Iztok Takač

Ultrasound screening for developmental dysplasia of the hip in the newborn : a population-based study in the Maribor region, 1997-2005

ZusammenfassungZIEL: Der bildgebende Ultraschall ist eine anerkannte Methode für die Diagnose der Entwicklungs-Dysplasie der Hüfte (EDH) bzw. für das Management dieser Erkrankung. Ziel der vorliegenden Studie war es, die Ergebnisse der Daten des Neugeborenen-Screening-Programms, welches in Marburg von 1997–2005 durchgeführt wurde, zu evaluieren und mit den früher publizierten Daten aus unserer Region, in der das Programm 1985 eingeführt wurde, zu vergleichen. PATIENTEN UND METHODEN: Von den 17846 in der 9-jährigen Beobachtungsperiode in unserer Frauenklinik geborenen Neugeborenen wurden 17393 in die Studie aufgenommen. Alle Hüften wurden mittels Ultraschall in der 1. Lebenswoche untersucht. Von 2,5% der Neugeborenen waren die Daten nicht verfügbar. Die Inzidenz der sonographisch erhobenen Hüfttypen nach der Methode von Graf wurde analysiert. Außerdem wurde die Geschlechtsverteilung bzw. die Seite der Hüftpathologie erhoben. ERGEBNISSE: 34786 Hüften wurden sonographisch untersucht. 84,9% waren bei der ersten Untersuchung reif (Graf Typ Ia und Ib), 14,1% wurden als unreif (Graf Typ IIa) klassifiziert und in 1,1% wurde ein pathologischer Befund (Graf Typ IIc oder schlechter) festgestellt. Mädchen wiesen häufiger (3,9:1) einen pathologischen Befund als Knaben. Die linke Hüfte war etwas häufiger betroffen als die rechte (1,2:1). Während des Beobachtungszeitraums nahm die Anzahl der erhobenen pathologischen Befunde (Graf Typ IIc oder schlechter) um das 7-Fache ab (von 2,1% in 1997 auf 0,3% in 2005). Diese Verteilung der Hüfttypen führte zu einer durchschnittlichen Behandlungsrate von 18 Neugeborenen auf 1000 Lebendgeborene im Jahr 1997 (von 42 behandelten Hüften auf 1000 im Jahr 1997 zu 6 Hüften auf 1000 im Jahr 2005). Im gesamten Beobachtungszeitraum benötigten nur 19 Patienten eine operative Therapie der Hüftdysplasie vor dem Alter von 3 Jahren. SCHLUSSFOLGERUNG: In unserer Region scheint ein allgemeines Neugeborenen-Screening auf EDH die Gesamt-Behandlungsrate wirksam zu senken. Die Zahl der operativen Korrekturen blieb während der Beobachtungs-periode von 9 Jahren stabil, war aber in dieser Zeit niedriger als in der Zeit vor Einführung der Ultraschalluntersuchung.SummaryAIM: Ultrasound imaging has become an accepted tool for accurate diagnosis of developmental dysplasia of the hip (DDH) and for its management. The aim of the present study was to evaluate the results of the general neonatal hip screening program in Maribor between 1997 and 2005 in comparison with earlier reported results for our region, where this program was introduced in 1985. PATIENTS AND METHODS: Of the total number of 17,846 newborns born in our maternity hospital, 17,393 were included in the study during the nine-year period. All hips were examined by ultrasonography within the first week of life. Data for 2.5% of newborns were not available. The incidence of sonographic hip types according to the Graf method was analyzed, together with the sex distribution, lateralization of hip pathology and treatment recommendations. RESULTS: A total of 34,786 hips were evaluated sonographically: 84.9% of hips were mature at first examination (Graf types Ia and Ib), 14.1% were immature (Graf type IIa) and 1.1% were pathological (Graf types IIc or worse). In the group of pathological hips, girls were more frequently affected than boys (3.9:1) and the left hip was more frequently affected than the right (1.2:1). The incidence of hip types IIc or worse decreased sevenfold throughout the observation period, from 2.1 in 1997 to 0.3 in 2005. This distribution of hip types resulted in an average treatment rate of 18 newborns per 1000 live borns, down from 42 treated hips per 1000 newborns in 1997 to 6 hips per 1000 in 2005. During this nine-year period, only 19 children required surgical treatment for DDH before the age of three years. CONCLUSION: In our region, general ultrasound hip screening of newborns for DDH seems to be effective in reducing the overall treatment rate. The number of surgical procedures has remained stable during the past nine-year screening period and is lower than in the pre-ultrasound era.

