RESUMO
PURPOSE OF INVESTIGATION: The aim of this study was to review the clinical features of women with unexpected borderline ovarian tumours. METHODS: Between October 1992 and December 2010, 1332 out of 4016 laparoscopies were performed for adnexal masses in women of reproductive age and 1838 cysts were removed. When ultrasonographic findings did not meet the criteria for low risk malignancy, tumour markers, colour Doppler and MRI/CT were applied. At laparoscopy any solid component or papilla was sent for rapid frozen section. RESULTS: Borderline ovarian tumours were found in eight (0.6%) out of 1332 patients, two of which were bilateral. The mean age was 28.75 +/- 9.27 years and the mean diameter of the cysts was 5.1 +/- 1.7 cm. In two cases unexpected malignancy was discovered during the diagnostic and in six cases during the operative phase of the intervention. CONCLUSION(S): Risk of failure to diagnose cancer could be minimised with careful patient selection preoperatively. Adequate training on laparoscopic oncology is the necessary prerequisite for a safe laparoscopic approach.
Assuntos
Achados Incidentais , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Doenças dos Anexos/sangue , Doenças dos Anexos/diagnóstico por imagem , Doenças dos Anexos/cirurgia , Adolescente , Adulto , Antígeno Ca-125/sangue , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Humanos , Laparoscopia , Ovariectomia , Estudos Retrospectivos , Salpingectomia , Ultrassonografia , Adulto JovemRESUMO
OBJECTIVE: To assess the effect of age on clinical, endocrine and sonographic features associated with polycystic ovary syndrome (PCOS) in normogonadotrophic anovulatory infertile women of reproductive years. DESIGN: Cross-sectional study. METHODS: Four hundred and seventy-two oligo-amenorrhoeic infertile patients, presenting with normal FSH and oestradiol concentrations, aged 17-42 years underwent a standardised initial evaluation including: cycle history, body mass index, waist-to-hip ratio and transvaginal ultrasound scanning of ovaries. Fasting blood samples were obtained for extensive endocrine evaluation. Cycle duration, serum levels of gonadotrophins, androgens, oestradiol, insulin, glucose, inhibin B as well as mean number of follicles, ovarian volume and ovarian stroma echogenicity were assessed. RESULTS: Older women had significantly lower LH and androgen and inhibin B serum levels. Similarly, older women presented with a reduced number of ovarian follicles. Age was inversely correlated with cycle duration (r=-0.112, P=0.02), LH (r=-0.154, P=0.001), testosterone (r=-0.194, P=0.001), androstenedione (r=-0.170, P=0.001), dehydroepiandrosterone (r=-0.157, P=0.001), insulin (r=-0.126, P=0.02), inhibin B (r=-0.118, P=0.03) serum levels and mean follicle number (r=-0.100, P=0.03). A positive correlation was observed between age and glucose to insulin ratio (r=0.138, P=0.009). CONCLUSIONS: Advanced age in normogonadotrophic anovulatory infertile women is associated with lower LH and androgen levels and with a decreased number of ovarian follicles. Although during reproductive years observed differences are relatively small, these age-related changes may affect the observed incidence of PCOS.
Assuntos
Envelhecimento , Gonadotropinas Hipofisárias/sangue , Infertilidade Feminina/etiologia , Síndrome do Ovário Policístico/diagnóstico , Adolescente , Adulto , Amenorreia/complicações , Androstenodiona/sangue , Constituição Corporal , Índice de Massa Corporal , Estudos Transversais , Desidroepiandrosterona/sangue , Jejum , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Inibinas/sangue , Insulina/sangue , Hormônio Luteinizante/sangue , Ciclo Menstrual , Oligomenorreia/complicações , Folículo Ovariano/diagnóstico por imagem , Ovário/diagnóstico por imagem , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/fisiopatologia , Testosterona/sangue , UltrassonografiaRESUMO
INTRODUCTION: Small intestinal bacterial overgrowth syndrome (SIBOS) has various clinical and biological presentations. Six observations are described in this review which is aimed at reporting recent data on SIBOS and proposing diagnosis and therapeutic attitudes. CURRENT KNOWLEDGE AND KEY POINTS: Chronic diarrhea, malabsorption syndrome and exsudative enteropathy are the main criteria of diagnosis. Breath hydrogen testing is commonly performed to confirm diagnosis, with a 78% sensitivity and a 89% specificity. The aim of therapy is reparation of malabsorption consequences, reduction of intestinal bacterial overgrowth, and surgical correction of intestinal stasis. In the absence of consensus, norfloxacin or amoxicillin-clavulinic acid (administered for a mean of 7 to 15 days) seem the more appropriate antibiotics. When possible, surgery represents the primary treatment of SIBOS recurrences. FUTURE PROSPECTS AND PROJECTS: Diagnosis of small intestinal bacterial overgrowth syndrome must be evoked on the basis of either surgical or medical context, i.e., the existence of chronic diarrhea, malabsorption syndrome (complete or not), and exsudative enteropathy. This review reports essential factors for diagnosis and treatment.
