Endometrioza u ožiljku troakara

A 24-year-old patient had an 8-month history of intense cyclic pain at the suprapubic trocar scar region. Two years earlier, the patient underwent operative laparoscopy during which endometrioma of the left ovary was removed. We present a case of endometriosis at a suprapubic trocar scar, which, to our knowledge, has previously been described in literature only once. Another rarity involved in this case is that the scar endometriosis developed after the removal of ovarian endometrioma. The most probable source of the trocar scar endometriosis is remnants of the tissue that remained in the abdominal wall during extraction of endometrioma.Prikazujemo slučaj endometrioze koja se razvila u ožiljku insercije 10-milimetarskog suprapubičnog troakara. Takav slučaj je, prema našim saznanjima, dosad u literaturi opisan samo jednom. Dodatna rijetkost vezana uz ovaj prikaz slučaja jest da se endometrioza u ožiljku razvila nakon odstranjenja ovarijskog endometrioma. Vjerojatni mehanizam nastanka je vitalno endometriotično tkivo zaostalo u trbušnoj stijenci pri ekstrakciji endometrioma

A case of septate uterus with double cervix and longitudinal septum of vagina

The incidence of Mullerian duct anomalies is around 3% in patients with infertility or poor reproductive outcomes. Most Mullerian duct anomalies are associated with a single cervix. However, double cervix can also be associated with bicornuate and septate uterus. We present a rare case of patient with septate uterus, double cervix and longitudinal septum of the vagina, successfully treated by hysteroscopy and laparoscopy with subsequent successful pregnancy outcome

EXTRAUTERINE PREGNANCY FOLLOWING LAPAROSCOPIC TUBAL STERILIZATION– A CASE REPORT

Prikazan je slučaj pacijentice koja se nakon devet trudnoća odlučila na laparoskopsku sterilizaciju tuba. Godinu dana nakon izvedene operacije zanijela je izvan maternice. Kod ponovne laparoskopske operacije primijećeno je da je zahvat sterilizacije godinu dana ranije učinjen kirurški korektno, to jest da obostrano nedostaje istmični dio jajovoda u dužini od oko 3 cm. Unatoč tomu, nađena je trudnoća u ampularnom dijelu desnog jajovoda.. The case of a patient who following nine pregnancies decided to undergo laparoscopic electrocoagulation of the tubes is presented. The patient subsequently became pregnant with an extrauterine pregnancy. At a new laparoscopic procedure it was prooved that laparoscopic electrocoagulation of the tubes a year ago was performed surgically correctly, with isthmic part of both tubes destroyed at a length of approximately 3 cm. This unfortunately did not prevent subsequent extrauterine pregnancy in the right ampular part of the tube

Clinical, Hormonal and Metabolic Characteristics of Polycystic Ovary Syndrome among Obese and Nonobese Women in the Croatian Population

Obesity has a deteriorating impact on women with PCOS, although prevalence and the impact of specific traits of PCOS remain inconstant in different populations. Therefore, the aim of this study was to explore the differences in clinical, hormonal and metabolic features between obese and nonobese Croatian women diagnosed as having PCOS according to Rotterdam consensus criteria. The study included 74 obese and 208 nonobese women with PCOS. Clinical, biochemical and metabolic variables were compared among those PCOS subgroups. Obese subjects with PCOS had a higher risk of developing oligo-amenorrhea (OR 3.7; 95% CI, 1.1–12.5) and lower risk for developing hirsutism and acne (OR 0.2; 95% CI, 0.1–0.3 and OR 0.8; 95% CI 0.5–1.4, respectively). Obese PCOS subjects also had a higher risk of developing hyperandrogenemia (OR 2.5; CI 95% 0.9–6.7), insulin resistance (OR 4.5; CI 95%, 2.6–7.9), hypercholesterolemia (OR 5.0, CI 95% 2.5–10.2), hypertriglyceridemia (OR 5.2; 95% CI, 2.9–9.2) as well as elevated serum CRP levels (OR 4.1; 95% CI 1.4–12.2) compared to nonobese PCOS women. In conclusion, nonobese Croatian women with PCOS are more inclined to cosmetic problems associated with PCOS then metabolic ones. This is the first study to report the impact of obesity on acne and irregular menses as a study outcome. Obesity deteriorates menstrual regularity, insulin sensitivity and lipid profile in Croatian women with PCOS; therefore one of the fundamental treatment strategies of PCOS should be obesity prevention

