Nonsteroidal anti-inflammatory drug with a local anesthetic compared to nonsteroidal anti-inflammatory drug alone significantly reduce the pain associated with vaginoscopic office hysteroscopy.

INTRODUCTION AND OBJECTIVES: Pain is the most common cause of office hysteroscopy (OH) failure. There is no consensus on alleviation of pain during OH. The aim was to compare the effectiveness of pain-relieving methods during OH. STUDY DESIGN: A prospective randomized open-label trial included women subjected to OH. All women received 100 mg of ketoprofen intravenously pre-procedure. Women were randomly assigned to 3 arms: A) no local anesthesia, B) infiltration anesthesia with 20 ml of 1% lidocaine solution, C) paracervical block with 20 ml of 1% lidocaine solution. Karl Storz Bettocchi® rigid hysteroscope with a 5 mm operative sheath was used. Intensity of pain in numeric rating scale (NRS), intensity of cervical bleeding, frequency of vasovagal episodes, and failure rate were compared. RESULTS: The study involved 201 women, 67 in each arm. NRS value during OH was higher in arm A than in B and C (6.3 vs. 5.1 vs. 5.0; p = 0.01). NRS value after OH did not differ and in all arms pain was imperceptible (p = 0.007). Cervical bleeding was more frequent in arm B than in A and C (76.1% vs. 33.4% vs. 35.9%; p < 0.0001), but its intensity did not differ from the other arms (p = 0.3). Vasovagal episode was most common in arm B (p = 0.048). There was no difference in the failure rate between the arms (p = 0.08). CONCLUSIONS: The paracervical block, albeit technically the most laborious, has proven to be the most beneficial for the patient in terms of overall comfort and for the surgeon regarding feasibility.

Uterine sarcoma - time is worth its weight in gold.

Leiomyosarcoma is one of the most common types of soft tissue sarcoma in adults, and it can occur in almost any part of the body. Uterine leiomyosarcoma constitutes 1% of all gynaecological tumours. Most diagnosed sarcomas are not even suspected before surgery. However, in recent years, awareness of their presence in society has increased. Our case aims to draw attention to the need for better cooperation between pathologists and clinicians and reduce the time from suspicion of the disease to final diagnosis.

Histopathological discrepancies between colposcopy-directed biopsy and LEEP-conization observed during SARS-CoV-2 pandemic.

OBJECTIVES: Long-term exposure to the human papillomavirus (HPV) is a known cause of squamous intraepithelial lesions that lead to cervical cancer. The loop electrosurgical excision procedure (LEEP) conization is an established treatment method. According to the latest recommendations, we present a paper to evaluate the effectiveness of various diagnostic methods of squamous intraepithelial lesions. MATERIAL AND METHODS: We analyzed 229 patients who reported to District Public Hospital in Poznan to undergo LEEP conization in 2019-2021 during the SARS-CoV-2 Pandemic. The analysis included Pap smear/liquid-based cytology, HPV genotyping, colposcopy with targeted biopsy and LEEP-conization. We offered post-treatment HPV vaccination and, as a follow-up, performed HPV re-genotyping after six months. RESULTS: In total, 89.1% of patients were HPV-positive. The coloscopy-directed biopsy (CDB) results show that almost 70% of the patients had high-grade intraepithelial lesions (HSIL). The diagnosis obtained by LEEP-conization showed that half of the women were diagnosed with HSIL and one-third with the low-grade squamous intraepithelial lesion (LSIL). The sensitivity of Pap smear/LBC accounted for 93.7% and was lower than for CDB, which reached 95.1%. Both diagnostic methods tend to underestimate the final diagnosis. CONCLUSIONS: The inclusion of a colposcopic examination in an in-depth diagnostic process in women with abnormal Pap smear results facilitates the identification of patients requiring therapeutic intervention. LEEP-conization may be used without the primary biopsy. It applies to multiparous women in the perimenopausal period, extensive abnormalities, discrepancies in test results, extensive visible abnormalities, and suspicion of invasive cervical cancer in the colposcopic examination.

