Results of treatment of patients with endometrial polyps using a differentiated approach

2020 ◽  
pp. 56-59
Author(s):  
V. Benyuk ◽  
◽  
V. Yarmak ◽  
Yu. Drupp ◽  
T. Kovaliuk ◽  
...  
Keyword(s):  
Antibacterial Therapy ◽  
Uterine Cavity ◽  
Sharp Decrease ◽  
Endometrial Polyp ◽  
Endometrial Polyps ◽  
Results Of Treatment ◽  
Group A ◽  
Receptor Phenotype ◽  
Apud System ◽  
Bacterial Screening

The problem of treatment of endometrial polyps remains relevant, because it has high risks of malignancy and a steady tendency to increase the frequency of relapses and is inherent from 26 to 78% in women of different age categories. The objective: is to reduce the frequency of relapses of endometrial polyps by introducing a differentiated treatment strategy for patients with endometrial polyps based on the study of new pathogenesis links. Materials and methods. Clinical and laboratory examinations and treatment of 66 women diagnosed with endometrial polyp at the age of 24–43 years were carried out, which were further divided into two statistically equivalent groups: A (n=34) and B (n=32). All women received treatment according to the 4-stage algorithm of the current order of the Ministry of health of Ukraine No. 676 dated 31.12.2004. The difference in the management of group A patients was that their treatment was supplemented by immunomodulate therapy. At the first stage of the study, additional hysteroresectoscopy was performed, endometrial samples were obtained to determine its type of pathology, develop an immunohistochemical profile of the endometrium with the establishment of a receptor phenotype, identify the inflammatory process, and determine the state of the apoptosis system and the APUD system of the endometrium. Results. Active histological screening of the endometrial condition showed that signs of chronic endometritis (positive reaction of CD-138 and CD-68 markers) in women with endometrial polyp with physiological background endometrium were observed in 26.5% of group A patients after 3 months of treatment, which required a repeat course of treatment based on the results of viral and bacteriological examination. In group B, this rate was 46.9%. All the examined women, against the background of the use of gestagens, showed changes in the endometrial receptor phenotype, which were manifested by a decrease in the number of progesterone receptors in the glandular epithelium by an average of 1.4 times. However, the expression levels of Bcl-2 protein and EC cells had no statistical differences, since there were no signs of proliferation in the background endometrium, including local ones. Viral-bacterial screening of the study showed a sharp decrease in the number of pathogens in the endometrium, but in studies of patients of both groups, viral-bacterial associations were determined. Bacterial screening revealed the presence of anaerobic microflora. The study of the level of tumor necrosis factor in flushes from the uterine cavity indicated a unidirectional trend with the dynamics of the CD-138 index. The results of treatment of patients with endometrial polyp with physiological endometrium showed that the full effect of treatment in group A (antibacterial therapy with gestagens + immunomodulatory therapy) was determined after a year in 85.2% of patients, 14.8% of women had a relapse of endometrial polyp, in the group where patients received only antibacterial therapy with gestagens – a relapse was diagnosed in 37.5% of patients. Conclusion. Determining the tactics of differentiated treatment of endometrial polyps, it is necessary to take into account the results of immunohistochemical research and viral-bacterial control of the endometrial condition, which allows improving the results of treatment of endometrial polyps from 62.5% to 85.2 %, and is a prevention of relapse of endometrial polyp. Key words: endometrial polyps, hysteroscopy, endometrial immunohistochemical examination, apoptosis system, endometrial APUD system, viral-bacterial screening.

scholarly journals Hysteroscopic polypectomy versus expectant management in endometrial polyps in asymptomatic infertile women: a meta-analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 3096
Author(s):  
Tauane Bahia Modesto ◽  
Amanda Tamiris Barbosa Dias ◽  
Sofia Andrade De Oliveira
Keyword(s):  
Pregnancy Rate ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Uterine Cavity ◽  
Expectant Management ◽  
Implantation Rate ◽  
Endometrial Polyp ◽  
Structural Abnormality ◽  
Endometrial Polyps ◽  
Intrauterine Abnormalities

