RAS in Pregnancy and Preeclampsia and Eclampsia.

Preeclampsia is a common disease of pregnancy characterized by the presence of hypertension and commitment of many organs, including the brain, secondary to generalized endothelial dysfunction. Its etiology is not known precisely, but it involved several factors, highlighting the renin angiotensin system (RAS), which would have an important role in the origin of multisystem involvement. This paper reviews the evidence supporting the involvement of RAS in triggering the disease, in addition to the components of this system that would be involved and how it eventually produces brain engagement.

Migration, ethnicity and environment: HIV risk factors for women on the sugar cane plantations of the Dominican Republic.

OBJECTIVE: To determine risk factors for HIV infection among women living in the sugar cane plantation communities (bateyes) of a large private sugar cane company in the Dominican Republic. DESIGN: Cross-sectional study of sexually active female volunteers living in the bateyes. METHODS: Of 98 bateyes, 23 were randomly selected and visited by a mobile medical unit, to interview, examine and test volunteers for seroreactivity to HIV and syphilis. RESULTS: The 490 subjects ranged in age from 16 to 72 years (median, 37 years); 53% were born in Haiti, 36% in Dominican Republic bateyes, and 12% elsewhere in the Dominican Republic; 58% had no formal education; and 87% had no income. HIV seropositivity was found in 28 women (5.7%), including 8.8% of those aged < 35 years. By logistic regression analysis, HIV infection was independently associated with age < 35 years [odds ratio (OR), 4.5; P < 0.01), being single with children (OR, 4.3; P < 0.01), more than one lifetime sex partners (OR, 3.4; P = 0.06), engaging in sex during menses (OR, 3.2; P = 0.02), and self-description as a prostitute (OR, 4.4; P = 0.05)1. For Haitian women, those coming to the Dominican Republic alone were more likely to have HIV infection than those coming with a male partner. Less than 4% of women reported condom use at last intercourse. CONCLUSIONS: Women in the bateyes have a much higher rate of HIV infection than that estimated for women in the general population of Dominican Republic and a rate comparable to that of female sex workers in the Dominican Republic. AIDS prevention in the bateyes should address condom education and distribution as well as employment opportunities and education for women.

Protecting paradise: tourism and AIDS in the Dominican Republic.

This study summarizes results from six data collection instruments administered to tourists, hotel workers, and commercial sex workers (CSWs) in the Dominican Republic (D.R.). The objective of this study was to assess: 1. how HIV/AIDS may affect tourism; 2. how tourists are likely to react to prevention campaigns; and 3. how tourism may affect the spread of HIV/AIDS. It was found that an overwhelming proportion of tourists did not consider the prevalence of HIV to be a factor when making their travel plans, and that most did not consider themselves at greater risk of becoming infected while on holiday than when they were at home. This study determined that the spread of HIV/AIDS was unlikely to affect the demand for tourism services in the D.R. The study also found that most tourists would respond positively to an HIV/AIDS prevention campaign and would not be discouraged from visiting the D.R. because of such campaigns. Those most receptive to prevention efforts were also those who felt they were at highest risk, according to study data. Finally, it was determined that while most tourists probably do not engage in high risk activities, there were some male and female tourists who do engage in sexual encounters with multiple Dominican CSWs and hotel employees. These encounters represent a risk to the health and economic development of the D.R., as well as to tourists and their other sexual partners. Based on these findings, it is recommended that in order to minimize the potential social and economic impact of HIV/AIDS in the D.R., prevention messages need to reach a number of groups which have not yet been adequately targeted. These groups include tourists, with a special emphasis on 'sex tourists', and hotel employees, with a special emphasis on entertainment staff.

Increase in prostaglandin bioavailability precedes the onset of human parturition.

