Análise das gestações ectópicas íntegras tratadas com o protocolo de dose única de metotrexato / Analysis of unruptured ectopic pregnancies treated with single-dose methotrexate protocol

Objetivo: Avaliar o índice de sucesso do tratamento da gravidez ectópica com o protocolo de dose única do metotrexato e verificar sua correlação com variáveis clínicas e dados dos exames complementares. Métodos: É um estudo epidemiológico observacional, analítico, retrospectivo, de delineamento transversal. Foi realizado de janeiro de 2014 a agosto de 2020 em um hospital público, de ensino, em nível terciário, do Sul do Brasil. Em 73 casos com diagnóstico de gestação ectópica íntegra, foi utilizado o protocolo de dose única de metotrexato intramuscular, com a dose de 50 mg/m2 de superfície corporal. As variáveis do estudo foram relacionadas ao sucesso do tratamento e abordaram as características clínicas na admissão, dos exames complementares e do tratamento realizado. As variáveis foram comparadas por análise de regressão de Poisson. O nível de significância estabelecido foi de p < 0,05. Resultados: O índice de sucesso foi de 83,6%, e em nove casos foi necessária uma segunda dose da medicação. Nível de ß-hCG inicial superior a 5.000 mUI/mL foi relacionado a menor chance de sucesso (odds ratio ajustado de 0,20 [0,05-0,95]). Tamanho da imagem anexial, presença de líquido livre na cavidade abdominal e demais variáveis estudadas não afetaram a chance de sucesso do tratamento. Conclusão: O protocolo de dose única de metotrexato mostrou-se uma opção válida para o tratamento da gestação ectópica íntegra, notadamente quando o nível de ß-hCG inicial é inferior 5.000 mUI/mL.

Objective: The purpose of the present study is to evaluate the success rate of treatment of ectopic pregnancy with the single-dose methotrexate protocol and to verify its correlation with clinical variables and complementary exam data. Methods: This is a retrospective epidemiological observational analytical cross-sectional study. It was carried out from January 2014 to August 2020 in a tertiary level teaching hospital in southern Brazil. In 73 cases with a diagnosis of intact ectopic pregnancy, the intramuscular methotrexate single-dose protocol was applied with a dose of 50 mg/m2 of body surface. The study variables were related to the success of the treatment and addressed the clinical characteristics on admission, the complementary exams and the treatment performed. The variables were compared by Poisson regression analysis. The level of significance was set at p < 0.05. Results: The success rate was 83.6%, and in nine cases a second dose of the medication was necessary. An initial ß-hCG level greater than 5,000 mIU/mL was related to a lower chance of success (adjusted odds ratio of 0.20 [0.05- 0.95]). The size of the adnexal image, the presence of free fluid in the abdominal cavity and other variables studied did not affect the chance of a successful treatment. Conclusion: The methotrexate single-dose protocol proved to be a valid option for the treatment of intact ectopic pregnancy, notably when the initial ß-hCG level is below 5,000 mIU/mL.

Recuperação anestésica e analgesia residual da infusão continua intravenosa de fantanil, lidocaína, cetamina e fentanyl-lidocaína-cetamina associados à anesthesia total intravenosa com Propofol em cadelas submetidas à ovariossalpingo-histerectomia eletiva / Anesthetic recovery and residual analgesia of constant rate infusion intraoperative of fentanyl, lidocaine, ketamine or fentanyl-lidocaine-ketamine associated with total intravenous anesthesia with propofol in bitches submitted to elective ovariohysterectomy

Avaliou-se a recuperação anestésica e a analgesia residual da infusão contínua (IC) de fentanil (F), lidocaína (L), cetamina (K) e fentanil-lidocaína-cetamina (FLK), associados à anestesia total intravenosa com o propofol, em cadelas submetidas à ovariossalpingo-histerectomia. Foram utilizados 32 animais pré-medicados com acepromazina, distribuídos em quatro grupos de acordo com o tratamento analgésico: F: bolus de 0,0036mg/kg de fentanil e IC de 0,0036mg mg/kg/h; L: bolus de 3mg/kg de lidocaína e IC de 3mg/kg/h; K: bolus de 0,6mg/kg de cetamina e IC de 0,6mg/kg/h; e FLK: bolus e IC dos três fármacos nas doses supracitadas. Após o bolus do tratamento analgésico, foi realizada a indução e o início da IC do tratamento analgésico e do propofol. Para avaliação da recuperação anestésica, foram considerados os tempos de extubação, decúbito esternal, posição quadrupedal e os efeitos adversos. A avaliação da analgesia foi realizada por meio da escala visual analógica e modificada de Glasgow, durante seis horas. Os efeitos adversos observados foram vômito, sialorreia e tremor muscular. Receberam analgesia de resgate 100% dos animais do grupo F, 87,5% do K, 50% do L e 12,5% do FLK. O FLK demonstrou maior analgesia, e a recuperação anestésica foi semelhante em todos os grupos.(AU)

