GIRADS: método de clasificación de masas anexiales, revisión sistemática y metanálisis. 10 años de experiencia / GIRADS: adnexal masses classification method, systematic review and metanalysis. 10 years of experience

OBJETIVO: evaluar la experiencia en la utilización del método GIRADS para clasificar masas anexiales a diez años de su primera publicación. MÉTODO: Se realizó búsqueda de estudios que utilizan el sistema GIRADS: Medline (Pubmed), Google Scholar y Web of Science, desde enero de 2009 hasta diciembre de 2019. Se calculó la sensibilidad y especificidad agrupada, Likelihood ratio (LR) (+) y LR (-) y Odds ratio de diagnóstico (DOR). La calidad de los estudios se evaluó con QUADAS-2. RESULTADOS: Se identificaron 15 estudios y se incluyeron 13 de ellos con 4473 masas, 878 de ellas malignas. La prevalencia media de malignidad ovárica fue del 23 % y la agrupada de 19.6%. El riesgo de sesgo fue alto en cuatro estudios para el dominio "selección de pacientes" y fue bajo en todos en todos los estudios para los dominios "prueba índice" y "prueba de referencia". La sensibilidad, especificidad, LR (+) y LR (-) agrupadas y el DOR del sistema GIRADS para clasificar las masas anexiales fueron: 96.8% (intervalo de confianza [IC] 95% = 94% - 98%), 91.2 % (IC 95 % = 85% - 94%), 11.0 (IC 95% = 6.9 -13.4) y 0.035 (IC 95% = 0.02- 0.09), y 209 (IC 95% = 99-444), respectivamente. La heterogeneidad fue alta para la sensibilidad y especificidad. De acuerdo a la metaregresión, la heterogeneidad entre los estudios se explica por la prevalencia de malignidad, múltiples observadores y la ausencia de diagnóstico histopatológico para todos los casos incluidos en un determinado estudio. CONCLUSIÓN: el sistema GIRADS tiene un buen rendimiento diagnóstico para clasificar masas anexiales.

OBJECTIVE: to evaluate the experience of using GIRADS method to classify adnexal masses ten years after its publication. METHOD: A search was carried out for studies reporting on the use of the GIRADS system in the Medline (Pubmed), Google Scholar and Web of Science databases, from January 2009 to December 2019. Pooled sensitivity and specificity, Likelihood ratio (LR) (+) and LR (-) and Diagnostic Odds ratio (DOR) were calculated. The quality of the studies was assessed by QUADAS-2. RESULTS: 15 studies were identified, and 13 of them were included with 4473 masses, of which 878 were malignant. The mean prevalence of ovarian malignancy was 23% and the prevalence pooled. of 19.6%. The risk of bias was high in four studies for the domain 'patient selection' and low for all studies for the domains 'index test' and 'reference test'. The sensitivity, specificity, pooled LR (+) and LR (-) and the DOR of the GIRADS system to classify adnexal masses were 96.8% (95% confidence interval [CI] = 94% -98%), 91.2 % (95% CI = 85% -94%), 11.0 (95% CI = 6.9-13.4) and 0.035 (95% CI = 0.02-0.09), and 209 (95% CI = 99-444), respectively. Heterogeneity was high for both sensitivity and specificity. According to meta-regression, this heterogeneity was explained by the prevalence of malignancy, the use of multiple observers, and the absence of histopathological diagnosis for all cases included in a given study. CONCLUSION: the GIRADS system has a good diagnostic performance to classify adnexal masses.

¿Es posible disminuir la incidencia de encefalopatía hipóxico isquémica? / Is it possible to reduce the incidence of hypoxic-ischemic encephalopathy?

Objetivo: Determinar si una política local, establecida en la Maternidad del Hospital Padre Hurtado (HPH), para bajar la incidencia de Encefalopatía Hipóxico Isquémica es efectiva, sin incrementar en forma relevante la tasa de cesáreas. Diseño: Estudio de cohorte. Escenario: Unidad de Gestión Clínica de la Mujer y el Recién Nacido del Hospital Padre Hurtado. Población: Neonatos mayores de 33 semanas de edad gestacional, nacidos en el Hospital Padre Hurtado durante los años 1999 y 2015. Método: Se revisaron los resultados de una política de intervención para prevención de asfixia neonatal establecida en la Maternidad del Hospital Padre Hurtado durante un periodo de 14 años. Resultados: Al analizar los datos de un total de 102.612 nacidos vivos, se constató una disminución en la incidencia de EHI en sus 3 grados de una tasa de 4.75/1.000 nacidos vivos previo a la intervención (grupo control) a una tasa de 1.46 por 1.000 nacidos vivos post intervenciones, con alta significancia estadística (p=0,008), llegando en los últimos 6 años a tasa promedio de 0.87/1.000 nacidos vivos. La tasa de EHI moderada y severa bajó de 1.15 por mil nacidos vivos a 0.62, también con alta significancia estadística (p=0.02). La tasa de cesáreas oscilo entre 26-29 % en estos años. Conclusión: La introducción de intervenciones protocolizadas y sistematizadas por medio de la implementación de guías de manejo del trabajo de parto, la capacitación del equipo de profesionales y la auditoría continua de los casos de EHI en el Servicio de Maternidad del Hospital Padre Hurtado se asoció a una disminución significativa de EHI, manteniendo la tasa de cesáreas bajo 30%.

