[Mammary ductal ectasia child. Diagnostic and therapeutic approach]. / Ectasia ductal mamaria infantil. Aproximación diagnóstica y terapéutica.

Mammary duct ectasia in childhood is a rare disease. It appears typically as a periareolar mammary mass and/or nipple discharge. Even though in the adult age is an acquired disease, its occurrence in children suggests it may constitute a development mammary gland anomaly. Sonography is highly useful in the diagnosis. Differential diagnosis must include other nipple discharge and mammary mass causes as the juvenile fibroadenoma or malignant pathology. This usually is a self-limited process, so that a conservative approach is recommended, even though occasionally surgical treatment is required. We report the case of a 13 years old girl with nipple discharge who finally was diagnosed bilateral mammary duct ectasia.

[Comparative study between pregnancies induced for premature rupture of membranes and for prolonged pregnancy]. / Estudio comparativo entre gestaciones finalizadas electivamente por rotura prematura de membranas y por gestación cronológicamente prolongada.

BACKGROUND: To decrease maternal and fetal morbidity oftem is indicated the elective termination of pregnancy; when the cervix is unfavourable, it is possible to try to artificially reproduce these changes with exogenous prostaglandins. OBJECTIVES: Comparative evaluation of maternal and fetal results between patients in which cervical ripening is practiced with indication of premature rupture of membranes and those with prolonged pregnancy. MATERIAL AND METHOD: Historic cohorts study about pregnancies requiring cervical ripening, either for premature rupture of membranes or for gestational age > or = 41 weeks, in the "Miguel Servet" Hospital (Zaragoza, Spain), from 15/11/2005 to 15/05/2008. In all the cases dinoprostone (slow release vaginal system) was employed and the initial Bishop score was < 7. The main analysed outcomes were: intrapartum fetal heart monitoring characteristics, type of delivery, umbilical artery pH, Apgar score, hospitalization in neonatal unit requirement and time from cervical ripening start to delivery. RESULTS: Neonatal hospitalization was significantly more frequent in the ruptured membranes cohort (11.70% vs 2.33%); p = 0.001. This difference could be justified by gestational age (OR: 2,623. IC: 0.515-13.353. P = 0.246). It was observed more time cervical ripening - delivery in prolonged pregnancies cohort (25.96h vs 20.11h); p < 0.001. Umbilical cord medium pH was significantly superior in ruptured membranes group (7.25 vs 7.23); p = 0.017. No significant differences were observed in the rest of analyzed outcomes. CONCLUSIONS: Pregnancies electively ended for premature rupture of membranes are associated with a shorter time to delivery and a slightly superior umbilical cord pH than induced prolonged pregnancies. Neonatal hospitalization requirement is determined by gestational age but not by the rupture of the membranes. Cervical ripening in those patients has been demonstrated to be secure and effective.

[Cervical preinduction and oligoamnios]. / Preinducción cervical y oligoamnios.

BACKGROUND: Twelve percent of women with 41 weeks of gestation and more had oligoamnios. Physiopathological mechanism of this disease still is under discussion. OBJECTIVE: To evaluate perinatal result of patients with more than 41 weeks of gestation oligoamnios-preinduced. PATIENTS AND METHOD: Analytic-observational and retrospective cohorts study. Patients with more than 41 weeks of gestation, oligoamnios-preinduced, were included. All patients received dinoprostone and had a Bishop score lower than seven. Amniotic fluid index of five or lower suggests diagnosis of oligoamnios. Preinduction indication, characteristics of intrapartum fetal monitoring, umbilical artery pH, Apgar score, neonatal weight, and admission in a neonatal unit were the variables analyzed. RESULTS: Among the 96 patients, 28 (29.2%) constituted the exposed cohort and 68 (70.8%) the non-exposed one. Both groups were homogeneous in maternal age, parity and initial Bishop score. There weren't significant differences for way of delivery, cesarean section indications, meconium-stained amniotic fluid and umbilical cord pathology. Frequency of bradycardia was significantly higher in oligoamnios group (14.3 vs 1.5%), as well as Apgar score at first (mean of 8.86 vs 8.38) and fifth birth minute (mean of 9.89 vs 9.69). Fetal weight was significantly lower (3,298 vs 3,546 g) in oligoamnios group. Admission in neonatal unit was higher in the non-exposed cohort (1.47%). CONCLUSIONS: Newborns of patients with oligoamnios had a better Apgar score, lower fetal weight and higher frequency of intrapartum bradycardia (without neonatal damage). A further study may offer new conclusions.

Síndrome de Meckel. Diagnóstico prenatal y diagnóstico diferencial / Meckel syndrome. Prenatal diagnosis and differential diagnosis

El síndrome de Meckel es un infrecuente y letal síndrome polimalformativo de herencia autosómica recesiva. Su incidencia oscila entre 1:1.300 y 1:140.000 nacimientos. Las malformaciones que se observan con más frecuencia son a nivel del sistema nervioso central (frecuentemente meningoencefalocele occipital), displasia renal multiquística bilateral, fibrosis hepática y polidactilia. La alteración genómica que lo produce puede localizarse en diversos loci. El diagnóstico prenatal es posible mediante sospecha ecográfica y, en muchos casos, mediante estudio del ADN fetal. Presentamos el caso de una paciente que tuvo 2 embarazos consecutivos en los que se diagnosticó dicho síndrome (AU)

Meckel syndrome is an infrequent and lethal syndrome characterized by multiple malformations. Inheritance is autosomal recessive. The incidence of this syndrome ranges from 1:1,300 to 1:140,000 births. The most common malformations are those affecting the central nervous system (usually occipital meningoencephalocele), bilateral renal cystic dysplasia, fibrotic changes of the liver and polydactyly. The associated genomic alteration can involve distinct loci. Prenatal diagnosis is feasible with ultrasound findings and, in numerous cases, with fetal DNA analysis. We present the case of a woman who had two consecutive pregnancies with a diagnosis of Meckel syndrome (AU)

Síndrome de Fraser / Fraser syndrome

El síndrome de Fraser es una enfermedad autosómica recesiva infrecuente. Su diagnóstico precisa al menos dos criterios mayores y uno menor, o bien un criterio mayor y cuatro menores (descritos por Thomas et al, en 1986). Presentamos el caso de una niña con dicho síndrome, nacida tras una gestación sin factores de riesgo, que no fue diagnosticado anteparto. Este caso presenta numerosos criterios diagnósticos (criptoftalmos, sindactilia, anomalías genitales...) y además algunas malformaciones muy infrecuentes en dicho síndrome como la ausencia de ovarios. Debemos sospechar este síndrome si la ecografía muestra oligoamnios, pulmones hiperecogénicos y voluminosos, agenesia renal y/o anomalías orbitarias (AU)

The Fraser syndrome is an infrequent recessive autosomal disease. Two major criteria and one minor criterion or one major and at least four minor criteria are required for the diagnosis (provided by Thomas et al in 1986). We present the case of a newborn with Fraser syndrome, born after a no - risk pregnancy, that was not detected before the delivery. This case shows numerous diagnostic criteria (cryptophthalmos, syndactyly, abnormal genitalia...) and some very infrequent malformations as a part of this syndrome as the ovarian absence. We should think about this syndrome when the ecography shows oligohydramnios, hyperechogenic and voluminous lungs, renal agenesis and/or ocular malformations (AU)