Pacientes con morbilidad obstétrica grave de acuerdo con la Organización Mundial de la Salud, atendidas en un hospital de alta especialidad (2010-2016) / Patients with severe obstetric morbidity, according to the World Health Organization, atended at the high specialty hospital (2010 to 2016)

Resumen OBJETIVO: Estimar la morbilidad obstétrica grave y mortalidad materna en el Hospital Juárez de México. MATERIALES Y MÉTODOS: Estudio retrospectivo y transversal efectuado para evaluar los registros de pacientes con morbilidad obstétrica grave y la mortalidad materna, de acuerdo con los criterios de la OMS, atendidas en el Hospital Juárez de México de 2010-2016. Se analizaron las variables relacionadas con el diagnóstico, insuficiencia o disfunción orgánica y las intervenciones asociadas con el tratamiento. Se calculó la tasa de morbilidad materna extrema y obstétrica grave (Near Miss/total de embarazadas). Se utilizaron medidas de tendencia central y de dispersión. RESULTADOS: Se registraron 137 casos de morbilidad obstétrica grave y 26 de muerte materna. La mortalidad promedio fue de 5.78% y el índice de mortalidad de 0.415. Las principales causas de morbilidad materna grave y mortalidad fueron: hemorragia obstétrica, hipertensión asociada con el embarazo y sepsis. Se observó un incremento en los casos de morbilidad materna grave y disminución de la mortalidad materna en el periodo estudiado. CONCLUSIÓN: Se sugiere establecer un comité de evaluación y análisis de pacientes con morbilidad obstétrica grave para mejorar la calidad de atención y tratamiento, y disminuir la tasa de mortalidad materna.

Abstract OBJECTIVE: To determine how many cases of severe obstetric morbidity and maternal mortality were presented in 2010-2016, at the Hospital Juárez de México. MATERIALS AND METHODS: A retrospective, cross-sectional, observational study was carried out in cases of severe obstetric morbidity and maternal death were included according, to WHO criteria, attended in the Hospital Juárez de México from 2010-2016,. We included variables related to the diagnosis, with the organic failure or dysfunction and the interventions related to the management. The extreme maternal morbidity rate was calculated; obstetric (Near miss / Total pregnant). Measures of central tendency and dispersion were used. RESULTS: A total of 137 cases of severe obstetric morbidity and 26 of maternal deaths were registered. The mortality rate on average was 5.78% and death rate .415. The main causes of severe maternal morbidity and mortality were obstetric haemorrhage, hypertension associated with pregnancy and sepsis. There was an increase in cases of severe maternal morbidity and decrease in maternal death in the period studied. CONCLUSION: We suggest the establishment of a committee to evaluate and analyze cases of severe obstetric morbidity to improve the quality of care and treatment for this group of pregnant women, to reduce maternal death.

Embarazo ectópico abdominal, presentación de un caso y revisión de la literatura / Abdominal ectopic pregnancy: case report and literature review

ANECEDENTES El embarazo ectópico abdominal es raro; con baja incidencia y ausencia de sintomatología especifica que dificulta el diagnóstico y no existan criterios para el diagnóstico y tratamiento. OBJETIVO se presenta un caso de embarazo intra-ligamentario de 16 semanas de gestación y se hacer una revisión de la literatura sobre el manejo y comparación de los resultados. CASO CLÍNICO Mujer de 32 años de edad, gestas 3 partos 2; desconoce fecha de ultima menstruación; y control de la fertilidad con condón; acude por presentar dolor abdominal, sin datos de irritación peritoneal; se le realiza ultrasonido y se diagnostica embarazo de 16 semanas con muerte fetal; con sospecha embarazo abdominal; se realiza laparotomía exploradora para extracción fetal, dejando la placenta in situ, y manejo con metotrexate dejando la placenta in situ y egresado al tercer día sin complicaciones. CONCLUSIÓN el embarazo abdominal es raro, de difícil diagnostico; que requiere la extracción quirúrgica y dejar la placenta in situ y manejo adyuvante con metrotexate; reportándose buenos resultados; pero, existe escasa información sobre la fertilidad futura.

