Tumor de Brenner fronterizo / Borderline Brenner Tumor

El tumor de Brenner es derivado de la superficie del ovario, que guarda similitud con epitelio transicional de la vejiga. Es un tumor raro debido a que representa 1,5 por ciento de las neoplasias de ovario. El objetivo del trabajo es presentar el caso de una paciente con tumor de Brenner fronterizo confirmado histopatológicamente y realizar una revisión de la literatura respecto al diagnóstico clínico e histopatológico de la entidad y compararla con otras entidades. Se presenta el caso de una mujer de 88 años, a quien se la practicó laparotomía por sospecha de un quiste complejo; se describe la historia clínica y su diagnóstico, y se realiza una revisión de la literatura con énfasis en el diagnóstico. Se realizó una búsqueda de literatura utilizando las bases de datos Medline, vía PubMed, OMIM y SciELO, con los términos tumor de Brenner y tumor de Brenner fronterizo en español e inglés sin límite por año de publicación. Se encontraron 10 artículos, que corresponden a reportes de casos y revisión de la literatura, los cuales describen las características en cuanto a presentación clínica, diagnóstico clínico basándose en estudios de histopatología, y aspectos genéticos de la entidad. El tumor de Brenner fronterizo es infrecuente en México debe tenerse en cuenta como diagnóstico diferencial de tumores de ovario(AU)

Brenner tumor derives from the ovary surface and is similar to the transitional epithelium of the bladder. It is a rare tumor representing just 1.5 percent of ovary neoplasies. The objective of this paper was to present a patient with histologically-confirmed borderline Brenner tumor and to make a literature review on the clinical and histopathological diagnosis of this disease and compare it with others. Here is a 88 years-old women who was performed laparatomy because of suspected complex cyst; her medical history and diagnosis was described and a literature review with emphasis on diagnosing process. A literature search was made by using Medline,OMIM y SciELO and terms Brenner tumor¨ and ¨bordeline Brenner tumor in Spanish and English regardless of year of publication. Ten articles were found about case reports and literature review; they describe the characteristics of clinical presentation, clinical diagnosis based on histopathological studies and general aspects of the disease. Borderline Brenner tumor is infrequent in Mexico and should be considered in the differential diagnosis of ovary tumors(AU)

Estrogen deficiency in ovariectomized rats: can resistance training re-establish angiogenesis in visceral adipose tissue?

OBJECTIVE: The purpose of this study was to investigate the effects of resistance training on angiogenesis markers of visceral adipose tissue in ovariectomized rats. METHOD: Adult Sprague-Dawley female rats were divided into four groups (n=6 per group): sham-sedentary, ovariectomized sedentary, sham-resistance training and ovariectomized resistance training. The rats were allowed to climb a 1.1-m vertical ladder with weights attached to their tails and the weights were progressively increased. Sessions were performed three times per week for 10 weeks. Visceral adipose tissue angiogenesis and morphology were analyzed by histology. VEGF-A mRNA and protein levels were analyzed by real-time PCR and ELISA, respectively. RESULTS: Ovariectomy resulted in higher body mass (p=0.0003), adipocyte hypertrophy (p=0.0003), decreased VEGF-A mRNA (p=0.0004) and protein levels (p=0.0009), and decreased micro-vascular density (p=0.0181) in the visceral adipose tissue of the rats. Resistance training for 10 weeks was not able to attenuate the reduced angiogenesis in the visceral adipose tissue of the ovariectomized rats. CONCLUSION: Our findings indicate that the resistance training program used in this study could not ameliorate low angiogenesis in the visceral adipose tissue of ovariectomized rats.

Video-assisted ovariohysterectomy in domestic cats (Felis catus, Linnaeus, 1758) using two access portals

PURPOSE : To describe video-assisted ovariohysterectomy (OHE) with two portals access in adult intact queens. METHODS Fifty-two females cats were used. A 4 mm cannula was positioned in the abdomen through an incision close to the umbilicus (first portal), and a pneumoperitoneum was established. A second portal was positioned in the midline of the pre-pubic region. Females were positioned in right lateral recumbency to locate the left ovarian pedicle, and the uterine horn was held by a transcutaneous suture. The pedicle was cauterized and incised. The procedure was then performed on the contralateral ovary. The ovaries were exteriorized from the abdomen, along with the uterus, through the second access point. The uterine body was exposed, fixed and sectioned, and the abdominal incisions were sutured. RESULTS Surgeries were performed in an average of 41.4±14.2 minutes. The main complications included hypotension (7.7%) and subcutaneous emphysema (7.7%), and 13.5% of the surgeries were converted to laparotomy. CONCLUSION Ovariohysterectomy using a video-assisted technique and two access portals is safe, has minimal risks and is effective for the spaying of queens.

