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Background@#Uterine fibroids are the most common benign tumors in women. Management of symptomatic fibroids may ultimately require surgery and for those desirous of fertility, laparoscopically assisted myomectomy and the conventional laparoscopic procedure are conservative treatment options, with the former providing a less technically demanding approach.@*Objectives@#This study aims to evaluate the clinical outcomes for laparoscopically assisted myomectomy (LAM) versus laparoscopic myomectomy (LM) done at a tertiary hospital.@*Methods@#This is a retrospective chart review of 118 patients with symptomatic myomas who underwent LM (n=66) or LAM (n=52) at a tertiary hospital from January 2010 to December 2017.@*Results@#There were significantly more fibroids removed in the LAM group compared to the LM group, but with no significant difference in the average diameter of fibroid removed. Complex plastic reconstruction with more than 2 layers of repair was done more often in the LAM group (p<0.001). The mean operative time was longer and more blood loss was incurred in the LM group, but this was not statistically significant. Almost 14% of patients in the LM group had blood transfusion compared to 4.1% in the LAM group (p=0.085). The rate of perioperative complications was similar for both groups. The length of hospital stay was shorter in the LM group, but was not statistically significant. A trend towards higher odds of pregnancy was seen in the LAM group. Majority of patients were delivered via cesarean section with no incidence of uterine rupture. The recurrence of fibroids was seen more in the LAM group (17.9% versus 13.7% for LM), however this was not statistically significant.@* Conclusions@#The surgical, reproductive, and long-term clinical outcomes for both LAM and LM are similar, thus, LAM provides a non-inferior minimally invasive approach and a conservative option for patients desirous of future fertility.
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Miomectomía Uterina , LaparoscopíaRESUMEN
@#This commentary is focused primarily on the relationship between menopausal hormone therapy (MHT) and breast cancer risk, the primary adverse outcome measure of the Women’s Health Initiative (WHI) hormone trials. The WHI hormone trials are to date the largest randomized, placebo-controlled studies that evaluated the risks and benefits of hormone therapy in postmenopausal women. There are two arms: the estrogen-progestin (conjugated equine estrogen/medroxyprogesterone acetate) arm for women with intact uterus and the estrogen-alone (conjugated equine estrogen) arm for women who had a hysterectomy1. Both arms, planned to continue for 8.5 years, were stopped prematurely, the CEE/MPA arm after a mean of 5.2 years of follow-up and the CEE-alone arm after a mean of 7.2 years follow-up.
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Femenino , Estrógenos Conjugados (USP) , Acetato de MedroxiprogesteronaRESUMEN
The objective of this chapter is to present an overview of how menstruation, a normal bodily function, was and is perceived in various ethnic groups and cultures in the world, from ancient mythology, historical, or traditional practices to contemporary belief systems. Mythical tales about menstruation abound in the legends and prehistory of ancient cultures. These tales characterize menstrual blood variously as sacred, a gift from the gods, or a punishment for sin, but it is almost always magical and powerful. In contrast, most world religions view menstruation, with varying degrees of severity, as a major problem, a sign of impurity and uncleanliness, and therefore, menstruating women are isolated, prohibited from polluting the holy places, and shunned. Many of these myths and cultural misperceptions persist to the present day, reflected in a wide range of negative attitudes toward menstruation, which can have serious and direct implications for reproductive health. In view of the increasingly globalized nature of current clinical practice, it is crucial that health care providers are familiar with existing cultural and social views and attitudes toward the menstrual function. The ultimate goal is to be able to provide women culturally sensitive and medically appropriate therapies for their menstrual disorders. This biocultural approach to menstruation management is desirable in contemporary medical practice.
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Cultura , Ciclo Menstrual , Menstruación , Mitología , Religión , Actitud , Femenino , Humanos , Hemorragia UterinaRESUMEN
@#Mullerian duct anomalies (MDAs) are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as a "double uterus," is one of the least common amongst the MDAs. Reported here is a case of a 16 year old female with a uterus didelphys with the obstructed left hemiuteri adherent in the anterior abdominal wall, and an endometriotic cyst on the same side. She underwent hysteroscopy-guided vaginoscopy, laparoscopic left hemihysterectomy, left oophorocystectomy. Cases such as these require careful preoperative planning and diagnostic imaging for more accurate diagnosis and, hence, for the most appropriate surgical procedure to be carried out. 3D ultrasonography and Magnetic Resonance Imaging have been the most widely used imaging techniques. The goals of management are to relieve the symptoms of obstruction and to restore the normal anatomy as much as possible in order to provide the best chance for future fertility.
