Competitive ligand - binding assay for thyroxine binding globulin. Comparison with TBG radioimmunoassay and T3 uptake test.

A simple and reproducible competitive ligand binding assay has been utilized to measure serum TBG concentration. In euthyroid subjects TBG concentration (mean +/- SD, mg/l) was 33.7 +/- 4; hyperthyroid 24 -/+ 6; T3-thyrotoxicosis 20 +/- 7; hypothyroid 37 -/+ 7; pregnant 67 -/+ 18; post-partum period 59.8 -/+ 17; oral contraceptives 45 -/+ 7. The correlation of CLBA with RIA measurement of TBG was significant (p less than 0.001). The estimations of serum TBG by CLBA correlated significantly with T3 uptake test (p less than 0.001), but at higher concentration of TBG correlation was non-linear. T4 : TBG ration according to serum T4 and TBG concentration provided a reliable index in the assessment of thyroid function.

Histoenzymatic and immunocytochemical characteristics of extravillous trophoblast cells of placental basal plate as parameter of their function in hypertensive pregnancy.

An intense activity of enzymes which actively participate in the renin-angiotensin-aldosterone system was shown in extravillous trophoblast cells which are involved in the performing of spiral arteries into uteroplacental vessels. The hydrolase activity in villous trophoblast underwent important variations, but it was constant in cells of the extravillous trophoblast. Activity of lysosomal hydrolases, of leucine aminopeptidase and N-acetyl glucosaminidase type, was markedly positive in X-cells, while negative in the villous trophoblast. Beta glucuronidase activity has shown moderate activity in cells of extravillous trophoblast, while in villous trophoblast it was weakly emphasized or negative. Intense activity of prostaglandin E2 dehydrogenase in the way of strongly emphasized microsomal reaction was noted exclusively in extravillous cells of basal plate, especially in perivascular cell groupings. Within all examined enzymes activities, only the membranous activity of alkaline phosphatase was of the same intensity in cells of extravillous trophoblast. Lacking of penetration of these cells into the spiral arteries wall in EPH-gestosis, which also means loss of their close contact with the blood of a pregnant, implicates the practical meaning of these observations.

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).

[Fetal hypoxia--etiology and pathophysiology of hypoxic damage]. / Fetalna hipoksija--etiologija i patofiziologija hipoksicnih ostecenja.

In current perinatology, the prevention of hypoxic damage to the organs, brain in particular, is given special emphasis. The causes of fetal hypoxia include maternal (preuterine), intrauterine, umbilical, placental and fetal causes. Hypoxia and hypoxic lesions occur prenatally in about 80%, and perinatally in 10-20% of cases. Hypoxia/ischemia induce cellular and subcellular responses in the fetal brain. Some of these are membraneous phenomena such as potassium channel activation, enhanced release of excitoxic amino acids aspartate and glutaminate, activation of NMDA receptors, transmembranous calcium ion influx, and membranous lipid peroxidation. Cytosolic events include the formation of free oxygen radicals, release of eicosanoids, prostaglandins, leukotriens and cytokines, enzyme activation, and gene induction.

[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.

[Correlation between changes in placental structure and fetal lung maturity in ultrasound examinations]. / Korelacija promjene strukture posteljice utvrdene ultrazvukom i zrelosti fetalnih pluca.

In 228 pregnant women examined by ultrasound in the 30th to the 40th week of gestation, the first placental maturity degree was found in the 31.6 week, the second degree in the 35.8 week, and the third degree in the 38.2 week. In 60 women with on term pregnancy also amniocentesis was carried out and the lecithin-sphingomyelin ratio (L/S) was compared with the ultrasound finding. In 6 of these pregnant women the third degree of placental maturity was observed, their L/S ratio was not below 2, and in their newborns no respiratory distress syndrome developed. Ultrasound estimation of placental maturity is a useful method in pregnancies in which no other methods could be applied.

[Tubal pregnancy carried to the 27th week]. / Tubarna trudnoca iznosena do 27. tjedna.

A 22-year-old primigravida in the 26/27 weeks of pregnancy with tubal pregnancy is presented. Clinical and ultrasound examinations indicated ectopic pregnancy; emergency laparotomy was performed. Intraoperatively, the tubal pregnancy with a ruptured hole was revealed. Typical salpingectomy was carried out. Histology confirmed tubal pregnancy. The postoperative course was normal.

Maternal cerebral circulation in normal and abnormal pregnancies.

