Recurrent multiple endometrial polyposis in patient treated by antipsychotic drugs.

Irregular uterine bleeding and profuse menstrual bleeding often occur in patients treated by antipsychotics, antiepileptics, and some antihypertensive drugs. Such bleedings represent an important problem in clinical practice, especially when related to antipsychotic treatment. Nonetheless, this problem has not been often analyzed in references. This paper describes a recurrent multiple endometrial polyposis accompanied by profuse menstrual bleeding in a patient undergoing a multi-year treatment of bipolar affective disorder by antipsychotics and discusses the possibilities of prevention of irregular and profuse menstrual bleeding in patients that must use antipsychotic therapy in order to treat a psychiatric illness.

Carcinosarcoma in endometrial polyp. Diagnosis and treatment--case report.

This paper presents a case of carcinosarcoma localized in the endometrial polyp inside the uterus of a 74-year-old patient. This carcinosarcoma was diagnosed in the first clinical disease stage. Postoperative treatment was conducted but was not followed by additional chemo or radiotherapy due to the fact that the illness was in the first clinical stage. Secondary deposits in the abdomen and in the pelvis appeared exactly six months after surgery. Illness progression was sudden causing death three months after the appearance of secondary deposits or nine months after the illness was detected, despite attempts with chemotherapic treatment. Although uterine carcinosarcomas account for three to seven percent of all uterine malignities while malignant polyp degeneration occurs in only 0.36% cases, treatment of this malignant disease is a special challenge to all those involved in oncological gynecological practice with the aim of prolonging the progression-free interval and the overall survival of patients suffering from this rare malignity.

Ectopic pregnancy and laparoscopy.

PURPOSE: The aim of this study was to compare the success of surgical procedures performed by laparoscopy and laparotomy in the treatment of tubal ectopic pregnancy. MATERIALS AND METHODS: In this prospective study, there were 57 women who were operated due to tubal ectopic pregnancy. Laparoscopic surgery was performed in 36 women (study group). Conventional abdominal surgical treatment was performed in 21 women (control group). RESULTS: Among 36 women from study group, a laparoscopic linear salpingotomy was performed in 69.44% cases, salpingectomy in 13.88% cases, and milking of tube in 16.66% cases. In the control group, linear salpingotomy was performed in 57.14% cases, salpingectomy in 28.57% cases, and milking of tube in 14.28% cases. Patent ipsilateral fallopian tube at three months after surgery was 66.66% in the study group and 52.38% in the control group. The intrauterine pregnancy rate was 19.44% in the study group and 19.05% in the control group. CONCLUSION: The percentage of tubal patency and intrauterine pregnancies after laparoscopical surgical treatment was not higher than after conventional surgical treatment by laparotomy.

Simultaneous dermoid cyst and endometriosis in the same ovary: a case report.

The authors present a case of a 33-year-old infertile woman with coincidental dermoid cyst and ovarian endometriosis in the same ovary. She was admitted to the Clinic because of cystic tumor of the left adnexa. Transvaginal ultrasound (TVUS) examination found a bilocular tumor of complex structure on the left ovary. Video-laparoscopy was also performed. On the left ovary, two adjacent cystic formations were found. Laparoscopic ovarian cystectomy was performed and a surgical specimen was sent for histopathologic analysis. The diagnosis was a dermoid cyst and ovarian endometriosis. Without complications, the patient was released from the hospital. The patient was treated with an analogue of gonadotropin releasing hormone (GnRH) for three months as a preparation for in vitro fertilization (IVF).

Carcinosarcoma of the uterus in advanced stage: a case report.

This is the case of an advanced stage carcinosarcoma uteri, in a patient with limited therapy options. Carcinosarcomas (malignant mixed Müllerian tumors) are histologically composed of malignant epithelial and mesenchymal components. Sarcomatous component of this mixed tumor in the present patient was of heterologous-type chondrosarcoma. The primary treatment option for uterine carcinosarcomas is surgery, but adjuvant therapy is always necessary. The optimal treatment is still uncertain, as the histogenesis of this tumor remains controversial.

The management of fusion of the labia minora pudendi in adult women using a radiosurgical knife.

Fusion of the labia minora is a rare event in adult women and rarely seen as a clinical entity. We present a case of a 30-year-old woman with labial fusion, unmarried, a virgin, and sexually inactive with the complaint of discomfort during menstruation and difficulty in micturition since her puberty. The labia minora were fused in the midline with a pinpoint aperture for draining urine, while the clitoris could not be visualized. Previous history regarding a causal factor was perineal trauma in childhood. Effective surgical resection to separate the fusion was done by a radio frequency surgical knife. After the surgical separation, it was possible to expose the normal hymen behind the previously fused labia. We have shown that the separation of labial fusion in adult women with a radio frequency surgical knife, associated with topical application of estrogen cream, prevents re-fusion of the labia and leads to healing without scarring of the vulva.

Treatment of early heterotopic interstitial (cornual) gestation with subsequent delivery of an intrauterine pregnancy--case report.

We present the case of a 38-year-old woman who was treated for a heterotopic interstitial (cornual) pregnancy diagnosed at the 7th week of gestation. The intervention was performed via transvaginal ultrasound-guided aspiration and instillation of a hypertonic solution of sodium chloride into the cornual sac. The heterotopic comrnual pregnancy was successfully aborted, and the intrauterine pregnancy was successfully maintained with delivery of a healthy newborn.

Successful pregnancy after uterovaginal anastomosis in patients with congenital atresia of cervix uteri.

