Location and removal of non-palpable subdermal single-rod contraceptive implant.

OBJECTIVE: The objective of the study was to present the experience of the family planning service Hospital General de México, in locating and removing no palpable subdermal single-rod contraceptive implants. MATERIALS AND METHODS: A descriptive, prospective, and cross-sectional study was performed from January 2011 to April 2018. RESULTS: Hundred and sixty-four patients in whom the implant was not palpable were reviewed, the time between insertion and removal averaged 3.3 years (maximum 10 years and minimum 3 months). Three implants were inserted in the right arm, the rest on the left one. Forty-seven implants were found in fatty tissue (29%), 18 in fascia (11%), 94 in muscle (57%), 2 in the armpit (1.2%), and 3 were not found (1.8%). CONCLUSIONS: The no palpable implant is caused by an incorrect insertion technique. Migration should not be assumed as a cause of difficult location. Amount of non-palpable implants is not possible to determine due to a lack of records, but approximately 3% are considered non-palpable. Ultrasound has proven to be the study of choice to locate an incorrect inserted implant. In this case, the total number of implants was located, except in two patients.

OBJETIVO: Presentar la experiencia del servicio de planificación familiar del Hospital General de México Dr. Eduardo Liceaga en la localización y la extracción de implantes anticonceptivos subdérmicos no palpables. MATERIALS Y MÉTODOS: Estudio clínico descriptivo, prospectivo y transversal, realizado desde enero de 2011 hasta abril de 2018 en el servicio de planificación familiar del Hospital General de México Dr. Eduardo Liceaga. RESULTADOS: Se incluyeron 164 pacientes con implantes no palpables, de los cuales 161 se localizaron por ultrasonido. El promedio entre la inserción y el retiro fue de 3.3 años. Tres implantes fueron insertados en el brazo derecho y el resto en el izquierdo; tres no se encontraron. CONCLUSIÓN: Por su fácil acceso y simplicidad, el ultrasonido es el método de elección para localizar implantes profundos no palpables.

[Cervical lymphangioma in the adult. A report of 2 cases]. / Linfangioma de cuello en el adulto. Reporte de 2 casos.

BACKGROUND: Cervical lymphangiomas are uncommon benign congenital malformations usually present in children, and are rare in adults. Currently, complete resection is still the standard care. Two cases are presented of a cervical lymphangioma in an adult. The diagnosis and surgical approach is also discussed. CLINICAL CASE: Case 1. The first case is a 23 year old male with chief complaint of a tumour in the posterior triangle of the neck, which showed a substantial increase in size in the last 9 months. No associated signs or symptoms, or any trauma history was reported. CT scan of the neck showed images suggestive of a posterior cervical lymphangioma. Exploratory cervical surgery was performed, with complete resection of a cystic tumour located in the posterior triangle of the neck. Surgery was performed without complications and postoperative care was unremarkable. CASE 2: The second case is a 28 woman with a cystic tumour in submandibular space. She had history of a previous incomplete operation in another institution 2 years ago, with recurrence of the tumour. A second surgery was performed with complete resection without complications, and with a good outcome. CONCLUSIONS: Cervical lymphangioma is a very rare benign disease, surgical treatment is preferred, but sclerotherapy can be used as alternative treatment.

[Contraception and breast feeding. Spacing of pregnancies. Present concepts]. / Anticoncepción y lactancia. Espaciamiento de los embarazos. Conceptos actuales.

The risk of pregnancy in breastfeeding should be a concern of women. Family planning programs in the postnatal period contraceptive choices offer high efficiency. Breastfeeding is a natural contraception method (LAM) as a contraceptive shield has 98 % efficiency. Women should consider using an alternate contraceptive method when feeding requirements for this method to be effective are not met. Some of contraceptive alternatives in lactation include hormonal methods. According to the Medical Eligibility Criteria for Contraceptive Use WHO combined hormonal methods are contraindicated during breast feeding, hormonal progestogen only method are considered only in Group 3 and Group 1 immediate postpartum after 6 weeks postpartum. There are modifications to these criteria by the CDC and the UK for the use of these hormones in early in lactation.

Complex localization of single-rod contraceptive implant. Report of two clinical cases.

BACKGROUND: The subdermal single-rod contraceptive implant is used by more than one million women worldwide. In México there are ~ 600,000 colocated implants. Cases of complex implant localization caused by a deep insertion procedure have been reported. CLINICAL CASES: Two clinical cases of implant with complex localization are presented. Case 1: we present a 21-year-old female. After the insertion procedure during the 12-, 24-, and 36-month revisions, the implant could not be located. Case 2: we present a 28-year-old female with subdermal single-rod contraceptive implant co-located in the external side of the left arm, partially palpable on the extreme distal area. Transverse cut of ultrasound showed the extreme distal area of the implant at 6 and 7 cm, respectively, at the site of insertion (scar). CONCLUSIONS: Due to simplicity and accessibility, ultrasound is the selected method for identifying deep nonpalpable implants.