The traditional paradigm that prostaglandins (PGS) are of central importance in the initiation of labor has been challenged. A group of investigators has recently reported that the amniotic fluid concentrations of PGE(2) and PGF(2 alpha) increase only late in the course of labor implying that "the accumulation of prostaglandins in amniotic fluid is an after-effect of labor and not indicative of a role of these compounds in the initiation of human parturition." The present study was conducted to determine whether amniotic fluid prostaglandin concentrations increase prior to the onset of human labor, the central question in this controversy. Three amniocenteses were performed in 17 women with intrahepatic cholestasis of pregnancy -- the first two prior to the onset of labor and the third during early spontaneous labor. PGE(2) and PGF(2 alpha) were measured with sensitive and specific radioimmunoassays. Amniotic fluid concentrations of PGE(2) and PGF(2 alpha) increased prior to the onset of spontaneous labor. An additional increase in the concentrations of PGE(2) and PGF(2 alpha) was found in samples obtained in early labor. We conclude that an increase in prostaglandin bioavailability precedes the onset of spontaneous human parturition.

[Fetal endoscopic surgery in a case of twin pregnancy complicated by reversed arterial perfusion sequence (TRAP sequence)]. / Cirugia endoscópica fetal en un caso de embarazo gemelar complicado con secuencia de perfusión arterial reversa (secuencia TRAP).

We present the first report in our country of endoscopic fetal surgery in a patient with a twin pregnancy and twin reversal arteral perfusion (TRAP sequence). We performed fetoscopic ligation of the umbilical cord of an acardiac twin at 26 week's gestation.

[Total parenteral nutrition in severe hyperemesis gravidarum]. / Nutrición parenteral total en hiperemesis gravídica grave.

Eight patients with severe HG, were treated through parenteral nutrition. This treatment was formulated as aminoacid, sucrose solution and fat solution (3 of 8 cases), blended with vitamins electrolites and oligoelements. The procedure lasted 5 at 16 days conforming a total of 77 days. Seven newborns were term delivery, and one case was missed abortion. Like this, there were no complications detected and clinical wellbeing was reached, successfully.

[Color Doppler of the utero placental territory and its relationship with the placental localization: normal and elevated resistance groups]. / Doppler color del territorio útero-placentario y su relación con la ubicación placentaria: grupos de resistencia normal y elevada.

Forty two pregnancies of gestational age between 20 and 40 weeks were studied, 26 with normal uterine artery resistance; Group A, and 16 with elevated UA resistance; Group B. Three categories of placental location were established: Type I; central, Type II; partially lateralized including uterine midline, Type III; completely lateralized not including uterine midline. A Diasonic doppler duplex color equipment was used to assess the systole/diastole ratio (s/d ratio). Five different pints of the uteroplacental vascular territory were evaluated in each patient; right and left bottom uterine artery (cervico ithsmical union), right and left top UA (laterally outstanding point of the uterine wall), and inter villous space. The results were analyzed with Statview (Macintosh) statistics software. Placental Type II, prevailed on Group A, Type III prevailed on Group B, Types II and III were predominantly located on the right side of the uterus. S/D ratio was higher in Group B than in Group A in all five sites. S/D rel was higher on left side than on right side measurements. On Group B, left placental side patients had significantly higher s/d rel on non placental uterine artery than right placental side patients. When one altered uterine Doppler flow value is found, all the uteroplacental vascular territory show a high resistance patterns. The lateral placental location patterns tend to express higher resistance values. Right lateral placental locations have even higher resistance values than left ones. The placental location classification is suggested as a screening method for detecting the group of patients in risk of having altered values of Uterine Doppler Flow Velocimetry.

Parenteral nutrition in hyperemesis gravidarum.

Hyperemesis gravidarum (HG) is a clinical condition that threatens fetal viability and even the mother's life when the severity of symptoms almost completely prevents the intake of food. Parenteral nutrition (PN) is a possible alternative. We present eight patients with HG. There were 10 PN treatments because two of the patients required the treatment twice. There were 9 central venous and 1 peripheral treatment delivery. The average age of the patients was 27.5 yr. Gestational ages varied from 8 to 19 wk. PN treatments were formulated as amino acid and glucose solutions (fat emulsions in 2 of the 8 cases) blended with vitamins and electrolytes. These treatments lasted 5-16 days. Before PN deliveries were initiated, five of the patients presented some degree of protein-calorie and/or visceral protein malnutrition. All of them showed minor liver dysfunction, which did not change during PN. Newborns were term deliveries, except for one case of missed abortion. Results show that PN constitutes a therapeutic alternative in cases of HG that do not respond to the standard treatment of parenteral hydration and antiemetics. In fact, symptoms disappear promptly, and no significant complications arise.

