Acute abdomen in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome

Background. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a malformation of female genital tract (incidence 1 in 4000 female newborn children). It appears as a result of a disorder in the development of Millerian cannals. Etiology is unknown. Syndrome MRKH is the most frequent cause of primary amenorrhoea (90%). Patients with MRKH have a normal female phenotype, with normal pubic hairness and thelarche, and female karyotype (46XX) followed by primary amenorrhoea. Hormonal status corresponds to healthy women, where the appearance of ovarian tumors and tumors on rudiment parts of uterus is possible. Case report. We presented a case of acute abdomen in a patient with previously not diagnosed MRKH. The diagnosis was done during the operation. Small pelvis and an abdominal part were filled with torquated tumor lump, where ovaries, oviducts, uterus or something resembling rudiment of uterus were not recognized through careful examination. Furthemore, the patient had a short, dead-end vagina. Tumorectomy was done and hystopathological finding showed the presence of vascular leiomyoma. Conclusion. The diagnosis of complex syndromes, such as MRKH, can, despite modern diagnostics, be absent for non-medical and psycho-social reasons. We can expect ovarian and uterine pathology on hypoplastic structures in these patients, as well as in healthy women. Vascular leiomyoma in the patients with MRKH was not found in the available literature

The role of colposcopy and typization of human papillomavirus in further diagnostic proceedings in patients with ASC-US cytological finding of the uterine cervix

Background/Aim. Bethesda system of classification of cytological findings was introduced in 2001 two subcategories in the category of atypical squamous cells (ASC) findings: ASC of undetermined significance (ASC-US) and ASC which cannot exclude high-grade intraepithelial lesions (ASC-H). The aim of our study was to assess a possible association of these two subcategories with pathologic biopsy finding and to find out the best further diagnostic proceedings. Methods. At the Clinic of Gynecology and Obstetrics, Niš 130 patients with ASC findings were analyzed. Colposcopy was performed in all study participants. Patients with pathological colposcopic findings underwent cervical biopsy. In 10 patients with pathologic histologic and 15 with benign findings human papilloma virus (HPV) typization was done using the Hybrid Capture method. Results. Patients with ASC-H finding had significantly more pathologic biopsies compared with patients with ASC-US finding (57.84: 20.72). Conclusion. Colposcopy was exhibited somewhat higher sensitivity compared to HPV typization (94.7 : 90), but lower sensitivity (79.27 : 86.6). The usage of HPV typization in the triage of patients with ASC cytologic smear induces statistically significant reduction of unnecessary percentage of cervical biopsies

Ascitic Fluid in Ovarian Carcinoma – From Pathophysiology to the Treatment

Due to low symptomatology, a lack of screening, and relatively complicated diagnostic procedures of ovarian carcinoma, more and more women are believed to visit their doctors in advanced stage of the disease, complicated with ascitic fluid. There is an increasing evidence that peritoneal cytology is a subjective assessment with certain percentage of false-positive and false-negative results that may cause application of unnecessary chemotherapy or nonapplication of necessary chemotherapy. Maximal cytoreductive surgery followed by intraperitoneal or systemic chemotherapy remains to be the gold standard in preventing ascites. Ascites is not only a symptom of a disease, but a specific microenvironment for formation and mediation of protumorigenic signals that control ovarian cancer progression, proliferation, invasion, anti-apoptosis, chemoresistance and tumor heterogeneity. Acellular cytokines and immunological factors influence ovarian cancer progression and its ability to prevent immune responses of the body and tumor reaction to chemotherapy. Ascites contributes to disease dissemination, changing its course and final outcomes. Management of patients with ascites and ovarian carcinoma is complex and often the goal of the treatment is to target palliative procedures. Multidisciplinary approach is necessary in the management of these patients. Further investigations of new drugs and immunomodulators are needed aiming at prolonged periods between relapses

Targeting autophagy to modulate cell survival: a comparative analysis in cancer, normal and embryonic cells