Torsión de tumor ovárico en paciente premenopáusica / Torsion of ovarian tumor in premenopausal patient

La torsión de un tumor ovárico constituye una urgencia ginecológica infrecuente. Es causada por la rotación del órgano afectado sobre su pedículo, lo que restringe su vascularización. Una intervención oportuna evita sus complicaciones. No es frecuente su aparición en tumores de ovario mayores de 15 cm. Se trata de una paciente premenopáusica de 47 años de edad que acude a la sala de emergencia del Centro de Diagnóstico Integral María Eugenia González por presentar dolor en mesogastrio e hipogastrio de elevada intensidad acompañada de vómitos. En el examen físico se constató una marcada distención del abdomen por tumor palpable con límite superior a nivel umbilical. Los estudios de imagen mostraron torsión de tumor quístico de ovario de 32 X 22 cm. Se realizó tratamiento quirúrgico: ooforectomía derecha complementado con apendicectomía profiláctica por invaginación(AU)

Torsion of an ovarian tumor is a rare gynecological emergency. It is caused by rotation of the affected organ on its pedicle, which restricts vascularization. Timely surgery avoids complications. It is rare in over 15mm ovarian tumors. This is a 47 years-old premenopausal patient who went to the emergency service of Maria Eugenia Gonzales comprehensive diagnosis center because she presented with acute pain in the mesogastrium and hypogastrium and vomiting. The physical examination revealed sizeable distention of her abdomen due to palpable tumor with upper limit at umbilical level. Scanning tests showed torsion of 32 x 22cm cystic ovarian tumor. She was operated on by using right oophorectomy supplemented with prophylactic appendicectomy through invagination(AU)

Dilemma in the Management of Ovarian Cyst in Pregnancy: A Series of Three Different Cases.

The incidence of ovarian cyst in pregnancy is increased due to ovulation induction and dating ultrasound. Mostly they are benign and managed by observation. Surgery is indicated if there are complications or any suspicion of malignancy. Here, we have presented three different cases of ovarian cyst in pregnancy, which was managed by surgery. The first case is a 27-year-old second gravida with para1 live1 with complaints of pain in right iliac fossa at 15 weeks of gestation that was diagnosed as a dermoid cyst of right ovary. She underwent laparoscopic cystectomy. Rest of the antenatal period was uneventful, and she delivered vaginally at term. The second case is 31 year old third gravida with para2 live2 came with complaints of lower abdominal pain around 14 weeks of gestation which was diagnosed as fibroma of ovary for which laparotomy and right salphingo-oophorectomy was done. Rest of the antenatal period was normal, she delivered by caesarean section at term. The third case was 30-year-old second gravid with para1 live1 with left ovarian mass presented at term for which cesarean section along with left salphingo-oophorectomy done.

Surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy / Tratamento cirúrgico do câncer de endométrio em estágio clínico precoce sem linfadenectomia radical.

Objective: the main aim of this study was to describe the authors’ experience with the surgical treatment of endometrial cancer without systematic lymphadenectomy. Methods: a retrospective cohort study was carried out on a subset of patients suffering of clinically early-stage endometrial carcinoma who underwent hysterectomy and salpingo-oophorectomy without systematic (radical) lymph nodes dissection at our centers from June, 2002, to November, 2011. Descriptive statistics were explored as medians (interquartile range) or frequencies (percentages), as appropriated, and the Kaplan–Meier method was applied for survival estimation. Results: eighty-three patients who underwent surgical treatment with no lymph node dissection (n = 20; 24.1%) or with only a sampling procedure (n=63; 75.98%) were selected for analysis. Among these patients, 27 (32.53%) underwent surgery alone and 56 (67.46%) received some adjuvant treatment. Postoperative complications occurred in five patients (6.02%). Over a median follow-up of 27.4 months (Q25 = 13.7 – Q75 = 46.5), 15 (18.07%) patients suffered from relapses and 11 deaths occurred as result of disease recurrence. Cumulative 1, 2 and 3-year disease- free survivals were 97.32, 91.18 and 78.02%, respectively. Conclusion: on a case-by-case basis, the surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy did not seem to decrease survival outcomes and presented low rates of surgical morbidity in our experience, but was also related to a high rate use of adjuvant therapy. .

