Unusual Manifestation of Membranous Dysmenorrhea: Case Report.

BACKGROUND In the 18th century, Morgagni described membranous dysmenorrhea as the sudden and complete detachment of the decidua during menstruation. This causes intense and painful contractions of the myometrium, aggravated by the expulsion of tissues produced by the decidualization of the endometrium. It is a rare pathology associated with oral contraceptives, ectopic pregnancies, abortions, and natural cycles, with consequent thickening and endometrial decidualization with molding of the tissue of the uterine cavity of membranous appearance. The definitive diagnosis is made by histopathological examination. CASE REPORT A 43-year-old female patient came for urgent consultation for an acute picture of severe pain in the lower abdomen, radiating to the genital area with transvaginal bleeding of 2 h of evolution. She had no significant past medical history. A transvaginal ultrasound was performed and showed an unchanged endometrial cavity. A vaginal examination revealed a foreign body of soft consistency; therefore, a speculum examination was performed, which showed tissue of endometrial origin located in the cervical canal of a reddish spongy texture. The tissue was removed, thus improving the symptomatology, and was sent to the pathological anatomy service for histopathologic diagnosis. CONCLUSIONS Membranous dysmenorrhea is a rare gynecologic disorder with only a few documented cases. According to other case reports, our patient's case, at age 43 years, was an atypical presentation. The clinical features and association with this pathology allowed the diagnosis and its confirmation by histopathological examination.

Quemadura genital por producto químico: reporte de caso / Genital burn by chemical product: case report

Resumen ANTECEDENTES: Las quemaduras son la forma más severa de estrés que el cuerpo puede sufrir; pueden generarse por diferentes agentes térmicos y químicos. CASO CLÍNICO: Paciente de 25 años, con dolor intenso en la región genital de 12 horas de evolución, secundario a la introducción en la vagina de una piedra de alumbre. Se le hicieron múltiples irrigaciones con solución salina al 0.9% sin obtener el resto de la piedra de alumbre. Se le aplicó sulfadiazina de plata en la cavidad vaginal cada 12 horas, óvulos vaginales de ketanserina, miconazol y metronidazol cada 8 horas, ketorolaco por vía oral 10 mg cada 8 horas. Durante su estancia hospitalaria tuvo buena evolución, con disminución de la inflamación en la zona genital, epitelización adecuada. Al tercer día se dio de alta del hospital con cita para valoración a los siete días. CONCLUSIÓN: El tratamiento de las quemaduras en el área genital, por agentes químicos, tiene como piedra angular la identificación del agente causante de la lesión que permita actuar de forma inmediata y evitar las secuelas físicas, sexuales y psicológicas mediante el lavado exhaustivo con solución o agua estéril para remover el agente causal y disminuir que continúe actuando en el sitio afectado.

Abstract BACKGROUND: Burns are the most severe form of stress that the body can suffer; they can be caused by various thermal and chemical agents. CLINICAL CASE: A 25-year-old female patient presented with severe genital pain of 12 hours' duration, secondary to the introduction of an alum stone into the vagina. She underwent several irrigations with 0.9% saline without obtaining the rest of the alum stone. She was given vaginal silver sulfadiazine every 12 hours, vaginal ketanserin, miconazole and metronidazole every 8 hours and oral ketorolac 10 mg every 8 hours. During her stay in hospital, she progressed well, with a decrease in genital inflammation and adequate epithelialisation. She was discharged on the third day with an appointment for a seven-day follow-up. CONCLUSION: The management of genital burns caused by chemical agents is based on the identification of the agent causing the lesion, which allows immediate action and prevents physical, sexual and psychological sequelae by thorough washing with sterile solution or water to remove the causative agent and reduce its continued action in the affected area.

Time of ureteral ejection of sodium fluorescein in the cystoscopic assessment of ureteral patency in patients undergoing total laparoscopic hysterectomy

Objective: To evaluate the time of ureteral ejection of intravenous sodium fluorescein in the assessment of ureteral patency in patients undergoing total laparoscopic hysterectomy (TLH). Material and Methods: Fifty-four women undergoing TLH were studied in a public teaching hospital in Culiacan, Sinaloa, Mexico. They underwent cystoscopic evaluation of ureteral patency after intravenous administration of 100 mg of sodium fluorescein. The present study analyzed the time elapsed in minutes from the intravenous administration of fluorescein to the outflow of stained urine by one or both ureteral meatus, the degree of urine staining, and the impact of body mass index (BMI) (BMI; normal, overweight, and obesity) on ejection time. Results: The overall average time elapsed to visualize the ejection of fluorescein through at least one ureteral meatus was 7.5 minutes [95% confidence interval (CI): 6.3-8.7]. There were no significant differences in the time of ureteral ejection of fluorescein taking BMI into account (p=0.579), with a mean time for normal BMI of 8.1 minutes (95% CI: 5.1-11.2), for overweight of 7.0 minutes (95% CI: 5.5-8.5), and for obesity of 7.8 minutes (95% CI: 5.3-10.3). Conclusion: Intravenously administered 10% sodium fluorescein dye is rapidly eliminated and strongly stains urine, which makes it useful for identifying ureteral patency during cystoscopy after TLH. Fluorescein excretion is not affected by patient BMI.

