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

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

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

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

The role of endocrine factors in the pathogenesis of spontaneous abortion after IVF-ET

Odpowiedź na pytanie, czy ryzyko poronienia samoistnego po IVF-ET jest wyższe niż po poczęciu naturalnym, nie jest łatwa. Wpływa na to fakt, iż rozwój wczesnych ciąż po IVF-ET jest zdecydowanie bardziej intensywnie monitorowany, co skutkuje w tej grupie pacjentek bardzo precyzyjnym określeniem częstości poronień, również subklinicznych. Przeważa jednak opinia, że ryzyko względne poronienia samoistnego po IVF-ET jest znamiennie większe aniżeli po poczęciu naturalnym.There is large body of evidence to show that the risk of early pregnancy loss is higher after IVF-ET than after natural conception. Several hypotheses have been proposed to explain this phenomenon. One of the possible etiopathogetic factors is the patient’s age which is significantly higher in women undergoing IVF than in the general population of naturally conceiving women. Immunologic factors have also been suggested. It seems that procedures like ICSI do not increase the risk of spontaneous abortion (SAB) after IVF-ET. Moreover, the proportion of products of conception with chromosomal aberration in cases of SAB following ICSI procedure is not elevated. Many authors point to the problem of iatrogenic luteal defect after IVF-ET. The use of luteal support after IVF-ET is widely recommended. Interestingly, firm evidence is lacking regarding the efficacy of progestagen or hCG supplementation on the risk of SAB after IVF-ET. However the issue of the effectiveness of progesterone support in decreasing the risk of SAB after ART procedures is far from being conclusively resolved – it deserves well planned, randomized studied to be performed

Uterine artery embolization using gelatin sponge particles performed due to massive vaginal bleeding caused by ectopic pregnancy within a cesarean scar: a case study

A pregnancy located within a cesarean scar is the rarest form of ectopic pregnancy. We present a case of a 34-year-old woman with a history of one cesarean section (gravida 2, para 1) admitted to the hospital at 9 weeks of gestation due to vaginal bleeding, initially diagnosed as a missed abortion. During the hospitalization spontaneous abortion took place, and the patient was qualified for dilatation and curettage. After the procedure massive vaginal bleeding occurred, a cesarean scar pregnancy was diagnosed, and uterine artery embolization (UAE) using gelatin sponge particles was performed. The treatment was successful. Our case shows that UAE might be a life-saving procedure in cesarean scar pregnancy hemorrhages. Absorbable properties of gelatin sponge particles reduce the risk of adverse effect on fertility

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