[Obstetric hysterectomy. Incidence, indications and complications]

BACKGROUND

Obstetric hysterectomy is indicated when patient's life is at risk, and it is a procedure that requires a highly experienced and skilled medical team to solve any complication.

OBJECTIVE

To identify incidence, indications, and complications of obstetric hysterectomy within a high-risk population.

PATIENTS AND METHODS

Transversal, retrospective study from July 1st 2004 to June 30 2006 at Unidad Medica de Alta Especialidad, Hospital de Ginecoobstetricia, Centro Medico Nacional de Occidente, IMSS. There were reviewed 103 patient' files with obstetric hysterectomy. Incidence was calculated, and clinical and socio-demographic characteristics, indications, and complications of obstetric hysterectomy identified and expressed in frequency, percentages, and central tendency measurements.

RESULTS

Incidence of obstetric hysterectomy was 8 cases within every 1,000 obstetric consultation. Age average was 31.1 +/- 5.1 years. 72.8% had cesarean surgery history. Main indication was placenta previa associated with placenta accreta (33%), followed by uterine hypotony (22.3%). Complications were hypovolemic shock (56.3%), and vesical injuries (5.8%). There were no maternal deaths.

CONCLUSIONS

Cesarean history induces higher obstetric hysterectomy incidence in women with high-risk pregnancy, due to its relation to placentation disorders, as placenta previa that increases hemorrhage possibility, and thus, maternal morbidity and mortality.

Sildenafil citrate diminishes microalbuminuria and the percentage of A1c in male patients with type 2 diabetes

Sildenafil citrate has shown to display beneficial cardiovascular effects, suggesting that it may have other systemic benefits involving the endothelium. There is little data regarding the long-term use of this drug and the effects of this on different organs.

OBJECTIVE

The primary aim of this study was to determine whether sildenafil citrate diminishes concentrations of microalbuminuria and percentage of A1c in patients with type 2 diabetes.

DESIGN

A double-blind, randomized, controlled trial in 40 male patients, age 35-50, with type 2 diabetes. Subjects received sildenafil citrate 50 mg daily (n=20) or placebo (n=20) for 30 days. Levels of hs-CRP, microalbuminuria, homocysteine, A1c and erectile function were measured at baseline and to the end of the study.

RESULTS

Men that received sildenafil citrate displayed a significant decrease in the microalbuminuria concentrations (p<0.01) versus baseline, (p=0.02) versus placebo and A1c (p<0.01) versus baseline, (p=0.01) versus placebo. In addition, we observed a significant increase in the total IIEF score after 30 days of treatment (p<0.01) versus baseline, (p<0.01) versus placebo.

CONCLUSIONS

The administration of 50mg of sildenafil citrate for 30 consecutive days diminishes microalbuminuria and the percentage of A1c in patients with type 2 diabetes.