The value of sentinel lymph-node biopsy in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy: a systematic review.

PURPOSE: To conduct a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy, compared to axillary lymph-node dissection. METHODS: The more relevant databases were searched. Main outcomes were false-negative rate (FNR), sentinel lymph-node identification rate (SLNIR), negative predictive value (NPV), and accuracy. We conducted meta-analyses when appropriate. RESULTS: Twenty studies were included. The pooled FNR was 0.14 (95% CI 0.11-0.17), the pooled SLNIR was 0.89 (95% CI 0.86-0.92), NPV was 0.83 (95% CI 0.79-0.87), and summary accuracy was 0.92 (95% CI 0.90-0.94). SLNB performed better when more than one node was removed and double mapping was used. CONCLUSIONS: SLNB can be performed in women with a node-negative tumour after neoadjuvant therapy. It has a better performance when used with previous marking of the affected node and with double tracer.

The value of sentinel lymph-node biopsy after neoadjuvant therapy: an overview.

PURPOSE: We conducted a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) after the neoadjuvant chemotherapy, compared to axillary lymph-node dissection, in terms of false-negative rate (FNR) and sentinel lymph-node identification rate (SLNIR), sensitivity, negative predictive value (NPV), need for axillary lymph-node dissection (ALND), morbidity, preferences, and costs. METHODS: MEDLINE, Embase, Scopus, and The Cochrane Library were searched. We assessed the quality of the included systematic reviews using AMSTAR2 tool, and estimated the degree of overlapping of the individual studies on the included reviews. RESULTS: Six systematic reviews with variable quality were selected. We observed a very high overlapping degree across the included reviews. The FNR and the SLNIR were quite consistent (FNR 13-14%; SLNIR ~ 90% or higher). In women with initially clinically node-negative breast cancer, the FNR was better (6%), with similar SLNIR (96%). The included reviews did not consider the other prespecified outcomes. CONCLUSIONS: It would be reasonable to suggest performing an SLNB in patients treated with NACT, adjusting the procedure to the previous marking of the affected lymph node, using double tracer, and biopsy of at least three sentinel lymph nodes. More well-designed research is needed. PROSPERO registration number: CRD42020114403.

Metabolic Changes in Children that Received Chemotherapy.

Cancer treatments are associated with short and long-effects. Epidemiological reports have revealed clinical features of metabolic syndrome (MS), obesity or overweight in young cancer survivors. The aim of the study was to examine the prevalence of unhealthy weight status and risk factors associated with MS related to chemotherapy. We study 52 pediatric cancer patients and analyze cholesterol, triglycerides, glycosylated hemoglobin, body mass index, waist circumference (WC), FINDRISC test. All the parameters were analyzed according to the percentile corresponding to sex and age of each child. The data show an important modification in weight, body mass index, and WC as in triglycerides, and cholesterol that could be associated with the development of MS. The variance analysis showed that the WC, triglycerides, and cholesterol are statistically correlated in our population. A follow-up for MS in children cancer survivor should be considered necessary.

Medical treatments for incomplete miscarriage.

