Embarazos exitosos en hemodiálisis crónica: experiencia de un único centro / Pregnancy during dialysis: Experience in six patients

Background: The frequency of pregnancies during dialysis is increasing. This condition requires changes in the dialysis schedule and nutritional approach. Aim: To report the experience in six patients with terminal kidney disease who became pregnant. Material and Methods: Retrospective review of medical records of women with terminal kidney disease in dialysis who became pregnant in a period of 27 years. Results: We recorded six successful pregnancies among women in hemodialysis treatment aged 32 ± 4 years. The mean dialysis-time per week was 19.5 ± 2.7 hours and Kt/V was 1.55 ± 0.17. The mean systolic blood pressure was 130 ± 13.3 mmHg. The mean packed cell volume of the group increased from 22.7% during pre-gestational stage to 30.2% during third trimester of pregnancy. All patients received an intensive treatment for anemia. The most common symptom of pregnancy was hyperemesis. The mean gestational age (GA) at diagnosis was 13.4 ± 4.7 weeks. All patients had preterm deliveries at a GA of 33 ± 1.7 weeks, and 66% of offspring were appropriate for gestational age. Conclusions: A multidisciplinary approach allows high rate of successful pregnancies during hemodialysis.

[Pregnancy during dialysis: experience in six patients]. / Embarazos exitosos en hemodiálisis crónica: experiencia de un único centro.

BACKGROUND: The frequency of pregnancies during dialysis is increasing. This condition requires changes in the dialysis schedule and nutritional approach. AIM: To report the experience in six patients with terminal kidney disease who became pregnant. MATERIAL AND METHODS: Retrospective review of medical records of women with terminal kidney disease in dialysis who became pregnant in a period of 27 years. RESULTS: We recorded six successful pregnancies among women in hemodialysis treatment aged 32 ± 4 years. The mean dialysis-time per week was 19.5 ± 2.7 hours and Kt/V was 1.55 ± 0.17. The mean systolic blood pressure was 130 ± 13.3 mmHg. The mean packed cell volume of the group increased from 22.7% during pre-gestational stage to 30.2% during third trimester of pregnancy. All patients received an intensive treatment for anemia. The most common symptom of pregnancy was hyperemesis. The mean gestational age (GA) at diagnosis was 13.4 ± 4.7 weeks. All patients had preterm deliveries at a GA of 33 ± 1.7 weeks, and 66% of offspring were appropriate for gestational age. CONCLUSIONS: A multidisciplinary approach allows high rate of successful pregnancies during hemodialysis.

Effects of tibolone and continuous combined hormone therapy on mammographic breast density and breast histochemical markers in postmenopausal women.

OBJECTIVE: To compare changes in mammographic density and the expression of markers of proliferation (Ki67) and apoptosis (Bcl-2) after 1 year of treatment with tibolone and continuous conjugated equine estrogens combined with medroxyprogesterone acetate (CEE-MPA). DESIGN: Comparative, randomized, evaluator-blinded study. SETTING: City research hospital. PATIENT(S): Thirty-seven postmenopausal women. INTERVENTION(S): Tibolone (2.5 mg; n = 18) or continuous conjugated estrogens (0.625 mg) combined with medroxyprogesterone acetate (5 mg; n = 19) for 1 year. MAIN OUTCOME MEASURE(S): Mammographic density (BI-RADS density score), expression of immunohistochemical markers Ki67 and Bcl-2. RESULT(S): Mean breast density score decreased significantly from 2.22 to 1.67 in the tibolone group, compared with a significant increase in the CEE-MPA-treated group from 1.84 to 2.63. Ki67 expression decreased in 12 of 15, increased in 2 of 15, and remained unchanged in 1 of 15 subjects in the tibolone group, compared with 1 of 19, 15 of 19, and 3 of 19 subjects, respectively, in the CEE-MPA group. Bcl-2 expression decreased in 12 of 15, increased in 2 of 15, and remained unchanged in 1 of 15 subjects in the tibolone group, compared with 5 of 19, 9 of 19, and 5 of 19 subjects, respectively, in the CEE-MPA group. CONCLUSION(S): One-year treatment with tibolone induced a decrease in breast density, with a reduction in proliferation and a stimulation of apoptosis, whereas 1-year treatment with CEE-MPA induced an increase in breast density, with stimulation of proliferation and inhibition of apoptosis, indicating that tibolone effects on the breast are different from those of CEE-MPA.

El Doppler en el diagnóstico de malignidad ovárica / Doppler in ovaric pathology diagnosis

Se presentan 4 pacientes portadoras de tumores ováricos, 2 de ellos benignos (teratoma y endometrioma) y 2 malignos (IIc y metastásico). Mediante Doppler pulsado se estudian las curvas de velocidad de los flujos arteriales tumorales, encontrándose que los tumores benignos tienen curvas de alta resistencia y los malignos de baja resistencia

Procesos expansivos intraselares secretores de prolactina y no secretores: experiencia clínica en 80 casos / Secretive and non secretive intrasellar expansive process of prolactin and non-secretive: clinical experience in 80 cases

Se estudian 80 mujeres con proceso expansivo intraselar secretor de prolactina o no secretor. 51,25% de ellas eran muy secretoras de prolactina (más de 75 ng/ml) y las otras eran no secretoras o poco secretoras (menos de 75 ng/ml). Las del primer grupo eran todas amenorreias, en cambio, en las otras existían inclusive eumenorreicas. Se identifican microadenomas (66,25%), macroadenomas o complicados (17,5% y aracnoideoceles (16,25%). El 45,3% de los microadenomas, el 92,9% de los adenomas complicados y el 30,8% de los aracnoideoceles demostraron ser muy secretores de prolactina. 13,6% del total fueron intervenidas por vía transesfenoidal, con indicación quirúrgica precisa. El estudio histológico demostró un adenoma cromófobo en 10 casos. En el 7,5% de las mujeres estudiadas hubo compromiso quiasmático según los campos visuales de Goldman. Se verificó un 52,9% de recidiva post-operatoria. 37 mujeres anovulantes que deseaban embarazo, lográndose gestación en el 86,5% de ellas