The anesthetic recovery and residual analgesia of continuous rate infusion (CRI) of fentanyl (F), lidocaine (L), ketamine (K) and fentanyl-lidocaine-ketamine (FLK) associated with total intravenous anesthesia with propofol in bitches submitted to ovariohysterectomy were evaluated. 32 animals were used, pre-medicated with acepromazine and distributed into four groups according to analgesic treatment: F loading dose (LD) of 0.0036mg/kg fentanyl, and CRI of 0.0036mg/kg/h, L: LD of 3mg/kg lidocaine, and CRI of 3mg/kg/h; K: LD of 0.6mg/kg ketamine, and CRI of 0.6mg/kg/h and FLK: LD and CRI of the three drugs in the above mentioned doses. After the LD of analgesic treatment, the induction was performed and the CRI of the analgesic treatment and propofol started. To evaluate the anesthetic recovery, the time of extubation, sternal decubitus, quadrupedal position and adverse effects were considered. The analgesia evaluation was performed using the visual scale and modified Glasgow for six hours. The adverse effects observed were vomiting, sialorrhea and muscle tremor. 100% of the animals in group F, 87.5% of K, 50% of L and 12.5% of FLK received rescue analgesia. FLK demonstrated greater analgesia, and anesthesia recovery was similar in all groups.(AU)

Recuperação anestésica e analgesia residual da infusão continua intravenosa de fantanil, lidocaína, cetamina e fentanyl-lidocaína-cetamina associados à anesthesia total intravenosa com Propofol em cadelas submetidas à ovariossalpingo-histerectomia eletiva / Anesthetic recovery and residual analgesia of constant rate infusion intraoperative of fentanyl, lidocaine, ketamine or fentanyl-lidocaine-ketamine associated with total intravenous anesthesia with propofol in bitches submitted to elective ovariohysterectomy

Avaliou-se a recuperação anestésica e a analgesia residual da infusão contínua (IC) de fentanil (F), lidocaína (L), cetamina (K) e fentanil-lidocaína-cetamina (FLK), associados à anestesia total intravenosa com o propofol, em cadelas submetidas à ovariossalpingo-histerectomia. Foram utilizados 32 animais pré-medicados com acepromazina, distribuídos em quatro grupos de acordo com o tratamento analgésico: F: bolus de 0,0036mg/kg de fentanil e IC de 0,0036mg mg/kg/h; L: bolus de 3mg/kg de lidocaína e IC de 3mg/kg/h; K: bolus de 0,6mg/kg de cetamina e IC de 0,6mg/kg/h; e FLK: bolus e IC dos três fármacos nas doses supracitadas. Após o bolus do tratamento analgésico, foi realizada a indução e o início da IC do tratamento analgésico e do propofol. Para avaliação da recuperação anestésica, foram considerados os tempos de extubação, decúbito esternal, posição quadrupedal e os efeitos adversos. A avaliação da analgesia foi realizada por meio da escala visual analógica e modificada de Glasgow, durante seis horas. Os efeitos adversos observados foram vômito, sialorreia e tremor muscular. Receberam analgesia de resgate 100% dos animais do grupo F, 87,5% do K, 50% do L e 12,5% do FLK. O FLK demonstrou maior analgesia, e a recuperação anestésica foi semelhante em todos os grupos.(AU)

The anesthetic recovery and residual analgesia of continuous rate infusion (CRI) of fentanyl (F), lidocaine (L), ketamine (K) and fentanyl-lidocaine-ketamine (FLK) associated with total intravenous anesthesia with propofol in bitches submitted to ovariohysterectomy were evaluated. 32 animals were used, pre-medicated with acepromazine and distributed into four groups according to analgesic treatment: F loading dose (LD) of 0.0036mg/kg fentanyl, and CRI of 0.0036mg/kg/h, L: LD of 3mg/kg lidocaine, and CRI of 3mg/kg/h; K: LD of 0.6mg/kg ketamine, and CRI of 0.6mg/kg/h and FLK: LD and CRI of the three drugs in the above mentioned doses. After the LD of analgesic treatment, the induction was performed and the CRI of the analgesic treatment and propofol started. To evaluate the anesthetic recovery, the time of extubation, sternal decubitus, quadrupedal position and adverse effects were considered. The analgesia evaluation was performed using the visual scale and modified Glasgow for six hours. The adverse effects observed were vomiting, sialorrhea and muscle tremor. 100% of the animals in group F, 87.5% of K, 50% of L and 12.5% of FLK received rescue analgesia. FLK demonstrated greater analgesia, and anesthesia recovery was similar in all groups.(AU)

Edema periglandular e necrosis epidérmica asociada con el tratamiento de hiperplasia mamaria en felina / Periglandular edema and epidermal necrolysis associated with the treatment of mammary hyperplasia in feline / Edema periglandular e necrose epidérmica associado a tratamento de hiperplasia mamária em felino

La hiperplasia mamaria felina, también conocida como hiperplasia fibroepitelial y se caracteriza microscopicamente por el rápido crecimiento de estroma y el epitelio ductal de la glándula mamaria en respuesta a la estimulación hormonal. El objetivo de este estudio fue describir un caso que tuvo un avance inesperado para la formación de edema después de la ovário salpingo histerectomía. Una gata, raza mezclada, con siete meses de edad, nulípara, fue remitida al Departamento de Medicina Veterinaria de la Universidad Federal de Sergipe, con un aumento de volumen de todas las cadenas mamarias a un mes, el desarrollo de los síntomas mencionados días la administración de un anticonceptivo. Como tratamiento, se propuso llevar a cabo el ovario salpingo histerectomía por el flanco por el aumento grande de las  glándulas mamarias. Después de dos semanas hubo una reducción del tejido mamario, pero gran acumulación de líquido, corroborando para la celebración de la mastectomía radical en el felino. Este reporte llama la atención a considerar la ocurrencia de edema en la mama después del tratamiento conservador por ovário salpingo histerectomía o drogas, ya que puede haber una falsa interpretación de que la mama no reduce ni tampoco aumenta.(AU)

