Ovarian cancer and ovulation induction drugs--is there a link?

Screening for ovarian cancer in a group of women with induced ovulations was encouraged by recently reported controversies about a possible association between the use of ovulation induction drugs and the increased risk of ovarian carcinoma. Transvaginal color Doppler ultrasonography was applied in screening for early stage ovarian malignoma in 110 asymptomatic women who received an ovulation induction therapy for infertility. Already reported standard parameters for discriminating malignant from benign flows, such as resistance index RI < 0.40, pulsatility index PI < 1 and morphological score (borders, cyst quality, septate areas, papilla and ovarian tissue echogenicity) were used. Screening included 110 women and was carried out from April 1, 1198 to March 31, 1999. Seven examinees had abnormal ovarian findings. The finding spontaneously regressed in five of them, one underwent surgery for a persistent cyst with a benign pathohistologic diagnosis, and one was diagnosed with early stage ovarian malignoma. RI < 0.40 was reported in one patient (0.9%) with a morphologically suspect finding and a pathohistologically confirmed malignoma, PI < 1 was found in 40 subjects or 36.4%, while malignoma was demonstrated in one case alone. The results showed the advantage of RI over PI in discriminating malignant from benign structures. The association between the use of ovulation stimulation drugs and the increased risk of ovarian carcinoma remains unproved and also challenges new dilemmas. The paper cautions against undesirable, potentially serious long-term effects of the use of ovulation induction agents. Additional trials should therefore be performed including a long-term prospective follow-up of women with induced ovulations.

Minimally invasive surgery in the field of gynecologic oncology.

The aim of this paper was to present the results in minimal invasive surgery in the field of gynecologic oncology at General hospital Zabok, Croatia. 381 laparoscopic procedures were performed between 1994 and 1998. There were 263 operations of the benign adnexal masses, and 107 operations due to benign tumors of corpus uteri (there were 18 LAVH, 12 LH and 77 TLH). There were 11 laparoscopic operations due to carcinoma (1 ovary, 6 corpus and 4 cervix). Operations were: 3 LAVH (laparoscopically assisted vaginal hysterectomy), 5 TLH (total laparoscopic hysterectomy) with pelvic lymphadenectomy, 1 LAVH with pelvic lymphadenectomy, 1 coelio Shauta operation with laparoscopic pelvic lymphadenectomy and paraaortal lymphadenectomy, and 1 laparoscopic adnexectomy. Among laparoscopic procedures in 370 patients operations were successfully performed as planed, while in 11 patients it was necessary to switch to laprotomy. Among serious complications of laparscopic operations it is necessary to note 2 lesions of the ureter and 1 lesion of the bladder. Laparoscopic lymphadenectomies were performed successfully; there were no serious early or late postoperative complications. There was no operative mortality. Even though many authors claim that laparoscopic operations in the field of gynecologic oncology are safe and have the same results as in open surgery, patients benefit from shorter recovery and better quality of life during laparoscopic procedures.

Cervicography in evaluation of early detection of the cervical lesions.

Analysis of evaluation of early cervical lesions detection has been made in 106 patients with the clinical signs of current genital organ's inflammation. The same analysis has been done comparing Papanicolaou cytodiagnostic analysis and cervicographic images of the cervix in the same group of patients. We have concluded that both methods (Papanicolaou cytodiagnostic analysis as well as cervicography) are equally useful in detection of preinvasive and invasive cervix lesions. Cervicography was three times more sensitive for the detection of inflammatory lesions in the area surrounding the cervix. Cytodiagnostic becomes equally useful after the treatment and repairment of the inflammation, whereby the conditions for the use of cytodiagnostic are fulfilled. At the same time we have verified that there is a need for cervicography only once in a lifetime of every woman, except for those at high risk of cervical cancer development. Those women can be evaluated according to the needs by additional analysis of atypical cervicogram or insufficiently good image of transformation zone, for which continuous cytodiagnostics surveillance is generally used.

Recombinant factor VIIa (rFVIIa) is effective at massive bleeding after caesarean section--a case report.

A case of 31-year old woman who underwent emergency caesarean section (CS) following suspicion of the HELLP syndrome was reported. She developed arterial hypertension in 33rd week. In 38th week of her gestation elevated liver enzymes and positive albumin in urine were reported and pathological flow in umbilical artery and fetal aorta was found on ultrasound. The HELLP score was 12 and the HELLP syndrome was diagnosed. The pregnancy was terminated by CS for fetal distress and the HELLP syndrome. Two hours after the section she developed massive uterine bleeding with the signs of hemorrhagic shock. Despite of replacement therapy laboratory data worsened. DIC was diagnosed. Recombinant factor VIIa was administrated; after several minutes bleeding decreased and laboratory data normalized.

Early diagnosis and treatment of ectopic pregnancy.