Autophagy is linked to multiple cancer-related signaling pathways, and represents a defense mechanism for cancer cells under therapeutic stress. The crosstalk between apoptosis and autophagy is essential for both tumorigenesis and embryonic development. We studied the influence of autophagy on cell survival in pro-apoptotic conditions induced by anticancer drugs in three model systems: human cancer cells (NCI-H460, COR-L23 and U87), human normal cells (HaCaT and MRC-5) and zebrafish embryos (Danio rerio). Autophagy induction with AZD2014 and tamoxifen antagonized the pro-apoptotic effect of chemotherapeutics doxorubicin and cisplatin in cell lines, while autophagy inhibition by wortmannin and chloroquine synergized the action of both anticancer agents. This effect was further verified by assessing cleaved caspase-3 and PARP-1 levels. Autophagy inhibitors significantly increased both apoptotic markers when applied in combination with doxorubicin while autophagy inducers had the opposite effect. In a similar manner, autophagy induction in zebrafish embryos prevented cisplatin-induced apoptosis in the tail region while autophagy inhibition increased cell death in the tail and retina of cisplatin-treated animals. Autophagy modulation with direct inhibitors of the PI3kinase/Akt/mTOR pathway (AZD2014 and wortmannin) triggered the cellular response to anticancer drugs more effectively in NCI-H460 and zebrafish embryonic models compared to HaCaT suggesting that these modulators are selective towards rapidly proliferating cells. Therefore, evaluating the autophagic properties of chemotherapeutics could help determine more accurately the fate of different cell types under treatment. Our study underlines the importance of testing autophagic activity of potential anticancer agents in a comparative approach to develop more rational anticancer therapeutic strategies.Related to published version: [https://imagine.imgge.bg.ac.rs/handle/123456789/1004]This is the peer reviewed version of the paper: Divac Rankov, A., Ljujić, M., Petrić, M., Radojković, D., Pesić, M., & Dinić, J. (2017). Targeting autophagy to modulate cell survival: A comparative analysis in cancer, normal and embryonic cells. Histochemistry and Cell Biology, 148(5), 529–544. [https://doi.org/10.1007/s00418-017-1590-4

The value of Pap test in women with endometrial cancer

Introduction: Endometrial cancer is the second most common gynecological tumor. There is still no recommended screening method for endometrial cancer. The application of transvaginal sonography, hysteroscopy and Pap test may prove useful in screening for this disease. Atypical glandular cells represent an important finding in Pap tests and they are related to histopathological verification of the endometrium. The aim of the study was to determine the usefulness of the Pap test in assessing the cervical infiltration, as well as to determine the significance of hormonal status and histopathological type of tumor in a pathological Pap test in patients with endometrial cancer.Methods: The study was retrospective. The analysis included the data obtained from 62 operated patients diagnosed with enometrial cancer, medical history (menopausal status), histopathological findings after surgery (type and stage of the disease) and a preoperative Pap smear. The chi squared and Fisher’s test were used.Results: The difference in the prevalence of pathological Pap test in premenopausal and postmenopausal group of patients was not statistically significant. The difference in the prevalence of pathological Pap test in the group of endometrioid and non-endometrioid tumours of the uterine corpus had statistical significance. The difference in the prevalence of pathological Pap test compared to the present stage (I and II) was not statistically significant.Conclusion: Pap smear does not correlate with menopausal status in women with endometrial carcinoma. Abnormal Pap test is more commonly found in cases of non-endometroid tumours. Pap smears cannot beused to assess cervical involvement

HYSTEROSCOPY BEFORE IN VITRO FERTILIZATION

In the last decade, success after in vitro fertilization process (IVF) has remained at a similar rate despite all the improvements implemented in the stimulation protocols and laboratory techniques. Hysteroscopy is a method becoming more widely used with patients after a failed IVF cycle, considering a large incidence of uterus cavum pathological states which have a negative impact on the favorable outcome. Numerous studies have provided different results on the IVF outcome with hysteroscopy performed prior to this treatment in cases with no uterus cavum pathology. The aim of the research was to examine the effect of both diagnostic and surgical hysteroscopy on the outcome of IVF.  Hysteroscopy was performed with 74 patients 30 to 50 days prior to IVF and in 33 of them (group I) some pathological state was noticed, which was treated during the same procedure. The control group (group III) included 151 patients who had IVF performed with no prior hysteroscopy. There is no statistically significant difference in the rate of post hysteroscopy implantation between I and II group when compared to the control group (20.62% vs 23.28% vs 17.31%), nor in the rate of clinical pregnancies (45.45% vs 46.34% vs 34.44%). Following the correctional treatment of uterus cavum pathological states, implantation and pregnancy rates remain at a level comparable to hysteroscopically normal medical findings. Statistically significant higher pregnancy rate is present in group I after the first IVF cycle, compared to the next IVF in the same group and in comparison to the next IVF cycle in the control group (60.00% vs 27.91%, p<0.05). Hysteroscopy is a simple and safe method allowing nearly identical rate of clinical pregnancies after a surgical treatment of uterus cavum pathological states when compared to the control group, but statistically much higher pregnancy rate if the order of IVF procedure is being compared. In cases of normal ultrasound findings and negative hysteroscopical findings, performing hysteroscopy prior to IVF does not provide significantly better results. Therefore, its routine execution is not recommended

