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

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

Embolizacja tętnic macicznych – zagadnienia kliniczne

The aim of the study was to present clinical issues concerning uterine artery embolization (UAE) in women with uterine fibromas. In order to ensure high clinical efficiency of UAE and prevent subsequent complications, it is necessary to carefully select patients eligible for the procedure. Patients with intramural fibromas, who do not plan to conceive, are the best candidates for the procedure. Fibroma necrosis, with following infection, and premature ovarian failure remain to be the most common complications after UAE. UAE may cause amenorrhea and increase FSH levels, what is typical for menopause. Thus, it may be responsible for problems with conception as well as optimal development of a pregnancy. It may also cause premature, iatrogenic menopause. This complication significantly more frequently occurs in women over the age of 45 as compared to younger patients. UAE is considered as an alternative therapeutic procedure, available to women who do not desire the surgery or wish to preserve the uterus. Patients subject to this procedure should be informed about the possible side effects.Celem pracy było przedstawienie zagadnień klinicznych związanych z zabiegami embolizacji tętnic macicznych (UAE) w przypadku objawowych mięśniaków macicy. Zwrócono uwagę, że odpowiednia kwalifikacja chorych do zabiegu ma kluczowe znaczenie dla wysokiej skuteczności klinicznej oraz zapobiegania powikłaniom po UAE. Kandydatkami powinny być kobiety z objawowymi mięśniakami położonymi śródściennie, które w przyszłości nie planują zachodzić w ciążę. Przedwczesne wygasanie czynności jajników, obok martwicy mięśniaka z następową infekcją stanowi jedno z najczęstszych powikłań embolizacji. Może być przyczyną przedwczesnej, jatrogennej menopauzy oraz trudności w zajściu i donoszeniu ciąży. UAE może niekorzystnie wpłynąć na funkcję jajników, powodując czasowe lub stałe zatrzymanie miesiączki, a także typowy dla okresu menopauzy wzrost poziomu FSH. Znacznie częściej to powikłanie UAE obserwuje się u kobiet po 45 roku życia, niż młodszych. Embolizacja tętnic macicznych przeprowadzana w celu leczenia objawowych mięśniaków macicy stanowi alternatywną opcję terapeutyczną, istotną dla kobiet, które nie chcą poddawać się operacji lub pragnących zachować macicę. Chore poddawane tego typu leczeniu powinny być poinformowane o możliwych skutkach ubocznych

Pelvic organ prolapse in women: how is it diagnosed and treated currently?

The aim of the paper was to summarize the current opinions about the management of pelvic organ prolapse in women. Food and Drug Administration safety announcements from 2008 and 2011 triggered the discussion about the methods of treatment of pelvic organ prolapse and the used materials and a partial return to the methods which had been totally criticized before the implementation of meshes. The decrease in mesh usage is also observed. The studies did not demonstrate the prevalence of any particular surgical procedure. The amount of studies concerning the evaluation and the treatment of pelvic organ prolapse ensures that the quality of care provided to women with urogynecological problems is continuously increasing

Clinical implications of vitamin D deficiency

Vitamin D deficiency is a common medical problem worldwide and its prevalence rises along with latitude, obesity, sedentary lifestyle, limited sunlight exposure and aging. A great body of evidence has shown that patients with vitamin D deficiency have increased cardiovascular risks and total mortality. Conversely, the presence of comorbidities progressive with age such as abdominal obesity, insulin resistance, type 2 diabetes and hypertension places the patients at an increased risk of vitamin D deficiency. The multidirectional effect of vitamin D deficiency is present in different phases of the aging process. Based on the literature review, the risk factors for vitamin D insufficiency most often found in post-menopausal women include limited sun exposure and time spent outdoors, inadequate dietary vitamin D intake, winter season and increased age. Vitamin D supplementation in this group might offer prevention of falls and fractures and may be beneficial for cardiovascular health, what may be especially important in osteoporotic and elderly populations. Prevention and treatment processes involve education regarding sunlight exposure and pharmacological cholecalciferol supplementation according to the recommendations for Central Europe. This manuscript reviews the role of vitamin D and its deficiency and considers their clinical implications, with particular regard to peri- and postmenopausal women

The effect of ulipristal acetate treatment on symptomatic uterine fibroids within 12-months follow-up

