Prevalence and significance of vaginal group B streptococcus colonization in pregnant women from Osijek, Croatia.

The aim of the study was to determine the prevalence of vaginal group B streptococcus (GBS) colonization in pregnant women from Osijek area, the possible effect of GBS colonization on pregnancy outcome and neonatal complications and the role of intrapartum prophylaxis in this context. This retrospective case-control study took place at the Department of Gynecology and Obstetrics, Osijek University Hospital Center from December 2003 to June 2006. A total of 118 pregnant women was enrolled in study and divided into two groups: 59 women in 35th-37th week of gestation, free from risk factors for infection (control group); and 59 women in 25th-41st week of gestation with risk factors for infection. Low vaginal swab for GBS isolation and identification on selective and enriched medium was obtained from each woman. GBS colonization was recorded in 29 (24.6%) women: 12 (20.3%) control and 17 (28.8%) women at risk of infection, yielding a statistically non-significant difference (Chi2 = 1.480489; p < 0.48). Early neonatal infection was observed in six (20.7%) neonates born to 29 mothers with GBS colonization, pointing to a correlation between vaginal GBS colonization and early neonatal infection (r(s) = 0.99). Early perinatal infection was found in 22 (18.6%) neonates, including 17 (28.8%) pregnancies with risk factors, pointing to a significant correlation between vaginal GBS colonization, risk factors and early perinatal infection (Chi2 = 88.68; p < 0.001); however, gestational age and pregnancy outcome were not influenced by GBS colonization. In eight (36.4%) newborns, early neonatal infection developed in spite of intrapartum administration of antibiotics; three of these children were born to GBS positive mothers, and perinatal GBS infection was demonstrated in one (0.84%) child. Study results revealed a relatively high rate of GBS colonization in the population of pregnant women in Croatia, occasionally leading to early neonatal infection. Large studies are needed to develop national strategy for the prevention of GBS infection in Croatia.

Vascular endothelial growth factor and intratumoral microvessel density as prognostic factors in endometrial cancer.

The aim of this research was to determine the VEGF A expression in tumor cells and the intratumoral microvessel density and their prognostic significance in the survival of the subjects. 87 subjects were monitored retrospectively for a period of 60 to 132 months. The subjects were treated at the Department of Obstetrics and Gynecology of Osijek University Hospital Center, Croatia. We analysed standard clinical, pathohistological and therapeutical prognostic factors, intratumoral microvessel density and expression of VEGF A. Five-year survival was calculated by the life chart method and presented graphically by Kaplan-Meier curves. Reaching conclusions on statistical hypotheses in this paper was done with a reliability level p < 0.05. Of the analyzed clinical prognostic factors, those which proved to be statistically significant and independent prognostic factors were age and clinical stage of the disease, and of pathohistologic ones it was the depth of myometrial invasion and VEGF expression. An elevated VEGF expression is associated with deep myometrial invasion, poorly differentiated tumors, histologic type and intratumoral microvessel density to a statistically significant degree. Elevated VEGF expression, age, FIGO stage and depth of myometrial invasion play a significant prognostic role in patients with endometrial cancer. VEGF receptors could be a target for adjuvant therapy in VEGF positive endometrial cancer.

Pap test--with or without vaginal smear?

The aim of this study was to evaluate medical and economic justification of vaginal smears as a part of primary screening for cervical carcinoma and its precursors. Study included 245.048 participants whose VCE (vaginal, cervical, endocervical) smears were examined at Department of clinical cytology of University Hospital Center Osijek from 2003 till 2008. There were 12.639 (5.2%) abnormal findings, and they were divided into three groups: abnormal cells found only in vaginal smear (V), abnormal cells found in vaginal and in at least one other smear (V+) and abnormal cells not found in vaginal smear (C/E). These three groups were analysed in respect to cytological differential diagnosis and age of participants. It was estimated how many women could be additionally included in the screening, if vaginal smear would be included in the Pap test only after 50 years of age. In 6.9% of cytologically diagnosed lesions abnormal cells were found exclusively in vaginal smears (0.35% of all findings). As for squamous cell lesions, 91.2% were mild lesions (ASC and LSIL). Invasive squamous cell carcinoma was not diagnosed exclusively by vaginal smear in either woman under 50 years of age, while in women over 50 years of age it was diagnosed in 2.3% of cases. Exclusively by vaginal smear was diagnosed 3.9% of all AGC and 6.3% of adenocarcinoma, while in 85.0% of glandular epithelium lesions abnormal cells were not found in vaginal smears. Two thirds of adenocarcinoma diagnosed exclusively by vaginal smears were endometrial adenocarcinoma, but that is only 10.3% of all endometrial carcinoma diagnosed by Pap test. Obtained results show that taking of vaginal smears along with cervical and endocervical smears as a part of primary screening for cervical carcinoma and its precursors in women under 50 years of age is not justifiable, since vaginal smear only has a role in detection of endometrial carcinoma that are extremely rare in younger age groups. If vaginal smear would be taken only in women over 50 years of age, additional 37.7% of women under 50, or 25.1% women over 50 years of age could be included in the screening.

Assessment of HPV DNA test value in management women with cytological findings of ASC-US, CIN1 and CIN2.

