The Impact of Allogeneic Hematopoietic Cells Transplantation on Female Reproductive Health: A Short Review

Transplantacija krvotvornih matičnih stanica (engl. HSCT) široko se koristi desetljećima kao na- jučinkovitiji tretman nekoliko zloćudnih i nemalignih hematoloških bolesti. Među mnogim komp- likacijama koje se javljaju nakon HSCT postupka, reproduktivna su pitanja često zanemarena, iako ona mogu negativno utjecati na kvalitetu života pacijenta. Najčešće ginekološke komplikacije nakon HSCT-a uključuju: insuficijenciju jajnika, povećani rizik od atipije i karcinoma cerviksa, menoragi- je povezane s trombocitopenijom, zahvaćenost transplantata u odnosu na domaćina, osteoporozu, plodnost i trudnoću itd. Zbog njihove važnosti za pacijente i konstantne rast očekivanog života žena nakon HSCT-a od velike je važnosti dijagnosticirati i liječiti reproduktivne komplikacije nakon pos- tupka transplantacije multidisciplinarnim pristupom.Hematopoietic Stem Cell Transplantation (HSCT) has been widely used fore decades as the most effec- tive treatment of several malignant and non-malignant hematological diseases. Among many complica- tions with occurrence after HSCT procedure, reproductive issues are often neglected although these can adversely affect the patient quality of life. The most common gynecological complications after HSCT include: ovarian insufficiency, increased risk of cervical atypia and carcinoma, thrombocytopenia-associ- ated menorrhagia, genital involvement of graft versus host disease, osteoporosis, fertility and pregnancy issues etc. Due to their relevance to the patients and constant growing of life expectance of women after HSCT it is of huge importance to diagnose and treat reproductive complications after the transplanta- tion procedure by multidisciplinary approach

The Impact of Allogeneic Hematopoietic Cells Transplantation on Female Reproductive Health: A Short Review

Transplantacija krvotvornih matičnih stanica (engl. HSCT) široko se koristi desetljećima kao na- jučinkovitiji tretman nekoliko zloćudnih i nemalignih hematoloških bolesti. Među mnogim komp- likacijama koje se javljaju nakon HSCT postupka, reproduktivna su pitanja često zanemarena, iako ona mogu negativno utjecati na kvalitetu života pacijenta. Najčešće ginekološke komplikacije nakon HSCT-a uključuju: insuficijenciju jajnika, povećani rizik od atipije i karcinoma cerviksa, menoragi- je povezane s trombocitopenijom, zahvaćenost transplantata u odnosu na domaćina, osteoporozu, plodnost i trudnoću itd. Zbog njihove važnosti za pacijente i konstantne rast očekivanog života žena nakon HSCT-a od velike je važnosti dijagnosticirati i liječiti reproduktivne komplikacije nakon pos- tupka transplantacije multidisciplinarnim pristupom.Hematopoietic Stem Cell Transplantation (HSCT) has been widely used fore decades as the most effec- tive treatment of several malignant and non-malignant hematological diseases. Among many complica- tions with occurrence after HSCT procedure, reproductive issues are often neglected although these can adversely affect the patient quality of life. The most common gynecological complications after HSCT include: ovarian insufficiency, increased risk of cervical atypia and carcinoma, thrombocytopenia-associ- ated menorrhagia, genital involvement of graft versus host disease, osteoporosis, fertility and pregnancy issues etc. Due to their relevance to the patients and constant growing of life expectance of women after HSCT it is of huge importance to diagnose and treat reproductive complications after the transplanta- tion procedure by multidisciplinary approach

The Antimetastatic Effect of Macrophages Restored by Indomethacin: Concomitant Tumor Immunity Model

The role of macrophages acting as immunologic antitumor effectors and promoters of tumor growth are poorly understood as yet. We investigated the role of macrophage in model of concomitant immunity (CI), a phenomenon of secondary tumor rejection during the primary tumor growth. It has been shown that the period of CI weakening can coincide with appearance of tumor metastases. We used mammary carcinoma (MC) artificial lung metastases to evaluate the influence of macrophages from various period of CI on the development of metastases in mice. Our results indicated that macrophages are responsible for the late period of CI weakening and suppression. To investigate weather prostaglandins can mediate suppressive effect of macrophages we used experiments with indomethacin and we found that inhibition of prostaglandin E2 synthesis by indomethacin restored antimetastatic effect of concomitant immune macrophages

