Ceska Gynekologie-Czech Gynaecology最新文献

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.

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.

Introduction and objective: Uterine NK (uNK) cells, a specialized subpopulation of natural killer (NK) lymphocytes located in the endometrium, play a crucial role in regulating the immune response and in the process of embryo implantation. This study aims to retrospectively analyze the outcomes of in vitro fertilization (IVF) treatment in a cohort of women who underwent uNK cell immunophenotyping with subsequent immunomodulatory therapy applied based on the results.

Methods: The study included 122 patients who underwent uNK cell immunophenotyping between April and December 2023. Immunophenotyping was performed using flow cytometry. Patients were categorized into four groups according to their uNK cell phenotypes: normal findings, low absolute and relative numbers of uNK cells (LOW-IMMUNE profile), low numbers of uNK cells combined with the shift towards the cytotoxic uNKc dim immunophenotype (MIXED-IMMUNE profile), and normal numbers of uNK cells, but an undesirable shift in the ratio of cytotoxic to regulatory uNK cells towards the cytotoxic uNK dim phenotype (OVER-IMMUNE profile). Embryo transfer outcomes and the occurrence of miscarriages up to the 12th week of pregnancy were evaluated in each group.

Results: The highest clinical pregnancy rate was observed in the treated OVER-IMMUNE group (70%), fol lowed by the MIXED-IMMUNE group (60%). The LOW-IMMUNE group did not differ significantly from the untreated NORMAL group (P = 0.205). Insufficient immune activation (LOW-IMMUNE profile) was significantly associated with first-trimester pregnancy loss (P < 0.0001).

Conclusion: This study provides new insights into the potential benefits of uNK cell immunophenotyping and subsequent immunomodulatory therapy in treating fertility disorders. While the results indicate possible clinical advantages, further research is necessary to confirm these findings and elucidate the mechanisms leading to improved outcomes in assisted reproductive techniques.

This is a short review about a rare metastatic physical finding of abdomino-pelvic malignancies that is called Sister Mary Joseph's nodule. It is cutaneous metastasis in the umbilical region and it was first used almost 200 years ago. Even though it is a rare finding, we should not forget it in the differential diagnosis of umbilical nodules. The article also includes two case reports.

Objective: To determine the profile of women undergoing uterine evacuation for suspected hydatidiform mole (HM) according to their clinical, laboratory, ultrasound, and anatomopathological characteristics at two referral centers in Northeastern Brazil.

Methods: Retrospective cohort study was performed in two referral centers between October 2016 and December 2022 with women undergoing uterine evacuation for suspected HM. Socio-demographic characteristics, clinics, biochemistry, ultrasound, anatomopathology, and outcome were evaluated.

Results: A total of 507 women were admitted with clinical suspicion of gestational trophoblastic disease, of which 334 were confirmed, with 107 being in Center-1 and 227 being in Center-2. Mean distance between the referral center and the patient's home was 88 km. Mean age of the women was 27 ± 9 years, with a predominance of 19 to 39 years (72%), and approximately 60% of the cases were diagnosed ≤ 12 weeks of gestation. Vaginal bleeding was observed in 79% of women. Transvaginal ultrasound showed a typical appearance in 90% of the examinations. The macroscopic aspect was described as a vesicle in 70% of cases. Uterine evacuation was mainly performed by uterine curettage (43%). The majority of women had no complications (69%). The outcome considered to be remission was achieved in 37.1% of cases, but 38.9% abandoned follow-up, and 9% did not start follow-up after hospital discharge.

Conclusion: The distance traveled by women to the referral centers was significant, but the majority of women had no complications. Remission was observed in 37.1% of women, but there was a high abandonment rate of 38.9%.