lunes, 26 de marzo de 2018

Curso Ginecología ME-4013 y Obstetricia ME-4012 - II Ciclo 2019 - Hospital México


En esta publicación se presenta la distribución de las sesiones asignadas con el Dr. Juan Picáns para el curso de ginecología y obstetricia del Hospital México. Los estudiantes deben distribuirse en 3 grupos.  Cada grupo debe desarrollar en conjunto, y no de manera individual, cada una de las guías que se le asignan a continuación.

Para cada tema o clase se han confeccionado tres guías de trabajo, una principal que consiste en la presentación del tema, y dos guías secundarias, que suelen ser casos clínicos, ilustraciones o ampliación del tema principal. Existe una bibliografía básica que debe ser revisada por todos los estudiantes para la confección y presentación de la guía de trabajo asignada de manera grupal. La bibliografía y distribución de las guías de trabajo se presentan a continuación.  Las guías de trabajo pueden descargarse siguiendo los enlaces que se muestran.

Cáncer de Endometrio (tumor maligno del endometrio - 24/9/2019)
Bibliografía recomendada:
  • Cáncer Uterino.  En: Oncología Ginecológica de Berek y Hacker. 6a edición: 2014.
Cáncer Epitelial de Ovario, Trompa de Falopio y Primario de Peritoneo (cáncer de ovario y trompas - 17/9/2019
Bibliografía recomendada:
  • Cáncer epitelial de ovario, de trompas de Falopio y peritoneal.  En: Oncología Ginecológica de Berek y Hacker. 6a edición: 2014.
Cáncer No Epitelial de Ovario (cáncer de ovario - 17/9/2019)
Bibliografía recomendada:

  • Cáncer de células germinales y otros cánceres ováricos no epiteliales.  En: Oncología Ginecológica de Berek y Hacker. 6a edición: 2014.

domingo, 5 de diciembre de 2010

La AAGL Recomienda el Abordaje Vaginal y Laparoscópico para las Histerectomías

November 16, 2010 — The American Academy of Gynecologic Laparoscopists (AAGL) recommends minimally invasive surgical approaches such as vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH) for benign uterine disease, according to a position statement published online November 7 in the Journal of Minimally Invasive Gynecology.

"When procedures are required to treat gynecologic disorders, the AAGL is committed to the principles of informed patient choice and provision of minimally invasive options," said Franklin D. Loffer, MD, executive vice president/medical director of the AAGL, in a news release. "When hysterectomy is necessary, the demonstrated safety, efficacy, and cost-effectiveness of VH and LH mandate that they be the procedures of choice. When hysterectomy is performed without a laparotomy, early institutional discharge is feasible and safe, in many cases within the first 24 hours."

In the United States, approximately 600,000 hysterectomies are performed every year for benign disorders of the pelvis, and more than two thirds are performed via an abdominal approach. In some countries, however, as few as 24% of hysterectomies are performed abdominally.

To lower morbidity risk and speed recovery, the AAGL recommends a vaginal or laparoscopic approach to hysterectomy for benign disease. Surgical risks are low for these minimally invasive procedures, which can often be done as an outpatient procedure or with a short hospital stay.

In contrast, the relatively large abdominal incision needed for abdominal hysterectomy (AH) may result in more complications, particularly associated with abdominal wound infections, leading to longer hospitalization and disability before normal activities can be resumed.

Obesity and a previous cesarean delivery were once thought to be contraindications to LH. However, the safety and efficacy of LH are similar in obese and nonobese patients, although operative times are longer in obese patients. Compared with other techniques, LH may be associated with an increased risk for cystotomy, but overall risk is low. The AAGL recommends that previous cesarean delivery should no longer be considered a contraindication to either VH or LH.

Even when the uterus is large, a number of surgeons can feasibly and safely perform VH. LH appears to be a safe alternative preserving most of the advantages of VH vs AH, and it can be performed when uterine size or other coexisting disease or surgical considerations preclude performance of VH.

Direct costs of either VH or LH are less than those of AH, but institutional costs of LH may be higher vs VH depending on what instrumentation is used. Compared with AH, LH appears to reduce indirect costs of hysterectomy by 50%, based on high-quality evidence from several randomized controlled trials.

In several oncologic studies, LH vs AH has been shown to lower morbidity risk without compromising clinical efficacy in women with cervical or endometrial carcinoma.

