Gestational surrogacy / Philippine Journal of Obstetrics and Gynecology

@#Some women may not be able to carry their own children even when capable of conceiving biological offspring. In-vitro fertilization and embryo-transfer (IVF-ET) through surrogacy can now make this possible for these women. Surrogacy however, is still considered unacceptable in the Philippines due to moral and legal issues. This article will explore the need and acceptability of surrogacy in this age of IVF-ET in a country where the prevailing social norms and religious values still disapprove of third-party assisted reproductive technology (ART). Medical indications that would benefit from gestational surrogacy were enumerated and briefly discussed. The differentiation between traditional and gestation surrogacy, as well as commercial and altruistic surrogacy were defined. IVF with gestational surrogacy is a feasible solution to a number of medical difficulties in the carrying of a gestation. Strictly regulating the practice and restricting its use only to cases with legitimate medical indications will prevent its misuse and exploitation. Moral issues, admittedly will still remain an issue particularly for commercial surrogacy. However, limiting these only to altruistic and gestational surrogacy in some cases may be an acceptable compromise.

Inducción de organogénesis in vitro con 6-bencilaminopurina en Cattleya trianae Linden & Rchb.f / Induction of organogenesis in vitro with 6-benzylaminopurine in Cattleya trianae Linden & Rchb.f

RESUMEN La orquídea Cattleya trianae Linden & Rchb.f. es reconocida como flor nacional de Colombia y se encuentra en peligro crítico, al presentar una reducción estimada mayor al 80% en los últimos 100 años, debido a la disminución en la calidad del hábitat y niveles altos de explotación o recolección. La familia Orchidaceae es una de las que mayor número de especies posee en el reino Plantae, con aproximadamente 900 géneros, de los cuales, el 38% es endémico de Colombia, concentrado en la región Andina, con 87,2%. Esta investigación buscó profundizar en el tema de la propagación como mecanismo de conservación, para lo cual, se determinó el efecto de la 6-Bencilaminopurina (6-BAP), sobre el desarrollo in vitro, en Fusagasugá (Cundinamarca), en un diseño de bloques completamente al azar, con 3 repeticiones. Cuerpos protocórmicos provenientes de semillas recolectadas en Pacho (Cundinamarca) fueron sembrados en medio básico Murashige & Skoog, enriquecido con 4 concentraciones de 6-BAP. Los resultados mostraron respuestas diferenciales a la adición de la citoquinina, ya que, con la concentración más alta, se obtuvo el mayor porcentaje de callos, con la de 0,05mg.L-1, el mayor porcentaje de brotes y sin la aplicación del regulador de crecimiento, el mayor porcentaje de raíz.

ABSTRACT The orchid Cattleya trianae Linden & Rchb.f. is recognized as the national flower of Colombia, the species is in a critical danger, presenting an estimated reduction of more than 80% in the last 100 years due to the decrease in habitat quality and high levels of exploitation or harvesting. The Orchidaceae family is one of the largest number of species in the Plant Kingdom, with approximately 900 genera, of which 38% are endemic in Colombia, concentrated in the Andean region with 87.2%. This research sought to deepen in the topic of the propagation as mechanism of protection for their conservation, for which the effect of cytokinin 6-benzylaminopurine (6-BAP) on development was determined in vitro in Fusagasugá (Cundinamarca), in a completely randomized block design with 3 replicates. The protocorm-like bodies from seeds collected in Pacho (Cundinamarca) were sown in a basic medium Murashige and Skoog enriched with 4 concentrations of 6-BAP. The results showed differential responses to the addition of cytokinin, as the highest concentration was obtained the highest percentage of callus, with the 0.05mg. L-1, the highest percentage of shoots and without the application of the growth regulator, the highest root percentage.

