The impact of HSF on endometrium

Summary Objective: We conducted the research in order to explore the impact of hydrosalpinx fluid (HSF) on endometrium. Method: HSF group: 261 patients with HSF scheduled to undergo laparoscopic surgery 3 to 7 days after menstruation in our center. Hysteroscopy would also be performed in order to observe the endometrial morphology during the surgery. Sixty (60) patients would be randomly selected for endometrial biopsy in order to detect the inflammatory cytokines TNF-a and IL-2 mRNA. Non-HSF group: 210 patients with no evidence of HSF due to chronic salpingitis or pelvic adhesion. IVF-ET treatment was performed after eliminating the factor of male infertility and hysteroscopy was conducted before the treatment. Fifty (50) patients underwent endometrial biopsy in order to detect TNF-a and IL-2 mRNA. Results: Hysteroscopy was performed in 261 patients with HSF and 210 patients without HSF. The incidence rate of endometritis manifestation among these two groups of patients was 37.2% (97/261) and 20.5% (43/210), respectively. The incidence rate of endometritis in the patients with HSF is significantly higher than in the patients without HSF (p<0.05). Sixty (60) patients from the HSF group and 50 patients from the non-HSF group were regrouped according to inflammatory and normal manifestation after the endometrial biopsy. There were 49 patients in the inflammatory manifestation group and 61 patients in the normal manifestation group. RT-PCR technology was adopted to detect the expression of inflammatory cytokines TNF-a and IL-2 mRNA in endometrial tissue. The level of TNF-a mRNA expression in endometrial tissues with inflammatory manifestation was higher than in normal endometrium (76.75±11.95 vs. 23.45±9.75, p<0.01). There are significant differences between them. The level of IL-2 mRNA expression in endometrial tissues with inflammatory manifestation was higher than that found in normal endometrium (80.56±13.35 vs. 35.12±8.35, p<0.01). There are significant differences between them. Conclusion: Chronic endometritis is related to HSF and may therefore affect endometrial receptivity.

Hydrosalpinx with adnexal torsion in a virgin patient

We present a case of 28-years-old female, presenting with acute right lower abdominal pain. She wasn't sexually active and in the absence of infection and hormonal treatment, with right side adnexal torsion due to hydrosalpinx

Schistosoma mansoni: a rare cause of tubal infection

S. haematobium is an important cause of urinary schistosomiasis, and symptomatic female genital infection is a common gynecological finding in areas where S. haematobium is prevalent. On the other hand, genital manifestations of intestinal schistosomas as S. mansoni are not frequent or are misdiagnosed. A case of a 40-year-old woman with abnormal uterine bleeding and asymptomatic tubal infection by S. mansoni identified in histological examination is presented.

MRI Appearance of Florid Cystic Endosalpingiosis of the Uterus: a Case Report

Endosalpingiosis is a non-neoplastic proliferation of ectopic tubal epithelium. It may be found incidentally or the patients may present with chronic pelvic pain. It may resemble a gynecologic malignancy on imaging findings and clinicians and radiologists should be aware of this benign entity to render a correct diagnosis and to avoid over-treatment. We report here the MR imaging appearance of a case of florid cystic endosalpingiosis.

Genital schistosomiasis mansoni: tubal tumor and parietal peritoneum involvement diagnosed during laparoscopy / Esquistossomose mansônica genital: tumor de trompa e envolvimento do peritônio parietal diagnosticados durante laparoscopia

Female genital schistosomiasis is not uncommon in endemic areas for schistosomiasis, but there are few reports in the Brazilian medical literature. Here, we describe the case of a 31-year-old woman with lower abdominal pain who was diagnosed as presenting a fallopian tube tumor caused by Manson's schistosomiasis. The diagnosis was delayed because her symptoms were considered nonspecific. Involvement of the parietal peritoneum of the ovarian fossa was observed during laparoscopy and confirmed by histological analysis. The left tube and the tumor were excised and schistosomiasis was treated with praziquantel. She presented a full recovery and options for future reproduction are under evaluation.

