Effects of oral calcium supplementation on mineral and acid-base status, energy metabolites, and health of postpartum dairy cows.

Two experiments were conducted to characterize blood concentrations of minerals and acid-base status after oral dosing of Ca salts and to determine the effects of oral Ca on mineral and metabolic status and incidence diseases. The hypotheses were that administration of oral Ca as CaCl2 and CaSO4 maintains blood total Ca (tCa) concentrations ≥2.125 mM and reduces the incidence of diseases in early lactation. In experiment 1, 18 Holstein cows on the day of calving were assigned to receive a single dose of 0, 43, or 86g of Ca as an oral bolus. Blood was sampled before and after treatments to characterize acid-base status and concentrations of minerals. In experiment 2, 450 Holstein cows considered of low (LRM; normal calving) or high risk (HRM; dystocia, twins, stillbirth, retained placenta, vulvo-vaginal laceration, or a combination of these) of metritis (primiparous-LRM=84; primiparous-HRM=84; multiparous-LRM=138; multiparous-HRM=138) on the day of calving were blocked by parity and then randomly assigned to control, no Ca supplementation; 86g of Ca on d 0 and 1 postpartum (CaS1); or 86g of Ca on d 0 and 1 postpartum followed by 43g/d on d 2 to 4 postpartum (CaS4). Blood was sampled before and 30 min after treatment on d 0, and 30 min after treatments on d 1 to 4, and d 7 and 10 for determination of concentrations of minerals and metabolites and blood acid-base responses. Disease incidence was evaluated for the first 30 DIM. Concentrations of ionized Ca (iCa) increased for 2h in cows supplemented with 43g of Ca and fewer than 8h in cows supplemented with 86g of Ca. The changes in iCa concentrations from pretreatment to 30 min after 86g of Ca supplemented on d 0 were 0.11±0.03 mM in multiparous cows and 0.25±0.03 mM in primiparous cows. Oral Ca reduced the incidence of subclinical hypocalcemia (SCH; tCa <2.125mM) in the first 4 d in the experiment (control=69.3%; CaS1=57.5%; CaS4=34.2%). Calcium supplementation decreased the prevalence of SCH on d 0 and 1 postpartum in all cows. Stopping oral Ca in CaS1 on d 1 postpartum, however, caused a rebound in SCH on d 2 to 4 postpartum in primiparous cows. Oral Ca increased the incidence of metritis (control=22.7%; CaS1=34.8%; CaS4=32.8%), primarily because of an increase in LRM primiparous cows (control=17.9%; CaS1=35.7%; CaS4=42.9%). Oral Ca increased morbidity in primiparous cows (control=38.1%; CaS1=61.8%; CaS4=60.3%) but had no effect on multiparous cows (control=38.2%; CaS1=35.1%; CaS4=30.1%). Large doses of oral Ca as salts of chloride and sulfate in the first days postpartum should be avoided in primiparous cows and used only in cows at risk of clinical hypocalcemia.

Beyond the boundaries-endometriosis: typical and atypical locations.

Endometriosis is characterized by the presence of endometrial glands and stroma in an ectopic location outside the endometrial cavity. This condition affects women during their reproductive years. Ovaries are by far the commonest location of endometriosis and have peculiar imaging features. However, the imaging diagnosis of extraovarian endometriosis is difficult to make both clinically and radiologically. The purpose of this article is to review the imaging features of endometriosis at typical and atypical sites on different modalities and to describe the commonly encountered complications. Atypical sites for endometriosis include the gastrointestinal tract, urinary tract, soft tissues, and chest. Depending on the site, they can present with varied symptoms, including bowel obstruction, melena, hematuria, dysuria, dyspnea, and swelling in the soft tissues, respectively. The endometriotic implant in the extraovarian location is a challenging diagnosis. It is important to be aware of the sites, radiologic appearances, and complications of ovarian and extraovarian endometriosis while evaluating a woman in the reproductive age group with appropriate symptomatology. Endometriosis at extraovarian locations is a challenging diagnosis clinically and radiologically. Clinical symptomatology with characteristic imaging features in the appropriate patient population is helpful in reaching the diagnosis. Precise diagnosis regarding presence, location, and extent of endometriosis is useful for preoperative evaluation and surgical planning of endometriosis.

A case of pelvic actinomycosis with hepatic actinomycotic pseudotumor.

Pelvic actinomycosis in women most commonly occurs during ascending infections, usually associated with intrauterine devices (IUDs). However, secondary hepatic actinomycosis is very rare. A 47-year-old woman using IUDs for 18 years was referred under the impression of ovarian cancer. Further investigation revealed a hepatic tumor diagnosed as an inflammatory pseudotumor by fine needle aspiration biopsy, and a pelvic mass diagnosed as pelvic actinomycosis by sulfur granules in bilateral adnexa gained by an explorative laparotomy. Long-term therapy with high-dose intravenous penicillin and oral amoxicillin resulted in clinical and radiological improvement. The management of pelvic actinomycosis is based on a medical approach, although it sometimes requires surgical intervention. However, the necessity for surgical treatment is controversial in cases of secondary hepatic actinomycosis.

