Prevention of postcesarean infectious morbidity with a single dose of intravenous metronidazole.

The efficacy of intravenous metronidazole for the prevention of postcesarean section infectious morbidity was studied in 100 healthy women, randomly given either the drug or a placebo. The metronidazole group received 1.0 g intravenously, immediately after cord clamping. Among the 50 patients who received metronidazole, endometritis developed in 7 (14%) as it did in 15 (30%) of the placebo group (P less than 0.01); wound infection was found in 1 (2%) and 4 (8%), respectively (P less than 0.01). If both infectious complications are compared together, the difference (16% versus 38%) is more significant (P less than 0.001). Metronidazole was well tolerated by the mother and with this type of administration regimen, the fetus is not exposed to the drug. It is concluded that metronidazole, used as here reported, is effective in reducing the frequency of postcesarean section endometritis and wound infection with the consequent clinical and economic impacts.

Vaginal intraepithelial neoplasia. Report of 14 cases.

From 1978 to 1985 we have found 14 cases of vaginal intraepithelial neoplasia (VAIN) in patients previously hysterectomized. VAIN was detected by an abnormal cytology; diagnostic process included a second cytology, colposcopy, Schiller test, and directed biopsies. VAIN was classified as grade I in 5 patients (35.7%); grade II in 5 patients (35.7%); and grade III in 4 patients (28.6%). Pathogenic classification of VAIN was: VAIN de novo 9 cases (64.3%); VAIN after vaginal irradiation, 3 cases (21.4%); VAIN following incomplete removal of a cervical intraepithelial neoplasia, one case (7.1%); and VAIN as manifestation of a multicentric neoplasia of the lower genital tract, one case (7.1%). The mean time between hysterectomy and VAIN diagnosis was 6.9 years; this time was larger for those women hysterectomized by benign uterine diseases (9.0 years vs. 2.4 years). Our conclusion is that patients who have lost their uterus by malignant or benign diseases should be followed-up with periodic vaginal cytology in order to detect vaginal neoplasia in its pre-invasive stages.

Ogilvie's syndrome in the postcesarean section patient.

Two cases of colonic pseudo-obstruction (the so-called Ogilvie's syndrome) are reported. Both patients were in the immediate postcesarean section puerperium. The importance of early diagnosis in these cases is stressed, because this complication has a high mortality rate, frequently in relation to delayed diagnosis and treatment. One patient was successfully treated with conservative measures because diagnosis was made early. A plain X-ray abdominal film which shows cecum dilatation, with or without ascending and transverse colon dilatation, and no distal air, makes the diagnosis. A cecum diameter of 9 cm or more is a surgical indication, because the possibility of wall perforation is high. Surgical techniques are: puncture decompression or cecostomy. When cecum diameter is less than 9 cm, non-surgical measures (nasogastric suction, correction of any fluid and electrolytic imbalance, and maybe a flatus tube) are indicated. Observation through repeated X-ray abdominal films shows when the surgical indication appears: (1) failure of the conservative treatment (cecal distension continues or increases); or (2) cecal perforation is documented.

[Maternal mortality in the Hospital Central Militar. Report on 25 years: 1968-1991]. / Mortalidad materna en el Hospital Central Militar. Informe de 25 años: 1968-1992.

A total of 122 cases of maternal death are reported. These cases occurred at the Hospital Central Militar, a 3rd. level general hospital, during the period of 25 years from 1968 to 1992. Maternal mortality rate was 181.7 x 100,000 live births (143.0 when non-obstetrical deaths were eliminated according to the World Health Organization recommendation). Annual and quinquennial variations were very width and erratic. Ninety cases were classified as direct obstetrical deaths (73.77% of the total) and 26 (21.31%) as non-obstetrical ones. The principal causes of deaths were: infection, toxemia and hemorrhage. Approximately the half of the patients was between 16 and 25 years-old and had a parity between 2 and 4. Sixty-two cases were considered preventable deaths (50.52%) and 36 cases probably preventable ones (29.51%), with a total of 98 cases (80.03%) with any possibility of prevention. Responsibility in these 98 deaths cases were in 52 cases (53.06%) on physicians and hospital and 46 cases (46.94%) on patients and community. The conclusion of this work is that the maternal mortality rate in this hospital is very high, in part because a complete registration and also because of the no-exclusion of cases policy. These results reflects the national conditions of maternal health and not the one of the particular health system at which the hospital belongs.

[Epidemiology of abortion. A one-year prospective study]. / Epidemiología del aborto. Estudio prospectivo de un año.

