Endometriosis in a post-laparoscopic scar – case report and literature review

Endometriosis is an estrogen-dependent, chronic disease consisting in implantation and hyperplasia of the endometrium outside of the uterine cavity. Endometriosis in post-laparoscopic scars applies to approx. 0.5-1% of the extraorganic locations of the disease. The purpose of the paper was to describe medical management and literature review for endometriosis in a post-laparoscopic scar. Two lesions located near the insertion site for the lower trocars were removed along with the border of healthy tissue. At the time of publication of this paper the patient did not report any complaints. In conclusion, each limited lesion in the subcutaneous tissue, with pain intensifying during menstruation, should suggest an initial diagnosis of scar endometriosis, regardless of patient age and type of surgery

Management of birth, postpartum care and breastfeeding — Polish recommendations and guidelines during SARS-CoV-2 pandemic

SARS-CoV-2 pandemic is an unusual phenomenon in the modern obstetric and midwifery history. Hospital staff from the isolation wards were trained in the safety and proper use of the hazardous materials suit and the proper managing of the biohazard materials. We were not expecting the situation, so we started to create more restrictions than facilities for mothers giving birth. In the context of infection risk for the fetus, scientists still search for vertical transmission evidence, but available data are ambiguous, and more research is needed. Concerning the infant safety and to minimalize the infection risk for medical teams, the first Polish guidelines published by the national consultants in obstetrics, midwifery, neonatology, and perinatology regarding the safest formula of birth were as the following: in the case of confirmed SARS-CoV-2 infection, the cesarean section for epidemic indications should be considered, except in an advanced or rapid labor. In the lately updated consensus (14th May), it was written that because the risk of vertical and intranatal SARS-CoV-2 transmission seemed to be low, the SARS-CoV-2 infection was not the main indication to perform cesarean section for any longer. Regardless of the birth formula, the newborns are separated from their mothers immediately after the labor in Polish obstetrician hospitals. The Polish Lactation Study Centre, consociating International Breastfeeding Certified Lactation Consultant, recommends feeding the newborn with its own mother’s milk, even if she is infected with SARS-CoV-2 and isolated from her infant

Mięśniak komórkowy w więzadle szerokim macicy – opis sytuacji klinicznej i przegląd piśmiennictwa

Myomas are most often benign tumours of the female genital tract. Uterine fibroids are the most common myomas, while uterine cervix and intraligamentary ones are statistically less frequent. The most common histopathological form is the leiomyoma and the least common is the cellular leiomyoma (Mięśniaki są najczęstszymi łagodnymi guzami żeńskich narządów rozrodczych. Mięśniaki macicy rozpoznawalne są najczęściej podczas gdy mięśniaki szyjkowe i międzywięzadłowe występują statystycznie rzadziej. Najczęstszą formą histologiczną mięśniaków jest mięśniak gładkokomórkowy a najrzadziej rozpoznawalną

Udział czynników chemokinowych i niechemokinowych w występowaniu dolegliwości bólowych u pacjentek z torbielami endometrialnymi

