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Biomedical subjects

Dubravko Habek

Publications and source records attributed to Dubravko Habek.

At least 19 recordsLinked to original sources
PubMed2006

Emergency peripartum hysterectomy in a tertiary obstetric center: 8-year evaluation.

OBJECTIVE: The aim of the study was to present the incidence, indications, and operative morbidity and mortality in pregnant women undergoing emergency peripartum hysterectomy (EPH) at a tertiary obstetric institution. METHODS: In this retrospective clinical study, performed during the period 1995-2003, 17 EPH procedures were recorded in a total of 21,659 deliveries carried out at Department of Gynecology and Obstetrics, Osijek Clinical Hospital in Osijek, Croatia. Data on the incidence of EPH in total number of deliveries, rate of EPH in vaginal delivery and cesarean section, indications for EPH, and maternal and fetal/early neonatal morbidity and mortality were derived from operative protocols and medical records of hospitalized patients. RESULTS: During the 8-year study period, the incidence of EPH in total number of deliveries was 0.078%. Out of 17 EPH procedures, 5 (29.41%) were performed after vaginal delivery and 12 (70.59%) during cesarean section, elective in five and urgent in seven cases. The indications for EPH included severe peripartum hemorrhage with placenta previa in four, placenta previa percreta in four, various forms of invasive malplacentation (placenta accreta, increta, percreta) in five, uterine rupture in two cases, and atony along with massive retroperitoneal hematoma due to rupture of periuterine vascular bundle during cesarean section in one multipara. EPH was carried out in 12 multipara and five primipara. Lesions of urinary bladder occurred in three cases and were managed by suture. Twelve patients received blood transfusion, whereas development of hemorrhagic shock necessitated transfer to Intensive Care Unit in three patients. No late complications or maternal mortality were recorded. Sixteen total hysterectomies and one supracervical hysterectomy were performed. One case of intrauterine fetal death was caused by total abruptio placenta and uterine rupture during the patient's transport from a primary obstetric institution. CONCLUSION: Invasive malplacentation is a major isolated risk factor for EPH, as shown in the present study. Other risk factors for EPH are massive hemorrhage because placenta previa, uterine atony and uterine rupture associated with multiparity, and previous cesarean section. A great proportion of EPH procedures can be prevented by the introduction of compressive operative methods such as B-Lynch suture in the obstetric algorithms, which will certainly favorably reflect in future fertility and genital health of the female population.

Algorithms↗
PubMed2006

Nonobstetrics vulvovaginal injuries: mechanism and outcome.

OBJECTIVE: The aim of this study is the evaluation of mechanisms and outcome of nonobstetrics vulvovaginal injuries (VVI). STUDY DESIGN: Medical documentation on 17 VVI recorded during the 1998-2005 period was analysed. The analysis included age, mode of injury infliction (accidental, intracoital, rape), treatment, and VVI outcome. Pregnant women and obstetrics peripartal and postpartal VVI were excluded from this study, and there was no sexual assault VVI in children and young girls in this period. RESULTS: There were five young girls, all of them raped by the straddle mechanism, five adolescents (aged <25), and five postmenopausal women. Two postmenopausal women were raped by young men. Straddle accident due to fall from bicycle was recorded in three, fall onto a metal object in two, and athletic injury by a foreign object, cow's horn, and kitchen knife in one patient each. Intracoital injuries, mostly rupture of the posterior fornix, were recorded in six patients. Revision and primary suture of the wound were performed in 16 patients, whereas 1 patient underwent laparotomy and revision of the vaginal stump due to intestinal prolapse after vaginal rupture. CONCLUSIONS: Besides primary operative management of the wound, the patient should receive broad-spectrum antibiotic and antitetanic prophylaxis in cases of accidental and penetrating injuries (foreign object, cow's horn, kitchen knife). In case of suspect mechanism of infliction, VVI in a child require careful inspection because of the potential forensic implications (rape, abuse).

Accidents↗
PubMed2006

Iliofemoral-popliteal phlebothrombosis in twin pregnancy treated with cesarean section and thrombectomy in the same act: a case report.

A case is presented of a 39-year-old primigravida who developed iliofemoral-popliteal thrombosis in the 34th week of twin pregnancy. Thrombectomy by use of a Fogarty catheter with previous protection from thrombus embolization by proximal placement of temporary occlusion was performed at the same time as the cesarean section for completion of premature delivery.

Adult↗
PubMed2006

Oncotic therapy in management of preeclampsia.

