A multi-centre, open-label, prospective, observational study to assess the safety of a nifedipine oral solution in the treatment of preterm labor / Estudio multicéntrico, de diseño abierto, prospectivo y observacional para evaluar la seguridad de una solución oral de nifedipino en el tratamiento del parto prematuro

Objective: To analyze the safety profile of a nifedipine oral solution in the treatment of preterm labor (PTL). Methods: A multi-center, open-label, prospective, single-arm, observational study was conducted in 500 women with PTL to whom a nifedipine oral solution was prescribed according to its Summary of Product Characteristics. Safety profile and tolerability of oral administration of nifedipine solution during routine clinical practice was assessed as the primary objective of the study and treatment efficacy as secondary objective. Results: No severe adverse events were reported among these women, including severe hypotension. Eight patients (2.3%) reported adverse reactions of moderate intensity, and in 0.9% of the patients (3 cases), these adverse reactions caused the discontinuation of the treatment. Conclusions: The results of this study show that nifedipine oral solution exhibits an excellent safety profile used as a tocolytic treatment in women with PTL.(AU)

Objetivo: Analizar el perfil de seguridad de una solución oral de nifedipino en el tratamiento del parto prematuro (PP). Métodos: Se llevó a cabo un estudio observacional, prospectivo, de diseño abierto, de rama única y multicéntrico en 500 mujeres que presentaban un PP, a las que se les administró una solución oral de nifedipino según la ficha técnica del producto. El perfil de seguridad y la tolerancia de la solución oral de nifedipino, en el contexto de la práctica clínica rutinaria, fueron evaluados como objetivo primario del estudio, y la eficacia del tratamiento, como objetivo secundario. Resultados: No se notificaron efectos adversos graves, incluyendo hipotensión severa. Ocho pacientes (2,3%) presentaron reacciones adversas de intensidad moderada, y en el 0,9% de las pacientes (3 casos) estos efectos adversos provocaron la discontinuación del tratamiento. Conclusiones: Los resultados de este estudio muestran que la solución oral de nifedipino dispone de un excelente perfil de seguridad para su uso como tocolítico en el tratamiento de mujeres con PP.(AU)

Identification of vaginal microbiome associated with IVF pregnancy.

The factors that cause a preterm birth (PTB) are not completely understood up to date. Moreover, PTB is more common in pregnancies achieved by in-vitro fertilization (IVF) than in spontaneous pregnancies. Our aim was to compare the composition of vaginal microbiome at 12 weeks of gestation between women who conceived naturally or through IVF in order to study whether IVF PTB-risk could be related to vaginal microbiome composition. We performed an observational, prospective and multicentre study among two public hospitals and a fertility private clinic in Spain. Vaginal swabs from 64 pregnant women at 12 weeks of gestation were collected to analyse the microbiome composition by sequencing the V3-V4 region of the 16S rRNA. Our results showed that the vaginal microbiome signature at 12 weeks of pregnancy was different from women who conceived naturally or through IVF. The beta diversity and the genus composition were different between both cohorts. Gardnerella, Neisseria, Prevotella, and Staphylococcus genus were enriched genus in the vaginal microbiome from the IVF group, allowing us to create a balance model to predict both cohorts. Moreover, at species level the L. iners abundance was higher and L. gasseri was lower in the IVF group. As a conclusion, our findings were consistent with a proposed framework in which IVF pregnancy are related to risk for preterm birth (PTB) suggesting vaginal microbiome could be the reason to the relation between IVF pregnancy and risk for PTB.

The role of seagrass meadows in the coastal trapping of litter.

