Comparación del cepillo endocervical y la torunda de algodón para la toma citológica cervical / Comparison of endocervical brush and cotton swab for cervical cytologic sampling

Objetivo: Comparación de la calidad y capacidad diagnóstica de las muestras citológicas según los criterios del sistema Bethesda 1988-1991 en función del uso del cepillo endocervical o la torunda de algodón. Material y métodos: Estudio aleatorizado de 595 mujeres distribuidas en 2 grupos. Las citologías del grupo A (305 mujeres) se practicaron con torunda de algodón y espátula de madera y las del grupo B (290 mujeres) con cepillo endocervical y espátula de madera. Resultados: No existieron diferencias estadísticamente significativas en las características clínicas o demográficas de las pacientes de ambos grupos. Los 2 instrumentos se revelaron igualmente eficaces para la detección de anomalías citológicas, la recolección de células endocervicales y la consecución de citologías satisfactorias. Conclusión: No se impone un cambio en las maniobras tradicionales de realización de la citología. Los esfuerzos para mejorar la calidad de las muestras y la tasa de falsos negativos deben realizarse en otros aspectos (AU)

Amenorrea secundaria en paciente con hidrocefalia, malformación de Chiari y siringomielia / Secondary amenorrhea in a patient with hydrocephalus: Chiari malformation and siringomielia

Mediante tratamiento quirúrgico se consiguió restaurar la función menstrual normal en una paciente que presentaba amenorrea secundaria a hidrocefalia, malformación de Chiari y siringomielia (AU)

Analgesia epidural a demanda. Estudio de las consecuencias sobre el parto / On-patient-request epidural analgesia. A study about the consequences on childbirth

Objetivos: Estudiar el efecto de la introducción en un hospital del Insalud de la analgesia epidural a demanda. Material y métodos: Un total de 207 nulíparas con feto único a término que parieron en 1997, y 198 que lo hicieron en 1999-2000. Se comparan los dos grupos y, aisladamente, los partos con epidural de ambos grupos. Resultados: No hemos observado cambios en la frecuencia de partos operatorios o en la morbilidad neonatal, aunque se ha prolongado significativamente el parto con aumento del uso de oxitocina y de fiebre intraparto en el grupo más reciente. Las epidurales restringidas se asociaban a un parto más prolongado, más dosis de oxitocina y mayor empleo de fentanilo. Con la epidural a demanda hemos observado una prolongación del período expulsivo y una mayor frecuencia de mujeres que reciben oxitocina. Conclusiones: No hemos encontrado que la analgesia epidural se asocie a efectos adversos importantes sobre la evolución de los partos, lo que realza aún más los beneficios de esta técnica. (AU)

Tumor ovárico virilizante oculto: "un problema diagnóstico". Estudio de 2 casos / Occult virilizing ovarian tumor: a diagnostic problem. Study of 2 cases

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Intraperitoneal sodium carboxymethylcellulose administration prevents reformation of peritoneal adhesions following surgical lysis.

Although intraperitoneal administration of sodium carboxymethylcellulose (SCMC) prevents the formation of adhesions following laparotomy in rats, it remains unknown whether SCMC treatment prevents the recurrence of preformed peritoneal adhesions following surgical lysis. Additionally, the optimal amount of SCMC required for adhesion prevention, as well as the effects of SCMC upon the healing of bowel anastomoses, has yet to be determined. To study this, 114 male rats underwent laparotomy and adhesion induction via peeling of the cecal serosa with a gauze sponge. Two weeks later, all animals again underwent laparotomy, the adhesions were graded, and surgical lysis of adhesions was performed. Following this, 3 to 12 ml of either normal saline or 1% SCMC solution was instilled into the peritoneal cavity prior to closure. A segment of small bowel was transected and reanastomosed prior to administration of SCMC or saline in another group of 70 rats. After an additional 2 weeks, the animals were sacrificed, the adhesions graded, and all the abdominal contents removed for fixation. The results show that treatment with high volume (i.e., 12 ml) intraperitoneal SCMC prevents reformation of adhesions following surgical lysis. This effect is demonstrated by a proportionate and significant decrease in the incidence of intraabdominal adhesions associated with administration of increasing amounts of SCMC (P < 0.05). While high volume SCMC did prevent adhesion of peritoneal structures to newly formed small bowel anastomoses, SCMC did not impair anastomotic healing.

Prevention of peritoneal adhesions by administration of sodium carboxymethyl cellulose and oral vitamin E.

BACKGROUND: Previous studies have shown that dietary supplements of vitamin E or the intraperitoneal administration of sodium carboxymethyl cellulose (SCMC) solution reduces postoperative adhesions by approximately 50%. The aim of this study was to determine whether there is a synergistic beneficial effect of vitamin E and SCMC in reducing postoperative adhesions. METHODS: Sixty Sprague-Dawley rats were fed an identical diet containing 32 IU vitamin E/kg and were divided into four main groups: group A (control) and groups B, C, and D (experimental). Group D was further subdivided into three subgroups (D1, D2, and D3). Oral supplements of vitamin E in doses of 10 IU, 30 IU, and 30 IU/kg body weight were given to subgroups D1, D2, and D3 and group B, respectively, 5 days before operation and were continued until the fourteenth postoperative day when all animals were killed. Adhesions were created by scraping the cecum with mesh gauze followed by application of absolute alcohol and placement of silk suture in the parietal peritoneum. SCMC solution was administered intraperitoneally in groups C and D before closure. Adhesions were graded by two different investigators. RESULTS: All control animals developed significant adhesions, compared with no adhesions in 30% of group B (vitamin E) (p < 0.04), 40% in group C (SCMC) (p = 0.0001), and an average of 90% in the D groups (SCMC+vitamin E) (p = 0.0001). CONCLUSIONS: It appears that there is a synergistic beneficial effect of oral supplements of vitamin E and the intraperitoneal administration of SCMC solution in reducing the incidence and degree of intraperitoneal adhesions.

Antenatal spontaneous perforation of the extrahepatic biliary tree.

Spontaneous perforation of the biliary system is an unusual neonatal phenomenon that is rarely recognized at birth. To date, it has not been reported antenatally. A 16-year-old pregnant adolescent had an ultrasonogram at 25 weeks of pregnancy that revealed ascites in the fetus. After the infant was delivered at 32 weeks, a hepato-iminodiacetic acid scan showed a spontaneous rupture of the common bile duct. The infant was treated with external drainage of the biliary tree and recovered well. This case demonstrates that spontaneous perforations of the bile ducts can occur much earlier than the usually described 2 to 12 weeks after birth, can be diagnosed antenatally, and should be added to the list of causes of fetal ascites.