Anti-Müllerian hormone, testosterone and free androgen index following the dose-adjusted unilateral diathermy in women with polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to investigate changes of anti-Müllerian hormone, testosterone and free androgen index after two diathermy methods. We have also aimed at evaluating prognostic value of these parameters for an ovulatory response. STUDY DESIGN: This prospective, comparative study included ninety-six women with polycystic ovary syndrome unresponsive to clomiphene citrate. Patients were assigned to two groups; the first group underwent unilateral laparoscopic ovarian drilling with thermal doses adjusted to ovarian volume: median of 720J (IQR), while the second group underwent bilateral drilling with fixed doses of 1200J. Anti-Müllerian hormone (AMH), testosterone (T), free androgen index (FAI)and luteinizing hormone (LH) were measured at baseline, at 1st and 6th month of follow up. RESULTS: AMH, T and LH levels significantly decreased (P<0.001, P≤0.024, P<0.001) after diathermy in both responders and nonresponders from either treatment group. On contrary, FAI levels (P<0.001) significantly changed only in responders, irrespective of the treatment. In 1st and 6th month of follow up median levels of AMH, T and FAI among responders from different treatment groups were equivalent, whereas the responders in bilateral group had higher LH levels in the 1st month of follow up (P=0.003). Nonresponders differed between treatment groups only in AMH level which was decreased in unilateral group throughout the follow up (P≤0.021). The baseline value of T (semi-standardized coefficient, ß=-0.28) and value of T in the 1st month (ß=-0.72) after the diathermy were significant and consistent indicator of the response to therapy within 6months and the ovulation response in the 1st month. CONCLUSIONS: The value of T is the strongest and consistent indicator of ovulatory response after diathermy. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov , NCT01833949.

Diffuse eosinophilic gastroenteropathy with pleural effusion and ascites.

We are reporting a case of a 39-year-old woman with a picture of constipation, who came to our department. Anamnesticly she claimed on constipation and flatulence for 6 days, and on slight cough for last two days, but no other symptoms. After complete diagnostic treatment we found a pleural effusion in right lung and ascites in a bowel. Cytologicly, we didn't find malignant cells in pleural effusion nor in ascites, but there was an amount of eosinophilic granulocytes in a gastric wall and a solid tumour mass near mesentery of a gut. We also found a lot of eosinophilic cells in a solid tumour mass. Other organs had no pathology. This finding indicated for eosinophilic gastroenteritis.

[Haemolytic disease of the newborn--from a mother with anti-Kell, anti-E and anti-Vel anti-erythrocyte alloantibodies]. / Morbus Haemolyticus Neonatorum (MHN) -- Hämolytische Krankheit des Neugeborenen von Mutter mit Anti-Kell, Anti-RhE und Anti-VEL Antierythrozytären Alloantikörpern.

A grave form of HDN (haemolytic disease of the new-born) is described in female twins, caused by Kell, E and Vel isoimmunisation. The weakly vital and anaemic new-born babies were hospitalised with signs of respiratory distress on the first day of their life after the delivery by Caesarean section in the 38 (th) week of pregnancy in the General Hospital Dubrovnik. Already during the first hours of their life jaundice developed with a high bilirubin level for their age. The direct Coombs' test on the twins and the indirect Coombs' test on the mother were positive. Immuno-haematological analysis proved the presence of anti-Kell, anti-E and the very rare anti-Vel antibodies in the mother's serum and in the plasma of both twins. We had no possibility to obtain appropriate blood for the indicated exsanguine transfusion because cross-probes with the accessible blood samples were positive. Up to the fourteenth day of life the anaemia deepened and was aggravated in one twin, the Kell positive one (phenotype CcDEe,Kk) in relation to the other, the Kell negative (phenotype CcDEe,kk) twin. The recovery of the female twins started on the 15 (th) day of life, after the transfusion of blood (phenotype: 0,ccddee, Vel negative, Kel negative), received from the bank of rare blood groups in London. This is the first described case of haemolytic disease of the new-born caused by antibodies on the antigen Kell, E and Vel. The low frequency of immunisation with rare antigens such as Kell, E and Vel, does not exclude the possibility of the occurrence of grave forms of haemolytic disease. All pregnant women with a positive indirect Coombs' test should be further immuno-haematologically tested in order to identify the antibodies type so that the treatment of the new-borns could be commenced in time.

