Investigation of familial tendency of endometriosis / 中华妇产科杂志

Objective: To investigate the familial heritability of endometriosis and to compare the clinical characteristics of patients with or without a family history of endometriosis. Methods: From January 2020 to June 2022, 850 patients with endometriosis confirmed by laparotomy or laparoscopy in Peking University Third Hospital were included in this study. Clinical data were collected, family history was followed up, and the differences of clinical indicators between patients with and without family history of endometriosis were compared. Results: A total of 850 patients were enrolled, with an average age of (33.8±7.0) years old, 315 (37.1%, 315/850) patients in stage Ⅲ and 496 (58.4%, 496/850) patients in stage Ⅳ. There were 100 patients with family history of endometriosis, accounting for 11.8% (100/850). Most of the 113 relatives involved were mothers, daughters and sisters (76.1%, 86/113), 81.5% (22/27) of the second and third degree relatives were maternal relatives. The median ages of patients with and without family history of endometriosis were 30 and 33 years old respectively at the time of diagnosis. The unmarried rate of patients with family history was higher [42.0% (42/100) vs 26.3% (197/750)]. The percentage of dysmenorrhea patients with family history was higher [89.0% (89/100) vs 55.5% (416/750)]. The medians of dysmenorrhea score in patients with and without family history were 6 and 2, and the median durations of dysmenorrhea were 10 and 1 years. There were significant differences in age, marital status, percentage of dysmenorrhea, dysmenorrhea score and duration (all P<0.001). The median levels of serum cancer antigen (CA) 125 in patients with family history and patients without family history at the time of diagnosis were 57.5 and 46.9 kU/L respectively, with a statistically significant difference (P<0.05). However, there were no significant differences between the two groups in nationality, bady mass index, menarche age, menstrual cycle, menstrual period, menstrual volume, serum CA19-9 level, cyst location and size, stage, history of adverse pregnancy and childbirth, infertility, adenomyosis and deep infiltrating endometriosis (all P>0.05). By comparing the specific conditions of dysmenorrhea patients with and without family history of endometriosis, there were no significant differences between the two groups in terms of the age of onset of dysmenorrhea, duration of dysmenorrhea, primary and secondary dysmenorrhea, and progressive aggravation of dysmenorrhea (all P>0.05). The difference in the degree of dysmenorrhea in dysmenorrhea patients with family history of endometriosis was significant (P<0.001). Conclusions: The incidence of endometriosis has a familial tendency, and most of the involved relatives are the first degree relatives. Compared with patients without family history of endometriosis, endometriosis patients with family history are diagnosed at an earlier age, with higher percentage of dysmenorrhea, had more severe dysmenorrhea and higher serum CA125 level.

Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma

INTRODUCTION@#To compare epidemiological features and clinical presentations of deep infiltrating endometriosis with endometrioma and adenomyosis, as well as to identify risk factors for the respective histologically confirmed conditions.@*METHOD@#Patients undergoing index surgery at the National University Hospital, Singapore for endometriosis or adenomyosis over a 7-year period-from 2015 to 2021-were identified from hospital databases using the Table of Surgical Procedures coding. Social and epidemiological features of cases with histologically confirmed diagnoses of endometrioma only, adenomyosis only, and deep infiltrating endometriosis were compared. Significant variables from univariate analysis were entered into 3 binary multivariate logistic regression models to obtain independent risk factors for: deep infiltrating endometriosis versus endometrioma only, deep infiltrating endometriosis versus adenomyosis only, and adenomyosis only versus endometrioma only.@*RESULTS@#A total of 258 patients were included with 59 ovarian endometrioma only, 47 adenomyosis only, and 152 deep infiltrating endometrioses. Compared to endometrioma only, deep infiltrating endometriosis was associated with higher rates of severe dysmenorrhoea (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.02-7.70) and out-of-pocket private surgical care (OR 4.72, 95% CI 1.85-12.04). Compared to adenomyosis only, deep infiltrating endometriosis was associated with a higher fertility desire (OR 13.47, 95% CI 1.01-180.59) and a lower body mass index (OR 0.89, 95% CI 0.79-0.99). In contrast, heavy menstrual bleeding was the hallmark of adenomyosis, being less common in patients with endometriosis.@*CONCLUSION@#Deep infiltrating endometriosis is associated with severe dysmenorrhoea, pain related to urinary and gastrointestinal tracts, higher fertility desire and infertility rate. Patients with pain symptomatology and subfertility should be referred early to a tertiary centre with the capability to diagnose and manage deep infiltrating endometriosis.

