Gestational surrogacy. Medical, psychological and legal aspects: 9 years of experience in Mexico.

STUDY QUESTION: What are the medical, psychological and legal aspects involved in running a gestational surrogacy (GS) program in Mexico? SUMMARY ANSWER: The correct and complete implementation of a medical protocol, adherence to legality and psychological screening are key elements for the success of a GS program. WHAT IS KNOWN ALREADY: To our knowledge, this is the first reported GS case series in Mexico. STUDY DESIGN SIZE DURATION: This was a retrospective, descriptive study of 135 cycles performed between 2007 and 2016 at a fertility center in Villahermosa, Tabasco, Mexico. PARTICIPANTS/MATERIALS SETTING METHOD: We analyzed data from 135 GS cycles, 57 intended parents (IP) and 63 gestational carriers (GC). MAIN RESULTS AND THE ROLE OF CHANCE: GS in Mexico is only allowed in its altruistic mode. The legal requirements for the GCs are age 25-35 years and a complete medical examination that certifies no pregnancy during the last 365 days before embryo transfer and excludes infectious and chronic diseases. The IPs must be aged 25-40 years of age, have Mexican citizenship, and provide life insurance and medical expenses for the GCs. The GC recruitment was carried out by word of mouth. Of the 150+ women that requested information, 89 were identified as possible candidates. In total, 77 underwent the psychological evaluation protocol and nine were rejected owing to behavior and emotional alterations, giving 68 who began the medical selection protocol. Five women were not accepted as they were positive for human papilloma virus, or had experienced endometrial polyposis or recurrent pregnancy loss. Finally, 63 women entered the IVF protocol as GCs. The indications for GS were: hysterectomy 32%, implantation failure 21%, single fathers 14%, maternal medical condition 14%, recurrent pregnancy loss 11%, previous pregnancy complication 5% and uterine pathologies 3%. The mean age of intended mothers was 38.8 years. The average number of embryos transferred per cycle was 1.9, with 22.2% of cycles resulting in pregnancies. The live-birth rate per IP was 33.3%, 18.5% of cycles resulted in live births, with 24% of live births being twins. LIMITATIONS REASONS FOR CAUTION: Owing to the retrospective nature of this study conclusions must be drawn accordingly. WIDER IMPLICATIONS OF THE FINDINGS: As the first article addressing GS in Latin America, it may serve as a reference for future practice and publications. The results demonstrate the importance of having an assisted reproduction program in the form of GS. STUDY FUNDING/COMPETING INTERESTS: There was no external funding used and there are no conflicts to report.

[Our experience in neuroma surgery]. / Nuestra experiencia en cirugía del neurinoma.

Our 24-year experience with acoustic neuroma surgery is reported. Three approaches were used in 34 patients: translabyrinthine (11 cases), transtemporal (2 cases), and retrosigmoid (21 cases). Prolonged facial paralysis occurred in 27% of patients with the translabyrinthine approach and in 15% with the retrosigmoid approach. Facial nerve monitoring was used in all operations with the retrosigmoid approach. In the translabyrinthine approach, 5 patients had CSF leak, 2 required secondary surgery, and 2 developed meningitis. With the retrosigmoid approach, 5 patients had CSF leak, 2 required secondary surgery, 3 developed meningitis (1 died), and 1 patient required emergency reoperation for posterior cranial fossa hematoma. Auditory function was preserved in one patient. The advantages of the retrosigmoid approach have become apparent: good exposure, speed, and preservation of the facial and cochlear nerves.

[Implantation of a program for the early detection of neonatal hearing loss]. / Implantación de un programa para la detección precoz de hipoacusia neonatal.

Permanent childhood hearing impairment is a serious public health problem. Identification by screening in the first few months of life has the potential to improve affected children development. Neonatal hearing screening programs endorse the WHO requirement for a cost efficient screening. This paper shows the implementation of a medium-size hospital-based universal newborn hearing screening program using transient evoked otoacoustic emissions. Operational procedures and requirements are discussed. Quality control and results are showed.

[Percutaneous mitral valvuloplasty with the Inoue balloon. The initial experience and 3-year clinical follow-up at the Instituto Nacional de Cardiología Ignacio Chávez]. / Valvuloplastía mitral percutánea con balón de Inoue. Experiencia inicial y seguimiento clínico a 3 años en el Instituto Nacional de Cardiología "Ignacio Chávez".