MOTHERS’ ANXIETY TO AGGRAVATED ACUTE FEAR OF EARTHQUAKES IN THE CITY OF ZAGREB IN THE COVID-19 PANDEMIC

Backround: Here we present the results of a psychometric investigation on current fear of COVID-19 infection aggravated by the earthquake-induced stress in the group of puerperal women. Subject and methods: A group of 16 hospitalized puerperal women that gave birth at Clinical Hospital Sveti Duh in Zagreb, Department of Obstetrics and Gynecology were enrolled in retrospective clinical investigation. All the patients delivered during COVID-19 pandemic and experienced devastating earthquake on March 22nd. The women were interviewed on the exact day of the earthquake, 4 hours after the main hit and 6 months after that during second pandemic wave on October of the same year. Women were also questioned about the breastfeeding. The participants provided written informed consent and were interviewed using Generalized Anxiety Disorder 7-item (GAD-7) scale for evaluation of generalized anxiety disorder. Results: Minimal level of anxiety after the earthquake was shown for 10 mothers with 6 of them having the highest level 4. Mild anxiety was proven for 3 patients, 2 exhibited moderate anxiety with one puerperal women with severe anxiety. One could say that 37.5% of enrolled patients exhibited some degree of anxiety after the earthquake (scoring >5). At second time point during COVID- 19 pandemic 13 participants had minimal anxiety score, 2 had mild, while 1 participant had moderate score evaluated by GAD-7 scale (18.8%). At the time of the earthquake 13 participants were breastfeeding (81.3%), while 3 were not due to the personal reasons. 6 months after the earthquake only 7 mothers were breastfeeding (43.8%), while 9 of the participants were feeding their children with adapted milk (56%). Main reason for breastfeeding discontinuation was the stop of milk secretion in the 6 months period after the delivery. Conclusions: To our knowledge, our study is the only national study dealing with mental health problems in a population of puerperal and breastfeeding mothers in a challenging time of COVID-19 pandemic aggravated by devastating earthquake

Šezdeset godina primjene modificirane manualne perinealne zaštite po Ritgenu

The aim is to present the 60-year experience in modified Ritgen maneuver according to perineal injuries. This retrospective clinical observational study (1950-2010) analyzed the impact of modified Ritgen maneuver delivery technique (controlled fetal head deflexion with left hand and synchronous reduction of perineal strain with extended right hand thumb along the right side of the vulva and perineum without pushing) on peripartum perineal tears at the Maternity Ward, Bjelovar General Hospital in Bjelovar, Croatia, divided into five-year intervals. The rate of perineal tear in general was less than 5% until 2000. The rate of perineal tear grade I was very low until 1995, then increased to 8.6% in 2010, yet never exceeding 10%. The rate of perineal tear grade II never exceeded 2%, whereas perineal tear grade III was a sporadic event never exceeding 0.4% of the study material with a single case of grade IV tear. The rate of intact perineum in vaginal deliveries without episiotomy ranged from 96.2% to 100% in the 1950-1960 period, with a decrease to 46% in 2010. The study revealed the modification of Ritgen maneuver described to have resulted in significant reduction of all grades of perineal tear over decades.Cilj istraživanja bio je prikazati 60-godišnje iskustvo u modificiranoj manualnoj perinealnoj zaštiti po Ritgenu u odnosu na razdore međice. Retrospektivna opservacijska klinička studija (1950.-2010.) analizirala je petogodišnje intervale učinka modificirane Ritgenove tehnike perinealne zaštite (kontrolirana fetalna defleksija lijevom rukom uz sinkronu redukciju napetosti međice desnom rukom koja je ispružena s desne strane međice i vulve, bez tiskanja rodilje) na peripartalne razdore međice u rodilištu Opće bolnice u Bjelovaru, Hrvatska. Ukupna stopa razdora međice bila je manja od 5% do 2000. godine. Stopa razdora I. stupnja bila je vrlo niska do godine 1995., zatim se povećala na 8,6% u 2010. godini, ali nikada iznad 10%. Razdori međice II. stupnja nisu prelazili stopu od 2%, dok su razdori međice III. stupnja bili sporadični i nisu prelazili 0,4% u ispitivanom materijalu, uz jedan slučaj razdora IV. stupnja. Netaknuta međica bez epiziotomije bila je u rasponu od 96,2% do 100% u razdoblju od 1950. do 1960. godine, sa smanjenjem od 46% u 2010. godini. Ovo istraživanje dokazalo je značajno smanjenje razdora međice svih stupnjeva uporabom modificirane manualne zaštite po Ritgenu

