[Follicular and endometrial growth profiles in stimulated cycles with clomiphene citrate]. / Perfil de crecimiento folicular y endometrial en ciclos estimulados con citrato de clomifeno.

To study follicular and endometrial growth patterns in Clomiphene Citrate (CC) stimulated cycles, 50 CC cycles of 31 infertile women with patient Fallopian Tubes, were followed, 17 spontaneous conceptional cycles of fertile women were followed as controls. The pattern of follicular growth was similar in both groups until the day before ovulation in which CC cycles showed larger follicular diameters than spontaneous ones; 23.8 +/- 3.1 mm versus 21.6 +/- 2.9 mm (p = 0.013). Follicular rupture occurred on day 16.1 +/- 2.9 in CC cycles, and on day 15.1 +/- 1.85 on spontaneous conceptional ones. This suggests that the follicle, under the influence of CC, has to reach a larger critical mass to produce enough estradiol to revert the hypothalamic blockage produced by the drug, thus permitting the preovulatory LH surge. Endometrium under CC action, was always thinner than in natural cycles. On the day of follicular rupture, the CC cycle's endometrium measured 11.1 +/- 2.02 mm and the natural cycle's endometrium measured 10.6 +/- 1.8 mm (ns). This finding could be attributed to a antiestrogenic effect of CC on the endometrium. It is concluded that cycles under CC action have different follicular and endometrial growth patterns than spontaneous conceptional cycles.

[Simplified management of an in vitro fertilization program]. / Manejo simplificado de un programa de fertilización in vitro.

The development of in vitro fertilization has accelerated in a dramatic way the understanding on gamete physiology. Results obtained with the technique are easily reproducible and consistent between different centers. It is well known that cumulative pregnancy rates with 5 or 6 cycles can reach up to 60% of couples being pregnant. However, the main limitations to successive attempts have been the cost of the procedure and the surgical transfer of the embryos. In an attempt to overcome this difficulties, efforts has been made to simplify the monitoring of induction of ovulation, use of GnRh analogs and non surgical transfers whenever it is possible. Results presented in 47 of these cycles show non significant differences, with data published elsewhere, on oocyte maturity, fertilization and cleavage rates. Moreover pregnancy rates per aspiration are 28.6% and per transfer 33.3%. We can conclude that ultrasonography alone to monitor ovulation induction as well as uterine transfers do not affect the outcome of the cycle.

[Sexually transmitted microorganisms and immunoglobulins in the amniotic fluid in mothers who carry sexually transmitted diseases]. / Germenes de transmisión sexual e inmunoglobulinas en el líquido amniótico, en madres portadoras de enfermedades de transmisión sexual.

Fetal behaviour as an intrauterine patient is unknown. In the diagnosis of sexually transmitted diseases (STD) and in the criteria for treatment only the mother is considered leaving the fetus out. The presence of immunoglobulin M in the amniotic fluid is an indicator of fetal infection and could allow an accurate diagnosis of fetal disease or treatment, if the measurement is related to the presence or absence of organism in the amniotic fluid. In this way, the study of fetal behaviour under these conditions could be done. The objective of this research was to determine the presence of STD organism in the amniotic fluid of the STD infected pregnant women and to evaluate the prevalence and evolution of these pathologies in the fetus. No STD organism, nor immunoglobulin M were found in the 13 samples of amniotic fluid (8 pre and 5 post-treatment) of infected pregnant women. The presence of microorganisms and its relation to immunoglobulin M was not observed. More cases are needed to arrive to a conclusion regarding fetal immunology and to a better understanding of antibacterial properties of the amniotic fluid. We concluded that no contamination in the amniotic fluid or fetal infection was found in pregnant women with STD.

[A laparoscopic approach to a paratyphoid ovarian abscess]. / Abordaje laparóscopico de absceso ovárico tífico.

