Introduction of the method of intravaginal culture (IVC), through the device INVOCell routine laboratory RHA in Brazil.

INTRODUCTION: The conventional in vitro fertilization and the intracytoplasmic sperm microinjection are currently the established techniques for the treatment of infertility. In the last decade, however, the process of in vitro fertilization has suffered several changes in ovulation induction and oocyte retrieval (Ranoux 1990, ; ).The INVO procedure has been used to treat patients with different causes of infertility in many countries. This is a procedure which was developed over 20 years ago and is simpler and less costly to the infertility treatment when compared to conventional techniques. Interesting finding of this intravaginal culture technique are the physiological benefits and the reduction of the number of handling steps, reducing the risk of contamination. OBJECTIVE: This study aimed to evaluate the possibility of including the method INVO through the use of the deviceINVOCell™ in routine laboratory treatments of couple infertility. That, in turn, tends to provide the simplification of laboratory work and thereby reduce the costs of infertility treatment. MATERIAL AND METHODS: 40 women were included in this study, who were treated at the Service of Human Reproduction School Hospital Álvaro Alvim, in the period from August 2011 to January 2012. On all of them it was used the protocol of modified mild ovarian stimulation. The number of pre-embryos transferred into the uterine cavity followed the CFM Resolution nº. 1.957/10. RESULTS AND CONCLUSION: There was no significant difference in the results presented by the device INVOCell™. Therefore showing that it can be included in routine laboratory assisted human reproduction.

Comparison of results of cycles treated with modified mild protocol and short protocol for ovarian stimulation.

The ovarian stimulation has been applied in order to increase the number of oocytes to compensate for the poor results of in vitro fertilization, allowing the selection of one or more embryos to be transferred. Our aim is to compare the results obtained in IVF/ICSI cycles using the short protocol for controlled ovarian stimulation to the results from the modified mild protocol used in our department. A total of 240 cycles were conducted from January 2010 to December 2011. When comparing both protocols, it could be observed that there was a significant difference in the quantity of gonadotropins doses in the mild protocol and in the short protocol. No significant difference was observed regarding pregnancy rates per cycle, 22% and 26.2%, in short and mild protocols, respectively. The protocols of controlled ovarian stimulation are often associated with high risk of complications such as ovarian hyperstimulation syndrome, excessive emotional stress, high rates of treatment dropouts, and abdominal discomfort. With the data obtained in this study, one can conclude that there are less risks and complications for the patient when using the mild stimulation protocol. It was also observed that in this group there was a slightly higher rate.

[The using of hollow bricks as a shelter for adaptation of wild rodents' colonies in captivity]. / Tijolos vazados como abrigo para adaptação de roedores silvestres em cativeiro.

Difficulties for adaptation of wild rodents' colonies in the laboratory may hamper experimental studies. We describe the use of a hollow brick inside cages, to provide shelter and reduce stress of the animals. It facilitates the cleaning of cages, since the animals stay inside the brick while they are transferred to a new cage. This method was applied in a trial for adaptation of Oryzomys nigripes in captivity. Despite transportation for more than 1500 km, mortality was zero in the group of 62 rodents and the colony expanded immediately. A hollow brick is a cheap and widespread available material for improving adaptation of wild rodents to captivity.

Tijolos vazados como abrigo para adaptação de roedores silvestres em cativeiro / The using of hollow bricks as a shelter for adaptation of wild rodents' colonies in captivity

Difficulties for adaptation of wild rodents' colonies in the laboratory may hamper experimental studies. We describe the use of a hollow brick inside cages, to provide shelter and reduce stress of the animals. It facilitates the cleaning of cages, since the animals stay inside the brick while they are transferred to a new cage. This method was applied in a trial for adaptation of Oryzomys nigripes in captivity. Despite transportation for more than 1500 km, mortality was zero in the group of 62 rodents and the colony expanded immediately. A hollow brick is a cheap and widespread available material for improving adaptation of wild rodents to captivity.

