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2.
Mymensingh Med J ; 28(3): 662-667, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391441

RESUMO

This study was done to compare the predictive capacity of Clinical scoring and Chlamydia antibody titre in predicting tubal patency. This cross sectional comparative study was done in Institute of Child and Mother Health, Dhaka, Bangladesh from January 2018 to December 2018. Eighty eight infertile women with normal ovarian reserve and their husbands with normal semen parameters were purposively included. After taking written informed consent, Clinical scoring, Chlamydia antibody titre and Hysterosalpingography of the study population were done. Data expressed as mean and standard deviation. Logistic regression analysis was done. The predictive capacity was analyzed by sensitivity, specificity, positive and negative predictive value and relative risk. Area under the Curve of Receiver Operating Characteristic was done. A p value <0.05 was considered as statistically significant. Fifty three and half percent had bilateral and 8% had unilateral tubal block and 38.5% had bilateral patent tubes. Clinical scoring versus Hysterosalphingography and Chlamydia antibody titre versus Hysterosalphingography of the study population had sensitivity 87.04% and 48.15%, specificity 76.47% and 58.82%, positive predictive value 82.95% and 52.27%, negative predictive value78.79% and 41.67% and relative risk 5.42 and 0.84 respectively. The Clinical Scoring is better than Chlamydia Antibody Titre as a tool in predicting tubal patency.


Assuntos
Doenças das Tubas Uterinas , Infertilidade Feminina , Laparoscopia , Bangladesh , Criança , Estudos Transversais , Doenças das Tubas Uterinas/diagnóstico , Feminino , Humanos , Infertilidade Feminina/diagnóstico
3.
Tex Med ; 115(6): 16-18, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31260541

RESUMO

It was an overwhelming, 12-0 verdict - a jury's unanimous rejection of a negligence case against a Laredo physician. Then, a judge took that decision away and ordered a new trial - not because of jury misconduct, or any procedural stumble that usually negates a court decision. It was taken away, essentially, because the judge said so.


Assuntos
Erros de Diagnóstico/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Radiologistas/legislação & jurisprudência , Criança , Doenças das Tubas Uterinas/diagnóstico , Feminino , Humanos , Texas
4.
Int J Gynaecol Obstet ; 146(2): 200-205, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31162639

RESUMO

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis infection and the correlates of tubal pathology among Ghanaian women undergoing hysterosalpingography for suspected tubal factor infertility. METHODS: A cross-sectional study was conducted among 189 women with infertility who underwent hysterosalpingography at Korle Bu Teaching Hospital, Ghana, from September 1 to November 30, 2016. Demographic data; obstetric and gynecologic history; and hysterosalpingography findings were collected using a structured questionnaire. Endocervical swabs were tested for the presence of Chlamydia trachomatis using a rapid antigen-based diagnostic kit. Associations between the variables were assessed using bivariate analysis. RESULTS: Positive test results for Chlamydia trachomatis were recorded among 15 participants, giving an overall prevalence of 7.9% (95% confidence interval [CI] 4.1%-11.7%). In all, 67 (35.4%) participants had abnormal findings on hysterosalpingography, with 40 (21.2%) displaying bilateral tubal occlusion. The remaining 122 (64.6%) women had normal findings on hysterosalpingography. Eight participants with normal tubal appearance tested positive for Chlamydia trachomatis (prevalence 6.6%, 95% CI 2.2%-11.0%), whereas seven participants with abnormal tubal appearance tested positive (prevalence 10.4%, 95% CI 3.1%-17.7%; P=0.402). No associations were found between participant characteristics and tubal pathology. CONCLUSION: The prevalence of Chlamydia trachomatis did not differ by hysterosalpingography findings.


