Trends of caesarean delivery from 2008 to 2017, Mexico.

Caesarean delivery rates in Mexico are among the highest in the world. Given heightened public and professional awareness of this problem and the updated 2014 national guidelines to reduce the frequency of caesarean delivery, we analysed trends in caesarean delivery by type of facility in Mexico from 2008 to 2017. We obtained birth-certificate data from the Mexican General Directorate for Health Information and grouped the total number of vaginal and caesarean deliveries into five categories of facility: health-ministry hospitals; private hospitals; government employment-based insurance hospitals; military hospitals; and other facilities. Delivery rates were calculated for each category nationally and for each state. On average, 2 114 630 (95% confidence interval, CI: 2 061 487-2 167 773) live births occurred nationally each year between 2008 and 2017. Of these births, 53.5% (1 130 570; 95% CI: 1 108 068-1 153 072) were vaginal deliveries, and 45.3% (957 105; 95% CI: 922 936-991 274) were caesarean deliveries, with little variation over time. During the study period, the number of live births increased by 4.4% (from 1 978 380 to 2 064 507). The vaginal delivery rate decreased from 54.8% (1 083 331/1 978 380) to 52.9% (1 091 958/2 064 507), giving a relative percentage decrease in the rate of 3.5%. The caesarean delivery rate increased from 43.9% (869 018/1 978 380) to 45.5% (940 206/2 064 507), giving a relative percentage increase in the rate of 3.7%. The biggest change in delivery rates was in private-sector hospitals. Since 2014, rates of caesarean delivery have fallen slightly in all sectors, but they remain high at 45.5%. Policies with appropriate interventions are needed to reduce the caesarean delivery rate in Mexico, particularly in private-sector hospitals.

Les taux d'accouchements par césarienne au Mexique sont parmi les plus élevés au monde. Au vu de la sensibilisation accrue de la population et des professionnels à ce problème et de la mise à jour des directives nationales de 2014 visant à diminuer la fréquence des accouchements par césarienne, nous avons analysé l'évolution des accouchements par césarienne selon le type d'établissement entre 2008 et 2017 au Mexique. Nous avons obtenu des données issues d'actes de naissance auprès de la Direction générale mexicaine des informations sur la santé et regroupé le nombre total d'accouchements par voie basse et par césarienne en cinq catégories d'établissement: hôpitaux relevant du ministère de la Santé, hôpitaux publics, hôpitaux relevant de l'assurance liée à l'emploi public, hôpitaux militaires et autres établissements. Les taux d'accouchements ont été calculés pour chaque catégorie à l'échelle nationale et pour chaque État. En moyenne, 2 114 630 (intervalle de confiance, IC, à 95%: 2 061 487-2 167 773) naissances vivantes ont eu lieu chaque année entre 2008 et 2017 à l'échelle nationale. Parmi ces naissances, 53,5% (1 130 570; IC à 95%: 1 108 068-1 153 072) étaient des accouchements par voie basse, et 45,3% (957 105; IC à 95%: 922 936-991 274) étaient des accouchements par césarienne, avec peu de variations dans le temps. Au cours de la période étudiée, le nombre de naissances vivantes a augmenté de 4,4% (de 1 978 380 à 2 064 507). Le taux d'accouchements par voie basse est passé de 54,8% (1 083 331/1 978 380) à 52,9% (1 091 958/2 064 507), ce qui correspond à une diminution relative du taux de 3,5%. Le taux d'accouchements par césarienne est passé de 43,9% (869 018/1 978 380) à 45,5% (940 206/2 064 507), ce qui correspond à une augmentation relative du taux de 3,7%. Le changement le plus important concernant les taux d'accouchements a été constaté dans les hôpitaux du secteur privé. Depuis 2014, les taux d'accouchements par césarienne ont légèrement diminué dans tous les secteurs, mais demeurent élevés (45,5%). Des politiques et des interventions appropriées sont nécessaires pour réduire le taux d'accouchements par césarienne aux Mexique, en particulier dans les hôpitaux de secteur privé.

