Ceska Gynekologie-Czech Gynaecology最新文献

Objective: We present two cases of isolated tubal torsion, one was asymptomatic in the postmenopausal period and the other was symptomatic in the reproductive period.

Case reports: Case 1: A 66-year-old asymptomatic postmenopausal woman underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy for atypical endometrial hyperplasia. Intraoperatively, the left fallopian tube was found to have isolated torsion. Case 2: A 36-year-old female presented to the emergency department with acute abdominal symptoms. Diagnostic laparoscopy revealed isolated torsion of the left fallopian tube.

Conclusion: Isolated tubal torsion, a rare condition in both reproductive and postmenopausal periods, may be asymptomatic or present with acute abdominal symptoms.

Angiosarcoma (AS) is a rare malignant tumor originating from the endothelial cells of blood or lymphatic vessels. It is characterized by an aggressive course with a high risk of generalization. The most frequent sites of metastasis include the skin, soft tissues, breasts, liver, and heart. Clinical symptoms vary depending on the site of origin. The most common include erythema, skin efflorescence, swelling, and tenderness. Diagnosis of AS is established based on histopathological examination with evidence of atypical endothelial cells and vascular structures. Imaging methods are used as supplementary examinations and help in determining the location and extent of the tumor. In this publication, we focus on the secondary type of angiosarcoma, which has been increasingly described in recent years in the irradiated breast area after breast-conserving surgery. We describe three case reports of patients comprehensively treated at our institution. A relatively long remission, spanning several years, is typical. The essential basis of AS treatment is surgical removal of the tumor with intact resection margins. Due to the size of the defect after resection, simple suturing of the skin cover is often insufficient, and collaboration with a plastic surgeon is necessary for the reconstruction of the resulting defect. Professional literature does not unequivocally state the sufficient width of the healthy tissue margin during resection. The benefit of adjuvant chemotherapy or radiotherapy is debatable. Prognosis is generally poor due to insufficient sensitivity to non-surgical treatment modalities and the speed of metastasis.

Vaginal fisting is an uncommon and risky sexual practice. It consists of penetrating the vagina with one or both hands. Fisting is practiced as heterosexual, homosexual, or autoerotic activity and may be the cause of vaginal injury and circumjacent organs. The article describes the case of a 33-year old pornographic film actress who developed vaginal injury and heavy bleeding during fisting while filming. Rupture of the vagina was sutured and blood loss was replenished with transfusions.

Objective: Effective labor pain management is essential in prenatal care. Identifying factors that contribute to increased pain in patients undergoing labor induction is essential for optimizing pain control. This study assesses pain levels in labor induction patients receiving vaginal misoprostol or dinoprostone for cervical ripening using a visual analogue scale (VAS).

Materials and methods: This prospective study includes 60 volunteer women who received either vaginal dinoprostone (50%) or vaginal misoprostol (50%) as cervical ripening agents. Group 1 consists of patients who received misoprostol, while Group 2 includes those who were administered dinoprostone. VAS scores were recorded during both active labor and crowning. In addition to these pain assessments, birth outcomes and patient characteristics were documented, and comparative analyses were conducted between the groups.

Results: According to VAS scores, pain intensity was significantly lower in Group 1 compared to Group 2 at both stages of labor (during active labor: 6.67 ± 2.68 vs. 7.77 ± 1.59, P < 0.05; during crowning: 8.9 ± 1.32 vs. 9.8 ± 0.55, P < 0.05). All participants' pain scores recorded during crowning were significantly higher than those recorded during active labor (P < 0.05). No statistically significant difference was observed between the two agents in terms of oxytocin administration or the interval from drug administration to delivery (P > 0.05).

Conclusions: Pain scores should be considered when selecting a cervical ripening agent. Misoprostol may be associated with lower pain levels.

Aim: To describe coping strategies and infertility stress in men and women undergoing in vitro fertilization (IVF) treatment. To determine whether there are differences in coping strategies between men and women and to identify adaptive and non-adaptive coping strategies for infertility.

Materials and methods: A correlational study, where 162 patients (99 women and 63 men) with primary infertility undergoing IVF treatment at Sanus Pardubice completed the Fertility Problem Inventory and COPE Inventory psychological questionnaires.

Results: There were no significant differences between women and men in experiencing infertility stress. The coping strategies used most frequently by both men and women were Positive Reinterpretation, Planning, and Acceptance; men used the strategies Restraint, Suppression, and Planning significantly more frequently than women; and women used the strategies Using Emotional Social Support and Religious Coping significantly more frequently than men. For both women and men, level of Global infertility stress significantly correlated with Denial in the positive direction and with Positive Reinterpretation and Acceptance in the negative direction.

Conclusion: Involuntarily childless women and men in IVF treatment experience similar infertility stress, but use slightly different coping strategies. For both men and women, Positive Reinterpretation and Acceptance emerged as adaptive strategies, while Denial emerged as non-adaptive.

