Introduction. Retroperitoneal ectopic pregnancy is extremely rare, but potentially fatal condition due to possible massive hemorrhage, representing a great challenge to clinicians. Case report. We ...presented early retroperitoneal pregnancy in a patient with previous caesarean section, diagnosed at the sixth gestational week, located in the left broad ligament, primary treated by laparoscopy, which had to be converted to laparotomy due to massive intraoperative bleeding from the implantation site. Conclusion. High index of suspicion, combined with carefully interpreted clinical and ultrasound findings are crucial for the timely diagnosis of retroperitoneal pregnancy, before the occurrence of severe bleeding. The rising, even plateau of serum ?-human chorionic gonadotropin (?-HCG) levels without identification of uterine or ectopic (tubal) pregnancy should cause suspicion on ectopic pregnancy in unusual location.
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The aim of this paper was to present the role of human papillomavirus (HPV) in cervical carcinogenesis from several aspects. By explaining the HPV virus lifecycle and structure, its effect on ...cervical cell cycle and subversion of immune response can be better understood. Early E region of the viral genome encodes proteins that are directly involved in carcinogenesis. The E6 protein binds to p53 protein (product of tumor-suppressor gene) blocking and degrading it, which in turn prevents cell cycle arrest and apoptosis induction. E6 is also capable of telomerase activation, which leads to cell immortalization; it also reacts with host proto-oncogene c-jun, responsible for transcription, shortens G1 phase and speeds up the transition from G1 to S phase of the cells infected by HPV. E7 forms bonds with retinoblastoma protein (product of tumor-suppressor gene) and inactivates it. It can inactivate cyclin inhibitors p21, p27, and abrogate the mitotic spindle checkpoint with the loss of protective effect of pRB and p53. The immune system cannot initiate early immunological reaction since the virus is non-lytic, while the concentration of viral proteins--antigens is low and has a basal intracellular position. Presentation through Langerhans cells (LC) is weak, because the number of these cells is low due to the effect of HPV. E7 HPV reduces the expression of E-cadherin, which is responsible for LC adhesion to HPV-transformed keratinocytes. Based on these considerations, it may be concluded that the process of cervical carcinogenesis includes viral, genetic, cellular, molecular-biological, endocrine, exocrine and immunological factors.
Female patients who underwent ceratin treatment forms of cervical intraepithelial neoplasia (CIN) are at five times greater risk for disease relapse in comparison to the rest of female population. ...The aim of the study was to investigate validity of human papillomavirus (HPV) typization and cytology in detection of relapse. METHODS; The prospective clinical investigation included 35 patients with relapse and 30 ones without it after adequate treatment of cervical intraepithelial neoplasia. HPV typization using PCR methods and cytological test (conventional Pap smear) were performed in all the patients. Validation of tests applied was performed by determining their sensitivity, specificity, and positive and negative predictive value.
More severe degrees of CIN relapse occur significantly more often in patients which remain HPV positive despite of the treatment. The patients which remain positive on HPV type 18 or, on both HPV types 18 and 16, have more often CIN relapses of more severe degree in relation to those just positive on HPV type 16. HPV typization has higher predictive value for diagnosis of the rezidual disease in older patients. Sensitivity of HPV typization for diagnosis all CIN relapse degrees is 68.57%, for more severe degrees (HSIL and MIC) 90.47%, specificity is 93.33%, while positive and negative predictive values are 90.47% and 93.53%, respectively. Sensitivity of cytology for diagnosis of more severe CIN relapses is 80.95%. HPV typization used along with cytology ofters the highest sensitivity (95.23%).
Both tests, HPV typization and Pap smear, offer satisfactory sensitivity and high specificity in detection of relapse, parcticularly those with more severe degree. The highest sensitivity in detection of CIN relapse is obtained by using both tests.
