Physical principles of gamma knife

Gama nož je otprilike 18 tona težak uređaj koji ima kao izvor gama zračenja kobalt-60. S vremenom se tehnički usavršava i početkom 80-ih godina prošlog stoljeća u kliničku uporabu ulazi model s 201 fotonskim snopom raspoređenim u polusferni prsten omogućavajući dobivanje više izocentričnih raspodjela apsorbirane doze za koje je svojstvena visoka geometrijska prilagođenost raspodjele doze tumoru te visoki gradijent doze. Predstavlja revolucionarno otkriće u području medicine i postavlja temelj razvoja stereotaktičke radiokirurgije. Riječ je o metodi prostornog navođenja snopova ionizirajućeg zračenja pomoću metalnog stereotaktičkog okvira radi precizne terapije malih, patoloških procesa unutar lubanje. Gama nož se danas uspješno upotrebljava kod raznih intrakranijalnih indikacija kao što su tumori hipofize (dobroćudni i zloćudni), meningeomi, liječenja arteriovenskih malformacija (AVM) i trigeminalne neuralgije. Radiokirurški principi kakve poznajemo još iz prošlog stoljeća, danas su prošireni i na ekstrakranijalne indikacije kao što su pluća, leđna moždina i tumori jetre. Neinvazivnost, odlični rezultati u kontroli rasta tumora i izlječenja uz smanjen broj dana hospitalizacije bolesnika u odnosu na druge terapijske modalitete, daje gama nožu sve veću prednost i mjesto u kliničkoj praksi.Gamma knife is approximately 18-ton machine that use gamma emitter cobalt-60 as a source. Over time, gamma knife was technically perfected and in early 80’s in clinical use enters the model with 201 photon beam arranged in a hemispheric ring which allows getting more isocentric distribution of absorbed dose that is characteristic of high geometric adjustment of dose distribution and high tumor dose gradient. It represents a breakthrough in the medical field and sets the basis for the development of stereotactic radiosurgery. This is a method of physical guidance beams of ionizing radiation by using a metal stereotactic frame, in order to cure small, pathological processes within the skull. Gamma knife has been successfully used for various intracranial indications such as pituitary tumors (benign and malignant), meningiomas, treatment of arteriovenous malformations (AVM) and trigeminal neuralgia. Radiosurgical principles of what we know from the last century, are now extended to extracranial indications such as lung, spinal cord and liver tumors. Its noninvasiveness, excellent results in controlling tumor growth and healing with a reduced patient’s number of days of hospitalization over other therapeutic modalities, gives the gamma knife advantage and increasing rate of usage in the clinical practice

Recidivirajući prolaps zdjeličnih organa kod 27-godišnje bolesnice s prirođenom ekstrofijom mokraćnog mjehura: prikaz slučaja

Bladder exstrophy (BE) is a rare congenital malformation estimated to occur in up to 1/250,000 female live births. The evidence supporting the incidence, uterine preservation and its overall fertility rate in patients with pelvic organ prolapse (POP) and BE is not precisely determined. We report a case of BE and POP in a 27-year-old nulliparous Caucasian. Due to the patient’s strong fertility desire, considering her extensive surgical history background, our approach was to correct POP via the Manchester-Fothergill procedure. After 36 months, the patient was still asymptomatic with no evidence for prolapse recurrence. This case demonstrates diagnostic challenges and surgical dilemmas in treatment strategy for patients with BE and co-existent POP. Furthermore, routine longterm surveillance is necessary in terms of renal function, urinary continence, malignancy and possible obstetric issues.Ekstrofija mokraćnog mjehura je rijetka prirođena malformacija za koju se procjenjuje da se javlja u do 1/250.000 ženske novorođenčadi. Prema trenutnim literaturnim navodima imamo nedovoljno podataka o incidenciji i ukupnoj reproduktivnoj sposobnosti žena koje istodobno uz ekstrofiju mokraćnog mjehura imaju i prolaps zdjeličnih organa. Prikaz slučaja obuhvaća naše iskustvo liječenja 27-godišnje bolesnice s prirođenom ekstrofijom mokraćnog mjehura i recidivirajućim prolapsom zdjeličnih organa. S obzirom na snažnu želju bolesnice za očuvanjem plodnosti te uzimajući u obzir njezinu opsežnu kiruršku povijest, naš pristup je podrazumijevao ispravak prolapsa zdjeličnih organa pomoću operacije po Manchester-Fothergillu. Nakon 36 mjeseci bolesnica je i dalje bez simptoma te bez ikakvih kliničkih dokaza recidiva prolapsa. Ovaj slučaj naglašava dijagnostičke izazove i kirurške dileme u strategiji liječenja bolesnica s ekstrofijom mokraćnog mjehura i istodobnom pojavom prolapsa zdjeličnih organa. Također, važno je naglasiti dugotrajno rutinsko praćenje u vidu kasnije bubrežne funkcije, moguće inkontinencije mokraće, maligniteta i mogućih opstetričkih komplikacija