BACKGROUND: Abnormal pregnancies are usually associated with an impairment of maternal cerebral circulation which is mainly a consequence of generalized vasospasm and cerebral edema. The pathogenesis of vasospasm has still been a matter of controversy. The aim of this study was to evaluate maternal cerebral blood flow velocity (CBFV) changes in normal and abnormal pregnancies, and to correlate CBFV findings with the severity of symptoms in abnormal pregnancies. METHODS: A group of 40 gravidas (aged between 25 and 32 years) with pre-eclampsia were analyzed by Transcranial Doppler (TCD), Color Doppler Flow Imaging of carotid arteries and Transcranial Color Coded System once a week, starting from 32nd week of pregnancy and followed 2 months after delivery. The study was performed from the January 1996 to June 1996. RESULTS: The results showed 70% of abnormal pregnancies to have impaired TCD findings, mostly increased CBFV. The degree of toxemia measured by Goecke's index significantly correlated with abnormal CBFV Nine gravidas with increased CBFV on the first examination developed vasospasm during 34 to 36 weeks of gravidity. No statistically significant difference of the M1 segment of MCA diameters was found between normal (3.8 +/- 0.7 mm) and abnormal pregnancies (4.1 +/- 0.9 mm). CONCLUSIONS: The increase in the maternal CBFV was the most frequent observation in abnormal pregnancies. It was progressive during late pregnancy, when vasospasm may develop, although the presence of vasospasm is still the matter of controversy. The most important observation was that significant changes in CBFV preceded neurologic symptoms, emphasizing the predictive role of TCD in abnormal pregnancies.

Antenatal diagnosis by means of ultrasound in the rare case of foetal parasitic tumor.

A case of hydramnion is presented. Antenatal diagnosis of a tumor in the sacral region of the foetus was made by means of ultrasound, while the roentgen investigation gave a negative result. Postnatal confirmation of the ultrasound diagnosis was subsequently obtained and a detailed patho-histological description of an abnormal foetus is given.

Transvaginal sonographic assessment of premalignant and malignant changes in the endometrium in postmenopausal bleeding.

PURPOSE: We explored the value of transvaginal sonography as a screening technique for endometrial abnormalities. METHODS: Transvaginal sonography was used to evaluate the likelihood that an endometrial abnormality was present in a group of 103 women with postmenopausal bleeding. RESULTS: Sonographic findings showed a mean endometrial thickness of 6.2 mm in patients with endometrial atrophy, 12.4 mm in patients with simple hyperplasia, 13.4 mm in patients with complex hyperplasia, and 14.1 mm in patients with endometrial carcinoma. There was no statistically significant difference in endometrial thickness measurements between the hyperplasia and endometrial carcinoma groups. However, the difference between these groups and the endometrial atrophy group was statistically significant. The mean age was significantly higher for patients with endometrial carcinoma (62 years) than for the patients in the other groups. CONCLUSIONS: Our study shows that transvaginal sonography is a useful method of screening for endometrial abnormalities.

[The HELLP syndrome--a case report]. / HELLP sindrom--uz prikaz bolesnice.

A 31-year-old secundipara with eclampsia developed the HELLP syndrome after delivery. Clinically, along with very high blood pressure values (29.3/17.3 kPa) and eclamptic attacks, an intense pain in the upper abdomen and nausea were dominant. The patient also had severe thrombocytopenia (18 x 10(9)/L), hemolysis, and increased liver enzymes (SGOT up to 220 U/L and SGPT up to 100 U/L). An intensive therapy, including--together with usual interventions in serious EPH gestoses--also plasmapheresis, antithrombin III substitution, freshly frozen plasma, and transfusion of blood and thrombocytes, proved successful in achieving the normalization of the blood pressure, blood count and liver enzymes, as well as a clinical improvement, so that 18 days after delivery it was possible for the patient to go home, provided with necessary instructions.

Modified fetal biophysical profile in the assessment of perinatal outcome.

The aim of the study is the evaluation of variables of the biophysical profile in the assessment of perinatal outcome. The prospective study included 87 pregnant women with singleton pregnancy in the 28th to 42nd week of gestation with clinically and ultrasonically verified fetal growth retardation, where the fetal biophysical profile was assessed antenatally. Through the factor analysis of biophysical profile variables we obtained values indicating the contribution of individual variables to the predictability of perinatal outcome. 70% of the patients were examined in 15 minutes according to the principles of modified biophysical profile. The most sensitive variable of the biophysical profile in the prediction of perinatal outcome was the amniotic fluid volume, followed by fetal breathing movements, non-stress test and fetal movements, while the lowest prediction value was assigned to the fetal tone. The modified biophysical profiles need to be perfected on a larger number of pregnant women, which would advance the predictability of this method in detection of hypoxically endangered fetuses.

Detection and typing of human papillomaviruses by polymerase chain reaction in cervical scrapes of Croatian women with abnormal cytology.

The association between certain human papillomaviruses (HPV) and cervical intraepithelial neoplasia (CIN) is well documented, but still unknown among Croatian women. In 1995, women between the age of 17 and 64 with cytomorphologically abnormal smears (CIN I-IV) were tested for the presence of HPV. Consensus and specific primers were used in the polymerase chain reaction (PCR) to detect the most common types: 6, 11, 16, 18, 31 and 33, as well as the unknown-risk HPV types (HPV X). Out of 379 specimens, 163 (43%) contained one or more HPV types. Coinfection with different HPV types in the same sample was observed in 16 cases. Beside low-risk HPV 6/11 (25.8%) the most frequently observed types were high-risk HPV types 16 (20.2%) and 31 (17.8%). Globally, the HPV positivity rate declines with age. The presence of HPV DNA significantly increased from 35.5 to 61.1% along with the severity of the cervical intraepithelial neoplasia (CIN I-IV). HPV type 6/11 was strongly associated with CIN I (33.8%), HPV type 31 with CIN II (22.9%), and HPV type 16 with CIN III (50%).