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Vol.12 No.1

Date: January 2003.

CONTENT:

GYNECOLOGIC CYTOLOGY – CERVIX UTERI (Vol.12 No.1, str.1-11)

Authors:

Silvana Audy-Jurković, Anita Grgurević-Batinica, Vesna Mahovlić, Ines Krivak

Editorial

Summary:
Cervical carcinoma can be prevented by health education (primary prevention) or early detection (secondary prevention). Cytologic analysis, generally known as Papanicolaou (Pap) test, is the most widely used method of secondary prevention. Among other parameters, the classification of cytologic findings includes differentiation of premalignant and malignant lesions, and identification of the agents causing sexually transmitted diseases (bacteria, fungi, parasites) or their cytopathic effects (viruses). The latest classification proposal is the NCI Bethesda System 2001 at the international level, and Zagreb 1990 in Croatia. Cytology can be used as a screening method of lesion detection to discriminate between positive and negative findings, or as a differential diagnosis method to predict the histologic diagnosis. In differential diagnosis, cytology is one of the complementary diagnostic methods along with colposcopy and histology, which taken together allow for a more accurate diagnosis to make. The conventional Pap test as a screening method for cervical carcinoma has been confirmed through the morbidity and mortality decrease, and is recommended in countries with developed cytology service like Croatia. Even higher screening sensitivity is achieved by the use of sophisticated cytologic methods (LBC and computed cytologic analysis) and their combination with other methods (HPV DNA typing). Nation- -wide cytologic screening has been used in many European Union countries. In Croatia, the main professional preconditions for national screening have been met, however, the plan and program should be designed, and the financial support ensured.

Key words:
gynecologic cytology, cervix uteri


CANCER OF THE CERVIX IN IRREGULARY MONITORED AND UNTREATED CYTOLOGIC PRECANCEROSIS (Vol.12 No.1,str.11-15)

Authors:

Miodrag Milojković, Mirjana Rubin

Original paper

Summary:
The aim. To estimate the importance of some risk factors that influence the time period between the precancer and cancer occurrence of the cervix. Methods. Retrospective study of 52 women with cervical cancer which developed due to the irregularly monitored and untreated cytological precancer, in the period from January 1st, 1991 to June 30th, 2001. In this statistical analysis we used analysis of variance (ANOVA), t-test, and Spearman’s rank correlation coefficient with Spearman’s nonparametric test for rank correlation. Results. At the time of the first HSIL cytological finding, patients were 37.6 years old, with first LSIL 39.6 and with ASCUS/AGCUS 52.9 years old on the average. The patients previously having HSIL were not cytologically followed for 77.5 months, with LSIL for 52.8 months and with ASCUS/AGCUS 36.3 months on the average. Cancer of the cervix was detected after 93.2 months on the average after the first HSIL cytological results had been obtained. Cervical cancer was discovered after 76.0 months on the average after the first LSIL cytological results, and after 47.9 months on the average after the first ASCUS/AGCUS cytological results had been obtained. The mean age of the patients with cervical cancer after HSIL was 45.4, after LSIL 46.0, and after ASCUS/AGCUS 56.9 years. Conclusion. It may be said that besides other risk factors, the time period, between the precancer and cervical cancer occurrence in studied women, is to great extent influenced by the age of the patients, at the time when precancer was cytologicaly diagnosed.

Key words:
cytological precancer, cervical cancer, monitoring, patients age


BREAST CANCER AND PREGNANCY – Dilemmas and Controversies (Vol.12 No.1, str.15-20)

Authors:

Josip Fajdić, Damir Hodžić, Željko Glavić, Nikola Gotovac

Review

Summary:
The incidence of breast cancer during pregnancy and breast-feeding is a very rare but challenging clinical problem whose solution, along with medical, also involves legal, ethical, religious and psychosocial standards. In this study, the evolution of medical views on the subject has been presented. From extremely pessimistic ones, which were prevalent in the past, to modern views which are valid today when pregnancy is considered a mere coincidence and not a cause for the disease. However, the doctor is faced with them in the way of a number of dilemmas. Inspite of the rare incidence of breast cancer among pregnant women, there are only 0.2% to 3.8% cancerstricken patients, that is 1:3,000– 1:10,000 pregnancies, there appear still numerous dilemmas and controversies regarding breast cancer diagnostics, treatement and other aspects that are of crucial interest both for the doctor and the patient. From the correct approach to solving many of those dilemmas arise many prognostic implications both for the mother and the child. Despite adequately conformed views on this multidisciplinarily pervading problem in medicine, the aim of this study is to point to the most fundamental dilemmas which draw the attention of the medical profession.

Key words:
breast cancer, pregnancy


UTERINE ANOMALIES AND PREGNANCY Case report of double pregnancy in uterus didelphys ( (Vol.12 No.1, str.21-25)

Authors:

Ante Dražančić

Review and case report

Summary:
Rare case of gemellar pregnancy in a duplicate uterus, that ended by spontaneous labor in the 35-th weeks of pregnancy of the first and thereafter of the second twin at interval of three days, is presented. The mechanism of initiation of the labor in the one and thereafter in the second uterus is discussed. The review of the frequency and of pregnancy outcome in uterine malformations before and following its correction is presented.

