THE EFFECTS OF HORMONAL THERAPY IN MENOPAUSE

Abstract. Through all the immediate and long-term consequences of estrogenic deprivation, menopause is an important public health issue with social, personal and economic impact. If immediate menopausal symptoms are sometimes noisy, the long-term, insidious consequences, especially cardiovascular and bone, are of major importance. In order to eliminate troublesome symptoms and prevent long-term consequences in order to provide a good quality of life for menopausal women, it is nowadays unanimously recognized that hormonal therapy is necessary in the context of adhering to recognized indications and contraindications, also rigourosly following the effects of therapy

THE EFFECTS OF HORMONAL THERAPY IN MENOPAUSE

Abstract. Through all the immediate and long-term consequences of estrogenic deprivation, menopause is an important public health issue with social, personal and economic impact. If immediate menopausal symptoms are sometimes noisy, the long-term, insidious consequences, especially cardiovascular and bone, are of major importance. In order to eliminate troublesome symptoms and prevent long-term consequences in order to provide a good quality of life for menopausal women, it is nowadays unanimously recognized that hormonal therapy is necessary in the context of adhering to recognized indications and contraindications, also rigourosly following the effects of therapy

PREVENTION WITH DESORGESTREL OF ENDOMETRIOUS CYSTS RECURRENCE AFTER SURGICAL TREATMENT

Currently, endometriosis is an important public health issue due to the increasing number of cases and the risk of developing ovarian and endometrial tumours(10% of ovarian endometrial carcinomas are associated with uterine endometrioid carcinomas), which has led to increased research into the mechanisms of appearance and progression of this condition.Although endometriosis is considered a benign chronic disease, it can show an invasive character causing severe symptoms. Endometriosis has an increasing incidence, affecting 2% of the general population, being the third gynecological cause of infertility, chronic pelvic pain, dyspareunia and dysmenorrhea. Endometriosis affects 7-15% of women of childbearing age, with 25-30% of sterility cases having a significant social impact. Endometriomas are difficult to excise due to vascularization and increased adhesion of the cyst wall. Surgical treatment of endometriosis is effective in the short term. Surgery most often reduces ovarian reserve. The rate of recurrence after surgery can be reduced with the help of menstrual suppression medications such as hormonal contraceptives. Desogestrel treatment improves intraoperative conditions mainly by reducing bleeding and increasing laxity between cyst coat and normal ovarian tissue

Interesarea nervilor pudendali la femeile în postmenopauză cu prolaps genital asociat sau nu cu incontinenţă urinară de stres

Prolapsul organelor pelvine este rezultatul deteriorării structurale a ţesuturilor pelviperineale, leziuni ce pot fi localizate la nivelul fi brelor musculare, ţesutului conjunctiv, vaselor de sânge şi la nivelul fi brelor nervoase, interesarea acestora modelând tabloul complex al prolapsului pelviperineal. Cercetarea de faţă s-a axat pe studiul anomaliilor nervoase periferice la femei cu prolaps pelviperineal asociat sau nu cu incontinenţă urinară de stress. În timpul intervenţiilor chirurgicale pentru rezolvarea prolapsului şi/sau a incontinenţei urinare la 50 femei, comparativ cu un lot martor de 25 femei, care au suferit intervenţii chirurgicale pelvine pentru alte afecţiuni, s-au obţinut fragmente tisulare din sistemele de susţinere care au fost prelucrate prin tehnici histologice. Examenul microscopic efectuat a relevat aspecte diferite, în funcţie de localizarea fi letelor nervoase, mai afectate fi ind cele din regiunea periuretrală, în toate aceste cazuri existând un grad de incontinenţă urinară de stress, concomitent cu alterări ale ţesutului muscular şi conjunctiv. Modifi cările fi brelor nervoase remarcate la bolnavele cu prolaps al organelor pelvine constau în reducerea numărului fi brelor nervoase, reducerea numărului fi brelor mielinice, dezorganizarea nervilor prin incluziuni fi broase care „ştrangulează” fi brele nervoase, dar şi degenerare moderată a fi brelor nervoase. În concluzie, leziunile microscopice observate susţin existenţa neuropatiei pudendale care este implicată în etiologia relaxării planşeului pelvin, a incontinenţei urinare de stres şi a incontinenţei fecale la femeile în postmenopauză. Afectarea nervilor muşchiului levator anal poate apare ca urmare a traumatismelor din timpul naşterii, ajungându- se la mişcarea paradoxală a muşchiului ia punct fi x pe sacrum şi coccige şi alungeşte fanta urogenitală, lăsând organele pelvine fără susţinere, în loc să ia punct fi x pe pubis şi să micşoreze această fantă

Challenges in the Delivery Room: Integrated Analysis of Biomarkers Predicting Complications in Lupus Pregnancy

