Chorangioma placentae

Chorangioma of the placenta is a rare tumor with a frequency of about 1%, which usually presents as a solitary nodule or, less frequently, as multiple nodules. It is found on the fetal surface of the placenta or in placental parenchyma. Most chorangiomas are small and possess no clinical significance. On the contrary, clinically significant chorangiomas, greater then 5 cm or multiple, may be associated with pregnancy complications. The case presented is one of the uncommon presentations of chorangioma, in which its presence and size were not related to a pregnancy disorders or developmental anomalies of the fetus.

Use of complementary and alternative medicine in departments of obstetrics in croatia and a comparison to Germany

BACKGROUND

This nationwide study assessed the use of complementary and alternative medicine (CAM) methods in departments of obstetrics in Croatia and compared it with an identical assessment carried out in Germany.

METHODS

All Croatian obstetrics departments were sent a questionnaire already tested in Germany which assessed the use of CAM methods: whether any were used during childbirth and if so how frequently, and the reasons behind their application.

RESULTS

Questionnaires were returned by 100% (36/36) of departments identified. The only used CAM therapy was acupuncture, which was available in 5.6% (2/36) of the departments. All other methods (homeopathy, aromatherapy, massage etc.) were not used at all. Furthermore, acupuncture was only administered by physicians. These findings were found to strongly contrast with the findings from Germany.

CONCLUSIONS

Among the main CAM methods only acupuncture is used to a small extent in the field of obstetrics in Croatia. Thus, the impression from the literature that shows a considerable use of CAM in this area definitely does not apply for all parts of the world. Future studies should seek to identify the reasons behind the intensive use of CAM in Germany and its virtual non-use in Croatia. This also means that analyses of CAM use are required with respect to perinatal outcome, the results of which could finally help decide about the reasonability of CAM.

Metastatic prostate cancer in an asymptomatic patient with an initial prostate-specific antigen (PSA) serum concentration of 21,380 ng/ml

BACKGROUND

Prostate cancer is the second most common cause of cancer death in men, being responsible for approximately 13% of all cancer deaths. Due to the high specificity for prostate tissue, prostate-specific antigen (PSA) is the primary serum tumor marker for prostate cancer. To our knowledge, in published data, the highest reported PSA level on initial presentation was 5,666 ng/ml.

CASE REPORT

We present a 64-year-old Caucasian man with no specific urologic or pain symptoms and with an initial PSA serum value of 21,380 ng/ml. Initial laboratory studies showed chronic anemia and elevated alkaline phosphatase, most likely from bone marrow infiltration due to metastatic disease. Prostate biopsies diagnosed an adenocarcinoma of the prostate (Gleason score 9). Computed tomography (CT) showed multiple liver metastases with retroperitoneal lymph nodes of up to 1 cm. The prostate was moderately enlarged (estimated weight 35 g). Both kidneys were normal (no hydronephrosis present). A bone scintigraphy demonstrated diffuse osseous metastasis. Treatment was initiated with bilateral subcapsular orchiectomy and bicalutamide therapy in an effort to create total androgen blockade. After 3 months of follow-up, the serum concentration of PSA was 29 ng/ml.

CONCLUSION

This case presents an asymptomatic prostate cancer patient with bone and liver metastasis, enlarged retroperitoneal lymph nodes and the highest PSA level published to date.

Hemolysis and survival of autologous red blood cells salvaged after cemented and uncemented total hip arthroplasty

