[Utility of transperineal ultrasound in stress urinary incontinence diagnosis]. / Utilidad diagnóstica del ultrasonido transperineal en la incontinencia urinaria de esfuerzo.

BACKGROUND: Urinary incontinence is a common women's illness which causes a significant negative impact in their lives' quality. Stress urinary incontinence and mixed one are the most usual types in postmenopausal women. It is considered that transperineal ultrasound imaging could be as efficient for stress urinary incontinence diagnostic purposes, as the urodynamic testing. OBJECTIVE: To determine the utility of transperineal ultrasound in the diagnosis of stress urinary incontinence in postmenopausal women. MATERIAL AND METHODS: A diagnostic test was applied based on employment of transperineal ultrasound, in postmenopausal women with clinical SUI from January 2001 to October 2008 in the Hospital Español de México. The procedure involved two phases: in the first phase, anatomical measurements were determined using transperineal ultrasound, in order to establish the normalcy in women not suffering stress urinary incontinence, and from them it began the second phase to study the utility of transperineal ultrasound in stress urinary incontinence. RESULTS: The group analyzed involved 80 patients with stress urinary incontinence clinical diagnosis; 15 (19%) patients were excluded. We obtained the following results: sensitivity: 94% (IC 95% 88-100%), specificity 73% (IC 95% 46-99%), positive predictive value: 94% (IC 95% 88-100%), negative predictive value: 73% (IC 95% 46-99%) and positive likelihood ratio 3.46, and negative likelihood ratio 0.08. CONCLUSIONS: Our data suggest that transperineal ultrasound can be use as a screening tool for stress urinary incontinence diagnosis in postmenopausal patients, based on measurements perfoming simple. It is important more studies with bigger sample size to establish the diagnostic utility.

[Laparoscopic cholecystectomy in pregnancy. Five years experience at the Spanish Hospital of Mexico and literature review]. / Colecistectomía laparoscópica en el embarazo. Experiencia de cinco años en el Hospital Español de México y revisión de la bibliografía.

BACKGROUND: Biliary pathology is the second cause of abdominal acute pain during pregnancy. The surgical approach most often used for the treatment of acute cholecystitis during pregnancy is laparoscopy. Some aspects have made this approach during pregnancy controversial. OBJECTIVES: To analyze the maternal-fetal benefits and complications of laparoscopic cholecystectomy during pregnancy and compare these results with the medical literature. MATERIAL AND METHODS: It is a retrospective, transverse study. Laparoscopic cholecystectomy cases and pregnancy from 2005 to 2009 at Hospital Español de Mexico city were reviewed. The following information was obtained: maternal age, gestational age, signs and symptoms, medical department that made the diagnosis, the laparoscopic entry techniques, the monitoring of CO2 for the pressure of pneumoperitoneum, the complications in the peri and postoperatory state, the use of tocolytics medication and other medicines in the hospital stay, maternal and perinatal morbi-morbility, days of hospitable stay, follow-up surgical postintervention in the office. We did a comparation of our results with the medical literature. RESULTS: 10 laparoscopic cholecystectomies were performed. Gestational ages were from 15 to 25 weeks. The incidence was 1:995. All the cases were diagnosed by doctors of the department of general surgery, and also the surgeries. 2/10 patients were in preterm delivery risk at 35 weeks of gestation. There was not any fetal loss or maternal death. CONCLUSIONS: Our results are similar with the literature research, and we confirm that laparoscopic cholecystectomy is a safe therapeutic option for gravid patients, which has minimal fetal-maternal morbidity.

[Placenta previa-accreta: a singular problem. A report of two cases and bibliographic review]. / Placenta previa acreta: un problema singular. Comunicación de dos casos y revisión de la bibliografía.

Placenta previa in women older than 34 years old with previous cesarean section has a high risk to develop placenta accreta/inccreta/perccreta. Such background is frequent nowadays, so placenta previa-accreta is a growing problem. This disease cause hypervascularity in the pelvic floor and increases the risk of placenta penetrating the bladder. For these peculiarities, the maternal morbidity and mortality are higher; besides, hysterectomy produces additional morbidity and mortality. For such reasons, experts explore at present other alternatives to be able to make a better maternal prognosis. In this article we report two cases with placenta previa-accreta, and make a review of medical literature about this topic.