Feline mammary hyperplasia, also known as fibroepithelial hyperplasia is characterized microscopically by rapid growth of the stroma and ductal epithelium of the mammary glands in response to hormonal stimulation. The purpose of the present study was to report a case of breast hyperplasia in a feline, which had an unexpected progress by edema formation after ovarian-salpingo hysterectomy. A female, mixed breed cat, seven months old, nulliparous, was referred to the Department of Veterinary Medicine, Federal University of Sergipe, with historical of swelling of all mammary chains for a month, developing symptoms after administration of a contraceptive. As treatment, the realization of ovarian-salpingo hysterectomy was proposed to approach the edge because the breasts were very large. After two weeks, the breast tissue reduced, but large accumulation of liquid was noticed leading to the realization of radical mastectomy in the feline. This study draws attention in order to consider this type of edema after conservative treatment by ovarian-salpingo hysterectomy or drugs, as it can lead to a false interpretation of no reduction or even enlargement of the mammary tissue.(AU)

A hiperplasia mamária felina, também conhecida como hiperplasia fibroepitelial, é caracterizada microscopicamente pelo rápido crescimento do estroma e epitélio ductal das glândulas mamárias em resposta a estímulo hormonal. O objetivo deste trabalho foi relatar um caso que teve um andamento inesperado pela formação de edema após a ovário-salpingo-histerectomia. Uma gata, sem raça definida, com sete meses de idade, nulípara, foi encaminhada ao Departamento de Medicina Veterinária da Universidade Federal de Sergipe, com histórico de aumento de volume de todas as cadeias mamárias há um mês, desenvolvendo os sintomas mencionados dias após a administração de um contraceptivo. Como tratamento, foi proposta a realização da ovário-salpingo-histerectomia com abordagem pelo flanco devido as mamas se apresentarem muito grandes. Após duas semanas houve redução do tecido mamário, porém grande acúmulo de líquido, corroborando para a realização de mastectomia radical no felino. Este relato chama a atenção para considerar a ocorrência deste edema nas mamas após tratamento conservador por meio de ovário-salpingo-histerectomia ou fármacos, já que pode haver uma falsa interpretação de que a mama não esteja reduzindo ou até mesmo aumentando.(AU)

Edema periglandular e necrosis epidérmica asociada con el tratamiento de hiperplasia mamaria en felina / Periglandular edema and epidermal necrolysis associated with the treatment of mammary hyperplasia in feline / Edema periglandular e necrose epidérmica associado a tratamento de hiperplasia mamária em felino

La hiperplasia mamaria felina, también conocida como hiperplasia fibroepitelial y se caracteriza microscopicamente por el rápido crecimiento de estroma y el epitelio ductal de la glándula mamaria en respuesta a la estimulación hormonal. El objetivo de este estudio fue describir un caso que tuvo un avance inesperado para la formación de edema después de la ovário salpingo histerectomía. Una gata, raza mezclada, con siete meses de edad, nulípara, fue remitida al Departamento de Medicina Veterinaria de la Universidad Federal de Sergipe, con un aumento de volumen de todas las cadenas mamarias a un mes, el desarrollo de los síntomas mencionados días la administración de un anticonceptivo. Como tratamiento, se propuso llevar a cabo el ovario salpingo histerectomía por el flanco por el aumento grande de las  glándulas mamarias. Después de dos semanas hubo una reducción del tejido mamario, pero gran acumulación de líquido, corroborando para la celebración de la mastectomía radical en el felino. Este reporte llama la atención a considerar la ocurrencia de edema en la mama después del tratamiento conservador por ovário salpingo histerectomía o drogas, ya que puede haber una falsa interpretación de que la mama no reduce ni tampoco aumenta.

Feline mammary hyperplasia, also known as fibroepithelial hyperplasia is characterized microscopically by rapid growth of the stroma and ductal epithelium of the mammary glands in response to hormonal stimulation. The purpose of the present study was to report a case of breast hyperplasia in a feline, which had an unexpected progress by edema formation after ovarian-salpingo hysterectomy. A female, mixed breed cat, seven months old, nulliparous, was referred to the Department of Veterinary Medicine, Federal University of Sergipe, with historical of swelling of all mammary chains for a month, developing symptoms after administration of a contraceptive. As treatment, the realization of ovarian-salpingo hysterectomy was proposed to approach the edge because the breasts were very large. After two weeks, the breast tissue reduced, but large accumulation of liquid was noticed leading to the realization of radical mastectomy in the feline. This study draws attention in order to consider this type of edema after conservative treatment by ovarian-salpingo hysterectomy or drugs, as it can lead to a false interpretation of no reduction or even enlargement of the mammary tissue.

