[Diagnostic importance of the sonographic scoring system in differentiating between malignant and benign ovarian tumors]. / Dijagnosticki znacaj sonografskog bodovnog sistema u diferencijaciji malignih i benignih tumora jajnika.

INTRODUCTION: There have been several different sonographic scoring systems developed for evaluation of particular characteristics of ovarian tumors in order to classify malignant diseases in the most objective way. The aim of this study was to evaluate diagnostic significance of our own scoring system and possibilities of its application in differentiation of malignant and benign ovarian tumors. MATERIAL AND METHODS: A prospective study comprised 177 women with different ovarian tumors. All patients underwent ultrasound examination using a unit with a 5 MHz probe. Certain tumor characteristics (size, morphology, septa, type of capsule and ascites) were estimated by scores from 0 to 2 whereas the sum of all scores presented the total score. A final diagnosis was made after histopathologic examination: group A--malignant ovarian tumors (n = 71) and group B--benign ovarian tumors (n = 106). RESULTS: The highest value of reliability in differentiation of malignant and benign ovarian tumors was score 6 and more than six (sensitivity 87.3%, specificity 91.5%, positive predictive value 87.3%, negative predictive value 91.5% and test accuracy 90.9%). DISCUSSION: A separate diagnostic problem during application of mentioned sonographic scoring system were solid malignant tumors with a low total score (4 and 5 scores) and benign tumors of complex consistence of high total score (7 and 8 scores). The total score 1-3 eliminates malignant tumors and the score from 9-10 eliminates benign type of tumors. CONCLUSION: High sensitivity (95.7%) is present at the total score of 5 and more than five, but low specificity (81.1%) and test accuracy (87%) gives advantage to the score 6 and more, where differences between separate statistical parameters are least present.

[The Wertheim-Meigs radical hysterectomy in surgical treatment of cervical carcinoma]. / Radikalna histerektomija po Wertheim-Meigsu u hirurskom lecenju karcinoma grlica materice.

INTRODUCTION: Wertheim from Vienna was the first to introduce the technique of radical hysterectomy into surgical practice in treatment of uterine cervix carcinoma associated with partial lymphadenectomy (1989). In concern to the level of surgical extensiveness, radical hysterectomy can be divided into 5 classes (after Piver-Rutledge). MATERIAL AND METHODS: At the Department of Obstetrics and Gynaecology in Novi Sad 55 patients with invasive cervical cancer (FIGO st. IB1-IIB) underwent surgery during the period from 1991 to 2001. All patients underwent radical hysterectomy after Wertheim-Meigs technique. The aim of this study was to present operative techniques of radical hysterectomy and complications following surgery. RESULTS: Distribution by stage of the disease was as follows: IB1 = 39 (70.9%), IB2 = 6 (10.9%), IIA = 7 (12.7%) and IIB = 3 (5.5%). On average, there were 15 lymph nodes removed, out of which 9 (16.4%) cases were positive. Postoperative complications were recorded in 19 (34.5%) patients, whereas the incidence of urinary fistulas and intrahospital mortality rate have been reduced to the minimum (0%). Recurrence was evident in 3 (5.4%) patients and 5-year survival rate was 92.3% (in patients operated up to 1997). DISCUSSION AND CONCLUSION: In relation to previously published results of treatment at the Department, there is an evident increase in the number of stage I patients and a decrease in stage II patients, as well as a reduced incidence of postoperative urinary fistulas, total number of complications, but an increase in the 5-year survival rate.

[Radical vulvectomy with inguino-femoral lymphadenectomy in the surgical treatment of vulvar carcinoma]. / Radikalna vulvektomija sa ingvinofemoralnom limfadenektomijom u hirurskom lecenju karcinoma vulve.

