Combined conservative surgical and medical treatment of a uterocutaneous fistula

Uterocutaneous fistula is a rare complication that may follow cesarean section. Herein is described a rare case of uterocutaneous fistula. The patient, a 28-year-old woman with a history of American Society for Reproductive Medicine stage IV endometriosis (Douglas pouch obliteration), underwent a cesarean section at 25 weeks of gestation (twin pregnancy). Postoperatively, the patient returned to the emergency service because of the appearance of pus through the cesarean section abdominal scar, and was treated for a subcutaneous abscess. Because drainage continued, the presence of a uterocutaneous fistula was suspected. Magnetic resonance imaging confirmed this diagnosis. Hysteroscopy clearly revealed the uterine neck of the fistula tract. Leuprolide acetate (gonadotropin-releasing hormone agonist) deposit suspension was administered subcutaneously monthly for 6 months. Surgery via laparoscopy and laparotomy was performed. This combined medical and conservative surgical treatment was successful. At 6-month follow-up, hysteroscopy revealed a normal uterine cavity. We conclude that magnetic resonance imaging and hysteroscopy are helpful in diagnosis of uterocutaneous fistula. Conservative surgical treatment associated with medical therapy can be an efficient procedure in women who desire subsequent pregnancies.     

Endometriotic uterocutaneous fistula after cesarean section. A case report

Endometriosis outside the pelvis is rare and most cases occur in surgical scars after operations involving the female genital tract. Fistulae involving the uterus are also very rare, usually being the result of postpartum and postoperative complications. In the present report, a case of a 44-year-old patient with an endometriotic uterocutaneous fistula is described. The patient presented 6 years after her fourth cesarean section with a painful nodule on the cesarean scar, which was bleeding during menstruation. The lesion extended to the uterine fundus, connecting the endometrial cavity with the skin. This is merely the second case of a uterocutaneous fistula to be reported in the literature and the first case developed on grounds of endometriosis.     

Uterocutaneous fistula after surgical treatment of an incomplete abortion: methylene blue test to verify the diagnosis

Introduction  Uterocutaneous fistula is an extremely rare clinical condition that can be seen after pelvic or uterine surgery. It can also complicate some obstetric procedures. Case  We report of an unusual case of an uterocutaneous fistula that developed in a multiparous woman after surgical evacuation of an incomplete first trimester septic abortion. The fistula tract was depicted on computed tomography, and to verify the diagnosis methylene blue was given through a transcervically introduced uterine catheter, and blue dye flow out through the external opening of fistula was observed. At laparatomy fistula tract was completely excised along with the enclosing omentum. Postoperative recovery and follow-up were uneventful. Discussion  Possible mechanisms of development of such a rare condition, and diagnostic and treatment options are discussed.     

Metástasis en mama de melanoma maligno cutáneo

Breast metastases from extramammary primary tumors account for 2% of all malignant breast tumors (the most common being lymphoma and malignant melanoma) and can mimic primary breast carcinoma clinically and radiologically. The prognosis of patients with metastases to the breast from solid tumors is generally poor, with 80% dying in the first year. The most widely accepted treatment is simple excision. Consequently, determining the source of metastases prior to surgery avoids further surgical procedures that will not improve prognosis. We present a case of metastases from malignant cutaneous melanoma to the breast diagnosed in the right thoracic wall and surgically excised 3 years previously.     

Cáncer de mama: metástasis en ovario y colon

We present a case of stage ii breast cancer that relapsed first in the surgical scar at 4 years after surgery, and then in the ovaries at 6 years and finally in the colon at 13 years. Adjuvant treatment consisted of chemotherapy after the initial diagnosis and hormonal therapy after the relapses. Even though hormonal adjuvant treatment alone was used after ovarian recurrence, the disease-free survival was long.     

Metrorragia disfuncional como primer síntoma de carcinoma de mama

During perimenopause, menstrual alterations are often considered within the normal range, and complementary studies are not usually performed. Symptomatic treatment is provided, if required, until cessation of ovarian function.     

Metástasis vaginal y uterina de un cáncer de colon: una combinación excepcional

Both vaginal and uterine metastases from colon cancer are rare. The co-occurrence of both entities is exceptional. After the most common causes of genital bleeding have been excluded, a diagnosis of metastasis should be considered in women with abnormal vaginal bleeding and a history of cancer. Because of the rarity of these cases, there are no established treatment guidelines or survival data. The factor with the greatest influence on a worse prognosis seems to be the presence of uterine metastasis, which is almost always associated with widespread metastatic disease.     

