[Pharmacokinetic variations in anticonvulsants in Mexican epileptic women during different stages of the postpartum period]. / Variaciones farmacocinéticas de anticonvulsivantes en mujeres epilépticas mexicanas durante las diferentes etapas del postparto.

During pregnancy, there are several physiological changes that influence the kinetics of medication administrated during this time. These physiological changes are not reestablished immediately during delivery; so, its concentration in biologic fluids is different when is administered immediately after delivery, than several weeks after. The purpose in this work was to identify the changes of pharmacocinetics constants for fenitoin and carbamacepine, in epileptic patients. When the same dose is maintained, during different times of postpartum. In 20 Mexican epileptic women, the plasma and milk concentrations of fenitoina during 60 day postpartum and in 14 carbamacepine was determined. In all the patients pharmakocinetics of anticonvulsivant, in each study period (5, 15, 30, 45 y 60 days postpartum). Excretion index of maternal milk was determined. Maximal plasmatic concentration of fentoine had no variation; however, carbamacepine was higher during the late period. There were no differences in the areas under curve and life all the middle of elimination and in excretion index.

Variaciones farmacocinéticas de anticonvulsivantes en mujeres epilépticas mexicanas durante las diferentes etapas del postparto / Pharmakocinetic variation of anticonvulsants in Mexican epileptic women during different parts of puerperium

Durante el embarazo existen una serie de cambios fisiológicos que influyen en la cinética de los medicamentos administrativos durante esta etapa: Estos cambios fisiológicos no se restauran inmediatamente en el parto, de tal manera que su concentración en los fluidos biológicos es diferente cuando se administra inmediatamente después del parto que varias semanas posterior al mismo. El presente trabajo tiene como propósito identificar los cambios en las constantes farmacocinéticas de fenitoína y carbamacepina, en pacientes epilépticas cuando se mantiene una misma dosis durante diferentes etapas del postparto. En 20 mujeres mexicanas epilépticas se determinó la concentración en plasma y leche de fenitoína durante 60 días postparto y en 14 se determinó carbamacepina. A todas las pacientes se les realizó la farmacocinética de los anticonvulsivantes en cada periodo de estudio (5, 15, 30, 45 y 60 días posparto) y se determinó el índice de excreción en leche materna. Las concentraciones plasmáticas de fenitoína no presentaron variaciones, sin embargo la carbanacepina fue más alta en el periodo tardió, también se observaron diferencias en las áreas bajo la curva y vida media de eliminación y en los índices de excreción

[Clinical characteristics of women with genital prolapse]. / Características clínicas de la mujer con prolapso genital.

Clinical features of severe urogenital prolapse, were studied. Fifteen patients were included in a retrospective study between January 1990 and June 1995. The diagnosis of severe uterine prolapse (where the cervix precedes the inverted vaginal tube) was the sole inclusion criteria. Age, parity, hormonal stage, occupation, simptomatology, body mass index, and the results of histopathological examinations were evaluated. The mean age was 60 years, parity most frequently observed was more than three, 80% were postmenopausal, the body mass index was 23.5, all patients were housewifes, the symptomatology that was present in 100% of the patients was the sensation of an intravaginal foreign material. The surgical treatment performed was vaginal hysterectomy. The results of histopathological examinations were in the most inflammation. The parity and postclimaterium were the principal factors associated with the pathogenesis of uterine prolapse.

[Bladder drainage in patients undergoing the Pereyra surgical procedure]. / Drenaje vesical en pacientes sometidas a operación Pereyra.

Postoperative acute urinary retention was evaluated in the patients who underwent Pereyra procedure. Comparison of suprapubic and urethral catheterization. Between January 1994 and July 1995, fifty two patients with urinary stress incontinence underwent Pereyra procedure, 31 female patient with suprapubic drainage (cistofix Ch 15) and 17 urethral catherization with a latex foley catheter. Sponatneous micturition and urinary retention was evaluated until the catheter was removed. Mean age was 43.8 years (32 a 66), the duration of suprapubic vesical drainage with suprapubic catheter were 3 days in 58.6% of the patients, and more than 3 days in 41.29%. Recatheterizacion in the patients with urethral drainage was more frequent. Urinary retention after 7 days was present in 23.99% with suprapubic vesical drainage and 28.5% with urethral catheter. Recatheterization is more frequent in patients with urethral catheter.

