Vulvovaginitis infantil / Child vulvovaginitis

La vulvovaginitis es el problema ginecológico más frecuente en las niñas prepúberes, favorecido por la menor protección del introito vaginal a los agentes externos y la presencia de factores anatómicos (proximidad del ano, labios mayores y menores menos desarrollados, etc.) y hormonales (hipoestrogenismo). A esto se suma el efecto de productos irritantes locales y la coexistencia en ocasiones de malos hábitos higiénicos. La mayoría de las vulvovaginitis en las niñas son inespecíficas, aunque en un porcentaje variable pueden aislarse bacterias patógenas específicas (entéricas, respiratorias, o de transmisión sexual), o ser secundarias a otros procesos como oxiurasis o cuerpos extraños intravaginales. En el presente artículo analizaremos la etiología, la patogénesis, la clínica y el manejo de esta entidad en la infancia, y realizaremos algunas consideraciones clínicas y microbiológicas sobre distintos cuadros con etiología específica(AU)

Vulvovaginitis is the most common gynecological problem in prepubertal girls, helped by lower introitus protection to external agents and the presence of anatomical (proximity of anus, minor and major labia less developed,...) and hormonal factors (low estrogen concentration) This is compounded by the effect of local irritants and sometimes co-existence of poor hygiene. Most vulvovaginitis in girls are nonspecific, although specific pathogenic bacteria (enteric, respiratory, or sexually transmitted) can be isolated and they can be also secondary to other causes as oxiurasis, or intravaginal foreign bodies. In this article we will analyze the etiology, pathogenesis, clinical features and management of this disorder in childhood, and we will have some clinical and microbiological considerations of different diseases with specific etiology(AU)

Reproducción asistida y salud infantil / Assisted reproductive techniques and child health

En los últimos años las gestaciones posibilitadas por técnicas de reproducción asistida han aumentado considerablemente. Con el aumento de parejas que se benefician de estas técnicas han surgido dudas acerca del efecto que podrían tener en la salud infantil y se han realizado diversos estudios para evaluar su seguridad y las posibles consecuencias a corto y largo plazo en los niños nacidos tras estos tratamientos. Con el aumento del desarrollo y la aplicación de estos procedimientos, el pediatra de Atención Primaria debe estar familiarizado con la terminología, indicaciones y técnicas que se realizan para facilitar la concepción, así como con los posibles riesgos y el impacto de las mismas en la salud pediátrica. En este artículo se revisarán en profundidad todos estos aspectos (AU)

In recent years pregnancies due assisted reproductive techniques have increased significantly. With the increase in couples who benefit from these techniques, there have been doubts about the effect they may have on children’s health and several studies have been made to evaluate its safety and possible short-and long-term outcomes in children born after these treatments. With the increasing development and application of these procedures, the primary care pediatrician should be accostumed with the terminology, indications and techniques being made to facilitate the pregnancy and the potential risks and their impact on pediatric’s health. In this article we reviewed in detail all these aspects (AU)

LH improves early follicular recruitment in women over 38 years old.

Although the capacity of recombinant FSH alone to induce folliculogenesis is undisputed, many believe that follicular recruitment in women over 38 years old could be improved by supplementing rFSH with human menopausal gonadotrophin (HMG). The present study sought to determine whether recombinant LH could reproduce the effect of HMG in women over 38 years during ovulation induction. Fifty-eight patients received rFSH (225 IU/day) supplemented with one ampoule of HMG (75 IU of FSH/75 IU of LH/HCG per day) for 5 days. Another 36 patients received rFSH (300 IU/day) supplemented with one ampoule of rLH (75 IU/day), also for 5 days. Both groups of patients received similar amounts of rFSH (1500 IU), LH/HCG (375 IU) and rLH (375 IU) and recruited a similar number of follicles as counted on day 6 (4.07 +/- 3.1 in the HMG group versus 3.7 +/- 3.2 in the LH group respectively) or on the day that human chorionic gonadotrophin (HCG) was indicated (6.5 +/- 2.7 versus 5.8 +/- 2.5 respectively). Ovarian stimulation was shorter, but not significantly so, in the group of patients receiving rFSH + HMG (10.5 +/- 1.7 days) than in the group of patients treated with rFSH +/- rLH (12 +/- 1.8 days). Significantly more MII oocytes were seen in the group treated with rFSH + rLH than in the group treated with rFSH + HMG (93.1 versus 75.3%, P < 0.05). With respect to pregnancy rates, 14/54 (26%) patients receiving rFSH + HMG and 16/34 (47%) patients receiving rFSH + rLH had a positive serum HCG. No significant difference in the number of miscarriages was observed between the two groups. In conclusion, the present results seem to indicate that rLH could be the HMG component that aids early follicular recruitment.

Timing ovulation for intrauterine insemination with a GnRH antagonist.

BACKGROUND: We aimed to assess the efficacy of a GnRH antagonist in intrauterine insemination (IUI) cycles to increase number of mature ovulatory follicles and pregnancy rates. METHODS: Prospective randomized study. Women (18-38 years old) with primary/secondary infertility were included. Eighty-two patients were randomly assigned to controlled ovarian stimulation (COS) consisting of rFSH + GnRH antagonist or rFSH alone. RESULTS: A non-significant increase in the total amount of rFSH was seen in the GnRH antagonist group (707+/-240 IU) with respect to the control group (657+/-194 IU). The number of mature follicles (> or =16 mm) was significantly higher in the GnRH antagonist group than in the control group (2.4+/-1.4 versus 1.7+/-1.2, P<0.05). Pregnancy rates were significantly increased in the group of patients receiving the GnRH antagonist (38%) compared to the control group (14%). The only non-single pregnancy (triplets) occurred in the antagonist group. CONCLUSIONS: In this preliminary study, adding the GnRH antagonist to the COS protocol for IUI cycles significantly increased pregnancy rates. Nevertheless, these results may not be associated directly with the antagonist itself but with the fact that more mature ovulatory follicles are present by the day of the hCG. Finally, the risk for multiple gestations needs to be carefully evaluated.

Revisión del tratamiento médico de la endometriosis / Medical treatment of endometriosis: a review

La endometriosis se define como la presencia de tejido endometrial ectópico fuera de la cavidad uterina normal. El tratamiento médico convencional tiene como objetivo eliminar o disminuir los depósitos de tejido endometrial ectópico. Hoy en día todavía no está clara la mejor estrategia terapéutica para esta patología. La elección del tratamiento está condicionada por múltiples factores (edad, fertilidad, gravedad del proceso,...) En este artículo se revisan las diferentes posibilidades de tratamiento médico de la endometriosis (AU)

Un caso de feocromocitoma intratorácico en una gestante en el tercer trimestre / A case of intrathoracic pheochromocytoma in a third trimester pregnancy

La asociación de feocromocitoma y gestación es rara; su diagnóstico es difícil dada su similitud con la preeclampsia. El pronóstico maternofetal es determinado por el diagnóstico precoz y el manejo multidisciplinario. El diagnóstico se establece por la elevación de catecolaminas en orina de 24 h y las técnicas de imagen. La extirpación del tumor, previo bloqueo adrenérgico, se realiza en función de la edad gestacional antes o después del parto.Así, se reduce de forma considerable la mortalidad maternofetal, que es muy alta cuando se desconoce el diagnóstico (AU)

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