Juan Orellana C

Estudio de fibras colágenas y elásticas del tejido conjuntivo de pacientes con y sin hernia inguinal primaria

: Patients without hernia had compact collagen tractshomogenously distributed towards the deep dermis. In contrast, patients with hernia had zonesin the dermis with thinner and disaggregated collagen tracts. Connective tissue had a lax aspectin these patients. Collagen fiber density was 52% lower in patients with hernia, compared tosubjects without hernia. No differences in elastic fiber density or distribution was observed be-tween groups.

ESTADO NUTRITIVO MATERNO INICIAL Y PESO PROMEDIO DE SUS RECIÉN NACIDOS A TÉRMINO

Se estudio la relacion existente entre la nutricion materna de primer trimestre, el Indice de Masa Corporal (IMC), que presentaban en un control prenatal inicial a las 8-12 semanas, con el crecimiento fetal expresado como peso promedio de nacimiento a termino, en 9.735 mujeres que tuvieron parto en la Maternidad del Hospital Regional de Temuco (1994-2002) con embarazos seleccionados, edad gestacional conocida precozmente y partos de termino (38 a 42 semanas), Los percentiles 10 y 90 de indice de masa corporal materna observados al control prenatal inicial fueron: 20.7, y 30.6 respectivamente. El peso neonatal promedio a termino para el momento del estudio (38 - 42 semanas) fue 3560 ± 442 g (1DE). Se observo una correlacion positiva entre el IMC materno inicial y el peso promedio de nacimiento (r = 0.0611). El analisis de tendencia mostro que por unidad de cambio de IMC materno (Kg / Mt2) se producen 27.9 g de cambio en el peso de nacimiento. Un modelo de asociacion obtenido por regresion lineal multiple entre el IMC materno y el peso neonatal ajustado por cuatro variables (edad de gestacion al parto, sexo del recien nacido, paridad y en menor grado edad materna), mostro que el IMC materno sigue en asociacion significativa con el peso de nacimiento (p < 0.00). Por cada unidad de cambio de IMC materno, se producen 23.3 de cambio en el peso neonatal. El IMC materno al comienzo del embarazo es un factor predictivo altamente asociado al peso de nacimiento, aun cuando sea corregido por variables intervinientes como edad gestacional al parto, sexo del recien nacido, y paridad edad materna

Diferencia en peso de nacimiento promedio según tres variables biológicas en recién nacidos normales

Background: The most important determinant of birth weight is gestational age. However, other biological variables may influence this parameter. Aim: To study the influence of maternal parity, height and neonatal gender on the birth weight of normal newborns in a public Hospital of Southern Chile. Material and methods: A computer registry of all deliveries attended in Temuco Hospital between 1993 and 1998 was analyzed. Normal deliveries giving birth to newborns of more than 2,500 g and from women who did not suffer from conditions that could influence birth weight, such as hypertension, undernutrition or smoking, were selected. Results: From 27,736 deliveries, 12,580 were selected for the study. Male newborns with gestational ages from 37 to 42 weeks, had a higher weight than their female counterparts. Multiparous women and those with a height over 154 cm gave birth to newborns with a higher weight than nulliparous women or than those with a height of less than 154 cm. Conclusions: According to these results, birth weight must be corrected by gender and maternal features, to define those newborns that have a low birth weight for their gestational age.

Evaluación de factores histológicos pronósticos de sobrevida en melanoma maligno cutáneo, seguimiento de 13 años

Prognostic factors for survival of malignant melanomas Background: The incidence of malignant melanoma is increasing steadily. Aim: To study pathologi- cal prognostic factors in malignant melanomas. Material and Methods: Review of pathological records of cutaneous malignant melanomas diagnosed between 1995 and 2008. Medical records of patients were re- viewed and those with distant metastases at the moment of surgery were excluded. Follow up was performed contacting patients and reviewing death records at the Chilean National Identification Registry. The cause of death was classified as related to the melanoma or unrelated. Results: One hundred sixty two records, corres- ponding to patients aged from 13 to 93 years (51% women), were included in the study. Twenty nine percent of patients died during the follow up period that ranged from 1 to 127 months. Five and ten years survival was 71 and 60% respectively. A multivariable Cox analysis demonstrated that only the TNM classification of the primary tumor, which is categorized using the Breslow maximal depth, had prognostic significance. Compared to women, men had a 1.97 higher relative risk of dying due to the melanoma. Conclusions: TNM classification of melanomas is the most important prognostic factor for survival.