Objetivo: descrever a experiência dos autores com o tratamento cirúrgico do câncer de endométrio em estádio precoce sem linfadenectomia radical. Métodos: realizou-se estudo de coorte retrospectivo envolvendo um subgrupo de pacientes com câncer de endométrio em estágio clínico precoce tratadas com histerectomia e salpingo-ooforectomia sem linfadenectomia radical, em dois centros pernambucanos, de junho de 2002 a novembro de 2011. As variáveis foram descritas como mediana (intervalo interquartílico) ou frequências (percentuais), utilizando- se o método de Kaplan-Meier para a estimativa das taxas de sobrevivência. Resultados: oitenta e três pacientes submetidas a tratamento cirúrgico sem dissecção linfonodal (n = 20, 24,1%) ou com dissecção apenas por amostragem (n = 63; 75,98%) foram selecionadas para análise. Entre essas pacientes, 27 (32,53%) foram tratadas somente com cirurgia e 56 (67,46%) receberam tratamento adjuvante. Cinco pacientes apresentaram complicações pós-operatórias (6,02%). Durante o acompanhamento mediano de 27,4 meses (Q25 = 13,7 - Q75 = 46,5), 15 (18,07%) pacientes apresentaram recorrência, dentre as quais 11 faleceram em decorrência da recidiva neoplásica. Observou-se sobrevivência cumulativa proporcional livre de doença em um, dois e três anos de 97,32, 91,18 e 78,02%, respectivamente. Conclusão: em um contexto de indicação caso-a-caso, o tratamento cirúrgico do câncer de endométrio em estádio precoce sem linfadenectomia radical parece não ter prejudicado a sobrevivência e apresentou baixas taxas de morbidade cirúrgica em nossa experiência, mas também foi acompanhado de elevada utilização de terapia adjuvante. .

Histological study of rat ovaries cryopreserved by vitrification or slow freezing and reimplanted in the early or late postmenopausal stage

PURPOSE: To compare two rat ovary cryopreservation techniques (vitrification vs. slow freezing) and two postmenopausal stages (early vs. late) with regard to graft take. METHODS: Thirty-three Wistar rats were submitted to bilateral oophorectomy. One ovary was submitted to histological analysis while the other was cryopreserved by slow freezing or vitrification. The cryopreserved ovary was thawed and reimplanted in the greater omentum one week (early menopause) or one month (late menopause) after oophorectomy. One month after ovary reimplantation, the graft take was evaluated macroscopically and histologically. RESULTS: Six of the animals were used ascontrols and seven died. The histological findings of 20 animals included atretic follicles (n=4), primordial follicles (n=2), and corpus luteum with primordial follicles (n=3). No ovarian tissue was found in 11 animals. Vitrification resulted in a higher graft take rate than slow freezing (50% vs. 38.5%), but the difference was not statistically significant. However, the graft take rate was 9.3 times higher in the early than in the late postmenopausal stage (61.5% vs. 14.3%) (p=0.043). CONCLUSION: Vitrification was superior to slow freezing as ovarian cryopreservation technique, and grafting was significantly more successful when the ovary was reimplanted in the late postmenopausal stage. .

Effect of cyclic versus continous hormonal replacement therapy on the structure of dentate gyrus of ovarictomized adult albino rats: a histological and immunohistochemical study

Hormonal replacement has been implicated as a possible therapeutic agent for ameliorating age-related cognitive decline in postmenopausal women. Estrogen in particular enhanced learning and memory in many women by improving the function of hippocampus after menopause. However, there is lack of studies concerning the most effective way of replacement therapy. The aim of the study was to investigate the effect of hormonal replacement on the structure of dentate gyrus and to assess the most effective therapy regimen. Thirty six adult female albino rats were used in the study and were divided into four groups: the control group, the ovariectomized group, the ovariectomy and continuous estrogen+progesterone group, and the ovariectomy and cyclic estrogen+progesterone group. All rats were sacrificed after 5 months from the beginning of therapy. Coronal brain specimens were obtained, processed into paraffin blocks, and subjected to histological, immunohistochemical, histomorphometric, and statistical studies. Ovariectomy resulted in neurodegenerative changes in the dentate gyrus. These changes were partially reversed by continuous hormonal therapy; however, cyclic method of therapy was more effective. Cyclic hormonal therapy was proven to be more effective than continuous method after ovariectomy. Hence, it is recommended to use the cyclic method of hormonal therapy for after menopause

Influência do ranelato de estrôncio na reparação de defeitos ósseos em fêmures e nos componentes moleculares do osso em ratas ovariectomizadas / Influence of strontium ranelate on the repair of bone defects in femurs and molecular components of bone in ovariectomized rats

O ranelato de estrôncio (RS) diminui a reabsorção óssea e ao mesmo tempo age como um agente anabólico deste tecido. Este estudo foi realizado para avaliar os efeitos da ovariectomia e do tratamento com RS na reparação de defeitos ósseos em fêmures e nos componentes moleculares do osso em ratas. Vinte e sete ratas adultas foram submetidas a ovariectomia ou cirurgia Sham e, após trinta dias, defeitos ósseos em fêmures foram confeccionados e os animais divididos em três grupos: ovariectomizadas (OVZ), cirurgia Sham (SHAM) e ovariectomizadas + tratamento com 625 mg/kg/dia de RS (RS). A eutanásia foi realizada quatro semanas após a cirurgia do defeito ósseo. A reparação do defeito ósseo foi analisada por microtomografia computadorizada (?CT) e a composição química do tecido ósseo foi verificada por espectroscopia de infravermelho com transformada de Fourier (FTIR) e espectroscopia de energia dispersiva de raios-X (EDS). O grupo SHAM apresentou em média volume ósseo (BV) superior ao grupo OVZ (p=0,014) e o volume ósseo relativo (BV/TV) foi cerca de 8% superior ao grupo OVZ. A comparação entre SHAM e RS apresentou valores limítrofes para essas variáveis. A espessura trabecular (Tb.Th) no grupo RS foi significativamente maior que no grupo OVZ cerca de 1,8% (p = 0,049) e não diferiu em média do grupo SHAM. Não houve diferenças significativas nas relações que avaliam compostos inorgânicos sobre orgânicos nos grupos...