This study evaluates the epidemiological characteristics of patients attended at the Hospital Central Militar (Service of Obstetrics), who had diagnosis of abortion. The study was prospective and was conducted through one year. There were 316 cases of abortion (12.4%) among 2,550 obstetrical patients. The most frequent type of abortion was the incomplete one (58.6%). Only 38 (12.0%) women had an septic abortion. From an epidemiological point of view, patients with abortion were young (mean age 26.45 +/- 6.49 years); married (87.4%); with mean parity of 2.20 +/- 2.16; 26.3% of them had their first pregnancy and 78.2% had their first abortion. Abortion were more frequent between 9 and 12 weeks of pregnancy. After the 10th week, the D&C had more complications than before. The conclusion from this study is that in this group of population, abortion is not an important problem of health.

[Colposuspension of the sacrospinal ligament]. / Colposuspensión al ligamento sacrociático.

During a period of 15 years, at the Hospital Central Militar, 36 operations were done to fix the vaginal cupule to sacrocyatic ligament, as therapeutic or preventive surgery; most of the fixations were together with vaginal hysterectomy by genital prolapse; and six of them were as surgical therapy of vaginal cupule prolapse. Complications were in 2.8% (one case), recidive of cupule prolapse and in 2.8% pudendal vein lesion. Long term result has been excellent, with minimal morbidity.

[Suppression of lactation by using a trihormone preparation]. / Inhibición de la lactanca mediante un preparado trihormonal.

PIP: Ablacton, and andro-estro-progestagen hormone combination, was administered to 59 postpartum and postcurettage patients to suppress lactation: primary inhibition was attempted in 40 cases and secondary in 19. In primary suppression, results were excellent in 83.5% of the cases, good in 10.0% and bad in 2.5%. In secondary suppression, results were excellent in all cases. The suppression of lactation was total and permanent. Tolerance to medication was very good. Because of the very small number of cases and the type of study, the study is limited to this single product.^ieng

[Uterine sarcoma. Analytic study of 37 cases]. / Sarcoma uterino. Estudio analítico de 37 casos.

The lack of uniformity in the nomenclature of the uterine sarcomas, it have contributed to a variety and variability of classifications. Fortunately the sarcomas of uterus are rare. The incidence of this tumor is of 3-5% of all the uterine cancers or of 1.7/100,000 women of 20 years or more. The clinical presentation of these tumors is diverse could come bleed uterine abnormal, abdominal pain, pelvic mass, discharge or cervix prominent mass. Clinical discoveries associated with exist the sarcomas how they are the obesity and high blood pressure in a 30% of the patients it are also observed antecedents of pelvic radiation in a 5-10% of the cases. The genomic alterations that is reported the chromosomes in the literature is associated with 1, 7 11 playing an important paper in the initiation or progression of the sarcomas. We was carried out a retrospective analysis of 37 cases of uterine sarcoma managed in the National Institute of Cancerology at one time of 5 years. Being that the leiomiosarcomas comes in the 51.3% of the cases, followed by the stromal sarcoma, bleed uterine abnormal it was the clinical fact of high importance, detecting these patients in Ia and IIa stadiums predominantly. We observed an increment in the incidence of the uterine sarcoma in patients of 40 years or more. 17 patients were managed exclusively with surgery, 17 patients with surgery and radiotherapy and 5 patients with surgery and chemotherapy (2 patients were managed with surgery + radiotherapy + chemotherapy). The index of failure was from the 45.1% to two years in general form, coming metastasic illness in lung, liver and breast mainly. In conclusion, the adjuvant radiotherapy and chemotherapy to the hysterectomy doesn't increase the index of survivor in the several subtype of uterine sarcomas.

[A parenteral monthly contraceptive (preliminary report)]. / Un anticonceptivo mensual parenteral (comunicación preliminar.

PIP: 100 volunteer patients of proven fertility were treated with a monthly injection of a mixture of 5 mg of estradiol cipionate and 25 mg of medroxyprogesterone acetate for approximately 1 year covering 1108 cycles. The contraceptive effectiveness of the drug was very satisfactory (0 pregnancies). Menstrual cycle alterations occur in the first 6 months of treatment, bleeding becomes spotting, cycles become longer, and amenorrhea follows in a number of cases. However, it is les s prolonged and frequent thatn when progestogen alone is used. Changes were found in vaginal cytology and endometrial histology. Only 7 of 100 patients discontinued the treatment, and side effects other than those related to the menstrual cycle were minimal and apparently of little significance. The findings suggest that research on these substances should continue.^ieng

[Calcium lonazolac and blood loss in users of intrauterine devices. Preliminary report]. / Lonazolac cálcico y pérdida sanguínea en usuarias de dispositivos intrauterinos. Informe preliminar.

