[Infectious pathology: vulvovaginitis, sexually transmitted diseases, pelvic inflammatory disease, tubo-ovarian abscesses]. / Patología infecciosa: vulvovaginitis, enfermedades de transmisión sexual, enfermedad inflamatoria pélvica, abscesos tubo-ováricos.

Sexually transmitted diseases are those where the principal path of infection is through intimate contact. Numerous patients attend Accidents and emergencies for this reason, both because of the clinical features and because of social implications. The most frequent symptoms are lower abdominal pain, vaginal bleeding or excessive or troubling vaginal flow. Vulvovaginites are one of the principal problems in the everyday clinical practice of gynaecology. A genital ulcer whose principal aetiology is herpes, followed by syphilis and chancroid, increases the risk of contracting HIV infection and alters the course of other sexually transmitted diseases. Inflammatory pelvic disease encompasses infections of the upper female genital tract. The importance of early diagnosis and suitable treatment is both due to the complications in its acute phase and to its sequels, which include chronic pain and sterility.

[Survival by surgical approach in patients with endometrial adenocarcinoma treated in Navarra in the 2001-2009]. / Supervivencia según vía de abordaje quirúrgico en pacientes con adenocarcinoma de endometrio tratadas en Navarra en el periodo 2001-2009.

BACKGROUND: Endometrial adenocarcinoma is the most frequent gynaecological neoplasia after breast cancer and represents 6% of cancers in women. The treatment for this disease is surgery. The majority of cases are diagnosed in their initial stages and surgery is curative; on other occasions it is necessary to add radiotherapy and chemotherapy. The classical treatment for endometrial adenocarcinoma is hysterectomy with double adnexectomy by laparotomy, with the addition of pelvic and para-aortic lymphadenectomy and omentectomy according to the characteristics of the case. During the last 10-15 years laparoscopy has been introduced in the surgical treatment of endometrial adenocarcinoma. The main aim of this study is to analyze the cases of endometrial adenocarcinoma treated surgically in the former Virgen de Camino Hospital (nowadays the Hospital Complex of Navarra) during 2001-2009. METHODS: Historical cohort of 444 patients with endometrial adenocarcinoma during 2001-2009 who received surgical treatment, followed four years. CONCLUSIONS: The results confirm that laparoscopy is a safe alternative to classical laparotomy as it does not affect either survival or time free of disease, in both endometrioid adenocarcinoma and non-endometrioid adenocarcinoma.

Trends in infant mortality inequalities in the Americas: 1955-1995.

STUDY OBJECTIVE: s: To describe overall and income related trends in infant mortality inequalities in the Region of the Americas from 1955 to 1995. DESIGN: Infant mortality rates (IMRs) were computed and their trends assessed by ordinary least squares. Overall trends in IMR inequalities among countries were analysed by comparing 10 year period IMRs, Gini coefficients, and Lorenz curves. Income related trends in IMR inequalities were assessed using 10 year period IMR ratios between the highest and the lowest quintiles of the per capita gross national product (GNP) distributions (adjusted for purchasing power). SETTING: Aggregated country data were used for all countries with over 200 thousand inhabitants (33 geopolitical units). The 10 year period midpoint IMR estimates used for the 1955-1995 time series were those published by the United Nations in 1997. MAIN RESULTS: IMRs decreased from 90.34 to 31.31 per 1000 live births between 1955 and 1995 at an average of 15.3 every 10 years. In contrast, Lorenz curves and Gini coefficients were similar for the five 10 year periods. After grouping by adjusted GNP distribution, a similar decreasing trend of IMR was observed in all groups. The rate ratio between the group at the lowest quintile and that at the highest quintile ranged from 4 to 5. The analysis of variance for repeated observations showed that there is a significant reduction in the IMR (F=130.18; p<0.01), that trends did not differ significantly among groups (F=1.16; p=0.32), and that they were approximately linear (F=155.83; p<0.01). CONCLUSIONS: Despite a sizable reduction in the infant mortality, whether or not income related, levels of IMR inequality among countries have remained almost constant between 1955 and 1995 in the Region of the Americas. Further analysis and focused interventions are needed to tackle the challenges of reducing these persistent mortality inequalities.

Surface-charging behavior of Zn-Cr layered double hydroxide.

