group was further segregated into children with positive or negative FH of CVD. Positive FH groups were analysed according to FH of CVD before or after 55 years of age, and in parents and grandparents separately. We assessed lipids, body mass index (BMI) and new risk factors: lipoprotein(a) Lp(a), apolipoprotein A-I (apo A-I) and apolipoprotein B (apo B), homocysteine (Hcy), fibrinogen (FB), tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1). A positive FH of CVD was found in 28% of the children and in 8.7% it was premature CVD. Children with a positive FH had higher BMI (25.4 versus 23.7 kg/m(2), P<0.05) and highest BMIs were found in those with FH of CVD <55 years (26.8 kg/m(2), P<0.05) or in parents (27.4 kg/m(2), P<0.05). Lp(a) levels were higher in children with a positive FH (0.38 versus 0.28 g/l, P<0.05) and highest in children with a FH of premature CVD (0.44 g/l, P<0.05). Differences were also found in apo B levels (0.90 versus 0.84 g/l, P<0.05). In logistic regression analysis only BMI and Lp(a) were significant in predicting future cardiovascular events., Conclusion: obese, hypertensive and diabetic children often originate from families with cardiovascular disease. Children with a family history of cardiovascular disease have a higher body mass index. Levels of lipoprotein(a) and apolipoprotein B may be predictive of future cardiovascular disease in predisposed children.

Aims/hypothesis: A rising incidence of Type I (insulin-dependent) diabetes mellitus in different countries in Europe during the last decade has been recently reported. However, in the early 1990s, Poland was reported to have a stable low incidence of this disease. This study aimed to estimate the annual incidence of Type I diabetes in a north-eastern region of Poland (Białystok region) and investigate if it is associated with age, sex, urban rural differences and the season of disease onset., Methods: A register of patients with Type I diabetes using two independent sets of data sources was established in 1994 as part of the EURODIAB TIGER programme. The primary data sources were paediatric and internal medicine divisions of the hospitals in the Białystok province and the secondary were outpatient diabetic clinics in the region. The degree of ascertainment was 98.5 % for the combinated data sources., Results: We found a significant rising trend in the incidence of Type I diabetes in children under 15 years of age (in 1998 the incidence was approximately twice as high as in 1994). Increasing incidence rates were observed in the rural areas but not in urban populations. Seasonal variation in the incidence was also found, with a peak in winter and nadir in summer., Conclusions/interpretation: These results show that the north-eastern region of Poland is an area with a moderate rather than a low risk of Type I diabetes. Our observations confirm the important role of environmental and socio-economic factors or both in the pathogenesis of Type I diabetes.

Antibodies recognising different pancreatic autoantigens (Abs) are detected many years before the clinical onset of insulin-dependent diabetes mellitus (IDDM). The humoral immune alterations, observed in the susceptible subjects, for example in first degree relatives of IDDM patients, could serve as predictive markers of IDDM development. It has recently been suggested that the predictive value of these humoral markers is associated with the number of the studied antibodies directed against different pancreatic antigens (ICA, GADA, IA-2,A IAA). The aim of the study was the estimation of the prevalence and titre of the antibodies directed against protein tyrosine phosphatase-2 (IA-2) and glutamic acid decarboxylase (GAD) in patients with newly diagnosed diabetes type 1 and their first degree relatives. The investigations were carried out in 52 diabetics (aged 5-25 years) and 136 first degree relatives. IA-2A and GADA were performed by radiobinding assay (RIA) using 2 microliters of serum and recombinant S35-labelled GAD65 and IA-2 antigens. The threshold of Abs detection was > or = 97.5 centile (of healthy schoolchildren). At least one of the antibody marker was detected in 92.7% of newly diagnosed IDDM patients, slightly more frequently observed were GADA (78.8%) than IA-2A (71.2%). The presence of 2 types of antibodies was found in 8.7% of parents and 9.4% of the siblings. The results of our study confirm high sensitivity and specificity of the combined measurement of IA-2A and GADA in recognising of autoimmune alterations in diabetes type 1 development. Taking into consideration small volume of the serum suitable for Abs measurement and possibility of the combined estimation of these Abs it seems that IA-2A and GADA combined measurement could actually serve as a screening marker for the detection of high risk of IDDM subjects also in the Polish population, but studies concerning their predictive value in the general population are suggested.

It was recently suggested that there is a tendency of the rising incidence of diabetes type 1 in different countries in Europe. In our previous studies we observed the high frequency of ICA among first degree relatives of diabetic subjects, what could suggest a rapid increase in the incidence of diabetes type 1 also in the north-eastern region of Polan. The aim of the study was to estimate the annual incidence of diabetes type 1 in the north-eastern region of Poland and to evaluate the association of the incidence rates with the age, gender, urban-rural differences and the season of the year of the disease onset. The register of new cases of IDDM was established in 1994 using 2 independent data sources. The degree of ascertainment was 98.9% for the combination of both data sources. We observed a rising trend in the incidence from 6.4 in 1994 to 9.9 cases per year per 100,000 in 1998 (p < 0.001). The highest incidence rate increase was recorded in boys aged 5 to 14 years old (16-17 cases per 100,000 in 1997-1998). The rising trend in this incidence was observed in the rural areas, while in urban populations the incidence was unchanged. Seasonal variation in the incidence was also recorded, with a peak in autumn and winter and nadir in summer. Our observations suggest the necessity of the continuation of the studies to identify the diabetogenic environmental factors and to try preventive procedures in the studied population.