[Fetal echocardiography. I. The technic and fundamentals]. / Ecocardiografía fetal. I: Técnica y fundamentos.

This study describes the method and principles of fetal echocardiography, analyzing the technics and the utility of bidimensional mode, M mode and Doppler ultrasound on congenital fetal cardiopathies. The importance of early diagnosis in the structural alterations and fetal cardiac arrhythmias is emphasized.

[Fetal echocardiography. II. Biometry of the normal fetal heart]. / Ecocardiografía fetal. II: Biometría del corazón fetal normal.

Normal fetal hearth biometry is analyzed by echocardiography in 80 pregnant women with 20 and 40 gestational weeks. Intraventricular septum, aorta, left and right ventricular dimensions were obtained. All dimensions showing progression with gestational age.

[Fetal echocardiography. III. The antenatal diagnosis of structural and rhythm changes]. / Ecocardiografía fetal. III: Diagnóstico antenatal de alteraciones estructurales y del ritmo.

We present 119 echocardiographies in 90 high-risk pregnancies, 20 to 40 weeks gestational age. There were found 18 fetuses with abnormal examinations (20%), six of them with structural alteration (6.6%), and 14 arrhythmias (15.5%). The diagnostic correlation in structural alterations with a sensibility of 83% and 100% specificity, and 100% of sensibility and specificity in arrhythmias. The importance of antenatal diagnosis in cardiac malformations and arrhythmias is described.

[Ultrasonography-guided transvaginal puncture of ovarian cysts]. / Punción vía transvaginal de quistes ováricos guiada por ultrasonografía.

Presenting the experience in 18 cases of ovarian cystic transvaginal puncture guided by ultrasonography. The cystic selected for puncture were unilateral, regular contours, uniloculated without internal papillae, without ascites. This procedure was made in women on reproductive age with failure to medical treatment.

[The successful prolongation of a twin preterm pregnancy complicated by a dead fetus and disseminated intravascular coagulation]. / Prolongación exitosa de gestación gemelar de pretérmino complicada con un feto muerto y coagulación intravascular diseminada.

A clinical case of twin pregnancy with one in utero death fetus, at 24 weeks of gestation is presented, accompanied by disseminated intravascular coagulation. The successful treatment with heparin its described.

Colestasia intrahepatica del embarazo influencia de los niveles sanguineos de diazepam. / Intrahepatic cholestasis of pregnancy: influence of diazepam serum levels

En embarazadas del tecer trimestre se estudio la influencia de la colestasia intrahepatica del embarazo (CIE) sobre los niveles sanguineos del diazepam, asi como los efectos de este farmaco sobre esa patologia.Las concentraciones plasmaticas de diazepam se determinaron a diversos tiempos despues de administraciones orales unicas o repetidas del farmaco en 12 embarazadas que presentaron CIE, y en 6 pacientes testigos sin esa patologia. En las pacientes con CIE los niveles plasmaticos de diazepam fueron significativamente superiores y de curso mas prolongado que en los controles. Se observo una relacion directa entre la severidad de la CIE y los niveles plasmaticos de diazepam alcanzados asi la correlacion entre diazepam y los niveles de fosfatasas alcalinas tuvo un valor R = 0,68 p < 0,05, y aquella entre diazepam con la bilirrubina fue r = 0,88, p < 0,01. La administracion de diazepam, sin embargo, no aumento ni redujo los indices de laboratorio de la CIE.Se discuten los posibles mecanismos que determinan un aumento de los niveles plasmaticos de diazepam en la CIE y los efectos que pueden tener estos cambios en el recien nacido

Transplante renal y embarazo.Tres casos clinicos de donante vivo. / Kidney transplantation and pregnancy. 3 clinical cases of living donors

Se relatan tres casos de embarazadas con transplante renal, que fueron atendidas en el Hospital Clinico de la Universidad de Chile, entre 1979 y 1983. La primera termina en un aborto espontaneo, y las otras dos pacientes en, parto espontaneo y cesarea por retardo de crecimiento intrauterino severo, respectivamente. Los recien nacidos nacieron con buena vitalidad, y su evolucion ha sido favorable a los 8 y 5 meses de observacion, fechas de esta publicacion. Se comentan los dos casos y se describen los cuidados maternos para cada caso