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Background: Hepatic ischemia and reperfusion (I/R) is common in liver surgery and transplantation and compromises postoperative liver function. Hepatic I/R injury is characterized by sterile inflammation that contributes to hepatocellular necrosis. Many immune cells and cytokines have been implicated in hepatic I/R injury. However, the role and relevance of IL-23 and IL-17A remains controversial in literature. Aim: To determine whether the IL-23/IL-17A signaling axis is activated in hepatic I/R using a triple-level experimental approach (in vitro, in vivo, and clinical). Methods: IL-23 and IL-17A were assayed by ELISA in the supernatant fractions of cultured murine (RAW 264.7) macrophages that were activated by supernatant fractions of necrotic cultured mouse (AML12) hepatocytes. Similarly, levels of these cytokines were determined in plasma samples and liver tissue of mice (N = 85) subjected to partial (70%) liver I/R. Finally, IL-23 and IL-17A were assayed in plasma samples obtained from a controlled cohort of liver resection patients who were either subjected to I/R (N = 27) or not (N = 13). Results: Activated macrophages did not produce IL-23 in response to supernatant of necrotic AML12 hepatocytes. IL-23 and IL-17A were not elevated in mice subjected hepatic I/R and were not elevated in serum from patients subjected to I/R during liver resection. Conclusion: IL-23 and IL-17A are not involved in hepatic I/R injury in mouse and man. Relevance for patients: If IL-23 and IL-17A were to mediate hepatocellular injury following I/R, these cytokines would constitute potential therapeutic targets. Since this study has revealed that IL-23 and IL-17A do not play a role in hepatic I/R, other pathways and therapeutic targets should be considered when developing modalities aimed at reducing hepatic I/R injury.

Pacijenti u određenoj često iskazuju zadovoljstvo postignutom bojom nakon izbjeljivanja, iako ponekad tu promjenu ne mogu u potpunosti percipirati. Cilj ovog istraživanja bio je odrediti u kojoj mjeri se boja zuba promijeni kratkoročno i dugoročno nakon izbjeljivanja te koliko tu razliku pacijenti percipiraju. Studija je provedena kao dvostruko slijepi, randomizirani, placebom kontrolirani pokus. Regrutirano je 60 ispitanika, po 30 u eksperimentalnu i kontrolnu skupinu. Nakon godinu dana analizirani su podaci 50 ispitanika (26 kontrolne skupine) u dobi od 19 do 28 godina (74% žena). Eksperimentalnoj skupini izbijeljeni su frontalni zubi lampom i gelom kroz 30 minuta dok je kontrolnoj skupini rađen isti postupak ali bez aktivne supstance. Za procjenu rezultata mjereni su elementi boje, L.a.b., na desnom središnjem sjekutiću digitalnim spektofotometrom. Zadovoljstvo bojom procijenjeno je petostupanjskom ljestvicom (1=potpuno zadovoljan; 5=potpuno nezadovoljan). Kratkoročna promjena boje je značajno veća u aktivnoj nego placebo skupini (p

Pacijenti u određenoj često iskazuju zadovoljstvo postignutom bojom nakon izbjeljivanja, iako ponekad tu promjenu ne mogu u potpunosti percipirati. Cilj istraživanja bio je odrediti u kojoj mjeri se boja zuba promijeni kratkoročno i dugoročno nakon izbjeljivanja te koliko tu razliku pacijenti percipiraju. Studija je provedena kao dvostruko slijepi, randomizirani, placebom kontrolirani pokus. Regrutirano je 60 ispitanika, po 30 u eksperimentalnu i kontrolnu skupinu. Nakon godinu dana analizirani su podaci 50 ispitanika (26 kontrolne skupine) u dobi od 19 do 28 godina (74% žena). Eksperimentalnoj skupini izbijeljeni su frontalni zubi lampom i gelom kroz 30 minuta dok je kontrolnoj skupini rađen isti postupak ali bez aktivne supstance. Mjereni su elementi boje, L.a.b., na desnom središnjem sjekutiću digitalnim spektofotometrom. Zadovoljstvo bojom procijenjeno je Likertovom petostupanjskom ljestvicom. Kratkoročna promjena boje je značajno veća u aktivnoj nego placebo skupini (p

