Complicaciones en la cirugía ginecológica / Complications in gynecological surgery

Introducción: Los procedimientos quirúrgicos tienen riesgos y complicaciones, que determinan el pronóstico de los pacientes. La tasa de mortalidad de la cirugía ginecológica, es inferior al 1 por ciento, la de complicaciones varía de 0,2 a 26 por ciento. Ambas están determinadas por factores de riesgo como la edad, enfermedad médica preexistente, obesidad, cirugías previas, anemia y cáncer. Objetivo: Determinar las principales complicaciones, su asociación con el diagnóstico preoperatorio, el tipo de operación realizada y la comorbilidad en pacientes intervenidas por afecciones ginecológicas. Métodos: Estudio descriptivo en pacientes intervenidas quirúrgicamente por vía convencional y de forma electiva. Se seleccionó una serie de 616 pacientes tributarias de cirugía mayor electiva por vía convencional. Las variables utilizadas fueron la comorbilidad asociada, diagnóstico preoperatorio, operación realizada y complicaciones postquirúrgicas. Resultados: Se produjeron complicaciones postquirúrgicas en 96 pacientes (15,5 por ciento). Las de mayor frecuencia fueron el íleo paralítico (4,2 por ciento de la serie y 26,04 por ciento de las complicaciones) y el absceso de cúpula (2,75 por ciento de la serie y 17,7 por ciento de las complicaciones), fundamentalmente en quienes presentaron antecedentes de obesidad y asociación de factores de riesgo. Conclusiones: Las principales complicaciones de la cirugía ginecológica fueron el íleo paralítico y el absceso de la cúpula, las complicaciones se presentaron fundamentalmente en pacientes operadas por mioma uterino y tumor de ovario. De acuerdo con el tipo de operación, ocurrieron en pacientes operadas por histerectomía total abdominal con doble anexectomía y la histerectomía total abdominal sin anexectomía, y las comorbilidades más frecuentes fueron la obesidad y la asociación de comorbilidad(AU)

Introduction: Surgical procedures have risks and complications, which determine the prognosis of patients. The mortality rate of gynecological surgery is less than 1 percent, that of complications varies from 0.2 to 26 percent. Both are determined by risk factors such as age, pre-existing medical illness, obesity, previous surgeries, anemia, and cancer. Objective: To determine the main complications, their association with the preoperative diagnosis, the type of operation performed and the comorbidity in patients operated on for gynecological conditions. Methods: Descriptive study in patients operated on by conventional and elective route. A series of 616 tributary patients of major elective surgery by conventional route were selected. The variables used were associated comorbidity, preoperative diagnosis, operation performed, and postoperative complications. Results: Post-surgical complications occurred in 96 patients (15.5 percent). The most frequent were paralytic ileus (4.2 percent of the series and 26.04 percent of complications) and dome abscess (2.75 percent of the series and 17.7 percent of complications), mainly in who presented a history of obesity and association of risk factors. Conclusions: The main complications of gynecological surgery were paralytic ileus and abscess of the cupola, complications mainly occurred in patients operated on for uterine myoma and ovarian tumor. According to the type of operation, they occurred in patients operated on for total abdominal hysterectomy with double adnexectomy and total abdominal hysterectomy without adnexectomy, and the most frequent comorbidities were obesity and the association of comorbidity(AU)

Relationships between female infertility and female genital infections and pelvic inflammatory disease: a population-based nested controlled study

OBJECTIVES: Our purpose was to examine the associations of female genital infections and certain comorbidities with infertility. METHODS: The Taiwan National Health Research Database was searched for women with a new diagnosis of infertility between 2000 and 2013. Women without a diagnosis of infertility served as a control group and were matched with the infertility cases by age (±3 years) and index year. They were divided into two groups: ≤40 years old and >40 years old. Univariate and multivariate conditional logistic regression models were employed to identify the risk factors associated with infertility. RESULTS: A total of 18,276 women with a new diagnosis of infertility and 73,104 matched controls (mean cohort age, 31±6.2 years) were included. According to the adjusted multivariate analysis, pelvic inflammatory disease involving the ovary, fallopian tube, pelvic cellular tissue, peritoneum (odds ratio (OR)=4.823), and uterus (OR=3.050) and cervical, vaginal, and vulvar inflammation (OR=7.788) were associated with an increased risk of infertility in women aged ≤40 years. In women aged >40 years, pelvic inflammatory disease of the ovary, fallopian tube, pelvic cellular tissue, and peritoneum (OR=6.028) and cervical, vaginal, and vulvar inflammation (OR=6.648) were associated with infertility. Obesity, lipid metabolism disorders, dysthyroidism, abortion (spontaneous or induced), bacterial vaginosis, endometritis, and tubo-ovarian abscess were associated with an increased risk of infertility according to the univariate analysis but not the multivariate analysis. CONCLUSIONS: Female genital tract infections, but not the comorbidities studied here, are associated with an increased risk of infertility.

