Macroscopic and microscopic anatomy of the oviduct in the sexually mature rhea (Rhea americana)

The morphological characteristics of the oviduct of 12 sexually mature rheas (Rhea americana) were studied. Only the left oviduct is developed as a long tube with a length of 122 +/- 23.1 cm, and is subdivided into infundibulum (15.2 +/- 4.0 cm), magnum (63.3 +/- 9.4 cm), isthmus (5.6 +/- 3.1 cm), uterus (16.0 +/- 4.2 cm) and vagina (11.5 +/- 1.4 cm). The mucous membrane of the oviduct, as a whole, possesses luminal folds covered by ciliated columnar epithelium with secretory cells. The infundibulum part presents a cranial opening with thin and long fimbriae with few tubular glands in caudal tubular portion. In the magnum, the largest portion of the oviduct, the folds are thicker and are filled with tubular glands. The isthmus is short and presents less bulky folds and a few tubular glands. A bag-shaped uterus in the cranial area shows thin folds, and in the caudal region (shell gland) more ramified folds with few tubular glands. The vagina has long luminal folds and a thick muscular tunic; no glands with sperm-storage characteristics have been observed. In conclusion, the oviduct in sexually mature rhea has morphological similarities with the other species of birds already described; however it presents its own characteristics to produce a big egg.

Short-term urea feeding decreases in vitro hatching of bovine blastocysts

Cows fed high-protein diets may have impaired reproductive performance. Although the pathogenesis has not been completely elucidated, it appears that not only the uterus, but also the follicle and oocyte, are affected by excessive plasma urea nitrogen (PUN) concentrations. Thus, the objective was to determine the effects of short-term urea feeding on the competence of bovine oocytes. Forty crossbred heifers (Bos indicus vs Bos taurus) were allocated to two groups, namely CONTROL (maintenance diet) and UREA (maintenance diet supplemented with 75 g of urea/day), following a cross-over design. Heifers received their respective diets for 6 d (without adaptation). On the sixth day, blood samples were harvested both before and 3 h after feeding, and cumulus oocyte complexes (COCs) were collected by ovum pick-up. Although PUN concentrations were higher in UREA than CONTROL heifers (31.31 mg/dL +/- 1.13 vs 22.12 mg/dL +/- 0.86; mean +/- SEM), neither the number of COCs recovered (8.8 +/- 1.0 vs 9.2 +/- 0.8, UREA vs CONTROL, respectively) nor their quality (based on morphology) differed significantly between groups. Next, oocytes were fertilized and cultured in vitro to assess developmental rates. There was an absence of significant differences between groups for rates of cleavage (Day 3) or blastocyst formation (Days 6, 7 and 9), but the hatched blastocyst rate on Day 11 after fertilization was lower (P < 0.05) in the UREA than the CONTROL groups (64.3 vs 83.5%). Therefore, we inferred that the effects of urea were only manifest later in development. In conclusion, high PUN concentrations decreased oocyte competence in heifers, reinforcing the hypothesis that poor reproductive performance in cows with high PUN was due, at least in part, to a deleterious effect on oocytes. (C) 2011 Elsevier Inc. All rights reserved.

Human immature dental pulp stem cells` contribution to developing mouse embryos: production of human/mouse preterm chimaeras

In this study, we aimed at determining whether human immature dental pulp stem cells (hIDPSC) would be able to contribute to different cell types in mouse blastocysts without damaging them. Also, we analysed whether these blastocysts would progress further into embryogenesis when implanted to the uterus of foster mice, and develop human/mouse chimaera with retention of hIDPSC derivates and their differentiation. hIDPSC and mouse blastocysts were used in this study. Fluorescence staining of hIDPSC and injection into mouse blastocysts, was performed. Histology, immunohistochemistry, fluorescence in situ hybridization and confocal microscopy were carried out. hIDPSC showed biological compatibility with the mouse host environment and could survive, proliferate and contribute to the inner cell mass as well as to the trophoblast cell layer after introduction into early mouse embryos (n = 28), which achieved the hatching stage following 24 and 48 h in culture. When transferred to foster mice (n = 5), these blastocysts with hIDPSC (n = 57) yielded embryos (n = 3) and foetuses (n = 6); demonstrating presence of human cells in various organs, such as brain, liver, intestine and hearts, of the human/mouse chimaeras. We verified whether hIDPSC would also be able to differentiate into specific cell types in the mouse environment. Contribution of hIDPSC in at least two types of tissues (muscles and epithelial), was confirmed. We showed that hIDPSC survived, proliferated and differentiated in mouse developing blastocysts and were capable of producing human/mouse chimaeras.