Assuntos
Infecções por Chlamydia/epidemiologia , Doenças das Tubas Uterinas/diagnóstico , Histerossalpingografia , Infertilidade Feminina/cirurgia , Adulto , Anticorpos Antibacterianos/sangue , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/patologia , Gravidez , Prevalência
5.
Artigo em Inglês | MEDLINE | ID: mdl-31227442

RESUMO

The aim of the present review is to give a comprehensive overview of fallopian subtle lesions and suggest the impacts of these abnormalities on fertility. Tubal subtle variations, including tubal diverticula, Morgagni hydatids, accessory fallopian tube, accessory ostium of the fallopian tube, tubal phimosis, agglutination, and sacculation, have been described and cited as making significant contributions to infertility. This review summarizes characteristics of these subtle abnormalities and provides an update of recent knowledge of the diagnosis and management of these variations. We hope that the present contribution may help to bring more attention to the clinical field to recognize these abnormalities and consequently aid in improving fertility.


Assuntos
Divertículo , Doenças das Tubas Uterinas , Laparoscopia , Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/patologia , Doenças das Tubas Uterinas/terapia , Tubas Uterinas/patologia , Feminino , Humanos , Infertilidade Feminina
6.
Taiwan J Obstet Gynecol ; 58(3): 324-327, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31122517

RESUMO

OBJECTIVE: Endosalpingiosis rarely occurs in the uterus. We report a case and review literature to explore its current clinical diagnosis and treatment. CASE REPORT: A 31-year-old woman was admitted to the hospital for suspected uterine leiomyoma with cystic degeneration based on ultrasound and magnetic resonance imaging and surgical treatment. Laparoscopy revealed a large cystic mass protruding from the posterior uterine wall. The mass was resected, and a histologic examination showed that the cyst wall was lined with benign fallopian tube-type ciliated epithelium surrounded by normal myometrium, consistent with the diagnosis of endosalpingiosis of the uterus (also known as a Müllerian cyst). Currently, there are 18 cases (including ours) in the literature. Of these, two had a uterine malignancy, one endometrioid endometrial carcinoma, and another cervical adenocarcinoma. The age at diagnosis varied from 31 to 73, with a mean of 47 ± 8. The typical clinical manifestations were a palpable low abdominal mass, abnormal menstrual bleeding, and pelvic pain. Overall, 75% (12 of 16) of patients underwent a total hysterectomy, while 62.5% (10 in 16) had a concomitant bilateral salpingo-oophorectomy for nonmalignancy. No recurrence was reported. CONCLUSION: We describe the youngest patient with tumor-like uterine endosalpingiosis. The preoperative diagnosis is challenging because of its rarity. Most patients had a hysterectomy with castration, which may have resulted in overtreatment. Awareness of this lesion is necessary for the differential diagnosis of uterine and adnexal tumors. Review of relevant literature has shown a relationship between endosalpingiosis progression and cancer development, indicating an uncertain and complicated pathology.


Assuntos
Cistos/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Cistos/patologia , Cistos/cirurgia , Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/patologia , Feminino , Humanos , Miométrio/patologia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
7.
JSLS ; 23(1)2019.
Artigo em Inglês | MEDLINE | ID: mdl-30846898

RESUMO

Background and Objectives: The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility. Methods: We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation. Results: In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general population. Patients with previous appendectomy had more intra-abdominal adhesions (P < .001) and patients with adhesions tended to have compromised tubal patency (P = .05). However, there was no direct correlation between a previous appendectomy and tube pathology (P = .727). Conclusion: Because previous appendectomy was associated with intra-abdominal adhesions, and these were in turn associated with tube pathology, but appendectomy was not directly associated with compromised tubal patency, previous appendectomy may indirectly affect female fertility through mechanisms other than direct tubal obstruction. This is one of the largest study analyzing laparoscopic chromopertubation in association with previous childhood appendectomy.


