Inadequate Content of Docosahexaenoic Acid (DHA) of Donor Human Milk for Feeding Preterm Infants: A Comparison with Mother's Own Milk at Different Stages of Lactation.

A cross-sectional single-center study was designed to compare the fatty acids profile, particularly docosahexaenoic acid (DHA) levels, between milk banking samples of donor human milk and mother's own milk (MOM) for feeding preterm infants born before 32 weeks' gestation. MOM samples from 118 mothers included colostrum (1-7 days after delivery), transitional milk (9-14 days), and mature milk (15-28 days and ≥29 days). In the n-3 polyunsaturated fatty acids (PUFAs) group, the levels of α-linolenic acid (C18:3 n3) and DHA (C22:6 n3) showed opposite trends, whereas α-linolenic acid was higher in donor human milk as compared with MOM, with increasing levels as stages of lactation progressed, DHA levels were significantly lower in donor human milk than in MOM samples, which, in turn, showed decreasing levels along stages of lactation. DHA levels in donor human milk were 53% lower than in colostrum. Therefore, in preterm infants born before 32 weeks' gestation, the use of pasteurized donor human milk as exclusive feeding or combined with breastfeeding provides an inadequate supply of DHA. Nursing mothers should increase DHA intake through fish consumption or nutritional supplements with high-dose DHA while breastfeeding. Milk banking fortified with DHA would guarantee adequate DHA levels in donor human milk.

Hypophosphatasia: A Novel Mutation Associated with an Atypical Newborn Presentation

Hypophosphatasia, a rare genetic disease affecting bone metabolism, is characterized by decreased activity of tissue non-specific alkaline phosphatase (TNAP). The gene encoding TNAP (ALPL) has considerable allelic heterogeneity, which could explain different degrees of enzyme activity resulting in a wide clinical variability. We report the case of a preterm newborn in whom a corneal opacity was detected at birth. Blood tests performed to investigate this finding showed low alkaline phosphatase concentrations. The corneal opacity disappeared within a week but alkaline phosphatase remained persistently low. With persistently decreased levels of alkaline phosphatase, upon suspicion of hypophosphatasia, plain radiography detected changes suggestive of rickets. Sequencing of the ALPL gene revealed a heterozygous variant that has not been described in the literature to date. Our patient's condition may be an atypical neonatal form of the syndrome, with a mild phenotype, very different from the classic neonatal form, which can lead to severe skeletal disease and respiratory failure. However, it could also be an early diagnosis of the childhood form, which is associated with a better prognosis.

Less Invasive Surfactant Administration in Spain: A Survey Regarding Its Practice, the Target Population, and Premedication Use.

OBJECTIVE: Scientific evidence supports the use of less invasive surfactant administration (LISA) techniques, but certain issues may be limiting its generalized incorporation in clinical practice. The objectives were to determine the level of acceptance of LISA techniques in Spanish hospitals, the types of methods used, the target population, and the premedication administered. STUDY DESIGN: An online survey was designed and sent to various secondary/tertiary hospitals in Spain. RESULTS: Among 67 neonatal units contacted, 44 (65.7%) participated. LISA was used in 89%, and those that did not perform the technique were contemplating its use in the future. In total, 77% of hospitals used some type of pharmacologic sedation/analgesia before the procedure: 28% always and 49% sometimes. In all cases, the reason for premedication was concerned about pain and discomfort. The types of drugs and doses varied. CONCLUSION: LISA has been incorporated in clinical practice of the hospitals surveyed, with a utilization rate higher than what has been reported to date. Sedation and analgesia are commonly administered. LISA is viewed as potentially involving some degree of pain and discomfort. Further studies are needed to determine the safest and most effective pharmacologic and nonpharmacologic measures to apply in these procedures.

