Comparison between extraperitoneal and transperitoneal cesarean section: Retrospective case-control study.

INTRODUCTION: The main advantage of extraperitoneal cesarean section (EXPCS) is not only less pain, faster recovery, and less potential for infection but also a possible lack of intraperitoneal adhesions. METHODS: In a 3-year period from 2019 to 2022, 88 EXPCSs were performed. A comparison was made with 90 patients who underwent a standard transperitoneal cesarean section (TPCS). For both groups, the inclusion criterion was uterine inertia and prolonged labor as an indication for cesarean section. Only pregnant women from 37 to 42 weeks were included. After this, 51 patients remained in the EXPCS arm, and 49 remained in the TPCS arm. RESULTS: No statistical difference was found in gestational weeks, newborn weight, Apgar score, erythrocyte (Er), hemoglobin (Hgb), and hematocrit (Htc) values and duration of operative time between the EXPCS and TPCS groups. Leukocytes, C-reactive protein (CRP) with fever higher than >38°C on the third postoperative day were found statistically significantly (p=0.005) higher in the TPCS group. The usage of tramadol + metamizole at 3, 6, and 9 hours after delivery and diclofenac at 6, 12, and 18 hours after surgery was statistically significantly (p<0.05) higher in the TPCS group. On the visual analog scale (VAS) 24 hours after surgery, a statistically significant difference was found (p = 0.001) between the two groups. In the small group of patients who underwent a TPCS section after an EXPCS, intraperitoneal adhesions were not found; in another group of patients who underwent a TPCS twice, adhesions were found in 12 patients; Fisher's exact test (p=0.04). CONCLUSION: The protective effect of EXPCS for infection could be proven in prolonged delivery. EXPCS could be a good solution in the fight against adhesions and infection in women who undergo second, third, or even fourth cesarean sections.

Extraperitoneal Cesarean Section after two Medial Laparotomies, Anus Prater, and Surgical Treatment of the Rectovaginal Fistula in a Patient with Crohn's Disease: A Case Report.

The aim of this case report is to show the advantages of the extraperitoneal cesarean section (ECS) approach in a pregnant patient with multiple previous abdominal transperitoneal colon surgeries and Crohn's disease. A pregnant nulliparous woman with Crohn's disease was admitted for delivery. After delivery, a large rupture and lesion of the rectum was observed. Suturing of the vagina, rectum and sphincter was performed by an abdominal surgeon. Because of a very large and irregularly shaped rectum rupture, the patient underwent infraumbilical medial laparotomy and sigmoidostomy. After 18 months, the patient started to experience vaginal discharge and Y-shaped rectovaginal fistula was confirmed. Surgical reconstruction was performed. The patient's second pregnancy began one year later. At 38 weeks of pregnancy, elective extraperitoneal cesarean section was performed. A healthy newborn was delivered. Follow-up showed full and fast recovery after the ECS. In cases of pregnant women who have had multiple colon surgeries, gynecology surgeons can choose to perform an ECS to avoid transperitoneal entrance into the abdomen. ECS avoids lysis of postoperative adhesions after repetitive gastrointestinal surgeries, the formation of new adhesions by lysis of the old adhesions, and most importantly, the possibility of colon or small intestine lesions during lysis of dense or firm adhesions.

Automated Road Defect and Anomaly Detection for Traffic Safety: A Systematic Review.

Recently, there has been a substantial increase in the development of sensor technology. As enabling factors, computer vision (CV) combined with sensor technology have made progress in applications intended to mitigate high rates of fatalities and the costs of traffic-related injuries. Although past surveys and applications of CV have focused on subareas of road hazards, there is yet to be one comprehensive and evidence-based systematic review that investigates CV applications for Automated Road Defect and Anomaly Detection (ARDAD). To present ARDAD's state-of-the-art, this systematic review is focused on determining the research gaps, challenges, and future implications from selected papers (N = 116) between 2000 and 2023, relying primarily on Scopus and Litmaps services. The survey presents a selection of artefacts, including the most popular open-access datasets (D = 18), research and technology trends that with reported performance can help accelerate the application of rapidly advancing sensor technology in ARDAD and CV. The produced survey artefacts can assist the scientific community in further improving traffic conditions and safety.

[Ovarian cancer - screening and diagnosis]. / Karcinom jajnika - probir i dijagnoza.

Despite advances in gynecologic oncology, ovarian cancer is still mostly diagnosed very late or in advanced stages, which leads to adverse outcome of the disease. The pathogenesis of this disease as well as the risk factors for its development are not completely understood, while symptoms in the early stage of disease are sometimes nonspecific and delay earlier diagnosis. The aim is to present recent knowledge about the screening and diagnosis of ovarian cancer, with sp6cial reference to the role of ultrasound in recognizing the disease and referring patients for further consultation.

Prognostic role of E-cadherin in patients with advanced serous ovarian cancer.