Strontium ranelate (SR) decreases bone resorption and at the same time acts as an anabolic agent in this tissue. This study was conducted to evaluate the effects of ovariectomy and treatment with SR on the repair of bone defects and molecular components of bones in femurs. Adult female rats (n=27) were subjected to ovariectomy or Sham surgery. Thirty days after surgery, a defect was made in the femur and the animals were divided into three groups: ovariectomy (OVZ), Sham surgery (SHAM) and ovariectomy plus treatment with SR, 625 mg / kg / day (SR). Euthanasia was performed four weeks after surgery to cause the bone defect. Repair in bone defect was assessed by computed microtomography (?CT) and the chemical composition of bone tissue was analyzed by Fourier transform infrared (FTIR) spectroscopy and energy dispersive X-ray spectroscopy (EDS). The SHAM group showed mean values for bone volume (BV) higher than those of the OVZ group (p = 0.014) and the relative bone volume (BV / TV) was about 8% higher than that of the OVZ group. Comparison between SHAM and SR showed borderline values for these variables. In the SR group, the average value for trabecular thickness (Tb.Th) was significantly higher (~1.8%) than that in the OVZ (p = 0.049) group and did not differ from that of the SHAM group. Significant difference was not observed in the relation between inorganic and organic compounds in the three groups. The ratio of the areas of the bands in 1057 and 1023 cm-1 for the calculation of IC was 1,024 in the SHAM group, 1,015 in the RS group and 1,108 in OVZ group. In the study of the amide III band, a change in the proportion of secondary structure of matrix proteins was observed in ovariectomized animals, possibly a decrease in of ?-helical and random coil (RC) and an increase in ?-sheet structures...

Extradural anesthesia with lidocaine combined with fentanyl or methadone to ovariohisterectomy in dogs

PURPOSE: To compare the cardiopulmonary effects and the quality of anesthesia of the extradural lidocaine in combination with fentanyl or morphine in bitches undergoing ovariohysterectomy. METHODS: Sixteen female dogs, were sedated with intramuscular acepromazine (0.05mg kg-1), followed by anesthetic induction with intravenous propofol (4mg kg-1), to perform the lumbosacral puncture. The animals were randomly assigned to two treatments: T-F (n=8) extradural administration of fentanyl (5µg kg-1), T-M (n=8) extradural administration of methadone (0.3mg kg-1). In both treatment groups, opioids were combined with lidocaine, in order to make up a final volume of 0.4mL kg-1. Heart rate (HR), respiratory rate (RR), systolic arterial blood pressure (SABP), intra-operative anesthetic supplementation, blood gases and adverse effects were investigated. RESULTS: HR, arterial pH and blood gases did not differ between treatments at any time point. RR and SABP decreased after epidural anesthesia, but the values were in terms of the physiological range of dogs. Intra-operative anesthetic supplementation was required in 50% and 62.5% of the fentanyl and methadone treated dogs, respectively. CONCLUSION: The extradural lidocaine in combination with fentanyl or morphine allowed cardiopulmonary stability, however sufficient sensitive blockade was not provided in 100% of the dogs.

Effects of exercises on the right ventricle of female micesubmitted to ovarian hormone deprivation

Introduction: Several studies indicate that the estrogen deficiency increase the incidence of the cardiovascular diseases in women in post-menopausal period and that the exercise program may prevent or relieve problems such as cardiovascular disease, obesity, muscle weakness, osteoporosis and depression. The effects of the estrogen deprivation in the myocardium still remain unclear, mainly in the right ventricle. The aim was to investigate the effects of exercises on the right myocardium in the female mice subjected to deprivation of ovarian hormones. Material and methods: A total of 15 female mice at 9 months of age, divided into 3 groups (n = 5) were studied: non-ovariectomized sedentary (S); ovariectomized sedentary (OS), ovariectomized trained (OT) animals. Ovariectomy was performed at 9 months of age and physical training began 7 days after surgery. The animals underwent a physical training protocol for 4 weeks on a treadmill with progressive speed and load (one hour a day/5 days a week at 50 to 65% of the maximum speed of running). After the experimental proceeding, the heart were removed and processed accordingly to conventional protocol for optical microscopy, and the slides stained by the methods of Hematoxylin and Eosin Stereology was used to analyze the components of the myocardium. Results: Ours results indicate that the exercise training promoted cardiomyocyte hypertrophy, increase in connective tissue with decreased cardiomyocytes. Conclusion: Our data suggest that moderate exercise promoted right ventricular remodeling with cardiomyocyte hypertrophy and increase in connective tissue, to fit the modifications promoted by exercise in the left ventricle.

