Abstract Background We compared the accuracy of preoperative transvaginal ultrasound (TVUS) versus magnetic resonance imaging (MRI) for the assessment of myometrial invasion (MI) in patients with endometrial cancer (EC), while definitive histopathological diagnosis served as a reference method. Patients and methods Study performed at a single tertiary centre from 2019 to 2021, included women with a histopathological proven EC, hospitalized for scheduled surgery. TVUS and MRI were performed prior to surgical staging for assessment MI, which was estimated using two objective TVUS methods (Gordon’s and Karlsson’s) and MRI. Patients were divided into two groups, after surgery and histopathological assessment of MI: superficial (≤ 50%) and deep (> 50%). Results Sixty patients were eligible for the study. According to the reference method, there were 34 (56.7%) cases in the study with MI < 50%, and 26 (43.3%) with MI > 50%. Both objective TVUS methods and MRI showed no statistical significant differences in overall diagnostic performance for the preoperative assessment of MI. The concordance coefficient between both TVUS methods, MRI and histopathology was statistically significant (p < 0.001). Gordon’s method calculating MI reached a positive predictive value (PPV) of 83%, negative predictive value (NPV) of 83%, 77% sensitivity, 88% specificity, and 83% overall accuracy. Karlsson’s method reached PPV of 82%, NPV of 79%, 69% sensitivity, 88% specificity, and 80% overall accuracy. Accordingly, MRI calculating MI reached PPV of 83%, NPV of 97%, 97% sensitivity, 85% specificity, and 90% overall accuracy. Conclusions We found that objective TVUS assessment of myometrial invasion was performed with a diagnostic accuracy comparable to that of MRI in women with endometrial cancer.

Aim To compare maternal, foetal and neonatal characteristics, and perinatal outcome of preterm and term deliveries in twins pregnancies in order to improve perinatal care in Bosnia and Herzegovina. Methods This retrospective cohort study included pregnant women with twin pregnancy who delivered during the period between 1 January 2012 and 31 December 2018 at the Clinic for Gynaecology and Obstetrics, University Clinical Centre Tuzla. Results During the seven-year period 26 734 deliveries were recorded, out of which 362 (1.35 %) were twin pregnancies, 226 (62.4%) preterm and 136 (37.5%) term ones. In the preterm group 38 (16.8%) pregnancies were assisted medical reproduction, and 16 (11.7%) of those were in the term group. The average birth weight was significantly higher for the first twin in both groups (p<0.00001). Incipient intrauterine foetal asphyxia was more frequent in the preterm group (p<0.05). The most common indication for Caesarean section was abnormalities of foetal presentation and lie, 176 (68.2%) for the overall sample. Conclusion Cornerstone of twin pregnancy antenatal care is to get correct data about amnionicity and chorionicity. Since majority of prenatal data did not have this information we call all obstetricians to declare about amnionicity and chorionicity in twin pregnancies during the first trimester ultrasound examination.

Aim To investigate clinical and obstetrical characteristics, an outcome and a prognosis for pregnant women with diagnosed and treated genital or extragenital cancer and their newborns. Methods This retrospective cohort study included pregnant and childbearing women with a history of cancer diagnosed before pregnancy during the period between 1 January 2014 and 31 December 2018. Data related to the course of pregnancy and childbirth were collected from medical records (mothers' disease history and partogram). The analysis covered clinical and histopathological characteristics of cancers, type of the treatment (surgery, chemotherapy, radiotherapy), demographic data, obstetric characteristics, comorbidities of women, and outcome of the newborns. Results The study recorded 18 414 deliveries, of which 30 (0.16%) were pregnancies in women who had been diagnosed and treated earlier for genital or extragenital cancer. The average age of the women at the time of delivery was 29.43±5.97 years. There were six (20%) women with genital and 24 (80%) with extragenital cancer. The most frequent extra genital cancer was Hodgkin lymphoma, in eight (26.6%) cases; ovarian cancer was the most frequent genital cancer, in four (13.3%) cases. The average time span from the cancer diagnosis and start of the treatment to the delivery was 59.2±44.4 months (5 years) (range 12 months - 15 years). Two (6.6%) women died. Conclusion Our data demonstrate a favourable obstetric and neonatal outcome for women who have survived cancer.