Dysmenorrhea due to undiagnosed obstructed hemi-vagina and ipsilateral renal anomaly syndrome can become a cause of suicide

BACKGROUND@#A Japanese woman in her early twenties had committed suicide, jumped from a 25-meter high bridge into a lake. She had been suffering from severe dysmenorrhea and general fatigue monthly.@*RESULTS@#A forensic autopsy revealed indications of a bicorporeal uterus, obstructed hemi-vagina, and ipsilateral renal agenesis, which lead to a diagnosis of obstructed hemi-vagina and ipsilateral renal anomaly (OHVIRA) syndrome. On the right side of the uterus, an enclosed cavity composed of black clots was observed. Histological findings suggested that her endometrium was in the early proliferative phase, implying that she was in the menstrual phase just before her death. She may have been suffering from severe lower abdominal pain from the increased pressure of the closed uterus cavity.@*CONCLUSIONS@#This case indicates that dysmenorrhea from undiagnosed OHVIRA syndrome can possibly lead to a suicide attempt. In Japan, because suicide was the leading cause of death for people aged 15 to 39 in 2019, preventive measures for suicide should be promoted. The present case also suggests that intervention for dysmenorrhea may prevent this in adolescent woman.

Dismenorreia membranosa (membranácea): um relato de caso / Membranous dysmenorrhea: a case report

A dismenorreia é a queixa ginecológica mais comum em mulheres jovens adultas, com um índice que varia entre 43% e 93% das mulheres que menstruam. A dismenorreia membranosa (DM), uma subclassificação da dismenorreia, é definida como a descida espontânea de tecido endometrial pela vagina, cursando com dor em có- lica intensa e súbita. O relato de caso descrito evidencia três episódios típicos de DM, com recorrência em três vezes distintas, após uso do mesmo anticoncepcional oral combinado de baixa dosagem. Esta publicação é importante para a comunidade científica devido à escassez de informações e artigos científicos publicados sobre o assunto, propondo a elucidação de alguns aspectos sobre o tema.(AU)

Dysmenorrhea is the most common gynecological complaint in young adult women, with an index that varies between 43% and 93% of women who menstruate. Membranous dysmenorrhea (MD) is a subclassification of dysmenorrhea and is defined as the spontaneous descent of endometrial tissue through the vagina, leading to severe and sudden colic pain. The case report described shows three typical episodes of MD, with recurrence three times after the use of the same low-dose combined oral contraceptive. This publication is important for the scientific community due to the scarcity of information and scientific articles published about this subject, proposing to elucidate some aspects about this theme.(AU

Quality of life assessment by the endometriosis health profile (EHP-30) questionnaire prior to treatment for ovarian endometriosis in brazilian women / Avaliação da qualidade de vida através do questionário Endometriosis Health Profile (EHP-30) antes do tratamento da endometriose ovariana em mulheres Brasileiras