Pregnancy in autoimmune rheumatic diseases remains a real challenge in clinical practice due to complex interplay between disease activity, pregnancy and drugs, and account for potential influence of pregnancy on rheumatic condition and the impact of disease on pregnancy outcomes. Indeed, innovative and successful therapies have dramatically improved the quality of life in immune-mediated rheumatic conditions and, subsequently, allowed more patients of reproductive age to plan a pregnancy/to conceive. The purpose of this chapter is to discuss emerging data about the interaction of pregnancy and systemic erythematosus lupus (SLE) focusing on modulation of the immune system by pregnancy, pregnancy outcomes in women with active lupus, biomarkers of adverse pregnancy outcomes (APO) including predictors of pre-eclampsia, predictors of obstetric complications in SLE, the influence of autoantibodies on fetal health, and, finally, evidence about rheumatologic and obstetric follow-up. There are still unmet needs in this new field of reproductive rheumatology and it becomes crucial that researchers, physicians (rheumatologists, specialists in maternofetal medicine, obstetricians) and midwifes share their knowledge and expertise in counseling women with SLE wishing to conceive, assisting pregnancy and managing different issues related to APO as well as drug optimization in preconception, during pregnancy and postpartum period

CANDIDIASIS IN PREGNANCY- PERSONAL STUDY

The impact of an intensive educational program regarding candidiasis in pregnancyon health professionals knowledge at Clinical Hospital of Obstetrics and Gynecology ”Elena Doamna” in Iași, Romania. The study was designed in three phases: Assessment phase, Implementation phase and Evaluation phase. The study was conducted from early January to the end of December 2019. The result of the study shows that its most frequent location is in the mouth and the vagina. The symptoms are reduced and the diagnosis is based on the clinical examination, the confirmation being performed by microscopic examination. Prophylactic treatment of candidiasis involves maintaining a rigorous hygiene, avoiding excessive and unprotected use of antibiotics and increasing the body's immunity through a balanced diet and through the intake of mineral salts and vitamins

ASSESSING PROGRESSION OF CERVICAL PRE-CANCER LESIONS

The purpose of this study was to accomplish a comparative assessment between the immune histochemical and the immunocytochemical expression of p16 protein and L1 major capsid protein of HPV respectively, in cervical squamous intraepithelial lesions with low and high grade, in order to determine, through morphological and clinical correlations, their applicability into practice when diagnosing and further monitoring the patients. There were 119 patients included in the study, having a mean age of 40, cytologically and histopathologically diagnosed in the Laboratory of Pathologic Anatomy of “Elena Doamna” Third Clinic of Obstetrics and Gynaecology in Iaşi. 42 of these patients were diagnosed with LSIL (low grade squamous intraepithelial lesion) and 51 with HSIL (high grade squamous intraepithelial lesion). The cervical- vaginal smears were interpreted using the Papanicolaou method. The conventional smears were assessed for the immunoexpression of L1 capsid protein HPV, and the corresponding biopsies for p16 immunoexpression. The colouring pattern of p16 protein was predominantly nuclear, with an occasional cytoplasmic positivity. P16 biomarker was positive in cytological smear prepared in a liquid environment for 71.6% of the patients, without significant differences for those over 40 years old (69.6% vs 69.0%; p=0.887), with an increase in positivity from 54.8% in LSIL to 98% in HSIL (p=0.05); the oncogenic risk was 1,55 higher (RR=1.55; IC95%: 1.19÷2.01). L1 protein was detected in 34,5% of the patients, the expression tending to increase in parallel with the increase in the severity of the lesions (66.7% LSIL; 17.6% HSIL). The presence of L1 protein in the patients with an increased risk of malignant transformation of HPV seems to be a protective factor (RR=0.42; IC95%: 0.27÷0.66). The immunoexpression of L1 HPV protein has clinical applications in assessing the progression of cervical pre-cancer lesions. The analysis of p16 status, in parallel with the expression of L1 HPV protein, can be very useful in assessing the risk of progression for cervical intraepithelial squamous lesions. The preventive conduct supported by a primary care screening, leads to a decrease in the morbidity by pre-invasive lesions and an evolution with a favourable prognostic

The cytological diagnostic of the cervical cancer

he present paper materializes the efforts made to emphasize the cervical cancer epidemiology and a high quality morphopathological diagnostic. We tracked the problem of the early detection of diagnostic, through mass cytological examination. Cytological screening was performed by a team of health personnel in The Third Clinic of Obstetrics-Gynecology “Elena Doamna”Iaşi between 01 January 2001 and 31 December 2007. We discovered a number of 145 cases of cervical cancer out of 650 that we studied, that is 22,30%. It is necessary to take a sample from the bottom of the posterior vaginal uterine sac and from the surface of the cervix with an Ayre spatula and in special circumstances you can even take an endocervical smear. The early diagnostic can be set after analyzing the vaginal smear through the optical microscope. We identified the pre-cancer and cancer status at 5,4% of the cases we analyzed as follows: L-SIL 3,7%; H-SIN 0,8%; CIN 1,1% (1 case associated with H-SIN). The cytological test has multiple valences, as it allows the discovery and location of the feminine genital cancer in other places than the cervix (even if its accuracy drops dramatically as the segment concerned is farther from the exocervix, endometrium, endosalpinx). The cytological examination proved to have exceptional qualities as a screening method, and has become lately the basic instrument in detecting the cervical cancer in a big number of patients. IN