To compare the three methods of assessment of free myometrial margin over myoma with the evaluation during hysteroscopic myomectomy under control of transrectal intraoperative ultrasonography (TRUS). 58 women with submucous and intramural myomas in which hysteroscopic myomectomy under control of TRUS was performed. In all cases the free margin of myometrium over the myoma was measured using USG TV, SHG and SHG-CP (120 mmHg) and these results were compared with intraoperative assessment by TRUS performed during hysteroscopic myomectomy. Statistical analysis: comparison of correlation R and determination R2 indices. The median free margin of myometrium over the myoma in assessing by USG TV was 8.91 mm, by SHG 6.9 mm, and by SHG-CP 6.7 mm, however in intraoperative assessment by TRUS was 6.84 mm. The highest correlation with intraoperative result has SHG-CP (r = 0.99), high has SHG (r = 0.95), and the lowest USG TV (0.67). SHG-CP gives the results of free myometrial margin evaluation most similar to intraoperative anatomy and prevents qualification to operation the myomas that in reality during action of intrauterine pressure are in contact with perimetrium.

Objectives: To document by transvaginal ultrasound how varies the distance between the submucous fibroids and the uterine serosa (myoma free margin or MFM) during resectoscopic myomectomy. Methods: We enrolled all patients with a hysteroscopically diagnosed G2 submucous fibroid undergoing a cold loop resectoscopic procedure from January to November 2009. MFM was evaluated by TVU pre-operatively (T0) and during the procedure. MFM was sonographically assessed after distension of the cavity for resectoscopic myomectomy (T1), after the beginning of myoma’s slicing (T2), during enucleation (T3) and at the end of the procedure (T4). Results: Overall, 10 patients were included in our study. The procedure was successfully performed without complications in all cases. The mean MFM at T0 was 6.58 ± 2.6 mm. This measurement decreased significantly at T1, but underwent progressive increase at steps T2 and T3. After complete enucleation of the fibroid (T4) the mean distance between the fovea and uterine serosa was 7.5 mm greater in comparison with preoperative MFM. Conclusions: MFM is a dynamic parameter and may considerably increase during hysteroscopic myomectomy. On this basis, even G2 submucous fibroids which appear very close to serosa on preoperative TVU may be eligible for resectopic removal.

Objective. Endometrium is a specialized organ in which phenomena controlling the level of cell proliferation and apoptosis are marked. The aim of our study was to determine the presence of proteins involved in apoptosis and proliferation: RCAS1, MT and the number of CD56-positive cells and their activity to elucidate their possible role in the development of adenocarcinoma and endometriosis. Materials and methods. MT, RCAS1, CD56-positivity and CD69 expression were assessed in 55 tissue samples by Western blot and immunohistochemistry methods. Results. We found that endometrium during secretory menstrual cycle phase is characterized by significantly higher RCAS1 and higher MT expression than in proliferative phase. The number of CD56-positive cells and the CD69 antigen expression was significantly increased. Endometrial adenocarcinoma was characterized by significantly increased RCAS1 expression, while MT expression was comparable to the level found in the secretory phase. The number of CD56-positive cells was significantly decreased and their activity was comparable to the level found in the secretory phase. Endometriosis was accompanied by significantly lower RCAS1 and MT expressions, with lower number of CD-56 positive cells and lower expression of CD69 antigen in comparison to the secretory phase. Conclusions. The ability of endometrium to determine cytotoxic activity (RCAS1 expression changes) and high protection against DNA damage (MT expression) with concomitant changes in the number of immune cells and their activity, observed in normal endometrium during the menstrual cycle phases seems to be fundamental for pathological features of endometrial adenocarcinoma and endometriosis.

Comparison of accuracy of qualifying procedure based on sonohysterographical or hysteroscopic assessment of submucosal myomas penetrating myometrium. The study group: 173 women with submucosal myoma penetrated myometrium qualified to hysteroscopic myomectomy All patients underwent sonohysterography and diagnostic hysteroscopy separately. Both procedures were performed by independent operators, with remark, that sonohysterography was a primary procedure. Regardless of qualifying results based on SIS and hysteroscopy, decision of histeroscopic myomectomy was taken based on primary sonographic result. Myomas resection was performed by combination of electroresection and,, in toto' technique with possibility of conversion into alternative procedure. Lack of conformity in qualification to G1 and G2 group in Wamstacker's classification occurred in 46 (26.1%) cases. Most frequent discrepancy occurred in cases of myomas with diameter > 3 cm, G1 and G2 grade, and when thickness of endometrium was > 8 mm, what made difficult to assess actual angle between myoma and myometrium and degree of its protruding to uterine cavity. Extension of indication for hysteroscopic myomectomy to myomas G2 grade, which in 1/5 protrude into uterine cavity and which distance from serous membrane is 5 mm do not cause significant increase of complication and duration of operating time. Sonohysterography should become a methods of choice in qualification for hysteroscopic myomectomy by patients with submucosal myomas penetrating myometrium. Level of protruding of submucosal myoma into uterine cavity is actually not a technical limitation of hysteroscopic myomectomy. Establishment of new, additional sonohysterografical qualifying criteria would allow widening of indications to hysteroscopic myomectomy without increase of complication, with high efficacy these procedures.

