Ginekologia polska最新文献

Chronic pelvic pain of venous origin (CPPVO) is a common yet frequently underdiagnosed condition that affects women's quality of life. This review analyzes studies from 2019 to 2024 on the effectiveness and safety of pelvic vein embolization. While pharmacological treatments offer limited relief, embolization of pelvic varicose veins has shown significant symptom improvement with acceptable complication rates. Studies report high patient satisfaction and long-term efficacy. Further research is needed to optimize qualifiaction for the procedure. Interdisciplinary collaboration between gynecologists, vascular surgeons and interventional radiologists remains crucial for effective CPPVO management.

Introduction: Intravenous leiomyomatosis (IVL) is a rare condition characterized by the proliferation of uterine smooth muscle cells within the lumen of vascular vessels. Despite its histologically benign nature, IVL can invade cardiac vessels, leading to severe complications such as circulatory failure and heart blockade. This underscores the critical need for accurate diagnosis and comprehensive preoperative management to prevent fatal outcomes. : RESULTS: A previously healthy 41-year-old woman was admitted to Gynecology Department following abnormal findings on a routine abdominal ultrasound (USG). The USG revealed a pelvic tumor accompanied by extensive thrombosis of the ovarian veins and inferior vena cava (IVC). Abdominal magnetic resonance imaging (MRI) showed an enlarged myomatous uterus measuring 85 x 70 x 60 mm with two oval-shaped focal lesions near the left ovary, measuring 50 x 50 x 45 mm and 80 x 50 x 60 mm. Additionally, vascular CT revealed a free-floating thrombus extending from the ovarian veins, right common iliac vein (CIV), IVC, and into the right atrium. The patient was scheduled for a single-step surgery. She underwent a total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO), followed by sternotomy with extracorporeal circulation (ECC) to remove the tumor from the circulatory tract. Postoperative histopathological examination confirmed the diagnosis of IVL. : CONCLUSION: Patients with IVL extending into the circulatory system should be managed by multidisciplinary teams comprising oncological gynecologists, as well as vascular and cardiothoracic surgeons. This collaborative approach ensures radical surgical resection, which is essential in preventing future recurrences of IVL.

Objectives: Vaginal flatus is a common postpartum issue that can impact women's quality of life. This study investigates the effectiveness of Kegel exercises in reducing vaginal flatus among postpartum women.

Material and methods: In this study, forty postpartum women were enrolled between July 2022 and December 2022 at the Gynecology and Obstetrics Clinic of Istanbul Camlıca Medipol Hospital. The required sample size was calculated based on a power analysis assuming a medium effect size (Cohen's d = 0.5), a power of 80%, and a significance level of 5%, resulting in a minimum of 17 participants per group. To account for potential dropouts, 20 participants were included in each group. Women in this study were randomly assigned to either an experimental or a control group. The experimental group performed Kegel exercises, whereas the control group received no intervention. Participants in the experimental group completed Kegel exercises three times daily in three different positions for three weeks. Additionally, a six-week home exercise program was implemented, including fast and slow contractions targeting both type I and type II muscle fibers. The assessment included vaginal flatus frequency and bother scores measured through a validated questionnaire, as well as sexual quality of life evaluated using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PSQ-12).

Results: A significant reduction in vaginal flatus frequency and bother scores was observed in the experimental group following the intervention (p < 0.01). The mean vaginal flatus frequency score decreased from 2.95 to 2.0 in the experimental group. Comparisons of pre- and post-intervention vaginal flatus frequency/bother scores and PSQ-12 values revealed a statistically significant difference only in the experimental group (p < 0.05).

Conclusions: The findings indicate that Kegel exercises effectively reduce the frequency and bother associated with vaginal flatus in postpartum women. Incorporating pelvic floor exercise into postpartum care programs may improve overall well-being and sexual health outcomes.

Cervical cancer is considered one of the most common cancers leading to deaths among women worldwide. It is caused by infection with the human papillomavirus (HPV), which is transmitted mainly through sexual contact. HPV vaccination is regarded as an efficient tool in reducing the incidence of cervical cancer. However, despite the effectiveness of vaccines and implementation of vaccination programs, many countries face challenges with unsatisfactory vaccination rates, which may result from limited public trust or insufficient knowledge. Social marketing campaigns are implemented in many countries to promote HPV vaccination as a part of cervical cancer prevention. Despite being relatively new, social marketing is used to encourage a transformation in attitudes and behaviors towards those beneficial for health. The objective of this study is to determine the application of social marketing in the prevention of cervical cancer caused by HPV infection worldwide and to analyze selected social marketing campaigns conducted in various countries (Australia, Japan, Denmark, the United States of America, Peru, and Nigeria). As indicated by the analysis, social marketing tools are more advanced in developed countries that dispose of a greater number of organizations compared to developing countries. While some campaigns focused solely on the topic of HPV vaccination, others expanded their scope to include additional preventive measures. The most frequently used distribution channel was the Internet. Nevertheless, social marketing tools are still not being fully used in the prevention of cervical cancer, particularly that caused by HPV infection. There remains room for improvement on this topic worldwide.

Objectives: Polycystic ovary syndrome (PCOS) is a chronic endocrinopathy associated with a wide range of psychological disorders. Recent literature suggests a correlation between PCOS and cognitive linguistics disorders. This study aimed to analyze the relationship between sex hormones, metabolic markers, and cognitive linguistic performance in patients with PCOS.

