Stage-based treatment of twin-twin transfusion syndrome.

OBJECTIVE: The purpose of this study was to compare the outcomes of patients with twin-twin transfusion syndrome who were treated with either serial amniocentesis or selective laser photocoagulation of communicating vessels according to disease severity (stage). STUDY DESIGN: Centers that were experienced in the treatment of twin-twin transfusion syndrome were invited to share stage-based perinatal outcome data. All patients met basic standard sonographic criteria for twin-twin transfusion syndrome (polyhydramnios maximum vertical pocket, > or =8 cm; oligohydramnios maximum vertical pocket, < or =2 cm). Gestational age at first treatment was <27 weeks of gestation. RESULTS: Three centers submitted stage-based data, for a total of 173 patients (serial amniocentesis, 78 patients from all 3 centers) and 95 selective laser photocoagulation of communicating vessels (1 center). The distribution of patients by stage was similar in the two groups. Successful pregnancy outcome (at least 1 surviving infant) was correlated inversely with stage in the serial amniocentesis but not in the selective laser photocoagulation of communicating vessels group and was significantly lower in the serial amniocentesis (66.7%) than in the selective laser photocoagulation of communicating vessels group (83.2%). Neurologic morbidity was related directly to stage in the serial amniocentesis group but not in the selective laser photocoagulation of communicating vessels group and was significantly higher in the serial amniocentesis (24.4%) than in the selective laser photocoagulation of communicating vessels (4.2%) group. Intact neurologic survival (at least 1 surviving infant without neurologic morbidity) was significantly lower in the serial amniocentesis group than in the selective laser photocoagulation of communicating vessel group (51.3% vs 78.9%), particularly in stage III and stage IV (23.5% vs 72.7% in stage IV). Patients who were treated with selective laser photocoagulation of communicating vessels were 2.4 times more likely to have at least one survivor than those treated with serial amniocentesis. CONCLUSION: Our study suggests a relationship between perinatal morbidity and mortality rates and stage in serial amniocentesis but not in selective laser photocoagulation of communicating vessel-treated twin-twin transfusion syndrome patients. These findings could be used to tailor the treatment of twin-twin transfusion syndrome. A clinical trial to confirm these results is being organized by our research groups.

Surgical treatment of spontaneous rupture of membranes: the amniograft--first experience.

A 28-year-old woman underwent surgical repair of spontaneous ruptured membranes at 17 weeks' gestation. A collagen graft was placed endoscopically over the membrane defect located over the internal os. Membranes re-ruptured 14 days later, but the patient did not deliver until 30.5 weeks. The infant did well.

Prevalencia de reacciones alérgicas sistémicas a picadura de himenópteros en una muestra poblacional de Uruguay / Prevalence of systemic allergic reactions to himenoptera sting in a population sample of Uruguay

Con el objetivo de evaluar la prevalencia y algunas características de las reacciones adversas sistémicas a picadura de insectos himenopteros (abeja, avispas, hormiga) se estudió una población de 4061 personas elegidas al azar, por medio de un cuestionario protocolizado. Fueron estudiados 1665 (41 por ciento) hombres y 2396 (59 por ciento) mujeres, con edad promedio de 34 años y un rango de 3 a 85 años. 69,9 por ciento presentaron historia de picadura de himenópteros (47 por ciento abejas, 42 por ciento hormiga y 27 por ciento avispa). 16 por ciento de la muestra había sido picada por dos o más insectos. En los 4061 sujetos estudiados se observaron reacciones sistémicas en 155 para todos los insectos (3,8 por ciento). 83 sujetos lo fueron a picadura de abeja (2 por ciento), 20 a avispas (0,5 por ciento) y 52 (1,3 por ciento) a hormigas. La sintomatología consignada fue: urticaria y angioedema en todos los pacientes con reacciones sistémicas, como único síntoma en 64 por ciento y asociado con síntomas respiratorios cardiovasculares o gastrointestinales en 36 por ciento. Treinta y tres por ciento tuvieron síntomas respiratorios, pérdida de conocimiento en 8 por ciento y síntomas gastrointestinales en 7 por ciento. Entre los sujetos que recibieron picadura de himenóptero, 349/2836 (12,3 por ciento) requirió asistencia médica. En los pacientes que presentaron reacciones sistémicas, 123/155 (79,3 por ciento) requirió asistencia médica de urgencia. No se observó diferencia significativa, en relación a edad, sexo o residencia en medio rural o urbano. Se observó una tendencia no significativa de mayor prevalencia de reacciones sistémicas en personas que realizan tareas rurales. Se concluye que la picadura de himenópteros es un riesgo severo para la salud en Uruguay, con una alta prevalencia de reacciones sistémicas (80 por ciento de los afectados requirió asistencia médica). Los insectos más frecuentemente responsables fueron la abeja y la hormiga