Common Arterial Trunk in Fetal Life: Accuracy of Diagnosis and Prediction of Outcome.

INTRODUCTION: Common arterial trunk (CAT) is a congenital heart disease with significant perinatal mortality in which diagnostic agreement remains low. METHODS: We conducted a retrospective cohort study on fetuses with suspected CAT. Diagnostic accuracy was tested considering gold-standard postnatal ultrasound or necropsy. Prenatal sonographic markers were evaluated by logistic regression for perinatal survival. RESULTS: There were 79 fetuses with suspected CAT, and 55 cases had available necropsy/postnatal ultrasound confirming the study population. The diagnostic accuracy was 90.9% for CAT and 83.6% at a subtype level. In those with a confirmed diagnosis and intention-to-treat (n = 28) composite early mortality (intrauterine, presurgical, and early surgery) was of 25%, 10.5% in isolated cases. The OR for early-mortality of isolated cases was 0.13 (95% confidence interval [CI]: 0.03-0.75). After adjusting for isolated cases, the only prognostic prenatal markers of perinatal mortality were a dysplastic truncal valve OR 7.78 (95% CI: 1.23-49.13) and a stenotic flow OR 8.48 (95% CI: 1.40-51.10). CONCLUSION: CAT is a condition that if evaluated by experts, can be diagnosed with a high degree of accuracy. It remains an entity with high perinatal mortality. Its most important prognostic factor is its association with other anomalies. In isolated cases, the presence of a dysplastic truncal valve and a stenotic flow increase the chances of perinatal death.

Seroprevalence analysis of SARS-CoV-2 in pregnant women along the first pandemic outbreak and perinatal outcome.

OBJECTIVES: To evaluate the progression of the seroprevalence of SARS-CoV-2 in the pregnant population of the south of Madrid during the first wave of the COVID-19 pandemic. Secondarily we aimed to evaluate maternal and perinatal outcomes. STUDY DESIGN: Retrospective cohort study conducted at Hospital Universitario 12 de Octubre during weeks 10 to 19 of 2020, coinciding with the Spanish lockdown. We tested 769 serum samples obtained from routine serological testing during the first and third trimesters of pregnancy for specific IgG anti SARS-CoV-2 RBD and S proteins. RT-PCR tests were performed in suspected cases according to clinical practice. We compared maternal and perinatal outcomes in those with delivered pregnancies (n = 578) according to the presence or absence of specific IgG antibodies. Those with positive IgG were subdivided by the presence or absence of Covid-19 related symptoms at any time and the results of RT-PCR testing if performed. Therefore, we had 4 study groups: G1 (IgG negative), G2 (IgG positive, asymptomatic, RT-PCR testing negative or not done), G3 (IgG positive, symptomatic, RT-PCR testing negative or not done), and G4 (IgG positive, symptomatic, RT-PCR positive). RESULTS: Seropositivity increased from 0% to 21.4% (95% CI 11.8-31.0) during the study period, of which 27.9% had an asymptomatic course. Overall outcomes were favorable with a significant increased rate of preterm birth in G4 vs G1 (21.4% vs 6.7%) and cesarean/operative delivery (50% vs 26.9%). Asymptomatic and mild cases did not have differences regarding pregnancy course when compared to seronegative women. There were no documented cases of vertical or horizontal transmission. CONCLUSION: Seroprevalence in pregnant women in southern Madrid went up to 21.4% of which 27.9% had an asymptomatic course. Overall perinatal results were favorable, especially in those asymptomatic.

