Wound Healing Complications After Radical Vulvectomy-treatment With the Use of Vacuum-assisted Closure (VAC)

Abstract: Cancer of the vulva accounts 3-5% of gynaecologic malignancies. In 90% it is a squamous cell carcinoma. The most common location is labia majora. Surgical treatment of vulvar cancer is often followed by complications in wound healing process. The aim of this work is to present advantages of negative-pressure drainage used in postoperative therapy of the wound. A patient diagnosed with a cancer of the vulva underwent radical vulvectomy with bilateral lymphadenectomy. Postoperatively, complex wound failure was observed and the patient was treated with vacuum-assisted closure therapy (VAC). After 10 days, the use of VAC resulted in amelioration of the wound state. Vacuum-assisted closure aims to reduce total time of wound healing, hospitalization and nursing work. Additionally, it enables to ameliorate patient’s general state. It is a safe and successful method used worldwide and it should be considered to be introduced in gynaecologic patients after. Read full text »

Accuracy of Sonographic Fetal Weight Prediction – Evaluation of Sex-specific Formulas

Abstract: Traditional evaluation of fetal weight is performed by means of ultrasonography and mathematical formulas using combinations of biometric parameters, like abdominal circumference (AC), head circumference (HC), biparietal diameter (BPD), femur length (FL). It was recently shown that mentioned parameters and intrauterine growth patterns demonstrate gender-related differences. These reports were used to develop new formulas which take into account the influence of fetal sex. The aim of this paper was to determine the accuracy of ultrasound fetal weight estimations with use of many different formulas, test sex-specific formulas against established methods and to compare their precision in different weight groups. This retrospective study included 97 singleton fetuses with birth weight (BW) between 1040 g and 4740 g and ultrasound examination within 7 days before delivery. Estimated fetal weight (EFW) was calculated by Hadlock, Shepard, Campbell and Merz formulas and sex-specific models of Schild and Melamed. EFW was confronted with actual BW. Achieved results were compared in a few groups considering gender and BW. The accuracy of fetal weight estimations turned out to be higher for males regardless of the used formula. For the whole study population, the best accuracy was proved for Melamed formulas and the worst for models of Shepard and Merz. The highest precision of predictions was revealed in the group of newborns with BW 2500 – 3999 g. Estimated errors for low birth weight (LBW) infants and macrosomic fetuses were more significant. In most cases, new sex-specific formulas provide smaller mean errors than established methods. Read full text »

Unexpected Cause of Chronic Cough in a Pregnant Woman

Abstract: Cough is an interdisciplinary symptom. Chronic cough in pregnant women requires precise diagnosis, especially when it appears for the first time during pregnancy. Case report. A 32-year old woman was seen by her obstetrician at 13th week of gestation. She had a history of miscarriage and premature birth. She did not report any medical problems and had no aberrations in a physical examination aside from abdominal wall scars caused by trauma during an assault with a knife. At 15th week of gestation the patient reported a severe, dry cough with no symptoms of infection. During the previous pregnancy the cough also appeared and ceased after delivery. She was diagnosed with asthma and gastro-oesopharyngeal reflux and received adequate treatment. A chest X-ray performed before the pregnancy showed elevation of the diaphragm. MRI during pregnancy revealed cavity in the diaphragm and a hernia. She was referred for surgery. Meanwhile, the cough became milder and the operation was postponed. Several weeks later the cough returned. Current treatment was modified, with improvement. As there was a risk of premature birth, the patient received full cycle of steroid therapy at 27th week. The elective caesarean section was performed at 39th weeks. She gave birth to a healthy newborn. The cough regressed during puerperium. Conclusions. The cough can be caused by a wide spectrum of factors. Carefully obtained medical history is crucial in establishing diagnosis. We should bear in mind anatomical changes in the body of pregnant women, which can potentially modify symptoms of certain diseases. Read full text »

The Significance of Ultrasound Prenatal Diagnosis in Optimal Therapy of the Newborn Based on a Case of Pulmonary Sequestrati

Abstract: Pulmonary sequestration is a rare congenital lesion in which nonfunctional lung tissue lacks connection with the tracheobronchial tree and receives systemic blood supply. It can be accompanied by free fluid in the pleura, lung hypoplasia, circulatory insufficiency, polyhydramnios or even hydrops fetalis. For this reason early and accurate diagnosis is required. We present a case of a fetus which developed hydrothorax in the 31st week of gestation. Ultrasonographic examination revealed a hyperechogenic mass in his chest that was classified as pulmonary sequestration. Thoracocentesis was performed twice (in 33th and 35th week of gestation) and preterm labor took place, due to preterm premature rupture of membranes, in 35+5 week of pregnancy. The newborn presented respiratory distress and was admitted to the Neonatal Intensive Care Unit (NICU). The postnatal diagnosis of the lesion was difficult and it took several days to confirm the prenatal finding. We emphasize the importance of cooperation between obstetricians and neonatologists, that consist of complete visualization of the fetal anatomy, proper classification of the anomalies and successful final management not only during pregnancy but also after the delivery. Read full text »

Recurrence of Triple Negative Breast Cancer in a 34-year Old Female Patient During the Second Pregnancy – A Case Report