Human Papillomavirus Infection: Knowledge, Risk Perceptions and Behaviors among SMW and AFAB.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) in the United States, and persistent HPV infection has been established as playing a major role in the development of cervical cancer. Providing HPV vaccination and regular screening tests have reduced the risk of developing cervical cancer or helped to detect the cancer at an early stage. Despite the above measures, cervical cancer still remains a major public health problem worldwide. Infection with HPV, and consequently cervical cancer, affects all people with an intact cervix, so not only heterosexual women, but also women from sexual minorities (SMW) together with people assigned female at birth (AFAB). These populations may be even more likely to develop cervical cancer, mainly because they are less likely to be aware of HPV transmission and prevention of cervical cancer. In our review, we summarized the current state of HPV knowledge, collected data assessing the orientation of this issue among SMW and AFAB, and indicated the causes of possible negligence in the prevention of cervical cancer.

Remission of HPV infection after LEEP-conization - a retrospective study.

OBJECTIVES: Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases. Long-term exposure to the HPV is a known cause of squamous intraepithelial lesions that consequently lead to cervical cancer development. The loop electrosurgical excision procedure (LEEP) conization is an established early cervical cancer treatment method. We aim to assess the remission of HPV infection after LEEP in non-vaccinated patients with pre-cancerous cervical lesions and establish the efficacy of cervical cancer prophylaxis. MATERIAL AND METHODS: We analyzed 31 LEEP conizations performed due to low and high-grade squamous intraepithelial lesions in 2019-2020. We obtained molecular test samples and detected DNA of 37 different HPV genotypes. After a six-month follow-up, each patient underwent subsequent high-risk HPV testing and genotyping. RESULTS: We observed that 54.8% of qualified patients were infected with HPV 16. We discovered complete viral remission in 64.5% of cases. After surgery, margins were negative in 71% of the patient's samples. During the follow-up, six patients got infected with new strains of HPV. CONCLUSIONS: We found that a correctly performed LEEP conization may contribute to the remission of persistent HPV infection; a more extended follow-up period might be recommended due to a high rate of post-surgery HPV infections.

Human papillomavirus genotyping in low-grade squamous intraepithelial lesions.

OBJECTIVES: Human papillomavirus infection is one of the most common sexually transmitted infections. Histological LSIL in 70-80% of cases will regress spontaneously, while a subset is associated with residual risk for a future precancerous lesion. This study evaluates the performance of HPV genotypes for LSIL preceded by normal or mildly abnormal Pap smear. MATERIAL AND METHODS: We provide a prospective observational cohort study. We obtained material from 428 women registered to Specialist Medical Practice and Provincial Hospital in Poznan in 2018-2021. In the current study, we analyze results from the first 112 inclusions with the diagnosis of LSIL from a cervical biopsy. The probe for the molecular test was collected with a combi brush and passed to the independent, standardized laboratory. HPV detection was done using PCR followed by DNA enzyme immunoassay and genotyping with a reverse hybridization line probe assay. Sequence analysis was performed to characterize HPV - positive samples with unknown HPV genotypes. The molecular test detected DNA of 42 HPV genotypes. We performed statistical analyzes using the STATISTICA package 13.3. RESULTS: We found that 77.7% of patients received HPV-positive test results. The most frequent HPV genotype was 16, which was assumed for 22.3%. We detected that following HPV types are next most common: HPV 56 (11.6%), HPV 52 (8.9%), HPV 31 (8.0%) and HPV 51 (8.0%). Among HPV 16-negative women, the vast majority are those living in the town (p = 0.048). Moreover, thyroid diseases were the most common comorbidities. CONCLUSIONS: To our knowledge, this study is the most extensive assessment of HPV genotypes in LSIL diagnoses in Poland.

Human papillomavirus genotyping in high-grade squamous intraepithelial lesion.

