Ljiljana Ivanović’s scientific contributions

Introduction: Primary retroperitoneal tumors account for 3% of all tumors, with sarcoma and schwannoma being the most common. Their growth period is rather long, without presence of characteristic symptoms related to the location and tumor size. Basic therapeutic procedure is complete surgical removal of tumor. Definitive diagnosis is made intraoperatively and after hystopathological examination. Objective: To present the results of surgically treated retroperitoneal tumors localized in female pelvis. Method: Eight (8) patients with different histological types of retroperitoneal tumors were operated in the period 2001-2010. Only in 4 (50%) cases, imaging diagnostic methods reliably confirmed retroperitoneal localization of pelvic tumors. Stage of the disease was determined according to staging classification of soft tissue sarcomas. Results: In the period 2001-2010, 4015 of women were operated for different pelvic tumors, out of which 8 (0.19%) had retroperitoneal tumors. 5 (62.5 %) patients had malignant tumors of mesenchymal origin (sarcomas), while 3 (37.5%) patients had benign tumors. In all cases, tumors were completely removed. Average length of operation was 189 minutes, and intraoperative blood loss was 360 ml. In 2 (25%) patients with malignant retroperitoneal schwannomas, bleeding from presacral veins and arteries of greater omentum occurred following the surgery, which required second look surgery. Conclusion: In spite of utilization of modern diagnostic methods, primary retroperitoneal tumors are in 50% of cases discovered intraoperatively. Successful treatment means complete surgical tumor removal. The total of 6 (75%) patients is alive and without clinical signs of tumor, while average survival rate is 4.3 years.

Introduction and Hypothesis: The aim of the survey is the presentation of surgical technique in the treatment of stress urinary incontinence joined with anterior vaginal vault prolapse (cystocele grade II 57,2% and III 42,8%), evaluation of obtained results and complications of the treatment. Methods: At 13 patients, we performed surgical correction of cystocele (Gynemesh PS - 6, tobacco pouch - 7) and then suburethral placement of Gynecare TVT Obturator System (Johnson & Johnson Company) by "inside-out" method in the same act. Urodynamic examinations were carried out at all patients prior the operation and 24 months after surgery. Results: Cystocele and stress incontinency recurrence occurred at 2 (14.2%) patients two years after the surgery, while 13 (92.9%) patients are dry. Other complications (mesh erosion, de novo urgency), which occurred at 3 (21,5%) patients, are similar to those which appear after separate cy-stocele correction and TOT tape placement.Conclusions: Urinary stress incontinency and anterior vaginal wall prolapse require surgical correction of these two disorders in the same act.

Introduction: Vulvar cancer make approximately 3-5% of all malignant female genital organs tumors. Different surgical procedures are available and the choice depends on 3 main factors: size of primary tumor, depth of penetration into stroma, and spread into regional lymph nodes. A special problem exists with treatment of tumor which covers large areas, urethra, bladder, perineum or anus. Objective: Demonstration of surgical technique in creation of V-Y sliding fasciocutaneous flap for covering the defect following the surgical excision of vulvar cancer and evaluation of obtained results. Method: Seven patients aged 59-75 years (x=65.5) were operated in the period from 2005 to 2008. After inguinal lymphadenectomy, wide local excision 4 (57.1%) and radical vulvectomy 3 (42.9%) were performed, followed by covering of the defect by V-Y fasciocutaneous flaps. Histopa-thological examination confrmed squamocellular type of carcinoma in all cases. Staging of the disease was determined postoperatively according to current FIGO classification. The period of monitoring and follow up was 29 months on average (24-36).Results: We applied 11 V-Y fasciocutaneous flaps (3 unilateral and 4 billateral). The average duration of operation was 155 minutes, and average blood loss was 250 ml. Regarding postoperative complications, we had 2 cases (18.2%) of partial superficial dehiscence at the junction of bilaterally created flaps. Local recurrence was recorded at one patient in the area of perianal region 36 months after the operation. Conclusion: Based on the donor-site scar, thickness and degree of flap advancement, the fasciocutaneous V-Y flap is a good method for re-construction of vulvoperineal defect after radical tumor excision.

