Transvaginal mesh in repair of pelvic organs prolapse as a minimally invasive surgical procedure

Background/Aim. Prolapse of genital organs with or without urinary stress incontinention is the most often health problem in the elderly female population tending to increase with ageing. The aim of this study was to assess the perioperative complications and short-term outcomes of prolaps repair using transvaginal polypropylene mesh (Prolift system, Gynecare, Ethicon, USA). Methods. A retrospective study was conducted evaluating 96 women from September 2006 to January 2010 who undewent vaginal repair with implatation of a soft mesh manufactured by Gynecare, Ethicon, USA. Results. All the patients had a stage 3 or stage 4 prolapse according to the POP-Q system of ICS. Total mesh was used in 12 (13%) patients isolated anterior mesh in 52 (54%) patients and isolated posterior mesh in 32 (33%) patients. We reported one intra-operative bladder injury and no other serious complications. At 3 months, all 96 patients were available for follow-up. Vaginal erosion occured in 9 (9.3%) patients, shrinkage of mesh in 6 (6.2%) patients and de novo urinary incontinence in 5 (5.2%) patients. Failure rate was 6.25% (recurrent prolapse stage 3 or 4 even asymptomatic). Conclusion. Our study suggests that transvaginal polypropylene mesh applied with a tensionfree technique is a safe and effective method with low intraoperative complications and low morbidity rates. However, some complications are serious and require highly specialised management

Significance of survivin immunoreactivity and morphometric analysis of HPV-induced cervical dysplasia

Genomic integration of high-risk human papilloma virus in the nucleus of cervical epithelial mucosal cells leads to epithelial dysplasia. The aim of this study was to determine the relevance of correlation between epithelial survivin expression and the degree of human papilloma virus (HPV)-induced cervical epithelial dysplasia, and to establish the significance of morphometric analysis of the nuclear area in the assessment of the degree of cervical dysplasia. This retrospective study included 99 women with primary, previously untreated lesions, and colposcopic findings indicating dysplasia, in whom a cytological test by Papanicolaou method was interpreted according to the Bethesda criteria as lowgrade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and atypical squamous cells of undetermined significance (ASCUS). We performed human papilloma virus (HPV) typing by PCR for evidence of viruse types 16, 18, 31, 33. After biopsy of the cervical mucosa, we performed hematoxylin-eosin (H-E) and Periodic Acid Schiff (PAS) staining, and immunohistochemical and morphometric analysis of tissue samples. The control group consisted of 12 women without dysplasia and without a verified infection of cervical high-risk HPV. A high statistical correlation between the degree of dysplasia and expression of survivin was found in patients with different types of cervical dysplasia (p = 0.003). We observed a high statistical difference between the area of nuclei at different degrees of cervical dysplasias (p = 0.000). The high-grade cervical dysplasia had a more than 2-fold higher level of ranking in comparison to low-grade dysplasia, and a more than 10-fold higher ranking than the control group without cervical dysplasia

Aktivnost antioksidativnih enzima u eritrocitima zdravih trudnica, trudnica sa preeklampsijom i novorođenčadi

Preeclampsia is a pregnancy-specific syndrome of unknown etiology and represents multisystem disorder. It is characterized by the increased blood pressure, proteinuria, and edema. Preeclampsia is a great risk for both mother and fetus. Disturbances of the balance between the production of reactive oxygen species antioxidants status is considered to be one of the causes of various pathological conditions of the reproductive system, including preeclampsia. The main objective of this study is to determine the activities of superoxide-dismutase and catalase in peripheral blood erythrocytes of the pregnant women with preeclampsia and healthy pregnant women before delivery and umbilical cord blood erythrocytes of their babies immediately after the delivery. The results showed that the activity of superoxide dismutase in erythrocytes were statistically significantly lower in the group of patients with preeclampsia than in healthy pregnant women, as in the group of their babies compared to the babies of healthy pregnant women. Similarly, catalase activity was significantly lower in women with preeclampsia compared to the controls, as well as in erythrocytes of their babies compared to babies of healthy mothers. An observed difference in the antioxidant enzyme activities suggests a putative association between preeclampsia and decreased antioxidant status. Since the direct application of antioxidants did not give expected results of the data presented indicate the opportunity for the prevention of preeclampsia and alleviation of symptoms by dietary measures and life style changes in the population of pregnant women and women of childbearing age, directy targeting the enzymatic antioxidant system.Cilj ovog rada je određivanje aktivnosti superoksid-dizmutaze i katalaze u eritrocitima periferne krvi trudnica sa preeklampsijom i zdravih trudnica pre porođaja i krvi pupčanika njihovih beba neposredno posle porođaja. Preeklampsija je sindrom nepoznate etiologije i podrazumeva multisistemski poremećaj u organizmu trudnice. Karakteriše se povećanjem krvnog pritiska, edemom i proteinurijom i u ozbiljnijim slučajevima može doći do dramatičnog pogoršanja bolesti i ugrožavanja funkcije bubrega, jetre, mozga i hematoloških poremećaja. Preeklampsija predstavlja veliki rizik za zdravlje i majke i ploda. Poremećaj balansa između antioksidanasa i produkcije reaktivnih vrsta kiseonika smatra se jednim od uzroka različitih patoloških stanja reproduktivnog sistema, uključujući i preeklampsiju. Deo enzimskog sistema antioksidativne zaštite organizma čine enzimi superoksid- dizmutaza i katalaza, uključeni u regulaciju nivoa reaktivnih vrsta kiseonika.Dobijeni rezultati pokazali su da je aktivnost superoksid-dizmutaze u eritrocitima statististički značajno niža u grupi ispitanica sa preeklampsijom u odnosu na zdrave trudnice, kao i u grupi beba ispitanica sa preklampsijom u odnosu na bebe zdravih trudnica.Takođe, pokazano je da je aktivnost katalaze u eritrocitima statistički značajno niža kod trudnica sa preeklampsijom u odnosu na kontrolnu grupu, kao i kod njihovih beba u odnosu na bebe zdravih majki. Razlike u aktivnost antioksidativnih enzima u ispitivanim grupama trudnica i njihovih beba ukazuje na povezanost preeklampsije i smanjenog antioksidativnog statusa. S obzirom da primena direktnih antioksidanasa nije dala očekivane rezultate prikazani podaci ukazuju na mogućnost prevencije ili ublažavanja komplikacija izazvanih preklampsijom dijetarnim merama i poboljšanjem stila života trudnica i žena u reproduktivnom periodu, usmerenim na jačanje mehanizama antioksidativne zaštite

