Mihaela Grigore

Awareness and Knowledge About HPV and HPV Vaccine Among Romanian Women

Cervical cancer is one of the most prevalent gynecological malignancies worldwide. Romania has the highest incidence of this type of cancer in Europe. A successful prevention strategy has to consider the primary prevention measures (including health education on human papilloma virus (HPV) infection but also vaccination). The aim of this study was to assess the knowledge and attitudes of Romanian women about HPV and HPV vaccine. We conducted a cross-sectional study survey of 454 women using an anonymously completed questionnaire covering the awareness and knowledge of HPV infection and attitudes to vaccination. We also analyzed the discussions and conclusion from a focus group of healthcare professionals regarding (1) HPV and HPV awareness and attitude, and (2) suggestions for improving HPV vaccine knowledge and acceptance. 69.2% of women were aware about HPV but their knowledge was minimal and incomplete. While 62.3% had heard about HPV vaccine, only 50.7% had a positive attitude toward it. The main barriers to vaccination were the fear of side effects, the perception that is risky, and the financial concerns. Deficiencies in knowledge were noted for vaccine, genital warts, or risks factors for HPV infection like the early onset of sexual life. The information regarding HPV and vaccine is not always accurate and complete, and only 50.7% of women have a positive attitude toward the vaccine. More educational programs and clearer communication are needed to raise awareness and knowledge regarding HPV and HPV vaccine.

Ultrasound features of osseous metaplasia of the endometrium—Case series and review of the literature

Osseous metaplasia of the endometrium is a rare condition characterized by abnormal bone formation in the uterine endometrium. The osseous fragments act like a foreign body in the uterine cavity; thus, infertility, menstrual abnormalities, pelvic pain dysmenorrhea, and dyspareunia are commonly associated. We present a case series of four women with osseous metaplasia of the endometrium with different symptomatology. Two-dimensional endovaginal examination played a primary role in the diagnosis, the characteristic ultrasound pattern being hyperechoic linear or irregular areas within the endometrium casting posterior acoustic shadowing. Three-dimensional ultrasound better demonstrated the irregular appearance and clearly differentiated the oseous metaplasia from an intrauterine device.

Pictorial essay of ultrasound-reconstructed coronal plane images of the uterus in different uterine pathologies: Coronal Plane Images of the Uterus

Imaging in the major planes (horizontal, coronal, and sagittal) of the uterus is important for determining anatomy and allowing the findings to be standardized, and for evaluating and diagnosing different pathological conditions in clinical practice. Examination of the coronal plane is an important step in identifying uterine pathologies and their relationships to the endometrial canal. Three‐dimensional (3D) ultrasound reveals the normal anatomy better and improves the depiction of abnormal anatomy, as the coronal plane of the uterus can easily be obtained using 3D reconstruction techniques. Our pictorial essay demonstrates that adding 3D ultrasound to a routine gynecological workup can be beneficial for clinicians, enabling a precise diagnosis to be made. In addition, the volumes obtained and stored by 3D ultrasound can allow students or residents to become more familiar with normal and abnormal pelvic structures. Clin. Anat. 31:373–379, 2018.

The role of 4D US in evaluation of fetal movements and facial expressions and their relationship with fetal neurobehaviour

The introduction of four-dimensional (4D) ultrasonography (US) allows the study of fetal movements and facial expressions in real time. The possibility of evaluating fetal movements has led to the study of fetal neurobehaviour, which has been for a long period of time a mystery for physicians. The study of fetal activity in utero could differentiate between normal and abnormal behavioural patterns, thus making possible the early recognition of fetal brain impairment. Facial expressions observed with 4D US represent a marker for neurobehaviour and at the same time could enhance fetal-maternal bonding. The present review represents an update of the literature on fetal movements, facial expressions, and their relationship with fetal neurobehaviour.

Three-dimensional ultrasound and HDlive in tubal serous cystadenofibroma: a case report and literature review

Cystadenofibromas of the fallopian tubes are very rare benign tumors and very few cases have been reported in the literature worldwide. Usually, the tumor is asymptomatic, and for almost all cases reported, the tumors were incidentally discovered during surgery for other genital pathology. We report the case of a 30-year-old woman with a serous cystadenofibroma of the fallopian tube, presenting with chronic abdominal pain and secondary infertility. The diagnosis of tubal tumor was formulated before surgery and confirmed during laparoscopic surgery. Both 3D ultrasound and HDlive were useful tools for the diagnosis. The ultrasound diagnosis was helpful in planning appropriate surgical management.

