[Seven-year experience with microsurgery]. / Experiencia de siete años de microcirugía.

From 700 laparoscopies performed, in 600 of them (85.7%) the tuboperitoneal factor was altered. Surgery included: termino-terminal plastia 70 cases (36%), (3 patients had previous plastia); adhensiolysis 62 (31%), salpingostomy 48 (24%), neoimplantation 10 (5%), and mixed surgery 9 (4%). After surgery, desertion was present in 78 patients. Of the 121 remaining, 34 (28.1%) had primary sterility and 87 (71.9%) secondary sterility. 74 patients (61.2%) obtained pregnancy, 62 (83.8%) reached term, seven were abortions of first trimester (9.5%) and were five ectopic pregnancies (6.7%). The interval between surgery and pregnancy achievement was 1 to 48 months, 12.8 months average. We emphasize the 47 patients analysis who didn't has pregnancy, through: remark time after surgery, histerosalpingography, new laparoscopy and reevaluation of sterility factors; the results were: 19 cases (40.5%) have a 5 to 60 months time after surgery, 19.5 months average, 18 (38.3%) had new tubary obstruction, three (6.4%) with endometriosis treatment, three (6.4%) have tuberculosis genital treatment, two (4.2%) with falling again endocrine-ovarian factor, and two (4.2%) with masculine relapse. A decease was present because anesthetic complication. We underline selection surgery criterion and a strictly evaluation, such as an antiadhesion pre, trans and postoperative regime, ligamentopexya of rounds ligaments and a conscious education of the patients in their strictly pursuit.

[The combined colposcopic index as a diagnostic method in human papillomavirus infection and cervical intraepithelial neoplasia]. / El índice colposcópico combinado (ICC) como método diagnóstico en la infección por papilomavirus humano y la neoplasia intraepitelial cervical.

This is a prospective, comparative study of 142 patients of combined colposcopic index according to Reid's criterium and the index used at the Clinics of Colposcopy, Gyn-Ob Hospital "Luis Castelazo Ayala", IMSS. Seventy two patients were studied with the Hospital Index, and 70 with the CCI. This constituted by neatness of peripheral edges, the color, characteristics of vessels and iodine tinction; a score of 0, 1, 2 was given, the sum of which gave a final qualification, and it was traspolated to a colposcopic diagnosis. The CCI correlated with the histological diagnosis in 64 patients (91.42%); while for the Hospital Index it was in 61 cases (84.7%). The indexes showed a good sensitivity (0.95), a high positive predictive value (0.95 vs 0.88), and adequate accuracy (0.91 vs 0.84), as well as a good prevalence (0.90 vs 0.85). It is concluded that the CCI is reliable for the colposcopic diagnosis of human papillomavirus and for CIN.

[The treatment of cervical human papillomavirus (HPV) infection with trichloroacetic acid]. / Tratamiento de la infección cervical por el virus del papiloma humano (VPH) con ácido tricloroacético.

Ever since the alterations caused by the HPV on the cervix were discovered, countless treatments have been employed but the ideal method still remains unknown. The objective of the experiment was to assess the efficiency of handling the cervical infection caused by the HPV, by means of trichloroacetic acid, 85% rate. During the period comprised between April 1989 and March 1990, 60 patients were subject to close analysis. The general diagnosis drawn cytology, colposcopy, and histopathology was cervical condyloma, lacking any collateral evidence of intraepithelial cervical neoplasia. The treatment consisted of 3 weekly applications of trichloroacetic acid at 85% rate directly upon the cervix. They were all assessed through cytology and colposcopy every 3 months, during a year's period. After the first 3 months, a 73.4% healing rate was observed, which decreased to 68% after 6 months and to a 65% after 9 months; this last healing rate remained unchanged after 12 months. Pregnant patients showed higher healing rates. We have drawn the conclusions that the trichloroacetic acid is an efficient agent to treat the referred injuries, and it offers as well the advantages of low costs, no secondary effects and an easy application and handling.

[Results of treatment of condyloma in the male and its effect on the couple in the presence of intraepithelial cervical neoplasia]. / Resultados del tratamiento del condiloma en el varón y el efecto en la pareja con neoplasia intraepitelial cervical (NIC).

