Rol de la imagenología en el proceso diagnóstico de la patología ginecológica benigna

En la actualidad, la selección y uso correcto de los diferentes métodos de imágenes disponibles (ecografía, tomografía axial computada y resonancia magnética) constituye uno de los pilares fundamentales para el adecuado proceso diagnóstico en ginecología. Para la mayoría de las patologías benignas que comprometen al aparato genital femenino, la ecografía transvaginal es una herramienta sensible, de fácil acceso, costo-efectiva y por tanto debiese constituir el método inicial de elección. Sin embargo, su eficacia depende de que el operador sea entrenado y experimentado en su interpretación. El uso de la tomografía computada (TC) y la resonancia magnética (RM) debiese restringirse a condiciones específicas, en especial para caracterizar lesiones que no son completamente evaluables por ultrasonido. La mayor utilidad de la TC está en el diagnóstico diferencial de las urgencias ginecológicas, en evaluar el compromiso extra pelviano de neoplasias anexiales y en el estudio preoperatorio de anomalías de la vía urinaria. Respecto de la RM, su mayor utilidad está en el estudio de lesiones anexiales complejas a la ultrasonografía, endometriosis pélvica profunda y extra pelviana, adenomiosis, malformaciones uterinas, etapificación local de neoplasias endometriales, cervicales y vaginales, y en la evaluación de miomas múltiples o extra pelvianos.

In gynecology, the selection and proper use of the different available imaging methods (ultrasound, computed tomography and magnetic resonance) is paramount for a proper diagnostic process. For most benign conditions affecting the female genital tract, transvaginal ultrasound constitutes an exam with has excellent sensitive, is readily accessible and cost-effective, therefore being the initial method of choice. However, its effectiveness depends on the operator training and expertise in interpretation. The use of computed tomography (CT) and magnetic resonance imaging (MRI) ought to be restricted for specific conditions, especially to characterize lesions not completely evaluated by ultrasound. The main benefit of CT is in the differential diagnosis of gynecological emergencies, in assessing extra pelvic extension of adnexal masses and in the preoperative assessment of urinary tract abnormalities. Regarding MRI it is most useful in the study of complex adnexal lesions, extra pelvic and deep pelvic endometriosis, adenomyosis, uterine malformations, local staging of endometrial, cervical and vaginal neoplasms, and multiple or extra pelvic leiomyomas.

Intratracheal infection as an efficient route for testing vaccines against Chlamydia abortus in sheep.

Pregnant ewes have been widely used to test vaccines against Chlamydia abortus. However, this model entails many disadvantages such as high economic costs and long periods of pregnancy. The murine model is very useful for specific studies but cannot replace the natural host for the later stages of vaccine evaluation. Therefore, a non-pregnant model of the natural host might be useful for a vaccine trial to select the best vaccine candidates prior to use of the pregnant model. With this aim, two routes of infection were assessed in young non-pregnant sheep, namely, intranasal (IN) and intratracheal (IT). In addition, groups of non-vaccinated sheep and sheep immunised with an inactivated vaccine were established to investigate the suitability of the model for testing vaccines. After the experimental infection, isolation of the microorganism in several organs, with pathological and immunohistochemical analyses, antibody production assessment and investigation by PCR of the presence of chlamydia in the vagina or rectum were carried out. Experimental IT inoculation of C. abortus induced pneumonia in sheep during the first few days post-infection, confirming the suitability of the IT route for testing vaccines in the natural host. The course of infection and the resulting pathological signs were less severe in vaccinated sheep compared with non-vaccinated animals, demonstrating the success of vaccination. IN infection did not produce evident lesions or demonstrate the presence of chlamydial antigen in the lungs and cannot be considered an appropriate model for testing vaccines.

Capacidad diagnóstica de la ecografía para detectar cáncer de endometrio en mujeres posmenopaúsicas sintomáticas y asintomáticas: experiencia de la universidad católica de chile / Diagnostic capability of ultrasound to detect endometrial cancer in postmenopausal women: experience of the catholic university of chile

