Síndrome de Herlyn-Werner Wünderlich: reporte de dos casos / Herlyn-Werner-Wünderlich syndrome: Two case report

El síndrome de Herlyn-Werner Wünderlich, también llamado OHVIRA por sus siglas en inglés (obstructed hemivagina and ipsilateral renal anomaly), es una anomalía congénita mülleriana poco frecuente que se caracteriza por la asociación entre útero didelfo, hemivagina obstruida y agenesia renal ipsilateral. La presentación clínica más común es la masa abdominal secundaria a hematocolpos, dolor y dismenorrea. Se asocia a infertilidad, endometriosis, alteraciones menstruales y obstétricas. La ecografía es la técnica de elección para la evaluación inicial, mientras que la resonancia magnética sigue siendo el método más exacto para el diagnóstico. La septotomía vaginal es el tratamiento recomendado. Se describen 2 casos clínicos con el objetivo de destacar la importancia del diagnóstico temprano para evitar las posibles complicaciones futuras.

Herlyn-Werner-Wunderlich syndrome, also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), is a rare, congenital Müllerian duct anomaly characterized by the association of septate uterus, obstructed hemivagina, and ipsilateral renal agenesis. The most common clinical presentation is an abdominal mass secondary to hematocolpos, pain, and dysmenorrhea. It is associated with infertility, endometriosis, and menstrual and obstetric alterations. The ultrasound is the technique of choice for the initial assessment, while the magnetic resonance imaging remains the most accurate method for diagnosis. The resection of the vaginal septum is the recommended treatment. Here we describe 2 clinical cases to highlight the importance of an early diagnosis to prevent potential complications in the future.

Histological and Endocrine Effects of Chronic Exposure to MP2.5 Derived from Wood Smoke in the Uterus of Nulliparous Adult Rats

SUMMARY: The study explores the relationship between chronic exposure to fine particulate matter (PM2.5), sourced from wood smoke, and the histological structure and endocrine function of the uterus in nulliparous adult rats. It assesses potential structural changes in the uterus that could impact reproductive health, viewing PM2.5 exposure as a possible risk factor. A controlled experiment was conducted in a city known for high air pollution levels, exposing rats to filtered and unfiltered air conditions, thus mimicking human PM2.5 exposure. Histological findings indicated a significant increase in collagen density and uterine wall thickness in PM2.5 exposed subjects, suggesting a reproductive function risk. However, no significant differences were observed in progesterone and estradiol hormone levels, pointing to the complex relationship between PM2.5 exposure and its endocrine impact, and emphasizing the need for further studies for a deeper understanding. This work highlights the importance of thoroughly investigating the long-term effects of PM2.5 pollution on reproductive health, underlining the significance of considering environmental exposure as a critical factor in reproductive health research.

El estudio explora la relación entre la exposición crónica a partículas finas (PM2,5), procedentes del humo de leña, y la estructura histológica y la función endocrina del útero en ratas adultas nulíparas. Evalúa posibles cambios estructurales en el útero que podrían afectar la salud reproductiva, considerando la exposición a PM2,5 como un posible factor de riesgo. Se llevó a cabo un experimento controlado en una ciudad conocida por sus altos niveles de contaminación del aire, exponiendo ratas a condiciones de aire filtrado y sin filtrar, imitando así la exposición humana a PM2,5. Los hallazgos histológicos indicaron un aumento significativo en la densidad del colágeno y el grosor de la pared uterina en sujetos expuestos a PM2,5, lo que sugiere un riesgo para la función reproductiva. Sin embargo, no se observaron diferencias significativas en los niveles de las hormonas progesterona y estradiol, lo que apunta a la compleja relación entre la exposición a PM2,5 y su impacto endocrino, y enfatiza la necesidad de realizar más estudios para una comprensión más profunda. Este trabajo destaca la importancia de investigar a fondo los efectos a largo plazo de la contaminación por PM2,5 en la salud reproductiva, subrayando la importancia de considerar la exposición ambiental como un factor crítico en la investigación de la salud reproductiva.

ZHU Ling's Experience in Treating Polycystic Ovarian Syndrome Based on the Principle of"Phlegm-Retention Resolved with Warm Herbs" / 广州中医药大学学报

Polycystic ovary syndrome(PCOS)is a common gynecological disease in clinic.Based on years of clinical practice,Professor ZHU Ling believes that the pathogenesis of PCOS is characterized by yang deficiency of kidney and spleen,and internal retention of phlegm and fluid,which accords with the pathogenesis nature of phlegm-retention.With reference to the pathogenic site of PCOS,PCOS can be allocated to the category of"phlegm-retention in uterus".Following the principle of"phlegm-retention resolved with warm herbs"established by ZHANG Zhong-Jing,Shenqi Pills plus Ling Gui Zhu Gan Decoction(aka,Shen Ling Decoction)recorded in Jin Gui Yao Lve(Synopsis of the Golden Chamber)can be used for the treatment of PCOS to warm yang and resolve phlegm-retention,dissolve phlegm and remove dampness,regulate menstruation and promote gestation,and significant efficacy can be achieved.The treatment of PCOS based on the principle of"phlegm-retention resolved with warm herbs"will provide a reference for clinical treatment of PCOS.