Esquistossomose genital feminina não é incomum em áreas endêmicas para esquistossomose, mas, há poucos relatos na literatura médica brasileira. Descrevemos aqui, o caso de uma paciente de 31 anos com dor abdominal no baixo ventre que recebeu o diagnóstico de tumor da trompa de falópio causada pela esquistossomose mansônica. O diagnóstico foi retardado porque os sintomas foram considerados inespecíficos. Havia envolvimento do peritônio parietal da fossa ovárica durante a laparoscopia, confirmado à histologia. A tuba esquerda e o tumor foram extirpados e a esquistossomose foi tratada com praziquantel. A paciente apresentou recuperação completa e opções para reprodução futura estão sob avaliação.

Isolated fallopian tube torsion with pregnancy-a case report

Isolated torsion of the fallopian tube occurring in pregnancy is very rare. This entity should be considered in the differential diagnosis of acute pelvic pain with cystic adnexal mass associated with a normal ipsilateral ovary. This is a case report of a primi gravida at 29 weeks of pregnancy who was presented with isolated fallopian tube torsion

Comparison of hysterosalpingography and laparoscopy in the evaluation of infertile women

To compare tuboperitoneal factors of infertile women by hysterosalpingography [HSG] and laparoscopy. In this cohort study, 82 infertile cases were evaluated retrospectively by laparoscopy, 3 months subsequent to HSG in the Department of Gynecology and Obstetrics, Medical School of Dicle University, Diyarbakir, Turkey, between March 2004 and April 2006. The findings of HSG and laparoscopy were compared. Out of the 82 infertile women, pathological findings were observed in 45.1% by HSG, and 54.9% had no pathological finding. On laparoscopic evaluation, however, pathological findings were observed in 65.85%, and 34.15% had no pathological findings. The pathological findings were detected by laparoscopy in 20 of the 45[44.4%] patients who had no pathological findings by HSG, and no pathological findings were detected by laparoscopy in 3 of the 37 [8.1%] patients who had pathological findings by HSG. Laparoscopy revealed no pathological findings in 6 of the 35 patients who had tubal pathology by HSG. The sensitivity of HSG was 63%, specificity was 89.3%, and the positive predictive value was 92%, with a 55% predictive value, and the accuracy ratio was 72%. Laparoscopy is a superior method for the research of tubal and pelvic pathologies in the evaluation of infertility. However, HSG is a more economical and elementary method suitable for evaluation of endometrial and tubal pathologies, and laparoscopy is an appropriate method for examining the external part of tubae, fimbriae, the relation of tuba and ovary, endometriosis, adhesions, tuberculosis, and other pathologies. Therefore, these 2 methods are not alternative, but complementary

Manejo laparoscópico de dispositivo intrauterino migrado a trompa de falopio con hidrosalpinx secundario / Laparoscopic management of translocated intrauterine contraceptive device (IUD) inserted in the right uterine tube with secondary hydrosalpinx

Se presenta el caso clínico de un dispositivo intrauterino ubicado en el lumen de la trompa de Falopio con hidrosalpinx secundario, diagnosticado en forma incidental al realizar una radiografía de columna lumbar, estudio complementado con ecotomografia transvaginal. Se realizó laparoscopia diagnóstica y salpingectomía sin complicaciones.

We present a case of asymptomatic IUD inserted in the right uterine tube, with secondary hydrosalpinx. The IUD was found during a non-related X-ray examination of lumbar spine. She underwent laparoscopic surgery and removal of the uterine tube, without any further complication. We discuss the current treatment of intraabdominal lUDs.

Tubal abnormalities in Thai infertile females.

