Showing papers in "Ginecología y obstetricia de México in 1991"

Uterine cervix cancer. Clinical stage III. Combined radiotherapy and chemotherapy treatment

Abstract: 55 patients with stage III carcinoma of the uterine cervix were entered into a prospective randomized study to evaluate the possible radiation-potentiating properties of bleomycin. Group A received classical radiation treatment with telecobalt-therapy 50 Gy/25 fractions plus 32 Gy/4 fractions (Cathetron). The other two groups received 15 mg of bleomycin by continue infusion two time of week during 5 week, groups B before, and group C after, irradiation. The morbidity was minimal. The initial response was complete in 49 cases and partial in 6 cases. At 2 years there were 26 recurrences, 22 (88.8%), locoregional recurrences and 4 distant metastasis, 3 in the group of bleomycin treatment. The probability of actuarial survival was 62.1%, 30.1% and 35.6% respectively to groups A, B and C. Addition of bleomycin to radiotherapy failed to increase the recurrence-free survival.

Proposed normal values for alpha fetoprotein in maternal serum for the detection of neural tube closure defects and Down syndrome. Preliminary study

Abstract: To establish a normal range of alpha fetoprotein in maternal serum (AFP sm) in the population at the "20 de Noviembre" Hospital in Mexico City, there were studied 46 patients with a normal pregnancy confirmed with ultrasonography between 16 to 18 week of gestation The 97 determinations of AFPsm were made by radioimmunoanalysis The multiples of the median (MoM) were 216 al 16th weeks, 233 a 17th week 243 al 18th week of pregnancy Now the methods to determine abnormalities in the product and the genetics studies are proposed only to the patients considered high risk (older than 35 years old, previous malformed son or family history of those abnormalities) AFPsm and the establishment of normal range allow us to amplify the study to every pregnant woman and to determine those malformations in the pregnant women of low risk which represents about 90-95% of DCTN and about 80% of SD

[Maternal mortality at the Hospital de Ginecobstetricia del Centro Médico de Occidente, IMSS. Review of 5 years].

Abstract: This study was carried out in order to know the mortality rate and related factors at Hospital de Ginecobstetricia, Centro Medico de Occidente, and to analyze the problem and to propose solutions. The files and reports of the Maternal Mortality Committee, regarding 74 deaths in a five year period, were reviewed. The definitions and classification criteria proposed by tha International Federation of Gynecology and Obstetrics, were used. The average maternal death rate was 8.01 per 10,000 births. The main death causes were: hemorrhage, systemic hypertension, probable pulmonary thromboembolism and sepsis. Direct obstetrical deaths, were 82.4%; predictable deaths, 66.2%, and deaths on hospital arrival, 39.1%. There was professional liability in 66.2%, and hospital liability in 25.6%. These and other data, were analyzed and possible strategies to diminish maternal mortality, were proposed.

[Management of severe pre-eclampsia in the puerperium. Comparative study of sublingual nifedipine and hydralazine].

Abstract: At random, two therapeutic schemes for severe preeclampsia during the puerperium, were evaluated. Group A (n = 20) was left without antihypertensive medication and sublingual nifedipine was used only in case of diastolic pressure of 110 mmHg or more. Group B (n = 18) receive Hydralazine 40 mlg. per os, every 6 hrs.; in this group also, nifedipine was administered in case of diastolic pressure of 110 mmHg or more. The only differences were that in group B the intervals for the administration of nifedipine were much shorter than in group A; also, in the same group the need for another antihypertensive was more frequent (5 of 18 vs 1 of 20 patients).

Manejo activo del trabajo de parto.

