Gineco.ro 20

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Title: Medicina maternofetala - dincolo de limite

Author: Dr. Jan Andi Marin

Introduction: In ultimii ani, evolutia cercetarii in domeniul biomedical a produs un salt urias in calitatea ingrijirilor medicale, in special in obstetrica. Calitatea ingrijirilor maternofetale se reflecta in mod direct asupra rezultatelor la nastere. In promovarea si imbunatatirea ingrijirilor maternofetale, asa cum recomanda OMS, medicul obstetrician trebuie sa aiba ca obiectiv atat sanatatea mamei, sanatatea copilului, cat si satisfactia emotionala a mamei si familiei.

Title: Genotipurile trombofilice mutante materne si fetale ca factori de risc pentru preeclampsie

Author: Lucia Maria Procopciuc¹, Gabriela Caracostea², Gabriela Zaharie², Mariana Puscas², Georgiana Iordache², Ileana Olteanu¹, F. Stamatian²

Afiliation: 1. Disciplina Biochimie Medicala, Universitatea de Medicina si Farmacie “Iuliu Hatieganu”, Cluj-Napoca; 2. Disciplina Ginecologie, Universitatea de Medicina si Farmacie “Iuliu Hatieganu”, Cluj-Napoca

Rezumat: Obiective: 1. Determinarea genotipurilor trombofilice mutante (mutatia factor V Leiden, 20210G®A din gena protrombinei, 677C®T si 1298A®C din gena metilentetrahidrofolat reductazei) la 26 perechi mama cu preeclampsie/nou-nascut din mama preeclamptica si 33 perechi mama cu sarcina normala/nou-nascut din mama cu sarcina normala 2. Calcularea scorului de risc pentru diferite tipuri de preeclampsia in asociere cu prezenta trombofiliei genetice 3. Analizarea genelor trombofilice fetale in asociere cu genele materne ca factori de risc pentru preeclampsie. Metode: Genotipurile normale si mutante pentru cele patru mutatii trombofilice au fost determinate utilizand metoda PCRRFLP. S-au calculat riscul relativ (odds ratio-OR) si intervalul de confidenta (95%IC). S-a considerat semnificatie statistica pentru valori ale lui p mai mici de 0,05. S-a utilizat testul Fisher, table 2x2. Rezultate: Riscul de aparitie a preeclampsiei a fost de 4,36 (p = 0,2), 5,55 (p = 0,003) si 1,25 (p = 0,8) in asociere cu mutatiile factor V Leiden, 677C®T si respective 1298A®C. Nici unul dintre subiectii luati in studiu nu a fost identificat pozitiv pentru mutatia 20210G®A din gena protrombinei. Riscul pentru preeclampsie este semnificativ crescut in cazul prezentei trombofiliei multiple (OR 4,4, p = 0,019). Mutatia 677C®T reprezinta un factor de risc crescut pentru preeclampsia moderata si preeclampsia severa (OR 12,5, p = 0,03 si respectiv OR 19,6, p = 0,005). Prezenta trombofiliei multiple confera un risc de 7 (p = 0,02) pentru preeclampsia severa. Frecventa mutatiei 677C®T si trombofilia multipla la nou-nascutii din mame preeclamptice au fost semnificativ crescute comparativ cu frecventa in grupul de nou-nascuti din mame cu sarcini normale (76,92% vs 39,39% si, respectiv, 38,46% vs 12,12%). Riscul pentru preeclampsia este semnificativ crescut daca mutatia 677C®T sau trombofilia multipla sunt prezente atat la mame, cat si copii (OR 6,53, p = 0,002 si, respectiv, OR 5,71, p = 0,06). Concluzii: Rezultatele noastre sugereaza rolul trombofiliei genetice in aparitia diferitelor forme de preeclampsie. Exista o interactiune intre genotipul mutant matern/fetal ca factor de risc in preeclampsie. Prezenta trombofiliei multiple atat la mama, cat si la copil este un factor de risc pentru aparitia preeclampsiei.

