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Pulmonary agenesis (PA) is a rare developmental malformation, with a frequency of approximately 1 in 10-15,000 pregnancies. Unilateral PA is often associated with other congenital anomalies, whereas bilateral PA is fatal. Prenatal diagnosis is rare and is diagnosed more frequently in the postnatal period than in the prenatal period. Is a challenge that may be difficult as it shares similar features with other more common pathologies. Ultrasound plays a crucial role in early diagnosis and management. Ultrasonographic findings for a correct prenatal diagnosis include mediastinum displacement with the absence of parenchymal or cystic tissue, decreased thoracic volume, an elevated diaphragm, cardiac axis deviation, and a hemithoracic cavity largely occupied by the heart. Cases of right PA have a worse prognosis compared to left PA, probably due to higher frequency of cardiac and great vessel abnormalities. A rare case of early prenatal ultrasound diagnosis of unilateral fetal PA, at 18 weeks of gestation, is reported.

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INTRODUCTION: Twin-twin transfusion syndrome (TTTS) is a typical complication of monochorionic twin pregnancies (MCTP). Placental vessels that communicate in the chorionic plate between donor and recipient, are responsible for the imbalance of blood flow. Circulatory imbalance causes hypovolemia in donor and hypervolemia in recipient fetus. In a typical case, recipient fetus develops polyhydramnios, weight gain, cardiomegaly and hydrops fetalis. In contrast, donor fetus develops oligohydramnios and fetal growth restriction. AIM: The objective of this review is to evaluate in detail the main diagnostic aspects and add other important data for diagnosis of TTTS. SCIENTIFIC BASES: The main diagnostic event for this condition is based on the ultrasonographic discovery of oligohydramnios-polyhydramnios sequence. Other useful elements for diagnosis, staging and prognosis are fetal urinary bladder visualization, urinary bladder volumen measurements, edema of subcutaneous and/or generalized tissue edema, Doppler flow velocity waves and cardiac evaluation. CONCLUSIONS: Considerations regarding diagnosis of TTTS make it possible to emphasize that role of physicians treating patients with MCTP is to identify ultrasound sequence of oligohydramnios-polyhydramnios. Other ultrasonographic fetal data as fetal urinary bladder visualization, urinary bladder volumen measurements, edema of subcutaneous and/or generalized tissue edema, Doppler flow velocity waves and cardiac evaluation; may help diagnosis, staging and prognosis of TTTS. It is their responsibility to accurately assess severity, therapeutic possibilities and prognosis. KEY POINTS: · The role of physicians treating patients with MCTP, regarding diagnosis of TTTS, must be to identify ultrasound sequence of oligohydramnios-polyhydramnios.. · Other ultrasonographic fetal data may help diagnosis, staging, and prognosis of TTTS as follows: fetal urinary bladder visualization, urinary bladder volume measurements, edema of subcutaneous and/or generalized tissue edema, Doppler flow velocity waves, and cardiac evaluation.. · It is physicians' responsibility to accurately assess severity, therapeutic possibilities, and prognosis of patients with MCTP and diagnosis of TTTS..

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El aneurisma de la arteria pulmonar (AAP) es una patología poco frecuente, con una prevalencia estimada en 0,06 %; si bien sus mecanismos fisiopatológicos aún se encuentran en estudio, se cree que la principal causa es el incremento de la presión y/o del flujo a través de la arteria pulmonar (AP), como sucede en la hipertensión pulmonar y el síndrome de Eisenmenger. Con frecuencia el AAP tiene un curso asintomático o desencadena síntomas inespecíficos, pero sus complicaciones pueden presentarse con independencia de los síntomas y llegar a tener un desenlace fatal. En el presente artículo se realiza una revisión de la literatura y se presentan dos casos de AAP.

