[Mammographic and ultrasonographic BIRADS classification and its correlation with histopathologic findings]. / Clasificación mastográfica y ultrasonográfica del BIRADS y su correlación con los hallazgos histopatológicos.

BACKGROUND: Screening programs for breast cancer include self and clinical examination and Imaging studies to obtain the BIRADS (Breast Imaging Reporting and Data System) grade has been described as an important tool. In México, breast cancer is the leading death cause from malignancy in women and thus an early detection and prompt treatment is an important public health concern OBJECTIVE: To compare the BIRADS classification with histopathological findings and cases of malignancy. METHODS: This is a retrospective, observational and descriptive study about of the correlation between histopathological reports and BIRADS classification. RESULTS: Records of 1551 patients were reviewed, of which only 176 met the inclusion criteria. There was a predominance of fibrocystic condition. 44 patients had cancer, with varying degrees of detection according to each category of the classification where BIRADS 5 corresponded to 100% of the malignant cases. CONCLUSION: Consistent with the results reported by other authors, highlighting some situations like BIRADS 4C (where there was a slight difference compared to literature) and the BIRADS 5 in which a detection of 100% of cases of cancer was achieved.

[Peripartum cardiomyopathy: a case report]. / Miocardiopatía periparto: reporte de un caso.

Background: Peripartum cardiomyopathy also known as cardiomyopathy associated with pregnancy, is rarely a cause of heart failure, it affects pregnant or puerperal women in the first 5 months. Although the first case reported was in 1849, it was recognized until 1930. In 2010 the European Society of Cardiology Working Group on peripartum cardiomyopathy, defined this pathology as an idiopathic cardiomyopathy that affects pregnant women between the third trimester and five months after delivery. Characterized by a left ventricular failure with an ejection fraction of ≤45% and an end-diastolic dimension ≥2.7 cm/m2 , in absence of an identifiable cause of heart failure. Case report: We report a case of a 39-year-old patient, diagnosed with a peripartum cardiomyopathy in the early puerperium, characterized by hypertension, tachycardia, dyspnea and oxygen desaturation. The transesophageal echocardiogram reported heart failure, a hypokinetic left ventricle and a ventricular failure with an ejection fraction <40%. We could not identify an other cause to justify heart failure. Multidisciplinary management was administered successfully. Conclusion: The importance of this article relies in the fact that eripartum cardiomyopathy has a high morbidity and mortality. The impact of this pathology is unknow in our country. Here we establish and discuss the multidisciplinary management held in our hospital with this specific patient in order to improve the prognosis on future occasions.

[Changes in preovulatory molecular relationship between estradiol and progesterone in patients undergoing controlled ovarian hyperstimulation. Can they be used for the evaluation of ovarian reserve?]. / Cambios en la relación molecular preovulatoria entre estradiol y progesterona en pacientes sometidas a hiperestimulación ovárica controlada. Pueden usarse como evaluación de la reserva ovárica?

The objective was to evaluate if the preovulatory molecular ratio between progesterone and estradiol has age-dependent changes in patients undergone controlled ovarian hyperstimulation. Were studied 180 cycles of conventional in vitro fertilization. Patients were divided in three groups: Group 1 (age less than 30 years; n = 40), group 2 (age between 30 and 35 years; n = 82), and group 3 (age between 36 and 40 years; n = 58). Leuprolide acetate was used in all cases. Molecular progesterone/estradiol ratio was calculate with the following formula: [Serum progesterone (ng/mL) x 3180 (SI x 10(3) divided by serum estradiol (pg/mL) x 3.671 (SI)]. In patients with age more than 38.5 years there was positive correlation between preovulatory progesterone and estradiol (R = 0.55, R2 = 0.30). There were significant difference in molecular progesterone/estradiol ratio between group 1 compared to group 2 (P less than 0.001), group 1 compared to group 3 (P less than 0.0001), as soon as group 1 compared to group 2 plus group 3 (P less than 0.0001). It is concluded that molecular progesterone/estradiol ratio decreases before any endocrino evidence of ovarian aging. The value of this putative test of ovarian reserve is discussed.

[Changes in preovulatory molecular progesterone/estradiol ratio in patients treated with controlled ovarian hyperstimulation. Can they be used in the assessment of ovarian reserve?]. / Cambios en la relación molecular preovulatoria entre estradiol y progesterona en pacientes sometidas a hiperestimulación ovárica controlada. Pueden usarse como evaluación de la reserva ovárica?

