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Vol.12 No.4

Date: December 2003.

CONTENT:

HORMONE THERAPY IN FEMALES AND GENITAL CARCINOMA (Vol.12 No.4, str.139-147)

Authors:

Ante Ćorušić, Marina Šprem, Dinka Pavičić-Baldani, Branka Petričević, Višnja Matković

Original paper

Summary:
Tamoxifen and other selective estrogen receptor modulators are new medications characterised by high estrogen receptor affinity. In certain tissues they express estrogen-like activity and in the others they act as estrogen antagonists. This review discussess their use in breast and endometrial carcinoma as well as their treatment results. It also reviews their potential effects on ovarial and cervical carcinoma. According to numerous clinical trials tamoxifen has proved effective in breast cancer treatment of premenopausal and postmenopausal women. The risks of this therapy, such as development of secondary endometrial carcinoma, have also been presented. The use of gestagenes in endometrial carcinoma treatment has been discussed too. This paper reviews the influence of hormone replacement therapy on the development of breast and endometrial carcinoma as well as the safety of its application in patients diseased of breast, endometrial, ovarian or cervical carcinoma.

Key words:
hormone therapy, genital carcinoma


THE CLASSIFICATION OF CYTOLOGIC FINDINGS OF CERVIX UTERI »ZAGREB 2002« The Modification of the »Zagreb 1990« and »NCI Bethesda System 2001« Classifications (Vol.12 No.4, str.148-153)

Authors:

Ana Ovanin-Rakić, Marija Pajtler, Teodora Stanković, Silvana Audy-Jurković, Nikola Ljubojević

Original paper

Summary:
»Zagreb 2002«, a new unique classification of cytologic findings of the cervix uteri in Croatia presents the modification of the »Zagreb 1990« and »NCI Bethesda system 2001« classifications. There are two categories, that are »adequate« and »inadequate«, applied for the assessment of specimen adequacy. The category of inadequate also includes specimen that have not been analysed as well as the ones that have been analysed but the abnormality assessment cannot be given for whatever the reason is, accompanied by the additional explanation. According to the general division, the findings are classified as »negative for intraepithelial or invasive lesion« (no irregularities, changes with reactive and reparative reactions, results indicating certain risk) and »abnormal cells« (cellular changes which morphologically are in compliance with intraepithelial or invasive malignant lesions). Descriptive diagnosis contains the following sections: »micro-organisms«, »other non-neoplastic findings« and »abnormal cells« (squamous, glandular, non-defined and other malignant lesions). Reactive cellular changes, reparative epithelium, reserve cells, parakeratosis, dyskeratosis, hyperkeratosis, glandular cells status post hysterectomy, endometrial cells finding out of the cycle or during the postmenopause, as well as the definition that cytohormonal status is not adequate to the age and/or anamnesis all pertain to the category of »other non-neoplastic findings«, that can be found with or without abnormal cells. Squamous lesions are divided into the three groups: »atypical squamous cells« (ASC), »squamous intraepithelial lesion« (SIL) and »carcinoma planocellulare«. The news is there are the three subgroups, those are »non defined« (ASC-US), »HSIL cannot be excluded« (ASC-H) and »invasion cannot be excluded« within the category of »atypical squamous cells«. There are still three current names applied for the category of squamous intraepithelial lesion (SIL). The only change concerns the supplement »initial invasion cannot be excluded« which refers to typical cytologic pictures of carcinoma in situ with several changes on cells and the base that indicate the possibility of the early stroma invasion. Glandular lesions are also divided into the three groups: »atypical glandular cells« (three subgroups: »favor reactive, favor intraepithelial and favor invasive), »adenocarcinoma in situ« (AIS) and »adenocarcinoma«, accompanied by the suggestion of origin. The »abnormal non-defined cells« group and »other malignant neoplasms« group refer to abnormalities where it is not/is possible to set a differential cytologic diagnosis.

Key words:
cytology, modification of classification, cervix uteri


THE VALUE OF THE INTRACARDIAC ECHOGENIC FOCI IN THE FETAL HEART: CURRENT UNDERSTANDING AND CLINICAL VALUES (Vol.12 No.4, str.154-156)

Authors:

Ulla Marton, Feodora Stipoljev, Milan Kos, Berigoj Mišković, Ratko Matijević, Asim Kurjak

Original paper

Summary:
Objective. To estimate the degree of risk of the echogenic intracardiac foci (IEF) for fetal chromosomopathies and to determine its association with structural anomalies of the fetus. Material and methods. During the period of two years 190 pregnant patients had been send for fetal echocardiography. Examination had been performed by transvaginal (12–17 weeks of gestation) or transabdominal approach (18 weeks or more of gestation). Results. IEF was observed in 17 fetuses, multifocal appearance was found in 2 out of 17 fetuses. In 3 cases IEF had resolved during the 8 weeks period of time. Additional structural anomalies were detected in 11 fetuses. In 2 fetuses trisomy 21 had been confirmed. Conclusion. A single soft marker as IEF is commonly encountered during the second trimester among the fetuses with chromosomal aberation. As do many sonographic markers IEF can be resolved during the pregnancy and often can be found in normal fetuses.