[Fatal amnioinfusion with previous choriocarcinoma in a parturient woman]. / Patientin mit fataler Fruchtwasserembolie unter der Geburt bei einem überstandenen Chorionkarzinom.

The case of 36-year-old tercipare is described who developed choriocharcinoma in a previous pregnancy. During the first term labour the patient developed cardiac arrest, so reanimation and sectio cesarea was performed. A male new-born was delivered in good condition, but even after intensive therapy and reanimation occurred death of parturient woman with picture of disseminate intravascular coagulopathia (DIK). On autopsy and on histology there was no sign of malignant disease, so it was not possible to connect previous choricarcinoma with amniotic fluid embolism. Maybe was place of choriocarcinoma "locus minoris resistentiae" which later resulted with failure in placentation what was hard to prove. On autopsy we found embolia of lung with a microthrombosis of terminal circulation with punctiformis bleeding in mucous, what stands for DIK.

[Differential diagnosis of urinary retention: aneurysm of the iliac artery]. / Aneurysma der A. iliaca als Differenzialdiagnose des Harnverhalts.

A 69-year old male presented with anuric acute renal failure. Abdominal ultrasound at admission revealed a mass in the pelvis thought to be the urinary bladder and the diagnosis of urinary retention was made. When placement of an urinary catheter did not induce urine flow, digital rectal examination was done. Palpation of a pulsating mass finally led to the diagnosis of aneurysm of the iliac artery. Based on this case, the general problem of diagnosing an iliac artery aneurysm is discussed.

Socio-demographic characteristics of postmenopausal estrogen users.

The purpose of the paper was to describe general health, socio-economic and demographic characteristics of postmenopausal estrogen users in comparison to nonusers. During years 1994-2000, 717 postmenopausal estrogen users and 235 postmenopausal nonusers were gynecological examined, interweaved with a questionnaire including information on their health, socio-economic and demographic status and compared. Women who had prescription on a hormone replacement minimally 6 months before interview were deemed to be current users, but the controls had not use hormone replacement ever. Hormone replacement users were statistically significant more often smokers, they had better physical activity and better general health than nonusers. Women with surgical menopause were more often hormone replacement users than nonusers. Women with better socio-economic status, higher education and urban population were more likely to use hormone replacement. Single, divorced and widowed women were more likely, but married women were less likely to use hormone replacement. However, more healthy profiles among hormone replacement users may inflate the apparent benefit of treatment. The gynaecologists play a major role in hormone replacement therapy decision-making because of a substantial public health impact.

Perinatal outcome of pregnancies in women aged 40 and over.

Perinatal outcome of pregnancies at forty and over was analyzed starting from the diagnosis of pregnancy to seven days following delivery. Retrospectively, pre-gestational health and reproduction status were dealt with, as well as the course of pregnancy, deliveries, and newborn children (study group). The control group was composed of pregnant women aged 20 to 29, who were identical to study group in terms of parity. Statistical data processing was done by means of chi2-test, and contingency 2 x 2 tables. The difference was significant if p < 0.05. Out of 2,099 diagnosed wanted pregnancies at forty and over, 415 (19.8%) had a miscarriage, in 33 (1.6%) an artificial abortion was performed after determining the fetus karyotype and 1,651 (78.2%) of pregnant women delivered. In 66.2% of pregnancies the fetus karyotype was determined and in 33 (2.5%) fetuses chromosomal abnormalities were found Incidence of deliveries at 40 and over is 1.38%, which is a 35.6-percent increase in the last ten years. Nullipara and pluripara had an increase, and multipara had a decrease. Pre-gestational health and reproduction status in study group is lower than in control group. Complications during pregnancy: threatened abortion, EPH gestosis, placenta praevia, gestational diabetes, late fetal death are more frequent than in control group (p < 0.05). In intrapartal terms, more frequent were induction of delivery, meconium-stained amniotic fluid, fetal distress, operative vaginal deliveries, and Cesarean section (p < 0.05). In neonatal outcome there are more premature infant, there are more VLBW, LBW, SGA, newborn with low Apgar index values, and the total perinatal death is greater than in the control group (p < 0.05). In perinatal terms, (from the diagnosis to the seventh day following delivery) 1,617 children survived (77.0%), meaning that perinatal loss was 482 (23.0%). Authors conclude that pregnancy at 40 and over is a high-risk pregnancy. There is a high risk of pre-gestational and gestational complications, and perinatal loss is high. Therefore, those pregnancies are not desirable from the medical point of view.

