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Dotlic J.,Institute of Obstetrics and Gynecology | Terzic M.,Institute of Obstetrics and Gynecology | Terzic M.,University of Belgrade | Likic I.,Institute of Obstetrics and Gynecology | And 2 more authors.
Vojnosanitetski Pregled | Year: 2011

Background/Aim. Concerning the growth of ovarian carcinoma incidence and bad prognosis for malignant forms, early and precise diagnostics is gaining in importance as a condition for precise and appropriate therapy for ovarian tumor masses. The aim of this study was to analyze pre- and postoperative findings of patients with adnexal masses in order to identify factors which could predict the nature and stage of the tumor prior to surgery. Methods. All patients with adnexal masses who were treated in a 6-month period in the Institute of Obstetrics and Gynecology, Clinical Center of Serbia, (IOG, CCS), Belgrade, had their epidemiologic and gynecologic anamnesis and standard laboratory analyses taken prior to surgery. Also, clinical and ultrasonographic check up of pelvic organs was performed, as well as calculation of body mass index (BMI) and risk of malignancy index (RMI). After surgery we analyzed histopathological (HP) findings of tumors as a mean of final diagnosis and staging. For statistical analysis, we used SPSS 15 program. Results. Throughout a 6-month period, we examined 81 patients with adnexal masses treated in the IOG CCS. HP findings showed that there were significantly more benign (n = 51) than malignant (n = 30) tumors in all the patients (χ 2 = 5.512). The patients with malignant HP findings were significantly older than those with benign adnexal masses (t = 3.362; p = 0.001). Significantly more patients with malignant HP findings were in menopause (p = 0.034). BMI values were highly significantly higher in the patients with malignant adnexal tumors (t = 3.421; p = 0.001). There was a statistically significant positive correlation between HP categories (benign, malignant) and RMI categories (low, intermediate and high risk) of all the patients (high risk, more malignant HP) (Ro xy = 0.428; df = 78; p = 0.000). Conclusion. Patients in menopause, especially older ones, with high BMI and RMI should immediately be referred to a tertiary level institution, where appropriate surgery could be performed.


Manchanda R.,University College London | Godfrey M.,University College London | Wong-Taylor L.A.,University College London | Halaska M.J.,Charles University | And 12 more authors.
Annals of Oncology | Year: 2013

Background: Primary data on training experiences of European gynaecological oncology trainees are lacking. This study aims to evaluate trainee profile, satisfaction and factors affecting the training experience in gynaecological oncology in Europe. Patients and methods: A web-based anonymous survey sent to ENYGO members/trainees in July 2011. It included sociodemographic information and a 22-item (1-5 Likert scale) questionnaire evaluating training experience in gynaecological oncology. Chi-square tests were used for evaluating the independence of categorical variables and t-test (parametric)/Mann-Whitney (non-parametric) tests for differences between two independent groups on continuous data. Cluster analysis was used to identify groupings in multivariate data and Cronbachs-alpha for questionnaire reliability. A multivariable linear regression model was used to assess the effect of variables on training satisfaction. Results: One hundred and nineteen gynaecological-oncology trainees from 31 countries responded. The mean age was 37.4 (S.D, 5.3) years and 55.5 were in accredited training posts. Two clusters identified in the cohort (Calinski-Harabasz, CH 47.35) differed mainly by accredited training (P 0.003). The training-satisfaction score (TSS) had high reliability (Cronbachs alpha, 0.951) and was significantly associated with accredited posts (P < 0.0005), years of training (P 0.001) and salary (P 0.002). The TSS was independent of age (P 0.360), working hours (P 0.620), overtime-pay (P 0.318), annual leave (P 0.933), gender (P 0.545) and marital status (P 0.731). Accredited programme trainees scored significantly higher than others in 17 of 22 aspects of training. The areas of greater need included advanced laparoscopic/urological/colorectal surgery, radiation oncology, palliative-care, cancer genetics and research opportunities. Conclusions: Our data demonstrate the importance of accredited training and the need for harmonisation of gynaecological oncology training within Europe. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Jovanovic N.S.,Institute of Obstetrics and Gynecology | Kocijancic D.M.,Institute of Obstetrics and Gynecology | Terzic M.M.,Institute of Obstetrics and Gynecology | Terzic M.M.,University of Belgrade
Central European Journal of Medicine | Year: 2011

An episiotomy is a surgical incision through the perineum made to provide sufficient area for the delivery of the infant. About 10 to 95% of women who deliver will have episiotomy depending on which part of the world they are having delivery. Too early episiotomy causes extensive bleeding and too late episiotomy causes the excessive stretching of a pelvic floor and lacerations could not be prevented. According to widely accepted arguments, there are many benefits of episiotomy for the neonate: prevention of injuries, shoulder dystocia and mental retardation of the infant. Benefits for the mother are: reduction of severe lacerations, prevention of sexual dysfunction, prevention of urinary and fecal incontinence. But those things could also be complications of episiotomy, if it is being used nonrestrictively. Some other complications are also extensive bleeding, hematoma or infection. There are many different opinions in literature about using episiotomy restrictively or routinely, so it is the right doubt arisen: is it inevitable or unnecessary? There is a wide variation in episiotomy practice, and the decision of performing it or not depends of actual clinical situation. There is still a great need for continuous obstetrics education according to the evidence based guidelines for the patient's safety. © 2011 Versita Warsaw and Springer-Verlag Berlin Heidelberg.


