Tratamiento del embarazo ectópico en cicatriz de cesárea: revisión de la literatura a propósito de 3 casos / Treatment of ectopic pregnancy in a cesarean scar: review of the literature regarding 3 cases

INTRODUCCIÓN Y OBJETIVOS: El embarazo en cicatriz de cesárea previa (ECC) es una entidad poco frecuente que puede tener graves consecuencias. Hasta la fecha no existen esquemas estandarizados de tratamiento y su manejo óptimo sigue siendo controvertido. Nuestro objetivo es realizar una revisión de la literatura publicada sobre el manejo del ECC y proponer un algoritmo. También exponemos tres casos de ECC resueltos con diferentes tratamientos en el Hospital Universitario Infanta Elena MÉTODOS: Búsqueda de la literatura en bases de datos utilizando las palabras clave: "embarazo en cicatriz cesárea"," gestación ectópica en cicatriz cesárea", "tratamiento", "manejo". RESULTADOS: Las opciones terapéuticas pueden ser médicas, quirúrgicas o una combinación de ambas. Los tratamientos quirúrgicos tienen altas tasas de éxito, sin embargo, son más invasivos y no están exentos de riesgo. La combinación de tratamientos parece aumentar la tasa de éxito, no obstante, podría implicar un mayor riesgo de efectos secundarios y costes. CONCLUSIONES: El manejo de los ECC debe de ser individualizado, basado en la evidencia científica, en los medios disponibles y la experiencia de los profesionales en los distintos procedimientos, guiándonos por el tipo de ECC y su grado de vascularización e invasión, grosor del miometrio, niveles de beta-hCG, presencia de actividad cardiaca, clínica y estabilidad hemodinámica de la paciente. Deben tenerse en cuenta las circunstancias y patología intercurrente de la mujer, así como su deseo genésico o de preservación del útero.

INTRODUCTION AND OBJECTIVES: Cesarean scar pregnancy (CSP) is a rare entity that can cause serious consequences. Up to now, there are no standardized treatment schemes, and its optimal management remains controversial. Our objetive is to review the literature regarding CSP management and propose an algorithm. We also present three cases of CSP resolved with different treatments at Hospital Universitario Infanta Elena. METHODS: Literature search in databases using the following keywords: pregnancy with cesarean section, ectopic pregnancy with cesarean section, treatment, management. RESULTS: The therapeutic options can be medical, surgical or a combination of both. Surgical treatments have high success rates; however, they are more invasive and are not without risk. The combination of treatments seems to increase the success rate; however, it could imply a higher risk of side effects and costs. CONCLUSIONS: The management of CSP must be individualized; based on scientific evidence, on the means available, and on the experience of the professionals in the different procedures; guided by the type of CSP and its degree of vascularization and invasion, by the thickness of the myometrium, beta-hCG levels, presence of cardiac activity, and by clinical and hemodynamic stability of the patient. The circumstances and intercurrent pathology of the patient must be considered, as well as her desire for future pregnancy or preservation of the uterus.

A propósito de un caso: útero miomatoso gigante torsionado / Torsion of a giant miomatous uterus: report of a clinical case autores

OBJETIVO: Reportar el caso de una torsión de útero, trompas y ambos ovarios a nivel de cuello uterino. Describir la patogenia, sintomatología y tratamiento, como un caso infrecuente y potencialmente grave, en la práctica clínica diaria. MATERIAL Y MÉTODOS: Analizar el curso de esta extremadamente rara patología, en una mujer postmenopáusica de 59 años. Se trata de un caso raro de torsión uterina en un útero no gestante, reportando los hallazgos en los exámenes previos a la cirugía y los hallazgos intraoperatorios e histopatológicos postcirugía. La resonancia magnética fue fundamental en el diagnóstico de la paciente y la laparotomía realizada demostró una torsión de cuerpo uterino de 360 ° a nivel de cérvix, y un gran mioma pediculado con signos de necrosis. Hemos revisado los últimos artículos de esta rara patología RESULTADOS Y DISCUSIÓN: La paciente fue operada. Se realizó una histerectomía total mediante una laparotomía media supra e infraumbilical. Los ovarios no tenían signos de necrosis. CONCLUSIONES: Debemos tener en cuenta esta posibilidad diagnóstica, en pacientes con aumento de tamaño uterino y clínica de dolor abdominal, ya que aunque es muy infrecuente, su diagnóstico es importante, ya que puede ser peligroso para la vida de la paciente.