Genital papillomavirus is an infection sexually transmitted, besides it is frequently associated with cancer of the uterine cervix. It is controversial if it is useful to treat the sexual partner. The present study analyzes in a comparative way patients with CIN with treated partner and untreated partner. From 1986 to 1991 251 women treated for CIN, were prospectively studied; they had completed a one year follow up and during this time they presented, or not, treatment failure. Fifty six were examined and their sexual partners were treated for genital papillomavirus, and the control were 195 women, similar to the study group as to age, race, socio-economical level, CIN histological degree, distribution of lesions and therapeutical methods, in whom the male was not examined nor treated. Statistical methods were Umann-Whitney, homogeneity test, and the fractions difference test to compare the groups. It were obtained the persistence and recidive of the treated couple and untreated couple (41% vs 32.8% with P greater than 0.05) not significant, which shows that papillomavirus treatment of the male partner has no effect on CIN treatment failure in the woman. These statistical results should be considered with caution as it is known that the male is a virus reservoir that together with other cofactors may explain the greater risk for the woman to develop CIN.

[The male factor in the incidence and persistence of condyloma of the cervix and intraepithelial cervical neoplasms]. / Factor masculino en la incidencia y persistencia de condiloma de cervix y neoplasia intraepitelial cervical.

From 1988 to 1990, prospectively, were studied 113 masculine couples (males), and 113 women, treated for intraepithelial cervical neoplasia, alone, or associated to viral infection by human papilloma virus-80 males were asymptomatic (70.7%). Colposcopy and local application of acetic acid, were needed for the diagnosis of 69.9% of lesions, which presented with a gray color to a brilliant white color. Papulous lesion, (56.70%) was most frequent; and the classical lesions as condyloma acuminatum, were 15.52%; urethral cytology was positive for condyloma (one condyloma in 30%), and biopsies in 91.66%. There were persistence and recidiva, nonsignificant, when the man had received treatment suggesting that the treatment does not alter the appearance of condyloma, nor cervical intraepithelial, neoplasia.

[Treatment of human papilloma virus of the cervix using cryosurgery]. / Tratamiento del virus del papiloma humano (VPH) del cervix con criocirugía.

The causal lesions by VPH in the cervix, are associated to cancer. Currently 56 different subtypes have been isolated, from which, the 16, 18, 31, 33, 35 and 39 are more frequently related with the cervical intraepithelial neoplasia; from here derives the importance of opportune treatment. The objective of this paper is to evaluate VPH of the cervix opportune treatment with cryosurgery. Seventy five patients were analyzed, from April 1988 to May 1990 with diagnosis of cervical VPH, by cytology, colposcopy and histopathology; in whom cryosurgery with double freezing technique, was practiced; and were evaluated ever six months, during two years with cytology and colposcopy. Whenever there was persistence or recurrence, cryosurgery was used again; doing this even three times, previously discarding intraepithelial cancer. Seventy seven per cent of the patients received only one session; 16% two, and 7% three. At the six months review, it was found that 92% of the cases were negative, and 8% with persistence; at 12 months, 89% negative and 11% with recurrences; at 18 months, 93% negative, 3% with persistence and 4% with recurrence; at 24 months, 96% negative and 4% with recurrence. It is concluded that cryosurgery is efficacious in the treatment of these lesions, easy to use, well tolerated, with minimal side effects, it does not require anesthesia and is of a low cost.

[An epidemiological study of 1000 sterile couples]. / Estudio epidemiológico en mil parejas estériles.

Our purpose was to study the characteristics of our infertile population, to evaluate prognostic fertility parameters and to know our pregnancy rates. One thousand infertile couples were studied under a protocol by factors. We found the highest alteration in the ovarian factor (35%), followed by the tuboperitoneal factor (28%) and male factor (26%). The woman's age, the duration of infertility and multifactorial infertility (17.6%), were of prognostic importance. Our pregnancy rate of 61.4% compares with the reported in the literature. We believe that establishing an infertility protocol with a multidisciplinary approach, helps to a more precise diagnosis and more specific treatments with better results.