Abstract: Eighty three primigravidae patients at the end of latency labor, erased cervix, 3 cm dilation, vertex presentation and adequate pelvis, were studied. Two groups were formed: 53 patients in the study group, who received active management of labor, and 30 patients in the control group, treated in the traditional way. In all the patients a graphic recording of labor, was carried out; it included all the events, and as labor advanced, a signoidal curve of cervical dilatation, was registered, as well as the hyperbolic one for presentation descent. The study group received the method in a systematized manner, as follows: 1. Peridular block. 2. Amniotomy. 3. IV oxytocin one hour after amniotomy. 4. FCR monitoring. 5. Detection of dystocia origin. Materno-fetal morbidity was registered in both groups, as well as cesarean section rate, instrumental delivery and its indications, labor duration, and time of stay in labor room. Diminution of above intems and opportune detection of dystocia, were determined. It was concluded that a constructive action plan, starting at hospital admission in most healthy women, allows a normal delivery of brief duration.

Prophylactic use of antibiotics in cesarean section

Abstract: The objective of this investigation was to determine the effectiveness of ampicillin administration as a prophylactic regime in patients undergoing cesarean section. A double blind randomized study compared a long course of ampicillin (7 days) to a short course of ampicillin (three doses) to placebo. Thirty one patients were included in the placebo group and sixty patients in the drug groups. Only one patient in the placebo group and one in the drug group developed infectious morbidity. There was no significant difference (p less than 0.001) between the placebo and ampicillin groups.

Prenatal diagnosis by ultrasonography. A randomized study of 3000 patients

Abstract: From January through December, 1990 at Hospital de Ginecoobstetricia Tlatelolco, 3,000 pregnant women were subjected to ultrasonography at random using a real time, B mode apparatus with a 3.5 MHz lineal transducer. Fetal malformation were diagnosed, some of which would have passed undetected in the labor room with consequent delay of treatment and false raise of perinatal morbidity and mortality rates.

[Comparative study of the morpho-functional features of the sperm of fertile and infertile men and their relation to fertilizing ability].

Abstract: The recent advances in assisted reproduction procedures have helped to the better understanding of the female reproductive physiology and pathology, however, male infertility remains as a poor explained medical problem, nevertheless it occurs in almost 50% of infertile couples. Oligoasthenozoospermia is one of the more common causes of male infertility, therefore we measured in 10 patients with this diagnosis and in 10 fertile euspermic men, besides the parameters included in the standard semen analysis, the quantitative motility (photography method), capacitation-acrosome reaction and the sperm ability to fertilize zona-free hamster oocytes, with the aim to correlate the morphofunctional characteristics of the male gametes with their fertilizing capacity. The results showed significant differences in every parameter studied, including the correlation analysis. In relation with the in vitro induction of the acrosome reaction in both groups, we found significant correlations of the sperm fertilizing ability and the progressive sperm motility with this parameter (fertile group: RS = 0.834, P less than 0.005 & RS = 0.612, P less than 0.05; infertile group: RS = 0.986, P less than 0.001 & RS = 0.536, P less than 0.05 respectively), nevertheless the sperm rate which completed this process was low in relation to the total sperm population even in the fertile men (9.4 +/- 2.0% & 4.4 +/- 2.5% acrosome reacted cells after 18 h of incubation, in the fertile and infertile males respectively). The results also showed the presence of fully capacitated spermatozoa in both groups, since they penetrated the zona-free hamster eggs and decondensed their chromatin (73.9 +/- 13.4% & 10.4 +/- 7.7% penetrated eggs in the euspermic and oligoasthenozoospermic individuals respectively), however, the spermatozoa from the oligoasthenozoospermic men showed low polyspermy indexes too (0.1 penetrated spermatozoa/inseminated oocyte). In this last group we found, in addition, that the mean sperm velocity and the abnormal sperm morphology rate showed significant correlations with the fertilizing ability of the male gametes too (RS = 0.986, P less than 0.005 & RS = -0.942, P less than 0.005. respectively). These data allow us to suggest that before an infertile man is involved in any assisted reproduction program, the presence of possible morphofunctional alterations in the spermatozoa be analyzed, with the aim to be able to make a better prognosis about the success with these patients.

