Effect of Milking Maneuver in Preterm Infants: A Randomized Controlled Trial.

OBJECTIVE: To assess the short and medium-term effects of milking maneuver (MM) compared with early cord clamping for infants born before 37 weeks of pregnancy. MATERIAL AND METHODS: 138 infants between 24+0 and 36+6 weeks of gestation were allocated to MM or early cord clamping. Primary outcomes were the requirement of red blood cell transfusions or phototherapy. RESULTS: Initial hemoglobin was significantly higher in the MM group by 1.675 g/dL (p < 0.05) and initial hematocrit by 5.36% (p < 0.05), but no differences in the need of transfusion during the first 30 days after delivery were found (RR 0.8; 95% CI 0.22-2.85). Peak serum bilirubin was similar in both groups (11,097 ± 3.21 vs. 11,247 ± 3.56 mg/dL, p = 0.837). Phototherapy requirements were higher in the MM group (RR 1.62; 95% CI 1.1-2.38). No differences regarding the need of oral iron supplementation, platelet transfusion, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, meconium aspiration syndrome, use of surfactant, days of oxygen supplementation, need of vasopressors, length of stay in the neonatal intensive care unit, or postpartum hemorrhage were found. CONCLUSION: MM does not reduce the need for red blood cell transfusions and increases phototherapy requirements in preterm infants.

Florid Cystic Endosalpingiosis (Müllerianosis) in Pregnancy.

Cystic endosalpingiosis refers to the existence of heterotopic cystic müllerian tissue resembling structures of the fallopian tubes. We report a case of florid cystic endosalpingiosis discovered in a pregnant woman during a scheduled cesarean section and review the current knowledge of this disease. A 30-year-old woman with a twin pregnancy attended the hospital day unit at term. The first twin was in a breech presentation and a cesarean section was scheduled. During the procedure the uterine fundus and part of the body were seen completely seeded with multitude of cyst-like structures resembling hydatids of Morgagni. The immunohistochemistry analysis showed a positive expression for PAX8 (Box-8), CK7, and estrogen and progesterone receptors. The lesions did not disappear after pregnancy. Cystic endosalpingiosis should be always borne in mind, even in pregnancy, when it comes to making the differential diagnosis of a pelvic or systemic multicystic mass.

Histerectomía total laparoscópica vs. histerectomía vaginal: análisis de costes y resultados operatorios / Total laparoscopic hysterectomy vs vaginal hysterectomy. Analysis of costs and surgical outcomes

Objetivo. Analizar y comparar los resultados perioperatorios y los costes económicos de la histerectomía total laparoscópica (HTL) y de la histerectomía vaginal (HV). Sujetos y métodos. Estudio retrospectivo realizado durante 2013 que incluye pacientes con similar perfil sometidas a HV (n = 20) o HTL (n = 29). La principal indicación quirúrgica fue útero miomatoso. Se recogen datos epidemiológicos, resultados perioperatorios y datos económicos. Resultados. Las características basales de las pacientes fueron similares. En resultados perioperatorios, el tiempo quirúrgico fue menor en HV (64,8 ± 14,5 min) que en HTL (102,8 ± 20,5 min) p < 0,01. No se encontraron diferencias significativas en peso uterino, caída de la hemoglobina y estancia hospitalaria. El coste medio de la HTL (2.036 ± 307 euros) fue significativamente mayor al de la HV (1.604 ± 346 euros). Conclusiones. En la elección de la vía quirúrgica, la HV parece ser un procedimiento más económico y con similares resultados perioperatorios que la HTL. No obstante, es importante individualizar según las características de la paciente. Son necesarios estudios con mayor tamaño muestral para confirmar los resultados (AU)

Objective. To evaluate and compare surgical outcomes and the overall costs of total laparoscopic hysterectomy (TLH) and vaginal hysterectomy (VH). Subjects and methods. A retrospective study was conducted that compared surgical outcomes and hospital costs obtained during 2013 in patients with similar profiles undergoing VH (n = 20) or TLH (n = 29). Epidemiological data, perioperative results and economic data were compared between the two groups. Results. Baseline characteristics were similar between the two groups. The mean operating time was shorter in the VH group (64.8 ± 14.5 min) than in the TLH group (102.8 ± 20.5 min) p < 0.01. No differences were found between the two groups in uterine weight, decrease in hemoglobin or length of hospital stay. The mean cost was significantly higher for TLH (Euros 2036 ± 307) than for VH (Euros 1603 ± 346). Conclusions. Our data suggest that VH is less expensive than TLH and has similar perioperative outcomes. Nevertheless, the choice of surgical route should be based on the patient's characteristics. Further studies with larger samples are required to confirm our data (AU)