Cirugías Comunes con Incisiones Mínimas

Menos dolor y mejor recuperación

El desarrollo vertiginoso de la ciencia en las últimas décadas ha generado un fenómeno que supera a veces nuestra capacidad de asombro.  La medicina en sus distintas especialidades no ha sido ajena a este suceso, y en el caso de la cirugía ha incorporado nuevos conceptos que cambian radicalmente el enfoque de la cirugía tradicional.

Todos sabemos que al momento de realizar una operación, el cirujano necesita realizar una incisión para poder alcanzar el problema y resolverlo.  El espacio necesario para trabajar “con la mayor seguridad posible” trajo aparejada la idea de que “a grandes cirujanos, grandes incisiones”. Esto significaba que era necesario “exponer lo suficiente” el área de trabajo para asegurar buenos resultados en la operación.   Alcanzado el éxito de la cirugía, los problemas se centraban ahora en la recuperación, ya que una incisión grande implica mucho más dolor, más tiempo de recuperación y una demora considerable en el retorno a la actividad laboral.

Basados en la idea de generar el menor daño posible en el paciente, surgió el concepto de la Cirugía Mínimamente Invasiva, que implica el cambio de rumbo desde la cirugía tradicional “abierta” hacia la cirugía actual “cerrada”.

Esto ha sido posible gracias al desarrollo de la tecnología digital en imágenes. A través de incisiones pequeñas se introduce una cámara que ofrece al cirujano una visión amplificada y real de la cirugía, que le permite resolver con gran detalle  el problema. Es por esto que, comparada con la cirugía convencional, esta técnica mejora notablemente los resultados a largo plazo.  Además, el desarrollo de instrumental cada vez más pequeño nos permite realizar incisiones de dos a tres milímetros, con un resultado estético excelente.

Las ventajas de esta técnica se resumen en menor dolor,  menores complicaciones en la herida, mayor confort para el paciente y corta estadía en el centro asistencial.

Las condiciones para que estos modernos procedimientos puedan realizarse en forma segura tienen que ver con la calidad profesional, determinada en la mayoría de los casos por la experiencia del cirujano en prestigiosos centros de formación del extranjero, y una infraestructura, equipamiento e instrumental adecuados para cada caso.

Es así como asistimos hoy a la posibilidad de resolver en forma segura a través de incisiones muy pequeñas, problemas habituales de distintas especialidades. A modo de ejemplo, afecciones de vesícula, hernias inguinales, quistes de ovario, varicocele, y hasta algunos casos de nódulos tiroideos pueden ser operados de este modo.

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Accelerated Fertility Treatment Leads to Shortened Time to Pregnancy and Charge Savings

For couples beginning infertility treatments, an accelerated path to IVF omitting the gonadotropin-stimulated artificial insemination cycles that conventionally precede assisted reproductive technology results in a shorter time to pregnancy. The accelerated treatment program also results in lower average charges per delivery.

Couples with unexplained infertility seeking treatment at Boston IVF or Harvard Vanguard Medical Associates were screened for eligibility to participate in the randomized, controlled trial. Eligibility criteria included: trying to conceive for 12 months without prior fertility treatment (excepting up to three cycles of clomiphene without intrauterine insemination (IUI)); a female partner 21 to 39 years old with sufficient ovarian reserve and without pelvic pathology; and adequate sperm concentration in the male partner.

Couples enrolled in the study followed either a conventional course of treatment or an accelerated course until they achieved pregnancy or elected to stop treatment. The conventional treatment included three IUI cycles stimulated with clomiphene citrate for ovulation induction, followed by three FSH-stimulated IUI cycles, then up to six cycles of IVF. The accelerated treatment plan omitted the FSH-stimulated cycles and went to IVF after three clomiphene-stimulated IUIs. The couples were followed from the date of their enrollment until the closing date of the study. Charge data obtained from insurers included all healthcare items and services for women during the trial- from the time of randomization through hospital discharge of mother and baby after delivery, or until one year after completing treatment without pregnancy.

Of 503 couples enrolled, 64% delivered at least one baby by the end of the study. Babies were born to 150/247 couples in the conventional treatment group and to 171/256 couples in accelerated treatment. The time to pregnancy was significantly shortened for the couples in the accelerated arm of the study. Those couples achieved pregnancy in an average of eight months compared with an average time to pregnancy of 11 months for couples in the conventional arm.

Insurance charge data were collected for 448 participating couples. Average charges per delivery were $9,800 lower in the accelerated arm than for conventional treatment. Savings of $2,624 per couple were observed in the accelerated treatment arm.

