ABSTRACT
INTRODUCTION: Perinatal asphyxia is a potential cause of brain injury that can produce some alterations on the neurologic development of the newborn. On the last years most part of the investigation have been focused on the physiopathology of the perinatal asphyxia, but correlation between asphyxia and brain damage is not well defined. PATIENTS AND METHODS: A retrospective study was made of the patients with the diagnosis of perinatal asphyxia born at the General Hospital of Segovia during a period of ten years (1992-2001). We took data about gestation, birth, neonatal period and follow-up period from their clinical histories. RESULTS: Over this period of ten years 703 cases of perinatal asphyxia have been diagnosed, supposing this an incidence of 7,2 cases of each 100 newborns. 116 of these newborns present risk factors of brain damage and were followed at least two years. 53 of the 116 newborns (45%) present evidence of hypoxic-ischemic encephalopathy on neonatal period. During the period of two years, 42 of the asphyxiated infants follow up (36%) present neurologic sequelae, being psychomotor retardation the most common. CONCLUSION: For a correct interpretation of the relationship between perinatal asphyxia and neurologic sequelae we have to analyze all of the perinatal data and discard any other possible aetiology or pathogenic mechanism.
Subject(s)
Asphyxia Neonatorum , Brain Damage, Chronic , Nervous System Diseases , Apgar Score , Asphyxia Neonatorum/complications , Asphyxia Neonatorum/diagnosis , Asphyxia Neonatorum/physiopathology , Brain Damage, Chronic/etiology , Brain Damage, Chronic/physiopathology , Female , Follow-Up Studies , Humans , Infant, Newborn , Nervous System Diseases/etiology , Nervous System Diseases/physiopathology , Pregnancy , Retrospective Studies , Risk Factors , Spain , Statistics as TopicABSTRACT
Objetivos. Evaluar el impacto asistencial de las técnicas oncoplásticas conservadoras en un programa quirúrgico de mujeres con cáncer de mama. Pacientes y método. El grupo a estudio lo constituyeron enfermas sometidas a una técnica oncoplástica conservadora mientras que el grupo control lo formaron mujeres intervenidas con técnicas conservadoras (tumorectomía/cuadrantectomía) y radicales (mastectomía). Los criterios de inclusión para una técnica oncoplástica comprendieron mujeres con tumores de diámetro inferior a 3 cm, tumores T2 tratados con quimioterapia neoadyuvante y reducidos a un tamaño menor de 3 cm, en estadios clínicos axilares N0-N1a-b y procesos multifocales (infiltrante y/o in situ). Se excluyó del estudio a las mujeres con tumores T3-4, imposibilidad para la radioterapia postoperatoria, volumen mamario reducido e imposibilidad de márgenes libres de enfermedad durante el estudio intraoperatorio. Resultados. Durante el período se intervino a 160 mujeres en las que se practicaron 50 técnicas oncoplásticas (29 para evitar una mastectomía y 21 para mejorar el resultado de la técnica conservadora), 57 técnicas conservadoras y 53 mastectomías. Las técnicas utilizadas para la remodelación mamaria fueron la mamoplastia horizontal (23 casos), la mamoplastia vertical de pedículo superior (10 casos), la mamoplastia vertical de pedículo inferior (10 casos), la mamoplastia de rotación (4 casos) y la mamoplastia lateral (3 casos). El grupo de técnicas oncoplásticas presentó un tiempo medio de intervención (131 min) superior a las técnicas conservadoras (56 min) y radicales (93 min). La incidencia de complicaciones postoperatorias fue mayor en las técnicas radicales (35%), fundamentalmente por seromas axilares tras linfadenectomía, respecto a las técnicas conservadoras (25%) y oncoplásticas (24%). Conclusiones. Las técnicas oncoplásticas constituyen una alternativa eficaz y eficiente a las técnicas quirúrgicas convencionales en la mujer con cáncer de mama (AU)
Objectives. To evaluate the impact of conservative oncoplastic techniques in a surgery program for women with breast cancer. Patients and method. The study group was composed of women who underwent a conservative oncoplastic technique and the control group consisted of women who underwent conservative (tumorectomy/quadrantectomy) and radical (mastectomy) techniques. Women with tumors smaller than 3 cm, axillary clinical stages N0-N1a-b and multifocal processes (infiltrating and/or in situ) were eligible for inclusion. Women with T3-4 tumors and reduced breast volume, and those in whom postoperative radiotherapy and disease-free margins during intraoperative study were not feasible were excluded. Results. One hundred sixty women underwent surgery during the study period. Fifty oncoplastic techniques (29 to avoid mastectomy and 21 to improve the result of a conservative technique), 57 conservative techniques and 53 mastectomies were performed. The techniques used for breast reconstruction were superior mammoplasty with transversal scar (23 patients), mammoplasty with superior pedicle (10 patients), mammoplasty with inferior pedicle (10 patients), J-shapped mammoplasty (four patients) and oblique mammoplasty (three patients). The mean operating time in the group undergoing oncoplastic techniques (131 minutes) was higher than that in the group undergoing conservative (56 minutes) and radical (93 minutes) techniques. The incidence of postoperative complications was higher with radical techniques (35%), mainly due to axillary seromas after lymphadenectomy, than with conservative (25%) and oncoplastic (24%) techniques. Conclusions. Oncoplastic techniques are an effective and efficient alternative to conventional surgical techniques in women with breast cancer (AU)