Assuntos
Infecções Bacterianas/microbiologia , Enteropatias/microbiologia , Intestino Delgado/microbiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/patologia , Testes Respiratórios , Doença Crônica , Diagnóstico Diferencial , Diarreia/etiologia , Feminino , Humanos , Enteropatias/diagnóstico , Enteropatias/patologia , Intestino Delgado/patologia , Síndromes de Malabsorção/etiologia , Masculino , Pessoa de Meia-IdadeAssuntos
Adenocarcinoma/complicações , Carcinoma Hepatocelular/complicações , Hipercalcemia/etiologia , Neoplasias Hepáticas/complicações , Neoplasias Retais/complicações , Idoso , Idoso de 80 Anos ou mais , Humanos , Hipercalcemia/patologia , Masculino , Proteína Relacionada ao Hormônio Paratireóideo , Proteínas/farmacologiaAssuntos
Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Mesotelioma/complicações , Mesotelioma/diagnóstico , Neoplasias Peritoneais/complicações , Neoplasias Peritoneais/diagnóstico , Antineoplásicos/uso terapêutico , Biópsia , Terapia Combinada , Dispepsia/etiologia , Humanos , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Masculino , Mesotelioma/terapia , Pessoa de Meia-Idade , Neoplasias Peritoneais/terapia , PrognósticoAssuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias Retais/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgiaAssuntos
Hemangioma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Adulto , Anemia Ferropriva/etiologia , Diagnóstico Diferencial , Feminino , Febre/etiologia , Seguimentos , Hemangioma/diagnóstico por imagem , Hemangioma/tratamento farmacológico , Hepatomegalia/etiologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Imageamento por Ressonância Magnética , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Fatores de Tempo , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Linfoma de Células B/complicações , Síndrome de Sjogren/complicações , Neoplasias da Glândula Tireoide/complicações , Idoso , Terapia Combinada , Feminino , Humanos , Linfoma de Células B/radioterapia , Linfoma de Células B/cirurgia , Dosagem Radioterapêutica , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaAssuntos
Doença das Coronárias/complicações , Transtornos de Deglutição/etiologia , Angiopatias Diabéticas/complicações , Embalagem de Medicamentos , Compostos Ferrosos/administração & dosagem , Corpos Estranhos/diagnóstico , Doença Iatrogênica/prevenção & controle , Adenocarcinoma/complicações , Idoso , Transtornos de Deglutição/prevenção & controle , Corpos Estranhos/etiologia , Corpos Estranhos/terapia , Gastroscopia , Humanos , Masculino , Neoplasias Gástricas/complicaçõesRESUMO
INTRODUCTION: Empty sella syndrome is sometimes associated with anterior pituitary insufficiency, the latter being mostly partial or dissociated. EXEGESIS: We report a case of a profound panhypopituitarism revealing an empty sella syndrome. This case shows that empty sella syndrome, although a generally benign and asymptomatic condition, can be associated with hypopituitarism. CONCLUSION: In case of empty sella syndrome, especially if an endocrine dysfunction is clinically suspected, minimal hormonal analysis must be requested.
