[Emergency contraception]. / Urgentna kontracepcija.

INTRODUCTION: The aim of this study was to point to the significance of emergency contraception following unsafe sexual intercourse. This method of contraception has been in use since the middle sixties, although in our country it is not applied very often. Indications for emergency contraception comprise every woman who experiences contraceptive failure or those not using any common contraception for any reason. MATERIAL AND METHODS: Emergency contraceptive devices are most often applied either in combination with estrogen and progesterone or only progesterone in high dosage (0.25 mg levonorgestrel and 50 mg ethinyl-estradiol) during 72 hours after the intercourse and a repeated dose 12 hours later. CONCLUSION: Emergency contraception is recommended as a single procedure. If used several times during a year, the risk of unwanted pregnancy increases. The mechanism of effect of emergency contraception depends on the timing during menstrual cycle; it can prevent ovulation, fertilization or implantation. Emergency contraception does not cause abortion and it is not effective if the process of implantation has started. Unwanted side-effects are not known.

Viruses as possible etiological factors in human genital cancer.

The antibodies against herpes virus were detected in 34 out of 60 (55%) patients with gynecological malignancies. Immunofluorescence revealed herpes virus antigens in 40 (66.7%) malignant tissues. EBV was not detected in either sera or tissue samples. Adenovirus was evidenced in sera and tissues of one case of endometrial cancer.

[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.

[Treatment strategy in malignant genital tumors in childhood and adolescence]. / Strategija lecenja malignih tumora genitalija u decijoj i adolescentnoj dobi.

In the period of 1960-1987 at the Clinic for Gynecology and Obstetrics in Novi Sad 30,398 extensive abdominal and vaginal operations were carried out. In the same lapse of time 59 female patients in their childhood or adolescence were operated on due to an ovarian gland tumor. There were 5 female patients up to the age of 14, and 54 female patients from 14-18 years of age. There were 4 malignant tumors: 2 in childhood age, and 2 in adolescence, and 55 benign ones. By presenting the severeness of the diagnosis (the rarity of the tumor) and the complete treatment strategy, the authors state the principals which should be observed with operations on the genitals of children and adolescents: operation is the method of choice; these cases should be operated on in great medical centers; "ex tempore" biopsy is necessary. The extent of the operative procedure presents a delicate problem, because great care should be taken about the endocrine function of the ovary, the somatic development, menstrual and reproductive function, potential malignancy, and possible relapse, so the authors speak in favor of relaparotomy and radicalization of the first procedure rather than in favor of a great radicalization in the first act. Depending on the nature of the tumor, postoperative irradiation or chemotherapy is recommended. In prevention, regarding early diagnosis, the opening of school dispensaries for childhood and adolescent gynecology is recommended, as well as vaginoscopic examination and the interdisciplinary work of the gynecologist, the surgeon for children and the pediatrician.

[Extraperitoneal transabdominal vacuum drainage of the parametrial cavity and suprapubic drainage of the urinary bladder after radical hysterectomy]. / Ekstraperitonealna transabdominalna vakuum drenaza parametralnih supljina i suprapubicna drenaza mokracne besike posle radikalne histerektomije.

Parametral cavity drainage was performed by the Penrose method after Wertheim's operation. In 14.4% of the patients inflammations were observed. After the introduction of extraperitoneal transabdominal vacuum drainage, the percentage of such complications decreased to 5%. In the previously performed transurethral urinary bladder drainage, the authors found uroinfections in 42.6% of the operated patients, whereas following the suprapubic drainage, urine samples remained bacteriologically clear, with less than 100,000 germs per 1 ml. In only one patient with suprapubic drainage, salt accumulated on the catheter, requiring removal by means of surgery cystoscope.

[Chronic cystitis and urinary stress incontinence in women]. / Hronicni cistitis i urinarna stres-inkontinencija kod zena.

Out of 534 inquired and examined women 151 (28.2%) of them had urinary stress incontinence and 383 (71.7%) women were continent. Of 151 incontinent women 75 (49.6%) of them repeatedly developed the inflammation of the urinary bladder and of 383 continent women data on chronic cystitis were registered in 74 (19.3%). These data pointed to the fact that the previous repeated inflammation of the urinary bladder and then the appearance of urinary stress incontinence could be regarded as one of etiologic factors in the occurrence of urinary stress incontinence.

Polychemotherapy and second-look laparotomy in the management of the ovarian cancer.

Polychemotherapy has proved to be a method of choice in the management of the ovarian cancer. The second-look operation helps exact estimation of the patient's conditions after chemotherapy. Our experience shows that chemotherapy improves the mobility of the malignant neoplasm. As yet we have not decided on the optimal time of reoperation of the residual tumours. For now, we have been performing it after 3-4 trials of the intermittent polychemotherapy. The dilemma has still remained when to stop the treatment of polychemotherapy after positive second-look operation and whether to apply the third-look approach. Our experience suggests that non-differentiated malignant tumours require more aggressive chemotherapy while compared with the differentiated tumours of the same stage.

Vaginal hysterectomy by means of morcellation.

There were 1365 vaginal hysterectomies performed at the Department of Obstetrics and Gynaecology at Novi Sad. Morcellation was applied in 162 (11.9%) patients. It was most often applied in the group of patients from 40 to 49 years of age and in the sixth decade of life (27.2%; 44 cases). Uterine size was the basic indication for morcellation, but some other factors were of importance as well, such as: moveability, descensus, adhesions, fibroma location, depth and width of the vagina. The largest uterus in our study was 700 g in weight, while in most cases the uterus weighed approx. 250 g. There were no other complications during morcellation application. Postoperative morbidity was 24.7% and it followed the usual morbidity rate in V.H. Inflammations were the most frequent complications.

[Air embolism in labor]. / Luftembolie unter der Entbindung.

Author report on a case of air embolism in delivery in a multigravida. Delivery was completed by an application of vacuum extractor. The parturient lost small amount of blood during delivery. Soon after delivery the patient complained about numbness in her arm and a headache. She turned pale, got disturbed and broke out in a cold sweat. Blood pressure was unmeasurable; peripheral pulse could not be felt. Immediately reanimation measures were performed. The condition of the patient got worse after a short time of improvement. For the reason of doubt about intra-abdominal hemorrhage, laparotomy was performed and finally abdominal hysterectomy was done. Incomplete rupture of the uterus was registered during the operation. The patient died during the operation. Vein air embolism was diagnosed only during the autopsy, and most probably it was a result of air aspiration through the split uterine veins.