Malformación arteriovenosa posterior a la retención de productos de la concepción / Arteriovenous malformation after retention of products of conception

Resumen OBJETIVO: Plantear un procedimiento para pacientes con retención de restos corioplacentarios y riesgo de formación de fístulas arteriovenosas que sea efectivo, seguro y ambulatorio. MATERIALES Y MÉTODOS: Estudio de serie de casos, retrospectivo, de pacientes atendidas en el Hospital Gea González de enero a mayo de 2022. Se empleó un equipo de Bettocchi, de flujo continuo de 5 mm, lente cilíndrico de 2.9 mm y 30°. En casos específicos se programó un procedimiento quirúrgico con resectoscopio Richard Wolf Princess, con diámetro exterior de 7 mm, sistema óptico de 2.7 mm, dirección visual de 30°. RESULTADOS: Se revisaron 642 expedientes de los que se obtuvo una serie de 31 casos que se incluyeron conforme a la clasificación de Gutenberg, con biopsia por protocolo posaborto y resección con Grasper para los tipos 0 y 1; dos pacientes se enviaron a Urgencias por sangrado abundante para aspiración mecánica endouterina inmediata; dos pacientes se catalogaron con tipo 3; en la primera se optó por el tratamiento médico con metotrexato con lo que se consiguió la resolución completa y la segunda finalizó el embarazo con histerectomía laparoscópica. CONCLUSIONES: En pacientes con imágenes ecográficas sugerentes de retención de restos corioplacentarios o malformación arteriovenosa, los procedimientos con visión directa evitan las complicaciones inmediatas y futuras. El diagnóstico mediante la clasificación de Gutenberg permite definir el tipo de acceso con extracción en frío con pinza Grasper para los tipos 0 y 1, o la aplicación de una prueba farmacológica con metotrexato y resección histeroscópica para los tipos 2 y 3 en pacientes hemodinámicamente estables.

Abstract OBJECTIVE: To propose an effective, safe and outpatient procedure for patients with retained chorioplacental remnants and risk of arteriovenous fistula formation. MATERIALS AND METHODS: Retrospective case series study of patients attended at the Gea González Hospital from January to May 2022. A Bettocchi equipment was used, 5 mm continuous flow, 2.9 mm cylindrical lens and 30°. In specific cases a surgical procedure was scheduled with a Richard Wolf Princess resectoscope, 7 mm outer diameter, 2.7 mm optical system, 30° visual direction. RESULTS: We reviewed 642 files from which we obtained a series of 31 cases that were included according to the Gutenberg classification, with biopsy by postabortion protocol and resection with Grasper for types 0 and 1; two patients were sent to the ER for heavy bleeding for immediate MVA; two patients were categorized as type 3; in the first one we opted for medical treatment with methotrexate with which we achieved complete resolution and the second one ended the pregnancy with laparoscopic hysterectomy. CONCLUSIONS: In patients with ultrasound images suggestive of retained chorioplacental debris or arteriovenous malformation, direct vision procedures avoid immediate and future complications. Diagnosis by Gutenberg classification allows to define the type of access with cold extraction with Grasper forceps for types 0 and 1, or the application of a pharmacological test with methotrexate and hysteroscopic resection for types 2 and 3 in hemodynamically stable patients.

[Intrauterine synechiae after use of monopolar resectoscope]. / Sinequias intrauterinas postaplicación de un resectoscopio con energía eléctrica monopolar.