Assuntos
Apendicectomia/efeitos adversos , Doenças das Tubas Uterinas/diagnóstico , Infertilidade Feminina/etiologia , Aderências Teciduais/diagnóstico , Adulto , Estudos de Coortes , Feminino , Humanos , Laparoscopia , Estudos Retrospectivos
8.
Eur J Obstet Gynecol Reprod Biol ; 236: 127-132, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30903885

RESUMO

OBJECTIVE: To assess the capacity of transvaginal hydrolaparoscopy (THL) versus hysterosalpingography (HSG) as a primary tool to diagnose tubal pathology. STUDY DESIGN: We performed a multicenter RCT (NTR3462) in 4 teaching hospitals in the Netherlands, comparing THL and HSG as first line tubal test in subfertile women. The primary outcome of the trial was cumulative live birth rate at 24 months. Here, we present the secondary outcomes, the diagnostic findings of both THL and HSG as well as performance defined as failures, complications and pain- and acceptability scores. RESULTS: Between May 2013 and October 2016, we allocated 149 women to THL and 151 to HSG, of which 17 women in the THL group (11.4%) and 12 in the HSG group (7.9%) conceived naturally before the scheduled procedure, while 13 HSGs and 5 THLs were not performed for other reasons (withdrawal of informed consent, not willing to undergo tubal testing and protocol violations). A total of 119 THLs and 134 HSGs were carried out. Failures were seen more in the THL group (n = 8, 5.6%) than in the HSG group (n = 1, 0.7%) (p = 0.014). Complications did not differ significantly between the groups (THL n = 4; 2.8% vs HSG n = 1; 0.7%) (p = 0.20). Bilateral tubal occlusion was detected in one versus three women (0.9% versus 2.2%) of the THL group and HSG group, while unilateral tubal occlusion was detected in seven (6.2%) versus eight (5.9%) women, respectively. Normal findings were seen in 96 (79.3%) women randomised to THL and in 119 (87.5%) in women randomised for HSG (RR 0.91 95%CI 0.81-1.01, p = 0.08). The pain score was significantly less for THL (VAS 4.7 (SD: 2.5)) than for HSG (VAS 5.4 (SD:2.5)) (p 0.038). The acceptability rate of THL and was high and comparable. CONCLUSION: THL and HSG have a comparable capacity in diagnosing tubal pathology with comparable performance in safety, pain and acceptability.


Assuntos
Doenças das Tubas Uterinas/diagnóstico , Histerossalpingografia/métodos , Infertilidade Feminina/diagnóstico , Laparoscopia/métodos , Adulto , Feminino , Humanos
9.
J Minim Invasive Gynecol ; 26(5): 935-940, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30273685

RESUMO

STUDY OBJECTIVE: To study the association between endometrial polyps and fallopian tube patency diagnosed by hysteroscopy, conventional histology, and 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy). DESIGN: A case-control study (Canadian Task Force classification II-2). SETTING: A university hospital. PATIENTS: A total of 323 women of reproductive age underwent 4D HyCoSy and hysteroscopy between January 2015 and December 2017. INTERVENTION: A retrospective analysis of the association of endometrial polyps and fallopian tube obstruction (n = 154) or patency (n = 169) in patients who underwent 4D HyCoSy. MEASUREMENTS AND MAIN RESULTS: The prevalence of endometrial polyps was significantly higher in patients with bilateral fallopian tube obstruction than in patients with bilateral fallopian tube patency (42.9% [66/154] vs 20.1% [34/169], p <.0001). In univariate and multivariate analyses, the presence of endometrial polyps was found to be a risk factor for tubal obstruction with an odds ratio of 3.16 and 2.59, respectively. CONCLUSION: The prevalence of endometrial polyps is higher in infertile patients with fallopian tube obstruction than in patients with fallopian tube patency. History of endometrial polyps, ectopic pregnancy, and pelvic inflammatory disease are risk factors for tubal obstruction.


Assuntos
Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/epidemiologia , Doenças das Tubas Uterinas/complicações , Doenças das Tubas Uterinas/epidemiologia , Pólipos/complicações , Pólipos/epidemiologia , Adulto , Estudos de Casos e Controles , Neoplasias do Endométrio/diagnóstico , Doenças das Tubas Uterinas/diagnóstico , Testes de Obstrução das Tubas Uterinas/métodos , Tubas Uterinas/diagnóstico por imagem , Tubas Uterinas/patologia , Feminino , Humanos , Histerossalpingografia/métodos , Histeroscopia , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Pólipos/diagnóstico , Gravidez , Prevalência , Estudos Retrospectivos , Ultrassonografia/métodos
10.
BJOG ; 126(2): 227-235, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30169895

