Análise das gestações ectópicas íntegras tratadas com o protocolo de dose única de metotrexato / Analysis of unruptured ectopic pregnancies treated with single-dose methotrexate protocol

Objetivo: Avaliar o índice de sucesso do tratamento da gravidez ectópica com o protocolo de dose única do metotrexato e verificar sua correlação com variáveis clínicas e dados dos exames complementares. Métodos: É um estudo epidemiológico observacional, analítico, retrospectivo, de delineamento transversal. Foi realizado de janeiro de 2014 a agosto de 2020 em um hospital público, de ensino, em nível terciário, do Sul do Brasil. Em 73 casos com diagnóstico de gestação ectópica íntegra, foi utilizado o protocolo de dose única de metotrexato intramuscular, com a dose de 50 mg/m2 de superfície corporal. As variáveis do estudo foram relacionadas ao sucesso do tratamento e abordaram as características clínicas na admissão, dos exames complementares e do tratamento realizado. As variáveis foram comparadas por análise de regressão de Poisson. O nível de significância estabelecido foi de p < 0,05. Resultados: O índice de sucesso foi de 83,6%, e em nove casos foi necessária uma segunda dose da medicação. Nível de ß-hCG inicial superior a 5.000 mUI/mL foi relacionado a menor chance de sucesso (odds ratio ajustado de 0,20 [0,05-0,95]). Tamanho da imagem anexial, presença de líquido livre na cavidade abdominal e demais variáveis estudadas não afetaram a chance de sucesso do tratamento. Conclusão: O protocolo de dose única de metotrexato mostrou-se uma opção válida para o tratamento da gestação ectópica íntegra, notadamente quando o nível de ß-hCG inicial é inferior 5.000 mUI/mL.

Objective: The purpose of the present study is to evaluate the success rate of treatment of ectopic pregnancy with the single-dose methotrexate protocol and to verify its correlation with clinical variables and complementary exam data. Methods: This is a retrospective epidemiological observational analytical cross-sectional study. It was carried out from January 2014 to August 2020 in a tertiary level teaching hospital in southern Brazil. In 73 cases with a diagnosis of intact ectopic pregnancy, the intramuscular methotrexate single-dose protocol was applied with a dose of 50 mg/m2 of body surface. The study variables were related to the success of the treatment and addressed the clinical characteristics on admission, the complementary exams and the treatment performed. The variables were compared by Poisson regression analysis. The level of significance was set at p < 0.05. Results: The success rate was 83.6%, and in nine cases a second dose of the medication was necessary. An initial ß-hCG level greater than 5,000 mIU/mL was related to a lower chance of success (adjusted odds ratio of 0.20 [0.05- 0.95]). The size of the adnexal image, the presence of free fluid in the abdominal cavity and other variables studied did not affect the chance of a successful treatment. Conclusion: The methotrexate single-dose protocol proved to be a valid option for the treatment of intact ectopic pregnancy, notably when the initial ß-hCG level is below 5,000 mIU/mL.

Actinomicosis pélvica invasiva: un desafío para el ginecólogo / Invasive pelvic actinomycosis: a challenge for the gynecologist

Resumen La actinomicosis pélvica es una infección bacteriana supurativa crónica, producida por especies de Actinomyces, principalmente Actinomyces israelii, que afecta el aparato genital interno y las estructuras vecinas, asociada al uso prolongado de dispositivo intrauterino sin control en casi la totalidad de los casos descritos en mujeres. La actinomicosis pélvica suele presentarse como un absceso tubo-ovárico y con menor frecuencia como una actinomicosis pélvica invasiva (API). La API se propaga por contigüidad desde el aparato genital hacia las vísceras adyacentes, originando un tumor pélvico difuso, de consistencia leñosa, pseudotumoral, que a menudo se confunde con una neoplasia pélvica. La API representa un gran desafío para el ginecólogo por las dificultades en su diagnóstico y manejo. Se presentan dos casos de API y se revisan los procedimientos diagnósticos y terapéuticos recomendados actualmente para el enfrentamiento de esta patología.