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The incidence of preinvasive changes in the cervix is constantly rising. It is particularly alarming that there is a larger number of younger patients in whom some stage of these changes has been ...diagnosed or who had already received some type of treatment before. Technological development and improvement of various forms of treatment have lead to changes in the surgical approach to intraepithelial lesions of the cervix. The techniques that have been developed for this purpose, besides the coldknife conization, include loop excision, radio wave conization, laser conization and, recently, the conization by Harmonic scalpel. The question that inevitably arises is: Has the technological development led to more conservative approaches and improvement in the results of surgical treatment? This paper will try to partly answer this question and initiate some new questions and dilemmas. A comparative review of all of the abovementioned surgical techniques and their detailed analysis is expected to provide at least some answers to the controversial opinions for and against the new surgical procedures. The results of surgical treatments and their complications were analyzed with particular emphasis on the influence that these methods have on fertility. The conclusion is that there is no ideal surgical procedure which could replace and neglect the experience of a colposcopist. New surgical techniques have brought more surgical comfort and faster recovery but have not demonstrated significant change in the final results of treatment and recurrence.
Incidenca preinvazivnih promena grlića materice je u stalnom porastu. Ono što je posebno zabrinjavajuće je da sve veći procenat bolesnica mlađe starosne dobi ima dijagnozu nekog od stadijuma ovih promena ili je već imala neki od vidova lečenja. Sa razvojem tehnologije i usavršavanjem različitih vidova lečenja došlo je i do promena u operativnom pristupu intraepitelnih lezija grlića materice. Uporedo sa klasičnom konizacijom nožem, razvijala se i tehnika Loop excizia, konizacija radiotalasima, konizacija laserom i u novije vreme konizacija ultrazvučnim nožem. Ono što se nameće kao pitanje je da li je razvoj tehnologije doveo do konzervativnijeg pristupa i boljitka u hirurškim rezultatima lečenja? Ovaj rad će pokušati da delimično odgovori na ovo pitanje i da pokrene neka nova pitanja i dileme. Uporednim prikazom svih gore pomenutih hirurških tehnika i njihovom detaljnom analizom očekujemo da dobijemo bar neke odgovore na kontraverzne stavove - za i protiv novih hirurških procedura. Analizirali smo rezultate hirurškog lečenja i njihove komplikacije, sa posebnim akcentom na uticaj ovih metoda na fertilnost. Došlo se do zaključka da ne postoji idealna hirurška procedura koja će zameniti i zanemariti iskustvo lekara kolposkopičara. Nove hirurške tehnike su dovele do većeg operativnog komfora, bržeg oporavka bolesnica, ali nisu bitno pro-menile ukupne rezultate lečenja i pojavu recidiva.
Introduction: Endometrial cancer is the second most common gynecological tumor. There is still no recommended screening method for endometrial cancer. The application of transvaginal sonography, ...hysteroscopy and Pap test may prove useful in screening for this disease. Atypical glandular cells represent an important finding in Pap tests and they are related to histopathological verification of the endometrium. The aim of the study was to determine the usefulness of the Pap test in assessing the cervical infiltration, as well as to determine the significance of hormonal status and histopathological type of tumor in a pathological Pap test in patients with endometrial cancer.Methods: The study was retrospective. The analysis included the data obtained from 62 operated patients diagnosed with enometrial cancer, medical history (menopausal status), histopathological findings after surgery (type and stage of the disease) and a preoperative Pap smear. The chi squared and Fisher’s test were used.Results: The difference in the prevalence of pathological Pap test in premenopausal and postmenopausal group of patients was not statistically significant. The difference in the prevalence of pathological Pap test in the group of endometrioid and non-endometrioid tumours of the uterine corpus had statistical significance. The difference in the prevalence of pathological Pap test compared to the present stage (I and II) was not statistically significant.Conclusion: Pap smear does not correlate with menopausal status in women with endometrial carcinoma. Abnormal Pap test is more commonly found in cases of non-endometroid tumours. Pap smears cannot beused to assess cervical involvement.
Bethesda system of classification of cytological findings was introduced in 2001 two subcategories in the category of atypical squamous cells (ASC) findings: ASC of undetermined significance (ASC-US) ...and ASC which cannot exlude high-grade intraepithelial lesions (ASC-H). The aim of our study was to assess a possible association of these two subcategories with pathologic biopsy finding and to find out the best further diagnostic proceedings.
At the Clinic of Gynecology and Obstetrics, Nis 130 patients with ASC findings were analyzed. Colposcopy was performed in all study participants. Patients with pathological colposcopic findings underwent cervical biopsy. In 10 patients with pathologic histologic and 15 with benign findings human papilloma virus (HPV) typization was done using the Hybrid Capture method.
