Improved national Croatian diagnostic and therapeutic guidelines for premalignant lesions of the uterine cervix with some cost-benefit aspects.

The national Croatian improved diagnostic and therapeutic guidelines for premalignant lesions of the uterine cervix are presented: for atypical squamous cells of undetermined significance (ASCUS), for cervical intraepithelial neoplasia (CIN I, CIN II CIN III) and for microcarcinoma (FIGO grade Ia1). Separately are presented the guidelines for abnormal glandular epithelium: atypical glandular cells of undetermined significance (AGCUS) and cervical glandular intraepithelial neoplasia (CGIN). The guidelines are created according to the guidelines of the FIGO. Improved diagnostic and therapeutic guidelines was presented and accepted at the Symposium of the Croatian Society for Colposcopy and Cervical Pathology and of the Croatian Society of Gynecologists and Obstetricians of the Croatian Medical Association, held on November 25th 2000. There are presented the chief differences and the some cost-benefit aspects between the guidelines before and the new one.

Comparison of protective media and freezing techniques for cryopreservation of human semen.

OBJECTIVE: To evaluate the influence of cryopreservation medium and freezing-thawing techniques on human sperm motility and morphology. STUDY DESIGN: 63 semen samples were obtained from 39 donors to the artificial insemination programme. Possible effects of the sperm dilution with cryomedium on the motility were examined 10 min after exposure of 24 high initial quality semen samples to TEST-yolk ¿zwitterion-citrate-egg yolk extender containing TES [N-Tris (hydroxymethyl) methylaminoethane sulfonic acid] and Tris [(hydroxymethyl) aminomethane]¿ and human sperm preservation medium (HSPM). Post-thaw sperm motility from 24 frozen semen samples was examined comparing the cryoprotective efficacy of TEST-yolk and HSPM following different freezing techniques (vapour freezing, fast programmable freezing and slow programmable freezing). The relationship of sperm morphology to the effects of freezing was investigated on 39 semen samples following different freezing techniques. Post-thaw sperm motility from 39 frozen semen samples was compared among three groups divided according to the percentage of morphologically normal cells (<40, 40-50 and >50%) in fresh semen. RESULTS: Exposure of spermatozoa to cryomedia for 10 min at room temperature significantly reduced motility in TEST-yolk treatment group for 9% and in HSPM treatment group for 18% (P<0.01). The recovery of motile sperms (mean+/-standard deviation) was 49+/-15.7, 43+/-15.2 and 52+/-16.8% when TEST-yolk was used and 34+/-17.8, 32+/-18.2 and 50+/-13.6% when HSPM was used as a cryopreservative following vapour freezing, and fast and slow programmable freezing, respectively. Following vapour freezing and also following fast programmable freezing, the recovery of motile sperm was significantly higher (P<0.05) after addition of TEST-yolk medium than after addition of HSPM. Post-thaw motility of the sperm cryopreserved in HSPM showed significant differences (P<0.05) after three different freezing techniques. The recovery of motile sperms was 57+/-26.4, 38+/-8.6 and 38+/-17.3% in groups with >50, 40-50 and <40% morphologically normal cells, respectively. The percentage of morphologically normal spermatozoa was reduced 8% after vapour freezing and 6 and 3% after fast and slow programmable freezing, respectively. The results were statistically analysed using SAS/STAT software. CONCLUSIONS: Slow programmable freezing was superior to vapour freezing and fast programmable freezing as a method for sperm cryopreservation. However, none of these methods of freezing had discernible effects on sperm morphology. Motility of spermatozoa decreased due to the exposure of semen to cryomedium. TEST-yolk was a superior cryomedium to HSPM. Fresh semen with more than 50% of morphologically normal cells showed the best recovery of motile cells after freezing and thawing.

Morphology of gonads in pure XY gonadal dysgenesis.