Introduction: A surgical treatment is stressful for a patient and its risks and complications can be fatal. The preoperative preparation is an important step when performing a surgical treatment and it is carried out in a precisely determined order. I getting information on the problem and previous examinations: It starts with taking the medical history, the first meeting and conversation between the patient and the gynecologist. A set of questions is devised to get information about the patient's problem. Status praesens reflects the present condition of the patient, other diseases, medicaments in use. Laboratory analyses (blood count, urine, liver enzymes, electrolytes, proteins) and other methods (ultrasound, x-ray, CT, MR) are done. An operation should be decided on only after all conservative methods have been used and the informed consent must be obtained from the patient. Ii preoperative preparation: A team consisting of an anesthesiologist, internist and other specialists, if needed, is to get insight into the patient's general health condition, decide on the application of antibiotics before the operation and on the prevention of thrombo-embolism and prepare the patient by disinfecting the region to be operated and placing Foley catheter into the bladder. Conclusion: The aim is to minimize possible intra and postoperative complications and to maximize the prospect of successful surgical treatment. Prior to the operation an estimation must be done whether the patient can safely bear the risks of the planned operation, the precise diagnosis must be made and possible intraoperative surprises must be minimized. The decision whether to operate or not should be made if at least one of the following reasons is present: to relieve the patient of the pain and suffering, to save her life or to correct the existing deformity. If none of these three reasons is present, the operation should be carried out.

The aim of this paper is to present a case of prenatal diagnosis of a congenital tumor of the oral cavity diagnosed at 28 weeks of gestation. After the diagnosis of oral cavity tumor was made by 21) ultrasound, a 3D scan was performed, which confirmed the diagnosis revealing a peduncle at the upper border of maxilla. A detailed scan was performed and no additional anomalies were seen. Magnetic resonance imaging was performed, confirming the diagnosis and the site of the tumor. Karyotype was previously done, and a normal female karyotype was found. Regular three-week follow-up scans were performed to follow the growth of the tumor, as well as the state of the amniotic fluid. No tumor growth was detected, and the amniotic fluid volume was normal until 39 weeks of gestation. Cesarean section was scheduled, due to the risk of tumor disruption during a vaginal delivery. A maxillofacial surgeon was present during an uneventful cesarean section and a complete surgical excision was done immediately after the baby was extracted and umbilical cord ligated. The histopathological diagnosis was: granular cell myoblastoma. The female newborn was developing normally, and at 5 months of age there were no traces of scarring at the place of the tumor. In cases of prenatal diagnosis of tumors of the oral cavity, where development of polyhydramnios can be expected, as well as difficulties with feeding and breathing after birth, it is important to make a plan for adequate follow-up and prompt surgical treatment immediately after birth.

The study evaluates serum levels of copper, chorionic gonadotropin, estradiol, progesterone and prolactin in patients with symptoms of miscarriage and in uncomplicated pregnancies in cases with or without cervical or vaginal infections detected by vaginal or cervical smears, as well as Chlamydia testing. The study included 50 patients with symptoms of threatening miscarriage and 50 patients with uncomplicated pregnancies. Hormone levels were determined by ELISA method and copper was evaluated by acid medium colorimetry. We found that values of serum copper, estradiol, progesterone and prolactin were significantly lower in patients with lower genital tract infection. Decreased levels of serum copper could be used as a method of choice for detecting infection during the first trimester of pregnancy.

Introduction The study evaluates serum levels of copper, chorionic gonadotropin, estradiol, progesterone and prolactin in patients with symptoms of miscarriage and in uncomplicated pregnancies in cases with or without cervical or vaginal infections detected by vaginal or cervical smears, as well as Chlamydia testing. Material and methods The study included 50 patients with symptoms of threatening miscarriage and 50 patients with uncomplicated pregnancies. Hormone levels were determined by ELISA method and copper was evaluated by acid medium colorimetry. Results We found that values of serum copper, estradiol, progesterone and prolactin were significantly lower in patients with lower genital tract infection. Conclusion Decreased levels of serum copper could be used as a method of choice for detecting infection during the first trimester of pregnancy.

Induction of labor represents initiation of uterine contractions before their spontaneous onset. The aim of the study was to establish the role of Bishop score in prediction of labor induction in routine clinical work. The study was a prospective, blind, observational one. All patients had a vaginal examination prior to induction, during which Bishop score was evaluated. The mode of induction was either intravenous infusion of oxytocin or endovaginal prostaglandins. The induction was considered successful if vaginal delivery took place within 24 hours from the onset of induction. There were 100 patients, and induction was successful in 74% and unsuccessful in 26%. Mean Bishop score in group A was 5.65 (SD 1.40, 95% CI 5.27-6.03), and in group B 4.15 (SD 1.04, 95% CI 3.66-4.63) (p < 0.01). Statistical analysis of the area under the ROC curve showed that Bishop score is a good and reliable predictor of the outcome of labor induction (0.816, 95% CI od 0.710-0.896), with the best statistical performances at the cut-off value of 5 (sensitivity 65.5%, specificity 95%, PPV 97.3%, NPV 50%). In our study Bishop score proved to be a reliable and good method for prediction of the outcome of pregnancy if a single, experienced operator evaluates it, with best statistical performances at the cut-off value more than 5 (sensitivity 65.5%, specificity 95%, PPV 97.3%, NPV 50%). The next step would be introduction of more operators, of different skills and experience and subsequent further testing of the method in different conditions.