OBJECTIVES: Human papillomavirus infection is one of the most common sexually transmitted infections. Long-term exposure to the HPV leads to high-grade squamous intraepithelial lesions affecting cervical cancer. Knowledge about the distribution of HPV genotypes is crucial to guide the introduction of prophylactic vaccines. We aimed the genotype distribution in patients reporting due to abnormal Pap - smear tests. MATERIAL AND METHODS: We provide a prospective observational cohort study. We obtained material from 428 women registered to Provincial Hospital in Poznan and Specialist Medical Practice in 2018-2020. In the current study, we analyze results from the first 110 inclusions with the diagnosis of HSIL from a cervical biopsy. The probe for the molecular test was collected with a combi brush and passed to an independent, standardized laboratory. HPV detection was done using PCR followed by DNA enzyme immunoassay and genotyping with a reverse hybridization line probe assay. Sequence analysis was performed to characterize HPV-positive samples with unknown HPV genotypes. The molecular test detected DNA of 41 HPV genotypes. We performed statistical analyzes using the STATISTICA package 13.3. RESULTS: We found that 98.2% of patients received HPV-positive test results. The most frequent HPV genotype was 16, which assumed for 54.1%. In patients negative for HPV 16, the percentage decreased with increasing age. We detected that the following HPV types are next most common: HPV 31 (16.2 %), HPV 52 (11.7%), HPV 51 (9.9%), HPV 18 (9.0%), HPV 33 (9%). Moreover, thyroid diseases were the most common comorbidities and occurred in 15 patients CONCLUSIONS: To our knowledge, this study is the most extensive assessment of HPV genotypes in HSIL diagnoses in Poland.

Genotyping of human papillomavirus DNA in Wielkopolska region.

OBJECTIVES: Human papillomavirus infection is one of the most common sexually transmitted diseases. Long-term exposure to the HPV leads to development of high-grade squamous intraepithelial lesions that can eventually transform into cervical cancer. The aim of the study was to assess the HPV genotype distribution in patients with abnormal pap smear and provide prospective study. MATERIAL AND METHODS: We obtained material from 674 women who registered to Specialist Medical Practice in the years 2008-2020. The sample for the molecular test was collected using combi brush and forwarded to the independent, standardized laboratory. HPV detection was done using PCR followed by DNA enzyme immunoassay and reverse hybridization line probe assay for virus genotyping. Sequence analysis was performed to characterize virus genotypes in HPV - positive samples. RESULTS: We found that 53% of patients tested positive for HPV. The percentage decreased with age. The following HPV types were the most common: HPV - 16 (24.5%), HPV - 53 (13.1%), HPV - 31 (10.3%), HPV - 51 (9.7%), HPV - 56 (9.5%). To our knowledge, this study is the largest assessment of HPV genotypes in Poland. CONCLUSIONS: Our results suggest that type-specific, high-risk HPV DNA - based screening should focus on HPV types 16, 31, 51, 56.

Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice.

INTRODUCTION: Enhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns. METHODS: Requests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods. RESULTS: Data from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 38%, Americas 33%, Asia 19%, and Africa 10%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding. CONCLUSION: This international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.

Challenging iatrogenic menopause. Oncofertility programme in Poland - a single-centre experience.

INTRODUCTION: Menopause is defined as a 12-month period of time when menstruation permanently ceases. In some cases, menopause may be caused by external factors - for example gonadotoxic treatment that irreversibly damages ovarian tissue leading to loss of its hormonal and reproductive function. Oncofertility is a discipline that merges oncology and reproductive medicine, giving patients a chance to experience parenthood after gonadotoxic treatment is finished. AIM OF THE STUDY: The purpose of the study is to present the implementation and first outcomes of the Oncofertility Programme in the University Clinic of Endocrinological Gynaecology and Gynaecology, University Hospital in Krakow, Poland. MATERIAL AND METHODS: Patients interested in fertility preservation have been consulted in the University Clinic of Endocrinological Gynaecology and Gynaecology in Krakow since April 2016. Preliminary qualification to one of the available methods (embryo cryopreservation, oocyte cryopreservation, ovarian tissue cryopreservation) was conducted. Patients declaring a wish to join the programme were then referred to one of the three infertility treatment centres cooperating with the University Clinic, in order to undergo the chosen procedure. RESULTS: During a period of 24 months, 18 patients were consulted. The youngest consulted patient was 20 years old, the oldest 39. Two years after the first consultation, a telephone survey among consulted patients was carried out to verify whether the patients finally underwent oncofertility procedures, and to ask about their reproductive status. CONCLUSIONS: The problem of fertility issues being inadequately addressed results in low referral rates to oncofertility programmes. Attempts to raise awareness of oncofertility possibilities among oncologists should be undertaken because critically few patients are being referred to oncofertility centres.