BACKGROUND: Miscarriage occurs in 10% to 15% of pregnancies. The traditional treatment, after miscarriage, has been to perform surgery to remove any remaining placental tissues in the uterus ('evacuation of uterus'). However, medical treatments, or expectant care (no treatment), may also be effective, safe, and acceptable. OBJECTIVES: To assess the effectiveness, safety, and acceptability of any medical treatment for incomplete miscarriage (before 24 weeks). SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (13 May 2016) and reference lists of retrieved papers. SELECTION CRITERIA: We included randomised controlled trials comparing medical treatment with expectant care or surgery, or alternative methods of medical treatment. We excluded quasi-randomised trials. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion, assessed risk of bias, and carried out data extraction. Data entry was checked. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We included 24 studies (5577 women). There were no trials specifically of miscarriage treatment after 13 weeks' gestation.Three trials involving 335 women compared misoprostol treatment (all vaginally administered) with expectant care. There was no difference in complete miscarriage (average risk ratio (RR) 1.23, 95% confidence interval (CI) 0.72 to 2.10; 2 studies, 150 women, random-effects; very low-quality evidence), or in the need for surgical evacuation (average RR 0.62, 95% CI 0.17 to 2.26; 2 studies, 308 women, random-effects; low-quality evidence). There were few data on 'deaths or serious complications'. For unplanned surgical intervention, we did not identify any difference between misoprostol and expectant care (average RR 0.62, 95% CI 0.17 to 2.26; 2 studies, 308 women, random-effects; low-quality evidence).Sixteen trials involving 4044 women addressed the comparison of misoprostol (7 studies used oral administration, 6 studies used vaginal, 2 studies sublingual, 1 study combined vaginal + oral) with surgical evacuation. There was a slightly lower incidence of complete miscarriage with misoprostol (average RR 0.96, 95% CI 0.94 to 0.98; 15 studies, 3862 women, random-effects; very low-quality evidence) but with success rate high for both methods. Overall, there were fewer surgical evacuations with misoprostol (average RR 0.05, 95% CI 0.02 to 0.11; 13 studies, 3070 women, random-effects; very low-quality evidence) but more unplanned procedures (average RR 5.03, 95% CI 2.71 to 9.35; 11 studies, 2690 women, random-effects; low-quality evidence). There were few data on 'deaths or serious complications'. Nausea was more common with misoprostol (average RR 2.50, 95% CI 1.53 to 4.09; 11 studies, 3015 women, random-effects; low-quality evidence). We did not identify any difference in women's satisfaction between misoprostol and surgery (average RR 1.00, 95% CI 0.99 to 1.00; 9 studies, 3349 women, random-effects; moderate-quality evidence). More women had vomiting and diarrhoea with misoprostol compared with surgery (vomiting: average RR 1.97, 95% CI 1.36 to 2.85; 10 studies, 2977 women, random-effects; moderate-quality evidence; diarrhoea: average RR 4.82, 95% CI 1.09 to 21.32; 4 studies, 757 women, random-effects; moderate-quality evidence).Five trials compared different routes of administration, or doses, or both, of misoprostol. There was no clear evidence of one regimen being superior to another. Limited evidence suggests that women generally seem satisfied with their care. Long-term follow-up from one included study identified no difference in subsequent fertility between the three approaches. AUTHORS' CONCLUSIONS: The available evidence suggests that medical treatment, with misoprostol, and expectant care are both acceptable alternatives to routine surgical evacuation given the availability of health service resources to support all three approaches. Further studies, including long-term follow-up, are clearly needed to confirm these findings. There is an urgent need for studies on women who miscarry at more than 13 weeks' gestation.

Estrategia estatal de conservación de las cícadas (Zamiaceae): una propuesta para el estado de Hidalgo, México / State strategy for Cycad (Zamiaceae) conservation: A proposal for the State of Hidalgo, Mexico

Mexico has the second largest cycad diversity in the world, and the Sierra Madre Oriental (SMO) is one of the richest biogeographic regions for these plants. Despite there is a general Cycad National Program in the country, there are no state-level cycad conservation strategies or programs. Thus the aim of this study was to propose a cycad conservation strategy for the state of Hidalgo, which is located in the Southern part of the SMO. For this, a cycad species inventory was made in the state, for which three methods were used: review of published literature; consultation in the main Mexican herbaria to verify botanical specimens; and exhaustive field research to compare findings with previously reported species and to recognize new records at the county and state level. The proposed research work strategy combined the following elements: prioritize the county and local areas with greatest cycad species richness; prioritize the species least resistant to environmental change and/or having restricted geographic distribution; and to consider the main uses of these plants by local residents. The results showed that Hidalgo has three genera and eight species of cycads: Ceratozamia fuscoviridis, C. latifolia, C. mexicana, C. sabatoi, Dioon edule, Zamia fischeri, Z. loddigesii and Z. vazquezii, all of which are considered by the International Union for Conservation of Nature (IUCN). This study added two new species records for Hidalgo and 21 at the county level. The species are distributed in 26 counties, of which Chapulhuacán and Pisaflores are notable for their high species richness. Hidalgo has the fourth-greatest cycad species richness among Mexican states, although its area accounts for only 1.07% of the country. The state’s diversity is greater than in other states with larger area, and even than in some other entire countries in Mesoamerica. The presented state cycad conservation strategy proposes that a total of some 11 325ha to be conserved in nine zones, including different vegetation types, distributed in seven counties. The strategy involves a mixed scheme that incorporates conservation in Protected Natural Areas (ANP), Small Farmer Reserves (Reservas Campesinas) and Environmental Management Units (UMA in Spanish). This proposal will be useful for government agencies to take into account in the process of designating land use for the Cloud Forest Biological Corridor (CBBMM in Spanish), a ANP in creation. The state of Hidalgo urgently needs a detailed analysis of trends in changes in vegetation cover and land use, and demographic studies of the cycads. It is recommended that the implementation phase of this state strategy be carried out jointly with local communities, academia, and state and federal agencies responsible for biodiversity conservation.