INTRODUCTION: Vulvar carcinomas comprise almost 5% of all malignant tumors of the female genital tract. The final diagnosis is made after histologic examination of biopsy specimens obtained from different sites in the vulva. Primary therapeutic approach in all cases is surgery, whereas the operative procedure depends on the size and location of the lesion, stage of the disease, general condition and age of the patient, as well as on the condition of the surrounding tissue and possible continuance of sexual life. METHODS: In the period from 1985-1999, there were 39 patients with invasive forms of vulvar carcinomas operated at the Department of Gynaecology in Novi Sad. Radical vulvectomy associated with inguinal-femoral lymphadenectomy was performed in 26 (66.6%) patients. During 1994, a wide "butterfly-shaped "block" dissection of the vulva, pubis and inguinal area was done, whereas during the following period, the operative area was reduced by application of separate inguinal incisions after Hacker, leaving the tissue bridge in between. RESULTS: The mean age of operated patients was 62.1 years (34-85). There were 53.8% stage I, 17.9% stage II, 20.7% stage III and 7.6% stage IV patients. In patients undergoing radical surgery the average number of extirpated lymph nodes was 16.3 out of which in 7 (26.9%) cases the nodes were positive. Lethal outcome was recorded in 4 (15.3%) patients. Two (7.6%) died of pulmonary thromboembolism and 2 (7.6%) during the following 5 years for diffuse dissemination of metastases. During 1994, complications were recorded in 69.2% operated patients versus 7.6% recorded during the following period. CONCLUSIONS: Radical vulvectomy associated with bilateral inguinal-femoral lymphadenectomy is a standard procedure in surgical treatment of invasive stages of vulvar carcinoma protruding more than 1 mm. The application of two separate inguinal incisions after Hacker resulted in shortening the intrahospital postoperative period from 34.2 to 14 days and reduction of the rate of wound dehiscence and postoperative complications in the period following 1994.

Dynamics of the HIV-1 subtype distribution in the Swedish HIV-1 epidemic during the period 1980 to 1993.

We have investigated the distribution of the major subtypes, or clades (A to E), in the Swedish human immunodeficiency virus type 1 (HIV-1) epidemic between the years 1980 to 1993, using gp120 V3 domain serotyping and genotyping. Until 1984 the Swedish HIV-1 epidemic was almost exclusively caused by HIV-1 subtype B. During the late 1980s and the early 1990s an increase in nonsubtype B infections (mainly subtypes A and C) was observed. Nonsubtype B infections constituted approximately 30% of the newly diagnosed HIV-1 cases in 1993. In the analyzed material we also noted a substantial increase in the proportion of HIV-1 infections caused by heterosexual transmission. The present data suggest that the subtype distribution in the Swedish HIV-1 epidemic may well continue to change with time, which may have implications for preventive research and vaccine development strategies.

[Pelvic inflammatory disease and the use of intrauterine contraceptive devices]. / Pelvicna inflamaciona bolest kod primene intrauterinih kontraceptivnih ulozaka.

Pelvic inflammatory disease includes a group of different diseases such as: endometritis, salpingitis, oophoritis and peritonitis. The risk of pelvic inflammatory disease in intrauterine contraceptive devices--users is 7-9 times higher than in the general population, whereas the incidence of occurrence of these diseases in this certain group is 2-5%. During the period 1989-1993, 155 intrauterine contraceptive users with pelvic inflammatory disease, were treated at the Clinic, which makes 25% of all hospitalized female patients with pelvic inflammatory disease. Serious cases have been established in regard to the period 10 years ago. In order to prevent the occurrence of pelvic inflammatory disease in users of intrauterine contraceptive devices, health education is necessary to motivate regular controls and check-ups, preventive application of antiseptic vaginal tablets and detection of signs of the disease.

[Use of suture materials in gynecologic surgery]. / Primena savnog materijala u ginekoloskoj hirurgiji.

This paper presents evolutionary development of suture materials in surgery from the "period of renaissance" to these days. Ideal suture materials in surgery should fulfil characteristic demands such as the four following: safety of knots, tension force, tissue reactions and wound safety. The table presents absorptive and nonabsorptive suture materials especially taking into consideration the application of the materials in contaminated-inflamed tissues. Recommendations in regard to choice of surgical suture materials are given considering gynecologic surgery.

[Actinomycosis of the minor pelvis associated with prolonged use of intrauterine contraceptive devices (IUD)]. / Aktinomikoza male karlice udruzena sa dugotrajnom primenom intrauterinog kontraceptivnog uloska (IUD).

Pelvic actinomycosis is a rare disorder caused by Gram-positive anaerobic bacteria Actinomyces Israeli, and it is commonly associated with the prolonged use of IUD. The authors present two cases of pelvic actinomycosis in patients who used IUD for prolonged periods of time (eight and fourteen years). The diagnostic procedure in both cases lasted long and the definite diagnosis was made only after the pathohistological examination of the material taken during the surgical treatment. Actinomyces Israeli should be considered as one of the causes of the diagnosed pelvic inflammation especially when it is associated with the prolonged use of IUD.

[Diagnostic significance of preoperative determination of CA-125 serum levels in the differentiation of malignant and benign pelvic masses]. / Dijagnosticki znacaj preoperativnog odredivanja koncentracije CA-125 u serumu u diferencijaciji malignhin i benignih karlicnih tumefakcija.

