[Iliacus muscle injury caused by inadequate exercise]. / Lesión del músculo ilíaco por ejercicio inadecuado.

BACKGROUND: Traumatic iliacus muscle injury is rare; it is usually caused by trauma or intense exercise involving the pelvic girdle; it can produce a hematoma with femoral nerve neuropathy. Spontaneous muscle hematomas occur in patients with coagulation disorders. CLINICAL CASE: A 45-year-old male with 18 days of evolution, with an intense pain in the right buttock, groin and iliac fossa, with an inability for hip flexion and ambulation caused by inadequate exercise (supine double leg lifts). On the physical examination: intense pain with bending and/or internal rotation of the right hip, positive Thomas maneuver, quadriceps rated 3/5; area of paresthesia in the right femoral nerve territory. Pelvic magnetic resonance imaging showed: right iliacus muscle tear with blood between its fibers. Initial treatment was rest and analgesics for eight days and gradual extension of the hip, axillary crutches with partial weight bearing and diathermy on the right abdominal lower quadrant, active hip exercises, bicycle and right quadriceps strengthening. The evolution was satisfactory, with full recovery in six weeks.

La lesión traumática del músculo ilíaco es rara; generalmente es causada por trauma o ejercicio intenso, que ocasiona hematoma del músculo con neuropatía del nervio femoral como complicación. Los hematomas espontáneos del mismo ocurren en pacientes con trastornos de la coagulación.

Lesión del músculo ilíaco por ejercicio inadecuado / Iliacus muscle injury caused by inadequate exercise

Resumen: Antecedentes: La lesión traumática del músculo ilíaco es rara; generalmente es causada por trauma o ejercicio intenso, que ocasiona hematoma del músculo con neuropatía del nervio femoral como complicación. Los hematomas espontáneos del mismo ocurren en pacientes con trastornos de la coagulación. Caso clínico: Masculino de 45 años con 18 días de evolución, con dolor intenso en la nalga, ingle y fosa ilíaca derechas e incapacidad de realizar flexión de la cadera, originados durante la realización de movimientos repetitivos (flexión de la cadera con elevación bilateral de las extremidades inferiores en posición supina). A la exploración: dolor a la flexión y/o rotación interna de la cadera derecha, maniobra Thomas positiva, cuádriceps con fuerza muscular 2/5; zona de parestesias en el territorio del nervio femoral derecho. La resonancia magnética de pelvis mostró ruptura parcial del músculo ilíaco, con sangre entre sus fibras. El paciente fue tratado con reposo y analgésicos durante ocho días, extensión gradual de la cadera, muletas axilares con apoyo parcial; a los ocho días se inició con diatermia a fosa ilíaca, ejercicios activos asistidos de flexión-extensión de cadera, bicicleta ergométrica y fortalecimiento del cuádriceps. La evolución fue satisfactoria; fue dado de alta asintomático a las seis semanas.

Abstract: Background: Traumatic iliacus muscle injury is rare; it is usually caused by trauma or intense exercise involving the pelvic girdle; it can produce a hematoma with femoral nerve neuropathy. Spontaneous muscle hematomas occur in patients with coagulation disorders. Clinical case: A 45-year-old male with 18 days of evolution, with an intense pain in the right buttock, groin and iliac fossa, with an inability for hip flexion and ambulation caused by inadequate exercise (supine double leg lifts). On the physical examination: intense pain with bending and/or internal rotation of the right hip, positive Thomas maneuver, quadriceps rated 3/5; area of paresthesia in the right femoral nerve territory. Pelvic magnetic resonance imaging showed: right iliacus muscle tear with blood between its fibers. Initial treatment was rest and analgesics for eight days and gradual extension of the hip, axillary crutches with partial weight bearing and diathermy on the right abdominal lower quadrant, active hip exercises, bicycle and right quadriceps strengthening. The evolution was satisfactory, with full recovery in six weeks.

[Cervical pregnancy. Report of a case. Diagnostic and therapeutic considerations]. / Embarazo cervical. Informe de un caso. Consideraciones diagnósticas y terapéuticas.

