[Stomas in pregnancy, clinical case and review of the literature]. / Estomas durante el embarazo, caso clínico y revisión de la literatura.

Stomas and pregnancy is an uncommon event and the literature in this regard is scarce, this poses significant concern on its management. Among the etiology we found the ulcerative colitis, trauma, and rectovaginal fistula, etc. The management should include a perinatologist and a specialist in colon and rectum. We should be familiarized with the potential complication as the intestinal obstruction, stoma prolapse, narrowing of the stoma and bleeding. The route delivery should be vaginal and the c-section is reserved for obstetric indications. The patient must receive education regarding stoma complications, and how to copy to live with a stoma.

[Comparative assessment of efficacy and safety of assisted vaginal delivery with forceps and with vacuum extractor]. / Evaluación de la eficacia y seguridad entre el parto vaginal asistido con fórceps y el extractor de vacío.

UNLABELLED: We performed a prospective, controlled, randomized trial to compare de safety and efficacy between the vaginal assisted delivery with vacum extractor forceps. We included a control group of primigravidae. We use the ACOG application criteria for operative obstetrics. We measured the differences in regard to indication for operative delivery, obstetric trauma and the general characteristics of the patients. A total of 210 patients were included which were distributed in three groups. In the first group we included the patients of vacum extractor, the second group of forceps and the third the control group. In our results we found no statistically significant differences among three groups in regard to the general characteristics and obstetric trauma. In the vacum extractor group we found six cefalohematomas (8.5%), two newborns with skin laceration (2.8%) and four newborns with cerebral edema (5.7%). In the forceps group we had two newborns diagnosed with cefalohematomas (2.8%), seven newborns with cerebral edema (10%) and scalp laceration on four newborns (6%). In the control group we found one cefalohematoma (1.4%) and cerebral edema in four newborns (5.7%). We did not find statistically significant differences when we compared the group of the vacum and the forceps. CONCLUSION: With this information we concluded that both instruments are equal in regard to efficacy and safety when they are use by experimented hands and following the application criteria. Nevertheless, there is a high incidence of vaginal injuries and obstetric trauma in the newborn in the operative delivery compared with the control group without an important increase in the perinatal mortality.

[Colposuspension of the sacrospinal ligament]. / Colposuspensión al ligamento sacrociático.

During a period of 15 years, at the Hospital Central Militar, 36 operations were done to fix the vaginal cupule to sacrocyatic ligament, as therapeutic or preventive surgery; most of the fixations were together with vaginal hysterectomy by genital prolapse; and six of them were as surgical therapy of vaginal cupule prolapse. Complications were in 2.8% (one case), recidive of cupule prolapse and in 2.8% pudendal vein lesion. Long term result has been excellent, with minimal morbidity.

[Peripartum cardiomyopathy: experience at the Central Military Hospital, Mexico]. / Cardiomiopatía peripartal: experiencia en el Hospital Central Militar.

Peripatum cardiomyopathy is a rare disease, which appears as cardiac failure, at the end of pregnancy and puerperium without an apparent cause. The diagnosis is done clinically based in accepted criteria by Demakis, and it is confirmed by auxiliary tests. Treatment includes rest, digitalic and diuretic medications. Prognosis is bad when there is not symptomatic regression, with a high mortality soon after. The experience at Hospital Central Militar from 1967 to 1995, is presented. There were nine cases, two of which had died; and the presentation of the last case, is done herein.

[Persistent mullerian duct syndrome. Presentation of a case]. / Síndrome de persistencia del conducto de Müller. Presentación de un caso.

Male sexual differentiation in based upon at least two factors; testosterone and the müllerian inhibitor factor. The absence of the latter produces a rare form of male pseudohermaphroditism, the persistence of the Müllerian duct syndrome. The case of a phenotypically male patient in whom surgery to correct bilateral cryptorchidism was performed is presented. The operatory findings included the presence of uterus and fallopian tubes which were removed. The right atrophic tes was removed and the left was fixated. Literature regarding etiology, clinical presentation, diagnosis and treatment is presented.

[Stress urinary incontinence. Its surgical management]. / Incontinencia urinaria de esfuerzo. Manejo quirúrgico.

Ninety eight patients with stress urinary incontinence treated surgically at Central Military Hospital, were studied. We analyzed the risk factors as age, weight, height, parity, menopause age, and previous medical and surgical procedures. They were divided in two groups. The Group I, vaginal approach, with 35 patients and Group II, retropubic surgery, with 63 patients. There were no differences both groups regarding age, weight, height, parity and menopausal age. The most frequent illness associated with stress urinary incontinence, was pelvic floor relaxation. The complications were 17.1% and 33.3%, respectively. The efficacy of Burch is procedure for the management of stress urinary incontinence, with a success rate of 84.1% versus 62.1% in the vaginal approach, was confirmed.