Clinical evaluation with self-sequential longitudinal reference intervals: pregnancy outcome and neonatal thyroid stimulating hormone level associated with maternal thyroid diseases / Evaluación clínica con intervalos de referencia longitudinal auto-secuencial: evolución clínica del embarazo y niveles de la hormona estimulante de la tiroides en neonatos asociados con enfermedades tiroideas maternas

OBJECTIVE: We attempted to evaluate maternal thyroid function in a new self-sequential longitudinal reference interval (SLRI) which we established recently. By this method, we analysed the correlation between pregnancy outcome, neonatal thyroid stimulating hormone (TSH) level and maternal thyroid diseases. METHODS: A total of 1744 pregnant women participated in the study and 1747 babies were born from those women (three bore twins). The levels of TSH, free thyroxine (FT4) and thyroid peroxidase antibodies (TPO-Ab) of mothers were quantified by electrochemistry immunoassay (ECL). The levels of neonatal blood TSH were detected by time-resolved fluorescence immunoassay (TRFIA). All data were collected and statistically analysed by SPSS 13.0 software. RESULTS: With our new SLRI method, we found that 0.11%~3.84% pregnant women would get thyroid diseases. Subclinical hypothyroidism was the most common maternal thyroid disorder. Being positive for thyroid peroxidase antibodies was a significant risk factor of subclinical hypothyroidism during pregnancy. The median, P2.5~P97.5, and interquartile range (IQR) of neonatal TSH (N-TSH) of 1747 babies were 2.72 mIU/L, 0.10~8.01 mIU/L and 2.62 mIU/L, respectively; 28.6% of pregnant women with thyroid diseases developed pregnancy complications. The prevalence was significantly higher than in the normal thyroid function group (p< 0.001). The levels of N-TSH were low correlated with maternal TSH levels (p < 0.05), but there were no significant correlations between N-TSH and maternal FT4 and maternal TPO-Ab (p > 0.05). CONCLUSIONS: Thyroid disorders, especially subclinical hypothyroidism, are common in pregnant women. These disorders are associated with pregnancy and fetal outcome. Routine maternal thyroid function screening is important and should be recommended.

OBJETIVO: Intentamos evaluar la función tiroidea materna en un nuevo intervalo de referencia longitudinal auto-secuencial (SLRI) que establecimos recientemente. Por este método, analizamos la correlación entre el resultado del embarazo, el nivel de la hormona estimulante de la tiroides (TSH) en neonatos, y las enfermedades tiroideas maternas MÉTODOS: Un total de 1744 mujeres embarazadas participó en el estudio y 1747 bebés nacieron de esas mujeres (tres de ellas tuvieron gemelos). Los niveles de TSH, la tiroxina libre (FT4), y los anticuerpos de la peroxidasa tiroidea (TPO-Ab) de las madres, fueron cuantificados mediante inmunoensayo electroquímico (ECL). Los niveles de TSH en la sangre de los neonatos, fueron determinados mediante inmunoensayo por fluorescencia resuelto en el tiempo (TRFIA). Todos los datos fueron recogidos y analizados estadísticamente usando el software SPSS 13.0 RESULTADOS: Con nuestro nuevo método SLRI, encontramos que 0.11%~3.84% de las mujeres embarazadas contraerán enfermedades tiroideas. El hipotiroidismo subclínico fue el trastorno de la tiroides materna más común. Ser positivo a los anticuerpos de la peroxidasa tiroidea fue un factor de riesgo significativo del hipotiroidismo subclínico durante el embarazo. La mediana, P2.5~P97.5, y el rango intercuartil (IQR) de la TSH (N-TSH) neonatal de los 1747 bebés fueron 2.72 mIU/L, 0.10~8.01 mIU/L y 2.62 mIU/L respectivamente. El 28.6% de las mujeres embarazadas que tenían enfermedades tiroideas, desarrollaron complicaciones del embarazo. La prevalencia fue significativamente más alta que en el grupo con función tiroidea normal (p < 0.001). Los niveles de N-TSH fueron bajos en correlación con los niveles de TSH maternos (p < 0.05), pero no hubo ninguna correlación significativa entre la N-TSH y la FT4 materna, y la TPO-Ab materna (p > 0.05). CONCLUSIÓNS: Los trastornos tiroideos, especialmente el hipotiroidismo, son comunes en las mujeres embarazadas.Estos trastornos se hallan asociados con el resultado del embarazo y el resultado fetal. El tamizaje de rutina de la función tiroidea materna es importante y debe recomendarse.

