[Uterine corpus extension of primary cervical carcinoma IIA-IIB. The compatibility of preoperative and postoperative diagnosis and its annual significance]. / Naciekanie trzonu w pierwotnym raku szyjki macicy IB--IIB. Zgodnosc rozpoznania przed- i pooperacyjnego oraz ich wartosc rokownicza.

OBJECTIVE: Evaluation of the concordance of preoperative diagnosis, based on dilatation and curettage (D&C) and postoperative diagnosis, based on specimen of uterine corpus, as well as finding if the material from D&C allows to conclude about extension of uterine corpus infiltration and thus patient's prognosis. MATERIAL AND METHODS: Analysis was done on 43 patients with uterine corpus infiltration in stage Ib-IIb of primary cervical cancer, on whom Wertheim-Meigs surgery was performed. Depth of uterine invasion in D&C material (free of cancer endometrium, cancerous endometrium, cancerous fragments of myometrium) was compared with actual postoperative assessment of uterine specimen. 5-year survival rate was also analysed. RESULTS: Statistically significant differences in depth and extension of uterine body infiltration between patients with soley endometrial infiltration and patients with infiltrated fragments of myometrium in D&C material were found. CONCLUSION: Presence of infiltrated fragments of myometrium in D&C material was mostly found in cases of extensive corpus infiltration (postoperative specimen) and it had much to do with poor prognosis.

[Primary carcinoma of the fallopian tube: a clinicopathological study of 11 cases]. / Analiza kliniczno-morfologiczna 11 przypadków pierwotnego raka jajowodu.

OBJECTIVES: Clinicopathological study of eleven cases of carcinoma of the fallopian tube to understanding possible risk factors for therapeutic failure. DESIGN: The study group consisted of 11 cases of primary carcinoma of the fallopian tube treated in our Department over 25-year period. Clinical and pathologic data were obtained from the hospital records review. RESULTS: The mean age of the patients was 57.22 years. Pelvic pain was the predominant symptom (81.8%). Three of 11 patients had the classic syndrome of "hydrops tubae profluens". On the physical examination the pelvic mass was the most frequent finding (72.7%). Five of the 11 patients had never been pregnant and five had had a single pregnancy. In all patients the diagnosis was established at the time of laparotomy. The tumor was unilateral in 72.7% of the cases with equal frequency in the left or the right tube. The tube was significantly dilated in nine patients, in two other the tumor was smaller then 10 mm. Histologically the vast majority of the tumors was papillary serous adenocarcinoma, and only in one case clarocellulare adenocarcinoma was found. The histologic grade was in 63.6% poorly- and in 36.4% moderate differentiated. In 6 patients we found evidence of salpingitis. All of the patients received postoperative adjuvant therapy: irradiation and or chemotherapy. The mean interval from diagnosis to death was 44.5 months. CONCLUSIONS: Multicenter studies are needed to improve the understanding of possible risk factors for diagnostic additionally therapeutic failure and the optimal treatment for each stage of the disease should be defined.

[Laparoscopic image of pelvic minor organs in women after ovary surgery]. / Laparoskopowy obraz narzadów miednicy mniejszej u kobiet po przebytych operacjach jajników.

An analysis of indications to laparoscopy and an evaluation of the abdominal cavity organs in patients who earlier in their history have undergone laparotomy, is the object of this report. A group of 86 patients was studied and in all cases laparoscopy followed previous laparotomy. Infertility, PPS, and pelvic mass were found to be the most frequent indications to laparoscopy. In 74.4% of patients who had laparotomy in their history, our laparoscopy revealed pelvic adhesions and in 9.3% of patients--endometriosis. Laparoscopy constitutes safe diagnostic and therapeutic procedure, complications occurred in 2.3% of patients.

[Surgical treatment of uterine myoma: need for surgery and long-term results]. / Zachowawcze operacyjne leczenie miesniaków macicy--wskazania i odlegle wyniki.

We analysed the indications to myomectomy in females in reproductive age and estimated efficasy of this treatment. 112 patients aged 23-45 were analysed. Most common indication to this procedure were: menorrhagia--45.54%, myoma found at gynecological examination--21.43%, adnexal mass--20.54% and pelvic pain--15.18%. 54.46% patients were parous, 34.82% nulligravid and 10.72% had a history of spontaneous abortion. There was low percentage of intraoperation complications--2.67%, as well as postoperation complications--3.57%. More than 5 years follow-up revealed recurrent myoma in 14.28% females and in 6.25% hysterectomy was performed. Cervical polypus was found in 8.04%, endometrial hyperplasia in 2.68%. 18.75% patients had menorrhagia and 5.36% abdominal pain. Successful pregnancies have occurred in 42.11% infertile women prior to surgery but with patent fallopian tubes. Our study shows that myomectomy is safe and well accepted method of treatment for uterine myomas however always stands a risk of recurrents.

[Balneologic rehabilitation in women operated on for ectopic tubal pregnancy]. / Rehabilitacja balneoterapeutyczna u kobiet operowanych z powodu ciazy ektopowej jajowodowej.