Objectives: Endometriosis is a chronic disease manifested as peritoneal endometrial implants and adhesions, as well as endometrial cysts, with pain as the dominant component. The aim: The aim of the study was to evaluate the role of chemokine (MCP-1, MCP-2, MIP-1α, MIP-1β and RANTES) and non-chemokine (urocortin, ghrelin, and leptin) factors in the intensity of pelvic pain in women with endometrial cysts. Material and methods: A total of 86 women, aged 18-38, treated laparoscopically between September 2009 and November 2012, due to adnexal changes, i.e. endometrial cysts and mature teratomas, were recruited for the study. On a numeric rating scale, i.e. PSS (Pain Sensation Scale – according to Johnson), the patients rated pain intensity. The level of pain-related stress was investigated with the Pain Distress Scale (PDS, according to Johnson). Results: Medians for MCP-1, MCP-2, MIP-1α, MIP-1β and RANTES concentrations were not statistically significantly different. The respondents rated pain intensity during menses as 6 and 3 points in the E and T groups, respectively (6 vs. 3 points; p=0.001). Statistically significant differences were also observed for pain intensity during work (apart from menses), (2 vs. 2 points, p=0,014) and during sexual intercourse (apart from menses) (3 vs. 1 points, p=0.006). Pain-related stress levels were higher in the T group as compared to the E group (3 vs. 5 points; p=0.007). Conclusions: It seems safe to conclude that chemokines and leptin may play a significant role in the occurrence of pain complaints among women with endometrial cysts. Further research might result in implementation of new treatment methods for pain management, especially in terms of pharmacotherapy.Wstęp: Endometrioza jest przewlekłą chorobą, występująca pod postacią wszczepów i zrostów otrzewnowych jak również torbieli endometrialnych w przebiegu, której dominuje komponenta bólowa. Cel pracy: Celem pracy była ocena wpływu chemokin (MCP-1, MCP-2, MIP-1α, MIP-1β i RANTES) i czynników niechemokinowych (urokortyny, greliny i leptyny) na występowanie dolegliwości bólów miednicy mniejszej u kobiet z torbielami endometrialnymi. Materiał i metody: Badaniem objęto łącznie 86 kobiet, w wieku 18-38 lat, leczonych laparoskopowo, z powodu zmian w przydatkach o charakterze torbieli endometrialnych i potworniaków dojrzałych, od września 2009 r. do listopada 2012 roku. Na skali intensywności bólu numerycznej (Pain Sensation Scale – PSS, wg. Johnsona) pacjentki zaznaczały odpowiedzi na pytania dotyczące stopnia nasilenia bólu. Badano również poziom stresu (Pain Distress Scale – PDS, wg. Johnsona) jaki występuje podczas dolegliwości bólowych. Wyniki: Mediany MCP-1, MCP-2, MIP-1α, MIP-1β i RANTES, urokortyny, leptyny, greliny nie różniły się istotnie statystycznie. Według respondentek, mediana natężenia bólu, występującego podczas miesiączki, wynosiła 6 pkt. w grupie kobiet z torbielami endometrialnymi a u pacjentek z potworniakami 3 pkt. (6 vs 3; p=0,001). Różnice istotne statystycznie występowały także dla wartości odpowiadającym natężeniu dolegliwości bólowych, poza miesiączką, w pracy zawodowej (2 vs 2pkt., p=0,014) i w trakcie odbywania stosunków płciowych (3 vs 1 pkt., p=0,006). Stopień odczuwania stresu z powodu dolegliwości bólowych był wyższy w grupie pacjentek z potworniakami vs torbielami (3 vs 5; p=0,007). Wnioski: Chemokiny oraz leptyna mogą mieć znaczący wpływ na występowanie dolegliwości bólowych u pacjentek z torbielami endometrialnymi. Dalsze badania w tym obszarze mogłyby przyczynić się zastosowania nowych metod leczenia bólu, zwłaszcza w zakresie farmakoterapii

Analysis of the odds ratio for developing breast cancer in women

Summary Malignant breast cancer is the most common neoplasm in women in most developed countries. The majority of cases of breast cancer are probably connected with environmental factors and lifestyle. According to the current state of knowledge, modification of risk factors may contribute to the reduction of breast cancer cases and individual assessment performed by selecting a group of women with increased risk may help to reduce mortality. The purpose of the study was to analyze risk factors affecting the increase of odds ratio (OR) for developing breast cancer and to define in which range OR increases or decreases significantly. The participants of the study were healthy women with no changes in mammary glands and women with breast cancer diagnosed on the basis of histopathological examination. The study was carried out in Great Poland and Lubuskie province between 2005 and 2006. The total number of participants was 371 females, aged 35-70 years. The highest risk of breast cancer was observed in women over 55, BMI >30, who had >5 deliveries, with cancer family history and suffering from severe depression. Apart from cancer family history all other factors are potentially modifiable. Appropriate education of women can result in reduction of breast cancer risk