[An alternative to perinatal care: traditional midwives in the state of Morelos].

Abstract: In Morelos, it is estimated that about 40 percent of the births are attended by traditional birth attendants or parteras. This indicates a considerable contribution made by these health care workers. The objective of this study is to present a profile of the parteras in the state of Morelos: their concepts, resources, practices, age groups, geographic concentration, and the degree of training they possess. At the National Institute of Public Health (INSP), a census was created from three sources: data on the rural areas obtained by researchers at INSP; censuses of the parteras made by the Secretary of Health; and those made by the Mexican Social Security System. The total number of parteras found was six hundred and thirty. They are distributed in 33 municipalities throughout the state with the majority lying in the border zones of the urban centers. Most of the parteras are between the ages of 51 and 70 years, however, there exists a small number who are less than 30 years old. Approximately 60 percent knew how to read and write, and half had received training on health services. Besides this information and other studies based on this theme, the parteras have been classified as traditional, trained, and untrained. Due to secondary sources, the data has inevitable limitations in quality. However, the integration of the three sources of information and its relation to qualitative variables constitutes the beginning point for elaboration on plans and programs with this therapeutic sector.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum concentrations of estradiol and testosterone in patients with oligoasthenozoospermia and asthenozoospermia

Abstract: In order to study the possible influence of circulating concentrations of estradiol (E2) and testosterone (T) on the spermatogenesis, 43 subjects, 21 to 43 years of age; 16 of them with oligoasthenozoospermia; 16 with "pure" asthenozoospermia, and 11 with normal semen study, were studied. This last group was taken as control for results evaluation and comparison. In all the cases, the presence of genitourinary infection, as well as testicular lesions and varicocele, was previously discarded. Serum concentrations of estradiol, testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL), were determined by radio-analysis, in fasting blood samples. The results are shown as average values +/- standard error (mean +/- SE). Statistical analysis of differences between the groups, was done by "t" Student test in paired samples. Patients with oligoasthenozoospermia showed a significant increase (56.9%) (less than 0.001) in estradiol circulating levels, while T, FSH, LH and PRL concentrations were below normal band, and there were not significant differences between the three groups. These results suggest that the excess of estradiol or of some of its metabolites could affect normal production of spermatozoa, maybe due to a direct effect on germinal epithelium of testicle.

Erythema nodosum and pregnancy. Report of a case

Abstract: Erythema nodosum is a rare disease, it appears frequently in association with infectious disease and with some drugs administration. A case associated with pregnancy is presented. The importance of hormonal behavior in its genesis, is considered. We conclude that the transitional hormone state in women is a very important factor in it's appearance. Estrogens play an important roll in the immunological response.

Nongynecological surgical procedures performed by an oncological gynecology service

Abstract: From March, 1987 to July 1990, 1,568 surgical procedures, were done at Oncological Gynecology Service; 206 of them (13.1%) were considered as "non-gynecological" surgical procedures; 182 (88.3%) were secondary to a malignity diagnosis, being the most frequent one ovarian carcinoma (54.4%). As to benign lesions, 11.7% caused "non gynecological" surgery, most frequent were severe pelvic adhesions, 41.6%, and severe endometriosis, 25%. "Non-gynecological" surgical procedure carried out most frequently was pelvic lymphadenectomy. Morbidity was 3.8%, and mortality, 0.48% due to acute myocardial infarction. The acceptance for oncologic gynecologist is justified in this series, based on survival and morbi-mortality, which permits the participation in a multidisciplinary team.

[Importance of free intracellular calcium in the physiopathology of pre-eclampsia].

