Umbilical cord wrapping and enlargement in monochorionic monoamniotic twins with letal outcome

We present the case of tapered umbilical cords in monoamniotic monocorial twins with late abortion as an outcome. A pregnant woman at the age of 38 had healthy course of her second pregnancy. In the 9th week of gestation, an monoamniotic monocorionic pregnancy was diagnosed by ultrasound. Early amniocentesis was done due to the older age of a mother. During the procedure an enlargement of the umbilical cord was discovered, and the wrapping of the two umbilical cords. Mosaic trisomy of the 21st chromosome was proved. In the 19 w + 3 d gest., negative heart beats were detected for both of fetuses. The induction of abortion was initiated by prostaglandin vaginal gel (dinoprost). There were no signs of maceration, the weights were 230 and 190 grams, with increased and wrapped umbilical cords. The pathohistological fi nding confi rmed monochorionic-monoamniotic twin pregnancy with a long and tightly knit umbilical cord with complete blood fl ow obstruction and no signs of fetal malformalities. Also, there were no clinical signs of fetal transfusion syndrome. It is probably that the umbilical cord of the second twin was hypoplastic and with more complications

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

Zadovoljstvo roditelja zdravstvenom skrbi djece u Klinici za dječje bolesti Zagreb

Aim. The goal of the research is to assess parent satisfaction with children’s health care in the Children’s Hospital Zagreb and to determine whether there were differences in their assessment with regard to the clinic at which the child is hospitalized. Methods. The sample included 160 participans (parents of children hospitalized in the Clinic for Pediatric Surgery and the Pediatric Clinic in the Children’s Hospital Zagreb). As a research method an anonymous modified Picker questionnaire was used. Participation in the research was voluntary. Results. 36.9% of respondents think that their children’s health care is excellent, 43.8% think it is very good and 15% think it is good. 58.1% of parents believe that their child was frightened during hospitalization. 53.8% of respondents rated the hospital food as good, 98.8% of them said they have confidence and trust in the doctors and nurses who take care of their child. 4.4% of parents felt they were not sufficiently involved in decision-making about their child. 72.5% of children during hospitalization felt pain. Parents of children hospitalized in surgical departments have a better opinion of alleviating pain. Conclusions. 81% of respondents assesed the care of their child as very good or excellent and there is no significant difference in satisfaction with regard to the clinic at which the child is hospitalized. The variables found to have a correlation with the total satisfaction score are: a sense of confidence and trust in doctors, psychological preparation of the child, parents’ perception of participating in their child’s care, quality of the food, perception of parents about safety on the ward.Cilj. Procijeniti stupanj zadovoljstva roditelja zdravstvenom skrbi djece u Klinici za dječje bolesti Zagreb te utvrditi postoje li statistički značajne razlike u procjeni zadovoljstva roditelja zdravstvenom skrbi djece s obzirom na kliniku pri kojoj je dijete hospitalizirano. Metode. Ispitanici su roditelji djece hospitalizirane na Klinici za pedijatriju i Klinici za dječju kirurgiju pri Klinici za dječje bolesti Zagreb (njih 160). Primijenjen je modificirani upitnik za procjenu zadovoljstva roditelja bolničkom skrbi djece prema Institutu Picker. Sudjelovanje u istraživanju bilo je dobrovoljno. Rezultati. 36,9 % roditelja smatra skrb odličnom, 43,8 % vrlo dobrom, 15 % dobrom. Da je skrb prihvatljiva smatra 3,8 % ispitanika, a jedan je ispitanik (0,6 %) skrb procijenio kao lošu. 58,1 % ispitanika smatra da je njihovo dijete bilo uplašeno tijekom boravka u bolnici. 53,8 % ispitanika bolničku je hranu ocijenilo dobrom, 98,8 % roditelja izjavilo je kako imaju pouzdanja i povjerenja u liječnike i medicinske sestre koji se brinu o njihovu djetetu. 4,4 % roditelja smatra kako nisu dovoljno uključeni u odlučivanje o skrbi o njihovu djetetu. 72,5 % djece tijekom hospitalizacije osjećalo je bol, samo je jedan roditelj (0,9 %) nezadovoljan tretiranjem boli djeteta, a ispitanici s kirurškog odjela imaju bolje mišljenje o ublažavanju boli. Zaključak. Ukupno 81 % ispitanika smatra da je skrb o njihovu djetetu vrlo dobra ili odlična te ne postoji znatna razlika u procjeni zadovoljstva s obzirom na kliniku pri kojoj je dijete hospitalizirano. Varijable su kod kojih je utvrđena povezanost s ukupnom ocjenom skrbi: osjećaj pouzdanja i povjerenja u liječnike, priprema djeteta za provođenje pretrage, osjećaj roditelja da može sudjelovati u skrbi za dijete, procjena kvalitete bolničke hrane, percepcija roditelja o sigurnosti djeteta na bolničkom odjelu

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

Primary peritonitis in a previously healthy child

Primarni peritonitis se rijetko javlja u dječjoj dobi i zahvaća uglavnom djecu s kroničnim bolestima jetre ili nefrotskim sindromom, a vrlo rijetko se javlja u prethodno zdrave djece. Cilj ovog prikaza je opisati kliničke i radiološke značajke primarnog peritonitisa kod prethodno zdravog djeteta.Primary peritonitis rarely occurs in childhood, affecting mainly children with chronic liver disease or nephrotic syndrome, but occurs very rarely in previously healthy children. The aim of this case report is to describe the clinical and radiological features of primary peritonitis in a previously healthy child

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

Kirurški sustavan pregled (kliničko-patohistološka korelacija) u Klinici za dječje bolesti Zagreb

Unatoč iskustvu kirurga, kvalitetno uzetoj anamnezi, kvalitetnom kliničkom pregledu te suvremenoj radiološkoj dijagnostici, do pouzdane i konačne dijagnoze dolazimo temeljem patohistološke dijagnoze. Patohistološka analiza započinje biopsijom ili operacijom nakon koje se uzorak tkiva stavlja u fi ksativ. Fiksacijom se tkivo stabilizira, sprječavajući njegovo propadanje. Uzorci tkiva režu se na tanke slojeve koji se nakon fi ksiranja na predmetno stakalce standardno boje kombinacijom hematoksilina i eozina. Standardno bojenje se prema potrebi nadopunjuje histokemijskim ili imunohistokemijskim metodama, ovisno o odluci patologa. Izgled promjene može prikriti njen karakter te je stoga nužna suradnja između liječnika operatera i patologa (1, 2). Točnost u potvrđivanju kliničkih dijagnoza mjerljiva je komponenta svakog cjelovitog programa osiguranja kvaliteta i prognostičke korisnosti. Do danas je zlatni standard za provjeru kliničkih dijagnoza, bez obzira na organski sustav i klasifi kaciju bolesti, bila i ostala patohistološka dijagnoza (3)