Symptomatic physiologic hydronephrosis in pregnancy: incidence, complications and treatment.

OBJECTIVE: We present the incidence and results of treatment of symptomatic physiologic hydronephrosis in 3,400 pregnant women. METHODS: We analyzed 103 consecutive women who presented with clinical signs and symptoms related to the upper urinary system. Renal sonography, urinalysis, serum creatinine levels, white blood cell (WBC) count, and urine culture were done in all patients at first visit and repeated at least once a month until 1 month after delivery. In patients who manifested acute pyelonephritis, urinalysis, WBC count, erythrocyte sedimentation rate and C-reactive protein levels were repeated every 3 days until normalization, and urine culture as well as renal sonography were performed once a week until 1 month after delivery. Conservative measures (positioning, analgesia, antibiotics) were performed in all patients with symptomatic physiologic hydronephrosis. If the patient's condition was refractory to medical management, drainage of the ureter with a double pigtail stent was performed. RESULTS: Conservative measures were successful in 97 (94%) of 103 patients but 6 (6%) patients had ongoing signs and symptoms of acute pyelonephritis progressing to urosepsis. In all of them, antibiotics were continued and a double pigtail stent was placed resulting in fast regression of symptoms, curing of renal infection and progress of the pregnancies to the term with vaginal delivery. CONCLUSIONS: Symptomatic hydronephrosis in pregnancy can be treated conservatively. If the patient's condition is refractory to medical management, an internal drainage with double pigtail stent may be necessary.

Attitudes, behaviour and knowledge on sexuality among female adolescents in Zagreb, Croatia.

The aim of this study was to estimate the level of knowledge about sexuality, attitudes and sexual behaviour of female adolescents. The study included 194 female students, 117 from Medical High School (MHS) and 77 from General High School (GHS) in Zagreb. Data was collected using an anonymous self-administered questionnaire. In addition to items on personal data (age, parental education etc.), the participants were asked to define terms about sexuality (e.g. menstruation, puberty) the definitions of which are found in biology textbooks for the fifth and eighth grade of primary school. The aim of the third part of the survey was to collect information about attitudes and behaviour of female adolescents. The results showed a low level of knowledge in students of both schools. General High School students showed a higher level of knowledge than their Medical High School peers. One fifth of General High School students and 1/3 of Medical High School students were unable to define the term "menstruation". The majority of adolescents talk about sexuality with their friends, 92.1% of General High School and 81.2% of Medical High School students. Almost 50% of students of both schools would like to talk about sexuality with their school doctor. 6.9% of Medical High School students had at least one sexual intercourse while none of the General High School students had been sexually active at the time of the survey. As the majority of students were not sexually active and results showed a rather low level of knowledge, this seems to be the ideal period for the implementation of educational programs aimed at increasing the level of knowledge, and thus preventing unwanted consequences (STD, pregnancy, abortion, infertility).

Seasonal variations in incidence of fractures among elderly people.

OBJECTIVE: To investigate seasonal variations in the incidence of fall related fractures among people 65 years and older. POPULATION AND METHODS: A prospective, population based cohort study was performed on people aged 65 years and older followed up from 1990 to 1997, a total of 459,904 person years. Cases were identified through a prospective registration system. RESULTS: There were 10,992 (2390 per 100,000 person years) fall related fractures. The risk was higher in the colder seasons (October through March) among people aged 65-79 years (relative risk (RR) = 1.39, 95% confidence interval (CI) 1.32 to 1.47) and in people aged 80 years and older (RR = 1.17, 95% CI 1.09 to 1.22). For arm fractures, the RR was 1.69 (95% CI 1.56 to 1.83) among people aged 65-79 years and 1.30 (95% CI 1.13 to 1.43) among those aged 80 years and older. The RR for hip fractures was 1.27 (95% CI 1.15 to 1.37) among people aged 65-79 years and 1.08 (95% CI 1.00 to 1.15) for people aged 80 years and older. Slipping on ice and snow seems to entirely explain the excessive incidence of hip and arm fractures during winter months. CONCLUSION: Season affects the incidence of all types of fractures in elderly people. Slipping on ice and snow seems to be a causal mechanism behind the seasonal effect. Preventive measures targeting this causal mechanism are likely to reduce the risk of fracture, but the size of the effect is difficult to estimate with certainty.

