Rotura uterina en gestante de 13 semanas: Embarazo ectópico intersticial / Uterine rupture in a 13-week pregnant woman: interstitial ectopic pregnancy

El embarazo ectópico intersticial es una entidad rara pero con una elevada tasa de mortalidad. El diagnóstico puede resultar difícil y tardío, dada la localización del embarazo en una porción intrauterina de la trompa de Falopio. La gestación puede evolucionar de manera asintomática hasta el segundo trimestre de la gestación, y debutar con una rotura uterina y shock hipovolémico por la proximidad del saco gestacional a la arteria uterina. El tratamiento suele consistir en una resección cornual por vía laparoscópica, aunque se individualizará en función de cada caso, primando ante todo la clínica de la paciente. Se expone el caso de un embarazo ectópico intersticial que debutó con rotura uterina a las 13 semanas de gestación.

Interstitial ectopic pregnancy is a rare but with a high mortality rate entity. Diagnosis can be difficult and late, given the location of the pregnancy in an intrauterine portion of the fallopian tube. Pregnancy can evolve asymptomatic until the second trimester, and debuting with uterine rupture and hypovolemic shock due to the proximity of the gestational sac to the uterine artery. Treatment usually consists of a laparoscopic cornual resection, although it will be individualized according to each case, giving priority to the patient clinic condition. The case of an interstitial ectopic pregnancy who presented with uterine rupture at 13 weeks of gestation is presented.

Randomized, Double-Blind Clinical Trial to Assess the Acute Diuretic Effect of Equisetum arvense (Field Horsetail) in Healthy Volunteers.

In this double-blind, randomized clinical trial, 36 healthy male volunteers were randomly distributed into three groups (n = 12) that underwent a three-step treatment. For four consecutive days, we alternately administered a standardized dried extract of Equisetum arvense (EADE, 900 mg/day), placebo (corn starch, 900 mg/day), or hydrochlorothiazide (25 mg/day), separated by a 10-day washout period. Each volunteer served as his own control, and the groups' results were compared. We repeated the same evaluation after each stage of treatment to evaluate the safety of the drug. The diuretic effect of EADE was assessed by monitoring the volunteers' water balance over a 24 h period. The E. arvense extract produced a diuretic effect that was stronger than that of the negative control and was equivalent to that of hydrochlorothiazide without causing significant changes in the elimination of electrolytes. There was no significant increase in the urinary elimination of catabolites. Rare minor adverse events were reported. The clinical examinations and laboratory tests showed no changes before or after the experiment, suggesting that the drug is safe for acute use. Further research is needed to better clarify the mechanism of diuretic action and the other possible pharmacological actions of this phytomedicine.

Incidencia de infección nosocomial quirúrgica en ginecología y obstetricia en un hospital comarcal / Incidence of nosocomial infections in obstetrics and gynecologic surgery

Introducción: Las infecciones nosocomiales en Obstetricia y Ginecología son causa importante de morbilidad y mortalidad, siendo las más frecuente las de localización quirúrgica. Objetivo: Analizar la incidencia de infecciones nosocomiales relacionadas con las intervenciones mayores más frecuentemente realizadas en Obstetricia y Ginecología. Métodos: Estudio prospectivo de 715 pacientes intervenidas de cesárea o histerectomía abdominal o vaginal, en el Hospital La Inmaculada de Huércal-Overa (Almería, España) en el periodo comprendido entre el 31 de octubre de 2008 y de 30 de agosto de 2011. Se han analizado como variables la Incidencia Acumulada y la Densidad de Incidencia para cada tipo de infección nosocomial detectada, independientemente para cada tipo de intervención. También se han calculado las incidencias ajustadas por el índice NNIS (Nacional Nosocomial Infection Surveillance System). Resultados: Se detectaron 30 infecciones nosocomiales (4,2 por ciento). La infección nosocomial diagnosticada con mayor frecuencia fue la endometritis tras cesárea, siendo el microorganismo más frecuentemente detectado la Eschericia Coli. Conclusiones: Las infecciones nosocomiales, en concreto las infecciones de localización quirúrgica, son un problema potencialmente grave y relativamente frecuente, que se relaciona con una mayor morbilidad, siendo importante realizar una profilaxis adecuada y una correcta vigilancia para el diagnóstico e instauración precoz del tratamiento.