Polymorphic expression of glutathione transferases A1, M1, P1 and T1 in epithelial ovarian cancer: a Serbian case-control study

PURPOSE: Since several studies have proposed that epithelial ovarian cancer should not be considered as a single disease entity and that it results from an accumulation of genetic changes, we aimed to assess the polymorphic expression of major cytosolic glutathione S-transferases (GSTM1, T1, A1 and P1) with respect to ovarian cancer susceptibility and aggressiveness. METHODS: This case-control study was conducted on 93 newly diagnosed epithelial ovarian cancer patients and 178 healthy matched controls. The multiplex polymerase chain reaction (PCR) was used to detect homozygous deletions of GSTM1 and GSTT1 genes. Analysis of the single nucleotide polymorphism (SNP) GSTA1 C69T was performed using PCR-restriction fragment length polymorphism (RFLP), while for SNP GSTP1 Ile105Val real-time PCR was used. RESULTS: No significant association to ovarian cancer risk was found for individual GSTM1, GSTA1 and GSTP1 genotypes (p>0.05). However, the carriers of GSTT1-active genotype were at 2-fold higher risk of ovarian cancer development (95%CI: 1.00-4.01, p=0.049), which was even more elevated in the subgroup of patients with positive family history of cancer. Moreover, the frequency of all three GST genotypes that might be associated to ovarian cancer risk (GSTT1-active, GSTA1-active and GSTP1-referent) was significantly higher in patients than in the control group (p=0.042). Even more, patients who were carriers of combination of these three genotypes represented over 64% of the total number of patients within any of the International Federation of Gynecology and Obstetrics (FIGO) stages of ovarian cancer. CONCLUSIONS: This study provides supportive evidence that GSTs might affect both susceptibility and progression of ovarian cance

Peripartum dilated cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that is defined as deterioration in cardiac function presenting towards the end of pregnancy or in the months following delivery, where no other cause of HF is found. As with other forms of dilated cardiomyopathy, PPCM involves systolic dysfunction of the heart with a decrease of the left ventricular ejection fraction (EF) with associated congestive heart failure and an i ncreased risk of atrial and ventricular arrhythmias, thromboembolism, and even sudden car¬diac death. m this case report, we describe the development of PPCM in 37 year-old primigravida with a twin pregnancy. It is well-known from literature that twin pregnancy is considered a risk factor for development of PPCM. However, the association of twin pregnancy and PPCM is unclear. Our patient improved remarkably. We review the diagnostic procedures of PPCM and its management. Conclusion: Early diagnosis and intensive treatment by a multidisciplinary team is a prerequisite for improved outcome

Paravesical haematoma following placement of an isolated anterior mesh for cystocele repair

Introduction. Pelvic organ prolapse is a substantial health problem for women around the world. Given the limitations of traditional surgery in the reconstruction of normal vaginal anatomy and function in genitourinary prolapse, various synthetic implants have been developed for surgical repair. Mesh procedures are gaining in popularity, encouraged by preliminary data. Although minimally invasive and relatively safe, serious complications following these procedures have been described. Case report. We presented a patient who had underwent an isolated anterior mesh procedure and developed postoperative haematoma which required surgical intervention. Conclusion. This report suggests that minimally invasive urogynecological procedures could result in significant complications. Thus, surgeons should be familiar with effective interventions in order to manage them