EVALUACIÓN NEONATAL DEL CRECIMIENTO INTRAUTERINO DE RECIÉN NACIDOS EN HOSPITAL REGIONAL DE TEMUCO: COMPARACION CON TRES ESTÁNDARES NACIONALES

Antecedentes: El peso, la talla, el perimetro del craneo y el indice ponderal neonatal segun la edad gesta-cional, son importantes indicadores del crecimiento intrauterino. La OMS recomienda para los distintos centros perinatologicos confeccionar y actualizar graficas y tablas que permitan valorar mejor las alteraciones del crecimiento fetal. Objetivo: Construir una curva neonatal local de crecimiento intrauterino segun edad gestacional, y comparar el peso neonatal con otras curvas chilenas. Metodo: Estudio de corte transversal en 57.470 partos de poblacion obstetrica seleccionada, nacidos entre las 24 y 42 semanas de gestacion, atendidos en el Hospital Regional de Temuco, durante los anos 1994-2007. Se obtuvo para las variables neonatales (peso, talla, craneo e indice ponderal neonatal) la distribucion percentilar (p3, p5, p10 p50y p90) por edad gestacional. Resultados: En el criterio de Temuco la distribucion del peso neonatal fue de 80% adecuados, 10% pequenos y 10% grandes para la edad gestacional. Con los estandares de comparacion (curvas de crecimiento intrauterino de Juez, Alarcon y Gonzalez, respectivamente) encontramos diferencias para la proporcion de recien nacidos bajo p10 de 8,2%, 7,8% y 4,2%, respectivamente, y en categoria grandes para la edad gestacional de 14,5%, 15,2% y 17,4%, respectivamente. Conclusion: La comparacion de nuestra curva local con los tres estandares chilenos, permite detectar diferencias significativas de crecimiento fetal, especialmente con el estandar nacional que incluye poblacion obstetrica no seleccionada.

Validez diagnóstica de la biopsia intraoperatoria en cirugía de lesiones mamarias palpables

Background: During the surgical treatment of breast neoplasms (benign or malignant), frozen section biopsy is frequently requested to assess the kind of lesion and determine the surgical margins. Aim: To assess the diagnostic yield of frozen section breast biopsy. Material and methods: All the pathological reports of frozen section biopsies and definitive biopsies of 337 women aged 26 to 88 years, operated for suspected breast neoplasms between 2002 and 2006, were reviewed. The sensitivity, specificity and predictive value of frozen section biopsy, were calculated using the definitive biopsy as the gold standard. Results: The definitive biopsy confirmed the presence of cancer in 290 women (86%). There were two false negative (0.59%) and no false positive frozen section biopsies for cancer detection. The sensibility for cancer detection was 99.3% and the specificity 100%. The positive predictive value was 100% and the negative predictive value 96.1%. The diagnosis of phyllodes tumor was missed by frozen section biopsy in three cases. The margins were informed in the 258 frozen section biopsies (79%) and in 59 cases (18%), these were positive for cancer. Conclusions: Frozen section biopsy is useful and reliable for cancer detection and margin status assessment

¿Son los niveles de prolactina y estradiol al tercer mes posparto factores predictores del tiempo de aparición de la primera menstruación posparto?: Modelo predictivo mediante análisis de sobrevida

Background: The variability in the duration of lactational amenorrhoea (LA) lead to develop statistical multivariate models to predict the risk of the appearance of the first postpartum menstruation. Aim: To estimate the probability of recovering the first postpartum menstruation by means of a survival analysis, including hormonal levels and other parameters as predictor variables. Material and Methods: Eighty one mothers in exclusive breastfeeding until the sixth postpartum month, in whom estradiol, basal and post suckling prolactin were measured at the third post partum month, were studied. The variables that better predict the appearance of the first menstruation between the 3 rd and 12 th postpartum months, were identified using a Cox model survival analysis. Results: The median amenorrhea survival time (the lapse when the chance of recovering menstruation is 50%) was 209 days from delivery. Dichotomized estradiol and post suckling prolactin were the only significant variables that predicted the return of menstruation, with cutoff points of 190 pmol/ and 2,550 mIU/L, respectively. Conclusions: Post suckling prolantin and estradiol levels, measured at the third post partum month, are predictors for the time of appearance of the first postpartum menstruation (Rev Med Chile 2007; 135: 419-26). (Key words: Amenorrhea; Estradiol; Lactation; Prolactin)

