Laparoscopic management of interstitial pregnancy: case report

Resekcije roga uterusa ili histerektomije, tradicionalno su se izvodile kod liječenja intersticijske trudnoće u slučajevima teško oštećene maternice. Suvremena medicina u ovakvim slučajevima razvila je poštednije operativne zahvate uključujući laparoskopsku metodu liječenja koja je unijela dodatne opcije zbrinjavanja bolesnica s intersticijskom trudnoćom. Ovaj prikaz slučaja opisuje neuobičajenu kliničku prezentaciju, te zbrinjavanje intersticijske trudnoće laparoskopskim putem i osvrt na tehnike i ishode konzervativnog popravka uterusa koji su prijavljeni u literaturi.The traditional treatment of interstitial pregnancy has been horn resection or hysterectomy in cases with severely damaged uteri. Recently, more conservative operations have been developed, and operative laparoscopy has provided yet another management option. This report describes the unusual presentation of symptoms, laparoscopic management of large interstitial pregnancy and reviews the techniques and outcomes of conservative repair that have been reported in literature

Laparoscopic management of interstitial pregnancy: case report

Resekcije roga uterusa ili histerektomije, tradicionalno su se izvodile kod liječenja intersticijske trudnoće u slučajevima teško oštećene maternice. Suvremena medicina u ovakvim slučajevima razvila je poštednije operativne zahvate uključujući laparoskopsku metodu liječenja koja je unijela dodatne opcije zbrinjavanja bolesnica s intersticijskom trudnoćom. Ovaj prikaz slučaja opisuje neuobičajenu kliničku prezentaciju, te zbrinjavanje intersticijske trudnoće laparoskopskim putem i osvrt na tehnike i ishode konzervativnog popravka uterusa koji su prijavljeni u literaturi.The traditional treatment of interstitial pregnancy has been horn resection or hysterectomy in cases with severely damaged uteri. Recently, more conservative operations have been developed, and operative laparoscopy has provided yet another management option. This report describes the unusual presentation of symptoms, laparoscopic management of large interstitial pregnancy and reviews the techniques and outcomes of conservative repair that have been reported in literature

Clinicopathological characteristic and prognostic factors for FIGO stage 1A2-1B2 of cervical cancer

Introduction: Cervical cancer is one of the most common malignant tumors of the female reproductive system in women between 15-35 years of age. It takes third place in the frequency of all reproductive system cancers in Croatia. The aim of the present study was to analyze prognostic factors influencing on reccurence to improve therapeutic management. Materials and Methods: We reviewed medical records and pathological materials obtained from 61 patients with stage IA2-IB2 between 2003 and 2013. The comparison of women with and without recurrence showed statistical significance in certain factors; age when diagnosed, size of tumor, depth of stromal invasion, lymph vascular space invasion, infiltration of the uterine isthmus and lymph node metastases. Results: Median age at diagnosis was 46 years. Lymph-vascular space invasion (LVSI) was present in 22 (36.1%) with cervical isthmus involvement in 18 (29.5%) patients. Tumor recurrence within observation interval was present in 6 (9.8%) patients. Median time of reccurrence was 24 (range 14-48) months. In univariate statistical analysis lymph-vascular space invasion (P=0.011), cervical isthmus involvement (P=0.002) and positive lymph nodes (P=0.005) were significant parameters for occurrence of recidive while in multivariate statistical analysis cervical isthmus involvement (P=0.036) remained as only independent risk factor for recidive occurrence. Conclusion: Cervical isthmus involvement could be of prognostic importance especially in the early stage of cervical cancer when we might decide in adding radiotherapy and concomitant chemotherapy to improve overall survival and lower recurrence rate

Primjena diodnog lasera u histeroskopiji: što trenutno znamo i što možemo očekivati u budućnosti?