Obesidad y cáncer de endometrio: las repercusiones de un problema de salud pública / Obesity and endometrial cancer: The impact of a public health problem

Resumen: OBJETIVO: Describir el incremento en la frecuencia del cáncer de endometrio en un hospital de tercer nivel en las últimas décadas y su asociación con el sobrepeso y la obesidad. MATERIALES Y MÉTODOS: Estudio retrospectivo, comparativo y observacional efectuado con base en la información de los expedientes de pacientes con diagnóstico de cáncer de endometrio atendidas en el servicio de Oncología del Hospital General de México (2000-2017). Los datos se compararon con un estudio previo de 1966-1993. RESULTADOS: Del 2000 al 2017 se registraron 785 pacientes y en el periodo global de 44 años, incluidos en el estudio, 1045 enfermas. En el lapso de 27 años se registraron 260 pacientes, y en el de 17 años: 785 enfermas; es decir, un incremento de 200% en la frecuencia de esta enfermedad. CONCLUSIONES: En esta serie los porcentajes de sobrepeso y obesidad se elevaron de 46 a 72.5%. El cáncer de endometrio en mujeres menores de 48 años aumentó de 19 a 28%. El 30.5% de las pacientes en etapas tempranas de cáncer de endometrio tuvieron factores de riesgo de recurrencia tumoral y 42% de la serie global cursó con neoplasias avanzadas, lo que está demostrado afecta su pronóstico.

Abstract: OBJECTIVE: To describe the increase shown in the frequency of endometrial cancer in a tertiary hospital in the last decades and its association with overweight and obesity. MATERIALS AND METHODS: Retrospective, comparative and observational study based on information from the files of patients with a diagnosis of endometrial cancer attended at the Oncology Service of the General Hospital of Mexico (2000-2017). Data were compared with a previous study from 1966-1993. RESULTS: From 2000 to 2017, 785 patients were registered and in the global period of 44 years, 1045 patients were included in the study. In the 27-year period, 260 patients were registered, and in the 17-year period, 785 patients were registered; that is, a 200% increase in the frequency of this disease. CONCLUSIONS: In this series the percentages of overweight and obesity rose from 46 to 72.5%. Endometrial cancer in women under 48 years of age increased from 19 to 28%. 30.5% of patients in early stages of endometrial cancer had risk factors for tumor recurrence and 42% of the overall series had advanced neoplasms, which is shown to affect their prognosis.

Clinical characteristics and location of lesions in patients with deep infiltrating endometriosis using the revised Enzian classification

Objective: To describe the clinical characteristics and location of lesions in patients with deeply infiltrating endometriosis using the revised Enzian (rEnzian) classification. Material and Methods: The clinical records of 60 patients undergoing laparoscopy for deeply infiltrating endometriosis at Hospital Civil de Culiacán, Sinaloa and Hospital San Javier, Jalisco, Mexico, were reviewed. Age, body mass index (BMI), number of pregnancies, childbearing, previous abortions, laparoscopic suggestion (pelvic pain, bleeding, infertility), and size and location of the lesions were assessed according to the rEnzian classification. Results: The mean age of the patients was 30.5 years. The mean BMI was 25.6 kg/m2. Sixty-eight percent were nulliparous and 13% had at least one birth. Eighty-five percent had pelvic pain and 8.3% had infertility. Seventy percent (n=42) of the women had ovarian endometriomas (middle compartment); uterosacral and the torus uterinus ligaments were affected in 23.3%, rectum and sigmoid colon in 35% (posterior compartment), and the appendix and small intestine in 3.3%. According to the rEnzian classification, the most affected compartment was C2 (rectum and sigmoid colon with 1-3 cm lesions). Conclusion: Pelvic pain was the main symptom of patients with deeply infiltrating endometriosis, mainly in nulliparous women. According to the rEnzian classification, the C2 compartment was the most affected (rectum and sigmoid colon).