Material and methods: 48 women with PCOS and 56 healthy control women were included in the study. Standardized questionnaires were used to assess depressive symptoms [the Beck Depression Inventory (BDI-II)] and linguistic capability [the Wechsler Vocabulary Subtest of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) test and "Łatysz" non-word reading test]. Baseline cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Laboratory tests included measurements of serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, dehydroepiandrosterone sulfate (DHEA-S), sex hormone binding globulin (SHBG), glucose, insulin, cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and total cholesterol (TC). Oral glucose tolerance test (OGTT) results were also obtained.

Results: We observed significant differences in testosterone, DHEA-S, SHBG, insulin, insulin measured in 120-minute post-OGTT, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) values between women with and without PCOS. A negative correlation was found between the Wechsler Vocabulary Subtest of the WAIS-R test and testosterone, LDL, insulin, and HOMA-IR. Our study revealed a negative correlation between "Łatysz" non-word reading test and testosterone and a positive correlation between "Łatysz" non-word reading test and 120-minute post-OGTT blood glucose concentrations.

Conclusions: Our results suggest that there is a relationship between hormonal, metabolic markers, and cognitive functions in patients suffering from PCOS.

Objectives: Ovarian cancer is a highly lethal gynecological malignancy with poor prognosis. Early diagnosis of ovarian cancer is crucial for improving patient survival rates. Ultrasound is currently the most used imaging modality for the detection of ovarian cancer. However, its diagnostic accuracy is limited, particularly in the early stages of the disease. Circulating tumor DNA (ctDNA) has emerged as a promising noninvasive biomarker for cancer diagnosis. In this study, we aimed to investigate the clinical value of ultrasound combined with ctDNA (mutations in: TP53, KRAS, and PIK3CA) in the early diagnosis of ovarian cancer.

Material and methods: A total of 686 participants were enrolled, comprising 186 advanced symptomatic ovarian cancer patients, 16 histologically confirmed asymptomatic ovarian cancer patients, and 484 patients with benign ovarian lesions. Of the 202 ovarian cancer cases, 57.4% were high-grade serous carcinomas, followed by endometrioid (15.8%), clear cell (9.9%), mucinous (7.9%), and low-grade serous carcinomas (6.9%). All participants underwent standardized ultrasound examination and ctDNA analysis. Ultrasound characteristics were evaluated for morphological features including mass composition, border definition, and presence of ascites. Circulating tumor DNA was analyzed for mutations in TP53, KRAS, and PIK3CA genes. Diagnostic performance was assessed through sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculations for individual and combined detection methods.

Results: In asymptomatic ovarian cancer patients, ultrasonography revealed complex solid-cystic masses in 50.0% of cases and ascites in 43.75%, with 87.50% sensitivity and 94.33% specificity. Molecular analysis detected ctDNA mutations in 81.25% of asymptomatic cases, predominantly in TP53 (31.25%), KRAS (25.00%), and PIK3CA (25.00%). This analysis, which focused exclusively on these three genes, demonstrated 81.25% sensitivity and 97.46% specificity. The combined diagnostic approach significantly improved detection parameters (p < 0.001), with sensitivity increasing to 93.75%, specificity to 99.25%, PPV to 75.00%, and NPV to 99.85%. False-positive results decreased from 38 (ultrasound alone) and 17 (ctDNA alone) to 5 cases with the combined approach. Distinct mutation profiles were observed between cancer and benign groups, with only 15.91% of benign cases showing detectable ctDNA mutations.

Conclusions: Our results suggest that ctDNA is a promising biomarker for the early detection of ovarian cancer, with higher sensitivity and specificity than ultrasound. The combination of ultrasound and ctDNA may provide a more accurate diagnostic strategy for the early detection of ovarian cancer. These findings may contribute to the development of novel noninvasive biomarkers for the early diagnosis of ovarian cancer.

Objectives: Endometriosis is a widespread gynecological condition characterized by the presence of endometrial like tissue outside the uterine cavity. According to the literature, the frequency of endometriosis in adolescents remains unclear; however, studies suggest that histologically confirmed disease may be present in up to 47% of girls with chronic pelvic pain (CPP) and in nearly 70% of girls with primary dysmenorrhoea unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs) or hormonal therapy. The aim of this study was to review and compare current diagnostic and therapeutic recommendations and expert consensus for adolescent endometriosis.

Material and methods: A descriptive qualitative review of the clinical guidelines and expert consensus statements by the American College of Obstetricians and Gynecologists (ACOG), the European Society of Human Reproduction and Embryology (ESHRE), the North American Society for Pediatric and Adolescent Gynecology (NASPAG), and the Polish Society of Gynecologists and Obstetricians (PTGiP) was conducted. NASPAG guaidance present a textbook-based expert consensus and was included due to the limited availability of high-quality evidence in adolescent populations.

Results: Adolescent endometriosis remains underrecognized and insufficiently studied. Current clinical guidelines and expert consensus statements emphasize the importance role of through symptom assessment and detailed medical history in the diagnostic process. The reviewed literature supports a clinical diagnosis based on symptoms presentations and response to hormonal therapy, without routine laparoscopic confirmation.

Conclusions: Endometriosis in adolescents requires an age-specific diagnostic and therapeutic process. Adherence to current clinical guidelines and expert consensus may help reduce diagnostic delays, limit unnecessary invasive procedures, and improve long-term quality of life.