Evaluation of internal markers in digestibility estimation for sheep and goats.

The objective of this study was to compare the indirect methods of obtaining digestibility with the direct method of total fecal collection to estimate the apparent digestibility of nutrients in sheep and goats supplemented with non-protein nitrogen. Five goats and five sheep with no defined racial pattern were used, distributed in two 5 × 5 Latin squares, with split plots, considering the diets as plots and the apparent digestibility determination methodologies as subplots. The diets were composed of buffelgrass hay and the addition, via ruminal infusion, of increasing amounts of nitrogen supplementation in order to gradually raise the CP level of the basal diet in intervals of 2% points, that is, + 2, +4, + 6 and + 8%. Samples of the feeds offered, and the leftovers were collected daily during the five days of collection to determine the nutrient intake, as well as the total collection of feces to determine the apparent digestibility of the nutrients. The amount of fecal dry matter excreted was estimated by the concentration of Indigestible Acid Detergent Fiber (ADFi), Indigestible Neutral Detergent Fiber (NDFi), Indigestible Dry Matter at 244 h (DMi 244 h) and Indigestible Dry Matter at 264 h (DMi 264 h). Among the evaluated markers, DMi 264 h had the lowest accuracy in estimating fecal excretion and nutrient digestibility. For the goat species, the markers ADFi and DMi 244 h proved to be able to adequately predict fecal excretion and digestibility indices, while NDFi stood out for both species. Among the evaluated markers, NDFi is the one that most accurately estimates the nutrient digestibility of the diet for goats and sheep.

Forage cactus as an additive in corn without the cob silages of feedlot sheep diets.

This study aimed to assess the impact of adding forage cactus as an additive to the production of corn silage without the cob on the performance of feedlot sheep and subsequent silage losses. The experimental design was completely randomized, consisting of three treatments: corn silage without cob; 0% = 100% corn plant without the cob; 10% = 90% corn plant without cob + 10% forage cactus; 20% = 80% corn plant without cob + 20% forage cactus. Significant effects were observed for dry matter intake (P = 0.0201), organic matter (P = 0.0152), ether extract (P = 0.0001), non-fiber carbohydrates (P = 0.0007). Notably, nutrient digestibility showed significant differences in organic matter (P = 0.0187), ether extract (P = 0.0095), neutral detergent fiber (P = 0.0005), non-fiber carbohydrates (P = 0.0001), and metabolizable energy (P = 0.0001). Performance variables, including total weight gain (P = 0.0148), average daily weight gain (P = 0.0148), feeding efficiency, and rumination efficiency of dry matter (P = 0.0113), also exhibited significant effects. Consequently, it is recommended to include 20% forage cactus in corn silage, which, based on natural matter, helps meet animals' water needs through feed. This inclusion is especially vital in semi-arid regions and aids in reducing silage losses during post-opening silo disposal.

Useful Pelvic Retroperitoneal Neuroanatomy for Benign Gynecologic Surgery: A Cadaveric Dissection.

OBJECTIVE: Knowledge of the retroperitoneal anatomy is particularly important to facilitate surgical procedure and reduce the number of complications. The objective of this video is to demonstrate pelvic neuroanatomic structures and their relationships in the pelvic sidewall and the presacral space in a laparoscopic cadaveric dissection. DESIGN: Case report (anatomic study). SETTING: Medical training center (AdventHealth Nicholson Center, Orlando, FL). INTERVENTIONS: The dissection started with the mobilization of the iliac vessels from the pelvic sidewall to identify the obturator nerve. The peritoneum of the ovarian fossa was opened, and the ureter was dissected up to the level of the uterine artery. The hypogastric nerve was identified. The close relationship between the ovarian fossa and the obturator nerve could be demonstrated. The deep dissection of the obturator fossa allowed for the identification of the lumbosacral trunk, S1, the sciatic nerve, S2, S3, S4, and the splanchnic nerves. Then, the ischial spine and the sacrospinous ligament were identified. The pudendal nerve and vessels could be observed passing below the sacrospinous ligament, entering the pudendal canal (Alcock's canal). The presacral space was dissected, and the hypogastric fascia was opened. S1 to S4 were identified coming from the sacral foramens. The laparoscopic dissection, using the cadaveric model, allowed for the development of the entire retroperitoneal anatomy, focusing on the dissection of the pelvic innervation. Anatomic relationships among the ureter, the hypogastric nerve, the uterosacral ligament, the splanchnic nerves, the inferior hypogastric plexus, and the organs (bowel, vagina, uterus, and bladder) could be demonstrated. CONCLUSION: A laparoscopic cadaveric dissection can be used as a resource to demonstrate and educate surgeons about the neurologic retroperitoneal structures and their relationships.

