[Clinical and endoscopic features of a selected population with serrated colorectal adenomas in a private clinic in Lima - Peru]. / Características clínicas y endoscópicas de una población seleccionada con adenomas aserrados de colon en una clínica privada de Lima - Perú

OBJECTIVE: To describe the clinical and endoscopic caracteristics of a population that has only serrated polyps of colon (mainly sessile serrated adenomas) in a private clinic in Lima, Perú, from 2009-2011. MATERIALS AND METHODS: Retrospective study conducted at the endoscopy center of Clinic Ricardo Palma, Lima, Peru. Olympus colonoscope was used with high definition, including NBI (narrow band imaging) and electronic magnification. Patients had pathologic diagnosis of â€Å“polyps and / or colorectal serrated adenomas” and excluded those with synchronous tubular or villous adenomas. Images were evaluated by two endoscopists and then by a third gastroenterologist. RESULTS: We found 201 serrated polyps in 108 patients. Women were 60.2% and overweight predominated. Eighty (74.1%) had only one serrated adenoma and 23 (21.3%) with at least one synchronous hyperplastic polyp. The average size of sessile serrated adenomas was 5.12 mm (± 3.87 DS) and the flat type was 91 (58.7%). There were significant differences in the diameter of sessile serrated adenomas between the distal and proximal colon (4.47 mm ± 2.23 vs. 6.90 mm ± 6.25; p<0.000). The common features of sessile serrated adenomas were: White (31/36, 86.1%), smooth (28/36, 77.8%) and regular margins (26/36, 72.2%). There was a relationship between vascular pattern according NBI and serrated polyp histology (p=0.024). CONCLUSION: The endoscopic features of sessile serrated adenomas can evade detection to white light. NBI is a useful tool to define some features of these lesions.

Características clínicas y endoscópicas de una población seleccionada con adenomas aserrados de colon en una clínica privada de Lima - Perú / Clinical and endoscopic features of a selected population with serrated colorectal adenomas in a private clinic in Lima - Perú

Objetivo: Describir las características clínicas y endoscópicas de una población que sólo presenta pólipos aserrados de colon (principalmente adenomas aserrados sésiles) en una clínica privada de Lima del 2009 al 2011. Materiales y métodos: Estudio retrospectivo realizado en el centro endoscópico de la Clínica Ricardo Palma, Lima, Perú. Se usó colonoscopios Olympus con alta definición, incluyendo NBI (narrow band imaging) y magnificación electrónica. Los pacientes tuvieron diagnóstico patológico de “pólipos y/o adenomas aserrados de colon”, excluyéndose aquéllos con adenomas tubulares o vellosos sincrónicos. Las imágenes fueron evaluadas por dos endoscopistas y luego por un tercer gastroenterólogo. Resultados: Se encontraron 201 pólipos aserrados en 108 pacientes. El 60,2% fueron mujeres y predominó el sobrepeso. Ochenta (74,1%) tuvieron sólo un adenoma aserrado y 23 (21,3%) con al menos un pólipo hiperplásico sincrónico. El tamaño promedio de los adenomas aserrados sésiles fue 5,12 mm (± 3,87 DS) y 91 (58,7%) fueron planos. Hubo diferencias significativas en el diámetro de adenomas aserrados sésiles entre el colon distal y proximal (4,47 mm ± 2,23 vs. 6,90 mm ± 6,25; p<0,000). El color blanco (31/36, 86,1%), superficie lisa (28/36, 77,8%) y márgenes regulares (26/36, 72,2%) fueron las características más frecuentes de adenomas aserrados sésiles. Hubo relación entre el patrón capilar según NBI y el tipo histológico del pólipo aserrado (p=0,024). Conclusión: Las características endoscópicas de los adenomas aserrados sésiles pueden dificultar su detección a la luz blanca. El NBI es una herramienta útil para definir algunas características de estas lesiones.