Las tasas de parto por cesárea en México están entre las más altas del mundo. Dada la creciente concienciación pública y profesional sobre este problema y las directrices nacionales actualizadas de 2014 para reducir la frecuencia de los partos por cesárea, se analizaron las tendencias de los partos por cesárea según el tipo de establecimiento en México entre 2008 y 2017. Se obtuvieron datos de los certificados de nacimiento de la Dirección General de Información Sanitaria de México y se agrupó el número total de partos vaginales y por cesárea en cinco categorías de establecimientos: hospitales del ministerio de salud pública, hospitales privados, hospitales gubernamentales para asegurados por empleo, hospitales militares y otras instalaciones. Se calcularon los índices de partos para cada categoría a nivel nacional y según cada estado. De media, 2 114 630 (intervalo de confianza, IC, del 95 %: 2 061 487­2 167 773) nacimientos vivos se produjeron a nivel nacional al año entre 2008 y 2017. De estos nacimientos, el 53,5 % (1 130 570; IC del 95 %: 1 108 068­1 153 072) fueron partos vaginales y el 45,3 % (957 105; IC del 95 %: 922 936­991 274) fueron partos por cesárea, con poca variación a lo largo del tiempo. Durante el periodo de estudio, el número de nacidos vivos aumentó un 4,4 % (de 1 978 380 a 2 064 507). La tasa de partos vaginales disminuyó del 54,8 % (1 083 331/1 978 380) al 52,9 % (1 091 958/2 064 507), lo que supone una disminución porcentual relativa de la tasa del 3,5 %. La tasa de partos por cesárea aumentó del 43,9 % (869 018/1 978 380) al 45,5 % (940 206/2 064 507), lo que representa un aumento porcentual relativo de la tasa del 3,7 %. El mayor cambio en las tasas de partos se produjo en los hospitales del sector privado. Desde 2014, las tasas de parto por cesárea se han reducido ligeramente en todos los sectores, pero siguen siendo elevadas (45,5 %). Se necesitan políticas con intervenciones apropiadas para reducir la tasa de partos por cesárea en México, especialmente en los hospitales del sector privado.

[Dienogest usefulness in pelvic pain due to endometriosis. A meta-analysis of its effectiveness]. / Evaluación de dienogest en el tratamiento del dolor pélvico asociado a la endometriosis. Un metaanálisis de su efectividad.

BACKGROUND: Endometriosis is the presence of functional endometrial tissue in the pelvic peritoneum and it affects several age groups. That is why the impact of endometriosis in quality of life is considerable. The objective of this study was to evaluate the effectiveness of dienogest in patients with pelvic pain associated to endometriosis (PPAE). METHODS: The evaluation of the effectiveness was carried out through a systematic review using the Cochrane methodology. It was used Markov model, which considers two states of health (with and without PPAE), with the possibility of weekly transition. Women between 18 and 45 years with PPAE were included, in a temporary horizon of 26 weeks. A level of statistical significance of 95% was used for a p < 0.05, with a multivariate probabilistic analysis of sensibility, as well as a univariate analysis of sensibility in several scenarios. RESULTS: The probability that the female patient did not experience PPAE with the initial treatment was 87.91% with dienogest, 80.07% with danazol, 84.93% with medroxyprogesterone (injectable and oral) and 89.17% with gosereline. The probability that the female patient abandoned her initial treatment was 9% with dienogest, 12.07% with danazol, 9.6 and 6.75% with medroxyprogesterone injectable and oral, respectively, and 10.8 and 3.6% 3-monthly and monthly with gosereline. CONCLUSION: Compared to danazol, medroxiprogesterone and gosereline, dienogest is the most efficient alternative to treat PPAE.

