Longitud cervical en la predicción de parto prematuro espontáneo y resultados perinatales en población de gemelos (dobles) en Hospital Provincial, Chile / Cervix measurement in spontaneous labor prediction and perinatal results in twins from a provincial hospital, Chile

RESUMEN Diversas publicaciones han demostrado que el acortamiento cervical es un elemento predictor de parto prematuro en embarazo gemelar. Los objetivos del presente trabajo fueron comparar los resultados perinatales de gestantes con longitud cervical (LC), entre las 20-24 semanas, ≤ 25mm y aquellas con LC > 25mm; y evaluar la capacidad predictiva para parto prematuro ≤ 32 semanas. Estudio analítico observacional, retrospectivo de cohorte, se recogieron los datos de las gestantes con embarazo gemelar doble, atendidas en el servicio de Obstetricia y Ginecología Hospital Las Higueras Talcahuano, durante los años 2010 al 2018; quienes se les había realizado al menos una evaluación cervical entre las 20 y 24 semanas; recolectando desde base de datos y ficha clínica sus datos perinatales. Se obtuvo los datos de 186 pacientes, la edad promedio de las pacientes fue 29 años, longitud cervical promedio fue 40,8 mm, parto promedio fue a las 35,6 semanas. El 71% de las gestantes fue gemelar Bicorial-Biamniótico y 29% Monocorial-Biamniótico. El 3,2% de los casos (n=6) tuvo longitud cervical ≤ 25mm en el segundo trimestre. En el grupo con longitud cervical ≤ 25 mm la EG al parto fue 30,7 semanas, con peso promedio de 1.555 gramos y una talla de 41,1 cm; mientras que estos mismos valores en el grupo con cérvix > 25 mm fueron 35,8 semanas, 2,527 gramos y 45,8 cm. La longitud cervical en relación a parto ≤ 32 semanas tuvo una sensibilidad de un 27,8%; especificidad de un 99,4%; VPP de 83,3% y un VPN de 92,8%. CONCLUSIÓN: Nuestros resultados muestran que la longitud cervical logra tener una gran especificidad, VPP y VPN en relación del parto prematuro ≤ 32 semanas, pero con una sensibilidad limitada. Pudiendo ser un buen método para identificar al embarazo gemelar en riesgo de parto prematuro ≤ 32 semanas.

ABSTRACT Several publications have shown that cervical shortening is a predictive element of premature delivery in twin pregnancy. The objectives of the present study were to compare the perinatal results of pregnant women with cervical length, between 20-24 weeks, ≤ 25mm and those with> 25mm; and evaluate the predictive capacity for premature delivery ≤ 32 weeks. An observational, cohort, retrospective, analytical study collected the data of pregnant women with double twin pregnancy treated at the Obstetrics and Gynecology Service Hospital Las Higueras Talcahuano during the years 2010 to 2018; who had at least one cervical measurement between 20 and 24 weeks of pregnancy; collecting perinatal data from database and clinical record. Data were obtained from 186 patients, the average age of the patients was 29 years, average cervical measurement was 40.8 mm, average delivery was 35.6 weeks. The 71% of pregnant women were twin BcBa and 29% McBa. The 3.2% (n = 6) had cervical measurement ≤ 25mm in the second trimester. In the group with cervical length ≤ 25 mm, the GA at delivery was 30.7 weeks, with an average weight of 1555 grams and a height of 41.1 cm; while these same values in the group with cervix > 25 mm were 35.8 weeks, 2527 grams and 45.8 cm. Cervical measurement in relation to childbirth ≤ 32 weeks had a sensitivity of 27.8%; specificity of 99.4%; PPV of 83.3% and a NPV of 92.8%. CONCLUSION: Our results show that cervical length has great specificity, PPV and NPV in relation to premature labor ≤ 32 weeks, but with limited sensitivity. It can be a good method to identify the twin pregnancy at risk of preterm birth ≤ 32 weeks.

Scanning electron microscopy of dermatofibroma

Abstract: Dermatofibroma is a proliferation of spindle cells located in the dermis. We used scanning electron microscopy to examine two histologically confirmed lesions and observed preserved collagen bundles in the perilesional area. In the lesional area, the collagen was denser, without formation of bundles. Higher magnification showed collagen with mesh-like appearance similar to stretched tufts of cotton. Very high magnification evidenced the tufts of cotton and spindle cells measuring 2 to 12 microns.

Acidosis láctica asociada a metformina: caso clínico / Metformin-associated lactic acidosis: report of one case

Metformin-associated lactic acidosis is a severe and infrequent adverse event. Early diagnosis is essential to start an early treatment, which often has favorable results. We report a 56 years old non-insulin-requiring type 2 diabetic female who developed a severe metabolic acidosis associated with metformin in relation to an acute renal failure secondary to infectious diarrhea. Early treatment with bicarbonate and continuous hemofiltration allowed a quick improvement of the patient. Metformin-associated lactic acidosis has an elevated mortality (50-80%) and has a specific and effective treatment. Therefore, the condition must be born in mind.

Enfisema subcutâneo, pneumotórax e pneumomediastino após tonsilectomia / Emphysema subcutaneous, pneumothorax and pneumomediastinum after tonsillectomy

Várias complicações podem estar relacionadas a procedimentos cirúrgicos na área de cabeça e pescoço. O pneumomediastino, pneumotórax e enfisema subcutâneo estão descritos em menor número de casos, em relação às demais complicações. Nesses procedimentos, constata-se importante o cuidado com a técnica cirúrgica, evitando manobras cirúrgicas agressivas, além de parcimônia no uso de máscaras de oxigênio sob pressão positiva e intubação. Este estudo relata um caso de enfisema subcutâneo, pneumotórax e pneumomediastino, com aparecimento 48 horas após tonsilectomia palatina, e discute possíveis mecanismos, morbidade, formas de prevenção e tratamento

Several complications can be related to surgical approaches of the head and neckareas. Subcutaneous emphysema, pneumothorax and pneumomediastinum are described in a small number of cases, among others. In these surgeries, a careful surgical technique approach is of utmost importance, and aggressive surgical maneuvers should be avoided.Caution should be taken with the use of oxygen masks for positive pressure ventilation during anesthesia recovery and intubation. This study reports a case of pneumomediastinum, pneumothorax and subcutaneous emphysema that appeared 48 hours after palate tonsillectomy and discusses possible mechanisms, morbidity, ways of prevention and treatment