Tromboflebitis séptica pelviana post cesárea / Septic pelvic thromboflebitis after cesarean section

RESUMEN Presentamos caso clínico de puérpera de cesárea de noveno día con cuadro febril en espigas, asintomática, en que se plantea desde su ingreso el diagnóstico de tromboflebitis séptica pelviana y se inicia tratamiento con antibióticos parenterales de amplio espectro y heparina de bajo peso molecular en dosis terapéuticas. La respuesta es a la mejoría al tercer día de tratamiento. Se discuten los métodos diagnósticos, el diagnóstico diferencial y el tratamiento.

ABSTRACT A case of a woman on her 9th post-operative day after childbirth by cesarean section (CS) consulting with febrile spikes, otherwise asymptomatic, is presented. The diagnosis of a septic pelvic thrombophlebitis is proposed from the admission and treated with parenteral broad-spectrum antibiotics and low-molecular-weight heparin at therapeutic doses. Patient significantly improved on her third day of treatment. The diagnostic procedures, differential diagnosis and treatment are discussed.

Trombosis de la vena ovárica derecha tras histerectomía subtotal y colposacropexia vía laparoscópica: a propósito de un caso / Right ovarian vein thrombosis after subtotal laparoscopic hysterectomy and colposacropexy: report of clinical case

La trombosis de la vena ovárica es una complicación infrecuente que suele ocurrir durante el postparto, comúnmente tras una cesárea. Sin embargo, existen otras causas como son: la cirugía abdominal, las infecciones, las neoplasias malignas o los estados procoagulantes. La sintomatología es variada e inespecífica. En el estudio de esta entidad, tanto la Resonancia Magnética como el TAC con contraste intravenoso juegan un papel importante. Puesto que las complicaciones pueden ser mortales, es fundamental el tratamiento inmediato con anticoagulación y antibioterapia. El caso presentado a continuación supone uno de los posibles diagnósticos a considerar en una paciente intervenida de histerectomía subtotal laparoscópica con colposacropexia, que presenta dolor abdominal persistente tras la cirugía y riesgo de trombosis moderado por sus factores de riesgo.

Ovarian vein thrombosis is a rare complication that might happen in the postpartum period, most commonly after a cesarean section. However, there are many other causes such as abdominal surgery, infection, malignant neoplasms and procoagulant statuses. Symptoms are varied and unspecific. The computed tomography with intravenous contrast and the magnetic resonance play an important role in the diagnosis. As complications can be fatal, treatment with anticoagulants and antibiotics is necessary. We present a case in which ovarian vein thrombosis needs to be considered in the differential diagnosis in a woman after a subtotal laparoscopic hysterectomy with colposacropexy with moderate risk factors of thrombosis.

Hemoperitoneo en el post parto secundario a la rotura aneurismática de la arteria ovárica: Caso Clínico / Post partum hemoperitoneum secondary to ovarian aneurysm rupture: Case Report

Resumen El hallazgo de hemoperitoneo en el post parto secundario a la rotura aneurismática de la arteria ovárica es una situación clínica extremadamente rara que presenta un cuadro clínico inespecífico y puede poner en riesgo la vida del paciente. El ultrasonido es una modalidad segura y rápida para la detección de líquido libre intraperitoneal. (1) . La tomografía computada es la herramienta de elección para un diagnóstico rápido y seguro (2) ; y la angiografía con embolización durante el mismo procedimiento es una alternativa útil y altamente efectiva para la resolución del cuadro. (3). Presentamos el caso de una multípara puérpera de 34 años que consulta en el servicio de urgencia por intenso dolor abdominal. La paciente se encontraba hemodinámicamente estable y afebril. La tomografía computada demostró un hematoma retroperitoneal y hemoperitoneo asociado a un aneurisma de la arteria ovárica derecha. Fue evaluada por el servicio de radiología intervencional y se trasladó de emergencia al pabellón angiográfico donde se realizó la embolización de la lesión mediante la cateterización vascular supra selectiva. La paciente evolucionó de manera favorable y fue dada de alta una semana después. Es necesario tener un alto índice de sospecha en pacientes de riesgo para lograr un diagnóstico y tratamiento oportuno.