Objectives: Determine whether a local policy to reduce the incidence of neonatal hypoxic-ischemic encephalopathy (HIE), established at the Maternity Unit of Hospital Padre Hurtado (HPH), is effective without significantly increasing the cesarean rate. Design: Cohort study. Setting: Maternity unit of Hospital Padre Hurtado. Population: Newborns older than 33 weeks born at Hospital Padre Hurtado between 1999 and 2015. Methods: The results of a training policy to prevent HIE and perinatal asphyxia established at the Maternity unit of Hospital Padre Hurtado were reviewed during a period of 14 years. Results: From a total of 102.612 newborns analyzed, results showed a decrease in all grades of HIE incidence, from a rate of 4.75 / 1,000 live births prior to intervention (control group) to a rate of 1.46 per 1,000 live births after interventions, with high statistically significance (p=0.008), it reached an average rate of 0.87/1000 for the last 6 years. The moderate and severe HIE rate decreased from 1.15/1000 to 0.62/1000, also with high statistically significance (p=0.02). During the same period of time, the cesarean rate varied between 26-29%. Conclusion: The introduction of protocolized and systematized interventions trough the implantation of Management guides, obstetrics emergency trainings to the professional team and continues audit of the HIE cases at the Maternity unit Hospital Padre Hurtado was associated to a significant decrease of HIE, maintaining the rate of cesareans below 30%.

Síndrome de transfusión feto-fetal: experiencia de 69 casos / Twin-to-twin transfusion syndrome: experience with 69 cases

La fetoscopia por síndrome de transfusión feto fetal es la cirugía fetal más realizada en el mundo. Los resultados deben ser reportados, para que las pacientes puedan elegir su opción de atención. Objetivo: Determinar los resultados de cirugía fetal en el síndrome de transfusión feto-fetal. Diseño: Estudio retrospectivo. Lugar: Clínica Alemana, Santiago, Chile. Participantes: Gestantes con gemelares. Intervenciones: La cirugía fetal se realizó con anestesia local, endoscopios Storz de 3,3 mm, específicos para fetoscopia. Principales medidas de resultados: Sobrevida fetal. Resultados: La serie de casos se inició en el año 2005, y hasta la fecha se han realizado 71 cirugías, con 69 que han resuelto su embarazo. Treinta y tres mujeres tuvieron ambos hijos vivos (48%), 25 solo un hijo vivo (36%) y 11 concluyeron sin hijos vivos (16%). Conclusiones: La tasa de embarazos con uno o ambos niños vivos fue 84%, superando 90% en los últimos 30 casos. Hubo 6 pacientes de Perú, de las cuales cuatro tuvieron ambos hijos vivos.

Fetoscopy for fetal-fetal transfusion syndrome is the most frequent fetal surgery performed in the world. The results should be reported, so that the patients can choose their choice of care. Objective: To determine the results of fetal surgery on twin-to-twin transfusion syndrome. Design: Retrospective study. Setting: Clínica Alemana, Santiago, Chile. Participants: Pregnant women with twins. Interventions: Fetal surgery was performed under local anesthesia, with 3.3mm fetoscopy-specific Storz endoscopes. Main outcome measures: Fetal survival. Results: The series of cases began in the year 2005, and to date 71 surgeries were carried out, with 69 that resolved their pregnancy. Thirty-three women had both living children (48%), 25 only one living child (36%) and 11 concluded without living children (16%). Conclusions: The rate of pregnancies with one or both children born alive was 84%, exceeding 90% in the last 30 cases. There were 6 patients from Peru, of which four had two living children.

Randomized study of orally administered fluorinated pyrimidines (capecitabine versus S-1) in women with metastatic or recurrent breast cancer: Japan Breast Cancer Research Network 05 Trial.