A patient with cervical pregnancy is reported, in spite of the important bleeding a radical management was not required. Clinical, ultrasonographical and histopathological criteria which are needed for diagnosis are reviewed. Also some management alternatives are discussed.

[Laparoscopic surgery in gynecology. Experience at the Luis Castelazo Ayala Hospital]. / Cirugía ginecológica laparoscópica. Experiencia en el Hospital Luis Castelazo Ayala.

The purpose of the present study was to demonstrate the various applications of the laparoscopic surgery in the field of gynecology. 40 patients who were submitted to laparoscopic surgery were studied and divided into 5 groups accordingly to the surgical procedure: adhesiolysis, surgery of ovarian tumors, hysterectomy, surgery of the Fallopian tube and myomectomy. All the patients had a preoperative study and once completed they were selected for laparoscopic surgery. The laparoscopic procedure was able to solve the gynecologic pathology. The mean overall surgical time was of 66.8 min with a maximum time of 180 and a minimum of 30 min, accordingly to the groups the surgical mean times were as follows: 1) adhesiolysis 111 min 2) ovarian surgery 69 min 3) hysterectomy 113 min 4) tubal surgery 60 min and 5) myomectomy 58 min. There were no surgical complications and they all had a brief hospitalization period and a fast return to active life. All procedures were done with a bipolar cautery. We conclude that laparoscopic surgery is a useful resource for the resolution of the majority of the benign gynecologic pathology and when indicated in the proper way there is no rise in the morbid-mortality, and offers a short hospitalization period and a quick return to active life.

[Modified factors in the study of the infertile couple in women with papilloma virus cervical infection, descriptive analysis]. / Factores alterados en el estudio de la pareja estéril en mujeres con infección cervical por virus del papiloma humano, análisis descriptivo.

The cervical infection by human papilloma virus (HPV) is considered one of the most common sexual transmitted diseases. Fifty couples were studied which consulted for sterility, in all women a cervical HPV infection was detected. Colposcopy, cervical biopsy, vaginal secretions culture, hysterosalpingography, laparoscopy and semen analysis were performed, in all of them. Age, obstetrical history, age at which patients began sexual relations, number of sexual partners, usage and time of usage of intrauterine device were analyzed. We can conclude that patients HPV cervical infection have risk factors for tuboperitoneal sterility, and are also in risk for other sexual transmitted diseases.

[Pregnancy after a partial dearterialization of the uterus. A case report]. / Embarazo post-desarterialización parcial del útero. Informe de un caso.

A case of a 27-year-old woman with a previous partial uterine dearterialization for uterine atony in its first gestation, is presented. This woman asked advise for secondary infertility and after a laparoscopic adhesiolysis she achieved pregnancy. With the exception of tubo-peritoneal factor all other infertility studied factors were normal. Partial uterine dearterialization must be taken in account in patients with obstetric bleeding and posterior fertility expectatives.

[Oocyte maturation and its relation to various components of the follicular fluid]. / Maduración del ovocito y su relación con algunos componentes del líquido folicular.

Thirty five follicular fluid (FF) non hematic samples were analyzed. It were obtained from patients who receive ovulation induction for in vitro fertilization (FIV) and gamete intrafallopian tube transfer (GIFT). The purpose of this retrospective study was to localize one or more markers for the oocyte maturity. The degree of expansion of the oocyte-cumulus-corona radiata complex (COCC), was measured and correlated with the absorbance of the yellow pigment from FF. The scanning spectrophotometry was made in the visible range at 350 to 600 nm. The total amount of protein, estradiol and progesterone were correlated too. Spectrophotometric scan showed four groups: the first one with 20 samples had'n one peak at 413.8 nm. The 45% of this ova were classified as immature by the morphology of the COCC. The second group with seven samples showed one peak at 457.2 nm. All of this oocytes were previously classified as preovulatories. In the next two groups the combination of two peaks were present. The group three with one peak at 416.4 nm and other at 457.9 nm; with one oocyte atretic and two immature. The group four with five samples that showed the first peak at 413.6 nm, and the second peak at 562 nm of maximum absorbance. Two of this ova were classified as atretic and the rest of them like preovulatories. In this study we could not find correlation between the proteins, estradiol and progesterone levels with the morphology of the COCC. In conclusion, spectrophotometric scan of the FF could be of great value for scoring the oocyte mature, mainly in the GIFT.

