Angle-closure glaucoma associated with vitreous prolapse after neodymium-doped yttrium-aluminumgarnet laser posterior capsulotomy.

Capsulotomy with neodymium-doped yttriumaluminum-garnet (Nd:YAG) laser is an effective treatment for posterior capsule opacification following cataract surgery. A wide opening of the posterior capsule associated with the ruptured anterior hyaloid can cause anterior chamber vitreous prolapse. Two patients who developed angle-closure glaucoma associated with vitreous prolapse following Nd:YAG laser posterior capsulotomy were successfully treated with antiglaucoma medication and peripheral iridotomies. Patient identification for potential risk factors and a careful postoperative follow-up are essential to avoid these serious complications.

Assistência ao parto pélvico / Breech birth assistance

É imprescindível retomar o ensino da versão cefálica externa e das manobras tocúrgicas no parto pélvico vaginal, tanto em litotomia quanto na posição vertical. A adoção de protocolos rígidos para o parto pélvico vaginal planejado correlaciona-se com taxa de sucesso de aproximadamente 70% e taxas de resultados adversos inferiores a 7%. A morbimortalidade fetal e neonatal é semelhante à de cesárea planejada. Gestantes elegíveis para o parto pélvico vaginal devem concordar com a via de parto, possuir baixo risco de complicações e ser assistidas por profissionais com experiência em parto vaginal de apresentações anômalas e suas manobras obstétricas. Cesariana prévia e prematuridade entre 32 e 36 semanas não são contraindicações absolutas ao parto pélvico vaginal, devendo ser individualmente avaliadas na decisão da via de parto. Neonatologistas devem estar presentes no nascimento de fetos pélvicos, e um exame neonatal completo deve ser realizado. A rotação posterior do dorso fetal, o prolapso de cordão umbilical, a deflexão dos braços e/ou do polo cefálico e o encarceramento da cabeça derradeira são as principais distocias relacionadas à assistência ao parto pélvico por via vaginal. Todo profissional que assiste parto pélvico vaginal deve estar capacitado para a resolução adequada desses eventos. No parto pélvico vaginal em litotomia, as principais manobras para o auxílio ao desprendimento da pelve fetal são a tração inferior bidigital na prega inguinal e a manobra de Pinard; para o desprendimento do tronco fetal, as de Rojas, Deventer-Miler e Pajot; e para o desprendimento da cabeça derradeira, as de Mauriceau, Bracht, Champetier de Ribes e Praga e o parto vaginal operatório com o fórcipe de Piper. As posições não litotômicas no parto pélvico vaginal se associam à redução dos períodos de dilatação e expulsão, da taxa de cesariana, da necessidade de manobras para extração fetal e da taxa de lesões neonatais. No parto pélvico vaginal assistido na posição de quatro apoios, os aspectos a serem observados durante o desprendimento do corpo fetal incluem o tônus dos membros inferiores fetais, a rotação correta do tronco fetal (abdome fetal voltado para o dorso materno), o ingurgitamento vascular do cordão umbilical, a presença dos cotovelos e das pregas do tórax fetal e a dilatação anal materna. No parto pélvico vaginal assistido na posição de quatro apoios, mais da metade dos fetos se desprendem sem a necessidade de nenhuma manobra. Habitualmente, apenas duas manobras podem ser necessárias: uma para auxílio à saída dos ombros ("rotação 180°-90°") e outra para desprendimento da cabeça fetal ("Frank nudge").

How I do it: endoscopic endonasal chiasmopexy for optic chiasm prolapse.

BACKGROUND: Prolapse of the optic system into an empty sella is an unusual complication of the management of pituitary tumors. METHOD: We described the technical nuances for an endoscopic endonasal chiasmopexy, the indications for the procedure, and the caveats on the diagnosis of optic chiasm prolapse. CONCLUSION: The endoscopic endonasal chiasmopexy provides a direct route to lift the optic system. In most cases, the procedure may be achieved extradurally, protecting the chiasm from manipulation and postoperative fibrosis.

Intermediate-term follow-up of laparoscopic pectopexy cases and their effects on sexual function and quality of life: a cross-sectional study.

