The perinatal origins of major reproductive disorders in the adolescent: Research avenues.

The fetal endometrium becomes responsive to steroid hormones around the fourth month of pregnancy starting with an oestrogenic phase, which is followed late in pregnancy by a secretory phase. Based on post-mortem studies, the endometrium at birth is secretory in only one-third of neonates and proliferative in the remaining cases. Decidual or menstrual changes are rare in fetal endometrium despite high circulating steroid hormone levels, which drop rapidly after birth. Hence, acquisition of progesterone responsiveness appears to be dependent on endometrial maturation and relative immaturity may persist in a majority of girls until the menarche and early adolescence. Two major reproductive disorders have been linked with either advanced or delayed endometrial maturation. First, early-onset endometriosis may be caused by menstruation-like bleeding in the neonate, leading to tubal reflux and ectopic implantation of endometrial stem/progenitor cells. Second, persistence of partial progesterone resistance in adolescent girls may compromise deep placentation and account for the increased risk of major obstetrical syndromes, including preeclampsia, fetal growth retardation and preterm birth. The concept of neonatal origins of common reproductive disorders poses important research challenges but also subsumes potential new preventative strategies.

Usefulness of beta hCG as tumor marker in the diagnosis and follow up of patients with ovarian cancer.

PURPOSE: To test the possibility of using beta human chorionic gonadotropin (ß-hCG) as a tumor marker in ovarian cancer by determining its diagnostic and prognostic value, and see for any relationship between disease stage, histological tumor types and serum and ascitic fluid ß-hCG levels, as well as to identify false positive and false negative results. METHODS: This was a prospective study in 60 surgically treated patients with ovarian cancer in the period 2006- 2010. The diagnosis was confirmed postoperatively based on the histopathological findings and the continuous determination of ß-hCG serum levels, during the 2 postoperative years at regular quarterly intervals. The obtained results were statistically processed using multivariate analysis. RESULTS: ß-hCG showed no reliable diagnostic value in ovarian cancer. A statistically significant difference between serum ß-hCG levels and different FIGO stages was noted, but not between ß-hCG levels and different histological groups of tumors. There were 10.2% of false positive and 18.9% of false negative results in all measurements. CONCLUSION: The use of ß-hCG as a tumor marker for ovarian cancer is justified only in patients with preoperatively high levels in advanced FIGO stages (III and IV), regardless of histological type of tumor.

Are the additional grafts necessary?

The goals of surgery for spinal deformity are to correct or improve the deformity to get a stable, balanced and fused spine. The long-term success of any procedure for scoliosis depends on a solid arthrodesis. Getting fusion of the instrumented segment with the aid of copious autogenous iliac graft has been the most important goal of treatment. However, harvesting copious graft from teenage iliac bone has its limitation in the quantity of graft, surgical time, and other complications of graft sites. Bone substitute is a promising concept, but there is not ideal bone substitute with all the characteristics of an autogenous bone graft. Several alternative graft materials like tricalcium phosphate, hydroxyapatite, and demineralized bone matrix have osteoinductive properties. Bone morphogenic protein has osteoconductive properties. The limitations with bone substitutes are osteoinduction and osteoconduction properties, sterilization, chances of transmitting infective disease and cost. We consider that the introduction of segmental spinal instrumentation which enables strong and firm correction and fixation of the scoliotic deformity has enabled getting fusion with less graft. We can obtain that quantity of graft after laminae and spinous process decortication. This retrospective study has been done in our hospital from January 2002 to December 2004. A total of 188 patients underwent posterior corrections for adolescent idiopathic scoliosis using segmental fixation by Moss-Miami. No autogenous iliac crest graft was taken or graft substitutes. After meticulous decortication and destruction of facet joints, we used local graft taken from spinous process and laminae. All patients had minimum thirty months follow-up. We have excellent results. Out of these 188 patients, 177 patients have fused spine, no implant failure, no pain, no infection and no loss of correction. Eleven (5.8%) patients underwent re-operation; four among them because of infection, three for symptomatic implants and four due to pseudarthrosis. We consider that the use of local harvesting graft is enough for getting good spondylodesis.

[Transvaginal sonography of the postmenopausal endometrium]. / Transvaginalna sonografija postmenopauzalnog endometrijuma.

