Estudio citogenético en 677 casos de aborto espontáneo / Cytogenetic study of 677 spontaneous abortions

INTRODUCCIÓN: La reproducción humana es un proceso relativamente ineficaz. Los abortos espontáneos ocurren entre el 15 a 20 por ciento de los embarazos clínicamente reconocidos. El impacto emocional se acentúa debido a la falta de diagnóstico. OBJETIVO: Describir la experiencia del Laboratorio de Citogenética de la Clínica Sanatorio Alemán de Concepción e identificarlas alteraciones más frecuentes y su relación estadística con la edad materna. MATERIAL Y MÉTODO: 677 muestras de tejido obtenidas de abortos espontáneos, ocurridos desde julio de1996 a abril de 2009. Es un trabajo de tipo transversal donde las muestras utilizadas son las vellosidades coriónicas, cultivadas en medios estandarizados. RESULTADOS: De las 677 muestras estudiadas, en 259 se obtuvo un cariotipo normal (38,3 por ciento). En 418 muestras se encontraron anomalías cromosómicas, correspondiendo estas a un 61,7 por ciento. Entre los cariogramas alterados se encontraron: 265 trisomías (63,4 por ciento), 83 poliploidías (19,9 por ciento), 48 monosomías (11,5 por ciento) y 22 alteraciones estructurales (5,3 por ciento). La trisomía más frecuente fue la 16 (34,4 por ciento), seguida de la trisomía 21 (13,6 por ciento). Se encontró una relación estadísticamente significativa entre la edad de la madre (> 37 años) y la presencia de alteraciones citogenéticas (p<0,0001). DISCUSIÓN: El 61,7 por ciento de los abortos presentó alguna alteración del cariotipo. La trisomía 16 fue la aberración más frecuente concordando con la literatura. La trisomía 21 se presentó en un 13,6 por ciento siendo más frecuente que lo encontrado en series extranjeras. En el grupo mayor de 37 años existe mayor prevalencia de anomalías cromosómicas siendo estadísticamente significativa (p<0,0001).

INTRODUCCION: The human reproduction is a relatively inefficient process. In the 15 to 20 percent of the pregnancy clinically diagnosticated finish in spontaneous abortions. The great emotional impact, that in many times is worst by the lack of diagnostic. OBJECTIVE: Describe experience of the Cytogenetic Laboratory of Clínica Sanatorio Alemán of Concepción Chile and determinate the frequency of alteration and his relationship with maternal age. MATERIAL AND METHOD: 677 samples of tissue of spontaneous abortions, taked from July, 1996 to April, 2009. It is a descriptive work; the samples are chorionic villous, cultivated in standard solutions. RESULTS: Of 677 samples in 259 was found a normal cariotype (38.3 percent). In 418 was found some type of chromosome aberrations (61.7 percent). The distribution of the abnormal result is the follow: 265 trisomies (63.4 percent), 83 polyploidy (19.8 percent), 48 monosomy (11.5 percent) and 22 abnormalities structures (5.3 percent). Of the trisomies the most recurrent is 16 trisomy with the 34.4 percent, follow by the 21 trisomy with 13.6 percent and the 22 trisomy with 12.8 percent. In the statistic analysis we found a statistically significant relation between the age of the mother (<38 years) and the development of chromosomal alterations (p<0.0001). DISCUSSION: The 61.7 percent of abortions show some cytogenetic alteration. The 16 trisomies were the most frequent, agreeing with the literature. The trisomy 21 was more common than published to date. In older women is most frequent found chromosome aberrations (p<0.0001).

Design, implementation and testing of an implantable impedance-based feedback-controlled neural gastric stimulator.

Functional neural gastrointestinal electrical stimulation (NGES) is a methodology of gastric electrical stimulation that can be applied as a possible treatment for disorders such as obesity and gastroparesis. NGES is capable of generating strong lumen-occluding local contractions that can produce retrograde or antegrade movement of gastric content. A feedback-controlled implantable NGES system has been designed, implemented and tested both in laboratory conditions and in an acute animal setting. The feedback system, based on gastric tissue impedance change, is aimed at reducing battery energy requirements and managing the phenomenon of gastric tissue accommodation. Acute animal testing was undertaken in four mongrel dogs (2 M, 2 F, weight 25.53 ± 7.3 kg) that underwent subserosal two-channel electrode implantation. Three force transducers sutured serosally along the gastric axis and a wireless signal acquisition system were utilized to record stimulation-generated contractions and tissue impedance variations respectively. Mechanically induced contractions in the stomach were utilized to indirectly generate a tissue impedance change that was detected by the feedback system. Results showed that increasing or decreasing impedance changes were detected by the implantable stimulator and that therapy can be triggered as a result. The implantable feedback system brings NGES one step closer to long term treatment of burdening gastric motility disorders in humans.

