ABSTRACT
AIM: The aim of this paper was to evaluate the feasibility, morbidity, and reproductive performance of fertile women undergoing minilaparotomic myomectomy for large uterine myomas. METHODS: Ninety-nine consecutive women with symptomatic myomas underwent myomectomy through a skin incision ≤8 cm. Operative, postoperative and reproductive data were prospectively collected. RESULTS: Median (range) age and Body Mass Index (BMI) were 37 years (23-44) and 23 (18-43), respectively. Median (range) myoma diameter was 7 cm (4-20), and the median number of myomas removed was 1 (range 1-31). Myomas were intramural in 76 (76%) cases. Median incision length was 7 cm (range 4-13) and median duration of surgery was 70 min (range 40-180). Operative time and length of skin incision were not correlated with the progressive number of interventions. An incision larger than 8 cm was necessary in 7 (7%) patients and the length of incision was significantly correlated with the diameter of the largest myoma (P<0.01). The feasibility of minilaparotomy was significantly reduced when the diameter of the largest myoma was >12 cm (P<0.05). Operative time was significantly longer in patients having >1 myoma (P<0.05). Three (3%) patients underwent blood transfusion. Median (range) postoperative stay was 2 days (range 2-12). Fever occurred in 8 (8%) patients, and wound complications in 5 (5%). CONCLUSION: Myomectomy by minilaparotomy is a feasible procedure in more than 90% of unselected patients with large symptomatic myomas. Feasibility is questionable when the myoma is >12 cm. This technique is a mini-invasive option to treat patients with large and multiple myomas.
Subject(s)
Laparotomy , Leiomyoma/surgery , Uterine Neoplasms/surgery , Adult , Female , Gynecologic Surgical Procedures/methods , Humans , Leiomyoma/pathology , Prospective Studies , Uterine Neoplasms/pathology , Young AdultABSTRACT
The identification of the heart rhythm during an episode of transient loss of consciousness (TLOC) is considered the reference standard method to elucidate the underlying aetiology. This study aimed to characterise heart rhythm in dogs during TLOC using Holter and external loop recorder monitoring. We retrospectively reviewed 24-h Holter monitoring and external loop recorder tracings from 8084 dogs. Heart rhythms from dogs that experienced TLOC during the recording was analysed to identify rhythm disturbances that occurred during episodes of TLOC. Electrocardiograms (ECGs) were subsequently categorised into Type 1 (ventricular arrest), Type 2 (sinus bradycardia), Type 3 (no/slight rhythm variations), and Type 4 (tachycardia). Transient LOC was documented in 92 dogs over 230 episodes of TLOC. Percentage of cases with ECGs compatible with each classification were as follows: 72.1%, Type 1; 6.1%, Type 2; 20.9%, Type 3; and 0.9%, Type 4. Cardiac rhythm during the TLOC could have been a consequence of a neurocardiogenic mechanism in 46.7% cases, while intrinsic rhythm disturbances of the sinus node or of the atrioventricular node were diagnosed in 31.5% cases. In two cases, tachycardia was the possible cause of the TLOC. ECG patterns in dogs presenting with multiple TLOC episodes were completely reproducible during each episode. TLOC in dogs was primarily caused by ventricular arrest. Most dogs with TLOC had electrocardiographic finding suggestive of a reflex or neurally-mediated syncope, but one third had an ECG more suggestive of a conduction disorder. Distinguishing these two entities could help inform diagnostic, therapeutic, and prognostic plans.
Subject(s)
Dog Diseases/physiopathology , Electrocardiography, Ambulatory/veterinary , Heart Rate/physiology , Unconsciousness/veterinary , Animals , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/veterinary , Dogs , Electrocardiography/veterinary , Electrocardiography, Ambulatory/methods , Female , Male , Retrospective Studies , Syncope/physiopathology , Syncope/veterinary , Unconsciousness/etiology , Unconsciousness/physiopathologyABSTRACT
One hundred patients with chronic lymphocytic leukemia (CLL) followed in our department between November 1969 and December 1982 were reviewed and classified according to the staging system proposed by the International Workshop on CLL (IWCLL). Analysis of actuarial survival curves revealed a significant chi-square value for heterogeneity and trend. In addition, thrombocytopenia and anemia appeared to be the most important risk factors. A large variability in the course of disease, not well explained by the staging system of the IWCLL, was found among the nonanemic and nonthrombopenic patients. Analysis of A and B stage patients according to absolute peripheral blood lymphocytosis (less or more than 50 X 10(9)/liter) showed two separate patterns of survival.
