Hiperenrollamiento con torsión del cordón umbilical como causa de muerte fetal: reporte de caso / Hypercoiled umbilical cord torsion as a cause of fetal death: case report

Resumen La torsión del cordón umbilical como causa de muerte fetal es rara, con pocos casos reportados. No se conoce con claridad la causa y se presenta principalmente en el segundo trimestre de embarazo. Los factores de riesgo descritos son la longitud del cordón umbilical y el aumento del número de giros. Se reporta el caso de una paciente de 37 años, grávida 2, para 1 con embarazo de 23 semanas, con hallazgo ecográfico de muerte fetal. En el estudio de histopatología se evidenció el cordón umbilical con hiperenrollamiento y torsión a nivel de la unión feto-umbilical con oclusión de la luz de los vasos umbilicales como causa de muerte fetal. Se requiere la investigación de esta patología para determinar los factores de riesgo y el riesgo de recurrencia en futuros embarazos con el fin de establecer métodos de vigilancia fetal antenatal.

Abstract Torsion of the umbilical cord as a cause of fetal death is a rare occurrence, with few reported cases. The cause is not clearly known, and it transpires mainly in the second trimester of pregnancy; the risk factors described are the length of the umbilical cord with increased number of twists. The case of a 37-year-old woman is reported, gravida 2 para 1, 23 weeks pregnant with ultrasound diagnosis of fetal death. Histopathology revealed hypercoiled umbilical cord torsion at the point where the umbilical cord attaches to the fetus, with occlusion of the lumen of the umbilical vein, as a cause of fetal death. Further research of this pathology is required to determine the risk factors and risk of recurrence in future pregnancies that will allow the preparation of antenatal fetal surveillance methods.

Identifying and understanding optical coherence tomography artifacts that may be confused with glaucoma / Identificando e compreendendo os artefatos de tomografia de coerência óptica que podem ser confundidos com o glaucoma

ABSTRACT Optical coherence tomography is often used for detection of glaucoma as well as to monitor progression. This paper reviews the most common types of artifacts on the optical coherence tomography report that may be confused with glaucomatous damage. We mainly focus on anatomy-related artifacts in which the retinal layer segmentation and thickness measurements are correct. In such cases, the probability maps (also known as deviation maps) show abnormal (red and yellow) regions, which may mislead the clinician to assume disease is present. This is due to the anatomic variability of the individual, and the normative database must be taken into account.

RESUMO A tomografia de coerência óptica é frequentemente usada para detectar glaucoma, bem como para monitorar a progressão. Este artigo analisa os tipos mais comuns de artefatos no relatório de tomografia de coerência óptica que podem ser confundidos com danos glaucomatosos. Nós nos concentramos principalmente nos artefatos relacionados à anatomia em que a segmentação da camada da retina e as medidas de espessura estão corretas. Nesses casos, os mapas de probabilidade (também conhecidos como mapas de desvio) mostram regiões anormais (vermelho e amarelo), o que pode induzir o clínico em erro ao supor que a doença está presente. Isto se deve à variabilidade anatômica do indivíduo, e o banco de dados normativo deve ser levado em conta.

Intestinal malrotation, mesocolic hernia, and Meckel diverticulum - differential diagnosis of abdominal pain in adults: case report and literature review

Intestinal malrotation is a congenital anomaly caused by incomplete rotation or absence of rotation of the primitive intestine along the axis of the upper mesenteric artery during embryonic development. Embryonic development and its anatomical variations were described by Dott in 1923. Intestinal malrotation is a rare condition among adults - prevalent in a mere 0.0001% to 0.19% of the population -, and it may be associated with other anatomical deformities. It can be asymptomatic or manifest with varying intensity, from obstruction to necrosis of intestinal segments. In general, this abnormality is diagnosed in the first year of life; however, symptomsmay appear later in life,making diagnosis in adults difficult on account of non-specific symptoms. In the present study, we report a case of intestinal malrotation associated with chronic non-specific symptoms progressing to mesenteric angina. (AU)

Effect of kinesio tape on scapular kinematics in subjects with scapular dyskinesis