Objective: To describe the clinical and endoscopic caracteristics of a population that has only serrated polyps of colon (mainly sessile serrated adenomas) in a private clinic in Lima, Perú, from 2009-2011. Materials and methods: Retrospective study conducted at the endoscopy center of Clinic Ricardo Palma, Lima, Peru. Olympus colonoscope was used with high definition, including NBI (narrow band imaging) and electronic magnification. Patients had pathologic diagnosis of “polyps and / or colorectal serrated adenomas” and excluded those with synchronous tubular or villous adenomas. Images were evaluated by two endoscopists and then by a third gastroenterologist. Results: We found 201 serrated polyps in 108 patients. Women were 60.2% and overweight predominated. Eighty (74.1%) had only one serrated adenoma and 23 (21.3%) with at least one synchronous hyperplastic polyp. The average size of sessile serrated adenomas was 5.12 mm (± 3.87 DS) and the flat type was 91 (58.7%). There were significant differences in the diameter of sessile serrated adenomas between the distal and proximal colon (4.47 mm ± 2.23 vs. 6.90 mm ​​± 6.25; p<0.000). The common features of sessile serrated adenomas were: White (31/36, 86.1%), smooth (28/36, 77.8%) and regular margins (26/36, 72.2%). There was a relationship between vascular pattern according NBI and serrated polyp histology (p=0.024). Conclusion: The endoscopic features of sessile serrated adenomas can evade detection to white light. NBI is a useful tool to define some features of these lesions.

[Microscopic colitis: pathogenesis]. / Colítis microscópica: patogénesis.

INTRODUCTION: Microscopic colitis (MC) is a chronic inflammatory process observed in colon biopsies of patients with chronic aqueous diarrhea. It is called microscopic because diagnosis is determined by histological studies since the microscopic characteristics of the colon endoscopy are normal. Two patterns exist: Lymphocytic Microscopic Colitis and Collagenous Microscopic Colitis. Etiology is unknown, and the proposed pathogenic mechanisms indicate an immunological phenomenon. Based on this, the authors of this study hypothesize that lymphocytic infiltration of the lamina propria could be related to cytotoxic lymphocytes CD8 as causative agents of colon tissue damage. OBJECTIVES: Prove hypothesis of immunological pathogenesis of MC. APPARATUS AND METHODS: Thirty eight (38) patients with diagnosed MC were recruited for the last four years in the Pathology Laboratory at Ricardo Palma University. Twenty two (22) colon biopsies with the most severe histological lesions were selected. These biopsies were obtained from 17 patients: 5 patients had 2 biopsies in 2 colonoscopy sessions. Biopsies were fixed in neutral formaldehyde, processed through the paraffin inclusion method, and stained with hematoxiline-eosine and Masson trichromic to distinguish collagenous tissue. Immunohistochemistry was conducted in 4- or 5-micron-thick histological sections processed through the immunoperoxidase method. RESULTS: Nineteen (19) biopsies corresponded to Lymphocytic MC and 3 to Collagenous MC. Lymphocytic MC showed intraepithelial lymphocytosis, dystrophic epithelial damage in the areas of lymphocytic infiltration, lamina propria inflammation with lymphocytes and plasma cells, and normal basement membrane. Collagenous MC showed thickened basement membrane due to the presence of a collagenous band, mild to moderate intraepithelial lymphocytosis, vacuolization,and frequent detachment of protective epithelium. Twenty two (22) biopsies were positive in the immunohistochemical studies.

Colitis microscópica: Patogénesis / Microscopic colitis: Pathogenesis

Introducción: Colitis microscópica (CM) es el proceso inflamatorio crónico observado en biopsias del colon de pacientes con diarrea crónica acuosa. Se denomina microscópica porque el diagnóstico es histológico ya que las características microscópicas de la endoscopía del colon son normales. Incluye 2 patrones: Colitis microscópica Linfocítica y la Colítis microscópica Colagenosa. La causa es desconocida y los mecanismos patógenos propuestos señalan un fenómeno inmunológico; de acuerdo a este concepto los autores del presente estudio suponemos que la infiltración linfocítica en la lámina propia podrían corresponder a linfocitos citotóxicos CD8 como ejecutores del daño tisular colónico. Objetivos: Probar la hipótesis de la patogénesis inmunológica de la CM. Material y Método: 38 pacientes con diagnóstico de CM reclutados durante los 4 últimos años en el laboratorio de patología Clínica Ricardo Palma. Se seleccionaron 22 biopsias de colon con lesiones histológicas más severas, correspondientes a 17 pacientes, 5 de ellos tuvieron 2 biopsias en 2 sesiones colonoscópicas, las biopsias fueron fijadas en formol neutro. Y procesadas por el método de inclusión en parafina, tenidas con hematoxilina y eosina y tricrómica de Masson para tejido colágeno. La inmunohistoquímica se hizo en secciones histológicas de 4 y 5 micras de espesor precesadas por el método de la Inmunopereoxidasa. Resultados: 19 biopsias correspondieron a CM Linfocítica y 3 a CM Colagenosa. El CM Linfocítica mostró linfocitosis intraepitelial, daño epitelial distrófico en las áreas de infiltración linfocítica, inflamación de la lámina propia con linfocitos y célula plasmática, membrana basal normal. La CM Colagenosa mostró membrana basal engrosada por la presencia de una banda colágena, linfocitos Intra epiteal leve a moderado vacuolización y frecuente desprendimiento del epitelio cobertor. Los estudios de Inmunohistoquímica fueron positivos en las 22 biopsias estudiadas.