Pulmonary artery aneurysm (PAA) is a rare disease with an estimated prevalence of 0.06%. Although its pathophysiological mechanisms are still under study, the main cause is believed to be an increased pressure and/or flow through the pulmonary artery (PA), as occurs in pulmonary hypertension and Eisenmenger syndrome. PAA often has an asymptomatic course or triggers nonspecific symptoms, but its complications can occur regardless of the symptoms and be fatal. In this article, a literature review is carried out and two cases of PAA are reported.

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La persistencia del conducto onfalomesentérico permeable es una de las formas de presentación menos frecuente, dentro de la patología, de los restos embrionarios derivados de este conducto. Se presenta el caso de un lactante de 30 días de vida a quien se le hace un diagnóstico de conducto onfalomesentérico permeable y se realiza cirugía resectiva, con una buena evolución postoperatoria inmediata y con alta a domicilio a los 8 días. Se revisan los datos de embriología así como de patología, la presentación clínica, los diagnósticos diferenciales y las opciones terapéuticas.

The persistence of permeable omphalosenteric duct is one of the less frequent forms of presentation, within the pathology, of the embryonic remnants derived from this duct. We present the case of a 30-day-old infant who is diagnosed with permeable omphalomesenteric duct, and resective surgery is performed, with a good postoperative evolution and with home discharge at 8 days. The embryology data as well as the pathology, the clinical presentation, the differential diagnoses and the therapeutic options are reviewed.

A persistência do ducto onfalossentérico permeável é uma das formas menos freqüentes de apresentação, dentro da patologia, dos remanescentes embrionários derivados desse ducto. Apresentamos o caso de um lactente de 30 dias que é diagnosticado comducto oncomumentérico permeável, sendo realizada cirurgia ressectiva, com boa evolução pós-operatória e com descarga domiciliar aos 8 dias. Os dados da embriologia, bem como a patologia, a apresentação clínica, os diagnósticos diferenciais e as opções terapêuticas são revisados.

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The family is one of the most important socializing agents in adolescent sex education. However, multiple barriers to communication within families have been identified. Therefore, this study aimed to characterize and understand the processes by which parents and their adolescent children communicate about sexuality. Two questionnaires were completed by 711 fathers/mothers and 566 male/female students in 21 schools in Cali (Colombia), and 15 discussion groups were formed. The results showed that conversations about sexuality focused on protection for women and on sexuality promotion for men. Furthermore, it was found that greater fluency exists in father/son and mother/daughter conversations. The largest discrepancy between parents and teenagers was the adults' belief that it is sufficient to mention certain topics in a directive manner and the children's expectations that parents will discuss the value and dynamics of the sexual experience. Embarrassment and lack of communication tools hinder communication processes.

A família é um dos principais agentes de socialização na formação da sexualidade adolescente. No entanto, diferentes barreiras de comunicação são identificadas. Esta pesquisa tem por objetivo caracterizar e compreender os processos de comunicação sobre sexualidade entre os pais e seus filhos adolescentes na cidade de Cali, Colômbia. Dois questionários foram aplicados a 711 pais/ mães e 566 alunos homens/mulheres em 21 escolas em Cali (Colômbia). Foram também conduzidos 15 grupos focais. Foram encontrados discursos de proteção sobre a sexualidade, no caso das mulheres, e incitamento para os homens. Foram relatadas mais frequentemente as conversas entre pai/filho do que entre mãe/filha. A principal discrepância é que os adultos consideram que é suficiente apresentar de maneira imperativa alguns tópicos, enquanto os seus filhos/as esperam discussões reais sobre valores e dinâmicas da experiência sexual. A vergonha e a falta de ferramentas de comunicação impedem estes processos.

