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Dubravko Habek

Publications and source records attributed to Dubravko Habek.

31 records · Page 2Linked to original sources
PubMed2003

Ruptured ovarian granulosa cell tumors as a cause of the acute abdomen.

A rare case of acute abdomen syndrome due to a ruptured ovarian tumor and a penetrated fallopian tube is described. Based on the intraoperative finding and patient's age, a right-sided salpingo-oophorectomy, appendectomy and peritoneal washings were performed. After a histological diagnosis of malignant granulosa cell tumors and FIGO IIA clinical classification, the patient returned 1 month after the procedure. A relaparotomy with a hysterectomy, left-sided salpingo-oophorectomy and omentectomy were then performed. No spread was found during the laparotomy, and the histologic diagnosis pointed to adenomyosis and chronic cervicitis. The patient regularly presents for control examination, and has now been free for 11 years since the surgery from clinical, biochemical or ultrasonographic signs of a relapse of the disease.

Abdomen, Acute↗
PubMed2003

Efficacy of Acupuncture for the Treatment of Primary Dysmenorrhea.

OBJECTIVE: The aim of this study was to evaluate the effect of acupuncture (AP) in the treatment of primary dysmenorrhea (PD). METHODS: A clinical prospective, placebo-controlled trial included 57 women with PD. Of these, 30 were treated with manual AP points: Du 20 (Baihui), bilateral Li 4 (Hegu), Ren 3 (Zhongji), Ren 4 (Guanyuan), Ren 6 (Qihai), bilateral Gb 34 (Yanglingquan), bilateral Ub 23 (Shenshu), bilateral Lp 6 (Sanyinjao) and auriculoacupuncture points (Shenmen); 27 women were treated with placebo AP. AP treatments were considered successful if PD did not occur any more, medication of PD became unnecessary or PD symptoms did not occur for 2 years after the AP treatment. RESULTS: The occurrence of PD in nulliparae was statistically relevant (p < 0.001). Statistically relevant was also the decrease in medication in women to whom AP had been applied (p < 0.0001), which was not the case in the placebo group (p > 0.5). CONCLUSIONS: The success rate of AP for the treatment of PD symptoms within 1 year after the AP treatment is 93.3% in the first group and 3.7% in the placebo group.

Acupuncture Therapy↗
PubMed2002

Fetal grasping of the umbilical cord and perinatal outcome.

This study assessed perinatal outcome in pregnancies with accidentally diagnosed fetal grasping of the umbilical cord (FGUC) on ultrasonography (US) in late gestation as a possible cause of fetal hypoxia due to mechanical occlusion of umbilical circulation. In this retrospective clinical study, routine antenatal US examination revealed FGUC from 32 to 41 weeks of gestation in seven normal single pregnancies. Upon FGUC findings, fetal condition was followed up every second day by repeat US findings of FGUC, and then by Doppler parameters of fetoplacental circulation measurement of resistance index in umbilical artery (URI) and middle cerebral artery (CRI), and cardiotocography (CTG), and perinatal outcome (peripartal cardiotocography, 5-min Apgar score, umbilical arterial blood pH, occurrence of meconium amniotic fluid, need of additional treatment at neonatal intensive care unit (NICU), and mode of pregnancy termination (cesarean section, forceps or vacuum extraction-VE for hypoxia). After delivery, neonatal neurosonography and neonatal complications related to pregnancy or birth were evaluated. All URI values were increased, resulting from persistent FGUC and elevated umbilical arterial RI. CRI showed great oscillations in the values for gestational age and decreased CRI. In two cases, cerebral/umbilical ratio was less than 1, indicating initial vasocentralization as a fetal compensatory mechanism for hypoxia. In these cases, a pathological peripartal CTG and pH 7.23, indicative of preacidosis, were verified. All children were discharged from NICU as healthy, free from neurological lesions, with the exception of the latter, who had dystonia syndrome and mild motor deficit as a sign of peripartal hypoxia. Although it probably belongs to normal reflexes, intermittent FGUC should be US controlled. Persistent FGUC should be considered pathological for its possible hypoxic effect and umbilical circulation obstruction. These pregnant women should be hospitalized and closely monitored, as in part confirmed by the present study.

Adult↗
PubMed2002

Unrecognized cervical pregnancy treated by suction curettage and cervicovaginal tamponade.