[The laparoscopic findings in patients with chronic pelvic pain and dysmenorrhea]. / Hallazgos laparoscópicos en pacientes con dolor pélvico crónico y dismenorrea.

Forty-nine laparoscopic findings of women with chronic pelvic pain and dysmenorrhea, were reviewed. In all of them a laparoscopy was performed under general anesthesia. Endometriosis was found as principal cause of the pain, followed by chronic pelvic inflammatory disease and adhesions. In 10.2% of the patients the pelvis was normal. We can conclude that in the patient with chronic pelvic pain, laparoscopy is a useful method to achieve the correct diagnosis to prescribe the most accurate treatment.

[Hysteroscopy in infertility]. / Histeroscopia en infertilidad.

An evaluation of hysteroscopy as complementary study of the sterile couple, was carried out; the hysteroscopic findings were compared with laparoscopic findings, and with Hysterosalpingography (HSG); it was a longitudinal, retrospective study of 20 patients. In the obstetrical antecedents there were 58 gestations, 50 of which ended in abortion. From de five normal cavities by HSG four were for hysteroscopy. As compared with hysteroscopy, HSG detected only 75% of submucous myomas, 85% of walls, 100% of IUD's fragments and of cervical incompetences. In the case of sinechias it was confirmed by hysteroscopy 80% of the diagnosed by HSG. The only case of endometrial polyp was detected by hysteroscopy. Surgical procedures were carried out in 40%, with complications in 16.6%. It was conclude that hysteroscopy is a complementary method, but necessary, in the study of the sterile couple with the possibility at the same time of being a therapeutic method.

[Laparoscopic findings during bilateral tubal obstruction]. / Hallazgos laparoscópicos durante la obstrucción tubaria bilateral.

During the period 1987 to 1990 at Hospital Luis Castelazo Ayala, IMSS, a prospective study was carried out. For this study 374 bilateral tubal obstructions (BTO) were included in interval of gestation by means of laparoscopy with silastic rings. The objective was to observe the status presented by the organs contained in the pelvic cavity of women considered healthy; so, as to present pathology, opportunely treat it. Main findings were: Pelvic adhesions 37 cases (9.8%), uterine myomatosis 33 cases (8.8%), tubal pathology 18 cases (4.8%), ovarian cysts 11 cases (2.9%), and endometriosis 9 cases (2.4%). Global pathology was 108 cases (28.8%). The use of laparoscopy in BTO allows to find non expected pathology in apparently healthy women and offers them the opportunity of receiving treatment immediately, avoiding thus to attribute to BTO symptomatology that could be derived from existing pathology.

Sperm motility improvement: comparison of two methodologies of reproductive techniques.

The objective of this study was to compare two methods for the extraction of high motility sperm; washed semen and swim-up techniques, on 172 ejaculates from 53 patients with suspected infertility. High quality motile sperm had been essential for the success of the assisted reproductive procedures, in which these patients were enrolled. Semen analyses were performed according to the criteria recommended by the WHO. In both methods Ham's F-10 medium plus 7.5% human cord serum were used. The incubations were carried out at 37 degrees C +/- 1. The percentage of motile spermatozoa with forward progression was measured in the fresh sample and after incubation with both methods. The results were analyzed by the two-way analysis of variance. Motility rates were significantly higher in swim-up than fresh samples (mean 41.158%, SD 20.1 vs. 27.572%, SD 16.6; p < 0.0001) and washed semen compared with fresh sample (mean 36.966%, SD 16.3 vs. 27.572% SD 16.6; p < 0.0001).