BACKGROUND: Apical prolapsus refers to downward displacement of the vaginal apex, uterus or cervix. Pelvic organ prolapse (POP) can significantly affect women's daily activities and sexuality. OBJECTIVE: To investigate, at the mid-term follow-up after laparoscopic pectopexy surgery, whether this procedure improved the patients' quality of life and sexual function. DESIGN AND SETTING: In this cross-sectional study, data on patients who underwent laparoscopic pectopexy in the Gazi Yasargil Education and Research Hospital were evaluated. METHODS: Thirty-five patients with symptomatic apical prolapse and POP quantification stage II and higher were included in this study. We used the Turkish version of the female sexual function index (FSFI) questionnaire to assess preoperative and postoperative sexual dysfunction, and the Turkish version of the Prolapse Quality of Life Questionnaire (P-QOL) to evaluate the severity of POP and its impact on quality of life. RESULTS: The mean age, parity and length of follow-up of the patients were 36.08 ± 9.04 years, 4.00 ± 1.86 and 28.88 ± 5.88 months, respectively. The most common complications were de novo rectocele in three patients (8.6%) and de novo cystocele in two patients (5.7%). All the FSFI and P-QOL scores were statistically significantly improved in the postoperative period (P < 0.001 for all scores of both FSFI and P-QOL). CONCLUSION: The quality of life and sexual function of the patients who underwent laparoscopic pectopexy were found to have become statistically improved at the midterm follow-up. Laparoscopic pectopexy was found to be a viable, effective and safe procedure.

Prolapso uretral em um cão da raça American Bully / Urethral prolapse in a dog of the American Bully breed

O prolapso uretral, o qual é incomum em cães, se caracteriza pela protusão da mucosa uretral além da extremidade do pênis e do orifício externo da uretra. Pode ocorrer por causas congênitas ou adquiridas, tendo maior incidência em animais jovens não castrados. O objetivo do presente trabalho é relatar um caso de prolapso uretral em um cão não castrado da raça American Bully Terrier, de dois anos, o qual foi atendido na Universidade Estácio de Sá localizada no Rio de Janeiro com histórico de lambedura excessiva do pênis, disúria, sangramento prepucial e protrusão da mucosa uretral após tentativa de cópula. Durante a avaliação física o animal apresentou todos os parâmetros clínicos dentro da normalidade, entretanto demonstrava agitação excessiva e dor na região afetada. Então, o diagnóstico foi definido por meio da inspeção direta da visualização da mucosa uretral protusa. Frente ao quadro clínico e físico do animal, foi adotado o procedimento cirúrgico de ressecção e anastomose da porção uretral prolapsada. Desta forma, conclui-se que esta técnica cirúrgica se mostrou eficaz, visto que o referido paciente apresentou ótima recuperação e cicatrização uretral, sem quaisquer sinais de complicações pós-cirúrgicas.

Urethral prolapse, which is uncommon in dogs, is characterized by protrusion of the urethral mucosa beyond the tip of the penis and the external orifice of the urethra. It can occur due to congenital or acquired causes, with a higher incidence in young animals not castrated. The present study aims to report a case of urethral prolapse in a non-castrated dog of 2 years old (American Bully Terrier), which was treated at the Estácio de Sá University located in Rio de Janeiro city, with a history of excessive penis licking, dysuria, prepucial bleeding, and protrusion of the urethral mucosa after an attempt of copulation. During the physical evaluation, the animal presented all clinical parameters within the normal range; however, it showed excessive agitation and pain in the affected region. Then, the diagnosis was defined through direct inspection of the visualization of the protruding urethral mucosa. Given the animal's clinical and physical condition, the surgical procedure of resection and anastomosis of the prolapsed urethral portion was adopted. Therefore, it is concluded that this surgical technique proved to be effective since the patient presented excellent recovery and urethral healing, without any signs of post-surgical complications.

Mitral valve prolapse in patients with atrial septal defect: A quantitative three-dimensional echocardiographic analysis.