Introducción: La endometriosis es la presencia de tejido endometrial funcional en el peritoneo pélvico y afecta a varios grupos de edad, por lo que su impacto en la calidad de vida es considerable. El objetivo fue evaluar la efectividad del dienogest en pacientes con dolor pélvico asociado a endometriosis (DPAE), al compararlo con danazol, medroxiprogesterona y goserelina. Métodos: se hizo una revisión sistemática de la literatura con la metodología Cochrane. Se usó el modelo de Markov, que considera dos estados de salud: con y sin DPAE, con posibilidad de transición semanal. Se consideraron mujeres entre 18 y 45 años con DPAE, en un horizonte de 26 semanas; se utilizó un nivel de significación estadística de 95% (p < 0.05), con un análisis probabilístico multivariante de sensibilidad y uno univariante de sensibilidad en varios escenarios. Resultados: la probabilidad de que la mujer se encontrara sin DPAE con el tratamiento inicial fue de 87.91% para dienogest, 80.07% para danazol, 84.93% para medroxiprogesterona inyectable y oral y 89.17% para goserelina; la probabilidad de que la mujer abandonara su tratamiento inicial fue de 9% para dienogest, 12.07% para danazol, 9.6 y 6.75% para medroxiprogesterona inyectable y oral, respectivamente, y 10.8 y 3.6% para goserelina trimestral y mensual, respectivamente. Conclusiones: Comparado con el danazol, la medroxiprogesterona y la goserelina, el dienogest es la alternativa más eficiente para el DPAE.

[Clinical practice guideline. Diagnosis and treatment of postmenopausal and perinemopausia]. / Guía de práctica clínica. Diagnóstico y tratamiento de la perimenopausia y la posmenopausia.

Post-menopause is the period of life where a deep decline occurs in circulating estrogen levels, inducing the appearance of psycho and somatic symptoms. The classification to understand the chronology of reproductive aging in women (known as STRAW) determines the clinical and endocrine changes contemplating menstrual cycles, symptoms, measurements of FSH, LH, inhibin B, anti-Mullerian hormone , and follicular account. The diagnosis of menopause is established by the absence of menstruation for 12 months or more. The most frequent clinical manifestations of the climacteric syndrome transition to menopause are menstrual disorders, vasomotor symptoms (flushes and/or sweats) and genitourinary manifestations. The assessment of women in the peri- or postmenopause aims to develop: cervicovaginal cytology , lipid profile , serum glucose, basal Mammography at least a year before, pelvic ultrasound, urinalysis, serum TSH, Densitometry in patients older than 60 years if there is no recourse can be applied and FRAX. Drug therapy for the treatment of disorders of the transition to menopause or menopause is divided into: hormone therapy (HT) based estrogens and progestin hormone not being the most recommended the serotonin reuptake inhibitors and norepinephrine, clonidine, gabapentin or veralipride.

La posmenopausia es el periodo de la vida en el que ocurre un profundo descenso en las concentraciones circulantes de estrógenos, lo cual induce la aparición de los síntomas psico y somáticos. La clasificación para entender la cronología del envejecimiento reproductivo en la mujer (reconocida como STRAW) determina los cambios clínicos y endocrinos a partir de examinar los ciclos menstruales, los síntomas, las mediciones de FSH, LH, inhibina B, hormona antimulleriana y la cuenta folicular. El diagnóstico de menopausia se establece por la ausencia de menstruación por 12 meses o más. Las manifestaciones clínicas más frecuentes del síndrome climatérico o transición a la menopausia son los trastornos menstruales, los síntomas vasomotores (bochornos o sudoraciones) y las manifestaciones genitourinarias. La evaluación de la mujer en la peri o la postmenopausia contempla la realización de citología cervicovaginal, perfil de lípidos, glucosa sérica, mastografía basal (por lo menos un año antes), ultrasonido pélvico, examen general de orina, TSH sérica, densitometría (ver la Guía de práctica clínica de osteoporosis) en pacientes mayores de 60 años (y si no se cuenta con el recurso se puede aplicar el FRAX). El tratamiento farmacológico para las alteraciones de la menopausia (o de la transición a esta) se divide en: tratamiento hormonal (TH) con base en estrógenos o progestágenos, y tratamiento no hormonal; los más recomendados son los inhibidores de recaptura de serotonina y norepinefrina, clonidina, gabapentina o veraliprida.

[Usefulness of a clinical questionnaire for screening osteopenia and osteoporosis in post-menopausal women]. / Utilidad de un cuestionario clínico en la detección de osteopenia y osteoporosis en la posmenopausia.