Abstract Pelvic actinomycosis (PA) is a chronic suppurative bacterial infection, produced by Actinomyces, mainly Actinomyces israelii. It affects the internal genital tract, adjacent structures and is associated with a prolonged intrauterine device use with an inadequate control in almost all described cases in women. Pelvic actinomycosis usually presents as a tube ovarian abscess and less frequently as invasive pelvic actinomycosis (IPA). The IPA spreads contiguously from the genital tract to adjacent viscera, causing a diffuse, woody, pseudotumoral pelvic tumor that is frequently confused with a pelvic neoplasm. The IPA represents a great challenge for the gynecologist due to the difficulties in the diagnosis and management of this disease. Two cases of IPA are presented and the currently recommended diagnostic and therapeutic procedures for dealing with this pathology are reviewed.

Principais causas ginecológicas de dor pélvica aguda em mulheres / Main gynecological causes of acute pelvic pain in women

Este trabalho buscou reunir dados essenciais sobre as etiologias de dor pélvica aguda, uma queixa constante nos serviços de emergências e ambulatórios de ginecologia, responsável por grande desconforto e impacto na qualidade de vida de pacientes mulheres. É uma condição laboriosa por causa de seu amplo espectro de causas, devendo ser abordada com cuidado e atenção pelo profissional médico, o qual deve considerar os diversos diagnósticos diferenciais, sendo a ultrassonografia o exame de maior importância para auxiliar em seu diagnóstico. As principais etiologias não obstétricas podem ser não ginecológicas e ginecológicas; essas últimas são divididas em anexiais e uterinas. Entre as causas ginecológicas, devem- -se investigar cistos ovarianos, torções anexiais, leiomiomas, doença inflamatória pélvica, abscesso tubo-ovariano, dismenorreia e complicações de dispositivos intrauterinos. A maioria das causas tem tratamento eficaz, com retorno da função do órgão e melhora da qualidade de vida, sem complicações, especialmente se diagnosticada precocemente.(AU)

The aim of this study was to gather important data on acute pelvic pain etiologies, a usual complaint in the emergency services and gynecology outpatient clinics, responsible for great discomfort and impact on quality of life in female patients. It is a laborious condition due to its wide spectrum of causes, which needs to be approached with attention by the physician, who must consider all the possible diagnoses, being the ultrasonography the most important exam to detect it. The main non-obstetric etiologies can be non-gynecological and gynecological, which are separated in adnexal and uterine causes. Among the gynecological causes, ovarian cysts, adnexal torsions, leiomyomas, pelvic inflammatory disease, ovarian tube abscess, dysmenorrhea and complications of intrauterine devices should be investigated. Most causes can be effectively treated, with return of organ function and improved quality of life, without complications, especially if diagnosed early.(AU)

Actinomicosis pélvica: a propósito de un caso que simula un tumor de recto / Pelvic actinomycosis: from a case that simulates rectal tumor

Resumen Introducción: La actinomicosis, es una infección crónica rara producida por bacterias del género Actinomyces sp. La afectación pélvica es una de sus formas más infrecuentes y en gran parte de los casos se relaciona al uso de un dispositivo intrauterino de larga data o a una cirugía previa. Como otras enfermedades raras, la infección es conocida como "la gran imitadora" por su variada forma de presentación y particular comportamiento pudiendo simular una neoplasia. El tratamiento es fundamentalmente médico y de buenos resultados. Caso Clínico: Damos a conocer el caso de una paciente que se presentó con un cuadro compatible con un tumor de recto, pero que resultó ser actinomicosis. El diagnóstico se realizó en base a la tinción de Gram, el cuadro clínico y el antecedente de un dispositivo intrauterino abandonado por más de 25 años. Fue corroborado posteriormente mediante anatomía patológica y tratada en forma exitosa con antibióticos por un periodo extendido. Conclusión: Si bien la actinomicosis es una patología infrecuente, debe ser considerada en el diagnóstico diferencial de los pacientes que se presentan con tumores de la pelvis. Un alto índice de sospecha y una actitud diagnóstica activa son fundamentales para un tratamiento oportuno, seguro y eficaz de esta enfermedad.