Fractura congènita amb enfonsament cranial en dos nounats sense factors de risc / Fractura congénita con hundimiento craneal tipo ping-pong en dos neonatos sin factores de riesgo / Congenital depressed skull ping-pong fracture in two newborns without risk factors

Introducció: Les fractures cranials congènites amb enfonsament solen tenir com a antecedent un part vaginal complicat o un trauma obstètric. Aquest tipus de fractures també es poden presentar de forma espontània en fins a 1 de cada 10.000 naixements. Observació clínica: Presentem dos casos clínics en què s'observa una fractura cranial espontània amb enfonsament de diagnòstic en les primeres hores de vida, sense antecedent de trauma extrínsec durant la gestació ni d'instrumentalització durant el part. En tots dos casos es va realitzar reparació quirúrgica del defecte amb una evolució posterior correcta. Comentaris: Trobar la causa de les fractures espontànies amb enfonsament cranial tipus ping-pong pot ser difícil. Entre les possibles causes destaquen la pressió produïda intraúter per diferents estructures sobre el cap del fetus. En els dos casos descrits no es va identificar cap antecedent com a possible causant de la fractura. El maneig d'aquestes fractures és controvertit; la cirurgia estaria indicada en els casos en què l'enfonsament cranial pogués produir dany cerebral secundari. Pel que fa a les fractures amb enfonsament no complicades, en alguns centres es prefereix el tractament conservador

Introducción: Las fracturas craneales congénitas con hundimiento suelen tener como antecedente un parto vaginal complicado o un trauma obstétrico. Este tipo de fracturas también se pueden presentar de forma espontánea en hasta 1 de cada 10.000 nacimientos. Observación clínica: Presentamos dos casos clínicos en los que se observa una fractura craneal espontánea con hundimiento de diagnóstico en las primeras horas de vida, sin antecedente de trauma extrínseco durante la gestación ni instrumentalización durante el parto. En ambos casos se realizó reparación quirúrgica del defecto con buena evolución posterior. Comentarios: Identificar la causa de las fracturas espontáneas con hundimiento craneal tipo ping-pong puede ser difícil. Entre las posibles causas destacan la ppresión producida intraútero por diferentes estructuras sobre la cabeza del feto. En los dos casos descritos, no se identificó ningún antecedente como posible causa de la fractura. El manejo de estas fracturas es controvertido; la cirugía estaría indicada en aquellos casos en los que el hundimiento craneal pudiera producir daño cerebral secundario. En algunos centros se prefiere el tratamiento conservador para las fracturas con hundimiento no complicadas

Introduction: Congenital depressed skull fractures frequently are associated with complicated vaginal birth or obstetrical trauma. However, they can be present spontaneously without history of birth trauma in up to 1 out of every 10,000 births. Clinical observation: We report two newborns with a depressed skull fracture diagnosed within the first hours of life, without any history of extrinsic trauma during gestation or instrument-assisted delivery. In both cases, the defect was corrected surgically with good outcomes. Comments: The cause of ping-pong type spontaneous depressed skull fracture may be difficult to ascertain. Possible causes include the pressure exerted upon the head of the fetus by extrauterine structures. In the two cases reported, no preceding trauma was identified as possible cause of the fracture. The treatment of this type of skull fractures is controversial; while surgery is always indicated in cases where the cranial depression could produce brain damage, conservative treatment may also be appropriate in uncomplicated depressed fractures

Intravenous immunoglobulin as monotherapy for myasthenia gravis during pregnancy.

INTRODUCTION: Pregnant women with myasthenia gravis (MG) are at increased risk of complications and adverse outcomes, including the teratogenic effects of many drugs used to treat MG women of childbearing age. The effectiveness of intravenous immunoglobulins (IVIg) on other autoimmune mediated diseases has been extensively reported in recent years, although little is known about the role of IVIg in the treatment of MG during pregnancy. We designed this study to determine the effectiveness of IVIg as monotherapy during pregnancy for women with MG. MATERIAL AND METHODS: Five pregnant MG patients (mean age at delivery 36.4years, SD 5.8, range 29.4-45.2) were studied in 2013-14. Their treatment was switched to monthly IVIg cycles 2months before the pregnancy. Follow-up included monthly neurological QMG throughout the pregnancy and postpartum, obstetrical monitoring during monthly visits in the first two trimesters of the pregnancy, fortnightly visits between week 32 and week 36, and weekly visits after 36weeks, and neonatal follow-up after delivery. RESULTS: We observed no exacerbations during pregnancy, delivery or post-partum. The mean QMG score at baseline (before pregnancy) was 7.4 points in five women with generalized forms of MG. The maximum mean value reached during pregnancy was 8.6 points. The mean pregnancy duration was 38 w+5 d. No infant with transient neonatal myasthenia gravis. CONCLUSIONS: These results suggest that monotherapy with IVIg during pregnancy in MG patients could be promising, although confirmation is required in studies with larger populations.