SUMMARY Spontaneous ovarian artery aneurysm rupture is a rare postpartum life-threatening event with non-specific clinical manifestations. The present article reports the case of a 34 year old multiparous post partum women who came to the emergency department with acute onset of intense abdominal right flank pain. Patient was afebrile and hemodynamically stable. A computed tomography revealed a retroperitoneal haematoma and hemoperitoneum related to an aneurysm of the right ovarian artery. The patient was taken to the interventional radiology suite and selective embolization was performed. Following the procedure, the patient symptoms subsided and 7 days later she was discharged. A high index of suspicion in patients with risk factors can lead to a prompt diagnosis and treatment. Computed tomography is the image modality for a fast and safe evaluation, although diagnostic angiography and subsequent transcatheter embolization are thought to be effective for treatment.

Is the effect of melatonin on vascular endothelial growth factor receptor-2 associated with angiogenesis in the rat ovary?

OBJECTIVES Vascular endothelial growth factor (VEGF) and its receptors play important roles in angiogenesis. Melatonin plays an important role in gonadal development; thus, its effect on the reproductive system is evident. We investigated the influence of melatonin on the expression of VEGF, vascular endothelial growth factor receptor-1 (VEGFR1) and vascular endothelial growth factor receptor-2 (VEGFR2), as well as on changes in oxidative stress markers and follicle numbers in rat ovaries. METHODS For this purpose, 45 Wistar rats were separated into the following groups: Group 1, control; Group 2, vehicle; and Group 3, melatonin. Rats in Group 3 were treated with melatonin at 50 mg/kg/day for 30 days. The effects of melatonin on the expression of VEGF, VEGFR1 and VEGFR2 were established by immunohistochemistry analysis. The effects of melatonin on antioxidant enzyme activities were demonstrated by spectrophotometric analysis. RESULTS Based on immunohistochemistry analysis, VEGFR2 was predominantly localized to theca cells in the ovary. Our data indicate that melatonin treatment can significantly increase VEGF and VEGFR1 expression in the ovary ( p <0.05). Additionally, the number of degenerated follicles significantly decreased with melatonin treatment ( p <0.05). Melatonin administration also led to significant increases in antioxidant enzyme levels in the ovary. CONCLUSION Melatonin treatment exerts protective effects on follicles against increased lipid peroxidation through modulating tissue antioxidant enzyme levels. These effects may be related to angiogenesis and antioxidant activities.

Dolor pélvico crónico secundario a síndrome de congestión pélvica: resultados del tratamiento endovascular de la insuficiencia venosa pelviana y várices genitales / Embolization of insufficient pelvic veins for pelvic congestion syndrome: analysis of 17 cases

Background: Pelvic venous insufficiency may cause pelvic congestion syndrome that is characterized by chronic pelvic pain exacerbated by prolonged standing, sexual activity or menstrual cycle. It may be treated by embolizing the dysfunctional pelvic venous drainage and sometimes resecting vulvar, perineal and thigh varices. Aim: To assess the results of embolization of insufficient pelvic or ovarian veins on pelvic congestion syndrome. Material and Methods: Analysis of 17 female patients aged 32 to 53 years, who underwent subjected to a selective coil embolization of insufficient pelvic and/or ovarian veins through the jugular, basilic or cephalic veins. In the preoperative period, all patients had a lower extremity venous duplex pelvic ultrasound examination and some had an abdominal and pelvic CT angiogram. Results: The technical success of the procedure was 100% and no complications were registered. During a 32 month follow up, no patient had symptoms of pelvic venous insufficiency or relapse of vulvar or thigh varices. Conclusions: Embolization of insufficient pelvic and ovarian veins is a safe and successful procedure for the treatment of pelvic venous insufficiency or vulvar varices.

