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SANTRAUKAReikšminiai žodžiai: gausus menstruacinis kraujavimas, intrauterininė sistema su levonorgestreliu, endometriumo abliacija, NovaSure tinklelis. Gausus menstruacinis kraujavimas -dažna reprodukcinio amžiaus moteris varginanti problema, kuri pablogina moters fizinę, socialinę, emocinę ir/arba materialinę gyvenimo kokybę. Straipsnyje aptariami gausaus menstruacinio kraujavimo reprodukciniu moters gyvenimo laikotarpiu priežiūros ypatumai kasdieniame akušerių-ginekologų darbe bei apžvelgiami šios patologijos gydymo metodai. Nesant organinės gimdos patologijos, pagrindiniai gydymo metodai yra intrauterininė sistema su levonorgestreliu, hormoniniai medikamentai, gimdos pašalinimo operacija. Šiame straipsnyje taip pat pristatoma antros kartos endometriumo abliacija kaip alternatyva gimdos pašalinimo operacijai. ABSTRACTKey words: abnormal uterine bleeding, the Levonorgestrel-Releasing Intrauterine System, NovaSure endometrial ablation. Heavy menstrual bleeding is a common concern among women of reproductive age which impedes a woman's physical, social, emotional and/or material quality of life. The article discuss the importance of abnormal uterine bleeding in pre-menopausal women in daily gynecologists work as well as reviews the most practiced treatment possibilities. The main treatment methods for heavy menstrual bleeding in women without organic pathology are the Levonorgestrel-Releasing Intrauterine System, hormonal therapy and hysterectomy. This article also reviews the second generation endometrial ablation as an alternative to hysterectomy. ĮVADASGydytojai akušeriai-ginekologai kasdien susiduria su pacientėmis, kurios skundžiasi gausiomis, ilgai trunkančio-mis mėnesinėmis. Tokias moteris dažnai vargina anemijai būdingi simptomai, be to, jos susiduria su gyvenimo kokybės problemomis. Normalios menstruacijos yra apibrė-žiamos kaip reprodukciniu moters gyvenimo laikotarpiu reguliariai kas 21-35 dienas pasikartojantis kraujavimas iš gimdos, užtrunkantis nuo 1 iki 7 dienų ir kurių metu 3 valandoms yra reikalingas < 1 sanitarinis paketas ar tamponas bei visų mėnesinių metu netenkama ≤ 80 ml kraujo [1,2]. MENORAGIJA IR JOS PRIEŽASTYSMenoragija ("menorrhagia") -tai per ilgas (≥ 8 dienų) ir per gausus (> 80 ml) reguliarus menstruacinis kraujavimas, kuris periodiškai pasikartoja mažiausiai 6 mėnesius. Tačiau šis apibrėžimas daugiau galėtų būti tinkamas moksliniams tyrimams. Kasdienėje medicinos praktikoje vertėtų atkreipti dėmesį ir į 2007 m. Nacionalinio moters ir vaiko bendradarbiavimo centro ("National Collaborating Centre for Women's and Children's Health") pateiktą menoragijos apibrėžimą. Tai toks menstruacinio kraujo kiekio netekimas, kuris pablogina moters fizinę, emocinę, socialinę

Background. Diaphragmatic peritoneal metastasis by advanced epi thelial ovarian cancer is a very common holdback precluding optimal cytoreduction. The aim of this study was to determine the rate of dia phragmatic peritonectomy during optimal cytoreductive surgery and its role in postoperative morbidity and survival in patients with advanced ovarian cancer. Materials and methods. 100 consecutive patients with advanced epithelial ovarian cancer underwent cytoreductive surgery and were followed up prospectively (January 2009-March 2014). Characteristics of surgery, rate of diaphragmatic peritonectomy and post operative complications were assessed. The Kaplan-Meier method was used for survival analysis. Results. The median age of the entire cohort at the time of primary cytoreduction was 58.5 years (23-83). Optimal cytoreduction was achieved in 73 cases out of 100 patients. From 73 patients in 30 cases (41.1%) upper abdominal procedures, specifically diaphragmatic peritonectomy, was performed to achieve the main goal of cytoreduction-no visible or palbable disease at the end of cytoreduction. Non-optimal cytoreduction was achieved in 27 cases. According to the Clavien-Dindo complication grading system grade I and grade II complications occurred more often in patients that underwent diaphragmatic surgery. The median overall survival from the time of diagnosis to the last follow-up or death was 28 months (range 0-63 months). The factors associated with the longest survival after primary cytoreductive surgery were the disease free interval from the primary cytoreduction of more than 19 months (n = 51) versus less than 19 months (n = 49) (95% confidence interval, 51.7-59.5; P = 0.013) and no visible or palpable residual disease at the end of cytoreduction (n = 73) versus visible or palpable residual di sease (n = 27) (95% confidence interval, 52.7-61.2; P = 0.03). Conclusions. Based on our prospective analysis of advanced ovarian cancer patients, diaphragmatic peritonectomy is feasible and safe, ensures better rates of optimal cytoreduction and should not be an obstacle towards better survival.

Background: Malignant effusions occur frequently in gynecologic neoplasms and may worsen the prognosis for these patients. Therefore a more detailed analysis for the different cavities is necessary to describe the association between the various histological subtypes and the time related occurrence of malignant effusions in gynecological malignancies. Methods: Malignant effusion specimens from patients diagnosed at Bayreuth Hospital from June 2013 to December 2018 were reevaluated retrospectively and correlated with the histolgogical subtype of primary tumors and with the clinical follow-up.Results: 435 patients with malignant effusions were analyzed, including 273 women and 162 men. 54.2% of patients developed malignant effusions in the pleural space in (54.2%) patients, in the peritoneum in (43.9%) patients and in the pericardium in (1.9%). Gynecological malignancies appear most common in (n=147, 34.0%; mean age 67.3 years) patients with predominant occurrence of ovarian carcinoma in malignant abdominal cytology in 75/191 (39.3%) patients, mostly of high-grade serous papillary subtype in 72/75 (96.1%), and only breast cancer in malignant pleural effusions in 49/236 (20.7%), frequently of 39/49 (79.6%) invasive carcinomas of no specific type. Both involvement of pleural- and peritoneal cavity in 244 female patients with gynecological-, lung- and gastrointestinal neoplasms we obtained in 37 (15.2%) patients, most common in 31/37 (83.78%) gynecological tumors and exclusively of high-grade serous papillary subtype. Malignant ascites occured in patients with lower genital tract tumors in 81/86 (94.2%) within one year after primary diagnosis, whereas breast cancer involves the peritoneum in 2/10 (20%) and the pleural cavity in 11/49 (22.4%) after 12 months. Conclusions: Gynecological neoplasms were the major cause of malignant effusions in our study. The high-grade serous papillary subtype of lower tract gynecological is most aggressive with predominant occurrence in the peritoneum and exclusive secondary involvement of the pleural cavity. Therefore, an alone/exclusive/sole involvement of the pleural cavity characterize the invasive breast carcinoma of no special type compared to predominant occurrence of the lobular subtype in malignant ascites. Breast cancer showed a statistical significant late occurrence in effusion fluids 12 months after primary diagnosis in contrast to early involvement in gynecological- as well as pulmonary- or gastrointestinal malignancies.

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