Histeroskopija je metoda vizualizacije šupljine maternice koja se koristi u svrhu dijagnosticiranja i liječenja intrakavitarne patologije. Zahvaljujući razvoju tehnike uloga histeroskopije mijenjala se od dijagnostičke, preko operativne u operacijskoj dvorani, do operativne u ambulantnom okruženju. Cilj ovog preglednog članka je analizirati uporabu diodnog lasera u histeroskopiji i minimalno invazivnim postupcima u području ginekologije, raspravljajući o pozitivnim i negativnim aspektima ove tehnologije s posebnim osvrtom na buduće primjene i perspektive u području ambulantne kirurške histeroskopije

Does assisted reproductive technology increase adverse perinatal outcome in preterm twins ? A hospital based comparative study at a single tertiary center in Croatia

Objective: The aim of this study is to investigate the association of assisted reproductive technology (ART) as an independent risk factor for obstetric complications and perinatal outcome in preterm twin pregnancies in 5 years period at a single tertiary center. Methods: We collected the data (from maternal and neonatal medical records) from 88 preterm twin pregnancies conceived after ART and 147 preterm twin pregnancies conceived naturally in a 5-year period. Results: Pregnancy complications in ART mainly included preterm premature rupture of membranes, gestational hypertension and gestational diabetes. More than 85% of ART twins were born by caesarean section, significantly higher than non-ART twins (p = 0.005). Neonatal complications in both groups mainly included low Apgar score in 1st minute, perinatal infections, respiratory distress syndrome (RDS) and hyperbilirubinemia and the incidences of these complications were comparable between the groups. According to Weinberg’s differential rule, there were 32 monozygotic ART twins and 119 monozygotic non-ART twins. This represents a monozygotic twin rate of 4.7% for ART births and 0.6% for non-ART births. Conclusion: Our results indicated that ART procedures were not associated with adverse perinatal outcome and that ART is not associated with increased obstetric complications in preterm twins followed and born in a single tertiary center

Učinak liječenja antiepilepticima u trudnoći na perinatalne ishode u Republici Hrvatskoj - iskustvo jednog centra

Pregnancy can alter the natural course of epilepsy and affect pharmacokinetic profile of antiepileptic drugs (AEDs) making therapeutic management more demanding. Since there is no relevant population-based study in Croatia to date, we conducted this research with the aim to observe antiepileptic treatment policy in pregnancy and to determine if the number of AEDs affects pregnancy outcomes. The study included all women with epilepsy with singleton pregnancy exposed to one or more AEDs divided into two groups (group 1: one AED and group 2: more than one AED used). Data were collected retrospectively at the Department of Obstetrics and Gynecology, Zagreb University Hospital Centre, Zagreb, Croatia, and included 153 women from January 2010 to December 2018. Primary outcomes included rates of preterm delivery, major fetal malformations, gestational hypertension, cesarean section rate, and appearance of seizures during pregnancy. We found higher rates of all pregnancy complications examined than in the general population, while comparison of the two study groups yielded significant differences. Preterm labor was detected in 30% of deliveries in polytherapy group compared to 16.6% in monotherapy group (p=0.03). Gestational hypertension was recorded in 20% of women in polytherapy group vs. 4.90% in monotherapy group (p=0.009). There was also a high rate of cesarean deliveries in polytherapy group (27.5%). Seizures during pregnancy occurred in 48.4% of patients in polytherapy group, which was significantly higher than the rate recorded in monotherapy group (p=0.015). In this single-center retrospective study, women with epilepsy using AEDs during pregnancy had a higher rate of gestational hypertension and preterm delivery than the general population of pregnant women. To the best of our knowledge, this is the first study in Croatia observing antiepileptic treatment policy in pregnancy with regards to AED regimen and perinatal outcome.Trudnoća može izmijeniti prirodni tijek epilepsije i utjecati na farmakokinetiku antiepileptika (AED), što dodatno otežava liječenje. Budući da do danas u Hrvatskoj ne postoji relevantno populacijsko istraživanje, proveli smo istraživanje s ciljem promatranja načina primjene AED-a u trudnoći i utvrđivanja utječe li broj primijenjenih AED-a na ishode trudnoće. Istraživanje je obuhvatilo sve žene s epilepsijom i jednoplodnom trudnoćom izložene jednom ili više AED-a podijeljenih u dvije skupine (1. skupina: monoterapija i 2. skupina: politerapija). Podaci su prikupljeni retrospektivno u Klinici za ženske bolesti i porode KBC Zagreb i pritom su uključene 153 žene od siječnja 2010. do prosinca 2018. godine. Primarni ishodi uključivali su stope prijevremenih porođaja, velike fetalne malformacije, gestacijsku hipertenziju, stopu carskog reza i pojavu epileptičkih napadaja tijekom trudnoće. Pronašli smo veću stopu svih ispitivanih komplikacija u trudnoći nego u općoj populaciji, dok je usporedba dviju ispitivanih skupina pokazala značajne razlike. Prijevremeni porođaj otkriven je u 30% porođaja u skupini koja je primala politerapiju u usporedbi sa 16,6% u skupini koja je primala monoterapiju (p=0,03). Gestacijska hipertenzija zabilježena je u 20% žena u skupini koja je primala politerapiju u odnosu na 4,90% u skupini koja je primala monoterapiju (p=0,009). Također je bila visoka stopa porođaja dovršenih carskim rezom u skupini koja je primala politerapiju (27,5%). Napadaji tijekom trudnoće dogodili su se u 48,4% bolesnica u skupini koja je primala politerapiju, što je bilo značajno više od stope zabilježene u skupini koja je primala monoterapiju (p=0,015). Zaključno, žene s epilepsijom koje su primale AED tijekom trudnoće imale su veću stopu gestacijske hipertenzije i prijevremenih porođaja u usporedbi s općom populacijom trudnica. Prema dosadašnjim spoznajama, ovo je prvo istraživanje u Hrvatskoj koje promatra obrasce antiepileptičkog liječenja u trudnoći s obzirom na režim AED i perinatalni ishod