Systemic administration of curcumin nanoparticles protects ischemia-reperfusion injury in ovaries: An animal model study

Summary Objective: Ovarian torsion must be diagnosed and treated as early as possible. The aim of the present study was to investigate the effects of intraperitoneal administration of nanocurcumin on ischemia-reperfusion injury in ovaries. Method: Thirty-five (35) healthy female Wistar rats weighing approximately 250 g were randomized into seven experimental groups (n=5): Group SSG - The rats underwent only laparotomy. Group I: A 3-hour ischemia only. Group I/R: A 3-hour ischemia and 3-hour reperfusion. Group I/C: A 3-hour ischemia only, and 1 mg/kg intraperitoneal administration of curcumin 2.5 hours after induction of ischemia. Group I/R/C: A 3-hour ischemia, 3-hour reperfusion, and 1 mg/kg intraperitoneal administration of curcumin 2.5 hours after induction of ischemia. Group I/NC: A 3-hour ischemia only and 1 mg/kg intraperitoneal administration of nanocurcumin 2.5 hours after induction of ischemia. Group I/R/C: A 3-hour ischemia, 3-hour reperfusion and 1 mg/kg intraperitoneal administration of nanocurcumin 2.5 hours after induction of ischemia. Results: Nanocurcumin-treated animals showed significantly improved development of ischemia and reperfusion tissue injury compared to those in the other groups (p<0.05). Significant higher values of SOD, tGSH, GPO, GSHRd and GST were observed in I/R/NC animals compared to those in the other groups (p<0.05). The damage indicators (NOS, MDA, MPO and DNA damage level) were significantly lower in I/R/NC animal compared to those of other groups (p<0.05). Conclusion: Intraperitoneal administration of nanocurcumin can be helpful in minimizing ischemia-reperfusion injury in ovarian tissue exposed to ischemia.

Trombosis de la vena ovárica: serie de 3 casos en el Hospital Universitario de Cabueñes / Thrombosis of the ovarian vein: series of 3 cases at the Hospital Universitario de Cabueñes

Se presentan 3 casos de trombosis de la vena ovárica, uno en relación a cirugía pélvica y dos durante el postparto. La trombosis de la vena ovárica es una complicación rara, de presentación clínica inespecífica, lo que hace plantearse un diagnóstico diferencial con otras patologías más frecuentes (apendicitis, pielonefritis, etc), siendo la TAC el gold standard para su diagnóstico. El tratamiento más adecuado son los anticoagulantes.

We report 3 cases of varian vein thrombosis, one in relation with pelvic surgery and 2 during the postpartum period. The ovarian vein thrombosis is a rare complication, with inespecific symptoms, that is why it is obligatory to propose a differential diagnosis with more frecuent patologies (appendicitis, pyelonephritis, etc.), the CAT is the gold standard in its diagnosis. Anticoagulants are the most suitable treatment.

Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome

OBJECTIVES: To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. METHODS: Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale. RESULTS: We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. CONCLUSION: Periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome appears to be an effective and safe technique.

The effects of an experimentally induced unilateral varicose ovarian vein on the activities of anti-oxidant enzymes in an adult rat ovary / Efectos de la inducción experimental unilateral de una vena ovárica varicosa sobre las actividades de las enzimas anti-oxidantes en ovarios de ratas adultas

In this study, we aim to examine effects of an experimentally induced unilateral varicose ovarian vein on the activities of anti-oxidant enzymes in an adult rat ovary. In this experimental study, a total of 30 adult female Wistar albino rats were divided into three groups. 10 rats in group 1 as the varicocele group, 10 rats in group 2 as the control group and 10 rats in group 3 as the sham group, that underwent a sham operation and. Anti-oxidant assays were assessed via specific assay kits. Statistical analysis was performed using the one way ANOVA and Tukey's tests were used for post hoc multiple comparisons, P<0.05 was considered statistically significant. The effects of the unilateral varicosity was more evident on the left side when compared to the right side as all activities of the anti-oxidant assayed were significantly reduced, P 0.05 when compared to the right side. Also, in this present study, the effect of the unilateral varicose vein was bilateral as there were no significant differences recorded between the two sides. Finally the result of this study shows that varicocele may lead to female infertility through various factors that includes reduction in the activities of anti-oxidant enzymes.