EXTRAUTERINE TWIN PREGNANCY FOLLOWING IN VITRO FERTILISATION – A CASE REPORT

Izvanmaternična blizanačka trudnoća je vrlo rijetka pojava i do sada ih je opisano tek nešto preko 100 slučajeva. Prikazana je 32-godišnja bolesnica s jednostranom blizanačkom trudnoćom u lijevom jajovodu koja je zanijela nakon šest-godišnje neplodnosti, salpingostomije i postupka izvantjelesne oplodnje. Transvaginalnim ultrazvukom je u 6. tjednu trudnoće prikazano prazno materište s odebljanom deciduom, a u predjelu lijevih adneksa dvije prazne gestacijske vreće. Pri operacijskoj laparoskopiji potvrđena je dijagnoza i odstranjen je lijevi jajovod. Analizirani su potencijalni uzročni čimbenici u nastanku bolesti te dijagnostičke metode i načini liječenja.Twin ectopic pregnancies are extremely rare and there are harderly 100 reported cases of twin tubal gestations. An unusual case of an intact unilateral ectopic twin pregnancy in the 6th week of gestation of a 32-year old patient with 6-year infertility, after left salpingostomy and in vitro fertilisation and embryo transfer is presented. Transvaginal sonography confirmed the presence of an intense decidual reaction and the left adnexal mass was determined to contain two gestational sacs without embryos. The patient was managed successfully by operative laparoscopic salpingectomy. Factors that contribute to the risk of ectopic pregnancies, diagnosis and the management of this condition are described

Reforma zdravstvenog sustava

Najveći problem u provođenju reforme zdravstvenog sustava je stanje opće rezignacije ( kako pučanstva tako i profesionalaca ) tako da potrebu za reformom ne ističe niti jedna interesna skupina, pa je prvi zadatak naše male skupine da nametnemo temu. Kako da u zemlji u kojoj je "ŽUJA ZAKON" , "DINAMO JE SVETINJA, OSTALO JE SRANJE" uspijemo istaknuti problem zdravlja, kao polaznu osnovu uspješnog sveopćeg oporavka

Usporedba dviju izvornih tehnika rekonstrukcije stijenke maternice pri laparoskopskoj enukleaciji intramuralnog mioma

The optimal technique of uterine wall reconstruction during laparoscopic enucleation of intramural fibroid is still not defined. Two original laparoscopic techniques were compared in the current study on 60 patients with an intramural fibroid with a diameter of between 3-10 cm. In 44 patients the uterine wall was sutured with the single suture technique, using monofilament suture for open surgery, knotted extracorporeally in Weston gliding knot and tied using originally designed reusable knot pusher. (SS) In 16 patients the uterine wall was reconstructed using the originally developed technique of single continuous spiraling suture (SCSS) using monofilament suture for open surgery, tied extracorporeally with Clarke-Reich knot pusher. There was no significant difference in the age distribution and parity between the two groups of patients, as well as in the distribution of the size of fibroids. The average suturing time in the SS group was 30.9+17 minutes, as compared to 23.3+13 minutes in the SCSS group. No significant difference was observed between these two groups. The median operation time was 100 minutes in both groups. The cost of suturing was 5-fold higher in the SS group since an average number of 4.8 sutures were used for each patient in this group. Since there were neither short-term nor long-term complications in both of patients we conclude that both presented techniques of uterine wall reconstruction after laparoscopic enucleation of intramural fibroids are efficient and safe

Endometrioza u ožiljku troakara

A 24-year-old patient had an 8-month history of intense cyclic pain at the suprapubic trocar scar region. Two years earlier, the patient underwent operative laparoscopy during which endometrioma of the left ovary was removed. We present a case of endometriosis at a suprapubic trocar scar, which, to our knowledge, has previously been described in literature only once. Another rarity involved in this case is that the scar endometriosis developed after the removal of ovarian endometrioma. The most probable source of the trocar scar endometriosis is remnants of the tissue that remained in the abdominal wall during extraction of endometrioma.Prikazujemo slučaj endometrioze koja se razvila u ožiljku insercije 10-milimetarskog suprapubičnog troakara. Takav slučaj je, prema našim saznanjima, dosad u literaturi opisan samo jednom. Dodatna rijetkost vezana uz ovaj prikaz slučaja jest da se endometrioza u ožiljku razvila nakon odstranjenja ovarijskog endometrioma. Vjerojatni mehanizam nastanka je vitalno endometriotično tkivo zaostalo u trbušnoj stijenci pri ekstrakciji endometrioma