Candida glabrata: an emergent opportunist in vulvovaginitis.

BACKGROUND: Candida genus has various species. The incidence of C. glabrata has presented itself with more frequency over the past years with clinical importance. METHODS: A case study was made to determine the frequency of C. glabrata in 468 patients who presented clinical symptomatology for vulvovaginal candidiasis and the in vitro response for fluconazole using two methods: diffusion in agar plates and microdilution in liquid medium [NCLSI (NCCLS) method]. RESULTS: The frequency for this specie was 12.6%, almost double the frequency observed 10 years ago. The resistance of C. glabrata to fluconazole treatment was confirmed in this study, representing 68.2% resistance in all strains on test plates and 51.2% on NCLSI method with a MIC of 16 microg/ml. CONCLUSIONS: The frequency of Candida glabrata has increased over the past years. It presents resistance to usual treatments, which promotes the persistence and recurrence of genital and systemic infections.

[Systemic lupus erythematous and pregnancy]. / Lupus eritematoso sistémico y embarazo.

OBJECTIVE: To determine the obstetrics outcomes of patients with systemic lupus erythematosus and pregnancy. MATERIALS AND METHODS: A retrospective, analytic, and descriptive case of study is presented about of the obstetrics outcomes of patients with systemic lupus erythematosus and pregnancy attended in Hospital General de Mexico Obstetrics and Gynecology Service from June, 2000 to February, 2003. RESULTS: Thirty-six records were reviewed. The mean age was 28 years. The most frequent maternal complications were the hypertensive disorders in association with pregnancy (27.5%). One patient had antiphospholipid syndrome, showed HELLP syndrome I and brain hemorrhage, she died in puerperium period. The main resolution of pregnancy was normal delivery. The median gestational age at delivery was 36 weeks (range of 24-40 weeks), and the mean birth weight was 2,389 g, median Apgar scores were 7 and 8 at 1 and 5 minutes of life respectively. There were 19 cases of low weight at birth and 7 preterm deliveries. There were no cases of neonatal lupus. CONCLUSION: The maternal-fetal morbid-mortality rates decrease when no lupic disease activity is reported. During the pregnancy stage, preterm delivery and intrauterine growth retardation grow in number as observed in all the study subjects. All pregnancies should still be considered high risk and be managed with a multidisciplinary team. Co-existing antiphospholipid syndrome is the poorer prognosis for pregnancy outcome.

Eficacia y seguridad de ciclopirox olamina en crema vaginal al 1 por ciento contra terconazol en crema vaginal al 0.8 por ciento en el tratamiento de candidiasis genital / Ciclopirox olamine 1 percent cream versus terconazole 0.8 percent cream effectiveness and safety in genital candidiasis treatment

Se efectuó un estudio multicéntrico comparativo, aleatorio, seleccionando 170 pacientes de 18 años o más, con diagnóstico clínico de candidiasis genital y con cultivo positivo a Candida, los cuales se asignaron aleatoriamente al tratamiento con ciclopirox olamina en crema vaginal al 1 por ciento (85 pacientes) o con terconazol en crema vaginal al 0.8 por ciento (85 pacientes) durante seis días, con el objeto de comparar la eficacia clínica, la eficacia fungicida y la seguridad de ambos tratamientos. Los resultados de la eficacia mixta (clínica y micológica) para ciclopirox olamina fue de cura al final del tratamiento - día siete - en 48 pacientes (62.3 por ciento) y al seguimiento - día 21 - de 42 (55.30 por ciento) y la mejoría al final en 25 pacientes (32.5 por ciento) y en el seguimiento 21 (27.6 por ciento) y para terconazol fue de cura al final en 45 pacientes (61.6 por ciento) y al seguimiento en 39 (57.4 por ciento) y de mejoría al final en 23 (31.5 por ciento) y en el seguimiento, 22 (32.4 por ciento). Se concluye que ambos medicamentos son eficaces y seguros para el tratamiento de candidiasis genital.

Estudio comparativo para evaluar la eficacia y seguridad de metronidazol y secnidazol en presentación de óvulos, para el tratamiento de tricomonisis vaginal / Comparative study to evaluate efficacy and security of metronidazol and secnidazol ovules presentation for the treatment of trichomoniasis

En el presente estudio se incluyeron, tres grupos de 20 mujeres con tricomoniasis demostrada parasitológicamente por exudado vaginal, el grupo A recibió tratamiento con óvulos vaginales con metronidazol por 10 días, el grupo B óvulos de secnidazol por tres días y el grupo C óvulos de secnidazol por siete días. Los resultados mostraron que las manifestaciones clínicas disminuyeron significativamente y la presencia de Trichomonas vaginales desapareció de la cavidad vaginal, por lo tanto se logró curación parasitológica en todos los casos. Se concluyó que son igualmente útiles el metronidazol por 10 días, y el secnidazol por tres o siete días, sin la presencia de efectos adversos