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Introduction/Objective. Fetal growth restriction (FGR) is associated with increased fetal and neonatal mortality and morbidity. The study objective was to investigate the correlation of maternal blood biochemical markers routinely determined in the first and second trimester screening and ultrasound fetal surveillance parameters in the prediction of fetal growth and condition in singleton pregnancies. Methods. In the first trimester we measured serum levels of beta subunit of human chorionic gonadotropin (βHCG) and pregnancy-associated plasma protein A (PAPP-A). In the second trimester we measured values of chorionic gonadotropin (HCG), alpha fetoprotein (AFP), unconjugated estriol (E3) and inhibin A, also examined ultrasonographic biometric fetal parameters, amniotic fluid index (AFI) and Doppler resistance indexes. FGR was defined as ultrasonographically determined fetal weight and growth parameters below the 10th percentile for the gestational age. Obtained biochemical and ultrasonographic parameters were correlated. Results. Study included 104 singleton pregnancies. βHCG in the first trimester correlated negatively with fetal growth in the second and third trimester, and the second trimester AFI. Increased PAPP-A correlated positively with elevated resistance index in medial cerebral artery, lower biophysical profile scores, and intermediate type of non-stress test. Lower values of E3 were associated with FGR. Elevated serum AFP levels were linked to oligoamnion in the third trimester. There was no correlation of inhibin A levels with fetal condition. Conclusion. First and second trimester biochemical markers of pregnancy (βHCG, PAPP-A, HCG, AFP and E3) in combination with ultrasonographic biophysical parameters of fetus have predictive value for fetal growth and development.

Introduction. Spontaneous bilateral ectopic pregnancy is a rare condition easily overlooked or misdiagnosed. We present a case of spontaneous bilateral tubal ectopic pregnancy and discuss the difficulties in diagnosing and treating such patients. Case outline. A 39-years-old patient with a history of irregular and abundant menstrual cycles complained of pelvic pain and light bleeding after 55 days of amenorrhea. Ultrasound revealed enlarged uterus with a myoma and a heterogenic formation with echogenic ring sign beside the left ovary. Free fluid with clots was present in the pelvis. As the patient was hemodynamically unstable and ectopic pregnancy was suspected, emergency laparotomy was performed. During the surgery we found that both tubes were significantly edematous, dilated, and livid in their ampullary regions. On the left tube anterior wall rupture 15 × 8 mm was noticeable, while right tube was intact with bleeding from its abdominal ostium. Even though the patient was not informed about the possibility of bilateral salpingectomy, after thorough consideration and due to the extent of tubal damage bilateral salpingectomy was eventually performed. Histopathological analysis confirmed the presence of decidua, partially viable and partially necrotic chorionic villi, and trophoblastic tissue in both right and left tubes. Conclusions. Careful preoperative and intraoperative examination of both Fallopian tubes as well as the whole abdominal and pelvic cavity should be mandatory during every assessment of patients with ectopic pregnancy.

Introduction/Objective. Even with the current treatment, mortality from aortic dissection remains high. The study aimed to evaluate the early postoperative outcome of patients with aortic dissection and identify which factors could influence it. Methods. The study included all consecutive patients who underwent surgery for acute aortic dissection type A from 2012 to 2017. We registered all parameters that could potentially impact the outcome (general data, medical history, clinical and cardiological diagnostic test findings, preoperative complications, type of cannulation and the operation performed, additional surgical procedures, operation duration, etc.). The patients were surgically treated according to the current protocols. The main outcome measures were complications and mortality during a one-month postoperative period. All data collected pre-, intra-, and postoperatively were compared and statistically analyzed. Results. The study included 246 patients, 57.54 ± 12.88 years old on average, and mostly of male sex (74%). Early postoperative mortality occurred in 17% of the patients. Preoperative chronic kidney insufficiency (p = 0.005) and cerebrovascular insult (p = 0.047) and tamponade (p = 0.036) were the major risk factors for postoperative complications and mortality. Long hypothermic cardiac arrest (p = 0.001), cross-clamp (p = 0.017) and cardiopulmonary bypass time (p = 0.036) increased postoperative complications. Postoperative complications started occurring after ≥ 33.5 minutes hypothermic cardiac arrest and ≥ 67.5 minutes cross-clamp time. Postoperative complications occurrence increased (p = 0.034), while performing anterograde cerebral perfusion decreased the frequency of lethal outcome (p = 0.001). Conclusion. The majority of patients surgically treated for acute aortic dissection had good postoperative outcome. However, numerous pre-, intra-, and postoperative factors can impact patient survival.

