Terapia Su Jok en pacientes con diagnóstico de hidrosalpinx / Su Jok therapy in patients with hydrosalpinx diagnosis

Se realizó un estudio cuasiexperimental de 56 pacientes con diagnóstico de hidrosalpinx, que acudieron a la consulta de Medicina Natural y Tradicional del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba - remitidas de las consultas de Ginecología e Infertilidad -, desde septiembre de 2014 hasta diciembre de 2015, para evaluar la respuesta a la terapia Su Jok. Entre las variables analizadas figuraron: edad, factores de riesgo, manifestaciones clínicas, síndromes tradicionales, evolución clínica y respuesta al tratamiento. En la casuística predominaron las féminas de 30-39 años, la enfermedad inflamatoria pélvica y las infecciones de trasmisión sexual como antecedentes patológicos (71,4 por ciento), el dolor y la secreción vaginal como síntomas principales, así como el estancamiento de Qi de hígado, Qi de riñón no firme y frío-humedad en bazo como síndromes más frecuentes. Finalmente, se logró una evolución favorable y una respuesta adecuada al tratamiento

A quasi-experiment of 56 patients with hydrosalpinx diagnosis that went to the Natural and Traditional Medicine Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba - referred from the Gynecology and Infertility Services -, was carried out from September, 2014 to December, 2015, to evaluate the response to Su Jok therapy. Among the analyzed variables there were: age, risk factors, clinical features, traditional syndromes, clinical course and response to the treatment. In the case material there was a prevalence of women aged 30-39, pelvic inflammatory disease and sexually transmitted infections as pathological history (71.4 percent), pain and vaginal secretion as main symptoms, as well as Qi liver stagnation, not firm Qi kidney and coldness-humidity in spleen as most frequent syndromes. Finally, there was a favorable clinical course and an appropriate response to the treatment

In-vitro fertilization: donor egg sharing for premature ovarian failure / Fertilización in vitro: una donante comparte un óvulo en un caso de fallo ovárico prematuro

Premature ovarian failure may be a consequence of gonadotoxic cytotoxic chemotherapy or radiation therapy for malignant or systemic disease often resulting in major quality of life concerns. This is the first reported case in the English-speaking Caribbean using in-vitro fertilization (IVF) donor egg sharing in a patient who experienced premature ovarian failure following chemotherapy and radiation for Hodgkin's disease. The donor's indication was tubal factor infertility. Both patients delivered healthy infants.

El fallo ovárico prematuro puede ser consecuencia de la quimioterapia citotóxica gonadotóxica o la terapia de radiación para alguna enfermedad maligna o sistémica, que a menudo trae consigo serios problemas para la calidad de vida. Se reporta el primer caso en el Caribe anglófono, en el que un óvulo de fertilización in vitro (FIV) de una donante, es compartido con una paciente que experimentó fallo ovárico prematuro tras ser sometida a quimioterapia y radiación a causa de la enfermedad de Hodgkin. El diagnóstico de la donante fue infertilidad por factor tubario. Ambos pacientes dieron a luz bebés saludables.

Epidemiología, resultados clínicos y costos del tratamiento del absceso tuboovárico, en un hospital público de Santiago / Epidemiology, clinical results and costs of treatment of the tuvoovarian abscess, in a public hospital in Santiago

Objetivos: Conocer frecuencia y factores de riesgo del absceso tuboovárico (ATO), complicaciones y costos del tratamiento. Método: Estudio retrospectivo de 64 pacientes operadas con el diagnóstico de ATO. Las pacientes se manejaron con criterio médico-quirúrgico: uso de antibióticos y cirugía en casos de peritonitis difusa, fiebre persistente con masa palpable y masa anexial mayor de 6 cm sin fiebre. Se evaluaron en fertilidad futura y en complicaciones: infección y dehiscencia de herida operatoria, reoperación por ATO residual, lesión intestinal, lesión vesical y complicaciones médicas. Resultados: El ATO representó el 73,6 por ciento de los casos hospitalizados por enfermedad inflamatoria pélvica, con frecuencia de 1,5 casos por mes y 17,2 por ciento de actinomicosis. La edad media de las pacientes fue 40,5 años. El dispositivo intrauterino (DIU) se asoció con ATO en 84,4 por ciento de los casos, 94,4 por ciento sin control y con media de uso de 10,2 años. El ATO unilateral fue el más frecuente (57,8 por ciento) y la anexectomía unilateral la operación más común. El 17,2 por ciento de las pacientes presentaron complicaciones y el 85,9 por ciento quedaron con infertilidad. El costo total de los 64 casos fue $86.331.713 (UF 3.788), con una media de $1.348.933 (UF 59,2). Conclusión: Existe un aumento de la frecuencia del ATO y de la actinomicosis pélvica, con incremento consiguiente de la infertilidad y de los costos, asociados al uso de DIU, sin control y por tiempo prolongado.

