Guiding opioid-free intravenous antinociception with the Analgesia Nociception Index: a case report / Antinocicepção intravenosa sem opioides orientada pelo Índice de Analgesia/Nocicepção: relato de caso

Abstract Background: Opioid-free anesthesia decreases the incidence of opioid adverse events, but its optimal antinociceptive depth has not been clearly defined. Personalizing intraoperative opioid-free infusions with a nociception monitor may be the solution. Case report: We describe the feasibility and potential limitations of titrating opioid-free antinociception during major abdominal surgery using the Analgesia Nociception Index (Mdoloris, Lille, France) in an obese patient. After stabilizing the patient's nociception-antinociception balance intraoperatively we quickly reversed anesthesia and the patient did not require postoperative opioids. Conclusion: Personalizing opioid-free antinociception with a nociception monitor is feasible. It may optimize intraoperative antinociception and improve postoperative comfort.

Resumo Introdução A anestesia sem opioides diminui a incidência de eventos adversos associados aos opioides, mas a profundidade antinociceptiva ideal dessa abordagem não está claramente definida. Personalizar a infusão intraoperatória sem opioides com o uso de monitor de nocicepção pode ser a solução. Relato de caso Descrevemos a viabilidade e as eventuais limitações da titulação da antinocicepção sem opioides por meio do uso do Índice de Analgesia/Nocicepção (Mdoloris, Lille, França) durante cirurgia abdominal de grande porte em paciente com obesidade. Depois de estabilizar o equilíbrio nocicepção-antinocicepção da paciente no intraoperatório, revertemos rapidamente a anestesia e a paciente não precisou de opioides no pós-operatório. Conclusão A personalização da antinocicepção sem opioides por meio do emprego de monitor de nocicepção é factível. A abordagem pode otimizar a antinocicepção intraoperatória e melhorar o conforto pós-operatório.

Correção laparoscópica de fístula vesicovaginal: relato de caso / Laparoscopic repair of vesicovaginal fistula: a case report

Apesar de constituírem complicação incomum, as fístulas vesicovaginais apresentam expressivo impacto na qualidade de vida dos pacientes. As abordagens minimamente invasivas têm ganhado mais espaço no tratamento de doenças geniturinárias. Ainda são poucos os relatos do acesso laparoscópico para correção das fístulas vesicovaginais. Relata-se aqui um caso de fístula pós-histerectomia tratada totalmente de forma laparoscópica com ótimo resultado. As vantagens do acesso laparoscópico, assim como alguns detalhes técnicos, são discutidos...

Despite being an uncommon complication, vesicovaginal fistulas have significant impact on patient quality of life. Minimally invasive approaches have gained more space in the treatment of genitourinary diseases. There are few reports on laparoscopic approaches for correction of vesicovaginal fistulas. This is a case report of a post-hysterectomy fistulatreated exclusively through laparoscopy with excellent results. The advantages of the laparoscopic approach, as well as some technical details, are discussed...

Vesicovaginal Fistula: a Review of Nigerian Experience

BACKGROUND: Vesicovaginal fistula is a preventable calamity; which has been an age-long menace in developing countries. OBJECTIVE: To review the causes; complications; and outcome of vesicovaginal fistula in Nigeria. METHODS: Studies on vesicovaginal fistula were searched on the internet. Information was obtained on Pubmed (medline); WHO website; Bioline Innternational; African Journal on Line; Google scholar; Yahoo; Medscape and e Medicine. RESULTS: Many Nigerian women are living with vesicovaginal fistula. The annual obstetric fistula incidence is estimated at 2.11 per 1000 births. It is more prevalent in northern Nigeria than southern Nigeria. Obstetric fistula accounts for 84.1-100of the vesicovaginal fistula and prolonged obstructed labour is consistently the most common cause (65.9-96.5) in all the series. Other common causes include caesarean section; advanced cervical cancer; uterine rupture; and Gishiri cut. The identified predisposing factors were early marriage and pregnancy; which were rampant in northern Nigeria; while unskilled birth attendance and late presentation to the health facilities was common nationwide. Among the significant contributory factors to high rate of unskilled birth attendance were poverty; illiteracy; ignorance; restriction of women's movement; non-permission from husband; and transportation. All but one Nigerian studies revealed that primiparous women were the most vulnerable group. Pregnancy outcome was dismal in most cases related to delivery with still birth rate of 87-91.7. Stigmatization; divorce and social exclusion were common complications. Overall fistula repair success rate was between 75and 92in a few centres that offer such services. CONCLUSION: Vesicovaginal fistula is prevalent in Nigeria and obstetric factors are mostly implicated. It is a public health issue of concern

