Femoral hernia containing the right fallopian tube: a rare finding / Hérnia femoral contendo a trompa de falópio direita: um achado raro

Abstract Femoral hernias comprise a small proportion of all groin hernias. They are more common in women and have a high rate of incarceration and strangulation, leading to emergency repair. A 61-year-old female patient was admitted to the emergency department complaining of a 2-day painful lump in the right groin, that had become more intense in the last 24 hours. Physical examination suggested the presence of a strangulated femoral hernia, and the patient underwent emergency surgical repair. Intraoperatively, the right fallopian tube was observed in the hernia sac. Since there were no signs of ischemia, the tube was reduced back into the pelvic cavity and the hernia was repaired. The postoperative period was uneventful, and the patient was discharged without complications, 3 days after surgery.

Resumo As hérnias femorais representamuma pequena fração de todas as hérnia da região inguinal. Elas são mais comuns entre as mulheres e estão associadas a elevadas taxas de complicações, como encarceramento e estrangulamento, com necessidade de cirurgia urgente. Uma paciente do sexo feminino, de 61 anos, recorreu ao serviço de emergência por quadro de dor e tumefação da região inguinal direita com 2 dias de evolução e agravamento nas últimas 24 horas. O exame objetivo sugeria a presença de uma hérnia femoral encarcerada, e a paciente foi submetida a cirurgia urgente. Intraoperatoriamente, confirmou-se o diagnóstico de hérnia femoral encarcerada, que continha a trompa de falópio direita no interior do saco herniário. Uma vez que a que a trompa não apresentava sinais de isquemia, o conteúdo da hérnia foi reduzido, e procedeu-se à sua reparação. O período pós-operatório decorreu sem intercorrências, e a paciente teve alta no 3° dia após a cirurgia.

Recuperación de la fertilidad en una paciente estéril,mediante microcirugía de trompa uterina, y la aproximación al ovario contralateral / Fertility recovery in a sterile patient, by means of uterine tube microsurgery, and the approach to the contralateral ovary

Para que ocurra un embarazo exitoso, se requiere la integridad del tracto genital femenino, destacando como elementos importantes las trompas uterinas (TU) que transportan gametos y al óvulo fecundado a la cavidad uterina. La enfermedad de las TU por varias causas, como el embarazo ectópico, constituyen un 20% de causas de infertilidad. Gracias al desarrollo de técnicas de reproducción asistida (TRA) como la fecundación in vitro (FIV), en un alto porcentaje de pacientes que tienen un daño permanente y severo en estas estructuras, la cirugía para reparar o recanalizar las trompas uterinas ha sido desplazada por esta técnica de reproducción asistida. La reanastomosis tubárica tiene una tasa de éxito y de embarazos naturales después de la cirugía del 9% en mujeres con enfermedad tubárica severa al 69% en casos de enfermedad tubárica leve. Se presenta el caso de una paciente joven diagnosticada de infertilidad postquirúrgica por antecedentes de dos embarazos ectópicos accidentados previos que afectaron ambas trompas uterinas y ooforectomía izquierda; luego de realizado el procedimiento microquirúrgico, recuperó la posibilidad de ser madre.

For a successful pregnancy to occur, the integrity of the female genital tract is required, highlighting as important elements the uterine tubes (TU) that transport gametes and the fertilized egg into the uterine cavity. The disease of TU due to several causes, such as ectopic preg- nancy, constitute 20% of infertility causes. Thanks to the development of assisted reproduction techniques (ART) such as in vitro fertilization (IVF), in a high percentage of patients who have permanent and severe damage to these structures, surgery to repair or recanalize the uterine tubes has been displaced by This assisted reproduction technique. Tubal reanastomosis has a success rate and natural pregnancies after surgery of 9% in women with severe tubal disease at 69% in cases of mild tubal disease. We present the case of a young patient diagnosed with post-surgical infertility due to a history of two previous injured ectopic pregnancies that affec- ted both uterine tubes and left oophorectomy; After performing the micro-surgical procedure, he recovered the possibility of being a mother.

