Evaluation of Burn Wound Infection in a Referral Center in Colombia.

Introduction Burn wound infection (BWI) is the second most important cause of death in burn patients. There is currently limited data about the incidence and clinical presentation of BWI using quantitative techniques as quantitative biopsy culture (QBC) to prevent progress to burn wound sepsis (BWS). Methods This is a prospective cohort study of patients diagnosed with BWI, confirmed by QBC, from February 2018 to July 2019 at University Hospital of Santander (HUS). The primary outcome was to determine clinical, microbiological, and histopathological characteristics of patients diagnosed with BWI along with a positive QBC and their relationship with early diagnosis and progression to BWS. Results 525 patients were admitted to HUS Burn Center. Of those, 44/525 (8.23%) presented a clinical diagnosis of BWI (median age, 20.5 years [1-67 years]; 25/44 [56.8%] male). QBC was positive in 26/44 (59%), Staphylococcus aureus 14/44 (31.8%), and Pseudomonas aeruginosa 7/44 (15.9%) were the mainly etiological agents isolated. Bacterial resistance to antibiotics was mostly to beta-lactams in 14/44 (31.8%), corresponding to methicillin-resistant Staphylococcus aureus (MRSA). Clinical signs more related to infection were erythema in 33/44 (61.3%). As many as 10/44 (22.7%) progressed to sepsis and 2/44 (6%) died. Conclusion BWI increases hospitalization time and number of surgeries, increasing the risk of sepsis and death. The QBC allows an accurate diagnosis with lesser false-positive cases that impact antibiotic resistance and mortality. Protocols targeting this problem are needed to decrease the impact of this.

Lead exposure in dogs fed game meat and offal from culled invasive species in El Palmar National Park, Argentina.

This is the first field study to evaluate lead exposure in dogs fed game meat and offal and, to our knowledge, the first study exploring associations between game consumption and dog health status. We quantified lead concentrations in blood and hair and haematological parameters of 31 dogs fed game meat and offal from wild boar (Sus scrofa) and axis deer (Axis axis) culled with lead ammunition in El Palmar National Park, Argentina. Despite variable weekly frequency in game consumption, dogs had detectable blood and hair lead levels, demonstrating recent and chronic exposure. Lead geometric mean and SD were 18.91 ± 346.85 µg/dL w.w. in blood (range = 0.53-216.58), and 0.721 ± 6.444 µg/gr d.w. in hair (range = 0.007-34.800). Hair lead levels were relatively low in most samples, except for the oldest dog which had an atypically high value concurrent with anaemia, a common outcome of chronic lead exposure. Dog's owner was significantly predictive of both blood and hair lead levels, which reflects the same feeding patterns for all dogs owned by the same person. Body condition was associated with hair lead, with dogs in good condition presenting higher lead levels. This could be related to greater game consumption by those dogs, resulting in higher lead ingestion. Dogs fed game meat and offal at very low or low frequency (≤4 times per week) showed higher blood lead levels, suggesting there might not be a risk-free frequency for game provision to dogs. Considering the risks of dietary lead exposure, avoiding feeding dogs lead-killed game and replacing lead ammunition with non-toxic alternatives are recommended. This would allow using hunted game as a valuable food resource without unnecessary risk for the health of consumers and the environment.

Lead exposure in consumers of culled invasive alien mammals in El Palmar National Park, Argentina.

Consumption of meat from animals hunted with Pb ammunition can cause toxic accumulation with consequent health risks, even if relatively small amounts are consumed in each exposure. In El Palmar National Park, Argentina, invasive alien mammals, wild boar (Sus scrofa) and axis deer (Axis axis), are culled with Pb ammunition and their meat is consumed. In this study, we evaluated blood Pb concentrations in 58 consumers of culled game and examined Pb exposure risk according to their demographics, duty, and consumption habits. Likewise, the likelihood of exposure was evaluated by quantifying Pb concentrations in meat samples of seven culled axis deer. Twenty-seven participants (46%) had detectable blood Pb levels (limit of detection = 3.3 µg/dL), with an average 4.75 ± 1.35 µg/dL (geometric mean ± geometric S.D.); the average for all participants was 3.25 ± 1.51 µg/dL. Blood Pb concentrations were significantly higher in hunters, in participants who reported consuming game meat more than 5 times per week, and in participants who reported frequently consuming cured game meat (compared to cooked or pickled). Pb concentration varied significantly along the trajectory of the bullet in deer muscle, being highest at mid-point but with detectable Pb levels even in distant tissue samples (control), suggesting potential for dietary intake by consumers. These findings provide evidence of Pb exposure risk in consumers and emphasize the relevance of replacing Pb ammunition with non-toxic alternatives. This change would reduce dietary exposure in frequent consumers and allow the use of game meat as safe food for people whilst eliminating collateral risks to wild animals and the environment.

