Background: Cervical insufficiency (CI) is a painless cervix dilation in the second or early third trimester due to a structural or functional defect. However, CI is often diagnosed retrospectively. A cervix with CI cannot retain the fetus. This condition significantly increases the morbidity associated with extreme prematurity. Women diagnosed with cervical incompetence and dilatation in the mid-second trimester are offered interventions to prolong the duration of pregnancy, with the mainstay of therapy being emergency cerclage. A prophylactic cerclage may be offered to women with a history of extremely preterm birth due to isthmic cervical incompetence. Aim: The aim of this study was to evaluate the perinatal outcomes of elective and emergency cerclages. Materials and Methods: A 10-year retrospective analysis, from 1 January 2015 to 29 February 2024 of pregnancies with indications for cervical cerclage, was conducted. Obstetric and neonatal outcomes were assessed. Results: Prophylactic cervical cerclage was performed in 43 (57%) and emergency cerclage in 32 (43%) of all analyzed cases. The mean prolongation of gestation (measured as the period between cerclage insertion and delivery) was higher in the elective cerclage group compared with the emergency cerclage group (18.6 ± 5.4 vs. 12.2 ± 6.4 weeks; p < 0.0001). The mean gestational week at cerclage removal was also higher in the elective group (36.1 ± 2.2 vs. 31.4 ± 5.6 weeks; p < 0.001). Deliveries in the extreme prematurity period (before 28 completed weeks of gestation) were five times more often in the rescue cerclage group. A significantly higher mean birthweight was reported in the elective cerclage group, at 2920.4 ± 946.8 g vs. 2078.8 ± 1147.8 g (p = 0.0004). Emergency cerclage insertion was associated with a higher need for NICU hospitalization (28% vs. 5%, p = 0.003), continuous positive airway pressure (38% vs. 2%, p < 0.0001), and intubation (22% vs. 0%, p = 0.003). Conclusions: While elective cerclage is associated with more favorable perinatal and neonatal outcomes, this likely reflects earlier intervention in lower-risk pregnancies rather than inherent superiority of the approach. Emergency cerclage, performed under urgent and often suboptimal conditions, remains a critical and effective intervention capable of prolonging gestation and improving neonatal survival in high-risk cases.

Wstęp: Guzy zlokalizowane w obrębie przewodu wyprowadzającego ślinianki przyusznej są rzadkimi nowotworami, w 80% stanowiącymi zmiany łagodne. Ze względu na rzadkie występowanie brakuje wystandaryzowanych algorytmów postępowania diagnostycznegoi chirurgicznego. Dodatkowym wyzwaniem chirurgicznym pozostaje konieczność wykonania radykalnej resekcji z jednoczesnym zachowaniem funkcji ślinianki. Celem pracy jest przedstawienie postępowania chirurgicznego u pacjenta z guzem przewodu wyprowadzającego ślinianki przyusznej, a także omówienie aspektów diagnostycznych zmian zlokalizowanych w tej okolicy.Opis przypadku: Czterdziestosiedmioletnia pacjentka została przyjęta do Kliniki Otorynolaryngologii, Chirurgii Głowy i Szyi Warszawskiego Uniwersytetu Medycznego z powodu guza zlokalizowanego na błonie śluzowej prawego policzka. Przeprowadzano badanie podmiotowe przy użyciu mikroskopu – ujście ślinianki przyusznej zlokalizowane było centralnie na szczycie guza. Przeprowadzono chirurgiczną resekcję guza przewodu wyprowadzającego śliniaki przyusznej prawej z jednoczasową rekonstrukcją jej ujścia przy użyciu mikroskopu operacyjnego. Wnioski: Precyzyjna identyfikacja ujścia przewodu ślinianki przyusznej oraz zastosowanie technik mikrochirurgicznych umożliwiają bezpieczne usunięcie zmiany z jednoczesnym zachowaniem funkcji gruczołu. W przypadku guzów zlokalizowanych w tej lokalizacji konieczne jest postępowanie zgodne z zasadami chirurgii onkologicznej oraz rozważenie rekonstrukcji przewodu w celu uniknięcia odległych powikłań czynnościowych. Jednocześnie taka lokalizacja guza powinna zawsze wzbudzać czujność onkologiczną, gdyż może świadczyć o złośliwym charakterze zmiany.

Xanthine oxidase (XO) and aldehyde oxidase (AO) are molybdenum-dependent flavoenzymes involved in purine catabolism and hepatic xenobiotic metabolism. This study aimed to assess XO and AO activities and molybdenum (Mo) content in liver tissue from liver graft donors and recipients with end-stage liver failure (ESLF). Liver tissue samples were obtained from 10 liver donors (LD; control group) and 30 patients with ESLF undergoing liver transplantation. The ESLF cohort was further divided by primary liver disease: hepatitis B or C viral infection (HBV/HCV), alcohol-associated liver disease (ALD), primary sclerosing cholangitis (PSC), Wilson’s disease (WD), and primary biliary cholangitis (PBC). Enzymatic activity was determined by spectrofluorometry, and hepatic Mo content was measured by inductively coupled plasma mass spectrometry. Compared with LD controls, ESLF recipients showed a significant decrease in both hepatic XO activity and Mo content. At the subgroup level, XO activity was significantly reduced in ALD, PSC, and PBC, whereas HBV/HCV and WD showed lower but non-significant values. Mo content was significantly reduced in the overall ESLF cohort and in the WD subgroup, although disease-specific variability was observed, including relatively high Mo content in PSC. AO activity was assessed in a subset of samples and did not differ significantly between donor and recipient liver tissues. Correlation analyses did not demonstrate a statistically significant association between hepatic Mo content and XO activity, suggesting that total tissue Mo content may not directly reflect Mo-dependent enzymatic activity. These findings indicate that ESLF is associated with altered hepatic trace-element composition, including Mo, and with disturbances in Mo-dependent enzymatic activity. Future studies should combine liver tissue analysis with matched serum and portal blood samples to better characterise hepatic Mo metabolism and the systemic biological effects of trace elements.