Abstract: Due to the participation of intracellular free calcium in the mechanisms of vascular smooth muscle contraction, and its importance in the physiopathology of essential arterial hypertension, its possible role in pre-eclampsia physiopathology, was investigated as a cellular model, platelets, were use, as they are similar to vascular smooth muscle cells. The study purpose was to investigate if intracellular concentration of ionized calcium is greater in the patients with pre-eclampsia than in normotensive pregnant women, and also, if there exists a correlation between intracellular calcium concentrations and arterial tension, Seven pre-eclamptic patients, diagnosed by the following criteria: arterial tension greater than or equal to 130/90 mmHg, edema and proteinuria, between 20 to 35 years of age, during the third trimester of gestation, without personal nor family antecedents of hypertension; none of them received treatment at the time, were studied. As control group seven normotensive pregnant women, equal by chronologic and gestational age, were included. Intracellular calcium in platelets was measured by Fluo-3-Am, and arterial blood pressure with conventional sphygmomanometer. Intracellular calcium and arterial blood pressure values, were compared, in both groups by Student's t, and analysis of lineal regression between intracellular calcium and mean arterial blood pressure, was done. Intracellular calcium was significantly greater in patients with pre-eclampsia, than the ones in the control group (142 +/- 5.6 vs 110 +/- 14 p less than 0.0001). Mean arterial blood pressure was also significantly greater in patients with pre-eclampsia (114 +/- 5 vs 83 +/- 3 p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Multifactorial analysis of patients with endometriosis in an institutional program of assisted reproduction

Abstract: It is a retrospective and transverse study with an analysis of results from patients submitted to intrauterine insemination (IIU), intratubal gamete transfer (GIFT) and in vitro fertilization and embryo transfer (FIVTE), at the Clinic of Assisted Reproduction, Instituto Nacional de Perinatologia in Mexico City. From 134 cycles of patients submitted to IIU, 113 corresponded to women with diagnosis of sterility from non determined cause, and 21 to cases with endometriosis, and at least one permeable tube. From the first group, 22 pregnancies were obtained, for a monthly fertility rate of 19.4%; and from the second one, 12 pregnancies with a fertility rate of 56%. This, which is very high , may be explained by the relatively small number of cases in the second group, or else, by the influence of a previous medical treatment for endometriosis; the square Chi analysis shows a P less than 0.01 in the two groups. In the GIFT and FIVTE cases, from which 35 cycles were analyzed, per each procedure, there were 10 pregnancies, 9 for GIFT and one for FIVTE; the amount is very limited in order to obtain conclusions, but it seems that there is a proportional tendency in GIFT to less amount of pregnancies in women with endometriosis. The analysis of hormonal follow up did not show differences in the groups, and the averages may be useful to determine, early, the cancellation, or not, of an stimulation cycle. Finally, in FIVTE cases there is a diminution of fertilization index in women with endometriosis (53%), as compared with the cases without disease (80%).(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of the usefulness of ultrasonography in the insertion and control of the intrauterine device

Abstract: The usefulness of ultrasonography in IUD insertion and control, was evaluated. A follow up of IUD localization, placed at the end of puerperium and in non puerperal patients, was done. The copper T IUD 200 was used, and was placed in 50 patients. Ultrasonographic study was done right after IUD placement, at one month and at three months; uterine longitudinal sections, as well as transversal ones, for adequate localization of IUD; data were taken for control and followup. There were no IUD expulsion, pregnancy, or uterine perforation. Conclusions were: 1. Ultrasonography is useful for IUD control. 2. IUD placement at the hospital is adequate. 3. There were no complications. 4. Alterations produced by IUD insertion are more frequent during the first month, and very scarce at third month. 5. Dysmenorrhea was most frequent after IUD insertion. 6. Echosonographic control of IUD is the most accurate method in order to know its localization within the uterine cavity.

