Respiratory Infections in Children Hospitalized at the University Hospital Mostar during War and Post-War Period

Our aim was to investigate the incidence of respiratory infections in children treated at the Pediatric Department of the University Hospital Mostar during war (1993 and 1994) and after the war (2003 and 2004). In order to collect data we used medical histories of children with respiratory infections. Incidence of respiratory infections in children in war period was 230/1000, while in post-war period it was 190/1000. There was no significant difference in the incidence of respiratory infections in children during war and after the war (p=0.051). We have not found increase in respiratory infections prevalence in children treated during war period at the Pediatric department of University Hospital Mostar, compared to the period after the war. However, we did report certain differences related to age, clinical parameters, seasonal pattern, diagnosis, therapy and mean hospitalization time

Socio-Demographic Characteristics and Lifestyle Habits of Pregnant Women Smokers

The aim of this study was to describe anthropometric, clinical, socio-demographic characteristics and lifestyle habits of pregnant smokers in comparison to pregnant nonsmokers. During years 1999–2003, 1,435 pregnant smokers and 4,772 pregnant nonsmokers were interviewed after delivery with a questionnaire. They were recorded clinical, anthropometric and socio-demographic data, smoking status, labor outcome, maternal and fetal hemoglobin concentrations for each patient. The two groups were comparable in anthropometric and clinical characteristics, duration of pregnancy and mode of delivery, except for birth weights, which were significantly lower in newborns of smokers. Maternal hemoglobin concentrations were significantly lower in smokers, but fetal hemoglobin concentrations were significantly higher in babies of smokers. The proportion of pregnant women who smoked during pregnancy was higher among urban women, among women with lower educational level and among unemployed subjects in comparison with nonsmokers. The pregnant women who smoked during pregnancy were more often caffeine and alcohol consumers. To further reduce smoking during pregnancy it is important to continue to promote smoking cessation among teenagers

Postoji li razlika u perinatalnom ishodu jednoplodnih i blizanačkih trudnoća nakon medicinski potpomognute oplodnje

The aim of the study was to compare perinatal outcome of singleton and twin pregnancies conceived after assisted reproductive technologies (ART ). This retrospective study included singleton and twin pregnancies conceived after ART in the period from January 1, 2007 until December 31, 2008. The study variables were maternal age (years), parity, body mass index (BMI; kg/m2), week (≤366/7 and ≥37) and mode of delivery (vaginal and cesarean section), birth weight (grams) and APGAR score (≤7; 8-10). During the study period, there were 195 pregnancies after ART that fulfilled inclusion criteria. We found no between-group difference in parity (χ2=0.0133; P=0.9081), but such difference was found in mean age (t=2.0486; p=0.0419) and BMI (χ2=31.038; P=0.001). A statistically significant difference was recorded in preterm delivery rate (χ2=25.539; P=0.001), average duration of pregnancy (t=12.8591; p=0.001), average birth weight (t=10.5446; P=0.001) and mode of delivery (χ2=13,691; P=0.001). A statistically significant difference was found in low birth weight babies (χ2=102.02; P=0.001) and APGAR score (χ2=19.96; P=0.001), but there was no difference in the prevalence of small for gestational age babies (χ2=0.90629; P=0.635). In conclusion, this study indicated the perinatal outcome after ART to be considerably poorer in twins than in singletons.Cilj ove studije bio je istražiti razliku u perinatalnom ishodu jednoplodnih i blizanačkih trudnoća nakon medicinski potpomognute oplodnje (MPO). Ispitana je medicinska dokumentacija jednoplodnih i blizanačkih trudnoća u žena koje su rodile živorođenu djecu nakon MPO u dvogodišnjem razdoblju u Klinici za ženske bolesti i porode, KBC Split, od 1. siječnja 2007. do 31. prosinca 2008. godine. Istraživane varijable bile su dob, paritet, indeks tjelesne mase (kg/m2), navršeni tjedan poroda (prijevremeni ≤366/7 i terminski ≥37), način dovršetka porođaja (vaginalno i carski rez), porođajna masa djeteta (grami), trofičnost djeteta (hipertrofično, eutrofično i hipotrofično) i APGAR zbroj novorođenčeta (≤7, 8-10). U promatranom razdoblju 195 trudnica je rodilo nakon neke od metoda MPO. Između rodilja s jednoplodnom i blizanačkom trudnoćom koje su zanijele nekom metodom MPO nije bilo razlike u paritetu (χ2=0,0133; P=0,9081), dok su razlike pronađene u prosječnoj dobi (t=2,0486; p=0,0419) i indeksu tjelesne mase (χ2=31,038; p=0,001). Statistički značajna razlika nađena je u učestalosti prijevremenog poroda (χ2=25,539; P=0,001), prosječnom trajanju trudnoće (t=12,8591; p=0,001) i prosječnoj porodnoj masi djece (t=10,5446; P=0,001). Blizanačke trudnoće u usporedbi s jednoplodnim trudnoćama nakon MPO češće se dovršavaju carskim rezom (χ2=13,691; P=0,001). Pronađena je statistički značajna razlika između istraživanih skupina u rađanju djece niske porodne mase (<2500 g) (χ2=102,02; P=0,001) i APGAR zbroju novorođenčadi (χ2=19,96; P=0,001). Nije bilo statistički značajne razlike u učestalosti rađanja hipotrofične djece između istraživanih skupina (χ2=0,90629; P=0,635). U zaključku, perinatalni ishod nakon MPO je lošiji u blizanačkih nego u jednoplodnih trudnoća

