Electroencephalographic activity during direct breastfeeding and breast milk expression in primiparous mothers.

Breastfeeding is recognized worldwide as the best option for infant feeding. Expressing breast milk is an alternative for mothers to provide their infants all the benefits of maternal milk. During breast milk expression, mothers receive a distinct kind of sensory stimulation, because there is no direct bodily or affective interaction with their infants, many women report feeling isolated, generating a love-hate relation with pumping, and even low levels of satisfaction while expressing breast milk. While it is well known that the prefrontal, parietal, and temporal cortices play important roles in the emotional and cognitive processing of maternal stimuli, knowledge about how these cortical areas function during breastfeeding is lacking. This study was designed to characterize EEG activity in the prefrontal and parietal cortices and the affective scores of primiparous breastfeeding mothers during two conditions of milk expression: breast milk expression and direct breastfeeding. Participants reported higher valence and arousal and a pleasant state during direct breastfeeding. In the direct breastfeeding condition, both prefrontal areas showed a higher absolute power (AP) of the slow bands, with a lower AP of the alpha band in the parietal cortex. A lower correlation between frontopolar and dorsolateral areas with a higher correlation between prefrontal and parietal cortices was obtained mainly in the right hemisphere. This EEG activity could be linked to an internal state of focused attention and, simultaneously, open monitoring of the environment that suggests an integration of the motive-emotional and cognitive processes necessary for adequate mother-baby interaction during direct breastfeeding.

Revealing the quantum nature of the voltage-induced conductance changes in oxygen engineered yttrium oxide-based RRAM devices.

In this work, the quasi-analog to discrete transition occurring in the current-voltage characteristic of oxygen engineered yttrium oxide-based resistive random-access memory (RRAM) devices is investigated in detail. In particular, the focus of our research is not on the absolute conductance values of this characteristic but on the magnitude of its conductance changes occurring during the reset process of the device. It is found that the detected changes correspond to conductance values predominantly of the order of the quantum unit of conductance G0 = 2e2/h, where e is the electron charge and h the Planck constant. This feature is observed even at conductance levels far above G0, i.e. where electron transport is seemingly diffusive. It is also observed that such behavior is reproducible across devices comprising yttrium oxide layers with different oxygen concentrations and measured under different voltage sweep rates. While the oxygen deficiency affects the total number of quantized conductance states, the magnitude of the changes in conductance, close to 1 G0, is invariant to the oxygen content of the functional layer.

El pico flujo espiratorio y la cuenta máxima son marcadores del compromiso respiratorio en la miastenia gravis / Peak expiratory flow and the single-breath counting test as markers of respiratory function in patients with myasthenia gravis

Introducción: La miastenia gravis (MG) es una enfermedad autoinmune mediada por anticuerpos. El cuadro clínico se caracteriza por debilidad muscular fluctuante y fatigable, con frecuente afectación de músculos fonodeglutorios y respiratorios. Dada la severidad que implica el compromiso respiratorio en la MG, su evaluación rutinaria es esencial.Nuestro objetivo fue identificar un marcador semiológico útil en la pesquisa del compromiso respiratorio en pacientes con MG.Métodos: Se realizó un trabajo observacional en pacientes con diagnóstico de MG. Los pacientes fueron evaluados con test de cuenta máxima, pico flujo espiratorio (PEF), cuestionario de disnea modificado (mMRC) y valoración de fuerza del cuello. Los resultados de estos parámetros fueron correlacionados con la medición de CVF (capacidad vital forzada) y presiones bucales estáticas máximas (PiMáx y PeMáx). Resultados:Cuarenta y cinco pacientes con MG fueron incluidos, dos pacientes tenían MGFA grado I, 35 grado II, siete grado III y uno grado IV al momento de la evaluación. Se halló una correlación positiva entre el test de cuenta máxima y la CVF (r = 0,57, p = 0,000), y entre el PEF y la CVF (r = 0,76, p = 0,000). El grado de disnea, según el mMRC, mostró una correlación negativa con la CVF (r =-0,31 p = 0,03). A su vez, el PEF correlacionó con la PeMáx de forma positiva, estadísticamente significativa (r = 0,51, p = 0,002).Conclusiones: El PEF, el test de cuenta máxima y el mMRC fueron útiles para evaluar la función respiratoria en pacientes con MG.(AU)