Use of cannabis in the improvement in the unified Parkinson’s disease rating scale score of Parkinson’s disease: A meta analysis

BACKGROUND@#Cannabis, the source of Δ9-tetrahydrocannabinol (THC), the primary psychotropic compound, and cannabidiol (CBD), a nonpsychoactive chemical with potential therapeutic properties, has been widely used as a psychoactive drug, medicinal drug, or industrial hemp. Cannabinoids exert their effect in the brain mainly by interacting with two types of receptors: CB1 and CB2 receptors, which are currently being studied for its possible therapeutic effects for the symptomatic treatment of Parkinson’s Disease.@*METHODOLOGY@#Databases searched were PubMed via National Center for biotechnology Information, CINAHL, Medline, Academic Search, Biomedical Reference collection, via EBSCOhost, and Cochrane Library. Queries were sent to local institutions for unpublished studies compatible with the criteria for study eligibility. Participants’ characteristics, study design, intervention features, outcome variables, reported effects, and study quality were retrieved. Random effects model was used because heterogeneity was significant.@*RESULTS@#The analysis of the four clinical trials included in the study showed that Cannabis and its derivatives’ effects on the mean motor UPDRS showed statistically significant decrease.@*CONCLUSION@#Cannabis and its derivatives may have an effect in the short-term symptomatic treatment of Parkinson’s Disease, although controlled studies with larger samples must be done before any conclusions may be made.

Uterine Isthmic Atresia: Hope for a rare mullerian anomaly

@#The true incidence and prevalence of congenital Mullerian duct anomalies are difficult to determine. Some patients may present as adolescents with apparent primary amenorrhea, cyclical abdominal pain and sexual difficulties. It is important to ascertain a correct diagnosis for timely and appropriate interventions necessary to prevent sequelae that often affect the future fertility of these patients. This is a case of a fifteen year old with severe cyclical pelvic pain and hematuria with amenorrhea. Work up included a transrectal ultrasound and a magnetic resonance imaging of the pelvis revealing presence of a uterine corpus and cervix but absence of uterine isthmus. A conservative surgical approach was planned. The patient underwent end-to-end anastomosis of the cervix and uterine corpus. At present, the patient is regularly menstruating with no pelvic pain.

Transcervical resection of prolapsed giant endometrial polyp with endometrioid adenocarcinoma in a patient with risk factors for malignancy

A premenopausal woman witj multiple risk factors for endometrial cancer, diagnosed with giant endometrial polyp with benign features on preoperative biopsy is presented. On hysteroscopy, intraoperative frozen section revealed a benign polyp, but was malignant on final histopathology. Definitive surgery yielded simple hyperplasia and endometrial polyp. Giant endometrial polyp grows to 9-12cm diameter. Complications in hysterosocopic removal of giant polyps are higher risk of perforation, more blood loss, hyponatremia, pulmonary edema, and hyperglycemia. All associated with dificult visualization and prolonged surgery. Frozen section of endometrial mass may help in instituting appropriate treatment. Local studies show high accuracy, although some reports were conflicting. In case of malignancy, maintenace of intrauterine pressure distention to less than 70mm Hg prevents dissemination of cancer cells. The hyperestogenic state seen in obesity with uncontrolled hypertension, diabetes, nulliparity and vaginal bleeding were associated in developing endometrial cancer arising from endometrial polyp resected by hysteroscopy.

Estética em prótese dentária / Esthetics in prosthetic dentistry

A harmonia facial é vitalmente influenciada pela aparência bucal, sendo que a restauração das estruturas orais perdidas deve estar direcionada à beleza natural. As funções da dinâmica da estética natural devem ser utilizadas para a criação dos parâmetros estéticos naturais. Uma prótese estética deve manter os traços faciais típicos, o perfil, a forma e suporte dos lábios e a harmonia ao sorrir, o que resulta numa fisionomia do paciente rotulada como agradável. O sorriso é uma das mais belas e importantes expressões faciais, sendo, por isso, essencial nas expressões de felicidade, humor, amizade, concordância e apreciação. Seja qual for a emoção, o sorriso tem uma função importante para a sociedade e, por uma série de razões que envolvem à Psicologia, faz com que tanto o doador quanto o receptor do sorriso tenham sensações positivas. Nesse contexto, a reabilitação bucal realizada pelo Cirurgião-Dentista, com maior ou menor amplitude, é de extrema importância na obtenção desses resultados. Assim, o objetivo deste trabalho é de proporcionar ao clínico considerações sobre a estética dental, aliada à fisiologia do sorriso

