El papel de la enfermedad de von Willebrand en la hemorragia uterina anormal / Von Willebrand Disease in Abnormal Uterine Bleeding

RESUMEN La hemorragia uterina anormal es un término empleado para las alteraciones en la regularidad, duración y/o volumen de sangrado menstrual y es considerada una causa común de consulta médica y en ocasiones supone un reto diagnóstico para el médico tratante. Dentro del abordaje de la etiología de dicha patología, las coagulopatías afectan alrededor del 13 por ciento de las mujeres, y la más común es la enfermedad de von Willebrand. El objetivo de este trabajo fue realizar una revisión de la literatura científica actual sobre el papel que cumple la enfermedad de von Willebrand en la hemorragia uterina anormal. Esta es una patología hereditaria derivada de una deficiencia del factor von Willebrand encargado de la adhesión plaquetaria. La prevalencia de esta enfermedad puede ser baja, sin embargo, cuando se estudia la población de mujeres con menorragia, la frecuencia puede ir de 5 a 20 por ciento. Se han descrito diferentes problemas ginecológicos asociados a la enfermedad de von Willebrand, tales como menorragia, dismenorrea y una importante deficiencia de hierro asociada a esta, además de una mayor incidencia de quistes ováricos, endometriosis, hiperplasia endometrial y pólipos endometriales. La literatura actual sugiere que se realice tamizaje a aquellas mujeres con cuadro clínico sugestivo. Con respecto al tratamiento la literatura reporta el uso de ácido tranexámico y anticonceptivos orales, pero el que mayor utilidad ha demostrado es la desmopresina(AU)

ABSTRACT Abnormal uterine bleeding is a term used for alterations in the regularity, duration and / or volume of menstrual bleeding and it is considered a common cause of medical consultation; sometimes it is a diagnostic challenge for the treating physician. Within the aetiology approach of said pathology, coagulopathies affect around 13 percent of women, and the most common is von Willebrand disease. The objective is to review the current scientific literature on the influence of von Willebrand disease in abnormal uterine bleeding. This is an inherited pathology derived from a deficiency of the von Willebrand factor responsible for platelet adhesion. The prevalence of this disease may be low, however, when studying the population of women with menorrhagia, the frequency can range from 5 to 20 percent. Different gynecological problems associated with von Willebrand disease have been described, such as menorrhagia, dysmenorrhea and a significant iron deficiency associated with it, in addition to a higher incidence of ovarian cysts, endometriosis, endometrial hyperplasia and endometrial polyps. The current literature suggests that those women with suggestive clinical symptoms should be screened. Regarding treatment, the literature reports the use of tranexamic acid and oral contraceptives, nonetheless desmopressin has proven to be most useful(AU)

Dilemma in the Management of Ovarian Cyst in Pregnancy: A Series of Three Different Cases.

The incidence of ovarian cyst in pregnancy is increased due to ovulation induction and dating ultrasound. Mostly they are benign and managed by observation. Surgery is indicated if there are complications or any suspicion of malignancy. Here, we have presented three different cases of ovarian cyst in pregnancy, which was managed by surgery. The first case is a 27-year-old second gravida with para1 live1 with complaints of pain in right iliac fossa at 15 weeks of gestation that was diagnosed as a dermoid cyst of right ovary. She underwent laparoscopic cystectomy. Rest of the antenatal period was uneventful, and she delivered vaginally at term. The second case is 31 year old third gravida with para2 live2 came with complaints of lower abdominal pain around 14 weeks of gestation which was diagnosed as fibroma of ovary for which laparotomy and right salphingo-oophorectomy was done. Rest of the antenatal period was normal, she delivered by caesarean section at term. The third case was 30-year-old second gravid with para1 live1 with left ovarian mass presented at term for which cesarean section along with left salphingo-oophorectomy done.