Scapular dyskinesis is an abnormality in scapula static or dynamic position. There are several techniques for scapular dyskinesis conservative treatment, including Kinesio Tape application, which is used to promote and support scapula joint alignment, decrease pain and improve local muscle control. The study aim to investigate the effect of kinesio tape on scapular kinematics in subjects with scapular dyskinesis. Fourteen subjects with scapular dyskinesis performed flexion and scaption movements in two conditions: (1) without load and (2) holding a dumbbell. A scapular tape was applied over the lower trapezius (Y shaped) muscle with a 20% tension. Kinematic data were captured with 10 infrared cameras and analyzed based on Euler angles, peak values of upward rotation, internal rotation, and posterior tilt angles. To compare the situations with and without kinesio tape the repeated measures two-way ANOVAs (α = 0.05) was performed using SPSS software. Scapular tape increase upward rotation and posterior tilt during flexion of the shoulder. No interaction (Load x KT) was found during flexion, suggesting that KT effect in the peak values is the same, regardless the load condition. Scapular tape decreases internal rotation during scaption and a significant interaction was found between load x KT, suggesting the effect of using KT could depend the load u sed during this movement. The results suggest that kinesio tape may can be use as assistant to increase upward rotation, posterior tilt and decrease internal rotation in scapular dyskinesis subjects. (AU)

Torsión aislada de la trompa de Falopio, con necrosis de un quiste paratubárico: una urgencia ginecológica infrecuente / Isolated torsion of the Fallopian tube, with necrosis of a paratubal cyst: an infrequent gynecological emergency

INTRODUCCIÓN: La torsión aislada de la trompa de Falopio ocurre en aproximadamente una de cada 50.000 a 1.500.000 mujeres, por ende, es una afección extremadamente rara. Fue originalmente descrita por Bland-Sutton en 1890. El cuadro clínico suele ser inespecífico y puede simular una amplia variedad de dolencias. CASO CLÍNICO: Paciente de 18 años de edad que acude al servicio de urgencias por dolor abdominal intenso, la cual se decide ingresar por cuadro agudo doloroso abdominal de posible etiología ginecológica, se realiza laparoscopía de urgencia por la posibilidad de un cuadro de torsión quística, durante esta se observa una imagen laparoscópica de la trompa izquierda violácea y torcida, además un quiste paratubárico hemorrágico, de color violacio; por las características laparoscópicas de la trompa y el quiste paratubárico que se relacionan con necrosis de estos elementos, se decide realizar a la paciente una anexectomía total izquierda con cistectomía del quiste paratubárico. DISCUSIÓN: La rotación de la trompa alrededor de su pedículo vascular es el evento fisiopatológico descrito, lo que provoca inicialmente la obstrucción del retorno venoso y linfático, con el consiguiente edema, ingurgitación y trombosis. Si la torsión progresa, y no se resuelve, se ve comprometida la vascularización arterial y se desencadena la necrosis del órgano y, finalmente la instauración de peritonitis, la conducta se basa en la viabilidad de la trompa: si no tiene signos de necrosis, la conducta indicada es destorcerla, si ya aparecieron signos de necrosis deberá ser extirpada.

INTRODUCTION: Isolated torsion of the Fallopian tube occurs in approximately one in every 50,000 to 1,500,000 women, therefore, it is an extremely rare condition. It was originally described by Bland-Sutton in 1890. The clinical picture is usually nonspecific and can mimic a wide variety of ailments. CLINICAL CASE: An 18-year-old patient who came to the emergency service for intense abdominal pain, which was decided to enter due to acute abdominal pain of possible gynecological etiology, an emergency laparoscopy was performed due to the possibility of a cystic torsion condition, During this, a laparoscopic image of the violaceous and crooked left tube is observed, as well as, a hemorrhagic paratubal cyst, violet in color; Due to the laparoscopic characteristics of the tube and the paratubal cyst that are related to necrosis of these elements, it was decided to perform a total left adnexectomy with cystectomy of the paratubal cyst. DISCUSSION: Rotation of the tube around its vascular pedicle is the described pathophysiological event, which initially causes obstruction of venous and lymphatic return, with the consequent edema, engorgement and thrombosis. If the torsion progresses and does not resolve, the arterial vascularization is compromised and the necrosis of the organ is triggered and, finally, the establishment of peritonitis, the behavior is based on the viability of the tube: if there are no signs of necrosis, the indicated conduct is to untwist it, if signs of necrosis have already appeared, it must be removed.

