Role of laparoscopic surgery in treatment of infertility

The role of laparoscopy in assisted reproduction is disputed by many. A rising problem of infertility is battled by an increasing number of centres for reproductive medicine in the region. Nevertheless, there is a large number of indications and conditions where laparoscopic surgery should not be avoided as a therapeutic choice or an aid in assisted reproductive techniques (ART). The number of centres where laparoscopic surgery is performed is significantly higher than the number of reproductive centres; a number of gynaecologists educated in laparoscopic gynaecology is growing, making it more available for patients.

Intermittent hepatic porphyria in pregnancy with good perinatal outcome

Porphyrias are rare metabolic diseases caused by enzymatic defects of the haeme biosynthesis. Association of pregnancy and acute porphyria is rare, but mortality rate among pregnant women from acute attack has been reported up to 42%. This paper presents a patient with pregnancy complicated by intermittent hepatic porphyria with good perinatal outcome. The pattern of the attack in pregnancy varies individually and it makes porphyric pregnancies a challenge. Previously diagnosed porphyria patients should be closely monitored during pregnancy and diagnosis of acute porphyria must be also considered in all pregnant women with unexplained abdominal pain.

Bone mineral density changes and bone turnover in thyroid carcinoma patients treated with supraphysiologic doses of thyroxine

The aim of this one-year prospective study was to determine whether longterm thyroxine treatment is a risk factor for elevated bone turnover, loss of bone mass and subsequent development of osteoporosis. Premenopausal women (N = 19), and men (N = 9) suffering from differentiated thyroid gland carcinoma in the mean age of 39.0 +/- 8.0 years and 41.8 +/- 10.0 years were investigated. All of them had undergone a total thyroidectomy and subsequent thyroxine therapy. The duration of the TSH-suppressive therapy prior to the the beginning of our study was 9.4 +/- 6.4 years in the female and 8.1 +/- 6.0 years in the male group. The prospective observation was performed by dual X-ray absorptiometry (DXA) at the spine and the femoral neck and by single-photon absorptiometry (SPA) at the distal radius. Laboratory testings included thyroid hormones T3, T4 and TSH, serum calcium, phosphate and PTH, and urinary calcium and phosphate from spontaneous and 24-hour urine samples. Markers of bone formation (osteocalcin, alkaline phosphatase and PICP) and resorption (Ca/Cr and ICTP) were determined. Statistically significant loss of bone mass was observed only on the distal radius in males (p<0.05). At the lumbar spine and femoral neck, only a minor bone loss was registered in a small number of patients. Almost 50 % of the females showed values above the reference range. In more than 30 % of the females, and smaller number of male patients, ICTP values ranged above the reference range, corresponding to elevated bone turnover. These two variables exhibited a slight correlation with bone density at the measured skeletal areas, mostly considering the male group. The results are a proof that accelerated bone turnover and subsequent bone loss occurs during TSH-suppressive thyroxine therapy. In future prospective studies a prolonged time of observation will be necessary, as well as to increase the number of studied patients, in order to better assess the relative risk of osteoporosis in patients undergoing TSH-suppressive treatment more precisely.

Maternal overnutrition and pregnancy

During the period from October 1, 1999 till February 29, 2000, 500 pregnant women were analyzed according to overnutrition, i.e. weight gain. The analysis was performed in the Department of Gynecology and Obstetrics, Osijek University Hospital for pregnant women from east Slavonia, Baranya and west Srijem, where large quantities of dietary fats and carbohydrates are used. The mean weight gain during pregnancy was assessed. The mean weight of male infants in primiparae was 3.22 g, i.e. 8% higher than the mean value for the same population in Zagreb. The rate of EPH gestoses in patients with weight gain over 12 kg was significantly higher (4.0%) than in those with weight gain less than 12 kg (1.8%). In pregnant patients with weight gain > 12 kg, the rate of cesarean section was significantly higher (9.2%) than in those with weight gain < 12 kg (4.4% o). Perinatal mortality was significantly higher (10.0%) in pregnancies with weight gain > 12 kg than in those with weight gain < 12 kg (2.0% o). It is concluded that dependence on overeating in pregnancy may result in higher rates of EPH gestosis, cesarean section and perinatal mortality.

Pleomorphic vulvar leiomyoma with local invasive behavior

A case of pleomorphic leiomyoma in Bartholin gland's area in a 26-year-old woman is reported. After diagnostic treatment, primary excision was done. A large, solid tumor 10 x 7.5 cm was extirpated. The tumor showed locally invasive behavior, which suggested a malignant tumor of Bartholin gland, because of it's localization and outlook. Pathohistological examination and immunohistochemical reactions proved that it was a mesenchymal tumor of smooth muscle origin with marked polymorphism, without mitosis, with a myxoid stroma and with biological aggressivity, and the possibility of local recurrence. Thus, a second more radical surgical procedure, was performed. In the excised tissue, no residual tumor was found and all lymph nodes were negative.

[Gasless laparoscopy]

Gasless laparoscopy is minimal invasive surgical procedure in combination with conventional abdominal surgical procedures. For installation surgical instruments are necessary two small (10 mm) noses in suprainguinal regions. In this regions the flexible 10 mm trokars are install. The patients precedence: the abort of instillation CO2 in abdominal cavity, the pain is significant less, the shoulders pain is significant less. Together with optic endoscopic increment the operation is precise and safely. Gasless laparoscopy is good at the price. Gasless laparoscopic procedure uses multiple surgical instruments. In conclusion gasless laparoscopy is advantageously than laparoscopy with CO2.

[Results of IVF treatment methods in Germany in 1998--the German IVF Registry]

We used data in Germany IVF registar 1998 from 86 (94.6%) centers which take upon IVF procedures. The total documentary were treated 46730. The cultivated data were 45459. The visible is increase number of group which use IVF procedures and growth IVF/ICSI centers with options KRYO preservations. In Germany 1998, IVF ICSI, KRYO and GIFT procedures were treated 30,009 women, on an average 1,515 cycles per year. The endurance leaning of children was amoung 2 and 8 years for both procedures. In stimulated cycles on an average were taken 9.04 eggs (follicule punction). During IVF procedures it was 22.64% clinical pregnancy and ICSI procedures 23.53% clinical pregnancy. In most of the cases cycles were stimulated with long gonadotropine protocol, with GnRH-agonists, after suppression adenohypophysis. Considering pregnancies and abortions in addiction to chosen gonadothropine it was not possible to confirm significant difference neither for IVF of ICSI procedures. Results of therapy showed clear addiction to age of women and become worse after 39 the year of life and distintcly less after 49th year for both procedures. During transvaginal ultrasonography follicule punction reported is 253 (0.67%) complications. Severe cases such as ovarial hyperstimulation syndroms (OHSS III) were reported in 1.12% cases.