Hormonal, apoptotic, proliferative and inflammatory markers' expression in Desogestrel-treated women with ovarian endometriosis.

Endometriosis is a relatively frequent pathology in gynecological practice. We performed an analysis to demonstrate the molecular changes that occur in endometriosis synthetic progestin-treated patients, hoping to sketch a possible pathophysiological pathway that will help us to better understand and treat this debilitating disease. We conducted a prospective study that included a group of 40 women, evaluated in our hospital between 2020-2021. We evaluated immunohistochemical tissue expression of estrogen receptor (ER), progesterone receptor (PR), B-cell lymphoma 2 (Bcl-2) protein, Ki-67, and serum levels of osteopontin (OPN) and vascular endothelial growth factor (VEGF) in patients with ovarian endometrioma with and without progestin treatment. Our study revealed that Desogestrel treatment increases OPN serum levels, PR and Bcl-2 tissue expression and reduces VEGF serum levels and Ki-67 tissue expression. The results we have obtained are very interesting because the serum levels of OPN seem to be more influenced by progestin treatment, than by endometriosis itself. The study we have conducted gives a molecular complex view of what endometriosis represents and on how Desogestrel treatment works.

Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia.

Despite advances in fetal monitoring during labor, one of the most critical causes of neonatal death and neurologic injuries remains intrapartum asphyxia. Umbilical cord gases can be used to detect acidosis and fetal distress. We conducted a retrospective, multicenter study to evaluate umbilical cord blood pH and lactate as a mean of evaluating the degree of intrapartum hypoxia and also to establish which of the two is more reliable in predicting morbidity in term neonates. The present study utilized a total of 124 cases that met the criteria for intrapartum asphyxia and 150 normal term newborns that were randomly selected as case control. Both umbilical cord lactate and pH proved to be accurate predictors of neonatal morbidity caused by intrapartum hypoxia. Lactate proved to be superior to pH in predicting adverse neonatal outcome. The greatest sensibility and specificity in predicting intrapartum asphyxia were achieved in our study by using a cutoff value of 3.75 mmol/l for lactate and 7.24 for pH.

Histological and immunohistochemical study on the apical granuloma.

INTRODUCTION: Periapical granuloma is one of the most frequent periodontal pathology and belongs to the group named as apical periodontitis. MATERIALS AND METHODS: Out of 78 of diagnosed granulomas, we selected samples that we analyzed histologically and immunohistochemically. RESULTS: The histopathological aspect has been dominated by the presence of mononuclear cells of the lymphocyte and plasma cells type, showing the chronic aspect of the apical lesion. Also, we noticed that in the apical granuloma macrophages occur most often. This density of macrophages explains cellular and tissular disruption that occur in apical region of the tooth under the influence of bacterial flora that reached this area, as they have the role to phagocyte pathogens and cell and tissue residues that result from bacterial aggression. The reaction of the plasma cells, determined by their number, has been always associated with the age of the granulomas, and it is more intense in old, neglected granulomas, compared to recent granulomas. CONCLUSIONS: The number and type of immunity cells varies in the apical granuloma accordingly to the age of granuloma.

The acute abdomen in pregnancy and postpartum of a teenager woman. Case report.

The acute abdomen with its many clinical aspects is not a condition that eludes pregnancy; acute appendicitis being the most frequently incriminated, but when it comes to its complication - peritonitis and the pregnant is a teenager, the cases cited in the literature are quite rare. We present the case of a 15-year-old teenager pregnant within 24 weeks admitted from the emergency department with the diagnosis of acute abdomen and operated for generalized peritonitis due to a perforated appendicitis. The microscopic analysis of the specimen indicated the presence of ulceration and extensive and deep and necrosis of the appendicle wall, the residual structures being dissected by a predominantly polymorphonuclear leukocytes inflammatory infiltrate associated with eosinophilic fibrinous deposits. Gangrenous extended necrosis of appendicle tissues, on the background of inflammatory thrombosis of appendicle vessels and mesothelium, sustained the diagnosis of acute gangrenous appendicitis. After a rather difficult evolution, she gave birth to a healthy fetus through a segmental-transverse Caesarean section at 35 gestational weeks. One week after the birth, the patient was operated for bowel obstruction by means of bridles and adherents. Both the appendicitis and the intestinal obstruction syndrome have been resolved by classic surgery. The fetal and maternal, vital and functional prognosis was good.

Clinical and morphological correlations in early diagnosis of endometrial cancer.