Estrógeno tópico vaginal y dehiscencia de la cúpula vaginal en pacientes con histerectomía total laparoscópica / Topical vaginal estrogen and vaginal vault dehiscence in patients rather than a laparoscopic total hysterectomy

Resumen OBJETIVO: Comparar la frecuencia de dehiscencia de la cúpula vaginal en pacientes tratadas con y sin estrógenos equinos conjugados por vía vaginal antes de la histerectomía total laparoscópica. MATERIALES Y MÉTODOS: Ensayo clínico controlado, comparativo, ciego simple, efectuado en pacientes atendidas entre enero de 2013 y agosto de 2016 en el Hospital Civil de Culiacán con indicación de histerectomía total laparoscópica por enfermedad benigna. Criterios de inclusión: haber recibido durante tres semanas previas al procedimiento estrógenos equinos conjugados por vía vaginal (grupo de estudio) o crema lubricante vaginal como placebo (grupo control). Criterios de exclusión: pacientes con diabetes mellitus tratadas con esteroides y antecedente de un evento tromboembólico reciente. Se evaluó la frecuencia de dehiscencia de la cúpula vaginal a los 7 y 30 días posteriores a la cirugía. Se utilizó la prueba t de Student para comparar medias y la χ2 para la comparación de proporciones, con cálculo de riesgo relativo para evaluar el riesgo de dehiscencia de la cúpula vaginal. RESULTADOS: Se estudiaron 236 pacientes con edad promedio, en ambos grupos, de 47.1 y 47.7 años, respectivamente (p > .05). Los antecedentes ginecoobstétricos y las indicaciones para histerectomía fueron similares en ambos grupos (p = .340). La incidencia total de dehiscencia de la cúpula vaginal fue de 4.6% (n = 11/236) con frecuencia de 6.8% (n = 8/118) en las pacientes del grupo tratado con lubricante vaginal y de 2.5% (n = 3/118) en el grupo tratado con estrógenos equinos conjugados por vía vaginal, sin diferencias entre ambos grupos (p = .123; RR=.359; IC95%: .093-1.387). CONCLUSIONES: El riesgo de dehiscencia de la cúpula vaginal fue similar entre el grupo que recibió lubricante y el de estrógenos tópicos vaginales, pero con una tendencia menor en la frecuencia de dehiscencia de la cúpula vaginal en el grupo tratado con estrógenos tópicos.

Abstract OBJECTIVE: To compare the frequency of vaginal cuff dehiscence in patients managed with and without conjugated equine estrogens vaginally prior to total laparoscopic hysterectomy (TLH). MATERIALS AND METHODS: In a single-blind controlled clinical trial, 236 patients with indications for laparoscopic total hysterectomy for benign pathology at the Hospital Civil de Culiacán and who agreed to participate in the study were randomly assigned to receive vaginally conjugated equine estrogens (study group) or vaginal lubricating cream as a placebo (control group) for 3 weeks prior to the procedure. Patients with diabetes mellitus, treated with steroids and history of a recent thromboembolic event were excluded. The frequency of vaginal cuff dehiscence was evaluated at 7 and 30 days after surgery. The student's t-test was used to compare means and the Chi-square test was used to compare proportions, with relative risk (RR) calculation to evaluate the risk of vaginal cuff dehiscence. RESULTS: We studied 236 patients with average age, in both groups, 47.1 and 47.7 years, respectively (p > .05). The mean age of the patients was similar between the groups (47.1 vs 47.7 years, p>.05). The gynecological-obstetric history and indications for hysterectomy were similar between both groups (p = .340). The incidence of vaginal cuff dehiscence was 2.5% (n = 3) in the group treated with conjugated equine estrogens vaginally and 6.8% (n = 8) in the patients of thse group treated with vaginal lubricant (p= .123; RM= .359; IC95%: .093-1.387). CONCLUSIONS: The risk of presenting vaginal cuff dehiscence was similar between the group of lubricant and topical vaginal estrogens, but with a lower tendency in the frequency of vaginal cuff dehiscence in the group of topical estrogens.

Patrón menstrual y reserva ovárica en pacientes con salpingectomía y oclusión tubárica para esterilización definitiva / Menstrual pattern and ovarian reserve in patients undergoing to salpingectomy and tubal occlusion for definitive sterilization