Intima media thickness in women with preeclampsia

Cilj istraživanja: Procijeniti debljinu intima-medije, zajedničke karotidne arterije u žena šest mjeseci nakon trudnoće i porođaja kompliciranih s preeklampsijom u komparaciji sa zdravim trudnicama. Materijal i metode: Klinička studija uključila je 55 žena šest mjeseci nakon trudnoće i porođaja kompliciranih preeklampsijom, bez aktualne hipertenzije, medikacije i komorbiditeta i kontrolnu skupinu od 50 zdravih žena, šest mjeseci nakon porođaja, bez perinatalnih komplikacija. Debljina intima-medije mjerena je u donjem segmentu zajedničke karotidne arterije na tipičnom mjestu 1-2 centimetra od bifurkacije uporabljujući B-mode. Rezultati: Srednja vrijednost debljina intima-medije u bolesnica koje su imale preeklampsiju iznosila je 0,419 ± 0,29 mm, dok je u kontrolnoj skupini iznosila 0,412 ± 0,43 mm, što je statistički neznačajno (p > 0,0001). Zaključak: Nisu pronađene rane aterosklerotske promjene, mjereći debljinu intima-medije šest mjeseci nakon trudnoće komplicirane preeklamspijom, no zbog poznate dugotrajne ateropatogeneze, potrebne su dugoročnije studije, što je zaključak istraživanja.Aim: To investigate the difference in intima-media thickness of common carotid artery in women 6 months after pregnancy and delivery complicated by preeclampsia as compared to the age-matched control. Material and methods: The clinical study enrolled 55 women six months after pregnancy and delivery complicated by preeclampsia without actual hypertension, medication and comorbidity and control group of 50 healthy women six months after delivery without perinatal complications. Intima-media thickness was measured on the lower segment of both common carotid arteries on the exact site of 1 to 2 centimetres proximal to the bifurcation using optimal B-mode settings. Results: The mean value of the intima-media thickness in patients who had preeclampsia 6 months prior to the measurement was 0.419 ± 0,29mm while in the control group the mean value was 0.412 ± 0.43 mm. The difference in intima-media thickness was shown to be insignificant (p > 0.0001). Conclusion: It was not possible to detect early atherosclerotic changes by measuring intima-media thickness six months after pregnancy with preeclampsia. Due to the long atheropathogenesis process, long term follow-up is needed

Three-dimensional reconstructed coronal plane in detection and differentiation of congenital uterine malformations

Background: Congenital uterine malformations develop during early embryogenesis, and their possible impact on female reproduction often represent a diagnostic and therapeutic challenge. In this study, the authors aimed to evaluate the possibility of detection and differentiation of Müllerian uterine anomalies on the basis of coronal plane obtained by three-dimensional transvaginal ultrasonography. Materials and Methods: The authors investigated 310 non-pregnant women who underwent three-dimensional ultrasound (3-D US) examination followed by the reconstructed three-dimensional images in the coronal plane. The patients were divided into two groups: infertile and unselected women. Results: Müllerian duct anomalies were diagnosed in 25 patients (8%). In the group of infertile patients the number of assessed anomalies was higher (16 ; 14.4%) as compared to the unselected patients (9 ; 4.6%). The prevalence of uterine anomalies was increased in the group of infertile patients. In the group of infertile patients, the length of uterine cavity was decreased compared to the unselected women (p = 0.0021). This difference was also visible in the case of nulliparous women from both groups (p = 0.0070). On the other hand, the thickness of fundal myometrium and the distance between the two internal tubal ostia did not vary among patients (p > 0.05). Conclusions: 3-D US represents a feasible and accurate technique for the detection and differentiation of congenital uterine malformations. Three-dimensional reconstructed coronal view could be used for the additional measurement of different uterine dimensions which were shown to differ between infertile patients and the control group, and according to the parit

Three-dimensional reconstructed coronal plane in detection and differentiation of congenital uterine malformations

Background: Congenital uterine malformations develop during early embryogenesis, and their possible impact on female reproduction often represent a diagnostic and therapeutic challenge. In this study, the authors aimed to evaluate the possibility of detection and differentiation of Müllerian uterine anomalies on the basis of coronal plane obtained by three-dimensional transvaginal ultrasonography. Materials and Methods: The authors investigated 310 non-pregnant women who underwent three-dimensional ultrasound (3-D US) examination followed by the reconstructed three-dimensional images in the coronal plane. The patients were divided into two groups: infertile and unselected women. Results: Müllerian duct anomalies were diagnosed in 25 patients (8%). In the group of infertile patients the number of assessed anomalies was higher (16 ; 14.4%) as compared to the unselected patients (9 ; 4.6%). The prevalence of uterine anomalies was increased in the group of infertile patients. In the group of infertile patients, the length of uterine cavity was decreased compared to the unselected women (p = 0.0021). This difference was also visible in the case of nulliparous women from both groups (p = 0.0070). On the other hand, the thickness of fundal myometrium and the distance between the two internal tubal ostia did not vary among patients (p > 0.05). Conclusions: 3-D US represents a feasible and accurate technique for the detection and differentiation of congenital uterine malformations. Three-dimensional reconstructed coronal view could be used for the additional measurement of different uterine dimensions which were shown to differ between infertile patients and the control group, and according to the parit

A new method for volumetric measurement of the normal female cervix by three‐dimensional transvaginal ultrasound

Until now, there have been few studies that have used imaging modalities to assess the volume of a non- pregnant female cervix ; the first study did so with magnetic resonance imaging, and the remaining two with three- dimensional ultrasound. The two latter studies showed that a geometric formula for regular cylinders can be used to determine normal cervical volume

A new method for volumetric measurement of the normal female cervix by three‐dimensional transvaginal ultrasound

Until now, there have been few studies that have used imaging modalities to assess the volume of a non- pregnant female cervix ; the first study did so with magnetic resonance imaging, and the remaining two with three- dimensional ultrasound. The two latter studies showed that a geometric formula for regular cylinders can be used to determine normal cervical volume