Differences in Sexual Functioning Between Patients with Benign and Malignant Breast Tumors

The aim of this study was to compare differences in sexual behavior between patients with benign and malignant breast tumors. A total of 187 patients treated for breast tumors (benign or malignant) at the General Hospital »Po`ega«, Croatia, filled in the questionnaire between January 2001 and May 2003. Patients were asked to fill in the questionnaire one to ten years after treatment of breast tumor, while they were on their regular control visit. Deterioration in sexual life experienced 36.27% of patients with benign tumors and 51.76% of patients with malignant tumor (p<0.01). The main reason of sex life impairment in both groups was distortion of body image perception. Most of partners did not change their behavior toward women with breast tumors (48.72% for benign group and 41.82% or malignant group, p>0.05). A great amount of women in both groups felt certain change in her »body image«, but in greater extent in malignant group (41.18% vs. 25.49%), (p<0.05). From our results we can see that patients in this study do not recognize need for consultation with their physician regarding sex life after treatment of tumor (41.18% for benign and 35.29% in malignant group). It can be concluded that considerable amount of attention should be given to psychological aspects of recovery which can improve prognosis and quality of life in general

Comparison of Fetal Plasma Cortisol Level between Eutrophic and Hypotrophic Newborns

We tested two groups of singletons born at term: fifty-six eutrophic newborns and 56 hypotrophic subjects. They randomly from all newborns delivered by vaginal route between 8 and 14 hours. Excluded were preeclampsia, diabetes, labours longer than 12 hours and newborns with malformations. Written informed consent was obtained from all women and data were collected before and after labour. Umbilical cord blood samples were obtained immediately following the delivery and plasma cortisol concentrations were measured by radioimmunoassay. The groups did not differ significantly regarding maternal age, parity, gestational age and Apgar score, but birth weight was significant differed (p<0.001). In addition, eutrophic newborns had significantly elevated cortisol levels (457.7 nmol/L, 321.8–696.6 nmol/L) compared with hypotrophic newborns (320.5 nmol/L, 215.1–578.7 nmol/L, p<0.001). The role of fetal cortisol in intrauterine growth restriction (IUGR) pregnancy and labour is uncertain, but fetal plasma cortisol levels may be lower in IUGR newborns

Expression of Matrix Metalloproteinase-1 in Uterosacral Ligaments Tissue of Women with Genital Prolapse

Collagen metabolism is altered in the pelvic organ tissues of women with genital prolapse. The aim of this study was to compare collagen metabolism by measuring matrix metalloproteinase – 1 (MMP – 1) expression in uterosacral ligament tissues of postmenopausal women with and without genital prolapse. Uterosacral ligament tissues were obtained at the time of abdominal or vaginal surgery from twenty-four patients with pelvic organ prolapse (POP) and 21 women who underwent gynecologic surgery for benign indications. The tissue samples were analyzed by immunohistochemistry. There were no differences in age, BMI and parity between two groups. The patients with genital prolapse demonstrated significantly higher occurences of MMP – 1 expression compared to controls. These findings indicate that increased MMP – 1 expression in uterosacral ligaments is associated with genital prolapse. Our data are consistent with the theory that increased collagen breakdown may play an important role in the onset and development of pelvic organ prolapse (POP)