En este estudio, nuestro objetivo fue examinar los efectos de la inducción experimental unilateral de una vena ovárica varicosa en la actividad de enzimas antioxidantes en un ovario de rata adulta. Un total de 30 ratas albinas Wistar, hembras adultas, se dividieron en tres grupos. Diez ratas en el grupo 1 (grupo varicocele), diez ratas en el grupo 2 (grupo de control) y diez ratas en el grupo 3 (grupo de tratamiento simulado), que se sometió a una operación simulada. Ensayos con anti-oxidantes se evaluaron a través de kits de ensayo específicos. El análisis estadístico se realizó mediante ANOVA de una vía y las pruebas de Tukey fueron utilizadas para comparaciones múltiples Post Hoc, siendo el P<0,05 considerado como estadísticamente significativo. Los efectos de la varicosidad unilateral fue más evidente en el lado izquierdo cuando fue comparada con el lado derecho en todas las actividades del ensayo con anti-oxidante que se redujeron significativamente, el P 0,05 cuando se compara con el lado derecho. Asimismo, en el presente estudio, el efecto de la vena varicosa unilateral fue bilateral ya que no hubo diferencias significativas registradas entre las dos partes. Por último, el resultado de este estudio muestra que el varicocele puede conducir a la infertilidad femenina a través de diversos factores que incluye la reducción en la actividad de las enzimas antioxidantes.

Pelvic Intravenous Leiomyomatosis - Case Report / Leiomiomatose intravenosa pélvica - caso clínico

Abstract Introduction Intravenous leiomyomatosis is a benign and rare condition that can result in cardiac events with fatal outcomes when left untreated. Intravenous leiomyomatosis is probably underestimated because the diagnosis is easily missed. We present a case of an intravenous leiomyomatosis without extra-pelvic involvement, with a brief review of this pathology. Case Report 46-year-old woman submitted to hysterectomy and bilateral adnexectomy because of a pelvic mass detected in ultrasound. During the surgery, intravenous leiomyomatosis diagnosis was suspected. Pathological analysis confirmed this suspicion. Further imaging exams were performed without detecting any anomalies related to this condition. The patient remained with no evidence of disease after one year of follow-up. Conclusion Intravenous leiomyomatosis is a rare condition that can lead to serious complications. Early diagnosis followed by an appropriate treatment is very important to patient outcome, and underdiagnoses can be counteracted if the gynecologist is aware of this entity.

Resumo Introdução A leiomiomatose intravenosa é uma condição benigna, rara, que pode resultar em eventos cardíacos, podendo ser fatal quando não tratada. Esta patologia está provavelmente subestimada, uma vez que facilmente não é diagnosticada. Neste artigo, apresentamos um caso de leiomiomatose intravenosa sem envolvimento extrapélvico, com uma breve revisão da patologia. Relato de Caso Mulher de 46 anos de idade, submetida a histerectomia e anexectomia bilateral após detecção ecográfica de massa pélvica. Durante a cirurgia, houve a suspeita de leiomiomatose intravenosa, e o exame anátomo-patológico confirmou o diagnóstico. A paciente foi submetida a outros exames de imagem, não sendo detectada qualquer anomalia relacionada com a patologia. Após um ano de followup, a paciente manteve-se sem evidência de doença. Conclusão A leiomiomatose intravenosa é uma condição rara que pode levar a complicações graves. O diagnóstico precoce e o tratamento adequado são muito importantes para o prognóstico da paciente, e os subdiagnósticos podem ser evitados se o ginecologista estiver ciente dessa entidade.

Effects of ovarian varicose vein on mitochondrial structure, malondialdehyde and prooxidants: antioxidants balance in rat ovaries / Efectos de las venas ováricas varicosas sobre la estructura mitocondrial, niveles de malondialdehído y balance prooxidantes: antioxidantes en ovarios de ratas

Oxidative stress is increased in varicose veins. Many studies have implicated oxidative stress in the pathogenesis of infertility causing diseases of the female reproductive tract. The aim of this study was to determine whether varicocele can cause raised levels of reactive oxygen species and denaturation of mitochondrial structure in ovaries of female rats or not. In each experimental study, 15 weaning-age female rats were divided equally in 3 groups: Unilateral Varicose Vein (A), Sham (B) and Control (C) groups. Mitochondrial structure and malondialdehyde levels as a product of lipid peroxidation and Prooxidants-Antioxidants Balance were evaluated 60 days after intervention in proestrus stage. Comparisons between groups were made by the measured test. After 2 months, our results showed that mitochondrial structure ultra-structurally was denatured with histologic examination, malondialdehyde and prooxidants-antioxidants balance levels of left ovaries increased significantly in varicocele group compared to control and sham groups (P0.05). In the right side, malondialdehyde increased significantly, but in prooxidants-antioxidants balance levels, there is no significant differences between groups. The data of control and sham groups were the same. These findings may support the concept that increased levels of malondialdehyde and PAB in varicocele may cause negative effects on fertility, so using antioxidants maybe useful.

