Microsatellite variation of ESR1, ESR2, and AR in Serbian women with primary ovarian insufficiency.

OBJECTIVE: This study aimed to investigate the potential role of microsatellite polymorphisms of the estrogen receptor alpha gene (ESR1) TA repeat, estrogen receptor beta gene (ESR2) CA repeat, and androgen receptor gene (AR) CAG and GGN repeats among Serbian women with primary ovarian insufficiency (POI). These microsatellites have been reported to be associated with POI in different racial/ethnic populations. METHODS: A cohort of 196 POI cases matched with 544 fertile controls was recruited by the Institute for Endocrinology, Diabetes and Metabolic Disorders of Serbia between 2007 and 2010. DNA was extracted from saliva. The four microsatellites were genotyped using a PCR-based assay to determine the repeat lengths. RESULTS: POI patients carried shorter repeat lengths of ESR2 (CA)n than controls (P = 0.034), but the difference was small. ESR1 (TA)n was on the borderline of statistical differences between groups (P = 0.059). AR (CAG)n and (GGN)n showed no association with POI. CONCLUSIONS: We cautiously conclude that microsatellite polymorphisms of gonadal steroid receptor genes might contribute to the genetic basis of POI in Serbian women, but a larger-scale study and family-based studies are warranted to validate our findings even though the sample size in this study is larger than any previously published in this field.

Lack of association between ESR1 gene polymorphisms and premature ovarian failure in Serbian women.

OBJECTIVE: It has previously been reported that estrogen receptor-alpha (ERα) gene (ESR1: estrogen receptor 1) polymorphisms are associated with premature ovarian failure (POF). The aim of this study was to investigate whether these genetic polymorphisms of ESR1 are associated with POF in Serbian women. METHODS: A series of 197 POF cases matched with 547 fertile controls was recruited by the Institute for Endocrinology, Diabetes and Metabolic Disorders of Serbia between 2007 and 2010. Genomic DNA was extracted from saliva using Oragene® DNA sample collection kits. Two single-nucleotide polymorphisms (SNPs), PvuII and XbaI, in ESR1 were genotyped by dynamic allele-specific hybridization. Haplotype analyses were performed with the restriction fragment length polymorphism method. SNP and haplotype effects were analyzed by logistic regression models. RESULTS: No significant difference was found in the distribution of ESR1 PvuII and XbaI polymorphisms or haplotypes between the POF and control groups. CONCLUSION: The two ESR1 SNPs, PvuII and XbaI, are not commonly associated with POF in Serbian women and may not contribute to the genetic basis of the condition.

Carcinosarcoma of the uterus in advanced stage: a case report.

This is the case of an advanced stage carcinosarcoma uteri, in a patient with limited therapy options. Carcinosarcomas (malignant mixed Müllerian tumors) are histologically composed of malignant epithelial and mesenchymal components. Sarcomatous component of this mixed tumor in the present patient was of heterologous-type chondrosarcoma. The primary treatment option for uterine carcinosarcomas is surgery, but adjuvant therapy is always necessary. The optimal treatment is still uncertain, as the histogenesis of this tumor remains controversial.

Correlation of human papilloma virus infection with cytology, colposcopy and histopathological examination of the bioptic tissue in low- and high-grade intraepithelial lesions.

INTRODUCTION: It is now believed that the majority of cervical cancer is preceded by long-term infection with high-risk types of the human papilloma virus (HPV). The presence of HPV high-risk types (HR-HPV) in the cells of intraepithelial change multiplies the possibility of its progressive development to high-grade cervical precancer and invasive disease. AIM: This study examined the correlation of HPV infection with cytology, colposcopy, and histopathological examination of the bioptic tissue in low- and high-grade cervical lesions. MATERIALS AND METHODS: This research was conducted as a study section. Data collection was performed during a ten-year period, at the University Clinic of Gynecology and Obstetrics - Narodni Front in Belgrade (Serbia). The basic set included 1,927 patients. Colposcopy, cytology, histopathology, and HPV test verification was made in all patients. Statistical analysis was performed using the SPSS program, version 17.0. Contingency tables were used to assess the degree of correlation of variables and chi-square test was used to determine the level of statistical significance in this study. A p value < 0.05 was considered statistically significant. RESULTS: Among 1,927 women studied, 635 (32.95 %) had abnormal cytological findings and among these, 272 (42.83%) were HR-HPV positive. There was a statistical difference between colposcopic and cytological findings in patients with HR-HPV (x2 = 35.33, p = 0.000). There was also a statistically significant difference between histophatological and colposcopical findings in patients with HR-HPV (x2 = 10,171, p = 0.001). Only HR-HPV types 16 and 18 showed a statistical significance compared to histopathological findings, unlike other HR-HPV. An important finding was that the authors found an abnormal colposcopy in 93.30% patients with low-grade intraepithelial neoplasia and 68.05% patients with low-grade squamous intraepithelial lesion (LSIL) had normal cytology and was 70.15 % HR-HPV negative. CONCLUSION: The findings imply that among high-grade intraepithelial neoplasias, the authors found a high presence of HPV type 16 and 18, and a statistical significant presence of HPV 16 in low-grade intraepithelial neoplasia, unlike other HR-HPV types in low-grade intraepithelial findings. The authors found a significant statistical correlation with abnormal cytology and presence of HPV type 16 in both groups (LSIL and high-grade squamous intraepithelial lesion (HSIL). The authors also found an abnormal colposcopy in 93.30% of patients with low-grade intraepithelial neoplasia, while 68.05% of patients with LSIL had normal cytology and were HR-HPV negative in 70.15% of the cases.