Introduction: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease characterised by fluctuating, fatigable muscle weakness, frequently involving bulbar and respiratorymuscles. Considering the severity of respiratory involvement in MG, routine evaluation ofrespiratory function is essential.The aim of this study was to identify a useful clinical marker of respiratory involvement inpatients with MG. Methods: We performed an observational study of patients with MG. All cases were evaluatedwith the single-breath counting test, peak expiratory flow (PEF), a modified Medical ResearchCouncil dyspnoea scale (mMRC), and a neck strength assessment. The results of these parameters were correlated with forced vital capacity (FVC), maximal inspiratory pressure (MIP), andmaximal expiratory pressure (MEP). Results: The study included 45 patients with MG: 2 patients classified as grade I on the Myasthenia Gravis Foundation of America classification at the time of evaluation, 35 classified asgrade II, 7 classified as grade III, and one classified as grade IV. Positive correlations were foundbetween single-breath counting test scores and FVC values (r = 0.57, p = .000), and betweenPEF and FVC values (r = 0.76, p = .000). Severity of dyspnoea according to the mMRC scaleshowed a negative correlation with FVC values (r = -0.31, p = .03). PEF also showed a significantcorrelation with MEP (r = 0.51, p = .002). Conclusions: PEF, the single-breath counting test, and the mMRC scale are useful measures forevaluating respiratory function in patients with MG.(AU)

MRI study of the cruciate ligaments and menisco-femoral ligaments of the knee.

PURPOSE: It has been argued that the meniscus-femoral ligaments disappear with age. We therefore analyzed the presence of the meniscus-femoral ligaments, in MRI. MATERIALS AND METHODS: We measured the PCL, ACL and MFL, noting their presence or absence in 120 Knee MRIs, 51 in women and 69 in men. All knees underwent MRI in the coronal, sagittal and axial planes. T1 and T2 weighted sequences were obtained. A descriptive statistical study of all the variables was carried out, and a comparative study was performed between sexes, sides and age groups. RESULTS: The MFLp was more frequent, found in 67 (55.8%) cases, than the MFLa, in 36 (30%) cases, and both together were present in 27 (22.5%) knees. We found a strong correlation between ACL length and PCL length (p = 0.001), we found no correlation between the presence of the posterior MFL either with age (p = 0.307) or with sex (p = 0.779) or side (p = 0.733). We also found no relationship between the presence of the anterior MFL and age (p = 0.553), or sex (p = 0.913), or laterality (p = 0.082). CONCLUSION: We found a strong correlation between ACL length and PCL length. In our study, the presence of the posterior MFL was more frequent, being present in 55.68%, while the anterior MFL was found in 30% of the knees. We did not observe that the presence of LMF decreases with age.

Peak expiratory flow and the single-breath count test as markers of respiratory function in patients with myasthenia gravis.

INTRODUCTION: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease characterised by fluctuating, fatigable muscle weakness, frequently involving bulbar and respiratory muscles. Considering the severity of respiratory involvement in MG, routine evaluation of respiratory function is essential. The aim of this study was to identify a useful clinical marker of respiratory involvement in patients with MG. METHODS: We performed an observational study of patients with MG. All cases were evaluated with the single-breath count test, peak expiratory flow (PEF), a modified Medical Research Council dyspnoea scale (mMRC), and a neck strength assessment. The results of these parameters were correlated with forced vital capacity (FVC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). RESULTS: The study included 45 patients with MG: 2 patients classified as grade I on the Myasthenia Gravis Foundation of America classification at the time of evaluation, 35 classified as grade II, 7 classified as grade III, and one classified as grade IV. Positive correlations were found between single-breath count test scores and FVC values (r = 0.57, P = .000), and between PEF and FVC values (r = 0.76, P = .000). Severity of dyspnoea according to the mMRC scale showed a negative correlation with FVC values (r = -0.31, P = .03). PEF also showed a significant correlation with MEP (r = 0.51, P = .002). CONCLUSIONS: PEF, the single-breath count test, and the mMRC scale are useful measures for evaluating respiratory function in patients with MG.

Bilateral facial palsy with paresthesias, variant of Guillain-Barré syndrome following COVID-19 vaccine: A case series of 9 patients.