Human papilloma virus screening by hybrid capture II in chinese women of Jiangsu Province / Tamizaje del virus del papiloma humano mediante captura híbrida en mujeres chinas de la Provincia de Jiangsu

OBJECTIVE: To survey Human Papilloma Virus (HPV) infection in Chinese Women of Jiangsu Province and discuss the relationship between HPV and the biology of cervical cancer. METHODS: Two thousand, one hundred and fifty-three sexually active women (including 66 cases of cervical cancer) were selected for high-risk human papilloma virus DNA test with Hybrid Capture II (HCII). RESULTS: The overall HPV prevalence was 32.6% (701/2153) with higher positive rates in cervical carcinoma and Cervical Interstitial Neoplasia (CIN) [93.9% and 54.6%] respectively. For women aged 40-59 years, the overall high-risk HPV prevalence was higher than those of other age groups. Compared with CIN I, the positivity rate and viral load of HPV DNA in CIN III is much higher (80.2% vs 29.9%, 11.89 vs 0.53). Ninety-four per cent (64/66) of patients with Cervical cancer were detected to be HPV positive. There was no significant difference in HPV DNA among each clinical stage and pathologic grade. But the positive rates and the value of HPV DNA were higher in the patients with cervical interstitial incursion. Eighty per cent of patients (20/25) could become negative within six months after operation. CONCLUSIONS: High-risk HPV DNA test is effective in screening for cervical diseases. HC II is an effective method to detect HPV DNA.

OBJETIVO: Investigar la infección por el virus del papiloma humano (VPH) en las mujeres chinas de la Provincia de Jiangsu y analizar la relación entre VPH y la biología del cáncer cervical o del cuello uterino. MÉTODOS: Dos mil ciento cincuenta y tres mujeres sexualmente activas (incluyendo 66 casos de cáncer cervical) fueron seleccionadas para una prueba de ADN con el fin de detectar el virus del papiloma humano de alto riesgo mediante Captura Híbrida 2 (HC2). RESULTADOS: La prevalencia general de VPH fue 32.6% (701/2153), hallándose las tasas positivas más altas en el carcinoma cervical y la neoplasia intersticial cervical (NIC) [93.9% y 54.6%]. Para las mujeres de 40-59 años de edad, la prevalencia general de VPH de alto riesgo fue mayor que para los otros grupos etarios. En comparación con el CIN, la tasa de positividad y la carga viral de ADN del VPH en el CIN es mucho mayor (80.2% vs 29.9%, 11.89 vs 0.53). Se detectó que noventa y cuatro por ciento (64/66) de las pacientes con cáncer del cuello uterino eran VPH positivas. No hubo ninguna diferencia significativa en el ADN del VPH ADN entre cada fase clínica y el grado patológico. No obstante, tanto las tasas positivas como el valor de VPH ADN fueron más altos en las pacientes con incursión intersticial cervical. Ochenta por ciento de las pacientes (20/25) podrían volverse negativas en seis meses tras la operación. CONCLUSIONES: La prueba de ADN para la detección del virus del papiloma humano de alto riesgo es un medio efectivo para el tamizaje de las enfermedades cervicales. El HC2 es un método efectivo para detectar el ADN del VPH.

Use of greater omentum in thoracic onco-surgery.

BACKGROUND: Omentum is well known for its immunocompetence and good blood supply; and therefore, is being used in various complex thoracic procedures. Specially, in situations when staplers, sealants and total parenteral nutrition may not be used because of financial constraints, omentum may prove very helpful in preventing post-operative fatal complications. METHODS: A retrospective review of 61 patients was undertaken. Patients were categorized into two groups. In group I, omentum was sutured to the anastomosis for prophylaxis of leak from gastro-oesophagectomy after radical surgery for cancer of cardia and oesophagus. In group II, it was used for therapeutic purpose, to control diffuse air leak from lung parenchyma after chest wall and invaded lung resection for malignant chest wall tumours (subgroup A) and treatment of post pneumonectomy bronchopleural fistula for NSCLC of right lung (subgroup B). Gastro-oesophagectomy, closure of bronchial stump and suturing of lung parenchyma after wedge resection was done with manual suturing technique only. RESULTS: Group I: There were 57 patients with the diagnosis of cancer of cardia and oesophagus, who underwent radical surgery. Transthoracic approach was used in 96.5% patients, whereas 3.5% patients underwent transhiatal resection. Anastomotic level was located in chest in 68.4% and in neck in 31.6% patients. The leakage rate was 5.4%. Group II: There were three patients in subgroup A, all with lesions located in left side of chest wall. There was one patient in subgroup B. Chest tube was removed after a mean time of 2 days and after 4 days in subgroup A and B, respectively. There was 1 mortality (1.6%) secondary to chylothorax. CONCLUSION: Use of pedicled omentum appears to be a very simple technique to prevent the anastomotic leak after radical surgery for cancer of cardia and oesophagus, and to seal the diffuse parenchymal pulmonary leak after various procedures in thorax.