DIU como anticonceptivo de emergencia

El problema es definir cuando empieza la vida, entonces decir si un metodo anticonceptivo es abortivo, o no, tiene que ver con este concepto previo.

Sin entrar en la discusion filosofica sobre el comienzo de la vida, aca un review donde muestra la alta efectividad del DIU como metodo anticonceptivo de emergencia.

 BACKGROUND Intrauterine devices (IUDs) have been studied for use for emergency contraception for at least 35 years. IUDs are safe and highly effective for emergency contraception and regular contraception, and are extremely cost-effective as an ongoing method. The objective of this study was to evaluate the existing data to estimate the efficacy of IUDs for emergency contraception.

RESULTS The 42 studies (of 274 retrieved) that met our inclusion criteria were conducted in six countries between 1979 and 2011 and included eight different types of IUD and 7034 women. The maximum timeframe from intercourse to insertion of the IUD ranged from 2 days to 10 or more days; the majority of insertions (74% of studies) occurred within 5 days of intercourse.The pregnancy rate (excluding one outlier study) was 0.09%.

CONCLUSIONS IUDs are a highly effective method of contraception after unprotected intercourse. Because they are safe for the majority of women, highly effective and cost-effective when left in place as ongoing contraception, whenever clinically feasible IUDs should be included in the range of emergency contraception options offered to patients presenting after unprotected intercourse. This review is limited by the fact that the original studies did not provide sufficient data on the delay between intercourse and insertion of the IUD, parity, cycle day of intercourse or IUD type to allow analysis by any of these variables.

The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience

Cleland K. et al

Hum. Reprod. (2012) doi: 10.1093/humrep/des140

Distrofias vulvares y VIN

El liquen escleroso no es por si mismo una lesión premaligna. El riesgo de transformación a CA (carcinoma), oscila alrededor de un 4%-6% y actualmente se discute si en realidad no sería una coexistencia de ambas lesiones sin causalidad. El riesgo es mayor en los casos dehiperplasia epitelial (se considera que el 8% van a evolucionar a carcinoma invasor)

La mayoría de las pacientes con LE nunca van a desarrollar un carcinoma vulvar, pero la mayoría de loa carcinomas vulvares se asocian a LE, Hiperplasia epitelial o VIN diferenciado. Mc Adams AJ, Kistner RW. The relationship of chonic vulvar disease, leukoplakia, and carcinoma of the vulva. Cancer  1958 ;11:740-7757

Test de Richard Collins

Consiste en pintar la vulva con Azul de toluidina al 1%  y luego de 3 minutos lavar con ac. Acético. El azúl de toluidina es captado por los núcleos celulares. En áreas de hiperqueratosis al colorante no es captado(falsos negativos), mientras que en erosiones y úlceras la tinción es muy marcada (falsos positivos).
El test de Collins, tiene baja especificidad y sensibilidad.por lo que pierde relevancia diagnóstica.

sindrome de Mondor

link a un caso clinico con review del tema EN ESPAÑOL


El sindrome de Mondor tiene una tríada sintomática característica compuesta por anemia, ictericia y cianosis, lo que constituye el llamado síndrome tricolor (pálido por la anemia, amarillo por la ictericia y azul por la cianosis).
Este síndrome es causado en la mayoría de los casos por el Clostridium perfringens , aunque lo pueden originar otros gérmenes anaerobios, grampositivos y gramnegativos, bacteriológicamente pertenece al género de bacilos grampositivos, que crecen en anaerobiosis y en el caso del C. perfringens no produce esporas en los tejidos. 
El sindrome tiene una gravedad que está dada por el corto período de incubación del Clostridium perfringens(24-48 h) y la presencia de un síndrome tóxico- hemolítico que conduce a un síndrome de disfunción o fallo multiorgánico (SMO) asociado por sí solo con una alta mortalidad independiente de lo precoz y correcto del tratamiento impuesto.