Reproductive development and function of female rats exposed to di-eta-butyl-phthalate (DBP) in utero and during lactation

Phthalates are environmental contaminants used in the production of plastics, cosmetics and medical devices. Studies on the effects of phthalates on female reproductive health are particularly sparse and mostly restricted to high-dose exposure in rats. In the present study, pregnant rats were treated with 100 mg/kg-d of di-eta-butyl-phthalate (DBP) or only the vehicle (control group), from GD 12 to GD 20 for evaluation of reproductive outcomes and fetal gonads analysis (F0), and from GD 12 to PND 21 to evaluate reproductive development and function on F1 female offspring. Results showed that all parameters were comparable between groups, although there was a significant increase in the fetal weight after DBP exposure. However, the body weight at birth was normal. Based on these data we can conclude that, in these experimental conditions, DBP did not disturb the reproductive development or function of female rats. (C) 2009 Elsevier Inc. All rights reserved.

Induction of birth in the bandicoot (Isoodon macrourus) with prostaglandin and oxytocin

As in eutherians, maturation of the fetal pituitary and adrenal glands together with an increase in prostaglandin and mesotocin or oxytocin production initiates birth in marsupials. in this study, prostaglandin (Lutalyse) or oxytocin (Syntocinon) were administered to pregnant bandicoots at 05:00 h on the calculated day of birth and the resultant effects were filmed for analysis. The administration of prostaglandin caused the bandicoot to adopt the birth position several minutes after injection (n = 2). However, the bandicoot did not give birth for several hours. Birth occurred at a similar time of day to that observed for untreated bandicoots (n = 7), between 08:00 h and 12:00 h. After an injection of oxytocin, the bandicoot assumed the birth position and birth occurred within several minutes. The young were alive while still connected to their allantoic stalks. However, they were unable to attach to the teats and did not survive (n = 4). The induced young were the colour of venous blood and died soon after the umbilicus was separated, indicating that the cardiopulmonary system of these neonates was underdeveloped and inadequate to maintain life. The results from this study demonstrate that prostaglandin is required to prepare the bandicoot for birth, and mesotocin is required for contraction of the uterus and for birth to occur.

Role of PGF(2 alpha) and oxytocin in parturition in the brushtail possum (Trichosurus vulpecula)

Maturation of the fetal pituitary and adrenal glands allows the secretion of cortisol, which in turn leads to an increase in prostaglandin and mesotocin production. The production of prostaglandin and mesotocin results in an increase in uterine contractions and initiates birth in marsupials. The major metabolite of PGF(2alpha), 13,14-dihydro-15-keto-prostaglandin F-2alpha (PGFM), has been found in the plasma of the possum at the time of birth and administration of PGF(2alpha) to female possums induced the adoption of the birth position. Evidence that mesotocin is an integral hormone of birth in the tammar wallaby indicates that both PGF(2alpha) and mesotocin or oxytocin are required for marsupial birth. The presence of PGF(2alpha) receptors in the uterus and corpus luteum of the possum, and the in vitro uterine responsiveness to PGF(2alpha) or oxytocin, were examined. PGF(2alpha) receptors were not observed in possum uteri and the inability of PGF(2alpha) to cause contractions indicates that PGF(2alpha) is not involved directly in contraction of the uterus at parturition. The presence of oxytocin and mesotocin receptors in the uterus of possoms and the ability of oxytocin to induce uterine contraction in vitro supports the view that mesotocin is required for expulsion of the young from the uterus. Low numbers of PGF(2alpha) receptors were found in the possum corpus luteum at birth, indicating an involvement of PGF(2alpha) in regression of the corpus luteum.

Proportional cancer incidence according to selected sites: comparison between residents in the City of S. Paulo, Brazil: Japanese and Brazilian/Portuguese descent

The percentual distributions of selected sites of cancer cases according to origin, sex and age are compared. Data were obtained from the Registry of Cancer of S. Paulo (School of Public Health of the University of S. Paulo, Brazil). The reference period for inhabitants of Japanese descent was 1969/78 and for those of Brazilian descent, the period was 1969/75. Standardized Proportionate Incidence Ratios (SPIR) with approximate 95% Confidence Intervals (CI) were evaluated using age specific Incidence Ratios of S. Paulo, 1973, as standards. The results agree with findings of previous works on mortality, but show different patterns according to origin. The well known fact that some sub-groups of a population may be different from the overall group is once again brought to the fore. Attention should be drawn to the differences detected for stomach, skin and prostate, in males, and for stomach, skin, cervix and uterus in females.