Expression and clinical significance of KIFC1 in endometrioid carcinoma / 临床与实验病理学杂志

Purpose The aim of this study is to investigate the relationship between the expression of kinesin family member C1(KIFC1)in endometrioid carcinoma and clinicopathological features and prognosis of endometrioid carcinoma patients.Methods The expression of KIFC1 in 30 cases of paracancer-ous endometrium and 95 cases of endometrioid carcinoma was detected by immunohistochemical SP method.qRT-PCR and Western blot were used to detect the expression level of mRNA and protein of KIFC1 in 30 pairs of fresh cancer tissues and ad-jacent non-cancer tissues.Furthermore,the relationship between KIFC1 protein expression and survival time was analyzed by TC-GA database,and their clinicopathologic features were analyzed.Results The immunohistochemistry results showed the positive rate of KIFC1 in endometrioid carcinoma(61.05％)was signifi-cantly higher than that in the neighboring noncancerous tissue(13.33％),and the difference was statistically significant(P＜0.05).The expression of KIFC1 was correlated with myometrial invasion,FIGO stage and lymphatic metastasis(all P＜0.05).The relative expression of KIFC1 mRNA in endometrioid carci-noma(2.99±0.59)was significantly higher than that in the neighboring noncancerous tissue(1.00±0.29),and there was significant difference(P＜0.05).The relative expression of KIFC1 protein in endometrioid carcinoma(1.70±0.36)was significantly higher than that in the neighboring noncancerous tissue(0.72±0.17),and there was significant difference(P＜0.05).Furthermore,elevated KIFC1 expression was positive-ly correlated with a poorer prognosis.Conclusion KIFC1 is upregulated in endometrioid carcinoma and associated with poor prognosis of patients,KIFC1 was expected to be a potential ther-apeutic target and prognostic indicator for endometrioid carcino-ma.

The predictive value of six changes of hormones in pregnant women with scar uterus on the occurrence of hydramnios in re-pregnancy / 中华内分泌外科杂志

Objective:To analyze the predictive value of six hormonal changes in pregnant women with scarred uterus for the occurrence of oligohydramnios in their second pregnancy.Methods:A retrospective study was conducted to select the clinical data of 54 pregnant women with hypohydramnios in scarred uterus who were admitted to the First People’s Hospital of Suzhou from May. 2021 to Mar. 2023. They were included in the oligohydramnios group, and another 54 patients with normal amniotic fluid in scar uterus re-pregnancy during the same period were selected and included in the normal amniotic fluid group. Both groups of postpartum women underwent six hormone tests, including follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E 2), progesterone (P), testosterone (T), and prolactin (PRL). Two sets of baseline data were collected and binary logistic analysis was used to investigate the relationship between six hormones and oligohydramnios in women with scarred uterus during re-pregnancy. Receiver operating characteristic curve (ROC) was adopted to evaluate the six hormonal factors in predicting oligohydramnios in pregnant women with scar uterus during re pregnancy. The restricted cubic spline method combining spline function and logistic regression were used to analyze the dose-response relationship between six hormones and oligohydramnios in scar pregnant women during re-pregnancy. Results:The proportion of multiple pregnant women in the oligoamnios group [20.37% (11/54) ] was higher than that in the normal amniotic fluid group [5.56% (3/54) ] ( P < 0.05). The levels of FSH, E 2, P and PRL in oligohydramnios group were lower than those in normal amniotic fluid group [ (8.11±1.83) IU/L, (125.61±61.43) p /L, (16.33±3.15) mmol /L, (315.15±87.63) mIU/L],[ (9.87±2.05) IU/L, (148.52±50.57) pg/L, (20.14±4.07) mmol/L, (366.18±99.36) mIU/L] ( P<0.05) ; The levels of LH and T in oligohydramnios group [ (18.65±7.16) IU/L, (1.75±0.19) mmol/L] were compared with those in normal amniotic fluid group [ (20.67±8.53) IU/L, (1.73±0.11) mmol/L] and there was no significant difference between the two groups ( P<0.05). The results of binary logistic regression analysis showed that multiple pregnancy ( OR=11.507, 95% CI: 2.174-60.902, P=0.004) was a risk factor for recurrent oligohydramnios in women with scarred uterus. The high expression of FSH ( OR=0. 620, 95% CI: 0.224-0.845, P=0.001), E 2 ( OR=0.988, 95% CI: 0.978-0.998, P=0.021), and P ( OR=0.750, 95% CI: 0.645-0.873, P<0.001) was a protective factor for oligohydramnios in pregnant women with scar uterus during re-pregnancy. The ROC curve was plotted, and the results showed that AUC of FSH, P, and combined detection for predicting oligohydramnios in pregnant women with scarred uterus during re-pregnancy were 0.754, 0.768, and 0.870, respectively. The correlation between serum levels of FSH, E 2, and P and the occurrence of oligohydramnios in pregnant women with scarred uterus during re-pregnancy showed a linear dose-response relationship ( P<0.05). The levels of serum FSH, E 2, and P were negatively correlated with the occurrence of oligohydramnios in pregnant women with scar uterus. Especially when FSH<9.255 IU/L, E 2<158.465 pg/L, P<19.000 mmol/L, the occurrence of oligohydramnios in pregnant women with scar uterus increased with the decrease of FSH, E 2, and P levels. Conclusion:The six hormonal changes in pregnant women with scar uterus are closely related to the occurrence of oligohydramnios during re-pregnancy, and can effectively predict the risk of oligohydramnios during re-pregnancy.