Facial harmony is vitally influenced by oral appearance, the restoration of lost oral structures, should be directed to a natural beauty. The functions of the dynamics of natural aesthetics should be used for the creation of the natural aesthetic prosthesis parameters. An esthetic must keep the typical facial features, profile, shape and support of the lips and harmony in smiling, resulting in a patient's face labeled as enjoyable. The smile is one of the most beautiful and important facial expressions, and is therefore essential in expressions of happiness, humor, friendship, agreement and appreciation. Whatever the emotion, the smile has an important function for society and for a variety of reasons involving psychology and it makes both the giver and receiver of the smile have positive feelings. In this context, oral rehabilitation conducted by the dentist, has an extreme importance in obtaining these results The objective of this work is to provide clinical considerations on dental aesthetics combined with physiology smile

Eficacia de leuprolide 11, 25 mg para supresión de testosterona en pacientes con cáncer prostático / Leuprolide s efficacy 11, 25 mg for suppression of testosterone in patients with prostatic cancer

Introducción: Los agonistas LHRH son de elección en bloqueo androgénico por cáncer prostático. En base a pacientes castrados se considera un bloqueo adecuado una testosterona total plasmática < 50 ng/dl. Se ha sugerido controlar la testosterona total por la posibilidad de no lograr una supresión adecuada. Material y método: Entre junio de 2008 a marzo de 2009 se midió el nivel de testosterona total al tercer mes de administrada una dosis de leuprolide 11,25 mg IM. Los exámenes se realizaron en la mañana y en el mismo laboratorio. En un grupo de pacientes se estimó peso, talla e índice de masa corporal (IMC) y se evaluó su asociación con los niveles de testosterona alcanzados. Resultados: Se evaluaron 81 pacientes, la edad promedio fue 76,4 años. La testosterona total plasmática promedio fue 33,9 ng/dl. En 12/81 pacientes (14,8 por ciento) el nivel de testosterona fue menos 50 ng/dl. No se observó asociación entre la duración de hormonoterapia y los niveles de testosterona. En 40 pacientes se estimó peso, talla e IMC sin encontrarse asociación de estas variables con el nivel de testosterona. En los pacientes en que se aumentó la dosis a leuprolide 22,5 mg se obtuvo una adecuada supresión de testosterona. Conclusión: En los pacientes en tratamiento con agonistas LHRH se debe medir el nivel de testosterona plasmática dada la posibilidad de un bloqueo inadecuado. En pacientes en tratamiento con leuprolide 11,25 mg y testosterona menos 50 ng/dl el aumento de la dosis a 22,5 mg lograría un nivel de testosterona en rangos de castración quirúrgica.

Introduction: The agonistas are LHRH of election in blockage androgenic for prostatic cancer. On the basis of castrated patients considers an adequate blockage a total plasmatic testosterone < 50 ng/dl. The total testosterone for the possibility to not to achieve an adequate suppression has been suggested to control. Material and method: Between June 2008 to March 2009 leuprolide’s dose measured the level of total testosterone itself to person under administration’s third month 11.25 mg IM. The exams had done in the morning and at the same laboratory. Weight, size and index of muscle mass (IMC) were estimated in patients’ group and his association with the levels of testosterone caught up with was evaluated. Results: We evaluated 81 patients, the mean age was 76.4 years. The total testosterone the average plasmatic was 33.9 ng/dl. In 12/81 patient (14.8 percent) the level of testosterone was > 50 ng/dl. we did not observe association between hormonoterapia’s duration and the levels of testosterone. Weight, size and IMC without finding association of these variables with the level of testosterone were estimated in 40 patients. We got an adequate suppression from testosterone in the patients that 22.5 mg increased itself the dose in to leuprolide. Conclusion: LHRH must try on in the patients in treatment with agonistic the level of plasmatic testosterone once the possibility of an inadequate blockage was given. In patients in treatment with leuprolide 11.25 mg and testosterone > 50 ng/dl the increase of the dose to 22.5 mg would achieve a level of testosterone in ranges of surgical castration.

