[The course and outcome of pregnancy in pregnant women with hypothyroidism]. / Tok i ishod trudnoce kod trudnica s hipotireozom.

The report presents the analysis of 56 pregnant women with hypothyroidism as a consequence of different aetiopathogenetic factor, and 20 healthy pregnant women with normal pregnancies and term deliveries. Patients with hypothyroidism diagnosed prior pregnancy (46) were treated before and during pregnancy with thyroid hormone preparations. Patients with hypothyroidism verified in subclinical form during pregnancy (10) were not treated. In all examined pregnant women the mean values with standard deviations for thyroid-stimulating form hormone levels, total thyroxine and triiodothyronine, in each trimester of pregnancy, free thyroxine and triiodothyronine in the first and the last trimester were recorded; dynamics of their trends, as well as correlation of values in healthy pregnant women were presented. The analysis of the pregnancy course revealed a significantly higher incidence of gestational diabetes mellitus and preeclampsia (p < 0.001). It may be suggested that hypothyroidism is one of the risk factors for development of gestational diabetes, and also one of the pre-existing factors for development of preeclampsia. Delivery occurred in 83.9% of patients; in 12.8% of patients delivery was prior to term while spontaneous abortion occurred in 16.1% of cases (in one third in the first trimester). Similar results were observed in pregnant women with subclinical hypothyroidism. There were 4.2% of stillbirths which corresponded to the rate of perinatal mortality. One infant was born with hydrocephalus and the others were healthy. In the authors' opinion it is necessary to achieve normal metabolic state before pregnancy which should be maintained with substitutional therapy during the whole pregnancy.

The estimation of fructosamine and HbAlc in pregnant women with diabetes mellitus.

Fructosamine, HbAlc, glucose, albumins and total proteins were estimated in 40 healthy pregnant women and 80 pregnant women with insulin dependent diabetes mellitus. Fructosamine was estimated by the NBT method with "Fructosamine test" commercially available kit on Technicom automatic analyser RA-1000. Glucose was determined on Beckman glucose analyser. HbAlc was assayed by the Bio-Rad test, while albumin and total proteins by Beckman tests. For all estimated parameters no significant differences were found between healthy pregnant women and pregnant women with insulin dependent diabetes mellitus.

[The effect of pre-eclampsia on thyroid gland function]. / Uticaj preeklampsije na funkciju tireoidne zlezde.

The prospective study involved 183 pregnant women with disorders of the thyroid gland, who were regularly followed up and delivered at the Department of Gynaecology and Obstetrics, University Clinical Centre, Belgrade, over a period of 10 years (1981-1990). There were 15 euthyroid patients in whom development of pre-eclampsia was diagnosed in the last trimester of pregnancy, and 20 healthy pregnant women with normal pregnancies and termed deliveries. The incidence of pre-eclampsia was analyzed depending on the basic disease, therapy and pregnancy metabolic status, as well as on their influence on the function. A statistically significant higher incidence of pre-eclampsia (p < 0.001) was observed in pregnant women with hyperthyroidism (26.0%) and hypothyroidism (26.8%). On the other hand, in euthyroid patients with pre-eclampsia the authors found that the concentration of total and free thyroxine was somewhat lower, while that of thyroid-stimulating hormone was a little higher comparing to the healthy pregnant women in the last trimester of pregnancy. Similar changes were noticed in patients with hypothyroidism. In pregnant women with hyperthyroidism and pre-eclampsia it was established that the concentration of thyroxine and triiodothyronine was somewhat higher, and that concentration of thyroid-stimulating hormone was a little lower comparing to all examined women in the equal metabolic condition. In the authors' opinion diseases of the thyroid gland represent a predisposing factor, i.e. a risk factor for the development of pre-eclampsia. The aim of further investigation is to observe mutual influences, pathogenetic mechanisms of further development of pre-eclampsia in patients with thyroid disorders, i. e. the influence of pre-eclampsia on thyroid disorders.

[Correlation of glycosylated hemoglobin and fructosamine in pregnant women with diabetes mellitus]. / Korelacija glikolizovanog hemoglobina i fruktozamina kod trudnica s dijabetesom melitusom.

Glycolisated hemoglobin (HBA1c), fructosamine, glucose, albumin and total proteins were estimated 40 healthy pregnant women and 90 pregnant women with diabetes mellitus. Fructosamine was estimated by NBT method with "Fructosamine test" commercially available kit on Technicom automatic analyser RA-1000. Glucose was determined on Beckmman glucose analyser. HBA1c was assayed by Bio-Rad test, while albumin and total proteins by Beckmman tests. We found best correlation between fructosamine and HBA1c at pregnant women who were on dietary therapy worst at pregnancy women on insulin therapy.