Clinical, hormonal and metabolic characteristics of polycystic ovary syndrome among obese and nonobese women in the Croatian population [Kliničke, hormonske i metaboličke karakteristike PCOS pacijentica u Hrvatskoj u ovisnosti o tjelesnoj težini]

Obesity has a deteriorating impact on women with PCOS, although prevalence and the impact of specific traits of PCOS remain inconstant in different populations. Therefore, the aim of this study was to explore the differences in clinical, hormonal and metabolic features between obese and nonobese Croatian women diagnosed as having PCOS according to Rotterdam consensus criteria. The study included 74 obese and 208 nonobese women with PCOS. Clinical, biochemical and metabolic variables were compared among those PCOS subgroups. Obese subjects with PCOS had a higher risk of developing oligo-amenorrhea (OR 3.7; 95% CI, 1.1-12.5) and lower risk for developing hirsutism and acne (OR 0.2; 95% CI, 0.1-0.3 and OR 0.8; 95% CI 0.5-1.4, respectively). Obese PCOS subjects also had a higher risk of developing hyperandrogenemia (OR 2.5; CI 95% 0.9-6.7), insulin resistance (OR 4.5; CI 95%, 2.6-7.9), hypercholesterolemia (OR 5.0, CI 95% 2.5-10.2), hypertriglyceridemia (OR 5.2; 95% CI, 2.9-9.2) as well as elevated serum CRP levels (OR 4.1; 95% CI 1.4-12.2) compared to nonobese PCOS women. In conclusion, nonobese Croatian women with PCOS are more inclined to cosmetic problems associated with PCOS then metabolic ones. This is the first study to report the impact of obesity on acne and irregular menses as a study outcome. Obesity deteriorates menstrual regularity, insulin sensitivity and lipid profile in Croatian women with PCOS; therefore one of the fundamental treatment strategies of PCOS should be obesity prevention

ANTIBIOTIC PROPHYLAXIS FOR HYSTEROSCOPY, D&C, ENDOMETRIAL BIOPSY AND HYSTEROSALPINGOGRAPHY

Cilj rada. Ustanoviti način propisivanja antibiotika pri intrauterinim zahvatima. Materijal i metoda. Analizirano je propisivanje antibiotika u Zavodu za humanu reprodukciju, Klinike za ženske bolesti i porode KBC-a i MF-a u Zagrebu, u razdoblju od 1. siječnja 2007. do 1. travnja 2007. Promatran je način propisivanja antibiotske profilakse trinaestoro liječnika. Rezultat. U promatranom razdoblju učinjena su 144 intrauterina zahvata; histeroskopija i kiretaža. Propisivanje antibitske profilakse zavisilo je isključivo od stila rada pojedinih liječnika, a ne o kliničkoj slici. Učestalost primjene antibiotika je u rasponu od 0% pa do 100%. U liječenih pacijentica nije bilo komplikacija koje bi zahtijevale dodatnu antimikrobnu terapiju. Zaključak. Ne postoji standardni postupnik pri propisivanju antibiotske profilakse. Potrebno je iz temelja revidirati način antibiotske profilakse i time upoznati sve ginekologe koji izvode intrauterine zahvate.Aim of study. Observation of the prophylactic antibiotic use during intrauterine procedures. Method. From Jan. 1st, to Apr. 1st, 2007, in Fertility/Sterility Dept. of Gynecologic Clinic, Zagreb, use of antibiotics was analyzed. Thirteen gynecologists were observed. Results. The 144 intrauterine procedures were performed: hysteroscopies and D&C-s. Antibiotics were recommended between 0% and 100%, even in the same procedure performed by the specific gynecologist. Antibiotic use differed from doctor to doctor and was not related to clinical situation. There were no complications described, regardless of antibiotic use. Conclusion. The prophylactic use of antibiotics during intrauterine procedures has to be revised. All doctors performing such operations should be reeducated