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Didelfo UterinoRESUMEN
PURPOSE: Recent findings indicate that urinary extracellular vesicles (EVs) might reflect the pathophysiological state of urinary system; and that EVs-induced ciliary signaling is a possible mechanism of intercellular communication within the tract. Here, we aimed to analyze the protein expression of urinary EVs during autosomal dominant polycystic kidney disease (ADPKD). EXPERIMENTAL DESIGN: EVs were isolated from pooled urine samples of healthy control and ADPKD patients at two different stages of the disease and under tolvaptan treatment using the double-cushion ultracentrifugation method. Proteins were identified and quantified by iTRAQ and multidimensional protein identification technology (MudPIT)-based quantitative proteomics. RESULTS: Quantitative analyses identified 83 differentially expressed EV proteins. Many of these have apical membrane origin and are involved in signal transduction pathways of primary cilia, Ca(2+) -activated signaling, cell-cycle regulation, and cell differentiation. CONCLUSIONS AND CLINICAL RELEVANCE: The reduced AQP-2 and the increased APO-A1 levels observed in all ADPKD-affected groups may reflects the impaired renal concentrating capability of these patients and correlated with estimated glomerular filtration rate decline. The levels of some upregulated proteins involved in Ca(2+) -activated signaling declined upon tolvaptan treatment. The results obtained suggest that the quantitative proteomics of urinary EVs might be useful to monitor proteins difficult to access noninvasively, and thus advance our understanding of urinary tract physiology and pathology.
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Vesículas Extracelulares/metabolismo , Enfermedades Renales Poliquísticas/orina , Adulto , Anciano , Antagonistas de los Receptores de Hormonas Antidiuréticas/farmacología , Antagonistas de los Receptores de Hormonas Antidiuréticas/uso terapéutico , Acuaporina 2/orina , Benzazepinas/farmacología , Benzazepinas/uso terapéutico , Biomarcadores/orina , Proteínas de Unión al Calcio/orina , Estudios de Casos y Controles , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Renales Poliquísticas/tratamiento farmacológico , Proteoma/metabolismo , Tolvaptán , Vía de Señalización Wnt , Adulto JovenRESUMEN
Urinary exosomes have received considerable attention as a potential biomarker source for the diagnosis of renal diseases. Notwithstanding, their use in protein biomarker research is hampered by the lack of efficient methods for vesicle isolation, lysis, and protein quantification. Here we report an improved ultracentrifugation-based method that facilitates the solubilization and removal of major impurities associated with urinary exosomes. A double-cushion sucrose/D(2)O centrifugation step was used after a two-step differential centrifugation to separate exosomes from the heavier vesicles. After the removal of uromodulin, 378 and 79 unique proteins were identified, respectively, in low- and high-density fractions. Comparison of our data with two previously published data sets helped to define proteins commonly found in urinary exosomes. Lysis, protein extraction, and in-solution digestion of exosomes were then optimized for MudPIT application. More than a hundred exosomal proteins were quantified by four-plex iTRAQ analysis of single and pooled samples from two different age groups. For healthy men, six proteins (TSN1, PODXL, IDHC, PPAP, ACBP, and ANXA5) showed significant expression differences between exosome pools of those aged 25-50 and 50-70 years old. Thus, exosomes isolated by our method provide the basis for the development of robust quantitative methods for protein biomarker research.
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Exosomas/química , Proteínas/análisis , Proteómica , Orina/química , Adulto , Factores de Edad , Anciano , Envejecimiento/orina , Biomarcadores/orina , Centrifugación por Gradiente de Densidad , Bases de Datos de Proteínas , Electroforesis en Gel de Poliacrilamida , Humanos , Masculino , Persona de Mediana Edad , Proteómica/métodos , Factores Sexuales , Espectrometría de Masa por Ionización de Electrospray , Espectrometría de Masas en TándemRESUMEN
To compare the accuracy of transvaginal ultrasound, hysterosalpingography and hysteroscopy in the detection of intrauterine lesions that may be associated with infertility, the medical records of 452 women who each underwent all three procedures from January 2007 to July 2010 were reviewed. Hysteroscopy appears to have the highest sensitivity for the diagnosis of endometrial polyp, submucous myomas and endometrial hyperplasia. On the other hand, hysterosalpingography has the highest specificity for the diagnosis of endometrial polyp, submucous myomas, endometrial hyperplasia, and intrauterine septa. Combination of procedures improved diagnostic accuracy in terms of specificity.
