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Background: Fibrocystic breast disease is one of the most frequent conditions of the breast among women from 30 to 49 years, with a frequency of about 60%, hence the interest in studying and treating it with the most advanced and effective resources., Objective: To compare the efficacy and adverse events of alpha dihydroergocryptine with cabergoline in patients with fibrocystic breast disease., Material and Methods: A prospective, longitudinal, open, comparative study between alpha-dihydroergocryptine and cabergoline, made in the service of Gynecology and Obstetrics at the Dr. Miguel Silva General Hospital in Morelia, Michoacán. 171 patients diagnosed with fibrocystic breast disease were randomly assigned to the alpha-dihydroergocryptine or the cabergoline group. Assessments were made at baseline and every month subsequently. The following symptoms were evaluated: breast tenderness, breast pain, lumps and nipple discharge. The concentrations of prolactin were determined and an ultrasound was performed at baseline and at 3 and 6 months, patients were questioned about adverse events., Results: 171 patients were included (81treated with alpha-dihydroergocryptine and 90 with cabergoline); 156 completed the study. The age limits were 18 and 51 years. The evolution time prior to study entry was 17.71 +/- 18.3 months for the alpha-dihydroergocryptine group and 18.57 +/- 20.35 for the cabergoline group. 15 patients discontinued treatment due to adverse events (8 of the alpha-dihydroergocryptine group and 7 of the cabergoline group). The most common adverse event was headache., Conclusions: In this study alpha-dihydroergocryptine was better tolerated and had better clinical response compared with cabergoline; breast pain and breast tenderness disappeared within the first month of treatment. Adverse events were similar for both treatments.

Angiomyofibroblastoma is a benign mesenchymal tumor of the lower genital tract described in 1992 by Fletcher and his group. Must be differentiated mainly from aggressive angiomyxoma, which has a high local recurrence rate. We report the case of a 21 year old patient who attended the General Hospital Dr. Miguel Silva, in Morelia, Michoacan, because post-term pregnancy of 41.1 weeks gestation, with a bulky vulvar tumor, asymptomatic with four years of evolution. Cesarean section and vulvar tumor resection were performed. The surgical specimen measured 14 x 10 x 5 cm, had a polypoid aspect, multilobulated, with nodules of varying size. From a microscopic point of view the tumor was well defined, formed by loose connective tissue septa, with stromal fusiform cells and benign characteristics, between collagen fibers, with abundant vessels. The histochemical studies were positive for desmin and vimentin. These anatomopathological findings are diagnostic of vulvar angiomyofibroblastoma, benign course tumor, does not resort nor does it generate metastases after simple surgical resection; however, recurrence in the vagina is reported. Must be differentiated from other mesenchymal neoplasms of the genital tract.

The cotyledonoid dissecting leiomyoma of the uterus, or Stenberg tumor, is a rare variant of a smooth muscle benign tumor, classified in the group presenting an unusual growth pattern; clinically, it affects women in reproductive age. We report the case of a 43 year-old woman, who turned up at the Centro Estatal de Atencion Oncologica (State Cancer Care Center) in Morelia, Michoacan, presenting abnormal uterine bleeding and uterine fibroid of major elements. When performing a palpatory bimanual exam, a loose uterus of approximately 7 by 6 inches was identified; it ached when moving. The laboratory tests reported normal parametriums; the ultrasound showed, however, uterine fibroids of major elements. The uterus was enlarged due to a tumor of exophytic growth, which resembles placental cotyledons extended over the uterine surface, composed by smooth muscle nodules that dissected the uterine wall, and with infiltrative appearance in parametriums and the myometrial wall. Despite this microscopic aggressive appearance, a number of ultrastructuctural studies and immunohistochemical techniques proved its benign nature. This can help patients who want to preserve fertility avoid radical surgery.