Gestación triple tubárica de origen espontáneo

The aim of this case report is to present a triplet ectopic pregnancy of spontaneous origin and tubal situation diagnosticated by ultrasonography after query for abdominal pain. Surgical treatment was performed due to an haemodynamic shock caused by tubarian hole.     

Embarazo ectópico ovárico

Ovarian pregnancy is an uncommon type of ectopic pregnancy. Preoperative diagnosis is difficult. Some cases are diagnosed during surgery and most need to be confirmed by histopathological study. The treatment of choice is conservative ovarian surgery to preserve fertility such as enucleation of the gestational sac or wedge resection of the ovary, preferably by laparoscopy. In some cases intramuscular methotrexate could be effective. We report two cases of ectopic ovarian pregnancy in our hospital.     

Neumotórax espontáneo en una gestante de 32 semanas

Primary spontaneous pneumothorax is characterized by dyspnea and progressive lung collapse, due to air accumulation in the pleural cavity. Although this entity is an exceptional finding in pregnancy, it can be life-threatening to the mother and fetus. Our Obstetrics and Gynecology Department treated a woman in the 32nd week of pregnancy with a spontaneous pneumothorax, who underwent thoracotomy for a bleb excision and pleurodesis a few days before delivery. A review of the international medical literature yielded only 50 cases reported to date, indicating the limited experience in the diagnosis and treatment of this entity.     

Mayer-Rokitansky-Küester-Hauser (MRKH) syndrome with rectovestibular fistula and imperforate anus

Objectives

The Mayer-Rokitansky-Küester-Hauser (MRKH) syndrome can be either isolated uterovaginal agenesis or associated with other organ anomalies. However, MRKH co-existing with rectovestibular fistula and imperforate anus is uncommonly seen. We present the specific clinical manifestation and discuss the diagnosis and treatment for this unique subtype of MRKH.

Study design

We reviewed 133 cases with MRKH admitted in our hospital within a 10-year span. Among them, three cases of uterovaginal agenesis concomitant with rectovestibular fistula and imperforate anus were reported in detail.

Results

This scenario of MRKH with rectovestibular fistula was characterized by the common features of two openings in the perineum along with an imperforate anus. Our patients were older girls whose main complaints were of primary anomerrhea and leakage of loose stool. A one-stage repair of anorectovaginoplasty was used in two patients, and with laparoscopic assistance in one case. Thirty-two similar cases in the previous relevant literature were also systematically reviewed.

Conclusion

MRKH with rectovestibular fistula and imperforate anus is extremely rare. A thorough understanding of this unique entity helps establish the correct and timely diagnosis, and also avoids inappropriate operative treatment.     

Carcinoma de células pequeñas de mama

Oat cell breast cancer is a rare and aggressive form of cancer. Because only a few cases have been described in the literature, there is no standard treatment. We report the case of a 64-year-old woman who attended our unit for investigation of a node in her left breast that was diagnosed as infiltrative oat-cell breast carcinoma.     

Metástasis peritoneales en cáncer de mama

Invasive lobular breast cancer has a special tropism for the peritoneal cavity and gastrointestinal and genitourinary systems. We describe 2 cases of peritoneal carcinomatosis secondary to metastatic spread of lobular carcinoma of the breast. The diagnosis was made several years after detection of the primary tumor. The peritoneal carcinomatosis (with genitourinary or gastrointestinal metastases) in breast cancer is rare and is most frequent in invasive lobular carcinoma. Diagnosis is difficult because the symptoms are often nonspecific and there is often a long interval between the initial diagnosis of breast cancer and peritoneal involvement. Clinical suspicion and histological-immunohistochemical study help to differentiate between a primary tumor of the peritoneal cavity and the presence of metastatic breast carcinoma. Treatment should be individualized in each patient.     

Metástasis ováricas y mamarias bilaterales de melanoma con localización primaria desconocida

Bilateral breast metastases from melanoma are rare and, at the time of diagnosis, usually show other sites of dissemination. The clinical prognosis is poor, with an average survival of less than 1 year despite aggressive treatment. Malignant melanoma involving the ovary is also uncommon and may be confused with a primary tumor, presenting a clinical and pathological diagnostic challenge. We report an unusual case of melanoma of unknown primary site that presented clinically as bilateral breast and ovarian metastases.     

