Esterilización tubaria transvaginal: Experiencia en el Hospital Universitario de Caracas

Objetivo: Evaluar las ventajas de la técnica de esterilización tubaria por vía vaginal en pacientes que acudieron al servicio de Ginecología del Hospital Universitario de Caracas y Ambulatorio del IVSS Patrocino Peñuela Ruíz, de enero a noviembre de 2014. Métodos: Investigación tipo ensayo clínico multicéntrico, en 49 mujeres no puérperas en edad fértil que solicitaron la esterilización quirúrgica. Se realizó la técnica de colpotomía posterior para localizar las trompas y realizar la esterilización. Resultados: La edad promedio fue de 32,5 años. El 80 % tenía de 1 a 3 partos. El 12,2 % tenía una cesárea previa y dos el 16, 3 %. El tiempo promedio de intervención fue de 22,8 minutos y de pérdida sanguínea de 32,5 cm³, sin necesidad de hemoderivados. Las complicaciones intraoperatorias se presentaron en 6 % de los casos, ameritando laparotomía 2 casos. Se pudo demostrar que las adherencias retrasan el tiempo quirúrgico. Según la escala visual análoga (EVA), 53,1 % de las pacientes a las seis horas no tenía dolor y a las 12 horas había disminuido notoriamente en el 85,7 %. Conclusión: La esterilización quirúrgica por colpotomía es beneficiosa porque el tiempo quirúrgico es corto, el sangrado escaso, el dolor leve y las complicaciones bajas.

Objective: To evaluate the advantages of tubal ligation by colpotomy incision in patients who assisted to the Gynecology Unit of University Hospital of Caracas and Patrocino Peñuela Ruíz Hospital form January to November 2014. Methods: Multicentric clinical assay, performed in 49 patients of reproductive age who demanded tubal ligation. Posterior colpotomy was performed to access the Fallopian tubes. Results: Mean age was 32,5 years. Eighty percent had 1 to 3 vaginal deliveries. One previous C section was reported in 12 %, and 2 in 16, 3 %. Mean surgery time was 22,8 minutes, and the mean blood loss 32,5 cc; blood transfusión was not required. Intraoperatory complications were present in 6 % of cases, 2 of them required laparotomy. The presence of adherences was related to longer surgical time. According to the Visual Analogue Scale (VAS), 53,1 % of the patients had no pain 6 hours after the surgery, and pain decreased significantly in 85. 7 % of the patients 12 hours after the procedure. Conclusion: Tubal ligation by colpotomy is highly recommended due to the short surgical time and low rate of complications, blood loss and pain.

Hydatidiform mole in ectopic pregnancy: clinical, imaging, pathological and immunohistochemical characteristics.

OBJECTIVE: To determine the clinical, pathological, immunohistochemical and imaging characteristics of hydatidiform mole in ectopic pregnancy (HMEP) in all the cases admitted to the Department of Obstetrics and Gynecology, University Hospital of Caracas (HUC), Central University of Venezuela. STUDY DESIGN: Retrospective and comparative study, based on clinical records review of 2 groups: 10 cases with a diagnosis of HMEP and 20 cases with intrauterine hydatidiform mole (IUHM) admitted to the Obstetrics and Gynecology Department of HUC from 1996 to 2010. Clinical, pathological, immunohistochemical and imaging features were analyzed. RESULTS: The prevalence of HMEP in this study was 0.14:1,000 pregnancies; in this group the mean age was 28.8 years, and the mean gestational age at admission was 8.6 weeks. Both groups (HMEP and IUHM) were comparable in these last variables. Abdominal pain and genital bleeding were the most common clinical symptoms in the HMEP group, while it was vaginal bleeding in the IUHM group. Ultrasound findings were similar to those traditionally described in nonmolar ectopic pregnancy. Histology and immunohistochemistry showed that all cases of HMEP were partial mole. CONCLUSION: Although in this study the prevalence of HMEP was high, the size of the sample limits definitive conclusions. This study concludes that all cases of HMEP are partial mole.

