No abstract

Kratak sadr`aj: Intrauterini zastoj u rastu ploda jedan je od vode}ih uzroka perinatalnog morbiditeta i mortaliteta. Kako kauzal na terapija ne postoji, predikcija intrauterinog zastoja u rastu je jedan od prioritetnih zadataka perinatalne za{tite. Cilj rada je bio da se na osnovu odre|ivanja nivoa serum skog feritina i ele menata crvene krvne loze kod trudnica izme|u 30. i 32. gestacijske nedelje izdvoji grupa trudnica kod kojih je mo gu }e o~ekivati nastanak zastoja u rastu ploda. Istra`ivanje je sprovedeno u vidu prospektivne studije me|u zdravim tru dni cama izme|u 30. i 32. gesta cijske nedelje. Svim trud nicama odre|ivane su vrednosti feritina. Posle poro|aja utvr|en je procenat beba malih za gesta cijsku dob; 8,1% rodilo je novoro|en~ad sa malom telesnom masom za gesta cijsku dob. Anemija nije utvr|ena ni kod jedne pacijen tkinje koja je rodila bebu male poro |ajne mase a bila je prisutna kod 47,44% pacijentkinja koje su rodile bebe normalne poro|ajne mase. Kod majki beba male poro|ajne mase, nivo serumskog feritina bio je u proseku za 6,42 mg/L vi{i nego kod majki koje su rodile bebe normalne poro|ajne mase (p<0,005). Uporednom analizom telesne mase novoro|en~adi i nivoa feritina iz krvi majke na|en je mali koeficijent korelacije, ali je ROC ana liza pokazala da nivo feritina u krvi ima dobru prediktivnu vrednost. Pri vrednostima feritina u krvi trudnice ve}im od 13,6 mg/L sa senzitivno{}u od 64,7% i specifi~no{}u od 91,7% mo`emo tvrditi da }e se razviti intrauterina retar da cija rasta ploda. Izostanak pada vrednosti serumskog feritina, eritrocita, hemoglobina i hematokrita u krvi zdrave trudnice u periodu izne|u 30. i 32. nedelje trudno}e mo`e ukazati sa velikom verovatno}om na razvoj intrauterine retar dacije rasta ploda.

The goals of surgery for spinal deformity are to correct or improve the deformity to get a stable, balanced and fused spine. The long-term success of any procedure for scoliosis depends on a solid arthrodesis. Getting fusion of the instrumented segment with the aid of copious autogenous iliac graft has been the most important goal of treatment. However, harvesting copious graft from teenage iliac bone has its limitation in the quantity of graft, surgical time, and other complications of graft sites. Bone substitute is a promising concept, but there is not ideal bone substitute with all the characteristics of an autogenous bone graft. Several alternative graft materials like tricalcium phosphate, hydroxyapatite, and demineralized bone matrix have osteoinductive properties. Bone morphogenic protein has osteoconductive properties. The limitations with bone substitutes are osteoinduction and osteoconduction properties, sterilization, chances of transmitting infective disease and cost. We consider that the introduction of segmental spinal instrumentation which enables strong and firm correction and fixation of the scoliotic deformity has enabled getting fusion with less graft. We can obtain that quantity of graft after laminae and spinous process decortication. This retrospective study has been done in our hospital from January 2002 to December 2004. A total of 188 patients underwent posterior corrections for adolescent idiopathic scoliosis using segmental fixation by Moss-Miami. No autogenous iliac crest graft was taken or graft substitutes. After meticulous decortication and destruction of facet joints, we used local graft taken from spinous process and laminae. All patients had minimum thirty months follow-up. We have excellent results. Out of these 188 patients, 177 patients have fused spine, no implant failure, no pain, no infection and no loss of correction. Eleven (5.8%) patients underwent re-operation; four among them because of infection, three for symptomatic implants and four due to pseudarthrosis. We consider that the use of local harvesting graft is enough for getting good spondylodesis.

Introduction. The aim of this prospective study was to estimate whether the presence of endometrial fluid detected by transvaginal ultrasound investigation was a marker for the pathological changes of the endometrium in postmenopausal women. Material and methods. 128 postmenopausal women with uterine bleeding and 29 asymptomatic postmenopausal women underwent transvaginal ultrasound investigation, curettage and histopathological investigation of the curettage specimens. Results. There were significantly more asymptomatic women with endometrial fluid collection was found (41,4%) than those with uterine bleeding (7,8%) (p<0,001). We found 4 cases of carcinoma of the endometrium, 4 with hyperplasia and 1 with polyp of the endometrium in women with uterine bleeding and endometrial fluid collection. In the asymptomatic group of women we found 1 case with polyp and 1 with carcinoma of the endometrium. In the presence of endometrial fluid collection the least thickness of the endometrium measured by transvaginal ultrasound was 12 mm in postmenopausal women with carcinoma of the endometrium, 7 mm in women with hyperplasia and 5 mm with polyp. No pathological changes were found below the above values. Conclusion. The presence of endometrial fluid detected by transvaginal ultrasonography is a good marker for pathological changes of the endometrium in postmenopausal women if the endometrial thickness is greater than 4 mm. If the endometrial thickness is 4 mm or less, the presence of endometrial fluid is not an indication for further invasive investigation of endometrial cavity, but we must eliminate possible presence of ednexal or cervical malignant disease in some patients