Encefalitis autoinmune y teratoma ovárico. Reto diagnóstico y terapéutico / Autoinmune encephalitis and ovarian teratoma. Diagnostic and therapeutic challenge

Introducción: la encefalitis por anticuerpos contra el receptor N-metil D-aspartato suele desarrollarse como un síndrome característico de evolución multifásica y diagnóstico diferencial amplio. Este tipo de encefalitis puede estar asociada a un tumor, y por lo tanto, ser considerada un síndrome paraneoplásico, con afectación predominante en mujeres y siendo el teratoma de ovario el tumor más frecuentemente involucrado. Caso clínico: paciente de 35 años con un cuadro neuropsiquiátrico prominente con diagnóstico final de encefalitis límbica por anticuerpos anti N-metil D-aspartato secundario a teratoma ovárico, con remisión total del cuadro después del tratamiento multimodal. Conclusión: este tipo de patología representa un verdadero reto diagnóstico-terapéutico. Es importante conocer la epidemiología de esta enfermedad con objeto de evitar demoras en el diagnóstico y en el potencial tratamiento curativo

Introduction: Encephalitis by antibodies against the N-methyl-D-aspartate receptor receptor usually represents a characteristic syndrome of multiphasic evolution and wide differential diagnosis. This type of encephalitis can be associated with a tumor, and therefore be considered a paraneoplastic syndrome, with predominant involvement in women and being the ovarian teratoma the most frequently implicated tumor. Clinical case: A 35-year-old patient with a prominent neuropsychiatric disorder with a final diagnosis of limbic encephalitis due to anti-N-methyl-D-aspartate receptor antibodies secondary to ovarian teratoma, with complete remission of the symptoms after multimodal treatment. Conclusion: This type of pathology represents a diagnostic-therapeutic challenge. It is important to know the epidemiology of this disease in order to avoid delays in the diagnosis and potential curative treatment

Tratamiento del carcinoma de cuerpo uterino mediante laparoscopia asistida por robot: nuestros primeros resultados / Treatment of corpus uteri carcinoma through robot-assisted laparoscopy: Our preliminary results

Objetivo. Presentación de nuestra experiencia desde octubre del 2009 hasta diciembre del 2011 y comparación de los resultados y las complicaciones con el amplio estudio publicado en el American Journal of Obstetrics and Gynecology (AJOG) en 2011. Material y métodos. Estudio prospectivo de nuestros primeros 55 carcinomas de cuerpo uterino: 50 adenocarcinomas endometrioides, 2 adenocarcinomas seroso-papilares de endometrio y 3 tumores müllerianos mixtos (TMM), tratados mediante laparoscopia asistida por robot (da Vinci) en el Hospital Universitario de Basurto desde octubre del 2009 hasta diciembre del 2011. Las variables analizadas han sido: edad, índice de masa corporal (IMC), tipos histológicos, estadios, tipos de tratamientos, medias del tiempo quirúrgico, media del número de ganglios obtenidos y número y porcentaje de ganglios invadidos, sangrado operatorio y conversiones a laparotomía. Así mismo, se han analizado el número y el porcentaje de las complicaciones intraoperatorias, postoperatorias y totales. Resultados. Media de ganglios pélvicos: 14,44 vs. 13,16. Tiempo operatorio: 181,1/286,5 min vs. 196,33 min. Conversión a laparotomía: 5,45% vs. 2,9%. Complicaciones totales: 16,36% vs. 6,4%. Conclusiones. 1) El número de ganglios pélvicos obtenidos y el tiempo operatorio son similares a los publicados en el estudio del AJOG; 2) la conversión a laparotomía y el porcentaje de complicaciones totales son superiores a los referidos en el estudio del AJOG, quizás debido al menor número de casos y a la menor experiencia (curva de aprendizaje); 3) la laparoscopia asistida por robot es una vía adecuada y con gran futuro en el tratamiento y la estadificación de los carcinomas de cuerpo uterino(AU)

