Conceptos en torno a la informática en obstetricia / Current concepts in digital information applying to feto-maternal area

La obstetricia contemporánea debe apoyarse en el uso adecuado de la información a fin de evaluar la eficacia y calidad de sus intervenciones permanentemente. Los avances vertiginosos experimentados en el último cuarto de siglo, sumado a la consolidación del concepto de medicina materno-fetal, han obligado a los clínicos a trabajar con múltiples variables biológicas en función de mantener una visión permanente de las condiciones que afectan al binomio madre-hijo. Esta vigilancia lineal multivariable hace imprescindible el uso estratégico de herramientas informáticas con ventajas claras sobre el ordenamiento, comparación y análisis de información, para una consecuente planificación y ejecución de acciones efectivas, disminuyendo costos y optimizando recursos. El presente artículo describe la conceptualización, evolución y situación actual de la informßtica en el área de la Medicina Materno-Fetal. Además, agrega conceptos y recomendaciones básicas sobre el manejo de la información digital.

Contemporary obstetrics must rely on the suitable use of information to permanently assess the effectiveness and quality of its interventions. The vertiginous advances in the last quarter of the century, and the consolidation of the feto-maternal specialization, have forced the physicians to work with multiple biological variables based on maintaining a permanent vision of the fetal-maternal relationship through time. The necessity of using a multi-variate linear analysis makes the strategic of incorporating software tools a big advantage for researches and clinicians. Furthermore, there are clear advantages over the arrangement, comparison and analysis of information, in order to achieve an adequate planning and execution of effective actions, thus reducing the costs and optimizing resources. The aim of this study is to describe the evolution and current concepts and state of the art in computer science applying to feto-maternal area. In addition, this review take into account the basic concepts and recommendations on the handling of digital information.

Partograma en mujeres multíparas con manejo médico del trabajo de parto / Graphic analyses of labor in multiparous womens with medical management

Antecedentes. La evaluación gráfica del parto fue descrito originalmente por Friedman, sin embargo, una descripción de la evolución del trabajo de parto con un manejo médico contemporáneo no ha sido completamente evaluado. Objetivo: Analizar el efecto de un manejo médico estandarizado del trabajo de parto, que incluye anestesia regional, rotura artificial de membranas y conducción ocitócica, sobre la fase activa del trabajo de parto en multíparas. Método. Análisis retrospectivo de 130 multíparas en trabajo de parto espontáneo, que ingresaron con 3 a 4 cm de dilatación. Resultados. Se observó una duración de la fase activa del trabajo de parto de aproximadamente 3,5 horas, con una progresión promedio de 1,5 cm/ h, produciéndose la mayor progresión entre los 7 y 9 cm de dilatación con 1,9 cm/h. La segunda fase del trabajo de parto presento una duración promedio de 28 minutos. Conclusiones. Nuestros resultados muestran que el manejo médico estandarizado del trabajo de parto no reduce los tiempos de la fase activa ni de la segunda fase en multíparas. Creemos que es necesario implementar estudios randomizados para determinar la influencia de este tipo manejo del trabajo de parto en la incidencia de cesáreas.

Incisiones transversas en oncología ginecológica / Transverse incisions in gynecologic oncology

OBJETIVO: Determinar si el tipo de laparotomía influye en la etapificación de pacientes con cáncer de cuerpo y cuello uterino. MÉTODO: Se revisaron todas las fichas clínicas de pacientes con cáncer de cuerpo y cuello uterino que fueron operadas en el Hospital Clínico de la Universidad de Chile y el Hospital Clínico de la Fuerza Aérea Chilena, entre enero de 1999 y mayo de 2005. Se recopiló la siguiente información: tipo de laparotomía, índice de masa corporal (IMC), comorbilidades médicas, tiempo operatorio, histología, número total y distribución de linfonodos, pérdida sanguínea, complicaciones, duración de la cirugía y hospitalización. Se aplicaron análisis estadísticos con t student y c². RESULTADOS: Se identificaron 51 pacientes. Se usó laparotomía media (LM) y transversa (LT) en 16 (31%) y 35 (69%) de las pacientes, respectivamente. No hubo diferencias significativas en índice de masa corporal, estadio FIGO, histología, comorbilidades, estimación de pérdida sanguínea ni complicaciones intra o post operatorias entre el grupo de LM y LT. Se encontraron diferencias significativas en pacientes con IMC 25 sometidas a laparotomías verticales comparadas con las transversas, donde ocurrió mayor sangrado intraoperatorio, se recolectó mayor número de ganglios para-aórticos y tuvieron hospitalizaciones más prolongadas. CONCLUSIONES: La etapificación quirúrgica de pacientes con cáncer de cérvix o cuerpo uterino se puede realizar adecuadamente a través de incisiones transversas, sin mayor morbilidad. Previa adecuada selección, pacientes con cánceres cervical y uterino pueden beneficiarse de las ventajas ya descritas para las laparotomías transversas.

