Ovarian Pedicle Research Articles

Haemorrhagic shock in a pregnant patient and the unsuspicious subclavian catheter

Introduction: Central venous catheterisation (CVC) is a commonly performed procedure in clinical practice. Although usually safe, complications can arise such inadvertent vascular lesion. This report is of a case of left brachiocephalic vascular lesion due to a subclavian catheter, thus raising awareness about this potential complication, which is not always immediately recognised. Case report: We report the case of a 31-year-old healthy woman, 42 weeks pregnant, who presented with complications during an elective caesarean section. The patient experienced haemorrhagic shock due to the incomplete rupture of the left ovarian pedicle, further complicated by the accidental lesion of the left brachiocephalic vein caused by the tip of a right subclavian catheter, aggravated by the late discovery only after extubation. This case highlights the importance of patient selection, proper technique and the careful monitoring pre- and post-procedure. Conclusion: Brachiocephalic vein lesions arising from CVC insertions are rare but significant complications that require timely recognition and intervention.

Comparison of intra and postoperative analgesia efficacy of intraperitoneal levobupivacaine alone or in combination with dexmedetomidine in cats undergoing ovariohysterectomy; a randomized, prospective, blinded, clinical trial

This study aimed to compare the analgesic and cardiopulmonary effects of levobupivacaine with or without dexmedetomidine, in cats undergoing ovariohysterectomy. In this prospective, randomized, and blinded clinical trial, 24 healthy cats were recruited. Animals received either saline (S group; 2 mL NaCl), levobupivacaine alone (Lev; 0.35 mg/kg), or levobupivacaine with dexmedetomidine (LevDex group; 0.004 mg/kg), which was infiltrated intraoperatively into the subcutaneous tissue at various incision sites, including the right and left ovarian pedicles and the caudal aspect of the uterine body. Intraoperative analgesia was evaluated using a cumulative pain scale, while postoperative analgesia was assessed at various time points: before surgery (Tb), and at 0 (T0), 1 (T1h), 2 (T2h), 4 (T4h), 8 (T8h), 12 (T12h), and 24 (T24h) hours after the procedure, using the UNESP-Botucatu multidimensional composite pain scale (MCPS). Significant decreases in heart rate, respiratory rate, and mean arterial pressure were observed in LevDex group as compared to S and Lev groups (p < 0.05). The S group required significantly more rescue morphine doses than the LevDex group (p = 0.029), but the difference was not significant when compared to the Lev group (p = 0.123). At T1h and T2h, the S group had significantly higher MCPS scores than both the Lev and LevDex groups (p = 0.029). However, at T8h, no significant difference was found between the S and LevDex groups (p = 0.741). While adding dexmedetomidine to levobupivacaine may slightly prolong postoperative analgesia, this combination does not provide significant additional benefit over levobupivacaine alone in terms of response to surgical stimulation.

Evaluation of preoperative intraperitoneal injection of bupivacaine for intraoperative antinociception in cats undergoing ovariohysterectomy: A randomized clinical trial

ObjectiveTo determine if preoperative intraperitoneal bupivacaine can minimize intra- and postoperative nociception/pain in cats undergoing ovariohysterectomy. Study designProspective, randomized, investigator-blinded, placebo-controlled clinical trial. AnimalsForty-seven, intact female cats. MethodsCats were anesthetized using a standard protocol and randomized to receive ultrasound-guided intraperitoneal 0.9 % saline (US-S) or 0.25 % bupivacaine (US-IPLA) before ovariohysterectomy. On recovery, US-S cats received 2 mg/kg robenacoxib subcutaneously and US-IPLA cats received equivalent volume of 0.9 % saline subcutaneously. Intraoperative outcome variables included heart rate (HR), respiratory rate (fR), systolic arterial pressure (SAP), and vaporizer setting associated with relevant surgical events characterized by manipulation of each ovarian pedicle (OP1, OP2) and the uterine body (UB). The postoperative outcome variable was need for rescue analgesia, determined using the Glasgow Composite Measure Pain Scale during 6 h after tracheal extubation. Intraoperative data were analyzed using two-way ANOVA and Šidák's multiple comparisons test. The probability of postoperative rescue analgesia was analyzed using the Gehan–Breslow–Wilcoxon test. Significance was p < 0.05. ResultsCompared to baseline, all surgical events caused significant increases in HR and SAP in both groups, fR increased in US-IPLA but not in US-S, vaporizer settings remained unchanged during OP1, OP2 and UB in group US-IPLA, and were significantly higher only during OP1 in group US-S. There were no significant between-group differences in intraoperative variables and postoperative need for rescue analgesia. Conclusions and clinical relevancePreoperative intraperitoneal bupivacaine had minimal effects on intraoperative indicators of nociception. The need for rescue analgesia was not significantly different between groups.

