Mauri José Piazza

Características ecográficas do corpo lúteo em gestações iniciais: morfologia e vascularização

PURPOSE the purpose of this research was to evaluate the morphological aspects and vasculature of the corpus luteum (CL) based on ultrasound parameters during early pregnancy and to assess their relationship with early pregnancy loss. METHODS this was a prospective cohort study of 90 pregnant patients between 6 and 8 weeks plus 6 days weeks of gestation. We included women at low risk, without acute or chronic systemic disease and with spontaneous conception. EXCLUSION CRITERIA use of drugs or smoking, drugs inducing ovulation, history of more than one abortion, no heartbeat visible in the embryo and impossibility of visualization of the corpus luteum. The size, volume, morphological aspects, resistive index, and peak systolic velocity of the corpus luteum were measured by transvaginal sonography. RESULTS ninety patients were included in the study. Maternal age ranged from 15 to 41 years (mean 28.6 ± 5.8 years). The corpus luteum could be visualized in 87 patients (96.7%), 79 patients had normal pregnancies (90.1%), whereas spontaneous losses occurred in 8 cases (9.9%). In a comparison of the survivors and losses, there was no difference in mean CL diameter (21.8 versus 20.0 mm; p=0.108, Mann-Whitney test), mean CL volume (4.2 versus 3.0 cm³; p=0.076, Mann-Whitney test), mean resistive index (0.55 versus 0,58; p=0.220, Mann-Whitney test), peak systolic velocity (15 versus 15 cm/s; p=0.757, Mann-Whitney test). There was a positive relation between maternal age and resistive index. CONCLUSIONS no apparent correlation was found between the morphological and vascular aspects of the corpus luteum in early normal pregnancies and first-trimester pregnancy losses.

Malignant syphilis in an HIV seropositive woman.

Malignant syphilis is a rare manifestation of secondary syphilis. It is characterized by papulopustular skin lesions that rapidly enlarge and evolve into round or oval ulcers with sharp borders centrally covered by a dark - sometimes rupioid - crust. The diagnosis is typically established by strongly positive serological tests a severe Herxheimer reaction and an excellent response to antibiotic therapy. Most reported cases of malignant syphilis are described in association with HIV infection. Patients co-infected with syphilis and HIV are also at risk for developing neurosyphilis. Penicillin remains the treatment of choice in all stages of syphilis. A 19-year-old woman presented to the Hospital de Clinicas a tertiary care center at the Federal University of Parana with aggressive skin and mucous membrane lesions and complaints of fever weight loss and malaise. The lesions had started exclusively in the patients mouth a few weeks prior and had since developed over her face thorax back and whole body. Physical examination revealed dry encrusted non-bleeding pruritic lesions disseminated over the patients body. Severe lesions on her back covered all possible puncture sites for collection of cerebrospinal fluid. The womans axillary temperature was 38.0 °C her blood pressure was 110/70 mm Hg and her pulse rate was 80 beats per minute. The patient refused to undergo a gynecologic exam. The clinical laboratory results were a positive Venereal Disease Research Laboratory (VDRL) test (dilution 1:128) with a positive FTA-ABS test a positive enzyme-linked immunosorbent assay (ELISA) HIV serology test followed by a Western blot confirmatory analysis. CD4+ cell count was 134/mm3 which characterized a co-infection of HIV and syphilis. Serological examination for hepatitis B and C showed negative results. A skin lesion biopsy was performed and confirmed secondary syphilis. Because it was impossible to test the patients spinal fluid and the extent of her clinical symptoms treatment with penicillin for neurosyphilis was started promptly. The patient received 3million units of intravenous penicillin G at 4 hour intervals for 14 days. The Jarisch-Herxheimer reaction occurred during the first penicillin administration. Treatment with dipirone produced satisfactory results. Highly active antiretroviral therapy (HAART) with a triple combination of lamivudine (3TC) zidovudine (AZT) and nelfinavir was started concomitantly as was prophylactic treatment with sulfamethoxazole-trimethoprim. After 2 weeks the patients lesions had regressed remarkably and she was discharged from the hospital with HAART and prophylactic sulfamethoxazole-trimethoprim therapy. The patient continued to respond positively to the treatment with a complete remission of the lesions. At the 2 follow-up visits (30 and 90 days later) only disseminated dischromic patches could be seen as sequela. The course of syphilis is often atypical or dramatic in HIV seropositive patients and other authors have also described its unusually aggressive dermatological manifestations. The classical clinical picture of malignant syphilis was diagnosed in the present case. HIV co-infection made the secondary stage of syphilis more aggressive and altered the natural course of the disease: lesions had a fast progression and disseminated over the whole body in a few days including the mouth and other major areas. Because the patient was immunocompromised by HIV she had a significantly higher likelihood of developing neurosyphilis. Secondary syphilis can have a more aggressive course in HIV-infected patients who develop malignant syphilis. The possibility of neurosyphilis should be promptly investigated. If testing is not possible as in the present case the patient should be presumptively treated for neurosyphilis. The lesions will typically respond rapidly to penicillin. (full-text)

Uterus Didelphys with Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA Syndrome).