Which mode and potency of electrocoagulation yields the Smallest Unobstructed Area of the Fallopian Tubes? / Qual modo e potência produzem a menor área de nãoobstrução nas tubas de Falópio?

Abstract Objective To determine which mode and potency of electrocoagulation, using a modern electrosurgical generator, yields the smallest unobstructed area of the Fallopian tubes. Methods In an experimental study, tubes from 48 hysterectomies or tubal ligation were evaluated. Tubes were randomly allocated to one of the following groups: group A) 25 W x 5 seconds (n = 17); group B) 30 W x 5 seconds (n = 17); group C) 35 W x 5 seconds (n = 18), group D) 40 W x 5 seconds (n = 20); group E) 40 W x 5 seconds with visual inspection (blanch, swells, collapse) (n = 16); group F) 50 W x 5 seconds (n = 8). Bipolar electrocoagulation was performed in groups A to E, and monopolar electrocoagulation was performed in group F. Coagulation mode was used in all groups. Digital photomicrography of the transversal histological sections of the isthmic segment of the Fallopian tube were taken, and themedian percentage of unobstructed luminal area (mm2) was measured with ImageJ software (ImageJ, National Institutes of Health, Bethesda, MD, USA). The Kruskal-Wallis test or analysis of variance (ANOVA) was used for statistical analysis. Results Ninety-six Fallopian tube sections were analyzed. The smallest median occluded area (%; range) of the Fallopian tube was obtained in the group with 40 W with visual inspection (8.3%; 0.9-40%), followed by the groups 25 W (9.1%; 0-35.9%), 40 W (14.2; 0.9-43.2%), 30 W (14.2; 0.9-49.7%), 35 W (15.1; 3-46.4%) and 50 W (38.2; 3.1-51%). No statistically significant difference was found among groups (p = 0.09, Kruskal-Wallis test). Conclusion The smallest unobstructed area was obtained with power setting at 40 W with visual inspection using a modern electrosurgical generator. However, no statistically significant difference in the unobstructed area was observed among the groups using these different modes and potencies.

Resumo Objetivo Determinar em qual modo e potência, usando unidades geradoras modernas de eletrocoagulação, produz a menor área de não-obstrução das tubas de Falópio. Métodos Num estudo experimental, tubas uterinas derivadas de 48 histerectomias ou ligadura tubária foram avaliadas. As tubas foram alocadas aleatoriamente para um dos seguintes grupos: grupo A) 25 W x 5 segundos (n = 17); grupo B) 30 W x 5 segundos (n = 17); grupo C) 35 Wx 5 segundos (n = 18), grupo D) 40 W, 5 segundos (n = 20); grupo E) 40 W x 5 segundos inspeção visual (branqueia, incha e colapsa) (n = 16); grupo F) 50 Wx 5 segundos (n = 8). A eletrocoagulação bipolar foi usada nos grupos de A a E, e a eletrocoagulação monopolar, no grupo F. O modo de coagulação foi utilizado em todos os grupos. Cortes histológicos transversais do segmento ístmico das tubas de Falópio foram corados e fotografados digitalmente, e a percentagem da área luminal (mm2) não-obstruída foi medida com o software ImageJ (ImageJ, National Institutes of Health, Bethesda, MD, USA). O teste de Kruskal-Wallis ou ANOVA foram usados para a análise estatística. Resultados Noventa e seis cortes histológicos de tubas de Falópio foram analisados. A mediana da menor área não-obstruída (%; amplitude) da tuba de Falópio foi obtida no grupo 40 W com inspeção visual (8,3%; 0,9-40%), seguido do grupo 25 W (9,1%; 0- 35,9%), 40W(14,2; 0,9-43,2%), 30 W(14.2; 0,9-49,7%), 35 W(15,1; 3-46,4%) e 50 W (38,2; 3.1-51%). Não houve diferença significativa entre os grupos (p = 0,09, teste de Kruskal-Wallis). Conclusão A menor área não-obstruída foi obtida com a potência de 40 W com inspeção visual usando um gerador moderno de eletrocirurgia. Contudo, nenhuma diferença significativa na área não-obstruída foi observada entre os grupos usando esses modos e potências.

