An Ayurvedic Approach in Infertility w.s.r to Tubal Blockage-A Case Report

Vandhyatva (infertility) is failure to conceive or give birth or experiencing Garbha Strava or Garbha pata (repeated abortion). Disturbed lifestyle, usage of contraceptives, stress, genetic problems, alcohol consumption and smoking addiction increases such cases day by day. Nowadays fallopian tube blockage has become one of the burning issues of female infertility. According to Ayurveda, successful conception depends upon Ritu, Kshetra, Ambu and Beeja. Beejagrahana is unable due to tubal blockage (Sanga Srotodusti of Arthavavaha) leads to failure of conception. Panchakarma plays an important role in treating female infertility and Uttara Basti is one of the best (Panchkarma therapy for the infertility treatment in Ayurveda). It detoxifies the uterine cavity and fallopian tubes, which clear the Srothoavarodha. Uttarbasti along with internal medication helps in Vata Dosha saman and remove the Sanga srotodusti. A diagnosed case of infertility due to bilateral tubal blockage, visited our clinic for treatment of tubal blockage and consequent infertility. Here is the case presentation of successful treatment with Ayurveda medicines and Uttara basti.

Case of Left Inguinal Hernia with an Unknown Syndrome

Ovaries and Fallopian Tubes are rarely found as content of indirect Inguinal Hernia even though Inguinal Hernia is a common entity encountered in surgeons daily practice. We report a case of 13 year old female presented with Left Indirect Irreducible Inguinal Hernia with Fallopian Tube and Ovary as a content along with some rare findings of unilateral renal agenesis along with C7 Bifida vertebrae

Ooforosalpingitis xantogranulomatosa. Comunicación de caso

La inflamación xantogranulomatosa del tracto genital femenino es infrecuente y es aún más rara en las trompas de Falopio y ovarios. Se presenta un caso de ooforosalpingitis xantogranulomatosa en una paciente femenina de 45 años quien asistió a consulta por presentar dolor en fosa iliaca izquierda acompañado de fiebre. La exploración bimanual mostró útero ligeramente aumentado de tamaño con masa anexial izquierda firme, no dolorosa, adherida al útero y con limitada movilidad. La evaluación ecográfica transvaginal determinó tumoración ovárica izquierda, heterogénea con paredes gruesas e irregulares con múltiples septos y ecos internos sin visualizar el ovario. Durante la cirugía, se encontraron adherencias densas desde la masa hacia la pared lateral pélvica, fosa ovárica y asas intestinales. El útero estaba desplazado por tumoración anexial quística izquierda, de color blanco grisáceo y paredes gruesas que drenaba líquido purulento fétido. El diagnóstico definitivo fue ooforosalpingitis xantogranulomatosa. Esta condición es un proceso inflamatorio poco frecuente que plantea dilemas diagnósticos. Sus manifestaciones clínicas y características de estudios por imágenes pueden simular una neoplasia pélvica maligna, por lo que es necesario un alto índice de sospecha para su diagnóstico, como diagnóstico diferencial en pacientes con tumoraciones ováricas quísticas complejas. El examen histopatológico es el estándar de oro para el diagnóstico.

Xanthogranulomatous inflammation of the female genital tract is infrequent and is even rarer in fallopian tubes and ovaries. We present a case of xanthogranulomatous oophorosalpingitis in a 45-year-old female patient who consulted for left iliac fossa pain accompanied by fever. Bimanual examination revealed a slightly enlarged uterus with a firm, non-painful left adnexal mass, adherent to the uterus and with limited mobility. Transvaginal ultrasound evaluation showed a heterogeneous left ovarian tumor with thick and irregular walls, multiple septa and internal echoes without visualization of the ovary. During surgery, dense adhesions were found from the mass to the pelvic lateral wall, ovarian fossa, and bowel loops. The uterus was displaced by a thick-walled, grayish-white, cystic left adnexal tumor draining foul-smelling purulent fluid. The definitive diagnosis was xanthogranulomatous oophorosalpingitis. This condition is a rare inflammatory process that poses diagnostic dilemmas. Its clinical manifestations and imaging features may mimic a malignant pelvic neoplasm, so a high index of suspicion is necessary for its diagnosis, as a differential diagnosis in patients with complex cystic ovarian tumors. Histopathological examination is the gold standard for diagnosis.

Hernia inguinal tubo-ovárica izquierda estrangulada

La hernia inguinal indirecta (HHI) es la anomalía congénita más frecuente en la infancia y niñez. En las niñas, las HII deslizantes contienen principalmente el ovario con o sin trompa de Falopio. Presentamos el caso de una niña de 6 meses, que acude por tumoración inguinal izquierda, irreductible, asociada a vómitos. Es intervenida de emergencia con diagnóstico de hernia inguinal indirecta izquierda complicada, conteniendo trompa de Falopio y ovario izquierdo gangrenados. Este tipo de hernia tiene una incidencia más alta en prematuros y de sexo femenino menores de un año. La ecografía preoperatoria puede ser útil para el diagnóstico. El procedimiento para la reparación es la herniorrafia clásica con ligadura alta del saco herniario, a través de un abordaje inguinal.