INTRODUCTION AND OBJECTIVES: Mitral valve (MV) prolapse is highly prevalent in patients with atrial septal defect (ASD). Abnormal left ventricular geometry has been proposed as the main mechanism of MV prolapse in ASD, however, the changes in the morphology of the MV apparatus remain to be clarified. Our aim was to assess the MV geometry in patients with ASD and MV prolapse. METHODS: We evaluated 99 patients (73% female, median age 40 years) with ASD who underwent a three-dimensional transesophageal echocardiogram. Three-dimensional analysis of the MV was done using dedicated automated software. Transthoracic echocardiographic parameters were assessed post ASD closure in 28 patients. RESULTS: MV prolapse was found in 39% of patients. Although smaller left ventricular dimensions and greater interatrial shunt were found in patients with MV prolapse compared with those without prolapse, there was no difference in the subvalvular parameters. MV prolapse was associated with larger mitral anterior-posterior diameter, anterolateral-posteromedial diameter, anterior perimeter, posterior perimeter, total perimeter, and anterior leaflet area (all p < 0.05). Mitral regurgitation was more frequent in patients with MV prolapse (80 vs. 48%, p = 0.002). CONCLUSIONS: In patients with ASD, the main mechanism of MV prolapse is the presence of an organic primary process of the MV apparatus (excessive anterior mitral leaflet tissue and mitral annular enlargement).

Primary adenocarcinoma at colostomy site: report of a clinical case

Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer in the United States and it is found in 17% of patients thought to have complicated diverticular disease. However, primary adenocarcinoma rarely occur in the colostomy site and the risk of developing malignancy is similar to that of any other colonic segment. Polyps found in CRC screenings can be divided into the following types: hyperplastic polyps, polyps with no malignant potential, adenomatous polyps, polyps with malignant potential, and malignancies. Local complications of the colostomy can appear in the immediate, early, or late postoperative period, with an incidence ranging from 15 to 30%; neoplasia is even less common. (AU)

Manejo quirúrgico de prolapso uretral en pediatría: Reporte de caso / Surgical management of urethral prolapse in pediatrics: A case report

Introducción. El prolapso uretral es una entidad poco común, con una incidencia estimada de 1 en 3000 mujeres. Se presenta cuando la mucosa uretral sobresale espontáneamente más allá del meato uretral. Es una patología poco diagnosticada dada su baja frecuencia y de allí la importancia de conocer sobre su presentación, diagnóstico y tratamiento. El objetivo de este artículo fue presentar el caso de una paciente de 10 años con diagnóstico de prolapso uretral y su manejo quirúrgico. Caso clínico. Paciente femenina de 10 años, que consultó por cuadro clínico de 1 año de evolución consistente en dolor en región urogenital, que se irradiaba a hipogastrio, asociado a pujo y disuria, a quien se le diagnosticó prolapso uretral y se realizó corrección quirúrgica de mucosa uretral prolapsada mediante técnica de Kelly-Burnham modificada. Conclusión. El prolapso uretral es una entidad que con frecuencia es diagnosticada erróneamente pues su diagnóstico es eminentemente clínico. Si bien se ha descrito el tratamiento médico en primera instancia, éste tiene una alta tasa de recurrencia, por lo que en estos casos se prefiere la resección quirúrgica del tejido prolapsado.

Introduction. Urethral prolapse is a rare entity, with an estimated incidence of 1 in 3,000 women. It occurs when the urethral mucosa spontaneously protrudes beyond the urethral meatus. It is a poorly diagnosed pathology given its low frequency and hence the importance of knowing about its presentation, diagnosis and treatment. The objective of this article was to present the case of a 10-year-old patient with a diagnosis of urethral prolapse and its surgical management. Clinical case. A 10-year-old female patient, who consulted for a 1-year clinical picture consisting of pain in the urogenital region, radiating to the hypogastrium, associated with pushing and dysuria, who was diagnosed with urethral prolapse and a surgical correction of the urethral mucosa was performed prolapsed by modified Kelly-Burnham technique. Conclusion. Urethral prolapse is an entity that is frequently misdiagnosed because its diagnosis is eminently clinical. Although medical treatment has been described in the first instance, it has a high recurrence rate, so surgical resection of the prolapsed tissue is preferred in these cases.

Syndrome of ventricular septal defect and aortic regurgitation - A 22-year review of its management

Abstract Introduction: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. Methods: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). Results: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. Conclusion: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.

Syndrome of Ventricular Septal Defect and Aortic Regurgitation - A 22-Year Review of its Management.

INTRODUCTION: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. METHODS: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). RESULTS: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. CONCLUSION: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.

