Evaluación de la efectividad y satisfacción de las pacientes tras miomectomía histeroscópica en consulta / Evaluation of effectiveness and patient satisfaction of hysteroscopic myomectomy in office

OBJETIVO: Analizar la efectividad de las miomectomías histeroscópicas en consulta realizadas con minirresector y conocer si hay factores relacionados con el grado de satisfacción de las pacientes. MÉTODO: Estudio observacional, transversal y prospectivo, de mujeres sometidas a miomectomía histeroscópica en consulta durante el año 2018. Las pacientes recibieron medicación para la preparación cervical, analgesia oral y anestesia paracervical. La miomectomía se realizó con un minirresector de 5.8 mm. Se registraron el tiempo y el dolor en una escala visual analógica (EVA) durante la entrada y la resección, así como la satisfacción de las pacientes a los 3 meses con el cuestionario validado CSQ-8. RESULTADOS: El estudio incluyó 59 pacientes. El tiempo medio de entrada fue menor de 1 minuto (47,93 segundos) y el de resección fue de 13,51 minutos. El dolor referido por las pacientes en la EVA durante la entrada y la resección puntuó en torno a 3 y 4, respectivamente. Se consiguió un 74.6% de resecciones completas de los miomas y la puntuación media de satisfacción de las pacientes fue de 27.17. La resección completa del mioma se asoció con una mayor satisfacción total de las pacientes. CONCLUSIONES: La miomectomía histeroscópica en consulta llevada a cabo con un minirresector de 5.8 mm con analgesia paracervical obtiene buenos resultados clínicos, con buena satisfacción de las pacientes. Esta última se relaciona con una resección completa del mioma, sin que influyan el tiempo necesario para su exéresis ni el dolor.

OBJECTIVE: To analyze the effectiveness of hysteroscopic myomectomy in office performed with mini-resectoscope, and to know if there is any variable related with patient satisfaction. METHOD: Observational and prospective transversal study, which included all women who underwent a hysteroscopic myomectomy in office in 2018. Patients received drugs for cervical preparation and pain management, as well as paracervical block. We used the 5.8 mm mini-resectoscope. We kept record of time and AVS pain during entrance and resection, as well as patient satisfaction 3 months after the procedure using the CSQ-8. RESULTS: The study included 59 patients. Mean entrance time was less than 1 minute (47.93 seconds), while mean resection time was 13.51 minutes. AVS pain during entrance and resection was around 3 and 4, respectively. We achieved 74.6% rate of complete resection. Mean patient satisfaction rate was 27.17 points. We found that a complete myoma resection is related to higher patient satisfaction. CONCLUSIONS: Hysteroscopic myomectomy in office performed with the 5.8 mm mini-resectoscope, using cervical block, achieves good clinical results and a good patient satisfaction. Patient satisfaction is associated with a complete resection of the myoma, without any influence of pain experienced or time required.

Anatomy of the olfactory mucosa.

The classic notion that humans are microsmatic animals was born from comparative anatomy studies showing the reduction in the size of both the olfactory bulbs and the limbic brain relative to the whole brain. However, the human olfactory system contains a number of neurons comparable to that of most other mammals, and humans have exquisite olfactory abilities. Major advances in molecular and genetic research have resulted in the identification of extremely large gene families that express receptors for sensing odors. Such advances have led to a renaissance of studies focused on both human and nonhuman aspects of olfactory physiology and function. Evidence that olfactory dysfunction is among the earliest signs of a number of neurodegenerative and neuropsychiatric disorders has led to considerable interest in the use of olfactory epithelial biopsies for potentially identifying such disorders. Moreover, the unique features of the olfactory ensheathing cells have made the olfactory mucosa a promising and unexpected source of cells for treating spinal cord injuries and other neural injuries in which cell guidance is critical. The olfactory system of humans and other primates differs in many ways from that of other species. In this chapter we provide an overview of the anatomy of not only the human olfactory mucosa but of mucosae from a range of mammals from which more detailed information is available. Basic information regarding the general organization of the olfactory mucosa, including its receptor cells and the large number of other cell types critical for their maintenance and function, is provided. Cross-species comparisons are made when appropriate. The polemic issue of the human vomeronasal organ in both the adult and fetus is discussed, along with recent findings regarding olfactory subsystems within the nose of a number of mammals (e.g., the septal organ and Grüneberg ganglion).

