Pathophysiology of adhesions.

Formation of intraperitoneal adhesions after abdominal or pelvic surgery is a very common phenomenon. Although there is no universally accepted definition, they are bridges of scar tissue between the various organs of the peritoneal cavity as a result of a local repair process excessively. Adhesions can be congenital or acquired as a local inflammatory process. Some adhesions can be asymptomatic, but many of them can cause severe complications such as abdominal or pelvic pain, female infertility, and intestinal obstruction. Physicians and patients should be informed of the possibility of postoperative intraperitoneal adhesions and this possibility should be mentioned in the informed consent signed by the patient. The formation of adhesions has multiple proinflammatory mechanisms involved, many with a pathophysiology still incomplete understood. Laparoscopic procedures do not diminish much the possibility of developing postoperative adhesions.Diagnostic imaging is quite uncertain, and the possibilities of preventing with a poor final result. The use of correct surgical technique and avoidance of traumatic intraperitoneal organs maneuvers may help reduce postoperative adhesions incidence.

The endoscopic management of uterine synechiae. A clinical study of 78 cases.

UNLABELLED: Intrauterine adhesions (1UA) are easily diagnosed by hysteroscopy, which also offers the main method for treatment. In this study, we analyze the value of the method. MATERIAL AND METHODS: We have selected 78 cases of IUA diagnosed during a 3 year period. In cases when interventions were needed, we used mechanical techniques (pushing, scissors, forceps) or electrical resection, addressed to synechiae and other concomitant pathologies (fibroids, polyps). The follow-up ranged between 3-6 months (for amenorrheic patients) and 6-12 months for infertility patients. RESULTS: In our 78 cases the presenting diagnostic was synechiae (44%), irregular cycles (19%), amenorthea (16%), infertility (15%). Hysteroscopy allowed the IUA extension evaluation, and the majority of cases had early stage disease. From them 60% had therapeutic gestures, with success criteria being: visualization of both tubal ostium- in 70%, clinical normal cycles (91%) and pregnancy in 5 cases (41% from patients addressed mainly for infertility). There was one perforation in an Ashermann syndrome case, with no further surgical gestures needed. The main postoperative treatment was hormonal treatment, in all cases. In conclusion, although hysteroscopy allows easy diagnostic for IUA, therapeutic gestures should be done in severe cases by experimented specialists.

[The use of hysteroscopy in the diagnostic on perimenopausal metrorrhagia. A study of 35 cases]. / Utilizarea histeroscopiei in diagnosticul hemoragiilor perimenopauzale. Studiu clinic pe 35 cazuri.

UNLABELLED: We have retrospectively evaluated the role of hysteroscopy for the diagnostic of the peri-menopausal metrorrhagia. METHODS: The cases included represented patients of more than 45 years, with persistent bleeding, from 2 gynecological hospitals (one public and one private), during one year, that were submitted to hysteroscopy for clarifying the diagnostic. The hysteroscopic endometrium descriptions were categorized as: atrophy, normal, simple or suspect hypertrophy, polyp, and adenocarcinoma, and they were compared to the pathological exam results. RESULTS: The descriptions were distributed among the categories: atrophy (8 cases), simple hypertrophy (17), suspect hypertrophy (3), polypoid (5), endometrial cancer (2) or normal (4). The correlation to pathological results was good, with only 14% of hysteroscopic underestimation of lesions. The sensitivity according to type of pathology, was 50 to 100%, specificity between 84% - 100%. CONCLUSION: Hysteroscopy is better than "blind" curettage in clarifying perimenopausal hemorrhagic endometrial pathology.

[The psycho-relational aspects of the psychopathological dynamics and profile in postpartum mental disorders in the county of Iasi in 1988-1993]. / Unele aspecte psiho-relationale ale dinamicii si profilului psihopatologic ale tulburarilor psihice postpartum din judetul Iasi, în perioada 1988-1993.

642 cases of mental disorder occurring or aggravating during the evolution of a pregnancy or postpartum assisted at the "Socola" University Hospital of Psychiatry in the interval 1988-1993 were analyzed. In 91 (38.39%) of these cases the postpartum mental disorders occurred in the absence of a psychotic psychiatric history. Based on a computerized record, the psycho-social factors with a potential pathologic risk were analyzed dynamically. The influence of social dynamics on the incidence and psychopathologic profile of mental disturbances with onset in the postpartum was evidenced, a somewhat paradoxical correlation of the frequency of these disorders with the dynamics of abortions and not with that of deliveries being underlined. Characteristic to these patients would be a lower education level, a more labile biological and psychological structure, the absence of obstetrical history and marital relational problems. An increased incidence of some postnatal complications in the evolution of these women' newborns was also found.

[THe role of biopsy in the early diagnosis of cancer of the cervix uteri]. / Rolul biopsiei în diagnosticul precoce al cancerului de col uterin.

Among the actions of early diagnosis of uterine cervix cancers, the sequence cytologic smear, colposcopy, cervix biopsy is well-known. The authors draw the attention that in some situations the cytologic smear and colposcopy are not sufficient and it is only biopsy that defines the nature of the lesion and may give therapeutic indications. Out of a series of 55 women to whom a cervix biopsy was performed, there were 27 cases in which biopsy was justified, showing either a severe lesion or the presence of koilocytes. The authors plead for a more frequent use of cervix biopsy as a means of early diagnosis of uterine cervix cancer or of its dysplasias.