The prevalence of endometrial cancer among asymptomatic women is rather reduced also due to the absence of a cost-efficient test, as there are no ideal screening examinations for endometrial cancer. Several methods were proposed in medical practice to discover endometrial neoplasia at an early stage, among which: endometrial biopsy, endovaginal ultrasound, targeted biopsy hysteroscopy. This study was made on a group of 38 patients monitored for metrorrhagia in the interval between July 1, 2014-July 1, 2016. All patients were monitored clinically and by ultrasound, endometrium samples were taken by biopsied uterine curettage, and a histopathological examination was performed, completed by immunomarking, whenever necessary. The clinical and paraclinical methods allowed for the creation of a protocol by which patients were monitored. This protocol allowed for the modulation and effectiveness of the treatment, establishing the best therapeutic conduct and the remote supervision.

Placental abruption: etiopathogenic aspects, diagnostic and therapeutic implications.

The severe form of retroplacental hematoma is a serious accident in the second stage of pregnancy and at birth with frightening for the mother and fetus that often lead to death. The pathological mechanism presumes conditions for a "special ground" capital for the "efficiency" of the acute intradecidual vascular accident with the rupture of the uterus-placental arterioles. The complete clinical picture of this severe form of retroplacental hematoma - the placental abruption, observed and mentioned by the classics (vascular drama of Couvelaire) consists of five syndromes, 18 signs and symptoms, four paradoxes, phenomena not fully met in the other forms of retroplacental hematoma (minor and intermediate). The rate of incidence of retroplacental hematoma is in between 0.13-1.38% and depends on the environment, on the socio-economic and medical conditions, on the "obstetric education" and associated pathology. Our study aims at re-evaluating the clinico-paraclinical phenomenon imposed by the dramatism of the phenomenon of in utero placental apoplexy, the impact on neonatal mortality and on the functional prognosis from the point of view of surgical climax.

Morphofunctional changes in distribution of pressure center in multiple sclerosis.

INTRODUCTION: Gait evaluation and assessment of motor performance are of utmost importance in the clinical management of multiple sclerosis (MS). A new approach to the analysis of static and dynamic balance of MS patients is the use of complex biomechanical analysis that includes an analysis of the distribution of the center of pressure (DCP) and loading, measured by using the pressure and force platforms. PATIENTS AND METHODS: The study was conducted on a total of 18 patients with MS, with the mean age of 41.2 years old, divided into two groups, according to the presence of clinically detectable gait disturbances. The biomechanical analysis that included the assessment of the loading and DPC was performed using the platform of force distribution. DPC represented the center of all the forces applied and its value could appreciate the mediolateral stability, hence the pronation or, respectively, the supination. Group 1, consisting of 12 patients with MS with clinically detectable gait disorders, including six men and six women, and group 2, of six MS patients without clinically detectable gait disorders, including two men and four women. RESULTS: For group 1, the center of pressure had a left-right asymmetric distribution, and also an anterior-posterior one. There was a predominant distribution at the medial heel, at metatarsals 1-3 and at the hallux. For group 2, the analysis of the plantograms recorded in our study indicated a tendency of the distribution of the pressure center in the metatarsals 2, 3 and less in the heel. CONCLUSIONS: The analysis of the loading and distribution of the pressure center was important not only to appreciate the static equilibrium disorders but also to appreciate how these disorders affected the gait initiation, since the patients suffered from anterior-posterior and mediolateral disorders, which produced spatial and temporal distortion preventing gait initiation. In the study of pressure and force, we noticed a predominant distribution on the lateral region of the heel, explained by an attempt of the body to compensate the disorders of balance and orientation of the reaction force of the ground to normalize the gait.

Difficulties of clinical and histopathological diagnosis in advanced vulvar clear cell carcinoma.

Clear cell carcinoma (CCC) of the female genital tract usually arises in the ovary, endometrium, cervix and vagina. A rare site for CCC is the vulva, and moreover even rarer are the cases involving the Bartholin gland. A 54-year-old female was admitted for a 1.5×2 cm tumor at the level of the right Bartholin gland. The magnetic resonance imaging (MRI) exam revealed enlarged inguinal, pelvic and para-aortic lymph nodes but no other primary tumor. Microscopic examination revealed CCC. The tumor was positive for cytokeratin 7 (CK7), paired-box 8 (Pax8), napsin A and vimentin, negative for estrogen receptor (ER), progesterone receptor (PR), calretinin, cluster of differentiation 10 (CD10), carcinoembryonic antigen (CEA), p16 and p63. Also, p53 was expressed in 30-40% and Ki67 in 70% of the malignant cells. Given the clinical, imagistic, histological and immunohistochemical features of the tumor, we concluded that the tumor is a CCC of the Bartholin gland. Aim of the study is to signal a rare case of CCC of Bartholin gland. Since there are only two other cases reported in literature, the natural history and prognosis of the disease is not known, also there are no therapeutic guidelines regarding this rare tumor so appropriate treatment is uncertain. Therefore, it is important that new cases are reported for a better understanding of this rare condition. Bartholin gland carcinoma is a pathology quite rarely encountered in practice. The positive diagnosis is eminently histological and immunohistochemistry. Bartholin gland CCC is an extremely rare diagnosis with, to our knowledge, only two other cases reported in literature, but with a potential aggressive clinical behavior and poor outcome.

