Razvan Vladimir Socolov's research while affiliated with Universitatea de Medicina si Farmacie Grigore T. Popa Iasi and other places

Introduction/Background Endometrial cancer is the most common gynecologic malignancy. It is often diagnosed in elderly women in an early stage. It can, sometimes affect women at fertile age and therefore less invasive fertility-spearing treatment and close follow-up should be thoroughly proposed. Since most of these malignancies are diagnosed in elderly women, most of them will have associated diseases and eventually post-surgery complications. Can we consider hysteroscopic resection in this patients to reduce post-operatively risks? Methodology Three patients were addressed to our clinic for intermitent bleeding, one was a 50 years old premenopausal patient, another one a 75 years old woman and another patient of 60 years of age. All three patients had transvaginal Color Doppler ultrasound and MRI to assess the highly suspected symptomatology of malignancy. They were all addressed to hysteroscopic resection and for all three patients the pathology report was positive for endometrial endometrioid carcinoma, stage 1A. Finally, on all patients total hysterectomy was performed in a one to two month interval. Results All three hysterectomy specimens were free from any malignancy. As the guidelines in our country, the Romanian Society of Obstetrics and Gynecology, do not stipulate that sentinel lymph node dissection is compulsory, we did not perform any further dissection. There were no recurrences after a 2 to 4 years follow-up period with no complementary treatment. Conclusion All our patients were treated through hysterectomy but If hysteroscopic tumor resection followed by progestin therapy for early-stage endometrial cancer is a safe conservative treatment strategy, than hysteroscopic resection could also be an option for elderly patients who have associated high risk diseases and for whom ultrasound and MRI characteristics do not raise the suspicion for an advanced malignancy. We believe that further studies should also be conducted to better assess this conclusion. Disclosures Authors have nothing to disclose.

Atypical polypoid adenomyoma (APAM) is a rare polypoid benign tumor of the uterus that causes irregular vaginal bleeding in women of reproductive age. It has the potential for malignant transformation, but it does not metastasize. APAM may coexist with endometrial hyperplasia and adenocarcinoma, usually leading to misdiagnosis. Histopathologically, it is a biphasic tumor, represented by the endometrioid glands with a complex histoarchitecture, with sometimes squamous morular metaplasia or cytologic atypia, interspersed with a fibromyomatous stroma. This tumor has a high incidence of recurrence. We present a very rare case of a 21-year-old patient, a virgin, without a significant medical history, with a bleeding mass occupying the vagina. The mass was excised using forceps, scissors, and a suture of the visible pedicle. After a four-year follow-up and no additional medical treatment, no relapse was observed. Given the risk of recurrence and progression, APAM might be treated via a hysterectomy in patients with no desire for pregnancy. Due to a lower recurrence rate, the conservative treatment of atypical polypoid adenomyoma performed via an operative hysteroscopy represents the best choice. Previously diagnosed in hysterectomy specimens, with the introduction of better-performing indirect imaging techniques, adenomyosis is a clinical entity that has the possibility of being diagnosed in the presurgical stage.

(1) Background: Thrombophilia is a tendency towards hypercoagulability, and it is increased by pregnancy, and peaking around delivery.; (2) Methods: 80 Eighty thrombophilia patients admitted for delivery between 1/10/2017 and 1/12/2021 were prospectively studied, together with 80 eighty age- and para-matched control patients. Patients were admitted for delivery at term by means of cesarean section. The inflammation indexes from the complete blood count values analysis, in during both the 24 hours before and the 24 hours after labor—, extracted from the hospital’s medical records—, were calculated, and then correlated with uterine involution.; (3) Results: In pregnant patients treated for thrombophilia patients, the patients who did not manage to have close their uterine cavity closed with in the first 24-48 hours had significantly higher SII and AISI inflammation indexes SII and AISI , than the onesthose who did manage to have their uterine cavity closed their uterine cavity. In pregnant patients treated for thrombophilia patients, MLR is higher in patients without the Rh factor than in those with the Rh factor. In non-thrombophilia patients, PLR was significantly higher as compared to treated thrombophilia patients. In non-thrombophilia patients, MCVL increased with age and, before labor, while SII and AISI increased with age, postpartum. ; (4) Conclusions: There may be an underlying inflammation state that persisted despite treatment in some pregnant thrombophilia pregnant patients.

Background Cervical cancer is the fourth most common female malignancy worldwide. In developing countries, it is the most common subtype of cancer and the third leading cause of cancer mortality among women. Artificial intelligence has the potential to be of real use in the prevention and prompt diagnosis of cervical cancer. The aim of our study was to develop a medical platform consisting of an automated observation sheet containing colposcopy data, a software that would use a machine learning module based on clinical and image data for diagnosis and treatment, and a telemedicine module to enable collaboration between gynecologists. Materials and methods Clinical and colposcopy image data from 136 patients were introduced into a machine learning module designed to generate an algorithm for proposing a preliminary diagnosis and treatment. The clinical and imaging data were corroborated to generate six options: ‘Follow-up’, ‘Pharmacotherapy’, ‘Biopsy’, ‘Curettage’, ‘DTC’, and ‘Conization’. Results Data generated by the machine learning module regarding treatment options were compared with the opinion of gynecologists and yielded an accuracy of 78% for ‘Follow-up’, 81% for ‘Pharmacotherapy’, 84% for ‘Biopsy’, 90% for ‘Curettage’, 96% for ‘DTC’, and 81% for ‘Conization’. Conclusions The developed software can be an important step towards the digitization of existing gynecology offices and the creation of intelligently automated gynecology offices related to prevention and treatment of cervical cancer. More data is needed to improve the accuracy of the developed software.

