Miomas sintomáticos: ¿miomectomía o embolización de las arterias uterinas? / Symptomatic uterine leiomyoma: myomectomy or uterine artery embolization?

Objetivo: Evaluar las complicaciones asociadas a la miomectomía laparotómica y a la embolización de las arterias uterinas en mujeres con miomas sintomáticos. Métodos: Estudio descriptivo restrospectivo efectuado en el Complejo Hospitalario Universitario de Vigo desde el año 2008 al 2010. La población en estudio la conformaron aquellas mujeres sometidas a una miomectomía laparotómica o a una embolización de las arterias uterinas. Se recopilaron las complicaciones registradas en las historias clínicas de las pacientes tras las técnicas. Resultados: La tasa de complicaciones en el grupo de las pacientes sometidas a miomectomía fue de 15,2 por ciento; las más frecuentes fueron fiebre, anemia, necesidad de trasfusión y hematoma subcutáneo. La tasa de complicaciones en el grupo de embolización fue de 4,5 por ciento recogiéndose casos de síndrome postembolización, mioma parido y un caso de histerectomía. Conclusión: La adecuada indicación de cada técnica es fundamental para tener una baja tasa de complicaciones. Se debe tener en cuenta la sintomatología, tipo y número de miomas, edad y deseo genésico de cada paciente.

Objective: This study was undertaken to evaluate the complications after laparotomy myomectomy and uterine artery embolization in women with symptomatic uterine leiomyoma. Methods: This was a descriptive and retrospective study of patients who were treated with embolization and myomectomy for leiomyomas from 2008-2010. Complications were measured. Results: The rate of complications collected in the myo-mectomy group was 15.2 percent; there were cases of fever, anemia, need for transfusion and subcutaneous hematoma. The rate of complications collected in the embolization group was 4.5 percent; there were cases of embolization syndrome, transcervical fibroid expulsion and a case of hysterectomy. Conclusion: The suitable indication of every tecnic is fundamental to have a low rate of complications. It is necessary to bear in mind the symptomatology, type and number of myomas and age and reproductive desire of each patient.

Health informatics for pediatric disaster preparedness planning.

OBJECTIVE: 1. To conduct a review of the role of informatics in pediatric disaster preparedness using all medical databases. 2. To provide recommendations to improve pediatric disaster preparedness by the application of informatics. METHODS: A literature search was conducted using MEDLINE, CINHL and the Cochrane Library using the key words "children" AND "disaster preparedness and disaster" AND "informatics". RESULTS: A total of 314 papers were initially produced by the search and eight that met the selection criteria were included in the review. Four themes emerged: tools for disaster preparedness, education, reunification and planning and response. CONCLUSION: The literature pertaining to informatics and pediatric disaster preparedness is sparse and many gaps still persist. Current disaster preparedness tools focus on the general population and do not specifically address children. The most progress has been achieved in family reunification; however, the recommendations delineated are yet to be completed.

Stability of highly shifted equilibria in a large-aspect-ratio tokamak.

High beta poloidal tokamaks can confine plasma pressures an order of magnitude higher than their low beta poloidal counterparts. The theoretical stability of these high beta poloidal magnetohydrodynamics equilibria was left unresolved for many years. Using modern computational tools, such configurations are now found stable to Mercier, resistive and high-n (ideal and resistive) ballooning criteria as well as fixed and free-boundary modes for a wide range of current density profiles in the framework of a low field large-aspect-ratio machine.

Perfluorochemicals: potential sources of and migration from food packaging.

Perfluorochemicals are widely used in the manufacturing and processing of a vast array of consumer goods, including electrical wiring, clothing, household and automotive products. Furthermore, relatively small quantities of perfluorochemicals are also used in the manufacturing of food-contact substances that represent potential sources of oral exposure to these chemicals. The most recognizable products to consumers are the uses of perfluorochemicals in non-stick coatings (polytetrafluoroethylene (PTFE)) for cookware and also their use in paper coatings for oil and moisture resistance. Recent epidemiology studies have demonstrated the presence of two particular perfluorochemicals, perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) in human serum at very low part per billion levels. These perfluorochemicals are biopersistent and are the subject of numerous studies investigating the many possible sources of human exposure. Among the various uses of these two chemicals, PFOS is a residual impurity in some paper coatings used for food contact and PFOA is a processing aid in the manufacture of PTFE used for many purposes including non-stick cookware. Little information is available on the types of perfluorochemicals that have the potential to migrate from perfluoro coatings into food. One obstacle to studying migration is the difficulty in measuring perfluorochemicals by routine conventional analytical techniques such as GC/MS or LC-UV. Many perfluorochemicals used in food-contact substances are not detectable by these conventional methods. As liquid chromatography-mass spectrometry (LC/MS) develops into a routine analytical technique, potential migrants from perfluoro coatings can be more easily characterized. In this paper, data will be presented on the types of perfluoro chemicals that are used in food packaging and cookware. Additionally, research will be presented on the migration or potential for migration of these chemicals into foods or food simulating liquids. Results from migration tests show mg kg(-1) amounts of perfluoro paper additives/coatings transfer to food oil. Analysis of PTFE cookware shows residual amounts of PFOA in the low microg kg(-1) range. PFOA is present in microwave popcorn bag paper at amounts as high as 300 microg kg(-1).

Circadian patterns in the onset of cardiogenic acute pulmonary edema.

BACKGROUND: Circadian patterns of onset favoring the morning hours have been demonstrated for many cardiovascular disorders. Although much is known about cardiogenic acute pulmonary edema (CAPE), the relationship between time of day and CAPE episode onset has not been previously studied. METHODS: We examined 154 consecutive episodes of CAPE treated at an urban community hospital to determine whether circadian patterns existed in the time these episodes began. RESULTS: For all episodes, a significant circadian pattern existed, with peak onset between 6:00 and 11:59 A.M. (p < 0.01). When CAPE episodes were analyzed by the most probable precipitant of pulmonary edema, only the pattern for patients with progressive symptoms, showing a peak in the 6:00 and 11:59 A.M. interval, was statistically significant (p < 0.01). Although a similar trend existed for CAPE occurring in association with acute myocardial infarction, the pattern fell short of statistical significance (p = 0.09). CONCLUSIONS: These data suggest that circadian patterns favoring the morning hours exist for episodes of CAPE, and that patterns may vary depending on the precipitant of the episode.

Thrombolytic therapy in acute myocardial infarction following prolonged cardiopulmonary resuscitation.

Thrombolytic therapy was administered to a 49-year-old woman with an acute anterior wall myocardial infarction after having prolonged cardiopulmonary resuscitation for 13 minutes. On admission, there was no clinical or radiographic evidence of gross trauma. There was no significant morbidity and the patient recovered to a completely functional status. The literature of thrombolytic therapy after cardiopulmonary resuscitation is reviewed. In the absence of gross trauma from cardiopulmonary resuscitation, thrombolytic therapy in acute myocardial infarction should not necessarily be excluded because of the duration of resuscitation. Further experience with such patients will shed additional light on efficacy and safety.