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

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

Torsión anexial: presentación clínica y manejo en una serie retrospectiva de 17 años

Objetivos: Analizar y presentar la epidemiología descriptiva de pacientes con antecedente de torsión anexial. Diseño: Estudio observacional, descriptivo y retrospectivo. Institución: Hospital Universitario Doctor Peset, Valencia, España. Participantes: Mujeres diagnosticadas de torsión anexial. Intervenciones: Diagnóstico y tratamiento de 54 mujeres de entre 11 y 64 años entre el 1/02/1997 y 30/06/2014. Resultados: En las 54 pacientes incluidas, la edad media al diagnóstico fue 31,7 años; 6 (11 ,1 %) pacientes habían sido intervenidas quirúrgicamente por patología anexial previa. El anexo más afectado fue el derecho; 34 (62,9%) pacientes presentaban masas anexiales. El síntoma de presentación en todas las pacientes fue el dolor pélvico agudo, y el tiempo medio transcurrido desde la aparición de la clínica hasta el trata­ miento fue de 24 a 72 horas. En 14 (25,9%) pacientes se realizó laparotomía y en 40 (74,1%) laparoscopia; 3 (5,6%) pacientes presentaron recidiva de la torsión de forma posterior. Conclusiones: El cuadro de torsión anexial debe tenerse en cuenta en toda mujer que acude a urgencias con dolor abdominal agudo. Esta patología es considerada una urgencia quirúrgica, y un retraso en el diagnóstico y tratamiento puede dar lugar a la pérdida del anexo afecto. Hoy en día, la vía laparoscópica es la de elección para su tratamiento en estas pacientes.

Objectives: To present the descriptive epidemiology in a group of women with adnexal torsion. Design: Observational, descriptive and retrospective study. Setting: Hospital Universitario Doctor Peset, Valencia. Spain. Participants: Women diagnosed of adnexal torsion. Interventions: Between February 1997 and june 2014, 54 patients 11-64 years old with adnexal torsion were included. Results: The mean onset age was 31.7 years old. Previous adnexal surgerywas reported in 6 cases (11.1 %). The right adnexal region was the most affected; 34 (62.9%) patients were adnexal mass carriers. The most common presenting symptom was acute pelvic pain, and the mean lag time between onset of symptoms and confirmation of diagnosis was 24-72 hours. Fourteen (25.9%) patients were treated by laparotomy and 40 (74.1 %) by laparoscopy. Recurrence occurred in 3 patients (5.6%). Conclusions: Adnexal torsion should be considered in everywoman complaining of pelvic pain in emergency services. A prompt surgical intervention is required to avoid irreversible ovarian damage. Nowadays, conservative therapy by laparoscopy is preferred in these patients.

Ultrasonography of adnexal causes of acute pelvic pain in pre-menopausal non-pregnant women

Acute-onset pelvic pain is an extremely common symptom in premenopausal women presenting to the emergency department. After excluding pregnancy in reproductive-age women, ultrasonography plays a major role in the prompt and accurate diagnosis of adnexal causes of acute pelvic pain, such as hemorrhagic ovarian cysts, endometriosis, ovarian torsion, and tubo-ovarian abscess. Its availability, relatively low cost, and lack of ionizing radiation make ultrasonography an ideal imaging modality in women of reproductive age. The primary goal of imaging in these patients is to distinguish between adnexal causes of acute pelvic pain that may be managed conservatively or medically, and those requiring emergency/urgent surgical or percutaneous intervention.

The influence of detorsion of adnexal torsion on melondialdehyde, peroxidase catalase, and catalase of ovarian tissue in rabbits / 解放军医学杂志

Objective To observe the influence of reperfusion after adnexal torsion (AT) on malondialdehyde (MDA), glutathione peroxidase catalase (GSH-Px) and catalase (CAT) contents of ovarian tissue in rabbits. Methods Forty female Japanese long-eared white rabbits were randomly divided into study group (n=32) and control group (n=8). The left adnexa of rabbits in the study group was clockwise twisted three laps, and then fixed on the left abdominal walls. Adnexal detorsion was then done 24 hours after adnexal torsion in the study group, and then the rabbits were divided into 4 groups (8 each). Both ovaries of each group were removed 24h, 48h, 72h and 96h, respectively, after reperfusion. The rabbits in the control group received sham-operation and both ovaries were removed 96h later. The removed left ovaries were used for biochemical detection of GSH-Px, CAT and MDA. All the right ovaries were used as experimental internal-control. Results The activity of GSH-Px declined significantly 24h to 72h after adnexal detorsion (P0.05). The activity of CAT declined significantly 24h and 48h after adnexal detorsion (P0.05). Conclusions Detorsion after adnexal torsion can affect the degree of oxidative stress injury in rabbits' ovaries as shown by the changes in the activities of GSH-Px, CAT and MDA. With the elongation of detorsion time, ovarian injury will be gradually alleviated.

