Therapeutical approach to uterine fibroids in women in perimenopause

Cilj ovog rada je prikazati pristupe u liječenju leiomioma u žena u perimenopauzi. Leiomiomi su benigni monoklonalni tumori nastali iz glatke mišićne stanice miometrija. Spadaju u najčešće tvorbe u maloj zdjelici, te su uzrok 1/3 operativnih zahvata kojima se odstranjuje maternica. Nastaju zbog kompleksne interakcije genetskih predisponirajućih čimbenika, steroidnih hormona jajnika i čimbenika okoliša. S obzirom da su miomi hormon ovisni tumori rijetko se javljaju prije puberteta, s nastupom menopauze regradiraju te mogu rasti tijekom uzimanja hormonskog nadomjesnog liječenja ili u trudnoći. Miome bez simptoma nije potrebno operirati. Liječenje simptomatskih mioma može biti konzervativno i kirurško. Konzervativno liječenje uključuje medikamentozno liječenje te embolizaciju materničnih krvnih žila. Kirurške mogućnosti liječenja trenutno uključuju abdominalnu miomektomiju, laparoskopsku miomektomiju, histeroskopsku miomektomiju, ablaciju endometrija i abdominalnu, vaginalnu ili laparoskopsku histerektomiju. Izbor liječenja je individualan jer ovisi o simptomima bolesti, narušenosti kvalitete života pacijentice te katkad terapijskom izboru same pacijetnice. Perimenopauza ili tranzicijski period je period u životu žene u kojem se postepeno gasi lučenje steroidnih hormona jajnika. Zbog učestalih anovulacija predominiraju simptomi estrogenskog suviška, a potom estrogenskog manjka klinički najčešće manifestirani nepravilnim krvarenjem iz maternice. Kod žena u perimenopauzi sa miomima češto postoje neopravdani pristupi u vidu ili zanemarivanja tegoba očekujući da će miomi nakon menopauze regredirati ili preagresivnog pristupa u vidu histerektomije. Današnje žene ne gledaju na uterus samo kao na organ koji omogućava rađanje, stoga je u terapijskom smislu potrebno razmatrati manje invazivne kirurške pristupe, ali i korištenje medikamentoznog liječenja koje će mnogim ženama sa miomima omogućiti prijelaz prema menopauzi bez simptoma uzrokovanih miomima uz održanu kvalitetu života.The aim of this paper is to present different approaches in the treatment of leiomyomas in women in perimenopause. Leiomyomas are benign monoclonal tumors arising from the smooth muscle cells of myometrium. They are the most common pelvic tumors and the reason for one third of all hysterectomies. They appear due to complex interactions of predisposing genetic factors, ovarian steroid hormones and environmental factors. Usually, they cause no symptoms, rarely occur before puberty, and regress after menopause due to reduced secretion of ovarian hormones. Fibroids are estrogen dependent and can grow while taking hormone replacement therapy (HRT) or during pregnancy. There is no need for the treatment of asymptomatic fibroids. Treatment of symptomatic fibroids may be conservative and surgical. Conservative treatments include the use of medication and embolization of uterine blood vessels. Surgical treatment options include abdominal myomectomy, laparoscopic myomectomy, hysteroscopic myomectomy, endometrial ablation and abdominal, vaginal or laparoscopic hysterectomy. The choice of treatment is individual as it depends on the clinical symptoms, the influence on quality of life and the patient’s choice. Perimenopause or the transitional period is the period in a woman's life in which the secretion of ovarian steroid hormones gradually extinguishes. Because of frequent anovulation symptoms of excess estrogen, followed by estrogen deficiency is frequently clinically manifested by abnormal uterine bleeding. In perimenopausal women with fibroids the therapeutic approach is often unjustified by neglecting complaints while expecting myomas to regress after menopause or on the other side using aggressive approach such as a hysterectomy. Modern women do not view the uterus as the organ which the only function is pregnancy, therefore the therapeutic approach should include less invasive surgical approaches, but also the use of medical treatment that can be offered to many women during the transition to menopause reducing the symptoms and sustaining the quality of life

