Acute abdomen in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome

Background. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a malformation of female genital tract (incidence 1 in 4000 female newborn children). It appears as a result of a disorder in the development of Millerian cannals. Etiology is unknown. Syndrome MRKH is the most frequent cause of primary amenorrhoea (90%). Patients with MRKH have a normal female phenotype, with normal pubic hairness and thelarche, and female karyotype (46XX) followed by primary amenorrhoea. Hormonal status corresponds to healthy women, where the appearance of ovarian tumors and tumors on rudiment parts of uterus is possible. Case report. We presented a case of acute abdomen in a patient with previously not diagnosed MRKH. The diagnosis was done during the operation. Small pelvis and an abdominal part were filled with torquated tumor lump, where ovaries, oviducts, uterus or something resembling rudiment of uterus were not recognized through careful examination. Furthemore, the patient had a short, dead-end vagina. Tumorectomy was done and hystopathological finding showed the presence of vascular leiomyoma. Conclusion. The diagnosis of complex syndromes, such as MRKH, can, despite modern diagnostics, be absent for non-medical and psycho-social reasons. We can expect ovarian and uterine pathology on hypoplastic structures in these patients, as well as in healthy women. Vascular leiomyoma in the patients with MRKH was not found in the available literature

The role of colposcopy and typization of human papillomavirus in further diagnostic proceedings in patients with ASC-US cytological finding of the uterine cervix

Background/Aim. Bethesda system of classification of cytological findings was introduced in 2001 two subcategories in the category of atypical squamous cells (ASC) findings: ASC of undetermined significance (ASC-US) and ASC which cannot exclude high-grade intraepithelial lesions (ASC-H). The aim of our study was to assess a possible association of these two subcategories with pathologic biopsy finding and to find out the best further diagnostic proceedings. Methods. At the Clinic of Gynecology and Obstetrics, Niš 130 patients with ASC findings were analyzed. Colposcopy was performed in all study participants. Patients with pathological colposcopic findings underwent cervical biopsy. In 10 patients with pathologic histologic and 15 with benign findings human papilloma virus (HPV) typization was done using the Hybrid Capture method. Results. Patients with ASC-H finding had significantly more pathologic biopsies compared with patients with ASC-US finding (57.84: 20.72). Conclusion. Colposcopy was exhibited somewhat higher sensitivity compared to HPV typization (94.7 : 90), but lower sensitivity (79.27 : 86.6). The usage of HPV typization in the triage of patients with ASC cytologic smear induces statistically significant reduction of unnecessary percentage of cervical biopsies

Ascitic Fluid in Ovarian Carcinoma – From Pathophysiology to the Treatment

Due to low symptomatology, a lack of screening, and relatively complicated diagnostic procedures of ovarian carcinoma, more and more women are believed to visit their doctors in advanced stage of the disease, complicated with ascitic fluid. There is an increasing evidence that peritoneal cytology is a subjective assessment with certain percentage of false-positive and false-negative results that may cause application of unnecessary chemotherapy or nonapplication of necessary chemotherapy. Maximal cytoreductive surgery followed by intraperitoneal or systemic chemotherapy remains to be the gold standard in preventing ascites. Ascites is not only a symptom of a disease, but a specific microenvironment for formation and mediation of protumorigenic signals that control ovarian cancer progression, proliferation, invasion, anti-apoptosis, chemoresistance and tumor heterogeneity. Acellular cytokines and immunological factors influence ovarian cancer progression and its ability to prevent immune responses of the body and tumor reaction to chemotherapy. Ascites contributes to disease dissemination, changing its course and final outcomes. Management of patients with ascites and ovarian carcinoma is complex and often the goal of the treatment is to target palliative procedures. Multidisciplinary approach is necessary in the management of these patients. Further investigations of new drugs and immunomodulators are needed aiming at prolonged periods between relapses

Targeting autophagy to modulate cell survival: a comparative analysis in cancer, normal and embryonic cells