Pacijenti u određenoj često iskazuju zadovoljstvo postignutom bojom nakon izbjeljivanja, iako ponekad tu promjenu ne mogu u potpunosti percipirati. Cilj ovog istraživanja bilo je odrediti u kojoj mjeri se boja zuba promijeni kratkoročno i dugoročnou periodu nakon izbjeljivanja, te koliko tu razliku pacijenti uistinu percipiraju. Studija je provedena kao dvostruko slijepi, randomizirani, placebom kontrolirani pokus.

Primary carcinoid tumors of the ovary account for 5% of ovarian teratomas. They are frequently components of mature cystic teratomas or, less commonly, mucinous cystadenomas. Most tumors are seen in peri- or postmenopausal women with symptoms of enlarging mass, or are incidental findings. Microscopically, there are four major variants of ovarian teratomas of carcinoid type: insular, trabecular, strumal and mucinous. One-third of patients with the insular type of carcinoids have symptoms of the carcinoid syndrome. Strumal carcinoid is an unusual form of ovarian teratoma composed of an intimate admixture of thyroid and carcinoid tissues that vary in their relative proportions. Two patients with ovarian tumors showing typical morphology of primary ovarian strumal carcinoid are described.

U radu je prikazan postupnik kod ultrazvučno detektiranih jednostavnih cista u postmenopauzi uz prikaz literature.

Cilj rada: Retrospektivna studija nakon primjene kombiniranog ultrazvučno-biokemijskog testa probira trisomija u prvom tromjesečju trudnoće. Metode: Od veljače 2006. do srpnja 2007. godine probir je proveden u 1112 trudnica između 10. i 14. gestacijskog tjedna. Individualni rizik trisomije 21, 18 i 13 izračunavali smo kombinacijom dobnog rizika trudnice, ultrazvučnih biljega u ploda (debljina nuhalnog nabora – NT, udaljenost tjeme-trtica – CRL) te biokemijskih biljega u serumu trudnice (slobodni β -hCG i PAPP-A), pomoću licenciranog računalnog programa (Typolog). Koncentracije biokemijskih biljega smo određivali imunometrijskom kemiluminiscentnom metodom (IMMULITE). Biokemijske biljege, kao i NT u odnosu na CRL, izrazili smo u obliku višekratnika MoM, u odnosu na regresijske medijane za odgovarajuću gestaciju u neugroženim trudnoćama. Rezultate smo obradili nakon dovršenih svih ispitanih trudnoća. Ukupno su 62 testirane trudnice imale povećani kombinirani rizik trisomije 21, a 10 trudnica povećani rizik trisomije 18/13. Otkrivene su 4 trisomije 21 i jedna trisomija 18. U trudnica s povećanim rizikom u probiru učinjeno je 7 biopsija koriona i 38 ranih amniocenteza. Udio lažno-pozitivnih rezultata bio je 5.2%. Zaključak: Prvi rezultati provođenja kombiniranog probirnog testa u Hrvatskoj potvrdili su visoku osjetljivost i veću specifičnost, u poredbi s biokemijskim probirnim testom u 2. tromjesečju trudnoće.

