[Cystic lymphangiomas of the mesentery and the epiploon. About two cases]. / Le lymphangiome kystique du mésentère et de l'épiploon. A propos de deux cas.

Two cases of cystic lymphangiomas of the mesentery and the epiploon are hereby related. The authors underline the following points: first, the rarity of these tumors along with the absence of significant clinical features makes the differential diagnosis with ovary tumors a difficult task. Second, although abdominal ultra sonography, completed by CT scan, allows the hypothesis of lymphangioma, only histological examination will confirm the diagnosis. There is no other treatment but complete exeresis, with a good prognosis and exceptional recurrences.

[Comparative analysis of multifollicular development with the application of recombinant FSH vs. urinary FSH in the results of in vitro fertilization]. / Análisis comparativo del desarrollo multifolicular con la aplicación de FSH recombinante vs. FSH urinaria en los resultados de fertilización in vitro.

The interactive function between intrafollicular factors related with ovum competence and embryo development played an important role getting high quality embryos during the embryo transference in in-vitro fertilization programs. Urinary gonadotropins are used widely to get homogeneous follicles during ovarian stimulation. Recombinant technology has been applied in these compounds to correlate with a best egg formation and higher pregnancy rates. We developed a prospective, linear and comparative study to aim the ovum/embryo development using urinary and recombinant FSH. A total of 100 patients were included in the study, 56 patients received rFSH (group I) and 44 hMG (group II). There were not differences in age, weight and body mass index as well as ovarian reserve. However, patients who used urinary gonadotrophins required a higher number of ampoules [31.7 +/- 8.6 vs. 20.7 +/- 6.4 (p < 0.001)]. No differences in peak E2, day of hCG and endometrial thickness. Although, no differences in number of egg mature, the fertilization rate was higher in the recombinant group [5.9 +/- 3.7 vs. 3.4 +/- 2.3 (p < 0.02)]. A higher number of embryo transfer were observed in the same group (3.4 +/- 1.7 vs. 1.9 +/- 2.2 (p < 0.004)]. The pregnancy rates were 34.3% and 29.6% for each group respectively.

[Assessment of nociceptive suppression in laparoscopic postoperative status: prospective, randomized and comparative study with a control group]. / Evaluación de la supresión nociceptiva en el status postoperatorio laparoscópico: estudio prospectivo, aleatorio comparativo con la inclusión de un grupo control.

In recent years endoscopic surgery has became a highly demanded procedure because it is an easy method for diagnosis and treatment in gynecological field. Post-operative pain is considered as a condition in the morbidity status. The objective of this study was to evaluate the nociceptive suppression in laparoscopic surgery. A prospective randomized trial was performed in order to evaluate this condition. A total of 45 patients were included. Three groups were randomized using two different anesthetics applied in the cult-de-sac and uterine-bladder union. Group A (n-15) received bupivacaine, group B (n = 15) ropivacaine and group C (control) saline solution was instilled. The pain was scored using the visual analog scale as same as blood pressure and heart rate in a 15 minute intervals in the recovery room. For study design there were no differences in age, weight, height and body mass index (EMI). The surgical and anesthetic times were similar among groups. However there were significant differences when pain was evaluated. For a less toxic effects and good preventive analgesia we recommend to use ropivacaine in the postoperative status.

[Influence of intrafollicular factors at ovarian level during oocyte/embryo development]. / Influencia de los factores intrafoliculares a nivel ovárico durante el desarrollo óvulo/embrionario.

There is series of factors associated to fertilization and embryo development events. Each factor has a role in the inter-relationship between various molecular events related to oocyte/embryo quality. Dynamic features associated to endocrine-paracrine environment are determinant to the role of each factor in ovaric follicullar development. Growth factors, vascular-endothelial growth factor, nitric oxide, leptin and others correlate in ovular maturity process. That is why growth factors, vascular-endothelial growth factor, nitric oxide, leptin and others can be expressed as embryo viability and implantation biomarkers.

[Embryo transfer: a critical step in assisted reproduction]. / Transferencia embrionaria: un paso crítico en reproducción asistida.