Influence of war circumstances on tumor morphological characteristics in patients with breast cancer.

The influence of war circumstances on tumor morphological characteristics in patients with breast cancer has not been studied up to now. The aim of this study is to investigate if war circumstances have influenced breast cancer incidence. The study covered both the patients in which during a period of observation a breast cancer was diagnosed as well as those who died of the same disease in the same period. Three sources of data were used: 1) The archives of the Oncology and Radiotherapy Center of the University Hospital "Split" (UHS): hospital data of 768 patients were reviewed. The war sample consisted of 380 patients aged 59.4+/-12.1 (31 to 86) (including 5 males), whereas the pre-war sample was made up of 388 patients aged 58.4+/-12.7 (19 to 88) (including 3 males); 2) Register of death of the Pathology Department of UHS with 162 analyzed persons whose death was caused by breast cancer in the six-year period between 1988 and 1993. The list of 162 dead patients included 79 people who died from breast cancer diagnosed in that period (1988-1993) and another 83 people that had been diagnosed before that period; 3) The biopsy register of the Pathology Department of UHS with 851 breast biopsies performed between 1988 and 1993. Breast cancer is predominantly a female illness (99.1%). The war circumstances influenced the of T, N and M rate. The rate of N2, N3, Ml were conspicuously higher in the war period. There were significantly more malignant histological diagnoses found in new patients and also significantly more patients died due to breast cancer. Stress and other war circumstances undoubtedly have a negative impact on the numerous markers of breast cancer which we have proved in this study.

The effect of delivery on regression of abnormal cervical cytologic findings.

The purpose of this study was to determine whether abnormal antepartum cervical cytologic findings result in differing postpartum regression rates. Between 1993 and 2000, 107 pregnant women with antepartum abnormal cervical cytologic findings were identified. Papanicolaou smear data were separated into three groups by use of the CIN classification system. Postpartum regression rates of antepartum Papanicolaou smears were analyzed six months after delivery. Normalization of Papanicolaou smears in the postpartum period were observed in 50 of 107 women (46.7%). Regression of cervical cytologic findings was noted in 61 of 107 women (57%). Respectively, persistence of Papanicolaou smear was noted in 43 of 107 patients (40%). Only 3 of 107 (3%) antepartum findings progressed after delivery. Desquamation of the cervical epithelium or enhancement of a localized reparative immunologic response after vaginal delivery could play an important role in the spontaneous regression of cervical dysplasia in the postpartum period.

Circulating platelet aggregates and progression of visual field loss in glaucoma.

The aim of the study was to assess a relationship between circulating platelet aggregates (CPA) and progression of visual field loss in primary open-angle glaucoma patients. CPA was determined in 27 patients with open-angle glaucoma with nonprogressive visual field loss and 15 patients with open-angle glaucoma and progression of visual field loss. Intraocular pressure (IOP) under topical therapy was < 18 mmHg in all patients. CPA in glaucoma patients with progression of visual field loss was not significantly higher than those without visual field progression (p = 0.59). In conclusion, our study shows that increased platelet aggregability is not solely responsible for progression of visual field loss in glaucoma patients, and indicates the role of IOP in the pathogenesis of visual field loss.

Acute angle-closed glaucoma and meteorological factors in Split, Croatia.

This study is a retrospective analysis of medical findings of patients treated at the Department of Ophthalmology, Clinical Hospital Split, Croatia in the period of 1995-1999. Seventy-three cases of acute closed-angle glaucoma were analyzed and compared in relation to the meteorological factors--hours of sunshine, air temperature and atmospheric pressure. No significant statistical correlation was found between the development of acute closed-angle glaucoma and air temperature, atmospheric pressure and mean sunshine hours in all months, except in November (z = 2.1; p = 0.03). The mean daily sunshine hours on the day of the acute closed-angle glaucoma onset were found to be lower than the mean monthly sunshine hours. An increased incidence of acute closed-angle glaucoma was found in the the winter months (chi 2 = 14.4; p < 0.01). Seasonal variations of the incidence of acute closed-angle glaucoma in Split cannot be directly attributed to the meteorological factors, although the correlation between acute glaucoma and sunshine seems to have a slightly inverse ratio.

Hypertensive retinopathy and pre-eclampsia.

