[Tramadol chlorhydrate in the management of gyneco-obstetric pain]. / Clorhidrato de tramadol en el manejo del dolor ginecoobstétrico.

An open prospective and longitudinal study was carried out including 102 female patients whose pain was due to gyneco-obstetric surgery. The average age was 31.5 years and the average weight was 67 kg. The tramadol hydrochloride was administered as a single 100 mg dose p.o. or i.m., when moderate to intense pain was present. At the beginning of the trial, 96.1% of the patients presented moderate to very intense pain. At the end of the period of the trial, 74% reported none or mild pain. The analgesia began after an average of 17 minutes i.m. and 28 minutes p.o. The identified adverse effects were: nausea 1%, vomiting 5% and somnolence 8%. In accordance with the obtained results, we conclude that tramadol chlorhydrate is a good alternative for the treatment of moderate-to-severe acute pain of obstetric and gynecological origin.

[Treatment of premenstrual tension syndrome (PMS) with lisuride maleate]. / Tratamiento del síndrome de tensión premenstrual (STP) con maleato de lisurida.

The etiology of PMS has not yet been defined, although there are several theories among which it is reported that there is an increase in prolactine levels involved in it. The purpose of this study was to evaluate a dopamine receptor agonist (lisuride maleate), in the treatment of PMS. 35 patients between 19 and 35 years old were recruited in a prospective study design, with diagnosis of PMS and no other gynecological disorder ruled out clinical and ultrasonographic examination, women with no previous treatment and with no use of hormonal agents, these patients were treated for three months with lisuride maleate, 0.3 mg-day in a three dosage scheme per day, the following symptoms were evaluated: headaches, mastalgia, bloating, edema of lower extremities and myalgia in legs, as well as hormonal parameters before and after treatment with estrogens, progesterone, prolactine, luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone, which were prescribed in the luteal phase (day 21). Results obtained were: reduction of all symptoms scores versus pretreatment: Headache from 85.7 to 20%, mastalgia from 91.4 to 25%, bloating from 74.2 to 40%, edema in lower extremities from 85.7 to 30%, myalgia in legs, from 61 to 34%. The hormonal profile only showed changes in FSH, since the basal pretreatment level was found in 18.6 and the post-treatment value was 13.86, progesterone from 2.7 to 4.6 and prolactine from 7.74 to 6.82. We conclude the lisuride maleate is a good option to the PMS treatment, since a significative reduction of symptoms are induced and it is well tolerated.

[Treatment of fibrocystic breast disease with lisuride]. / Tratamiento de la mastopatía fibroquística con lisurida.

To study the efficacy of lisuride in fibrocystic mastopathy, we conducted a clinical trial in 23 out patients, aged 19-50 years, randomly recruited from the gynecological service of the ISSSTE, Dr. Darío Fernández Fierro. Hospital. The only exclusion criteria was having received previous treatment. The patients clinical history was recorded. Physical examination, hormone profile (FSH, LH, prolactin, testosterone, estrogen and progesterone) and ultrasound exam of the mammae at baseline were performed in all patients, as well as, mammography in patients older than 40 years or those requiring so. Treatment was started with 1/2 tablet of lisuride (0.1 mg)/8 hours, preferably with meals, for 3 months. At the end of therapy, hormone profile, ultrasound of the mammae and physical examination were repeated for control purposes. We obtained the following results; fibrocystic mastopathy was most frequent in women aged 20-29 years, mean age 31 years symptoms disappeared in 36.9% and were reduced notably in 63.1%, of cases. Grade O ultrasound lesions disappeared in 100% of patients and grade I and II lesions improved. On physical examination all patients showed improvement; estrogen values were reduced and progesterone incremented. The prolactin level were normal at baseline, as well as by the end of treatment. One patient suffered severe side effects which required interruption of treatment; 4 patients experimenting light side effects were able to continue therapy and in the remaining 18 patients, no adverse reactions were observed.

[Tocolytic therapy with magnesium sulfate and terbutaline for inhibition of premature labor]. / Terapia tocolítica con sulfato de magnesio y terbutalina para la inhibición del trabajo de parto pretérmino.

Magnesium sulfate has been recommended as a safe and effective tocolytic agent. However has not been substantiated by randomized, controlled trials. To assess the efficacy of magnesium sulfate, we initiated prospective randomized study competing the capabilities of magnesium sulfate and terbutaline for labor inhibition. The study population consisted of 30 patients (15 patients with terbutaline and 15 patients with magnesium sulfate) between 28 and 36 weeks of gestation and in preterm labor. One patient in terbutaline group was excluded of the study because we found a severe fetal distress. The diagnosis of labor was made if, persistent uterine contractions occurred at a frequency of at last three in a team-minute period and cervical examination suggested active labor. Success was defined as postponement of delivery for at least 48 hours after initiation of therapy. Despite a trend toward increased efficacy in the terbutaline group (tocolytic Bishop grade and its success) there were no significant differences between the two treatment groups with regard to capability of delaying delivery at least 48 hours. Although there were significant differences for terbutaline regard the tocolysis time. For all these reasons, the efficacy between both groups of treatment is similar, and in a future cases, will be necessary to choose the better agent for every case to study.

[Breech presentation. Management at the Dr. "Dario Fernández" Hospital]. / Presentación pélvica. Manejo en el hospital Dr. "Dario Fernández", ISSSTE.

The management of 73 breech presentation was reviewed, in order to see if cesarean section and adequate maneuvers improve, maternal or fetal outcome. From 33 to 36 weeks of gestational age, were 19.2%; from 37 to 42 weeks, 80.8%. Nulliparous, 53.4%; multiparous, 46.6%. Maternal morbidity was 15%; mortality, of zero. Fetal weight, 2500 to 3500 gm, 69.9%. Apgar scores at five minutes of 7 or more, were 90.5%. Adequate maneuvers during cesarean section with Apgar scores of seven o more, 97%; inadequate maneuvers, 62%. Fetal morbidity was 9.5%; and zero mortality. Congenital abnormalities, 6.8%. In conclusion, cesarean section and adequate maneuvers, improve perinatal outcome, in the breech presentation.

[Nimesulide in the treatment of primary dysmenorrhea. Comparative clinical evaluation with mefenamic acid and fentiazac]. / Nimesulide en el tratamiento de la dismenorrea primaria. Evaluación clínica comparativa con ácido mefenámico y fentiazac.

Sixty patients with primary dismenorrhea were treated: 20 with nimesulide, 20 with fentiazac and 20 with mefenamic acid during three consecutive cycles under double blind design. The doses used in each group were: nimesulide or fentiazac 100 mg, every 12 hrs., mefenamic acid 500 mg. every 8 hrs. in all cases during 5 days, beginning a day before the beginning, of the menstruation. The pain evolution and the symptoms were evaluated three times a day using a scale from 0 to 10, so measure its intensity. Concluding, the nimesulide is useful in the treatment of pain associated with primary dismenorrhea, answering with little statistical advantage over the fentiazac and with bigger statistical advantage over the mefenamic acid. The tolerance was excellent with the three drugs studied.