Resumen Objetivo: Evaluar el patrón menstrual y la reserva ovárica mediante la determinación de FSH y conteo de folículos antrales en pacientes con salpingectomía y oclusión tubárica bilateral como métodos de esterilización definitiva. Material y métodos: Estudio prospectivo, longitudinal, comparativo, experimental, con asignación al azar, ciego simple, al que se incluyeron pacientes con deseos de esterilización definitiva como método anticonceptivo. Las pacientes se asignaron al azar a dos grupos, el primero con oclusión tubárica bilateral y el segundo con salpingectomía. A los seis meses posprocedimiento se evaluaron en forma ciega el patrón menstrual y la determinación sérica de hormona folículo estimulante (FSH) y el recuento de folículos antrales por ultrasonido transvaginal como marcadores de reserva ovárica. El análisis estadístico se llevó a cabo con t de Student para muestras independientes (comparación entre los grupos) y dependientes (comparación intragrupo) para comparación de medias y la prueba x2 para comparación de proporciones. Resultados: Se estudiaron 60 pacientes, 31 con oclusión tubárica bilateral y 29 con salpingectomía. Se registraron aumentos significativos en los días de sangrado menstrual con respecto a la basal después de la oclusión tubaria bilateral (p = .002) y salpingectomía (p = .008). No hubo diferencias entre oclusión tubárica bilateral y salpingectomía con respecto al tiempo quirúrgico para llevar a cabo la técnica de esterilización (p = .83), duración del ciclo menstrual (p = .35), duración de los días de sangrado menstrual (p = .40). Tampoco resultaron diferencias en las concentraciones séricas de FSH (p = 0.75) ni en el recuento de folículos antrales (p = .44) entre los grupos. Conclusiones: El patrón menstrual y la reserva ovárica son muy similares en pacientes con oclusión tubárica bilateral o salpingectomía. Ambas técnicas incrementan la duración del sangrado menstrual posterior al procedimiento. La salpingectomía implica un aumento ligero en el tiempo quirúrgico, sin diferencias en la frecuencia de complicaciones.

Abstract Objective: To evaluate the menstrual pattern and ovarian reserve in patients undergoing salpingectomy and bilateral tubal occlusion as definitive sterilization methods. Material and methods: A prospective, longitudinal, comparative, experimental, randomized, single blind study was carried out in patients with a desire for definitive sterilization as a contraceptive method. Patients were randomly assigned to perform bilateral tubal occlusion or salpingectomy. Six months after the procedure in each patient, the menstrual pattern and the serum determination of follicle stimulating hormone (FSH) and the antral follicle count were evaluated by transvaginal ultrasound as markers of ovarian reserve. The statistical analysis was carried out using the student's t-test for independent samples (comparison between groups) and dependent samples (intra-group comparison) for comparison of means and the x2 test for comparison of proportions. Results: Sixty patients were studied, 31 with bilateral tubal occlusion and 29 with salpingectomy. Significant increases were observed in the days of menstrual bleeding with respect to the baseline after bilateral tubal occlusion (p = .002) and salpingectomy (p = .008). No differences were observed between bilateral tubal occlusion and salpingectomy with respect to the surgical time to carry out the sterilization technique (p = .83), menstrual cycle duration (p = .35), duration of the days of menstrual bleeding (p = .40). No differences were observed in the serum levels of FSH (p = .75) nor in the antral follicle count (p = .44) between the groups. Conclusions: The menstrual pattern and the ovarian reserve are very similar in patients who undergo bilateral tubal occlusion and salpingectomy, although the two techniques increase the duration of menstrual bleeding after the procedure.

Cáncer de vulva. Repercusiones del tratamiento quirúrgico: experiencia con 151 pacientes / Vulvar cancer. Impact of surgical treatment: experience with 151 patients

Resumen Objetivo: Reportar la experiencia institucional en el tratamiento quirúrgico de pacientes con cáncer de vulva de acuerdo con la clasificación vigente de la Federación Internacional de Ginecología y Obstetricia (FIGO). Materiales y métodos: Análisis retrospectivo de expedientes de pacientes con diagnóstico de carcinoma vulvar operadas con o sin coadyuvancia en el servicio de Oncología del Hospital General de México en un lapso de 34 años. Para el análisis estadístico se utilizó el programa Epi Info versión 7.2. Resultados: Se incluyeron 151 pacientes: 24 (16%) con lesiones preinvasoras o con mínima invasión, se intervinieron con escisiones locales o vulvectomías simples; 16 (15%) con cánceres invasores en quienes se efectuó cirugía conservadora de la vulva con o sin disección ganglionar unilateral. En 94 (62%) se efectuaron vulvectomías con linfadenectomías: 47 con cirugías en bloque y 47 mediante incisiones separadas. En 11 (%) pacientes se practicaron cirugías ultrarradicales: 6 resecciones abdominoperineales y 5 exenteraciones pélvicas. De 127 pacientes que tuvieron seguimiento, 62 (49%) evolucionaron 30 meses en promedio sin evidencia de enfermedad. Se incluyen 21/23 (91%) lesiones tempranas (VIN 2,3 y I- A); 37/49, (76%) de las invasoras en estadios IB-II; 13/41, (32%) de los estadios III (p = 0.00007) y 3/14 (21%) de los IV-A. Conclusiones: Si bien la tendencia actual se orienta a individualizar el tratamiento quirúrgico de pacientes con cáncer de vulva invasor, en esta serie solo en 15% fueron cirugías conservadoras. La metástasis ganglionar fue el factor pronóstico más desfavorable.

