[The Misgav-Ladach method for cesarean section compared to the Pfannenstiel technique]. / Ciecie cesarskie sposobem Misgav-Ladach w porównaniu z technika Pfannenstiela.

OBJECTIVE: The aim of the study was to evaluate the outcome of two different methods of cesarean section. To determine whether the Misgav-Ladach caesarean technique can offer benefits when compared with conventional Pfannenstiel caesarean section technique. STUDY DESIGN: This study describes operative details and the postoperative course of 110 patients who underwent caesarean section in May 2000 to December 2000 in Department of Gynecology and Obstetrics in Regional Hospital in Slupsk, Poland. METHOD: One group (50 women) was operated with the Misgav-Ladach method for caesarean section and the other group (60 women) with Pfannenstiel method. RESULTS: Operating time was significantly different between the two methods, with an average of 20.2 minutes with the Misgav-Ladach method and 47.3 minutes with the Pfannenstiel method (p < 0.001). Time of child delivery was with average 1.1 minutes with the Misgav-Ladach method and 3.8 minutes with the Pfannenstiel method (p < 0.001). The amount of blood loss different significantly, with 336 ml and 483 ml respectively (p < 0.001). No significant difference was found in Apgar scores. No difference was found in overall postoperative complications, wound infection, febrile illness, febrile morbidity, wound dehiscence affected by the new technique. Significantly less suture material was used during Misgav-Ladach caesarean section compared to Pfannenstiel technique (p < 0.001). CONCLUSION: The Misgav-Ladach method of caesarean section has advantages over the Pfannenstiel technique by being significantly quicker to perform, with the reduced amounts of bleeding and suture material. The women were satisfied with the appearance of their scars. In this study no negative effects of the new operation technique were discovered.

[Hydronephrosis in course of actinomycosis of female reproductive organs]. / Wodonercze w przebiegu promienicy zenskich narzadów plciowych.

OBJECTIVES: Pelvic actinomycosis is a chronic suppurative granulomatous disease caused by an anaerobic Gram positive germ, Actinomyces. The most difficult task was to obtain the diagnosis in a patient with an intrauterine device and poor general health, signs of infection and a pelvic syndrome. RESULTS: This is a report of a case of hydronephrosis in course of actinomycosis of female reproductive organs in a patient aged 46 years with the intrauterine contraceptive device admitted to The Department of Gynecology & Obstetric in Hospital of Slupsk. Symptoms were presented as an acute abdomen associated with painful epigastric and mass in right adnexa. A pre-operative diagnosis of the right hydronephrosis, on ovarian tumor and uterus myoma were detected which lead to an extensive and difficult surgery. The pathologic process infiltrated the retroperitoneal space simulated sarcoma or lymphoma. The disease was serious and required hysterectomy with salpingo-oophorectomy and intra-abdominal drainage. Actinomycosis was confirmed by the postoperative histopathologic examination, and the patient was successfully treated with penicillin. The patient was completely free of symptoms two months within the operation. CONCLUSIONS: In patients who have intrauterine contraceptive devices or who have had them removed recently, abdominal pain, recurrent vaginal bleeding or adnexal masses should prompt a thorough search for potentially pathogenic actinomyces in the genital tract.

[Pregnancy and delivery in women over 40 years old]. / Ciaza i poród u kobiet po 40 roku zycia.

UNLABELLED: Our purpose was to describe the maternal and fetal outcomes of pregnancies in women of 40 years or older who delivered in the Department of Gynecology and Obstetrics in Hospital of Slupsk (Poland). STUDY DESIGN: We reviewed the delivery records of 98 mothers aged 40 years and above who delivered since 1st January 1999 to 31st December 2000 and we compared them with 100 younger ones (20-30 year-old) comprising the control group. MATERIAL AND METHODS: The women of 40 years or older had lower education status rate (p<0.001) and more often were cigarette smokers (p<0.001) than those of control group. The mean duration of gestation was significantly shorter in women of 40 years or older (p<0.001). The older mothers had an average of 5.1 antenatal visits, whereas the younger ones 7.5 (p<0.001). Preterm delivery was observed more frequently in the older mothers compared with controls (19% vs 5%) (p=0.002). Pregnancies in older women ended significantly more often by cesarean section than in younger women (p=0.001). The rate of cesarean section was 40% in older women compared to 19% in young mothers. Significant differences were observed at 1-min and 5-min Apgar score (p=0.02 and p=0.04). The older mothers had an average of 7.9 at 1-min Apgar score versus 9.0 of younger and 8.5 at 5-min Apgar score, whereas the younger ones 9.3. CONCLUSIONS: Older pregnant women had increased risk of preterm delivery, cesarean section, and lower Apgar score. These data suggest that the prenatal care of older mothers should concentrate on the prevention of premature deliveries and the improvement of perinatal care.

Factors affecting the survival of 121 patients treated for endometrial carcinoma at a Polish hospital.

A retrospective analysis was made of 121 patients treated for endometrial carcinoma. Patients who were married and were professionally active at the time of the diagnosis of endometrial cancer had a significantly longer predictive 5-year survival in comparison to other groups of patients. A significantly longer expected 5-year survival was observed in married patients compared to widowed and single patients (P=0.01). Patients who were professionally active at the time of diagnosis had a longer expected 5-year survival than retired patients and housewives (P=0.05). Statistically better prognoses were confirmed in patients with clinically less advanced disease (P=0.003) and a lesser degree of histologic differentiation (P=0.04). However, obese patients had a longer 5-year survival compared to non-obese patients and the difference was statistically significant (P=0.05). Body-mass index (BMI) in the range of 25-29 had a favourable influence on predictive 5-year survival (P=0.05).