RESUMEN
BACKGROUND: Reproductive surgery preserves, enhances or restores fertility. The minimal access surgery offers many benefits in relation to open surgery. Robot-assisted laparoscopic surgery is a relatively new technique in the field of gynecological surgery. CLINICAL CASE: A 30-year-old female patient, with primary infertility of five years of evolution in who uterine myomatosis of large elements was diagnosed and robot-assisted laparoscopic surgery was indicated. CONCLUSION: The advantages of robot-assisted laparoscopic surgery are: lower blood loss, hospital stay and postoperative pain and faster reinstatement to normal activities, in addition to a promising reproductive outcome for the patient.
Asunto(s)
Laparoscopía/métodos , Procedimientos Quirúrgicos Robotizados , Miomectomía Uterina/métodos , Adulto , Femenino , Humanos , Infertilidad Femenina/etiología , Infertilidad Femenina/cirugía , Leiomioma/complicaciones , Leiomioma/cirugía , Embarazo , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/cirugíaRESUMEN
BACKGROUND: Meckel-Gruber syndrome is a ciliopathy, a lethal autosomal recessive disorder that occurs in all races and ethnicities; it is characterized by central nervous system abnormalities, resulting in mental retardation, bilateral renal cystic dysplasia and malformations of hands and feet. To date there have been only about 200 cases reported worldwide. It is a disease with a recurrence rate of 25% whose most reliable method for diagnosis is prenatal ultrasound. The mortality rate is 100% and in view of the high index of recurrence, subsequent pregnancies should be investigated appropriately with genetic counseling. CLINIC CASE: We present the case of a 15 years-old mother with 30.2 weeks pregnancy resulting from rape by consanguinity (grandfather), without prenatal care. On admission HD ultrasound study is performed finding fetus fetometria average 26.2 weeks (for discordant fetometria head circumference 187.5 mm to 21.0 weeks gestation -3DE-) lost in the skull shape of the shell line is observed winding mean; not cut down, cavum septum pellucidum or herniated sac cerebellum and occipital level (encephalocele) are evident. It starts cervical ripening with prostaglandins for 24 hours to conduct further labor with oxytocic and delivery care where a fetus death, female, 1516 g is obtained. Fetal autopsy family is authorized; however, it not has done because it is legal and only medical geneticist obtains medical case assessment. CONCLUSIONS: The Meckel-Gruber syndrome is a very rare condition that occurs in cases of consanguinity occasions. Mortality occurs in 100% of cases, so you should talk to parents and explain the best maternal prognosis, with abortion in the early stages and subsequent genetic counseling.
Asunto(s)
Trastornos de la Motilidad Ciliar/diagnóstico , Encefalocele/diagnóstico , Enfermedades Fetales/diagnóstico por imagen , Enfermedades Renales Poliquísticas/diagnóstico , Ultrasonografía Prenatal/métodos , Aborto Inducido/métodos , Adolescente , Trastornos de la Motilidad Ciliar/fisiopatología , Encefalocele/fisiopatología , Femenino , Asesoramiento Genético/métodos , Edad Gestacional , Humanos , Enfermedades Renales Poliquísticas/fisiopatología , Embarazo , Retinitis PigmentosaRESUMEN
A case of cornual pregnancy is presented, the clinic evolution and the laparoscopic resolution are mentioned, and the world literature revision was done given special attention to the laparoscopic resolution. Finally, a comment about a laparoscopic technique.
Asunto(s)
Laparoscopía/métodos , Embarazo Ectópico/cirugía , Adulto , Femenino , Humanos , Embarazo , Embarazo Ectópico/diagnósticoRESUMEN
We tried to determine if the toxemia of pregnancy has during its clinical evolution a dependent DO2/VO2 relationship and determine its critical DO2 and finally define if this has a prognostic value. There were included patients with diagnosis of preeclampsia/eclampsia that were enter at the Intensive Care Unit for treatment and monitoring. It was placed a catheter in the pulmonary artery and it was determine the cardiac output and by means of standard formulas the DO2, VO2 and EO2 were calculated. The critical delivery of oxygen was stablished in agree at the Gutiérrez's method. At the same time it was monitorised the base excess which was gotten from arterial and venous blood gases. 36 patients (29 with preclampsia and 7 with eclampsia) were included, with a mean age of 26.3 years old. The mean gestational age was 36.1 weeks. The critical delivery for preeclamptic patients was stablished in 924 mL/min and at the eclamptic patients in 830 mL/min: both values had prognostic correlation with survival and nonsurvival patients (p < 0.001, x2 = 28.29). In survival patients it was a dependent DO2/VO2 relationship during the first 72 hours of study and then it was independent; this fact was accompaniment of a positive increase in the base excess and a decreasing in the EO2 values (< 27%). In the nonsurvival group, these mainteined a DO2/VO2 relationship in a dependent way during all the study and it was accompaniment with a continuous negative base excess with values of EO2 > 30%. The toxemia of pregnancy had a behaviour like state accompaniment of a dependent DO2/VO2 relationship causing an important oxygen deficient that was improved was improved in the survival patients that reach values over the critical delivery. These facts suggesting the presence of a metabolic blockade in variable degree that can improve or increase agree a therapeutic manipulations in the critic DO2.