PIP: 3 groups of IUD users participated in a preliminary study to evaluate the effect of calcium lonazolac, a nonsteroid antiinflammatory agent, on excessive menstrual bleeding. All participants were parous women aged 20-30 years in good health. Multiload 250 IUDs were inserted in 15 women averaging 24.5 years of age. They were also supplied with calcium lonazolac tablets in 200 mg doses to be taken continuously 3 times daily. 15 women averaging 26.1 years also had multiload 250 IUDs inserted. They were given the same instructions but their medication was a placebo. A third group of 30 women averaging 26.2 years of age who had experienced heavy bleeding during 6-36 months of IUD use were given 200 mg tablets of calcium lonazolac to be taken 3 times daily. The 30 women used various types of IUDs. All 60 women were provided with sanitary pads to be returned at their regular clinic visits. Hemoglobin and hematocrit levels were also determined at each visit. The method of Hallberg and Nilsson was used to measure menstrual blood loss. There were no significant changes in the volume or duration of bleeding or hemoglobin or hematocrit levels in the 15 women given the drug. The 15 women given the placebo had a significant increase in the quantity of blood loss and a significant increase in the duration bleeding in the 3rd month. The 30 women with histories of heavy bleeding had significant decreases in volume and duration of bleeding. Modifications in hemoglobin were not especially significant, while the hematocrit levels increased in the 2nd and 3rd months. None of the women reported significant side effects except 1 woman with a prior history of gastritis. Her gastric distress was controlled by an antacid after meals for 1 week. Comparison of results between the treated and control groups suggests that calcium lonazolac gives good results. Its use should be evaluated at lower doses with consumption limited to days of bleeding only.^ieng

[The results of a selective program to detect intraepithelial neoplasms of the vulva]. / Resultados de un programa selectivo de detección de la neoplasia intraepitelial de la vulva.

Early detection and treatment of preinvasive neoplasias decrease the incidence and mortality of the subsequent invasive cancers. This paper presents the results of a selective program to detect vulvar intraepithelial neoplasia (VIN). The program was selective because only "relative high risk" women were included, i.e. women with one or more of the following items: a) age more than 50 years; b) past history of epidermoid cervical or vaginal cancer (included intraepithelial stages); c) past history of genital radiation; d) past or actual history of genital condyloma; and e) past or actual history of hyperplasic or mixed vulvar dystrophy. Detection was made with the test described by Collins et al., staining the vulva with a toluidine blue aqueous solution and decoloring it with acetic acid. All positive sites (areas retaining the blue color) were biopsied under local anesthesia. Histopathology diagnosis served as gold standard for the program's evaluation. Patient with negative tests and those with NIV I were rescreened each 6 months. From March 1984 to September 1986, 212 patients were admitted in this program and 318 tests were performed. Individual tests varied from 1 (105 patients) to 5 (3 patients). The group was followed-up until March 1989, when the program was evaluated. There were 77 positive tests, among them 21 cases of NIV. Three women with NIV I progressed to NIV II during the observation period. NIV cases were classified as: NIV I, 7 cases (33.3%); NIV II, 10 cases (47.7%); and NIV III, 4 cases (19.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

[The search for, detection and control of the human papillomavirus (HPV)]. / Búsqueda, detección y control del virus del papiloma humano (V.P.H.).

The research, detection and control of the human virus of papilloma has called the investigators attention because of the verification of its direct participation as a cofactor in the origin of premalign and malign lesions in the genital organs. This is the objective of the present bibliographic reviewing in which we are trying to move gynecologists to establish a management protocol in the external consultation, so that it will become possible to decrease the highest index of female morbimortality produce by this suffering and that now a days continues to be the first death rate cause by cancer, in Mexico.

[Peripartum cardiomyopathy: experience at the Central Military Hospital, Mexico]. / Cardiomiopatía peripartal: experiencia en el Hospital Central Militar.

Peripatum cardiomyopathy is a rare disease, which appears as cardiac failure, at the end of pregnancy and puerperium without an apparent cause. The diagnosis is done clinically based in accepted criteria by Demakis, and it is confirmed by auxiliary tests. Treatment includes rest, digitalic and diuretic medications. Prognosis is bad when there is not symptomatic regression, with a high mortality soon after. The experience at Hospital Central Militar from 1967 to 1995, is presented. There were nine cases, two of which had died; and the presentation of the last case, is done herein.

[Treatment of giant vulvar condylomata acuminata combining CO2 laser and electrosurgery]. / Tratamiento de condilomas acuminados gigantes de la vulva combinando láser CO2 y electrocirugía.

Since no antiviral treatment exists for human papilloma viruses (HPV), the clinician's role is to treat all detectable lesions in order to help the patient's immune system fight the virus and to prevent transmission by contact with lesions. HPV-associated lesions have been treated by a wide range of modalities, which may be divided into chemical, surgical and immunity-stimulating methods. We treated patients with large vulva lesions with Electrosurgery in combination with laser CO2 vaporization. HPV-associated lesions have been treated by a wide range of modalities, which may be divided into chemical, surgical and immunity-stimulating methods.