Abstract Objective: The present study is a review of our experience of the surgical options for vulvar cancer using The International Federation of Gynecology and Obstetrics (FIGO) classification. Materials and methods: Retrospective analysis of records of patients diagnosed with vulvar carcinoma operated with or without coadyuvance in the Oncology service of the General Hospital of Mexico in a span of 34 years. For the statistical analysis, the Epi Info version 7.2 program was used. Results: Patients were divided into groups, those with pre-invasion or minimal invasion disease were resolved with local excision or simple vulvectomy 24 (16%). Patients with invasive cancer were treated with conservative surgery with or without unilateral lymph node dissection 16 (15%); radical vulvectomy with inguino femoral lymphadenectomy 94 (62%) (47 block surgeries and 47 with separate incision); ultra-radical surgery 11 (7%) (6 abdomino-perineal resections and 5 pelvic exenterations). 127 patients had follow-up and 62 of them had a disease-free survival rate of 30 months (48.8%). The overall survival in pre-invasion or minimal invasion disease were 91.3% (21/23), in stage IB-II 75.5% (37/49), in stage III 31.7% (13/41) (p=0.00007) and in stage IVA 21.4% ( 3/14 ). Conclusions: Although a more individualized and less radical treatment is suggested, in this series only 14.5% of patients, could be resolved with conservative surgery. In addition, the lymph node status was the most important prognostic factor for survival.

[Laparoscopic myomectomy and use of electromechanical morcellator: clinical results in a series of cases]. / Miomectomía laparoscópica y uso de morcelador electromecánico: resultados clínicos en una serie de casos.

OBJECTIVE: to describe the clinical and operative characteristics of patients undergoing laparoscopic myomectomy and use of electromechanical morcellator for removal of tissue. MATERIAL AND METHODS: An observational, descriptive and retrospective study was done with the medical records of 65 patients that underwent laparoscopic myomectomy from July 2008 to July 2013. The clinical outcomes, including body mass index (BMI), pregnancies number, parity, previous abortions, indication of myomectomy, surgical findings, length of the procedure, operative bleeding, entry into the endometrial cavity, operative complications and conversion rate to laparotomy were collected and analyzed. RESULTS: The mean age and BMI of the patients were 33.1 years and 26.1 kg/m2, respectively. 64% of patients did not have any pregnancy and 33% had a history of one or more abortions. The most frequent indications for myomectomy were infertility (40%) and abnormal uterine bleeding (53%). The most frequent location of the fibroids was the intramural fundal (46%), with an average size of 6.5 cm (SD ± 3.6). The number of myomas extracted ranged from 1 to 6. The mean operative time was 107.8 min (SD ± 27.5) and the operative bleeding was 145.4 mL (SD ± 42.2). There were no operative complications. The conversion rate to laparotomy was 2%. Power morcellation was used in all cases without complications. CONCLUSIONS: Laparoscopic myomectomy with electromechanical morcellator for tissue extraction in low risk patients for malignancy is a feasible procedure with a low conversion rate, minimal operative bleeding and the operative time similar to that reported for myomectomy performed by laparotomy.

[Infected jejunal mesenteric pseudocyst: A case report]. / Pseudoquiste mesentérico infectado en yeyuno: reporte de un caso.

BACKGROUND: Mesenteric cysts are very rare abdominal growths, generally asymptomatic, and which are usually detected incidentally while performing a physical examination or an imaging test. Complications such as infections, haemorrhage, torsion, rupture, or bowel obstruction, are seldom found in this pathology, but they can be a cause of acute abdomen. The purpose of this report is to describe the characteristics and the clinical outcome of a male patient with an infected mesenteric pseudocyst of the jejunum. CLINICAL CASE: A 49 year-old male was admitted to the emergency department with 6-day onset of abdominal pain, bowel obstruction signs, palpable tumour located in the upper hemi-abdomen, systemic inflammatory response syndrome, 36,100/mm(3) white cells, 4.21 ng/ml procalcitonin, abdominal computed tomography scan with evidence of a mesenteric cystic tumour. An exploratory laparotomy was performed, finding the presence of a mesenteric pseudocyst of the jejunum with infection signs, extirpated and sent for histopathological examination. The clinical progress of the patient was satisfactory with the discharge of the patient 7 days after the surgical intervention. CONCLUSION: These cysts can debut as an acute abdomen due to haemorrhage, infection, obstruction and/or bowel perforation, complications can be life threatening if not detected and surgically treated at an early stage by performing a resection of the pseudocysts, with or without bowel resection, depending on the location and the size of the cyst.

[Repeated ectopic pregnancy in previous caesarean scar: a case report and literature review]. / Embarazo ectópico repetido en cicatriz de-cesárea previa: reporte de un caso y revisión bibliográfica.