Introduction: Actinomycosis is a rare chronic infection caused by bacterias of the genus Actinomyces sp. Pelvic involvement is one of its most infrequent forms and in many cases it is related to the use of a longstanding intrauterine device or a previous surgery. Like other rare diseases, the infection is known as "the great imitator" because of its varied form of presentation and its particular behavior, which can simulate a neoplasm. The treatment is fundamentally medical with good results. Case Report: We present the case of a patient who presented with a rectal tumor but that turned out to be Actinomycosis. The diagnosis was made based on the Gram stain, the clinical presentation and the history of an intrauterine device left for more than 25 years. It was subsequently corroborated by pathological anatomy and successfully treated with antibiotics for an extended period. Conclusion: Although actinomycosis is an infrequent pathology, it should be considered in the differential diagnosis of patients who present with tumors of the pelvis. An active diagnostic attitude and a high index of suspicion are fundamental for the timely, safe and effective treatment of this disease.

Removal of intramural trapped intrauterine device by cystoscopic incision of bladder wall

ABSTRACT A healthy 37 - year - old woman referred to our clinic with one - year history of recurrent urinary tract infection, dysuria and frequency. Her past medical history informed us that an IUD (Copper TCu380A) had been inserted 11 years ago. Eleven months after the IUD insertion she had become pregnant, unexpectedly. At that time, she had undergone gynecological examination and abdominal ultrasound study. However, the IUD had not been found, and the gynecologist had made the diagnosis of spontaneous fall out of the IUD. She had experienced normal pregnancy and caesarian section with no complications. On physical examination, pelvic examination was normal and no other abnormalities were noted. Urinalysis revealed microhematuria and pyuria. Urine culture was positive for Escherichia coli. Ultrasound study revealed a calculus of about 10 mm in the bladder with a hyperdense lesion. A plain abdominal radiograph was requested which showed a metallic foreign body in the pelvis. We failed to remove the IUD by cystoscopic forceps because it had strongly invaded into the uterine and bladder wall. Despite previous papers suggesting open or laparoscopic surgeries in this situation (1, 2), we performed a modified cystoscopic extraction technique. We made a superficial cut in the bladder mucosa and muscle with J - hook monopolar electrocautery and extracted it completely with gentle traction. This technique can decrease the indication of open or laparoscopic surgery for extraction of intravesical IUDs. In the other side of the coin, this technique may increase the risk of uterovesical fistula. Therefore, the depth of incision is important and the surgeon should cut the bladder wall superficially with caution. Although present study is a case report which is normally classified as with low level of evidence, it seems that our modified cystoscopic extraction technique is a safe and useful method for extraction of partially intravesical IUDs.

Pseudotumor vesical a causa de un dispositivo intrauterino / Vesical pseudotumor due to an intra-uterine device

Se describe el caso clínico de una paciente atendida en el Hospital Oncológico Docente Provincial Conrado Benítez García de Santiago de Cuba por presentar una perforación en la vejiga y desplazamiento de un dispositivo intrauterino hacia la cavidad vesical, lo cual generó la formación de litiasis y, consecuentemente, la aparición de frecuentes infecciones urinarias y dolor en bajo vientre, sin mejoría alguna ante la terapéutica aplicada. Se decidió realizar una cistotomía para extraer la litiasis compacta junto con la T de cobre; la paciente evolucionó favorablemente y los síntomas desaparecieron

The case report of a patient assisted in Conrado Benítez García Teaching Provincial Cancer Hospital in Santiago de Cuba is described, due to a bladder perforation and displacement of an intra-uterine device toward the vesical cavity, which generated the lithiasis formation and, consequently, emergence of frequent urinary infections and pain in lower abdomen, without any improvement with therapy. It was decided to carry out a cystotomy to extract the lithiasis compacted with the copper T; the patient had a favorable clinical course and the symptoms disappeared

Presentación tumoral de actinomicosis pélvica / Tumor Presentation of Pelvic Actinomycosis

La actinomicosis es una enfermedad crónica granulomatosa poco común causada por bacterias gram positivas, anaeróbicas, microaerófilas principalmente del género Actynomices. Se presenta el caso de una mujer de 49 años de edad, con cuadro clínico de aproximadamente 4 meses de evolución dado por estreñimiento, asociado a tenesmo rectal durante la defecación y pérdida de peso, portadora de dispositivo intrauterino desde hace 7 años. En el examen físico se encontró la presencia de una masa, de bordes mal definidos, en flanco y fosa iliaca derechos, y en hipogastrio, no dolorosa a la palpación. El ultrasonido abdominal reportó una masa en lóbulo caudado hepático y una estructura de contornos mal definidos en íntimo contacto con techo vesical y fundus uterino. La biopsia de lesión reveló actinomicosis. Se confirma la actinomicosis en una paciente con masa palpable en hipogastrio y dispositivo intrauterino colocado(AU)

