Articles - Revista Brasileira de Ginecologia e Obstetrícia

PURPOSE: to present a series of cases of umbilical endometriosis in patients in reproductive age, with no previous pelvic surgery. METHODS: four patients aged between 33 and 43 years were included in the study. They all presented umbilical bleeding associated or not with pelvic pain, and medical history varied from two months to four years. Abdominal wall ultrasound was performed for diagnosis support before surgical excision of the umbilical lesions, and histological examination was also performed. RESULTS: the ultrasonographic evaluation of the four patients showed hypoechogenic umbilical lesion suggestive of endometriosis. All patients were submitted to surgical excision and histological examination of the lesions. CA-125 serum levels were measured in three of the patients, but they were within normal ranges (from 6.8 to 10.1 U/mL). In addition to umbilical surgery, laparoscopy was performed in all patients, but only one presented concomitant pelvic endometriosis. In a one-year follow-up, patients maintained asymptomatic and there was no recurrence of the lesions. CONCLUSIONS: umbilical endometriosis is a rare entity, but it may be remembered as a possibility in cases of umbilical nodulations or bleeding, even if there is no previous history of pelvic surgery with endometrial manipulation. Its treatment is always surgical and, in general, it is enough to promote complete elimination of the lesion and of the symptoms.

The present context of medical practice demands from the obstetrician and gynecologist broad understanding of the scientific and technological advances of the area. The main purpose of prenatal evaluation is to identify fetuses at risk for adverse events or death, for preventive action to avoid mishappenings. The determination of fetal biophysical profile reaches its maximum efficiency when applied within the clinical context of each case. In high risk gestations, the Doppler velocimetry of the umbilical artery has shown to be useful to improve perinatal outcome. In the fetal growth deficit, due to severe placentary insufficiency, Doppler velocimetry of the venous duct has been showing to be an important tool in handling of the cases before the 34th week of gestation. Although no test itself is considered the best to evaluate the fetus’s prenatal vitality, the joint analysis of all methods may lead to a better understanding of the fetal response to hypoxia.

PURPOSE: to compare the effects of functional electrostimulation of the pelvic floor and therapy with cones in women with stress urinary incontinence (SUI). METHODS: randomized clinical study for which 45 patients with SUI were selected. The effects of functional electrostimulation of the pelvic floor were evaluated in the SUI treatment of 24 women, with the use of clinical data (micturition diary, pad test and a questionnaire about quality of life – I-QoL). The patients were submitted to two 20′ weekly sessions for four consecutive months, under the supervision of a physiotherapist. The electrode used had 10 cm length and 3.5 cm width with a double metallic ring and a cylindrical shape, positioned in the medium third of the vagina. The electric parameters used were: intensity varying from 10 to 100 mA and 50 Hz of fixed frequency, with pulse duration of 1 ms. Also, we evaluated 21 patients who were submitted to vaginal cone treatment. The cone therapy was done with two 45 minute sessions per week. The cones’ weight varied from 20 to 100 gr. RESULTS: there was no difference between the outcomes of electrostimulation of the pelvic floor and the vaginal cones for the treatment of SUI (p>0.05). After four months, there was a significant improvement in the I-QoL index of the patients treated both with electrostimulation (40.3 versus 82.9) or with the cones (47.7 versus 84.1). There was a significant decrease in pad weight in both groups, measured before and after the treatment (28.5 and 32 g versus 2.0 and 3.0 g for the electrostimulation and cone group, respectively). Finally, there was a significant decrease in the number of urinary leakage evaluated by the micturition diary in both groups (p<0.0001). CONCLUSIONS: both electrostimulation and vaginal cones were effective in the treatment of women with SUI.

PURPOSE: To evaluate the anatomical distribution of deep infiltrating endometriosis (DIE) lesions in a sample of women from the South of Brazil. METHODS: A prospective study was conducted on women undergoing surgical treatment for DIE from January 2010 to January 2012. The lesions were classified according to eight main locations, from least serious to worst: round ligament, anterior uterine serosa/vesicouterine peitoneal reflection, utero-sacral ligament, retrocervical area, vagina, bladder, intestine, ureter. The number and location of the DIE lesions were studied for each patient according to the above-mentioned criteria and also according to uni- or multifocality. The statistical analysis was performed using Statistica version 8.0. The values p<0.05 were considered statistically significant. RESULTS: During the study period, a total of 143 women presented 577 DIE lesions: uterosacral ligament (n=239; 41.4%), retrocervical (n=91; 15.7%), vagina (n=50; 8.7%), round ligament (n=50; 8,7%), vesico-uterine septum (n=41; 7.1%), bladder (n=12; 2.1%), and intestine (n=83; 14.4%), ureter (n=11; 1.9%). Multifocal disease was observed in the majority of patients (p<0.0001), and the mean number of DIE lesions per patient was 4. Ovarian endometrioma was present in 57 women (39.9%). Sixty-five patients (45.4%) presented intestinal infiltration on histological examination. A total of 83 DIE intestinal lesions were distributed as follows: appendix (n=7), cecum (n=1) and rectosigmoid (n=75). The mean number of intestinal lesions per patient was 1.3. CONCLUSIONS: DIE has a multifocal pattern of distribution, a fact of fundamental importance for the definition of the complete surgical treatment of the disease.