Actualización sobre las posibilidades de tratamiento médico hormonal para el sangrado menstrual abundante / Update on the possibilities of hormonal medical treatment for heavy menstrual bleeding

El sangrado uterino anormal (SUA) se define como cualquier variación del ciclo menstrual, incluyendo cambios en la regularidad, frecuencia, duración o volumen del sangrado menstrual. El sangrado menstrual abundante (SMA) es el tipo más frecuente de SUA y se define como una pérdida excesiva de sangre menstrual que interfiere con una normal actividad física, emocional o social, o bien, empeora la calidad de vida de la mujer. El SMA puede llegar a afectar al 8-27% de las mujeres en edad reproductiva, siendo uno de los motivos de consulta ginecológica más frecuentes, y un problema que tiene un gran impacto en la calidad de vida de la mujer y comporta un gasto de recursos significativo para el sistema sanitario.El tratamiento del SMA tiene como objetivo disminuir la cantidad del sangrado menstrual, corregir la anemia, prevenir su recurrencia y mejorar la calidad de vida. Entre los diferentes tratamientos disponibles que han demostrado algún tipo de eficacia en el control del SMA destacan el tratamiento médico no hormonal (AINE, antifibrinolíticos), el tratamiento hormonal (DIU-LNG, anticonceptivos hormonales combinados, gestágenos) y el tratamiento quirúrgico. Cualquiera de estos tratamientos debe combinarse con ferroterapia en caso de presentar anemia o ferropenia asociada.El objetivo del presente artículo es realizar una revisión de los diferentes tratamientos hormonales disponibles para el manejo del SMA.(AU)

Abnormal uterine bleeding (AUB) is defined as any variation in the menstrual cycle, including changes in the regularity, frequency, duration, or volume of menstrual bleeding. Heavy menstrual bleeding (HMB) is the most common type of AUB and is defined as excessive menstrual blood loss that interferes with normal physical, emotional, and social activity and impairs a woman's quality of life. HMB can affect up to 8–27% of women of reproductive age, and is one of the most frequent reasons for gynaecological consultations and a problem that has a great impact on women's quality of life, involving significant resource expenditure for the health system. Treatment of HMB aims to reduce the amount of menstrual bleeding, correct anaemia, prevent recurrence, and improve quality of life. Among the different treatments available that have shown some efficacy in the control of HMB are non-hormonal medical treatment (NSAIDs, antifibrinolytics), hormonal treatment (LNG-IUDs, combined hormonal contraceptives, gestagens), and surgical treatment. Any of these treatments should be combined with ferrotherapy in case of anaemia or associated iron deficiency. The aim of this article is to review the different hormonal treatments available for the management of HMB.(AU)

Hemangiomas hepáticos: respuesta espectacular al tratamiento con propranolol / Hepatic hemangiomas: Spectacular response to treatment with propranolol

No disponible

Agenesia de pedículo de una vértebra cervical / Pedicle agenesis in the cervical spine

No disponible

Duodenal compression caused by superior mesenteric artery: study of 10 patients.

BACKGROUND: the compression of the third portion of the duodenum by the superior mesenteric artery (aorto-mesenteric clamp) is a rare cause of abdominal pain. Its clinical appearance may range between an asymptomatic and accidental radiological finding and an acute duodenal ileus (superior mesenteric artery syndrome), which requires urgent surgical intervention. METHODS: we revised all of the reports of upper gastrointestinal tract contrast-medium study (which included the duodenum) made in our hospital between May 1999 and April 2002. We analysed the case history of those patients with a radiological image compatible with aorto-mesenteric clamp. RESULTS: of the 1280 studies analysed, 10 of them (0,78%) were compatible with an aorto-mesenteric clamp. The 10 patients were females whose mean age was 25,7 years (range 9-77) that consulted for different abdominal discomfort. The symptoms of the 9 youngest patients were not typical of duodenal obstruction and their evolution was favourable. In the eldest patient, the clinical data were compatible with a mesenteric superior artery syndrome, although a subsequent study showed the presence of a colon adenocarcinoma. CONCLUSIONS: the aorto-mesenteric clamp is a rare radiological finding (<1 %) which does not always justify the supported clinical data. In our series, 9 cases were considered non-obstructive aorto-mesenteric clamps, although some of them showed pathogenical factors (scoliosis and thinness). The superior mesenteric artery syndrome should be considered as a diagnosis of exclusion after performing an adequate clinical study when the situation of the patient requires it.

