Comparsion the histopathological findings after cervical biopsy and excisional procedures.

INTRODUCTION: A definitive diagnosis of cervical intraepithelial neoplasia (CIN) is confirmed after histopathological (HP) examination of the tissue obtained through the biopsy. The aim of this study was to compare histopathological results obtained with punch biopsy and results obtained through one of the excisional techniques. MATERIAL AND METHODS: We analysed histology results of 130 patients referred to our institution with abnormal smear. Punch biopsy was performed after colposcopic examination in all patients before one of the excision methods. Excision methods performed were: large loop excision of transformation zone (LLETZ), radio-frequency knife conisation or cold knife conisation. Based on the histopathological examination of the punch biopsy specimen or excisional specimen diagnosis of CIN was established. RESULTS: CIN and invasive cancer were the most common diagnoses in the 31-40 age group at 45.4% (59/130). Discrepancies in the histological diagnosis between punch biopsy and excisional biopsy was identified in 58.5% (76/130) of the patients. In 6% of the of the cases the biopsy did not detect an invasive carcinoma. CONCLUSION: The most frequent discrepancies between punch biopsy and excisional biopsy were in the group of patients with a higher grade cervical dysplasia. Mild dysplastic changes diagnosed through punch biopsy, require a more conservative approach, as the majority of this group had negative specimens on the cone after excision, especially in the younger population. It is advisable that the patients above 30 years of age and a higher grade dysplasia in the biopsy specimen, should undergo one of the excisional techniques as a diagnostic/therapeutic method of treatment.

Radical abdominal trachelectomy in the 19th gestation week in patients with early invasive cervical carcinoma: case study and overview of literature.

Treating pregnant patients with a verified malignant disease represents a great clinical problem. Pregnancy-associated invasive cervical cancer is usually diagnosed at an early stage (approximately 70%). A 27-year-old patient was given the diagnosis of a pathohistologically verified cervical carcinoma, International Federation of Gynecology and Obstetrics stage IB1, in the 17th gestational week (GW). A radical abdominal trachelectomy was performed in the 19th GW. The patient was undergoing regular examinations at our institute of oncology while the Clinic of Gynecology and Obstetrics in Novi Sad, Serbia, monitored the pregnancy. In 36th GW, the patient had a cesarean section, with no visible traces of relapse, with good postoperative recovery and normal results in the newborn. The patient was discharged on the fifth postoperative day and advised to have her condition monitored at our institute of oncology. One year after radical trachelectomy, the patient is in the 15th GW of a new pregnancy with a normal Papanicolaou smear result.

[Endometrial carcinoma--what are the protocols for?]. / Karcinom tela materice--cemu sluze protokoli?

INTRODUCTION: Endometrial cancer accounts for 10% of all malignant diseases affecting women in Western Europe. Women suffering from colonic, breast and ovarian cancer are at higher risk for developing endometrial carcinoma, which points to the fact that some women have a genetic predisposition for developing endometrial cancer. Precancerous conditions, adenomatous hyperplasias, are rarely diagnosed in our institutions. Treatment of endometrial cancer is individual, but surgeons are required to follow some treatment protocols. The aim of this study was to analyze how well treatment protocols are known and used MATERIAL AND METHODS: This study analyzed parameters of treatment of patients with endometrial cancer treated in two institutions treating oncologic patients in Novi Sad during a ten-year period (1991-2000). Results were obtained from patient records, specialist reports, surgery reports and history of disease. RESULTS: The investigation included 450 patients undergoing surgery for endometrial cancer. The average age was 62.5 years. Most patients underwent surgery in stage one (69.1%), two (14.57%), three (9.38%), zero (3.95%) and stage four (2.96%). Surgeries were performed by 16 surgeons, but none of them performed a standard treatment protocol completely. During the last 10 years 10% of patients did not undergo postoperative radiotherapy, due to outworn facilities and follow up of these patients by control of tumor markers was particularly important. DISCUSSION: The stage distribution of cancers is corresponding to that stated in literature. In regard to surgical approach and using treatment protocols, our surgeons stand behind their foreign colleagues. According to treatment standards of oncologic patients in developed countries, only specialised gynecologists and surgeons oncologists can perform operative treatment of oncologic patients. In regard to criteria in the leading countries of the world, 18 surgical gynecologists oncologists (23 the maximum) are sufficient for the territory of Serbia. CONCLUSION: Inadequate primary surgical treatment significantly increases the cost of therapy by late reoperations or additional postoperative treatment and has a negative effect on survival. In order to group patients and provide a well-educated staff with full work-time and adequate facilities, two (maximum three) institutions are sufficient at the territory of Vojvodina.

[Treatment protocol for cervical carcinoma]. / Protokol lecenja karcinoma grlica materice.

INTRODUCTION: Cervical cancer is the second most common cancer in women worldwide and the second cause of cancer death among women. About 95% (90% in developed countries) of invasive carcinomas are of squamous types, and 5% (10% in developed countries) are adenocarcinomas. FIGO classification of cervical carcinomas, based on clinical staging and prognostic factor dictate therapeutic procedures and help in designing treatment protocols. THERAPEUTIC MODALITIES: Surgical therapy includes conization, radical hysterectomy with pelvic lymphadenectomy and palliative operation--urinary diversion and colostomy. Radiotherapy, brachytherapy and teletherapy are most recently combined with chemotherapy as concurrent chemoradiation. DISCUSSION AND CONCLUSION: No change in therapeutic modalities will ever decrease mortality rate of cervical carcinoma as much as education, prevention and early screening. The 5-year survival for locally advanced disease has not improved during the last 40 years as a result of failure to deliver therapy to the paraaortic region. Paraaortic lymph nodes should be evaluated before therapy planning by different imaging procedures, or more exactly by surgical staging: laparoscopy or laparotomy. Radical operations of cervical carcinoma should be performed by experienced surgeons, educated for this type of operation, with sufficient number of cases.

[Olfactory perception in women with physiologically altered hormonal status (during pregnancy and menopause]. / Osecaj mirisa kod zena u fizioloski izmenjenim hormonalnim stanjima (u trudnoci i postmenopauzi).

INTRODUCTION: Olfaction is considered to be the ability to: perceive, conduct and recognize scents and odors. With its numerous connections to the limbic system and reticular formation, the olfactory system affects regulation of numerous vegetative functions, visceral functions and sexual behavior. Since estrogen and progesterone protect the olfactory function, changes in their levels in particular physiological states in women (in pregnancy and posmenopause) exert an influence on the ability to feel and recognize smells. It has its role in creating emotions and adjustment of visceral and vegetative response to particular emotional states. Also, it represents the connection between higher cortical functions and the endocrine system. MATERIAL AND METHODS: Our investigation was performed at the Ear, Nose and Throat Clinic in Novi Sad. The research included 80 healthy women classified into 4 groups; 20 women aged between 20 and 30; 20 women in the first trimester of pregnancy aged between 20 and 30; 20 premenopausal women aged between 41 and 50; and 20 women at least 3 years in postmenopause, aged between 41 and 50. For our research we used an olfactometer and the Fortunato-Niccolini method. RESULTS AND DISCUSSION: In pregnancy the thresholds of perception (TP) and identification (TI) of examined substances were slightly lower in comparison to nonpregnant women of the same ages, but without any statistical significance (p > 0.05). In climacteric-postmenopausal women there was a significant decrease of olfactory ability in comparison to nonmenopausal women of the same ages (p < 0.01). CONCLUSION: All changes of the olfactory function in pregnancy are explained by mental changes of pregnant women as well as their hormonal status. Significant decrease of olfactory ability in postemnopause is explained by decline in sexual hormone levels.