PURPOSE: To analyse correlation between expression of E-cadherin and clinical and pathological features and overall survival in advanced-stage serous ovarian carcinoma. METHODS: The expression of E-cadherin was analysed immunohistochemically in formalin-fixed, paraffin-embedded samples from 54 patients with advanced-stage serous ovarian cancer and related to clinicopathological characteristics and patients survival. The clinicopathological characteristics included the stage according to the International Federation of Gynecology and Obstetrics (FIGO), tumour differentiation, number of mitoses per 10 high-power fields (HPF), residual tumour size, and vascular invasion. Only patients with serous ovarian cancer FIGO stages III-IV were included. Overall survival (OS) was defined as time from surgery to the last follow-up date on 01.10.2010. OS was evaluated using Kaplan-Meier method, and log-rank test was used to asses the differences between the positive and E-cadherin negative group. Multivariate analysis was completed using the Cox proportional hazard regression model. RESULTS: E-cadherin immunoreactivity was not associated with FIGO stage, tumour grade, number of mitotic figures per 10 HPF, residual tumour volume or vascular invasion. Negative E-cadherin expression significantly predicted shorter OS (p < 0.001). The multivariate analyses showed that negative E-cadherin (p < 0.001), FIGO stage (p = 0.012) and residual tumour size >1 cm after the initial cytoreductive surgery (p < 0.001) were predictors of shorter OS. CONCLUSION: Negative E-cadherin expression like presence of residual tumour after primary cytoreductive surgery and higher FIGO stage seem to predict unfavourable clinical outcome in patients with advanced-stage serous ovarian cancer. Negative expression of E-cadherin was shown to be a significant independent predictor of poorer OS. E-cadherin as marker has prognostic value.

Gastric carcinoma presenting as pericardial tamponade during pregnancy.

We describe a rare presentation of acute cardiac tamponade in a patient with gastric cancer in pregnancy. A 32-year-old woman developed dyspnea and tachycardia during the 28(th) week of her pregnancy. These symptoms were interpreted initially by the patient as a condition related to the normal state of pregnancy; however, her symptoms persisted over the next two weeks, and she was hospitalized for evaluation. The diagnostic work-up revealed metastatic gastric carcinoma to the pericardium associated with pericardial tamponade. Large pericardial and pleural effusions were the primary causes of her shortness of breath. Gastric cancer is very rare in pregnancy, and therefore may be not be suspected by physicians. Diagnosis may be further delayed because of overlapping symptoms occurring during normal pregnancy (nausea, vomiting, and shortness of breath). All these factors may contribute to a very high mortality of this malignancy during pregnancy.

[Perinatal outcome of multiple pregnancies in maternity wards in Knin and Livno in 1990-2002]. / Perinatalni ishod viseplodnih trudnoca u rodilistima Knin i Livno 1990-2002. godine.

The aim of this study was to examine perinatal outcome of twin pregnancies in maternity wards in Livno and Knin. The perinatal outcome in these two maternity wards was examined retrospectively during the period 1990-2002. The incidence of twin births, the month with the highest incidence of twin births, the age and parity of the women with twins and their gestational age were examined. Also, we compared the perinatal outcome of twins with singletons, distribution according to sex, lie and presentation at birth. During 13 years 10,856 newborns were delivered, and 127 (1.2%) of them were twins. The incidence of twins in maternity wards in Knin and Livno during the war and after the war was not significantly different (p = 0.89). The month with the highest incidence of twin births was May (14.8%). The avarage age of women with twins was 28.9 +/- 9.7. Twins were born mostly by multiparas (2-4 deliveries). 94 (74%) twins were born on term and 33 (26%) twins before term. 74 newborns (7% per hundred) from singletons and 11 (43% per hundred) from twins died during perinatal period. Twins were delivered by cesarean section (27%) three times more often than singletons (8%). Hypertension in twin pregnancies (7%) was twice as frequent as in singletons (4%). 132 (51.6%) male and 122 (48.4%) female newborns were born. The distribution according to sex was: 58 pairs "male-females", 37 "male-male" and 32 pairs "female-female". The distribution according to presentation at birth was: 49% "cephalic-cephalic", 29% "cephalic-breech", 12% "cephalic-transverse", 5% "breech-breech" and all other combinations got 5%. In conclusion, our results during the war and after the war were not different from other centers and studies thanks to good antenatal care and selection of twin pregnancies for transportation on time to the center with higher level of health care.

Ultrafiltration volume is associated with changes in blood pressure in chronically hemodialyzed patients.

INTRODUCTION: Volume overload is a main factor in development of hypertension in hemodialysis patients. In order to demonstrate impact of ultrafiltration volume on blood pressure during 15-months period in a group of patients undergoing chronic hemodialysis therapy, we conducted this study. We hypothesized that ultrafiltration volume different affects the pre/postdialysis systolic pressure, diastolic pressure, mean arterial pressure (MAP), and pulse pressure (PP) values. SUBJECTS AND METHODS: Study subjects were 23 anuric chronically hemodialyzed patients. The overall study time was 15 months, and 136 single hemodialysis treatments were analyzed. RESULTS: Ultrafiltration was negatively correlated with predialysis systolic blood pressure (r = -0.169, p = 0.025), postdialysis systolic blood pressure (r = -0.292, p < 0.001), postdialysis MAP (r = -0.186, p = 0.015), predialysis PP (r = -0.290, p < 0.001), and postdialysis PP (r = -0.370, p < 0.001). Ultrafiltration/dry body mass (UF/W) ratio was negatively correlated with predialysis PP (r = -0.222, p = 0.005), postdialysis PP (r = -0.340, p < 0.001), and postdialysis systolic blood pressure (r = -0.243, p = 0.002). We found significant difference in postdialysis PP between dialyses with UF/W ratio < or = 0.05 an dialyses with UF/W ratio > 0.05 (63.49 +/- 20.76 vs. 56.27 +/- 16.33 mmHg, p = 0.033). CONCLUSION: The ultrafiltration volume strongly affects postdialysis PP values. Evaluation of elevated blood pressure treatment in patients undergoing chronic hemodialysis therapy must be considered in respect of postdialysis PP values, not just depending on pre/postdialysis systolic and diastolic pressur or MAP values.