OBJECTIVE: To report a case of torsion of the uterus, fallopian tubes and both ovaries around the uterine collum and the symptomatology, pathogenesis and treatment of this uncommon pathology. MATERIAL AND METHODS: The article analyses the course of this extremely rare pathology in a postmenopausical woman of 59 years. It is a rare case like a non gravid uterine torsion in a postmenopausical woman. We have the exams previous to the surgery, the finds intraoperative and the histolopathological reports postsurgery. RMN was the most important in diagnosis and the laparotomy showed a 360° an uterus increased on size and a big pedunculated myoma with signs of necrosis We have reviewed the latest articles on this strange pathology RESULTS AND DISCUSSION: The patient was operated. A infra-supra medium laparotomy was practiced and a total hysterectomy was made. Ovarians had not signs of necrosis. CONCLUSIONS: We must take into account, in patients with pathologies that increase uterine size and abdominal pain, the possibility of uterine torsion. Although it is a very infrequent pathology, its diagnosis is important, since it can be dangerous for the life of the patient

Impairment of locomotor activity induced by the novel N-acylhydrazone derivatives LASSBio-785 and LASSBio-786 in mice

The N-acylhydrazone (NAH) analogues N-methyl 2-thienylidene 3,4-benzoylhydrazine (LASSBio-785) and N-benzyl 2-thienylidene 3,4-benzoylhydrazine (LASSBio-786) were prepared from 2-thienylidene 3,4-methylenedioxybenzoylhydrazine (LASSBio-294). The ability of LASSBio-785 and LASSBio-786 to decrease central nervous system activity was investigated in male Swiss mice. LASSBio-785 or LASSBio-786 (30 mg/kg, ip) reduced locomotor activity from 209 ± 26 (control) to 140 ± 18 (P < 0.05) or 146 ± 15 crossings/min (P < 0.05), respectively. LASSBio-785 (15 or 30 mg/kg, iv) also reduced locomotor activity from 200 ± 15 to 116 ± 29 (P < 0.05) or 60 ± 16 crossings/min (P < 0.01), respectively. Likewise, LASSBio-786 (15 or 30 mg/kg, iv) reduced locomotor activity from 200 ± 15 to 127 ± 10 (P < 0.01) or 96 ± 14 crossings/min (P < 0.01), respectively. Pretreatment with flumazenil (20 mg/kg, ip) prevented the locomotor impairment induced by NAH analogues (15 mg/kg, iv), providing evidence that the benzodiazepine (BDZ) receptor is involved. This finding was supported by the structural similarity of NAH analogues to midazolam. However, LASSBio-785 showed weak binding to the BDZ receptor. LASSBio-785 or LASSBio-786 (30 mg/kg, ip, n = 10) increased pentobarbital-induced sleeping time from 42 ± 5 (DMSO) to 66 ± 6 (P < 0.05) or 75 ± 4 min (P < 0.05), respectively. The dose required to achieve 50% hypnosis (HD50) following iv injection of LASSBio-785 or LASSBio-786 was 15.8 or 9.5 mg/kg, respectively. These data suggest that both NAH analogues might be useful for the development of new neuroactive drugs for the treatment of insomnia or for use in conjunction with general anesthesia.

Factores que inciden en la compra de alimentos en distintos ámbitos de comercialización y su relación con la implementación de educación alimentaria nutricional (EAN) / Factors influencing the purchase of foods in different marketing settings, and their relation to the implementation of food and nutrition education (FNE)

La Educación Alimentaria Nutricional (EAN) promueve la adquisición por parte de la población de conductas saludables permanentes relativas a la producción, selección, compra, preparación y utilización de alimentos, valiéndose de variados espacios sociales. Los canales minoristas de comercialización de alimentos urbanos –categorizados en dos grandes grupos: ferias/mercados y supermercados/hipermercados- constituyen espacios potenciales para la EAN, con diferencias importantes entre ellos. Los primeros ofrecerían canales de comunicación interpersonales más directos que los segundos. Ambos canales proponen un desafío en cuanto a estrategias y redes comunicacionales alternativas. Los dos escenarios están siendo estudiados para conocer y comprendermotivaciones, conductas, hábitos, orientaciones en las acciones, valores, conocimientos sobre hábitos de alimentación saludables y nutrición; canales de comunicación utilizados; información provista por consumidores y vendedores sobre conductas alimentarias y nutricionales; factores determinantes de la compra de alimentos para, a partir de esos insumos, proponer el desarrollo de posibles intervenciones de EAN. En el marco de un estudio cualitativo exploratorio y descriptivo, trabajando con datos de fuente primaria obtenidos mediante distintas técnicas cualitativas de investigación (observaciones, entrevistas) se plantea como objetivo general identificar y caracterizar distintos factores que influyen en el proceso de selección y compra de alimentos en canales minoristas de comercialización de Capital Federal con la finalidad de plantear acciones posibles de Educación Alimentaria. Se considera que existen diferencias significativas entre estos dos tipos de canales de comercialización y en los clientes que predominantemente concurren a unos y a otros comercios...

