Biomedical subjects
Publications and source records attributed to A Kably-Ambe.
It presents three cases of Mullerian anomalies with septate uterus and cervical duplication and longitudinal vaginal septum. There are a few previous cases reported. The cases are discussed and the literature is revised.
The HELLP syndrome is an English acronym, for describing patients with Pregnancy Induced Hypertension (PIH), who also has hemolysis, elevated hepatic enzymes and low platelets, its presence is associated with a frequency of maternal mortality from 5 to 25% and when it is associated with hepatic rupture it increases to 35% and a perinatal one from 30 to 60%. It is present in 2 to 12% among women with PIH. Its etiology has not been elucidated completely, the base of its pathophysiology is an unbalance in prostanoid metabolism which conduces to generalize vasopasm with the subsequent endothelial damage and platelets activation. Sibaí describes the diagnostic parameters of the syndrome. Its initial treatment is the hemodinamic stabilization of the maternal status and the evaluation of fetal well-being for decide whether immediate delivery is indicated. HELLP appears in the puerperium in 30% of the cases. There are both maternal and perinatal severe complications, and a recurrence risk of a 4 to 27%. We emphasize the importance of early detection of the syndrome which improves maternal-fetal prognosis.
The objective was to evaluate the utility of the pure FSH as treatment of women clomiphene-resistant. Seventy two patients clomiphene-resistant were treated with pure FSH. Ovulation induction was started with 75 IU of pure FSH on day 3 of the menstrual cycle, monitoring the follicular growth with transvaginal ultrasonography, additional doses of pure FSH were administered accordingly. Human chorionic gonadotropin (10,000 IU) was administered when the dominant follicle reached a diameter > or = 16 mm. The pregnancy rate per cycle was 18.0%, on the other hand, the cumulate rate of pregnancy was 72.2%. There was not significant difference in the pregnancy rate between patients with primary or secondary infertility. The rate of spontaneous abortions was similar to the general population. As conclusion, it therefore appropriate to offer the treatment with pure FSH to patients clomiphene-resistance. The cases with gonadotropin-resistance, will be candidates to surgical procedures.
The incidence of neural tube defects (NTDs) is about 1.3 cases per 1000 live births. The higher incidence of NTDs occurs among certain ethnic groups, and geographic areas. The fetal morbimortality is high and the treatment for those babies who live is expensive with pour quality of live. It is unclear what biochemical mechanism involving folate explain the relationship of this vitamin to the pathogenesis of NTDs. However elevated concentrations of homocysteine or decreased methionine concentrations could be interfere with closure of the neural tube. The pharmacologic periconceptional intake of 0.4-4.0 mg/day of folic acid reduces the risk of occurrent NTDs by approximately 40-75%. A relatively high dietary intake of folate may also reduce the risk.
A descriptive, transversal retrospective study was performed, to determine the prevalence of HELLP syndrome among patients with Pregnancy-Induced Hypertension (PIH), who were admitted into the Gynecology and Obstetrics Service the American British Cowdray Hospital in Mexico City, since July 1992 to June 1995. We detected a total or 11 patients who had the diagnostic parameters proposed by Sibaí, those were 11.8% of all the patients with PIH. The medial gestational age was 33 weeks (range from 30 to 39) The mean tensional levels were 170/ 107 mm Hg, in base of platelet count, nine patients were classified as Class I (82%) and two in Class II (18%), the medial peak levels of transaminases and bilirubins was reached 40 hours and that of lactic deshidrogenase 60 hours after the diagnosis was established, while the minimum levels of hematocrit and platelets were at 48 and 57 respectively. The mean weight of the neonates was 1,655 g, the maternal mortality rate was 9% and the perinatal 8.3%, the diagnosis of HELLP syndrome was established before delivery in 40% of the cases and after that in 60%, puerperal HELLP may occur more frequently that is believed. Point out the importance of early detection of this clinic entity in order to establish an opportune and efficient treatment which improves maternal and fetal prognosis.
