Concept of cervical ectopy/Quruhal Rahim in Unani system of medicine: a review

Cervical ectopy is one of the commonest gynecological conditions seen in OPD’s, about 80-85% of women suffer from cervical ectopy during their life time. Many a times, it is an accidental finding in an asymptomatic woman coming for routine gynecological examination. Although it is a benign lesion, but may predispose to complications like infertility, cervical intraepithelial neoplasm, risk of various sexually transmitted infections like C. trachomatis, N. gonorrhoea, human papilloma virus, human immunodeficiency virus, cytomegalovirus and shows malignant changes as it progresses. Ectopy occurs when the columnar epithelium lining the endocervix, extends onto the ectocervix. As the disease takes 10-20 years to progress from pre invasive to invasive disease, preventive measures such as screening and treatment modalities should be adopted. Early diagnosis of cervical ectopy is important for its effective management and for prevention of its long-term sequel. The treatment option available in conventional medicine includes surgical procedure either electro or, cryocautery, but have their own complications. Hence, this treatment is limited due to its complications and contraindications and need for safer alternate therapy. In Unani system of medicine, various formulations are available as treatment of quruhal rahim, which have been recommended to be used locally in the form of humool for immediate healing of wound, exhibiting the properties of anti-inflammatory (muhallile warm), desiccant (mujaffif), wound healing (mundamile qurooh), sedative (musakkin), antiseptic (dafa’e ta’ffun) etc. This review article gives a detailed description of cervical ectopy as mentioned in classical Unani text including its etiopathogenesis, clinical presentation and principles of treatment as well as evidence-based Unani medicine.

Caracterización del tejido columnar del cérvix mediante espectroscopia de impedancia eléctrica y modelado computacional / Characterization of cervical columnar tissue through electrical impedance spectroscopy and computer modeling

RESUMEN Introducción: En este artículo se presenta la utilización de la espectroscopia de impedancia eléctrica (EIE) en la caracterización del tejido columnar cervical y como herramienta de apoyo a las técnicas diagnósticas del cáncer de cuello uterino. Métodos: Se realizó un estudio de validez diagnóstica a 30 pacientes no menopáusicas que presentaron ectopia cervical durante la colposcopia. Se obtuvieron 129 espectros de impedancia eléctrica de tejido columnar, que fueron diferenciados en cuatro zonas o puntos de toma de medidas, semejantes a las zonas horarias 12, 3, 6, y 9 de un reloj análogo. Los datos experimentales obtenidos fueron ajustados al modelo de Cole-Cole, que describe la fisiología y estructura del tejido mediante parámetros eléctricos de resistividad R y S, frecuencia característica Fc y capacitancia de membrana Cm. Resultados: La comparación entre tejidos columnares sanos y con lesión en cada uno de los puntos de medida se realizó mediante pruebas no paramétricas U de Mann-Whitney, que mostraron diferencias estadísticamente significativas (p <0,05) para las medianas de R y S, con un nivel de confianza del 95%. Los valores promedio de R y S para tejido columnar sano fueron 2,0 Ω-m y 11,36 Ω-m, con desviación estándar 0,41 y 0,51 respectivamente; mientras que para los tejidos con lesiones el valor promedio R y S fueron de 4,21 Ω-m y 7,03 Ω-m, con desviación estándar 0,40 para ambas medidas. Conclusión: Se encontró que la resistividad del líquido extracelular R y la resistividad de la matriz intracelular S son las que mejor discriminan entre epitelios columnares sanos y aquellos afectados por lesiones.

