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Antoni Basta,
Aleksandra Brucka,
Jarosław Górski,
Jan Kotarski,
Bartosz Kulig,
Przemysław Oszukowski, Ryszard Poreba,
Stanisław Radowicki,
Jerzy Radwan,
Jerzy Sikora,
Andrzej Skret,
Jana Skrzypczak,
Krzysztof Szyłło
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ABSTRACT: Endometriosis is defined by endometrial glands and stroma outside of the endometrial cavity Three types of endometriosis have been described: peritoneal endometriosis, ovarian endometriosis and deep infiltrating endometriosis. Endometriosis afflicts 6-15% of women population. It occurs mainly in the group of women in reproductive age, but also in the group of minors and approximately 3% of women after menopause. Within the group of women suffering from infertility the frequency of endometriosis increased to 35-50% of cases. Endometriosis is associated with pain symptoms which can bear the character of pain occurring periodically and altering into constant pain, dysmenorrhea, dyspareunia, dysuria and dyschezia. The correlation between the stage of endometriosis and intensity of pain symptoms not always has to be proportionate. Laparoscopy can be perceived as a standard procedure in endometriosis diagnostics as it allows simultaneous treatment. Profound interview as well as visual diagnostics (USG, MRI) should precede laparoscopy Treatment of endometriosis can be divided into pharmacological and surgical treatment, which can be invasive or non-invasive. The type of treatment depends on patient's age and her procreation plans, occurring ailments and endometriosis type. Important role is played by adjuvant treatment such as appropriate diet and lifestyle. Treatment of advanced endometriosis should be conducted in reference centres that are appointed with adequate equipment and have the possibility of interdisciplinary treatment. Presented standards can digest and outline the order of proceedings both in diagnostics and endometriosis treatment. The research group believes that the above compilation will facilitate undertaking appropriate decision in diagnosis and treatment of the disease, which will subsequently contribute to therapeutic success.
Ginekologia polska 11/2012; 83(11):871-6. · 0.41 Impact Factor
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ABSTRACT: Intrahepatic Cholestasis of Pregnancy (ICP) constitutes the most common, reversible liver disease closely connected with pregnancy and spontaneously resolving in puerperium. ICP usually reoccurs in consecutive pregnancies (45-90%), often in a more intensified form. Many compounds (hormones, cytokines, medicines, endotoxins) can impair transport in the hepatocyte, disturb the intracellular transport and increase the permeability of the intercellular connections. As a result, the elements of bile may appear in the peripheral blood. Gestational cholestasis constitutes a classic example of intrahepatic cholestasis. The etiology of ICP is multifactorial with hormonal, genetic and environmental factors participating in the process. The diagnosis is based on the presence of pruritus, elevated values of bile acids in the blood serum and of aminotransferases (aspartic, aminopropionic and gamma-glutamylotranspeptydase (AspAt, AlAt, GGTP)), as well as spontaneous remission in the second or third week after childbirth, of lack of other illnesses causing pruritus and icterus. Clinical and biochemical symptoms of ICP include: pruritus without skin rash (usually after 30 weeks of gestation), mild icterus, steatorrhea etc. Abnormalities in the laboratory tests of the LFT (liver function tests) encompass: an increase in the serum concentration of fatty acids (BA) which can be the first and only laboratory abnormality. Concentrations surpassing 10 micromol/l are considered to be abnormal. Concentration of BA higher than 40 micromol/l allows to recognize a case of severe ICP, connected with the risk of premature delivery presence of the meconium liquor, surgical means of delivery and low APGAR score of the newborn (< 7 pt). In about 80% of pregnant women with ICP, the BA concentration ranges between 10-40 micromol/l, but perinatal results are comparable with uncomplicated pregnancies. Some authors are of the opinion that abnormal AlAt value is the most sensitive test, other authors consider the abnormal values of alkaline phosphatase and bilirubin to be the most pathognomonic factors. Other abnormal tests include: higher activity of alpha-hydroxybutyric dehydrogenase correlated with an increase of the alkaline phosphatase and bilirubin; mild metabolic acidosis; dyslipidemia with elevated concentrations of the total lipids, total cholesterol and free LDL cholesterol and apolipoprotein; abnormal glucose tolerance test. ICP constitutes a medical problem that carries a considerable risk for the fetus, resulting from an increased flow of bile acids to the fetal blood circulation (elevated level in the amniotic fluid, in the umbilical blood serum and meconium). The risk of adverse effects for the fetus correlates with the rise of BA concentration in maternal blood serum. Cholestasis increases the risk of premature labor, presence of meconium in the amniotic fluid, fetal bradycardia, intrauterine asphyxia and stillbirth, particularly when the concentration of serum bile acids on an empty stomach is above 40 micromol/l. However, maternal clinical signs and symptoms do not correlate with the fetal outcome. Aspiration of bile acids or their accumulation in the fetal blood circulation are responsible for the increased frequency of RDS appearing in ICP. The aim of the obstetric management of ICP is to reduce maternal symptoms and biochemical disorders and to minimize the risk of premature delivery fetal distress and sudden death. ICP management should include: bed regime, light, low-fat diet, no stress, upper abdomen ultrasound examination, LFT tests and thrombotic tests once a week, monitoring of the fetal well-being with the available biophysical methods, pharmacotherapy and therapeutic termination of pregnancy in case of serious illness and/or the fetal distress. Ursodeoxycholic acid (UDCA) is the basis of the pharmacological treatment of pregnant women and currently constitutes the most promising treatment option of ICP. UDCA is administered orally in the dosage of 10-16 mg/kg/24, what in practice means 250-300 mg/2-3 times a day.
