Cervical, vaginal and vulvar intraepithelial neoplasms

nem

Multiple endometrial polyps in patient undergoing long-term gestagen therapy

Endometrial polyps represent a limited focal, circumscribed overgrowth of the endometrium. Their aetiopathogenesis has not been completely explained yet. They are often found in perimenopausal women; during the reproductive period they are less common. We present the case of a 32-year-old patient, who came for a check-up to the Gynecology and Obstetrics Clinic "Narodni Front" because of irregular bleeding. The patient was subjected to hormonal linestrenol therapy, which she had administered herself, without further consultations with her gynecologist, during the previous 10 years. Complete diagnostic examinations were performed. Contrast sonohysterography enabled the visualization of multiple polyps inside the uterine cavity, which were confirmed by histopathological analysis of material obtained via explorative curettage. Histopathological material contained over 30 endometrial polyps. A control check-up after one month, as well as subsequent quarterly check-ups, resulted in normal findings. Analysis of the described case has indicated that the loss of sensitivity of progesterone receptors in endometrial cells is possible if there is a continuous presence of progesterone agonists in circulation, as is true of linestrenol in this case. The loss of sensitivity of progesterone receptors upsets normal hormonal activity during the secretory phase of the menstrual cycle, leading to copious, irregular bleeding. These changes may, however, have even deeper effects. More recent research shows that, if the agent causing the loss of sensitivity of the receptors is present in circulation over a longer time period, changes may also appear at the DNA molecular level, i.e. in the cell genome itself. This, in turn, may lead to the beginning of the process of oncogenesis and the formation of timorous tissue

Role of hydrosonography in prevention and screening of premalignant and malignant endometrial disease

Introduction: The study emphasizes the significance of hydrosonography in prevention and early diagnostics of endometrial pathology. Objective: To express the significance of hydrosonography in relation to timely detection and treatment of premalignant and malignant endometrial disease. Method: Our study included 104 patients referred to transvaginal sonography, after which hydrosonography was recommended in order to obtain precise visualization of the endometrium because of suspected endometrial pathology. After hydrosonography, dilatation and curettage with endometrial biopsy were performed in all patients. Biopsy specimens were histologically analyzed. Results: The application of contrast sonography described in our research helped diagnose and timely treat as many as 30.8% of patients suffering from premalignant and malignant endometrial disease (23.2% of premalignant and 7.6% of malignant). Discomforts (bleeding and pelvic pain) occurred in 72.1% of patients, out of whom 43.3% had already undergone curettage once or more than once because of the same or similar symptoms, while 27.9% of cases presented for regular control, i.e. they were symptom free. The obtained Results clearly emphasized the significance of application of contrast sonohysterography as a Method for timely detection of endometrial pathology and its adequate treatment. Conclusion: The study shows that application of contrast sonohysterography before exploratory curettage significantly facilitates the use of invasive diagnostics and improves accuracy and validity of the obtained Results, especially in cases of endometrial focal changes; consequently, it is also possible to achieve positive cost - benefit effect

Uterine compression suture technique in the management of severe postpartum haemorrhage as an alternative to hysterectomy

Introduction. One of the most dramatic conditions in obstetrics is definitely bleeding from the uterus which fails to compress. This condition is known as postpartum atony. When such a condition is diagnosed, the obstetrician has a choice of several conservative methods to stimulate the uterus to contract and several surgical methods to stop the bleeding. The most extreme measure used to save the patient's life and stop the bleeding is hysterectomy. This surgery is characterized by high morbidity, primarily by the loss of woman's fertility. In order to avoid hysterectomy, several authors have introduced the compressive uterine suture technique into gynaecological practice. Objective. The aim of the paper is to demonstrate the technique of applying compressive uterine suture after delivery to stop excessive bleeding, and to present results obtained by this technique. Methods. The paper explains the technique of applying compressive suture to the atonic uterus in cases when all other procedures to stop excessive bleeding after delivery fail. Since uterine atony is the main reason for excessive and uncontrollable bleeding after childbirth, the need to perform such surgery is rather common. Authors demonstrate the technique of applying four compressive sutures which prevent uterus dilation and thus stop the bleeding. Results. Compressive suture technique was used by the authors eight times, seven of which during caesarean section and one after spontaneous delivery. All patients had normal postpartum period and normal involution of the uterus. Conclusion. Although this surgery requires a skilful and experienced obstetrician, the authors find it rather easy to perform and it is suggested to be applied in all cases of uterine atony when excessive bleeding cannot be stopped by other any other method except hysterectomy. This surgical procedure saves the uterus and facilitates quick and easy patient's recovery

