Amniocentesis genética precoz:530 casos realizados entre las 10-13 semanas / Early genetic amniocentesis: 530 cases performed between weeks 10 and 13

En este estudio hemos analizado los resultados de 530 amniocentesis guiadas por ecografía realizadas entre las semanas 10-13 de gestación y describimos las indicaciones, los problemas técnicos, volumen de líquido amniótico, éxito del cultivo y tiempo, proporción de abortos y pérdidas fetales, y resultados perinatales. El líquido amniótico se obtuvo en el 97,06 por ciento de los casos. El cariotipo se obtuvo con éxito en el 96,7 por ciento, y la pérdida fetal dentro de las dos primeras semanas fue del 0,37 por ciento. La pérdida fetal durante todo el embarazo fue del 0,74 por ciento. El tiempo medio de cultivo fue similar a las publicadas en otras series. Podemos concluir que la amniocentesis realizada entre la 10-13 semanas es una técnica fácil, segura y eficaz, y que aporta beneficios reales a la mujer embarazada (AU)

Mammography and 99mTc-MIBI scintimammography in suspected breast cancer.

UNLABELLED: The aim of this work has been to evaluate whether a diagnostic protocol based on the joint use of mammography and 99mTc-methoxyisobutyl isonitrile (MIBI) scintimammography is capable of reducing the number of biopsies required in patients with suspected breast cancer. METHODS: We performed prone scintimammography in 90 patients with suspected breast cancer, involving 97 lesions. In all patients, the diagnosis was established by way of biopsy. On mammography, we evaluated the degree of suspicion of malignancy and the size of the lesion (smaller or larger than 1 cm in diameter). RESULTS: The results of only 41 of the biopsies indicated malignancy. On mammography, 20 lesions (of which 1 was breast cancer) were considered to be of low suspicion of malignancy, 31 (of which 4 were breast cancer) as indeterminate and 46 (of which 36 were breast cancer) as high. Fourteen lesions (2 low probability, 2 indeterminate and 10 high) were smaller than 1 cm, whereas 83 (18 low probability, 29 indeterminate and 36 high) were larger. The sensitivity, specificity, positive predictive value and negative predictive value of scintimammography were 85%, 79%, 74% and 88%, respectively. Scintimammography was positive in all cases of breast cancer that initially had a low or indeterminate suspicion of malignancy according to mammography, as well as in 30 cases of breast cancer that initially were highly suspicious. Six false-negative scintimammography studies were obtained in lesions with a high suspicion of malignancy. CONCLUSION: We propose a diagnostic protocol with a biopsy performed on lesions that have a high suspicion of malignancy as well as those with low or indeterminate suspicion that are smaller than 1 cm or with positive scintimammography results. This would have reduced the total number of biopsies performed by 34%. More importantly, there would have been a 65% reduction in number of biopsies performed in the low and indeterminate mammographic suspicion groups. All 41 cases of breast cancer would have been detected.

[Gammography using Tc 99m MIBI in patients with suspected breast cancer. Proposed diagnostic protocol]. / Gammagrafía con MIBI-99mTc en pacientes con sospecha de cáncer de mama. Propuesta de un protocolo diagnóstico.

The aim of this work has been to determine whether the joint use of mammography and scintimammography is capable of reducing the number of biopsies required in patients with suspected breast cancer. We have performed scintimammography in 90 patients, 97 lesions, with breast cancer suspicion. In the mammography was evaluated the degree of malignancy suspicion and the size of the lesion. Only 41 of the biopsies revealed the presence of cancer. The sensitivity, specificity, PPV and NPV of scintimammography were 85%, 79%, 74% and 88%. According to the mammography findings 20 lesions (1 breast cancer) were included as low, 31 lesions (4 breast cancer) as indeterminate and 46 lesions (36 breast cancer) as high malignancy suspicion. 14 lesions (2 low, 2 indeterminate and 10 high suspicion) were smaller than 1 cm. The scintimammography was positive in all breast cancer of low and indeterminate suspicion of malignancy and in 30 of high probability. On the basis of this results we propose that a biopsy must be carried out to those lesions with a high suspicion of malignancy, and to lesions with low or indeterminate suspicion that are smaller than 1 cm or that present a positive scintimammography. Following this protocol, only 64 of the 97 biopsies would have been necessary, with a reduction of the 34% in the total number of biopsies and, more important, a 65% of reduction in the number of biopsies carried out in the groups of low and indeterminate suspicion of malignancy. At the same time we would indicate biopsy in all cases of breast cancer.

Early amniocentesis at 10-12 weeks' gestation.

In this study we report the results of 181 ultrasound-guided genetic amniocenteses performed at 10-12 weeks of gestation and describe the indication, technical problems, amniotic fluid volume, culture success and timing, abortion and fetal loss rate, and perinatal results. Amniotic fluid was obtained in 98.4 per cent of the cases; at the first attempt, in 167 out of 181. The culture success rate was 94.5 per cent, and the fetal loss rate within 2 weeks was 0.5 per cent (one case with a sonographic abnormality). The total fetal loss rate during pregnancy was 1.6 per cent. A comparison of our data and those of other published series shows no significant differences, either with respect to this period of gestation (10-12 weeks) or with respect to the traditionally called early amniocentesis' (12-14 weeks) or conventional amniocentesis (15 weeks or more). The mean culture time was just a few days longer in some of the series, and in some cases, there was also a lower success rate after culture, particularly when amniocentesis was carried out at 10 weeks or less. We conclude that amniocentesis performed at 10-12 weeks is feasible, safe, and easy to perform, and provides a real benefit to the pregnant woman.

[Neonatal changes in relation to mother's oxitocyn administration (author's transl)]. / Cambios neonatales en relación con oxitocina administrada a la gestante.

Authors have studied in four groups of newborns the possible relationship between administration of oxitocyn to the mother during labor or during the pregnancy and appearance of neonatal jaundice, alterations of hematocrit and Na+ levels in the immediate hours post-partum. In the present study, with dosages of oxitocyn administered during true labor which never exceded 1,200 mUI, no significant differences appeared between levels of bilirubin present in newborns and those whose mothers did not receive this type of treatment (p greater than 0.05). Sodium levels in the first day of life did show significant difference when comparing control and problem series respectively (p less than 0.01).