[Medical treatment of endometriosis. An update]. / Actualitati in tratamentul medical al endometriozei.

Endometriosis is a major health problem, because of difficult diagnosis and limited therapies available. The surgical approach is done by very specialised surgeons, doing classical or laparoscopic ablative interventions. This article is an up-to date evaluation of medical treatment, reviewing the hormonal drugs (contraceptives, progestatives, GnRH analogues) and non-hormonal ones (anti-aromatase, anti-progestative, anti-tissular growth factors). The conclusion is that the medical treatment should be used in well selected cases, and adapted regimens, choosing among continuous contraceptives, intrauterine devices with levonorgestrel, or aromatase inhibitors. The main objective in this cases is rarely the complete cure, but more frequently optimal timing before surgery.

[Clinical and paraclinical diagnosis of pelvic endometriosis. Clinical study]. / Studiu privind diagnosticul clinic si paraclinic al endometriozei pelvine.

UNLABELLED: Pelvic endometriosis is a difficult diagnosis in gynecological practice, due to different symptoms and advanced stages in which the patients arrive to us. MATERIAL AND METHOD: This study retrospectively analyses 73 cases of confirmed endometriosis admitted in our service during 5 years. We gathered information about their clinical data and diagnosis, and intraoperative laparoscopic or laparotomic findings. RESULTS: The majority of our cases were in the 3rd age decade (52%). The clinical symptoms were: infertility (34%), pelvic or abdominal pain (71%), vaginal bleeding (14%), or an accidental finding after laparotomy or laparoscopy for other reasons (7%). The intraoperative evaluation of the cases showed: endometrial genital foci in 59%, with half of them located at the ovary; extragenital sites in 30 cases (bladder--4 cases, Douglas pouch 19 cases, abdominal wall 5 cases, para-cervix 2 cases). Associated pathology included: adhesions in 46%, retroverted uterus in 15%, ovarian non endometriotic cysts (18%), polycystic ovaries (12%) and tubal pathology (6%). CONCLUSION: Our study confirm the difficulty of a clinical diagnostic of endometriosis, but the main symptoms remain infertility and pelvic-abdominal pain. The laparoscopy or laparotomy were the main tools for the diagnostic and management of our cases.

[Giant uterine fibroma. Case report]. / Fibrom uterin gigant. Prezentare de caz.

The presence of the giant abdominal-pelvic tumours is more and more rare because of the precocious methods of diagnosis. Sometimes the rare cases of giant uterine fibroma are met in medical practice and they need the use of atypical surgical techniques that are not entirely risk-free. In the present case, the giant uterine fibroma that was diagnosed (23/21/20 cm) was investigated clinically, and with imaging and pathologic techniques, then it underwent a surgical procedure in two stages, with major difficulties, because the entire anatomical structure of the pelvis was totally modified.

[The evaluation of different methods of paraclinical diagnosis in endometrial hyperplasia and endometrial cancer of women in perimenopause]. / Evaluarea diferitelor metode de diagnostic paraclinic in hiperplazia de endometru si cancerul endometrial la pacientele aflate in perimenopauza.

UNLABELLED: Almost all types of endometrial pathology in perimenopause have the same clinical features. That's why the paraclinical methods are the most useful for diagnosis. OBJECTIVE: To find which of the following: Pap smear, sonography, hysterography or hysteroscopy is more appropriate for the diagnosis. MATERIAL AND METHOD: We investigated 218 cases of endometrial hyperplasias and 57 of endometrial cancer between 45-74 years old. The final diagnosis was settled by pathological exam. RESULTS: For both of them the Pap smears has no significance; hysterography is not specific and old fashioned; the sonography may diagnose the disease but the hysteroscopy put the diagnosis in 87% cases of endometrial hyperplasias. In endometrial cancer the sonography separate the normal cases from the suspects and the hysteroscopy put the diagnosis in all cases but can not appreciate the myometrial invasion. CONCLUSION: There is no paraclinical method to be used alone for a correct diagnosis. Sonography can choose, hysteroscopy and biopsy put the diagnosis and treat.

[Correlations between the ultrasound aspects of endometrial hyperplasias and the pathological exam]. / Corelatii între aspectele ecografice ale hiperplaziilor endometriale si rezultatele anatomo-patologice.

UNLABELLED: The endometrium has a few possibilities to express the underlying pathology, even if there may be a potential dangerous one. This study is searching for a relationship between the ultrasound images of endometrial hyperplasias and the respective pathologic exams. MATERIAL AND METHOD: We analyzed 385 cases of endometrial hyperplasias hospitalized in the "Elena Doamna" Maternity from Iasi, Romania during the period 2000-2005. RESULTS: For all the cases included, the endometrium had a width from 2 mm to 20 mm, with a median of 9mm. The hyperplasias were: 70.18% simple hyperplasias without atypia, 18.52% complex hyperplasias without atypia, 7.1% complex hyperplasias with atypia and 4.17% secretory hyperplasias. There were no differences between the aspects or thickness of the endometrium in regard with any of the types of hyperplasias. CONCLUSIONS: Ultrasounds exams have a limited role to diagnose endometrial hyperplasias. They only selects patients for mandatory other investigations. Key words:

The prenatal detection of Jeune syndrome (asphyxiating thoracic dystrophy). Case report.

The authors present the case of a foetus with Jeune syndrome (asphyxiating thoracic dystrophy) in a woman with a previous deceased child with the same disease, and also with a normal sibling. The diagnosis was mentioned at 26 week of pregnancy, based on ultrasonographic findings: short proximal bones (under 3 percentiles), and a diminished thoracic circumference, (although greater than 10 percentiles for the gestational age). There was an interdisciplinary agreement for the therapeutic termination of the pregnancy, and the post-expulsion assessment confirmed the diagnosis. This case demonstrates a higher incidence of Jeune dystrophy than the one expected for an autosomal recessive disease, with 2 out of 3 children affected, instead of 25%. It also shows that the earliest change is the one regarding the shortened long bones, often difficult to notice before 20 weeks, fact which favors a detailed genetic sonogram done after this limit.