Actinomycosis is an uncommon granulomatous chronic disease caused by gram-positive, anaerobic, microaerophilic bacteria, mainly of the genus Actynomices. We present the case of a 49-year-old woman with a clinical condition of approximately 4 months of evolution due to constipation, associated with rectal tenesmus during defecation and weight loss, carrier of an intrauterine device for 7 years. In the physical examination, the presence of a mass was found, with poorly defined edges, flank anda iliac fossa right, and hypogastrium, not painful on palpation. Abdominal ultrasonography reported a mass in the hepatic caudate lobe and a structure of ill-defined contours in intimate contact with the bladder roof and uterine fundus. The lesion biopsy revealed actinomycosis. It was confirmed in a patient with palpable mass in hypogastrium and intrauterine device placed(AU)

Abdominal and pelvic actinomycosis due to longstanding intrauterine device: a slow and devastating infection

Actinomycosis is a chronic or subacute bacterial infection characterized by large abscess formation, caused mainly by the gram-positive non-acid-fast, anaerobic, or microaerophilic/capnophilic, obligate parasites bacteria from the genus. Although pelvic inflammatory disease is an entity associated with the longstanding use of intrauterine devices (IUDs), actinomycosis is not one of the most frequent infections associated with IUDs. We present the case of a 43-year-old female patient who was referred to the emergency facility because of a 20-day history of abdominal pain with signs of peritoneal irritation. Imaging exams revealed collections confined to the pelvis, plus the presence of an IUD and evidence of sepsis, which was consistent with diffuse peritonitis. An exploratory laparotomy was undertaken, and a ruptured left tubal abscess was found along with peritonitis, and a huge amount of purulent secretion in the pelvis and abdominal cavity. Extensive lavage of the cavities with saline, a left salpingo-oophorectomy, and drainage of the cavities were performed. The histopathological examination of the surgical specimen revealed an acute salpingitis with abscesses containing sulfur granules. Therefore, the diagnosis of abdominal and pelvic actinomycosis was made. The postoperative outcome was troublesome and complicated with a colocutaneous fistula, which drained through the surgical wound. A second surgical approach was needed, requiring another extensive lavage and drainage of the recto-uterine pouch, plus the performance of a colostomy. Broad-spectrum antibiotics added to ampicillin were the first antimicrobial regimen followed by 4 weeks of amoxicillin during the outpatient follow-up. The patient satisfactorily recovered and is already scheduled for the intestinal transit reconstitution.

Enfermedad pélvica inflamatoria por Actinomyces sp. en paciente con dispositivo intrauterino: reporte de un caso / Pelvic inflammatory disease by Actinomyces sp. in a patient with an intrauterine device: Case report

Dentro de las infecciones pélvicas que se presentan en mujeres, se encuentran las causadas por microorganismos anaerobios del género Actinomyces. Esta etiología es poco sospechada, debido a los esporádicos casos que se presentan, por lo que la infección permanece por largos periodos de tiempo y conlleva diferentes complicaciones que solo pueden resolverse con procedimientos quirúrgicos y tratamiento antibiótico prolongado. Por esto, se hace el reporte de caso de una paciente de 48 años de edad portadora de dispositivo intrauterino desde hace 13 años, el cual se consideró como el principal factor de riesgo. Se describen las características de la infección, procedimientos realizados, hallazgos microbiológicos y tratamiento, con lo cual se resuelve de manera satisfactoria.

Among the pelvic infections in women there exist those caused by anaerobic microorganisms of the genera Actinomyces . This etiology is rarely suspected, due to the few number of cases presented, thus the infection continues for long periods of time. This persistence can lead to various complications that can only be resolved with surgical procedures and prolonged antibiotic treatment. We present a case report on a 48-year old patient with a 13-year history of intrauterine device use, which we considered to be the principal risk factor. We describe the characteristics of the infection, the procedures performed, microbiological findings and the treatment, with which it was satisfactorily resolved.

