[Ecographic viewing and prenatal diagnosis of infradiaphragmatic total anomalous pulmonary venous drainage: report of a case]. / Visualización ecográfica y diagnóstico prenatal de drenaje venoso pulmonar anómalo total infradiafragmático: a propósito de un caso.

Anomalous pulmonary venous connection is a rare pathology, both partial and total forms, according to the number of pulmonary veins draining into the left atrium, respectively. Total forms are classified into four groups, depending upon the anomalous connections to the systemic veins: supra, intracardiac or below, and finally a mixed form, the less frequent. Prenatal, even postnatal diagnose is difficult, especially in partial isolated forms. The association with chromosomal abnormalities is low, however is highly associated with complex heart malformations, especially total forms, often in the context of heterotaxy syndromes. We present a case of infracardiac APVC, in the context of complex heart disease, associated with complete atrioventricular canal and conotruncal anomaly, that came to surgery at 48 hours of life with poor outcome. We described the ultrasound and magnetic resonance angiography of this anomaly and its perinatal prognosis and management.

[Laparoscopic management of a spontaneous live monochorionic monoamniotic twin tubal ectopic pregnancy. A case report]. / Tratamiento laparoscópico de una gestación ectópica tubárica gemelar monocorial monoamniótica espontánea. Caso clínico.

We present a case of a spontaneous live monochorionic monoamniotic twin tubal ectopic pregnancy detected by transvaginal ultrasound scan after medical therapy with single dose of methotrexate failed. The incidence of this type of ectopic pregnancies is probably arising due to the increasing use of the assisted reproduction techniques, but they are underdiagnosed and mistreated, as surgical approach seems to be the most adequate in these cases.

The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients.

BACKGROUND AND AIM: To asses the nutritional status of hospitalised trauma patients and the repercussion on the clinical follow up. METHODS: In a prospective way 161 adult patients admitted to the units of Intensive Care (ICU), General Surgery, Maxillofacial Surgery and Orthopedics of the Centro de Emergencias Médicas in Asunción, Paraguay, from March 2002 to March 2004 were evaluated at admission by using the Subjective Global Assessment (SGA). Patients were followed to determine length of hospital stay, complications and in-hospital mortality. RESULTS: From the trauma patients median age was 27 (14-92) years and 94% were males. Most patients (74%) were from the countryside. The most frequent anatomic sites of trauma were: head 25%, thorax 16.6%, limbs 15.4%, abdomen 14%. The median Injury Severity Score (ISS) was 20 (1-39). From this population of patients, 40% were malnourished or at risk of malnutrition according to the SGA. Multivariate analysis identified as significant risk factors for mortality: malnutrition according to the SGA (p = 0.04, RR = 4 (1-15), and admission to the ICU (p = 0.0001, RR 53 (12-234). Risk factors for complications were malnutrition according to the SGA (p = 0.003, RR 2.9 (1.4-5.8) and ISS over 20 (p = 0.001, RR = 8.4 (2.3-29.9). The risk factors for length of stay were malnutrition according to the Subjective Global Assesment (p = 0.01, RR = 2.3 (1.2-4.7) and Injury Severity Score over 20, p = 0.03, RR = 2.8 (1-7.3). CONCLUSIONS: In the conditions of this study, malnutrition is frequent on admission in trauma patients, and is an independent risk factor for morbidity, mortality, and prolongs the length of hospitalisation. Efforts should be made to quickly assess the nutritional status of these patients and early start nutritional intervention.