Uterine rupture at 28 weeks of gestation after laparoscopic myomectomy - a case report.

There are many reasons for sterility, and uterine malformations are of the greatest concern. Among uterine disorders, myomas play a significant role and are present in 27% of infertile women. The occurrence of myomas is frequent - 20-40% in women of reproductive age. Thus, for those infertile patients surgical treatment may be needed to preserve an opportunity to conceive. This case report refers to an uterine rupture at 28 weeks of gestation after laparoscopic myomectomy (3 months before conceiving). The myomectomy was conducted correctly and two layers of sutures on the myometrium were performed. The purpose of the myomectomy in a young woman should be well considered. In cases of infertility, removal of the lesions is usually necessary to give the patient a chance of pregnancy. At the same time, the risk of uterine rupture is increased. There are some suggestions referring to myomectomy to reduce the risk of uterine rupture in a subsequent pregnancy. It seems that the method of sewing the uterine closure is crucial. For example, multilayer uterine stitches, preservation of the endometrial cavity, and avoidance of using electrosurgery to prevent devascularization (to avoid haematoma formation) should be taken into consideration to prevent weakness of the wall of the uterus. Uterine scars differ histologically and biochemically.

Canonical analysis of concentrations of toxic metals in endometrium of women with gynecological disorders.

OBJECTIVES: Among the main adverse environmental factors, we usually distinguish the impact of heavy metals, especially Cd and Pb. Apart from the carcinogenic and toxic properties, their potential, stimulating estrogen receptors effect (metaloestrogens) is strongly emphasized; as well as participation in gene regulation mechanisms (epigenetic). The aim of this study is to examine if there is a special scheme of concentrations of heavy metals accumulated in the female endometrium in certain pathologies: endometrial hyperplasia, endometrial cancer, endometrial polyps and miscarriages. The control group consisted of patients with abnormal uterine bleeding or functional bleeding with correct histopathological findings. MATERIAL AND METHODS: The study was performed on 92 women. Microwave induced plasma atomic emission spectrometry was used to assess metals concentrations in tissue material and the results of obtained concentrations were converted to µg/kg. The calculations were performed using discriminant and canonical analyses and revealed four discriminant functions. RESULTS: The results showed that metal's tissue concentrations vary in different types of histopathological diagnosis and the scheme of concentrations might be characteristic for analyzed diagnosis. Pb and Al has the most substantial impact on discrimination. CONCLUSIONS: Endometrium may accumulate toxic metals such as: Pb, Cd, Ni, Mn, Cu, Zn, Al, Cr. It can be assumed that there are characteristic distributions of toxic metals concentrations for individual histopathological diagnoses.