Cirugía ortognática: diagnóstico, protocolo, tratamiento y complicaciones: análisis de experiencia clínica / Orthognatic surgery: diagnosis, protocol, treatment and complications: analysis of clinical experience

Los autores muestran su experiencia en el manejo de las malformaciones máxilo mandibulares por métodos ortodoncicoquirúrgicos. Presentan una casuística de 38 pacientes atendidos en el área privada agrupados por edad, sexo y categoría de diagnóstico. Se propone un esquema de estudio y tratamiento protocolizado el cual se expone en forma resumida. Se discuten los aspectos quirúrgicos con las diferentes modalidades de cirugía. Se comunican los casos considerados como complicaciones y se discuten las medidas de resolución para dichos pacientes. A manera de conclusión se entregan algunas recomendaciones para una práctica segura de la cirugía ortognática.

A double-blind comparison of the safety and efficacy of intravaginal misoprostol and prostaglandin E2 to induce labor.

OBJECTIVE: Our purpose was to compare the safety and efficacy of intravaginally administered misoprostol versus prostaglandin E2 for labor induction in a double-blind, randomized trial. STUDY DESIGN: One hundred three patients with indications for labor induction (including prelabor rupture of membranes) were randomized and received either misoprostol 50 micrograms or prostaglandin E2 (dinoprostone) 3 mg intravaginally. The dose was repeated 6, 24, and 30 hours after the first dose until active labor was achieved. For proper blinding, the drugs were prepared as identical-looking vaginal tablets. RESULTS: With use of a random number-generated table 52 patients were allocated to the misoprostol group and 51 to the prostaglandin E2 group. After exclusion of 3 patients, 50 in each group were evaluated. Delivery within 24 hours after administration occurred more often in the misoprostol group (70% vs 46% in the prostaglandin E2 group, p = 0.009), and fewer patients in this group needed more than two doses (12% vs 30%, p = 0.027). No difference in cesarean section rate (12% vs 14%, p = 0.67), fetal heart rate anomalies (33% vs 34%, p = 0.89), tachysystole (8% vs 14%, p = 0.37), hyperstimulation syndrome (0% vs 2%, not significant), meconium passage (28% vs 18%, p = 0.22), and fetal outcome (Apgar score at 1 and 5 minutes, arterial and venous umbilical cord blood pH, transfer to neonatal intensive care unit) was noted between the two groups. CONCLUSION: Intravaginal misoprostol is a safe drug for labor induction with superior effectiveness compared with intravaginal prostaglandin E2.

[Fetal fibronectin as a marker of prematurity in a high risk patient sample]. / Fetales Fibronectin als Marker der Frühgeburtlichkeit im Risikokollektiv.

The accuracy of cervicovaginal fetal fibronectin as a predictor of preterm birth was studied in patients with increased risk for preterm delivery (according to the Creasy-score). In a prospective blind observational study the smear from the posterior fornix vaginae of 56 pregnant patients without PROM was examined using a quantitative immunoassay for the detection of fetal fibronectin. The patients who tested positively for fetal fibronectin had significantly more preterm deliveries than those with a negative result (CHI square-test, p < 0.01, RR 5.1). Overall, sensitivity, specificity, positive and negative predictive values were 56%, 87%, 45% and 91%, respectively. In patients with preterm labor these values were 75%, 87%, 60%, and 93%, respectively. No patient with a negative result delivered preterm during the following two weeks. It is concluded that performing the fetal fibronectin test in patients with preterm labor is useful for the prediction of preterm birth. Routine testing in patients at increased risk (asymptomatic patients) is not recommended for lack of effectiveness.

Transcervical intrapartum amnioinfusion: a simple and effective technique.

OBJECTIVE: To test a simple method of intrapartum amnioinfusion to replace amniotic fluid during labor in cases of prolonged labor and severe variable fetal heart rate decelerations or thick meconium. STUDY DESIGN: We conducted a prospective study of intrapartum amnioinfusion in sixteen consecutive patients. A simple transcervically placed Foley bladder catheter was used for intrauterine infusion of saline solution, while monitoring was performed by external cardiotocography. RESULTS: In twelve patients, catheter placement was easily performed; the remaining four required stabilization by a mandrel for insertion. Amnioinfusion was effective in ten out of thirteen patients for relief of fetal heart rate anomalies. No complications were observed; all had good neonatal outcome. CONCLUSIONS: In our small, uncontrolled study, this amnioinfusion method proved to be a simple, inexpensive, effective and safe technique for the relief of severe heart rate anomalies in prolonged labor.