The objective was to evaluate if the preovulatory molecular ratio between progesterone and estradiol has age-dependent changes in patients undergoing controlled ovarian hyperstimulation. There were 180 cycles of conventional in vitro fertilization which were studied. Patients were divided in three groups: Group 1 (age less than 30 years; n = 40), group 2 (age between 30 and 35 years; n = 82), and group 3 (age between 36 and 40 years; n = 58). Leuprolide acetate was used in all cases. Molecular progesterone/estradiol ratio was calculated with the following formula: [Serum progesterone (ng/mL) x 3180 (Sl x 10(3)) + serum estradiol (pg/mL) x 3.671 (Sl)]. In patients older than 38.5 years there was positive correlation between preovulatory progesterone and estradiol (R = 0.55, R2 = 0.30). There were significant difference in molecular progesterone/estradiol ratio between group 1 compared to group 2 (P less than 0.001), group 1 compared to group 3 (P less than 0.0001), as well as group 1 compared to group 2 plus group 3 (P less than 0.0001). It is concluded that molecular progesterone/estradiol ratio decreases before any endocrine evidence of ovarian aging. The value of this putative test of ovarian reserve is discussed.

[Effect of intrafollicular interleukin-6 levels on the secretion of estradiol and progesterone in patients treated with in vitro fertilization and embryo transfer]. / Efecto de los niveles de interleucina-6 intrafolicular en la secreción de estradiol y progesterona de pacientes tratadas con fertilización in vitro y transferencia de embriones.

The objective was to evaluate the relationship between follicular fluid levels of Interleukin-6 (IL-6) and the seric concentrations of estradiol and progesterone during controlled ovarian hyper-stimulation. The levels of IL-6 were measured in follicular fluid of 15 patients undergone to in vitro fertilization and embryo transfer and correlated with the values of seric estradiol and progesterone. There were a negative correlation between follicular levels of IL-6 and either estradiol and progesterone. Four patients achieved pregnancy following embryo transfer (pregnancy rate 26.6%), one of them aborted. As conclusion, the increased levels of IL-6 may be a reaction to controlled ovarian hyper-stimulation and probably a protective response. According to the reduction of estradiol, there may be a subtle reduction in aromatase action by effect of IL-6 and other cytokines.

[Effect of maternal death on family dynamics and infant survival]. / Efecto de la muerte materna sobre la dinámica familiar y la sobrevivencia infantil.

Family adjustments, which are generated by a maternal death, have been analysed previously in Mexico by using a reduced number of cases in rural areas. This study was design in order to establish changes in family dynamic generated b y a maternal death and to analyse child surviving after one year of birth. Family members of maternal deaths cases, which occurred during 1988-89 in the Federal District, were interviewed by first time in order to know information related to family dynamic and women's characteristics. A second interview was made after one year of birth for cases in which the newborn survived hospital discharge. Simple frequencies were calculated and using X2 test compared groups. Main consequences were family disintegration, child acquiring new roles and economic problems when woman was the main or the only one support of the family. Child surviving was higher than we expected considering other national or international reports. Children were mainly integrated to their grandparent's family.

[Factors related to the recognition of alarm signals during pregnancy]. / Factores relacionados con el reconocimiento de signos de alarma durante el embarazo.

INTRODUCTION: The medical literature has noted the relationship between perinatal morbidity and mortality and cultural factors for more than twenty years. During this time, however, rates of diseases such as hypertension, which complicate pregnancy and delivery, threatened preterm delivery and premature rupture of the membranes have decrease little. These conditions required other, complementary actions such as health education. The purpose of this research was to explore existing knowledge about warning signs during pregnancy in a population using third level medical facilities as the first step in designing an educational program. MATERIAL AND METHODS: We applied a 17 item multiple choice questionnaire regarding alarm sings during pregnancy to a group of 100 pregnant women. The sample was classified into six groups according to the age of the patient and the presence of aggregate risk. The analysis focused on the proportion of correct responses, applying different statistical tests according to the nature of the variables. RESULTS: In stepwise multiple regression, years of education explained 8.1% of the variance of correct responses, the number of pregnancies 5.5%, and gestational age 6.6%. The ANOVA of the complete regression was significant (F = 9.41; df = 99; p < 0.001) with a standard error of 2.23 ans a final adjusted r = 0.45. The number of consultations was positively associated with gestational age but had no relationships with correct responses. Groups with the greatest information deficits were adolescents and patients of adequate reproductive age with low reproductive risk. CONCLUSIONS: Patients with the least obvious alarm signs failed the most items in the alarm sing questionaire. The educational relationship between the physician and the patient should be more carefully explored. We are in agreement with other authors that educational level of patients is a determining to the attitude and knowledge of the population towards its own health.