Cuvinte-cheie: trombofilia genetica, preeclampsia, metoda PCR-RFLP

Abstract: Objectives: 1. to determine the mutant thrombophilic genotypes (factor V Leiden mutation, 20210G®A mutation in the prothrombin gene, 677C®T and 1298A®C mutations in the metylenetetrahydropholate reductase gene) in the 26 pairs - preeclamptic mother/newborn of preeclamptic mother and 33 pairs - mother with normal pregnancy/newborn of mother with normal pregnancy 2. to calculate a risk score for different types of preeclampsia associated with the presence of genetic thrombophilias 3. to analyse the fetal thrombophilic genes in association with maternal genes as risk factors for preeclampsia. Methods: Mutant and normal genotypes for the four thrombophilic mutations were determined using the PCR-RFLP methods. The relative risk (odds ratio- OR) and confidence interval (95%CI) were calculated. p values lower than 0.05 were considered statistically significant. The Fisher exact test table 2x2 was used. Results: The risk of preeclampsia was 4.36 (p = 0.2), 5.55 (p = 0.003) and 1.25 (p= 0.8) in association with factor V Leiden, 677C®T and 1298A®C, respectively mutation. None of the subjects included the study was identified as positive for the 20210G®A mutation in the prothrombin gene. The risk of preeclampsia was significantly increased in the case of presence of multiple thrombophilias (OR 4.4, p = 0.019). The 677C®T mutation represents higher risk factor for mild and severe preeclampsia (OR 12.5, p = 0.03 and OR 19.6, p = 0.005, respectively). Multiple thrombophilias presence confers a risk of 7 (p = 0.02) for the severe forms of preeclampsia. The frequency of 677C®T mutation and multiple thrombophilia in newborns of preeclamptic mothers was significantly more increased compared to the frequency in the group of newborns from normal pregnant mothers (73.07% vs. 39.39% and 38.46% vs. 12.12%, respectively). The risk of preeclampsia is significantly increased when the 677C®T mutant genotypes or multiple thrombophilias are present both in the mother and the child (OR 6.53, p = 0.002 and OR 4.65, p = 0.06, respectively). Conclusions: Our results emphasize the role of genetic thrombophilia in the development of different forms of preeclampsia. There is a mutant maternal/fetal genotype interaction, as a risk factor for preeclampsia. The presence of multiple thrombophilias in both the mother and the child is a risk factor for the development of preeclampsia.

Keywords: genetic thrombophilias, preeclampsia, PCR-RFLP methods

Title: Valoarea ecografiei de trimestrul III la fetii cu malformatii cardiace

Author: C. Marginean¹, Rodica Toganel², Liliana Gozar², Iolanda Muntean², Cristina Oana Marginean³, L. Puscasiu¹, B. Szabo¹

Afiliation: 1. Clinica de Obstetrica Ginecologie I, Targu-Mures; 2. Clinica de Cardiologie Pediatrica, Targu-Mures; 3. Clinica de Pediatrie I, Targu-Mures

Rezumat: Obiectiv: Analiza concordantei de diagnostic ecografic intre fetii depistati cu anomalii cardiace si nou-nascuti. Material si metoda: Studiul de fata s-a desfasurat pe o perioada de 13 luni, din ianuarie 2009 pana in ianuarie 2010, in Targu-Mures. A studiat 16 sarcini, adresate Clinicii Obstetrica Ginecologie I si respectiv Clinicii de Cardiologie Pediatrica, pentru anomalii cardiace fetale cunoscute. S-au utilizat sectiunile ecografice descrise de Societatea Internationala de Ecografie in Obstetrica si Ginecologie. Rezultate: Cei 16 nou-nascuti au fost evaluati ecografic cu o concordanta de diagnostic la 15 din 16 feti, diagnosticul de coarctatie larga de aorta si stenoza aortica valvulara fiind stabilit doar la nou-nascut. Concluzii: Acuratetea diagnosticului anomaliilor cardiace in trimestrul III de sarcina poate fi foarte buna, atunci cand explorarea unui fat déjà suspicionat cu acest tip de malformatie se face de o echipa mixta de medici obstetricieni si cardiologi pediatri.

Cuvinte-cheie: malformatii cardiace congenitale fetale, ecografie

Abstract: Objective: Analysis of ultrasound diagnostic concordance between fetuses diagnosed with heart abnormalities and newborn babies. Material and method: The present study was conducted over a period of 13 months, from January 2009 to January 2010, in Targu-Mures. Were studied 16 pregnancies addressed to Obstetrics and Gynecology Clinic I and Pediatric Cardiology Clinic, for fetal cardiac anomalies. Were used ultrasound sections described the International Society of Ultrasound in Obstetrics and Gynecology. Results: The 16 newborn babies were evaluated with a concordance of diagnostic ultrasound in 15 of 16 fetuses, the diagnosis of large coarctation of aorta and valvular aortic stenosis, being established only in one neonate. Conclusions: Accurate diagnosis cardiac anomalies in the third quarter of pregnancy can be very good, when exploring a fetus already suspected this type of malformation is made by a team of obstetricians and pediatric cardiologists.

