Assessment of late on-set fetal growth restriction using SMI (superb microvascular imaging) Doppler.

Background: The identification of late-onset fetal growth restriction (FGR) fetuses remains a challenge, given the difficulty to distinguish them from healthy small for gestational age (SGA) fetuses. Given the limitations of conventional Doppler for the identification of placental insufficiency, the appearance of superb microvascular imaging (SMI) Doppler seems promising. Our main objective was to evaluate the diagnostic capability of SMI Doppler for the detection of placental insufficiency findings. Methods: A prospective observational study was conducted at a tertiary care center, including 51 patients who had been diagnosed with late on-set SGA or FGR. A placental ultrasonographic evaluation was carried out using SMI Doppler. Patients were sorted into two groups attending to the histologic evaluation of the placentas after delivery: Group 1 (21 cases), Normal group; and Group 2 (30 cases), FGR group. Results: Placentas in the FGR group had lower peak systolic velocity (PV) values of the chorionic plate. The PV of the other vessels were consistently lower in the FGR group that in the normal group, although without reaching statistical significance. Conclusions: The PV of the chorionic plate measured with SMI Doppler, have the capacity to identify placental insufficiency findings. Ultrasonographic placental assessment using SMI Doppler appears to be a useful technique for the evaluation of suspected late on-set placental insufficiency.

Ultrasound Features and Ultrasound Scores in the Differentiation between Benign and Malignant Adnexal Masses.

BACKGROUND: Several ultrasound (US) features help ultrasound experts in the classification of benign vs. malignant adnexal masses. US scores serve in this differentiation, but they all have misdiagnoses. The main objective of this study is to evaluate what ultrasound characteristics are associated with malignancy influencing ultrasound scores. METHODS: This is a retrospective analysis of ultrasound features of adnexal lesions of women managed surgically. Ultrasound characteristics were analyzed, and masses were classified by subjective assessment of the ultrasonographer (SA) and other ultrasound scores (IOTA Simple Rules Risk Assessment SRRA, ADNEX model, and O-RADS). RESULTS: Of a total of 187 adnexal masses studied, 134 were benign (71.7%) and 53 were malignant (28.3%). SA, IOTA SRRA, ADNEX model with or without CA125 and O-RADS had high levels of sensitivity (93.9%, 81.1%, 94.3%, 88.7%, 98.1%) but lower specificity (80.2%, 82.1%, 82.8%, 77.6%, 73.1%) with similar AUC (0.87, 0.87, 0.92, 0.90, 0.86). Ultrasound features significantly related with malignancy were the presence of irregular contour, absence of acoustic shadowing, vascularized solid areas, ≥1 papillae, vascularized septum, and moderate-severe ascites. CONCLUSION: IOTA SRRA, ADNEX model, and O-RADS can help in the classification of benign and malignant masses. Certain ultrasound characteristics studied in ultrasound scores are associated with malignancy.

Papel de la ansiedad preoperatoria en la percepción de dolor en pacientes sometidas a histeroscopia quirurgica en consulta / Impact of preprocedural anxiety levels on pain perception in patients undergoing office surgical hysteroscopy

OBJETIVO: Determinar si la ansiedad preoperatoria supone un factor de riesgo independiente para la percepción de dolor severo durante la realización de una histeroscopia quirúrgica ambulatoria. MATERIAL Y MÉTODOS: Estudio de cohortes en el que incluimos179 pacientes. Se ha aplicado el formulario STAI-S para valorar la ansiedad preoperatoria de las pacientes y distribuirlas en dos cohortes: Pacientes con ansiedad (STAI-S >50) y pacientes sin ansiedad (STAI-S7. Se ha calculado la asociación y el riesgo entre ambas variables mediante el Test X2 y el Riesgo Relativo (RR). Se ha utilizado el test de correlación de Pearson para valorar la correlación entre ambas variables. Se ha considerado estadísticamente significativo un valor de p<0.05. RESULTADOS: Las pacientes que percibieron dolor severo durante la entrada a la cavidad uterina (78,3% vs 29,5%; p<0,001) y durante la realización del proceso quirúrgico (78,8% vs 26,2%; p<0,001) fueron en su mayoría pacientes con ansiedad preoperatoria. El RR de las pacientes con ansiedad para percibir dolor severo es de 6,46 (IC 95%; 2,52 -16,60) durante la entrada y de 6,61 (IC 95%; 3,04 -14,38) durante la resección. Existe una correlación moderada y positiva entre las puntuaciones obtenida en la escala STAI-S y la puntuación EVA, tanto durante la entrada a la cavidad (r = 0,629; p = 0,042) como durante el proceso quirúrgico (r = 0'661; p =0'021). CONCLUSIONES: Las pacientes con ansiedad preoperatoria tienen más riesgo de percibir dolor severo durante la entrada en la cavidad uterina y durante la realización de la intervención histeroscópica.

