Current Issue - new design

 
 

Recommendation

Bolesti štitnjače u trudnoći

 

Read more...

Lijekovi u trudnoći i laktaciji

Read more...

 

Vol.20 No.3

Date: August 2011.

CONTENT:

LAPAROSCOPIC PELVIC LYMPHADENECTOMY IN THE TREATMENT OF ENDOMETRIAL CANCER (Vol.20 No.3, str.120-124)

Authors:

Herman Haller,1 Stanislav Rupčić,1 Ozren Mamula,1 Miroslav Stamatović,1 Maja Krašević,2 Senija Eminović,2 Marko Klarić,1 Alemka Brnčić-Fischer,1 Miljenko Manestar,1 Danko Perović1

Original paper

Summary:
Objective. The purpose of this retrospective study was to assess at the Department of Obstetrics and Gynecology of Rijeka the effect of increasing experience in the laparoscopic management of women with endometrial cancer. Methods. Sixty-three women with endometrial cancer and imaging predicting myometrial invasion less than half uterine wall underwent laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection using the same technique and instruments over a period of 7 years (2004–2010). The patients were divided into three equal groups based on the date of surgery. The three groups were compared with regard to patient’s characteristics and surgical outcome. Results. The three groups were similar in patient’s characteristics. There was no significant difference in the established amount of hemoglobin decrease, FIGO stage and need for adiuvant therapy among the three groups. There was a significant decrease in operating time between the first and second group (means: 138 min for the first period vs 111 min. for the second period, P=0.023), while between the second and third group there was no further significant decrease in operating time (means of the third group was 109 minutes, second vs. third group P = 0.849). The number of removed lymph nodes were almost equal in all three periods (17,7 in the first period vs 16,2 in the second and 14.2 in the third period). There were no recurrence, neither disease death related. Conclusion. In the laparoscopic management of women with endometrial cancer the learning curve was seen only in the operating time. We also observed that after a certain number of procedures there was no further decrease in operating time.

Key words:
endometrial cancer, laparoscopic pelvic lymphanedectomy


CONTROLLED OVARIAN STIMULATION FOR IN VITRO FERTILIZATION (Vol.20 No.3, str.125-133)

Authors:

Branko Radaković, Marko Kisić

Review

Summary:
Controlled ovarian stimulation (COS) has become a key component of assisted reproductive technologies (ART). For 25 years COS has been applied with aim to increase the number of oocytes in order to compensate for inefficiencies of the in vitro fertilization (IVF) procedure, enabling the selection of one or more embryos for transfer. During that period a long gonadotrophin-releasing hormone (GnRH) agonist pituitary supression regimen, combined with relatively high doses of exogenous follicle-stimulating hormone (FSH), remains the most frequently used stimulation protocol. This medication regimens for ovarian stimulation are complex and expensive. Such regimens are associated with risk of complications such as ovarian hyperstimulation syndrome (OHHS) and multiple pregnancies (MP), of emotional stress and high drop-out rates. In 1996 Edwards was the first to express concern with regard to contemporary ovarian stimulation aopproaches for IVF and called those milder stimulation protocols. The aim of mild stimulation is to develop safer and more patient-friendly protocols in which the risks of treatment are minimized. Increased efficacy of IVF laboratory procedures and current tendency to limit the number of embryos transferred, has reduced the need for large quantities of oocytes. Supportive evidence regarding a potentially negative effect of supraphysiological steroid levels on endometrial receptivity, corpus luteum function, oocyte and embryo quality indicate that limited ovarian stimulation and response might have a benefical effect upon implantation potential of embryos. Today, recombinants and urinary gonadotropines are used for COS in IVF procedure, while GnRH agonists and antagonists are used for prevention of premature increase of endogenous luteinizing hormone (LH). In patients with normal response on COS, success of procedure doesn’t depend on the type of gonadotropines and GnRH analogues being used. Introduction of GnRH antagonists in clinical practice ensured higher success rates of IVF in modified natural cycle, but also a wider application of mild and milder COS protocols. In view of favorable efficacy, safety and tolerability profile, GnRH antagonists should be applied more often in modern, patient-friendly IVF. In clinical trial data and meta-analyses, treatment with these agents is associated with similar live birth rates but reduced treatment burden and less risk of OHSS and MP, compared with GnRH agonist long protocols. GnRH may also be associated with reduced psychological distress compared with agonist. In view of favorable efficacy, safety and tolerability profile GnRH antagonists should be considered as a first-line therapeutic option in modern, patient-friendly ART treatment for COS.