Several cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 vaccination have been reported, including the rare subtype known as Bilateral Facial Palsy with paresthesias (BFP). To date, it is not known whether a causal relationship may exist between the two. We report 9 cases of BFP in patients vaccinated against COVID-19 in the previous month. Nerve conduction studies revealed demyelinating polyneuropathy in 4 patients, and 5 presented bilateral, focal facial nerve involvement, exclusively. Ganglioside antibody panel was positive in 4 patients (anti-GM1=2, anti-GD1a=1 and anti-sulfatide=1). Seven patients received intravenous immunoglobulin treatment, one plasma exchange, and one patient died from sudden cardiac arrest following arrhythmia before treatment could be administered. Rates of BFP following COVID-19 vaccination, did not differ from those reported in previous series. Epidemiological studies are essential to determine whether a causal relationship may exist between this rare form of GBS and COVID-19 vaccination.

Environmental DNA metabarcoding for benthic monitoring: A review of sediment sampling and DNA extraction methods.

Environmental DNA (eDNA) metabarcoding (parallel sequencing of DNA/RNA for identification of whole communities within a targeted group) is revolutionizing the field of aquatic biomonitoring. To date, most metabarcoding studies aiming to assess the ecological status of aquatic ecosystems have focused on water eDNA and macroinvertebrate bulk samples. However, the eDNA metabarcoding has also been applied to soft sediment samples, mainly for assessing microbial or meiofaunal biota. Compared to classical methodologies based on manual sorting and morphological identification of benthic taxa, eDNA metabarcoding offers potentially important advantages for assessing the environmental quality of sediments. The methods and protocols utilized for sediment eDNA metabarcoding can vary considerably among studies, and standardization efforts are needed to improve their robustness, comparability and use within regulatory frameworks. Here, we review the available information on eDNA metabarcoding applied to sediment samples, with a focus on sampling, preservation, and DNA extraction steps. We discuss challenges specific to sediment eDNA analysis, including the variety of different sources and states of eDNA and its persistence in the sediment. This paper aims to identify good-practice strategies and facilitate method harmonization for routine use of sediment eDNA in future benthic monitoring.

Efectos perinatales de la metformina en diabetes gestacional / Perinatal effects of metformin in gestational diabetes

Antecedentes: La diabetes gestacional es una condición en la que una mujer sin diabetes previa desarrolla intolerancia a la glucosa en cualquier momento del embarazo y puede o no resolverse al término de la gestación. La metformina, del grupo de las biguanidas, se considera manejo alternativo de la diabetes gestacional, incluido en el listado de los medicamentos esenciales por la OMS. El objetivo del presente fue identificar la incidencia de complicaciones obstétricas y perinatales en mujeres con diabetes gestacional que son sometidas a tratamiento con metformina. Material y método: Estudio transversal, con análisis comparativo de los resultados perinatales del tratamiento de diabetes gestacional. Donde el grupo 1 corresponde a pacientes que realizaron únicamente dieta y ejercicio y el grupo 2 a pacientes a las que además se les pautó metformina. Resultados: Fueron incluidas un total de 104 pacientes, edad materna promedio de 35 años, con ganancia ponderal de 10kg, media de peso al nacimiento de 3082 gramos. En el grupo 1 45,2%(n=47) con mayor ganancia ponderal materna y aumento en la incidencia de enfermedades hipertensivas del embarazo (9 casos de hipertensión gestacional y una preeclampsia con criterios de severidad); en contraste con el grupo 2, 54,8%(n=57) donde se reporta menor edad gestacional al nacimiento y un nacimiento pretérmino. Conclusiones: Con los resultados observados se demuestra que el uso de metformina para lograr el control metabólico de las pacientes con diabetes gestacional es una opción viable.(AU)

Background: Gestational diabetes is a condition in which a woman without previous diabetes develops glucose intolerance at any time during pregnancy, and may or may not be resolved at the end of gestation. Metformin, from the biguanide group, is considered as an alternative for the management of gestational diabetes, and is listed in essential drugs by the WHO. The objective of this study was to identify the incidence of obstetric and perinatal complications in women with gestational diabetes undergoing treatment with metformin. Material and method: A cross-sectional study was carried out, with comparative analysis of the perinatal outcomes of Gestational Diabetes treatment with lifestyle modification with and without metformin. Group 1 corresponded to patients who only performed exercise and diet, and Group 2 to patients who were also prescribed metformin. Results: A total of 104 patients were included. The mean maternal age was 35.05 years, with weight gain of 10kg. The mean birth weight was 3082 grams. Group 1, 45.2% (n=47) with greater maternal weight gain and increased incidence of hypertensive diseases of pregnancy (9 cases of gestational hypertension and 1 pre-eclampsia with severity criteria); in contrast to group 2, 54.8% (n=57) where 1 preterm birth and a lower gestational age at birth was reported. Conclusions: With the results observed, it is shown that the use of metformin to achieve metabolic control of patients with gestational diabetes is a viable option.(AU)