México es el segundo país con mayor diversidad de cícadas en el mundo. En él, la Sierra Madre Oriental (SMO) es una de las regiones biogeográficas con mayor riqueza de estas plantas. El objetivo de este estudio fue plantear la estrategia de conservación de cícadas para el estado de Hidalgo, ubicado en la parte sur de la SMO; para esto se revisó la literatura científica, se consultaron los principales herbarios de México y se hicieron recorridos de campo. Los resultados muestran que Hidalgo alberga tres géneros y ocho especies: Ceratozamia fuscoviridis, C. latifolia, C. mexicana, C. sabatoi, Dioon edule, Zamia fischeri, Z. loddigesii, Z. vazquezii, posicionándose en el cuarto lugar nacional en riqueza de cícadas. Las especies se distribuyen en 26 municipios. Se encontró que la diversidad de cícadas es mayor a la de otras entidades con mayor superficie e incluso a la de algunos países de Centroamérica. La estrategia estatal de conservación de cícadas aquí desarrollada propone conservar cerca de 11 325ha, distribuidas en siete municipios, bajo un esquema mixto de conservación. Esta propuesta será útil para que las instancias gubernamentales establezcan nuevas ANP’s en la región biogeográfica de la SMO.

Medical treatments for incomplete miscarriage.

BACKGROUND: Miscarriage occurs in 10% to 15% of pregnancies. The traditional treatment, after miscarriage, has been to perform surgery to remove any remaining placental tissues in the uterus ('evacuation of uterus'). However, medical treatments, or expectant care (no treatment), may also be effective, safe and acceptable. OBJECTIVES: To assess the effectiveness, safety and acceptability of any medical treatment for incomplete miscarriage (before 24 weeks). SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2012) and reference lists of retrieved papers. SELECTION CRITERIA: Randomised controlled trials comparing medical treatment with expectant care or surgery or alternative methods of medical treatment. Quasi-randomised trials were excluded. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked. MAIN RESULTS: Twenty studies (4208 women) were included. There were no trials specifically of miscarriage treatment after 13 weeks' gestation.Three trials involving 335 women compared misoprostol treatment (all vaginally administered) with expectant care. There was no statistically significant difference in complete miscarriage (average risk ratio (RR) 1.23, 95% confidence interval (CI) 0.72 to 2.10; two studies, 150 women, random-effects), or in the need for surgical evacuation (average RR 0.62, 95% CI 0.17 to 2.26; two studies, 308 women, random-effects). There were few data on 'deaths or serious complications'.Twelve studies involving 2894 women addressed the comparison of misoprostol (six studies used oral administration, four studies used vaginal, one study sub-lingual, one study combined vaginal + oral) with surgical evacuation. There was a slightly lower incidence of complete miscarriage with misoprostol (average RR 0.97, 95% CI 0.95 to 0.99, 11 studies, 2493 women, random-effects) but with success rate high for both methods. Overall, there were fewer surgical evacuations with misoprostol (average RR 0.06, 95% CI 0.02 to 0.13; 11 studies, 2654 women, random-effects) but more unplanned procedures (average RR 5.82, 95% CI 2.93 to 11.56; nine studies, 2274 women, random-effects). There were few data on 'deaths or serious complications'. Nausea was more common with misoprostol (average RR 2.41, 95% CI 1.44 to 4.03; nine studies, 2179 women, random-effects).Five trials compared different routes of administration and/or doses of misoprostol. There was no clear evidence of one regimen being superior to another. Limited evidence suggests that women generally seem satisfied with their care. Long-term follow-up from one included study identified no difference in subsequent fertility between the three approaches. AUTHORS' CONCLUSIONS: The available evidence suggests that medical treatment, with misoprostol, and expectant care are both acceptable alternatives to routine surgical evacuation given the availability of health service resources to support all three approaches. Women experiencing miscarriage at less than 13 weeks should be offered an informed choice. Future studies should include long-term follow-up.

