[Transforming growth factor alpha (TGF-alpha) and epidermoid growth factor (EGF) in polycystic ovary syndrome: potential role in the decrease of apoptosis mechanisms in the follicle]. / El factor de crecimiento transformante-alpha (TGF-alpha) y el factor de crecimiento epidermoide (EGF) en el síndrome de ovarios poliquísticos: posible papel en la disminución de los mecanismos apoptóticos en el folículo.

Knowledgement on ovary function regulation is advancing. Classic concept about endocrine regulation by sexual hormones and gonadotrophin has turning to an hypothesis: autocrine and paracrine factors as intra-ovarian regulators. Follicular growth and steroidogenesis are mainly driven by follicle stimulating hormone (FSH), luteine hormone (LH) and steroids. On the other hand, the presence of intra-ovarian growth factors have an important role in modulation of gonadotrophin effects on ovarian functions. The influence of this factors on follicle growth are described.

[Most of the complaints in gynecology and obstetrics care are generated by perceptions stemming from unavoidable results]. / La mayoría de las quejas por atención ginecológica y obstétrica se generan por percepciones derivadas de resultados inevitables.

UNLABELLED: The annual rises in the cost of claims suffered by some countries had led to increases in: costs of the attention; malpractice premiums; health personnel stress level; risks for the patients with difficult problems, and lack of opportune attention. The intricate interaction between clinical state, responses variability and medical procedures flaws makes impossible stop unavoidable outcomes (UO). Though UO are not derived from negligence or inability, patients and relatives can see it as a malpractice result. OBJECTIVE: To determine the proportion of complaints generated by UO related perceptions (UORP) and their distribution in obstetric and gynecologic stages of care. MATERIAL AND METHODS: A search for claims derived from gynecologic or obstetric care was undertaken in the Medical Arbitrition National Commission (CONAMED) database, those presented between Jun. 1, 1996, and Nov. 30, 1998, were chosen. Some claims were derived directly from UORP (D-UORP claims), others were derived indirectly (UORP clamis); claims were grouped for stage of the attention in which they were originated; non D-UORP claims were grouped also by motives. RESULTS: In 625 claims (98.6% of total) was possible obtain precise information as required for the study. 79% of complaints were derived from UORP; 17% from perceptions generated for medical activities unrelated to UO (MAU-UO claims) and 4% by perception originated from care system (CS claims). 46% of complaints concerned surgical treatment, 27% medical treatment, 14% initial study, 2.1% delivery, in 10% a specific stage of the attention was not mentioned. The motives of the non D-UORP complaints were: 1) I-UORP claims; a) opportunity of the action, when the patient referred delay or inopportuneness as cause of the complaint (17%, overall); b) Professional quality, when questioned de outcomes or medical criteria (23%); 2) MAU-UO claims: a) Professional capacity when patient questions ability, or complaint of error in diagnosis (failure to diagnose or incorrect diagnosis), wrong removal, unnecessary treatment or other actions outside of the norm (13%); b) Improper information (3%); c) Inappropriate manner (0.8%); 3) CS claims: a) Resources (1%); b) Accessibility (2.9%). COMMENTS: The damage risk attributable to medical negligence is very low among patients who had received obstetrical or gynecological care, most of the complaints are UORP generated. In obstetrical care--from 1997 national statistics and described results--a benefit was procured to 1,705,161 persons and were produced 17 possible wrong attentions by professional capacity, five by improper information and one by inappropriate manner; the rest, 123 complaints, were derived from perceptions induced by UO. Undoubtedly there is low complaint registration, however, even at worst the wrong attention effect is lower than the impact attained if the possibility of economic benefit search through medical demands is not totally canceled. The damage risk derived from cost of claims is greater, as suffered on many countries. Medical associations in countries without professional liability problems must accomplish negotiations so that the legislation does not establish compensations by medical care results, the request may be based in: a) the deleterious consequences derived from cost of claims; and, b) the low probability of affecting the patients interests, in Mexico complaints derived from perceptions about the professional capacity are one in 103,022 obstetrical care attentions, the improper information derived one in 316,989 and the inappropriate manner generated one in 1,373,620. These organizations and other health related could assume the commitment to abate the foreseeable complaints and to do research on feasible forms to forecast UO, technically this must be long-range and though international collaboration.

[Maternity desire in patients undergoing assisted reproduction treatment at a public health institution]. / El deseo de maternidad en pacientes sujetas a tratamientos de reproducción asistida en una institución de salud pública.

The main purpose of this investigation was to define how different psychic representations of the desire for maternity have determined the decision of a group of patients to be under complicated reproductive treatments such as in vitro fertilization. A hundred patients who wanted to be under Assisted Human Reproduction (AHR) treatments in a public health institution were interviewed. Ten of them were selected to be studied in depth. The methodology employed was interpretative on a grounded theory design. Although this analysis included many factors, such as gender, family pressures, medical institution and side effects of this treatment, the two constant predominanting factors were narcisistic personality and the imaginary child.