INTRODUCTION: The most frequent symptom suggesting endometrial pathology is uterine bleeding. Each postmenopausal uterine bleeding requires fraction explorative curettage and histopathologic examination of the material obtained from the cervical canal and uterine cavity. The aim of this study was to estimate the efficacy of ultrasonography as a non-invasive method in detection of endometrial pathology in postmenopausal women, and to find out whether its more frequent use could safely decrease the number of curettages in detection of these conditions. MATERIAL AND METHODS: A prospective investigation has been performed in postmenopausal women not menstruating for more than a year, and who reported to the Department of Obstetrics and Gynaecology in Novi Sad for uterine bleeding during 1996 and 1997. Each woman underwent ultrasonographic examination by vaginal probe of 5 MHz and fraction curettage, whereas the samples from cervical canal (if obtained) and from uterine cavity were sent to histopathologic examination to the Institute of Pathology in Novi Sad. Standard statistical methods have been used for the analysis of the results. Validity of the applied ultrasonographic method in detecting endometrial pathology has been estimated by calculation of its sensitivity and specificity. RESULTS: A satisfactory visualisation of the endometrium has been obtained in all 35 examined cases. The thinnest endometrium was 1 mm wide and the thickest one was--25 mm. The fraction curettage has been used to obtain material from the cervix in 2 cases and from the uterine cavity in 35 cases. In our patients with uterine bleeding, who were in the postmenopause for 13 years on average, endometrial atrophy was recorded in 17.14%, endometrial polyp in 11.43%, endometrial hyperplasia in 22.86%, endometrial adenocarcinoma in 42.86% and uterine sarcoma in 5.71%. There were 2 false negative ultrasonographic findings (2 cases of endometrial hyperplasia) and sonographic thickness less than standard versus 2 false positive cases (endometrium thicker than the limit value, 7 and 14 mm, with no real pathology) which showed that the sensitivity of the investigated method was 93.10% and the specificity was 66.66%, if the limit value for the thickness of endometrium was 3 mm. DISCUSSION: Ultrasonographic thickness of endometrium means maximum double thickness in longitudinal plane, i.e. the distance of the opposite bordering surfaces of endometrium and myometrium. The procedure of measurements of endometrial thickness is simple in most cases. Most authors agree that there is a positive correlation between the thickness of endometrium and its pathological conditions. The most often used limit values are 3 and 4 mm. Higher limit values of endometrial thickness increase the sensitivity of the method even to 100%, but negatively affect its specificity making this method inadequate as a screening method for endometrial carcinoma. Many authors insist on introducing other criteria for evaluation of the endometrium i.e. for taking its thickness as the only criterion. Ultrasonography does not provide a completely safe differentiation between benign hyperplasia and endometrial carcinoma. CONCLUSION: The transvaginal sonography is an efficient and acceptable, noninvasive method for early detection of endometrial pathology in postmenopausal women. The thickened endometrium during menopause is the most significant ultrasonographic criterion implicating its pathology. The vaginosonographically measured thickness of 3 mm and less, gives a relatively safe prediction of endometrial atrophy, whereas the thickness above 3 mm requires explorative curettage and histopathologic examination of the endometrium, no matter if the woman has or has not uterine bleeding. (ABSTRACT TRUNCATED)

Induction of labor by endocervical application of prostaglandins and intravenous infusion of oxytocin in postterm pregnancy.

The study compares two contemporary modes of labor induction: intravenous application of Syntocinon and endocervical application of prostaglandins and examines their efficacy and safety. Ninety women were divided according to the degree of cervical maturation (shown by Bishop score) into two groups. In group I there were 60 women with unripe cervix (Bishop score < or = 5) and induction was performed by endocervical application of 0.5 mg Dinoprostone, and in group II there were 30 women with ripe cervix (Bishop score < or = 6) in which the induction was performed by intravenous application of Syntocinon (500 ml of 5% glycose with 10 iu of Syntocinon). After three hours the initially significantly different Bishop score values were equalized and it was possible to correlate the duration of the labor (Group I 545 min, Group II 338 min). The correlation of initial Bishop score values and the total duration of the labor was negative and high in both groups. All the neonates from both groups were in good condition and no serious complication was noted. Both methods of labor induction appear similarly effective and safe both for the fetus and the mother.

[Ectopic pregnancy in women who use intrauterine contraceptive devices]. / Ektopicne trudnoce kod korisnica intrauterinih kontraceptivnih ulozaka.

This study analyzes occurrence of ectopic pregnancies in women using intrauterine contraceptive devices. During a 5-year period, 1990-1994, 524 women with ectopic pregnancies underwent surgery at our Clinic, while 22 (4.2%) had intrauterine devices. At admission most patients had signs of heavy intraabdominal bleeding, so in 77.27% cases the diagnosis was made by punction of the Douglas area, and only in 9.09% by laparoscopy, that is other methods for early detection of diseases. Rupture of the fallopian tube occurred in 50% of patients, tubal abortions in 36.36% and ovarian pregnancies in 13.64%, whereas 18 salpingectomies and 4 adnexectomies were performed. Late diagnosis and impossibility of performing conservative operations on fallopian tubes are the consequence of disregarding the possibility of getting pregnant by the users of intrauterine devices themselves, as well as by physicians whose help is asked for after symptoms appear.