Lesions of the fallopian tube following tube occlusion

Abstract: This is a study using light microscopy and electronic microscopy of Fallopian tube subjected to sterilization; and compare it with a control group. A total of 60 samples from patients with different surgical procedures, whose age was from 20 to 40 years; they were amenorrheic, without antecedents of pelvic inflammatory disease nor endometriosis. Among the control group, there were lesions as isthsmical nodular salpingitis in 30.7%. There was chronic salpingitis in 15.3%; follicular salpingitis in 23%, and polyps in 15%. In the group with OTB antecedents, endosalpingiosis was found in 20%; follicular salpingitis in 30% and chronic salpingitis in the remaining 50%. By means of electronic, ultrastructural microscopy, were seen lesions at myosalpinx level, that is, alterations in myofilaments, formation, much fibrosis and descilliation in the adjacent to OTB. It may be concluded that these findings, never seen before, may condition an alteration of tubal motility in patients subjected to rechannelization procedures, that condition an alteration in gametes transportation, avoiding fecundation or a greater incidence ectopic pregnancy incidence.

Treatment of cervical intraepithelial neoplasia using the CO2 laser

Abstract: The use of laser therapy in CIN, is a practical method that has revolutionized the treatment of a very common pathology, that is the cervical neoplasia in its early stages. 86 patients with different stages of cervical intraepithelial neoplasia, were studied. Patients in groups I (45 patients) y II (28 patients), were submitted to a vaporization crater of the whole transformation zone because of having the cervical canal free of lesion. In group III (13 patients), a cylinder of the cervix was done to perform histological study, whether the cervical canal was compromised or not. The cytology control results for group I were excellent; from (45 patients) who came to 3-month check-up 79.1% of the whole presented negative II. For group II (28 patients), in first pap smear two patients (7.1%) had CIN, the rest of smears were reported 66% negative II, and in the 30.6% negative I. For the group III 14.2% (5 patients) of the whole had abnormal results, the rest of the smears 73.5% of the results reported negative II. The incidence of failure for this procedure is similar to that of hysterectomy with the same therapeutic goal .

Tratamiento de la mastopatia fibroquistica con lisurida

Abstract: Se realizo una investigacion clinica en la que se estudiaron 23 pacientes, con un rango de edad entre 19 y 50 anos, seleccionadas al azar en la consulta externa de ginecologia de nuevo ingreso del H. Dr. Dario Fernandez Fierro del ISSSTE, a las que se diagnostico masatopatia fibroquistica (MFQ), y con unico criterio de exclusion que hubiesen recibido tratamiento previo. A todas las pacientes se les realizo historia clinica, exploracion fisica, perfil hormonal ginecologico, (FSH, LH, Prolactina, Testosterona, Estrogenos y Progesterona), ultrasonografia mamaria y mastografia en pacientes de mas de 40 anos o que lo ameritaran. Se indico tratamiento a dosis de media tableta (0.1 mg) de lisurida cada 8 horas de preferencia,con los alimentos, durante 3 meses. Al termino se efectuo control con perfil hormonal ginecologico, ultrasonografia mamaria y exploracion fisica. Se obtuvieron los siguientess resultados: la media fue de 31 anos, la mayor incidencia de MFQ se encontro entre 20 y 29 anos, la sintomatologia desaparecion en 36.9 por ciento, y disminuyo notablemente en 63.1 por ciento. Las lesiones por ultrasonografia de grado \"0\" desaparecieron en 100 por ciento, de los casos y las de grado I y II mostraron mejoria. A la exploracion fisica todas las pacientes presentaron mejoria, las cifras de estrogeno disminuyeron y las de progesterona aumentaron. Las cifras dse prolactina se encontraron normales tanto al inicio como al final del tratamiento. Una de las pacientes presento efectos secundarios severos que ameritaron suspender el tratamiento; 4 pacientes con efectos secundarios leves pudieron continuar el tratamiento y en 18 pacientes no se manifestaron efectos indeseables. (au).