El intervalo QT corregido durante la hipotermia terapéutica en la encefalopatía hipóxico-isquémica / Corrected QT interval during therapeutic hypothermia in hypoxic ischaemic encephalopathy

INTRODUCCIÓN: La hipotermia es el tratamiento estándar en la encefalopatía hipóxico isquémica (EHI) a pesar de que todavía no se conocen todos sus efectos y complicaciones. La bradicardia sinusal está ampliamente descrita en la literatura como consecuencia de dicho enfriamiento pero se ha estudiado poco la actividad eléctrica cardiaca en este grupo de pacientes. OBJETIVO: Determinar si existe un alargamiento del intervalo QT corregido (QTc) durante la hipotermia en neonatos con EHI moderada-grave y su evolución durante el tratamiento. MATERIAL Y MÉTODOS: Se reclutó a pacientes con EHI tratados con hipotermia entre noviembre del 2012 y octubre del 2013. Se realizaron electrocardiogramas (ECG) durante la hipotermia (uno cada 24 h durante el tratamiento) y durante el recalentamiento (a 34,5, 35,5 y 36,5°C). Se realizó un séptimo ECG a la semana de vida. RESULTADOS: Se incluyó a un total de 19 pacientes. Se observó un alargamiento del QTc en todos los pacientes durante la hipotermia. En 84% de los pacientes (n=16), el alargamiento se apreció en todos los ECG durante la hipotermia. Tras el recalentamiento, todos los pacientes presentaron una normalización del mismo. No se encontraron diferencias estadísticamente significativas al evaluar la prolongación del QTc según el grado de EHI (p = 0,192) y según el uso de soporte inotrópico o no (p = 0,669). Ningún paciente presentó arritmias potencialmente graves. CONCLUSIONES: La hipotermia moderada aplicada a los recién nacidos con EHI moderada-grave parece inducir una prolongación en el intervalo QTc temporal que se resuelve con el recalentamiento del paciente hasta temperatura fisiológica

INTRODUCTION: Therapeutic hypothermia is the standard treatment for hypoxic ischaemic encephalopathy (HIE), despite not knowing all its effects and complications. Sinus bradycardia is one of the consequences of cooling that has been previously documented in the literature, but little is known about the cardiac electrical activity in these patients. OBJECTIVE: To determine the corrected QT (QTc) interval in newborns treated with therapeutic hypothermia for HIE. MATERIAL AND METHODS: A prospective observational study was conducted in all patients treated with hypothermia for HIE that were admitted to our Unit between November 2012 and October 2013. ECGs were performed during hypothermia (every 24h), during the re-warming period (at 34.5°C, 35.5°C, 36.5°C), and on the 7th day of life. RESULTS: A total of 19 patients were included. A prolonged QTc was observed in all patients during hypothermia, and 84% (n=16) had prolonged QTc in all the ECGs during treatment. In 3 patients, one of the ECGs did not have a prolonged QTc. After re-warming, the QTc interval returned to normal in all patients. No statistically significant differences were seen when the degree of HIE (P=.192) or the use of inotropic support (P=.669) were considered. CONCLUSIONS: Therapeutic hypothermia applied to asphyxiated newborns with HIE seems to induce a QTc prolongation that resolves when the patient regains physiological temperature

Dosificación de surfactante: del dicho al hecho / Surfactant doses: From words to action

No disponible

[Corrected QT interval during therapeutic hypothermia in hypoxic ischaemic encephalopathy]. / El intervalo QT corregido durante la hipotermia terapéutica en la encefalopatía hipóxico-isquémica.

INTRODUCTION: Therapeutic hypothermia is the standard treatment for hypoxic ischaemic encephalopathy (HIE), despite not knowing all its effects and complications. Sinus bradycardia is one of the consequences of cooling that has been previously documented in the literature, but little is known about the cardiac electrical activity in these patients. OBJECTIVE: To determine the corrected QT (QTc) interval in newborns treated with therapeutic hypothermia for HIE. MATERIAL AND METHODS: A prospective observational study was conducted in all patients treated with hypothermia for HIE that were admitted to our Unit between November 2012 and October 2013. ECGs were performed during hypothermia (every 24h), during the re-warming period (at 34.5°C, 35.5°C, 36.5°C), and on the 7th day of life. RESULTS: A total of 19 patients were included. A prolonged QTc was observed in all patients during hypothermia, and 84% (n=16) had prolonged QTc in all the ECGs during treatment. In 3 patients, one of the ECGs did not have a prolonged QTc. After re-warming, the QTc interval returned to normal in all patients. No statistically significant differences were seen when the degree of HIE (P=.192) or the use of inotropic support (P=.669) were considered. CONCLUSIONS: Therapeutic hypothermia applied to asphyxiated newborns with HIE seems to induce a QTc prolongation that resolves when the patient regains physiological temperature.

