IMMUNOHISTOCHEMISTRY IN ENDOMETRIAL HYPERPLASIA AND ENDOMETRIAL ADENOCARCINOMA.

AIM: Endometrial hyperplasia is a proliferation of endometrial glands due to the prolonged stimulation with estrogens of the endometrium that occurs in women receiving exogenous estrogens, with anovulatory cycles, or in patients with ovarian tumours with estrogen secretion. MATERIAL AND METHODS: The study performed by the authors included 575 patients with endometrial hyperplasia and 163 patients with endometrial adenocarcinoma admitted to the "Cuza-Voda" Obstetrics and Gynaecology Clinical Hospital of Iasi, between 2005-2007. RESULTS: There were selected, for these immunohistochemistry reactions, 22 cases of simple hyperplasia without atypia, 26 cases of complex hyperplasia without atypia, 23 cases of endometrial adenocarcinoma of endometrioid type, well differentiated, 22 cases of endometrial adenocarcinoma of endometrioid type, moderately differentiated, and 19 cases of non-endometrioid adenocarcinomas represented by nine clear cells and 10 serous endometrial adenocarcinomas. Estrogen receptors have been positive in about 85-90% of the tumour cells of the well-differentiated endometrial adenocarcinomas of endometrioid type (GI). In endometrioid-type endometrial adenocarcinomas moderately differentiated (GII), the estrogen receptors were positive in approximately 70-85% of the tumour cells. CONCLUSIONS: Endometrial hyperplasia, especially complex endometrial hyperplasia with atypia, increase the risk for endometrial adenocarcinoma, and their early detection becomes mandatory under cancer prevention. Well-differentiated endometrioid endome- trial adenocarcinomas were ER and PR-positive, so that the ER expression correlated with the PR expression. Well-differentiated endometrioid endometrial adenocarcinomas (GI) in the studied group also showed a higher content of ER and PR compared to the endometrial moderately-differentiated endometrioid endometrial adenocarcinomas (GII). In nonendometrioid adenocarcinomas, represented by clear-cell endometrial adenocarcinomas, the ER content was reduced and the PR expression was negative. Serous adenocarcinomas failed to show an immunohistochemically expression for ER and PR.

COMPARISONS BETWEEN THE NON-PROLIFERATIVE AND PROLIFERATIVE THERAPY IN FIBROCYSTIC MASTOSIS.

AIM: Fibrocystic mastosis (FCM) is the most frequent benign breast lesion. Most treatments for fibrocystic mastosis are: hormonl, with beneficial results and non-hormonal, with fluctuating results. MATERIAL AND METHODS: A number of 210 cases were studied, which were divided into 7 groups. The study lasted for 9 months and it was carried out on the basis of a personal examination sheet. The following were monitored: age groups, mastodynia, reducing breast nodules, a significant reduction in the volume of the mastosic cysts, reducion of the fibrous tissue, medication tolerance. RESULTS: Mastodynia has declined by 90% in the cases treated with Tamoxifen and Danazol, by 70% in the case of Lynestrenol and Bromocriptine, by 50% in the 15 patients who were given Utrogestan. Knowing the advantages and disadvantages of drugs (contraindications, side effects), age category, breast pain reduction, antiproliferative activity, tolerability, relapse allow us to assess the benefit-risk. Even in those circumstances that remained incompletely clarified for objective reasons, related to the inaccurate/incorrect reporting by the patients, there is a significant difference (p < 0.05) between the frequency of relapses following the treatment with Tamoxifen and the other categories of drugs who were administered. CONCLUSIONS: Our study shows that in the groups that were administered Logest, Utrogestan and Bromocriptine, only antalgic effects were achieved (disappearance or only decrease of mastodynia) and no anti-proliferative effects were obtained. Basically, hormone treatment should be made based on a histopathological examination.

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.

INTRAUTERINE GROWTH RESTRICTION--PREDICTIVE SERUM MARKERS.