Introduction/Objective. As of recently, an increasing number of premenopausal women is being diagnosed with endometrial carcinomas. The objective of our study was to determine if routinely collected clinical and imaging parameters, implying on tumor characteristics, are different in pre- and postmenopausal endometrial carcinoma patients, enabling their appropriate preoperative evaluation. Methods. The study included all patients (n = 209) operated on due to endometrial carcinoma over a period of three years. The diagnosis was based on histopathological findings of exploratory curettage. Medical history was taken for all the patients and they were divided regarding menopausal status. On preoperative ultrasound scan, the endometrial echo pattern was established. The existence of myomas, adnexal masses, free fluid in the abdomen or uterine cavity was noted. Magnetic resonance imaging detected the presence of pelvic metastases and tumor spreading into the uterine cavity, myometrium, cervix, and lymph nodes. Postoperatively, histopathological findings, the tumor stage and grade were established. Results. The majority of women were postmenopausal and secundiparous. Significantly more patients were obese, especially the postmenopausal ones (p = 0.001). Most tumors were endometrioid adenocarcinomas regardless of menopausal status. Irregular/abnormal bleeding (p = 0.037), presence of ascites (p = 0.010), obesity (p = 0.046), and lower parity (p = 0.016) correlated with postmenopausal status. Large exophytic endometrial carcinomas were predominant in younger patients (p = 0.026). Endometrial carcinomas were significantly more often diagnosed in the II FIGO stage in premenopausal patients. There were no other significant differences (endometrial thickness, uterine homogeneity, echogenicity, tumor infiltration and spreading, histopathological type and grade) between pre- and postmenopausal endometrial carcinoma patients. Conclusions. Few differences between pre- and postmenopausal endometrial carcinoma patients existed and the most prominent ones were obesity, parity, irregular/abnormal bleeding, and tumor growth into the cavity.

Introduction. Premalignant changes of the uterine cervix occur with similar frequency during pregnancy and in non­pregnant women. Due to the fact that any surgery on the cervix can jeopardize pregnancy, it is important to define the protocol of procedures for the treatment of these changes during pregnancy. Objective. The aim of the study was to investigate the natural course of premalignant cervical changes during pregnancy and the impact of their treatment on the pregnancy course. Methods. Study involved all patients with colposcopically, cytologically and hystopathologically diagnosed premalignant cervical changes during pregnancy from 2002 to 2008. Patients were divided into two groups according to the applied treatment during pregnancy: surgery or monitoring by regular colposcopic and cytological examinations. The two groups were compared concerning treatment outcome, persistence or regression of changes and pregnancy duration. Results. Study involved 58 patients. Spontaneous remission of lesions occurred after pregnancy in 63.79% of cases. Highgrade squamous intraepithelial lesion (H­SIL) demonstrated a higher rate of persistency in comparison with low­grade squamous intraepithelial lesion (L­SIL) (χ2=25.115; p

Introduction The need for assessing the quality of life in chronic rhinosinusitis is emphasized by the medical, social and economic importance of this pathological condition. Questionnaires have been employed in majority of studies while there are no available data that Q method has been used for quality of life research in chronic rhinosinusitis up to the present. Objective The aim of this study was to identify, group and analyze subjective perception of the impact of the disease on health-related quality of life in patients with chronic rhinosinusitis. Methods The study involved 36 consecutive patients of both sexes, older than 10 years of age, diagnosed with chronic rhinosinusitis in the tertiary health clinic in three successive weeks. They were selected for medicamentous treatment. Health-related quality of life was assessed by Q method. Through 34 representative statements, which were sorted by the examinees related to subjective priorities, 10 key quality of life domains were examined. The data were processed by factor analysis employing specialized software package PQMethod. Results Analyzing individual opinions of the examinees, five different opinion-types (factors) on the impact of chronic rhinosinusitis on quality of life were demonstrated. They were marked numerically and descriptively according to dominant characteristics of the group: Factor 1 - stable group (47.2% of individuals), Factor 2 - symptomatic group (11.1% of individuals), Factor 3 - mental group (5.6% of individuals), Factor 4 - physical group (11.1% of individuals) and Factor 5 - optimistic group (25.0% of individuals). Each group was systematically analyzed. Conclusion Majority of patients with chronic rhinosinusits (72.2%) were found to be satisfied with the quality of life, while just a small number (5.6%) heavily bore the illness which especially jeopardised their mental health. This study demonstrates the strength of Q method in analyzing and categorizing subjectivity and offers quality practical information which enables a more comprehensive approach and more adequate intervention in patients with chronic rhinosinusitis.