Dissecting the role of CLASP1 in the mammalian development

A mitose é o evento celular, através do qual uma células transmite uma cópias do seu DNA às células filhas. Este processo é mediado pelo fuso mitótico, o qual consiste numa rede bipolar microtubulos. A dinâmica dos microtubulos é regulada por proteínas associadas a estes (MAPs – Microtubule-Associated Proteins), tais como as proteínas associadas às extremidades positivas dos microtubulos (+TIPs – Plus-ends Tracking proteins). As proteínas associadas às CLIPs (CLASPs – CLIP-associated proteins) pertencem a esta família e estão altamente conservadas nos eucariotas. Estas interagem com os microtubulos regulando o fuso mitótico, a segregação dos cromossomas e o comportamento dos microtubulos ao nível do cinetocoro. Assim, as CLASPs têm sido descritas como essenciais à manutenção da integridade genética durante a divisão celular. Um modelo animal knockout para o gene Clasp1 é uma ferramenta indispensável à descoberta do papel da CLASP1 a nível fisiológico. Nos animais knockout foi observado um fenótipo letal, no qual 100% dos recém-nascidos morreram poucos minutos após o nascimento, no decurso de falência respiratória. Após análise histopatológica, observamos que os pulmões dos animais knockout apresentam um atraso no desenvolvimento. Porém, a análise da expressão de marcadores de diferenciação celular, mostrou que os pneumócitos tipo I e II estão presente e diferenciados nos animais knockout aquando do seu nascimento. No entanto, um defeito primário a nível pulmonar ainda não pode ser excluído. Níveis elevados de glicogénio no parênquima alveolar dos animais knockout sugerem imaturidade pulmonar ou deficiente produção do líquido surfactante. Adicionalmente, ainda não está esclarecido de que forma pode este atraso explicar a letalidade observada nos recémnascidos knockout. Verificamos também que expressão de CLASP1 é transiente ao longo do desenvolvimento, sendo particularmente elevada no cérebro, o que pode explicar o seu papel já descrito na biologia dos neurónios. A CLASP1 é ubiquamente expressa em mamíferos adultos, o que sugere que esta proteína é também importante em tecidos diferenciados. Nesta fase, o significado biológico da CLASP1 em mamíferos ainda não foi descortinado. No entanto, nenhum animal knockout para Clasp1 foi capaz de sobreviver ex uterus, o que sugere um papel fundamental desta proteína na fase final do desenvolvimento dos mamíferos.

Symphysis-fundal height curve in the diagnosis of fetal growth deviations

OBJECTIVE: To validate a new symphysis-fundal curve for screening fetal growth deviations and to compare its performance with the standard curve adopted by the Brazilian Ministry of Health. METHODS: Observational study including a total of 753 low-risk pregnant women with gestational age above 27 weeks between March to October 2006 in the city of João Pessoa, Northeastern Brazil. Symphisys-fundal was measured using a standard technique recommended by the Brazilian Ministry of Health. Estimated fetal weight assessed through ultrasound using the Brazilian fetal weight chart for gestational age was the gold standard. A subsample of 122 women with neonatal weight measurements was taken up to seven days after estimated fetal weight measurements and symphisys-fundal classification was compared with Lubchenco growth reference curve as gold standard. Sensitivity, specificity, positive and negative predictive values were calculated. The McNemar χ2 test was used for comparing sensitivity of both symphisys-fundal curves studied. RESULTS: The sensitivity of the new curve for detecting small for gestational age fetuses was 51.6% while that of the Brazilian Ministry of Health reference curve was significantly lower (12.5%). In the subsample using neonatal weight as gold standard, the sensitivity of the new reference curve was 85.7% while that of the Brazilian Ministry of Health was 42.9% for detecting small for gestational age. CONCLUSIONS: The diagnostic performance of the new curve for detecting small for gestational age fetuses was significantly higher than that of the Brazilian Ministry of Health reference curve.

