Use of a levonorgestrel-releasing intrauterine device for menorrhagia treatment during adjuvant therapy of adrenocortical carcinoma with mitotane

Adrenocortical carcinoma is a rare tumour with high malignancy and poor prognosis. This tumour is rarely diagnosed in the reproductive age. Complete surgical resection is the only curative treatment for adrenal cancer in all stages. After surgery adjuvant chemotherapy is required. Mitotane is the most important drug in adrenal cancer chemotherapy. Mitotane’s mode of action is not entirely explained. Animal studies have shown that the substance exerts a direct cytotoxic effect on the cells of the adrenal cortex. This activity is selective, progressive and affects only the zona reticularis and fasciculata of the adrenal cortex. Mitotane inhibits cortisol synthesis by disrupting the chain of cholesterol. It has been suggested, that mitotane also affects the peripheral metabolism of steroids, especially of transcortin (CBG). This results in an increase of CBG blood concentration and a reduction of the amount of free hormones

Zastosowanie elastografii w przewidywaniu porodu przedwczesnego u pacjentek z krótką szyjką macicy stwierdzoną między 18-22 tygodniem ciąży: prospektywne badanie obserwacyjne

Objectives: The aim of the study was to estimate the potential value of elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length for prediction of preterm delivery (PTD). Material and methods: This prospective observational study included 109 patients with cervical length of ≤25 mm at 18-22 weeks scan. Stiffness of the internal cervical os was assessed by elastography. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard), and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. The following outcome measures were analyzed: percentage of PTDs in various categories of elastographic cervical assessment, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of elastography in predicting PTDs. Additionally, ROC curves were constructed for elastography and cervical length for predicting PTDs. Results: Forty-five cases of PTDs (Cel: Ocena znaczenia elastograficznej oceny ujścia wewnętrznego szyjki macicy w przewidywaniu porodu przedwczesnego (PTD) u pacjentek z krótką szyjką macicy stwierdzoną w 18-22 tygodniu ciąży. Materiał i metody: Prospektywne badanie obserwacyjne obejmujące 109 pacjentek z długością szyjki macicy ≤25 mm stwierdzoną w 18-22 tygodniu ciąży. Elastograficznie oceniano twardość ujścia wewnętrznego szyjki macicy z użyciem następującej skali kolorów: czerwone (miękkie); żółte (średnio miękkie); niebieskie (średnio twarde); fioletowe (twarde). W przypadku uwidocznienia dwóch kolorów w okolicy ujścia wewnętrznego wybierano opcję bardziej miękką. Analizowano następujące zmienne: odsetek PTD w poszczególnych kategoriach twardości ujścia wewnętrznego oraz czułość, swoistość, ujemną i dodatnią wartość predykcyjną (NPV i PPV) elastografii w przewidywaniu PTD. Ponadto wyznaczono krzywe ROC dla elastografii i długości szyjki macicy w przewidywaniu PTD. Wyniki: W badanej populacji wystąpiło 45 PTD

Ascites Index — a novel technique to evaluate ascites in ovarian hyperstimulation syndrome: a concept-proof study

 Objectives: Controlled ovarian hyperstimulation is an important step in infertility treatment. In some cases, however, ovar­ian hyperstimulation syndrome (OHSS) can occur. In its severe forms, ascites is likely to develop, associated with dyspnea. The aim of this study was to explore the usefulness of Ascites Index (AsI), a new tool for quantitative determination of ascites in patients with OHSS, to obtain data for planning further trials. Material and methods: Twelve patients with OHSS and ascites were included in the study. All patients were admitted to the hospital because of abdominal pain and dyspnea due to increasing ascites. Ultrasound measurements of ascites extent were performed in four external quadrants of the abdomen. Pockets of free fluid were measured. The obtained values were totaled, forming the Ascites Index (AsI), similarly to the amniotic fluid index. Because of dyspnea, paracentesis was performed in all cases. Results: Median AsI at which patients reported dyspnea was 29.0 cm (range 21.6–38.6 cm). At AsI values less than 21.6 cm, no dyspnea was observed in any of the 12 studied patients. To avoid complications, 2000 mL of ascitic fluid was collected in each patient. After paracentesis, range of AsI decreased to 12.1–14.5 cm. Conclusions: The proposed AsI seems to be a promising tool for estimating and monitoring the ascites extent in OHSS. It can be estimated using basic ultrasound equipment. AsI requires further studies for standardization and transferability to other causes of ascites

Powikłania okołooperacyjne u pacjentek z cukrzycą poddanych zabiegom ginekologicznym