Unilateral non-rotated left kidney with vascular and ureter variations in a cadaver: a unique case report with embryological and educational aspects / Rim esquerdo unilateral sem rotação com variações vasculares e de ureter em cadáver: relato de caso com aspectos embriológicos e educacionais

Abstract The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.

Resumo Os rins e o ureter são estruturas retroperitoneais localizadas na parte superior do sulco paravertebral, inclinados contra as estruturas laterais das duas vértebras torácicas inferiores e das três vértebras lombares superiores. Assim, as superfícies anteriores e posteriores estão nas porções anterolateral e posteromedial, respectivamente. As anomalias congênitas do trato urinário frequentemente são causas subjacentes de patologias renais, e 40% delas ocorrem devido a variações no local, formato e tamanho dos rins, cálices, ureter ou bexiga. Este relato de caso descreve a presença de rim esquerdo unilateral sem rotação com variações vasculares e de ureter encontradas durante uma dissecção de cadáver rotineira com graduandos de Medicina. As alterações na rotação do rim e a sua relação com as estruturas no hilo têm grande importância clínica durante procedimentos cirúrgicos como a nefrectomia parcial, a cirurgia poupadora de néfrons e o transplante renal.

A propósito de un caso: útero miomatoso gigante torsionado / Torsion of a giant miomatous uterus: report of a clinical case autores

OBJETIVO: Reportar el caso de una torsión de útero, trompas y ambos ovarios a nivel de cuello uterino. Describir la patogenia, sintomatología y tratamiento, como un caso infrecuente y potencialmente grave, en la práctica clínica diaria. MATERIAL Y MÉTODOS: Analizar el curso de esta extremadamente rara patología, en una mujer postmenopáusica de 59 años. Se trata de un caso raro de torsión uterina en un útero no gestante, reportando los hallazgos en los exámenes previos a la cirugía y los hallazgos intraoperatorios e histopatológicos postcirugía. La resonancia magnética fue fundamental en el diagnóstico de la paciente y la laparotomía realizada demostró una torsión de cuerpo uterino de 360 ° a nivel de cérvix, y un gran mioma pediculado con signos de necrosis. Hemos revisado los últimos artículos de esta rara patología RESULTADOS Y DISCUSIÓN: La paciente fue operada. Se realizó una histerectomía total mediante una laparotomía media supra e infraumbilical. Los ovarios no tenían signos de necrosis. CONCLUSIONES: Debemos tener en cuenta esta posibilidad diagnóstica, en pacientes con aumento de tamaño uterino y clínica de dolor abdominal, ya que aunque es muy infrecuente, su diagnóstico es importante, ya que puede ser peligroso para la vida de la paciente.

OBJECTIVE: To report a case of torsion of the uterus, fallopian tubes and both ovaries around the uterine collum and the symptomatology, pathogenesis and treatment of this uncommon pathology. MATERIAL AND METHODS: The article analyses the course of this extremely rare pathology in a postmenopausical woman of 59 years. It is a rare case like a non gravid uterine torsion in a postmenopausical woman. We have the exams previous to the surgery, the finds intraoperative and the histolopathological reports postsurgery. RMN was the most important in diagnosis and the laparotomy showed a 360° an uterus increased on size and a big pedunculated myoma with signs of necrosis We have reviewed the latest articles on this strange pathology RESULTS AND DISCUSSION: The patient was operated. A infra-supra medium laparotomy was practiced and a total hysterectomy was made. Ovarians had not signs of necrosis. CONCLUSIONS: We must take into account, in patients with pathologies that increase uterine size and abdominal pain, the possibility of uterine torsion. Although it is a very infrequent pathology, its diagnosis is important, since it can be dangerous for the life of the patient

Vólvulo vesicular: un hallazgo quirúrgico / Vesicular volvulus: a surgical finding

Se describe el caso clínico de una paciente de 95 años de edad, quien acudió al Cuerpo de Guardia del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba por presentar dolor abdominal difuso, de comienzo súbito con 48 horas de evolución, acompañado de náuseas y vómitos de escasa cuantía y de coloración oscura, así como ligera distención abdominal, sin expulsión de heces ni gases. Se decidió su ingreso para tratamiento quirúrgico urgente, con el diagnóstico presuntivo de oclusión intestinal. Durante la cirugía se encontró la vesícula distendida con su pedículo torcido. Se realizó colecistectomía típica. La paciente evolucionó satisfactoriamente y no presentó complicaciones posoperatorias.