Abstract Objective To evaluate the existence of an association between ultrasound findings and epidemiological and clinical factors using results obtained from the EHP-30 questionnaire in women with ovarian endometriosis. Methods A cross-sectional observational study was performed between July 2012 and May 2015, in which patients with chronic pelvic pain suggestive of endometrioma, as indicated by the results from a transvaginal pelvic ultrasonography, completed the standardized Endometriosis Health Profile - 30 (EHP-30) questionnaire to access quality-of-life scores before beginning treatment for endometriosis. A total of 65 patients were included. The data was analyzed in the statistical program IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA) for the comparison of data through linear multiple regression. Results The suitability of the linear regression model was confirmed by the histogram of the dependent variable and the residue distribution plot, confirming the trend of linearity as well as the homogeneous dispersion of the residues. The mean age of the patients was 39.7 ± 7.1 years old. Themajority was Caucasian (64.5%), had completed higher education (56.5%) and was nulligravida (40.3%). Infertility was present in 48.4% of the patients studied. Out of the total sample, 80.6% of the cases were symptomatic and complained mainly of acyclic pain, 79% of dysmenorrhea, and 61.3% of dyspareunia. This reflects the negative influence of endometriosis on the quality of life of patients with this disease. Conclusion Dyspareunia and acyclic pain were independent factors of correlation with high scores in the EHP-30 questionnaire, reflecting a worse quality of life.

Resumo Objetivo Avaliar a existência de associação entre os achados ultrassonográficos e os fatores epidemiológicos e clínicos com os resultados obtidos no questionário EHP-30 em mulheres com diagnóstico de endometriose ovariana. Métodos Realizou-se um estudo observacional transversal entre julho de 2012 emaio de 2015, no qual as pacientes com dor pélvica crônica com imagem sugestiva de endometrioma na ultrassonografia pélvica transvaginal preencheram o questionário padronizado Endometriosis Health Profile - 30 (EHP-30) para acessar os escores de qualidade de vida antes de iniciar qualquer tratamento para a endometriose. Foram incluídas 65 pacientes. Os dados foram analisados no programa estatístico IBM SPSS Statistics for Windows, Versão 22.0 (IBM Corp., Armonk, NY, EUA) para a comparação dos dados através de regressão múltipla linear. Resultados A adequabilidade do modelo de regressão linear foi confirmada através do histograma da variável dependente e do gráfico de distribuição dos resíduos, confirmando a tendência de linearidade, assim como a dispersão homogênea dos resíduos. A idade média das pacientes foi de 39,7 ± 7,1 anos. Amaioria era caucasiana (64,5%), apresentava ensino superior completo (56,5%), e era nuligesta (40,3%). Infertilidade estava presente em 48,4% das pacientes estudadas. Do total de casos 80,6% eram sintomáticas e queixaram-se principalmente de dor acíclica, 79%de dismenorreia , e 61,3% de dispareunia em , refletindo a influência negativa da endometriose sobre a qualidade de vida das pacientes portadores desta doença. Conclusão Dispareunia e dor acíclica foram fatores independentes de correlação com altos escores no EHP-30, refletindo uma pior qualidade de vida.

Variables associated with endometriosis-related pain: a pilot study using a visual analogue scale / Variáveis associadas à dor relacionada à endometriose: estudo piloto usando uma escala analógica visual

Abstract Objective Endometriosis is a complex disease, and pain is an important component of the syndrome. One of the most used methods to assess pain is the visual analogue scale (VAS). The aim of the present research was to study the pain experienced by patients who referred to our unit for endometriosis, using the VAS to understand the variables that could influence it. Methods We have conducted a prospective study from February 2012 to December 2016, enrolling 388 patients who referred to a university hospital, in Florence, Italy. We have included in the present study patients during their follow-up for endometriosis; we have also included patients who underwent surgery with a histological diagnosis of endometriosis. We have collected sociodemographic and clinical information regarding age, body mass index (BMI), smoking habit, number of pregnancies, and endometriosis staging. Finally, we have administered the VAS for several symptoms. Results Dysmenorrhea was the symptom associated with the highest perception of pain (mean VAS score of 5.76). The logistic regression showed that the stage of endometriosis could influence the pain associated to constipation and to dysuria. The linear regression showed that age couldinfluencethe pain associated to constipation, to dyspareunia,and to dysmenorrhea. A positive correlation was found between dysmenorrhea and chronic pelvic pain(CPP), between dysmenorrhea and dyspareunia, and between constipation and dysuria. Conclusion Using a validated method, the VAS, we have studied the pain experienced by a group of patients with a history of endometriosis and observed that smoking habit and BMI did not influence the VAS scores, and that dysmenorrhea was associated with the highest perception of pain.