The protective effect of Cloprostenol on ischemia/reperfusion injury in rat ovary: Histopathologic and immunohistochemically evaluation: An experimental study

ObjectıvesThis study investigates whether Cloprostenol, a synthetic prostaglandin analog, could protect against ischemia/reperfusion (IR) injury in rat ovaries. MethodsAdult female rats were divided into four groups: Sham groups, ischemia (IS) groups, ischemia/reperfusion (IR) groups, and Cloprostenol-treated (CT) groups. The IR injury model was established by clamping the ovarian pedicle for a specified period, followed by reperfusion. The CT group received a pre-treatment of Cloprostenol before inducing ischemia. Ovarian tissues were collected for histological, and immunohistochemical examination. ResultsThe IS group exhibited severe morphological damage to ovarian tissues, including disrupted tissue architecture and increased apoptosis (p < 0.001). In contrast, the CT group displayed significantly improved ovarian histology, with notable preservation of ovarian tissue and reduced apoptotic activity (p < 0.01). Immunohistochemical analysis revealed that the levels of 8-Hydroxy-2-deoxyguanosine (8-OHdG), Caspase 3, Cyclooxygenase 2 (COX-2), and Interleukin 1 beta (IL-1β) staining, which were elevated in the IS and IR groups, were significantly diminished in the CT group (p < 0.05). ConclusıonCloprostenol administration before IR injury in rat ovaries demonstrated a remarkable protective effect by improving histological damage and reducing DNA damage inflammation. These results highlight the therapeutic potential of Cloprostenol in safeguarding ovarian health against IR.

Veterinarian Use of and Sentiment Regarding Standard of Care for Feline Ovarian Pedicle Tie.

Ligation of the feline ovarian pedicle is commonly performed via autoligation ("pedicle tie") by high-quality high-volume surgeons. It is not commonly taught in veterinary school, resulting in general practice veterinarians who are not comfortable with the technique, despite being faster than double ligation with suture, having very low risk of hemorrhage-related complications, and no increased risk for student surgeons. This study aimed to determine the use of and opinions regarding standard of care (SOC) related to the pedicle tie for feline ovariohysterectomy. An anonymous 23-question survey was targeted to private practice veterinarians via social media from September to November 2021. There were 142 respondents, with 77 indicating the use of the pedicle tie and 65 indicating no use. Of those who used the pedicle tie, most reported learning the technique from either a dedicated high-quality high-volume facility (32%) or a colleague/mentor (32%). Nearly half used it in all cases. They had used it for a median of 5 (IQR 3,8) years, and 99% were comfortable teaching the technique to others. Of those who did not use the pedicle tie, 60% reported that it meets SOC, 14% reported that it does not, and 26% reported that it sometimes meets SOC. Over half of the respondents reported using the pedicle tie. Absence from the veterinary curriculum was the most frequently cited reason for not using the technique.

Strangulation of the small colon by a pendulous ovarian pedicle in an adult broodmare

SummaryA 17‐year‐old Quarter Horse broodmare was taken to surgery for signs of colic unresponsive to medical management. The small colon was strangulated by a pendulous ovarian pedicle. The strangulation was freed, and the affected ovary was removed. The mare developed signs of a small colon obstruction 4 days after surgery. The mare was euthanised 6 days after surgery because of a GI rupture. A post‐mortem examination revealed necrosis of the previously strangulated portion of small colon.