The aim of this study was to evaluate the advantages of the Misgav Ladach surgical technique compared to traditional cesarean section. Methods. A prospective randomized trial of 111 women undergoing cesarean section was carried out in the Pula General Hospital. Forty-nine operations were performed using the Pfannenstiel method of cesarean section, 55 by the Misgav Ladach method and 7 by lower midline laparotomy. Results. It was proved that the cases where the Misgav Ladach method was implemented, compared to the Pfannenstiel method, showed a significantly shorter delivery/extraction and operative time (P=0.0009), the incision pain on the second postoperative day was significantly lower (0.021), we recorded a quicker stand up and walking time (P=0.013), significantly fewer analgesic injections and a shorter duration of analgesia were required (P=0.0009) and the bowel function was restored to normal sooner (P=0.001). Conclusion. The Misgav Ladach method of cesarean section has advantages over the Pfannenstiel method in so far as it is significantly quicker to perform, with diminished postoperative pain and less use of postoperative analgesics. The recovery of physiologic function is faster. No differences were found in intraoperative bleeding, maternal morbidity, scar appearance, uterus postoperative involution and the assessment of the inflammation response to the operative technique.

Fetal hypoxia is one of the leading causes of perinatal morbidity and mortality. One of the most severe sequels of fetal hypoxic insult is the development of perinatal brain lesions resulting in a spectrum of neurological disabilities, from minor cerebral disorders to cerebral palsy. One of the most important fetal adaptive responses to hypoxia is redistribution of blood flow towards the fetal brain, known as the "brain sparing effect". The fetal blood flow redistribution in favor of the fetal brain can be detected and quantified by the Doppler cerebral/umbilical ratio(C/U ratio=cerebral resistance index (CRI)/umbilical resistance index (URI)). Our studies on animal models and human fetuses have demonstrated clearly that this phenomenon cannot prevent the development of perinatal brain lesions in the case of severe or prolonged hypoxia. Fetal deterioration in chronic and severe hypoxia is characterized by the disappearance of the physiological cerebral vascular variability (vasoconstriction and vasodilatation), followed by an increase in cerebral vascular resistance. However, our latest study on growth-restricted and hypoxic human fetuses has shown that perinatal brain lesions can develop even before the loss of cerebrovascular variability. The fetal exposure to hypoxia can be quantified by using a new vascular score, the hypoxia index. This parametar, which takes into account the degree as well as duration of fetal hypoxia, can be calculated by summing the daily %C/U ratio reduction from the cut-off value 1 over the period of observation. According to our results, the use of this parameter, which calculates the cumulative, relative oxygen deficit, could allow for the first time the sensitive and reliable prediction and even prevention of adverse neurological outcome in pregnancies complicated by fetal hypoxia.

Fetal hypoxia is one of the leading causes of perinatal morbidity and mortality. One of the most severe sequelae of fetal hypoxic insult is the development of perinatal brain lesions resulting in a specter of neurological disabilities, from minor cerebral disorder to cerebral palsy. One of the most important fetal adaptive responses to hypoxia is redistribution of blood flow towards the fetal brain, known as the “ brain sparing effect” . The fetal blood flow redistribution in favor of the fetal brain can be detected and quantified by the Doppler cerebral/umbilical ratio (C/U ratio= cerebral resistance index (CRI)/umbilical resistance index (URI)). Our studies on animal models and human fetuses have demonstrated clearly that this phenomenon can not prevent the development of perinatal brain lesions in case of severe and/or prolonged hypoxia. Fetal deterioration in chronic and severe hypoxia is characterized by the disappearance of the physiological cerebral vascular variability (vasoconstriction and vasodilatation), followed by an increase in cerebral vascular resistance. However, our latest study on growth restricted and hypoxic human fetuses has shown that perinatal brain lesions can develop even before the loss of cerebrovascular variability. The fetal exposure to hypoxia can be quantified by using the new vascular score, hypoxia index. This parameter, which takes into account the degree as well as duration of fetal hypoxia, can be calculated by summing the daily %C/U ratio reduction from the cut-off value 1 over the period of observation. According to our results, the use of this parameter, which calculates the cumulative, relative oxygen deficit, could allow for the first time the sensitive and reliable prediction and even prevention of adverse neurological outcome in pregnancies complicated by fetal hypoxia.

