Long-Term Improvement in Urinary Incontinence in an Elite Female Athlete Through the Laser Treatment: A Case Report.

Stress urinary incontinence (SUI) is increasing in elite female athletes (EFAs), affecting competition results and quality of life. Pelvic floor muscle training (PFMT) is the first-line treatment for SUI, and surgery is generally performed when PFMT is insufficient. However, in EFA, there are few cases in which surgery is performed and fewer reports. Therefore, there is no known general treatment strategy for EFA with SUI. In our study, a 23-year-old track-and-field medalist with severe SUI was successfully treated with a vaginal and urethral erbium-doped yttrium aluminum garnet laser (VEL + UEL). After 12 treatments over one year, urinary incontinence decreased from 300 mL or more in the 400 m track run before treatment to 0 mL. She did not experience any more problems during running or competition. There was no recurrence of SUI for three years, and the urethral pressure profile examination confirmed improvement. MRIs showed that the left puborectalis muscle was absent from the first visit. The urethra was oval with an anteroposterior outer diameter of 10 mm and a transverse outer diameter of 13 mm before treatment. However, after three years of treatment, both anteroposterior and transverse diameters became circular, measuring 11 mm. Vaginal wall thickness increased from 8 to 12 mm at the center of the height of the urethra, making it possible to support the urethra, and pretreated adipose tissue space between the urethra and vagina disappeared. It was noted that the uneven and fragile urethra/vagina, the presence of adipose tissue space, and the absence of the left puborectalis muscle may have been the cause of the SUI. One year of VEL + UEL treatment resulted in long-term improvement of SUI; MRI showed changes in the urethra and vagina.

Endothelial biomarkers in the light of new sepsis definition.

The aim of our study was to compare usefulness of endothelial biomarkers for severity and outcome prediction in patients with positive Sepsis-3 criteria with traditionally used biomarkers. A total of 150 patients were included in our study. Patients were divided into two groups: patients with sepsis and those with infectious systemic inflammatory response syndrome. Development of septic shock and 28-day mortality were assessed. Endocan and thrombomodulin showed better discriminative power than procalcitonin for the presence of sepsis. Endocan showed good discriminative power for septic shock prediction. Addition of endocan significantly contributed to sequential (sepsis-related) organ failure assessment score in logistic regression model. Conclusion: Endothelial biomarkers have a good diagnostic potential for sepsis. Endocan is useful as a predictor of the severity and fatality of sepsis.

[Prediction of labor induction outcome using different clinical parameters].

INTRODUCTION: Induction of labor is one of the most common obstetric interventions in contemporary obstetrics. OBJECTIVE: The aim of the study was to evaluate the clinical and sonographic parameters in prediction of success of labor induction. METHODS: The prospective study included 422 women in whom induction of labor was carried out at the Department of Obstetrics and Gynecology of Clinical Centre of Vojvodina. The role of body mass index and age of women, parity Bishop score, cervical length measured by transvaginal ultrasound was evaluated in regard of the success of induction, which was considered successful if a vaginal delivery occurred within 24 hours after the onset of induction. Data were statistically analyzed by univariate statistical analysis and Pearson's chi2 test. RESULTS: Out of 422 women, induction of labor was successful in 356 (84.4%), and it failed in 66 (15.6%) cases. The values of Bishop score and cervical length had positive correlation with the success of induction. CONCLUSION: Bishop score and transvaginal cervical length were both reliable predictors in determining the success of labor induction, as well as parity and BMI. These parameters are mostly complementary, not competitive in prediction of labor induction success.

Lipid and protein oxidation in female patients with chronic fatigue syndrome.

INTRODUCTION: Chronic fatigue syndrome (CFS) is a widely recognized problem, characterized by prolonged, debilitating fatigue and a characteristic group of accompanying symptoms, that occurs four times more frequently in women than in men. The aim of the study was to determine the existence of oxidative stress and its possible consequences in female patients with CFS. MATERIAL AND METHODS: Twenty-four women aged 15-45 who fulfilled the diagnostic criteria for CFS with no comorbidities were recruited and were age matched to a control group of 19 healthy women. After conducting the routine laboratory tests, levels of the lipid oxidation product malondialdehyde (MDA) and protein oxidation protein carbonyl (CO) were determined. RESULTS: The CFS group had higher levels of triglycerides (p = 0.03), MDA (p = 0.03) and CO (p = 0.002) and lower levels of HDL cholesterol (p = 0.001) than the control group. There were no significant differences in the levels of total protein, total cholesterol or LDL cholesterol. CONCLUSIONS: The CFS group had an unfavorable lipid profile and signs of oxidative stress induced damage to lipids and proteins. These results might be indicative of early proatherogenic processes in this group of patients who are otherwise at low risk for atherosclerosis. Antioxidant treatment and life style changes are indicated for women with CFS, as well as closer observation in order to assess the degree of atherosclerosis.

Fetal ultrasound scan--prerogatives for the basic level.