BACKGROUND: The prevalence of osteoporosis in post-menopausal women (PMW) is 30 %, and bone densitometry (BD) is the gold standard. This is not recommended as a screening test because of its cost. Instead, the SCORE index (Simple Calculated Osteoporosis Risk Estimation) is proposed. The objective is to determine the sensitivity and specificity of this test in the population and the optimization of BD. METHODS: The SCORE Index is a pre-screening questionnaire; it was used in PMW to compare with BD, registering the total score of the questionnaire, densitometry diagnosis, the fracture risk and the site of osteoporosis. The sensitivity and specificity of SCORE Index and chi(2) of Mantel-Hanszel were calculated. RESULTS: We studied 201 patients, mean age 55.70 years. Osteoporosis was recognized in 22.8 %, osteopenia in 68.3 % and 8.9 % was normal. The sensitivity of the SCORE index was 87 % (95 % CI = 77-97) and specificity was 34.6 % (95 % CI = 27-42) with p = 0.000. A positive probability quotient of 1.33 (95 % CI = 1.1-1.7). CONCLUSIONS: Osteoporosis is a frequent disease in PMW. It is mandatory to have cheap and easy-tools which can detect osteoporosis cases.

[Clinical aptitude of residents that attend patients with the cervical intraepithelial neoplasia]. / Aptitud clínica de médicos residentes en la atención de pacientes con neoplasia intraepitelial cervical.

OBJECTIVE: To build, validate and apply an instrument to evaluate the clinical aptitude in intraepitelial cervical neoplasia (ICN) in residents. METHODS: The instrument included four clinical real cases, validated by experts and included 106 items using true, false and don't know answers. A pilot test and the 21 Kuder-Richardson formula were used to estimate consistency. It was applied to residents, in an observational, transversal, comparative and open study, including 11 second year residents, 13 third year residents and 12 fourth year residents. RESULTS: Consistency of 0.88 was obtained; 22% were located in the middle level, 39% were located in the low level and 39% in the very low level. There were no residents in the high or very high level or by chance answer level. The Kruskal-Wallis test showed significant differences among the three groups and with the U test of Mann Whitney there were no differences between groups. CONCLUSIONS: The year of residence did not show differences in the development of clinical aptitude in ICN. Most of the residents were located in the inferior level of clinical aptitude. This study makes evident the need to reframe our educative processes in a qualitative different manner.

[Abdominal pregnancy care. Case report]. / Atención del embarazo abdominal. Comunicación de un caso.

Abdominal pregnancies are the implantation of gestation in some of the abdominal structures. This kind of pregnancies represents sevenfold maternal death risk than tubarian ectopic pregnancies, and 90-fold death risk than normal ones. Previous cases have erroneously reported as abscess in Douglas punch, and frequently result in obitus or postnatal deaths. We report a case of a patient with 27 years old, and diagnosis of 25.2 weeks of pregnancy, prior placenta and anhidramnios, referred due to difficult in uterine contour delimitation, easy palpation of fetal parts, cephalic pole in left hypochondrious and presence of mass in hypogastria, no delimitations, pain with mobilization, no transvaginal bleed and fetal movements. Interruption of pregnancy is decided by virtue of severe oligohidramnios, retardation in fetal intrabdominal growth, and recurrent maternal abdominal pain. Surgical intervention was carried out for resolution of the obstetrical event, in which was found ectopic abdominal pregnancy with bed placental in right uterine horn that corresponded to a pregnancy of 30 weeks of gestation. Abdominal pregnancy is still a challenge for obstetrics due to its diagnosis and treatment. Early diagnosis is oriented to prevent an intrabdominal hemorrhage that is the main maternal cause of mortality.

[Mesenteric cyst. A case report]. / Quiste mesentérico. Informe de un caso.

Mesenteric cysts are rare, it had been reported a frequency of 1 in 250,000 hospital admissions. We present a case of a 17-year-old female, attended at gynecology service with 8 weeks amenorrhea and diffuse pain in all abdominal regions. Without preceding pathological history of importance, menarche at 14 year, menstrual cycles of 30-45 x 5, nuligesta. She had negative immunology pregnancy tests, and sonography showed left ovary with anecoique ovoid area of approximately 15 x 8.8 x 7 cm. Physical examination showed a soft abdomen, depressible, with pain on the left side, where presence of a tumor of approximately 8 cm was perceived. Vaginal examination showed cervix of 3 x 2 cm, not painful to mobilization, uterus in a head position of 6 x 5 x 4 cm, a tumor of 18 x 10 cm was delimited in left salpinge, not painful to the compressedness. It was carried out a laparotomy with diagnostic of cyst in left ovary, but it was a tumor of 18 x 14 x 10 cm of cyst aspect that was dependented of mesenterious at sigmoid colon level, which could be eradicated without difficulty. Mesenteric tumors are difficult for diagnosis, and can be asymptomatic or to be suspect as cause of recurrent abdominal pain, abdominal tumor or acute abdomen. Unfortunately, it is difficult to establish the diagnosis with precision before surgery, still employing diagnostic resources of high technology, as sonography and tomography.

