HLA-DQ2/DQ8 and HLA-DQB1*02 homozygosity typing by real-time polymerase chain reaction for the assessment of celiac disease genetic risk: evaluation of a Spanish celiac population.

Celiac disease (CD) is a complex autoimmune disorder caused by ingestion of gluten in genetically susceptible individuals. Different genetic risk factors have been identified, but virtually all patients are human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8 positive. We describe a new, fast, accurate and simple real-time polymerase chain reaction (PCR)-based assay for the genotyping and homozygosity analysis of the CD-related HLA alleles. The assay overcomes the major limitations of protocols currently in use, allowing HLA-DQ2/DQ8 genotyping by using only three real-time PCR reactions. For the appraisal of DQ2 homozygosity, only one more reaction is needed. These reactions are easily automated and suitable for large screening studies in diagnostic procedures, as it is demonstrated by their successful application in our HLA diagnostic laboratory. Finally, we assessed the clinical relevance of this real-time PCR-based assay by studying a cohort of fully characterized patients. As expected, all CD patients had at least one of the CD-associated alleles, and the highest CD risk was indicated by the presence of the HLA-DQ2.5 heterodimer (HLA-DQA1*05-DQB1*02) with HLA-DQB1*02 in homozygosity.

[Cervix carcinoma with endometrial and myometrial involvement. Report of a case]. / Carcinoma de cervix con extensión endometrial y miometrial. Presentación de un caso.

Cervical carcinoma extending to endometrium, and even more, to myometrium is very rare. At the present time there are only 28 reported cases in the literature, and 31 as primary of endometrium. The diagnosis of this condition requires strict histological criteria. The prognosis is bad. Surgery continues as the main therapeutic resource; the adjunt radiotherapy does not improve survival, and experience with chemiotherapy is limited.

[Microinvasive cervico-uterine cancer. Diagnosis and treatment]. / Cáncer cervicouterino microinvasor. Diagnóstico y tratamiento.

This is a retrospective review of 63 patients with diagnosis of microinvasive cervical carcinoma. Diagnostic methodology included etiology, colposcopy, biopsy and cervical conization. Study parameters were: age, symptomatology, type of treatment and survival. The treatment to be established was chosen according to adverse prognostic factors, such as invasion depth, lymphovascular permeation, invasion pattern. The patients with an invasion depth up to 1 mm (IA1, FIGO) may be conservatively treated by cervical conization, if fertility is to be kept; there is risk of metastasis or recurrence. The patients with invasion of 1 to 5 mm (IA2, FIGO) may have a greater risk of recurrence and lymph node disease; the treatment should be individualized. There are no specific colposcopic data about microcarcinoma, and because of that, diagnostic precision is not high; however, colposcopy shows the adequate site for biopsy sampling, identifies vaginal extension areas and may influence the treatment.

[Active management of labor]. / Manejo activo del trabajo de parto.

Eighty three primigravidae patients at the end of latency labor, erased cervix, 3 cm dilation, vertex presentation and adequate pelvis, were studied. Two groups were formed: 53 patients in the study group, who received active management of labor, and 30 patients in the control group, treated in the traditional way. In all the patients a graphic recording of labor, was carried out; it included all the events, and as labor advanced, a signoidal curve of cervical dilatation, was registered, as well as the hyperbolic one for presentation descent. The study group received the method in a systematized manner, as follows: 1. Peridular block. 2. Amniotomy. 3. IV oxytocin one hour after amniotomy. 4. FCR monitoring. 5. Detection of dystocia origin. Materno-fetal morbidity was registered in both groups, as well as cesarean section rate, instrumental delivery and its indications, labor duration, and time of stay in labor room. Diminution of above intems and opportune detection of dystocia, were determined. It was concluded that a constructive action plan, starting at hospital admission in most healthy women, allows a normal delivery of brief duration.