Single Uterine Access for Bilateral Pleuroamniotic Shunting in Fetuses with Severe Hydrothorax by an Internal Rotational Maneuver: Feasibility and Outcomes between Successful and Failed Procedures.

OBJECTIVE: The objective of this study was to describe the feasibility of single percutaneous uterine access for bilateral pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax by using an internal rotational maneuver and to compare perinatal outcomes between successful and failed procedures. METHODS: A prospective cohort of 25 fetuses with isolated bilateral hydrothorax and hydrops were referred to our fetal surgery center in Queretaro, Mexico during an 8-year period. Bilateral PAS was first attempted through a percutaneous single uterine access by internal rotation of the fetus, which was achieved by using the blunt tip of the same cannula, and in case of a failed procedure, a second uterine port was used to place the second shunt. The perinatal outcomes between successful (single uterine port) and failed (2 uterine ports) fetal procedures were compared. RESULTS: Placing of bilateral shunts through a percutaneous single uterine access was feasible in 15/25 (60%) cases. Overall, median GA at delivery was 35.2 weeks with a survival rate of 64.0% (16/25). Three cases were excluded due to shunt dislodgement, leaving a final population of 22 fetuses; 13/22 (59.1%) and 9/22 (40.9%) managed using 1 and 2 uterine ports, respectively. The group with bilateral PAS placement through a successful single uterine port showed a significantly higher GA at birth (36.5 vs. 32.8 weeks, p = 0.001), lower surgical time (11.0 vs. 19.0 min, p = 0.01), longer interval between fetal intervention and delivery (5.7 vs. 2.7 weeks, p = 0.01), lower risk of preterm delivery (46.2 vs. 100%, p < 0.01), and lower rate of perinatal death (15.4 vs. 55.6%, p < 0.05) than the failed procedures requiring 2 uterine ports. CONCLUSION: In fetuses with severe bilateral hydrothorax and hydrops, bilateral pleuroamniotic shunting through a successful single percutaneous uterine access is feasible in up to 60% of cases and is associated with better perinatal outcomes.

Manejo in útero de teratoma sacrocoxigeo y resección postnatal / In utero management of sacrocoxygeal teratoma and postnatal resection

Describimos un caso de teratoma sacro-coxígeo gigante diagnosticado a las 21 semanas de gestación. Debido a los signos de robo vascular y de insuficiencia cardíaca fetal a las 24 semanas de gestación, se planteó la esclerosis del vaso nutricio por medio de laser Diodo. El procedimiento se realizó mediante punción percutánea guiada por ecografía en tres oportunidades, a las 25 semanas, a las 27 y a las 30 semanas. No hubo efecto secundario inmediato post tratamiento. La desvascularización fue parcial, debido a la híper-vascularización periférica de la masa. Los signos de insuficiencia cardíaca fetal se normalizaron después de 1 semana con disminución de crecimiento del tumor. El parto se realizó por cesárea a las 34 semanas, por rotura prematura de membranas y trabajo de parto avanzado en presentación pelviana. Tras 6 horas posteriores a su nacimiento se realizó cirugía de exceresis tumoral por técnica convencional, donde se extirpó por completo el teratoma sacrocoxígeo con un peso total de 630 gramos, material que se envió a anatomía patológica, cuyo diagnóstico final fue teratoma inmaduro grado III. Conclusión: La cirugía mínimamente invasiva con esclerosis del vaso nutricio parece mejorar el resultado perinatal en casos de teratoma sacro-coxígeo (TSC) fetal de alto riesgo. La identificación y el tratamiento temprano nos pueden dar resultado exitoso

We describe a case of giant sacrococcygeal teratoma (SCT) diagnosed at 21 weeks of gestation. Due to the signs of vascular steal and fetal heart failure at 24 weeks of gestation, sclerosis of the nutrient vessel was proposed by a laser diode. The procedure was performed by percutaneous puncture guided by ultrasound on three occasions, at 25 weeks, at 27 and at 30 weeks. There was no immediate side effect after treatment. The devascularization was partial, due to the peripheral hypervascularization of the mass. Signs of fetal heart failure normalized after 1 week with decreased tumor growth. Delivery was performed by cesarean at 34 weeks, due to premature rupture of the membranes and advanced labor in pelvic presentation. Six hours after birth, tumor excision was performed using a conventional technique, in which SCT with a total weight of 630 grs was completely removed, material that was sent to the pathological anatomy. Final diagnosis was immature teratoma grade III. Conclusions: Minimally invasive surgery with sclerosis of the nutrient vessel seems to improve the perinatal outcome in cases of high-risk fetal SCT. Identification and early treatment can give us a successful outcome