Comparison of electrolytic status (Na+, K+, Ca2+, Mg2+) in preterm and term deliveries.

PURPOSE OF INVESTIGATION: The objective of this study was to evaluate the electrolytic status of Na+, K+, Ca+, and Mg2+ in serum and red blood cells in idiopathic preterm and term deliveries. METHODS: The study included 105 pregnant women diagnosed with idiopathic premature delivery (study group) and 36 pregnant women with physiologically term delivery (controls). Samples of mother's blood were collected and analyzed for the level of electrolytes in the serum/plasma and red blood cells. RESULTS: Measured values of magnesium in red blood cells in the study group were far lower than physiological values, intracellular calcium levels were higher in the study group compared to levels measured in the controls. Sodium concentrations in cells were significantly lower in subjects with premature delivery. CONCLUSION: The magnesium intracellular level is the best representative value of magnesium in the body.

Carney complex and teratoma maturum ovarii--a case report.

This is a case report of an extremely rare Carney complex (CNC) syndrome in a 17-year-old patient. After the decision made by a team of cancer specialists, the patient was admitted to the hospital for surgery because of adnexal tumor associated with ascites and increased Ca 125 tumor marker level. The patient underwent cardiac surgery twice. Adnexal mass and ascites, revealed by transvaginal ultrasound (TVUS) and confirmed by magnetic resonance imagings (MRI), indicated the malignant alteration. Surgery was performed and surgical pathological staging was refined according to the FIGO guideline and included a staging laparotomy. After surgery, general condition of the patient was good, without ascites and pain, with Ca 125 marker levels within reference ranges.

Short-segment jejunoplasty: the option treatment in the management of benign esophageal stricture.

A non-dilatable benign stricture of the esophagus is a problem for the patient and always a challenge for the surgeon. The present study is intended to provide some details of surgical technique and the physiological concept that constitutes the basis for patient selection for short-segment jejunoplasty. In this study, out of 98 patients, 91 had complex stricture of the lower, and seven of the cervical esophagus. The main cause of stenosis in 60 patients (61.2%) was gastroesophageal reflux, in 34 (34.7%) post-corrosive damage, and in three (3.0%) it was other causes. All patients were treated by three methods of jejunoplasty: group I (n=54 patients) short-segment of the jejunum; group II (n=37 pts) Roux-en-Y double tract; and group III (n=7 patients) short jejunal segment on the long vascular pedicle. Intraoperative complications occurred in 17 (17.34%) of the patients. An anastomotic leak occurred only in three (3.29%) in group I and II, and 1/98 patients (1.02%) died from mediastinitis. Follow-up of functional results for up to 36 months (average 18 months) was available in 77/97 (79.3%) hospital survivors. Fifty-seven (74%) patients are satisfied with their ability to take food, postoperative reflux was completely denied by 72 (93.5%) patients. Postvagotomy diarrhea was transient and gradually subsided over the course of the first 6 months.

[Surgical methods for the treatment of breast phyllodes tumors--a report of 319 cases].

UNLABELLED: Breast phyllodes tumors (FT) belong the fibroapitelial group of breast tumors arising in terminal ductulo-lobular unit (TDLU). Their incidence do not exceed 1% of all breast tumors. Biologicaly they can be divided into benign, borderline and malignant group. Incomplete tumor excision can be the reason for local reccurence. Malignant form of FT metastazise hematogenous most often in the lung. There is no uniform surgical opinion about the treatment FT. METHODS: We analyzed histopathology features of 319 FT of the breast surgicaly removed on Departement of surgery Institut of oncology and radiology of Serbia between 1.1.1985.-31.12.1994. Retrospective study of surgical treatment 84 patients with FT of the breast (69 benign, 4 borderline and 11 malignant) and 5 year follow up after surgery we analysed. RESULTS: local reccurence after surgery was found in 17 (20,2 %) patients(14 benign , 2 borderline and 1 malignant FT), pulmonary metastases in 6 (7,1%) patients with malignant FT. DFI was 21,3 months for local reccurences and 25,1 months for pulmonary metastases. DFS for al forms of FT was 71 % (p =0,7104) in 5-year follow up. CONCLUSION: According to biological behavior we propose wide excision for benign and borderline forms and simple mastectomy for malignant FT, and voluminous benign and borderline forms. Axillary disection is not necessary because lymphatic spread of malignant FT is unfrequent.