RESUMO

BACKGROUND: Fallopian tube occlusion is a common cause of infertility, but the effect of unilateral tubal block (UTB) on pregnancy rates (PR) after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) remains controversial. OBJECTIVE: To evaluate PR after COH-IUI among infertile women with proximal and distal UTB diagnosed by hysterosalpingogram (HSG), compared against women with bilateral patent tubes experiencing unexplained infertility. SEARCH STRATEGY: We searched EMBASE, MEDLINE, Google Scholar, Cochrane Library, and PUBMED from inception to 14 January 2018. SELECTION CRITERIA: Studies that report PR/cycle or cumulative PR among women with UTB and controls were included. DATA COLLECTION AND ANALYSIS: Two authors independently selected and extracted study characteristics and data. Methodological quality was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. MAIN RESULTS: Among 2965 patients and 5749 IUI cycles across ten studies, no significant difference in PR/cycle (odds ratio, OR = 0.88; 95% confidence interval, 95% CI = 0.69-1.12) and cumulative PR (OR = 0.80, 95% CI = 0.62-1.04) was observed. Patients with proximal UTB demonstrated similar PR/cycle (OR = 1.06, 95% CI = 0.68-1.66) and cumulative PR (OR = 1.10, 95% CI = 0.75-1.62), compared with controls, whereas patients with distal UTB had significantly lower cumulative PR (OR = 0.49, 95% CI = 0.25-0.97, P = 0.04). Patients with proximal block also demonstrated significantly improved cumulative PR, compared with patients with distal block (OR=2.41, 95% CI = 1.37-4.25, P = 0.002). CONCLUSION: Infertile patients with proximal UTB diagnosed by HSG can expect similar pregnancy rates after COH-IUI, compared with those with bilateral tubal patency and unexplained infertility, whereas patients with distal UTB have lower odds of pregnancy. These differences may reflect inherent diagnostic limitations of HSG or differences in underlying pathologies. TWEETABLE ABSTRACT: Meta-analysis evaluates pregnancy outcomes after COH-IUI in women with unilateral tubal block diagnosed by HSG.


Assuntos
Doenças das Tubas Uterinas/diagnóstico , Inseminação Artificial/métodos , Indução da Ovulação/métodos , Taxa de Gravidez , Adulto , Doenças das Tubas Uterinas/complicações , Feminino , Humanos , Histerossalpingografia , Infertilidade Feminina/etiologia , Estudos Observacionais como Assunto , Gravidez
11.
J Gynecol Obstet Hum Reprod ; 48(4): 241-245, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29689309

RESUMO

OBJECTIVES: To compare the diagnostic performance for tubal patency by chromopertubation and hysterosalpingography in the female infertile patients. METHODS: We prospectively evaluated 103 female patients (age range 19-35 years; mean age 27.60 years) diagnosed as infertile, underwent hysterosalpingography (HSG) for tubal patency and uterine pathology during initial diagnostic work-up. All the enlisted patients fulfilled the criteria of infertility and these also underwent hysterolaparoscopic chromopertubation (CPT). The results of HSG were compared with the reference standard using CPT. RESULTS: Out of 103 female infertile patients, 60 (58.2%) were of primary and rest of them 43 (41.8%) secondary infertile patients. HSG showed abnormalities in tubal patency in 69/103 (∼67%) patients. The detected abnormalities were distributed in 40/60 (66.6%) primary and 29/43 (67.4%) secondary infertile patients. On comparison to HSG with CPT (reference standard) for tubal blockage detection, it was found that HSG was true positive (TP) in 38 patients, true negative in 34 patients, false positive in 31 patients and FN in 0 patients. We found that for detection of tubal blockage, the sensitivity, specificity, PPV, NPV and accuracy of HSG was 100.00%, 52.31%, 36.89%, 57.07% and 67% respectively. Tubal occlusion detected on HSG and CPT showed a moderate agreement (weighted kappa - 0.447; 95% CI -0.312 to 0.583). In present study, no patient shows tubal blockage in CPT while HSG was normal. CONCLUSION: We concluded that hysterolaparoscopic mediated chromopertubation not only diagnostic but also therapeutic, so it can obviate the need of hysterosalpingography.


