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Prolonged pregnancy, associated with low amniotic fluid is a reason for the increase of fetal mortality and morbidity. There is no a define test at prolonged pregnancy which can determine which pregnancy are at a risk for adverse outcome and complications. Dopplerometry as a noninvasive method for examination of blood circulation, and especially a. cerebri media and a. umbilicalis can be used for the prediction of the outcome of prolonged pregnancy.

CDX2 is a nuclear transcribing factor, important for the development and differentiation of the bowels. According to the recent publications, CDX2 expression is immunochystochemisry detector in the normal enterocytes of the bowels and is normally met in the most, but not at all colorectal carcinomas. Two homeostatic genes are detected at people CDX1 u CDX2. We present examination of CDX2 expression at 15 adenomas and 30 colorectal carcinomas. All the adenomas are positive for CDX2, 27 /90%/ of the adenocarcinomas show nuclear expression of CDX2.

Ovarian cancer is the most lethal gynecologic neoplasia. The risk of ovarian cancer in Europe is 1 to 80. In 80-90% of cases, the clinical manifestation is in advanced stage. The 5 year survival is for III /IV stage 25%, but for I/II stage is 90%. In the present study we present the molecular and genetic changes of hereditary and sporadic ovarian cancer.

Defined as hemolysis, liver dysfunction and low platelets, HELLP syndrome is a severe complication of preeclampsia with worsening seriously the prognosis of mother and foetus. Frequently it is associated with the development of DIC syndrome. We present a case of HELLP syndrome developed in 30 gestational week, complicated with DIC syndrome.

The aim of the study was to evaluate the frequency of cytolitic vaginosis amongst women with symptoms that mimic vulvovaginal candidiasis. We include 1152 patients, which are microbiologically and citologically tested. We found in 3.9% cytolytic vaginosis. The clinical presentation is suggestive of vulvovaginal candidiasis. The differentiation of these two conditions is essential for appropriate treatment and resolution of chronic vaginal subjective complaints.

Multiple pregnancy is associated with some specific syndromes: twin to twin transfusion syndrome, syndrome of the disappeared twin, intrauterine loss of one of the twin, development of foetus papiraceus and syndrome of asymmetric growth of the twin. We present a case of term pregnancy with death of one of the twin and normal delivery of healthy baby and Foetus papiraceus.

Introduction: Metastases from colorectal adenocarcinomas can be histologically similar to serous, mucinous and endometrioid ovarian adenocarcinomas. The differentiation between primary and metastatic ovarian tumours is of great importance for the patients because of the different treatment and prognosis., Aim: The aim of the study was to determine whether the differences in the expression of Cytokeratin 7, Cytokeratin 20, Beta catenin and CDX2 can be used to distinguish the different types of carcinomas and their metastases., Materials and Methods: The immunohistochemical expression of the listed above antibodies was examined retrospectively and prospectively in 38 colorectal adenocarcinomas (primary and metastatic) and 32 ovarian adenocarcinomas (primary and metastatic). The metastases in both types of adenocarcinomas are located in the peritoneum., Results: The immunohistochemical expression was evaluated using a semi-quantitative method. The ovarian adenocarcinomas are mostly positive for Cytokeratin 7 (in 63%), while colorectal carcinomas are mostly positive for Cytokeratin 20 (in 73%). Regarding Beta catenin, in colorectal carcinomas the expression is mostly nuclear (in 65%) and in ovarian carcinomas mostly membrane (in 68%). In cases of uncertain expression of the markers mentioned above, CDX2 was used. Positive nuclear expression was observed only in intestinal tumours (in 86%)., Conclusion: For differential diagnosis between ovarian and colorectal adenocarcinomas, the use of antibodies, determining the intestinal differentiation of the tumours like Cytokeratin 20, Beta catenin and CDX2 is recommended.

Uterine carcinosarcomas are highly aggressive malignant tumours, consisting of both epithelial and mesenchymal components. They represent 1-3% of the malignant uterine neoplasms. Their histogenesis is unclear. Because of their rarity and the very few clinical data available, the studies of potential therapeutic goals are scarce. We present clinical and pathohistological description of a rare case of a 76-year-old woman with a uterine carcinosarcoma with a chondroid differentiation, examined immunohistochemically with Cytokeratin, Vimentin and S-100 protein.