Prenatal diagnosis in 350 amniocenteses

Abstract: Between march 1988 and march 1991, 350 amniocenteses were performed as a part of the prenatal diagnosis program at the Instituto Nacional de Perinatologia. Cytogenetic diagnosis was obtained in 348 cases (99.4%). A total of ten abnormal fetal karyotypes (2.9%) were detected: Down's syndrome, (5) Edwards' syndrome, (2) Turner's syndrome, (1) Klinefelter's syndrome (1) and chromosomal instability. (1) In addition, one carrier of a Robertsonian translocation, two balanced carriers of reciprocal translocations and three cases of true mosaicism, were also detected. In the group of patients studied for indications other than risk of chromosomopathy, one female fetus affected by congenital adrenal hyperplasia, was observed. There were two miscarriages, resulting in a post-procedural fetal loss of 0.57%.

Systematic examination of the uterine cavity after parturition

Abstract: The revision of uterine cavity afterbirth should be a process preventing complications immediate or late during puerperium, due to the retention of ovular remains that are not diagnosed in opportunely, avoiding so the risk that implies for the patients who show bleeding that leads them to complications of hemorrhaging in the interest of puerperal infection, with consequences so serious such as mutilation or death, otherwise undergoing surgery under poor conditions, in addition to the extra administrative costs, that imply surgery and those costs, derived from hospitalization; 1,205 patients were studied. On 1,155 the revision of the uterine cavity was performed; only one of them developed complications irrelevant to the process, consisting in fever, uterine subinvolution, more than normal hemorrhaging. On fifty patients the uterine cavity afterbirth was not found, fourteen patients experienced greater than normal hemorrhaging and hypothermia two to five days after being released, caused by the presence of ovarian remains, requiring posterior hospitalization. One patient experienced inflammation of the peritoneo due to the presence of placental remains.

The male factor in the incidence and persistence of condyloma of the cervix and intraepithelial cervical neoplasms

Abstract: From 1988 to 1990, prospectively, were studied 113 masculine couples (males), and 113 women, treated for intraepithelial cervical neoplasia, alone, or associated to viral infection by human papilloma virus-80 males were asymptomatic (70.7%). Colposcopy and local application of acetic acid, were needed for the diagnosis of 69.9% of lesions, which presented with a gray color to a brilliant white color. Papulous lesion, (56.70%) was most frequent; and the classical lesions as condyloma acuminatum, were 15.52%; urethral cytology was positive for condyloma (one condyloma in 30%), and biopsies in 91.66%. There were persistence and recidiva, nonsignificant, when the man had received treatment suggesting that the treatment does not alter the appearance of condyloma, nor cervical intraepithelial, neoplasia.

[Cryosurgery of the uterine cervix. Our experience in 3,184 cases].

Abstract: An analysis is made of 3,184 cases of cryosurgery of the uterine cervix treated along 18 years for diverse types of lesions: 2,050 cases of ectropion of the cervix (64.38%), 811 chronic cervicitis (25.47%), 48 eversions of the cervical canal (1.51%), 24 of cervical condyloma acuminata (0.75%) and 251 of CIN (7.88%). A nitrous oxide cryosurgical system was used. This study evaluate the features of the cryolesion, correlating the freeze time, the size of the frosted area around the probe, the size of the resulting ice-ball and the depth of the epithelial tissue necrosis microscopically measured. For this study cryosurgery was applied to the cervix of 56 women, 1 to 7 days before hysterectomy was performed for benign disease. Statistical analysis was made using regression-correlation calculations to determine the correlation coefficient (r), concluding that the freezing effect and the depth of tissue necrosis are not correlated with the freeze time, but it was demonstrated that there is a reliable correlation between the width of the frosted area around the probe and the depth of tissue necrosis. The extension of cryolesion was influenced by the type of probe, the anatomical position in the cervix, shape of the external is and freeze time, which may be related with the pressure of the gas and the possible clogging of the tubes by pollution. In this paper it is studied too the histopathologic features of the cryolesion. The results obtained in the diverse groups of treated lesions were: 1. In 92% of cases of mucous ectropion of the cervix, one treatment was enough to heal the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)