Spineless cactus use management on microbiological quality, performance, and nutritional disorders in sheep.

The physically effective neutral detergent fiber content alone has not been able to explain the appearance of diarrhea in ruminants fed diets with large volumes of spineless cactus, so the proliferation of enterobacteria in spineless cactus may be associated with cases of diarrhea in sheep. In the in vitro test, used two varieties of spineless cactus, both of which were chopped to particles of 4 and 2 cm2. For the in vivo test, 15 lambs were allocated to three treatment groups, namely, spineless cactus crushed and immediately supplied to the animals; spineless cactus crushed 8 h before supply; and silage of spineless cactus. The variables evaluated were dry matter intake, weight gain, fecal score, hemogram, and fecal colony count. In the in vitro test, higher Enterobacteriaceae and lactic acid bacteria counts were found both at 12 h and 24 h when the spineless cactus was crushed to 2 cm2 in both varieties. The sheep fed the spineless cactus crushed 8 h prior to supply showed the highest Enterobacteriaceae count in the feces (8.48 CFU/g), compared to animals fed silage of spineless cactus (4.95 CFU/g). It can thus be concluded that the management of spineless cactus influences the development of total and fecal coliforms, especially when it is chopped to 2 cm2 and exposed to the environment for periods longer than 7 h, and that the bacterial population can be controlled by administering the spineless cactus in the form of silage.

Comparison of Five Kinematic-Based Identification Methods of Foot Contact Events During Treadmill Walking and Running at Different Speeds.

This study involved a comparison of 5 kinematic-based algorithms to detect heel strike (HS) and toe-off (TO) events during human locomotion at different speeds. The objective was to assess how different running and walking speeds affect contact event determination during treadmill locomotion. Thirty male runners performed walking at 5 km/h and running at 9, 11, and 13 km/h on a treadmill. A kinematic system was used to capture the trajectories of 2 retroreflective markers placed at the subject's right heel and second metatarsal. A footswitch device was used to determine the "true" times of HS and TO compared with 5 kinematic-based algorithms. The results of the current study illustrated that speed influences the HS error in the vertical position and horizontal velocity algorithms, and the TO error in the vertical position and horizontal velocity algorithms. This difference was found in the transition from walking to running; however, higher running speeds did not affect the error estimation. Higher accuracy was found with combined algorithms, namely, one using vertical acceleration and position and another using horizontal and vertical position with no influence from different locomotion speeds. Therefore, these algorithms are recommended in studies where speed is self-selected because they work well for a broad range of locomotion velocities.

Anatomic variations and lesions of the mandibular canal detected by cone beam computed tomography.

PURPOSE: The mandibular canal is a significant anatomical structure in implant dentistry, and cone beam computed tomography (CBCT) is an important diagnostic image modality in this field of dentistry. The aim of this study was to evaluate the frequencies of anatomic variations and lesions affecting the mandibular canal in CBCT images of the mandible produced for dental implant planning. METHODS: This cross-sectional study evaluated a sample of 250 CBCT examinations (500 mandibular canals). The inclusion criterion was CBCT examinations of the mandible requested for dental implant planning. The presence of anatomic variations and lesions affecting the mandibular canal was evaluated in the CBCT examinations. Moreover, the buccolingual position of the mandibular canal was evaluated in the molar region and in the ramus region. The CBCT exams were evaluated by one observer. The data were analyzed using descriptive and analytical statistics. The one-way ANOVA test was employed to compare the age between the anatomic variations. A paired t test was used to compare the buccolingual position between the molar region and the ramus region. Differences were considered significant when p values were lower than 0.05. RESULTS: The anatomic variations detected were large-diameter mandibular incisive canal (51.6 %), ramification (12 %), and accessory mental foramen (3.2 %). No difference was observed in the age of the patients between the anatomic variations (p > 0.05). The identified lesions included hypomineralization of the canal walls (20.8 %), idiopathic osteosclerosis (8.8 %), osteolytic lesions (3.2 %), iatrogenic perforation of the mandibular canal (2.8 %), and fibro-osseous lesions (1.6 %). The distance between the mandibular canal and the vestibular cortical bone was higher in the molar region than in the ramus region (p < 0.05). CONCLUSIONS: Anatomic variations and lesions affecting the mandibular canal were common findings in the CBCT images of the mandible produced for dental implant planning. An awareness of these alterations is important for dentistry because some of them might require treatment, change oral surgery planning and difficult inferior alveolar nerve anesthetic block.