Cilj istraživanja. Utvrditi prednosti tehnike carskog reza »Misgav Ladach« u usporedbi s konvencionalnom metodom po Dörffler-u. Ispitanice i metode. U Općoj bolnici u Puli obuhvaćeno je randomiziranim prospektivnim pokusom 104 pacijentica. U 49 pacijentica je izvršen carski rez konvencionalnom metodom, a u 55 izvršena je »Misgav Ladach« operacijska tehnika. Rezultati. U »Misgav Ladach« operacijskoj tehnici u usporedbi s konvencionalnom metodom dokazali smo da je trajanje ekstrakcije novorođenčeta kraće (p=0, 0009), kraće je ukupno trajanje operacijskog zahvata (p=0, 0009), smanjena je postoperacijska bol nakon prvog postoperacijskog dana (p=0, 021), ranije je ustajanje iz kreveta i hodanje (p=0, 013), smanjena je postoperacijska potro{;nja analgetika (p=0, 0009), vremenski je kraća primjena analgetika (p=0, 0009) i raniji je oporavak peristaltike crijeva (p=0, 001). Zaključak. »Misgav Ladach« operacijska tehnika u usporedbi s konvencionalnom metodom značajno skraćuje trajanje operacije, bolji su rezultati s obzirom na postoperacijsku bol, manja je potro{;nja analgetika te br`a je uspostava osnovnih fizioloških funkcija. Intraoperacijsko krvarenje, morbiditet majke, nalaz na rani, involucija maternice te procjena upalnog odgovora na operacijski pristup nisu se razlikovali u istraženim skupinama pacijentica.

Prikazani su rezultati detekcije fetalnih malformacija uključujući fetalno srce na osnovi ultrazvučnog prikaza intrakardijalnih ehogenih fokusa.

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OBJECTIVE: To analyze the potential of three-dimensional power Doppler sonography in morphologic and functional assessment of the fetus and placenta.METHODS: Review of the recent literature on three-dimensional sonography in early pregnancy and in the second and third trimester.RESULTS: Three-dimensional sonography plays an important role in obstetrics predominantly for assessing fetal anatomy. Multiplanar images and rotation of the object allow systematic review of anatomic structures, such as limb buds, cerebral cavities, cord insertion, stomach, and bladder. Using this modality, volumes of the gestational sac, yolk sac, and fetal organs can be obtained easily. Three-dimensional power Doppler sonography has the potential to study the intervillous and placental circulation and evaluate the development of the embryonic and fetal cardiovascular system.CONCLUSIONS: Three-dimensional ultrasound imaging complements pathologic and histologic evaluation of the developing embryo, giving rise to the new term "three-dimensional sonoembryology." It is evident that three-dimensional ultrasonography improves the visualization of the normal and abnormal fetal anatomy giving a realistic impression of the extent of the defects. These data are useful not only for obstetricians but also for pediatricians and pediatric surgeons.

Objective: To estimate the value of a new vascular score, hypoxia index (HI), in prediction of functional and/or structural brain lesions caused by fetal hypoxia and to examine the relationship between this index, Doppler cerebral-umbilical ratio (C/U) and neonatal neurosonography in growth retarded and hypoxic fetuses. Study design: In the prospective study 41 growth retarded fetuses were included from 29 to 40 weeks of gestation. Flow velocity waveforms from the umbilical and middle cerebral arteries were recorded each other day, at least two weeks. The C/U ratio and HI were calculated. After the birth, obstetric parameters and ultrasound of neonatal brain were used as outcome parameters. Results: Doppler C/U ratio1 as well as HI150 were associated with poor perinatal outcome. The neonatal brain damage was detected in 16 growth-retarded and hypoxic fetuses. Hypoxia index had greater statistic significance in the prediction of neonatal brain lesions. Also, specificity and sensitivity of HI was better than the last value of C/U ratio measured before delivery. Conclusions: The C/U ratio and HI represent the best indicators for early detecting and assessment of fetal hypoxia. Furthermore, they may also be parameters for the prediction of poor neurological outcome in pregnancies with growth retardation. So, the use of HI score would represent a significant advance in prevention of hypoxic brain lesions, which are one of the most frequent causes of perinatal morbidity and mortality.