Tubocutaneous Fistula due to Endometriosis - A Differential Diagnosis in Cutaneous Fistulas with Cyclic Secretion / Fístula tubocutânea secundária à endometriose - diagnóstico diferenciado em fístulas cutâneas com secreção cíclica

ABSTRACT The development of a tubocutaneous fistula due to endometriosis in a post-cesarean section surgical scar is a rare complication that generates significant morbidity in the affected women. Surgery is the treatment of choice in these cases. Hormonal therapies may lead to an improvement in symptoms, but do not eradicate such lesions. In this report, we present a 34-year-old patient with a cutaneous fistula in the left iliac fossa with cyclic secretion. Anamnesis, a physical examination, and supplementary tests led us to suggest endometriosis as the main diagnosis, which was confirmed after surgical intervention.

RESUMO O desenvolvimento de fístula tubocutânea secundária à endometriose em cicatriz cirúrgica após cesariana é uma complicação rara, que gera importante morbidade às mulheres acometidas. A cirurgia é o tratamento de escolha nesses casos. Terapias hormonais podem conduzir a uma melhora dos sintomas, mas, de forma alguma, levam à erradicação de tais lesões. No presente relato, temos uma paciente de 34 anos de idade que apresentava uma fístula cutânea em fossa ilíaca esquerda com secreção cíclica. Anamnese, exame físico e exames complementares nos levaram a aventar como principal hipótese diagnóstica a endometriose, que foi confirmada após intervenção cirúrgica.

Dolor pélvico ginecológico: caracterización de egresos hospitalarios en Chile, 2001-2012 / Gynecologic pelvic pain: characterization of hospital discharges in Chile, 2001-2012

Introducción: se define dolor pélvico como aquél que se presenta en la región abdominal baja o pélvica, que puede ser agudo o crónico, y representa un frecuente motivo de consulta y hospitalización ginecológica. Mientras la valoración del dolor pélvico agudo está orientada a disminuir el riesgo de morbimortalidad a través de su identificación etiológica oportuna, en el caso del dolor pélvico crónico aún existe controversia respecto de su definición y criterios de inclusión etiológicos. Si bien existen amplias variaciones en las estimaciones de prevalencia de dolor pélvico, existe consenso que el dolor pélvico crónico tiene importantes repercusiones, tanto a nivel individual como del sistema de salud. En Chile no existen estudios que hayan cuantificado la prevalencia de dolor pélvico. Se presenta una descripción demográfica y epidemiológica de los egresos hospitalarios por dolor pélvico de causa ginecológica en Chile, desde los años 2001 al 2012, con el fin de aportar cifras iniciales sobre la magnitud de esta problemática de salud de la mujer. Materiales y métodos: Estudio descriptivo del universo de egresos hospitalarios por dolor pélvico en mujeres de 12 años y más, ocurridos en Chile entre los años 2001 y 2012, a partir de las bases de datos nacionales del Ministerio de Salud de Chile. Se seleccionaron los códigos CIE-10, correspondientes a dolor pélvico y perineal, y dolor relacionado con órganos genitales femeninos y con el ciclo menstrual. A partir de las variables disponibles, se realizó un análisis descriptivo sociodemográfico y epidemiológico, realizando inferencia estadística con nivel de significancia de 5%...