Opis przypadku mi´saka prà˝kowanokomórkowego pleomorficznego trzonu macicy

Abstract Pleomorphic rhabdomyosarcoma of the uterus is a rare malignant tumor. It is connected with postmenopausal abnormal vaginal bleeding and abdominal pain. We report a case of a 66-year-old postmenopausal woman diagnosed with abnormal vaginal bleeding and abdominal pain. Vaginal ultrasonography showed enlarged uterus, 82mm x 64mm in size. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with postoperative chemotherapy due to pleomorphic rhabdomyosarcoma of the uterus. The patient died 2,5 years after the surgery as a result of a rapid spread of the neoplastic process. The case of rhabdomyosarcoma, together with the review of the literature, is presented in the following work. We find that the rarity of this histological entity makes it particularly worthy of publication.Mięsak pleomorficzny, prążkowanokomórkowy jest rzadkim nienabłonkowym nowotworem złośliwym mięśnia macicy, występującym u pomenopauzalnych pacjentek, które zgłaszają w wywiadzie nieprawidłowe krwawienia maciczne i dolegliwości bólowe podbrzusza. W opisywanej sytuacji klinicznej 66 letnia wieloródka była hospitalizowana z powodu nieprawidłowego krwawienia z dróg rodnych oraz bólu podbrzusza. W badaniu USG uwidoczniono powiększony trzon macicy o wymiarach 82x64 mm. Przeprowadzono zabieg usunięcia macicy z przydatkami w sposób typowy. W badaniu histopatologicznym, potwierdzonym immunohistochemiczne, stwierdzono postać pleomorficzną mięsaka trzonu macicy. Po operacji pacjentka przeszła chemioterapię. Z powodu przerzutów pacjentka zmarła po około 2,5 roku od leczenia chirurgicznego. Z powodu bardzo rzadkiego występowania postaci pleomorficznej mięsaka prążkowanokomórkowego macicy, ten opis przypadku, łącznie z przeglądem literatury, wart jest opublikowania

Peripartum prolactin and cortisol level changes. A prospective pilot study

Although the role of prolactin and cortisol in the human lactation process seems to be undisputed, the changes in postpartum serum concentrations in mothers make data interpretation difficult. To determine the factors that possibly influence these hormones, we examined a group of patients who were admitted to the Gynecology-Obstetrics Clinical Hospital in Poznan for labor induction and/or in the active phase of the first labor period. The serum levels of cortisol and prolactin were assessed in these full-term pregnant women during admission to labor, in the third stage of labor, and on the second day postpartum. The prolactin and cortisol levels were also measured in the umbilical cord for the assessment of newborn babies. The results showed a significant relationship between maternal age and the level of prolactin measured before childbirth and fluctuations in cortisol level with respect to labor duration. In addition, we observed a strong correlation between the level of prolactin assessed before childbirth and the pH and base excess of the umbilical cord artery. Most importantly, a correlation was noted between breastfeeding within two hours after the labor and the level of cortisol measured after childbirth, which is worth mentioning to emphasize the significance of early maternal–neonatal skin-to-skin contact

Interstitial Ectopic Pregnancy—Case Reports and Medical Management

The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2–4% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (β-HCG) level measurements in peripheral blood, and monitoring of the patient’s general condition. Due to signs of intra-abdominal bleeding in patient A and inadequate β-HCG level reduction in patient B, both patients eventually underwent laparoscopic cornual resection. Pregnancy, implanted into the interstitial part of the Fallopian tube and surrounded by myometrial tissue with myometrial invasion of the trophoblast, poses a serious diagnostic challenge to modern gynecology due to particularly low sensitivity and specificity of symptoms, and may require both pharmacological and surgical treatment

Interstitial Ectopic Pregnancy—Case Reports and Medical Management

The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2–4% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (β-HCG) level measurements in peripheral blood, and monitoring of the patient’s general condition. Due to signs of intra-abdominal bleeding in patient A and inadequate β-HCG level reduction in patient B, both patients eventually underwent laparoscopic cornual resection. Pregnancy, implanted into the interstitial part of the Fallopian tube and surrounded by myometrial tissue with myometrial invasion of the trophoblast, poses a serious diagnostic challenge to modern gynecology due to particularly low sensitivity and specificity of symptoms, and may require both pharmacological and surgical treatment