Resumo Objetivo A endometriose é uma doença complexa, e a dor é um componente importante da enfermidade. Um dos métodos mais utilizados para avaliar a dor é a escala visual analógica (EVA). O objetivo da presente pesquisa foi estudar a dor sentida pelas pacientes que se referiram à nossa unidade para endometriose, usando a EVA para entender as variáveis que poderiam influenciá-la. Métodos Realizamos um estudo transversal de fevereiro de 2012 a dezembro de 2016, envolvendo 388 pacientes que se referiram a um hospital universitário, em Florença, Itália. Incluímos nossos pacientes do estudo durante o acompanhamento da endometriose; incluímos também pacientes que sesubmeteramàcirurgia comdiagnóstico histológico de endometriose. Coletamos informações sociodemográficas e clínicas sobre idade, índice de massa corporal (IMC), hábito de fumar, número de gravidezes e estágio da endometriose. Finalmente, administramos a EVA para vários sintomas. Resultados A dismenorreia foi o sintoma associado à maior percepção de dor (média do escore EVA de 5,76). A regressão logística mostrou que o estágio da endometriose poderia influenciar a dor associada à constipação e à disúria. A regressão linear mostrou que a idade poderia influenciar a dor associada à constipação, à dispareunia e à dismenorreia. Uma correlação positiva foi encontrada entre dismenorreia e dor pélvica crônica, entre dismenorreia e dispareunia, e entre constipação e disúria. Conclusão Utilizando um método validado, a EVA, estudamos a dor sentida por um grupo de pacientes com história de endometriose e observamos que o hábito de fumar e o IMC não influenciaram os escores EVA, e que a dismenorreia foi associada à maior percepção de dor.

Manejo laparoscópico multidisciplinario de la endometriosis profunda del 2010 al 2017: estudio de cohorte retrospectivo / Multidisciplinary laparoscopic management of deep infiltrating endometriosis from 2010 to 2017: A retrospective cohort study

INTRODUCCIÓN La laparoscopía es actualmente el estándar en el manejo de la endometriosis profunda. Sin embargo, requiere de un entrenamiento específico e involucra la realización de procedimientos complejos y asociados a una alta tasa de complicaciones. Por lo anterior en Chile y Latinoamérica, la endometriosis profunda es frecuentemente manejada de manera inadecuada. OBJETIVO Describir nuestra experiencia en el enfrentamiento clínico y manejo quirúrgico laparoscópico de la endometriosis profunda, durante los últimos siete años. MÉTODOS Estudio de cohorte retrospectivo de 137 pacientes consecutivas operadas y con confirmación histológica de endometriosis profunda. Se recolectaron los datos demográficos, datos quirúrgicos, complicaciones, resultados reproductivos y seguimiento. RESULTADOS Todas las cirugías fueron completadas por laparoscopía, sin conversión. La dismenorrea y la dispareunia fueron los síntomas más frecuentes en 85,4 y 56,9%, respectivamente. La localización más frecuente de endometriosis profunda fueron los ligamentos úterosacros, coexistiendo un endometrioma en 48,9% de los casos. La mediana de tiempo operatorio fue de 140 minutos, siendo significativamente más prolongado en casos con compromiso intestinal (p < 0,0001). Quince pacientes (10,9%) presentaron complicaciones. El seguimiento medio fue de 24,5 meses. La tasa de embarazo fue de 58,1% y 90% de las pacientes reportó una mejoría significativa de su sintomatología. CONCLUSIONES El manejo laparoscópico de la endometriosis profunda es efectivo y seguro, pero debe reservarse a centros especializados y con disponibilidad de equipo multidisciplinario.

