Maternal hemodynamic influence on uteroplacental oxygen distribution during cesarean section.

This study investigated maternal hemodynamic influence on uteroplacental oxygen distribution and neonatal outcome during cesarean section (CS). CS was performed on 80 parturients using two anaesthetic techniques: spinal anaesthesia (SA) and general balanced anaesthesia (GBA). Indications for CS were exclusively obstetric related. Monitored maternal parameters were: ECG, heart rate (HR), non-invasive blood pressure (NIBP), saturation (SaO2). Gas parameters in umbilical artery, vein, and neonatal capillary blood were sampled. Vitality was assessed by the Apgar scoring, first breath-taking time and the first breastfeeding attempt. Hypotension was the most common finding after SA induction. GBA group presented changes such as QT inversion (12.5%), tachycardia (55%), and bradycardia (2.5%). SA group experienced higher rates of sinus tachycardia (45%) and ventricular dysrhythmias (2.5%). Neonatal oxygenation was significantly higher in SA group. Higher quality of early neonatal adaptation in the SA group confirms it as the technique with the least neonatal risk during CS.

Atypical polypoid adenomyoma mixed with endometrioid carcinoma: a case report.

The following is a description of an extremely rare tumor of the uterus, malignant atypical polypoid adenomyoma (APA), admixed with well-differentiated endometroid carcinoma, in a 29-year-old patient previously treated for sterility in whom, due to the existence of a ten-millimeter sessile tumor on the uterine corpus, verified by transvaginal ultrasonography (TVUS), a hysteroscopic resection of the anomaly was performed. The patient underwent all requisite examinations and was referred to the malignant diseases panel for an examination and a decision on further treatment. As the patient wished to preserve fertility, the authors decided to continue performing regular controls at intervals of two to three months. The first subsequent control called for a TVUS examination or one using another imaging method, with a multiple endometrial biopsy with curettage of the endocervix. The results of the first examination promised that fertility could be preserved. Therapy with medroxyprogesterone acetate (MPA) in daily dosages of 200 to 500 mg was advised, which the patient intentionally did not take. A spontaneous desired pregnancy was verified following the first control.

Uterine tumor resembling ovarian sex cord tumor. Case report and review of literature.

A uterine tumor resembling an ovarian sex cord tumor (UTROSCT) shows a poly phenotypic immunophenotype with coexpression of epithelial, myoid, and sex cord markers, as well as hormone receptors. The authors present a case of a 59-year-old multiparous woman admitted to the Institute of Gynecology and Obstetrics Clinical Centre of Serbia in January 2010 due to prolonged vaginal bleeding and abdominal discomfort. The vaginal ultrasound showed an enlarged uterus size of 100 x 74 x 81 mm, with extended cavity with an unhomogenic content and myomas sized 54 x 69 mm located in fundus with secondary changes. She underwent abdominal hysterectomy with adnexectomy. Microscopic examination revealed submucosal uterine tumor with variabile histological organization that had anastomotic trabeculae with solid cellular grupations. Rare mitotic figures (2/10 HPF) were found. Additional imunohistochemistry showed immunophenotype: the sex cord areas were positive for vimentin(++), aSMA(++), AE1/AE3(+), PR(+), and ER(+). The poly phenotypic immunophenotype can be useful in differential diagnosis from other neoplasms but also suggests an origin of UTROSCT from uncommitted stem cell enabling for multidirectional differentiation.

Cesarean section scar pregnancy treatment--case report.

This is a case report of a 36-year-old patient with an ectopic pregnancy located in the previous cesarean section scar following in vitro fertilization (IVF). The patient was treated by 50 mg of intrasacular methotrexate locally under ultrasound guidance. Transvaginal ultrasound (TVUS) confirmed that the pregnancy was no longer vital within 24 hours, dilatation and aspiration of the ovular tissue were performed after seven days and it was sent for pathohistological analysis. Eight hours after the procedure, the patient began bleeding abundantly and was consequently treated locally by 1 ml of Beriplast P Combi set, human fibrinogen, and human thrombin set (CSL Behring). After the treatment, the patient was discharged in good health, with normal laboratory values. Her menstrual period resumed 35 days after the procedure.

Influence of placental mannose/n-acetyl glucosamine-binding proteins on the interaction of insulin and insulin-like growth factors with their receptors.

