Radomir Živadinović

Assessment of endometrial receptivity by color Doppler and ultrasound imaging

INTRODUCTION Color Doppler sonography is a new method used to investigate changes during the menstrual cycle in infertile women. The objective of this study was to investigate the correlation of uterine and endomterial-subendomterial blood flow in infertile women using ultrasound and color Doppler sonography. MATERIAL AND METHODS A prospective clinical study included 65 infertile women divided into three groups. Transvaginal ultrasound examination was performed on days XI, XIV and XX All results were statistically analyzed. We investigated the correlation between cycles, pregnancy outcome and distribution of endomterial-subendomterial blood flow, as well as uterine arterial blood flow. RESULTS AND CONCLUSION Endomterial-subendometerial blood flow distribution pattern assessed by transvaginal color Doppler, as well as good flow in uterine vessels, are necessery for good pregnancy rates. Thin endomterium, undetectable subendomterial blood flow and higher uterine arterial resistance, were associated with low pregnancy rate and poor outcome.

Ascites in Ovarian Carcinoma - Reliability and Limitations of Cytological Analysis.

OBJECTIVE The objective of this study was to examine the validity of ascitic fluid cytology in the detection of pathological findings, to examine the percentage of false positive and false negative results in the cytology of ascitic fluid and to determine the validity of peritoneal cytology in relation to the histopathological type of the ovarian tumour. METHODS This retrospective study included 170 peritoneal cytology findings. The study was conducted from January 2010 to December 2012. The experimental group included 76 cytology findings obtained from patients diagnosed with ovarian carcinoma, whereas the control group was composed of 94 cytology findings of benign ovarian tumours and liver cirrhosis ascites. The patients with ovarian carcinoma had grades III, as well as grades I and IIc but only in cases where operative and pathological finding indicated a ruptured or perforated tumour capsule. RESULTS The sensitivity of peritoneal cytology is 68.92%, specificity is 93.61%, positive predictive value is 89.65% and negative predictive value is 78.57%. In 30.02% of patients, the peritoneal cytology showed false negative results, while in 6.38%, the results were false positive. The highest percentage of false negative findings was 77%, found in endometrioid carcinoma. CONCLUSION Peritoneal cytology of ascitic fluid is highly specific but has relatively low sensitivity, particularly in the case of endometrioid ovarian carcinoma. In order to increase sensitivity, peritoneal cytology should be combined with monoclonal antibodies and other biochemical and immunohistochemical markers.

Flexible GnRH antagonist protocol vs. long GnRH agonist protocol in patients with polycystic ovary syndrome treated for IVF: comparison of clinical outcome and embryo quality.

OBJECTIVES Polycystic ovary syndrome (PCOS) is a common endocrine disorder, primarily affecting women of the reproductive age. The aim of the study was to assess the clinical efficacy and embryo quality in flexible gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison to the long GnRH agonist protocol in PCOS women undergoing in vitro fertilization (IVF). MATERIAL AND METHODS This prospective, randomized study was conducted at the Department of Gynecology and Obstetrics, Clinical Center Niš, Serbia, between 2013 and 2014. The treatment included either a flexible GnRH antagonist protocol (n = 45, antagonist group) or a long GnRH agonist protocol (n = 45, agonist group). RESULTS The length of the stimulation, total amount of gonadotropins used, as well as the average number of the aspirated and mature oocytes were higher in the agonists group. The endometrial thickness was also greater in the agonists group. A higher number of Class I and Class IV embryos were obtained after the agonist treatment and higher number of Class II and Class III embryos were obtained after the antagonist treatment. Pregnancy, implantation, and miscarriage rates were comparable between the groups. CONCLUSIONS The GnRH antagonist protocol in PCOS patients has a pregnancy rate comparable to that of the GnRH agonist protocol. Since this protocol has a lower rate of complications and is more convenient for patients, we believe that the GnRH antagonist protocol should be used as the first-line treatment for PCOS patients in an IVF program.

Controversies in the Choice of the Optimal Therapeutic Approach to High Grade Intraepithelial Lesions (HSIL) of the Cervix

Controversies in the Choice of the Optimal Therapeutic Approach to High Grade Intraepithelial Lesions (HSIL) of the Cervix The incidence of preinvasive changes in the cervix is constantly rising. It is particularly alarming that there is a larger number of younger patients in whom some stage of these changes has been diagnosed or who had already received some type of treatment before. Technological development and improvement of various forms of treatment have lead to changes in the surgical approach to intraepithelial lesions of the cervix. The techniques that have been developed for this purpose, besides the coldknife conization, include loop excision, radio wave conization, laser conization and, recently, the conization by Harmonic scalpel. The question that inevitably arises is: Has the technological development led to more conservative approaches and improvement in the results of surgical treatment? This paper will try to partly answer this question and initiate some new questions and dilemmas. A comparative review of all of the abovementioned surgical techniques and their detailed analysis is expected to provide at least some answers to the controversial opinions for and against the new surgical procedures. The results of surgical treatments and their complications were analyzed with particular emphasis on the influence that these methods have on fertility. The conclusion is that there is no ideal surgical procedure which could replace and neglect the experience of a colposcopist. New surgical techniques have brought more surgical comfort and faster recovery but have not demonstrated significant change in the final results of treatment and recurrence. Kontraverze u izboru najoptimalnijeg terapijskog pristupa intraepitelnim lezijama grlića materice visokog gradusa (HSIL) Incidenca preinvazivnih promena grlića materice je u stalnom porastu. Ono što je posebno zabrinjavajuće je da sve veći procenat bolesnica mlađe starosne dobi ima dijagnozu nekog od stadijuma ovih promena ili je već imala neki od vidova lečenja. Sa razvojem tehnologije i usavršavanjem različitih vidova lečenja došlo je i do promena u operativnom pristupu intraepitelnih lezija grlića materice. Uporedo sa klasičnom konizacijom nožem, razvijala se i tehnika Loop excizia, konizacija radiotalasima, konizacija laserom i u novije vreme konizacija ultrazvučnim nožem. Ono što se nameće kao pitanje je da li je razvoj tehnologije doveo do konzervativnijeg pristupa i boljitka u hirurškim rezultatima lečenja? Ovaj rad će pokušati da delimično odgovori na ovo pitanje i da pokrene neka nova pitanja i dileme. Uporednim prikazom svih gore pomenutih hirurških tehnika i njihovom detaljnom analizom očekujemo da dobijemo bar neke odgovore na kontraverzne stavove - za i protiv novih hirurških procedura. Analizirali smo rezultate hirurškog lečenja i njihove komplikacije, sa posebnim akcentom na uticaj ovih metoda na fertilnost. Došlo se do zaključka da ne postoji idealna hirurška procedura koja će zameniti i zanemariti iskustvo lekara kolposkopičara. Nove hirurške tehnike su dovele do većeg operativnog komfora, bržeg oporavka bolesnica, ali nisu bitno pro-menile ukupne rezultate lečenja i pojavu recidiva.