Cáncer serosopélvico de alto grado: evidencia sobre su origen en la trompa de Falopio / High-grade serous pelvic cancer: evidence of its origin in the fallopian tube

Cáncer epitelial de ovario es una enfermedad altamente letal. Constituye la quinta causa de muerte por cáncer en mujeres a nivel mundial. El subtipo histológico más frecuente es el carcinoma seroso de alto grado. Este es el responsable de la alta letalidad de la enfermedad. Se presenta evidencia que respalda el origen tubario de este tipo histológico desde lesiones precursoras. A partir de estos datos se ha establecido que el cáncer tradicionalmente conocido como cáncer ovárico seroso de alto grado, el cáncer de trompa de Falopio y el carcinoma peritoneal primario, corresponden a una misma entidad nosológica: cáncer seroso pélvico de alto grado. Se revisa además la evidencia disponible para establecer que la salpingectomía podría constituir una medida de prevención para este tipo de cáncer.

Epithelial ovarian cancer is a highly lethal disease. It is the 5th cause of cancer death in women worldwide. The most common histologic subtype is the high-grade serous carcinoma. This is the responsible for the high lethality of the disease. Evidence supporting the tubal origin of this histological type from precursor lesions is presented. From these data it has been established that cancer traditionally known as serous high-grade ovarian cancer, cancer of the fallopian tube and primary peritoneal carcinoma, correspond to a single disease entity: pelvic serous high-grade cancer. We also check the available evidence to establish that the salpingectomy could be a preventive measure for this type of cancer.

Ovarian cancer risk reduction through opportunistic salpingectomy / 부인종양

No abstract available.

Dispositivo anticonceptivo intraovárico. Presentación de caso / Intraovaric anticonceptive device. Case presentation

Fundamento: los dispositivos intrauterinos no están exentos de complicaciones y al igual que cualquier otro cuerpo extraño implantado en el organismo puede migrar a otra región. Presentación de caso: paciente femenina con antecedentes de implantación de un dispositivo intrauterino (T de cobre) en su área de salud hace seis meses, acude al servicio de cirugía refiriendo dolor intermitente en fosa iliaca izquierda y bajo vientre de varios meses de evolución, además de proctodinia. En el ultrasonido abdominal y ginecológico no se observó la presencia del dispositivo intrautero pero sí hacia la proyección anexial izquierda, en el rayos x de pelvis antero posterior se comprobó la imagen radiopaca del dispositivo intrauterino hacia fosa ilíaca izquierda. Conclusiones: se intervino quirúrgicamente encontrándose dispositivo intrauterino de localización intraovárica y trompa de Falopio de ese lado inflamada y adherida al ovario, realizándosele salpingectomía y ooforectomía izquierda. La paciente evolucionó favorablemente sin complicaciones postoperatorias, se egresó a los cinco días después de terminado el tratamiento antibiótico de la sala de cirugía.

Background: the intrauterine devices are not exempt of complications and as any other foreign body implanted in the organism can migrate to another area. Case presentation: a female patient with a history of an implant of an intrauterine device (copper T) in her health area six months ago comes to the surgery service with an intermittent pain in the left iliac fossa and low abdomen with several months of evolution, besides proctodinia. In the abdominal and gynecological ultrasounds there was no presence of the intrauterine device but towards the left iliac fossa. Conclusions: She had a surgery, finding the intrauterine device of intraovaric and pallopian's tube of that swollen and adhered side to the ovary, carrying out left salpingectomy and oophorectomy. The patient evolved favorably without post-operatory complications. She was released five days after finished the antibiotic treatment of the surgery ward.

