Quality of life assessment in women of reproductive age treated for pathological changes in the uterine cervix

Učestalost pojave displazije grlića materice pokazuje porast, naročito kod žena u reproduktivnom periodu. Pravovremeno lečenje ovih promena je značajno za smanjenje učestalosti pojave invazivnog karcinoma grlića materice, a ispitivanje kvaliteta života povezanog sa zdravljem (HRQoL) nakon lečenja displazije doprinosi unapređenju ishoda lečenja. I pored toga, u kliničkoj praksi kod nas nisu zaživeli adekvatni instrumenti za ispitivanje HRQoL ovih žena. Pored same bolesti i njenog hirurškog lečenja, na HRQoL žena u reproduktivnom periodu hirurški lečenih zbog patoloških promena grlića materice mogu uticati i dugoročne posledice lečenja na reproduktivnu funkciju, mogući infertilitet i povišen rizik perinatalnog morbiditeta i mortaliteta. Pored toga, lečenje može dovesti do značajnih promena u psihičkoj sferi i seksualnosti. Ciljevi: Primarni cilj istraživanja bila je psihometrijska validacija srpske verzije instrumenta za ispitivanje HRQoL žena sa cervikalnom displazijom FACIT-CD (Functional Assessment of Chronic Ilness Therapy-Cervical Dyplasia). Drugi cilj bilo je ispitivanje HRQoL žena u reproduktivnom periodu lečenih ekscizionim hirurškim metodama zbog skvamozne intraepitelne lezije (SIL) FACIT-CD upitnikom, SF-36v2 upitnikom, Bekovim upitnikom za anksioznost (BAI) i Bekovim upitnikom za depresiju (BDI), posebno u odnosu na reproduktivne karakteristike ispitanica: paritet i zainteresovanost za reprodukciju. Pacijenti i metode: Istraživanje je sprovedeno kao studija preseka i obuhvatilo je žene operisane iz dijagnostičkih ili terapijskih razloga dve i više godina pre uključivanja u studiju, kod kojih je histološki potvrđeno postojanje SIL. Kriterijumi za isključivanje iz studije bili su postojanje invazivne promene grlića, naknadni tretman grlića, kao i postojanje drugih patoloških promena na genitalnim organima i/ili hroničnih oboljenja koja mogu remetiti HRQoL. Prikupljeni su sociodemografski i klinički podaci ispitanica, a HRQoL je procenjivan FACIT-CD, SF-36v2, BAI i BDI upitnicima. Rezultati: Srpska verzija FACIT-CD upitnika je pokazala zadovoljavajuće psihometrijske karakteristike...The incidence of cervical dysplasia is growing, particularly in women of reproductive age. Timely treatment of these changes is important for reducing the incidence of invasive cervical cancer, and the investigation of health related quality of life (HRQoL) following dysplasia treatment contributes to a better treatment outcome. Nevertheless, adequate instruments for studying HRQoL in women are still not widely used in our clinical practice. Apart from the disease itself and its surgical treatment, the HRQoL in women of reproductive age that were surgically treated can be influenced by the long-term consequences of the treatment on the reproductive function, possible infertility, and increased risk of perinatal morbidity and mortality. Moreover, treatment may lead to significant changes in the psychological field and in sexuality. Aims: The primary aim of our research was psychometric validation of the Serbian version of the HRQoL assessment instrument for women with cervical dysplasia - FACIT-CD (Functional Assessment of Chronic Illness Therapy-Cervical Dysplasia). The secondary aim was the evaluation of the HRQoL in women of reproductive age treated by excisional surgical methods for squamous intraepithelial lesion (SIL), using the FACIT-CD questionnaire, the SF-36v2 questionnaire, the Beck’s anxiety inventory (BAI), and the Beck’s depression inventory (BDI), particularly in relation to the reproductive characteristics of the participants: parity and fertility interest. Patients and methods: Research was conducted as a cross-sectional study, and it encompassed women operated for diagnostic or therapeutic reasons two and more years prior to study enrollment, in whom SIL was histologically confirmed. The exclusion criteria were: the presence of invasive disease, repeated cervical treatment, the presence of other pathological changes on the reproductive organs and/or chronic diseases that could impair the HRQoL. The data on socio-demographic and clinical characteristics of the participants were collected, and the HRQoL was assessed using the FACIT-CD, SF-36v2, BAI and BDI questionnaires..

