Morbidity and chronic pain following different techniques of caesarean section: A comparative study.

Research examining long-term outcomes after childbirth performed with different techniques of caesarean section have been limited and do not provide information on morbidity and neuropathic pain. The study compares two groups of patients submitted to the 'Traditional' method using Pfannenstiel incision and patients submitted to the 'Misgav Ladach' method ≥ 5 years after the operation. We find better long-term postoperative results in the patients that were treated with the Misgav Ladach method compared with the Traditional method. The results were statistically better regarding the intensity of pain, presence of neuropathic and chronic pain and the level of satisfaction about cosmetic appearance of the scar.

Comparative study of the ''Misgav Ladach'' and traditional Pfannenstiel surgical techniques for cesarean section.

AIM: The aim of this study was to evaluate the advantages of the Misgav Ladach surgical technique compared to traditional cesarean section. METHODS: A prospective randomized trial of 111 women undergoing cesarean section was carried out in the Pula General Hospital. Forty-nine operations were performed using the Pfannenstiel method of cesarean section, 55 by the Misgav Ladach method and 7 by lower midline laparotomy. RESULTS: It was proved that the cases where the Misgav Ladach method was implemented, compared to the Pfannenstiel method, showed a significantly shorter delivery/extraction and operative time (P=0.0009), the incision pain on the second postoperative day was significantly lower (0.021), we recorded a quicker stand up and walking time (P=0.013), significantly fewer analgesic injections and a shorter duration of analgesia were required (P=0.0009) and the bowel function was restored to normal sooner (P=0.001). CONCLUSION: The Misgav Ladach method of cesarean section has advantages over the Pfannenstiel method in so far as it is significantly quicker to perform, with diminished postoperative pain and less use of postoperative analgesics. The recovery of physiologic function is faster. No differences were found in intraoperative bleeding, maternal morbidity, scar appearance, uterus postoperative involution and the assessment of the inflammation response to the operative technique.

[Laparoscopic resection of the rectum]. / Laparoskopska resekcija rektuma.

Improving the laparoscopic equipments and the techniques have spreaded the repertoire of the laparoscopic procedures. In the beginning, it was performed the laparoscopic-assisted resection of the rectum, and later was performed the entire laparoscopic procedures on the colon. It had presented a patient, 71 years old man with diagnosis of the adenocarcinoma recti. After preoperately prepare carried out the laparoscopic procedure with T-T anastomosis by EEA stapler. We presented the first case of the laparoscopical performed resection of the rectum with desire to show possibilities and advantages of the laparoscopic surgery in the relation with conventional surgery and with hope that this techniques would be found the application in our land.

[Oral contraceptives and breast cancer]. / Oralni kontraceptivi i rak dojke.

Hormonal contraception is important for the way of life of many modern women. Since the oral contraceptives were introduced 30 years ago, millions of women were using the pill and large number of experimental, clinical and epidemiological studies have analyzed the risks of their administration. The question whether the usage of exogenous sex-steroids as hormonal contraception may favor the development of breast malignancy is a much debated problem, but a complete answer to the question of the relationship between contraception pill and breast cancer is at present still unresolved. Most studies have not found an overall increased risk of breast cancer associated with the use of the pill, but several recent studies suggested a link between the early-onset breast cancer and a long-term use of oral contraceptives at young ages. The risks for some subpopulations of women seem small (relative risk about 2.0 or less), but consistency of the findings has enforced further study. Women under the age of 35, if they have used the pill long-term or if they are at increased risk of breast cancer for other reasons, should discuss the risks of oral contraceptive use. Contraindications of pill usage must be strictly respected and their users carefully watched, including routine breast examinations. It is equally important to inform our patients about important and numerous positive impacts of pill usage on women's health, to reassure these women and prevent cancerophobia. Sufficient time has now elapsed to permit prospective epidemiological studies with large numbers of women who took the pill for many years beginning at a young age, and follow them as they come in age when breast cancer is most common. So we should carefully examine their results.

[The Institute of Surgery in Novi Sad as a trauma center--10 years' experience]. / Institut za hirurgiju u Novom Sadu kao trauma centar--desetogodisnje iskustvo.