Indirect inguinal hernia (IHH) is the most frequent congenital anomaly in infancy and childhood. In girls, the sliding IIHs contain mainly the ovary with or without a fallopian tube. We present the case of a 6-month-old girl who was presented with an irreducible left inguinal tumor associated with vomiting. She was operated of emergency with a diagnosis of complicated left indirect inguinal hernia containing gangrenous fallopian tube and left ovary. This type of hernia has a higher incidence in prematures and females under one year of age. Preoperative ultrasound may be helpful for diagnosis. The repair procedure is the classic herniorrhaphy with high ligation of the hernia sac, through an inguinal approach.

Prevalence of precursor lesions (P53 signature, SCOUT, STIL, STIC) in fallopian tubes resected for non-neoplastic causes

Background: High-grade pelvic serous carcinoma is a common cause of death in women worldwide and India. Recent evidence has clearly implicated the changes in the mucosa of the fimbrial end of the fallopian tube in its pathogenesis. Objective: 1) To study histopathology features of surgically resected specimens of fallopian tubes received with non-neoplastic lesions of the uterus and ovary for the presence of any precursor lesions [secretory cell outgrowth (SCOUT), serous tubal intraepithelial lesion (STIL), p53 signatures, and serous tubal intraepithelial carcinoma (STIC)]. 2) To confirm the findings with immunohistochemistry. 3) To correlate the prevalence of precursor lesions with clinical parameters and benign lesions of the uterus and ovaries. Materials and Methods: Assessment of histopathological changes in 100 specimens of distal fallopian tubes was done using the sectioning and extensive examination of the fimbrial end (SEE-FIM) protocol. H and E stain followed by immunohistochemistry for Bcl-2, p53, and Ki-67. The statistical significance of the difference in the mean values of precursor areas was evaluated by an unpaired t-test. Results: Among 100 specimens taken on H and E, precursor lesions were suspected in 49% of the cases. SCOUT, suspicious for STIC, suspicious for STIC with areas of SCOUT, and unequivocal for STIC with areas of SCOUT were seen in 8%, 4%, 33%, and 4% of the cases, respectively. However, on IHC, SCOUTS were confirmed in 45% of the cases, p53 signature in 2%, STIL in 9%, and STIC in 4% of the cases. Conclusion: Sectioning and extensive examination of the fimbrial end (SEE-FIM) should be routinely done as it provides the opportunity to detect the early malignant changes. It may help in evolving the strategies for early detection, management, and reducing mortality.

Alteraciones genitales en la infección por leptospiras en ratas Wistar gestadas / Genital alterations in leptospiras infection in pregnant Wistar rats

RESUMEN Introducción: la leptospirosis en Cuba se presenta de forma endémica, y a veces de forma epidémica, por lo que es un problema de salud. Su efecto sobre los genitales internos, en gestantes, ha sido poco tratado por los investigadores. Objetivo: describir las principales alteraciones en los genitales internos de ratas Wistar gestadas infestadas por leptospiras. Métodos: se realizó un estudio experimental en ratas Wistar preñadas: siete grupos con tres animales cada uno: un control negativo y seis casos con dosis de una concentración bacteriana de 300 millones de Leptospiras por mL; se inocularon dos mililitros a cada animal al cuarto día de gestadas por 17 meses. Se tomaron los genitales internos de todas las ratas el día 20 de la gestación, estos fueron procesados en parafina y teñidos con hematoxilina/eosina. Resultados: se observaron alteraciones en útero, ovarios y trompas; el mayor número de lesiones se presentaron en útero mientras que en ovarios y trompas se visualizaron la misma cantidad de lesiones. Conclusiones: la leptospirosis infectó los genitales internos con la producción de quistes, necrosis, abscesos, ooforitis y microhemorragias en ovarios; congestión vascular y hemorragias en las trompas uterinas y endometritis, hemorragias, miometritis, piometristis, perimetritis y congestión vascular en el útero. Predominaron las alteraciones congestivas y hemorrágicas.