The accelerated discard and mismanagement of human-made products are resulting in the continued input of litter into the oceans. Models and field observations show how floating litter can accumulate in remote areas throughout the global ocean, but far less is known about the non-floating litter fraction. Seagrass meadows play an important role in the sediment and natural-debris dynamics, and likely also in the storage and processing of non-floating litter. In this work, non-floating litter was studied across six Posidonia oceanica meadows. Litter accumulated mainly around the landside edge of the meadow. The outer margin of the edge predominantly trapped macro-litter, whilst microplastics accumulated mainly along the inner margin. On average, macro-litter concentrations increased 3-fold after heavy rainfall. Retention of non-floating litter by coastal meadows facilitates the recurrent landward-seaward conveyance of the easily-transportable litter (mainly plastic items) and its fragmentation before it is buried or transferred to deeper areas.

Distribution and abundance of microplastics in coastal sediments depends on grain size and distance from sources.

Microplastic deposition in marine sediments is a geographically widespread problem. This study examines microplastics in intertidal and subtidal sediments at 87 locations in habitats designated as Special Areas of Conservation (SACs) and Special Protection Areas (SPAs) on the coastline of Ireland. Established methodological approaches including, organic matter digestion, density separation, particle extraction and polymer identification were applied. Microplastic abundance was closely related with distance from known sources and concentrations were greater in intertidal as opposed to subtidal sediments. Colourless, polyethylene fibres and polypropylene fragments were the most abundant MP recorded and finer grained sediments were shown to entrap more MPs than coarser sediments. The results demonstrate that an understanding of potential sources of pollution, sediment type and hydrodynamic conditions are very important in terms of MP abundance and distribution in marine sediments and also in terms of effective waste management strategies and policy aimed at reducing the global plastics problem.

Effectiveness of 12 week ledipasvir/sofosbuvir and predictors of treatment failure in patients with hepatitis C.

OBJECTIVE: The efficacy of ledipasvir/sofosbuvir (LDV/SOF) have been demonstrated in randomized controlled trials, however,there is an unmet need for real-world effectiveness data. It is important to gather data regarding potential predictors of treatment failure with (LDV/SOF). Predictors of sustained virologic response (SVR) to all-oral HCV regimens can inform nuanced treatment decisions. The objectives of this study were to evaluate the effectiveness of LDV/SOF, SVR12 as main endpoint and SVR24 as second endpoint, and identify predictors of treatment failure. METHODS: Retrospective and observational study carried out from April 2015 to January 2016. Inclusion criteria: patients with HCV infection treated with LDV/SOF for 12 weeks during study period. The patients that were treated during 24 weeks were excluded as well as those treated with peg-interferon. Binary logistic regression was used to predict what variable was associated with treatment failure. RESULTS: A total of 122 patients were analyzed achieving SVR12 91.80% (112/122) of them. The patients with HCV genotype (GT) 1a or GT1b or GT4 achieved SVR12. Only one pre-treated non-cirrhotic HCV GT1 patients relapsed to treatment. The lowest SVR12 were obtained for GT3, 43.75%, (7/16). Everybody that got SVR12 achieved SVR24. None of the variables analyzed significantly influenced the SVR12, except GT (p=0.001). Almost all the relapses occurred in GT3. CONCLUSIONS: LDV/SOF combination has been very effective to treat GT1 and GT4 infected patients, however, has constituted a suboptimal therapeutic option for those patients infected with GT3, regardless of the rest of the variables analyzed.

Strength limits in mesoscaled 3Y-TZP ceramics for micro-surgical instruments.