Antecedentes: El 10 por ciento de las mujeres postmenopáusicas con sangrado uterino anormal (SUA) tendrán cáncer de endometrio. Se recomienda efectuar una biopsia endometrial en toda mujer postmenopáusica con SUA y grosor endometrial ecográfico >5 mm. Estudios recientes sugieren que el uso de un valor menor (3 mm) mejora la capacidad diagnóstica de la ecografía. En mujeres postmenopáusicas asintomáticas se ha sugerido efectuar biopsia endometrial si se detecta un endometrio >11mm. Objetivo: Determinar la capacidad diagnóstica de la ecografía para detectar cáncer de endometrio, utilizando los valores de corte de 3 y 5 mm en mujeres posmenopáusicas sintomáticas y de 11 mm en mujeres postmenopáusicas asintomáticas. Método: Revisión retrospectiva de biopsias de endometrio e historia clínica de mujeres atendidas en la Red de Salud UC (2007-2012). Resultados: Se analizó 132 casos, 63,6 por ciento presentaron SUA. Hubo 17 casos de cáncer de endometrio (12,9 por ciento), con un grosor endometrial promedio de 18 mm, el 8 por ciento presentó SUA. En mujeres sintomáticas la sensibilidad para el diagnóstico de cáncer de endometrio fue de 100 por ciento y de 93 por ciento para valores de corte 3 y 5 mm respectivamente. En mujeres asintomáticas, el punto de corte 11 mm, tuvo una sensibilidad de 50 por ciento y una especificidad de 65 por ciento para el diagnóstico de cáncer de endometrio. Conclusión: Recomendamos efectuar biopsia endometrial a toda mujer postmenopáusica con SUA y endometrio >3 mm. En postmenopáusicas sin SUA, no recomendamos la evaluación ecográfica endometrial de rutina.

Introduction: 10 percent of postmenopausal women with abnormal uterine bleeding (AUB) have endometrial cancer. Endometrial biopsy is recommended in all postmenopausal women with AUB and endometrial thickness >5 mm on ultrasound. Recent studies suggest that the use of a lower value (3 mm) improves the ability of ultrasound to detect endometrial cancer. In asymptomatic postmenopausal women, endometrial biopsy is recommended if the endometrial thickness is >11mm. Objective: To determine the diagnostic accuracy of ultrasound for detecting endometrial cancer, using a cutoff value of 3 and 5 mm in symptomatic and 11 mm in asymptomatic postmenopausal women. Methods: Retrospective review of endometrial biopsies and clinical history of women attending UC Health Network (2007-2012). Results: 132 cases were analyzed, 63.6 percent had AUB. There were 17 cases of endometrial cancer (12.9 percent), with a mean endometrial thickness of 18 mm. 88 percent of women with endometrial cancer had SUA. In symptomatic women the sensitivity for the diagnosis of endometrial cancer was 100 percent and 93 percent using a cutoff value of 3 and 5 mm respectively. In asymptomatic women, the cutoff value of 11 mm, had a sensitivity of 50 percent and a specificity of 65 percent for endometrial cancer. Conclusion: We recommend endometrial biopsy in all postmenopausal women with AUB and endometrial thickness >3 mm. In postmenopausal women without AUB we do not recommend routine endometrial ultrasound evaluation.

Pólipo endometrial, una causa infrecuente de sangrado genital anormal en la adolescencia / Endometrial polyp, a rare cause of abnormal genital bleeding in adolescence

Antecedentes: El sangrado genital anormal es una causa frecuente de consulta en la adolescencia. En este período, la principal causa de sangrado es la metrorragia asociada a ciclos anovulatorios producto de la inmadurez del eje hipotálamo-hipofisario-gonadal. Dentro de las causas infrecuentes de sangrado genital anormal en ese período está el pólipo endometrial. Caso clínico: Presentamos el caso de una niña de 13 años cuya causa de sangrado correspondió a un pólipo endometrial, sospechado por ultrasonografía, resecado mediante histeroscopia y confirmado mediante estudio histológico. Discusión: Pese a su baja incidencia, los pólipos endometriales deben ser considerados como parte del diagnóstico diferencial en adolescentes que consultan por trastorno menstrual, particularmente en aquellos casos sin respuesta a la terapia hormonal y donde la ultrasonografía muestra engrosamiento endometrial.

Background: Abnormal genital bleeding is a common cause of medical consultation in patients during adolescence. In this period, the main cause of genital bleeding is metrorrhagia in relation to anovulatory cycles due to immaturity of hypothalamus- pituitary-gonadal axis. Among the uncommon causes of bleeding at this age is the endometrial polyp. Case report: We report a 13 year old girl with abnormal uterine bleeding due to endometrial polyp, suspected during a pelvic ultrasound, removed by hysteroscopy, and confirmed by histological analysis. Discussion: Despite its low incidence, endometrial polyps should be included in the differential diagnosis of adolescents presenting menstrual disorders, particularly in those with no response to hormonal therapy and endometrial thickness in ultrasound.

