[Diagnosis of molar pregnancy by hysteroscopy]. / Diagnóstico de embarazo molar por histeroscopia.

BACKGROUND: Gestational trophoblastic disease has a high incidence worldwide. Proper pre-evacuation diagnosis must be performed due to the risk of malignant complications associated with hydatidiform moles. Diagnosis of early molar pregnancies might be elusive due to atypical clinical manifestations and inconclusive ultrasonographic findings. OBJECTIVE: Report on the efficiency and precision by hysteroscopy for the diagnosis of molar pregnancy in one particular case. CLINICAL CASE: Thirty-year old woman, 5.6-week pregnant, suffering from pelvic pain, uterine bleeding and high concentrations of human chorionic gonadotropin beta fraction (beta-hCG). Ultrasonography suggested inconclusively either a hematoma or a gestational sac so that further evaluation by hysteroscopy had to be performed in order to reach a proper diagnosis. RESULTS: Hysteroscopic evaluation provided conclusive diagnostic images of hydropic degeneration of the chorionic villi. Histopathological evaluation confirmed a molar pregnancy. The mole was removed by uterine curettage and beta-hCG tests followed. CONCLUSIONS: Hysteroscopy is a useful tool for diagnostic protocol in case of early atypical molar pregnancy.

[Total laparoscopic hysterectomy: descriptive study of institutional experience with 198 cases]. / Histerectomía total laparoscópica: estudio descriptivo de la experiencia institucional con 198 casos.

BACKGROUND: Total laparoscopic hysterectomy is a useful surgery in current gynecology, specially, in cases where abdominal access is indicated. Total laparoscopic hysterectomy performance has increased in recent years. OBJECTIVE: To analyze the clinical characteristics and surgical variables of patients undergoing laparoscopic total hysterectomy for benign disease, performed at the Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, between 2007 and 2009. MATERIAL AND METHOD: Retrospective, longitudinal and descriptive study. Medical records of all patients with a noncancer diagnosis underwent laparoscopic hysterectomy were reviewed, at the Instituto Nacional de Perinatologia, between January 1, 2007 and December 31, 2009. RESULTS: 594 hysterectomies were performed, of which 37.3% were by laparoscopic surgery, within these 89.1% were through the total laparoscopic hysterectomy technique. Surgical indications were 58.6% for fibroids, 23.2% abnormal uterine bleeding and 18.2% for adenomiosis. Studied variables revealed an average surgical time of 139 + 66.9 min (range: 75-225 min), average surgical bleeding of 119.7 +/- 60.5 mL (50-350 mL), average uterine longitude of 12.4 +/- 2 cm (8-16 cm), average uterine weight 222.7 +/- 113.8 g (90-860 g), and average hospital stay of 2.3 +/- 0.5 days (2-4 days), all of these results within the range reported in the literature. CONCLUSIONS: Previous surgical interventions were observed as complications risk factors, 162 (81%) patients had previous surgeries, 29% with 2 c-sections, 20% with 3 or more and 27% had other non-obstetrical interventions. This technique is safe and reliable, it does not replace the vaginal access and with adequate training and equipment it may be performed in an efficient manner with satisfactory results in our population.

[Comparison of laparoscopic vs. laparotomy treatment in ovarian teratomas]. / Comparación del tratamiento laparoscópico vs laparotomía en teratomas ováricos.

BACKGROUND: Benign cystic teratoma is one of the most common benign tumors of the ovary, according to international series represents between 44 and 62% of all ovarian tumors diagnosed in women younger than 40 years. OBJECTIVES: To evaluate and compare the efficacy and safety between laparoscopy and laparotomy in the management of ovarian teratomas, as well as the recurrence between both techniques. MATERIALS AND METHOD: Retrospective, clinical series study involving 169 cases of ovarian teratomas operated at the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes in the period comprehended between 2000-2008. The cases were divided into the ones solved by laparoscopy, corresponding to group 1 (102 cases) and 67 cases solved by laparotomy, corresponding to group 2. RESULTS: Group 1 (laparoscopic approach) consisted of 102 patients (60.3%), and group 2 (laparotomy approach) had 67 patients (39.7%). Surgical bleeding: 55.7 +/- 21.4 mL vs. 91.6 +/- 29.2 mL (p < 0.0001), hospital stay: 1.6 +/- 0.57 vs. 2.7 +/- 0.42 days (p < 0.0001), surgical time: 110.3 +/- 27.2 vs. 83.6 +/- 26.9 minutes (p < 0.0001), teratoma size: 7.2 +/- 2.3 vs. 11.5 +/- 4.2 cm (p < 0.0001) in groups 1 and 2, respectively. Teratoma rupture had 57.8% incidence (59 cases) in group 1, and 16.4% in group 2 (11 cases). Laparoscopy was a risk factor for broken open for ovarian cyst (OR: 6.9; CI 95%: 3.3-14.8). Not a single case was complicated by chemical peritonitis in any study group. CONCLUSIONS: Laparoscopic approach to teratomas is a safe and efficient procedure, it does not increase complications in comparison to the laparotomy approach; it presents less bleeding and short hospital stay, offering a quick recovery.

Inducción de la ovulación con gonadotropinas hipofisiarias menopásicas humanas / Induction of ovulation with human menopausic hypophysis peal gonadotropins

Es un reporte preliminar del uso de gonadotropinas hipofisiarias menopáusicas humanas para inducir ovulación en el Instituto Nacional de Perinatología (INPer), que incluye 20 pacientes anovulatórias sin ninguna otra causa de esterilidad divididas en dos grupos: 4 casos por falla hipotálamo hipofisiaria con FSH baja E2 bajo PRL normal y 16 casos con disfunción hipotálamo-hipofisiaria con FSH normal o bajo, E2 normal, PRL normal. Todos los casos se sujetaron a un ciclo de tratamiento bajo un protocolo de seguimiento a base de determinaciones seriadas de estradiol, seguimiento de crecimiento folicular por ultrsonografía, valoración de lo índice cariopicnótico por citología vaginal seriada y valoración clínica del moco cervical. Se logró ovulación en 13 casos (66%) y embarazo en 6 casos (30%). Se analiza la correlación de ls diferentes parámetros de seguimiento