Publications (10)4.74 Total impact
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Article: Prevalence and significance of vaginal group B streptococcus colonization in pregnant women from Osijek, Croatia.
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ABSTRACT: The aim of the study was to determine the prevalence of vaginal group B streptococcus (GBS) colonization in pregnant women from Osijek area, the possible effect of GBS colonization on pregnancy outcome and neonatal complications and the role of intrapartum prophylaxis in this context. This retrospective case-control study took place at the Department of Gynecology and Obstetrics, Osijek University Hospital Center from December 2003 to June 2006. A total of 118 pregnant women was enrolled in study and divided into two groups: 59 women in 35th-37th week of gestation, free from risk factors for infection (control group); and 59 women in 25th-41st week of gestation with risk factors for infection. Low vaginal swab for GBS isolation and identification on selective and enriched medium was obtained from each woman. GBS colonization was recorded in 29 (24.6%) women: 12 (20.3%) control and 17 (28.8%) women at risk of infection, yielding a statistically non-significant difference (Chi2 = 1.480489; p < 0.48). Early neonatal infection was observed in six (20.7%) neonates born to 29 mothers with GBS colonization, pointing to a correlation between vaginal GBS colonization and early neonatal infection (r(s) = 0.99). Early perinatal infection was found in 22 (18.6%) neonates, including 17 (28.8%) pregnancies with risk factors, pointing to a significant correlation between vaginal GBS colonization, risk factors and early perinatal infection (Chi2 = 88.68; p < 0.001); however, gestational age and pregnancy outcome were not influenced by GBS colonization. In eight (36.4%) newborns, early neonatal infection developed in spite of intrapartum administration of antibiotics; three of these children were born to GBS positive mothers, and perinatal GBS infection was demonstrated in one (0.84%) child. Study results revealed a relatively high rate of GBS colonization in the population of pregnant women in Croatia, occasionally leading to early neonatal infection. Large studies are needed to develop national strategy for the prevention of GBS infection in Croatia.Collegium antropologicum 03/2011; 35(1):21-6. · 0.61 Impact Factor -
Article: Placenta previa percreta with bladder invasion.
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ABSTRACT: A 43- year old woman, with ten previous deliveries and history of two cesarean sections was admitted to our Department at 32 weeks of gestation with massive vaginal hemorrhage from an ultrasound diagnosed placenta previa. An emergency cesarean section with vertical abdominal incision was performed. A healthy 2300 g female infant was delivered. Attempts to manually remove the placenta caused massive hemorrhage. The lower uterine segment was widened due to placenta previa with suspicious placental invasion of the posterior wall of the bladder. Persistent hemorrhage demanded bilateral anterior internal iliac artery ligation and suture ligation of the bleeding vessels with supracervical hysterectomy done.Medicinski glasnik 02/2011; 8(1):66-8. · 0.06 Impact Factor -
Article: Vascular endothelial growth factor and intratumoral microvessel density as prognostic factors in endometrial cancer.
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ABSTRACT: The aim of this research was to determine the VEGF A expression in tumor cells and the intratumoral microvessel density and their prognostic significance in the survival of the subjects. 87 subjects were monitored retrospectively for a period of 60 to 132 months. The subjects were treated at the Department of Obstetrics and Gynecology of Osijek University Hospital Center, Croatia. We analysed standard clinical, pathohistological and therapeutical prognostic factors, intratumoral microvessel density and expression of VEGF A. Five-year survival was calculated by the life chart method and presented graphically by Kaplan-Meier curves. Reaching conclusions on statistical hypotheses in this paper was done with a reliability level p < 0.05. Of the analyzed clinical prognostic factors, those which proved to be statistically significant and independent prognostic factors were age and clinical stage of the disease, and of pathohistologic ones it was the depth of myometrial invasion and VEGF expression. An elevated VEGF expression is associated with deep myometrial invasion, poorly differentiated tumors, histologic type and intratumoral microvessel density to a statistically significant degree. Elevated VEGF expression, age, FIGO stage and depth of myometrial invasion play a significant prognostic role in patients with endometrial cancer. VEGF receptors could be a target for adjuvant therapy in VEGF positive endometrial cancer.Collegium antropologicum 06/2010; 34(2):447-53. · 0.61 Impact Factor -
Article: Assessment of HPV DNA test value in management women with cytological findings of ASC-US, CIN1 and CIN2.