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

Manejo laparoscópico de masas anexiales: experiencia local / Laparoscopic handling of anexial masses: local experience

Se analizaron 132 pacientes evaluando características epidemiológicas y clínicas, la correlación entre ecografía y anatomía patológica, la evolución y el uso laparoscópico en el tratamiento de masas anexiales. El diagnóstico se basó en la identificación ecográfica de una masa anexial. El rango de edad fue 16-66 años. El dolor abdominal y pélvico estuvo presente en 34 por ciento de los casos; en 45 por ciento se diagnosticó la masa anexial por examen ecográfico de rutina. En 53 por ciento de las pacientes se realizó quistectomía y en 16 por ciento ooforectomía completa. En 78 por ciento la masa correspondió a ovario y en 22 por ciento a trompa. Para las masas de origen ovárico la frecuencia mayor correspondió a tumores epiteliales (22 por ciento), seguido por quistes endometriósicos con 18 por ciento. Hubo 3 complicaciones vasculares y cambio a vía abierta en 5 casos. Solo hubo 1 tumor borderline y como hallazgo un cáncer de cuello uterino. El objetivo de este trabajo es presentar la experiencia quirúrgica en el manejo laparoscópico de los tumores anexiales.

Cirugía endoscópica para la enfermedad tubárica en mujeres referidas a centros de fertilización in vitro / Endoscopic surgery in tubal disease for women referred to Centers of Fertilization in Vitro

Se evalúa el valor de efectuar salpingectomía endoscópica en mujeres infértiles por enfermedad tubárica y que optaron ser referidas a diversos centros de fertilización in vitro. Se discute un protocolo de referencia.

Salpingographie selective et recanalisation tubaire transcervicale technique, indications, resultats

The aim of the study is to evaluate the efficacy of selective salpingography and fallopian tube recanalization as a diagnostic and therapeutic procedure when proximal tubal obstruction is present. Fifty-three procedures were performed between January 95 and March 98 in the Radiology Department of HoteI-Dieu de France Hospital, on 53 infertile women aged between 25 and 43 years. Unilateral or bilateral obstruction was documented on hysterosalpingogram or by laparoscopy. The technique consisted of a direct fallopian tube catheterization, under fluoroscopy using an hydrophilic guidewire. Water soluble contrast material was used. Eighty-eight tubes were evaluated [35 with bilateral and 10 with unilateral obstruction, 8 single tubes]. Recanalization was possible in 52 cases [97.5%].Twenty-nine patients were followed. Thirteeen pregnancies were reported [45%]. This pregnancy rate is however increased to 62% if we exclude the cases where other infertility problems coexisted. No complications occurred. Selective salpingography and fallopian tube catheterization is a non invasive successful technique that is extremely useful in the diagnosis and treatment of tubal obstruction in women with infertility problems. It can be performed immediately after an hysterosalpingogram when the fallopian tubes are not opacified

Faloposcopia: Acceso Transcervical por Histeroscopia / Falloposcopy: Transcervical access by histeroscopy

En 1990 se realizó la primera descripción del lumen tubárico desde el ostium hasta la fimbria, con técnica microendoscópica y ayuda del sistema de liberación coaxial o de eversión lineal. En vista que el factor tubárico alcanza el 30 por ciento de los casos de infertilidad femenina y de éste el 25 por ciento son debidos a obstrucción tubárica proximal; que la faloposcopia puede evaluar la naturaleza, el sitio y la extensión de una obstrucción; que puede distinguir entre espasmos tubáricos, bloqueos reversibles (tapones de moco y detritos) y bloqueos irreversibles (oclusiones fibróticas); se justifica su pertinencia en la evaluación endoluminal. La severidad de la enfermedad intratubárica se clasifica con un sistema de puntaje (<20 leve, 20-30 moderada, >30 severa), que permite establecer un pronóstico de la posibilidad de embarazo y orientar un plan. En la evaluación del segmento distal la salpingoscopia es reconocida como el mejor método y aunque por vía faloposcópica es un procedimiento más difícil, la navegación por todo el lumen desde el ostium hasta la fimbria, sin incisiones, sin anestesia y completamente ambulatorio, sería ideal. La complicación más frecuente es la perforación tubárica observada solamente en trompas previamente lesionadas. Aunque su lugar en el diagnóstico y tratamiento de la patología endoluminal está descrito, los resultados publicados no han podido ser totalmente reproducidos por algunos equipos además, su aplicación generalizada y relación costo beneficio permanecen aún sin establecer