Key words:
controlled ovarian stimulation, in vitro fertilization, gonadotropins, GnRH agonists, antagonists


NEW PERCEPTIONS IN EPISIOTOMY (Vol.20 No.3, str.134-139)

Authors:

Matija Prka, Dubravko Habek

Review

Summary:
Episiotomy is obstetrician’s surgical procedure of perineal incision and it is done as prophylaxis against softtissue trauma of perineal region. According to prevalence it represents second surgical procedure in the world at all, following another surgical procedure from our profession, clamping and cutting the umbilical cord. During last 30 years obstetricians and midwifes around the world keep asking continuously significance and meaning of episiotomy. As a result, routine (liberal) episiotomy has been excluded from clinical practice, and full affirmation got restrictive (selective) episiotomy, based on strict medical indications. World’s perinatal societies consider that episiotomy percent could not be over 30% in tertiary perinatal centers with higher number of complicated pregnancies and deliveries, since in primary and secondary grade delivery rooms this percent could not be over 10–20%. Continuous intracutaneous suture with fast-absorbing polyglactin 910 today is the »gold standard« in episiotomy repair (midline or mediolateral).

Key words:
episiotomy, midline/mediolateral episiotomy, episiotomy repair, continuous intracutaneous suture, fast-resorbing polyglactin 910


ULTRASONOGRAPHY OF THE HIP IN PRETERM NEONATES (Vol.20 No.3, str.140-144)

Authors:

Vesna Vukelić,* Javor Vrdoljak,** Emilja Juretić,* Snje`ana Gverić-Ahmetašević,* Ana Čolić,* Iva Kulić,* Ozren Vrdoljak***

Professional paper

Summary:
Developmental dysplasia of the hip (DDH) is the most frequent congenital deformation of skeleton-joints system. DDH represents disturbance of the anatomical relations in the joint – most often undeveloped acetabulum with or without instability or deranged relations of the joint parts. It occurs in prenatal and postnatal age. Aim. We wanted to determine incidence of abnormal hips in premature newborns, whether they present newborn population with risk for DDH and therefore whether they should be included in nonselective screening. Methods. Ultrasonographic examinations by method of Graf were performed in 336 premature newborns in period from October 2005 till September 2006 in the University Hospital for Gynecology and Obstetrics, University Hospital Center Zagreb (91,3% of all premature infants born during that period). Results. 92,6% of examined hips had normal ultrasonographic findings Graf type Ia/Ib. 43 (6,4%) of the hips were immature type IIa+, and 7 (1,0%) were classified as dysplastic hips type IIc/IId. In examined population we have not found abnormal findings types III or IV. Follow up examinations in the age 4 to 6 weeks were performed in newborns with DDH findings at first examination (ultraonograms IIa+ or more by Graf). 85,7% of abnormally formed hips at first examination spontaneously normalized in Ia/Ib. Based on our investigation, we concluded that premature newborns belong to population with risk for DDH and should be included in nonselective screening.

Key words:
developmental dysplasia of the hip, premature newborns, ultrasonographic examinations by method Graf


EXPERIENCE WITH CORDOCENTESIS IN THE THREE YEAR PERIOD AT WOMEN’S HOSPITAL OF HAMAD MEDICAL CORPORATION IN DOHA QATAR (Vol.20 No.3, str.145-149)

Authors:

Badreldeen Ahmed, Zohra Hasnani-Samnani

Profesional papers

Summary:
Aim. To describe the clinical value of cordocentesis in the diagnosis and management of patients in the 2nd and the 3rd trimester of pregnancy. Patients and methods. Average maternal age at the time of cordocentesis was 29 years. The only indication was rapid karyotyping in severely malformed or intrauterine growth restricted (IUGR) fetuses with or without polyhidramnios, oligohydramnios or anhydramnios. Results. In 7 out of 31 patients intrauterine fetal death unrelated to the procedure occurred. Out of 24 fetuses 19 were live-born, 8 of whom died postnatally, while 5 have been lost from the follow-up. Vaginal delivery occurred in 14 out of 19 live-born neonates, 10 out of 19 were delivered preterm, and 13 out of 19 were admitted to the neonatal intensive care unit (NICU). Besides transient bradycardia in 11 out of 31 fetuses other post procedural complications were not observed. Chromosomal abnormalities were detected in 5 out of 31 patients (three trisomies 18, one trisomy 21 and one trisomy 13). Conclusion. Cordocentesis is a safe procedure for karyotyping in the middle and late pregnancy when indicated. Fetal transient bradycardia has been the only complication observed, while seven deaths were related to the condition of the fetus and not to the procedure itself..