ABSTRACT Introduction: Thi s pape r shows the implementation of Electrical Impedance Spectroscopy (EIS) in the characterization of the cervical columnar tissue and as a supporting tool to the diagnostic techniques of cervical cáncer Methods: A diagnostic validity study was performed on 30 non-menopausal patients who presented cervical ectopy during colposcopy. A total of 129 electric impedance spectra of columnar tissue was obtained, which were differentiated into four measurement zones or points similar to time zones 12, 3, 6, and 9 of an analog clock. The experimental data obtained were adjusted to the Cole-Cole model which describes the physiology and structure of the tissue through electrical resistivity parameters R and S, characteristic frequency Fc and membrane capacitance Mc. Results: The comparison between healthy and damaged columnar tissue at each of the measurement points was performed using non-parametric Mann-Whitney U tests which showed statistically significant differences (p <0.05) for the R and S medians with a 95% confidence level. The average values of R and S for healthy columnar tissue were 2.0 Ω-m and 11.36 Ω-m, with 0.41 and 0.51 standard deviation respectively, whereas for a damaged tissue the average value of R and S were 4.21 Ω-m and 7.03 Ω-m, with 0.40 standard deviation for both measurements. Conclusions: It was found that the resistivity of the extracellular liquid R, and the resistivity of the intracellular matrix S, are the parameters that better discriminate between healthy columnar epithelia and those affected by lesions.

Glándula tiroides lingual: diagnóstico y tratamiento / Lingual thyroid gland: diagnosis and treatment

La presencia de glándula tiroidea ectópica es una entidad rara. La tiroides lingual es la ectopía mas frecuente, predominando en mujeres. Este tejido glandular es pasible de sufrir todas las patologías que pueden afectar a la glándula normotópica, pudiendo ser sintomática o asintomática. Se presenta un caso de tiroides lingual en una paciente previamente tiroidectomizada que consultó por disnea y disfagia en la unidad de Cirugía de Cabeza y Cuello del Servicio de Otorrinolaringología del Hospital Central del Instituto de Previsión Social, Asunción, Paraguay. La paciente recibía tratamiento hormonal de reemplazo,mostrando examen funcional normal. La semiología permitió observar un abombamiento de la base de la lengua. La fibroscopía mostró un tumor en base de lengua de unos 3 cm de diámetro, que pudo evaluarse correctamente con una tomografía computada. Ante la sospecha de una tiroides lingual se realizó un centellograma que demostró captación en piso de cavidad oral. Se realizó excéresis tumoral a través de una faringotomía suprahioidea, previa traqueostomía proofiláctica. El informe de Anatomía Patológica confirmó el diagnóstico de bocio coloide ectópico.

The presence of ectopic thyroid gland is a rare entity. The lingual thyroid is the most frequent ectopy, predominating in women. This glandular tissue is capable of suffering all the pathologies that can affect the normotopic gland, being able to be symptomatic or asymptomatic. We present a case of lingual thyroid in a previously thyroidectomized patient who consulted for dyspnea and dysphagia in the Head and Neck Surgery Unit of the Otolaryngology Service of the Central Hospital of the Institute of Social Prevision, Asuncion, Paraguay. The patient received hormone replacement therapy, showing normal functional examination. Semiology allowed to observe a bulging of the base of the tongue. The fibroscopy showed atongue-based tumor about 3 cm in diameter, which could be correctly evaluated with computed tomography.Suspicion of a lingual thyroid was performed with a scintigram demonstrating uptake in the oral cavity floor.Tumor excision was performed through a suprahyoid pharyngotomy, following a prophylactic tracheostomy.The Pathologic Anatomy report confirmed the diagnosis of ectopic colloid goitre.

Prolapso uterino em gata - Relato de caso / Uterine prolapse in a cat - A case report / Prolapso uterino en gata ­ Relato de caso

O prolapso uterino em cadelas e gatas é uma emergência reprodutiva na qual ocorre eversão de um ou ambos os cornos uterinos através da vagina, durante ou após o parto. Tal patologia não é frequente em gatas, por isso o presente relato tem o objetivo de descrever um caso de prolapso uterino em uma gata atendida no Hospital Veterinário da Universidade Federal do Piauí. Na anamnese o proprietário se queixou de massa avermelhada na vulva após a expulsão de dois filhotes. Ao exame clínico, observou-se que a massa era o útero prolapsado. O animal foi encaminhado imediatamente ao centro cirúrgico para redução do útero prolapsado e realização de ovariosalpingohisterectomia (OSH). Após a OSH, o animal permaneceu internado durante 24 horas. Findo este período o animal teve alta e apresentou boa recuperação.