The aim of this retrospective study was to answer the following questions: 1) is HPV DNA test for high-risk types able to predict lesion behaviour in women with cytological abnormalities lower than CIN3 (ASC-US, CIN1 and CIN2); 2) how to predict the histological diagnosis CIN3, and 3) is its use in diagnostic management in these patients justified or not? The study included 345 women (11 ASC-US, 312 CIN1 and 22 CIN2) that underwent conventional diagnostic management (repeat cytology and colposcopy with or without histology) and HPV testing for high-risk HPV types by PCR method. The value of HPVDNA test in predicting lesion regression/persistence was assessed in 275 subjects without histology. In 70 subjects, diagnostic accuracy (sensitivity, specificity, and positive and negative predictive value) of repeat cytology and HPV DNA test in predicting severe intraepithelial lesion (CIN3) was determined on the basis of colposcopy guided biopsy. The prevalence of persistent lesions was significantly higher in the group of HPV positive than in the group of HPV negative subjects (37.7% vs. 16.4%; p < 0.001). Positive HPV test was associated with a 3.1-fold risk of lesion persistence [OR (95% CI) = 3.095 (1.65-5.82)]. However, on screening to predict the outcome of cytologically diagnosed cervical lesion with sensitivity of 39.7% and positive predictive value of 37.7% showed that a positive test could not be considered a reliable indicator of lesion persistence. In contrast, the specificity of 82.5% and negative predictive value of 83.6% suggested that a negative test result could be taken as a good indicator of lesion regression. In comparison with repeat cytology, HPV test showed higher sensitivity (69.2% vs. 61.5%) but significantly lower specificity (63.2% vs. 93.0%) and positive predictive value (30.0% vs. 66.7%), and comparable negative predictive value (90.0% vs. 91.4%) in predicting histologically verified CIN3. In one patient with a histological diagnosis of squamous cell carcinoma with minimal invasion, repeat cytology indicated CIN3, whereas HPV test was negative. Due to authors experience in women with cytological abnormalities lower than CIN3, HPV testing is not a method to reliably predict lesion behaviour (regression, persistence) or presence of CIN3. HPV testing is of limited value in daily routine and should not be widely used until it is definitely demonstrated to be superior to conventional methods in improving the sensitivity, specificity and positive predictive value of CIN3 and invasive carcinoma detection.

How to evaluate the risks of illnesses when there is a disorder of embroidery and supporting tissues.

For the gynecologist it is not the priority activity of investigation the skin, bones and tissues, but we have the great relation and connection across the endocrinological ways. The main point is estrogen, gestagen and androgen, but also the condition of embroidery and supporting tissues have influence through the anabolic effects. If sexual steroids in anabolic activity are missing, the skin will dehydrate based on weither of corium, the risk of fracture of bones is bigger, the yielding of hardness of embroidery apparatus can cause deep pains in small of the back and we have a great number of cardiovascular illness. The function of skin, bones and blood vessels is mostly based on special characteristics of extracellular matrix. This can be defined again through the collagen. In spite of the coristant building and demolishing rise through the control of sexual steroids. At the same time, the mineralization of osteoids in the skeleton has influence of estradiol. A deficit of sexual steroids, unhealthy living and other factors can influence the degenerative changes of skin bones and blood vessels. To evaluate, obliged risk of illness and risks of accidents there are different procedures: the contents of collagen in skin and the fatness of blood vessels can be measured only by a high frequent ultrasound. Nevertheless we can confirm the condition of bones with radiological and ultrasound methods. In truth, the controversies about the prognostic values in consideration of risks of fractures exist which measured in the different cases trend in diagnosis of osteopenia/osteoporosis.

Maternal overnutrition and pregnancy.

During the period from October 1, 1999 till February 29, 2000, 500 pregnant women were analyzed according to overnutrition, i.e. weight gain. The analysis was performed in the Department of Gynecology and Obstetrics, Osijek University Hospital for pregnant women from east Slavonia, Baranya and west Srijem, where large quantities of dietary fats and carbohydrates are used. The mean weight gain during pregnancy was assessed. The mean weight of male infants in primiparae was 3.22 g, i.e. 8% higher than the mean value for the same population in Zagreb. The rate of EPH gestoses in patients with weight gain over 12 kg was significantly higher (4.0%) than in those with weight gain less than 12 kg (1.8%). In pregnant patients with weight gain > 12 kg, the rate of cesarean section was significantly higher (9.2%) than in those with weight gain < 12 kg (4.4% o). Perinatal mortality was significantly higher (10.0%) in pregnancies with weight gain > 12 kg than in those with weight gain < 12 kg (2.0% o). It is concluded that dependence on overeating in pregnancy may result in higher rates of EPH gestosis, cesarean section and perinatal mortality.

Unrecognized cervical pregnancy treated by suction curettage and cervicovaginal tamponade.

The authors presented a case of a 30-year tertigravidar women with unrecognized cervical pregnancy, treated by suction curettage and cervicovaginal tamponade. In our case of unrecognized cervical pregnancy, during hysterometry and cervical dilatation occured uterine bleeding and clinical pictures of obstetrics hemorrhagic shock, so we continued with suction curettage and cervicovaginal tamponade as a urgent procedure which turned out as a final. Medicamentous chemotherapy of the cervical pregnancy (methotrexat) was not used, because after described procedure beta-HCG lytic decreased and without colour-Doppler visualization of local cervical trophoblastic vascularisation.