Objective: To determine frequency and risk factors of tuboovarian abscess (TOA) and observe complications, fertility damages and surgical costs of medical-surgical treatment. Method: Retrospective study in 64 patients operated with TOA diagnosis. Patients were managed with medical-surgical treatment: use of antibiotics and then surgery in cases of peritonitis diffuse, persistent fever with palpable mass and adnexial mass greater than 6 cm without fever. They were evaluated in future fertility and complications: infection and of surgical wound dehiscence, reoperation by residual TOA, intestinal injury, bladder injury and medical complications. Results: The TOA accounted for 73.6 percent of hospitalized cases of pelvic inflammatory disease (PID), 1.5 cases per month and 17.2 percent of actinomycosis. The mean age of patients was 40.5 years. The intrauterine device (IUD) was associated with TOA in 84.4 percent of cases, 94.4 percent uncontrolled and with a 10.2 years mean use. The unilateral TOA was the most frequent (57.8 percent) and the unilateral anexectomy the most common operation. The 17.2 percent of patients presented complications and 85.9 percent remained infertile. These results showed an increase compared with those obtained in the series published in 1993. The total cost of the 64 cases was $86.331.713 (UF 3.788), with a mean of $1.348.933 (UF 59.2). Conclusion: There is an increased frequency of the TOA and of pelvic actinomycosis, with consequent increase of infertility and costs associated with the uncontrolled and long-term use of IUD.

Hysteroscopic tubal cannulation under laparoscopic guidance for diagnosis and treatment of proximal tubal obstruction