BACKGROUND Laparoscopy has become the standard of care in the surgical management of deep infiltrating endometriosis (DIE). However, it is a challenging procedure with a high complication rate. Despite the benefits of the minimally invasive approach, DIE resection is often performed by surgeons without adequate training, especially in developing countries like Chile. OBJECTIVE To asses our experience in the diagnosis and laparoscopic management of DIE during seven years. METHODS A retrospective cohort study of data including 137 patients with pathology-proven DIE. Surgical and fertility outcomes were evaluated. RESULTS All procedures were performed laparoscopically without conversion. Dysmenorrhea and dyspareunia were the most common symptoms in 85.4% and 56.9%, respectively. Uterosacral ligaments were the most common DIE location. Endometrioma was present in 48.9% of cases. Median operative time was 140 minutes; however, it was longer in cases requiring bowel surgery (p < 0.0001). The complication rate was 10.9%. Median follow-up was 24.5 months. The pregnancy rate was 58.1% and 90% of patients reported significant symptom relief after surgery. CONCLUSION Laparoscopic surgical management of DIE is effective and safe but it must be performed in tertiary centers with the availability of multidisciplinary teams.

Dismenorrea membranácea durante la menarquia / Membranous dysmenorrhea during menarche

La dismenorrea membranosa se caracteriza por dolor menstrual acompañado de la expulsión de la mucosa endometrial en forma de grandes fragmentos, e incluso en una única pieza, con la forma del molde de la cavidad uterina. Se presenta el caso de una paciente con expulsión de un gran molde de endometrio durante la menarquia. Se presentan las imágenes del molde endometrial íntegro de la cavidad uterina y el estudio anatomopatológico.

Membranous dysmenorrheal consist of menstrual pain accompanied by the expulsion of endometrial mucosa in the form of large fragments or even in one piece with the shape of the uterine cavity. We present the case of a patient with expulsion of endometrial during menarche. The pictures of endometrial piece, the shape of the uterine cavity and anatomo-pathological study has presented.

Dismenorreia / Dysmenorrhoea

O artigo discorre sobre a dismenorreia, patologia de origem primária ou secundária que acomete mulheres no período fértil, tanto as que ainda não menstruam quanto as que já menstruaram. Caracteriza-se por dor intensa, em forma de cólica durante a menstruação, manifestada em região do baixo ventre ou lombar. Trata-se de um grande problema de Saúde Pública, gerador de prejuízos econômicos por provocar absenteísmo na vida profissional e escolar das mulheres acometidas. Diversos fatores estão envolvidos nessa patologia, como a produção e a liberação de prostanoides, que promovem um desequilíbrio hormonal. Hoje, é designada como de causa endócrino-ginecológica e está relacionada com outros hormônios da mulher.(AU)

The article describes the dysmenorrhea, pathology of primary or secondary origin which affects women in the fertile period, both those that still do not menstruate as those that have already menstruated. It is characterized by severe pain, colic so during menstruation, manifested in the lower abdomen or lower back. It is a major Public Health problem, economic losses generator for causing absenteeism at work and school life of the women affected. Several factors are involved in this pathology, such as the production and release of prostanoids, which promote a hormonal imbalance. Today, it is known as a gynecological endocrine cause and is related to other hormones of women.(AU)

Urinary Bladder Endometriosis.

Endometriosis is characterized by the presence of endometrial tissue in the ectopic foci outside the uterus.Usual sites of its occurence are ovaries, uterine ligaments, fallopian tubes, rectum and cervico-vaginal regions. Urinary tract is a rare site of occurence and accounts for 1-2% cases.84% of cases in urinary tract occur in urinary bladder. We report a case of urinary bladder endometriosis in a 35 years old female patient who presented with cyclical pain and hematuria with a mass in right posterolateral wall of the urinary bladder.

Controvérsias acerca do dispositivo intrauterino: uma revisão / Controversies about the intrauterine device: a review

