Browsing by Author "Nejković, L. (55566568600)"

The following is a description of an extremely rare tumor of the uterus, malignant atypical polypoid adenomyoma (APA), admixed with well-differentiated endometroid carcinoma, in a 29-year-old patient previously treated for sterility in whom, due to the existence of a ten-millimeter sessile tumor on the uterine corpus, verified by transvaginal ultrasonography (TVUS), a hysteroscopic resection of the anomaly was performed. The patient underwent all requisite examinations and was referred to the malignant diseases panel for an examination and a decision on further treatment. As the patient wished to preserve fertility, the authors decided to continue performing regular controls at intervals of two to three months. The first subsequent control called for a TVUS examination or one using another imaging method, with a multiple endometrial biopsy with curettage of the endocervix. The results of the first examination promised that fertility could be preserved. Therapy with medroxyprogesterone acetate (MPA) in daily dosages of 200 to 500 mg was advised, which the patient intentionally did not take. A spontaneous desired pregnancy was verified following the first control.

This is a case report of a 36-year-old patient with an ectopic pregnancy located in the previous cesarean section scar following in vitro fertilization (IVF). The patient was treated by 50 mg of intrasacular methotrexate locally under ultrasound guidance. Transvaginal ultrasound (TVUS) confirmed that the pregnancy was no longer vital within 24 hours, dilatation and aspiration of the ovular tissue were performed after seven days and it was sent for pathohistological analysis. Eight hours after the procedure, the patient began bleeding abundantly and was consequently treated locally by 1 ml of Beriplast® P Combi set, human fibrinogen, and human thrombin set (CSL Behring). After the treatment, the patient was discharged in good health, with normal laboratory values. Her menstrual period resumed 35 days after the procedure.

Purpose: To determine the role of fetal multiples of the median of middle cerebral artery peak systolic velocity (MoM MCA-PSV), in predicting the degree of fetal anemia for determination of the best timing for the second intrauterine intravascular transfusion (IUIVT) in hydropic fetuses with Rh alloimmunization. Materials and Methods: Prospective study of 30 monofetal pregnancies with maternal Rh D alloimmunization and hydrops fetalis, from 2005 to 2012 that underwent first and second IUIVT were assessed. Results: Thirty IUIVT were performed at 26.9 weeks (standard deviation, SD 4.3). Mean interval to the second procedure was 11.23 (SD 6.21) days and average hematocrit decline rate was 1.45%/day. The study did not demonstrated statistical significance between MCA-MoM-3 before the second IUIVT, and the mean decline rate in fetal hematocrit levels (expressed in percentage/day) r = 0.220; p = 0.242, and between MCA-MoM-3 and the time interval between both procedures (T) r = -0.157; p = 0.408. Conclusion: The measurements fetal MoMMCA before every IUIVT cannot be useful as predictor for the best timing for the next IUIVT, but it can be useful in predicting severity of fetal anemia.

This study investigated maternal hemodynamic influence on uteroplacental oxygen distribution and neonatal outcome during cesarean section (CS). CS was performed on 80 parturients using two anaesthetic techniques: spinal anaesthesia (SA) and general balanced anaesthesia (GBA). Indications for CS were exclusively obstetric related. Monitored maternal parameters were: ECG, heart rate (HR), non-invasive blood pressure (NIBP), saturation (SaO2). Gas parameters in umbilical artery, vein, and neonatal capillary blood were sampled. Vitality was assessed by the Apgar scoring, first breath-taking time and the first breastfeeding attempt. Hypotension was the most common finding after SA induction. GBA group presented changes such as QT inversion (12.5%), tachycardia (55%), and bradycardia (2.5%). SA group experienced higher rates of sinus tachycardia (45%) and ventricular dysrhythmias (2.5%). Neonatal oxygenation was significantly higher in SA group. Higher quality of early neonatal adaptation in the SA group confirms it as the technique with the least neonatal risk during CS.

Epithelial ovarian cancer is the leading cause of mortality among gynecologic malignancies. It occurs more often in women in menopause, which facilitates the implementation of adequate surgical treatment. The aggravating approach arises when diagnosed with young patients who have not given birth. Approximately 10% of all epithelial ovarian carcinoma is diagnosed in women under the age of 40. In those cases, it is necessary to find a balance between adequate treatment and a strong desire for achieving progeny. Criteria guaranteeing safe fertility preservation are not cleary identified. Most studies recommend that fertility sparing surgery can be performed in all young women in whom ovarian cancer is detected as Stage IA grade 1. Here the authors report a preservation of fertility in 19-year-old patient with mucinous ovarian carcinoma. © 2019 S.O.G. CANADA Inc.. All rights reserved.

Granulosa cell tumors of the ovary are rare ovarian neoplasms developing from ovarian stromal cells. They are characterized by insidious growth, low malignancy potential, and late recurrence. Due to the production of estrogen by these tumors, the frequent symptoms that occur in these patients develop as a result of hyperestrogenism. Standard treatment involves surgery in all patients. Fertility-sparing surgery is considered safe in young patients only in case of early-stage IA and IC tumors, where it is necessary to perform a unilateral salpingo-oophorectomy and complete staging. Surgical staging includes peritoneal washing, multiple peritoneal biopsies, omental biopsy, and biopsy of any suspicious area. © 2020 Nejković et al.