Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'.

OBJECTIVE: To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS). METHODS: Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls). RESULTS: Of the 102 pregnancies examined, 26 (25.5%) underwent the Solomon technique and 76 (74.5%) did not. Of the 204 fetuses, 139 (68.1%) survived up to 30 days of age. At least one twin survived in 82 (80.4%) pregnancies and both twins survived in 57 (55.9%) pregnancies. When compared with the control group, the Solomon-technique group had a significantly higher survival rate for both twins (84.6 vs 46.1%; P < 0.01) and a higher overall neonatal survival rate (45/52 (86.5%) vs 94/152 (61.8%); P < 0.01). Use of the Solomon technique remained independently associated with dual twin survival (adjusted odds ratio (aOR), 11.35 (95% CI, 3.11-53.14); P = 0.0007) and overall neonatal survival rate (aOR, 4.65 (95% CI, 1.59-13.62); P = 0.005) on multivariable analysis. There were no cases of recurrent TTTS or twin anemia-polycythemia sequence (TAPS) in the Solomon-technique group. CONCLUSIONS: Use of the Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival and may reduce the risk of recurrent TTTS and TAPS. Our data support the idea of performing a randomized controlled trial to evaluate the effectiveness of the Solomon technique.

Correlation between periodontal disease, inflammatory alterations and pre-eclampsia.

BACKGROUND AND OBJECTIVE: Several studies have hypothesized that periodontal disease may increase the risk of pre-eclampsia. The correlation between the two diseases would probably be based on hypertension-related cytokine release in the local periodontal environment. The aim of this study was to evaluate the association between periodontal disease and pre-eclampsia, and the correlation of the two conditions with interleukin-6 (IL-6) and tumor necrosis factor-α(TNFα) mRNA expression. MATERIAL AND METHODS: A case-control analysis of 116 pregnant women, 58 with pre-eclampsia (cases) and 58 normotensive pregnant women (controls) was performed. In addition to collection of socio-demographic data and periodontal evaluation, peripheral blood samples were collected for laboratory analysis of IL-6 and TNFα mRNA expression by real-time PCR. RESULTS: There was an association between periodontitis and pre-eclampsia (adjusted odds ratio 3.73; 95% confidence interval 1.32-10.58). Increased TNFα mRNA expression was observed in pre-eclamptic women; however, there was no correlation between periodontitis and systemic cytokine expression. In the case group, systemic cytokine mRNA levels were similar in pregnant women with and without periodontitis (means±SD): 0.73±0.24 vs. 0.82±0.38 for TNFα and 1.31±1.49 vs. 1.09±0.74 for IL-6, respectively. CONCLUSION: Periodontitis was clinically related to pre-eclampsia; however, the supposed mechanism that correlates the two diseases, i.e. a systemic inflammatory process involving cytokines TNFα and IL-6 in the presence of periodontal disease, could not be confirmed in this study.

Utilização de prótese endovascular em aneurisma roto de aorta torácica / Endovascular protese in broken aneurysm of thoracic aorta

Os autores relatam caso cirúrgico de paciente com aneurisma roto da aorta descendente, em tratamento de neoplasia de colon e submetido ao tratamento com implante de prótese endovascular com êxito.

Studies of the immediate postpartum diabetes remission and/or hypoglycemia after cesarean section in diabetic pregnancy

Five non-diabetic subjects, 5 gestational diabetics (GDM) treated with diet and 4 non-insulin dependent pregestational diabetics (NIDDM) treated with beef-pork insulin during their pregnancy, undergoing elective cesarean section (C-s), were given dextrose infusions without insulin for 7 hours (h) starting lh before the operation. Multiple blood samples were drawn up to 72 h after the C-s. The lowest glucose levels were observed at 3 3 or 6 h after surgery in all but two subjects. Plasma glucose below 2.75 mmol/l (49.5 mg/dl) were observed in 2 NIDDM patients. While in the non-diabetics and GDM the free (total) insulin and C-peptide values fell to very low levels, coinciding with the fall in plasma glucose, in the NIDDM there was a negative correlation between nadir glucose and free insulin levels with the progressive fall of antibody-bound insulin. In 3 out of NIDDM patients the antibodybound insulin fell to 57 to 73 per cent of the preoperative values. IGF-I/SmC, lower in the NIDDM, hGH immunoreactivity and hPL fell after C-s. The results suggest increased glucose utilization insulin-independent in the immediate postpartum in the non-diabetic pregnancy and GDM. However, in the NIDMM, in the presence of significant levels of free insulin, they tend to develop lower plasma glucose levels, sometimes hypoglycemia. Furthermore, lower IGF-I/Smc levels in the NIDDM in comparison to the non-diabetics and GDM would discard their role in the induction of hypoglycemia.