Introduction: pelvic pain is defined as the one presenting in lower abdomen or pelvis, which may be acute or chronic, and it represents a frequent reason for gynecologic consultations and hospitalization. While acute pelvic pain valuation is oriented to diminish morbidity and mortality through its opportune etiological identification, in chronic pelvic pain, there is still controversy about its definition and optimal inclusion criteria. While there are wide variations in prevalence estimates of pelvic pain, there is consensus in that chronic pelvic pain has important effects at an individual and health system level. In Chile there are not studies that quantify pelvic pain prevalence. Our work presents a demographic and epidemiological description of hospital discharges by gynecological pelvic pain in Chile, from 2001 to 2012, in order to provide initial figures on the extent of this health issue in women. Materials and methods: Descriptive study of hospital discharges by pelvic pain in women 12 years old and older in Chile between 2001 and 2012, from the national databases of the Chilean Health Ministry. We selected ICD-10 codes corresponding to pelvic and perineal pain, and pain related to female genitalia and the menstrual cycle. With the available variables, we made a sociodemographic and epidemiological analysis, conducting statistical inference with a significance level of 5%...

Angiomiofibroblastoma vulvar. Reporte de un caso / Angiomyofibroblastoma of the Vulva. A case report

Introducción: El angiomiofibroblastoma es una lesión mesenquimatosa benigna, nodular, bien circunscrita, poco frecuente, localizada principalmente en la vulva, se presenta casi exclusivamente en mujeres de mediana edad. Clínicamente son tumores de crecimiento lento, acompañados de dolor, que con frecuencia tiende a diagnosticarse como un quiste de Bartolino, hidroceles del canal de Nuck y angiomixoma agresivo. El tratamiento de elección es la exéresis quirúrgica. Caso clínico: Se presenta el caso de una mujer de 49 años de edad quien acudió a consulta por presentar una masa de 3 años de evolución con crecimiento progresivo en región vulvar, que se acompañaba de intenso dolor y ardor limitando sus actividades diarias. A la evaluación clínica se encuentra masa de gran tamaño que abarca labio mayor y menor izquierdo de la vulva. El diagnóstico tras la exéresis quirúrgica y estudio patológico fue angiomiofibroblastoma. Discusión: Aunque esta patología es una entidad poco frecuente, el diagnóstico correcto del angiomiofibroblastoma, evitará que se confunda con otras lesiones de mayor riesgo y que se realice por tanto, un tratamiento excesivo e inadecuado, ya que este tumor se cura con la excisión simple. Conclusión: Aunque el angiomiofibroblastoma es una entidad poco frecuente, su reconocimiento y correcto diagnóstico es importante ya que el tratamiento estriba en una resección simple, con excelente pronóstico y sin recurrencia, por lo que debe ser considerado como parte del repertorio de diagnósticos clínicos cuando una mujer consulta por una lesión vulvar...(AU)

Síndrome de Allen Master: causa excepcional de abdomen agudo en el embarazo / Allen Master syndrome: exceptional cause of acute abdomen in pregnancy

Se presenta un caso de abdomen agudo en una gestante de 20 semanas, por una torsión anexial. Ante la ausencia de signos ecográficos compatibles con patología en los primeros momentos y el empeoramiento clínico, se solicitó una RMN que permitió la aproximación diagnóstica y facilitó la indicación urgente de cirugía abdominal. En el curso de la laparotomía se diagnosticó una hernia interna del anexo, con marcado componente vascular a través de un defecto del ligamento ancho, que obligó a la anexectomía. Tras el diagnóstico y el tratamiento realizado, la gestación continúa con buenos resultados materno-fetal. Estos orificios han sido presentados excepcionalmente como causa de hernias internas digestivas, urológicas y anexiales, siendo controvertido su origen, congénito, inflamatorio o traumático. Se repasan las pruebas complementarias indicadas en el manejo diagnóstico del dolor abdominal en el embarazo, incluyendo las últimas recomendaciones de la European Society of Urogenital Radiology-ESUR.

A case of acute abdomen in a pregnant 20 weeks is presented with an adnexal torsion. In the absence of pathologic ultrasound signs with in the early stages and clinical worsening, was requested an MRI that allowed the diagnostic approach and the indication for urgent abdominal surgery. During laparotomy was observed an internal adnexal hernia through a defect in the broad ligament, with marked vascular component which forced the adnexectomy. After the diagnosis and treatment performed, the pregnancy continues with good maternal and fetal outcomes. These defects were presented exceptionally as a cause of digestive, urological and adnexal internal hernias. The origin remains controversial, congenital, inflammatory or traumatic. Complementary tests in the diagnostic management of abdominal pain in pregnancy are reviewed, including the latest recommendations of the European Society of Urogenital Radiology-ESUR.