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Humanos , Femenino , Persona de Mediana Edad , Adulto , Ultrasonografía , Histerosalpingografía , HisteroscopíaRESUMEN
This is the case of a 26 year-old nulligravida with Polycystic Ovary Syndrome who developed severe Ovarian Hyperstimulation Syndrome (OHSS) during ovulation induction for Intrauterine Insemination (IUI). Three problems were encountered during treatment. The first was whether to convert a planned ovulation induction and IUI, that resulted in multiple follicular development, to an in vitro Fertilization - Intracytoplasmic Sperm Injection cycle. The second problem was determining what strategies are relevant in preventing OHSS in a woman at high risk for developing severe hyperstimulation. The third problem was why, when and how to employ abdominal paracentesis in the management of severe OHSS. Though the patient's course was turbulent, management was successful. She is now awaiting embryo transfer and, ultimately, motherhood.
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Humanos , Femenino , Adulto , Síndrome de Hiperestimulación Ovárica , Síndrome del Ovario PoliquísticoRESUMEN
The diagnosis of the Herlyn-Werner-Wunderlich syndrome is frequently misleading, not only to underreporting of cases, but, more seriously, to suboptimal treatment that can be detrimental to the reproductive potential of the affected woman. The case of a 14-year old girl with the HWW syndrome is presented. Although the diagnosis was suggested by imaging modalities such as ultrasound and magnetic resonance imaging, the use of endoscopic procedures such as laparoscopy and hysteroscopy, provided additional vital information that allowed an accurate assessment of her condition and a definitive, minimally-invasive management that was protective of her reproductive function.
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Humanos , Femenino , Adolescente , Conductos ParamesonéfricosRESUMEN
Intrauterine insemination (IUI) together with controlled ovarian hyperstimulation (COH) has been increasingly used for the treatment of variety of subfertile indications, both male and female or even combined. The overall success rate of IUI ranges from 4% to 66%. The wide variance of success of the procedure is likely to be influenced by a number of factors. The pregnancy rate in the local setting has never been determined. This cross-sectional study reviewed all available clinical records of patients undergoing fertility work-up who had sperm processing in a hospital-based andrology unit and who underwent intrauterine insemination in either the hospital-based facility or a private clinic from January to December, 2004. Objective: It aimed to determine the pregnancy rate following IUI and assess the intrinsic and extrinsic variables affecting its success and describe the IUI's pregnancy outcome. The intrinsic factors include patient's age (male and female), number of subfertility years, previous reproductive history specifically involving the different factors (male, cervical, uterine, ovarian, tubal, peritoneal). Extrinsic factors include treatment effect and timing of IUI (medicine administered, monitoring of number and size of follicles, endometrial thickness, total motile count inseminated, number of inseminations) and preference for facility (hospital-based clinic or private clinics). Results: For the period of one year, there were a total of 1051 cycles of IUI, 305 in the hospital-based facility and 746 in private clinics. Due to limitation of accessible data, only 424 cycles were studied. However, out of the 424 cycles data retrieved, only 365 showed IUI outcomes. The overall pregnancy rate following IUI was 2.47%. In this study, it seems that only the wives' age (younger) and years of subfertility (2.9 years), were found to be associated with pregnancy rates. The median female age was 35.4 years (range 23.4-48.2), and median male age was 36.5 years (range: 25.0 - 54.4) with a median duration of subfertility of 6.0 years (range: 0.3 -18.0). Conclusion: There is no sufficient evidence to conclude that the other factors studied under treatment, different parameters and topography are associated with rates of pregnancy following IUI.
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Humanos , Masculino , Femenino , Adulto , Historia Reproductiva , Esposos , Infertilidad , Útero , Trompas Uterinas , Inseminación , Fertilidad , EspermatozoidesRESUMEN
A method to obtain the absorbed dose in Drosophila melanogaster irradiated in the thermal column facility of the Triga Mark III Reactor has been developed. The method is based on the measurements of neutron activation of gold foils produced by neutron capture to obtain the neutron fluxes. These fluxes, combined with the calculations of kinetic energy released per unit mass, enables one to obtain the absorbed doses in Drosophila melanogaster.