Development and psychometric evaluation of a questionnaire to measure university students' knowledge on the effects of alcohol use during pregnancy.

Introduction: Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders. This study developed and validated a questionnaire to assess university students' knowledge regarding the effects of alcohol during pregnancy. Methods: We designed an instrument with true-false-I do not know statements. Initially, 45 true statements were formulated and subjected to content validation by 19 experts. Based on the Content Validity Index (CVI), 17 items were selected. The instrument, called the Fetal Alcohol Consequences Test (FACT), was first assessed by 31 university students for the level of understanding. Then, the questionnaire was administered to a national Brazilian sample of university students, and an Exploratory Factor Analysis (EFA) was conducted. Each correct FACT answer was worth 1 point, and the knowledge was categorized as high (total score ≥ 80%), moderate (score between 60 and 79%), and low (score ≤ 59%). Results: When the questionnaire was being designed, the CVI values ranged from 0.779 to 1.0, and all statements were considered suitable by the target audience. For psychometric evaluation, 768 students from 24 Brazilian states participated. In the EFA, five statements were removed, revealing a tool with 12 items and two latent factors: "fetal alcohol spectrum disorders" and "conceptions and guidance on alcohol consumption during pregnancy." The KMO index (0.76426) and Bartlett's sphericity test (6362.6, df = 66, p < 0.00001) both supported the final EFA model. The goodness-of-fit indices for the factor structure were adequate: χ2 = 119.609, df = 43, p < 0.00001; RMSEA = 0.048; CFI = 0.977; TLI = 0.965. The mean total FACT score among participants was 7.71 ± 2.98, with a median of 8; 32.03% of the students had high (10-12 points), 24.09% moderate (8-9 points), and 43.88% low knowledge (<8 points). The questionnaire proved reliable, with a floor effect of 1.17%, a ceiling effect of 9.25%, and a Cronbach's alpha index of 0.798. Conclusion: The FACT can be utilized in university students' health education processes, contributing to greater knowledge and information dissemination about the effects of alcohol during pregnancy, in addition to the formulation of policies on the subject directed to this group of young adults.

Photophysical, photobiological, and biomolecule-binding properties of new tri-cationic meso-tri(2-thienyl)corroles with Pt(II) and Pd(II) polypyridyl derivatives.

We report the synthesis and characterization of new tri-cationic corrole derivatives, containing Pt(II) or Pd(II) complexes attached at the peripheral position of thienyl moieties. Corrole derivatives were characterized through microanalysis, electrochemical, spectrometry and spectroscopy analysis. Singlet and triplet excited-states are investigated by photophysical/theoretical calculation methods and photobiological parameters were also evaluated spectroscopic techniques (UV-Vis and EPR). Also, the binding capacity of each corrole derivative with nucleic acids (DNA) and human serum albumin (HSA) was determined by UV-Vis, steady-state, and time-resolved fluorescence spectroscopy, combined with molecular docking analysis. Moreover, the new corroles containing peripheral complexes improve their interactions with biomacromolecules, generate reactive oxygen species under light source irradiation studied and has potential for application in photodynamic therapeutic processes.

Microbiological Composition of Diets of Cactus Pear-Based with Increasing Levels of Buffel Grass Hay and Relationship to Nutritional Disorders in Sheep.

This study aimed to evaluate the microbiological composition of cactus pear-based diets with increasing levels of buffel grass hay, and its effect on the blood and physiological parameters and occurrence of diarrhea in feedlot sheep. Four diets containing different percentages of buffel grass hay were tested. Diets were composed of forage cactus, buffel grass hay and concentrate, and the treatments were represented by different levels of hay in the dry matter of the feed: 7.5% buffel grass hay; 15% buffel grass hay; 30% buffel grass hay; and 45% buffel grass hay on a dry matter basis. There was a significant effect (p = 0.0034) of inclusion levels of buffel grass hay on fecal score. Only at the 45% inclusion level diarrhea was not observed, showing that the level of buffel grass affected more the animals than the collection period, although the collection period has affected the microbial counts. Probably there was a physiological adaptation of animals over time. There were significant changes (p < 0.0001) in the blood parameters of sheep. The reduction of the proportion of cactus and the inclusion of greater than 15% buffel grass hay, on a dry matter basis, provides less contamination of the diet and animal feces by enterobacteria, such as E. coli.