Cincha transobturatriz con anestesia local para incontinencia urinaria de esfuerzo / Tansobturator tape under local anesthesia for urinary stress incontinence

Evaluar la técnica de cura de incontinencia urinaria de esfuerzo con cincha transobturatriz bajo anestesia local. Estudio descriptivo y prospectivo en 22 pacientes con incontinencia urinaria de esfuerzo de la consulta de piso pélvico del Hospital Universitario de Caracas entre abril y noviembre de 2010, a las que se les colocó cincha transobturatriz con anestesia local y sedación consciente complementaria en la mayoría de los casos. El tiempo quirúrgico promedio fue 9,57 min. Dos pacientes toleraron el procedimiento quirúrgico con anestesia local exclusiva, mientras que las otras 20 (90,9 por ciento) requirieron sedación endovenosa, similar a lo descrito en la literatura. El dolor intraoperatorio en promedio fue de 3,18 puntos en la escala visual análoga. El 100 por ciento de las pacientes estuvo satisfecha con el procedimiento anestésico y el 95,5 por ciento lo recomienda. La anestesia local con sedación consciente constituye una técnica tolerable, segura, y rápida para la cura de incontinencia urinaria de esfuerzo con cincha transobturatriz

To evaluate the transobturator tape procedure for urinary stress incontinence under local anesthesia. Prospective and descriptive study of 22 patients with urinary stress incontinence from the Pelvic Floor Unit of Universitary Hospital of Caracas, between April and November 2010, in whom the transobturator tape procedure was performed under local anesthesia and sedation. Mean surgical time was 9.57 min. Two patients tolerated the surgical procedure with local anesthesia without sedation, while the other 20 (90.9 percent) required intravenous sedation, as described in most publications. Mean intraoperative pain was 3.18 points in the Visual Analogue Scale. One hundred percent of the patients were satisfied with the anesthetic technique, and 95.5 percent would recommend it. Local anesthesia with sedation is a well-tolerated, safe, and fast technique for the surgical treatment of urinary stress incontinence with transobturator tape

Utility of p57 protein(KIP2) in molar disease to determine its androgenetic origin.

OBJECTIVE: To determine, qualitatively and semiquantitatively, the expression of p57 protein in different trophoblastic cell populations of hydatidiform mole and anembryonic pregnancy. STUDY DESIGN: We performed an observational study of the histopathologic and immunohistochemical findings of 48 cases of hydatidiform mole and 2 anembryonic pregnancies. The histologic samples stained with hematoxylin-eosin were reviewed blindly by 3 pathologists to establish a diagnosis and compare it to the previous one. Afterward, immunohistochemical staining was performed using a polyclonal antibody on paraffin-embedded, formalin-fixed tissue sections. The nuclear staining was assessed in 5 cell types: villous mesenchyme, cytotrophoblast, syncytiotrophoblast, intervillous trophoblast and decidua. RESULTS: The degree of agreement between the previous histologic diagnosis and the current one was excellent (kappa = 0.702). The sensitivity was 82.6% for complete and 84% for partial mole. On immunohistochemical analysis, the degree of agreement was low (kappa = 0.2). The sensitivity was 53.9% for complete mole and 59.1% for partial mole. The cell population with the least expression for p57 was the cytotrophoblast. The results for anembryonic pregnancies remained the same. CONCLUSION: Immunohistochemistry with p57 is a useful method to differentiate complete from partial mole, which is important to establish the prognosis of the patient.

Gestational trophoblastic neoplasia: clinical trends in 8 years at Hospital Universitario de Caracas.

OBJECTIVE: To analyze the clinical trends of gestational trophoblastic neoplasia (GTN) at the Department of Obstetrics and Gynecology, Hospital Universitario de Caracas (HUC). STUDY DESIGN: A medical record review was performed of epidemiologic, clinical and diagnostic features of 25 cases of GTN at HUC from 1997 to 2004. RESULTS: During the study period, 35,300 deliveries occurred, and 25 patients were diagnosed with GTN; the prevalence was 0.70:1,000 deliveries. The mean age was 29.2 years. Fifty-six percent were posthydatidiform mole (HM), 36% postchoriocarcinoma (CC), 4% postinvasive mole and 4% postabortion with abundant intermediate trophoblast. Vaginal bleeding was the main symptom in patients with CC. Two cases resembled ectopic pregnancy, and another resembled a vaginal endometrioma. Fifty-two percent of cases were at stage Ib; 76% received single-agent chemotherapy. Hysterectomy was performed in 6 cases. Twenty-one patients achieved remission, 2 showed regression and 2 died. CONCLUSION: GTN had a high prevalence because HUC is a reference center. The most common presentation was post-HM GTN. Vaginal bleeding is frequent in CC and can mimic other gynecologic diseases. Chemotherapy is helpful, and hysterectomy can be performed in selected cases at early stages or with severe vaginal bleed-with a good ing. GTN has a good prognosis, and early diagnosis is possible.

Metastasis detection with 18 FDG-positron emission tomography/computed tomography in gestational trophoblastic neoplasia: a report of 2 cases.