BACKGROUND: Ectopic pregnancy in previous caesarean scar, which is detected in the first trimester, is a recognized and documented today alteration. CLINICAL CASE: Female of 38 years old with a history of five pregnancies (two cesarean sections and three ectopic pregnancies, two EPCSS and one tubal ectopic). In March 2013 she presented the first eight weeks EPCSS diagnosed by transvaginal ultrasound. Gestational sac at the level of the previous cesarean section (CS) over the inner hole and a living embryo were observed. The patient received medical treatment with methotrexate. In March 2014 she was diagnosed with a new tubal ectopic pregnancy which was managed with laparoscopic salpingectomy. In February 2015 (Second EPCSS) she was checked for seven weeks amenorrhea and symptoms of pregnancy. A vaginal ultrasound was performed, finding a gestational sac implanted in the lower uterine segment cesarean scar level and a living embryo. The patient undergoing laparoscopic hysterectomy. CONCLUSION: The recurrent pregnancy caesarean section scar is rare and needs to be properly diagnosed as soon as possible to avoid complications. Transvaginal ultrasound is a suitable tool for diagnosis. Management must be individualized according to patient characteristics.

[Hemorrhagic dengue and vertical transmission to the newborn: a case report and literature review]. / Dengue materno de tipo hemorrágico con trasmisión vertical al neonato: reporte de un caso y revisión de la bibliografía.

OBJECTIVE: To describe the case of a patient with term pregnancy and infection with hemorrhagic dengue and vertical transmission to the newborn. CLINICAL CASE: Thirty-two year old patient with pregnancy at 38 weeks was admitted with fever 2 days earlier (38 degrees C). During her stay she continued with fever of 39 degrees C and platelets of 85,000/mm3. Serology for dengue NS1 antigen was reported positive. Labor was induced getting a new-born, male, 3,220 g, who breathed and cried at birth. During the postpartum period continued with fever, malaise, retro-ocular pain, generalized rash in upper and lower limbs, bleeding gums and petechial on the soft palate and thrombocytopenia of 5,000/mm3, later. At 8 days of stay, platelet concentration increased to 42,000/mm3 without requiring platelet concentrates and she was discharged after ten days in hospital with platelets of 94,000/mm3. The 4th day of extra-uterine live (EUL), neonate shows generalized rash over the trunk; The 5th day starts with 38 degrees C fever and thrombocytopenia (78,000/mm3). Dengue serological tests reported positive for Ag NS1 and negative for Abs IgM and IgG. Neonate was admitted to NICU, he continued with a decrease in platelet of 14,000/mm3- and ecchymotic areas by pressure and veno-punction sites. Four platelet concentrates were transfused. At 10th day of EUL platelet count was reported with 387,000/mm3. CONCLUSIONS: In an endemic area, such as Sinaloa state, in a pregnant woman with fever and thrombocytopenia, we should be alert to possibility of a DV infection and its complications. Although rare, such as this case, infection can be transmitted to fetus (vertical transmission) and produce a primary congenital dengue, even in its severe hemorrhagic types.

[Acute appendicitis during pregnancy: report of 4 cases]. / Apendicitis aguda durante el embarazo: reporte de 4 casos.

BACKGROUND: Acute appendicitis is the more frequent no obstetric surgical emergency during pregnancy with an incidence of 1 in 1500 pregnancies. The clinical diagnosis is difficult because of the physiological changes of pregnancy itself. If not treated early increases the risk of maternal and fetal morbidity. OBJECTIVE: To describe the diagnosis and treatment of four cases of acute appendicitis during pregnancy. CLINICAL CASE: Four cases of acute appendicitis during pregnancy diagnosed in the period of a month. Gestational age at diagnosis of appendicitis was between 8 and 13 week. All patients underwent laparotomy; three cases were appendicitis phase II and one phase III. The preoperative was managed with indomethacin and ceftriaxone. There were no maternal or obstetric complications. CONCLUSIONS: An early diagnosis and treatment of acute appendicitis during pregnancy, and a multidisciplinary approach between surgeon, obstetrician and anesthesiologist is the basis for success in the management of these patients.

Comparison between unidirectional barbed and polyglactin 910 suture in vaginal cuff closure in patients undergoing total laparoscopic hysterectomy.

The aim of the study was to compare the efficacy and safety of barbed unidirectional vs. polyglactin 910 suture in vaginal cuff closure on patients submitted to total laparoscopic hysterectomy. From November 2011 until March 2012, a prolective, comparative, longitudinal, non-randomized study was performed on patients submitted to total laparoscopic hysterectomy (TLH). On entry, patients were assigned to two different groups, Group 1: Vaginal cuff closure with unidirectional #00 (n = 25) barbed suture, and Group 2: Vaginal cuff closure with polyglactin 910 #1 suture. The length of closure time and the frequency of dehiscence in vaginal vault were measured on the 14th postoperative day. We did not find significant differences between the groups on the general characteristic analysis. However, significant differences were found (P = .029) in the average vaginal cuff closure time (12.7 ± 3.1 min. for barbed suture group vs. 20.4 ± 7.1 min. for polyglactin 910 group). No dehiscence case was found in any group. Based on the results of this study, we can conclude that unidirectional barbed suture reduces the surgical time for vaginal cuff closure during total laparoscopic hysterectomy and doesn't increase the vaginal cuff dehiscence risk.