[Bronchoalveolar lavage technique in patients with alveolar proteinosis]. / Técnica del lavado broncoalveolar total en pacientes con proteinosis alveolar.

Bronchoalveolar Lavage (BAL) was first described more than fifteen years ago; it is still the treatment of choice in Alveolar Proteinosis. Despite several clinical therapeutic trials, for new therapeutics none of them has achieved the results of Bronchoalveolar Lavage. It has been proved that, not only are they ineffective, but they can also have dangerous consequences. Alveolar proteinosis is a rare lung illness that implies the patient's hypoxia and progressive incapacity, being clinical dyspnea its most frequent characteristic. The BAL. with sodium chloride by filling and emptying the lungs allows to wash the fosfolipid material. That its on the alveoli giving the patient a great improve in short space of time. The aim of our work is to describe the technique used in Bronchoalveolar Lavage as well as the changes that have taken place since the beginning of its practice in our Critical Care Unit for the last fifteen years and so the nursing work that it is on this technic. This procedure needs to be made on a UCI for the need of mechanical ventilation. The time of instance on UCI is 24 h. In our experience we are able to make the BAL. in both lungs in the same session, there are no important complications and there is no need of readmission. We conclude that there is evidence that these treatment is effective.

Técnica del lavado broncoalveolar total en pacientes con proteinosis alveolar / Bronchoalveolar lavage technique in patients with alveolar proteinosis

El lavado broncoalveolar total, descrito por primera vez hace más de 30 años, continúa siendo el tratamiento de elección en la proteinosis alveolar. A pesar de la realización de múltiples ensayos terapéuticos, ninguno ha conseguido superar los resultados del lavado, habiendo demostrado que aquellos no sólo son ineficaces sino que pueden tener consecuencias peligrosas. La proteinosis alveolar es una enfermedad pulmonar rara, que conlleva una incapacidad progresiva del paciente, siendo la disnea la característica clínica más frecuente. El lavado broncoalveolar total, mediante la introducción y vaciado de líquido en los pulmones, permite la salida del material fosfolipídico presente en los alveolos, proporcionando al paciente una notable mejoría en un corto espacio de tiempo. El objetivo de este trabajo es describir la técnica utilizada para el lavado, con las modificaciones realizadas desde el inicio de su utilización en nuestra unidad, hace más de 15 años, así como las actividades de enfermería que acompañan al procedimiento. El paciente necesita ingresar en la Unidad de Cuidados Intensivos (UCI) por la necesidad de ventilación mecánica durante la técnica. La estancia media del paciente en la UCI es menor de 24 h. En nuestra experiencia es posible realizar el lavado de ambos pulmones en una única sesión, no habiendo encontrado complicaciones mayores ni necesidad de reingreso y se concluye que existe evidencia de la efectividad del tratamiento (AU)

[Accumulated years of potential productive life lost due industrial accidents in Petróleos Mexicanos]. / Años acumulados de vida productiva potencial perdidos por accidentes de trabajo en Petróleos Mexicanos.

OBJECTIVE: There are different indicators to give priority to health problems within the area of occupational health; we propose the calculation of accumulated years of potential productive life lost (AYPPLL) to estimate the loss of material and human resources due to work accidents. MATERIAL AND METHODS: A total of 8 638 work accidents were analyzed using this method. Independent variables were: sex, age, place and type of accident, subject's income and work conditions. The dependent variable was permanent disability. RESULTS: Subjects who had some kind of permanent damage were 19.5%; the total number of AYPPLL was 5611, with an average of 3.2 YPPLL per accident. Variables associated with the highest AYPPLL were the sociodemographic variables, male sex, lowest income levels, temporary work contracts and injuries of the hand and wrist. CONCLUSIONS: The AYPPLL method was found to be a valuable indicator of the safety and hygiene of the worksite and a useful tool for planning and evaluating work accident programs.