Tubal ectopic pregnancy after bilateral tubal ligation

Tubal sterilization is an increasingly common method of contraception. Although pregnancy after sterilization is uncommon, it can occur and may be ectopic. Surprisingly, failures are not limited to the first year or two, but continued to appear even after many years during follow-up. In this paper, we report a case of ectopic pregnancy in a patient who underwent bilateral tubal ligation seven years ago for contraception

Anestesia para salpingectomia parcial bilateral em paciente com miocardiopatia hipertrófica idiopática: relato de um caso e revisão da literatura / Anesthesia for partial bilateral salpingectomy in a patient with idiopathic hypertrophic cardiomyopathy: case report and review of the literature / Anestesia para salpingectomía parcial bilateral en paciente con miocardiopatía hipertrófica idiopática: relato de un caso y revisión del literatura

Justificativa e objetivos: A miocardiopatia hipertrófica é uma doença cardíaca rara, com transmissão autossômica dominante e que se caracteriza pela hipertrofia do septo ventricular e pelas anormalidades da valva mitral. Relato do caso: Paciente secundípara, de 25 anos, com diagnóstico de miocardiopatia hipertrófica há quatro anos e antecedente de asma leve intermitente controlada com inalações esporádicas de corticosteroides. Apresentava sopro holossistólico IV/VI plurifocal e importante escoliose, com os espaços intervertebrais palpáveis. Acusou palpitações esporádicas durante toda a gravidez e recebia medicação de 100 mg de atenolol por dia. Apresentava hemograma, creatinina e eletrólitos dentro dos limites normais, ecocardiograma com miocardiopatia hipertrófica de predomínio septal, com fração de ejeção sistólica de 0,76 por cento. A paciente entrou em trabalho de parto de rápida evolução e nasceu criança viva, do sexo feminino, com APGAR 9/9 sem complicações maternas nem fetais. Foi realizada a programação para a realização de salpingectomia parcial bilateral. Em consulta, a paciente negou-se a receber anestesia para o procedimento. A técnica anestésica de eleição foi a regional combinada. O procedimento cirúrgico durou 20 minutos e as mudanças de pressão arterial junto com a frequência cardíaca foram 10 por cento menores que as dos valores iniciais, sem complicações hemodinâmicas nem cirúrgicas imediatas. Conclusões: A mortalidade absoluta materna com miocardiopatia hipertrófica (MH) é muito baixa e costuma aparecer em mulheres com fatores de alto risco. Não há evidências de que a anestesia regional aumente o risco em mulheres com MH quando é utilizada para o parto vaginal. Tanto a anestesia geral como a regional foram utilizadas com sucesso e sem complicações em cesarianas de parturientes com MH.

Background and objectives: Hypertrophic cardiomyopathy is a rare, autosomal dominant cardiac disorder characterized by hypertrophy of the interventricular septum and mitral valve abnormalities. Case report: A 25-year old female, second gestation, with a diagnosis of hypertrophic cardiomyopathy for four years and history of mild intermittent asthma controlled with sporadical use of corticosteroids. On physical exam, the patient had a IV/VI systolic and plurifocal heart murmur and accentuated scoliosis with palpable intervertebral spaces. She complained of occasional palpitations during pregnancy, and was treated with 100 mg of atenolol a day. Complete blood count, creatinine, and electrolytes were within normal limits; echocardiogram showed hypertrophic cardiomyopathy predominantly septal and ejection fraction of 0.76 percent. The patient underwent emergency labor giving birth to a live female fetus, Apgar 9/9, without maternal and fetal hemodynamic complications. The patient was scheduled for bilateral partial salpingectomy. During the interview, the patient refused general anesthesia for the procedure. A decision was made for combined regional blockade. The surgical procedure lasted 20 minutes during which changes in blood pressure and heart rate were up to 10 percent lower than baseline levels without immediate hemodynamic or surgical complications. Conclusions: Absolute maternal mortality in hypertrophic cardiomyopathy (HC) is very low and it is usually seen in patients with high risk factors. Evidence does not show an increased risk of regional blocks in females with HC when it is used for vaginal delivery. Both general anesthesia and regional blocks were successfully used without complication for cesarean sections in patients with HC.