The advances and development of new procedures and techniques related to embryo development, and its final outcome, the embryo transfer; have increased significantly the pregnancy rate through this reproductive assisted technique. The embryo transfer is probably the last part in in-vitro fertilization programs and the success should be determined through the technical approach and procedure's characteristics. The use and standardization of the current techniques during the embryo transfer process allow increasing the success in pregnancy and implantation rates in a short period of time in the current Assisted Reproduction Programs.

[Assessment of the penetration of culture media in uterine cavity as an effect of cervical lavage before embryo transfer: prospective and observational study of samples obtained in hysterectomy]. / Evaluación de la penetración del medio de cultivo a la cavidad uterina como efecto del lavado cervical previo a la transferencia embrionaria: estudio prospectivo y observacional en piezas obtenidas por histerectomía.

Cervical lavage used to remove and cleaning some of the scale elements as well as cervical mucous during embryo transfer has been a regular practice in many reproductive centers worldwide. However, the microenvironment influence using these techniques will or not be detrimental in the embryo development. Under this issue, a prospective study was doing in 16 patients (underwent hysterectomy). A cervical lavage was performed previous to the procedure similar to the embryo's transfer step, subsequently cervical invasion was checking. The age was 36.4 +/- 8.6 years, preoperatory diagnosis was abnormal uterine bleeding (n = 4), myomata (n = 4), adenomiosis (n = 4), endometrial polyp (n = 3) and chronic pelvic pain (n = 1). Uterine weight was 127.5 +/- 55.4 g with a surgical time of 48.8 +/- 12.5 minutes. Medium in the uterine cavity was founded in only one case. We believe that cervical lavage is a secure technique in embryo transfer.

[A prospective randomized trial of the impact of misoprostol (PgE1) on pregnancy rate after intrauterine insemination (IUI) therapy: a preliminary report]. / Estudio prospectivo y aleatorio del impacto de misoprostol (PgE1) en las tasas de embarazo con inseminación intrauterina (IIU): informe preliminar.

Although the use of prostaglandin plays an important role in the reproductive human physiology, it is still controversial in the reproductive field. Ovarian stimulation as well as intrauterine insemination increased the reproductive goals in certain group of patients. The objective of the present study was to evaluate the prostaglandin effect (misoprostol) in patients under ovarian stimulation and intrauterine insemination and their final outcome in the clinical pregnancy rate. There were a total of 59 ovarian stimulated cycles, the study group (n = 29) received 200 micrograms of prostaglandin E1 (misoprostol) intravaginal after IUI, compared with the control group (n = 30). Demographic characteristics were similar in both groups. There were no differences in age, FSH. LH and E2, hCG day and number of ampoules between groups. However, a significant pregnancy rate was observed between groups (31% study group vs. 20% control group). We concluded that prostaglandin application in stimulated cycles under intrauterine insemination remain a beneficial effect showing in the pregnancy outcome.

Introduction to anatomy and physiology of human conception.

Anatomical and physiological concepts of human reproduction currently in use have been developed over generations, following clinical and basic research guidelines that preceded modern technology. The application of new forms of research over recent decades, as in the case of molecular biology, has contributed to a more in-depth and accurate understanding of the interaction of each of the inter- and intracellular structures in the mechanics of human physiology. On the other hand the use of non-human primate models has provided invaluable information in the reproductive field. The information obtained through models and techniques that have changed over time has led to concepts that continue to have the same validity as when they were first described. The principal objective of this review is to develop an understanding of the physiological processes applied in the anatomical sphere, taking as a reference the fact that it is impossible to understand reproductive mechanics in terms of static phenomena, but rather they should be understood as dynamic and changing processes adaptable to the conditions of each individual's surroundings.

[Ovarian hyperstimulation with menotropins as treatment for unexplained sterility; effect of reproductive characteristics on the results]. / Hiperestimulación ovárica con menotropinas como tratamiento para la esterilidad inexplicable; efecto de las características reproductivas en los resultados obtenidos.