Matrizes hidrofílicas de quitosana/captopril: Desenvolvimento e Caracterização físico-química / Hydrophilic Matrices of Chitosan/Captopril: Development and physicochemical Characterization

Neste trabalho, avaliou-se a utilização da quitosana como matriz hidrofílica no desenvolvimento de comprimidos de liberação prolongada de captopril. Os comprimidos foram obtidos por compressão direta utilizando-a em diferentes proporções (10, 15, 20 e 25%). As formulações contendo quitosana foram comparadas com uma formulação de liberação imediata contendo croscarmelose. Os resultados obtidos nos ensaios de peso médio, friabilidade, dureza, uniformidade de conteúdo e doseamento indicaram que todos os comprimidos apresentavam características de qualidade condizentes com os limites especificados na Farmacopeia Brasileira. Os ensaios de dissolução evidenciaram um aumento do tempo de liberação do captopril com o aumento da proporção de quitosana na matriz, indicando que essas formulações apresentaram perfis de liberação prolongada do fármaco, especialmente a formulação contendo 25% de quitosana. Os valores dos coeficientes de correlação indicaram que os modelos cinéticos que melhor se ajustam ao perfil de dissolução das formulações avaliadas foram o modelo proposto por Higuchi (pH 1,2) e o de primeira ordem (pH 6,8).

In this study, chitosan was used as a hydrophilic matrix in the development of prolonged-release tablets of captopril. The tablets were obtained by direct compression, with the chitosan in various proportions (10, 15, 20 and 25%). The formulations were compared with an immediate-release formulation containing croscarmellose. In assessments of weight variation, friability, hardness, content uniformity and drug assay, all the tablets complied with the standards of quality set by the Brazilian Pharmacopoeia. Dissolution tests showed that the release time of captopril increased with the content of chitosan in the matrix, indicating that these formulations showed prolonged-release profiles of the drug, especially the one containing 25% chitosan. The kinetic models that fitted the dissolution profiles of the formulations best (with the highest correlation coefficients) were the Higuchi (at pH 1.2) and first-order (at pH 6.8) models.

Development and validation of HPLC and UV spectrophotometric methods for the determination of lumiracoxib in tablets

In this study, two methods, based on high-performance liquid chromatography (HPLC) and UV spectrophotometry, were developed and validated for the quantitative determination of lumiracoxib in tablets. The HPLC was carried out on a column of propylsulfonic acid bonded to silica gel (250 x 4.6 mm; 5 mium), with a mobile phase of phosphate buffer (pH 7.4; 10 mM)-water-acetonitrile (10:40:50, v/v/v) fl owing at 1.0 mL/min and detection of the drug at 278 nm. The UV method was based on absorbance at 275 nm, with ethanol as solvent. Both assays were linear over the concentration range of 2–30 miug/mL (R approximate 0.999), as wellas accurate and precise, with recoveries between 98 and 100% and relative standard deviation (%RSD) smaller that 2.0%. The proposed methods are highly sensitive, precise and accurate and were successfully applied to the quantitation of lumiracoxib in the commercial formulation. The spectrophotometric method is a simple, cheap and less time-consuming method. However, the chromatographic method is selective for the determination of the degradation products of lumiracoxib.