Gestación heterotópica espontánea. Diagnóstico ecográfico precoz y asintomático

Heterotopic pregnancy is a potentially fatal situation that rarely occurs in a natural conception. Diagnosis in the absence of symptoms is even more exceptional. Furthermore, due to the low index of suspicion of heterotopic pregnancy in natural conceptions, the incidence of serious clinical complications (hemoperitoneum, tubal rupture, acute abdomen) is greater in this group of patients.We report the case of a 33-year-old primigravida with a spontaneous pregnancy who attended her first prenatal visit at 6 weeks and 3 days of amenorrhea. The patient was asymptomatic. Vaginal ultrasound scan showed two gestational sacs, an intrauterine sac and an extrauterine sac next to the right ovary. A laparoscopic right salpingectomy was performed to remove the ectopic pregnancy. A healthy neonate was delivered at 38 weeks’ gestation without complications.Heterotopic pregnancy can be diagnosed after spontaneous conception, even in asymptomatic patients. It is important to carry out routine examination of the adnexae in the first ultrasound scan to exclude ovarian disease and diagnose (or exclude) the presence of asymptomatic heterotopic pregnancy.     

Valoración ecográfica del endometrio en pacientes tratadas con tamoxifeno

Objective

To measure endometrial thickness and characterize ultrasonographic endometrial images induced by tamoxifen, as well as to determine changes in ultrasonographic patterns throughout treatment.

Patients and methods

We analyzed 278 patients with breast cancer between 1995 and 2000 under adjuvant therapy with tamoxifen for 5 years. Annual ultrasonographic examination was performed. Endometrial thickness and the morphological endometrial patterns in stored ultrasonographic images were retrospectively analyzed.

Results

Endometrial thickness significantly increased during treatment from a mean of 7.84 mm in the first year to 16.67 mm in the fifth year. Five endometrial patterns were found on ultrasonography in patients receiving tamoxifen: linear, heterogeneous-hyperechoic, homogeneoushyperechoic, endometrial polyp, and suspicious for malignancy. The homogeneous-hyperechoic pattern predominated in the first year and the heterogeneous-hyperechoic pattern in the fifth year.

Conclusions

Tamoxifen increases endometrial thickness in the course of treatment and induces five ultrasonographic patterns which change year-by-year.     

Trombosis séptica puerperal de la vena ovárica

We report a case of postpartum ovarian vein thrombosis and review the literature on the topic. The patient developed fever and abdominal pain after delivery. Empiric antibiotic treatment was prescribed and computed tomography showed right ovarian vein thrombosis.Ovarian vein thrombosis is an exceptional cause of postpartum fever. Differential diagnosis must be made with more frequent complications (appendicitis, pyelonephritis, and tubo-ovarian abscesses). The pathogenesis is multifactorial and treatment is based on a combination of antibiotics and anticoagulation. The diagnostic procedure of choice is computed tomography scan.     

La vulvovaginitis candidiásica recurrente

Recurrent vulvovaginal candidiasis (RVVC) is a common infection in daily clinical and emergency practice. The symptoms of this infection cause distressing chronic conditions that seriously affect women's quality of life, prompting them to seek solutions that are sometimes hard to find. Diagnosis should always be confirmed by culture and treatment should be based on the use of topical or oral antifungal imidazoles. Triple therapy focused on symptom and reservoir elimination should initially be used, followed by maintenance therapy for 6 to 12 months. The options to prevent RVVC are highly limited and, except for elimination of the causative agent, no other preventive measures have been effective. We provide an updated review of RVVC in an attempt to aid health professionals and improve the care of women with this infection.     

Tratamiento de la endometriosis con 5 mg o 25 mg diarios de mifepristona durante 6 meses. Ensayo clínico aleatorizado,doble ciego

Objectives

To evaluate the safety and efficacy of 5 mg and 25 mg doses of mifepristone for the treatment of endometriosis.

Design

Randomized double-blind study.

Setting

Eusebio Hernández Hospital, Havana, Cuba.

Subjects

Twenty-six women laparoscopically diagnosed with endometriosis were included.

Treatment

Group I received one tablet of 25 mg mifepristone daily and group II received one tablet of 5 mg mifepristone daily for 6 months. Laparoscopy and endometrial biopsy were performed before and after treatment.

Variable to evaluate efficacy

Reduction in the intensity of dysmenorrhea measured by a visual analogue scale.

Results

In both groups reductions in the intensity of dysmenorrhea and dyspareunia were highly significant compared with initial values (P <.001). All the women were amenorrheic after 45 days of treatment.

Conclusions

At doses of 5 mg or 25 mg, mifepristone could be an alternative for the treatment of endometriosis.     

Miofibroblastoma mamario en paciente posmenopáusica

Breast myofibroblastoma usually develops in postmenopausal patients and is a unilateral, painless and mobile tumor. Growth is slow and, unlike the case presented here, the margins are not usually invasive. The key features to exclude a diagnosis of cancer are the typical characteristics of breast myofibroblastoma and histological and immunohistochemical studies. Although the tumor recurred in our case, the preferred treatment is tumorectomy because there is a low rate of recurrence.