Improved national Croatian diagnostic and therapeutic guidelines for premalignant lesions of the uterine cervix with some cost-benefit aspects.

The national Croatian improved diagnostic and therapeutic guidelines for premalignant lesions of the uterine cervix are presented: for atypical squamous cells of undetermined significance (ASCUS), for cervical intraepithelial neoplasia (CIN I, CIN II CIN III) and for microcarcinoma (FIGO grade Ia1). Separately are presented the guidelines for abnormal glandular epithelium: atypical glandular cells of undetermined significance (AGCUS) and cervical glandular intraepithelial neoplasia (CGIN). The guidelines are created according to the guidelines of the FIGO. Improved diagnostic and therapeutic guidelines was presented and accepted at the Symposium of the Croatian Society for Colposcopy and Cervical Pathology and of the Croatian Society of Gynecologists and Obstetricians of the Croatian Medical Association, held on November 25th 2000. There are presented the chief differences and the some cost-benefit aspects between the guidelines before and the new one.

Intravesically administered ketoprofen in treatment of detrusor instability: cross-over study.

AIM: To evaluate the therapeutic efficacy of intravesically administered ketoprofen in patients with urodynamically verified detrusor instability. METHODS: This double-blind randomized placebo-controlled cross-over study included 30 patients with urodynamically verified detrusor instability. Their mean age was 44+/-3.6 years (range 37-49) and the median of the parity was 2 years (1-3). The mean duration of symptoms was 18.3+/-3.1 months (range 14-23). After a 6-week screening, patients were randomized to receive ketoprofen or placebo once a day for 4 weeks. Out of 30 patients, 16 started with ketoprofen, and 14 received placebo. After a week of washing period, 16 patients received placebo, and 14 received ketoprofen. The solution for intravesical application was 50 mL of saline with 2 mL (100 mg) of ketoprofen warmed to 37 degrees C. The placebo solution contained 2 mL of distilled water instead of ketoprofen. The assessment including micturition diaries, cystometric measurements, and bacteriological analysis of urine specimens was performed at the beginning of the study and after the treatment. RESULTS: The subjective cure rate was 18/30 after ketoprofen. The instability index was lower after ketoprofen than before treatment or after placebo (p<0.001). Maximal cystometric capacity and the urinary bladder volume at which the patients felt urgency to void were larger after ketoprofen than before it (p<0.001) or after placebo (p<0.001). The number of patients with uninhibited bladder contractions decreased significantly after ketoprofen, but not after placebo (p<0.001). No side effects were observed. CONCLUSION: Intravesically administrated ketoprofen is a feasible and effective treatment for detrusor instability.

Quantitative tissue carcinoembryonic antigen (T CEA) assay as a screening test for severe dysplasia in colorectal adenomas.

Relationship between the serum (S CEA) and the tissue (T CEA) carcinoembryonic antigen concentrations with regard to the degree of dysplasia in colorectal adenomas was investigated. Our study included 56 single or multiple colorectal adenomas in 46 patients. The measurements of T CEA concentrations were performed using the quantitative CEA-EIA method (Abbott) modified for wet tissue, obtained from heads of the adenomas. As a control point the mucosa near adenoma and the rectal mucosa were used. Our results suggest that the T CEA concentrations from the head of the adenoma demonstrate a highly significant difference between mild and severe dysplasia (P < 0.001), between mild dysplasia and invasive adenocarcinoma (P < 0.001) and a significant difference between mild and moderate dysplasia (P < 0.05). On the other hand, the S CEA concentrations corresponding to these cases showed no such differences. In conclusion, we suggest the quantitative measurement of T CEA concentrations as a screening test for severe dysplasia in colorectal adenomas.

Morphology of gonads in pure XY gonadal dysgenesis.

The authors gathered 20 patients having Swyer's syndrome and performed a bilateral gonadectomy and carried out a pathohistologic evaluation of the streak gonads. A more frequent occurrence of streak gonad tumors was found together with the possibility of tracing the merge gonadoblastoma into dysgerminoma (the youngest patient was 15 years old). In 95% of the streak gonads checked an ovary-like stroma was found. In 11 of the patients (55%) one of the above mentioned tumors was found. A frequent finding was the presence of Leydig-type cells, calcifications and the remains of Wolffian canals. In three streak gonads, the corpora albicans-like formations were found.

Apolipoprotein E genotypes and metabolic risk factors for coronary heart disease in middle-aged women.

