[Conservative treatment of women in perforations of the uterus in legal abortions].
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Abortion, Induced↗
Biomedical subjects
R Ganović
Publications and source records attributed to R Ganović.
[Diagnostic value of hysterosalpingography in examination of Fallopian tubes in infertile women].
UNLABELLED: Hysterosalpingography (HSG) is a radiographic examination of endocervical canals, uterine cavity and Fallopian tube with the use of a radiographic contrast medium [1]. This method is an integral part of gynaecological examination and its value has not been underestimated in the modern gynaecological practice. GOAL OF THE STUDY: The goal of the study was to evaluate the reliability of HSG in the diagnosis of Fallopian tube and to compare the obtained results with laparoscopic findings. METHODS: The study included 140 infertile women. HSG was performed in the first half of the cycle, usually on the ninth day, without anaesthesia. The instruments after Schultze were used; 15 mL of Telebrix-contrast was used. Three radiograms were done. Laparoscopic examination was carried out in general endotracheal anaesthesia. A Storz laparoscope was used. CO2 was used for artificial pneumoperitoneum and indigolipstick for tube passage. The obtained findings were elaborated statistically. Descriptive and analytic models were used. p < 0.05 and p < 0.01 were considered as a risk factor of statistical significance. RESULTS: An approximate time interval between the two procedures was 5.18 months. Normal findings of HSG examination were noted in 53 women (37.9%); tube occlusion in 67 women (47.9%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. A normal finding was found in 56 women (40.0%), tubal occlusion in 64 women (45.7%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. HSG and laparoscopic findings regarding normal tubes were in agreement in 32 women (22.9%), tubal occlusion in 35 women (25.0%) and peritabal adhesion with tubal passage in 5 (3.6%) patients. The best sensitivity of HSG was observed in detection of proximal tubal occlusion (78%), and the smallest in occlusion with the accompanying adhesion (2%). The best specificity of HSG was noted in the diagnosis of combined occlusions (96%) and the smallest in tubal passage with peritubal adhesion (25%). There were 15% of false negative findings and 17.1% of false positive findings. DISCUSSION: The time interval from one to the other procedure can be considered as an important factor in laparoscopic confirmation or negative HSG findings. With the continuation of the time interval the conditions are made for the aggravation of old and occurrence of new pathological processes in genital internal female organs. The possible causes of differential diagnosis of tubal occlusion between HSG and laparoscopic examination might be: 1) unequal anaesthesia during HSG and laparoscopic examination; 2) different properties of contrast media; 3) anatomic variations in the width of lumen tubes; 4) erroneous interpretation of the results. The sensitivity of HSG in this study was different in various types of tubal passage. In other studies the sensitivity of HSG was from 65% [10] to 96%[7]. The high specificity was found during detection of combined tubal occlusion (96%). The results of other authors were similar [7, 10]. This is a good contribution to the statement that HSG is a useful test of tubal obstruction. A rather high percent of false positive results of HSG was established in this study. The possible reasons might be tubal spasm and endometrial polyp in the area of the uterine opening of the tubes. CONCLUSION: On the basis of the obtained results, the following conclusions can be drawn: 1) HSG is a simple method for examination of female sterility; 2) HSG and laparoscopy are the complementary methods in the examination of tubal sterility; 3) HSG is inferior in relation to laparoscopy in the examination of peritubal adhesion.
Constriction, Pathologic↗
[Diagnostic value of hysterosalpingography in examination of fallopian tubes in infertile women].