The prevention of rectovaginal fistula after rectal cancer surgery by packing with laparoscopic dislocated fat flap containing ovarian vascular pedicle anterior to the anastomotic stoma: a parallel group randomized controlled trial protocol

BackgroundRectovaginal fistula (RVF) is an abnormal channel formed by epithelial tissue between the anterior wall of the rectum and the posterior wall of the vagina, which manifests as vaginal gassing and defecation. It is one of the common complications of female pelvic surgeries. With the increased number of proctectomies for rectal cancer, the number of postoperative rectovaginal fistulas also increases. Once RVF occurs, the failure rate is still high with various treatments available. RVF causes great suffering to women and is still a major problem in treatment. Therefore, it is significant for female rectal cancer patients to prevent RVF after rectal cancer surgery. In this study, we introduce a new method to prevent RVF during rectal cancer radical operation.MethodsIn this randomized controlled trial (RCT), all operations are performed according to the principle of total mesorectal excision (TME) radical resection in rectal cancer surgery. All eligible participants will be divided into two groups: the experimental group and the control group. Experimental group: the anterior rectal wall of about 1 cm distal to the anastomosis was dislocated. Before the anastomosis of the rectal end, a fat flap (usually left side) containing the ovarian vascular pedicle was dislocated, measured by 10–15 cm in length and 2 cm in width. The fat flap containing the ovarian vascular pedicle was packed and fixed anterior to the anastomotic stoma with fibrin glue. Control group: surgery will be carried out in accordance with the TME principle. Participants will be compared on several variables, including the incidence of RVF after operation (primary outcomes), the occurrence time of postoperative RVF, the occurrence time of RVF after stoma closure, and other postoperative complications, such as anastomotic leakage, chylous leakage, and intestinal obstruction (secondary outcomes). The follow-up data collection will be conducted according to the follow-up time point, and the baseline data will also be collected for follow-up analysis. By comparing the incidence of rectovaginal leakage between the experimental group and the control group, we aim to explore the feasibility of this method for the prevention of postoperative RVF.DiscussionThis RCT will explore the feasibility of packing with a laparoscopic dislocated fat flap containing an ovarian vascular pedicle anterior to the anastomotic stoma after rectal cancer surgery to prevent RVF.Trial registrationChinese Clinical Trial Registry (ChiCTR) registration ChiCTR2000031449. Registered on June 26, 2019. All items of the WHO Trial registration data set can be found within the protocol.

儿童卵巢畸胎瘤蒂扭转1例并文献复习

儿童卵巢畸胎瘤蒂扭转1例并文献复习

Protective effects of carvedilol against ovarian ischemia-reperfusion injury in rats

Ovarian torsion is a gynecological emergency that can lead to ovarian ischemia-reperfusion injury (IRI). This study aimed to investigate the potential protective effects of carvedilol against ovarian IRI in rats. A total of 24 female rats were divided into four groups: control, ischemia (I), ischemia-reperfusion (IR), and ischemia-reperfusion with carvedilol treatment (IR-C). Ovarian ischemia was induced by clamping the ovarian pedicle for 4 hours, followed by reperfusion for 4 hours. The IR-C group received carvedilol treatment 30 minutes before reperfusion. After the experiment, the ovaries were removed and evaluated for hemorrhage, edema, and immunopositivity of Caspase 3, apoptosis-inducing factor (AIF), Microtubule-associated protein 1 light chain 3b (LC3B), and Tumor necrosis factor-alpha (TNFa). In the staining performed with Caspase 3 and AIF, moderate immunopositivity was observed in the I and IR groups (p&lt;0.001), while the IR-C group showed mild immunopositivity. In the stainings performed with LC3B and TNFa, the I and IR groups exhibited severe immunopositivity (p&lt;0.001), whereas in the IR-C group, TNFa showed moderate immunopositivity (p&lt;0.001), and LC3B showed mild immunopositivity (p&lt;0.001). The results suggest that carvedilol may have protective effects against ovarian IRI in rats.

Surgical Time for Laparoscopic Ovariectomy in Adult and Prepubertal Dogs

Two-portal laparoscopic ovariectomy (LOVE) was performed in adult (n=23) and prepubertal dogs (n=23) to compare surgical time and to evaluate the effect of age, body weight (BW), body condition score (BCS), ovarian pedicle fat score (OPFS) and intraoperative surgical complications on surgical time. Three classes of BCS were considered: BCS 1-2=lean; BCS 3=ideal; BCS 4-5=overweight. The same surgeon performed all surgeries. OPF was scored and was considered negative or positive. Intraoperative complications were recorded. Total surgical time was recorded from the first skin incision to the last portal closure suture placement. The surgical procedure was divided into seven stages, and each stage’s time was recorded. Data are reported as mean±SEM. Differences in the duration of defined surgical stages between groups were evaluated by age, BW, OPFS and intraoperative complications. One-way analysis of variance was used to assess the effect of BCS. No major complications were observed. Five and four minor complications were observed in adult and prepubertal dogs, respectively. Total surgical time was not different (p&gt;0.05) between adult (20.63±0.60 min) and prepubertal (21.48±1.75 min) dogs. BCS, BW, and OPF did not affect total surgical time (p&gt;0.05). Intraoperative complications have prolonged surgical procedure times (25.20±2.33 min vs 20.04±0.93 min). The time from the first skin incision to the insertion of the first trocar was shorter (p