Patients with ASC-H finding had significantly more pathologic biopsies compared with patients with ASC-US finding (57.84: 20.72).
Colposcopy was exhibited somewhat higher sensitivity compared to HPV typization (94.7 : 90), but lower sensitivity (79.27 : 86.6). The usage of HPV typization in the triage of patients with ASC cytologic smear induces statistically significant reduction of unnecessary percentage of cervical biopsies.
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Shoulder dystocia (SD) is defined as unpredictable and urgent obstetric complication that happens when the pelvis of a mother is spread sufficiently to deliver fetal head, but insufficiently to ...deliver fetal shoulders. It is associated with high percentage of maternal and fetal morbidity. Fetal lethality from hypoxia ranges from 2-16%.We observed the case of vaginal delivery in a multiparous woman in the 39th gestational week. Head delivery was performed by using vacuum extraction. Because of the shoulder dystocia, we applied McRoberts’ maneuver with Resnik’s suprapubic pressure and performed one more episiotomy. Since these maneuvers did not give the expected result, we did the aspiration of the upper respiratory paths of the fetus, after which we performed Hibbard’s cord with simultaneous Kristeler’s maneuver. It led to releasing the shoulders and fetal delivery. On delivery, male fetus was 6000 g/60 cm, estimated with Apgar 1. The urgent reanimation was undertaken. After few hours, the baby was transferred to Pediatric Surgical Clinic for further treatment of present pneumotorax and humerus fracture. After many days, the baby being in normal state, was referred to physical rehabilitation treatment. Today, the baby is without sequelae.SD is one of the most difficult, hardly predictable perilous obstetric complications with high percentage of maternal morbidity and fetal morbidity and mortality. It requires caution, training and skills of obstetric-neonatal team. Liberalization of the use of Caesarian section in managing SD decreases the appearance of injuries in both mother and child. However, regardless of very rapid development of perinatology and the use of modern diagnostic-therapeutic protocols, some questions from classical, practical obstetrics remain unanswered.
Introduction. It has been generally accepted that the benefits of menopausal hormone therapy outweigh the risks, but there are still some concerns about the administration of menopausal hormone ...therapy, which has introduced alternative treatments. Pharmacological Alternatives. Central alpha-2 agonist clonidine is only marginally more effective than placebo, and significantly less effective than estrogen. Antiepileptic drug gabapentin reduces hot flashes; however, it is less effective than estrogen. Selective serotonin reuptake inhibitors (paroxetine and fluoxetine) and selective noradrenaline reuptake inhibitors (venlafaxine) reduce vasomotor symptoms and improve depression, anxiety and sleep. Results of studies about dehydroepiandrosterone effects on menopausal symptoms are inconsistent and additional investigations are needed. Non-Pharmacological Alternatives. Stellatum ganglion blockade is a successful treatment for reducing vasomotor symptoms in patients with contraindications for menopausal hormone therapy. Efficacy of acupuncture, homeopathy and reflexology should be proved by adequate studies. Phytoestrogens could reduce vasomotor symptoms but to a lesser extent than conventional menopausal hormone therapy. However, they have not been proved yet to provide cardiovascular protection and prevention of osteoporosis, nor they could be recommended instead of traditional menopausal hormone therapy. There is a concern about their undesirable effects. Adequate diet, unchanging body weight within ideal values and adequate physical activities have beneficial long-term effects, first of all on preservation of bone density. Alternatives for Atrophic Changes of Vaginal Epithelium. Menopausal symptoms resulting from vaginal atrophy could be resolved by use of hydrophilic preparations, lubricants and topical lidocaine cream or 4% lidocaine water solution for dyspareunia. Conclusion. If there are contraindications to menopausal hormone therapy or patients are unwilling to take hormone therapy, alternative treatments, which can also solve menopausal symptoms, should be considered. Key words: Estrogen Replacement Therapy; Perimenopause; Complementary Therapies; Treatment Outcome; Pharmaceutical Preparations; Phytoestrogens