Fetal ventriculomegalies during pregnancy course, outcome, and psychomotor development of born children.

PURPOSE: The objectives of this study were as follows: to present the course and outcome of pregnancies complicated with fetal ventriculomegaly, determine the association between prenatal ultrasound diagnoses and definitive postnatal diagnosis or diagnoses after autopsy and additional analysis, and to monitor the psychomotor development of children born with ventriculomegaly. MATERIALS AND METHODS: The survey was designed as retrospective study and included 62 pregnant women who were attending a regular ultrasound examinations at the Department of Gynecology and Obstetrics, Clinical Center of Serbia, or patients who were referred from other institutions in Serbia. RESULTS: Ventriculomegalies were divided into three groups: mild, moderate, and severe or hydrocephalus. The most common were severe ventriculomegalies, with 34 cases (55%). Of all pregnancies complicated with ventriculomegalies, 61% were terminated. Among those continued, 88% had normal psychomotor development. In 97% ultrasonographic diagnosis was confirmed. CONCLUSION: Majority of pregnancies complicated with ventriculomegaly were continued and most of the children born with anomalies had normal psychomotor development.

The outcome and course of pregnancies complicated with fetal neural tube defects.

PURPOSE: The objectives of this study were as follows: to present the course and outcome of pregnancies complicated with neural tube defects, determine the association between prenatal ultrasound diagnoses, and definitive diagnoses after autopsy. MATERIAL AND METHODS: The survey was designed as a retrospective study and included 24 pregnant women who were attending a regular ultrasound examinations at the Department of Gynecology and Obstetrics, Clinical Center of Serbia, or patients who were referred from other institutions in Serbia. RESULTS: Neural tube defects are divided into five subgroups: spina bifida, meningocele, myelomeningocele, acranius, and anencephaly. The most frequent in the present study was spina bifida with 67%. All pregnancies complicated with neural tube defects were terminated. CONCLUSION: Their clinical severity and uncertain cause make them priorities for further research, whether to better target primary preventive measures, to improve in-utero surgery for prenatal repair, or to identify the causative genes to provide an objective basis for individual genetic counselling.

Maternal mortality in Serbia.

Maternal mortality related to obstetric events is still high today. The main components of reproductive health are evaluated. Early diagnosis of the obstetric risks can significantly reduce maternal mortality.

Expression of tumor associated antigens CA 15-3 and CA 19-9 in trophoblast of the normal human placenta.

Mucin 1 (MUC1) is abundantly expressed by various organs, including human placenta and endometrium. Since glycan modifications of MUC1 are potentially relevant for physiological as well as pathological processes, this study was aimed at establishing an expression profile of two MUC1 glycoepitopes, CA 15-3 and CA 19-9, in trophoblast throughout pregnancy. Immunohistochemical analysis of normal placenta demonstrated that trophoblast cells express both mucin antigens throughout gestation with a distinct staining pattern. The staining of villous trophoblast was non-uniform for both antigens, and stronger for CA 15-3. Only a proportion of extravillous trophoblast of the cell column, in decidual stroma or lining blood vessels was also stained. Whether the studied MUC 1 glycoforms can be linked to trophoblast cells invasion remains to be established.

Removal of a vaginal leiomyoma presenting as tumor previa allowing vaginal birth.

Leiomyomas of the vagina are very rare tumors of the female genital tract with only 300 cases reported so far. A case of removal of the vaginal leiomyoma presenting as tumor previa in advanced pregnancy is described. Removal of the tumor allowed vaginal birth three weeks after surgery.

Refractory metastatic choriocarcinoma treated surgically with polychemotherapy--case report.

The authors present the course of treatment of refractory metastatic choriocarcinoma in a 49-year-old woman was treated surgically by hysterectomy and resection of suprarenal gland metastases. During the treatment the patient received 15 courses of polychemotherapy with different protocols. After five years of treatment and seven years of follow-up there is no evidence of recurency of the disease.

[Acute renal failure after cesarean section as a consequence of hematoma of the retropubic space of Retzius].

Acute renal failure is rare postoperative complication of cesarean section. Postrenal acute renal failure is corectible ant it shoud be done immediately in order to avoid secundary destruction of renal parenchim. Surgical techniques shoud be directed to achieve adequat haemostasis, espetialy at low transverse Pfannenstiel incision, as well as in tender manipuliating with tissues to prevent unnecessery formation of dead space and tissues devitalisation. Authors are presenting the case of acute renal failure after cesarean section as a consequence of hematoma of the retropubic space of Retzius and way of treatment.

Diagnosis and surgical therapy of uterine sarcoma.