Anestesia intracervical en la histeroscopia / Intracervical anesthesia in hysteroscopy

Objetivo: Valorar los resultados obtenidos con la utilización de anestesia intracervical con jeringa y aguja de dentista en la histeroscopia. Material y métodos: Desde el 1 de enero hasta el 30 de junio se han realizado 622 histeroscopias en nuestra consulta. A las mujeres a quienes no se puede practicar la histeroscopia porque sienten dolor, se les inyecta anestesia intracervical con jeringa y aguja de dentista. Resultados: De las 622 histeroscopias realizadas en el primer semestre de 2004, han precisado anestesia local 90 mujeres (14,5%). El porcentaje de histeroscopias que no se han podido realizar en consulta ha sido del 1,7%, bastante menor que el observado en años anteriores: en el primer semestre de 2000 fue del 4,9%, en 2001 y 2002 del 8,3%, y en 2003 del 6,1%. Conclusiones: Al revisar la bibliografía, todos los estudios han encontrado beneficioso el uso de anestesia intracervical en la histeroscopia, y hacen hincapié en la importancia de la selección de las pacientes. Nuestro estudio llega a las mismas conclusiones, y aporta la ventaja que supone la utilización de la jeringa y aguja de dentista, con lo cual se consigue una correcta analgesia y una mejor tolerancia de la mujer, sin olvidarnos del ahorro económico que supone la anestesia local respecto a la general

Objective: To evaluate the results obtained with the use of intracervical anesthesia injected with a dental syringe in outpatient hysteroscopy. Material and methods: From January 1st to June 30th 2004, we performed 622 outpatient hysteroscopies. Intracervical anesthesia was injected with a dental syringe in women who did not tolerate the pain during hysteroscopy. Results: Of 622 outpatient hysteroscopies performed in the first semester of 2004, 90 women required local anesthesia (14.5%). The percentage of hysteroscopies that could not be performed in the office was 1.7%, less than that observed in previous years (4.9% in the first semester of 2000, 8.3% in 2001 and 2002 and 6.1% in 2003). Conclusions: A review of the literature reveals that all studies have found intracervical anesthesia to be beneficial in outpatient hysteroscopy, emphasizing the importance of patient selection. Our study supports these conclusions and additionally reports the advantage of the use of a dental syringe, which allows adequate analgesia and better patient tolerance, as well as economic savings in comparison with general anesthesia

[Diagnostic hysteroscopy in abnormal uterine bleeding. Five-years' experience]. / L'isteroscopia diagnostica nel sanguinamento uterino anomalo. Cinque anni di esperienza.

BACKGROUND: Hysteroscopy has acquired a central role in the clinical diagnosis of intrauterine pathologies. This study evaluated the feasibility, procedure modality, tolerability, complications and diagnostic accuracy of hysteroscopy in the management of patients with abnormal uterine bleeding (AUB). METHODS: This retrospective study was carried out on 512 women (age range: 38-80 years, mean age: 63) with AUB who attended our hysteroscopy outpatient service from January 1996 to December 2001. After undergoing transvaginal sonography, the patients were referred for further diagnostic studies. Ambulatory hysteroscopy without premedication was performed using a Hamou hysteroscope and physiological solution or CO(2) as distension medium. Guided biopsy with a Novak cannula completed the examination. When focal lesions were found, the patients were referred for surgical treatment (hysteroscopic resection, hysterectomy, etc.). Hysteroscopic and histologic findings were then compared. RESULTS: Locoregional or general anaesthesia was required in only 9.3% of cases to complete the examination. Overall, the examination was well tolerated; one case of serious complications (vagal syndrome which resolved rapidly) and 18 cases of shoulder blade pain were recorded. The hysteroscopic picture was normal in 25% of cases, benign pathology was diagnosed in 58.6% and suspected malignant neoplasia in 16.4%. Correlation rates between hysteroscopic and histologic diagnoses are reported for the various hysteroscopic pictures. CONCLUSIONS: Ambulatory hysteroscopy was shown to be a simple, safe, well tolerated and reliable procedure in the diagnosis of AUB across all age groups. Its widespread use can drastically reduce the need for conventional curettage, thereby increasing patient satisfaction and lowering costs.

Resolución de un síndrome de Youssef mediante tratamiento con análogos de GnRH. Caso clínico / Resolution of Youssef's syndrome by treatment with GnRH analogues. Case report

El síndrome de Youssef o menuria tras una fístula vesicouterina ha sido raramente publicado. Este caso difiere de los previamente comunicados en que el tratamiento mediante análogos de la GnRH hizo posible el cese de la menuria y, por tanto, un éxito del tratamiento conservador (AU)

Acceptability and pain of outpatient hysteroscopy.

