Síndrome de Hamman (neumomediastino) posparto. Síntesis de la bibliografía y reporte de caso / Postpartum Hamman (pneumomediastinal) syndrome. Synthesis of the literature and case report

Resumen ANTECEDENTES: El síndrome de Hamman se caracteriza por la coexistencia de aire libre en el mediastino sin una causa identificable; también puede ser secundario a traumatismos, infecciones intratorácicas, procedimientos médicos como la esofagoscopia y broncoscopia. Su incidencia se estima entre 1 en 2000 y 1 en 100,000 embarazos. CASO CLÍNICO: Paciente de 18 años, con 65 kg de peso, 1.56 m de talla e IMC 26.74, correspondiente a sobrepeso, primigesta, sin antecedentes patológicos ni heredofamiliares relevantes, con evolución normal del embarazo. A las 39 semanas acudió a urgencias ginecológicas debido a contractilidad uterina y salida de líquido por la vagina. La finalización del embarazo fue por parto, con recién nacido vivo. En el puerperio mediato (30 horas después del parto) súbitamente tuvo disnea, ortopnea y dolor en la región infraclavicular, sensación de "burbujeo" en la parte anterior del tórax. La radiografía simple de tórax mostró aire libre en el mediastino y enfisema subcutáneo. La TAC de tórax evidenció múltiples burbujas de aire, con extensión del espacio perivertebral de predominio derecho. La conclusión diagnóstica fue: enfisema extenso subcutáneo en los espacios del cuello, con alcance al mediastino anterior, con extenso neumomediastino y cardiomegalia global. CONCLUSIONES: El síndrome de Hamman prevalece en primigestas jóvenes y tiene un curso benigno. El tratamiento debe ser conservador, con oxígeno y analgésicos.

Abstract BACKGROUND: Hamman's syndrome is characterized by the coexistence of free air in the mediastinum without an identifiable cause; it may also be secondary to trauma, intrathoracic infections, medical procedures such as oesophagoscopy and bronchoscopy. Its incidence is estimated to be between 1 in 2000 and 1 in 100,000 pregnancies. CLINICAL CASE: 18-year-old female patient, weight 65 kg, height 1.56 m and BMI 26.74, corresponding to overweight, primigravida, with no relevant pathological or heredofamilial history, with normal evolution of pregnancy. At 39 weeks, she attended the gynaecological emergency department due to uterine contractility and leakage of fluid from the vagina. The pregnancy was terminated by delivery, with a live newborn. In the immediate postpartum period (30 hours after delivery) she suddenly experienced dyspnoea, orthopnoea and pain in the infraclavicular region, with a sensation of "bubbling" in the anterior chest. Plain chest X-ray showed free air in the mediastinum and subcutaneous emphysema. Chest CT showed multiple air bubbles, with extension of the perivertebral space predominantly on the right. The diagnostic conclusion was: extensive subcutaneous emphysema in the neck spaces extending into the anterior mediastinum, with extensive pneumomediastinum and global cardiomegaly. CONCLUSIONS: Hamman syndrome is prevalent in young primigravidae and has a benign course. Treatment should be conservative, with oxygen and analgesics.

[Correlation between clinical characteristics and mycological tests in the vulvovaginitis by Candida]. / Correlación clinico-micológica de la candidiasis vulvovaginal.

BACKGROUND: Vulvovaginitis caused by Candida sp is one of the most frequent infections. OBJECTIVES: To culture and to identify the fungi related to clinical manifestations of patients based on a suspected diagnosis of vulvovaginal candidiasis. PATIENTS AND METHODS: A prospective, transversal and comparative study was performed on 181 women older than 18 years with vulvovaginitis by Candida sp. A correlation was made between the clinical characteristics of this entity and mycological tests such as direct examination and cultures. RESULTS: The direct exam or fresh vaginal exam and cervical sample was positive for the different microscopic forms of Candida (blastoconidia, pseudohyphye or pseudomycelia) in 60.8% (110 women); at the same time that cultures were positive for Candida sp in 51.9% (94 patients). CONCLUSIONS: The direct examination and the cultures of vaginal and cervical exudate are mandatory tests for diagnosis of Candida sp in women with vulvovaginitis.

[Infection of the surgical site. Experience of two years in the gynecology and obstetric service of Mexican General Hospital]. / Infección del sitio quirúrgico. Experiencia de dos años en el servicio de ginecología y obstetricia del Hospital General de México.

OBJECTIVE: To know the incidence and causal agents of the surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico. MATERIAL AND METHOD: A retrospective, descriptive and analytical study was performed on patients with surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico during January 1st, 2000 to December 31st, 2001. RESULTS: A global low rate of surgical site infection was observed, with predominance on the third life decade patients and on obstetrics events (69.5%). The initial treatment consisting of 600 mg intravenous clindamycin every eight hours and 500 mg intravenous amikacin every 12 hours showed high efficacy. The mean time of hospital stay was nine days; 97% of the discharges were due to improvement, with a minimum rate of mortality. CONCLUSIONS: The index of surgical site infections for gynecological and obstetric procedures is lower than the accepted percentage, but it is more frequent in patients submitted to total abdominal hysterectomy.