The case report of a 95 years patient is described, she went to the emergency department of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba due to a diffuse abdominal pain, of sudden beginning with 48 hours of clinical course, accompanied by nauseas and vomits of scarce quantity and dark color, as well as slight abdominal distention, without expulsion of stools neither gases. Her admission was decided for emergency surgical treatment, with the presumptive diagnosis of intestinal occlusion. During the surgery the distended gallbladder with bent pedicle was found. A typical cholecystectomy was carried out. The patient had a favorable clinical course and she didn't present postoperative complications.

Investigation of the role of rosmarinic acid treatment in regulating inflammation, cell damage, and angiogenesis in rat ovarian torsion and detorsion models

Abstract Purpose To investigate the protective effect of rosmarinic acid (RA) in ovarian ischemia/reperfusion injury using biochemical, histopathological, and immunohistochemical methods. Methods Wistar female rats (n = 32) were randomly divided into four groups: control, ischemia, ischemia-reperfusion, and ischemia-reperfusion with RA. Rosmarinic acid was given at a dose of 50 mg/kg by oral gavage three hours after reperfusion. Malondialdehyde (MDA) levels and glutathione peroxidase (GSH-Px) activities were determined in the ovary tissue homogenates for each rat. Results In the ischemia-reperfusion with RA group, the epithelial cells are regularly regulated at the periphery, and the degenerative changes in preantral and antral follicle cells are reduced. Follicle cells and cells in the corpus luteum showed a decrease in vascular endothelial growth factor (VEGF) expression, while VEGF demonstrated a positive reaction in vascular endothelial cells and stromal cells. The TNF-α expression due to the decreased degenerative effect and inflammation was positive in the macrophage cells. The expression of caspase-3 as an apoptosis change was negative in antral follicle cells and granular cells around the antral follicle. Conclusion Different doses of RA may be useful in preventing ischemic damage after vascularization, inflammation, and apoptotic development after ischemia/reperfusion.

Bazo errante gigante con torsión del pedículo e infarto esplénico: reporte de un caso / Giant Wandering Spleen with torsion of the pedicle and splenic infarction: a case report

INTRODUCCIÓN: El bazo errante, es una entidad clínica poco común. Su espectro clínico varía desde enfermedad asintomática hasta complicaciones asociadas y su manejo es predominantemente quirúrgico. CASO CLÍNICO: Hombre, con cuadro clínico de dolor y masa abdominal palpable, con hallazgos tomográficos sugestivos de patología con asiento en retroperitoneo, con obstrucción intestinal secundaria; por laparotomía se identifica de forma incidental bazo ectópico solo fijado a través de pedículo vascular torsionado y signos de hipertensión portal, realizándose esplenectomía. CONCLUSIONES: La torsión esplénica es la complicación más frecuente del bazo errante, una entidad bastante rara con muy pocos casos publicados en Colombia.

BACKGROUND: The wandering spleen is an uncommon clinical entity. Its clinical spectrum varies from asymptomatic disease to associated complications and its management is predominantly by surgery. CLINICAL CASE: Man with clinical picture of pain and palpable abdominal mass, with tomographic findings suggestive of pathology with retroperitoneal seating, with secondary intestinal obstruction; by laparotomy incidentally, an ectopic spleen is identified, only fixed through a torsioned vascular pedicle and signs of portal hypertension, performing splenectomy. CONCLUSIONS: Splenic torsion is the most frequent complication of the errant spleen, a very rare entity with very few cases published in Colombia.

Torsión aislada de trompa de falopio en niñas prepúberes / Isolated torsion of the fallopian tube in premenarcheal girls

La torsión aislada de la trompa de Falopio es una causa poco común de dolor abdominal agudo. Se describen dos casos clínicos de niñas prepúberes de 10 y 13 años de edad, con manifestaciones clínicas compatibles con apendicitis aguda, en quienes se evidenció torsión de la trompa derecha con signos de necrosis en la intervención quirúrgica. La existencia de esta entidad debe ser considerada en niñas con dolor abdominal agudo para evitar la lesión irreversible de la trompa.

