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.

Maternal-fetal prognosis in HELLP syndrome in a level 3 maternal-fetal care centre.

PURPOSE OF INVESTIGATION: The purpose of this study was to evaluate the maternal and perinatal outcome and prognosis in pregnant women with HELLP syndrome. MATERIALS AND METHODS: Medical records of eligible pregnant women with HELLP syndrome were reviewed retrospectively. Patients were evaluated in terms of maternal complication, as well as the types of delivery. Perinatal outcome were evaluated in terms ofApgar score, birth weight, respiratory distress syndrome, and neonatal intensive care unit admission. RESULTS: The leading maternal complications associated with HELLP syndrome were the following: severe preeclampsia, eclampsia, placental abruption, acute pulmonary edema, acute kidney failure, disseminated intravascular coagulation syndrome, and immediate maternal death. The most prominent neonatal outcomes associated with HELLP syndrome were: antenatal fetal death, intrauterine growth restriction, prematurity. CONCLUSION: The management and delivery of the patients with HELLP syndrome must take place in a tertiary referral maternal and fetal care centre.

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.

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.

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.

Postpartum splenic rupture: a possible iatrogenic event, but finalized with successful conservation of the spleen.

The authors present the case of a postpartum splenic rupture induced probably by iatrogenic injury (recent vaginal delivery with a prolonged expulsion with uterine fundus compression) including the left hypochondria region costal grid. The case was solved with splenic preservation and achieving hemostasis only by local plugging and Gelaspon. The case raised also other problems regarding the etiology of splenic rupture, in establishing a causal relationship between a intrapartum splenic injury, and the three episodes of inferior genital tract hemorrhaging, in establishing the cause of the infectious syndrome from the 24h postpartum day, (parietal infection or splenic abscess requiring splenectomy).

An unusual enhanced Doppler vascular profile of a rare uterine tumor: PEComa.

PEComas represent a rare class of mesenchymal tumors, with different primary locations. There are less than 100 cases of uterine PEComas published in English literature until now and information considering imaging features of these PEComas is very limited, focusing on CT and MRI and not as much on ultrasounds (US). The authors present here a case of rapidly growing uterine PEComa, with local invasive potential and recurrence, and the review of literature on US characteristics of PEComas. Harboring a hyperechogeneous heterogeneous aspect with no clear separation from the adjacent uterus on the whole boundary, with an extremely rich central vascular network, with low impedance and a rapidly growing profile, this tumor does not show the classic US appearance of malignant PEComas, which are generally easily confused with leiomyomas. However, even if this pattern did not allow the authors to anticipate the histopathological result, it offered clear clues about its invasiveness potential.

Clinico-epidemiological study of endometrial hyperplasia--a risk factor for the development of endometrial carcinoma?

AIM: Metaplasia is defined as a transformation of an adult epithelial or conjunctive cellular type into another adult cellular type. Endometrial hyperplasia and particularly complex atypical hyperplasia exposes to a high risk of development of the endometrial carcinoma, being considered a lesion precursory to the same. Endometrial hyperplasias are risk factors for the development of endometrial carcinoma and their prophylaxis implies their accurate diagnosis, taking into account that the adenocarcinomas diagnosed in an advanced stage, whose therapeutic context differs from the early stages, have a much lower chance of survival. MATERIAL AND METHODS: Our study aimed at highlighting objective criteria in establishing the morphological diagnosis and in evaluating the prognostic elements. The studied batch included 875 patients with endometrial hyperplasia and 263 patients with endometrial adenocarcinoma, who were admitted between 2003 and 2007, and the histopathologic diagnosis was obtained by processing the hysterectomy pieces. The presence of this tumour was at its highest level half-way through the study, which was in 2005. RESULTS: According to the study, there was a higher proportion of patients with endometrial carcinoma from the urban environment (58.2%) than the ones from the rural environment (only 41.8%). Depending on their age, most cases of endometrial adenocarcinoma were diagnosed in 53-year old patients, with an average age of 58.94 years. Our study, made of the two batches of endometrial adenocarcinomas, shows that between the endometrial and non-endometrial adenocarcinoma there are significant differences related to the patients' age, the morphological aspect of the carcinoma, the architectural degree, the nuclear degree of tumours and the invasion in the myometrium. CONCLUSIONS: Our study proves that endometrial hyperplasia is a frequent diagnosis in peri- and postmenopausal patients and is frequently identified following investigations for an abnormal uterine bleeding. The age of patients with endometrial carcinoma is an important prognostic factor independent of other parameters. The difference between complex hyperplasia with no atypias and complex hyperplasia with atypias is important, because atypical complex hyperplasia is considered the precursor of endometrial adenocarcinoma.

Pelvic endometriosis and uretero-hydronephrosis: clinical, imagistic and surgical implications--case report.

