Transrectal ultrasound evaluation in tropical dairy goats: an indispensable tool for the diagnosis of reproductive disorders.

In Brazil, great milk productivity was achieved after the implementation of a genetic improvement program. However, reproductive efficiency is still far from optimal, possibly due to the high number of undiagnosed disorders that may affect fertility. The aim of this study was to evaluate occurrences of the main reproductive disorders in dairy goats in southeastern Brazil. Data were collected between January 2015 and May 2017 from 23 commercial herds of different breeds, with goats ranging from 8 months to 12 years of age. Transrectal ultrasound exams were performed in 2680 goats. A total of 14.8% of the does showed a disorder in the reproductive tract: hydrometra (10.0%), ovarian follicular cysts (2.3%), gestational loss (1.5%), and hydrosalpinx (1.1%). This was the first study evaluating reproductive disorders in live animals that used a high number of Brazilian dairy goats. Considering that all these diseases affect fertility to different degrees, the performance of transrectal ultrasonography exams twice a year is strongly suggested, in order to guide precocious treatment or discard the animal as soon as possible, thus reducing economic losses in dairy goat farming.

O papel da videolaparoscopia nas emergências ginecológicas e obstétricas / The role of videolaparoscopy in gynecological and obstetric emergencies

Introdução: A videolaparoscopia (VLP) tem sido cada vez mais empregada na prática clínica uma vez que auxilia, tanto no diagnóstico, quanto no manejo de diversas condições ginecológicas. Essa revisão tem como objetivo esclarecer a importância da VLP nas principais emergências ginecológicas. Métodos: Foi realizada uma revisão da literatura no mês de maio de 2018 nos bancos de dados Pubmed, Medline e Portal Periódico Capes. Foram incluídos no estudo os artigos que abordavam o uso de VLP no manejo de emergências e foram excluídos os relatos de caso. Resultados: A VLP é importante na medida em que permite a visualização direta das condições que constituem emergências ginecológicas, contribuindo dessa forma para o seu diagnóstico definitivo e precoce. A abordagem VLP frequentemente está relacionada a uma menor morbidade nesses casos. Na torção ovariana a VLP é útil tanto para identificar a viabilidade do ovário acometido quanto para desfazer a torção. No abscesso tubo ovariano, entretanto, estudos indicam que não há superioridade da técnica laparoscópica em relação à laparotomia no manejo cirúrgico desses pacientes. Na rotura de cisto ovariano, a VLP é o método preferencial nas patologias benignas, enquanto a laparotomia é o método de escolha na suspeita de lesões malignas. Na gestação ectópica, a VLP pode ser empregada nos casos de instabilidade hemodinâmica, gravidez tubária rota e quando há ascensão dos títulos de ß-hCG nas dosagens séricas associada à massa de 5 cm. Conclusão: A combinação entre o conhecimento adequado das patologias ginecológicas, a correta indicação do método VLP e a habilidade do cirurgião são fatores determinantes no sucesso terapêutico desse método.

Introduction: Video-laparoscopy (VLP) has been increasingly used in clinical practice since it assists in the diagnosis and management of various gynecological conditions. This review aims to clarify the importance of VLP in major gynecological emergencies. Methods: A literature review was performed in the month of May, 2018 in Pubmed, Medline and Capes Periodical Portal databases. The articles that addressed the use of VLP in emergency management were included in the study and the case reports were excluded. Results: VLP is important because it allows direct visualization of conditions that constitute gynecological emergencies, thus contributing to its definitive and early diagnosis. The VLP approach is often related to lower morbidity in these cases. In ovarian torsion the VLP is useful both to identify the viability of the affected ovary and to undo the torsion. In the ovarian tube abscess, however, studies indicate that there is no superiority of the laparoscopic technique in relation to laparotomy in the surgical management of these patients. In ruptured ovarian cyst, VLP is the preferred method in benign pathologies, while laparotomy is the method of choice in the suspicion of malignant lesions. In ectopic pregnancy, VLP may be used in cases of hemodynamic instability, tubal rupture, and when there is a rise in ß-hCG serum levelst associated with a 5 cm mass. Conclusion: The combination of adequate knowledge of the gynecological pathologies, the correct indication of VLP and the surgeon's ability are determining factors in the therapeutic success of this method. Keywords: videolaparoscopy,

The role of diagnostic laparoscopy in gynecology.