Índice de masa corporal materno y su asociación con la vía de resolución del embarazo y los resultados perinatales / Maternal body mass index and its association with mode of delivery and perinatal outcomes

Evaluar si un índice de masa corporal anormal (IMC) se asocia con mayor frecuencia de operación cesárea y resultados perinatales adversos. Material y métodos: De noviembre de 2010 a diciembre de 2011 se llevó a cabo un estudio de cohortes comparativas en 595 pacientes embarazadas, divididas en tres grupos de acuerdo con su IMC al inicio del embarazo: normal: 18.5 a 24.99 kg/m2, (n = 146), sobrepeso: 25 a29.99 kg/m2 (n = 240) y obesidad: > 30 kg/m2 (n = 209). Se analizaron las siguientes variables: frecuencia de operación cesárea, RPM, parto pretérmino, inducción del trabajo de parto, embarazo prolongado y los resultados perinatales (peso, puntaje de Apgar, vitalidad y malformación congénita en el recién nacido).Resultados: No hubo diferencias significativas en la frecuencia de operación cesárea entre los grupos (p = 0.988). Se observó mayor ganancia de peso en el grupo de pacientes obesas (p = 0.000). La frecuencia de complicaciones transoperatorias fue significativamente mayor en el grupo de sobrepeso (p = 0.012). La frecuencia de macrosomía fue mayor en pacientes del grupo de obesidad (p = 0.001). No hubo diferencias en otros resultados perinatales entre los grupos. Conclusiones: La frecuencia de operación cesárea no difiere entre pacientes con peso normal, sobrepeso y obesidad. El sobrepeso incrementa el riesgo de complicaciones operatorias durante la cesárea. La obesidad se asoció con mayor riesgo de macrosomía fetal...

Effect of body mass index on clinical outcomes of patients undergoing total laparoscopic hysterectomy.

OBJECTIVE: To evaluate the effect of normal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and obesity on clinical results among patients who underwent total laparoscopic hysterectomy (TLH). METHODS: In a prospective study at the Civil Hospital of Culiacan in Sinaloa State, Mexico, data were compared from 209 patients who underwent TLH between July 6, 2009, and December 30, 2011. The following primary variables were analyzed for 77 normal BMI patients, 82 overweight patients, and 50 obese patients: procedure duration, operative bleeding, major and minor trans-operative complications, length of hospital stay, and postoperative pain. RESULTS: The mean duration of surgical procedure (P<0.001) and operative bleeding (P=0.002) were lower for patients with normal BMI compared with the other 2 groups. The rate of conversion to laparotomy was similar among the 3 groups. Overall, the frequency of complications was 6.2% (n=13/209); the frequency of complications by study group was 2.6%, 4.8%, and 14% for the normal BMI, overweight and obesity groups, respectively (P<0.05). Major complications were more frequent among patients with obesity (P=0.010). CONCLUSION: The duration of surgical procedure and operative morbidity were found to increase, mainly owing to major complications, among patients with obesity (BMI ≥ 30).

[Resistant ovary syndrome. Case report]. / Síndrome de ovario resistente. Reporte de un caso.

Patients with primary amenorrhea, sexual infantilism and elevated pituitary gonadotropins are frequently diagnosed with hypogonadism hypergonadotropic and suspected ovarian failure, secondary to a chromosomal abnormality, intrinsic ovarian failure or altered receptors for gonadotropins, mainly FSH (ovarian resistance). We report the case of a 16-year-old, admitted to the endocrinology clinic for primary amenorrhea and lack of development of secondary sexual characteristics. A complete physical examination revealed: height of 1.58 m and 57 kg weight, with incipient breasts (Tanner I), sparse pubic and axillary hair (Tanner I). The ultrasound reported small uterus and ovaries. Laboratory studies reported high levels of FSH and LH, estradiol and testosterone levels before puberty, prolactin, TSH, T3 and T4 normal. Normal female karyotype. Diagnostic laparoscopy was performed which showed two ovarian slips; biopsy was taken and reported both abundant primordial follicles and spindle cell stroma without evidence of primary and antral follicles, which integrates the diagnosis of resistant ovary syndrome.

[Uterine leiomyomas during pregnancy and its impact on obstetric outcome]. / Miomas uterinos durante el embarazo y su repercusión en el resultado obstétrico.

