MTHFR C677T and A1298C Genotypes and Haplotypes in Slovenian Couples with Unexplained Infertility Problems and in Embryonic Tissues from Spontaneous Abortions.

The objective of this study was to analyze the methylenetetrahydrofolate reductases ( MTHFR s) C677T and A1298C genotype distributions in couples with unexplained fertility problems (UFP) and healthy controls, and to analyze the genotype and haplotype distribution in spontaneously aborted embryonic tissues (SAET) using allele specific polymerase chain reaction (PCR) in 200 probands with UFP, 353 samples of SAET and 222 healthy controls. The analysis revealed a significant overall representation of the 677T allele in male probands from couples with UFP ( p = 0.036). The combined genotype distribution for both MTHFR polymorphisms was also significantly altered (χ (2) 21.73, p <0.001) although female probands made no contribution (χ (2) 1.33, p = 0.72). The overall representation of the 677T allele was more pronounced in SAET (0.5 vs. 0.351 in controls, p <0.001) regardless of the karyotype status (aneuploidy vs. normal karyotype). In addition, the frequencies of the CA and CC haplotypes were significantly lower than in the control group ( p = 0.021 and p = 0.001, respectively), whereas the frequency of the TC haplotype was significantly higher than in controls ( p <0.0001). The presented findings indicate that only male probands contribute to the association of MTHFR mutations with fertility problems in grown adults and demonstrate a high prevalence of mutated MTHFR genotypes in SAET.

Use of various contraceptives and human papillomavirus 16 and 18 infections in women with cervical intraepithelial neoplasia.

The aim of the study was to evaluate the frequency of human papillomavirus (HPV) 16 and 18 infections in patients with cervical intraepithelial neoplasia (CIN) according to the use of various contraceptive methods. In a study group of 1435 patients with histologically proven CIN, among whom 391 (27.2%) used no contraception, 44 (3.1%) used barrier methods, 705 (49.1%) used oral contraceptives and 295 (20.7%) used an intrauterine device (IUD), the presence of HPV infection was evaluated by DNA in situ hybridization. HPV 16 or 18 infection was present in 666 (46.4%) of all patients in 348 (49.4%) patients who used oral contraceptives, in 169 (43.2%) patients with no contraception, in 128 (43.4%) patients with an IUD and in 21 (47.7%) patients who used barrier methods. There were no significant differences in HPV 16 and 18 infection frequencies among all four groups of patients regarding the contraception method used.

Clinical audit of patients with cervical cancer in Slovenia. Data analysis from 2003-2006.

PURPOSE OF INVESTIGATION: From 2003 to 2006 the data on Slovenian cervical cancer patients who regularly attended a gynecologist were gathered. Data were analyzed in order to improve the efficiency of the cervical cancer screening program. METHODS: Data on all patients newly diagnosed with cervical cancer were collected at three central clinics in Slovenia. The results are a presentation and comparison of detailed information on some characteristics of cervical cancer patients of the group that regularly visited a gynecologist and of the other group who did not. Data were processed by descriptive epidemiological methods. Mantel-Haenzel chi2 and Fisher's p tests were used to evaluate statistical significance. RESULTS: On average, 55% of patients with cervical cancer underwent a gynecological examination five years before the diagnosis. The patients who regularly attended their gynecologist were, in all age groups, statistically significantly younger, the stage of cervical cancer at diagnosis was statistically significantly lower (p = 0.01) and were, in statistically significantly higher percentage, treated surgically (p < 0.01). From 2003 to 2006, each patient had on average five examinations at her gynecologist within the period of five years to six months before the diagnosis of cervical cancer. The average number of collected smear samples was 3.2. CONCLUSION: From the results of our analysis, it may be concluded that improvements are needed in Slovenia in the field of screening for and early detection of cervical cancer.

Relationships between bone mineral density and cell size in cervical smears, serum estradiol levels, and anthropometric characteristics.

OBJECTIVE: To evaluate relationships between bone mineral density and morphometric characteristics of squamous cells in cervical smears, serum estradiol levels, body weight, and body mass index. METHOD: Dual X-ray absorptiometry measurements were performed in 107 women who had recently undergone routine screening for cervical cancer. Serum estradiol levels were determined. Mean areas for squamous cells, squamous cell nuclei, and squamous cell cytoplasm were calculated, as well as the nucleus area to cytoplasm area ratio. RESULTS: The mean cell and cytoplasmic areas were significantly lower in women with lower T scores for femoral neck and lumbar spine (P<0.001). Mean T scores were significantly lower for the women with atrophic cells than for those with mature cells (P<0.001). A correlation between estradiol levels and T scores was found for the lumbar spine (P<0.05) but not for the femoral neck. Multiple linear regression analysis showed the cytoplasmic area to be the most significant predictor of T scores for the total hip, followed by BMI and age, and to be the only significant predictor of T scores for the total spine. CONCLUSION: Relationships were found between bone mineral density and both the total cell and cytoplasmic areas of squamous cells obtained from cervical smears.