Isolated torsion of the fallopian tube is a rare cause of abdominal pain. We report on two premenarcheal girls, ages 10 and 13 years, who presented with clinical manifestations compatible with acute appendicitis, in whom, torsion of the right tube with signs of necrosis was evidenced during surgical intervention. This condition should be considered in all girls with acute abdominal pain to avoid irreversible damage to the tube.

Isolated tubal torsion in the third trimester of pregnancy managed with simultaneous salpingectomy and cesarean section / 영남의대학술지

Isolated tubal torsion is an uncommon cause of acute abdomen in pregnancy. Tubal torsion may occur in the absence of adnexal disease. Diagnosing tubal torsion is especially difficult in pregnancy because no precise preoperative radiological and biochemical investigations have been conducted. Most patients are diagnosed during surgery. Here, I present a case of isolated tubal torsion in a pregnant woman at 35 weeks and 6 days of gestation that was managed with salpingectomy and cesarean section simultaneously.

Oophoropexy to the round ligament after recurrent adnexal torsion / Ooforopexia ao ligamento redondo em um caso de torção anexial recorrente

Abstract Recurrent adnexal torsion is a rare gynecological emergency. We report a case of recurrent ipsilateral adnexal torsion in a woman with polycystic ovaries, previously submitted to a laparoscopic plication of the utero-ovarian ligament. Due to the recurrence after the plication of the utero-ovarian ligament, the authors performed a laparoscopic oophoropexy to the round ligament, which is an underreported procedure. The patient was asymptomatic for 1 year, after which she had a new recurrence and needed a unilateral laparoscopic adnexectomy. Since then, she regained the quality of life without any gynecological symptoms. Oophoropexy to the round ligament may be considered when other techniques fail or, perhaps, as a first option in selected cases of adnexal torsion, as it may allow the prevention of recurrence without increasing morbidity while preserving the adnexa.

Resumo A torção anexial recorrente é uma emergência ginecológica rara. Os autores descrevem um caso de torsão anexial unilateral recorrente em uma paciente com síndrome de ovário policístico, previamente submetida a plicatura do ligamento utero-ovárico por laparoscopia. Nesta circunstância, os autores decidiram realizar uma ooforopexia laparoscópica ao ligamento redondo, uma técnica pouco descrita na literatura. A paciente manteve-se assintomática durante 1 ano, período após o qual teve nova recorrência, tendo-se decidido realizar uma anexectomia laparoscópica unilateral. Desde então, ela recuperou a qualidade de vida sem qualquer sintoma ginecológico. A ooforopexia ao ligamento redondo é uma técnica que deverá ser considerada quando outras falham e, em casos selecionados de torsão anexial recorrente, poderá ser considerada a primeira abordagem, para prevenir a recorrência e preservar o anexo.

Tumores ováricos en niñas y adolescentes / Ovarían masses in infant-juvenile age

Introducción. El tratamiento quirúrgico adecuado para las pacientes pediátricas con lesiones ováricas es heterogéneo, y en las niñas es conveniente conservar los ovarios. El objetivo de este estudio es analizar los hallazgos relacionados con un grupo de pacientes a las que se operó por lesiones ováricas. Pacientes y métodos. Un estudio retrospectivo realizado durante 13 años con 56 pacientes menores de 17 años. Estas pacientes se dividieron en 3 grupos según el diagnóstico de patología ovárica: 25 tenían lesiones funcionales (quistes y torsión), 18 tenían lesiones ováricas epiteliales y 13 tenían tumores germinales. Se comparó a estos tres grupos en términos de menarquia, torsión, edad, duración, tamaño, dolor, tumor, vómitos, menstruación irregular, ubicación y tipo de operación. Resultados. Enestosgrupos,fueronmásfrecuentes los quistes foliculares, los cistoadenomas serosos y los teratomas. La media de edad de las pacientes fue de 12,18 ± 4,84 años. Los síntomas y signos más frecuentes fueron dolor (85,7%) e hinchazón (37,5%) en la región abdominopélvica. Se observó torsión en 21 pacientes (37,5%); la media del tamaño del tumor fue de 10,46 ± 6,55 cm. Se realizó una salpingoovariectomía (SO, por sus siglas en inglés) en 38 pacientes y una resección del quiste (CE, por sus siglas en inglés) en 18 pacientes. Se observaron más casos de torsión en las pacientes premenárquicas que en las menárquicas y en el grupo de lesiones funcionales. Se realizaron más resecciones quirúrgicas en el grupo de lesiones funcionales, y más SO en los grupos de lesiones epiteliales y tumores germinales. Conclusión. Se considera que la torsión y las patologías ováricas funcionales son frecuentes en la edad premenstrual, y las lesiones malignas son muy raras en todos los grupos etarios, por lo que se recomienda preservar la fertilidad en la cirugía.