Autotransfusion is widely used after total hip arthroplasty (THA), but there are concerns about damage of red blood cells (RBCs) collected after surgery. In this study, we wanted to determine the damage and survival of RBCs salvaged after cemented THA and after uncemented THA and to compare the results. In this prospective study of 60 patients-30 who underwent cemented THA and 30 who underwent uncemented THA-postoperative autotransfusion systems (BIODREN; B.E.R.C.O., Modena, Italy) were used. Levels of potassium and free hemoglobin in the postoperative blood samples were analyzed. Before transfusion, salvaged RBCs were labeled with radioactive chromium-51, and their survival was measured. In blood salvaged after cemented THA, medium potassium level was 4.1 mmol/L (range, 3.2-5.6 mmol/L), and mean free hemoglobin level was 327 mg% (range, 120-410 mg%). In blood salvaged after uncemented THA, mean potassium level was 4.2 mmol/L (range, 3.1-5.5 mmol/L), and mean free hemoglobin level was 296 mg% (range, 130-402 mg%). In the cemented group, RBC survival was 73% at 48 hours after transfusion (range, 61%-79%), and mean time from 100% activity to 50% activity was 21 days (range, 14.2-28.2 days). In the uncemented group, RBC survival was 75% at 48 hours after transfusion (range, 68%-82%), and mean time from 100% to 50% activity of radio-labeled RBCs was 22 days (range, 16.2-29.4 days). There were no statistically significant differences in potassium levels, free hemoglobin levels, or RBC survival between the cemented and uncemented groups. Blood salvaged after surgery was not significantly damaged. Our study results confirmed that washing blood collected after surgery is not necessary. Not washing this blood is safe and decreases allogeneic transfusion in orthopedic procedures.

Case report of congenital cystic adenomatoid malformation type III with lethal outcome

We present a rare case of congenital cystic adenomatoid malformation (CCAM) type III (mycrocystic) in young, 19 years old primigravida. Diagnosis has been accomplished by ultrasound examination in 26th week of gestation. Hyperechogenic, mycrocystic mass was found in left pulmonary lobe with contra lateral displacement of mediastinum, hypoplasia of the right lung and extensive polyhydramnios. Prenatal therapy was based upon a serial of amniodrainage procedures and pharmacological inhibition of amniotic fluid production and uterine activity. Spontaneous preterm labor occurred at 34 weeks of gestation, Diagnosis was confirmed postnatal. Infant was ventilated due to respiratory insufficiency and was operated at the age of 24 hours. Lethal outcome occurred during the second day due to heavy respiratory insufficiency provoked by pulmonary hypoplasia. We discuss about types of a disease, prenatal diagnostic and therapeutic possibilities and pregnancy outcome.

Xanthogranulomatous epididymitis: clinical report and immunohistochemical analysis

Xanthogranulomatous epididymitis is an uncommon non-neoplastic process with destruction of tissue and replacement by striking cellular infiltration of foamy macrophages, dense lymphocytes and plasma cells. We report on a 72-year-old man with a clinical history of inadequately treated arterial hypertension, who presented with a right scrotal mass associated with right scrotal pain for 10 days. Physical examination revealed pyogenic discharge from the hyperemic and edematous scrotum, with normal body temperature. Testicular tumor markers were normal. Ultrasonography (US) of the right testis showed edematous scrotal layers and a heterogeneous area of poorly defined margins within the testis and epididymis. There was minimal hydrocele, and the right funiculus was of normal diameter with no edema or pathologic formation. The progression of clinical findings, inflammatory parameters, US and color Doppler US findings with negative testicular tumor markers indicated surgical treatment. After preoperative treatment, right orchiepididymectomy was performed. Histology confirmed the diagnosis of xanthogranulomatous epididymitis.

Prenatal ultrasound assessment and fetal heart monitoring: analysis of dizygotic twins discordant for body stalk anomaly in the third trimester of pregnancy

We describe a case of dizygotic twin pregnancy which was referred to our centre because of a discordant anomaly of one of the twins. The ultrasound examination revealed a large extra-abdominal mass (liver and bowel) with micromelia, severe kyphoscoliosis and a short umbilical cord of the second dizygotic discordant twin. These ultrasound findings were diagnosed as body stalk anomaly. Body stalk anomaly in twins is extremely rare. This is, to our knowledge, one of the few documented cases reported on dizygotic twins discordant for this anomaly. This finding, in association with a decrease of amniotic fluid volume, may be attributed to early amniotic membrane rupture as the primary event in the pathogenesis of body stalk anomaly.