ABSTRACT Introduction: leptospirosis in Cuba occurs endemically, and sometimes epidemically, making it a health problem. Its effect on internal genitalia in pregnant women has been little treated by researchers. Objective: to describe the main alterations in the internal genitalia of pregnant Wistar rats infested by leptospiras. Methods: an experimental study was carried out in pregnant Wistar rats: 7 groups with three animals each: 1 negative control and 6 cases with doses of a bacterial concentration of 300 million Leptospira per mL; each animal was inoculated with two milliliters on the fourth day of pregnancy for 17 months. The internal genitalia of all rats were taken on day 20 of gestation, processed in kerosene and stained with hematoxylin/eosin. Results: alterations were observed in the uterus, ovaries and tubes; the greatest number of lesions was present in the uterus while the same number of lesions was visualized in the ovaries and tubes. Conclusions: leptospirosis infected the internal genitalia producing cysts, necrosis, abscesses, oophoritis and microhemorrhages in the ovaries; vascular congestion and hemorrhages in the uterine tubes and endometritis, hemorrhages, myometritis, pyometristis, perimetritis and vascular congestion in the uterus. Congestive and hemorrhagic alterations predominated.

Proportional vascularization along the fallopian tubes and ovarian fimbria: assessment by confocal microtomography / Proporção vascular ao longo das tubas uterinas e fímbria ovariana: avaliação pela microtomografia confocal

Abstract Objective: To evaluate and reconstruct three-dimensional images of vascularization along the fallopian tube (FT), as well as to determine its relationship with the ovary and ovarian fimbria, and to quantify the blood vessels along the FT according to its anatomical segments, using confocal microtomography (micro-CT). Materials and Methods: Nine specimens (six FTs and three FTs with ovaries) were fixed in a solution of 10% formalin for > 24 h at room temperature. Iodine staining was performed by soaking the specimens in 10% Lugol's solution for 24 h. All specimens were evaluated using micro-CT. A morphometric analysis was performed on the reconstructed images to quantify the vascular distribution along the FT. Results: In the FTs evaluated, the density of blood vessels was significantly greater in the fimbrial segments than in the isthmic segments (p < 0.05). The ovarian fimbria was clearly identified, demonstrating the important relationship between these vessels and the FT fimbriae. Conclusion: We believe that the vascularization in the fimbriae is greater than and disproportional that in the other segments of FT, and that the ovarian fimbria plays an important role in the development of that difference.

Resumo Objetivo: Avaliar e reconstruir imagens tridimensionais da vascularização ao longo da trompa de Falópio (TF) e sua relação com o ovário e fímbria do ovário, além de quantificar os vasos sanguíneos ao longo da TF de acordo com seus segmentos anatômicos usando microtomografia confocal (micro-TC). Materiais e Métodos: Nove espécimes (seis com TFs e três com TFs e ovários) foram fixados em solução de formol a 10% por mais de 24 h à temperatura ambiente. A coloração com iodo foi realizada usando solução de Lugol a 10% durante 24 h. Todos os espécimes foram avaliados usando micro-TC. Uma análise morfométrica foi realizada nas imagens reconstruídas para quantificar a distribuição vascular ao longo da TF. Resultados: A densidade dos vasos sanguíneos nas fímbrias foi significativamente aumentada em comparação ao segmento ístmico da TF (p < 0,05). A fímbria ovariana foi claramente identificada, demonstrando importante relação entre esses vasos e as fímbrias da TF. Conclusão: Acreditamos que as fímbrias apresentam vascularização aumentada e desproporcional em comparação com os demais segmentos da TF e que a fímbria ovariana desempenha importante papel nessa diferença.

Multi-slice CT in differential diagnosis of female periappendiceal abscess and right salpingotubo-ovarian abscess in women / 中国介入影像与治疗学

Objective: To observe the value of multi-slice spiral CT (MSCT) in differential diagnosis of female periappendiceal abscess and right tubo-ovarian abscess in women. Methods: MSCT data of 42 female patients with peri-appendicular abscess and 35 cases of right tubo-ovarian abscess confirmed by surgical pathology were retrospectively analyzed. The differences of preoperation CT imaging features were compared between the two groups. Results: The incidence rates of free pelvic fluid, the thickness of the cecal wall, fat stranding around the appendix and/or cecum, fluid accumulation around the cecum, the thickness of the appendix wall > 3 mm, the appendix diameter > 6 mm, mass in the appendix area, anteriorly movement of the broad ligament of the uterus, extraluminal gas, appendix fecal stones, peri-ovarian fat stranding, the right ovarian mass, the thickness of the sacral uterine ligament, tube-shaped lesions and the comorbidity of left tubo-ovarian abscess were significantly different (all P 0.05). Conclusion: MSCT can display characteristic features of female peri-appendicular abscess and right tubo-ovarian abscess, and facilitate the differentiation of these two diseases.

