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Biomedical subjects

B Spiewankiewicz

Publications and source records attributed to B Spiewankiewicz.

13 recordsLinked to original sources
PubMed2003

Hysteroscopy in cases of cervical polyps.

To assess the usefulness of hysteroscopy in cases of cervical polyps, we studied 78 patients with a lesion found during a routine gynecological examination. All women were referred for diagnostic hysteroscopy followed by endoscopic polypectomy. In 83.3% of the cases intrauterine investigation confirmed primary diagnosis - a polyp peduncle in the cervical canal. Sixty-five of those lesions were the only pathologic condition, and six (7.7%) were associated with an endometrial polyp. In the remaining 16.7% of examined patients, primary polyps identified as cervical polyps appeared to be endometrial. All women admitted to the study were successfully treated by hysteroscopy. Our results suggest that endoscopic evaluation of the uterine cavity in women with cervical polyps can clarify the initial diagnosis. Hysteroscopy allows not only a precise visualisation of the polyp peduncle but also gives the possibility to identify and treat concurrent asymptomatic intrauterine pathological conditions.

Adult↗
PubMed2003

The effectiveness of hysteroscopic polypectomy in cases of female infertility.

The authors, based on their own material, evaluated the value of hysteroscopic treatment of endometrial polyps in a group of infertile women. Polypectomy was performed in 25 patients using either endoscopic microscissors or electric loop. Follow-up hysteroscopy was performed after two months as an integral part of the treatment. All the patients were observed for 12 months. The primary intrauterine investigation was complete in all patients without regard to kind of instrument which was confirmed by second-look hysteroscopy. About 80% of the patients who underwent surgery conceived. Restoration of reproductive ability did not depend on the size of the removed lesion.

Adult↗
PubMed2003

The value of ultrasonography in preoperative assessment of selected prognostic factors in endometrial cancer.

OBJECTIVE: To determine the efficiency of transabdominal and transvaginal ultrasonography (TAS and TVS) in the assessment of myometrial invasion, cervical involvement, pelvic lymph nodes, adnexal and omental metastases (preoperative staging) of endometrial cancer. METHODS: Transabdominal and transvaginal 2D, ultrasound were performed on 90 women to classify myometrial invasion, cervical involvement, pelvic lymph nodes and adnexal metastases in endometrial cancer. According to this 13 type E (invasion involving the endometrium), 41 type S (superficial, of less than 50% of myometrial infiltration), 36 type D (deep infiltration) and 22 cervical involvement were identified. There were 15 G1, 60 G2 and 15 G3 cases. Adnexal, omental and lymph-node metastases were found in 11, two and 15 cases, respectively. Endometrial cancer was diagnosed on the basis of dilatation and curettage. The degree of invasion was evaluated preoperatively. Ultrasonographic findings were compared to surgical staging and histopathology of the surgical specimen. RESULTS: The median age of the 90 women was 63.3 +/- 12.3 years (range 32 to 86 years). The median thickness of malignant endometrium was 19.5 +/- 9.6 (range 7 to 54 mm). In type E the median thickness was 11.76 +/- 4.2, in type S 17.3 +/- 7.6, in type D 24.8 +/- 9.8 and in cases with cervical involvement 23.2 +/- 11 mm. Myometrial invasion evaluated by TVS was accurate in 76 of 90 cases (accuracy 84.4%). In type E sensitivity was 92.3%, specificity 87.0%, positive and negative predictive value, respectively, 63.1% and 98.6%. In type S these values were respectively: 78.0%, 93.9%, 91.4%, 80.0% and in type D--88.9%, 92.6%, 88.9% and 100.0%. Tumor extension to the cervix was properly assessed in 19 of 22 women in which it was present (sensitivity 86.4%, specificity 85.3%, positive predictive value 85.5%, negative predictive value 95.1%). Adnexal metastasis was correctly diagnosed in 8 of 11 cases in which it was present (sensitivity 72.7%, specificity 97.5%, positive predictive value 80%, negative predictive value 96.3%), and lymph-node metastasis in only 5 of 15 cases (sensitivity 33.3%, specificity 100%, positive predictive value 100%, negative predictive value 88.2%). CONCLUSION: These results suggest that 2D TAS and TVS evaluation of endometrial cancer are reliable methods for preoperative assessment of selected prognostic factors, e.g. myometrial invasion, cervical involvement and adnexal metastases. However in assessing lymph-node metastases, TVS with its low sensitivity, did not provide additional information. Preoperative ultrasound examination should be speculated as an important tool in the establishment of different surgical choices which can be made after a correct pretreatment prognosis.