Medical treatments for incomplete miscarriage (less than 24 weeks).

BACKGROUND: Miscarriage occurs in 10% to 15% of pregnancies. The traditional treatment, after miscarriage, has been to perform surgery to remove any remaining pregnancy tissues in the uterus. However, it has been suggested that drug-based medical treatments, or expectant care (no treatment), may also be effective, safe and acceptable. OBJECTIVES: To assess the effectiveness, safety and acceptability of any medical treatment for early incomplete miscarriage (before 24 weeks). SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009). SELECTION CRITERIA: Randomised controlled trials comparing medical treatment with expectant care or surgery. Quasi-randomised trials were excluded. DATA COLLECTION AND ANALYSIS: Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked. MAIN RESULTS: Fifteen studies (2750 women) were included, there were no studies on women over 13 weeks' gestation. Studies addressed a number of comparisons and data are therefore limited.Three trials compared misoprostol treatment (all vaginally administered) with expectant care. There was no significant difference in complete miscarriage (average risk ratio (RR) 1.23, 95% confidence interval (CI) 0.72 to 2.10; two studies, 150 women), or in the need for surgical evacuation (average RR 0.62, 95% CI 0.17 to 2.26; two studies, 308 women). There were few data on 'deaths or serious complications'.Nine studies involving 1766 women addressed the comparison of misoprostol (four oral, four vaginal, one vaginal + oral) with surgical evacuation. There was no statistically significant difference in complete miscarriage (average RR 0.96, 95% CI 0.92 to 1.00, eight studies, 1377 women) with success rate high for both methods. Overall, there were fewer surgical evacuations with misoprostol (average RR 0.07, 95% CI 0.03 to 0.18; eight studies, 1538 women) but more unplanned procedures (average RR 6.32, 95% CI 2.90 to 13.77; six studies, 1158 women). There were few data on 'deaths or serious complications'. Limited evidence suggests that women generally seem satisfied with their care. Long-term follow up from one included study identified no difference in subsequent fertility between the three approaches. AUTHORS' CONCLUSIONS: The available evidence suggests that medical treatment, with misoprostol, and expectant care are both acceptable alternatives to routine surgical evacuation given the availability of health service resources to support all three approaches. Women experiencing miscarriage at less than 13 weeks should be offered an informed choice.

Supervivencia de pacientes con carcinoma broncógeno en el Hospital "Hermanos Ameijeiras" de 1997-2002 / Survival rate of patients presenting with bronchogenic carcinoma from "Hermanos Ameijeiras" Clinical Surgical Hospital, 1997-2002

Se estudió la supervivencia de 201 pacientes a quienes se les diagnosticó un carcinoma broncógeno (155 con carcinoma de células no pequeñas y 46 con carcinoma de células pequeñas) y recibieron tratamiento oncoespecífico, en sus diferentes modalidades, entre el año 1997 y el 2002. Se describió la muestra y se analizó la supervivencia mediante el método de Kaplan Meier en función de variables como edad, estirpe histológica, estadio clínico y tratamiento empleado. Se halló que la supervivencia global de los pacientes incluidos en el estudio fue de 15 %. La probabilidad de sobrevivir a los 5 años fue de 18,5 %, para el carcinoma de pulmón de células no pequeñas. Los principales factores predictores pronósticos de la enfermedad fueron los estadios potencialmente curables (I y II) en el momento del diagnóstico con la posibilidad de recibir tratamiento quirúrgico. La edad no influyó significativamente en la supervivencia. La utilización de quimio-radioterapia, como régimen adyuvante a la cirugía mejoró la supervivencia de los pacientes operados. La supervivencia media a los 5 años lograda en los pacientes con carcinoma indiferenciado de células pequeñas fue de 4,5 %.

Survival from 201 patients was studied, which were diagnosed with bronchogenic carcinoma (155 with non-small cell carcinoma and 46 with small cell carcinoma) different modalities of specific oncotherapy from 1997 to 2002. Sample was described and the survival was analyzed by Kaplan Meier method according to variables including age, histological lineage, clinical status and treatment used. We noted that 5-years global survival was of 18,5% for non-small cells lung carcinoma. Main predisposing factors of disease were the probability of surgical treatment. Use of chemotherapy as surgery adjuvant regime improves survival of patients operated on. 5-years mean survival achieved in patients presenting with in small cells non-differentiated carcinoma was of 4,5%.