Cuidados de enfermagem na redução manual de prolapso de estomia / Nursing care in manual reduction of stoma prolapse / Atención de enfermería en la reducción manual del prolapso de ostomía

Objetivo: relatar um caso sobre a redução manual do prolapso em um estoma intestinal. Método: trata-se de um estudo descritivo, tipo relato de caso clínico, sobre a redução manual do prolapso em um estoma intestinal de um paciente. Relata-se que o cenário foi um centro de referência no atendimento ao estomizado. Avaliaram-se a efetividade das intervenções de Enfermagem com base na comparação dos resultados iniciais e finais do procedimento. Resultados: nota-se a presença de lesões e permeabilidade na presença de prolapso, realizando a manobra de redução digital, até a sua total regressão, facilitando a limpeza da pele e a colocação do equipamento coletor, observando as possíveis lesões periestomais e na mucosa. Conclusão: informa-se que os pacientes com prolapso em estoma intestinal têm um desconforto devido ao volume dentro do equipamento coletor e ao pouco espaço para conter as suas eliminações. Utiliza-se a técnica de redução manual para facilitar a troca do equipamento coletor, esta deverá ser realizada por enfermeiro estomaterapeuta ou enfermeiro capacitado. Salienta-se que os casos em que se afeta o desenvolvimento de atividades cotidianas merecem uma avaliação da equipe cirúrgica.(AU)

Objective: to report a case about manual reduction of prolapse in an intestinal stoma. Method: it is a descriptive, case report type study on the manual reduction of prolapse in a patient's intestinal stoma. It is reported that the scenario was a reference center in the care of the stoma. They evaluated the effectiveness of nursing interventions based on the comparison of the initial and final results of the procedure. Results: the presence of injuries and permeability in the presence of prolapse is noted, performing the digital reduction maneuver, until its total regression, facilitating the cleaning of the skin and the placement of the collector equipment, observing the possible periestomal and mucosal lesions. Conclusion: it is reported that patients with prolapse in the intestinal stoma have a discomfort due to the volume inside the collector equipment and the little space to contain their eliminations. The manual reduction technique is used to facilitate the exchange of the collector equipment, this should be performed by a stoma therapist or trained nurse. It is emphasized that the cases in which the development of daily activities is affected deserve an evaluation of the surgical team.(AU)

Objetivo: reportar un caso de reducción manual del prolapso en un estoma intestinal. Método: se trata de un estudio descriptivo, a modo de reporte de caso clínico, sobre la reducción manual del prolapso en el estoma intestinal de un paciente. Se informa que el escenario fue un centro de referencia en la atención de pacientes ostomizados. Evaluaron la efectividad de las intervenciones de Enfermería a partir de una comparación de los resultados iniciales y finales del procedimiento. Resultados: se observa la presencia de lesiones y permeabilidad en presencia de prolapso, realizando la maniobra de reducción digital, hasta su total regresión, facilitando la limpieza de la piel y la colocación del equipo colector, observando las posibles lesiones periestomales y mucosas. Conclusión: se informa que los pacientes con prolapso en estoma intestinal presentan molestias por el volumen dentro del equipo de recolección y el poco espacio para contener sus eliminaciones. La técnica de reducción manual se utiliza para facilitar el intercambio del equipo colector, esto debe ser realizado por un estomaterapeuta o enfermero capacitado. Cabe destacar que los casos en los que se ve afectado el desarrollo de las actividades diarias merecen una valoración por parte del equipo quirúrgico. (AU)