African experience of hysterosalpingography abnormalities tubes management by laparoscopy in infertile women

Background: Infertility affects about 80 million people worldwide and one in ten couples. The objective of this study was to report our experience of the contribution of laparoscopy in the diagnostic and prognostic approach of fallopian tubes pathology in infertile women in sub-Saharan Africa.Methods: We conducted a retrospective study in the Gynecology and Obstetrics unit of Yopougon Teaching Hospital over a 2-year period (January 1, 2017 to December 31, 2018) which included 49 cases of tubo-peritoneal infertility diagnosed by hysterosalpingography (HSG) then laparoscopy procedure.Results: The average age was 33 years old.  30.6 % were single. 75% had secondary infertility. 59.2% had a medical history of abortion. Pelvic Inflammatory Disease and pelvic surgery accounted 84.2% and 49 respectively. Laparoscopy showed a predominance of distal tubal damage (66.6%) whose 47% hydrosalpinx. Bilateral tubal patency was demonstrated in 77.5% of our patients during laparoscopy procedure. We observed a sensitivity, a specificity, and a concordance laparoscopy / HSG of 63.6%, 80% 63.1% respectively. Laparoscopy also allowed therapeutic procedures such as adhesiolysis or tubal plasty in 22 patients (44.89% of our cases). At the end of laparoscopy procedure, 35 patients (71.42%) were turned towards IVF.Conclusions: Laparoscopy allows an assessment of tubal abnormalities revealed by hysterosalpingography and the fertility prognostic as well as better therapeutic approach in management of tubal infertility.

Serous Adenocarcinoma of Fallopian Tubes: Histological and Immunohistochemical Aspects

BACKGROUND: Although primary cancer of the fallopian tubes is a relatively rare type of tumor in female reproductive organs, its mortality is quite high. It is important to identify molecular and biological markers of this malignancy that determine its specific phenotype. METHODS: The study was carried out on samples received from 71 female patients with primary cancer of the fallopian tubes. The main molecular and biological properties, including hormone status (estrogen receptor [ER], progesterone receptor [PR]), human epidermal growth factor receptor (HER2)/neu expression, proliferative potential (Ki-67), apoptosis (p53, Bcl-2), and pro-angiogenic (vascular endothelial growth factor) quality of serous tumors were studied in comparison with clinical and morphological characteristics. RESULTS: ER and PR expression is accompanied by low grade neoplasia, early clinical disease stage, and absence of lymphogenic metastasis (p < .001). HER2/neu expression is not typical for primary cancer of the fallopian tubes. Ki-67 expression is characterized by an inverse correlation with ER and PR (p < .05) and is associated with lymphogenic metastasis (p < .01). p53+ status correlates with high grade malignancy, tumor progression, metastasis, negative ER/PR (p < .001), and negative Bcl-2 status (p < .05). Positive Bcl-2 status is positively correlated with ER and PR expression and low grade malignancy. CONCLUSIONS: Complex morphologic (histological and immunohistochemical) study of postoperative material allows estimation of the degree of malignancy and tumor spread to enable appropriate treatment for each case.

MRI findings and clinical characteristics of adnexal torsion in pregnancy / 中国医学影像技术

Objective:To explore MRI findings and clinical characteristics of adnexal torsion (AT) in pregnancy. Methods: Clinical and MRI data of 14 patients in pregnancy with pathologically confirmed AT were retrospectively analyzed. Results: There were 2 cases of primary AT and 12 cases of secondary AT (5 with ovarian cyst, 4 with ovarian teratoma, 2 with hydrosalpinx and 1 with tubal mesothelial cyst). AT occurred on the right side in 5 cases and on the left in 9 cases, with torsion angles ranged from 180° to 1 720°. MRI showed that except for 3 cases of solitary AT, ovarian enlargement occurred in 11 cases. Mass in pelvic or abdominal cavity was found in 12 cases, including 8 cystic masses and 4 cystic solid masses. The torsional pedicle next to the masses presented typical "beak sign" in 6 cases, while 1 case showed whirlpool sign, all showed mixed high signal in DWI. Adnexal hemorrhage was noticed in 6 cases and pelvic effusion in 8 cases. The pregnancy outcome was 6 full-term healthy fetuses and 8 preterm infants. Conclusion: MRI findings of AT in pregnancy have certain characteristics, which are helpful to diagnosis of AT combined with clinical manifestations.

Female genital tuberculosis: Revisited

Female genital tuberculosis (FGTB) is caused by Mycobacterium tuberculosis (rarely Mycobacterium bovis and/or atypical mycobacteria) being usually secondary to TB of the lungs or other organs with infection reaching through haematogenous, lymphatic route or direct spread from abdominal TB. In FGTB, fallopian tubes are affected in 90 per cent women, whereas uterine endometrium is affected in 70 per cent and ovaries in about 25 per cent women. It causes menstrual dysfunction and infertility through the damage of genital organs. Some cases may be asymptomatic. Diagnosis is often made from proper history taking, meticulous clinical examination and judicious use of investigations, especially endometrial aspirate (or biopsy) and endoscopy. Treatment is through multi-drug antitubercular treatment for adequate time period (rifampicin, isoniazid, pyrazinamide, ethambutol daily for 60 days followed by rifampicin, isoniazid, ethambutol daily for 120 days). Treatment is given for 18-24 months using the second-line drugs for drug-resistant (DR) cases. With the advent of increased access to rapid diagnostics and newer drugs, the management protocol is moving towards achieving universal drug sensitivity testing and treatment with injection-free regimens containing newer drugs, especially for new and previously treated DR cases.

