Epidemiología, resultados clínicos y costos del tratamiento del absceso tuboovárico, en un hospital público de Santiago / Epidemiology, clinical results and costs of treatment of the tuvoovarian abscess, in a public hospital in Santiago

Objetivos: Conocer frecuencia y factores de riesgo del absceso tuboovárico (ATO), complicaciones y costos del tratamiento. Método: Estudio retrospectivo de 64 pacientes operadas con el diagnóstico de ATO. Las pacientes se manejaron con criterio médico-quirúrgico: uso de antibióticos y cirugía en casos de peritonitis difusa, fiebre persistente con masa palpable y masa anexial mayor de 6 cm sin fiebre. Se evaluaron en fertilidad futura y en complicaciones: infección y dehiscencia de herida operatoria, reoperación por ATO residual, lesión intestinal, lesión vesical y complicaciones médicas. Resultados: El ATO representó el 73,6 por ciento de los casos hospitalizados por enfermedad inflamatoria pélvica, con frecuencia de 1,5 casos por mes y 17,2 por ciento de actinomicosis. La edad media de las pacientes fue 40,5 años. El dispositivo intrauterino (DIU) se asoció con ATO en 84,4 por ciento de los casos, 94,4 por ciento sin control y con media de uso de 10,2 años. El ATO unilateral fue el más frecuente (57,8 por ciento) y la anexectomía unilateral la operación más común. El 17,2 por ciento de las pacientes presentaron complicaciones y el 85,9 por ciento quedaron con infertilidad. El costo total de los 64 casos fue $86.331.713 (UF 3.788), con una media de $1.348.933 (UF 59,2). Conclusión: Existe un aumento de la frecuencia del ATO y de la actinomicosis pélvica, con incremento consiguiente de la infertilidad y de los costos, asociados al uso de DIU, sin control y por tiempo prolongado.

Objective: To determine frequency and risk factors of tuboovarian abscess (TOA) and observe complications, fertility damages and surgical costs of medical-surgical treatment. Method: Retrospective study in 64 patients operated with TOA diagnosis. Patients were managed with medical-surgical treatment: use of antibiotics and then surgery in cases of peritonitis diffuse, persistent fever with palpable mass and adnexial mass greater than 6 cm without fever. They were evaluated in future fertility and complications: infection and of surgical wound dehiscence, reoperation by residual TOA, intestinal injury, bladder injury and medical complications. Results: The TOA accounted for 73.6 percent of hospitalized cases of pelvic inflammatory disease (PID), 1.5 cases per month and 17.2 percent of actinomycosis. The mean age of patients was 40.5 years. The intrauterine device (IUD) was associated with TOA in 84.4 percent of cases, 94.4 percent uncontrolled and with a 10.2 years mean use. The unilateral TOA was the most frequent (57.8 percent) and the unilateral anexectomy the most common operation. The 17.2 percent of patients presented complications and 85.9 percent remained infertile. These results showed an increase compared with those obtained in the series published in 1993. The total cost of the 64 cases was $86.331.713 (UF 3.788), with a mean of $1.348.933 (UF 59.2). Conclusion: There is an increased frequency of the TOA and of pelvic actinomycosis, with consequent increase of infertility and costs associated with the uncontrolled and long-term use of IUD.

Treatment of ovarian inactivity in post partum buffalo-cows with special reference to its economic evaluation [with 5 tables]

The objective of this study was to evaluate the effects of different trials for treatment of post partum [p.p.] ovarian inactivity in buffaloes and their economic values. 75 buffalo-cows not observed in estrus 3 months followed parturition, were used in this study. Clinical examinations and progesterone assay revealed ovarian inactivity. The animals were randomly allocated to 5 treatment groups. Group I [GI] was kept as control [injected by 5 ml saline]. Group II [GII] was injected by 0.02 mg buserelin [5 ml Receptal, GnRH analogue]. Group III [GIII] was injected by 40mg progesterone for successive 8 days and 0.02 mg buserelin at 8[th] day. Group IV [GIV] was injected by 40mg progesterone for successive 8 days and 2mg and 1mg estradiol benzoate at 1[st] and 8[th] day respectively. Group V [GV] was injected by 10 ml tonophosphane daily for 2 days and received 200 gm disodium phosphate and 250 gm mineral mixture divided into 5 days with bran mash. All buffalo-cows were observed for estrus detection three times daily [at dawn, afternoon and evening]. Animals came in estrus were naturally mated using fertile buffalo-bulls and their plasma were tested for progesterone level 8 days after mating. While animals did not came in estrus were weekly examined. Pregnancy diagnosis was done using rectal palpation 42 days after mating. The results indicated that, buffalo-cows came in estrus were 40%, 73.3%, 80%, 60% and 53.3% in GI, GII, GIII, GIV and GV respectively. GIII showed the shortest treatment-estrus interval [TEI], treatment conception interval [TCI] and days open [DO] [8.1 +/- 1.7, 20.9 +/- 4.7 and 116.4 +/- 6.1 days, respectively], followed by GIV [18.3 +/- 5.7, 31.9 +/- 5.7 and 127.7 +/- 6.1 days, respectively]. While, the longest TEI, TCI and DO [52.6 +/- 4.6, 66.5 +/- 6.2 and 161.6 +/- 6.9 days, respectively] was obtained in GI. The lowest service per conception [S/C] [1.60 +/- 0.2] was obtained in GIII while, the highest was obtained in GV [1.86 +/- 0.3]. The highest 1[st] service conception rate was obtained in GIII [60%] while, it was equal in other groups [46.7%]. Plasma progesterone assay revealed highly significant increase in progesterone levels at day 8 post service [> 1ng /ml] indicating functioning corpora lutea. The obtained net profit, profit/cost ratio, net profit/return and net profit/cost in GIII were the highest followed by that of GIV. Hormonal treatment of buffalo-cows proved useful in reducing the calving interval and to increase fertility