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UNLABELLED: Hyaluronic acid is an important component of the extracellular matrix and has a crucial role in wound healing by stimulation of neutrophil migration, fibroblast proliferation and neoangiogenesis. OBJECTIVE: To study the efficacy of topical application of Bionect (Hialuronic Acid Sodium Sal 0.2%t) in wound treatment after cesarean section. RESULTS: The incidence of edema, infiltration, exudation and superficial blood collections was significantly lower in cases of Bionect application. The results in patients, treated with Bionect makes it a reasonable wound treatment option.

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It is well known that the increased numbers of NK cells with phenotype CD3-CD16+CD56+ can execute cytotoxic effect against trophoblast cells and might be responsible at least for a part the immune mediated reproductive failures. The aim of this study is to follow up the correlations between the increased absolute numbers of NK cells, their activation status and secretion of some cytokines in infertile patients. The results obtained clearly show that in patients with increased numbers of NK cells the percentages of HLA-DR positive NK cells were significantly higher compared to the patients with normal number of NK cells. A similar correlation was revealed when the data of blood plasma where the concentrations of IL-12 were significantly higher in patients from the first group (with increased NK cells numbers). The results from our study demonstrate that the increased numbers on CD3-CD16+CD56+ NK cells is accompanied by enhanced activation of these cells and secretion of cytokines.

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The purpose of this study was to determine the historical roots of so called routine or prophylactic episiotomy and its real value in now-a-day obstetric practice. We made a retrospective study on clinical trails and medical anthropology data.

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Episiotomy continues to be a frequently used procedure in obstetrics despite little scientific support for its routine use. The rationale for routine episiotomy is based on two foundation arguments: that episiotomy reduces perineal trauma and that it prevents subsequent pelvic relaxation. A careful review finds little evidence to support these arguments. Although episiotomy does decrease the occurrence of anterior lacerations, it fails to accomplish the majority of goals stated as reasons for its use. Episiotomy does not decrease damage to the perineum but rather increases it. The midline episiotomy increases the risk for third-degree and fourth-degree lacerations. Episiotomy fails to prevent the development of pelvic relaxation and its attendant complications. Rather than decreasing maternal morbidity, episiotomy increases blood loss and is related to greater initial postpartum pain and dyspareunia. The claims of a protective effect on the fetus in shortening the second stage of labor, improving Apgar scores, and preventing perinatal asphyxia have not been borne out. Efforts should be directed to determine whether episiotomy is beneficial. It is now very important to improve new birthing techniques that maintain the integrity of the perineum and do not involve surgical procedures. More trials are necessary to clarify which are the real indications to use episiotomy. Meanwhile, without the proper scientific evidence, the most correct attitude seems to be a careful use of episiotomy, with decisions on a case-by-case basis.

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Clinical confusion and inappropriate management continues to surround endometriosis. It is poorly recognized that the disorder can exist in two different morphological forms that have different symptoms, signs and prognosis. Earlier classification systems have been useful for research but are of limited value in aiding day-to-day management. In the clinic, two discrete phenotypes can be defined by the presence or absence of palpable nodules in the deep pelvis. Patients with such nodules with or without associated ovarian endometrioma usually have severe symptoms with significant risks of bowel and urinary tract involvement. The predominant histological feature of these lesions is extensive fibromuscular hyperplasia (adenomyoma). These patients will often need extensive surgical intervention. Patients without such palpable lesions usually have the classic superficial subperitoneal lesions with endometrial-like glands and stroma on histological examination. This group often has less severe symptoms and has little risk of developing serious associated problems. These lesions may be helped by medications and/or simple ablative surgery. It is suggested that these collections of symptoms and signs or syndromes be named after the pioneers who first described the lesions. Cullen's syndrome can be used to describe those patients with severe symptoms of endometriosis associated with palpable pelvic nodules. Sampson's syndrome can describe those with similar symptoms associated with a structurally normal pelvis. This paper seeks to present evidence to suggest the reality of this 'two forms of endometriosis' concept, and the possibility of developing a simple clinically useful method of differentiating them.

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The aim of this study was to evaluate Ca 125 II, C-reactive protein (CRP) and serum amyloid A (SAA) and anticardiolipin antibody (aCL) concentrations for the diagnosis of pelvic endometriosis. The study population consisted of 15 women without endometriosis, as confirmed by laparoscopy (group A), and 35 patients with pelvic endometriosis. All of them were diagnosed by laparoscopy or laparotomy. Group B patients were divided into those at stages I and II of the disease (B I/II) and those at stages III and IV (B III/IV). Blood samples were obtained twice during the menstrual cycle: on day 1-3 of the cycle and on day 8-10 of the cycle. Our results claim that the measurement of these molecules may therefore provide a valuable tool in the diagnosis and management of endometriosis.