Novos conceitos e revisão atualizada sobre sarcomas uterinos / New concepts and update review of uterine sarcomas

Realizou-se uma revisão sistemática das publicações dos últimos dez anos sobre os sarcomas uterinos. Este artigo traz novos conceitos, como a mudança do carcinossarcoma para carcinoma metaplásico. Evidencia-se a necessidade de individualizar o tratamento dos sarcomas, pois existem muitas diferenças de comportamento clínico, padrão metastático e prognóstico entre os diferentes tipos histológicos. Também foram enfocadas as controvérsias existentes quanto a extensão cirúrgica, a necessidade de ooforectomia e de esvaziamento ganglionar e o papel da adjuvância

It was performed a systematic review of publications for the past 10 years about uterine sarcomas. This article introduces new concepts, such as the change of carcinosarcoma to metaplastic carcinoma. This study highlights the need to individualize the treatment of uterine sarcomas, as there are many differences in clinical behavior, prognosis and metastatic pattern between the different histological types. Controversies have also been focused on the surgical extension, the need for lymph node dissection and oophorectomy and the role of adjuvant therapy

Descrição de um novo método de ooforectomia em ratas / Description of a new method of ovariectomy in female rats

Atualmente, os ratos são os animais de laboratório mais usados para investigar a osteoporose. Apresentamos um método eficiente de ooforectomia e o comparamos com dois outros comumente utilizados para indução experimental de osteoporose (incisão cutânea dorsal na linha média e abordagem dorsolateral dupla). Ratas Wistar de 12 semanas de idade foram divididas em três grupos. No grupo A, a ooforectomia foi precedida por uma única incisão cutânea dorsal na linha média de 3 cm de comprimento; no grupo B, por incisões dorsolaterais duplas de aproximadamente 1 cm de comprimento cada; e no grupo C, por uma única incisão ventral transversal de 0,4-0,6 cm na região abdominal média. Os pesos corporais médios dos animais nos grupos A, B e C foram 258,12 ± 0,54 g, 255,78 ± 0,42 g e 254,55 ± 1,69 g, respectivamente. Houve diferenças significativas quanto à duração (em minutos) da cirurgia nos grupos B (9,65 ± 0,86) e C (7,55 ± 0,11;P < 0,001) em comparação à do grupo A (15,52 ± 0,30), e no grupo B (P < 0,01) em comparação à do grupo C. Os tempos de cicatrização da ferida (em dias) nos grupos B (9,22 ± 0,67) e C (8,01 ± 0,93) foram significativamente menores que aquele no grupo A (11,58 ± 1,2;P < 0,001), sendo tal tempo no grupo C discretamente menor que no grupo B. A cirurgia, como conduzida no grupo C, foi tecnicamente mais fácil, consumiu menos tempo e apresentou cicatrização mais rápida de ferida.

Rats are currently the most used laboratory animals to investigate osteoporosis. We report an efficient method of ovariectomy and compared this method with the two other operative methods of ovariectomy (i.e., midline dorsal skin incision and double dorsolateral approach, which are used commonly for inducing experimental osteoporosis. Female Wistar rats, 12 weeks old, were divided into three groups. Ovariectomy was preceded by a single midline dorsal skin incision, 3 cm long, in the group A; double dorsolateral incisions, approximately 1 cm long, in the group B; and a single ventral transverse incision of 0.4-0.6 cm at the middle abdominal region in the group C. Animals in groups A, B, and C had a mean weight of 258.12 ± 0.54 g, 255.78 ± 0.42 g, and 254.55 ± 1.69 g, respectively. There were significant differences in the duration (in minutes) of surgery in the groups B (9.65 ± 0.86) and C (7.55 ± 0.11, P < 0.001) when compared to the group A (15.52 ± 0.30) and in the group B (P < 0.01) when compared to the group C. Wound healing time (in days) for groups B (9.22 ± 0.67) and C (8.01 ± 0.93) was significantly shorter than that for group A (11.58 ± 1.2, P < 0.001), with the wound healing time for group C being slightly shorter than that for group B. The surgery, as conducted in the group C, was technically easier, less time consuming and showed less wound healing duration.