Impact of the implementation of an interdisciplinary infection control program to prevent surgical wound infection in pediatric heart surgery.

UNLABELLED: Surgical site infection (SSI) remains a major source of morbidity, mortality, and increased health care costs in children undergoing heart surgery. The aim of this study was to assess the effectiveness of an intervention program designed to reduce the high incidence of SSI observed at our center in pediatric patients. An interdisciplinary infection control program including pre-, intra-, and postoperative measures was introduced for children undergoing heart surgery with cardiopulmonary bypass. We conducted a quasi-experimental interventional study comparing a pre-intervention cohort (June 2009 to March 2010) and a post-intervention cohort (July 2011 to July 2012). A significant drop in SSI incidence from 10.9 % (95 % CI 4.7-18.8) to 1.92 % (95 % CI 0.4-5.52) was observed. Variables significantly associated with infection risk were median age (14 days in infected vs 2.3 years in non-infected patients; p<0.01), hospitalization unit (10.3 % SSI cumulative incidence in the neonatal intensive care unit vs 0 cases in the pediatric intensive care unit; p<0.01), and median preoperative hospital stay (14 days in infected vs 1 day in non-infected patients; p=0.03). CONCLUSIONS: The implementation of a new intervention program was associated with an 82 % (95 % CI 34-94) reduction in SSI incidence in children undergoing heart surgery at our center. WHAT IS KNOWN: • Surgical site infection (SSI) is associated with significant morbidity and mortality following pediatric cardiac surgery. • Younger patients and longer cardiopulmonary bypass times are associated with higher SSI rates. What is New: • Comprehensive infection control program including preoperative, intraoperative and postoperative nonpharmacologic measures is a key factor for the prevention of SSI. • A significant reduction in SSI rates can be achieve despite a narrower-spectrum antibiotic usage.

Better outcomes in severe and morbid obese patients (BMI > 35 kg/m2) in primary Endo-Model rotating-hinge total knee arthroplasty.

The Endo-Model rotating-hinge prosthesis is preferably indicated as a primary implant in patients with advanced axial deviation of the lower limbs or unstable knees with severe bone defects. Outcomes were studied in 111 knees, operated in a three-year period; the mean followup was 28 months. Joint balance enhancement and limbs mechanical axis correction were achieved after surgery. There were 6 deep infections and 16 patients referred postoperative anterior knee pain. WOMAC index scores disaggregated by gender and BMI showed better outcomes in obese patients (specifically, those with a BMI of 35-40 kg/m(2)) and in men. Although the lack of a control group did not allow definite conclusions and despite a nonnegligible complication rate, our results reveal that the Endo-Model total knee arthroplasty can be a useful tool to deal with severe and morbid obese patients affected of severe gonarthrosis associated with marked axial deviations, ligament instability, or bone defects.

Caracterización del parto pretérmino en la Isla de la Juventud, 2007-2009 / Characterization of preterm delivery in Youth Island (Cuba), 2007-2009

Se realizó un estudio descriptivo retrospectivo para caracterizar el comportamiento del parto pretérmino en la Isla de la Juventud durante el trienio 2007-2009. Se analizaron 148 casos a partir de la revisión del registro de partos y las historias clínicas individuales y obstétricas, así como las historias clínicas de los recién nacidos. Predominaron las gestantes menores de 24 años de edad con un 55%, aquellas que tenían como antecedente dos abortos (38%) y/o un parto previo (46%), las que dieron a luz con una edad gestacional entre 34,0 y 36,6 semanas (71%) y aquellas cuyo hijo/a tuvo un peso al nacer mayor a 2.000g (69%). El síndrome de flujo vaginal (77%), la infección del tracto urinario (53%), la rotura prematura de membranas (23%) y los trastornos hipertensivos (22%) fueron las condiciones obstétricas más frecuentes. En el 64% de los casos el trabajo de parto se inició de forma espontánea y sólo el 49% de los nacimientos pretérmino estudiados ocurrieron por vía transpelviana. Las dos terceras partes de los partos pretérmino se iniciaron de forma espontánea y casi la mitad se produjeron por vía transpelviana, siendo el síndrome de distrés respiratorio (26%) y la sepsis (18%) las complicaciones más frecuentes en los nacidos pretérmino en nuestra muestra de estudio. Sólo fallecieron el 5,4% de todos los nacimientos pretérmino (AU)