BACKGROUND: We undertook this study to examine the effects of oncotic therapy for preeclampsia (PE). METHODS: The study included 29 pregnant women with PE and 14 pregnant women with PE and intrauterine growth retardation (IUGR) and hematocrit (Htc) concentration >0.38. All study women received regular antihypertensive therapy and oncotic therapy (dextran 40 or hydroxyethyl starch). The parameters of Htc, uric acid, fibrinogen and platelet count, sonography RI (resistance index) of uterine artery, umbilical artery, middle cerebral artery and fetal biophysical profile were monitored before and after oncotic therapy. Perinatal outcome assessment was based on 5-min Apgar score, umbilical pH, need of neonatal intensive care unit (NICU) treatment, and birth weight. RESULTS: Statistically significant improvement of hemorheological parameters upon the introduction of oncotic therapy was recorded in the values of Htc, fibrinogen and diastolic blood pressure, whereas other parameters (uric acid, platelet count, uterine arterial RI on the side of placentation, and systolic blood pressure) showed a decrease that did not reach statistical significance. Upon the introduction of oncotic therapy, favorable changes in perinatal Doppler ultrasonography parameters were recorded in uterine arterial RI but not in middle cerebral artery RI. There was no statistically significant change in the fetal biophysical profile (FBP) values either. Perinatal outcome was favorable with a mean 5-min Apgar score 8 and pH 7.26. Lower birth weight values (mean 2631 +/- 407 g) were consequential to preterm delivery and IUGR, resulting in a number of neonates requiring NICU treatment. CONCLUSIONS: Careful oncotic treatment with antihypertensive therapy improves the maternal hemorheological parameters and uteroplacental sonographic parameters.

Adult↗
PubMed2006

Giant paraovarian myxoma.

We present an extremely rare case of a successfully operated giant (6700 g) paraovarian myxoma and uterus myomatosus in a 49-year-old woman. Preoperative examination (biochemical investigations, ultrasound and computed tomography scan) and perioperative findings did not identify a malignant tumor so that total abdominal hysterectomy/bilateral salpingo-oophorectomy and tumorectomy was chosen to treat the patient. Histologically, the tumor was clearly differentiated from the surrounding tissue. In solid regions there were spindle-shaped cells arranged in sheaves and within the profuse, well-vascularized myxomatous stroma there were star-shaped cells. Immunohistochemical analysis showed that tumor cells were positive to vimentin and smooth muscle actin. Electron microscopic analysis showed that tumor cells had ultrastructural characteristics that corresponded to cells in fibroma and thecoma in a profuse intercellular matrix, which confirmed the result of light microscopy.

Fallopian Tubes↗
PubMed2006

3D-ultrasound detection of fetal grasping of the umbilical cord and fetal outcome.

A case of persistent fetal palmar grasping of the umbilical cord in a 23-year-old primigravida is described. Palmar grasping was detected with three-dimensional ultrasound examination after cardiotocographically recorded fetal bradyarrhythmia. Because of acute fetal hypoxia, urgent Misgav-Ladach cesarean section was performed to deliver a hypotrophic female newborn, 2,120 g/43 cm, Apgar score 4/7, pH 7.29. No other pathology was found during the procedure. The postoperative course proceeded uneventfully and the early neonatal neurological status and neurosonographic findings were normal.

Adult↗
PubMed2006

Successful term pregnancy after B-Lynch compression suture in a previous pregnancy on account of massive primary postpartum hemorrhage.

A case is presented of a successful term pregnancy in a 28-year-old secundipara after previous Misgav-Ladach cesarean section and B-Lynch compression suture on account of massive postpartal hemorrhage caused by uterine atony. On account of dystocia and relative cephalopelvic disproportion, secondary repeated cesarean section was performed; she gave birth to a live child 3,900 g/52 cm, Apgar score 9/10, with a regular neonatal course. During the repeated cesarean section, thin laces of connective tissue were found along the sutures placed on the uterus during the previous B-Lynch operation. Pelvic and intrauterine adhesions were not found.

Adult↗
PubMed2006

Infective puerperal endocarditis caused by Escherichia coli.

Presentation is made of a rare case of infective puerperal endocarditis involving the native mitral valve in a young puerpera after cesarean section, without a history of pre-existing heart disease, inflammation focus or intravenous drug abuse.

Adolescent↗
PubMed2006

Intact radial and median nerve after open third degree distal fracture of the humerus.

