Análisis de la mortalidad fetal en el Hospital Universitario La Fe: estudio comparativo 1996-2000 frente a 2001-2005 / Analysis of fetal mortality in the Hospital Universitario La Fe: comparison between 1996-2000 vs 2001-2005

Objective: To evaluate fetal deaths in the last 10 years by comparing two time periods and to analyze possible causes and variations of fetal mortality. Material and methods: We examined the fetal death rate between 1996 and 2005. Two groups were compared: group A included fetal deaths occurring in the period 1996-2000 and group B comprised those occurring in the period 2001-2005. Maternal, delivery and fetal characteristics were analyzed. Results: The fetal death rate at our hospital was 6.25 per 1000 births. Fetal death mainly occurred in Spanish mothers aged between 20 and 35 years old. Birth weight was between 500 and 1000 g in 53.4% of deaths and gestational age was less than 28 weeks in 32.5%. Mortality was higher in multiple pregnancies than in single pregnancies. Comparison of the two groups showed no significant differences in fetal death rate but a statistically significant increase (p <0.05) was found in patients aged less than 20 years old (1.2% vs. 6.9%) and foreigners (4.7% vs. 15.5%). There was a nonsignificant increase in fetal mortality in assisted reproductive pregnancies (5.8% vs. 9.2%). The cause of death was unexplained in 20.3% of fetal deaths. The most frequent causes registered were funicular abnormalities (13.3%), chorioamnionitis (8.7%), premature rupture of fetal membranes (8.4%), and abruptio (6.7%). Conclusion: The fetal death rate did not decrease during the periods studied and increased among young women and foreigners (AU)

Objetivo: Evaluar la mortalidad fetal en los últimos 10 años dividiéndola en 2 períodos, y analizar las posibles causas y variaciones de ésta. Material y métodos: Se estudia la tasa de mortalidad fetal (TMF) entre los años 1996 y 2005. Se comparan 2 grupos, el Grupo A con las muertes fetales entre 1996-2000 y el grupo B con los casos entre 2001-2005. Se estudian variables maternas, relacionadas con el parto, y fetales. Resultados: La TMF en nuestro medio fue del 6,25‰ recién nacidos. Principalmente se dio en madres españolas de entre 20 y 35 años. El peso fetal fue, en el 53,4% de los casos, de entre 500-1.500 g y el 32,5% era de edad gestacional < 28 semanas. La mortalidad está incrementada en las gestaciones múltiples respecto a las únicas. Al comparar los 2 grupos no ha habido diferencias significativas en la TMF, pero sí se evidencia un aumento estadísticamente significativo (p < 0,05) de pacientes < 20 años (el 1,2 frente al 6,9%) y extranjeras (el 4,7 frente al 15,5%). Sin embargo, aumenta la mortalidad en gestaciones de reproducción asistida (el 5,8 frente al 9,2%), sin alcanzar significación estadística. La causa de muerte fue, en el 20,3% de los casos, desconocida destacan como causas registradas la patología funicular (13,3%), la corioamnionitis (8,7%), la rotura prematura de membranas pretérmino (8,4%) y el desprendimiento prematuro de la placenta normoinserta (6,7%). Conclusión: No ha disminuido la TMF en los últimos años, aumentando entre gestantes extranjeras y jóvenes (AU)

Snake instability of a spatiotemporal bright soliton stripe.

We study experimentally the snake instability of the bright soliton stripe of the (2+1)-dimensional hyperbolic nonlinear Schrödinger equation. The instability is observed, through spectral measurements, on spatially extended femtosecond pulses propagating in a normally dispersive self-defocusing semiconductor planar waveguide.

[Surgical treatment of a pheocromocytoma bilateral in a 5 year old patient with the von Hippel-Lindau disease]. / Tratamiento quirúrgico de un feocromocitoma bilateral en un paciente de 5 años con enfermedad de von Hippel-Lindau.

INTRODUCTION: The disease of Von Hippel Lindau (VHL) is hereditary and causes a predisposition to the development of tumours. Organs such as the cerebellum, the pancreas, the kidney, the suprarenal glands and the retina are more usually affected by this disease. CLINICAL CASE: We present the case of a 5-year-old patient who suffers from asiymptomatic high blood pressure. In the family antecedents, it is relevant the case of the father, with pheocromocytoma bilateral, which led us to carry out a genetic study of his two sons. Our patient, the younger; presented a mutation of the VHL gene in the short arm of the chromosome 3. In one of the periodic controls, it could be detected high blood pressure of 160/100 mm. Hg, clinically asymptomatic. The other child did not present a genetic mutation and has no disease. The presence of high catecholamines, the detection of a 3 cm left suprarenal mass through the ecography, the TAC that did not show a right suprarenal pathology and the MBIG scintigraphy confirmed the diagnostic of pheocromocytoma. The RNM showed another 0.8-cm mass which confirmed a pheocromocytoma bilateral. We started the treatment against high blood pressure with fenoxibenzamine and diltiazem, and we controlled this problem. We also prepared the pre-and-post operation anesthetic strategy, which is so important for the surgical success. The operation started by a laparoscopic, we made left adrenalectomy and we had to reconvert to laparotomy to make partial right adrenalectomy. Six months after the operation, the patient is free from symptomatology and follows a treatment with glucocorticoides with smaller and smaller doses. COMMENTS: The case is exceptional because it embodies the following characteristics: early diagnostic age, family affectation and discovery of asymptomatic high blood pressure. It needed an appropriate preanesthetic and anesthetic preparation, which gave way to an operation without complications. The postoperation was also stable and presented no complications.

[The prevalence of anemia in the children and adolescents of Madrid]. / Prevalencia de anemia en niños y adolescentes de Madrid.

Iron deficiency and iron deficiency anemia are very important disorders in childhood because, during this stage of life, the confluence of different factors can lead to iron deficiency. During childhood, there are rapid growth periods in which the need for iron increases and these needs are not always compensated for by a sufficient iron intake. We have studied a sample of 2,224 schoolchildren, both males and females, between the ages of 2 and 18 years, from five different schools in the Community of Madrid. The prevalence of anemia was studied by determining the hemoglobin, MCV and MCHC, whereas iron deficiency was assessed by measurement of serum iron. In our study population, the prevalence of iron deficiency was 4.94% and the rate of iron deficiency anemia was 0.94%. This disorder is predominant in 13 to 15 year olds (3.7% of the males and 3.53% of the females showed hemoglobin values below the reference range). In addition 6.73% of this group were iron deficient. The MCV was decreased in 2.69% of the subjects, after the exclusion of six children with thalassemia trait.

[Variations in the excretion of N-acetyl-glucosaminidase in the first year of life]. / Variación de la excrección de N-acetil-glucosaminidasa en el primer año de vida.

We have studied 122 patients, all younger than 12 months of age, to whom we check the N-acetylglucosaminidase/creatinine (NAG/creatinine) ratio in the first morning urine. The NAG/creatinine values were decreasing with age increase of the patients, being significantly different (p less than 0.001) in the younger 3 months of age comparative with the older than six months of age. The NAG/creatinine values were inversely correlated with age, height and weight. We have made normal values percentils of the NAG/creatinine ratio for each age group.