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Vol.11 No.3

Date: August 2002.

CONTENT:

PARAVAGINAL PUBOCERVICAL FASCIA RUPTURE IN WOMEN WITH STRESS URINARY INCONTINENCE DETECTED BY TRANSVERSAL ABDOMINAL BLADDER SONOGRAPHY (Vol.11 No.3, str.101-109)

Authors:

Vladimir Jolić

Original paper

Summary:
Objective. The pubocervical fascia central or paravaginal damage is the main cause of pelvic organs descent and stress urinary incontinence (SUI). Richardson described clinical diagnostic procedures for detecting the type and level of those tissues rupture, which is not always useful especially in older women and patients with strong urogenital organs descent. Aim of the study. The study was undertaken to analyze the possibility of sonographic diagnostic of the paravaginal supportive tissue defect in women with SUI. Study design. Two groups of female patients were formed. In the first control group (A) there were 50 younger continent and otherwise healthy nuliparous women. In the second group (B) there were 100 women with obvious urogenital organ descent and SUI. They gave birth from 1–8 times (an average of two children), 60% of them were climacteric, 76% of them had worked hard physically, and 52% had their uterus in RVF position. Following the procedure described by Richardson each was examined for central or paravaginal pubocervical fascia rupture. Afterwards followed the sonography of their spontaneously and moderately filled bladders. Toshiba Sonolayer SSA-250 A equipped with an inner protractor and 3.75 MHz ultrasound real-time abdominal probe (PVF – 375 MT) was used. Mitsubishi video copy processor took the hard termoprint copies. The abdominal probe was leaned on the upper edge of the pubic bones symphysis (this is the main pointer and prop) and directed downwards. Two diameters were measured out of the frozen picture of the trapeziform transversal bladder scans: the distance between the inner sides of the transversal bladder scans under the lower edge of the pubic bones symphysis (diameter A), and the width of the bladder base (diameter B). The bladder base morphology depends on the endopelvic fascia and quality of the bladder surrounding tissues. The distance A is normally longer than the B one so the A/B ratio is higher than 1.0. The bladder bases of the incontinent women are relatively wider than the diameter A (the A/B ratio is smaller than 0.99) and in case of the paravaginal pubocervical fascia defect slopes to the right (more often) or to the left side. In case of the central longitudinal or other types of the pubocervical fascia defect, the bladder base could be plane, concave or slopes to the both sides. SUI caused by paravaginal defects has to be cured by Burch’s colposuspension. Results. 92% of the healthy women had the bladder base more narrow than the distance A but all the group B women (100%) had the bladder base wider than the distance A. 60% of these women had bladder base sloping (70% of them to the right, and 30% of them to the left side). The remaining 29% of the incontinent women’s bladder bases were concave because of the longitudinal central vaginal fascia defect, 11% of them had other types of bladder sonograms, which also exclude the vaginal operative approach. The sensitivity and the negative predictivity of the A/B ratio test were 1.0, respectively; its specificity and the positive test results predictivity were 0.92 respectively. Cohen’s Kappa Test was 0.96; likelihood positive ratio was 125 and likelihood negative ratio was 0.0. Conclusion. Transabdominal transversal bladder sonography was proved an accurate diagnostic procedure for the pubocervical fascia defects discovering, what is very important guide towards the best operative procedure.

Key words:
bladder sonography, urogenital organs descent, stress urinary incontinence


PUNCTION AND ALCOHOL SCLEROSIS OF CYSTIC OVARIAN LESIONS (Vol.11 No.3, str.110-112)

Authors:

Vlastimir Kukura, Srećko Ciglar, Željko Duić, Mario Podgajski, Gojko Zovko, Tomislav Čanić, Josip Valetić, Vanja Radić