Aim of the study: The purpose of the study was to monitor the effect of ulipristal acetate treatment on symptomatic uterine fibroids within 12-months follow-up. Material and methods : Fifty six patients with symptomatic uterine fibroids qualified for surgical treatment were included in the prospective observational study. All patients received preoperative oral UPA treatment for 3 months (1 × 5 mg). Patients that refused surgical treatment after UPA therapy were followed-up for the next 9 months. The volume of the intramural fibroid was estimated by TV-US using and integrated VOCAL 3D imaging program at baseline, after 3 months of UPA treatment and further at 3-months intervals. Results: Before UPA mean dominant fibroid volume was estimated to be 216.0 cm3 (38.4-768.2 cm 3 ) and decreased to 117.6 cm 3 (12.6-668.0 cm 3 ) after 3 months of UPA therapy. Mean percentage volume reduction was 45.6%. Mean hemoglobin level increased from an initial 10.1 g/dL (6.8-12.9 g/dL) to 12.6 g/dL (10.1-14.8) after 3 months of UPA therapy. At 12 months after initiating UPA treatment mean dominant fibroid volume decreased by 43.9%. In one third of followed-up patients the effect of 3 month UPA therapy persisted for the next 9 months. Conclusions : Three month UPA therapy decreases fibroid volume and improves hemoglobin level before planned surgical treatment. In one third of followed-up patients the effect of 3 month UPA therapy persisted for the next 9 months

Zmiany stezenia TNF-alpha w okresie po-operacyjnym u pacjentek operowanych z powodu łagodnych guzów przydatków metoda laparoskopii i laparotomii.

OBJECTIVES: The aim of the study was to compare serum concentrations of the TNF-alpha (TNF-alpha) in the early postoperative period in patients with benign adnexal masses operated by laparoscopy or laparotomy. MATERIAL AND METHODS: The study was conducted in a group of patients aged from 20 to 52, operated due to adnexal masses. Out of 40 patients included in the study, 25 underwent laparoscopy and 15 underwent laparotomy. Serum concentrations of TNF-alpha were measured by commercially available ELISA assays before the surgery and 4, 24 and 48 hours after the start of the operation. RESULTS: A decrease of TNF-alpha serum concentrations was observed in the early postoperative period. 24 h after the operation concentrations of TNF-alpha were significantly higher in the laparotomy group as opposed to the group operated by laparoscopy. CONCLUSIONS: Lower concentrations of TNF-alpha in the laparoscopy group, observed 24 hours after the operation, may reflect more favorable changes in the systemic inflammatory response after minimally invasive management of benign ovarian masses

Polycystic ovary syndrome: clinical implication in perimenopause

Polycystic ovary syndrome (PCOS), a hyperandrogenic disorder, is the commonest endocrinopathy in premenopausal women. This syndrome is associated with fertility problems, clinical manifestations of hyperandrogenism and metabolic disturbances, particularly insulin resistance and obesity. There is a great body of evidence that patients with PCOS present multiple cardiovascular risk factors and cluster components of metabolic syndrome from early ages. The presence of comorbidities such as abdominal obesity, insulin resistance, type 2 diabetes, hypertension places these females at an increased risk of future cardiovascular events. However, the extent to which PCOS components are present in perimenopausal women and the degree to which PCOS increases various risk factors in addition to the known risk of the perimenopausal period have not been fully determined. The perimenopausal period per se is associated with weight gain and an increased cardiovascular risk, which may be additionally aggravated by the presence of metabolic disturbances connected with PCOS. The phenotype of PCOS may improve with aging and it is still uncertain whether the presence of PCOS significantly increases the cardiovascular risk later in women’s life. Most recent data suggest that the prevalence of cardiovascular diseases and the related long-term consequences in females with PCOS seem to be lower than expected. This manuscript reviews long-term consequences of PCOS and considers their clinical implications in perimenopause

Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease

Introduction and objective : Uterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic fibroids. Long-term follow-up studies have shown that at five-year follow-up after UAE, up to 30% of patients required a hysterectomy. Therefore, it seems of utmost importance to identify patients, who are unlikely to benefit from UAE. It has been postulated that the percentage volume reduction of fibroids may predict long-term UAE outcome. The results of available studies are equivocal, therefore it seemed of interest to investigate the correlation between the preinterventional intramural fibroid volume and imaging outcome of UAE in premenopausal patients. Material and methods : Uterine artery embolization was performed in 65 premenopausal patients with symptomatic, intramural fibroids. Dominant fibroid volume was assessed using an integrated VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program at baseline and 3 months after UAE. The percentage reduction of fibroid volume was calculated. The association between preinterventional fibroid volumes and percentage volume reductions was determined with the Spearman rank correlation test. Results : Before UAE, the median dominant fibroid volume was 101 cm3 (range 23.6-610). At three-month follow-up the median dominant leiomyoma volume decreased to 50.4 cm3 (range 6.9-193.9). Median percentage reduction of fibroid volume three months after UAE was calculated at 50.1% (range 2.7-93.5). The Spearman correlation test between the preinterventional dominant fibroid volume and percentage volume reduction showed a statistically significant, positive correlation (R = 0.33; p = 0.006). Conclusions : The percentage volume reduction of intramural leiomyomas after UAE seems to be more pronounced in the case of larger tumors