During the period from 1995 to 1999, 64 patients were treated for ectopic pregnancy. All patients admitted to the department passed the same procedure including (complete preoperative laboratory findings, Beta HCG, serum progesterone and transvaginal colour Doppler). In patients who had ultrasound finding typical for ectopic pregnancy in combination with positive Beta HCG, conservative treatment was primarily done. In the rest of the patients, Beta HCG was tested every second day and in combination with the clinical and vaginosonographical findings the patients underwent diagnostic or operative laparoscopy. Out of 64 patients 36 had visible ectopic pregnancy when admitted to the clinical department. Three patients had no visible ectopic pregnancy neither at the time of their admission to the department nor at the time of laparoscopy. One of them had cervical pregnancy and the other two had pregnancies in the uterine part of the tube. The patient with cervical pregnancy was treated with metrotrexat (MTX) 12 mg daily in 5 doses. One patient with cornual pregnancy was treated with high doses of oxytocin infusion in combination with MEB intravenously 3 x 1 amp. The other patient with cornual pregnancy underwent laparoscopy with cornual resection and salpingectomy. Four of other tubar pregnancies were treated with metrotrexat 12 mg/day for 5 days. Other ectopic pregnancies were treated as follows: 36 laparoscopic salpingectomies, 10 laparoscopic salpingotomies with ovum expression, 9 adnexectomies by laparotomy, and 2 laparoscopic adnexectomies.

Preoperative tumor marker CA125 levels in relation to epithelial ovarian cancer stage.

The paper deals with 62 ovarian cancer patients observed from 1988 to 1997. Considering the ovarian cancer stage, the patients were divided in two groups. Group I consisted of 31 patients at the early stage of ovarian carcinoma (FIGO classification I and II), while group II included 31 patients with the advanced disease (FIGO classification III and IV). According to FIGO classification, a majority of group I and group II patients was classified as IA (61.3%) and IIIC, respectively. Ovarian carcinoma of the serous pathohistologic type accounting for 48.4% prevailed in both groups, but there were also endometroid and mucinous types. Sensitivity to CA125 was observed in 93.5% of the group I and in 96.7% of the group II patients. In group I, the mean value of tumor marker CA125 read 262.97 U/ml, median 93 U/ml, ranging from 13-2000 U/ml. In comparison with group I, the mean value of group II tumor marker CA125 was significantly higher reading 1053.81 U/ml, median 365 U/ml, with CA125 levels ranging from 15-9960 U/ml. In relation to patients at the early stage of ovarian cancer, preoperative CA125 serum levels were statistically more significant in the advanced ovarian cancer patients (statistically significant difference p = 0.002). When comparing CA125 levels and tumor differentiation according to Broders, no statistically significant difference was observed in both group I (p = 0.6144) and group II (p = 0.6605). The statistically significant correlation (p = 0.00008) was confirmed between advanced ovarian carcinoma and less differentiated tumors (Broders differentiation III and IV).

Attitudes, behaviour and knowledge on sexuality among female adolescents in Zagreb, Croatia.

The aim of this study was to estimate the level of knowledge about sexuality, attitudes and sexual behaviour of female adolescents. The study included 194 female students, 117 from Medical High School (MHS) and 77 from General High School (GHS) in Zagreb. Data was collected using an anonymous self-administered questionnaire. In addition to items on personal data (age, parental education etc.), the participants were asked to define terms about sexuality (e.g. menstruation, puberty) the definitions of which are found in biology textbooks for the fifth and eighth grade of primary school. The aim of the third part of the survey was to collect information about attitudes and behaviour of female adolescents. The results showed a low level of knowledge in students of both schools. General High School students showed a higher level of knowledge than their Medical High School peers. One fifth of General High School students and 1/3 of Medical High School students were unable to define the term "menstruation". The majority of adolescents talk about sexuality with their friends, 92.1% of General High School and 81.2% of Medical High School students. Almost 50% of students of both schools would like to talk about sexuality with their school doctor. 6.9% of Medical High School students had at least one sexual intercourse while none of the General High School students had been sexually active at the time of the survey. As the majority of students were not sexually active and results showed a rather low level of knowledge, this seems to be the ideal period for the implementation of educational programs aimed at increasing the level of knowledge, and thus preventing unwanted consequences (STD, pregnancy, abortion, infertility).

[The effect of the presence of the husband during childbirth]. / Ucinak nazocnosti muza pri porodu.

In the course of 1994 a particular number of deliveries were examined in the maternity ward of the Clinical Hospital "Sestre milosrdnice". Randomly a hundred pregnant women were chosen whose husbands were present at the childbirth. The same number of women delivered their babies without their husband's presence. The duration of labor was examined as well as APGAR score, threatening intrauterine asphyxia, uterine inertia, prolonged labor, induced labor, medical analgesia, and the frequency of cesarean section and vacuum extraction. In the group, in which the husband was present, the labor was shorter, the number of threatening intrauterine asphyxia cases and cesarean sections was smaller, but there were more induced deliveries. Contrary to all expectations, the uterine inertia with the administration of oxytocin was comparably present in both groups, the same as medical analgesia. Other above mentioned parameters were also comparably present in both groups. The level of labor analgesia was not examined in particular to avoid the subjective factor, and besides, the aim was to achieve the maximal possible analgesia. The results suggest the importance of husband's presence at childbirth. Apart from being a very important psychosocial factor, reducing the duration of labor as well as the frequency of threatening intrauterine asphyxia and cesarean section, it also directly affects the course and result of labor.

Malignant melanoma of the urethra: a rare histologic subdivision of vulvar cancer with a poor prognosis.

Malignant melanoma of the urethra is a rare tumour that is difficult to diagnose and treat, resulting in a poor prognosis. In this paper, we present the case of a 65-year-old woman who was referred to a gynaecologist because of a urethral mass that mimicked a caruncle. The tumour was removed by local excision, and a pathological analysis revealed a malignant melanoma. Distal urethrectomy was performed after three months with no evidence of residual tumour. There was no evidence of disease at a six-year followup. In this paper, we compare the epidemiology, treatment, staging, and prognosis of vulvar cancer in general to malignant melanoma of the vulva in particular.