Management of Fournier's gangrene--report of 7 cases and review of the literature

Fournier's gangrene is a rare infection characterized with fast-progressing myonecrosis, that affect regions of perineum, genitalia and perianal area. This retrospective study presents authors' experiences and their principles in early diagnosis and treatment of Fournier's gangrene. The goal of this paper is to point out numerous diagnostically and therapeutic difficulties that lead to a high mortality if not recognized in time. We here describe seven male patients with myonecrosis and necrotising fasciitis in scrotal, perianal and perineal regions. Average age was 61 years (form 57 to 66 years of age), and average length of treatment was 25.8 days (from 14 to 36 days), with lethality of 14% (one case). We have recognised diabetes mellitus as risk factor, together with urethrostenosis, and other diseases of the perianal region (hemorrhoids, anal fissure, abscesses). Our hypothesis is that the key of the successful treatment is to treat as soon as symptoms onset, early and aggressive necrectomy under broad antibiotic protection. We also emphasize the possibility of recurrence of this disease even several years after treatment.

Diffuse eosinophilic gastroenteropathy with pleural effusion and ascites

We are reporting a case of a 39-year-old woman with a picture of constipation, who came to our department. Anamnesticly she claimed on constipation and flatulence for 6 days, and on slight cough for last two days, but no other symptoms. After complete diagnostic treatment we found a pleural effusion in right lung and ascites in a bowel. Cytologicly, we didn't find malignant cells in pleural effusion nor in ascites, but there was an amount of eosinophilic granulocytes in a gastric wall and a solid tumour mass near mesentery of a gut. We also found a lot of eosinophilic cells in a solid tumour mass. Other organs had no pathology. This finding indicated for eosinophilic gastroenteritis.

The congruity between urine and cervical swab cultures in pregnant women with versus without amniotic fluid infection

INTRODUCTION

We observed the congruity of bacteria found in urine and cervix of pregnant women with amniotic fluid infection (AFI) compared to healthy controls.

PATIENTS AND METHODS

Over three years, we prospectively analysed urine and cervical swabs cultures in 120 pregnant women in gestational week 16-20. The patient population was divided in two groups: group I patients had clinical symptoms of AFI. The rest of the patients were designated as healthy controls (group II). Congruity between findings in both groups was observed. In patients with bacterial growth, antibiotic treatment was initiated as recommended and once ended - culture probes were repeated.

RESULTS

The rates of nonsignificant and significant bacteriuria were doubled in group I. Fifty-five percent (n = 33) of patients in group I had identical bacteria cultured both from the urine sample and cervical swab, in contrast to only 13.3 % in group II. Congruity was most pronounced for Klebsiella species and E. coli, the later being single most dominant isolate in regards to both cultures. After antimicrobial treatment, microbial eradication occurred in 15 patients (45.5 %). The observed incidences of abortions and preterm deliveries were significantly lower in patients with microbial eradication versus patients with microbial persistence.

CONCLUSION

Patients with clinical symptoms of AFI have high risk for bacteriuria identical to bacterial culture from cervical swab. Antimicrobial treatment was effective only partially where indicated. Screening for eradication is recommended and consensus on the most appropriate therapy is needed.

[A new approach to the transvaginal needle suspension technique after Raz. Technique and long-term results]

AIM

Our aim is to describe the surgical technique and to present a long-term evaluation of the results.

MATERIALS AND METHODS

A total of 53 patients with stress incontinence underwent a Raz transvaginal needle suspension operation with the introduction of a polypropylene mesh strip (15x1.5-2 cm) pulled under the suspension threads. The suspension threads occur on the endopelvic fascia in order to support the bladder neck and to permit the function of the polypropylene mesh strip, which, however, does not take part in supporting the bladder neck. The same urologist carried out 53 consecutive operations with clinical evaluation at 6 months, 1 and 5 years after surgery.

RESULTS

After 6 months, 51 of the patients (96.2%) reported remaining dry after increasing intra-abdominal pressure. Two (3.7%) still had stress incontinence symptoms. After 1 and 5 years, 47 (88.6%) were dry and urinated normally, with spontaneous disappearance of nightly enuresis in two and surgery for subvesicular obstruction in one.

CONCLUSIONS

The introduction of a polypropylene mesh strip in the suspension threads in cases using the trasvaginal suspension technique has good, long-term results for the treatment of patients with stress incontinence.

