Results of extension of classic indications of vaginal hysterectomy for benign uterine conditions.

OBJECTIVE: to compare the results of two surgical approaches: one is to apply vaginal hysterectomy (VH) for non-prolapsed uterus respecting classic indications and contraindications and the other is to extend the indications of VH and decrease the contraindications by performing VH for large uterus, in nulliparous and in women with history of C section. STUDY DESIGN: 816 women with benign uterine pathology were included in this prospective study. In 465 were applied classic indications of VH and in 351 VH was applied as first choice, trying to overcome classic contraindications of VH. RESULTS: By extending classic indications of VH important benefits were obtained such as decreasing the operation time and shorter hospital stay. No differences were registered between the two arms of the study regarding intra and postoperative bleeding or major complications. CONCLUSIONS: extending classic indications of VH has important benefits without an increase in major complications occurrence.

Human papilloma virus infection and cervical dysplasia.

UNLABELLED: Pap testing is considered to be the best screening tool for cervical cancer but there is currently great interest in the possible application of human papilloma virus (HPV) testing to supplement Pap screening for cervical cancer. AIM: To determine the prevalence of high-risk HPV types in the studied population and to explore the association between high-risk HPV types and cervical dysplasia. MATERIAL AND METHODS: Cross-sectional study conducted at the Iasi Cuza Voda Obstetrics-Gynecology Hospital and Suceava County Hospital. 332 women who underwent colposcopy for cervical lesions between 2006 and 2011 were included in this study. RESULTS: The overall prevalence of HPV was 57.23%. HPV prevalence differs significantly in the three age groups up to 50 years. It was highest in patients below the age of 40 and progressively lower with advancing age. The overall prevalence of cervical dysplasia was 56.62%. The prevalence of cervical dysplasia was highest in the age groups up to 40 years. The most important determinant of HPV infection is age. CONCLUSIONS: Persistence of HPV appears to be associated with progression to squamous intraepithelial lesion. Dysplasia is often missed in a cervical sample either because of human error in screening and interpretation, or because of suboptimal quality of Pap smear. Incorporation of HPV testing into the present Pap screening program has the potential of making screening for cervical cancer more effective, and a necessary prelude to assessing this is by determining the prevalence of the high-risk types.

[Diagnostic problems in fetal echocardiographic examination. Observations on a lot of study during 2005-2010]. / Probleme de diagnostic în examinarea ecocardiografica fetalaa. Observatii pe un lot de studiu in perioada 2005-2010.

UNLABELLED: Echocardiography is the key diagnostic method in the diagnostics of structural heart pathologies. AIM: To underline some possible situations that may cause errors in ultrasound examination of the fetal heart. MATERIAL AND METHOD: We examined a number of 39,370 fetuses along a period of six years. The ultrasound scan was performed according with international standards of basic and extended cardiac scan. RESULTS: 442 of them (1.12%) were diagnosed with cardiac malformations. CONCLUSION: Ultrasound examination errors can cause false positive, false negative or incomplete diagnosis. Limitations in fetal echocardiography are related to the examiner experience to do an accurate diagnosis. The difficulty of assessing complex congenital heart lesion is increased. The unsatisfactory study should be repeated and sometimes the exact diagnosis requires sequential procedures. The aim is to define fetal heart anatomy and adise the family, in collaboration with neonatologist. The final results ia an optimal behavior for the fetus and newborn.

[Agnogenic myeloid metaplasia in pregnancy. Case report]. / Metaplazia mieloida agnogenica si sarcina. Prezentare de caz.

UNLABELLED: Idiopathic myelofibrosis is a rare myeloproliferative disorder characterized by excessive accumulation of connective tissue in the bone marrow in association with anemia, splenomegaly and extramedullary hematopoiesis. A rare case of pregnancy in a patient with agnogenic myeloid metaplasia who carried a term pregnancy is described. In spite of the increased perinatal risks, a favorable outcome was possible with close antepartum surveillance. CONCLUSION: Idiopathic myelofibrosis was once thought to be a contraindication to pregnancy. With careful management, successful pregnancies can be achieved.