BACKGROUND The abdominal ectopic pregnancy is rare; with low incidence and absence of specific symptomatology diagnosis difficult and there are no criteria for the diagnosis and treatment. OBJECTIVE a case of intra-ligament 16 weeks of gestation pregnancy occurs and a review of literature on the handling and comparison of results is done. CASE REPORT Female 32 years old, deeds 3 births 2; known last menstrual period; and fertility control with a condom; comes because of abdominal pain without peritoneal irritation; Ultrasound was performed 16 weeks pregnant and diagnosed with fetal death; abdominal suspected pregnancy; laparotomy for fetal extraction is performed, leaving the placenta in situ, and leaving management methotrexate placental site and discharged on the third day uncomplicated. CONCLUSION abdominal pregnancy is rare, difficult to diagnose; requiring surgical removal and leave the spot and adjuvant use with methotrexate placenta; good results being reported; but there is little information on future fertility.

[Profile dipper/non-dipper in patient with severe preeclampsia, eclampsia and HELLP syndrome during pregnancy and puerperium]. / Perfil dipper-no dipper en pacientes con preeclampsia severa, eclampsia y síndrome de Hellp durante el embarazo y puerperio.

BACKGROUND: Blood pressure (BP) has a circadian rhythm, decreases at night and increases in the morning (dipper), have been observed in patients with impaired in this profile, increased at night and lower in the morning (no dipper) have increased cardiovascular risk. Preeclampsia-eclampsia complicates about 7% of pregnancies, preeclampsia is known to reverse the normal circadian cycle of the BP. OBJECTIVE: To determine the profile dipper/non-dipper in patients with severe preeclampsia, eclampsia and HELLP syndrome patients in Intensive Care and Obstetrics Hospital Juárez of México. MATERIAL AND METHODS: 15 patients were reviewed, 10 with severe preeclampsia, 4 with HELLP syndrome and 1 eclampsia, systolic, diastolic, mean and pulse PA were analyzed during the day/night and pregnancy/postpartum. Using ratios pregnancy day/night pregnancy, puerperium day/night postpartum dipper/non-dipper profile is determined RESULTS: Maternal age 30 ± 6.34 years, 7 primiparous (46%) 8 multiparous (54%), pregnancy was 31.67 ± 4.59 weeks. In all but two results in the ratio of pulse pressure during pregnancy was not the result dipper raiser and did not change during the postpartum period. CONCLUSION: in all patients during pregnancy profile was observed no dipper no change during the postpartum period. The established treatment did not modify this result. So it is appropriate to establish strategies to change this behavior and try to get the patient to regain normal circadian BP rhythm.

[Primary cervical cancer screening]. / Detección primaria del cáncer cervicouterino.

Cervico-uterine cancer screening with cytology decrease incidence by more than 50%. The cause of this cancer is the human papilloma virus high risk, and requires a sensitive test to provide sufficient sensitivity and specificity for early detection and greater interval period when the results are negative. The test of the human papilloma virus high risk, is effective and safe because of its excellent sensitivity, negative predictive value and optimal reproducibility, especially when combined with liquid-based cytology or biomarkers with viral load, with higher sensitivity and specificity, by reducing false positives for the detection of cervical intraepithelial neoplasia grade 2 or greater injury, with excellent clinical benefits to cervical cancer screening and related infection of human papilloma virus diseases, is currently the best test for early detection infection of human papillomavirus and the risk of carcinogenesis.

[Serum hormones that regulate the reproductive axis in men with testicular germ cell cancer and its impact on fertility]. / Hormonas séricas que regulan el eje reproductor en el varón con cáncer germinal de testículo y su repercusión en la fertilidad.

BACKGROUND: Epidemiological studies treat testicular germ cancer as a single disease, the behavior of the two histological types of cancer; seminoma and nonseminoma have differences in reproductive hormone secretion and impair fertility differently. OBJECTIVE: To demonstrate that the serum concentration of pituitary hormones involved in fertility and spermatogenesis in the affected male is different in the two histological types. METHODS: Were determined by radioimmunoassay or inmunoradiometric assay, luteinizing hormone, follicle stimulating hormone, total testosterone, prolactin, estradiol, human chorionic gonadotropin and alpha fetoprotein in 37 patients with germ cell cancer (15 seminoma and 22 nonseminoma) and 35 controls. We analyzed the semen of patients, and were questioned about paternity before the cancer diagnosis. RESULTS: Age was higher in patients with seminoma cancer, showed decreased luteinizing hormone, follicle stimulating hormone, and testosterone and increased estradiol and prolactin in nonseminoma compared with seminoma. In patients with nonseminoma they had 9 children, 5 were oligozoospermic, 3 azoospermic and 6 normal concentration, 8 did not provide sample, seminoma group they had eight children, only one azoospermic, nine normal concentration, and 5 did not provide sample . CONCLUSIONS: The hormonal behavior is different in men with nonseminoma compared with seminoma, so that the negative impact on the reproductive axis and fertility is higher in cases of non-seminoma.