[Fetal ovarian cyst. A report of a case]. / Quiste de ovario fetal. Presentación de un caso.

Fetal ovarian cyst is uncommon; it represents the second place of fetal abdominal tumors, after urinary tract tumors. The cause of fetal ovarian cysts still remains unclear, although it is likely to be promoted by hormones. Its prognosis is usually good. Differential diagnosis should rule out urinary tract malformations. A case of a female newborn with giant fetal ovarian cyst, diagnosed on week 37 of the pregnancy period, treated with exploratory laparotomy and cyst exeresis, with serum cystadenoma histopathology diagnosis is presented.

[Arachnoid cyst and pregnancy. Report of a case]. / Quiste aracnoideo y embarazo. Informe de un caso.

The arachnoid cysts are intracranial liquid collections with a congenital etiology. It is necessary to establish the absence of bibliographical information about this disease and its relation with pregnancy. A case is presented related to the treatment of a nineteen year old pregnant patient with a 31 week pregnancy and a history of arachnoid cysts with convulsions as the main symptom.

[Risk factors for cervical cancer]. / Factores de riesgo para cáncer de cérvix.

In the following document a case and control study carried out in the Hospital General de Mexico is presented. The research obtained and analyzed facts related to social and cultural issues, as well as the obstetrics and gynecologist background, stating for each one of them, the relative risk and its statistical meaning with a trust degree of 95%. All of these aspects are considered critical causes for the development of cervix and uterine cancer. The results demonstrated that the scholar degree, the age in which the patients started sexual activity, the number of sexual partners, the number of births, the age in which the first birth occurred, and the smoking habits are facts that influence the natural evolution of this disease and should be considered as important background.

[Study on Candida no-albicans species and its relation to recurrent vulvovaginal candidiasis]. / Estudio de especies de Candida no albicans y su relación con candidiasis vulvovaginal recurrente.

Genital candidiasis is a frequent pathology among women. It has a 5% incidence rate of presenting itself in a recurrent way, which leads to a longer treatment. Candida gender has various species. The ones, which are the most usual and the cause of vaginal, cervicovaginal, and vulvovaginal candidiasis are: Candida albicans, C. glabrata and C. krusei. Their presence is related to further appearances. A case study was made to identify the species of Candida gender. It was based on the diagnostics made in three Mexico City hospitals on female genital candidiasis cases. The identified and isolated Candida species obtained were: albicans with a 71.91%, C. glabrata with a 11.80%, and C. tropicalis with a 7.87%.

[Hematologic profile in pregnancy]. / Perfil hematológico durante el embarazo.

We show a study about haematologic profile at 214 pregnant women, who came to prenatal control at Gynecology and Obstetrics service in the Hospital General de México. This study was realized to stablish the haematologic profile and to have better basis for interpret the different changes that ocur during pregnancy.

Embarazo ectópico abdominal con producto vivo. Presentación de un caso / Living abdominal pregnancy. A case report

Se presenta un caso de embarazo ectópico abdominal de 36.3 semanas de gestación, atendido en el Hospital General de México, obteniendo un recién nacido de sexo masculino con peso de 1,920 gramos, Apgar de 2/5/7 y Capurro de 36.3 semanas. Se describe la revisión estadística, cuadro clínico y tratamiento.

Leiomioma retroperitoneal: reporte de dos casos / Retroperitoneal leiomyoma: report of two cases

Los tumores benignos del músculo liso presentan una frecuencia alta en el tracto genitourinario y gastrointestinal, siendo poco frecuentes en retroperitoneo, situación que conduce a errores diagnósticos. La información acerca de leiomiomas retroperitoneales es escasa. Se presentan dos casos en mujeres de 37 y 35 años con diagnósticos de miomatosis uterina y tumor de ovario en los que los hallazgos quirúrgicos fueron leiomiomas retroperitoneales.

Toxoplasmosis y aborto en evolución / Toxoplasmosis and abortion in evolution

Para conocer la prevalencia de toxoplasmosis en población abierta de Comitán Chiapas, se realizó estudio serológico por inmunofluorescncia indirecta en voluntarios sanos. Además se identifico la presencia de anticuerpos anti Toxoplasma gondii en 50 mujeres con aborto en evolución. Los resultados mostraron que alrededor de 5 por ciento de la población general tiene títulos positivos de anticuerpos anti Toxoplasma gondii, y el 18 por ciento en el caso de las mujeres con aborto en volución. Se concluyó que la seropositividad para esta parasitosis estadísticamente es signficativa en los casos de aborto que entre la población general (P<0.006) y también, es significativamente mayor a las mujeres con aborto, que con respecto a la mujeres de la población general de Comitán Chiapas (P<0.01)