Introduction: Microscopic colitis (MC) is a chronic inflammatory process observed in colon biopsies of patients with chronic aqueous diarrhea. It is called microscopic because diagnosis is determined by histological studies since the microscopic characteristics of the colon endoscopy are normal. Two patterns exist: Lymphocytic Microscopic Colitis and Collagenous Microscopic Colitis. Etiology is unknown, and the proposed pathogenic mechanisms indicate an immunological phenomenon. Based on this, the authors of this study hypothesize that lymphocytic infiltration of the lamina propria could be related to cytotoxic lymphocytes CD8 as causative agents of colon tissue damage. OBJECTIVES: Prove hypothesis of immunological pathogenesis of MC. Apparatus and Methods: Thirty eight (38) patients with diagnosed MC were recruited for the last four years in the Pathology Laboratory at Ricardo Palma University. Twenty two (22) colon biopsies with the most severe histological lesions were selected. Thesebiopsies were obtained from 17 patients: 5 patients had 2 biopsies in 2 colonoscopy sessions. Biopsies were fixed in neutral formaldehyde, processed through the paraffin inclusion method, and stained with hematoxiline-eosine and Masson trichromic to distinguish collagenous tissue. Immunohistochemistry was conducted in 4- or 5-micron-thick histological sectionsprocessed through the immunoperoxidase method. RESULTS: Nineteen (19) biopsies corresponded to Lymphocytic MC and 3 to Collagenous MC. Lymphocytic MC showed intraepithelial lymphocytosis, dystrophic epithelial damage in the areas of lymphocytic infiltration, lamina propria inflammation with lymphocytesand plasma cells, and normal basement membrane. Collagenous MC showed thickened basement membrane due to the presence of a collagenous band, mild to moderate intraepithelial lymphocytosis, vacuolization, and frequent detachment of protective epithelium. Twenty two (22) biopsies were positive in the immunohistochemical...

Unopposed matrix metalloproteinase-9 expression in human tuberculous granuloma and the role of TNF-alpha-dependent monocyte networks.

Tuberculosis is characterized by granuloma formation and caseous necrosis, but the factors causing tissue destruction are poorly understood. Matrix metalloproteinase (MMP)-9 (92-kDa gelatinase) secretion from monocytes is stimulated by Mycobacterium tuberculosis (M. tb) and associated with local tissue injury in tuberculosis patients. We demonstrate strong immunohistochemical MMP-9 staining in monocytic cells at the center of granuloma and adjacent to caseous necrosis in M. tb-infected patient lymph nodes. Minimal tissue inhibitor of MMPs-1 staining indicated that MMP-9 activity is unopposed. Because granulomas characteristically contain few mycobacteria, we investigated whether monocyte-monocyte cytokine networks amplify MMP-9 secretion. Conditioned medium from M. tb-infected primary human monocytes or THP-1 cells (CoMTB) stimulated MMP-9 gene expression and a >10-fold increase in MMP-9 secretion by monocytes at 3-4 days (p < 0.009, vs controls). Although CoMTB stimulated dose-dependent MMP-9 secretion, MMP-1 (52-kDa collagenase) was not induced. Anti-TNF-alpha Ab but not IL-1R antagonist pretreatment decreased CoMTB-induced MMP-9 secretion by 50% (p = 0.0001). Anti-TNF-alpha Ab also inhibited MMP-9 secretion from monocytic cells by 50%, 24 h after direct M. tb infection (p = 0.0002). Conversely, TNF-alpha directly stimulated dose-dependent MMP-9 secretion. Pertussis toxin inhibited CoMTB-induced MMP-9 secretion and enhanced the inhibitory effect of anti-TNF-alpha Ab (p = 0.05). Although chemokines bind to G protein-linked receptors, CXCL8, CXCL10, CCL2, and CCL5 did not stimulate monocyte MMP-9 secretion. However, the response to cholera toxin confirmed that G protein signaling pathways were intact. In summary, MMP-9 within tuberculous granuloma is associated with tissue destruction, and TNF-alpha, critical for antimycobacterial granuloma formation, is a key autocrine and paracrine regulator of MMP-9 secretion.

