Hernia útero inguinal derecha atascada en mujer en edad fértil: reporte de un caso / Incarcerated right utero inguinal hernia in a woman of reproductive age: case report

Resumen Introducción: La hernia de pared abdominal es una patología habitual; la presentación más frecuente es de tipo inguinal, cercano a un 70% del total. La incidencia de un saco herniario inguinal conteniendo ovarios y trompas de Falopio, es un hecho reportado en 2,9% de los casos. Caso clínico: Se presenta una paciente, sexo femenino, de 42 años de edad, con historia de hernia inguinal derecha de larga data, ingresa por aumento de volumen doloroso e irreductible, en región inguinal derecha, no impresiona estrangulada; ingresa a pabellón de urgencia. Dentro de los hallazgos quirúrgicos destacan saco herniario que contiene útero y ambos ovarios, sin compromiso vascular. Paciente evoluciona de forma favorable egresando 2 días posterior a la cirugía.

Introduction: Abdominal wall hernia is a frequent pathology, the most frequent hernia are the inguinal type, closed to 70% of all. Although the incidence of inguinal hernial sac containing ovary and Fallopian tubes are reported on a 2.9% of the cases. Case Report: Female patient 42 years old, with a long-term history of right inguinal hernia, with sudden pain and irreducible increase of volume in the correspondent inguinal zone that doesn't look strangled; she was admitted to the emergency operating room. Among surgical findings hernia's sac content was uterus and both ovaries with no signs of vascular compromise. The patient's favorable evolved let her to be discharged from the hospital after 2 days from post operative care

Prevalência de fatores associados à infertilidade em mulheres inférteis submetidas à laparoscopia diagnóstica / Prevalence of factors associated with infertility in infertile women undergoing diagnostic laparoscopy

Objetivo: Analisar o papel da laparoscopia na investigação da infertilidade nos últimos cinco anos na Universidade Estadual de Campinas. Métodos: Estudo retrospectivo descritivo com todas as videolaparoscopias para o diagnóstico da infertilidade feitas de 2008 a 2012 na Universidade Estadual de Campinas. Foram analisados 353 prontuários de mulheres com infertilidade submetidas à laparoscopia diagnóstica. Foram avaliadas as características clínicas dessas mulheres e os achados intraoperatórios. Foi feita uma análise univariada de frequência, médias e desvio padrão para cada uma das variáveis e para avaliar as associações entre as variáveis foi usado o teste de Kruskal-Wallis. Resultados: A média de idade das mulheres com infertilidade foi de 32 ± 4,4 anos. A laparoscopia encontrou 52,98% de alterac¸ões tubárias, 17,84% de endometriose e 11,33% de aderências. Quase 18% dos exames não apresentaram qualquer tipo de alteração. A histerossalpingografia apresentou sensibilidade de 84,61% e especificidade de 32,58% em relação à laparoscopia. As mulheres com infertilidade apresentaram maior risco de ter alterações tubárias. Conclusão: As alterações tubárias são ainda a principal causa de infertilidade. A laparoscopia se mostra como uma técnica melhor do que a histerossalpingografia para detecção de alterações tubárias, além de permitir detectar alterações em outros órgãos que possam causar infertilidade.(AU)

Objective: To evaluate the role of laparoscopy in the investigation of infertility at the University of Campinas in the last five years. Methods: Retrospective descriptive study with all diagnostic laparoscopy in the last five years made in endoscopic gynecology clinic of the tertiary hospital. 353 medical records of women with infertility undergoing diagnostic laparoscopy between the years 2008 to 2012 were analyzed the clinical characteristics of these women and the indications of laparoscopy and intraoperative findings were evaluated. Descriptive analysis (frequency, mean and standard deviation) was performed for categorical variables. To evaluate the association between the variables, we used the Kruskal Wallis test. Results: The women were on average 32 ± 4.4 years. Laparoscopy found 52.98% of tubal alterations, 17.84% of endometriosis and 11.33% of adhesions. Almost 18% of tests did not show any change. The hysterosalpingography had a sensitivity of 84.61% and specificity of 32.58% compared to laparoscopy. Infertile women have a higher risk for tubal changes. Conclusion: Tubal alterations are still the leading cause of infertility. Laparoscopy appears as a better technique hysterosalpingography for detecting tubal alterations, in addition to be able to detect changes in other organs that can cause infertility.(AU)