Clinical audit of patients with cervical cancer in Slovenia--data analysis for the year 2003.

PURPOSE OF INVESTIGATION: The data gathered in 2003 on the patients with cervical cancer who regularly attended their gynecologist were analyzed with the purpose of clinical audit. METHODS: The data on newly detected patients with cervical cancer in 2003 who regularly attended their gynecologist were gathered simultaneously at three Advisory Boards for Gynecology in Slovenia. RESULTS: Of 149 patients in whom, according to our data, invasive cervical cancer had been diagnosed, 92 (61.7%) patients were examined by a gynecologist in the previous five years. In the majority of these patients, cervical cancer was diagnosed in early, localized disease stage. In the periods of 13-24 and of seven to 12 months before the diagnosis of cervical cancer, almost half the patients had Pap II, and three to six months before diagnosis, 67.6% of patients had Pap II. CONCLUSION: These results encourage us to proceed with clinical audits to analyze individual cervical cancer cases, including another independent reevaluation of cervical smears in the five-year period before diagnosis. A suitable calendar of refresher training courses on colposcopy, which should be obligatory for all performing this examination method, also needs to be set up.

Chlamydia trachomatis infections in eastern Europe: legal aspects, epidemiology, diagnosis, and treatment.

OBJECTIVES: Knowledge concerning genital Chlamydia trachomatis infections in eastern Europe is scarce. Data on the legal aspects, epidemiology, diagnosis, and treatment of the infection have never been collected, summarised, and presented to the international scientific community. The aim of this study was to present the current situation on the main aspects of chlamydial infections in the countries of eastern Europe. METHODS: Written questionnaires concerning legal aspects, epidemiology, diagnosis, and treatment of the infection were distributed among national STI operating administrators as well as researchers who had presented papers at earlier meetings of European chlamydia or STI societies. RESULTS: Most of the countries have not legalised reporting of chlamydial infections and in those who have done so, the quality of the reporting system is poor. Contact tracing is mostly done on a voluntary basis. Reported chlamydia incidence varies from 21 to 276 per 100000 inhabitants. The most commonly used diagnostic test remains the direct immunofluorescence test; however, some tendencies towards nucleic acid amplification are in evidence. Diagnostic services are paid for by the patient himself, while treatment in many countries is partially or completely covered by public insurance. CONCLUSIONS: This is the first report summarising data concerning the situation on C trachomatis infections in eastern Europe. The reporting system and diagnosis of C trachomatis infections remain suboptimal, which allows neither control of the epidemiological situation nor optimal treatment of the patients. The most urgent work currently necessary is the education of professionals and the general population.

Intraoral sonographic evaluation of parapharyngeal space tumors.

We performed transcutaneous (external) sonography and then intraoral sonography to evaluate 3 parapharyngeal space tumors (1 vagal paraganglioma, 1 pleomorphic adenoma, and 1 carcinoma arising in a pleomorphic adenoma). All 3 patients had medial displacement of a tonsil. In all cases, we could measure the size and see the borders of the tumors and their relation to other structures on intraoral sonography. Intraoral sonography is useful for differentiating between unilaterally enlarged and medially displaced tonsils.

Database reusability in intelligent medical systems.

Reuse or reusability is not a specific, algorithmic, heuristic or only a simple set of guidelines. Database reuse means the use of an existing component--a database entity--in a new context, either elsewhere in the same system or in another system. According to different definitions, an intelligent system is a "power tool for thinking"; but on the other side it is only a kind of information system with built-in knowledge to support decisions made by human experts. Similar conclusions could be made for intelligent medical systems and introduce the database reusability in this environment with a purpose to increase the quality of an intelligent medical system. In the paper the problem of the database reusability will be presented more in detail, especially its integration in an intelligent medical system. Finally, the results of such integration and the benefits for the medicine will be discussed.

A prospective study of the correlation between Chlamydia trachomatis infection and secondary bleeding following large loop excision of the transformation zone (LLETZ).