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ABSTRACT: The aim of this retrospective study was to answer the following questions: 1) is HPV DNA test for high-risk types able to predict lesion behaviour in women with cytological abnormalities lower than CIN3 (ASC-US, CIN1 and CIN2); 2) how to predict the histological diagnosis CIN3, and 3) is its use in diagnostic management in these patients justified or not? The study included 345 women (11 ASC-US, 312 CIN1 and 22 CIN2) that underwent conventional diagnostic management (repeat cytology and colposcopy with or without histology) and HPV testing for high-risk HPV types by PCR method. The value of HPVDNA test in predicting lesion regression/persistence was assessed in 275 subjects without histology. In 70 subjects, diagnostic accuracy (sensitivity, specificity, and positive and negative predictive value) of repeat cytology and HPV DNA test in predicting severe intraepithelial lesion (CIN3) was determined on the basis of colposcopy guided biopsy. The prevalence of persistent lesions was significantly higher in the group of HPV positive than in the group of HPV negative subjects (37.7% vs. 16.4%; p < 0.001). Positive HPV test was associated with a 3.1-fold risk of lesion persistence [OR (95% CI) = 3.095 (1.65-5.82)]. However, on screening to predict the outcome of cytologically diagnosed cervical lesion with sensitivity of 39.7% and positive predictive value of 37.7% showed that a positive test could not be considered a reliable indicator of lesion persistence. In contrast, the specificity of 82.5% and negative predictive value of 83.6% suggested that a negative test result could be taken as a good indicator of lesion regression. In comparison with repeat cytology, HPV test showed higher sensitivity (69.2% vs. 61.5%) but significantly lower specificity (63.2% vs. 93.0%) and positive predictive value (30.0% vs. 66.7%), and comparable negative predictive value (90.0% vs. 91.4%) in predicting histologically verified CIN3. In one patient with a histological diagnosis of squamous cell carcinoma with minimal invasion, repeat cytology indicated CIN3, whereas HPV test was negative. Due to authors experience in women with cytological abnormalities lower than CIN3, HPV testing is not a method to reliably predict lesion behaviour (regression, persistence) or presence of CIN3. HPV testing is of limited value in daily routine and should not be widely used until it is definitely demonstrated to be superior to conventional methods in improving the sensitivity, specificity and positive predictive value of CIN3 and invasive carcinoma detection.Collegium antropologicum 03/2010; 34(1):81-6. · 0.61 Impact Factor -
Article: A case of intra-amniotic maternal hemorrhage in term pregnancy.
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ABSTRACT: Intra-amniotic maternal hemorrhage is a rare condition, hard to differentiate from some other conditions in pregnancy. We report an unusual case of intra-amniotic maternal hemorrhage in term pregnancy ending in urgent cesarean section, identified on ultrasound examination. A 24-year-old female (gravida 3, para 2, abortion 0) was admitted to hospital at 40 weeks' gestation for collapse and general weakness. Her blood pressure was 90/60 mm Hg, pulse 112 bpm, temperature 36 degrees C. The fetal heart race tracings were stable and reactive. The cervix was opened 3 cm. Further examination revealed no vaginal bleeding and normal amnioscopic findings. An ultrasound examination confirmed singleton, head-presenting gestation without any visible congenital anomalies, amniotic fluid index was at the 50th percentile, anterior placenta without evidence of previa, abruption or retroplacental hematoma. An inhomogeneous echogenic mass, measuring 12 x 8 cm, was noted within the amniotic cavity, there was no evidence of pathological flow through the mass on color Doppler. After admittance to the hospital, the patient complained of regular pains, weakness and collapsed with signs of hemorrhagic shock. Repeated ultrasound evaluation showed no change in acoustic texture and size, but the amniotic fluid now had a hyperechoic appearance which revealed increasing intra-amniotic hemorrhage. Because of clinical signs of maternal hemorrhagic shock confirmed by laboratory findings of decreasing red blood parameters, an urgent cesarean section was performed. A female infant weighing 3,070 g, Apgar score 5/7, was delivered. After removal of the placenta there was no sign of abruption, which was confirmed at histopathology. Hemoglobin A was detected in the amniotic fluid by Abt's test. The patient had an uncomplicated postoperative course. The infant developed normally. When there are signs of fetal distress or maternal hemorrhagic shock, an urgent cesarean section should be performed.Fetal Diagnosis and Therapy 02/2007; 22(4):299-301. · 1.05 Impact Factor -
Article: Serologically detected "new" tick-borne zoonoses in eastern Croatia.
