Can 3D-printed patient-specific instruments improve local control and overall survival in pelvic sarcoma? A clinical validation study. / Guías impresas en 3D: ¿mejoran el control local y la supervivencia global en el tratamiento de los sarcomas pélvicos? Estudio de validación clínica.

BACKGROUND AND OBJECTIVES: 3D-printed patient-specific instruments (PSIs), also known as 3D guides, have been shown to improve accuracy in resection of pelvic tumors in cadaver studies and achieve better surgical margins in vivo. This study evaluates the clinical impact of 3D-printed guides on medium-term local and distant disease control, as well as disease-free and overall survival in patients. MATERIAL AND METHODS: A cohort study included 25 patients with primary pelvic or sacral sarcomas: 10 in the 3D group and 15 in the control group, with a median follow-up of 47 months. Demographic and clinical data, including tumor histology, stage, resection technique, associated reconstruction, adjuvant therapies, and complications, were evaluated. Surgical margins (free, marginal, and contaminated) and relapse-free and overall survival curves were analyzed. RESULTS: The 3D group achieved a higher rate of free margins (80% vs 66.7%, p = 0.345). Local recurrence (50% vs 60%, P=.244) and distant disease relapse (20% vs 47%, p = 0.132) rates were lower in the 3D group. At the end of the follow-up, the 3D group had a higher overall survival rate (60% vs 40%, p = 0.327). The complication rate was similar in both groups, with a deep infection rate of 40%. CONCLUSIONS: The use of 3D guides in resecting primary pelvic tumors not only achieves a higher rate of free margins compared to conventional techniques but also shows a trend towards higher local, distant, and overall disease-free survival. Further studies with larger sample sizes and higher levels of evidence are necessary to validate these clinical trends.

Validación de los modelos de impresión 3D paciente-específicos para cirugía ortopédica oncológica pélvica / Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery

Introducción: Los tumores del anillo pélvico suponen un reto por la dificultad de obtener márgenes quirúrgicos adecuados. Herramientas como la navegación quirúrgica o la impresión 3D para la fabricación de plantillas de posicionamiento quirúrgico paciente-específicas ayudan en la planificación preoperatoria y la ejecución intraoperatoria. Su correcta colocación es fundamental en localizaciones complejas como la pelvis, por lo que es necesario identificar los errores de posicionamiento. El objetivo de este estudio es demostrar la fiabilidad en la colocación de plantillas 3D para la realización de osteotomías en el anillo pélvico. Material y métodos: Estudio experimental en cadáver con 10 hemipelvis. Se realiza TC para la obtención del modelo tridimensional, planificación de osteotomías, diseño de plantillas de posicionamiento en rama isquiopubiana (I), iliopubiana (P), supracetabular (S) y cresta iliaca (C); y un marcador de posicionamiento (rigid-body) sobre las plantillas C y S para la navegación. Las plantillas y el rigid-body son impresos en 3D y se colocan según planificación previa. La navegación permite comprobar la posición final de las plantillas y de las osteotomías. Resultados: El posicionamiento de las plantillas respecto a la planificación preoperatoria varió dependiendo de la localización, siendo mayor el error en las de cresta iliaca. Utilizando la navegación, la media de error de distancia al plano de corte está en 3,5mm, excepto en pubis (5-8mm), estando condicionado por la posición del rigid body. Conclusión: El uso de plantillas paciente-específicas impresas en 3D es una herramienta fiable para la realización de osteotomías en cirugía oncológica pélvica.(AU)

Introduction: Pelvic ring tumors pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. Material and methods: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. Results: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis 5-8mm), being conditioned by the position of the rigid body. Conclusion: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.(AU)

[Translated article] Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery / Validación de los modelos de impresión 3D paciente-específicos para cirugía ortopédica oncológica pélvica

Introducción: Los tumores del anillo pélvico suponen un reto por la dificultad de obtener márgenes quirúrgicos adecuados. Herramientas como la navegación quirúrgica o la impresión 3D para la fabricación de plantillas de posicionamiento quirúrgico paciente-específicas ayudan en la planificación preoperatoria y la ejecución intraoperatoria. Su correcta colocación es fundamental en localizaciones complejas como la pelvis, por lo que es necesario identificar los errores de posicionamiento. El objetivo de este estudio es demostrar la fiabilidad en la colocación de plantillas 3D para la realización de osteotomías en el anillo pélvico. Material y métodos: Estudio experimental en cadáver con 10 hemipelvis. Se realiza TC para la obtención del modelo tridimensional, planificación de osteotomías, diseño de plantillas de posicionamiento en rama isquiopubiana (I), iliopubiana (P), supracetabular (S) y cresta iliaca (C); y un marcador de posicionamiento (rigid-body) sobre las plantillas C y S para la navegación. Las plantillas y el rigid-body son impresos en 3D y se colocan según planificación previa. La navegación permite comprobar la posición final de las plantillas y de las osteotomías. Resultados: El posicionamiento de las plantillas respecto a la planificación preoperatoria varió dependiendo de la localización, siendo mayor el error en las de cresta iliaca. Utilizando la navegación, la media de error de distancia al plano de corte está en 3,5mm, excepto en pubis (5-8mm), estando condicionado por la posición del rigid body. Conclusión: El uso de plantillas paciente-específicas impresas en 3D es una herramienta fiable para la realización de osteotomías en cirugía oncológica pélvica.(AU)