OBJECTIVE: To determine if the type of abdominal incision influences the adequacy of surgical staging in patients with uterine and cervical cancer. METHODS: A retrospective review of all uterine and cervical cancer patients operated on by the same surgeon at the Universidad de Chile Clinical Hospital and the Chilean Air Force Clinical Hospital between January 1, 1999, and May 1, 2005, is presented. Data on type of incision, body mass index (BMI), medical comorbilities, histology, total number and distribution of lymph nodes, estimated blood loss, complications, length of surgery and hospital stay were abstracted. Statistical analysis with two-tailed Student t test and c² were performed. RESULTS: 51 patients were identified. A vertical incision (VI) was used in 16 (31%) while 35 (69%) received a transverse incision (TI). There were no statistically significant differences in BMI, FIGO stage, histology, comorbilities, estimated blood loss or intraoperative and postoperative complications between the VI and TI groups. Compared patients with BMI 25, VI was associated with significantly more intraoperative blood loss, number of para-aortic lymph nodes harvested and length of hospital stay. CONCLUSION: Comprehensive surgical staging for uterine and cervical cancer can be adequately performed through a TI without greater morbidity. After appropriate selection, patients with uterine and cervical cancer can benefit from the inherent benefits previously described for TI.

Electrochemical and EPR characterization of 1,4-dihydropyridines. Reactivity towards alkyl radicals.

This work reports the electrochemical oxidation of a series of three synthesized 4-substituted-1,4-dihydropyridine derivatives in different electrolytic media. Also, an EPR characterization of intermediates and the reactivity of derivatives towards ABAP-derived alkyl radicals are reported. Dynamic, differential pulse and cyclic voltammetry studies on a glassy carbon electrode showed an irreversible single-peak due to the oxidation of the 1,4-dihydropyridine (1,4-DHP) ring via 2-electrons to the corresponding pyridine derivative. Levich plots were linear in different media, indicating that the oxidation process is diffusion-controlled. Calculated diffusion coefficients did not exhibit significant differences between the derivatives in the same medium. The oxidation mechanism follows the general pathway (electron, H+, electron, H+) with formation of an unstable pyridinium radical. One-electron oxidation intermediate was confirmed with controlled potential electrolysis (CPE) and EPR experiments. On applying N-tert-butyl-alpha-phenylnitrone (PBN) and 5,5-dimethyl-1-pyrroline N-oxide (DMPO) as the spin trap, these unstable radical intermediates from the oxidation of 1,4-DHP derivatives were intercepted. The final product of the CPE, i.e. pyridine derivative, was identified by GC-MS technique. Direct reactivity of the synthesized compounds towards alkyl radicals was demonstrated by UV-Vis. spectroscopy and GC-MS technique. Results indicate that these derivatives significantly react with the radicals, even compared with a well-known antioxidant drug such as nisoldipine.

Scavenging of the one-electron reduction product from nisoldipine with relevant thiols: electrochemical and EPR spectroscopic evidences.

PURPOSE: To determine the formation of the one-electron reduction product from nisoldipine and its reactivity with relevant thiols in mixed medium. METHODS: Cyclic voltammetry (CV) and electron paramagnetic resonance (EPR) techniques were used to determine the one-electron reduction product corresponding to the nitro radical anion. CV was employed to assess both the rate constants corresponding to the decay of the radicals and its interaction with relevant thiols. RESULTS: The nisoldipine radical anion follows second order kinetics, with an association rate constant of 283+/-16 l mol(-1) sec(-1). Nitro radical anion from nisoldipine significantly reacted with thiol compounds. This reactivity was significantly higher than the natural decay of the radical in mixed medium. EPR spectra recorded in situ using DMF/ 0.1 N NaOH (pH 13) confirmed the formation of the nitro radical anion, giving a well-resolved spectra in 35 lines using 0.1 G modulation. CONCLUSIONS: Electrochemical and EPR data indicated that all the tested thiols scavenged the nitro radical anion from nisoldipine. The following tentative order of reactivity towards the thiols can be proposed: cysteamine approximately glutathione > N-acetylcysteine > captopril > penicillamine.

[Thyroid microsomal autoantibodies in thyroid disease: their value as an antigenic marker]. / Anticuerpos antimicrosomales tiroideos en patología tiroidea: su valorcomo marcador antigénico.

An autoimmune disease can be the cause of thyroid disfunction. Determination of autoantibodies titers is the best way of demonstrating its existence. We studied 172 thyroid patients (146 females, 26 males) with ages ranging from 15 to 81 years. Thyroid microsomal autoantibodies (TMA) were detected by a modified agglutination test (SERA-TEK kit, Ames Div); a dilution greater than or equal to 1/1600 was considered as diagnostic of autoimmune disease. Patients were classified according to morphological and functional status in 3 groups: GI = non toxic goiter, n = 98 (71 diffuse, 20 multi and 7 uninodular); GII = toxic goiter, n = 62 (52 diffuse, 4 multi, 2 uninodular and 4 subacute thyroiditis); G III = hypothyroidism, n = 12 (5 primary hypothyroidism and 7 chronic thyroiditis). A control group of 30 normal individuals, ages ranging from 19 to 85 years was also studied. Diagnostic titers of TMA were found in 30.8% of group I, 88.5% of group II, 91.6% of group III and only in 6.6% of controls. The high incidence of positive TMA in toxic diffuse goiter (96.1%) as well as in hypothyroid patients was expected since these are typical examples of thyroid autoimmune disease. In the non toxic goiter group, positive TMA were present in 50% of multinodular, 28% of uninodular and 25% of diffuse goiters and the incidence of positive TMA varied according to age, being higher over the age of 40 years and lower under the age of 20 years. We postulate that this unexpected high incidence of positive TMA in non toxic goiter is due to amelioration of chronic iodine deficiency inducing the expression of latent autoimmune disease.(ABSTRACT TRUNCATED AT 250 WORDS)