Adenomyosis: opportunities and perspectives of endosurgical treatment with consideration of morfological structure of myometry, endometry and ovaries

Approaches to the treatment of painful genital endometriosis have been discussed for many years and to this day represent the most urgent aspect of this problem. With the development of endosurgery, a new method for treating internal endometriosis of the uterine body was proposed - laparoscopic electro-destruction of the affected myometrium followed by hysteroresectoscopic ablation of the endometrium. For the first time this technique was applied by C. Wood in 1994.

Study of nosological features of morbidity and mortality of the population of Ukraine caused by malignant neoplasms

Annotation. Oncological disorders remain one of the most important medical, biological and economic problems in the world. The aim of the study is to analyze the indicators of morbidity and mortality of the population of Ukraine from oncological pathologies in their distribution by nosological forms. The study was conducted on the basis of data analysis of the National Cancer Registry of Ukraine over a ten-year period: from 2010 to 2019. Statistical methods (analysis of relative values, calculation of growth rate), structural-logical analysis and system approach are used. Statistical calculations were performed using RStudio v. 1.1.442 and R Commander v.2.4-4. The study revealed that the main form of morbidity and mortality in women are malignant neoplasms of the breast, while in men it is malignant neoplasms of the trachea, bronchi, lungs, and in children aged 0−17 − leukemia and malignant tumors of the brain. An increase in morbidity and mortality due to malignant neoplasms of the prostate in men, malignant neoplasms of the uterine body in women and malignant neoplasms of the pancreas in the general population of Ukraine has been noted. The highest degree of neglect is observed in patients diagnosed with malignant neoplasms of the stomach (32,2-38,2%), malignant neoplasms of the pancreas (30,8-37,9%), malignant pharyngeal neoplasms (27,6-39%), malignant neoplasms of the trachea, bronchi, lungs (27,3-37,9%) and malignant neoplasms of the liver (27,9-35,9%). Only one in two patients diagnosed with malignant neoplasms of the esophagus (50,2-56%), malignant neoplasms of the stomach (44,3-47,6%), malignant neoplasms of the trachea, bronchi, lungs (40,8-43,7%), one in four patients with malignant pancreatic neoplasms (25,7-28,7%) and one in five patients with malignant liver neoplasms (17,7-19,8%) received special antitumor treatment within a year of diagnosis. The highest mortality rate up to one year is characteristic of individuals with malignant neoplasms of the pancreas and malignant neoplasms of the liver: 70,2-77,8% and 69-77,7%, respectively. The results of the study are the basis for the development and improvement of measures to combat the prevalence of certain nosological forms of oncological pathologies and reduce mortality caused by a specific pathology.

PSV-4 Peri-estrus ovarian, uterine, and hormonal variables influence the uterine luminal fluid metabolome in beef heifers

In cattle, uterine luminal fluid (ULF) is the main source of molecules that support embryo development and survival during the peri-implantation period. Overarching hypothesis was that peri-estrus changes in ULF volume through accumulation and resorption mechanisms influence ULF composition during the estrous cycle and early pregnancy. Objectives were (1) to characterize individual temporal and spatial changes in ULF volume, endometrial and luteal vascularity, endometrial and luteal size, and progesterone (P4) concentrations during the peri-estrus period in beef heifers and, (2) associate such changes with the metabolite composition in the ULF, four days after estrus. Fourteen Bos indicus heifers that presented a PGF2α responsive CL received 500 µg PGF2α analog i.m. and were examined daily by rectal B-mode and pulse-wave color-Doppler ultrasonography until the fifth day after estrus (estrus = d 0). Plasma P4 was measured daily. On d 4, the uterine body was sampled using a cytology brush for targeted metabolomic analysis by mass spectrometry. Multivariate analyses clustered heifers according to ovarian, uterine, and hormonal variables in clusters A (n = 5) and B (n = 8 heifers). Individual metabolite concentrations were compared between clusters A and B by univariate analysis using t-test after FDR correction. Concentrations of Pro, Ala, Leu, Gly, Val, Lys, Ile, Phe, Asp, Orn, Tyr, Arg, Trp, Suc, Cit, ADMA, the sum of essential Amino Acids (AA), sum of non-essential AA, sum of aromatic AA, and total AA were greater in cluster A (FDR ≤ 0.05). ULF volume dynamics and associated uterine, ovarian, and hormonal variables during the peri-estrus period presented a concerted variation among heifers, which was associated with the ULF composition four days after estrus. Potential implications for embryo receptivity and reproductive outcomes are the focus of the current investigation.

Lower segment of the uterine body

Comprehensive anatomical histopathological examinations as non-pregnant

Diagnostic possibilities and limitations of urgent intraoperative pathologicanatomical studies in oncogynecology

Introduction. One of the variants of intravital pathological and anatomical diagnostics is intraoperative pathological and anatomical ("urgent") examination, which serves for tumor process verification. Urgent intraoperative pathological and anatomical examination is widely used when there are certain differential diagnostic difficulties and limitations of instrumental methods of examination.The purpose of the study — to analyze the possibilities, limitations and the accuracy of "urgent" pathologic and anatomical diagnostics in oncogynecological diseases. Materials and methods. We retrospectively analyzed medical records of 378 inpatients treated in the gynecologic oncology department of CHOKZO and NM for the period from January 2016 to January 2021. Results and discussion. Urgent histological examination was used to diagnose ovarian tumors (82%, n=310); to evaluate the extent of a tumor process in uterine body cancer, ovarian cancer, cervical cancer (peritoneal carcinomatosis, ingrowth into adjacent tissues and organs) (15%, n=57); less often to evaluate resection margin ablation in cervical cancer, uterine body cancer (3%, n=11). In a comparison of conclusions after urgent morphological examination and conduction of material, discrepancies were registered only in hypodiagnostic ovarian tumors (in 5.8% of all "urgent" ovarian tumor studies, n=18), when the question about the malignancy potential of a process cannot be reliably decided. The reliability of intraoperative morphological verification of the process is 94.2%. The sensitivity is 96%, specificity is 97%, which is consistent with the results of other studies. Conclusions. Intraoperative morphological diagnosis is a highly specific and highly sensitive method of investigation. There are limitations of this diagnostic method depending on the volume of tissue material, quality of cryostat sections, as well as tumor features (e.g., ovarian masses) consisting of heterologous morphological areas. A compliant, multidisciplinary approach is required to successfully meet the challenges of intraoperative examination.

