[Postpartum left ovarian vein thrombosis: case report and literature review]. / Trombosis de vena ovárica izquierda posparto: revisión de la bibliografía basada en un caso clínico.

BACKGROUND: Ovarian Vein Thrombosis is an uncommon complication of the puerperium. Its unspecific clinical presentation and its low incidence make it difficult to diagnose. CASE REPORT: A 36-year-old pregnant woman has a vaginal delivery at 39+2 weeks of gestation and develops left lumbar pain irradiated to the left iliac fossa. She is diagnosed of left ovarian vein thrombosis by sonography and TC and receives anticoagulant treatment. DISCUSSION: A high index of suspicion is the key to a correct diagnosis and treatment. Confirmation with modern imaging methods is crucial for the diagnosis and treatment nowadays. CONCLUSION: The best results and lower rate of complications are achieved with an early diagnosis and anticoagulant treatment.

Inhalation analgesia with nitrous oxide versus other analgesic techniques in hysteroscopic polypectomy: a pilot study.

STUDY OBJECTIVE: To show the decrease in pain and better tolerance to inhalation analgesia with a 50% equimolar mixture of nitrogen protoxide and oxygen in hysteroscopic polypectomy compared with paracervical anesthesia and a control group. DESIGN: One hundred six patients scheduled for office hysteroscopy and polypectomy were divided into the following 3 groups: the control group, the nitrous oxide group, and the paracervical infiltration group. Patients were assigned sequentially (Canadian Task Force classification II-1). SETTING: The study took place in a hysteroscopy outpatient clinic under the supervision of a gynecologist and 2 nurses trained to cooperate in the trial. PATIENTS: One hundred six women from Area III of Madrid Community, Spain, who had been diagnosed with endometrial polyps at a gynecology office and were scheduled for office hysteroscopy and polypectomy agreed to participate in the study. INTERVENTIONS: Patients in group 1 (control group) received no treatment. Group 2 received inhaled nitrous oxide and group 3 paracervical infiltration with 1% lidocaine. MEASUREMENTS AND MAIN RESULTS: Pain was assessed using the visual analog scale (0-10). Pain perceived by patients was lower in the nitrous Oxide group (mean: 3.55 ± 0.60, median: 3) versus the control group (mean: 5.49 ± 1.88, median: 6, p < .05) and the paracervical infiltration group (mean: 4.22 ± 1.73, median: 5). Tolerance to pain, assessed by the medical staff using qualitative variables, was bad for the control group, very good for the nitrous oxide group, and good for the paracervical infiltration group (p < .05). There were no complications in 82% of the patients in the nitrous oxide group, whereas in the paracervical infiltration group, there were complications in more than 50% of the patients. No severe complications occurred. CONCLUSION: Nitrous oxide is a safe and effective analgesic technique for polipectomy office hysteroscopy compared with the paracervical infiltration and control groups.

Hemofilia A adquirida posparto: guía de diagnóstico y tratamiento a raíz de un caso clínico / Postpartum adquired A Hemophilia: guide to diagnosis and treatment apropos of a case report

La hemofilia A adquirida (HAA) posparto es una entidad extremadamente infrecuente (100 casos descritos en la literatura) y potencialmente grave. Se caracteriza por la aparición de anticuerpos antifactor viii (FVIII) circulante, que producen clínica hemorrágica en el puerperio, sin afectar al feto. Por lo general, los anticuerpos desaparecen espontáneamente en las primeras semanas o meses y no se reproduce en gestaciones posteriores. Pese a que el retraso en el diagnóstico puede ser fatal, la HAA posparto presenta buena respuesta al tratamiento procoagulante e inmunosupresor, siendo de mejor pronóstico que otras causas de hemofilia A. Por esta razón, ante síntomas como metrorragia incoercible sin causa obstétrica que lo justifique y signos como pruebas de coagulación alteradas, debemos sospechar esta enfermedad y realizar las pruebas diagnósticas de confirmación para instaurar sin demora el tratamiento sintomático y etiológico (AU)

Postpartum acquired hemophilia A is an extremely rare (100 cases in the literature) and potentially serious disease. Anti-circulating factor viii (FVIII) antibodies develop in the puerperium, leading to hemorrhagic symptoms without fetal danger. In general, the antibodies disappear spontaneously in the first few weeks or months after delivery and do not recur in subsequent pregnancies. Even though a delay in diagnosis can be fatal, postpartum hemophilia A has a good response to treatment and a better prognosis than other causes of hemophilia A. Consequently, it is important to suspect this disease in the presence of symptoms such as intractable vaginal bleeding without underlying obstetric disorders and signs such as abnormal coagulation tests. The correct diagnostic tests must be carried out to establish symptomatic and etiologic treatment without delay (AU)