[Course of pregnancy in patients with known infertility]. / Evolución de los embarazos en pacientes con antecedente de esterilidad.

Two hundred and ninety cases of pregnant patients with antecedents of sterility, were analyzed; 55.8% corresponded to primary sterility and 44.2% to secondary sterility. About cases 38.2% corresponded to endocrine-ovarian factor; 17.9% to tuboperitoneal; 7.4% to cervico-spermatic and 36.5% of undetermined cause. The main complications of pregnancy were: abortion, ectopic pregnancy, twin pregnancy, toxemia, pre-term delivery, placenta previa, and premature detachment of normoinserted placenta. The frequency of such complications, as well as the indexes of perinatal mortality and congenital malformations, were no higher than for general population. However, analyzing separetely the different groups, it was found a notable increase the abortion and twin pregnancy indexes in factor endocrine-ovarian (25.2% and 4.5%). In tuboperitoneal the ectopic pregnancy index was higher (7.5%), and one case of heterotopic pregnancy was found. The global index for cesarean section was 47.2%, increased due to frequent use of elective section (11.2%). It is concluded that currently and because the use of diagnostic technology and surveillance since early phases, the evolution and outcome of pregnancies in women previously sterile are similar to the ones for general population.

[Presentation of a mathematics formula of duplicated times of estradiol predictive for ovular harvesting]. / Presentación de una fórmula matemática de tiempos de duplicación de estradiol pronóstica para captura ovular.

30 patients were studied, that were included in the IVF program of the INPer. The estradiol response was studied and was correlated with the number of retrieved oocytes. The previously known E2 values considered as indicative for cancellation did no were observed in this series, and there are proposed new ones, also prognostic criterion for oocyte retrieval are proposed.

Bacterial vaginosis associated with G vaginallis / Mobiluncus sp: ultrastructural parameters.

PIP: Physicians at the National Institute of Perinatology in Mexico City, Mexico used a Carl-Zeiss EM 10C electron microscope to examine genital secretion samples from 10 pregnant women (15-38 weeks' gestation) who had been diagnosed with Mobiluncus species and Gardnerella vaginalis infections to illustrate the form and structure of bacteria responsible for bacterial vaginosis. They were concerned that these bacteria induce preterm labor and premature rupture of membranes (PL/PROM). These bacteria have been present in the genital tract of 30% of pregnant women with a thick whitish discharge who have attended the Institute's prenatal outpatient clinic. Physicians noted on the microscope slides that bacteria surrounded vaginal squamous epithelial cells (clue cells). Numerous gardnerella-like bacteria surrounded elongated squamous epithelial cells with many plasma projections. An extensive area of lysis existed around the bacteria in the cytoplasm of many squamous epithelial cells with intact membrane and nonexistent microfilaments. This finding indicated that the bacteria invade and destroy the cells. Plasma membrane projections almost completely surrounded the gardnerella-like bacteria in certain areas. Since this study strengthened the theory that G. vaginalis enters the vaginal squamous epithelial cells, researchers should conduct more studies to determine its role in PL/PROM.^ieng

[AIDS and the gynecologist-obstetrician]. / El SIDA y el ginecoobstetra.

After the first case of HIV infection in a pregnant woman in our hospital, we thought on the need to review the medical literature about HIV infection and pregnancy and bring up to date the knowledge of this topic to the obstetricians and neonatologists. HIV infection is caused by a retrovirus. It selectively infects helper/inducer lymphocytes after binding to a glycoprotein receptor on their surface, named CD4. This depletion is slow and gradual, and by time is characterized by the presence of opportunistic infections and some class of tumors. Homosexual men are by now the group most affected by this virus. In Mexico, until August 1988, there were reported 1,628. One hundred forty one of these were women that is 8.6%; that mean that we have a significant female fertile population with an increased risk of perinatal transmission of HIV. The risk calculated to be infected by the HIV for obstetricians and other health care workers is less than 0.5%. However they had to take some measures to avoid contamination with body fluids and blood during the performance of a cesarean section or during delivery. We review briefly the measures that had to be taken by the neonatologist and the obstetrician in the attention of a pregnant woman since the prenatal care until the postpartum period. Among the measures that are reviewed are the use of gloves, gown, mask, glasses and the precautions that had to be taken with the use of sharp instruments during the performance of surgery.