Abstract The uterine leiomyoma is a benign mesenchymal tumor of the smooth muscle tissue of the uterus, in parallel with the proliferation of fibroconjunctive stroma, and is found in 20% of the female population aged 35-50 years old. The treatment for each patient is individual and multifactorial. Fibroids can grow anywhere in the uterus, and their size varies from microscopic to giant. Uterine fibroids can be located in different parts of the muscle cavity. Depending on the areas where growth occurs, they are classified into intramural, subserous and submucosal. The prolapsed ute¬rine fibromatous nodule is a pedunculated submucosal fi¬bro¬matous uterine nodule that migrates from the uterine cavity through the cervical canal into the vagina. This ar¬ti¬cle presents the clinical case of the patient H.E., aged 45 years old, who was diagnosed and treated at the “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology, from Iaşi, in the gynecology department, being diagnosed with hemorrhagic fibromatous uterus and giant uterine fibromatous node prolapsed from the uterine cavity into the vagina. This case presents difficulties in making the decision, which refers to the volume and character of the surgical in¬ter¬ven¬tion due to the particularity of the case. Uterine le¬io¬myo¬mas are the most common tumors of the female ge¬ni¬tal tract. The massive pediculated uterine fibromatous no¬dule prolapsed through the cervical canal is a very rare tumor and is a major diagnostic and therapeutic challenge.

Background: Uterine involution assessments are critical for the prevention of postpartum hemorrhage. Various methods have been used worldwide. Methods: The PUUS (Postpartum Uterine Ultrasonographic Scale) method evaluates, by transabdominal ultrasonography, the length of the endometrium of the uterine cavity occupied by blood or debris, from grade 0 (no blood) to grade 4 (over three-quarters of the endometrial length occupied by blood/debris). A total of 131 consecutive patients admitted for delivery in the Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, were prospectively evaluated using the PUUS method. The mean age was 27.72 years old, and they were examined during the first 24-48 h after vaginal delivery, or in the first 48-72 h after cesarean delivery. For patients with a PUUS grade greater than 1, re-examination was preformed daily in the following days, until the PUUS grade decreased to 1 or 0. Results: By standardizing uterine involution in a numerical fashion, we precisely demonstrate that uterine involution varied with the method of delivery (vaginal/cesarean) and with the number of vials of oxytocin received intrapartum, but not with the number of vials of ergometrine maleate received, and not with the origin of the parturient (rural/urban).

Postpartum hemorrhage is a leading cause of maternal mortality. Various methods can be used to evaluate the postpartum uterine cavity volume. This work aims to introduce a simple method for uterine postpartum cavity volume evaluation, called Postpartum Uterine Ultrasonographic Scale (PUUS), which could be used routinely. In this prospective study, 131 consecutive Caucasian patients were evaluated by using the PUUS method. The mean age was 27.72 years (ranging from 15 to 42). Patients were examined in the same time intervals: within the first 24-48 hours after delivery in case of vaginal delivery, and within the first 48-72 hours, in case of cesarean delivery. Patients with PUUS grades 2, 3, or 4 were reexamined daily until the PUUS grade declined to 1 or 0. The PUUS method evaluated the length of the endometrium of the uterine cavity occupied by blood or debris, from grade 0 (no blood) to grade 4 (over three-quarters of the endometrial length occupied by blood/debris). The PUUS grade of uterine involution varied with the day of examination, gestation, and parity. In this article, a novel method of evaluating uterine postpartum involution titled PUUS is introduced. This method standardized uterine cavity involution in a numerical fashion. We hope that the PUUS scale could further be used to decrease the morbidity and mortality of women due to postpartum hemorrhage.

Intrauterine devices (IUD) are one of the most commonly used methods of contraception worldwide. The long term effect makes it desirable by most patients. The insertion of an IUD is not difficult as a technique but it involves multiple complications such as uterine perforation and migration into the abdominal cavity, urinary bladder perforation, fistula formation, bowel perforation and intra-abdominal adhesions. We present the case of a 31-year-old female patient (para=4) with a medical history of an IUD insertion during her postpartum period in February 2018. In April 2019, during her normal follow up consultation, the speculum examination did not detect any IUD strings and the abdominopelvic ultrasound showed no signs of the device inside the uterine cavity. A subsequent X-ray identified the device in a horizontal position in the pelvic region. The patient was scheduled for surgical intervention, but in the meantime she became pregnant. Decision to continue with the pregnancy was taken and surgery was delayed until the postpartum period. In August 2020, a laparoscopic surgical procedure was performed; during the intervention, the IUD was identified in the anterior rectal wall with only the strings exiting the wall. Therefore, a visceral surgeon advice was required. The device was removed by continuing the laparoscopic intervention. The patient was given antibiotic treatment and had a favorable evolution. Although IUD is thought to be an easy and accessible method of contraception, complications such as uterine perforation must always be taken in consideration and well explained to all patients.