Antecedentes: los estudios epidemiológicos tratan al cáncer germinal de testículo como una sola patología, el comportamiento de los dos tipos histológicos: el seminoma y no seminoma tienen diferencias en la secreción de hormonas reproductivas y alteran la fertilidad de forma diferente. Objetivo: demostrar que la concentración sérica de las hormonas hipofisarias que intervienen en la fertilidad y espermatogénesis en el varón afectado es diferente en los dos tipos histológicos. Material y métodos: estudio clínico, prospectivo, transversal, comparativo de tres grupos de pacientes. Por medio de radioinmunoensayo o ensayo inmunorradiométrico se determinaron las concentraciones de: hormona luteinizante, hormona folículo estimulante, testosterona total, prolactina, estradiol, gonadotropina coriónica humana y alfa feto proteína en suero de 37 pacientes (15 seminoma, y 22 no seminoma) y 35 controles. Se analizó el semen de los pacientes y se les interrogó acerca de su satisfacción de paternidad antes del diagnóstico de cáncer. Resultados: los pacientes con cáncer tipo seminoma fueron de mayor edad, se encontró disminución de: hormona luteinizante, hormona folículo estimulante y testosterona; aumento de: estradiol y prolactina en cáncer no seminoma, en comparación con seminoma. En los pacientes con no seminoma 9 ya tenían hijos, 5 eran oligozoospérmicos, 3 azoospérmicos y 6 con concentración normal 8 no proporcionaron muestra; en el grupo de seminona, 8 ya tenían hijos, sólo 1 azoospérmico; 9 concentración normal, y 5 no proporcionaron muestra. Conclusiones: el comportamiento hormonal es diferente en los hombres con cáncer no seminoma en comparación con los de seminoma, por lo que la repercusión negativa en el eje reproductor y fertilidad es mayor en los casos de no seminoma.

[Giant cystic lymphangioma breast. Report of a case with 20-year follow-up and review of the literature]. / Linfangioma quístico gigante de mama. Reporte de un caso con seguimiento de 20 años y revisión de la bibliografía.

BACKGROUND: Lymphangiomas are congenital malformations or acquired (secondary to trauma, infection or neoplasia) in the mammary gland, are extremely rare. These lesions tend to infiltrate surrounding tissues and malignant degeneration is extremely rare. Clinically manifests as benign masses, slow growing; diagnosed clinically and by imaging studies. Suegery with removal of the mass is performed for aesthetic reasons and to make differential diagnosis with other common injuries. CLINICAL CASE: Women 45 years of age with progressive increase in size of the left breast, breast trauma concerns and has no other symptoms.The histologic diagnosis was cystic lymphangioma giant left mammary gland. DISCUSSION: Lymphangiomas are uncommon lesions and extremely rare in the mammary gland, locally aggresive behavior and are benign, where abnormal lymphatic tissue has some ability to proliferate and accumulate large amounts of liquid, representing cystic appearance, as presented in our case. Local surgical excision is the treatment. CONCLUSION: In this first case of giant breast cystic lymphangioma reported in Mexico, which corroborates the benignity of the lesion.

Antecedentes: los linfangiomas son malformaciones congénitas o adquiridas (secundarias a traumatismos, infecciones o neoplasias) de la glándula mamaria sumamente raras. Estas lesiones tienden a infiltrar los tejidos circundantes y la degeneración maligna es excepcional. Su manifestación clínica es en tumores benignos y de crecimiento lento. Se diagnostica clínicamente y por estudios de imagen. El tumor se extirpa por razones estéticas y para establecer el diagnóstico diferencial con otras lesiones más comunes. Caso clínico: paciente femenina de 45 años de edad, con incremento progresivo del tamaño de la mama izquierda, quizá originado por un traumatismo y no tiene otros sintomas. El diagnóstico histológico definitivo fue: linfangioma quístico gigante de la glándula mamaria izquierda. Discusión: los linfangiomas son lesiones extremadamente raras en la glándula mamaria, de comportamiento agresivo local y benignas. El tejido linfático anormal posee cierta capacidad de proliferar y de acumular grandes cantidades de líquido, lo que representa su apariencia quística, como sucedió en el caso aquí reportado. La extirpación quirúrgica local es el tratamiento indicado. Conclusión: este primer caso de linfangioma quístico gigante de mama reportado en México permite corroborar la benignidad de la lesión.

