The role of oral glucose intolerance test in reducing pregnancy complications.

The influence of glucose monitoring during pregnancy on newborn body weight, and complications during pregnancy and labor was assessed. We performed a retrospective analysis of macrosomal children, fetal growth, caesarean sections, malformations, still-births and the number of oral glucose tolerance test (OGTT) carried out in a five-year period. The proportion of women participating in OGTT tests increased from 20% to 40% (p<0.05) between 2000 and 2004. Gestation diabetes mellitus (GDM) proportions among pregnant women seen at the Department of Obstetrics and Gynecology at Slavonski Brod General Hospital, Croatia increased from 1% to 6.7% (p < 0. 05) during the observed period. Proportion of births identified as macrosomal decreased from 13.3% to 12.2% (p<0.05). Additionally, infant mortality and still-births along with other fetal and maternal complications declined during the same period. These results suggest that regular measurements of glucose tolerance during pregnancy may prevent preterm birth, decrease the proportion of macrosomal newborns, lower mortality and decrease fetal and maternal complication incidence during pregnancy and delivery.

Effects of raloxifene on changes in bone density.

Raloxifene hydrochloride therapy effectiveness in bone mineral density (BMD) changes compared to calcium and vitamin D3 therapy over a 2-year period. Case-control study: a group of 254 women was prescribed raloxifene (raloxifene hydrochloride) together with calcium and vitamin D3 while other group of 254 women used calcium and vitamin D3 therapy. BMD was measured at the hip, spine and forearm at the beginning and at the end of the 2-year period. Treatment with raloxifene resulted in a 3.7% increase in BMD at the spine in 98% of examinees. A 1.2% BMD increase was shown in 75% of examinees at the hip. A 1.2% decrease in BMD at forearm shown in 93% of examinees using raloxifene. The calcium and vitamin D3 therapy led to an increase in BMD in 58% examinees at the spine, in 56% at the hip and in 38% at the forearm, which was significantly lower than in women using raloxifene. Among women using calcium and vitamin D alone an average BMD decrease of 1.2% was registered on 42% of examinees at the spine, 2.6% decrease on 46% of examinees at the hip and 4.2% decrease on 35% of examinees at the forearm. Treatment with raloxifene resulted in a significant increase in BMD at the spine with odds ratio (OR 5.85, p <0.05) compared with calcium and vitamin D3 alone. There was no statistically proven increase in BMD at either the hip (OR 0.015) or forearm (OR 0.122).

Laparoscopic treatment of achalasia--first case in Croatia.

Esophageal achalasia is a primary esophageal motility disorder. Commonly used treatments are botulinum toxin injections, endoscopic balloon dilation and surgical myotomy with or without fundoplication. We are hereby presenting the first case of laproscopic myotomy with fundoplication performed in Croatia. A 32-year old female was admitted to the hospital due to the symptoms of dysphagia, regurgitation, chest pain and weight loss. Upper gastrointestinal tract radiography with contrast and flexible endoscopy confirmed the clinical diagnosis of achalasia. She was treated by the Heller laparoscopic procedure and Dor anterior fundoplication. The patient had a successful recovery and was discharged on the fifth postoperative day. This case shows that laparoscopic treatment of achalasia is a feasibile and safe procedure which can be performed even in a small country hospital, but it requires great technical care and experience of the surgeon.