[Lawsuits against gynecologists-obstetricians in the National Commission of Medical Arbitration]. / Demandas contra ginecoobstetras en la Comisión Nacional de Arbitraje Médico.

UNLABELLED: The study of claims motives is relevant since Obstetrics and Gynecology (O&G) is one of the specialties that it is involved with greater frequency in demands in the Medical Arbitration National Commission (CONAMED). OBJECTIVE: In order to know the causes by those which the patients have attended to be complained of the attention provided by a Obstetrician/Gynecologist (OG). MATERIAL AND METHODS: Between June 1, 1996, and November 30, 1998, there were 635 demands reported to the CONAMED for obstetrical or gynecological care, 375 (60%) derived from obstetrical care; claims were grouped by motives and for stage of the attention in which they were originated. RESULTS: There were more than 17 different causes of claim, the most frequent were: complications (20%), care not opportune (16%), accidents (15%), improper actions (15%), diagnostic error (10%). Claims were derived from: Surgical procedures (45%), medical treatment (27%) and diagnosis (13%). 15 (2.4%) of claims were generated from vaginal delivery, but only 9 (1.4%) were obstetrician related. Obstetric surgical procedures account for 23% of claims. CONCLUSIONS: OG are more claimed because work harder, more than one million vaginal and more than 500,000 cesarean deliveries are performed yearly in Mexico. The rates of reported claims are low, one per 10,000 deliveries attended; one per 275,000 vaginal deliveries, one per 8,400 obstetric surgical procedures. It all points OG claims as a probabilistic problem, risk related.

[Treatment of pelvic endometriosis with goserelin acetate or nafarelin acetate. Comparative study]. / Tratamiento de la endometriosis pélvica con acetato de goserelina o acetato de nafarelina. Estudio comparativo.

The medical treatment of the pelvic endometriosis includes the hormonal therapy that attacks directly to the endometriosis lesions or indirectly it inhibits the endometrial proliferation and it induces atrophy through the estrogenic deprivation, or to inclination of a combination of these effects. The objective of the present study was to evaluate the effects of two gonadotrophin release analogs in the treatment of the endometriosis. 15 patients were studied in who the diagnosis settled down of endometriosis by means of laparoscope; these were formed two groups in aleatory form and there were administered to each one them nafarelin acetate in dose of 200 or 400 micrograms each 12 hours or goserelin acetate in dose of 3.6 mg every 21 days; the serum levels of the stimulating follicle, luteinizing, estradiol and prolactin hormones were determined at intervals of four weeks and the secondary effects of these drugs were reported. There were carried out a second look laparoscope in 10 patients. The statistical analysis was carried out by means of the test of hypothesis of Wilcoxon and X2. Inside those results were found that as much the nafarelin as the Goserelin are able to diminish the gonadotropins and estradiol serum levels. Both analogs are effective for the control of the endometriotic lesions. The secondary symptoms are smaller and better supported by the patients using nafarelin. In conclusion as much the nafarelin as the goserelin are appropriate medications for the treatment of the pelvic endometriosis and the election between one or another one can settle down for the comfort of application, secondary effects and cost.

[Scuba diving and pregnancy. A case report and review of the literature]. / Buceo y embarazo. Informe de un caso y revisión de la literatura.

The number of women in childbearing age participating in SCUBA dividing is increasing. Some dives during first trimester before pregnancy is confirmed. The preoccupation of both parents, is that the child could have any damage in the embryonal stage. This is a review of the literature and we present one case of a patient 28 years old with one immersion of 25 meters, at 28 days of gestation. The child did not present any congenital deformity at birth and his growth and development in the eighteen months have been normal.

[Retroperitoneal leiomyoma. Report of a case]. / Leiomioma retroperitoneal. Informe de un caso.

Benign tumors of smooth muscle are relatively common in the genitourinary and gastrointestinal tracts. Retroperitoneal leiomyoma is a rare. A case of a 37 year old woman with diagnostic of leiomyoma of the uterus with the finding of retroperitoneal leiomyoma is presented.

[Comparative study of the management of abscesses of the abdominal wall after cesarean section]. / Estudio comparativo del manejo de abscesos de pared abdominal post-cesárea.

Abdominal wall wound dehiscences, more frequently those involving skin and subcutaneous tissue, are a common surgical complication in Obstetrics and Gynecology. A prospective, longitudinal study was done in 65 patients presenting with wound abscess. The evolution of the wound was compared using the following methods a) Bandage, b) Bandage with 30% iron subcarbonate pomade, c) Silk, d) Silk with 30% iron subcarbonate pomade. Eighty five percent of the patients, with silk used, were completely recovered in less than 10 days; comparing this option with the others used in this study, there were significant statistical differences.