Currently Available Treatment Modalities for Uterine Fibroids.

Uterine fibroids (leiomyomas and myomas) are the most common benign gynecological condition in patients presenting with abnormal uterine bleeding, pelvic masses causing pressure or pain, infertility and obstetric complications. Almost a third of women with fibroids need treatment due to symptoms. OBJECTIVES: In this review we present all currently available treatment modalities for uterine fibroids. METHODS: An extensive search for the available data regarding surgical, medical and other treatment options for uterine fibroids was conducted. REVIEW: Nowadays, treatment for fibroids is intended to control symptoms while preserving future fertility. The choice of treatment depends on the patient's age and fertility and the number, size and location of the fibroids. Current management strategies mainly involve surgical interventions (hysterectomy and myomectomy hysteroscopy, laparoscopy or laparotomy). Other surgical and non-surgical minimally invasive techniques include interventions performed under radiologic or ultrasound guidance (uterine artery embolization and occlusion, myolysis, magnetic resonance-guided focused ultrasound surgery, radiofrequency ablation of fibroids and endometrial ablation). Medical treatment options for fibroids are still restricted and available medications (progestogens, combined oral contraceptives andgonadotropin-releasing hormone agonists and antagonists) are generally used for short-term treatment of fibroid-induced bleeding. Recently, it was shown that SPRMs could be administered intermittently long-term with good results on bleeding and fibroid size reduction. Novel medical treatments are still under investigation but with promising results. CONCLUSIONS: Treatment of fibroids must be individualized based on the presence and severity of symptoms and the patient's desire for definitive treatment or fertility preservation.

Outcomes of Open Surgery for Retroperitoneal Hematoma in Covid-19 Patients: Experience from a Single Centre.

Background: Spontaneous retroperitoneal hematoma is a severe and potentially fatal complication that appears in the course of anticoagulation therapy. Therapeutic doses of low molecular weight heparin (LMWH) are used for the prevention of thrombosis in patients seriously ill with Covid-19. Methods: We describe 27 (0.14%) patients with retroperitoneal hematomas who required emergency surgery out of 19108 patients with Covid-19 who were hospitalized in Batajnica COVID Hospital between March 2021 and March 2022. All the patients were on therapeutic doses of LMWH. The existence of retroperitoneal hematoma was confirmed by abdominal ultrasound and computed tomography scans. Results: Open surgery was performed on 27 patients with spontaneous retroperitoneal hematomas (12 female and 15 male). The mean age of the study population was 71.6+-11.9 years. D-dimer was significantly elevated two days before the surgery in comparison with the values on the day of surgery (p=0.011). Six patients (22.23%) survived, while 21 (77.77%) patients died. Conclusion: Bleeding in Covid-19 patients treated by LMWH is associated with an increased risk of developing retroperitoneal hematoma. Open surgery for retroperitoneal hematoma in Covid-19 patients on anticoagulation therapy is a procedure associated with a high rate of mortality.

New Compound Heterozygous Splice Site Mutations of the Skeletal Muscle Ryanodine Receptor (RYR1) Gene Manifest Fetal Akinesia: A Linkage with Congenital Myopathies.

Mutations in the skeletal muscle ryanodine receptor (RYR1) gene have been linked to malignant hyperthermia susceptibility, central core disease, and minicore myopathy with external ophthalmoplegia. RYR1 is an intracellular calcium release channel and plays a crucial role in the sarcoplasmic reticulum and transverse tubule connection. Here, we report 2 fetuses from the same parents with compound heterozygous mutations in the RYR1 gene (c.10347+1G>A and c.10456-2Α>G) who presented with fetal akinesia and polyhydramnios at 27 and 19 weeks of gestation with intrauterine growth restriction in the third pregnancy. The prospective parents of the fetuses were heterozygous carriers for c.10456-2Α>G (mother) and c.10347+1G>A (father). Both mutations affect splice sites resulting in dysfunctional protein forms probably missing crucial domains of the C-terminus. Our findings reveal a new RYR1 splice site mutation (c.10456-2Α>G) that may be associated with the clinical features of myopathies, expanding the RYR1 spectrum related to these pathologies.

Comparison of the clinical and cognitive features of genetically positive ALS patients from the largest tertiary center in Serbia.

