Hernia útero inguinal derecha atascada en mujer en edad fértil: reporte de un caso / Incarcerated right utero inguinal hernia in a woman of reproductive age: case report

Resumen Introducción: La hernia de pared abdominal es una patología habitual; la presentación más frecuente es de tipo inguinal, cercano a un 70% del total. La incidencia de un saco herniario inguinal conteniendo ovarios y trompas de Falopio, es un hecho reportado en 2,9% de los casos. Caso clínico: Se presenta una paciente, sexo femenino, de 42 años de edad, con historia de hernia inguinal derecha de larga data, ingresa por aumento de volumen doloroso e irreductible, en región inguinal derecha, no impresiona estrangulada; ingresa a pabellón de urgencia. Dentro de los hallazgos quirúrgicos destacan saco herniario que contiene útero y ambos ovarios, sin compromiso vascular. Paciente evoluciona de forma favorable egresando 2 días posterior a la cirugía.

Introduction: Abdominal wall hernia is a frequent pathology, the most frequent hernia are the inguinal type, closed to 70% of all. Although the incidence of inguinal hernial sac containing ovary and Fallopian tubes are reported on a 2.9% of the cases. Case Report: Female patient 42 years old, with a long-term history of right inguinal hernia, with sudden pain and irreducible increase of volume in the correspondent inguinal zone that doesn't look strangled; she was admitted to the emergency operating room. Among surgical findings hernia's sac content was uterus and both ovaries with no signs of vascular compromise. The patient's favorable evolved let her to be discharged from the hospital after 2 days from post operative care

Prevalência de fatores associados à infertilidade em mulheres inférteis submetidas à laparoscopia diagnóstica / Prevalence of factors associated with infertility in infertile women undergoing diagnostic laparoscopy

Objetivo: Analisar o papel da laparoscopia na investigação da infertilidade nos últimos cinco anos na Universidade Estadual de Campinas. Métodos: Estudo retrospectivo descritivo com todas as videolaparoscopias para o diagnóstico da infertilidade feitas de 2008 a 2012 na Universidade Estadual de Campinas. Foram analisados 353 prontuários de mulheres com infertilidade submetidas à laparoscopia diagnóstica. Foram avaliadas as características clínicas dessas mulheres e os achados intraoperatórios. Foi feita uma análise univariada de frequência, médias e desvio padrão para cada uma das variáveis e para avaliar as associações entre as variáveis foi usado o teste de Kruskal-Wallis. Resultados: A média de idade das mulheres com infertilidade foi de 32 ± 4,4 anos. A laparoscopia encontrou 52,98% de alterac¸ões tubárias, 17,84% de endometriose e 11,33% de aderências. Quase 18% dos exames não apresentaram qualquer tipo de alteração. A histerossalpingografia apresentou sensibilidade de 84,61% e especificidade de 32,58% em relação à laparoscopia. As mulheres com infertilidade apresentaram maior risco de ter alterações tubárias. Conclusão: As alterações tubárias são ainda a principal causa de infertilidade. A laparoscopia se mostra como uma técnica melhor do que a histerossalpingografia para detecção de alterações tubárias, além de permitir detectar alterações em outros órgãos que possam causar infertilidade.(AU)

Objective: To evaluate the role of laparoscopy in the investigation of infertility at the University of Campinas in the last five years. Methods: Retrospective descriptive study with all diagnostic laparoscopy in the last five years made in endoscopic gynecology clinic of the tertiary hospital. 353 medical records of women with infertility undergoing diagnostic laparoscopy between the years 2008 to 2012 were analyzed the clinical characteristics of these women and the indications of laparoscopy and intraoperative findings were evaluated. Descriptive analysis (frequency, mean and standard deviation) was performed for categorical variables. To evaluate the association between the variables, we used the Kruskal Wallis test. Results: The women were on average 32 ± 4.4 years. Laparoscopy found 52.98% of tubal alterations, 17.84% of endometriosis and 11.33% of adhesions. Almost 18% of tests did not show any change. The hysterosalpingography had a sensitivity of 84.61% and specificity of 32.58% compared to laparoscopy. Infertile women have a higher risk for tubal changes. Conclusion: Tubal alterations are still the leading cause of infertility. Laparoscopy appears as a better technique hysterosalpingography for detecting tubal alterations, in addition to be able to detect changes in other organs that can cause infertility.(AU)

Asociación MURCS: reporte de caso / MURCS Association: case report

La asociación MURCS (Mullerian aplasia, Renal aplasia, Cervicothoracic Somite dysplasia) (OMIM%601076) hace referencia a un conjunto de anomalías congénitas, que sin ser debidas al azar, aparecen de forma concomitante en una persona. Se caracteriza por una aplasia Mülleriana, aplasia renal y displasia cérvico-torácica provocadas por alteraciones en los somitas correspondientes, es de etiología heterogénea. Se presenta el caso de una paciente de 9 años de edad, que es diagnosticada con la asociación MURCS, por presentar agenesia uterina, hipoplasia y ectopia renal unilateral y malformación de la 5ta vértebra cervical. Se enfatiza en la importancia de la búsqueda activa de las otras anomalías diferentes a las Müllerianas para lograr el diagnóstico y realizar un manejo integral e interdisciplinario.