Abstract We present an overview of the case of a patient with early hysterorrhaphy dehiscence (uteroperitoneal fistula) with endomyometritis and post-cesarean section peritonitis and puerperal acute abdomen in a 35-year-old puerpera. A exploratory relaparotomy, necrectomy, and resuture of the dehiscent part of the hysterotomy were performed with placement of hemostatic sponges on the same portion of the uterus with good recovery.

Introduction/Background Malignant ovarian germ cell tumors (MOGCTs) account for 2–5% of all ovarian cancers and among them pure embryonal cell cancer is rare condition.1 2 3 4 Methodology Aim: To show successful pregnancy after unilateral salpingooopherectomy and chemotherapy in a girl with embryonal carcinoma of ovary (ECO). Results Case report: A 11 year old girl presented in January 2008. with pain in abdomen and abdominal wall hardness. CT revealed a 12 × 10 × 11 cm heterodense mass. Right sided salpingoophorectomy, omentectomy, biopsy left sided ovary was done. Histopathology examination and immunohistochemistry revealed embryonal cell cancer of ovary. Patient had FIGO stage III c disease. After the surgical removal of the tumour, the patient underwent six cycles of adjuvant chemotherapy with bleomycin, etoposide and cisplatin. Within eight year after the completion of chemotherapy she conceived spontaneously. At 39th gestational week, laparotomy as well as a C-section was done and the patient was managed successfully in giving birth to a healthy female baby (birth weight and lenth 3,430 gm/53 cm, Apgar score: 9/9). At the last follow-up visit (May 5, 2018), all the tumor markers were negative, and the control MRI and ultrasound examinations did not reveal tumor recurrence or pathological lymph nodes. Conclusion Fertility preservation surgery followed by chemotherapy may be considered as standard care of treatment in embryonal carcinoma of ovary in young girls, who want to retain fertility. Disclosure Nothing to disclose.

Introduction: There are many ethical and moral dilemmas regarding the termination of pregnancy(TOP) with severe fetal anomalies. Aim: Our aim is to present a case of severe fetal hydrocephalus (HCP), spina bifida aperta and, meningomyelocoella (MMC). Case report: A gynecologist examined a 23-year-old patient with vital pregnancy of 24/25 week of gestation (WG) with the anomaly of the fetus. At the Perinatological Medical Advisory Board, a decision was made that the pregnancy should be continued and monitored bearing in mind that pregnancy exceeded the legal framework for TOP. Medical Advisory Board’s ultrasound examination showed the following: severe hydrocephalus (HCP), spina bifida aperta, hyperehogen intestine, pes equinovarus. Via multidisciplinary consultation it was decided to make a delivery with the elective caesarian section (CS) causing as little trauma to the fetus as possible, with 37 WG completed due to the pelvic presentation and fetal anomalies. The patient gave birth via CS to a live female newborn–birth weight 3920 grams, birth length 56 cm, head circumference 48 cm, and Apgar score 8/8. The head was hydrocephalic with spaced suture. There was thoracolumbar defect of spina bifida aperta and meningomyelocele (MMC) 10x12 cm in size. An urgent surgical procedure - the external ventricular derivation of the liquor, and then the successful resection and plastic meningomyelocele was performed by a team of neuro and plastic surgeons. During the fourth postoperative day due to a suspicion of abscess collection and febrility of the mother a relaparotomy is performed and the abscess collection of Retzius space was found. Due to the fall in blood count, blood transfusion in a total dose of 580 ml was given. The patient was discharged on a home treatment as she had a regular general and local status. After the surgery, the condition of the newborn resulted in deterioration, the progression of HCP and dehiscence of head wounds and the thoracolumbar region, in spite of all the measures taken. At that time a decision was made to provide palliative care and this decision was conveyed to the mother. The child had a prolonged apnoeic episode and was not resuscitated. The child died in hospital after surviving for two months postpartum. Conclusion: Indication of TOP based on fetal anomalies could be a medical decision but also a personal moral choice of the mother related to legal rules, socio-cultural values and religious beliefs.