Overcoming adnexal torsion: Whirlpool sign

Ovarian torsion or adnexal torsion is an acute gynecologic disorder involving complete or partial rotation of the ovarian vascular pedicle. The majority occurs in young women and is mainly associated to an underlying ovarian mass. It remains a challenging diagnosis and imaging plays a pivotal role for timely and accurate diagnosis [1]. In fact, clinical presentation is nonspecific, most patients present with acute abdominal or pelvic pain, either intermittent or persistent with possible nausea and vomiting.

Case Report on Double Primordial Uterine and Vaginal Atresia with Torsion of Left Ovarian Cyst Pedicle

Case Report on Double Primordial Uterine and Vaginal Atresia with Torsion of Left Ovarian Cyst Pedicle

Development of an acute ovine model of polycystic ovaries to assess the effect of ovarian denervation.

Polycystic ovary syndrome (PCOS) seems to be associated with increased ovarian sympathetic nerve activity and in rodent models of PCOS reducing the sympathetic drive to the ovary, through denervation or neuromodulation, improves ovulation rate. We hypothesised that sympathetic nerves work with gonadotropins to promote development and survival of small antral follicles to develop a polycystic ovary phenotype. Using a clinically realistic ovine model we showed a rich sympathetic innervation to the normal ovary and reinnervation after ovarian transplantation. Using needlepoint diathermy to the nerve plexus in the ovarian vascular pedicle we were able to denervate the ovary resulting in reduced intraovarian noradrenaline and tyrosine hydroxylase immunostained sympathetic nerves. We developed an acute polycystic ovary (PCO) model using gonadotrophin releasing hormone (GnRH) agonist followed infusion of follicle stimulating hormone (FSH) with increased pulsatile luteinising hormone (LH). This resulted in increased numbers of smaller antral follicles in the ovary when compared to FSH infusion suggesting a polycystic ovary. Denervation had no effect of the survival or numbers of follicles in the acute PCO model and did not impact on ovulation, follicular and luteal hormone profiles in a normal cycle. Although the ovary is richly inervated we did not find evidence for a role of sympathetic nerves in ovarian function or small follicle growth and survival.

A vessel sealing device and an ultrasonic dissector are equally effective and safe for single port laparoscopic ovariectomy in dogs.

To evaluate ovary removal surgery times and intraoperative complication rates between a 5-mm Sonicision cordless ultrasonic dissector (SCUD) and 5-mm vessel sealing device (VSD) for laparoscopic ovariectomy in dogs. Client-owned, intact female dogs (n = 10) presented for elective laparoscopic ovariectomy. In each dog, 1 ovarian pedicle was randomly assigned to the SCUD group and 1 to the VSD group. In the SCUD group (n = 10), the ovariectomy was performed using the SCUD device; the ovariectomy in the VSD group (10) was performed using a VSD. The number of applications of each device during ovariectomy, surgery time required for each ovary removal, total surgery duration, ovarian pedicle fat score, and intraoperative complications were recorded. Both left and right ovaries had median pedicle fat scores of 2 (range, 1 to 3). To complete an ovariectomy, the median number of SCUD applications was 9 (range, 7 to 13) times; the VSD had a median of 10 (range, 5 to 18) times (P = .98). Median surgery times for the removal of 1 ovary with the SCUD and VSD were 96 seconds (range, 45 to 417 seconds) and 110 seconds (range, 42 to 164 seconds), respectively (P = 1). No intraoperative complications were associated with either device. Therefore, the VSD was not required for rescue in the SCUD group, and no conversions to open ovariectomy were necessary. A standard approach laparoscopic ovariectomy performed with the SCUD was successful in our population of dogs, making the 5-mm SCUD safe for laparoscopic ovariectomy in healthy dogs, which provides a more affordable option for practitioners and clients.

