La mujer en la medicina del siglo XXI / Women in 21st century's medicine

El número de mujeres que estudian medicina ha ido incrementando del 6 al casi 50% en los últimos 20 años, siguen siendo pocas las que llegan a ocupar puestos de alta responsabilidad y toma de decisiones, ya que se enfrentan a problemáticas sociales, culturales y personales, la inclusión de la mujer al mercado laboral ha hecho que la discriminación de género se transforme en una forma indirecta y discreta. Las mujeres han desarrollado mejores y más eficientes vías de comunicación con pares, pacientes y familiares, lo cual hace que las instituciones con mujeres al mando, mejoren sus relaciones y su eficiencia en relaciones públicas. Las mujeres líderes aseguran a las generaciones más jóvenes que lo han logrado gracias a 3 actitudes: excelencia académica personal, trabajo duro y cuidado al construir su femineidad en un entorno hostil. Para conseguir que la integración total del género femenino sea posible, es necesario que los involucrados en la formación de recursos humanos en salud, así como las instituciones busquen eliminar los obstáculos a los que se puede enfrentar. La resiliencia y el cambio de políticas son lo que podrá ayudar al posicionamiento de las mujeres en posiciones de liderazgo

The number of women studying Medicine has been increasing from 6 to almost 50% in the last 20 years. However, only a few of these women can achieve high responsibility positions and decision making, in the clinical and academic area, since they face social, cultural, and personal problems. Nowadays women have developed better and more efficient ways of communicating with peers, patients and family members, which means that institutions with women in charge improve relations and efficiency in public relations. Women leaders assure younger generations that they have achieved it thanks to three attitudes: personal academic excellence, hard work and care in building their femininity in a hostile environment. In order to achieve total integration of the feminine gender, it is still necessary that those involved in the training of human resources in health, as well as the Institutions, look forward to eliminating the obstacles that may be faced. Although the outlook may seem daunting, it is precisely resilience and policy change that may help to position women in leadership positions, eliminate biases and ideologies to prepare for the very near future

Primary umbilical endometriosis (Villar's nodule): Case report / Endometriosis umbilical primaria (nódulo de Villar): reporte de un caso

Background: Umbilical endometriosis or Villar's nodule is uncommon. Incidence goes up to 0.5-1.2% of all patients with endometriosis. As far as 2012, only 109 cases of umbilical endometriosis have been reported worldwide, there is no incidence reports in Mexico. Clinically, it's a solitary node, solid and well defined, colored red, blue or black and it's ocassionally accompanied by bleeding and dysmenorrhea. The treatment can be medical or surgical and it consists of painkillers, and hormonal suppression using GnRH analogues, hormonal contraceptives, danazol or progesterone. Surgical treatment consists in complete resection of the umbilical lesion. The aim of this paper is to present a clinical report case and have a bibliographic review of this pathology. Clinical case: A 34 year-old patient comes to the clinic due to severe umbilical pain of some months, associated with enlargement, swelling and cyclic menstrual bleeding. Escision of the lesion is performed and sent to pathology having the diagnosis of umbilical endometriosis. There is no evidence of endometriosic implants under laparoscopic control. Conclusions: Regards of being a rare pathology, umbilical endometriosis must be taken as a differential diagnosis in patients with umbilical lesions associated with menstrual cycle pain.

Introducción: La endometriosis umbilical o "nódulo de Villar" es poco común. La incidencia varía entre 0.5-1.2% de todas las pacientes con endometriosis. Hasta el año 2012 solo se habían reportado 109 casos de endometriosis umbilical en el mundo; en México hasta el momento, no hay incidencia reportada. Clínicamente se presenta como una tumoración o nódulo solitario, sólido y bien delimitado, de coloración rojo, azul o negro, en ocasiones se acompaña de sangrado y dolor asociado al ciclo menstrual. Puede ser tratada de manera médica o quirúrgica.El tratamiento médico consiste en administración de analgésicos y supresión hormonal utilizando análogos de GnRH, anticonceptivos hormonales, danazol o progestágenos. El tratamiento quirúrgico consiste en resección completa de la lesión umbilical. El obejtivo de este trabajo es presentar el caso clínico y realizar una revisión bibliográfica sobre la endometriosis umbilical primaria, debido a que es una patología inusual. Caso clínico: Presentamos a una paciente de 34 años que acude por presentar dolor umbilical de varios meses de evolución, asociado con aumento de volumen, tumefacción y sangrado cíclico relacionado al ciclo menstrual. Se realiza exéresis de la lesión enviándola a Patología para su estudio definitivo, reportando endometriosis umbilical. Sin presencia de implantes endometriósicos en cavidad abdominal buscados de manera intencional por laparoscopia. Conclusiones: A pesar de ser una entidad poco frecuente, la endometriosis umbilical debe siempre de sospecharse como diagnóstico diferencial en pacientes con lesiones en la región, que presentan dolor asociado al ciclo menstrual.

Divertículo uretral en la mujer: diagnóstico y resección quirúrgica temprana / Female urethral diverticulum: early diagnosis and surgical resection

Resumen ANTECEDENTES El divertículo uretral es la formación de un saco entre la uretra y la vagina. El tratamiento, dependiente de los síntomas, puede ser conservador o quirúrgico. El primero consiste en la descompresión por aspiración, antibióticos profilácticos y dilatadores uretrales. Para el tratamiento quirúrgico existen diversas técnicas, su elección dependerá de la ubicación del divertículo. OBJETIVO Reportar el caso clínico de un padecimiento infrecuente y describir cómo se trató. CASO CLÍNICO Paciente de 59 años que acudió a consulta debido a una disuria severa de varios meses de evolución, asociada con aumento del volumen de la uretra distal, goteo postmiccional y dolor severo en la región vaginal. Se estableció el diagnóstico de divertículo uretral, se efectuó la escisión de la lesión y la evolución fue favorable. CONCLUSIONES El divertículo uretral es un diagnóstico poco frecuente y sospechado, por lo que debe haber un alto grado de sospecha en los cirujanos que intervienen esta área para evitar diagnósticos erróneos, reoperaciones innecesarias y complicaciones. Los tratamientos son variados según el tipo, lugar anatómico y síntomas de la lesión.