A hiperplasia mamária felina, também conhecida como hiperplasia fibroepitelial, é caracterizada microscopicamente pelo rápido crescimento do estroma e epitélio ductal das glândulas mamárias em resposta a estímulo hormonal. O objetivo deste trabalho foi relatar um caso que teve um andamento inesperado pela formação de edema após a ovário-salpingo-histerectomia. Uma gata, sem raça definida, com sete meses de idade, nulípara, foi encaminhada ao Departamento de Medicina Veterinária da Universidade Federal de Sergipe, com histórico de aumento de volume de todas as cadeias mamárias há um mês, desenvolvendo os sintomas mencionados dias após a administração de um contraceptivo. Como tratamento, foi proposta a realização da ovário-salpingo-histerectomia com abordagem pelo flanco devido as mamas se apresentarem muito grandes. Após duas semanas houve redução do tecido mamário, porém grande acúmulo de líquido, corroborando para a realização de mastectomia radical no felino. Este relato chama a atenção para considerar a ocorrência deste edema nas mamas após tratamento conservador por meio de ovário-salpingo-histerectomia ou fármacos, já que pode haver uma falsa interpretação de que a mama não esteja reduzindo ou até mesmo aumentando.

Avaliação da analgesia pós-operatória da dexmedetomidina isolada e associada à morfina quando utilizada na medicação pré-anestésica em cadelas submetidas à ovariosalpingohisterectomia eletiva / Evaluation of postoperative analgesia of dexmedetomidine alone or associated to morphine as premedicants in bitches undergoing ovariosalpingohisterectomy

Background: Elective ovariossalpingohysterectomy is a common surgery that causes mild to moderate pain. Aiming at the treatment of pain in these patients, analgesia should be balanced from pre-anesthetic, transoperative and postoperative medication, with-2-agonists and opioids being commonly used, especially dexmedetomidine that has sedation, relaxation muscle and analgesia.The aim of the present study was to evaluate the postoperative analgesic efficacy of dexmedetomidine alone and associated withmorphine when used in the preanesthetic medication of bitches submitted to elective ovarian oysterectomy using the modifiedGlasgow pain scale and the Melbourne pain scale.Materials, Methods & Results: Twenty bitches were used in this study, all of them submitted to ovarian oysterectomy, and were clinically healthy according to laboratory and clinical exams. During the experiment, bitches were randomly distributed into two groups,which received preanesthetic medication (MPA) with 5 μg/kg dexmedetomidine alone (GD) or associated with 0.3 mg/kg morphine(GDM) intramuscularly (IM). In both groups, anesthetic induction with dose-effect propofol was performed and maintained withisoflurane diluted in 100% oxygen administered through a calibrated vaporizer and appropriate anesthetic system based on the weightof the animal and maintained on spontaneous ventilation. After stabilization of the patient the surgery was started, which lasted 45min. The bitches were evaluated by the Modified Glasgow Scale (GSM), the Melbourne Scale (MS) and the Dobbins Sedation Scale(DS), previously administered MPA (T0) and the others performed in 1h (T1), 2h (T2), 4h (T3), 8h (T4), 12h (T5) and 24h (T6) afterextubation. If the GSM score was greater than the value of 3.3 an analgesic rescue of 0.5 mg/kg of morphine intramuscularly would beadministered. An increase in the scoring of pain scales in both groups can be observed from the T1, with significant difference only ofthe...

Avaliação da analgesia pós-operatória da dexmedetomidina isolada e associada à morfina quando utilizada na medicação pré-anestésica em cadelas submetidas à ovariosalpingohisterectomia eletiva / Evaluation of postoperative analgesia of dexmedetomidine alone or associated to morphine as premedicants in bitches undergoing ovariosalpingohisterectomy

Background: Elective ovariossalpingohysterectomy is a common surgery that causes mild to moderate pain. Aiming at the treatment of pain in these patients, analgesia should be balanced from pre-anesthetic, transoperative and postoperative medication, with-2-agonists and opioids being commonly used, especially dexmedetomidine that has sedation, relaxation muscle and analgesia.The aim of the present study was to evaluate the postoperative analgesic efficacy of dexmedetomidine alone and associated withmorphine when used in the preanesthetic medication of bitches submitted to elective ovarian oysterectomy using the modifiedGlasgow pain scale and the Melbourne pain scale.Materials, Methods & Results: Twenty bitches were used in this study, all of them submitted to ovarian oysterectomy, and were clinically healthy according to laboratory and clinical exams. During the experiment, bitches were randomly distributed into two groups,which received preanesthetic medication (MPA) with 5 μg/kg dexmedetomidine alone (GD) or associated with 0.3 mg/kg morphine(GDM) intramuscularly (IM). In both groups, anesthetic induction with dose-effect propofol was performed and maintained withisoflurane diluted in 100% oxygen administered through a calibrated vaporizer and appropriate anesthetic system based on the weightof the animal and maintained on spontaneous ventilation. After stabilization of the patient the surgery was started, which lasted 45min. The bitches were evaluated by the Modified Glasgow Scale (GSM), the Melbourne Scale (MS) and the Dobbins Sedation Scale(DS), previously administered MPA (T0) and the others performed in 1h (T1), 2h (T2), 4h (T3), 8h (T4), 12h (T5) and 24h (T6) afterextubation. If the GSM score was greater than the value of 3.3 an analgesic rescue of 0.5 mg/kg of morphine intramuscularly would beadministered. An increase in the scoring of pain scales in both groups can be observed from the T1, with significant difference only ofthe...(AU)