Management of uterine cystic adenomyosis by laparoscopic surgery: case report

Background Endometriosis of the uterine body can be manifested as diffuse solid lesions or cystic lesions. The former is common, while the latter is rare, especially for cystic adenomyosis larger than 5 cm. Case presentation A 30-year-old woman was admitted for severe and worsening dysmenorrhea. Ultrasound examination revealed a rare well-circumscribed cystic lesion about 5.5 × 4 × 5.0 cm. CA-125 level was slightly elevated. She accepted laparoscopic surgery and the adenomyotic tissues were excised. The histopathology of the specimen demonstrated the endometrial glands in the walls of cysts and an area of extensive hemorrhage can be seen in the inner wall of cyst. The patient made a good recovery after surgery and her symptoms complete resoluted. Conclusions This is a rare case of a cystic adenomyotic lesion that was treated by laparoscopic surgery.

Assessment of the prognostic cancer risk in patients with type 2 diabetes mellitus

Background. The epidemiological analysis has shown an increased risk of cancer of the mammalian gland (MG), ute­rine body, and pancreas in patients with type 2 diabetes mellitus (T2DM). The different clinical characteristics and features of the course of DM, and schemes of treatment of patients with these types of oncological diseases (OD) were identified. The purpose of the study was to create a model of mathematical calculation and assessment of the predicted risk of cancer of MG, uterine body, pancreatic and colorectal cancer (CRC) in patients with T2DM, given the importance of diabetes-associated factors of oncogenesis. Materials and methods. The study included an analysis of medical records of patients with T2DM with first diagnosed OD during 2012–2016. The statistical analysis of the results was performed in the program Statistica 12.0 (StatSoft Inc., USA). The differences between indicators were determined by Student’s t-test, considered significant at p < 0.05. The method of multi-factor analysis and the logistic regression equation was used to calculate the coefficient of prognostic risk of the OD. Results. It was found that cancer of MG and the uterine body was most often diagnosed in people at the age of 60–70 years, with obesity, duration of DM more than 5 years, with HbA1c level > 7.5 %, on combination therapy with drugs without influence on the insulin synthesis with stimulators of insulin production. Patients with CRC had the same characteristics, without gender diffe­rences. Pancreatic cancer was most often diagnosed in patients aged 60–70 years, without obesity, with a duration of DM up to 5 years, with HbA1c > 7.5 %, on monotherapy with insulin or sulfonylureas, without gender differences. The created model for calculating the coefficient of the prognostic risk of MG and uterine body cancer is characterized by high prognostic power (accuracy 76.24 %), good prognostic power for cancer of the pancreas (accuracy 75.0 %), and CRC (accuracy 72.2 %). Conclusions. Correction of dysmetabolic disorders is a method of prevention of OD in patients with T2DM. The calculation of the predicted cancer risk will contribute to the prevention of malignant neoplasms in patients with T2DM.

The Role of Neurogenic Bioamines in Nerve Fibers of Uterus during the Postpartum Involution in Experimental Animal Models

Background: Biogenic amines (BAs) secreted by the sympathetic neural apparatus of rat uterus is reported to be conducive to the uterine functional activity during postpartum involution; the imbalance in BAs ratio could confer postpartum reproductive disorders including improper postpartum involution. Objective: The changes in density of uterine sympathetic nerves implicated in the pathology of endometriosis, adenomyosis, and delayed uterine involution. The present study is aimed to ascertain ‘serotonin’ and ‘catecholamine’ concentrations in mesenteric mast cells (MCs), and structural elements of nerve fibers across the perivascular plexuses (PPs) and single sympathetic nerve terminals (SST). Methods: Furthermore, the density of their spatial distribution (SDP and SDT) in the uterine body, cervix, and mesometrium was determined during postpartum involution. Tissue specimens of postpartum uterus were obtained from 55 nulliparous female Wistar outbred strain rats, which were grouped according to the days after parturition at the time of sacrifice. The nerve fibers of PP and SST exhibited emerald green fluorescence, which was detected by glyoxylic acid fluorescence technique; the fluorescence invoked by BAs was identified by microspectrofluorimetry. Results: Concentrations of BAs were extensive in the varicosities of PP and SST on the 10th day. However, the highest BA concentrations were found in structural elements of PP in the uterine mesometrium in the initial days of postpartum. In mesenteric MC, serotonin and catecholamines were at the highest concentration on 10th day postpartum. Histamines peaked on the 6th day. Conclusion: SDP and SDT were increased significantly in all structural elements of uterine nerve fibers in the uterine body and cervix compared to SDP in mesentery. Considering that catecholamines and serotonin are antagonists in many aspects of their biological action, the ratio of BAs should be well-balanced to maintain anabolic-catabolic equilibrium in the rat uterus.