The diagnostic value of MRI in invasive lesions originating from uterine smooth muscle / 实用放射学杂志

Objective To analyze the MRI findings of invasive lesions originating from uterine smooth muscle,and to improve the preoperative accurate diagnosis ability.Methods A total of 29 patients with invasive tumors originating from uterine smooth muscle and confirmed by surgery and pathology were selected and divided into benign group and malignant group.The shape of the lesion and the signal characteristics of MRI sequences were analyzed retrospectively,the apparent diffusion coefficient(ADC)values of solid components of lesions were measured,and the ADC values of different tumors were compared.Independent sample t test was used for statistical analysis.Results A total of 26 cases were correctly diagnosed by MRI,and the diagnostic accuracy rate was 89.7%.Eighteen cases of intravenous leiomyomatosis(IVL)had a history of uterine fibroid,extrauterine lesions showed sausage or nodular-shaped with slightly higher signal on T2WI,equi signal on T1WI and diffusion weighted imaging(DWI),dynamic enhanced scanning sequence showed synchronous enhancement with myometrium of uterus;Two cases of leiomyomatosis peritonealis disseminate(LPD)had a history of uterine fibroid,solid cystic masses were found in the uterus,solid components showed equivalent or slightly higher signal on T2WI,equi signal on T1WI,equivalent or slightly higher signal on DWI,multiple solitary nodules were found in pelvic wall,uterus and rectum fossa,mesentery and omental sac,with uniform signal and clear boundary,equi signal on T2WI,T1WI and DWI,dynamic enhanced scanning sequence showed synchronous enhancement with myometrium of uterus,strengthening uniform;Of the 9 cases of leiomyosarcoma,8 cases showed solid cystic masses with T1WI high signal bleeding focus,solid components showed slightly higher signal on T2WI,equi signal on T1WI,obvious higher signal on DWI,the boundary of the mass was unclear,and the enhancement was uneven after enhancement;There were 20 cases in benign group,including 18 cases of IVL and 2 cases of LPD,the mean ADC values were(1 357.06±74.55)×10-3mm2/s,the malignant group was leiomyosarcoma,the mean ADC values were(849.56±22.80)×10-3mm2/s,there were statistical difference between the groups(P<0.05).Conclusion The MRI findings of invasive tumors originating from uterine smooth muscle are dif-ferent,the measurement of ADC value can be used as a quantitative diagnostic basis for benign and malignant determination.

Effects of multiple shared decision-making mode on the mode of delivery for pregnancies with scarred uterus / 实用医学杂志

Objective To explore the effects of the multiple shared decision-making mode using a decision aid manual in conjunction with online labor and delivery decision support on the delivery mode for pregnant women with a scarred uterus.Methods A total of 94 women with scarred uterus who received prenatal care at a tertiary hospital from September 2019 to October 2022 were enrolled and assigned to experimental and control groups using the random number table method.The control group received standard prenatal education,and the experimental group received multiple shared decision-making interventions in addition to standard prenatal education.The degree of conflict in decision-making for delivery,preference for delivery mode,postpartum decision regret,and the final delivery mode between the two groups were compared,respectively.Results Following the multiple shared deci-sion intervention,decision conflict scores in the experimental group were significantly reduced(P<0.001).In the survey on delivery mode preferences,there was a reduction in the number of individuals in the experimental group expressing"uncertainty",and an increase in those choosing vaginal delivery.Ultimately,in the experimental group,30 women(68.2%)underwent cesarean sections,and 14(31.8%)had vaginal deliveries.The level of post-decision regret in the experimental group was lower than that in the control group(P<0.001).Conclusions Multiple shared decision-making for women pregnant with a scarred uterus could reduce the level of decision-making conflict,increase the willingness for vaginal delivery,and assist them in making rational and scientifically informed decisions regarding childbirth.