Analiza czynników klinicznych, biologicznych i położniczych wpływających na decyzję o usunięciu mięśniaka macicy w trakcie cięcia cesarskiego

Objectives: Myomas in pregnancy are associated with a significantly higher risk for cesarean section (CS). Cesarean myomectomy (CM), i.e. myomectomy during cesarean section, has been the source of much debate and was considered relatively contraindicated for many years. However, some authors advise to perform routine myomectomy during CS. The aim of our study was to determine factors influencing the intraoperative decision to perform CM. Material and methods: A total of 185 patients with uterine myomas, who delivered by caesarean section during a 5-year period, were included in the study - 102 patients underwent CM (study group) and 83 women underwent CS without myomectomy (control group). Clinical and obstetric data were recorded and processed for analysis. Using non-parametric correlation methods, we investigated the influence of different variables on the decision to perform CM. Results: No differences were recorded between the two groups in terms of parity, fetal presentation, gestational age, number of previous laparotomies, and previous myomectomy, presence of diabetes and hypertension, indications and type of CS. Significant differences were detected in type and location of the myomas, contrary to their number and size, where no significant differences were registered. Conclusions: The most significant predictors of CM included age, surgical experience and type of myomas. CM is generally performed by experienced surgeons and in younger women. Also, it is more often performed in patients affected by pedunculated and subserosal myomas, and less frequent in case of intramural and multiple myomas.Cel pracy: Mięśniaki macicy w ciąży są związane z istotnie wyższym ryzykiem cięcia cesarskiego (CS). Miomektomia podczas cięcia cesarskiego (CM) jest źródłem wielu debat a przez wiele lat była uznana za przeciwwskazaną. Aczkolwiek niektórzy autorzy zalecają rutynową miomektomię podczas cięcia cesarskiego. Celem naszego badania jest określenie czynników wpływających na decyzję o miomektomii podczas cięcia cesarskiego. Materiał i metoda: Do badania włączono 185 pacjentek z mięśniakami macicy, które miały wykonane cięcie cesarskie w czasie 5 letniej obserwacji – 102 pacjentki przeszły miomektomię podczas cięcia cesarskiego (grupa badana) a 83 miały wykonane cięcie cesarskie bez miomektomii (grupa kontrolna). Analizie poddano dane kliniczne i położnicze. Przy pomocy testów nieparametrycznych zbadano wpływ różnych zmiennych na decyzję o cięciu cesarskim. Wyniki: Nie znaleziono różnic pomiędzy dwiema grupami pod względem rodności, położenia płodu, wieku ciążowego, liczby uprzednio wykonanych laparotomii oraz miomektomii, obecności cukrzycy lub nadciśnienia, wskazań do cięcia cesarskiego oraz rodzaju wykonanego cięcia cesarskiego. Istotne różnice dotyczyły typu i lokalizacji mięśniaków, w przeciwieństwie do liczby i rozmiaru, które nie miały znaczenia. Wnioski: Na wykonanie miomektomii podczas cięcia cesarskiego największy wpływ miały wiek, doświadczenie operatora i rodzaj mięśniaka. CM jest wykonywana przez doświadczonych chirurgów i u młodszych kobiet. Również miomektomia podczas cięcia cesarskiego częściej jest przeprowadzana na uszypułowanych i podsurowicówkowych mięśniakach a rzadziej w przypadku śródściennych i mnogich mięśniaków

Brain metastases of choriocarcinoma: A report on two cases

Introduction. Gestational trophoblastic diseases (GTD) are a spectrum of tumors with a various of biological behavior and potential for metastases. It consists of hydatiform mole, invasive mole, choriocarcinoma and placental site trophoblastic tumor. Choriocarcinoma presents a very aggressive tumor with high malignant potential. Case report. We presented the two cases of choriocarcinoma with brain metastases. The first one was manifested by neurological deterioration as the first sign of metastasis, while the second patient had firstly metrorrhagia and in the further couse neurological disturbances that suggested the presence of brain tumor. In both cases we applied a combined treatment of surgery, chemotherapy and radiation therapy. Both patient survived with high quality of life. Conclusion. A successful outcome of brain metastases of choriocarcinoma was obtained by the use of a combined treatment of surgery, chemotherapy and radiation therapy. In cases of young women with brain metastases, gynecological malignancy should be always considered

Intraoperative hemorrhage as a complication of cesarean myomectomy: Analysis of risk factors