[FAMOTIDINE VERSUS PLACEBO IN NON ULCER DYSPEPSIA TREATMENT] / Famotidina versus placebo en el tratamiento de la dispepsia no ulcerosa.

BACKGROUND: Non ulcer dyspepsia is an important health problem with a very high prevalence in the general population, being its pathophysiology still unclear and its association with H. pylori highly controversial. Many trials have been carried out assessing the effects of different drugs on the symptoms in dyspeptic patients, being one of the most common the use of H2 antagonist, even though the results have shown conflicting as far as efficacy is concerned. The goal of the present study is to determine the efficacy of famotidine (administered in three different regimens) as compared to placebo in relieving the symptoms of non ulcer dyspepsia.METHODS: Patients with chronic non ulcer dyspepsia were included and were selected by random in four groups; group I received famotidine 40 mg before breakfast, placebo before dinner and at bedtime; group II received famotidine 20 mg before breakfast and dinner and placebo at bedtime; group III received famotidine 40 mg at bedtime, placebo before breakfast and dinner; group IV received placebo before breakfast, dinner and at bedtime. A four week treatment period was completed. Endoscopy, measure of the gastric juice pH, and biopsy (including study for H.p) was done at the beginning of the study, at week 4 and at week 8. The patient was asked for a global assessment of improvement in the overall symptoms of dyspepsia at the end of weeks 1,4 and 8.RESULTS: Forty-eight patients (12 men and 36 women) participated in the study. There was not statistical difference between any of the four schemes of treatment and the effect over the pain and the symptoms during the study. Nevertheless there was a highly statistically difference (p<0.01) of the well being of the patient with all the groups of treatment received. There was a significant difference (p<0.05) between the pH of the groups II, III, IV, being the pH at fourth week, the one with a high mean value. There was not statistical difference in the pH value between patients that improve its symptoms and those that not H.p. presence was the same along the study in the group that showed improvement of pain and related symptoms and the group that did not improve. There was no significant changes in the histological pattern and the grade of inflammatory activity in relation to symptoms improvement. During the study there was not any clinical laboratory adverse experience.CONCLUSIONS: Non of the three schemes with famotidine used in this trial has proven to have any therapeutical benefit in non ulcer dyspepsia compared to placebo, even though patients improved their symptoms in all the four groups. It seems that gastric juice does not play a rol in the genesis of non ulcer dyspepsia. In this study, nor the presence of H.p. neither inflammatory activity are associated with the symptoms of non ulcer dyspepsia. More studies carefully designed are required not only to understand pathophysiological mechanism, also to identify effective treatments for this frequent entity.

Compromiso gastrointestinal en Bartonellosis o Enfermedad de Carrión / Gastrointestinal involvement in human bartonellosis

Se estudió en forma prospectiva en el Hospital Nacional Cayetano Heredia a 68 pacientes afectados, en la fase aguda anemizante, de la Enfermedad de Carrión o bartonellosis humana. De los síntomas a la admisión destacan los generales, gastrointestinales, neurológicos y cardiopulmonares. De los síntomas gastrointestinales se tuvo en orden de importancia: Dolor abdominal 46.3 por ciento (31/68), coluria 44.4 por ciento (28/68), vómito 40.3 por ciento (27/68), ictericia 38.5 por ciento (25/68), diarrea 29.9 por ciento (20/68), estreñimiento 8.9 por ciento (6/68). En relación a los signos más importantes en la fase aguda se detectó: 97 por ciento palidez, 91.2 por ciento de regular a mal estado general, 82 por ciento hepatomegalia, 79.1 por ciento fiebre, 75.2 por ciento de regular a mal estado nutricional, 77.9 por ciento soplo sistólico, 71.6 por ciento ictericia, 70.1 por ciento linfoadenomegalia. Otros signos destacados en la evolución son: 29.4 por ciento edema pretibial, 22 por ciento mialgias, 16.4 por ciento derrame pericárdico y anasarca. De los signos gastrointestinales, destacan la hepatomegalia en 82 por ciento (52/68), la ictericia 71.6 por ciento (48/68) y la esplenomegalia 29.4 por ciento (20/68). La hepatomegalia entre 1-4 cm. drcd fue hallada en 71.6 por ciento(48/67) y entre 5 cm. drcd 11.9 por ciento (8/67). El análisis de las pruebas hepáticas reveló un compromiso importante de los pacientes en fase aguda; así un 60 por ciento de ellos presentan valores incrementados de la bilirrubina total, en un 54.6.por ciento se detectó predominio de la bilirrubina directa y en 45.4 por ciento de la bilirrubina indirecta. También sedetectó aumentos de la transaminasa glutámico oxalacética (TGO) en un 28.5 por ciento y de la transaminasa glutámico pirúvica (TGP) en un 25 por ciento, de la fosfatasa alcalina(FA) en un 28.3 por ciento. ...