Efeito da fluidoterapia transcirúrgica sobre o hematócrito pós-cirúrgico em cadelas submetidas a ovariossalpingo-histerectomia eletiva / Effects of trans surgical fluid therapy over the post surgical packed cell volume in bitches undergoing elective ovariohisterectomy

Apesar dos inúmeros benefícios da fluidoterapia transcirúrgica, sobrecarga de volume pode trazer efeitos deletérios, como a alteração de parâmetros hematimétricos. Dessa maneira, o presente trabalho teve como objetivo avaliar duas diferentes taxas de infusão de solução cristaloide no período transanestésico e seus efeitos até 24 horas pós-operatório. Foram utilizados dois grupos de seis animais cada, um deles recebeu solução de cloreto de sódio 0,9% a 10mL/kg/h (G10) e o outro a 5mL/kg/h (G5). Os valores de hematócrito foram avaliados no período de 24 horas em 10 diferentes momentos. Os resultados não apontaram diferenças significativas entre os grupos, porém foi observada redução significativa do hematócrito após indução anestésica. Foi ainda observada redução de hematócrito após o término da cirurgia em ambos os grupos, e o retorno aos valores basais de hematócrito ocorreu de forma significativa 12 horas após o procedimento cirúrgico em G10, e após oito horas em G5, mostrando uma tendência à hemodiluição mais persistente em G10.(AU)

Despite the beneficial goals of fluid therapy administered during surgery, volume overload can cause deleterious effects, such as alterations on hematimetric parameters. Thus, the objective of this paper was to evaluate two different cristaloid infusion rates during the surgical period and its effects on the 24-hour post-surgical period. Two groups of six animals each were used in the present study, one received 10mL/kg/h (G10) of 0,9% sodium chloride solution and the other 5mL/kg/h (G5) of the same solution. Packed cell volume (PCV) was evaluated in 10 different times during the 24 hours following surgery. The results did not show significant differences between groups, but they showed a major tendency of hemodilution in G10. A significant decrease of PCV was observed after induction of anesthesia. Decrease of PCV after the end of surgery in both groups was also observed, and the return to PCV basal values was observed 12 hours after the procedure in G10 and after eight hours in G5, showing a tendency of prolonged hemodilution in G10.(AU)

Efeito da fluidoterapia transcirúrgica sobre o hematócrito pós-cirúrgico em cadelas submetidas a ovariossalpingo-histerectomia eletiva / Effects of trans surgical fluid therapy over the post surgical packed cell volume in bitches undergoing elective ovariohisterectomy

Apesar dos inúmeros benefícios da fluidoterapia transcirúrgica, sobrecarga de volume pode trazer efeitos deletérios, como a alteração de parâmetros hematimétricos. Dessa maneira, o presente trabalho teve como objetivo avaliar duas diferentes taxas de infusão de solução cristaloide no período transanestésico e seus efeitos até 24 horas pós-operatório. Foram utilizados dois grupos de seis animais cada, um deles recebeu solução de cloreto de sódio 0,9% a 10mL/kg/h (G10) e o outro a 5mL/kg/h (G5). Os valores de hematócrito foram avaliados no período de 24 horas em 10 diferentes momentos. Os resultados não apontaram diferenças significativas entre os grupos, porém foi observada redução significativa do hematócrito após indução anestésica. Foi ainda observada redução de hematócrito após o término da cirurgia em ambos os grupos, e o retorno aos valores basais de hematócrito ocorreu de forma significativa 12 horas após o procedimento cirúrgico em G10, e após oito horas em G5, mostrando uma tendência à hemodiluição mais persistente em G10.(AU)

Despite the beneficial goals of fluid therapy administered during surgery, volume overload can cause deleterious effects, such as alterations on hematimetric parameters. Thus, the objective of this paper was to evaluate two different cristaloid infusion rates during the surgical period and its effects on the 24-hour post-surgical period. Two groups of six animals each were used in the present study, one received 10mL/kg/h (G10) of 0,9% sodium chloride solution and the other 5mL/kg/h (G5) of the same solution. Packed cell volume (PCV) was evaluated in 10 different times during the 24 hours following surgery. The results did not show significant differences between groups, but they showed a major tendency of hemodilution in G10. A significant decrease of PCV was observed after induction of anesthesia. Decrease of PCV after the end of surgery in both groups was also observed, and the return to PCV basal values was observed 12 hours after the procedure in G10 and after eight hours in G5, showing a tendency of prolonged hemodilution in G10.(AU)

Comparación de embarazos ectópicos tubarios y cirugía laparoscópica por incisión transversal con la incisión longitudinal / Tubal Ectopic Pregnancy and Laparoscopic Transverse Incision Surgery Compared To Longitudinal Incision