Influence of green tea extract with different concentrations of epigallocatechin gallate on calvaria bone repair of ovariectomized rats / Influencia del extracto de té verde con diferentes concentraciones de galato de epigalocatequina sobre la reparación ósea de calvaria de ratas ovariectomizadas

Impairing osteoporosis progression is a challenge, and recently the role of antioxidants has been associated to bone metabolism. Green tea extract is rich in catechins, especially epigallocatechin gallate (EGCG), which may help control osteoporosis damage in bone tissue. This investigation evaluated the efficacy of green tea ingestion containing different concentrations of EGCG in calvaria bone repair of ovariectomized rats. Wistar rats (n=15) were ovariectomized and divided into 3 groups: ovariectomized (OVX), ovariectomized + GTE 15 % EGCG (OVX/GTE15), and ovariectomized + GTE 94 % EGCG (OVX/GTE94). Green tea extract was administered by gavage in the concentration of 50 mg/kg and sham group (n=5) received water. Bone defects were performed in the calvaria 60 days after ovariectomy followed by 4 weeks until euthanasia. Bone samples were collected to perform qualitative and quantitative histological analysis of bone formation. Data obtained were submitted to normality and ANOVA statistical test for p<0.05. The mean values of neoformed bone for Sham, OVX, OVX/GTE15 and OVX/GTE94 were respectively: 21.11 ± 3.91; 19.92 ± 2.20; 33.05 ± 1.26 e 34.75 ± 0.54 (p<0.05). Results show that continuous ingestion of green tea extract immediately after ovariectomy shows positive effects in the prevention of bone loss in osteoporosis, even with low concentrations of EGCG.

La disminución en la progresión de la osteoporosis es un desafío, y recientemente el papel de los antioxidantes se ha asociado al metabolismo óseo. El extracto de té verde es rico en catequinas, especialmente el galato de epigalocatequina (EGCG), lo que puede ayudar a controlar el daño de la osteoporosis en el tejido óseo. Esta investigación evaluó la eficacia de la ingesta de té verde con diferentes concentraciones de EGCG en la reparación ósea de calvaria de ratas ovariectomizadas. Las ratas Wistar (n = 15) fueron ovariectomizadas y divididas en 3 grupos: ovariectomizadas (OVX), ovariectomizadas + GTE 15 % EGCG (OVX / GTE15), y ovariectomizadas + GTE 94 % EGCG (OVX / GTE94). El extracto de té verde se administró por sonda en una concentración de 50 mg/kg y el grupo simulado (n = 5) recibió agua. Los defectos óseos se realizaron en la calvaria 60 días después de la ovariectomía, seguido de 4 semanas hasta la eutanasia. Se obtuvieron muestras de hueso para realizar un análisis histológico cualitativo y cuantitativo de la formación ósea. Los datos obtenidos se sometieron a normalidad y prueba estadística ANOVA (p<0,05). Los valores medios de hueso neoformado para Sham, OVX, OVX / GTE15 y OVX / GTE94 fueron: 21,11 ± 3,91; 19,92 ± 2,20; 33,05 ± 1,26 y 34,75 ± 0,54 (p <0,05), respectivamente. Los resultados muestran que la ingesta continua de extracto de té verde, inmediatamente después de la ovariectomía, muestra efectos positivos en la prevención de la pérdida ósea ocurrida en la osteoporosis, incluso con concentraciones bajas de EGCG.

[Myomectomy in the second trimester of pregnancy: case report]. / Miomectomia em gestação de segundo trimestre: relato de caso.

Uterine leiomyomas are characterized as a benign disease and are observed in 2 to 3% of all normal pregnancies. Out of these, about 10% may present complications during pregnancy. We present a case of a pregnant patient sought emergency obstetric care at the 17th week, complaining of severe pain, presenting with painful abdominal palpation and sudden positive decompression. Ultrasonography revealed a myoma nodule measuring 9.1 x 7.7 cm; the patient was hospitalized and medicated, being also submitted to laparotomy and myomectomy due to worsening of her condition. Prenatal care revealed no further abnormalities, with resolution of gestation at 39 weeks. The newborn weighed 3,315 g, with Apgar scores of 9 and 10. In such cases, clinical treatment should always be attempted and surgery should be considered only in selected cases, mainly in the impossibility of conservative treatment or when the patient's clinical features require immediate intervention. In this case, myomectomy was effective against maternal-fetal obstetric complications.