Introduction: Nosocomial infections in obstetrics and gynecology are an important cause of morbidity and mortality, the most frequent in the surgical site. Objective: To analyze the incidence of nosocomial infections related to major interventions most frequently performed in the service of Obstetrics and Gynaecology. Methods: Prospective study of 715 patients undergoing surgery, of caesarean section and abdominal or vaginal hysterectomy at the Hospital La Inmaculada of Huercal-Overa (Almería, Spain) in the period from October 31, 2008 and August 30, 2011. Variables were analyzed as Cumulative Incidence and Incidence Density for each type of nosocomial infection detected, separately for each type of intervention. Also calculated adjusted incidences NNIS index (Nacional Nosocomial Infection Surveillance System). Results: We detected 30 nosocomial infections (4.2 percent). The nosocomial infection most frequently diagnosed in our study was the endometritis after cesarean, being the most frequent microorganism detected E. Coli. Conclusions: Nosocomial infections, particularly surgical site infections are a potentially serious problem and relatively frequent, which is related to increased morbidity, is important to perform adequate prophylaxis and make a correct surveillance for diagnosis and an early start of treatment.

Histerectomía postparto en el siglo XXI / Pospartum hysterectomy in the 21 st century

OBJETIVO. Evaluar la incidencia de histerectomía postparto durante los primeros 11 años de este siglo, sus indicaciones y los resultados que hubo en nuestro Hospital de León (España). MATERIAL Y MÉTODOS. Estudio transversal, retrospectivo y descriptivo de las mujeres sometidas a histerectomía postparto (HP) desde el año 2000 hasta el 2010. Se considera histerectomía postparto (HP) la que se realiza en las primeras 24 horas después del parto. Se obtienen los datos obstétricos de las pacientes, la indicación de la histerectomía y su resultado. RESULTADOS. La incidencia de histerectomía postparto (HP) fue de 0,42 por mil partos, hubo 10 histerectomías postparto (HP) en 23.563 partos. La principal indicación fue la atonía uterina (6 de 10, 60%). Hubo 3 (30%) laparotomías por persistir el sangrado intraabdominal y todas las pacientes recibieron transfusiones de sangre. CONCLUSIÓN. Nuestra incidencia de histerectomías postparto (HP) es baja. La atonía uterina sigue siendo la principal causa. La morbilidad materna es alta, no hubo ninguna muerte materna. Hubo una muerte fetal (AU)

OBJECTIVE. The aim of this study was to find the incidence of pospartum hysterectomy in the first eleven years of this century, their indications and outcomes that there were in our Hospital in León (Spain). MATERIAL AND METHODS. A retrospective, transversal, descriptive study of women under went postpartum hysterectomy between 2001 and 1010. Pospartum hysterectomy is defined as the one which is performed within 24 hours of delivery. Details of the index pregnancy and birth, previous obstetric history, indications for postpartum hysterectomy and outcomes are obtained from the patients’files. RESULTS. The incidence of postpartum hysterectomy was 0,42 per 1.000 deliveries, there were 10 postpartum hysterectomies in 23.563 deliveries. The primary indication was uterine atony (6 of 10, 60%). There were 3 (30%) laparotomies because of postoperative hemorrage and all patients received a transfusion. CONCLUSIONS. Our pospartum hysterectomy incidence is low. Uterine atony is still the primary indication. The maternal morbidity is high. There were no maternal deaths. There was one fetal death (AU)

Amenaza de parto prematuro: ¿Diagnóstico en exceso? / Preterm labour: Over-Diagnosis?

INTRODUCIÓN. La amenaza de parto prematuro es la causa más común de hospitalización en la segunda mitad del embarazo. El objetivo de este estudio es evaluar la incidencia del diagnóstico de amenaza de parto prematuro sin rotura prematura de bolsa amniótica, la evolución de estas gestantes y los costes económicos. MATERIAL Y MÉTODOS. Se obtuvieron del Departamento de Codificación todos los diagnósticos de amenaza de parto prematuro que hubo durante los años 2001 y 2002. El coste económico actualizado se pidió al Departamento de Gestión. A su vez, se utilizaron los datos epidemiológicos y las características obstétricas de un estudio de cohortes sobre la validez de la ecografía vaginal en el diagnóstico de parto prematuro espontáneo. RESULTADOS. El 4,3% de todos los partos tuvieron un diagnóstico de amenaza de parto prematuro. El 8,9% ingresaron dos o más veces por le mismo diagnóstico. El 18,2% de las mujeres con amenaza de parto prematuro acabaron en parto prematuro y el 81,8% acabaron en parto a término. El coste económico del proceso actualizado es de 326 euros. CONCLUSIONES. La incidencia de amenaza de parto prematuro está en el rango aportado por la bibliografía. La finalización en parto prematuro es similar al de la mayoría de los trabajos. El coste económico, por proceso, no se puede comparar por las diferencias en el nivel de vida y en el tipo de sanidad (AU)