Ultrazvučna dijagnostika makrosomije kod žena s gestacijskim dijabetesom - pregled literature

Pregnancies burdened with gestational diabetes (GDM) are more likely to end in birth of a macrosomic child, where the frequency of operative termination of pregnancy is more common, accompanied with more complications and injuries of both mother and child in comparison to the general population. The need to calculate fetal weight right before delivery has led to the development of numerous methods for greater estimation accuracy. We reviewed the related literature from 1980 to 2020, using the terms macrosomia, ultrasound assessment, gestational diabetes, and relevant articles were considered in preparation of this article. The most frequently used methods are based on two-dimensional ultrasound measurements of individual fetal biometric parameters and their combination in a mathematical regression model. Some methods involve the addition of other mother and child conditions to increase reliability of the method in recognizing macrosomia. In daily work, especially with pregnant women suffering from GDM, it is necessary to have reliable data on the estimated fetal weight before making the correct clinical decision on how to terminate the pregnancy. In this regard, we bring a review of the literature related to the assessment of fetal macrosomia, especially in women with GDM.Trudnoće opterećene gestacijskim dijabetesom (GDM) vjerojatnije će, u usporedbi s općom populacijom, završiti rođenjem makrosomskog djeteta, gdje je učestalost operativnog dovršenja trudnoće češća, popraćena s više komplikacija i oštećenja majke i djeteta. Potreba za izračunavanjem fetalne mase neposredno prije porođaja dovela je do razvoja brojnih metoda u svrhu veće preciznosti procjene. Pregledali smo literaturu od 1980. do 2020. godine rabeći izraze makrosomija, ultrazvučna procjena, gestacijski dijabetes, i upotrijebili smo relevantne članke u pripremi ovog članka. Najčešće primjenjivane metode temelje se na dvodimenzionalnim ultrazvučnim mjerenjima pojedinih fetalnih biometrijskih parametara i njihovoj kombinaciji u matematičkom regresijskom modelu. Neke su metode uključivale dodavanje drugih stanja majke i djeteta kako bi se povećala pouzdanost metode u prepoznavanju makrosomije. U svakodnevnom radu, osobito kod trudnica koje pate od GDM-a, potrebno je imati pouzdane podatke o procijenjenoj fetalnoj težini prije donošenja ispravne kliničke odluke o načinu dovršenja trudnoće. S tim u vezi donosimo pregled literature koja se odnosi na procjenu fetalne makrosomije, naročito u žena s GDM-om

Idiopathic hypoparathyreoidism, reversible cardiomyopathy and nephrogenic diabetes insipidus - case report

We are presenting a case of a 36-year-old patient with idiopathic hypoparathyroidism and reversible dilated cardiomyopathy as a result of hypocalcaemia. Twelve years later, the patient presented a picture of nephrogenic diabetes insipidus, which according to available literature has so far not yet been described

Discussion on "Utopia and Inaugural Paradox", a Book by Gordana Bosanac

Ova četiri teksta prilagođena su izlaganja o knjizi Gordane Bosanac "Utopija i inauguralni paradoks", održana prigodom njezina predstavljanja. Predstavljanje se, uz raspravu, odvijalo u Klubu sveučilišnih nastavnika u Zagebu 24. listopada 2005.These four contributions are adapted talks on Gordana Bosanac\u27s book "Utopija i inauguralni paradoks" ("Utopia and Inaugural Paradox"), delivered on the occasion of its presentation. This presentation took place at the Croatian University Teacher\u27s Club in Zagreb on 24th October 2005