Apo E genotypes and plasma metabolic risk factors (total cholesterol, triglycerides, HDL and LDL cholesterol, total/HDL cholesterol ratio, lipoprotein Lp (a), apolipoprotein A-I, A-II, apo B, and apo E) were determined in 134 healthy middle-aged (X +/- SD 49.62 +/- 4.83) women. The aim of this study was to investigate metabolic risk markers according to various apo E genotypes, and to evaluate a possible risk for coronary heart disease. The results revealed that the frequencies of apo E3/3 are the most frequent (46%), followed by E4/4 (2%), E3/4 (14%), E2/3 (14%), and E2/4 (2%) in the middle-aged women. Higher mean triglycerides, LDL-C and apo B levels were found with apo E3/4, and lower mean levels of HDL-C i.e. apo A-I than in other analyzed genotypes. Greater mean of total/HDL ratio and lower levels of apo A-II were seen with E2/4. Serum lipoprotein Lp (a) concentration was higher in women with genotypes E3/3. Apo E concentration was the lowest with genotypes E4/4, i.e. the highest with E2/3. Serum total cholesterol tended to be higher in women with genotypes E4/4. Genotype E3/4 is connected with the highest concentrations of (X +/- SD) triglycerides (1.74 +/- 0.78), LDL (4.28 +/- 1.88), apo B (1.03 +/- 0.32) and with the lowest concentrations of HDL cholesterol (1.11 +/- 0.21) in the relation to the other analyzed genotypes. This group of women could possibly represent high risk women for CHD. Genotype E3/3 is associated with the highest concentration of independent genetic risk marker for CHD, lipoprotein Lp (a) (0.19 +/- 0.27). The genotype E4/4 has the highest concentration of total cholesterol (5.93 +/- 1.01), and has to be taken in account for risk evaluation in women. High level of apo E (0.11 +/- 0.05) and low level of apo A-I (1.80 +/- 0.44) were associated with E2/3 genotypes. The significance of E3/4 with the high total/HDL ratio (5.52 +/- 2.21) and low apo A-II (0.53 +/- 0.09) is important indicator, because total/HDL cholesterol ratio represents independent Established Risk Factor (ERF) for CHD. Apolipoprotein E genotypes as genetic markers and investigation of serum metabolic risk markers appear to be important in view for further evaluation of high risk women for CHD in our population.

Loop excision of the transformation zone (LETZ) as an outpatient method of management for women with cervical intraepithelial neoplasia: our experience.

Between March 1996 and July 1998, 90 patients were treated with diathermy loop excision (LETZ) for cytologically, colposcopically and histologically verified cervical intraepithelial neoplasias (CIN), at the outpatient clinic. In average, the patients were 30.22 years of age, and 61.1% of them were nulliparas. In 80 surgical samples (88.9%), the exocervical and endocervical margins were histologically free of disease. From the total of 65 patients with CIN III diagnosis, 58 (89.2%) had free margins samples. In the post-operative period the patients had a changed vaginal discharge for 16 days. A slight feeling of pain in the abdomen lasted for 2.5 days on the average, and most patients did not take analgetics. Moderate postoperative hemorrhage from the excision site occurred in 5 (5.5%) patients, and was outpatiently treated with electrocoagulation, with no need for blood replacement. In 65 patients (90.3%), the cytological control results were normal. During the follow-up period, 9 patients became pregnant, which resulted in 6 terminal deliveries so far; 2 pregnant women are about to deliver, and one is in the first trimester of pregnancy. Cerclage cervicis has not been performed on any of the patients. LETZ is a safe and simple procedure which can be done at outpatient clinics, it is relatively easily mastered, it is short, quite bearable for patients if done only under local analgesia, the equipment costs are acceptable, and the treatment can be used both diagnostically and therapeutically, since an adequate surgical sample is obtained for histological assessment. Cytological and colposcopical check ups are imperative in the postoperative period.

[Elephantiasis of the vulva of an unclear etiology: case report]. / Elefantijaza vulve nepotpuno razjasnjene etiologije: prikaz bolesnice.

A patient with vulvar elephantiasis, which had been developing since 1985 when biopsy was first performed showing only signs of chronic inflammation, is described. From 1985-1987 (when she was first admitted to the hospital) microbiological analyses were negative and antibiotic therapy was administered without success. At the first admittance abscess of the left Bartholin's gland and furunculosis of vulva were diagnosed. Serological tests to agents that usually cause vulval infections with elephantiasis were negative, and microbiological analyses revealed mixed bacterial flora. Biopsy showed again only nonspecific chronic inflammation. The patient received ampicyllin, oxytetracyclin and doxycillin. She did not return for the control until 1993. At that time the vulvar mass reached 16:13:10 cm and was surgically removed. The histological picture showed chronic granulomatous inflammation. The results of microbiological and serological tests were again the same as before.

