Predicción de la madurez fetal mediante la caracterización ultrasónica del pulmón

AimTo evaluate the usefulness of computerized ultrasound texture analysis of fetal lung in the determination of fetal maturityMaterial And MethodsHistograms of fetal lung and liver frequency were obtained by ultrasonography in 230 fetuses aged between 20 and 42 weeks. The relationship between both organs was analyzed by mean grey-levels, standard deviation and histogram width. In 20 fetuses, sonographic data were compared with biochemical data obtained from amniotic fluidResultsThe liver showed no changes in the reflection pattern in the different gestational ages while from weeks 33-34 pulmonary sonographic refringency significantly increased. These modifications were also seen when we analyzed histogram width and on comparison with fetal biometric data or stages of lung development. Significant correlations were obtained when mean grey-levels of the lung/liver and histogram width were compared with several biochemical parameters in amniotic fluid, particularly with the L/S index and OD 650ConclusionsThe fetal lung is mature when pulmonary echogenicity is greater than that of the liver and when the mean grey-level of the lung/liver is higher than unit (1.04) and histogram width is 2.2     

Descripción de un caso de angioedema hereditario dependiente de estrógenos

IntroductionHereditary angioedema is a rare genetic disease without any specific treatment.Main symptomsIt is characterized by recurrent episodes of skin and mucous oedema.Main diagnosesThere are three types of angioedema and type III has been related to high-level oestrogen conditions.Therapeutic interventionsWe describe the case of a patient with hereditary angioedema type III, who had an episode of angioedema associated with the periovulatory and premenstrual period.Due to this hormonal influence, we used gestagen therapy to attempt to reduce the number of ovulations.ResultsAfter several months of treatment with desogestrel, the patient reports a decrease in the number and severity of episodes.ConclusionGestagen therapy seems to be useful for controlling episodes of hereditary angioedema type III.     

Struma ovarii: presentación de 37 casos y actualización de la evidencia disponible

Objective

To determine the medical data that could behave as risk factors for poor prognosis in the struma ovarii, as well as establishing the criteria that could be of help for an early diagnosis, comparing the results obtained, with the scientific evidence that has been published to date.

Un caso de osificación endometrial

Endometrial ossification is a rare condition mainly associated with two factors: First, a malignant tumor, especially a mixed müllerian tumor. Second, a previous miscarriageThe pathogeny of the ossification is not totally understood. While, for some, it represents just a mere inclusion of fetal parts in endometrial stroma, it is, for others, the outcome of complete osseous metaplasiaWe present a case of endometrial ossification in a 27-year-old woman, secondary to previous curettage owing to miscarriage, seven months before     

Uso del balón intrauterino en caso de inversión uterina recurrente

Uterine inversion is an infrequent but serious obstetric emergency. Management of uterine inversion should be staggered to control postpartum haemorrhage, return the uterus to the abdominal cavity and prevent recurrent inversion. In cases of resistant inversion, the intrauterine balloon has been reported to control bleeding and prevent uterine reversal. This is conservative management, which maintains the reproductive potential of women and constitutes an additional use for the intrauterine balloon in the delivery room. We present a case of grade III uterine inversion with subsequent incomplete reinversion in a low-risk pregnancy after eutocic delivery. Manual uterine replacement and administration of uterotonics was performed in the delivery room, showing partial or incomplete uterine inversion, vaginal bleeding with maternal haemodynamic instability. In the operating room, under general anaesthesia and uterine relaxation, complete uterine replacement was performed under ultrasound guidance, the patient was stabilized, and bleeding was controlled using a double-balloon tamponade system.     

Malformación adenomatoidea quística de pulmón: diagnóstico prenatal

Congenital cystic adenomatoid malformation of the lung (CCAM) is a congenital lesion amenable to prenatal ultrasound diagnosis. The initial finding is a solid or cystic intrathoracic mass. Ultrasound allows not only prenatal diagnosis but also detection of possible complications, that may affect managementTwo cases of CCAM are presented, with different clinical course in both the prenatal and postnatal periods. In both cases, long term outcome was favorable. The main characteristics of this malformations, its prenatal management and the different treatment option are reviewed     

Opinión de las parejas sobre el futuro de sus embriones pasados 5 años de congelación

ObjectivesTo contact all the couples who have embryos that have been frozen for more than 5 years at the Institut Universitari Dexeus and to know their opinion about the different options.Material And MethodsCurrently, 1,419 frozen embryos from 260 couples have remained in our center for more than 5 years. These couples were contacted by telephone and/or by a written questionnaire.ResultsAmong the legal options in our country, 24 (27%) couples prefer the self-transfer, 29 (32.5%) secondary donation and 28 (31.5%) disagreed with the legal options given. Concerning other currently illegal alternatives, 28 (31.5) would accept donation for research and 39 (43.8%) would prefer destruction of the embryos.ConclusionsThe results of this study show that it is necessary to review the current legal regulations in our country.     