We present a case of successful pregnancy after effective uterovaginal anastomosis in a 26-years-old patient with congenital atresia of the cervix uteri. She spontaneously achieved pregnancy after four years of uterovaginal anastomosis. Gestation was at the eighth lunar month and the delivery was done by cesarean section due to rapidly progressing fetal asphyxia. The patient gave birth to a live healthy male, weighing 1,950 g, with an Apgar score of 5 and 8 at 1 and 5 min, respectively. The postoperative course was uneventful, and leakage of lochia was normal.

Pregnancy following conservative surgical treatment of the malignant mixed germ-cell tumor of the ovary--case report.

We present a case of pregnancy after complete conservative surgical treatment in a young woman with malignant mixed germ-cell tumor of the ovary. She was submitted to surgical treatment involving only unilateral salpingo-oophorectomy, with infracolic omentectomy and dissection of the pelvic and paraaortal lymph nodes. Three years after the operation and chemotherapy the patient spontaneously conceived and gave birth to a healthy baby. A patient who has malignant germ-cell tumor of the ovary in early stage, can successfully preserve fertility by conservative surgical treatment.

Endometrial carcinoma with ovarian metastases incidentally detected in a 30-year-old infertile patient--case report.

This is a case of invasive endometrial carcinoma with ovarian metastases incidentally detected in a 30-year-old infertile woman. The patient was asymptomatic. Carcinoma was discovered during hysteroscopy. She was submitted to surgical treatment involving total hysterectomy, bilateral salpingo-oophorectomy and dissection of the pelvic and paraaortal lymph nodes. Postoperative irradiation therapy was performed. Since treatment the patient has been well.

Diffuse malignant peritoneal mesothelioma in a 31-year-old patient--case report.

This is a case report of a diffuse malignant peritoneal mesothelioma in a 31-year-old woman. The patient presented with pains in the small pelvis followed by abdominal distension. By pelvic ultrasonography a tumorous mass of cystic architecture was verified in the small pelvis. She was submitted to laparoscopy. The diagnosis of the disease was established by histopathological examination of the material sample taken during laparoscopy. The patient was subsequently submitted to laparotomy upon which peritonectomy, omentectomy and appendectomy were performed. Postoperative combined chemotherapy was given. The patient has been well since completion of the treatment.

[The role of insulin-like growth-factor binding proteins in normal and polycystic ovaries]. / Uloga vezujucih proteina za faktore rasta slicne insulinu u normalnom i u policisticnom ovarijumy.

The insulin-like growth factor binding proteins are single chain polypeptides, that can bind insulin-like growth factors, but not insulin. They can serve as autocrine or paracrine regulators of the actions of insulin-like growth factor. The human granulosa cells produce insulin-like growth factor-II but not insulin-like growth factor-I, while the human theca cells produce insulin-like growth factor-I and II. Polycystic ovarian syndrome is a disorder which is characterised by hyperandrogenism and anovulation. In polycystic ovarian syndrome there is a disorder of follicular development, with the accumulation of antral follicles within the ovary which fail to respond appropriately to endogenous follicle-stimulating hormone. Significance is given to insulin-like growth factor binding proteins, which have an inhibitory action on follicle-stimulating hormone. No differences were found in the total level of insulin-like growth factor binding proteins follicular profiles between women with polycystic ovarian syndrome and without it. Serum insulin-like growth factor binding protein-I levels are lower in polycystic ovarian syndrome with hyperinsulinaemia, probably as a consequence of insulin-mediated suppression of insulin-like growth factor binding protein-I. Consequently, serum free insulin-like growth factor-I levels are higher. This alteration may cause an excessive thecal androgen production. The alterations in the insulin-like growth factor-insulin-like growth factor binding proteins axis may be one of several mechanisms that help to sustain the steady state of anovulation and follicular dysmaturation that are characteristic of this syndrome.

[Importance of daily serum progesterone measurement in ovulation induction]. / Znacajnost dnevnog doziranja progesterona u serumu u toku stimulacije ovulacije.

It is known that the rise of serum progesterone concentration frequently precedes the rise of serum luteinizing hormone in spontaneous menstrual cycles and during induction of ovulation. The aim of this study was to evaluate the role of single serum progesterone measurement in the prediction of spontaneous serum luteinizing hormone rise in patients with ovulation induction. The study concerned 97 infertile women. The induction of ovulation was performed according to individual endocrine profile of a patient. In 59 (61%) patients spontaneous increase of luteinizing hormone was not recorded and in 31 (32%) patients this increase was evident. In 7 (7%) high serum luteinizing hormone concentration was measured at the time of use of human chorionic gonadotropin. The correlation between serum progesterone level and serum luteinizing hormone concentration in patients with spontaneous serum luteinizing hormone rise was statistically significant (r=0.79; p<0.01). The double daily serum progesterone rise is an important method for prediction of serum luteinizing hormone rise (x2=24.08; p<0.001). After the use this method the pregnancy rate was 29 percent in our study group.

Intrauterine insemination with spermatozoa recovered from the aspirate of artificial spermatocoele.

Congenital absence of both vas deferens accounts for approximately 10% of cases of obstructive azoospermia. The purpose of the present study was to develop a treatment protocol for a group of azoospermic patients using surgical implantation of alloplastic spermatocoele to enable repeated sperm cell aspiration. Nine patients with congenital absence of both vas deferens, two with obstructed and one with destroyed vas, underwent surgery for the implantation of an alloplastic spermatocoele. In 10 of the 12 patients, vital spermatozoa were recovered from the aspirate and used for intrauterine insemination of their female partners with induced ovulation, some of whom then conceived.