[Obstetric hysterectomy. Review of 675 cases at the Instituto Nacional de Perinatología]. / Histerectomía obstétrica. Revisión de 675 casos en el Instituto Nacional de Perinatología.

A retrospective study of 675 patients subject to obstetric hysterectomy from January 1st, 1985 to December 31st, 1995 at the Instituto Nacional de Perinatología was carried out. The incidence of this procedure reached its highest level in patients from 26 to 40 years, which represented 60.5% (409 cases) of the studied population. Patients with one previous cesarean section comprised 34.8% of total obstetric hysterectomies, followed by women with two to three previous cesarean sections (24.5% and 22.2%, respectively). As for gestational age, it reached term in 51.1% (345 cases), pre-term in 38% (257), post-term in 1.4% (10), and less than 20 weeks in 9.3% (63 cases). Main indications for obstetric hysterectomy included placenta accreta in 34.07% (230 cases), uterine atony in 32.4% (219), deciduomyometritis in 6.3% (43 cases), and uterine rupture in 4.5% (31). Most frequent complications included hypovolemia (12.1%), bladder injury (5.4%), and ureteral injury (0.7%). Postoperative complications included anemia (61.6%), febrile syndrome (7.5%), mechanic ileum (7.5%), wall abscess (3.4%), and vesicovaginal fistula (1.6%). A total of eight maternal deaths (1.1%) was reported.

[Therapeutic efficacy of vaginal administration of bromocryptin in patients with hyperprolactinemia]. / Efectividad terapéutica de la bromocriptina (BEC) administrada por vía vaginal en pacientes con hiperprolactinemia.

Oral bromoergocriptine (BEC) is currently the treatment of choice in women with hyperprolactinemia secondary to a prolactinoma. However, undesirable side effects (of variable type and intensity) are frequently present in these women due to both local irritation and to a direct effect upon the central nervous system. The present work was undertaken as a pilot study to assess the therapeutic effectiveness of vaginally administered BEC and to corroborate if the side effects are less frequent and of minor intensity when compared to oral BEC. Initially, 16 women were included, but two of them did not accept to continue in the study; thus, a total of 14 women with hyperprolactinemia (> or = 40 ng/ml) were divided in two groups: Group A encompassed five women, aged 27 to 36 years old, two with normal menstrual cycles and three with oligomenorrhea; all had primary or secondary sterility during 3 to 12 years and galactorrhea from 6 months to 3 years; in only one patient a brain computerized axial tomography (CAT) was performed which showed the existence of a macroprolactinoma. All received oral BEC (2.5-5 mg/day, except one patient with 10 mg/day). Group B included nine women, aged 26 to 36 years old, four had normal menstrual cycles and five had oligomenorrhea; all had primary or secondary sterility during the last 2 to 7 years and eight out of nine, also had galactorrhea during 1 to 8 years; in four of them a CAT was performed showing a pituitary microadenoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypertonic saline as a resuscitation solution in hemorrhagic shock: effects on extravascular lung water and cardiopulmonary function.

To determine the effect of resuscitation with hypertonic saline on extravascular lung water, seven adult sheep were endotracheally intubated; mean arterial pressure (MAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), and central venous pressure (CVP) were monitored. A 5-French, thermistor-tipped catheter was used to measure extravascular lung water (EVLW). Colloid oncotic pressure (COP), serum electrolytes and osmolality, and arterial and mixed venous blood gas tensions were measured. The COP-PCWP gradient and the shunt fraction (Qsp/Qt) were calculated. After baseline measurements, the animals were bled to an MAP of 50 mm Hg (blood volume removed, 16.2 +/- 3.6 ml/kg), which was maintained for 30 min, measurements then being repeated. Three percent sodium chloride solution was infused at 500 ml/15 min until two of three parameters--cardiac output (CO), PCWP, or MAP--were restored to baseline values. Data were recorded again and then 60 min later. No shed blood was reinfused. The total volume of hypertonic saline infused was 39 +/- 19 ml/kg. Pulmonary artery pressure did not vary throughout the study. PCWP, MAP, and CO were significantly lower than baseline (P less than 0.05) 30 min after bleeding but all except MAP returned to baseline with resuscitation. Throughout the study, EVLW did not vary despite a COP-PCWP gradient less than 4 mm Hg. Serum sodium levels and serum osmolality were significantly above baseline values after resuscitation. In this animal model of hemorrhagic shock, infusion of hypertonic saline effected resuscitation without compromising cardiopulmonary function or increasing EVLW.

Acquired immunodeficiency syndrome in the United States: a selective review.

The acquired immunodeficiency syndrome (AIDS) epidemic shows no sign of waning. Recent calculations suggest that several hundred thousand asymptomatic people may have been infected with the putative AIDS agent, HTLV-III/LAV. This review includes an analysis of immunologic data, means of preventing transmission of the syndrome, and a discussion of the psychosocial and ethical impact of the disorder. Also summarized are epidemiologic and clinical parameters of AIDS in the US.

Continuous positive airway pressure and expiratory positive airway pressure increase functional residual capacity equivalently.

The effect of continuous positive airway pressure (CPAP) and expiratory positive airway pressure (EPAP) on functional residual capacity (FRC) of ten healthy, spontaneously breathing, lightly anesthetized intubated mongrel dogs was studied. The CPAP and EPAP at 5, 10, 15, and 20 cm H2O were alternately applied to all animals. Total (lung and chest wall) compliance, esophageal pressure, airway pressure, transpulmonary pressure, control FRC, and the change in FRC (delta FRC) were measured before and after each application of CPAP and EPAP. Neither expiratory transpulmonary pressure nor delta FRC with CPAP differed significantly from that with EPAP at all levels (p greater than 0.05). These data suggest that CPAP and EPAP, when applied at the same expiratory pressure, result in an equivalent increase in FRC due to passive mechanical distention of the lungs.

Subdural empyema and group C Streptococcus.

We have described a case of subdural empyema in a 13-year-old boy whose presentation was not atypical for the disease. The unusual organism cultured from his blood, frontal sinuses, middle ear, meninges, and epidura was group C beta-hemolytic Streptococcus.

Altered T-lymphocyte subsets in hospitalized intravenous drug abusers.

Baseline immunologic abnormalities were identified in 16 hospitalized intravenous drug abusers ( IDAs ) without acquired immune deficiency syndrome (AIDS). Twelve (75%) of 16 had inverted helper-suppressor ratios. In seven patients (44%), the abnormal ratio resulted from an increase in the absolute number of suppressor cells with a normal number of helper T lymphocytes. In five patients (31%), the reduced ratio resulted primarily from decreased helper cells, immunophenotypic findings similar to those seen in patients with AIDS. These findings are similar to what has been noted in other groups at risk for AIDS. Longitudinal follow-up as well as studies of "healthy" IDAs are required to understand the prognostic implications of these data.

Late bone metastasis in breast carcinoma.

A 49-year-old woman was free of metastases for 14 years after a left radical mastectomy. Metastases were found only in the skull, also the bone marrow biopsy demonstrated metastases.