The laparoscopic treatment of adnexal masses has been controversial; however, the study of the case with the judicious use of the laboratory and ultrasound permit the laparoscopic approach of the most of the adnexal masses, including the dermoid cyst or mature cystic teratomas, and offer to the patient the benefits of the laparoscopic surgery with low morbidity. However, it should be do it in medical centers with the human and technics recourse need it for the performance. It present the first report in Mexico of laparoscopic treatment in contrast with a group of patients with laparotomy. The results of this study, are in conformity with the reports on the literature and suggest the initial laparoscopic approach of the dermoid cyst.
Determining sex of offspring has been a subject of intense interest for the public and professional community. Although methods of selecting sex before concepts are not entirely reliable, couples could satisfy their wishes for the size and composition of their family and the children might benefit by being wanted. On the other hand, the ability to selectively separate X from Y chromosome-bearing spermatozoa and use the X spermatozoa to preferentially produce female offspring; could be reduce, or may even eliminate, the probability of conceiving affected males of X-linked diseases.
Two extreme cases of pregnancy-induced hypertension with puerperal HELLP syndrome are presented and the literature is review. HELLP is an English acronym, for describing the preeclamptic or eclamptic patient, who also has hemolysis, elevated hepatic enzymes and low platelets. Its etiology has not been elucidated, but it has been accepted the theory of dysequilibrium in prostanoid metabolism. It has an incidence of 5 to 15% among patients with pregnancy-induced hypertension. Maternal mortality is about 10 to 28% and neonatal of 40%. Owing to fatal complications, treatment consist of interrupting pregnancy. Point out the importance of early detection of this clinic entity, which improves maternal-fetal prognosis.
The response to supraphysiological ovarian stimulation in Assisted Reproduction (particularly FIV-TE and GIFT) may be very heterogeneous, despite the fact that selected patients have clinical and paraclinical characteristics very homogeneous. Highly significant differences, were found, in two groups of patients with similar clinical characteristics, who were stimulated with the same scheme. Group I (Adequate response = 22 patients) and Group II (Inadequate response = 13 patients), regarding to basal seric levels of FSH (P = 0.007) and to quality of follicular response (P = 0.000). These results suggest that quality of response to supraphysiological ovarian stimulation, may reflect a "Functional ovarian reserve" and that this can be predicted (partially) with basal seric levels of FSH; but, may be, the inadequate response, paradoxical to certain point, would not represent an ovarian failure or a resistant ovarian syndrome, incipient or transitory during the reproductive age?
The prognosis as to reproduction of patients with two surgical procedures for the tubes for managing ectopic pregnancy, is very bad. Two cases of live intrauterine pregnancy, after two tubal pregnancies surgically managed, are presented. Salpingectomy and salpingostomy were carried out in one patient, and salpingostomy and salpingectomy in the other one. In world literature there are only 23 reported cases, since 1947.
Considering that information from the literature clearly establishes that human follicular fluid enhances both motility and viability of spermatozoa and that this fluid contains substances with chemotactic activity for leukocytes, we looked to see if follicular fluid might exert any chemical attraction to male germinal cells. In an vitro model using 0.8% agarose plates, it was demonstrated that the number of cells migrating to wells containing follicular fluids from patients in a program for GIFT, classified as mature in accordance to oocyte morphology, was significantly higher than those migrating to control wells. Further studies are needed to confirm these results and to study the possible specificity of the signal.
OBJECTIVE: To determine the correlation between body mass index, follicular synchrony, and pregnancy rate in a controlled ovarian hyperstimulation program with menotropins. SUBJECTS AND METHODS: Seventy-nine hyperstimulation cycles were evaluated. Transvaginal ultrasonographic control was performed and 10,000 IU of human chorionic gonadotropin were administered when the dominant follicle reached a diameter > 16 mm. In order to evaluate the follicular response, the ovarian synchrony factor was used (# follicles > or =16 mm/# follicles > 10 mm). For the statistical analysis, linear correlation and chi-square tests were used. RESULTS: When patients had a normal body mass index there was a positive correlation ( r = .52) between body mass index (kg/m(1.5)) and the ovarian synchrony factor. Weight deficiency and obesity had a deleterious effect on the ovarian response ( r = -.47 and r = -.77, respectively). There was a significant difference in the number of pregnancies in patients with ideal weight in relationship to the subgroup with weight deficit. CONCLUSIONS: An adequate body constitution increases the possibilities of achieving success in ovulation induction programs; on the other hand, weight disturbances have a deleterious effect on ovulation.