O dispositivo intrauterino (DIU) é atualmente o método contraceptivoreversível mais usado no mundo, sobretudo nos países em desenvolvimento, com maior número de usuáriasna Ásia oriental. Entretanto, ainda há controvérsias envolvendo o seu uso. Por esse motivo, consultamos sitescom bancos de dados eletrônicos como Medline, Lilacs, Wholis e Biblioteca Cochrane, sem restrição linguística,à procura de artigos que abordassem controvérsias sobre o DIU e selecionamos 32, os quais foram incluídos napresente revisão. O mecanismo de ação se deve à reação inflamatória, citotóxica, comprometendo a qualidade,viabilidade e a migração do esperma pela ação do DIU com cobre sobre o muco cervical. A inserção imediatamenteapós uma gestação apresenta várias vantagens, como prevenção de gravidez indesejada, porém não há consensose é tão segura e eficaz quando comparada à inserção fora desse período. O uso profilático de antibióticos nãodiminui o risco de infecções do trato genital, podendo ser indicada para mulheres que vivem em regiões comalta prevalência de doenças sexualmente transmissíveis (DST). Menorragia e dismenorreia são os efeitos colateraismais frequentes referidos pelas usuárias de DIU e as principais causas de sua remoção. O uso de anti-inflamatóriosnão hormonais para tratá-los é motivo de controvérsias na literatura. Sobre o uso de DIU em nulíparas, existemrelativamente poucos estudos na literatura e as conclusões não são seguras. Apesar dos dados sobre adolescentesquanto à segurança, eficácia e aceitação, serem escassos, há pressa no que diz respeito ao uso nesse grupo,tendo em vista a prevenção de gravidez indesejada, tão comum entre elas. As contraindicações são limitadas àgravidez, neoplasias malignas uterinas e efeitos adversos aos componentes do DIU. Apesar de o DIU ser usadohá muitos anos, existe ainda questionamentos de como a fertilidade subsequente é afetada...

The intrauterine device (IUD) is nowadays the most widely used reversiblecontraceptive method in the world, particularly in developing countries, with the highest use in Eastern Asia.Nevertheless, there are still controversies involving its use. For this reason, we searched Medline, Lilacs, Wholisand Cochrane Collaboration databases for articles in any language, addressing controversies about the IUD, selecting 32 for inclusion in this review. The mechanism of action is due to cytotoxic and inflammatory reaction,compromising the quality, viability and sperm migration, by the action of the IUD with cupper on the cervicalmucus. Insertion immediately after a pregnancy ends has several potential advantages, like preventing an unwantedpregnancy. However, there is no consensus if the insertion in this period is as safe and effective as the intervalinsertion. The prophylactic use of antibiotics has not decreased the risk of upper genital tract infection, but itmay be justified for women living in regions with high prevalence for sexually transmitted diseases (STD). Themost frequent side effects reported by users of IUD are menorrhagia and dysmenorrhea, considered the mostcommon reasons for its removal. Non-steroidal anti-inflammatory drugs used for these associated symptoms arecause for controversy in the literature. Concerning the utilization of IUDs in nuliparous women, there are relativelyfew studies in the medical literature and the conclusions are no definitive. There are little data regarding safety,efficacy, and acceptability of IUDs in teenagers. However, this should be countered with the pressing need toprevent unintended pregnancy in this group of women. Contraindications are restricted to pregnancy, malignantuterine neoplasms and adverse effects of the IUD components in the user...

Importancia de la relación cobre-zinc como indicador bioquímico de dismenorrea primaria / Importance of the copper-zinc ratio as a biochemical indicator of primary dysmenorrheal

La dismenorrea primaria requiere de una evaluación de los niveles séricos de cobre y zinc antes del ciclo menstrual y durante éste, permitiendo administrar estos elementos y minimizar el impacto que esta entidad ocasiona, tales como depresiones, dolores, irritabilidad de conducta, lo que conlleva ausentismos escolares y laborales.

Extensa metaplasia ósea endometrial y exitoso embarazo espontáneo post tratamiento / Bony metaplasia of the endometrium. Report of two cases

We report a 28 year old female consulting for infertility and a 26-year-old woman consulting for severe dysmenorrhea. In both patients a osseous metaplasia of the endometrium was found. Both patients were subjected to a hysteroscopic resection of the osseous material and both achieved spontaneous pregnancies and term deliveries following the procedures. If the bony material is removed, normal pregnancies and deliveries are feasible afterwards, no matter how extensive is the the osseus metaplasia.