Discussion on "Utopia and Inaugural Paradox", a Book by Gordana Bosanac

Ova četiri teksta prilagođena su izlaganja o knjizi Gordane Bosanac "Utopija i inauguralni paradoks", održana prigodom njezina predstavljanja. Predstavljanje se, uz raspravu, odvijalo u Klubu sveučilišnih nastavnika u Zagebu 24. listopada 2005.These four contributions are adapted talks on Gordana Bosanac\u27s book "Utopija i inauguralni paradoks" ("Utopia and Inaugural Paradox"), delivered on the occasion of its presentation. This presentation took place at the Croatian University Teacher\u27s Club in Zagreb on 24th October 2005

Atypical clinical presentation of an acute abdomen

Prikazali smo slučaj šezdesetogodišnjeg bolesnika s atipičnom kliničkom slikom akutnog abdomena. Bio je bezbolnog trbuha, uz očuvano, spontano pražnjenje crijeva. Atipičnoj prezentaciji akutnog abdomena kod našeg bolesnika mogli su pridonijeti prethodno preboljeli moždani udar i šećerna bolest.We have presented a case of a sixty-year-old patient with atypical clinical manifestations of acute abdomen: the abdomen was painless with preserved spontaneous bowel movement. Stroke and diabetes could contribute to such an atypical presentation

Preživljenje fetusa određeno utjecajem 5-azacitidina na placentu

DNA methylation as a regulatory mechanism for mammalian gene expression is involved in the process of placentation as well as foetal development. 5azaC is a demethylating agent, which incorporates into DNA instead of cytosine and prevents its methylation, subsequently changes expression of genes involved in normal placental and foetal development. Single dose of 5azaC (5 mg/kg) was administered to pregnant rats at 11th, 12th and 13th day of gestation. Placentas and foetuses were isolated at day 20, weighted and histologicaly analyzed. After 5azaC administration on the 11th day of gestation, treated placentas were significantly smaller and labyrinth was significantly reduced. Consequently complete foetal resorption occurred. When administrated at day 12 of gestation, labyrinth was slightly recovered and 24% foetuses survived, while after its application at 13th day of gestation, almost normal distribution of placental layers was found and survival was 96%. These results confirmed epigenetic influence upon placental development. 5azaC caused changes in its structure, especially the reduction of labyrinth that is crucial for foetal survival. After establishment of normal placental layers distribution, 5azaC has no impact on placental morphology, neither on foetal survival. On the other hand, the influence of 5azaC remains visible in appearance of foetal malformations.Metilacija DNA kao regulatorni mehanizam ekspresije gena u sisavaca uključena je kako u procese placentacije tako i razvitka fetusa. Demetilacijsko sredstvo 5azaC ugrađuje se u DNA umjesto citozina i sprječava njegovu metilaciju, što ima za posljedicu promijenjenu ekspresiju gena uključenih u normalnu placentaciju i fetalni razvitak. Trudne ženke Fisher soja štakora tretirane su s 5 mg/kg 5azaC jedanaestog, dvanaestog i trinaestog dana gestacije. Dvadesetog dana gestacije izolirani su, izvagani i histološki analizirani kako fetusi tako i placente. Nakon primjene 5azaC jedanaestog dana gestacije, tretirane placente bile su značajno manje, a labirint reduciran, zbog čega je uslijedila potpuna resorpcija fetusa. Dvanaesti dan primjene 5azaC rezultirao je blagim povećanjem labirinta, a preživljenje fetusa bilo je 24%. Tek trinaestog dana aplikacije 5azaC uspostavila se normalna distribucija labirinta i bazalnog sloja s preživljenjem od 96%. Dobiveni rezultati potvrđuju epigenetski utjecaj na razvitak placente. Primjena 5azaC uzrokovala je promjene u strukturi placente, osobito redukciju labirinta čija je uloga očito ključna za preživljenje fetusa. Nakon uspostave normalne građe placente, 5azaC više nije imao utjecaja na njezinu morfologiju niti na preživljenje fetusa. S druge strane, njegov je teratogeni utjecaj ostao i dalje vidljiv na fetusima u obliku različitih malformacija