Predictive value of serum thrombospondin-1,D-dimer and tissue inhibitor of metalloproteinase-1 levels in late pregnancy for postpartum hemorrhage in re-pregnant women with scarred uterus / 新乡医学院学报

Objective To investigate the predictive value of serum thrombospondin-1(THBS-1),D-dimer(D-D)and tissue inhibitor of metalloproteinase-1(TIMP-1)levels in late pregnancy for postpartum hemorrhage(PPH)in re-pregnant women with scarred uterus.Methods Totally 108 re-pregnant women with scarred uterus admitted to the First Affiliated Hospital of Xinxiang Medical University from June 2020 to August 2022 were selected and divided into the PPH group(n=21)and the non-PPH group(n=87)according to whether PPH occurred after delivery.On the day of admission,5 mL elbow venous blood was collected from re-pregnant women in the two groups,and the levels of serum THBS-1,D-D and TIMP-1 of pregnant women in the two groups were detected by enzyme-linked immunosorbent assay.The serum THBS-1,D-D TIMP-1 levels and clinical data of pregnant women between the two groups were compared.The influencing factors on the occurrence of PPH in re-pregnant women with scarred uterus were analyzed by multivariate logistic regression,and the predictive value of serum THBS-1,D-D and TIMP-1 levels on the occurrence of PPH in re-pregnant women with scarred uterus was evaluated by receiver operating characteristic curve.Results The percentage of patients with ≥ 2 induced abortions,placental abruption,uterine incision laceration,uterine inertia or scar thickness＜0.3 cm,as well as serum THBS-1 and D-D levels in late pregnancy in the PPH group were significantly higher than those in the non-PPH group,and serum TIMP-1 level in late pregnancy were significantly lower than that in the non-PPH group(P＜0.05).The uterine inertia,as well as high D-D and THBS-1 levels,were independent risk factors for PPH in re-pregnant women with scarred uterus(P＜0.05),and low TIMP-1 level was a protective factor(P＜0.05).The area under the curve of combined serum THBS-1,D-D and TIMP-1 levels to predict PPH in re-pregnant women with scarred uterus was greater than that predicted by the three factors alone(P＜0.05).Conclusion Serum THBS-1,D-D and TIMP-1 levels in late pregnancy can be used as reference indicators for predicting the occurrence of PPH in re-pregnant women with scarred uterus,and the combination of the three indexes is more effective in predicting the occurrence of PPH.

Design of heating and pressurizing flushing device and effectiveness assessment in hysteroscopic surgery / 中国医学装备

Objective:To design a heating and pressurizing flushing device and to assess its application effect in hysteroscopic surgery.Methods:The heating and pressurizing flushing device was composed of a heating and pressing device,a liquid crystal control panel module,flushing pipeline,heating pipeline and a support frame.A total of 100 female patients who underwent gynecological hysteroscopic surgery at Shengjing Hospital of China Medical University from May 2021 to April 2022 were selected and divided into observation group and control group by random number table method,with 50 cases in each group.The observation group adopted a heating and pressurizing device to perform heating and pressurizing operations during hysteroscopic surgery,the control group adopted manual inflatable pressurized infusion bags to perform heating and pressurizing operations during hysteroscopic surgery by inflating and squeezing the air bag.The clarity of dilated uterus,operation time,preoperative,intraoperative and postoperative body temperature of the patients,and satisfaction of doctors and nurses were compared between the two groups.Results:The clarity rate of dilated uterus and satisfaction of doctors and nurses in the observation group were significantly higher than those in the control group,the difference was statistically significant(x2=7.862,8.392,P<0.05).The operation time of the observation group was significantly lower than that of the control group,the difference was statistically significant(t=51.099,P<0.05).The body temperature of the patients at 15 minutes during operation and 20 minutes after operation in the observation group were higher than those in the control group,the difference was statistically significant(t=-13.153,-17.911,P<0.05).Conclusion:The use of heating and pressurizing device in gynecological hysteroscopic surgery can increase the clarity of dilated uterus,effectively shorten operation time,save human resources,reduce complications and improve the satisfaction of medical staff.The clinical application effect is good.