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The pathogenic mechanisms which lead to development of endometriosis are still unclear. Despite that the immunological mechanisms are not the primary, there is no doubt that they take a part in pathogenesis of the disease. In current review, the influence of the cells of the immune system which are connected with endometriosis is described.

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Struma ovarii was first described in 1899 and is extremely rare, with only 150 reported cases in the medical literature. Struma ovarii is most common between the ages of 40 and 60 years. Women with struma ovarii usually present with a pelvic mass or, less frequently, with hyperthyroidism or ascites. As in follicular tumors of the thyroid gland, the thyroid epithelium in the teratoma may be organized in a solid, embryonal or pseudotubular pattern, rather than thyroid follicles. The authors present an extremely rare case of struma ovarii in 14-year-old girl.

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From an immunological point of view during pregnancy the interactions between the steroid sex hormones and immunocompetent cells as a part of the dynamic local and peripheral immune response is of a particular interest. The aim of our study is to investigate the expression of the early activation marker CD69 in T-lymphocytes subpopulation: CD4+ and CD8+ in peripheral blood from pregnant and non-pregnant women. Our data clearly demonstrate an increase of the percentage of activated CD4+ lymphocytes in pregnant women in comparison to non-pregnant and this difference is statistically significant. A similar but not statistically significant dependency is observed in CD8+ and CD69+ lymphocytes. From the obtained results we conclude that during pregnancy the activation of CD4+ lymphocytes is increased, which probably leads to an increased production of cytokines that shifts the immune response to Th2 type which is protective for pregnancy. This could be partly due to the increased levels of progesterone.

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Fibroma ovarii is a solid benign tumor which consists of fibrous tissue. It is usually hard, but there may be small cystic spaces due to degenerative changes. The incidence of fibroma ovarii is about 8 to 10%. The authors present a case of this tumor with difficulties in diagnosis before operation.

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Its etiology remains uncertain, its pathogenesis disputed and its treatment poor. Most medical treatment is based on ovulation suppression and inducing amenorrhoea. New findings on the genetics, the possible roles of the environment and the immune system, intrinsic abnormalities in the endometrium and secreted products of endometriotic lesions have given explanation into the pathogenesis of this disorder and give us new trends for treatment the disease.

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In our retrospective study we try to find out the correlation between appendectomy and development and severity of tubal sterility. We analyzed 342 HSG and the results of 210 following diagnostic laparoscopies. The results show direct connection between complicated appendectomy and the stage of development of tubal sterility.

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The purpose of this study was to describe the endothelial cell activity of the endometrial tissue in women with and without endometriosis, and find out the diagnostic opportunities for everyday gynecologic practice. There were 30 women with laparoscopic proved endometriosis involved in our study and 27 women with no endometriosis used as a control group. The histological findings were scored after Noyes criteria and classified according to the phase of the menstrual cycle. We found out a significant difference between the two groups, especially during the proliferate phase of the menstrual cycle.

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In this study, the authors tried to figure out the value of immunodiagnostics, and especially the protein characteristics of the peritoneal fluid in women with endometriosis. The main purpose was to establish whether this kind of diagnostics is reliable enough for clinical purposes.

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This article reveals one of the newest theories on the pathogenesis of endometriosis. The research was carried out in the last two years and the suggested conclusions give much more convenient explanations on the way endometriosis develops.

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OBJECTIVE: To determinate the effectiveness of treatment with gonadotrophine releasing hormone agonist. METHODS: We investigated 164 patients with laparoscopy divided in two groups. Women in first group received Dipherelin 3. 75 mg /lpsen/ for 3 months. Second group had received Dipherelin 3.75 mg for 6 months. Preparation was done i.m. every 28 days. All patients in the study had endometriosis grade I-II using the AFS classification after laparoscopy. The measures according to compare in the 2 groups was as following: 1. Dysmenorhoea, dyspareunia and pelvic pain before and after treatment. 2. Rate of pregnancy. 3. Bleeding during the treatment. 4. Amenorhoea after treatment. CONCLUSIONS: After analysis of the patients in the 2 groups we decided that Dipherelin 3.75 mg is an effective treatment of sterility related to endometriosis.

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The ovarian fibroma is a rare benign tumor growing from the connective tissue of the ovarian cortex. The authors introduce a case with primary sterility and fibroma ovarii dextra. They discuss the etiology and diagnostic methods for this kind of tumor formation as well as the predictivity of the ultrasound examination.

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