Early diagnosis and treatment of ectopic pregnancy.

During the period from 1995 to 1999, 64 patients were treated for ectopic pregnancy. All patients admitted to the department passed the same procedure including (complete preoperative laboratory findings, Beta HCG, serum progesterone and transvaginal colour Doppler). In patients who had ultrasound finding typical for ectopic pregnancy in combination with positive Beta HCG, conservative treatment was primarily done. In the rest of the patients, Beta HCG was tested every second day and in combination with the clinical and vaginosonographical findings the patients underwent diagnostic or operative laparoscopy. Out of 64 patients 36 had visible ectopic pregnancy when admitted to the clinical department. Three patients had no visible ectopic pregnancy neither at the time of their admission to the department nor at the time of laparoscopy. One of them had cervical pregnancy and the other two had pregnancies in the uterine part of the tube. The patient with cervical pregnancy was treated with metrotrexat (MTX) 12 mg daily in 5 doses. One patient with cornual pregnancy was treated with high doses of oxytocin infusion in combination with MEB intravenously 3 x 1 amp. The other patient with cornual pregnancy underwent laparoscopy with cornual resection and salpingectomy. Four of other tubar pregnancies were treated with metrotrexat 12 mg/day for 5 days. Other ectopic pregnancies were treated as follows: 36 laparoscopic salpingectomies, 10 laparoscopic salpingotomies with ovum expression, 9 adnexectomies by laparotomy, and 2 laparoscopic adnexectomies.

Minimally invasive surgery in the field of gynecologic oncology.

The aim of this paper was to present the results in minimal invasive surgery in the field of gynecologic oncology at General hospital Zabok, Croatia. 381 laparoscopic procedures were performed between 1994 and 1998. There were 263 operations of the benign adnexal masses, and 107 operations due to benign tumors of corpus uteri (there were 18 LAVH, 12 LH and 77 TLH). There were 11 laparoscopic operations due to carcinoma (1 ovary, 6 corpus and 4 cervix). Operations were: 3 LAVH (laparoscopically assisted vaginal hysterectomy), 5 TLH (total laparoscopic hysterectomy) with pelvic lymphadenectomy, 1 LAVH with pelvic lymphadenectomy, 1 coelio Shauta operation with laparoscopic pelvic lymphadenectomy and paraaortal lymphadenectomy, and 1 laparoscopic adnexectomy. Among laparoscopic procedures in 370 patients operations were successfully performed as planed, while in 11 patients it was necessary to switch to laprotomy. Among serious complications of laparscopic operations it is necessary to note 2 lesions of the ureter and 1 lesion of the bladder. Laparoscopic lymphadenectomies were performed successfully; there were no serious early or late postoperative complications. There was no operative mortality. Even though many authors claim that laparoscopic operations in the field of gynecologic oncology are safe and have the same results as in open surgery, patients benefit from shorter recovery and better quality of life during laparoscopic procedures.

[Regional differences in the incidence of femoral neck fractures in Norway]. / Regionale forskjeller i forekomst av lårhalsbrudd i Norge.

Studies reporting data from the late seventies indicated there were significant differences in the incidence of hip fracture from county to county in Norway. We used the most recent available data on the occurrence of hip fracture in 1994 and 1995 and analyzed regional variations in the incidence of hip fracture, standardized for age and sex, among people aged 65 years and over. In 1994 and 1995 16,779 hip fractures occurred in Norway among people aged 65 years and over, making an overall annual crude incidence rate of 12.1 per 1,000 population. Incidence rates varied from 8.1 for the county of Finnmark to 14.9 per 1,000 population for Oslo. Standardized rates per 1,000 aged 65 years and over varied from 9.2 in the county of Finnmark to 15.0 in Vestfold. There has been a clear regional pattern in the incidence rate. Oslo and the counties in the south and south-east had the highest incidence rate. Compared with reports from 1978 and 1979, the span of relative differences in the county incidence rates has narrowed. The sources of these differences are not explained.

