Milan Terzic

The role of antioxidant vitamins in hypertensive disorders of pregnancy.

Abstract Preeclampsia (PE) is an important and a leading cause of both maternal morbidity and adverse perinatal outcomes. Despite progress in perinatal medicine for patients with an established diagnosis of PE, a therapeutic approach other than termination of pregnancy was unsuccessful. Women predisposed to PE begin pregnancy with a certain degree of endothelial dysfunction, a lesion that precedes shallow placentation. The proposed sequence of events comprises endothelial dysfunction, defective trophoblast invasion, and consequential impaired placental perfusion, immune maladaptation and inflammation. The possible link between these could be oxidative stress by excessive production of reactive oxygen species coupled with inadequate or overwhelmed antioxidant defense mechanisms. These defense mechanisms, involving antioxidant vitamins and enzyme systems, may restrain the extent of damage caused by oxidative stress. Markers of oxidative stress in women with established PE were confirmed. Accordingly, these findings support an expected beneficial effect of antioxidant therapy in the prevention of PE and other pregnancy-related disorders. Numerous studies have been carried out in order to investigate this possible and simple prophylactic and/or therapeutic approach in prevention of oxidative stress and eventual reduction of PE and its perinatal complications. In this review the role of vitamin antioxidants in prevention and treatment of PE is discussed. Despite the logic behind using antioxidant vitamins, the data, thus far, are at best conflicting.

Evaluation of the risk malignancy index diagnostic value in patients with adnexal masses.

BACKGROUND/AIM Ovarian cancer is the leading cause of death from gynecologic malignancies. Risk of malignancy index (RMI) is recommended in assessment of patients with adnexal masses. The aim of this study was to verify the effectiveness of the RMI in the discrimination between benign lesions and malignant adnexal masses in clinical practice. METHODS Ultrasounds were performed for all the patients and menopausal status, CA125 level and calculated RMI were defined. All the patients were divided into 3 groups depending on RMI (< 25, 25-200, > 200). After operations all adnexal masses were analyzed histopathologically (HP) and then sensitivity, specificity and predictive value of RMI were calculated. RESULTS Out of a total of 81 patients involved benign tumor had 51 (62.96%) and malignant 30 (37.04%) of the patients. The average value of CA125 in the group of patients with benign adnexal masses was 68.3 U/mL and in the group of patients with malignant adnexal masses it was 581.95 U/mL. In the group of patients with benign adnexal masses the average RMI was 284.9 and in the group of patients with malignant adnexal masses RMI was 469.2. All the results showed a positive correlation between both HP categories and RMI categories. The more malignant HP result produced higher RMI and the cut off value was RMI = 200. Sensitivity of RMI w as 83.33%, specificity was 94.12%, positive predictive value was 89.29% and negative predictive value was 90.57%. CONCLUSION Our study showed that RMI is very reliable in differentiation benign from malignant adnexal masses.

Influence of red clover-derived isoflavones on serum lipid profile in postmenopausal women

Aim:  Menopause is associated with adverse metabolic changes, especially in plasma lipoprotein and cholesterol levels. Estrogens have beneficial effects on lipid metabolism. Phytoestrogens are plant substances that are structurally and functionally similar to 17β‐estradiol and are capable of producing estrogenic effects. The goal of the present study was to estimate the effects of red clover‐derived isoflavones on serum lipid levels in postmenopausal women.

Lupus mastitis mimicking a breast tumor

Lupus mastitis represents a subset of breast‐limited lupus panniculitis, and occurs very rarely in patients with systemic lupus erythematosus. We report a case of a 33‐year‐old white woman with a previous history of systemic lupus erythematosus, complaining of an acute tenderness and pain in the right breast associated with localized skin erythema. Ultrasound and mammography reports from a private breast clinic, where she was scheduled for core needle biopsy, aroused suspicion of a breast tumor. Clinically the patient had a painful mass suggestive of an inflammatory lump with an abscess. Her double‐stranded DNA antibody level, white blood cell count and erythrocyte sedimentation rate (ESR) were increased; and her renal function was impaired and serology findings negative. All other laboratory tests were within the normal ranges. The patient underwent urgent surgical incision and excisional biopsy of the lesion, and histology revealed lupus mastitis. Lupus mastitis very rarely may appear as a breast lump and therefore presents a great diagnostic challenge for clinicians, occasionally for radiologists and rarely for pathologists.