Screening of TERC gene amplification as an additional genetic diagnostic test in detection of cervical preneoplastic lesions

TERC gene amplification was investigated as a possible diagnostic marker for use in routine cytological screening to improve the accuracy of conventional screening procedures in detection of cervical preneoplastic lesions. Cervical smears were screened and classified as low-grade or high-grade squamous intraepithelial lesions (LSIL or HSIL). A fluorescence in situ hybridization procedure using a TERC-specific DNA probe was performed on the same specimens and TERC gene copy number was evaluated. More than two signals per cell were defined as TERC positive. In cervical smears graded after conization as cervical intraepithelial neoplasia grade 1 (CIN 1), no TERC-positive cases were found in either LSIL or HSIL, and no TERC amplification was found in LSIL cases with histological results CIN 1 and CIN 2. Amplifications of the TERC gene first appeared in HSIL cases with CIN 2 histology. In the CIN 3 group, TERC-positive cases were present in both LSIL and HSIL; in these, there were no statistically significant differences between TERC-positive and TERC-negative cases. Statistically significant differences in TERC-positive cases were found between LSIL and HSIL without regard to the CIN grade. From the results obtained, it can be concluded that TERC gene amplifications inevitably lead to a high risk of CIN 3 in both LSIL and HSIL after cytological smear examination. A high CIN grade is not necessarily correlated with TERC amplification, but a positive TERC result certainly demands a high CIN classification.

Ultrasound guided aspiration in pathological adnexal processes

OBJECTIVE To establish the efficiency of ultrasonographically guided transvaginal adnexal cyst aspiration as a treatment and diagnostic method. STUDY DESIGN In 72 patients with an adnexal cystic mass, transvaginal ultrasound guided cyst aspiration was performed. Before the procedure, presence of primary malignant disease was excluded by gynecologic and ultrasound examination. Cyst content was sent for cytological analysis. Cytological findings were staged according to Papanicolaou. Patients were re-examined 3 and 6 months after the ultrasound intervention. Cysts measuring 3 cm or more in diameter were considered to be recurrence of the disease. RESULTS Recurrence of the disease appeared in 32 cases (44%) and was more common with larger cysts. Malignant cells were found in one case (1.5%), a recurrent ovarian cancer, previously treated by surgery and chemotherapy. CONCLUSION In our study, ultrasound guided aspiration of adnexal cysts was not shown to be an efficient method of treatment because of the high recurrence rate. It may be used in selected patients at high anaesthesiologic risk for surgery as a therapeutic or a diagnostic procedure.

Outcomes and risk factors for unplanned delivery at home and before arrival to the hospital