Dificuldade para o estabelecimento de colônias de roedores silvestres no laboratório podem impedir realização de estudos experimentais. Descrevemos o emprego de tijolos vazados dentro das gaiolas, com objetivo de proporcionar abrigo e reduzir o estresse dos animais. Isto facilita a limpeza das gaiolas e outros procedimentos, já que os animais permanecem espontaneamente dentro do tijolo, enquanto são transferidos para uma nova gaiola. Este método foi empregado em uma tentativa de adaptação de Oryzomys nigripes em cativeiro. Apesar do transporte por mais de 1500km, mortalidade foi zero no grupo de 62 roedores e a colônia expandiu-se imediatamente. O tijolo vazado é um material barato, facilmente disponível e contribui para a adaptação de roedores silvestres em cativeiro.

[Myocardial revascularization through small left anterior minithoracotomy]. / Revascularização do miocárdio através de minitoracotomia esquerda.

PURPOSE: To analyze the results of myocardial revascularization through small left anterior thoracotomy utilizing the left thoracic internal artery (LTIA) to left anterior descending coronary artery (LAD) without cardiopulmonary bypass, in order to simplify the operative procedure. METHODS: From September/95 till August/96 we operated on 45 patients with lesions in LAD or LAD and diagonal arteries that were revascularized with an anastomoses of the LTIA to LAD or LAD and diagonal as composite grafts, through left anterior small thoracotomy. In the second postoperative day 43 out of 45 patients were restudied with arteriography and/or transthoracic echocardiography that showed excellent patency in 39 of them. RESULTS: Six patients with obstruction or stenoses were reoperated through median sternotomy without complications. We did not observe flow through intercostal arteries in these restudies except in cases of obstructed anastomosis, showing that it is not necessary to ligate these branches. We observed too, excellent correlation between angiographic patterns and diastolic flows detected in the thoracic internal artery with transthoracic echocardiography. CONCLUSION: These initial results suggest that this approach may be good to a subset of patients with lesions in LAD and/or diagonal arteries and if associated with complementary angioplasties of other coronary arteries may be the best choice of invasive treatment of coronary insufficiency in a near future.

Eficácia e segurança de um novo sistema matricial para liberaçäo transdérmica de stradiol comparativamente ao sistema clássico de reservatório / An open, randomized assessment of the efficacy and safety of two transdermal estradiol patches for relief of climacteric symptoms

Estudo comparativo, aberto, randomizado, foi conduzido em 10 centros da América Latina (oito no Brasil, um na Argentina e um no Chile), para avaliar a eficácia e segurança de dois sistemas transdérmicos para liberação de estradiol. Um total de 182 pacientes foi aleatoriamente distribuído para receber o sistema matricial (Climaderm-Wyeth-Ayerst) ou sistema clássico do tipo reservatório (Estraderm TTS 50 - Ciba-Geigy). Os sistemas foram aplicados na região inferior do abdome em áreas alternadas, durante seis ciclos consecutivos de 28 dias. Os sistemas liberavam aproximadamente, 50gr de estradiol por dia. Em ambos os grupos houve, em relação ao pré-tratamento, decréscimo significativo do número diário de fogachos nos ciclos de um a seis, porém houve, em relação ao sistema matricial, melhora significativa nos ciclos 4 (p = 0,033) e 6 (p = 0,046). Houve também diferença significativa entre os grupos com relação à fraqueza nos ciclos 2 (p = 0,019) e 3 (p + 0,015), fadiga no ciclo 2 (p = 0,033), interrupções do sono no ciclo 6 (p + 0,048), nervosismo no ciclo 3 (p = 0,045) e escore total nos ciclos 2 (p = 0,030) e 3 (p = 0,041), a favor do sistema matricial e 18 ( 21,2 por cento) do grupo medicado com o sistema reservatório abandonaram o tratamento

Coronary artery bypass grafting without cardiopulmonary bypass.