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ABSTRACT: To establish serologically a contact with causative agents of human monocytic and granulocytic ehrlichiosis, human babesiosis, recently detected rickettsioses, and Lyme disease in individuals with a history of tick bite from three counties in eastern Croatia. Seroepidemiologic testing was performed in 102 subjects with a history of tick bite, who either requested examination for a tick bite or were suspected of having tick-borne disease. The study was carried out during the 1998-1999 period in the area of the Vukovar-Srijem, Osijek-Baranya, and Brod-Posavina counties. Serum analysis was performed by indirect immunofluorescence assay for the detection of antibodies to causative agents of human monocytic and granulocytic ehrlichiosis (Ehrlichia chaffeensis and human granulocytic ehrlichiosis agent), human babesiosis (Babesia divergens), and rickettsiosis. Enzyme-linked immunosorbent assay was used for the detection of antibodies to the spirochete Borrelia burgdorferi, the cause of Lyme disease. The assays were performed at the Department of Microbiology, Osijek Public Health Institute in Osijek, and their results were confirmed at the Department of Microbiology and Immunology, School of Medicine in Ljubljana, Slovenia. Ehrlichia chaffensis antibodies were detected in 5 sera, and antibodies to the causative agent of human granulocytic ehrlichiosis in 7 sera. A low titer of antibodies to the etiologic agent of babesiosis (Babesia microti) was detected only in a single serum. Eight sera that were positive for rickettsial antibodies contained rather high titers of antibodies against Rickettsia conorii, the agent of Mediterranean fever, and Rickettsia rickettsii, the agent of Rocky Mountain spotted fever. In six out of these 8 sera, antibodies to Rickettsia typhi, the cause of murine typhus, were detected possibly as a cross-reaction with some "newly detected" rickettsia circulating in this part of Europe, most likely Rickettsia slovaca. Positive titer of antibodies to Borrelia burgdorferi was detected in 15 sera. The agents of human monocytic and granulocytic ehrlichiosis and of possibly newly detected rickettsiae were indirectly demonstrated to circulate in eastern parts of Croatia. The results obtained by IFA failed to provide definite evidence for the circulation of the human babesiosis agent, because the IFA used in our study detected Babesia microti, which prevails in the USA, but not Babesia divergens, which is the predominant cause of the disease in Europe. Serologic evidence for Borrelia burgdorferi infection was demonstrated in 80% of the subjects suspected of having the skin manifestation of Lyme disease.Croatian Medical Journal 11/2003; 44(5):626-9. · 1.80 Impact Factor -
Article: Laparoscopic treatment of primary ovarian pregnancy.
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ABSTRACT: Ovarian pregnancy is an uncommon type of ectopic pregnancy. A 35-year-old, gravida 3, para 3 woman was admitted because of a vaginal bleeding of 17 days' duration after amenorrhea for 10 weeks. She had right lower quadrant pain. Serum beta-human chorionic gonadotropin concentration was 1530 mIU/ml. Transabdominal ultrasonography showed a normal-size uterus, empty uterine cavity, solid cystic mass 43 x 39 mm on the right adnexa, and no free fluid in the pouch of Douglas. Diagnostic operative laparoscopy under general anesthesia was performed for suspected ectopic pregnancy. Right oophorectomy was done because of minimal intact ovary tissue. It was later histopathologically confirmed as primary ovarian pregnancy. The woman experienced no postoperative complications.The Journal of the American Association of Gynecologic Laparoscopists 06/2002; 9(2):221-2. -
Article: [Surgical treatment of urinary stress incontinence with the tension-free vaginal tape].