Mortality of Adult Patients With Cancer Admitted to an Intensive Care Unit in Chile: A Prospective Cohort Study.

PURPOSE: Increasing numbers of reports have shown acceptable short-term mortality of patients with cancer admitted into the intensive care unit (ICU). The aim of this study was to determine the mortality of critically ill patients with cancer admitted to the ICU in a general hospital in Chile. MATERIALS AND METHODS: This was a prospective cohort trial in which we included all patients with cancer admitted to the ICU between July 2015 and September 2016. Demographic, physiologic, and treatment data were registered, and survival at 30 days and 6 months was evaluated. A prespecified subgroup analysis considering the admission policy was performed. These subgroups were (1) ICU admission for full code management and (2) ICU trial (IT). RESULTS: During the study period, 109 patients with cancer were included. Seventy-nine patients were considered in the full code management group and 30 in the IT. The mean age of patients was 60 years (standard deviation [SD], 15), and 56% were male. Lymphoma was the most frequent malignancy (17%), and 59% had not received cancer treatment because of a recent diagnosis. The mean Acute Physiology and Chronic Health Evaluation and Sequential-Related Organ Failure Assessment scores were 22.2 (SD, 7.3) and 7 (SD, 3), respectively. There were no differences in vasopressor, fluid, or transfusion requirements between subgroups. Lactate levels, Sequential-Related Organ Failure Assessment scores (day 1, 3, and 5), complications, and ICU length of stay were similar. In the entire cohort, 30-day and 6-month mortality was 47% and 66%, respectively. There was no difference in mortality between subgroups according to the admission policy. CONCLUSION: Patients admitted to the ICU in a developing country are at high risk for short-term mortality. However, there is a relevant subgroup that achieves 6-month survival, even among patients who undergo an IT.

Revisiting the Vomeronasal System From an Integrated Perspective.

"Olfactory subsystems" is a relatively new terminology to refer to the different regions of the nasal cavity featuring olfactory sensory neurons. In mice, the olfactory chemical cues are detected in four well delimited areas: the main olfactory epithelium, the septal organ, Grüneberg's ganglion, and the sensory epithelium of the vomeronasal organ. Nevertheless, such distribution is by no means exhibited by all mammals. In microsmatic mammals -humans included- the only existing olfactory subsystem is the main olfactory epithelium. This raises the question of whether the lack of certain olfactory structures in those species implies that they are unable to identify certain olfactory signals, or on the contrary, their main olfactory epithelium assumes such role. It would be interesting to determine, in the context of biomedical research, if the sense of smell in humans is fully or partially endowed with the wide range of functions assigned to the vomeronasal system in mice. If it is not, presumptive implications of the lack of such functions should be addressed in human health and well-being. Anat Rec, 299:1488-1491, 2016. © 2016 Wiley Periodicals, Inc.

Dog and mouse: toward a balanced view of the mammalian olfactory system.

Although the most intensively studied mammalian olfactory system is that of the mouse, in which olfactory chemical cues of one kind or another are detected in four different nasal areas [the main olfactory epithelium (MOE), the septal organ (SO), Grüneberg's ganglion, and the sensory epithelium of the vomeronasal organ (VNO)], the extraordinarily sensitive olfactory system of the dog is also an important model that is increasingly used, for example in genomic studies of species evolution. Here we describe the topography and extent of the main olfactory and vomeronasal sensory epithelia of the dog, and we report finding no structures equivalent to the Grüneberg ganglion and SO of the mouse. Since we examined adults, newborns, and fetuses we conclude that these latter structures are absent in dogs, possibly as the result of regression or involution. The absence of a vomeronasal component based on VR2 receptors suggests that the VNO may be undergoing a similar involutionary process.