[Nutritional status in women and estrogen production in surgical menopause]. / Uhranjenost zena i produkcija estrogena u hirurskoj postmenopauzi.

The objective of this study was to examine how nutritional status, in women with bilateral ovariectomy and after preservation of ovaries, influences estrogen production. After bilateral ovariectomy statistically significant low values of urinary estrogens were recorded (21.76 nmol) in regard to ovarian preservation (87.80 nmol). Urinary estrogen values correlated with obesity in women with bilateral ovariectomy: in undernourished they were 10.50 nmol, in normally nourished 21.05 nmol, and in obese women 25.05 nmol. These differences are statistically significant. This can be explained by a higher conversion of androstendione to estrone, in the massive tissue, which is the main source of estrogen in postmenopause. This correlation does not exist in women with preserved ovaries, because in that case they are the basic source of estrogen.

[Serum lipids in surgical and natural postmenopause]. / Serumski lipidi u hirurskoj i prirodnoj postmenopauzi.

Values of serum lipids in women of different estrogenic status were analyzed in this paper. A deficit of estrogen was established in groups of surgically induced and natural postmenopausal women, but a relatively preserved production of estrogenic hormones in the group of women with preserved ovaries and group of premenopausal women. Serum triglycerides, the total serum cholesterol and LDL fraction of cholesterol were highest in surgically induced premenopausal women, somewhat lower in natural postmenopausal women, while they were statistically significantly lower in premenopausal women and women with preserved ovaries. Values of HDL cholesterol did not statistically significantly differ in certain groups of women. Index of atherosclerosis (IA) was highest in surgically induced postmenopausal women (3.18), somewhat lower in natural postmenopausal women (2.99) and premenopausal women (2.64), while it was statistically significantly lower in women with preserved ovaries (2.57).

[Inhibition of initial puerperal and postabortion lactation using oral prostaglandin E2 (Dinoprostone)]. / Inhibicija inicijalne puerperalne i postabortalne laktacije oralnom primenom prostaglandina E2 (dinoprostona).

Authors present their experience in oral administration of Prostaglandin E2 (Dinoproston, Upjohn) during postpartal and postabortal period (à 0.5 mg after legal pregnancy interruption) in suppression of lactation. Indications for postpartal lactation suppression were such as: stillbirth, postpartal neonatal death and maternal negative attitude towards breast feeding. The patients in whom the suppression of lactation was applied were of generative age (18-40 years) either primiparas or multiparas. All were delivered vaginally with no extra intrapartal or postpartal complications being the same in legal pregnancy interruptions which were performed by application of intravaginal, intracervical and intramuscular Prostaglandin preparations. The patients were administered 1 tbl od 0.5 mg Dinoproston preparation every 6-7 hours, 48 h after the delivery, i.e. 2 tbl in total (after meal). This method of lactation suppression was applied in 50 patients during 1990. Satisfactory results were achieved in all cases, while negative side effects and complications were not noted. Oral administration of PGE2 was found very efficient in postpartal and postabortal lactation suppression while compared with previously applied methods such as Estrogen-Testosterone preparation, i.e. small doses of Bromergon applied during 10-14 days. Oral administration of PG2 is more efficient and in a certain way more comfortable in relation to the previously applied methods.

[Preservation and relocation of the ovaries in an experiment on female dogs and the initial experience in radical hysterectomy in women]. / Konzervacija i dislokacija jajnika u eksperimentu na kujama i prva iskustva kod radikalne histerektomije na pacijentkinjama.

During an experiment in bitches, the ovaries were placed sub-peritoneally beneath the skin of the abdominal wall preserving the infundibulo-pelvic ligament. A year later a relaparotomy was performed. No alterations were evidenced in the ovaries placed either sub-peritoneally of beneath the skin. In 7 patients of less than 36 years of age, during radical hysterectomy performed for cervical carcinoma the ovaries were placed intraperitoneally at the level of the lower kidney pole, preserving the vascularisation of the infundibulo-pelvic ligament. In one patient a cystic degeneration occurred on the right side, while the ultrasound control did not reveal any pathology in the rest of the patients. A year later the total urine estrogen levels were within normal ranges.