[Cervical Foley catheter versus vaginal misoprostol for cervical ripening and induction of labor: a randomized clinical trial]. / Sonda de Foley cervical versus misoprostol vaginal para o preparo cervical e indução do parto: um ensaio clínico randomizado.

PURPOSE: To compare the effectiveness of the Foley balloon with vaginal misoprostol for cervical ripening and labor induction. METHODS: Randomized clinical trial, not blind, conducted from January 2006 to January 2008. A total of 160 pregnant women with indication for induction of labor were included and divided into two groups, 80 for Foley and 80 for vaginal misoprostol. Inclusion criteria were: gestational age of 37 weeks or more, a live single fetus with cephalic presentation and a Bishop score of four or less. We excluded patients with a uterine scar, ruptured membranes, estimated fetal weight greater than 4000 g, placenta previa, chorioamnionitis and conditions that imposed the immediate termination of pregnancy. Statistical tests employed were Mann-Whitney, χ² test or Fisher's exact test, and p value was significant if less than 0.005. RESULTS: Misoprostol triggered more frequently spontaneous delivery (50.0 versus 15.0% for Foley, p<0.001) and required less use of oxytocin (41.2 versus 76.2%), and this group presented more tachysystole (21.2 versus 5.0%). The Foley catheter caused more discomfort to the patient (28.7 versus 1.2%). There were no differences in the time required for development of the Bishop score (20.69 versus 21.36 hours), for triggering delivery (36.42 versus 29.57 hours) or in rates of cesarean delivery (51.2 versus 42.5%). There were no significant differences in perinatal performance, with similar rates of abnormal cardiotocography (20.0 versus 21.2%), presence of meconium (13.7 versus 17.5%) and need for neonatal intensive care unit (3.7 versus 6.2%). CONCLUSIONS: The use of the Foley catheter was as effective as misoprostol for cervical ripening, but less effective in triggering spontaneous labor. Our results support the recommendation of its use for cervical ripening, especially in patients with cesarean scar.

Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature.

CONTEXT AND OBJECTIVE: The incidence of scar endometrioma ranges from 0.03 to 3.5%. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. The aim here was to identify the clinical pattern of the disease and show surgical results. The literature on this topic was reviewed. DESIGN AND SETTING: Retrospective descriptive study at Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva. METHODS: Data from the medical records of patients with preoperative diagnoses of scar endometrioma who underwent operations between 2001 and 2007 were surveyed and reviewed. The postoperative diagnosis came from histopathological analysis. The main information surveyed was age, obstetric antecedents, symptoms, tumor location, size and palpation, duration of complaint, diagnosis and treatment. All patients underwent tumor excision with a safety margin. RESULTS: There were 33 patients, of mean age 30.1 +/- 5.0 years (range: 18-41 years). The total incidence was 0.11%: 0.29% in cesarean sections and 0.01% in vaginal deliveries. Twenty-nine tumors (87.9%) were located in cesarean scars, two (6.0%) in episiotomy scars and two (6.0%) in the umbilical region. The main symptom was localized cyclical pain (66.7%), of mean duration 30.5 months (+/- 23). Surgical treatment was successful in all cases. CONCLUSION: This is an uncommon disease. The most important diagnostic characteristic is coincidence of painful symptoms with menstruation. Patients undergoing cesarean section are at greatest risk: relative risk of 27.37 (P < 0.01). The surgical treatment of choice is excision of the endometrioma with a safety margin.

Miomectomia em gestação de segundo trimestre: relato de caso / Myomectomy in the second trimester of pregnancy: case report

Os leiomiomas uterinos caracterizam-se por doença benigna e são evidenciados em 2 a 3 por cento de todas as gestações normais. Destes, cerca de 10 por cento podem apresentar complicações durante a gravidez. Apresentamos um caso de paciente gestante que procurou o pronto-socorro obstétrico na 17ª semana, queixando-se de fortes dores, apresentava palpação abdominal dolorosa e descompressão brusca positiva. À ultrassonografia, apresentava nódulo de mioma medindo 9,1 x 7,7 cm, foi internada, medicada e devido à piora do quadro, submetida a laparotomia exploradora e miomectomia. O seguimento pré-natal se deu sem mais anormalidades, com resolução da gestação na 39ª semana. O recém-nascido pesou 3.315 g com Apgar 9 e 10. Deve-se sempre tentar o tratamento clínico nesses casos, e intervenções cirúrgicas devem ser consideradas para casos selecionados, principalmente na impossibilidade de tratamentos conservadores ou quando o quadro clínico da paciente exige intervenção imediata. Neste caso, a miomectomia mostrou-se eficaz para complicações obstétricas materno-fetais.