A descriptive retrospective study was carried out to identify the characteristics of preterm delivery in Youth Island during the triennium 2007-2009. A total of 148 cases were examined, based on a review of the Registry of Deliveries and individual and obstetric case histories, as well as the newborns’ case histories. The most frequent maternal characteristics were age less than 24 years (55%), a history of two abortions (38%) and/or a previous childbirth (46%), delivery at 34.0 to 36.6 weeks’ gestational age (71%), and birthweight of more than 2000 grams (69% of the neonates). The most frequent obstetric complications were vaginal discharge syndrome (77%), urinary tract infection (53%), premature rupture of membranes (23%) and hypertension (22%). Labor was spontaneous in 64% of the patients and only 49% of the preterm deliveries occurred through the vaginal route. Two-thirds of preterm deliveries started spontaneously and almost half occurred through the vaginal route. The most frequent complications in preterm neonates were respiratory distress syndrome (26%) and sepsis (18%). Only 5.4% of all preterm neonates died (AU)

Neoplasia intraepitelial de cuello uterino en un área de salud de la Isla de la Juventud, Cuba: 1999-2008 / Cervical intraepithelial neoplasm in patients of the University Policlinic Dr Juan Manuel Paez Inchausti in the Isla de la Juventud, Cuba

Antecedentes: Las neoplasias intraepiteliales cervicales (NIE) constituyen lesiones precursoras del cáncer de cuello uterino, mostrando un incremento de sus tasas de incidencia en todo el mundo. Cuba, a pesar de contar con un programa de tamizaje hace más de 40 años no ha logrado disminuir la mortalidad por este cáncer. Objetivo: Estudio de casos y controles entre los años 1999 y 2008 para determinar los factores de riesgo asociados a la probabilidad de tener una neoplasia intraepitelial cervical en las pacientes del área de salud del Policlínico Universitario "Doctor Juan Manuel Páez Inchausti", Isla de la Juventud, Cuba. Método: La muestra estuvo compuesta por 632 pacientes, de ellos 316 casos con NIE y pareados por edad, a partir de la revisión de sus tarjetas individuales de citología. Resultados: El promedio de edad fue de 36,08 +/- 7,23 años. La mayor diferencia entre los grupos de estudios se encontró entre las pacientes de piel negra. En las pacientes que iniciaron sus relaciones sexuales antes de los 15 años el riesgo de padecer una NIE fue 3,8 veces mayor, triplicándose también el riesgo en las pacientes multíparas y en aquellas que usaron anticonceptivos orales por más de 10 años. Conclusión: Los factores de riesgo más relevantes en la muestra de estudio fueron el inicio precoz de las relaciones sexuales, las infecciones de transmisión sexual y la multiparidad.

Background: The cervical intraepithelial neoplasm (CIN) constitutes pre-cancer lesions of uterine cervix, showing an increment of their rates of incidence in everybody. Cuba, in spite of having a screening program, it does more than 40 years have not been able to diminish the mortality for this cancer. Objective: A case control study during the period of 1999-2008 was made to determinate the risk' factors associated with the probability of having a CIN in patients of the University Policlinic "Doctor Juan Manuel Paez Inchausti" in the Island of the Youth (Cuba). Method: This study includes 632 patients, the half of them with this illness and the same number of healthy persons. The information about the patients was obtained by revision of his clinical history documents. Result: The age average was from 36.08 +/- 7.23 years. The more differentiates between both studies groups were between the patients of black skin. In the patients that began their sexual relationships before the 15 years the risk of suffering a CIN was 3.8 times, also tripling the risk in the multipary patient and in those that used oral contraceptive for more than 10 years. Conclusions: The risk factors of more relevance were the precocious beginning of the sexual relationships, the infections of sexual transmission and multiparity.