Background: Endometrial polyp is a hyperplastic structural abnormality of the uterine cavity and is one of the most commonly found intrauterine abnormalities. The endometrial polyp is mostly asymptomatic and sometimes diagnosed only during infertility investigation. The influence of endometrial polyps on female infertility is not completely understood, however, due to the possibility of endometrial polyps influencing fertility, their removal is usually performed in women undergoing infertility treatment.Methods: This meta-analysis was performed through an electronic search using MEDLINE, PubMed in October 2017, bringing together the terms of interest in order to select studies that would compare polypectomy and expectant management for endometrial polyps in sub fertile women. Four articles were selected according to the inclusion and non-inclusion criteria.Results: Five variables were collected from the selected articles to be compiled and analyzed (rate of live births per transferred embryo, chemical pregnancy rate, spontaneous abortion rate, implantation rate and clinical pregnancy rate), none of which showed any difference statistically significant in conduct.Conclusions: The data concluded that there is no statistical significance between expectant management and polypectomy.

The empiric antibacterial therapy of postpartum endometritis

2016 ◽  
Vol 22 (5) ◽  
pp. 242-246
Author(s):  
M. A Kurtser ◽  
Tat’yana S. Kotomina ◽  
A. D Podtetenev
Keyword(s):  
Antibacterial Therapy ◽  
Uterine Cavity ◽  
Average Degree ◽  
Diffusion Method ◽  
Alternative Scheme ◽  
Results Of Treatment ◽  
Systemic Inflammatory Reaction ◽  
Amoxicillin Clavulanic Acid ◽  
Degree Of Severity

The purpose of study. To ameliorate results of treatment of postpartum endometritis if puerperals labored in Moscow as a result of prescription of effective empiric antibacterial therapy Material and methods. The sampling of 50 puerperals with endometritis as complication during postpartum period was examined. In all female patients, the inoculation of secretion of uterine cavity was taken and successive determination of sensitivity to antibacterial pharmaceuticals was applied using agar diffusion method. The results. In all inoculations in diagnostic significant titers (≥105 CFU/ml), in overwhelming majority of cases the associations of microorganisms were secured where leading positions occupied by Enterococcus faecalis and faecium, Escherichia coli and Staphylococcus aureus. Conclusion. The Amoxicillin/Clavulanic acid is pharmaceutical of choice in treatment of postpartum endometritis of average degree of severity. The combination of Levofloxacin and Metronidazole is an alternative scheme of treatment of postpartum endometritis of average degree of severity. Under severe endometritis with syndrome of systemic inflammatory reaction carbapenems are pharmaceuticals of choice.

scholarly journals How Can We Treat Endometrial Polyp Without Using Curettage?

2021 ◽  
Vol 4 (7) ◽  
pp. 01-05
Author(s):  
Huang W. L
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Uterine Cavity ◽  
Invasive Procedure ◽  
Endometrial Polyp ◽  
Low Back ◽  
Endometrial Polyps ◽  
The Third ◽  
Mustard Seeds

Introduction: Endometrial polyps are considered begin tumours that protrude inside the uterine cavity. It affects women in reproductive or in menopausal age. It can regress spontaneously or if symptomatic, it can be treated efficiently by hysteroscopy excision. Purpose: to demonstrate that endometrium polyps can be treated without using curettage but only using homeopathic medication without needing to do any invasive procedure. Methods: through two case report (47 and 57 years-old women respectively, with endometrium polyps diagnosed by routine ultrasound). Both patients were programed to do hysteroscopy. They were doing acupuncture (for treatment of low back pain and pain in the shoulder respectively) using needles and mustard seeds. I decided to prescribe for both patients a homeopathy medication called Medorrhinum to treat their miasma. In both cases, they intake the medication first with 30CHXX-20 ml. After one month, the patients need to have the second round of this medication, now with 200CHXX-20 ml. After one month from the first medication, it was possible to intake the third medication, now in 1000CHXX-20 ml. Results: the endometrial polyps disappeared completely after the intake of these medications in both patients without needing to use hysteroscopy exam. Conclusion: the use of homeopathy medication called Medorrinun was very important to recover from the endometrium polyp without the necessity in using hysteroscopy exam and do the curettage.