To determine the effect of Chlamydia trachomatis (CT) on the occurrence of secondary bleeding following large loop excision of the transformation zone (LLETZ), 103 patients with cervical intraepithelial neoplasia (CIN) were included in this study. In order to determine the presence of CT infection, cytological material for direct immunofluorescence analysis was obtained prior to LLETZ. After surgery, the patients were followed up for postoperative bleeding. Groups with and without postoperative bleeding were compared as regards the frequency of CT infection. Of 103 patients, 8 (7.8%) were CT positive and 95 (92.2%) were CT negative. Postoperative bleeding only occurred in 6 (2.8%) patients, all of whom were CT negative. Thus, in CT-positive patients, no secondary bleeding occurred. CT infection of the uterine cervix in patients with CIN is rare and does not appear to be important for the occurrence of postoperative bleeding after LLETZ.

High frequency transvaginal ultrasonography in preoperative assessment of myometrial invasion in endometrial cancer.

The aim of the study was to assess the depth of myometrial invasion by endometrial cancer using preoperative 5-9 MHz, high frequency transvaginal ultrasonography as compared with postoperative assessment using histopathologic examination. The study included 120 patients with histologically proven cancers of the endometrium. All patients underwent transvaginal sonography before surgery. The depth of myometrial invasion was classified as none, inner half of uterine wall, and outer half of uterine wall. Of 106 (88.3%) patients with proven myometrial invasion, 98 cases (92.5%) were revealed by sonography. In 109 cases (90.8%) invasion was believed to be present on transvaginal sonography. Histologically proven invasion that correlated with sonography was shown in 88 patients (73.3%). In 32 patients (26.7%) ultrasonography could not correctly predict the depth of myometrial invasion. The depth of invasion was underestimated in 10 (8.3%) cases and overestimated in 22 (18.3%) cases. Preoperative assessment of invasion of the uterine wall by transvaginal ultrasonography had an accuracy of 73% if correlated with the definitive histopathologic examination. The role of high frequency transvaginal ultrasonography in preoperative assessment of the depth of myometrial invasion in patients with endometrial cancer is limited.

Role of appendectomy in predicting lymph node metastases in patients with ovarian cancer.

OBJECTIVE: The aim of this study was to assess the diagnostic accuracy of appendectomy in predicting lymph node metastases in women undergoing cytoreductive procedures for ovarian cancer. STUDY DESIGN: In 127 consecutive patients with ovarian carcinoma appendectomy was performed in 30 patients over a period of 5 years. Eight of them were found to have metastases to the appendix. Pelvic and paraaortic lymphadenectomy was performed in 34 patients, in 24 of them the appendix was removed during primary surgery. RESULTS: Among 19 patients without metastases to the appendix the lymph nodes were positive in five cases (26.3%) and among five patients with metastases to the appendix the lymph nodes were positive in four cases (80.0%), which is not a significant difference. Evaluation of the appendiceal metastases as a predictor of lymph node metastases in patients with ovarian cancer gives a sensitivity of 44%, a specificity of 93%, a positive predictive value of 80%, a negative predictive value of 74% and an accuracy of 75%. CONCLUSION: The possibility of predicting retroperitoneal lymph node metastases in ovarian cancer on the basis of histological examination of the appendix is limited.

Cold knife conization and loop excision for cervical intraepithelial neoplasia.

AIMS AND BACKGROUND: Our aim was to investigate whether loop excision is an acceptable alternative to traditional cold knife conization of the cervix. PATIENTS AND METHODS: 240 with cervical intraepithelial neoplasia (CIN) were randomly assigned to loop excision (n = 120) or cold knife conization (n = 120). Success and complication rates of both methods were analysed. RESULTS: 100% of cold knife conization and 98% of loop excision surgical specimens were positive for dysplasia. The rate of complete resection was 91% in the cold knife and 82% in the loop excision group, but histologic confirmation of residual CIN was obtained in only 2 (1.7%) women after cold knife conization and in 5 (4.2%) after loop excision. Loop excision cones were significantly shallower than those obtained by a cold knife. Secondary surgical procedures due to early hemorrhage were performed in 9 (7.5%) patients treated with cold knife conization and in 8 (6.7%) treated with loop excision. Elevated temperature postoperatively was observed in 16.4% of patients after cold knife conization and in 13.9% after loop excision. There were no other postoperative complications. CONCLUSIONS: The results suggest that cold knife conization and loop excision are comparable and equally effective diagnostic and therapeutic procedures for CIN.

