Hysteroscopic myomectomy for submucosal type 2 fibroids with cold enucleation technique and complete fibroid extraction using a double-lumen intracervical cannula.

OBJECTIVE: To introduce a new double-lumen intracervical cannula designed to allow a single-step hysteroscopic myomectomy with nonfragmented complete fibroid extraction after cold enucleation of submucosal type 2 fibroids, avoiding complications related to the use of energy and hypo-osmolar solutions. DESIGN: Video article depicting the use of a new double-lumen intracervical cannula for single-step hysteroscopic cold myomectomy, according to our institutional care guidelines and after obtaining the patient's informed consent. (The publication of this video has been authorized by the Institutional Ethics Committee of CES University in Medellín, Colombia.) SETTING(S): Private infertility clinic. PATIENT(S): A 45-year-old woman with abnormal uterine bleeding consisting of polymenorrhea and hypermenorrhea, nonresponsive to medical treatment, caused by three type 2 (FIGO leiomyoma subclassification system) submucosal fibroids of 17, 15, and 13 mm with more than 80% of intramyometrial component. INTERVENTION(S): Hysteroscopic enucleation of three submucosal fibroids performed by blunt dissection using the 30° Bettocchi hysteroscope's bevel under continuous observation of the avascular subcapsular plane of the fibroids. Once full enucleation was attained, cervical dilatation to 12 mm with Hegar plugs was performed followed by intracervical placement of a newly designed double-lumen intracervical cannula that allows the concomitant introduction of the Bettocchi diagnostic hysteroscope and a 5-mm laparoscopic tenaculum into the uterine cavity for complete nonfragmented fibroid extraction under direct visualization. MAIN OUTCOME MEASURE(S): Complete and unfragmented fibroid extraction in a single intervention, absence of surgical complications, and postoperative course. RESULT(S): Ambulatory hysteroscopic myomectomy of three submucosal type 2 fibroids was successfully performed by blunt enucleation and complete nonfragmented fibroid extraction using the double-lumen intracervical cannula. The total operative time was 32 minutes, and the total amount of distension media (normal saline) used was 800 mL with a liquid balance of 50 mL. No surgical or anesthesia-related complications occurred. In the postsurgical evaluation, the patient classified her pain as minimal, giving it a score of 1 on a pain scale of 1 to 5 (in which 1 is the lowest and 5 the highest pain perception). When asked about the level of satisfaction with the surgical procedure, the patient reported the highest degree of satisfaction with a score of 5 on a satisfaction scale of 1 to 5 (in which 1 is the lowest and 5 the highest satisfaction). The patient reported having postsurgical regular menstrual cycles every 28 days and 3 bleeding days without hypermenorrhea. CONCLUSION(S): An efficient hysteroscopic myomectomy of submucosal type 2 fibroids with deep intramyometrial component can be performed with complete and nonfragmented fibroid extraction in a single intervention by using a newly designed double-lumen intracervical cannula. This technique allows the completion of the surgery without the need of a resectoscope, electrosurgery, or hypo-osmolar uterine distension media, thus avoiding potential complications such as thermal-induced myometrial injury and hyponatremia; a second surgical intervention will not be required because the fibroid enucleation is complete. The procedure can be performed with the use of a diagnostic hysteroscope that is widely available in gynecologic practices. (Acknowledgment: The authors thank Dr. David Olive for the invaluable help and guidance with this surgical technique and video article.).

Presencia de cadmio y plomo en suelos y su bioacumulación en tejidos vegetales en especies de brachiaria en el magdalena medio colombiano / Presence of cadmium and lead in soil and its accumulation in plant tissue in brachiaria species in the middle magdalena colombian

En el Magdalena Medio colombiano confluyen dos actividades económicas: una ganadería intensiva y una consolidada industria petroquímica. Esta última representa un potencial peligro para la Salud Pública, como consecuencia de la emisión de metales tóxicos (plomo y cadmio) que pueden incorporarse a la cadena trófica. Por ello se realizó un inventario de pasturas en esta región en función de la distancia (100, 500, 2500 y 5000 m) al foco emisor contaminante. Así se muestrearon en zonas próximas a la refinería de crudo (Barrancabermeja, Santander), en pozos de extracción (Yondó, Antioquía) y tomando como testigo el Campus académico de la Universidad de la Paz (Barrancabermeja, Santander). Los resultados obtenidos indican una alta frecuencia de representantes de la familia Poaceae y de sus géneros de Brachiaria spp., con importantes diferencias. La información se interpretó en los tres primeros componentes, donde las variables con mayor peso fueron la profundidad del suelo a 5 y 30 cm, tipo de pastura con predominio de las especies introducidas y el transecto en relación a la distancia focal de las fuentes de contaminación. Así, en la zona de la refinería solo se han detectado dos especies de Brachiaria, mientras que en la zona de los pozos de extracción y en la zona testigo se presenta mayor frecuencia de otras especies de Brachiaria. Se concluye que los mayores niveles de bioacumulación de metales en tejidos vegetales presentó el siguiente orden: raíz > tallo > hojas, a su vez la acumulación en suelo mostró ser mayor en la profundidad de 5 cm.

In the Middle Magdalena Colombian converge two economic activities: intensive livestock and a consolidated petrochemical industry. The latter represents a potential danger to public health, resulting from the emission of toxic metals (lead and cadmium) that can enter in the food chain. Therefore pasture inventory is performed in this region depending on the distance (100, 500, 2500 and 5000 m) to the emitting source contaminant. So they were sampled near the oil refinery (Barrancabermeja, Santander) in extraction wells (Yondó, Antioquia) and sampling as witness the academic campus of the Universidad de la Paz (Barrancabermeja, Santander) areas. The results indicate a high frequency of representatives of the Poaceae family and its genera Brachiaria, with important differences. The information was interpreted in the first three components, where the variables with more weight were soil depth to 5 and 30 centimeters, type of pasture with predominance of introduced species and transect relative to the focal length of the sources of pollution. Then, in the area of the refinery were detected only two species of Brachiaria, while in the area of the extraction wells and in the control area it is presented a higher frequency of other species of Brachiaria. It’s concluded that higher levels of bioaccumulation of metals in plant tissues presented the following order: root > stem > leaves, turn the accumulation in soil was found to be higher in the depth of 5 cm