[Sonosalpingography and/or hysterosalpingography, advantages and disadvantages]. / Sonosalpingografija i /ili histerosalpingografija, prednosti i nedostaci.

Sonosalpingography is a new procedure in the examination of the passage of the uterine tube. It was first used by Dr. Richman from the United States. On the basis of the comparison of sonosalpingographic and histerosalpingographic findings it was concluded that in spite of advantages (simple and fast method) sonosalpingography should be indicated only in cases where hysterosalpingography is contra-indicated.

[Sonographic prediction and detection of ovulation]. / Sonografsko predvidjanje i dokazivanje ovulacije.

The aim of the study was to define the role of sonography as a separate method in prediction and confirmation of ovulation. The growth of the follicle over the period from the 10th to the 17th day of menstruation was sonographically followed-up in 63 spontaneous and induced cycles. It was found that sonography was a quick and simple method. As separate method it can be used for the confirmation of ovulation, prevention of hyperstimulated ovarian syndrome and determination of the best time for artificial insemination. In combination with the other procedures it is convenient for prediction of ovulation.

[Levels of immunoglobulins in various media from healthy pregnant women and women with diabetes mellitus and EPH gestosis]. / Vrednosti imunoglobulina u razlicitim mediumima kod zdravih trudnica, sa diabetes mellitusom i EPH gestozama.

The introduction deals with of the history, etiology and, briefly, clinical manifestations of endemic nephropathy. The authors state that a large number of investigations have been done until today, but without producing a diagnostic test for early diagnosis of the disease. This led the authors to pursue certain laboratory investigations. The control group consisted of 30 healthy individuals while patients diagnosed as Endemic Nephropathy were grouped according to stages of the disease: initial, developed, terminal stages. Nucleotides in erythrocytes (5' UMP, 5' IMP, 5' GMP, 5,CMP, 5' AMP, 5' ADP, 5' ATP) were determined on the Acidic Aminoanalyzer, with use of a special UV detector. Catecholamines in the urine were determined by using ratiofluorometery. Creatinine phosphocinase, hydroxybutirat--dehydrogenase and 2,3 DPG were determined on the "Carlbiochem" enzymometer. LDH, its isoenzymes as well as its profile were determined by electrophoresis on starch gel. Specific proteins such as haptoglobin, alpha 2 macroglobulin, alpha 1 antitrypsin, alpha 1 acid glycoprotein, properdin factor B, ceruloplasmin were determined on the Immunochemistry Analyzer. Total cholesterol and cholesterol in lipoproteins fractions VLDL, LDL and HDL were determined on the Cholesterol Analyzer. All results were evaluated statistically. Our conclusion is that they are interesting and contribute to the diagnosis of endemic nephropathy.

Alpha 2 macroglobulin in healthy pregnant women and those with EPH gestosis.

The Authors determined alpha 2 macroglobulin in 50 healthy pregnant women and in 50 pregnant women with EPH gestosis, using the technique of nephelometry on the Immunochemistry Analyzer. The assays were done in blood serum of the mother and umbilical cord, urine and in the amniotic fluid of the affected patients. Serum values were expressed in gr/L, and amniotic fluid and urine values in mg/L. Significant reduction was found in the pregnant women with EPH gestosis in serum values of the mothers (healthy pregnant women 2.871 g/L +/- 1.015, with EPH gestosis 2.239 g/L +/- 1.323, p less than 0.05), and in the umbilical cord serum (healthy pregnant women 3.351 g/L +/- 0.859, affected ones 2.032 g/L +/- 0.693 g/L, p less than 0.01). The reduction was also noted in the urine values but was significant one. The importance of these determinations is presented in the discussion.

[Drug therapy of Graves' disease in pregnancy]. / Medikamentozna terapija Gravesove bolesti u graviditetu.

An analysis was made of 75 pregnant patients who received medicamentous therapy for Graves' disease before the investigated pregnancy and 20 healthy pregnant women with normal pregnancies and term delivery. A severe form of hyperthyreosis was found in 35 examined persons. A separate analysis was made of the patients who had no previous therapy (17) and pregnant patients who were treated with antithyroid drugs (18), with the aim to investigate their effect on the course and outcome of pregnancy and the condition of the newborn infant. In all examined pregnant women the median values with standard deviations for TSH, T4 and T3 in each trimester of pregnancy, the dynamics of their trends, as well as the correlation of values in treated and untreated pregnant women were recorded. The analysis of the pregnancy course in patients with hyperthyreosis indicated a significantly higher incidence of gestational diabetes and EPH gestoses (p less than 0.001). A separate analysis indicated that hyperthyreoidism is one of the risk factors in the occurrence of gestational diabetes. There were 90% of pregnant women who were delivered in an euthyroid condition achieved before pregnancy and maintained during pregnancy, 85% with mild and 77.1% with severe hyperthyreosis. The comparison of treated and untreated patients indicated that the percentage of delivered patients is similar (77.8:76.4), while the incidence of spontaneous abortions was higher (16.7:11.8) and of fetal deaths lower (5.5:11.8). There was one stillbirth in an untreated patient, while the remaining infants were healthy. The authors are of the opinion that it is necessary to achieve remission before pregnancy. In patients with severe hyperthyreosis the authors suggest the administration of antithyreoid drugs.