Vesico-vaginal fistula: interposition flap, a key to success

Vesico-vaginal Fistula [VVF] is an abnormal communication between bladder and vagina that causes continuous discharge of urine into vaginal vault. The objective of this study is to describe current trends of aetiology and repair of Vesico-vaginal Fistulae. This is a Descriptive Study, conducted at Armed Forces Institute of Urology, Rawalpindi and Combined Military Hospital, Kharian between May 2001 and May 2007. All patients diagnosed as cases of vesico-vaginal fistulae were included in the study. Their demographic profile and repair success was determined. A total of 86 patients were included in the study. The mean age of the patients was 35.5 years [range 25-46]. Total abdominal hysterectomy was the most common cause [53% of the cases] followed by obstetric causes [43.92% of the cases]. Success rate of the surgery in the study was 97.5%. The common causes of vesico-vaginal fistula in this study were total abdominal hysterectomy and obstetric causes. The success rate was high, yet the attempt should be made to prevent this socially distressing condition

Vesicovaginal fistula [VVF]

Vesicovaginal fistula is not an uncommon condition. It gives rise to multiple socio-psychological problems for women usually of younger age. It can be prevented by improving the level of education, health care and poverty. Early diagnosis and appropriate treatment is required to help the patient. Preoperative assessment, treatment of co-morbid factors, proper surgical approach and technique ensures success of surgery. Postoperative care of the patient is equally important to avoid surgical failure

[Rare complication of the surgical treatment of vesico-vaginal fistulae [VVF]: menouria due to concealed cervix]

Vesico-vaginal fistula [VVF] is a complication of difficult labor, which occurs very frequently in certain areas of Africa lacking sufficient obstetric facilities. VVF is an abnormal connection between the bladder and vagina, and its treatment is sometimes associated with complications. The authors describe two cases of menouria which occurred after treatment of VVF

Profile and repair success of vesico-vaginal fistula in Lahore

To describe the profile of patients with vesico-vaginal fistula [VVF] and success rate of the surgery. Design: Descriptive study. Place and Duration of Study: Sir Ganga Ram Hospital and Ghurki Trust Hospital, Lahore, between 1998 and 2002. Patients and All patients diagnosed as cases of vesico-vaginal fistula were included in the study. Those patients, who had previous unsuccessful surgery for vesico-vaginal repair, whether done in the hospital or outside, were also included. Their demographic profile and repair success was determined. Out of 2570 gynaecological admissions, 14 women had vesico-vaginal fistulae showing the prevalence of 0.55 / 100 gynaecological admissions. Obstetrical cause was found in 71.4% of the cases. The mean age of the patients was 34.85 +/- 6.3 years [range 25-45] with parity varying from 0-9 [median 4]. The position of majority of the fistulas [57.2%] was high [vault, juxta-cervical]. Success rate of the surgery in the study was 85.7%. Majority of the repairs [78.6%] were done through vaginal route. The most common cause of vesico-vaginal fistula in this study was obstetrical, either prolonged labour or caesarean hysterectomy. Although the success rate of repair was high, yet the attempt should be focussed on prevention

Trans-vaginal sonographic evaluation of vesicovaginal fistula

To determine the sensitivity of transvaginal ultrasound [TVUS] in the detection of vesicovaginal fistula [VVF]. The study included 15 patients with urinary incontinence suspected or diagnosed to be due to vesico-vaginal fistula that were originally referred to the department for intravenous urography [IVU]. Complimentary TVS was done with consent. Cases with stress incontinence and co-existent rectovaginal fistulae were excluded. Findings were compared against the cystogram, cystoscopy and surgical findings for determining the sensitivity, the last being taken as the gold standard. The fistula was visualized as a jet of echoes in real time from bladder to the vagina in all 15 cases. The location number and size corresponded with the surgical findings. The sensitivity of trans-vaginal scanning in diagnosing VVF was 100%, that of cystoscopy- 93% and of cystography- 60%. In this series, the trans-vaginal scan findings correlated well with the surgical findings. It was less invasive and more tolerable than cystoscopy