Laparoscopia na decisão da estratégia terapêutica para o casal infértil / Laparoscopy in the decision of treatment strategy for the infertile couple

OBJETIVO: avaliar a contribuição da laparoscopia diagnóstica na abordagem do casal infértil. MÉTODOS: estudo retrospectivo com análise dos 86 casos consecutivos de pacientes acompanhadas em consulta de esterilidade que foram submetidas à laparoscopia entre Janeiro de 2004 e Dezembro de 2006. Oitenta e duas pacientes tinham realizado histerossalpingografia (HSG) previamente à laparoscopia. Avaliaram-se os achados laparoscópicos bem como os procedimentos acessórios efetuados, e correlacionaram-se os achados histerossalpingográficos com os da laparoscopia. A análise estatística foi efetuada com o Statistical Package for the Social Sciences 15. A sensibilidade e a especificidade da HSG foram determinadas e os intervalos de confiança calculados assumindo-se um erro alfa de 0,05 (IC95 por cento). RESULTADOS: na laparoscopia foram identificadas alterações compatíveis com endometriose em 21 casos (24,4 por cento), salpinge uni/bilateral em 14 casos (16,3 por cento) e doença inflamatória pélvica em 16 casos (18,6 por cento). Procedeu-se à adesiólise e à fulguração dos focos de endometriose em oito pacientes. Foram feitas duas salpingostomias, duas quistectomias do paraovário, duas quistectomias do ovário e três drillings do ovário. A prova de permeabilidade tubar foi normal em 44 casos (53 por cento), revelou obstrução unilateral em 21 (25,3 por cento) e obstrução bilateral em 17 (20,5 por cento). Os resultados da histerossalpingografia foram concordantes com os da laparoscopia em 44 dos 82 casos (53,7 por cento). Quando definimos doença como qualquer forma de obstrução tubar presente na laparoscopia, a sensibilidade da HSG foi 0,79 (IC95 por cento=0,62-0,9) e a especificidade 0,58 (IC95 por cento=0,42-0,73). Quando limitamos a definição de doença à presença de obstrução tubar bilateral na laparoscopia, a sensibilidade e a especificidade da HSG foram 0,47 (IC95 por cento=0,24-0,71) e 0,77 (IC95 por cento=0,64-0,86), respectivamente. Em nove casos (15,3 por cento) em que a HSG havia sido normal ou revelado apenas obstrução unilateral, a laparoscopia revelou obstrução bilateral. Em 15 casos (65,2 por cento) em que a HSG havia demonstrado obstrução bilateral, a laparoscopia foi normal ou revelou apenas obstrução unilateral. CONCLUSÕES: a laparoscopia demonstrou sua relevância diagnóstica e terapêutica revelando-se fundamental na clarificação do status tubo-peritoneal. Permitiu a realização concomitante de atos terapêuticos, possibilitando a definição da melhor estratégia terapêutica no casal infértil.

PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG) prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95 percentCI). RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4 percent), 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3 percent), and 16 cases of pelvic inflammatory disease (18.6 percent). Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53 percent), revealed unilateral obstruction in 21 cases (25.3 percent) and bilateral obstruction in 17 cases (20.5 percent). The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7 percent). HSG sensitivity was 0.79 (95 percentCI=0.62-0.9) and its specificity was 0.58 (95 percentCI=0.42-0.73) when the disease was defined as any form of tubal occlusion detected with the laparoscopy, wheter this occlusion was one-sided or two-sided. HSG sensitivity and specificity were 0.47 (95 percentCI=0.24-0.71) and 0.77 (95 percentCI=0.64-0.86), respectively, when the definition of the disease was limited to two-sided tubal occlusion. In nine cases (15.3 percent) in which HSG had shown normal findings or only a unilateral occlusion, laparoscopy revealed a two-sided occlusion. And in 15 cases (65.2 percent) in which HSG had shown a two-sided occlusion, laparoscopy revealed normal findings or one-sided occlusion. CONCLUSIONS: the laparoscopy demonstrated its diagnostic and therapeutic relevance, proving to have fundamental importance for the clarification of the tuboperitoneal status. It has permitted the development of concomitant accessory therapeutic procedures, thus defining the best treatment strategy for the infertile couples.