Justificativa y objetivos: La cardiomiopatía hipertrófica es enfermedad cardíaca rara, con transmisión autosómica dominante que se caracteriza por hipertrofia del septum ventricular y anormalidades de la válvula mitral. Relato del caso: Paciente segundigesta, 25 años con diagnóstico de cardiomiopatía hipertrófica hace 4 años e antecedente de asma bronquial leve intermitente controlada con inhalaciones esporádicas de corticoesteroides. Presentaba soplo holosistólico IV/VI plurifocal e importante escoliosis, con los espacios intervertebrales palpables. Refirió palpitaciones esporádicas durante todo el embarazo y se encontraba medicada con 100 mg de atenolol diarios. Presentaba hemograma, creatinina y electrolitos dentro de los límites normales, ecocardiograma que reportaba cardiomiopatía hipertrófica de predominio septal con fracción de eyección sistólica del 76 por ciento. La paciente entró en labor de parto de urgencia, obteniéndose producto femenino vivo, APGAR 9/9, sin complicaciones hemodinámicas maternas ni fetales. Se programa para la realización de salpingectomía parcial bilateral. Se entrevista a la paciente, la cual nos refirió que se rehusaba a recibir anestesia general para el procedimiento. La técnica anestésica elegida fue la regional combinada. El procedimiento quirúrgico duró 20 minutos, y los cambios de presión arterial y frecuencia cardíaca fue menos del 10 por ciento que el de los valores iniciales, sin complicaciones hemodinámicas ni quirúrgicas inmediatas. Conclusiones: La mortalidad absoluta materna con cardiomiopatia hipertrófica (CH) es muy baja y suele estar confinada a mujeres con factores de alto riesgo. No hay evidencia que la anestesia regional aumenta el riesgo en mujeres con CH cuando se utiliza para el parto vaginal. Tanto la anestesia general como regional han sido utilizado con éxito y sin complicaciones en cesáreas de parturientas con CH.

Análisis epidemiológico y clínico del embarazo ectópico: Hospital Base de los Ángeles / Clinical and epidemiological analysis of ectopic pregnancy

Antecedentes: El embarazo ectópico (EE) se produce cuando el blastocisto se implanta en un sitio distinto al endometrio de la cavidad uterina, siendo el sitio más frecuente las trompas de Falopio. Objetivo: Conocer la incidencia y caracterizar el perfl de las pacientes con EE desde el punto de vista clínico, médico, quirúrgico y obstétrico. Método: Se realizó un estudio observacional analítico. La muestra fue obtenida a través de un muestreo no probabilístico consecutivo, obteniendo una muestra fnal de 70 pacientes. Resultados: El promedio de edad materna fue 30,6 años. El 78,6 por ciento eran multíparas y 90 por ciento no usaban ningún método anticonceptivo. El 85,7 por ciento no tenían antecedentes de cirugías previas y el 91,4 por ciento no presentó antecedentes mórbidos. El 5,7 por ciento tenía antecedentes de proceso infamatorio pélvico, 18,5 por ciento tabaquismo, 12,9 por ciento abortos previos, 14,3 por ciento embarazo ectópico anterior. El manejo fue quirúrgico en 95,7 por ciento. El 78,6 por ciento presentó alguna complicación asociada, siendo la más frecuente el hematosalpinx. Conclusión: Los antecedentes epidemiológicos y clínicos de nuestra experiencia fueron concordantes con los registrados en la literatura y avalan nuestra conducta quirúrgica.

