Open Fetal Microneurosurgery for Intrauterine Spina Bifida Repair.

OBJECTIVES: The aim of the study was to describe the feasibility of open fetal microneurosurgery for intrauterine spina bifida (SB) repair and to compare perinatal outcomes with cases managed using the classic open fetal surgery technique. METHODS: In this study, we selected a cohort of consecutive fetuses with isolated open SB referred to our fetal surgery center in Queretaro, Mexico, during a 3.5-year period (2016-2020). SB repair was performed by either classic open surgery (6- to 8-cm hysterotomy with leakage of amniotic fluid, which was replaced before uterine closure) or open microneurosurgery, which is a novel technique characterized by a 15- to 20-mm hysterotomy diameter, reduced fetal manipulation by fixing the fetal back, and maintenance of normal amniotic fluid and uterine volume during the whole surgery. Perinatal outcomes of cases operated with the classic open fetal surgery technique and open microneurosurgery were compared. RESULTS: Intrauterine SB repair with a complete 3-layer correction was successfully performed in 60 cases either by classic open fetal surgery (n = 13) or open microneurosurgery (n = 47). No significant differences were observed in gestational age (GA) at fetal intervention (25.4 vs. 25.1 weeks, p = 0.38) or surgical times (107 vs. 120 min, p = 0.15) between both groups. The group with open microneurosurgery showed a significantly lower rate of oligohydramnios (0 vs. 15.4%, p = 0.01), preterm rupture of the membranes (19.0 vs. 53.8%, p = 0.01), higher GA at birth (35.1 vs. 32.7 weeks, p = 0.03), lower rate of preterm delivery <34 weeks (21.4 vs. 61.5%, p = 0.01), and lower rate of perinatal death (4.8 vs. 23.1%, p = 0.04) than the group with classic open surgery. During infant follow-up, the rate of hydrocephalus requiring ventriculoperitoneal shunting was similar between both groups (7.5 vs. 20%, p = 0.24). All patients showed an intact hysterotomy site at delivery. CONCLUSION: Intrauterine spina repair by open fetal microneurosurgery is feasible and was associated with better perinatal outcomes than classic open fetal surgery.

Síndrome de dificultad respiratoria aguda severo en el embarazo. Revisión de la literatura y reporte de dos casos / Severe acute respiratory distress syndrome in pregnancy. Review of the literature and two cases report / Síndrome do disconforto respiratório agudo grave na gestação. Revisão de literatura e relato de dois casos

Resumen: La mujer durante el embarazo, parto y puerperio presenta cambios anatómicos, fisiológicos y en la dinámica ventilatoria, por lo que una de las complicaciones que puede presentar es el síndrome de dificultad respiratoria aguda, el cual representa un reto para el clínico, pudiendo aparecer complicaciones en el embarazo como corioamnionitis, aborto, embolismo de líquido amniótico. El abordaje y tratamiento del síndrome de dificultad respiratoria aguda es primordial, se han presentado avances en la estrategia ventilatoria como: disminución del volumen tidal y posición prono durante la ventilación mecánica, que han mejorado el pronóstico de manera favorable en esta población.

Abstract: The woman during pregnancy, delivery and puerperium presents anatomical changes, physiological and ventilatory dynamics, so one of the complications that may present is the acute respiratory distress syndrome (ARDS) representing a challenge for the clinician, and complications may appear in pregnancy as chorioamnionitis, abortion, amniotic fluid embolism. The approach and treatment of ARDS in the patient is paramount. Advances have been made in the ventilatory strategy, such as: decreased tidal volume, prone position during mechanical ventilation, which have improved the prognosis favorably in this population.

Resumo: A mulher durante a gestação, parto e puerpério apresenta alterações anatômicas, fisiológicas e ventilatórias, por isso uma das complicações que ela pode apresentar é a Síndrome do Desconforto Respiratório Agudo (SDRA), representando um desafio para o clínico, podendo aparecer complicações na gestação, como corioamnionitis, aborto, embolia do líquido amniótico. A abordagem e tratamento da SDRA no paciente é essencial, houve avanços na estratégia ventilatória como: diminuição do volume corrente, posição prona durante a ventilação mecânica, que melhoraram o prognóstico favoravelmente nessa população.

Insuficiencia cardiaca aguda secundaria a estenosis mitral reumática durante el puerperio / Puerperal acute heart failure secondary to mitral stenosis. Case report / Insuficiência cardíaca aguda secundária à estenose mitral reumática durante puerpério

Resumen: Las cardiopatías complican 4% de los embarazos y 60% son por valvulopatías reumáticas; la más común es la estenosis mitral. Por esta razón, reportamos el caso de una puérpera en apariencia sana con embarazo normoevolutivo que debutó con falla cardiaca derecha. Se integró el diagnóstico de estenosis mitral grave por enfermedad reumática, la cual se estabilizó de manera precoz para realizar de forma externa corrección quirúrgica. Aunque en la actualidad la prevalencia de enfermedades reumáticas ha disminuido, la estenosis mitral sigue siendo la valvulopatía más común en las embarazadas y es una entidad potencialmente mortal si no se lleva el control adecuado.

Abstract: Heart disease complicates 4% of pregnancies, and rheumatic valve diseases make up 60% of these cases. The most common one is mitral stenosis. We present the case of a healthy puerperal woman with a non-complicated pregnancy who begin with pulmonary edema and acute heart failure. She was diagnosed with severe mitral stenosis with rheumatoid etiology, which was stabilized for external surgical correction. Although the prevalence of rheumatoid diseases has decreased, mitral stenosis remains the most common valve disease in pregnant women and is life-threatening without proper control.