[Elaboration and validation of an index for preeclampsia diagnosis]. / Elaboración y validación de un indice para el diagnóstico de preeclampsia.

OBJECTIVE: To build a consistent and valid preeclampsia diagnosis index (IDP) for its Spanish acronyms. PATIENTS AND METHOD: The study was done in a Gyneco-Obstetrics Hospital and a Family Medicine Unit from March 2000 to February 2001. Fifty items were chosen from the literature, with a design to validate diagnostic tests, which were assessed by family doctors and gyneco-obstetricians in regard to their appearance and content validity. Concurrent criterion validity. Golden standard: Two gyneco-obstetricians diagnosed pre-eclampsia (hypertension and proteinuria). Simultaneously a family doctor (in an independent and blinded way) questioned, examined and recorded laboratory data of 219 preeclamptic patients and 251 non preeclamptic patients. RESULTS: Preeclampsia diagnosis index is an additive index with 21 clinical and paraclinical parameters weighted according to their individual diagnostic capacity. It has two parts: The first one with 82% (95%CI 80-84) sensitivity; 93% (95%CI 91-95) specificity; the second one with 86% (95%CI 83-89) sensitivity; 75% (95%CI 65-85) specificity. CONCLUSIONS: Preeclampsia diagnosis index is easily applied and has immediate results, which makes easier the physician's decisions.

[Analysis of trends in maternal mortality during a 10 year-follow up in a urban region]. / Análisis de la tendencia de mortalidad materna durante 10 años de seguimiento en una región urbana.

BACKGROUND: Maternal mortality is considered a worldwide health problem, since the WHO has estimated that there are 500,000 maternal deaths annually and that the highest percentage of these deaths occurs in developed countries. It was not until 1970 that this problem became important, by revising the birth's registrations and the maternal causes of morbidity and mortality, and that the mortality committees study began. OBJECTIVE: To determine the epidemiological profile and the trend of the maternal mortality in a urban hospital. MATERIAL AND METHODS: This retrospective and descriptive study was carried out at the Reproductive Health Coordination of the Centro Medico Nacional La Raza, through the registrations of the maternal deaths reported from 1993 to 2002 by the local committees of maternal mortality. Maternal mortality was defined as an event occurred during pregnancy or within 42 days after delivery, by any associated cause and aggravated by the same pregnancy. We used analytic and descriptive statistics, with central trend measurements, as well as chi square test. RESULTS: During the 10 years of analysis, 244 deaths were shown, with mean per year of 24.4 +/- 5.2 deaths. Preeclampsia-eclampsia, hypovolemia and sepsis represented 71.7% of the cases. The highest number of deaths ranged from 30 to 34 years, with 64 deaths. Women with the first pregnancy had the highest number of deaths, with incidence of one maternal death for each 664.7 +/- 135.6 new born in each year. DISCUSSION: The main maternal deaths per year corresponded to direct obstetric causes, with percentages from 53.3 to 86.9% annually, where preeclampsia-eclampsia syndrome maintains these high percentages, with a death average within the international standard parameters considered adequate.

[Incidence of infected surgical wound and prophylaxis with cefotaxime in cesarean section]. / Incidencia de herida quirúirgica infectada y profilaxis con cefotaxima en cesárea.