[Renal colic in pregnancy]. / Colica nefretica la gravide. Experienta clinicii urologice Iasi.

UNLABELLED: Renal colic in pregnant women is a serious condition, mainly when is associated with fever. MATERIAL AND METHOD: Our retro-prospective study analyzes 111 cases managed conservatively or with endourological procedures for renal colic--insertion of JJ stents and percutaneous nephrostomy. RESULTS: Clinical evolution determined the insertion of JJ stents in 60 cases and the failure of this procedure imposed percutaneous nephrostomy in 5 cases. In 56 cases urinary tract infection was associated and in 2 cases, despite all efforts, the patients deceased due to sever sepsis. CONCLUSIONS: The immediate drainage of the upper urinary tract for renal colic in pregnancy is the recommended treatment, especially when the pain is associated with fever. JJ stens were well tolerated, even when they were replaced after 3 months. Pregnant women with a history of UTI or stone disease should be carefully followed-up.

[Endometrial hyperplasia, diagnosis. Clinical, paraclinical exam and management]. / Metodologia diagnosticului hiperplaziilor endometriale examen clinic, paraclinic si management.

UNLABELLED: Factors associated with unopposed estrogenic stimulation such as obesity, exogenous hormone use endometrial hyperplasia are related to the development of the most common form of endometrial carcinoma, that is, the endometroid subtype. MATERIAL AND METHODS: We selected a group of patients diagnosed with endometrial hyperplasia by endometrial biopsy and histopathological examination. The main complaint in all cases was abnormal uterine bleeding. All patients had gynecological examination, vaginal ultrasound, hysteroscopy endometrial biopsy or D&C. 32 patients had also immunohistochemical staining for Ki67, EGF, ER, PGR. RESULTS: Cases with ages between 24-67 years were classified as: 100 simple hyperplasia, 10 complex hyperplasia, 43 atypical simple hyperplasia, 7 atypical complex hyperplasia. PR were 40-60% at all forms of hyperplasia, E2R were 30-40% in simple hyperplasia without atypia and 50-70% in complex hyperplasia without atypia. Correlation between immunohistochemical expression of E2R, PGR, Ki-67, EGF and body mass revealed an high immunohistochemical expression of E2R and Ki-67 in patients with hyperplasia without atypia and a low expression and high reactivity of EGF in cases with high body mass. CONCLUSIONS: Vaginal ultrasound and hysteroscopy are efficacious completion for histopathological diagnosis. We recommend an age/risk appropriate screening to detect risk factors and early disease in the asymptomatic patients.

[Breast cancer in women over 60 years of age]. / Cancerul mamar la femeile cu vârsta peste 60 de ani.

UNLABELLED: The breast cancer is the most frequent malignancy in women over 60 years of age in the developed countries and it represents the second frequent cause of death through malignancies in women. MATERIAL AND METHOD: The study was performed on 63 women over 60 years old diagnosed with breast cancer in an one year period (2006) in our service. The aim of the study is to establish the clinical particularities and the optimal therapeutically management of this disease on elderly women. RESULTS: The incidence of the malignancy is high (78% of all cases) in women of 60 to 69 years of age. The most common risk factor revealed in this study is obesity (33%). Cardiovascular diseases (70%) and atrophic cervico-vaginitis (43%) are the most frequent associated conditions. The incidence of the early stages of the malignancy is low (14%) and usually the tumors are well differentiated ductal invasive carcinomas (63%). The modified Madden radical mastectomy was performed in most of the cases (75%). CONCLUSIONS: Breast cancer in elderly women has an incidence peak at the age of 60 to 69 years. Despite numerous associated conditions the surgical treatment remains the most effective therapy.

[Breast cancer in diabetic patients]. / Cancerul mamar la pacienta diabetica.