Diagnóstico de madurez pulmonar fetal por velocimetria doppler / Diagnosis of fetal pulmonary maturity by doppler flow assessment

Objetivo: Establecer la relación entre la edad gestacional y la velocidad máxima del ductus arterioso (VmxDA), y determinar si es posible predecir la madurez pulmonar fetal con flujometría Doppler de la VmxDA. Diseño del estudio: Se realizó un estudio de cohortes, prospectivo, con muestreo no probabilístico donde se tomó como población a pacientes sanos que cumplan los criterios de inclusión. Se valoró la velocidad máxima del ductus arterioso. Se estimaron los valores paramétricos y se evaluó el coeficiente regresión y correlación, sensibilidad y especificidad, con la edad gestacional. Se utilizó un intervalo de confianza del 95%, se obtuvo las diferentes velocidades máximas del ductus arterioso según edad gestacional, y su respectivo error estándar junto con sus desviaciones estándar y se correlacionaron con la edad gestacional, para determinar la posibilidad de predecir la madurez pulmonar por flujometría Doppler. Resultados: Se evaluó un total de 824 pacientes donde se evidenció un aumento de la velocidad máxima del ductus arterioso a medida que avanza la edad gestacional. Se encontró dos puntos de inflexión en la curva de la VmxDA a las 28 semanas y a las 35 semanas. Se obtuvo un coeficiente de correlación de 0.97 con un nivel de probabilidad menor de 0.0001. Los valores de sensibilidad y especificidad para predecir madurez pulmonar fueron de 83.9% y 100% para 95 cm/s y 91.5% y 100% para 98 cm/s, con un VPP del 0.709 y un VPN del 1.0. La variabilidad interobservador fue menor de 5%para la VmxDA. Conclusiones: Existe una relación directa entre la edad gestacional y la velocidad máxima del ductus arterioso, pudiendo ser utilizado como un buen predictor de madurez pulmonar fetal.

Objective: To establish the relationship between the gestational age and the maximum velocity of the ductus arteriosus (VmxDA), and to determine if it is possible to predict the fetal lung maturity with Doppler flow assessment of the VmxDA. Study design: A prospective, cohort study was conducted with non-probabilistic sampling where healthy patients who met the inclusion criteria were taken as a population. The maximum velocity of the ductus arteriosus was evaluated. Parametric values were estimated and the coefficient of regression and correlation, sensitivity and specificity was evaluated with gestational age. A 95% confidence interval was used, the different maximum ductus arteriosus velocities were obtained according to gestational age, and their respective standard error along with their standard deviations and they were correlated with gestational age, to determine the possibility of predicting lung maturity by flow assessment of the VmxDA. Results: 824 patients were evaluated where it was evidenced an increase in the maximum velocity of the ductus arteriosus was observed as gestational age progressed. Two inflection points were found in the VmxDA curve at 28 weeks and at 35 weeks. A correlation coefficient of 0.97 was obtained with a probability level of less than 0.0001. The values of sensitivity and specificity to predict lung maturity were 83.9% and 100% for 95 cm / s and 91.5% and 100% for 98 cm / s, with a PPV of 0.709 and a NPV of 1.0. The interobserver variability was less than 5% for the VmxDA. Conclusions: There is a direct relationship between gestational age and the maximum velocity of the ductus arteriosus, which can be used as a good predictor of fetal lung maturity

Polidocanol versus alcohol absoluto como sustancias esclerosantes en modelo experimental animal / Polidocanol versus absolute alcohol as sclerosing substances in experimental animal model