Modern determinants of endometrium hyperplastic processes pathogenesis

2016 ◽  
pp. 137-142
Author(s):  
V.O. Benyuk ◽  
◽  
V.M. Goncharenko ◽  
T.R. Nykoniuk ◽  
◽  
...  
Keyword(s):  
Conservative Therapy ◽  
Solid Phase ◽  
Research Direction ◽  
Immunohistochemical Method ◽  
Results Of Treatment ◽  
Treatment And Prevention ◽  
Receptor Phenotype ◽  
The Relationship ◽  
Endometrial Proliferation

The objective: to еxplore the relationship between the activity of endometrial proliferation and the state of the local immune response in the uterus in the conditions berprestasi process. Patients and methods. Examined 228 women of reproductive and perimenopausal age with endometrial pathology using ultrasound and then performing hysteroresectoscopy. Determination of the concentrations of the cytokines IL-1, IL-2, IL-6 and TNF was performed by solid phase ELISA. Results. Found a trend that confirms the loss of sensitivity to hormones at the stage of malignancy of the endometrium and can be used as diagnostic determinants in determining the nature of intrauterine pathology and criterion of the effectiveness of conservative therapy. Conclusion. Improving etiopatogenetice approach to the therapy of hyperplastic proce.sses of endometrium with determination of receptor phenotype of the endometrium is a research direction in modern gynecology, which will help to improve the results of treatment and prevention of intrauterine pathology. Key words: endometrial hyperplasia,the receptors for progesterone and estrogen, immunohistochemical method.

BACTERIAL MENINGITIS

PEDIATRICS ◽  
1973 ◽  
Vol 52 (4) ◽  
pp. 586-600
Author(s):  
David H. Smith ◽  
David L. Ingram ◽  
Arnold L. Smith ◽  
Floyd Gilles ◽  
M. J. Bresnan
Keyword(s):  
Bacterial Meningitis ◽  
Medical Care ◽  
Newborn Infant ◽  
Antibacterial Therapy ◽  
Tuberculous Meningitis ◽  
Current Knowledge ◽  
The Past ◽  
Meningococcal Group ◽  
Group A ◽  
Almost All

Prior to the introduction of specific antibacterial therapy, bacterial meningitis was a disease with a universally fatal or disastrous outcome. The introduction of typespecific antiserum, and then of the antibacterial drugs, improved this situation dramatically. Improvements in the general medical care of acutely ill children, and the introduction of a series of more potent antibiotics against its bacterial causes helped to generate an attitude that bacterial meningitis was, or soon would be, a disease of the past. The experience of the past two decades belies this thesis. Today, interest in many facets of this disease has been renewed by many physicians concerned with the health of children: the epidemiology, pathophysiology, diagnosis, and treatment. This symposium attempts to summarize for the practitioner the highlights of current knowledge in this area, and to outline certain areas in which recent advances can be anticipated, or will be studied. Tuberculous meningitis will be omitted for the sake of brevity, as will the special problems of meningitis in the newborn infant. There has been a resurgence of interest in developing vaccines to prevent Hemophilus influenzae b, pneumococcal, and meningococcal Group A, B, and C meningitis. These organisms cause almost all the bacterial meningitis after the first two months of life. If, as now seems possible, vaccines against most or all of these organisms will soon become available, those children having the greatest risk must be defined to determine who, and at what age should have priority in receiving the vaccine(s). A. THE CURRENT MAGNITUDE OF THE PROBLEM

scholarly journals Hysteroscopic evaluation in infertility and abnormal uterine bleeding

2018 ◽  
Vol 7 (2) ◽  
pp. 612
Author(s):  
Navneet Kaur ◽  
Ruby Bhatia ◽  
Paramjit Kaur ◽  
Surinder K. Bhopal
Keyword(s):  
Endometrial Hyperplasia ◽  
Uterine Cavity ◽  
Invasive Procedure ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Therapeutic Modality ◽  
Secondary Infertility ◽  
Endometrial Polyps ◽  
Submucous Fibroid

