Comparative study of the clinical features of patients with a tubo-ovarian abscess and patients with severe pelvic inflammatory disease.

OBJECTIVE: To determine the clinical characteristics that indicate the presence of tubo-ovarian abscess (TOA) among patients with severe pelvic inflammatory disease (PID). METHODS: An observational cohort study was performed from October 2011 to March 2013. The study included all patients with a diagnosis of TOA and PID admitted to a university hospital in Mexico. A complete medical history and physical examination were performed, and laboratory studies were reviewed. A logistic regression analysis was performed on variables with statistical significance. RESULTS: Overall, 26 patients with PID and TOA (TOA group) and 26 with PID without TOA (PID group) were included in the study. Significant differences between patients with TOA and PID were found with regard to the patients' age (39.3years vs 33.1years; P=0.04), educational level (only elementary, 13 [50%] vs 5 [19%]; P=0.14), presentation with fever (23 [88%] vs 16 [62%]; P=0.025), white blood cell count (21.8×10(9)/L vs 14.9×10(9)/L; P<0.001), number of deliveries (2.2 vs 1.1; P=0.01), and presence of diarrhea (16 [62%] vs 5 [19%]; P<0.001). The triad of fever, leukocytosis, and diarrhea was positively related to the presence of TOA. CONCLUSION: The triad of fever, leukocytosis, and diarrhea should alert clinicians to the possibility of TOA formation in patients with PID.

Factors associated with the need for blood transfusion during hysterectomy.

OBJECTIVE: To identify the preoperative clinical conditions associated with the need to perform a blood transfusion among patients undergoing hysterectomy. METHODS: In a retrospective, comparative, case-control trial at the University Hospital, Nuevo León, Mexico, the records of patients who underwent elective hysterectomy between 2007 and 2009 were reviewed. Patients were grouped depending on whether or not they required blood transfusion. Clinical features were compared and statistical analysis was performed via the χ(2) test. RESULTS: Among 794 patients who underwent hysterectomy, 89 (11.2%) required transfusion. The factors significantly associated with transfusion were history of abnormal uterine bleeding (67.0% versus 52.1%), preoperative hemoglobin level (10.1g/dL versus 12.3g/dL), magnitude of intra-operative bleeding (410 mL versus 298 mL), and operative time (172 min versus 144 min); P<0.001. A significant number of patients who underwent transfusion had increased preoperative prothrombin levels; P=0.04. CONCLUSION: Hemoglobin level before surgery and a history of abnormal uterine bleeding can be identified preoperatively and might warn about the possibility of a need for transfusion among patients undergoing hysterectomy. For young patients, alterations in clotting mechanisms should be ruled out.

[Acrosomic reaction of human spermatozoid demonstrated with clorotetracycline]. / Respuesta acrosomal de espermatozoides humanos demostrada con clorotetraciclina.

BACKGROUND: Sperm preparation and acrosomic reaction have been largely studied to explain the physiology of sperm as reproductive cell. OBJECTIVE: To identify the morphological changes on in vitro prepared human sperm cells and in spontaneous and ionophore A23187 induced acrosome reaction of infertile males, through the application of the chlortetracycline test. DESIGN: Experimental prospective study. MATERIALS AND METHODS: Sperm samples of 17 subfertile males were processed as routine for a sperm analysis, we carried out sperm preparation and induction of the acrosomic reaction by means of calcium ions A23187. The prepared sperm with direct swim-up was assessed at one hour and at four hours. Direct aliquots were taken and processed for the test with CTC, we considered as positive result obtaining more than 15% increase in the induced AR versus spontaneous. RESULTS: The whole population was classified as asthenozoospermic. Eight training morphological patterns were identified and we found four types of responses for the induced AR: Type I had an increase at one and at four hours incubation (47%); type II had an increase only after 1 hour incubation (23.5%); type III had an increase only at 4 hours incubation (17.7%), and type IV did not have increase (11.8%). CONCLUSION: These results suggest that in astenozoospermic patients the training process has variations during the incubation time, demonstrated by the response at A23187. These findings could let us to select better spermatozoa in this group of males at the moment when capacitance is actually attained, thus being able to carry out more effective techniques in assisted reproduction.