STUDY OBJECTIVE: To investigate the pain and acceptability of diagnostic hysteroscopy performed without local anesthesia. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: University-associated department of obstetrics and gynecology. PATIENTS: The 1144 consecutive women who underwent diagnostic hysteroscopy. INTERVENTIONS: Diagnostic hysteroscopy and endometrial biopsy as indicated. MEASUREMENTS AND MAIN RESULTS: Patients were asked to rate the pain experienced on a 10-cm visual analog scale and to state if they were willing to repeat the procedure. The mean pain score was 4.7 +/- 2.5; 398 patients (34.8%) experienced severe pain. No risk factors for painful hysteroscopy were found, although abnormality of the cervical canal was associated with high pain scores. Acceptance of the procedure was high, 83.0% (950 women). CONCLUSION: Diagnostic hysteroscopy is a painful procedure even when performed with atraumatic technique by experienced surgeons. Most women, however, stated they were willing to have a second procedure under the same conditions.

Office microlaparoscopy under local anesthesia in the diagnosis and treatment of chronic pelvic pain.

STUDY OBJECTIVE: To evaluate the safety of diagnostic and operative microlaparoscopy performed in the office under local anesthesia in the diagnosis and treatment of chronic pelvic pain. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: Office-based, free-standing private obstetrics and gynecology practice. PATIENTS: Twenty women with chronic pelvic pain. INTERVENTION: Diagnostic and operative microlaparoscopy performed under local anesthesia with conscious sedation. MEASUREMENTS AND MAIN RESULTS: All 20 patients had diagnostic microlaparoscopy and 19 had conscious pain mapping. Nine of 14 patients with endometriosis underwent fulguration of lesions and 7 of 8 with pelvic adhesions had lysis of adhesions. Four women with uterosacral ligament involvement had laparoscopic uterosacral nerve ablation. All patients tolerated office diagnostic and operative procedures without difficulty and had no complications. CONCLUSION: In selected women, several laparoscopic procedures traditionally done in a hospital or ambulatory surgery center under general anesthesia can be performed safely in the office laparoscopy suite under local anesthesia with conscious sedation.

[Colo-uterine fistula, a complication of sigma diverticulitis]. / Fistola colo-uterina, complicanza della diverticolite del sigma.

The colo-uterine fistula is a rare complication of diverticular disease of the colon; the literature review has shown only few well studied cases. The fistula, among the complications of the sigma diverticulitis, is 20% of the observed cases; generally, the bladder is the most involved organ, but also the skin or gut can be interested. If we consider the aetiology of the colo=uterine fistula of the observed case, the presence of the sigma locked stenosis with an endocolic pressure increase, associated with a peridiverticulitis condition, seems to have a relevant rule. The clinical symptomatology is represented by vague abdominal pain localized in particular in the left iliac cavity and by emission of blood, purulent material and stools from the vagina. The diagnosis of colo-uterine fistula is not easily reached: barium enema, Fallopian tube endoscopy and colon endoscopy not always allow to visualize in a right manner the fistula and only the oral administration of non-absorbable substances to be searched in the vaginal tampon, clear each doubt. Regarding the therapy to be carried out, we think that, colic resection en bloc with the uterus is the treatment of choice, while, in emergency, the Hartman operation is the most suitable to avoid the beginning of septic complications.

Case report: torsion of a gravid horn of a didelphic uterus.

Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.

Colouterine fistula complicating diverticulitis: charcoal challenge test aids in diagnosis.

Fistula formation between a segment of colon and the uterus is an unusual complication of diverticulitis; only 17 cases have been reported in the world literature. We describe a 69-year-old woman with a colouterine fistula secondary to diverticulitis. She presented with a malodorous vaginal discharge that grew multiple enteric organisms on culture. A barium enema revealed colonic diverticula but no fistula tract. Orally administered activated charcoal was seen flowing from the cervical os during a pelvic examination the following day, establishing a diagnosis of colouterine fistula. Pathologic examination of the resected colon and uterus confirmed this diagnosis and determined that diverticulitis was the etiology. From a review of the literature, we conclude that radiographic and invasive procedures cannot be depended upon for diagnosis. Ingestion of activated charcoal may provide a simple, noninvasive approach to the diagnosis of enterouterine fistulas.

Panoramic CO2 hysteroscopy.

The method of CO2 panoramic hysteroscopy was described. It can be performed as an office procedure without the need for preliminary cervical dilatation or even a paracervical nerve block. The risks are minimal, and the benefits of being able to see the uterine cavity are manifold. Hysteroscopy is a relatively simple endoscopic procedure to learn, and its use in the diagnosis and management of abnormal uterine bleeding was emphasized.

[Acupuncture analgesia in instrumental examinations of the uterus]. / Analgesia mediante agopuntura nelle revisioni strumentali dell'utero.

The Authors put in choise the acupunctural-analgesia in front of general anaesthesia in uterus's critical instrumental inspections. Following the biomolecular data and the obtained results without any anaesthesiologic risk, the Author presents the used methods and, also if the number of patients is low, the Author advises the acupunctural method in above-mentioned disease.

PIP: Acupuncture was used on 20 patients to induce analgesia for instrumental inspection of the uterus. The procedure was successful in 80% of cases; in 12 patients single manual manipulation of the needles was used, without electrical stimulation. There was, after the procedure, less bleeding and less pain than after regular anesthesia. Acupuncture is to be recommended in all instances in which anesthesia would entail a risk, or would generally not be advisable.