Background: Hysteroscopy an endoscopic procedure for visualization of uterine cavity may be extensively used in both primary and secondary infertility and abnormal uterine bleeding for evaluating intrauterine pathology. The objectives of this study were to visualize and identity intrauterine pathology in both primary and secondary infertility and abnormal uterine bleeding (AUB) by hysteroscopic evaluation and to perform hysteroscopic guided therapeutic procedures like endometrial currettage, polypectomy, adhesiolysis.Methods: Hysteroscopic evaluation of uterine cavity for any intrauterine pathology in AUB and Infertility. Adhesiolysis, polypectomy, endometrial biopsy misplaced copper T removal were carried out under hysteroscopic vision.Results: Intrauterine synechia in 20.51%, Submucous fibroid in 5.13%, bicornuate uterus, endometrial hyperplasia and endometrial polyp were seen in 2.56% patient each were detected in infertility group while 81.95% cases with AUB had abnormal intrauterine pathology commonest being endometrial hyperplasia in 33.33% followed by endometrial polyps in 23.81% cases, submucous fibroid and misplaced copper T in 9.52% each and intrauterine synechia in 4.76% patient. Endometrial biopsy and polypectomy was done in 23.80% each with AUB, misplaced copper T removal in 9.52% and adhesiolysis in 4.76% patient with AUB.Conclusions: Hysteroscopy remains gold standard for evaluating intrauterine lesions in abnormal uterine bleeding and infertility. A safe, simple minimally invasive procedure not only diagnostic but therapeutic modality for adhesiolysis, endometrial biopsy/curettage, polypectomy, misplaced copper T removal under direct vision with minimal complication within reach of every Gynaecologist thereby reducing burden of major surgical intervention.

scholarly journals Hysteroscopy is Gold standard in Uterine evaluation for Infertility, but HSG still has a place

2021 ◽  
Vol 12 (4) ◽  
pp. 98-104
Author(s):  
Manisha Bajaj ◽  
Rajib Roy ◽  
Motiur Rahman ◽  
Joydeb Roychowdhury
Keyword(s):  
Predictive Value ◽  
False Negative ◽  
Screening Method ◽  
Uterine Cavity ◽  
High Specificity ◽  
Filling Defect ◽  
Endometrial Polyp ◽  
Care Hospital ◽  
Saline Infusion Sonography ◽  
First Choice

Background: Uterine abnormalities, congenital or acquired are implicated as causal factor in 10%-15% of infertile couplesreporting for treatment. Hysteroscopy, hysterosalpingography (HSG), saline-infusion-sonography and USG are available for evaluation of uterine cavity. HSG helps in initial evaluation of a sub-fertile woman, but hysteroscopy is gold standardas itallows direct visualisation ofintrauterine pathology and treatment in same-setting, if required. Aims and Objective: To describe hysteroscopic findings of infertile patients and compare the observations with their respective HSG findings. Materials and Methods: It’s a prospective analysis of 105 women with infertility who attendedtertiary-care hospital during 18 monthsfulfilling pre-defined inclusion and exclusion criteria. All cases were evaluated with both HSG and hysteroscopy, observations were recorded and co-related with each other. Results: Among 105 cases, maximum (76.19%) were 25-35 years of age. The primary infertility accounted for 68.57% cases.Abnormal HSG findings observed in 19 cases (20%), most common being filling-defect.Hysteroscopy detected abnormalities in 39 cases (37.14%), commonest being endometrial polyp. Out of 39 cases of abnormal uterine cavity detected on hysteroscopy only 19 were picked-up by HSG, rest 20 cases failed to be identified. The strength of agreement between hysteroscopy and HSG calculated is moderate (Kappa=0.505). Conclusion: As HSG hadlow false positivity (03%), high positive-predictive-value (90.48%) and negative-predictive-value (76.19%) and high specificity (96.96%) it is still considered as a first-choice screening method of uterine cavity. However, high false-negative-value (51.28%)of HSG makes Hysteroscopy a better diagnostic test. HSG couldn’t differentiate endometrial polyp, adhesions and submucous fibroid, shown them as filling defect only.

scholarly journals Prevalence and characteristics of endometrial polyps in patients with abnormal uterine bleeding