[Effects of statins in cancer]. / Efectos de las estatinas en cáncer: ¿potencial rol en terapéutica y prevención?

This review explores the evidence supporting a potential benefit of statins in cancer. In particular, the lipophilic forms (i.e. lovastatin, simvastatin, or similar) would have a therapeutic but not a preventive role. The pleiotropic effects that statins possess mainly explain this phenomenon, influencing the natural history of disease and the response to currently available therapies. By inhibiting the mevalonate pathway, statins would have a systemic effect, similar to that observed in atherosclerosis, reducing the inflammatory stimuli present in the tumor micro-environment and inhibiting the activation of intracellular signaling cascades critical for proliferation, migration/invasion and metastasis of the cancer cell. Despite all this evidence, randomized trials are needed to confirm the benefit of statins on cancer, before promoting their widespread use as a therapeutic or preventive strategy for this condition.

Efectos de las estatinas en cáncer: ¿potencial rol en terapéutica y prevención? / Effects of statins in cancer

This review explores the evidence supporting a potential benefit of statins in cancer. In particular, the lipophilic forms (i.e. lovastatin, simvastatin, or similar) would have a therapeutic but not a preventive role. The pleiotropic effects that statins possess mainly explain this phenomenon, influencing the natural history of disease and the response to currently available therapies. By inhibiting the mevalonate pathway, statins would have a systemic effect, similar to that observed in atherosclerosis, reducing the inflammatory stimuli present in the tumor micro-environment and inhibiting the activation of intracellular signaling cascades critical for proliferation, migration/invasion and metastasis of the cancer cell. Despite all this evidence, randomized trials are needed to confirm the benefit of statins on cancer, before promoting their widespread use as a therapeutic or preventive strategy for this condition.

IFN-γ expression in placenta is associated to resistance to Chlamydia abortus after intragastric infection.

Intragastric infection mimics the natural route of infection of Chlamydia abortus (etiological agent of ovine enzootic abortion). In the mouse model, intragastric experimental infection induces very mild signs of infection followed by late term abortions, as it is shown by the natural ovine host. In order to evaluate the immune mechanisms associated to the dissemination of the pathogen from the gastrointestinal tract, we have administered an intragastric dose of C. abortus to pregnant mice. Systemic and local expression of cytokines, tissue colonization and excretion of bacteria after parturition were monitored during pregnancy. Susceptible CBA/J mice showed a higher bacterial colonization of the placenta and excretion of live bacteria after parturition that were related to a higher local IL-10 expression. By contrast, resistant C57BL/6 mouse strain had higher local IFN-γ mRNA expression in the placenta just before parturition and a transient bacterial colonization of the reproductive tract, with no excretion of C. abortus after parturition. In summary, intragastric infection not only mimics the natural route of infection of C. abortus, but can also be useful in order to understand the immunopathogenesis of chlamydial abortion in the mouse.

Colpoperineocleisis de Labhardt: una alternativa segura y eficaz para el tratamiento del prolapso genital en pacientes sin actividad sexual / Labhardt colpocleisis in the treatment of pelvic organ prolapse

Introducción: El prolapso genital impacta negativamente la calidad de vida y autoimagen de la mujer. Rutinariamente indicamos la colpoperineocleisis de Labhardt a pacientes de edad avanzada y sin actividad sexual. Objetivo: Evaluar los resultados con esta técnica e identificar posibles factores de riesgo que predigan la falla. Métodos: Análisis retrospectivo de pacientes tratadas con la técnica entre los años 2008-2010. Se realizó análisis univariado y multivariado para identificar factores de riesgo asociados a la falla y se construyeron curvas libre de falla anatómica a fin de evaluar la durabilidad. Resultados: 68 pacientes cumplieron los criterios de inclusión. La edad promedio fue 71,9 +/- 5,7 años; 95,6 por ciento fueron clasificadas en etapa III o IV según POP-Q. El tiempo operatorio fue de 54 +/- 20 minutos. Seguimiento promedio de 21 meses; la tasa de recidiva anatómica fue de 14,7 por ciento. La tasa de incontinencia de orina de esfuerzo (IOE) de novo fue de 5,9 por ciento. El análisis univariado identificó como factor predictor de recidiva el flujo vaginal posoperatorio; en análisis multivariado de Cox, esa condición mantuvo significancia estadística (OR 6,3). Se identificó como factor de riesgo el no acatamiento de la técnica quirúrgica (OR 7,2). Conclusión: La colpoperineocleisis de Labhardt es una técnica segura, con baja tasa de complicaciones, una tasa de recurrencia aceptable y baja tasa de IOE de novo. Pilar del éxito es evitar la infección y respetar la técnica quirúrgica. Es necesario estudios comparativos con otras técnicas oclusivas, como también evaluar el rol de la infección como causa de falla de la técnica.