Markers of implantation in ectopic and high-risk early eutopic pregnancies.

INTRODUCTION: This study focused on the assessment of HSP-10, HSP-27 and PSG-11 which are one of the first detectable serum pregnancy proteins. Contrary to ultrasound imaging, biochemical methods allow to clarify the pathogenesis and pathomechanism of high-risk pregnancies, fetal anomalies, and abnormal fetal implantation. Early serum concentration estimation of HSP-10, HSP-27 and PSG-11 may be very useful not only in prognosis of pregnancies of unknown localization (PUL), but also as markers of ectopic pregnancies. OBJECTIVES: The aim of the study was to evaluate the expression of HSP-10, HSP-27, PSG-11 implantation proteins in ectopic and eutopic pregnancies, and their mutual correlations. PATIENTS AND METHODS: The study involved 42 healthy women who were hospitalized, due to symptoms of imminent miscarriage, risk of spontaneous abortion, or the diagnosis of an ectopic pregnancy. The subjects were subdivided into two equal groups of 21 women who consented to participate in this clinical trial. Biochemical assays were performed involving PSG-11, HSP-27, and HSP-10 serum concentration. RESULTS: Serum concentration levels of HSP-10, HSP-27, and PSG-11 were significantly higher in pregnancies at risk of spontaneous abortion as compared to ectopic pregnancies. CONCLUSIONS: The results of the study indicate high value of PSG-11, HSP-27 and HSP-10 serum concentrations as predictors of correct implantation site. This may be very useful in prognosis of pregnancies of unknown localization (PUL) and early conservative/surgical ectopic pregnancies treatment if necessary to preserve maximum fertility.

Reduction in the level of antibodies against heat shock proteins 60 during different hormonal protocols in postmenopausal women.

INTRODUCTION: In current literature, the immune-inflammatory theory of atherosclerosis is widely discussed. The role of how heat shock proteins 60 (HSP60) lead to the development of the atheromatous plaque is especially underlined. The aim of the study is to estimate the influence of three hormonal protocols on behavior of antibodies against HSP60. It determines the state of endothelium in postmenopausal women. MATERIAL AND METHODS: The study was carried out on 90 women between 2007 and 2012. All the women were in their menopausal age (51 ± 3 years), from the south region of Poland, with a follicle stimulating hormone (FSH) level above 25 mIU/ml, and with menopausal symptoms disturbing their normal daily activity. The study was done for a period of 6 months. Three groups of 30 randomized patients were formed. In the first group we used transdermal estrogen therapy in a 37.5 µg/24 h dose combined with a 10 mg dose of dydrogesterone. In the second group we applied transdermal estrogen therapy in a 50 µg/24 h dose with 2.5 mg of oral medroxyprogesterone. In both these groups, gestagens were administered continuously. In the third group, we prescribed continuous, oral, low-dose combined estrogen-gestagen therapy with 1 mg of ethinyl estradiol and 0.5 mg of norethisterone acetate. The control group consisted of 30 volunteers who were also from the south region of Poland, in good health, with menopausal symptoms, no menstrual period for the last 12 months, selected considering their age and weight, with an FSH level above 25 mIU/ml and with normal levels of thyroid stimulating hormone (TSH) and prolactin. All patients treated and in the control group were seronegative to Chlamydia pneumonia for the entire duration of the study. In the analysis conducted, nonparametric tests were used (Mann-Whitney U test, Wilcoxon test, Kruskal-Wallis test - ANOVA). RESULTS: After 6 months of hormonal therapy, we found that all schemes of treatment promote a significant reduction in antibodies against HSP60 in all treated groups vs. the control group. CONCLUSIONS: All of the investigated estrogen protocols have a favorable impact on the blood level of HSP60 antibodies in early postmenopausal women who have no cardiovascular risk factors. It triggers a better condition of endothelium.