Introducción: el manejo y tratamiento del embarazo ectópico ha evolucionado en los últimos años de forma impresionante. Actualmente predomina una terapia conservadora, tanto médica como quirúrgica. Esta última, se manifiesta en función de la fertilidad a pesar del incremento de las afecciones tubárica. Objetivo: determinar el uso de la técnica de salpingostomía transversal con respecto al número de embarazos intrauterinos y recidivas posteriores. Métodos: se realizó un estudio experimental, prospectivo y longitudinal, en pacientes con diagnóstico de embarazo ectópico desde el año 2007 hasta el año 2012 en el Centro de Investigaciones Médico-Quirúrgicas. Esta población quedó conformada por 251 pacientes en edad fértil, que acudieron al Cuerpo de Guardia del Centro de Investigaciones Médico-Quirúrgicas por presentar dolor en bajo vientre, sangramiento uterino anormal y/o amenorrea, a quienes se les realizó laparoscopía diagnóstica. De ellas, 204 fueron diagnosticadas de embarazo ectópico, con 167 ampulares. La totalidad de las mujeres a las que se realizó la salpingostomía transversal mostraron interés en conservar la fertilidad. La muestra control quedó constituida por 200 pacientes que presentaron embarazo ectópico ampulares. Estas pacientes fueron sometidas a la técnica de cirugía conservadora longitudinal, en un periodo inmediato anterior, 2004-2007. Resultados: se demostró que por la técnica de salpingostomía transversal se logró un mayor número de embarazos intrauterinos (60) y menos recidivas de ectópicos (10), con valores altamente significativos respecto a la salpingostomía lineal. Conclusiones: el beneficio de realizar la técnica de salpingostomía transversal, respecto al número de embarazos logrados fue cuatro veces superior al riesgo de desarrollar recidivas o complicaciones en el período de un año(AU)

Introduction: The management and treatment of ectopic pregnancy has evolved dramatically in recent years. Presently, conservative therapy, both medical and surgical, prevails. The latter is manifested as a function of fertility despite the increase in tubal conditions. Objective: Determine the use of the transverse salpingostomy technique with respect to the number of intrauterine pregnancies and subsequent relapses. Methods: An experimental, longitudinal and prospective study was performed in patients diagnosed with ectopic pregnancy from 2007 to 2012 at Center for Medical-Surgical Research. 251 patients of childbearing age were the population of this study and they came to Center for Medical-Surgical Research emergency room for having low-grade pain, abnormal uterine bleeding and / or amenorrhea, who underwent diagnostic laparoscopy.This population consisted of 251 patients of childbearing age, who came to the Center for Medical-Surgical Research Guard Corps for having pain in the lower abdomen, abnormal uterine bleeding and / or amenorrhea. They underwent diagnostic laparoscopy. 204 of them were diagnosed of ectopic pregnancy, with 167 ampullaries. All women who underwent transverse salpingostomy showed interest in preserving fertility. 200 patients were the control sample ant they presented with ampullary ectopic pregnancy. These patients underwent longitudinal conservative surgery in an immediate previous period (2004-2007). Results: It was demonstrated that by the transverse salpingostomy technique, greater number of intrauterine pregnancies were achieved (60); fewer ectopic recurrences (10) with highly significant values ​​with respect to linear salpingostomy. Conclusions: The benefit of using transverse salpingostomy technique in relation to the number of pregnancies achieved was 4 times higher than the risk of developing relapses or complications in the period of one year(AU)

Embarazo ectópico intersticial: ¿variedad de incidencia incrementada? / Interstitial ectopic pregnancy: a variety of increased incidence?

Se describen 6 casos clínicos de mujeres con embarazo ectópico intersticial de menor incidencia entre las formas de la variedad tubárica, tratadas en el Hospital Ginecoobstétrico Docente Tamara Bunke Bider de Santiago de Cuba. Esta entidad clínica ha mostrado un incremento inusual en la población asistida (7,59 por ciento) que resulta, 2,57 veces mayor que la media (2,95 por ciento) del intervalo notificado en la bibliografía médica (1,9-4 por ciento). Se exponen las historias individuales de las pacientes en forma tabulada y, asimismo, los autores ofrecen sus consideraciones a propósito de estas experiencias(AU)

Six case reports of women with interstitial ectopic pregnancy of lower incidence among the forms of tubaric variety treated in Tamara Bunke Bider Teaching Gynecological and Obstetrical Hospital from Santiago de Cuba are described. This clinical entity has shown an unusual increase in the assisted population (7.59 percent), which is 2.57 times higher than the mean (2.95 percent) of the interval notified in the medical literature (1.9-4 percent). Tabulated individual medical records of the patients are exposed and, likewise, the authors offer their considerations concerning these experiences(AU)

Analgesia pós-operatória com metadona em gatos: administração epidural e intramuscular / Postoperative analgesia of methadone in cats: epidural and intramuscular administration