Micro-surgical instruments are a new application for mesoscale ceramics formed using the lost mold-rapid infiltration forming (LM-RIF) process. Instrument strength and reliability are the foremost concerns for this sensitive application. It is hypothesized that increasing grain size can improve the damage tolerance of the parts associated with the transformation toughening in the 3Y-TZP material, while retaining high strength. In this work, mesoscale bend bars (314 × 22 × 18 µm) of 3Y-TZP fabricated using the LM-RIF process were heat treated at 1400 °C for 1 h, 8 h, or 16 h, respectively, to obtain samples with different grain sizes. Strength tests were performed under three-point bending and results were evaluated using Weibull statistics. Fractographic and confocal Raman spectroscopic analyses were carried out to interpret the data. Experimental findings showed that the characteristic strength decreased with increasing grain size contrary to the damage tolerance hypothesis. An Orowan-Petch model was recalled to correlate the strength with the flaw size to grain size ratio. At fine grain sizes the strength was controlled by the flaws introduced by the LM-RIF process, whereas at large grain sizes the strength become more grain size controlled. Although larger-grained samples did have a higher propensity to transform, and thus increase toughening, exaggerated grain growth in some of the specimens tested caused an additional flaw population which led to an overall lower strength. Finally, based on the experimental observations and fracture mechanics considerations, we believe that an upper bound of ∼2.5 GPa exists for the strength of mesoscale as-fabricated 3Y-TZP ceramic parts.

Improving quality in healthcare: What makes a satisfied patient?

OBJECTIVE: To update the metric properties of a perceived quality questionnaire for patients admitted to hospital medical departments, to determine the level of patient satisfaction achieved, and to identify the variables which predict satisfaction. METHODS: Self-administered questionnaire completed at home following patient discharge, using a questionnaire prepared by the authors on a sample of 7207 users of medical departments in 9 public hospitals during the years 2006-2009. A principal component analysis with varimax rotation was performed. Reliability was assessed using internal consistency coefficient. An analysis was made of the compliance with each indicator reported by respondents. A logistic regression analysis was performed to determine the perceived quality dimensions which predicted overall patient satisfaction. RESULTS: The results of the reliability analysis indicated good coefficients for interpersonal manner (0.94) and professional competence (0.85) dimensions, and moderate values for the other dimensions (comfort 0.55, information 0.38, and organisation 0.37). Factor analyses showed single factors in each of the perceived quality dimensions, with a percentage of explained variance greater than 35% for information, interpersonal manner, professional competence, and comfort, and less than 30% for organisation. The dimensions which predicted satisfaction were interpersonal manner of healthcare staff, professional competence, and information. CONCLUSIONS: The metric properties of the questionnaire used have been updated, yielding a valid and reliable questionnaire for assessing patient satisfaction in quality management programmes, both for internal purposes and for conducting external comparisons. A positive relationship was obtained between the level of patient satisfaction and level of professional competence, interpersonal manner of healthcare staff, and information received.

Cardiomiopatía de Takotsubo en el contexto de sepsis por Staphylococcus aureus / Takotsubo cardiomyopathy in the context of Staphylococcus aureus sepsis

La cardiopatía de Takotsubo consiste en una disfunción transitoria del ventrículo izquierdo. Se caracteriza por una alteración de la contractilidad segmentaria, sin lesiones coronarias significativas en la coronariografía. Se suele manifestar tras un episodio de estrés físico o emocional. Presentamos el caso de una mujer de 70 años que en el postoperatorio de una osteosíntesis de tobillo desarrolló una cardiomiopatía de Takotsubo en el contexto de una sepsis por Staphylococcus aureus. Presentó edema agudo de pulmón y un cuadro clínico de bajo gasto cardíaco. El ecocardiograma evidenció acinesia medioapical del ventrículo izquierdo. La coronariografía fue normal. Fue tratada con medidas de soporte, con buena evolución. A los 33 días del ingreso pudo darse el alta domiciliaria, con función sistólica normal en la ecocardiografía (AU)

Takotsubo cardiopathy consists of a transient dysfunction of the left ventricle. It is characterized by an impaired left ventricular segmentary contractility, without significant coronary lesions in the coronary angiography. It usually ocurrs after an episode of physical or emotional stress. We present the case of a 70-year-old woman, who, in the postoperatory period of ankle osteosynthesis developed Takotsubo cardiomyopathy in the context of a sepsis caused by Staphylococcus aureus. She presented with acute lung oedema and a clinical picture of low cardiac output. The echocardiogram showed a left ventricular medioapical akinesia. Coronari angiography was normal. She was treated with supportive measures with good progress. At 33 days from onset she was able to be discharged form to hospital to home with normal systolic function on echocardiography (AU)

[Takotsubo cardiomyopathy in the context of Staphylococcus aureus sepsis]. / Cardiomiopatía de Takotsubo en el contexto de sepsis por Staphylococcus aureus.

