[Subsequent reoperation obstetric hysterectomy and selective ligation of hypogastric arteries]. / Reintervención posterior a histerectomía obstétrica y ligadura selectiva de arterias hipogástricas.

Background: Bleeding in pregnancy, childbirth or postpartum period is an emergency. Selective internal iliac (hypogastric) arteries ligation is a surgical therapy in selected cases of obstetric massive hemorrhage. It had proven to be safe. Objetive: To evaluate the risk for re-intervention for post-operatory bleeding in patients with obstetric hysterectomy and selective hypogastric arteries ligation. Material and method: Cross-sectional study including women diagnosed with obstetric hysterectomy with and without selective arterial ligation as a factor to assess the risk of re-intervention, from December 2013 to December 2014, at High Specialty Medical Unit 23 of Gynaecology and Obstetrics, in Monterrey, which is a tertiary care medical center. Those patients with 28 weeks of gestation or more were selected. The postoperative blood loss was quantified by open drainage system (Penrose). Results: We performed 88 hysterectomies in the study period. We included 45 women according to selection criteria. The average was 31.9 ± 5.48 years old. Performing a selective hypogastric arteries ligation may be a protective factor (p<0.05) for re-intervention as a consequence of postoperative bleeding. Conclusion: Selective arterial ligation is a factor that could help to prevent a re-intervention. A continuous training of physicians and residents of Gynecology and Obstetrics is essential to ensure the reduction in morbidity and maternal mortality.

Conorfamide, a Conus venom peptide belonging to the RFamide family of neuropeptides.

A novel Conus peptide, conorfamide-Sr1, has been characterized. The sequence of the natural peptide was determined using standard Edman sequencing methods and mass spectrometry, and confirmed by chemical synthesis. The peptide has 12 amino acids and no cysteine residues. The following sequence was obtained: GPMGWVPVFYRF-NH(2). No other peptide from a vermivorous Atlantic Conus species has previously been characterized. Conorfamide-Sr1 belongs to the RFamide neuropeptide family, and is the first RFamide peptide to be found in any venom. The presence of conorfamide-Sr1 as a major peptide in Conus spurius venom suggests that Conus lineages in the Atlantic may have evolved novel Conus venom peptide families.

Gonadal dysgenesis and Rokitansky syndrome. A case report.

BACKGROUND: Primary amenorrhea and lack of sexual development occur in gonadal dysgenesis due to missing ovaries. Primary amenorrhea with sexual development occurs in Rokitansky syndrome due to absence of the uterus, with normal ovarian function. The association of these two conditions has been previously described as a rare event. CASE: A 19-year-old woman presented with primary amenorrhea and lack of secondary sexual characteristics. Physical examination confirmed the absence of mammary development and of pubic and axillary hair. Pelvic ultrasound disclosed absence of the uterus and ovaries. Gonadotropin serum levels were in the menopausal range, and the karyotype showed two mosaic cell lines, 45,X/46,Xdic(X). Scanning of a large number of cells by interphase fluorescence in situ hybridization showed 12% of cells with a dicentric X chromosome. Laparoscopic study confirmed the absence of the uterus and ovaries, with normal fallopian tubes. CONCLUSION: This patient had two anomalies affecting reproductive performance, gonadal dysgenesis and congenital absence of the uterus, the first associated with an abnormal karyotype; the second seems to have occurred coincidentally. At this time there is no treatment for the reproductive dysfunction.