Compararam-se os efeitos analgésico, sedativo e neuroendócrino decorrentes da administração epidural e intramuscular da metadona em gatas submetidas à ovariossalpingoisterectomia (OSH). Todos os animais foram tranquilizados com acepromazina, 0,1mg kg-1 IM, seguindo-se a indução e manutenção anestésica com tiopental sódico, 12mg kg-1 IV, e halotano, respectivamente. Após a estabilização anestésica, os animais foram distribuídos em três grupos, com oito animais cada, tratados com metadona pela via epidural (EP) ou intramuscular (IM) 0,2mg kg-1, respectivamente, ou com solução salina (S) 0,2mL kg-1. Foram avaliados: graus de analgesia e de sedação, necessidade de analgesia de resgate, efeitos adversos e concentração sérica de cortisol. Os graus de analgesia e de sedação e o cortisol não diferiram entre os tratamentos. Analgesia de resgate foi administrada quatro, nove e 11 vezes nos tratamentos EP, IM e S, respectivamente. Nos tratamentos IM e S, a suplementação analgésica foi necessária a partir da primeira hora pós-cirúrgica, enquanto no tratamento EP, somente a partir da terceira hora após a OSH. Conclui-se que a administração de metadona pela via epidural resulta em menor quantidade do analgésico pós-operatório, e que a analgesia é mais prolongada quando comparada à obtida pela via intramuscular, em gatas submetidas à OSH.(AU)

The aim of this study was to investigate the analgesic, sedative and neuroendocrine effects of epidural (EP) and intramuscular (IM) methadone in cats submitted to ovariohysterectomy. The pre-anesthetic medication was acepromazine (0.1mg kg-1, IM) followed by induction of anesthesia with intravenous thiopental, 12mg kg-1, and anesthesia maintenance with halothane. After anesthesia stabilization the cats were randomly assigned to three groups of eight animals each and received EP or IM methadone, 0.2mg kg-1 diluted with saline to 0.2mL kg-1, EP and IM, respectively, or a saline placebo (S), 0.2mL kg-1. Pain measurements, degree of sedation, rescue analgesia requirements, adverse effects and serum cortisol concentration were recorded. Cortisol, pain and sedation scores did not differ among the groups. Rescue analgesia was administered 4, 9 and 11 times in the EP, IM and S treatment, respectively. In the IM and S rescue analgesia treatments were required early (first hour postoperative), whereas in the EP treatment, additional analgesics were required after the third hour postoperative. In conclusion, methadone epidural reduced the postoperative analgesic requirements and produced longer analgesia when compared to intramuscular administration in cats undergoing ovariohysterectomy.(AU)

Salpingoplastia tubaria distal videolaparoscópica: Hospital Vladimir Ilich Lenin / DistTubal Videolaparoscopic Salpingoplasty Vladimir Ilich Lenin Hospital

Se realizó un estudio prospectivo longitudinal con 217 pacientes, con el diagnóstico de obstrucción tubaria distal, las cuales fueron remitidas desde la Consulta de Infertilidad en el Hospital Vladimir Ilich Lenin de Holguín, en el período comprendido de 1998 a 2007. Se encontró que el 26,7 por ciento de las pacientes tenía una historia de embarazos anteriores interrumpidos o perdidos por distintas causas y el 78,8 por ciento de las pacientes tuvieron relaciones sexuales sin evitar el embarazo. Las principales causas de obstrucción tubaria distal fueron el hidrosalpinx, la estenosis intramural de las trompas y las adherencias tanto posquirúrgicas como inflamatorias. Durante la comprobación transoperatoria, la estenosis intramural constituyó la causa más frecuente para un 62,8 por ciento. Se logró realizar más de tres hidrotubaciones postoperatorias al 46,2 por ciento de las pacientes. La complicación postoperatoria más frecuente reportada, fue la inflamación pélvica aguda, la sepsis de la herida quirúrgica se reportó en un 1,3 por ciento. El proceder tuvo una efectividad comprobada del 21,1 por ciento lo que significó el logro de un embarazo a término en estas pacientes...(AU)

A prospective and longitudinal study in 217 distal tubal obstruction carrier patients assisted at Infertility Cosulting Room at V I Lenin Teaching Hospital, Holguín, from 1998 to 2007 was carried out. The results showed that 26,7 percent of patients had difficulty conceiving pregnancy or having children due to different causes and 78,8 percent of patients had sexual intercourse without condom. The complete treatment was given in 46,2 percent of all patients...(AU)

Recent developments in the ability to predict and modify breast cancer risk.

The identification of women at higher risk for breast cancer is a matter of public health and anyone who participates in any treatment modality of this condition (this includes the plastic surgeon) should be aware of the tools and predictive models of breast cancer. Screening for breast cancer in the community, and probably during the daily plastic surgery consultation, until recently, was limited to decisions about when to initiate a mammography study. New developments that predict and modify breast cancer risk must be clearly understood by our specialty through identification of women at higher risk for breast cancer and be familiar with the current issues related to screening and risk-reduction measures. In this review, we discuss current knowledge regarding the recent data of breast cancer risk, screening strategies for high-risk women and medical and surgical approaches to reduce breast cancer risk. Patients with breast cancer belong to one of three groups: a. Sporadic breast cancer (75%)--patients without family history or those who have a breast biopsy with proliferative changes. b. Genetic mutation breast cancer (5%)--women who have a genetic predisposition, and most of these are attributable to mutations in the breast cancer susceptibility gene 1 (BRCA1) and breast cancer susceptibility gene 2 (BRCA2). c. Cluster family breast cancer (20%)--seen in women with a relevant history of breast cancer in the family and breast biopsy with proliferative breast changes with no association with mutations.Those at high risk for breast cancer should investigate the family history with genetic testing consideration, clinical history, including prior breast biopsies and evaluation of mammographic density. Tools for breast cancer risk assessment include the Gail and Claus model, genetic screening,BRCAPRO and others that are evaluated in this review.