Effect of pulse Doppler ultrasound on placental hormone excretion in vitro.

There is no literature data on the effects of ultrasound on the metabolism of placental tissue. In the present study, the authors have investigated the possible influence of pulsed field Doppler ultrasound on hormonal excretion of human placental trophoblasts in vitro. For the detection of placental hormones, specific immunoassays for chorionic gonadotropin (hCG), human placental lactogen (hPL), estrogen and progesterone were used. Compared to control trophoblast hormone excretion, pulsed field ultrasound exposure induced no changes in the excretion of the hormones in vitro. The authors were unable to demonstrate any alterations caused by pulsed field Doppler ultrasound in this in vitro model. Additional studies are required to deepen our understanding of the effect of pulsed Doppler ultrasound on other biomolecules and their metabolism.

[Fetal growth in pregnant women with chronic hypertension]. / Rast fetusa u trudnica s kronicnom hipertenzijom.

This study represents a retrospective analysis of pregnancies with chronic arterial hypertension and their outcomes. The aim was to evaluate the influence of arterial hypertension on 101 essential and 109 cases of secondary hypertension in comparison to the control group consisting of 499 normotensive pregnancies. According to the obtained data, 27.7% of the women with chronic hypertension had proteinuria, 61% had bacteriuria and 58.6% had superimposed EPH gestosis. The occurrence of EPH gestosis among the controls was 5.6%, that is significantly less than in the experimental group (X2 = 282.8%; p < 0.001). The outcomes of pregnancies associated with chronic hypertension were: 19% preterm deliveries compared to the controls in which only 9.2% preterm deliveries occurred (X2 = 14.4; p < 0.001). Newborns from pregnancies with essential hypertension were significantly heavier, weighing 3177 +/- 734 g, than those from pregnancies with secondary hypertension, which weighted 2578 +/- 932 g. Perinatal mortality was higher in the study group and significantly higher in the pregnancies with associated secondary hypertension (30.3%) than in pregnancies associated with essential hypertension (15.8%).

[Lipoleiomyoma of the uterus]. / Lipoleiomyoma uteri.

A case of lipoleiomyoma uteri in a 44-year old women is presented. The tumor, 9 cm in diameter, was situated beneath the serous membrane, at the back wall. There were also smaller leiomyomas, but the tumour described differed from them in being pale-yellow and having a somewhat softer consistency.

[Endometriosis in an episiotomy scar]. / Endometrioza u oziljku epiziotomije.

A case of perineal endometriosis at the site of on episiotomy scar is reported. The first disorders in the scar appeared soon after the second delivery at the woman's age of 25. Surgical treatment was applied six years after the appearance of the first symptoms. Endometrioma recurred briefly after the excision. Clinical data suggested decidual autologous transplantation during manual uterine exploration.

[Primary insular carcinoid tumor in a benign cystic teratoma of the ovary (author's transl)]. / Primarni inzularni karcinoidni tumor (argentafinom) u zrelom cisticnom teratomu jajnika.

A case of primary, insular, argentaffin carcinoid tumor (argentaffinoma) of the left ovary, arising in a bening cystic teratoma in a 60-year-old woman is reported. The tumor was not accompanied by any signs of the carcinoid syndrome despite a large volume, prominent acinar differentiation, and strong argentaffinity. Considering the morphologic carcinoid classification by Soga and Tazawa, the case had a mixed A + C pattern. A few Paneth-like cells and a few small calcifications in the stroma were present. Microscopic, ultrastructural, and histochemical findings were identical with those of carcinoids arising in midgut derivatives. There were small mucinous areas about 1.5 cm in diameter. Microscopic examination revealed pools of mucin with more of less disintegrated acini. This morphologic feature was not as yet reported in the insular carcinoid tumor. The patient feels well one and half year after hysterectomy and bilateral salpingo-oophorectomy, without any signs of metastatic disease.

[Acute appendicitis in the puerperium after cesarean section]. / Akutna upala crvuljka u puerperiju nakon carskog reza.

A very rare case of appendicitis coupled with righthand salpingitis (hödrosalpinx) is described. The disorder manifested itself on the 9th following the cesarean section.