Assuntos
Doenças das Tubas Uterinas/diagnóstico , Testes de Obstrução das Tubas Uterinas/métodos , Histerossalpingografia , Histeroscopia/métodos , Infertilidade Feminina/diagnóstico por imagem , Laparoscopia/métodos , Adulto , Doenças das Tubas Uterinas/complicações , Doenças das Tubas Uterinas/terapia , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Estudos Prospectivos , Sensibilidade e Especificidade , Centros de Atenção Terciária , Útero/diagnóstico por imagem , Útero/patologia , Adulto Jovem
12.
J Minim Invasive Gynecol ; 26(1): 110-116, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29702271

RESUMO

STUDY OBJECTIVE: To assess the effect of hyoscine-N-butylbromide (HBB) as premedication on the rate of proximal tubal obstruction during hysterosalpingography (HSG). DESIGN: A randomized, double-blind controlled trial (Canadian Task Force classification I). SETTING: The Infertility Clinic of Songklanagarind Hospital. PATIENTS: One hundred and forty-six infertile women indicated for HSG investigation. INTERVENTIONS: Between May 1, 2016, and March 31, 2017, patients were assigned at random to receive either oral HBB 20 mg or placebo 30 minutes before the HSG procedure. If proximal tubal obstruction was found, participants were be assigned to undergo a second confirming HSG or laparoscopy with chromopertubation within 6 months. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the rate of proximal tubal obstruction. The secondary outcome was the false-positive result of proximal tubal occlusion from HSG. Proximal tubal obstruction was found in 6 of 70 patients in the HBB group and in 16 of 71 in the placebo group. The rate of proximal tubal obstruction was significantly lower in the HBB group than in the placebo group (8.6% vs 22.5%; p = .04; absolute difference, 13.9%; 95% confidence interval [CI], 0.02-0.26; relative risk, 0.38; 95% CI, 0.16-0.92). After the second HSG or laparoscopy was performed (n = 22), the rate of false occlusion was 20% (1 of 6 patients) in the HBB group, compared with 69.2% (9 of 16 patients) in the placebo group. CONCLUSION: Premedication with HBB before HSG can reduce the rate of diagnosis of proximal tubal obstruction and false occlusion.


Assuntos
Brometo de Butilescopolamônio/administração & dosagem , Doenças das Tubas Uterinas/diagnóstico , Histerossalpingografia , Infertilidade Feminina/diagnóstico , Administração Oral , Adulto , Método Duplo-Cego , Reações Falso-Positivas , Feminino , Humanos , Hidrocarbonetos Bromados/administração & dosagem , Laparoscopia , Pré-Medicação , Escopolamina , Esterilização Tubária
13.
Pediatr Med Chir ; 40(2)2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514074

RESUMO

Isolated tubal torsion (ITT) is a rare cause of acute abdominal pain. Preoperative diagnosis is difficult because of a lack of specific signs. Surgery is recommended to preserve the integrity of the tube. Seven patients of median age of 13 years (range 9 to 15) came to our observation for worsening abdominal pain, nausea and vomiting. On admission, all girls had blood tests and ultrasound. Laparoscopy was performed for diagnosis in all cases. The girls had one-month and one-year ultrasound and clinic follow up. In all cases diagnosis was delayed, median 66 hours after the onset of symptoms and laparoscopy showed necrosis of the Fallopian tube. In five girls a laparoscopic salpingectomy was performed. In the other two, an open salpingectomy was necessary because of pelvic adhesions. Histology showed a hemorrhagic infarction of the Fallopian tubes. At follow up all patients were asymptomatic with normal ovaries, but one ovarian cyst. In the differential diagnosis of acute abdominal pain in children or female adolescents the possibility of ITT should be considered for a conservative treatment. Laparoscopy allows for definitive diagnosis and treatment.