UNLABELLED: Hysterosalpingography (HSG) is a radiographic examination of endocervical canals, uterine cavity and Fallopian tube with the use of a radiographic contrast medium [1]. This method is an integral part of gynaecological examination and its value has not been underestimated in the modern gynaecological practice. GOAL OF THE STUDY: The goal of the study was to evaluate the reliability of HSG in the diagnosis of Fallopian tube and to compare the obtained results with laparoscopic findings. METHODS: The study included 140 infertile women. HSG was performed in the first half of the cycle, usually on the ninth day, without anaesthesia. The instruments after Schultze were used; 15 mL of Telebrix-contrast was used. Three radiograms were done. Laparoscopic examination was carried out in general endotracheal anaesthesia. A Storz laparoscope was used. CO2 was used for artificial pneumoperitoneum and indigolipstick for tube passage. The obtained findings were elaborated statistically. Descriptive and analytic models were used. p < 0.05 and p < 0.01 were considered as a risk factor of statistical significance. RESULTS: An approximate time interval between the two procedures was 5.18 months. Normal findings of HSG examination were noted in 53 women (37.9%); tube occlusion in 67 women (47.9%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. A normal finding was found in 56 women (40.0%), tubal occlusion in 64 women (45.7%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. HSG and laparoscopic findings regarding normal tubes were in agreement in 32 women (22.9%), tubal occlusion in 35 women (25.0%) and peritubal adhesion with tubal passage in 5 (3.6%) patients. The best sensitivity of HSG was observed in detection of proximal tubal occlusion (78%), and the smallest in occlusion with the accompanying adhesion (2%). The best specificity of HSG was noted in the diagnosis of combined occlusions (96%), and the smallest in tubal passage with peritubal adhesion (25%). There were 15% of false negative findings and 17.1% of false positive findings. DISCUSSION: The time interval from one to the other procedure can be considered as an important factor in laparoscopic confirmation or negative HSG findings. With the continuation of the same time interval the conditions are made for the aggravation of old and occurrence of new pathological processes in genital internal female organs. The possible causes of differential diagnosis of tubal occlusion between HSG and laparoscopic examination might be: 1) unequal anaesthesia during HSG and laparoscopic examination; 2) different properties of contrast media; 3) anatomic variations in the width of lumen tubes; 4) erroneous interpretation of the results. The sensitivity of HSG in this study was different in various types of tubal passage. In other studies the sensitivity of HSG was from 65% [10] to 96% [7]. The high specificity was found during detection of combined tubal occlusion (96%). The results of other authors were similar [7, 10]. This is a good contribution to the statement that HSG is a useful test of tubal obstruction. A rather high percent of false positive results of HSG was established in this study. The possible reasons might be tubal spasm and endometrial polyp in the area of the uterine opening of the tubes. CONCLUSION: On the basis of the obtained results, the following conclusions can be drawn: 1) HSG is a simple method for examination of female sterility; 2) HSG and laparoscopy are the complementary methods in the examination of tubal sterility; 3) HSG is inferior in relation to laparoscopy in the examination of peritubal adhesion.
Constriction, Pathologic↗
[Inborn disorders of amino acid metabolism as etiologic factors in progressive encephalopathy in the early neonatal period].
The authors report three cases of neonates with severe, progressive encephalopathy provoked by congenital disturbances of amino acid metabolism (hyperglycinemia, citrulinemia, and hyperamoniemia type: II). The occurrence of convulsions is particularly pointed out, because they are the most indicative signs of brain damage manifested in the first seven days of life.
Amino Acid Metabolism, Inborn Errors↗
[Diagnostic value of hysterosalpingography and laparoscopy in infertile women].