Takotsubo cardiomyopathy consists of a transient dysfunction of the left ventricle. It is characterised by an impaired left ventricular segmentary contractility, without significant coronary lesions in the coronary angiography. It usually occurs after an episode of physical or emotional stress. We present the case of a 70 year-old woman, who, in the postoperative period of an ankle osteosynthesis, developed a Takotsubo cardiomyopathy in the context of a sepsis caused by Staphylococcus aureus. She presented with acute lung oedema and a clinical picture of low cardiac output. The echocardiogram showed left ventricular medioapical akinesia. Coronary angiography was normal. She was treated with supportive measures with good progress. At 33 days from onset she was able to be discharged from hospital to home with normal systolic function on echocardiography.

Apendicitis aguda atípica diagnosticada durante una colonoscopia / Colonoscopic diagnosis of acute appendicitis with atypical presentation

No disponible

Influencia de la mamografía digital en la detección y manejo de microcalcificaciones / Impact of digital mammography in the detection and management of microcalcifications

Objetivo. Valorar si la introducción de la mamografía digital (MD) en el cribado del cáncer de mama ha supuesto cambios en cuanto a la detección y manejo de las microcalcificaciones. Material y métodos. Se ha realizado un estudio retrospectivo de los indicadores de rendimiento de un programa de cribado del cáncer de mama que se relacionan con el diagnóstico de microcalcificaciones (tasas de recitación y de recomendación de controles intermedios después del cribado, tasa de indicación de procedimientos invasivos por microcalcificaciones, y su valor predictivo positivo, tasa de detección por microcalcificaciones y número de carcinomas ductales in situ [CDIS] diagnosticados). Se han comparado los resultados obtenidos con la mamografía digital directa (septiembre 2008-agosto 2009) frente a la mamografía analógica (septiembre 2006-agosto 2007). Para el análisis estadístico se utilizaron la Prueba de X2 y medidas de asociación. Resultados. Con MD se ha observado un aumento significativo de las tasas de recitación (de 50,8 a 64‰), de realización de controles intermedios (de 9,41 a 18,7‰), de indicación de pruebas invasivas (de 1,88 a 3,01‰), de cánceres detectados por microcalcificaciones (de 0,86 a 1,36‰) y del número de CDIS. Conclusión. La MD directa ha mejorado la detección de microcalcificaciones incrementando el número de CDIS diagnosticados, sin disminuir el valor predictivo positivo de los procedimientos invasivos indicados por microcalcificaciones. Sin embargo, ha tenido un efecto negativo por el aumento en la tasa de recitación y de indicación de seguimiento a corto plazo, posiblemente debido a la dificultad de comparación con estudios analógicos anteriores(AU)

Objective. To determine whether the introduction of digital mammography in breast cancer screening has resulted in changes in the detection and management of microcalcifications. Material and methods. We retrospectively studied the performance indicators of our breast cancer screening program that are related to the diagnosis of microcalcifications (rates of recall and recommendation of intermediate follow-up after screening, rate of indication of invasive procedures for microcalcifications and their positive predictive value, detection rate for microcalcifications, and number of ductal carcinomas in situ (DCIS) diagnosed). We compared the results obtained using direct digital mammography (september 2008-august 2009) with those obtained using analog mammography (september 2006-august 2007). Statistical analysis. Chi-square test and measures of association. Results. We found that using digital mammography led to significant increases in the recall rate (from 50.8 to 64‰), in the rate of intermediate follow-up after screening (from 9.41 to 18.7‰), in the rate of indication for invasive procedures (from 1.88 to 3.01‰), in the cancers detected through microcalcifications (from 0.86 to 1.36‰), and in the number of DCIS diagnosed. Conclusion. Direct digital mammography has improved the detection of microcalcifications, increasing the number of DCIS diagnosed without decreasing the positive predictive value of the invasive procedures indicated for microcalcifications. However, direct digital mammography has had a negative effect by increasing the recall rate and indication for short-term follow-up, possibly due to the difficulty of comparing the findings with those of earlier analog mammograms(AU)