Introduction: Pelvic ring tumors pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. Material and methods: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. Results: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis 5-8mm), being conditioned by the position of the rigid body. Conclusion: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.(AU)

[Translated article] Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery.

INTRODUCTION: Pelvic ring tumours pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. MATERIAL AND METHODS: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. RESULTS: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis (5-8mm), being conditioned by the position of the rigid body. CONCLUSION: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.

Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery. / Validación de los modelos de impresión 3D paciente-específicos para cirugía ortopédica oncológica pélvica.

INTRODUCTION: Pelvic ring tumors pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. MATERIAL AND METHODS: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. RESULTS: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis (5-8mm), being conditioned by the position of the rigid body. CONCLUSION: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.

Hipotiroidismo primario y síndrome nefrótico / Primary hypothyroidism and nephrotic syndrome

No disponible

Mujer con síndrome de Turner, anemia y colestasis / Woman with Turner's syndrome, anaemia and cholestasis

No disponible

Hemipelvectomías tras sarcomas de localización pélvica de alto grado: pronóstico en condrosarcomas frente a otros tipos histológicos / Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types

Introducción. La baja incidencia y la heterogeneidad histológica de los sarcomas pélvicos primarios dificulta el análisis y publicación de cohortes homogéneas. Objetivo. Describir el pronóstico vital y funcional dependiendo del tipo histológico en una serie de sarcomas primarios de localización pélvica de alto grado localmente avanzados tratados mediante hemipelvectomía. Material y métodos. Estudio descriptivo, epidemiológico y funcional de 15 casos tratados entre 2006-2012. Se realizó análisis de supervivencia, valoración funcional y estudio comparativo en función del tipo histológico, comparando los condrosarcomas frente al resto de diagnósticos histológicos. Resultados. El tipo histológico más frecuente en la serie fue el condrosarcoma (46%), y la localización más frecuente la zona P2 (periacetabular) (73%). Se realizó una hemipelvectomía interna en el 66% de los casos, siendo mayor (83%) en el caso de los condrosarcomas. La supervivencia global a los 2 años fue del 54%, siendo más elevada en el grupo condrosarcoma (67%) que en el resto (43%). La situación funcional dependió del tipo de intervención, sin encontrar diferencias en función del tipo histológico ni de la realización de reconstrucción. Discusión y conclusiones. La hemipelvectomía como procedimiento quirúrgico está indicada para el tratamiento de los sarcomas primarios de localización pélvica de alto grado localmente avanzados independientemente del tipo histológico. La incidencia de conservación del miembro y la supervivencia global es mayor en los condrosarcomas frente al resto de tipos histológicos (AU)

Introduction. The low incidence and histological heterogeneity of primary sarcomas located in the pelvis makes it difficult to find homogeneous cohorts. Objective. To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. Methods. A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. Results. The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. Discussion and conclusions. Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas (AU)

[Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types]. / Hemipelvectomías tras sarcomas de localización pélvica de alto grado: pronóstico en condrosarcomas frente a otros tipos histológicos.

INTRODUCTION: The low incidence and histological heterogeneity of primary sarcomas located in the pelvis makes it difficult to find homogeneous cohorts. OBJECTIVE: To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. METHODS: A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. RESULTS: The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. DISCUSSION AND CONCLUSIONS: Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas.

Artropatía neuropática de hombro asociada a siringomielia / Artrophatic neuropathy of the shoulder associated to syringomyelia

Se presenta un caso del conocido como hombro de Chopart, una artropatía neuropática como consecuencia de siringomielia en una paciente de 62 años con antecedentes durante 5 años en su hombro. La clínica y la RMN de la columna cervical permitieron el diagnóstico. El tratamiento fue conservador con una buena evolución (AU)

A case of Chopart shoulder, a neuropathic shoulder arthropathy associated with syringomyelia, was detected in a 62 years old woman with five years shoulder clinic. The clinical examination and a cervical MRI detected the ethiology. The treatment was functional with a good outcome (AU)

Prognostic value of (13)C-phenylalanine breath test on predicting survival in patients with chronic liver failure.