AIM: To determine during the first trimester of pregnancy some serum and ultrasound markers that could improve perinatal morbidity and mortality in women with intrauterine growth restriction (IUGR). MATERIAL AND METHODS: Prospective study of pregnant women gestational age 11 weeks and 0 days--13 weeks and 6 days, consisting in the determination of pregnancy associated plasma protein (PAPP-A), mean platelet volume (MPV), and ultrasound appearance of placenta. DISCUSSION AND CONCLUSIONS: This study suggests that screening by detailed history and PAPP-A and MPV determination during the first trimester of pregnancy in women at risk for IUGR makes possible the prophylactic treatment and monitoring of pregnancy according to a given protocol and thus neonatal morbidity and mortality to be reduced.

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.

Topicalities in the Sudden Unexpected Death Syndrome in Infants.

Sudden Infant Death Syndrome (SIDS) represents the third cause in postnatal mortality. The pathogenesis is multifactorial. SIDS victims can present sign of preexisting chronic asphyxia, persistent increase in dendritic spine and delayed maturation of synapses in medullary respiratory centers, if a decreased reactivity of 5 hydroxytryptamine 1A (5-HT1A) and 5-HT2A in the dorsal nucleus of the vagus, solitary nucleus and ventrolateral medulla. SIDS is an exclusion diagnosis, so that inexplicable SIDS is the accepted term. The objective of this report is to present current data about the pathogenesis oh this syndrome and the medico-legal measures applied in preventive and curative aim. The "face-up" sleeping position has cut in half the SIDS frequency. In conclusion, the infant sleep studies represent an important line for the future research to provide sufficient explanation of the sudden death in these infants.

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.

[The lymph nodes status--prognostic factor in breast cancer]. / Statusul limfoganglionar--factor prognostic în cancerul mamar.

AIM: The assessment of the survival rate according to axillary lymph nodes status in patients diagnosed with breast cancer. MATERIAL AND METHODS: The study group included 206 women, treated in the 4th Obstetrics and Gynecology Clinic during 2002-2005. All patients were treated surgically with lymph nodes dissection. The analyzed variables included clinical and morphological features of both primary tumor and axillary lymph nodes. We have evaluated 5 years survival in relation to positivity and number of dissected lymph nodes. In order to determine the prognostic value of evaluated variables we have used Kaplan Meir method. RESULTS: 77.7% of all patients were aged between 40 and 49 years old and 62.6% of them presented stage II tumors. Invasive ductal carcinoma was the most frequent histologic type (79.12%) and 71.2% of tumors were moderated of poorly differentiated, lymph nodes invasion being presented in 93 cases. Survival was significantly influenced by lymph node status (p = 0.0001), number of involved nodes (p = 0.0001), number of dissected nodes in pN0 patients (p = 0.0001) and application of adjuvant systemic therapy in pN0 patients (p = 0.0001). CONCLUSIONS: The pathological examination of axillary nodes in breast cancer patients offers a valuable information regarding survival. The absence of lymph node metastases of 10 lymph nodes dissection or more, and the application of adjuvant systemic therapy favorably influence the survival.

[The current stage in the trends and control of the principle cancer sites]. / Stadiul actual în tendinta si controlul principalelor localizari canceroase.

Nowadays, cancer is responsible of one of ten deaths in the world and one of seven deaths in Romania. Its main present sites are: stomach, lungs, breast, colon/rectum, uterine cervix, mouth and pharynx, esophagus and liver. The three ways of prevention (primary, secondary and tertiary) vary in effectiveness according to the possibilities of identifying the risk factors, early detection and therapeutical means.

[Identification of the risk factors for morbidity from the most common diseases as part of the primary health care for the personnel of industrial enterprises]. / Identificarea factorilor cu risc de îmbolnavire la boli mai frecvente, în cadrul îngrijirilor primare de sanatate pentru personalul unei întreprinderi.

The investigations were performed in a building enterprise with 7,500 workers with a mean age of 37 years, mainly males. It aimed at identifying the risk factors for the common diseases. The knowledge of these factors should be considered when elaborating the health programmes intended to prevent the frequent diseases (traumas, respiratory locomotor and digestive diseases).

[Identification of the risk factors for morbidity as a part of providing primary medical care--complete support within a health program]. / Nominalizarea factorilor cu risc de îmbolnavire, concomitent cu acordarea îngrijirilor medicale primare--suport complet pentru programul sanitar.

The carried out investigation showed that when elaborating the annual health programme, morbidity aspects, types of medical care and risk factors specific to the factory under study (in this case a shoe factory) should be taken into consideration.