El estrés oxidativo aumenta en las venas varicosas. Diversas investigaciones han implicado al estrés oxidativo en la patogénesis de las enfermedades que causan la infertilidad del tracto reproductivo femenino. El objetivo de este estudio fue determinar si el varicocele puede provocar niveles de especies reactivas del oxígeno y la desnaturalización de la estructura mitocondriales en los ovarios de ratas. En cada estudio experimental, cinco ratas hembras en edad de destete se dividieron por igual en 3 grupos: Várices unilateral (A), simulado (B) y control (C). La estructura mitocondrial y los niveles de malondialdehído como un producto de la peroxidación lipídica y el balance pro-oxidantes-antioxidantes (BPA) se evaluaron 60 días después de la intervención en la etapa proestro. Las comparaciones entre grupos se realizaron mediante la prueba de medición. Después de 2 meses, observamos que la estructura mitocondrial se desnaturalizó ultraestructuralmente, los niveles malondialdehído y el balance prooxidantes-antioxidantes de los ovarios izquierdos aumentaron significativamente en el grupo A en comparación con los grupos B y C (P0.05). En el lado derecho, los niveles de malondialdehído aumentaron significativamente, pero el BPA, no mostró diferencias significativas entre los grupos. Los datos de los grupos B y C eran los mismos. Estos hallazgos pueden apoyar el concepto de que el aumento de niveles de malondialdehído y BPA en presencia de varicocele, puede causar efectos negativos sobre la fertilidad, por tanto el uso de antioxidantes puede resultar útil.

Aberrant Ovarian Artery Arising from the Common Iliac Artery: Case Report

A 46-year-old Vietnamese woman received embolization therapy in order to control postpartum hemorrhage. Angiography revealed an aberrant ovarian artery arising from the right common iliac artery. Superselective catheterization and subsequent embolization of the aberrant ovarian artery and bilateral uterine arteries were performed. Precise knowledge of the anatomic variations of the ovarian artery is important for successful embolization.

Estudo morfológico dos componentes de pedículo ovariano em suíno da raça Landrace / Morphologic study of the ovarian pedicle components in Landrace sow

Introdução - Este trabalho teve como objetivo estudar a morfologia dos componentes de pedículos ovarianos de porcas, e também a possibilidade de transferência do sangue venoso uterino para o arterial ovariano. Material e Método - Pedículos ovarianos de 15 porcas adultas da raça Landrace foram estudados mediante cortes histológicos de 6um de espessura de diferentes segmentos, corados segundo os métodos de Hematoxilina e Eosina, tricrômico de Masson, Van Gieson,Verhoeff, reticulina de Gomori e Picrosirius-red. Os componentes vasculares também foram examinados após injeção de látex corado, emulsão de sulfato de bário, acetato de vinil e tinta da China, seguidos respectivamente pelas técnicas de dissecção, exames radiográficos, corrosão em ácido sulfúrico a 30% e exames histológicos. Resultados - Foram descritos os aspectos histológicos dos vasos do pedículo ovariano, seus envoltórios, suas relações e a constituição do tecido conjuntivo intervascular. Foi identificada ainda a passagem de tinta da China do sistema venoso uterino para a artéria ovárica. Conclusão - Os achados permitem concluir que, na porca da raça Landrace, existe a possibilidade de passagem direta de substâncias do sistema venoso uterino para o sistema arterial ovariano.

Introduction - This research had as objective to study the morphology of the components of ovarian pedicles of sow and also the possibility of substance transfer from the uterine venous blood to the ovarian arterial blood. Material and Method - Ovarian pedicles of 15 adult Landrace sow hadbeen studied by means of 6um histological sections of different segments, stained according tothe Hematoxilin Eosin method, trichrome of Masson, Van Gieson, Verhoeff, Gomori's reticulin and Picrosirius-red. The vascular components were also examined after injection of colored latex, with or without contrast, vinil acetate and Chinese ink, followed respectively by the techniques of dissection, radiodiagnosis, sulfuric acid corrosion and histological examination. Results - The morphological aspects of the blood vessels of ovarian pedicle, its wrappers, relationships and the components of the intervascular connective tissue were described, as well as it was identified the transference of Chinese ink from the uterine venous system into the ovarian artery. Conclusion -Achieved findings lead to the conclusion of a possibility of direct transference of active substances from the uterine venous to the ovarian arterial systems in Landrace pig.