Cloacoplasty in a 40-day-old monk parakeet with cloacal prolapse

Background: The monk parakeet (Myiopsitta monachus) is also known as the quaker parrot and belongs to the order Psittaciformes in the family Psittacidae. The cloaca is a posterior orifice common to reproductive, digestive and urinary systems and the cloacal prolapse is the displacement or inversion of its anatomic position. Nowadays, the non-conventional pet market in Brazil is rapidly growing, which demands more skills and competences from an avian veterinarian. This study case has as its main objective to present a 40-day-old monk parakeet (Myiopsitta monachus) with cloacal prolapse, treated using the cloacoplasty technique. It is important to mention that the occurrence of cloacal prolapse in this species and in such an early age is uncommon. Case: The patient presented 1 day before the physical examination an increased volume in the cloacal region and hematochezia, and diagnosed as cloacal prolapse. For the treatment, wounds were washed using physiological saline solution, ice and sugar were applied in order to reduce the edema, and mineral oil was used for repositioning the cloacal mucosa. Finally, local anesthesia was applied and 2 isolated contralateral sutures were done with the objective of reducing the sphincter's diameter, without compromising the flow of urine and feces. The monk parakeet was treated with antibiotic Avitrin® [oxytetracycline hydrochloride - 8.1 mg/mL] and a vermifuge [mebendazole 50 mg/mL]. A sample of feces was also obtained and sent to the Laboratory of Avian Pathology Diagnosis. The patient was discharged after 7 days of the treatment, obtaining a favorable result with no further complications. Discussion: The results of the coproparasitological examination were negative for the samples analyzed; nevertheless, the possibility of a false negative result cannot be totally dismissed. Cloacal prolapse may be related to cases of hypersexual disorder or overexertion to defecate due to intestinal parasites, posture, polyps, enteritis, neoplasm or cloacal hyperplasia. Besides that, endoparasitism is common in captive birds. For the correct treatment, proceed with a cloacoplasty, in which 1 or 2 simple sutures are made separated laterally in both sides, promoting the narrowing of the orifice. The surgeries such as the cloacoplasty are currently being defended, but in most cases as an adjuvant therapy. Cloacal prolapse in birds is a disease considered as an intestinal emergency. The techniques presented in this work demand sedation or anesthesia for the patient, which were not authorized by the tutor due to the high risk involved. However, due to the characteristic of domestication and docile behavior of the bird, it was possible to perform the 2 sutures with a local anesthetic block only. Cloacal prolapse is relatively common in adult psittacine birds, but uncommon in monk parakeets and young birds. The treatment performed was effective for the monk-parakeet presented in this study case. The authors, however, would like to strongly reinforce the need to identify the cause of cloacal prolapse in order to properly treat it. The importance of correctly identifying the anatomy of a psittacine bird as well as applying precisely the suture techniques are the most important conclusions obtained, making both the identification of the problem and its solution through surgical intervention a simpler and successful process.

A eficácia dos pessários vaginais no tratamento de distopias genitais: uma revisão integrativa / The effectiveness of vaginal pessaries in the treatment of genital dystopias: an integrative review / Eficacia de los pesarios vaginales en el tratamiento de lasdistopias genitales: una revisión integrativa

Objetivo: descreveros benefícios e a eficácia dos pessários vaginais na vida das mulheres que apresentam prolapsos de órgãos pélvicos. Métodos: trata-se de uma revisão integrativa da literatura,com busca nas bases de dados: a Base de Dados de Enfermagem(BDENF), Índice Bibliográfico em Ciências da La Salud(IBECS), Literatura Latino-Americana e do Caribe em Ciência da Saúde (LILACS),medical Literature Analysis and Retrievel System online (MEDLINE), acessadaspela Biblioteca Virtual em Saúde (BVS). Resultados: Acoleta deu-se em maio de 2021, resultando em 8artigos como amostra final. Osresultadosdos dados analisados mostramos benefícios dos pessários, que melhoram a qualidade de vida e diminuem os sintomas causadospelas distopias genitaise que esse dispositivo pode ser usado como primeira linha de tratamento. Considerações Finais: apesar dos benefícios, identifica-se ainda um desconhecimento por parte das mulheres e dos profissionais de saúde na utilização desses pessários, tornando-se necessário maior qualificação para essa utilização e indicação do uso, para que possa tornar-se habitual no cotidiano clínico.

Objective: To describe the benefits and effectiveness of vaginal pessaries in the lives of women with pelvic organ prolapse. Methods:this is an integrative literature review, with a search in the following databases: the Nursing Database (BDENF), La Salud Science Bibliographic Index (IBECS), Latin American and Caribbean Literature on Science of the Health (LILACS), online medical Literature Analysis and Retrievel System (MEDLINE), accessed by the Virtual Health Library (VHL). Results:The collection took place in May 2021, resulting in 8 articles as the final sample. The results of the analyzed data show the benefits of the pessaries, which improve the quality of life and reduce the symptoms caused by genital dystopias and that this device can be used as a first line of treatment. Final Considerations:despite the benefits, there is still a lack of knowledge on the part of women and health professionals in the use of these pessaries, requiring greater qualification for this use and indication of use, so that it can become habitual in daily life clinical.

