Esterilidad de origen uterino. Revisión narrativa de la bibliografía / Sterility of uterine origin. Narrative review of the literature

El útero es un órgano fundamental para la concepción y el desarrollo de un embarazo a término. En el estudio de la paciente con problemas reproductivos siempre debemos realizar una correcta valoración del factor uterino y tenerlo presente, ya que las anomalías de este órgano pueden estar implicadas hasta en la mitad de los casos de esterilidad. En este trabajo se realiza una revisión bibliográfica en la base de datos Medline, seleccionando los artículos con mayor evidencia científica sobre las principales anomalías uterinas que pueden causar problemas reproductivos y obstétricos: congénitas (como malformaciones müllerianas) o adquiridas. Se expone la presentación clínica, repercusiones reproductivas y obstétricas (esterilidad, abortos de repetición, complicaciones obstétricas como parto prematuro), métodos diagnósticos y principales opciones terapéuticas de cada entidad.(AU)

The uterus is a fundamental organ for the conception and development of a full-term pregnancy. In the study of the patient with reproductive problems, we should always make a correct assessment of the uterine factor and keep it in mind since uterine abnormalities may be involved in up to half of the cases of sterility. In this work, we carried out a literature review in the Medline database selecting the articles with a higher level of evidence on the main uterine anomalies that can cause reproductive and obstetric problems: congenital (such as Müllerian malformations) or acquired. The clinical presentation, reproductive and obstetric repercussions (sterility, repeated miscarriage, obstetric complications such as premature birth), diagnostic methods and main therapeutic options of each entity are exposed.(AU)

Quilting sutures compared with sponge packing in septolplasty and turbinoplasty.

INTRODUCTION: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. OBJECTIVE: The purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. MATERIAL AND METHODS: Seventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients' pain and bleeding on removal of the packing were evaluated. RESULTS: Both techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. CONCLUSION: The use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.

Comparación entre una sutura transfixiante y el taponamiento nasal en la septoplastia y turbinoplastia / Quilting sutures compared with sponge packing in septolplasty and turbinoplasty

Introducción: No existe un consenso sobre la necesidad del taponamiento nasal después de una septoplastia. El uso de los taponamientos ha sido propuesto con el fin de reducir las hemorragias, sinequias o hematomas después de este procedimiento. A pesar de estas ventajas la evidencia del uso de un taponamiento nasal es baja. Adicionalmente este procedimiento no es agradable para el paciente y puede tener complicaciones.ObjetivoEl propósito de este estudio es investigar la eficacia de la sutura transfixiante o transeptal comparada con el taponamiento nasal. Analizar el control de la epistaxis, hematomas y sinequias después de una septoplastia.Material y métodosSetenta y seis pacientes con indicación de septoplastia y turbinoplastia con radiofrecuencia fueron incluidos en el estudio. Pseudoaleatoriamente se utilizó una sutura transfixiante en 50 pacientes y taponamiento nasal en 26 pacientes después de la cirugía. En los 2 grupos se comparó el porcentaje de epistaxis, hematomas y sinequias. Además, el dolor y la epistaxis de los pacientes al retirar el taponamiento nasal.ResultadosTanto la sutura transfixiante como el taponamiento nasal tienen resultados similares en cuanto al control de las epistaxis, sinequias y hematomas después de la septoplastia con radiofrecuencia de cornetes. Los pacientes con taponamiento nasal presentaron dolor y epistaxis autolimitada en el momento de retirar el taponamiento nasal.ConclusiónEl uso de la sutura transfixiante después de una septoplastia y turbinoplastia con radiofrecuencia es igual de eficaz que el taponamiento nasal para el control de epistaxis, sinequias y hematomas. (AU)

Introduction: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications.ObjectiveThe purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty.Material and methodsSeventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients’ pain and bleeding on removal of the packing were evaluated.ResultsBoth techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal.ConclusionThe use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty. (AU)

Quilting sutures compared with sponge packing in septolplasty and turbinoplasty. / Comparación entre una sutura transfixiante y el taponamiento nasal en la septoplastia y turbinoplastia.

INTRODUCTION: There is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. OBJECTIVE: The purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. MATERIAL AND METHODS: Seventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients' pain and bleeding on removal of the packing were evaluated. RESULTS: Both techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. CONCLUSION: The use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.

Iris alterations after DSAEK. / Alteraciones iridianas tras Queratoplastia endotelial automatizada con stripping de la Descemet.