Adequate level of prenatal ultrasound scan is a prerequisite for a successful definition of high risk population that needs further investigations. "Basic", standardized fetal mid-trimester scan, with an informative report enables not only diagnosis of anomaly but also evaluation of state of pregnancy in general. This paper was aimed at reviewing the benefits of and requirements for a complete basic mid-trimester fetal ultrasound scan and the necessary documentation. Potential directions for development of organization of basic mid-trimester fetal ultrasound scans are standardization of the scan, with establishing the number and the level of examination, and continual education of both the doctors and the patients. In order to standardize the exam, a uniform check list is needed, so that the examination should always be done in the same manner and at the same level, no matter where it is done and by whom. International and national guidelines should be agreed upon and they should state clear standards on who should do the scan, how, what kind of ultrasound machine should be used and what documentation should be kept. This paper presents a possible standardization of basic level mid trimester fetal ultrasound scan. A routine complete second trimester ultrasound between 18 and 22 weeks and a complete ultrasound report will provide the best opportunity to diagnose fetal anomalies and to help in the management of prenatal care. It will also reduce the unnecessary number of ultrasound examinations done during the second trimester for completion of fetal anatomy survey, which would decrease the costs.

Thiobarbituric acid reactive substances as marker of oxidative stress in pregnancies with pre-eclampsia.

Pre-eclampsia is characterized by increased lipid peroxidation and diminished antioxidant capacity. The aim of the study was to establish concentration of thiobarbituric acid reactive substances as a marker of lipid peroxidation in normal pregnancies and in pregnancies complicated with pre-eclampsia, and to estimate the possibility of using thiobarbituric acid reactive substances as a screening method for development of pre-eclampsia. The study was conducted at the Department of Obstetrics and Gynaecology, Clinical Centre of Vojvodina. The study included 57 singleton pregnancies, gestation > or = 24 weeks, of which 29 were healthy pregnancies and 28 were with pre-eclampsia, defined as systolic arterial pressure of > or = 90 mmHg, diastolic of > or = 145 mmHg, and 24h proteinuria of > or = 300 mg. Thiobarbituric acid reactive substances concentrations evaluated by malondialdehyde equivalent standards (OxiSelect TBARS Assay Kit (malondialdehyde Quantitation), Cell Biolabs' OxiSelect) showed that oxidative stress was more evident in the group with pre-eclampsia, though not statistically significant (p = 0.107). There was no correlation ofthiobarbituric acid reactive substance levels with gestation in either group. The differences between the level of thiobarbituric acid reactive substance concentrations in pre-eclampsia and healthy pregnancies indicate the possibility of using thiobarbituric acid reactive substances as a screening tool for the development of pre-eclampsia. Further studies with larger numbers of patients are needed in order to come to final conclusions.

Surgical treatment of neonatal ovarian cysts.

Medical experts are still at issue over the most suitable management of simple neonatal ovarian cysts exceeding 40mm and complex cysts of any size. The authors present surgical treatment of these cysts by classical laparotomy and laparoscopy. The study included 13 newborn babies surgically treated for 6 simple and 7 complex ovarian cysts. The diameter of the cysts ranged from 29 to 102mm. The age of children was from 2 days to 10 months. The open classical laparotomic approach was performed in 8 babies. In the laparotomy group, cystectomy was done in 3 infants with simple cysts. The other 5, presented with ovarian torsion, required salpingo-oophorectomy. Video-assisted cystectomy was the procedure for 3 simplex and one complex cyst with torsion. Laparoscopic adnexectomy was applied in one case with auto-amputated cyst. Our small study demonstrates that laparoscopy is as safe and effective as classical laparotomy in managing neonatal ovarian cysts, but with better cosmetic results.

[Comparative analysis of amniotic fluid lamellar body count and foam stability test as indices of fetal lung maturity].

INTRODUCTION: Respiratory distress syndrome of the newborn caused by the fetal lung immaturity is a very serious clinical problem. Different tests of prenatal analysis of amniotic fluid, such as lamellar body count and Clements' test, are available for predicting the fetal lung maturity. MATERIAL AND METHODS: A prospective clinical study was conducted on amniotic fluid samples from 2005 to 2006. The amniotic fluid samples were obtained at the gestational age of 30 to 42 weeks and collected by vaginal amniotomy, amniotomy during Caesarean section and 72 hours before the delivery by amniocentesis. A haematology analyzer (Nikon - Kohden) was used to determine the lamellar body counts. Clements' test involved adding an equal volume of 96% ethanol to the multiple amniotic fluid volume (1:2, 1:4, 1:16. 1:32), followed by shaking and noting the presence of ring of bubbles. After the delivery, we compared the lamellar body count results and Clements' test and the outcome of pregnancies, primarily the development of respiratory distress syndrome. The most specific lamellar body cutoffs for maturity and immaturity were determined according to receiver operating characteristic curves. RESULTS AND DISCUSSION: Out of 232 amniotic fluid samples which were tested, 112 samples were collected after vaginal amniotomy, 88 during the Caesarean delivery and 32 samples by amniocentesis. The overall incidence of respiratory distress syndrome was 14.6%. Receiver operating characteristic curves were used to identify cutoff points for the test. We found that both tests are good screening tests for predicting the fetal lung maturity with the area under the curve of 0.782 in Clements' test and 0.751 in the lamellar body count. Clements' cutoff 2 with sensitivity of 67.6% and specificity of 72.2%, proved best in the prediction of the fetal lung maturity. The lamellar body count cutoff of 42 x 10(3)/microl had the sensitivity of 82.4% and specificity of 64.6% in predicting the fetal lung maturity. CONCLUSION: Although both tests are good in predicting the fetal lung maturity, the lamellar body count has more advantages, because it is not only more objective, but also inexpensive, easy and fast to do, requires a small sample volume and is universally available.