The aim of this research is to present that pregnant women with preeclampsia risk factor often give birth to infants with lower birth weight as well as infants who have lower Apgar score values. Material and methods: This prospective study included 240 pregnant women of different priority, aged 20 to 40, with one or more preeclampsia risk factors which are related to personal or family anamnesis and their infants. Results: Pregnant women with preeclampsia risk factors gave birth to infants with 19% chance of being hypotrophic, chance that infants might be hypotrophic is 3,16 (95%CI: 1,39-7,41) is bigger in this group of pregnant women. Giving birth to babies with lower birth weight is often with pregnant women who have more preeclampsia syndromes. Linear decline of Apgar score values has been evident with increased number of infants with lower birth weight, meaning more children with lower birth weight have lower Apgar score values at the 1st. minute of birth. Lower Apgar score values at birth is seen with infants from mothers who had more preeclampsia syndromes. Conclusion: Frequency of giving birth to infants with lower birth weight as well as giving birth to infants with lower Apgar score values is often with mothers who have preeclampsia risk factors.

Introduction: The method of carrying out PTB is one of the most controversial topics of modern perinatology, because there are no clear and undeniable works and studies that would in any case support vaginal delivery (VD) or delivery to the cesarean section (CS). Aim: To determine more frequent mode of delivery in different groups of birth weights and degrees of prematurity from single and twin pregnancies. To determine the degree of vitality of premature born vaginal delivery (VD) in relation to the cesarean section (CS) in different degrees of prematurity from single and twin pregnancies. Patients and methods: Research has retrospective cohort character. Data were collected from the databases of University Clinic of Gynecology and Obstetrics Tuzla for the period of five years (January 1st, 2012–December 31st, 2016). The study included newborns of both genders, gestational age from 24 to 37 weeks of gestation (WG) in singleton and twin pregnancies. Results: Out of 19506 births, 1350 (6.92%) were preterm birth (PTB). Singleton PTB was 1180 (87.40%), and the twins were 170 (12.59%). Vaginal delivery (VD) was born 788 (58.37%). Cesarean section (CS) was born 562 (41.63%). There was statistically significant association between the mode of delivery (MD) in singleton and twins pregnancy in all three subgroups of birth weight (BW) 1000-1499, 2000-2499 and >2500 grams in 33-37 WG. In this group was more frequent VD than CS mode of singleton delivery, and CS than VD mode of twins delivery. In contrast to newborn with BW 1500-1999 grams (chi-square = 23.16, P <0.0001) in same gestational period where was more frequent CS than VD (OR: 2.56, 95% CI: 1.71-3,85). Apgar score (AS) at first and five minute 5-7 and 8-10 in the period 28-32 and 33-37 was a statistically significant frequent in VD and singletons in contrast to CS and twins. Conclusion: VD was more frequent in the higher WG, as well as the higher AS in singletons in contrast to twins delivery.