EVALUATION OF ADNEXAL MASSES: CORRELATION BETWEEN CLINICAL, ULTRASOUND AND HISTOPATHOLOGICAL FINDINGS

BACKGROUND/AIM Concerning the growth of ovarian carcinoma incidence and bad prognosis for malignant forms, early and precise diagnostics is gaining in importance as a condition for precise and appropriate therapy for ovarian tumor masses. The aim of this study was to analyze pre- and postoperative findings of patients with adnexal masses in order to identify factors which could predict the nature and stage of the tumor prior to surgery. METHODS All patients with adnexal masses who were treated in a 6-month period in the Institute of Obstetrics and Gynecology, Clinical Center of Serbia, (IOG, CCS), Belgrade, had their epidemiologic and gynecologic anamnesis and standard laboratory analyses taken prior to surgery. Also, clinical and ultrasonographic check up of pelvic organs was performed, as well as calculation of body mass index (BMI) and risk of malignancy index (RMI). After surgery we analyzed histopathological (HP) findings of tumors as a mean of final diagnosis and staging. For statistical analysis, we used SPSS 15 program. RESULTS Throughout a 6-month period, we examined 81 patients with adnexal masses treated in the IOG CCS. HP findings showed that there were significantly more benign (n = 51) than malignant (n = 30) tumors in all the patients (Chi2 = 5.512). The patients with malignant HP findings were significantly older than those with benign adnexal masses (t = 3.362; p = 0.001). Significantly more patients with malignant HP findings were in menopause (p = 0.034). BMI values were highly significantly higher in the patients with malignant adnexal tumors (t = 3.421; p = 0.001). There was a statistically significant positive correlation between HP categories (benign, malignant) and RMI categories (low, intermediate and high risk) of all the patients (high risk, more malignant HP) (Ro(xy) = 0.428; df = 78; p = 0.000). CONCLUSION . Patients in menopause, especially older ones, with high BMI and RMI should immediately be referred to a tertiary level institution, where appropriate surgery could be performed.

Risk of malignancy index validity assessment in premenopausal and postmenopausal women with adnexal tumors

OBJECTIVE The aim of this study was to investigate the validity of the risk of malignancy index (RMI) in premenopausal and postmenopausal patients with adnexal masses. MATERIALS AND METHODS The study involved all women treated for adnexal tumors throughout an 18-month period in the Clinic for Gynecology and Obstetrics, Clinical Center of Serbia (Belgrade, Serbia). On admission, detailed anamnestic and laboratory data were obtained and an expert ultrasound scan was performed. The RMI was calculated for all patients and the obtained data were related to histopathological findings of the tumors. For statistical analysis, we used descriptive and analytical statistics methods and an SPSS computer program. RESULTS From a total number of 540 women, 85 women had malignant tumors; 20 women, borderline tumors; and 435 women, benign adnexal tumors. The RMI was reliable in 84.6% of all patients; in 77% of premenopausal patients, and in 81.1% of postmenopausal patients. The sensitivity of the RMI in the overall population was 83.81%; the specificity was 77.24%; the positive predictive value (PPV) was 47.06%, and the negative predictive value (NPV) was 95.18%. In premenopausal women, the RMI sensitivity was 83.87%; specificity, 80.31%; PPV, 28.89%; and NPV, 98.12%. In postmenopausal women the RMI sensitivity was 83.78%; specificity, 68.18%; PPV, 63.92%; and NPV, 74.71%. CONCLUSION The RMI was a reliable factor for differentiating benign from malignant adnexal masses in premenopausal and postmenopausal patients.