INTRODUCTION. A preterm labour is the most common cause for hospitalization in the second half of the pregnancy. The purposeof this study is to evaluate the incidence in the diagnoses of a preterm labour without a preterm rupture of the membranes, the outcomes of these diagnoses and the economical cost. MATERIAL AND METHODS. All the diagnoses of a preterm labour, that were recorded in 2001-2002, were obtained from The Codes Department. The present economical cost was asked to The Management Department. Epidemiologic and obstetric characteristics from a study of cohort about the usefulness of the transvaginal ultrasonography in the diagnosis of a spontaneous preterm labour were also used. RESULTS. The 4,3% of all the deliveries had a diagnosis of preterm labour. The 8,9% were admitted to hospital twice or more times due to the same diagnosis. The 18,2% of the women with preterm labour ended in preterm delivery and the 81,8% in delivery a term. The present economical cost of the process is 326 euros. CONCLUSIONS. The incidence of preterm labour is in the range given in the reference. The outcome in a preterm delivery is similar in most of the papers. The economical cost per process cannot be compared due to the differences in the standard of living and the type of health service (AU)

La ecografía vaginal como factor pronóstico del parto prematuro / Transvaginal ultrasonography as a prognostic factor of preterm delivery

Objetivo: Valorar la longitud del cuello del útero entre las semanas 20-24 de gestación, por ecografía vaginal, como factor pronóstico de parto prematuro en gestantes normales. Sujetos y métodos: 411 embarazos normales con feto único, sin selección, que acudían a consulta de obstetricia durante 2001-2002. Cuatro pacientes se perdieron y 5 partos fueron prematuros por indicación médica, quedando 402. Realizamos estudio longitudinal, prospectivo. Las pacientes se clasificaron utilizando un punto de corte de 30 mm. Resultados: Hubo 17 (4,2 por ciento) partos prematuros espontáneos. Debajo de 30 mm había 21 gestantes con 5 partos prematuros; sensibilidad, 29,4 por ciento; valor predictivo positivo, 23,8 por ciento; especificidad, 95,8 por ciento; valor predictivo negativo, 96,9 por ciento, y razón de verosimilitud positiva, 7,1. En nulíparas aumenta la sensibilidad al 36,4 por ciento, el valor predictivo positivo al 30,8 por ciento y la razón de verosimilitud positiva al 8,9.Conclusiones: La ecografía vaginal presenta baja sensibilidad, alta especificidad y no es útil como factor pronóstico del parto prematuro en embarazos normales (AU)

[CAT-guided percutaneous drainage of abscesses]. / Drenaje percutáneo de abscesos dirigido por T.A.C.

Drainage of percutaneous abscesses guided by Computerized Axial Tomography (CAT) is a technique being employed more frequently all the time by Radiodiagnostic Services. Correctly put into practice by trained professionals, this procedure can prevent patients having to undergo another series of treatments which bear greater risks, to have a longer hospital stay, or even, depending on the case, to have to undergo an operation. Nurses in a radiological unit have an overwhelming role in every step of a percutaneous abscess drainage, a role which can not be carried out by any other personnel. To achieve being up to date in this technique and to perform our function as nurses in the use of this technique are the main objectives of this review.

Estudio multicéntrico abierto no comparativo sobre la eficacia y la seguridad del acetónido de triamcinolona -inhalador nasal- una vez al día por tres meses en los síntomas de rinitis alérgica perenne / Non operative open label multicenter study on the efficacy and security of triamcinolone acetonide -nasal inhalator- once daily for three months in the treatment of the symptoms of permanent allergic rhinitis

Objetivo: evaluar la respuesta clínica (evolución de los síntomas de rinitis y manifestaciones alérgicas) en un grupo de pacientes con diagnóstico de rinitis alérgica perenne, luego de la administración de acetónido de triamcinolona -inhalador nasal- 110 a 220 mcg/1 vez al día (según la edad y severidad de los síntomas) y describir la tolerabilidad de la medicación administrada durante 3 meses. Diseño: estudio clínico observacional, descriptivo (serie de casos)., fase IV, no comparativo, abierto. Pacientes centros: fueron incluidos en el estudio 61 pacientes evaluados en 14 centros, con diagnóstico de rinitis alérgica perenne, mayores de 4 años, sin contraindicaciones para administración de acetónido de triamcinolona. Variables de seguridad y eficacia: frecuencia de eventos adversos. Evolución de una escala de severidad de la sintomatología de rinitis en 4 dominios: congestión nasal, estornudos, prurito y secreción nasal. Evaluación global subjetiva de mejoría por parte del médico tratante y del paciente. Resultados: se reclutaron 61 pacientes, 26 hombres (42,6 por ciento) y 35 mujeres (57,4 por ciento), con edades entre 4 y 48 años (promedio: 23 años). El seguimiento planeado a 3 meses fue logrado en 52 sujetos. Se administró una dosis diaria de acetónido de triamcinolona -inhalador nasal- por un período de 12 semanas. Los pacientes fueron evaluados antes de iniciar el tratamiento y a las semanas 6 y 12. Se produjo una reducción significativa en el puntaje de severidad de la rinitis de un valor mediano de 10 antes de tratamiento a 0 a las 12 semanas (p<0,001). No se presentaron efectos adversos severos y solo un efecto leve (costras nasales) fue relacionado con la administración de acetónido de triamcinolona -inhalador nasal- , no obstante no se requirió descontinuar el medicamento. Conclusiones: el tratamiento de los síntomas de la rinitis alérgica perenne con acetónido de triamcinolona -inhalador nasal- mostró una reducción clínica y estadísticamente significativa de la sintomatología en la mayoría de los pacientes tratados y fue excelentemente tolerado