Application of a hormonal intrauterine device causing uterine perforation: A case report

Introduction. The last decade of the usage of intrauterine contraception has been marked by the application of levonorgestrel-releasing hormonal devices. A hormonal intrauterine device (IUD) releases a certain amount of progestogen, whose effect on endometrium is such that, apart from preventing unwanted pregnancy, also regulates the menstrual bleeding by reducing the quantity and the duration of haemorrhage. This effect of hormonal IUDs has led to their additional indications and use, so that nowadays these IUDs are used not only as contraceptives but for therapeutic purposes as well. Case Outline. After examination and treatment in an out-patient department, a 38-year-old woman was referred to our hospital due to suspected spontaneous uterine perforation caused by hormonal IUD (Mirena®) one month after its application. Clinical and sonographic examinations were unable to determine the uterine perforation or the exact IUD location. Radiographic examination confirmed the presence of the IUD in the abdomen, so it was decided to operate on the patient. Perforation in the isthmus of the uterus and to the right was identified intraoperatively. By exploration of the genital organs and the abdominal cavity, the IUD was finally located in the omentum. Conclusion. Even in cases of adequate indications for hormonal IUD application, the doctor’s experience and complying with all the principles of appropriate insertion, we should always consider the possibility of the occurrence of serious complications, which sometimes may even require surgery. The extragenital position of IUD, as in this case, may create serious difficulties in the detection of location. A possible development of asymptomatic complications additionally emphasizes the necessity of regular check-ups of all IUD users

Acute intermittent porphyria in the puerperium

Introduction. Acute intermittent porphyria emerges as a result of partial defect of porphobilinogen deaminase and is manifested by repeated episodes of somatic, psychiatric and neurological disorders. The disease is conducted via the autosomaldominant gene of variable penetration, so most of the carriers never experience seizures. Timely making of diagnosis, screening of blood relatives of the patient and education of patients on avoidance of provoking factors are the key to adequate treatment. Case Outline. A 23-year-old patient having born the third child was hospitalized due to pains in the abdomen and convulsive seizures nine days after the vaginal delivery. At admittance, she suffered a generalized convulsive seizure of clonic-tonic type. The patient immediately underwent a complete clinical, laboratory, bacteriological and ultrasound examination. Bearing in mind the fact that the patient had several convulsive seizures even after the given neurological therapy, haem-arginate was introduced into therapy during four days. The administration of haem-arginate led to the normalization of blood pressure, pulse and bowel function. The administration of haem-arginate led to the normalization of blood pressure, pulse and bowel function. The patient was treated by a team of doctors, in the intensive care ward, with the use of medicaments, which are allowed in the case of acute porphyria. Sixteen days after the admittance, with clean neurological status and gynaecological and ultra-sound findings, she was released for ambulatory treatment. Conclusion. The presented case exhibits the gravity of making a diagnosis of acute intermittent porphyria in puerperium and the necessity of multi-disciplinary approach in treating this disease. Acute intermittent porphyria should be considered in cases of ambiguous abdominal pain, as well as in patients having abdominal pains followed by neuro-psychiatric disorders

Uterine torsion in term pregnancy

Introduction Uterine torsion has been defined as a rotation of more than 45 degrees of the uterus around its long axis that occurs at the junction between the cervix and the corpus. The extent of the rotation is usually 180 degrees, although cases with torsion from 60 to 720 degrees have been reported. Aetiopathogenesis of this condition is still unclear. Establishing clinical diagnosis of this condition is difficult, but very important for reducing maternal and fetal morbidity and mortality. Clinical symptoms are either absent or nonspecific, and the diagnosis is usually made at laparotomy. Case outlineA 31-year old patient was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, as an emergency, seven days upon the established intrauterine fetal demise in the 40th gestation week. On uterine examination, the cervical length of 1.5 cm and dilatation of 3 cm were determined, as well as a palpable soft tissue formation, not resembling placenta praevia. Ultrasound examination confirmed fetal demise and exclusion of the presence of placenta praevia. The labor was completed by caesarean section. During surgery, uterine torsion of 180 degrees to the right was diagnosed. There was a stillborn male baby, and the cause of death was intrauterine asphyxia. A fibrosing and calcified accessory lobe 9x6x2.5 cm in size was observed on placental examination, which is a possible sign of initial gemellary pregnancy. Conclusion The clinical presentation of uterine torsion is variable and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. The method of choice for establishing the diagnosis is magnetic resonance imaging. Once the diagnosis of uterine torsion in pregnancy is established, emergency laparotomy is indicated. Following caesarean delivery, it is necessary to surgically remove all the anatomical causes of torsion, and rotate the uterus back to its normal position. There are some authors who suggest bilateral plication of the round ligaments as a preventive procedure for repeated torsion in puerperium and following pregnancies. The effectiveness of this method requires further investigation. It is necessary to have in mind the possibility of uterine torsion in all cases of abdominal pain during pregnancy and dystocia