Validation of the Filipino translation of the fertility problem inventory as a measure of infertility problem inventory as a measure of infertility related stress among female infertile patients at a tertiary hospital

Objective: To validate the Filipino Translation of the Fertility Problem Inventory as a measure of infertility-related stress among female infertile patients. Design: Cross-sectional study Setting: Tertiary referral center Study Population: Female infertility patients aged 21-40 years, with at least one year of attempting to achieve pregnancy. Outcome Measures: Patients' infertility-related stress was assessed by written questionnaire using the Filipino translation of the Fertility Problem Inventory. Results: Global stress scores were identical across all ages and educational level attained. increasing number of years trying to conceive has no impact on the global stress scores. Conclusion: The Filipino translation of the Fertility Problem Inventory provides a valid measure of infertility-related stress.

Bancos de sangue de cordão umbilical e placentário para uso familiar, de caráter privado, no Brasil: subsídios técnicos, legais e éticos para uma análise de implementação: [errata] / Private umbilical cord blood banks for family use, in Brazil: technical, legal and ethical issues for an implementation analysis: [errata]

Os bancos de sangue de cordão umbilical e placentário foram criados a partir da comprovação de que o sangue de cordão umbilical e placentário (SCUP) é uma fonte rica em células progenitoras hematopoéticas (CPH) e alternativa às células provenientes da medula óssea para transplante, fato que gerou o interesse pelo armazenamento das células nele contidas. A legislação brasileira distingue bancos para uso alogênico não aparentado (públicos) e para uso exclusivamente autólogo (privados). Por sua vez, o armazenamento de SCUP para uso familiar (doação dirigida) pode ser realizado em bancos de sangue de cordão umbilical e placentário públicos, serviços de hemoterapia ou centros de transplante, quando há um membro da família do nascituro com doença diagnosticada e que necessite de transplante de CPH como tratamento. Apesar de a legislação ser clara, a Anvisa tem identificado o interesse sobre a possibilidade da liberação de unidades de SCUP, armazenadas em bancos autólogos, para a utilização de outrem, familiar, além do recém-nascido beneficiário. O objetivo do trabalho visa promover a reflexão sobre uma possível modificação dos parâmetros legais nacionais que regem os bancos de SCUP autólogo, tornando-os bancos com vistas ao uso familiar, por meio da exposição dos principais elementos relacionados ao tema. O estudo analisou os critérios técnico-sanitários legais para regulamentação dos bancos; descreveu as características das CPH de diversas fontes e tipos de doação para transplante; contextualizou a relação com os princípios da Bioética; avanços sobre terapia e pesquisas relativas às CPH; e discutiu possíveis riscos envolvidos no processo

Bancos de sangue de cordão umbilical e placentário para uso familiar, de caráter privado, no Brasil: subsídios técnicos, legais e éticos para uma análise de implementação / Private umbilical cord blood banks for family use, in Brazil: technical, legal and ethical issues for an implementation analysis

Os bancos de sangue de cordão umbilical e placentário foram criados a partir da comprovação de que o sangue de cordão umbilical e placentário (SCUP) é uma fonte rica em células progenitoras hematopoéticas (CPH) e alternativa às células provenientes da medula óssea para transplante, fato que gerou o interesse pelo armazenamento das células nele contidas. A legislação brasileira distingue bancos para uso alogênico não aparentado (públicos) e para uso exclusivamente autólogo (privados). Por sua vez, o armazenamento de SCUP para uso familiar (doação dirigida) pode ser realizado em bancos de sangue de cordão umbilical e placentário públicos, serviços de hemoterapia ou centros de transplante, quando há um membro da família do nascituro com doença diagnosticada e que necessite de transplante de CPH como tratamento. Apesar de a legislação ser clara, a Anvisa tem identificado o interesse sobre a possibilidade da liberação de unidades de SCUP, armazenadas em bancos autólogos, para a utilização de outrem, familiar, além do recém-nascido beneficiário. O objetivo do trabalho visa promover a reflexão sobre uma possível modificação dos parâmetros legais nacionais que regem os bancos de SCUP autólogo, tornando-os bancos com vistas ao uso familiar, por meio da exposição dos principais elementos relacionados ao tema. O estudo analisou os critérios técnico-sanitários legais para regulamentação dos bancos; descreveu as características das CPH de diversas fontes e tipos de doação para transplante; contextualizou a relação com os princípios da Bioética; avanços sobre terapia e pesquisas relativas às CPH; e discutiu possíveis riscos envolvidos no processo.