The authors gathered 20 patients having Swyer's syndrome and performed a bilateral gonadectomy and carried out a pathohistologic evaluation of the streak gonads. A more frequent occurrence of streak gonad tumors was found together with the possibility of tracing the merge gonadoblastoma into dysgerminoma (the youngest patient was 15 years old). In 95% of the streak gonads checked an ovary-like stroma was found. In 11 of the patients (55%) one of the above mentioned tumors was found. A frequent finding was the presence of Leydig-type cells, calcifications and the remains of Wolffian canals. In three streak gonads, the corpora albicans-like formations were found.

Pathophysiology of venous insufficiency during pregnancy.

Pregnancy is a risk factor for venous insufficiency. Up to 30 percent of women will develop venous insufficiency during their first pregnancy, and with each next pregnancy its prevalence is higher. Several pathophysiologic mechanisms are involved in the pathophysiology of venous insufficiency during pregnancy. The role of these mechanisms in the pathophysiology of venous insufficiency during pregnancy is still a point of discussion. Mechanical compression of enlarged uterus on pelvic veins was the first considered responsible for the occurrence of venous insufficiency during pregnancy. Soon, it was found that hormonal changes in pregnancy cause reduction in venous tone, and this reduction was postulated to be a major factor in pathophysiology of venous insufficiency. In a large number of subsequent studies both hypotheses were tested, being confirmed or rejected, but no consensus has been reached. This paper reviews current knowledge regarding pathophysiology of venous insufficiency during pregnancy, and discusses the possible role that some as yet uninvestigated mechanisms might have in it.

Loop excision of the transformation zone (LETZ) as an outpatient method of management for women with cervical intraepithelial neoplasia: our experience.

Between March 1996 and July 1998, 90 patients were treated with diathermy loop excision (LETZ) for cytologically, colposcopically and histologically verified cervical intraepithelial neoplasias (CIN), at the outpatient clinic. In average, the patients were 30.22 years of age, and 61.1% of them were nulliparas. In 80 surgical samples (88.9%), the exocervical and endocervical margins were histologically free of disease. From the total of 65 patients with CIN III diagnosis, 58 (89.2%) had free margins samples. In the post-operative period the patients had a changed vaginal discharge for 16 days. A slight feeling of pain in the abdomen lasted for 2.5 days on the average, and most patients did not take analgetics. Moderate postoperative hemorrhage from the excision site occurred in 5 (5.5%) patients, and was outpatiently treated with electrocoagulation, with no need for blood replacement. In 65 patients (90.3%), the cytological control results were normal. During the follow-up period, 9 patients became pregnant, which resulted in 6 terminal deliveries so far; 2 pregnant women are about to deliver, and one is in the first trimester of pregnancy. Cerclage cervicis has not been performed on any of the patients. LETZ is a safe and simple procedure which can be done at outpatient clinics, it is relatively easily mastered, it is short, quite bearable for patients if done only under local analgesia, the equipment costs are acceptable, and the treatment can be used both diagnostically and therapeutically, since an adequate surgical sample is obtained for histological assessment. Cytological and colposcopical check ups are imperative in the postoperative period.

[Ultrasound diagnosis of early pregnancy failures]. / Ultrazvucna dijagnostika poremecene rane trudnoce.

A total of 754 patients with suspected abnormal intrauterine pregnancy and ectopic pregnancy were examined by ultrasound in 1979 and 1980. The correlation between clinical, laboratory and ultrasound findings was made. Plasma hCG levels are shown to be valid in the differentiation between nonpregnant cases and normal intrauterine pregnancies and ectopic cases but not between intrauterine early pregnancy failures and ectopic pregnancies. In the diagnosis of ectopic pregnancy, ultrasound, in combination with the plasma hCG determination and, in some cases, with laparoscopic findings, is a very useful method. According to the results obtained, ultrasound is the method of choice for the detection of early pregnancy failures: missed abortion, blighted ovum, incomplete abortion, and hydatidiform mole.