Ultrasound measurement of cervical length as predictor of threatened preterm birth: a predictive model.

INTRODUCTION: The incidence of preterm delivery has been increasing even in developed countries and remains a serious problem for fetuses and neonates. Although many predictors for preterm delivery have been proposed, complete prediction and prevention have not yet been established. AIMS: To examine the potential association between sonographic measurement of cervical length and threatened preterm birth (TPTB) in pregnant woman at 24-36 weeks of gestation. MATERIALS AND METHODS: A cross-sectional study included a total of 360 pregnant woman at 24-36 weeks of gestation categorized in two groups: TPTB group (n=160) and non TPTB group (n=200). The study was carried out at the Department of Obstetrics and Gynecology of the Clinical Center University of Sarajevo (KCUS). Sociodemographic and clinical characteristics of patients were obtained from medical records and physical examination by gynecologist. Transvaginal sonography was carried out by GE Voluson 730. RESULTS: There was a significant association between TPTB and sonographic measurement of cervical length <25 mm (P<0.001). The logistic regression model was statistically significant, x(2)(7) = 281.530, P<0. 001. The model explained 72.6% of the variance in TPTB and correctly classified 88.1% of cases. Sensitivity was 83.8%, specificity was 91.5%, positive predictive value was 88.7% and negative predictive value was 87.6%. Out of the 7 predictor variables only 5 were statistically significant: cervical length, cervical consistency, rupture of membranes, uterine contractions and amine odor test. CONCLUSION: The findings of this study suggest association between sonographic measurement of cervical length and TPTB.

Features of postmenopausal uterine haemorrhage.

INTRODUCTION: Postmenopausal uterine bleeding is a "cancer until proven otherwise". Endometrial cancer is a typical disease among postmenopause woman, because every bleeding in this age etiology associated with endometrial cancer (10-30%). The lifespan of women today has been extended and post menopause today last one third of a woman's life. Early diagnosis of endometrial cancer has a very high cure rate. Screening for this cancer has limits in practice and is necessary given the definition of high-risk groups would be subject to primary and secondary prevention. GOAL: Primary to evaluate the leading causes of postmenopausal uterine bleeding among patients at risk for endometrial cancer (diabetes, obesity, nulliparity, late menopause (after 55 years) and compared them with the causes of postmenopausal uterine bleeding patients without this risk. MATERIAL AND METHODS: A retrospective, descriptive study with a targeted sample of 50 consecutive patients who had registered postmenopausal uterine bleeding in high-risk groups (cohorts) and the same number of patients with postmenopausal uterine bleeding that does not belong to the risk group (control group). Each patient underwent clinical examination, then fractionated curettements and its histopathological verification and assessment of treated clinical stage of disease with PH analysis of the resected specimens. RESULTS: The patients of the studied risk group were significantly affected by endometrial cancer compared with the control group (RR=2.45, 95% CI 1.2 4.6, p=0.005). Endocervical pathology did not differ between groups. Clinical forms of bleeding: for those that are profuse bleeding cancer was present in 54.6% of cases. With intermittent bleeding cancer is verified in the 33.3% of patients. Risk patient groups with cancer frequently suffer from clinically more advanced stages of histologically aggressive endometrial cancer (serous adenocarcinoma-type II, low differentiated cancer).

Frequency of vaginal birth after cesarean section at clinic of gynecology and obstetrics in sarajevo.

UNLABELLED: At the Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo there is a trend of increasing number of cesarean deliveries in the last 15 years. MATERIAL AND METHODS: During the 2012 percentage of Caesarean sections was 35 %, which represents a true pandemic in obstetrics profession and all scientific postulates are threatened by these practices. Of the total number of vaginal births only 48 deliveries were after previous cesarean section. Of the total number of subjects in which the delivery is completed vaginally after a previous cesarean delivery in 5 (10.42 %) was used vacuum extraction, forceps was not used, while manual exploration of the uterus in order to check the condition of the scar of a previous cesarean section was performed in 32 (66.67%) cases. RESULTS AND DISCUSSION: The largest number of respondents who were surveyed were at age from 31 - 35 years (n=25), followed by group between 26-30 years (39.58%). The analysis of complications of vaginal birth after Caesarean delivery revealed that 93.75 % of the patients did not have any complications, at 4.17 % occured postpartum hemorrhage and in one patient febrile condition. Birth after cesarean delivery can be successfully completed vaginally, with a careful application of prostaglandins, with a good estimate of an experienced obstetrician, and adequate conditions to complete delivery by caesarean section if a vaginal birth is not going in the right direction and as planned.

Incidence of testicular carcinoma, therapy and quality assesment.

OBJECTIVE: This study aimed to demonstrate incidence, symptoms and therapy management of testicular cancer patients. Also we had evaluated significance of testicular tumor markers. PATIENTS AND METHODS: The study was retrospective, clinical and manipulative, analytical and descriptive and covers the period from 01.01.2000 to 31.12. 2008 with 58 male patients from 16 years upwards. For each patient, the data were analyzed from ambulance and hospital protocol on the Urology Clinic Sarajevo. RESULTS: Incidence of testicular cancer among patients at the Urology Clinic clinical center Sarajevo is on the rise for the last three years (about 20%). Of the 58 patients with testicular cancer, 70% of patients were in age 20-39 years. 47% were patients with right side testicular cancer and 53% were left sided. Walter Reed Hospital tumor classification showed I 50%, IIa 10%, IIb 19% and III 21% of patients. The highest incidence of pathohistological reports showed mixed tumors 46%, seminoma 26%, yolk sack 2%, teratoma 2%, carcinoma embrionale 16%, dysgerminoma 5% and Laydig cell carcinoma 3%. Mixed, seminoma and carcinoma embirionale represents 90% of testicular tumors. betaHCG marker was positive in 53% of patients with seminoma and non seminoma 80%. CEA marker was positive only in 9% of all testicular cancer, LDH showed higher incidence with metastatic seminoma tumor. 27,5% of patients undergone retroperitoneal lymphadenectomy treatment, all patients had radical orchiectomy. CONCLUSION: The common therapeutic procedure in the treatment of testicular tumors are surgical methods radical inguinal orchiectomy, chemotherapy (advanced stages of seminoma and all stages of non seminoma tumor and radiotherapy (early stage seminoma). AFP and betaHCG are excellent markers in the evaluation of surgical and oncology treatment of testicular tumor.