The aim of the study was to determine the relationship between hypertensive retinopathy and the severity of pre-eclampsia. Forty women with pre-eclampsia, mean age 29.1 (+/- 7.4; range, 19-44) years, were retrospectively analyzed. They were treated at the Department of Obstetrics and Gynecology of the Clinical Hospital Split, from January 1997 to December 1999. The mean age of gestation was 36.0 +/- 2.8 weeks (range, 28-39). Pre-eclampsia was classified according to Goecke. Based on the ophthalmoscopic fundus examinations the patients were divided into four groups, according to Keith-Wagner classification system of grading retinal changes. Of 40 analyzed women, 18 (45%) had ophthalmologically verified hypertensive retinopathy. Ten of them were classified as grade I, six as grade II and two as grade III. Twenty-two patients had mild pre-eclampsia, ten patients had moderate pre-eclampsia, and eight patients had severe pre-eclampsia. A statistically significant correlation (t-test) was found between the degree of hypertensive retinopathy and patient age, Apgar score, trophism, Goecke's index, proteinuria, systolic and diastolic pressure (P < 0.001) and edema (P = 0.01). The degree of hypertensive retinopathy was directly proportional with the severity of pre-eclampsia and significant correlation was found between them (r = 0.338, p = 0.033). These findings showed that the degree of hypertensive retinopathy in women with pre-eclampsia is a valid and reliable prognostic factor in determining the severity of the pre-eclampsia. Therefore, it can be concluded that the examination of the fundus is a valuable and necessary diagnostic procedure in pregnant women with pre-eclampsia.

Should we screen for asymptomatic left ventricular dysfunction in glaucoma patients?

BACKGROUND: The aim of the study was to assess the frequency of asymptomatic left ventricular dysfunction in primary open-angle glaucoma patients. PATIENTS AND METHODS: Two-dimensional and pulsed Doppler echocardiography of transmitral flow was performed on 31 glaucoma patients and 27 controls. RESULTS: No significant difference was found in early (E) and late (A) transmitral filling velocity, velocity time integral E wave (VTIE) and A wave (VTIA), left ventricular end-diastolic pressure, pulmonary capillary wedge pressure, left ventricular ejection fraction (EF) and fractional shortening (FS). A significant difference was found in ratio E/A (P=0.04) and ratio VTIA/VTIE (P=0.05), although all obtained values were within the 95% confidence limit for the corresponding age. CONCLUSION: Our study tends to indicate the possibility of dysfunction of myocardial relaxation in glaucoma patients, which might be partially attributed to systemic vascular dysregulation.

Renoprotective role of nifedipine during gentamicin therapy: randomized controlled trial.

AIM: To investigate the protective effect of nifedipine, a dihydropyridine calcium-channel blocker, on renal function (glomerular and tubular) in patients treated with gentamicin, an aminoglycoside antibiotic. METHODS: Thirty-two patients with gentamicin sensitive upper urinary tract infection have been screened and randomized to two groups. The placebo group was given gentamicin and placebo, and the intervention group gentamicin and nifedipine. Gentamicin was given in slow intravenous injection every 12 hours for 10 days, and nifedipine 10 mg orally, 3 times a day. RESULTS: Nifedipine administration during gentamicin therapy promoted primarily the glomerular filtration. In 62% of the patients treated with nifedipine creatinine clearance increased significantly by the end of the study. In the placebo group, 69% of the patients had a creatinine clearance significantly below the baseline at the end of the study. The decrease in creatinine clearance by more than 50% from the initial values was found in 2 patients (1 in each group). There was a significant increase in gammaGT/creatinine clearance ratio in both groups at the end of therapy, indicating that nifedipine did not prevent the brush-border membranous enzyme release caused by gentamicin. CONCLUSION: Nifedipine has positive effects on renal hemodynamics in patients treated with gentamicin. Most likely, the mechanism of action is an increase in glomerular filtration caused by preglomerular vasodilatation.

[Development of obstetrics at Knin Hospital after liberation in 1995]. / Razvoj porodnistva u kninskoj bolnici nakon oslobodenja 1995. Godine.

