[Conservative treatment of interstitial ectopic pregnancy and endometriosis with laparoscopic methotrexate and potassium chloride and complementary management with nasal nafarelin. Report of a case and review of the literature]. / Tratamiento conservador del embarazo ectópico intersticial y endometriosis con metotrexato y cloruro de potasio por vía laparoscópica y manejo complementario con nafarelina nasal. Informe de un caso y revisión de la literatura.

A case of a 30 year-old patient is presented with infertility, 56 days opsomenorrhea, cervical tenderness, left adnexial mass, beta subunit of Human Gonadotrophin Corionic (HGC) of 112 mUl/mL, endovaginal ultrasonogram showed trophoblastic vascular flow with cardiac output, suggestive of ectopic gestation. Laparoscopy confirmed the diagnostic of left ectopic interstitial pregnancy, salpingocentesis was done with Methotrexate and potassium chloride and severe endometriosis was found. The postoperative control with seric levels of beta subunit HGC were negativized at 28 days. The treatment lasted 4 months with Nafarelin. The second look Hysteroscopy-Laparoscopy showed complete resolution of ectopic gestation, endometriosis improvement and bilateral tubal permeability.

[An orthotopic pregnancy after 2 ectopic ones. A report of 2 cases and review of the literature]. / Embarazo ortotópico posterior a dos ectópicos. Informe de dos casos y revisión de la literatura.

The prognosis as to reproduction of patients with two surgical procedures for the tubes for managing ectopic pregnancy, is very bad. Two cases of live intrauterine pregnancy, after two tubal pregnancies surgically managed, are presented. Salpingectomy and salpingostomy were carried out in one patient, and salpingostomy and salpingectomy in the other one. In world literature there are only 23 reported cases, since 1947.

[Presence of inhibitors of activated partial thromboplastin time (TTPA). Clinical repercussion in obstetric patients]. / Presencia de inhibidores del tiempo tromboplastina parcial activada (TTPA). Repercusión clínica en pacientes obstétricas.

Partial thromboplastin time, activated with kaolin (TTPA) is a qualitative test used to find defects of some factor of intrinsic via of coagulation or to rule out the presence of some circulating inhibitor. The lupus anticoagulant (LA) is part of a group of several auto-antibody with pathogenic potential in several branches of medicine, mainly rheumatology, hematology and gyneco-obstetrics. In this last area the LA has been associated with different obstetrical repercussions. The purpose of this study was to determine the main obstetrical events associated with patients with circulating anticoagulants identified by TTPA with kaolin. Ninety six patients were included in cases-control study. Group I (n = 48) cases and Group II (n = 48) controls, were selected from the same population and information source. The cases were included when presenting prolongation of more than 4 seconds of TTPA activated with kaolin regarding a control with lack of correction with normal plasma. A registration sheet for data captation, was designed specially for this study. The comparability of both groups was established, as there were no differences (significant) among the variable considered as basal. The group of cases presented with a greater frequency of habitual abortion, neonatal death and thrombotic phenomena. This relationship of autoimmunological pictures with recurrent fetal loss and thromboembolic incidents has been consistently described in literature. To this respect, several immunological abnormalities. Including positive anticardiolipin antibodies and VDRL falsely positive. The incidence, in this country of these entities, is unknown. These observations show the need of a methodologic superation.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: In a retrospective case control study of 96 obstetrical patients 48 cases had partial thromboplastin time (TTPA) with kaolin over 4 seconds compared with the test group. The control group of 48 women with normal TTPA were also studied. Age, socioeconomic status, weight, family and personal illness history were included. Habitual abortion,neonatal death, and hypertension were recorded. The average TTPA value was 53.6 +or- 7.87 seconds for the case group vs 38.8 =or- 4.9 for the controls which was not statistically significant. No statistical significance was found regarding age, start of menarche, nutritional and socioeconomic status, and blood group. The body weight of the case group was higher with 58.5 kg =or- 14.4 kg (a range of 43.4-81.4 kg). There were 7 cases of thrombophlebitis (14.5%) in the lower extremities in the case group and none in the controls. There were 7 cases of habitual abortion in the case group defined as 3 or more miscarriages before 20 weeks of gestation vs 2 cases in controls. There were 4 cases of neonatal deaths associated with premature delivery in the case groups and none in controls. Acute hypertensive disease associated with pregnancy totaled to 8 cases in the 1st group (16.6%) and 4 cases in controls (8.3%). In both groups there were 2 cases of fetal death. In the case group there was 1 case of chromosomopathy and in the control group 1 case of premature expulsion of placenta. The TTPAs test is used mostly for the initial phase of studying patients suspected of having lupus anticoagulant (LA). LA belongs to abnormalities characterized by the presence of antiphospholipid antibodies. It is often used for diagnosing initial stages of autoimmunity which can frequently occur in thrombotic process, fetal loss, intrauterine growth retardation, and increased hypertensive illness in pregnancy.

[Evaluation of the Espinosa Flores' operation of isthmo-cervical insufficiency]. / Evaluación de la operación Espinosa Flores en la insuficiencia istmico cervical.

An analysis of the results obtained in 66 patients with Espinosa Flores' operation for isthmo-cervical insufficiency, operated upon at La Raza Hospital, IMSS, was carried out. The study period was from January 1st to December 31, 1988. Gestational age and pregnancy evaluation were studied. The operation was done at 15.8 weeks of gestation, in average; the cerclage procedure was used as a second choice in 12 patients (18.1%) by slipping the tape: in two patients it was repeated in three different moments, which represents 21% of failure. There were a total of 17 cases of premature rupture of membranes, which represents 21.7%. Pregnancy was solved by delivery in 33 patients (50%), and by cesarean section in 25 cases (37.8%). There were a total of 8 abortions, and the total amount of alive products being discharged from the hospital, was 48 (72.7%).