Foregoing gonadotropin-stimulated IUI eliminated not only the charges for that treatment from overall charges, but also reduced the risk of multiple conception and the increased charges associated with multiple pregnancies and births.

Elizabeth Ginsburg, President of the Society for Assisted Reproductive Technology, commented, “This is a very important study that will likely influence physicians to reduce the number of stimulated inseminations for patients with unexplained infertility. Adoption of such an accelerated course of treatment could result in many patients conceiving in less time with less expense.”

Worldwide report shows an increase in Assisted Reproduction

An estimated 250,000 babies are born in one year

Assisted reproductive technology (ART) is responsible for an estimated 219,000 to 246,000 babies born each year worldwide according to an international study. The study also finds that the number of ART procedures is growing steadily: in just two years (from 2000 to 2002) ART activity increased by more than 25%.

The study, which is published online in Europe’s leading reproductive medicine journal Human Reproduction, gives figures and estimates for the year 2002, the most recent year for which world figures are available. A total of 1563 clinics in 53 countries provided data for the report, but data were missing from several other countries, mostly in Asia, Africa, Oceania and the West Indies. The authors estimated that these missing countries probably performed between 10-20% of ART procedures, and they took this into account when they calculated the total number of ART babies born worldwide.

Professor Jacques de Mouzon, a specialist in public health at INSERM (Paris, France), led the International Committee for Monitoring Assisted Reproductive Technology (ICMART) that compiled the report. He said: “This is the eighth world report on ART produced by ICMART since 1989, and is useful because, even if it is imperfect, it gives data that can inform debate and decision-making on issues such as availability and the benefits and risks of this important medical practice. It allows us to make comparisons between countries and regions, and to analyse trends by comparing with previous reports.

“There are several important points to highlight. There has been a constant increase in ART activity: it increased by more than 25% in the two years since the previous report for the year 2000. This is due not only to an increase in the number of countries participating in this report but also to an increase in ART activity in most individual countries.

“However, there are wide variations between countries in the availability and quality of ART. There are several reasons for this, such as fertility rates, women’s age, insurance cover, the national economy, but the most important is certainly inequality in access to healthcare and ART. In Western Europe it is easier for people to access good healthcare, and funding for ART tends to be more generous than in developing countries. This raises the question of developing so called ‘low cost’ ART in low-income countries; it would probably mean lower success rates (the problem would be to define what rates would be acceptable), but greater access to treatment. In addition, treatment is usually more aggressive in developing countries and in all countries where ART is expensive for patients, leading to the consequent problems of multiple births, ovarian hyperstimulation syndrome and the need for foetal reductions.”

Availability of ART varied from two cycles per million inhabitants (Ecuador) to 3688 per million in Israel.

Other key findings from the study include:

1. A large increase in the use of ICSI (intracytoplasmic sperm injection) as opposed to conventional IVF (in vitro fertilisation) worldwide. Since 2000 it increased from 54% to 61% in North America, 46% to 54% in Europe, and in 2002 it had reached 76% in Latin America and more than 92% in the Middle East.

2. Pregnancy and delivery rates have increased for both fresh and frozen embryo cycles despite a decrease in the number of embryos transferred. More than 601,250 ART cycles worldwide resulted in delivery rates after IVF, ICSI and frozen embryo transfer (FET) of 22%, 21% and 15% respectively per aspiration (attempt at egg retrieval). This compares with delivery rates after IVF, ICSI and FET in 2000 of nearly 19%, 20% and 12% respectively.

3. When cycles using fresh embryos were combined with frozen embryo cycles, the cumulative delivery rate per aspiration was 26%.

4. Cumulative delivery rates per aspiration varied among countries, ranging from 14% to 39%. While Tunisia and Libya reported the highest rates at 39%, this represented only a few fertility centres in each country. Therefore, the USA, where reports cover almost all fertility centres in the country, had the highest rate at 37.5%.

5. The transfer of multiple embryos has decreased, leading to a small decline in multiple births. The percentage of four or more embryo transfers decreased from 15.4% in 2000 to 13.7% in 2002. The proportion of twin and triplet pregnancies decreased from 26.5% to 25.7%, and from 2.9% to 2.5% respectively.

6. There has been a 47% increase in the proportion of FET cycles, which is due mainly to the decrease in the number of embryos transferred at one time, with any left over being frozen for future attempts.

