Hysteroscopic Findings Related with the Assessment and Treatment of Uterine Florid Cystic Endosalpingiosis: A Case Report and Review of All the Published Cases.

INTRODUCTION: Endosalpingiosis is a rare benign condition characterized by the presence of tubal epithelium outside the Fallopian tube. The clinical presentation of endosalpingiosis is nonspecific, and the diagnosis is typically incidental in women undergoing surgery for pelvic pain, infertility, urinary symptoms, or a pelvic mass. It can only be confirmed with histopathological examination. CASE REPORT: We report the first case of uterine florid cystic endosalpingiosis, with unusual hysteroscopic findings. We reviewed all the published cases of uterine florid cystic endosalpingiosis and their clinical presentation including hysteroscopic characteristics. It is a rare benign condition, with only 32 cases described in the literature. This is the first hysteroscopic description of this condition to be made. DISCUSSION: The patient first underwent a hysteroscopy and a leiomyoma resection when she was 51 years old. At 55, she went through another hysteroscopy, and a polypoid lesion was excised. A third hysteroscopy, one year later, revealed a new polypoid lesion in a similar location. After the initial incisions, this polypoid lesion disappeared. By decreasing the intrauterine pressure, it became visible again, corresponding histologically to an endometrial polyp with tubal metaplasia. At last, she underwent a laparoscopic hysterectomy with a final histopathological diagnosis of uterine florid cystic endosalpingiosis. CONCLUSION: Florid cystic endosalpingiosis is a rare condition that may be associated with several bizarre hysteroscopic findings.

Introdução: A endossalpingiose é uma condição benigna rara caracterizada pela presença de epitélio tubário fora da trompa de Falópio. A apresentação clínica da endossalpingiose é inespecífica e o diagnóstico é geralmente incidental em mulheres submetidas a cirurgia por dor pélvica, infertilidade, sintomas urinários ou massa pélvica. O diagnostico só pode ser confirmado com exame histopatológico. Caso Clínico: Relatamos o primeiro caso de endosalpingiose cística florida uterina, no qual se encontrou achados histeroscópicos incomuns. Foram revistos todos os casos publicados de endosalpingiose cística florida uterina e suas apresentações clínicas, incluindo características histeroscópicas. Trata-se de uma condição benigna rara, com apenas 32 casos descritos na literatura. Apresentamos a primeira descrição histeroscópica desta patologia. Discussão: A doente foi submetida a uma primeira histeroscopia e resseção de leiomioma aos 51 anos de idade. Com 55, realizou uma nova histeroscopia e removeu uma lesão polipóide. Uma terceira histeroscopia, um ano depois, revelou uma nova lesão polipóide num local semelhante. Após as incisões iniciais, essa lesão polipóide desapareceu. Ao diminuir a pressão intrauterina, tornou-se visível novamente, correspondendo histologicamente a um pólipo endometrial com metaplasia tubária. A doente foi submetida a uma histerectomia laparoscópica com diagnóstico histopatológico final de endosalpingiose cística florida uterina. Foram revistos todos os casos publicados de endosalpingiose cística florida uterina e suas apresentações clínicas, incluindo características histeroscópicas. Conclusão: A endosalpingiose cística florida uterina é uma condição rara que pode estar associada a achados histeroscópicos bizarros.

Oophoropexy to the round ligament after recurrent adnexal torsion / Ooforopexia ao ligamento redondo em um caso de torção anexial recorrente

Abstract Recurrent adnexal torsion is a rare gynecological emergency. We report a case of recurrent ipsilateral adnexal torsion in a woman with polycystic ovaries, previously submitted to a laparoscopic plication of the utero-ovarian ligament. Due to the recurrence after the plication of the utero-ovarian ligament, the authors performed a laparoscopic oophoropexy to the round ligament, which is an underreported procedure. The patient was asymptomatic for 1 year, after which she had a new recurrence and needed a unilateral laparoscopic adnexectomy. Since then, she regained the quality of life without any gynecological symptoms. Oophoropexy to the round ligament may be considered when other techniques fail or, perhaps, as a first option in selected cases of adnexal torsion, as it may allow the prevention of recurrence without increasing morbidity while preserving the adnexa.

Resumo A torção anexial recorrente é uma emergência ginecológica rara. Os autores descrevem um caso de torsão anexial unilateral recorrente em uma paciente com síndrome de ovário policístico, previamente submetida a plicatura do ligamento utero-ovárico por laparoscopia. Nesta circunstância, os autores decidiram realizar uma ooforopexia laparoscópica ao ligamento redondo, uma técnica pouco descrita na literatura. A paciente manteve-se assintomática durante 1 ano, período após o qual teve nova recorrência, tendo-se decidido realizar uma anexectomia laparoscópica unilateral. Desde então, ela recuperou a qualidade de vida sem qualquer sintoma ginecológico. A ooforopexia ao ligamento redondo é uma técnica que deverá ser considerada quando outras falham e, em casos selecionados de torsão anexial recorrente, poderá ser considerada a primeira abordagem, para prevenir a recorrência e preservar o anexo.