We present a prospective study of 68 patients with the acute phase of human bartonellosis, admitted to Cayetano Heredia National Hospital. Gastrointestinal symptoms were reported as follows: abdominal pain 46.3 per cent, coluria 44.4 per cent vomiting 40.3 per cent, jaundice 38.5 per cent, diarrhea 29.9 per cent, constipation 8.9 per cent. The more common signs were pallor 97 per cent, hepatomegaly 82 per cent, fever 79.1 per cent, malnutrition 75.2 per cent, systolic heart murmur 77.9 per cent, jaundice 71.6 per cent, lymph node enlargement 70.1 per cent. Signs observed during the hospital course were 29.4 per cent lower extremities edema, 22.6 per cent myalgia, 16.4 per cent pericardial effusion, 16.4 per cent generalized edema. The more common gastrointestinal signs were hepatomegaly 82 per cent (52/68), jaundice 71.6 per cent (48/68) and splenomegaly 29.4 per cent (20/68). The lower liver border was found between 1to 4 below the lower rib border in 71.6 per cent (48/67) and below 5 cm b.l.r.b. in 11.9 percent (8/67). 60 percent had abnormal liver function tests, 54.6 per cent had mainly direct bilirrubin elevation and 45.4 per cent mainly indirect. SGOTwas elevated in 28.5 per cent and SGPTin 25 per cent, 28.3 per cent had elevated alkaline phosphatase. The bilirrubin media was 3.5 mgldl (range 0.6-21),the indirect bilirrubin media was 1.6 mg/dl (range 0.5-11.5), the direct bilirrubin media was 1.9 mg/dl (range 0.3-18), The SGOT media 73.9 U/L(range 9-1250), SGPT media 65.5U/L (range 6-1596). Alkaline phosphatase 5.9 mui/ml (range 3-497). Albumin media 3.09 (range 2-4.2). Patients with bacterial coinfection (salmonella, staphilococcus, enterobacter, shigella) had a higher increase in bilirrubin and transaminases. ...

[GASTROINTESTINAL INVOLVEMENT IN HUMAN BARTONELLOSIS] / Compromiso Gastrointestinal en Bartonellosis oEnfermedad de Carrión.

We present a prospective study of 68 patients with the acute phase of human bartonellosis, admitted to Cayetano Heredia National Hospital.Gastrointestinal symptoms were reported as follows: abdominal pain 46,3%, coluria 44,4%, vomiting 40,3%, jaundice 38,5%, diarrhea 29,9%, constipation 8,9%. The more common signs were pallor 97%, hepatomegaly 82%, fever 79,1%, malnutrition 75,2%, systolic heart murmur 77,9%, jaundice 71,6%, lymph node enlargement 70,1%.Signs observed during the hospital course were 29,4% lower extremities edema, 22,6% myalgia, 16,4% pericardial effusion, 16,4% generalized edema. The more common gastrointestinal signs were hepatomegaly 82%(52/68), jaundice 71,6% (48/68) and splenomegaly 29,4%(20/68).The -lower liver border was found between 1 to 4 below the lower rib border in 71,6%(48/67) and below 5 cm b. l. r. b. in 11,9%(8/67).60% had abnormal liver function tests, 54,6% had mainly direct bilirrubin elevationand 45,4% mainly indirect.SGOT was elevated in 28,5% and SGPT in 25%, 28,3% had elevated alkaline phosphatase. The bilirrubin media was 3,5 mg/dI (range 0,6-21), the indirect bilirrubin media was 1,6 mg/dI (range 0,5-11,5), the direct bilirrubin media was 1,9 mg/dI (range 0,3-18), The SGOT media 73,9 U/L (range 9-1250), SGPT media 65,5U/L (range 6-1596). Alkaline phosphatase 5,9 mui/ml (range 3-497). Albumin media 3,09 (range 2-4,2).Patients with bacterial coinfection (salmonella, staphilococcus, enterobacter, shigella) had a higher increase in bilirrubin and transaminases.Three patients had liver biopsies, two revealed Küpffer cells hyperplasia (moderate to severe), one revealed intracellular hyperplasia, one patient coinfected with diseminated hystoplasmosis had granulomas in the liver.Mortality(8,8%) was associated to hepatocellular involvement (SGOT media 330U/L, SGPT media 207 U/L, alkaline phosphatase media 183 mui/ml), hypoalbuminemia media = 2,4 gr/1) and generalized edema.