Exploration on Acupuncture and Moxibustion Treatment Ideas for Gynecological Reproductive Diseases Based on the"Heart-kidney-Chong Ren-uterus"Reproductive Axis / 中国中医药信息杂志

This article mainly elaborated the acupuncture and moxibustion treatment scheme of"eighteen needles for reproduction"based on Professor You Zhaoling's reproductive axis theory of"heart-kidney-Chong Ren-uterus".The"eighteen needles for reproduction"aims to regulate the disordered reproductive axis in gynecological reproductive diseases.It selects the acupoints on the main viscera and meridians of the reproductive axis as the main acupoints,and the acupoints regulating the qi and blood of the related viscera as the matching acupoints.Through specific manipulation,it can regulate the qi and blood,dredge the meridians,and treat the viscera,so as to nourish the essence and help pregnancy,and provide ideas and reference for the treatment of gynecological reproductive diseases with acupuncture and moxibustion.

Exploring the Prevention and Treatment of Female Reproductive Disorders from the Theory of Five Viscera Correlation and Reproductive Axis in Traditional Chinese Medicine / 中医杂志

This article applied the five-viscera correlation theory proposed by Professor DENG Tietao to the field of gynecology， and combined with Professor LUO Yuankai's theory of female reproductive regulation axis of traditional Chinese medicine （TCM）， to identify from the perspective of the overall transmission of diseases between the five-viscera correlation theory， which affects the female reproductive regulation axis of TCM and leads to reproductive disorders. It advocates breaking away from specialized barriers， forming a new medical concept of holism， combining multiple specialties， and using the concept of treating diseases before they occur to prevent and treat reproductive disorders caused by chronic diseases in various departments； in the meanwhile， paying attention to female patients with chronic diseases in various specialties who have been using medication for a long period of time； making sure that they understand menstruation in adolescent and childbearing females， checking the function of the ovaries in a timely manner， and protecting their fertility； so as to propose new ideas of research on TCM theories， as well as providing a new concept for clinical research on integration of TCM with Western medicine.

Non-communicating rudimentary horn mimicking a degenerated subserous leiomyoma: A case report

@#Unicornuate uterus with a rudimentary horn is a rare Müllerian anomaly, with an incidence of 0.06%. Due to this relative rarity, an accurate preoperative diagnosis of unicornuate uterus with rudimentary horn still remains to be a diagnostic challenge. Reported here is a case of a 27-year-old nulligravida who complained of severe debilitating dysmenorrhea 5 months prior to admission, necessitating frequent visits to the emergency department for administration of intravenous pain medications and antiemetics. She was misdiagnosed preoperatively with subserous leiomyoma, mainly based on clinical presentation, and findings on ultrasound and pelvic MRI. On exploratory laparotomy, a definitive diagnosis of unicornuate uterus with an enlarged rudimentary horn was established, and patient underwent resection of rudimentary horn, with enterolysis, due to dense adhesions in the left adnexa and cul de sac. We emphasize the need for early diagnosis and prompt management of cases like this to prevent complications, and optimize fertility and quality of life of affected patients.

Application of suturing uterine blood vessels with barbed polydioxanone cog thread through transumbilical single-port access large laparoscopic hysterectomy / 中国内镜杂志

Objective To present our initial experience of suturing uterine blood vessels with barbed polydioxanone cog thread by single-port-access large laparoscopic hysterectomy.Methods A respective non-randomized study with two parallel groups was performed from June 2021 to June 2022.The medical records of a total of 41 patients with enlarged uterus were divided into two groups:The single-port access large laparoscopic hysterectomy group by suturing uterine blood vessels with barbed cog thread(experimental group,n = 20),and the four-port assess laparoscopic hysterectomy group(control group,n = 21).The age,body mass index(BMI),a history of abdominal and pelvic surgery,pre-and post-operative hemoglobin(HGB),operative duration,intraoperative bleeding volume,uterine weight,postoperative pain visual analogue scale(VAS)at 24 h,the first postoperative exhaust time and postoperative length of hospital stay were compared between the two groups.Results 41 patients completed the entire procedure successfully without serious complications.Experimental group had a longer median operative time(P<0.01).There were no significant differences in intraoperative bleeding volume,uterine weight,HGB on postoperative day 1,postoperative hospital stays,postoperative exhaust time and postoperative 24-hour pain VAS(P>0.05).Conclusion Our study shows that suturing uterine blood vessels with barbed polydioxanone cog thread in experimental group is safe and feasible for large uterus,but the surgical time is significantly longer than the control group,as the technology becomes more proficient,this situation will be improved.

