Correlation between preoperative tomographic staging and definitive histopathologic results in gastric cancer at the Hospital Central Militar. / Correlación entre la estadificación tomográfica preoperatoria con los resultados histopatológicos definitivos en cáncer gástrico en el Hospital Central Militar.

BACKGROUND: In relation to the number of new cases diagnosed, gastric cancer is the fourth most common cancer worldwide, and the second cause of cancer death. The development of multidetector tomography has improved the preoperative staging of gastric cancer. AIM: To correlate preoperative tomographic studies with the definitive pathologic results according to the TNM staging system. METHODS: A retrospective, cross-sectional study within the time frame of January 2009 to December 2013 was conducted that included the case records of 67 patients. They all had upper endoscopy and preoperative multidetector tomography examinations, underwent surgical resection, and had the corresponding histopathology study. Statistical analysis was carried out with the SPSS version 15.0 software and the sensitivity and specificity calculations were made using the Excel 2011 program for Mac. RESULTS: The majority of the patients included in the case series had clinical stage iii and iv disease. When compared with the histopathologic result, the overall accuracy of multidetector CT was 83% (T0 96%, T1 94%, T2 93%, T3 67%, and T4 67%) for tumor size (T) and was 70% (N0 72%, N1 73%, N2 70%, and N3 66%) for lymph node involvement (N). Overall sensitivity was 48% (T0 100%, T1 0%, T2 33%, T3 44%, and T4 65%) for T and was 41% (N0 58%, N1 56%, N2 15%, and N3 35%) for N. A strong association between the multidetector CT results and the pathology results was demonstrated through the Spearman's correlation, especially in T4 and N3. CONCLUSIONS: Multidetector computed tomography showed greater congruency in detecting stages T4, N0, and N3 in gastric cancer, when compared with the definitive histopathologic results.

[Prenatal steroids for fetal maturation in preterm birth. Experience at an institution]. / Uso de esteroides prenatales para la maduración fetal en nacimientos prematuros. Experiencia institucional.

INTRODUCTION: Prenatal steroids have been proved useful in the prevention of respiratory distress syndrome (RDS) and other complications in premature infants. OBJECTIVE: To analyze retrospectively the impact of prenatal steroids in premature infants < 34 weeks. MATERIAL AND METHODS: Two hundred nineteen premature infants were divided into two groups: Group I (n = 145) without prenatal steroids and Group II (n = 74) with steroids. Maternal age, prenatal control, gestational age, gender, weight, Apgar score at 1 and 5 minutes, duration of neonatal hospital care, the presence or absence of RDS, intraventricular haemorrhage (IVH), necrotising enterocolitis (NEC), chronic lung disease (CLD) and neonatal death were analyzed. Chi square test and OD ratios were calculated. RESULTS: Significant statistical difference were found in maternal age, prenatal control, and birth weight. Gestational age, gender and Apgar score at 1 and 5 minutes showed no significant difference. RDS and CLD incidence proved to be lower in group II (with prenatal steroids) showing a significant statistical of X2 = 31.32; p < 0.01 and X2 = 5.42; p < 0.01 respectively. Intraventricular difference (X2 = 5.02; p < 0.1), NEC (X2 = 1.47; p < 0.1), duration of neonatal hospital care and neonatal death showed no significant difference. DISCUSSION: As reported by other authors, RDS incidence in premature infants is reduced by the use of prenatal steroids, and secondarily the incidence of CLD. No effect was found in the presence of IVH even though the OD ratio showed a protective effect. No beneficial effect nor an increase in the frequency of NEC was demonstrated. It is necessary to incorporate strategies at different levels that have the objective of preventing premature births and its complications.

[Changes in plasma values of interleukin 1-beta and TNF-alpha at birth]. / Cambios en los valores plasmáticos de interleucina 1-beta y TNF-alpha al nacimiento.

OBJECTIVE: To describe the changes during the period of transition of the TNF-alpha and IL-1 beta in newborn healthy, under effect of deliver. MATERIAL AND METHODS: They were selected randomly at term newborn, with low perinatal risk. We quantified the plasmatic concentrations of TNF-alpha and IL-1 beta at birth, one hour and 24 hours of life. RESULTS: We included 110 newborn. The concentrations of TNF-alpha and IL-1 beta quantified to the birth, at the time of life and to the 24 hours of life; were of 7.4, 8.7 and 9.3 pg/mL and of 1.1, 1.3 and 0.7 pg/mL, respectively. In the TNF-alpha, was significant difference to the birth (12.9 versus 4.4 pg/mL) and one hour of life (14.7 vs 5.6 pg/mL), with more elevated values in neonates born by vaginal delivery (p < 0.01). There was not the same effect for the IL-1 beta. There was not statistical influence in relation to sex, birth weight when or gestational age. CONCLUSIONS: The TNF-alpha, but not it IL-1 beta, it presented statistical changes associate to the delivery.

[Perinatal morbidity and mortality secondary to systemic lupus erythematosus in a tertiary care institution]. / La morbimortalidad perinatal secundaria a lupus eritematoso sistémico en una institución de tercer nivel.

INTRODUCTION: Autoimmune diseases occur more often in procreation age women, being systemic lupus erythematosus (SLE) a multisystemic, chronic inflammatory illness, the prototype of them. OBJECTIVE: Evaluate the behavior of perinatal morbidity/mortality in a group of pregnant patients, identifying maternal and secondary neonatal complications secondary to SLE. MATERIAL AND METHODS: Between January 1992 and December 1997, seventy two cases of maternal SLE were seen at the Instituto Nacional de Perinatología in Mexico City. Maternal and neonatal files were reviewed retrospectively in search of maternal and neonatal complications secondary to SLE. RESULTS: Maternal SLE diagnosis was confirmed in all cases: Ideal reproductive age was seen in 84.7% and extreme ages in 15.3% of the maternal population. Effective prenatal control was carried out in 87% of the pregnancies and 16.6% required at least one hospitalization during gestation. The most frequent complications were infectious (37.5%), haematologic (13.9%) and renal (5.5%). No mortality was seen in the maternal population. Normal weight for gestational age was seen in 58.3% of the neonates and low weight for gestational age in 41.6%; prematurity was seen in the same percentage (41.6%). The most frequent complications in the neonatal population were haematologic (18.0), respiratory (12.5%), metabolic (8.3%) and heart block and cutaneous lesions (1.4%). Neonatal lupus was diagnosed in 8.3%, and survival was of 94.4%). DISCUSSION: Maternal and neonatal morbidity secondary to SLE was seen in less than 50% of the cases. Infectious complications, the most frequent in the maternal population, is probably secondary to medical treatment. Of the patients with neonatal lupus only 2.8% had heart block and cutaneous lesions. Maternal outcome and neonatal repercussion of maternal SLE do not differ in relation to other authors results. However it is necessary to evaluate the immunologic behavior and genetic predisposition because each population has a different of HLA antigens.