[Influence of the level of training of the specialist in intra and post operative pain in patients who undergo officinal hysteroscopy ]. / Influencia del nivel de adiestramiento del especialista en dolor intra y posoperatorio en pacientes a quienes se efectúa histeroscopia en el consultorio.

BACKGROUNDS: There are variable results regarding the risk factors associated with levels of pain during office hysteroscopy. OBJECTIVE: Describe levels of pain in Colombian patients who undergo office hysteroscopy performed by doctors in training. MATERIAL AND METHODS: Case series study. Conducted in patients who undergo office hysteroscopy without anesthesia in outpatient clinic in May 2012. The procedure was performed by Gynecologists in training and under supervision of the specialist. The Obstetric and Gynecological history was obtained through questionnaire. The pain perception, according to visual analog scale (VAS), was taken at three moments during the study: (1) 5 minutes before the procedure, (2) At the end of the procedure, (3) 10 minutes after the procedure.The major outcomes were: VAS 0-4, considered as absent or mild pain and VAS 5-10 considered as moderate or severe pain. RESULTS: We studied 44 patients, aged between 29 and 65 years. The group of patients with a VAS score >5 was mainly compose by: (1) Patients older than 50 years (58.8%), (2) with positive history of C-section (66.7%), (3) with positive history of abortion (75%) and menopausal (56.3%). CONCLUSION: 47.7% of our patients presentVAS score > 5. The majority of this group was composed by patients with risk factors to have pain during office hysteroscopy. Then we can't conclude that the level of pain experimented by our patients was due to the level of training of the doctors.

Barbed suture for vaginal cuff closure in laparoscopic hysterectomy.

BACKGROUND AND OBJECTIVES: Our aim was to evaluate whether the use of barbed suture for vaginal cuff closure is associated with a decrease in postoperative vaginal bleeding compared with cuff closure with polyglactin 910 in patients who have undergone laparoscopic hysterectomy. METHODS: We performed a cohort study of patients who underwent laparoscopic hysterectomy between January 2008 and July 2012 by the minimally invasive gynecologic surgery division of the Gynecology, Obstetrics and Human Reproduction Department at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia. RESULTS: A total of 232 women were studied: 163 were in the polyglactin 910 group, and 69 were in the barbed suture group. The main outcome, postoperative vaginal bleeding, was documented in 53 cases (32.5%) in the polyglactin 910 group and in 13 cases (18.8%) in the barbed suture group (relative risk, 0.57; 95% confidence interval, 0.34-0.9; P = .03). No statistically significant differences were found in other postoperative outcomes, such as emergency department admission, vaginal cuff dehiscence, infectious complications, and the presence of granulation tissue. CONCLUSION: In this study an inverse association was observed between the use of barbed suture for vaginal cuff closure during laparoscopic hysterectomy and the presence of postoperative vaginal bleeding.

Land use change on coffee farms in southern Guatemala and its environmental consequences.

Changes in commodity prices, such as the fall in coffee prices from 2000 to 2004, affect land use decisions on farms, and the environmental services they provide. A survey of 50 farms showed a 35% loss in the area under coffee between 2000 and 2004 below 700 m with the majority of this area (64 %) being coffee agroforest systems that included native forest species. Loss of coffee only occurred on large and medium-scale farms; there was no change in area on cooperatives. Coffee productivity declined below 1,100 m altitude for sun and Inga shade coffee, but only below 700 m altitude for agroforest coffee. Coffee productivity was 37-53% lower under agroforests than other systems. Increases in rubber and pasture were related to low altitude large-scale farms, and bananas and timber plantations to mid-altitude farms. Average aboveground carbon stocks for coffee agroforests of 39 t C ha(-1) was similar to rubber plantations, but one-third to one half that of natural forest and timber plantations, respectively. Coffee agroforests had the highest native tree diversity of the productive systems (7-12 species ha(-1)) but lower than natural forest (31 species ha(-1)). Conversion of coffee agroforest to other land uses always led to a reduction in the quality of habitat for native biodiversity, especially avian, but was concentrated among certain farm types. Sustaining coffee agroforests for biodiversity conservation would require targeted interventions such as direct payments or market incentives specifically for biodiversity.

[Uterine myoma in remnant cervix]. / Miomatosis uterina en cérvix residual.

Parasitic myomas are rare and their ethiopathogenesis is uncertain. They may develop from a detached fibroid adhering to an extrauterine surface in order to obtain new blood supply. It has been stated that they form from uterine or myoma fragments left behind after morcellation in the abdominopelvic cavity and thus are called "iatrogenic". Surgeons must be aware of this recently reported complication related to the increasing number of laparoscopic procedures. Thorough inspection and washing of the abdominal cavity are recommended. A case of a patient with iatrogenic parasitic myomas, which appeared six years after a laparoscopic supracervical hysterectomy involving a morcellator, is reported.

[Laparoscopic resection of an interstitial ectopic twin pregnancy resection: the role of barbed sutures in haemostatic control]. / Utilidad de la sutura barbada en el tratamiento de pacientes con embarazo ectópico por vía laparoscópica.

Interstitial pregnancy is a dangerous and uncommon variation of ectopic pregnancy occurring in the interstitial part of the fallopian tube and extending beyond the muscular layer of the uterus. This ectopic pregnancy-related mortality rate has been reported to be as high as 2%-2,5% due to complications involving bleeding and hypervascularity. No prospective clinical trials have evaluated available treatment options for interstitial ectopic pregnancy due to its low incidence; there is thus no consensus regarding optimal treatment. Surgical treatment can be divided into conservative approaches, such as cornuectomy or cornuostomy, and radical approaches such as hysterectomy. However, intraoperative hemorrhage is an ever-present risk, regardless of the surgical approach adopted. This paper presents a case involving a patient who underwent laparoscopic resection of an interstitial twin ectopic pregnancy; a barbed suture pursestring was used which proved useful during the surgical technique and improved hemostasia.