UNLABELLED: Endometriosis represent the presence and proliferation of functional endometrial-like tissue outside the uterine cavity, and is a chronic, recurrent, debilitating desease, in which kidney implications are rare, but complex. OBJECTIVE: Evaluation of clinical, imagistic and surgical implications of uretero-hydronephrosis secondary to recurrent pelvic endometriosis. MATERIAL AND METHODS: 30 year old patient diagnosed with primary infertility and left ovarian endometriosis (treated with classically conservative surgical procedure), presented acute onset of obstructive urinary symptoms, requiring internal drainage of the upper urinary straight path (Cook probe) for uretero-hydronephrosis grade III. CT and MRI examination reveals the presence of a imprecise pelvic mass incorporating right distal ureter and uretero-bladder ostium. RESULTS: In this clinical and laboratory context, classic surgery is practicing with right anexectomy and direct right uretero-vesical reimplantation, also with psoas bladder-hitch. Histopathological examination confirmed the presence of recurrent ovarian endometriosis with right distal ureteral invasion. CONCLUSION: Recurent endometriosis, although considered a benign condition, often present invasive characters, determining considerable anatomical destructions and severe symptoms.

Benign breast disease and the risk of breast cancer in the next 15 years.

AIM: Fibrocystic mastosis (FCM) is defined by the totality of dystrophic changes of the mammary tissue, the grouping in the form of fibrosis of epithelial, cystic, metaplastic and hyperplastic alterations. A very good estimation of the cancer risk is related specifically to the microscopic aspect. Other factors, the family history as well as the presence of an inherited gene determining the increase in the risk of breast cancer are also considered. But, if a woman known with fibrocystic mastosis has not undergone any biopsy, then it is impossible to calculate the specific individual risk of developing cancer. MATERIAL AND METHODS: The data collected as a study material and considered refer to: the total num- ber of cases investigated and diagnosed with fibrocystic mastosis, the annual distribution of this disease cases, the distribution of the cases according to age groups, admission reasons, clinical examination, personal pathologic history clinically significant for the basic disease (the main diagnosis), the family medical history significant for the basic disease, the anatomopathological diagnosis. RESULTS: Between 2004 and 2006, at "Cuza Voda" Obstetrics and Gynecology Hospital of Iasi, a maximum number of cases is noticed in 2006, when there were 147 cases, and the lowest number of cases was in 2005. There was high frequency of the anatomopathological examinations that highlighted the presence of fibrocystic lesions (both proliferative and non-proliferative), and the second most often diagnosis is fibroadenoma. Though fibrocystic mastosis is not clearly defined, it is still admitted that in order to support this diagnosis it is first compulsory to exclude malignant tumours. CONCLUSIONS: Only in 5% of the women with fibrocystic mastosis cellular changes can be revealed in the form of atypical hyperplasia, which are a risk factor for cancer. The lesion that delimits cancer from non-cancer is ductal carcinoma in situ. An incidence of over 20% is present in the countries that use mammographic screening programmes, mammographic surveillance programmes and programmes for the guided localization of nonpalpable lesions of the mammary gland.

The endovaginal ultrasound finding of a thin and regular endometrium is uncommon in endometrial cancer.

AIM: To present the clinical and ultrasound features in patients with endometrial cancer in whom the endometrial thickness was less that 5 mm. METHOD: Retrospective study on 263 patients with endometrial carcinoma in whom the ultrasound evaluation of the endometrium was performed. The features noticed in the patients with endometrial thickness below 5 mm are presented. RESULTS: In 249 (94.68%) of our patients with endometrial carcinoma the mean endometrial thickness was 15 mm. In 14 patients (5.32%), in whom biopsy was performed prior to ultrasound examination, endometrial thickness was less than 5 mm. CONCLUSIONS: A thin and regular endometrium (below 5 mm) rules out an endometrial carcinoma provided that no biopsy has been performed within 3 months before ultrasound examination.

[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.

The use of the supra-pubic fibrous complex in isthmic hysteropexies.

This study forwards a new surgical approach we have performed in the treatment of genital prolapse, associated or not with stress urinary incontinence. The study used 150 patients with genital prolapse and stress urinary incontinence in various stages, and lasted from 1985 until 2001. Four-five threads of silk were passed through the uterine muscle in the isthmus area, just below the bladder-uterus recess, and fastened to the supra-pubic ligament complex. Although the mechanical basis for this surgical approach is not entirely clear, no relapse, incident or post-surgery complications (bladder voiding problems, enteroceles, detrusor instability, urethra or bladder bottom lesions, incomplete urinary retention or clearance, hematoma or abscess of the Retzius space) were noted in any of the studied cases. The suspension of the uterine isthmus on to the supra-symphyseal fibrous complex leads to an increase in urethral closure pressure during the occasional increase of intra-abdominal pressure (cough, laughter, spontaneous movements, walking), the results being superior to the other methods used for treating genital prolapse.