Placenta is a source of carbohydrate-binding proteins that function as molecular scavengers, but they could also be involved in interactions that assist in metabolic control. Mannose/N-acetyl-glucosamine (Man/GlcNAc)-binding proteins from placenta were isolated and their reactivity towards placental insulin and insulin-like growth factor receptors (IR and IGF-Rs) was analyzed. The lectins reduced the binding of insulin and IGF-I in a dose-dependent manner, while almost no effect was observed on the binding of IGF-II. The shape of the inhibition curves changed, suggesting altered binding specificity. The presence of sugar could not reverse completely the effect of the lectins, implicating both lectin-sugar and protein-protein conformational recognition. Since biological molecules in our experimental system were those that are in close relation in vivo, placental Man/GlcNAc-specific lectins may be regarded as potential allosteric modulators of ligand-receptor interactions in a system of homologous ligands, selectively affecting only binding to tyrosine kinase type receptors (IR and IGF-1R).

Postoperative complications--massive transfusions in radical malignant gynecological surgeries.

At the Institute of Gynecology and Obstetrics we examined 24 women who were radically operated on and received massive transfusions during the intraoperative and postoperative period. Twelve developed massive transfusion complications such as urticaria, fever, and respiratory insufficiency known as TRALI (transfusion-related acute lung injury).

Increased AFP as an indicator of ovarian carcinoma and fetal kidney carcinoma--case report.

We examined a young primipara with increased alpha-fetoprotein (AFP) values and cystic tumefaction of the right ovary. Having in mind a mild decrease in ovarian artery resistance index (RI) and suspected findings of fetal kidney, this situation was delicate due to its double pathology which was later confirmed. Wilms' tumor is the most common urogenital tumor in childhood, and it is detectable in the prenatal period by ultrasound examination. In utero kidney biopsy confirms diagnosis and facilitates decisions concerning the course of pregnancy. Relative risk of intervention limits this diagnostic procedure for indicated cases.

Cervical and duodenal polyps and their malignant alterations--case report.

During routine examination of a 32-year-old patient, a cervical polyp was found and CIN III was confirmed by biopsy. After performing colposcopy, biopsy and establishing CIN III as well as performing gastroscopy where a duodenal polyp was found, thorough diagnostic exams and therapy were carried out. Complete duodenal resection and conization were performed. The medical board decided that neither further radiation nor chemotherapy was needed.

Endometrial carcinoma and hormonal disturbances in middle-aged women--an overview.

Endometrial hyperplasias and endometrial adenocarcinomas present a morphological continuity. In 1,150 cases of patients admitted to two hospitals over the past two years with diagnosed irregular bleeding, suspected ultrasonography findings and positive family history, we performed, not only hormonal examinations, but also fractioned explorative curettage after receiving patient consent.

Torsion of carcinomatous ovarian cyst and polycystic omental diseases--case report.

A middle-aged patient, without any positive personal or familial history was urgently hospitalized and, after primary diagnostic procedures, treated by surgery for torsion and acute abdomen. During the procedure, torsioned ovarian cyst and a probable perforated omental cyst were found. Primary ovarian cancer and secondary polycystic metastatic echoes of the omentum were established by histopathology.

Metastases of the digestive tract and ovarian tumors--or vice versa: an analysis.

Ovarian carcinoma may appear regardless of age, including during childhood. Predisposing factors for the development of ovarian carcinoma are age (usually over 40), positive family history, mumps parotitis, small number of deliveries, environmental factors, persistant ovulation, etc. Metastases may appear in the ovary from almost all primary sites.

Antibodies detected in samples from 21,730 pregnant women.

Although anti-D is still the main cause of HDN, many other antibodies have been implicated. From September 1995 to April 2000,screening for RBC antibodies was performed on samples from 21,730 pregnant women regardless of RhD type. Standard tube and gel methods were used. Anti-D was identified in 254 samples; other antibody specificities were detected in 376 samples, for a total of 630 antibodies. For this study, 522 antibodies were considered clinically significant. The incidence of potentially clinically significant antibodies was 2.4 percent. The majority belonged to the Rh system, followed by anti-M, -Fya, -S, -Jka, and -Jkb. Among antibodies of no clinical significance, the most frequent were anti- H, -Lea, and -P1.