OBJECTIVE: To evaluate a series of case that developed iris changes after performing Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS: Retrospective study of eyes that developed iris abnormalities, such as pupil ovalisation, iris atrophy, iridocorneal synechiae, mydriatic pupil, and pigmentary changes after performing DSAEK in a tertiary hospital. RESULTS: In a series of the first 32 DSAEK procedures performed, new single or mixed iris alterations were observed in 12 eyes (37.5%). Iris-corneal synechiae were observed in 7 eyes, corectopias in 9 eyes, iris atrophy in 3 cases, and one case developed an areflexic mydriatic pupil. Long-term pigment dispersion at the edge of the lenticule was observed in 12 eyes. The alterations occurred after three months from the surgery. In the evaluation of the associated factors, malignant glaucoma had occurred in 1 case, 2 eyes had required a second surgery, one case by re-DSAEK, and the other one by removing the intraocular lens due to lens opacification. Two cases had a shallow anterior chamber. No relationship was found between the thickness of the peripheral lenticule and the presence of synechiae. CONCLUSION: Iris changes regarding DSAEK are possible. A discussion is presented on the relationship between increased intraocular pressure due to air in anterior chamber and its relationship with ischaemia and secondary alterations in the iris.

Septoplastía endoscópica / Endoscopic septoplasty

La septoplastía es uno de los procedimientos quirúrgicos más frecuentes en otorrinolaringología, cuya principal indicación es la presencia de desviación septal nasal significativa. Este enfoque quirúrgico ha evolucionado en forma considerable en las últimas décadas, siendo la septoplastía endoscópica la técnica más reciente. Esta técnica moderna, basada en la septoplastía convencional, ha mostrado beneficios en cuanto al procedimiento, resultados y complicaciones. El objetivo de este artículo es revisar las indicaciones, técnica, ventajas y principales resultados de la septoplastía endoscópica.

Septoplasty is one of the most common surgical procedures in otolaryngology, whose main indication is the presence of significant nasal septal deviation. This surgical approach has evolved considerably in recent decades, and endoscopic septoplasty is the most recent technique. This modern technique based on conventional septoplasty has shown several benefits in terms of procedure, results and complications. The aim of this article is to review the indications, techniques, advantages and main results of endoscopic septoplasty.

Estudio retrospectivo del efecto del furoato de mometasona al 0.1% en el tratamiento no quirúrgico de fimosis y adherencias prepuciales en niños mexicanos / A retrospective study of the effect of mometasone furoate 0.1% in the nonsurgical treatment of phimosis and preputial adhesions in Mexican children

Introducción. El término fimosis abarca distintas condiciones que van desde la presencia de un anillo fibroso hasta un prepucio asintomático pero no retráctil. Hasta hace algunos años, la circuncisión era la única opción disponible para el manejo de la fimosis. Sin embargo, diversos estudios y ensayos clínicos han evaluado el uso de esteroides tópicos para la liberación del prepucio fimótico. En el presente trabajo se evaluó el efecto del furoato de mometasona al 0.1% como tratamiento en la liberación de adherencias prepuciales y fimosis en niños mexicanos. Métodos. Se realizó un estudio retrospectivo y descriptivo en el que se incluyeron a 129 pacientes de 1 a 8 años de edad, a quienes se les aplicó furoato de mometasona al 0.1% en el prepucio y el glande una vez al día por 4 semanas y se les realizó una sinequiotomía al término del tratamiento. Resultados. Al realizar la sinequiotomía, se logró la retracción total del prepucio en 98% de los casos; de estos, 20% presentó recaída. En términos generales, la eficacia a largo plazo fue de 81% (IC 95% 73-89). Conclusiones. La aplicación tópica de furoato de mometasona al 0.1% fue eficaz para manejar la fimosis y liberar adherencias en el prepucio de niños mexicanos.

Background. In this study we evaluated the effect of mometasone furoate (0.1%) as a nonsurgical treatment of phimosis in Mexican children. Methods. We carried out a retrospective and descriptive study including 129 patients between 1 and 8 years old who were treated with the topical administration of 0.1% mometasone furoate on the prepuce and glans once daily for 4 weeks followed by sinechiotomy at the end of treatment. Results. After sinequiotomy, the foreskin was able to be fully retracted over the glans in 98% of the patients; however, in 20% of patients it returned to the original condition. Overall long-term efficacy was 81% (95% CI: 73-89). Conclusions. Topical administration of mometasone furoate (0.1%) was effective in the detachment of the foreskin of the prepuce from the glans, making it an effective, nonsurgical treatment for phimosis.