Uterine prolapse in dogs and cats is a reproductive emergency in which there is the protrusion of one or both uterine horns through the vagina during or after delivery. This condition is not common in cats, so this report aims to describe a case of uterine prolapse in a cat treated at the Veterinary Hospital of the Federal University of Piaui. Upon anamnesis, the owner complained of a reddish mass in the vulva after the expelling of two kittens. Clinical examination revealed that the mass was the prolapsed uterus. The animal was immediately sent to the operating room for reduction of the prolapsed uterus and an ovariosalpingohisterectomy (OSH) was performed. After OSH, the animal remained hospitalized for 24 hours. After this period, the animal was discharged and recovered well.

El prolapso uterino en perras y gatas es una emergencia reproductiva en la cual ocurre eversión de uno o ambos los cuernos uterinos a través de la vagina, durante o después del parto. Tal patología no es común en gatas, este informe tiene como objetivo describir un caso de prolapso uterino en una gata tratada en el Hospital Veterinario de la Universidad Federal de Piauí. En la anamnesis el propietario se quejó de una masa rojiza en la vulva después de la expulsión de dos gatitos. El examen clínico reveló que la masa era el prolapso de útero. El animal fue enviado de inmediato al centro quirúrgico para reducción del prolapso de útero y realización de ovariosalpinghisterectomía (OSH). Después de realizada la OSH, el animal permaneció hospitalizado durante 24 horas. Después de este período, el animal fue dado de alta y se recuperó bien.

The research on the different expression of matrix metalloproteinase-9 in cervical columnar ectopy and cervical intraepithelial neoplasia / 中国医师进修杂志

Objective To explore the different probability of carcinoma and the necessity of treatment in cervical columnar ectopy (CCE),normal smooth cervix and cervical intraepithelial neoplasia(CIN) by investigating the different expression of matrix metalloproteinase-9(MMP-9).Methods The expression of MMP-9 was detected by using immunohistochemical method in 30 cases of CCE,28 cases of CIN and 30 cases of normal smooth cervix from 2007 to 2012.Results The positive expression of MMP-9protein in CIN was 96.4％ (27/28),CCE was 23.3％ (7/30) and normal smooth cervix was 20.0％ (6/30)respectively.The positive expression of MMP-9 protein was higher in CIN than CCE and normal smooth cervix,the difference has statistical significance (P＜ 0.01),there was no significant difference between CCE and normal smooth cervix (P ＞ 0.05).Conclusions CCE,which was a physiological performance of cervical erosion,should not be overtreated.But the women of childbearing age should be routinely performed in cervical cancer screening.

Carcinoma renal de células claras en riñón ectópico presacro / Clear cell renal carcinoma in pre-sacrum ectopic kidney

A pesar de ser la ectopia renal una anomalía usual y el carcinoma de células claras la neoplasia renal más frecuente, existen muy escasos reportes de presentación simultánea de ambas condiciones. Se notificó una paciente, con estas características, que fue tratada quirúrgicamente y mantuvo una evolución satisfactoria

In spite of the fact that the renal ectopy is a common anomaly and the clear cell carcinoma is the more frequent renal neoplasm, there are not many reports on a simultaneous presentation of both conditions. There was the case of a female patient presenting these features and that was operated on with a satisfactory course

Metaplasia ósea endometrial: reporte de casos y revisión de la literatura / Osseous metaplasia of the endometrium: case reports and literature review

