[Recurrence of cervical intraepithelial neoplasia pre-conization with diathermic handle]. / Recidiva de lesión intraepitelial cervical en pacientes postresección de cono con asa diatérmica.

BACKGROUND: Cervical cancer is a major public health problem worldwide. In Mexico there are an estimated 50 cases per 100,000 women. Cervical intraepithelial neoplasia (CIN) is a precursor of inva- sive cancer. Early detection and treatment of this condition lead to a cure rate close to 100%. OBJECTIVES: To know the percentage of patients who, following a loop diathermy conization, present premalignant lesion recurrence within a cyto-colpo-histological follow-up period of one year; to identify risk factors for patients with persistent lesions. METHODS: A descriptive, retrospective, observational and analytical study of cases and controls conducted at the Hospital General Dr. Miguel Silva in Morelia, Mexico from January 2012 to June 2014. The subjects were patients who had undergone diathermy loop conization due to intraepithelial lesions. RESULTS: The population was comprised of 251 patients, of whom 53 (21.1%) presented recurrence within a one-year follow-up period. The average period between the conization procedure and the diagnosis of a persistent lesion was 8.92 ± 3.2 months. The average patient age was 36.1 ± 7.49 in the group that presented post-procedure recurrence, while that of patients without recurrence was 39.1 ± 7.58, with a p value of 0.025. The only risk factor that showed a statistically significant differ- ence was the persistence of oncogenic hybrids, with an odds ratio of 17.568 (8.33-37.02); p = 0.0001. CONCLUSIONS: Despite the high effectiveness of loop diathermy conization, cyto-colpo-histological follow-up is necessary owing to the high risk of persistent lesions.

[Pure form of primary ovarian choriocarcinoma. Report of a case]. / Coriocarcinoma puro, primario, del ovario. Presentación de un caso.

Ovarian choriocarcinoma from the germ cells is a very rare malignant neoplasia. About the pure form, very few cases have been reported in medical literature. Ovarian choriocarcinoma may originate in three modalities. As primary choriocarcinoma associated to ovarian pregnancy, 2. As a metastatic ovarian carcinoma, from other organs, mainly the uterus, 3. As a primary tumour of germ cells with differentiation to trophoblastic structures. The latter grows in girls or in adult woman, generally young, where necessarily pregnancy has to be excluded. A case is presented of a 21 years old woman, treated at Hospital General "Dr. Miguel Silva", Morelia, Mich. single, without sexual life, with an abdomino-pelvic tumor of 24 cm, from the right ovary and adhered to ascending colon. Beta subunity of chorionic gonadotrophin was 200,000 mUI/ml of blood plasma. At laparotomy a right ovarian tumour, with infiltration to ascending colon, was found; this required total hysterectomy with bilateral salpingo-oophorectomy and right hemicolectomy. After surgery the patient received chemotherapy with cisplatin, bleomicin and vinblastine. After the third treatment cycle and at three months, chorionic gonadotropin became negative; and at four years follow up residual tumoural activity is absent. Largest mortality with these tumors appears during early post-operative stage and it is atributed to the tumour itself or to post-operative complications. If the patient survives this stage and with a good chemotherapeutic program, survival and even complete cure, occurs.

[The efficacy of sulbactam-ampicillin in preventing postoperative infections in gynecology and obstetrics. A comparative open study]. / Eficacia de Sulbactam/Ampicilina en la profilaxis de infecciones postquirúrgicas en gineco-obstetricia. Estudio abierto comparativo.

An open comparative and multicentric trial was carried out to assess the activity of sulbactam ampicillin combination against no treatment, as a prophylactic agent of post-surgical infection in ob-gyn practice. 100 patients were included in the trial and distributed in two groups. sulbactam/ampicillin 0.5/1.0 g, i.v. was administrated during the surgery and the dose was repeated 6 h. later. No cases of post-surgical infection was detected in the group of sulbactam/ampicillin, while 4 cases were observed in the no treatment group. Sulbactam/ampicillin is an effective and well tolerated antimicrobial agent in the prophylaxis of post-surgical infections.