Keywords: congenital fetal heart malformations, ultrasonography

Title: Relatia temporala: suferinta fetala acuta-operatia cezariana

Author: A. Ciulcu¹, R. Cristea², Ioana Olaru³, P. Vartej³

Afiliation: 1. Spitalul “Dr. I. Cantacuzino”; 2. Spitalul Ramnicu-Sarat; 3. Spitalul Universitar de Urgenta, Bucuresti, UMF “Carol Davila”, Bucuresti

Rezumat: Obiectiv: Cercetarea corelatiei clinice dintre modificarile patologice ale RCF (ritmul cardiac fetal) - in cursul travaliului si modificarile materno-fetale in functie de momentul efectuarii extractiei fatului (operatie cezariana). Material si metoda: S-a realizat corelarea intre instalarea suferintei fetale si momentul interventiei (nasterii sau operatiei cezariene) pe un grup de 33 de parturiente internate in SUUB in perioada 2005-2008, care au prezentat ca numitor comun statusul fetal grav alterat la nastere (scor Apgar <7) - tradus prin detresa respiratorie severa, care a impus ventilarea. Probele de sange au fost prelevate din artera radiala in perioada imediat postpartum si ulterior la intervale de 8 ore. Rezultate: Din cei 33 de nou-nascuti ventilati, 28 au fost recuperati, iar 5 au decedat; de mentionat ca un singur nou-nascut era prematur, ceilalti fiind normoponderali. Exitusul s-a produs la 24-72 de ore postpartum; scorul Apgar a variat intre 1 si 3 la 1’ si nu a depasit 3 la 5’. Din cele 33 de cazuri analizate modificarile de RCF au fost: tahicardie - 3 cazuri, bradicardie moderata - 7, bradicardie severa - 3, deceleratii precoce - 1, deceleratii tarive - 19. Intervalul de timp necesar instalarii unei acidoze la 50% dintre feti este semnificativ mai scurt in caz de deceleratii tardive (115 min.) decat in caz de deceleratii variabile (145 min.) sau traseu plat (185 min.). Concluzii: Prezentul studiu confirma relatia temporala intre momentul aparitiei modificarilor patologice ale RCF si debutul acidozei metabolice. Cu cat timpul de extractie este mai prelungit, cu atat prognosticul fetal este mai grav.

Cuvinte-cheie: suferinta fetala, acidoza, detresa respiratorie, bradicardie

Abstract: Objective: To assess clinical correlation between pathological changes of the RCF (fetal heartbeat) – during labor and maternal-fetal changes depending on time of extraction the fetus (cesarean). Material and method: The correlation between fetal suffering and installation time intervention (birth or cesarean operation) was studied on 33 parturient SUUB hospitalised in the period 2005-2008, which presented as common feature seriously altered fetal status at birth (Apgar score <7) - translated by severe respiratory distress that required ventilation. Blood samples were taken from the radial artery immediate postpartum and then every 8 hours. Results: Of the 33 ventilated newborn babies, 28 were recovered and 5 died, noted that one infant was premature, others had normal birthweight. The exitus occurred in 24 -72 hours post partum, Apgar score ranged 1-3 1 ‘and did not exceed 3 to 5’. Changes recorded in FHR: tachycardia - 3 cases, moderate bradycardia - 7, severe bradycardia - 3, early deceleration - 1, late deceleration - 19. Time to acidosis in 50% of fetuses is significantly shorter in case of late deceleration (115 min) than in the case of variable deceleration (145 min) or flat route (185 min). Conclusions: This study confirms the temporal relationship between the onset of pathological changes of the FHR and metabolic acidosis. The longer the extraction time the worse fetal prognosis.

