Lymphadenectomy during radical hysterectomy for cervical cancer (stage IB 1-2, HA): state of the art.

Pelvic lymphadenectomy during radical hysterectomy in surgical candidates with cervical cancer (stage IBI-1, IIA) has become a standard method of therapy starting from mid 20th century. More knowledge about the natural history, predictive and prognostic factors of disease and effectiveness of surgical and adjuvant treatments of early stage cervical carcinoma has been accumulated over the past 5 decades. During the latter part of the 20th century the accumulating information base led to more conservative approaches for cancer resection in an effort to decrease the morbidity of radical surgery and to preserve the fertility if possible. Lymph node metastasis is a bad prognostic factor in the early stages of disease and automatically classifies a patient in a high-risk group necessitating adjuvant therapy. Preoperative diagnostic procedures, such as echotomography, computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and lymphangiography are all helpful in determining lymph node status, although their accuracy rate is anywhere between 57-85%. Recent studies of sentinel lymph nodes and lymph node topography are still very controversial and neither give information on the extent of lymphadenectomy needed nor help in patient selection in planning additional adjuvant therapy. Published results on laparoscopic lymphadenectomy demonstrate decreased postoperative morbidity, but still pose questions whether laparotomic lymphadenectomy should be replaced by this technique. Thus the question remains: how many lymph nodes, of which groups and by which technique should be dissected during pelvic lymphadenectomy?

[Importance of daily serum progesterone measurement in ovulation induction]. / Znacajnost dnevnog doziranja progesterona u serumu u toku stimulacije ovulacije.

It is known that the rise of serum progesterone concentration frequently precedes the rise of serum luteinizing hormone in spontaneous menstrual cycles and during induction of ovulation. The aim of this study was to evaluate the role of single serum progesterone measurement in the prediction of spontaneous serum luteinizing hormone rise in patients with ovulation induction. The study concerned 97 infertile women. The induction of ovulation was performed according to individual endocrine profile of a patient. In 59 (61%) patients spontaneous increase of luteinizing hormone was not recorded and in 31 (32%) patients this increase was evident. In 7 (7%) high serum luteinizing hormone concentration was measured at the time of use of human chorionic gonadotropin. The correlation between serum progesterone level and serum luteinizing hormone concentration in patients with spontaneous serum luteinizing hormone rise was statistically significant (r=0.79; p<0.01). The double daily serum progesterone rise is an important method for prediction of serum luteinizing hormone rise (x2=24.08; p<0.001). After the use this method the pregnancy rate was 29 percent in our study group.

[Prevention of thromboembolic disease in gynecologic surgery]. / Prevencija tromboembolijske bolesti kod ginekoloskih operacija.

We presented two groups of patients gynecologically operated and examined in a five year period; the first group of 11536 patients was under thromboembolic protection, whereas the second group of 8532 patients was without thromboembolic protection. Protective measures concerning thromboembolic disease were carried out by applying elastic stockings 24 hours before operation and by early post-operative getting up from bed. Low-molecular dextran was applied before operation as well as during the operation in the amount of 500-1000 ml. In risky patients with varicosities, recidive thrombophlebitis and cardiovascular diseases, we applied small doses of heparin subcutaneously two hours before the operation and after the operation every eight hours five days long. With such prevention of thromboembolic disease in gynecologic surgery, we achieved very favorable effects in reducing mortality to 0.05% concerning the operated, while it amounts to 0.3% in those who were without this kind of protection.

[Management of pregnancy in a patient on chronic hemodialysis]. / Vodjenje trudnoce kod bolesnice na hronicnoj hemodijalizi.

Conception and fetal survival are possible in patients undergoing long term hemodialysis. We report a case of successfully managed pregnancy complicated by maternal chronic renal failure requiring hemodialysis, severe intrauterine growth retardation and polyhydramnios. Pregnancy was terminated by cesarean section at 30 weeks' gestation due to premature labor. A normal-appearing female weighting only 1000 gr was delivered. The infant is now more than a year old and is developing normally.

The in vivo metabolism of progestins. I. The metabolic clearance rates of progesterone and medroxyprogesterone acetate in the dog.

[3H]Medroxyprogesterone acetate (MPA) was synthesized by selective catalytic tritiation of the delta1-olefinic bond of 6alpha-methyl-17alpha-hydroxy-pregn-1,4-diene-3,20 dione acetate. [14C]MPA was synthesized by acetylation of 6alpha-methyl-17alpha-hydroxy-pregn-4-ene-3,20-dione with [14C]acetic anhydride. These radioactive materials were used to determine the MPA metabolic clearance rates (MCRMPA)and volumes of distribution (VoMPA) in dogs by the single injection technique. The metabolism of progesterone was also studied in the same animals. The MCRMPA (696 +/- 51 l/day) was only one-half that of progesterone (1332 +/- 59). By contrast, the volumes of distribution for the two steroids were similar. The metabolic clearance rates and the volumes of distribution for MPA and progesterone did not change during treatment with amino-glutethimide, a drug which is known to alter steroid metabolism in man.

[Conservative treatment of women in perforations of the uterus in legal abortions]. / Konzervativno lecenje zena sa perforacijom uterusa kod dozvoljenih prekida trudnoce

PIP: Out of 65,765 legal abortions performed in the Belgrade Gynecological Hospital over the course of 5 years, 71 patients suffered uterine perforations (.11%). Of these patients, 40 (50.6%) were given conservative treatment and 31 (43.3%) were operated on. The conservative treatment of violent uterine perforation is considered preferable to surgical intervention, if possible. This decision is considered to depend on the state of the lesion and the condition of the patient. The cases examined here were successful and no complications were encountered. Conservative therapy consists of a wide spectrum of antibiotics administered parenterally, as in therapy for acute inflammation. Uteronics, rest, and ice on the stomach are the most important parts of the treatment.^ieng