Quistes paratubarios: Frecuencia y correlación clínica, ultrasonográfica e histológica / Paratubal cyst. Frequency and clinical ultrasonographic and histologic correlation

Se revisaron 5,100 Biopsias realizadas en el Servicio de Anatomía Patológica en el lapso de noviembre de 1994 a noviembre de 1995, encontrando un total de 100 quistes paratubáricos. El 80 por ciento de los casos fue hallazgo quirúrgico el 40 por ciento de las pacientes tuvieron manifestaciones clínicas de dolor y 3 por ciento de las mismas abdomen agudo por torción del quiste que ameritó cirugía de urgencia. En 38 por ciento de los casos el informe ultrasonofráfico fue de Quistes de Ovario, y en 62 por ciento no fue detectado por este método. Con respecto al tamaño: 84 por ciento de los quistes paratubarios fueron menos de 6 cm, 12 por ciento entre 6 y 12 cm. y 4 por ciento de 12-18 cm. El informe Histopatológico fue quiste seroso (57 por ciento) y quiste simple (43 por ciento)

Salpingosonografía transvaginal para la evaluación de las trompas en infertilidad femenina: metodología y experincia clínica

El objetivo de nuestro trabajo fue estudiar la sensibilidad y especificidad de la salpingosonografía (SSG) en su capcidad diagnóstica de la permeabilidad tubárica y de detectar la patológia asociada. En comparación a la histerosalpingografía (HSG). Estudiamos 40 pacientes a quienes se les practicaron ambos métodos. Para la comparación se tomó como prueba de oro la HSG. La SSG mostró una sensibilidad del 73.1 por ciento I.C 95 por ciento (51.9-87.6 por ciento) y una especificidad del 92.6 por ciento I.C 95 por ciento (81.3-97.6 por ciento), en la patología tubárica bilateral. Con un valor predictivo positivo de un 82.6 por ciento I.C 95 por ciento (60.5-94.3 por ciento) y predictivo negativo de un 87.7 por ciento I.C 95 por ciento 75.7-94.5 por ciento. La correlación diagnóstica entre ambos métodos fue de 86.2 por ciento (69 diagnósticos de 80 posibles). Con el análisis general de los resultados se puede apreciar que la SSG sirve más como tamizaje en la evaluación de la permeabilidad tubárica, por su alta especificidad, bajo costo, ausencia de radiación y de reacción alergica al contraste. Debido a su baja sensibilidad en detectar obstrucción tubárica, es necesario continuar realizando la HSG cuando no existan signos positivos de permeabilidad. En la patología asociada endometrial, anexial y miometral la SSG detectó algunas patologías no demostradas por la HSG

Achados laparoscópicos em dor pélvica crônica / Laparoscopy in diagnosis of chronic pelvic pain

O papel da laparoscopia no diagnóstico de dor pélvica crônica permanece controvertido. Avaliamos 105 laparoscopias realizadas no Centro de Atençäo Integral à Saúde da Mulher (CAISM) - UNICAMP, indicadas por dor pélvica crônica, e apenas 14,2 por cento apresentaram pélvis normal. Em 31,3 por cento dos casos foram observados sinais de endometriose e 57,1 por cento das pacientes apresentavam aderências. Em 47,8 por cento dos casos havia mais de uma alteraçäo. Concluímos que a laparoscopia é ferramenta importante na elucidaçäo diagnóstica da causa de dor pélvica crônica, mas näo é definitiva, nem prescinde de outras avaliaçöes clínicas e psicológicas.

Tuberculose genital e amenorréia primária: descriçäo de caso / Primary amenorrhea and tuberculosis: case report

A associaçao de amenorréia primária e tuberculose genital é rara. Nesse relato descreve-se o caso de uma mulher de 16 anos de idade com história de amenorréia primária com presença de caracteres sexuais secundários normais. Por suspeita clínica de anomalia mulleriana foi feito laparotomia exploradora que foi inconclusiva, e o diagnóstico foi direcionado pelo PPD fortemente reator, sendo definido após pela histeroscopia e análise histológica do material endometrial.