[Morbidity from bilateral tubal ligation, via laparoscopy]. / Morbilidad de la obstrucción tubaria bilateral, vía laparoscopia.

From January 1, 1987 January 30, 1990, 374 laparoscopic sterilizations using silastic rings (Falope), were carried out. Morbidity and main risk factors, were analyzed. More frequent surgical complications were: mesosalpinx rupture, and fallopian tube rupture in 22 cases (5.8%); abdominal wall emphysema, three cases (0.8%), uterine perforation, two cases (0.5%); other pelvic structures lesions, three cases (0.8%). Morbidity risk factors were: previous abdominal surgery, obesity, salpingitis, use of an uterine mobilizer in a puerperal uterus, and practice of tubal occlusion during the luteal phase of cycle, due to possibility of luteal phase pregnancy; therefore, if a risk factor is present, it is advisable to use other contraceptive technique.

PIP: Between January 1, 1987-January 30, 1990, 374 laparoscopic sterilizations using silastic rings (Falope) were undertaken. Morbidity and major risk factors were analyzed. The most frequent surgical complications were: mesosalpinx rupture and fallopian tube rupture in 22 cases (5.8%); abdominal wall emphysema in 3 cases (0.8%); uterine perforation in 2 cases (0.5%); other pelvic structure lesions in 3 cases (0.8%). Morbidity risk factors were: previous abdominal surgery, obesity, salpingitis, use of a uterine mobilizer in a puerperal uterus, and the practice of tubal occlusion during the luteal hase of the cycle due to the possibility of a luteal phase pregnancy. Therefore, if a risk factor is present, it is advisable to use another contraceptive method. (author's modified)

[The use of clomiphene and menotropins as inducers of multiple follicular growth in a program of in vitro fertilization]. / Empleo de clomifeno y menotropinas como inductores de crecimiento folicular múltiple en un programa de fertilización in vitro.

In our IVF & related techniques program, clomiphene 50 mg was used from days 2 to 6 of the cycle in 20 patients and 20 cycles. (17 IVF patients and 3 GIFT patients) menotropins were also used in 2 different schemes: a) 2 ampules in alternated days (12 cases) and b) one ampule daily (8 cases). The patients with the daily scheme required lesser total dose of menotropins and developed higher estradiol levels, although this had none statistic significance, and they also developed a greater number of follicles. There were 16 laparoscopies for ovum capture and 53 oocytes were retrieved (30.2% mature) 10 oocytes were from the GIFT patients. 16 oocytes were fertilized and 8 cleaved. There was only one pregnancy from and IVF patient with the alternated scheme that ended with a first trimester abortion.

[Clomiphene as an inducer of multiple follicular growth]. / Clomifén como inductor de crecimiento folicular múltiple.

In our IVF + ET & GIFT programs we gave 100 mg of clomiphene from cycle days 2 to 6 in 35 cycles of 32 infertile patients. Serum estradiol curves were made establishing 3 types of curves: 1. climbing curve which was subdivided in curve A (6 cycles) with more than 600 pg/mL of estradiol, more than 4 follicles of a mean size of 35 mm; curve B (13 cycles) with an estradiol range from 300 to 600 pg/mL, 2.9 follicles of 24 mm and curve C with less than 300 pg/mL of estradiol, 0.8 follicles of 22 mm. 2. Flat curve with minimum estradiol level and follicle size and 3. Irregular curve with atypic variations that probably reflect oocyte atresia and cyst formation. The progesterone level in the luteal phase was parallel to the estradiol. There was evidence of multiple follicular growth in 20 cycles (57%). Nine laparoscopies for ovum capture were made, collecting a mean of 1.2 oocytes per laparoscopy; they were fertilized in vitro and later transferred 4 embryos and 4 oocytes were transferred to the fallopian tubes. There was at most one mature oocyte per laparoscopy. No pregnancies were achieved. The clomiphene as a single agent, for its wide availability, might be choice for some women that show a good response, which might depend on several factors, but it cannot be considered the ideal single agent for programs that include ovum pick ups.