Autophagy is linked to multiple cancer-related signaling pathways, and represents a defense mechanism for cancer cells under therapeutic stress. The crosstalk between apoptosis and autophagy is essential for both tumorigenesis and embryonic development. We studied the influence of autophagy on cell survival in pro-apoptotic conditions induced by anticancer drugs in three model systems: human cancer cells (NCI-H460, COR-L23 and U87), human normal cells (HaCaT and MRC-5) and zebrafish embryos (Danio rerio). Autophagy induction with AZD2014 and tamoxifen antagonized the pro-apoptotic effect of chemotherapeutics doxorubicin and cisplatin in cell lines, while autophagy inhibition by wortmannin and chloroquine synergized the action of both anticancer agents. This effect was further verified by assessing cleaved caspase-3 and PARP-1 levels. Autophagy inhibitors significantly increased both apoptotic markers when applied in combination with doxorubicin while autophagy inducers had the opposite effect. In a similar manner, autophagy induction in zebrafish embryos prevented cisplatin-induced apoptosis in the tail region while autophagy inhibition increased cell death in the tail and retina of cisplatin-treated animals. Autophagy modulation with direct inhibitors of the PI3kinase/Akt/mTOR pathway (AZD2014 and wortmannin) triggered the cellular response to anticancer drugs more effectively in NCI-H460 and zebrafish embryonic models compared to HaCaT suggesting that these modulators are selective towards rapidly proliferating cells. Therefore, evaluating the autophagic properties of chemotherapeutics could help determine more accurately the fate of different cell types under treatment. Our study underlines the importance of testing autophagic activity of potential anticancer agents in a comparative approach to develop more rational anticancer therapeutic strategies.Related to published version: [https://imagine.imgge.bg.ac.rs/handle/123456789/1004]This is the peer reviewed version of the paper: Divac Rankov, A., Ljujić, M., Petrić, M., Radojković, D., Pesić, M., & Dinić, J. (2017). Targeting autophagy to modulate cell survival: A comparative analysis in cancer, normal and embryonic cells. Histochemistry and Cell Biology, 148(5), 529–544. [https://doi.org/10.1007/s00418-017-1590-4

Initial management of traumatic brain injury in children in the pediatric intensive care unit

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability in children. Objectives of our study were to determine the most commonly applied measures in the initial care of children with head trauma before admission to the Pediatric Intensive Care Unit (PICU) and in the first 24 hours after admission to the PICU, as well as to identify measures correlated with the length of stay. Materials and methods: The research was conducted as a retrospective study analyzing data from medical records of patients who had a traumatic head injury and were hospitalized at the Institute for Health Protection of Children and Youth of Vojvodina (IHPYV) from August 2021 to August 2023, in the PICU. Results: The study included 34 children with an average age of 9.43 ± 5.3 years. Boys were statistically significantly more likely to sustain injuries (61.8%). Isolated head injury was present in 19 patients (55.9%), while 15 (44.1%) had associated injuries. The most common mechanism of injury was traffic accident trauma (61.8%). The Glasgow Coma Scale (GCS) averaged 11.38 ± 3.7. The average length of stay in the PICU was 4.18 ± 2.87 days. Eight patients (23.5%) underwent surgery after admission to the PICU and CT diagnostics, while anti-edema therapy was applied in 19 patients (55.9%). Mechanical ventilation was used in 10 patients (29.4%). Patients with lower GCS values had a longer stay in the PICU. GCS was not a suitable parameter for assessing the need for surgery in the first 24 hours of patient treatment in the PICU, nor was it an adequate indicator of the need for mechanical ventilation. Conclusion: The results of our research show that the average age of children was 9.43 ± 5.3 years, predominantly boys. Despite many pediatric patients initially having a low GCS, they ultimately had a positive clinical outcome. Low GCS on admission of pediatric patients with head trauma was statistically significantly associated with a longer hospitalization in the PICU

The value of Pap test in women with endometrial cancer

Introduction: Endometrial cancer is the second most common gynecological tumor. There is still no recommended screening method for endometrial cancer. The application of transvaginal sonography, hysteroscopy and Pap test may prove useful in screening for this disease. Atypical glandular cells represent an important finding in Pap tests and they are related to histopathological verification of the endometrium. The aim of the study was to determine the usefulness of the Pap test in assessing the cervical infiltration, as well as to determine the significance of hormonal status and histopathological type of tumor in a pathological Pap test in patients with endometrial cancer.Methods: The study was retrospective. The analysis included the data obtained from 62 operated patients diagnosed with enometrial cancer, medical history (menopausal status), histopathological findings after surgery (type and stage of the disease) and a preoperative Pap smear. The chi squared and Fisher’s test were used.Results: The difference in the prevalence of pathological Pap test in premenopausal and postmenopausal group of patients was not statistically significant. The difference in the prevalence of pathological Pap test in the group of endometrioid and non-endometrioid tumours of the uterine corpus had statistical significance. The difference in the prevalence of pathological Pap test compared to the present stage (I and II) was not statistically significant.Conclusion: Pap smear does not correlate with menopausal status in women with endometrial carcinoma. Abnormal Pap test is more commonly found in cases of non-endometroid tumours. Pap smears cannot beused to assess cervical involvement