Study of ovarian tumor in young girls

To analyze various clinical presentation and the surgical management of ovarian pathology in young girls ranges from 15-25 years. Case series. Gynae Department 1, Lahore General Hospital Lahore. From January 2008 to December 2009. All young girls in the age group mentioned above having an ovarian pathology and managed during study period were included. Age of patients, presenting symptoms, USG findings, surgical management and finally histological diagnosis were noted. There were 20 cases with ovarian lesions. Most of patients presented at the age of 20-25 years [55%]. Mass abdomen seen in [30%] cases, followed by pain abdomen in [20%]. Lapratomy was done in most of cases and main aim was toward ovary sparing surgery as Cystectomy was done in [50%] cases and Oophorectomy was done in [30%] cases. 85% cases were benign on histology report and 15% were malignant. Ovarian tumors are rare in young age group. Benign lesions such as simple ovarian cysts are very common in this age. In young girls main interest is toward conservative and fertility sparing surgery

scope of pediatric and adolescent gynecological problems in Kuwait

To establish an insight into pediatric and adolescent gynecological disorders encountered in a tertiary care center in Kuwait. A retrospective case cohort review of 89 case records of patients under the age of 19 years who were admitted to the Maternity Hospital, Kuwait, from October 2002 through September 2003 was undertaken. For a variety of reasons, 35 patients were excluded and the remaining 54 patients constituted the study population. The patients were divided into 5 groups [A-E]: group A=ovarian cysts, group B=disorders of pregnancy, group C=menstrual disorders, group D=gynecological infections and group E=miscellaneous. The clinical presentation and management of patients were analyzed. The following spectrum of gynecological disorders was obtained: 13 ovarian cysts [24.1%], 28 disorders of pregnancy [51.8%], 4 menstrual disorders [7.4%], 2 infections [3.7%] and 7 miscellaneous cases [13.9%]. Of the 54 patients, 36 [66.7%] were Kuwaitis and the remaining 18 [33.3%] were non-Kuwaitis. The mean age of the study population was 15.16 years, the median was 15.5 years, and the range was 8-19 years. The mean age of the patients with disorders of pregnancy was 17.52 +/- 1.16 years, which is significantly higher than that of groups A, C and E [p=0.007, 0.0001 and 0.05]. The main presenting symptoms at admission were vaginal bleeding: 31 [57.4%], abdominal pain: 17 [31.5%], abdominal mass: 10 [18.5%], and vomiting: 10 [18.5%]. Ultrasonography revealed that dermoid cysts were the most frequently encountered ovarian cysts. Patients were hospitalized for 1-7 days. Disorders of pregnancy and ovarian cysts were the most frequently encountered pediatric/adolescent gynecological disorders. It is recommended that there should be a dedicated specialized clinic to guarantee privacy and centralized discreet care for these patients

Conduta no cisto simples de ovário na pós-menopausa / Management of simple ovarian cysts in postmenopausal women

Os cistos simples ovarianos são ocorrências relativamente comuns em mulheres após a menopausa, com uma incidência que varia entre 2,5 a 17%. O percentual de remissão espontânea do cisto simples de ovário é muito alto na literatura mundial (49 a 74%) e o potencial de malignidade muito baixo (0,6 a 1%), o que permite conduta conservadora na maioria dos casos. O acompanhamento deve ser realizado com ultrassonografia e dosagem sérica de CA125. São desnecessários o Doppler colorido e a tomografia computadorizada ou ressonância magnética pélvica para este seguimento.(AU)

Simple ovarian cysts are common in postmenopausal women, with an incidence of 2.5 to 17%. The spontaneous remission of simple ovarian cysts percentage is high (49 to 74%) and the malignant potential is low (0.6 to 1%), which allows a conservative management in most cases. The follow-up is with ultrasonography and serum CA 125 levels. The color Doppler and magnetic resonance or computed tomography of the pelvis is not necessary.(AU)

Clinicopathologic study of pelvic lesions managed by surgeons in a medical college in Kolkata in the last 2 years.

The pelvic cavity is a basin-like space in the lowermost part of the abdomen where various neoplastic and non neoplastic lesions can occur involving its contents. When the nature of lesions are not clearly gynecological, patients are managed by surgeons. Our study aims to asses the clinicopathologic analysis of neoplastic lesions of the pelvic cavity managed by surgeons particularly over a period of 2 years. Out of 162 total lesions, 102 cases were non neoplastic, such as appendicular lump, Tubo-ovarian (TO) mass, hematoma and 60 cases were neoplastic. Among the 60 cases of neoplastic lesions, 40 cases were benign comprised of twisted ovarian cyst, broad-ligament fibroid, and neurofibroma and 20 cases were malignant comprised of colorectal carcinoma, ovarian carcinoma, liposarcoma, Primitive nurectodermal tumor (PNET), seminoma, and lymphnode metastasis. The lesions in such closed, difficult to approach areas throws clinicians into a diagnostic dilemma during both the preoperative and intraoperative period. Even pathologists cannot ascertain some diagnosis without the help of immunohistochemistry. So, to adopt early and concise management protocol, there should be more such studies in different institutions that are currently lacking in world literature.