Introducción: La esclerosis se caracteriza por la destrucción celular epitelial con apoptosis, inflamación estéril, fibrosis irreversible y disminución de la masa tisular por retracción con subsecuente obliteración de la luz de los quistes y/o vasos sanguíneos. Existen diferentes sustancias esclerosantes que pueden ser utilizados. Aun así, actualmente no se han definido pautas claras en el manejo con sustancias esclerosantes. Esto puede considerarse como un tratamiento poco invasivo y efectivo. Objetivo: Determinar la eficacia y seguridad del polidocanol versus alcohol absoluto como sustancias esclerosantes en modelo experimental animal. Materiales y Métodos: El estudio se realizó con 34 ratas, distribuidas en forma aleatoria en 3 grupos. Grupo A con 16 ratas a las cuales se les introdujo 1 ml de polidocanol intravesical. Grupo B con 16 ratas a las que se les introdujo 1 ml de alcohol absoluto intravesical. Grupo C (control) con 2 ratas sin intervención. Las 2 ratas del grupo control fueron sacrificadas con sobredosis de halotano. Igualmente las ratas de cada grupo experimental, que fueron sacrificadas en pares, escogidos al azar, a las 12, 24, 48, 72, 96 y 120 horas post aplicación respectivamente. Luego se realizó el estudio anatomopatológico. Se verificó la profundidad y extensión de la esclerosis y se adjudicó puntaje según escala numérica previamente diseñada. Se determinó y comparó la eficacia y seguridad de ambas sustancias dependiendo de la extensión y profundidad de la esclerosis según el tiempo de acción con regresión logística y test exacto de Fisher. Resultados: Ambas sustancias mostraron similar efectividad al producir esclerosis con retracción de la pared vesical en 100% de los casos después de 24 horas de aplicación. El polidocanol mostró acción biológica progresiva encontrándose correlación entre el tiempo de acción y la profundidad de la esclerosis mediante el análisis de regresión logística con coeficiente de correlación de 0.75 e índice de probabilidad: 0.00183 (p < 0.05). El alcohol absoluto produjo esclerosis profunda inmediata, sin correlación con el tiempo de acción, con coeficiente de correlación de - 0.0465 con un índice de probabilidad de 0.864 (p > 0.05). Se estimó la seguridad de las sustancias según el hallazgo de esclerosis transmural y lesión de órganos vecinos. En ningún caso con polidocanol (0%) hubo paso transmural ni lesión de órganos vecinos mientras que en 83,33% de los casos del alcohol absoluto se presentó esclerosis transmural con lesión de órganos adyacentes en 50% de los casos (Test de Fisher's p < 0.0001 extremadamente significativo). Ninguna de las 2 sustancias produjo lesiones de órganos a distancia. Conclusiones: Tanto el alcohol como el polidocanol son efectivos para generar esclerosis. La esclerosis con polidocanol impresiona ser segura por quedar limitada a la vejiga. La escleroterapia con alcohol no parece ser segura porque genera esclerosis transmural y lesión de órganos contiguos. La diseminación de las sustancias a través de vasos sanguíneos o linfáticos con lesiones de órganos distantes no ocurrió en ningún caso y parece improbable ya que los esclerosantes producen la oclusión de estos vasos.

Introduction: Sclerosis is characterized by epithelial cell destruction with apoptosis, sterile inflammation, irreversible fibrosis and decreased tissue mass by retraction with subsequent obliteration of the lumen of the cysts and / or blood vessels. There are different sclerosing substances that can be used. Even so, clear guidelines have not yet been defined in the management of sclerosing substances. This can be considered as a minimally invasive and effective treatment. Objective: To determine the efficacy and safety of polidocanol versus absolute alcohol as sclerosing substances in an experimental model. Materials and Methods: The study was conducted with 34 rats, randomly distributed in 3 groups. Group A with 16 rats to which 1 ml of intravesical polidocanol was introduced. Group B with 16 rats to which 1 ml of intravesical absolute alcohol was introduced. Group C (control) with 2 rats without intervention. The 2 rats of the control group were sacrificed with halothane overdose. Also the rats of each experimental group, which were sacrificed in pairs, chosen at random, at 12, 24, 48, 72, 96 and 120 hours after application respectively. Then the anatomopathological study was carried out. The depth and extension of the sclerosis was verified and a score was awarded according to a previously designed numerical scale. The efficacy and safety of both substances were determined and compared depending on the extension and depth of the sclerosis according to the time of action with logistic regression and Fisher's exact test. Results: Both substances showed similar effectiveness in producing sclerosis with retraction of the bladder wall in 100% of the cases after 24 hours of application. The polidocanol showed progressive biological action, finding a correlation between the time of action and the depth of the sclerosis by means of the logistic regression analysis with a correlation coefficient of 0.75 and a probability index of 0.00183 (p <0.05). Absolute alcohol produced immediate deep sclerosis, without correlation with the time of action, with a correlation coefficient of - 0.0465 with a probability index of 0.864 (p> 0.05). The safety of the substances was estimated according to the finding of transmural sclerosis and injury to close organs. In no case with polidocanol (0%) there was transmural passage or injury of close organs, while in 83.33% of cases of absolute alcohol, transmural sclerosis with lesion of adjacent organs occurred in 50% of the cases (Fisher's Test p <0.0001 extremely significant). None of the 2 substances produced remote organ injuries. Conclusions: Both alcohol and polidocanol are effective in generating sclerosis. Sclerosis with polidocanol is safe because it is limited to the bladder. Sclerotherapy with alcohol does not appear to be safe because it generates transmural sclerosis and injury to contiguous organs. The dissemination of the substances through blood or lymphatic vessels with lesions of distant organs did not occur in any case and seems unlikely since the sclerosants produce the occlusion of these vessels

