[The effect of maternal smoking on pregnancy outcome]. / Utjecaj majcina pusenja na ishod trudnoce.

The aim of the study was to determine the influence of smoking on the pregnancy outcome. The retrospective study was based on the original database made at the Department of Gynecology and Obstetrics, Medical School, University of Rijeka, in the period between 1987 and 1997. In the mentioned period we analysed 37,417 total singleton births out of which there were 1,685 (4.5%) preterm and 35,732 (95.5%) term births, as well as 1,739 (4.6%) hypotrophic and 35,678 (95.4%) eutrophic newborns. The analysis of smoking during the whole pregnancy on the gestation outcome was performed in 9,895 (26.4%) parturient smokers and 27,522 (73.6%) parturient nonsmokers (control group). The frequency of preterm and/or term delivery, intrauterine fetal growth retardation, Apgar score, birth weight, as well as morbidity and perinatal mortality, were analysed in both groups. The frequency of preterm deliveries was 5.4% (n = 529) in parturient smokers and 4.2% (n = 1,156) in parturient nonsmokers. This difference is statistically significant (p < 0.001). The frequency of hypotrophic newborns born to parturient smokers (n = 631 or 6.4%) was statistically significantly higher (p < 0.001) compared to the frequency of hypotrophic newborns (n = 1,108 or 4.0%) born to parturient smokers. The obtained results point to the importance of chronic smoking during pregnancy as a risk factor in the development of maternal and/or fetal complications.

[Premalignant and malignant lesions of the uterine cervix--personal experience]. / Premaligne i maligne lezije grlica materice--nasa iskustva (1993-1997).

INTRODUCTION: Cervical pathology represents the most frequent cause of mortality and morbidity in regard to female genital diseases in Serbia. The aim of this study was to establish the occurrence and grade of histopathologic lesions by examination of cervical biopsy specimens taking into consideration the patient's age and knife conization as a diagnostic-therapeutic procedure. The study included a period of 1993-1997 at the Department of Gynecology and Obstetrics of the Health Center in Sremska Mitrovica. MATERIAL AND METHODS: Criteria for biopsy were: colposcopic or naked eye evaluation of lesions and Papanicolaou smear grade III or higher. Conization was not performed in cases with: low grade squamous intra-epithelial lesion (L-SIL) with HPV (human papillomavirus) and high grade squamous intra-epithelial lesion (H-SIL) or microinvasive Ca (< 5 mm without distribution by lymph or blood). None of the patients had undergone biopsy before. RESULTS AND DISCUSSION: Our results show high occurrence of malignancy, mainly of invasive type. In elder patients all grades of pathologic lesions were established, whereas knife conization showed high efficacy. Although patients might be exposed to risk factors predominantly in their older age, it is evident that public knowledge is poor, while physician-patient relationship is unsatisfactory. CONCLUSION: In accordance with reported, it can be concluded that there is a great need for public health education as well as improvement of secondary health care in the long run.

[Counseling protocol for early cancer detection at the Women's Health Center in Ruma]. / Protokol rada savetovalista za rano otkrivanje raka dispanzera za zdravstvenu zastitu zena Doma zdravlja Ruma.