The narrowest portion of the human fallopian tube extending from the uterotubal ostium to the ampullary-isthmic junction is exceptionally vulnerable to pathogenic organisms and other insults which often induce block of this narrow segment. Proximal tubal obstruction [PTO] exists in about 20% of patients with tubal infertility, and frequently is an isolated finding with otherwise normal pelvic anatomy. PTO presents a significant diagnostic and therapeutic problem. Several reports in the literature suggest that up to two-thirds of fallopian tubes resected for PTO reveal an absence of transluminal or luminal pathology. Conventional HSG or even laparoscopic chromopertubation may not determine whether the visualized obstruction is due to a temporary cause such as cornual spasm and loose mechanical blocks, or whether true anatomic occlusion exists. This differentiation is critical in determining the type of therapy offered to the patient. Only true pathologic tubal occlusion necessitates either IVF or microsurgical tuboplasty. To present the diagnostic findings, the immediate and the remote tubal patency rates, and the reproductive outcome following hysteroscopic tubal cannulation performed under laparoscopic guidance, for the patients with proximally obstructed fallopian tubes. PTO was diagnosed by three approaches HSG, laparoscopic transcervical chromopertubation, and hysteroscopic/laparoscopic transostial selective chromopertubation. Prospective observational clinical study presenting the laparoscopic/hysteroscopic findings in patients with proximal tubal occlusion, and discussing the immediate and the remote tubal patency rates and the reproductive outcome following hysteroscopic tubal cannulation under laparoscopic guidance. Tanta University Hospital and private centers. Thirty-nine consecutive infertile women who had bilateral PTO on HSG and subsequently underwent combined laparoscopy and hysteroscopy were evaluated. Seventeen women were found to have bilateral PTO as an isolated finding with otherwise normal pelvic anatomy and intact other fertility factors. In these 17 women the diagnosis of PTO was based on the initial findings of HSG, supported by the results of laparoscopic transcervical chromopertubation, and finally confirmed by hysteroscopic/laparoscopic transostial selective chromopertubation. In trial to relieve PTO in these 17 women, hysteroscopic tubal cannulation was performed. A coaxial cannulation set composed of a Labotect flexible guide cannula, a 3-French end-hole Teflon ureteric catheter, and a Teflon-coated stainless steel urologic guidewire were utilized for hysteroscopic tubal cannulation under laparoscopic guidance. The immediate on-table success of tubal cannulation evidenced by intraoperative tubal patency rate documented by laparoscopic chromopertubation, the long term persistence of achieved tubal patency evidenced by the remote tubal patency rate documented by HSG performed 6 months after the procedure for those patients who did not conceive, and the reproductive outcome following the hysteroscopic tubal cannulation meaning the pregnancy rate achieved during the follow up period of six months. The average age [ +/- SD] of the patients was 27.3 +/- 3.5 yean [range 22-35 years], and the mean duration of infertility [ +/- SD] was 3.61 +/- 1.2 years [range 2-7 years]. Fourteen women [35.90%] presented with primary infertility and 25 women [64.10%] presented with secondary infertility. Laparoscopic transcervical chromopertubation demonstrated proximall tubal patency in 7 [17.95%] out of the 39 women; and hysteroscopic/ laparoscopic transostial selective chromopertubation demonstrated tubal patenq in another 4 [10.26%] women. This means 28.21% false +ve results for HSG, and 10.26% false +ve results for laparoscopic transcervical chromopertubation. Successful tubal cannulation with achievement of immediate tubal patency was evident in 24 [70.59%] tubes present in 13 [76.47%] patients. Tubal patency was achieved bilaterally in 11 patients, and unilaterally in 2 patients. Initial total failure of the procedure [i.e. inability to achieve tubal patency in either of both tubes whether due to inability of tubal cannulation or due to persistence of PTO after tubal cannulation] was evident in 4 [23.53%] patients. Inability of tubal cannulation was evident in 6 [17.56%] tubes present in 4 patients. Persistence of tubal occlusion after cannulation was observed in 4 tubes [11.76%] present in 3 patients. Tubal perforations have complicated the tubal cannulation of 5 [14.70%] tubes, Three of the perforations were associated with persistence of tubal occlusion, and the other two perforations were associated with successful tubal cannulation and restoration of tubal patency. Six women [35.29%] achieved intrauterine pregnancies, and one patient [5.88%] had a tubal ectopic pregnancy. HSG, performed six months after tubal cannulation for the patients who did not conceive, revealed preservation of tubal patency in 4 [23.53%] patients, and bilateral tubal reocclusion in 2 [11.76%] patients. Hysteroscopic tubal cannulation under laparoscopic guidance has a major impact on the management and counseling of infertile wmen with PTO. IVF is a present first choice for treatment of tubal factor infertility, but IVF is still stressful economically and physically. On the other hand, pregnancies achieved naturally are not only inexpensive but also easy for the patients from all aspects. Hysteroscopic tubal cannulation is a safe and cost effective procedure which has clear diagnostic and therapeutic benefits for infertile patients with PTO. Considering the success rate of hysteroscopic tubal cannulation, about three-fourths of the patients with PTO managed by this technique are recommended to try to conceive naturally, instead of being referred for ART or microsurgery. Hysteroscopic tubal cannulation under laparoscopic guidance should be recommended as first choice for further diagnosis and treatment of infertile women with PTO

Absceso Tuboovárico. Estudio retrospectivo / Tubo-ovarian abscess. Retrospective study