Background: Ectopic pregnancy (EP) occurs when the developing blastocyst becomes implanted at a site other than the endometrium of the uterine cavity. The most common extra-uterine location is the fallopian tube. Objective: The aim of our study is to know the incidence and the clinical, medical, obstetric and surgical profle of patients with EP. Method: An observational analytic study was made with a fnal sample of 70 patients. Results: Mean age was 30.6 years old, 78.6 percent were multiparas and 90 percent didn't use any contraceptive method. 85 percent had no history of previous surgery and 91.4 percent had no morbid background. 7.5 percent had history of pelvic infammatory disease, 18.5 percent smoked, 12.9 percent had previous abortion and 14.3 percent previous EP. The management was surgical in 95 percent of patients; 78.6 percent presented an associated complication, being hema-tosalpinx the most often. Conclusion: The epidemiological and clinical background of our experience was consistent with those reported in the literature and guarantees our surgical treatment.

Rupture of unilateral twin tubal pregnancy.

A 32-year-old Thai woman presented with acute severe lower abdominal pain and 8 weeks of amenorrhea. The patient was hypotension, had anemia and signs of lower abdominal peritonitis. Initial diagnosis was tubal pregnancy with rupture. Intraoperatively, there were hemoperitoneum and two fetuses were found in the pelvis. Final diagnosis of ruptured unilateral twin tubal pregnancy was achieved. A right salpingectomy was done. There was no immediate complication.

Cornual pregnancy resulting from frozen embryo transfer in a woman with history of bilateral salpingectomies

A 34 year-old woman presented with left cornual ectopic pregnancy following in vitro fertilization-frozen embryo transfer treatment. Her medical history included two previous ectopic pregnancies treated by salpingectomies at Westmead Fertility Center-Sydney-Australia. Cornual pregnancy may be an unexpected complication after bilateral salpingectomies which have been managed conservatively. This case was successfully managed conservatively by intramuscular methotrexate and laparoscopic local injection of methotrexate

Hysteroscopy and the butyl-cyanoacrylate on experimental sterilization of rabbit uterine tubes

PURPOSE: To assess the sterilization effectiveness on uterine tube of rabbit by the cyanoacrylate adhesive. METHODS: Hysteroscopy tubal catheterization was performed randomly in 12 animals (24 uterine tubes) assigned to the sham group (GS) and 15 animals (30 uterine tubes) to the n-butyl-cyanoacrylate (GB). The female rabbits were observed during 30, 90 and 180 days and mated to fertile males. The no pregnant rabbits were submitted to in vitro burst pressure test for patency by air insufflation (40 mmHg). The microscopic assessment was performed to parameters of damages in epithelium caused by the adhesive, the degree of inflammatory process, morphometry data values of tube diameter (UT) (cm), mucosa thickness (MT) and the myosalpinx thickness (MyT) (mm). The mucosa cells densitometry (total optical density) was expressed by the amount of DNA. The significance of the differences in histological scores and in thickness measurements were made by ANOVA test (P value < 0.05). RESULTS: In all animals of GB: the adhesive was attached to the mucosa; there was no pregnancy; no records of significant degree on inflammatory process; the patency test was negative and densitometry of DNA showed similar values to the both groups independently of observation periods. The layers thickness of GB-UT(1.118±0.117), GB-MT(0.447±0.247) and GB-MyT(0.853±0.097) were larger than the GS-UT(0.666±0.409), GS-MT(0.211±0.070) and GS-MyT(0.442±0.143). CONCLUSION: This approach offers a safe and feasible method of uterine tube obstruction.