Peak expiratory flow and the single-breath counting test as markers of respiratory function in patients with myasthenia gravis. / El pico flujo espiratorio y la cuenta máxima son marcadores del compromiso respiratorio en la miastenia gravis.

INTRODUCTION: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease characterised by fluctuating, fatigable muscle weakness, frequently involving bulbar and respiratory muscles. Considering the severity of respiratory involvement in MG, routine evaluation of respiratory function is essential. The aim of this study was to identify a useful clinical marker of respiratory involvement in patients with MG. METHODS: We performed an observational study of patients with MG. All cases were evaluated with the single-breath counting test, peak expiratory flow (PEF), a modified Medical Research Council dyspnoea scale (mMRC), and a neck strength assessment. The results of these parameters were correlated with forced vital capacity (FVC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). RESULTS: The study included 45 patients with MG: 2 patients classified as grade I on the Myasthenia Gravis Foundation of America classification at the time of evaluation, 35 classified as grade II, 7 classified as grade III, and one classified as grade IV. Positive correlations were found between single-breath counting test scores and FVC values (r = 0.57, p = .000), and between PEF and FVC values (r = 0.76, p = .000). Severity of dyspnoea according to the mMRC scale showed a negative correlation with FVC values (r = -0.31, p = .03). PEF also showed a significant correlation with MEP (r = 0.51, p = .002). CONCLUSIONS: PEF, the single-breath counting test, and the mMRC scale are useful measures for evaluating respiratory function in patients with MG.

Diagnóstico ultrasonográfico de quiste ovárico fetal: reporte de caso / Ultrasound diagnosis of fetal ovarian cyst: Case report

Los quistes ováricos son los tumores abdominales más frecuentemente diagnosticados en los fetos femeninos, con una incidencia estimada de 1 en 1.000-2.600 embarazos. La probabilidad de malignidad es extremadamente baja y la asociación a malformaciones resulta excepcional. Se presenta un quiste ovárico en el diagnóstico ultrasonográfico prenatal, se observa por ecografía bidimensional en la región pélvica fetal una imagen anecoica con diámetro de 89mm y volumen de 242cc. El beneficio más importante es realizar un buen diagnóstico diferencial para así establecer un buen manejo del caso

Ovarian cysts are the most frequently diagnosed abdominal tumours in the female foetus, with an estimated incidence of 1 in 1,000-2,600 pregnancies. The probability of malignancy is extremely low and the association with malformations is exceptional. A case is presented of an ovarian cyst in the prenatal ultrasound diagnosis, with an anechoic image of 89mm diameter and 242cc of volume being observed in the fetal pelvic region with the two-dimensional ultrasound. The most important benefit is to make an optimal differential diagnosis in order to establish the treatment of the case

SAFIIRA: A heavy-ion multi-purpose irradiation facility in Brazil.

This work describes the new facility for applied nuclear physics at the University of Sao Paulo, mainly for irradiation of electronic devices. It is a setup composed of a quadrupole doublet for beam focusing/defocusing plus multiple scattering through gold foils to produce low intensity, large-area, and high-uniformity heavy-ion beams from 1H to 107Ag. Beam intensities can be easily adjusted from 102 particles cm2/s to hundreds of nA for an area as large as 2.0 cm2 and uniformity better than 90%. Its irradiation chamber has a high-precision motorized stage, and the system is controlled by a LabViewTM environment, allowing measurement automation. Design considerations and examples of use are presented.

Caso clínico: agenesia pericárdica, diagnóstico imagenológico de una patología infrecuente / Clinical case: pericardial agenesis, radiological diagnosis of a rare disease

Resumen: La agenesia pericárdica congénita es una condición infrecuente, que generalmente cursa de forma asintomática y es diagnosticada como hallazgo radiológico. Sin embargo, se describe la asociación con malformaciones cardiacas y herniaciones del miocardio con el subsiguiente riesgo de muerte súbita. La radiografía de tórax es un pilar fundamental para la sospecha diagnóstica. Presentamos un caso clínico de una paciente de 11 años que consulta por dolor torácico y disnea, que frente a los hallazgos típicos en radiografía de tórax se sospecha agenesia pericárdica, posteriormente confirmada con TC y RM.

