[Endometrial ablation by liquid heat using the EnAbl system in patients after abdominal hysterectomy. Study of safety]. / Ablación endometrial por medio de calor líquido usando el sistema EnAbl, en pacientes sometidas a histerectomía abdominal. Estudio de seguridad.

Security and efficacy of an EnABL, were evaluated; this system had been designed for endometrial ablation by liquid heat in uterine cavity. Eleven patients were included, from the Outpatient Department (INP), programmed for different causes that objectives of this study for abdominal hysterectomy due to abnormal uterine bleeding. The study was approved by Ethical and Scientific Committees. Each patient had preoperative studies, endometrial biopsy, PAP, and ultrasound, in series. The patients with uterus larger than 14 cm, possible cancer; younger than 18 year, or with active bleeding at the time of hysterectomy, were excluded. Each patient received a schema of standard endometrial suppression. The system was applied previously to TAH; 2271 measurements of temperature at one minute intervals were done during liquid heat application. Surgical pieces were sent to histology to analyze the thermic damage through macroscopic aspect, HE tinction and an immunohistochemical cellular viability of NADH test. The thermal damage by macroscopic appearance was 4.33 +/- 1.03 mm, with HE of 4.15 +/- 0.75 mm and with the tinction of NADH of 4.25 mm +/- 0.79. The maximal damage by macroscopic appearance was 4.33 +/- 1.03 mm, with HE of 4.15 +/- 0.75 mm, and with NADH it was 4.25 mm +/- 0.79. The maximal damage was by macroscopic appearance was 6.0 mm and the minimal one was 2.0 mm. In evaluation by H/E, maximal was 5.1 mm and the minimal one was 2.3 mm. In NADH tinction maximal was 4.25 and minimal 2.4 mm. Horizontal analysis showed eight patients with major thermal damage at 4 mm; and two patients with lesser damage at 4 mm. Sub-serous temperatures measured with thermopairs, were done 1504 times, in total. Average was 36.28 degrees C, ranging 35 to 37 degrees C. Maximal temperature was 45 degrees C, 1-2 mm, bellow from serous surface of uterus, and the last one was 28 degrees C. The serous temperatures measured by infrared radiation were done 767 times with an average temperature of 34.6 degrees C. Average was 34-35 C, with standard deviation of 1-2 degrees C. Maximal temperature was 40 degrees C and minimal 29 degrees C. There were no adverse effects. This study shows that EnAbl system is an efficacious method.

Endometrial Ablation with the EnAbl System

We assessed the safety of a new method of endometrial ablation using heated saline in 11 patients who were undergoing elective hysterectomy. The EnAbl system consists of a controller, computer, and disposable, flexible probe that provides in situ heating and circulation of the saline while maintaining a tight seal at the internal os. The system's low pressure precluded ligation of the oviducts. Temperatures of the saline, uterine serosa, subserosa, and oviducts were monitored throughout the 15-minute procedure in all 10 treatments and 1 control. Histology revealed an average depth of treatment of 4 mm, including necrosis of the surface myometrium. Average depth of necrosis was consistent throughout the cavity regardless of the presence of insignificant myomas. Serosal, subserosal, and oviduct temperatures remained low (<e;45° C) during the 10 treatments of 70 to 85° C. We believe that this method provides an efficacious depth of treatment while maintaining safe serosal temperatures.

[Ovulation induction with human menopausal gonadotropins in hypothalamic-hypophyseal disfunction]. / Inducción de ovulación con gonadotropinas menopáusicas humanas en disfunción hipotálamo-hipofisiaria.

This is a report on the institutional experience of the use of Human Menopausal Gonadotropins (HMG) in anovulatory women diagnosed as hypothalamic-hypophysiary dysfunction of Group II of WHO with previous failure to chlomifen citrate therapy. In a period of three years 180 patients were gathered with 420 cycle of treatment, obtaining ovulation in 340 cycles (81%). The ovarian hyperstimulation syndrome (OHS) was present in 15 cases (3.5%). There were 115 pregnancies that correspond to 33.8% of oculatory cycles and to 63.8% of the amount of patients. Multiple pregnancy incidence was 10.4%, and the gestational loses rate was 26%; these results are similar to what has been reported in literature. It is concluded that this medication is a good option of treatment for this type of patients, provided that there are the necessary means to expert and adequate surveillance.

[Unexplained sterility. Treatment with superovulation and intrauterine insemination]. / Esterilidad inexplicable. Tratamiento con superovulación e inseminación intrauterina.

Fifty couples with unexplainable sterility, were selected for study. They were treated following a uniform treatment protocol, consisting in inducin superovulation by human menopausic gonadotropins hormones, followed by intrauterine insemination with husband's fresh semen. One hundred and thirty six cycles of treatment, were obtained; 15 pregnancies were achieved, corresponding to 30% of the total of couples, and to 11% of amount of treatment cycles. These figures were similar to other author's, and similar to the ones obtained by intrauterine gametes transference. It is concluded that this a new alternative of treatment that may be used before IGT, or in places where there is not such methodology.

[C-reactive protein as early marker of chorioamnionitis in premature rupture of membranes]. / Proteína C reactiva como detector temprano de corioamnioitis en ruptura prematura de membranas.

This study was done in order to correlate the C-Reactive Protein levels (CRP) determined by nephelometric technique, with other infection indicators, and to know its exactness in early detection of chorioamnioitis. Thirty patients were prospectively studied with pregnancies from 28 to 35 weeks of gestation with diagnosis of premature rupture of membranes (PRM); and were compared to control group (30 patients) with similar gestation without PRM, infection, autoimmune diseases or chronic inflammation. The value for CRP was 2 mg/dl. The study group included 17 patients considered as positive, and 13 negative; the differences in CRP values in infected women was significant and not infected ones with a probability less than 0.001 (Fisher), with a sensitivity of 94.12%, and specificity of 100% positive predictive value of 100%, and a negative predictive value of 98.86%. The present data show that CRP is an early detector of amniotic infection.