BACKGROUND: Surgical wound infection after cesarean section varies from 2.5 to 16.1%, thus the utilization of antibiotic prophylaxis has increased routinely and irrationally. Despite this, we can still see cases of infections. OBJECTIVE: To determine if the antibiotic prophylaxis with cefotaxime is associated with the decreased incidence of wound infection in patients submitted to cesarean section without risk factors. PATIENTS AND METHODS: This study was carried out as a randomized clinical trial in patients submitted to cesarean section. Two groups were formed: in the first group we administered cefotaxime and the other one did not receive prophylaxis. The follow-up lasted 30 days to evaluate clinical data of infection. RESULTS: We performed 3,300 cesarean in the studied period; 1,000 patients had the inclusion criteria to participate in the study. A surgical wound infection was observed in 31 (0.96%) patients without risk factors. In 14 of these patients we administered cefotaxime, and in 17 patients we did not use prophylaxis. The highest frequency of infection was observed in the group of 24 to 30 years old, with 16 patients (51.6%). The clinical data of infection were: dehiscence in 29 patients (93.5%), pus secretion in 23 (74.2%), and fever in only 3 (9.7%) of them. The hospital stay after the infection was of five days in 75% of the cases. When the use of cefotaxime as prophylaxis was analyzed in both groups we had an odds ratio of 0.82, which was not significant. DISCUSSION: The use of cefotaxime in patients operated of cesarean does not have great transcendence since it does not reduce the infection incidence. The use of antibiotics in an irrational way implies a high cost, since the majority of the post-operation infections are not complicated, involving exclusively the skin and cellular subcutaneous tissue. Then, the cases with risk factors should be analyzed carefully for the cefotaxime administration.

[Hormonal replacement therapy and breast cancer. A case-control study]. / Terapia de reemplazo hormonal y cáncer de mama. Estudio de casos y controles.

AIMS: Breast cancer is the second more frequently neoplasia in the woman and the first cause of mortality after 35 years old. It is considered a multifactorial illness, since is influenced for genetic, dietary and endocrine factors. Among these, hormonal replacement therapy (HRT) have been assigned benefits effect, as well as risks to increase the breast cancer incidence, because presence of estrogens receptor in the neoplasia cells makes think that the estrogens and other sexual hormones constitute a factor promoter of this cancer. OBJECTIVE: The objective of this study was to determine the association of HRT as risk factor in the incidence of breast cancer, in women from oncology-gynecological service. PATIENTS AND METHOD: Was carried out this descriptive study in patients that used HRT, considering as cases patients with breast cancer confirmed by hystophatological study and controls the patients without breast cancer. To statistical analysis took mean occurrence using the momios reason (MM), with confidence interval of 95% (CI), and chi2 test of Mantel-Haenszel, for a significant value of p < 0.05. RESULTS: Were included successively 250 patients, in 100 of these were confirmed diagnosis of breast cancer, 60 patients (37.5%) used HRT with mean of 3 years and 40 patients (44.4%) did not use HRT (Cases), the other 150 patients did not have breast cancer, 100 of these used HRT and 50 patients did not use HRT (Control). The statistical analysis showed that the HRT had a MM 0.75 (IC 95% 0.62-1.15) p=0.28, the maternal nursing with MM 0.68 (IC 95% 0.59-1.08) p=0.05, the multiparity with MM 0.42 (IC 95% 0.16-1.87) p=0.26, obesity MM 1.67 (IC 95% 0.99-1.54) p=0.05, familial history with MM 1.23 (IC 95% 0.83-1.54) p=0.05. CONCLUSIONS: These results show that does not exist a direct association between HRT and breast cancer. Therefore, whenever takes the decision to use the HRT should be considered the possible risks and benefits individualizing the patient, also the mammography should be present in mind, same that frequent physical examination, autoexploration and the use of HRT smaller to 5 years.

[Survival of breast cancer patients treated with inhibitors of the aromatase vs tamoxifen]. / Supervivencia de pacientes con cáncer de mama tratadas con inhibidores de la aromatización vs tamoxifeno.