Comparación de costes de la cesárea mediante técnicas de Misgav Ladach y convencional con incisión de Pfannenstiel

ObjectiveTo compare the costs of the Misgav- Ladash method of cesarean delivery with those of the conventional cesarean technique.Subjects and methodsWe performed a retrospective, observational analysis of a sample of 96 cesarean operations performed from 2001–2002 at the Severo Ochoa Hospital, using the Misgav Ladach technique and conventional methods.ResultsDemographic characteristics and indications for cesarean section were similar in both groups. The costs of each technique were estimated by evaluating surgical and postsurgical data and a saving of 164.5 z.euro; was found for the Misgav Ladach group.ConclusionsThe Misgav Ladach method for cesarean delivery is cost-effective and reduces costs in comparison with the conventional method.     

Síndrome de transfusión feto-fetal

Twin-twin transfusion syndrome is a complication that appears in 10-15% of hiamniotic monochorial twin pregnancies. The syndrome occurs only in this type of multiple pregnancy and is caused by te presence of multiple and unbalanced arteriovenous anastomoses, which result in the oligoamnioshydramnios sequence. Fetal involvement is due to hypovolemia in the donor twin and hypervolemia in the recipientWe present our experience of this type of condition and discuss differences in management according to gestational age and severity at diagnosis. There are two types of procedure in our centre: firstly, legal termination of pregnancy in the earliest and most severe cases and secondly amniodrainage in patients referred at the beginning of the third trimesterWe provide a review of the literature on currently accepted treatment options, which range from expectant management with 100% mortality to etiological treatments based on selective laser ablation of the arteriovenous communications. This latter treatment has a 70% survival rate of a least one twin and a neurological handicap rate of less than 5%     

Corrección de la incontinencia urinaria de esfuerzo mediante cinta libre de tensión (TVT). Resultados a corto plazo

PurposeTo analyse the short term results of tension free vaginal tape (TVT) implantation in order to relieve stress incontinence inpatients with no associated pelvic pathologyMaterial and methodsA cross sectional study was conducted on 56 patients who, after clinical and urodynamic testing, had been diagnosed with genuine stress incontinence. A TVT device was implanted in all the patients. Surgical technique and methodology were analysed together with any associated complicationsResultsThe success rate (total cure) in this group of patients was 96% (54/56). One patient subjectively improved (1.8%) and one had to have the implant removed due to urinary retentionConclusionTension free vaginal tape implantation is a useful technique in the short term for the correction of stress incontinence     

Angioleiomiosarcoma de clítoris. Presentación de caso

Vulvar carcinoma is rare, and represents 3-5% of the all gynaecological cancers. Epidermoid carcinoma accounts for 90% of them, followed by melanoma, Paget?s disease, Boweńs disease illness, basal carcinoma and sarcomas. The leiomyosarcoma is the most frequent type of sarcoma. The case is presented of a 29 year-old woman that suffered from clitoral tumour. She was treated for a benign lesion in the labia majora 3 years ago. In the current referral, she presented with pain and an ulcerated lesion, without local or regional adenopathies. The total excision was referred for a histological study, and the results showed an angio-leiomyosarcoma of the clitoris. Two years later, the patient showed no signs of residual lesion.     

Neuroestimulación de cordones posteriores y gestación. Evidencia y recomendaciones sobre el uso de la neuroestimulación durante el embarazo y el parto

Currently, spinal cord stimulation is used to manage chronic pain syndromes such as complex pain syndrome. However, many patients are women of childbearing age who may later become pregnant and the effects of this therapy on the pregnancy and developing foetus are unknown. We report the case of a 26-year-old woman who became pregnant after undergoing implantation of a posterior spinal cord stimulator. The purpose of this case report is to review and summarize the existing literature and recommendations on the use of spinal cord stimulation during the prenatal period and labour.