El triaje en urgencias en los hospitales españoles / Triage in Spanish hospitals

El objetivo del presente artículo es conocer el modelo de triaje utilizado y sus características principales en los hospitales de la red sanitaria nacional pública. Se hizo un estudio descriptivo transversal en los hospitales públicos con más de 100 camas para el ingreso. Se envió un formulario a 123 hospitales, y se obtuvo respuesta en el 54,5%. Los sistemas de triaje empleado son el Modelo Andorrano de Triaje (MAT) o Sistema Español de Triaje(SET) en el 37,3% de los casos y el Sistema de Triaje de Manchester (MTS) en el 23,9%.En los 58 hospitales que tienen implantado algún sistema, no se realizó estudio previo de implantación en el 53,4% de los casos. Los profesionales encargados de realizar el triajeson el enfermero (DUE) en el 77,6% de los casos y el facultativo (FEA) en el 6,9%. No existe una comisión/grupo de triaje en el 53,7% de los casos. El grado de satisfacción (1-5) es para el FEA de 3,16; para el médico interno residente (MIR) de 3,28 y para el DUE de 3,23. Cambiarían el sistema el 49,2% de los centros encuestados. No se observan diferencias significativas de implantación en cuanto a los modelos MAT-SET y MTS (AU)

The objective to determine what triage systems are being used in Spanish national health service hospitals and to define the characteristics of the models in place. Cross-sectional descriptive survey of hospitals with more than 100 beds in the Spanish national health service. Responses to a questionnaire sent to 123 hospitals were received from 54.5% of the facilities. The Andorran Triage Model adapted for use as the Spanish Triage System (ATM-STS) was used in 37.3% of the hospitals. The Manchester Triage System was used in 23.9%. Of the 58 hospitals that use some triage system, 53.4% had not carried out a study before starting to apply the selected system. The professionals in charge of triage are nurses in 77.6% of the hospitals and physicians in 6.9%. No triage committee or group had been established in 53.7% of the hospitals responding to the survey. The degree of satisfaction with the chosen system expressed on a scale of 1 to 5 was 3.16 for physicians, 3.28 for residents in training, and 3.23 for nurses. Another system would be chosen by 49.2% of the respondents. The difference in the numbers of hospitals using the ATM-STS and the MTS was not great (AU)

[Impact of digital mammography in the detection and management of microcalcifications]. / Influencia de la mamografía digital en la detección y manejo de microcalcificaciones.

OBJECTIVE: To determine whether the introduction of digital mammography in breast cancer screening has resulted in changes in the detection and management of microcalcifications. MATERIAL AND METHODS: We retrospectively studied the performance indicators of our breast cancer screening program that are related to the diagnosis of microcalcifications (rates of recall and recommendation of intermediate follow-up after screening, rate of indication of invasive procedures for microcalcifications and their positive predictive value, detection rate for microcalcifications, and number of ductal carcinomas in situ (DCIS) diagnosed). We compared the results obtained using direct digital mammography (september 2008-august 2009) with those obtained using analog mammography (September 2006-August 2007). STATISTICAL ANALYSIS: Chi-square test and measures of association. RESULTS: We found that using digital mammography led to significant increases in the recall rate (from 50.8 to 64‰), in the rate of intermediate follow-up after screening (from 9.41 to 18.7‰), in the rate of indication for invasive procedures (from 1.88 to 3.01‰), in the cancers detected through microcalcifications (from 0.86 to 1.36‰), and in the number of DCIS diagnosed. CONCLUSION: Direct digital mammography has improved the detection of microcalcifications, increasing the number of DCIS diagnosed without decreasing the positive predictive value of the invasive procedures indicated for microcalcifications. However, direct digital mammography has had a negative effect by increasing the recall rate and indication for short-term follow-up, possibly due to the difficulty of comparing the findings with those of earlier analog mammograms.