[A continuous experience of the use of norethindrone-ethinyl estradiol combination in small doses as a contraceptive]. / Experiencia continuada con el empleo de la combinación noretindrona-etinil estradiol a dósis baja como anticonceptivo

PIP: Since recent recommendations advocate that smaller doses of estrogen should be used, a combination of .5 mg of norethindrone and .015 mg ethinyl estradiol was tested on 198 patients for a total of 2546 cycles, the longest usage being over 2 years. The women ranged from 15 to 45 years of age, the average age being 28, and the average number of pregnancies, 5.2. The medication was taken daily for 21 days and then stopped for 7. The group was controlled for secondary effects, bleeding, weight changes, and nucleal or hormonal changes. 14.2% stopped taking it because of secondary problems like spotting, nausea, transhormonal bleeding, and depression. The only pregnancy was due to inadequate attention to the prescription by the patient. Tolerance of the medication was quite good overall and no severe difficulties resulted.^ieng

[Cytologic-colposcopic-histopathologic correlations in preinvasive cervical lesions and cervical Human Papillomavirus infections]. / Correlación cito-colposcópica-histopatológica de lesiones cervicales preinvasoras e infección cervical por virus del papiloma humano.

Cervico-uterine cancer is the most frequent gynecological neoplasia in Mexico and cervico-vaginal cytology is the most practical and dependable resource in lesions detection. During the last years precursory lesions detection (NIC and HPV infection) has increased. So, every patient presenting with an abnormal cytology should be included in an evaluation program, that includes a colposcopic study with biopsy of suspicious lesions, in order to know cellular abnormality degree, as these studies combination increases diagnosis certainty. Ninety three patients were evaluated by colposcopy, as the Papanicolaou showed abnormality ICN type in any degree or HPV infection data, during the first three years of the Unidad de Colposcopia de la Beneficiencia del Hospital ABC. In 49 patients histopathological study, was done. A correlation of all studies was carried out. There was a correlation cytology-histopathology of 59.18%; and colposcopy-histopathology of 89.79%. It was concluded that evaluation by cytology is insufficient to establish a final diagnosis and treatment, and that colposcopic study is fundamental in the evaluation of the patient with abnormal exfoliative cytology.

[Effects of lynestrenol used singly in low doses, as a contraceptive]. / Efectos del linestrenol utilizado solo a dósis baja, como anticonceptivo

PIP: The effects of lynestrenol, administered continuously in the dose of .5 mg/day, were studied in 50 women during 1146 menstrual cycles. 45 patients completed 24 cycles each. Before treatment and every 6 cycles all patients were subjected to questioning, physical examination, cytological, blood and urea nitrogen tests and urinalysis. 50% were also subjected to hepatic function tests (sulfobromophtalein excretion, glutamic oxalacetic transaminase, alkaline phosphatase, cephalin-cholesterol flocculation) and endometrial biopsies every 6 cycles. Subjective side effects were absent and weight and blood pressure remained unchanged. Laboratory tests and cytological studies showed normal results. Only 14% of the biopsies performed showed interferen ce with the normal hormonal transformation of the endometrium. The average duration of menstruation was 4-5 days; 7% of all cycles were shortened by 5-10 days and .2% by 11-14 days. 7% of the cycles were prolonged by 5-10 days and .8% by 11-20 days. Amenorrhea was present in .4% of the cycles. Irregular bleeding (either spotting or breakthrough bleeding) was present in 14% of the cycles. 6 patients (12%) stopped the treatment for this reason. It is concluded that the preparation studied is effective and very well tolerated. Patients must be advised regarding the possibility of irregularities in the menstrual cycle, the efficacy of the drug and the absence of other unwanted side effects, to decrease the dropout rate.^ieng

[Maternal mortality at the Hospital Central Militar]. / Mortalidad materna en el Hospital Central Militar.

PIP: 71 maternal deaths at the Hospital Central Militar (Central Military Hospital) over the 12-year period 1968-1979 were reviewed. Maternal mortality rate was 23.07% which is higher than for the rest of the population. The most frequent type of mortality was due to obstetrical causes (69.01%) and here it was infection, pre-eclampsia, eclampsia, and hemorrhage which were most frequent. Among nonobstetrical causes, viral hepatitis was the most frequent. Death occurred more often among young women ages 21-25 with 2-4 previous deliveries. Death was considered evitable and probably evitable in 50 cases (70.42%). Of these, 62% were the responsibility of physicians and hospitals, while the rest were attributable to the patient and the community. (author's modified)^ieng