Preoperative blood transfusion for gynecological operation of a patient with Bernard-Soulier syndrome: Case report

Bernard-Soulier syndrome belongs to congenital thrombocytopathic platelet disorders. There is a change of the structure of the glycoprotein in platelet membrane, causing the impair of platelet adherence on the blood vessel wall. This syndrome is clinically manifested by spontaneous bleeding in the skin and mucosa. The prognosis is usually good with an adequate support, but serious bleeding episodes occur during menstruation, trauma or surgery intervention. Treatment of bleeding or prophylaxis during surgical intervention is usually based upon platelet transfusion and the use of antifibrinolitic drugs. The object of case report is the significance of the right and an adequate preparation for the operational treatment: Mrs 42 year old, with diagnosis: Bernard-Soulier thrombocytopathia. Iron deficiency anemia. Status post operationem cystis ovarii sinistri. Admitted to the Clinic of gynaecology and obstetrics 'Narodni front' for operative treatment. The menstrual cycle is on 28 days, duration 7 days. From juvenile period there were reports of episodes of bleeding with thrombocytopathia. In prepartal period transfused with few doses of platelet. All dental interventions followed with bleeding, done with 6 doses of platelet concentrate. The history of operation of a cyst with a diagnosis: Cysta ovarii lateralis dextri torquata in 2005. The operation followed with pre-operative use of 15 doses of platelet concentrate, 2 units of fresh frosen plasm and 3 units of deplasmatic erythrocytes. There was a report of adverse reaction due to plasm transfusion and erythrocytes as a hypersensitive reaction, but during operation, there was no bigger post-operative bleeding. In following 2 years, the patient was hospitalized few times because of seriuos menometrorrhagia, and conservativly treated with iron preparations, with a difficult tolerating. Anamnesis: allergy to preparation of salicylate, ranitidin, diclofenac and tranexamic acid. In last hospitalization, the patient was admitted because of a large bleeding. Haematological parameters: Hgb 63 g/L, Rbc 2,61 x 1012/l, MCV 76fL, Plt 22 x 109/l. Biochemical parameters in referential values. Global tests of haemostasis preoperativly: PT 13,4s (9-12,6s), INR 1,02, APTT 20,7s (24-35s), fib 2,08 g/L (1,69-5,15 g/L), TT 18,9s (18-25s), 3 doses of deplasmatic erythrocytes and 2 x 7 doses of platelet concentrate with preoperativly used of methylprednisone (80 mg). Operation: Hysterectomia totalis abdominalis classica cum adnexectomiam lateralis dextri. Pre-operative and post-operative period regular. Therapy: antibiotics, analgetics, infusion solutions and 5 x 7 doses of platelet concentrate with methylprednisone (80 mg). Wound healing per primam. The patient was discharged from the Clinic well recovered, with a plan for a treatment and a future care needs

Uterine Compression Suture Technique in the Management of Severe Postpartum Haemorrhage as an Alternative to Hysterectomy

Introduction One of the most dramatic conditions in obstetrics is definitely bleeding from the uterus which fails to compress. This condition is known as postpartum atony. When such a condition is diagnosed, the obstetrician has a choice of several conservative methods to stimulate the uterus to contract and several surgical methods to stop the bleeding. The most extreme measure used to save the patient’s life and stop the bleeding is hysterectomy. This surgery is characterized by high morbidity, primarily by the loss of woman’s fertility. In order to avoid hysterectomy, severa