PURPOSE: Capecitabine and S-1 are orally administered fluorinated pyrimidines with high-level activity against metastatic breast cancer (MBC). This randomized, multicenter, phase II study compared the activities and safeties of the oral fluoropyrimidines, capecitabine and S-1, in breast cancer patients. METHODS: Patients with MBC were randomly assigned to receive capecitabine 825 g/m(2) twice daily on days 1-21 every 4 weeks or S-1 40-60 mg twice daily, according to body surface area, on days 1-28 every 6 weeks. The primary endpoint was progression-free survival (PFS). RESULTS: A total of 142 patients were enrolled and randomized to either capecitabine (N = 73) or S-1 (N = 69). Median PFS (progression-free survival) was 1.2 years for capecitabine and 1.3 years for S-1, with a hazard ratio (S-1/capecitabine) of 0.85 (95 % confidence interval [CI] 0.52-1.38) (P = 0.48 by log-rank). The confirmed objective response rates were 24.0 % for capecitabine and 23.1 % for S-1 (P = 0.938). The most common treatment-related adverse events were grade 1-2 in intensity. Thrombocytopenia (S-1: 9.2 %, capecitabine: 1.4 %; P = 0.040) and nausea (S-1: 26.2 %, capecitabine: 14.1 %; P = 0.079) were more frequent in the S-1 group, while hand-foot syndrome occurred more often in the capecitabine group (S-1: 10.8 %, capecitabine: 25.4 %; P = 0.029). CONCLUSIONS: The results of the current study demonstrate that both S-1 and capecitabine are effective and well-tolerated treatments in patients with MBC, while their adverse events were different. They are both convenient, orally administered drugs, making them attractive agents for use in outpatient treatment.

The Tol2 transposon system mediates the genetic engineering of T-cells with CD19-specific chimeric antigen receptors for B-cell malignancies.

Engineered T-cell therapy using a CD19-specific chimeric antigen receptor (CD19-CAR) is a promising strategy for the treatment of advanced B-cell malignancies. Gene transfer of CARs to T-cells has widely relied on retroviral vectors, but transposon-based gene transfer has recently emerged as a suitable nonviral method to mediate stable transgene expression. The advantages of transposon vectors compared with viral vectors include their simplicity and cost-effectiveness. We used the Tol2 transposon system to stably transfer CD19-CAR into human T-cells. Normal human peripheral blood lymphocytes were co-nucleofected with the Tol2 transposon donor plasmid carrying CD19-CAR and the transposase expression plasmid and were selectively propagated on NIH3T3 cells expressing human CD19. Expanded CD3(+) T-cells with stable and high-level transgene expression (~95%) produced interferon-γ upon stimulation with CD19 and specifically lysed Raji cells, a CD19(+) human B-cell lymphoma cell line. Adoptive transfer of these T-cells suppressed tumor progression in Raji tumor-bearing Rag2(-/-)γc(-/-) immunodeficient mice compared with control mice. These results demonstrate that the Tol2 transposon system could be used to express CD19-CAR in genetically engineered T-cells for the treatment of refractory B-cell malignancies.

Desenvolvimento vegetativo e produção de óleo essencial de patchouli (Pogostemon cablin (Blanco) Benth. ) após a aplicação de ácido giberélico e extrato de alga marinha / Development and essential oil production of Pogostemon cablin (Blanco) Benth. patchouli after applying gibberellic acid and seaweed extract

Pogostemon cablin (Blanco) Benth., comumente conhecido como patchouli, é uma espécie aromática utilizada pela indústria de perfumes devido a fragrância amadeirada e propriedade fixadora do óleo essencial. Fatores que afetam o teor dos constituintes do óleo essencial devem ser avaliados visando obter matéria prima de melhor qualidade. O experimento foi conduzido em casa de vegetação com delineamento inteiramente casualizado em esquema fatorial 2x3 e 4 repetições, sendo dois níveis de giberelina (0 e 200 mg L-1) e três níveis de extrato de alga marinha (0, 15 e 30 mg L-1). A aplicação dos reguladores vegetais foi realizada 30 dias após o plantio das mudas, e a avaliação do experimento deu-se 45 dias após a aplicação dos tratamentos. Não houve diferença significativa para a altura das plantas, a concentração de extrato de alga marinha de 15 mg L-1 promoveu aumento no número de folhas em relação à testemunha e a concentração de 30 mg L-1 promoveu decréscimo. Em relação à área foliar e ao número de folhas houve relação inversa para os níveis de extrato de alga marinha, onde o tratamento com maior concentração do regulador resultou em aumento da área foliar e redução do número de folhas. O teor de óleo essencial foi superior após a aplicação de 15 mg L-1 de extrato alga marinha isoladamente ou combinado com GA3. A produtividade do óleo essencial também aumentou com a aplicação 15 mg L-1 de extrato de alga marinha e quando utilizado somente GA3. A utilização de extrato de alga marinha aumentou a concentração de patchoulol no óleo essencial.