Key words:
cordocentesis, rapid karyotyping, chromosomal abnormalities, intrauterine fetal death


»SVETI DUH« HOSPITAL DELIVERY WARD 1959.–1964. (Vol.20 No.3, str.150-156)

Authors:

Dubravko Habek, Ljubica Špoljarić, Matea Klikić

Original paper

Summary:
The first Zagreb maternity ward was opened in 1871 at the »Brothers of Charity Hospital« and worked for only a few years, then again for a short period during 2nd World War on a temporary location at the »Rebro Endowment Hospital«. The first permanent maternity department was opened on August 1, 1959 at »Sveti Duh« Hospital, working up to the present. Data on department organization and working conditions, first physicians and professional activities (perinatal indicators, obstetric operations, maternal morbidity and mortality) during the first five years (1959–1964) are analyzed. During the study period, Mladen Bival, MD, was head of the Department, with Dr Mileva [tigli}, Dr Davor S. Zanella, Dr Nikola Kljai}, Dr Vladimir Nöthig, Dr Lovro Dulibi} and Dr Vlado Radovi} working at Department as specialists/residents. According to the incomplete obstetric documentation, during the 1959–1964 period 5534 deliveries were performed, including 67 (1.2%) twin births, 284 (5.1%) preterm neonates and 63 (1.1%) stillbirths. There were 47 (8.5‰) early neonatal deaths and 25 (4.5‰) fetuses died sub partu. Hypertensive disease in pregnancy accounted for considerable maternal morbidity and two maternal deaths: one from decompensated cardiomyopathy and another from cardiac arrest during cesarean section, probably of anesthesiologic causation. Evaluation of neonatal viability according to Apgar was adopted; endotracheal intubation at resuscitation was introduced as well. The rate of episiotomy ranged from 28.3% (1961) to 49.6% (1964), and of cesarean section from 1% to 2.1%. The first vacuum extraction was performed on May 10, 1963; the rate of this procedure ranged from 3.5% in 1963 to 6.4% in 1964. Until then, forceps extraction was performed at a rate of 2%–3.2%. The rate of manually assisted breech delivery through birth canal according to Bracht or by classic approach was 2.8%–4.2%. Metreurysis or colpeurysis was employed in bleeding placenta previa, at prolapse of the cord, incision of the cervix, fetal rotation and extraction in case of oblique and transverse positions. Repositioning of prolapsed hand and cord, and six embryotomies performed on dead fetuses were recorded. Professional data on the beginning of maternity department at »Sveti Duh« Hospital from 1959 are presented, revealing that perinatal activities, professional characteristics and dynamics of introducing novel methods in obstetric routine were comparable with those from other maternity departments. During the 50-year period, the tradition of continuous obstetric activities at »Sveti Duh« Hospital has resulted that the maternity ward has developed into a tertiary perinatal center.

Key words:
obstetrics, history, delivery wards, Zagreb


SURGICAL TREATMENT OF CORNUAL PREGNANCY AFTER PREVIOUSLY ONE TREATED BY METHOTREXATE: CASE REPORT AND LITERATURE REVIEW (Vol.20 No.3, str.157-161)

Authors:

Marko Kisić, Branko Radaković*

Case report

Summary:
Cornual or interstitial pregnancy is a rare form of ectopic pregnancy with a significant mortality rate. The report concerns a recurrent spontaneous cornual pregnancy two years after a cornual pregnancy diagnosed as missed abortion which was successfully treated by the systemic application of methotrexate (MTX). After a lack of success by MTX therapy, recurrent corneal pregnancy was successfully treated laparoscopically. Although conservative medical and surgical methods of management are showing good outcomes, these methods do not protect against recurrence. Conservative medicamentous therapy with parenteraly applied methotrexate in cases of cornual pregnancy with early diagnosis and nonviable fetus, provides the possibility of successful treatment and outcome. In cases with viable fetus or unsuccessful treatment with methotrexate, laparoscopic removal of cornual pregnancy is the therapy of choice.

Key words:
recurrent cornual pregnancy, interstitial pregnancy, methotrexate, laparoscopy


LEIOMYOMATOSIS PERITONEALIS DISSEMINATA – A CASE REPORT (Vol.20 No.3, str.161-163)

Authors:

Tonči Visković,* Rajko Fureš,* Mirela Čarapina,** Danijela Batas,* Igor Maričić*

Case reports

Summary:
Leiomyomatosis peritonealis disseminata (LPD) is a rare but well documented disorder mainly found in woman in reproductive period. It is characterized by multiple small nodules on the peritoneal surface, mimickring a malignant process, but demonstrates benign histologic features. It is usually an incidental finding during procedures such as laparoscopy, cesarean section, laparotomy, tubal ligation etc.Etiology is unknown but LPD seems to be a multifactorial disease with a genetec or hormonal component (high levels of estrogen and progesterone) leading to metaplasia of peritoneal mesenchymal cells. There is evidence to suggest that LPD is a product of a hormonal imbalance. When LPD occurs during pregnancy or during the use of birth control pills (contraceptive pills), it may regress spontaneously after delivery or discontinuation of the use of the pills. In this paper we report a case of LPD in a pregnat woman, who has been using birth control pills for three years between two pregnacies..

Key words:
disseminated leiomyomatosis peritonealis, pregnancy


Dževad Džanič, Andreas Roth i sur. MIKROINVAZIVNA KIRURGIJA U GINEKOLOGIJI (Vol.20 No.3, str.164-166)

Authors:

Ante Dražančić*

Book review


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