Ozren Mamula

Frequency and distribution of lymph node metastases in epithelial ovarian cancer : Significance of Serous Histology

Background: The aim of this retrospective study was to evaluate the incidence and distribution of nodal metastases in relation to the serous versus nonserous histological subtypes of epithelial ovarian cancer. Methods: Patients were treated primarily with upfront surgery, including pelvic and para-aortic systematic lymphadenectomy, up to the level of the left renal vein, before any kind of chemotherapy administration. Patients were classified according the tumor histology into 2 groups: serous (including the cases of mixed histology with a serous component) and nonserous group. Results: A total of 173 patients fulfilled the inclusion criteria; 76 and 97 patients had serous and nonserous ovarian carcinoma, respectively. Positive lymph nodes were found in 59.3% (45/76) and 14.4% (14/97) of patients in the serous and nonserous histology groups, respectively. There was no difference in positive node distribution in 3 regions (pelvic and para-aortic regions, below and above the inferior mesenteric artery) between these 2 groups. Early spread including 1 or 2 positive lymph nodes was predominantly found in the para-aortic region in both groups, serous and nonserous, whereas distribution of positive nodes in patients with 3 or more lymph nodes shows equal presence in pelvic and para-aortic regions. Conclusions: Serous ovarian carcinomas are much more prone to metastasize to lymph nodes than nonserous histological types. However, the pattern of lymph node distribution did not differ between these 2 groups and was similar in the pelvic and para-aortic regions.

Maternal and fetal outcomes in grand multiparous women

The goal was to examine the influence of grand multiparity on the fetal and maternal outcome. The medical records of women delivered in Clinical Hospital Rijeka during seven years period were analyzed and divided into two study groups: grand multiparous women, (five or more infants), and women having given birth to three to four infants. The socio-economic parameters, frequency of pregnancy and labor complications as fetal outcome were compared between groups. The statistical analysis was done by chi square test, p<0.05. There were 22504 deliveries and 107 (0.47%) were in the grand multiparas group and 2745 (12.19%) in the control group. Cesarean section rate was significantly higher in the grand multiparas group (13.08 % vs 8.19 %). The neonatal outcome in the grand multiparas group indicated a significantly higher incidence of low Apgar score, and higher fetal mortality rate. Grand multiparity is linked with low socioeconomic status. Higher fetal mortality rate is a result of paritys interrelationship with social class factors and not parity per se.

Neonatal outcome in discordant eutrophic twins:: Twin growth

Objective: To compare maternal characteristics and neonatal outcome in discordant twin gestations (DT) and concordant twin gestation (CT). Method: Maternal and neonatal data base of live twins >25 weeks’ gestation (N=351 pairs) were reviewed for antepartum complications, labor beginning, mode of delivery, neonatal complications, malformations and perinatal mortality. The chi‐squared analysis and Student t‐tests were used to analyze the differences between discordant and concordant premature and term twin pairs, and appropriate for gestational age (AGA) twins, separately. Results: DT occurred in 15.1% of all twin pregnancies. In preterm and term DT there were significantly more elective cesareans. Growth discordance among preterm and term eutrophic twins was not connected with increased neonatal death or other complications, except higher incidence of early neurological signs in term DT. Conclusion: We strongly believed that prematurity and not discordant growth of eutrophic twins has important influence on neonatal outcome.

Complications during pregnancy, labor and puerperium in women with increased BMI at pregnancy term

The aim of this study was to analyse perinatal complications in woman with increased BMI at pregnancy term. Study included 23190 women who gave singleton birth during a 10-year period in our institution. Maternal databases were reviewed for pregnancy, labor and delivery complications and early maternal postpartum morbidity. Women with increased BMI at pregnancy term had a significantly higer incidence of postterm pregnancy, gestational diabetes, pregnancy-induced hypertension and third trimester hemorrhage, compared to normal weight women (p 0.000). Women with increased BMI had significantly more labor induction with prostaglandins (p 0.001 and 0.000) and elective caesarean (p 0.025 and 0.000). Also, overweight and obese women had higher incidence of operative delivery: caesarean section (p 0.000) and vacuum extraction (p 0.000). The incidences of postpartum febrility (p 0.057, 0.000, 0.002) and trombophlebits (p 0.013) were also significantly higher. We can conclude that prepregnancy normal weight women with increased BMI during pregnancy need special follow-up and counseling in pregnancy and delivery.

Treatment and outcome of stage Ia1 squamous cell carcinoma of the uterine cervix

To evaluate the treatment and clinical outcome of patients with FIGO stage IA1 cervical squamous cell carcinoma (SCC).

Serum and follicular LH, pregnancy prediction and assisted reproduction

The aim of this study was to determine the mean serum and follicular fluid LH and estradiol values in patients treated by IVF/ET (ICSI) after completed ovarian stimulation and to determine the range of values for these hormones with higher chances of conceiving pregnancies. All patients underwent stimulation in long agonistic protocol. Collected samples of body fluids (serum n = 31, follicular fluid n = 93) were centrifuged and supernatant was separated, aliquoted, frozen and stored at − 20°C. LH and E2 were measured in serum and follicular fluids. Cutoff value of E2 determined using follicular LH and follicular E2 correlation was 2100 nmol/L. If the E2 value was lower than 2100 nmol/L the ratio of results related to pregnancy was 29,4% (15/51). If the follicular E2 values were higher than 2100 nmol/L the ratio of results related to pregnancy was (7,1%, 3/42). The observed differences were significant (p 0.03). Follicular LH values higher than 3.1 IU/L and follicular E2 values < than 2100 nmol/L indicate higher conceiving probability. Our results can be fit in previous findings on negative effects of low LH values in IVF treatment procedures.