Bilateral salpingectomy to reduce the risk of ovarian/fallopian/peritoneal cancer in women at average risk: a position statement of the Korean Society of Obstetrics and Gynecology (KSOG)

Based on the current understanding of a preventive effect of bilateral salpingectomy on ovarian/fallopian/peritoneal cancers, the Korean Society of Obstetrics and Gynecology, Korean Society of Gynecologic Endocrinology, Korean Society of Gynecologic Oncology, Korean Society of Maternal Fetal Medicine, and Korean Society for Reproductive Medicine support the following recommendations:• Women scheduled for hysterectomy for benign gynecologic disease should be informed that bilateral salpingectomy reduces the risk of ovarian/fallopian/peritoneal cancer, and they should be counseled regarding this procedure at the time of hysterectomy.• Although salpingectomy is generally considered as a safe procedure in terms of preserving ovarian reserve, there is a lack of evidences representing its long-term outcomes. Therefore, patients should be informed about the minimal potential of this procedure for decreasing ovarian reserve.• Prophylactic salpingectomy during vaginal hysterectomy is favorable in terms of prevention of ovarian/fallopian/peritoneal cancer, although operation-related complications minimally increase with this procedure, compared to the complications associated with vaginal hysterectomy alone. Conversion to open or laparoscopic approach from vaginal approach to perform prophylactic salpingectomy is not recommended.• Women who desire permanent sterilization at the time of cesarean delivery could be counseled for prophylactic salpingectomy before surgery on an individual basis.

Torsión tubárica aislada como complicación de un quiste paraovárico en el Hospital Universitario de Santander, Colombia / Isolated Fallopian Tube Torsion as a Complication of a Paraovarian Cyst in the University Hospital of Santander, Colombia / Torção tubária isolada como uma complicação de um cisto paraovariano no Hospital Universitário de Santander, Colômbia

Introducción: El quiste paraovárico representa el 10 al 20% de las masas anexiales, genera síntomas cuando causa torsión de los anexos, pero es poco frecuente, la torsión aislada de las trompas tiene una incidencia de 1 en 1.5 millones de mujeres. Objetivo: Presentar un caso de torsión tubárica aislada como complicación de un quiste paraovárico en el Hospital Universitario de Santander. Caso clínico: Paciente femenino de 17 años, presenta dolor en hemiabdomen inferior; hallazgo ecográfico, quiste paraovárico derecho; mejora la sintomatología en 24 horas; egreso con recomendaciones; regresa dos meses después por exacerbación del dolor, masa anexial de 5 centímetros, laboratorios normales, ecografía reporta ovario aumentado de tamaño y trompa de paredes engrosadas; se realiza laparoscopia; se encuentra trompa derecha torcida con necrosis y quiste paraovárico derecho de 6 x 5cm. Discusión: El diagnóstico de quiste paraovárico es generalmente incidental por ecografía, cuando se complica con torsión, se presenta dolor abdominal pélvico asociado a náuseas y vómito, al examen físico el 42.9% de las mujeres presentan a la palpación una masa anexial; la paciente del caso presenta dolor abdominal, con masa anexial palpable evidenciada en ecografía, por lo cual se realiza laparoscopia. El tratamiento del quiste paraovárico es el seguimiento, sin embargo, si aumentan de tamaño o hay persistencia, debe retirarse quirúrgicamente por el riesgo de torsión de anexos. De presentar torsión el manejo depende del estado de la trompa, al realizar destorsión persiste la coloración violácea, se debe realizar salpingectomía y cistectomía procedimiento realizado en esta paciente. Conclusiones: El diagnóstico de la torsión tubárica se realiza con clínica de dolor abdominal pélvico agudo, náuseas, vómito y presencia de masa anexial al tacto vaginal. La laparoscopia es el tratamiento de elección, cuyo manejo con cistectomía y salpingectomía que depende del compromiso vascular de los anexos. [Sepúlveda-Agudelo J, Torrado-Arenas DM, Martínez-Moreno N. Torsión tubárica aislada como complicación de un quiste paraovárico en el Hospital Universitario de Santander, Colombia. MedUNAB 2017; 20(3): 393-398].

