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Vol.13 No.1

Date: March 2004.

CONTENT:

PELVIC BONE SYSTEM CHANGES AND PATHOGENESIS OF GENITAL PROLAPSE – A RADIOPELVIMETRIC STUDY  (Vol.13 No.1, page.1-12)

Authors:

Momčilo B. Lazarevski

Original paper

Summary:
Radiopelvimetric investigations, on the colpocystographies in I position, are carried out on 476 patients: 392 genital prolapses and 84 control cases in the period from April 1, 1968 to February 28, 1973. Out of classic pelvic bone parameters, an original measure – distance »X« is introduced, which characterizes the anterior compartment of the pelvis directly exposed to the action of the intra-abdominal force. The pelvic bone system of prolapse cases presents a horizontalization and an infundibular caudal enlargement. Thus, in total uterine prolapses, the middle pelvis is larger for 6.7%, the pelvic outlet for 13.8% and the distance »X« is longer for 56.7%; the pelvic inlet is more horizontal for 9.8° in comparison to the control cases. The nutation of the sacrum, associated with dorsal transposition of its inferior part and the antero-posterior rotation of the whole pelvis around a center located in the acetabulum seem to be the causes. The relations of these changes to the aging process are studied, too. Showing quantitative identity with changes found in prolapse cases, this analysis also demonstrates their clear progress parallel to the patients aging. In the group of patients aged over 61 years, the horizontalization is more accentuated (14.5°) than the infundibular caudal pelvic enlargement; the distance »X« is longer for 91.4% and nutation, curving and »shortening« of the sacrum are found in comparison with patients aged less than 30 years. In contrast, the pelvis of the control cases, without relation to their age, looks like the pelvis of young patients aged less than 30 years and to the pelvis of nulliparous women aged less than 35 years. Consequently, it is possible to suppose that a part of the population, who during their whole life preserve »youthful« form of the pelvis, should be protected from prolapse development. As such bone changes could be provoked by overloading due to human erect position, they could represent the mechanism by which the aging and the body overloading influence the development of genital prolapses. Due to the enlargements of the middle pelvis and of the pelvic outlet, pelvic suspension and sustention systems are exposed to distensions, provoking a decrease of arrows of their cupolas with a consequent decrease of resistance and deterioration. The calculations demonstrated that the resistance of the pelvic diaphragm in the total uterine prolapses group is three times lower than in the control cases. On the other hand, the augmentation of distance »X« in the group of patients aged over 61 years, exposes their ventral pelvic compartment to a three times greater force in comparison to that of the group of patients aged less than 30 years. By introducing a biomechanical approach, the author throws a new light on this domain of gynecology, permitting better understanding of the complex pathogenesis of genital prolapse, which enables a more sophisticated prevention and treatment of this disease.

Key words:
genital prolapse, etiopathogenesis of genital prolapses, pelvis anthropology, pelvic bone system, erect posture in humans


THE RELATIONSHIP OF BIRTH WEIGHT AND LENGHT TO WEIGHT, HEIGHT AND BODY MASS INDEX IN ADULT WOMEN (Vol.13 No.1, page.13-15)

Authors:

Tomislav Miletić, Frane Mikulandra, Eugenio Stoini, Jozo Anić, Mila Periša, Nelka Tomić

Original paper

Summary:
Objective. To examine the realationship of birth weight and birth lenght to body weight, body height and body mass index (BMI kg/m2) in adult women. Subjects and Methods. The mean age (years), birth weight (g), birth lenght (cms), adult body weight (kg), height (cms) and BMI kg/m2 for 735 healthy women were determined. BMI values up to 19.9 were considered low, from 20.0 to 24.9 normal (ideal), from 25.0 to 29.9 high (overweight) and from 30.0 very high (very overweight, obese). Statistical analysis was performed using arithmetic mean (–), standard deviation (SD), χ2-test with n X m contingency tables, null-hypothesis and analysis of variance. The difference reached significance at the p<0.05 level. Results. The adult women, whose mean age is 27.86±5.4 years, had a mean birth weight of 3490.2±544.2 g and a mean birth length of 51.41±3.76 cms. Their mean weight was 64.03±9.32 kg, height 169.9±11.9 cms and the mean BMI 22.77±6.74 kg/m2. Increasing birth weight (by groups) and length (by groups) resulted in increasing adult body weight, height and BMI (p<0.009). With increasing birth weight the incidence of adult women with a low BMI decreased (p<0.001), whereas the incidence of those with high BMI increased (p<0.001). Increasing birth length had no influence on the incidence of adult women with either low, moderate, high or very high BMI (p<0.05). 19.7% of the subjects had low, 64.0 moderate (ideal), 15.0% high and 1.4% very high BMI. Conclusion. The positive correlation exists of birth weight (by groups) and birth length (by groups) and the mean body weight, height and BMI in adult women. Birth length plays no role in the incidence of adult women by BMI groups. A high incidence of obese and extremely obese young adult women is observed.