Comparative gastric motility study of Enterra ™ Therapy and neural gastric electrical stimulation in an acute canine model.

BACKGROUND: Gastric electrical stimulation (GES) is an avenue for treating gastroparesis and obesity by controlling gastric motility using electrically mediated gastric contractions. Neural gastrointestinal electrical stimulation (NGES) is a GES modality capable of producing strong lumen-occluding local gastric contractions. Conversely, Enterra ™ Therapy, a commercial implantable gastric electrical stimulator, has been utilized to treat symptoms of gastroparesis, but its nominal electrical parameters are not capable of generating lumen-occluding contractions. However, comparative studies between these two stimulation modalities are lacking. METHODS: Strain gauge transducers complemented by endoscopic monitoring have been utilized to register gastric contractions invoked with NGES and Enterra neurostimulators in four acute dogs. Mucosal and serosal electrode implantations, 'nominal' and 'maximum' electrical parameters, and longitudinal and transverse electrode placements have been tested with each neurostimulator type. KEY RESULTS: Strong lumen-occluding, circumferential contractions were induced with a wide variety of NGES parameters utilizing both transverse and longitudinal electrode configurations from the serosal side of the stomach. Similarly, local gastric contractions were observed with the Enterra neurostimulator programmed at its 'maximum' electrical parameters but only when utilizing transverse serosal electrode implantation. Under 'maximum' electrical parameters Enterra was not capable of producing registerable gastric contractions with longitudinally implanted serosal electrodes. Mucosal electrode implantations did not result in GES-invoked gastric contractions in both stimulation modalities. CONCLUSIONS & INFERENCES: Enterra Therapy is capable of producing gastric contractions under 'maximum' parameters and transverse electrode configuration. Neural gastrointestinal electrical stimulation produces stronger, lumen-occluding contractions under a wider range of electrode configurations and parameters.

Implantable functional gastrointestinal neurostimulation.

Neural Gastrointestinal Electrical Stimulation (NGES) is a new microprocessor-based method for invoking gastric or colonic contractions by generating multi-channel, high energy, high frequency waveforms. It has been shown that when applied to the lower stomach, NGES offers the possibility for enhancing propulsive peristalsis for the treatment of gastric motor dysfunctions, or for producing retrograde peristalsis for the treatment of obesity. When applied to the colon, NGES can be utilized either for propulsive control in severe constipation or for invoked retrograde contractility. This paper briefly discusses the implementation of an implantable neurostimulator and summarizes the performance of the NGES technique in acute tests on experimental animals and humans, and in chronic tests on animals. These experimental tests indicate that NGES is successful in accelerating gastric emptying of both liquids and solids, and in producing strong, externally-controlled, retrograde contractions.

El peso asistencial de los accidentes en la consulta a un Servicio de Urgencia / Burden of accidental injuries on an outpatient emergency service

En Chile los accidentes son un importante problema de salud pública, constituyendo la primera causa de muerte en menores de 45 años. El Objetivo de este trabajo fue analizar las consultas por accidentes en un servicio de urgencia y determinar su importancia en la carga asistencial. Se analizaron 6510 consultas por accidentes de un universo de 166131 consultas por "urgencias médicas y quirúrgicas" realizadas durante 1998 en la Asistencia Pública. Los datos fueron analizados en una base de datos DBASE III PLUS. Los accidentes correspondieron al 3,9 por ciento de las urgencias médico-quirúrgicas, con un promedio de 17,83 consultas diarias. El 76,9 por ciento de las consultas fueron accidentes de tránsito, de los cuales un 42,5 por ciento corresponden a choques. Los accidentes de trabajo y escolares representan el 5,8 por ciento y 12,9 por ciento respectivamente. El 71,15 por ciento de las consultas fue realizada por personas entre 16 y 44 años. Los meses en que se presentó la mayor cantidad de consultas por accidentes fueron abril, agosto y noviembre. Casi el 4 por ciento de las consultas de urgencia en la Asistencia Pública se debe a accidentes, ocupando el primer lugar los accidentes de tránsito. Los varones generan 2/3 de las consultas y el 70 por ciento de las consultas por accidentes de tránsito. La mayoría de los accidentados están en plena edad productiva