OBJETIVO: Verificar a eficácia do adesivo de cianoacrilato na esterilização de tubas uterinas de coelhas. MÉTODOS: A cateterização tubária por histeroscopia foi realizada randomicamente em 12 animais (24 tubas uterinas) formando o Grupo Sham (GS) e 15 animais (30 tubas uterinas) para o grupo do n-butil-cianoacrilato (GB). As coelhas foram observadas por 30, 90 e 180 dias e acasaladas com machos férteis. As tubas uterinas das fêmeas que não ficaram grávidas foram submetidas ao teste de pressão de rompimento in vitro, com insuflação de ar (40mmHg). A microscopia óptica estudou os danos causados ao epitélio pelo adesivo, o grau de processo inflamatório, a morfometria do diâmetro tubário (UT) (cm), da mucosa (MT) e do miosalpinge (MyT) (mm). A densitometria das células da mucosa (Densidade Optica Total) foi expressa pela contagem do DNA. As significâncias dos diferentes escores histológicos e das medidas das camadas foram avaliadas pelo Teste de ANOVA (P<0,005). RESULTADOS: Em todos os animais do GB: o adesivo estava aderido na mucosa tubária, não ocorreu prenhez, não houve significância nos graus do processo inflamatório, o teste de perviedade foi negativo e a densitometria do DNA apresentou valores similares em todos os grupos, independente do período de observação. A medida das camadas do GB-UT(1.118±0.117), GB-MT(0.447±0.247) e GB-MyT (0.853±0.097) foi maior que as dos GS-UT(0.666±0.409), GS-MT(0.211±0.070) e GS-MyT(0.442±0.143). CONCLUSÃO: O procedimento proposto foi de fácil execução e eficaz para obstrução da tuba uterina de coelhas.

[Laparoscopic management of ectopic pregnancy about 166 cases]

The ectopic pregnancy [EP] is a frequent and serious pathology. It represents a medical and surgical emergency. To study the epidemiologic profile and to evaluate the laparoscopic management of ectopic pregnancy by comparing our results with those of the literature. Retrospective study of 166 cases of ectopic pregnancies treated by laparoscopy in the department of obstetric and gynaecology of the Charles Nicolle Hospital, over one period of five years [January 2002-December 2006]. The mean age of the patients was 32.07 years [21-41]. The mean parity was 1, 42 [27.71%when nulliparous]. 9.03%of our patients had a history of ER Clinical symptomatology was dominated by the pelvic pains and the bleeding in 90%of the cases. The amenorrhoea missed in 32 patients. The rate of beta HCG was superior to 1500 at 47.61%of the patients. The pelvic ultrasonography carried out in all the patients, objectified a pelvic mass in 81.92%of the cases. Serology of chlamydiaewas positive at 9.03%of the patients. The laparoscopy was initially indicated in 155 patients; a medical treatment with methotrexate was begun in the six other patients. A laparoconversion was indicated in 16 cases, 9 times for operational difficulties and 7 times for a hemorrhagic complication. A salpingectomy was practised in 79.72%of the cases. The treatment was conservative in 20.27%of the cases. The laparoscopic treatment at best conservative should be the gold standard in the treatment of EP in order to preserve the fertility of the patients. who are generally young

Ectopic pregnancy after bilateral salpingectomy

Ectopic pregnancy is a life threatening condition and is a major event in a woman's reproductive life. We report herein an unusual case of repeated ectopic pregnancy even after the excision of both fallopian tubes with a deleterious consequences and a near miss. This case teaches us a lesson not to forget ectopic pregnancy. The lady in this report underwent in vitro fertilization treatment cycle due to absence of both fallopian tubes as consequence of previous ectopic pregnancy and a hydrosalpinx; she conceived successfully but unfortunately the pregnancy was another ectopic pregnancy

Comparative study of the efficacy of the Songkla uterine manipulator and the Hulka controlling tenaculum in laparoscopic tubal ligation.