Abstract: Congenital pericardial agenesis is an infrequent but usually asymptomatic condition, and is diagnosed as an incidental radiological finding. However, the association with cardiac malformations and myocardial herniation with the subsequent risk of sudden death has been reported. Chest plain films are a fundamental tool to raise the diagnostic suspicion. We present a clinical case of an 11-year-old patient who consulted for chest pain and dyspnea, in which, with the typical findings on chest radiography, pericardial agenesis was suspected and later confirmed by CT and MRI.

Diagnóstico prenatal de teratoma sacrococcígeo: reporte de un caso / Prenatal diagnosis of a sacrococcygeal teratoma: Case report

El teratoma sacrococcígeo es el tumor más común en recién nacidos, con incidencia reportada de uno por cada 40.000 nacidos vivos, habitualmente en fetos del sexo femenino, su mortalidad va del 15 al 35%, condicionada por el tamaño de la lesión, la extensión y el subtipo histológico. Se presenta un caso de teratoma sacrococcígeo diagnosticado en forma prenatal. En la región sacra se observó una imagen redondeada de bordes regulares, definidos, heterogénea, de 8,8×6,9×8,4cm, con un volumen de 266cc. El beneficio más importante es la prevención de distocias, por cesárea

Sacrococcygeal teratoma is the most common tumour found in newborns, with a reported incidence of one per 40,000 live births. It usually appears in female foetuses, with a mortality ranging from 15 to 35%, depending on the size of the lesion, extension, and histological subtype. The case is presented of a sacrococcygeal teratoma found in the prenatal diagnosis. It was observed in the sacral region as a rounded image with regular, defined, heterogeneous borders of 8.8×6.9×8.4cm, with a volume of 266cc. The most important action is the prevention of dystocia either by elective or emergency caesarean section

Reset Osmostat: Facts and Controversies.

Reset osmostat (RO) consists of a change in the normal plasma osmolality threshold (reduction or increase), which consequently induces chronic dysnatremia (hyponatremia or hypernatremia). Although the early papers on RO state that hyponatremic patients with this condition are usually not symptomatic, the current view is that most patients with hyponatremia are symptomatic and should be treated. RO has been associated with a myriad of clinical conditions and has clear diagnostic criteria which are crucial to arrive at the correct diagnosis and treatment.

Order-disorder phase transitions in Au-Cu nanocubes: from nano-thermodynamics to synthesis.

Catalysts have been widely used in industries and can be optimized by tuning the composition and chemical ordering of the elements involved in the nano-alloy. Among bi-metallic alloys, the Au-Cu system is of particular interest because it exhibits ordered phases at low temperatures. Nevertheless, the temperature at which these ordered structures are formed is totally unknown at the nanoscale. Consequently, to speed up the development of these catalysts, this paper theoretically predicts the structural phase transitions between ordered and disordered phases for the Au-Cu system by using nano-thermodynamics. Following the predictions, the suggested annealing temperatures have been carefully chosen and consequently, Au-Cu ordered nanocubes have been successfully synthesized through a solventless protocol. The results are fully supported by electron microscopy observations.

Resultado de un programa de rehabilitación pulmonar sobre la adherencia y la técnica inhalatoria en pacientes con enfermedad respiratoria crónica / Result of a pulmonary rehabilitation program on adherence and inhalation technique in patients with chronic respiratory disease