Introduction: The paraovarian cyst represents from 10% to 20% of the adnexal masses, it generates symptoms when it causes torsion of the annexes but this is rare. The isolated torsion of the fallopian tubes has an incidence of 1 in 1.5 million women. Objective: To show a case of isolated fallopian tube torsion (IFTT) as a complication of a paraovarian cyst at the University Hospital of Santander. Clinical case: A 17-year old female patient who presents pain in lower hemi-abdomen. After performing the ultrasound, a right paraovarian cyst is found. Her symptomatology improves within 24 hours. Therefore, she is discharged after telling her some recommendations. Two months later, she returns because of pain exacerbation caused by an adnexal mass of 5 centimeters. Now, her lab tests are normal but her new ultrasound reports an enlargement in the ovary and thickened fallopian tubes, so a laparoscopy is performed. This test shows that the right fallopian tube is twisted with necrosis and a right paraovarian cyst of 6 x 5cm. Discussion: The diagnosis of paraovarian cyst is usually incidental by ultrasound; but when there is a torsion complication, pelvic abdominal pain associated with nausea and vomiting is presented. When the physical examination is performed, 42.9% of women present an adnexal mass on palpation. The patient of this clinical case shows abdominal pain, including a tangible adnexal mass, which is evidenced by the ultrasound. For this reason, a laparoscopy is performed. The treatment of the paraovarian cyst is the follow-up; however, if it increases in size or there is persistence, it should be removed surgically due to the risk of torsion of its annexes. If it presents torsion, its handling will depend on the state of the tube. So, if at the moment of performing a distortion in it the violaceous color persists, a salpingectomy and a cystectomy must be performed in this patient. Conclusions: The diagnosis of fallopian tube torsion is performed if the patient has clinical symptoms such as acute pelvic abdominal pain, nausea, vomiting and presence of adnexal mass when performing a digital vaginal examination. Laparoscopy is the treatment of choice, and its management with cystectomy and salpingectomy depends on the vascular commitment of the cyst annexes. [Sepúlveda-Agudelo J, Torrado-Arenas DM, Martínez-Moreno N. Isolated Fallopian Tube Torsion as a Complication of a Paraovarian Cyst in the University Hospital of Santander, Colombia. MedUNAB 2017; 20(3): 393-398].

Introdução: o cisto paraovariano representa 10 a 20% das massas anexiais, gera sintomas quando provoca a torção dos anexos, mas é raro, a torção isolada dos tubos tem uma incidência de 1 em 1,5 milhão de mulheres. Objetivo: Apresentar um caso de torção tubária isolada como complicação de um cisto paraovariano no Hospital Universitário de Santander. Caso clínico: paciente do sexo feminino de 17 anos, apresenta dor em hemiabdomen inferior; com ultra-som foi descoberto um cisto paraovariano direito; no prazo de 24 horas, melhora a sintomatologia; sai de alta, com recomendações. Retorna dois meses depois, por causa da dor intense e uma massa anexial de 5 centímetros (cm), como resultado nos laboratórios normais. O ultra-som revelou o aumento do tamanho do ovário e o bico afundado; é realizada uma laparoscopia; O tronco torcido direito é encontrado com necrose e cisto paraovariano direito de 6 x 5cm. Discussão: O diagnóstico do cisto paraovariano geralmente é descoberto por incidente, ao se fazer a ultrassonografia, quando é um caso complicado com torção, a dor abdominal pélvica está associada a náuseas e vômitos; no exame físico, 42,9% das mulheres apresentam palpação, uma massa anexial. A paciente, no caso apresenta dor abdominal, com uma massa anexial palpável evidenciada no ultra-som, razão pela qual a laparoscopia é realizada. O tratamento do cisto paraovariano é o acompanhamento, no entanto, se eles aumentam de tamanho ou haja persistência, ele deve ser removido cirurgicamente devido ao risco de torção de anexos. Se a torção persiste, o tratamento depende do estado do tubo e, se ao realizar a distorção, a cor violácea persiste, a salpingectomia e a cistectomia devem ser realizadas nessa paciente. Conclusões: o diagnóstico de torção tubária é feito com sintomas de dor abdominal pélvica aguda, náuseas, vômitos e presença de massa anexial ao toque vaginal. A laparoscopia é o tratamento de escolha, cujo manejo com cistectomia e salpingectomia depende do comprometimento vascular dos anexos. [Sepúlveda-Agudelo J, Torrado-Arenas DM, Martínez-Moreno N. Torção tubária isolada como uma complicação de um cisto paraovariano no Hospital Universitário de Santander, Colômbia. MedUNAB 2017; 20(3): 393-398].