Evaluation of lidocaine administration into the ovarian pedicle for the control of intraoperative and early postoperative pain during ovariohysterectomy in dogs

ObjectiveTo evaluate effects of lidocaine 2% administration into the ovarian pedicle on intraoperative nociception and early postoperative pain in dogs undergoing ovariohysterectomy. Study designProspective, randomized, blinded clinical study. AnimalsA total of 20 healthy adult female dogs of different breeds. MethodsDogs were premedicated with acepromazine (0.02 mg kg–1) and morphine (0.5 mg kg–1) intramuscularly, anesthesia induced with propofol and maintained with isoflurane. Dogs were randomly assigned to be administered 2 mL of saline (group S) or lidocaine 2% (group L) into the mesovarium (1 mL each side). Heart rate (HR) and noninvasive systemic arterial pressure were recorded before surgery (T0), before (T1) and during ligation of the right ovarian pedicle (T2), before (T3) and during ligation of the left ovarian pedicle (T4). Rescue treatment (propofol) was administered if HR or systolic arterial pressure (SAP) increased by 20% compared with the previous time point. Pain, assessed with the Glasgow Composite Measure Pain Scale-Short Form (CMPS-SF) was recorded before premedication (baseline) and after extubation. Administration of postoperative rescue analgesia was recorded. ResultsIn group S, HR was higher at T2 than T1 (112 ± 18 versus 89 ± 21 beats minute–1, p = 0.001) There were no significant differences between treatments at any time. SAP was higher at T2 than T1 in group S (110 ± 12 versus 100 ± 10 mmHg, p = 0.031). SAP was higher in group S than group L at T3 (113 ± 12 and 91 ± 10 mmHg, respectively, p = 0.001). No dogs required propofol intraoperatively. All dogs required postoperative rescue analgesia. Compared with baseline, CMPS-SF increased 60 minutes after extubation (group S; p = 0.019, group L; p = 0.043). Conclusions and clinical relevanceAdministration of lidocaine 2% into the mesovarium did not reduce intraoperative nociception and did not improve postoperative analgesia.

A successful pregnancy complicated with ovarian cyst torsion in the first trimester

Introduction: Ovarian cyst torsion is a rare gynecological emergency characterized by acute abdominal pain due to torsion of the ovarian vascular pedicle. Most cases are associated with several risk factors including pregnancy, ovarian cyst size, and pelvic organ anatomy. Despite the incidence of detected ovarian cysts during pregnancy increasing along with better antenatal care, the clinician needs to consider appropriate management for the safety of the mother and fetus. Case description: A 25-years old woman who was pregnant with a gestational age of 10 weeks was referred to the Emergency Department of Zainoel Abidin General Hospital. The patient complained of sudden abdominal pain at the lower right abdominal quadrant within the last 5 hours before hospital admission. The patient stated the history of the ovarian cyst based on previous ultrasonography assessment on previous antenatal care. Abdominal tenderness on the relevant quadrant was positive during the physical examination. A vaginal examination revealed a regular non-tender cystic mass with a diameter of 5 cm on the right adnexa. The ultrasonographic finding showed the presence of a cystic mass on the right ovary with a size of 6.52 cm x 5.6 cm x 4.06 cm and a positive whirlpool sign. The patient was diagnosed with ovarian cyst torsion in the first trimester of pregnancy. Due to the patient refractoriness to conservative management, the patient was treated surgically by cystectomy laparotomy in an emergency setting. Histopathology examination of the intraoperative specimen revealed a luteoma. The pregnancy was successfully maintained until full-term pregnancy and the baby was delivered by caesarian section due to malposition. Conclusion: Appropriate supportive management was required to maintain pregnancy and prevent fetal loss.

Veterinary Clinician's Opinions and Experiences with the Feline Ovarian Pedicle Tie