Uterine leiomyomas are characterized as a benign disease and are observed in 2 to 3 percent of all normal pregnancies. Out of these, about 10 percent may present complications during pregnancy. We present a case of a pregnant patient sought emergency obstetric care at the 17th week, complaining of severe pain, presenting with painful abdominal palpation and sudden positive decompression. Ultrasonography revealed a myoma nodule measuring 9.1 x 7.7 cm; the patient was hospitalized and medicated, being also submitted to laparotomy and myomectomy due to worsening of her condition. Prenatal care revealed no further abnormalities, with resolution of gestation at 39 weeks. The newborn weighed 3,315 g, with Apgar scores of 9 and 10. In such cases, clinical treatment should always be attempted and surgery should be considered only in selected cases, mainly in the impossibility of conservative treatment or when the patient's clinical features require immediate intervention. In this case, myomectomy was effective against maternal-fetal obstetric complications.

Sonda de Foley cervical versus misoprostol vaginal para o preparo cervical e indução do parto: um ensaio clínico randomizado / Cervical Foley catheter versus vaginal misoprostol for cervical ripening and induction of labor: a randomized clinical trial

OBJETIVO: comparar a efetividade da sonda e Foley com o uso de misoprostol vaginal para o preparo cervical e indução do parto. MÉTODOS: ensaio clínico randomizado, não cego, realizado entre Janeiro de 2006 a Janeiro de 2008. Foram incluídas 160 gestantes com indicação de indução do parto, divididas em dois grupos: 80 para uso da sonda de Foley e 80 para misoprostol vaginal. Os critérios de inclusão foram: idade gestacional a partir de 37 semanas, feto único, vivo, cefálico e índice de Bishop igual ou menor que 4. Foram excluídas pacientes com cicatriz uterina, ruptura das membranas, peso fetal estimado maior que 4000 g, placenta prévia, corioamnionite e condições que impunham o término imediato da gestação. Os testes estatísticos utilizados foram Mann-Whitney, χ2 de Pearson ou exato de Fischer, sendo considerado significativo se menor que 0,005. RESULTADOS: o misoprostol desencadeou mais vezes o parto de forma espontânea (50,0 versus 15,0 por cento para Foley p<0,001) e menor uso de ocitocina (41,2 versus 76,2 por cento), sendo que esse grupo apresentou mais taquissistolia (21,2 versus 5,0 por cento). A sonda de Foley causou mais desconforto à paciente (28,7 versus 1,2 por cento). Não houve diferenças em relação ao tempo necessário para evolução do índice de Bishop (20,69 versus 21,36 horas), para o desencadeamento do parto (36,42 versus 29,57 horas) e nas taxas de cesáreas (51,2 versus 42,5 por cento). Não houve diferenças significativas no desempenho perinatal, com frequências semelhantes de cardiotocografia anormal (20,0 versus 21,2 por cento), presença de mecônio (13,7 versus 17,5 por cento) e necessidade de UTI neonatal (3,7 versus 6,2 por cento). CONCLUSÕES: o uso da sonda de Foley apresentou efetividade semelhante ao misoprostol para o preparo cervical, porém foi menos efetivo para o desencadeamento espontâneo do parto. Nossos resultados apoiam a recomendação de seu uso para o preparo cervical, sobretudo em pacientes portadoras de uma cicatriz de cesárea.