New transobturator sling for less invasive treatment of urinary incontinence in women--SERASIS TO

Urinary incontinence, defined as a leakage of small amounts of urine during physical movement (coughing, sneezing, exercising) is rather a common problem. The treatment of this disorder is even more non-uniformed: there have been roundly 100 operations proposed for it. The Burch procedure has become probably the most popular. As traumatic and invasive as it is, this procedure is performed under general anaesthetic, the abdomen is opened, the bladder neck suspended and fixed with clips or sutures to the back of the pubic bone. Some of the advantages with this procedure include safety and reproducibility, direct access to internal organs and possibility of performing this procedure in laparoscopic settings. A recent study by the same group, employing 150 patients treated with this type of procedure showed that the SERASIS TO transobturator sling seems to be very effective, less traumatic, less dangerous and does not require cystoscopy or urethral deviation devices. Although long-term follow-up data are not available for the transobturator approach, short-term results are encouraging. Large comparative studies with other anti-incontinent procedures are needed.

Significance of CA 125 serum level in discrimination between benign and malignant masses in the pelvis

AIM

Our aim was to confirm that preoperative CA 125 serum level can be useful for discrimination between benign and malignant masses in the pelvis.

METHODS

Preoperative CA 125 serum level was analyzed retrospectively in 121 patients who had surgery because of a malignant ovarian tumor and in 91 patients with benign masses in the pelvis. The cutoff serum level CA 125 between benign and malignant masses in the pelvis was 35 and 65 IU/ml.

RESULTS

Of those patients with a malignant ovarian tumor, 65.3% had menopause whereas only 31.5% of those with a benign tumor did so. The average age of the patients with a malignant tumor was 54.2 years and of those with a benign tumor 46.8 years. The preoperative CA 125 serum level was higher than 35 IU/ml in 80.2% and higher than 65 IU/ml in 72.7% of all analyzed patients with a malignant tumor, whereas it was 23.9% and 9.8% respectively in patients with a benign mass. In early stage ovarian cancer disease (borderline stage, I/II) the preoperative CA 125 serum level was higher than 35 IU/ml in 67.8% and in 52.5% higher than 65 IU/ml. In advanced stages (III/IV), it was higher than 35 and 65 IU/ml in 96.1%. After therapy the CA 125 serum level dropped below 35 IU/ml in 70.8% and after three chemotherapy courses in 78.1%. A CA 125 level less than 35 IU/ml was achieved by therapy in 84.2% patients with an early stage disease (I/II) and in 62.1% in advanced stages (III/IV). The calculated sensitivity was 80.2% and negative 74.5% (CA 125 higher than 35 IU/ml) and 72.7%, 90.2%, 90.7%, 71.6% respectively (CA 125 higher than 65 IU/ml).

CONCLUSION

. Preoperative determination of CA 125 is a very useful method to discriminate between benign and malignant masses in the pelvis.

[Differential diagnosis of urinary retention: aneurysm of the iliac artery]

A 69-year old male presented with anuric acute renal failure. Abdominal ultrasound at admission revealed a mass in the pelvis thought to be the urinary bladder and the diagnosis of urinary retention was made. When placement of an urinary catheter did not induce urine flow, digital rectal examination was done. Palpation of a pulsating mass finally led to the diagnosis of aneurysm of the iliac artery. Based on this case, the general problem of diagnosing an iliac artery aneurysm is discussed.

The treatment of cervical dysplasia with laser

In 14 patients with different stages of cervical dysplasia laser vapourization was performed. Patients were between 25 and 44 year old (mean 35). Gynaecological history included 0-2 deliveries (mean 1.5). The procedure is minimally invasive after which complete cervical restitution is achieved. Control PAPA smear taken after 2 months, 6 months and one year respectively showed maximal therapeutic success. No complications were observed. The procedure is recommended for young women planning childbirth.

