Silent spontaneous uterine rupture after previous cesarean section and myomectomy with delivery of a healthy newborn

Introduction. Silent spontaneous rupture of the uterus before labor with delivery of a healthy newborn and with no maternal or neonatal morbidity or mortality is very rare. Very few cases have been reported in literature. Case report. We report a case of silent spontaneous uterine rupture. Rupture was found during an elective repeat cesarean section. Patient had history of one prior cesarean myomectomy. At 38 weeks of gestation, before labour has started and before any symptoms, the patient underwent elective caesarean section with delivery of a healthy and eutrophic female infant. Uterine rupture in previous myomectomy scar and intact amniotic sac with fetus inside was found as soon as peritoneum was opened. The patient was discharged on postoperative day 5 with healthy newborn. Conclusion. Though silent spontaneous rupture of the uterus before term is very rare condition, all pregnant women with previous hysterotomy should be warned about possibility of spontaneous uterine rupture even before labour has started

Sex Hormone Binding Globulin (SHBG) as a Marker of Clinical Disorders

Sex hormone binding globulin (SHBG) is an important protein, not only for transporting sex steroids which is its primary role, but with the discovery of a specific receptor that binds SHBG, a novel approach regarding classic ‘free-hormone hypothesis’ should be implemented. Research in SHBG gene and it expression has been done, as well as cellular signaling that controls it. It provides significant knowledge of the impact of certain well –defined cellular level signaling pathways and how they affect the level of SHBG production. Moreover, new insights have proven that SHBG isn’t just a peripherally synthesized protein. Its origin has been proven to exist in the brain, namely in the hypothalamus and the pituitary, where it is spatially closely related to oxytocin-producing neurons. The main peripheral organ that produces SHBG is the liver. Since the liver is the central metabolic organ, certain metabolic diseases will result in changed SHBG serum levels. On the other hand, endocrine disorders that affect tissues involved in sex hormone regulation will also have an impact on SHBG levels. Thusly, SHBG stands as one of the mediators between various endocrine tissues and definitely contributes with its own pathophysiological role in diseases such as: obesity, metabolic syndrome, polycystic ovary syndrome, osteoporosis, breast and prostate cancer. Its value expands to the area of clinical medicine as a marker of certain pathological states. Some studies already established its reliability and the growing trend to implement it as a useful clinical marker is present. It still remains largely understudied, from physiological and clinical aspect, but recent findings give notions that SHBG plays an important role in health and disease and could be a useful assessment marker

Fertility in men with spinal cord injury

Young men comprise the overwhelming majority of men with spinal cord injury (SCI), the incidence of which has been growing over the years. Due to advances in physical medicine and rehabilitation, remarkable improvements in survival rates have been reported, leading to life expectancies similar to those of the general population. However, many sexual and reproductive functions may be impaired due to erectile or ejaculatory dysfunction and semen abnormalities, characterised by low-sperm motility or viability in SCI males who have not become parents yet. Nevertheless, fatherhood is still possible through the introduction of specialised medical management, by using various medical, technical and surgical methods for sperm retrieval in combination with assisted reproductive techniques. Erectile dysfunction can be managed by the use of phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be obtained from the vast majority of anejaculatory men by medically assisted ejaculation through the use of penile vibratory stimulation or electroejaculation and via prostate massage or surgical procedures. Despite impaired sperm parameters, reasonable pregnancy rates similar to those in able-bodied subfertile cohorts have been reported. However, future research should focus on the optimisation of semen quality in these men and on improving natural ejaculation