UNLABELLED: Tubal pathology with tubal blockage due to the pelvic inflammatory diseases is one of the most frequent causes of infertility in a woman [1]. The two most important diagnostic procedures which are used for evaluation of tubal patency are hysterosalpingography and laparoscopic hydrotubation [4]. SUBJECT: The aim of the study was the comparison of hysterosalpingographic and laparoscopic findings and determination of accuracy of these two procedures in the diagnosis of tubal patency. MATERIAL AND METHODS: We studied and compared the results of hysterosalpingography and laparoscopy in 102 infertile women who were operated on at the Narodni Front Hospital of Gynaecology and Obstetrics in Belgrade during 1993 and 1994. Of 102 operated women 47 women were with primary infertility and 55 with secondary infertility. The patients were from 20 to 41 years of age, the average 28 +/- 2.4 years. RESULTS: Of one hundred and two operated women tubal blockage was found in 94 (92.1%) patients. Unilateral hydrosalpinx was found by hysterosalpingography in 16 (15.7%) subjects and bilateral hydrosalpinx in 30 (29.4%) women. Unilateral hydrosalpinx was found by laparoscopy in 17 (16.1%) patients and bilateral hydrosalpinx in 32 (31.4%) subjects. The concordant findings by hysterosalpingography and laparoscopy in the diagnostics of unilateral hydrosalpinx were found in 76.5% of cases, and in bilateral hydrosalpinx in 70.4%. This difference was not statistically significant. Unilateral tubal blockage was identified by laparoscopy in 26 (25.5%) patients and bilateral in 27 (26.5%) subjects. The concordant findings by hysterosalpingography and laparoscopy in unilateral tubal blockage were found in 61.5% of cases, and in bilateral tubal blockage in 70.4% of women. The total concordant findings by hysterosalpingography and laparoscopy in tubal blockage were found in 65.7 of cases, and concordant findings after hysterosalpingography and surgery were noted in 61.7% cases. The findings by laparoscopy and surgery were in harmony in 86.3% patients. Ovarian abnormalities were found by laparoscopy and surgery in 22 (21.6%) women. Pelvic adhesions were found by laparoscopy in 42 women of 49 patients in whom pelvic adhesions were found during the operation. Uterine congenital anomalies were found by laparoscopy in 3 (2.9%), women and by hysterosalpingography in 6 (5.9%) patients. DISCUSSION: Of 102 operated women tubal blockage was found in 94 (92.2%) women. Unilateral tubal blockage was found in 38 (40.4%) patients, and bilateral tubal blockage in 56 (59.6%) subjects. Hysterosalpingographic and laparoscopic hydrotubation findings in the diagnosis of tubal patency were concordant in 65% of cases, hysterosalpingographic and operative findings in 61.7% of patients, and laparoscopic and operative findings in 86.3% of subjects. Although concordant findings of 65.7% were noted in this study, which were similar to findings of other authors, the percentage of 62.5% [4], and 76% was observed [5]. During the operation pelvic adhesions were found in 49 patients, and laparoscopic in 42 women only. Ovarian abnormalities were found by laparoscopy in 22 (21.6%) patients, while uterine fibroid was found in 10 (9.8%) subjects. Uterine congenital anomalies were found by hysterosalpingography in 6 (5.9%) cases and by laparoscopy only in 3 (2.9%) patients. The advantage of visual hysterosalpingography seems to be in identification of some congenital uterine anomalies. However, the advantage of laparoscopy is identified by the possibility of visualisation of some other pelvic abnormalities which may be the cause of infertility. CONCLUSION: There are some hysterosalpingographic and laparoscopic advantages and disadvantages in the diagnosis of infertility in women. Only by using both procedures accurate results can be achieved in the tubes, the uterus and the ovary, that can be a cause of infertility in women.
Adult↗
[Antibiotic therapy in the treatment of inflammatory diseases in the minor pelvis].
UNLABELLED: Pelvic inflammatory diseases are usually caused by sexually transmitted microorganisms, as are Neisseria gonorrhoeae and Chlamydia trachomatis, either alone or associated with endogenous flora of the lower genital tract, as with other gram-positive and gram-negative anaerobic and aerobic bacteria [1, 2]. SUBJECT: The aim of the study was to estimate the effect of three broad-spectrum combinations of antimicrobial therapy in the treatment of pelvic inflammatory diseases in hospitalized patients. MATERIAL AND METHODS: We analysed the therapeutic success of some antimicrobial therapies in 154 patients with pelvic inflammatory disease, who were treated in the Narodni Front Hospital of Gynaecology and Obstetrics in Belgrade, during 1992 and 1993. Three drug therapies were applied. The combination of Ceftriaxon plus Doxycycline was given to 51 women. Fifty five women were treated by a combination of Gentamycin plus Clidamycin, and 48 women