Background: pharmaceutical forms (presentations) influence treatment compliance and therefore the effectiveness. Here we present the results in the relief of vaginitis and vaginosis with two different dosage forms., Objective: To compare the efficacy and safety of a combination of ketoconazole 800 mg + clindamycin in soft vaginal gel capsules 100 mg (vaginal capsules) against ketoconazole 800 mg + 100 mg clindamycin vaginal tablets (TV) in the management of vaginitis by C. albicans and/or vaginosis., Material and Method: In a randomized, multicenter, comparative open label study, patients between 18 and 60 years with a diagnosis of vaginitis by C. albicans and/or vaginosis were included. Patients were evaluated clinically and direct exam of genital discharge and culture were performed. Patients were randomized to one of two treatments vaginal tablets or vaginal capsules, for 3 days., Results: one hundred an sitxty nine patients were included, 85 in TV Group and 84 in vaginal capsules group. We found significant statistical difference in clinical response for tablet group at day three for burning p = 0.032 and itching p = 0.043. Microbiological cure was observed in patients with vaginitis by C. albicans, 92.5% in Group TV vs. 90.47% vaginal capsules group, all patients with G. vaginalis at baseline were negative for the organism at the end of the study, cure in patients with mixed infections were 78.94% for TV group vs. 78.26% vaginal capsules; group no adverse events were reported during treatment., Conclusions: Treatment of vaginitis/vaginosis with vaginal tablets is clinically better than vaginal soft gelatin capsules both treatments were well tolerated.

Background: Vulvovaginitis is one of the main causes of premature membrane rupture., Objective: To evaluate effectiveness of a combination of ketoconazole (400 mg) and clindamycin (100 mg) in vaginal tablets, compared with clindamicyn alone (600 mg/daily) orally, for six days, to prevent premature membrane rupture in patients with vulvovaginitis., Patients and Method: Longitudinal, prospective, comparative, randomized, double-blind, double-dummy study in patients older than 18 years, during them third trimester of normoevolutive pregnancy with symptomatic vulvovaginitis. Patients were monitored as out patient. Genital secretion culture and fresh studies were made. Signs and symptoms were evaluated in regular intervals: 4, 7 and 11 days. Pregnancy control was performed every three weeks, until childbirth or premature membrane rupture., Results: 105 patients were included: 53 in the group of ketoconazole and clindamicyn (1), and 52 in the group of clindamycin alone (2). Symptoms were similar in both groups of treatment, without statistically significant differences. A case of group 2 has premature membrane rupture (p = 0.495). C. albicans was cultured in 35% of group 2 and in 11% of group 2. No adverse events with treatments were reported., Conclusions: The combination of ketoconazole and cindamycin was effective to prevent premature membrane rupture in patients with vulvovaginitis.

Background: The cesarean section was designed to extract to the neoborn, when the childbirth becomes difficult by the natural routes. The institutional obstetrical work demands long surgical time and high raw materials; therefore, simpler procedures must be implemented., Objective: To compare traditional cesarean section vs Misgav-Ladach technique to assess surgical time, and hospital stay and costs., Patients and Methods: Forty-eight pregnant patients at term with obstetrical indication for cesarean delivery were randomized in two groups: 24 were submitted to traditional cesarean and 24 to Misgav-Ladach technique. The outcomes included surgical time, bleeding, amount of sutures employed, pain intensity and some others adverse effects., Results: The surgical time with Misgav-Ladach technique was shorter compared with traditional cesarean section, bleeding was consistently lesser and pain was also low. None adverse effects were registered in both groups., Conclusion: Although short follow-up showed significant operative time reduction and less bleeding, longer follow-up should be desirable in order to confirm no abdominal adhesions.

Objective: To evaluate the effectiveness of alpha dihidroergocriptine in patients with fibrocystic mastopathy., Patients and Methods: Patients with diagnosis of fibrocystic breast disease were included in a prospective longitudinal blind double, controlled with placebo study. Patients were randomly assigned to one of two treatment groups: of treatment group A: Alpha dihidroergocriptine tablets of 10 mg, group B: Placebo, during 6 months. After to basal evaluation, the patients were revised in a monthly way evaluating the following symptoms and signs: mastalgia, mammary tension, presence of nodules, nipple secretion, and the presence of adverse events., Results: 39 patients with alpha dihidroergocriptine and 38 with placebo. Mastodinia, a satisfactory response was observed in 100% of alpha dihidroergocriptine group vs 61.11% of placebo group (p = 0.0002). Mastalgia responded in 100% of alpha dihidroergocriptine group vs 64.86% of placebo group (p = 0.0003). Galactorrea responded 100% of alpha dihidroergocriptine group vs 93.33% of the placebo. The nodules in the group alpha dihidroergocriptine disappeared in 23.1% and in 21.1% of the placebo group. Ultrasound evaluation of the nodules did not show significant differences between both groups. Prolactin levels showed a decrease in the group treated with alpha dihidroergocriptine with an important difference between both groups at the end of the 6 months study period. There were not differences in the presence of adverse events between groups., Conclusions: Alpha dihidroergocriptine is effective in the treatment of fribrocystic breast disease with minimum adverse events when compared with similar drugs.

