ABSTRACT
Case Report: A 44-year-old patient attended the gynecology service for routine consultation. The patient reported implantation of a levonorgestrel-releasing intrauterine system (LNG-IUS), five years ago. No macroscopic changes were seen in the uterus or in the endometrium cavity during the procedure, but an endometrial biopsy was performed. Histopathological analysis revealed an endometrium with an expanded stroma by pseudo-decidualization and mucoid (mucinous) alterations, forming small puddles of mucin, also presenting with polypoid indentations, ectatic vessels, lymphoid cell foci, including plasma cells and deposits of calcium salts. Conclusion: As the use of this type of contraceptive method becomes more usual, knowledge of LNG-IUS-induced changes becomes increasingly relevant for the assessment of its long-term efficacy and safety.
Relato de Caso: Paciente de 44 anos compareceu ao serviço de ginecologia para consulta de rotina. Relatou implante de dispositivo intrauterino com liberação de levonorgestrel (DIU-LNG) há cinco anos. Durante o exame físico, o fio do dispositivo não foi visualizado. À histeroscopia, para remoção do dispositivo, não foram evidenciadas alterações na cavidade endometrial. Material foi, então, colhido para biópsia. O estudo histopatológico evidenciou um endométrio com estroma expandido por pseudodecidualização e alterações mucoides, formando pequenos aglomerados de mucina, também se apresentando com endentações polipoides, vasos ectásicos, focos de células linfoides e depósitos de sais de cálcio. A presença de DIU-LNG na cavidade uterina causa uma série de alterações histopatológicas e funcionais no endométrio, as quais não são relacionadas, exclusivamente, ao efeito contraceptivo do dispositivo. Conclusão: Com o aumento da utilização desse método anticoncepcional, o conhecimento das alterações provocadas pelo seu uso se torna cada vez mais relevante para avaliação de sua eficácia e segurança em longo prazo.
Subject(s)
Endometrium , LevonorgestrelABSTRACT
Abstract Objective: Composite graft of left internal thoracic artery and great saphenous vein in revascularization of the left coronary system is a technique well described in literature. The aim of this study is to analyze blood flow dynamics in this configuration of composite graft especially in what concerns left internal thoracic artery's adaptability and influence of great saphenous vein segment on left internal thoracic artery's flow. Methods: Revascularization of left coronary system with composite graft, with left internal thoracic artery revascularizing the anterior interventricular artery and a great saphenous vein segment, anastomosed to the left internal thoracic artery, revascularizing another branch of the left coronary system, was performed in 23 patients. Blood flow was evaluated by transit time flowmetry in all segments of the composite graft (left internal thoracic artery proximal segment, left internal thoracic artery distal segment and great saphenous vein segment). Measures were performed in baseline condition and after dobutamine-induced stress, without and with non-traumatic temporary clamping of the distal segments of the composite graft. Results: Pharmacological stress resulted in increase of blood flow values in the analyzed segments (P<0.05). Non-traumatic temporary clamping of great saphenous vein segment did not result in statistically significant changes in the flow of left internal thoracic artery distal segment, both in baseline condition and under pharmacological stress. Similarly, non-traumatic temporary clamping of left internal thoracic artery distal segment did not result in statistically significant changes in great saphenous vein segment flow. Conclusion: Composite grafts with left internal thoracic artery and great saphenous vein for revascularization of left coronary system, resulted in blood flow dynamics with physiological adaptability, both at rest and after pharmacological stress, according to demand. Presence of great saphenous vein segment did not alter physiological blood flow dynamics in distal segment of left internal thoracic artery.