[Transabdominal oocyte retrieval: case report on an IVF cycle]. / Aspiración folicular mediante punción transabdominal: reporte de un caso en fertilización in vitro.

BACKGROUND: Ultrasound-guided transvaginal follicular aspiration is the standard of care in women undergoing oocyte retrieval during vitro fertilization (IVF). When this approach is inaccessible, there are alternative methods to extract the oocytes at the exact moment. One of these alternative options is the transabdominal ultrasound-guided follicular aspiration. We present a case report of a mixed follicular aspiration in a patient with ovaries of difficult access. CASE REPORT: A 36-year-old patient with primary infertility came for medical advice. Because of bilateral tubal occlusion, an in vitro fertilization cycle was started. Transvaginal sonograms revealed a normal left ovary, but the right one was completely attached to the anterior face of the uterus. After ovarian stimulation, transvaginal follicular aspiration was done on the left ovary, meanwhile, on the right ovary; transabdominal follicular aspiration was performed, retrieving 3 oocytes on metaphase II by this technique. Finally, there were no complications during the procedure and the patient got pregnant at the end of the treatment. CONCLUSIONS: Ultrasound-guided transabdominal follicular aspiration, is the safest and most effective technique when transvaginal access to the ovaries is compromised.

[Hormone therapy effect in postmenopausal women with history of endometrial cancer]. / Efecto de la terapia hormonal en mujeres posmenopáusicas con antecedente de cáncer de endometrio.

BACKGROUND: The increase of endometrial cancer survivors' incidence let the question if the management of postmenopausal hormone therapy will increase the risk of carcinogenesis. OBJECTIVE: To determine the recurrence rate, in postmenopausal patients managed with hormonal therapy (HT) compared with patients without HT treated in El Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes. PATIENTS AND METHOD: Retrospective, analytical, historical cohort. We analyzed 29 patients who met the inclusion criteria from January 1, 2000 to December 31, 2008 RESULTS: The average age for diagnosis of endometrial cancer was 45 years. 100% of the patients had surgical treatment (82.8% routine endometrial open approach, laparoscopic 17.2%). The 93% of patients had criteria to begin HT, however, was administered alone to 37% due to medical criteria, 36% received tibolona, 64% received estrogen with an average administration time of 39 and 54 months for each one without affecting disease-free period. Patients who received hormonal therapy had no recurrence of disease-free period of 58 months. There was only one patient with recurrence for which no hormonal therapy was administered. CONCLUSIONS: Patients who were under hormonal therapy did not modify the rate of endometrial cancer recurrence compared with those without HT. Although we cannot conclude irrefutably the safety of hormone therapy, based on biological knowledge and the results of this study, hormone therapy can be safely administered in stage I and II.

[Fetal acardia in a twin pregnancy achieved by in vitro fertilization]. / Acardia fetal en embarazo gemelar logrado por fertilización in vitro.

The frequency of fetal arcadia in the world is 1:35,000 to 1:48,000 pregnancies; is currently estimated that 1% of newborns in developed countries are the result of assisted reproduction techniques and the frequency of twin pregnancies is close to 18%, of these, an estimated relative risk for cardiac defect is 1.6. However, the association of acardiac fetus, twin pregnancy and assisted reproductive techniques is not fully established. In this paper, we describe a case of fetal acardia, in a pregnancy resulting from assisted reproduction and its obstetric care.

[Adnexal tumor and pregnancy: diagnosis and treatment]. / Tumor anexial y embarazo: diagnóstico y tratamiento.

BACKGROUND: The finding of adnexal masses during pregnancy is an exceptional event. Its reported incidence is less than 5% and most cases resolve spontaneously as the pregnancy progresses. OBJECTIVE: Describe a case series of patients with adnexal mass and pregnancy. MATERIAL AND METHODS: We retrospectively reviewed the medical records of patients who had diagnosis of pregnancy and adnexal over a period of five years. RESULTS: The incidence was 0.22%. The mean age was 26 +/- 7.3 years, mean gestational age was 17 +/- 6.6 weeks. The diagnosis was established by ultrasound (USG) in 95% of cases, 48% had cystic characteristics, the mean diameter of the tumor was 99 +/- 42 mm. Cistectomy was performed during pregnancy or trans-cesarean section in 30% and 58% of patients respectably. The mean tumor size was 118 mm (range 2 a 40 mm), weight 1,370 g (range 10 a 5,800 g). The most frequent histological diagnosis were serous cyst (40%), mature teratoma (28%), mucinous (6%), malignancy (4%). There were not complications related to the surgical procedure. CONCLUSIONS: The USG constitute a safe method for the diagnosis, but the image method with the highest positive predictive value is the MRI. Tumor markers (CA-125, AFP, GCH-B,DHL, ACE), are not useful during pregnancy. If the tumor doesn't achieve surgical criteria the recommended follow up is clinical observation and USG. If surgery is decided, it should be performed between 16 a 23 weeks of pregnancy, and it's recommended to send the tumor to histological diagnosis, in case of malignancy the surgery will continue according to the tumor stage. The time and delivery route will be decided by the obstetrician.

[Alpha-fetoprotein as an early predictor of adverse perinatal outcome]. / Alfa fetoproteína como predictor temprano de desenlace perinatal adverso.