Abstract: A 34-year-old female patient at 36th week of her second pregnancy was admitted to the 1stDepartment of Obstetrics and Gynecology, Medical University of Warsaw. She had a cesarean section at 32nd week of her first multiple pregnancy in 2010. She had a history of bilateral mastectomy [a right breast in 2012, partially left breast (without neoplasia) in 2013] because of carcinoma mammae – ER (-) PGR (-), HER 2 (1) according to Ventana (negative status). In the current pregnancy a cervical cerclage and pessary were inserted at 14th and 17th week of gestation, respectively. At 36 weeks she started suffering from increasing pain in the lumbar part of spine, unresponsive to medication . Due to pain and limited mobility she was qualified for an operative delivery under general anesthesia – a baby boy of 3310g was born in good general condition. However, the pain did not regress after the delivery. In addition, pain of lower limbs appeared. 20 days after cesarean section PET – CT was performed: metabolically active metastases were found in bones, lymph nodes (chest, abdomen, neck), in the right lung and pleura and the liver – breast cancer recurrence. Additional X-ray of the right femur revealed a large metastasis requiring surgical treatment. The patient was referred for systemic treatment with a poor prognosis. She died 5 months after delivery. Read full text »

Mesothelin as a New Diagnostic Marker for Ovarian Cancer

Abstract: Ovarian cancer (OC) is the most aggressive of all gynecological cancers. The disease is most frequently diagnosed at a very advanced stage, because the tumor is asymptomatic for a long time. Even then, the signs are not specific. Researchers are still looking for markers which detect OC at the early stage. Mesothelin is expected to become such marker in the future. This protein exhibits high specificity to ovarian cancer and according to clinical trials could be detected in urine, serum and ascites. Nevertheless, its accurate function in the body remains unknown. It is presumed that mesothelin is involved in the pathogenesis of ascites and tumor cell migration. Evaluation of this new molecule in women may be a chance to increase overall survival and decrease mortality rate among ovarian cancer patients. Read full text »

Pregnancy In Liver Recipients – Management And Outcome. Review.

Abstract: Possession of the offspring and experiencing maternity is desired by many women, including solid-organ transplant recipients. The number of women post liver transplantation (LT) in reproductive age in the USA is approximately 14 000 and raises up to 500 more new cases each year. Moreover, 1/3 of LTs is performed in women of reproductive age. It is necessary to emphasize that pregnancy after LT is a high risk pregnancy, yet it does not increase the risk of graft rejection. In 2017 the first case of woman giving birth to a healthy child after ABO-incompatible LT was described. A period of 1-2 years between LT and conception is considered safe. Complications of pregnancy such as increased risk of hypertension, preeclampsia or gestational diabetes are more frequent among liver recipients than in general population. Increased risk of low birth weight, preterm birth and graft rejection were reported if the conceiving took place within the first year after transplantation. Choosing the right lifestyle, contraceptives and preventing drug interactions are pivotal tasks for the gynaecologist at the time. Management of patients wishing to become pregnant after LT should be based on the lowest effective dose of immunosuppressant. Calcineurin inhibitors and glucocorticosteroids are currently recommended in this group of patients. Read full text »

Uterus Transplantation As A New Method In Uterine – Factor Infertility (UFI)

Abstract: Approximately 0.2 % of women suffer from absolute uterine infertility. There used to be no existing treatment for this condition. However, up till now, a total of sixteen cases of human uterus transplantation have been reported worldwide. It seems that the procedure is to become the method of choice in the treatment of women with UFI. We introduce a review which summarizes current experience in this field, with long-term patient analysis included. It also covers such important issues as potential risks for both involved parties and immunosuppressive therapy during pregnancy Read full text »

Assessment Of The Incidence Of Transplant Renal Artery Stenosis (Tras) In The Early Post-transplantation Period

Abstract: Transplant renal artery stenosis (TRAS) affects 1-23% of recipients and accounts for about 75% of all post- transplantation vascular complications. Objective: The purpose of the work was to evaluate the incidence of TRAS in the period up to 6 months after kidney transplantation and analysis of selected stenosis risk factors in a group of patients transplanted in the Clinic of General and Transplantation Surgery of the Institute of Transplantology of the Medical University of Warsaw. Material and methods: A retrospective analysis of a group of 334 patients treated in the period from January 2014 to December 2015 was performed. The cases of patients in whom a≥50% stenosis of artery lumen was described on imaging studies within 6 months after transplantation were evaluated and selected stenosis risk factors were analysed. Results: The incidence of TRAS in the study (7.2%) is comparable to the results of other centres in Poland and abroad. No statistically significant relationships were found in the TRAS vs. non-TRAS groups for the studied risk factors (p>0.05). In the TRAS CD vs. LD groups, the value of the Phi index (φ=0.318) for the parameter of multiple renal arteries is of note. Conclusions: Multiple renal arteries may represent an important indicator in the diagnosis for TRAS. Read full text »

Obesity and Metabolic Syndrome

Abstract: Obesity is a state of the body, when the amount of energy delivered from food exceeds its consumption by the body. The concept of metabolic syndrome (MS) is determined by the coexistence of the clinical condition with connects risk factors for cardiovascular disease of atherosclerotic character and type 2 diabetes. Metabolic syndrome consists of: increased waist circumference, fasting blood glucose, hyperinsulinemia, lipid disorders, including reduced HDL cholesterol, hypertension, proinflammatory and prothrombotic states. The etiology of metabolic syndrome can be related to two reasons: “adipose-centric” and “diabetes-centric”. The basis of all these metabolic changes is an increased fat mass, a fundamental element of the pathogenesis of insulin resistance. Lack of physical activity, caloric and highly processed diet are not without significance for the development of MS. The paper discusses the influence of adipose tissue in the development of metabolic syndrome and the common denominator that links obesity to insulin resistance, which results in inflammation. In addition, the indicators reveal the prevalence of obesity and metabolic syndrome in Poland and in the world on the basis of the available literature. Additionally, the principles of dietary treatment and its importance in reducing the risk of cardio – vascular patients with metabolic syndrome are discussed. Data from studies conducted around the world confirm that we are dealing with an epidemic of the XXI century in the form of obesity and its complications, including metabolic syndrome. Read full text »