Introduction: Genital prolapse affects up to 50 percent of multiparous women, impacting their quality of life and self-image. At our Institution Labhardt's colpoperineocleisis is usually proposed to older patients, without sexual activity, regardless the type or grade of prolapse. Objective: To evaluate the results with this technique and identify potential risk factors predicting the failure. Methods: Analysis of a retrospective cohort of patients treated with this technique between 2008 and 2010. Univariate and multivariate analysis were carried out to identify risk factors and failure-free curves were built to estimate durability. Results: 68 patients met the inclusion criteria. Average age was 71.9 +/- 5.7 years; 95.6 percent of patients were classified as stage III or IV based on POP-Q system. Operative time was 54 +/- 20 min. At 21 months of follow-up, recurrence rate was 14.7 percent. De novo stress urine incontinence (SUI) was diagnosed in 5.9 percent of patients. In univariate analysis, post operative vaginal discharge was identified as predicting factor for defect recurrence. In Cox analysis, this condition remained significant (OR 6.3), In addition, failure to observe the surgical technique was also identified as risk factor for defect recurrence (OR 7.2). Conclusion: Labhardt 's colpoperineocleisis is a safe technique, with low complication rate, acceptable recurrence rate, and low de novo SUI rate. Mainstay for success is to avoid infection and observe the surgical technique. Comparative studies with other occlusive techniques might be carried out, as well as exploring the role of infection as predisposing condition for failure.

Hiperandrogenismo avanzado en una mujer postmenopáusica: Caso clínico / Virilization caused by an ovarian tumor: Report of one case

We report a 76-year-old woman with a virilization syndrome characterized by progressive androgenic alopecia, clitoris enlargement and hirsutism predominating in the face. Plasma testosterone was 711 ng/dl. Magnetic resonance imaging showed slightly enlarged ovaries with a cyst in the left. A bilateral oophorectomy was performed, demonstrating the presence of a Leydig cell hilar tumor in the right ovary. The patient had a good postoperative evolution with reduction of androgen levels and reversion of alopecia.

[Virilization caused by an ovarian tumor. Report of one case]. / Hiperandrogenismo avanzado en una mujer postmenopáusica. Caso clínico.

We report a 76-year-old woman with a virilization syndrome characterized by progressive androgenic alopecia, clitoris enlargement and hirsutism predominating in the face. Plasma testosterone was 711 ng/dl. Magnetic resonance imaging showed slightly enlarged ovaries with a cyst in the left. A bilateral oophorectomy was performed, demonstrating the presence of a Leydig cell hilar tumor in the right ovary. The patient had a good postoperative evolution with reduction of androgen levels and reversion of alopecia.

Manejo conservador de la torsión anexial: ¿una alternativa o una obligación frente a un posible error de apreciación por parte del cirujano? / Conservative management of adnexal torsion

Antecedentes: La torsión anexial es una complicación frecuente en ginecología que motiva una cirugía de urgencia y muchas veces conlleva la anexectomía como tratamiento basado en la impresión visual cirujano. Objetivo: Evaluar la contabilidad de la impresión visual del cirujano para la toma de decisiones. Método: Se estudiaron las torsiones anexiales operadas entre enero de 2006 y julio de 2009. Se revisaron las placas de los casos sometidos a anexectomía y se determinó la presencia de compromiso vascular irreversible. Se correlacionó la impresión visual del cirujano con la del patólogo usando la biopsia como estándar dorado. Resultados: En el período de estudio se operaron 51 pacientes. La edad promedio fue 35,5 +/- 2 años (rango: 8-80 años). El 72,6 por ciento de los casos fue abordado por laparoscopia y en 60,7 por ciento de los casos se realizó anexectomía. En 38,7 por ciento de los casos sometidos a anexectomía se demostró en la biopsia un infarto hemorrágico masivo. A mayor intervalo de tiempo entre diagnóstico y cirugía, mayor fue la probabilidad de compromiso vascular (regresión logística, p<0,01). La concordancia entre la impresión del cirujano y del patólogo fue leve (kappa 0,2 +/- 0,16 p<0,02). La sensibilidad, especificidad, valor predictivo positivo y negativo de la impresión visual del cirujano para necrosis isquémica fueron 88,9 por ciento, 26,3 por ciento, 36,4 por ciento, 83,3 por ciento respectivamente. Conclusiones: Este estudio demuestra que la apreciación visual del cirujano es un mal predictor de daño vascular irreversible. Ante la sospecha diagnóstica de torsión debe preconizarse el abordaje quirúrgico precoz e intentar preservar el ovario.