Uteroplacental apoplexy associated with invasive cervical neoplasm.

The cervical cancer is the worldwide second neoplasia in women, after the breast cancer. The incidence of invasive carcinoma in pregnancy is 1÷2000 to 1÷10 000 pregnancies. In most of the studies, almost all the patients had microinvasive carcinoma or limited cervical carcinoma at the cervix level. In the uteroplacental apoplexy, pathologically, retroplacental hematoma is formed while the fetus is still in the uterus. When speaking about the uteroplacental apoplexy, the fetal mortality is 100% and the maternal mortality can reach 5%. The particularity of the presented case is the association of the invasive cervical neoplasm, pathology unknown to the patient, with uteroplacental apoplexy, diagnosis for which she was hospitalized as an emergency. After the extraction of the dead fetus by segmental-transversal cesarean section, we continued to perform the total hysterectomy with adnexectomy. The fetus, the placenta, the uterus and the ovaries were sent for histopathological examination. Subsequently, the histopathological bulletin revealed cervical lesions in the neck of type cervical intraepithelial neoplasia (CIN) I, CIN II, CIN III, metaplastic squamous epithelium and moderately differentiated squamous cell carcinoma.

Endometrial proliferative lesions associated with uterine fibromatosis.

Hysteroscopy and uterine curettage are required in cases of atypical hyperplasia in premenopause and in all cases of hyperplasia with/without atypia in postmenopausal women. Biopsic curettage is the method of choice in the diagnosis of endometrial pathology. Transvaginal ultrasound and Doppler examination are useful in assessing the risk of endometrial hyperplasia or endometrial cancer in postmenopausal women without/with continuous replacement therapy, but cannot replace endometrial biopsy to exclude endometrial cancer diagnosis. Medical treatment with progesterone containing drugs addresses endometrial hyperplasia without atypia. Surgical treatment is recommended for premenopausal and postmenopausal patients with uterine fibromatosis associated with atypical hyperplasia as well as patients with adenocarcinoma. Risk of progression to malignancy requires clinical and histopathological monitoring to avoid insufficient treatment of lesions with evolutive risk and aggressive treatment of lesions without risk.

Clinical and paraclinical study regarding the macro- and microscopic diagnosis of various anatomo-clinical forms of operated uterine fibromyoma.

UNLABELLED: The research focused on a systematic review of 959 cases operated for uterine fibromyoma (24.8%) from 3859 gynecological surgeries performed over a period of 10 years (2000-2010). MATERIALS AND METHODS: The important parameters were those related to the general clinical and laboratory data, and especially those focused on the macro- and microscopic histopathological diagnostic methods. Thus, we inserted some details on the methods used for the histopathological examination of surgically removed samples. RESULTS: The age of patients operated for uterine fibromyoma was between 20 and 60 years, with the highest incidence in the 40-50 years group (594 cases--62.4%). The most frequent anatomo-clinical forms observed were uterine fibromyoma with menometrorrhagia (78.9%), large uterine fibromyoma associated with compression and metrorrhagia (81.1%), uterine fibromyoma with aseptic necrobiosis (33.6%). The other forms showed a reduced frequency. Uterine fibromyoma associated with infertility was found in patients under 40-year-old, their evolution being initially asymptomatic. The incidence of uterine fibromyoma, which degenerated into a leiomyosarcoma, was "0". DISCUSSION: 1/5 of patients operated after the age of 35 years presented with various anatomo-clinical forms of uterine fibromyoma. Several hypotheses are formulated regarding the etiopathogenesis, morphology and embryogenesis of this benign tumor of the myometrium. The estrogen-progestogen hormonal imbalance after this age in correlation with the genetic predisposition lead to the synthesis of various proteins, enzymes, and growth factors, decrease of apoptosis and stimulation of leiomyomatous cells with the development of a large, even gigantic form of fibromyoma, representing the most common form encountered in our study. The medical treatment with progesterone derivatives did not lead to the expected results, radical surgery usually being the final therapeutical approach. CONCLUSIONS: Between 31 and 60-year-old, the incidence of operated uterine fibromyoma was 941 cases out of 959 (98.1%). The correlation between the preoperative clinical and laboratory diagnosis, the intra-operative morphological appearance and especially the post-operative histopathological examination was 100%. In all cases of uterine fibromyoma, histopathological examination was and will remain the sovereign exploration for surgical practice in general and for gynecological surgery in particular.