"Given the advantages that VH and LH offer to women, their families, their employers, and the health care system in general, it seems desirable to optimize their application in women requiring hysterectomy because of benign uterine conditions," the authors of the position statement write. "Abdominal hysterectomy should be reserved for the minority of women for whom a laparoscopic or vaginal approach is not appropriate. These situations are not common."

Women in whom LH is not appropriate may include the following:

  • Those with cardiopulmonary disease or other medical conditions in which the risks are unacceptable, either for general anesthesia or for increased intraperitoneal pressure associated with laparoscopy.
  • Those in whom morcellation, or cutting the tumor into pieces before removal, is known or likely to be required and uterine malignancy is either known or suspected.

Situations in which LH and VH are not appropriate may include the following:

  • Although hysterectomy is indicated, there is no access to the surgeons or facilities needed for VH or LH, and referral is not feasible.
  • Surgeons expert in either VH or LH techniques consider the vaginal or laparoscopic approach to be unsafe or unreasonable because of uterine disease or adhesions significantly distorting the anatomy.

"It is the position of the AAGL that most hysterectomies for benign disease should be performed either vaginally or laparoscopically and that continued efforts should be taken to facilitate these approaches," the authors of the position statement write. "Surgeons without the requisite training and skills required for the safe performance of VH or LH should enlist the aid of colleagues who do or should refer patients requiring hysterectomy to such individuals for their surgical care."

J Minim Invasive Gynecol. Published online November 7, 2010.

Clinical Context

For surgical treatment of benign disorders of the pelvis, approximately 600,000 hysterectomies are performed in the United States each year. Although an abdominal incision is used in more than two thirds of these procedures, as few as 24% of hysterectomies are performed abdominally in some countries.

The AAGL therefore issued a position statement committed to the principles of informed patient choice and provision of minimally invasive options, and recommending VH or LH to reduce morbidity risk and recovery time. Because surgical risks are low, VH or LH can often be performed in an outpatient setting or with a short hospital stay.

Study Highlights


  • Study Highlights
  • VH and LH are safe, effective, and cost-effective approaches to hysterectomy.
  • Avoiding laparotomy allows early, safe institutional discharge, often within the first 24 hours and/or as an outpatient procedure.
  • Surgical risks of VH and LH are low, whereas AH requires a relatively large abdominal incision.
  • Abdominal wound infections and other complications of AH may result in longer hospital stay and delayed return to usual activities.
  • Although obesity was once thought to be a contraindication to LH, the safety and efficacy of LH are similar in obese and nonobese patients.
  • Operative times for LH are longer in obese patients vs nonobese patients.
  • LH vs other techniques may be associated with an increased risk for cystotomy, but overall risk is low.
  • Previous cesarean delivery should no longer be considered a contraindication to either VH or LH.
  • VH may be feasible and safe in the hands of expert surgeons, even when the uterus is large.
  • When uterine size or other coexisting disease or surgical considerations render VH not feasible, LH appears to be a safe alternative, with most of the advantages of VH over AH.
  • Direct costs of either VH or LH are less than those of AH.
  • Institutional costs of LH may be higher than for VH, depending on instrumentation.
  • LH has approximately half the indirect costs of AH.
  • In women with cervical or endometrial carcinoma, LH vs AH has a lower morbidity risk but a comparable efficacy.
  • LH may not be appropriate for women with cardiopulmonary disease or other medical conditions posing unacceptable risks for general anesthesia or for increased intraperitoneal pressure because of laparoscopy.
  • LH may be inappropriate in women needing morcellation for uterine malignancy.
  • Neither LH nor VH may be appropriate if access is lacking to the surgeons or facilities needed, or if these approaches are unsafe or unreasonable because of uterine disease or adhesions significantly distorting the anatomy.
  • Surgeons lacking the needed training and skills to safely perform VH or LH should collaborate with or refer patients to surgeons with these qualifications.

Clinical Implications

  • The AAGL has issued a position statement recommending minimally invasive surgical approaches such as VH and LH for benign uterine disease because these procedures offer advantages vs AH to women, their families, their employers, and the healthcare system in general.
  • AH should be reserved for those few women in whom a LH or VH is not appropriate. These situations are not common.

viernes, 13 de agosto de 2010

Terapia de Reemplazo Hormonal - Guías 2010

Me parece interesante y se aterriza un poco en este tema. Disculpen por la falta de traducción.