Pogostemon cablin (Blanco) Benth., commonly known as patchouli, is an aromatic species used by the perfume industry due to its woody fragrance and the fixative characteristic of its essential oil. Factors affecting the content of the constituents of essential oils should be evaluated in order to obtain raw materials with better quality. The experiment was carried out in a greenhouse in a completely randomized 2x3 factorial arrangement and four replications, with two levels of gibberellin (0 and 200 mg L-1) and three levels of seaweed extract (0, 15 and 30 mg L-1). Plant regulators were applied thirty days after planting the seedlings; the experiment was evaluated forty-five days after the treatments. There was no significant difference in plant height; the 15 mg L-1 concentration of seaweed extract promoted an increase in the number of leaves in relation to the control; and the 30 mg L-1 concentration promoted a decrease. In relation to leaf area and leaf number, there was an inverse relationship for the seaweed extract levels, in which the treatment with higher a concentration of the regulator resulted in an increased leaf area, reducing the number of leaves. The essential oil content was higher after applying 15 mg L-1 of seaweed extract alone or combined with GA3. The yield of essential oil also increased by applying 15 mg L-1 of seaweed extract and when only GA3 was used. The use of seaweed extract increased the patchoulol concentration in the essential oil.

Conteúdo polifenólico e atividade antioxidante dos frutos da palmeira Juçara (Euterpe edulis Martius) / Polyphenolic content and antioxidant capacity of fruits of Juçara (Euterpe edulis Martius) palm tree

O conteúdo polifenólico e a atividade antioxidante do extrato do fruto de Euterpe edulis Martius foram avaliados. Esta espécie é uma palmeira conhecida como Juçara, nativa da Mata Atlântica e utilizada para a extração de palmito. O processo de extração do palmito acarreta a morte da planta, uma vez que esta apresenta estipe único. A elevada demanda ocasionou a escassez deste recurso natural. Muitas espécies da Mata Atlântica podem ser utilizadas pelo manejo sustentável para a preservação e exploração econômica pelas comunidades locais. O fruto da palmeira Juçara pode ser uma das alternativas de manejo sustentável dos recursos naturais da Mata Atlântica. A capacidade antioxidante do fruto pode ser utilizada como justificativa para a aplicação como alimento nutricional. O conteúdo polifenólico do fruto foi determinado pelo método de Folin-Ciocalteau e os resultados obtidos foram: 10,31 ± 0,25%, 12,42 ± 0,89%, 12,75 ± 0,94%, para o extrato bruto, fração acetato de etila e fração remanescente, respectivamente. A atividade antioxidante foi determinada pelos métodos de redução do complexo fosfomolibdênico e DPPH. O extrato bruto e as frações acetato de etila e remanescente apresentaram atividade antioxidante, sendo que as duas últimas demonstraram maior atividade indicando que o conteúdo polifenólico pode ser responsável por esta atividade.

The polyphenolic content and the antioxidant activity of Euterpe edulis Martius fruit extract were assessed. This species is a Palm tree known as Juçara, native to Atlantic Forest and used for palm heart extraction. The process of palm heart extraction leads to the death of the plant since the latter has one single stem. The high demand has resulted in the depletion of this natural resource. Many species from Atlantic Forest can be used by means of sustainable management for the preservation and economic exploration by local communities. The fruit of Juçara palm can be one of the sustainable management alternatives for the Atlantic Forest natural resources. The antioxidant capacity of this fruit can justify its application as nutritional food. The fruit polyphenolic content was determined by the Folin-Ciocalteau method and the obtained results were: 10.31 ± 0.25%, 12.42 ± 0.89%, 12.75 ± 0.94% for crude extract, acetyl acetate and remaining fractions, respectively. The antioxidant capacity was determined through the phosphomolybdenium complex and DPPH methods. The crude extract and the acetyl acetate and remaining fractions showed antioxidant activity, and the latter two showed higher activity, indicating that polyphenolic content may be responsible for this activity.

Avaliação do extrato etanólico de Ottonia martiana Miq. para o controle de duas doenças florestais / Evaluation of Ottonia martiana Miq. alcoholic extract to control two forest diseases

Metabólitos secundários presentes em plantas medicinais apresentam várias propriedades biológicas incluindo a atividade antifúngica. Esse estudo avaliou o potencial antifúngico da planta medicinal Ottonia martiana no controle da pinta-preta em erva-mate (Ilex paraguariensis) e do mofo-cinzento em eucalipto (Eucalyptus dunnii). Extrato etanólico (EBEtOH) dos órgãos totais (raízes, caules, folhas e frutos) foi preparado e testado na concentração de 1000 μg mL-1 contra os patógenos Cylindrocladium spathulatum (pinta-preta) e Botrytis cinerea (mofo-cinzento). Bioensaios in vitro (germinação de esporos e bioautografia direta) e in vivo (teste de patogenicidade em mudas) mostraram que o EBEtOH reduziu o crescimento micelial dos patógenos testados e a germinação dos esporos de C. spathulatum e estimulou a germinação de esporos de B. cinerea. O teste de patogenicidade mostrou que o controle da pinta-preta em erva-mate e do mofo cinzento em eucalipto não é viável usando-se a concentração testada de EBEtOH de O. martiana. Na bioautografia direta, foram detectadas zonas de inibição de crescimento micelial dos fungos e que foram relacionadas com a presença de piperovatina.

