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1.
Rev. peru. ginecol. obstet. (En línea) ; 69(4): 00002, oct.-dic. 2023. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1565781

RESUMO

RESUMEN Demostrar mediante la disección de piezas anatómicas y de imágenes ultrasonográficas prenatales del corazón fetal la presencia del fulcro cardíaco como estructura de fijación que sirve de soporte a la banda miocárdica helicoidal. Se disecaron 6 corazones de fetos entre las 20 y 24 semanas de edad gestacional productos de abortos espontáneos, logrando encontrar el fulcro cardíaco en la proximidad de la aorta y conexiones con fibras miocárdicas. En 50 embarazos simples con fetos entre las 18 y 37 semanas de gestación, mediante ultrasonografía cardíaca fetal se obtuvieron las modalidades 2D, Doppler, color y tridimensión, STIC, HD Flow y speckle tracking, imágenes, medidas del fulcro y su cinética. Con la estrategia descrita se identificó y demostró la presencia del fulcro cardíaco o palanca miocárdica, estableciendo sus características anatómicas, conexiones con fibras miocárdicas del asa cardíaca y la biometría según la edad gestacional. Se formula una hipótesis sobre la biomecánica o cinética del fulcro durante el ciclo cardíaco. Para que el corazón cumpla su función de bomba aspirante e impelente debe poseer un punto de apoyo, una palanca o fulcro, que constituye una especie de unidad músculo-tendinosa. Dicha palanca presenta desplazamientos mixtos durante la torsión y detorsión del miocardio. Sus diámetros aumentan progresivamente a medida que avanza la gestación.


ABSTRACT To demonstrate by dissection of anatomical specimens and prenatal ultrasonographic images of the fetal heart the presence of the cardiac fulcrum as a fixation structure supporting the helical myocardial band. Six hearts of fetuses between 20-24 weeks of gestational age resulting from spontaneous abortions were dissected, finding the cardiac fulcrum in the proximity of the aorta and connections with myocardial fibers. In 50 singleton pregnancies with fetuses between 18-37 weeks of gestation, fetal cardiac ultrasonography was used to obtain 2D, Doppler, color and three-dimensional modalities, STIC, HD Flow and speckle tracking, images, fulcrum measurements and its kinetics. With the described strategy, the presence of the cardiac fulcrum or myocardial lever was identified and demonstrated, establishing its anatomical characteristics, connections with myocardial fibers of the cardiac loop and the biometry according to gestational age. A hypothesis on the biomechanics or kinetics of the fulcrum during the cardiac cycle is formulated. In order for the heart to fulfill its function as an aspirating and impelling pump, it must have a support point, a lever or fulcrum, which constitutes a sort of muscle-tendon unit. This lever presents mixed displacements during myocardial torsion and detorsion. Its diameters increase progressively as gestation advances.

2.
J Matern Fetal Neonatal Med ; 33(17): 3010-3015, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30616410

RESUMO

Objective: To describe the use of a self-retaining thermoplastic polyurethane wound retractor for the management of hysterotomy during prenatal repair of myelomeningocele.Methods: The preliminary experience with 16 consecutive cases of open surgery for prenatal repair of myelomeningocele using a new technique is presented. Under general anesthesia, the gravid uterus was partially exteriorized through a low transverse abdominal incision and a high 3-4-cm midline vertical mini-hysterotomy was performed. After chorioamniotic membranes were opened with scissors, the internal ring of the retractor was placed into the amniotic cavity to compress the chorioamniotic membranes against the internal uterine wall and permit full retraction of the hysterotomy. Once the neurosurgical intervention was completed, the retractor was removed manually and uterine and abdominal incisions were closed using conventional techniques. Intra- and post-operative complications, as well as short-term pregnancy outcomes, were evaluated.Results: Intrauterine surgery was performed at a mean gestational age of 25.3 weeks and all except two of the interventions were completed within 3.0 h. When compared with the technique described in the Management of Myelomeningocele study (MOMS) trial, the use of the retractor was associated with a lower, although statistically nonsignificant, rate of chorioamniotic membrane separation (20/78 (26%) versus 2/16 (13%), respectively), preterm rupture of membranes (36/78 (46%) versus 4/16 (25%), respectively), and persistent oligohydramnios (16/78 (21%) versus 1/16 (6%), respectively) as well as higher gestational age at delivery (34.1 weeks ± 3.1 versus 36.0 weeks ± 1.93, respectively) and birthweight (2383 g ± 688 versus 2790 g ± 529, respectively). There were no intra- or post-operative complications associated with the use of the device. Only one (6%) of the hysterotomy scars was noted to be thin at the time of the cesarean delivery and no cases of dehiscence occurred.Conclusions: The use of a plastic wound retractor at the hysterotomy site provides a less traumatic approach than the conventional technique for the management of the uterine incision during open intrauterine surgery. Our experience with this technique was associated with short-term pregnancy outcomes that are similar and perhaps even superior to the technique reported in the MOMS trial. Because the device is inexpensive, easy to use, and widely available, its use during open intrauterine surgery should be considered. However, further clinical experience is required to reach a definitive conclusion regarding whether this technique should be incorporated into the protocol of prenatal repair of myelomeningocele.


Assuntos
Histerotomia , Meningomielocele , Cesárea , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Meningomielocele/cirurgia , Plásticos , Gravidez
3.
Rev. obstet. ginecol. Venezuela ; 65(2): 69-75, jun. 2005. tab
Artigo em Espanhol | LILACS | ID: lil-419084

RESUMO

Evaluar los resultados de las histerectomías vaginales asistidas por laparoscopia. Estudio descriptivo, evolutivo, en el cual se evalúa una población de 400 pacientes a quienes se les realizó histerectomía veginal asistida por laparoscopia, durante octubre de 1991 a octubre de 2003. Los datos se analizaron según técnicas de estadísticas descriptiva. Describimos en detalle nuestra técnica quirúrgica personal. Hospital Luis Blanco Gásperi. Cruz Roja Venezolana, Seccional Valencia. Estado Carabobo, Venezuela. La edad promedio de las pacientes fue de 42 años. Las principales patologías fueron leiomiomatosis y prolapso genital. El tiempo quirúrgico promedio fue de 148 minutos, aunque en el 70 por ciento de los casos se asoció a otra cirugía. El peso uterino promedio fue de 198 g con una longitud media de 12.6 cm. Las complicaciones transoperatorias se presentaron en menos del 5 por ciento de las pacientes, destacando lesiones vesicales e intestinales. Hubo complicaciones posoperatorias en el 2 por ciento de las pacientes, principalmente infecciones urinarias. El tiempo promedio de hospitalización fue de 1,8 días. La Técnica empleada es segura, más económica que las que utilizan engrapadoras y de facilidad para su uso en grupos poblacionales de bajos recursos económicos


Assuntos
Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Laparoscopia , Histerectomia Vaginal , Venezuela , Ginecologia
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