The MURCS association (Mullerian aplasia, renal aplasia, Cervicothoracic Somite dysplasia) (OMIM%601076) refers to a set of congenital abnormalities, without being due to chance, they appear concomitantly in a person. It is characterized by Müllerian aplasia, renal aplasia and cervicothoracic dysplasia caused by alterations in the corresponding somites. We describe a case report of a 9-year-old female, who is diagnosed with MURCS association, to present uterine agenesis, hypoplasia and unilateral renal ectopia and deformity of the 5th cervical vertebra. We emphasize the importance of interdisciplinary care, including a clinical geneticist in the care of patients with these characteristics.

Recurrence of uterine rupture in a pseudo-unicornuate uterus at 17 weeks of amenorrhea: case report and literature review

Pregnancy in a rudimentary horn is a very rare condition. It is responsible for several complications. Prognosis is reserved because the natural evolution generally leads to a cataclysmic uterine rupture at the beginning of the second trimester. Classically, the treatment after foetal extraction consists of ablation of the rudimentary horn and associated fallopian tube. We report the obstetric outcome of a patient with history of rudimentary uterine horn rupture, the treatment of which was ablation of the rudimentary horn

Tubal abnormalities in Thai infertile females.

OBJECTIVE: To determine the prevalence of tubal abnormalities among infertile patients attending the clinic at Srinagarind Hospital. DESIGN: A descriptive study SETTING: Infertility clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. SUBJECT: A total of 740 female patients presented at the infertility clinic, Srinagarind Hospital between 1 January 1998 and 31 December 2002. MATERIAL AND METHOD: A retrospective review of demographic data, baseline infertility information and the results of tubal assesments (including both hysterosalpingography and laparoscopy) were conducted. MAIN OUTCOME MEASURE: Prevalence of tubal abnormalities in infertile females being treated in the infertility clinic during the study period. RESULTS: Among the 740 patients being recruited to the present study, 533 cases (72.03%) were diagnosed with primary infertility while the rest (207 or 27.97%) came to the clinic due to secondary infertility. The mean infertile period of all study subjects was 4.68 years. Regarding the methods used for tubal assessments, hysterosalpingography (HSG), laparoscopy and combination of the two methods were conducted in 556 cases (75.14%), 30 cases (4.05%) and 154 cases (20.81%), respectively. The prevalence of tubal abnormalities demonstrated in the present study was 27.30% (202 from 740 cases). Among the 202 patients with tubal abnormalities, the pathologies detected were cornual occlusion (46.04%), combined tubal abnormalities (30.20%), distal tubal occlusion (8.42%), hydrosalpinx (3.47%), peritubal adhesion (3.96%), and other abnormalities (7.91%). Other pelvic pathologies detected from laparoscopy were endometriosis (61.49%), pelvic adhesion (24.22%), leiomyoma (12.42%), and ovarian cyst (1.87%). CONCLUSION: Tubal abnormalities were detected in over one-fourth of all infertile females being treated at Srinagarind Hospital. Further study investigating the etiologies of these abnormalities is needed since it could be the measure to bring down the occurrence of such conditions.

Antibodies to chlamydia trachohomatis heat shock protein 60 [chlamydial HSP 60] and chlamysia trachomatis major outer membrane proten [MOMP] in women with tubal factor infertility

Most of the acute infections of Chlamydia trachomatis are asymptomatic and are thus left untreated. In some women repeated or persistent C. trachomatis infection leads to scarring of the fallopian tube tissue and subsequent infertility because of occlusion of the tubes. Screening for C trachomatis specific antibodies is mandatory in. diagnosing asymptomatic tubal factor infertility [TFI], particularly because it has been shown that C trachomatis is rarely isolated from the upper genital tract and clinical diagnosis requires invasive procedures not routinely available in general practice. C. trachomatis has immunodominant proteins such as major outer membrane protein [MOMP] and Chlamydial heat shock protein6o [chlamydial hsp60] that most of the host's immune response is directed at. The aim of the present study was to evaluate the association between, antibodies to C. trachomatis-specific IgG and chlamydial hsp60 in women with TFI. This study was done on 45 women diagnosed as having TFI by means of hysterosalpingogram [HSG] and laparoscopy, and 31 wives of male factor infertility patients with documented patent tubes by hysterosalpingogram, as a control group. Their age ranged from 19 to 35 years. Antibodies to C. trachomatis-specific IgG were more prevalent in younger women [<25 years old] than older women [>25 years old]. 77% versus 47% in TFI group, and 37% versus 27% in control group. Antibodies to C. trachomatis specific IgG were present in 29 [64%] of 45 women with tubal infertility compared with 10 [32%] of 31 control women. The difference was statistically significant [P=0, 0019]. antibodies to chlamydial hsp60 were significantly higher in TFI patients [28 of 45; 62%] than controls [6 of 31; 20%]. The difference was satistica1ly significant [P 0, 0002], Using the Spearman rank order correlation test, the antibodies chlamydial hsp6o had a highly significant correlation to C. trachomatis specific IgG antibodies in TFI patients [rs 0.53, P<0.001] and in controls [rs= 0.54, P<0.001]. In conclusion, Antibodies to chlamydial hsp60 and C. trachomatis-specific IgG are strongly associated with TFI a when used in combination at initial infertility evaluation, they would provide a rapid non-interventive means of diagnosing tubal factor infertility