Objetivo: presentar dos casos y revisar la literatura acerca de la etiología de la enfermedad y los métodos utilizados para su diagnóstico. Casos clínicos: los casos fueron atendidos en el Hospital de San José, Hospital Universitario de referencia de tercer nivel de atención, a donde llegaron remitidas, por infertilidad y dolor pélvico crónico, dos pacientes. Sus ecografías mostraban imágenes hiperecogénicas en endometrio. Se les realizó histeroscopia, encontrando múltiples formaciones óseas flotantes en cavidad endometrial, extraídas con pinza grasper, cuyos cortes histológicos confirmaron el diagnóstico de metaplasia ósea endometrial. La primera mujer quedó en estado de embarazo 8 meses después de la intervención, finalmente tuvo un recién nacido a término sano. La segunda mujer inició dos embarazos que terminaron en abortos tempranos completos. Materiales y métodos: se realizó una búsqueda electrónica en las bases de datos Medline vía PubMed, SciELO y Ovid, en donde se incluyeron artículos publicados en los últimos 15 años. Conclusión: la metaplasia ósea es un problema de diferenciación celular, de las células madre estromales del endometrio secundario, a raíz de una deficiencia de superóxido dismutasa. Esta entidad se sospecha por ecografía transvaginal y se debe diagnosticar y tratar con histeroscopia.

Objective: presenting two cases and reviewing the pertinent literature concerning the methods used in diagnosing the entity and its etiology. Clinical cases: the cases were attended in the third-level San José teaching hospital where they had been referred due to infertility and chronic pelvic pain. Their echographies revealed hyperechogenic images in the endometrium. Hysteroscopy was performed, revealing multiple osseous formations floating within the endometrial cavity; these were extracted with grasper tweezers and their histological sections confirmed a diagnosis of osseous metaplasia of the endometrium. The first woman became pregnant 8 months later, delivering a healthy newborn at full-term; the second woman became pregnant twice but her attempts ended in complete early abortions. Materials and methods: a search was made of MEDLINE databases via PUBMED, SciELO and Ovid, including articles published during the last 15 years. Conclusion: osseous metaplasia is a cause of infertility involving cellular differentiation of secondary endometrial stromal (stem) cells leading to superoxide dismutase deficiency; this is suspected by transvaginal echography (ultrasound) and should be diagnosed and treated with hysteroscopy.

A Case of Congenital Single Ectopic Kidney in Pelvis of Patients with Proteinuria / 대한신장학회잡지

Congenital anomalies of the genitourinary tract are the most common organ system anomalies. Ectopic kidney in pelvis is a kidney located outside the renal fossa, failed migration of ureteral bud and developing metanephric blastema to the renal fossa and rare fusion anomaly of the kidneys characterized by the presence of a displaced, lobulated pelvic renal mass. Herein we report a rare case of a patient presenting with single kidney in pelvis, review literatures and discuss prognosis of this case.

RESULTS OF TWENTY FOUR HOURS AMBULATORY MONITORING OF ELECTROCARDIOGRAM AND EXERCISE STRESS TESTING IN PVC SCHOOL CHILDREN WITHOUT ORGANIC HEART DISEASE / 体力科学

Twenty four hours ambulatory monitoring of electrocardiogram and exercise stress testing were performed in 60 children who were refered to our hospital because of isolated premature ventricular contractions (PVCs) .<BR>Complex ventricular ectopy was found in 28 out of 60 PVC children. Out of 28 subjects with complex ventricular ectopies 21 had PVCs originated from the right ventricle.<BR>Frequency of PVCs per day was high in primary ventricular tachycardia and low in ventricular tachycardia with organic heart disease and there was statistical significance (p<0.01) between these two groups.<BR>There was no characteristics in coupling interval, prematurity index and vulnerability index which could specify ventricular tachycardia, couplets PVCs and isolated PVC.<BR>VT rate in exercise stress testing was higher than that in twenty four hours ambulatory monitoring of electrocardiogram (Holter recording) . Both exercise stress testing and twenty four hours monitering of electrocardiogram should be done to control VT school children.