Inmunodeficiencias / Immunodeficiencies

Las inmunodeficiencias son un grupo heterogéneo de enfermedades que se clasifican en primarias o secundarias. Las primarias corresponden a un pequeño grupo de enfermedades bien caracterizadas y que son habitualmente congénitas; las secundarias, son bastante más frecuentes y acompañan a la gran mayoría de las enfermedades crónicas en adultos. En el presente resumen se muestra en forma general la clasificación de estas enfermedades, sus características clínicas y de laboratorio y lo más importante, se da una pauta guía para enfrentar este tipo de problemas partiendo desde su identificaciíon precoz y algunas medidas terapéuticas de apoyo

Antineutrophil-cytoplasmic-autoantibodies in poststreptococcal nephritis.

Sera from 210 patients with APSGN, were tested for the presence of ANCA (IgG-isotype). Indirect immunofluorescence (IF) on ethanol fixed human PMNs was used, and for those positive sera, ELISA kits for PR3 (Proteinase 3) and MPO (Myeloperoxidase) was performed. ANCA were detected in 9% (18 out of 210 cases) in a predominantly diffuse cytoplasmic staining pattern in 14 cases (77%), and in a perinuclear pattern in the remaining 4 cases (22%). Anti-MPO was found in 4 cases (C-ANCA 3; P-ANCA 1) and anti-PR3 was always negative. The presence of ANCA was significantly associated with a more severe glomerular disease as assessed by the serum creatinine value and the crescents formation. Longitudinal studies performed in 11 cases have shown that raised levels of these autoantibodies may persist for at least six months, without relationship with disease activity. Further studies are required to dilucidate the specificity of these autoantibodies, and if its presence is either an epiphenomenon of the heterogeneous humoral immune response in streptococcal infection, or they play some pathogenic role in APSGN.

Age influence on mononuclear phagocyte system Fc-receptor function in poststreptococcal nephritis.

The Fc-receptor function of the mononuclear phagocyte system (MPS) was examined in 41 children and adult patients, by measuring the clearance of IgG-sensitized, 51Cr-labeled erythrocytes. The Fc-receptor-mediated clearance observed in patients (mean +/- SE) was not significantly different as compared to the control group of similar age distribution. However, the immune clearance time was significantly age-correlated in both groups (acute poststreptococcal glomerulonephritis, APSGN, r = 0.39, p less than 0.05; control r = 0.63, p less than 0.01). The magnitude of the Fc-specific immune clearance and the serum creatinine were also significantly correlated (r = 0.59; p less than 0.01). Circulating immune complexes (as measured by the C1q and conglutinin ELISA) did not correlate with immune clearance, which remained stable in longitudinal studies. Age-related changes in MPS Fc-receptor function could explain, at least in part, prognostic differences between children and adult patients with APSGN.

[Clinical course in 51 patients with idiopathic membranous glomerulopathy]. / Estudio de la evolución de 51 pacientes con glomerulopatía membranosa idiópatica.

51 patients, mainly adults, with idiopathic membranous glomerulonephropathy were studied to evaluate their clinical course and long-term prognosis. Glomerular lesions were classified into four groups, according to Ehrenreich and Churg: 5 had type I, 19 type II, 20 type III and 7 type IV lesions. The onset was marked by a nephrotic syndrome in 47 patients (92%). Hypertension was present in 41% and the serum creatinine was over 2 mg/dl in 17%. During the follow-up period (mean 42 months) clinical remission occurred in 7 cases, clinical improvement in 4 patients, renal insufficiency in 11 patients (with end-stage renal failure in 10 and the condition remained unchanged in 29 cases. The actuarial life-table survival at 5 and 15 years was 80% and 56% respectively, excluded the 5 patients with renal vein thrombosis. The retrospective comparison in patients who did (n = 29) or did not (n = 22) receive corticosteroids, shows a favorable outcome of treated patients. Poor prognostic indicators were: impaired renal function at time of diagnosis, and advanced histologic staging.