Increased serum levels of inflammatory mediators and low frequency of regulatory T cells in the peripheral blood of preeclamptic Mexican women.

Regulatory T cells (T(regs); CD4+CD25(high)Foxp3+) are critical in maintaining immune tolerance during pregnancy and uterine vascularization. In this study, we show that, in Mexican women with different preeclamptic severity levels, the number of T(regs) and the subset of CD4+CD25(high)Foxp3+ are decreased compared with those of normotensive pregnant women (NP). Moreover, a systemic inflammatory state is a pivotal feature in the pathogenesis of this disorder and could be related to hypertension and endothelial dysfunction. Likewise, we observed elevated levels of IL-6, TNF-α, and IL-8 in the serum of severe preeclamptic patients (SPE); no differences were found in the IL-1ß and IL-10 levels compared with those of NP patients. An analysis of chemokines in the preeclamptic serum samples showed high levels of CXCL10, CCL2, and CXCL9. Our findings suggest that the preeclamptic state is linked with systemic inflammation and reduced numbers of T(regs).

[The religious aspects of maternal mortality at the time of the Aztecs. Cihuateteo: dead women at first birth]. / Aspectos religiosos de la mortalidad materna en la época de los aztecas. Cihuateteo: las mujeres muertas en el primer parto.

Women who die during pregnancy or childbirth, the Aztec goddess regarded with the same value that was given to the warriors who died on the battlefield, accompanied the sun during its journey through the land, but were also feared and regarded as witches who could fly and cause damage and disease to children, could occupy bodies and produce paralysis, at the funeral the relatives of the Cihuateteo should take care of the woman's body because there was a possibility that parts of soldiers stealing him to gain courage in battle. The governing Cihuateteo magical occupations of women.

[Clinic characteristics of patients with trophoblastic gestational disease complicate with hypertension]. / Características clínicas de pacientes con enfermedad trofoblástica gestacional complicada con enfermedad hipertensiva.

BACKGROUND: The molar pregnancy is complicated with hypertension before 20 weeks, divided into complete mole and partial mole, and in diploid and triploid hydatidiform mola depending on the fetal chromosomes. OBJECTIVE: To determine clinical and laboratory characteristics of patients with hydatidiform mole with and without hypertension, and choriocarcinoma, correlate serum chorionic gonadotropin (hCG) and hypertension. MATERIAL AND METHODS: We reviewed 55 cases with histopathologically proven mole, separately analyzed clinical, laboratory and hCG. RESULTS: The prevalence of mole with hypertension was 1:7; with the choriocarcinoma is 1:11. The age and sexual initiation of mole with hypertension was higher (p = .004 and .002 respectively), liver transaminase AST (p =. 004) and lactate dehydrogenase are higher in the group with hypertension (p =. 000). Positive correlation was obtained r = .246 p =. 044 statistically significant between mean arterial pressure and hCG. We reviewed 31 cases of 28 national and international articles, in patients with diploid hydatidiform the product is allowed to live normal and high blood pressure is showing mild preeclampsia, while partial moles are triploid, malformed products, incompatible with life and with hypertension severe like severe pre-eclampsia. CONCLUSIONS: The molar pregnancy is partially diagnosed with hypertension in our environment, is not properly analyzed and that most of the products of curettage were not performed genetic testing. The hCG probably participate in the hypertensive disorders of pregnancy.

[Fertility and testicular function in a patient with germ cell extragonadal tumor. A report of a case]. / Fertilidad y función testicular en un paciente con tumor extragonadal de células germinales. Comunicación de un caso.

Males are affected from primary extragonadal germ cell tumors with a frequency of 2 to 5%. There is a high incidence of infertility of more than 60% and most of the cases have azoospermia due to testicular damage. The hormonal profile of these patients shows normal luteinizing hormone, normal follicle stimulating hormone and normal testosterone and estradiol. We communicate the case of a male who had a primary retroperitoneal germ cell tumor with a low title of chorionic gonadotropin, elevated estradiol and normal testosterone, prolactin and seminogram. Before beginning treatment with chemotherapy, his wife became pregnant delivering twins, both males. The patient was treated with chemo and radiotherapy after which he became azoospermic with an increase in both luteinizing hormone and follicle stimulating, decreased levels of estradiol and without alteration in prolactin and testosterone. The pituitary testicle axis was affected by the tumor, but the microenvironment of the testicles did not seem to be damaged only after initiating treatment.

