Browsing by Author "Nikolić, Branka (36905814200)"

Detectable serum levels of beta subunit of human chorionic gonadotropin (βhCG) in nonpregnant, perimenopausal women bring confusion in both clinician and patient and could lead to unnecessary diagnostic and therapeutic procedures. A 45-year-old woman with the continuous elevation of βhCG underwent hysteroscopy, two laparoscopic surgeries, two explorative uterine cavity curettages and three cycles of cytostatic therapy. No ultrasonographic, macroscopic or histological signs of pregnancy, both uterine and ectopic or gestational trophoblastic disease were found. Both radiographic and computed tomography reports ruled out the presence of a nongynecological neoplasm. All recommended steps were taken for confirmation or ruling out the possibility of heterophile antibodies interference, but the results were not absolute. Finally, the referent laboratory confirmed the presence of the antibodies, but their exact type remains unknown. This case underlines the importance of the universally accepted protocol in the cases of persistent βhCG elevation in nonpregnant, perimenopausal women. © 2020 Japan Society of Obstetrics and Gynecology

Introduction. Anesthetic management of a patient with spinal muscular atrophy type II, who underwent elective cesarean section with neuraxial anesthesia is presented in this case report. Case report. A 33-year old woman with first pregnancy and no previous birth, at 39 weeks gestational age was scheduled for a cesarean section due to placenta previa. She had a history of spinal muscular atrophy type II, that confined her to a wheelchair, and a surgical history that included corrective surgery for kyphoscoliosis. The patient had predictors for a difficult intubation (limited mouth opening and reduced neck extension) so the decision was made to attempt the needle-through-needle combined spinal-epidural technique for surgical anesthesia. Harrington rods and scar tissue complicated placement of the combined spinal-epidural anesthesia, however successful placement was achieved. Conclusion. Spinal muscular atrophy in pregnancy is rare and represents big challenge for an anesthesiologist due to respiratory dysfunction, anticipated difficult intubation, severe kyphoscoliosis and limitations of the use neuromuscular blocking agents. The potential risks need to be considered when administering anesthesia in patients with spinal muscular atrophy undergoing a cesarean section. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction. Choriocarcinoma is a malignant form of gestational trophoblastic neoplasm (GTN). It is a rare event but also a curable malignancy. In the majority of instancies it developes after any gestational event. In some cases it developes as non-gestational extrauterine malignancy. Prognosis of choriocarcinoma is poor when invasion and metastases appear early and spread fast. This form of choriocarcinoma can lead to incurable and letal outcome. Case report. We presented a 20-year-old patient with abdominal and retroperitoneal malignancy - anaplastic carcinoma combined with choriocarcinoma metastases in. Tumor developed three months after left adnexectomy which had been done because of adnexal tumor. Choriocarcinoma was immunohistochemicaly confirmed in adnexal masses. Two courses of chemotherapy, metotrexate + folic acid (MTX+FA) regimen, were administrated. The initial serum beta human chorionic gonadotropin level stayed unknown as well as the last one after the treatment. The patient came from the other country and was hospitalized because of pelvic and abdominal pain and palpable abdominal masses in hypogastrium with progressive anemia. The human chorionic gonadotropin level was 38 mIU/L. Tumor biopsy was done and choriocarcinoma metastases were immunohistochemicaly confirmed with predominant anaplastic carcinoma. Five day course of MTX + cyclophosphamide regimen was administrated and the patient was prepared for operative treatment. Relaparotomy was perforemed and tumor completely exceeded. Tumor mass mostly developed retroperitonely and partialy in abdominal cavity infiltrating intestinal wall with rupture of sigmoid colon. Anaplastic carcinoma, with large fields of necrosis and bleeding, was confirmed after histological examination. Immunohistochemical examination excluded choriocarcinoma in tumor mass. After 20 blood units transfusion, one course of chemotherapy and tumor excision, the patient left hospital on the 9th postoperative day. The patient rejected chemotherapy which was recommended according to the protocol and died one month after the operation. Conclusion. Non-gestational metastatic choriocarcinoma complicated with another type of malignancy with early spread of the disease and low responsiriness to chemotherapy has poor prognosis and leads to lethal outocome.