OBJECTIVE: To compare the efficacy of the Songkla uterine manipulator (SUM) and the Hulka controlling tenaculum for manipulation of the uterus for laparoscopy. METHOD: Forty women scheduled for laparoscopic tubal ligation were randomized to the SUM group (n=20) or the Hulka group (n=20) as uterine manipulator. Laparoscopic evidence of antevertion and lateral uterine movements and organ exposure was video recorded. Assessment of organ exposure and degree of lateral uterine deviation were subsequently evaluated. RESULTS: The characteristics of the women were similar in both groups. Right, left and range of lateral uterine motion were greater in the SUM group than the Hulka group (59 vs 42 degrees, 60 vs 47 degrees, and 118 vs 89 degrees, respectively, p<0.0001). The SUM group had 2.4 times better cul-de-sac exposure than the Hulka controlling tenaculum (95% CI: 0.51-11.51, p= 0.475). The SUM exposed fallopian tubes better than the Hulka tenaculum (p=0.022) but other structures were not significantly better visualized. There were no complications in the SUM group but two had cervical bleeding in the Hulka group. CONCLUSION: The SUM has advantages over the Hulka controlling tenaculum in giving a wider angle of lateral uterine deviation and better exposure of the fallopian tubes.

Microcirugía tubárica distal translaparoscópica: sus resultados / Translaparoscopic distal tubal micro surgery: its results

Introducción: La patología tubárica distal representa un 30 a 40 por ciento de la causas de disfunción reproductiva. Objetivos: Mostrar los resultados obtenidos con el tratamiento laparoscópico del factor tubárico distal en la paciente con esterilidad de origen tuboperitoneal. Material y Métodos: Desde el año 1996 se analizaron propectivamente pacientes sometidas a cirugía tubárica distal por laparoscopia, con esterilidad por factor tuboperitoneal. Se excluyeron del trabajo a la mujeres con baja reserva ovárica y aquellas parejas con factor masculino severo, pero se incluyeron casos de factor masculino en tratamiento médico o reproducción asistida de baja complejidad. Se realizó un seguimiento mínimo de 1 año. Resultados: Se estudiaron 123 pacientes operadas hasta marzo de 1999, con esterilidad primaria (n=84) o secundaria (n=39). Se realizaron fimbrioplastias (n=107) y salpingoneostomías (n=19). Se obtuvieron 47 embarazos (38.2 por ciento), y en 12 casos ya se verificó un segundo embarazo. La mayoría de los embarazos se obtuvieron en el primer año postoperatorio (74.5 por ciento)y en las pacientes menores de 34 años (76.6 por ciento). La tasa de embarazos ectópicos fue del 6.4 por ciento (3 casos, todos correspondientes a salpingostomías por hidrosálpinx) y la de abortos 23.4 por ciento (11 casos). En 76 casos se halló endometriosis que se trató laparoscópicamente y, en 48 casos (63.1 por ciento) con leuprolide adyuvante por 4-6 meses. De estas pacientes, 24 embarazaron, independientemente del uso adyuvante de leuprolide (p=0.8). Conclusiones: La laparoscopia operatoria permite hoy en día resolver la patología tubárica distal de una manera mínimamente invasiva, con resultados similares a la técnica convencional, en pacientes con factor tuboperitoneal

Espectro clínico de la torsión tubo-ovárica en niñas / Clinical spectrum of ovarian torsión in girls

La torsión tubo-ovárica en las niñas, en ausencia de alguna masa ovárica predisponente, es una entidad que ocurre con mayor frecuencia de lo que se cree, y que de no tratarse conduce a la necrosis del órgano afectado.Se presentan tres casos representativos: sólo uno manifestó dolor abdominal bajo agudo e intenso, que orilló a laparotomía con destorsión de la trompa y el ovario afectados. Los otros dos casos manifestaron dolor abdominal intermitente, de corta duración, que fue insuficientemente valorado y su diagnóstico sólo se estableció por la aparición de imágenes de desorganización o calcificación ovárica en estudios radiológicos indicados para la evaluación de síntomas urinarios.Se concluye la importancia de realizar una evaluación precisa de todos los cuadros de dolor abdominal bajo agudo de las niñas, especialmente de las que tienen entre ocho y 13 años de edad y dolor en el lado izquierdo.