Cáncer de cuello uterino / Cervix cancer

Se realizó un estudio descriptivo retrospectivo para caracterizar el comportamiento del cáncer de cuello uterino en una muestra de 162 pacientes con este diagnóstico durante el periodo 2003-2009, en la Isla de la Juventud. A partir de la revisión de los reportes de casos de la Unidad Nacional de Cáncer, las historias clínicas individuales del Hospital General Docente de la Isla de la Juventud y del Instituto Nacional de Oncología y Radiología (INOR), así como los reportes de fallecidos, se pudo observar que el 63 por ciento de los casos se presentaron en mujeres de 34 a 57 años y que el 20 por ciento estaban en edades fuera del programa de pesquisa. El antecedente de neoplasia intrepitelial cervical (NIC) y/o infección por virus del papiloma humano (HPV) y el tabaquismo fueron los factores de riesgo más frecuentes. Predominó el carcinoma epidermoide no queratinizado de células grandes y el estadio 0 o si situ. A la mayor parte de las pacientes se les practicó tratamiento quirúrgico como terapia inicial. La mayor mortalidad se observó entre la 5ta y 6ta décadas de la vida, con una supervivencia aceptable al término de 5 años

A retrospective and descriptive study was conducted to characterize the behavior of cervix cancer in a sample of 162 patients with this diagnosis during 2003-2009 in the Isla de la Juventud municipality. From the review of case reports from the National Unit of Cancer the individual medical records of Teaching General Hospital of this municipality and from the National Institute of Oncology and Radiology, as well as the deceased persons, it was possible to note that the 63 percent of cases were women aged 34-57 and that the 20 percent was in ages outside the screening program. The NIC and/or infection by HPV and smoking were the more frequent risk factors. There was predominance of large cells epidermoid non-keratini zed carcinoma and the O stage or in situ. Most of patients were operated on is initial therapy. The great mortality was between fifth and sixth decades of life with a acceptable survival at 5 years

Cáncer de cuello uterino / Cervix cancer

Se realizó un estudio descriptivo retrospectivo para caracterizar el comportamiento del cáncer de cuello uterino en una muestra de 162 pacientes con este diagnóstico durante el periodo 2003-2009, en la Isla de la Juventud. A partir de la revisión de los reportes de casos de la Unidad Nacional de Cáncer, las historias clínicas individuales del Hospital General Docente de la Isla de la Juventud y del Instituto Nacional de Oncología y Radiología (INOR), así como los reportes de fallecidos, se pudo observar que el 63 por ciento de los casos se presentaron en mujeres de 34 a 57 años y que el 20 por ciento estaban en edades fuera del programa de pesquisa. El antecedente de neoplasia intrepitelial cervical (NIC) y/o infección por virus del papiloma humano (HPV) y el tabaquismo fueron los factores de riesgo más frecuentes. Predominó el carcinoma epidermoide no queratinizado de células grandes y el estadio 0 o si situ. A la mayor parte de las pacientes se les practicó tratamiento quirúrgico como terapia inicial. La mayor mortalidad se observó entre la 5ta y 6ta décadas de la vida, con una supervivencia aceptable al término de 5 años (AU)

A retrospective and descriptive study was conducted to characterize the behavior of cervix cancer in a sample of 162 patients with this diagnosis during 2003-2009 in the Isla de la Juventud municipality. From the review of case reports from the National Unit of Cancer the individual medical records of Teaching General Hospital of this municipality and from the National Institute of Oncology and Radiology, as well as the deceased persons, it was possible to note that the 63 percent of cases were women aged 34-57 and that the 20 percent was in ages outside the screening program. The NIC and/or infection by HPV and smoking were the more frequent risk factors. There was predominance of large cells epidermoid non-keratini zed carcinoma and the O stage or in situ. Most of patients were operated on is initial therapy. The great mortality was between fifth and sixth decades of life with a acceptable survival at 5 years (AU)

Cáncer de cuello uterino / Cervix cancer

Se realizó un estudio descriptivo retrospectivo para caracterizar el comportamiento del cáncer de cuello uterino en una muestra de 162 pacientes con este diagnóstico durante el periodo 2003-2009, en la Isla de la Juventud. A partir de la revisión de los reportes de casos de la Unidad Nacional de Cáncer, las historias clínicas individuales del Hospital General Docente de la Isla de la Juventud y del Instituto Nacional de Oncología y Radiología (INOR), así como los reportes de fallecidos, se pudo observar que el 63 por ciento de los casos se presentaron en mujeres de 34 a 57 años y que el 20 por ciento estaban en edades fuera del programa de pesquisa. El antecedente de neoplasia intrepitelial cervical (NIC) y/o infección por virus del papiloma humano (HPV) y el tabaquismo fueron los factores de riesgo más frecuentes. Predominó el carcinoma epidermoide no queratinizado de células grandes y el estadio 0 o si situ. A la mayor parte de las pacientes se les practicó tratamiento quirúrgico como terapia inicial. La mayor mortalidad se observó entre la 5ta y 6ta décadas de la vida, con una supervivencia aceptable al término de 5 años (AU)

