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The aim of this paper was to present the role of human papillomavirus (HPV) in cervical carcinogenesis from several aspects. By explaining the HPV virus lifecycle and structure, its effect on cervical cell cycle and subversion of immune response can be better understood. Early E region of the viral genome encodes proteins that are directly involved in carcinogenesis. The E6 protein binds to p53 protein (product of tumor-suppressor gene) blocking and degrading it, which in turn prevents cell cycle arrest and apoptosis induction. E6 is also capable of telomerase activation, which leads to cell immortalization; it also reacts with host proto-oncogene c-jun, responsible for transcription, shortens G1 phase and speeds up the transition from G1 to S phase of the cells infected by HPV. E7 forms bonds with retinoblastoma protein (product of tumor-suppressor gene) and inactivates it. It can inactivate cyclin inhibitors p21, p27, and abrogate the mitotic spindle checkpoint with the loss of protective effect of pRB and p53. The immune system cannot initiate early immunological reaction since the virus is non-lytic, while the concentration of viral proteins--antigens is low and has a basal intracellular position. Presentation through Langerhans cells (LC) is weak, because the number of these cells is low due to the effect of HPV. E7 HPV reduces the expression of E-cadherin, which is responsible for LC adhesion to HPV-transformed keratinocytes. Based on these considerations, it may be concluded that the process of cervical carcinogenesis includes viral, genetic, cellular, molecular-biological, endocrine, exocrine and immunological factors.

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BACKGROUND/AIM: Female patients who underwent ceratin treatment forms of cervical intraepithelial neoplasia (CIN) are at five times greater risk for disease relapse in comparison to the rest of female population. The aim of the study was to investigate validity of human papillomavirus (HPV) typization and cytology in detection of relapse. METHODS; The prospective clinical investigation included 35 patients with relapse and 30 ones without it after adequate treatment of cervical intraepithelial neoplasia. HPV typization using PCR methods and cytological test (conventional Pap smear) were performed in all the patients. Validation of tests applied was performed by determining their sensitivity, specificity, and positive and negative predictive value. RESULTS: More severe degrees of CIN relapse occur significantly more often in patients which remain HPV positive despite of the treatment. The patients which remain positive on HPV type 18 or, on both HPV types 18 and 16, have more often CIN relapses of more severe degree in relation to those just positive on HPV type 16. HPV typization has higher predictive value for diagnosis of the rezidual disease in older patients. Sensitivity of HPV typization for diagnosis all CIN relapse degrees is 68.57%, for more severe degrees (HSIL and MIC) 90.47%, specificity is 93.33%, while positive and negative predictive values are 90.47% and 93.53%, respectively. Sensitivity of cytology for diagnosis of more severe CIN relapses is 80.95%. HPV typization used along with cytology ofters the highest sensitivity (95.23%). CONCLUSION: Both tests, HPV typization and Pap smear, offer satisfactory sensitivity and high specificity in detection of relapse, parcticularly those with more severe degree. The highest sensitivity in detection of CIN relapse is obtained by using both tests.

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BACKGROUND/AIM: A repeated or habitual miscarriage (PSP) is defined as three or more consecutive losses of pregnancy. In the first three months of pregnancy, habitual miscarriages occur in about 1% of pregnant women, out of which 50% are of an unknown etiology. It is believed that among them, the greatest number is the consequence of an inadequate alloimmune response of a women to the pregnancy. The endocrine and immune systems are in a close interaction during the implantation and maintaining of pregnancy. This communication is the most obvious on endometrium of pregnancy decidua. The aim of the study was to identify the number and the subpopulation distribution of the decidual NK cells in the decidua by using an immunohistochemical method. METHODS: The research included a group of 30 women who had had two spontaneous miscarriages consecutively in the first three months of their pregnancy, while the curettage after the third spontaneous abortion was histopathologically and immunohistochemically analyzed. The control group consisted of 20 women without a problematic reproductive anamnesis, who had had their pregnancy terminated for social reasons. The criteria for the eliminating from the research were the diagnosed uterus anomalies, positive screening on thrombophilia, as well as women suffering from diabetes melitus and the ones with the thyroid gland function disorder. RESULTS: The number and the phenotype structure of the uterus NK cells were significantly different between the decidua of a normal pregnancy and that in PSP. In the decidua in PSP, there were much more NK cells with the phenotype of the peripheral circulation CD57 and CD56dim, while in the decidua of the control group the dominant cells were the typical uNK cell subpopulation CD56bright. CONCLUSION: The above mentioned results show that the disregulation of the immunocompetent cells of the decidua, by creating an inadequate cytokine milieu, is one of the mechanism of rejecting the semiallogeneic blastocyst.

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BACKGROUND: Epithelial ovarian cancer (EOC) accounts for 25% of all malignancies in the female genital tract and it is the most common cause of death among women who develop gynecologic malignancies. According to recent reports at least 20% of EOC are diagnosed at stage I of the disease. Because women tend to give birth to their first child at an older age, and due to the usage of more sensitive diagnostic procedures, the diagnosis of EOC during reproductive age has become more frequent. Therefore, the demand for fertility-sparing surgery in early-stage of EOC is increased. CASE REPORT: We presented the case of accomplished reproduction at 41 after the conservative treatment of mucinous ovarian cancer. In the absence of a complete surgical staging, her decision was to spare her fertility capacities opposed to the treatment recommendations of the oncological council. The bottom-line of this report was to give its contribution to the ongoing controversies in the decision to recommend the conservative surgical treatment of the EOC and also to reveal the need of reconsideration of the necessity of a complete surgical staging in patients with stage I of mucinous ovarian cancer. CONCLUSION: The profile of EOC cases in which a conservative surgical approach is the appropriate one has not yet been defined. Correct surgical staging is still an indispensable guideline for that kind of clinical decision. In the case of stage I of mucinous ovarian cancer with the low tumor grade, the necessity of a complete surgical staging should be reconsidered.