Introduction. The appropraite surgical treatment to pediatric patients with ovarian lesions are heterogeneous and ovarian preservation is desirable in children. The aim of this study is to the discuss findings related to a set of patients who were operated on for ovarian lesions. Patients and methods. A retrospective study carried out in 13 years on 56 patients under the age of 17. These patients were divided into 3 groups according to ovarian pathologic diagnosis: 25 with functional (cyts and torsion), 18 with epithelial ovarian lesions and 13 with germ cell tumours. These three groups were compared in terms of menarche, torsion, age, duration, size, pain, mass, vomiting, irregular menstruation, location and operation type. Results. Follicle cysts, serous cyst adenomas and teratomas were the most common in these groups. The mean age of the patients was 12.18+4.84 years. The most common symptoms and signs were abdominal-pelvic pain (85.7%) and swelling(37.5%). Torsion was seen in 21 patients (37.5%), mean mass size was found to be 10.46+6.55 cm. A salpingo-oophorectomy (SO) was performed in 38 patients and cyst excision (CE) was performed in 18 patients. In premenarcheal cases, torsion was seen more in menarcheal cases and in the functional lesion group. CE was performed more often in the functional and t SO was performed often in the epithelial and germ cells groups. Conclusion. Torsion and functional ovarian pathologies are thought to be common in premenstrual ages and malign lesions are very rare in all age groups so we recommend ovarian protective surgery should be preferred.

Investigation of Allium sativum's protective effect on ovarian reserve in an experimental ovarian injury model / Investigación del efecto protector de Allium sativum de la reserva ovárica en un modelo experimental de lesión ovárica

We aimed to evaluate the effects of detorsion and Allium sativum (garlic oil) treatment on the ovarian reserve in an ovarian torsion model. Ovarian torsion may lead to loss of ovarian tissue and infertility. It is an experimental rat study that was carried out on 16 sets of ovaries each, one for treatment group and a control group. In the control group, the procedure involved only the surgically opening and closing the abdomen. Bilateral adnexal torsion/detorsion was performed after a 3-hour ischemia period for the detorsion-only group. The detorsion + Allium sativum group received a 5 ml/kg dose of Allium sativum intraperitoneally, 2 hours before surgery. After the second surgery, removed ovarian samples were evaluated for follicle counts, damage scores and other parameters. Primordial, preantral, small antral and large antral follicle counts were significantly higher in the detorsion + Allium sativum group. Degeneration, congestion, hemorrhage ,inflammation and total damage scores were significantly elevated in the detorsion only group compared to those for the detorsion + Allium sativum group. Finally, there was a significant correlation between AMH alterations and postoperative, preantral follicle count (p<0.05). As a conclusion detorsion + Allium sativum treatment may be effective in protecting the ovarian reserve after torsion.

Intentamos evaluar los efectos de la detorsión y el tratamiento con Allium sativum (aceite de ajo) en la reserva ovárica en un modelo de torsión ovárica. La torsión ovárica puede ocasionar pérdida de tejido ovárico e infertilidad. Este es un estudio experimental en ratas que se llevó a cabo en 16 sets de ovarios para cada grupo: tratamiento y control. En el grupo control, el procedimiento involucró solamente la apertura y el cierre quirúrgicos del abdomen. La torsión / detorsión anexial bilateral se realizó después de un período de isquemia de 3 horas para el grupo de solo detorsión. El grupo de detorsión + Allium sativum recibió una dosis de 5 ml / kg de Allium sativum por vía intraperitoneal, 2 horas antes de la cirugía. Después de la segunda cirugía, las muestras ováricas eliminadas se evaluaron para recuentos de folículos, puntajes de daño y otros parámetros. Los recuentos de folículos antrales primordiales, preantrales, antrales pequeños y grandes fueron significativamente mayores en el grupo con detorsión + Allium sativum. Los puntajes de degeneración, congestión, hemorragia, inflamación y daño total fueron significativamente elevados en el grupo de solo detorsión, en comparación con los del grupo de detorsión + Allium sativum. Finalmente, hubo una correlación significativa entre las alteraciones de AMH y el recuento de folículos preantrales postoperatorios (p <0,05). Como conclusión, el tratamiento con detorsión + Allium sativum puede ser eficaz para proteger la reserva ovárica después de la torsión.

