GIANT INTRALIGAMENTARY UTERINE LEIOMYOMA AND ITS COMPLICATIONS.

Uterine leiomyomas are benign tumors arising from uterine smooth muscle. Although their pathogenesis remains unclear, they are the most common tumor of the female reproductive tract, occurring in as many as half of women older than 35 years. Uterine leiomyomas represent the most common benign tumors of the female reproductive tract. Giant uterine leiomyomas are very rare and represents a great diagnosis and therapeutic challenge. Uterine leiomyoma is one of the most frequent types of tumours and it is diagnosed in 20-40% of the women of reproductive age. Until the age of 50, approximately 70% of the white women and less than 80% of the black women will have had at least one leiomyoma. The frequency of the emergence of uterine leiomyoma in black women is significantly higher than in white women.

Efficiency of Treatment for Female SUI (Stress Urinary Incontinence) Using the TVT-O® (Tension-Free Vaginal Tape Obturator) Technique.

Aims: The modern Tension-Free Vaginal Tape Obturator (TVT-O®) technique is used worldwide to treat Stress Urinary Incontinence (SUI). The subject of the paper is timely and with a major practical potential. The paper presents an ample retrospective study on a series of patients hospitalized at the Second Clinic of Obstetrics-Gynecology of "Cuza-Voda" Obstetrics and Gynecology Clinical Hospital from Iasi, for a period of 3 years. In the period January 2010-January 2012, 164 female patients were subjected to surgical procedures to treat type II SUI, inserting TVT-O® tapes. Material and methods: Patients were selected based on anamnesis, clinical examination and positive Bonney's test. When genital prolapse was associated with SUI, simultaneous with strip insertion, other interventions were practiced, too. Cases were followed in the immediate postoperative period, at 2 months, 6 months, and 1 year, in order to analyze the efficiency of the method. 164 female patients aged between 38 and 65 were included in the study, of which 60 cases had isolated SUI and in 104 of the cases SUI was associated with genital prolapse. Results: In 85% of the cases, the healing rate was satisfactory, and in 15% of the cases, it was partially satisfactory, keeping the percentage at 6 months and 1 year. In respect of complications at 16 female patients, SUI was improved, but persistent in 14 cases the mictional necessity was described as absent before intervention; in these cases, we used oxybutynin, in 4 of them-tape sectioning and in 4 cases the exteriorization of the tape was relieved after 2 months, performing the secondary vaginal suture. The simple operatory technique, the reduced hospitalization period, the short convalescence and the immediate results support the TVT-O® procedure in the treatment of SUI. Postoperative complications are rare and do not compromise results. The main goal of "Sling" interventions is the creation of a reliable closure mechanism, supporting the passive urinary retention by urethral compression. Conclusions: Our point of view with regard to the controversy of using TVT-O® tapes is that the technique does not have to be abandoned, being extremely efficient in academic centers with ultra-specialized staff.

A Thin and Regular Endometrium In Endometrial Cancer - Endovaginal Ultrasound Assessment.

Aim: Our study had as a major objective the highlighting of more objective criteria in establishing the morphological diagnosis and the evaluation of prognosis elements in endometrial hyperplasia and endometrial carcinoma, representing a specific pathology for the premenopausal and postmenopausal women. Endometrial adenocarcinoma is a malignant tumor, rare in women under 40 years of age, but the incidence increases after menopause, gradually reaching a maximum between 70-79 years. Material and Methods: The study included 291 patients with endometrial adenocarcinoma. The patients were admitted in 2005-2010 to "Cuza-Voda" Obstetrics and Gynecology Hospital in Iasi. The study group was diagnosed and investigated on the basis of the clinical examination and the specialized complementary explorations. The histopathological diagnosis was obtained by the processing of the hysterectomy specimen. Results: The results of the study that we conducted highlight the fact that nearly half of the patients diagnosed with endometrial adenocarcinoma were 50-59 years old. In 78.01% cases the uterus was of normal size, between 4-6cm, in 10.31% cases was increased over 6 cm and 11.68% it was of small size, less than 4 cm. Conclusions: The study recommends surveillance of cases with endometrial hyperplasia especially if are associated with incriminated risk factors in the etiology of carcinoma of the uterus.

Clinico-epidemiological study of endometrial hyperplasia--a risk factor for the development of endometrial carcinoma?