Índices de resistência nas artérias ovariana e uterina na fase lútea média em portadoras de esquistossomose mansônica na sua forma hepatoesplênica / Ovarian and uterine arterial resistance indexes on the midluteal phase in patients suffering from schistosomiasis mansoni in its hepatosplenic form

OBJETIVO: avaliar a repercussão da hipertensão porta nos índices de resistência arterial ovariano, uterino e na periferia do corpo lúteo, na fase lútea média do ciclo menstrual. MÉTODOS: em estudo observacional com corte transversal, 28 portadoras de esquistossomose mansônica na forma hepatoesplênica submetidas à esplenectomia e ligadura da veia gástrica esquerda (EHEO), um grupo similar de 28 pacientes não operadas (EHENO) e 29 voluntárias sadias (VS) foram submetidas à doplerfluxometria na fase lútea média do ciclo menstrual. O índice de resistência (RI) de Pourcelot foi usado como referência RI=[(S-D)/S], em que S significa o pico de velocidade sistólica, e D, o fim da diástole. Escolhia-se o melhor traçado no ramo ascendente da artéria uterina, na artéria ovariana, quando acessível, ou na artéria intraovárica. Quando da existência de corpo lúteo, o RI era medido na periferia do mesmo. Os dados obtidos foram analisados pelos testes de Kruskal-Wallis e Mann-Whitney. RESULTADOS: não houve diferença significativa entre os grupos no que diz respeito às médias dos índices de resistência das artérias ovarianas (Kruskal-Wallis-p=0,50). Foi observada a tendência de que a média dos índices de resistência da artéria uterina direita fosse maior no grupo de EHENO (Kruskal-Wallis-p<0,07); todavia, foi similar no que diz respeito à artéria uterina esquerda (Kruskal-Wallis-p=0,14). Índices de resistência arterial significativamente mais baixos foram observados na periferia do corpo lúteo, quando comparados com os índices das artérias ovarianas contra laterais em todos os grupos (Mann-Whitney-p<0,0001). CONCLUSÕES: não se demonstrou diferença entre os grupos no que diz respeito aos índices de resistência das artérias ovarianas e uterinas. A hipertensão porta em portadoras de doença esquistossomótica na forma hepatoesplênica não altera o fenômeno natural de diminuição do índice de resistência arterial no ovário no qual ocorre a ovulação.

PURPOSE: to evaluate the repercussion of portal hypertension in the indexes of the ovarian, uterine and luteus body periphery arterial resistance, at the medium luteal phase of the menstrual cycle. METHODS: in an observational study with transversal cohort, 28 patients with hepatosplenic schistosomiasis mansoni, submitted to splenectomy and ligation of the left gastric vein (HESO), a similar group of 28 patients who had not had the surgery (HESNO) and 29 healthy volunteers (HV) were submitted to Doppler fluxmetry in the medium luteal phase of the menstrual cycle. Pourcelot's resistance index has been used as RI=[(S-D)/S], in which S means the highest systolic speed, and D, the end of diastole. The best record in the ascendant branch of the uterine artery, in the ovarian artery, when accessible, or in the intraovarian artery, was chosen. When the luteus body was present, the RI was measured in its periphery. The data obtained were analyzed by Kruskal-Wallis and Mann-Whitney tests. RESULTS: there was no significant difference among the groups, concerning the mean RI of the ovarian arteries (Kruskal-Wallis, p=0.50). There was a tendency for higher right uterine artery RI in the HESNO group (Kruskal-Wallis, p<0.07), but it was similar in the left uterine artery (Kruskal-Wallis, p=0.14). Arterial RIs significantly lower have been observed in the luteus body periphery, when compared to the contralateral ovarian arteries in all the groups (Mann-Whitney, p<0.0001). CONCLUSIONS: there was no difference among the groups, regarding the ovarian and uterine RIs. The portal hypertension in patients with hepatosplenic schistosomiasis does not affect the natural phenomenon of arterial RI decrease in the ovary where ovulation occurs.