Key words:
fetal echocardiography, echogenic intracardiac foci, ultrasonography, prenatal diagnosis


THE POSSIBILITIES OF COLPOSCOPY IN RECOGNITION OF THE LATENT CERVICAL HPV INFECTION (Vol.12 No.4, str.157-163)

Authors:

Nikola Tuškan, Vesna Kljajo, Miroslav Furdek, Emil Tuškan

Original paper

Summary:
Objective. The concept of latent HPV infection implies the presence of viral genome within morphologically normal cells. Therefore the latent HPV infection couldn’t be diagnosed by either cytologic or histologic examinations but by DNA hibridization. Our intention was to examine the possibilities of colposcopy in recognition of the latent cervical HPV infection. Methods. There were two groups of examinees selected for testing with DNA hibridization. In the first there were 65 women recently treated with combined therapy because of subclinic HPV infection. The cytologic and colposcopic examinations were performed 3 months after therapy completed. In the second group there are 52 examinees with cytologic signs of CIN without koilocytosis. Hibridization tests and colposcopy were performed in all examinees. Results. Hibridization tests were positive in 38 patients (58,46%) of the first group and in 34 (65,38%) of those of the second group. Colposcopic findings in both groups of examinees with positive hibridization tests showed microcapillary contours, irregular widths of the intercapillar spaces with poor fine-caliber vessels in 70,83% of them. Conclusions. A common colposcopic signs in patients with latent HPV infection of the uterine cervix are the findings of the microcapillary contours, irregular widths of the intercapillar spaces and fine-caliber vessels, poorly formed patterns. Colposcopy could be used for presumptive recognition of latent HPV infection of the uterine cervix.

Key words:
uterine cervix, latent HPV infection, colposcopy


CERVICAL CERCLAGE IN COUNTY HOSPITAL LIVNO 1986–2002 YEAR (Vol.12 No.4, str.164-168)

Authors:

Stipe Krezo, Žarko Mišić, Ivica Mamić, Deni Karelović, Boris Bačić

Professional paper

Summary:
Aim of the study. To establish the indications, necessity and efficiency of the cerclage. Methods. In retrospective study at the county hospital Livno the 756 pregnant women who had undergone cervical cerclage from 1986 till the year 2002 were analyzed. The age of pregnant women, gestational age when the cerclage was performed, the lasting of pregnancy after the procedure, as well as the number of labors that occurred prior to 37 completed weeks of gestation were analyzed. Patients have been divided into three groups, according to the indications for the procedure. First group of patients, 68 of them, had history of abortion or preterm labor. In the second group there were 125 with a dilatation of internal os of the cervix, whereas in the third group of 563 pregnant women cervical cerclage was performed for other reasons. Results. In 19% of patients with history of abortion or preterm labor pregnancies finished in preterm labor, that is a statistically significant higher rate (p=0.017). In other groups there were no significant results. Conclusion. According to our results cervical cerclage is indicated in the cases of incompetent cervical os, either congenital or acquired. Before performing it, all laboratory and clinical tests, in order to exclude different reasons of cervical incompetence, should be done. Output of cervical cerclage on the outcome of pregnancy is probably less than 1%.

Key words:
pregnancy, preterm labor, cerclage of the cervix


CERVICAL INTRAEPITHELIAL NEOPLASIA IN HEALTH CENTER BENKOVAC (Vol.12 No.4, str.169-173)

Authors:

Vjekoslav Krpina, Domagoj Krpina

Professional paper

Summary:
Objective. To investigate the frequency of cervicovaginal smear tests in the screening program of cancer and premalign lesions of the cervix uteri in rural environment; to find out at what age women undergo screening most frequently, and the number of abnormal cytologic findings in cervical lesions; the number of changes in cervicovaginal smears associated with the human papilloma virus (HPV). Method. In a three-year period, from January 2000 to December 2002, 792 cervicovaginal smear tests or in about 10% women patients in the primary health care unit at the Benkovac Health Care Center, were taken. The subjects were sorted out according to age, examination age and to the frequency of abnormal cytologic findings. Results. In the examination period, the greatest number of cervicovaginal smear tests was taken in the 30–49-year-old group (451 – 56.94%) and in the 50-year and older group (245 – 30.93%). They were fewer in the 20–29-year-old group (94 – 11.86%) and the fewest in 19-year-old and younger group (2 – 0.25%). There were 42 (5.30%) abnormal cytologic findings: 21 (2.65%) DL, 8 (1.01%) DM, 12 (1.52%) DG and 1 (0.13%) IC. Of all 792 cervicovaginal smear tests, there were 8 (66.66%) serious cytologic findings (DG) in the 20–39-year-old group, and 4 (33.33%) in the 40-year and older group; there was 1 (1.00%) IC in the group of 50-year olds and older. Cervicovaginal smear and changes associated with HPV (coilocytes) were found in 4 (0.50%) women only. Conclusion. During our research made in the rural environment, only 10% cervicovaginal smear tests were taken which is insufficient for the prevention of cancer of cervix uteri as there were 5.30% abnormal cytologic findings.