Objective: To present a case of a patient who developed acute Sheehan's syndrome, despite adequate estimated blood loss.

Case report: Sheehan's syndrome is a relatively rare disease with various incidences, mainly due to different obstetric care factors in individual countries. Pathogenetic mechanisms are not fully understood. An important factor is reduced blood flow through the pituitary arteries caused by hypotension in the setting of postpartum hemorrhage. Subsequent clinical manifestations depend on the extent of damage to the pituitary gland, and consequently, on the loss of individual hormones, the secretion of which is controlled by the pituitary gland. Most patients are diagnosed years later. Our case describes a patient with Sheehan's syndrome that developed in the early postpartum period. The patient was successfully diagnosed and adequate replacement therapy was started.

Conclusion: In summary, acute Sheehan's syndrome is a rare occurrence. Agalactia, amenorrhea, fatigue, and other non-specific symptoms should be considered despite its rarity.

Objective: An overview of the types of uterine sarcoma, supplemented by an illustrative case report of a rare uterine childhood tumor.

Case report: Our case report describes the case of a 9-year-old girl with a 15-cm tumor in the abdominal cavity, which prolapsed vaginally before introitus during a clinical examination of the abdominal wall causing life-threatening bleeding. This bleeding was stopped by ligation of the tumor pedicle and its resection. Histological examination of the resected specimen described Müllerian adenosarcoma of the uterus. Based on the staging, laparoscopic hysterectomy with bilateral salpingectomy was indicated by the oncogynecological committee. The operation was performed without complications, and intraoperatively, a complete inversion of the uterus was diagnosed.

Cantrell's pentalogy is a rare syndrome associated with a midline embryological defect involving a series of malformations: anomalies of the lower sternum, anterior diaphragm, heart, and anterior abdominal wall. It can be classified as complete, probable or partial, but the most important thing is to describe and understand the anomalies involved. We describe a case of a late diagnosis of Cantrell's pentalogy at 35 weeks and 5 days of pregnancy in a woman from the interior of Pará state, an Amazon Brazilian region. Fetal echocardiography confirmed the diagnosis of Cantrell's pentalogy with tetralogy of Fallot and ultrasound examination showing a bilateral clubfoot. Cesarean section was performed at 36 weeks because of pre-eclampsia superimposed on chronic arterial hypertension with signs of severity. The male newborn was delivered weighting 2,320 grams. Postnatal echocardiography confirmed the diagnosis of Cantrell's pentalogy and karyotype was normal (46, XY). Infant was discharged at 47 days of age with good weight gain, artificial breastfeeding, and outpatient follow-up by the cardiology and cardiac surgery specialists.

Objective: We describe a case of a young girl diagnosed with vascular malformation of the left ovary and genetically confirmed Cowden syndrome.

Case report: Clinically, the girl had no gynecological problems, but there was swelling of the right knee after physical exercise. The predominant finding on imaging was a venolymphatic malformation arising from the musculus vastus medialis detected by magnetic resonance imaging. After puncture of the lesion, the biopsy specimen was subjected to genetic examination, which revealed a heterozygous PTEN gene mutation. This proved Cowden syndrome at the molecular level. At the same time, heterogeneous expansion in the region of the left ovary was described on magnetic resonance imaging. Based on staging, diagnostic laparoscopy with lavage was indicated. Perioperatively, multiple adhesions in the small pelvis and a tumor arising from the left ovary were detected. Partial resection of the left ovary was performed, and perioperative cryobiopsy confirmed a vascular malformation, with no concomitant findings of a benign tumor or malignancy. Definitive histological examination of the resected left ovary showed the presence of vascular malformations, which clinically corresponds to possible symptoms of Cowden syndrome.

Conclusion: Cowden syndrome is a rare genetic disorder whose diagnosis is based on clinical manifestations, imaging studies, and subsequent genetic testing. Follow-up of patients abides by the National Comprehensive Cancer Network recommendations and requires a multidisciplinary approach.

Uterine torsion belongs to one of the most dangerous labor complications also because of its rarity. As it is not common for an obstetrician to come across this state, it is usually not at the very top of the differential diagnostics list when solving acute child delivery complications. However, it is serious enough to pose a lethal threat to both mother and child. In this case, the term gravidity was ended by acute cesarean section because of HELLP syndrome. During the operation, as well as after a complicated delivery and hysterotomy suture uterine torsion of 120 degrees to the right, the patient was diagnosed with detorsion. The rest of the operation was done according to normal standards. Thanks to this very prompt procedure, the aftermath of the described state meant little to no harm to the mother and her child. This case study should highlight the importance of including uterine torsion into differential diagnostics of acute abdominal pain and vomiting to prevent fatal labor complications for the mother and her child.