Resumo: As cardiopatias complicam 4% das gestações e 60% são decorrentes de valvopatias reumáticas, sendo a mais comum a estenose mitral. Por esse motivo, relatamos o caso de uma puérpera aparentemente saudável com gestação normoevolutiva, que debutou com insuficiência cardíaca direita, integrando o diagnóstico de estenose mitral grave por doença reumática, que se estabilizou precocemente para realizar correção cirúrgica externa. Embora atualmente a prevalência de doenças reumáticas tenha diminuído, a estenose mitral ainda é a doença valvular mais comum em mulheres grávidas e é uma entidade potencialmente fatal se não for adequadamente controlada.

Correlación entre la clasificación Child-Pugh lactato y la mortalidad en pacientes cirróticos internados en la unidad de terapia intensiva / Relationship between the Child-Pugh+lactate score and mortality in cirrhotic patients in the intensive care unit / Correlação entre a classificação child-pugh lactato e a mortalidade em pacientes cirróticos internados na Unidade de Terapia Intensiva

Resumen: Objetivo: Comprobar la capacidad pronóstica como predictor de mortalidad de la clasificación de Child-Pugh lactato en la población de pacientes cirróticos que ingresan en la Unidad de Cuidados Intensivos de la Fundación Clínica Médica Sur. Material y métodos: Estudio de investigación clínica, cohorte no concurrente, donde se obtuvieron datos en el periodo comprendido del 1 de enero de 2012 al 31 de diciembre de 2014. Resultados: Ingresaron 28 casos a la Unidad de Terapia Intensiva de la Fundación Clínica Médica Sur con diagnóstico de cirrosis hepática; de ellos, fallecieron un total de 16 (57.1%) sujetos dentro de los primeros 40 días posteriores a su ingreso y sobrevivieron 12 (42.9%). Se calculó si existía correlación entre la defunción y el puntaje de la clasificación Child-Pugh lactato mayor de 14, y se encontró una r = 0.708. El puntaje mayor a 14 puntos se asoció a mortalidad en 87.5%, así como el puntaje menor a 14 se vinculó a supervivencia a 40 días en 83.33%. Conclusiones: La clasificación de Child-Pugh más lactato mayor de 14 puntos tiene una fuerte correlación con la mortalidad.

Abstract: Objective: This study aimed to establish if the Child-Pugh+lactate score is a reliable prognostic scoring tool as mortality predictor in cirrhotic patients admitted to the Médica Sur Clinic Foundation Intensive Care Unit. Material and methods: This was a 3-year, single-centered retrospective cohort study performed in a general ICU. Results: Twenty-eight cases were collected in the period from January 1, 2012 to December 31, 2014, of which a total of 16 patients (57.1%) died within the first 40 days after admission and 12 survived (42.9%). It was assessed if there was a correlation between death and a Child-Pugh lactate score greater than 14, finding an r = 0.708. Conclusions: A Child-Pugh+lactate score with a numerical value above 14 points has a direct relation with mortality in cirrhotic patients admitted to the ICU.

Resumo: Objetivo: Comprovar a capacidade prognóstica como preditor de mortalidade da Child Pugh lactato na população de pacientes cirróticos admitidos na terapia intensiva da Fundação Clínica Médica Sur. Material e métodos: Estudo de investigação clínica, coorte não concorrente, onde os dados foram coletados no período de 1 de Janeiro de 2012 a 31 Dezembro de 2014. Resultados: 28 casos admitidos na unidade de terapia intensiva da Fundação Clínica Médica Sur, diagnosticados com cirrose hepática, dos quais faleceram um total de 16 pacientes (57.1%) nos primeiros 40 dias após a admissão e sobreviveram 12 (42.9%). Calculou-se a existência de uma correlação entre a defunção e a Classificação Child Pugh lactato maior de 14 pontos, encontrando um r = 0.708. A pontuação CPL maior a 14 pontos está associado à mortalidade em 87.5% e inferior a 14 foi associado a sobrevida à 40 dias em um 83.33%. Conclusões: A Clasificação Child Pugh lactato maior a 14 pontos tem uma forte correlação com a mortalidade.

Standardization of Sonographic Diaphragm Thickness Evaluations in Healthy Volunteers.

BACKGROUND: B-mode ultrasound can be used to measure diaphragm thickness at the zone of apposition. We believe it is necessary to develop normal values for diaphragm thickness at rest in a large group of healthy subjects and compare them with international results. METHODS: Ultrasound measurements of diaphragm thickness at expiratory rest were taken in 109 healthy individuals, with results stratified by sex, body mass index, and thorax circumference. The following methods were used for analysis and interpretation. Multivariable databases with descriptive statistical analyses were made. The Pearson chi-square test was used to evaluate the distribution between variables. Additionally, mean and SD values were calculated. For standardization, the data were separated by sex within a 95% CI, and we calculated a Z test. A 95% CI was also constructed for proportion analyses. RESULTS: One hundred nine healthy volunteers were included in the study, and the correlation between the body mass index and thorax circumference values with a Pearson chi-square test resulted in an r = 0.69. Additionally, the average value of diaphragmatic thickness was 0.19 ± 0.04 cm (95% CI 0.17-0.20 cm) for men and 0.14 ± 0.03 cm (95% CI 0.13-0.15 cm) for women (P = .001). There was no relation between body mass index thorax circumference, and diaphragmatic thickness. CONCLUSION: Real-time ultrasound of the diaphragm is a simple, inexpensive, and portable imaging technique that can provide qualitative anatomical information. The findings in this study show that sonographic diaphragm evaluations can be applied to the general population.