Factores de riesgo para el cáncer de mama

Factores de riesgo y causas posibles (National Cancer Institute)


Uso de terapia de reemplazo hormonal


Según los resultados, los efectos del uso de las hormonas variaron entre los tipos de cáncer de mama. En general, el riesgo de cáncer de mama aumentó de manera importante entre quienes estaban usando las hormonas.


Anticoncepción hormonal oral

• Algunos estudios han mostrado un riesgo mayor de cáncer de seno entre las mujeres que toman las píldoras anticonceptivas, sin embargo otros estudios indican que no hay cambios en el riesgo 
• Múltiples estudios han mostrado que el uso de píldoras anticonceptivas disminuye el riesgo de cáncer de ovario y de endometrio.
• Se ha mostrado que las píldoras anticonceptivas aumentan el riesgo de cáncer cervical (cérvix o cuello uterino), pero el virus del papiloma humano es el factor principal de riesgo de esta enfermedad 
• El riesgo de padecer cáncer de hígado es mayor entre las mujeres que toman la píldora anticonceptiva y que, por lo demás, tienen un riesgo bajo de padecer esta enfermedad

HPV transmission—still feeling the way

Lancet. 1999 Dec 18-25;354(9196):2097-8.

Some sexually transmitted infections such as gonorrhoea, syphilis, molluscum contagiosum, hepatitis B, herpes simplex virus, pubic lice, and scabies can be transmitted via non-sexual routes (fomites, fingers, nonsexual skin-to-skin contact, and perhaps flies).1
However, sexual intercourse (including genital-togenital, orogenital, and anogenital contact) remains by far the most important route of transmission.
Most cases of genital human papillomavirus (HPV) infection are transmitted sexually.2However, understanding of the exact modes of and risk factors for transmission of genital HPV has been hampered by the high rate of subclinical infections and the lack of a routine test that is sensitive and specific. Non-sexual transmission of genital HPV has been thought to occur among adults and among children. In the first half of this century, genital warts were believed to be transmitted by hand-genital rather than sexual contact.3 More recently, anogenital warts in children have been reported to occur as a result of hand warts in the child or relatives, mostly via non-sexual contact.4,5 This conclusion is supported by the observation that many anogenital warts in children are caused by HPV types 1–4, the types commonly found on the hands.6 Now, C Sonnex and colleagues7 have shown that HPV DNA of the genital types can be detected on the fingers of some men and women with genital HPV infections, evidence which supports the possibility that these infections could be transmitted via fingers from one adult to another.
Sexual activity often involves contact between hands and genitals. However, for transmission to occur several steps are necessary. First, intact, live virus needs to be transferred from the genitals to the fingers. The detection of HPV DNA does not necessarily imply the presence of intact, infectious virus.8 Second, most HPV types seem to be site specific.2 Consequently genital HPV types probably do not cause finger warts, rather contaminated fingers just carrying a virus may transfer HPV to the genitals. This seems to differ from the situation of  “active” transfer of skin warts from hands to genitals as described above in children, and as occasionally occurs in adults. Third, a sufficient quantity of live virus would need to be transferred from fingers to the partner’s genital tract. Hand-washing probably reduces the quantity of infectious virus. The “ infectious dose” of HPVs including genital HPV types is unknown.
Finally, some breach of the genital skin or mucosa may be necessary to allow entry of the virus, since infection takes place in the basal-cell layer of the genital squamous epithelium.9
Although each of these steps is possible, the whole sequence of events probably rarely occurs. In addition, in most circumstances, contact between hands and genitals is usually accompanied by genital-to-genital contact by which transmission is far more likely to occur because of the presence of a large amount of infectious virus and the microtrauma that commonly occurs with sexual intercourse.9
Carriage of HPV DNA on the hands of individuals with genital warts probably does not have any major
public or personal health implications. And apart from general advice about personal hygiene and handwashing, there does not seem to be any specific advice to offer. A recommendation to wear rubber gloves for all sexual contact is unlikely to enjoy much support from the general public. On the other hand, a recent casecontrol study has shown that condoms may offer substantial protection against genital warts.10 In that study, in both sexes, failure to use condoms was independently associated with an increased risk of genital warts in men (odds ratio 3·0 [95% CI 2·2–4·3]) and in women (1·7 [1·0–2·9]), whereas consistent condom use was associated with a decreased risk of warts in men and women (0·7 [0·3–0·9] and 0·7 [0·4–1·0], r espectively).10
Transmission of genital HPV by fingers may occur occasionally. However, most infections almost certainly occur because of genital-to-genital contact. At present, the only intervention that is proven to reduce the risk of genital warts is consistent condom use. Consequently, current efforts should remain directed at convincing sexually active individuals to cover their genitals, rather than their hands, with rubber.