Medscape Ob/Gyn & Women's Health

Menopausal Hormone Therapy: 2010 Guidelines From NAMS and Endocrine Society

JoAnn E. Manson, MD, DrPH

Posted: 08/04/2010







Hi, I'm JoAnn Manson, Professor of Medicine at Harvard Medical School and Chief of the Division of Preventive Medicine at Brigham and Women's Hospital. I would like to talk with you today about 2 recent reports on menopausal hormone therapy. One of these reports was a physician statement from the North American Menopause Society (NAMS) published in the journal Menopause, and the second is a scientific statement from The Endocrine Society published in the Journal of Clinical Endocrinology and Metabolism; both were published in recent months.

These 2 reports provide perspective and interpretation of recent findings on hormone therapy and how they can inform clinical decision making. Overall the reports are remarkably congruent in terms of their interpretation of the recent findings. There are at least 3 areas where the reports find common ground. One of the areas is that they both endorse the concept of the timing hypothesis, which suggests that a woman's age and time since onset of menopause influence her health outcomes on hormone therapy and her overall benefit-risk ratio. This seems to be particularly true for coronary events and all-cause mortality.

The second area of common ground is the emphasis on absolute risk and the background risk for clinical events in a woman, which is heavily influenced by a woman's age and time since menopause. A woman who has a low absolute risk for coronary disease, stroke, various cancers, and all-cause mortality is less likely to have adverse events from hormone therapy and more likely to have a favorable tradeoff in terms of the effects she'll have. Therefore, she will be more likely to have an indication for hormone therapy use because she is recently menopausal and may have hot flashes and night sweats, and will be less likely in absolute terms to have a stroke, clinical event, or adverse event related to hormone therapy. This would lead to a more favorable benefit-risk ratio.

Another area of common ground is that both reports recommend that hormone therapy use be limited to the management/treatment of menopausal symptoms and not be used for chronic disease prevention. This is particularly important in regard to the findings from the post-stopping period of the estrogen-plus-progesterone trial that showed several cancers increased, including lung cancer, which became apparent after stopping hormone therapy, and overall the benefit-risk ratio became less favorable after stopping. It's clear that hormone therapy continues to have a clinical role in the management of menopausal symptoms but not for prevention of chronic disease outcomes, and that's where the tradeoff may be less favorable, especially with long-term use.

Overall we need more research on hormone therapy in recently menopausal women. We need to know more about the role of the dose of hormone therapy; lower doses are now being used. We also need to know more about different routes of delivery (eg, the transdermal option), and also the effect of bioidentical hormones on the benefit-to-risk-ratio: Is there really any evidence that they are more effective or safer than conventional hormone therapy?

These recent reports do help to inform clinical decision making about hormone therapy and are very useful and helpful in providing us perspective on the recent evidence. Thank you for listening. I'm JoAnn Manson.

  1. North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010;17:242-255. Available at: http://www.medscape.com/viewarticle/718376 Accessed July 30, 2010. Download pdf.
  2. Santen RJ, Allred DC, Ardoin SP, et al. Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab. 2010;95(suppl 1):S1-S66. Available at: http://www.endo-society.org/journals/ScientificStatements/upload/jc-2009-2509v2.pdf Accessed July 30, 2010.

viernes, 12 de marzo de 2010

Tecnologías de la Información y Comunicación

A solicitud de varias personas pongo a disposición la presentación impartida el pasado 26 de febrero del 2010. Muchas gracias a todos por su asistencia y atención, y en especial a aquellas personas que me han manifestado su agrado. Es indispensable reconocer la colaboración del Msc. Johnny Cartín Quesada, profesor del curso de Didáctica Universitaria, en el contenido de la presentación.

viernes, 13 de noviembre de 2009

ASCCP 2010 - Biennial Meeting

A solicitud del Dr. Jorge Sagot, se pone a disposición de todos la siguiente información con respecto a la reunión de la ASCCP, a realizarse durante el mes de marzo del 2010 en Las Vegas, Nevada.

lunes, 26 de octubre de 2009

Anticoncepción

A solicitud de la Dra. Flory Morera se pone a disposición el siguiente artículo sobre anticoncepción, esperando que les sea de utilidad a todos, principalmente a los que imparten la clase de anticoncepción.

viernes, 23 de octubre de 2009

Vacuna contra HPV

Siempre estamos presionados por las visitas de las compañías farmacéuticas para que recetemos y recomendemos sus productos. A continuación encontrarán un enlace a un artículo interesante que compara las dos vacunas contra HPV que existen en el mercado. Además aprovecho para mantener el blog actualizado. Acuérdense que cualquiera puede publicar; me parece particularmente útil para divulgar los temas de las sesiones. Espero les sea de provecho.