Prevalence of Gestational Diabetes Mellitus and Perinatal Outcomes According to the Old Who Criteria and IADPSG Criteria.

BACKGROUND: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy. Pregnancies with GDM have worse outcomes compared to pregnancies with normal glucose tolerance. The objectives of the study were to determine the prevalence of GDM and perinatal outcomes according to the old WHO criteria and IADPSG criteria. SUBJECTS AND METHODS: A retrospective study included 2,405 pregnant women who delivered between January 2009 and December 2010. According to the OGTT results, pregnant women were divided into 4 groups. We analyzed the prevalence of GDM, characteristics of pregnant women and their newborns and perinatal outcomes. RESULTS: We found significantly higher prevalence of GDM according to the IADPSG criteria compared to the WHO criteria. Pregnant women with GDM were significantly older, had higher pre-pregnancy BMI, fasting and 2-h plasma glucose. Pregnant women with GDM had worse pregnancy outcomes compared to control group. The overall proportion of overweight and obese pregnant women was the highest in the group of untreated pregnant women with GDM according to the IADPSG criteria. In this group we found significantly higher rate of fetal macrosomia and LGA. The rate of caesarean section was significantly higher in comparison to control group. Pre-eclampsia was significantly more common in groups of pregnant women with GDM compared to control group. CONCLUSION: IADPSG diagnostic criteria reveals more women with hyperglycemic disorders in pregnancy. A group of pregnant women who were normoglycemic according to the WHO criteria, but according to the IADPSG were diagnosed GDM, had adverse pregnancy outcomes. Lower values of glycemia, than those defined for diabetes in pregnancy, are associated with adverse pregnancy outcomes.

Clear cell variant of urothelial carcinoma in urinary bladder; a clinicopathological and immunohistochemical study--a case report.

The clear cell variant urothelial carcinoma of urinary bladder is very rare and unusual neoplasm defined histologically by clear cell pattern and glycogen-rich cytoplasm. Our case of clear cell carcinoma was diagnosed with immunohistochemistry stain. A 72-year-old man, presented with painless macroscopic hematuria in November 2007. Evaluation revealed papillary tumor in urinary bladder. A transurethral resection of the bladder tumor (TUR-Bt) was performed. Histopatologic evaluation showed superficial transitional cell carcinoma and carcinoma in situ. On three month follow-up, a solitary pedunculated tumor was detected again in the left wall of the urinary bladder. A repeated transurethral resection of the bladder tumor (reTUR-Bt) was performed in February 2008. The pathological diagnosis was difficult due to diffuse clear cell appearance. Immunohistochemistry stain showed urothelial carcinoma and finally it was diagnosed as clear cell variant. Urothelial carcinoma has many variants that show a variety of appearances and characteristics. These should be well known for evaluation and optimal treatment.

Expression of matrix metalloproteinase-1 in uterosacral ligaments tissue of women with genital prolapse.

Collagen metabolism is altered in the pelvic organ tissues of women with genital prolapse. The aim of this study was to compare collagen metabolism by measuring matrix metalloproteinase-1 (MMP-1) expression in uterosacral ligament tissues of postmenopausal women with and without genital prolapse. Uterosacral ligament tissues were obtained at the time of abdominal or vaginal surgery from twenty-four patients with pelvic organ prolapse (POP) and 21 women who underwent gynecologic surgery for benign indications. The tissue samples were analyzed by immunohistochemistry. There were no differences in age, BMI and parity between two groups. The patients with genital prolapse demonstrated significantly higher occurences of MMP-1 expression compared to controls. These findings indicate that increased MMP-1 expression in uterosacral ligaments is associated with genital prolapse. Our data are consistent with the theory that increased collagen breakdown may play an important role in the onset and development of pelvic organ prolapse (POP).

Fetal macrosomia in pregnant women with gestational diabetes.

The aim of the study was to determine the frequency of fetal macrosomia in newborns from mothers with gestational diabetes mellitus (GDM) and healthy mothers, as well as determining the influence of fetal growth on pregnancy termination, on complications in pregnancy, during delivery and puerperium and on neonatal complications. In the study were included 351 pregnant women with GDM, as well as control group of 1502 healthy pregnant women. Newborns of mothers with GDM had significantly higher birth weight and length, ponderal index > 2.85 was more frequent, they were macrosomic and hypertrophic (disproportional and proportional), had smaller Apgar score and more frequent neonatal complications (p < 0.05). Fetal macrosomia and fetal hypertrophy alone or, particularly, connected with disproportional fetal growth, but disproportional hypotrophy as well, had significantly influence on greater frequency of delivery and puerperal complications, delivery completion with Cesarean section and neonatal complications in pregnant women with GDM.

Sex or surgery--erectile dysfunction after radical treatment of localized prostate cancer.

The maintenance of satisfactory quality of life is major concern in majority of patients who elect treatment for localized prostate cancer. We conducted a cross-sectional study to determine sexual function after radical prostatectomy (RP) and external beam radiotherapy (EBRT). Study population consisted of series of 57 patients with early-stage adenocarcinoma of the prostate, treated in our institution in the period from January 2003 till December 2003. Thirty three patients underwent radical retropubical prostatectomy and 24 patients were treated by primary radical radiotherapy. Patients have been given the full international index of erectile function (IIEF) questionnaire two to four and six months after the treatment. Post treatment sexual function in patients treated by EBRT is significantly better than in patients treated by RP (48.5% vs. 21.57%, p < 0.0001). Subgroup analysis reveals that satisfaction with erectile function, maintaining of sexual intercourse and possibility of ejaculation is better in patients treated by EBRT than in patients treated by RP (44.67% vs. 11.57%, p < 0.0001) as well as general satisfaction with quality of sexual life (48.5% in EBRT group vs. 21.57% in RP group, p < 0.0001). On the other hand, sexual desire remains the same in both groups of patients (63.75% in EBRT group vs. 60.61% in RP group, p = 0.71). Six months after surgical or radiotherapy treatment erectile function is almost as twice as worse in patients treated by surgery than in patients treated by radiotherapy.