Adult↗
PubMed2001

Preoperative discrimination between malignant and benign adnexal masses with transvaginal ultrasonography and colour blood flow imaging.

BACKGROUND: Ovarian cancer is one of the causes of death in women, and in about 70% of cases is recognized only in advanced stages. This study was undertaken to evaluate distinctive values of transvaginal and color Doppler ultrasonography in differentiating malignant and benign adnexal masses through analysis of ultrasonic morphological features of malignancy and estimation of location and intensification of angiogenesis as well as values of resistance of flow in examined masses. PATIENTS AND METHODS: 329 women with malignant and benign adnexal masses underwent ultrasonographic and colour Doppler examination 1-5 days before surgery (laparotomy, laparoscopy) thus allowing histological verification of diagnosis. The ultrasonographic structure was assessed using a morphological scoring system devised by Sassone, Jain and Benacerraf. Regions showing vasculature, especially within septae and solid parts of tumours were examined by means of transvaginal colour Doppler. Location and intensification of angiogenesis as well as resistance index (RI) were investigated. Sensitivity, specificity, PPV and NPV of both techniques were assessed. Statistical analysis of obtained data were based on the Student's t test; p < 0.05 level was considered significant. RESULTS: Postoperatively 255 (77.5%) benign and 74 (22.5%) malignant tumours were seen. In the group of benign masses the average age of women was 42.6+/-12.3 and in the malignant it was 53.1+/-12.6 (p<0.0001). The transverse dimension of benign lesions was 77.2+/-19, whereas for malignant it was 107.0+/-31 (p<0.0001). Benign tumours in 63.0% were cystic, in 26.0% mixed cystic-solid and in 11.0% solid echostructures while in malignant they were respectively, 6.8%, 56.8% and 36.4% (p<0.0001). Doppler flow within the tumour was 74.5% in benign and 98.6% in malignant masses (p<0.0001). In benign lesions homogenous superficial or peripheral vasculature was visualized, and in the majority of cases (82.7%) it was of medium intensification. However in malignant central, peripheral or mixed vascularisation. in the majority intensified character was found. Average value of the resistance index in all benign masses amounted to 0.77+/-0.14, however in malignant it was 0.39+/-0.07 (p<0.0001). CONCLUSIONS: We contend that complete ultrasonographic estimation of ovarian neoplasms outside the qualification of structural details should include Doppler analysis of vasculature parameters. Most important is the qualification of resistance of flow, and location and intensification of vascularisation in examined masses which permit the differentiation of malignant and benign lesions. Preoperatively recognizing malignant processes with colour Doppler ultrasonography shows higher accuracy, specificity and PPV.

Adolescent↗
PubMed1995

Hysteroscopic tubal catheterization in diagnosis and treatment of proximal oviductal obstruction.

Hysteroscopic tubal catheterization in patients with proximal tube obstruction, was successful in our material in 11 out of 15 cases. In 36.6% women this pathology was connected to the presence of pathologic microflora in the oviducts, as confirmed by bacteriological examination of tubal fluid. The pregnancy rate in endoscopically treated patients reached 13.3%. Three months follow-up HSG showed that in 78% of cases insertion of a catheter into their oviducts resulted in their complete patency. Hysteroscopic tubal catheterization failed in 4 women, who were subsequently qualified to IVF. The present study shows that hysteroscopic tubal catheterization in patients with proximal tubal obstruction can be used both as a diagnostic and considerably effective therapeutic method.

Adult↗
PubMed1995

Hysteroscopy with selective endometrial sampling after unsuccessful dilatation and curettage in diagnosis of symptomatic endometrial cancer and endometrial hyperplasias.

We report the incidence of endometrial hyperplasia and endometrial cancer recognised by hysteroscopy in 202 patients with recurrent abnormal uterine bleeding. In all these women previously performed dilatation and curettage was unsuccessful. Endoscopy connected with direct biopsy allowed us to recognise in 26 (12.9%) patients pathological endometrial lesions in 19 of cases endometrial hyperplasia (with or without cell atypia) and in 7 patients endometrial cancer. The hysterosocpically recognised abnormalities in more than 70% were focal. Hysteroscopy with selective endometrial biopsy, performed after unsuccessful curettage is an essential tool in the diagnosis of recurrent abnormal uterine bleeding caused by pathological endometrial lesions.

Adult↗
PubMed1995

Transvaginal Doppler ultrasound with colour flow imaging in benign and malignant ovarian lesions.

