[Ultrasonography as a method to determine the correct implantation of intratubaric devices]. / La ecografía como método para determinar la correcta implantación de dispositivos intratubáricos.

BACKGROUND: Essure procedure consists in the placement of two coils in the intramural segment of Fallopian tubes by hysteroscopic causing a fibrosis reaction that unleashes a physiological obstruction. Hysterosalpingography, until today, is the gold standard checking the success of this method of sterilization. OBJECTIVE: Determining if a scan at three months postimplantation is sufficient to confirm the correct positioning of the device. MATERIAL AND METHODS: Descriptive study with 61 patients undergoing definitive hysteroscopic sterilization to validate transvaginal ultrasound as a technique to determine the effectiveness of the method. RESULTS: There were placed 120 devices, of which 117 (97'5%) were visible by ultrasound. Comparing ultrasound findings with gold standard, we obtain that in cases of proper bilateral implantation by hysterosalpingography, with ultrasound we diagnosed the 81 '13%; in cases of correct unilateral implantation we detected 75% with ultrasound, except one patient who was considered proper placement of the coil by ultrasound but hysterosalpingography reported that it was misplaced and the Fallopian tube was permeable. DISCUSSION: Transvaginal ultrasound is an appropriate method to confirm the correct position of intratubaric Essure devices, its safety, low cost and reproducibility. However, our study cannot replace the hysterosalpingography as gold standard.

[Diagnostic hysteroscopy indications and results in Complexo Hospitalario Universitario De Ourense]. / Indicaciones y resultados de la histeroscopia diagnóstica ambulatoria en el Complexo Hospitalario Universitario de Ourense.

BACKGROUND: Diagnostic hysteroscopy is an endoscopic technique that allows the evaluation of the endocervical canal and uterine cavity. OBJECTIVE: To evaluate indications, complications and referral to operative hysteroscopy. To analyze the correlation between sonographic display, hysteroscopy findings and histological diagnosis. MATERIALS AND METHODS: Retrospective and descriptive study of 904 patients who underwent diagnostic hysteroscopy between January 1, 2008 and June 30, 2012. RESULTS: The most frequent indication was sonographic detection of endometrial polyps (75% were premenopausal and 71.2% postmenopausal). The complication rate associated with the test was 11.4%. The reduction experimented in operative hysteroscopies was from 31.2% in 2008 to 12.2% between January and June 2012. When a polyp or a myoma was detected by sonography, diagnostic hysteroscopy showed them in 64.4% y 62.5% of the cases, respectively. The correlation between hysteroscopic findings and histopathologic diagnosis was 77.7% for normal endometrium, 77.9% for polyps, 17.8% for hyperplasic appearance and 100% for carcinoma suspicion. CONCLUSIONS: Diagnostic hysteroscopy is a safe technique that allows small interventions avoiding operative hysteroscopies. There is a good relation between hysteroscopic visual inspection and anatomopathologic diagnosis, but biopsy should be taken except if normal endometrium is visualized.

Tumor virilizante de células esteroideas del ovario / Virilizing steroid cell tumor of the ovary

Los tumores de células esteroideas representan el 0,1% de los tumores ováricos. Pertenecen al grupo de los tumores del estroma, también llamados de los cordones sexuales. Aunque pueden aparecer a cualquier edad, son más frecuentes en mujeres menopáusicas y con frecuencia se asocian a síndromes endocrinos. El hirsutismo y la virilización son los hallazgos clínicos más significativos. El manejo debe individualizarse en función de la histología, el estadio quirúrgico y el deseo genésico de la mujer. Presentamos el caso de una paciente de 78 años con alopecia e hirsutismo severo, marcado incremento de testosterona y tumoración en ovario derecho de 4cms., informada de tumor de células esteroideas (AU)

Steroid cell tumors account for 0.1% of ovarian tumors and are classified within the group of stromal tumors, also known as sex cord tumors. These neoplasms can appear at any age but are more common in menopausal women and are associated with endocrine syndromes. The most significant clinical findings are hirsutism and virilization. Management should be individualized according to histological findings, surgical stage and the woman's reproductive wishes. We describe a 78-year-old patient with alopecia and severe hirsutism, a marked increase in testosterone and a 4-cm tumor of the right ovary, diagnosed as a steroid cell tumor (AU)

Carcinoma indiferenciado de trompa / Undifferentiated carcinoma of the fallopian tube

La neoplasia primaria de trompa de Falopio es una entidad poco frecuente. El diagnóstico preoperatorio es difícil y en muchas ocasiones es un hallazgo intraoperatorio o un diagnóstico histopatológico. Presentamos un caso de cáncer primario de trompa en una mujer de 61 años con algias pélvicas de un mes de evolución, masa pélvica izquierda dolorosa y Ca 125 elevado. Las pruebas diagnósticas fueron compatibles con patología uterina maligna (sarcoma uterino) o patología neoplásica ovárica izquierda con infiltración uterina como segunda posibilidad. El resultado histológico fue de carcinoma indiferenciado de trompa izquierda que infiltra pared uterina en cuerpo y cérvix. Actualmente, la paciente se encuentra sometida a tratamiento quimioterápico (AU)

Primary carcinoma of the fallopian tube is a rare entity. Preoperative diagnosis is difficult and these tumors are usually detected during surgery or on histopathological examination. We describe the case of a 61-year-old woman with pelvic pain, left adnexal mass and elevated Ca125 levels. Diagnostic tests were compatible with uterine sarcoma or primary left ovarian carcinoma with uterine invasion. Histopathological analysis showed a primary undifferentiated carcinoma of the left fallopian tube involving the uterus and cervix. The patient is currently undergoing chemotherapy (AU)

Bloqueo aurículo-ventricular completo fetal de causa inmune / Immune-mediated complete fetal Atrioventricular block

Se presenta un caso de bloqueo aurículo-ventricular completo (BAVC) de causa inmune en el que destaca un buen resultado perinatal al implantar marcapasos al nacimiento, a pesar de la alta morbimortalidad reflejada en la literatura. El diagnóstico se realiza mediante ecografía, al visualizar bradicardia fetal persistente con disociación aurículo-ventricular y en ausencia de otras alteraciones estructurales y de patología infecciosa (AU)

We report one case of congenital heart block with a good perinatal outcome after a pacemaker implant at birth, despite the high morbidity and mortality of this condition reported in the literatura (AU)

Útero didelfo y hemivagina ciega. Una causa de dolor abdominal en la adolescencia / Didelphic uterus and septate vagina. A cause of abdominal pain in adolescence

Objetivo: Consideración del útero didelfo comocausa de dolor abdominal.Material y método: Revisión de 2 casos clínicosen pacientes adolescentes controladas en nuestroservicio en el período 2002-2006.Resultados: En ambos se confirma la existenciade útero didelfo y hemivagina ciega asociada aagenesia renal; en ambos casos hubo buenaevolución tras la intervención quirúrgica.Conclusiones: Los casos que presentamosmuestran la necesidad de incluir lasmalformaciones congénitas en el diagnósticodiferencial de dolor abdominal y masa vaginalen pacientes adolescentes

Objective: To evaluate didelphic uterus as a causeof abdominal pain.Material and method: We reviewed 2 cases inadolescents managed by our service from 2002 to2006.Results: In both patients, we confirmed theexistence of didelphic uterus and septate vaginaassociated with renal agenesis. Outcome wasfavorable in both patients after surgery.Conclusions: The 2 cases described illustrate theneed to include congenital abnormalities in thedifferential diagnosis of lower abdominal pain andvaginal mass in adolescents