A case report of a 29-year-old nulligravid patient with a ovarian typhoid abscess managed endoscopically is presented. Puncture and drainage of the pelvic mass was performed laparoscopically. The infrequency of Salmonella paratyphi as an etiologic agent of pelvic inflammatory disease is discussed and a review of the literature regarding endoscopic management of purulent pelvic collections is presented.

[Polycystic ovary syndrome as expression of 3-beta-hydroxysteroid dehydrogenase deficiency]. / Síndrome de ovario poliquístico como expresión de déficit de la enzima 3 beta hidroxiesteroide deshidrogenasa.

Late-onset adrenal enzymatic deficiencies are a common cause of hirsutism. They can produce a PCO syndrome-like clinical course, underscoring the multi-causality of this condition. We report a 18 year old woman with secondary amenorrhea and hirsutism, whose serum levels of testosterone and DHEA-S were 175 ng/dl and 7.3 micrograms/ml and the LH/FSH ratio was 5.9. Dexamethasone decreased testosterone and DHEA-S levels, while the ACTH stimulation test increased the 17 hydroxypregnenolone serum concentration and the 17 hydroxypregnenolone/17 hydroxyprogesterone ratio to values considered diagnostic of 3 beta hydroxysteroid dehydrogenase deficiency.

[Pregnancy in a patient with premature ovarian failure secondary to chemotherapy]. / Embarazo en una paciente con falla ovárica prematura secundaria a quimioterapia.

A 30 year old patient with idiopathic thrombocytosis received chemotherapy and developed amenorrhea and secondary ovarian failure. After discontinuation of chemotherapy, she became pregnant and recovered normal ovarian function 6 months after delivery.

[Gynecological endoscopic surgery. Surgical approach by laparoscopy]. / Cirugía endoscópica ginecológica. Abordaje quirúrgico por vía laparoscópica.

We report the first 32 patients in whom surgical procedures were performed through laparoscopy. We practiced adhrenciolysis, biopsy and fenestration of cystic ovarian lesions, section of uterosacral ligaments as a treatment for pelvic pain, ovaric biopsies in cases of premature ovarian failure, fulguration of endometriotic implants, myomectomy, conservative management of an hemorrhagic corpus luteum, linear salpingostomy and total salpingectomy in ectopic pregnancy. The average operating time was 45 minutes, and the postoperative stay 28 hours. The only complication was active tubal bleeding in an ectopic pregnancy initially approached through linear salpingostomy, that required laparotomy. We describe the utilized technique, discussing the most frequent indications, and also, the basic elements necessary for performing laparoscopy surgery.

[Tubal pregnancy: surgical management by endoscopy]. / Embarazo tubario: resolución quirúrgica por vía endoscópica.

We present the first 10 cases of ectopic pregnancy surgically resolved by laparoscopy. Tubal expression and aspiration was performed in 2 cases, linear salpingostomy in 2, and total salpingectomy in 6 cases. The procedure was successfully done in 9 cases, with an excellent postoperative evolution. The intrahospital permanence was brief (43 hours in average), and rejoining habitual activities was rapidly achieved. The only complication was a case of salpingostomy that required laparotomy due to active bleeding.

[Diagnostic and therapeutic laparoscopy in gynecology: analysis of the first 100 cases in the Hospital Parroquial de San Bernardo]. / Laparoscopia diagnóstica y terapéutica en ginecologia: análisis de los primeros 100 casos en el Hospital Parroquial de San Bernardo.

The first hundred laparoscopies carried out in the "Hospital Parroquial de San Bernardo", between november 1986 and june 1988; were evaluated. The indications for the procedure were: 38% study of infertility, in which a 78% of tubal obstruction or adherencial syndrome was demonstrated; 37% because of ectopic pregnancy, with a diagnostic correlation of 48.6%. The remainder cases were adnexal masses or pelvic pain study. A 42% of the patients had previous pelvic or abdominal surgery. As complications there were two "pre-pneumoperitoneaum", one pelvic inflammatory process and one anesthetic accident, hospitalization time and costs, justifies completely the acquisition of the necessary equipment and technical ability.