Since early detection of ovarian cancer is difficult, most cases are diagnosed at advanced stages. The imaging diagnosis is based on pattern classification and is limited with respect to the precise determination of malignancy. High-frequency transvaginal sonography improves the ability to detect malignant ovarian tumors over that of transabdominal route, however, the predictive values are unsatisfactory because of inability to distinguish between malignant and benign tumors that have similar morphologic characteristics. The introduction of transvaginal colour flow imaging has allowed detection of low-resistance intratumoral blood vessels, characteristic of malignant tumors, and visually reflected the state of blood flow of an ovarian tumor. These two ultrasonographic methods were used for diagnosis of ovarian tumors in 65 women treated in our Department of Obstetrics and Gynecology. Waveforms of the parenchymal tumor arteries or tumor surface arteries were compared using value of the resistance index (RI). The sensitivity, specificity and accuracy of the preoperative RI in detecting malignant ovarian tumors were 100%, 94%, 95.4% respectively. The sensitivity, specificity and accuracy of preoperative suspicious sonographic findings in detecting malignant ovarian tumors were 100%, 61% and 71%. Positive and negative predictive values of colour flow imaging were 85% and 100%, whereas for grey-scale transvaginal ultrasonography they were 46% and 100% respectively. The findings of this study suggest that transvaginal colour Doppler is a method which is superior to the other methods for preoperative evaluation of ovarian malignancy.

Adult↗
PubMed1995

[Evaluation of endometrial changes in women with cyclical mastalgia].

Cyclical mastalgia which almost 40% of women suffer from is caused by inadequate ovarian hormones secretion. There are reports regarding increased number of endometrial steroid receptors in this group of women. The possibility of higher risk of endometrial cancer development in these women is very probable. 119 women with cyclical mastalgia aged 16-55 (means age 35.4 years) were investigated. Anovulatory cycles occurred in 63%. Increased estrogen action in vaginal smears was found in 24.1%, also decreased progesterone effect had been seen in 20.3% of our cases. Serum estradiol levels were elevated in 10.6% and 39.1% of the patients had lower serum progesterone levels. Mean progesterone--estrogen luteal index value was decreased to 0.99. Irregular uterine bleedings occurred in 16.8 of women (aged 41-48 years). Histological endometrium examinations revealed changes due to insufficient progesterone action.

Adolescent↗
PubMed1991

[Not Available].

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Equipment and Supplies↗
PubMedDate not supplied

[Use of estrogens in skin patches in treatment of pre-menstrual syndrome].

A consequence of the diminishing the normal functioning of ovaries is progressing decrease in the levels of sex steroids leading to the clinical symptoms termed menopausal syndrome. This study aimed at evaluating the efficiency of Estraderm TTS-50 (Ciba-Geigy) in the treatment of this syndrome. The study involved 33 female patients, aged between 30 and 65 years. Estraderm in the form of patches containing 0.004 g of 17-estradiol was administered for 3 weeks every month, for 9 weeks. Kupperman's index, cytohormonal tests, and blood serum FSH and LH were tested before, during and after the treatment. A diminishing of the most common symptoms manifested by a statistically significant decrease in Kupperman's index and FSH, and LH levels with significant increase in serum estradiol was noted in 75% of patients following a 9-week treatment with Estraderm. Changes in the sex steroids levels led to a marked increase in the percentage of superficial cells, assessed with cytohormonal tests. Transdermal administration of estrogens in the form of Estraderm TTS-50 is the treatment of choice in the menopausal syndrome.

Administration, Cutaneous↗
PubMedDate not supplied

Cesarean section in grandmultiparas.

Grandmultiparity which has been considered to be a factor in maternal and neonatal morbidity [3], is still high in Libya as compared with European countries. A retrospective study of one aspect of this problem concerned the Cesarean section in patients who had delivered 6 or more babies. During the period of January Ist to the end of December 1993, the records of all grandmultiparous women who delivered by a Cesarean section (287 cases) were reviewed at Obstetric Department of University Hospital in Benghazi-Libya. The incidence was 7.9%. The most common indications for the Cesarean section were: fetopelvic disproportion or failure to progress (26.5%), previous Cesarean sections (19.5%), malpresentation (16%), placenta praevia and failed induction for each of them (7%). The perinatal mortality was 17/1000. We conclude that grandmultiparas require Cesarean sections more frequently than nongrandmultiparas, especially primary and emergency Cesarean sections. For such patients an effective family planning program is necessary.

Adult↗