Keywords: fetal distress, acidosis, respiratory distress, bradycardia

Title: Anomalii cromozomiale in diagnosticul prenatal

Author: Ruxandra Cretu¹, Daniela Neagos², Roxana Bohiltea³, C. Strugaru⁴, Andreea Mustata⁵, L.C. Bohiltea⁶

Afiliation: 1,2,4,6. Disciplina Genetica, Facultatea de Medicina, UMF “Carol Davila”; 1,5. Life Memorial Hospital, Bucuresti, Romania; 3. Spitalul Universitar Bucuresti

Rezumat: Obiectiv: Investigarea depistarii antenatale a anomaliilor cromozomiale in sarcini cu risc crescut si corelarea datelor intre analiza cariotipului si FISH (Fluorescent in situ Hybridization). Metoda: Au fost analizate rezultatele citogenetice dintr-un total de 594 de cazuri in perioada 2008-2009. Cariotipul a fost efectuat la femeile gravide cu risc genetic pe celulele amniotice dupa protocolul standard utilizand bandarea GTG, iar tehnica FISH (hibridizare fluorescenta in situ) - pe nuclei interfazici. Rezultate: Au fost gasite 22 de cariotipuri anormale: 13 de cazuri cu anomalii numerice (13 aneuploidies homogenuous: trisomii - 3 cazuri din 47, 21 XX, 3 cazuri din 47, XY 21; 2 cazuri din 47, XY 18, 1 caz din 47, XXY, 2 cazuri din 47, XXX si monosomii - 1 caz de 45, x0; 1 triploidie - 69 XXX, 1 anomalie structurala, un caz 46, XY, der (14; 21) (Q10; Q10), 21), si 8 variante normale (3 cazuri din 46, XX inv. (9) (p11; Q13); 1 caz, cu 46, XY inv. (3) (p11; q11.2); 2 cazuri, cu 46, XX inv. (3) ( P11; q11.2), 1 caz 46, XY inv. (3) (p11; q11.2), si 1 caz din 46, XY inv. (3) (p11; q11.2) inv (9) (p11; Q13)). Anomalii numerice au fost in continuare verificate prin tehnica FISH. A fost o corelare de 100% in rezultatele obtinute. Concluzii: Acest raport confirma importanta cariotiparii si a FISH in diagnosticul prenatal. FISH fiind mult mai important pentru diagnosticarea prenatala din cauza timpului scurt pentru obtinerea rezultatului.

Cuvinte-cheie: fluorescence in situ hybridization (FISH), aneuplodie, amniocenteza

Abstract: Objective: To investigate antenatal detection the chromosome abnormalities in high risk pregnancies and correlation between karyotype analysis and FISH (Fluorescent In Situ Hybridization). Method: Were analyzed cytogenetic results from a total of 594 cases between 2008-2009. Amniotic fluid karyotyping and FISH have been offered to pregnant women with genetic risk, using the standard method and GTG banding techniques. Results: Were found 22 abnormal karyotypes: 13 cases with numerical abnormalities (13 homogenuous aneuploidies: trisomies - 3 cases of 47,XX+21, 3 cases of 47,XY+21; 2 cases of 47,XY+18, 1 case of 47,XXY, 2 cases of 47,XXX and monosomies - 1 case of 45,X0; 1 triploidy - 69 XXX), 1 structural abnormality, one case of 46, XY, der(14;21)(q10;q10) +21) and 8 normal variants (3 cases of 46, XX inv(9)(p11;q13); 1 case with 46,XY inv (3)(p11;q11.2); 2 cases with 46,XX inv(3)(p11; q11.2), 1 case 46,XY inv(3)(p11;q11.2), and 1 case of 46,XY inv (3) (p11;q11.2) inv(9)(p11;q13)). The numerical abnormalities have been further verified by FISH analysis. There was a 100% correlation between the results obtained. Conclusion: This report confirms the importance of karyotyping and FISH in prenatal diagnosis, FISH being much more important for prenatal diagnosis due to the short time of results which is very important for the anxiety and management of the patients in due time.

Keywords: fluorescence in situ hybridization (FISH), aneuploidy, amniocentesis

Title: Pattern-uri atitudinal comportamentale, caracteristici socio-demografice cu risc pentru cancerul cervical

Author: Cornelia Rada¹, D. Hudita², Suzana Manolescu³, Ileana Prejbeanu⁴, Corina-Aurelia Zugravu⁵

Afiliation: 1. Institutul de Antropologie ,,Francisc I. Rainer”, Bucuresti; 2. Universitatea de Medicina si Farmacie ,,Carol Davila”, Bucuresti; 3. Institutul de Antropologie ,,Francisc I. Rainer”, Bucuresti; 4. Universitatea de Medicina si Farmacie, Craiova; 5. Universitatea de Medicina si Farmacie ,,Carol Davila”, Bucuresti