Magnetic resonance imaging findings in adnexial torsion / Achados da ressonância magnética na torção anexial

Adnexial torsion is an unusual event, but a major cause of abdominal pain in women. It is often associated with ovarian tumor or cyst, but can occur in normal ovaries, especially in children. The twisting of adnexial structures may involve the ovary or tube, but frequently affects both. In most cases, it is unilateral, with slight predilection for the right side. In imaging findings, increased ovarian volume and adnexial masses are observed, with reduced or absent vascularization. In cases of undiagnosed or untreated complete twist, hemorrhagic necrosis may occur leading to complications; in that, peritonitis is the most frequent. Early diagnosis helps preventing irreversible damage with conservative treatment, thereby saving the ovary. Limitations in performing physical examination, possible inconclusive results in ultrasound and exposure to radiation in computed tomography makes magnetic resonance imaging a valuable tool in emergency assessment of gynecological diseases. The objective of this study was to report two confirmed cases of adnexial twist, emphasizing the contribution of magnetic resonance imaging in the diagnosis of this condition.

A torção anexial é um evento incomum, porém constitui importante causa de dor abdominal em mulheres. Está frequentemente associada a tumor ou cisto ovariano, mas pode ocorrer em ovários normais, principalmente em crianças. A torção de estruturas anexiais pode envolver o ovário ou a tuba, mas geralmente acomete ambos. Na maioria dos casos, é unilateral, com discreta predileção pelo lado direito. Como achados de imagem, observam-se massas ovarianas e aumento do volume ovariano, com redução ou ausência de sua vascularização. Se a torção for completa e não diagnosticada ou tratada, pode ocorrer necrose hemorrágica, evoluindo com complicações, sendo a peritonite a mais frequente. O diagnóstico precoce ajuda a prevenir danos que são irreversíveis com tratamento conservador, poupando-se o ovário. A limitação do exame físico, a possibilidade de resultados inconclusivos pela ultrassonografia e a exposição à radiação pela tomografia computadorizada fazem da ressonância magnética um complemento valioso na avaliação de emergência das doenças ginecológicas. O objetivo deste trabalho foi relatar dois casos confirmados de torção anexial, enfatizando a contribuição da ressonância magnética no diagnóstico dessa entidade.

Clinical observation of laparosopy operation on the treatment of uterine appendages lump / 中国基层医药

Objective To evaluate the advantage of uterine appendages lump operation by laparoscopy and the choose of the patient. Methods 215 cases of ovrarian tumor operation and fallpian tubes operation by laparoscopy,50 cases of similar period and similar operation indication were chosen by laparoscopy or by abdorminial operation apiece, blood loss, postoperative analgesic rate, the time of using antibiotics, hospitalization day were compared. Results Uterine appendages lump operation by laparoscopy were all operated successfully, compared with abdorminial operation, the laparoscopy group had less blood loss,less drug after operation,less pain, shortened hospitalization day.Conclusion As long as choosing the appropriate cases before the operation, uterine appendages lump operation by laparoseopy has the advantage of minimal trauma, recovery fastly,less postoperative complication and safety.

Expression of neuropeptide Y and its receptors in the cardinal ligaments and uterosacral ligaments in patients with pelvic organ prolapse / 中华妇产科杂志

Objective To evaluate the distribution of neuropeptide Y and its receptors in the cardinal ligament and uterosaeral ligaments in women with and without pelvic organ prolapse(POP).Methods Sixteen patients with pelvic organ prolapse entered the study.All patients were evaluated by pelvic organ prolapse quantitation(POP-Q).Group A consisted of six patients with grade Ⅰ,Ⅱ POP,and group B comprised ten patients with grade Ⅲ,Ⅳ POP.Eight nonfunctional ovarian tumor patients without POP were recruited as control subjects.Biopsies of cardinal ligament and uterosacral ligament were obtained from each woman during surgery.Immunohistochemical study with polyclonal antibody against a general nerve marker S-100 and neuropeptide Y was performed on paraffin-embedded sections of all the samples.In addition,mRNA levels of the human NPY-Y1 and NPY-Y2 receptors were assessed in both patients and controls.Results (1)NPY immunoreactivities were identified in both cardinal ligament and uterosacral ligament. NPY immunoreactive nerve fibers were insignificantly lower in POP patients(P＞0.05).The distribution pattern of NPY was similar in cardinal ligament and uterosacral ligament ( P＞0. 05 ). (2)mRNAs encoding the NPY-Y1 and NPY-Y2 receptors were detected in the pelvic supporting tissues. Besides the expected NPY-Y1 PCR products, an additional 97 bp long amplicon originating from an alternative splicing event was found in most tissues studied. (3)In cardinal ligaments, mRNA encoding NPY-Y1 receptor had a significant difference between group A(3.9±1.0)and B (6. 0±1.5), and between control (3.4±0.9) and group B (P = 0. 019,P = 0. 004), while there was no significant difference between group A and controls(P =0. 082). In uteresacral ligaments, mRNA encoding NPY-Y1 receptor had no significant difference between Group A(6. 0±1.1) and B (6. 3±0. 7), or between group A and controls(4. 8±0. 7;P = 0. 151 ,P = 0. 690);while there was a significant difference between group B and controls (P = 0. 016).(4) mRNA encoding NPY-Y2 receptor had no significant difference between controls (0. 49±0. 34, 0. 61±0. 15 ), group A (0. 56±0. 21,0. 67±0. 13) and group B (0. 85±0. 43, 0. 69±0. 21 ) patients in cardinal ligament and uterosacral ligaments ( P＞0. 05 ). (5) mRNA encoding NPY-Y1 ( P = 0. 084 ) and NPY-Y2 (P=0.470) receptors had no significant difference between cardinal ligament and uterosacral ligament.Conclusions There are NPY and NPY receptors in cardinal and uterosacral ligaments. The increased expression of NPY Y1 receptor may be related to local blood flow reduction and structural changes of pelvic supporting tissue.