Introduction: Malignant ovarian germ cell tumors (MOGCTs) account for 2-5% of all ovarian cancers and among them pure embryonal cell cancer is rare condition (1, 2, 3, 4). Aim: To show successful pregnancy after unilateral salpingooopherectomy and chemotherapy in a girl with embryonal carcinoma of ovary (ECO). Case report: Patient had FIGO stage III c disease. After the surgical removal of the tumour, the patient underwent six cycles of adjuvant chemotherapy with bleomycin, etoposide and cisplatin (BEP). Eight years after chemotherapy she conceived spontaneously. The patient went through regular antenatal checkups in a consultation with a gynecological oncologist. In addition to all regular examinations and controls, monthly monitoring of carbohydrate antigen (CA) 125, human epididymis protein 4 (HE 4), Roma Index is also recommended. Congenital malformation excluded at 20 weeks of gestation by level III ultrasonography. At 39th gestational week, laparotomy as well as a C-section was done and the patient was managed successfully in giving birth to a healthy female baby. Three months after delivery, the woman was recurrence free and the infant did not show any problems. At the last follow-up visit (May 5, 2018), all the tumor markers were negative, and the control MRI and ultrasound examinations did not reveal tumor recurrence or pathological lymph nodes. Conclusion Normal gonadal function and fertility are possible after fertility preservation surgery for ovarian germ cell malignancies, even with adjuvant chemotherapy.

Aim The aim of the paper is to present the risk of pregnancy for mother and her child in a young patient who had a surgery to repair Tetralogy of Fallot (ToF), who gave a birth to her firstborn by having a cesarean section. Case report 23 years old patient, in 28 weeks of pregnancy was admitted to the clinic due to her medical record. She did not have any subjective complaints. She had two surgeries to repair ToF. After the surgery, she had residual ventricular septal defect (VSD). She had her first surgery 20 years ago (she was 3 years old), and second 7 years ago (she was 16). She had regular check-ups since, and her heart condition was unchanged. Due to her heart surgeries and VSD, a cardiologist indicates that she should deliver by having a c-section when she is 36 weeks pregnant. The patient’s heart condition was stabilized and the patient was sent home. She was recommended to have her cardiologist check up on her as she leaves the hospital and to have a gynecological examination in 6 weeks. Conclusion It can be concluded that team work and prenatal care, in most cases, lead to delivery without complication, both for mother and fetus.

Stem cells are basic cells of the human body; it builds human body, but also participate in the regeneration of damaged tissues and organs. They are undifferentiated that can differentiate into various types of cells in an organism, which is very important in terms of therapeutic applications. They differ in embryonic and adult stem cells. Adult cells are divided into pluripotent and unipotent. Pluripotent cells are found in the blood and in the tissue of the umbilical cord. Stem cells taking process is performed immediately after birth, sampling blood and cord tissue. Today, stem cells are used to treat more than 80 different diseases. The number of possible treatments increases every day, and treatment of stem cell becomes a special branch of medicine.

(ProQuest: ... denotes non-US-ASCII text omitted.)...AbstractThe aim of this paper is to examine recidivists' and non-recidivists' differences in characteristics of the psychosocial functioning after a treatment in a Disciplinary Centre for Juveniles in Sarajevo Canton, the Federation of Bosnia and Herzegovina. The research was conducted on a sample of 131 juvenile delinquents adjudicated with the educational measure of referral to the juvenile disciplinary centre. The statistical analysis was performed in the SPSS 17.0 program package. The differences between recidivists and non-recidivists were measured using Mann-Whitney test on all variables. A group of four variables were compared by: (a) school factors, (b) family factors, (c) spare time activities and peer relationships and (d) personality and behaviour of juveniles. The results have shown that risk factors are more pronounced in recidivists in all four areas of the psychosocial functioning. The largest difference is in the areas related to spare time activities and peer-relationships, as well as family functioning. The results indicate that the intensified treatment should focus on these areas in order to prevent recidivism.Keywords: recidivism, educational measure, responsiveness factorsIntroductionEvery society had its youth whose behaviour deviated from the socially acceptable and as such it was condemned or sanctioned in one way or another. Juvenile delinquency is a dynamic category subjected to various changes in its scope, phenomenology and implemented interventions. In comparison to crime committed by adults, juvenile delinquency is specific in terms of the age category of offenders, motivation, type of offense and applicable interventions (1). Youth engaged crime represents a considerable problem for society and their families (2). It remains an unresolved question how to respond to the delinquent behaviour and with what methods, e.g. sanctions, while simultaneously ensuring that they take responsibility for their behaviour, since it is necessary to establish a balance between the retribution and rehabilitation elements each sanction has (3). Educational measures are now the largest and the most frequently pronounced type of criminal sanctions for juveniles, with the purpose of providing education, rehabilitation and a proper development of the juvenile (4). Amongst all education measures, a significant place is reserved for the educational measure of referral to the Disciplinary Centre due to its specificities in relation to its implementation and juveniles adjudicated with this measure. The purpose of the imposition of these measures is that, in a relatively short period of time, a powerful impact may be achieved in children via various strategies, in strictly structured conditions by means of direct methods focused on behavioural modifications, development of a personal responsibility and prevention of future criminal acts (4). The efficiency of a treatment method may be assessed by measuring the number of juveniles who come again into conflict with the law (recidivism) or via other different indicators of progress in social functioning (5). Considering the consensus in general literature that adult criminals begin their criminal careers in their juvenile years suggesting that, in order to fight adult criminality, we must begin by controlling juvenile delinquency, the recidivism of young offenders presents an even more disturbing problem. Understanding juvenile recidivism is crucial for the development of effective policy responses to the broader ramifications of juvenile offense (6). Recidivism is most frequently defined as any arrest or offence within a specified follow-up period after release from a detention or rehabilitation facility (7) and it is alsoa key indicator for determining whether criminal justice interventions, from diversion to incarceration, are making a difference in turning offenders away from crime. …