The objective was to evaluate the utility of the ovarian hyperstimulation with menotropins as treatment of unexplained infertility. One hundred couples with unexplained infertility were treated. Ovarian stimulation was started with 150 IU of menotropins on day 3 of the menstrual cycle, monitoring the follicular growth with transvaginal ultrasonography, additional doses of menotropins were administered accordingly. Human chorionic gonadotropin (10000 IU) was administered when the dominant follicle reached a diameter > or = 16 mm. The pregnancy rate per cycle was 12.0%, on the other hand the cumulate rate of pregnancy was 48.0%. The age under 30 years and the antecedent of previous pregnancies were correlated with the likelihood of conception. The spontaneous abortion rate was 35.4%. As conclusion, it therefore appears appropriate, to offer a treatment with menotropins to that specific group of couples with unexplained infertility with good prognostic factor as age < 30 years and infertility duration < 5 years. The increase on the spontaneous abortion rate was probably induced for the luteal insufficiency produced by the ovarian hyperstimulation with menotropins.

Hiperestimulacion ovárica con menotropinas como tratamiento para la esterilidad inexplicable; efecto de las características reproductivas en los resultados obtenidos / Controled ovarian hyperstimulation with menotropins as treatment for unexplained infertility. effect of reproductive characteristics on procedure success

El objetivo del estudio fue evaluar la utilidad de la hiperestimulación ovárica con menotropinas en el tratamiento de la esterilidad inexplicable. Se trataron 100 parejas con esterilidad inexplicable. La estimulación fue iniciada con 150 UI de menotropinas el día tres del ciclo menstrual, se realizó control ultrasonográfico vaginal del desarrollo folicular, y se ajustó la dosis de menotropinas de acuerdo con los resultados del ultrasonido. Fueron administradas 10000 UI de gonadotropina coriónica humana cuando el folículo dominante alcanzó un diámetro ò 16 mm. La incidencia de embarazo por ciclo fue de 12.0 por ciento, mientras que la cifra acumulada de embarazo fue de 48.0 por ciento. La edad menor de 30 años y antecedente de embarazos previos tuvieron relación con una mayor posibilidad de lograr el embarazo. La incidencia de aborto espontáneo fue de 35.4 por ciento. Como conclusión, parece apropiado ofrecer la terapia con menotropinas a parejas con esterilidad inexplicable en las cuales la mujer tiene < 30 años y hay < 5 años de duración del problema. El aumento en la incidencia de abortos espontáneos fue probablemente ocasionado por la deficiencia de fase lútea producida por la hiperestimulación ovárica con menotropinas

[Multifactorial analysis of patients with endometriosis in an institutional program of assisted reproduction]. / Análisis multifactorial de pacientes con endometriosis en un programa institucional de reproducción asistida.

It is a retrospective and transverse study with an analysis of results from patients submitted to intrauterine insemination (IIU), intratubal gamete transfer (GIFT) and in vitro fertilization and embryo transfer (FIVTE), at the Clinic of Assisted Reproduction, Instituto Nacional de Perinatología in Mexico City. From 134 cycles of patients submitted to IIU, 113 corresponded to women with diagnosis of sterility from non determined cause, and 21 to cases with endometriosis, and at least one permeable tube. From the first group, 22 pregnancies were obtained, for a monthly fertility rate of 19.4%; and from the second one, 12 pregnancies with a fertility rate of 56%. This, which is very high , may be explained by the relatively small number of cases in the second group, or else, by the influence of a previous medical treatment for endometriosis; the square Chi analysis shows a P less than 0.01 in the two groups. In the GIFT and FIVTE cases, from which 35 cycles were analyzed, per each procedure, there were 10 pregnancies, 9 for GIFT and one for FIVTE; the amount is very limited in order to obtain conclusions, but it seems that there is a proportional tendency in GIFT to less amount of pregnancies in women with endometriosis. The analysis of hormonal follow up did not show differences in the groups, and the averages may be useful to determine, early, the cancellation, or not, of an stimulation cycle. Finally, in FIVTE cases there is a diminution of fertilization index in women with endometriosis (53%), as compared with the cases without disease (80%).(ABSTRACT TRUNCATED AT 250 WORDS)