Introducción: Los programas de rehabilitación pulmonar deben incluir actividades educativas encaminadas a que el paciente conozca la enfermedad y reciba el adiestramiento que le permita abordar adecuadamente su tratamiento. Objetivo: Analizar la adherencia y la técnica inhalatoria en pacientes remitidos al programa de rehabilitación pulmonar de la Fundación Neumológica Colombiana y evaluar los cambios que se presentaron en éstas al finalizar el programa ambulatorio. Metodología: Estudio no experimental preprueba postprueba en pacientes mayores de 18 años. Se calificó la técnica inhalatoria utilizando la escala EDEN y la adherencia utilizando preguntas adaptadas de la escala de adherencia a la medicación de Morisky. Resultados: Se analizaron 320 pacientes; el porcentaje de pacientes que utilizaba correctamente los dispositivos inhalados al iniciar el programa de rehabilitación osciló entre 9% y19%; el error más común en todos los dispositivos fue no expulsar el aire antes de iniciar la inhalación. Después del programa de rehabilitación el porcentaje de pacientes que empleaban una técnica inhalatoria correcta fue en promedio 61% para inhaladores de dosis medida y 83% para dispositivos de polvo seco. La adherencia a los inhaladores antes del programa fue 58%, siendo descuido y olvido las principales razones que explican la no adherencia. Al finalizar el programa 86% de los pacientes eran adherentes. Conclusiones: Un porcentaje bajo de pacientes remitidos al programa de rehabilitación pulmonar aplicaba correctamente la técnica inhalatoria, la instrucción educativa dentro de un programa de rehabilitación pulmonar mejoró la técnica y la adherencia a los inhaladores en un porcentaje importante de pacientes.

Introduction: Pulmonary rehabilitation programs must include educational activities focused on the acquisition of necessary knowledge and skills to control the disease and approach treatment appropriately. Objective: To analyze treatment adherence and inhalation technique in patients referred to pulmonary rehabilitation program of Fundación Neumológica Colombiana and evaluate changes in them at the end of the outpatient program. Methodology: Pretest - posttest design in patients older than 18 years. The inhalation technique was assessed using the EDEN scale, and adherence was scored with modified questions from the Morisky medication adherence scale. Results: We analyzed 320 patients. The percentage of patients who used inhalers correctly before starting the rehabilitation program ranged between 9% and 19%; the most common mistake was not exhale the air before starting inhalation. Upon completion of the program the percentage of patients performing a correct inhalation technique ranged between 61% for metered dose inhalers to 83% for dry powder inhalers. Adherence to inhalers before the program was 58%, with neglect and forget being the main reasons encountered. It improved in 86% of evaluated patients. Conclusion: A small percentage of patients referred to pulmonary rehabilitation program applied the inhalation technique correctly; educational instruction in a pulmonary rehabilitation program improved the technique and adherence to inhalers in a significant percentage of patients.

Giant cross-magnetic-field steps due to binary collisions between pair particles.

Giant cross-magnetic-field steps can occur as a result of positron-electron collisions. Within a constant magnetic field (e.g., 1 T), a collision between a positron and an electron can result in a correlated drift across the magnetic field for a continuous range of impact parameters. Within this range, drift distances orders of magnitude larger than that associated with like-charge collisions were observed by computer simulation. Outside of this range, the collisional behavior is similar to that for collisions between particles with the same charge. A theoretical analysis of the phenomenon using center-of-mass and relative coordinates provides insights regarding the occurrence of giant cross-magnetic-field steps.

Revisión pictográfica de las anomalías de los conductos de Müller por resonancia magnética / Pictographic review of Müllerian duct anomalies by magnetic resonance imaging

Las anomalías útero-vaginales o müllerianas son un grupo de patologías congénitas que se originan por un defecto del desarrollo, fusión o canalización de los conductos de Müller en la etapa embrionaria, excepcionalmente pueden deberse a una alteración adquirida. La mayoría se diagnostica en forma tardía, como resultado de estudios de infertilidad o complicaciones obstétricas tempranas o tardías. La resonancia magnética (RM) es un examen no invasivo, que no utiliza radiación ionizante, con una alta resolución de contraste, que permite la evaluación multiplanar de las malformaciones müllerianas, permitiendo su aproximación diagnóstica y caracterización, complementando otras técnicas de imágenes como la histerosalpingografía y la ecografía ginecológica. El radiólogo debe estar familiarizado con las alteraciones anatómicas de los genitales femeninos y su representación en RM permitiendo un diagnóstico diferencial apropiado, oportuno y en consecuencia, un tratamiento adecuado. Este artículo describe los hallazgos en este grupo de malformaciones según la clasificación de la American Fertility Society, la más utilizada en la literatura actual.

