Parotiditis recurrente / Recurrent parotiditis

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[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.

[Inhaled nitric oxide in the treatment of persistent pulmonary hypertension in a newborn]. / Oxido nítrico inhalado en el tratamiento de la hipertensión pulmonar persistente del RN.

OBJECTIVE: Our aim was to assess from a clinical and analytical point of view the response to inhaled nitric oxide in patients with persistent pulmonary hypertension of the newborn (PPHN). PATIENTS AND METHODS: A retrospective study was analyzed in ten patients with PPHN who received inhaled nitric oxide. The ventilatory and gasometric data were reviewed before treatment, during the first hours and afterwards, in all patients, in the surviving group and in the most common associated disease group (intrauterine pneumonia). The parameters analyzed to assess the response to NO treatment were the oxygenation index (IO) and the PaO2 increase. Statistical analysis was performed by using a comparison of means. RESULTS: The mean oxygenation index before starting the treatment with inhaled NO was 39 +/- 7.3 in the total group and 38.4 +/- 8.8 in the surviving patients. At 2.9 +/- 1.1 hours after treatment a mild improvement was observed in the total group and it was more evident in the surviving group (32.4 +/- 15.2 and 26.4 +/- 7.8, respectively; p < 0.05). After treatment was discontinued, the IO was 24.7 +/- 21.9 (p < 0.05) and 12.8 +/- 7.5 (p < 0.001). The PaO2 increment in both groups was 51.2 +/- 55.5% and 66.8% +/- 28.1%. The patients with intrauterine pneumonia showed the highest PaO2 increase after treatment was discontinued (78.3% +/- 41.9%). CONCLUSIONS: Early treatment with inhaled NO in term newborns with PPHN produced a sustained improvement in oxygenation. This treatment might reduce the number of patients who need extracorporal membrane oxygenation.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

Desogestrel-ethinylestradiol, an oral monophasic contraceptive. Clinical and lipid metabolic effects: a 5-year experience.

A comparative study of 5 years' duration using desogestrel (DSG), levonorgestrel (LN), and norethindrone (NET), combined with ethinyl estradiol (EE), was conducted. A total of 4499 cycles on DSG-EE, 3691 on LN-EE (1980 on triphasic and 1711 on monophasic schemes) and 1680 on NET-EE was evaluated. A contraceptive efficacy of 100% was obtained in all the groups. Minimal side effects were observed. In particular, body weight in those women on DSG-EE did not show noticeable changes and headaches were minimal. No alterations on blood pressure readings or on the routine laboratory tests were noticed in any of the groups. There was a significant increase in high-density lipoprotein-c (HDL-c) in women on DSG-EE. There was no change in NET-EE, and a significant decrease in women on LN-EE in both schemes. Changes in LDL-C, very low density lipoproteins, triglycerides, total lipids, total cholesterol, and glucose were not significant, although there was some increase at 60 cycles on triglycerides on those women on DSG-EE and on NET-EE. At the end of 5 years, 76% of women continued on DSG-EE. They indicated their satisfaction with this method.

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.

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.