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

Extensive postpartum urinary retention successfully treated with clean intermittent catheterization

We present a case of extensive urine retention after vaginal delivery. Postpartum urinary retention occurs in 0.7 to 0.9% of vaginal deliveries. In the literature, mediolateral episiotomy, epidural analgesia, perineal lacerations, macrosomic birth and prolonged 2nd stage of labor are suggested as risk factors for postpartum urine retention.          

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

Relation between mistake as to the object of performance and seller's liability for lack of conformity

Zagadnienie relacji między normami o błędzie i rękojmi nie jest obce literaturze i orzecznictwu. Zwracano na nie uwagę już na gruncie Kodeksu zobowiązań, a próby jej regulacji zawierają projekt Księgi pierwszej kodeksu cywilnego, a także projekt Wspólnej Ramy Odniesienia. Stanowiła ona już przedmiot zainteresowania Sądu Najwyższego. Obecnie przyjmuje się niemal powszechnie, że zachodzi tu nieunormowany ustawowo zbieg rzeczywisty. Praca określa warunki faktyczne i prawne, jakie muszą zaistnieć, by zaszła interferencja tych norm, wskazuje na podobieństwa i różnice, jakie zachodzą między ich dyspozycjami, porównuje funkcje obydwu instytucji, aż wreszcie determinuje czy wyżej wskazany pogląd jest trafny. Opracowanie wieńczy kilka spostrzeżeń na płaszczyźnie de lege ferenda.The doctrine of law and judiciary is not unfamiliar with the issue of the relation between the institutions of mistake and statutory warranty for goods sold. It has already been the subject of reflection under the terms of the Code of Obligations, and the attempts at normative regulation of this relation were undertaken in the draft Book One of the Civil Code and Draft Common Frame of Reference. It has also been considered by the Supreme Court. Presently, there appears to be a consensus that there is a real concurrence of legal provisions. This paper specifies similarities and differences between the dispositions of the norms concerned, stipulates factual and legal circumstances under which the concurrence occurs, compares the functions of both legal institutions and finally, discusses whether the aforementioned concept of real concurrence is correct. The thesis is concluded with a few observations de lege ferenda

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

The influence of uterine artery embolisation on ovarian reserve, fertility, and pregnancy outcomes – a review of literature

Uterine fibroids are considered to be the most frequent female benign tumours. Fibroids affect mainly women of reproductive age. The most frequently reported signs and symptoms of fibroids include disturbances of the menstrual cycle such as heavy bleeding and painful menstruation, pelvic masses associated with pelvic pain, urinary problems or constipation, as well as infertility and recurrent pregnancy loss. The mainstay of fibroid treatment is still surgery. However, many patients seek alternative treatment options for fibroids, to preserve their uterus and fertility. One of the most important alternative treatment options for fibroids is uterine artery embolisation (UAE). However, there are some concerns that UAE may negatively influence ovarian function and even result in premature menopause. Moreover, the use of UAE in patients with future reproductive plans is still controversial, due to the possible pregnancy complications. The purpose of this review is to summarise the current knowledge regarding the possible influence of UAE on fertility, pregnancy outcome, and ovarian reserve

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

Infertility in the light of new scientific reports – focus on male factor

Epidemiological data indicate that infertility is a problem of global proportions, affecting one- fifth of couples trying to conceive worldwide (60–80 mln). According to the trends observed, the problem is predicted to increase by another two million cases annually. In Poland, infertility-related issues are found in about 19% of couples, including 4% with infertility and 15% with limited fertility. Inability to conceive occurs equally in men and women (50%), irrespective of the direct cause. Although it is generally thought that reproductive issues concern women, infertility affects men and women equally. This study is an attempted to systematize knowledge about the role of the male factor in infertility, particularly current knowledge concerning the environmental factors of infertility. For this purpose, the Medline and CINAHL databases and the Cochrane Library was searched for articles published in English during the last 10 years, using the following keywords: infertility, male factor, semen examination and environmental factor of infertility

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