Inter-twin placental anastomoses not crossing the dividing membrane: laser photocoagulation of communicating vessels in the twin-to-twin transfusion syndrome / Anastomosis placentarias intergemelares que no cruzan la membrana divisoria: fotocoagulación láser de vasos comunicantes en el síndrome de transfusión intergemelar

Twin-to-twin transfusion syndrome (TTTS) is thought to result from an unbalanced exchange of blood through inter-twin vascular anastomoses. Laser photocoagulation of communicating vessels has been used to prevent the development of the syndrome. Some authors have proposed that vessels crossing the membrane are "suspicious" to participate in the development of the syndrome and the laser photocoagulation of these vessels would reverse the syndrome. We present two cases of TTTS where the communicating vessels did not cross the dividing membrane, which were successfully treated with laser.

El síndrome de transfusión intergemelar (STIG) resulta de un intercambio desbalanceado de sangre a través de anastomosis vasculares entre las circulaciones de ambos fetos en embarazos monocoriales. La fotocoagulación láser de vasos comunicantes se ha utilizado para detener el desarrollo del síndrome. Algunos autores han propuesto que los vasos que cruzan la membrana divisoria son 'sospechosos' de participar en el desarrollo del síndrome y que la fotocoagulación láser de estos es capaz de revertirlo. Presentamos dos casos de STIG tratados exitosamente con fotocoagulación láser de anastomosis intergemelares, en los cuales los vasos comunicantes no cruzaban la membrana divisoria.

Supracondylar femoral osteotomy and knee joint replacement during the same surgical procedure in a type A haemophiliac patient with knee flexion deformity and ankylosis.

BACKGROUND: Haemophilia A is the cause of diverse musculoskeletal disorders such as ankylosis, arthritis and associated angular deformity. There are few reported cases in patients with haemophilia A in which simultaneous supracondylar femoral osteotomy and knee joint replacement has been performed to treat knee angular deformity and ankylosis. Here we present the case of an 18year old male patient, with an evolution of two years, who was unable to walk due to the presence of an untreated supracondylar fracture in the left femur and ipsilateral haemophilic arthropathy which led him to develop an ankylosis in flexion close to 70°. METHODS AND RESULTS: Supracondylar osteotomy of the femur and of the left knee joint was performed in the same surgical procedure. Bleeding control was achieved with a protocol of factor VIII supply. The patient was followed up for eight years, and recovered a 0 to 90° range of motion and regained his gait pattern. CONCLUSIONS: This case potentially provides a new alternative approach for haemophilia patients presenting with angular deformities and complex ankylosis. We suggest that mixed lesions of intra- and extra-articular deformity in haemophiliac patients can be corrected during the same surgical intervention. In addition, interdisciplinary management including haematology for operative and immediately postoperative control of intra-bleeding using factor VIII supply and control, combined with a controlled rehabilitation plan, can yield good functional outcomes in patients with haemophilic arthropathy.

Percutaneous fetal sclerotherapy for congenital cystic adenomatoid malformation of the lung.

OBJECTIVES: Congenital cystic adenomatoid malformation (CCAM) is a rare lesion of the developing fetal lung consisting of increased cell proliferation in the bronchial structures with lack of differentiation of the alveoli. Pregnancies may be at an increased risk for perinatal loss with type III CCAM. The purpose of this paper is to present our experience with the management of complicated types II and III CCAM with a novel technique: percutaneous ultrasound-guided fetal sclerotherapy (FST). METHODS: Three patients were referred with type II-III CCAM. Poor prognostic factors included hydrops, severe mediastinal shift, polyhydramnios and early gestational age (<26 weeks). Patients signed an informed consent. FST was performed with percutaneous injection of Ethamolin (ethanolamine oleate) or Polidocanol (aethoxysklerol) under ultrasound guidance using a 22-gauge needle. RESULTS: Resolution of hydrops and of the mass effect was observed in all cases without any complications. All patients were delivered at term. CONCLUSIONS: Fetal sclerotherapy is a novel approach to the management of complicated type II-III CCAM. Further studies are indicated to assess the risks and benefits of this innovative technique.