ZusammenfassungEINLEITUNG: Ziel der Studie war es, die Ergebnisse und Risikofaktoren nicht geplanter Geburten zu Hause und vor Ankunft im Spital in der Region Marburg, Slowenien, zu analysieren. METHODEN: Wir verwendeten die Daten der medizinischen Dokumentationen aller Geburten der Region Marburg vom jahre 1997 bis zum Jahr 2005. Wir analysierten insgesamt 17846 Geburten der Jahresberichte des Marburger Universitäts-Spitals. ERGEBNISSE: Von den 17.846 Geburten handelte es sich bei 58 (3,2%) um Geburten, die ungeplant zu Hause beziehungsweise am Weg ins Spital stattfanden. Der Vergleich der Sicherheit mit den Geburten im Spital ergab, dass diese ungefähr 7 mal sicherer sind als die ungeplanten Geburten zu Hause. Dies ergibt sich durch den Vergleich der perinatalen Mortalität, die bei den ungeplanten Geburten zu Hause 68% im Vergleich zu 8,8% bei den Geburten im Spital betrug. Auch die Frühgeburtenrate war bei den ungeplanten Hausgeburten mit 13 (22%) im Vergleich zu 1399 (8%) bei den Geburten im Spital höher. Ungeplante Geburten zu Hause beziehungsweise am Weg ins Spital waren bei Multipara häufiger (4:1 verglichen mit 1:1 bei Geburten im Spital). Während die Geburten im Spital alle nach überwachter Schwangerschaft erfolgten, waren ein Drittel der ungeplanten Geburten zu Hause oder am Weg ins Spital ohne Betreuung während der Schwangerschaft. 55,2% der Mütter, die ungeplant zu Hause oder am Weg ins Spital gebaren hatten keine höhere Bildung. Bei den Müttern, die im Spital niederkamen war der Anteil mit höherer Bildung bei 87,4 %. SCHLUSSFOLGERUNGEN: Geburten, die ungeplant zu Hause oder am Weg ins Spital stattfanden, hatten eine höhere Rate der perinatalen Morbidität im Vergleich zu Geburten im Spital. Folgende Faktoren begünstigen die Prävalenz ungeplanter Geburten zu Hause: Mehrfachgeburt, fehlende Schwangerschaftsbetreuung, Familienstand, niedriger Bildungsgrad. Zusätzliche Bemühungen, die pränatale Betreuung zu verbessern und soziale Verwundbarkeiten zu erkennen würden möglicherweise die Zahl ungeplanter Geburten zu Hause reduzieren und damit das perinatale Outcome verbessern.SummaryINTRODUCTION: The aim of this study was to analyze the outcomes and risk factors for unplanned delivery at home and before arrival to the hospital in Maribor region, Slovenia. METHODS: We used data from medical records of all deliveries in Maribor region from the year 1997 to the year 2005. We analysed a total of 17,846 births from annual reports of the Maribor University Hospital. RESULTS: Among the total of 17,846 births, there were 58 (3.2‰) unplanned births at home and on the way to the hospital. The study based on the data from medical records on safety of unplanned home birth reveals that hospital delivery is approximately 7 times safer than unplanned home delivery. This conclusion is reached by comparing perinatal mortality, which was 68‰ for unplanned deliveries at home versus 8.8‰ for deliveries at hospital. The prematurity was more common in unplanned home deliveries: 13 (22%) versus 1399 (8%) for hospital deliveries. Unplanned deliveries at home and on the way to the hospital were more common in multiparous women (ratio 4:1 compared to 1:1 for hospital births). When for all hospital deliveries the pregnancies were followed, for one third of unplanned deliveries at home or on the way to the hospital the pregnancies were not monitored. Mothers who gave birth at home or on the way to the hospital were without higher education (i.e. 55.2%) and mothers who gave birth in hospital were with higher education (i.e. 87.4%). CONCLUSIONS: There was higher rate of perinatal morbidity for unplanned home deliveries compared to hospital deliveries. Factors that make unplanned home deliveries more common are high parity, absence or inadequacy of antenatal care, marital status and lower education. Some conditions in newborn, such as hypothermia, were clearly the result of unplanned birth at home. Additional effort to improve antenatal care and also identifying social vulnerabilities would possibly decrease the number of unplanned deliveries and improve the perinatal outcomes.

Serum CA 125 levels and lymph node metastasis in patients with endometrial cancer.

SummaryThe aim of this study was to evaluate the correlation of preoperative serum CA 125 levels and lymph node metastasis in patients with endometrial cancer. Preoperative levels of serum CA 125 were determined in 64 patients with endometrial cancer treated with total abdominal hysterectomy with a lymph node dissection as initial therapy. Lymph node status, determined by histopathology, was correlated with both normal and elevated CA 125 levels, determined preoperatively. A serum CA 125 level of >30 IU/ml was considered elevated. There were five patients (7.8%) with pelvic or paraaortic lymph node metastases and 59 patients (92.2%) without nodal metastases. In all five patients with lymph node metastases, serum CA 125 was within normal limits. Preoperative serum CA 125 levels were above normal in eight lymph node-negative patients. In the remaining group of 51 node-negative patients, serum CA 125 levels were within normal limits. Among the five lymph nodepositive patients, four had endometrioid and one had serous papillary cancer. One patient had histologic grade 2 tumor and four patients had histologic grade 3. Preoperative serum CA 125 levels do not offer any information for predicting lymph node metastasis in patients with endometrial cancer.

Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor type-1 (PAI-1) in breast cancer - correlation with traditional prognostic factors

Abstract Background. Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor type-1 (PAI-1) play a key role in tumour invasion and metastasis. High levels of both proteolytic enzymes are associated with poor prognosis in breast cancer patients. The purpose of this study was to evaluate the correlation between traditional prognostic factors and uPA and PAI-1 expression in primary tumour of breast cancer patients. Patients and methods. 606 primary breast cancer patients were enrolled in the prospective study in the Department of gynaecological oncology and breast oncology at the University Medical Centre Maribor between the years 2004 and 2010. We evaluated the traditional prognostic factors (age, menopausal status, tumour size, pathohistological type, histologic grade, lymph node status, lymphovascular invasion and hormone receptor status), together with uPA and PAI-1. We used Spearman’s rank correlation, Mann Whitney U test and χ2 test for statistical analysis. Results. Our findings indicate a positive correlation between uPA and tumour size (p < 0.001), grade (p < 0.001), histological type (p < 0.001), lymphovascular invasion (p = 0.01) and a negative correlation between uPA and hormone receptor status (p < 0.001). They also indicate a positive correlation between PAI-1 and tumour size (p = 0.004), grade (p < 0.001), pathohistological type (p < 0.001) and negative correlation between PAI-1 and hormone receptor status (p = 0.002). Conclusions. Our study showed a relationship between uPA and PAI-1 and traditional prognostic factors. Their role as prognostic and predictive factors remains to be further evaluated.

Seasonal variations of vitamin D concentrations in pregnant women and neonates in Slovenia

OBJECTIVE While foreign research shows a high prevalence of vitamin D deficiency in pregnant women and consequently in neonates, we do not have any data on vitamin D concentration in these risk groups for Slovenia. We performed a prospective study to evaluate vitamin D concentration in pregnant women and neonates in Maribor region. STUDY DESIGN We determined 25-hydroxy-vitamin D concentration from blood samples taken before delivery from 100 pregnant women who gave birth in Maribor University Clinical Centre in September and December 2013, respectively, and from the cord blood of their neonates. We collected data on nutrition and sun exposure during pregnancy. We calculated the vitamin D concentrations in pregnant women and neonates according to season of birth and use of nutrition supplements, determined the vitamin D levels in some pregnancy complications and checked the correlation of maternal and neonatal vitamin D concentrations. RESULTS The average vitamin D concentration in the September group was 54.3±25.2nmol/L, and in the December group 33.3±18.6nmol/L (p<0.001). Optimal vitamin D concentration (>80nmol/L) was reached by 12.0% of pregnant women in September and by only 2.0% in December. Women who took nutrition supplements containing vitamin D during pregnancy had significantly higher vitamin D levels than those who did not (September 68.9±27.0nmol/L vs. 46.5±20.3nmol/L, p<0.001; December 38.7±17.9nmol/L vs. 30.2±18.4nmol/L, p=0.028). Neonates had higher average levels of vitamin D than their mothers but there was a good correlation between maternal and neonatal vitamin D values. CONCLUSION Vitamin D deficiency is very common in pregnant women in Slovenia as well, especially in winter and in those women who do not take nutrition supplements containing vitamin D.