Trombosis de la vena ovárica: Factores de riesgo, diagnóstico y tratamiento / Ovarian vein thrombosis: risk factors, diagnosis and treatment

La trombosis de la vena ovárica es una complicación muy poco frecuente (0.002-0.05%), que se observa en mujeres que presentan un incremento en los factores de coagulación. La principal situación en la que es posible detectar esta complicación es el embarazo, aunque no es la única. Se describe el caso de una mujer de 31 años de edad, gestante de 16 semanas, que presenta un aborto espontáneo séptico complicado con una trombosis de la vena ovárica. Se aprovecha el caso clínico para revisar en la literatura los factores de riesgo, el diagnóstico y el tratamiento de esta inusual patología.

Ovarian vein thrombosis is an uncommon complication (0.002-0.05%) related to hypercoagulated status of women. The most frequent condition associated to ovarian vein thrombosis is pregnancy, but there are other possible causes. We present a case of a 31 year old pregnant woman at 16th week of gestation who had spontaneuos septic abortion complicated with an ovarian vein thrombosis. A discussion of risk factors, diagnostic and treatment options of ovarian vein thrombosis are presented.

Utilización de la resonancia magnética con contraste de fase para el diagnóstico del síndrome de congestión pelviana / Using phase contrast MRA for the diagnosis of pelvic congestion syndrome

Introduction: Pelvic congestion syndrome (PCS) is produced by anomalous flow in ovarían veins. Direct venography (DV) is the gold-standard for diagnosis. Phase-Contrast Magnetic Resonance Angiography (PC-MRA) appears as an alternative that would permit a morphological and functional assessment. The purpose of the study was to evaluate the usefulness of flow velocity (measured with PC-MRA) as a diagnostic criterion and also to compare it with the DV technique. Patients and methods: We prospectively included 8 female patients with clinical suspicion of PCS who were referred for undergoing DV over a six-month period. PC-MRA examinations were performed in all of them. Slow anterograde or retrograde flow were the diagnostic criteria. Sensitivity, specificity, PPV, and NPV were also calculated. Results: Data from 16 veins were analized by means of a home-made software written in Matlab. There were 12 abnormal and 4 normal veins according to DV results. All the abnormal veins were correctly identified by MR-PC. Two veins (corresponding to the same patient) were considered as normal in accordance with DV results, whereas the PC-MRA analysis revealed them as abnormal veins. This patient presented with PCS typical symptoms. Sensitivity and specificity values were 100 and 50 percent, respectively, whereas PPV and NPV values were 86 and 100 percent, respectively. Conclusion: PC-MRA is a useful diagnostic tool for patients with clinical suspicion of PCS and could avoid unnecessary invasive procedures.

Introducción: El síndrome de congestión pelviana (SCP) es producido por flujo anómalo en las venas ováricas. La venografía directa (VD) es el estándar de referencia. La resonancia magnética con contraste de fase (MR-CF) permitiría una evaluación morfológica y funcional. El propósito fue evaluar la utilidad de la velocidad de flujo medida con RM-CF como criterio diagnóstico comparado con VD. Pacientes y Métodos: Incluimos prospectivamente 8 pacientes derivadas para VD por sospecha de SCP durante 6 meses; todas fueron sometidas a RM-CF. Los criterios diagnósticos fueron: flujo retrógrado o anterógrado lento. Se calculó sensibilidad, especificidad, VPP y VPN. Resultados: Analizamos los datos de 16 venas, utilizando un software propietario escrito en Matlab. Hubo 12 venas anormales y 4 venas normales en VD. Todas la venas anormales fueron correctamente identificadas por MR-PC. Dos venas (la misma paciente) fueron normales en VD y anormales en MR-PC. Esta paciente tenía clásicos síntomas de SCP La sensibilidad fue de 100 por ciento, especifidad de 50 por ciento, VPP de 86 por ciento y VPN de 100 por ciento Discusión: MR-PC es una herramienta útil en el diagnóstico del SCP y evitaría exámenes invasivos innecesarios.