In 113 patients with mitral stenosis a balloon mitral valvuloplasty (VMPB) was performed. There were 97 female and 16 male patients. Mean age was 40 +/- 11 with range of 18 and 70 years. 95 patients had sinus rhythm and 18 were on atrial fibrillation. Previous mitral commissurotomy was reported in 13 patients and 5 were pregnant at the moment of the procedure. Patients were carefully selected using both clinical and echocardiographic studies as well as the Wilkins score (SW). Transesophageal echocardiography (ETE) was performed when transthoracic echocardiography was not satisfactory. After right and left catheterization, VMPB was performed. In 106 patients (93.8%) a significant increase of the area mitral valve (AVM) was obtained. Echocardiographic results showed an AVM increase from 0.95 +/- 0.19 to 1.61 +/- 0.34 cm2 (p < 0.0001). Mean mitral gradient (GTM) decreased from 16.18 +/- 4.69 to 9.14 +/- 3.2 mmHg (p < 0.0001). Functional class improved in all patients in the long term. As complications there was severe mitral regurgitation (IM) reported in 6 patients who subsequently underwent mitral valve exchange, 2 of then died during surgery (one of them by bleeding and the other by non reparable rags on the atrium). A patient had cerebrovascular event (EVC) one week after the VMPB. In 3 of them non-significant interatrial communication (CIA) was produced. One patient died two months after the procedure due to bacterial endocarditis (EBSA). VMPB can be considered as a safe and effective treatment to patients with mitral stenosis.

[Usefulness of exercise test in programming dual chamber pacemakers]. / Utilidad de la prueba de esfuerzo en la programación de los marcapasos bicamerales.

Prospectively, we studied 42 patient to evaluate the usefulness of treadmill exercise to programme pacemaker DDD in relation to the functioning upper frequency (relation between block frequency of pacemaker and the upper rate frequency). We excluded patient who had no treadmill exercise test after implant pacemaker. During stress 7 (17%) patient presented AV conduction 1:1 (group I); 16 (38%) second degree AV block type Wenckebach (group II); 14 (33%) second degree AV block 2:1 (group III); and 5 (12%) showed inhibition of the pacemaker by intrinsic activity (group IV). Block frequency of the pacemaker in group I and II was superior in regard of the upper rate frequency, 156.85 +/- 22.16 vs 141.43 +/- 20.82 and 135.25 +/- 11.54 vs 121.25 +/- 5.9, respectively. In group III and IV, it was lower, 120.36 +/- 15.31 vs 138.57 +/- 13.29 and 121.0 +/- 7.38 vs 142.0 +/- 14.39. The comparative analysis of the block frequency of the pacemaker in relation with the upper rate frequency showed statistically significant differences (p < 0.05) between groups I and II, and between the group I and III. The appearance of second degree AV block 2:1 is nonphysiologic, is rather due to an abrupt falling in the cardiac output. This phenomenon is able to be predicted and corrected by programming with the use the telemetry with parameters as the AV delay, as well as upper rate frequency and post-ventricular refractory atrial period.

[Ablation using radiofrequency in the treatment of ventricular tachycardia]. / Ablación con radiofrecuencia en el tratamiento de la taquicardia ventricular.

We performed radiofrequency catheter ablation in 14 consecutive patients with Ventricular Tachycardia (VT) 10 of which had healthy hearts, one patient with ischemic heart disease, one with arrhythmogenic dysplasia, one with dilated cardiomyopathy, and one with congenital heart disease. The localization of the VT was: 10 in the left posterior fascicular region, 3 in the right ventricular outflow tract (RVOT), and one patient with ischemic heart disease with the substrate in the left ventricular apex. All of them with VT refractory to pharmacological management, using an average of 2.7 drugs per patient. After all patients underwent Electrophysiological Study (EPS), an intracavitary mapping was performed, in order to locate the arrhythmogenic substrate. Later on, the RF ablation was performed, delivering an average of 15 pulses, using 40 Watts, and an average time of 25 sec. per pulse. The procedure was successful in 60% of the fascicular VT, with a 16% of recurrence; 100% of success with those originated in the RVOT with no recurrence; in the ischemic patient we achieved primary success, but with recurrence, a second session was successful with no recurrence up to date. No major complications occurred in this group. Those patients which showed no success required the use of antiarrhythmic drugs. The total success of the series is 71.4% with 10% recurrence, and no mortality.

Implantación de un programa para la detección precoz de hipoacusia neonatal / Implementing an universal newborn hearing screening program

La hipoacusia neonatal es un problema de salud pública importante sobre el que se puede incidir mediante programas de detección precoz. Estos programas cumplen los criterios de la OMS para la realización de screening de forma eficaz. En este artículo se expone la implantación de un plan de screening universal de hipoacusia neonatal, mediante detección de otoemisiones acústicas transitorias evocadas, en un hospital con una media de 1200 nacimientos anuales. Discutimos los recursos materiales y humanos requeridos, los resultados en el primer año y la necesidad de la generalización de estos programas (AU)

Permanent childhood hearing impairment is a serious public health problem. Identification by screening in the first few months of life has the potential to improve affected children development. Neonatal hearing screening programs endorse the WHO requirement for a cost efficient screening. This paper shows the implementation of a medium-size hospital-based universal newborn hearing screening program using transient evoked otoacoustic emissions. Operational procedures and requirements are discussed. Quality control and results are showed (AU)