A study of abdominal pain in children.

Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal. Knowledge about its etiology and frequency helps in its evaluation and management. The present study was undertaken to find out the causes and their frequency of pain abdomen in Nepali children. Children with pain abdomen presenting at the emergency room and pediatric outpatient department of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 were clinically evaluated and investigated to find out the causes and frequency of their pain abdomen. The outcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completed investigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only. 91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic (9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related to surgical conditions, which needed operative management. Secondary or extra-abdominal causes were found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic (11) were predominant causes. Our study showed that the causes of pain abdomen in children were predominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, including functional and emotional causes were infrequent. Small percentage needing surgical management formed a diagnostic challenge.

Co-infection of herpes simplex virus (HSV) with human immunodeficiency virus (HIV) in women with reproductive tract infections (RTI).

In India, HSV seroprevalence and its coinfection with HIV among female patients with reproductive tract infections (RTI) are sparse. We aim to ascertain the seroprevalence of HSV and its coinfection with HIV and common sexually transmitted infections attending Obstetrics and Gynaecology outpatient department, RIMS. The study included 92 female patients with RTI. Diagnostic serology was done for HSV-1 and HSV-2 using group specific IgM indirect immunoassay using ELISA, HIV by 3 ELISA/Rapid/Simple (E/R/S) test of different biological antigen. Diagnosis of RTI was made on clinical grounds with appropriate laboratory investigations--microscopy, Gram stain smear etc. Bacterial vaginosis was diagnosed using Nugent's criteria, Syphilis by rapid plasma reagin (RPR) card test and Chlamydia trachomatis by IgG ELISA. Out of 92 sera tested for HSV, 18 (19.6%) were IgM HSV positive and 9 (9.8%) were HIV positive. Co-infection rate of HSV in HIV positive was 16.7%. None of the patients had clinical herpes genitalis, all were subclinical cases. 55.5% of HSV positives belongs to age group 21 to 30 years. Of the HSV-1 and HSV-2 IgM positives 3 (15%) had HIV, 4 (22.2%) bacterial vaginosis, 2 (11.1%) were RPR positive, 4 (22.2%) Chlamydia trachomatis, 3 (15%) were pregnant. 16 (88.8%) were unemployed, 14 (77.7%) had education level below 10 standard. Our study suggest that every case of RTI, be it an ulcerative or nonulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications. Early diagnosis and treatment of HSV infection together with prophylaxis for recurrent HSV disease will prevent progression and spread of HIV disease.

A study of Body Mass Index (BMI) of Nepalese women attending gynaecology clinic.

This prospective study was carried out to find out the body mass index (BMI) of all the women attending a gynaecological clinic at Kathmandu Valley. Total of 1450 women attended this clinic over the study period. After excluding few hundreds of women, one thousand women of reproductive age (15-49) were enrolled. Detail history was taken, general, systemic and pelvic examinations were performed and a provisional diagnosis was made on the clinical ground. In this process height and weight of each patient was measured then Body Mass Index (BMI) was calculated. Eight percent (8%) of women were underweight and equal numbers of them were obese too. Forty-four point six percent were healthy and 37.3 were overweight. Most of them were diagnosed vaginitis, urinary tract infection (UTI), pelvic inflammatory disease (PID), subfertility, menstrual disorders, and cervical conditions. In eleven percent no gynaecological abnormalities were detected (NAD). Commonly diagnosed conditions were vaginitis, UTI, PID, primary subfertility and menstrual disorders were the commonly diagnosed conditions.

Abortion etiologies and their forensic identification / 法医学杂志

The causes of abortion are complicated and variable. Genetic abnormalities, immune disorders, endocrine disorders, and sperm abnormalities are the most common etiologies. Other risk factors include infections, genital malformation and diseases, systemic diseases, environmental factors, psychiatric problems, fections, genital malformation and diseases, systemic diseases, environmental factors, psychiatric problems, surgery, and maternal trauma. In forensic assessment of abortion and its etiology, trauma-induced abortion can only be determined after exclusion of all other non-traumatic causes.

