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.

The effects of bioadhesive hyaluronic acid gel versus diclofenac after surgical removal of impacted wisdom teeth

Surgical extraction of impacted lower wisdom teeth is a frequent minor intraoral surgical process. It is regularly linked with aching and postoperative consequences as pain and swelling. The aim of this study is to evaluate the efficacy of two methods in reducing swelling and pain subsequent to the removal of impacted wisdom teeth. This randomized study incorporated 20 patients with impacted wisdom teeth of different surgical complexity. Topical hyaluronic acid gel 2g/2ml with aloe vera (Kin®Care) was given to the patients to be applied to the surgical area three times a day, or diclofenac sodium tablet 50mg (Voltaren®) to be taken every eight hours, for one week. Swelling was estimated using a strip gauge technique, and pain with a visual analogue scale. Evaluations were made on day one of surgical treatment and on 72hrs and one week later. Statistically no significant differences were identified regarding the swelling and pain values between the two treatment groups on the third and seventh day after surgery. Hyaluronic acid gel was as efficient as diclofenac tablets in reducing the two parameters. The use of hyaluronic acid may be advantageous in medically compromised patient such as those with hypertension, chronic asthma, gastric ulcers or in those with any contraindications to using non-steroidal anti-inflammatory drugs, or in pregnant patients to reduce pain and swelling subsequent to impacted wisdom teeth surgery.

Conjuntivitis cicatrizal recalcitrante: Tratamiento de nueve pacientes con rituximab / Recalcitrant cicatrizing conjunctivitis. Treatment of nine patients with rituximab

La conjuntivitis cicatrizal es la consecuencia de distintas enfermedades oculares. Entre ellas, las más graves son el penfigoide cicatrizal y el síndrome de Stevens-Johnson crónico. El tratamiento de estas enfermedades con corticoides e inmunosupresores es habitualmente exitoso, pero unos pocos pacientes siguen un curso recalcitrante. En los últimos años se introdujo el uso de rituximab, asociado o no a gammaglobulina endovenosa, en forma abierta, para el control de la inflamación conjuntival. Describimos aquí el tratamiento de siete pacientes con penfigoide y dos con Stevens-Johnson recalcitrante, con rituximab. Ocho recibieron también gammaglobulina y todos alcanzaron la remisión de la actividad. Tres recayeron y recibieron dos o tres nuevos cursos de la medicación con mejoría sintomática. El rituximab probó ser una droga efectiva para el tratamiento de la conjuntivitis cicatrizal crónica recalcitrante.

Cicatrizing conjunctivitis is the final consequence of several diseases. The most severe among them are cicatricial pemphigoid and chronic Stevens-Johnson syndrome. Systemic immunosuppressive drugs and steroids are usually an effective approach to these diseases. However, a few patients follow a recalcitrant course unremitting to usual therapy. We describe the treatment with rituximab of seven patients with cicatricial pemphigoid and two with chronic Stevens-Johnson syndrome. Eight of them also received gammaglobulin and all achieved clinical remission. Three relapsed and required two or three new courses of rituximab with good control of disease activity. Rituximab proved to be an efficacious drug for chronic recalcitrant cicatrizing conjunctivitis.

Efecto clínico de copaifera paupera en la recuperación de la mucosa alveolar post exodoncia / Clinical effect of copaifera in the recovery of the mucous alveolar post extraction

Introducción: El presente trabajo de investigación buscó determinar el aspecto clínico en la reparación de la mucosa alveolar en pacientes postexodóncia con y sin la aplicación tópica de Copaifera paupera en pacientes atendidos en el Policlínico Essalud de Juliaca, en tre junio y agosto del 2015. Materiales y método: Se obtuvo una muestra no probabilística de 37 pacientes para el grupo control y 38 pacientes para el grupo experimental, se aplicó 3 gotas de copaifera paupera y se hicieron controles a los 7, 15 y 21 dias. Resultados: Se encontrón que del grupo experimental el 100% de los pacientes presentaba aspecto adecuado, el 97.4% mostró una coloración rosado coral, 2.6% fue rojizo. El 94.7% de los pacientes experimentales presentaba consistencia firme y resiliente, en un 5.7% fue de consistencia blanda; el 100% de los pacientes no mostró sangrado. De manera general el 94.7% mostró una buena cicatrización, 5.3% una cicatrización regular, y el 0% presenta mala cicatrización. Conclusión: Se concluye que los efectos de la aplicación de copaifera paupera son positivos, en cuanto a sus propiedades curativas, cicatrizantes, antiinflamatorias y antibacteriano permitiendo la recuperación de la mucosa alveolar de los pacientes que acuden al Policlínico Essalud de Juliaca en el periodo de junio - agosto del 2015. (AU)