Key words:
multiple pregnancy, uterine malformations, uterus didelphys


OUTCOME AND DURATION OF INDUCED DELIVERIES IN GENERAL HOSPITAL BJELOVAR (Vol.12 No.1, str.26-32)

Authors:

Ante Dražančić

Professional paper

Summary:
The aim. There were many comparative studies about induction of deliveries, but they are still object of discussion. The aim of this study was, using retrospective analysis, to determine the differences in succes of induction of delivery between two methods: oxytocin plus amniotomy versus oxytocin plus amniotomy after previous local prostaglandine application. Patients and methods. In the period between 1997–2001 in Maternity department of General hospital Bjelovar there were 909 induced (19.09%) out of 4640 deliveries. In 159 (17.5%) of these cases modified Bishop index was unfavourable (<5), in 472 (51.9%) relatively favourable (5–8), and favourable (>8) in 278 (30.6%) cases. 339 (37.3%) parturients were primiparas, 315 (34.6%) II-paras and 255 (28.1%) >II-paras. Oxytocin with amniotomy was used as the only method of induction in 786 (86.5%) of cases. Combination, oxytocin with amniotomy after previous application of Prepidil® gel was used in 45 (4.9%) cases, in 62 inductions (6.8%) after application of Prostin® vaginal tablets and in 16 (1.8%) cases after application of Prostin® vaginal gel. Results. Induced programmed deliveries (N=604) were accomplished vaginaly in 565 (93.5%) and induced indicated deliveries (N=305) in 246 (80.7%) cases. Deliveries which were induced by prostaglandins were more successfull and less lasting than deliveries which were induced only by oxytocin and amniotomy. Statistically was found signifficant difference in Bishop index and parity influence (p<0.05). Deliveries induced after previous cesarean section were accomplished vaginaly in 83.3% after application of Prepidil® gel, and in 58.3% in those induced by oxytocin and amniotomy. Perinatal mortality in induced deliveries was 1.1‰. There was not registered any case of uterine hypertonus, uterine rupture or puerperal sepsis. Conclusion. The use of local prostaglandine in induced deliveries with immature and relative immature uterine cervix is superior method than induction only with oxytocin and amniotomy. To foreseeing the succes between two methods of induction, and considering the costs of induction means, there is a need to find more objective diagnostic method than Bishop cervical index.

Key words:
induction of delivery, prostaglandin E2, oxytocin


SHOULD WE INCREASE THE NUMBER OF CASES OF CESAREAN SECTIONS? (Vol.12 No.1, str.33-37)

Authors:

Edita Tadić, Danijela Štefanić-Mitrović, Nikša Milić, Dinko Kulišić, Krešimir Baraka

Professional paper

Summary:
Objective. In order to determine whether there is an objective reason to increase the number of Cesarean sections in General Hospital Zadar, for the period from 1997–2001 (8479 deliveries) the perinatal mortality and post-born conditions of children (a 1-minute and 5-minute Apgar score, clinical and laboratory signs of asphyxia, head ultrasound) were analyzed. Separate analysis was made of vaginally delivered children and of those delivered by Cesarean section. Breech deliveries, deliveries after previous Cesarean section and twin pregnancies were analyzed too. Results. Annually, the number of Cesarean sections was nearly equal (6.3–7.79%) in average 7.26%. Perinatal mortality indicated wider differences, i.e. 10.18–3.0‰, in average 6.73‰. Perinatal mortality of vaginally delivered children was 6.02‰ and of children delivered by Cesarean section 15.70‰ (t=2,81). The most part of perinatally dead children refers to fetal death. Early neonatal mortality of vaginally delivered children was 2.55‰, and of children delivered by Cesarean section 9.47‰ (t=3.12). The 64% of all early neonatally dead children where delivered as prematures. A 1-minute Apgar score <7 was recorded in 1.1% of vaginally delivered children and in 25.7% of children delivered by Cesarean section (t=35.27). A 5-minute Apgar score <7 was in 0.48% of vaginally delivered children and in 13.4% of children delivered by Cesarean section (t=11.59). Hypoxia diagnosis was made in 0.88% of vaginally delivered children, and in those delivered by Cesarean section in 25.37% (t=36.49). Conclusion. Consequently, there are in the Hospital of Zadar no objective reasons to increase the number of Cesarean sections, especially not in the sense of liberalization.

Key words:
Cesarean section, frequency, perinatal mortality, neonatal hypoxia


Prim.mr.sc.dr. Eduard Pitner (Vol.12 No.1, str.38-38)

Authors:

Viktor Latin

In memorian


Prim.dr. Mladen Bival (Vol.12 No.1, str.39-40)

Authors:

Davor S. Zanella

In memorian


Mjesto održavanja kongresa: Hotel President****, Split, Starčevićeva 1, www.hotelpresident.hr/split
Vrijeme održavanja kongresa: 22.- 24. listopad 2015.