Descripción de la Cronología del Dolor de las Contracciones Uterinas para Analgesia del Trabajo de Parto, una tarea pendiente

Aim: To describe the timing of the moment of maximum intensity of uterine contraction (UC) pain in labor to possibly enable the development of new models for administering endovenous analgesia. Materials and Methods: Full-term pregnant women in labor, recruited from March 2014 for 18 months, using consecutive nonprobability sampling. The moment of maximum pain was ascertained as self-reported by patients previously trained with chronometers. Analysis: Regression for repeated measurements from mixed results at 3-5, 6-7 and 8-10cm of dilation. The response variable was the time interval from the moment of maximum pain of the baseline UC to the following contraction. Results: In 64 patients, 5 time intervals were obtained. For the dilation of 3-5cm, a median=140.92 seconds and regression coefficients (RC) in 4 time intervals relative to the baseline of 4.2, 15.9, -2.7 and -5.8 seconds. For 6-7cm, a median =131.16 sec and RC 13.4, 11.3, 2 and -10 sec. For 8-10cm, a median =129.3 sec and RC -6.7, 0.49, -2.5 and -7.7 sec. There were no significant differences among the REV CHIL OBSTET GINECOL 2017; 82(2) 76 regression coefficients. Conclusions: With the data collected we can report that there were no statistically significant differences between the time intervals of the moments of maximum pain during active labor. This information is relevant to support the development of a predictive model for this pain.

ÍNDICES ANTROPOMÉTRICOS PARA LA EVALUACIÓN DE LA EMBARAZADA Y EL RECIÉN NACIDO: CÁLCULO MEDIANTE TABLAS BIDIMENSIONALES

SUMMARY Background: Nutritional assessment is a widely used criterion for prognostic purposes and clinical management. In obstetrics, maternal and neonatal body mass index and neonatal ponderal index, respectively, are used. Objective: To construct bidimensional tables to facilitate indexes obtaining process in clinical practice, moreover, graphs also are recommend for nutritional categorize using this indexes. Methods: The anthropometric indexes that associate weight with height were calculated by their respectively formulas: weight divided by height squared or cubed, depending if body mass index or neonatal ponderal index is needed. For the subsequently categorization of both maternal and neonatal nutritional status, these indexes have to be judged in terms of gestational age graphics. For this process, we recommend national standard references. Results: Two bidimensional tables were built to calculate the indexes and were delimited according to anthropometric averages of our population. Conclusion: These tables will facilitate the obtaining of indexes by the clinicians and, at the same time, the nutritional status diagnosis of pregnant women and their newborn.

Survival of patients with vulvar cancer

Background: Vulvar cancer corresponds to 3 to 5% of all female reproductive tract malignancies. Therefore it is classifed as a low frequency disease. Aim: To estimate overall and conditional survival one and two years after diagnosing women with vulvar cancer. Material and Methods: Retrospective cohort study. The patient database of an oncological hospital was revised and patients with vulvar cancer diagnosed between 1997 and 2006 were selected. The clinical records of these women were reviewed. Results: Eighty six women aged 32 to 92 years, were identified. Eighty percent had a squamous carcinoma, 46% were in stage III, 48% received incomplete treatment, 40% consulted due to the presence of a vulvar mass and 18% had lesions in labia majora or minora. Overall five years survival at 5 years was 41.8%. There were statistically significant differences in survival depending on the initial stage of cancer (p = 0.02). Five year conditional survival, one and two years after the diagnosis, was 59 and 79%, respectively. Conclusions: Five years overall survival of these group of women with vulvar cancer was 41.8%. The figures increased to 59 and 79% in patients who had survived one and two years after the diagnosis. The stage of the lesion and the initial survival are survival prognostic factors for vulvar cancer.