Ligation of the feline ovarian pedicle is commonly performed by autoligation, also known as the pedicle tie. This technique is faster than double ligation with suture, has a very low risk of hemorrhage-related complications, and has been suggested as an acceptable standard in all practice settings. However, although it has been demonstrated to be appropriate for novice surgeons under supervision, fewer institutions teach autoligation than double ligation. This study aimed to determine the opinions and experiences of general practitioners regarding the feline ovarian pedicle tie. An anonymous 23-question online survey entitled “Veterinary Clinician's Opinions and Experiences with Surgical Spay/Neuter Techniques” was advertised to veterinarians performing feline ovariohysterectomies via social media posts that also encouraged sharing and cross-posting. The survey questions, most of which presented non-exclusive answer options resulting in percentages summing to greater than 100%, probed the opinions and experiences of veterinarians regarding the technique. There were 142 respondents, with 77 indicating the use of the pedicle tie and 65 indicating no use. Of those who used the pedicle tie, most reported learning from either a dedicated high-quality high volume (HQHV) educational setting (32%) or a colleague/mentor (32%). Nearly half used it in all cases, although 20% did not use it for pregnant cats. They had used it for a median of 5 (IQ 3-8) years, and 99% were comfortable teaching the technique to others. Of those who did not use the pedicle tie, 60% reported that it meets the standard of care (SOC), 14% reported that it does not, and 26% that it sometimes meets SOC. Most veterinarians not performing the pedicle tie thought it was appropriate for unowned cats or cats in HQHV programs (77-82%), but only 55% thought it was appropriate for owned cats in general practice. The most common reasons given for not using the technique were that they had not learned it in vet school (51%), followed by the fact that they had not seen it used before (34%) and that while they had seen it done, they were nervous to try (28%). Seventy-four percent of those who did not use autoligation of the feline ovarian pedicle used autoligation of the testicular pedicle, either the pedicle tie (40%) or figure 8 (34%). Of those who believed that the pedicle tie does not meet SOC, 78% indicated it was because they had not seen it used, and 67% because it was not taught in vet school. However, 89% reported that an expensive commercially available device with similar positive attributes, specifically reduced procedure time, met SOC. Veterinarians using the pedicle tie graduated more recently (P = 0.040), with the median year of graduation in 2011 (IQR 2004-2016) as compared to 2007 (IQR 1998-2014). The greatest barrier to performing the technique or considering it SOC is a lack of familiarity with the method and the fact that it is not taught routinely in veterinary school. There is an encouraging trend, with more recent graduates being more likely to perform the technique; however, there remains an opportunity to increase use.

Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage ovarian cancer: A prospective multicentre study (SELLY).

e17579 Background: Comprehensive surgical staging of early epithelial ovarian cancer includes systematic paraaortic and bilateral pelvic lymphadenectomy but its therapeutic role is controversial and it is associated with potential severe morbidity. The feasibility of sentinel lymph-node (SLN) identification in early stage ovarian cancer has been shown only. We did a prospective multicenter study to assess the feasibility, detection rate and diagnostic accuracy of the SLN procedure in predicting the pathological pelvic-node status in patients with early stage ovarian cancer. Methods: This is a phase II single arm study (EUDRACT 2019-001088-58) including patients with presumed stage I-II epithelial ovarian cancer planned for immediate or delayed minimally-invasive comprehensive staging. The ovarian pedicle is injected with 2 mL of a 1.25 mg/mL indocyanine green (ICG) solution. The pelvic and lumbo-aortic retroperitoneum is then accessed and inspected to identify and remove SLNs. Staging is then completed including systematic pelvic and para-aortic lymphadenectomy and an histopathological examination of all nodes is performed. The primary endpoint was estimation of the sensitivity and sensibility of SLN in predicting nodal status. Assuming a sensitivity of 98.5% in predicting positive sentinel lymph nodes at histology, a pathological lymph node prevalence of 14.2%, a precision of estimate (i.e. the maximum marginal error) d=5%, a type I error α = 0.05, a sample size of 141 patients is needed to test the general hypothesis (i.e. to answer whether SLN(s) identified with ICG can accurately predict nodal status at histology of patients with apparently early EOC). Assuming a drop-out rate of 20%, a total of 176 patients will be enrolled in the study. Results: One-hundred and seventy-six patients were included with a drop-out rate of 22%. Sentinel node was identified in 102 patients (detection rate, 58%, [95% CI: 51-65]). There were no clinical differences between patients with successful or unsuccessful mapping. Both the infundibolopelvic ligament and the legamentum ovarii proprium were injected in 29.0% of cases. Twenty-one patients had positive nodes and 71% of them showed successful mapping. Among the latter, a negative sentinel node was identified in 3 patients (Sensitivity 78.6% [95% CI: 57-100]; Specificity 100%; Accuracy 97% [95% CI: 94-100]; PPV 100%; NPV 96,6% [95% CI: 93-100]). Twenty-two (12.5%) intra- and 25 (14.2%) postoperative complications occurred (12 G1; 9 G2; 2 G3, 2 G4). Clinical trial information: EUCTR2019-001088-58 .