The nasal cavity of the sheep and its olfactory sensory epithelium.

Macro and microdissection methods, conventional histology and immunohistochemical procedures were used to investigate the nasal cavity and turbinate complex in fetal and adult sheep, with special attention to the ethmoturbinates, the vestibular mucosa, and the septal mucosa posterior to the vomeronasal organ. The ectoturbinates, which are variable in number and size, emerge and develop later than the endoturbinates. The olfactory sensory epithelium is composed of basal cells, neurons, and sustentacular cells organized in strata, but numerous different types are distinguishable on the basis of their thickness and other properties; all variants are present on the more developed turbinates, endoturbinates II and III. Mature neurons and olfactory nerve bundles express olfactory marker protein. We found no structure with the characteristics that in mouse define the septal organ or the ganglion of Grüneberg. Our results thus suggest that in sheep olfactory sensory neurons are exclusively concentrated in the main olfactory epithelium and (to a lesser extent) in the vomeronasal organ.

Anatomy, histochemistry, and immunohistochemistry of the olfactory subsystems in mice.

The four regions of the murine nasal cavity featuring olfactory neurons were studied anatomically and by labeling with lectins and relevant antibodies with a view to establishing criteria for the identification of olfactory subsystems that are readily applicable to other mammals. In the main olfactory epithelium and the septal organ the olfactory sensory neurons (OSNs) are embedded in quasi-stratified columnar epithelium; vomeronasal OSNs are embedded in epithelium lining the medial interior wall of the vomeronasal duct and do not make contact with the mucosa of the main nasal cavity; and in Grüneberg's ganglion a small isolated population of OSNs lies adjacent to, but not within, the epithelium. With the exception of Grüneberg's ganglion, all the tissues expressing olfactory marker protein (OMP) (the above four nasal territories, the vomeronasal and main olfactory nerves, and the main and accessory olfactory bulbs) are also labeled by Lycopersicum esculentum agglutinin, while Ulex europaeus agglutinin I labels all and only tissues expressing Gαi2 (the apical sensory neurons of the vomeronasal organ, their axons, and their glomerular destinations in the anterior accessory olfactory bulb). These staining patterns of UEA-I and LEA may facilitate the characterization of olfactory anatomy in other species. A 710-section atlas of the anatomy of the murine nasal cavity has been made available on line.

Morphological and immunohistochemical features of the vomeronasal system in dogs.

Each of the structures integrating the sense of smell in mammals has a different degree of development, even in the so-called macrosmatic animals, according to the capacity of the olfactory system to detect thousands of different chemical signals. Such morphological diversity implies analogous physiological variation. The study of the accessory olfactory system, also known as the vomeronasal system, is a useful way to analyze the heterogeneity of the sense of smell. Macrodissection and microdissection methods as well as conventional histology and immunohistochemistry protocols were used to study aspects of the vomeronasal organ and the accessory olfactory bulbs in dogs. Observations regarding the end of the anterior part of the vomeronasal duct have been emphasized. Both lectins, Ulex europaeus agglutinin I and Lycopersicum esculentum agglutinin, and one G protein, G(αi2), show a similar pattern of binding in the sensory epithelium of the vomeronasal organ and in the vomeronasal nerve and glomerular layers of the accessory olfactory bulb, whereas the expression of protein G(αo) was not observed. Taken together, our results emphasize the contribution of comparative data to our understanding of the vomeronasal system function.

A detailed morphological study of the vomeronasal organ and the accessory olfactory bulb of cats.