Umbilical cord blood banks have been created worldwide after the discovery that umbilical cord blood (UCB) is a rich source of Hematopoietic Stem Cells (HSC) and an alternative to HSC from bone marrow for allogeneic transplantation. According to Brazilian legislation, banks for allogeneic use (government services) and exclusively autologous use (private services) can be created in the country. The storage of UCB units for direct donation (family use) can occur in public cord blood banks, hemotherapy services and transplant centers when there is a specific need to treat a known patient that is a member of the newborn's family. Even with the legislation being quite clear about the creation of cord blood banks and distribution of UCB units, ANVISA has identified an interest, demonstrated by the population and regulated sector, in the possibility of releasing UCB units, stored in autologous cord blood banks, with the purpose of clinical applicability to another family member other than the newborn owner of the cells. The objective of this study is to promote a discussion on a possible alteration in the legal parameters that support the implementation of autologous cord blood banks, towards the constitution of private banks for family use, pointing out the main issues. The study analyzed the technical and legal criteria related to cord blood banks, described the characteristics of HSC from different sources and types of transplant donations and procedures; discussed concerns related to Bioethical principles, current and potential clinical HSC applications, and possibly risks and benefits.

Reporte de un caso de tumor desmoplásico de células pequeñas redondas / Case report: patient with round cell desmoplastic tumor

Introducción: El tumor de células pequeñas redondas desmoplásico (TCPRD), es una neoplasia agresiva maligna poco frecuente que afecta a adolescentes y adultos jóvenes. Usualmente son intraabdominales asociados con un mal pronóstico. Existen algunas publicaciones donde incluyen manifestaciones paratesticulares. Caso: Reportamos un caso de un joven de 29 años que consulta por aumento de volumen del hemiescroto izquierdo de 3 meses de evolución. Al examen destacaba 2 nódulos duros uno en relación al polo inferior y el otro al epidídimo de aproximadamente 2 cm. Alfafetoproteína y beta HCG eran normales. Se decide exploración quirúrgica donde biopsia rápida confirma tumor que se origina en las envolturas y que infiltra hacia el testículo. La biopsia definitiva informó tumor desmoplásico de células pequeñas redondas. El estudio de extensión con tomografía axial computarizada y radiografía de tórax no mostró metástasis. El paciente recibió 2 ciclos de QMT con ciclofosfamida, etoposido, adriamicina y cisplatino, con buena tolerancia, evolucionando con depresión medular moderada que se recupera. Actualmente 6 años después del diagnóstico el paciente se encuentra en remisión completa. Discusión: Al parecer y según los últimos reportes de la literatura, la ubicación paratesticular ha mostrado mejor pronóstico en comparación con los tumores abdominales. Se debe incluir este diagnóstico diferencial al enfrentarse con tumores paratesticulares.

Introduction: Small round cell desmoplastic tumor (SRCDT) is an infrequent malignant tumor that affects adolescents and young adults. Usually they occur in the abdomen. Paratesticular manifestations have been reported. Case report: A 29 year old male presented with a 3 month history of a mass in the left scrotum. Physical exam showed 2 hard nodules in the scrotum. Serum levels of alpha-fetoprotein and beta-HCG were normal. The patient was submitted to surgery. Frozen section confirmed a tumor arising in the paratesticular area with involvement of the testis. Permanent sections showed a SRCDT. CT scans and chest x-rays showed no metastases. The patient received two courses of ciclophosphamide, etoposide, adryamicin and cisplatinum. Treatment was well tolerated. The patient is in complete remission at 6 years following the diagnosis. Discussion: Paratesticular location seems to have a better prognosis compared to intraabdominal tumors. SRCDT should be included in the differential diagnosis of paratesticular tumors.

Contralateral-unilateral reproductive tract syndrome: a case of a unicornuate uterus with ipsilateral ovarian and fallopian tube agenesis

A 22 year old nulligravid presented with progressively increasing dysmenorrhea. Transvaginal ultrasound showed a unicornuate uterus with a functioning left rudimentary horn which was confirmed on exploratory laparotomy. The patient was also found to have a missing right fallopian tube and ovary. Excision of the left rudimentary horn was done. The surgery resulted in the patient with a remaining hemiuterus on one side and a separate fallopian tube with the ovary on the other. A very limited number of case reports are available in the literature to describe concomitant occurrence of gonadal and uterine developmental abnormalities. Rarer still is the occurrence of a unilateral fallopian tube and ovary contralateral to a unicornuate uterus. Its possible pathogenesis and implications on the patient's reproductive outlook are discussed.

