Resumo Objetivo Avaliar se existe alguma relação entre os valores plasmáticos de progesterona no dia da transferência de um blastocisto desvitrificado em ciclos hormonalmente substituídos e a taxa de gravidez, aborto ou nascido vivo. Métodos Estudo observacional, ambispectivo, incluindo todos os ciclos de transferência de blastocistos congelados no nosso departamento, entre maio de 2018 e junho de 2019. Avaliou-se a taxa de gravidez e de nascidos vivos após 24 semanas de gestação. Os grupos foram comparados de acordo com os valores de progesterona plasmáticos dosados no dia da transferência do blastocisto: comparou-se o 1° quartil com os outros e depois os 2° e 3° quartis com o 4°. Resultados Avaliaram-se 140 transferências: 87 com β gonadotrofina coriônica humana (β-HCG)>10 IU/L (62%), 50 das quais terminaram em nascido vivo (36% do total), enquanto 37 tiveram um aborto (42% das gravidezes). Verificou-se uma tendência para menor número de recém-nascidos nas transferências com níveis de progesterona no 1° quartil (<10.7ng/mL) (26 versus 39%; p>0.05) e ummaior número de abortos (64 versus 33%; p<0.01). Comparando o 2° e 3° quartis com o 4°, verificouse que nos casos em que a progesterona estava acima do percentil 75, apesar de uma taxa de gravidez semelhante (60 versus 57%; p>0.05), houve uma tendência para uma maior taxa de nascidos vivos (43 versus 31%; p>0.05) emenor número de abortos (28 versus 45%; p>0.05) abaixo do percentil 75. Estas diferenças não foram estatisticamente significativas. Conclusão Não se verificaram diferenças estatisticamente significativas para taxa de gravidez e de nascido vivo. A taxa de aborto foi maior no primeiro quartil.

Abstract Objective To establish a relationship between serum progesterone values on the day of frozen blastocyst transfer in hormone-replaced cycles with the probability of pregnancy, miscarriage or delivery. Methods This was an ambispective observational study including all frozen-thawed embryo transfer cycles performed at our department following in vitro fecundation from May 2018 to June 2019. The outcomes evaluated were β human chorionic gonadotropin (β-hCG)-positive pregnancy and delivery. Groups were compared according to the level of serum progesterone on the day of embryo transfer: the 1st quartile of progesterone was compared against the other quartiles and then the 2nd and 3rd quartiles against the 4th quartile. Results A total of 140 transfers were included in the analysis: 87 with β-HCG>10 IU/L (62%), of which 50 (36%) delivered and 37 had a miscarriage (42%).Women with lower progesterone levels (< 10.7ng/mL) had a trend toward higher β-HCG-positive (72 versus 59%; p>0.05), lower delivery (26 versus 39%; p>0.05) and higher miscarriage rates (64 versus 33%; p<0.01). Comparing the middle quartiles (P25-50) with those above percentiles 75, the rate of pregnancy was similar (60 versus 57%; p>0.05), although there was a trend toward a higher number of deliveries (43 versus 31%; p>0.05) and a lower number of miscarriages (28 versus 45%; p>0.05). These differences were not statistically significant. Conclusion There were no differences in pregnancy and delivery rates related with the progesterone level when measured in the transfer day. The miscarriage rate was higher in the 1st quartile group.

ABSTRACT Introduction and objectives: Gender identity is the internal and individual experience of the gender as each person feels it. In some cases, the acquisition of secondary sexual characteristics of the other gender is important in the process of gender reassignment, with endocrinological treatment being important. The question is whether prolonged administration of androgens is safe in cases of transsexual women to men, since there is little scientific evidence in the long term. The aim of this study is to analyze the clinical characteristics of trans patients in our unit, and the anatomopathological findings of the surgical pieces of hysterectomy and double adnexectomy, to see the influence of androgen therapy on the female internal genitalia. Methods: This is a descriptive study where demographic and clinical data of the patients referred for genital surgery were analyzed, as well as the results of the anatomopathological study of the hysterectomy and adnexectomy pieces were analyzed. Results: 66 patients were included, of which 59 were intervened. No malignancy was found in any of the surgical pieces, but several benign findings such as myomas, endometrial atrophy / proliferation, follicular activity in ovaries or ovaries like polycystic ovary syndrome. Conclusions: Long-term exposure to androgens does not seem to produce malignant changes in uterine or ovarian histology, however, it often leads to changes in ovarian activity and architecture, with functional ovaries being seen in most cases and even similar ones. those observed in women with polycystic ovary.

RESUMEN Introducción y objetivos: La identidad de género es la vivencia interna e individual del género tal como cada persona la siente. En algunos casos, la adquisición de los caracteres sexuales secundarios del otro género es importante en el proceso de reasignación de género, siendo importante el tratamiento endocrinológico. La cuestión es si la administración prolongada de andrógenos es segura en los casos de pacientes transexuales mujer a hombre, ya que es poca la evidencia científica a largo plazo. El objetivo de este estudio es analizar las características clínicas de los pacientes trans de nuestra unidad, y los hallazgos anatomopatológicos de las piezas quirúrgicas de histerectomía y doble anexectomía, para ver la influencia de la androgenoterapia en los genitales internos femeninos. Métodos: Se trata de un estudio descriptivo donde se analizaron datos demográficos y clínicos de los pacientes remitidos para cirugía genital, así como se analizaron los resultados del estudio anatomopatológico de las piezas de histerectomía y anexectomía. Resultados: Se incluyeron 66 pacientes, de los que 59 se intervinieron. No se halló malignidad en ninguna de las piezas quirúrgicas, sí diversos hallazgos benignos como miomas, atrofia/proliferación endometrial, actividad folicular en ovarios u ovarios tipo síndrome de ovario poliquístico. Conclusiones: La exposición a andrógenos a largo plazo no parece producir cambios malignos en la histología uterina ni ovárica, sin embargo, a menudo lleva a cambios en la actividad y la arquitectura ovárica, apreciándose en la mayoría de los casos ovarios funcionales e incluso semejantes a los observados en mujeres con ovario poliquístico.

Peritoneal tuberculosis is an uncommon form of extra-pulmonary tuberculosis. A 53-year-old female presented with weight loss, fever and abdominal pain with abnormal vaginal discharge. On physical examination rebound lower abdominal tenderness, leucorrhoea and painful cervical motion were noted. Intravenous antibiotics were started, assuming the diagnosis of pelvic inflammatory disease, without clinical improvement and a pelvic MRI was done that showed signs consistent with peritoneal carcinomatosis. Surgical peritoneal biopsies showed multiple granulomas with central necrosis. Tuberculosis treatment was started with clinical improvement. Among suspicious cases peritoneal biopsies are essential to confirm the diagnosis of peritoneal tuberculosis.

Overview: The office “see and treat” hysteroscopy has become to some authors the gold standard for the diagnosis and treatment of intrauterine pathology. It is associated with lower costs and greater safety for the patient. However, this model can be limited by the patient's discomfort or pain, due to the lack of analgesia and by the dimensions of the mass that are removed. Study objective: To compare the costs of office hysteroscopy with ambulatory hysteroscopy within a public and a private institution. Methods: In the public hospital calculus were carried out by using DRG (“DiagnosisRelated Group”) tables. In the private health unit, calculations were made according to the insurance company tables, assuming an average cost to the healthcare provider. A comparison between the three surgical hysteroscopy models was performed. Results and Conclusions: The costs associated with the procedure are different in the public hospital and private institutions. However, the model of office hysteroscopy, in both systems, has shown to be associated with significantly lower costs.