RESUMEN
INTRODUCTION: A surgical treatment is stressful for a patient and its risks and complications can be fatal. The preoperative preparation is an important step when performing a surgical treatment and it is carried out in a precisely determined order. I GETTING INFORMATION ON THE PROBLEM AND PREVIOUS EXAMINATIONS: It starts with taking the medical history, the first meeting and conversation between the patient and the gynecologist. A set of questions is devised to get information about the patient's problem. Status praesens reflects the present condition of the patient, other diseases, medicaments in use. Laboratory analyses (blood count, urine, liver enzymes, electrolytes, proteins) and other methods (ultrasound, x-ray, CT, MR) are done. An operation should be decided on only after all conservative methods have been used and the informed consent must be obtained from the patient. II PREOPERATIVE PREPARATION: A team consisting of an anesthesiologist, internist and other specialists, if needed, is to get insight into the patient's general health condition, decide on the application of antibiotics before the operation and on the prevention of thrombo-embolism and prepare the patient by disinfecting the region to be operated and placing Foley catheter into the bladder. CONCLUSION: The aim is to minimize possible intra and postoperative complications and to maximize the prospect of successful surgical treatment. Prior to the operation an estimation must be done whether the patient can safely bear the risks of the planned operation, the precise diagnosis must be made and possible intraoperative surprises must be minimized. The decision whether to operate or not should be made if at least one of the following reasons is present: to relieve the patient of the pain and suffering, to save her life or to correct the existing deformity. If none of these three reasons is present, the operation should be carried out.
Asunto(s)
Procedimientos Quirúrgicos Ginecológicos , Cuidados Preoperatorios , Profilaxis Antibiótica , Femenino , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Humanos , Anamnesis , Factores de Riesgo , Tromboembolia/prevención & controlRESUMEN
INTRODUCTION: The aim of this paper is to present a case of prenatal diagnosis of a congenital tumor of the oral cavity diagnosed at 28 weeks of gestation. CASE REPORT: After the diagnosis of oral cavity tumor was made by 21) ultrasound, a 3D scan was performed, which confirmed the diagnosis revealing a peduncle at the upper border of maxilla. A detailed scan was performed and no additional anomalies were seen. Magnetic resonance imaging was performed, confirming the diagnosis and the site of the tumor. Karyotype was previously done, and a normal female karyotype was found. Regular three-week follow-up scans were performed to follow the growth of the tumor, as well as the state of the amniotic fluid. No tumor growth was detected, and the amniotic fluid volume was normal until 39 weeks of gestation. Cesarean section was scheduled, due to the risk of tumor disruption during a vaginal delivery. A maxillofacial surgeon was present during an uneventful cesarean section and a complete surgical excision was done immediately after the baby was extracted and umbilical cord ligated. The histopathological diagnosis was: granular cell myoblastoma. The female newborn was developing normally, and at 5 months of age there were no traces of scarring at the place of the tumor. CONCLUSION: In cases of prenatal diagnosis of tumors of the oral cavity, where development of polyhydramnios can be expected, as well as difficulties with feeding and breathing after birth, it is important to make a plan for adequate follow-up and prompt surgical treatment immediately after birth.
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Tumor de Células Granulares/congénito , Neoplasias de la Boca/congénito , Neoplasias de la Boca/diagnóstico , Femenino , Enfermedades Fetales/diagnóstico , Tumor de Células Granulares/diagnóstico , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Embarazo , Ultrasonografía PrenatalRESUMEN
INTRODUCTION: The study evaluates serum levels of copper, chorionic gonadotropin, estradiol, progesterone and prolactin in patients with symptoms of miscarriage and in uncomplicated pregnancies in cases with or without cervical or vaginal infections detected by vaginal or cervical smears, as well as Chlamydia testing. MATERIAL AND METHODS: The study included 50 patients with symptoms of threatening miscarriage and 50 patients with uncomplicated pregnancies. Hormone levels were determined by ELISA method and copper was evaluated by acid medium colorimetry. RESULTS: We found that values of serum copper, estradiol, progesterone and prolactin were significantly lower in patients with lower genital tract infection. CONCLUSION: Decreased levels of serum copper could be used as a method of choice for detecting infection during the first trimester of pregnancy.
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Amenaza de Aborto/sangre , Cobre/sangre , Complicaciones Infecciosas del Embarazo/sangre , Gonadotropina Coriónica/sangre , Estradiol/sangre , Femenino , Humanos , Embarazo , Primer Trimestre del Embarazo , Progesterona/sangre , Prolactina/sangre , Estudios ProspectivosRESUMEN
INTRODUCTION: Pregnancy is an intriguing immunologic phenomenon. In spite of genetic differences, maternal and fetal cells are in close contact over the whole course of pregnancy with no evidence of either humoral and/or cellular immunologic response of mother to fetus as an allotransplant. The general opinion is that the fundamental protective mechanism must be located locally at the contact-plate, between the maternal and fetal tissues. Immunologic investigations proved the presence of specific systems which block the function of antipaternal maternal antibodies, as well as formation of cytotoxic maternal T-cells to paternal antigens. The system preventing rejection of graft during pregnancy is functioning at the level of maternal and fetal tissues. The protective mechanisms are coded by genes of MCH region, locus HLA-G. PROTECTIVE MECHANISMS IN THE PLACENTA: The placenta protects itself against antibody-mediated damage. A high level of complement-regulatory proteins (CD46, CD55 and CD59), being the response to the synthesis of complement-fixing maternal antibodies to paternal antigens and regulation of the placental HLA expression as a preventive reaction of the feto-placental unit to the influence of maternal CTL, are the most important protective mechanisms of placenta. PROTECTIVE MECHANISMS SHARED BY THE PLACENTA AND UTERUS: Protective mechanisms common both for placenta and uterus are as follows: expressions of Fas ligand prevention of infiltration of activated immune cells, regulation of immunosuppression which prevents proliferation of immune cells and high natural immunity (Na cells and macrophages) of the decidua.
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Tolerancia Inmunológica , Embarazo/inmunología , Femenino , Feto/inmunología , Humanos , Placenta/inmunología , Útero/inmunologíaRESUMEN
INTRODUCTION: Induction of labor represents initiation of uterine contractions before their spontaneous onset. The aim of the study was to establish the role of Bishop score in prediction of labor induction in routine clinical work. MATERIAL AND METHODS: The study was a prospective, blind, observational one. All patients had a vaginal examination prior to induction, during which Bishop score was evaluated. The mode of induction was either intravenous infusion of oxytocin or endovaginal prostaglandins. The induction was considered successful if vaginal delivery took place within 24 hours from the onset of induction. RESULTS: There were 100 patients, and induction was successful in 74% and unsuccessful in 26%. Mean Bishop score in group A was 5.65 (SD 1.40, 95% CI 5.27-6.03), and in group B 4.15 (SD 1.04, 95% CI 3.66-4.63) (p < 0.01). Statistical analysis of the area under the ROC curve showed that Bishop score is a good and reliable predictor of the outcome of labor induction (0.816, 95% CI od 0.710-0.896), with the best statistical performances at the cut-off value of 5 (sensitivity 65.5%, specificity 95%, PPV 97.3%, NPV 50%). CONCLUSION: In our study Bishop score proved to be a reliable and good method for prediction of the outcome of pregnancy if a single, experienced operator evaluates it, with best statistical performances at the cut-off value more than 5 (sensitivity 65.5%, specificity 95%, PPV 97.3%, NPV 50%). The next step would be introduction of more operators, of different skills and experience and subsequent further testing of the method in different conditions.