Hemocultivos... ¿Qué te han contado y qué haces? / Blood cultures... What they tell you and what you do

Objetivo: Objetivo principal: Conocer la variabilidad práctica de los enfermeros/as (DUE's) del Hospital General Nuestra Señora del Prado, sobre la técnica para la extracción de hemocultivo. Objetivos específicos: Determinar las condiciones de asepsia/ esterilidad de la técnica. Establecer la utilización (desinfección, orden de llenado, volumen, cambio de aguja) de los frascos de hemocultivos. Método: Estudio descriptivo transversal realizado en el Hospital General Nuestra Señora del Prado. Ha consistido en la entrega de un cuestionario para autocumplimentación a los profesionales de enfermería, donde se han incluido variantes tanto cuantitativas como cualitativas. Resultados: Se han recogido 52,9% encuestas de los 363 DUE's del centro hospitalario, con una experiencia profesional media de 12,9 años [DE±7,9]. El 57,8% cree que no es necesario técnica estéril para el procedimiento. 94,7% utiliza un único antiséptico. 78,6% afirman que en la extracción de acceso venoso central desecha los primeros 10cc que extrae. Conclusiones: Consideramos un alto índice de respuesta, ya que es superior al 40% para cuestionarios autocumplimentados. Hemos observado que la mayoría de DUE's utilizan técnica aséptica y en los protocolos estudiados no existe un consenso entre la utilización de técnica estéril y aséptica. Este estudio nos revela que la mayoría de los DUE's utilizan un único antiséptico, sin embargo la mayoría de los protocolos recomiendan la utilización primero de alcohol y luego povidona yodada para la desinfección de la piel (AU)

Aims: Main aim: To ascertain differences in nurses at the Hospital General Nuestra Señora del Prado, in blood extraction and blood culture techniques. Specific aims: To determine the asepsis/sterility conditions of the technique; to establish the use (disinfection, filling order, volume, needle change) of the blood culture vials. Method: Transversal descriptive study made at the Hospital General Nuestra Señora del Prado. A self-completion questionnaire including quantitative and qualitative variants was delivered to nursing professionals. Results: 52.9% of the questionnaires were collected from the 363 DUE's at the hospital. Mena working experience was 12.9 years [DE±7,9]. 57,8% believe sterile technique for the procedure was not necessary. 94.7% use a single antiseptic. 78.6% stated that they discard the first 10 cc extracted from the central vein. Conclusions: We consider that the response is high, with over 40% of the questionnaires being completed. We observed that most DUE's use aseptic techniques and in the protocols studied there was no consensus about the use of sterilization and septic techniques. The study reveals that the majority of the DUE's use a single antiseptic, even though most protocols recommend the use of alcohol, followed by povidone.iodine to disinfect the skin (AU)

Whisking in air: encoding of kinematics by VPM neurons in awake rats.

Rodent whisking behavior generates two types of neural signals: one produced by whisker contact with objects; the other by movements in air. While kinematic signals generated by contact reliably activate neurons at all levels of the trigeminal neuraxis, the extent to which the kinematics of whisking in air are reliably encoded at each level remains unclear. Previously, we showed that the responses of trigeminal ganglion (TG) neurons in awake, head-fixed rats are correlated with whisking kinematic parameters, but that individual neurons may differ substantially in the reliability of their kinematic encoding. Here, we extend that analysis to neurons in the ventral posterior medial (VPM) nucleus. Three possible coding strategies were examined: (1) firing rate across an entire movement; (2) the probability of individual spikes as a function of the instantaneous movement trajectory; and (3) the coherence between spikes and whisking. While VPM neurons were clearly responsive to variations in whisker kinematics during whisking in air, the encoding of whisker kinematics by VPM neurons was less consistent than that of TG neurons. Furthermore, we found that, in VPM as in TG, movement direction is an important determinant of unit responsiveness during whisking in air.