Chlamydia trachomatis infection in women with and without cervical intraepithelial neoplasia.

The aim of the study was to compare the frequency of Chlamydia trachomatis infection in patients with cervical intraepithelial neoplasia (CIN) and in women without cervical pathology. In a study group of 423 patients with histologically proven CIN and in 108 controls with normal cervical smear, cytological material for direct immunofluorescence analysis was obtained. Among 423 patients, 24 (5.7%) had CIN 1, 108 (25.5%) CIN 2 and 291 (68.8%) CIN 3. Among all patients with CIN, 27 (6.4%) were C. trachomatis positive and 396 (93.6%) C. trachomatis negative. In the control group 6 (5.6%) were C. trachomatis positive and 102 (94.4%) C. trachomatis negative. The difference between C. trachomatis infection incidence in patients with CIN and in women without cervical pathology was not significant (chi2=0.29; P>0.05). In this study, no difference in C. trachomatis infection incidence was detected between patients with CIN and women with normal cervical smears. The impact of C. trachomatis infection seems not to interfere with the development or even the promotion of CIN.

User friendly inquiry and computer program for following patients with ovarian malignancy.

The establishing of a correct diagnosis in patients with ovarian malignancy requires the combination of a variety of methods of examination. An inquiry for following of malignoma patients has been compiled, accompanied by an adequate computer program. Beside general information regarding the patient, diagnosis and treatment, the inquiry also includes the case history, data regarding clinical, ultrasonographic and preoperative examinations, surgery, histologic findings and follow-up after termination of treatment. A user-friendly computer program was developed for recording and processing of all available data collected during the diagnostic and treatment procedures. The inquiry and the computer program have been in use for three years and we find they are very useful in follow-up of patients with ovarian malignancy. Data are collected at one site, transparent and always available. Statistical analysis of collected data can be performed by computer. The aim of this uniform inquiry and computer program is a concurrent, radical and simplified collecting, processing and comparing of data at each center and between centers dealing with the treatment of ovarian malignancy.

The frequency of Chlamydia trachomatis infection in women with intraepithelial neoplasia of the uterine cervix.

OBJECTIVE: To evaluate the frequency of Chlamydia trachomatis (CT) infection in patients with cervical intraepithelial neoplasia (CIN) referred for conisation. METHODS: 423 patients with histologically proven CIN were included in this study. Before conisation, cytological material for direct immunofluorescence analysis was obtained. The incidence of CT in cytologic smears of all three CIN groups was calculated. RESULTS: Among all patients with CIN, 27 (6.4%) were CT positive and 396 (93.6%) CT negative. There were 2 (8.3%) CT positive patients with CIN 1, 10 (9.3%) with CIN 2 and 15 (5.2%) with CIN 3. The difference between CT infection incidence in patients with CIN 1 and CIN 2 was not significant; neither was it significant between patients with CIN 1 and CIN 3 nor between those with CIN 2 and CIN 3. CONCLUSIONS: Chlamydia trachomatis infection in patients with CIN is not very common. The impact of CT infection does not seem to interfere with development or even promotion of CIN.

The frequency of bacterial and yeast infection in women with different grades of cervical intraepithelial neoplasia (CIN).

OBJECTIVE: To determine bacterial and yeast infection of the uterine cervix in women with different grades of cervical intraepithelial neoplasia (CIN). STUDY DESIGN: 578 patients with CIN were included in this study. In order to determine the presence of bacterial and yeast infection, a cervical swab was obtained before conization of the uterine cervix. After surgery and the definitive histology report, the frequency of bacterial and yeast infection in different grades of CIN was calculated. RESULTS: Among 578 patients with CIN, bacterial or yeast infection was present in 379 (65.6%) patients. In patients with CIN 1, infection was present in 20 (71.4%), in CIN 2 in 106 (69.7%) and in CIN 3 in 252 (63.3%) cases. The differences in the frequency of infection among all three groups are not significant. CONCLUSION: In patients with CIN bacterial and yeast infection of the uterine cervix is very common. Its occurrence does not depend on the grade of CIN.

Analysis of blood flow in adnexal tumors by using color Doppler imaging and pulsed spectral analysis.