Bergeron C.,Laboratoire Cerba | Nogales F.F.,University of Granada | Rechberger T.,Medical University of Lublin | Tatarchjuk T.,Institute of Obstetrics and Gynecology | Zipfel L.,Solvay Group
Maturitas | Year: 2010

Objectives and study design: The aim of this open, multicentre study was to demonstrate the endometrial safety and assess the bleeding pattern of ultra low dose continuous combined hormone replacement therapy with 0.5 mg 17β-oestradiol and 2.5 mg dydrogesterone in 446 healthy, non-hysterectomised, postmenopausal women with symptoms of oestrogen deficiency. Main outcome measure: Aspiration endometrial biopsies were performed at baseline and after 1 year of treatment to assess the incidence of endometrial hyperplasia or a more serious endometrial outcome. Results: The only adverse endometrial outcome at the end of the study was one case of simple hyperplasia. This gives an overall incidence of 0.27% (95% CI: 0.01-1.48%) in the per protocol sample (n = 395). The overall rate of amenorrhoea in the full sample (n = 446) was 68% and 14% had only one or two bleeding/spotting episodes. The rate of amenorrhoea in months 10-12 (n = 413) was 88%. The number of bleeding/spotting days per cycle fell during the study. The mean number of bleeding/spotting days was 5.8 and the mean number of days without bleeding was 358.2. Spotting alone was the most prevalent bleeding intensity, whilst heavy bleeding was rare. Conclusions: In conclusion, 2.5 mg dydrogesterone continuously combined with 0.5 mg 17β-oestradiol effectively protects the endometrium in postmenopausal women in accordance with the guidelines of the Committee for Medicinal Products for Human Use (CHMP). It has a favourable amenorrhoea rate and is well tolerated by the majority of women. © 2010 Elsevier Ireland Ltd. All rights reserved.


Terzic M.,Institute of Obstetrics and Gynecology | Dotlic J.,Institute of Obstetrics and Gynecology | Ladjevic I.L.,Institute of Obstetrics and Gynecology | Atanackovic J.,Center for anesthesiology and resuscitation | And 2 more authors.
Vojnosanitetski Pregled | Year: 2011

Background/Aim. Ovarian cancer is the leading cause of death from gynecologic malignancies. Risk of malignancy index (RMI) is recommended in assessment of patients with adnexal masses. The aim of this study was to verify the effectiveness of the RMI in the discrimination between benign lesions and malignant adnexal masses in clinical practice. Methods. Ultrasounds were performed for all the patients and menopausal status, CA125 level and calculated RMI were defined. All the patients were divided into 3 groups depending on RMI (< 25, 25-200, > 200). After operations all ad-nexal masses were analyzed histopathologically (HP) and then sensitivity, specificity and predictive value of RMI were calculated. Results. Out of a total of 81 patients involved benign tumor had 51 (62.96%) and malignant 30 (37.04%) of the patients. The average value of CA125 in the group of patients with benign adnexal masses was 68.3 U/mL and in the group of patients with malignant adnexal masses it was 581.95 U/mL. In the group of patients with benign adnexal masses the average RMI was 284.9 and in the group of patients with malignant adnexal masses RMI was 469.2. All the results showed a positive correlation between both HP categories and RMI categories. The more malignant HP result produced higher RMI and the cut off value was RMI = 200. Sensitivity of RMI was 83.33%, specificity was 94.12%, positive predictive value was 89.29% and negative predictive value was 90.57%. Conclusion. Our study showed that RMI is very reliable in differentiation benign from malignant ad-nexal masses.


Babovic I.,Institute of Obstetrics and Gynecology | Plesinac S.,University of Belgrade
Clinical and Experimental Obstetrics and Gynecology | Year: 2012

Aim: The relations between abnormal umbilical and cerebral Doppler, cerebral-umbilical (C/U) ratio, and outcomes in pregnancies complicated by gestational hypertension and fetal intrauterine growth retardation were evaluated. Materials and Methods: A retrospective study of 53 monofetal pregnancies in 2010 was conducted at the Institute of Gynecology and Obstetrics, Belgrade. Statistical analysis: chi-square likelihood ratio test, Student's t-test and Spearman's coefficient correlation. Results: There was not a significant correlation between the timing of registration of abnormal umbilical Doppler to delivery and outcomes of high-risk pregnancies. There was a significant correlation between C/U ratio and APGAR-5 (p = 0.003). We found a significant correlation between neonatal birth weight and APGAR-5 (p = 0.000), neonatal asphyxia (p = 0.000), intracranial hemorrhage (p = 0.000) and respiratory distress syndrome (p = 0.000). Conclusion: Umbilical and cerebral artery Doppler is a relatively poor predictor of neonatal outcome. It seems that neonatal birth weight is the best predictor of neonatal outcome in high-risk pregnancies.