Presentation simultaneous transrectal sonography with outpatient hysteroscopy as diagnostic method of uterine cavity assessment at women after hysteroscopic electrodestruction of endometrium. Material -55 women after hysteroscopic electrodestruction of endometrium diagnosed because of suspected scans of uterine. The study group: 29 women with performed outpatients hysteroscopy (OHS) with associated transrectal sonography (TRUS). The control group: 26 women with performed OHS (possible combined with endometrial biopsy) without application of TRUS. In some patients hysterectomy was performed because of recurrent ailments. The results of performed procedures in both groups were compared: possibility of uterine cavity visualization, satisfactory collection of specimen to histological examination, necessity of general anesthesia and l complications. The diagnostic value of OHS with TRUS vs. OHS was assessed in these cases. Chi2and McNemar tests were used for statistical analysis. In study group illustrating of suspected area was recognized as satisfactory in 25 (87%) cases vs. 10 (36%) in control group. The biopsy from suspected area was possible in 19 (65.5%) cases in study group and in 9 (34%) in control group. Complications occure only in control group in 3 (11.5%) cases alleged canal, that in 1 (3.8%) was ended by perforation of uterus. Among women with performed hysterectomy-control group 3 (5.4%) cases of focal hyperplasia were stated, within 2 (3.6%) of atypical hyperplasia, that was not revealed by carried out diagnostic proceedings. Simultaneous application of OHS and TRUS allow imaging and biopsy performing these areas of uterine cavity which can not be reach by hysteroscopic optics for the sake of numerous adhesions after endometrial destruction procedures. In cases of partial or total occlusion of uterine cavity, “blind performed” biopsy or biopsy only under control of hysteroscopy can be reason of overlooking of significant pathology.

PURPOSE:The study was carried out to ascertain the experience of pregnant women with cardiac disease in one referral center.METHODS:From 1986 to 2004, 242 pregnant women with heart disease were followed by the same obstetrical and cardiology center. The cardiac diagnosis was additionally confirmed with echocardiography and heart catheterization during cardiosurgery. The subjects were classified into groups with respect to the congenital heart abnormality type, and cardiovascular insufficiency according to the NYHA classification. The results from the evaluated groups were compared to a control group.RESULTS:A significant increase in percentage of congenital heart disease was found, however acquired cardiac defects prevailed. A significant increase in rate of congenital heart disease was found. A higher incidence of cesarean sections in women with underlying heart disease with respect to the control group was also found.CONCLUSIONS:In pregnant women with underlying heart disease, congenital heart disease is presently more frequent than acquired heart disease compared to the situation in the beginning of the analysis. Pregnancy duration time depends on cardiac sufficiency and it is statistically shorter in NYHA class III and IV patients.

modified radical mastectomy group. When prognostic factors for survival were included in a multivariate Cox analysis, adjuvant treatment (p ¼ 0.01) and axillary lymph node status (p ¼ 0.03) were significant. Conclusions: Breast conservation will be always recommended if the relation between tumor diameter and breast volume permits a cosmetic attractive result. Acceptance of conservative approach to the treatment of breast cancer has been gradually, and parallels other trends, with similar treatment results. Our findings prove the sucessful integration of research-proven innovations into community practice.

diation was administered in 18 (9,5%) patients due to large volume disease. Postoperative radiotherapy was applied to 69 (36,7%) due to one or more high risk factors. Variables studied included age, stage, histological type, grade, depth of invasion, tumor size, LVSI, uterine extension, lymph node metastases, number of lymph nodes excised, number of positive nodes, preoperative brachytherapy and postoperative radiation therapy. Univariate and multivariate analysis was performed using the Cox regression model. Results: The mean age was 46, 6 þ/ 11, 6 years. Overall survival was 86, 8% for 143 (76%) Stage Ib patients and 82, 2% for ST IIa, 59% with lymph node metastases and 91, 6% without. Factors that predict overall survival in multivariate analysis were: a) favorable: age p1⁄4 0,03 (RR1⁄4 0,77) (for every 5 years), b) unfavorable: lymph node metastases p1⁄4 0,03 (RR1⁄4 2,89), uterine extension p1⁄4 0,02 (RR1⁄4 4,26) and preoperative brachytherapy p1⁄4 0,02 (RR1⁄4 4,41). All the other factors examined were also associated with poor prognosis, but none reached statistical significance. Conclusion: Surgery þ/ radiation therapy achieved considerable disease control in early stage cervical cancer except for large volume, bulky tumors, regardless of the aggressive use of the therapeutic modalities.

An important clinical and therapeutical problem is coexistence of VIN and vulvar carcinoma with intraepithelial neoplasia and invasive cancer of the vagina and uterine cervix. The study group was consisted of 148 patients aged 22 - 45 yrs with VIN or vulvar carcinoma,who were diagnosed with use of cytology and colposcopy. The material of punch biopsies was diagnosed with use of In Situ Hybridisation technique. Not only an increase of VIN and vulvar cancer in young women in last 25 years has been observed but a high percent(10,8%) of coexistence of the changes within the vulva with intraepithelial neoplasia and/or invasive vaginal or cervical cancer, as well. There has been also a high percent(81,3%) of high oncologic HPV potential observed in women with the changes widespread within the low genital tract. These observations oblige to a very careful diagnosis within low genital tract including cytology, colposcopy and DNA hybridization technique especially in young women.