BACKGROUND: Coronary artery bypass grafting without cardiopulmonary bypass is now an accepted technique of myocardial revascularization. We herein report our total experience with this procedure. METHODS: In a consecutive series of 8,751 patients operated on in our institution for coronary artery disease from 1981 to 1994, 1,274 patients received coronary artery bypass grafting without cardiopulmonary bypass. RESULTS: Results indicate that the operation can be performed with an acceptable mortality (2.5%), and that all types of arterial conduits can be used. Most commonly the left anterior descending and right coronary arteries were bypassed. The incidence of arrhythmias and of pulmonary and neurologic complications were significantly lower in this group of patients compared with patients receiving coronary artery bypass grafting with cardiopulmonary bypass. Most importantly, there was decreased cost when the procedure was used because no extracorporeal circulation, cardioplegia sets, or other cannulas were used. CONCLUSIONS: We conclude that the continuing use of coronary artery bypass grafting without cardiopulmonary bypass is justified and that, with proper selection of patients, the procedure is safe and cost-effective.

[Myocardial revascularization without extracorporeal circulation. Surgical results in 1090 patients]. / Revascularização miocárdica sem circulação extracorpórea. Resultados cirúrgicos em 1090 pacientes.

PURPOSE: To report our experience of 12 years of myocardial revascularization without cardiopulmonary bypass (CPB) and to discuss its expanding surgical indications. METHODS: This technique was employed in 1090 patients, between September/81 and April/93, corresponding to 17.4% of all revascularized patients. Regarding gender, male patients were the majority (73.7%) and ages ranged from 28 to 86 year-old (mean 57). Chronic coronary insufficiency was the main indication (69.4%) and 18.9% of our global experience were operated on during acute ischemia. The average number of grafts per patient was 1.6 and internal mammary artery was utilized in 60.1% of patients. Left anterior descending coronary artery and right coronary artery were the coronary arteries most often treated. RESULTS: Our hospital mortality rate was 2.5% (28/1090) although it was 7% for patients over 70 years. The most common cause of death was cardiogenic shock after failed angioplasty. Postoperative complications included AMI in 4.8%, arrhythmias in 5.5% and pulmonary in 3.2%. Mean of any type of blood derivate utilization was 0.28 units/patients. CONCLUSION: Myocardial revascularization without CPB is a valid alternative in a selected cohort of patients and it is performed with low morbidity and mortality. Nowadays it represents an excellent tactical option for high-risk patients and in failed angioplasties.

[An unusual indication of deep hypothermia with total circulatory arrest for myocardial revascularization surgery]. / Uma indicação incomum da hipotermia profunda com parada circulatória total para cirurgia de revascularização miocárdica.

The authors relate a case of 69 years old patient with unstable angina and left main coronary artery disease, who underwent aggressive mediastinal radiotherapy for lymphoproliferative syndrome 20 years ago and who needed urgent myocardial revascularization. Due to great calcification and heavily heart adherences it was performed 20 degrees C deep hypothermic circulatory arrest to avoid aortic clamping and to make the anastomosis with better exposition of the aorta and coronary arteries.

Myocardial revascularization without extracorporeal circulation. Seven-year experience in 593 cases.

The authors present the results of 593 consecutive and non-selected patients who underwent direct myocardial revascularization without extracorporeal circulation in the period September 1981 to December 1988. The results are compared with 3086 patients who underwent conventional bypass surgery over the same period of time. The ages varied from 33 to 80 years (mean = 56) with 40 patients older than 70. The overall mortality in the group without cardiopulmonary bypass (CPB) was 1.7% (10/593) compared with 3.8% for conventional revascularization. Our mortality in the last 3 years has been 0.5% and 0% in the last 203 patients revascularized without CPB. The number of grafts varied from 1 to 5 (average 1.6). The treated arteries were: anterior descending (557), right (282) marginal (5) and circumflex marginal (4). Immediate postoperative complications were fewer and hospital discharge was earlier in the group treated without CPB. The authors conclude that this tactical alternative has the advantages of: lower morbidity and mortality, lower cost and no need for blood transfusion. Drawbacks are the need for greater technical expertise and it seems to be possible in about 19% of all patients who undergo myocardial revascularization.