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ABSTRACT: TVT is the modern operative technique for the treatment of female urinary stress incontinence which was invented by Ulmsten and his co-operators. Tension-free vaginal tape implies the implantation of a prolene tape around mid-urethra via a minimal vaginal incision. It is the minimal invasive procedure under local anaesthesia and ambulatory performed. The majority of the women to be discharged from the clinic the same day or the day after the procedure. Results of studies about tension-free vaginal tape operation presents high success rate (90%) without serious complications, specially long term urinary incontinence. There is no signs of rejection the tape.Medical Archives 02/2002; 56(1):25-7. -
Article: Assessment of HPV DNA Test Value in Management Women with Cytological Findings of ASC-US, CIN1 and CIN2
[show abstract] [hide abstract]
ABSTRACT: The aim of this retrospective study was to answer the following questions: 1) is HPV DNA test for high-risk types able to predict lesion behaviour in women with cytological abnormalities lower than CIN3 (ASC-US, CIN1 and CIN2); 2) how to predict the histological diagnosis CIN3, and 3) is its use in diagnostic management in these patients justified or not? The study included 345 women (11 ASC-US, 312 CIN1 and 22 CIN2) that underwent conventional diagnostic management (repeat cytology and colposcopy with or without histology) and HPV testing for high-risk HPV types by PCR method. The value of HPV DNA test in predicting lesion regression/persistence was assessed in 275 subjects without histology. In 70 subjects, diagnostic accuracy (sensitivity, specificity, and positive and negative predictive value) of repeat cytology and HPV DNA test in predicting severe intraepithelial lesion (CIN3) was determined on the basis of colposcopy guided biopsy. The prevalence of persistent lesions was significantly higher in the group of HPV positive than in the group of HPV negative subjects (37.7% vs. 16.4%; p<0.001). Positive HPV test was associated with a 3.1-fold risk of lesion persistence [OR (95% CI) =3.095 (1.65–5.82)]. However, on screening to predict the outcome of cytologically diagnosed cervical lesion with sensitivity of 39.7% and positive predictive value of 37.7% showed that a positive test could not be considered a reliable indicator of lesion persistence. In contrast, the specificity of 82.5% and negative predictive value of 83.6% suggested that a negative test result could be taken as a good indicator of lesion regression. In comparison with repeat cytology, HPV test showed higher sensitivity (69.2% vs. 61.5%) but significantly lower specificity (63.2% vs. 93.0%) and positive predictive value (30.0% vs. 66.7%), and comparable negative predictive value (90.0% vs. 91.4%) in predicting histologically verified CIN3. In one patient with a histological diagnosis of squamous cell carcinoma with minimal invasion, repeat cytology indicated CIN3, whereas HPV test was negative. Due to authors experience in women with cytological abnormalities lower than CIN3, HPV testing is not a method to reliably predict lesion behaviour (regression, persistence) or presence of CIN3. HPV testing is of limited value in daily routine and should not be widely used until it is definitely demonstrated to be superior to conventional methods in improving the sensitivity, specificity and positive predictive value of CIN3 and invasive carcinoma detection.Collegium Antropologicum (croantro@inantro.hr ); Vol.34 No.1. -
Article: Prevalence and Significance of Vaginal Group B Streptococcus olonization in Pregnant Women from Osijek, Croatia
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ABSTRACT: The aim of the study was to determine the prevalence of vaginal group B streptococcus (GBS) colonization in pregnant women from Osijek area, the possible effect of GBS colonization on pregnancy outcome and neonatal complications and the role of intrapartum prophylaxis in this context. This retrospective case-control study took place at the Department of Gynecology and Obstetrics, Osijek University Hospital Center from December 2003 to June 2006. A total of 118 pregnant women was enrolled in study and divided into two groups: 59 women in 35th–37th week of gestation, free from risk factors for infection (control group); and 59 women in 25th–41st week of gestation with risk factors for infection. Low vaginal swab for GBS isolation and identification on selective and enriched medium was obtained from each woman. GBS colonization was recorded in 29 (24.6%) women: 12 (20.3%) control and 17 (28.8%) women at risk of infection, yielding a statistically non-significant difference (c 2=1.480489; p<0.48). Early neonatal infection was observed in six (20.7%) neonates born to 29 mothers with GBS colonization, pointing to a correlation between vaginal GBS colonization and early neonatal infection (rs=0.99). Early perinatal infection was found in 22 (18.6%) neonates, including 17 (28.8%) pregnancies with risk factors, pointing to a significant correlation between vaginal GBS colonization, risk factors and early perinatal infection (c 2=88.68; p<0.001); however, gestational age and pregnancy outcome were not influenced by GBS colonization. In eight (36.4%) newborns, early neonatal infection developed in spite of intrapartum administration of antibiotics; three of these children were born to GBS positive mothers, and perinatal GBS infection was demonstrated in one (0.84%) child. Study results revealed a relatively high rate of GBS colonization in the population of pregnant women in Croatia, occasionally leading to early neonatal infection. Large studies are needed to develop national strategy for the prevention of GBS infection in Croatia.Collegium Antropologicum (croantro@inantro.hr ); Vol.35 No.1.