Heterotopic pregnancy is the simultaneous occurrence of intrauterine and ectopic pregnancy. Because of the increasing use of assisted reproductive technology techniques, the frequency of heterotopic pregnancy rises during the past years. We present a case of simultaneous occurrence of ruptured extrauterine /tubal/pregnancy and intrauterine /twin/pregnancy after IVF and ET.

Ovarian cancer spreads primarily by intraperitoneal implantation of exfoliated cancer cells, by lymphatic dissemination, and by haematogenous spread. Very rarely it metastasizes to cervix, vulva and vagina; this type of metastases present a diagnostic challenge to the gynecologist and pathologist. We present a case of ovarian cancer with initial clinical manifestation-lesion of the vagina.

Patients with metastatic carcinomas with unclear primary tumor site are often clinical and pathological problem. They are diagnosed in about 3-65 of the cases with solid tumors. In 60% of cases the reason is adenocarcinomas. The most frequent reason for peritoneal carcinomas at women is the ovarian cancer. In such cases we must exclude the probability of colorectal cancer. In fact there are not international standards for prove the origin of adenocarcinomas; different research groups use different criteria. We present the use of four antibodies--Cytokeratin 7 and 20, Beta cathenin and CDX2 and define their positiveness at metastases from different groups of adenocarcinomas in the peritoneum.

Gonadal dysgenesis is defined by incomplete or defect forming of gonads, a result of disturbed process of migration of germ cells or and their correct organization in gonadal ridge. The combination of dysgenetic gonads and Y chromosome is a prerequisite for developing ovarian neoplasma--most frequent gonadoblastoma. We present a case of mixed gonadal dysgenesis at a patient with caryotype 46XY in combination with gonadoblastoma.

Adnexial torsion is a rare, but important cause for abdominal pain during pregnancy. During pregnancy, its frequency is 10-20%, with highest frequency in the first trimester. We present a case of 24 year primigravida, with an acute onset of clinical symptoms with concominant disease chronic pyelonephritis. The initial diagnosis was exacerbation of the concominant disease and acute inflammation of the appendix. The intraoperative diagnosis was right adnexial torsion and inflammation of the appendix; the diagnosis was pathologically proved. Although rare, it can be included in the differential diagnosis of acute abdomen during pregnancy.

Endometrial stromal sarcoma (ESS) is a rare disease. Low-grade endometrial stromal sarcoma (LGESS) is characterized by proliferations composed of cells with endometrial stromal cell differentiation and typically show extensive worm-like vessel invasion. We present a case of a 38-year-old woman with complaints of abdominal pains and ultrasound findings of a tumour formation in the pelvis. The biopsy examination showed a low-grade endometrial stromal sarcoma (LGESS), with a primary location in the uterine corpus and a tumour infiltration in the myometrium and cervix of the uterus, with tumour emboli in the lymph vessels and tumour methastases in the peritoneum--FIGO III Stage. The patient underwent postoperative polychemotherapy and radiotherapy. The gynecological and ultrasound examination found no pathological changes in the pelvic region five years after the operation.

We present four cases, 3 in the obstetrics with and without coagulation disorders and a case in gynecology with Glanzmann Thrombasthenia and the application of rFVIIa when acute hemorrhage occurred. We achieved fast and definitive hemostasis in cases with life threatening bleeding. rFVIIa helps to decrease the bleeding in order to achieve better surgical haemostasis.

Phlebodia possess complex mechanism of action; except the venotonic one, it blocks the production of mediators of inflammation-prostaglandins and leukotriens; thus stops the uterine contractions and the preterm delivery. We use the tablet at pregnant women for preterm delivery. It was given one tablet a day /600 mg/ along with the tocolytic therapy.

In the present study we present the changes in the variables of coagulation and fibrinolysis and spontaneous abortion in comparison to normal pregnancy. It is not yet clear if these changes are etiologic factor, pathogenetic link or result, explaining these frequent obstetric diseases.