Assuntos
Síndrome da Sela Vazia/complicações , Hipopituitarismo/etiologia , Hormônio Adrenocorticotrópico/deficiência , Síndrome da Sela Vazia/diagnóstico , Feminino , Humanos , Hidrocortisona/deficiência , Hidrocortisona/uso terapêutico , Hipopituitarismo/tratamento farmacológico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tireotropina/deficiência , Tiroxina/uso terapêuticoRESUMO
PURPOSE: This study was undertaken to correlate the follicular levels of interleukin (IL)-1 alpha, IL-2, tumor necrosis factor-alpha (TNF-alpha), and leukotriene (LT) B4 with oocyte maturity, fertilization, and achievement of pregnancy. METHODS: The material was obtained from 22 women undergoing IVF, 8 of whom became pregnant and 14 of whom did not. RESULTS: All of the studied cytokines and LT B4 were found in follicular fluids, but there were no significant differences according to oocyte maturity, fertilization, embryo quality, and achievement of pregnancy. On the other hand, a significant positive correlation was found between IL-1 alpha and TNF-alpha, IL-1 alpha, and LT B4 as well as between TNF-alpha and LT B4 in follicular fluids with subsequently fertilized oocytes. CONCLUSIONS: It seems that IL-1 alpha, TNF-alpha and LT B4 may take part in the process of follicle wall degradation, and their follicular correlations may suggest more optimal follicular and oocyte development and maturation.
Assuntos
Citocinas/análise , Fertilização in vitro , Líquido Folicular/química , Leucotrieno B4/análise , Adulto , Transferência Embrionária , Ensaio de Imunoadsorção Enzimática , Feminino , Fármacos para a Fertilidade Feminina/farmacologia , Líquido Folicular/citologia , Humanos , Interleucina-1/análise , Interleucina-2/análise , Menotropinas/farmacologia , Oócitos/química , Oócitos/fisiologia , Ovário/citologia , Ovário/efeitos dos fármacos , Ovário/fisiologia , Indução da Ovulação , Gravidez , Fator de Necrose Tumoral alfa/análiseRESUMO
OBJECTIVE: To present a case of immotile cilia syndrome, a very rare cause of male infertility and to evaluate the role of the recently suggested treatment by intracytoplasmic sperm injection (ICSI). DESIGN: Case report. SETTING: Tertiary-care academic hospital. PATIENT(S): One man with immotile cilia syndrome, showing no motile spermatozoa despite normal morphology and viability. INTERVENTION(S): The patient's partner underwent two cycles with IVF of the oocytes achieved by ICSI. MAIN OUTCOME MEASURE(S): Evaluation of ICSI procedure in cases of immotile cilia syndrome. RESULT(S): Thirty-three percent of the oocytes were fertilized and subsequently divided enabling ET in both cycles. CONCLUSION(S): Intracytoplasmic sperm injection seems to represent a promising approach to the problem of infertility in men with immotile cilia syndrome.
Assuntos
Fertilização in vitro/métodos , Infertilidade Masculina/etiologia , Motilidade dos Espermatozoides , Espermatozoides/anormalidades , Adulto , Dineínas/deficiência , Humanos , Masculino , Microinjeções , Microscopia Eletrônica , Oócitos , Indução da Ovulação/métodos , Cauda do Espermatozoide/patologia , Cauda do Espermatozoide/ultraestrutura , Espermatozoides/patologia , Espermatozoides/ultraestrutura , SíndromeAssuntos
Adenocarcinoma/patologia , Antagonistas de Androgênios/efeitos adversos , Neoplasias Ósseas/secundário , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/tratamento farmacológico , Síndrome de Abstinência a Substâncias , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/secundário , Idoso , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/patologia , Humanos , Masculino , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologiaRESUMO
Blind loop syndrome is the most common syndrome of bacterial overgrowth following gastrectomy. We report two cases with diarrhea, steatorrhea, exudative enteropathy and major nutritional deficiency. Diagnosis was based on the breath test and aspirate analysis. Surgery with restoration of the duodenal continuity was the treatment. Patients with contraindications for surgery should be given prolonged antibiotic therapy which should be repeated if symptoms reoccur.