Unilateral Ovarian Hypoplasia with Ipsilateral Fallopian Tube Hypoplasia

Herein, we present the case of a 36-year-old nulliparous woman with mild dysmenorrhea, diagnosed with a left endometrioma who underwent laparoscopic cystectomy. Laparoscopic findings confirmed an endometrioma with a normal fallopian tube in the left adnexa (Fig. 1a), and a hypoplastic ovary in the right adnexa (Fig. 1b). A balloon catheter was inserted into the uterus, and tube passage was verified using indigo carmine solution. The left fallopian tube was patent (Fig. 1c); however, the right fallopian tube was obstructed at the end of the fimbria (Fig. 1d). This was thus a rare case of unilateral ovarian hypoplasia with ipsilateral tubal hypoplasia, and we considered several theories to explain our findings. First, one theory to explain the etiology of congenital ovarian hypoplasia involves the loss of an ovary as a result of ischemia secondary to torsion of an ovarian pedicle with profound ovarian hypoxia, leading to cell death during fetal or early postnatal life [1, 2]; another theory is adnexal hypoplasia resulting from embryologic developmental agenesis or aplasia [3-5]. Second, embryologic theories of the etiology of unilateral adnexal agenesis and hypoplasia point to embryologic defects in the development of the genital ridge and the caudal end of the Müllerian (paramesonephric) duct [6, 7]. Failure of the Müllerian ducts to canalize is believed to result in failure of oviductal development, and Müllerian anomalies generally include combined ipsilateral uterine and renal-ureteric anomalies. The present case had only hypoplasia of the fallopian tubes, with the absence of other congenital anomalies of the reproductive organs or kidneys, making the hypothesis of an embryologic anomaly unlikely. Therefore, we postulated that the patient experienced torsion of the ovarian pedicle in the neonatal period or very early childhood.

Assessment of thermal response, cardiorespiratory parameters and post-operative analgesia in dogs undergoing ovariohysterectomy with different combinations of epidural analgesia and isoflurane

This study aimed to evaluate the thermal response of the eyelids and lacrimal gland of the left eye (LETG) through infrared thermography (IRT), cardiorespiratory parameters, and their association with nociception and pain in bitches undergoing elective ovariohysterectomy (OVH) anesthetized with isoflurane and epidural analgesia. Twenty-one healthy bitches of different breeds were randomized into three groups receiving epidural blocks: GL (n=7), lidocaine (2 mg Kg-1); GLF (n=7), lidocaine (2 mg Kg-1) and fentanyl (3 µg Kg-1); and GLM (n=7), lidocaine (2 mg Kg-1) with morphine (0.1 mg Kg-1). IRT and cardiorespiratory parameters were evaluated at baseline (Ebasal), thirty minutes before anesthetic premedication, and at different surgical events: first incision (EInc), ligature and section of the left (ELoV), and right (ERoV) ovarian pedicle, ligature, and re-section of the cervix (EUt), and skin suture (ESut). The assessment of acute pain in the immediate post-operative period was registered at E1h, E2h, and E3h using IRT, the Dynamic Interactive Visual Analogic Scale (DIVAS), and the University of Melbourne Pain Scale (UMPS) scales. The results showed a statistically significant decrease in the lower eyelid surface temperature (LELT) during EInc for GL (32.9°C ± 0.62), in comparison to GLF (34.2°C ± 0.62) and GLM (35.3°C ± 0.62) (P = 0.006). Regarding LETG, a significant increase (P = 0.03) in the IRT of Ebasal (36.8°C ± 0.63) and EInc (36.1°C ± 0.63) for GLM was observed in comparison to the thermographic values for both perioperative events and groups. The GLM showed a significant decrease in IRT values of ERoV at E3h in the upper and lower eyelids (P = 0.03 and P = 0.01, respectively). A progressive and significant reduction of the IRT values of LETG was also recorded in GLM, with differences in ERoV (35.2 °C ± 0.63) (P = 0.02) and E3h (35.3 °C ± 0.63) (P = 0.01). The cardiovascular parameters (SAP, DAP, and MAP) did not differ between treatments, but in GL, there was a significant difference (P = 0.01) during EInc and ESut, compared to Ebasal. In the body temperature, EInc and ESut gradually decreased in all treatment groups (P = 0.01). In conclusion, hemodynamic and cardiorespiratory stability was associated with IRT readings and the absence of nociception. Changes in superficial temperature in the immediate post-operative period were lessened using isoflurane and epidural analgesia of lidocaine alone or in combination with pure opioids. These findings were clinically validated to the DIVAS and UMPS acute pain assessment scales.