Urogenital involvement in the Klippel-Trenaunay-Weber syndrome: treatment options and results

OBJECTIVE: Klippel-Trenaunay-Weber syndrome (KTWS) is a congenital condition characterized by vascular malformations of the capillary, venous and lymphatic systems associated to soft tissue and bone hypertrophy in the affected areas. This syndrome may involve bladder, kidney, urethra, ureter and genitals. We report the treatment of 7 KTWS patients with urogenital involvement. MATERIALS AND METHODS: From 1995 to 2005, 7 patients with KTWS were evaluated and the charts of these patients were reviewed. RESULTS: PatientsÆ median age was 19-years (range 4 to 46-years) and only 1 was female. The clinical presentation included genital deformities in 3 cases, hematuria in 2 and urethrorragia in 2, one of which associated with cryptorchidism and phimosis. Three patients had an association of pelvic and genital malformations, including 2 patients with hematuria due to vesical lesions and 1 patient with left ureterohydronephrosis due to a pelvic mass. Two patients had urethral lesions. Treatment included endoscopic laser coagulation for 1 patient with recurrent hematuria and 1 patient with urethrorrhagia, pelvic radiotherapy for 1 patient with hematuria and circumcision in 2 patients with genital deformities. One patient required placement of a double-J catheter to relieve obstruction. Hematuria and urethrorragia were safely and effectively controlled with laser applications. Circumcision was also effective. The patient treated with radiotherapy developed a contracted bladder and required a continent urinary diversion. CONCLUSIONS: Urogenital involvement in patients with KTWS is not rare and must be suspected in the presence of hematuria or significant cutaneous deformity of the external genitalia. Surgical treatment may be warranted in selected cases.

Maternal genital bacteria and surface colonization in early neonatal sepsis.

OBJECTIVE: The study was intended to evaluate the role of maternal genital bacteria and baby's surface colonization in early onset neonatal sepsis. METHODS: Babies (born in the hospital of Jawaharlal Institute of Postgraduate Medical Education and Research) who developed clinical signs of sepsis were studied. Swabs were collected for culture from baby's umbilicus, ear, throat in addition to gastric aspirate and blood culture. The genital tract of the mother was also studied for bacterial colonization. The organisms isolated from the maternal genital tract and baby's surface colonization were correlated with those isolated from blood culture by calculating Phi correlation coefficient. RESULTS: Esch coli was the most common organism isolated from maternal genital tract and surface cultures of babies, but Klebseilla-Spp was the most common organism isolated from blood. There was a significant correlation between surface colonization of babies and maternal genital bacteria, so also was baby's surface culture and blood culture. However, correlation between maternal genital bacteria and baby's blood culture was not significant. CONCLUSION: Surface colonizing bacteria and not maternal genital bacteria are important in early onset neonatal sepsis.

Etiopathophysiology of disseminated intravascular coagulation.

Disseminated intravascular coagulation (DIC) involves activation of clotting as well as fibrinolytic pathways. Thrombosis from thrombin release results in end-organ damage, whereas consumption of coagulation factors results in bleeding. Sepsis is the commonest cause of DIC. The consumption of antithrombin in sepsis abrogates its anti-inflammatory role and so its low level is a poor prognostic marker in sepsis. The increased release of plasminogen activator inhibitor-1 (PAI-1) as seen in sepsis decreases fibrinolysis and promotes increased microvascular thrombosis. Here, we discuss the role of inhibitors of coagulation, cytokines, kinins, complement and vasoactive peptides in DIC.