2008 ◽  
Vol 65 (5) ◽  
pp. 349-352 ◽  
Author(s):  
Biljana Djordjevic ◽  
Jelena Milosevic ◽  
Zorica Stanojevic
Keyword(s):  
Endometrial Carcinoma ◽  
Statistical Significance ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Atypical Hyperplasia ◽  
Endometrial Polyps ◽  
Female Population ◽  
Group A ◽  
Malignant Changes ◽  
Group B

Background/Aim. The prevalence of endometrial polyps (EPs) in the general female population is about 24%. Abnormal uterine bleeding is frequently the presenting symptom of EPs. The aim of this study was to determine the prevalence and characteristics of EPs in patients with abnormal uterine bleeding. Methods. The prevalence and characteristics of EPs were investigated in 961 patients with abnormal uterine bleeding who underwent dilatation and curettage between January and December 2006. Regarding histopathological features of EPs (presence of atypical hyperplasia or endometrial carcinoma), patients were divided into two groups: group A - patients who had EPs and EPs with hyperplasia without atypia (n = 204) and group B - patients who had EPs with atypical hyperplasia and EPs with carcinoma (n = 7). Results. In 211 (21.94%) patients EPs were found with abnormal uterine bleeding. Histopathologically, there were 175 (82.94%) EPs, 29 (13.74%) EPs with hyperplasia without atypia, 5 (2.37%) EPs with atypical hyperplasia, and 2 (0.95%) EPs with endometrial carcinoma. Contrary to the patients with EPs and EPs with hyperplasia without atypia (group A), patients who had EPs with atypical hyperplasia and EPs with carcinoma (group B) were older (p < 0.05), and more commonly postmenopausal (p < 0.05) and with hypertension (p < 0.05), all of statistical significance. Conclusion. The prevalence of endometrial polyps in patients with abnormal uterine bleeding according to our data was 21.95%. Atypical hyperplasia and endometrial carcinoma were rarely confined to a polyp. Older age, postmenopausal period and hypertension may increase the risk of premalignant and malignant changes in endometrial polyps.

scholarly journals Multiple endometrial polyps in patient undergoing long-term gestagen therapy

2005 ◽  
Vol 133 (9-10) ◽  
pp. 438-440
Author(s):  
Milena Zamurovic ◽  
Pavle Srbinovic ◽  
Jovana Petrovic
Keyword(s):  
Progesterone Receptors ◽  
Uterine Cavity ◽  
Reproductive Period ◽  
Histopathological Analysis ◽  
Endometrial Polyps ◽  
Endometrial Cells ◽  
Gynecology And Obstetrics ◽  
Irregular Bleeding ◽  
Continuous Presence ◽  
Cell Genome

Endometrial polyps represent a limited focal, circumscribed overgrowth of the endometrium. Their aetiopathogenesis has not been completely explained yet. They are often found in perimenopausal women; during the reproductive period they are less common. We present the case of a 32-year-old patient, who came for a check-up to the Gynecology and Obstetrics Clinic "Narodni Front" because of irregular bleeding. The patient was subjected to hormonal linestrenol therapy, which she had administered herself, without further consultations with her gynecologist, during the previous 10 years. Complete diagnostic examinations were performed. Contrast sonohysterography enabled the visualization of multiple polyps inside the uterine cavity, which were confirmed by histopathological analysis of material obtained via explorative curettage. Histopathological material contained over 30 endometrial polyps. A control check-up after one month, as well as subsequent quarterly check-ups, resulted in normal findings. Analysis of the described case has indicated that the loss of sensitivity of progesterone receptors in endometrial cells is possible if there is a continuous presence of progesterone agonists in circulation, as is true of linestrenol in this case. The loss of sensitivity of progesterone receptors upsets normal hormonal activity during the secretory phase of the menstrual cycle, leading to copious, irregular bleeding. These changes may, however, have even deeper effects. More recent research shows that, if the agent causing the loss of sensitivity of the receptors is present in circulation over a longer time period, changes may also appear at the DNA molecular level, i.e. in the cell genome itself. This, in turn, may lead to the beginning of the process of oncogenesis and the formation of timorous tissue.

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