Research on the mechanism of lipopolysaccharide involvement in regulating uterine contraction during pregnancy through TREK-1 / 安徽医科大学学报

Objective @#To explore the molecular mechanism of lipopolysaccharide ( LPS) on the contraction of pregnant uterine smooth muscle at tissue and cellular levels . @*Methods @#C57BL/6J mice at 16 days of gestation were randomly divided into control group and LPS group . The mice in LPS group were intraperitoneally injected with 20 μg in LPS solution to establish the model of preterm birth , and the mice in control group were intraperitone- ally injected with the same amount of normal saline . Isolated uterine muscle strips were used to detect changes in the contractile function of the tissue , as well as changes in the expression and function of the contraction key signa- ling molecule TWIK-related K + channel 1(TREK-1) . Primary cultured pregnant mouse uterine smooth muscle cells were used to detect the expression of TREK-1 under the regulation of LPS .@*Results @#The contractility of mouse u- terine tissues was significantly enhanced by LPS , and the protein expression of TREK-1 , a key signal for contrac- tion , was significantly reduced , and activation of TREK-1 resulted in a significant down-regulation of the enhanced contractility of mouse uterine tissues in the LPS group . However , there was no significant difference in the expres- sion of TREK-1 protein , which was highly expressed in the smooth muscle of pregnant mice , when LPS acted on the primary uterine smooth muscle cells of pregnant mice .@*Conclusion @#Uterine contractility is enhanced in pregnant mice uterine tissues by inhibiting TREK-1 expression and function in response to LPS , and it may be one of the mechanisms by which LPS induces preterm labor. However , the effect of LPS on TREK-1 on mouse pregnant uter- ine smooth muscle cells may be realized through intercellular signaling and not directly on uterine smooth muscle cells . This further suggests that the animal and histological experiments cannot be completely replaced by isolated cell experiments in the study of inflammatory preterm labor.

Variante incomum da síndrome de Herlyn- -Werner-Wunderlich: relato de caso / Unsual Herlyn-Werner-Wunderlich syndrome: case report

Malformações müllerianas correspondem a variações anatômicas do trato repro- dutor feminino. Comumente assintomáticas, o diagnóstico e a verdadeira incidên- cia são difíceis de determinar. A síndrome de Herlyn-Werner-Wunderlich, clas- sicamente descrita pela tríade útero didelfo, hemivagina cega e agenesia renal ipsilateral também pode ter variações diferentes. Em virtude da mesma origem embrionária dos tratos genital e urinário, anomalias renais devem ser investigadas nesses casos, sendo a mais comum a agenesia renal. Este artigo relata o caso de uma paciente de 18 anos, do sexo feminino, com história de piocolpo por cinco anos. Em propedêutica complementar, foi identificado útero com septação com- pleta associado a hemissepto de terço superior de vagina, formação de piocolpo e agenesia renal à direita. Apesar de não ser a definição clássica, o quadro está incluído nos casos de síndrome de Herlyn-Werner-Wunderlich.

Mullerian malformations correspond to anatomical variations of the female repro- ductive tract. Commonly asymptomatic, the diagnosis and true incidence are difficult to determine. The Herlyn-Werner-Wunderlich syndrome, classically described by the triad: uterus didelphus, blind hemivagina and ipsilateral renal agenesis, can also have different variations. Due to the same embryonic origin of the genital and urinary tracts, renal anomalies must be investigated in these cases, the most common being renal agenesis. This article reports the case of an 18-year-old female patient with a 5-year history of pyocolpus. In complementary exams, a uterus with complete septa- tion was identified, associated with a hemiseptum in the upper third of the vagina, formation of pyocolpus and renal agenesis on the right side. Despite not being the classic definition, it is included in the cases of Herlyn-Werner-Wunderlich syndrome.

Tumor de colisión de útero. Reporte de caso y revisión de la literatura / Uterine collision tumor. Case report and review of he literature

Objetivos: Reportar el caso de una paciente con tumor de colisión del útero y realizar una revisión de la literatura respecto al diagnóstico histopatológico, tratamiento y pronóstico de esta condición. Materiales y métodos: Mujer de 76 años que consultó al centro nacional de referencia del cáncer en Bogotá (Colombia), donde se hizo el diagnóstico de tumor de colisión del útero, compuesto por un adenocarcinoma de endometrio tipo seroso y adenosarcoma de cérvix. Recibió tratamiento quirúrgico más quimioterapia y radioterapia complementaria, falleció a los 16 meses. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed y Embase, que incluía reportes y series de caso de mujeres con diagnóstico de tumor de colisión del útero, y se extrajo información sobre el diagnóstico, tratamiento y pronóstico. Se realizó un resumen narrativo de los hallazgos. Resultados: La búsqueda identificó 36 títulos, de los cuales se incluyeron 14 estudios que incluían 17 pacientes. El diagnóstico histopatológico más frecuente fue el adenocarcinoma endometrioide de endometrio y sarcoma endometrial de alto y bajo grado (47 %). El tratamiento básico fue quirúrgico. Cerca del 50 % recibió tratamiento adyuvante con quimioterapia y radioterapia (15 %). La sobrevida a un año fue del 75 %. Conclusiones: En la literatura no se identificaron casos de tumores de colisión de útero con la histopatología y en la ubicación del caso presentado. La mortalidad a dos años es cercana al 28 % si se toma en cuenta el caso reportado. Se necesitan más estudios que describan la inmunohistoquímica, el tratamiento y el pronóstico de esta condición.