Preoperative estimation of serum C-125 tumour marker was performed in 45 patients with adnexal malignancies, 50 patients with benign pelvic masses and in 30 healthy women who underwent plastic surgery for disturbed statics of genital organs. Elevated serum CA-125 values (above 65 U/ml) were observed in 38 (84.5%) patients with ovarian malignancies (chi = 355.93, SD +/- 251.86) and in 7 (14%) patients with palpable benign pelvic masses (chi = 48.09, SD +/- 77.08). Preoperatively evaluated serum CA-125 values were not evident in the control group (chi = 7.20, SD +/- 6.98). There were statistically significant differences (T = 8.13, p < 0.05) between preoperative mean serum CA-125 values in the patients with malignant and benign pelvic masses. Also, there was statistically significant difference between the control group, the group with malignancies (T = 7.48, p < 0.05) and the group with benign pelvic masses (T = 2.86, p < 0.05). Preoperative assessment of the serum CA-125 values proved to be significant but not absolutely reliable laboratory-diagnostic parameter in differentiation of malignant and benign pelvic masses in the female.

[Evaluation of short-term exposure to a polyacrylonitrile cervical dilator in preabortion preparation of the uterine cervix in adolescent girls]. / Evaluacija kratkotrajne ekspozicije poliakrilonitrilskih cervikalnih dilatatora u preabortusnoj pripremi grlica materice adolescenata.

Authors investigated possibilities of application of polyacryl-nitrile cervical dilators PCD-Dilapan in preabortion preparation of the cervix during the first trimester of pregnancy in 39 adolescent patients. Control of the achieved degree of cervical dilatation was performed by largest No Hegar dilator which did not show resistance during insertion. The control group comprised 35 adolescent patients in whom cervical dilatation was performed only by Hegar dilators till optimal dilatation for vacuum aspiration was achieved. Mean cervical dilatation in the investigated group was means = 8.85 mm (SD +/- 0.85) and in the control group means = 8.55 mm (SD +/- 0.78) with no statistically significant difference (T = 0.024, p greater than 0.05). "Analogous visual scale" was used for pain estimation during cervical dilatation. In the investigated group means = 2.01 (SD +/- 1.83) of pain degrees while means = 6.71 (SD +/- 1.89) in the control group. Side effects during cervical dilatation were noted in 15.38% of patients in the investigated group and in 51.41% of patients in the control group which difference was not statistically significant (chi 2 = 5.59, p greater than 0.05).

[Evaluation of various methods and means in atraumatic dilatation of the uterine cervix]. / Evaluacija razlicitih metoda i sredstava u atraumatskoj dilataciji grlica materice.

The method of dilation of the uterine cervix precedes the evacuation and curettage of the uterine cavity and at the same time presents the oldest method of conducting an artificial abortion. In the aim of decreasing the possibility of damaging the uterine cervix by a forcible mechanical dilation by means of metal dilators, it has always been attempted to dilate the cervix by various materials which would alleviate aggression towards tissue. A significant contribution to the solving of this problem has been made by the discovery and the application of laminaria which consist of seaweed. More recently, synthetic hygroscopic laminaria and prostaglandin preparations are in use, and they show a whole line of advantages in relation to traditional laminaria. The advantages are reflected in a faster and more gradual cervical dilation and the absence of genital tract infections following their application.

[Conditions and indications for urodynamic examinations]. / Uslovi i indikacije za urodinamska ispitivanja.

Urodynamic investigations (UDI) present a new diagnostic method for the research of the physiology, pathophysiology, biomechanics and hydrodynamics of the urine flow. The purpose of UDI is to establish the function of the lower part of the urinary tract, most frequently in the presence of urinary incontinence. They are used in gynecology, urology, neurology, pediatrics, rehabilitation, geriatrics and general surgery. There are absolute and relative indications for UDI. Adequate preparations of the patient are necessary prior to UDI. Exact diagnostics of the impaired function of the lower part of the urinary tract can be maintained only by a complete performance of the UDI objectivity tests. A correct diagnosis will enable adequate therapy.

[Tumor markers and their use in gynecologic oncology]. / Tumor-markeri i njihova primena u ginekoloskoj onkologiji.

The following specific tumour markers used in female patients affected by neoplasm of the genital system are described, such as: CA-125, pheritin, beta--HCG, UGF, CEA and AFP. A continuous postoperative follow-up of all cited tumour markers has been made at the Clinic of Gynecology and Obstetrics at the Faculty of Medicine in Novi Sad from January 1989. Each of the cited tumour markers has been individually described and the explanation pertaining to the validity of individual onco-markers for the specific kind of tumour has been given.