Sposób porodu a umieralność przedwcześnie urodzonych noworodków

Abstract Objective: The purpose of our study was to analyze the frequency of preterm deliveries in Obstetrics & Gynecology Clinic, University Clinical Centre of Kosovo, Prishtina (Republic of Kosovo), as well as to assess the survival advantage of premature newborns according to mode of delivery (cesarean section vs. vaginal). Material and methods: A cohort of 12.466 deliveries from the year 2002 was studied retrospectively and preterm deliveries were analyzed. Survival advantage until 28 days of life associated with cesarean and vaginal delivery was assessed with regard to birth weights (500-999g, 1000-1499g, 1500-1999g, and 2000-2499g). Results: There were 1.135 preterm deliveries which resulted in 1.189 preterm infants (including multiples). The overall cesarean delivery rate in this group was 32.2%. Among preterm newborns with birth weight 500-999g, 68 children were delivered vaginally and 5 by caesarean section (5.7% and 0.4% of all preterm babies respectively). None of the infants survived. The percentage of children from cesarean deliveries in the other groups was higher: for preterm infants with birth weight 1000-1499g – 3.2%, 1500-1999g – 8.8% and 2000-2499g – 19.8%. A survival advantage associated with cesarean section was observed in neonates with birth weight 1000-1499g (pStreszczenie Cel pracy: Celem pracy była analiza częstości porodów przedwczesnych odbywających się w Klinice Ginekologii i Położnictwa w Kosowskim Uniwersyteckim Centrum Klinicznym w Prishtinie (Kosovo), jak również ocena przeżywalności wcześniaków, w zależności od sposobu porodu (poród drogami natury vs cesarskie cięcie). Materiał i metodyka: Retrospektywnie analizowano przebieg 12466 porodów, które odbyły się w roku 2002, biorąc pod uwagę porody przedwczesne. Oceniano przeżywalność wcześniaków do 28 dnia życia, urodzonych drogami natury i cięciem cesarskim w odniesieniu do ich urodzeniowej masy ciała (od 500 do 999g, od 1000 do 1499g, od 1500 do 1999g i od 2000 do 2499g). Wyniki: W analizowanym okresie odbyło się 1135 porodów przedwczesnych, w wyniku których urodziło się 1189 wcześniaków (w tym dzieci z ciąż mnogich). Odsetek cięć cesarskich w tej grupie wyniósł 32,2%. Wśród wcześniaków z urodzeniową masą ciała od 500 do 999 gramów, 68 dzieci urodziło się drogami natury i 5 cieciem cesarskim (odpowiednio 5,7% i 0,4% wszystkich wcześniaków). Żadne dziecko nie przeżyło. Odsetek dzieci z cięć cesarskich w pozostałych grupach był wyższy: wśród wcześniaków z masą urodzeniową od 1000 do 1499g - 3,2%, z masą urodzeniową od 1500 do 1999g – 8,8%, z masą urodzeniową od 2000 do 2499g – 19,8%. Stwierdzono, że przeżywalność wcześniaków urodzonych cięciem cesarskim w porównaniu do urodzonych drogami natury była istotnie wyższa (

Clear cell variant of diffuse large B-cell lymphoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Diffuse large B-cell lymphoma is a diffuse proliferation of large neoplastic B lymphoid cells with a nuclear size equal to or exceeding the normal macrophage nuclei. We report a case of a clear cell variant of diffuse large B-cell lymphoma involving a lymph node in the neck, which was clinically suspected of being metastatic carcinoma.</p> <p>Case presentation</p> <p>A 39-year-old Caucasian ethnic Albanian man from Kosovo presented with a rapidly enlarging lymph node in his neck, but he also disclosed B symptoms and fatigue. A cytological aspirate of the lymph node revealed pleomorphic features. Our patient underwent a cervical lymph node biopsy (large excision). The mass was homogeneously fish-flesh, pale white tissue replacing almost the whole structure of the lymph node. The lymph node biopsy showed a partial alveolar growth pattern, which raised clinical suspicion that it was an epithelial neoplasm. With regard to morphological and phenotypic features, we discovered large nodules in diffuse areas, comprising large cells with slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells. In these areas, there was high mitotic activity, and in some areas there were macrophages with tangible bodies. Staining for cytokeratins was negative. These areas had the following phenotypes: cluster designation marker 20 (CD20) positive, B-cell lymphoma (Bcl)-2-positive, Bcl-6^-, CD5^-, CD3^-, CD21⁺(in alveolar patterns), prostate-specific antigen-negative, human melanoma black marker 45-negative, melanoma marker-negative, cytokeratin-7-negative and multiple myeloma marker 1-positive in about 30% of cells, and exhibited a high proliferation index marker (Ki-67, 80%).</p> <p>Conclusion</p> <p>According to the immunohistochemical findings, we concluded that this patient has a clear cell variant of diffuse large B-cell lymphoma of activated cell type, post-germinal center cell origin. Our patient is undergoing R-CHOP chemotherapy treatment.</p

