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Vol.22 No.4

Date: October–December 2013.

CONTENT:

MATERNAL SERUM C-REACTIVE PROTEIN AND WHITE BLOOD CELL COUNT IN THE PREDICTION OF CHORIOAMNIONITIS AND FETAL INFLAMMATORY RESPONSEAFTER PRETERM RUPTURE OF MEMBRANES (Vol.22 No.4, p.165-169)

Authors:

Katja Jarc, Tanja Carli, Miha Lučovnik, Tanja Premru Sršen,1Lilijana Kornhauser Cerar, Metka Derganc

Original paper 

Summary:

Background: C-reactive protein (CRP) and white blood cell count (WBC) are often used to diagnose chorioamnionitis and predict fetal-inflammatory-response-syndrome (FIRS) after preterm premature rupture of membranes (PPROM) at an early gestation. The objective was to determine how reliably maternal CRP and WBC predict chorioamnionitis and FIRS after PPROM at <32 weeks of gestation. Methods: Patients with PPROM at 23 6/7 to 31 6/7 weeks were included. CRP and WBC were measured in maternal blood within 24 hours from delivery. Chorioamnionitis was diagnosed histologically. FIRS was defined as neonatal inflammation within 72-hours post-partum. Mann Whitney U test was used to compare CRP and WBC levels in groups with vs. without chorioamniontis, and with vs. without FIRS (p < 0.05 significant). Diagnostic accuracies of CRP and WBC levels were determined by receiver-operator-characteristics (ROC) analysis. Results: Fourty-two pregnant women and 42 neonates were included. CRP and WBC levels were higher in 29 cases of chorioamnionitis (p=0.01, p=0.02), but not in 12 cases of FIRS (p=0.46, p=0.99). Areas under the ROC curve (AUC) for CRP and WBC in prediction of chorioamnionitis were 0.78 and 0.77, respectively. AUC’s for CRP and WBC in prediction of FIRS were 0.45 and 0.49, respectively. Conclusions: Elevated maternal serum CRP and WBC levels are associated with histological chorioamnionitis, but are not a reliable marker for FIRS.

Key words:

preterm rupture of membranes, chorioamnionitis, fetal inflammatory response, C-reactive protein, white blood cell count


THREE-DIMENSIONAL CONTRAST SONOHYSTEROGRAPHY IN THE EXAMINATION OF INTRAUTERINE PATHOLOGY (Vol.22 No.4, p.170-177)

Authors:

Vesna Harni,* Dubravko Barišić,** Damir Babić,** Herman Haller,*** Maja Gudelj*

Original paper

Summary:

Three-dimensional contrast sonohysterography represents an excellent diagnostic method in the evaluation of intrauterine pathology, which deserves the name of »the virtual hysteroscopy«. Our investigation of 228 three-dimensional contrast sonohysterography at 191 patients with suspect 2D TVS shows the sensitivity of 3D SIS as high as the sensitivity of the hysteroscopy (99%). The accuracy in relation to pathohistological diagnosis was 91% for three-dimensional sonohysterography and 96% for hysteroscopy. Both methods were characterized by high positive and high negative predictive value (PPV: 91% vs. 97%; NPV: 93% vs. 88%). The hysteroscopy had higher specificity of 78% in comparison to the specificity of three-dimensional contrast sonohysterography (62%), that partially could be explained by inconsistencies in surgical procedure in patients with normal ultrasound finding (ethical reason). The review of the epidemiological characteristics of the patients with intrauterine pathology revealed higher number of women with cervicitis and abnormal PAP smear, which underlines the necessity of deeper analysis of the characteristics of this category of patients. The analysis of the false-positive results especially has a value in recognition of the long time between the test and hysteroscopy as a probably reason of false-positive diagnosis; this assumption should be further evaluated. In this investigation, we recognized two groups of patients who could benefit from the 3D contrast sonohysterography. This is already mentioned the group of patients with positive 2D TVS ultrasound and negative 3D SIS, and the group of patients with 2D TVS inhomogeneous endometrial echo. In this way, the operative procedure could be cancelled in the first group of patients after negative 3D SIS, and in the second group of patients hysteroscopy could be selectively performed (instead of a blind curettage). These assumptions should be evaluated in future investigations.