Indirect evaluation of estrogenic activity post heterotopic ovarian autograft in rats / Avaliação indireta da atividade estrogênica após transplante heterotópico de ovário em ratas

PURPOSE: To morphologically evaluate the estrogenic effect on the uterus and vagina of rats submitted to ovarian autografts. METHODS: Twenty Wistar EPM-1 adult rats were bilaterally ovariectomized, followed by ovarian transplants in retroperitoneal regions. The animals were divided in four groups of five animals, according to the day of euthanasia: G4, G7, G14 and G21, corresponding to the 4th, 7th, 14th and 21st day after surgery, respectively. Vaginal smears were collected from the first day of surgery until euthanasia day. After that, the vagina and uterus were removed, fixed in 10 percent formaldehyde and submitted to histological analysis and stained with hematoxiline and eosine. RESULTS: All animals showed estrous cycle changes during the experiment. In 4th day, the uterus showed low action of estrogen with small number of mitosis and eosinophils as well as poor development. On the 7th day, the endometrium was atrophic without mitotic signals and presented a small number of eosinophils. On the 14th and 21th days the histological findings were similar, with the presence of mitosis in the endometrial glands and intense leucocyte infiltration with a large number of eosinophils. Morphometric results showed that the endometrial and myometrial thickness as well as the number of eosinophils presented the highest values during the 14th and 21th days of the evaluation. The 7th day group also presented the lowest eosinophil numbers. Vaginal epithelium features were: 4th and 7th day groups presented non-keratinized stratified epithelium with 5 and 2 cell layers, respectively. The 14th and 21st day groups presented non-keratinized stratified epithelium with 14 and 15 cell layers. CONCLUSION: Experimental ovarian autografts in the evaluated organs presented maximum estrogen activity after the 21st day of surgery, according to morphological and morphometric data.

OBJETIVO: Avaliar morfologicamente a atividade estrogênica no útero e vagina de ratas submetidas a transplante autólogo de ovário. MÉTODOS: Foram utilizadas 20 ratas adultas, Wistar EPM-1, submetidas à ooforectomia bilateral seguida de transplante de ovário em retroperitônio, distribuídas em grupos, conforme a data pré-estabelecida para eutanásia, com cinco animais cada: G4, G7, G14 e G21 - eutanásia no 4º, 7º, 14º e 21º dia de pós-operatório, respectivamente. No 1º dia após a cirurgia foi iniciada coleta de esfregaço vaginal diariamente até o dia pré-estabelecido para eutanásia. Após a eutanásia foi realizada exérese em bloco da vagina e útero, que foram fixados em formol 10 por cento para processamento histológico e coloração pela Hematoxilina-Eosina. RESULTADOS: Todos os animais mostraram alterações do ciclo estral no decorrer dos dias do experimento. No 4º dia, o útero mostrava sinais de baixa atividade estrogênica, o endométrio apresentava poucas figuras de mitose, pouco desenvolvimento e pequena quantidade de eosinófilos. Já no 7º dia, o endométrio encontrava-se atrofiado, sem atividade mitótica e com raros eosinófilos. No 14º e 21º dias os achados foram semelhantes, com presença de mitose nas glândulas endometriais e intenso infiltrado leucocitário, com predomínio de eosinófilos. Os resultados da morfometria mostraram que tanto as espessuras endometrial e miometrial quanto o número de eosinófilos foram maiores no 14º e 21º dias de avaliação, com menores valores no 7º dia. As características do epitélio vaginal foram: epitélio pavimentoso não queratinizado no 4º e 7º (com cerca de cinco e duas camadas celulares, respectivamente) e pavimentoso queratinizado em no 14º e 21º dias (com cerca de 14 e 15 camadas celulares, respectivamente) CONCLUSÃO: O transplante experimental autólogo de ovário manteve a atividade estrogênica nos órgãos avaliados, com atividade estrogênica máxima ao final de 21 dias, conforme parâmetros morfológicos...

Idiopathic ovarian vein thrombosis

Ovarian vein thrombosis [OVT] is mainly associated with the puerperium or with gynaecological surgery. OVT can be seen as a complication of pelvic inflammatory disease. It may also be seen in cases of coagulation disorders. We present an idiopathic case of OVT with no definite precipitating aetiology. Prompt recognition of this condition on imaging is important for guiding proper clinical management