OBJECTIVE: Determine if preprocedural anxiety is an independent risk factor for the perception of severe pain during an outpatient surgical hysteroscopy. MATERIAL AND METHODS: There were 179 patients included in this cohort study. The STAI-S questionnaire has been applied to assess the preoperative anxiety of the patients and distribute them into two cohorts: Patients with anxiety (STAI-S>50) and patients without anxiety (STAI-S 7. The association and the risk between both variables have been calculated using X2 test and relative risk (RR). Pearson's correlation test was used to assess the correlation between both variables. A p value < 0,05 has been considered statistically significant. RESULTS: Patients who perceived severe pain during access to the uterine cavity (78,3% vs 29,5%; p<0,001) and during the surgical procedure (78,8% vs 26,2%; p<0,001) were mostly patients with preoperative anxiety. The RR of patients with anxiety to perceive severe pain is 6.46 (95% CI; 2,52-16,60) during access to the uterine cavity and 6,61 (95% CI; 3,04-14,38) during resection. We have found a moderate and positive correlation between the scores obtained on the STAI-S questionnaire and VAS score during access to the uterine cavity (r=0,629; p=0,042) and during the surgical process (r=0,661; p=0,021) CONCLUSIONS: Patients with preprocedural anxiety are more at risk of perceiving severe pain during access into the uterine cavity and during the hysteroscopic intervention.

Tuberculosis en pacientes en diálisis en Uruguay / Tuberculosis in dialysis patients in Uruguay / Tuberculose em pacientes em diálise no Uruguai

Resumen: Objetivos: estimar el riesgo de tuberculosis (TB) en pacientes en terapia de reemplazo renal diálisis (TRR) y analizar la variación de la incidencia, su presentación clínica y pronóstico. Método: estudio retrospectivo desde 1995 a 2013. Los datos fueron extraídos del Registro Uruguayo de Diálisis y de la Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes (CHLA-EP). Se analizó la forma de diagnóstico, presentación clínica, prueba de tuberculina, evolución y mortalidad. Asimismo, se estudiaron variaciones de incidencia, riesgo y relación temporal con la terapia de reemplazo. Resultados: en 18 años, 10.516 pacientes recibieron diálisis crónica en Uruguay, y 13.083 casos de TB fueron diagnosticados. El 1,4% (n= 119) de todos los casos de TB en ese período fueron pacientes en TRR. La incidencia de TB en la población general en el período estudiado fue de 21 casos cada 100.000 pacientes/año (cp105) vs 212 cp105 en TRR. El riesgo de TB fue ocho veces mayor en TRR (SIR: 8, IC95% [6,5-9,3]). El tiempo medio de TRR al momento del diagnóstico fue de cuatro años (0 a 20), el 37,8% de los casos sucedieron en los dos primeros años de TRR; sin embargo, la incidencia se incrementó significativamente luego de los nueve años de TRR. La letalidad en la población general relacionada TB fue de 10,3%, siendo esta cifra duplicada en la población en TRR (23,5%). Conclusiones: el riesgo de TB en TRR es mayor y su mortalidad duplica la de la población general.

Summary: Objectives: this study aims to estimate the risk of tuberculosis in patients with renal replacement therapy (RRT) and to analyse the variation of its incidence, clinical presentation and prognosis. Method: retrospectve study from 1995 to 2013. Data was drawn from the Uruguayan Dialysis Registry and the Honorary Commission for the Fight against Tuberculosis and Prevalent Diseases (CHLA-EP). We analysed diagnosis, clinical presentation, tuberculin tests, evolution and mortality. Likewise, variations in incidence, risk and temporary relation of replacement therapy were studied. Results: in 18 years, 10,516 patients received chronic dialysis in Uruguay and 13,083 cases of tuberculosis were diagnosed. 1.4% (n= 119) of all cases of tuberculosis during that period were patients in renal replacement theraphy (RRT). The incidence of tuberculosis in the general population during the period studied was 21 every 100,000 patients/year (cp105) vs. 212 cp105 in RRT. The risk of tuberculosis was 8 times greater in RRT (SIR: 8 IC 95% (6.5; 9.3) patients. Average time of RRT at the time of diagnosis was 4 years (0 a 20), 37.8% of cases occurred in the first two years of RRT. However, incidence increased significantly after 9 years of RRT. Mortality in connection with tuberculosis in the general population was 10.3%, this figure being double in the RRT population (23.5%). Conclusions: the risk of tuberculosis in RRT is greater and its mortality doubles that of the general population.