Impacto do hidrossalpinge na implantação embrionária / Hydrosalpinx impact on embryo implantation

Hidrossalpinge é uma afecção na qual o fluido tubário acumula-se no lúmen ampolar, como resultado da oclusão infundibular. Geralmente, é uma seqüela da doença inflamatória pélvica (DIP) clínica ou subclínica, causada principalmente pela Chlamydia tracomatis e pela Neisseria gonorrhoeae. Sabe-se que está associada à diminuição das taxas de implantação e gestação, além de aumentar a taxa de abortamento nos ciclos de fertilização in vitro (FIV). O objetivo desta revisão é apresentar as teorias que tentam explicar como o hidrossalpinge dificulta a implantação embrionária, além de discutir as diferentes formas de tratamento antes dos ciclos de fertilização in vitro.

Fertilidad después del tratamiento laparoscópico del embarazo ectópico, en la Clínica del Prado en Medellín, Colombia. Estudio de cohorte / Fertility following laparoscopic treatment of ectopic pregnancy at the Prado Clinic in Medellín, Colombia. A cohort study

Objetivo: conocer y comparar los índices de fertilidad luego de salpingostomía vs. salpingectomía laparoscópicas en pacientes con embarazo ectópico.Diseño y población: cohorte concurrente de pacientes sometidas a cirugía de embarazo ectópico por laparoscopia en la Unidad de Cirugía Endoscópica Ginecológica, Clínica del Prado, Medellín, Colombia.Metodología: revisión de historias clínicas e interrogatorio telefónico a pacientes que cumplieron criterios de inclusión.Variables principales: tasa global de embarazo intrauterino, tasa acumulada por año de embarazo intrauterino, tasa de recurrencia de ectópico, tasa de persistencia de ectópico.Resultados: 31 pacientes en el grupo de salpingostomía y 14 pacientes en el grupo de salpingectomía. La tasa global de embarazo intrauterino después de salpingostomía fue de 54,8 por ciento comparada con 57,1 por ciento para salpingectomía (p = 0,88). Se presentaron recurrencias en el 10,5 por ciento de las salpingostomías y en el 20 por ciento de las salpingectomías (p = 0,77). La tasa de persistencia de ectópico después de manejo conservador fue de 9,6 por ciento.Conclusiones: este estudio no demuestra diferencias significativas en los índices reproductivos al comparar salpingostomía vs. salpingectomía laparoscópicas.

Bilateral ectopic pregnancy.

Bilateral simultaneous ectopic pregnancy is a very rare clinical condition. Two different subsets of patients can be distinguished: women presenting with the disease as a result of spontaneous conception and those with the condition after undergoing assisted reproduction procedures. This article reviews and analyzes 42 cases of bilateral ectopic pregnancies reported in the last 10 years, proposes a new classification of the disease, and presents some data that should be useful for the clinician who confronts this difficult entity.

[Conservative, laparoscopic and medical treatment of ectopic pregnancy]. / Tratamiento conservador, laparoscópico y médico del embarazo ectópico.

BACKGROUND: Ectopic pregnancy is that in which implantation of fertilized zygote occurs out of the uterine cavity mucosa (fallopian tube ampulla, isthmus, interstice, cervix, ovary or abdomen). Patients with ectopic pregnancy history have bad forecast on subsequent fertility. OBJECTIVE: To describe conservative, laparoscopic and medical treatment to ectopic pregnancy (estimation of results). MATERIAL AND METHODS: Revision of 65 files of ectopic pregnancy with salpingocentesis, lineal salpingostomy and methotrexate terapy. RESULTS: Salpingocentesis and lineal salpingostomy prove tube permeability in 81.4 to 90% of cases. The number of intrauterine pregnancies has a 60 to 67% of variation. Presently we take care four intrauterine pregnancies, two with each surgical procedure. CONCLUSION: It is important to asses prophylactic administration of methotrexate to avoid ectopic pregnancy. This drug was prescribed in six successful cases with a unique dosage of 25 mg. Determination of HCG and gynecologic ultrasonography facilitate ectopic pregnancy diagnosis.

Manejo laparoscópico de dispositivo intrauterino migrado a trompa de falopio con hidrosalpinx secundario / Laparoscopic management of translocated intrauterine contraceptive device (IUD) inserted in the right uterine tube with secondary hydrosalpinx

Se presenta el caso clínico de un dispositivo intrauterino ubicado en el lumen de la trompa de Falopio con hidrosalpinx secundario, diagnosticado en forma incidental al realizar una radiografía de columna lumbar, estudio complementado con ecotomografia transvaginal. Se realizó laparoscopia diagnóstica y salpingectomía sin complicaciones.

We present a case of asymptomatic IUD inserted in the right uterine tube, with secondary hydrosalpinx. The IUD was found during a non-related X-ray examination of lumbar spine. She underwent laparoscopic surgery and removal of the uterine tube, without any further complication. We discuss the current treatment of intraabdominal lUDs.