[Epidemiological analysis of infertility in a Mexican population]. / Análisis epidemiológico de la infertilidad en una población mexicana.

BACKGROUND: Infertility is defined as the failure to conceive after a year of sexual life without a method of birth control. Most studies indicate that 15% of all couples will experience primary or secondary infertility in some moment of their reproductive life. OBJECTIVE: To gain knowledge of general characteristics from patients with infertility in our environment (social, clinical, diagnostic and therapeutic) that attended the Reproductive Biology Department of Hospital Juárez de Mexico. PATIENTS AND METHODS: A descriptive, observational, situational, and retrospective indagatory study was performed on 116 infertile patients, seen in the outpatient clinic, from January through December 1999. All had entered our protocol of infertility and selected treatment. RESULTS: The altered ovarian endocrine factor was the most frequent (82.7%), followed by cervical factor (80%), masculine factor (38%) and tuboperitoneal factor (29%). In most cases the cause was multifactorial. The percentage of successful pregnancies (31.88%) was similar to that reported in the literature. CONCLUSIONS: The most common factors that influence infertility resembled those exhibited by specialized clinics of affluent countries with similar pregnancy rates.

[Heterosexual precocious puberty due to arrhenoblastoma. Postsurgical spontaneous pregnancy]. / Pubertad precoz heterosexual por arrenoblastoma: embarazo espontáneo postescisión.

It is presented the case of a female with heterosexual precocious puberty associated to hyperandrogenism and virilization due to arrhenoblastoma, who became pregnant after surgery. Clinical study: a 14-year-old female initiated at age 6 years with premature pubarche and telarche. By age 11, the patient only had one menstrual period along with virilization. Physical exam disclosed: facial acne, cricoid enlargement, breast Tanner II, pubic hair Tanner III, clitoromegaly of 4.5 cm and hypotrophy of labia majora. Ferriman and Gallwey: 12. Basal quantitation of circulating testosterone: 1.25 ng/mL (normal: 0.2 to 0.8 ng/mL), androstenedione 13.9 ng/mL (normal: 0.5 to 2.4 ng/mL). A pelvic ultrasonographic study showed: uterus of 66 x 25 x 30 mm, right ovary of 50 x 50 mm, hyperechoic with echolucid and nodular areas (vol. 65.3 cc). Left ovary was of 30 x 30 mm with echolucid areas of 2.0 mm (vol. 5.1 cc). Cariotype: 46XX. Surgical right oophorectomy was performed containing an ovoid tumor of 4 x 3 x 3 cm. Histologic analysis revealed a Sertoli Leydig (Type II, Mayoer) cell tumor. The patient resumed menses and became pregnant at age 20 (22 week obitus). In the last assessment, performed 6 years after surgery, the patient resumed normal menses, Ferriman and Gallwey 5, Tanner V and regression of clitoromegaly to 3.0 cm. In this case, surgery provided remission of hyperandrogenism, normal menstrual cycles and fertility restoration.

[Craniopharyngioma and its impact upon human reproduction: analysis of 15 cases at the Hospital Juarez de Mexico]. / Craneofaringioma y sus repercusiones en la reproducción humana: análisis de 15 casos en el Hospital Juárez de México.

BACKGROUND: Craniopharyngiomas are intracranial tumors of non-glial origin derived from cellular remnants of the Rathke's pouch. Their frequency is 1-3% of intracranial tumors and 13% of suprasellar neoplasms. Histologically, it is a benign lesion, albeit clinically severe with a high index of relapse and sequelae upon the reproductive function. OBJECTIVE: To identify the clinical characteristics of patients with craniopharyngiomas before and after treatment. MATERIAL AND METHODS: We reviewed our experience of 15 cases with craniopharyngioma seen at the Hospital Juarez de Mexico from 1995 throughout 2002. RESULTS: Prevalence was higher in males (ratio 2:1) with ages between 6-45 years old (X 17.9 +/- 6.45 years). The most common symptoms were cephalalgia (100%) and visual disorders (93%); the average levels of hormonal determination were in females: FSH 1.0 mIU/mL, LH 0.5 mIU/mL, estradiol 11.0 pg/mL, PRL 80 mg/mL. In males: FSH 1.7 mIU/mL, LH 2.6 mIU/mL, testosterone 0.6 mg/dL and PRL 29 mg/mL. All patients had hypogonadotropic hypogonadism. Tumoral relapse was mostly seen in patients who underwent only surgery (n = 7, 46.6%). The ones with surgery and radiotherapy (n = 8, 53.3%) did not disclose symptoms that required another surgery. CONCLUSIONS: The main repercussion of craniopharyngioma, due to its proximity to hypothalamus and hypophysis, is on the endocrine and reproductive areas of human being.