Whisking in air: encoding of kinematics by trigeminal ganglion neurons in awake rats.

Active sensing requires the brain to distinguish signals produced by external inputs from those generated by the animal's own movements. Because the rodent whisker musculature lacks proprioceptors, we asked whether trigeminal ganglion neurons encode the kinematics of the rat's own whisker movements in air. By examining the role of kinematics, we have extended previous findings showing that many neurons that respond during such movements do not do so consistently. Nevertheless, the majority ( approximately 70%) of trigeminal ganglion neurons display significant correlations between firing rate and a kinematic parameter, and a subset, approximately 30%, represent kinematics with high reliability. Preferential firing to movement direction was observed but was strongly modulated by movement amplitude and speed. However, in contrast to the precise time-locking that occurs in response to active whisker contacts, whisker movements in air generate temporally dispersed responses that are not time-locked to the onset of either protractions or retractions.

Ambient air levels of volatile organic compounds (VOC) and nitrogen dioxide (NO2) in a medium size city in Northern Spain.

Ambient concentrations of volatile organic compounds (VOC) and nitrogen dioxide (NO2) were measured by means of passive sampling at 40 sampling points in a medium-size city in Northern Spain, from June 2006 to June 2007. VOC and NO2 samplers were analysed by thermal desorption followed by gas chromatography/mass-selective detector and by visible spectrophotometry, respectively. Mean concentrations of benzene, toluene, ethylbenzene, xylenes, propylbenzene, trimethylbenzenes, and NO(2) were 2.84, 13.26, 2.15, 6.01, 0.59, 1.32 and 23.17 microg m(-3) respectively, and found to be highly correlated. Their spatial distribution showed high differences in small distances and pointed to traffic as the main emission source of these compounds. The lowest levels of VOC and NO2 occurred during summer, owing to the increase in solar radiation and to lower traffic densities. Mean concentrations of benzene and NO2 exceeded the European limits at some of the monitored points.

Diagnóstico prenatal de una tumoración quística suprarrenal: conducta que hay que seguir / No disponible

Ante el hallazgo ecográfico prenatal de una masa quística suprarrenal se debe hacer un exhaustivo diagnóstico diferencial. Éste incluye procesos benignos, como la hemorragia suprarrenal, quistes renales, secuestros pulmonares, malformaciones adenomatosas pulmonares, quistes mesentéricos y retroperitoneales, y duplicaciones entéricas, y también se tienen que descartar tumores malignos, como el neuroblastoma y el nefroblastoma mesoblástico congénito. El mayor problema de diagnóstico diferencial se presenta entre la hemorragia suprarrenal, que generalmente es un proceso regresivo, con ausencia de vasos en el estudio Doppler color, y el neuroblastoma, que permanece estableo puede ser expansivo, demostrándose con el Doppler color la presencia de vasos intratumorales (AU)

When an adrenal cystic mass is detected on prenatals onography, a differential diagnosis must be made, which should include benign lesions – such as adrenal hemorrhage, simple renal cyst, extralobar pulmonary sequestration, pulmonary cystic adenomatoid malformation,enteric duplication cyst, mesenteric and retroperitonealcyst – and malignant tumors, such as neuroblastoma and congenital mesoblastic nephroblastoma. The main difficulty is to differentiate between adrenal hemorrhage, which is usually a regressive process and shows the absence of vessels on color Doppler sonography, and neuroblastoma, which remains stable ormay grow and shows vessels that invade the tumor on color Doppler sonography (AU)