[Hereditary antithrombin III deficiency. Report of an obstetric case and review of the literature]. / Deficiencia hereditaria de antitrombina III. Presentación de un caso obstétrico y revisión de la literatura.

This case is a gravida 2, para 1, 21 years old, with a 36 weeks pregnancy, complicated with light toxemia, hereditary Antithrombin III (AT III) deficiency, and left iliofemoral thrombophlebitis; the patient was in labor. Two family members had thromboembolic phenomena, one of them had died because of this. The patient have had thrombophlebitis in both lower limbs during the puerperium of her previous delivery. She had received anticoagulants irregularly. Four months before the diagnosis of hereditary AT III deficiency, by laboratory. Labor was normal and had an eutocic delivery, masculine product, 3,250 g, without complications. Three hours before the effect of heparin had been reverted with protamine sulphate. Eight hours after delivery administration of heparin, was reestablished. The patient did not present other complications, and was discharged nine days after delivery. The literature about this subject was reviewed. Special emphasis is given to treatment alternatives in this type of disease that produce hypercoagulability and thromboembolic phenomena. This is the first report in Mexican literature.

A model to improve the utilization of health and social services in Latino communities.

There are two salient issues beginning to impact drastically on health and social services in the nation: nativist anti-immigrant hysteria among the populace and President Clinton's national health care proposal. This article is neither an examination of the nativist anti-immigrant hysteria nor of the merits of the President's health care plan. Rather, the focus here is to propose a model to improve the utilization of health and social services to Latinos despite nativism and outcome of the final health care program.

[Toxic shock. Presentation of an obstetrical case]. / Choque tóxico. Presentación de un caso obstétrico.

The case of a 22 years old patient, primigravida, who underwent cesarean for acute fetal distress, and who presented with, at the second day of puerperium, puerperal infection, with clinical picture of shock at the third day, is presented. The clinical picture was preceded by skin rash which became a pyoderma, and ended up as desquamation; there were several alterations: hepatic, renal, hematological (disseminated intravascular coagulation) and digestive (gastroenteritis); and Staphylococcus aureus (coagulase positive) was isolated from the skin, lochia, coproculture; and they were negative to this microorganism the ones from blood, urine and pharynx. The patient received general care for her shock, steroids, blood and fresh plasma and antimicrobial agents (dicloxacillin, cefoperazone and netilmicin). Evolution was favourable, and was discharged at the eleventh day of puerperium in good conditions. A brief summary of the bibliography about this condition, and its very low incidence in our country, is pointed out, as this report is the second one in Latin American literature.

[Dextran 40 for hypovolemia caused by hypertensive disease in pregnancy]. / Dextrán 40 en hipovolemia por enfermedad hipertensiva en embarazo.

Dextran 40 was used in the management of hypovolemia and hemoconcentration in patients with hypertensive disease induced by pregnancy; 50 cases were randomly selected from a total of 150 patients from the Intensive Care Unit for Adults. The obstetrical profile, and perinatal profile, were determined. Hemodynamic and laboratory parameter, were statistically analyzed, before administration of Dextran 40 and at 2, 4, 6 and 8 hours after, and were compared. Eighty eight per cent of the selected cases corresponded to severe pre-eclampsia, and 12% to eclampsia; the age of the patients was 24 years; the number of gestations was 2.1 and they were at 32.6 weeks of gestation, average; eighty four percent were pregnant, and 16% were in puerperium at the moment of starting infusion; ninety per cent of the patients underwent cesarean section, and 10% were attended of a delivery. The products weighed 2,696 g; Apgar of 7.1 and 8.4 at fetal one and five minutes respectively, in average; there was one fetal death (2.4%), and one mortinate (2.4%); morbidity was 12%, and 85% of the products evolutionated satisfactorily. There were no maternal deaths. There was an statistically significant decrease is of BP after two hours, and a decrease of heart beat after four hours from starting infusion; as well as an increase in central venous pressure and diuresis, both after two hours from starting infusion of Dextran 40. There was a quantitative diminution of edema and proteinuria; as well as a quantitative diminution of hemoglobin, hematocrit, and fibrinogen after eight hours from starting infusion.(ABSTRACT TRUNCATED AT 250 WORDS)