Prematurity and congenital malformations differ according to the type of pregestational diabetes.

BACKGROUND: Diabetes mellitus (DM) is the most common metabolic disorder in pregnancy. Women with Type 2 DM seems to have no better perinatal outcomes than those with Type 1 DM. METHODS: Single-center prospective cohort observational study. Pregnant women with diabetes (141 with Type 1 DM and 124 with Type 2 DM) that were followed in the university hospital between 2009 and 2021 were included in this study. Clinical data and obstetric and perinatal outcomes were collected. RESULTS: As expected, women with Type 1 DM were younger and had a longer duration of diabetes than women with Type 2 DM. Obesity and chronic hypertension were higher in the group of women with Type 2 DM and their value of HbA1c in the second and third trimesters were lower than in Type 1 DM. No differences in prematurity were found, but more extreme prematurity was observed in Type 2 DM, as well as a higher rate of congenital malformations. The frequency of hypoglycemia and the weight of the newborn was higher in Type 1 DM. The maternal independent factors related to the weight of the newborn were: the glycemic control at the third trimester, the weight gain during pregnancy, and pregestational BMI. CONCLUSIONS: Newborns born to mothers with Type 1 DM were larger and had a higher frequency of hypoglycemia, while congenital malformations and precocious preterm was more associated to Type 2 DM. Metabolic control, weight gain and pregestational weight were important determinants of both obstetric and neonatal complications.

Validation of sentinel lymph node biopsy in breast cancer women N1-N2 with complete axillary response after neoadjuvant chemotherapy. Multicentre study in Tarragona. / Validación de la biopsia selectiva del ganglio centinela en mujeres con cáncer de mama N1-2 con respuesta axilar completa tras la neoadyuvancia. Estudio multicéntrico en la provincia de Tarragona.

INTRODUCTION: The aim of our study was to evaluate sentinel lymph node biopsy as a diagnostic test for assessing the presence of residual metastatic axillary lymph nodes after neoadjuvant chemotherapy, replacing the need for a lymphadenectomy in negative selective lymph node biopsy patients. MATERIAL AND METHODS: A multicentre, diagnostic validation study was conducted in the province of Tarragona, on women with T1-T3, N1-N2 breast cancer, who presented with a complete axillary response after neoadjuvant chemotherapy. Study procedures consisted of performing an selective lymph node biopsy followed by lymphadenectomy. RESULTS: A total of 53 women were included in the study. Surgical detection rate was 90.5% (no sentinel node found in 5 patients). Histopathological analysis of the lymphadenectomy showed complete disease regression of axillary nodes in 35.4% (17/48) of the patients, and residual axillary node involvement in 64.6% (31/48) of them. In lymphadenectomy positive patients, 28 had a positive selective lymph node biopsy (true positive), while 3 had a negative selective lymph node biopsy (false negative). Of the 28 true selective lymph node biopsy positives, the sentinel node was the only positive node in 10 cases. All lymphadenectomy negative cases were selective lymph node biopsy negative. These data yield a sensitivity of 93.5%, a false negative rate of 9.7%, and a global test efficiency of 93.7%. CONCLUSIONS: Selective lymph node biopsy after chemotherapy in patients with a complete axillary response provides valid and reliable information regarding axillary status after neoadjuvant treatment, and might prevent lymphadenectomy in cases with negative selective lymph node biopsy.

Detección de iones metálicos en cabello tras artroplastia de cadera metal-metal / Detection of metal ions in hair after metal-metal hip arthroplasty

Objetivo. Tras el implante de algunos modelos de prótesis de cadera metal-metal se produce una elevación de los niveles de metales en suero y orina. Recientemente se ha demostrado que hay concordancia entre estas cifras y los niveles encontrados en el cabello. Nuestro objetivo ha sido estudiar la presencia de metales en cabello y conocer si ello se modifica con el paso del tiempo o con la extracción del implante. Material y método. En 45 pacientes con una artroplastia de superficie se ha realizado una determinación de los niveles de cromo, cobalto y molibdeno en cabello a los 3, 4, 5 y 6 años desde el implante. La edad media fue de 57,5 años, 2 eran mujeres. En 11 pacientes, en 5 de ellos por metalosis y quiste periarticular, fue necesaria una reintervención para extracción de la artroplastia e implante de un nuevo modelo con fricción metal-polietileno. Resultados. Las cifras medias de metales en cabello fueron cromo 163,27 ppm, cobalto 61,98 ppm y molibdeno 31,36 ppm, muy por encima de los niveles referidos en la población general. En los pacientes reintervenidos para extracción de la artroplastia se observó al año de la intervención una disminución del 43,8% en los niveles de cromo, del 51,1% en molibdeno y del 90,3% en cobalto. Conclusiones. En las artroplastias de cadera con fricción metal-metal se aprecia una alta concentración de metales en el cabello, que disminuye cuando dicho implante es extraído. La determinación de iones en cabello puede ser un buen marcador de la intoxicación por metales que sucede en estos modelos artroplásticos (AU)

Objective. There is an increase in the levels of metals in the serum and urine after the implantation of some models of metal-metal hip prosthesis. It has recently been demonstrated that there is an association between these levels and the levels found in hair. The aim of this study is to determine the presence of metals in hair, and to find out whether these change over time or with the removal of the implant. Material and method. The levels of chromium, cobalt and molybdenum were determined in the hair of 45 patients at 3, 4, 5, and 6 years after a hip surface replacement. The mean age was 57.5 years, and two were female. Further surgery was required to remove the replacement and implant a new model with metal-polyethylene friction in 11 patients, 5 of them due to metallosis and a periarticular cyst. Results. The mean levels of metals in hair were chromium 163.27 ppm, cobalt 61.98 ppm, and molybdenum 31.36 ppm, much higher than the levels found in the general population. A decrease in the levels of chromium (43.8%), molybdenum (51.1%), and cobalt (91.1%) was observed at one year in the patients who had further surgery to remove the prosthesis. Conclusions. High concentrations of metals in the hair are observed in hip replacements with metal-metal friction, which decrease when that implant is removed. The determination of metal ions in hair could be a good marker of the metal poisoning that occurs in these arthroplasty models (AU)

[Detection of metal ions in hair after metal-metal hip arthroplasty]. / Detección de iones metálicos en cabello tras artroplastia de cadera metal-metal.

OBJECTIVE: There is an increase in the levels of metals in the serum and urine after the implantation of some models of metal-metal hip prosthesis. It has recently been demonstrated that there is an association between these levels and the levels found in hair. The aim of this study is to determine the presence of metals in hair, and to find out whether these change over time or with the removal of the implant. MATERIAL AND METHOD: The levels of chromium, cobalt and molybdenum were determined in the hair of 45 patients at 3, 4, 5, and 6 years after a hip surface replacement. The mean age was 57.5 years, and two were female. Further surgery was required to remove the replacement and implant a new model with metal-polyethylene friction in 11 patients, 5 of them due to metallosis and a periarticular cyst. RESULTS: The mean levels of metals in hair were chromium 163.27 ppm, cobalt 61.98 ppm, and molybdenum 31.36 ppm, much higher than the levels found in the general population. A decrease in the levels of chromium (43.8%), molybdenum (51.1%), and cobalt (91.1%) was observed at one year in the patients who had further surgery to remove the prosthesis. CONCLUSIONS: High concentrations of metals in the hair are observed in hip replacements with metal-metal friction, which decrease when that implant is removed. The determination of metal ions in hair could be a good marker of the metal poisoning that occurs in these arthroplasty models.