CONTEXT AND OBJECTIVES: Laparoscopy is a diagnostic method that is currently becoming consolidated for therapeutic use. It consists of endoscopically viewing the abdominal cavity. The aim here was to evaluate the indications for diagnostic videolaparoscopy and the intraoperative findings in an endoscopic gynecology clinic at a tertiary-level hospital over the last five years. DESIGN AND SETTING: Retrospective descriptive study on all diagnostic videolaparoscopy procedures of the last five years carried out in the endoscopic gynecology clinic of a tertiary-level hospital. METHODS: The medical records of 618 women who underwent diagnostic laparoscopy between 2008 and 2012 were analyzed. The clinical characteristics of these women, the indications for videolaparoscopy and the intraoperative findings were evaluated. RESULTS: The women's mean age was 32 ± 6.4 years. Most of the women had already undergone at least one previous operation (60%), which was most frequently a cesarean. The indications for performing videolaparoscopy were infertility in 57%, chronic pelvic pain in 27% and others (intrauterine device, adnexal tumor, ectopic pregnancy or pelvic inflammatory disease) in 16%. The main laparoscopic findings were tubal alterations in the group with infertility (59.78%) and peritoneal alterations in the group with chronic pelvic pain (43.54%). CONCLUSION: The main indications for videolaparoscopy in gynecology were infertility and chronic pelvic pain. However, in most procedures, no abnormalities justifying these complaints were found.

Síndrome de Allen Master: causa excepcional de abdomen agudo en el embarazo / Allen Master syndrome: exceptional cause of acute abdomen in pregnancy

Se presenta un caso de abdomen agudo en una gestante de 20 semanas, por una torsión anexial. Ante la ausencia de signos ecográficos compatibles con patología en los primeros momentos y el empeoramiento clínico, se solicitó una RMN que permitió la aproximación diagnóstica y facilitó la indicación urgente de cirugía abdominal. En el curso de la laparotomía se diagnosticó una hernia interna del anexo, con marcado componente vascular a través de un defecto del ligamento ancho, que obligó a la anexectomía. Tras el diagnóstico y el tratamiento realizado, la gestación continúa con buenos resultados materno-fetal. Estos orificios han sido presentados excepcionalmente como causa de hernias internas digestivas, urológicas y anexiales, siendo controvertido su origen, congénito, inflamatorio o traumático. Se repasan las pruebas complementarias indicadas en el manejo diagnóstico del dolor abdominal en el embarazo, incluyendo las últimas recomendaciones de la European Society of Urogenital Radiology-ESUR.

A case of acute abdomen in a pregnant 20 weeks is presented with an adnexal torsion. In the absence of pathologic ultrasound signs with in the early stages and clinical worsening, was requested an MRI that allowed the diagnostic approach and the indication for urgent abdominal surgery. During laparotomy was observed an internal adnexal hernia through a defect in the broad ligament, with marked vascular component which forced the adnexectomy. After the diagnosis and treatment performed, the pregnancy continues with good maternal and fetal outcomes. These defects were presented exceptionally as a cause of digestive, urological and adnexal internal hernias. The origin remains controversial, congenital, inflammatory or traumatic. Complementary tests in the diagnostic management of abdominal pain in pregnancy are reviewed, including the latest recommendations of the European Society of Urogenital Radiology-ESUR.

Pelvis: normal variants and benign findings in FDG-PET/CT imaging.

With the widespread use of whole-body fluorodeoxyglucose (FDG)-PET/computed tomography as a diagnostic tool in patients with cancer, incidental findings are of increasing importance. This is particularly true within the pelvis, where several benign findings might present with increased FDG uptake. In addition, physiologic excretion of radiotracer by way of the urinary tract can complicate image analysis. This article reviews potential incidental benign findings in the pelvis that one should be aware of when interpreting FDG-PET/computed tomography scans.

[Hydrometrocolpos: prenatal diagnosis. A case report]. / Hidrometrocolpos: diagnóstico prenatal. Informe de un caso.

Hydrometrocolpos is cHaracterized by a vaginal obstruction with cystic dilatation of uterus and vagina caused by accumulation of cervical and endometrial mucus. It could be in association with other malformations, such as postaxial polydactyly, anal atresia, esophageal atresia, renal agenesis, genital anomalies, cardiopathy or autosomal recessive disorder. The appropriate prenatal detection with the help of prenatal ultrasonography differential diagnosis and early treatment and prevention of complications.

Ultrasonography in emergency medicine.

The use of ultrasonography in emergency medicine is an area of rapid growth and controversy. This article reviews the current and future applications of emergency ultrasonography with particular emphasis on the role of bedside scanning by the emergency practitioner. Abdominal, pelvic, and cardiac ultrasonographic applications are reviewed, as are the uses of ultrasonography as an adjunct to the performance of procedures in the Emergency Department.