Uterine transposition in a patient with vulvar cancer.

Objective: To report the first uterine transposition for fertility preservation in a patient with vulvar cancer.Case: A 26-year-old nulliparous patient with stage IIIB vulvar cancer, which was resected with adequate margins and bilateral inguinofemoral lymphadenectomy.Laparoscopic transposition of the uterus to the upper abdomen, outside of the scope of radiation was performed to preserve fertility and ovarian function. After the end of radiotherapy, the uterus was repositioned into the pelvis.Main Outcome Measure: Uterine and ovarian function preservation. Result: The patient recovered her menstrual cycles spontaneously 1 month after the reimplantation and exhibited normal variation in ovarian hormones.Twelve months after the surgery, the uterus was normal and there was no sign of recurrent disease. Conclusion: Uterine transposition might represent a valid option for fertility preservation in women who require pelvic radiotherapy. However, studies that assess its viability, effectiveness, and safety are required.

Embarazo y transposición de grandes vasos congénitamente corregida / Pregnancy and congenitally corrected transposition of the great vessels

Los casos de pacientes embarazadas con cardiopatías congénitas complejas han incrementado su incidencia en los últimos años dados los avances terapéuticos actuales. Presentamosel caso clínico de una paciente que tiene como antecedente personal una transposición de grandes vasos arteriales congénitamente corregida y que cursa su primer embarazo, se discute sobre su desenlace, y, a propósito del mismo, los efectos de las cardiopatías en el estado grávido puerperal y viceversa, y de la importancia del asesoramiento y abordaje multidisciplinario de dichas pacientes.

Given current therapeutic progress made in the recent years, the cases of pregnant women with congenitalheart disease have increased in terms of incidence. The study presents the clinical case of a patient who has apersonal history of congenitally corrected transposition of the great arteries and is pregnant with her first child. Her outcome is discussed, and based on this, the effects of heart disease in the pregnancy-puerperal cycle and viceversa are likewise discussed, the same as the importanceof counseling and the multidisciplinary approach of these patients.

Graças aos avanços terapêuticos atuais o número de gestantes com cardiopatias congênitas complexas vem aumentando. Apresentamos o caso clínico de uma paciente que tem como antecedente pessoal uma transposição de grandes vasos arteriais corrigida congenitamentee que está grávida pela primeira vez. A evolução da gestação e sua terminação, os efeitos das cardiopatias sobre o estado grávido puerperal e vice versa, a importância do assessoramento e a importância da abordagem multiprofissional dessas pacientes sãodiscutidos.

Síndrome de Wolff Parkinson White y embarazo / Wolff Parkinson White Syndrome and pregnancy

El embarazo se asocia a un incremento en la incidencia de diversas arritmias. A propósito de dos casos clínicos de pacientes con síndrome de Wolff Parkinson White se presenta unarevisión en el tratamiento agudo y crónico de la arritmia con fármacos antiarrítmicos y/o cardioversión eléctrica, así como la conducta obstétrica a seguir.

Pregnancy is associated to an increase in the incidence of several arrhythmias. A review of acute and chronic treatmentof arrhythmias with anti- arrhythmic drugs and/or electric cardioversion and the obstetric conduct to be followedis presented in this study, based on two clinical cases of patients suffering from Wolff Parkinson White syndrome.

A gravidez está associada a um aumento da incidência de arritmias. Apresentamos dois casos de pacientes com síndrome de Wolff Parkinson White e uma revisão do tratamento agudo e crônico da arritmia com fármacosantiarrítmicos e/ou cardioversao elétrica e da conduta obstétrica recomendada.

Vasa previa: comunicación de un caso / Vasa previa: a case report

La vasa previa (VP) es una rara causa de metrorragia del tercer trimestre del embarazo, en la cual vasos sanguíneos procedentes de la placenta se interponen entre la presentación y el orificio cervical interno (OCI). Se trata de una patología que en la mayoría de los casos no se diagnostica durante el embarazo (prenatal) si no se la busca específicamente, siendo responsable de una alta mortalidad perinatal que oscila entre 60 por ciento a 90 por ciento, según distintas fuentes bibliográficas. Se presenta el caso clínico de una paciente de 26 años de edad, con 1,41 m de estatura, nulípara, que ingresa para cesárea de coordinación por desproporción feto-pélvica debida a estrechez pélvica absoluta. Se obtiene neonato vivo de sexo masculino y puntaje de Apgar de9 puntos al minuto y 10 puntos a los 5 minutos. Como hallazgo en el alumbramiento se destaca placenta fúndica normoinserta con vasa previa. Se enfatiza la importancia del diagnóstico prenatal mediante la ultrasonografía Doppler para poder realizar un tratamiento programado y oportuno, logrando disminuir notablemente la mortalidad por esta rara pero igualmente letal entidad clínica.