Key words:
birth weight, birth lenghts, weight, height, BMI adult women


TRANSDERMAL ESTROGEN TREATMENT IN HORMONAL REPLACEMENT THERAPY OF THE WOMEN IN POSTMENOPAUSIS (Vol.13 No.1, page.16-19)

Authors:

Branko Radaković

Review

Summary:
The results of recent studies regarding the influence of hormone replacement therapy (HRT) into the health of women in postmenopause, have brought anxiety and dilemmas among women who use HRT, but among doctors too. Consequences are total individualization of HRT towards the type and difficulty of the symptoms of menopause, usage of the lowest efficient hormonal doses, shorter lasting therapy than the one being recommended so far, but also wider clinical- laboratory treatment of each woman before the start of HRT. There is also a great importance in choosing the way to use estrogens in HRT. Series of already known information as well as more and more recent reports, draw ones attention to the benefits of transdermal application of estrogens in HRT.

Key words:
hormone replacement therapy (HRT), menopause, estrogens, transdermal HRT


THROMBOEMBOLIC COMPLICATIONS IN ONCOLOGIC PATIENTS (Vol.13 No.1,page.20-23)

Authors:

Doroteja Pavan Jukić, Suzana Lide Škalec, Ante Ćorušić, Goran Vujić, Željko Štajcer

Original paper

Summary:
Deep venous thrombosis is the second most common cause of death in cancer patients. Patients with cancer are at heightened risk of venous and arterial thromboembolism due to the hypercoagulable state. Surgery, chemotherapy, radiotherapy and immobilization of the cancer patients heighten this risk even more. Having in mind all the pre- and intraoperative prognostic factors, we are capable to prevent and reduce possible complications. Low-molecular-weight heparin is proven to be beneficial in the prevention and treatment of the thrombotic complications. There are numerous studies reporting on improved survival of cancer patients treated with LMW heparin.

Key words:
venous thromboembolism, malignant disease, low-molecular-weight heparin


HORMONE REPLACEMENT THERAPY WITH CLIMEN© AND ITS EFFECTS ON THE BREAST TISSUE (Vol.13 No.1,page 24-30)

Authors:

Vesna Antovska, Svetlana Antevska Grujoska, Goran Dimitrov, Vesna Livrinova, Gordana Kiproska

Professional paper

Summary:
Objective. To evaluate the effect of the hormone replacement therapy on breast changes in postmenopausal women. Material and methods. The study includes 35 women with natural or surgical menopause who were treated with sequential estrogen/progestogen hormone replacement therapy (E/P HRT) during one year. The therapeutic program consisted of three weeks treatment with estradiol valerate 2 mg/day orally, combined with ciproterone acetate 1 mg/day in the last 10 days (Climen© – Schering) followed by one week pause. Before the start with E/P HRT basic mammography and ultrasound examination of the breast tissue was performed in all patients. At the end of the study after 12 therapeutic cycles, control mammography and ultrasonographic examination were done. Results. In the short-term study 18 patients (51.43%) showed regression of the finding, 15 (42.86%) stagnation, and only 2 (5.71%) progression of the finding (D=0.27, p<0.01). Conclusion. A clear consensus regarding the relationship between HRT and breast cancer risk cannot yet be drawn. Key words:
hormone replacement therapy, estrogens, progestogens, breast tissue, mammography, ultrasound

INCIDENCE OF ACTINOMYCOSIS IN CERVICAL SMEARS OF WOMEN USING IUD (Vol.13 No.1,str.31-33)

Authors:

Ratomir Hasan, Sandra Moslavac, Hrvoje Brijačak

Professional paper

Summary:
The aim of investigation. Actinomyces are Gram positive, anaerobic bacteria that normally reside in the gastrointestinal tract. Their presence in female genital tract is rare, but significant concerning the possibility of spread of the infection and causing pathological conditions such as pelvic inflammatory disease. The association between the presence of intrauterine devices (IUD) and Actinomycosis is well known. The aim of this study was a retrospective analysis of the incidence of Actinomyces in cytological cervical smears of women who did or did not use IUD. Methods. Papanicolaou (PAP) smears were collected during years 2001 and 2002 in General Hospital of Virovitica and surrounding health care centres. During that period total of 8729 samples had been taken, 597 of which from patients using IUD. Results. Actinomyces positive smears were found in 104 (17%) of women using IUD and in 36 (0.44%) patients who did not use IUD. Conclusion. The incidence of Actinomyces is scarce. It is more frequent in the presence of IUD. In addition, this study shows the value of cytology as a method of choice in detection of Actinomyces.

Key words:
actinomycosis, intrauterine device (IUD), Papanicolaou smear (PAP), pelvic infection


OTVORENO PISMO HRVATSKOM DRUŠTVU ZA PERINATALNU MEDICINU HRVATSKOGA LIJEČNIČKOG ZBORA (Vol.13 No.1,str.34-35)

Authors:

Josip Grgurić

Letter to the editors

Summary:
*

Key words:
*


ODGOVOR NA OTVORENO PISMO PROF. GRGURIĆA (Vol.13 No.1, str.35-36)

Authors:

Zlata Beer, Ante Dražančić

Leters to the editors

Summary:
*

Key words:
*


Lidija Andolšek-Jeras (Vol.13 No.1, page 37-37)

Authors:

Ljiljana Randić

In Memoriam

Summary:
*

Key words:
*


Mjesto održavanja kongresa: Hotel President****, Split, Starčevićeva 1, www.hotelpresident.hr/split
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