A Zn-Cr layered double hydroxide (LDH) having the formula Zn(2)Cr(OH)(6)Cl(0.7)(CO(3))(0.15)2.1H(2)O was synthesized and characterized by powder X-ray diffraction, infrared spectroscopy, acid-base potentiometric titration, mass titration, electrophoretic mobility, and modeling of the electrical double layer. Adsorption of alizarin was also performed in order to show some particular features of the HDL. Net hydroxyl adsorption, which increases with increasing pH and decreasing supporting electrolyte concentration, takes place above pH 5. The electrophoretic mobility of the particles was always positive and it decreased when the pH was higher than 9. An isoelectric point of 12 could be estimated by extrapolating the data. The modified MUSIC model was used to estimate deprotonation constants of surface groups and different adsorption models were compared. Good fit of hydroxyl adsorption and electrophoresis could be achieved by considering both OH(-)/Cl(-) exchange at structural sites and proton desorption from surface hydroxyl groups. The modeling, in agreement with alizarin adsorption, indicates that most of the structural positive charge of the LDH is screened at the surface by exchanged anions and negatively charged surface groups. It also suggests that only structural charge sites initially neutralized by chloride ions are active for anion exchange. The remaining sites are blocked by carbonate and do not participate in the exchange.

Hemangiolinfangioma cerebral. reporte de caso / Orbital limphangioma. case report

El tratamiento del linfangioma orbitario es desafante. El sildenafl se ha propuesto como una opción terapéutca para pacientes con linfangiomas orbitariosirresecables.Se reporta el caso de una paciente de 10 años de edad quien presenta extrusión parcial del globo ocular derecho de curso progresivo rápido, asociado apérdida parcial de la visión, limitación de la movilidad y resistencia a la retropulsión del globo ocular ipsilateral diagnostcado como hemangiolinfangiomacerebral quirúrgicamente irresecable. Se inicia tratamiento con sildenafl a 40mg/día durante 12 semanas, basado en los datos de un estudio pilotorealizado en la Universidad de Stanford; evidenciando regresión marcada del proceso con mejoría clínica, estétca y radiológica.En el presente caso, el tratamiento tras 12 semanas con sildenafl disminuyó el crecimiento de la malformación linfátca. Se requieren estudios conmayor número de pacientes para determinar la efcacia de este tratamiento.

Treatment of orbital lymphangioma can be challenging. Sildenafl has been proposed as a therapeutc opton in patents with unresectable orbitallymphangiomas.We report a 10 year old patent with rapid partal extrusion of the right ocular globe associated with visual impairment whose orbital lymphangiomatreated with 40 mg of sildenafl improved afer 12 weeks.In this case report, treatment with sildenafl for 12 weeks improved surgically irresectable orbital lymphangioma. Larger clinical trials are needed toestablish efcacy of this treatment.

Uso de Sistema de terapia al vacío en cierre de gastrosquisis complicada: reporte de caso / Vacuum-assisted device in gastroschisis

La gastrosquisis constituye una patología grave neonatal que plantea un reto para el cirujano y es una emergencia quirúrgica. En la mayoría de casos, el cierre de la fascia en los casos de gastrosquisis puede realizarse primariamente o después de colocar una bolsa de Silo. Presentamos el caso de unpaciente masculino de 34 semanas por Ballard con gastrosquisis; a quien se le coloco bolsa estéril (Silo) al nacer y presentó dehiscencia parcial de lamisma y evisceración, en seis ocasiones durante un período de tres semanas. Por lo que se colocó sistema de terapia al vació sobre bolsa de plástico estéril fenestrada, realizando tres cambios y logrando el cierre completo del defecto a los 17 días. El sistema de terapia al vacío puede utilizarse comouna alternativa cuando la bolsa de Silo no puede cerrar el defecto abdominal en pacientes con gastrosquisis.

Gastroschisis is a serious neonatal pathology and a surgical emergency. A general procedure for closure of the abdominal wall defect is by primary closureor by placing a protectve ¨silo¨. We report the case of male neonate born at 34 gestatonal weeks with gastroschisis. A Silo bag was placed at birth butpresented dehiscence and partal abdominal evisceraton six tmes during a three week period. A vacuum-assisted device was used over a fenestratedsilo. Three vacuum changes were performed achieving complete closure of the abdominal wall defect in 17 days. The use of vacuum-assisted device isan alternatve when closure of the abdominal wall defect of gastroschisis cannot be achieved with the use of a silo.