Vascularização do útero: estudo morfológico e experimental

RESUMO Os trabalhos de investigação, conducentes à elaboração do presente estudo morfofuncional, subordinado ao tema da "VASCULARIZAÇÃO ARTERIAL DO ÚTERO",fundamenta-se em conceitos da anatomia descritiva clássica, complementados por técnicas de estudo mais modernas, permitindo-nos observações originais. O principal objectivo é de definir um padrão descritivo da vascularização uterina e de estabelecer uma correlação anatomo-fisiológica e anatomo-clínica na descrição da angiomorfologia uterina, actualizando as descrições clássicas da artéria com dados de observação originais, segundo as técnicas de estudo angiomorfológicas correntemente empregues no Departamento de Anatomia da Faculdade de Ciências Médicas da Universidade Nova de Lisboa. Correlacionam-se as observações com os mais recentes dados publicados, no âmbito da imuno-histoquímica e da moderna bioquímica endocrinológica, uma vez que os conceitos modernos de fisiologia uterina e ginecológica praticamente dominam a vasta literatura científica mundial. Como objectivos particulares, ou linhas orientadoras da tese, escolhemos: - A definição de parâmetros descritivos do padrão genérico da vascularização uterina, actualizando a nomenclatura descritiva de acordo com a moderna Nomina Anatomica mundialmente debatida, desde o XIV Congresso Internacional da Federação Internacional das Associações de Anatomistas, sob a presidência do Prof. Doutor J.A. Esperança Pina (1994) e publicada em 1999-2001. - A comparação do caso humano com o do animal de experiência, por observação meticulosa do maior número de casos possíveis, realizando um estudo comparativo que nos permita extrapolar dados de experimentação animal para o caso humano; - O estabelecimento de uma correlação anatomo-fisiológica, por análise do comportamento da vascularização uterina, ao longo da vida, desde o nascimento até à menopausa, e perante as influências hormonais a que se encontra exposta. A tese constrói-se em torno de três núcleos fundamentais: 1. Um capítulo introdutório, de contextualização teórica, por enquadramento histórico dos estudos dos órgãos genitais femininos e da evolução das técnicas de diagnóstico e terapêutica do útero, focando as primeiras referências à técnica da histerotomia (Cesariana) (com a lenda persa do nascimento do herói Rostam, ou do nascimento do deus Asclepius), as primeiras representações da vascularização uterina (por LEONARDO e iii VESÁLIO), ou as primeiras descrições anatómicas do útero, da autoria de Portugueses (RODRIGO DE CASTRO, 1516 e AMATO LUSITANO, 1551). Prossegue a contextualização teórica com breve referência à recente evolução das técnicas de diagnóstico e terapêutica dos fibromiomas uterinos, mencionando de modo particular a evolução das técnicas de embolização arterial uterina, por nos parecer corresponder a um campo de aplicação imediata dos estudos da vascularização do útero. Termina este capítulo com breve referência aos trabalhos do Prof. Doutor J. MARTINS PISCO que tem actualmente, no nosso País uma das mais extensas listas de trabalhos efectuados com sucesso a nível mundial, no campo da embolização arterial de fibromiomas uterinos. 2. O segundo núcleo fundamental, intitulado "Angiomorfologia uterina" corresponde a extensa revisão bibliográfica dos estudos descritivos da vascularização uterina, desde logo ilustrando a resenha teórica com algumas imagens fotográficas de úteros humanos, seleccionadas da nossa colecção. A descrição da vascularização uterina, fundamentada em 1500 citações bibliográficas, organiza-se, de acordo com o paralelismo entre a estratificação histológica e angiológica do órgão, e a hierarquia funcional, regulada pelas cíclicas variações hormonais. Descreve-se a camada serosa e correspondente vascularização; a camada muscular e vascularização do miométrio; e, por fim, a camada mucosa e os vasos endometriais. Verifica-se, perante os dados colhidos da literatura mundial, o interesse do aprofundamento dos estudos morfológicos da microvascularização endometrial e da adaptação das descrições aos resultados dos modernos estudos funcionais obtidos por técnicas da imuno-histoquímica. 3. Fundamentados nos dados colhidos das revisões bibliográficas, elaborámos um projecto de investigação original, visando o estabelecimento da relação morfo-funcional resultante do aprofundamento dos estudos descritivos da angiomorfologia e da microvascularização do útero. O capítulo de trabalho experimental organiza-se em três principais passos: – No capítulo de Materiais e métodos, procede-se à escolha, por um lado do animal de experiência mais adequado para os estudos da vascularização uterina (por estudo comparativo ao longo da escala animal) e, por outro lado, à escolha de três das técnicas disponíveis no Laboratório de Anatomia Experimental e aplicáveis à investigação angiomorfológica do útero; iv - No capítulo de Resultados, procedemos à exposição das nossas observações de 25 úteros humanos e de 154 úteros de animais de experiência, segundo as três técnicas seleccionadas (dissecção, Injecção-corrosão-fluorescência, Injecção-diafanização e injecção-corrosão paraobservação de moldes vasculares em microscopia electrónica de varrimento), organizando aselecção da vasta iconografia coleccionada em três novos subcapítulos: o útero humano, oútero do animal de experiência e um estudo comparativo, essencial para validar osresultados do trabalho experimental. - O capítulo de trabalho experimental, inteiramente efectuado por estudos na artéria uterina do rato Wistar, abrange primeiramente a tentativa de definição macroscópica de territórios de vascularização, seguido das observações microscópicas conducentes à definição dos parâmetros angiomorfológicos característicos de cada uma das etapas da grande variabilidade a que se sujeita a vascularização uterina, ao longo da vida, incluindo a infância, a gravidez, a paridade e o envelhecimento, e