Tuberculosis y esteroides / Tuberculosis and steroids

Se revisó lo escrito en la literatura sobre el efecto que pudieran tener los corticosteroides, tan ampliamente usados en la actualidad, en el desencadenamiento de la tuberculosis y su presentación con cuadros clínicos atípicos. Se analizaron las ventajas que pueda o no tener el uso de los corticosteroides como terapia adjunta en sus distintas formas clínicas y localizaciones

Pseudoaneurisma de la aorta con fístula aortobronquial como causa de hemoptisis / Pseudoaneurysm of the aorta with aortobronchial, fistula as a cause of hemoptysis

Se presentó el caso de una paciente de 36 años, de la raza negra, del sexo femenino que se ingresó por presentar cuadros de hemoptisis de moderada intensidad, de aproximadamente 1 año de evolución, que aparecieron después de una herida por arma blanca y a la cuál se le diagnosticó un pseudoaneurisma de la aorta con fístula aortobronquial por tomografía axial computadorizada y aortografía. Se le practicó tratamiento quirúrgico, mediante el cual se reparó la aorta y se hizo lobectomía inferior izquierda. Se dio el alta completamente asintomática

Derrame pleural: marcadores bioquímicos en el enfoque diagnóstico

Se describieron las principales características del líquido pleural normal y los diferentes mecanismos que conducen a la formación de un derrame pleural. Se presentó una estrategia diagnóstica a partir de la diferenciación de trasudados y exudados. Se definieron sus criterios diagnósticos. Se revisaron los marcadores bioquímicos de uso más frecuente en la práctica médica y se especificó la utilidad de cada uno para el diagnóstico de las diferentes entidades que causan derrame pleural. Se aclararon las limitaciones de estos marcadores y la importancia de su uso racional a partir de los datos clínicos de cada caso.

The main characteristics of the normal pleural fluid, as well as the different mechanisms leading to the formation of a pleural effusion were described. A diagnostic strategy was presented starting from the separation of transudates and exudates. Their diagnostic criteria were also defined. Those biochemical markers that are most commonly used in the medical practice were reviewed, and the utility of each of them for the diagnosis of different diseases causing pleural effusion was specified. The limitations of these markers and the importance of their rational use according to the clinical data of every case were explained.

Tratamiento de la tuberculosis resistente a múltiples drogas / Treatment of multidrug-resistant tuberculosis

Se hace una revisión de la situación actual de la tuberculosis a múltiples drogas en el mundo, los mecanismos biológicos que producen la misma, su epidemiología que pone de manifiesto las grandes diferencias existentes entre las distintas regiones del mundo en cuanto al número de casos y su atención, así como las bases del tratamiento de tan difícil problema con las llamadas drogas de segunda línea. Se mencionan algunos nuevos medicamentos que traen ciertas esperanzas en la mejoría del pronóstico de dicha enfermedad

Utilización de aprotinina en el trasplante cardíaco / The use of aprotinin in heart transplantation

La aprotinina es un inhibidor de las proteasas, como plasmina y kalikreína. La circulación extracorpórea activa, en sus superficies no endoteliales, mecanismos de la coagulación que la heparina es incapaz de neutralizar. Se evalúa una población de 23 pacientes sometidos a trasplante cardíaco, 12 de ellos tratados con aprotinina (grupo AP) versus 11 de un grupo control histórico (grupo C) sin esta droga. En el grupo AP, tanto el sangrado posquirúrgico como el consumo de hemoderivados fue significativamente menor. En el grupo C hubo 2 reoperaciones por sangrado, sin ocurrir esto en el grupo AP. No se evidenciaron efectos adversos atribuíbles a la aprotinina

Curso de técnicos perfusionistas en cirugía cardíaca: experiencia de tres años / Course on technical perfusionists in cardiac surgery during 3 years