BACKGROUND: Uterine synechiae are defined as abnormal adhesions and fibrosis within the uterine cavity due to direct trauma or injury to the basal membrane of the endometrium. OBJECTIVE: To identify, by routine hysteroscopy, how many patients who were treated because of intrauterine pathology developed uterine synechiae within the first six months after treatment with monopolar resectoscope. MATERIAL AND METHOD: A descriptive, open, observational, retrospective and cross-sectional study was performed at Hysteroscopy Unit, Gynecology Service of General Hospital Manuel Gea Gonzalez, Mexico City. From January 1, 2008 to December 31, 2011, we took, from the record books of the operating rooms, the file number of those patients who were treated with monopolar resectoscopy, and subsequently underwent routine hysteroscopy within the first six months. RESULTS: 69 records were included in the study. The main diagnoses were: endometrial polyp in 48% (n=33), submucosal myoma in 45% (n=3 1); 48% (n=33) polypectomy and 45% (n=31) myomectomy. Within the first six months after the main procedure, patients underwent a routine hysteroscopy, which revealed the development of intrauterine synechiae in 5.8% (n=4) of the patients. Of the patients who underwent myomectomy, 5.8% (n=4) developed uterine synechiae; while those patients who underwent polypectomy, synechiaes were not found. Minimal synechiaes were found in 4.3% (n=3) of patients, moderate synechiaes were found in 1.4% (n=1) of patients, and severe synechiaes were found in none patient. CONCLUSION: Uterine synechiaes were found in 5.8% of patients with intrauterine pathology and treated with monopolar resectoscopy. Minimal to moderate synechia occur more commonly after myomectomy.

[Cervical ectopic pregnancy. Hysteroscopy treatment, case report]. / Embarazo ectópico cervical. Tratamiento histeroscópico, presentación de un caso.

The cervical ectopic pregnancy is extremely rare accounting for approximately 0.1% of all ectopic pregnancies. The incidence is estimated at 1:2500-1:98,000 pregnancies. Before the decade of the 80s, the diagnosis is usually performed to made curettage for incomplete abortion likely secondary to uncontrollable bleeding culminating in hysterectomy, is extremely dangerous, as the trophoblast uterine vessels can reach through the thin wall cervical and cause serious and intractable bleeding that usually ends even today in mutilating surgeries to limit future playback. Currently exist no clear criteria in the literature to help decision-making. We report a case of cervical pregnancy successfully treated by operative hysteroscopy ablation and proposes criteria that could help in the future to address this devastating disease.

[Tubal obstruction with an implant inserted by hysteroscopy: a report of 50 cases]. / Obstrucción tubaria con un implante insertado mediante histeroscopia: reporte de 50 casos.

BACKGROUND: The Essure contraceptive device consists of a titanium and nickel coiled spring containing Dacron fibers. It is placed under hysteroscopic visualizaron in the proximal section of the Fallopian tube. The microinsert acts by inducing a tissue reaction that permanently blocks the tube within three months. OBJECTIVE: Show our experience in the use and insertion of the Essure device, in a private office. METHODS: We reviewed insertion procedure, complications, degree of tolerance and acceptance by user. Between June 2008 and May 2013 fifty cases with Essure placement were made in our office. RESULTS: The average age was 36 years, as for the average number of pregnancies was two. The procedure time average was 6 minutes 25 seconds, no intraoperative complication was reported. All patients expressed very good tolerance and high degree of satisfaction with the procedure. A simple abdominal radiography was performed three months after the hysteroscopy to dem6nstrate the correct placement and position of the device, in all patients. CONCLUSION: [corrected] The number of patients is enough to show the advantages of the method and the possibility of performing it in an ambulatory environment, as it can be a private office with the correct equipment to do it.

[State-of-the-art of classification, diagnosis and treatment of Müllerian anomalies]. / Estado actual de la clasificación, diagnóstico y tratamiento de las malformaciones müllerianas.

Congenital malformations of the female genital tract represent a relevant clinical entity, especially in reproductive age. Novel technological advances improve diagnostic mechanisms for simple to complex malformations with the subsequent implementation of an integrated management plan. This review has the only purpose to communicate updated information regarding all Müllerian anomalies classification systems known, presenting advances in diagnostic procedures and management currently recommended.

[Operative office hysteroscopy using bipolar technology. Our experience in seven years]. / Experiencia de siete años en la práctica de la cirugía histeroscópica en el consultorio con tecnología bipolar.

BACKGROUND: In the last decade have developed small diameter instruments with pods streaming and highly efficient working channels that allow outpatient surgical procedures. OBJECTIVE: To evaluate the utility of operative office hysteroscopy with the use of the bipolar electrosurgical system. We analyzed clinical characteristics, results and patient acceptability. MATERIAL AND METHODS: We performed a descriptive study of 1591 operative hysteroscopies, using an office hysteroscopic procedure with Bipolar technology; with a 5.5 mm rigid hysteroscope Bettocchi type. RESULTS: The mean operating time was 8 min. The most common procedure was polypectomy. Severe pain and/or vagal reflex occurred in less than 0.7% of the patients. CONCLUSIONS: The Bipolar technology facilitates operative office hysteroscopy and allows resectoscopy to be reserved for the treatment of special cases. Patient acceptability is high.