Continued Compliance and Degree of Satisfaction in Nulligravida and Parous Women with Intrauterine Contraceptive Devices / Adesão e grau de satisfação em nuligestas e mulheres com parto anterior usuárias de dispositivo intrauterino

Purpose To evaluate the compliance and degree of satisfaction of nulligravida (has not given birth) and parous (had already given birth) women who are using intrauterine devices (IUDs). Methods A cross-sectional cohort study was conducted comparing nulligravida and parous women who had had an IUD inserted between July 2009 and November 2011. A total of 84 nulligravida women and 73 parous women were included. Interviews were conducted with women who agreed to participate through telephone contact. Statistical analysis was performed with Student s t-test and Mann-Whitney test for numeric variables; Pearson s chi-square test to test associations; and, whenever pertinent, Fisher s exact test for categorical variables. A survival curve was constructed to estimate the likelihood of each woman continuing the use of the IUD. A significance level of 5% was established. Results When compared with parous women, nulligravida women had a higher education level (median: 12 vs. 10 years). No statistically significant differences were found between the nulligravida and parous women with respect to information on the use of the IUD, prior use of other contraceptive methods, the reason for having chosen the IUD as the current contraceptive method, reasons for discontinuing the use and adverse effects, compliance, and degree of satisfaction. The two groups did not show any difference in terms of continued use of the IUD (p = 0.4). Conclusion There was no difference in compliance or the degree of satisfaction or continued use of IUDs between nulligravida and parous women, suggesting that IUD use may be recommended for women who have never been pregnant.

Objetivo Avaliar a adesão e o grau de satisfação de nuligestas emulheres com partos anteriores usuárias do dispositivo intrauterino (DIU). Métodos Realizamos um estudo de corte transversal comparando-se um grupo de nuligestas commulheres com partos anteriores que tinham sido submetidas à inserção do DIU no período de julho de 2009 a novembro de 2011. Foram incluídas 84 nuligestas e 73mulheres compartos anteriores. Uma entrevista foi realizada comas mulheres que concordaram em participar por meio de contato telefônico. Para se verificar as diferenças entre os dois grupos foram utilizados os testes t de Student e Mann- Whitney para as variáveis numéricas, e os testes qui-quadrado de associação e exato de Fisher, quando pertinente, para as variáveis categóricas. Realizou-se análise de sobrevivência de Kaplan-Meyer para continuidade do uso do DIU. Adotou-se o nível de significância de 5%. Resultados As nuligestas apresentaram escolaridade (mediana: 12 anos) superior às mulheres com um ou mais partos anteriores (mediana: 10 anos). Não houve diferença entre as nuligestas e mulheres comparto anterior em relação à informação sobre o uso do dispositivo intrauterino (DIU), uso prévio de outrosmétodos contraceptivos,motivo da escolha do DIU como método contraceptivo atual, motivos para descontinuidade, efeitos colaterais, adesão e grau de satisfação. A continuidade do uso do dispositivo intrauterino foi diminuída como passar do tempo emambos os grupos e sem diferença significativa (p = 0,4). Conclusão A adesão, o grau de satisfação e a continuidade do uso do DIU entre as nuligestas e mulheres com parto anterior são semelhantes, sugerindo que o DIU pode ser recomendado para mulheres que nunca engravidaram.

unusual cause of hydronephroureter

Intrauterine contraceptive device [IUCD] is a common method of contraception among women because of its low cost and high efficacy. Perforations are possible resulting in multiple complications including urinary complications. Obstructive hydronephrosis and hydroureter is one of the main clinical concerns in genitourinary practice leading to radiological investigations for determination of the cause. Determination of the cause leads to early treatment, hence saving the renal function. In this case report, we describe hydronephrosis and hydroureter secondary to a migrated/displaced IUCD

Apendicite aguda e perfuração colônica provocada por DIU com abordagem videolaparoscópica / Appendicitis and colonic perforation caused by intrauterine contraceptiv e device with a videolaparoscopic approch

A perfuração uterina é uma das principais complicações relacionadas à inserção de dispositivo intrauterino (DIU), podendo provocar danos a órgãos intra-abdominais. O artigo tem como objetivo descrever o caso de uma paciente tratada por videolaparoscopia após o diagnóstico de apendicite e perfuração colônica, causadas por DIU em cavidade abdominal. A perfuração uterina deve sempre ser considerada nos casos de dor pélvica em pacientes que fazem uso de DIU, sendo a videolaparoscopia um método seguro para a retirada do corpo estranho e tratamento das lesões de órgãos intracavitários.