The objective of this study is to present the development of obstetrics in the Knin General Hospital after military action "Storm" and consecutive liberation in 1995. Delivery register was used as the source of data in the period from liberation, i.e. from August 1995 to December 31, 1998. The number of medical visits during pregnancy, number and methods of deliveries and perinatal outcome are presented. Along with the improved organization of the Obstetrics and Gynecology Department of the Knin General Hospital the number of visits during pregnancy increased from average 2.4 (0-4) in 1995 to 6.7 (2-13) in 1998. With return of the population, the number of deliveries increased from 18 in 1995 to 275 in 1998. Also, the number of Cesarean sections increased from 1 (5.6%) in 1995 to 18 (6.5%) in 1998, but the frequency is the same. Perinatal mortality was low, only one child died from twin pregnancy, as a fetal death because of cord prolapse. The results of the Department of Obstetrics and Gynecology from the Knin General Hospital are comparable with other modern centers which were not under war occupation, thanks to the great effort of the Ministry of Health and help of medical staff from Zagreb, Sisak, Sibenik, Bjelovar, Cakovec and the Knin General Hospital.

A cure from the small cell neuroendocrine carcinoma of the uterine cervix following conventional surgery.

The small cell neuroendocrine carcinoma of the uterine cervix is a rare, but very aggressive neoplasm. Previous reports suggested that it had dismall prognosis if treated with conventional surgery and radiotherapy, even in early stage disease. We present the case of neuroendocrine cervical carcinoma that was cured from the disease following conventional surgery only.

Peripheral nerve war injuries.

OBJECTIVE: The purpose of this study is to evaluate peripheral nerve war injuries sustained during the war in southern Croatia and Bosnia and Herzegovina. PATIENTS AND METHODS: During the war in Croatia, 713 patients (99% male and 1% female) with wounds inflicted by firearms were examined at the Laboratory of Neurophysiology, University Hospital, Split. The patients, soldiers and civilians alike, ranged in age from 6 to 73 years (average, 28 years). All patients with firearm nerve war injuries underwent detection by electromyography and plurisegmental examination of the damaged peripheral nerve (neurography). The patients were examined and controlled on three occasions: within 2 months after wounding; up to 6 months after wounding; and more than 6 months after wounding. RESULTS: Single peripheral nerve lesions were present in 80% of the patients, and multiple peripheral nerve or plexus lesions were present in 20% of the patients. Peroneal and ulnar nerves were most often involved (20.9% and 19.8%, respectively). Associated massive injuries to the muscles, large blood vessels, or vital organs were present in 45% of the patients. Wounds were inflicted by shell fragments in 80% of the patients and by projectiles in 20% of the patients. CONCLUSION: According to our results, better recovery was achieved with conservative treatment and when physical therapy was initiated early with maximal patient cooperation. Electromyoneurographic findings were the most valid in the prognostic classification of war-inflicted peripheral nerve injuries.

Influence of betaxolol and timolol on the venous tone in glaucoma patients.

The aim of this study was the assessment of physiological venous reflexes in 40 glaucoma patients treated with topically applied timolol maleate 0.50% and betaxolol HCL 0.50%. They were divided into two groups of twenty each; one group being given timolol and the other betaxolol. The assessment of the venous tone was performed by testing venous reflexes. We found no statistically significant difference between timolol and betaxolol; however, when the influence of circulating catecholamines and the other vasoactive substances was excluded by suprasphygmatic insufflation of a pediatric cuff, a significant difference was found in the Valsalva's maneuver (125.5 +/- 8.1 vs 85.0 +/- 34.3 venoconstrictive units VCUs, p = 0.03). The IOP was significantly decreased in both treatment group, although the pressure reduction effect was more pronounced in the timolol group. Our study suggests that timolol and betaxolol have a slightly different mode of action on the venous side of circulation under topical medications. It is possible that the use of betaxolol topically may reduce a systemic venoconstriction.

Physiological anthropology and the Internet.

The Internet is the greatest computer network with many services like Web, FTP, Gopher, E-mail Discussion Groups, and Usenet Discussion Groups, that provides a rapid and the cheapest exchange of information. The benefits to anthropologists of using the Internet are growing rapidly, as the Internet becomes easier to use and ever more anthropological resources become available on line. Physiological anthropology is concerned with the evolution and biological features of human population and it's sources on the Internet are growing continuously. However, in that enormous number of data, is not easy to find a needed information. Currently, number of indexed physiological anthropology related sites on Web only is 233990 (October 98). This paper provides informations about Internet and needed hardware and software for using it. It also describes and lists the most important physiological anthropology addresses, together with physiological anthropology-related journals on the Internet, as well as the ways of searching them.