Objectives: To report the case of a patient with a uterine collision tumor and to conduct a review of the literature. Material and methods: A 76-year-old patient who presented to the national cancer referral center in Bogota (Colombia), where she was diagnosed with a uterine collision tumor consisting of a serous-type endometrial adenocarcinoma and a cervical adenosarcoma. The patient underwent surgical treatment followed by chemotherapy and supplemental radiotherapy, and died 16 months later. A search was conducted in the Medline via PubMed and Embase databases, including reports and case series of women with a diagnosis of uterine collision tumor, with retrieval of information regarding diagnosis, treatment and prognosis. A narrative summary of the findings was made. Results: The search identified 36 titles, of which 14 studies with 17 patients were included. The most frequent histopathological diagnosis was endometrial adenocarcinoma and high and low grade endometrial sarcoma (47 %). Primary treatment was surgery and adjuvant treatment with chemotherapy and radiotherapy (15 %) was performed in close to 50 % of cases. One-year survival was 75 %. Conclusions: No cases of uterine collision tumors with the histopathology or in the location of the reported case were found in the literature. If this reported case is taken into account, 2-year mortality is 28 %. Further studies to describe the immunohistochemistry, treatment and prognosis of this condition are needed.

The prognostic significance of the heterologous component in uterine carcinosarcomas

SUMMARY OBJECTIVE: Uterine carcinosarcomas are aggressive, rare biphasic tumors with malignant epithelial and malignant sarcomatous components. The prognostic significance of the presence of extrauterine sarcoma (heterologous component) is controversial. Therefore, the aim of this study was to investigate the effect of heterologous components in uterine carcinosarcomas on disease-free survival, overall survival, and other prognostic factors. METHODS: Clinical and histopathological data from patients treated for uterine carcinosarcoma in a tertiary cancer center in Turkey between July 2000 and January 2020 were collected. Independent risk factors affecting overall survival and disease-free survival were analyzed by univariate and multivariate Cox regression analyses. RESULTS: A total of 98 patients were identified. The median follow-up was 21.8 (1.2-233.1) months. In the multivariate analysis, the median overall survival and disease-free survival were 23.8 and 20.7 months in those with homologous mesenchymal components and 17.6 and 9.7 months in those with heterologous mesenchymal components, respectively. It was found that the presence of heterologous mesenchymal components significantly reduced both overall survival and disease-free survival (odds ratio [OR], 2.861; 95% confidence interval [CI] 1.196-6.841; p=0.018 and OR, 3.697; 95%CI 1.572-8.695; p=0.003, respectively). In addition, both lymphadenectomy and adjuvant radiotherapy were found to significantly increase overall survival and disease-free survival. Age was found to increase only disease-free survival. CONCLUSION: The results obtained in this study showed that the presence of heterologous components in uterine carcinosarcoma is a prognostic factor that adversely affects both overall survival and disease-free survival. Lymphadenectomy and adjuvant radiotherapy have beneficial effects on both overall survival and disease-free survival.

Malformaciones müllerianas: actualización y revisión a propósito de casos clínicos, 2022 / Müllerian malformations: update and review of clinical cases, 2022

Las malformaciones müllerianas (MM) son un grupo de anomalías estructurales originadas por fallas de desarrollo de los conductos paramesonéfricos o de Müller durante las primeras 16 semanas de gestación. Un oportuno diagnóstico y una correcta clasificación permiten ofrecer el mejor manejo y diferenciar aquellas pacientes que requieren tratamiento quirúrgico. Se realizó una revisión de la literatura sobre MM en las bases de datos Epistemonikos, SciELO, Cochrane y PubMed. Se rescataron todas las pacientes ingresadas con diagnóstico de MM. En el año 2021, la American Society of Reproductive Medicine publicó un consenso en el que se estandarizó la nomenclatura, se amplió el espectro y se simplificó la clasificación. La clínica es variada, e incluye pacientes asintomáticas cuyo diagnóstico es un hallazgo por imágenes. Los mejores estudios imagenológicos son la resonancia magnética (RM) y la ultrasonografía 3D, dejando la histeroscopia y la laparoscopia (método de referencia) como procedimiento diagnóstico-terapéutico. Se presentan casos clínicos desarrollados durante el primer trimestre de 2022. Recomendamos la utilización sistemática de la RM para el diagnóstico de anomalías complejas u obstructivas del aparato genital. El tratamiento de estas patologías debe ser realizado por ginecólogos endoscopistas expertos, e incluye tratamiento médico y quirúrgico, el cual debe ser enfocado en cada paciente dependiendo del tipo de MM y de los deseos de fertilidad.

