Laparoscopic Approach for Fibroid Removal at 18 Weeks of Pregnancy.

Leiomyomas are the most frequently solid tumors found in pregnancy. This kind of tumor has a wide incidence depending on the age, race, and type of population studied. Most of the cases have an asymptomatic course; however, they could develop different kinds of complications during the pregnancy such as severe abdominal pain, often due to degeneration or torsion with ischemia. In these cases, a surgical approach is required because these tumors do not respond to the conventional treatment. Very few of these cases are reported in the literature. We report the case of a 36-year-old woman pregnant 18 weeks, who experienced acute abdominal pain without initial reponse to regular analgesics. She was taken to the operating room, and under laparoscopic exploration, torsion of a subserosal myoma was observed. The fibroid was resected laparoscopically, and she was released from the hospital without complications. Unfortunately, she was readmitted 45 days later with signs of preterm labor because of a motorcycle accident. An emergency cerclage was performed, but the pregnancy was compromised with amnionitis and early fetal demise. We concluded that the laparoscopic approach could be a successful alternative treatment in selected cases.

Optimal activation ratio of the scapular muscles in closed kinetic chain shoulder exercises: A systematic review.

BACKGROUND: Muscle synergies contribute to scapular position during arm movement. The trapezius and serratus anterior (SA) muscles are the main stabilizers and are therefore the main target muscles of therapeutic exercises. OBJECTIVE: To systematically review the current literature investigating the optimal activation ratio of the scapular muscles during a range of closed kinetic chain exercises. METHODS: A systematic review search was conducted to identify studies reporting shoulder electromyography (EMG) activity during rehabilitation exercises in healthy participants. The search was conducted in PubMed, Cochrane Library, MEDLINE, CINAHL, Scopus, SPORTDiscus, and ScienceDirect. The included studies reported closed kinetic chain exercises and the muscle activity as a percentage of maximum voluntary isometric contraction (%MVIC) or muscle ratios of the lower trapezius (LT), middle trapezius (MT), and SA with respect to the upper trapezius (UT). Muscle ratios were classified as optimal if they were equal to or lower than 0.6, and the adapted Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of the selected studies. RESULTS: Twenty-nine studies were included in this review; 7 main exercises and 30 variations of these were reported. The average electromyographic activity of the concentric and eccentric phase was considered. Half Push Up, Push Up Plus, and Scap Protraction exercises showed optimal SA activity (UT/SA < 0.6), while Press Up, Half Push Up, and One Hand Plank exercises showed optimal LT activity (UT/LT < 0.6). According to the NOS, 15 studies were classified as moderate methodological quality. CONCLUSIONS: The exercises in higher positions (e.g. exercises with the trunk closest to the vertical line) or unstable surfaces tend to favor UT activity over the MT, LT and SA. The exercises including scapular retraction showed optimal UT/MT and UT/LT ratios, while those including scapular protraction showed optimal UT/SA ratios. This will assist therapists in the correct selection of exercises for shoulder rehabilitation.

New technologies applied to ultrasound diagnosis of sports injuries.

INTRODUCTION: The aim of this study was to compare the ultrasound images of different soft tissue lesions from two different portable sonography devices: a conventional portable sonography device (ultrasound [US]-A, Micromaxx model; Sonosite Inc., Bothell, WA, USA), and a recently marketed compact device (US-B, Logiq e; General Electric Healthcare, Wauwatosa, WI, USA). The US-B device uses the new technologies of tissue harmonic imaging, real-time compound ultrasound, panoramic view, three-dimensional imaging, and virtual convex imaging. METHODS: We compared ultrasound images of six different types of soft tissue lesions (muscle contusion, muscle strain, patellar tendinosis, calcifying patellar tendinosis, rupture of the lateral internal ligament of the knee, and deep infrapatellar synovial bursa), from six different subjects. Analysis of images was performed by the same ultrasound specialist. In accordance with the classical criteria for ultrasound studies, the following quantitative indicators and parameters of ultrasound quality were used to evaluate the images: degree of echogenicity, size of the lesion area, aspect, shape, borders, and overall visualization. RESULTS: In muscle lesions due to contusion, not only is the edematous area better visualized with the new system, but definition of hemorrhagic area borders and their content is especially increased. In lesions of the tendons, the new system affords better definition of the borders of the hypoechogenic area of tendinous degeneration and perfect visualization of the extension of the damaged area using a panoramic study. Sonographic study of ligaments with chronic lesions permits visualization of scar areas. Finally, use of the new system with a small synovial bursa shows the content of the bursa and thickness of the walls more clearly. CONCLUSION: Overall, the quantitative indicators and parameters of image quality performed in this study of common sports lesions demonstrate the improvement in visualization of damaged soft tissues with the new technologies now incorporated into portable sonography devices.

Relation of alcohol/tobacco use with metastasis, hormonal (estrogen and progesterone) receptor status and c-erbB2 protein in mammary ductal carcinoma.

BACKGROUND: An association between alcohol/tobacco use and risk of metastasis in breast cancer has been clearly shown. MATERIALS AND METHODS: The present study explored, in 48 samples of tissue from mammary ductal carcinoma (taken from Mexican women with an average age of 58.2±10.9 years), the association of risk of metastasis with the status of hormonal receptors and the c-erbB2 protein (by immunohistochemistry) as well as clinical, histopathological and sociodemographic factors. RESULTS: Of 48 patients, 41.6% (20/48) presented with metastasis, 43.8% were positive for the estrogen receptor (RE+), 31.3% for the progesterone receptor (RP+) and 47.7% for c-erbB2 (c-erbB2+). The following combinations were found: RE+/RP+/c-erbB2+ 8.3%, RE+/RP+ 22.9%, RE+/RP- 20.8%, RE-/RP+ 8.3%, RE-/RP-/c-erbB2- 22.9% and RE-/RP- 47.8%. There were 12 patients who used alcohol/tobacco, of which 91.6% did not present metastasis and 81.9% were RE-/RP-. Compared to the RE-/RP-/c-erbB2+, the RE+/RP+/c-erbB2+ group had a 15-fold greater risk for metastasis (95%CI, 0.9-228.8, p=0.05). The carriers of the double negative hormonal receptors had a 4.7 fold greater probability of being (or having been) smokers or drinkers (95%CI, 1.0-20.4, p = 0.03). CONCLUSIONS: There was a clear protective effect of using alcohol and/or tobacco, in the cases included in the present study of mammary ductal carcinoma, associated with double negative hormonal receptors. However, this association could be due to a protective factor not measured (Neyman bias) or to a bias inherent in the rate of hospitalization (Berkson fallacy). This question should be explored in a broad prospective longitudinal study.