Vasa previa (VP) is an unusual cause of metrorrhagia in the third trimester of pregnancy, where the blood vessels coming from the placenta are located in front of the internal cervical os. In the vast majority of cases this pathologyis not diagnosed during pregnancy unless it is specifically looked for, and it results in high mortality rates ranging from 60 percent to 90 percent according to different sources. A clinical case is presented: A 26 year old patient, 1.41mhigh, nulliparous, is admitted to hospital to undergo a coordinated c-section due to cephalopelvic disproportion absolute narrow pelvis. A live male newborn is obtained, Apgar 9 after one minute and 10 after five minutes. During delivery it was found that placenta was fundal and normally located although there was vasa previa. We emphasize emphasize on the importance of prenatal diagnosis with Doppler scanning to draw up a timely and planned treatment and thus significantly diminish mortality resulting from this infrequent, though lethal condition.

A vasa previa (VP) é uma causa rara de metrorragia do terceiro trimestre de gestação, na qual os vasos sanguíneos procedentes da placenta se cruzam ou atravessam a membrana amniótica passando pelo orifício cervical interno(OCI). Trata-se de uma patologia que, na maioria dos casos, não é diagnosticada durante a gravidez (pré-natal) se não é investigada especificamente, e que é responsável por uma alta mortalidade perinatal que varia entre 60 por cento a 90 por cento de acordo com diferentes estudos. Apresenta-se o caso clínico de uma paciente de 26 anos de idade, com estatura de 1,41 m, nulípara, que ingressa a maternidade para cesárea de coordenação por desproporção feto-pélvica absoluta. O recém nascido vivo de sexo masculino apresentou boletim de Apgar de 9 pontos no primeiro minuto e 10 pontos aos 5 minutos. No momento do parto se observou placenta fúndica normoinserta com vasa previa. Destaca-se a importância do diagnóstico pré-natal utilizando ultrassonografía Doppler que permite realizar tratamento programado e oportuno buscando diminuir consideravelmente a mortalidade por esta rara, mas letal entidade clínica.

Effect of pethidine administered during the first stage of labor on the acid-base status at birth.

OBJECTIVE: To evaluate the association between the use of pethidine during the first stage of labor and the presence, type and timing of acidosis in the newborn at birth. STUDY DESIGN: Secondary data analysis of a randomized controlled trial, which included term singleton pregnancies diagnosed with dystocia and requiring active management of labor. Women were randomized to receive either 100 mg of pethidine or placebo. Statistical analyses were performed using chi(2) or Fisher's exact tests for proportions and multiple linear regression for continuous outcomes. RESULTS: Three hundred and eighty-three pregnant women with a valid arterial blood cord sample were included in the final analysis. Lower pH and bicarbonate levels, as well as higher pCO(2) levels were found in the pethidide group. A higher incidence of acidosis was found in the pethidine group (pH<7.12 OR: 8.59 95% C.I. 3.29, 22.46). The highest frequency of acidosis was encountered when pethidine-delivery interval was 5 h. CONCLUSION: Pethidine use during the first stage of labor was associated with an increased risk of acidosis at birth.

Mapeo linfático e identificación de ganglios centinelas en pacientes con cáncer de cuello uterino sometidas a histerectomía radical / Lymphatic mapping and identification of sentinel ganglia in patients with uterine cervix cancer submitted to radical histerectomy

Objetivo. El compromiso tumoral de los ganglios regionales es uno de los factores pronósticos más importantes del cáncer precoz del cuello uterino. Si bien no ha sido extensamente estudiada en esta patología, la estrategia del ganglio centinela (GC) tiene el potencial de evitar linfadenectomías innecesarias en estas pacientes. El objetivo del presente trabajo fue el de determinar la factibilidad de la identificación del GC por medio de linfocentellografía preoperatoria y detección intraoperatoria guiada por sonda gama (SG) en pacientes sometidas a histerectomía radical con linfadenectomía pélvica y periaórtica para el tratamiento de cáncer de cuello uterino en estadios precoces