[Postoperative evaluation of different surgical procedures in genuine stress urinary incontinence: a retrospective study]. / Evaluación del posoperatorio de los diferentes procedimientos quirúrgicos para incontinencia urinaria genuina de esfuerzo: estudio retrospectivo.

An evaluation of the surgical treatment for stress and mixed urinary incontinence and pelvic relaxation. One-year follow-up, was done. A retrospective study with 144 files from the surgeries performed between February 1993 and June 1994, at the Clínica de Urología Ginecológica del Instituto Nacional de Perinatología. We excluded 37 files because of incomplete information. The age, parity, hormonal stage, preoperative diagnosis by urodynamic studies, surgical treatments and one-year follow-up were analyzed. The mean age was 45.5 years. Pereyra procedure was performed in 53, Burch procedure in 47, anterior colporrhaphy in 5, and sling procedure in 2 patients. The incidence of complications was similar between the different groups. Resumption of spontaneous postsurgical voiding was delayed in the Pereyra group. The Burch urethropexy and Pereyra procedures were equally effective, with no statistical differences observed. Burch vaginal suspension was not more effective for the correction of urinary stress incontinence than Pereyra procedure.

[Incidence of pelvic-genital static disorders in patients with urinary incontinence]. / Frecuencia de trastornos de estática pelvigenital en pacientes con incontinencia urinaria.

Urogenital prolapse in patients with urinary incontinence, was studied. Retrospective and analytic study was made in the Clínica de Urología Ginecológica del Instituto Nacional de Perinatología, 121 patients with urinary incontinence were included, urogenital prolapse was evaluated (urethrocele I, II, III. cistocele I, II, III). 117 patients had urogenital prolapse (96.6%), 53 had cistocele I, 46 cistocele II, 11 cistocele III. 19 patients had urethrocele 1, 54 urethrocele II, 35 urethrocele III and 13 no urethrocele. According with the type of urinary incontinence, 72 patients had urinary stress incontinence, 41 mixed urinary incontinence, 8 with urge incontinence. Patients with urinary stress incontinence show greater frequency of cistocele I, urethrocele II. 13 patients had low urethal close pressure.

[Value of the Q-tip test in patients with urinary incontinence]. / Valor de la Prueba del Hisopo en pacientes con incontinencia urinaria.

We evaluated the accuracy of the Q-tip test to measure uretrhovesical junction mobility in patient's histories of urinary incontinence, and pelvic relaxation. A retrospective study of 183 files of patients with urinary incontinence and anterior vaginal wall relaxation in the Instituto Nacional de Perinatología (INPer) between march 1994 and may 1995. All patients underwent a systematic diagnosis evaluation with detailed history and physical examination including Q-test, neurology examination, urinary, urine culture, uretrhoscopy and urodinamic studies. We correlated Q-tip test pelvic relaxation to measure urethrovesical junction mobility. They were placed in three groups. Group I formed by stres incontinence, group II formed by mixed incontinence and group III formed by recurrent incontinence. Mean age 46.3 years (29-72), almost all the patients were multiparas, menopausal status in 72, with hormonal treatment 48. Q-tip test was not different between the groups. Group I had cystocele II with hipermobility statistically significant difference, the same in group II. No differences were found in the group III. We concluded that urethral position and mobility as measure by the Q-tip test are related to defects in interior vaginal support, but not to specific urologic diagnosis.

[Urethral leiomyoma during pregnancy. Report of a case and review of the literature]. / Leiomioma de la uretra durante el embarazo. Informe de un caso y revisión de la literatura.

We present a case of leiomyoma of the urethra diagnosed during pregnancy. The patient a 40 year old woman, gravida II, who presents a mass that depend of the proximal urethra, it was observed in the vaginal introitus, it's growth was progressive after 8th weeks of pregnancy. We realized local excision at 23rd weeks pregnancy. Histopathological examination reported leiomyoma of the urethra. The pregnancy was resolved through cesarean section by fetal indication. Actually the patient is free of symptoms.