*Adrian Mindel, Robin Tideman
Academic Unit of Sexual Health Medicine, S ydney Hospital, S ydney,
New South Wales 2001, A ustralia

1 Matters R,Wong I, Mak D.An outbreak of non-sexually transmitted gonococcal conjunctivitis in Central Australia and the Kimberley region. Commun Dis Intell 1998; 22: 52–58.
2 Koutsky LA, K iviat NB. Genital human papillomav irus. I n :Holmes KK, Sparling PF,Mårdh PD, et al, eds. Sexually transmitted diseases. 3rd edn. New Yo r k :M c G r aw - H i l l ,1 9 9 9 :3 4 7 – 5 9 .
3 Oriel JD.Viruses and chlamydiae .I n : The scars of Venus: a history of venereology. L ondon:Springer-Verlag, 1994:149–69.
4 Oriel JD. Sexually transmitted diseases in children: human papillomavirus infection. Genitourin Med 1992; 68: 80–83.
5 Handley J, Hanks E, Armstrong K, et al. Common association of HPV 2 with anogenital warts in prepubertal children. Pediatr Dermatol 1997; 14: 339–43.
6 Fairley CK, G ay NJ, Forbes A , Abramson M, Garland SM. Handgenital transmission of genital warts? An analysis of prevalence data. Epidemiol Infe ct 1995; 115: 169–76.
7 Sonnex C, Strauss S, G ray JJ. Detection of human papillomavirus DNA on the fingers of patients with genital wa rt s. Sex Transm Infect 1999; 75: 317–19.
8 Ferenczy A , Bergeron C, R ichart RM. Human papillomavirus DNA in fomites on objects used for the management of patients with genital human papillomav irus infections. Obstet Gynecol 1989; 74:
950–54.
9 Shah KV, H owley PM. Pa pillomaviruses. I n: Fields BN, Knipe DM, Chanock RM, et al, e ds. F i e l d s ’v i r o l o g y, 2nd edn. New Yo r k :R aven P r e s s ,1 9 9 0 :1 6 5 1 – 7 6 .
10 Wen LM, E stcourt CS, Simpson JM,Mindel A . Risk fa ctors for the acquisition of genital warts: are condoms protective ? Sex Transm Infect 1999; 75: 312–16.

Toma de muestra en la citología cervical

Las espátulas de punta extendida (dispositivo de Aylesbury) de diferentes diseños parecen ser mejores para la recolección de células endocervicales que las espátulas de Ayre que se usan habitualmente. La combinación más efectiva parece ser el uso del citocepillo con una espátula de punta extendida. Los trabajadores de la salud requerirán capacitación, en la forma de taller de un día, para implementar esta intervención.

Extended tip spatulas of various designs appear to be better for collecting endocervical cells than the commonly used Ayre spatula. The most effective combination appears to be the cytobrush with an extended tip spatula. The rate of detection of endocervical cells appears to be a valid and convenient surrogate for the ability to detect dyskaryosis and for adequate smear rates. The ability of the extended tip spatula with the cytobrush compared with the extended tip spatula alone to detect disease, needs to be evaluated in a trial.