INTRODUCTION: Women's health care office in Ruma Health Center provides health care for women of Ruma and Irig communities. According to census in 1991, Ruma community has 55.063 inhabitants; 28.266 women out of which 13.149 are of reproductive age. Irig community, has 11.696 inhabitants, 6.072 women and 2.526 are of reproductive age. PROTOCOL: According to protocol each woman who consults her gynecologist, is thoroughly examined. The overall examination included the following: anamnesis in regard to risk factors for malignant diseases of female genital organs and breast, speculum examination, cytologic smear, colposcopy, palpatory examination of breast gynecological palpatory examination. On the basis of gathered results, further examinations, if necessary, were carried out: cervical biopsy, endocervical curettage, ultrasound examination, mammography and so on. Two groups of patients were formed on the basis of gathered results--high-risk group and "no-risk" group of patients with no risk from malignant disease. The high-risk group of patients has a separate file and is actively controlled; if necessary this group is called for check-ups at intervals from six months to a year periods. The group of "no-risk" patients is controlled once in a three-year period. FORMING THE HIGH-RISK GROUP: High-risk group in regard to a malignant disease of the cervix is formed on the basis of the following findings: 1. Positive family history (mother, aunt, sister, etc.). 2. Positive personal history (positive sexual factor, early sexual relations, early marriage, more sexual partners, more marriages, bad sexual hygiene, human papilloma virus infection (HPV), herpes simplex virus infection, bad living and social conditions, smoking, intra-uterine and oral contraception, immune suppression, and human immune deficiency virus infection (HIV). 3. Positive clinical findings: chronic cervicitis, condylomas. 4. Positive laboratory findings: positive cytological smear, all atypical colposcopic findings, all histopathological findings of precancerous, high oncogenes groups of HPV. 5. Detected cases of malignant disease of the cervix uleri. Cervical biopsy is performed in each woman with positive cytologic and colposcopic findings. Histopathological findings are done according to Bethesda system. HPV classification according to type is done with LSIL changes, and if a high oncogenes HPV type is obtained, women require conisation of the cervix uteri. With HSIL changes, women require cervix conisation. Invasive forms of cervix uteri malignant disease, require treatment in Oncology Institute. High-risk group for endometrial and breast carcinomas is formed on the basis of positive family and personal history, positive clinical and laboratory findings. High-risk women have separate files (marked with "R") and if necessary they are asked for additional check-up. RESULTS: In the framework of the Office for early cancer detection the Cancer Registry (2,3) contains the following: personal data, address, date of disease detection, diagnosis and the disease stage, way of treatment, outcome and a questionnaire on risk factors. Morbidity of precancerous and malignant diseases of female genitalia and breast as well as mortality will be monitored in the forthcoming period. CONCLUSION: We consider the Protocol of work of the Office for early detection of cancer to be an acceptable and compulsory model for protection of women by existing public health services. 1. Each woman who comes to see her gynecologist for examination, should be systematically examined; the risk of malignant disease and necessary further examinations also must be determined. 2. An accurate file on high-risk group must be kept and women should be actively called to come for check-ups, unless they do it in an appointed period--one year at the latest. 3. Women should be kept informed, through local media, about the importance of overall examinations and risk factors for malignant diseases in women. 4.

[Dermatofibrosarcoma protuberans: case report]. / Dermatofibrosarcoma protuberans: prikaz slucaja.

OBJECTIVE: Dermatofibrosarcoma protuberans (DFSP) is a relatively rare, slow-growing, fibrohistiocytic sarcoma of intermediate malignancy. The tumor appears most frequently on the trunk and extremities as a slow-growing indurated plaque or nodule. It appears mostly between the second and fifth decades of life. METHODS: This is a case presentation of a 59-year-old woman with a 10 x 12 cm dermal erythematous plaque on the anterior chest wall. RESULTS: The patient has a two year history of painless tumor on the chest. The lesion started as a small erythematous plaque and gradually increased in size. At that time the histologic examination revealed a benign fibrous histiocytoma. Less than two years later the lesion was firm, painless to palpation and movable over deeper structures. The second histologic examination revealed a myxoid liposarcoma. The third incisional biopsy was diagnostic for DFSP showing a dermal tumor consiting of a storiform pattern with cartwheel-like cells arranged around collagenous hubs. The patient underwent a standard surgical treatment. CONCLUSION: We report an interesting case of dermatofibrosarcoma protuberans where limitations of standard vertical histology section resulted in postponed conformation of the diagnosis.

[Perineal endometriosis at the site of an episiotomy scar]. / Perinealna endometrioza na mestu oziljka od epiziotomije.

This study presents a case of vaginoperineal histologically verified endometriosis at the site of episiotomy scar in a 40-year female subject, 17 years after delivery. Apart from episiotomy during delivery manual revision of the uterus was performed and the cervical rupture managed. Residue symptoms occurs 8 months after the first surgical excision. Clinical data indicate that decidua implantation at the site of episiotomy occurred during the manual revision of the uterine cavity during delivery.

[Ultrasonic characteristics of kidneys in chronic kidney insufficiency]. / Ultrazvucne karakteristike bubrega u hronicnoj bubreznoj insuficijenciji.

Ultrasound examination of kidneys obtains various information on the state of kidneys which may point to the function itself: the size of kidneys, their shape, the state of edges and cortex, their relation with the surrounding tissues and organs, parenchymal structure and width, presence of delay in the conveying system, nature of obstacles as well as their localization. Excretory, intravenous urography is mostly impossible to perform in patients with renal insufficiency so that is why we mainly practice ultrasound checkups and laboratory analyses in surveying the state of kidneys. This is a report on a sample of patients with chronic renal insufficiency who were on chronic hemodialyses. The most common cause of renal failure are the following: endemic nephropathy 29.70%, various inflammatory states 34.24% and congenital anomalies 6.6%.

Largactil (chlorpromasine) and cervical dilatation in primiparae.

The effects of Largactil on cervical maturation and dilatation during induced labour in primiparous women were investigated. The obtained results suggest that Largactil has significant influence on the maturation and dilatation of the cervix in severely "neurotic" women relative to "non-neurotic" women.