[Epidemiologic assessment of erectile function in a selected mexican population]. / Análisis epidemiológico de la función eréctil en una población mexicana escogida.

UNLABELLED: We determined the incidence, epidemiology and type of erectile dysfunction, as well as risk factors related to erectile function in a Mexican population. MATERIAL AND METHODS: 452 surveys were applied in direct form, integrated by 38 questions with open answers, dichotomics and multiple to men that accompanied patients that requested medical attention in our clinic and to workers of the Hospital Juárez de México, 18 years or older, with active sexual life, that knew how to read and write. An analytic, prospective and transverse study was performed; obtaining the incidence, frequency of presentation (organic or psychological) of erectile dysfunction and the odds ratio of risk factors observed in the study. RESULTS: The incidence of erectile dysfunction in the population studied was 26.1% (n = 118); 67.8% probably of psychological origin and 32.2% organic. People younger than 40 years had a presentation of 16.45% and for those > or = 40 years was 50%. Factors of risk: > or = 40 years (OR-5.08), Obesity (OR-1.48), started sexual life > or = 18 years (OR-1.17), intercourse < or = 3/week (OR-1.86), monthly income < or = 250 american dollars (OR-4.81), married (OR-1.39) and in free union (OR-1.44), peasants (OR-3.43), bricklayers (OR-2.96), merchants (OR-2.34), using antihypertensive medication (OR-6.18), with diabetes mellitus (OR-4.09). DISCUSSION: The incidence of erectile dysfunction and its psychological origin was higher than that referred in the literature revised; the higher risk factors associated to erectile dysfunction were: age, diabetes mellitus, obesity, and the use of antihypertensive drugs.

[Frequency of altered male factor in an infertility clinic]. / Frecuencia del factor masculino alterado en parejas que consultan por infertilidad.

UNLABELLED: Infertility is the incapacity of a couple to conceive after a year of regular sexual life without using a method for family planning. The infertility state is dependent on the female factor as well as masculine factor; an altered masculine factor is designated when any cause or causes of infertility reside in the male. The masculine factor as a cause of infertility is present in 40 to 50% of cases hence the importance of an integral evaluation of male alterations and its fertility. The World Health Organization (WHO) has proposed to classify the masculine infertility based on semen features. OBJECTIVE: To determine the frequency of the masculine factor altered in association to diagnosed abnormalities, according to the number of affected seminal indexes based on seminograms performed in infertile patients seen at the department of Human Reproductive Medicine, Hospital Juárez de México. MATERIAL AND METHODS: An observational, descriptive, transverse, retrospective study was performed. SUBJECTS: the seminograms practiced were reviewed from 571 clinical files of couples that the consultation for infertility from January 1993 to February 2001. Collection and analysis of semen samples was based on standards settled by WHO. RESULTS: Of 571 seminogram informs, 371 (65%) showed alterations in the seminal indexes, the stocking of age of this group was of 31.89 years +/- SD 6.3 years. Our findings were: azoospermia in 89 (23.98%), astenonecrozoospermia in 44 (11.85%), hypospermia in 43 (11.59%), astenozoospermia in 33 (8.89%), oligoastenozoospermia in 31 (8.35%) hyponecrozoospermia in 30 (8.08%), oligozoospermia in 25 (6.73%), others in 21 (5.7%), necrozoospermia in 19 (5.12%), hypoastenozoospermia in 18 (4.85%), cryptozoospermia in 11 (2.97%), and hypooligoastenozoospermia in 7 (1.88%). In 62.6% of seminograms practiced there was an isolated alteration, in 34.4% two alterations and in the remaining 3% more than two alterations. CONCLUSION: We found masculine factor altered in 65% of couples who were requiring consultation for infertility. The three main alterations of seminal indexes were azoospermia, astenonecrozoospermia and hypospermia.

[Polycystic ovarian disease: clinical and biochemical expression]. / Ovarios poliquísticos: expresión clínica y bioquímica.