Cirugía fetal en la hernia diafragmática congénita / Fetal surgery in congenital diaphragmatic hernia

La hernia diafragmática congénita, se cree es resultado de la fusión incompleta de la membrana pleuroperitoneal y el paso del contenido abdominal al interior del tórax. Realizamos una revisión de la literatura sobre la etiología y del tratamiento de esta patología

Congenital diaphragmatic hernia is believed to result from incomplete pleuroperitoneal membrane fusion and passage of abdominal contents into the chest. We carry out a literature review regarding the etiology and treatment of this pathology

Aumento de la translucencia nucal y flujo reverso del ductus venoso en cardiopatía congénita. Reporte de un caso en Caracas, Venezuela / Increased foetal nuchal translucency and reverse flow of the ductus venosus in congenital cardiopathy

Introducción: el aumento de la translucencia nucal (TN) fetal aumentada, en la gestación entre las 11 y 14 semanas, es una expresión fenotípica común de anormalidades cromosómicas, incluyendo la trisomía 21. Sin embargo, incluso en ausencia de aneuploidía, el engrosamiento nucal es un dato relevante desde el punto de vista clínico, porque se asocia con un aumento en el resultado perinatal adverso causado por una variedad de malformaciones fetales, displasias, deformaciones, disrupciones y de síndromes genéticos. Se presenta este caso con el objetivo de resaltar la importancia de la TN como marcador de patologías diferentes de las aneuploidías cuando la misma se encuentra por encima del percentil 99. Discusión: una vez descartada la aneuploidía, el riesgo del resultado perinatal adverso no disminuye de forma estadística, si este engrosamiento nucal alcanza los3,5 milímetros o más(percentil 99).Este aumento del riesgo ocurre de manera exponencial a medida que aumenta la TN. Sin embargo, si el feto sobrevive, el riesgo de presentar una cardiopatía congénita es elevado. Por lo tanto, un ultrasonido entre las 20 a 22semanas puede revelar las diferentes anormalidades cardiacas.

Residencia de Perinatología en el Hospital Universitario de Caracas (Venezuela) / Perinatology residence in the Caracas Teaching Hospital, Venezuela

La unidad de perinatología del Hospital Universitario de Caracas, fue fundada en 1975 por los doctores Freddy Guevara y Miguel Yáber; su objetivo ha sido mejorar la salud materno-fetal para la solución de los principales problemas perinatales.Dentro de sus objetivos específicos, está la formación de subespecialistas en perinatología; la residencia inicia en enero de 1989, bajo la dirección del doctor Guevara.Actualmente cuenta con una moderna planta física en el Hospital Universitario de Caracas, con tecnología de punta, convenios interinstitucionales y un equipo de profesionales altamente capacitados, continuando con la formación de perinatólogos en Venezuela y Latinoamérica, ingresando para la subespecialización cinco ginecoobstetras por año, durante un período de dos años.El perinatólogo de la unidad está capacitado para prestar servicios de salud en aspectos preventivos, médicos, quirúrgicos y de rehabilitación en sus áreas de especialización; participar en trabajos de investigación en humanos, animales y docencia universitaria

Mamoplastia: estudio realizado en el Centro de Cirugía Plástica, Santo Domingo / Mammoplasty: study done at the Plastic Surgery Center, Santo Domingo

Se realizó un estudio prospectivo en el Centro de Cirugía Plástica Santo Domingo, (CEPCI), durante el período febrero-marzo 1997, con la finalidad de determinar cual técnica quirúrgica fue la más empleada, edad de prevalencia y los resultados cosméticos tempranos tardíos. De un 58.6// fue sometido a Mamoplastia reductiva. La técnica quirúrgica más empleada fue Pedículo inferior para un 48.3//. En cuanto a el estado civil las solteras representaron un 53.46//. En cuanto a la nacionalidad las dominicanas fueron las más sometidas a esta cirugía para un 41.4//. Un 98.2// de las pacientes tuvieron resultados de buenos a excelentes. La técnica anestésica empleada en un 100// fue la peridural