Se realizó un estudio retrospectivo sobre 75 casos de absceso tuboovárico (ATO) atendidos en el Hospital Nacional Cayetano Heredia de Lima, Perú, durante el período de 1981-1990, con el fin de determinar los factores de riesgo, cuadro clínico, los procedimientos diagnósticos utilizados y evaluar el manejo junuto con las complicaciones que de él se derivan. Se encontró que la la frecuencia de ATO en el este hospital fue de 1.3 por ciento. Además, el ATO ocurre con mayor frecuencia en mujeres entre la tercera y la cuarta décadas de la vida, nulíparas y con actividad sexual. El ATO ocurre independientemente del uso de dispositivo intrauterino. Otro hallazgo fue que los signos y síntomas de presentación más frecuentes del cuadro clínico del ATO son el dolor abdominal bajo o pélvico (98.63 por ciento), presencia de masa anexial (94.52 por ciento) y el dolor a la movilización cervical (73.97 por ciento) asociados a fiebre y taquicardia en 87.38 por ciento. La leucocitosis con desviación izquierda estuvo presente en 50.68 por ciento de los casos. La ecografía (realizada en 27 casos) fue positiva en el 74.07 por ciento y negativa en 25.93 por ciento, la laparoscopía (realizada en 6 casos) fue positiva en 83.33 por ciento y negativa en 16.67 por ciento. La culdocentesis (realizada en 39 casos) fue positiva en 84.61 por ciento y negativa en 15.39 por ciento. El 76.72 por ciento de los casos correspondioeron a ATO no roto, de los cuales el 21.43 por ciento recibieron tratamiento médico conservador y 78.57 por ciento recibieron tratamiento quirúrgico, de éstos el 75 por ciento fueron sometidos a histerectomía con anexectomía y 25 por ciento a anexectomía. El 23.28 por ciento de los casos fueron ATO roto, practicándose histerectomía con anexectomía en 88.24 por ciento y anexectomía sola en 11.76 por ciento. No hubo mortalidad en nuestro estudio probablemente en relación al tratamiento médico y/o quirúrgicos inmediatos.

Consideraciones sobre la obstruccion tubarica distal / Considerations about obstruction of distal fallopian tube

La cirugia de la parte distal de la trompa de Falopio puede ir desde la lisis de adherencias para mejorar la relacion anatomica entre la trompa y el ovario, a la salpingostomia en la cual se crea un nuevo ostium en una trompa gravemente lesionada. El exito de esta cirugia depende de varios factores: 1.- El grado de dano de la trompa. 2.- La edad de la paciente. 3.- La tecnica quirurgica utilizada. Es obvio que el cirujano no tiene control en los dos primeros factores, los cuales tienen un gran impacto en el resultado final. La clasificacion de la enfermedad distal de la trompa de Falopio es importante porque hay una gran variacion en el pronostico. Este es inversamente proporcional al dano de la fimbria, o sea entre mayor sea el dano, peor es el pronostico. Algunas pacientes presentan un mejor pronostico si se observan a la histerosalpingografia pliegues en la porcion ampular de las trompas obstruidas. El tamano del hidrosalpinx esta relacionado directamente con el grado de dano de la fimbria; los hidrosalpinx pequenos tienen un mejor pronostico que los grandes, cuando se realiza la salpingostomia. Es importante por lo anterior realizar una clasificacion adecuada del dano de la porcion distal de la trompa de Falopio con el objeto de dar un pronostico real al paciente.

Abscesso tubo-ovariano: análise microbiológica e implicaçöes terapêuticas / Tubo-ovarian abscess: microbiological analysis and therapeutic aspects

Foram estudadas, do ponto de vista microbiológico, 19 pacientes portadoras de abscesso tubo-ovariano. O material para análise bacteriológica foi obtido do canal endocervical e através da culdocentese. Conteúdo com aspecto purulento, recuperado através da punçäo do fórnice vaginal posterior, foi observado em 15 (78,9%) casos. Dentre os germes isolados da cavidade peritoneal, os mais importantes foram os bacilos Gram-negativos, cultivados em 8 (44,5%) e os cocos Gram-positivos em 7 (38,9%), enquanto que a Neisseria gonorrhoeae foi recuperada em apenas 1 (5,6%) paciente. Culturas específicas para Chlamydia trachomatis e Micoplasmas foram efetuadas em sete casos, sendo que demonstraram positividade em 1 (14,3%) e 2 (28,6%), respectivamente. Aborda-se a complexidade bacteriológica envolvida nos casos de abscesso tubo-ovariano e suas implicaçöes terapêuticas