Jorge Salvador

Embarazo múltiple. Estudio en el Hospital Nacional Cayetano Heredia

Two groups of patients were studied, 126 between 1979 and 1981 and 109 between 1994 and 1995, with similar characteristics. No significant differences were found with age of patients, parity, pregnancy induced hypertension, duration of gestation, newborn weight, but cesarean section and IUGR increased lately and newborns less than 1500 g decreased. Puerperal morbidity was higher with cesarean section. Maternal mortality was nil and perinatal mortality decreased, with prevalence of prematurity. Fetal mortality was 50% or more when less than 1000 g, but early neonatal mortality newborns less than 1500 g decreased from 80% to 46,7%.

Hallazgos Laparoscópicos en pacientes con infertilidad. Experiencia en el Hospital Nacional Cayetano Heredia. 1995-1998

OBJECTIVE: Discover the laparoscopic findings in the study of infertility patients. DESIGN: Retrospective descriptive study based on a review of medical records, laparoscopy sheets and sheets infertility patients undergoing diagnostic laparoscopy. MATERIALS AND METHODS: Between January 1995 and December 1998, at the National Hospital Cayetano Heredia diagnostic laparoscopy to 106 infertility patients was performed. The study variables were: Features of infertility (type and time inferlilidad), affiliation, background, symptoms, gynecologic, laparoscopic examination (findings and complications). RESULTS: The secondary infertility was 60.4% and 39.6% Primary; 95.3% showed abnormal laparoscopy; factors were most frequently altered tubal factor (67%) and peritoneal factor (66%). The most frequent pathologies were endometriosis and tubal obstruction (43.4% each). CONCLUSION: Laparoscopy is a safe and useful for the study of infertility method.

Colpopexia anterior y uretrosuspensión con monoprótesis en el tratamiento quirúrgico del cistocele e incontinencia urinaria de esfuerzo

Objectives: To describe our experience in surgical repair of cystocele and urinary stress incontinence (SUI) using a synthetic monofilament monoprothesis. Design: Retrospective, descriptive, series of cases study. Setting: Gynecology service, Hospital Nacional Cayetano Heredia. Participants: Women who underwent the surgical technique. Interventions: We had 44 patients operated of anterior colpopexy and urethral suspension with monoprothesis mesh (Atrium, Prolene), similar to the NazcaTC mesh, in order to repair cystocele and SUI, between May 2007 and April 2008. Main outcome measures: Cure and complications. Results: By Baden Walter and POP-Q scores, three months after cystocele surgery cure rate was 28/31 (91%) with patient satisfaction in 31/33 (94%). For SUI, cure was found in 27/33 (82%) and improvement in 5/33(15%). The most important complications were urinary tract infection 10/44 (23%), urinary retention 8/44(18%), and vaginal dome infection 4/44 (9%); cystocele recurred in one patient and SUI persisted in another patient. Conclusions: Use of monoprothesis may be safe, effective and with low morbidity to repair both cystocele and SUI; nevertheless it is necessary to follow-up these patients for long term collateral effects or recurrence.

Factores de riesgo del parto pretérmino: Estudio caso-control

OBJECTIVES: To determine the factors of maternal and fetal risks that are associated with premature birth. Material and Methods: A retrospective, comparative, case-control, based on medical records and interviews of patients whose births were attended at the Cayetano Heredia National Hospital between January 1 and March 31, 2003. Study was included all cases (106 premature) and controls (term 1325) that occurred in the study period. In the statistical evaluation the multivariate analysis (logistic regression) was used; thus the odds ratio (ratio of products) and the confidence interval for each variable was determined. The significance level used was 95% (p <0.05]. RESULTS: maternal risk factors were age <20 years, history of prematurity, inadequate prenatal care, urinary tract infection, premature rupture of membranes, and preeclampsia-eclampsia antepartum haemorrhage and fetal risk factors, stillbirth, twins and poor presentation.