BACKGROUND: The imaging methods proposed by the International Consensus for the Diagnosis of Metastases in Trophoblastic Neoplasia are sufficient to stage the disease in most cases. However, there are 2 circumstances in which a more accurate imaging method is necessary: condemonstrate tl fusing images in conventional studies and persistent low 18 FDG-PET/CT human chorionic gonadotropin (hCG) values. Eighteen-fluoro-2-deoxyglucose-positron emission tomography/ computed tomography (18 FDG-PET/CT) can be helpful in these cases. CASES: Case 1. A 51-year-old woman was referred to the Hospital Universitario de Caracas from another hospital with a diagnosis of cervical adenosquamous carcinoma. She complained of vaginal bleeding; clinical and sonographic evaluation demonstrated a tumor in the uterus and lower third of the vagina. A new histopathologic study was performed, and choriocarcinoma (CC) was diagnosed and staged as International Federation of Gynecologists and Obstetricians (FIGO) II:12 The im aging studies were confusing, so an 18 FDG-PET/CT was performed, showing multiple nodules in the lungs. Case 2. A 25-year-old woman was admitted with symptoms that mimicked those of ectopic pregnancy; a left salpingectomy was performed, with a histopathologic report of CC. It was classified as FIGO stage 11:4. Treatment consisted of chemotherapy, hysterectomy and 1 pelvic tumor resection. Two years after discontinuing therapy, persistent low hCG values were detected without evident metastatic disease demonstrated by CT. Eighteen FDG-PET/CT showed multiple pulmonary nodules. CONCLUSION: Eighteen FDG-PET/CT seems to reveal metastases that are either confusing or not detected by other imaging techniques currently accepted in most gestational trophoblastic neoplasia protocols.

Gestational trophoblastic disease in ectopic pregnancy: A case series.

OBJECTIVE: To describe 6 cases of gestational trophoblastic disease (GTD) in ectopic pregnancy admitted to Hospital Universitario de Caracas (HUC). STUDY DESIGN: Medical records of 6 patients admitted to the Obstetrics and Gynecology Department, HUC, from 1996 to 2004 were reviewed. They underwent surgery with a diagnosis of ectopic pregnancy, and histologic analysis revealed GTD. Clinical trends were analyzed. RESULTS: The prevalence of GTD in ectopic pregnancy was 0.16:1,000 deliveries. The mean patient age was 29 years. The preceding gestation was a term delivery in 4 and abortion in 2. The mean gestational age at admission was 8 weeks. All patients complained of abdominal pain, and 3 of them also had vaginal bleeding. Ultrasound revealed an adnexal tumor in 5 cases; this tumor and hemoperitoneum (6 cases) were the most frequent surgical findings. Histopathologic diagnosis was partial mole in 5 and choriocarcinoma in 1. Four patients were lost to follow-up. CONCLUSION: In this series the prevalence of ectopic GTD was high. The condition can mimic the usual symptoms of ectopic pregnancy, especially when a hemoperitoneum is present. It is important to apply strict histologic criteria for GTD when a sample of ectopic pregnancy is analyzed and to monitor those patients with careful human chorionic gonadotropin follow-up.

Histopathologic and immunohistochemical evaluation of blood vessels in complete and partial hydatidiform mole.

OBJECTIVE: To assess 46 cases diagnosed as complete and partial hydatidiform mole in regard to their histopathologic aspects according to current World Health Organization (WHO) criteria and to determine whether their immunohistochemical features are related to the presence of blood vessels. STUDY DESIGN: An observational, descriptive study was done on the histopathologic and immunohistochemical findings of 46 molar pregnancy cases seen at the Gynecological Pathology Department, Anatomopathological Institute, Central University of Venezuela, during 1990-2003. Data were obtained primarily from the tumor registry. These cases were histopathologically and immunohistochemically evaluated with CD34 antibody to detect endothelial cells. RESULTS: Baseline histopathologic diagnoses were partial moles in 25 cases (54%) and complete moles in 21 (46%). Based on the current criteria we demonstrated 25 cases of partial moles, 20 of complete moles and 1 anembryonic pregnancy case. Diagnostic differences in 4 cases from complete to partial mole, 3 cases from partial to complete mole and 1 case from partial mole to anembryonic pregnancy were determined. Blood vessels were identified in 93.8% of complete moles, in which cisterns were predominantly extensive. CONCLUSION: Using CD34 immunostain, blood vessels were found in complete and partial hydatidiform moles, without significant differences between them.