Tubal factor infertility: which is the possible role of tubal microbiota? A fresh look to a busy corner focusing on the potential role of hysteroscopy.

There is a growing body of evidence regarding the importance of the urogenital microbiota associated to reproductive outcomes, both for achieving pregnancy naturally or with the use of assisted reproductive technology (ART). The role of the vaginal and endometrial microbiota in potential infertility can be applied to the tubal milieu, which is currently a hot topic in clinical research. Given that the incidence of tubal infertility factor is constantly increasing, and the incidence of previously known infectious causes is declining, it is extremely important to encourage research to identify the real composition of the tubal microbiota. On the other hand, the potential importance of the role of hysteroscopy in elucidating tubal infertility factor is currently underestimated and not completely clarified. This short review article presents the most recent evidence on the possible role of tubal microbiota on female infertility, focusing on the role of its potential diagnostic effectiveness and, in particular, on the role of hysteroscopy

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

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

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

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

ENDOMETRIOSIS, PAIN AND MENTAL HEALTH

Background: Endometriosis is a chronic and progressive disease which can significantly affect a woman\u27s personal, as well as intimate and professional aspects of life. The aim of this study was to asses health-related quality of life and mental health status in patients with endometriosis, investigating also their relationship with endometriosis-related comorbid symptoms and conditions, such as pain and infertility. Subjects and methods: An observational cross-sectional study involved 79 women with endometriosis. All patients filled the Endometriosis Health Profile (EHP-5), the Depression Anxiety Stress Scales (DASS-21) and the Visual Analogue Scale (VAS). Their medical data were retrieved from medical records. Data was analyzed using the SPSS 23.0 (IBM Corp., Armonk, NY). Results: Of all the patients evaluated in our study, 44.3% presented depressive symptoms and 25.3% presented anxiety, while 31.7% reported stress symptoms. Moderate correlations were found between results on EHP-5 and depression (r=0.515), stress (r=0.558) and VAS score (r=0.565). Furthermore, weak positive relationship was observed between EHP-5 and anxiety (r=0.295) and infertility (r=0.267). Additionally, moderate correlation was found between depression and infertility (r=0.519), while there was weak association between VAS score and stress (r=0.236). Conclusions: This study showed complex relationships between symptoms and conditions manifesting in patients with endometriosis. Due to diversity of symptoms, potentially including mental health issues, it is important to emphasize the need for combined personalized treatment for these patients, taking into account both physical and psychological aspect of the disease

Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?

Uterine cervical intraepithelial abnormalities and cancer development may also depend upon biological problems that arise as a result of complex molecular disturbances within the vaginal space, in addition to the widely known causative effect of human papillomavirus (HPV) infection. Chronic oxidative stress is a consequence of oxygen reduction in the vaginal space. Reactive oxygen species (ROS) and free radicals are yet unrecognizable causative agents and are probably very important factors for cervical intraepithelial neoplasia (CIN) and cancer development. The intermediate compounds of oxygen reduction on these metabolic pathways are superoxide anion (O2˙-), hydrogen peroxide (H2O2), hydroxide ions (OH-), and hydroxyl radical (HO˙). Considering these points, the aim of this work was to summarize how these compounds can damage all molecules, including DNA, of vulnerable metaplastic cervical epithelium. Finally, in some women with a poor immune defense system, ROS alone or accompanied by a high-risk HPV type may promote all levels of CIN and cancer development