Genital and anorectal mucosal melanoma is associated with cutaneous melanoma in patients and in families.

BACKGROUND: Genital and anorectal mucosal melanomas (GAMMs) are rare compared with cutaneous melanoma (CM). Many epidemiological and genetic studies have been carried out on CM. In contrast, the genetic and environmental risk factors for GAMM have been poorly documented up to now. OBJECTIVES: To compare the distribution of pigmentation and naevus phenotypes, sun exposure and family history of melanoma between patients with GAMM and CM. METHODS: We compared two series of patients, 81 with GAMM and 293 with CM. RESULTS: Patients with GAMM and CM did not show significant differences for phenotypic risk factors. However, patients with GAMM tended to display red hair (11% vs. 5·5%, P = 0·08) and a poor tanning ability (22% vs. 13·3%, P = 0·06) at a higher frequency than patients with CM. A family history of melanoma was significantly more frequent with GAMM than with CM (18% vs. 7·5%, P = 0·005). Apart from the GAMM index case, affected relatives had CM except in one family. The frequency of multiple primary melanomas (MPMs) was similar in the GAMM and CM series (6% vs. 5·3%, P = 0·43). All patients with GAMM and MPM had only one GAMM primary, while the other primary was cutaneous. No CDKN2A germline mutation was detected in patients with GAMM. CONCLUSIONS: This study shows that GAMM and CM may occur in the same patient, and GAMM may develop in a familial setting. The association of both GAMM and CM in patients and families suggests shared genetic factors by these two types of melanoma.

[Eclampsia: 8-year experience]. / Eclampsia: experiencia de 8 años.

Eighty-one cases of eclampsia were managed from april 1985 to may 1993 with an incidence of 1.0 in 1.000 deliveries, at the Department of Obstetric, Gynecology and Neonatology of Barros Luco-Trudeau Hospital, Santiago, Chile. 84.6% of patients were primipara and 45.7% were less than 20 years of age. Convulsions occurred during pregnancy in 61.7% of patients, during labor 22.2% and 16.1% post partum. Eleven cases (13.6%) had convulsions while receiving magnesium sulfate therapy. Prior to convulsion 21.3% of patients showed blood pressure below 140/100 mmHg. 25.9% of patients had normal urine protein. Cesarean section was performed in 75.3%, and the most frequent indication was poor cervical conditions. Fetal distress respiratory and the intrauterine growth retardation were the most frequent neonatal morbidity. Perinatal mortality was 13.2%. Maternal mortality was 3.7%.

[Eclampsia at the Rancagua Regional Hospital]. / Eclampsia en Hospital Regional de Rancagua.

Forty-four cases of eclampsia with an incidence of 2.3 in 1,000 deliveries were analyzed. The major frequency was in primiparas (81.8%) and were less than 19 years old (54.5%). Convulsions occurred during pregnancy in 65.9% of patients, during labor 6.8% and 11.4% postpartum. In 91% of patients a cesarean section was performed. The most frequent indication was low pelvic score. The 61.4% of the labor occurred at 37 weeks or less. Perinatal mortality was 2.3% (one new born of 1,340 g death in the neonatal period). We don't have maternal mortality.

[Obstetric and perinatal management of myasthenia gravis]. / Manejo obstétrico y perinatal en miastenia gravis.

Three new cases of patients with myasthenia gravis during pregnancy are presented. The unpredictable course of myasthenia gravis (MG) in pregnancy is discussed. The course of labor in patients with MG is normal. The effects of certain drugs on the course of diseases are assessed. In our group of patients only one patient had an exacerbation of her MG after using an aminoglycoside. There were 7 live births. None of the newborns developed neonatal myasthenia.

[Gestation of 42 weeks or longer. Management protocol]. / La gestación de 42 o más semanas. Protocolo de manejo.

We have evaluated, in a prospective approach to the perinatal results of 98 patients with gestation of 42 weeks and more. The patients with an uncertain gestation age were excluded. The vigilance of the fetus was realized by electronic monitorization, sonographic examination and amnioscopy 55.1% of patients begin labor spontaneously 44.9% were interrupted. The principals causes of interruption were pelvic score of bishop > 7 points and condition that suggest fetal injury. In 31.6% of patients a cesarean section was made. Neonatal morbidity was a 19.4% and we don't have mortality.

[Myocardial infarction and pregnancy]. / Infarto del miocardio y embarazo.

We show a clinic case of a female patient 42 years old that suffered a myocardial infarction by coronary spasm, while she was in her 30th and a half weeks of gestation. We analyze the bases of the diagnostic its evolution and the neonatal complications.

[Spontaneous liver rupture in pregnancy-induced hypertension]. / Ruptura hepática espontanea en hipertensión inducida por el embarazo.

Spontaneous rupture of liver during pregnancy is associated with a very high maternal mortality. This lesion is an unusual complication of the preeclampsia-eclampsia syndrome. We report the case of a 34 years old woman who suffered this complication; responding satisfactorily after conservative surgical treatment.