Uterus perforation is one of the major complications caused by insertion of Intrauterine Contraceptive Device (IUD), being able to provoke injury to intraabdominal organs. This article describes the case of a patient treated laparoscopically after having the diagnosis of appendicitis and colonic perforation caused by IUD within abdominal cavity. The uterus perforation must always be considered in cases of pelvic pain in female patients using IUD, and videolaparocopy is a safe procedure to remove the device and treat abdominal organs damages.

Migración de un dispositivo intrauterino al ovario / Migration of a intrauterine device to ovarium

Los dispositivos intrauterinos constituyen el método anticonceptivo más empleado en países en vías de desarrollo. No exentos de complicaciones y, al igual que cualquier otro cuerpo extraño implantado en el organismo, puede migrar. Se realiza la presentación de una paciente en la que se diagnostica la migración de un DIU al ovario, una de las localizaciones más infrecuentes, y su exitosa remoción por cirugía videoasistida. Se recomienda este método como proceder de elección para la extracción de estos dispositivos translocados a la cavidad abdominal en los casos no complicados

The intrauterine devices (IUD) are the more used contraceptive method in developing countries. Not exempt of complications and just like other foreign body inserted in the organism, may migrate. This the case of a patient diagnosed with migration DIU to ovarium, one of the more frequent locations and its successful removal by means of video-assisted surgery. Authors recommended this method as a choice procedure to removal of theses translocated devices to abdominal cavity in non-complicated cases

Knowledge and attitudes about intrauterine devices among women's health care providers in El Salvador / Conocimientos y actitudes de los prestadores de atención de salud de la mujer en El Salvador acerca de los dispositivos intrauterinos

In order to gain an understanding of Salvadoran health care providers' clinical knowledge, attitudes, and practice toward the intrauterine device (IUD), Ministry of Health providers completed a self-administered, anonymous survey. Surveys were completed by 135 participants. The majority (94.7 percent and 97.0 percent) agreed the IUD is a safe and effective form of contraception. Only 46.6 percent of participants had ever received training in IUD placement, and 32.0 percent of them had ever inserted more than 10 IUDs. The majority of providers (54.2 percent) believed that the IUD was associated with a higher rate of infection than is described in the literature. Lack of formal training and knowledge about persistent infection rates associated with IUDs may contribute to low IUD placement by Salvadoran providers. Health care providers surveyed are open to learning more about the IUD and sharing the information with their patients.

A fin de evaluar el conocimiento, las actitudes y las prácticas clínicas de los prestadores de atención de salud salvadoreños en torno al dispositivo intrauterino (DIU), se solicitó a un grupo de prestadores del Ministerio de Salud que respondiera un cuestionario anónimo autoadministrado. Se recibieron 135 respuestas. La mayoría manifestó que el DIU es un método anticonceptivo seguro (94,7 por ciento) y eficaz (97,0 por ciento). Solo 46,6 por ciento de los participantes habían recibido algún tipo de capacitación acerca de la colocación del DIU y 32,0 por ciento habían colocado más de 10 dispositivos. La mayoría de los prestadores (54,2 por ciento) consideraron que el DIU está asociado a una incidencia de infecciones más alta que la descrita en la bibliografía. La escasa frecuencia con que los prestadores salvadoreños colocan el DIU probablemente sea atribuible, en cierta medida, a la falta de capacitación formal y de conocimiento acerca de los índices de infección persistente asociados a los DIU. Los prestadores de servicios de salud encuestados refirieron estar dispuestos a instruirse más acerca del DIU y a transmitir la información a sus pacientes.

Dispositivo intrauterino intravesical en expulsión en embarazo de tercer trimestre: reporte de un caso / Intravesical migration of intrauterine device in a pregnant woman

Se estima que en el mundo cerca de 160 millones de mujeres son usuarias de dispositivos intrauterinos (DIU), siendo Chile uno de los países con más alta tasa, con cerca del 70 por ciento de las usuarias en el sistema público. Sin embargo, su uso no está exento de complicaciones. Presentamos un caso infrecuente de DIU intravesical en expulsión en gestante de 28 semanas.