Función hormonal y flujo sanguíneo útero-ovárico en pacientes sometidos a salpingectomía / Hormonal function and uterine and ovary blood flow in patients under salpingectomy

El objetivo de la investigación fue comparar los efectos de la salpingectomía sobre la función hormonal y el flujo sanguíneo útero-ovárico. Se incluyeron 33 mujeres sanas con ciclos menstruales regulares. La salpingectomía fue realizada inmediatamente en los 5 días siguientes a la menstruación. Se tomaron muestras de sangre venosa para determinar las concentraciones de las hormonas folículo estimulante y luteinizante, estradiol y progesterona antes y luego de 3 meses de la cirugía. El flujo sanguíneo fue evaluado usando Doppler color y de pulso para medir el índice de resistencia, índice de pulsatilidad y velocidad sistólica pico en la vasculatura ovárica y las arterias uterinas. Se observó un aumento estadísticamente significativo en las concentraciones de hormonas folículo estimulante y luteinizante después de 3 meses de la salpingectomía (P<0,05). No se encontraron diferencias estadísticas significativas en las concentraciones de estradiol y progesterona (P=ns). Se observaron variaciones estadísticas significativas en los valores de velocidad sistólica pico, índice de resistencia e índice de pulsatilidad de la arteria ovárica al comparar los valores antes y 3 meses después de la salpingectomia (P<0,05). También se observó un aumento estadísticamente significativo en el volumen de los ovarios después de 3 meses de la cirugía (P<0,05). Se concluye que luego de 3 meses, la salpingectomía produce cambios en las concentraciones de gonadotropinas, tamaño de los ovarios y en los parámetros ecográficos Doppler de las arterias ováricas

The objetive of research was to compare the effects of salpingectomy over hormonal function and uterine and ovary blood flow. Thirty-three healthy women with normal menstrual cycles were included. Salpingectomy was performed immediately in five days following menstruation. A venous blood sample was taken to determine folicular stimulant and luteinizant hormones, estradiol and progesterone before and after three months of surgery. Bood flow was evaluated using color and pulse Doppler to measure resistance index, pulsatility index and peak systolic flow in ovary vasculare and uterine artery. There were statically significant increased in folicular stimulant and luteinizant hormones concentrations after three months of salpingectomy (P<0.05). There were not significant differences in estradiol and progesterone concentrations (P=ns). There were statistically significant variations in values of peak systolic flow, resistance index and pulsatility index of ovarian arteries when values before and three moths after salpingectomy were compared (P<0.05). There was also a statistically significant increase in ovary volume after three months of surgery (P=0.05). It is concluded that after three months, salpingectomy produces changes in gonadotropins concentrations, ovary size and ultrasound Doppler parameters of ovarian artery

study of dysmenorrhea among female residents aged 18-45 years in semirural area of West Turkey

To determine the correlates and the prevalence of Dysmenorrhea in a group of women. This cross sectional study was carried out on the 556 subjects aged 18-45 years in a town of western Turkey between January, and March 2009. We used visual analogue scale to assess the severity of dysmenorrhea. The data were evaluated by Logistic Regression Analysis and Chi-square tests. The prevalence of dysmenorrhea was 66.7%. About 32.3% of the women described their dysmenorrhea as severe. When compared to the age group of 35 and over, the risk of dysmenorrhea was 2.677 fold higher in the age group of 24 and over. The risk of dysmenorrhea was nearly 2.5 fold higher in those who had family history of dysmenorrheal. The prevalence of depression among women was relatively high. This indicates the need for knowledge concerning dysmenorrhea to be addressed by menstruation-related health education programs

Resección histeroscópica del tabique vaginal en el síndrome de herlyn-werner-wünderlich: reporte de un caso / Hysteroscopic resection of the vaginal septum in herlyn-werner-wünderlich syndrome

El síndrome de Herlyn-Werner-Wünderlich es una malformación uterina caracterizada por útero didelfo, hemivagina ciega total o parcial y agenesia renal ipsilateral. Los hallazgos clínicos son variables; en general se manifiesta después de la menarquia como dismenorrea progresiva, secundaria a la criptomenorrea, menos frecuentemente se asocia a infertilidad. Se presenta un caso clínico y su resolución mediante la resección del tabique vaginal por histeroscopia.