Risk Estimation of Intraamniotic Infection Development after Serial Amniocentesis

Microbial invasion and growth in amniotic fluid play an important role in infectious perinatal morbidity and mortality. In order to determine the influence of amniocentesis (ACT) on intra-amniotic infection development, we performed a study of 239 complete microbiological examinations of amniotic fluid specimens obtained by serial interventions. In 1 case (0.42%), during the second procedure, Staphylococcus epidermidis was discovered. Neither spontaneous abortion nor preterm labor were provoked by the procedure. We can conclude that ACT has been confirmed as a safe and successful intrauterine intervention if it is made in a proper manner.

Amniotic fluid embolism-apropos two consecutive cases.

Abstract:  Amniotic fluid embolism (AFE) is a sporadic, unpredictable, and usual fatal obstetric complication. The paper deals with two cases of maternal deaths because of AFE verified by medicolegal autopsy. In both the cases, several known risk factors associated with AFE, such as increased maternal age (41 and 35 years), diabetes, augmented labor, and cesarean delivery, were identified. Clinical features were typical, including sudden onset of cardiovascular and respiratory symptoms. In the patient who survived longer, both clinical and autopsy signs of disseminated intravascular coagulopathy were present, while they were absent in the case where death occurred rapidly. This paper describes briefly the particular features to look for at autopsy and stresses the importance of histology examination and staining techniques.

Endometrioid adenocarcinoma of the ovary: MRI findings with emphasis on diffusion-weighted imaging for the differentiation of ovarian tumors

Background Preoperative differentiation of ovarian malignant tumors still remains a challenge. Diffusion-weighted imaging (DWI) provides information about cellularity of the lesion and might facilitate discrimination between different malignant ovarian lesions. Purpose To evaluate magnetic resonance imaging (MRI) findings of endometrioid adenocarcinoma of the ovary and to determine the value of DWI in the differential diagnosis of malignant and benign adnexal tumors. Material and Methods The following MRI findings were reviewed in 162 patients (21 endometrioid adenocarcinoma, 103 other malignant tumors, 38 benign tumors): lesion size, morphological appearance, T2-weighted (T2W) signal intensity, T1-weighted (T1W) signal intensity, contrast-enhancement pattern, DWI signals with apparent diffusion coefficient (ADC) calculated for b = 800 s/mm2 in solid tumor components. Results The most common morphological appearance was predominantly cystic lesion, found in 90.3% of patients with endometriod adenocarcinoma. The solid parts were slightly hyperintense on T2W images in 19 patients with marked enhancement after contrast administration. No significant difference (P = 0.13) in conventional MRI features was found between endometrioid adenocarcinoma and other malignant ovarian tumors. Hyperintensity on DWI was more frequently observed in malignant tumors than in benign lesions (P < 0.001). ADC values were significantly lower in endometrioid adenocarcinoma than other malignant tumors (0.79 ± 0.21 vs. 0.90 ± 0.19; P = 0.04) and in all malignant lesions compared with benign tumors (0.88 ± 0.31 vs. 1.33 ± 0.17; P < 0.001). Conclusion DWI with ADC measurement could indicate the presence of endometrioid adenocarcinomas due to a slightly but significantly lower ADC values compared to other malignant ovarian lesions. Thus, DWI is beneficial and should be part of a standard protocol for the evaluation of indeterminate adnexal lesions.

Current diagnostic approach to patients with adnexal masses: which tools are relevant in routine praxis?

OBJECTIVE The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. METHODS Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index (PDI), risk of malignancy index (RMI) and body mass index (BMI) were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. RESULTS The study included 689 women (112 malignant, 544 benignant, and 33 borderline tumors). Malignant and borderline tumors were more frequent in postmenopausal women (P=0.000). Women who had benignant tumors had the lowest BMI (P=0.000). There were significant (P<0.05) differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen (CEA) levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors (P=0.000). Women with malignant tumors had highest values of RMI and PDI (P=0.000). CONCLUSIONS Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.