The aim of this prospective, blind, observational study was to estimate the role of transvaginal ultrasound examination of the uterine cervix in prediction of labour induction outcome in order to adequately chose patients that will have high chance for labour induction. One hundred patients scheduled for induction of labour had a transvaginal ultrasound scan during which cervical length and anterior cervical angle were assessed and the presence/absence of cervical tunneling was noted. Induction was successful if a vaginal delivery within 24 hours took place. The difference between the mean values of the cervical lengths assessed by transvaginal ultrasonography in the group of successful (25.89 mm--SD 8.27, 95% CI 23.65-28.13) and unsuccessful inductions (32.03 mm--SD 6.25, 95% CI 29.01-34.96) is statistically significant (p < 0.05). The anterior cervical angle is not a useful predictor of induction success (sensitivity 22%, positive predictive value 40%). Cervical length assessed by transvaginal ultrasonography is a reliable predictor of labour induction outcome and the best statistical performance of this parameter this test has at the cut-off value of 30 mm (positive predictive value 87.2%, sensitivity 74%, specificity 70%).

Fibronectin is a glycoprotein produced by different types of cells. It can be divided into two main groups--soluble fibronectin, found in human plasma and other body fluids (amniotic fluid) and tissue fibronectin, found in basal membrane and connective tissue between endothelial cells (2). There are three subtypes--plasmatic, cellular and onco-fetal fibronectin, the most important during pregnancy, with different concentrations during the course of pregnancy. The aim of the study is to establish normal distribution of fetal fibronectin in cervicovaginal fluid during pregnancy in our population and afterwards establish the relation between concentrations in different stages of pregnancy and the pregnancy outcome. This prospective, observational study was done at the Department of Obstetrics and Gynaecology, Clinical Centre Novi Sad, during the period June-October 1988. The presented results are preliminary ones. The patients were randomly chosen from the population that came for routine consultations as well as the ones hospitalized at the Department, at the High Risk Pregnancy Unit, for reasons other than threatening miscarriage and preterm delivery. One-hundred and thirty two pregnant women were examined, divided into three groups, according to gestational age. In group I were women between 7-20 weeks, in group II between 21 and 37 weeks and in group III 38 and more weeks. In every case general and obstetric data were collected, and cervico-vaginal fibronectin was taken from the posterior vaginal fornix, using a special kit (Specimen Collection Package, Adeza Biomedical). Fetal fibronectin concentration was tested using enzyme immunoassay (Adeza Biomedical) and positive was considered the concentration of and above 0.05 microgram/ml. The mean cervico-vaginal fibronectin concentration, uncorrected for the outcome of the pregnancy was as follows--in group I 0.045 (0-0.11) microgram/ml, group II 0.037 (0-1.22) microgram/ml, and in group III 0.226 (0.001-1.05) microgram/ml. The concentration trend was from weakly negative during the period 7-20 weeks, over highly negative (21-37 weeks) to very positive, after 38 weeks. The positive/negative relation in group I was 29.2%/70.8%, group II 11.7%/88.3% and group III 48.4%%/51.6%. After the correction of the results for miscarriages/preterm deliveries/failed induction in postterm pregnancies, the mean concentrations were somewhat different--group I 0.029 microgram/ml, II 0.019 microgram/ml and III 0.282 microgram/ml. The relations of positive and negative results were changed as well and in group I the relation was 27.3%/72.7%, group II 6.8%/93.2% and group III 71.4%/28.6%. After the correction for duration and outcome of the pregnancy, our results differed from the results in the literature. Thus in the 1st trimester fetal fibronectin was positive in cervico-vaginal fluid of 27.3% pregnant women, which is double the number usually found in the literature, between 21 and 37 weeks, when a positive result (> 0.05 microgram/ml) would be expected in only 3% of cases, it was positive in 6.8%, whereas 2.3 of the women delivered at term had a positive concentration. The discrepancy in group II (21-37 weeks) cannot be explained neither with a higher incidence of late miscarriages, nor preterm deliveries, for the incidence of such complications was only 3%, which is far less than usually found in the non-selected population (10%) (9). It is also possible that the discrepancy in our results and the results found in literature is based on a fact that our population was not preselected, which was the case in other studies' populations that did not include women with heavy, non-treated vaginal discharge, nor the ones that had sexual intercourse within 24 hours from the moment of fibronectin sampling. (ABSTRACT TRUNCATED)