Leiomioma vulvar em lobo-guará (Chrysocyon brachyurus) - relato de caso / Leiomyoma vulvar in maned wolf (Chrysocyon brachyurus) - case report

Descrição de leiomioma vulvar em lobo-guará (Chrysocyon brachyurus), fêmea, castrada, apresentando 10 anos de idade e mantida em cativeiro. Com base na avaliação clínica, no monitoramento de formação nodular de crescimento lento e progressivo e no diagnóstico preliminar sugestivo de neoplasia, procedeu-se à exérese da massa tumoral e à identificação anatomopatológica do leiomioma. Exames complementares radiográficos e ultrassonográficos não apontaram presença de metástases. A ressecção cirúrgica se mostrou satisfatória como conduta clínica, não havendo recidiva.(AU)

Description of leiomyoma vulvar in a female castrated Chrysocyon brachyurus, , ten years of age, and maintained in captivity. Based on the clinical evaluation, monitoring of nodular formation of slow and progressive growth, and preliminary diagnosis suggestive of neoplasia, the tumor mass was excised and anatomopathological identification of the leiomyoma was done. Complementary radiographic and ultrasound examinations did not indicate the presence of metastases. Surgical resection proved to be satisfactory as a clinical practice, and there was no relapse.(AU)

Aspectos clínicos, cirúrgicos, histológicos e pós-operatórios de oito cadelas com leiomioma vaginal / Clinical, surgical, histological and postoperative aspects in the case of eight bitches with vaginal leiomyoma

O presente trabalho reporta as características clínicas e cirúrgicas de oito casos de cadelas portadoras de leiomioma vaginal, com histórico de aumento de volume na região perineal, aparecimento de massa pela vulva, disquezia, tenesmo e disúria. As pacientes foram submetidas à cirurgia de episiotomia para ressecção da massa neoplásica, e em quatro casos foi necessária a ovariossalpingo-histerectomia. Porém, uma delas apresentou recidiva, e, no segundo procedimento cirúrgico de exérese de neoformação, o histopatológico diagnosticou leiomiossarcoma. A paciente ainda apresentou mais duas recidivas, até o proprietário optar pela eutanásia. Decorridos quatro meses, as sete cadelas diagnosticadas com leiomioma não apresentaram recidiva, e os proprietários relataram ausência de sinais relacionados com a doença descrita. Conclui-se que a episiotomia para ressecção da massa vaginal e a ovariossalpingo-histerectomia nas cadelas inteiras nos casos de tumores vaginais benignos são tratamentos satisfatórios, com bom prognóstico, ao contrário do leiomiossarcoma.

This study reports the clinical and surgical procedures of eight cases of bitches with vaginal leiomyoma. All animals presented increased volume in the perineal region, and exteriorization of the vulva, dyschezia, tenesmus and dysuria. The patients underwent episiotomy surgery for resection of the neoplastic mass, and ovariosalpingohisterectomy in four cases. However, one had recurrence on the second surgical procedure for removal of neoformation, histopathological diagnosed leiomyosarcoma, the patient also had two more relapses, until the owner chose euthanasia. After four months, the seven dogs diagnosed with leiomyoma showed no recurrence and the owners reported no signs of the disease described. We concluded that episiotomy for vaginal mass resection combined with ovariohysterectomy in cases of benign vaginal tumors have shown satisfactory treatment with good prognostic.

Are we underutilizing Palmer's point entry in gynecologic laparoscopy?

OBJECTIVE: To report our experience using Palmer's point entry in women undergoing gynecologic laparoscopic surgery. DESIGN: Retrospective observational study. SETTING: University teaching hospital, London, United Kingdom. PATIENT(S): We reviewed all patients who underwent laparoscopic gynecologic surgery under the care of the senior author between January 1, 2005, and December 31, 2008. INTERVENTION(S): Gynecologic laparoscopic surgery. MAIN OUTCOME MEASURE(S): Indications, incidence, success, and complications of using Palmer's entry. RESULT(S): Three hundred eighty-five patients underwent laparoscopic surgery. We used umbilical entry in 249 (64.6%) and Palmer's entry in 136 (35.4%). In almost three fourths of cases, the indications for using Palmer's point were previous laparotomy or the presence of large uterine fibroids. The next most common reasons for choosing Palmer's point were known documentation of intra-abdominal adhesions from prior laparoscopies, large ovarian cysts, and hernias or hernia repairs. Entry via Palmer's point was successful in all but two cases (98.5%), and there were no entry-related complications. CONCLUSION(S): Our experience shows that laparoscopic entry using the left upper quadrant is safe with a low failure rate. Because the vast majority of gynecologic laparoscopies are done using subumbilical entry, it seems that Palmer's entry is underused by many gynecologists, despite it being safer in patients at risk of underlying adhesions and more appropriate in the presence of a large pelvic mass or a nearby hernia.

Strategy of cervical myomectomy under laparoscopy.