Cistos ovarianos funcionais na reproduçäo assistida / Functional ovarian cysts in assisted reproduction

Os procedimentos envolvidos na reproduçäo assistida têm apresentado uma rápida evoluçäo, pois o insucesso destas açöes ocasiona frustraçäo aos casais que apresentam alta expectativa quanto a este tipo de tratamento. Na década passada, a introduçäo dos agonistas de GnRH nos protocolos de estimulaçäo da ovulaçäo para a realizaçäo de FIV constituiu um grande avanço, o que se refletiu em melhores taxas de gravidez. Apesar deste benefício, os agonistas de GnRH podem apresentar alguns efeitos adversos, como a formaçäo de cistos ovarianos funcionais. Isto se deve basicamente ao efeito flare-up que acontece no momento da administraçäo dos agonistas. Tem-se verificado que estes cistos influenciam negativamente a reproduçäo assistida, por isso, nos últimos anos muito trabalho tem sido empreendido na tentavia de prevenir o seu surgimento. A utilizaçäo de progestogênios, por aspiraçäo transvaginal destas estruturas, tem surgido num esforço para contornar este efeito. Desta forma, uma adequada compreensäo de como estes cistos se formam e dos aspectos relativos a prevençäo e tratamento deste problema é útil na utilizaçäo destes medicamentos na reproduçäo assistida.

Incidencia de quiste ovarico en el Hospital Enrique Garcés-1995

El presente trabajo es un estudio retrospectivo de la incidencia de quiste ovárico en el servicio de Gineco-obstetricia del Hospital "Enrique Garcés", en el período comprendido de enero a agosto de 1995. Se encuentra un número total de 20 pacientes hospitalizados, observando que los meses, en los que hubieron más ingresos fueron: enero, febrero con 25 por ciento (n=5) pacientes; y abril, junio en un 15 por ciento (n=3) pacientes. Su procedencia fue mayormente en Quito, en el 50 por ciento (n=12) pacientes y el 40 por ciento (n=8) pacientes de otras ciudades. Además encontramos que el 70 por ciento (n=14) pacientes, no tenía antecedentes de enfermedad. El 60 por ciento n=12 pacientes de nuestro estudio se encuentran entre los 21 a 40 años de edad y con un nivel de instrucción bajo; el cuadro clínico prevalente fue de dolor en el 95 por ciento (n=19) pacientes, masa palpable en el 80 porciento n=16 pacientes, el diagnostico fue de quiste ovárico, el que es confirmado por el ecosonograma. El tratamiento fue netamente quirurgico en el 100 por ciento n=29 pacientes, por diagnostico histopatológico de cistoadenoma seroso simple en el 55 por ciento (n=11) pacientes y el 30 por ciento (n=6) pacientes, fue de hidatide de Morgagni, cistoadenoma papilar quiste endometriosico, cuerpo amarillo hemorragico, cervicitis crónica quistica y apendicitis catharral.

Anomalías de desarollo sexual en Puerto Rico: estado de situación / Abnormalities of sexual development in Puerto Rico: status report

Puerto Rico presenta el mayor número de casos conocidos de anomalias de desarrollo sexual en infantes, niños y adolescentes. Los autores han evaluado sobre 3100 pacientes en un período aproximado de 19 años. Diversos estudios clínicos y de laboratorio sugieren una posible contaminación de carnes, pollo y derivados de éstos con sustancias estrogénicas. Una dieta modificada, libre de estos alimentos, causa una mejoría clínica y/o de laboratorio en un número significativo de pacientes. Un estudio preliminar en alimentos utilizados en el engorde de pollos sugiere la contaminación por Fusarium sp, hongo que puede producir micotoxinas con efecto estrogénico. Al presente, diversos investigadores, privados y de gobierno, llevan a cabo diversos estudios. Sin embargo, se precisa de una acción más vigorosa y fiscalizadora. Consideramos imprescindible un estudio específico de los alimentos de engorde para determinar la presencia de contaminantes con efecto hormonal. La persistencia de estas anomalías debe deterner-se por sus posibles consecuencias a largo plazo

Results of Pap smear examinations in women with abnormal ovaries.