Medikamentna prevencija sindroma hiperstimulacije jajnika

The purpose of this review is to analyze current medical strategies in the prevention of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation for in vitrofertilization. Owing to contemporary preventive measures of OHSS, the incidence of moderate and severe forms of the syndrome varies between 0.18% and 1.40%. Although none of medical strategies is completely effective, there is high-quality evidence that replacing human chorionic gonadotropin (hCG) by gonadotropin-releasing hormone (GnRH) agonists after GnRH antagonists and moderate-quality evidence that GnRH antagonist protocols, dopamine agonists and mild protocols reduce the occurrence of OHSS. Among various GnRH agonists, buserelin 0.5 mg, triptorelin 0.2 mg and leuprolide acetate (0.5-4 mg) have been mostly utilized. Although GnRH trigger is currently regarded as the best tool for OHSS prevention, intensive luteal support with exogenous administration of estradiol and progesterone or low-dose hCG on the day of oocyte retrieval or on the day of GnRH agonist trigger are required to achieve optimal conception rates due to early luteolysis. Among currently available dopamine agonists, cabergoline, quinagolide and bromocriptine are the most common drugs that should be used for prevention of both early and late OHSS. Mild stimulation protocols offer attractive option in OHSS prevention with satisfactory pregnancy rates.Svrha ovoga rada bila je analizirati današnje medikamentne strategije u prevenciji sindroma hiperstimulacije jajnika za vrijeme stimulacije ovulacije u postupku izvantjelesne oplodnje. Zahvaljujući suvremenim metodama prevencije pojavnost sindroma hiperstimulacije se kreće od 0,18% do 1,40%. Premda se nijedna prevencijska strategija nije pokazala u potpunosti djelotvornom, postoje čvrsti dokazi da zamjena humanog korionskog gonadotropina gonadotropnim otpuštajućim hormonom nakon antagonista gonadotropnog otpuštajućeg hormona te umjereni dokazi da protokoli antagonista gonadotropnog otpuštajućeg hormona, agonisti dopamina i blagi protokoli smanjuju pojavnost sindroma hiperstimulacije. Između nekoliko agonista gonadotropnog otpuštajućeg hormona najčešće se koriste buserelin 0,5 mg, triptorelin 0,2 mg i leuprolid (0,5-4 mg). Premda se danas smatra da je gonadotropni otpuštajući hormon najuspješniji u prevenciji sindroma hiperstimulacije jajnika, zbog rane luteolize potrebna je intenzivna potpora žutom tijelu primjenom estradiola i progesterona ili sniženim dozama humanog korionskog gonadotropina na dan aspiracije jajnih stanica da bi se postigle optimalne stope zanošenja. Između danas dostupnih agonista dopamina kabergolin, kinagolid i bromokriptin su lijekovi koji se najčešće primjenjuju i koje bi trebalo primjenjivati u prevenciji ranog i kasnog oblika sindroma hiperstimulacije. Blagi stimulacijski protokoli predstavljaju privlačan izbor u prevenciji sindroma hiperstimulacije sa zadovoljavajućim stopama trudnoće

Atipične glandularne stanice u papa testu kao primarna prezentacija seroznog borderline tumora jajnika

The Pap test is designed as a screening test to detect primarily carcinoma of the cervix and its precursors, most often of squamous type. Rarely atypical or malignant cells found in cervical smear can be indication for the existence of an extrauterine disease. We present a case of a 26 year old woman with very small asymptomatic ovarian bilateral borderline tumors whose diagnosis was triggered by finding of atypical glandular cells with psammoma bodies on Pap smear. She had a history of abnormal Pap smears and was admitted to our Hospital for colposcopy. Pap smear was taken and reported as atypical glandular cells (AGC) with psammoma bodies. Colposcopically directed biopsy along with an endocervical curettage showed no abnormalities as well as transvaginal ultrasound examination. Three months later control Pap smear confirmed AGC with psammoma bodies (suggestive of endometrial or serous origin), ultrasound showed the presence of indistinctive, hyperechoic mass 2 cm in diameter in the left ovary along with slightly elevated CA-125 and diagnostic hysteroscopy and laparoscopy was performed. At laparascopy, both ovaries had surface cauliflower like papillary projections measuring up to 3 cm. A histological examination revealed bilateral serous borderline tumor.Papa test je test probira primarno namijenjen za rano otkrivanje karcinoma cerviksa i njegovih prekursora, najčešće pločastog tipa. Rijetko nalaz atipičnih ili malignih stanica u Papa testu može biti prvi znak tumora ekstrauterinog porijekla. U ovom radu prikazujemo slučaj 26 godišnje pacijentice s vrlo malim asimptomatskim bilateralnim borderline tumorima jajnika čija je dijagnoza pokrenuta nalazom atipičnih žljezdanih stanica sa psamomskim tjelešcima u Papa testu. Pacijentica je upućena u našu bolnicu na kolposkopiju radi abnormalnih nalaza Papa testa. Kod nas uzeti Papa test pokazao je atipične glandularne stanice (AGC) sa psamomskim tjelešcima. Kolposkopski vođena biopsija i endocervikalni ekskohleat nisu pokazali abnormalnosti, kao ni transvaginalni ultrazvučni pregled. Tri mjeseca kasnije ponovljeni Papa test potvrđuje AGC sa psamomskim tjelešcima (porijeklo endometralno ili serozno), ultrazvučni nalaz opisuje uz lijevi jajnik nejasnu hiperehogenu tvorbu promjera 2 cm, uz blago povišeni CA 125 zbog čega je učinjena dijagnostička histeroskopija i laparoskopija. Na operaciji su nađeni jajnici obostrano s tumorskim tvorbama karfiolastog izgleda veličine do 3 cm. Patohistološki je potvrđen serozni borderline tumor oba jajnika