OBJECTIVE: To evaluate a strategy of laparoscopic excision of a cervical myoma (CM). DESIGN: Prospective study. SETTING: University-affiliated hospital. PATIENT(S): Twenty-eight patients with CM underwent laparoscopic myomectomy. These cases were classified into five types according to the location: [1] anterior cervical myoma (ACM); [2] posterior cervical myoma (PCM); [3] central cervical myoma (CCM); [4] lateral cervical myoma [LCM]; and [5] deep-rooted cervical myoma (DCM). INTERVENTION(S): After preoperative assessment, patients underwent laparoscopic myomectomy. Ligation of the uterine artery and diluted vasopressin injection were performed to decrease bleeding during laparoscopy. MAIN OUTCOME MEASURE(S): Myoma numbers, myoma weight, operative time, estimated blood loss, hospital stay, complication rate. RESULT(S): Most of the lesions were ACM (43%) and PCM (32%). The mean operative time was 121 minutes, mean blood loss was 99 mL, and mean myoma weight was 287 g. The mean hospital stay was 2.2 days. There were no complications. Histopathologic examination showed that all lesions were leiomyoma. Hypermenorrhea, dysmenorrhea, and symptoms of compression improved after the operation. Two infertile patients conceived spontaneously at 1 and 7 months postoperatively, and successfully delivered infants by cesarean section at term. CONCLUSION(S): Surgical treatment of CM is empirically difficult. It is important that the approach be changed according to the location and size of the myoma.

Laparoscopy versus minilaparotomy in women with symptomatic uterine myomas: short-term and fertility results.

OBJECTIVE: To retrospectively compare the feasibility, safety, morbidity, and pregnancy outcome of laparoscopy (LPS) and minilaparotomy (LPT) in the treatment of symptomatic uterine myomas. DESIGN: Retrospective, nonrandomized study. SETTING: Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy. PATIENT(S): 680 nonconsecutive patients with symptomatic uterine myomas. INTERVENTION(S): 350 women underwent LPS, and 330 underwent LPT myomectomy. MAIN OUTCOME MEASURE(S): Operative time, blood loss, hospital stay, pregnancy rate, and spontaneous abortion rate. RESULT(S): The mean operative time was 63 +/- 21 minutes (95% CI, 48-143) in the LPS group and 57 +/- 23 minutes (95% CI, 38-121) in the LPT group. The mean length of hospital stay was statistically significantly greater in the LPT group (3.1 +/- 0.5; 95% CI, 1-5) than the LPS group (2.1 +/- 0.8; 95% CI, 1-4). The overall spontaneous pregnancy rate after myomectomy was 53%; the pregnancy rate after LPS myomectomy (56%) was not statistically significantly higher than the rate for LPT (50%). CONCLUSION(S): Laparoscopy showed a lower morbidity than reported for the open approach and was characterized by less blood loss and a shorter postoperative hospitalization with an higher pregnancy rate. The operating time was not much longer in the laparoscopic group, and the intraoperative and postoperative complications appeared acceptable and not more than what is traditionally expected with the open approach.

New tool (Laparotenser) for gasless laparoscopic myomectomy: a multicenter-controlled study.

OBJECTIVE: To assess feasibility and safety of a new surgical instrument-Laparotenser-in the procedure of gasless laparoscopic myomectomy. DESIGN: Multicenter controlled study. SETTING: Academic departments of obstetrics and gynecology, Italy. PATIENT(S): Thirty patients scheduled for gasless laparoscopic myomectomy (experimental group) and another group of 30 patients from our historical records that have undergone traditional laparoscopic myomectomy, matched with the cases for number of fibroids and for size of the main fibroid (control group). INTERVENTION(S): Gasless laparoscopic myomectomy using Laparotenser. MAIN OUTCOME MEASURE(S): Surgical data. RESULT(S): No significant differences in total operative time, postoperative ileus, hospitalization, time to return to full activity/work, and complication rates were observed between groups. Intraoperative blood loss, hemoglobin level, and surgical difficulty were significantly higher in the experimental than in the control group. Postoperative pain and number of analgesic vials used were significantly lower in the experimental group than in the control group. CONCLUSION(S): Although performed during the learning curve period, the use of the Laparotenser instrument in gasless laparoscopic myomectomy is a safe procedure.

[The effect of transcerebral electrical impulse exposures on regional hemodynamics after the surgical treatment of uterine myoma]. / Vliianie transtserebral'nykh élektroimpul'snykh vozdeistvii na regionarnuiu gemodinamiku posle khirurgicheskogo lecheniia miomy matki.

After surgical treatment of uterine myoma 28 patients with cardiovascular diseases experienced disturbances of cerebral, upper limb and small pelvis circulation. The course of transcerebral electrotherapy (short bipolar nonsymmetrical impulses with large amplitude of the negative part) relieved the symptoms as a results of better cerebral and upper limb hemodynamics.