PURPOSE: to compare the effectiveness of the Foley balloon with vaginal misoprostol for cervical ripening and labor induction. METHODS: randomized clinical trial, not blind, conducted from January 2006 to January 2008. A total of 160 pregnant women with indication for induction of labor were included and divided into two groups, 80 for Foley and 80 for vaginal misoprostol. Inclusion criteria were: gestational age of 37 weeks or more, a live single fetus with cephalic presentation and a Bishop score of four or less. We excluded patients with a uterine scar, ruptured membranes, estimated fetal weight greater than 4000 g, placenta previa, chorioamnionitis and conditions that imposed the immediate termination of pregnancy. Statistical tests employed were Mann-Whitney, χ2 test or Fisher's exact test, and p value was significant if less than 0.005. RESULTS: misoprostol triggered more frequently spontaneous delivery (50.0 versus 15.0 percent for Foley, p<0.001) and required less use of oxytocin (41.2 versus 76.2 percent), and this group presented more tachysystole (21.2 versus 5.0 percent). The Foley catheter caused more discomfort to the patient (28.7 versus 1.2 percent). There were no differences in the time required for development of the Bishop score (20.69 versus 21.36 hours), for triggering delivery (36.42 versus 29.57 hours) or in rates of cesarean delivery (51.2 versus 42.5 percent). There were no significant differences in perinatal performance, with similar rates of abnormal cardiotocography (20.0 versus 21.2 percent), presence of meconium (13.7 versus 17.5 percent) and need for neonatal intensive care unit (3.7 versus 6.2 percent). CONCLUSIONS: the use of the Foley catheter was as effective as misoprostol for cervical ripening, but less effective in triggering spontaneous labor. Our results support the recommendation of its use for cervical ripening, especially in patients with cesarean scar.

Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature / Endometrioma de cicatriz após incisões cirúrgicas obstétricas: estudo retrospectivo de 33 casos e revisão da literatura

Context and objective: The incidence of scar endometrioma ranges from 0.03 to 3.5 percent. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. The aim here was to identify the clinical pattern of the disease and show surgical results. The literature on this topic was reviewed. Design and setting: Retrospective descriptive study at Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva. Methods: Data from the medical records of patients with preoperative diagnoses of scar endometrioma who underwent operations between 2001 and 2007 were surveyed and reviewed. The postoperative diagnosis came from histopathological analysis. The main information surveyed was age, obstetric antecedents, symptoms, tumor location, size and palpation, duration of complaint, diagnosis and treatment. All patients underwent tumor excision with a safety margin. Results: There were 33 patients, of mean age 30.1 ± 5.0 years (range: 18-41 years). The total incidence was 0.11 percent: 0.29 percent in cesarean sections and 0.01 percent in vaginal deliveries. Twenty-nine tumors (87.9 percent) were located in cesarean scars, two (6.0 percent) in episiotomy scars and two (6.0 percent) in the umbilical region. The main symptom was localized cyclical pain (66.7 percent), of mean duration 30.5 months (± 23). Surgical treatment was successful in all cases. Conclusion: This is an uncommon disease. The most important diagnostic characteristic is coincidence of painful symptoms with menstruation. Patients undergoing cesarean section are at greatest risk: relative risk of 27.37 (P < 0.01). The surgical treatment of choice is excision of the endometrioma with a safety margin.

Contexto e objetivo: A incidência de endometrioma de cicatriz varia de 0,03 a 3,5 por cento. Alguns fatores relacionados ao conhecimento da história clínica da doença dificultam o diagnóstico e o tratamento corretos. O objetivo é traçar o padrão clínico da doença e avaliar resultados cirúrgicos. Foi revisada a literatura sobre o assunto. Tipo de estudo e local: Estudo descritivo e retrospectivo realizado no Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva. Métodos: Foi realizado levantamento e revisão de dados dos prontuários médicos das pacientes com diagnóstico pré-operatório de endometrioma de cicatriz, operadas entre 2001 e 2007. O diagnóstico pós-operatório foi feito por exame histopatológico. As principais informações levantadas foram: idade, antecedentes obstétricos, sintomatologia, localização, tamanho e palpação do tumor, duração da queixa, diagnóstico, tratamento. Todas as pacientes foram submetidas a exerese da massa tumoral com margem de segurança. Resultados: Foram encontrados 33 pacientes com média de idade 30,1 (± 5,0), variando de 18 a 41 anos. A incidência total foi de 0,11 por cento, nas cesarianas foi de 0,29 por cento e nos partos vaginais, 0,01 por cento. Localização do tumor: 29 casos em cicatriz de cesária (87,9 por cento), dois em região umbilical (6,0 por cento) e dois em cicatriz de episiotomia (6,0 por cento). A principal sintomatologia foi dor cíclica localizada (66,7 por cento), com duração média de 30,5 meses (± 23). O tratamento cirúrgico foi realizado com sucesso em todas as pacientes. Conclusão: Trata-se de uma doença incomum. O dado de maior importância diagnóstica foi: coincidência da sintomatologia dolorosa com a menstruação. Pacientes submetidas a cesariana têm maior risco (risco relativo = 27,37 e P < 0,01). O tratamento cirúrgico de escolha é exerese do endometrioma com margem de segurança.