A retrospective and descriptive study was conducted to characterize the behavior of cervix cancer in a sample of 162 patients with this diagnosis during 2003-2009 in the Isla de la Juventud municipality. From the review of case reports from the National Unit of Cancer the individual medical records of Teaching General Hospital of this municipality and from the National Institute of Oncology and Radiology, as well as the deceased persons, it was possible to note that the 63 percent of cases were women aged 34-57 and that the 20 percent was in ages outside the screening program. The NIC and/or infection by HPV and smoking were the more frequent risk factors. There was predominance of large cells epidermoid non-keratini zed carcinoma and the O stage or in situ. Most of patients were operated on is initial therapy. The great mortality was between fifth and sixth decades of life with a acceptable survival at 5 years (AU)

Therapeutic indications of fetoscopy: a 5-year institutional experience.

BACKGROUND: Prenatal ultrasound study allows the detection of fetal malformations. Intrauterine interventions are now contemplated to correct, or interfere with, the natural history of these anomalies. Minimally invasive techniques, such as the so-called "Fetendo" (fetal endoscopy), are now therapeutic possibilities. METHODS: From 2002 to 2007, 205 fetoscopies were performed in our hospital's fetal surgery program. Fetoscopic interventions were carried out under epidural anesthesia, accessing the uterine cavity with a fetoscope containing a 1.2-mm telescope. Following ultrasound-guided needle puncture of the amniotic cavity, the fetoscope was inserted through a 3-mm sheath by the Seldinger technique. Visibility was maintained with an amnioinfusion system. This procedure offers access to the placental surface, umbilical cord, and fetus. RESULTS: Fetoscopy was used to perform laser coagulation of communicant placental vessels in 148 biamniotic monochorionic gestations with twin-to-twin transfusion syndrome (TTTS) and to occlude the umbilical cord in 32 cases of discordant monochorionic twins with a severe or lethal anomaly in one of the fetuses, and 5 cases of reversed arterial perfusion (TRAP) sequence. In addition, fetoscopy was performed in 18 cases to treat severe congenital diaphragmatic hernia by tracheal occlusion with an endotracheal balloon. Finally, in 2 cases, fetoscopic release of amniotic bands was performed to rescue extremities and the umbilical cord. The most common complications (10%) were preterm rupture of membranes, which resulted in preterm delivery. Other indications for fetoscopy, which we are currently using in experimental animal models, include low urinary tract obstruction, sacrococcygeal teratoma, and repair of myelomeningocele defects. CONCLUSIONS: Fetoscopy can lower the incidence of preterm labor that occurs in response to the aggression of open surgery. At present, fetoscopy is effective for treating several fetal anomalies. Preterm rupture of membranes remains the weak link of fetoscopy. Refinement of the technique and technologic advances will help this problem and allow the use of fetoscopy for other pathologies in the future.

Factores de riesgo de la neoplasia ginecológica en la tercera edad. Isla de la Juventud. 2003-2007 / Risk factors for gynecological malignancy in the elderly. Isle of Youth. 2003-2007

Se realizó un estudio de caso control para caracterizar la morbi-mortalidad por cáncer ginecológico en la tercera edad durante el periodo 2003-2007 en la Isla de la Juventud. Se estudiaron 242 mujeres, de las cuales a 121 (todas las edades) se les había diagnosticado una neoplasia de mama, cuello uterino, endometrio u ovario, así como 67 controles con pareo 1:1 por edad con aquellas pacientes con 60 años o más. Se incluyeron además las 54 pacientes de este grupo etáreo fallecidas por esta causa durante el periodo de estudio. Se encontró que en todas las localizaciones anatómicas el grupo de pacientes ancianas representó más de la mitad de los casos, excepto en el cáncer de cérvix. En las pacientes con cáncer de cuello uterino y endometrio fue el grupo de 60 a 75 años el de mayor riesgo de padecer una neoplasia, mientras que en los de mama y ovario fue el grupo de mayores de 75 años. Las patologías benignas del cérvix, la menopausia tardía, los antecedentes familiares de cáncer ginecológico y la obesidad/tabaquismo fueron los principales factores de riesgo en las neoplasias de cérvix, mama, endometrio y ovario, en ese orden(AU)