3D ultrasound and HD live of an ovarian mucinous cystadenoma

Ovarian mucinous cystadenoma is a benign tumor that arises from the surface epithelium of the ovary. We present a case of a bilateral mucinous adenoma in a 19 years old patient. The 2D ultrasound was used in combination with 3D and HD live images. The preoperative diagnosis according to ultrasound images was mucinous adenoma and the pathological report after surgery confirmed it. HD live is a novative ultrasound software which can improve the diagnosis.

The Role of HDlive Technology in Obstetrics and Gynecology, Present and Future

Imaging techniques have continually evolved during the last few decades to improve diagnosis in obstetrics and gynecology. Developed more than 15 years ago, three-dimensional (3D) ultrasound has been widely used in clinical practice during the last decade, and its use continues to grow as researchers explore innovative new applications. High definition live (HDlive) ultrasound (US) is a novel ultrasound technology that improves both 3D and four-dimensional (4D) ultrasound images. This technology can mainly be used to study normal and pathologic embryonic and fetal development. HDlive could be important to perinatal research and could provide a better understanding of the development of the early embryo and fetus. Because of the natural pictures of the fetus that it provides, HDlive could be beneficial for increasing the fetal-maternal bonding, an important factor for healthy behavior during the pregnancy. In gynecology, HDlive could be useful in providing a better image of the adnexal pathology or coronal plane of the uterus. Although its advantages need to be further explored, in our opinion, HDlive is an innovative technique and a useful tool with applications both in obstetrics and gynecology.

Molecular markers in cervical screening – a promise for the future

Abstract Cervical cancer is one of the leading cancers in women worldwide. The detection and diagnosis of cervical carcinoma and its precursor lesions, called cervical intraepithelial lesions (CIN), represents the main goal in order to decrease the morbidity and mortality of this disease. In the majority of cases CIN resolve spontaneously. Only a minor part of the lesions develop to high-grade lesions and eventually invasive cancer and it is important to detect those CIN with potential to progress to cervical cancer. For clinical management it is important to distinguish the cervical dysplasia with regression potential in order to avoid unnecessary treatments. Many potential biomarkers have been analyzed for the characterization of cervical cancer and pre-cancer. So far, detection of HPV has been the most promising clinical application. Several new markers have been evaluated intensively and might be used in some clinical settings, mainly p16, MCM5/CDC6 and HPV RNA, integration of HPV DNA into the host genome, chromosomal imbalances. In this article, representative examples of these markers are presented in the context of improved cervical disease detection and progression. Rezumat Cancerul de col uterin reprezintă unul din cele mai frecvente cancere întâlnite la femeie. Elementul cheie pentru scăderea morbiditătii şi mortalităţii în cancerul cervical este diagnosticul acestuia în stadii incipiente precum şi a leziunilor precanceroase numite displazii de col uterin. Displaziile de col uterin pot fi de grad redus sau de grad înalt. Un număr semnificativ dintre displaziile de grad redus regresează spontan şi doar un număr limitat progresează către leziuni de grad înalt şi cancer cervical. Pentru clinician este esenţială identificarea acestora întrucât pot fi astfel evitate tratamente inutile. De-a lungul timpului au fost analizaţi multipli markeri care să identifice displaziile cervicale cu potenţial evolutiv. Momentan cel mai utilizat marker este reprezentat de genotiparea virală. Pe lângă acesta şi alţi markeri şi-au demonstrat utilitatea în încadrarea evolutivă a leziunilor cervicale: p16, MCM5/CDC6, integrarea ADN-ului în genomul celulei gazdă. Articolul trece în revistă cei mai importanţi markeri utilizaţi la ora actuală ilustrând cu cazuistica proprie utilizarea acestora.

Spontaneous hematoma of the rectus abdominal wall in pregnancy

Abstract Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. We report such a case of a 42-year-old woman who developed an abdominal-wall hematoma at 32 weeks of gestation. Initially, she was suspected as having a complicated ovarian tumor associated with pregnancy, because of the intense abdominal pain. Both ultrasound and magnetic resonance imaging proved to be useful in diagnosing rectus sheath hematoma. A conservative management was applied for the rectus sheath hematoma and the patient recovered uneventfully. Although it is a very rare entity, rectus sheath hematoma should be included in the differential diagnosis of every pregnant patient who presents with abdominal pain.