Prof de Mouzon said: “It is difficult to explain the reasons behind the increase in ICSI as we have no reason to believe there has been a similar increase in the rise in male infertility, and ICSI has not been demonstrated to improve treatment results for infertility that is not caused by infertile men. It could be because more infertile men are agreeing to seek treatment, that the diagnosis of male infertility is improving, that male infertility per se is increasing (due to exposure to sperm-damaging compounds in the environment), that fertility teams turn to ICSI more rapidly when conventional IVF fails, or that ICSI is still viewed as more efficient, even in the absence of scientific proof, which may be the major factor in Latin America and the Middle East. I suspect the overall explanation is probably a mixture of several of these factors.”

The increased use of frozen embryo cycles was very good news because it improved cumulative pregnancy and delivery rates and helped reduce the number of multiple embryo transfers and multiple births, he said.

“Our report shows that delivery rates per aspiration increased in 2002 even though the average number of embryos transferred was reduced. For example, in Australia where a mean average of 1.8 embryos were transferred, the delivery rate per aspiration was 19.5% for fresh cycles and 29.4% for fresh and frozen cycles together. This should encourage countries to implement embryo transfer policies that reduce the risk of multiple births,” said Prof de Mouzon.

The authors warn that variation in data quality, in addition to differences in practices, legislation, guidelines, culture and religion, means that comparisons between countries “must be done with caution”.

SOURCE: www.eshre.com 

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Survey Shows Majority of Respondents Openly Discuss Use of BOTOX® Cosmetic and Hyaluronic Acid Dermal Fillers

“In a similar survey issued four years ago, we dispelled the myth that Hollywood and corporate wives were the typical BOTOX® Cosmetic patient,” says ASERF President Laurie Casas, MD, a plastic surgeon practicing in suburban Chicago. “Now, demographic and perception data trends show us that aesthetic injectable treatments have continued to evolve into mainstream and accepted options for the everyday woman.”

Survey results found that the typical aesthetic injectable patient is a married, working mother between 41-55 years of age with a household income of under $100,000. The survey also found that women receiving aesthetic injectable treatments are health-conscious and philanthropy minded, with the majority incorporating exercise (95 percent) and healthy eating habits (78 percent) into their lives, and many volunteering with charitable organizations that matter to them (32 percent). In addition, nearly seven out of 10 respondents believe that BOTOX® Cosmetic (72 percent) and hyaluronic acid dermal fillers (65 percent) are important parts of their aesthetic routine.

“Interestingly, among BOTOX® Cosmetic patients, nearly seven out of 10 respondents also received treatment with hyaluronic acid fillers,” says Dr. Casas. “Most people have great success with BOTOX® Cosmetic and dermal fillers; however, we need to make patients aware that even though injectables are not ‘surgery,’ their administration is a medical procedure with risks that depend on the training and experience of the clinician, the clinical setting and the technique used.”

Additional findings of the survey found that 72 percent of respondents received BOTOX® Cosmetic injections to treat their glabellar lines – also referred to the “11” – the frown lines in between the brows, while 63 percent of those surveyed received hyaluronic acid dermal filler injections to treat their nasolabial folds – also known as the “parentheses” – the lines around the nose and mouth. A few of the most frequently cited reasons to receive treatment with BOTOX® Cosmetic was “to look more relaxed, less stressed” while patients reported choosing treatment with hyaluronic acid dermal fillers to “look more rejuvenated.”

Based on its annual survey of U.S. physicians performing cosmetic procedures, ASAPS recently reported that BOTOX® Cosmetic injections have remained the most frequently performed procedure since FDA approval of the product in 2002. Hyaluronic acid dermal fillers ranked as the third most popular procedure performed last year. ASERF conducted this follow-up survey to quantify the characteristics and opinions of the patients who receive the treatment to help its members and the public obtain a better understanding of these important modalities.

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Infertilidad sin causa aparente

Definición y diagnóstico

La infertilidad o subfertilidad sin causa aparente es un diagnóstico de exclusión que suele determinarse en un10 a 15% de las parejas con infertilidad o subfertilidad.

El profesional así lo denomina cuando la etapa de diagnóstico de la pareja descartó otras causas posibles. No significa que no hay razón para la infertilidad, sino que la causa no se ha podido identificar aún.

La evaluación convencional de la infertilidad en la mujer puede incluir: historia médica, examen físico, niveles de hormonas en sangre, función ovulatoria e histerosalpingografía (HSG) (radiografía del útero y trompas de Falopio). Laparoscopía, lo que comprende la inserción de un instrumento delgado, como un telescopio iluminado dentro del abdomen para ver el útero, ovarios, y trompas de Falopio; puede ser necesario excluir factores como la endometriosis y adherencias que pueden no ser vistas por HSG.