Postmenopausal vaginal atrophy correlates with decreased estradiol and body mass index and does not depend on the time since menopause

Objective. To evaluate the relationship between morphologic cell characteristics in Papanicolaou (Pap) smears and serum estradiol, body mass index (BMI) and the time elapsed since menopause. Study design. In 92 women Pap smears were grouped into atrophic and mature cell patterns and compared with estradiol, BMI and the time since menopause. Results. Forty-one patients with mature cell pattern were on average 7.1 years from menopause and 51 patients with atrophic pattern 8.2 years, but this difference was not significant. Estradiol in patients with mature cell pattern was significantly higher (52.1 ± 48.5 pmol/l) than in patients with atrophic pattern (25.6 ± 40.0 pmol/l). Similarly, BMI was significantly higher (27.9 ± 4.2 kg/m2) in patients with mature cell pattern than in patients with atrophic pattern (25.7 ± 3.8 kg/m2). There was no significant correlation between the time since menopause and estradiol among patients with mature and atrophic cell pattern. The same was true for the correlation between the time from menopause and BMI in patients with mature and atrophic pattern. Conclusions. Estradiol and BMI are associated with vaginal cell maturation and atrophy in postmenopausal women. Vaginal cell atrophy does not depend on the time since menopause.

Clinicopathological characteristics of cervical cancer between 2003 and 2005, after the introduction of a national cancer screening program in Slovenia

OBJECTIVE An organized cervical cancer (CC) screening program was introduced in Slovenia in 2003. With the purpose of clinical audit we analyzed the clinicopathological characteristics of CC patients for the period between 2003 and 2005. STUDY DESIGN The retrospectively collected data of 450 CC patients were presented at three Advisory Boards of Gynecologic Oncology in Slovenia. They were stratified for stage, tumor characteristics and treatment methods according to gynecologic examination attendance in the last 5 years preceding the diagnosis of CC (attenders vs. nonattenders). RESULTS In the period of observation, 242 women (53.8%) visited their gynecologists in the 5-year period prior to diagnosis of CC. Squamous cell carcinoma was present in 378 women (84.0%), adenocarcinoma in 45 (10.0%), adenosquamous carcinoma in 24 (5.3%) and other types in 3 women (0.7%). Attenders were significantly more frequently diagnosed with squamous cell carcinoma than nonattenders (chi-square=5.13; P<0.05). Attenders were significantly more frequently diagnosed in stage IA than in stage IB (chi-square=22.35; P<0.01). Similarly, in attenders stage I was significantly more frequent than stage II (chi-square=18.81; P<0.01). Pathologic smears of women with CC in the last 5-year period were most frequently evaluated as Pap II in the years 2003 and 2004 (in 39.1 and 26.4% of women, respectively) and as Pap III (in 27.9% of women) in 2005. Surgery was performed in 282 women (62.7%), radiotherapy in 158 (35.1%), symptomatic therapy in 9 (2.0%) and chemotherapy alone in 1 (0.2%) woman. In attenders, surgery alone was the most frequent treatment method (chi-square=91.18; P<0.01). CONCLUSION Only in attenders a significant redistribution of CC stages in favor of early stages is observed, and in these women more conservative and less extensive treatment methods could be applied.

Role of appendectomy in predicting lymph node metastases in patients with ovarian cancer

OBJECTIVE The aim of this study was to assess the diagnostic accuracy of appendectomy in predicting lymph node metastases in women undergoing cytoreductive procedures for ovarian cancer. STUDY DESIGN In 127 consecutive patients with ovarian carcinoma appendectomy was performed in 30 patients over a period of 5 years. Eight of them were found to have metastases to the appendix. Pelvic and paraaortic lymphadenectomy was performed in 34 patients, in 24 of them the appendix was removed during primary surgery. RESULTS Among 19 patients without metastases to the appendix the lymph nodes were positive in five cases (26.3%) and among five patients with metastases to the appendix the lymph nodes were positive in four cases (80.0%), which is not a significant difference. Evaluation of the appendiceal metastases as a predictor of lymph node metastases in patients with ovarian cancer gives a sensitivity of 44%, a specificity of 93%, a positive predictive value of 80%, a negative predictive value of 74% and an accuracy of 75%. CONCLUSION The possibility of predicting retroperitoneal lymph node metastases in ovarian cancer on the basis of histological examination of the appendix is limited.