Background/Aim. Cesarean myomectomy is a controversial issue. It was considered relatively contraindicated for many years due to increased risk of intraoperative hemorrhage. Recent studies showed that cesarean myomectomy in some women may not be associated with increased morbidity. The aim of the study was to determine the causes and risk factors for intraoperative hemorrhage in patients subjected to cesarean myomectomy. Methods. This retrospective study included women subjected to cesarean myomectomy, divided into the study group of 36 patients in whom intraoperative hemorrhage was registered, and the control group of 66 patients in whom it was absent. The following parameters were analyzed: age, parity, gestational age of delivery, indications, type and duration of cesarean section, surgeon's experience, type, localization, size and number of myomas, number of incisions on uterus and neonatal birth weight. Results. There was a significant difference between the groups in terms of the type and size of myomas (p = 0.007 and p = 0.000, respectively) and duration of the surgery (p = 0.000). The size of the defect resulting from myoma enucleation and speed of suturing it have significant influence on the occurrence of intraoperative hemorrhage. In our study, operation on the patients of the study group lasted 14.53 minutes longer and their myomas were 39 mm bigger compared to the controls, with no difference in surgical experience of the obstetricians (p = 0.111). Conclusion. Cesarean myomectomy is associated with an increased risk of hemorrhage. Therefore, it would be advisable to discuss the hemorrhage and transfusion risks with patients with large multiple and intramural myomas before making decision to perform cesarean myomectomy. Those who perform cesarean myomectomy should be prepared to manage intraoperative hemorrhage during surgery in cases they encounter it

Molecular Insights in Uterine Leiomyosarcoma: A Systematic Review

Uterine fibroids (UFs) are the most common benign tumors of female genital diseases, unlike uterine leiomyosarcoma (LMS), a rare and aggressive uterine cancer. This narrative review aims to discuss the biology and diagnosis of LMS and, at the same time, their differential diagnosis, in order to distinguish the biological and molecular origins. The authors performed a Medline and PubMed search for the years 1990–2022 using a combination of keywords on the topics to highlight the many genes and proteins involved in the pathogenesis of LMS. The mutation of these genes, in addition to the altered expression and functions of their enzymes, are potentially biomarkers of uterine LMS. Thus, the use of this molecular and protein information could favor differential diagnosis and personalized therapy based on the molecular characteristics of LMS tissue, leading to timely diagnoses and potential better outcomes for patients

Metastatic brain tumour in pregnancy: A case report

Introduction. Malignant tumours of the central nervous system in pregnancy are rare and are most frequently diagnosed in the second part of pregnancy Of all malignant tumours which may occur in pregnancy, intracranial tumours bear the highest risk of maternal and foetal morbidity and mortality. Case Outline. A 29-year-old primipara was admitted to our hospital as an emergency in the twenty-ninth week of pregnancy due to headache, right eye sight disorders (double vision), nausea and vomiting. The patient had a total thyroidectomy and a dissection of lymph glands of the neck at the age of seven years due to papillary carcinoma of the thyroid glands. The clinical and sonographic test revealed regular foetal growth and morphology. The MRI showed expansive changes in the brain parenchyma corresponding to metastatic lesion with the subtentorial herniation of the uncus of the hippocampus by compressive effect onto the right cerebral peduncle of the mesencephalon. Emergent neurosurgical intervention was indicated. Having in mind the age at pregnancy, it was decided to perform a caesarean operation. Alive female child was born weighing 1,370 grams. The post-operative procedure was normal. The patient was transferred to the neurosurgery department on the first post-operative day, where she underwent emergent surgery. Immunohistochemistry confirmed the metastatic tumour originating from the primary papillary adenocarcinoma of the thyroid gland. Conclusion. Neurosurgical diseases in pregnancy simultaneously jeopardize two lives and represent both medical and ethical problem. Upon confirming the presence of intracranial malignancy in pregnancy, further procedure is very individual and it implies cooperation of gynaecologists, neurologists, neurosurgeons, oncologists, anaesthesiologists and neonatologists

Reflections on Postpartum Hysterectomy as a Possible Complication of Cesarean Myomectomy: A Long Debate