La familia es uno de los agentes socializadores más importantes para la formación en sexualidad de los adolescentes. Sin embargo, se han identificado múltiples barreras en los procesos de comunicación. Por este motivo, esta investigación tuvo como objetivo caracterizar y comprender los procesos de comunicación en sexualidad entre los padres de familia y sus hijos adolescentes en la ciudad de Cali, Colombia. Se aplicaron dos cuestionarios a 711 padres/madres de familia y 566 estudiantes hombres/mujeres en 21 colegios de Cali (Colombia) y se desarrollaron 15 grupos de discusión. Se encontraron discursos de protección frente a la sexualidad hacia las mujeres y de incitación hacia los hombres. Además, se identificó que existe mayor fluidez en las conversaciones entre padre/hijo y madre/hija. La mayor discrepancia es que los adultos consideran suficiente mencionar de manera directiva ciertos temas, mientras que sus hijos/as esperan discusiones en torno a valores y dinámicas de la experiencia sexual. La vergüenza y falta de herramientas de comunicación dificultan estos procesos.

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Abstract The family is one of the most important socializing agents in adolescent sex education. However, multiple barriers to communication within families have been identified. Therefore, this study aimed to characterize and understand the processes by which parents and their adolescent children communicate about sexuality. Two questionnaires were completed by 711 fathers/mothers and 566 male/female students in 21 schools in Cali (Colombia), and 15 discussion groups were formed. The results showed that conversations about sexuality focused on protection for women and on sexuality promotion for men. Furthermore, it was found that greater fluency exists in father/son and mother/daughter conversations. The largest discrepancy between parents and teenagers was the adults' belief that it is sufficient to mention certain topics in a directive manner and the children's expectations that parents will discuss the value and dynamics of the sexual experience. Embarrassment and lack of communication tools hinder communication processes.(AU)

Resumo A família é um dos principais agentes de socialização na formação da sexualidade adolescente. No entanto, diferentes barreiras de comunicação são identificadas. Esta pesquisa tem por objetivo caracterizar e compreender os processos de comunicação sobre sexualidade entre os pais e seus filhos adolescentes na cidade de Cali, Colômbia. Dois questionários foram aplicados a 711 pais/ mães e 566 alunos homens/mulheres em 21 escolas em Cali (Colômbia). Foram também conduzidos 15 grupos focais. Foram encontrados discursos de proteção sobre a sexualidade, no caso das mulheres, e incitamento para os homens. Foram relatadas mais frequentemente as conversas entre pai/filho do que entre mãe/filha. A principal discrepância é que os adultos consideram que é suficiente apresentar de maneira imperativa alguns tópicos, enquanto os seus filhos/as esperam discussões reais sobre valores e dinâmicas da experiência sexual. A vergonha e a falta de ferramentas de comunicação impedem estes processos.(AU)

Resumen La familia es uno de los agentes socializadores más importantes para la formación en sexualidad de los adolescentes. Sin embargo, se han identificado múltiples barreras en los procesos de comunicación. Por este motivo, esta investigación tuvo como objetivo caracterizar y comprender los procesos de comunicación en sexualidad entre los padres de familia y sus hijos adolescentes en la ciudad de Cali, Colombia. Se aplicaron dos cuestionarios a 711 padres/madres de familia y 566 estudiantes hombres/mujeres en 21 colegios de Cali (Colombia) y se desarrollaron 15 grupos de discusión. Se encontraron discursos de protección frente a la sexualidad hacia las mujeres y de incitación hacia los hombres. Además, se identificó que existe mayor fluidez en las conversaciones entre padre/hijo y madre/hija. La mayor discrepancia es que los adultos consideran suficiente mencionar de manera directiva ciertos temas, mientras que sus hijos/as esperan discusiones en torno a valores y dinámicas de la experiencia sexual. La vergüenza y falta de herramientas de comunicación dificultan estos procesos.(AU)