Sex hormone binding globulin (SHBG) as a marker of clinical disorders [Globulin koji veže spolne hormone (SHGB) kao marker u kliničkim poremećajima]

Sex hormone binding globulin (SHBG) is an important protein, not only for transporting sex steroids which is its primary role, but with the discovery of a specific receptor that binds SHBG, a novel approach regarding classic ‘free-hormone hypothesis’ should be implemented. Research in SHBG gene and it expression has been done, as well as cellular signaling that controls it. It provides significant knowledge of the impact of certain well –defined cellular level signaling pathways and how they affect the level of SHBG production. Moreover, new insights have proven that SHBG isn’t just a peripherally synthesized protein. Its origin has been proven to exist in the brain, namely in the hypothalamus and the pituitary, where it is spatially closely related to oxytocin-producing neurons. The main peripheral organ that produces SHBG is the liver. Since the liver is the central metabolic organ, certain metabolic diseases will result in changed SHBG serum levels. On the other hand, endocrine disorders that affect tissues involved in sex hormone regulation will also have an impact on SHBG levels. Thusly, SHBG stands as one of the mediators between various endocrine tissues and definitely contributes with its own pathophysiological role in diseases such as: obesity, metabolic syndrome, polycystic ovary syndrome, osteoporosis, breast and prostate cancer. Its value expands to the area of clinical medicine as a marker of certain pathological states. Some studies already established its reliability and the growing trend to implement it as a useful clinical marker is present. It still remains largely understudied, from physiological and clinical aspect, but recent findings give notions that SHBG plays an important role in health and disease and could be a useful assessment marker

Bosanski muzički folklor : Banjalučke i Bihaćke oblasti

Radnja je muzička analiza zbirke V. Miloševića "Bosanske narodne pjesme I". Autor je tijekom školske godine marljivo analizirao cijelu zbirku te je krajem godine rezultate iznio u radnji

Bosanski muzički folklor : Banjalučke i Bihaćke oblasti

Radnja je muzička analiza zbirke V. Miloševića "Bosanske narodne pjesme I". Autor je tijekom školske godine marljivo analizirao cijelu zbirku te je krajem godine rezultate iznio u radnji

Bosanski muzički folklor : Banjalučke i Bihaćke oblasti

Radnja je muzička analiza zbirke V. Miloševića "Bosanske narodne pjesme I". Autor je tijekom školske godine marljivo analizirao cijelu zbirku te je krajem godine rezultate iznio u radnji

Current Medical Strategies in the Prevention of Ovarian Hyperstimulation Syndrome

The purpose of this review is to analyze current medical strategies in the prevention of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation for in vitrofertilization. Owing to contemporary preventive measures of OHSS, the incidence of moderate and severe forms of the syndrome varies between 0.18% and 1.40%. Although none of medical strategies is completely effective, there is high-quality evidence that replacing human chorionic gonadotropin (hCG) by gonadotropin-releasing hormone (GnRH) agonists after GnRH antagonists and moderate-quality evidence that GnRH antagonist protocols, dopamine agonists and mild protocols reduce the occurrence of OHSS. Among various GnRH agonists, buserelin 0.5 mg, triptorelin 0.2 mg and leuprolide acetate (0.5-4 mg) have been mostly utilized. Although GnRH trigger is currently regarded as the best tool for OHSS prevention, intensive luteal support with exogenous administration of estradiol and progesterone or low-dose hCG on the day of oocyte retrieval or on the day of GnRH agonist trigger are required to achieve optimal conception rates due to early luteolysis. Among currently available dopamine agonists, cabergoline, quinagolide and bromocriptine are the most common drugs that should be used for prevention of both early and late OHSS. Mild stimulation protocols offer attractive option in OHSS prevention with satisfactory pregnancy rates