Rezumat: Obiectiv: Identificarea caracteristicilor si a unor obstacole atitudinal-comportamentale in calea prezentarii pentru consultul ginecologic de rutina si testul Babes-Papanicolau (PAP). Metoda: 961 de femei si 941 de barbati au fost selectionati aleator din 8 orase. Din chestionarul care a acoperit conceptul de sanatate sexual-reproductiva, ne referim la 2 itemi pe intregul esantion si la 2 specifici pentru femei. S-au folosit: testul Pearson Chi patrat, regresia logistica binara, analizele de clusteri in clase latente si de clasificare arborescenta. Rezultate: Peste ¼ au apreciat controlul ginecologic necesar doar daca esti bolnav si nenecesar daca esti tanar, doar 17,9% au facut recent un test Papanicolau; ponderea femeilor peste 44 de ani cu o scazuta prezentare la medicul ginecolog fiind semnificativ mai mare. Modelarea statistica arata ca femeile cu risc ridicat au un venit si nivel educational mai scazute si sunt in varsta de sub 24 si peste 50 de ani. Concluzii: Semnalam o sub-reprezentare a femeilor incluse in standardul optim al asistentei medicale ginecologice, axat pe descoperirea precoce a debutului cancerului de col uterin.

Cuvinte-cheie: cancer de col uterin, test PAP, screening, disparitati sociale, atitudini

Abstract: Objective: Identification of the characteristics and attitudinal-behavioral barriers in compliance with the routine gynecological examination and Babes-Papanicolau test (PAP) recommendations. Method: 961 women and 941 men that were randomly selected from 8 cities. From the survey questionnaire that covered the concept of sexual-reproductive health we shall evaluate 2 items (for the whole sample) and 2 specific items dedicated to the women. Pearson Chi square test, binary logistic regression, latent class cluster analysis and classification tree analysis were employed. Results: Over one-fourth of the sample considered gynecological examination necessary only in sickness and unnecessary in early ages, only 17.9% have received a PAP test; the proportion of women aged over 44 years with a low visit rate to gynecologist the was significantly higher. Statistical modeling revealed that the high-risk women have a lower income and educational level and are aged under 24 and over 50. Conclusions: We give notice about the under-representation of women included in the optimal standard of gynecological healthcare, focused on the discovery of the early onset of cervical cancer.

Keywords: cervical cancer, Pap test, screening, social disparities, attitudes

Title: Aspecte privind contraceptia la adulti in judetul Mures

Author: Monica Tarcea¹, S. Voidazan², J. Szavuj³, F. Szasz⁴, Daniela Ceana⁵

Afiliation: 1. Disciplina de Igiena, UMF Targu-Mures; 2. Disciplina de Epidemiologie, UMF Targu-Mures; 3. Disciplina de Epidemiologie, UMF Targu-Mures; 4. Clinica de Obstretica Ginecologie, Spitalul judetean de urgenta Targu-Mures; 5. Disciplina de Sanatate Publica, UMF Targu-Mures

Rezumat: Obiectiv: Scopul lucrarii a fost de a stabili nivelul de informare si de comportament legat de contraceptie la un lot reprezentativ de adulti provenind din judetul Mures, in vederea pregatirii unor programe eficiente de planning familial in areal. Material si metoda: Este un studiu epidemiologic descriptiv pe 2005, iar datele culese au fost evaluate statistic folosindu-se programul Epi Info 6.00. Am folosit chestionare de autoevaluare care s-au adresat separat sexului feminine si masculin, completate de 991 de subiecti. Rezultate: Nivelul stadiului la care se afla educatia sexuala in judetul Mures este destul de scazut. Protejarea primului act sexual nu este o optiune pentru persoanele intervievate. Calitatea contactului sexual este direct proportionala cu calitatea vietii si cu durata activitatilor profesionale. Prima sarcina este cea neplanificata, iar a doua sarcina este cea planificata; prin corelatie se deduce ca la prima sarcina cuplul a fost neinstruit si nu a stiut sa-si planifice viata familiala, pe cand cea de-a doua sarcina a fost dorita si a aparut la momentul oportun. Metoda calendarului este cea mai utilizata metoda de abstinenta periodica. Femeile sunt mai putin instruite in ceea ce priveste modul de utilizare a prezervativului. Metodele contraceptive de bariera sunt mai putin cunoscute decat dispozitivele intrauterine. Metodele hormonale sunt utilizate in siguranta si cu eficacitate pentru un procent important de persoane, dar, din pacate, serviciile medicale nu se implica suficient in informarea populatiei privind efectele adverse ale contraceptivelor orale combinate. Concluzii: Se poate obtine un nivel corespunzator de cunostinte in domeniu prin actiuni adecvate de educatie pentru sanatate a populatiei si modelarea unui comportament sexual individual adecvat. Se impune asigurarea unor servicii preventive adecvate cu principal obiectiv reducerea morbiditatii si imbunatatirea starii de sanatate a populatiei asistate.