consoante as fases do ciclo hormonal ovárico. Aperfeiçoámos essa tarefa com a elaboração de três experiências distintas, para análise dos efeitos microvasculares uterinos da administração exógena de preparados comerciais hormonais, por observação em microscopia electrónica de varrimento. De acordo com as leituras da literatura clássica sobre a metodologia do trabalho científico, completamos os trabalhos por um capítulo de síntese e critica dos resultados, sequencialmente organizado consoante cada um dos passos experimentais atrás referidos. SUMMARY The aim of the present thesis is the description of the uterine arterial network, complementing the classical concepts of descriptive Anatomy with modern techniques of anatomical research, thus achieving original final results and observations. One of the main objectives of the research is to establish physiological and clinical correlations in the description of the uterine angiomorphology, with the techniques currently available for angiomorphological research in the Department of Anatomy of Faculty of Medical Sciences of the New University of Lisbon. As guidelines to our research, we established the following specific objectives: - defining the descriptive parameters of the standard pattern of the uterine vasculature, according to the modern Nomina Anatomica, as underlined in the latest Federative Congresses of the International Federation of the Associations of Anatomists, one of which took place in Lisbon, in 1994, under the presidency of Professor J.A. Esperança Pina, the supervisor of the present works; - comparing the human uterus with the uterus of the experimental animal, to extrapolate the experimental observations in animals to the particular case of the human uterus; - establishing a correlation between the physiology and the anatomical observations of the uterine vasculature throughout life, from childhood to menopause and in relation to the hormonal influences to which the uterus is exposed. The thesis is built around three main chapters: 1) The introduction chapter defines the historical framework of the studies of the female genital anatomy and the historical evolution of the clinical management of common uterine diseases, focusing on the first historical references to the Caesarean section (such as the Persian legend of the birth of the hero ROSTAM, or that of the birth of ASCLEPIUS, the Greek god of Medicine); the first depictions of the uterine vasculature (by LEONARDO and VESALIUS) or the first anatomical descriptions of the uterus, by Portuguese authors (RODRIGO DE CASTRO, 1517, or AMATUS LUSITANUS, 1551). The theoretical context proceeds, with reference to the recent evolution of the clinical and surgical management of uterine fibroids, and a particular mention to the modern techniques of Uterine Fibroid Embolisation, which corresponds to one of the fields of interest of the anatomic studies of uterine arterial vascularization. 2) The second chapter, devoted to the anatomical description of the Uterine Angiomorphology, is based on an extensive review of the available Medical literature,illustrated by a selection of our own research observations of the human uterine vasculature. The description is organized in view of the parallelism between histological and angiological stratification and the functional hierarchy, under the control of the cyclic hormonal variations. Each layer of the uterine wall is depicted with photographs of the human uterus and descriptions of its specific vascular network: the serosa, the muscular Myometrium, and the mucosa, or endometrium. This classical description, based on extensive quotations of the international scientific literature, enhances our interest for the research of a more detailed knowledge of the endometrial microvascular network, accordingly to the modern physiologic results obtained through immunohistochemical studies. 3) The results of our experimental research, aiming to establish the intimate relationship between the anatomical and functional studies of uterine vasculature, are organized in three main steps: - The chapter of Materials and Methods debates the choice of the experimental animal, based on a short review of the comparative anatomy of the uterus, and uterine physiology, throughout the animal scale. The selection of three fundamental techniques of anatomic research is made from the current variety available in the Laboratory of Experimental Anatomy of the Lisbon School of Medical Sciences. - The Results of our personal research and observations of 25 human and 154 animal uteri,after dissection, and the techniques of arterial injection for the preparation of fluorescent corrosion casts, of vascular injection and clearing, and of arterial injection and preparation of corrosion casts for Scanning Electron Microscopy are rganized in terms of human or animal macroscopic anatomy and microvascular network, followed by a summary of the comparative anatomy of human and rat uteri, which is essential to validate the resultant experimental observations of the rat endometrial microvasculature. - The experimental research is entirely devoted to the uterine artery of the Wistar rat. The first step consists of the attempt to define macroscopic territories of vascularization, followed by microscopic observations for the definition of the angiomorphological pattern that is characteristic of each stage of the extreme variations to which the uterus is subject throughout life, from childhood to sexual maturity, throughout the hormonal cycle, in pregnancy, according to parity, and through ageing. We complete these observations with the experimental exposure of the Wistar rat uterus to pharmacologic preparations of hormones, currently available in clinical practice, and observations of the vascular uterine changes in Scanning Electron Microscopy. The outcome results of our anatomical observations are followed by a critical synthesis of the results.