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].

Vólvulo de la vesícula biliar como causa de abdomen agudo: reporte de caso y revisión de la literatura / Gallbladder volvulus as a cause of acute abdomen: case report and literature review

Resumen Antecedentes: El vólvulo de la vesícula biliar se produce por el giro de la vesícula sobre su mesenterio a lo largo del eje del conducto y arteria císticos, con afectación de la irrigación vascular de forma completa o incompleta, pudiendo existir ciertas características anatómicas predisponentes. Caso clínico: Masculino de 87 años quien cursó con abdomen agudo; sospechando cuadro de piocolecisto, se realizó exploración quirúrgica encontrando como hallazgos triple torsión vesicular y múltiples litos color oscuro; se realizó colecistectomia abierta, cursando con una evolución satisfactoria. Discusión: Se trata de una entidad infrecuente que puede simular una colecistitis aguda; generalmente tiene buen pronóstico cuando el diagnóstico se realiza a tiempo. El tratamiento de elección es la colecistectomía laparoscópica.

Abstract Background: The gallbladder volvulus is produced by the rotation of the gallbladder over its mesentery along the axis of the cystic duct and artery, with involvement of vascular irrigation in a complete or incomplete way, and there may be certain predisposing anatomical characteristics. Clinical case: Male patient of 87 years who attended with acute abdomen, suspecting pyogenic cholecystitis, performs surgical exploration finding as vesicular triple twist, multiple stones dark. Open cholecystectomy is performed, following a satisfactory evolution. Discussion: It is an uncommon entity that can simulate acute cholecystitis, usually has a good prognosis, when the diagnosis is made on time. The treatment of choice is laparoscopic cholecystectomy.

Flexible ureterorenoscopy in position or fusion anomaly: Is it feasible? / Ureterorrenolitotripsia flexível no tratamento de cálculos em rins anômalos: Qual a viabilidade?

Summary Objective: To analyze the results of flexible ureterorenoscopy (F-URS) with holmium laser in the treatment of kidney stones with ectopic and fusion anomalies (horseshoe kidney and rotation anomalies). Method: We reviewed data from 13 patients with fusion and ectopic renal anomalies that underwent F-URS from April 2011 to April 2017. We analyzed demographic and clinical data (age, gender, BMI, anatomical abnormality, location and dimension of the renal calculi) and perioperative data (method of treatment, stone-free rate, number of days with DJ catheter and perioperative complications). Results: The mean stone size was 12.23 +/- 5.43 mm (range 6-22mm), located in the inferior (58.33%) and middle (16.76%) calyceal units, renal pelvis (16.67%) and multiple locations (8.33%). All 13 patients were treated with Ho-Yag laser, using dusting technique (25%), fragmentation and extraction of the calculi (58.33%) and mixed technique (16.67%). We did not have any severe perioperative complication. After 90 days, nine patients (75%) were considered stone free. Conclusion: Our data suggest that F-URS is a safe and feasible choice for the treatment of kidney stones in patients with renal ectopic and fusion anomalies.

Resumo Objetivo: Analisar os resultados da ureterorrenolitotripsia flexível (ULT-F) no tratamento de cálculos em rins com anomalia de posição e de fusão (rins em ferradura e rins com vício de rotação). Método: Realizamos a coleta prospectiva dos dados de 13 pacientes com anomalias de fusão e de posição submetidos a ULT-F entre abril de 2011 e abril de 2017. Analisaram-se dados clínicos (idade, gênero, IMC, anormalidades anatômicas, dimensão e localização dos cálculos) e perioperatórios (método de tratamento do cálculo, índice de stone free, tempo de cateter DJ e complicações perioperatórias). Resultados: Nos 13 pacientes, os cálculos mediam em média 12,23 mm +/- 5,43 mm (variando de 6 a 22 mm), em sua maioria distribuídos em apenas um grupo calicinal (58.33% em grupo calicial inferior, 16.67% em grupo calicial médio, 16,67% em pelve e 8,33% em múltiplos cálices). Todos os pacientes foram tratados com utilização de laser Ho-Yag, com fragmentação e retirada de cálculos em sete casos (58,33%), pulverização em três casos (25%) e técnica mista em dois casos (16,67%). Não houve complicações intraoperatórias ou pós-operatórias graves. Após 90 dias, nove pacientes tornaram-se stone free (75%). Conclusão: A ULT-F apresenta-se como método seguro e eficaz no tratamento de litíase em rins com anomalia de posição e de fusão.