Because of various contradictory reports in the literature and an increasingly urgent need for preoperative evaluation of adnexal masses before laparoscopic surgery, our aim was to disclose if examination by means of color Doppler ultrasound is useful in distinguishing benign from malignant adnexal tumors in our population. Prior to surgery, pulsed color Doppler velocimetry of the adnexal blood supply was performed in a prospective study in 80 patients with benign and 40 with malignant adnexal tumors. Vascularization was equally frequent in both groups of tumors. Blood vessels of benign tumors had a diffuse, intraseptal or intraproliferative location significantly more often and malignant tumor vessels more often exhibited a diffuse, intraseptal or intraproliferative location (p < 0.01). The mean value of RI+/-SD was 0.56+/-0.14 in benign and 0.33+/-0.13 in malignant tumors. The differences in RI between benign and malignant tumors are statistically significant (p < 0.01). In detecting malignant adnexal tumors, the sensitivity of RI < or = 0.40 is 82%, its specificity 97%, positive predictive value 94%, negative predictive value 92% and its accuracy 92%. The analysis of vascularization presence seems not to have any value in predicting the nature of adnexal tumors, and blood vessels arrangement, as well as measured RI < or = 0.40, allows us to predict the presence of malignancy with limited reliability.

Role of preoperative transvaginal sonography, color flow imaging, and Doppler waveform analysis in predicting lymph node metastases in patients with ovarian cancer.

The aim of this prospective study was to assess the diagnostic accuracy of transvaginal sonography, color flow imaging, and Doppler waveform analysis of adnexal tumors in predicting lymph node metastases in women undergoing laparotomy for ovarian cancer. In 30 consecutive women undergoing pelvic and paraaortic lymphadenectomy due to ovarian cancer, the morphology of the adnexal mass was evaluated preoperatively with transvaginal sonography. Besides conventional gray-scale analysis as well as localization and intensity of angiogenesis, the resistance index (RI) was computed on the arteries detected with color flow imaging. There were 20 (66.7%) patients with negative and 10 (33.3%) patients with positive lymph nodes. The differences in maximal tumor diameter, maximal thickness of tumor wall, echographic structure, or presence of ascites between both groups of patients were not significant. There was no significant difference in the presence or absence of tumor vascularization between both groups of patients. In both groups of patients the mean value of the lowest RI was 0.37. Also, the difference in frequency of RI

Receiver operating characteristic curves of transvaginal Doppler blood flow measurements in benign and malignant adnexal tumors.

The role of receiver operating characteristic curves of transvaginal Doppler velocimetry in predicting malignancy was evaluated in 80 patients with benign and 40 patients with malignant adnexal tumors. The mean values of peak systolic velocity did not differ significantly. Malignant tumors had a significantly higher end diastolic velocity and mean flow velocity than benign tumors. Benign tumors had a significantly higher ratio of peak systolic to end diastolic velocity, pulsatility index, and resistive index than malignant tumors. The diagnostic accuracies in predicting malignancy were as follows: peak systolic velocity, 62%; end diastolic velocity, 79%; ratio of peak systolic to end diastolic velocity, 63%; mean flow velocity, 73%; pulsatility index, 91%; resistive index, RI 92%. Doppler velocimetry analysis allows us to predict the presence of malignancy with limited reliability.

Human papillomavirus 16 and 18 infection of the uterine cervix in women with different grades of cervical intraepithelial neoplasia (CIN).

OBJECTIVE: To evaluate the frequency of human papillomavirus (HPV) 16 and 18 infection in patients with different grades of cervical intraepithelial neoplasia (CIN). METHOD: Five-hundred and five patients with CIN, referred for conization, were included in this study. Before conization, cytological material for in situ hybridization was obtained from the uterine cervix to detect the presence of HPV 16 and 18 infection. RESULT: Among all patients with CIN, 82 (16.2%) were solely HPV 16 and 51 (10.1%) were solely HPV 18 positive. There were 133 patients (26.3%) positive for HPV 16 or HPV 18 and 31 patients (6.1%) were positive for both viral types, giving an overall HPV 16/18 infection rate of 32.4%. There were 15 (55.5%) HPV 16 or HPV 18 positive patients with CIN 1, 45 (33.8%) HPV 16 or HPV 18 positive patients with CIN 2 and 104 (30.2%) HPV 16 or HPV 18 positive patients with CIN 3. CONCLUSION: In patients with CIN 1, HPV 16 and 18 infection was more frequent than in patients with CIN 2, but the difference was not significant. Patients with CIN 2 were infected slightly more frequently, but not significantly, than patients with CIN 3. On the other hand, patients with CIN 1 were significantly more frequently infected than patients with CIN 3.