Swyer syndrome: discordance in genotype and phenotype

Swyer syndrome is a medical condition that begins with a mutation in the SRY gene that favors the development of female reproductive organs despite the presence of Y chromosome. The aberrancy in testicular differentiation will lead to abnormal testosterone production and impaired Mullerian Inhibiting Substance secretion resulting in the formation of Mullerian derived structures and regression of Wolffian ducts. Since an XY karyotype is incompatible with follicle formation, the gonads will degenerate and become streak fibrous tissue. Patients are phenotypically female at birth with a uterus, fallopian tubes and bilateral steak gonads. Management involves puberty induction and bone loss prevention through combined hormonal replacement therapy. Bilateral gonadectomy should be performed soon after the diagnosis because of the risk of malignancy. Infertile, childbearing is only through assisted reproductive technology and oocyte donation.

Expresión de marcadores tumorales P16, ciclina D1, BCL2 y Ki67 en cáncer de pene / Expression of tumor markers P16, ciclin D1, BCL2 and Ki67 in penile cancer

El cáncer de pene es una enfermedad de baja incidencia. Su tratamiento se basa en la cirugía y no está establecido si el control tumoral local debe o no ser complementado con linfadenectomía inguinal y pélvica. La linfadenectomía en el cáncer de pene se asocia a elevadas tasas de complicaciones y no está establecido a qué pacientes se les debe realizar. Éste trabajo retrospectivo analiza la expresión de marcadores tumorales en cáncer de pene y su correlación con otros factores pronósticos. La expresión del marcador Ciclina D1 fue alta en todas las muestras, la de Ki-67 y P16 fue alta en los tumores de alto grado y la de BCL-2 fue negativa en todos los casos.

Penile carcinoma is a low incidence disease. Treatment is based in surgery and controversy persists regarding the need of inguinal and pelvic lymphadenectomy. To date, no specific inclusion criteria have been established to indicate surgery. This retrospective work analyses the expression of tumoral markers in penile cancer and correlation with other prognostic factors. The expression of the Cicline D1 marker was high in all the samples, Ki-67, P16 was high in high grade tumors and BCL-2 was negative in all cases.

Asherman's syndrome and tuberculosis: what are the reproductive options?

Infertility may be caused by a number of diverse reasons. The diagnostic and therapeutic modalities in the management of this have advanced tremendously in the last three decades with the birth of the first "test tube" baby, Louise Brown in 1978. The underlying problem in infertility may be any of the following: semen quality; ovulation; passage of the sperm to the fallopian tubes; fertilization; or the transport of the embryo to the uterine cavity. All this can now be addressed by doing in-vitro fertilization and embryo transfer (IVF-ET). However, the solution to the problem of implantation remains elusive. The dilemma is even worse, if there is no endometrium to implant on. Presented here is one such case where a disease in childhood was likely to have made a lasting impact on the future of her reproductive potential. The diagnosis, fertility prognostication and reproductive options in these cases are also discussed.

A second look at the embryogenesis of the mullerian duct system in the background of purulent vaginal discharge in wunderlichhherlyn-werner syndrome

Wunderlich-Herlyn-Werner syndrome is an uncommon but already well-established mullerian anomaly consisting of uterine didelphys, hemivaginal septum and ipsilateral renal agenesis. The discussion here would concentrate on the occurrence of foul-smelling vaginal discharge in some of these cases, its pathogenesis and its impact on generally-accepted assumptions on the embryogenesis of the mullerian system. Reported here are three such cases with discussions on the goals of therapy being relief of the obstructive symptoms, restoration of normal menstrual egress and sexual function, with preservation of reproductive potential.