Background: Adnexal torsion constitutes one of the major surgical emergencies in gynecology commonly leading to adnexal removal based on visual assessment of vascular damage. Aims: The goal of present study is to establish the accuracy of the surgeon's visual impression in correctly doing the decision-making. Methods: All cases of adnexal torsion undergoing surgery between January 2006 and July 2009 were recruited. A pathological review was conducted in all cases undergoing adnexal removal to assess the presence of irreversible vascular damage. A correlation was done between pathologist and surgeon assessment using pathological report as gold standard. Results: During the period of study a total of 51 patients were operated. The average age was 35.5 +/- 2 years (range: 8-80 years). The 72.6 percent of cases was approached by laparoscopy and in 60.7 percent of cases adnexal removal was done. In 38.7 percent of those cases treated with adnexal removal a massive ischemic necrosis or complete infarction was demonstrated at biopsy. As longer the time interval was between diagnosis and surgery, major the incidence was of vascular damage (log regression, p<0.01). Slight agreement was observed between surgeon and pathologist (kappa 0.2 +/- 0.16, p<0.02). Sensitivity, specificity, positive and negative predictive values for visual assessment of ischemic necrosis done by surgeon were 88.9 percent, 26.3 percent, 36.4 percent, 83.3 percent respectively. Conclusions: This study demonstrates that visual assessment has a low positive predictive value for irreversible vascular damage. In those cases with presumptive diagnosis of adnexal torsion, an early surgical approach should be prompted to preserve the adnexa.

Legumain and cathepsin-L expression in human unstable carotid plaque.

OBJECTIVE: The cysteine protease, legumain, is thought to have a role in the processing and activation of proteases such as cathepsin-L, which have been implicated in plaque rupture. This study aimed to determine: if legumain activity is up-regulated in unstable areas of plaque; the effect of legumain over-expression on the activity of cathepsin-L and the effect of mutation of the legumain RGD sequence on its cellular location. METHODS AND RESULTS: Legumain was measured in human carotid plaque extracts (n=17) using a novel ELISA and modified activity assay. Unstable regions of plaque contained more than twice the amount of legumain protein (P<0.001) and activity (P<0.03) compared with stable regions of the same plaque. Over-expression of legumain in THP-1 macrophages using an adenoviral construct resulted in the processing of cathepsin-L from its 30kDa to its 25kDa form compared with controls. CONCLUSION: Unstable regions of plaque contain increased levels of active legumain. Over-expression of legumain in macrophages alters intracellular processing of cathepsin-L to its mature 25kDa form. This may be a means by which legumain could contribute to plaque instability.

Hallazgo de fragmentos uterinos intrabdominales poshisterectomía / Intraabdominal uterine fragments after laparoscopic hysterectomy