UNLABELLED: Many of the risk factors for postmenopausal breast cancer are related to excess estrogen exposure. Hyperinsulinemia associated with type 2 diabetes mellitus may promote breast cancer via increased peripheral production of estrogens and direct mitogenic effect of insulin itself. MATERIAL AND METHODS: Our retro-prospective study compares breast cancer characteristics between two study groups consisting of 53 diabetic and 391 non-diabetic patients diagnosed and treated for breast cancer. RESULTS: Almost 12% of the patients presenting breast cancer were diabetic and menopause occurred at 48.71 years for diabetic patients and at 49.87 years for the non-diabetic ones. Type 2 diabetes mellitus patients were treated by diet and oral agents, had greater body mass index (32.18 kg/m2), presented well differentiated (57% in G1) but greater (68% in T2) tumors and an increased incidence of lobular (13%) and mixed type (19%) carcinoma. CONCLUSIONS: Diet and physical exercises as methods for preventing type 2 diabetes mellitus together with screening strategies among diabetic patients could contribute to decreasing the incidence of breast cancer.

[Obstetric management of Klippel-Trenaunay syndrome. A case report]. / Managementul obstetrical in cazul unei paciente cu sindrom Klippel - Trenaunay. Prezentare de caz.

UNLABELLED: A rare case of pregnancy in a patient with Klippel-Trenaunay-Weber syndrome is described. The arterio-venous anomalies in this patient originally occurred in her left leg. Her pregnancy was uneventful. A Cesarean section was performed at term. There were no signs of intravascular coagulation or cardiac decompensation. Prophylactic anticoagulant treatment was given during the 3rd trimester and into the early puerperium The clinical course and the risks of a pregnancy with this condition are discussed. CONCLUSION: Klippel-Trenaunay syndrome was once thought to be a contraindication to pregnancy. With careful management, successful pregnancies can be achieved.

[Cervugid ovules in cervico-vaginal infections and cervix uteri precancerous conditions treatment]. / Tratamentul infectiilor cervico-vaginale si a starilor precanceroase ale colului uterin cu Cervugid-ovule.

UNLABELLED: This medicine was authorized by the National Drug Agency (ANM, Bucuresti) in 2001. PURPOSE: To evaluate the effectiveness and the tolerance to Cervugid-ovules, a preparation that combines the polyvalent local antiinflammatory action of chloramphenicol, metronidazole and nystatin with the effect of hydrocortisone acetate, an unspecific anti-inflammatory agent; they all are embedded in a Lipex-403, semisynthetic fat. MATERIALS AND METHODS: The evaluation of 500 patients ages between 15 and 85 years with genital infections, registered in the files of "Cl. II Obst. and Gynecology" of the Cuza-Voda Hospital from Iasi has been studied. We studied the subjective manifestations (local discomfort and pelvic pains, local burning and dryness,vulvovaginal itching and dyspareunia) and objective manifestations (vaginal and cervical secretion, the cytotest performed and colored though the Papanicolaou method and reported in the Bethesda system). RESULTS AND DISCUSSION: Healing of the subjective symptoms in 98%, healing of the leukorrhea--as a main objective symptom--in 95%; The Bethesda system cytotest was one of the inflammatory type in the most of the cases and there wew found in 85 cases: 6 ASCUS, 41 LSIL, and 37 HSIL. The use of Cervugid had a healing response in most of the cases when used in acute and chronic cervico-vaginal inflammatory processes. Cervugid may be considered as an important agent in the treatment of the precancerous affections af the cervix uteri on the following reasons: zhe cure of the infections caused by chlamydia, involved in the etiology of cervical neoplasms, the cure of the HPV infection under episome form, classified in the Bethesda system within the ASCUS, AGUS or LSIL classes. When the cytotest was in the HSIL class, a conization in the LLETZ method was performed. CONCLUSIONS: Cervugid is conceived for those three main categories of pathogenic factors related to the etiology of cervico-vaginitis: microbia germs, protozoa and mycosis. In addition, it is active on chlamydia and mycoplasms, always sensitive to chloramphenicol therapy. That is why Cervugid with in local administration is indicated in the microbial, trichomoniasis and mycotic vaginitis caused by one category of pathogenic agents or by associated forms, in cervicitis, in the pelvic inflammatory processes (pelvic congestion, metritis, adnexitis, and inflammatory processes associated with benign or malignant tumors of the genital apparatus). The results obtained proved that Cervugid is highly effective medicine.