ABSTRACT
Resumen ANTECEDENTES: La endometriosis de la pared abdominal implica la coexistencia de tejido endometrial en la superficie peritoneal parietal; la incidencia reportada es de 0.03 a 3.5%. Su causa aún no está debidamente esclarecida. CASO CLÍNICO: Paciente de 35 años, con antecedentes ginecoobstétricos de: tres embarazos, tres cesáreas, última cinco años previos a la intervención, en la que se practicó una histerectomía obstétrica indicada por sangrado transoperatorio. El padecimiento actual se inició 24 horas previas a su ingreso a Urgencias, con dolor espontáneo en la fosa iliaca derecha, de difícil relación con los ciclos menstruales debido al antecedente quirúrgico, acompañado de aumento de volumen y náuseas. En la exploración inicial se identificaron dos masas intraabdominales que se confirmaron en la tomografía computada, situadas por encima de la aponeurosis. Se procedió a la intervención quirúrgica para extirpación de ambas masas. El estudio histopatológico reportó: tumores compatibles con endometriosis. CONCLUSIÓN: La endometriosis es un padecimiento con alta prevalencia en el mundo, no así en su ubicación en la pared abdominal. A pesar de que aún no se conoce con certeza su causa, se sabe que la inoculación directa (muchas veces debida a un procedimiento ginecológico quirúrgico) y la proliferación celular tienen participación relevante en su origen.
Abstract BACKGROUND: Abdominal wall endometriosis is the coexistence of endometrial tissue on the parietal peritoneal surface with a reported incidence of 0.03 to 3.5%. Its cause is not well understood. CLINICAL CASE: 35-year-old female patient with a gyneco-obstetric history of: three pregnancies, three cesarean sections, last five years prior to surgery, in which an obstetric hysterectomy was performed, indicated by transoperative bleeding. The current presentation began 24 hours before her admission to the emergency department with spontaneous pain in the right iliac fossa, difficult to relate to menstrual cycles due to her surgical history, accompanied by increased volume and nausea. Initial examination revealed two intra-abdominal masses, confirmed by computed tomography, located above the aponeurosis. Surgery was performed to remove both masses. Histopathologic examination revealed tumors compatible with endometriosis. CONCLUSION: Endometriosis is a very common disease in the world, but not in the abdominal wall. Although its cause is still not known with certainty, it is known that direct inoculation (often due to gynecologic surgery) and cell proliferation play a relevant role in its origin.
ABSTRACT
BACKGROUND: Mexican-American women exhibit high rates of prenatal maternal depressive symptoms relative to the general population. Though pregnant acculturated Mexican-American women experience cultural stressors such as acculturation, acculturative stress and discrimination that may contribute to elevated depressive symptoms, the contribution of these socio-cultural correlates to depressive symptomology is unknown. METHOD: Ninety-eight pregnant women of Mexican descent were recruited from a community hospital clinic during their first trimester. Women completed surveys about acculturation, acculturative stress, perceived discrimination, general perceived stress, and maternal depressive symptoms as well as the potential protective factor of Mexican cultural values. RESULTS: Women who experienced greater acculturative and perceived stress, but not perceived discrimination or acculturation, reported significantly elevated depressive symptoms during pregnancy. Also, women who experienced greater acculturative stress identified with a mixture of Mexican and American cultural values. However, only the Mexican cultural value of respect was protective against maternal depressive symptoms while adhering to the Anglo value of independence and self-reliance was a risk factor. LIMITATIONS: A limitation in the study is the cross-sectional and descriptive self-report nature of the work, underscoring the need for additional research. Moreover, physiological measures of stress were not analyzed in the current study. CONCLUSIONS: Results point to acculturative stress, above other cultural stressors, as a potential intervention target in culturally competent obstetric care. These findings have implications for maternal mental health treatment during pregnancy, which likely affects maternal-fetal programming and may favorably affect perinatal outcomes in the vulnerable Mexican-American population.