A comparison of extradural tramadol and extradural morphine for postoperative analgesia in female dogs undergoing ovariohysterectomy / Tramadol peridural comparativamente à morfina para analgesia pós-operatória em cadelas submetidas à ovariosalpingohisterectomia

PURPOSE: To compare the postoperative analgesic effects of the extradural tramadol or morphine in female dogs undergoing ovariohysterectomy. METHODS: Sixteen female dogs were randomly assigned to two groups of eight animals each and received morphine (0.1mg kg-1 M group) or tramadol (2mg kg-1 T group). The pre-anesthetic medication was intravenously (iv) acepromazine (0.05mg kg-1). Anesthesia was induced with propofol (4mg kg-1iv) and maintained with isoflurane. The degree of analgesia was evaluated using a numerical rating scale that included physiologic and behavior variables. Dogs were scored at one, three, six and 12 hours after surgery by one blinded observer. Dogs were treated with morphine (0.5mg kg-1) if their scores were >6. Serum cortisol was measured before the pre-anesthetic medication was administered (basal), at the time of the ovarian pedicle clamping (T0), and at 1 (T1), 6 (T6) and 12 (T12) hours postoperative. RESULTS: The pain score did not differ between morphine and tramadol treatments. Rescue analgesia was administered to one dog in the T treatment group. Serum cortisol did not differ between treatments. CONCLUSION: The extradural administration of morphine or tramadol is a safe and effective method of inducing analgesia in female dogs undergoing ovariohyterectomy.

OBJETIVO: Comparar o efeito analgésico pós-operatório do tramadol em relação à morfina quando utilizados por via peridural em cadelas submetidas à ovariosalpingohisterectomia (OSH). MÉTODOS: Dezesseis cadelas foram aleatoriamente distribuídas em dois tratamentos, com oito animais em cada, tratadas com morfina (0,1mg kg-1, M) e tramadol (2mg kg-1, T). A medicação pré-anestésica foi feita por via intravenosa (iv) com acepromazina (0,05mg kg-1), seguindo-se indução e manutenção anestésicas com propofol (4mg kg-1 iv) e isofluorano, respectivamente. O grau de analgesia foi avaliado uma, três, seis e 12 horas após o término da cirurgia, com escala descritiva numérica, que incluiu a observação de alterações fisiológicas e comportamentais. Animais com escore > 06 foram tratados com morfina (0,5mg kg-1). A concentração sérica de cortisol foi mensurada antes da sedação (basal), ao término da cirurgia (T0), 1 (T1), 6 (T6) e 12 (T12) horas após a cirurgia. RESULTADOS: Os escores de dor e a concentração sérica de cortisol não diferiram entre os tratamentos. Analgesia de resgate foi necessária em um cão do tratamento T. CONCLUSÃO: A administração peridural de morfina e de tramadol resulta em analgesia adequada e de longa duração em cadelas submetidas à ovariosalpingohisterectomia.

Funcionamiento sexual después de la histerectomía / Sexual function after a hysterectomy

Objetivo: describir el funcionamiento sexual después de la histerectomía. Método: a 147 pacientes a quienes se les practicó histerectomía, se les entrevistó para evaluar el funcionamiento sexual por medio de la Escala de Experiencia Sexual de Arizona (EESA). Esta consta de 5 ítems que evalúan diferentes aspectos de la respuesta sexual humana. Cada ítem fue calificado desde 1 (no disfunción) hasta 6 (disfunción en grado extremo), a mayor puntuación , mayor disfunción sexual...

¿Debemos seguir haciendo salpingoooforectomía como profilaxis de cáncer de ovario? / Should we continue prophylactic salpingo-oophorectomy for ovarian cancer?

Hasta hace algunos años en las mujeres sometidas a histerectomía por patología benigna, que tuvieran 45 o más años, se efectuaba de regla una salpingoooforectomía (SOB) bilateral, como prevención de cáncer de ovario. Esto está actualmente en discusión. Hay dos grandes estudios de cohortes poblacionales y un estudio prospectivo observacional que analizan los efectos adversos cardiovasculares y el cáncer de ovario en mujeres sometidas a SOB. Basados en estos análisis y otros datos de la literatura, se pueden plantear algunas conclusiones. En mujeres premenopáusicas y hasta los 50 años la conducta óptima es preservar los ovarios, entre 51 y 65 años no está claro que lo mejor sea extirparlos y en mayores de 65 aún no se ha probado efectos deletéreos a raíz de la intervención.

The age to perform prophylactic oophorectomy at the time of hysterectomy for benign conditions is being actually discussed. Two population based cohorts studies and one prospective observational study evaluate cardiovascular disease and ovarian cancer with a history of oophorectomy. Some conclusions can be drawn. Until 50 years or premenopausal women, ovarian conservation should be the norm, between 51 and 65 there are no clear indications for removal and in older than 65 no negative effects have been described.