Secondary metabolites from medicinal plants have several biological properties, including antifungal activity. This study evaluated the antifungal potential of the medicinal plant Ottonia martiana to control maté leaf spot (Ilex paraguariensis) and eucalypt gray mould (Eucalyptus dunnii). Ethanol extract (EBEtOH) of the total parts (roots, stems, leaves and fruits) was prepared at the concentration of 1000 μg mL-1 and tested against Cylindrocladium spathulatum (maté leaf spot) and Botrytis cinerea (eucalypt gray mould). In vitro bioassays (spore germination and direct bioautography) and in vivo bioassays (pathogenicity test in seedlings) showed that EBEtOH reduced the mycelial growth of the tested pathogens and the germination of C. spathulatum spores and stimulated the germination of B. cinerea spores. The pathogenicity test showed that the control of maté leaf spot and eucalypt gray mould is not viable using the tested concentration of O. martiana EBEtOH. Zones of mycelial growth inhibition were detected in direct bioautography and were related to the presence of piperovatine.

Activation of projective neurons from the nucleus accumbens to ventral pallidum by a learned aversive taste stimulus in rats: a manganese-enhanced magnetic resonance imaging study.

Conditioned taste aversion (CTA) causes a palatability shift of a taste stimulus (conditioned stimulus, CS) from ingestive to aversive. We previously found that the ventral pallidum (VP) mediates the palatability shift in CTA. Because the VP receives major projections from the nucleus accumbens (NAc), we examined whether the presentation of CS activates the NAc-VP projective neurons after the establishment of CTA, using a manganese-enhanced magnetic resonance imaging technique. Rats were implanted with a guide cannula in the NAc and an intraoral cannula. After the surgery, they received a pairing of 5 mM saccharin solution with an i.p. injection of 0.15 M lithium chloride (CTA group) or saline (sham group). Two days after the conditioning, rats were microinjected with manganese chloride (MnCl2) into the NAc. Thirty minutes later, the rats were presented with saccharin (CTA-CS and sham-CS groups) or water (CTA-DW and sham-DW groups) via the intraoral cannula. Only the CTA-CS group showed a robust aversion to the CS. At 1 and 2 h after the MnCl2 injection, T1-weighted MR images were acquired using an 11.7 T MRI. Imaging analysis showed that significantly more manganese moved toward the VP in the CTA-CS group than in the other groups. These results indicate that the conditioned aversive taste enhanced the activities of the projective NAc-VP neurons and suggest specific involvement of the NAc-VP pathway in the rejection of CS in retrieval of CTA.

Embolización selectiva de arterias uterinas en la resolución de patologías ginecológicas y emergencias obstétricas / Uterine artery embolization in the management of obstetric and gynecologic haemorragic pathology

Antecedentes: La embolización de arterias uterinas es un procedimiento que permite manejar patologías hemorrágicas ginecológicas y obstétricas de manera conservadora y mínimamente invasiva. Métodos: Revisión retrospectiva de casos tratados con embolización selectiva en nuestro Servicio desde su inicio en octubre de 2007. Objetivo: Conocer las indicaciones y resultados de esta técnica. Resultados: Seis casos por patología ginecológica y 7 de causa obstétrica fueron tratados con este procedimiento. El procedimiento fue factible y libre de complicaciones en todos los casos, siendo terapéutico en primera instancia en 12 de los 13 casos. En ningún caso se requirió un tratamiento complementario quirúrgico para cumplir el objetivo terapéutico planificado. Conclusiones: La embolización de arterias uterinas representa una excelente herramienta para tratar cuadros hemorrágicos graves del puerperio, deteniendo hemorragias activas con manejo conservador del útero. En casos de patología ginecológica, el resultado inmediato resulta adecuado, consiguiendo buen control de la hemorragia. Este procedimiento debe ser considerado como alternativa posible en el manejo de la patología hemorrágica obstétrica y ginecológica.

Background: The uterine artery embolization is a procedure that can manage haemorrhagic obstretrics and gynecologic pathologies, in a conservative fashion and minimally invasive. Method: Retrospective review of cases that had been treated in our institution since October 2007. Objectives: To know the indication and results of this technique. Results: Six cases were done for gynecologic indications and seven for obstetrics cases. The procedure was feasible and without complications in all cases, being therapeutic in 12 of 13 patients. There was no need of a surgical procedure in order to achieve the therapeutic objective. Conclusions: The uterine artery embolization can be used as an excellent tool in the management of postpartum haemorrhage, reducing the necessity to perform an hysterectomy. In gynecology cases, the results in bleeding response are good as well. This procedure should be considerate as an acceptable alternative in the management of obstetric and gynecologic haemorragic pathology.