Original paper

Summary:
Objective. The purpose of the study is a technique of punction and conservative treatment of cystic ovarian lesions. Methods. Cyst must be unilocular, sonolucent, with smooth inner wall of the capsule, without septa and without neovascularisation on transvaginal color Doppler. Serum CA-125 levels were lover than 35 U/ml. Cysts capsule was punctured by 18 gauge needle under the control of 5 MHz transvaginal probe. If the cytologic findings were negative, after complete evacuation of cyst we injected sterile 96% alcohol in the 50% of the evacuated liquor amount. Alcohol remains in situ for 5 minutes and then it was completely evacuated. Results. For this procedure we punctured 160 patients with ovarian cyst volume between 40 and 140 ml in the age from 18 to 60. Six patients (3.75%) had very intensive pelvic pain but we treated them with analgetics. Relapse after three months appeared in 8 patients (5.00%) where the volumens of cysts were bigger than 100 ml. Conclusion. Technique of punction is simple and easy performed. Method of treating by 96% alcohol showed good results. For the cyst volume over 100 ml perhaps is better to inject two-thirds of the quantity of aspirated fluid and leave alcohol in place 15–20 minutes.

Key words:
ultrasound-guided punction, ovarian cysts, alcohol sclerozation


DYSFUNCTIONAL UTERINE BLEEDING (Vol.11 No.3, str.113-118)

Authors:

Miro Kasum

Review

Summary:
In the article all the basic characteristics, clinical significance, etiology and pathophysiology, diagnosis and differential diagnosis, clinical feature and treatment are described. The etiologic analysis is expressed by presentation of all direct causative factors in anovulatory and ovulatory cycles, in correlation with pathophysiologic endometrial changes. In diagnostic procedure the clinical, laboratory, ultrasonic and operative examinations were described. In differential diagnosis the local and systemic illnesses that could imitate dysfunctional bleeding were presented. The clinical feature describes different bleedings in correlation with local pathohistologic finding and with the local regulatory mechanisms. The modern therapeutic approach was expressed by presentation of all hormonal and surgical methods in the treatment and prevention of dysfunctional uterine bleeding.

Key words:
dysfunctional uterine bleeding, irregular bleeding, uterine bleeding, adolescency, perimenopause


INFLUENCE OF BIRTH WEIGHT AND LATER CHILD'S BODY WEIGHT ON HYPERTENSION APPEARANCE IN ADULT LIFE )(Vol.11 No.3, str.119-122)

Authors:

Zora Zakanj, Tomislav Miletić

Review

Summary:
Almost 90% of hypertension cases in childhood are primary or essential hypertension. In the genesis of that kind hypertension numerous etiological factors can participate. In this review, influence of birth weight and child body weight on hypertension appearance in adult life will be presented. There are more and more evidences that hypertension in childhood goes before hypertension in adults, so, it is important risk factor for development of atherosclerosis and cardiovascular diseases. Higher values of blood pressure are noticed among children with birth weight below 10th centile and among children of lower socioeconomic state who are more common by fat. In this connection, body fat, as hypertension etiology factor has bigger part in girls than boys. It was noticed that systolic pressure growing up with years, until value of diastolic pressure is almost the same in all age groups. Preventive measures, specially control examinations, as well as supervision of children with lower birth weight, lower socioeconomic state and excessive body mass, must get a role in health care of that children.

Key words:
low birth weight, hypertension of children, hypertension in adult life


THE SHARE OF PERINATAL CARE IN A NATURAL INCREASE AT KARLOVAC (Vol.11 No.3, str.123-125)

Authors:

Nikola Tuškan, Emil Tuškan, Boško Milanković

Professional paper

Summary:
Introduction. The natural increase of population at Karlovac is lower than the limit of reproductive rate since 1987. Lower natality rates and unfavourable age-structure of population are the main causes of the lowering demographic trends. Perinatal mortality at Karlovac is a lower than national average. Methods. Analysis of the natural increase of population at Karlovac and perinatal mortality rate in the period from 1986 to 2000 has been performed. Results. The natural increase has descent trends and perinatal mortality ranges from 2.7‰ to 4.5‰. Conclusion. Negative trends of the natural increase result from the lower rate of natality as a consequence of the low socioeconomic circumstances of the generative-age population.

Key words:
perinatal care, natural increase, vital index


BARCELONSKA DEKLARACIJA O PRAVIMA MAJKE I NOVOROĐENČETA (Vol.11 No.3, str.135-136)

Authors:

Milan Kos

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