Objective. To present our experience from October 2009 though December 2011 and to compare outcomes and complications with a large study published in the American Journal of Obstetrics and Gynecology (AJOG) in 2011. Material and methods. We performed a prospective study of our first 55 corpus uteri carcinomas: 50 endometrioid adenocarcinomas, two papillary serous carcinomas and three Müllerian adenosarcomas, treated with robot-assisted laparoscopy (da Vinci) in the Basurto University Hospital from October 2009 through December 2011. The variables analyzed were age, body mass index, histologic type, stages, treatment, mean operating time, mean of number of lymph nodes retrieved, the mean number and percentage of involved lymph nodes, surgical bleeding and conversion to laparotomy. We also analyzed the number and the percentage of operative, post-operative and total complications. Results. The mean number of pelvic nodes was 14.44 vs. 13.16. Operating time was 181.1/286.5minutes vs 196.33minutes. Conversion to laparotomy was 5.45% vs. 2.9%. The percentage of total complications was 16.36% vs. 6.4%. Conclusions. 1) The number of pelvic nodes retrieved and the operating time were similar to those reported by the AJOG study. 2) Conversion to laparotomy and the percentage of total complications were higher than those reported in the AJOG study, possibly due to the smaller number of cases and the lesser experience (learning curve). 3) Robot-assisted laparoscopy is a viable approach with an excellent future in the treatment and staging of corpus uteri carcinomas(AU)

Úlcera genital aguda en adolescentes. Úlcera de Lipschütz / Acute genital ulcer in adolescents. Lipschütz ulcer

La aparición de úlceras genitales en niñas y mujeres jóvenes, de aparente origen no venéreo, es una entidad infrecuente, descrita ya a principios del siglo pasado, conocida como úlcera vulvar aguda o de Lipschütz. Es una entidad de incidencia baja, por lo que es poco conocida y genera confusión cuando se presenta. La falta de una etiología clara y su presentación en una población a caballo entre la población pediátrica y mujeres jóvenes aumentan esta confusión. Detallamos un caso a continuación (AU)

The development of genital ulcers, of apparently non-venereal origin, in adolescents and young girls is a rare entity known as acute genital ulcer or Lipschütz ulcer. Because of their low incidence, these ulcers are little known and can cause confusion when they occur. This confusion is increased by the lack of a clear cause and the occurrence of these ulcers in an age group that falls between the pediatric and young adult populations. We describe a case of Lipschütz ulcer treated in our hospital (AU)

Hipertensión arterial y anovulatorios transdérmicos / Hypertension and the transdermal contraceptive patch

Entre las complicaciones de la anticoncepción hormonal destacan las cardiovasculares (doble riesgo de accidente cerebrovascular e infarto isquémico, y riesgo cuatro veces mayor de presentar complicaciones tromboembólicas). A pesar de que la aparición de hipertensión arterial (HTA) es poco frecuente, se han descrito casos de HTA acelerada acompañada de daño renal. Este efecto adverso se ha documentado en relación con los anticonceptivos orales y no se han encontrado en la literatura científica referencias al uso de anticonceptivos transdérmicos pese a la diferencia en su farmacodinamia. Presentamos el caso clínico de una paciente de 22 años que desarrolló HTA maligna con fallo renal tras sustituir anticonceptivos orales por vía transdérmica y que cedió al detener el tratamiento. Son necesarios más estudios para aclarar esta posible relación, pero este hecho aislado remarca la importancia de la recomendación sobre la toma de presión arterial como parámetro de control clínico de las usuarias de anticoncepción hormonal (AU)

Cardiovascular complications are one of the risks of hormonal contraception use (a two-fold risk of stroke and ischemic infarct and a four-fold risk of thromboembolic complications). Although the development of hypertension is infrequent, cases of accelerated hypertension accompanied by renal failure have been described. This adverse effect has been reported in relation to oral contraceptives but there are no references in the literature to the use of transdermal contraceptives, despite differences in the pharmacodynamics between the two routes of administration. We report the case of a 22-year-old woman who developed malignant hypertension with renal failure after replacing oral contraceptives for the transdermal patch. The hypertension resolved after discontinuing transdermal contraceptive use. Further studies are required to clarify this possible association but this isolated case highlights the importance of blood pressure measurement in the monitoring of hormonal contraception users (AU)