Resultados actualizados en el tratamiento por fetoscopía del síndrome de transfusión feto fetal en Clínica Alemana de Santiago / Results in fetoscopy-guided treatment of twin to twin transfusion syndrome in Clinica Alemana

Twin to twin transfusion syndrome diagnosed before 26 weeks has 90 percent mortality and occurs in 15 percent of monochorionic twin pregnancies. Treatment is complex as a screening program, referral, complex surgical procedure and specialized perinatal care are required. The objective is to report the recent results in fetoscopy-guided treatment of TTTS cases in Clínica Alemana. Results: 18 new cases were treated in the latest 2 years, in a series of 36 cases from 2005. Survival of one or both twins was 72.8 percent in the first 18 cases, and 77.8 percent in the latest 18 cases. The number of cases with both survivors increased from 5/18 to 7/18. Conclusions: The outcome was similar to that reported from international series. The results are better in the later cases, according to the increasing experience in our center.

Antecedentes: El Síndrome de Transfusión Feto Fetal (STFF) diagnosticado antes de las 26 semanas tiene una mortalidad de 90 por ciento y se afecta el 15 por ciento de los gemelares monocoriales. El manejo es complejo dado que requiere un proceso de diagnostico en los centros de atención, un proceso de derivación, la cirugía y el manejo perinatal especializado posterior. Objetivo: Actualizar el resultado del tratamiento por fetoscopía en Clínica Alemana de Santiago (CAS) en los casos recientemente tratados. Resultados: Desde 2005 hasta la fecha se han tratado 36 casos con sus embarazos resueltos. La sobrevida de al menos un feto fue 77,8 por ciento en los últimos 18 casos, mostrando una mejora en relación a los primeros (72,8 por ciento). El número de embarazos con ambos fetos vivos aumento de 5 a 7. Conclusiones: El resultado materno-perinatal es similar a las series internacionales y muestran una mejora progresiva en la sobrevida en la serie tratada. Los resultados favorables se mantienen a largo plazo y se consolidan en beneficio de las pacientes.

Medición in vitro del flujo con Doppler en diferentes condiciones mecánicas y su comparación con el real / Measuring in vitro Doppler flow at different mechanical conditions and compared with the real

Objective: to compare Doppler measurements with real flow in a in-vitro model, with variable diameters and insonation angle. Methods: The silicone tubes were 3-8 mm width, and set with variable inclinations from 40° to 70°. Two pumps with constant flow were used for all combinations of diameters and angles. A Sonoace 8000 from Medison was used. Real flow was compared to measured flow. Results: The measured flows varied importantly in different conditions. In a 3 mm tube, estimated flow increased from 212 ml/min to 403 ml/min when the angle was increased from 40° to 70°, when real flow was 140 ml. As well, in 8 mm tubes, estimated flow increased from 651 ml/min to 1.080 ml/min when the angle was increased from 40° to 70°, when real flow was 360 ml/min. Measured flows were 1.6 times greater than real flow. Conclusion: Measured flows were greater than real, with greater increase in larger tubes and greater angles. This confirms that velocity measurements need lowest angles possible. Measured flows are only representations of real flow, but can be considered useful as they were reproducible.

Objetivos: Recientes aplicaciones del Doppler pulsado se han orientado hacia la medición del flujo (ml/s) de la vena umbilical fetal, sin embargo sus mediciones han tenido cuestionamientos desde el punto de vista de la validez, por el efecto del ángulo y el flujo laminar. El objetivo de este estudio es probar la validez de las mediciones ecográficas en un modelo in vitro. Métodos: Se construyó un sistema dentro de un reservorio de agua, en que se instalaron tubos de silicona variando el lumen (3-8 mm), inclinación del tubo (40°-70°) y dos velocidades de infusión de agua. Se instaló la sonda convexa del transductor transabdominal a 5 cm sobre el tubo, de modo que todo el trayecto del tubo sea visualizado en la pantalla del ecógrafo SONOACE 8000 de Medison. Se corrigió el ángulo con la función del ecógrafo. El flujo se estimó por ecografía al multiplicar la velocidad medida por Doppler pulsado por el área interna del tubo. Se comparó el flujo medido real, obtenido por el volumen de agua obtenida en un minuto de funcionamiento de la bomba, y el medido por ecografía Doppler. El flujo medido por Doppler se obtuvo 2 veces, para comparar la variación intrínseca del método y verificar su confiabilidad. Resultados: Los flujos obtenidos variaron según las condiciones mecánicas importantemente. En tubos de 3 mm de diámetro, con ángulos crecientes de 40° a 70°, los fl ujos estimados aumentaron de 212 ml/min a 403 ml/min cuando el flujo real era de 140 ml/min. A su vez, en tubos de 8 mm, con ángulos crecientes de 40° a 70°, los flujos estimados aumentaron de 651 ml/min a 1.080 ml/min, cuando el flujo real era de 360 ml/min. Se demostró una correlación lineal entre el flujo estimado y el real de: Qestimado=(Qreal x 1,63)+181, r= 0,84. La aplicación del test de Bland y Altman demostró que las mediciones son repetibles y consistentes. Conclusión: Los flujos medidos en ecografía fueron 1,6 veces más que los obtenidos en flujo real en las condiciones mecánicas...