Successful twin pregnancy in homozygous beta-thalassemia after ovulation induction with growth hormone and gonadotropins.

OBJECTIVE: To describe infertility treatment and pregnancy outcome in a patient with transfusion-dependent beta-thalassemia major and hypopituitarism. DESIGN: Case report. SETTING: University-affiliated infertility clinic. PATIENT: Twenty-four-year-old infertile patient with homozygous beta-thalassemia. INTERVENTION: Co-treatment with GH and gonadotropins. RESULTS: Ovulation induction with clomiphene citrate or gonadotropins alone was unsuccessful. Combined treatment with hMG, hCG, and recombinant human GH followed by intrauterine insemination resulted in a viable twin pregnancy. CONCLUSION: Human GH as an adjunct to hMG and hCG seems to be a sensible approach in the treatment of infertile homozygous beta-thalassemic patients among which very few pregnancies are reported.

Características de la dentición mixta segunda fase en una muestra de niños del area metropolitana / Characteristics of the mixed dentition second phase in a Chilean children group

El propósito de la presente investigación fue determinar las características de la dentición mixta, segunda fase, en una muestra de niños del área metropolitana y la frecuencia de aparición de dichas características en esta población. Se encontró que la edad de erupción de las piezas dentarias es más precoz que lo determinado en la literatura; que el 2§ molar permanente erupciona antes que el 2§ premolar en un porcentaje no despreciable y que a pesar de ello el espacio disponible es adecuado para la correcta ubicación de canino y premolares. La relación de oclusión de los 1§ molares en sus distintos estadios es predominantemente la neutroclusión en sentido sagital y normal en sentido vertical y transversal

[Polychlorinated biphenyls as a cause of sterility in women?]. / Polychlorierte Biphenyle als Sterilitätsursache bei der Frau?

A total of 59 female infertile patients were investigated for the concentration of polychlorinated biphenyls (PCB) in their blood serum and follicular fluid. The average concentration of PCB in 66 related samples of follicular fluid and blood serum was 1.6 and 1.8 ng/ml, respectively. A splitting of the patients into two collectives, one with explained infertility, the other with unexplained infertility, showed no evidence of a higher PCB concentration in unexplained infertility patients. These results may exclude PCB as a primary reason for unexplained infertility.

[Routine screening for Chlamydia: is it sensible during pregnancy?]. / Routinemässiges Screening auf Chlamydien: in der Schwangerschaft sinnvoll?

610 pregnant patients were examined for evidence of Chlamydia trachomatis infection. Chlamydia trachomatis could be detected in 18 of these 610 patients. This results in a low prevalence rate of 3%; therefore, screening for Chlamydia trachomatis is not indicated in our pregnant population. Among the 18 chlamydia-positive patients we could not discover any risk factors that were associated with this infection. Because of the varied and sometimes silent course in affected patients, this special investigation should be used liberally in a variety of situations.

[Obstetrics for HIV positive pregnant patients]. / Geburtshilfe bei HIV-positiven Schwangeren.

We analysed 13 pregnancies from HIV-positive women, 12 intravenous drug abusers, and found the following complications: (1) 4 small-for-date babies and 1 premature baby; (2) 12 spontaneous births, 1 cesarean section; (3) 6 children with acute withdrawal syndrome and/or sepsis; (4) 2 children have AIDS, 3 mothers too; 1 child got ARC; (5) 4 children became HIV-negative. We propose some guidelines through pregnancy and birth for this group at risk.

[Fertility and Turner mosaicism syndrome]. / Fertilität und Turner-Mosaik-Syndrom.

Six patients with a Turner mosaicism are reported. All six women were investigated for sterility or infertility. Four of six patients had a total of nine pregnancies: six abortions, one stillbirth, two normal children. The literature contains reports of 17 pregnancies in 10 women with 45.X karyotype and 106 pregnancies in 48 women with mosaicism. Miscarriages, stillbirths and malformations were common. These women need special counselling and in case of a pregnancy amniocentesis is indicated. We discuss the pathogenesis of reduced fertility with Turner patients and explain the problems related to the cystogenetic diagnosis of the Turner-Mosaic Syndrome.