Objectives: The aim of the study was to estimate whether diabetes was an independent risk factor for perioperative complications in patients undergoing gynecologic surgery. Material and methods: The study population consisted of 182 women (diabetics and controls) who underwent elective gynecologic surgery. Each patient without diabetes from the control group and matched for age and body mass index diabetic patient were admitted with the same gynecologic diagnosis, underwent the same gynecologic procedure, were operated on in the same operating room and were hospitalized within the same time interval. The following parameters of the perioperative period were compared between every matched pair of patients (diabetic vs. non-diabetic patient): number and characteristics of intra- and postoperative complications, length of postoperative hospitalization, decrease in hemoglobin level, increase in body temperature, and postoperative use of antibiotics. Results: The study revealed no statistically significant differences between the diabetic patients and pair-matched controls in terms of the examined parameters of the perioperative period. Conclusions: Diabetes was not an independent risk factor for early postoperative complications after gynecologic procedures in the examined population. Good pre-operative glycemic control and strict cooperation of the diabetologist with the surgeon in the perioperative period resulted in reduction of the complication rate to the level typical for non-diabetic patients.  Cel pracy: Celem pracy było ustalenie, czy w badanej grupie pacjentek które zostały poddane zabiegom ginekologicznym, cukrzyca stanowiła niezależny czynnik ryzyka powikłań okołooperacyjnych. Materiał i metody: Badaniami objęto 182 kobiety (grupa badana i kontrolna łącznie) które zostały poddane zabiegom oraz operacjom ginekologicznym w trybie planowym. Każdej pacjentce z cukrzycą przyporządkowano pacjentkę bez cukrzycy: w podobnym wieku, o zbliżonej wartości wskaźnika masy ciała, z tym samym ginekologicznym rozpoznaniem zasadniczym, poddaną takiemu samemu zabiegowi operacyjnemu i na tej samej sali zabiegowej/operacyjnej, co pacjentka z grupy badanej oraz hospitalizowaną w tym samym okresie czasu. Następujące parametry okresu okołooperacyjnego zostały porównane między każdą pacjentką z cukrzycą i przyporządkowaną jej pacjentką bez cukrzycy: liczba i charakter powikłań, czas pooperacyjnej hospitalizacji, spadek stężenia hemoglobiny, wzrostu temperatury ciała, pozabiegowe zastosowanie antybiotyków. Wyniki: Nie wykazano istotnych statystycznie różnic między grupą cukrzycową a grupą kontrolną w zakresie analizowanych parametrów okresu okołooperacyjnego. Wnioski: Cukrzyca nie stanowiła niezależnego czynnika ryzyka wczesnych powikłań okołooperacyjnych po zabiegach ginekologicznych we wszystkich rodzajach zabiegów. Dobre przedoperacyjne wyrównanie cukrzycy, ocena pacjentek z cukrzycą przez lekarza diabetologa oraz ścisła współpraca okołooperacyjna między lekarzem ginekologiem a diabetologiem umożliwia ograniczenie liczby powikłań okołozabiegowych w grupie chorych z cukrzycą poddawanych zabiegom ginekologicznym do poziomu odpowiadającego pacjentkom bez cukrzycy.

Usefulness of three dimensional transvaginal ultrasonography and hysterosalpingography in diagnosing uterine anomalies

Objective and methods: In this study we discuss the advantages and disadvantages of HSG and 3D TV USG in diagnosing uterine anomalies. Additionally we present the results of HSG and 3D TV USG of 155 patients referred to our Department because of infertility and/or suspected uterine anomalies. Results: After performing HSG, in the studied group 118 patients were diagnosed with a normal uterus, 4 with unicornuate (including 1 patient with an unicornuate uterus, with rudimentary horn), and 6 with didelphys uterus. In 22 cases, due to the lack of evaluation of external contour of the uterus, we could not differentiate arcuate, septate and bicornuate uterus. After performing 3D TV USG we confirmed the HSG diagnosis and precise differentiated 22 disputable cases: 8 with arcuate, 11 with septate (2 complete and 9 partial) and 3 with complete bicornuate uterus. In 5 patients, severe pain and lack of cooperation during HSG made the acquisition of diagnostic X-ray images impossible. In these cases 3D TV USG allowed the anatomic assessment of the uterus, a normal uterus was found in all of them. All uterine anomalies were then confirmed by hysteroscopy and/or laparoscopy. for diagnosing uterine anomalies, while 3D TV USG can accurately show the uterus anomalies and may become an alternative method to MRI

Placenta percreta leading to uterine rupture at 18 weeks of pregnancy with consecutive hysterectomy: a case report

A 26-year-old woman in the fourth pregnancy with a history of two Cesarean sections and one dilation and curettage was admitted to the hospital at 18 weeks of gestation with acute abdominal pain. Life-saving laparotomy revealed uterine rupture and placental invasion into the uterine wall. Supracervical hysterectomy was performed. This case shows that pathological placentation due to previous cesarean sections may be the cause of uterine rupture

Secondary dysmenorrhea due to a rudimentary, non-communicating functional uterine horn

Unicornuate uterus with a rudimentary horn is a rare congenital Müllerian anomaly, which may lead to many obstetrical and gynaecological complications. This pathology occurs in approximately 1/100 000 women. A rudimentary horn forms due to insufficient development of the Müllerian duct. The diagnosis of this anomaly is usually delayed, as it remains asymptomatic until adolescence and its main symptom is dysmenorrhea