Asociación MURCS: reporte de caso / MURCS Association: case report

La asociación MURCS (Mullerian aplasia, Renal aplasia, Cervicothoracic Somite dysplasia) (OMIM%601076) hace referencia a un conjunto de anomalías congénitas, que sin ser debidas al azar, aparecen de forma concomitante en una persona. Se caracteriza por una aplasia Mülleriana, aplasia renal y displasia cérvico-torácica provocadas por alteraciones en los somitas correspondientes, es de etiología heterogénea. Se presenta el caso de una paciente de 9 años de edad, que es diagnosticada con la asociación MURCS, por presentar agenesia uterina, hipoplasia y ectopia renal unilateral y malformación de la 5ta vértebra cervical. Se enfatiza en la importancia de la búsqueda activa de las otras anomalías diferentes a las Müllerianas para lograr el diagnóstico y realizar un manejo integral e interdisciplinario.

The MURCS association (Mullerian aplasia, renal aplasia, Cervicothoracic Somite dysplasia) (OMIM%601076) refers to a set of congenital abnormalities, without being due to chance, they appear concomitantly in a person. It is characterized by Müllerian aplasia, renal aplasia and cervicothoracic dysplasia caused by alterations in the corresponding somites. We describe a case report of a 9-year-old female, who is diagnosed with MURCS association, to present uterine agenesis, hypoplasia and unilateral renal ectopia and deformity of the 5th cervical vertebra. We emphasize the importance of interdisciplinary care, including a clinical geneticist in the care of patients with these characteristics.

Acute labio-scrotal pain in a patient with ovotesticular syndrome. Case report.

Ovotesticular syndrome (OTS) belongs to the group of disorders of sex development (DSD). We present a case of a patient with OTS presenting with acute labioscrotal pain. A surgical exploration was indicated, and hemorrhage was identified. A gonadectomy was performed and the final pathology report revealed an ovotestis with a bleeding follicle, normal ovarian parenchyma and atrophic testicular parenchyma. After reviewing the literature there is scarce information on this complex topic, but conservative management could be an option if the risk of a gonadal malignancy is low.

Unilateral ovarian absence in two capuchin monkeys.

BACKGROUND: Ovarian absence is a rare condition with congenital or traumatic origin. METHODS: Gross and microscopic examination of two capuchin monkeys were performed. RESULTS: Case 1 had absence of the right ovary and distal uterine tube, bilateral absence of fimbriae, and a rudimentary uterus. Case 2 had unilateral ovarian absence, but a functional contralateral ovary, and a normal uterus. CONCLUSIONS: Unilateral ovarian absence was confirmed in two capuchin monkeys for the first time.

Persistent müllerian duct syndrome and prostate cancer.

A localized Gleason score 6 (3 + 3) prostate cancer was found in a 56-year-old man with bilateral cryptorchidism. Radical laparoscopic prostatectomy was performed. However, at the beginning of the procedure, a uterus, two fallopian tubes, and two intra-abdominal gonads were endoscopically identified. The müllerian rests were excised and the gonads biopsied. The histologic examination showed testicular tissue. The association of prostate cancer and persistent müllerian duct syndrome to our knowledge has not previously been reported. Prostate cancer is an androgen-dependent neoplasm, and patients with male pseudohermaphroditism have poor androgen production that should provide protection against it.

Evaluación diagnóstica mediante R. M. I. de las malformaciones m³llerianas / Diagnostic evaluation of the m³llerian malformations by means of nuclear magnetic resonance

Objetivos: Analizar el uso de la Resonancia Magnética Nuclear (N.M.R.) en la evaluación de las malformaciones M³llerianas, malformaciones total o parcialmente obstructivas, y en las patologías asociadas. Material y métodos: Se estudiaron diez adolescentes (edad promedio 16.5 años con un rango entre los 13 y 21) que consultaron al Programa de Adolescencia del Hospital de Clínicas en el período entre el 1 de junio de 1995 y 31 de mayo de 1998, con diagnóstico prsuntivo de malformación M³lleriana. Se le efectuó a cada paciente: anamnesis, exámen físico, ecografía ginecológica y renal, y N.M.R. pelviana sin contraste. En algunas situaciones se utilizó vaginoscopía así como tacto bajo anestesia y laparoscopía. Resultados: Utilizamos la modificación de J. Rock a la clasificación de la Sociedad Americana de Fertilidad (A.F.S.). 1) 3 pacientes con disgenesia del conducto de M³ller (Síndrome de Mayer-Rokitansky-Kuster-Hauser). 2) 3 pacientes con anomalías de la fusión lateral del conducto de M³ller. 3) 4 pacientes con anomalías de la fusión vertical del conducto de M³ller. Las complicaciones asociadas fueron: 4 hematometras, 2 hematosalpinx, 1 piosalpinx, 1 piocolpos. También se diagnosticaron 6 agenesias renales unilaterales. Conclusiones: La N.M.R. fue muy útil para realizar diagnósticos diferenciales en los distintos tipos de malformaciones complejas del conducto de M³ller (AU)