Fístulas genitourinarias en el Instituto Nacional de Perinatología / Urogenital fistulae at Instituto Nacional de Perinatología

Se evaluaron las características clínicas de las pacientes con diagnóstico de fístula genitourinaria. Se realizó un estudio retrospectivo en la Clínica de Urología Ginecológica de Instituto Nacional de Perinatología, en un período comprendido de marzo 1992 a junio de 1995, se encontraron 21 pacientes evaluadas con diagnóstico de fístula urogenital, en las cuales se analizó la etiología, la localización, la vía de abordaje quirúrgico, la frecuencia de infección de vías urinarias y la resolución. La etiología fue ginecológica en 51.1 por ciento de los casos y obstétrica en 48.5 por ciento, la localización fue: vesicovaginales 14 (66.6 por ciento), ureterovaginales 5 (23.5 por ciento), uretrovaginales 2(9.5 por ciento). La resolución por vía abdominal fue de ocho pacientes, por vía vaginal en 9 y con manejo conservador, dos. El porcentaje de resolución fue de 8.9 por ciento. La infección de vías urinarias bajas a su ingreso fue para la de causa obstétrica de 47.6 por ciento y las de causa ginecológica de 52.2 por ciento. Se observa un incremento en la presentación de fístulas urogenitales de causa obstétrica, lo cual puede esta influido por el hecho de que la mayoría de las pacientes en el Instituto son de tipo obstétrico

A psycho-social study on genito-urinary fistula.

This study was done on a series of 132 vesico-vaginal fistula (V.V.F.) cases to assess the social factors that are related to this morbidity and its psycho-social effects on them. About 54% of the respondents developed VVF as an outcome of their first pregnancy and none of them had a living child. Of this 39% were in the age group of 15-20 years. About 68% were illiterate and 22% had received formal education for up to 5 years. Fifty two per cent of the subjects had a family income of up to Tk. 1,000 only per month. Almost all were Muslims (94.7%). Of the respondents 64.6% had home delivery by TBA and 72% had history of prolonged labour. Fifty six per cent of the subjects did not like to avail the health facilities of the nearby clinic/hospital. Lack of privacy, objection from husband/family and conduction of delivery by male doctor were mentioned as causes for not availing the facilities by this large group. Indifferent attitude of husband and in-laws, expressed willingness of husband for taking another wife, disturbed socio-psycho-sexual life and deterioration of general health were the after effects of the morbidity at individual, conjugal and community level of the respondents.

Litiasis vaginal: informe de un caso clínico y revisión de la literatura / Vaginal lithiasis: clinical case report and review of the literature

La observación de litiasis vaginal es sumamente rara y en el presente informe se analiza un método diagnóstico sencillo, económico y pocas veces utilizado, como lo es la vaginografía. El diagnóstico fue corrobarado por cirugía

Tratamento cirúrgico de incontinência urinária por lesäo total do esfíncter (correçäo cirúrgica de fístula uretrovesicovaginal) pela suspensäo endoscópica do colo vesical / Surgical treatment of urinary incontinence caused by total injury of the sphincter (surgical repair of ureterovesicovaginal fistula) by endoscopic suspension of the vesical neck

Apresentam-se 4 casos de incontinência urinária que surgiram após tratamento cirúrgico de fístula uretrovesicovaginal. Em todos os pacientes a incontinência foi corrigida com sucesso através da técnica de Stamey, que consiste na suspensäo endoscópica do colo vesical. A importância dessa técnica como soluçäo de täo grave afecçäo, sem resultados com outros métodos, pode indicar que num futuro próximo sirva para corrigir também certos casos de incontinência neurogênica caracterizados por estudos urodinâmicos do paciente