El potencial maligno de los pólipos endometriales / Malignant potential of endometrial polyps

Objetivo Determinar el potencial premaligno y maligno de los pólipos endometriales e investigar sobre posibles factores clínicos asociados al potencial maligno de estos. Material y métodos Se revisan 452 polipectomías por histeroscopia. Se analizan de forma estadística el diagnóstico histológico y parámetros clínicos como el sangrado uterino anormal y el tamaño del pólipo. Resultados En nuestro estudio se incluyó a 203 mujeres premenopáusicas y 249 mujeres posmenopáusicas. La edad media ± desviación estándar de las mujeres premenopáusicas fue de 44,3±0,4 años, y de 59,1±0,5 años en las mujeres posmenopáusicas. El diagnóstico de los pólipos endometriales se realizó mediante ecografía sola o en combinación con histerosonografía, o mediante histeroscopia. La principal indicación de histeroscopia fue el sangrado uterino anormal, en un 65,1% en el grupo de mujeres premenopáusicas y un 74,7% en el grupo de mujeres posmenopáusicas. Se hallaron 23 (11,3%) casos de hiperplasia sin atipia en el grupo de mujeres premenopáusicas, y 8 (3,2%) casos en el grupo de mujeres posmenopáusicas. Se encontraron 2 (0,9%) casos de hiperplasia con atipia en el grupo de mujeres premenopáusicas, y 9 (3,6%) casos en el grupo de mujeres posmenopáusicas. Se encontraron 16 (6,45) casos de carcinoma de endometrio, todos ellos en el grupo de pacientes posmenopáusicas. Sólo uno de los 16 casos cursó de forma asintomática; la sospecha ecográfica de pólipo endometrial fue la indicación de histeroscopia. Se encontró una asociación estadísticamente significativa entre el estado menopáusico y el potencial premaligno y maligno de los pólipos. Sin embargo, no se encontró una asociación estadística entre la presencia de sangrado uterino anormal y el tamaño del pólipo, con el potencial premaligno y maligno de los pólipos. Conclusiones Deben extirparse todos los pólipos en las pacientes menopáusicas, tengan o no tengan síntomas. En cuanto a las pacientes premenopáusicas asintomáticas, se debe individualizar cada caso, y aquellas sin ningún factor de riesgo puede obviarse la extirpación del pólipo y llevarse a cabo un seguimiento (AU)

Objectives To determine the pre-malignant and malignant potential of endometrial polyps, and to asses whether different clinical parameters are associated with malignancy in the polyps. Material and methods 452 hysteroscopic resections of endometrial polyps were reviewed. Histological diagnosis and clinical characteristics (presence of abnormal uterine bleeding and polyp size) were analyzed. Statistical analysis was performed. Results The study included 203 pre-menopausal and 249 post-menopausal women. The mean age of pre-menopausal women was 44.3±0,4 years, and 59.1±0.5 years for postmenopausal women. The diagnosis of polyps was by ultrasound with or without hysterosonography, or by hysteroscopy. The main indication of hysteroscopy was abnormal uterine bleeding, which was 65.1% in the pre-menopausal group and 74.7% in the post-menopausal group. There were 23 cases (11.3%) of hyperplasia without atypia in the pre-menopausal group, and 8 cases (3.2%) in the post-menopausal group. Hyperplasia with atypia was found in 2 cases (0.9%) in the pre-menopausal group, and in 9 cases (3.6%) in the post-menopausal group. There were 16 cases of endometrial carcinoma (6.4%), all of them in post-menopausal women. In 1 of these 16 patients there was no abnormal bleeding, but an endometrial polyp was suspected in the ultrasound. Menopause status was significantly associated with pre-malignant or malignant changes. No significant association was found between the presence of abnormal uterine bleeding and polyp size with pre-malignancy or malignancy in the polyp. Conclusions Post-menopausal women with endometrial polyp, whether symptomatic or not, should be evaluated by hysteroscopic resection. Asymptomatic pre-menopausal patients, without any risk factor, should be followed up (AU)