[Smoking and nonmalignant changes in the uterine cervix]. / Pusenje i nemaligne promene grlica materice.

The evidence of the association between smoking and cervical dysplasias has been established by several reports. It has been suggested that smoking might depress the immune mechanism and allow a sexually transmitted infective agent to result in an abnormal cellular development, leading to the onset of dysplasia. It, was also established that some chemical products of smoking could be selectively deposited in gynaecological tissues. The aim of this study was to examine the frequency of smoking habits in patients with non-malignant cervical changes and to compare it to the one in patients without cytological or colposcopical cervical abnormalities. The study group consisted of 63 patients with historically confirmed non-malignant cervical changes: 6 patients with cervicitis, 12 with leukokeratosis of the cervical epithelium, 13 with mild dysplasia, 21 with moderate dysplasia and 11 patients with sever dysplasia. 68 patients were without cervical changes and made the control group. The percentage of smokers among the patients with cervical changes (53.97%) statistically significantly differs from the results of the control group (32.35%). This percentage is increasing with the severity of cervical change. Testing for a dose-response relationship reveals no difference between the light and heavy smokers. An increased risk for development of cervical changes with increasing duration of smoking could not be established. The results are in agreement with the opinions that smoking is associated with an increased risk for development of cervical dysplasia which is considered to be a precursor lesion of cancer of the cervix. Although it could not be established by our analysis, it is thought that this risk increases with the increased frequency and longer duration of smoking.

The complements and immunoglobulins in different media of healthy pregnant women and in pregnant women with increased blood pressure.

We have determined the levels of complement C3, C4 and immunoglobulin G, M, A in mothers' and cord blood serum. Parallelly properdin factor B and immunoglobulin G tests were done in urine samples. All estimations were performed on Immunochemistry Analyzer "Beckman". The investigations were made on 30 healthy pregnant women and 30 with arterial hypertension at the end of third trimester. In the mothers' serum C3 was not significantly changed. In the cord blood of healthy pregnant women it was 0.69 g/L. (SD 0.12) and in those with hypertension 0.38 g/L. (SD 0.15), which means significantly decreased. Complements C4 was not significantly increased in mothers' and cord blood serum. Properdin factor B was significantly increased in mothers' and cord blood serum (healthy pregnant women in serum 0.38 g/L., SD 0.07; with hypertension 0.48 g/L., SD 0.15; while in the cord blood serum of healthy women it was 0.14 g/L., SD 0.06; and hypertensive it was 0.22 g/L., SD 0.10). The same parameter was significantly decreased in the urine of healthy subjects 3.94 mg/L., SD 1.91; and in the hypertensive too, 2.42 mg/L., SD 0.90. The IgG level was significantly increased in the urine of healthy pregnant women 4.42 mg/L., SD 2.24; with hypertension 6.64 mg/L., SD 3.61. IgM was not significantly changed in mothers' and cord blood serum. IgA was significantly increased in the cord blood serum of healthy mothers', 0.02 g/L., SD 0.01, with hypertension 0.12 g/L., SD 0.05.

[Use of simethicone in the prevention of postoperative abdominal discomfort and gastrointestinal distension after cesarean section]. / Prevencija postoperativnih abdominalnih tegoba i gastrointestinalne distenzije posle carskog reza simeticonom.

A double blind trial was performed in patients with Cesarean section in order to study the effect of Simeticon (Stuart Pharmaceutical Company, Pasadena, California) on the occurrence of subjective and objective signs of gas distress during the immediate postoperative period. The results obtained with Simeticon show a highly significant reduction of the analysed subjective complaints (nausea, vomiting, meteorism, discomfort in the stomach, abdominal pains) in relation to placebo. Peristaltic movements in patients treated with Simeticon appeared in the first two days in 100% of cases and only in 30% in the placebo group. Flatulence also appeared in all the patients receiving Simeticon, in contrast to only 20% in the placebo group. There was no difference in spontanous defecation between the groups. On the basis of the results obtained, and considering the non-toxicity of the drug, its chemical inertnees, good tolerance, and simple use, the authors consider simeticon very useful for the prevention and therapy of postoperative discomfort due to gas accumulation and gastro-intestinal distention after Cesarean section.