SCREENING AND TREATMENT OF PREKANCEROUS LESIONS OF CERVIX UTERI National Guideline

It is proved that the Screening of Cervix for neoplasia has decreased the incidence and mortality from the Cancer of Cervix and has raised the scale of healing from the Cervical Cancer. Prevention of the Cervical Cancer throughout Southeastern Europe is barely documented, despite the fact that the Countries of this region are the most affected places in Europe by the Cervical Cancer. It is estimated that the number of cases with Cervical Cancer and the number of deaths from this malignity in 11 States of Southeastern Europe during the period from 2002-2004 has been around 9000 women affected from the Cervical Cancer and around 4600 deaths from this illness. Based on the incidence of the surrounding countries, the incidence in Kosova might be 7.8 to 10.1. 2 The standard ways of Screening and Diagnosing are Citology, Colposcopy, Biopsy and Histological confirmation of intraepithelial cervical neoplasia. The “see and do” approach may be applied as an alternative method, during which the decision for treatment is based on the Screening Test and treatment according to the positive test result. The available screening tests include: Testing for Human Papilloma Virus (HPV), Visual Inspection via Acetic Acid (VIA) and Citology (Pap Test). Possible Treatments are: Cryotherapy, Loop Electrosurgical Excision Procedure (LEEP) and Conisation. This guideline offers the recommendations for Screening and Treatment of intraepithelial cervical neoplasia . It is adapted from the existing guidelines of WHO and NCCN, NHS and USPTF. Methodology Group for the Guideline Adaptation has been appointed by the decision of the Ministry of Health, Republic of Kosova. Goal and Focus According to the Definition of intraepithelial cervical neoplasia (CIN), intraehelial cervical neoplasia ( CIN), is a premalignant lesion, which can be developed in one of these stages: CIN1, CIN2 or CIN3. If untreated, CIN2 and CIN3 may progress into a Cervical Cancer. Target Population Guideline recommends applying the Screening from the age 21 (when the Screening should begin) until the age 65. Dedication of Guideline Guideline is dedicated to the policy-makers, managers of medical institutions and medical professionals who have responsibility to apply the prevention programme of the Cervical Cancer on the Republican and Municipal level. In the future, from this guideline should be drawn Clinical Protocols for the respective diseases. Key words for literature research: ‘Clinical Guideline’, ‘Clinical Protocol’, ‘Cervical Cancer’, ‘intraepithelial neoplasia‘ Recommendation Based on the above Guideline, women suffer and die from the Cervical Cancer, hence it is of a particular importance that on the level of UBT to be charted a leaflet which is dedicated to the women, so that they may have the peace of mind knowing that they are able to protect themselves from the Cervical Cancer. Women of every group-age will understand that: - Cervical Cancer is a scary disease, but it is one of a few types of cancer that can be prevented. - What is Cervical Cancer - When the PAP test should be taken - Which group-age should check for the HPV virus (Humam Papilloma Virus) - Which is the connection between the virus HPV and the Cervical Cancer - How the human gets infected with this virus - Does it mean that every woman that is infected by this virus will get Cervical Cancer - Does a simple PAP test detect the HPV virus - What does the PAP test observe - What does the HPV test observe - In which age the women should do the PAP test - In which age should they do the testing for HPV - Will Insurance pay for the HPV test - What do the patients who are suffering or who have suffered from the Cervical Cancer say I strongly believe that the short explanations on these key points about the Cervical Cancer will be an undisputed contribution which will positively influence the consciousness of population. It is not enough to inform professionals and policy-makers alone, but the population,especially the women, who will enjoy the life instead of suffering, must be informed too. For making this leaflet, Faculty of Nursery, respectively the UBT will give an important contribution not only in education of nurses in the Bachelor studies, but also in the education of the population