Marijan Ilijaš

Histologic architecture and vascularization of hysteroscopically excised intrauterine septa.

STUDY OBJECTIVE To investigate histologic structures of intrauterine septa resected hysteroscopically. DESIGN Prospective, consecutive study (Canadian Task Force classification II-2). SETTING University-affiliated hospital. PATIENTS Seventy-six women evaluated for uterine septa and infertility. INTERVENTIONS All patients with diagnosis of uterine septum detected by transvaginal color Doppler (TVCD) underwent operative hysteroscopy in which the most prominent part of the septum was encircled with a hysteroscopic loop electrode and removed. Specimens were sent for histopathologic evaluation. The rest of the septum was divided by monopolar needle electrode until the uterine cavity assumed a globular shape. MEASUREMENTS AND MAIN RESULTS In 63 women (82.8%) preoperative TVCD revealed septal vascularity typical for radial arteries with mean resistance flow of 0.64 +/- 0.06, and enlarged sunusoidal and capillary spaces. Histopathologic results revealed fibromuscular tissue with moderately more connective tissue in 55 cases (72.3%) and myometrial tissue in 21 (27.6%). There was no statistically significant difference (p >0.05) in frequency of septa between patients with primary and secondary infertility. CONCLUSION Intrauterine septa consisted of the same type of tissue as normal myometrium, with many muscular fibers. We suspect that muscular tissue within the uterine septum is a potential cause of irregular contractility and consequently increased abortion rate in these patients. (J Am Assoc Gynecol Laparosc 8(1):111-116, 2001)

The value of transvaginal color Doppler in the assessment of pelvic inflammatory disease

This study compares transvaginal color and pulsed Doppler (TVCD), laparoscopic and clinical findings in 102 women with proven pelvic inflammatory disease (PID). Seventy-two (72) of them had acute symptoms, 11 presented with chronic pelvic pain and 19 patients were infertility cases suspected of tubal etiology. Uterine sonographic findings were demonstrated in 72 patients (70.6%). Free fluid in the cul-de-sac was demonstrated in 39 (38.2%) patients. Ovarian enlargement as the only finding was demonstrated in 6 (5.9%) patients, 22 (21.6%) presented with tubular adnexal structure, while in 74 (72.5%) patients it was of a complex nature. Color flow was obtained in all 6 patients presenting with ovarian enlargement, in 12 (54.5%) of those presenting with tubular adnexal structure, and in 56 (75.7%) of those with complex adnexal mass. Ovarian morphology was clearly delineated from adnexal mass in 59 patients (55.9%). The ipsilateral ovarian flow was altered in 50 of them (84.7%). The mean resistance index (RI) in patients with acute symptoms was 0.53 +/- 0.09 (+/-SD). It significantly differed from those obtained in patients with chronic pelvic pain (RI = 0.71 +/- 0.07) and infertility cases (RI = 0.73 +/- 0.09). We concluded that transvaginal color Doppler is useful additional tool in diagnosis and treatment monitoring in patients with PID.

Detection and typing of human papillomaviruses by polymerase chain reaction in cervical scrapes of Croatian women with abnormal cytology

The association between certain human papillomaviruses (HPV) and cervical intraepithelial neoplasia (CIN) is well documented, but still unknown among Croatian women. In 1995, women between the age of 17 and 64 with cytomorphologically abnormal smears (CIN I–IV) were tested for the presence of HPV. Consensus and specific primers were used in the polymerase chain reaction (PCR) to detect the most common types: 6, 11, 16, 18, 31 and 33, as well as the unknown-risk HPV types (HPV X). Out of 379 specimens, 163 (43%) contained one or more HPV types. Coinfection with different HPV types in the same sample was observed in 16 cases. Beside low-risk HPV 6/11 (25.8%) the most frequently observed types were high-risk HPV types 16 (20.2%) and 31 (17.8%). Globally, the HPV positivity rate declines with age. The presence of HPV DNA significantly increased from 35.5 to 61.1% along with the severity of the cervical intraepithelial neoplasia (CIN I– IV). HPV type 6/11 was strongly associated with CIN I (33.8%), HPV type 31 with CIN II (22.9%), and HPV type 16 with CIN III (50%).

Proposal of a modified FIGO 1985 classification of stages I and II cancer of the uterine cervix

A modified FIGO (1985) classification of cancer of the uterine cervix has been suggested. The changes refer to stages I and II of the disease. The already accepted system of cervical cancer staging has been used. Stages Ib, IIa, and IIb have been subdivided, similar to stage Ia. The criterion used in staging is the size of the tumor up to, or more than 2 cm (Ib 1 and Ib 2) and, for stage II, the extent of penetration into adjacent tissue. The condition of lymph nodes should be noted by LN(+) or LN(-) along with the stage of the disease. Such staging should demonstrate an objective evaluation of treatment results obtained by different methods and their combinations.