Assuntos
Doenças das Tubas Uterinas/diagnóstico , Tubas Uterinas/cirurgia , Salpingectomia/métodos , Anormalidade Torcional/diagnóstico , Dor Abdominal/etiologia , Adolescente , Criança , Diagnóstico Tardio , Diagnóstico Diferencial , Doenças das Tubas Uterinas/cirurgia , Tubas Uterinas/anormalidades , Feminino , Seguimentos , Humanos , Laparoscopia/métodos , Náusea/etiologia , Estudos Retrospectivos , Anormalidade Torcional/cirurgia , Ultrassonografia/métodos , Vômito/etiologia
14.
J Obstet Gynaecol Can ; 40(11): 1466-1467, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30473124

RESUMO

BACKGROUND: Candida species are harmless commensals of hosts, including humans, but they can cause infection when the immune system is compromised. Infections with non-albicans species can occur, ranging from urinary tract infections to sepsis, especially among patients in intensive care units. CASE: The patient, a 37-year-old woman, presented with severe abdominal pain, fever, and vomiting. The patient's symptoms and fever continued in spite of treatment with antibiotics, and she underwent exploratory laparotomy. Cyst content culture results showed that Candida kefyr was present in the cyst. CONCLUSION: To the best of our knowledge, this is the first case report of a tubo-ovarian abscess caused by C. kefyr. Rare pathogens can be found in patients with a tubo-ovarian abscess, so culture of the abscess material is important for determining subsequent treatment, particularly in women who require an operation for tubo-ovarian abscess.


Assuntos
Abscesso Abdominal , Candida , Candidíase , Doenças das Tubas Uterinas , Doenças Ovarianas , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/microbiologia , Abscesso Abdominal/terapia , Dor Abdominal/diagnóstico , Dor Abdominal/microbiologia , Adulto , Antifúngicos/uso terapêutico , Candidíase/diagnóstico , Candidíase/diagnóstico por imagem , Candidíase/microbiologia , Candidíase/terapia , Cistectomia , Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/diagnóstico por imagem , Doenças das Tubas Uterinas/microbiologia , Doenças das Tubas Uterinas/terapia , Feminino , Fluconazol/uso terapêutico , Humanos , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/diagnóstico por imagem , Doenças Ovarianas/microbiologia , Doenças Ovarianas/terapia , Salpingectomia
15.
Eur J Contracept Reprod Health Care ; 23(4): 309-310, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30203680

RESUMO

BACKGROUND: The subdermal etonogestrel contraceptive implant has a current approved duration of 3 years. There is, however, recent and strong evidence of its effectiveness for 2 additional years during which no pregnancies were documented. CASE: We report a case of a 28-year-old woman who had an etonogestrel implant inserted 4 years earlier and wished to get pregnant. The implant was, however, deep in the triceps muscle and could not easily be removed. Her serum levels of etonogestrel remained positive even 6 years after insertion. As infertility investigation revealed endometriosis and bilateral tubal obstruction she was referred for assisted reproduction. Despite obtaining oocytes during an ovarian stimulation cycle, the endometrium was never above 4 mm, precluding embryo transfer. It was decided to remove the implant in order to improve endometrial conditions, after which the patient achieved pregnancy. CONCLUSION: This case report suggests that the etonogestrel implant is effective for even longer than the most recent studies have shown.


Assuntos
Desogestrel , Implantes de Medicamento , Endometriose , Endométrio/efeitos dos fármacos , Doenças das Tubas Uterinas , Adulto , Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Femininos/efeitos adversos , Eficácia de Contraceptivos , Desogestrel/administração & dosagem , Desogestrel/efeitos adversos , Remoção de Dispositivo/métodos , Implantes de Medicamento/administração & dosagem , Implantes de Medicamento/efeitos adversos , Endometriose/diagnóstico , Endometriose/etiologia , Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/etiologia , Feminino , Humanos , Fatores de Tempo
16.
BMC Urol ; 18(1): 70, 2018 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-30134978

RESUMO

BACKGROUND: Uretero-fallopian fistula (UFF) is a very rare surgery complication which usually happens after surgeries of fallopian tube or ureter. There has been no report of interventional operations of fallopian tube causing UFF. CASE PRESENTATION: A 41-year-old female received fallopian tube embolization for birth control. After that she noticed "clear vaginal discharge". She neglected that symptom for 7 years, until a sudden onset of abdominal pain brought her to the ER. Retrograde ureterogram confirmed UFF and revealed severe hydronephrosis of the left kidney. She received left nephrectomy afterwards and recovered well, with no urine leakage from her vagina. CONCLUSION: UFF could be caused by interventional operations of fallopian tube, and could lead to severe consequences. The application of fallopian tube embolization should be carefully controlled.