Se presentan los casos de tres pacientes en su quinta década de vida que fueron sometidas a histerectomia por miomas uterinos sintomáticos. Caso 1: Paciente sometida a histerectomia supracervical laparoscópica. El cuerpo uterino fue extraído del abdomen mediante morcelación eléctrica. Cuatro años después presenta intenso dolor pélvico cíclico que requiere hospitalizaciones. La resonancia magnética sugiere nodulos vascularizados en pelvis. Se efectúa laparotomía diagnóstica resecándose implantes de tejido miometrial y endometrio en pelvis. Caso 2: Paciente sometida a histerectomia subtotal laparoscopica hace 12 años por miomatosis uterina. Consulta por dolor en fosa iliaca izquierda con exacerbación cólica de larga evolución. La tomografia helicoidal sin contraste (pielo TAC) muestro imagen hipodensa en fosa iliaca izquierda. Se realiza laparoscopia quirúrgica resecándose el tumor. La biopsia fue informada como muestra constituida por pared tipo corporal uterino. Caso 3: Paciente sometida a histerectomia total abdominal. Dos años después en ecotomografía vaginal de rutina se pesquisa tumor pelviano sólido de probable origen anexial izquierdo. La resonancia magnética sugiere leiomioma. La laparoscopia diagnóstica objetiva tumor sólido en relación a la cúpula vaginal compatible con mioma. Se reseca el tumor y el estudio anátomo patológico confirma el diagnóstico. Conclusión: La retención de fragmentos uterinos es una complicación infrecuente de la histerectomia supracervical laparoscópica que sería posible prevenir. La laparoscopia tiene un rol en la resolución de retención de fragmentos uterinos post histerectomia. La resonancia magnética aportó información relevante en estos casos.

We will present the cases of three patients in the fifth decade of their life, that had undergone an histerec-tomy with the diagnosis of uterine leiomyoma. Case 1: Pacient had undergone a supracevical laparocopic hysterectomy. The uterus had been extracted from the abdominal cavity by electrical morcellation. Four years after the procedure, she presents ciclic pelvic pain which requires hospitalization. The magnetic resonante suggests vascularized tumors in the pelvis. A diagnostic laparoscopy was done, removing miometrial and endometrial tissue. Case 2: Pacient had undergone a supracevical laparocopic hysterectomy twelve years ago with the diagnosis of leiomyoma. She requires medical attention because of a colic pain in the left ilac fossa. The unhenhanced helicoidal CT- Scan shows an hipodense image in the left iliac fossa. A diagnostic laparoscopy was done, removing the tumor. The biopsy showed a sample constituded of uterine corpus. Case 3: Pacient had undergone an abdominal histerectomy. Two years after the procedure, a vaginal ecotomography showed a solid pelvian tumor that was propably located in the left adnexa. The magnetic resonante suggests a leyomioma. The diagnostic laparoscopy shows a solid tumor in touch with the cúpula vaginalis, the tumor was removed. The biopsy confirms the diagnosis. Conclusion: The uterine fragments retention is an infrecuent complication of the supracervical laparoscopic hysterectomy that can be prevenible. The laparoscopy has a role in the resolution of the uterine fragments post histerectomy. The magnetic resonance contributed with relevant information in this cases.

High prevalence of antibodies against Chlamydiaceae and Chlamydophila abortus in wild ungulates using two "in house" blocking-ELISA tests.

Few data are available on the prevalence and relevance of chlamydiae in wild mammals, and even fewer studies have been conducted to determine the prevalence of Chlamydophila abortus in wildlife hosts, most probably due to the absence of suitable species-specific serological assays for testing sera from wild animals. In light of this, we have developed two in-house blocking-ELISA tests for detection of antibodies against Chlamydiaceae and C. abortus in wild ungulates, and analyzed the relationship between geographical and biological factors and the prevalence of antibodies against Chlamydiaceae and C. abortus in 434 wild ungulates from Spain, including sera from European wild boar, Red deer, Fallow deer, Roe deer, Mouflon, Barbary sheep, Southern chamois, and Iberian ibex. Serology revealed that 41.7+/-4% of the sera were positive for the b-ELISA-LPS (Chlamydiaceae-specific) and 18.9+/-3% for the b-ELISA-rPOMP (C. abortus-specific). Antibodies against Chlamydiaceae lipopolysaccharide (LPS) were detected in sera from all eight ungulate species, the prevalence ranging from 23 to 60%. Iberian ibex was the only wild ungulate not showing seropositivity to the C. abortus specific polymorphic outer membrane protein (POMP). The prevalence of anti-POMP antibodies in the other seven wild ungulate species ranged from 7 to 40%. While significant seroprevalence differences were detected among species and among sampling regions, no effect of age and sex was observed. The high prevalence levels found should be considered with regards to livestock and human health, and warrant further research.

Chlamydophila abortus infection in the mouse: a useful model of the ovine disease.