[Modified sling operation: institutional experience]. / Operación de cabestrillo modificada: experiencia institucional.

We report the retrospective experience in the treatment of six patients with recurrent or severe stress urinary incontinence or low urethral pressure. They were treated with sling modified procedure with polytetrafluoroethylene (Gore-Tex); in the National Institute of Perinatology (INPer) at 1992-1994. The morbidity was highest, the patients in the post operatory present detrusor instability, voiding problems and tissue reaction to polytetrafluoroethylene. The patients are continent in the actuality. They were observed by 8-32 months. This surgery is easy to make and not required of more experience than the necessary for realizing the cysto-urethropexy with needle, but, the selections criteria must be carefully analyzed.

[Urinary retention secondary to surgical treatment of stress urinary incontinence]. / Retención urinaria secundaria al tratamiento quirúrgico de incontinencia urinaria de esfuerzo.

A retrospective, descriptive study at the National Institute of Perinatology (INPer), was carried out. 401 records of patients with stress urinary incontinence who underwent surgical treatment, were reviewed. The objective of this study was to know the urinary retention rate. Urinary retention was present in 103 of 401 patients (25.68%). In modified Pereyra's procedure it was present in 67 of 195 (34.35%); in modified Burch's procedure, in 25 of 131 (19.08%); in Kelly's procedure in 9 of 70 (12.85%) and in 2 of 5 patients with sling procedure with polytetrafluoroethylene (Goretex). The problem of urinary retention was observed more frequently in vaginal surgery (modified Pereyra procedure and/or sling procedure).

[Genuine stress urinary incontinence. An analysis of 2 surgical technics: Pereyra's and Burch's]. / Incontinencia urinaria genuina de esfuerzo. Análisis de dos técnicas quirúrgicas: Pereyra y Burch.

Two hundred and twenty-nine patients operated for genuine stress urinary incontinence by two surgical techniques, were studied. Risk factors were analyzed: age, gesta, para, and added gynecological pathology. They were placed in two groups. Group I formed by operated patients with Pereyra's technique (136), and Group II operated by Burch's technique (93). There were no differences as far as general characteristics of patients in both groups. More frequent added pathologies for Group I were pelvic statics changes, and for Group II, uterine myomatosis. Technically there were no advantages for one technique as compared with the other one, independently of indications for each one.

[Urogenital fistula: our institutional experience]. / Fístula urogenital: experiencia institucional.

We are reporting the institutional experience of March 1992 to May 1993. Eleven patients were studied with a diagnostic of urogenital fistula, one of them was vesico-uterine, two uretero-vaginal and eight vesico-vaginal. Only to eight of the patients surgery correction was realized, one of them was aboarded by vaginal tract and seven by abdominal tract. Of the patients with abdominal aboarded, two cases were ureteroneocystostomies. The failure of the surgery was presented in two cases, both with abdominal aboarded. These data clears up that the urogenital fistula is a frequent complication in patients that are submitted to surgical gynecological procedures. The surgical success probably depends more of the surgical technique rather than aboarded tract.

[The correlation of the findings between the urological clinical history and urodynamic evaluation in urinary incontinence]. / Correlación de los hallazgos entre la historia clínica urológica y la evaluación urodinámica en incontinencia urinaria.

Patient's histories of urinary incontinence and results of several standard clinical tests, were correlated with final diagnosis obtained by multichannel urodynamic testing. One hundred and thirty one histories of women with urinary incontinence who were in the Urogynecology Clinics of the Instituto Nacional de Perinatología in the period from july to december 1992, were evaluated including dates of standardized questionnaire and structural clinical examination with the urodynamic testing to obtain a final diagnosis. Although the objective urinary loss and the cystocele II-III were significantly associated with genuine stress incontinence and mixed incontinence, in patients with detrusor instability did not. Women with complaints of urinary incontinence, especially those for whom surgery is contemplated, should undergo complete urodynamic evaluation.