Global Longitudinal Strain or Left Ventricular Twist and Torsion? Which Correlates Best with Ejection Fraction? / Strain Longitudinal Global ou Twist do Ventrículo Esquerdo e Torção? Qual se Correlaciona Melhor com a Fração de Ejeção?

Abstract Background: Estimative of left ventricular ejection fraction (LVEF) is a major indication for echocardiography. Speckle tracking echocardiography (STE) allows analysis of LV contraction mechanics which includes global longitudinal strain (GLS) and twist/torsion, both the most widely used. Direct comparison of correlations between these novel parameters and LVEF has never been done before. Objective: This study aims to check which one has the highest correlation with LVEF. Methods: Patients with normal LVEF (> 0,55) and systolic dysfunction (LVEF <0,55) were prospectively enrolled, and underwent echocardiogram with STE analysis. Correlation of variables was performed by linear regression analysis. In addition, correlation among levels of LV systolic impairment was also tested. Results: A total of 131 patients were included (mean age, 46 ± 14y; 43%, men). LVEF and GLS showed a strong correlation (r = 0.95; r2 = 0.89; p < 0.001), more evident in groups with LV systolic dysfunction than those with preserved LVEF. Good correlation was also found with global longitudinal strain rate (r = 0.85; r2 = 0.73; p < 0.001). Comparing to GLS, correlation of LVEF and torsional mechanics was weaker: twist (r = 0.78; r2 = 0.60; p < 0.001); torsion (r = 0.75; r2 = 0.56; p < 0.001). Conclusion: GLS of the left ventricle have highly strong positive correlation with the classical parameter of ejection fraction, especially in cases with LV systolic impairment. Longitudinal strain rate also demonstrated a good correlation. GLS increments analysis of LV systolic function. On the other hand, although being a cornerstone of LV mechanics, twist and torsion have a weaker correlation with LV ejection, comparing to GLS.

Resumo Fundamento: A estimativa da fração de ejeção do ventrículo esquerdo (FEVE) é uma das pincipais indicações para a ecocardiografia. Speckle tracking (ST) permite a análise da mecânica de contração do VE que inclui a deformação (strain) longitudinal global (SLG) e o twist / torção, sendo ambos os mais utilizados. A comparação direta de correlações entre esses novos parâmetros e a FEVE nunca foi feita antes. Objetivo: Verificar qual delas tem a maior correlação com a FEVE. Métodos: Pacientes com FEVE normal (> 0,55) e disfunção sistólica (FEVE < 0,55) foram prospectivamente inscritos e submetidos a ecocardiograma com análise do ST. A correlação das variáveis foi realizada por análise de regressão linear. Além disso, também foi testada a correlação entre os níveis de comprometimento sistólico do VE. Resultados: Foram incluídos 131 pacientes (média de idade de 46 ± 14 anos e 43% de homens). A FEVE e SLG apresentaram forte correlação (r = 0,95; r2 = 0,89; p < 0,001), mais evidente em grupos com disfunção sistólica do VE do que naqueles com FEVE preservada. Também foi encontrada boa correlação com a taxa de deformação (strain rate) longitudinal (SRL) global (r = 0,85; r2 = 0,73; p < 0,001). Comparando-a à SLG, a correlação entre FEVE e mecânica de torção foi mais fraca: twist (r = 0,78; r2 = 0,60; p < 0,001); Torção (r = 0,75, r2 = 0,56, p < 0,001). Conclusão: A SLG do ventrículo esquerdo apresenta alta correlação positiva com o parâmetro clássico de fração de ejeção, principalmente nos casos de comprometimento sistólico do VE. O SRL também demonstrou uma boa correlação. A SLG incrementa a análise da função sistólica do VE. Por outro lado, apesar de ser a pedra angular da mecânica do VE, o twist e a torção têm uma correlação mais fraca com a ejeção do VE, quando comparados ao SLG.