Chlamydophila (C.) abortus is an obligate intracellular bacterium able to colonize the placenta of several species of mammals, which may induce abortion in the last third of pregnancy. The infection affects mainly small ruminants resulting in major economic losses in farming industries worldwide. Furthermore, its zoonotic risk has been reported in pregnant farmers or abattoir workers. Mouse models have been widely used to study both the pathology of the disease and the role of immune cells in controlling infection. Moreover, this animal experimental model has been considered a useful tool to evaluate new vaccine candidates and adjuvants that could prevent abortion and reduce fetal death. Future studies using these models will provide and reveal information about the precise mechanisms in the immune response against C. abortus and will increase the knowledge about poorly understood issues such as chlamydial persistence.

Abordaje laparoscópico en cáncer de endometrio / Laparoscopic approach for endometrial cancer

El cáncer de endometrio es una neoplasia ginecológica relevante en todo el mundo, con cambios acelerados en su manejo. La cirugía es el tratamiento de elección, pero puede llegar a tener una alta tasa de complicaciones y retraso en el inicio de terapias adyuvantes por el trauma quirúrgico que provoca. Este artículo revisa el rol de la laparoscopia en el manejo de las pacientes con cáncer endometrial, haciendo hincapié en su seguridad oncológica, beneficios y complicaciones. Al comparar la vía clásica por laparotomía, la laparoscopia, en manos experimentadas, tiene similares resultados respecto de sobrevida, recurrencia y etapificación completa, pero con una menor tasa de complicaciones. La vía endoscópica podría ser la herramienta del futuro en el manejo del cáncer de endometrio.

Endometrial cancer is a relevant gynecologic neoplasm, with accelerated changes in its management. Surgery is the treatment of choice, but it can have a high rate of complications and delay in adjuvant therapies due to the surgical trauma that it inflicts. This article reviews the role of laparoscopy in the management of women with endometrial cancer, highlighting the oncologic safety, benefits and complications. Comparing laparotomy with laparoscopy, in experienced hands, it has the same results concerning to survival, recurrence and complete staging, with a lower rate of complications. Celioscopy could be the tool of the future in the management of endometrial cancer.

Miomectomía abdominal versus miomectomía laparoscopica: experiencia preliminar del Hospital Clínico de la Pontificia Universidad Católica de Chile / Laparoscopic versus abdominal myomectomy: initial experience of the Clinical Hospital of the Pontificia Universidad Catolica de Chile

Antecedentes: Múltiples pacientes requieren un manejo conservador del mioma uterino. Muchas de ellas no han completado su paridad, y otras no desean la remoción del útero preocupadas del impacto que esa alternativa tenga en su vida sexual. Objetivos: Evaluar nuestra experiencia en pacientes miomectomizadas mediante laparoscopia o laparotomía y revisar la literatura para definir las ventajas de cada técnica y recomendaciones para su indicación. Método: Estudio prospectivo, no randomizado, de pacientes miomectomizadas en el Servicio de Ginecología del Hospital Clínico de la Universidad Católica de Chile, durante el período noviembre de 2007 y mayo de 2008. Resultados: La población incluida fue de 43 casos; 16 casos correspondieron a miomectomía laparoscópica (37,2 por ciento) y 27 a miomectomía por laparotomía (67,8 por ciento). La miomectomía por laparotomía se realizó en 40 por ciento de los casos utilizando una incisión transversa mínima. Esta vía de abordaje fue más frecuentemente utilizada cuando se trataba de miomas de gran tamaño o de múltiples miomas. En nuestra serie, la miomectomía laparoscópica se asociaría a un menor requerimiento de analgesia. No hay diferencias en la frecuencia de complicaciones, tiempo operatorio y estadía hospitalaria entre ambas técnicas, cuando se trata de miomas operados menores de 5 cm. Conclusión: Nuestros resultados sugieren que la miomectomía por laparotomía es una técnica segura que debiese privilegiarse cuando se trata de miomas grandes y múltiples. La laparoscopia es igualmente segura reservada para casos bien seleccionados y cirujanos experimentados en el procedimiento.