Changes of collagen content in uterine ligaments of perimenopausal women with relaxation of pelvic supports / 中华妇产科杂志

Objective To investigate the changes in histological characteristics and collagen content in uterosacral and cardinal ligaments of pefimenopausal women in relation to relaxation of pelvic supports.Methods Twenty-eight subjects undergoing hysterectomies were selected,in which 14 cases were perimenopausal women with relaxation of pelvic support as the relaxation group and 14 women at perimenopansal age with leomyoma,cervical cancer,adenomyosis as the control group.Samples of cardinal ligaments and uterosacral ligaments were obtained at hysterectomies,and the tissues were shced and stained bv Masson's trichrome technique.Histological characteristics of the samples were studied and immunohistochemistry assay was applied to demonstrate the contents of collagen types I andⅢ.Results (1)The collagen in uterosacral ligaments and cardinal ligaments were stained blue by tlle MaSson's trichome technique.In comparison to the control group,the relaxation group had milder positive stains of the collagen and the stains were distributed in unequal intensities.Collagen content was arranged in loose pattern.Focal arrangement of the collagen was dense but fragmented.Collagen fibers were atrophic. (2)In immunohistochemistry assay and image analysis,collagen was positive in light to deep brown areas.In the relaxation group,positive units of collagen types I and III in cardinal ligaments were 13.8±2.1 and 9.6±2.4 respectively.Positive units of coHagen types I and Ⅲ of cardinal ligaments in the control group were 27.4 ±3.5 and 17.7 ±4.0 respectively.Difierences between these two groups were statistically significant (P<O.01).In the relaxation group,positive units of collagen types I and IU in utero-sacral ligaments ligaments of the control group were 29.5 ±4.4 and 19.3 ±4.6 respectively.Differences between these two groups were statistically significant(P<0.01). Conclusions Reductions in collagen types I and Ⅲ occur in pelvic floor tissue of perimenopausal patients who suffer from pelvic support relaxation.Atrophic and degenerative changes of collagen fibers may be the basic pathological structural alteration in pelvic floor.

A Granulocytic Sarcoma of Right Uterine Adnexa Region as an Extramedullary Relapse in a Patient with Chronic Myeloid Leukemia / 대한진단검사의학회지

Granulocytic sarcoma of the uterine adnexa is a rare event. A 50-year-old woman, who had previously been diagnosed as chronic myeloid leukemia (CML), but had a complete hematologic response, presented with lower abdominal pain and a large pelvic mass involving the right uterine adnexa region and extending to the right posterior wall of the bladder and right distal ureter. A biopsy of the uterine adnexa revealed granulocytic sarcoma, and a subsequent bone marrow biopsy confirmed the diagnosis of CML in the blastic phase.

Selected Adnexal Cystic Masses in Postmenopausal Women Can be Safely Managed by Laparoscopy

The aim of this study was to assess the efficacy and safety of laparoscopic treatment for adnexal cystic masses that were predicted to be benign in postmenopausal women. Postmenopausal women found to have an adnexal cystic mass were retrospectively evaluated with transvaginal ultrasonography, and serum CA-125 levels. The selection criteria were adnexal cystic masses greater than 3 cm but less than 10 cm, the masses were in the benign range (4-8) of Sassone's scoring system for transvaginal ultrasonography, and the patients had serum CA-125 levels less than 65 IU/mL. Two hundred nineteen women fulfilled the criteria and underwent operative laparoscopy. Almost all the masses (99.5%) were accurately predicted to be benign except for one borderline ovarian tumor. Two hundreds thirteen (97.3%) women were successfully managed by operative laparoscopy and six (2.7%) required laparotomy. For the patients managed by laparoscopy, the mean operative time was 51.3 min; the mean hospital stay was 2.5 days. There was no significant morbidity and surgery-related mortality. The combination of the Sassone's scoring system for transvaginal ultrasonography and serum CA-125 level can accurately predict benign cystic masses, and operative laparoscopy is technically feasible and safe for the management of adnexal mass in postmenopausal women.