Objetivo: describir los beneficios y la eficacia de los pesarios vaginales en la vida de mujeres con prolapso de órganos pélvicos. Métodos:se trata de una revisión integrativa de la literatura, con búsqueda en las siguientes bases de datos: Base de Datos de Enfermería (BDENF), Índice Bibliográfico de Ciencias de la Salud (IBECS), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Literatura médica Sistema de Análisis y Recuperación en línea (MEDLINE), accedido por la Biblioteca Virtual en Salud (BVS). Resultados:La recolección se realizó en mayo de 2021, resultando 8 artículos como muestra final. Los resultados de los datos analizados muestran los beneficios de los pesarios, que mejoran la calidad de vida y disminuyen los síntomas causados por las distopías genitales y que este dispositivo puede ser utilizado como tratamiento de primera línea. Consideraciones finales:a pesar de los beneficios, aún existe un desconocimiento por parte de las mujeres y profesionales de la salud en el usode estos pesarios, por lo que es necesario tener mayor capacitación para este uso e indicación de uso, para que pueda volverse habitual en la vida cotidiana clínica.

Prolapso de cúpula vaginal, prevalencia en mujeres en climaterio, en el Quindío, Colombia, 2007-2017 / Vaginal Vault Prolapse, Prevalence in Women in Climacteric, in Quindío, Colombia, 2007-2017

Objetivo establecer la prevalencia de prolapso de cúpula vaginal en mujeres del Quindío en climaterio, así como los factores asociados a su aparición. Métodos Se realizó un estudio de corte transversal. Se evaluaron retrospectivamente las historias clínicas de 3,576 pacientes ambulatorias, en una clínica de alta complejidad de la ciudad de Armenia (Quindío), Colombia; entre enero de 2007 y junio de 2017. Se determinó la prevalencia de prolapso de cúpula vaginal y se analizaron los datos socio-demográficos, clínicos y quirúrgicos. Resultados La edad media en las mujeres fue de 59,7 ± 14,7 años, con predominancia de las hispánicas (58,5%). La prevalencia de prolapso de cúpula vaginal fue del 14,17%. En el subgrupo de mujeres histerectomizadas, la prevalencia fue del 21,64% en las realizadas por prolapso y del 6,34% en las hechas vía abdominal. En el análisis multivariado, los factores asociados a prolapso de cúpula vaginal fueron: 65 o más años (OR: 4,76; 1,57­20,82), IMC[3] 25 (OR: 8,42; 2,68­31,04), multíparas (OR: 9,03; 2,75­32.27), antecedente de cirugía vaginal (OR: 7.04; 1.96­28.49) y presencia de enfermedades pulmonares crónicas (OR: 5,31; 1,64­23,57). Conclusión la prevalencia global de prolapso de cúpula vaginal, en las mujeres del Quindío, fue del 14,17%. En Colombia existen pocos datos registrados al respecto, pero con la información presente, se manifiesta la necesidad de elaborar efectivas estrategias de prevención, detección y manejo.

Objective To establish the prevalence of vaginal dome prolapse in women of Quindío in climacteric, as well as the factors associated with its appearance. Methods A cross-sectional study was performed. The medical records of 3,576 outpatients were retrospectively evaluated in a highly complex clinic in the city of Armenia (Quindío), Colombia; between January 2007 and June 2017. The prevalence of vaginal vault prolapse was determined and socio-demographic, clinical and surgical data were analyzed. Results The mean age in women was 59.7 ± 14.7 years, with a predominance of Hispanic women (58.5%). The prevalence of vaginal vault prolapse was 14.17%. In the subgroup of hysterectomized women, the prevalence was 21.64% in those performed for prolapse and 6.34% in those performed by the abdominal route. In the multivariate analysis, the factors associated with vaginal dome prolapse were: 65 or more years (OR: 4.76; 1.57­20.82), BMI[3] 25 (OR: 8.42; 2.68­31.04), multiparous (OR: 9.03; 2.75­32.27), a history of vaginal surgery (OR: 7.04; 1.96­28.49) and presence of chronic lung diseases (OR: 5.31; 1.64­23.57). Conclusion The overall prevalence of vaginal dome prolapse, in Quindío women, was 14.17%. In Colombia there are few registered data in this regard, but with the present information, there is a need to develop effective prevention, detection and management strategies.