Babovic I.,Institute of Obstetrics and Gynecology | Radojicic Z.,University of Belgrade | Plesinac S.,University of Belgrade | Aksam S.,Institute of Obstetrics and Gynecology
Clinical and Experimental Obstetrics and Gynecology | Year: 2013

Aim: The relation between biophysical profile (BPP), cerebroplacental (C/P) ratio, and lecithin/sphingomyelin (L/S) ratio as a predictor perinatal outcome in term intrauterine growth restricted (IUGR) neonates was evaluated. Materials and Methods: A retrospective study of the perinatal outcome of 77 term monofetal pregnancies complicated with IUGR fetuses (< 10 percentile) who were terminated by cesarean section in 2010 was performed at the Institute of Gynecology and Obstetrics, Belgrade. Results: The most frequent early neonatal complication was asphyxia. The authors found a strong correlation between the L/S ratio and birth weight (BW) r = 0.609, as well as between BPP and Apgar score 5 r = 0.583. Significant negative correlation was found between asphyxia and BPP r = -0.398, as well as between asphyxia and C/P ratio r = -0.379. Conclusion: In serous IUGR neonates, low values of BPP and L/S ratios predicted asphyxia.


PubMed | Institute of Obstetrics and Gynecology and Saveetha Medical College & Hospital
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2014

Presence of signet ring cells in ovarian neoplasms are commonly encountered in Krukenberg tumours of ovary. Unusual presence in primary ovarian mucinous tumours may create a diagnostic difficulty. To the best of our knowledge only very few such cases have been reported in the literature indicating their rarity. We report a case of primary ovarian mucinous carcinoma with signet ring cells. The purpose of this presentation is to sensitize the pathologists to consider primary mucinous carcinoma as a differential diagnosis in tumours with signet ring cells.


Jiang R.,Institute of Obstetrics and Gynecology | Teng Y.,Institute of Obstetrics and Gynecology | Huang Y.,Institute of Obstetrics and Gynecology | Gu J.,Institute of Obstetrics and Gynecology | And 3 more authors.
Experimental and Molecular Medicine | Year: 2014

In women with preeclampsia (PE), endothelial cell (EC) dysfunction can lead to altered secretion of paracrine factors that induce peripheral vasoconstriction and proteinuria. This study examined the hypothesis that PE sera may directly or indirectly, through human umbilical vein ECs (HUVECs), stimulate phospholipase C-γ1-1,4,5-trisphosphate (PLC-γ1-IP3) signaling, thereby increasing protein kinase C-α (PKC-α) activity, collagen I expression and intracellular Ca2+ concentrations ([Ca2+]i) in human umbilical artery smooth muscle cells (HUASMCs). HUASMCs and HUVECs were cocultured with normal or PE sera before PLC-γ1 silencing. Increased PLC-γ1 and IP3 receptor (IP3R) phosphorylation was observed in cocultured HUASMCs stimulated with PE sera (Po0.05). In addition, PE serum significantly increased HUASMC viability and reduced their apoptosis (Po0.05); these effects were abrogated with PLC-γ1 silencing. Compared with normal sera, PE sera increased [Ca2+]i in cocultured HUASMCs (Po0.05), which was inhibited by PLC-γ1 and IP3R silencing. Finally, PE sera-induced PKC-α activity and collagen I expression was inhibited by PLC-γ1 small interfering RNA (siRNA) (Po0.05). These results suggest that vasoactive substances in the PE serum may induce deposition in the extracellular matrix through the activation of PLC-γ1, which may in turn result in thickening and hardening of the placental vascular wall, placental blood supply shortage, fetal hypoxia-ischemia and intrauterine growth retardation or intrauterine fetal death. PE sera increased [Ca2+]i and induced PKC-α activation and collagen I expression in cocultured HUASMCs via the PLC-γ1 pathway. © 2014 KSBMB. All rights reserved.


PubMed | Institute of Obstetrics and Gynecology
Type: Journal Article | Journal: Clinical and experimental obstetrics & gynecology | Year: 2013

The relation between biophysical profile (BPP), cerebroplacental (C/P) ratio, and lecithin/sphingomyelin (L/S) ratio as a predictor perinatal outcome in term intrauterine growth restricted (IUGR) neonates was evaluated.A retrospective study of the perinatal outcome of 77 term monofetal pregnancies complicated with IUGR fetuses (< 10 percentile) who were terminated by cesarean section in 2010 was performed at the Institute of Gynecology and Obstetrics, Belgrade.The most frequent early neonatal complication was asphyxia. The authors found a strong correlation between the L/S ratio and birth weight (BW) r = 0.609, as well as between BPP and Apgar score 5 r = 0.583. Significant negative correlation was found between asphyxia and BPP r = -0.398, as well as between asphyxia and C/P ratio r = -0.379.In serous IUGR neonates, low values of BPP and L/S ratios predicted asphyxia.

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