Rol de la laparoscopia en la infertilidad inexplicada: Experiencia del Hospital Clínico de la Pontificia Universidad Católica de Chile

Antecedentes: Existe una tendencia global creciente de no realizar laparoscopia diagnóstica en el estudio de pacientes con infertilidad inexplicada e histerosalpingografía normal. Este tipo de manejo podría tener ciertos inconvenientes dado que existen lesiones, especialmente tuboperitoneales, que no son diagnosticadas y pudiesen influir en los resultados. Nuestro grupo maneja estas pacientes con laparoscopia diagnóstica/terapéutica y posteriormente tres ciclos de inseminación intrauterina. Objetivos: Validar nuestro manejo de la infertilidad inexplicada, estimar la frecuencia de patología pélvica en pacientes con infertilidad inexplicada con histerosalpingografía normal, evaluar la tasa de embarazo posterior a la resolución laparoscópica de su patología y revisar la literatura existente. Resultados: Se revisaron todas las cirugías laparoscópicas realizadas en pacientes con infertilidad inexplicada del Hospital Clínico de la Universidad Católica, entre los años 2007-2011. De estas, 57 pacientes cumplían los criterios de inclusión y 39 recibieron al menos 1 ciclo de inseminación intrauterina posterior al procedimiento. El 82,4% de las pacientes presentaron hallazgos a la laparoscopia, siendo los más prevalentes la endometriosis grado I y II (57,8%), y las adherencias pelvianas (43,8%). De las 57 pacientes que fueron sometidas a laparoscopia diagnóstica/terapéutica, sólo 25 completaron 3 ciclos de inseminación intrauterina posterior, 8 lograron concepción (32%). Conclusión: Nuestros resultados son similares a los expuestos en otros trabajos en términos de hallazgos patológicos y tasa de fertilidad post laparoscopia. Dado el escaso acceso a técnicas de fertilización in vitro en nuestro medio, nuestro manejo plantea una excelente alternativa para este grupo de pacientes

Genetic diversity of Mycoplasma hyopneumoniae isolates from conventional farrow-to-finish pig farms in Serbia

Mycoplasma hyopneumoniae is a primary agent associated with mycoplasma pneumonia and the porcine respiratory disease complex (PRDC). Various reports have indicated that different strains of M. hyopneumoniae are circulating in the swine population. Lysates from lung swabs from naturally infected pigs of different ages were tested according to a new variable number of tandem repeats (VNTR) genetic typing method based on the polyserine repeat motif of the P146 lipoproteoadhesin, which can be applied directly on clinical material without isolation of M. hyopneumoniae . The aim was to determine the diversity of M. hyopneumoniae isolates from conventional farrow-to-finish pig farms located in different geographical areas of Serbia. PCR amplification was carried out using M. hyopneumoniae -specific designed, conserved primers (p146MH — L and p146MH — R) flanking the region encoding the repeat motif, followed by sequencing and cluster analysis. Five groups of M. hyopneumoniae with thirteen to twenty-four serine repeats were observed. Analysis of three samples from each farm indicated that the specific isolate is ubiquitous in pigs of different ages. Furthermore, seven clusters were observed within 27 tested samples. The results indicated a considerable diversity among M. hyopneumoniae field isolates in the swine population from conventional farrow-to-finish farms in Serbia and suggest close genetic relatedness of the corresponding isolates

First isolation of methicillin-resistant Staphylococcus aureus from pigs’ clinical samples in Serbia

