Branka Nikolic

Hormone replacement therapy and successful pregnancy in a patient with premature ovarian failure

Premature ovarian failure (POF), premature ovarian insufficiency, premature menopause or hypergonadotropic hypogonadism, a serious life-changing condition that affects young women, remains an enigma and the researchers challenge. In the present article we described a case of singleton pregnancy in a 33-year-old patient, presenting with POF and treated with hormone replacement therapy. Twenty months later this therapy led to maturation of one follicle, recruitment and fertilisation of the residual oocyte and spontaneous pregnancy ensued. A normal infant was delivered by cesarean section.

Gammopathy and B lymphocyte clonality in patients with Gaucher type I disease.

INTRODUCTION We evaluated a novel approach for investigation of lymphocyte dysregulation in Gaucher patients by including determination of IgH and TCR gene rearrangements together with levels of immunoglobulins, natural autoantibodies as well as presence of monoclonal protein. MATERIALS AND METHODS Measurement of serum immunoglobulins, monoclonal immunoglobulins, selected autoantibodies, as well as analysis of immunoglobulin heavy chain and T cell receptor gene rearrangements. RESULTS Immunoglobulin disorder was detected in 29.6% patients, 40.7% demonstrated presence of B cell clonality and 44.4% demonstrated presence of autoantibodies. In five patients in our series, the presence of IgH gene rearrangement was the only detectable indicator of B cell dysfunction. TCR gene rearrangements were not found in any of the patients. CONCLUSION Based on our results, we propose IgH gene rearrangements as a new biomarker for investigation of B cell dysfunction occurring as a complication of Gaucher disease.

Triple pregnancy: intrauterine and bilateral tubal ectopic pregnancies.

A 32-year-old gravida 2, para 1 woman was hospitalised because of lower abdominal pain and vaginal bleeding during the second month of her pregnancy, after spontaneous conception. Speculum examination revealed light uterine bleeding with no cervical dilatation. Transabdominal ultrasound examination revealed a viable intrauterine 8 week pregnancy with a crown-rump length of 21 mm, a normal fetal heart rate, and a retrochorial haematoma 7 × 8 mm; the adnexae appeared normal and there was no free fluid in the pouch of Douglas (Fig. 1). The serum human chorionic gonadotropin level was 113 102.30 IU/L (reference value: 11 500– 289 000 IU/L for that gestational age). During the 2-week hospitalisation period, transvaginal ultrasound examination with colour Doppler did not reveal dilatated fallopian tubes and no free fluid was seen in the pouch of Douglas. Clinically, there were no palpable adnexal findings. The patient was treated supportively and improved. After 2 weeks of hospitalisation, the patient collapsed. On transvaginal ultrasound examination, free fluid was seen in the pouch of Douglas and dilatated areas were seen in both fallopian tubes (Figs 2,3). Urgent laparotomy confirmed intra-abdominal haemorrhage was a result of bilateral fallopian tube rupture. Billateral salpingectomy was performed. Histopathological examination confirmed bilateral tubal pregnancies. The postoperative period was normal. The intrauterine pregnancy proceeded without further complication. Supportive progesterone therapy was given until 12 weeks’ gestation, followed by tocolytic therapy (fenoterol bromid 50 mg; four to six times daily). At 16 weeks’ gestation a cervical suture was inserted. The tocolytic therapy was continued throughout the pregnancy and at 39 weeks’ gestation, a vaginal birth of a liveborn male infant weighting 2850 g occurred. Discussion

Hyperbaric oxygen and in vitro fertilisation.

In vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) are used to help infertile couple to conceive their own biological child. Success of IVF is associated with several factors, although many important factors are, unfortunately, not known. Known prognostic factors include maternal age, ovarian reserve, past reproductive performance, embryonal culture, endometrial receptivity, embryo transfer and luteal phase support. The therapeutic application of hyperbaric oxygen (HBO) has been known over three decades in different fields of medicine. Our objective was to determine the usefulness of HBO therapy during IVF procedure. While it is difficult to prove that HBO is the crucial factor for the success of this IVF/ICSI procedure, it is important to report that pregnancy occurred.

Diagnostic value of serum tumor markers for adnexal masses

ObjectiveThe study aim was to investigate the diagnostic value of measuring preoperative serum tumor markers in patients with adnexal masses.MethodsThe study included all (358) consecutive patients treated for adnexal tumors at the Clinic of Obstetrics and Gynecology, Clinical Center of Serbia during 12 months. Tumor-marker levels (Ca 125, CEA, HE 4, Ca 19.9 and Ca 15.3) obtained from all women on admission were compared with histopathological findings in cases in which tumors were removed.ResultsWomen with malignant tumors had the highest levels of Ca 125, CEA and HE 4 (p<0.01). Mucinous adenocarcinoma produced the highest amounts of Ca 19.9 and CEA. Ca 15.3 was the highest in women with endometrioid carcinoma. There were no significant differences in the levels of all serum tumor markers between women with benign and borderline tumors (p>0.05). Malignant forms of tumors were well indicated by Ca 125, HE 4 and Ca 15.3 levels. The combination of Ca 125 and HE 4 resulted in the highest sensitivity, specificity, and positive or negative predictive value (91.04%, 87.6%, 67.9%, 77.2%, respectively).ConclusionsBlood levels of tumor markers can be effective? predictors of the nature of adnexal masses. For the most precise evaluation, a combination of serum tumor markers should be used.

Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Antiphospholipid syndrome is an autoimmune disorder defined as association of vascular thrombosis and/or pregnancy complications with presence of antiphospholipid antibodies (lupus anticoagulant, anticardiolipin and anti-β2 glycoprotein I). It is the most common cause of acquired thrombophilia, and can occur as an independent entity or in relation with other diseases, especially systemic lupus erythematosus. Presence of antiphospholipid syndrome in systemic lupus erythematosus is additional vaso occlusive factor in already present inflammation, bringing further risk for thrombotic events. Clinical and serological manifestations of antiphospholipid syndrome and systemic lupus erythematosus are very similar, so possible connection for these two autoimmune disorders is assumed.

Fetus Sound Stimulation: Cilia Memristor Effect of Signal Transduction

Background. This experimental study evaluates fetal middle cerebral artery (MCA) circulation after the defined prenatal acoustical stimulation (PAS) and the role of cilia in hearing and memory and could explain signal transduction and memory according to cilia optical-acoustical properties. Methods. PAS was performed twice on 119 no-risk term pregnancies. We analyzed fetal MCA circulation before, after first and second PAS. Results. Analysis of the Pulsatility index basic (PIB) and before PAS and Pulsatility index reactive after the first PAS (PIR 1) shows high statistical difference, representing high influence on the brain circulation. Analysis of PIB and Pulsatility index reactive after the second PAS (PIR 2) shows no statistical difference. Cilia as nanoscale structure possess magnetic flux linkage that depends on the amount of charge that has passed between two-terminal variable resistors of cilia. Microtubule resistance, as a function of the current through and voltage across the structure, leads to appearance of cilia memory with the “memristor” property. Conclusion. Acoustical and optical cilia properties play crucial role in hearing and memory processes. We suggest that fetuses are getting used to sound, developing a kind of memory patterns, considering acoustical and electromagnetically waves and involving cilia and microtubules and try to explain signal transduction.

Diagnostic value of serum tumor markers evaluation for adnexal masses

ObjectiveThe study aim was to investigate the diagnostic value of preoperative serum tumor markers in patients with adnexal masses.MethodsStudy included all (358) consecutive patients treated for adnexal tumors at the Clinic of Ob/Gyn, Clinical Center of Serbia in 12 months. Tumor marker levels (Ca 125, CEA, HE 4, Ca 19.9, and Ca 15.3), taken from all women on admission, were compared with postoperative histopathological findings of extracted tumors. Results. Women with malignant tumors had the highest levels of Ca 125, CEA, and HE 4 (p<0.01). Mucinous adenocarcinoma produced the highest amounts of Ca 19.9 and CEA. Ca 15.3 was the highest in women with endometrioid carcinoma. There were no significant differences in the levels of all examined tumor markers (p>0.05) between women with benign and borderline tumors. Ca 125, HE 4, and Ca 15.3 can discriminate the malignant from other tumor types well. The highest sensitivity, specificity, positive and negative predictive values (91.04%, 87.6%, 67.9%, 77.2%, respectively) were achieved for the combination of Ca 125 and HE 4.ConclusionsBlood levels of examined tumor markers can be good predictors of the adnexal masses nature. For the most precise evaluation the combination of serum tumor markers should be used.

Review of potential doppler ultrasonographic findings in patients with confirmed gestational trophoblastic neoplasms

Transvaginalna dopler ultrazvucna dijagnostika, kao neinvazivna i neskodljiva dijagnosticka metoda, ima respektabilno mesto u ranoj dijagnostici gestacijskih trofoblastnih neoplazmi. Uz određivanje serumske vrednosti humanog horionskog gonadotropina i pracenje dinamike njegovih promena, histoloski nalaz i promene u ultrazvucnoj slici, moguce je rano dijagnostikovati GTN, pa cak i maligne oblike, sto se pokazalo važnim u donosenju pravovremene odluke o nacinu lecenja bolesnica i ocuvanja reproduktivnog zdravlja.

[Tumor marker CA-125 in adnexal inflammatory tumors].

BACKGROUND/AIM The glycoprotein of a high molecular weight CA-125, which is not a specific tumor marker of ovarian cancer, is secreted by the endothelial cells of most pelvic organs. Endometriosis, inflammatory processes in the pelvic cavity, as well as some nongynecoligical malignant diseases, could be followed by the increased values of CA-125. Serial assessment of the values of CA-125 makes it possible to avoid surgical treatment, and, by means of the used conservative treatment, to avoid malignant diseases not to be noticed. METHODS The study included 57 female patients hospitalized due to inflammable adnexal tumors. Besides following the values of serum CA-125 during and after the therapy, also performed were the transvaginal Doppler ultrasonography and the determination of the values of resistance index (RI). RESULTS In 27 patients (55.1%) the CA-125 values ranged from 38.8 U/ml to 794 U/ml, while in 30 of the patients they were within the range of normal. In this group of the patients, besides the increased values of CA-125, also increased were the values of leucocytes (11(9)/1-20(9)/1), as well as the sedimentation rates (65-120) within the first hour. In all the 57 patients, transvaginal Doppler ultrasonography revealed the presence of adnexal tumor of inflammatory kind. The measured values of RI were within the range of 0.539-0.681. Eight of the patients were treated by the conservative--triple antibiotic therapy, while in 49 patients explorative laparotomy was performed. Hystorectomy was done in 12 of the patients, and one-side adnexectomy in 37 of them. CONCLUSION The method for the assessment of CA-125 is simple and available which facilitates the monitoring of surgical, conservative or the combined therapy that is particularly significant in younger patients with inflammable adnexal tumor developed on the basis of endometrosis.