Dopaminergic profile of new heterocyclic N-phenylpiperazine derivatives

Dopamine constitutes about 80 percent of the content of central catecholamines and has a crucial role in the etiology of several neuropsychiatric disorders, including Parkinson's disease, depression and schizophrenia. Several dopaminergic drugs are used to treat these pathologies, but many problems are attributed to these therapies. Within this context, the search for new more efficient dopaminergic agents with less adverse effects represents a vast research field. The aim of the present study was to report the structural design of two N-phenylpiperazine derivatives, compound 4: 1-[1-(4-chlorophenyl)-1H-4-pyrazolylmethyl]-4-phenylhexahydropyrazine and compound 5: 1-[1-(4-chlorophenyl)-1H-1,2,3-triazol-4-ylmethyl]-4-phenylhexahydropyrazine, planned to be dopamine ligands, and their dopaminergic action profile. The two compounds were assayed (dose range of 15-40 mg/kg) in three experimental models: 1) blockade of amphetamine (30 mg/kg, ip)-induced stereotypy in rats; 2) the catalepsy test in mice, and 3) apomorphine (1 mg/kg, ip)-induced hypothermia in mice. Both derivatives induced cataleptic behavior (40 mg/kg, ip) and a hypothermic response (30 mg/kg, ip) which was not prevented by haloperidol (0.5 mg/kg, ip). Compound 5 (30 mg/kg, ip) also presented a synergistic hypothermic effect with apomorphine (1 mg/kg, ip). Only compound 4 (30 mg/kg, ip) significantly blocked the amphetamine-induced stereotypy in rats. The N-phenylpiperazine derivatives 4 and 5 seem to have a peculiar profile of action on dopaminergic functions. On the basis of the results of catalepsy and amphetamine-induced stereotypy, the compounds demonstrated an inhibitory effect on dopaminergic behaviors. However, their hypothermic effect is compatible with the stimulation of dopaminergic function which seems not to be mediated by D2/D3 receptors

Ascorbate protects (+)-catechin from oxidation both in a pure chemical system and human plasma

We evaluated the interaction between ascorbic acid (AA) and (+)-catechin (CTCH) in potassium phosphate solution, pH 7.4 (PPS) and in human plasma. In both systems, the oxidation was started by adding 2,2'-azobis-(2-amidinopropane) clorhidrate (AAPH). The concentrations of AA and CTCH were determined by HPLC using electrochemical detection. In PPS, CTCH was oxidized by AAPH (50 mM), in either the absence or presence of different initial concentrations of AA (25-200 microM). In the presence of AA, CTCH depletion was delayed, an effect that was dependent upon the initial concentration of AA. When 100 microM AA was added after the oxidation had begun, CTCH depletion was arrested for 30 min. The kinetics of AA oxidation by AAPH was also characterized in PPS. AA (100 microM) was completely consumed after 60 min of reaction at 37 degrees C, in both the absence and presence of 100 mM CTCH. When human plasma was incubated with 50 mM AAPH in the absence of added CTCH, AA was completely consumed after 45-60 min. CTCH did not prevent AA depletion in human plasma at the concentrations tested (10, 50 100 microM). The results point out that AA is able to protect other aqueous soluble antioxidants, e.g.: CTCH.

Cardiovascular adjustments in limb retraction provoked by noxious stimulation in decerebrate and spinal cats: evidence for a somatotopic organization

Arterial blood pressure, heart rate and iliac blood flow were continuously recorded in 61 adult cats and their alteration induced by noxious stimulation of the interdigital spaces of the four limbs was studied in intact (anesthetized) and in decerebrate and spinal preparations. Noxious stimulation of any limb in the decerebrate animals provoked retraction 61 percent of the times and an increase of blood pressure and heart rate in approximately 80 percent of the stimulations. Stimulations of a hindlimb provoked an increase of blood flow in the same limb in about 80 percent of the stimulations, due to active vasodilation. Contralateral stimulation provoked as smaller increase of blood flow but with an increase in vascular resistance, indicating some degree of vasoconstriction. Stimulation of the forelimbs induced small increases of blood flow in the hindlimbs but the calculated vascular resistance was higher than the basal values, also indicating vasoconstriction. Neuromuscular blockade with gallamine did not affect the increase of hindlimb blood flow, suggesting a central regulation of the intricate distribution of blood to the limbs...

Asma brônquica: conduta de tratamento nas crises

Os autores tecem comentários sobre a importância clínica da asma brônquica, classificando as crises em leves, moderadas e graves. Fazem uma rápida revisäo sobre os mecanismos de açäo das drogas simpaticomiméticas, das metilxantinas e dos corticosteróides, apresentando as vantagens e inconvenientes da utilizaçäo de cada um desses grupos de fármacos; ao mesmo tempo, valorizam a hidrataçäo no tratamento das crises de asma. Alertam para a necessidade de um atendimento abrangente por parte das equipes de emergência, às quais compete estabelecer as primeiras medidas após a alta hospitalar e orientar sobre a necessidade de tratamento intercrise