UNLABELLED: The policystic ovary (PO) results from a systemic hormonal dysfunction, characterized by hyperandrogenemia, insulin resistance and anovulation. OBJECTIVE: Assessment was made of clinical and biochemical features of patients with PO. MATERIAL AND METHODS: A retrospective analysis of 211 clinical of charts of patients with ultrasonographic diagnosis of PO seen at the Hospital Juárez de México from 1996 to 2000 was performed. Evaluation was made of body mass index (BMI), waist hip index (WHI), Ferriman index, acanthosis nigricans, lipid and hormonal profile. RESULTS: Of patients studied (n = 211) 64% had infertility and abnormal menses associated to PO, while the rest was normal. Both groups (PO and normal), were similar in age and distribution as well as family back grown for diabetes mellitus, hypertensive disease and obesity. The clinical manifestations observed on patients with PO were infertility 79.16%, anovulation 68.42%, hirsutism 66.9% obesity (66.9%). Biochemical findings in PO patients vs normal patients were: hyperandrogenism (86.73% vs 71.4%), insulin resistance (60.46% vs 37.5%), dislipidemic (56.41% vs 31.5%), LH/FSH ratio > 2 (19.51% vs 10.51%). Regarding sensitivity and specificity for clinical and biochemical findings ranged from 0.64 at 0.90, minimum value had infertility and maximum anovulation; specificity (interval 0.31 to the 0.71) minor corresponded to hyperprolactinemia and higher to infertility. The estimated risk factor (OR) for the population studied exhibited anovulation (OR, 7; 95% IC, 1.79-32.92); infertility (OR, 4.51; 95% IC, 2.03-10.13); insulin resistance (OR, 3; 95% IC, 0.82-8.16); hyperandrogenism (OR, 2.61; 95% IC, 1.02-6.69); and obesity (OR, 2.16; 95% IC, 1.17-4). We concluded that population with PO has a higher risk of infertility, anovulation, obesity, hyperandrogenism, dyslipidemia, insulin resistance and abnormal menses.

Índice de resistencia a la insulina: medición y potencial en reproducción humana / Insulin resistance Index: assessment and potential un human reproduction

La resistencia a la insulina (IRI) denota anomalías en el metabolismo de glucosa mediadas por insulina. Los cambios bioquímicos asociados a este fenómeno son difíciles de detectar en ausencia de algún trastorno evidente como la diabetes mellitus. Se evaluó un método simple para determinar la resistencia a insulina mediante la cuantificación de glucosa e insulina (glucosa de ayuno [mmol/L] X insulina de ayuno [mU/L]/22.5) en pacientes (n=50) vistos en nuestra clínica de la Reproducción Humana, incluyendo controles (n=10) y diabéticos (n=5) inestables y controlados. Los casos con obesidad, ovario poliquístico, diabetes mellitus, infertilidad e hipoglucemia exhibieron un IRI sensiblemente mayor (p=0.001 - 0.005) que los controles y pacientes con otras alteraciones. Los cambios observados en IRI correlacionaron en forma inversa con la disminución progresiva de glucosa registrada en diabéticos bajo tratamiento y con grados diversos de control. Se concluye que este método para evaluar IRI ofrece un estimado confiable de la resistencia a insulina con aplicaciones potenciales para el estudio de la reproducción humana.

Influencia del tumor testicular sobre el eje de hipotálamo, hipófisis y testículo / Testicular tumor influence on the hipothalamus-hypophisis-testicle axis

El teatículo contiene en su interior a las células germinales, que pueden producir cualquier clase de tejido o susbstancia en el organismo. Cuando existe crecimiento celular desorganizado, como en el cáncer, la gónada puede producir substancias, como la gonadotropina coriónica humana (HCG) y la alfafetoproteína (AFP), que se utilizan como marcadores de actividad tumoral. Se determinaron los valores basales de hormona luteinizante (LH), hormona foliculoestimulante (FSH), HGC y AFP e cuatro pacientes con tumor testicular. En tres de ellos el informe histopatológico indicó teratocarcinoma. En estos pacientes los niveles de HGC y AFP se encontraron elevados, en tanto que las gonadotropinas hipofisarias se hallaron bajas: en un paciente con diagnóstico de atrofia testicular todas las determinaciones fueron normales. Se observó que en estos pacientes la HCG circulante inhibió la liberación de LH y FSH.