Laparoscopic Assisted Vaginal Hysterectomy Versus Vaginal Hysterectomy

Introduction: Hysterectomy is the commonest gynecologic operation, performed for malignant and benign conditions. There are many approaches to hysterectomy for benign disease. Studies comparing the techniques have showed that vaginal hysterectomy has benefits in terms of reduced hospital stay, faster recovery and less operating time. Objective: The purpose of this study is to compare the surgical and immediate postoperative outcomes of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) with those of Vaginal Hysterectomy (VH). Methods: Retrospective descriptive study, comparing two groups of women who underwent LAVH or VH in our department during a 24 months period, from January 2009 to December 2010. The two groups were compared regarding age, vaginal deliveries, previous abdominal surgery, uterine and adnexal pathology, intra-operative and post-operative complications, uterus weight, blood loss and number of days until discharge. Results: In our study 42 LAVH and 99 VH were included, with a patient mean age of 47 and 59, respectively. The most frequent indication for hysterectomy was fibroids (80%) for LAVH and POP(58.6%) for HV. In LAVH group 47.6% of patients had previous abdominal surgery, vs 28.2% in VH group. The medium operative time was 167 minutes for LAVH vs 99 minutes for HV. The intra-operative complications were one case (2%) of accidental incision of rectum in LAVH, and one bladder incision in the VH (1%). There were 3 conversions to laparotomy for difficult technique (7%) in LAVH group. There were no significant post-operative complications for LAVH. In VH group there were 2 cases of haemoperitoneum (2%) and 1 case requiring blood transfusion (1%). The mean time for discharge was 4.23 days for LAVH and 4.46 days for VH. Conclusions: In our study, the main advantage for VH was the reduced operative time. In terms of time to discharge there was no difference between the 2 groups. The main intra-operative complication of LAVH was the risk of conversion to laparotomy, but post-operatively this procedure had fewer complications than VH. In conclusion, LAVH is a safe option for women requiring hysterectomy in cases where VH is anticipated to be technically difficult.