Efficacy of S-1 in patients with capecitabine-resistant breast cancer-Japan Breast Cancer Research Network (JBCRN) 04-1 trial.

BACKGROUND: S-1 is an orally administered fluorinated pyrimidine with high activity in metastatic breast carcinoma (MBC) and in chemotherapy-pretreated metastatic breast carcinoma. PATIENTS AND METHODS: Forty patients with MBC who did not respond to capecitabine-based chemo-therapy and then received S-1 were identified from our data base of records between 2006 and 2008. The clinico-pathological data and outcomes of these patients were then reviewed. RESULTS: The overall response rate was 27.8%. The median survival was 19.2 months, and the median time to disease progression was 6.2 months. The most common treatment-related adverse events (all grades) were hand-foot syndrome (15%), nausea (15%), vomiting (7.5%), disorder of taste (7.5%), and diarrhea (5%). However, the majority were mild to moderate in intensity, and only one patient experienced grade 3 (according to the National Cancer Institute of Canada Common Toxicity criteria) adverse events. Myelosuppression and alopecia were rare, and there were no reported treatment-related deaths. CONCLUSION: The results of the current study demonstrate that S-1 is an effective and well-tolerated treatment in patients with capecitabine-resistant MBC. In addition, it is a convenient, orally administered drug, which makes it an attractive agent for use in outpatient treatment.

Tubulointerstitial nephritis with IgM-positive plasmacytoid large lymphocyte infiltration in a patient with primary biliary cirrhosis and Sjögren's syndrome.

We report a 38-year-old woman diagnosed with tubulointerstitial nephritis (TIN) on renal biopsy, followed by being diagnosed with primary biliary cirrhosis (PBC) and Sjögren's syndrome (SS). Immunohistochemically, the cellular infiltrates in TIN were mainly composed of small lymphocytes and IgM-positive plasmacytoid large lymphocytes. IgM-positive plasmacytoid large lymphocytes were not identical with, but colocalized with CD3- or CD20-positive lymphocytes. TIN in patients with PBC is very rare and little is known about immunohistochemical characteristics of infiltrating cells in this setting. To our knowledge, this is the first report demonstrating predominant infiltrating of IgM-positive plasmacytoid large lymphocytes in TIN due to PBC and SS.

Diagnóstico incidental de tumor vesical por ecografía ginecológica transvaginal / Incidental findings of bladder tumor by transvaginal ultrasonography

Se presenta el caso clínico de una mujer de 60 años que acude al Servicio de Ginecología y Obstetricia del Hospital Padre Hurtado, bajo la sospecha de un mioma cervical pequeño. Se realiza una ecografía transva-ginal la cual evidencia incidentalmente un tumor vesical sólido, vascularizado, intravesical y dependiente de la mucosa. La paciente no refería espontáneamente hematuria. El estudio urológico definitivo es de un carcinoma papilar de células transicionales. El tratamiento endoscópico logró la resección completa del tumor. El hallazgo ecográfico permitió realizar el diagnóstico en una forma poco habitual para esta enfermedad, aprovechando una instancia definida para otros fines. Se rescata la importancia de observar detenidamente todas las estructuras pélvicas al alcance visual del equipo de ecografía.

We present a clinical case of a 60 year-old patient, who concurs to the Obstetrics and Gynecology Department of the Padre Hurtado Hospital under the suspect of a uterine-cervical myoma. A transvaginal ultrasonography was performed which incidentally revealed a bladder tumor which was solid, vascularized, clearly inside of the bladder and attached to the bladder mucosa. The definitive urological study was compatible with a transitional cells papillary carcinoma. The woman did not refer hematuria spontaneously. The finding allowed an unusual diagnosis in an ultrasound aimed for different purposes, which underlines the potential use of this method in other pelvic organs.

Acute on chronic subdural hematoma as a rare complication in a microscopic polyangiitis patient receiving antithrombotic treatment.

We report a 56-year-old man with microscopic polyangiitis (MPA) who developed acute exacerbation of a chronic subdural hematoma (SDH). Laboratory data demonstrated elevation of myeloperoxidase antineutrophil cytoplasmic antibody (MPOANCA) and rapidly progressing renal dysfunction. Renal biopsy showed crescentic glomerulonephritis (GN) with membranous nephropathy (MN). He was treated with corticosteroids, antithrombotic agents, and an immunosuppressant. One month after initiation of treatment, he had a mild headache. One month later, he developed acute SDH. Although he recovered completely after the operation, he finally died of bacterial infection. On autopsy, a scar of vasculitis was confirmed in the leptomeninges as well as in the kidney and lung. Although SDH is a rare complication in MPA, nephrologists must pay more attention to the initial symptoms before a hematoma attack such as headache, especially in patients using antithrombotic agents.

Genotoxic activity of Eucalyptus globulus essential oil in Aspergillus nidulans diploid cells.