Assuntos
Bactérias/crescimento & desenvolvimento , Síndrome da Alça Cega/microbiologia , Gastrectomia/efeitos adversos , Idoso , Antibacterianos/uso terapêutico , Síndrome da Alça Cega/etiologia , Síndrome da Alça Cega/cirurgia , Testes Respiratórios , Doença Celíaca/etiologia , Diarreia/etiologia , Duodeno/cirurgia , Exsudatos e Transudatos/microbiologia , Feminino , Humanos , Doenças do Jejuno/etiologia , Síndromes de Malabsorção/etiologia , Pessoa de Meia-Idade , Distúrbios Nutricionais/etiologia , RecidivaRESUMO
Umbilical cord blood erythropoietin levels and hematocrit are significantly higher in smoking mothers than those nonsmoking ones. In addition, the incidence of newborns with low birthweight is higher in women who smoke. We conclude that in addition to other parameters, cord blood erythropoietin might be used as a valuable indicator of fetal distress in smokers.
Assuntos
Eritropoetina/sangue , Sangue Fetal/química , Sofrimento Fetal/sangue , Complicações na Gravidez/etiologia , Fumar/efeitos adversos , Adulto , Estudos de Casos e Controles , Feminino , Sofrimento Fetal/diagnóstico , Sofrimento Fetal/etiologia , Hematócrito , Humanos , Recém-Nascido , Masculino , Gravidez , Complicações na Gravidez/diagnósticoRESUMO
Over the last 16 years the evolution of 24 pregnancies in 17 women with biopsy-proven glomerular disease was analyzed. The underlying renal histology was IgA nephropathy in 8 cases, lupus nephritis in 7, mesangiocapillary glomerulonephritis type I in 1, and focal segmental glomerulosclerosis in 1. All but 2 had normal renal function before conception and 3 were hypertensive. Fetal survival rate was 75%. There were 6 preterm deliveries (33.3%), 3 newborns small for gestational age (17%), 1 stillbirth, and 5 therapeutic abortions. The perinatal mortality was 5.5%. De novo hypertension occurred in 8 pregnancies (33.3%). In 11 pregnancies (46%) increased proteinuria was diagnosed and in 6 (25%) a decline in maternal renal function was recorded. Permanent impairment of renal function was seen in 2 women with renal insufficiency before conception. Maternal hypertension and renal function impairment were associated more frequently with obstetric complications. In conclusion, pregnancy is safe for normotensive mothers with glomerular diseases and normal renal function. Hypertension and impaired renal function at conception seem to carry increased risk for mothers and fetuses. Low-dose immunosuppressive treatment during pregnancy is not harmful for the fetus.
Assuntos
Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite Membranoproliferativa/diagnóstico , Glomerulosclerose Segmentar e Focal/diagnóstico , Nefrite Lúpica/diagnóstico , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Adulto , Feminino , Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite Membranoproliferativa/epidemiologia , Glomerulosclerose Segmentar e Focal/epidemiologia , Grécia/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Recém-Nascido , Nefrite Lúpica/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de RiscoAssuntos
Granulomatose com Poliangiite/complicações , Otorrinolaringopatias/complicações , Doenças Retais/complicações , Síndrome do Desconforto Respiratório/etiologia , Antineoplásicos Alquilantes/uso terapêutico , Terapia Combinada , Ciclofosfamida/uso terapêutico , Quimioterapia Combinada , Evolução Fatal , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Granulomatose com Poliangiite/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Otorrinolaringopatias/tratamento farmacológico , Prednisona/uso terapêutico , Doenças Retais/tratamento farmacológico , Doenças Retais/patologia , Doenças Retais/cirurgiaRESUMO
Since a few years, the medical thoracoscopy has already been used specially for the diagnostic and therapeutic taking up of the pleural pathology. Behind it, the video-assisted thoracic surgery has been improved since 1990. As a surgical technology, it proved its interest refering to the classical thoracotomy by lessening operative morbidity and mortality. The authors discuss its main indications about seven cases, recruted in the internal medicine service and operated in the thoracic surgery service of the Val-de-Grâce hospital. Some of these indications are now admited by most of the authors: 1) diagnostic aims: pulmonary biopsy in case of interstitial pathology, of pulmonary peripheral under-pleural nodule and sometimes of solid tumors of the mediastinum, specially of some lymph-nodes. 2) Therapeutic aims: the spontaneous pneumothorax treatment of the adult remains the most classical indication; the thoracic sympathectomy, the creation of pleuropericardial windows and the resection of benign tumors of the mediastinum are now well acknowledged indications.