Ovarian neoplasms and pregnancy.

The aim of our study was to investigate the incidence of ovarian malignant neoplasms in pregnancy. In the prospective study, during a 2-year period of time, we had the ethical dilemma concerning the conciliar treatment vs the patient's wish to deliver and save the reproductive capabilities. We examined 37 pregnant women; the incidence of ovarian cancer was 13.5% vs 6.5% in other works. Diagnoses were made by ultrasound criteria and physical examinations. Statistically significant results were obtained by Student t test. Mean gestational age was 20.1 weeks and mean age 31.1 years. Treatment depends on the neoplasms type, grade, and presence of the metastatic pathways. In benign neoplasms, we used laparoscopic treatment with minor invasion. Distribution of benign neoplasms was in the same range as that in other works.

[Initial diagnosis of intra-abdominal hemorrhage caused by isolated splenic injury in blunt abdominal trauma]. / Inicijalna dijagnostika intraabdominalnog krvavljenja uzrokovano izolovanom povredom slezine kod tupe abdominalne traume.

Diagnosis of intraabdominal bleeding caused by spleen injury must be performed in the shortest possible period of time, with little risk for the patient, and with high preciseness. By its simple performance, high preciseness and little risk for the patient, DPL imposes as the predominant method in initial diagnostic of intraabdominal bleeding. Control and monitoring of lavage may duly signalize degree of bleeding. Preciseness of this diagnostic in our series ranges up to 93.3%. DPL method is especially important in a combined neurotrauma. Ultrasonography is a sovereign method in diagnostic of bleeding source as well as in monitoring of bleeding that from the very beginning does not require urgent surgical intervention. Its importance is in monitoring both intrasplenic and subcapsulary hematomas. It is not appliable in disturbed and haemodynamically unstable patients. It is in particular important in children where a maximum conservative attitude with respect to operative treatment has been assumed. CT takes the leading place with respect to preciseness of bleeding area, and the combined thoracoabdominal trauma. Preciseness of CT in our series comes up to 96.6%, but can be applied only in haemodynamically stable patients. Same as US of abdomen so the CT of abdomen represents a prominent method in monitoring of both intrasplenic and subcapsular hematomas, which do not require urgent surgical intervention.

[Modern aspects of the premenstrual syndrome]. / Savremeni aspekti premenstruacionog sindroma.

Premenstrual Syndrome (PMS) has being a more and more current problem in gynaecology nowadays. The outstanding of symptoms with their repercussion in the psychosocial sphere, no matter whether the problems of psysiological nature are primary oe secondary characteristics of PMS, all inclusive perception of this syndrome. There are individual various aeriological factors, i.e. pathophysiological mechanisms responsible for PMS development, with precisely known varieties of symptom expression, being dominant and frequent, which contribute to the choice of the most suitable therapy. The paper presents a review of various therapeutical possibilities that will make possible the establishment of up-to-date concepts of the premenstrual syndrome treatment, individualized and harmonized according to the current knowledge of dysfunction of relevant system and presence of neuroendocrinological imbalance, responsible for the development of specific PMS symptoms.

The application of GnRH analogues in the treatment of uterine myomas in perimenopausal women.

Our objective was to determine whether long GnRH agonists induce effective and persistent shrinkage of uterine myomas in perimenopausal women, as well as to determine the usefulness of Doppler sonography study in evaluating the therapy benefit. The study covers 30 patients with symptomatic myomas in perimenopausal period. We used long GnRH agonist-Decapeptyl (Ferring) at 28 days intervals in the course of 4 months. After discontinuing the application of Decapeptyl, medroxyprogesterone acetate was introduced for 6 months. The GnRH/gestagens therapy is useful and effective in treatment of symptomatic myomas in perimenopausal patients, and may be a valid alternative to hysterectomy. Doppler sonography is reliable in monitoring of uterine circulation in patients under GnRH therapy.

[Correlation between ultrasonographic and celioscopic findings during stimulated cycles in women undergoing fertilization in vitro]. / Korelacija izmedju ultrasonografskog i celioskopskog nalaza u stimulisanim ciklusima zena za fertilizaciju in vitro.

The authors emphasize the importance of ultrasonographic follow-up of the growth and development of the follicle in patients prepared for fertilization in vitro. The study concerned 30 patients in whom an appropriate stimulation was carried out. Correlation between ultrasonographic and coelioscopic findings is analysed. On the basis of the obtained results it was concluded that ultrasonographic diagnosis may be useful in the evaluation of the number, size and volume of a follicle. This method was also appropriate for the evaluation of the follicle maturity and determination of the best time for their puncture. In this was follicles that are in the most favourable time for fertilization in vitro, can be obtained.