The authors presented a case of a 30-year tertigravidar women with unrecognized cervical pregnancy, treated by suction curettage and cervicovaginal tamponade. In our case of unrecognized cervical pregnancy, during hysterometry and cervical dilatation occured uterine bleeding and clinical pictures of obstetrics hemorrhagic shock, so we continued with suction curettage and cervicovaginal tamponade as a urgent procedure which turned out as a final. Medicamentous chemotherapy of the cervical pregnancy (methotrexat) was not used, because after described procedure beta-HCG lytic decreased and without colour-Doppler visualization of local cervical trophoblastic vascularisation.

Adult↗
PubMed2002

Fetal shoulder dystocia.

Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%. An increase in the incidence of shoulder dystocia has been recorded over the last 20 years, probably just because it has now been regularly registered at maternity wards as an obstetric complication. The risk factors for shoulder dystocia include fetal macrosomia, fetal malformations and tumors, maternal adiposity, excessive weight gain during pregnancy, diabetes mellitus, pathologic pelvis, multiparity, short maternal stature, advanced maternal age, postterm pregnancy, so-called midforceps delivery or vacuum extraction, prolonged delivery stage II, oxytocin labor induction, premature fetal expression according to Kristeller, and previous shoulder dystocia in macrosomatic children. The sequels of shoulder dystocia and obstetric maneuvers for incarcerated shoulder release include clavicular fracture, brachial plexus lesions, sternocleidomastoid muscle distension with or without hematoma, diaphragmatic paralysis, Horner's syndrome, peripartal asphyxia and consequential cerebral lesions (cerebral palsy), and peripartal death. Maternal complications due to shoulder dystocia are postpartal hemorrhage, cervical and vaginal lacerations, frequent infections during the puerperium, symphysiolysis and rupture of the uterus, and secondary cesarean section with related complications due to unsuccessful obstetric procedures or as continuation of Zavanelli's maneuver. McRoberts' maneuver (or Gaskin maneuver) is recommended as the initial procedure for shoulder release in case of shoulder dystocia. If it fails, other obstetric procedures such as Resnik's suprapubic pressure and Woods' grip with posteriorly placed arm release should be used, always with gross lateral episiotomy. The performance of all these obstetric procedures requires skilfull and highly experienced obstetrician and obstetric team as a whole.

Delivery, Obstetric↗
PubMed2002

[New findings in acupuncture therapy].

Acupuncture is an ancient method of healing coming from the Chinese traditional medicine. In Western medical science it is accepted and proven method of healing based on neurophysiological, neurobiochemical and neuroendocrinological research. Acupuncture as a method of healing has been accepted also by the World Health Organisation with strongly defined indications and contraindications. Indications for acupuncture included: acute and chronic pain syndrome, allergic disorders, addiction, psychosomatic and psychosexual illness and acupuncture analgesia/anaesthesia. It is very important that there are no harms of acupuncture treatment, although mild side effects are possible. Acupuncture is based on characteristics of meridian points, afferent nerve information evoked by acupuncture stimulation, inhibitory mechanisms in the central nervous system, endogenous antinociceptive substances concerned with acupuncture analgesia and descending mechanisms of antinociceptive control.

Acupuncture Therapy↗
PubMed2002

[Intrauterine hypoxia and sudden infant death syndrome].

Sudden infant death syndrome (SIDS) or crib or cot death are synonyms for the sudden, unexpected and unexplained death of an infant. The incidence of SIDS has been estimated to be from 1-2% to 3%. Protracted intrauterine hypoxia or recurrent hypoxic insults during fetal life undoubtedly influence the development of the central nervous structures as a tissue most susceptible to hypoxia, although well developed mechanisms of defense against hypoxia exist during the fetal life. The mechanisms underlying SIDS include neurologically compromised infants who are deprived of compensatory mechanisms during sleep, sustaining a hypoxic insult with alterations in neurotransmitter receptors within the regions involved in chemoreception and cardiovascular control. Changes in the brain result from perinatal prolonged hypoxia (persistent reticular pathways in the pons and medulla, astroglia in the brainstem, gliosis of brain nerve nuclei, defects in neurotransmitter receptors, neuronal apoptosis, microthrombosis, and hypoxic ischemic lesion). Hypoxic perinatal risk factors for SIDS included passive and active exposure to cigarette smoking in pregnancy, abuse of drugs, alcohol, coffee and medication in pregnancy, intrauterine growth retardation, perinatal hypoxia with or without resuscitation, preeclampsia, anemia in pregnancy, prematurity, multiparity, multiple pregnancy, pregnant women aged < 20 years and > 35 years, cardiocirculatory, pulmonary and endocrine diseases in pregnancy, and short time interval between two pregnancies. As cigarette smoking has been demonstrated to lead to fetoplacental insufficiency, which result in fetal hypoxia, it is concluded that hypoxia is a precondition for the occurrence of SIDS. Prenatal exposure to cigarette smoke decreases maternal red blood cell count, and concentrations of tyrosine and selenium, reduces fetal and neonatal cerebral blood flow, and increases maternal MCV, leukocytosis, especially neutrophils, monocytes and lymphocytes, maternal and fetal heart rate, systolic and diastolic blood pressure, resistance index in umbilical artery, fetal hemoglobin, cytokine, serotonine, dopamine, catecholamine, hypoxanthine, endorphin and interleukin-6. Pregnancy at a risk of hypoxia, especially in heavy smokers, is a major risk factor for SIDS, and such pregnancy requires close and intensive antenatal monitoring.

Female↗
PubMedDate not supplied

Fetal tobacco syndrome and perinatal outcome.

OBJECTIVE: The aim of this study was to evaluate perinatal outcome in newborns of mothers who are smokers. METHODS: The study included 87 pregnant women with a single pregnancy in the cephalic position, 64 of them nonsmokers (group 1), 13 who smoked 5-20 cigarettes per day (group 2) and 10 who smoked more than 20 cigarettes per day (group 3). Maternal demographic variables and laboratory hemoglobin concentration, hematocrit and erythrocyte count in the last trimester were recorded. Perinatal outcome included type of delivery (vaginal or cesarean section), birth weight, occurrence of meconium in the amniotic fluid, 5-min Apgar score, umbilical arterial blood pH postpartum, sex of the newborn, need for treatment at a neonatal intensive care unit (NICU) and clinically and neurosonographically verified postpartum neurologic complications in the newborn. RESULTS: A statistically significant correlation (p < 0.01) was found with the mean gestational age at delivery in all three groups of women, especially in those smoking >20 cigarettes per day, who had a higher incidence of premature deliveries. Maternal laboratory findings also differed significantly among the three groups of women, i.e. erythrocyte count (p < 0.01), hemoglobin concentration (p < 0.01) and hematocrit (p < 0.001). The rate of delivery by cesarean section was significantly higher in the groups of smokers, irrespective of the number of cigarettes per day (groups 2 and 3). Birth weight was lower by about 250 and 350 g (p < 0.001) in groups 2 and 3, respectively. Five-minute Apgar score and umbilical arterial blood pH were lower in group 3 as compared with groups 1 and 2 (p < 0.01). NICU treatment was required in more than 50% of infants born to group 3 mothers, in whom 70% of perinatal neurologic complications such as subependymal hemorrhage, periventricular hemorrhage, porencephalic cysts, intracranial hemorrhage and swallowing disturbance of the newborn were recorded (p < 0.001). The infants born to group 3 mothers had a longer and more difficult period of adaptation, thus often requiring an NICU stay. CONCLUSION: Our study confirmed that pregnancy burdened with smoking, especially in the case of >20 cigarettes a day, is associated with a high risk due to the development of maternal anemia and fetal hypoxia and polyglobulia, which in turn result in a significantly poorer perinatal outcome in infants born to smoking mothers and compromised subsequent development of the child, as evidenced by the morphological substrates on the brain resulting from the fetal mechanism of defense against hypoxia. Clinically, there was no other (etiologic) reason for (chronic) fetal hypoxia; thus, the clinical substrate of fetal tobacco syndrome could be presumed to have developed consequentially to chronic smoking during pregnancy, as a preuterine factor of fetal hypoxia. Other gestational or gestation-related diseases (e.g., gestosis, diabetes) that may potentially cause nutritional and respiratory insufficiency of the placenta were ruled out.

Adult↗
PubMedDate not supplied

Fetal biophysical profile and cerebro-umbilical ratio in assessment of perinatal outcome in growth-restricted fetuses.

AIM: To examine the value of the fetal biophysical profile (FBP) and the Doppler cerebro-umbilical ratio (C/U) in the assessment of perinatal outcome in growth-restricted and hypoxic fetuses. STUDY DESIGN: The prospective clinical study included 87 pregnant women with singleton pregnancies at 28-42 weeks of gestation with clinically verified intrauterine growth restriction (IUGR). After assessment of FBP, flow velocity waveforms from the umbilical and middle cerebral arteries were recorded and the C/U ratio was calculated. The C/U ratio and FBP were assessed twice a week. At delivery, umbilical arterial pH, the occurrence of meconium-stained amniotic fluid (MAF), Apgar score at 5 min and the incidence of cesarean sections were used as outcome parameters. RESULTS: The mean FBP value was 5.5 +/- 0.96 in cases with MAF, and 6.88 +/- 0.26 in cases without MAF. Also, there was no statistical significance in the relation between the C/U ratio and the appearance of MAF. At pH >7.2, the mean FBP value was 7.11 +/- 0.23, while it was 2.83 +/- 0.79 in newborns with acidosis. Both FBP and C/U values were statistically correlated with pH (p < 0.01). The mean umbilical arterial pH was 7.31 +/- 0.0 at a C/U ratio of >/=1 and 7.21 +/- 0.03 at a C/U ratio of <1. In cases with Apgar scores of 8-10, the mean FBP value was 7.28 +/- 0.23, at Apgar scores of 5-7 it was 3.9 +/- 0.52, while at Apgar scores of 0-4 the mean FBP value was 1.5 +/- 0.5. The mean Apgar score at 5 min was 9.54 +/- 0.09 at a C/U ratio of >/=1, and 8.12 +/- 0.49 at a C/U ratio of <1. The mean FBP value in cases of vaginal delivery was 7.55 +/- 0.31. In cesarean section deliveries, the mean FBP value was 5.97 +/- 0.37. Also, there was a high frequency of cesarean sections in growth-restricted fetuses with a C/U ratio of <1 (p < 0.05), i.e. slightly less than FBP. CONCLUSIONS: FBP and C/U ratio were associated with low arterial pH, low Apgar score and the rate of cesarean sections (p < 0.05), but there was no association between FBP or C/U ratio and the appearance of MAF (p > 0.5). Due to their good predictive value the FBP and C/U ratio could be used in the prenatal monitoring of growth-retarded and hypoxic fetuses. These two methods can be used as important parameters in the decision to end pregnancies with IUGR, when pathological values occur. Thus a reduction in perinatal morbidity, mortality and the incidence of infants with poor neurologic outcome can be expected.

Biophysical Phenomena↗
PubMedDate not supplied

Acupuncture conversion of fetal breech presentation.

AIM: The aim of this study was to assess the value of acupuncture (AP) in the conversion of fetal breech presentation into vertex presentation. PATIENTS AND METHODS: A randomized prospective controlled clinical study included 67 pregnant women with fetal breech presentation: 34 women with singleton pregnancies treated with manual AP (urinary bladder 67, Zhiyin) and a control group which included 33 women with singleton pregnancies without AP treatment. The AP treatment lasted 30 min a day, and was conducted during and after 34 weeks of pregnancy with simultaneous cardiotocography. RESULTS: The success rate of the AP correction of fetal breech presentation is 76.4% (26 women), and spontaneous conversion without AP in vertex presentation is observed in 15 women (45.4%; p<0.001). CONCLUSIONS: We believe that AP correction of fetal malpresentation is a relatively simple, efficacious and inexpensive method associated with a lower percentage of operatively completed deliveries, which definitely reflects in improved parameters of vital and perinatal statistics.

Acupuncture Therapy↗
PubMedDate not supplied

Sudden death because of massive pulmonary thromboembolism and concomitant cerebrovascular trophoblastic embolism following artificial abortion.

A rare case of sudden death due to cerebral embolization of trophoblastic tissue and concomitant massive pulmonary embolization following artificial abortion in a 42-year-old woman with poorly regulated hypertension and chronic smoking is described. Histopathological analysis showed syncytiotrophoblast cells, positive on hPL immunostaining, obstructing vascular lumina in the small perforating arteries irrigating the diencephalon. There was no trophoblast invasion of capillary walls. Severe perivascular edema and lymphocytic infiltration were observed. No trophoblastic cells were found in the pulmonary circulation.

Abortion, Induced↗
PubMedDate not supplied

[Complementary obstetrical delivery methods].

Complementary methods in obstetrics are related to humanization of delivery and woman's decision on the mode of delivery in normal labor. The methods include various birthing positions, aids such as delivery chair, birthing wheel, etc., and water delivery. Results of recent studies comparing these methods with classic delivery in supine position are presented. The advantages of these alternative methods of delivery include shorter duration of delivery, reduced need of labor induction, lower use of analgesics, and women's acceptance of these methods of delivery with the same level of maternal and neonatal safety as in classic delivery. All these advantages apply to water delivery providing the prerequisities, contraindications and measures of surveillance are strictly met.

Delivery, Obstetric↗