UNLABELLED: Trauma is a surgical disease and a leading cause of death in the population in the age of forties. The Institute for Surgery in Novi Sad (trauma center of the first rank) takes care of all injured people brought to the Institute either directly from the place of accident or from other centers. AIM OF THE STUDY: Retrospective analysis of the injured people treated at the Institute for Surgery in the period 1987-1996. MATERIAL AND METHODS: Multivariate analysis of the traumas from the register of the Institute for Surgery according to the trauma system elements: number of injured individuals, sex and age structure, categorization of injuries, etiology of injuries, distribution of serious injuries by regions, results obtained from the treatment of serious injuries. RESULTS: They show a global representation of all elements involved with injured people: due to moderately serious, serious and critically serious injuries 21.6% of patients were hospitalized; in the age of 29-30 years men with traumas caused on work or in traffic were predominant, while women with injuries caused by falling were predominant in the age of 60-69 years; drastically increased injuries caused by fire-arms in the period 1991-1993 were directly caused by the state of war and these injuries are still numerous; in case of hospitalized patients isolated trauma (80%) was predominant, multiple trauma was under 20% and polytrauma was registered in 5% of patients; after surgical treatment of injuries approximately 17% of patients were indicated for postoperative prolonged treatment and in intensive care unit at the Institute for Surgery; the average mortality of hospitalized patients was 5-7% but with extremely high mortality rate (< 70%) in the group of patients with polytraumas.

[A fetal bone as a foreign body in the uterus]. / Fetalna kost kao strano tijelo u maternici.

The ultrasound examination of a 49-year-old female patient with irregular and painful menstruations has revealed a foreign body in the uterus. In 1973 (19 years prior to procedure), the patient had an artificial abortion and since then has not been able to conceive. In 1977, hysterosalpingography and laparoscopy did not reveal the cause of infertility. Hysteroscopy was undertaken and diaphysis of a fetal bone 22 mm long was removed. This bone was most probably, functioning as an intrauterine device, the cause of infertility. Thus, the authors' findings strengthen once again the association between abortion and infertility. It is concluded that transvaginal sonography and hysteroscopy open new possibilities in identifying and treating such disturbances.

[Personal experience with segmental corporo-caudal allotransplantation of the pancreas in an experiment on dogs]. / Nasa iskustva segmentalne korporokaudalne alotransplantacije pankreasa u eksperimentu na psima.

In the Institute for Surgery, its Experimental Centre, has already several years an experimental transplantations of pancreas been carried out with the aim of learning surgery technique and performing a clinical transplantation of that organ. In our work we have used a technique of corporacaudal allotransplatation of pancreas with vascular anastomosis. As the blood vessels of the graft we have used the arteria and vena lienalis with parts of aorta and portal vein, which have been anastomosed with a. and v. iliaca communis of the pancretotomized recipient. We have used techniques of the open pancreatic duct, ligated pancreatic duct, our own technique of permanent bleeding of the pancreatic graft during the transplantation pancreaticojejunostomy and pancreatico-vesicular anastomosis. As the parameters of function of allograft we are using: glycaemia, i.v. GT test, K constant, insulinaemia, amylasaemia, length of survival of animals and pathohistological finding. The average term of survival of experimental animals was 28 days. During the function of alograft the experimental animals shown some signs of laboratory subclinical diabetes. Refusal of transplant was followed by sudden increase of glycaemia, without any clinical or laboratory sign of anticipation of the refusal.

[Thoracic injuries treated at the surgery clinic in Novi Sad from 1968-1977]. / Povrede grudnog kosa lecene na klinici za hirurske bolesti u Novom Sadu od 1968-1977 g.

The authors analysed 516 injuries of the thorax. treated in a ten year period (1968-1977). These injuries were 2,2% of 23.300 injuries treated by this Clinic during this time period. The etiology shows that 63,9% of these cases were caused through traffic accidents. In 516 of this cases, there were 5% penetrating injuries. A big percent of polytrauma (42,6%), traumatic, haemorrhagic shock (21,5%) and the difficultes in mechanics of breathing or respiration function (61,2%), shows the difficulties and importance of the medical attitude in curing these injuries in peace time, and in war, or during massive injury. The authors have also stressed the necessity of education for professional medical staff, equipment for the staff and its organization during peace time. This also serves the goals for national defence.