Introduction In spite of the advances of modern medicine, puerperal infection is still one of the leading causes of morbidity and mortality of women in postpartal period. Objective The aim of this study was to analyze the presence of microorganisms in the cervicovaginal region of women in labor, as well as the frequency of puerperal endometritis in order to determine optimal treatment for isolated microorganisms and to prevent postpartal endometritis. Methods In this study, all women who gave birth to a healthy child per vias naturalis during the past two years in a tertiary health institution, Institute of Gynaecology and Obstetrics, Clinical Centre of Serbia, were analyzed. The investigation involved 6,391 women in labor. Cervicovaginal smear was taken from all patients before labor, on admission for delivery, and sent to microbiological analysis. Standard procedures of bacterial cultivation were used. For statistical analysis of the results, we used the statistical programme SPSS 15. Results A single microorganism was isolated from each smear of 612 women and in 52 patients two microorganisms were registered in the same smear. We identified 10 sorts of microorganisms, out of which Escherichia coli (in 43.8% of cases), and Enterococcus spp. (in 27.9% of cases) were the most frequent ones. Due to the appropriate approach, there were no cases of puerperal endometritis registered. Reactivity tests showed that Escherichia coli was sensitive to trimethoprim-sulphamethoxazole, Enterococcus spp. to macrolides and cephalosporines, while both types of microorganisms were sensitive to synthetic penicillins and fluoroquinolines. Conclusion The study results show that 10.9% of pregnant women have positive findings of the cervicovaginal smear and that infection prevention should be directed towards Escherichia coli and Enterococcus spp. by administration of the listed antibiotics.

Introduction Female workers in textile and metal industry are exposed to various physical and chemical hazards that can lead to the occurrence of gynaecological diseases. Objective The aim of this study was to estimate the frequency of gynaecological diseases among workers of textile and metal industries. METHOD The investigation comprised 197 female workers, 148 from textile and 49 from metal industry, aged from 26 to 57 years. All subjects were hospitalized based on non-gynaecological diagnoses. Gynaecological diagnoses included: tumours of the genital organs and breasts, cervical ectopy and lacerations, inflammatory diseases, disturbances of static of genital organs, cysts, and irregularities of menstrual cycle. Results Textile workers were significantly younger than metal workers, but the groups were comparable according to total and exposure work-time, qualifications and diagnosis on hospital admission. Gynaecological diseases were diagnosed among all investigated subjects. About 80% were diagnosed with tumours and inflammatory diseases. A highly statistically significant difference was observed among groups according to the presence of cervical ectopy and lacerations, which were more frequent among textile workers. Conclusion Comparison of gynaecological status of workers revealed that, among textile workers, cervical ectopy and lacerations were more frequent than among workers in metal industry. .

In order to determine the risk factors of odontogenic maxillary sinusitis, a total number of 40 patients with this pathological condition was examined in three-year period. Oroantral communication was detected in 40% of patients, oroantral fistula in 25%, sinus foreign bodies in 15% and other pathological conditions in 10% of cases. The extraction of the upper lateral teeth was the cause of odontogenic sinusitis in 65% patients. Given the specific tooth, the first upper molar was the most common cause of the condition, i.e. in 40% of cases. It may be concluded that odontogenic sinusitis is the complication of the oral cavity surgery in 85% of patients, what should be taken into consideration in prevention.