Herlyn-Werner-Wünderlich syndrome is a uterine malformation characterized by uterus didelphys, unilateral blind hemivagina and ipsilateral renal agenesis. Its clinical findings are variable; it generally appears after menarche as progressive dysmenorrhea, secondary to criptomenorrhea, less frecuently it's associated with infertility. We present a case report and its resolution by resection of the vaginal septum trough hysteros-copy.

Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis case report and literature review / Útero bicorne bicollis, hemivagina imperforada, y agenesia renal ipsilateral reporte de caso y revisión de la literatura

We present a case of a patient with Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis. This group of congenital malformations is often asymptomatic until puberty, when it presents as cyclic dysmenorrhoea, leucorrhoea or a pelvic mass. Magnetic resonance imaging is becoming the preferred modality for delineation of uterine malformations. When congenital abnormalities ofthe reproductive tract are encountered, a search should also be made for renal anomalies. Patients with Uterus bicornis bicollis and unilateral imperforate vagina are often seen with pain severe enough to mimic an acute abdomen. It is important to keep this unusual congenital malformation in mind in the differential diagnosis of vaginal discharge, pelvic mass and/or abdominopelvic pain in young women so as to avoid inappropriate surgical procedures.

Presentamos el caso de una paciente con útero bicorne bicollis, hemivagina imperforada, y agenesia renal ipsilateral. Este grupo de malformaciones congénitas es a menudo asintomático hasta la pubertad, cuando se presenta en forma de dismenorrea cíclica, leucorrea, o una masa pélvica. La imagen por resonancia magnética se está convirtiendo en la modalidad preferida para delinear las malformaciones uterinas. Cuando se encuentran anormalidades del aparato reproductor, debe realizarse también una investigación en busca de anomalías renales. A los pacientes con útero bicorne bicollis y vagina imperforada se les ve a menudo con dolores suficientemente severos como para parecer un abdomen agudo. Es importante tener en mente esta inusual malformación congénita en el diagnóstico diferencial del flujo vaginal, la masa pélvica y/o el dolor pélvico-abdominal en las mujeres jóvenes, a fin de evitar procedimientos quirúrgicos inadecuados.

Endometriose pélvica em adolescentes: novas perspectivas / Adolescent pelvic endometriosis: news perspectives

Endometriose pélvica é a presença de glândulas e/ou estroma endometrial em localizações atípicas. É a principal causa de dor pélvica e infertilidade na mulher em idade reprodutiva. Também é uma causa comum de dor e dismenorréia em adolescentes, afetando cerca de 45 a 70 porcento daquelas com dor pélvica crônica. Há cerca de um quarto de século, a endometriose em adolescentes vem sendo reconhecida como uma causa importante de dor pélvica. Entretanto, ainda hoje, as referências sobre endometriose em adolescentes na literatura são poucas. Estima-se que 4 a 17 porcento das adolescentes pós-menarca possuam endometriose. O reconhecimento de formas atípicas da doença nas adolescentes vem aumentando sua prevalência nos estudos mais recentes. Ainda assim, há grande atraso para diagnóstico da doença em jovens. O tratamento ideal para adolescentes com endometriose ainda é discutível. Deve-se priorizar o alívio da dor e a preservação da fertilidade. O tratamento empírico de dismenorréia pode ser realizado com antiinflamatórios não hormonais e anticoncepcionais hormonais orais. O uso de análogos de GnRH é limitado nesta faixa etária. O cirurgião deve estar atento, na videolaparoscopia, para presença de lesões atípicas, de coloração vermelho-vivas e claras. São lesões mais dolorosas e que normalmente correspondem aos estádios iniciais da doença. Uma abordagem multidisciplinar da dor, mudanças no estilo de vida e terapias alternativas complementares podem auxiliar no alívio dos sintomas. A endometriose pélvica continua sendo uma doença enigmática e as dúvidas nesta faixa etária são ainda maiores.