Analysis on the analgesic effect of sufentanil combined with dezocine in endoscopic resection of fallopian / 中国生化药物杂志

Objective To study the analgesic effect of sufentanil combined with Dezocine in endoscopic resection of fallopian.MethodsA total of 188 patients with tubal pregnancy from April 2013 to December 2014 in Haining central hospital were enrolled in the study, they were randomly divided into two groups (n=94).On the basis of conventional intravenous analgesia, the patients in control group was were received sufentan, the observation group were given sufentan combined with dezocine.The score of pain at different time points after operation, the Ramsay sedation score, and the level of IL-6 and IL-10 were compared.The adverse reactions were compared between the two groups.ResultsThe score of VAS in the observation group was significantly lower than that in the control at 4h, 8h, 12h and 24h after operation (P<0.05).The score of VAS in the two groups were similar at 48h after operation;the Ramsay score in the observation group was significantly higher than that in the control group(P<0.05) at five time points (4h, 8h, 12h, 24h and 48h after operation);when compared Compared with the indexes before operation, the level of IL-6 was significantly increased in the two groups at 24h and 48h, but the observation group increased less, the IL-6 in observation group was lower than that in the control group at the two points(P<0.05);while the IL-10 was higher than that beforeoperation, and the observation group was more higher(P<0.05).The adverse reactions in the two groups were mainly dizziness, nausea, pruritus and lethargy, and the incidence was only 12.8% in the observation group, which lower than that in the control of 29.8%(P<0.05).ConclusionIt which dazocine combined with sufentanil had a good analgesic effect in the process of analgesia in gynecological laparoscopic resection of fallopian tube after the operation.The VAS score and Ramsay sedation score was improved significantly.The levels of inflammatory factors were lower, and the incidence of adverse reaction was significantly reduced.It is a reliable method for clinical intravenous analgesia.

Analysis of related factors associated with pelvic adhesion and its influence on fallopian tube recanalization in infertile patients / 中国基层医药

Objective To investigate related factors of pelvic adhesions and its effect on fallopian tube recanalization in infertile patients.Methods Infertile patients undergoing hysteroscopy and laparoscopic surgery in Department of Obstetrics and Gynecology,Kangning Women and Children Hospital of Jinyun were studied retrospec-tively.They were divided into adhesion group and non -adhesion group.The differences of past medical history, complication,prognosis between the two groups were determined.Results There were 301 patients in this study, including 97 patients with pelvic adhesions in adhesion group and 204 patients without pelvic adhesions in non -pelvic adhesion group.Among those events of past medical history,the incidence rates of abortion,pelvic inflammation,pelvic cavity and abdominal operation in the adhesion group were significantly higher than those in the non -adhesion group (χ2 =7.39,20.27,29.99,all P 0.05).Among the events of complications,concurrent rates of pelvic tuberculosis,tubal effusion or fester,ovary endometriosis cyst in the adhesion group were statistically higher than those in the non -adhesion group(χ2 =9.39,24.71,22.89,all P 0.05 ).At the time of 3 months after curing,the rate of recanalization fallopian tube of patients cured by salpingostomy in the two groups had no statistical difference(χ2 =0.00,P >0.05 ).And the rate of recanalization fallopian tube of patients cured by interventional therapy in the adhesion group was statistically higher than that in the non -adhesion group(χ2 =5.87,P <0.05 ).Conclusion Abortion,pelvic inflammation,pelvic cavity and abdominal operation,pelvic tuberculosis,tubal effusion or fester and ovary endometriosis cyst are the risk factors of pelvic adhesion in the reproductive age women,and pelvic adhesion has significant effect on the fallopian tube recanalization in infertile patients.

The affects of placement of intrauterine device on the incidence of fallopian tube obstruction / 天津医药

Objective To investigate whether the placement of intrauterine device (IUD) can increase the incidence of fallopian tube obstruction. Methods A total of 458 patients with secondary infertility who visited the outpatient clinic between January 2014 and December 2015 were selected for observation group, of which, 246 cases who used IUD in the past but were not pregnant were the IUD group, and 212 cases with no history of using IUD were the control group. According to the medical history of two groups,and based on test results of gynecological routine inspection, mycoplasma (UU), chlamydia (CT), type B ultrasound examination of pelvic cavity and hysterosalpingography (HSG) in two groups, whether the placement of IUD increased the risk of fallopian tube obstructive infertility was comprehensively analyzed. Results There was a higher incidence of reproduction tract infection in patients with fallopian tube obstruction than that in patients without fallopian tube obstruction in IUD group (pelvic infection 32.6% vs. 15.7%,CT 23.9% vs. 9.3%,UU 42.8% vs. 18.5%, vaginitis 36.2%vs. 24.1%,P0.05). There were no significant differences in history of uterine cavity operations and incidence of reproductive tract infection between two groups of patients with tubal obstruction(uterine cavity operations 55.8%vs. 45.2%,pelvic infection 32.6%vs. 39.3%,vaginitis 36.2% vs. 34.1%, CT 23.9% vs. 27.4%,UU 42.8% vs. 40.7%,P>0.05). Conclusion There is no necessary correlation between fallopian tube obstruction and placement of IUD, which therefore will not increase the incidence of fallopian tube obstruction.