Leiomyomas arising from the uterine remnants of a woman with mayer rokitansky kuster hauser syndrome - a case report

The Mayer Rokitansky Kuster Hauser Syndrome (MRKHS) is characterized by congenital absence of the uterus and the middle to upper thirds of the vagina. Women with this syndrome are genotypically female presenting with primary amenorrhea, female secondary sexual characteristics, normal ovarian function, absent or short blind vagina and the presence of uterine remnants or rudimentary uteri. The occurrence of leiomyoma in a patient with MRKHS arising from the fibromuscular tissues of uterine remnants is very rare. As the mullerian ducts have smooth muscles, the presence of a myoma is a possibility. This paper aims to explain the pathogenesis of leiomyoma arising from the uterine remnants in patients with MRKHS and to present a comprehensive review on the clinical presentation, diagnostic evaluation, and management of this condition. There is paucity of documented cases of leiomyoma associated with MRKHS reported in literature. This is a the first case reported locally.

A rare case primary amenorrhea in a patient with Turner Syndrome with concomitant Mayer-Rokitansky-Kuster-Hauser Syndrome

The possible etiologies for primary amenorrhea are classified into four groups based on the presence or absence of the uterus and the development of the breasts. Based on this, gonadalc dysgenesis and mullerian agenesis in a patient with no Y chromosome are two separate causes of primary amenorrhea. These two conditons seen together is a very uncommon occurence. Presented here is such a case where the diagnosis Turner Syndrome and the Mayer-Rokitansky-Kuster-Hauser Syndrome coexist in apatient with a 45, X [6]/46, X, i(X) (q10)[9] karyotype.

La Medicina Nuclear más allá de la imágenes / The Nuclear Medicine beyond the images

La Medicina Nuclear clínica se apoya tradicionalmente en tres grandes pilares básicos, estos son las imágenes, la terapia con radionucleidos y las técnicas "in vitro". En los últimos años, tanto con el desarrollo de las imágenes moleculares como con el surgimiento de nuevas aplicaciones terapéuticas con radionucleidos, se nos abren insospechadas oportunidades para que nuestra especialidad ocupe un valioso sitial en las nuevas aplicaciones oncológicas. En este artículo se revisa nuestra experiencia en dos novedosas áreas en las cuales hemos tenido la oportunidad de desarrollarlas en nuestro centro. Estas son la terapia con 90Y-DOTATOC en tumores con sobre-expresión de receptores de somatostatina[1] (carcinoides, neuroendocrinos y otros) y el uso de 90Y-Ibritumomab-Tiuxetan en Linfomas No Hodgkin de células B con presencia de antígeno CD20+[2].

Precisão de montagem em articulador de modelos com cobertura acrílica (Accutrac) usando diferentes tipos de gesso / Precision of mounting in articulador of models winth a acrylic cover (such as accutrac) using different types of gypsum

O objetivo desta pesquisa foi investigar a alteração da posição do modelo superior quando fixado ao articulador por meio de três tipos de gessos. Um modelo com base de resina acrílica foi elaborado com a finalidade de simular os sistemas de troquel como o AccuTrac(Whaledent, USA), que apresentam uma base plástica sobre o modelo de gesso, impedindo o contato do mesmo com o material de fixação. O modelo foi fixado ao articulador usando três tipos de gesso, Grupo 1 (gesso comum-Ultra-cal herodent, Vigodent),Grupo 2 (gesso pedra-Herodent Soli-Rock,Vigodent)e Grupo 3 (gesso pedra especial-Vel-Mix, Kerr). Dez montagens foram feitas com cada tipo de gesso. O movimento do modelo decorrente da alteração dimencional do gesso de montagem foi registrado com o uso de quatro relógios comparadores de precisão micrométrica (Mitutoyo Corporation, Japão), sendo três precionados sobre o ramo superior do articulador e um sob o modelo. Os resultados submetidos à análise de variância, complementada pelo teste de Tukey em nível de 5 por cento, mostraram que todos os Grupos apresentaram diferenças estatisticamente significantes entre si. O Grupo 4 foi o único que apresentou uma contratação média predominante (3mm + ou - 3,7). Os Grupos 2 e 3 apresentaram uma expansão média predominante , porém o grupo 3 (124mm + ou - 9,5) indicou uma expansão significativamente maior do que a do Grupo 2 (55mm + ou -3,2). Os resultados permitiram concluir que a menor alteração de posição do modelo ocorreu quando o gesso especial foi usado (Grupo 4)