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INTRODUCTION: Absent or reversed end-diastolic blood flow in the umbilical artery is usually associated with poor perinatal outcome and high perinatal mortality rate. CASE REPORT: We present the case of a pregnant woman with absent end-diastolic blood flow in the umbilical artery in the 27th week of pregnancy with initial restriction of fetal growth. Allthough it was more and more obvious that the fetal growth was hindered, the Doppler, cardiotocographic and biophysical parameters did not get any worse as the pregnancy developed. The full fetal maturation was reached after the intense monitoring of the fetal condition and the pregnancy was terminated in the 37th week by elective Cesarean section. CONCLUSION: The basic purpose of prenatal fetal monitoring in the situation of hindered fetal growth with chronic hypoxia is to predict the phase of decompensation and to terminate pregnancy before it is developed. The major problem is in great individual variations at the moment of development of decompensation phase, so the major obstetric aim in the monitoring of the fetus hindered in growth is to determine the optimal time and way of delivery.

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BACKGROUND/AIM: Bethesda system of classification of cytological findings was introduced in 2001 two subcategories in the category of atypical squamous cells (ASC) findings: ASC of undetermined significance (ASC-US) and ASC which cannot exlude high-grade intraepithelial lesions (ASC-H). The aim of our study was to assess a possible association of these two subcategories with pathologic biopsy finding and to find out the best further diagnostic proceedings. METHODS: At the Clinic of Gynecology and Obstetrics, Nis 130 patients with ASC findings were analyzed. Colposcopy was performed in all study participants. Patients with pathological colposcopic findings underwent cervical biopsy. In 10 patients with pathologic histologic and 15 with benign findings human papilloma virus (HPV) typization was done using the Hybrid Capture method. RESULTS: Patients with ASC-H finding had significantly more pathologic biopsies compared with patients with ASC-US finding (57.84: 20.72). CONCLUSION: Colposcopy was exhibited somewhat higher sensitivity compared to HPV typization (94.7 : 90), but lower sensitivity (79.27 : 86.6). The usage of HPV typization in the triage of patients with ASC cytologic smear induces statistically significant reduction of unnecessary percentage of cervical biopsies.

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INTRODUCTION: The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complication development. MATERIAL AND METHODS: The research was conducted at the Clinic of Gynecology and Obstetrics in Nis covering 10-year-period (from 1995 to 2005) with 32358 deliveries, 1280 deliveries after a previous cesarean section, 131 cases of placenta previa and 118 cases of placental abruption. The experimental groups was presented by the cases of placenta previa or placental abruption with prior cesarean section in obstetrics history, opposite to the control group having the same conditions but without a cesarean section in medical history. RESULTS: The incidence of placenta previa in the control group was 0.33%, opposite to the 1.86% incidence after one cesarean section (p<0.001), 5.49% after two cesarean sections and as high as 14.28% after three cesarean sections in obstetric history. Placental abruption was recorded as placental complication in 0.33% pregnancies in the control group, while its incidence was 1.02% after one cesarean section (p<0.001) and 2.02% in the group with two previous cesarean sections. The difference in the incidence of intrapartal hysterectomy between the group with prior cesarean section (0.86%) and without it (0.006%) shows a high statistical significance (p<0.001). CONCLUSION: The previous cesarean section is an important risk factor for the development of placental complications.

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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.

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BACKGROUND/AIM: Conization is an excisive technique used for both diagnostic and therapeutic purposes. If conizate margines do not show any pathologic changes (negative findings) it is also the only therapeutic measure which should be applied. In case of conizate margins affected by the disease (positive findings), it is necessary not only to assess various parameters but also to decide on a further therapeutic approach. The aim of this study was to determine the incidence of positive findings and its impact on a further optimal therapeutic approach choice. METHODS: The data for analyses were retrospectively acquired through an insight into the medical records of the female patients who had undergone conization in the Institute for Gynecology and Obstetrics, Clinical Center of Serbia, within a period from 1995 to 2000. Histopathologic analyses of the bioptic and cervical conizate and reconizate samples were performed in the same institute. The acquired data were analyzed and statistically processed. RESULTS: Within the above mentioned period, a total of 823 conizations were done. In 76 patients, positive findings were determined. The acquired data analysis revealed positive findings decrease during this period, yet with no statistical significance. Higher statistically significant incidence of positive findings, however, was revealed in the patients over 40 years of age. Also, a statistically significantly higher incidence of positive findings was revealed in the apex as compared with other localizations. During the period observed, there was the raise of the number of patients only followed up after the conization without reconization. Also evident was decreasing in the number of histerectomies followed by increasing in the number of reconizations, as the method for reintervention. The most common cause of histerectomy was the apex positive findings with no statistical significance, while of reconization it was positive finding on lateral conizate margins with statistical significance. The association of the apical conizate positive finding with that in the curettements in all the cases was in correlation with positive findings at reintervention. CONCLUSION: According to the results obtained by analyzing and statistical processing of the acquired data, it could be concluded that reconization does represent a more suitable reintervention in patients with positive conizate findings as compared to histerectomy.

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