Assuntos
Embolização Terapêutica/efeitos adversos , Doenças das Tubas Uterinas/etiologia , Tubas Uterinas , Histeroscopia/efeitos adversos , Esterilização Reprodutiva/efeitos adversos , Doenças Ureterais/etiologia , Fístula Urinária/etiologia , Adulto , Doenças das Tubas Uterinas/diagnóstico , Feminino , Fístula/diagnóstico , Fístula/etiologia , Humanos , Doenças Ureterais/diagnóstico , Fístula Urinária/diagnóstico
17.
Female Pelvic Med Reconstr Surg ; 24(4): e23-e25, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29894327

RESUMO

Fistulas are defined as abnormal connections between 2 organ, vessels, or structures. They can often present in the genitourinary tract as a result of iatrogenic injury during pelvic surgery. A 46-year-old female presents many years after a hysterectomy for persistent vaginal leakage with concern for a vesicovaginal fistula. Computed tomography urogram, intravenous retrograde pyelogram, and cystoscopy were negative for vesicovaginal fistula; however, a vaginal sinus tract was noted and further explored. This case report will describe the use of both laparoscopy and concomitant vaginoscopy to diagnose and, ultimately, surgically excise a salpingovaginal fistula.


Assuntos
Doenças das Tubas Uterinas/diagnóstico , Salpingectomia/métodos , Fístula Vaginal/diagnóstico , Doenças das Tubas Uterinas/etiologia , Doenças das Tubas Uterinas/cirurgia , Feminino , Humanos , Histerectomia/efeitos adversos , Pessoa de Meia-Idade , Prolapso , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgia
18.
Prog. obstet. ginecol. (Ed. impr.) ; 61(2): 173-175, mar.-abr. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-173670

RESUMO

Introducción: se presenta un caso de endosalpingiosis apendicular diagnosticado casualmente en pieza de apendicectomía. Caso clínico: paciente de 40 años con antecedentes de esterilidad primaria que acudió a urgencias por apendicitis. Se realizó apendicectomía laparoscópica sin incidencias. El estudio anatomopatológico reveló glándulas de epitelio cilíndrico ciliado sugestivas de endosalpingiosis, derivándose a nuestro servicio para valoración ginecológica, que resultó normal. Discusión: la endosalpingiosis es una entidad benigna caracterizada por presencia de epitelio y glándulas de las trompas de Falopio en una localización externa. La endosalpingiosis apendicular es extremadamente rara, con pocos casos descritos, y que constituye un diagnóstico casual por ser asintomática. Sin embargo, en ocasiones puede asociarse a dolor pélvico crónico, infertilidad o trastornos menstruales, por lo que esta patología no debe pasar desapercibida entre los profesionales médicos


Introduction: We report a case of appendiceal endosalpingiosis diagnosed by a routine histopathological examination of an appendicectomy specimen. Case report: A 40-year-old female, with a history of primary infertility, presented with acute appendicitis. A laparoscopic appendicectomy was performed with no complications associated. The pathological study revealed ciliated columnar epithelium suggestive of endosalpingiosis. She was referred to our department for gynecologic examination that was normal. Discussion: Endosalpingiosis is a benign entity defined by the presence of glands lined by tubal-type epithelium with cilliated and secretory cells in sites other than Fallopian tubes. Endosalpingiosis of the appendix is extremely rare and few cases have been reported. This disease is predominantly asymptomatic, however, it can be associated with chronic pelvic pain, infertility or menstrual irregularities