INTRODUCTION: Uterine sarcomas are rare gynaecological neoplasms and their classification is complicated. Uterine sarcoma is usually diagnosed in postmenopausal women and the diagnosis is often accidental and postoperative. Aim of this study was to present clinical and pathological characteristics of uterine sarcomas, diagnostic procedures, treatment and two-, three- and five-years cumulative survival rates. MATERIALS AND METHODS: The retrospective study of 61 cases of uterine sarcomas was conducted. Cases were distributed into groups based on definitive diagnosis of uterine sarcoma: group of leiomyosarcomas (LMS), carcinosarcoma (CS), endometrial stromal sarcomas (ESS), adenosarcomas (AS) and other rare uterine sarcomas. We investigated patients with clinical and pathological characteristics of uterine sarcomas, diagnostic procedures and treatment. Survival rate was calculated by Kaplan-Meier method. RESULTS: From 61 patients 43 patients (70.49%) were postmenopausal. Mean period from menopause until appearance of symptoms was 14,63 years. One or more risk factors were present in 46 (75.4%) patients. Diagnosis of uterine sarcoma were established averagely 7.38 months after appearance of symptoms. 50 patients (82.0%) underwent one or more diagnostic procedures. Preoperative diagnosis of uterine sarcoma was established in 42.5% of patients. 53 (86.9%) of patients were treated operatively. The most used operative procedure (60,7%) was total hysterectomy with bilateral salpingooophorectomy. Postoperative pathohistologic analysis showed that low grade (LG) leiomyosarcoma were present in 19 (35.9%) cases, high grade (HG) leiomyosarcoma in 1 (1.9%) case, carcinosarcoma in 14 (26.4%) cases, low grade (LG) endometrial stromal sarcoma in 5 (9.4%) cases, high grade (HG) endometrial stromal sarcoma in 9 (17.0%) cases, adenosarcoma in 2 (3.8%) cases, and 2 cases of rare uterine sarcomas: 1 (1.9%) MALT HG lymphoma and 1(1.9%) malignant hemangiopericytoma. In one case of ESS (1.9%) only adenomyosis was found postoperatively suggesting that the whole tumour was removed during diagnostic procedure. Eight patients were not treated operatively. Two-years cumulative survival rate was 74.3%, three-years cumulative survival rate was 71.1%, and five years survival rate was 64.3%. DISCUSSION: Average age, percent of postmenopausal patients and the mean age at the time of menopause in our studied correlate with current data. Clinical presentation of uterine sarcoma is associated with obesity and hypertension in more than 30% of cases, which is approved in our study. For early diagnostics it is important to notice that risk factors are similar to those connected with far more frequent endometrial carcinoma. Postmenopausal abnormal bleeding was the main reason for medical examination, explaining relatively short period for establishing the diagnosis in this group of patients. The variety of clinical findings in our studied group showed that the diagnosis must be based on preoperative pathohistology. CONCLUSION: Adequate diagnosis and treatment of uterine sarcoma is possible with regular yearly or more frequent follow-up, especially in postmenopausal women with known risk factors present. We need special attention for unclear symptoms and postmenopausal bleeding and we need to use all diagnostic procedures soon as possible including preoperative histology because early metastases are characteristic for uterine sarcomas. Factor of the most important predictive value is histologic grade.

[Surgical treatment of a 5 month pregnancy in the rudimentary uterine cornu].

Cornual ectopic pregnacy is rare clinical entity with high maternal mortality. In all cases surgical treatment is indicated, and taking care of most important complication--haemorrhagic shock. Therapeutic approach is individual and depending of simptomatplogy, gestational age of pregnancy and condition of the patient in time of diagnosis. Authors are presenting the case of cornual ectopic pregnancy of five months.

[Enanthema fixum as side effect in the use of a combination of trimethoprim and sulfamethoxazole]. / Enanthema fixum kao nuspojava kod primjene kombinacije trimetoprima i sulfametoksazola.

Cases of fixed drug eruption due to trimethoprim-sulfamethoxazole combination are reported. In these cases the oral mucous membranes were affected. Fixed drug eruption is a distinct entity characterized by the development of circular erythematous lesions which over a period of time becomes violaceous. Sulfamethoxazole is probably the main cause of this drug eruption but there are some reports that trimethoprim itself can cause them too.

Prostaglandin release and nociceptor stimulation by peptides.

The effects of substance P, somatostatin, vasoactive intestinal polypeptide, cholecystokinin octapeptide, eledoisin and bombesin on release and metabolism of incorporated (1-14C)-arachidonic acid was investigated in the isolated rabbit ear. The influence of eledoisin and bombesin on release of prostaglandins was compared with that of bradykinin (Sametz and Juan 1982). Only eledoisin and bombesin stimulated the release of prostaglandins I2 and E2 but with a lesser potency than bradykinin. Only eledoisin in a high dose stimulated nociceptors per se whereas bombesin did not. Eledoisin and bombesin in a low dose enhanced nocicpetion induced by acetylcholine in the rabbit ear; this enhancement of the algesic effect of acetylcholine was abolished by indometacin which indicates a sensitization of nociceptors by released prostaglandins. Although effects of eledoisin and bombesin are mediated at least in part by released prostaglandins, the nociceptor-stimulating and prostaglandin-releasing potency of bradykinin remaines unique among all peptides tested so far.

Release of histamine by neuropeptides from the perfused rat hindquarter.

The release of histamine and serotonin by neuropeptides and capsaicin was measured in the isolated perfused rat hindquarter preparation. Substance P and two antagonistic peptides, [D-Pro2, D-Phe7, D-Trp9]-SP and [D-Pro2, D-Trp7,9)]-SP, release histamine, the SP(4-11) and SP(6-11) analogues did not. VIP and somatostatin released histamine and also serotonin. No amines were released by bombesin. Thus, all amine releasing peptides possessed at least two basic charges. However, the histamine releasing activity of the neuropeptides tested did not correlate with their reported ability to cause vasodilation and plasma extravasation. The SP(4-11) and SP(6-11) analogues which did not release histamine caused plasma extravasation. It is concluded that SP causes plasma extravasation by a direct action on blood vessels. Capsaicin released only serotonin but no histamine either in untreated rats and such desensitized with capsaicin as neonates. In rats desensitized with capsaicin 4 days prior to the experiment the substance P induced histamine release was as high as in untreated controls; it was, however, absent in rats desensitized with capsaicin as neonates. It is assumed that the sensitivity of mast cells to substance P is lost after degeneration of substance P containing primary sensory fibers.