BACKGROUND: In Mexico the breast cancer occupies the second place as cause of death by oncological illness and the etiology is considered multifactorial. The systemic treatment of this cancer is necessarily after the surgery and simultaneously when radiotherapy is used; therefore the recent introduction of newly non toxics and efficient antiestrogens which block the effect of estrogens from circulation have become drugs of first line in the metastasis illness. OBJECTIVE: To compare the clinical evolution and the survival of patients with locally advanced breast cancer and metastasis with the use of two therapeutic modalities. MATERIAL AND METHODS: Under informed consent 20 patients with diagnosis of breast cancer and out of oncological therapeutic processing were included. Randomly an inhibitor of the aromatase (anastrozole, 1 mg for day) was used in 10 patients and in the other 10 patients tamoxifen (20 mg for day) both for 2 years, subject to verification of positive estrogens-progesterone receptors. RESULTS: Half of the patients of each group had a clinical stage III. The most frequent histological diagnosis was the ductal carcinoma in 70% of the group with tamoxifen use, while in anastrozole group was 90%; the mastectomy prior to the tamoxifen was carried out in 60% of the patients and in 50% of the group with anastrozole. The acceptable response to the processing in the patients with tamoxifen was complete in the 60% of the cases, but with the use of anastrozole was 80%; survival in the group with anastrozole was of 100% in two years of follow up, while in women that received tamoxifen the survival was 90% (p<0.001). CONCLUSIONS: The use of anastrozole improved the survival as well as the quality of life, showing no side effects in this group of patients.

[Clinical experience with chemotherapy of the malignant tumor of germinal cells (dysgerminoma) of the ovary]. / Experiencia clínica con el tratamiento a base de quimioterapia del tumor maligno de células germinales (disgerminoma) del ovario.

OBJECTIVE: To evaluate two alternative plans of chemotherapy with EP (etoposide, platinum) and BEP (bleomycin, etoposide, platinum) after oncological surgery. MATERIAL AND METHODS: A clinical, longitudinal and descriptive study was done, where the cases with pure dysgerminoma diagnosed in the gynecology-oncology service during the years from 1992 to 2003 were included. Information was recollected in a precoding survey that included sociodemographic characteristics, tumor size, free survival of disease, general survival, recurrence index and the index of fertility. RESULTS: The age of the group studied was of 22.1 +/- 6.5 years, with stratification to 9 patients in phase I (50%), phase III in 7 patients (38.9%) and phase IV in 2 patients (11.1%). Histological study confirmed the pure dysgerminoma, with a mean duration of the symptoms of 5.2 months, the free survival of disease was of 39.6 months and general survival was of 49.5 months. It was administered early chemotherapy in 11 patients, from which 7 received EP and the other 4 received BEP. Eight patients were found in advanced phases and with metastasis. There were 4 (22.2%) recurrences, of which 3 corresponded to phase III and a case to phase IV with tumors all of them over 15 cm. There were 3 patients rescued with chemotherapy of second line and a patient with radiotherapy to central nervous system. The statistical analysis showed that size of tumor among the recurrent group (24.2 cm) and the group without recurrence (14.5 cm) had significant differences (p = 0.018), the size of the tumor and the free survival of disease did not have significant correlation (p = 0.99), but upon comparing the general survival with the phase of the disease, a significant correlation was found (p = 0.03), where the survival to 5 years was observed in 6 cases (33.3%), of which a case was treated with surgery and without chemotherapy, 4 cases with EP and a case with BEP. Out of the 11 cases treated with conservative surgery, two patients got pregnancy in three occasions.

[Is the high frequency of Caesarean sections in a highly specialized gyneco-obstetric hospital justifiable?]. / Se justifica la alta frecuencia de la cesárea en un Hospital Gineco-Obstétrico de alta especialidad?

OBJECTIVE: To determine if the high proportion of cesarean section performed at Obstetrics and Gynecology number 3 Hospital of the Medical Center "La Raza", IMSS (HGO3) is justified. MATERIAL AND METHODS: We carried out a cross sectional study of 300 patients who underwent cesarean section during a period of 35 consecutive days, from October to November 2001. We reviewed their clinical expedients and went to additional direct interrogatory. The studied variables were the number and indications of cesarean section; if they were programmed or urgent events and if the indication of surgery was related with perinatal outcome. RESULTS: We used descriptive statistics with frequencies and percentages in statistics program SPSS10. We found high incidence of prematurity (38.3%), pregestational and gestational maternal diseases (66%) and urgent indication of surgery (60.7%). CONCLUSION: The incidence of cesarean section in similar third level concentration hospitals in this country ranks from 20 to 40%. At HGO3 it was 72.51% in the last year (2001). This suggests that pregnancy comorbidity seen at this hospital, may be proportionally larger than in other similar units, because two thirds of patients had a high risk pregnancy and, if not, they had an obstetric or fetal justification for cesarean section in 80% of cases.