La biopsia hepática en el Hospital Nacional Cayetano Heredia de 1969 a 1993 / Hepatic biopsy at the Hospital Cayetano Heredia

El presente trabajo revisa 1813 biopsias hepáticas realizadas en el Hospital Nacional Cayetano Heredia de 1969 a 1993, para demostrar en forma estadística la incidencia de la patología hepática determinada por este procedimiento. Se discuten y comparan los resultados con los de la literatura nacional y extranjera. 887 (48.92 por ciento) correspondieron a pacientes del sexo masculino y 926 (51.07 por ciento) al sexo femenino. El promedio de edad fue de 40 años y 276 (15.22 por ciento) pertenecieron a pacientes menores de 14 años de edad. 983 (54.22 por ciento) se obtuvieron por punción percutánea a ciegas, 501 (27.63 por ciento) por cirugía, 215 (11.86 por ciento) por punción postmortem y 114 (6.28 por ciento) dirigidas por laparoscopía. Se listan los diagnósticos histológicos. En la serie fueron los más frecuentes la neoplasia hepática con 195 (10.75 por ciento) y la esteatosis hepática con 187 (10.31 por ciento). En estos últimos la relación del sexo femenino sobre el masculino fue 1.83, la edad promedio de 37.1 años. Los casos de hepatitis granulomatosa fueron 123 (6.78 por ciento), ocupando el sexto lugar en la serie, de éstos 33 (26.82 por ciento) fueron por tifoidea, 29 (23.57 por ciento) por brucela y 25 (20.32 por ciento) por tuberculosis. En la edad pediátrica, menores de 14 años, los diagnósticos más frecuentes fueron la esteatosis hepática, en segundo lugar biopsias sin anormalidades significativas y en tercer lugar la hepatitis granulomatosa

Compromiso ovárico en la pelviperitonitis post-aborto y post-parto / Ovarian involvement in post-abortion and post-partum pelvia pertinitis

En la pelviperitonitis post-aborto y post-parto (40 casos) los ovarios pueden hallarse inafectos, con compromiso periférico (perioforitis) o compromiso parenquimal (oforitis absceso) lo que sugiere dos vías de difusión de infección del foco uterino al ovario por contigüidad y por vía hamatógena a través del ligamento infundíbulo pélvico, estimándose que esta es una estructura importante para la decisión de resección de una gonada, sugiriéndose la conservación de éstas en pacientes jóvenes si están indemnes o afectadas superficialmente y con ligamento infundíbulo pélvicos normales. La ablación de una gonada o persistencia de ambas en 24 casos seleccionados, no incrementaron la morbilidad post-operatoria, ni el tiempo de hospitalización y presentaron recuperación funcional adecuada, constatada por el seguimiento clínico y hallazgos hormonales, a diferencia del síndrome climatérico precoz y florido presentado por pacientes castradas

Compromiso ovárico en la pelviperitonitis post-aborto y post-parto / Ovarian involvement in post-abortion and post-partum pelvia pertinitis

En la pelviperitonitis post-aborto y post-parto (40 casos) los ovarios pueden hallarse inafectos, con compromiso periférico (perioforitis) o compromiso parenquimal (oforitis absceso) lo que sugiere dos vías de difusión de infección del foco uterino al ovario por contig³idad y por vía hamatógena a través del ligamento infundíbulo pélvico, estimándose que esta es una estructura importante para la decisión de resección de una gonada, sugiriéndose la conservación de éstas en pacientes jóvenes si están indemnes o afectadas superficialmente y con ligamento infundíbulo pélvicos normales. La ablación de una gonada o persistencia de ambas en 24 casos seleccionados, no incrementaron la morbilidad post-operatoria, ni el tiempo de hospitalización y presentaron recuperación funcional adecuada, constatada por el seguimiento clínico y hallazgos hormonales, a diferencia del síndrome climatérico precoz y florido presentado por pacientes castradas (AU)