AIM: To evaluate the prognostic value of percentage of (13)C-phenylalanine oxidation ((13)C-PheOx) obtained by (13)C-phenylalanine breath test ((13)C-PheBT) on the survival of patients with chronic liver failure. METHODS: The hepatic function was determined by standard liver blood tests and the percentage of (13)C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox. RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of (13)C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of (13)C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival. CONCLUSION: Percentage of (13)C-PheOx obtained by (13)C-PheBT is a strong predictor of survival in patients with chronic liver disease.

Análisis de factores de riesgo asociado a estadías prolongadas en una Unidad de Terapia Intensiva de la Ciudad de Buenos Aires / Analysis of risk factors associated with prolonged stays in a Therapy Unit Intensive of the City of Buenos Aires

Objetivo. Definir en los pacientes con estadía prolongada en Terapia Intensiva las variables demográficas, epidemiológicas y establecer los factores de riesgo asociados a la misma. Material y Método. Estudio retrospectivo, descriptivo, observacional en el que se evaluaron los pacientes ingresados consecutivamente en la Unidad de Terapia Intensiva (UTI) polivalente del Hospital Bernardino Rivadavia, de enero de 2003 a diciembre 2005. Se analizaron los pacientes con estadía prolongada, considerada como estadía en UTI 21 días (EP21), efectuando un análisis comparativo con la población de pacientes con estadía < a 21 días. Se registraron variables demográficas, Apache II, origen de la internación (guardia, SAME, quirófano, sala general), necesidad de Ventilación Mecánica, nutrición enteral y/o parenteral, transfusiones de glóbulos rojos, tratamiento activo (definido por soporte de drogas vasoactivas y/o vía central al ingreso) y motivos de ingreso a UTI (causa cardiovascular, Sepsis, post-operatorio de urgencia o programado, gastrointestinal, alteraciones del medio interno y patología del sistema nervioso central). Se consignó presencia de infección a la admisión en UTI y la mortalidad en UTI. Estadística. Se realizo un Análisis bivariado entre la variable dependiente EP21 y las independientes utilizando el Modelo de regresión logística simple y multivariado. Resultado. En el período de estudio ingresaron 780 pacientes. La estadía media de la población fue de 9,1±11.5 días. Tuvieron EP21 el 10% de la población y consumieron el 40% del total de los días de UTI. Las variables relacionadas a tener EP21 fueron Apache II, origen de la internación en guardia o SAME, postoperatorio de urgencia, soporte nutricional precoz, de transfusiones, necesidad de Ventilación Mecánica e infección al ingreso a UTI. El pos operatorio programado se asoció a no tener el evento. La mortalidad de los pacientes con EP21 fue de 48% y la mortalidad global 28.5%. En el análisis de regresión logística multivariada, las variables independientes asociadas a tener EP21 fueron: infectados: OR: 11.2 (p: 0.001), IC95% (5.7-22), nutrición: OR: 8.2 (p: 0.001) IC95% (4.3-15.4), Ventilación Mecánica VM: OR:3.5 (p: 0.01) IC95% (1.7- 7.4), patología del sistema nervioso central OR 2.5, (p 0.01) IC 95% 1.2-5.14 (p 0.014). Conclusiones. Los pacientes con estadías mayores o iguales a 21 días tienen una allta prevalencia con un elevado consumo de días de internación dentro de la Unidad. Los factores de riesgo para estadía prolongada en UTI son: infectados, patología neurológica, necesidad de soporte nutricional y ventilación mecánica.(AU)

Embarazo molar y feto vivo / Live fetus co-existent with a hydatiform mole

Se presenta un caso de mola hidatiforme con feto vivo diagnosticado mediante ecografía en la semana 20 de gestación, cuyo feto nació vivo a las 36 semanas. En raras ocasiones aparece una neoplasia trofoblástica compartiendo embarazo con un feto vivo, particularmente si finaliza con fetos vivos nacidos durante el segundo o tercer trimestre, generalmente los fetos mueren intraútero durante el primer trimestre del embarazo. En nuestro caso el embarazo se llevó a término sin complicaciones. De cualquier forma es preciso un control y vigilancia estricta de estas pacientes (AU)

Comparison of Three 7-Day Pantoprazole-Based Helicobacter pylori Eradication Regimens in a Mexican Population with High Metronidazole Resistance.