In the world, about 160 million women are users of intrauterine devices (IUD); Chile is one of the countries with the highest rate, with about 70 percent of users in public system. However, its use may be complications. We present an unusual case of intravesical IUD expulsion in 28 weeks pregnant.

Abdominal actinomycosis

This case report describes abdominal Actinomycosis of the greater omentum which was detected accidentally in a patient who had been suffering from right lower quadrant abdominal pain mimicking acute appendicitis. She had history of previous appendisectomy. During surgery multifocal masses were detected in greater omentum, suspicious of inflammation. She had partial omentectomy done and the specimen was sent for histopathological examination. The histopathological examination confirmed it to be Actinomycosis. The patient had an intensive antibiotic therapy prescribed in order to prevent a disease relapse because it was not sure whether the remaining part of omentum was affected by microscopic Actinomycosis

Control ecográfico post inserción de dispositivo intrauterino / Ultrasound control post insertion of intrauterine device

INTRODUCCIÓN: Los dispositivos intrauterinos (DIU) son métodos de anticoncepción reversible, ampliamente usados en el mundo. Se estima que 120 millones de mujeres usan un DIU en el mundo como método anticonceptivo. OBJETIVO: Evaluar los factores de riesgo que puedan relacionarse con una incorrecta inserción del DIU. MÉTODO: 93 pacientes de un Centro de Salud Familiar de la ciudad de Talca, Chile. Utilizando tablas de contingencia se calcularon diferentes medidas de asociación y se compararon los casos de DIU mal posicionado con los casos con uno o más factores de riesgo identificados. RESULTADOS: Se encontró una incidencia de DIU incorrectamente posicionado de un 15,8%, de los cuales hubo un 2,1% de perforación uterina, 2,1% para DIU incrustado y 11,8% para DIU descendido. Se identificaron como factores de riesgo de DIU incorrectamente posicionado la cicatriz de cesárea (RR: 2,31), inserción dificultosa (RR: 3,31) y opinión de un resultado dudoso (RR: 3,64), con una sensibilidad de 73,3%. CONCLUSIONES: La ecotomografía transvaginal es una herramienta crucial para la confirmación de una correcta inserción del DIU y debería ser un examen de rutina ante la presencia de cualquiera de los factores de riesgo identificados.

BACKGROUND: Intrauterine devices (lUDs) are reversible birth control methods that are widely used throug-hout the world. It is estimated that 120 million women use an IUD in the world as a contraceptive. AIM: To assess the risk factors that may relate to incorrect insertion of the IUD. METHODS: The sample included 93 patients of a Family Health Center, Talca, Chile. Using contingency tables, various measures of association were calculated, and the cases of incorrectly positioned IUD were compared with the cases where one or more risk factors were identified. RESULTS: We found an incidence of 15.8% of incorrectly positioned IUD, of which 2.1% presented with uterine perforation, 2.1% with embedment of the IUD and 11.8% with a descended IUD. We identified the following risk factors for incorrectly positioned IUD: cesarean section (RR: 2.31), difficulty on insertion (RR: 3.31) and practitioner's opinión of an uncertain result (RR: 3.64), with a sensitivity of 73.3%. CONCLUSIONS: Transvaginal ultrasound is a crucial tool for confirmation of proper insertion of an IUD and should be considered a routine examination when any of the identified risk factors are present.

Tubo-ovarian Actinomycosis: A case report with brief review of literature.

Pelvic actinomycosis is an uncommon condition, often associated with the use of intrauterine contraceptive device (IUCD). Pelvic actinomycosis is rare accounting for 3% of all human actinomycotic infections. Ovarian actinomycosis is even rarer. Here, we present a 24-year-old woman using an IUCD for 3 1 / 2 years with right-sided adnexal mass, which was diagnosed postoperatively as tubo-ovarian actinomycosis. Many times, an appropriate management is overlooked or delayed due to its non-specific and variable clinical and radiological features. Sometimes, it can even mimic an advanced pelvic malignancy. Therefore, the gynecologist should consider the possibility of this infection to spare the patient from morbidity of radical surgical procedure.