The case-control study to characterize the morbidity and mortality by gynaecologic cancer in patients with 60 years old or more, during 2003-2007 in the Island of Young. Were studied 242 women, 121 of them with diagnostic of cancer of breast, uterus, ovary or cervix. So, 67 health patients as control and the 54 patients that died by this cause during this period. All anatomy locations of cancer were most frequently in older patients, except in the cervix cancer. The uterus and cervix cancer was most common find in the patients with 60-75 years old, while the ovary and breast cancer was most common in the patients older tan 75 years old. The benign illness of cervix, older menopause, family history of gynecologic cancer and obesity/ smoking were the main risk factors to cervix, breast, uterus and ovary cancer, in this order(AU).

The exit procedure (ex-utero intrapartum treatment): management of giant fetal cervical teratoma.

The prognosis of giant cervical teratomas is determined by the severity of the associated airway obstruction. Ex-utero intrapartum treatment (EXIT) is a technique to establish a patent airway before completion of birth, while the infant remains on placental support. We present two cases of newborns with cervical teratomas treated with the EXIT procedure. In the first, this technique allowed a tracheotomy to be performed, and in the second, correction of tracheal displacement and subsequent nasotracheal intubation was achieved.

Quilotórax en el período neonatal / Chylothorax in the neonatal period

Fundamento. El quilotórax es la causa más frecuente de derrame pleural en el período neonatal. Su tratamiento está basado en medidas nutricionales, farmacológicas y quirúrgicas. Aunque algunos autores han propuesto algoritmos terapéuticos, su manejo sigue sin estar bien establecido en lo referente a la mejor estrategia nutricional, la utilidad de los fármacos empleados y el momento y tipo de cirugía indicados. Hemos observado un aumento de la incidencia de quilotórax, especialmente los relacionados con procedimientos quirúrgicos, que, si persisten de manera prolongada, pueden afectar significativamente al estado clínico del paciente y contribuir a una mayor morbilidad y mortalidad. Objetivo. Revisar y actualizar las diferentes causas de quilotórax neonatal, los criterios diagnósticos y la eficacia y seguridad de las diferentes modalidades terapéuticas, tanto médicas como quirúrgicas. Método. Revisión bibliográfica de los diferentes aspectos relacionados con etiología, fisiopatología, clínica, diagnóstico y tratamiento del quilotórax neonatal. Conclusiones. No existe un algoritmo terapéutico uniforme. La mayoría de los autores abogan por un período inicial de tratamiento médico conservador con medidas nutricionales y somatostatina o análogos y, en los casos de fracaso de éste, tratamiento quirúrgico. Serían necesarios ensayos clínicos prospectivos randomizados con el objetivo de establecer la eficacia y seguridad de la somatostatina y el octreótide. El momento adecuado de indicar la cirugía sigue siendo motivo de controversia

Background. Chylothorax is the most frequent cause of pleural effusion in the neonatal period. The management includes nutritional, medical, and surgical interventions. Although therapeutic algorithms have been suggested, its management is not well established. The best nutritional approach, the effectiveness of the medical agents, and the time and type of surgery have not been defined. We have observed an increasing incidence of chylothorax, specially those cases related with surgical procedures. This condition, when long-standing, may have a profound effect on the patient clinical condition, and may result in significant increase in morbidity and mortality. Objective. To review and update the different causes and diagnostic criteria of neonatal chylothorax, and to evaluate the efficacy and safety of the different therapeutic approaches. Method. We reviewed the medical literature regarding etiology, pathophysiology, clinical features, diagnosis and treatment of neonatal chylothorax. Conclusions. The therapeutic algorithm of neonatal chylothorax is not well established. Most authors suggest an initial conservative treatment that includes nutritional management and pharmacological intervention with somatostatin or octreotide. If medical management fails, surgical intervention must be considered. Randomised prospective trials are necessary to establish the efficacy and safety of somatostatin and octreotide. Controversy exists about the appropriate time to perform surgery