McCune Albright Syndrome: A Diagnosis to be Kept in Mind

Precocious puberty, defined as the development of secondary sexual characteristics before the age of 8, often leads to anxiety in patients and their families but also in clinicians searching for the final diagnosis. After adequate investigation, the majority of the cases in girls turn out to be idiopathic. The authors present a case of McCune Albright syndrome in order to call attention to a rare cause of sexual precocity and the value of ultrasound in the evaluation of these situations. 10 years old infant girl admitted in our department due to irregular menstrual bleeding. She experienced a vaginal bleeding by the age of 3 which led to the diagnosis of McCune Albright Syndrome after a complete evaluation. Pubertal assessment revealed a reversed sequence in the remaining events with adrenarche at 5 and thelarche at 8. Hormonal evaluation demonstrated low FSH and LH levels (11,2 and 6,72 respectively) with high estrogen (204). Pelvic ultrasound showed a normal sized uterus (73x 29x32 mm), endometrial thickness of 5 mm and ovaries with several microfollicles and a copus luteum measuring 23 mm in the right ovary. McCune Albright syndrome is a very uncommon cause of sexual precocity that should, however, be suspected in all infant girls who present with vaginal bleeding. It is characterized by a triad: polyostotic fibrous dysplasia, gonadotropin-independent precocious puberty and café-au-lait skin spots. Due to autonomous production of estrogen by the ovaries, ultrasound image of the female reproductive tract is inconsistent with chronologic age. Pelvic ultrasound demonstrates a normal sized uterus with a well defined cervix and clearly identified ovaries with several follicles, similar to adult women of reproductive age. Ultrasonography of the pelvis has also an important role excluding other causes of GnRH-independent precocious puberty conditions like ovarian cysts or tumors.

Two Gestational Sacs, Two Locations - Heterotopic Pregnancy - Case Report

Introduction: Heterotopic pregnancy (HP) is defined as two gestational sacs simultaneously present in two different locations, being the uterus and the fallopian tubes the more common. Sporadic HP is a very rare condition (1:30,000 pregnancies). With the use of medically assisted reproduction the prevalence is significantly higher(1:7,000). Considering spontaneous pregnancy, HP is associated with risk factors, being prior inflammatory pelvic disease the most common. The clinical presentation is similar to that of ectopic pregnancy or spontaneous miscarriage although it is usually a more late diagnosis. Case report: 25 year-old pregnant woman, OI 0000, previously healthy; admitted at the Emergency Department (ED) with acute pelvic pain mainly at the right iliac fossa and moderate vaginal bleeding confirmed by speculum examination. She was hemodynamically stable and the bimanual palpation was painful; no prior medically assisted reproduction technique had been performed. The haemoglobin value was within normal range and the serum β-hCG was 2,763mUI/mL. The ultrasonography at the ED showed an in uterus gestational sac and another one inside the right fallopian tube; in both gestational sacs cardiac activity was absent. HP diagnosis was then established and the patient was admitted at the Obstetrics Ward for surveillance and ultrasonographic/laboratorial reassessment; complete miscarriage of the uterine pregnancy occurred but methotrexate was necessary for the treatment of persistent tubarian pregnancy. Conclusion: When evaluating a pregnant woman with pelvic pain and vaginal bleeding one should always be aware of several differential diagnosis amongst which HP should be considered. If the patient has in uterus viable pregnancy the treatment of the ectopic concomitant gestational sac should be as conservative as possible; methotrexate should not be used in that situation as it leads to uterine pregnancy miscarriage in about one third of the patients.

Dirofilariasis involving the oral cavity: report of the first case from South America

Oral dirofilariasis is very rare with non-specific clinical manifestations. Here, we report the case of a 65-year-old South American woman with a submucosal nodule on her right buccal mucosa. The nodule was slightly tender and painful. Differential diagnoses included mesenchymal (lipoma or fibrolipoma, solitary fibrous tumor, and neurofibroma) or glandular benign tumors (pleomorphic adenoma) with secondary infections. We performed excisional biopsy. A histopathological examination revealed a dense fibrous capsule and a single female filarial worm showing double uterus appearance, neural plaque, well-developed musculature and intestinal apparatus. Dirofilariasis was diagnosed, and the patient was followed-up for 12 months without recurrence.

Unusual abdominal tumors with intracardiac extension. Two cases with successful surgical resection

Abdominal tumors that can grow through vascular lumen and spread to the right heart are rare. Although these tumors have different histologic aspects, they may cause similar abdominal and cardiac symptoms and are a serious risk factor for pulmonary embolism and sudden death when they reach the right atrium and tricuspid valve. The best treatment is radical surgical resection of the entire tumor using cardiopulmonary bypass with or without deep hypothermia and total circulatory arrest. We report the cases of two patients, the first with leiomyosarcoma of the inferior vena cava and the other with intravenous leiomyomatosis of the uterus that showed intravascular growth up to right atrium and ventricle, who underwent successful radical resection in a one-stage procedure with the use of cardiopulmonary bypass. We discuss the clinical and histologic aspects and imaging diagnosis and review the literature.