Using the VCE technique, the Pap smears of 249 women with abnormal ovaries were examined at the Cytological Laboratory, Siriraj Hospital. The cases, ranging in age from 15 to 85 years (the mean age being 42.1 +/- 14.7 years), were diagnosed as follows: 49 cases with cysts, 89 cases with tumours and 111 cases with cancer. The mean ages of the women with cysts, tumours and cancer of the ovaries were 34.0 +/- 8.6, 37.2 +/- 12.8 and 49.5 +/- 14.8 years, respectively. The percentages of women with cysts, tumours and cancer diagnosed cytologically as having a normal smear were 44.9, 28.1 and 23.4; and infection and inflammation of abnormal ovaries 49.0, 49.4 and 41.5, respectively. The percentages of those with abnormal cells at the uterine cervix were 6.1, 21.4, and 31.5; endometrial adenocarcinoma 0, 1.1 and 0; and ovarian adenocarcinoma 0, 0 and 3.6, respectively. Although Pap smear examination using the VCE technique is sensitive in the early detection of cervical cancer, it is not a sensitive method in the detection of ovarian cancer.

Patología anexial no inflamatoria durante el uso de implantes de levonorgestrel (Norplant) o dispositivos intrauterinos / Annexial pathology non inflammatory during levonorgestrel implant use (Norplant) or intrauterine devices

Se revisan las fichas clínicas de 477 mujeres usuarias de Norplant y 200 portadoras de T-Cobre que reúnen 28548 y 9752 meses de exposición, respectivamente. Se evaluó la presencia de masas anexiales no inflamatorias iguales o mayores de 5 cm, analizando su frecuencia, evolución natural y terminaciones. En 54 usuarias de Norplant (11,3%) se diagnosticaron 62 episodios de masas anexiales que corresponden a 2,6 episodios por 1.200 meses de uso. En 7 usuarias de T-Cobre (3,5%) se diagnosticaron 8 episodios, con una tasa de 1,0 episodios por 1.200 meses de uso. Las masas fueron casi siempre ováricas y unilaterales y se interpretaron en su mayoría como quístes ováricos funcionales por sus características clínicas y ecográficas y por su evolución. En 2 mujeres de cada grupo la masa se ubicó en la trompa y correspondió a embarazos tubarios. La incidencia de embarazo tubario en el grupo Norplant fue de 1 por 100 años mujer, inferior a lo ocurrido en el grupo T-Cobre y a lo referido con otras progestinas. En la mayoría de los casos (72,6% en el grupo Norplant y 62,5% en el grupo T-Cobre) la masa anexial era asintomática y se detectó en un control ginecológico de rutina. Los motivos de consulta en los otros casos fueron algia pelviana y sangrado anormal. Los episodios regresaron espontáneamente en el 90,4% de las usuarias de Norplant y en el 62,5% del grupo T-Cobre, la mayoría de ellos en los 60 días que siguieron al diagnóstico. Las indicaciones quirúrgicas en usuarias de Norplant fueron 2 embarazos tubarios, 2 quistes foliculares y 2 tumores neoplásicos. En el grupo T-Cobre las indicaciones quirúrgicas fueron 2 embarazos ectópicos y un quiste ovárico simple. Se concluye que los quistes funcionales ováricos son más frecuentes en mujeres portadoras de implantes Norplant que en los controles, que generalmente son asintomáticos y regresan espontáneamente. Deben ser vigilados hasta su desaparición por la posibilidad que se trate de una masa anexial de otra etiología que requiera tratamiento quirúrgico

Incidencia de quistes y tumores del ovario en nuestro medio: revisión de diez años / Incidence of ovarian cysts and tumores: diez year review

Se revisan las historias clínicas de 32 pacientes que presentan quistes o tumores del ovario, y que son atendidas en nuestro servicio durante los años 1972-1982.Se expresa que la edad de mayor incidencia de estas afecciones fue por encima de los 11 años (53,2), y que predominaron las pacientes de la raza blanca (78,2). Se señala que el síntoma principal fue el dolor abdominal (78,2), seguido por los vómitos (50.0), y que el 65,6 de las pacientes tenían un tumor palpable. Se informa que el hallazgo más común en el urograma descendente resulto ser la compresión extrinseca de la vejiga (29,4), y que el 25,0 de los casos fueron operados con el diagnóstico de apendicitis aguda más frecuentes con el 56,2 de los casos, y que hubo 3 disgerminomas, 2 teratocarcinomas y un linfoma de ovario, como tumoraciones malignas en nuestra serie