Risk factor analysis and diagnoses of coronary heart disease in patients with hypercholesterolemia from Croatian Zagorje County.

Our aim is to determine if there exists a difference in risk factors and diagnosis between patients being treated on internal medicine ward for coronary heart disease who have higher levels of cholesterol in their blood and other patients, without proved higher levels of cholesterol, hospitalized for coronary heart disease. We followed patients hospitalized in General Hospital Zabok for coronary heart disease for the period between 2004-2006y. On admission patients were diagnosed with coronary heart disease based on laboratory markers specific for the disease (CK, troponin, LDH,CRP), ECG and history taking. We analyzed two groups of patients for diagnosis and risk factors on discharge from the hospital: one group with proven hypercholesterolemia, the other with coronary heart disease without hypercholesterolemia. For the duration of the study there were no significant alternations concerning risk factors for coronary heart disease, and hypertension was the most prevalent of these factors in both groups. Values of HDL, as an indirect indicator of coronary heart disease, were lower in both groups for the duration of the study. In group of patients with hypercholesterolemia myocardial infarction with a ST segment elevation, as a discharge diagnosis, was a more prevalent complication of the disease, while for the group of patients without hypercholesterolemia stable angina pectoris was more prevalent and this is explained as atheroma plaque stabilization when there are normal values of blood cholesterol.

The analysis of walk cycle in patients with spastic cerebral palsy after surgical management on the lower extremity.

Gait pattern is a frequent problem in cerebral palsy. The aim of the investigation is the evaluation of proximal femur normalization and/or pelvis normalization after surgical correction and simultaneous operations on soft tissues of lower limbs, as well as walk analysis. From 1980. to 2000. were operated 856 patients, 476 male and 380 female, between 1-51 years. Basic walk parameters were analyzed: step length, speed and the number of steps in one minute (cadence). 75.25% of patients had good results with improved of centrum collum diaphysis (CCD) and angle of anteversion (AV) or antetorsion (AT) for 70%, and more independent walking with contracture corrections and decreased spasticism. The best results were achieved with simultaneous two-side operations, with patients' age between 1 and 3, achieving independent walking. More operations at the same time significantly reduce spasticism--one anesthesia, one immobilization, and later same time post-operative physical therapy and satisfactory better results.

Epidemiology of pelvic floor disorders between urban and rural female inhabitants.

The aim of this study was to investigate the prevalence of pelvic organ prolapse in urban and rural women and to identify possible related factors. They were 1749 participants; one thousand four hundred seventeen (81%) urban women and 332 rural residents (19%). The urban and rural women were congruently regarding to age, parity, using oral contraceptives and postmenopausal status. The urban women were more often obese (p < 0.01), estrogen replacement users (p < 0.001), smokers (p < 0.001), with mild (p < 0.001) and high (p < 0.001) education, and they were often divorced (p < 0.05) than rural women. Rural women were more often alcohol consumers (p < 0.001), with low level of education (p < 0.001) and more often married (p < 0.05) than rural examinees. There were no association between the presence of prolapse and: weight, menopausal status, oral contraceptives and estrogen replacement using, smoking, alcohol consuming and marital status. There were not observed differences in prevalence of prior hysterectomy, urinary incontinence, uroinfectio, sexual and bowel dysfunction between both groups. The prevalence of cystocele, rectocele and uterine prolapse were similar among urban and rural participants. In conclusion, a more complete picture of factors associated with genital prolapse would include in investigation, such as molecular and genetic ones.

Prevalence of gestational diabetes mellitus according to IADPSG and NICE criteria.

OBJECTIVE: To investigate the impact of the International Association of Diabetic Pregnancy Study Group (IADPSG) diagnostic criteria on the prevalence of gestational diabetes mellitus (GDM) and overt diabetes as compared with the UK National Institute for Health and Care Excellence (NICE) criteria, and to evaluate the prevalence of maternal and perinatal outcomes among pregnant women with fasting plasma glucose (FPG) levels of 5.1-5.5 mmol/L. METHODS: A retrospective study was undertaken of data for women who underwent a 2-hour 75-g oral glucose tolerance test at 24-32 weeks of a singleton pregnancy at a center in Croatia between January 2012 and December 2014. RESULTS: Among 4646 included women, 1074 (23.1%) had GDM according to IADPSG criteria, 826 (17.8%) would be diagnosed according to NICE criteria, and 50 (1.1%) had overt diabetes. FPG levels were 5.1-5.5 mmol/L for 409 (8.8%) women. Compared with a control group (n=3391), these women had higher odds of large-for-gestational-age newborns (odds ratio 3.7, 95% CI 2.0-4.6) and cesarean delivery (odds ratio 1.8, 95% CI 1.3-2.3). CONCLUSION: Women with FPG levels of 5.1-5.5 mmol/L have an increased risk of adverse maternal and perinatal outcome, although they would not be diagnosed with GDM according to NICE criteria.