BACKGROUND: The alpha-fetoprotein (AFP) is a glycoprotein, which is produced by the human fetus. Previous studies have shown associations between elevated AFP levels and an increased risk of adverse perinatal outcomes. OBJECTIVE: To determine if abnormal AFP levels are associated with adverse perinatal outcomes. The AFP concentrations were calculated as Multiples of the medians (MoM). PATIENTS AND METHOD: A prospective cohort study, including 283 pregnant women, the maternal serum concentration of AFP was determined between 15 and 20 weeks of pregnancy, and the pregnancy was followed until term, when we search for the perinatal outcomes. The study was made in the Instituto Nacional de Perinatología, in Mexico City, from August 2007 to January 2008. For the analyses, the AFP concentrations were calculated as Multiples of the medians (MoM). RESULTS: The threshold of 1.5 MoM increases the risk for preterm delivery (RR: 1.77, IC 95%: 1.04-3.03), abruption placentae (RR: 3.67, IC 95%: 1.59-8.49), placenta accreta (RR: 3.67, IC 95%: 1.59-8.49) and for intrauterine growth restriction (RR: 2.86, IC 95%: 1.74-4.68) There was a weak relation between AFP concentration and birth weight (r = -0.12, p = 0.047) and no correlation with pregnancy weeks at birth. CONCLUSIONS: There is a relation between adverse perinatal outcome and abnormal AFP levels. The evidence of an increase in the AFP concentration in fetuses without congenital defects should alert de clinician about the possibility of other adverse perinatal outcomes and those results must be included in the prenatal risk assessment.

[Impact of male aging in the functional capacity of sperm through the expression of phosphatidyl serine and oligonucleomas]. / Impacto del envejecimiento masculino en la capacidad funcional del espermatozoide a través de la expresión de fosfatidil serina y oligonucleomas.

BACKGROUND: biomolecular processes associated with aging and programmed cell death during spermatogenesis are well known, but not its biological significance in ejaculated sperm, because it ignores the behavior of these apoptotic markers in relation to the age of man. OBJECTIVE: To evaluate the effect of aging on the functional capacity of sperm and their relationship to programmed cell death processes. MATERIAL AND METHODS: Prospective, cross-sectional and analytical performed with semen samples from 25 healthy subjects 20 to 70 years old, were divided into two groups [(A: under 40 years) and (B: over 40 years age)]. Semen parameters were evaluated WHO (1999) and transformation processes biomolecular membrane and the expression of oligonucleosomes in the terminal cascade of apoptosis. Were measured by flow cytometry with an argon laser as a source of reading at 480 nm, the degree of cellularity discriminate negative and positive for each of the indicators. RESULTS: The percentage of live cells with phosphatidylserine translocation in the membrane (annexin-V / PI) was significantly higher in men older than 40 years (p <0.05). These findings are enriched with a significant positive correlation (r = 0.50, P <0.008) between early biomarker and age of the subjects. With regard to DNA fragmentation, although no statistically significant differences were found, it is a clear trend of increase as older the subjects (r = 0.51). CONCLUSIONS: The increasing age of the man is associated with increased expression of apoptosis, as demonstrated by the increased expression of phosphatidylserine translocation at the Membrane. Thus, this study confirms that the subject's age is associated with a decline in some of the seminal parameters.

[Effect of merocianina-540 in the fertilizing capacity of sperm correlated with the expression of 3-OH terminal fragments]. / Efecto de la merocianina-540 en la capacidad fertilizante del espermatozoide correlacionada con la expresión de fragmentos 3-OH terminales.

BACKGROUND: The packaging of heterochromatin during spermatogenesis has been correlated with the expression of residual apoptotic bodies (which stain with merocyanine A) that will impact on sperm function in the fertilization process; as well as the joint expression of the transmembrane translocation phosphatidyl serine and oligonucleosomes. OBJECTIVE: To evaluate the expression of bodies stained with merocyanine in the functional processes of sperm and their level of agreement with apoptotic Annexin V and TUNEL biomarkers. MATERIAL AND METHOD: We performed a prospective, cross, including 11,000 cells belonging to semen samples from infertile men, were evaluated according to WHO criteria (1999), bounded by the lines of Tygerberg. The biomolecular transformation processing of the membrane and the expression of oligonucleosomes in the terminal cascade of apoptosis were quantified by cytometry flow, using an argon lasser as a reading source of 480 nm, discriminating the degree of cellularity, both negative and positive for each indicators. RESULTS: Because of the study design was found low quantification in semen parameters, motility, morphology and sperm concentration. The average expression of cells [DNA-PI(+) / dUTP-FITC(+)] (quantification of TUNEL) and [Annexin-V(+) / PI(-)] was 36.5 +/- 17.4% and 31.2 +/- 17.4%, respectively. By comparing the expression of TUNEL without the effect of M540 bodies (36.3 +/- 1.7% vs. 36 +/- 1.7%) a significant difference was not determined. CONCLUSIONS: This study shows that there is a remnant of the primary processes of spermiation, which can take an important role in apoptotic and functional processes of the sperm. However, its expression does not affect measurement of biomarkers of apoptosis seminal, whose determination changed the diagnosis and functional perception of reproductive parameters in the sperm.

[Phyllodes tumor: institutional experience]. / Tumor phyllodes: experiencia institucional.

BACKGROUND: Phyllodes tumor represents one of the fibroepithelial breast neoplasms that accounts for 0.3% to 1% of the breast tumors. OBJECTIVE: To describe a case series of patients with phyllodes tumor diagnosis. MATERIAL AND METHODS: We retrospectively reviewed the medical records of patients that had confirmed histological phyllodes tumor collected over a period of ten years. RESULTS: The incidence was 0.8%, 12.5% of cases corresponded to malignant phyllodes. The average age was 35 years (range 14-50 years); the most frequent site of localization was the superior and external quadrant of the breast; the average tumoral size by image studies (ultrasound or mastography) and by direct measurement was 61 mm (13-150 mm) and 77 mm (30-300 mm), respectively. One case coexisted with pregnancy. CONCLUSIONS: It is a rare neoplasm, andthe clinician must be aware of its timely diagnosis and treatment, if not some cases will develop breast deformity and some others will be borderline or malignant.