HYSTEROSCOPY BEFORE IN VITRO FERTILIZATION

In the last decade, success after in vitro fertilization process (IVF) has remained at a similar rate despite all the improvements implemented in the stimulation protocols and laboratory techniques. Hysteroscopy is a method becoming more widely used with patients after a failed IVF cycle, considering a large incidence of uterus cavum pathological states which have a negative impact on the favorable outcome. Numerous studies have provided different results on the IVF outcome with hysteroscopy performed prior to this treatment in cases with no uterus cavum pathology. The aim of the research was to examine the effect of both diagnostic and surgical hysteroscopy on the outcome of IVF.  Hysteroscopy was performed with 74 patients 30 to 50 days prior to IVF and in 33 of them (group I) some pathological state was noticed, which was treated during the same procedure. The control group (group III) included 151 patients who had IVF performed with no prior hysteroscopy. There is no statistically significant difference in the rate of post hysteroscopy implantation between I and II group when compared to the control group (20.62% vs 23.28% vs 17.31%), nor in the rate of clinical pregnancies (45.45% vs 46.34% vs 34.44%). Following the correctional treatment of uterus cavum pathological states, implantation and pregnancy rates remain at a level comparable to hysteroscopically normal medical findings. Statistically significant higher pregnancy rate is present in group I after the first IVF cycle, compared to the next IVF in the same group and in comparison to the next IVF cycle in the control group (60.00% vs 27.91%, p<0.05). Hysteroscopy is a simple and safe method allowing nearly identical rate of clinical pregnancies after a surgical treatment of uterus cavum pathological states when compared to the control group, but statistically much higher pregnancy rate if the order of IVF procedure is being compared. In cases of normal ultrasound findings and negative hysteroscopical findings, performing hysteroscopy prior to IVF does not provide significantly better results. Therefore, its routine execution is not recommended

Influence of larvae solidity of cereal leaf beetle (Coleoptera, Chrysomelidae: Lema melanopus L.) on yield decreasing of small grains

Flag leaf area in eight winter wheat cultivars (Dicna, NS rana 5, Proteinka, Jugoslavija, Studenica, KG 56-S, Levcanka and Ravanica) and one winter barley cultivar (Partizan) was investigated. The value of flag leaf varied from 10.16 cm2 in barley cultivar Partizan to 29.24 cm2 in Dicna wheat cultivar. Estimation of density of larvae on flag leaf showed differences among analyzed cultivars. The highest average number (1.27) of larvae was in Studenica cultivar and the lowest one (0.46) in Ravanica wheat cultivars and (0.42) in barley cultivar Partizan. Also difference was registered considering damages of flag leaf area which cereal leaf beetle (Coleoptera, Chrysomelidae: Lema melanopus L.) as well as differences in yield decreasing. In average the highest level of damages by larvae of beetle was established in barley cultivar Partizan (75.86%) and Studenica wheat cultivar (72.40%)

Influence of meteorological factors on the appearance and dynamics of development of cereal leaf beetle

The dynamics of development and influence of meteorological conditions on the appearance of cereal leaf beetle (CLB) were investigated during two years, which differed according to temperature regime. Cumulative values of average daily temperature were registered 7, 14, 21 and 28 days before appearance of adult of CLB. The cumulative temperature was the most similar about 14th day (108,40 C 1st-year, and 106,20 C 2nd-year), while identical values of cumulative temperate (102,00 C) was registered on 13 days before stop of hibernation and can use as basic indicator in prognostication of appearance of CLB in spring. The period from beginning of oviposition to the appearance of larva varied between 11 to 19 days during two experimental years and sum temperature was from 203,30 C to 232,60 C. Period of larva development was 17- 19 days and cumulative temperatures in that period were between 258,9 and 283,30 C. The period from cocoon to appearance of first adult of new generation was between 13 and 15 days at the sum temperature from 245,30 C to 247,20 C.Međunarodni naučni skup „Održiva poljoprivreda i proces evropske integracije” : International conference on sustainable agriculture and European integration processes September 19–24, 2004, Novi Sad, Serbia and Montenegr