Abstract BACKGROUND The urethral diverticulum is the formation of a sac between the urethra and the vagina. The treatment, dependent on the symptoms, can be conservative or surgical. The first consists of aspiration decompression, prophylactic antibiotics and urethral dilators. For surgical treatment there are several techniques, their choice will depend on the location of the diverticulum. OBJECTIVE To report the clinical case of an infrequent condition that generates ignorance of the health professional to detect, treat and refer this type of patients. DESCRIBE The management of an uncommon case, reporting a favorable mediate and long-term postoperative evolution. CLINICAL CASE A 59-year-old patient attended the clinic due to a severe dysuria lasting several months, associated with an increase in the volume of the distal urethra, post-voiding drip, and severe pain in the vaginal region. Diagnosis of urethral diverticulum was made, and excision of the lesion was performed with favorable evolution. CONCLUSIONS The urethral diverticulum is a rare and suspected diagnosis, so there should be a high degree of suspicion in surgeons who address this area to avoid poor diagnosis, unnecessary reoperations and complications. The treatments are varied according to the type, anatomical location and symptomatology of the lesion.

[Use of chemotherapy during pregnancy]. / Uso de quimioterapia durante el embarazo.

The presence of malignant tumors during pregnancy complicates the management of both tumor and pregnancy, since any diagnostic or therapeutic intervention could imply risks that may bring on detrimental effects to fetus or mother. The risks involved in exposing a fetus to cytotoxic therapy are associated to gestational age and the time of in utero exposure to that therapy. Cancer treatment has two different objectives: local control by surgery and radiotherapy, and one that seeks to eradicate systemic disease through chemotherapy, immunotherapy, hormone therapy, or targeted therapies.

La presencia de tumores malignos durante la gestación complica tanto el manejo como el propio embarazo, ya que cualquier intervención diagnóstica o terapéutica puede conllevar riesgos que puedan generar efectos nocivos para la madre o para el feto. Los riesgos que tiene un feto sometido a la administración de la terapia citotóxica se correlacionan directamente con la edad gestacional y con el tiempo de la exposición intrauterina a la misma. El tratamiento antineoplásico busca dos objetivos principales; el primero es el control local por medio de cirugía complementada con radioterapia; el segundo busca erradicar la enfermedad sistémica a través de quimioterapia, inmunoterapia, hormonoterapia o terapias blanco.

[Latzko surgery in recidivant vesicovaginal fistulae. Two case reports and literature review]. / Operación de Latzko en fistula vesicovaginal recidivante. Reporte de dos casos y revisión del tema.

Recurrent vesicovaginal fistulae represent a clinical problem of the utmost importance due to the impact on the patients' quality of life. The current standard of treatment for this problem is surgical, with an abdominal approach, notwithstanding, may authors state that this repair should be done with the technique and approach that the surgeon feels most comfortable. We have successfully treated two patients with recurrent vesicovaginal fistulae using a vaginal approach, therefore we suggest it as a viable alternative in the treatment of this condition. We present two case reports an literature review, with the necessary modifications of the Latzko technique.

[Fusion of the labia minora as a cause of urinary incontinence in a postmenopausal woman. A case report and literature review]. / Fusión de los labios menores como causa de incontinencia urinaria en una mujer posmenopáusica. Reporte de un caso y revisión bibliográfica.

Labial fusion is rarely presented in the postmenopausal age group, its predisposing factors are hipoestrogenism and a inflamation/repair process in the vaginal epithelium. Our case report involves a 73 years old woman that presents with urinary incontinence. On physical exploration, complete labial fusion was noted, a surgical approach was undertaken with liberation of the labia and fixation, postoperatory local estrogen ointment was indicated with complete recovery. The literature review confirmed that this was the ideal treatment and also confirms the role of local estrogen ointment as profilactic and therapeutic.

[Ureteral injury at the National Institute of Perinatology]. / Lesiones ureterales atendidas en el Instituto Nacional de Perinatologia.

OBJECTIVES: To evaluate the incidence of ureteral injury at Instituto Nacional de Perinatologia and to know the variables associated to ureteral injury as a ginecoobstetric surgery complication, and to do a theme review. MATERIAL AND METHODS: We conducted a study including patients with ureteral injury from January 1st 1992 to July 1st 2005. Files were registered for age, parity, surgery associated to the injury, injury type, diagnostic time and methods, management type and evolution. The study was observational, transversal, and retrospective. We analyzed the results with descriptive statistics. RESULTS: We included 39,405 surgeries; a total of 32 injuries were identified, and in 41% the injured ureter was the left one, in 42% was the right one and both in 17%. We included patients from the Instituto and from another hospital. Mean age was 38.9 years, media 43 and mode 44 years. Principal surgery related was the gynecological histerectomy. Patients' evolution was satisfactory. The most frequent surgery to repair the ureter was the reimplantation, followed by the immediate reparation with simple stitches. CONCLUSIONS: The ureteral injury frequency was 0.04%, in relation principally with gynecological histerectomy. The most frequent injury type was the ligation in the distal third. In three cases there was a ureter-bladder fistula. The ureteral reimplantation was the most frequent surgical repair.