Ovarian cancer is the second and the most frequent fatal gynecological malignancy worldwide and the fourth reason for mortality of neoplasmas in Europe. The lifetime risk for ovarian cancer in Europe is approximately 1 in 80. One of the reasons for the high mortality rate is that in more than 70% of women with such cancer are diagnosed in advanced stage. After physiological menopause or after surgery, with the depletion of ovarian follicules (the granulose cells produce inhibins), the circulating serum inhibin A and B and the free alpha-subunit decrease low or non detectable levels. We present the significance of measuring total inhibin with new double ELISA method, as a diagnostic and prognostic factor in the sera of postmenopausal women with mucinous and granulose cells tumors. The serum total inhibin is a sensitive marker for diagnosis and monitoring of mucinous and granulose cells tumors as its levels decrease significantly after surgery and increase in case of recurrence. Total inhibin is useful marker with high specificity and sensitivity for these tumors; CA 125 for other varian cancer; the combination of both resulted in 95% detection of all ovarian cancers.

It is observed that the combined oral hormonal contraceptives affect significantly haemostasis and induce changes of many factors taking part in it. Some of them increase their concentrations, while others decrease. The changes in haemostasis during oral contraceptive use with third generation gestagens and same dose of ethynilestradiol and the biological plausibility for eventually increased risk of VTE at women using these drugs, are not cleared and continue to be an object of investigation and discussion.

Haemostasis is complex, dynamic and self-regulated system; the maintenance of this balanced equilibrium is achieved by complex regulation between coagulation (pro- and anticoagualants) and fibrinolysis (pro- and antifibrinolytics). During normal pregnancy the cganges in haemostasis are complex, inspite of that the haemostatic balance is preserved and the ratio coagulation/fibrinolysis remains constant. Despite marked changes in the different subsustems of haemostasis and the dominant procoagulant effects, the incidence of VTE remains relatively small.

Guillain-Barre Syndrome is an acquired neurologic disease associated with demyelinisation of the peripheral nerves. It affected 6-24/100,000 population during pregnancy; the frequency is increased after delivery in puerperium. We present a case of Syndrome of Guillain-Barre in puerperium. We discuss the clinical presentation of the disease during pregnancy and in puerperium, diagnosis and treatment.

Menorrhagia is frequent at women at reproductive age. Nowadays the standart for diagnosis of menorrhagia is hysteroscopy with histological verification. When there is no effect of the conservative treatment, an operative treatment is applied--hysterectomy or ablation of the endometrium. The aim of the present study is to present our experience with transcervical resection of the endometrium with classic abdominal hysterectomy as a therapeutic management for women with menorrhagia. Transcervical resection of the endometrium at selected patients (proved menorrhagia and length of the endometrium <10-12 sm) is a safe alternative of hysterectomy.

The frequency of obesity is increasing worldwide. Among the group of teenagers who are pregnant there is a tendency of increasing of BMI. We present BMI at the beginning and at the end of pregnancy at pregnant teenagers, according to the scheme of Institute of Medicine. The optimal weight gain during teenage pregnancy would minimize the risk of overweight and obesity postpartum and during subsequent pregnancy as well the associated complications.

Aim: To compare the influence of two contraceptive combinations with 20 microg EE/ 150 microg DSG u 30 microg EE/ 150 microg DSG upon menstrual cycle, BMI, blood pressure and the side effects., Materials and Methods: The study is prospective, continues one year and consisted of 70 clinically healthy women, who use two monophase oral contraceptives with desogestrel., Results: The use of both contraceptive formulas have PI = 0.00. The intermenstrual bleeding are more frequent at the group with 20 microg EE/ 150 microg DSG. The more frequent side effects were: headache and breast tenderness. We do not find statistically significant changes in the BMI and blood pressure with the use of the presented contraceptive combinations., Conclusion: Contraceptive combinations with 20 microg EE/ 150 microg DSG u 30 microg EE/ 150 microg ensure good control upon the menstrual cycle, high contraceptive safety and good tolerance.

Diabetes insipidus is a temporary or chronic disorder of the neurohypophyseal system, due to deficiency of vasopressin and is characterized of excessive quantities of very dilute urine, excessive thirst and profound electrolyte abnormalities. The association of diabetes insipidus and pregnancy is rare with incidence of about 1:300,000. We report two cases of pregnancy with accompanied disease--central diabetes insipidus. We discuss the pathogenesis, clinical manifestation and the terapeutic management during pregnancy.