Cirugía endoscópica por monopuerto: reporte de nuestra experiencia en los primeros 175 casos por sils port en Venezuela / Endoscopic surgery by singleport: report of our experience in the first 175 cases by sils port in Venezuela

El último paso hacia el menor grado de invasión después del surgimiento de la cirugía laparoscópica ocurre cuando los cirujanos del mundo se inician en técnicas emergentes, que entre otras, utilizan el ombligo como único puerto de entrada al abdomen quedando camufladas en la cicatriz umbilical, Presentamos la experiencia inicial de nuestro grupo, entre julio de 2009 hasta enero 2011 en variados procedimientos laparoscópicos por monopuerto con el uso del dispositivo SILS® port. Fueron intervenidos 175 pacientes, 163 adultos (93%), 12 niños (7%), todos abordados por un sólo puerto y a través del SILS® port. Se realizaron 102 colecistectomías (58%), 37 apendicectomías (21%), 8 histerectomías (4,6%), 7 ooforectomías (4%), 7 biopsias hepáticas (4%), 6 liberación de bridas y adherencias (3,4%), 4 salpingoclasias (2,3%), 2 esplenectomías (1%), 1 miotomía de Heller con funduplicatura de Dor (0,6%) 1 hiatoplasia esofágica (0.6%). Los procedimientos complejos se efectuaron después de realizados los primeros 50 casos. Todos los procedimientos en niños se completaron por incisión única de manera satisfactoria. En los adultos, 6 requirieron un puerto un adicional, en un paciente fue necesario dos puertos con posterior conversión a laparotomía (hiatoplastia esofágica). Los tiempos promedios resultaron para colecistectomías 42 min (12-72 min), apendicectomía 37,5 min (13-62 min), histerectomías 95 min (65-125 min), ooforectomías 32,5 min (15-50 min), salpingoclasia 18,5 min (12-25 min), miotomía de Heller 182 min, hiatoplastia esofágica 155 min. La cirugía laparoscópica por incisión única es una técnica emergente en franco desarrollo, en niños ha demostrado ser un procedimiento seguro y eficaz, al igual que en adultos. El desarrollo y perfeccionamiento del instrumento hará ampliar el horizonte y abarcar cirugía más complejas y considerarse como alternativa a la cirugía laparoscópica tradicional otorgando el beneficio de menos dolor y mejores resultados estéticos...

We present the initial experience of our work group, between July 2009 and January 2011 in several laparoscopic procedures by monoport with device SILS port. Patients and method: 175 patients underwent surgery, 163 adults (93%), 12 children (7%), all boarded through a single port with SILS port device, 102 cholecystectomies were made (58%), 37 appendectomies (21%) 8 hysterectomies (4.6%), 7 oophorectomies (4%). 7 hepatic biopsies (4%), 6 liberation of bridles and adhesions (3,4%), 4 segmental resection of fallopian tube (2.3%), 2 splenectomies (1%), 1 Heller miotomy with Dor funduplication (0.6%) and 1 hiatal repair (0.6%). The complex procedures were carried out alter made the first 50 cases. All the procedures in children were completed through unique incision. In the adults. 6 required an additional port; in a patient was necessary two port with later conversion to laparotomy (hiatal hernia repair). The operative times averages were for cholecystectomies 42 min (12-72 min), Appendectomies 37,5 min. (13-62 min). Hysterectomies 95 min (65-125 min), Oophorectomies 32.5 min (15-50 min), segmental resection of fallopian tube 18.5 min (12-25 min), Heller miotomy 182 min. Hiatal hernia repair 155 min. The laparoscopic surgery through unique incision is an emergent technique in frank development, in children has demonstrated to be a safe and effective procedure, like in adults. The development and improvement of instruments will make extend the horizon and include more complex surgeries and consider themselves like alternative to the traditional laparoscopic surgery, granting the benefit of less pain and better aesthetic results. The development of skills and abilities to move in a NEW ATMOSPHERE represent a main concern.

large unilocular mucinous cystadenoma in third trimester of pregnancy

Ovarian malignancy is the second most common gynaecological malignancy diagnosed during pregnancy. A grand multipara, aged 30 years presented with gestational amenorrhea with abdominal discomfort and breathlessness for last 15 days. Sonographic examination demonstrated a huge, unilocular ovarian cyst and an alive fetus of about 30 weeks gestation. Intraoperative findings were huge left ovarian cyst [42x40x20 cm] with straw coloured mucinous fluid. Left salpingo-oophorectomy was performed followed by peritoneal washings and omental biopsy. Histopathology revealed mucinous cystadenomas with inflammatory changes in omentum and no malignant cells in peritoneal washings. She delivered vaginally a female baby of 3.5 kg at 38 weeks with good Apgar score

Hemodynamics and bispectral index (BIS) of dogs anesthetized with midazolam and ketamine associated with medetomidine or dexmedetomidine and submitted to ovariohysterectomy / Avaliação hemodinâmica e do índice bispectral (BIS) de cadelas anestesiadas com midazolam e cetamina associados à medetomidina ou dexmedetomidina e submetidas a ovário-salpingo-histerectomia

