Embarazo triple espontáneo en paciente con síndrome de ovario poliquístico. Tratamiento con metformina / Spontaneous triplet pregnancy in a patient with polycystic ovarian syndrome. Metformin treatment

Describimos un caso de embarazo triple en paciente con esterilidad primaria, obesidad y síndrome de ovario poliquístico, tratada con metformina. La paciente, nulípara, desarrolló una gestación tricorial-triamniótica que cursó sin incidencias, salvo incompetencia cervical tratada con cerclaje. Se expone la importancia de la resistencia insulínica en la infertilidad en esta patología (AU)

We describe a triplet pregnancy in an obese patient with primary sterility andpolycystic ovary syndrome treated with metformin. The patient, who was previously nuliparous,achieved a triamniotic trichorid pregnancy that developed normally, except for cervicalincompetence resolved by cervical cerclage. The importance of insulin resistance in this typeof patient is stressed (AU)

Embarazo ectópico ovárico / Ovarian ectopic pregnancy

El embarazo ectópico se define como todo embarazo implantado fuera de la cavidad endometrial. La localización más frecuente es la tubárica, fundamentalmente en la porción ampular de la trompa, seguida del embarazo ectópico cornual, abdominal, ovárico y cervical. La incidencia del embarazo ectópico ha aumentado en los últimos años, pero la tasa de embarazo ectópico ovárico permanece estable. El diagnóstico se establece de manera similar al embarazo ectópico de otra localización, mediante ecografía y niveles de b-HCG en sangre; el diagnóstico preoperatorio de embarazo ectópico ovárico es más difícil. El tratamiento consiste en la resección del saco gestacional u ooforectomía por vía laparoscópica o el tratamiento con metotrexato en los casos precoces. Se exponen los casos clínicos de tres pacientes que acudieron por dolor abdominal y metrorragia a nuestro hospital; el tratamiento consistió en resección ovárica por laparoscopia y el diagnóstico se confirmó mediante estudio anatomopatológico (AU)

Ectopic pregnancy is defined as a gestation out of the endometrial cavity. The most frecuent implantation is the ampular portion of the tube, next to abdominal, ovarian and cervical location. The incidence of ectopic pregnancy is increasing in the last years, but the frecuency of ovarian pregnancies has remained stable. The clinical diagnosis is based in sonography and serum concentrations of b-HCG. The preoperative diagnosis of ovarian pregnancy is difficult. The treatment is ovarian wedge resection by laparoscopy or medical therapy with methotrexate. We report the management of three patients in our hospital. The clinical symptoms were abdominal pain and menstrual irregularities; the diagnosis was confirmed by histopathological study and the treatment was ovarian wedge resection by laparoscopy (AU)

Angiomixoma agresivo vulvar / Aggressive vulvar angiomyxoma

El angiomixoma agresivo es un tumor mesenquimal poco frecuente, de crecimiento localmente infiltrativo y alto riesgo de recidiva local. Presentamos un caso de localización vulvar

Aggressive angiomyxoma is a rare mesenchymal tumor. It is locally infiltrative with frequent local recurrences. We report a case of vulvar localization

Thyroid carcinoma originating in a teratoma of the ovary.

The malignant degeneration of a cystic teratoma of the ovary is a rare complication which different authors place at between 0.8 to 4%. Adenocarcinomas represent a relatively rare complication, 8% of secondary cancers, those of thyroid origin being reported in only 5 cases. The aim of this paper is to present the sixth such case of thyroid carcinoma developed in a mature teratoma in the ovary.

Quantitative pathology of the cervical intraepithelial neoplasia.

The objective of this study was to determine the efficiency of quantitative microscopy as a method of estimating the progressive cervical intraepithelial neoplasia (CIN). The research design consisted of an analytical study of cases and controls. The study took place in the Pathology Services of 4 hospitals in our region and the Image Processing and Cytometry Service of the university. Two subsequent cervical biopsies taken more than six months apart belonging to 42 patients diagnosed for CIN were studied. As a reference, 20 normal biopsies were taken. Quantitative Microscopy by Digital Image Processing was applied to each one of the three epithelial layers. Cellular orientation, shape factor, perimeter, area and nuclear diameter were taken as maturative markers and the cellularity as a marker of proliferative change. The cellularity in the middle layer of the epithelium allowed us to distinguish patients with CIN (22.9 +/- 6.9) from normal cases (4.6 +/- 2.3) in 93% of the cases. According to this variable in the middle and superficial layers, in 95.2% of the cases 4 new groups were automatically defined. The shape factor of the cells in the superficial cell layer enabled us, although with low sensitivity (45.45%), to predict evolution towards cancer in 65.5% of the cases. In conclusion the validity of Quantitative Microscopy as an objective marker of structural change in the CIN was verified although its value as a predictive marker of evolution is low.

[The glucose perfusion test: value in detecting fetal distress]. / L'épreuve de perfusion de glucose: valeur dans le dépistage de la souffrance foetale.

The authors use an intravenous dose of 0.5 g glucose/kg. body weight as a fetal stimulation test in one hundred pregnant patients after the 34th week. Glucose produced a remarkable increase of fetal heart rate variability, as well as an increase in the number of fetal movements and accelerations. Those fetuses lacking reactivity before and after the glucose test presented, in 55.5% of the cases, neonatal depression. This suggests that glucose perinatal surveillance is of utmost importance in these cases. The glucose overload test presents a clear advantage with respect to the oxytocin test, which is the total absence of labor stimulation and this may not be desirable in cases of prematurity or previous uterine scars.