"Utilidad diagnóstica y terapéutica de la cirugía laparoscópica en el abdomen agudo de origen ginecológico" / Diagnostic and therapeutic usefulness of laparoscopic surgery in the gynecological emergencies

El objetivo fue determinar la utilidad de la laparoscopia en el tratamiento del abdomen agudo que se presenta de primera intención al ginecólogo. Se analizaron los casos de 78 pacientes que fueron atendidas en el servicio de Urgencias del Hospital ABC por dolor abdominal y sintomatología relacionada con el aparato reproductivo. La edad de las pacientes fue de 27.7 ñ 6.3 años. Los diagnóstico preoperatorios más frecuentes fueron embarazo ectópico y quiste de ovario, el resto de las pacientes se operó para determinar la etiología de dolor abdominal. El antecedente de embarazo ectópico fue factor determinante de riesgo para el desarrollo ulterior del problema (X2, p<0.05), otros factores condicionantes fueron los antecedentes de esterilidad y enfermedad imflamatoria pélvica. Se encontró patología intraabdominal en 97.4 por ciento de los casos; de estas pacientes 98.6 por ciento presentaba patología ginecoobstétrica. El valor predictivo positivo del diagnóstico preoperatorio fue de 83.3 por ciento y 91.3 en los casos de embarazo ectópico y quiste de ovario, respectivamente. En 25.6 por ciento de los casos la laparoscopia se transformó en cirugía abierta, siendo el hemoperitoneo masivo secundario a embarazo ectópico roto la situación que determinó más frecuentemente esta conducta. Se concluye que la laparoscopia es de utilidad en la mayoría de los casos de abdomen agudo de origen ginecológico. La detección temprana de la patología intraabdominal, especialmente del embarazpo ectópico contribuirá a disminuir la frecuencia de conversión de la cirugía endoscópica en procedimientos abiertos convencionales

Sepse em Ginecologia e Obstetrícia / Sepsis in Gynaecology and Obstetrics

Infecçöes de origem gineco-obstétrica constituem uma das mais frequentes causas de sepse, com importante morbi-mortalidade. O autor realizou uma extensa revisäo da literatura com o objetivo de atualizar conceitos relacionados a incidência, causas determinantes, fisiopatologia, microbiologia, classificaçäo, terapêutica e prognóstico de sepse de origem gineco-obstétrica

El Síndrome de Fitz-Hugh-Curtis. Causa frecuente de error de diagnóstico en hepatología y gastroenterología / The Fitz-Hugh-Curtis Syndrome. a frequent misdiagnosis in hepatology and gastroenterology

Antecedentes: El síndrome de Fitz-Hugh-Curtis (FHC) consiste en perihepatitis secundaria e infección pélvica. Descrito inicialmente como una complicación debido al gonococo, en la actualidad es producido más a menudo por Chlamydia trachomatis. Se observa en el 5 a 10 por ciento de las mujeres con salpingitis o esterilidad tubaria en los países desarrollados. Su prevalencia en México se desconoce, pero podría ser similar a la observada en otros países en vías de desarrollo (34 por ciento). Métodos: Se revisaron en bases de datos (Med Line y Current Contents) artículos sobre FHC publicados en los últimos 10 años. Se estableció el estado de conocimiento actual con énfasis especial en el diagnóstico serológico. Al mismo tiempo se analizaron las implicaciones en la práctica clínica en nuestro país: Resultados: El FHC no es una afección que ponga en riesgo la vida de los pacientes; sin embargo, su reconocimiento temprano es de fundamental importancia por tres razones: 1) Puede ser causa frecuente de error de diagnóstico en mujeres con dolor abdominal, fiebre y leucocitosis, ya que pocas veces se considera dentro del diagnóstico diferencial. A veces, debido a su desconocimiento, se llevan a cabo operaciones innecesarias (Colecistectomía, apendicectomía, etc.), 2) es de fácil tratamiento, ya que responde fácilmente a la terapia con antibióticos; 3) su desconocimiento es causa de angustia en el paciente, pues acude con múltiples médicos, y aún más importante es que puede provocar complicaciones graves, como embarazo tubario y esterilidad. El diagnóstico de certeza puede hacerse actualmente por medio de pruebas serológicas, las cuales han reemplazado los costosos e imprácticos métodos de cutlivo de muestras del cérvix y de las adhesiones perihepáticas. El diagnóstico morfológico se hace por laparoscopia. Conclusión: El FHC debe tomarse en cuenta en el diagnóstico diferencial en mujeres con dolor abdominal, fiebre y leucocitosis. El cambio operado recientemente en la sociedad mexicana en relación a los hábitos sexuales entre jóvenes podría incrementar este tipo de padecimientos sexualmentes transmitidos. Es necesario realizar estudios epidemiológicos con el fin de establecer la prevalencia en México