Purpose: To evaluate hemodynamics and bispectral index (BIS) in bitches anesthetized with ketamine and midazolam in combination with dexmedetomidine or medetomidine and submitted to ovariohysterectomy. Methods: Twenty bitches pretreated with levomedetomidine and buprenorphine were anesthetized with 5 mg.kg-1 ketamine and 0.2 mg.kg-1 midazolam i.v. Continuous infusion of 0.4 mg.kg-1.h-1 midazolam and 20 mg.kg-1.h-1 ketamine was initiated in combination with DEX (n=10): 20 µg.kg-1.h-1 dexmedetomidine or MED (n=10): 30 µg.kg-1.h-1 medetomidine over 30 minutes. A pharmacokinetic study provided dexmedetomidine plasma concentration, set to be 3.0 ng.mL-1. Results: BIS decreased in both groups (P<0.05), but it was lower in DEX (P<0.05) as compared to MED. No differences were found in hemodynamic parameters (heart rate, systolic, diastolic and mean arterial pressure) between groups (P>0.05), but heart rate decreased in both groups, as compared to control values (P<0.05). Respiratory rate decreased (P<0.05) and expired end tidal CO2 increased progressively (P<0.05) and similarly in both groups. Anesthetic recovery period was similar between groups (P<0.05) with no adverse effects. Conclusion: Continuous administration of dexmedetomidine with calculated plasma concentration equal to 3 ng.mL-1 in combination with midazolam and ketamine provides suitable anesthesia for spay surgery in bitches, hemodynamic stability and calm awakening with no adverse effects.

Objetivo: Verificar o comportamento hemodinâmico e o índice bispectral de cadelas anestesiadas com cetamina e midazolam associados à dexmedetomidina ou medetomidina. Métodos: Vinte cadelas receberam pré-tratamento com levomepromazina e buprenorfina e foram anestesiadas com cetamina, 5 mg.kg-1 i.v., e midazolam, 0,2 mg.kg-1 i.v., seguidos da administração contínua de midazolam, 0,4 mg.kg-1.h-1, e cetamina, 20 mg.kg-1.h-1, associados, conforme o grupo, à: DEX (n=10): dexmedetomidina 20 µg.kg-1.h-1 ou MED (n=10): medetomidina 30 µg.kg-1.h-1, mantidos por 30 minutos. A dose de dexmedetomidina foi obtida por meio de estudo farmacocinético planejando-se concentração plasmática de 3,0 ng.mL-1. Resultados: Os valores do BIS diminuíram em ambos os grupos (P<0,05), mas foram menores no grupo DEX (P<0,05), em comparação com o grupo MED. Não houve diferença significativa nos atributos hemodinâmicos (frequência cardíaca, pressão arterial sistólica, diastólica e média) entre os grupos, mas a frequência cardíaca diminuiu em ambos os grupos em relação ao momento controle (P<0,05). A frequência respiratória diminuiu (P<0,05) e o CO2 expirado aumentou progressivamente em ambos os grupos (P<0,05). O tempo de recuperação anestésica foi semelhante entre os grupos (P>0,05), sem a presença de efeitos adversos. Conclusão: A administração contínua de dexmedetomidina em concentração plasmática calculada de 3 ng.mL-1, em combinação com midazolam e cetamina, resulta em plano anestésico adequado para castração de cadelas, estabilidade hemodinâmica e despertar tranquilo, sem efeitos adversos.

Teratoma grande de ovario derecho y el contralateral con cambios similares en adolescente: reporte de un caso / Large teratoma of right ovary and similar changes in contralateral ovary in adolescent: case report

El objetivo de este trabajo es describir el caso de una adolescente de 17 años de edad con diagnóstico de teratoma grande de ovario derecho (42x35x19 cm y peso de 3,450 g) y el contralateral con cambios patológicos similares. Se practicó ooforosalpingectomía derecha y cuña de ovario izquierdo verificándose cambios patológicos similares. El seguimiento por dos años fue satisfactorio. Es importante sospechar esta forma de presentación de tumores de ovario, principalmente en la adolescencia, ya que el diagnóstico suele ser difícil por lo poco frecuente y porque el examen físico y los estudios complementarios no son concluyentes

The aim of this paper is to describe the case of a 17 years of age diagnosed with a big ovarian teratoma right (42x35x19 cm and weight of 3,450 g) and contralateral with similar pathological changes. We practiced right oophorosalpingectomy and left ovarian wedge verified similar pathological changes. The two-year follow-up was satisfactory. It is important to suspect this form of presentation of ovarian tumors, especially in adolescence, as the diagnosis is often difficult so rare and because physical examination and complementary studies are inconclusive