The organization of the vomeronasal system (VNS) of fetal, newborn, and adult cats was investigated by microdissection and microscopic examination of sections stained conventionally or with lectins (UEA-1, LEA) or antibodies against proteins Gα(i2) (associated with vomeronasal receptor type1) and Gα(o) (associated with receptor vomeronasal receptor type2). The feline VNS is morphologically similar to that of other mammals. Staining with lectins and anti-Gα(i2) was uniform throughout the sensory epithelium of the vomeronasal organ, and throughout the nervous and glomerular layers of the accessory olfactory bulb (AOB); anti-Gα(o) stained no VNS tissue. This organization places the cat together with several other domestic or farm animals (dog, horse, sheep, goat, pig) in a group of mammals with just a single path of communication between the sensory epithelium of the vomeronasal organ and AOB, in contrast to the two-path model found in rodents and other mammals (in which apical and basal sensory epithelium layers project to rostral and caudal AOB areas, respectively). However, the cat differs from the sheep and pig in that the development of its VNS is still incomplete at birth.

Influencia de la visita puerperal temprana en la detección y evolución de la depresión posparto / Influence of early postpartum home visits on the detection and clinical course of postpartum depression

Objetivos. Nos proponemos determinar y valorar la influencia de la visita puerperal temprana (VPT) domiciliaria en la disminución de la incidencia de depresión posparto en nuestro medio. Material y métodos. Cuatrocientos treinta pacientes con embarazo y partos sin complicaciones que se aleatorizan en dos grupos homogéneos (grupo con VPT y grupo control). Se utilizó la hospital anxiety and depresión scale para valorar la depresión posparto a los 7 y 30 días. Resultados. Se observó un score positivo para depresión puerperal a los 7 días del parto en un 10,2%. En el grupo de VPT se observó una disminución de incidencia de la depresión puerperal (0,9%) frente al grupo control (3,7%). Conclusión. La incidencia de depresión posparto en nuestra área es similar a la esperada. La visita puerperal temprana parece ser útil en la detección de patología psiquiátrica y disminuye la evolución de los síntomas(AU)

Objectives. The aim of this study was to determine the influence of early postpartum home visits in reducing the incidence of puerperal depression in our environment. Material and methods. A total of 430 patients with uncomplicated pregnancy and delivery were randomized to two homogeneous groups (one group receiving an early postpartum home visit and a control group). The hospital anxiety and depression scale was used to assess puerperal depression at 7 and 30 days. Results. At 7 days, 10.2% of the patients had a positive score for puerperal depression. At 30 days, the incidence of puerperal depression was lower in the group receiving an early home visit (0.9%) than in the control group (3.7%). Conclusion. The incidence of postpartum depression in our setting was similar to the expected incidence. Early postpartum home visits seem to be useful in detecting this disorder and in reducing symptoms(AU)

The risk of extrapolation in neuroanatomy: the case of the Mammalian vomeronasal system.

The sense of smell plays a crucial role in mammalian social and sexual behaviour, identification of food, and detection of predators. Nevertheless, mammals vary in their olfactory ability. One reason for this concerns the degree of development of their pars basalis rhinencephali, an anatomical feature that has been considered in classifying this group of animals as macrosmatic, microsmatic or anosmatic. In mammals, different structures are involved in detecting odours: the main olfactory system, the vomeronasal system (VNS), and two subsystems, namely the ganglion of Grüneberg and the septal organ. Here, we review and summarise some aspects of the comparative anatomy of the VNS and its putative relationship to other olfactory structures. Even in the macrosmatic group, morphological diversity is an important characteristic of the VNS, specifically of the vomeronasal organ and the accessory olfactory bulb. We conclude that it is a big mistake to extrapolate anatomical data of the VNS from species to species, even in the case of relatively close evolutionary proximity between them. We propose to study other mammalian VNS than those of rodents in depth as a way to clarify its exact role in olfaction. Our experience in this field leads us to hypothesise that the VNS, considered for all mammalian species, could be a system undergoing involution or regression, and could serve as one more integrated olfactory subsystem.