Müllerian malformations (MM) are a group of structural anomalies caused by developmental failure of the paramesonephric or Müllerian ducts during the first 16 weeks of gestation. Timely diagnosis and classification allow us to offer the best management and to differentiate those patients who require surgical treatment. Literature review on MM in Epistemonikos, SciELO, Cochrane and PubMed databases. All patients admitted with a diagnosis of MM were rescued. In 2021, the American Society of Reproductive Medicine publishes a consensus where it standardizes the nomenclature, broadens the spectrum, and simplifies the classification. The clinical picture is varied and includes asymptomatic patients whose diagnosis is an imaging finding. The best imaging studies are magnetic resonance imaging (MRI) and 3D ultrasonography, leaving hysteroscopy and laparoscopy (gold standard) as diagnostic therapeutic. Clinical cases developed during the first trimester 2022 are presented. We recommend the routine use of MRI for the diagnosis of complex and/or obstructive anomalies of the genital tract. The treatment of these pathologies should be performed by expert endoscopic gynecologists and include medical and surgical treatment, which should be focused on each patient, depending on the type of MM and fertility desires.

Successful Outcome of a Rare Complication of Vaginal Birth: A Case Report

Uterine inversion is a condition in which the interior surface of the relaxed uterus protrudes through the vaginal entrance. Its causes are divided into two categories: puerperal and non-puerperal, with puerperal uterine inversion being more common than non-puerperal uterine inversion. The most common variety is acute inversion, which occurs immediately or within 24 hours after delivery. Chronic Uterine Inversions (CUI) that occur more than four weeks after delivery are uncommon. In this study we discuss a case of a 30-year-old woman who came with the complaints of feeling of a mass in the vagina after her last confinement which was gradually coming down through the vagina and remain outside the introitus for 5 years. Based on clinical and sonographic evaluation, she was diagnosed with CUI and developed post partum haemorrhage. We adopted Haultain’s method for correction of CUI. Since, CUI as a painless vaginal mass in the delayed post-partum period is uncommon and hence documented.

Deep infiltrating endometriosis: cine magnetic resonance imaging in the evaluation of uterine contractility / Endometriose infiltrativa profunda: cine ressonância magnética na avaliação da contratilidade uterina

Abstract Objective: To evaluate uterine function by using cine magnetic resonance imaging to visualize the contractile movements of the uterus in patients with and without deep infiltrating endometriosis (with or without associated adenomyosis). Materials and Methods: This was a prospective case-control study. The study sample comprised 43 women: 18 in the case group and 25 in the control group. We performed cine magnetic resonance imaging in a 3.0 T scanner, focusing on the presence, direction, and frequency of uterine peristalsis. Results: The frequency of uterine peristalsis was higher in the case group than in the control group, in the periovulatory phase (3.83 vs. 2.44 peristaltic waves in two minutes) and luteal phase (1.20 vs. 0.91 peristaltic waves in two minutes). However, those differences were not statistically significant. There was a significant difference between the patients with adenomyosis and those without in terms of the frequency of peristalsis during the late follicular/periovulatory phase (0.8 vs. 3.18 peristaltic waves in two minutes; p < 0.05). Conclusion: The frequency of uterine peristalsis appears to be higher during the periovulatory and luteal phases in patients with deep infiltrating endometriosis, whereas it appears to be significantly lower during the late follicular/periovulatory phase in patients with adenomyosis. Both of those effects could have a negative impact on sperm transport and on the early stages of fertilization.

Resumo Objetivo: Avaliar a função uterina mediante visualização dos movimentos contráteis do útero por meio de cine-ressonância magnética em pacientes com e sem endometriose infiltrativa profunda (com ou sem adenomiose associada). Materiais e Métodos: Estudo caso-controle prospectivo. A amostra foi composta por 43 mulheres, sendo 18 mulheres no grupo caso e 25 mulheres no grupo controle. A cine-ressonância magnética foi realizada com magneto 3.0 T, com foco na presença, direção e frequência do peristaltismo uterino. Resultados: O peristaltismo uterino foi mais frequente nas pacientes do grupo endometriose do que no grupo controle na fase periovulatória (3,83 × 2,44 peristalses em dois minutos) e lútea (1,20 × 0,91 peristalse em dois minutos). No entanto, esses resultados não foram estatisticamente significantes. Nas pacientes com adenomiose, observou-se redução significativa na frequência de peristaltismo durante a primeira fase do ciclo menstrual (3,18 × 0,8 peristalses; p < 0,05). Conclusão: A frequência de peristaltismo uterino parece estar aumentada durante a fase periovulatória e lútea em pacientes com endometriose infiltrativa profunda e significativamente reduzida em pacientes com adenomiose durante a primeira fase do ciclo menstrual. Ambos os efeitos têm potencial de interferir negativamente no transporte de espermatozoides e nos primeiros estágios de fecundação.