Application value of ultrasound contrast on evaluating fallopian tube patency / 中国基层医药

Objective To discuss the clinical application value of ultrasound contrast on evaluating fallopian tube patency.Methods Ultrasound contrast examination was conducted on 84 patients suffering from infertility and the flowing status of contrast agent in the uterine cavity and the fallopian tube and the distribution condition in the pelvic cavity were observed under the real -time ultrasound to judge the patency condition of the fallopian tube.Results After 84 patients receiving ultrasound contrast,38 cases'bilateral fallopian tubes were unobstructed,26 cases'lateral fallopian tube were unobstructed and 20 cases'bilateral fallopian were obstructed.Comparing the result of ultrasound contrast with laparoscopy,the diagnosis accuracy was 89.5%,the specificity 86% and the sensitivity 94%.Conclusion Fallopian tube ultrasound contrast technique can make an accurate and objective evaluation on the fallopian tube patency,it is an effective method to check fallopian tube patency and it is of high clinical application value.

Morphologic features of fallopian tubal epithelium in pelvic high-grade serous carcinoma / 中华病理学杂志

Objective@#To study the pathologic features of fallopian tubal epithelium in patients with pelvic high-grade serous carcinoma (HGSC), to investigate its role in pelvic serous carcinogenesis and to reclassify the primary site of HGSC based on recently proposed criteria.@*Methods@#The fallopian tubes in 58 cases of pelvic HGSC (54 cases of ovarian primary, 3 cases of tubal primary, 1 case of peritoneum) and 25 cases of pelvic non-HGSC (5 cases of ovarian low-grade serous cancer, 9 cases of endometrioid cancer, and 11 cases of clear cell ovary carcinoma) were collected from June 2015 to December 2016, and serially examined under light microscope (SEE-FIM protocol). Immunostaining for p53 and Ki-67 was performed to evaluate the presence of p53 signature, serous tubal intraepithelial lesion (STIL), serous tubal intraepithelial carcinoma (STIC) and invasive carcinoma in these fallopian tubes. Meanwhile, primary site of HGSC based on the recently proposed diagnostic criteria were also reclassified.@*Results@#Among the study group, the frequencies of p53 signature, STIL, STIC and invasive HGSC were 27.6% (16/58), 43.1% (25/58), 36.2% (21/58) and 67.2% (39/58), respectively, while in control group, the proportions were 24.0% (6/25), 0, 0 and 8.0% (2/25), respectively. The continuum of epithelial changes in the process of serous neoplasia including p53 signature, STIL, STIC and invasive carcinoma was identified in 8 cases of pelvic HGSC. The proportions of STIL, STIC and invasive carcinomas in HGSC group were higher than that in non-HGSC group (P<0.01). About 80.0% (20/25) of STIL and 85.7% (18/21) of STIC were present unilaterally. Diagnostically, the study group contained the 17 cases of ovarian HGSC, 40 cases of tubal HGSC, and 1 case of peritoneal HGSC after reclassification of the cancer primary.@*Conclusions@#Continuous changes of tubal epithelium including p53 signature, STIL, STIC and invasive carcinomas are identified in patients with HGSC, supporting the current understanding that the fallopian tube is likely the cellular source of the majority HGSC. STIL and STIC may be specific to pelvic HGSC and may act as a target for future research on the early detection and prevention of this disease. The newly proposed diagnostic criteria for pelvic HGSC will lead us to more accurate classification of cancer primary sites. Correct classification of HGSC may have potential impacts for cancer prevention and improve our understanding of ovarian serous carcinogenesis.

Significant elevation in serum CA 125 and CA 19-9 levels with torsion of the hydrosalpinx in a postmenopausal woman

Isolated torsion of the fallopian tube in postmenopausal women is rare. In this case report, we detail the case of a 53-year-old patient who presented with adenomyosis and a left hydrosalpinx with high levels of CA 125 and CA 19-9. The isolated torsion of the left hydrosalpinx was observed during the operation. The serum levels of CA 125 and CA 19-9 were reduced from 129.62 and 348 to 58.2 and 12.41 U/mL, respectively, after total laparoscopic hysterectomy with salpingectomy. On radiologic evaluation, there were no other factors that may have influenced the increase in serum levels of CA 125 and CA 19-9 in this patient, which were reduced after operation. To the best of our knowledge, this is the first case of association between perioperative changes in CA 19-9 levels and isolated torsion of the fallopian tube.