Subject(s)
Leukemia, Lymphoid/mortality , Adult , Aged , Female , Humans , Leukemia, Lymphoid/blood , Leukemia, Lymphoid/pathology , Lymphocytosis/pathology , Male , Middle Aged , Neoplasm Staging , PrognosisABSTRACT
BACKGROUND: Benign paraoxysmal postural vertigo (BPPV) is one of the most frequent causes of peripheral dizziness. Treatment based on vestibular rehabilitation exercises (VRE) is effective in 90% of the cases in an interval of 3 to 4 weeks. This treatment however is often abandoned by the patient. The only therapeutic maneuvers (based on otolyte release) are equally effective but present a high medium term recurrence. AIM: To compare the efficacy of the Semont maneuver (SM), the VRE and the combination of both in the treatment of BPPV at three months of follow up. MATERIAL AND METHODS: Forty patients with the clinical and electronystagmographic diagnosis of BPPV were divided into three groups: 1. SM, 2. VRE and 3. SM + VRE. The results were compared in regard to the signs and symptoms observed in the three groups of patients at 15 days, one month and at three months of treatment. RESULTS: The SM was effective in 80% of the patients at 15 days of treatment versus 45% of those receiving only VRE. The third group of patients, receiving the combined treatment, demonstrated a cure in 100% of the cases when evaluated at three months while only 66% of the SM group were found to be asymptomatic at the same time period (p < 0.05). CONCLUSIONS: The SM is easy to perform, rapid and effective in the short term, however has high recurrence. The VRE are effective in the long term based on the patient persistence. Combination of the two treatment leads to symptom remission in 100% of the patients at three months of treatment.
Subject(s)
Exercise , Vertigo/rehabilitation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Posture , Treatment OutcomeABSTRACT
Alterations in brain cell membrane structure and function during cerebral hypoxia were investigated by measuring Na+,K(+)-ATPase activity and levels of lipid peroxidation products in brain cell membranes obtained from newborn piglets following exposure to 60 min of hypoxic hypoxia in vivo. Cerebral hypoxia was documented as a decrease in the ratio of phosphocreatine to inorganic phosphate (PCr/Pi) using 31P-NMR spectroscopy. During hypoxia (FiO2 0.07-0.11), PCr/Pi decreased 28-47% compared to the corresponding baseline value without a decrease in cerebral ATP levels. No change in brain cell membrane Na+,K(+)-ATPase activity was observed for changes in PCr/Pi of less than 30%. When PCr/Pi was at least 30% lower than baseline, Na+,K(+)-ATPase activity decreased linearly as a function of the decrease in PCr/Pi (r = 0.95). Levels of lipid peroxidation products (conjugated dienes and fluorescent compounds) increased significantly as PCr/Pi decreased. These data suggest that below a critical threshold value of oxidative metabolism there are progressive changes in brain cell membrane structure and function during cerebral hypoxia, and demonstrate that membrane alterations occur prior to changes in cellular ATP levels.
Subject(s)
Cell Hypoxia , Hypoxia, Brain/pathology , Animals , Animals, Newborn/physiology , Cell Membrane/enzymology , Cell Membrane/pathology , Cell Membrane/physiology , Hypoxia, Brain/enzymology , Hypoxia, Brain/physiopathology , Magnetic Resonance Spectroscopy , Sodium-Potassium-Exchanging ATPase/metabolism , SwineABSTRACT
Fundamento: El vértigo postural paroxístico benigno (VPPB) es una de las causas más frecuentes de vértigo periférico. El tratamiento con ejercicios de rehabilitación vestibular (ERV) es efectivo en el 90 por ciento de los casos en un intervalo de 3 a 4 semanas; sin embargo, frecuentemente es abandonado por el paciente. Las maniobras terapéuticas únicas (basadas en la liberación de otolitos) son igualmente efectivas pero presentan alta recurrencia a medio plazo. Objetivo: Comparar la eficacia de la maniobra de Semont (MS), los ERV y la combinación de ambos en el tratamiento del VPPB a los 3 meses de seguimiento. Material y métodos: Se estudiaron 40 pacientes con el diagnóstico clínico y electronistagmográfico de VPPB divididos en 3 grupos: I MS, II ERV y III MS + ERV. Se compararon los resultados en cuanto a síntomas y signos observados en los tres grupos a los 15 días, al mes y a los 3 meses de tratamiento. Resultados: La MS fue eficaz en el 80 por ciento de los pacientes a los 15 días de tratamiento frente al 45 por ciento de los que recibieron únicamente ERV. El grupo de pacientes sometidos a ambos tratamientos se curó en el 100 por ciento de los casos valorados a los 3 meses, mientras que sólo el 66 por ciento del grupo de MS se encontraron asintomáticos en el mismo período de tiempo (p < 0,05). Conclusiones: La MS es fácil de realizar, rápida y eficaz a corto plazo; sin embargo, cursa con alta recurrencia. Los ERV son efectivos a largo plazo, en función de la persistencia del paciente. Combinar ambos tratamientos lleva a la remisión de los síntomas en el 100 por ciento de los pacientes a los 3 meses de tratamiento (AU)