Introduction: This research study sought to determine the clinical appearance in the repair of the alveolar mucosa in patients post-extraction with and without the topical application of Copaifera paupera in patients treated at the polyclinic, Juliaca Essalud, between June and August 2015. Materials and method: is obtained a sample not probabilistic of 37 patients for the group control and 38 patients for the group experimental, is applied 3 drops of copaifera paupera and is made controls to them 7, 15 and 21 days. Results: Were encontron presenting right aspect of the experimental group 100% of patients, the 97.4% showed a color pink coral, 2.6% was red. The 94.7% of those patients experimental presented consistency firm and resilient, in a 5.7% was of consistency soft; the 100% of the patients not showed bleeding. In general the 94.7% showed a good healing, 5.3% regular healing, and 0% has poor healing. Conclusion: It is concluded that the effects of the application of copaifera paupera are positive, in terms of its properties, healing, healing, anti-inflammatory and anti-bacterial to allowing the recovery of the alveolar mucosa of patients who come to the Juliaca Essalud polyclinic in the period of June - August 2015. (AU)

Analysis of the histology of the scar bladder and biochemical parameters of rats with a solitary kidney undergoing immunosuppression with tacrolimus

PURPOSE: To evaluate bladder histology in healing and biochemical analysis of rats with single kidney in ischemia/reperfusion, treated with tacrolimus. METHODS: Fifty rats randomized into five groups. Three rats died in surgery, 47 rats divided in groups: Control (non-operated, n=10), Sham (operated without drugs, n=8), T1 (operated + tacrolimus 1mg/kg, n=10), T2 (operated + tacrolimus 0.1 mg/kg, n=10), T3 (operated + tacrolimus 10mg/kg, n=9). The surgery was: laparotomy, right nephrectomy, left kidney ischemia/reperfusion, cystotomy followed by bladder suture. After that, rats were submited to gavage daily (Control and Sham with saline solution. T1, T2, T3 with tacrolimus in doses already mentioned). On the 14th day, after death induction, cystectomy was performed and bladder was histologicaly analysed. The serum urea, creatinine and tacrolimus were analysed too. RESULTS: There was difference in serum tacrolimus in T3 compared to the other groups (p<0.05). There was higher doses of creatinine in T3 group and higher urea in groups with tacrolimus. There were significant differences among all histologic variables comparing groups with and without tacrolimus (p<0.05). CONCLUSION: Tacrolimus associated with ischemia/reperfusion is nephrotoxic, suppresses inflammation and seems to delay the healing bladder. .

Diclofenac topical gel in excisional wounds maintain heal quality and reduce phlogistic signals1

PURPOSE: To investigate diclofenac topical gel as an alternative to reduce phlogistic signals and maintain quality of wound repair. METHODS: Fifteen Wistar rats were used in this study; four excisional wounds were performed on the dorsum of each animal. Once in a day, cranial wounds received topical diclofenac gel administration and caudal wounds were washed with isotonic saline. After seven, 14 and 21 postoperative days, five animals were randomly chosen for macroscopic and microscopic wound analysis. RESULTS: On the 7th day: diclofenac wounds showed significant higher scab formation, however showed less phlogistic signal; diclofenac wounds had larger area and had less neutrophil invasion. On the 14th day: No area difference was noted and diclofenac wounds showed less hyperemia and phlogistic signals; diclofenac wounds showed greater keratinocytes invasion. On the 21st day: Almost all wounds were closed and there were no difference regarding the type of scar formation; diclofenac wounds showed greater monocytes invasion and lower angiogenesis level. No difference was noted in any postoperative day regarding fibroblast invasion, collagen deposit quantity and quality. CONCLUSION: Diclofenac topical gel is capable of reducing phlogistic signals and do not cause fibroblast or keratinocyte downregulation thus do not lead to excisional wound healing impairment. .

Avaliaçäo da eficácia e tolerabilidade da ranitidina no tratamento da úlcera duodenal / Evaluation of the efficacy and tolerability of ranitidine in the treatment of duodenal ulcer

Foram avaliados num estudo aberto näo-comparativo 30 doentes portadores de úlcera duodenal confirmada através de exame endoscópico. Os pacientes foram tratados com rantidina por um perído de quatro semanas na posologia de 1 comprimido de 150 mg a cada 12 horas. Além da evoluçäo endoscópica, foi dada um ênfase à evoluçäo do sintoma dor abdominal através de uma ficha individual de auto-avaliaçäo. Foi obtido um índice de cicatrizaçäo da lesäo ulcerosa de 86,7% sendo que a dor abdominal melhorou já a partir do 2§ dia de tratamento, e no 4§ dia de tratamento somente oito doentes ainda apresentavam dor de intensidade moderada intensa