Fetal choroid plexus cysts (CPCs) are hypoechoic structures within the choroid plexus of the lateral brain ventricles. They are symmetrical in appearance, have sharply circumscribed margins and my be either unilateral or bilateral. On the follow-up examination they are rarely found after 24 weeks of pregnancy. In anatomical and structural terms, CPCs are of no serious significance for the pregnancy ; however, they have been associated with trisomies (mostly 18 and less commonly 21) and other chromosomal abnormalities. Several authors have suggested further evaluation of pregnancy for an additional risk factor before undertaking further invasive diagnostic tests. Recent studies have suggested that isolated choroid plexus cysts are not an absolute indication for invasive prenatal diagnosis. A choroid plexus cyst associated with other ultrasonographic markers or with other risk factors such as advanced maternal age should be an idication for offering prenatal diagnosis.

Sažetak: U okviru citogenetske studije obrađeno je 125 parova s učestalim spontanim pobačajima. U ovih parova su prethodnom obradom isključeni ginekološki uzroci sponatanih pobačaja. U 12 parova (9, 6%) nađena je kromosomska abnormalnost. U skupini parova sa dva spontana pobačaja, u 8 od 63 para (12, 69%) nađena je kromosomska anomalija. U parova sa 3 spontana pobačaja nađena su 4 nositelja kromosomskih razmještanja (4/57, 7, 01%). Također je nađena povećana učestalost mozaicizma s X kromosomom (0, 8%) u ove skupine ispitanika u odnosu na opću populaciju. U ovoj skupini ispitanika uočeno je 4, 2% nositelja pericentrične inverzije tipa I kromosoma 9. Bračni parovi sa dva spontana pobačaja trebali bi se uputiti na citogenetsku obradu uz prethodno isključenje ginekoloških uzroka infertiliteta.

Sažetak: U preimplnatacijskom i implantacijskom periodu gubi se od 33 do 67% trudnoća. Impatacija je veoma kompleksan proces i zahtjeva precizno regulirane stanične i molekulske puteve prijenosa signala. Oni induciraju ili reguliraju signale neophodne za impantaciju. Dosadašnja istraživanja na modelu homozigotnih mutantnih miševa dala su početne spoznaje o važnosti određenih gena za impantaciju i placentaciju. U tu skupinu spadaju geni za leukemijski inhibicijski čimbenik, c-mos protoonkogen i estrogenski receptor čije delecije uzrokuju infertilitet. Oko 10-15% klinički prepoznatih trudnoća spontano se pobaci. Udio kromosomskih abnormalnosti među spontanim pobačajima je velik i kreće se između 30-65%. Od patoloških kariotipova najčešće su trisomije autosoma i monosomija X. Kod bračnih parova s učestalim spontanim pobačajima nalazi se od 0-30% nosioca strukturnih razmještanja. Velike razlike u učestalosti u literaturi su posljedica neujednačenih kriterija za probir bračnih parova s infetilitetom . Učestalost embrionalnom mozaicizma je veoma velika u skupini plodova sa poremećenom organizacijom rasta i razvitka. Međutim, Novije spoznaje su pokazale da mozaicizam može biti ograničen samo na posteljicu. Metoda biopsije korionskih resica koja se koristi u okviru prenatalne dijagnostike daje oko 2% slučajeva mozaicizma koji nisu embrionalnog porijekla. Kod trudonoća s mozaicizmom posteljice značajno je veća učestalost prenatalnog gubitka (22%) i prisutnosti intrauterinog zastoja u rastu ploda. Mehanizam na koji način mozaicizam posteljice utječe na gubitak ploda još nije razjašnjen.

autopsy, perinatology