Eucalyptus globulus essential oil was evaluated for its genotoxic potential using a somatic segregation assay and a diploid strain of the fungus Aspergillus nidulans, heterozygous for nutritional and conidia color markers. The main compounds of the current essential oil sample were eucalyptol (49.0 %), alpha-pinene (8.9), beta-pinene (1.5), globulol (6.9), alpha-eudesmol (1.12), spathulenol (1.42), gamma-cadinene (1.45), trans-beta-elemenone (1.23) and aromandendrene (2.3), totaling 74 % of oil. Oil at 0.12 and 0.25 microL/mL was found to increase the mitotic instability of the original diploid strain and the number of diploid mitotic recombinants of A. nidulans. The genotoxicity of the oil was associated with the induction of mitotic crossing-over or with oil-broken chromosomes.

Tratamiento por fetoscopia del síndrome de transfusión feto fetal en Clínica Alemana de Santiago / Fetoscopy guided laser coagulation for twin to twin transfusion syndrome

Antecedentes: El síndrome de transfusión feto fetal (STFF) afecta el 15 por ciento de los gemelares monocoriales y tiene una mortalidad de 90 por ciento cuando se diagnostica antes de las 26 semanas. Objetivo: Evaluar el resultado perinatal mediante fotocoagulación con láser por fetoscopia, de las anastomosis vasculares placentarias en pacientes con STFF. Método: Fotocoagulación láser por fetoscopia de 18 casos de SFF tratados en Clínica Alemana de Santiago entre los años 2005-2008. Resultados: 72,8 por ciento de los embarazos concluyeron con al menos un niño vivo. No se requirió una nueva fetoscopia en ningún caso. No hubo rotura de membranas posprocedimiento en pacientes previamente asintomáticas. No se ha presentado daño neurológico en los niños sobrevivientes. Conclusiones: El resultado materno-perinatal es similar a las series internacionales y demuestra la factibilidad de este procedimiento de ser realizado en nuestro país por profesionales capacitados.

Background: Twin to twin transfusion syndrome (TTTS) occurs in 15 percent of monochorionic twins and has a 90 percent mortality when diagnosed before 26 weeks. Objective: To evaluated the perinatal outcome following fetoscopy guided laser coagulation of placental anatomoses. Method: Retrospective analysis of 18 cases treated in Clinica Alemana, between 2005 and 2008. Results: 72.8 percent of the pregnancies had at least one survivor at neonatal discharge. No case needed a second fetoscopy. There was no rupture of the membranes in patients without symptoms before surgery. There were no neurological sequels in survivors. Conclusions: The maternal and perinatal outcome is similar to international series and demonstrates feasibility in our country by experienced operators.

Alta prevalencia de IgG anti citomegalovirus en 583 embarazos: Hospital Padre Hurtado / High prevalence of IgG anti cytomegalovirus in 583 pregnancies: Hospital Padre Hurtado

ANTECEDENTES: Citomegalovirus (CMV) es la infección congénita más frecuente, demostrado en el 1% de recién nacidos en países desarrollados. Es la primera causa de sordera y alteraciones del desarrollo neuro-lógico infantil. Recientes estudios han demostrado que la seropositividad no evita una reinfección materna ni la enfermedad congénita, por lo que la caracterización de la seroprevalencia permite saber si la infección congénita proviene mayoritariamente de primoinfección o de reinfección. OBJETIVOS: Conocer la seroprevalencia al parto en 583 mujeres beneficiarías del Hospital Padre Hurtado durante mayo y junio del 2006. MÉTODOS: Estudio prospectivo, observacional, en que se estudio la presencia de IgG anti CMV en sangre materna al parto. RESULTADOS: Se obtuvo una seroprevalencia de 95%, sin casos de infección sintomática al nacer. CONCLUSIÓN: La seroprevalencia es elevada, lo que sugiere que la reinfección sería la forma principal de infección congénita. Un estudio en recién nacidos con cultivos virales o PCR permitiría conocer la tasa de infección congénita real, y no un estudio basado en seroconversión pues omitiría todos los casos que reinfección, que serían mayoritarios.

BACKGROUND: Cytomegalovirus is the most frequent congenital infection, affecting 1% of the population in developed countries, and the leading cause of deafness and brain development abnormalities in children. Recent studies have demonstrated that seropositivity do not avoid reinfection and congenital disease. OBJECTIVE: To study the seroprevalence in 583 pregnant women at delivery at Padre Hurtado Hospital, during 2006. METHODS: Prospective, observational study, in which maternal blood at delivery was studied for the presence of anti CMV IgG. RESULTS: There was 95% seroprevalence, without any case of symptomatic infection. CONCLUSION: The high prevalence supports that most of the cases of congenital disease would occur in seropositive women, supporting that reinfection is the main way of neonatal compromise. This supports that a study with direct detection in liveborns would be suitable to reveal the impact of cytomegalovirus in our population and not that of seroconversión.