Abdome agudo em ginecologia / Acute abdomen in gyncology

O objetivo deste trabalho é revisar as três principais causas do abdome agudo em ginecologia que säo a doença inflamatória pélvica, prenhez ectópica e a torçäo anexial, abordando aspectos epidemiológicos, diagnósticos e terapêuticos

Alteraçöes morfológicas em útero, tubas e ovários de égua. I. Cistos endometriais / Morphological changes in the uterus, tubes and ovarian in mares. I. Endometrial cysts

Em 160 éguas näo gestantes, com idade de dois a 21 anos e abatidas em matadouros, diagnosticaram-se macroscopicamente e microscopicamente 24 (15 por cento) casos de cistos endometriais. Todos eram de origem linfática, mais frequentes nas éguas velhas e comumente associados à endometrite crônica ou à lacunas linfáticas

Malformaçöes das trompas de falópio e infertilidade: aspectos videolaparoscópicos / Fallopian tube malformation and infertility: videolaparoscopic aspects

Esta pesquisa vem abordar as malformaçöes das trompas de Fallópio, sob o ponto de vista embriológico, funcional e sua possível relaçäo com a infertilidade. Ao mesmo tempo analisa a avaliaçäo videolaparoscópica de 51 mulheres inférteis e seus achados, dando ênfase para a anomalia e sua abordagem diagnóstica e terapêutica.

Hernia uteroinguinal / Utero-inguinal hernia

Se describe el caso de un varón de 10 años de edad, operado por hernia inguinal izquierda, que, aparentemente, contenía rudimentos de trompa de Falopio y útero, a los 4 años. Su cromatina sexual, corpúsculo Y y cariotipo correspondían al genotipo masculino. Las concentraciones séricas de testosterona, basales y después de estímulo con gonadotrofina coriónica humana eran normales. En una segunda laparotomía exploradora se encontraron dos testículos, conductos deferentes y estructuras Müllerianas (útero rudimentario y dos trompas de Falopio), lo que sugiere que se trata de hernia uteroinguinalis por un defecto en la secreción o acción del factor inhibidor Mülleriano

[Utero-inguinal hernia]. / Hernia uteroinguinal.

A ten year old boy was operated for left inguinal hernia at age four years. Male gender was confirmed by sex chromatin. Y corpuscle and male genotype in chromosomal studies, and testicular function was tested by normal testosterone serum levels before and after parenteral human chorionic gonadotropin stimulus. On a second operation, two structurally normal testes and was deferens coexisted with Müllerian structures (rudimentary uterus and two Fallopian tubes of normal histological features) were found. A diagnosis of uterus-inguinalis hernia was made. Deficiencies at Müllerian inhibiting factor's secretion, activity or receptors have been postulated to explain this anomaly.

Incomplete regression of müllerian ducts in the androgen insensitivity syndrome.

The biochemical and histological features of two related patients with the complete form of the androgen insensitivity syndrome (AIS) coexisting with incomplete regression of the Müllerian ducts are described. Both patients presented unilateral Müllerian derivatives (fallopian tube) identified by microscopic examination of surgically excised internal genital tissue. Biochemical studies performed in genital skin-derived fibroblasts from one of the affected subjects showed the existence of a specific and saturable 8.2 to 8.4 S cytosolic and 3.4 S nuclear androgen receptor exhibiting a Kd of 1.32 nmol/L. These mutant cells, however, clearly presented a significantly low maximal nuclear [3H]-5 alpha-dihydrotestosterone uptake (71.0 fmol/mg of deoxyribonucleic acid [DNA]; control strain, 284 fmol/mg DNA). Thus, an impaired uptake of the androgen receptor complex at the nuclear level was probably the cause of the complete absence of phenotypic expression of androgen action in this family. The overall findings are on line with the well-demonstrated genetic and molecular heterogeneity of the AIS.