Cuvinte-cheie: contraceptie, comportament sexual, sanatatea reproducerii, educatie sexuala

Abstract: Objective: To establish knowledge level and behaviour regarding contraception in a group of adults in Mures County, in order to develop an efficient family planning programme. Methods: It was a descriptive epidemiological study, performed in 2005. The collected data were statistically evaluated by the aid of Epi Info software. Were used distinctive self-evaluation questionnaires for males and females, completed by a total number of 991 subjects. Results: Sexual education in Mures County is medium-level and presents deficiencies. Protection during the first sexual act is not an option for most of the interviewees. The first pregnancy is usually not planned because of lack of information regarding contraception but the second one is desired and expected. The Calendar method (Rhythm method) is the most widely used method in  contraception. Women are less instructed regarding the use of condom. Barrier contraception methods are less familiar than intrauterine appliances. Hormonal methods are safely and efficiently used by a great number of persons. Unfortunately medical services are not sufficiently involved in alerting people regarding the side effects of combined oral contraceptives. Conclusions: We can achieve an adequate level of knowledge in this field by individual sexual behaviour modeling and appropriate health education of the population. Adequate prevention services are also required in order to reduce morbidity and to improve the health status of the population.

Keywords: contraception, sexual behaviour, reproductive health, sexual education

Title: Colpo-histerosacropexia vaginala asistata laparoscopic

Author: Elvira Bratila¹, P. Bratila²

Afiliation: 1. Universitatea de Medicina si Farmacie “Carol Davila” Bucuresti; Spitalul Clinic „Sf. Pantelimon” Bucuresti; 2. Spitalul Euroclinic Bucuresti

Rezumat: Obiectiv: Scopul lucrarii este de a prezenta realizarea unui procedeu clasic - colposuspensia la sacru prin procedee minim invazive pe cale combinata vaginala si laparoscopica. Material și metoda: In perioada 2007-2009 au fost operate 14 paciente cu prolaps uterovaginal avansat si prolpas gr II recidivat, la care s-a efectuat colpo-histerosacropexie pe cale total laparoscopica sau combinata vaginala-laparoscopica. Principiul terapeutic a fost cel de refacere a inelului cericervical si suspensia boltei vaginale a uterului la promontoriu. Rezultate: Timpul operator s-a redus semnificativ in cazul abordului combinat vaginal-laparoscopic comparativ cu timpul de efectuare a tehnicii total laparoscopice. Simptomele prezente preoperator specifice defectelor de compartiment anterior, mediu si posterior s-au remis in totalitate postoperator. Concluzii: Suspensia boltei vaginale sau a zonei pericervicale la promontoriu ramane o tehnica de aur in tratamentul prolapsului uterin avansat. Efectuarea acestui procedeu pe cale laparoscopica sau combinata vaginala si laparoscopica ofera acestuia caracterul de tehnica microinvaziva cu cea mai mare rata de succes.

Cuvinte-cheie: prolaps al organelor pelvice, colposacropexie, tratamentul laparoscopic al prolapsului uterovaginal

Abstract: Objective: To present the acheviement of the a classical procedure - coplopsacopexy by means of minimally invasive technique involving combined laproscopic and vaginal approach. Study Design: Between 2007-2009, Colpo-histerosacropexy by totally laparoscopic or vaginal-laparoscopic method was performed on 14 patients with advanced uterovaginal prolapse and recurrent IInd grade prolapse. The therapeutic principle was the recovery of the pericervical ring and suspension of the vaginal vault/uterus to the promontory. Results: The operating time was significantly reduced when a combined vaginallaparoscopic procedure was performed, versus the totally laparoscopic technique. Preoperative symptoms specific to the flaws of the anterior, medium and posterior compartment totally remitted postoperatively. Conclusion: The suspension of the vaginal vault or pericervical area to the promontory remains a gold technique in the treatment of the advanced uterine prolapse. Performing this procedure laparoscopically or combined makes it the microinvazive technique with the highest success rate.