The incidence of venous thromboembolism is increased five to six times in pregnancy; and it is estimated that thromboembolic episodes- superficial and deep venous thromboembolism and pulmonary embolism occur in 1:1000 to 1:1500 pregnancies. These complications during pregnancy and puerperium, are not common but serious and leading cause of maternal morbidity and mortality. Thrombophilias--acquired or inherited, result of anticoagulant regulatory proteins deficiency, could compromise normal pregnancy by increasing the risk of developing first or recurrent thromboembolic incidents and adverse obstetric events.

Myasthenia gravis is an acquired immune-mediated neuromuscular disorder, characterised by muscle weakness and fatigabillity of the voluntary muscles. It often affects women in the second and third decade of life with predilection of childbearing years (incidence in pregnancy--1:20,000). We present a case of a pregnant woman with myasthenia gravis and review the literature upon the problem - association of myasthenia gravis and pregnancy.

Background: We present the influence of monophasic combined oral contraceptive with 20 mmicrog ethinylestradiol /150 microg desogestrel upon some acute phase proteins: C- reactive protein, fibrinogen, haptoglobin and the connection between the proinflammatory effect of oestrogens, Methods: Forty clinically healthy young women between 18 and 35 years, using oral contraceptives in the duration of 12 months, are included in this study., Results: We don't find statistically significant differences in the plasma concentrations of C--reactive protein, fibrinogen, haptoglobin on the 12th month of the using of the oral contraceptives in comparision with the initial levels of the variables, before starting the study., Conclusion: The reduction of the dose of ethinylestradiol, definitely reduces the effects of oral contraceptives upon acute phase proteins and eventually the increased risk of cardiovascular disease.

The contraceptive and non contraceptive advantages of oral chormonal contraceptives as well as the good control on fertility, make it one of the most preffered method of contraception. The normal vaginal flora is a dynamic ecosystem and itsequilibrium and status of eubyosis amongst its inhabitants is an important mechanism against exogenous infections. The use of oral contraceptives is not associated with significant changes in the vaginal microbial flora; the normal concentration of the lactobacillli is preserved.

Acute appendicitis remains the most common nonobstetric surgical diagnosis during pregnancy, requiring surgery. It is estimated that its frequency is 1 case per 1500 pregnancies. The delay in the diagnosis correlates with an increase in ruptured appendix and a dramatic elevation in fetal and maternal morbidity and mortality. In the study the authors discuss the clinical presentation, laboratory findings, operative treatment, pathologic diagnosis and the outcome of the disease of 17 cases with acute appendicitis in pregnancy, operated in the Clinic of Thoraco Abdominal Surgery for a ten years period of time. The early surgical treatment plays an important role for the succsessful outcome of the disease and reduces the complications for the mother and the fetus.

The authors examined the changes in the haemostasis during the use of the oral contraceptive combination with 20 microg ethynil estradiol/150 microg desogestrel at 35 women, a basic group, who used the oral contraceptive in the duration of 12 months and a control group (n=35), who do not use the pills. We found statistically significant increase of Antithrombin III (ATIII) (p<0.011), Cofactor II of Heparin (HCII) (p<0.001), the activity of plasminogen (p<0.026) and beta2-antiplasmin (0.026), significant decrease of Protein C (PrC) (p<0.0001) and of total Protein S (TPrS) (p<0.03) in the basic group in comparision with the control one. We do not observe significant changes in the rest of the haemostatic variables between the two groups. During the use of the oral contraceptive combination with 20 microg ethynil estradiol/150 microg desogestrel the changes in the system of the natural inhibitors are balanced by these in the system of fibrinolysis.

Unlabelled: Except of the success in the diagnosis and treatment of acute pancreatitis, and at present this illness and its complications continue to be actual problem of urgent surgery. The object of our study is to establish the frequency of renal complications at patients with severe acute pancreatitis and to assess the most important risk factors of their development and mortality., Material and Methods: The object of our study is 198 patients with severe acute pancreatitis, 75 of whom have renal complications.

Authors present 28 cases of bowel injuries after blunt abdominal trauma. Patients were from 14 to 71 years of age, 18 (64%) men and 10 (36%) women. The most common cause for the trauma was the car accident--in 18 cases. In the rest 10 the trauma was result of household activities. The small bowel was injured in 16 patients, the large bowel in 9 and in 3--the duodenum. In 15 cases the trauma was only abdominal and in the rest 13 it was accompanied by other traumas. Three of the 28 patients reported herein died.