This paper aimed to report a series of 19 cases of uterus didelphys associated with obstructed hemivagina and ipsilateral renal agenesis. This retrospective descriptive observational study included the medical records of 19 patients seen at the Endocrinology Gynecology Sector of the Obstetrics and Gynecology Department of the Federal University of Paraná, and focused on clinical data, complementary exams, patient management, and follow-up. From the 229 patients with genital anomalies seen between 1984 and 2009, 19 (8.3%) were diagnosed with uterus didelphys with vaginal septum and renal agenesis. The patients had a median age of ±16.3 years. Eight subjects (42.6 %) reported abdominal pain; two of them (0.1%) had pelvic masses and seven (36.8%) had dysmenorrhea. Blood retention was confirmed by ultrasound and/ or magnetic resonance imaging of the pelvis, which revealed the existence of a duplicated uterus of the didelphys type with a cystic mass containing old blood obliterating the hemivagina. Urinary tract examination revealed the existence of ipsilateral renal agenesis. Unusual manifestations such as associated infection and rupture of the vaginal septum during sexual intercourse were also reported. The prevalence of uterus didelphys associated with obstructed hemivagina and ipsilateral renal agenesis was 8.3% in a series of 229 genital anomalies. The observance of clinical features is essential for the early identification of the syndrome and the adequate management of the patients.

Estudo por microscopia eletrônica do epitélio de neovaginas confeccionadas com membrana amniótica e pesquisa de receptores para estrogênios

Objetivo: verificar pela microscopia eletronica as alteracoes ocorridas no âmnio empregado para a construcao de neovaginas e a presenca de receptores para estrogenio (REc) nesse epitelio. Metodos: um grupo de 33 pacientes jovens portadoras de agenesia vaginal, em sua maioria amenorreicas, com dificuldade ou impossibilidade de manter atividade sexual, submeteu-se a correcao cirurgica da anomalia pela tecnica de McIndoeBanister. Em cada uma das mulheres, a vaginoplastia criou uma cavidade ampla pela disseccao romba do espaco vesicoretal. Um molde de esponja sintetica revestido pelo condom e pela membrana amniotica era introduzido e fixado na cavidade criada. No 8o dia do pos-operatorio, o molde era retirado, permanecendo um neoepitelio em formacao, oriundo da metaplasia da membrana amniotica. Resultados: a microscopia eletronica de transmissao (MET) realizada em tecidos obtidos de biopsias das neovaginas mostrou caracteristicas semelhantes nas tres camadas destes epitelios, quer no citoplasma, quer nas organelas celulares em comparacao com mulheres normais. Comparou-se a intensidade de coloracao dos REc em cortes histologicos do neoepitelio vaginal do grupo de mulheres submetidas a neovaginoplastia pela tecnica de McIndoe modificada com mulheres normais no menacme. Os REc apresentaram intensidade distinta nas tres camadas da mucosa no grupo de mulheres em que foi elaborada a neovagina com revestimento de membrana amniotica. A analise do neoepitelio vaginal obtido com enxerto de membrana amniotica para correcao cirurgica de agenesia vaginal evidenciou pela MET caracteristicas de um epitelio vaginal trofico. Conclusoes: o tecido amniotico enxertado sofre um processo de transformacao completa e esta mudanca foi evidenciada a MET; os graus de intensidade dos REc das diferentes camadas do epitelio vaginal estudado, em cortes histologicos oriundos de mulheres no menacme, sao semelhantes aos cortes histologicos obtidos em biopsias de neovaginas revestidas com membrana amniotica.

Hand-foot-genital syndrome - analysis of two cases

Hand-food-genital syndrome (HFGS) is a rare genetic condition. This report describes the cases of two patients, aged 33 and 15, presenting related somatic abnormalities. HFGS stems from an autosomal anomaly linked to the HOXA 13 gene. Therapeutic procedures are discussed in order to identify the best treatment approach to the patients, as well as possible conditioning genetic anomalies.