AIM: Metaplasia is defined as a transformation of an adult epithelial or conjunctive cellular type into another adult cellular type. Endometrial hyperplasia and particularly complex atypical hyperplasia exposes to a high risk of development of the endometrial carcinoma, being considered a lesion precursory to the same. Endometrial hyperplasias are risk factors for the development of endometrial carcinoma and their prophylaxis implies their accurate diagnosis, taking into account that the adenocarcinomas diagnosed in an advanced stage, whose therapeutic context differs from the early stages, have a much lower chance of survival. MATERIAL AND METHODS: Our study aimed at highlighting objective criteria in establishing the morphological diagnosis and in evaluating the prognostic elements. The studied batch included 875 patients with endometrial hyperplasia and 263 patients with endometrial adenocarcinoma, who were admitted between 2003 and 2007, and the histopathologic diagnosis was obtained by processing the hysterectomy pieces. The presence of this tumour was at its highest level half-way through the study, which was in 2005. RESULTS: According to the study, there was a higher proportion of patients with endometrial carcinoma from the urban environment (58.2%) than the ones from the rural environment (only 41.8%). Depending on their age, most cases of endometrial adenocarcinoma were diagnosed in 53-year old patients, with an average age of 58.94 years. Our study, made of the two batches of endometrial adenocarcinomas, shows that between the endometrial and non-endometrial adenocarcinoma there are significant differences related to the patients' age, the morphological aspect of the carcinoma, the architectural degree, the nuclear degree of tumours and the invasion in the myometrium. CONCLUSIONS: Our study proves that endometrial hyperplasia is a frequent diagnosis in peri- and postmenopausal patients and is frequently identified following investigations for an abnormal uterine bleeding. The age of patients with endometrial carcinoma is an important prognostic factor independent of other parameters. The difference between complex hyperplasia with no atypias and complex hyperplasia with atypias is important, because atypical complex hyperplasia is considered the precursor of endometrial adenocarcinoma.

The role of EEG brain mapping in quantification of brain damage in hypertensive disease associated with pregnancy.

UNLABELLED: The existence of a high blood pressure during the pregnancy represents a real danger for the mother and child, responsible for damage of the kidney, brain, liver, and placenta, cardiovascular and hormonal system. Nervous system changes can include blurred vision, seeing spots, severe headaches, convulsions, brain hemorrhage, and even occasionally blindness. AIM: To evaluate the spatial distribution of electroneuro-pathological aspects of brain activity at pregnant women with hypertensive disease by BEAM (Brain Electrical Activity Mapping). MATERIAL AND METHODS: Twenty pregnant women (week 20 to 39) with hypertensive disease were recruited. Healthy pregnant women were also recruited control group. Maternal monitoring included spectral multichannel EEG analysis (brain mapping), repeated clinical examinations and laboratory investigations. RESULTS: The major EEG changes observed were focal slowing of the background activity (14 patients)--occipital lobes especially, and intermittent spike and sharp wave transients (5 patients). CONCLUSIONS: Our finding's indicate that EEG brain mapping are probably sensitive in detecting the extent of the pathology in the brain in women with in hypertensive disease associated with pregnancy.

[Sonohysterosalpingography versus hysterosalpingography in the evaluation of uterine and tubal infertility]. / Sonohisterosalpingografia versus histerosalpingografia in evaluarea infertilitatii de cauza uterina si tubara.

OBJECTIVE: The evaluation of the role of sonohysterosalpingography with saline with air as a contrast solution (HYCOSY), in the assessment of uterine cavity and tubal patency, versus hysterosalpingography (HSG) and laparoscopy with dye test combined with hysteroscopy. MATERIAL AND METHOD: Prospective study of 95 infertility patients, with ages 25-40 years (median 31), in which HYCOSY was compared with HSG regarding the diagnostic acuracy for uterine cavity pathology and tubal patency, and compared to laparoscopy with dye test combined with hysteroscopy as gold standard. RESULTS: The sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnostic of uterine cavity pathology was: HYCOSY versus hysteroscopy of 72.1%, 96.15%, 93.93% and 80.64% respectively; HSG versus hysteroscopy was 83.3%, 60.7%, 63.6% and 81.6%; both methods combined versus hysteroscopy 95.34%, 61.53%, 67.21% and 94.11%. The same parameters for the tubal patency were: HYCOSY versus dye test laparoscopy 81.39%, 87.69%, 67.30% and 97.79%; HSG versus dye test laparoscopy 61.9%, 85.3%, 56.5% and 87.9%; both methods combined versus dye test 86%, 76%, 52.9% and 94.6%. CONCLUSION: HYCOSY can be used in combination with HSG for selecting the patients that need further more invasive investigations, in order to describe uterine and tubal pathology.