O controle da hemorragia pós-parto com a técnica de sutura de B-Lynch: série de casos / The control of postpartum hemorrhage with the B-Lynch suture technique: a case series

OBJETIVO: apresentar uma técnica cirúrgica para pacientes submetidas ao parto cesáreo e que evoluem com hemorragia refratária ao uso de medicamentos. MÉTODOS: o critério de seleção das pacientes era falha do tratamento farmacológico no controle da hemorragia pós-parto e o desejo da paciente em preservar o útero. As pacientes foram submetidas ao parto cesáreo e evoluíram com hemorragia pós-parto imediata refratária ao uso de ocitocina, ergometrina e misoprostol. Aplicamos a técnica de sutura descrita por B-Lynch sem modificações. Com fio cromado catgut-2 ou poliglactina-1, transfixamos o útero em seis pontos, conforme padronização. Após compressão manual do útero realizada pelo assistente, o fio é tracionado pelas suas extremidades pelo cirurgião e é aplicado um nó duplo seguido de dois nós simples, para em seguida realizar-se a histerorrafia. RESULTADOS: utilizamos o fio cromado catgut-2 agulhado em três casos e poliglactina-1 agulhado em um. Nos quatro casos houve parada imediata do sangramento vaginal após aplicação da sutura. Não houve qualquer complicação durante a realização do procedimento e nem no puerpério imediato e tardio das quatro pacientes. CONCLUSÕES: esta técnica representa uma alternativa cirúrgica para o manejo da hemorragia pós-parto. Com sua aplicação relativamente fácil, rápida e segura, pode representar uma redução da morbimortalidade materna em nosso país.

PURPOSE: to present a surgical technique for patients submitted to caesarean section, which evolves to medicine refractory hemorrhage. METHODS: a case report study, of which the including criteria were failure in the pharmacological treatment to control post-partum hemorrhage, and the patients' request to preserve their uterus. Four patients submitted to caesarean section which evolved to immediate post-partum hemorrhage, refractory to the use of ocytocin, ergometrine and misoprostol, were treated with the suture technique described by B-Lynch, without modification. The uterus was transfixed in six points according to the standard procedure, with chrome catgut-2 or polyglactine-1thread. After the assistant's manual compression of the uterus, the thread was pulled by its extremities by the surgeon, and a double knot followed by two simple knots were applied before performing the hysterorraphy. RESULTS: needled chrome catgut-2 thread was used in three cases and needled poluglactine-1 in one case. In the four cases there was immediate discontinuity of the vaginal bleeding, after the suture. The four patients did not present any complication during the procedure or along the immediate and late puerperal period. CONCLUSION: this technique represents a surgical alternative to deal with post-partum hemorrhage and may represent a reduction in the maternal morbidity and mortality in our country.

Pacientes não responsivos à terapia de ressincronização cardíaca: [revisão] / Patients unresponsive to cardiac resynchronization therapy: [review]

Em que pesem os avanços científicos e o aumento do número de implantes de ressincronizadores cardíacos, a porcentagem de pacientes não responsivos varia de 11 a 43 por cento, na dependência dos critérios utilizados. Este artigo faz uma revisão das causas associadas à ausência de resposta efetiva à terapia de ressincronização cardíaca (TRC), assim como dos cuidados para reduzir o número de pacientes nãos responsivos. Essas medidas incluem critérios de seleção adequados dos candidatos à TRC, cuidados durante o implante e otimização da programação dos dispositivos durante o acompanhamento dos pacientes.

Desenvolvimento historico do transplante hepatico: os enxertos parciais / Historical development of the liver transplantation orthotopic transplantation - part X

O transplante hepatico ortotopico em pacientes pediatricos e frequentemente limitado pela disponibilidade de doadores pediatricos. Entre 25 e 50//dos candidatos pediatricos morrem antes da realizacao do transplante devido a dificuldade de se obter orgao de tamanho adequado. Este problema se acentua quando a indicacao para o transplante e urgente, como nos casos de insuficiencia fulminante, deterioro importante do paciente portador de hepatopatia cronica, e nos casos de retransplante urgente devido a trombose arterial e insuficiencia primaria do enxerto. A realizacao do enxerto parcial, tornou possivel a melhoria dos resultados dos transplantes hepaticos ao ofertar uma melhor arteria e uma melhor via biliar. Mas sobretudo, diminuiu a lista de espera dos receptores infantis, evitando seu deterioro ou morte