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UNLABELLED: Hormone replacement therapy in surgical menopause is a prophylactic measure that is used for preventing the short and long term effects of the lack of ovarian hormones. MATERIAL AND METHODS: This is a retrospective study conducted between 2004 and 2006 at the Iasi "Elena-Doamna" Hospital of Obstetrics and Gynecology on two series of patients: 46 patients with surgical menopause who received treatment with transdermal estradiol (Climara), and 20 surgical menopause patients not receiving this treatment who served as controls. RESULTS: A decreases in the average levels of total cholesterol, triglycerides and LDL cholesterol and an increase in the HDL cholesterol level were identified in the series receiving Climara compared to the controls. The climacteric symptoms improved in the patients receiving treatment. CONCLUSIONS: Transdermal therapy with estradiol (Climara) is an effective method of treatment in surgically induced menopause.

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Cyclooxygenase 2 (COX-2) regulates the prostaglandins production and it seems to have a role in the onset and progression of different malignant tumors, being overexpressed in numerous human malignancies and premalignant conditions. Some cellular elements from chronic inflammatory processes, together with stromal cells may be involved in neoplastic transformation of proliferative stem cells and in the process of tumor invasion. Cervical carcinoma, as a commonly pattern of different tumors, can express COX-2 in association with glutathione-S-transferase isoenzymes and can be considered as possible molecular targets in antitumoral therapy. The purpose of this study was to evaluate the expression of cyclooxygenase (COX)-2 in cervical squamous intraepithelial lesions of low-grade (LSIL) and high-grade (HSIL), with morphologic evidence of HPV infection. Immunostains with COX-2 antibodies were performed on formalin-fixed and paraffin-embedded tissue sections from 20 cervical biopsies: 10 with LSIL histopathologic diagnosis and 10 with HSIL histopathologic diagnosis. All LSIL biopsies and four HSIL cases (equivalent to CIN2) presented also intermediate squamous cells, with pathognomonic morphology of HPV infection (koilocytes). The Allred immunohistochemical score for the intensity of staining and the percent of cells stained was assigned. The slides were scored by three independent pathologists and compared across histological categories. Regarding the intensity of cytoplasmic COX-2 immunostaining, a weaker expression was observed in specimens with LSIL and a stronger one in those diagnosed with HSIL, the highest score being noted in HSIL corresponding to CIN3 lesions. The increase of COX-2 expression in cervical cancer precursors certifies that COX-2 may have a role in the development and progression of cervical squamous intraepithelial lesions.

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The presence of the giant abdominal-pelvic tumours is more and more rare because of the precocious methods of diagnosis. Sometimes the rare cases of giant uterine fibroma are met in medical practice and they need the use of atypical surgical techniques that are not entirely risk-free. In the present case, the giant uterine fibroma that was diagnosed (23/21/20 cm) was investigated clinically, and with imaging and pathologic techniques, then it underwent a surgical procedure in two stages, with major difficulties, because the entire anatomical structure of the pelvis was totally modified.

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UNLABELLED: Struma ovarii is a rare tumor in its pure form, but its true incidence is hard to estimate because of all the variation in the diagnostic criteria due to the fact that some authors reported it as within a teratoma and others only in its pure form. In general, it is an asymptomatic tumor, "benign-like" in most of the cases, and the diagnostic is based only on the histopathological findings. MATERIAL AND METHOD: This is a retrospective study of all ovarian tumors treated in our departments over a period of 11 years, from January 1, 1995 to January 1, 2006. RESULTS: All medical records of 644 patients were reviewed, of which 502 patients (77.96%) with unilateral tumors and 142 (22.04%) with bilateral involvement. 879 tumors were removed: 88.39% benign and 11.61% malignant. Struma ovarii was demonstrated in 2 patients. The only complaint in these 2 patients diagnosed and treated in our clinics was pain in the lower abdomen. The clinical examination and ultrasound suggested ovarian tumors, but the diagnosis was made on the histopathological findings. Following surgical treatment (classic or laparoscopic) the postoperative course was excellent, confirming that this approach is the only practical solution.

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In this study, we have aimed to point out the reliability and importance of the cerebro-umbilical ratio obtained by Doppler exploration, in comparison with classical investigations, as well as to verify the diagnosis of ante-partum foetal disorder through the amount of the Apgar score at the fetuses having been monitored.

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AIM: The qualitative and quantitative analysis of the histological structure of the Levator Ani (LA) muscle at female patients with pelvi-perineal prolapse (PPP). MATERIAL AND METHODS: After having taken biopsies of LA from 50 patients with PPP, a microscopic qualitative and quantitative study has been performed. This study was done by comparison with a control lot. RESULTS: The connective, muscular and vascular modifications in the structure of the LA are presented, in connection with the hormonal status of patients with PPP and also the influence of these modifications on the anatomic and functional integrity of the pelvic floor. CONCLUSIONS: Applying the hormonal maintenance treatment for menopause patients has become strictly necessary, both in the PPP prophylaxis and after restoring surgeries.

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The pelvi-perineal prolapse (PPP), which is a relatively well defined anatomo-clinical and surgical entity, involves a complex etiology and pathogeny. The relatively rapid appearance of PPP after subtotal hysterectomy without the suspension of the vaginal stump and perineal reconstruction has already been substantiated. This study refers to a similar case, where it was necessary to apply some non-typical surgical technics (cervical stump extirpation, colpoligamentopexy with 4 non-resorbable threads at the Cooper ligaments and perineal reconstruction), with the aim of vaginal suspension, at a menopausal patient with PPP of 3rd degree, stress urinary incontinence, ulcerating remaining cervix and cystorectocele, installed at 2 years after the inter-annexal subtotal hysterectomy.

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Presentation of a case of dicephalic conjoined twins, rare malformation with an incidence of 1:50000. Before dissection, the specimen was investigated by CT, x-ray and ultrasound. Dissection was performed under Zeiss surgical microscope and the images were taken with a Sony video line. Specimens for histologic examination were collected. The parents refused genetic examination. The complex study of the specimen allowed us to make the following diagnosis: dicephalus dibrahii dipus conjoined twins. In the past 20 years no such case was reported in Romania. An etiological diagnosis is impossible. Embryologically, we support the fusion theory (Winslow) promoted by O'Rahily (1998): gemellarity disturbance during the first week of pregnancy.

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