Prognostic factors in endometrial carcinoma - a single-center study

Endometrial cancer (EC) is the fourth most common cancer in women in Croatia and the second most common gynecological malignancy with the trend of increasement in incidence. The aim of this single-centre study was to analyze ECs clinical and pathological characteristics and to assess the correlation between risk factors and the reccurence of the disease. We retrospectively reviewed medical records of 174 women that were diagnosed with endometrial cancer between January 2011 and May 2015. Among the women that were diagnosed ECs in the patohistologic specimen, histologic subtype, grade, cancer stage, depth of myometrial tumor invasion, presence of lymph-vascular space involvement (LVSI), lower uterine segment or surface cervical glandular involvement were documented. In addition, women’s age, BMI, number of successful deliveries and comorbidities (diabetes mellitus and hypertension) were obtained and incorporated in the statistical analysis. We demonstrated a strong corellation between higher tumor grade, deeper myometrial invasion, presence of lymphovascular space invasion and disease reccurence in our cohort. Due to rapid increasement in incidence, further education, increasement of public awareness, measures for prevention, diagnostic procedures and advances in therapy are imperative to decrease the overall morbidity and mortality rate

Application of UAS for Monitoring of Forest Ecosystems – A Review of Experience and Knowledge

In the last couple of years, there have been a great number of articles that cover and emphasize the advantages and possibilities that UAS (Unmanned Air System) offers in forest ecosystem research. In the available research, alongside UAS, the importance of developing sensors that are designed to be used with UAV (Unamnned Air Vehicle), a flight programming software and UAS collected data processing software have been pointed out. With the widespread use of high-precision sensors and accompanying software in forestry, it is possible to obtain accurate data in a short time that replaces long-term manpower in the field with equal or in some cases, such as windthrow calculation or wildlife counting, greater accuracy. The former practice of manual imagery processing is being partly replaced with automated approaches. The paper analyses studies that deal with some form of application of UAS in forestry, e.g. forest inventory, forest operations, ecological monitoring, forest pests and forest fires, and wildlife monitoring. In the forest inventory, a large number of studies deal with the possibilities of applying UAS in mapping vegetation and individual trees, morphological research of individual parts of trees, surface analysis, etc. The use of remote and proximal sensing technologies in forest engineering has mainly been focused on defining surface roughness and topology, road geometry, planning and maintenance, ground-based and cable-based harvesting and soil characteristics and displacement. Wildfire monitoring already relies heavily on the use of UAS and thermal cameras in operations, and it is similar to the mapping of windthrow or directions of the spread of certain insects important for forestry. In wildlife research, numerous studies deal with abundance research of individual terrestrial birds and mammals using UAS thermal imagery. With some drawbacks such as wildlife disturbance or limited UAV range, common to most of the processed studies are positive attitudes regarding the application of UAS in forestry sensing and monitoring, which is slowly becoming a common operative practice, with the scientists’ focus being on developing automated approaches in UAS imagery processing. Reducing the error by improving the technological characteristics of the sensors will in the long run reduce the number of people required to collect data important for forestry, reduce risks and in some cases increase accuracy