The uterus-vaginal or Müllerian anomalies are a group of congenital diseases that are caused by a developmental defect, merger or channeling of Müllerian ducts in the embryonic stage, exceptionally may be due to an acquired disorder. Most belatedly diagnosed as a result of studies of infertility or early or late obstetric complications. Magnetic resonance imaging (MRI) is a noninvasive test that does not use ionizing radiation, with high contrast resolution, which allows multiplanar evaluation of Müllerian malformations, allowing its diagnostic approach and characterization, complementing other imaging techniques such as hysterosalpingography and gynecological ultrasound. The radiologist should be familiar with the anatomical abnormalities of the female genitalia and its representation in MRI, allowing an appropriate and timely differential diagnosis, and consequently, an appropriate treatment.

Paratiroidectomía en pacientes renales crónicos en Argentina: estudios prequirúrgicos, tipos de cirugía, recurrencia y persistencia / Parathyroidectomy in chronic kidney disease patients in Argentina: pre surgical studies, types of surgery, recurrence and persistence

La paratiroidectomía (PTx) es el tratamiento de elección en pacientes con HPT 2º severo, refractario al tratamiento médico. Se cuenta con muy poca información en Argentina de este procedimiento, por lo cual se realizó este estudio. Material y Métodos: Se incluyeron 255 pacientes con PTx entre el año 2003 al 2007 de un registro voluntario. Se evaluaron los estudios de localización prequirúrgicos, de laboratorio de metabolismo fosfocálcico previo y posterior a la cirugía y el tipo de técnica quirúrgica utilizada. Se analizó la persistencia y recidiva del HPT postcirugía. Resultados: La tasa de PTx fue de 2,7/1000 pacientes año. 83% de los pacientes tuvieron ecografía de cuello y 59% Sesta Mibi con Tc 99. Hubo una correlación positiva (p<0.001) entre el número de glándulas detectadas por ecografía y Sesta Mibi. La paratiroidectomía realizada fue: subtotal en 77%, total con autoimplante en 14% y total sin autoimplante en 9%. Hubo descensos significativos de Ca y P, fosfatasa alcalina y PTH (1744 ± 788 pg/ml a 247 ±450 pg/ml; p<0.0001) postcirugía. A los 2,4 ±2,5 meses de la PTx, el 72% de los pacientes tenía PTH <250 pg/ml, 19,8% tenía persistencia y 8,3% había recidivado. De acuerdo al tipo de cirugía la persistencia y recidiva fueron para PTx subtotal 22% y 8,3%, PTx total con implante 11% y 11% y PTx total sin autoimplante 13% y 4% respectivamente. La realización de Sesta Mibi no influyó en los resultados de la PTx. No se observaron diferencias entre los centros en relación con persistencia y recidiva. Conclusiones: La tasa de PTx fue muy baja, la ecografía fue el método de localización prequirúrgico preferido y la PTX subtotal la técnica quirúrgica más utilizada. La PTx fue exitosa en la mayoría de los pacientes y la persistencia y recidiva no estuvieron relacionadas con la técnica.

Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary hyperparathyroidism, refractory to medical treatment. There is not enough information about this procedure in Argentina, that is the reason why we performed this study. Material and Methods: 255 patients with PTx were included from the year 2003 to 2007 on a voluntary register. Studies of pre-surgical localization, phosphocalcic metabolism laboratories before and after surgery were evaluated, and the type of surgical technique used. The persistence and recurrence of post-surgical hyperparathyroidism was analyzed. Results: The PTx rate was 2,7/1000 patients year. 83% of the patients had neck echography and 59% Sestamibi scans with Tc 99. There was a positive correlation (p<0,001) between the number of detected glands by echography and Sestamibi. The parathyroidectomy performed was: subtotal in 77%, total with self-implant in 14% and total without self-implant in 9%. There were significant falls of Ca and P, Alkaline Phosphatase and PTH (1744±788 pg/ml to 247±450 pg/ml; p<0.0001) post-surgical. 2.4 ±2,5 months after the PTx, 72% of patients had PTH <250 pg/ml, 19,8% had persistence and 8,3% had recurrence. According to the type of surgery, the persistence and recurrence were for subtotal PTx 22% and 8,3%, total PTx with implant 11% and 11%, and total PTx without selfimplant 13% and 4% respectively. The performance of the Sestamibi scan did not affect the PTx results. No noticeable differences were observed among the centers for persistence and recurrence. Conclusions: The PTx rate was very low, echography was the preferred method of pre-surgical localization, and subtotal PTx was the most used surgical technique. PTx was successful in most of the patients, and persistence and recurrence were not related to the technique.