A 54 year old man sustained a third degree open fracture at the distal part of the right humerus with massive soft tissue defect involving most of the upper arm. The radial and median nerves were completely bared and exposed by 6 cm for radial and 3 cm for median nerve. The nerves were in continuity, but there was complete rupture of surrounding muscles: biceps, triceps and brachialis. The fracture was stabilized by external fixation method--reinforced by wires. Preoperative and postoperative sensorimotor status of the right hand was good. One year later sensory and motoric status of right hand showed no deficiencies, but flexion and extension in elbow were limited to 100 and 180 degrees respectively. Pronosupination was restricted. This case report is consistent with results of biomechanical studies in vitro confirming high tolerance of radial and median nerve to stretching injury.

Biomechanical Phenomena↗
PubMed2006

[Syndrome of acute abdomen in gynaecology and obstetrics].

The syndrome of acute abdomen in gynecology and obstetrics can develop due to inflammatory, ischemic-obstructive and hemorrhagic intra-abdominal etiology as a complication of primary disease, pathologic processes on some organs or injuries (genital, gastrointestinal, urinary, vascular, neurologic and musculoskeletal systems). Clinical and ultrasound examination, x-ray diagnosis, laparoscopy (in early pregnancy) and laboratory findings are the basic diagnostic methods to evaluate etiology of acute abdomen syndrome in gynecology and obstetrics. Rare cases with atypical clinical pictures and etiology of acute abdomen syndrome in gynecologic and obstetric casuistic are described.

Abdomen, Acute↗
PubMed2005

Successful of the B-Lynch compression suture in the management of massive postpartum hemorrhage: case reports and review.

The authors describe three patients who developed massive primary postpartum hemorrhage and review the case reports. In two patients, primary postpartum hemorrhage was due to uterine atony, and in one patient it was due to atony and thrombophilia. In all three patients, excellent effect was achieved with hemorrhage reduction by a compression B-Lynch suture alone, with bimanual compression following medicamentous uterotonic therapy. B-Lynch suture is an efficient, safe, and simple method for the treatment of primary postpartum hemorrhage during cesarean section, which successfully reduces the number of urgent postpartum hysterectomies, also preserving subsequent fertility. In our opinion, the method should be included in the algorithm of primary postpartum hemorrhage management at all obstetric departments.

Adult↗
PubMed2004

Fetal biophysical profile and cerebro-umbilical ratio in assessment of brain damage in growth restricted fetuses.

OBJECTIVE: To examine the relationship between fetal biophysical profile (FBP), Doppler cerebro-umbilical (C/U) ratio and neonatal neurosonography in growth restricted newborns. STUDY DESIGN: This prospective study included 87 growth restricted fetuses from 28 to 42 weeks of gestation. The FBP and C/U ratio were assessed twice a week. Within 48h and on the seventh day after birth, neonatal neurosonography was performed as the outcome parameter. RESULTS: Brain damage was detected, by neurosonography, in 34 newborns with intrauterine growth restriction (IUGR). Severe periventricular echodensities (PVE) were ultrasonographically verified in eleven infants. Intraventricular or intraparenchymal hemorrhage (severe intracranial hemorrhage ICH) was detected in seven infants, and subependymal hemorrhage (SEH) in nine infants with IUGR. Porencephalic cysts, as a result of chronic intrauterine hypoxia, were found in four infants, and brain atrophy was detected in one case. Nonspecific ultrasonographic changes were observed in two newborns. The FBP and C/U ratio were statistically significantly associated with neurosonographicaly verified neonatal brain lesions (P < 0.001). CONCLUSIONS: The FBP and the C/U ratio represent the useful indicators for early detection and assessment of fetal hypoxia. They may also be parameters for the prediction of neonatal neurosonography findings in newborns with IUGR.

Blood Flow Velocity↗
PubMed2003

Acute abdomen as first symptom of acute leukemia.

CASE REPORT: The authors presented a rare case of acute abdomen syndrome caused by the rupture of the corpus rubrum as the first symptom in a 35-years-old woman with the acute lymphatic leukemia. During the laparotomy is notice diffuse bleeding from under skin blood vessels and muscles. The blood was electrocoagulated and was sewn with catgut sutures. The right ruptured corpus rubrum was found from which fresh blood was leaking. The right ovary was carefully resected and sutured, and each ligature was bleeding. At the beginning of the surgery laboratory analysis results arrived which showed a high leukocytosis (28.0 x 10(9)/l) with sever thrombocytopenia (10 x 10(9)/l) and afibrinogenemia (0.1 g/l) with anemia (1.9 x 10(12)/l erythrocyte, haematocrit 0.24), which indicated leukemia with disseminated intravascular coagulopathy (antithrombin III levels 0.9 g/l, D-dimers 1989 micro g/l). RESULT. A year later she died with the picture of severe disseminated intravascular coagulopathy, agranulocytosis and septic condition with multiorganic failure.

Abdomen, Acute↗