Assuntos
Humanos , Feminino , Adulto , Apendicectomia/métodos , Endometriose/diagnóstico , Infertilidade/complicações , Doenças das Tubas Uterinas/patologia , Endometriose/patologia , Dor Pélvica/etiologia , Dor Abdominal/etiologia , Vagina/diagnóstico por imagem , Vagina/patologia , Doenças das Tubas Uterinas/diagnóstico , Epitélio/diagnóstico por imagem , Epitélio/patologia , Salpingite/diagnóstico por imagem
19.
Arch Gynecol Obstet ; 297(5): 1201-1204, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29478102

RESUMO

PURPOSE: Tubo-ovarian abscess (TOA) is a serious and potentially life-threatening complication of pelvic inflammatory disease (PID). TOA formation may be an uncommon, but serious complication associated with the use of an intrauterine device (IUD). While the majority of TOA respond to antibiotic therapy, in approximately 25% of cases surgery or drainage is indicated. In the present study, we compared the failure rate of conservative management in patients with and without IUD, who were admitted with a diagnosis of TOA. METHODS: In this retrospective case-control study, 78 women were diagnosed with TOA. All patients were treated initially by broad-spectrum intravenous antibiotics. The failure of conservative management after 72 h was followed by surgical intervention. RESULTS: The patients were divided into two groups: 24 patients were IUD-carriers, and 54 did not use IUD. There was no significant difference in surgical intervention rate between IUD group (50%) and no-IUD group (43%), p = 0.32. The WBC count was significantly higher in IUD-carriers diagnosed with TOA than in patients without IUD (16.5 ± 6.6 vs. 13.1 ± 4.6, p = 0.001). The patients with IUD had significantly larger abscesses as revealed by ultrasound than patients without IUD (61.6 ± 21.4 vs. 49.6 ± 20.6 mm, p = 0.02). CONCLUSION: The surgical intervention rate in TOA patients with and without IUD was similar.


Assuntos
Abscesso/terapia , Antibacterianos/uso terapêutico , Remoção de Dispositivo , Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/terapia , Febre/etiologia , Procedimentos Cirúrgicos em Ginecologia , Dispositivos Intrauterinos/efeitos adversos , Doenças Ovarianas/diagnóstico , Doença Inflamatória Pélvica/tratamento farmacológico , Abscesso/complicações , Abscesso/diagnóstico , Adulto , Estudos de Casos e Controles , Tratamento Conservador , Doenças das Tubas Uterinas/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Ovarianas/complicações , Doenças Ovarianas/tratamento farmacológico , Doenças Ovarianas/cirurgia , Doença Inflamatória Pélvica/diagnóstico , Doença Inflamatória Pélvica/microbiologia , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Adulto Jovem
20.
J Obstet Gynaecol Res ; 44(4): 792-796, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29316041

RESUMO

A 32-year-old woman consulted for an evaluation of pelvic pain following intrauterine insemination (IUI). Vaginal and abdominal sonography, septic workup were performed and laparoscopic surgery was scheduled after failure to respond to a course of antibiotics. During laparoscopic surgery, bilateral tubo-ovarian abscesses arising on the endometriotic cysts of both ovaries were identified with a vast amount of brownish peritoneal fluid under the adhesion of the greater omentum. Bilateral ovarian cystectomy, right salpingectomy and lysis adhesion were performed. Pathologic organisms were not detected in any of the specimen cultures. Pelvic infection is an uncommon complication following IUI. Endometriosis might be a risk factor predisposing the pelvic organ to be susceptible to such infection. Performing IUI in a patient with endometriosis should be done with great vigilance.


Assuntos
Abscesso/diagnóstico , Endometriose/diagnóstico , Doenças das Tubas Uterinas/diagnóstico , Infertilidade Feminina/terapia , Inseminação Artificial/efeitos adversos , Doenças Ovarianas/diagnóstico , Abscesso/cirurgia , Adulto , Endometriose/cirurgia , Doenças das Tubas Uterinas/cirurgia , Feminino , Humanos , Doenças Ovarianas/cirurgia
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