Methicillin-resistant Staphylococcus aureus is a highly important human pathogen that is also a significant concern in veterinary medicine. Despite the high prevalence of colonization, clinical infections with methicillin-resistant Staphylococcus aureus appear to be rare in pigs. Methicillin-resistant Staphylococcus aureus was isolated from a sow with endometritis and her five piglets with dermatitis originating from a Serbian farm. Identification of the strains was done by automated system and confirmed by polymerase chain reaction for mecA and nuc genes. Detection of Staphylococcal Cassette Chromosome mec type was performed by multiplex polymerase chain reaction. Antimicrobial susceptibility testing on erythromycin, clindamycin, gentamicin, kanamycin, tobramycin, ciprofloxacin, tetracycline, trimethoprim/sulfamethoxazole and vancomycin was done by disc diffusion method. Six isolated strains from the infected sow and her piglets showed resistance only to tetracycline beside resistance to all beta-lactam antibiotics. In the tested methicillin-resistant Staphylococcus aureus isolates, Staphylococcal Cassette Chromosome mec type V was present. To our knowledge, this finding is the first documented detection of methicillin-resistant Staphylococcus aureus from pigs’ clinical samples in Serbia. The results of our study indicate the emergence of methicillin-resistant Staphylococcus aureus in a pig farm in Serbia highlighting the threat of this antibiotic-resistant microorganism as a pathogen causing both animal and human infections

A Very Rare Case of Colosalpingeal Fistula Secondary to Diverticulitis: An Overview of Development, Clinical Features and Management.

BACKGROUND: Colosalpingeal fistula is a rare complication secondary to diverticular disease. The pathogenesis is still not clearly understood. We present the case of a colosalpingeal fistula and a review of the management of this pathology. CASE REPORT: A 69-year-old patient with uncomplicated diverticular disease was referred to our department for recurrent vaginal discharge. The clinical examination was unremarkable, hysteroscopy revealed the presence of air in the uterine cavity in the absence of a uterine fistula. A preliminary diagnosis of colosalpingeal fistula was made and was confirmed by computed tomography (CT) scan and hysterosalpingography. A one-stage surgery via laparotomy was successfully performed with remission of the symptoms. CONCLUSION: Colotubal fistula is a rare complication resulting from intestinal diverticular disease. The purpose of this paper was to emphasize the presence of a rare, but serious complication occurring in diverticular disease with atypical symptoms and one-stage surgery treatment

PROCEDIMIENTO DE ESCISIÓN ELECTRO-QUIRÚRGICA POR ASA TÉRMICA Y RIESGO DE PARTO PREMATURO: UNA REVISIÓN SISTEMÁTICA DE LA LITERATURA

Antecedentes: A diferencia de la conización cervical por cono frío, no se ha podido demostrar una clara asociación entre el procedimiento de escisión electro-quirúrgica por asa térmica (LEEP) y el riesgo de parto prematuro. Objetivo: Análisis crítico de la literatura científica, en relación al riesgo de presentar un parto prematuro en pacientes que han sido sometidas a LEEP, y los resultados materno-perinatales asociados. Búsqueda sistemática en múltiples bases de datos. Resultados: Se encontraron sólo tres artículos que cumplían los criterios de inclusión, los cuales son incluidos en esta revisión. De éstos, el primero muestra que el LEEP no aumenta el riesgo de parto prematuro ni de recién nacidos de bajo peso. El segundo evidencia un aumento del riesgo de rotura prematura de membranas y parto prematuro secundario a esto, pero no de parto prematuro espontáneo. Sin embargo, el tercero, señala que el LEEP se asocia en forma significativa a riesgo aumentado de parto prematuro, parto prematuro secundario a rotura prematura de membranas y recién nacidos de bajo peso. Los tres estudios son de cohortes retrospectivas, lo cual les otorga un nivel de evidencia de tipo 2b. Conclusión: La evidencia indica que la excision de la zona de transformación a través del uso de LEEP está asociada a un pequeño, pero real incremento del riesgo de presentar un parto de prétermino.<br>Background: Unlike cold-knife conization, studies have shown conflicting results on the outcome of pregnancy following loop electrosurgical excision procedure (LEEP). Objective: Critical analysis of the literature to establish if the LEEP treatments increase risk of preterm delivery and its influence in maternal-perinatal results. Results: Only three studies were filling the inclusion criteria. The first study does not show that LEEP treatment increase risk of preterm delivery and low birth weight. The second study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, but not spontaneous preterm delivery. Nevertheless, the third study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, spontaneous preterm delivery and low birth weight. The three studies are based in retrospective cohorts, which grant them a level of evidence of type 2b. Conclusion: The evidence indicates that loop excision of the transformation zone by LEEP is associated with a small but real increase the risk of preterm delivery