[Hysteroscopy clinic: diagnostic and therapeutic method in abnormal uterine bleeding]. / Histeroscopia de consultorio: método diagnóstico y terapéutico en sangrado uterino anormal.

BACKGROUND: Abnormal uterine bleeding is a public health problem prevalence exceeded only by abnormal vaginal discharge as a reason for medical consultation. OBJECTIVE: To describe the findings reported by the Hysteroscopy clinic of the Hospital GEA Gonzalez on patients with Abnormal Uterine bleeding diagnosis. MATERIAL AND METHOD: Retrospective, transversal, descriptive study. The total 2546 records of those patient that were evaluated by Office Hysteroscopic between January 2007 and December 2008 on the Hysteroscopy Clinic of Hospital Manuel GEA Gonzalez, then we selected the 1482 records of those patients that were sended because of an Abnormal Uterine bleeding condition. We descrive the frequencies of the diagnosis and its interrelation with the age of the patients. We also report the therapeutical interventions during office hysteroscopy. RESULTS: The mean age of the patients was 42.15 +/- 9.30 years (from 12 a 92 years); the age groups of patients that belonged to 40-44 years and 45-49 years are the most frequent patient and they represent the 25% y el 23.3% of the records. The abnormal findings occurred on the 66% de of the patients. Those patients of 65 years old and older do not have any report of normal cavities, all of then have abnormal findings. The leiomyoma (26.9%) and the endometrial polyps (27.3%) were the most frequent findings. The postmenopausal bleeding had a rate of 90.9% abnormal findings and in this group of patients the most frequent diagnosis was atrophic endometrium (32.2%) and polyps (24.3%). Besides that the office hysteroscopy show its therapeutical usefulness because of the 67% and 77.5% of polipectomy perform for endometrial and cervical polyps respectively CONCLUSIONS: The office Hysteroscopy is a well tolerated diagnosis and therapeutic method that is useful for any women with abnormal uterine bleeding condition and it is the ideal technique for the examination of abnormal uterine bleeding in postmenopausal women... The office hysteroscopy is a efficient cost-effective and cost-benefic method for the management for endometrial and cervical polyps.

[Of office hysteroscopy for the removal of intrauterine device. Literature review]. / Histeroscopia de consultorio para la extracción de dispositivo intrauterino. Revisión de la bibliografía.

OBJECTIVE: To review the literature related to the hysteroscopic techniques such as outpatient diagnostic and therapeutic tools for the extraction of foreign bodies in patients with intrauterine device. METHOD: We searched the main electronic databases were searched for those words: hysteroscopy and intrauterine device in articles related to the removal of intrauterine devices by hysteroscopy. RESULTS: The loss or translocation of IUD is a common problem resulting from the large number of women who have applied. The importance of early diagnosis is to avoid, such as the inappropriate position of the device promotes an unwanted pregnancy, genital bleeding and injury to adjacent organs such as bowel and bladder. The assessment by ultrasound or X-rays, or both, allowing the device to locate and determine the desirability or otherwise of outpatient hysteroscopy (in practice) without anesthesia and with low morbidity for the patient or, well, resorting to other methods, and laparoscopy in the operating room. CONCLUSIONS: Hysteroscopy is an effective procedure for recovering intrauterine foreign bodies or hidden in properly selected patients.

[Hysteroscopy used in infertility. Diagnosis and therapy]. / Histeroscopia en infertilidad. Diagnóstico y tratamiento.

The purpose of this study is to review the prevalence of different uterine defects associated with infertility, recurrent pregnancy loss, and preterm pregnancies. Various infertility etiologies are analyzed, mainly that of uterine basis (adhesions, septa, myomas, polyps, pelvic inflammations or infection, and endometriosis). Importance of surgical techniques with minimal invasion is studied, basically hysteroscopy as a diagnosis and therapeutic method, which is compared with the rest of techniques.