The exact incidence and mortality rate in Bosnia and Herzegovina are unknown as there are no National Cancer Register. The available data are mostly based on the estimation from neighboring countries. Therefore, the aim of this study was to present the preliminary but more accurate estimates of cervical cancer incidence and mortality rates in Bosnia and Herzegovina. The data on cervical cancer cases in Bosnia and Herzegovina were collected from different sources and varies depending on the size of the city or region. To calculate the crude rates for the period from 2000 to 2008, we used the Bosnian and Herzegovinian population census for 1991. Thus, the crude incidence rate in Sarajevo region is more equable (app. 30.4/100,000 women-year), while in Tuzla Canton it varied from 18.5 in 2005 to 4.8/100,000 in 2000. In Tuzla Canton, in the period 1993-2006, 27.1% of all women with cervical cancer were younger than 30. However, the exact crude incidence in Bosnia and Herzegovina could be even higher. Data from Tuzla Canton showed slight increase in mortality rate in the last 5years (4.9/100,000), with the peak in 2007 (7.0/100,000). The presented data reflects the situation throughout Bosnia and Herzegovina and underline the necessity of the implementation of cervical cancer register and organized screening program.

Abstract Background. The aim of the study was to examine on the CT basis the inter-application displacement of the positions D0.1cc, D1cc and D2cc of the brachytherapy dose applied to the bladder and rectum of the patients with inoperable cervical cancer. Patients and methods. This prospective study included 30 patients with cervical cancer who were treated by concomitant chemo-radiotherapy. HDR intracavitary brachytherapy was made by the applicators type Fletcher tandem and ovoids. For each brachytherapy application the position D0.1cc was determined of the bladder and rectum that receive a brachytherapty dose. Then, based on the X, Y, and Z axis displacement, inter-application mean X, Y, and Z axis displacements were calculated as well as their displacement vectors (R). It has been analyzed whether there is statistically significant difference in inter-application displacement of the position of the brachytherapy dose D0.1cc, D1cc and D2cc of the bladder and rectum. The ANOVA test and post-hoc analysis by Tukey method were used for testing statistical importance of differences among the groups analyzed. The difference among the groups analyzed was considered significant if p < 0.05. Results. There are significant inter-application displacements of the position of the brachytherapy dose D0,1cc, D1cc and D2cc of the bladder and rectum. Conclusions. When we calculate the cumulative brachytherapy dose by summing up D0,1cc, D1cc and D2cc of the organs at risk for all the applications, we must bear in mind their inter-application displacement, and the fact that it is less likely that the worst scenario would indeed happen