Resumo: Objetivos: os objetivos deste estudo são 1. estimar o risco de tuberculose (TB) em pacientes em terapia de substituição renal - diálise (TSR) e 2. analisar a variação da incidência, sua apresentação clínica e prognóstico. Método: estudo retrospectivo do período 1995- 2013. Os dados foram obtidos do Registro Uruguayo de Diálisis e da Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes (CHLA-EP). Foram analisadas a forma de diagnóstico, apresentação clínica, prova de tuberculina, evolução, mortalidade e também as variações da incidência, risco e relação temporal com a TSR. Resultados: em 18 anos, 10.516 pacientes foram tratados com diálise crônica no Uruguai e foram diagnosticados 13.083 casos de TB. 1.4% (n= 119) de todos os casos de TB nesse período foram diagnosticados em pacientes em TSR. A incidência de TB na população em geral no período estudado foi de 21 cada 100.000 pacientes/ano (cp105) vs. 212 cp105 em TSR. O risco de TB foi 8 vezes maior em TSR (SIR: 8 IC 95% (6.5; 9.3). O tempo médio de TSR no momento do diagnóstico foi de 4 anos (0 a 20); 37,8% dos casos foram observados nos dos primeiros anos de TSR; no entanto, a incidência aumentou significativamente depois de 9 anos de TSR. A letalidade na população geral relacionada TB foi de 10.3%, sendo que na população em TSR esse valor se duplicou (23.5%). Conclusões: o risco de TB em TSR é maior e sua mortalidade é o dobro da observada na população geral.

Registro Uruguayo de Diálisis: Informe año 2005: Parte I / Uruguayan Dialysis Registry: Report year 2005: First Part

El Registro Uruguayo de Diálisis (RUD) es actualmente un registro obligatorio que incluye a todos los pacientes que reciben tratamiento dialítico crónico en el país.El Registro de diálisis de cada año incluye todos los pacientes en tratamiento con cualquier modalidad de diálisis, vivos al 31 de diciembre de dicho año y todos los pacientes que egresaron de tratamiento en el año correspondiente.

Angiotensin converting enzyme genotype and chronic allograft nephropathy in protocol biopsies.

Genotype DD of the angiotensin-converting enzyme (ACE) is not associated with an increased incidence of native renal diseases, although it could modulate progression to renal failure in patients who already display chronic lesions. Because its role in renal allograft degeneration is not well characterized, whether ACE genotype was associated with the prevalence of chronic allograft nephropathy (CAN) was studied, in a group of protocol biopsies from 180 patients, or with the incidence of CAN in 152 patients with at least two sequential biopsies. As a control group, ACE genotype was also studied in 41 donors and 72 healthy subjects. For analyzing the influence of ACE genotype in graft survival, patients were grouped into six categories (II-normal biopsy, ID-normal, DD-normal, II-CAN, ID-CAN and DD-CAN). Finally, relative renal ACE mRNA levels were measured in 67 cases by real-time PCR using the delta threshold cycle method. ACE-DD genotype was more frequent in patients who received a transplant than in control subjects (43.3% versus 30.1%, P = 0.026), but prevalence (DD = 42.7% versus non-DD = 42.2%) or incidence (DD = 24.6% versus non-DD = 29.9%) of CAN was not different regarding recipient ACE genotype. Furthermore, patients with the ACE-DD genotype and CAN had the poorest graft survival (II-normal = 100%, ID-normal = 91%, DD-normal = 84%, II-CAN = 100%, ID-CAN = 66%, and DD-CAN = 36%; P = 0.034) and higher ACE mRNA levels than non-DD and CAN (DD = -3.36 +/- 2.35 versus non-DD = -5.65 +/- 1.72-fold in ACE copies; P = 0.012). It is concluded that ACE-DD genotype is not associated with an increased prevalence or incidence of CAN but is actually associated with higher ACE mRNA levels and poorer graft survival in patients who already display CAN.

Herida de corazón: conducta quirúrgica de urgencia / Penetrating heart wound: surgical emergency behavior

Los heridos de corazón son cada vez más frecuentes en los servicios quirúrgicos de urgencia. Se presenta el estudio de un paciente de 20 años con herida de ventrículo derecho por arma blanca que fue tratado quirúrgicamente con éxito en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto". Debido al incremento de la red asistencial en nuestro país y al hecho de que los períodos de traslado de un herido son cada vez más breves, un número considerable llega con vida a los hospitales, por lo que el cirujano general debe dar solución quirúrgica a este tipo de paciente en tiempo de paz, situación que en esencia no difiere de los principios de tratamiento del herido en tiempo de guerra