"PNR-Bleed" classification and Hemorrhoid Severity Score-a novel attempt at classifying the hemorrhoids / Classificação "PNR-Bleed" e escore de gravidade das hemorróidas - uma nova tentativa de classificação de hemorróidas

ABSTRACT Hemorrhoids are the most common anorectal disorders with a prevalence of 39% in general population. Hemorrhoids are generally classified on the basis of their location and degree of prolapse. Goligher's classification does not describe the number of hemorrhoidal columns involved and does not give much consideration to the amount of blood loss. To describe the hemorrhoidal disease more vividly, we devised the "PNR-Bleed" (or PNR-Booking) classification system. We tried to classify the hemorrhoids based on the four main characteristics of the hemorrhoidal disease i.e. the degree of hemorrhoidal Prolapse (P), Number (N) of the primary hemorrhoidal columns involved, Relation (R) of the hemorrhoidal tissue to dentate line and the amount of Bleeding (B) from it. All the four components in this classification system are graded into five grades ranging from 1 to 5. The peculiarity of this new classification system is that it allows more detailed documentation of the hemorrhoids in a particular patient and conveys more explicit meaning and information about the hemorrhoids for future references. Based on this 'PNR-Bleed' classification, we are introducing another concept of scoring the severity of hemorrhoids and referred it as the Hemorrhoid Severity Score (HSS). Hemorrhoid Severity Score (HSS) is the total score obtained by the sum of the numerical grades of all four characteristics of hemorrhoids in "PNR-Bleed" classification. This new "PNR-Bleed" system of classifying the hemorrhoids and calculation of HSS seems to be more comprehensive, detailed, more objective and easily reproducible.

RESUMO As hemorróidas são os distúrbios anorretais mais comuns, com uma prevalência de 39% na população em geral. As hemorróidas são geralmente classificadas com base em sua localização e grau de prolapso. A classificação de Goligher não descreve o número de colunas hemorroidais envolvidas e não dá muita importância à quantidade da perda de sangue. Para descrever a doença hemorroidária de maneira mais precisa, criamos o sistema de classificação "PNR-Bleed" (ou PNR-Booking). Tentamos classificar as hemorróidas com base nas quatro principais características da doença hemorroidária, isto é, o grau de prolapso da hemorroida (P), número (N) das colunas hemorroidais primárias envolvidas, a relação (R) do tecido hemorroidário para a linha denteada e a quantidade de sangramento (B) originando-se dele. Todos os quatro componentes deste sistema de classificação são classificados em cinco graus, variando de 1 a 5. A peculiaridade desse novo sistema de classificação é que ele permite uma documentação mais detalhada das hemorróidas em um paciente em particular e transmite o significado e informações mais explícitos sobre as hemorróidas. para referências futuras. Com base nessa classificação "PNR-Bleed", estamos introduzindo outro conceito para o escore da gravidade das hemorróidas e denominado HSS, de "Hemorrhoid Severity Score". O escore de gravidade da hemorroida (HSS) é o escore total obtido pela soma dos graus numéricos de todas as quatro características das hemorróidas na classificação "PNR-Bleed". Esse novo sistema "PNR-Bleed" de classificação de hemorróidas e cálculo do HSS parece ser mais abrangente, detalhado, mais objetivo e facilmente reproduzível.

Detección de nudos críticos para la disminución del tiempo de espera en atención de prolapso de órganos pélvicos en hospital público chileno / Detecting critical knots to decrease the waiting time when caring the pelvic organ prolapse in a chilean public hospital

Resumen Introducción: El problema que se presenta en la atención de salud en los hospitales públicos es la alta cantidad de pacientes, generando un sostenido crecimiento en las listas de espera y provocando un aumento del tiempo de espera, generando un impacto negativo en los usuarios. Objetivo: Mejorar el proceso clínico de atención del prolapso de órganos pélvicos de un hospital público chileno. Metodología: Se identifican nudos críticos mediante diagramas de flujo, realizando un diagnóstico del proceso desde el ingreso del paciente hasta su alta del hospital. Resultados: Se identifican cada uno de los puntos críticos y se proponen soluciones para agilizar el proceso y con ello mejorar la atención a las usuarias, lo que en definitiva llevó a una disminución del tiempo de espera y, lo más relevante, a una disminución en la cantidad de personas en la lista de espera.

Abstract Introduction: The high number of patients is a common issue in public hospitals that causes a negative impact on the users due to the increment in the waiting lists and in the waiting time to be treated. Objective: To improve the clinical process for caring pelvic organ prolapse in a chilean public hospital. Methodology: The methodology was focused on identifying critical knots using flowcharts and diagnosing the patient's process from their admission until their discharge from the hospital. Results: Some solutions were proposed for each critical point identified so as to accelerate the process, thus improving users' health caring. As a result, the high number of people in the waiting lists and the waiting time decreased substantially.