were treated by a combination of Gentamycin and Metronidazole. RESULTS: The therapeutic success after the application of the three different antibiotic therapies was recorded in 139 of 154 women (90.26%). Of 136 patients with uncomplicated pelvic inflammatory diseases, the therapeutic success was noted in 129 (94.85%) individuals, while of 18 women with tubo-ovarian abscess therapeutic success was recorded in 10 (55.56%) patients. Of 51 women treated by the combination of Ceftriaxon plus Doxycycline, the therapeutic success was observed in 46 (90.19%) patients. Fifty five women treated by the combination of Gentamycin plus Clindamycin, the therapeutic success was noted in 50 (90.19%) subjects. Of 48 women, treated by the combination of Gentamycin plus Metronidazole, the therapeutic success was found in 43 (89.58%) women. No statistically significant difference was found among the applied antibiotic therapies (p > 0.05). Of 18 women with tubo-ovarian abscess 8 were operated on. Of these 8 women in 6 patients hysterectomy with bilateral salpingo-oophorectomy was performed and in two women unilateral salpingo-oophorectomy was carried out. DISCUSSION: Pelvic inflammatory diseases are often of polymicrobial aetiology. In 43 patients we found two types of bacteria in the cervical culture. The therapeutic success was achieved by these three antibiotic therapies. It was 90.26%, the therapeutic success in the treatment of pelvic inflammatory diseases by Ceftriaxon plus Doxycycline was noted in 90.19% of patients. The therapeutic success of antibiotic therapy with Gentamycin plus Clindamycin was obtained in 90.91% of patients. The success of antibiotic therapy with Gentamycin plus Metronidazole was recorded in 89.59% of patients. Our results are similar to those of other authors [3, 4, 6, 7]. No statistically significant difference was found among the applied antibiotic therapies. CONCLUSION: An early diagnosis and an aggressive treatment may prevent serious sequelae of this increasingly common sexually transmitted disease. The antibiotics should be of antimicrobial broad spectrum. Good effects can be best reached by a combined antibiotic therapy. Duration of parenteral administration of antibiotics should be several days and for at least 48 hours after the patient's defervescence.
Adult↗
[The ovarian hyperstimulation syndrome].
The use of controlled ovarian hyperstimulation has increased the efficacy of ovulation induction and enhanced the ability to recruit multiple mature oocytes for use in the assisted reproductive technologies. However, the administration of medications is not without risk. Ovarian hyperstimulation syndrome is a serious complication with various manifestations. Two fundamental pathologic changes are characteristic: ovarian enlargement with underlying stromal oedema and multiple haemorrhages of luteinized cysts coupled with a dramatic shift of fluid from the intravascular spaces into the peritoneal, pleural, and pericardial cavities. The most efficacious treatment of hyperstimulation syndrome is its prevention. The correction of hypovolaemia and electrolyte abnormalities is one of the most important procedures in the treatment of this syndrome.
Female↗
[The role of insulin-like growth-factor binding proteins in normal and polycystic ovaries].
The insulin-like growth factor binding proteins are single chain polypeptides, that can bind insulin-like growth factors, but not insulin. They can serve as autocrine or paracrine regulators of the actions of insulin-like growth factor. The human granulosa cells produce insulin-like growth factor-II but not insulin-like growth factor-I, while the human theca cells produce insulin-like growth factor-I and II. Polycystic ovarian syndrome is a disorder which is characterised by hyperandrogenism and anovulation. In polycystic ovarian syndrome there is a disorder of follicular development, with the accumulation of antral follicles within the ovary which fail to respond appropriately to endogenous follicle-stimulating hormone. Significance is given to insulin-like growth factor binding proteins, which have an inhibitory action on follicle-stimulating hormone. No differences were found in the total level of insulin-like growth factor binding proteins follicular profiles between women with polycystic ovarian syndrome and without it. Serum insulin-like growth factor binding protein-I levels are lower in polycystic ovarian syndrome with hyperinsulinaemia, probably as a consequence of insulin-mediated suppression of insulin-like growth factor binding protein-I. Consequently, serum free insulin-like growth factor-I levels are higher. This alteration may cause an excessive thecal androgen production. The alterations in the insulin-like growth factor-insulin-like growth factor binding proteins axis may be one of several mechanisms that help to sustain the steady state of anovulation and follicular dysmaturation that are characteristic of this syndrome.
Female↗