Key words:
cervicovaginal smear, cervical dysplasia, cytologic screening


THE DIAGNOSTIC METHODS FOR THE SUBCLINICAL HUMAN PAPILLOMA VIRUS INFECTION (Vol.12 No.4, str.174-179)

Authors:

Anton Gojko Mladinov

Professional paper

Summary:
Objective. To compare diagnostic procedures for subclinical HPV infection, with a special attention to vulvoscopy. Further, to make sure that many infections that did not cause abnormal cytologic findings, especially among adolescent patients, can be seen by means of vulvoscopy. Methods. After smearing 5% acetic acid, 400 new patients were subjected to vulvoscopy and in 124 suspect findings were established. From 76, out of 124 subjects, smears were taken for cytologic and HPV test, then extended colposcopy was performed and their tissue for histological analysis taken. Results. Mean age of the patients was 27 years. Younger subjects (≤29 years, n=41) had more lesions – LSIL (11) and cytologic findings of inflammation (48) than 35 older subjects (≥30 years, 7 and 37), but the difference was not statistically significant. HPV tests were more frequent in younger patients and they had more low risk findings (P<0.05). In high risk HPV strains, a higher dysplasia (P<0.05) and more colposcopic abnormalities were found (P<0.05) than in low risk infections. Of all 76 vulvoscopic suspect findings, there were significantly more positive tests (38=50%) than cytologically abnormal findings (22=29%; P<0.01). There were no histological findings to HSIL. Conclusion. It is very important to detect more initial subclinical HPV infections, preferably at the first examination and immediately teach the patient self-protection and start the treatment of side discomforts. After smearing the genito-anal area with 5% acetic acid, it is possible, by using vulvoscopy, to suspect a HPV infection in a bigger number of patients than by visualisation. Therefore, adolescent patients, who are usually reluctant to present themselves for a gynecological examination, and particularly for check-ups, are those who were especially in favour of vulvoscopy considering it acceptable (without speculum introduction).

Key words:
subclinical HPV infection, diagnostic methods, vulvoscopy


NEONATAL DEATH OF THE MOTHER TREATED BY METHYLPHENOBARBITONE DUE TO EARLY MASSIVE PULMONARY HAEMORRHAGE PROBABLY CAUSED BY VITAMIN K DEFICIENCY (Vol.12 No.4, str.180-182)

Authors:

Anija Matičević, Hrvojka Vranješ, Tomislav Ivičević Bakulić, Ahmed Pirkić

Case report

Summary:
A case of a very mature well-developed newborn which manifested massive pulmonary hemorrhage immediately after birth is presented. The hemorrhage repeated within 8 hours and the child died. The hemorrhage was probably caused by a vitamin K deficit due to the fact that his epileptic mother had been treated with methylphenobarbitone (Phemiton) during pregnancy. She had kept it secret during pregnancy and on admission to maternity hospital. Considering the rapid course of events and massive hemorrhage, a coagulopathy was not discovered, but as the bleeding stopped immediately following birth after vitamin K had been administered it can be a sign of its deficit. Not before the newborn’s death did we learn from the mother that for four years she had been treated with methylphenobarbitone taking a 400 mg dosage daily. It is well-known that the anti-epileptic drug treatment can, in newborns, cause a secondary early form of hemorrhagic disease, which can be manifested intracranially, intrathoracally, intra-abdominally and as a bleeding at the place of scalp electrode insertion. Pulmonary hemorrhage, like in our patient, appears exceptionally rarely. In order to prevent an early hemorrhage disease in pregnancy it is important to administer vitamin K to mother from 36th week onward, and to make coagulation tests immediately after birth. The child must be then cared for accordingly either by vitamin K or fresh frozen plasma administration.

Key words:
pulmonary hemorrhage, early hemorrhagic disease in newborn, methylphenobarbitone,vitamin K deficit


Rezolucija XX. Perinatalnih dana "Ante Dražančić" - "Za zaštitu materinstva i djece i humanije rađanje" (Vol.12 No.4, str.183-184)

Authors:

From professional societies

Original paper

Summary:
*

Key words:
*


Dr. Kurt Karl Stephan Semm (Vol.12 No.4, str.186-186)

Authors:

Miroslav Kopjar

Original paper

Summary:
*

Key words:
*


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Vrijeme održavanja kongresa: 22.- 24. listopad 2015.