Keywords: Pelvic organ prolapse, colposacropexy, laparoscopic prolapse repair

Title: Aritmiile supraventriculare in sarcina

Author: Virgil Petrescu¹, Mariana Petrescu², Stefan Bogdan³

Afiliation: 1. Spitalul Clinic Colentina; 2. CMDTA Ministerul Justitiei; 3. Clinica de Cardiologie - Spitalul Clinic de Urgenta Bucuresti, UMF “Carol Davila

Rezumat: Raportam un caz de fibrilatie atriala la o gravida (cunoscuta cu sindromul Wolff-Parkinson-White) tratata prin cardioversie electrica. Riscul aritmiilor in sarcina este legat de hipoperfuzia embrionului/fatului si posibilele efecte teratogene ale tratamentului antiaritmic. Intotdeauna in sarcina trebuie tentata oprirea rapida a episoadelor de fibrilatie atriala. Pentru tratamentul in acut al tahicardiilor paroxistice supraventriculare in timpul sarcinii putem utiliza manevrele vagale, adenozina sau metoprololul.

Cuvinte-cheie: sindrom WPW, aritmii supraventriculare, radiofrecventa, antiaritmice

Abstract: We present a case of atrial fibrilation in a pregnant woman (known with Wolff-Parkinson-White syndrome) treated with direct courent cardioversion. The risk of arrhythmia in pregnancy is related to fetal hypoperfusion, with possible teratogenic effect. Termination of atrial fibrillation episodes must always be attempted in pregnancy. Also, for acute treatment of supraventricular tachycardia during pregnancy we can use vagal maneuvers, adenosine or metoprolol.

Keywords: WPW syndrome, supraventricular arrhythmia, radiofrequency ablation

Title: Rolul Flowcytometriei trombocitare in diagnosticul trombocitopeniei severe din sarcina

Author: Minodora Onisai¹, Ana-Maria Vladareanu¹, Horia Bumbea¹, Sanziana Radesi¹, Anca Nicolescu¹, Irina Voican¹, M. Ciorascu², C. Pop², D. Campean³, F. Anca³, I. Badea³, Valerica Horhoianu³, R. Vladareanu²

Afiliation: 1. Clinica de Hematologie Spitalul Universitar de Urgenta Bucuresti; 2. Clinica de Obstetrica-Ginecologie Spitalul Universitar de Urgenta Elias; 3. Clinica de Obstetrica-Ginecologie Spitalul Universitar de Urgenta Bucuresti

Rezumat: Discutam cazul unei paciente de 16 ani, insarcinata (aproximativ 7 luni - sarcina neurmarita), care se prezinta la Spitalul Universitar de Urgenta Bucuresti cu sindrom hemoragipar intens (leziuni petesiale diseminate pe piele si sangerari mucoase). Testele de laborator releva trombocitopenie severa (sub 10.000 de trombocite pe mmc), anemie usoara, leucocitoza cu neutrofilie, citoliza hepatica si semne de hemoliza usoara. Prima suspiciune este de preeclampsie – sindrom HELLP. Este discutat diagnosticul diferential, pornind de la cauzele trombocitopeniei in sarcina. Prezentam valoarea importanta a studiului functional al trombocitului, respectiv imunofenotiparea prin flowcytometrie, intrucat acesta a avut o contributie semnificativa la stabilirea diagnosticului corect.

Cuvinte-cheie: sarcina, trombocitopenie, flowcytometrie, preeclampsie/sindrom HELLP, anticorpi antitrombocitari

Abstract: We discuss the case of a 16 years-old woman, approximately seven months pregnant (unmonitored pregnancy), that presented to the Emergency Department with intense hemorrhagic syndrome on skin (disseminated petechial lesions) and mucosa (including nose bleed). Emergency laboratory tests reveal severe thrombocytopenia (less than 10000 thrombocytes/mmc), slight anemia, leucocytosis with neutrophilia, liver cytolysis and signs of slight hemolysis. The first suspicion of diagnosis was preeclampsia/HELLP syndrome. The differential diagnosis is discussed, starting from a presentation of the causes of thrombocytopenia in pregnancy. We highlight the value of platelet functional study -  immunophenotyping through flowcytometry, because it particularly oriented us to the positive diagnostic.

Keywords: pregnancy, thrombocytopenia, flowcytometry, preeclampsia/HELLP syndrome, platelet antibodies

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