[Large uterine leiomyoma in a young patient]. / Leiomiomatosis uterina de grandes elementos en una paciente joven.

BACKGROUND: Great elements uterine leiomyomas are the most common tumours in the reproductive life affecting up to 30 % of the women in the United States. Its aetiology remains uncertain; cytogenic studies suggest that 40 to 50% present chromosomic abnormalities. Clinical manifestations are: hypermenorrhea and abdominal pain. In the great element cases, patients suffered intestinal constipation and rectal tenesm. The treatment includes analogous of human chorionic gonadotrophin liberation hormone (GnRH), progesterone, surgical treatment, myomectomy and hysterectomy, uterine artery embolization, high frequency ultrasound, laser, cryotherapy and thermoablation. CLINICAL CASE: An 18 year-old female, menarquia at 12, periods 28/4, nubil. 6 months previous: intestinal constipation, tumour-like mass in hypogastrium, of about 8 cm in diameter, which increased gradually up to 18 cm, smooth, movile and irregular. The pelvic ultrasound showed a tumour of 140 mm dependent of uterus. Myomectomy was performed. The histopathologic report was a 19.9 cm uterine leiomyoma, weighing 949 g and with hyaline degeneration. The patient was asymptomatic and without relapse a year later. CONCLUSIONS: Myomectomy is the choice treatment for the large uterine myomatosis when the patient's fertility is to be preserved.

Hallazgos laparoscópicos en pacientes con dolor pélvico crónico y dismenorrea / Laparoscopic findings in patients with chronic pelvic pain and dysmenhorrea

Fueron revisados en forma retrospectiva los hallazgos laparoscópicos de 49 pacientes que consultaron por dismenorrea y dolor pélvico crónico. A todoas ellas se les realizó laparoscopia con doble punción. Se encontró como causa principal del dolor a la endometriosis, seguida por la enfermedad pélvica inflamatoria crónica y las adherencias. El porcentaje de pacientes con una pelvis normal fue de 10.2 por ciento Por lo que se puede concluir que en la paciente con dolor pélvico crónico, la laparoscopia es el método más útil con el cual poder precisar el diagnóstico y así instituir el tratamiento más adecuado