Ginekologia polska 09/2012; 83(9):713-7. · 0.41 Impact Factor
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Ginekologia polska 07/2012; 83(7):555-7. · 0.41 Impact Factor
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ABSTRACT: Nomegestrol acetate (NOMAC) combined with E2 (Zoely) is a monophasic oral contraceptive (OC) which safety and efficacy was confirmed in a number of level I evidence clinical trials. Zoely is highly effective OC, especially in overweight and obese patients, with good cycle control, safe and well tolerated. NOMAC/E2 combination causes no or minimal weight gain and is characterized by minimal influence on bone mineral density or blood pressure and presence of acne. Moreover lipids profile, carbohydrates metabolism, haemostasis and endocrine glands functioning were not affected. High tolerance and acceptance of NOMAC/E2 combination by women, low adverse event profile, fast recovery of ovarian activity and ovulation is a reasonable treatment tool in everyday practice.
Ginekologia polska 04/2012; 83(4):316-8. · 0.41 Impact Factor
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Ginekologia polska 02/2012; 83(2):155-6. · 0.41 Impact Factor
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Ginekologia polska 02/2012; 83(2):149-54. · 0.41 Impact Factor
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Ginekologia polska 07/2011; 82(7):550-3. · 0.41 Impact Factor
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Ginekologia polska 04/2011; 82(4):313-7. · 0.41 Impact Factor
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Ginekologia polska 03/2011; 82(3):230-3. · 0.41 Impact Factor
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Ginekologia polska 12/2010; 81(12):947-9. · 0.41 Impact Factor
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Ginekologia polska 11/2010; 81(11):874-6. · 0.41 Impact Factor
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Ginekologia polska 10/2010; 81(10):786-8. · 0.41 Impact Factor
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Ginekologia polska 09/2010; 81(9):712-4. · 0.41 Impact Factor
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ABSTRACT: Postpartum hemorrhage (PPH) is one of the leading causes of maternal death and one of the major causes of mortality in women in developing countries. According to the Central Statistical Office, in 2006, in Poland 540 maternal peripartum deaths were noted, 34.7% of which due to PPH. Therefore, active postpartum management should be the main goal in contemporary obstetrics. Some PPH management algorithms have been proposed by the World Health Organization, the American College of Obstetricians and Gynecologists and Polish Gynecological Society. In the event of unsuccessful conventional management of PPH (uterotonics, curettage, etc.) a new technique, intrauterine Bakri balloon tamponade, has been recently proposed. The current paper presents two case reports where this method has been successfully applied.
Ginekologia polska 03/2010; 81(3):224-6. · 0.41 Impact Factor
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Ginekologia polska 02/2010; 81(2):144-8. · 0.41 Impact Factor
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Ginekologia polska 01/2010; 81(1):69-73. · 0.41 Impact Factor
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Jan Kotarski,
Antoni Basta,
Romuald Debski,
Agata Karowicz-Bilińska,
Witold Kedzia,
Tomasz Niemiec,
Ewa Nowak-Markwitz,
Anita Olejek, Ryszard Poreba,
Marek Spaezyński,
Jacek Wysocki
Ginekologia polska 11/2009; 80(11):870-6. · 0.41 Impact Factor
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Ginekologia polska 09/2008; 79(8):567-77. · 0.41 Impact Factor
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Ryszard Poreba,
Jacek Brazert,
Bogdan Chazan,
Ryszard Czajka,
Krzysztof Czajkowski,
Romuald Debski,
Krzysztof Drews,
Stefan Jaworski,
Agata Karowicz-Bilińska,
Janusz Kubicki, [......],
Alfred Reroń,
Elzbieta Ronin-Walknowska,
Zbigniew Słomko,
Wiesław Szymański,
Mirosław Wielgoś,
Jan Wilczyński,
Mariusz Zimmer,
Edmund Waszyński,
Michał Jóźwik,
Polish Gynecological Society
Ginekologia polska 06/2008; 79(5):378-84. · 0.41 Impact Factor
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Ginekologia polska 02/2008; 79(1):69-77. · 0.41 Impact Factor