[Inhibition of lactation with lisuride. CLinical evaluation]. / Inhibición de la lactancia con lisurida. Evaluación clínica.

Lactation in humans requires the collaboration of neural and endocrine systems. During pregnancy and after parturition prolactin and also sex steroids, corticoids, growth hormone and human placental lactogen are necessary for lactogenesis. In an open, simple and prospective study, 50 women with normal delivery or cesarean section, between 34 and 41 weeks of gestation, were treated with lisuride, 0.2 mg t.i.d. for 14 days in order to inhibit lactation. The arrest of lactation was mandatory for medical reasons and the results were evaluated by changes in breast related with shape, volume, symmetry, coloring, temperature, turgescence, venous appearance, nipple condition, colostrum and lymph nodes increase. Lactation that was already present in 87% of patients in the first exploration 24 hours after delivery was satisfactorily suppressed and also breast pain, engorgement and discomfort caused by milk leakage. None had rebound lactation. 5 patients had light nausea. The dopamine agonist lisuride can be used for primary arrest of lactation with clinical effectiveness and without potential dangerous side effects of hormonal compounds.

[Effect of a combination of gestoden-ethylene estradiol on the endometrium]. / Efectos de la combinación gestodeno etinilestradiol sobre el endometrio.

It has been long established that contraceptive steroid mixtures are highly effective due to the fact that they act simultaneously upon different levels of the pituitary-ovarian-genital tract axis. We hypothesized that the mixture of 30 mcg of ethynylestradiol plus 75 mcg of gestodene might be effective partly through the changes it induces in the histology and histochemistry of the endometrium. To test this hypothesis, 32 healthy patients willing to participate, aged 23 to 34 years, were treated with the above mentioned combination of steroids from day 1 through day 21 of the cycle for six consecutive cycles. They were previously proven to be fertile and ovulatory. In ten of them, selected at random, an endometrial biopsy was taken on the cycle previous to therapy and upon completion of the steroid treatment, for comparison. Tissues were processed for histologic evaluation with hematoxylin-eosin and with acridine orange for the histochemical demonstration of glycogen and ribonucleic acid under fluorescence microscopy. All pre-treatment endometria showed normal findings for ovulatory cycles, while the post-treatment tissues were typical of the steroid-treated endometria, i.e., they had a disrupted balance between glandular and stromal maturation, plus a diminished and abnormally distributed glycogen and ribonucleic acid. We conclude that the established working hypothesis was confirmed.

[Septic shock in obstetrics]. / Choque séptico en obstetricia.

Septic shock in obstetrics is a major cause of mortality. Postpartum endometritis is often the first step of bacterial colonization inside the uterus which becomes the nidus of infection. Rapid spread into general circulation is favoured by hemodynamics patterns of pregnancy. Bacteremia would result in cardiovascular collapse and a myocardial depressant factor has been proposed to explain the fall in cardiac output. Later, endotoxin activates the substances of malignant intravascular inflammation and multiple systems organ failure may be observed in uncontrolled sepsis. Eight cases are reported hospitalized at Morelia's General Hospital, SSA, with septic shock and MSOF. Presumably because of aggressive acute resuscitation nobody succumbed during acute cardiac failure and hypotensive episode but two patients died later with multiple system organ failure. The mortality was 25%. Fluid, resuscitation, and vasoactive drugs are the most effective way to reduce mortality. Antibiotics, specific treatment of MSOF and taking away the nidus of infection are critical components of therapy.

[Abdominal pregnancy. An unusual case]. / Embarazo abdominal. Un caso insólito.

A general review is made about concept, incidence and clinical features of abdominal pregnancy. The early and accurate diagnosis of an abdominal pregnancy is very important in order to avoid catastrophic hemorrhage from placental separation. A case is reported of a young woman hospitalized at Morelia's General Hospital, SSA, with an abdominal pregnancy. The fetus died about 26th week and underwent mummification. Some time later the fetus spontaneously divided and the lower segment extruded through the intestines. The remain upper thoracic and cephalic segment was removed at laparotomy closing an intestine stoma; 60% of the placenta was also removed. The postoperative course was uneventful.