This paper is in support of balneological rehabilitation in patients operated on due to ectopic pregnancy and still willing to have children. In a group of 203 patients, in which histopathological findings from the material obtained at the time of surgery enabled determination of the cause of ectopic pregnancy, causative pharmacological treatment was established. Than the successive balneological treatment was carried out in 74 out of these 203 patients. Our data shoved that patients who underwent balneological rehabilitation after surgery tended to become pregnant two times more often, number of repeated ectopic pregnancies was just inconspicuous and the preservation of the patency of operated Fallopian tubes was also two times higher.

[Results of treating tubal factors in infertile women in light of successful pregnancies]. / Wyniki leczenia czynnika jajowodowego u kobiet nieplodnych w swietle uzyskanych ciaz.

We retrospectively analyzed 80 pregnancies ended by delivery of a healthy child in women after treatment of tubal infertility. The results were influenced by the duration of infertility, duration of the treatment and by the age of the patients. 13.75% of women with clinical symptoms of chronic exacerbate inflammation became pregnant after preliminary anti-inflammatory treatment but 86.25% of women following treatment due to earlier determined etiology (endometriosis, post inflammatory tubal disease). The group of women (38.75%) with oviductal occlusion apart from the treatment based on etiology were also treated surgically in 70%.

[Fertility of women after past ectopic pregnancy]. / Plodnosc kobiet po przebytej ciazy ektopowej.

An analysis of the fates of women after passed pregnancy was performed concerning the type of surgery and the microscopic findings in the excised oviducts. The analysis based on the subsequent frequency of intrauterine pregnancies in the operated subjects, incidence of repeat ectopic pregnancies and following sterility. In the group 416 operated women intrauterine pregnancy followed in 31.2% and ectopic pregnancy--in 8.9%, secondary sterility was noted in 29.6%. The performed surgical interventions were analysed in 4 subgroups depending on the range of surgery. A higher rate of intrauterine pregnancies was seen in women after unilateral salpingectomy or unilateral reconstructive-conservative operation. Higher incidence of ectopic pregnancies was seen in women undergoing unilateral salpingectomy and recanalization of the other oviduct. Analysis of the microscopic findings revealed a higher incidence of intrauterine pregnancies in women demonstrating functional changes in the operated oviduct, versus a lower one in those, with inflammatory or endometriosis process in the affected oviduct. No differences could be found--correlated with the microscopic diagnosis.

[Ectopic pregnancy as treatment failure of limited fertility states]. / Ciaza ektopowa jako niepowodzenie leczenia stanów ograniczenia plodnosci.

We analyzed 51 women experiencing limited fertility in which our treatment resulted in ectopic pregnancy. We took into account preliminary appearance of the reproductive organs, its intraoperative appearance and histopathological conclusions. All gathered data gave way to treatment which complied with etiology of the condition. As a result of all undertaken procedures 6 women totally lost their fertility due to repeated ectopic pregnancy. Some 50% of patients give up any further treatment because of aging or other reasons. In all our patients the organic factor was found as a causative factor of incorrect nidation.

[Role of pelvic endoscopy in diagnosing congenital uterine malformations]. / Rola pelviscopii w diagnostyce wad rozwojowych macicy.

The role of pelvic endoscopy in diagnosing uterine abnormalities, considering material of 1170 patients, is presented in this paper. It has been documented that pelviscopy together with hysterosalpingography play basic role in determining type of uterine abnormality. In 20 cases pelvic endoscopy enabled verification of the primary diagnosis set by hysterosalpingography. Pelvic endoscopy is a method by choice in the diagnostics of the Rokitansky-Küster-Hauser syndrome.

[Pelvic endoscopy in diagnosing fallopian tube disorders that cause infertility]. / Pelviscopia w diagnostyce czynnika jajowodowego nieplodnosci.

Over the period of 25 years, 1080 pelvic endoscopy in infertile women were performed, with special attention payed to the pathology of Fallopian tubes. Pelvic endoscopy was performed after previous HSG. During the pelvic endoscopy, the state of the uterus, ovaries and uterine tubes were evaluated, with much attention paid to the condition of the abdominal ostium of the uterine tube, symptoms of active and chronic inflammation, endometriosis, the authors also tried to diagnose the extension and character of pelvic-salpingian adhesions. Confrontation of the results enabled diagnosis in 111 (41.7%) women, out of 266, with patient Fallopian tubes the organic factors which impaired conception or made conception impossible. In the group of 814 women with tubal impotency in 15 (1.8%) cases extratubal factor was found, subserosal myoma in uterine horn, cyst, adhesions, while Fallopian tube itself was patent and unchanged. Organic factors of Fallopian tube disorder were determined. In 360 (44.2%) patients, out of 814, with tubal impotency pathological status was found (active salpingitis, tuberculosis, endometriosis) which required establishing of a necessary treatment and cancelling the surgical treatment.

[Pregestational secretory change in endometrium in infertility (author's transl)]. / Das Bild sekretorischer Vorschwangerschaftsumwandlungen im Endometrium bei Infertilität.

The degree of secretory transformation in connection with infertility was studied by morphologico-histochemical analysis. The results seem to provide evidence to the effect that severe secretory insufficiency of surface epithelium is the major pathological phenomenon recordable from the endometrium in cases of infertility. Defective function of epithelial oestrogen receptors and disorders in endometrial regeneration during one cycle have to be taken into consideration regarding the pathogenesis of segmental insufficiency of secretory endometrial transformation. More elucidation will depend, last but not least, on immunological response which often lies within all endometrial strata.