Uterine Artery Embolization for the Treatment of Uterine Fibroids

Uterine artery embolization can be regarded as a less invasive procedure for the treatment of fibroids compared with myomectomy, hysterectomy, and laparoscopic myolysis. The aim of this study was the evaluation of safety and efficacy of uterine artery embolization and of womens’ opinion about this treatment. After gynecological examination sixty-nine premenopausal women underwent uterine artery embolization. All procedures but four were technically successful; three women underwent unilateral embolization because of vascular malformation and one of them had an allergic reaction to contrast medium. Of the 69 patients: 58 went home the day after embolization, and 11 within first week. The follow-up examinations after 3, 6 and 12 month showed a significant reduction of uterine and fibroid volume with significant improvement of bleeding. Therefore, according to this report, uterine artery embolization is a successful, minimal invasive treatment of myoma that preserves the uterus and requires shorter hospitalization and recovery times than surgery

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH OVARIAN CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak jajnika i jajovoda po učestalosti je peta zloćudna bolest žena u Hrvatskoj. Histološki je rak jajnika najčešće epitelnog podrijetla, i to seroznog podtipa. Rjeđi su različiti neepitelni malignomi jajnika, a posebnu skupinu čine epitelni karcinomi niskoga zloćudnog potencijala karakterizirani neinvazivnošću, klinički indolentnim tijekom i dobrom prognozom te primarni rak potrbušnice i rak jajovoda. Klinički su ovi zloćudni tumori u ranim stadijima razvoja uglavnom asimptomatski, zbog čega se najčešće dijagnosticiraju u kasnijim stadijima bolesti. Dijagnoza se potvrđuje patohistološkim nalazom, a iznimno citološkim nalazom nakon provedene dijagnostičke obrade. O liječenju odlučuje multidisciplinarni tim uzimajući u obzir dob, opće stanje i komorbiditete bolesnice, kao i obilježja samog tumora uključujući stadij bolesti, histološki tip i gradus tumora. Principi liječenja primarnog raka potrbušnice i jajovoda temelje se na principima liječenja epitelnog raka jajnika koji obuhvaćaju primjenu kirurških zahvata, kemoterapije, imunoterapije i hormonske terapije, kao i suportivno-simptomatskih mjera tijekom cijelog liječenja. Razlikuje se terapijski pristup rjeđim, neepitelnim histološkim tipovima tumora koji se češće dijagnosticiraju u ranim stadijima bolesti, imaju indolentniji tijek pa se kod ovih bolesnica češće primjenjuju poštedni kirurški zahvati s ciljem očuvanja plodnosti. U tekstu koji slijedi predstavljene su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnica s rakom jajnika, jajovoda i potrbušnice u Republici Hrvatskoj.Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH UTERINE CERVICAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak vrata maternice, u odnosu na malignome drugih ginekoloških sijela, jest bolest mlađih žena koja se može redovitim kontrolama i zdravstvenim odgojem prevenirati, a u slučaju pojave bolesti učinkovito liječiti. Metode liječenja uključuju kirurgiju, radioterapiju i kemoterapiju, ovisno o stadiju bolesti i općem stanju bolesnica. Odluku o liječenju donosi multidisciplinarni tim. S obzirom na važnost ove bolesti, potrebno je definirati i provoditi standardizirani pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu koji slijedi iznesene su kliničke smjernice s ciljem implementacije standardiziranih postupaka u radu s bolesnicama s rakom vrata maternice u Republici Hrvatskoj.Cervical cancer, in comparison with other gynecological malignancies, mainly affects younger women. It can be prevented trough educational programs, screening and early detection. It also can be efficiently treated when it appears. Treatment modalities include surgery, chemotherapy and radiotherapy, according to the stage of the disease and patient condition. Treatment decisions should be made after multidisciplinary team discussion. Due to the significance of this disease it is important to define and implement standardized approach for diagnostic, treatment and monitoring algorithm as well. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with uterine cervical cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak trupa maternice javlja se u većini slučajeva u poslijemenopauzalnih žena, a najčešće se očituje ginekološkim krvarenjem. Nakon raka jajnika i vrata maternice treći je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistološkim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrđuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeličnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia