Biomedical subjects
Publications and source records attributed to P Draca.
The antibodies against herpes virus were detected in 34 out of 60 (55%) patients with gynecological malignancies. Immunofluorescence revealed herpes virus antigens in 40 (66.7%) malignant tissues. EBV was not detected in either sera or tissue samples. Adenovirus was evidenced in sera and tissues of one case of endometrial cancer.
In the period of 1960-1987 at the Clinic for Gynecology and Obstetrics in Novi Sad 30,398 extensive abdominal and vaginal operations were carried out. In the same lapse of time 59 female patients in their childhood or adolescence were operated on due to an ovarian gland tumor. There were 5 female patients up to the age of 14, and 54 female patients from 14-18 years of age. There were 4 malignant tumors: 2 in childhood age, and 2 in adolescence, and 55 benign ones. By presenting the severeness of the diagnosis (the rarity of the tumor) and the complete treatment strategy, the authors state the principals which should be observed with operations on the genitals of children and adolescents: operation is the method of choice; these cases should be operated on in great medical centers; "ex tempore" biopsy is necessary. The extent of the operative procedure presents a delicate problem, because great care should be taken about the endocrine function of the ovary, the somatic development, menstrual and reproductive function, potential malignancy, and possible relapse, so the authors speak in favor of relaparotomy and radicalization of the first procedure rather than in favor of a great radicalization in the first act. Depending on the nature of the tumor, postoperative irradiation or chemotherapy is recommended. In prevention, regarding early diagnosis, the opening of school dispensaries for childhood and adolescent gynecology is recommended, as well as vaginoscopic examination and the interdisciplinary work of the gynecologist, the surgeon for children and the pediatrician.
Out of 534 inquired and examined women 151 (28.2%) of them had urinary stress incontinence and 383 (71.7%) women were continent. Of 151 incontinent women 75 (49.6%) of them repeatedly developed the inflammation of the urinary bladder and of 383 continent women data on chronic cystitis were registered in 74 (19.3%). These data pointed to the fact that the previous repeated inflammation of the urinary bladder and then the appearance of urinary stress incontinence could be regarded as one of etiologic factors in the occurrence of urinary stress incontinence.
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Polychemotherapy has proved to be a method of choice in the management of the ovarian cancer. The second-look operation helps exact estimation of the patient's conditions after chemotherapy. Our experience shows that chemotherapy improves the mobility of the malignant neoplasm. As yet we have not decided on the optimal time of reoperation of the residual tumours. For now, we have been performing it after 3-4 trials of the intermittent polychemotherapy. The dilemma has still remained when to stop the treatment of polychemotherapy after positive second-look operation and whether to apply the third-look approach. Our experience suggests that non-differentiated malignant tumours require more aggressive chemotherapy while compared with the differentiated tumours of the same stage.
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There were 1365 vaginal hysterectomies performed at the Department of Obstetrics and Gynaecology at Novi Sad. Morcellation was applied in 162 (11.9%) patients. It was most often applied in the group of patients from 40 to 49 years of age and in the sixth decade of life (27.2%; 44 cases). Uterine size was the basic indication for morcellation, but some other factors were of importance as well, such as: moveability, descensus, adhesions, fibroma location, depth and width of the vagina. The largest uterus in our study was 700 g in weight, while in most cases the uterus weighed approx. 250 g. There were no other complications during morcellation application. Postoperative morbidity was 24.7% and it followed the usual morbidity rate in V.H. Inflammations were the most frequent complications.
Author report on a case of air embolism in delivery in a multigravida. Delivery was completed by an application of vacuum extractor. The parturient lost small amount of blood during delivery. Soon after delivery the patient complained about numbness in her arm and a headache. She turned pale, got disturbed and broke out in a cold sweat. Blood pressure was unmeasurable; peripheral pulse could not be felt. Immediately reanimation measures were performed. The condition of the patient got worse after a short time of improvement. For the reason of doubt about intra-abdominal hemorrhage, laparotomy was performed and finally abdominal hysterectomy was done. Incomplete rupture of the uterus was registered during the operation. The patient died during the operation. Vein air embolism was diagnosed only during the autopsy, and most probably it was a result of air aspiration through the split uterine veins.
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The analysis comprised 240 uterine carcinomas: 145 carcinomas of the cervix and 95 carcinomas of the corpus uteri. Preoperatively 100 patients--57 with the carcinoma of the cervix and 43 with the carcinoma of the uterine body--were radiated with Co60 intracavitary. In the first stage of the carcinoma of the cervix a five-year survival in primarily operated patients amounted to 74.30% and in the group of preoperatively intracavitary radiated patients to 83%. In patients with the stage I carcinoma of the corpus uteri a five-year survival proved to be 69.57% if primarily operated and 93.75% if preoperatively radiated. Local relapses were recorded in 33 patients surgically treated for carcinoma of the uterine cervix and in 9 patients surgically treated for the carcinoma of the uterine body. In both these localizations the relapses were more frequent in the group primarily operated patients: in patients with the primarily operated carcinoma of the cervix the relapses occurred in 20.69% and in preoperatively radiated patients in 3.4% of cases. The same observations were recorded in the carcinoma of the corpus uteri (11.51% : 6.97%). This means that the relapses were six times as frequent in patients with the primarily operated carcinoma of the uterine cervix and about 1.65 times as frequent in those with the primarily operated carcinoma of the corpus uteri as in intracavitary radiated patients.
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