Uvod. Generalno je prihvaceno da korist od hormonske terapije u menopauzi prevazilazi rizik kod adekvatno izabranih pacijentkinja, a ipak postoji zabrinutost koja prati upotrebu hormonske terapije u menopauzi, sto je i dovelo do pojave alternativnih tretmana. Farmakoloske alternative. Centralni alfa-2-agonist klonidin je samo marginalno efikasniji od placeba, a znatno manje od estrogena. Antiepileptik gabapentin redukuje talase vrucine, ali manje uspesno od estrogena. Selektivni inhibitori preuzimanja serotonina (fluoksetin i paroksetin) i inhibitori preuzimanja serotonina-epinefrina (venlafaksin) redukuju vazomotorne simptome, popravljaju depresiju, anksioznost i kvalitet sna. Rezultati ispitivanja efekata dehidroepiandrosterona na simptome menopauze su nekonzistentni i potrebne su dodatne studije. Nefarmakoloske alternative. Blokada gangliona stelatum uspesno resava vazomotorne simptome pacijentkinja sa kontraindikacijama za primenu hormonske terapije u menopauzi. Efikasnost akupunkture, homeopatije i akupresure tek treba da se dokaze. Fitoestrogeni mogu da redukuju vazomotorne simptome, ali u manjoj meri od konvencionalne hormonske terapije u menopauzi. Za sada nema adekvatnih dokaza za povoljan efekat na kardiovaskularni sistem i sprecavanje osteoporoze, niti da se preporucuju umesto tradicionalne hormonske terapije u menopauzi. Postoji bojazan od nezeljenih dejstava. Pravilna ishrana, stabilna telesna tezina u idealnim granicama i adekvatna fizicka aktivnost imaju povoljne dugorocne efekte, najpre na ocuvanje gustine kosti. Alternativni tretmani atroficnih promena epitela vagine. Simptome menopauze koji su posledica atroficnih promena je moguce kupirati vaginalnom upotrebom hidrofilnih preparata, lubrikanata i lidokaina u obliku krema ili 4% rastvora za dispareuniju. Zakljucak. Ako postoje kontraindikacije za hormonsku terapiju u menopauzi ili pacijentkinja ne zeli da uzima hormone, treba razmatrati alternativne mogucnosti koje takode mogu da pomognu u kupiranju simptoma menopauze. Kljucne reci: estrogenska supstituciona terapija; perimenopauza; alternativne terapije; ishod lecenja; farmakoloska terapija; fitoestrogeni
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ALTERNATIVES OF MENOPAUSAL HORMONE THERAPY Kutlesic, Ranko M; Popovic, Jasmina; Stefanovic, Milan ...
Medicinski pregled,
10/2016, Volume:
69, Issue:
5-6
Journal Article
Peer reviewed
Open access
It has been generally accepted that the benefits of menopausal hormone therapy outweigh the risks. but there are still some concerns about the administration of menopausal hormone therapy, which has ...introduced alternative treatments. Pharmacological Alternatives. Central alpha-2 agonist clonidine is only marginally more effective than placebo, and significantly less effective than estrogen. Antiepileptic drug gabapentin reduces hot flashes; however, it is less effective than estrogen. Selective serotonin reuptake inhibitors (paroxetine and fluoxetine) and selective noradrenaline reuptake inhibitors (venlafaxine) reduce vasomotor symptoms and improve depression, anxiety and sleep. Results of studies about dehydroepiandrosterone effects on menopausal symptoms are inconsistent and additional investigations are needed. Non-Pharmacological Alternatives. Stellatum ganglion blockade is a successful treatment for reducing vasomotor symptoms in patients with contraindications for menopausal hormone therapy. Efficacy of acupuncture, homeopathy and reflexology Should be proved by adequate studies. Phytoestrogens could reduce vasomotortymptoms but to a lesser extent than conventional menopausal hormone therapy. However, they have not been proved yet to pro-ide cardiovascular protection and prevention of osteoporosis. nor they could be recommended instead of traditional menopausal hor-one therapy. There is a concern about their undesirable effects. Adequate diet, unchanging body weight Nwthin ideal values and adequate physical activities have beneficial long-term effects, first of all onlpreservation of bone density Alternatives for Atrophic Changes of Vaginal Epithelium. Menopausal symptoms resulting from vaginal atrophy could be resolved by use of hydrophilic prep- arations, lubricants and topical lidocaine creamn r 4% lidocaine water solution for dyspareunia.
If there are contrain-ications to menopausal hormone therapy or patients are unwilling to take hormone therapy, alternative treatments, which canlalso solve menopausal symptoms, should be considered.
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