Oophoropexy to the Round Ligament after Recurrent Adnexal Torsion.

Recurrent adnexal torsion is a rare gynecological emergency. We report a case of recurrent ipsilateral adnexal torsion in a woman with polycystic ovaries, previously submitted to a laparoscopic plication of the utero-ovarian ligament. Due to the recurrence after the plication of the utero-ovarian ligament, the authors performed a laparoscopic oophoropexy to the round ligament, which is an underreported procedure. The patient was asymptomatic for 1 year, after which she had a new recurrence and needed a unilateral laparoscopic adnexectomy. Since then, she regained the quality of life without any gynecological symptoms.Oophoropexy to the round ligament may be considered when other techniques fail or, perhaps, as a first option in selected cases of adnexal torsion, as it may allow the prevention of recurrence without increasing morbidity while preserving the adnexa.

A torção anexial recorrente é uma emergência ginecológica rara. Os autores descrevem um caso de torsão anexial unilateral recorrente em uma paciente com síndrome de ovário policístico, previamente submetida a plicatura do ligamento utero-ovárico por laparoscopia. Nesta circunstância, os autores decidiram realizar uma ooforopexia laparoscópica ao ligamento redondo, uma técnica pouco descrita na literatura. A paciente manteve-se assintomática durante 1 ano, período após o qual teve nova recorrência, tendo-se decidido realizar uma anexectomia laparoscópica unilateral. Desde então, ela recuperou a qualidade de vida sem qualquer sintoma ginecológico.A ooforopexia ao ligamento redondo é uma técnica que deverá ser considerada quando outras falham e, em casos selecionados de torsão anexial recorrente, poderá ser considerada a primeira abordagem, para prevenir a recorrência e preservar o anexo.

Uterine compression sutures for postpartum hemorrhage: is routine postoperative cavity evaluation needed?

Postpartum hemorrhage due to uterine atony continues to be one of the major causes of maternal morbidity and mortality. Several uterine compression suture techniques have been described and are increasingly being used worldwide as a conservative approach. However, little is known about the long-term effects on the uterine cavity, as well as fertility and pregnancy outcomes. We reviewed the reported complications and uterine findings after the use of compression sutures, both in examinations to evaluate the cavity (hysteroscopy, hysterosalpingography or sonohysterography) and at cesarean section, in order to assess the possible usefulness of routine postoperative cavity evaluation. Overall, the use of uterine compression sutures is effective and safe; however, some severe and potentially life-threatening complications have been reported and could possibly have been prevented if uterine cavity evaluation had been performed. Routine follow-up, both by hysteroscopy and an imaging technique, seems worthwhile.

[Management of menopause in primary health care]. / Abordagem da menopausa nos cuidados de saúde primários.

INTRODUCTION: Menopause is a biological process that occurs as part of aging in women. The increase in average life expectancy and the decline in mortality have caused the aging of global population and, currently, women live about a third of their life in postmenopausal. The General Physician (GP) is usually the first health professional whom women rely on to relieve their menopause symptoms. It is essential for the GP to know how to properly approach women at this stage of their life and how to provide them the best support. OBJECTIVES: To evaluate women in perimenopause and postmenopausal, to recognize its signs and symptoms, and to use properly the Hormone Replacement Therapy (HRT) in Primary Health Care (PHC). METHODS: We performed a literature search in the PubMed database using the MeSH terms: Menopause, Hormone Replacement Therapy, Primary Health Care. The search was limited to articles published between January 2000 and March 2009 in English, Portuguese and Spanish. Recommendations from Scientific Societies were also searched. RESULTS: During menopause women are more predisposed to change their habits and to adopt healthy lifestyles. The GP plays a key role in health promotion among these women. The most common complaints that lead women to the PHC during perimenopause are vasomotor symptoms, sleep disorders, weight gain, uterine bleeding, urogenital and sexual changes and disturbances of mood and memory. The use of HRT is only recommended for the control of severe vasomotor symptoms that affect women's quality of life, as well as for vaginal atrophy and urinary symptoms. It should be used for a short period of time and in the lowest dose. It is important for the GP to know the existing formulations, the way of administration and the correct monitoring of this therapy. CONCLUSION: Women experience physical and psychological changes during perimenopause and postmenopausal, resulting from aging and hypoestrogenism. It is essential that the GP recognizes the symptoms and their impact on quality of life of women, offering treatment when necessary. The HRT and its follow-up can be performed in PHC, if the GP know how to use this type of treatment.