Key words:

three-dimensional ultrasound, contrast-sonohysterography, intrauterine pathology

 


SIDE EFFECTS OF SPINAL ANESTHESIA FOR CAESAREAN SECTION (Vol.22 No.4, p.178-181)

Authors:

Kristina Kotorac, Gordana Brozović, Kata Šakić

Original paper

Summary:

Background and objective. Adverse events of spinal anesthesia are hypotension and post puncture headache. The study compares hypotension in spinal and general anesthesia and shows incidence of severe post puncture headache that treats with blood patch. Material and Methods. For this research, data were analyzed retrospectively from medical records of women who gave birth in a Clinical hospital »Sveti Duh« in the period from 1. 1. 2011. to 30. 6. 2011. It is separated highest systolic and diastolic pressure and lowest systolic and diastolic pressure. Using the values of pressure was calculated the highest and lowest MAP, difference of MAP, and frequency of receiving ephedrine. Also was recorded how many times was made blood patch. Results. After statistical analysis of the data is obtained that the difference between the highest and lowest MAP is similar for all three forms of anesthesia and is not statistically significant. During spinal anesthesia with bupivacaine was intervened with ephedrine in 44.1% of cases, and during spinal anesthesia with levobupivacaine in 18.9%. In general anesthesia, ephedrine was not received. The frequency of blood patch was 4.54%.Conclusion. It is not confirmed stronger hypotension in anesthesia with bupivacaine compared with levobupivacaine or with spinal anesthesia compared to general anesthesia. It was confirmed that ephedrine was often used with bupivacaine compared to levobupivacaine. The assumption is that the difference between MAP showed no hypotension due to infusion before spinal anesthesia and ephedrine timely intervention in the event of a pressure drop.

Key words:

spinal anesthesia, levobupivacaine, bupivacaine, ephedrine, post puncture headache

 


INTERDISCIPLINARY APPROACH TO TRANSSEXUALITY – GYNAECOLOGICAL EXPERIENCE (Vol.22 No.4, p.182-190)

Authors:

Jasenka Grujić Koračin

Review

Summary:

Transsexuality is a disorder of sexual identity characterized by permanent feeling of not belonging to the sex being born with and identification with the opposite sex and wish to change his/her biological sex using drugs or by surgical operations. The etiology of the disorder is not fully demonstrated, but it is known that psychological support and treatment (endocrinological, surgical) brings relief to transsexual people and decreases suffering. We differ the male-to- -female (MTF) transsexual persons and female-to-male (FTM) transsexual persons. In the Surgery Gruji} Kora~in two MtF transsexual persons have been examined by whom well reconstructed female genitals and vagina have been found. In the process of sex transition a gynecologist takes part in a surgical procedure of changing sex in FTM transsexual persons (hysterectomy, adnexectomy), but also in later controls and supervision of FTM and MTF transsexuals (depending on a surgical procedures previously carried out) and gives an additional social support to MF transsexual persons.

Key words:

transsexuality, changing sex


MEDICAL PROFESSIONAL SECRET (Vol.22 No.4, p.191-198)

Authors::

Jadranka Šanjug

Review

Summary:

Medical professional secret covers all information about the patient and his environment that are entrusted to the doctor or that are learned in doing their job, as well as all written documentation and notes about the patient collected during the medical examination and treatment. Medical professional confidentiality is an ethical and legal duty of physicians and health care professionals and the unauthorized disclosure of medical professional secrets that hurt person could have different consequences and responsibilities. The aim of this article is to describe and explain the causes and types of medical confidentiality breach and in particular the modalities of authorized and unauthorized disclosure of data representing a medical professional secret.

Key words:

medical professional secret


GINGIVAL CYSTS IN NEWBORN AGE – COMMON DIFFERENTIAL DIAGNOSTICS DOUBT (Vol.22 No.4, p.199-201)

Authors:

Zora Zakanj

Case report

Summary:

Gingival cyst of the newborn belongs to the group of intraoral cystic lesions. In literature also known as dental laminal cyst and alveolar cyst, and it is benign oral mucosal lesions of transient nature. It is often mistaken as natal teeth. We presented gingival cyst at term healthy newborn infant, perinatal period and follow-up of the child. We observed spontaneously shed of the cyst after four week. There were no feeding difficulties in neonatal period, and later dentition in age of one and two years was normally. Physician should be able to explain clinical presentation and selflimiting nature of these cystic lesions at neonates, so that unnecessary surgical intervention can be avoid.

Key words:

gingival cyst, dental laminal cyst, alveolar cyst, newborn, perinatology


 

 

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