Ovarian choriocarcinoma from the germ cells is a very rare malignant neoplasia. About the pure form, very few cases have been reported in medical literature. Ovarian choriocarcinoma may originate in three modalities. As primary choriocarcinoma associated to ovarian pregnancy, 2. As a metastatic ovarian carcinoma, from other organs, mainly the uterus, 3. As a primary tumour of germ cells with differentiation to trophoblastic structures. The latter grows in girls or in adult woman, generally young, where necessarily pregnancy has to be excluded. A case is presented of a 21 years old woman, treated at Hospital General "Dr. Miguel Silva", Morelia, Mich. single, without sexual life, with an abdomino-pelvic tumor of 24 cm, from the right ovary and adhered to ascending colon. Beta subunity of chorionic gonadotrophin was 200,000 mUI/ml of blood plasma. At laparotomy a right ovarian tumour, with infiltration to ascending colon, was found; this required total hysterectomy with bilateral salpingo-oophorectomy and right hemicolectomy. After surgery the patient received chemotherapy with cisplatin, bleomicin and vinblastine. After the third treatment cycle and at three months, chorionic gonadotropin became negative; and at four years follow up residual tumoural activity is absent. Largest mortality with these tumors appears during early post-operative stage and it is atributed to the tumour itself or to post-operative complications. If the patient survives this stage and with a good chemotherapeutic program, survival and even complete cure, occurs.

Lactation in humans requires the collaboration of neural and endocrine systems. During pregnancy and after parturition prolactin and also sex steroids, corticoids, growth hormone and human placental lactogen are necessary for lactogenesis. In an open, simple and prospective study, 50 women with normal delivery or cesarean section, between 34 and 41 weeks of gestation, were treated with lisuride, 0.2 mg t.i.d. for 14 days in order to inhibit lactation. The arrest of lactation was mandatory for medical reasons and the results were evaluated by changes in breast related with shape, volume, symmetry, coloring, temperature, turgescence, venous appearance, nipple condition, colostrum and lymph nodes increase. Lactation that was already present in 87% of patients in the first exploration 24 hours after delivery was satisfactorily suppressed and also breast pain, engorgement and discomfort caused by milk leakage. None had rebound lactation. 5 patients had light nausea. The dopamine agonist lisuride can be used for primary arrest of lactation with clinical effectiveness and without potential dangerous side effects of hormonal compounds.

Congenital absence of the vagina depends on partial or complete failure of Müllerian duct development. The ovaries develop normally and the fimbrial ends of the tubes are vestigial but there is no uterus, cervix or vagina. The urinary and genital systems and some skeletal portions developing from Müllerian ducts are so closely linked embryologically that congenital abnormality of kidney and bones is said to accompany genital defects in approximately 20% of cases. Several surgical techniques have been proposed but the gynecologist can have sufficient experience to choose the most suitable treatment according to the pecularities of each case. McIndoe Operation offers the best possible result opening a space between the ureta and the rectum and placing within in a large penile shaped mold draped with a split skin graft. This operation can result in a vagina that looks and feels absolutely normal but the most discouraging however is the time required for the completion of the whole treatment. There are several photos illustrating the procedure.

Septic shock in obstetrics is a major cause of mortality. Postpartum endometritis is often the first step of bacterial colonization inside the uterus which becomes the nidus of infection. Rapid spread into general circulation is favoured by hemodynamics patterns of pregnancy. Bacteremia would result in cardiovascular collapse and a myocardial depressant factor has been proposed to explain the fall in cardiac output. Later, endotoxin activates the substances of malignant intravascular inflammation and multiple systems organ failure may be observed in uncontrolled sepsis. Eight cases are reported hospitalized at Morelia's General Hospital, SSA, with septic shock and MSOF. Presumably because of aggressive acute resuscitation nobody succumbed during acute cardiac failure and hypotensive episode but two patients died later with multiple system organ failure. The mortality was 25%. Fluid, resuscitation, and vasoactive drugs are the most effective way to reduce mortality. Antibiotics, specific treatment of MSOF and taking away the nidus of infection are critical components of therapy.