La evaluación convencional en el hombre puede incluir: historia médica, examen físico, análisis de semen y exámenes de hormonas. Tests para determinar la capacidad fertilizante del esperma del esposo, o pruebas de penetración de ovocitos de hamster pueden ser realizados pero no son completamente con?ables. Este problema, sin embargo, puede ser descubierto durante la Fertilización in Vitro (FIV).

La FIV es una técnica de reproducción asistida que une en el laboratorio el ovocito (huevo) con el esperma. Si el ovocito fertiliza y comienza su división celular, el embrión resultante es luego transferido al útero de la paciente.

Otros factores

Los factores más relevantes para ser considerados en la evaluación y manejo de la infertilidad sin causa aparente son la duración de la infertilidad y la edad de la mujer.

Una pareja joven sin problemas de infertilidad cuenta con un 20% de probabilidad de embarazo por mes. Por el contrario, parejas con infertilidad sin causa aparente que no han logrado el embarazo durante tres años, tienen una chance de embarazo espontáneo de 1 a 2% por mes solamente.

El proceso de envejecimiento en la mujer, particularmente luego de los 35 años, trae aparejado una reducción en la capacidad reproductiva e incremento en los abortos espontáneos. Las pruebas de capacidad reproductiva (reserva ovárica) que pueden incluir niveles de FSH y estradiol en el día 3 del ciclo menstrual para evaluar la función ovárica. Parejas infértiles o subfértiles, donde la mujer es mayor de 35 años, deberían consultar sin demoras al especialista luego de 6 meses sin lograr embarazo. Especialmente cuando se haya identificado un factor de infertilidad como endometriosis, historia de ciclos menstruales irregulares, etc.

Tratamiento

No hay acuerdo sobre el procedimiento óptimo para tratar la infertilidad sin causa aparente, dado que muchas parejas con uno a tres años en esta situación, finalmente lograrán concebir espontáneamente.

En la mujer, el tratamiento empírico (tratamientos de infertilidad cuando no hay una causa definida) con drogas inductoras de la ovulación por 3 a 4 ciclos combinados con inseminación intrauterina (IIU) (insertando el semen procesado directamente dentro del útero), seguido de FIV es un proceso frecuentemente utilizado.

Investigaciones recientes indican que las tasas de embarazo con estos tratamientos son iguales o más altas que las tasas de embarazo de parejas con otros diagnósticos de infertilidad.

En el futuro, un conocimiento mejor de la fisiología reproductiva humana permitirá tratamientos aún más efectivos para pacientes con infertilidad sin causa aparente.

Contáctenos para tener una consulta con el  Doctor Andrés Juárez Villanueva o el Doctor Gustavo Gallardo.

Nearly 15-Million U.S. Working Women Considering Cosmetic Procedures

Faced with news of increasing layoffs, straining economic times, and a belief that hiring is based on looks, millions of American women are looking at cosmetic medical procedures to give them a competitive edge in the workplace. In a new telephone survey* compiled by the American Society of Plastic Surgeons (ASPS) of 756 women between the ages of 18 and 64, many reveal cosmetic plastic surgery procedures now appear to be an important rung on the success ladder.

* 13 percent (more than 1 out of 10 of the 115-million working-age women) say they would consider having a cosmetic medical procedure specifically to make them more confident and more competitive in the job market.

* An astounding 3 percent (nearly 3.5-million working women) say they’ve already had a cosmetic procedure to increase their perceived value in the workplace.

* 73 percent (almost three out of four or, 84-million working women) believe, particularly in these challenging economic times, appearance and youthful looks play a part in getting hired, getting a promotion, or getting new clients.

* 80 percent (four out of five or 92-million working women) think having cosmetic medical procedures can boost a person’s confidence.

An Insurance Broker recently had a chemical peel and fat transfers from her abdomen to her face. “Time has given me the professional knowledge. But time can take away the youthful sparkle of my appearance if I let it. When you look good, you feel confident. That gives me a competitive edge and something my clients have come to expect from me,”.

ASPS Member Surgeon, MD performed Axelrod’s cosmetic procedures at Advocate Lutheran General Hospital in Park Ridge, Illinois. He says “Not only do the women believe youthful looks help in the workplace…they’re acting on that belief.”

“Consumers need to remember that while cosmetic procedures might help them in the job market, they’re still medical procedures.”

Feel free to contact us for a free quotation with Doctor Roberto Martinez Rinaldi.

Source: ASPS