Objetivo: evaluar el Curso de Técnicos Perfusionistas en cirugía cardíaca durante los años 1993-95. Método: el curso duró dos años y empleó dos mil horas de carga horaria, dividido en cuatro módulos. Se seleccionó un máximo de diez alumnos por años. La metodología de enseñanza y aprendizaje se llevó a cabo con 20 por ciento del tiempo dedicado a actividades teóricas y 80 por ciento a las actividades prácticas. La evaluación fue continua, con exámenes parciales al final de cada módulo y prueba integradora final. Los alumnos debieron realizar una monografía y completar una encuesta de opinión sobre el curso. Resultados: los alumnos calificaron como muy bueno el aprovechamiento de las clases teóricas, el aprendizaje con los trabajos prácticos y la comunicación docente-alumno, bueno el aprovechamiento de los ateneos bibliográficos, distinguida la relación con el personal administrativo del curso y se sintieron bien evaluados. Todos los alumnos que completaron el curso y ya trabajaban como perfusionistas lo siguen haciendo en sus mismos lugares de trabajo, los dos alumnos graduados sin experiencia previa ya tienen trabajo como perfusionistas. Conclusión: el curso es útil para la formación o perfeccionamiento de perfusionistas en cirugía cardíaca

Tumor mucoepidermoide bronquial: presentacion de 1 caso / Bronchial mucoepidemoid tumor: report of 1 case

Se presenta el caso de una paciente de 21 anos de edad, raza blanca y sexo femenino que en los 2 ultimos anos tuvo cuadros de sibilancias y neumonias a repeticion en pulmon derecho, ademas, en los rayos X de torax, al momento del ingreso, se observo atelectasia del lobulo medio. Por broncoscopia se detecto tumor que ocluia la entrada de dicho lobulo. Se le realizo neumectomia derecha. Se demostro una lesion de 2,5 cm, polipoidea, que resulto ser un carcinoma mucoepidermoide bronquial de bajo grado de malignidad

Blastoma Pulmonar. Presentacion de 1 Caso / Pulmonary blastoma. A case report

Se presenta el caso de un paciente de 18 anos de edad, de raza blanca y sexo masculino, con manifestaciones respiratorias de tos, expectoracion, dolor toracico y rayos X de torax con una masa del lobulo superior izquierdo. Despues de pleurotomia minima y biopsia se le diagnostico un blastoma pulmonar. Se le realizo neumectomia y posteriormente, se le administro poliquimioterapia

Granulomatosis alérgica con presentación inusual

La granulomatosis alérgica es poco frecuente y de causa desconocida. La prostatitis como parte de la extensión de esta enfermedad es rara, sólo existen 12 casos reportados en la literatura. Se presenta un paciente de 26 años de edad, mestizo, con antecedentes de asma bronquial alérgica en la niñez, que en 1993 ingresó por manifestaciones disúricas. Se le detecta tumoración prostática que se concluye histológicamente como prostatitis granulomatosa alérgica. Se comenzó tratamiento con 60 mg de prednisona oral en dosis decrecientes; 1 año después. cuando el mantenimiento es de 5 mg en días alternos, presenta fiebre y aparece eritema nudoso en la porción interna de ambos pies. Se constata eosinofilia periférica y la histología de estos nódulos coincide con la de la próstata, se concluye como una granulomatosis alérgica. Al aumentar la dosis de esteroides desaparecieron completamente las manifestaciones. Se hace una revisión de esta entidad sin encontrar casos de prostatitis como su inicio.

Sindrome antifosfolipidico: Aspectos diagnosticos y terapeuticos / Antiphospholipid syndrome: Diagnostic and therapeutic aspects

El sindrome antifosfolipido, descrito inicialmente en el lupus eritematoso sistemico, aparece tambien en personas que no reunen criterios de alguna enfermedad conocida, por lo que su identificacion y tratamiento adquieren gran importancia en personas con fenomenos tromboticos aparentemente inexplicables y en mujeres con abortos y muertes fetales recurrentes sin otra reconocible. Su diagnostico se hace en presencia de trombosis arterial, trombosis venosa, abortos o muertes fetales recurrentes, trombocitopenia y positividad de cualesquiera de las pruebas que detectan anticuerpos antifosfolipidos. Se hace una revision de sus manifestaciones clinicas mayores y menores. Se resalta que la anticoagulacion ante fenomenos tromboticos debe realizarse de forma indefinida, y que las mujeres embarazadas con anticuerpos antifosfolipidos deben ser tratados desde su inicio para evitar el aborto o la muerte fetal