The use of the Beck Depression Inventory to screen for depression in the general population: a preliminary analysis.

OBJECTIVE: The aim of the present paper is to study the performance of Beck's Depression Inventory (BDI) as a screening instrument for depressive disorders in a general population sample. METHODS: 1250 subjects, from 18 to 64 years old, were randomly selected from the Santander (Spain) municipal census. A two-stage method was used: in the first stage, all individuals selected completed the BDI; in the second, 'probable cases' (BDI cut-off>/=13) and a random 5% sample of the total sample with a BDI score less than 13 were interviewed by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), which generates diagnoses of depressive disorders. RESULTS: Our data confirm the predictive value of the selected cut-off point (12/13): 100% sensitivity, 99% specificity, 0. 72 PPV, 1 NPV, and 98% overall diagnostic value. The area under ROC (AUC) was found to be 0.99. There were no statistical differences in terms of sex or age. We conclude that the BDI is a good instrument for screening depressive disorders in community surveys.

[Presence of red tides along the eastern coast of the Gulf of California]. / Presencia de mareas rojas en la costa este del Golfo de California.

Records of the occurrence of red tides during the last 24 years in Guaymas and for the last 16 years in Mazatlán, on the coast of the Gulf of California, Mexico are presented here. The results indicate the presence of 4 dominant species in 34 red tides in Guaymas and 9 dominant species in 60 red tides in Mazatlán. The most common species is Mesodinium rubrum, while the toxic one is Gymnodinium catenatum. Noctiluca scintillans and Gonyaulax sp. were also present in Guaymas. In Mazatlán Scrippsiella trocoidea, Prorocentrum dentatum, Ceratium tripos var. ponticum, C. furca, Gymnodinium splendens and Gonyaulax triacantha were also present. Red tides occur frequently during winter in Guaymas and during the late winter and early spring in Mazatlán. Both periods coincide with the upwelling season in the region. The absence of the red tides is related to the "El Niño" phenomenon, which is significant in the Mazatlán area. Ciliates decrease 11.4%, while dinoflagellates increase from 1.6 to 3.8%. The duration period of red tides increase (5.6%) from 3 to 6 days, as compared with the records between 1979 and 1990.

[2-directional ventricular tachycardia associated with mitral valve prolapse]. / Taquicardia ventricular bidireccional asociada a prolapso valvular mitral.

We describe the case of a 11 year old male who developed a bidirectional tachycardia associated to mitral valve prolapse as the only evident anatomical anomaly. Simultaneous recordings of surface ECG readings and intracavitary tracings showed left ventricular origin of such tachycardia. In the present study we confirm the site of origin of the arrhythmia and the association between bidirectional tachycardia and mitral valve prolapse.

[Mallory-Weiss syndrome. Considerations on 27 cases]. / Síndrome de Mallory-Weiss. Considerações sobre 27 casos.

Twenty seven patients, inspected by endoscope, and diagnosed as having the Mallory-Weiss syndrome, have been studied taking into account their age, sex, background, clinic presentation, manifestations, number of lacerations, associated lesions and evolution. Twenty three of them were males and 4 females. The age average was 46.7 years. Only 8 patients had intra-abdominal increased pressure, suffering retching and vomiting 7 of them, while one had a cough access. Out of the 21 patients that we controlled, 9 were chronic alcoholism while 3 had ethanol intoxication previously. Immediate prior ingestion of salicylates had taken place in 6 patients. The clinical presentation of 22 of them was gastrointestinal bleeding, that is, 4.9% of all the upper endoscopies carried out within the bleeding patients. Single laceration was present in 22 cases, double one in 4, and triple in 1. We have frequently found endoscopy lesions associated, the most common one (37%), was hiatal hernia. They all were medically treated except one, who was operated because of gastric perforation was associated. Just one of the Mallory-Weiss syndrome patient died, due to an associated diffused bleeding gastritis.