[ assessment of sonohysterography as a diagnostic tool for uterine cavity defects and tubal patency]

In a prospective blind study, we evaluated Sonohysterography [SHG] as a diagnostic tool for uterine cavity and tubal patency and compare SHG with laparoscopy in tubal patency and hysterosalpyngography for Uterine anomaly as gold standard methods. 76 infertile patients undergone SHG and HSG and laparoscopy and comparison between the different diagnostic techniques for the evaluation of the uterine cavity and tubes was carried out. In comparison between SHG and HSG in the evaluation of uterine cavity, the sensivity of SHG for uterine anomalies was 50% and its specificity was 86.95%. In comparison between SHG and laparoscopy in evaluating tubal patency, specificity of SHG was 81.29% and its sensivity was 28.57%. Sonohysterography can be considered as a reliable and accurate method in the first line of evaluation of uterine cavity and tubal patency in infertile patients before HSG, Hysteroscopy, laparoscopy and the all of patients with history of failed IVF

Incidental observations during routine laparoscopic sterilisation.

Chance observations made in 24 (0.91%) of the 2639 cases in whom tubal ligation was done by laparoscopic method in the department of obstetrics and gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi during the last 4 years are reported and analysed. Congenital anomalies of the reproductive tract (0.30%), pelvic adhesions with or without thickened tubes due to inflammatory causes (0.49%) and other abnormalities (0.11%) were visualised. It is concluded that surgical correction of all uterine defects is not so necessary for a successful outcome of pregnancy.

Abdome agudo em ginecologia / Acute abdomen in gyncology

O objetivo deste trabalho é revisar as três principais causas do abdome agudo em ginecologia que säo a doença inflamatória pélvica, prenhez ectópica e a torçäo anexial, abordando aspectos epidemiológicos, diagnósticos e terapêuticos

Alteraçöes morfológicas em útero, tubas e ovários de égua. I. Cistos endometriais / Morphological changes in the uterus, tubes and ovarian in mares. I. Endometrial cysts

Em 160 éguas näo gestantes, com idade de dois a 21 anos e abatidas em matadouros, diagnosticaram-se macroscopicamente e microscopicamente 24 (15 por cento) casos de cistos endometriais. Todos eram de origem linfática, mais frequentes nas éguas velhas e comumente associados à endometrite crônica ou à lacunas linfáticas

Malformaçöes das trompas de falópio e infertilidade: aspectos videolaparoscópicos / Fallopian tube malformation and infertility: videolaparoscopic aspects

Esta pesquisa vem abordar as malformaçöes das trompas de Fallópio, sob o ponto de vista embriológico, funcional e sua possível relaçäo com a infertilidade. Ao mesmo tempo analisa a avaliaçäo videolaparoscópica de 51 mulheres inférteis e seus achados, dando ênfase para a anomalia e sua abordagem diagnóstica e terapêutica.

MURCS association--a review of 7 cases.

MURCS association (Mullerian hypoplasia/aplasia, renal agenesis and cervicothoracic somite dysplasia) is emerging as the second most frequent cause of primary amenorrhoea after Turner syndrome. Seven cases have been described and analysed. All cases had absence of uterus and tubes 85% had cervical spine abnormalities such as vertebral fusion, hypoplasia of vertebrae or butterfly vertebrae and short stature and 28% had renal agenesis or ectopy. The latter finding is in contrast to the reports in world literature where the frequency of renal agenesis is higher. There was no familial incidence in these seven cases lending credence to the belief that the association is essentially sporadic.

Hernia uteroinguinal / Utero-inguinal hernia

Se describe el caso de un varón de 10 años de edad, operado por hernia inguinal izquierda, que, aparentemente, contenía rudimentos de trompa de Falopio y útero, a los 4 años. Su cromatina sexual, corpúsculo Y y cariotipo correspondían al genotipo masculino. Las concentraciones séricas de testosterona, basales y después de estímulo con gonadotrofina coriónica humana eran normales. En una segunda laparotomía exploradora se encontraron dos testículos, conductos deferentes y estructuras Müllerianas (útero rudimentario y dos trompas de Falopio), lo que sugiere que se trata de hernia uteroinguinalis por un defecto en la secreción o acción del factor inhibidor Mülleriano