Introduction. Epithelioid trophoblastic tumor (EТТ) is an extremely rare form and unusual type of trophoblastic tumor. In 1998 ЕТТ became an independent entity because it possesses specific histological and immunohistochemical features which make it different from placental site tumor and choriocarcinoma. ЕТТ origins from intermediate trophoblast and it can overlap with the squamous cell carcinoma as per differential diagnosis. The relevant literature data suggest that surgical treatment is a treatment of choice for ETT considering that its response to chemotherapy is considerably poor. Case report. A 35-years-old patient G3 P2 came to an examination due to the low pelvic pain and absence of menstrual cycle. She reported that menstrual cycles were irregular during the past year. During the bimanual pelvic examination, a painful tumefaction being approximately 8 cm was palpated in the pouch of Douglas. The patient was operated on as being suspected for ectopic pregnancy when it was noticed that the aforementioned tumefaction was located retroperitoneally immediately against rectosigmoid part of the colon. After the histopathological analysis of the sample, in order to make the final diagnosis, the immunohistochemical test was performed and it found that this EТТ. Due to an inadequate response to administered chemotherapy, both resection of rectosigmoid colon with appurtenant tumor and left hepatectomy with salpingectomy on both sides were performed considering a possibility of gestational trophoblastic neoplasia (GTN) after ectopic pregnancy. Because of dehiscence of colorectal anastomosis, relaparotomy with colostomy bag fitting was performed. The patient died on the day 40 after surgical treatment due to hepatic insufficiency. Conclusion. In order to make as much adequate treatment method of ETT as possible, it is necessary to organize a team work with multidisciplinary approach. Surgical resection of the tumor is a primary method for treating ETT. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction. Infectious diseases caused by Streptococcus pyogenes, a member of the group A Streptococci (GAS) are among the most common life threatening ones. Patients with GAS infections have a poor survival rate. Cellulitis is a severe invasive GAS infection and the most common clinical presentation of the disease associated with more deaths than it can be seen in other GAS infections. According to the literature data, most cases of GAS toxic shock syndrome are developed in the puerperium. However, there are two main problems with GAS infection in early puerperium and this case report is aimed at reminding on them. The first problem is an absence of awareness that it can be postpartal invasive GAS infection before the microbiology laboratory confirms it, and the second one is that we have little knowledge about GAS infection, in general. Case report. A 32-year-old healthy woman, gravida 1, para 1, was hospitalized three days after vaginal delivery with a 38-hour history of fever, pain in the left leg (under the knee), and head injury after short period of conscious lost. Clinical picture of GAS infection was cellulites. Group A Streptoccocus pyogenes was isolated in vaginal culture. Rapid antibiotic and supportive treatment stopped development of streptococcal toxic shock syndrome (STSS) and potential multiorganic failure. Signs and symptoms of the infection lasted 25 days, and complete recovery of the patient almost 50 days. Conclusion. In all women in childbed with a history of fever early after delivery, vaginal and cervical culture specimens should be taken as soon as possible. Early recognition of GAS infection in early puerperium and prompt initiation of antimicrobial drug and supportive therapy can prevent development of STSS and lethal outcome.

[No abstract available]

Endometrial sonographic and color doppler features can be used to predict the occurrence of pregnancy in natural or stimulated cycles. Implantation will usually only take place if the endometrium has reach a certain stage of vascularisation and development. The aim of this study was to evaluate endometrial development -- endometrial thickness and reflectivity , subendometrial, endometrial and uterine perfusion, after hyperbaric oxygenation, using transvaginal color doppler. During a three years period 32 women with unexplained infertility were entered into a randomised study. The patients were treated in multiplaced HAUX chamber at pressure of 2.3 ATA during 70 minutes, 7 days consecutively beginning with day 5th of menstrual cycle.The evaluation of effects of hyperbaric oxygen therapy was carried out by transvaginal color doppler sonography which was continuously used starting from 8th day of menstrual cycle until the ovulation in the cycles when the therapy was applied , one month before and one month after the therapy. Folliculometry in the cycles when hyperbaric oxygen therapy at 2.3 ATA was applied, indicated an excellent response of endometrium. Thickness of endometrium at the time of ovulation was 11.0 +/- 2.6 mm. Desirable quality of endometrium was significantly better in the cycle when HBO therapy had been applied (p< 0.001). The doppler flowmetry of the uterine arteries indicated that the uterine blood vessel resistance was slightly higher than expected. Mapping of subendometrial blood vessels in the cycles covered by hyperbaric oxygen therapy showed the intensive capillary network of endometrium with low resistance Ri< 0.45. The oxygen used under higher pressure -- oxygen as a drug , may have an extraordinary significance for better outcome of pregnancy implantation by improving endometrial receptivity. If endometrial receptivity is conditioned by adequate vascularisation and oxygenation, then hyperbaric oxygen therapy is the treatment of choice.