Background: Multiple patients ask for a conservative management of uterine fibroids. Some of the patients have not completed their parity at the time of surgery, and others do not want a hysterectomy worried about de impact of this procedure in their sexual life. Objectives: The objective of this study was to evaluate our experience in the short term surgical results of patients undergoing a laparoscopic or abdominal myomectomy. We also did a literature review to define the advantages for each technique and their indications. Methods: A prospective, non-randomized study comparing short term surgical outcomes in patients undergoing laparoscopic versus abdominal myomectomy in the Gynecology Service of the Clinical Hospital of the Pontificia Universidad Católica de Chile, between November 2007 and May 2008. Results: Forty-three patients undergoing myomectomy in our centre were analyzed. 16 of them were approached by laparoscopy (37.2 percent) and 27 by laparotomy (67.8 percent). In 40 percent of them, abdominal myomectomy was performed using a minimal transverse incision. This approach was more frequently used when treating larger size (>5 cm) or multiple myomas. In our study, laparoscopic myomectomy was associated with less requirements of analgesia. No differences in complication rates, operative time, and hospital stay were observed between techniques in myomas smaller than 5 cm. Conclusions: Our results indicate that abdominal myomectomy is a safe technique that should be used in cases of larger size or multiple myomas. Laparoscopy is equally safe but should be reserved for well-chosen cases and performed by experienced laparoscopic surgeons.

Distribución de la patología quirúrgica del cuerpo uterino en mujeres chilenas sometidas a histerectomía en un hospital clínico universitario / Distribution of pathology in patients undergoing hysterectomy for uterine diseases in Chilean women in an academic centre

Antecedentes: La histerectomía es la cirugía ginecológica mundialmente más frecuente. Pocas series analizan la distribución de los hallazgos patológicos en histerectomizadas. Objetivos: Describir la distribución de la patología uterina originada en el endometrio, miometrio y estroma, en histerectomías efectuadas en un centro universitario. Determinar la frecuencia en que coexisten patologías, particularmente cáncer incidental en histerectomías por condiciones presuntamente benignas. Métodos: Estudio retrospectivo de todas las histerectomías efectuadas entre los años 1991 y 2005. Análisis descriptivo de la distribución de las enfermedades benignas y malignas originadas en el cuerpo uterino. Resultados: Se realizaron 5683 histerectomías. En 4275 úteros se diagnosticaron lesiones de origen no epitelial, principalmente leiomiomas uterinos y adenomiosis. En las 2070 piezas con lesiones epiteliales (endometrio) los hallazgos más prevalentes fueron atrofia, pólipo endometrial e hiperplasia glandular del endometrio. Hubo coexistencia de patología miometrial y endometrial en 905 piezas quirúrgicas. En 240 casos no hubo lesiones en la biopsia (4,2 por ciento). En el 1 por ciento de las histerectomías se encontró como hallazgo un cáncer ginecológico, siendo los dos diagnósticos más frecuentes asociados con esta situación, la metrorragia disfuncional perimenopáusica y el pólipo endometrial. Conclusiones: La distribución de los diagnósticos de la patología uterina es similar a la descrita por series internacionales. El hallazgo más común es el leiomioma uterino, frecuentemente asociado con adenomiosis. Se destaca el hallazgo incidental de cáncer de endometrio en histerectomizadas por metrorragia y/o pólipo endometrial; esto nos hace recomendar el uso rutinario del estudio biópsico preoperatorio en pacientes con metrorragia y de la biopsia contemporánea en casos de pólipo endometrial.

Background: Hysterectomy is the most frequently performed gynecologic procedure worldwide. Few studies have been done to analysis the distribution of pathological findings in hysterectomies. Objectives: To determine the distribution of epithelial and non-epithelial pathology in patients undergoing hysterectomy for uterine disease in an academic centre. To establish what is the percentage and the etiology of concurrent pathologies and the incidence of unexpected cancer within patients undergoing surgery for a presumably benign condition. Methods: A retrospective study was done of all the patients undergoing hysterectomy between 1991 and 2005. In addition a descriptive analysis of the distribution of benign and malignant conditions originated in the uterine corpus was done highlighting the occurrence of incidental cancer among different preoperative diagnosis. Results: During the period, 5683 hysterectomies were performed. In 4275 cases a non-epithelial pathology was found, mainly, fibroids and adenomyosis. In 2070 cases endometrial pathology was diagnosed: atrophy, polyps and hyperplasia as the most prevalent findings. In 905 cases myometrial and endometrial pathology of uterine corpus coexists. In 240 cases any pathology was found (4.2 percent). In 1 percent of hysterectomies an incidental gynecological cancer was found, and the two conditions more frequently associated were metrorrhagia and polyps. Conclusions: The distribution of etiologies for the uterine pathology, is similar to other international series. The most common finding is fibroid frequently associated to adenomyosis. It is important to highlight the incidental finding of endometrial cancer among patients operated on by metrorrhagia and/or polyps. Based on this, we recommend the routine use of preoperative biopsy in patients with metrorrhagia and frozen section biopsy in those with polyps.