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Determinar la incidencia, factores asociados y repercusiones de la histerectomía obstétrica. Estudio retrospectivo, descriptivo, analítico y transversal que incluyó 50 pacientes sometidas a histerectomía obstétrica en 64293 casos obstétricos, durante un período de 15 años (del 01 de agosto de 1993 al 31 de julio de 2008). Departamento de Obstetricia y Ginecología. Hospital Nuestra Señora de Chiquinquirá. Maracaibo, Venezuela. La incidencia de histerectomía obstétrica fue 0,07 por ciento (1 HO por 1 285 casos obstétricos). Fue más frecuente en mujeres entre 25-29 años (26 por ciento), IV gestas (34 por ciento), para 3 (26 por ciento), con control prenatal (63,33 por ciento), embarazos de 37-41semanas (56 por ciento), poscesárea (46 por ciento), histerectomía tipo total (86 por ciento), indicadas por atonía uterina (38 por ciento), complicadas con anemia (88 por ciento), ameritaron transfusión sanguínea (84 por ciento) y duraron <7 días de hospitalización (56 por ciento). Hubo 8 muertes maternas (16 por ciento) y la tasa de mortalidad materna ajustada fue 792 por 10000 nacidos vivos. Hubo 9 abortos (18 por ciento), 15 muertes fetales (30 por ciento) y la tasa de mortalidad perinatal fue 129 por 1000 nacidos vivos. En la población estudiada, la histerectomía obstétrica fue poco frecuente, más comúnmente indicada por trastornos hemorrágicos y tuvo cifras de morbilidad y mortalidad materna elevadas

To determine the incidence, associated factors and repercussions of obstetric hysterectomy. Retrospective, descriptive, analytic and transversal study that included 50 obstetric hysterectomies (OH) in 64293 obstetrics cases, during fifteen years (from August 1st, 1993 to July 31th, 2008). Department of Obstetrics and Gynecology. Our Lady of Chiquinquira Hospital. Maracaibo, Venezuela. The incidence of OH was 0.07 percent (1 OH by 1285 obstetric cases). It was more frequent in women between 25-29 years (26 percent), IV gestations (34 percent), para 3 (26 percent), prenatal care (63,33 percent), pregnancies 37-41 weeks (56 percent), after cesarean section (46 percent), total hysterectomy (86 percent), uterine atony as mean indication (38 percent), complicated with anemia (88 percent), blood transfusion (84 percent) and discharged home <7 days length of stay (56 percent). There were 8 maternal deaths (16 percent) and adjusted maternal mortality rate was 792 by 10000 live births. There were 9 abortions (18 percent), 15 fetal deaths (30 percent) and adjusted perinatal mortality rate was 129 by 1000 live births. Obstetric hysterectomy in the studied population, was not frequent, commonest indicated by hemorrhagic disorders and there were high maternal morbidity and mortality

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Vaginal leiomyomas are rare benign tumors. This is a case report with menstrual and urinary difficulties and vaginal mass with inner urethral meatus and hymen displacement. Miccional cystourethrography showed a posterior displaced, comprised and elongated urethra. Excretory urography and pelvic sonogram were normal. Preurethral enucleation extirpation with no complications was practiced. Current literature is reviewed.

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Los grandes miomas uterinos son raros durante la gestación. Este es el reporte de un caso cuyo mioma pesó 2880 g que se resolvió por cesárea y miomectomía, sin complicaciones maternas perinatales

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La placenta adherida al miometrio es muy rara. Varía entre 1:500 y 1:93 000 partos. La placenta percreta es el tipo menos común. Es importante porque las complicaciones pueden ser mortales. La ruptura uterina anterior es más frecuente que la posterior. En la literatura inglesa, entre 1899 y 1999, sólo se reportaron menos de 50 casos con hemoperitoneo. En Venezuela se han descrito 6 placentas percretas. En esta nota clínica se reporta un caso de placenta percreta con rotura uterina posterior, hemoperitoneo e invasión a epiplón.

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El embarazo ectópico cervical es muy raro. Entre 1978 y 1994, sólo se reportaron 120 casos en la literatura inglesa. En Venezuela se han descrito 4. En esta nota clínica se reporta un caso de embarazo ísmico-cervical con invasión a región vésico-uterina

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