How to evaluate the risks of illnesses when there is a disorder of embroidery and supporting tissues

For the gynecologist it is not the priority activity of investigation the skin, bones and tissues, but we have the great relation and connection across the endocrinological ways. The main point is estrogen, gestagen and androgen, but also the condition of embroidery and supporting tissues have influence through the anabolic effects. If sexual steroids in anabolic activity are missing, the skin will dehydrate based on weither of corium, the risk of fracture of bones is bigger, the yielding of hardness of embroidery apparatus can cause deep pains in small of the back and we have a great number of cardiovascular illness. The function of skin, bones and blood vessels is mostly based on special characteristics of extracellular matrix. This can be defined again through the collagen. In spite of the coristant building and demolishing rise through the control of sexual steroids. At the same time, the mineralization of osteoids in the skeleton has influence of estradiol. A deficit of sexual steroids, unhealthy living and other factors can influence the degenerative changes of skin bones and blood vessels. To evaluate, obliged risk of illness and risks of accidents there are different procedures: the contents of collagen in skin and the fatness of blood vessels can be measured only by a high frequent ultrasound. Nevertheless we can confirm the condition of bones with radiological and ultrasound methods. In truth, the controversies about the prognostic values in consideration of risks of fractures exist which measured in the different cases trend in diagnosis of osteopenia/osteoporosis.

Ruptured interstitial pregnancy Two case reports

The authors described two cases of the ruptured unrecognized interstitial pregnancy. 32-year-old woman, was admitted for abdominal colics in 17th week of uncontrolled pregnancy. Obstetric finding on admission was normal, while ultrasonography pointed to 17th week of gestation. During the first night of hospitalization, severe abdominal pain, with collapse, tachycardia and hypotension developed. Laparotomy was performed in general endotracheal anesthesia with resuscitation measures, and revealed hematoperitoneum and ruptured right-sided interstitial pregnancy with a dead fetus among the bowels. Abdominal hysterectomy without adnexa was performed. S. J., a 35-year-old tertigravida, six years before, left-sided adnexectomy was performed for perforated tubal pregnancy. 5 weeks before artificial abortion now, ultrasonography revealed a vital fetus biometrically corresponding to the 11th week of gestation. The condition was recognized as an unsuccessful artificial abortion and intact pregnancy. During preoperative preparation the patient lost consciousness and required immediate resuscitation. The abdominal cavity was opened by Pfannenstiel's relaparotomy, and revealed hematoperitoneum with numerous adhesions between the small intestine, sigma, uterus and urinary bladder, and ruptured left-sided interstitial pregnancy. Adhesiolysis was completed, a lesion in the sigma was sutured, and hysterectomy was performed. Exploration of the abdominal cavity revealed a dead fetus among small intestine loops, and an indurated, sharply delineated neoplasia of the head of the pancreas.

Assessment of reliability endometrial brush cytology in detection etiology of late postmenopausal bleedings

We evaluated the possibility of discovering bleeding causes in late postmenopausal period with cytological examination of material received by endometrial brush in comparison with Pap test and fractionated curettage. Sixty-two women in late postmenopausal period with cervical canal bleeding, treated in gynecological department of clinical hospital in Osijek, were cytological and histological processed. Final diagnosis in 29 from 62 (46.8%) women with late postmenopausal bleeding was cancer. 25 (40.3%) women had endometrial adenocarcinoma and 4 (6.5%) of them had squamous endocervical carcinoma. Two women had endometrial precancerous (3.2%). With Pap test accurate diagnosis was set up in 13 from 25 (52.0%) women with endometrial adenocarcinoma and in all of them with squamous endocervical carcinoma. With endometrial brush accurate diagnosis was set up in 14 from 25 (56.0%) women with endometrial adenocarcinoma and in 3 from 4 (75.0%) women with squamous endocervical carcinoma. With fractional curettage the diagnosis of endometrial adenocarcinoma was accurately correct in 21 from 25 (84.0%) women and in all of them with squamous endocervical carcinoma. Cytological examination of material derived with endometrial brush, alike vaginal cytology, is not enough reliable method in our conditions for discovering bleeding causes in late postmenopausal period. Diagnostic exactness of procedure could be increased by histopathological examination of material from endometrial brush procedure and with ultrasound evaluation of endometrium thickness.

[Methemoglobinemia in a newborn infant following pudendal anesthesia in labor with prilocaine. A case report]

A genetically intact newborn suffered from methaemoglobinaemia after delivery under pudendum anaesthesia with prilocaine. Complete restitution was promoted by i.v. applied ascorbic acid and thionine. This is of special importance because in this case methaemoglobinaemia was not produced by medication of the patient herself but must be attributed to the local anaesthesia of the mother with prilocaine. The special sensitivity of newborn and infants, as well as the use of possible treatment methods as described in literature, are discussed.