[Changes in follicular acid phosphatase levels in relation to oocyte maturity in humans]. / Modificaciones en los niveles de fosfatasa ácida folicular en relación con la madurez ovular en el humano.

The changes in enzymatic activity of acid phosphatase (AP) have an important role in ovulation, and it seems that there is relationship between ovocyte fertilization by spermatozoon. In this study AP enzymatic activity in follicular fluid of 32 patients of fertile age who underwent laparoscopy or laparotomy, was determined. Ovarian follicles were functioned in all the patients, and bloody follicles were discarded, as well as the ones without ovule. The ovule was morphologically classified according to complex ovocyte-cummulus-crown radiated in three groups: immature, mature or pre-ovulatory and atresic or post-ovulatory. AP levels in follicular fluid, containing immature ovocytes (0.5 +/- 0.3 UBL) were significantly lower, p greater than 0.05, than AP levels for follicles with mature ovocytes (3.7 +/- 1.3) and postmature (4.8 +/- 3.2); there were no significant differences for AP values in these last two groups. These findings show that these AP levels could be used as an indicator of follicular immaturity, and to choose the optimal time for follicular punction for the in vitro fertilization and gamet transference procedures.

Laparoscopia abierta. Analisis de 60 casos. / Open laparoscopy. Analysis of 60 cases

Sesenta pacientes las cuales presentaban alguna contraindicacion relativa para efectuar una laparoscopia, como cirugia abdominal previa y obesidad, fueron manejadas con laparoscopia abierta, mediante una tecnica simple, la cual no requiere intrumental especial. La tecnica se efectuo para comprobar la facilidad de ejecucion de la misma en pacientes con cirugia previa y obesidad. Importantes adherencias subincisionales fueron encontradas en el 15.6 por ciento de las pacientes con incisiones abdominales previas. No se apreciaron efectos colaterales de importancia. El tiempo quirurgico para la colocacion de la camisa del laparoscopio asi como la ejecucion del neumoperitoneo y cirugia fue entre 10 y 20 minutos. Las complicaciones observadas despues del procedimiento fueron de tipo infeccioso leve y a nivel de piel en tres pacientes. No hubo ninguna laparoscopia fallida con esta tecnica. La laparoscopia abierta es una tecnica confiable en particular para pacientes obesas y en aquellas con antecedentes de cirugias abdominales previas

[Salpingoclasia by minilaparotomy following spontaneous abortion]. / Salpingoclasia por minilaparotomía postaborto espontáneo.

PIP: 200 cases of bilateral tubal occlusion by minilaparotomy after noninfected spontaneous abortion and 1 year follow-up were reviewed. 45% of the patients had a previous abortion. Tubal occlusion was carried out using the same anesthesia for uterine curettage and Pomeroy's technique. Complications may arise in abortions with an IUD in situ, with failure to use a uterine mobilizer in the intrapelvic uterus, obesity, and lack of experience on the part of the surgeon. There was 1 case of pregnancy which occurred, indicating a 0.5% failure rate. Postabortion sterilization should be included in all family planning programs. (author's)^ieng

Salpingoclasia por minilaparotomia postaborto espontaneo. / Salpingochlasia by minilaparotomy after spontaneous abortion

Se presenta la revision de 200 casos de oclusion tubaria bilateral por minilaparotomia, postaborto espontaneo no infectado, con un seguimiento a un ano. El 45 por ciento de las pacientes tenian la experiencia de un aborto previo. Se encontro util realizar la salpingoclasia aprovechando el mismo tiempo anestesico-quirurgico de el legrado uterino y emplear la tecnica de Pomeroy. Se encontro que pueden ser causa de complicaciones el aborto con DIU in situ, la falta de empleo de un movilizador uterino en uteros intrapelvicos, la obesidad de la paciente y la falta de experiencia del cirujano. Hubo un caso de embarazo lo que implica una falla del 0,5 por ciento.La esterilizacion postaborto debe formar parte importante de los programas de planificacion familiar