BACKGROUND: The association of uterine leiomyoma and pregnancy is increasing due to the tendency of couples to delay first pregnancy after age 30. The risk of uterine fibroids is greater with advancing age of the woman. OBJECTIVE: To evaluate the impact of fibroids on the incidence of complications during pregnancy, labor and delivery. PATIENTS AND METHODS: We observed 65 pregnant patients with uterine fibroids and 165 pregnant patients without fibroids. Follow-up ultrasound was performed at weeks 20 to 24, 30 to 32 and 36 to 40. We analyzed the following variables: threatened abortion, pregnancy loss, preterm birth, premature rupture of membranes, abnormal fetal presentation, mode of termination of pregnancy, uterine atony, postpartum hemorrhage and perinatal outcome. RESULTS: The frequency of threatened abortion, risk of pregnancy loss in the second trimester, preterm births, premature rupture of membranes and abnormal fetal presentation was significantly higher in patients with uterine fibroids compared to patients without fibroids. It was not demonstrated that fibroids grow during follow-up even, there was a trend toward reduction in size as pregnancy progressed and until its completion. No significant differences in the frequency of cesarean section between groups (52.3 vs. 47.9%, RR 1.09; 95% CI 0.82-1.45, p = 0.646). Uterine atony was more frequent in patients with fibroids than in patients without fibroids (12.3 vs 4.2%, RR = 2.9, 95% CI 1.2-7.6, p = 0.036). There were no differences in perinatal outcomes between the groups. CONCLUSIONS: Uterine fibroids increase the risk of complications during pregnancy and childbirth. Could not be demonstrated an increased risk of caesarean section.

[Teaching of total laparoscopic hysterectomy in a gynecological laparoscopy university diploma course]. / Enseñianza de la histerectomía total laparoscópica en un diplomado universitario de laparoscopia ginecólogica.

BACKGROUND: Total laparoscopic hysterectomy is a procedure that requires proper training so that implementation is safe and effective. OBJECTIVE: To describe the clinical outcomes of the teaching of total laparoscopic hysterectomy in a university program. PATIENTS AND METHODS: for a period of two years (2009-2010), 18 doctors enrolled in the diploma program in gynecological laparoscopy conducted at the Hospital Civil de Culiacán, Sinaloa, made 82 total laparoscopic hysterectomy. Were analyzed: age and gender of the participating physicians, exercise time of gynecology, general characteristics of the patients, indications, route of access to the pneumoperitoneum, duration of procedure, intraoperative and postoperative complications, size and weight of the uterus, closing time of the dome by laparoscopy and laparotomy conversion rate. RESULTS: The median age of physicians was 34 years (range 28 to 50 years), 69.2% were male, seven years on average for the exercise of gynecology (range 1 to 20 years). The mean procedure time was 121.5 minutes (95% CI 110.5-132.4), the mean uterine size was 12.1 cm (95% CI 11.3-12.8) and uterine weight of 229.6 g (95%: 182.5-276.7). The average intraoperative bleeding was 133.9 mL (95% CI 112.9-154.8), hospital stay was 24.8 hours (95% CI 23.1-26.4). Major complications occurred in 1.2% of patients (95% CI 0.6-5.8). Minor complications were demonstrated in 7.3% of procedures (95% CI 3.01-14.5). The frequency of conversion to abdominal hysterectomy was 1.2% (95% CI 0.6-5.8). CONCLUSION: Total laparoscopic hysterectomy was performed safely and efficiently by training students in university teaching program in gynecologic laparoscopy.

[Effect of post-abortion interpregnancy interval on obstetric and perinatal outcomes]. / Efecto del intervalo intergenésico postaborto en los resultados obstétricos y perinatales.

BACKGROUND: The interval between pregnancies is important because it allows the mother to recover after an obstetric event. OBJECTIVE: To evaluate if postabortion short interpregnancy intervals affect the obstetrics and perinatal outcome. MATERIAL AND METHODS: A cases and controls study was carried out. We studied 858 patients with a history of early pregnancy loss in the previous pregnancy, of which 286 were cases (interval postabortion < or = 6 months) and 572 controls (interval postabortion > 6 months). Abortion, preterm birth and perinatal outcomes: apgar < or = 7, morbidity, mortality, and weight of newborns were analyzed. RESULTS: The risk of abortion was similar in both groups (14.68% and 13.28%, for the cases and controls respectively (OR: 1.12; IC 95%: 0.75-1.69), and there were no differences in preterm birth (5.59% vs 8.21%; OR: 0.66; IC 95%: 0.37-1.19). Apgar was similar between the groups; there were not differences in the perinatal morbidity (RM: 0.77; IV 95%: 0.27-2.17; p = 0.8005), mortality (RM: 1.14; IC 95%: 0.33-3.94; p = 0.9145) and weight of the newborns between cases and control group. CONCLUSIONS: A short interpregnancy interval less than or equal to six months is not a risk factor for adverse obstetrical and perinatal outcome.