High live birth rate after conservative treatment of ectopic pregnancy with methotrexate.

OBJECTIVES: The aim of the study was to assess fertility in patients diagnosed with ectopic pregnancy and treated with methotrexate, as well as safety and efficacy of conservative treatment. Also, risk factors of recurrent ectopic pregnancies were determined. MATERIAL AND METHODS: The study included 86 female patients with ectopic pregnancy hospitalized and treated in the clinic of Gynecological Endocrinology, UJCM, Cracow, between 2007 and 2011. A total of 73 patients received a single dose of MTX in the amount of 50 mg/m2 of body surface area. Serum b-hCG concentration was measured on days 4 and 7. The treatment was considered successful when b-hCG concentrations dropped to less than 0.2 mIU/ml without surgery. RESULTS: Among 34 patients on follow-up, 8 (23.5%) did not attempt to conceive again, whereas 26 patients declared their wish to conceive again. The attempt proved to be successful in case of 16 women (61.53%), and they gave birth to healthy children. Average time to pregnancy was 14.9 months (SD +/- 10.9). The first pregnancy occurred after 6 months and the last after 35 months. No congenital birth defects were found in the newborns. CONCLUSIONS: Systemic, conservative treatment with methotrexate is an effective and safe way of managing ectopic pregnancy even in cases with higher b-hCG concentrations. Most patients can be successfully treated without surgery thus they may even be treated in outpatient settings. High fertility can be maintained and is independent of the skills of the operators and access to laparoscopic techniques. Conservative treatment does not increase the risk of recurrent ectopic pregnancy but should be offered in wards that provide 24-hour surgical care.

Markers of insulin resistance in perimenopausal women with endometrial pathology.

OBJECTIVES: To determine and compare the prevalence of insulin resistance and carbohydrate metabolism parameters in women with endometrial pathology MATERIAL AND METHODS: 100 perimenopausal women with abnormal uterine bleeding and/or abnormal endometrium were included into the study. Hysteroscopy with biopsy was performed. The study population was divided into four groups according to histopathological results of the endometrium: non-atypical endometrial hyperplasia, endometrial polyp, endometrial cancer and controls. Fasting glucose and insulin levels and OGTT, IR indexes, occurrence of diabetes, pre-diabetic state, overweight, obesity and hypertension were assessed. RESULTS: Insulin resistance was diagnosed in 41.0% of the patients. The prevalence of markers of insulin resistance increased to 57.1% in cases with confirmed endometrial pathology compared to 31.8% in histologically normal endometrium (p<0.01). The frequency of insulin resistance was 52.6% (p=0.059) and 55.5% (p=0.04), respectively in women with non-atypical hyperplasia and patients with endometrial polyps when compared to the control group. Abnormal parameters of carbohydrate metabolism indicate little sensitivity and specificity in predicting endometrial hyperplastic lesions. The insulin levels at 120 minutes of OGTT correlate best with such changes (concentration >57 microU/ml in case of hyperplasia and >61 microU/ml in endometrial polyps). CONCLUSION: Insulin resistance and carbohydrate metabolism disturbances are common in women with endometrial pathologies. In these patients there is clinical basis for recommending lifestyle modification (change of diet, more physical activity), or for introduction of pharmaceutical insulin-sensitizing agents.

[The incidence of neoplasm in women using contraceptives]. / Czestosc nowotworów u kobiet stosujacych doustne srodki antykoncepcyjne.

Contraceptive is an important issue of women's life. In the present times there are many methods to prevent unwanted pregnancy. Each of them has its advantages and disadvantages and an appropriate choice of the method determines its promotion high efficiency and comfort its application. Today there is no method of contraception, which would not be charged some risk for the application. Following the review will allow literature to analyze impact of the various methods for the development of cancer control means diseases which may constitute a serious threat to health and life women.