Anatomical, immnunohistochemical and physiological characteristics of the vomeronasal vessels in cows and their possible role in vomeronasal reception.

The general morphology of the vomeronasal vessels in adult cows was studied following a classic protocol, including optical, confocal and ultrastructural approaches. This anatomical work was completed immunohistochemically. The vomeronasal organ in cows is well developed, and its vessels are considerable in size. This fact allowed some functional properties of the vomeronasal arteries to be evaluated and, for the first time, their isometric tension to be recorded. Our functional studies were in agreement with the immunohistochemistry, and both corroborated the morphological data on the similarity between the vomeronasal vessels and those of the typical erectile tissue. In consequence, the vasoconstriction and vasodilation of the vomeronasal vessels would facilitate an influx and outflow of fluids in the vomeronasal organ, that is to say, this organ in cows would be able to work as a pump mechanism to send chemical signals to the vomeronasal receptor neurones.

Hormonal and morphological study of the pituitaries in reeler mice.

Reelin is a neuronal glycoprotein that plays a crucial role in brain layer formation during prenatal development. The reeler mutant mouse lacks Reelin, leading to abnormalities in the neuronal layering of cerebral cortex and cerebellum, producing ataxia, tremor and abnormal locomotion. Reeler mice are reported to have growth retardation and most of them are sterile or unable to bring up their newborns. Since the brain is one of the main regulator of pituitary hormone secretion and no information was reported regarding pituitary function and structure in these mutant mice, we studied pituitary endocrine activity and morphology in reeler mice. Mice were classified in three groups as reeler homozygote (RHM), reeler heterozygote (RHT) or control (CO). Pituitary hormone blood levels were assessed by enzyme immunoassay (EIA) and immunoradiometric assay (IRMA). Animals and their pituitaries were weighted and pituitaries were studied by histology, immunohistochemistry and electron microscopy. Results showed statistically significant differences in body weight and in adrenocorticotropic hormone (ACTH) and luteinizing hormone (LH) blood levels between the three groups. In contrast, growth hormone (GH) blood levels showed a high individual variation and no decrease in reeler groups compared with CO. Morphological studies revealed no differences in pituitary cell types except that somatotrophs appeared to be slightly smaller in RHM and RHT. Although it seems that pituitary hypofunction is not responsible for growth retardation, more studies are needed to obtain a deeper insight into the endocrine status of these mutant mice to elucidate the cause of their low body weight and reproductive behaviour.

Diversity of the vomeronasal system in mammals: the singularities of the sheep model.

The enormous morphological diversity and heterogeneity of the vomeronasal system (VNS) in mammals--as well as its complete absence in some cases--complicates the extrapolation of data from one species to another, making any physiological and functional conclusions valid for the whole Mammalian Class difficult and risky to draw. Some highly-evolved macrosmatic mammals, like sheep, have been previously used in interesting behavioral studies concerning the main and accessory olfactory systems. However, in this species, certain crucial morphological peculiarities have not until now been considered. Following histological, histochemical and immunohistochemical procedures, we have studied the vomeronasal organ (VNO) and the accessory olfactory bulb (AOB) of adult sheep. We have determined: (1) that all structures which classically define the VNO in mammals are present and well developed, providing the morphological basis for functional activity. (2) that, conversely, there is only a scant population of scattered mitral/tufted cells. One morphological consequence of both details is that the strata of the AOB in adult sheep are not as sharply defined as in other species; moreover, the small number of the mitral/tufted cells in the AOB may imply that the VNS of adult sheep is not capable of functioning in the way a well-developed VNS does in other species. (3) the zone to zone projection from the apical and basal sensory epithelium of the VNO to the anterior and posterior part of the AOB, respectively, typical in rodents, lagomorphs and marsupials, is not present in adult sheep.

General organization of the perinatal and adult accessory olfactory bulb in mice.