[Hysteroscopy findings in patients with postmenopausal genital bleeding]. / Hallazgos histeroscópicos en pacientes con sangrado genital posmenopáusico.

OBJECTIVE: To describe morphological and histological findings in postmenopausal patients with abnormal uterine bleeding. PATIENTS AND METHODS: An open, descriptive, observational, retrospective and cross sectional study was done at Clinica de Histeroscopia at Hospital Dr. Manuel Gea Gonzalez, in Mexico City. There were included 372 patients with postmenopausal abnormal uterine bleeding diagnosis without hormone replacement therapy. Hysteroscopy study was made with a 5 mm surgical hysteroscope using warm saline solution (280C) as a medium of distension, and a trans-hysteroscopy endometrial biopsy was taken for histopathological correlation. Statistic analysis was obtained using SPSS program version 10 for windows with a kappa test. In order to analyze more than two samples, we used the chi-square test. RESULTS: Endometrial atrophy was the most frequent hysteroscopic diagnosis (202 patients, 54.3%), followed by polyps (93 patients, 25%), cancer (14 patients, 4%) and hyperplasia (11 patients, 2.95%). Correlated results between hysteroscopic findings and hystopathological biopsy diagnosis obtained were: atrophy (157 cases, 63.3%), polyps (76 cases, 77.55%), endometrial cancer (14 cases, 93.05%), endometrial hyperplasia (10 cases, 90.63%) and miomatosis (three cases, 16.20%). CONCLUSION: It can be stated that there is a high level of concordance between findings of hysteroscopic studies and the directed endometrial biopsy. So, we recommend initially the use of hysteroscopy for diagnosis and treatment of endometrial cavity malignant and benign pathology.

[In-office hysteroscopic polypectomy: eight years analysis]. / Polipectomía histeroscópica en consultorio: análisis de ocho años.

OBJECTIVE: To evaluate endometrial polypectomy procedure results through in-office hysteroscopy. MATERIAL AND METHOD: Retrospective study based on a 641 patients sample with endometrial polyp, within 5,103 diagnostic hysteroscopies done at hysteroscopy clinic in the Hospital General Dr. Manuel Gea Gonzalez, from November 1998 to December 2005. RESULTS: Abnormal uterine bleeding cases had higher rate within premenopausic (2,951, 57.8%) than postmenopausal (347, 6.7%) patients. From 641 hysteroscopy identified endometrial polyps, 490 (76.37%) were in premenopausic and 151 (23.35%) in postmenopausal patients; 468 (73%) of them were unique, 374 (58.5%) < 1 cm in diameter, 133 (20.7%) with a diameter from 1 to 4 cm, and 134 (20.9%) > 4 cm in diameter. Diagnostic and therapeutic hysteroscopy, at the same time, was performed in all the cases (no major complications); one patient had epileptic crisis during polypectomy and another one uterine perforation, treated only with uterotonic agents. Endometrial cancer was detected in 35 cases (5.4%), 12 (34.29%) premenopausic and 23 (65.71%) postmenopausal. CONCLUSIONS: Successful systemic resection can be performed in-office in most endometrial polyps' cases, through hysteroscopic study. This technique allows high rate endometrial polyps detection within studied patients.

[Vulvar cellular angiofibroma. A report of a case and bibliographic review]. / Angiofibroma celular de la vulva. Comunicación de un caso y revisión de la bibliografía.

The vulvar cellular angiofibroma is a rare mesenchymal tumor. It can be located in many places, but it is more frequent in the vulvar area. It is characterized for being of superficial and slow-growth and for having low propensity of local recurrence. It was described in 1997 by Nucci and it had been reported 51 cases worldwide, from which 18 had vulvar location. This is the first case in Mexico City. It was found in a 36 years-old woman. The specimen was processed by structural and immunohistochemical analysis. Misdiagnosis is common and it can be confounded with spindle cell lipoma, hydrocele of the canal of Nuck, fibromas, angiomyofibroblastoma and many other mesenchymal tumors. It should be distinguished from the aggresive angiomixoma. To improve the clinical diagnosis and treatment, it is very important to have in mind this relatively new entity.