OBJECTIVE: To compare the efficacy and tolerability of three 7-day pantoprazole-based regimens to eradicate Helicobacter pylori in Mexican patients with peptic ulcer (PU) or non-ulcer dyspepsia (NUD). BACKGROUND: Short-term therapeutic regimens based on a proton pump inhibitor (PPI) and two antibiotics have been recommended for the eradication of H. pylori. Resistance of H. pylori to metronidazole may adversely affect the efficacy of such regimens. PATIENTS AND METHODS: This was a single-centre, randomised, open-label, parallel-group study in which three groups of H. pylori-positive patients with PU or NUD were compared (n = 159; intention-to-treat population). Patients were randomised to receive a 7-day pantoprazole-based triple therapy for eradication of H. pylori. Patients received pantoprazole (P) 40mg twice daily in combination with either i) amoxicillin (A) 1000mg twice daily and clarithromycin (C) 500mg three times daily (PAC regimen, n = 51 patients), or ii) clarithromycin 500mg three times daily and metronidazole (M) 500mg three times daily (PCM regimen, n = 55 patients), or iii) amoxicillin 1000mg twice daily and metronidazole 500mg three times daily (PAM regimen, n = 53 patients). After completing eradication therapy, all PU patients were further treated with once-daily pantoprazole 40mg, either for another 3 weeks (patients with duodenal ulcer) or for another 7 weeks (patients with gastric ulcer), to ensure complete ulcer healing. At baseline examination, all patients underwent the (14)C-urea breath test and endoscopy; biopsy specimens were taken for histology, CLO-test, H. pylori culture and antibiotic susceptibility testing (agar dilution E-test). Eradication of H. pylori was assessed after all treatment with pantoprazole had been discontinued for at least 4 weeks, using the (14)C-urea breath test. RESULTS: In the per-protocol population (n = 153), eradication was achieved in 81.3% (39/48) of patients receiving PAC, 66.0% (35/53) of PCM recipients, and 48.1 % (25/52) of those receiving PAM (p = 0.13 for PAC vs PCM and 0.001 for PAC vs PAM). In the intention-to-treat population, respective eradication rates were 76.5 (39/51), 63.6 (35/55) and 47.2% (25/53) [p = 0.22 for PAC vs PCM and 0.004 for PAC vs PAM]. Patient compliance was very good in all treatment groups. The main adverse event affecting 40% of all patients was a metallic taste, assessed as likely related to the antibiotics. Susceptibility to the three study antibiotics was determined for H. pylori isolates using the pretreatment biopsies from 103 patients. Resistance to metronidazole was present in 68.2% of patients and to clarithromycin in 24.3%. In 16.8% of patients, H. pylori isolates were resistant to both metronidazole and clarithromycin. In patient populations with H. pylori strains resistant to one or both of the antibiotics used in the respective treatment regimen, eradication rates were consistently lower than in those with susceptible H. pylori strains. However, these differences were not statistically significant, probably due to the small sample size. CONCLUSIONS: The 7-day H. pylori eradication regimen with PAC was superior to PCM and PAM. This is probably due to the high resistance rate to metronidazole in the Mexican population. Thus, H. pylori eradication regimens that involve metronidazole cannot be recommended for Mexican patients. RESULTS from this study highlight the regional differences in efficacy of some well established H. pylori eradication regimens, and suggest that culture and susceptibility testing to define H. pylori resistance patterns in specific geographical areas may be indicated before recommending any particular eradication schedule.

Increasing multidrug resistance in Helicobacter pylori strains isolated from children and adults in Mexico.

The susceptibilities to three antimicrobials of 195 Helicobacter pylori strains isolated from Mexican patients is reported; 80% of the strains were resistant to metronidazole, 24% were resistant to clarithromycin, and 18% presented a transient resistance to amoxicillin. Resistance to two or more antimicrobials increased significantly from 1995 to 1997.

Liver adenoma and focal nodular hyperplasia associated with oral contraceptives.

We report the case of a woman, with a 15-year history of high-dosage oral contraceptive use, who came to our center for a gynecological screening. Elevated liver enzymes were detected in blood samples and an abdominal ultrasound showed a hypoechogenic nodular image of 8 cm in the right hepatic lobe of the liver. Routine examinations, including hepatitis B surface antigen, hepatitis C viral antibody and alpha-fetoprotein, were all negative. Imaging studies, including computerized tomography scan, magnetic resonance imaging, sulfur colloid gammagraphy and hepatic angiography, were performed and confirmed the presence of the lesion, detecting the characteristic central scar structure of focal nodular hyperplasia. Discontinuation of oral contraceptives and follow-up showed no change in lesion size so that a surgical approach was adopted in order to remove the hepatocellular carcinoma. Pathological findings confirmed focal nodular hyperplasia.

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)