[Hemorrhagic shock--an emergency in extrauterine pregnancy]. / Hemoragijski sok--hitno stanje u izvanmaternicnoj trudnoci.

A total of 59 female patients with suspected extrauterine pregnancy were admitted to the Department of Gynecology and Obstetrics of Zabok General Hospital from January 1, 1990 to December 31, 1994. The incidence of extrauterine pregnancies is 1.3% with regard to a total number of deliveries. Dominant clinical symptoms were amenorrhea, abdominal pain and abnormal bleeding from the uterus. Seven (14%) patients developed hemorrhagic shock. Resuscitation had not postponed the surgical procedure. The average value of serum beta HCG was 1700 IU/L. Amenorrhea was from 6-12 weeks. The age of patients ranged from 20 to 40 years. Seven (14%) patients had intrauterine device. There were 14 (27%) nulliparas, 15 (29%) primiparas, 20 (39%) secundiparas and two (4%) women had three pregnancies. The evaluation included ultrasound of the abdomen in 22 (37%) patients, culdocentesis in 31 (53%) of which 4 (13%) procedures were negative punctures. Laparoscopy was performed in 15 (25%) patients and exploration of the uterus in 36 (61%). Pathohistological finding of decidua was seen in 19 (53%) patients, Arias-Stella reaction in 3 (8%) and histological finding of the endometrium in secretion was obtained in 14 (39%) patients. Laparotomy was done in 44 (75%) patients; adnexectomy in 23 (39%), salpingectomy in 30 (51%), and expression of the ovum in 3 (5%). One patient underwent laparoscopic administration of carboprost. Postoperative course was uneventful. Ectopic pregnancy is still the cause of 10% of the maternal deaths and is the leading cause of deaths in the first trimester of pregnancy of which more than 80% of deaths are due to massive hemorrhage. We have emphasized that efforts should be made to improve the diagnosis and, thus, the treatment.

[Fall-related injuries among elderly at home]. / Fallskader blant eldre i hjemmet.

The aim of this study was to describe the extent of the problem of injuries from falling among elderly people at home. The study is based on data from the National Injury Register, which contains information on all inpatients and outpatients treated for injuries by hospitals and emergency clinics in four Norwegian towns. This study included 594 cases of accidental fall-related injuries which occurred at home in 1992 among a total population of 23,942 persons aged 65 years and over living in two towns, Drammen and Stavanger. The incidence of fall-related injuries at home was 25 per 1,000. The incidence was higher among women than men (32 and 13 per 1,000 respectively). The ratio between falls to the same level and falls to lower levels was 2:1 in the age group 65-79 year and 4:1 in the age group over 80 years. The most common mechanisms causing injuries were loss of balance (46%), stumbling (19%) and sliding (12%). 60% of all patients sustained fractures (15 per 1,000). 50% of all patients were hospitalised. The findings show that possibilities exist for preventing these injuries. The strategies must be directed both at the home environment and at individual factors among the elderly population.

[Apparent decrease in the occurrence of anencephalus in Norway 1967-90]. / Tilsynelatende fall i forekomsten av anencephalus i Norge 1967-90.

The occurrence of anencephalus as reported to the Norwegian Medical Birth Registry has fallen from 4.9 per 10,000 births in 1967-71 to 2.7 in 1987-90. The decrease is particularly noticeable for births with a gestational length of 28 weeks or more. On the other hand, there has been a significant increase in the number of cases of anencephalus with a gestational age less than 28 weeks. The occurrence of meningomyelocele has remained relatively stable throughout the same period. Ascertainment error could explain these contrasting trends, since cases of anencephalus detected on ultrasound screening may lead to early termination of pregnancy without notification to the Medical Birth Registry. Better routines for notification of malformations are needed to improve the basis for surveillance in Norway.