The vomeronasal system is currently a topical issue since the dual functional specificity, vomeronasal system-pheromones, has recently been questioned. Irrespective of the tools used to put such specificity in doubt, the diversity of the anatomy of the system itself in the animal kingdom is probably of more importance than has previously been considered. It has to be pointed out that a true vomeronasal system is integrated by the vomeronasal organ, the accessory olfactory bulb, and the so-called vomeronasal amygdala. Therefore, it seems reasonable to establish the corresponding differences between a well-developed vomeronasal system and other areas of the nasal cavity in which putative olfactory receptors, perhaps present in other kinds of mammals, may be able to detect pheromones and to process them. In consequence, a solid pattern for one such system in one particular species needs to be chosen. Here we report on an analysis of the general morphological characteristics of the accessory olfactory bulb in mice, a species commonly used in the study of the vomeronasal system, during growth and in adults. Our results indicate that the critical period for the formation of this structure comprises the stages between the first and the fifth day after birth, when the stratification of the bulb, the peculiarities of each type of cell, and the final building of glomeruli are completed. In addition, our data suggest that the conventional plexiform layers of the main olfactory bulb are not present in the accessory bulb.

The prenatal maturity of the accessory olfactory bulb in pigs.

The morphological development of the accessory olfactory bulb of the fetal pig was studied by classical and histo-chemical methods, and the vomeronasal organ and nasal septum were studied histochemically. Specimens were obtained from an abattoir and their ages estimated from their crown-to-rump length. The accessory olfactory bulb was structurally mature in fetuses of crown-to-rump length 21-23 cm, by which time the lectin Lycopersicum esculentum agglutinin stained the same structures as in adults (in particular, the entire sensory epithelium of the vomeronasal organ, the vomeronasal nerves, and the nervous and glomerular layers of the accessory olfactory bulb). These results suggest that the vomeronasal system of the pig may, like that of vertebrates such as snakes, be functional at birth.

Identification of pheromones in mouse urine by head-space solid phase microextraction followed by gas chromatography-mass spectrometry.

Given the key role of pheromones in animal communication and behaviour, there is need to identify the different classes of these molecules under varying physiological conditions. However, the highly volatile nature of pheromones and the fact that they occur at very low concentrations in urine makes this task all the more difficult. Herein, we present a method of detecting and identifying the five main pheromones known: 2-sec-butyl-4,5-dihydrothiazole, geraniol, indole, trans-beta farnesene and trans-alpha farnesene in individual urine microsamples taken from male mice. Urine volumes as small as 20 microl were subjected to solid phase microextraction (SPME) followed by gas chromatography-mass spectrometry (GC-MS). This selective analytical method permits the rapid detection of these pheromones free from cross-contaminants as a clearly distinguishable spectral signals. Highest recovery rates of natural pheromones were achieved by extraction on a carboxen/polydimethylsiloxane (CAR/PDMS) fibre of 85 microm film thickness. This selective, sensitive and accurate method will help address the question of possible links between certain pheromone classes, and social and reproductive behaviour in mice.

Development of the vomeronasal receptor epithelium and the accessory olfactory bulb in sheep.

The morphological development of the vomeronasal organ (VNO) and accessory olfactory bulb (AOB) of the sheep from anlage to birth were studied by classical and histochemical methods using embryos and fetuses obtained from an abattoir with ages estimated from crown-to-rump length. Both VNO and AOB developed in a biologically logical sequence and completed their morphological development around day 98, at entry into the last third of the gestation period. A lectin with specificity for oligomeric N-acetylglucosamine labeled the sensory epithelium of the VNO, the vomeronasal nerves, and the nervous and glomerular layers of the AOB before birth. These results suggest that the vomeronasal system, which is well developed and functional in adult sheep, may be able to function at or even before birth in these animals (whereas in rodents, for example, this is precluded by the AOB not completing its development until after birth).