Patient with malignant Gestational Trophoblastic Neoplasm (GTN) was treated by mean of MTX-FA, MAC, EMA-CO and EMA-EP. Changes in serum human chorionic gonadotropine (beta hCG) levels and changes in ultrasonographic findings were checked weekly. Finally transabdominal hysterectomy with ovaries conservation was done and polychemotherapy administrated after the operation until three consecutive serum chorionic gonadotropine values were negative. This is a case report of Invasive mole in 32 years old patient without possibillity to preserve reproductive health. GTN developed two months after spontaneous abortion in 13th week gestation. No changes in uterine structure were found during the first ultrasonographic examination. Th ree months after abortion and one month after GTN confirmed, massive destruction of lateral uterine wall was detected during transvaginal Doppler ultrasound examination. Resistance index of 0,366 was significantly lower than normal, with hypervascularisation in affected tissue. Serum beta hCG confirmed poor effect of polychemotherapy treatment and decision for operative treatment was made. Hystological findings after the operation confirmed malignant GTN-invasive mole. Specific changes in ultrasonographic picture could have an impact in therapy making decision and could not be refereed without the most relevant parameter such is serum human chorionic gonadotropine.

Laboratory findings such are white blood count and sedimentation rate are of relative value in inflammations of the upper genital tract and adnexal inflammatory tumors. Antibiotics are administrated in all cases according to the protocol but some of them need operative treatment also. Inflammatory tumors can develop in endometriotic and even in cancer adnexal masses. CA 125 is elevated in great number of patients with advanced ovarian cancer. It can also be elevated in endometriosis, inflammations and in non-gynecological malignancies. Adnexal inflammatory tumor was confirmed in 57 patients. Laboratory findings: white blood count and sedimentation rate were in normal levels in 17 patients. CA 125 was elevated in 27 patients. 49 patients were operated and CA 125 decreased in the first 5 days after the operation. Only 8 patients without CA 125 elevation were successfully treated by mean of antibiotics. Even there is no need for routine examining of serum CA 125 in adnexal inflammatory tumors it can be examined in cases with suspected Doppler ultrasonographic findings or unclear clinical findings. Endometriosis brings some risk of malignancy. Inflammatory tumor can develop in endometriotic tumor as well as in necrotic malignant ovary tissue. These could be reasons for making decision to do the operation in cases with inflammatory tumor followed with increased CA 125, hystological assessment and serious interpretation of final results.

Hypogonadotropic hypogonadism is one of the causes of infertility. In women with hypogonadotropic hypogonadism both follicle-stimulating hormone and luteinizing hormone are required to induce optimal follicular growth and steroidogenesis. We described a case of singleton pregnancy in a 38-year-old patient, presenting with primary hypogonadotropic amenorrhea and empty sella syndrome, treated with human menopausal gonadotropins and performing intrauterine insemination in first attempt. This therapy led to maturation of two follicles and one of them was fertilized. A singleton pregnancy ensued and a normal infant was delivered by cesarean section. © 2006 Blackwell Munksgaard.

Hypogonadotropic hypogonadism is one of the causes of infertility. In women with hypogonadotropic hypogonadism both follicle-stimulating hormone and luteinizing hormone are required to induce optimal follicular growth and steroidogenesis. We described a case of singleton pregnancy in a 38-year-old patient, presenting with primary hypogonadotropic amenorrhea and empty sella syndrome, treated with human menopausal gonadotropins and performing intrauterine insemination in first attempt. This therapy led to maturation of two follicles and one of them was fertilized. A singleton pregnancy ensued and a normal infant was delivered by cesarean section. © 2006 Blackwell Munksgaard.

Introduction. Invasive mole, a form of gestational trophoblastic neoplasia (GTN), is defined as penetration of molar tissue into the myometrium and/or presence of extrauterine metastases. An invasive mole arising from a complete hydatidiform mole is more common than an invasive mole arising from the partial hydatidiform mole. Dilatation and uterine evacuation and/or curettage (D&E/C) is the first step in managing molar pregnancy. Uterine perforation is the most serious complication of this procedure. A less common one is the false passage. Case report. The first case report describes a 47-year-old woman who was referred to our Clinic under the suspicion of GTN, with elevated serum beta human chorionic gonadotropin (beta hCG) levels. Intraoperatively, devitalized ovular tissue arising from the uterine perforation was observed. Histopathological exam (HPE) of tissue obtained from hysterectomy confirmed an invasive mole as a result of uterine perforation made during D&E/C. The second patient, a 32-year-old woman with vaginal bleeding, nausea, and high levels of serum beta hCG levels was admitted to our Clinic. After four D&E/C, and persistently high levels of serum beta hCG levels, explorative laparotomy has been performed. A false passage created during D&E/C with necrotic and molar tissue was observed. The partial hydatidiform mole was confirmed by the HPE. Conclusion. This is the second reported case in the literature of postmolar GTN as a result of iatrogenic perforation of the uterus, and also the first described case of postmolar GTN arising from a false passage, created as an iatrogenic complication of D&E/C. A national survey of iatrogenic events during the treatment of gestational trophoblastic disaeses is needed since these events could completely change the therapeutic strategies in managing these diseases. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.