[The Wertheim-Meigs radical hysterectomy in surgical treatment of cervical carcinoma]. / Radikalna histerektomija po Wertheim-Meigsu u hirurskom lecenju karcinoma grlica materice.

INTRODUCTION: Wertheim from Vienna was the first to introduce the technique of radical hysterectomy into surgical practice in treatment of uterine cervix carcinoma associated with partial lymphadenectomy (1989). In concern to the level of surgical extensiveness, radical hysterectomy can be divided into 5 classes (after Piver-Rutledge). MATERIAL AND METHODS: At the Department of Obstetrics and Gynaecology in Novi Sad 55 patients with invasive cervical cancer (FIGO st. IB1-IIB) underwent surgery during the period from 1991 to 2001. All patients underwent radical hysterectomy after Wertheim-Meigs technique. The aim of this study was to present operative techniques of radical hysterectomy and complications following surgery. RESULTS: Distribution by stage of the disease was as follows: IB1 = 39 (70.9%), IB2 = 6 (10.9%), IIA = 7 (12.7%) and IIB = 3 (5.5%). On average, there were 15 lymph nodes removed, out of which 9 (16.4%) cases were positive. Postoperative complications were recorded in 19 (34.5%) patients, whereas the incidence of urinary fistulas and intrahospital mortality rate have been reduced to the minimum (0%). Recurrence was evident in 3 (5.4%) patients and 5-year survival rate was 92.3% (in patients operated up to 1997). DISCUSSION AND CONCLUSION: In relation to previously published results of treatment at the Department, there is an evident increase in the number of stage I patients and a decrease in stage II patients, as well as a reduced incidence of postoperative urinary fistulas, total number of complications, but an increase in the 5-year survival rate.

Evaluation of the epidemiology of hepatitis B virus cross-infection in a maternity hospital.

OBJECTIVE: To determine the hepatitis B infection risk in a university hospital of obstetrics and gynecology. SETTING: The University Hospital of Obstetrics and Gynecology, The University of Sarajevo, Yugoslavia. DESIGN: Staff members were divided into three groups: 73 doctors, 184 medical technicians working in delivery rooms, and 55 medical technicians working with postnatal care. The patients were 63 women, aged 17 to 39 years (mean = 26.11 years), pregnant for the first time and in the first stage of labor. Participants all had a negative history of hepatitis B and no known contact with the hepatitis B virus. RESULTS: The incidence of hepatitis B infections among physicians, technicians, and postnatal care technicians was 1.36%, 3.8%, and 3.6%, respectively. The incidence among patients was 4.76%. The daily infection risk varied between 1% and 17% of all deliveries. CONCLUSIONS: The risks of transmission of the hepatitis B virus to hospital workers in this setting is indeed high enough to make a case for hepatitis B vaccination in susceptible staff members. Even if vaccination of staff members is carried out, hygienic measures to prevent the transmission of bloodborne infection between patients and from patients to staff are of the utmost importance.

[The significance of synergism between cervical infections and prostaglandins in inducing preinduction priming in the 3rd trimester of pregnancy]. / Znacaj sinergizma cervikalne infekcije i prostaglandina u izazivanju preindukcionog priminga u III trimestru trudnoce.

The length of labour and foetal trauma could be significantly reduced by reduction of cervical resistance in the cause of labour. It is well known that the most effective way of priming is by prostaglandins. Microorganisms of cervico-vaginal flora, with or without inflammatory component, can produce factors which can create predisposition for preterm delivery. Namely, increased levels of prostaglandins E2 and F2 alpha could be noticed in amniotic fluids, compared with these levels in pregnant women without signs of infection. The study included 60 parturients with low Bishop score (less then 5), with average gestational age of 40.5 weeks. Group A: Prepidil gel with 0.5 mg of prostaglandin E2 was applied to cause priming. Group B: Half of doses of Prepidil gel (0.25 mg) was applied to the 30 patients with clinical signs and with positive laboratory findings of cervical infection. After 12 hours all patients were induced with oxytocin. All obstetrically important parameters were closely followed in the course of priming and induction. Presence of cervical infection could be beneficial, because priming can be produced with half of doses of prostaglandin, which means medical (reduction of side-effects and dangers of hyperstimulation) and significant economical benefits regarding the high price of prostaglandins.

[Early diagnosis of malignant tumors of the the ovary using ultrasound]. / Ranija dijagnostika malignih tumora ovarija pomocu ultrazvuka.

On Gynecology-Obstetric Clinic in Sarajevo in 100 women, aged 22-80, was made the indication for laparotomy because of the changes on ovaries and it was done according to the palpatory, ultrasound and laparoscopic examination. After the operative treatment and pathologic verification from the 100 studied tumors were found 15 (15%) carcinous cystadenoma, 2 (2%) mucinous cystadenocarcinoma, 25 (25%) serous cystadenoma, 10 (10%) serous cystadenocarcinoma, 10 (10%) adenocarcinoma, 23 (23%) teratoma and 13 (13%) tumors of the other kind, 25 (25%) of tumors were malign and 75 (75%) was benign. The predicted value of the ultrasoundly proved malignity was 80% (20 from 25 patients) and for the benign tumors it was 96% (72 from 75 patients). Malignant tumor of ovary is the third most common malignant disease of genital organs of a woman and at the same time the most often cause of death of women suffering from gynecologic malignant diseases. From all kinds of gynecologic malignant tumors 25% are carcinoma of ovaries. It is the cause of death in 47% women with the malignant diseases of genital organs. The bad prognosis of this tumor is mostly caused by the late diagnosis. Patients most often do not feel any disturbances until the illness comes to the phase of methastase and the most of patients (60-70%) at the time of diagnosis is already in the III or IV stage of illness.

Smoking and carboxyhaemoglobin concentrations in mothers and their newborn infants.

There were significantly higher carboxyhaemoglobin blood concentrations in mothers who were smokers than those in mothers who were non-smokers and ex-smokers (P less than 0.001). Carboxyhaemoglobin blood concentrations in newborn infants were nearly one-third higher than those in their mothers. Newborn infants from mothers who smoked had lower birthweights and higher carboxyhaemoglobin blood concentrations than those in newborn infants from mothers who were non-smokers and ex-smokers. Smoking during pregnancy increases the risk for a baby. This finding shows the importance of women giving up smoking during pregnancy.