Uterine fibroids are common benign tumors found in fertile women. Numerous obstetrical issues, such as dystocia during labor, fetal hypotrophy, a ruptured amniotic sac, early labor, low-birth-weight newborns, etc., are associated with fibrous pregnant uteri. Cesarean myomectomy is not a common procedure because of the possibility of postpartum hysterectomy or a potentially lethal hemorrhage. For the chosen topic, we present two instances of emergency postpartum hysterectomies following cesarean myomectomy. After a cesarean myomectomy, two women experienced a perioperative hemorrhage that required a postpartum hysterectomy without a salpingo-oophorectomy. A postpartum hysterectomy was required in every instance due to the failure of additional hemostatic techniques to control the bleeding after the cesarean myomectomy. In every case, the location and number of fibroids—rather than their size—were the primary factors leading to the postpartum hysterectomy. In order to ensure that the patient is safe and that the advantages outweigh the dangers, the current trends in cesarean myomectomy include aiming to conduct the procedure either electively or when it offers an opportunity. The treatment is still up for debate because it is unknown how dangerous a second hysterectomy is for people who have had a cesarean myomectomy

Screening methods of ovarian cancer in adults

Ovarian cancer is associated with high mortality rate which has improved a little despite therapeutic advances. It causes more deaths than combined cervical and uterine cancer. High mortality is believed to be a direct result of already advanced stage at the time of diagnosis. Survival is excellent in case of early stage disease but poor in late stage disease, regardless of histology. The goal of screening for ovarian cancer is restricted to detection of asymptomatic early stage disease, as precursor lesions of ovarian cancer have not been identified. At present, there is no reliable method of ovarian cancer screening which has been shown to reduce mortality from ovarian cancer. Therefore, routine screening of women in general population can not be currently advised. Screening should be limited to high-risk population and subjects participating in research projects as long as the results of current studies are available

Small bowel incarceration as a complication of port site drainage following laparoscopic hysterectomy

Introduction. Indication for surgical drainage may be prophylactic or therapeutic. However, surgical drains may cause complications. These complications can arise either following laparoscopic or open surgery. One of the rare complications resulting from drainage includes herniation of abdominal viscera at the drain site. The most common herniated abdominal organ is the small bowel. Case report. A 75-year-old woman underwent laparoscopic hysterectomy for atypical endometrial hyperplasia. After the operation, she developed small bowel herniation in the abdominal wall at the drain site, which was confirmed by multislice computed tomography. The patient underwent emergency relaparotomy that identified drain site incarceration of an ileal loop. Following resection of the incarcerated bowel, her postoperative recovery was uneventful. Conclusion. This case presents rare causative mechanism of intestinal obstruction. The possible occurrence of hernias following surgical drainage must be kept in mind

Obstetric complications of placenta previa percreta

Introduction. Placenta previa is related to severe maternal and fetal morbidity. The increasing incidence of cesarean delivery rate causes a marked increase in abnormally invasive placenta over the past decades. The abnormally invasive placenta is becoming the foremost cause of obstetric hemorrhage and postpartum hysterectomy, causing a significant maternal and fetal morbidity and even mortality. Maternal morbidity in such cases also comprise politransfusion, development of disseminated intravascular coagulation, uterine rupture, cystostomy, fistula formation, ureteral stricture, intensive care unit admission, infection, and prolonged hospitalization, adult respiratory distress syndrome, renal failure, septicemia and even death. Case report. A 38-year-old gravida 3, para 2, was admitted to our hospital at 27 weeks of gestation as an emergency due to vaginal bleeding, previously diagnosed with an anterior placenta previa. Following tocolytic therapy, bleeding stopped. The patient was informed on the diagnosis and the possibility of lifethreatening hemorrhage necessitating preterm delivery. She was given corticosteroids to enhance fetal lung maturity. At 28 weeks of gestation, she experienced massive vaginal bleeding, and a decision was made to perform emergency cesarean section. We made a corporeal transverse uterine incision well above the uterovesical fold and tortuous vessels, at the same time avoiding the superior edge of the placenta. The placenta was found to be densely adherent to the lower uterine segment, penetrating through it and infiltrating the posterior wall of the urinary bladder. An attempt to remove the placenta resulted in injury to the bladder wall and the uterine rupture at a previous cesarean scar. The decision was made to perform total abdominal hysterectomy with placenta left in situ. At present, both mother and the baby are well. Conclusion. Anticipation and the surgeon's judgment are leading factors for surgery, from the choice of uterine incision type to the decision to proceeding to hysterectomy in order to reduce maternal morbidity