Discovering novel mutations in C9orf72, FUS, ANG, and TDP-43 genes in ALS patients arises necessities for better clinical characterizations of these subjects. The aim is to determine clinical and cognitive profile of genetically positive Serbian ALS patients. 241 ALS patients were included in the study (17 familiar and 224 apparently sporadic). The following genes were analyzed: SOD1, C9orf72, ANG, FUS, and TDP-43. An extensive battery of classic neuropsychological tests was used in 27 ALS patients (22 SOD1 positive and 5 SOD1 negative) and 82 healthy controls (HCs). Overall 37 (15.4%) of 241 ALS patients carried mutations in tested genes-among 17 familiar ALS patients 16 (94.1%) were positive and among 224 apparently sporadic 21 (9.4%) had causative mutation. Mutations in SOD1 gene were the most common, representing 27 (73.0%) of all genetically positive ALS patients. The main clinical characteristics of SOD1 positive patients were: spinal onset in lower extremities, common sphincter and sensitive disturbances, and dysexecutive syndrome. Within SOD1 positive patients, we noticed somewhat earlier onset in patients with A145G, sensory and sphincter disturbances were dominant in patients with L144F, while D90A patients had significant sensory involvement. SOD1 negative group consisted of ten (27.0%) patients (six C9orf72, two ANG, one TDP-43, and one patient baring triple FUS, C9orf72 expansion, and ANG variants). Bulbar involvement and more extensive neuropsychological impairment (including executive, visuospatial, and memory difficulties) were the main features of SOD1 negative cohort. Our results suggest that meaningful clinical suspicion of certain ALS genotype might be made based on thorough clinical evaluation of patients.

Erythropoietin in the Evaluation of Treatment Outcomes in Patients with Polytrauma.

Polytrauma is a term describing patients with injuries involving multiple body regions that compromises function of the body and/or organ involved. The aim of the study was to evaluate the potential role of erythropoietin in predicting poorer outcome in trauma patients. This prospective study included 86 patients admitted to the Emergency Center of Serbia due to polytrauma assigned according to Injury Severity Score (ISS). The patients were further evaluated using the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores and erythropoietin levels. There was a significant difference among erythropoietin levels at admission, after 48 and 72 hours, and on day 7 of hospital stay, with significantly higher levels in patients with ISS values 49-75. Based on the results, ROC curves were used to identify cut-off levels to predict ISS score with critical clinical course. It was concluded that erythropoietin could be a good marker of injury severity. Further research has to be performed to determine the cut-off values of erythropoietin that are significant for injury severity.

Clinical relevance of IL-10 gene polymorphism in patients with major trauma.

AIM: To assess IL-10 serum concentration according to outcome of severe trauma treatment and influence of short nuclear polymorphism (SNP) 1082G/A within IL-10 gene on treatment outcome of patients with severe trauma. METHODS: Forty-seven patients with major trauma were prospectively recruited, and they were divided into two groups according to outcome (survivors and non-survivors). The IL-10 gene polymorphisms were genotyped using restriction fragment length polymorphism analysis. Serum IL-10 levels were determined with enzyme-linked immunosorbent assay. Association between IL-10 serum concentration, IL-10 SNP type and IL-10 serum concentration in groups of patients with different SNPs with outcome after severe trauma was evaluated. RESULTS: Mean age of patients was 35.53±14.53 years. The major mechanism of injury was traffic, and the mean injury severity score was 35.47±11.23. Despite higher values of IL-10 serum concentrations in patients with lethal outcome, the difference was not statistically significant. In 40 (85%) patients no gene polymorphism for IL-10 was recorded. No statistical significance in frequency of IL-10-1082 gene polymorphism was observed between the patients with different outcomes of polytrauma. No statistically significant difference in IL-10 values was evidenced between the subjects with and without polymorphisms in any of the observed times of measurement, although a trend toward the higher values may be observed in patients with polymorphism in heterozygous form. CONCLUSION: The patients with IL-10 SNP gene polymorphism despite no proven statistical significance appeared to have higher values of IL-10 and consequently worse outcome.

Preoperative assessment and preparation of patients with neurologic disorders.

Ageing of populataion world wide has significant contribution as one of the major risk factor for neurodegenerative disorders. The patients with neurodegenerative as well as other neuological diseases presented the population with possible great need either of small or big surgical intervention. There are several important issues in patients with neurological diseases: the nature, disease duration, therapy, the patient's ability to live without assistance. Neurological disease may become worst by general and regional anesthesia. Stopping therapy may lead to worsening of neurological diseases. One of the main common threat is the risk of significant cardiorespiratory complications, which is important in assessing operational risk, in preoperative preparation and in terms of postoperative recovery and outcomes of surgical treatment. This has resulted in greater preoperative care by detailed patient history evaluation and examination, patient information and informed consent. Besides the effect of the anaesthetic technique upon the course of the disease, there is also the interaction of drugs administered during anaesthesia and patient medication. Several undiagnosed diseases may be disclosed following a surgical/anaesthetic intervention.

Preoperative preparation for patients with nutritional disorders.

Eating disorders are very common today. An increasing number of patients that undergo anesthesia and surgery have some nutritional disorder. These disorders are very versatile starting from obesity to anorexia. Significant changes in all organ systems are present. These pathophysiological changes are increased with the duration of the disease. There are many changes in the functioning of the cardiovascular system in all these diseases and there are significant. Respiratory and ventilatory functions are changed too. There are also many endocrine disorders. As a final result, there are many serious biochemical and coagulation disorders. These patients are often under some drug treatment. Patients could be under psychiatric therapy (psychiatric drugs) and/or could take drugs for relieving symptoms related to the pathophysiological changes in different organ systems. Preoperative preparation of patients must be detailed. All changes must be improved to optimal condition. In addition, it is necessary to think about the possible influence of used drugs on the anesthesia.