Marsupialization for the treatment of nictitating membrane cyst in a dog: case report / Marsupialização para o tratamento de cisto em membrana nictitante de cão: relato de caso

This study aims to describe the first Brazilian report of a nictitating membrane cyst's surgical treatment in a dog. A 6-month-old female French Bulldog presented at HOSVET-UNIME with a reddish mass-like structure in the medial canthus of both eyes, with a history of recurrent third eyelid gland prolapse previously treated with two surgeries performed at another clinic. Physical examination revealed a third eyelid gland prolapse in the right eye and a cyst in the left eye's third eyelid. The animal was submitted to surgical correction of the right eye's third eyelid prolapse using pocket technique and of the left eye's third eyelid using marsupialization technique for the cyst's treatment. 180 days after th1e surgical procedure no recurrence was observed. The marsupialization technique for the treatment of a third eyelid's lacrimal cyst in a dog allowed the maintenance of its gland and prevented the formation of a new cystic cavity.(AU)

O objetivo do presente trabalho é descrever o primeiro relato no Brasil de tratamento cirúrgico de um cisto da membrana nictitante em um cão. Um Buldogue Francês, fêmea, seis meses, foi atendido no Hosvet-Unime, com queixa de aumento de volume avermelhado no canto medial de ambos os olhos, com histórico de recidiva de prolapso de glândula da terceira pálpebra, onde haviam sido realizadas duas cirurgias anteriormente em outro local. Ao exame físico, foi observado prolapso de glândula da terceira pálpebra no olho direito e a presença de um cisto na terceira pálpebra do olho esquerdo. O animal foi submetido ao procedimento cirúrgico de sepultamento de glândula da terceira pálpebra no olho direito e uma marsupialização na terceira pálpebra do olho esquerdo para o tratamento do cisto. Cento e oitenta dias após o procedimento cirúrgico, não foi observada recidiva. A técnica de marsupialização para tratamento de cisto lacrimal na terceira pálpebra em um cão possibilitou a manutenção da sua glândula e impediu a formação de nova cavidade cística.(AU)

Marsupialization for the treatment of nictitating membrane cyst in a dog: case report / Marsupialização para o tratamento de cisto em membrana nictitante de cão: relato de caso

This study aims to describe the first Brazilian report of a nictitating membrane cyst's surgical treatment in a dog. A 6-month-old female French Bulldog presented at HOSVET-UNIME with a reddish mass-like structure in the medial canthus of both eyes, with a history of recurrent third eyelid gland prolapse previously treated with two surgeries performed at another clinic. Physical examination revealed a third eyelid gland prolapse in the right eye and a cyst in the left eye's third eyelid. The animal was submitted to surgical correction of the right eye's third eyelid prolapse using pocket technique and of the left eye's third eyelid using marsupialization technique for the cyst's treatment. 180 days after th1e surgical procedure no recurrence was observed. The marsupialization technique for the treatment of a third eyelid's lacrimal cyst in a dog allowed the maintenance of its gland and prevented the formation of a new cystic cavity.(AU)

O objetivo do presente trabalho é descrever o primeiro relato no Brasil de tratamento cirúrgico de um cisto da membrana nictitante em um cão. Um Buldogue Francês, fêmea, seis meses, foi atendido no Hosvet-Unime, com queixa de aumento de volume avermelhado no canto medial de ambos os olhos, com histórico de recidiva de prolapso de glândula da terceira pálpebra, onde haviam sido realizadas duas cirurgias anteriormente em outro local. Ao exame físico, foi observado prolapso de glândula da terceira pálpebra no olho direito e a presença de um cisto na terceira pálpebra do olho esquerdo. O animal foi submetido ao procedimento cirúrgico de sepultamento de glândula da terceira pálpebra no olho direito e uma marsupialização na terceira pálpebra do olho esquerdo para o tratamento do cisto. Cento e oitenta dias após o procedimento cirúrgico, não foi observada recidiva. A técnica de marsupialização para tratamento de cisto lacrimal na terceira pálpebra em um cão possibilitou a manutenção da sua glândula e impediu a formação de nova cavidade cística.(AU)