ASSOCIATION BETWEEN HYPERPROLACTINAEMIA AND OTHER CAUSES OF FEMALE INFERTILITY

Hyperprolactinaemia is one of the major causes of reproductive axis disorders. Adequate treatment for hyperprolactinaemia is very successful in restoring ovulation, but there is still a proportion of patients unable to achieve pregnancy despite adequate control of hyperprolactinaemia. This prospective clinical trial included 104 hyperprolactinaemic patients in reproductive age: 78/104 (75%) suffered from infertility and the other 26 hyperprolactinaemic patients were still unmarried and not interested in pregnancy. Hyperpolactinaemia as the only reason for anovulation and infertility was diagnosed in 43/78 (55.12%) of our patients. In 35/78 (44.88%) patients, hyperprolactinaemia was associated with other causes of infertility: endometriosis, premature ovarian failure, PCO and insulin resistance, etc. After the appropriate treatment, mostly with bromocriptine (in 69/78 – 88.46%, alone or in combination with induction of ovulation), 35/78 (44.87%) patients achieved pregnancy. In the group of infertile patients with hyperolactinaemia as the only cause of infertility, 33/43 (76.74%) patients became pregnant, and in the group of patients who had combination of hyperprolactinaemia and other causes of infertility only 2/35 (5.71%) achieved pregnancy. The treatment of hyperprolactinaemia is obligatory in all patients with infertility. If adequate suppression of serum prolactin levels is achieved, but the pregnancy is still missing despite the fact that ovulatory cycles are established, the other causes of infertility should be searched for, and the clinician should not reject the possible existence of some unknown cause of infertility, so the patient should be referred to ART procedures which give more chances in such circumstances.Key words: Hyperprolactinaemia, infertility, bromocriptine, assisted reproductive technique

CROATIAN WAR VETERANS IN PRINT MEDIA IN 1996 AND IN 2006

Introduction: The media have an important role in maintaining and creating social relations and social environment. This especially refers to the war and post-war period in which the media can form a part of the prevention context, i.e., the media can facilitate the process of recovery from war trauma, but they can also contribute to stigmatization and retraumatization. Our aim was to analyze Croatian newspaper reports about Croatian war veterans and to determine the differences in ways of dealing with the subject during 1996 and 2006. Methods: The data were gathered by reviewing two daily papers, Novi list and Večernji list and Globus weekly. The analysis included newspaper reports related to the subject of Croatian war veterans, published in the first six months of 1996 and 2006. Quantitative and qualitative methods were used to analyze both the form and the content of the reports. Results: A total of 538 newspaper reports were published in the above-stated periods. In the first half of 2006 the number of reports related to the subject of Croatian war veterans dropped 6.5 percent compared to the first half of 1996. Topics prevalent at the end of the war were different from those ten years later. The 1996 articles mostly reported on activities organized by various associations, medal-awarding ceremonies, military operations etc. Ten years later the topics focused on war crimes, trials of Croatian war generals and dissatisfaction with veterans\u27 rights and legislation. Moreover, articles relating to crime and reports about suicides and attempts of suicide increased significantly in 2006. Conclusion: During the ten-year period, the media image of Croatian war veterans significantly changed, which was expected owing to different social circumstances immediately after the war and ten years later. The prevalence of topics negative in tone and a lack of proactive stories reflect, but also create, a social context which can affect the process of recovery from traumatization

Multi-criteria evaluation tool (NoAW H2020 Project)

Пројекат NoAW настоји да пронађе нова решења за креативну поновну употребу неминовно и континуално генерисаног отпада из пољопривреде. Овај плакат представља резултате рада у оквиру Радног пакета 2 (Deliverable D2.3) и повезан је са Задатком 2.3 „Мултикритеријумска евалуација за потребе стратешке процене утицаја плана управљања отпадом из пољопривреде на животну средину“. Унутар D2.3 представљен је концепт модела за мултикритеријумско одлучивање. Овај модел је примењен у Стратешкој процени утицаја плана управљања отпадом на подручју Опленачког виногорја на животну средину.The NoAW project aims at finding new solutions for up-cycling unavoidable and continuously generated by-products from agriculture. This paper is related with the Deliverable (D2.3) which represents the result within the Work Package 2 and it is related to the Task 2.3 “Multi-criteria evaluation in strategic environmental assessment of agro-waste management plan”. Within D2.3, concept for multicriteria decision model was presented. This model was applied in Strategic Environmental Assessment process for Agro Waste Management Plan in Oplenac vineyards.Трећа награда на 28. Међународном салону урбанизма у категорији Истраживања, студије и пројекти из области просторног и урбанистичког планирања, 2019