Ex utero intrapartum surgery (EXIT): Combined spinal epidural anesthesia (CSE) and general anesthesia with remifentanil. Case Report

Congenital high airway obstruction syndrome (CHAOS) is a life-threatening condition with a poorly understood natural history[1]. EXIT is a controlled technique that is designed to allow partial fetal delivery via cesarean section with subsequent establishment of a safe fetal airway, requires maintenance of uterine relaxation to continue placental perfusion and prevent placental separation[2]. A healthy 28 year old primigravida, 33 weeks of gestation, with a fetus known to have CHAOS due to tracheal atresia and ascites, scheduled for EXIT. Phase 1: ascites drainage by punction and fetus external version (breech presentation) before EXIT. CSE was chosen for this phase (5mg hyperbaric bupivacaine and 25ug fentanyl, intrathecally), with light conscious sedation (midazolan 5mg). Epidural catheter was placed. Phase 2: Fetus had a tracheal atresia. Laryngotracheoplasty was needed. Based on estimated fetal weight, an intramuscular injection of fentanyl 10ug/kg, vecuronium 0.2mg/kg and atropine 10ug/kg was given to the fetus[3]. After propofol induction, sevoflurane (2 MAC) and intravenous nitroglycerin, to ensure a fully relaxed uterus, and remifentanyl infusion (cardiovascular stability), was given to the mother. Fetopalcental support last for 20 min, fetus laryngotracheoplasty was done. Apgar was 3/4. CSE should be considered for EXIT. Nitroglycerin infusion along with deep volatile anesthesia provides full uterine relaxation preventing placental separation while preserving placental perfusion. Remifentanyl should be considered in high-risk obstetric surgery[4]

CHALLENGE 6: Exposing the roots of mental disorders

Mental disorders have devastating and increasing impact in our societies. CSIC researchers face the challenge of determining the biological and social causes and consequences of these disorders, and of finding efficient therapies. To these aims, the collaborative effort of neuroscientists, neurologists, psychiatrists, psychologists and human and social scientists, the use and development of state-of-the-art technologies and the contact with patient associations and pharma industry are required.Peer reviewe

Quantificação de Bisfenol-A livre em sangue de cordão umbilical humano a nível de traços

El Bisfenol-A (BPA) es ampliamente utilizado en la producción de plásticos de policarbonato, por lo que está presente en productos de uso masivo. Es un disruptor endócrino e incide en el desarrollo gonadal y del sistema nervioso central. La exposición de mujeres embarazadas al BPA es particularmente preocupante para el feto en desarrollo, debido a que atraviesa la placenta pasando a la sangre de cordón y al líquido amniótico. Esto se suma a la escasa o nula actividad enzimática fetal para biotransformarlo en BPAglucurónido inactivo, causando posibles efectos nocivos a la descendencia a dosis muy bajas y sostenidas. Con el propósito de estudiar la exposición al BPA y sus efectos en la población de Argentina se desarrolló y validó un método analítico por cromatografía líquida acoplada a espectrometría de masa, que permite la cuantificación de trazas de BPA libre (forma estrogénica, activa) en plasma de cordón umbilical. La técnica consiste en la precipitación de proteínas de la sangre de cordón por agregado de acetonitrilo y posterior centrifugado e inyección del sobrenadante. Se utilizó una elución isocrática en la cromatografía líquida, y la espectrometría de masa se realizó empleando Electrospray negativo en modo de monitoreo de reacciones múltiples. Los valores de BPA libre cuantificados están en el rango de 1,0 a 12,1 ng/mL, límite de detección: 0,6 ng/mL.Bisphenol-A (BPA) is widely used in the production of polycarbonate plastics and therefore, it is present in products of massive use. It is known as an endocrine disruptor and has an impact on gonadal and central nervous system development. Exposure of pregnant women to BPA is particularly worrying for the developing fetus because it crosses the placenta into the cord blood and amniotic fluid, coupled with little or no fetal enzymatic activity to biotransform it into inactive BPA-glucuronide, causing possible harmful effects to the offspring at very low and sustained doses. With the aim to study the exposure to BPA and its effects on the population of Argentina, an analytical method was developed and validated by liquid chromatography coupled to mass spectrometry, which allows the quantification of trace amounts of free BPA (estrogenic, active form) in plasma of umbilical cord. The method involves protein precipitation by the addition of acetonitrile and subsequent centrifugation and injection of supernatant. An isocratic elution was used in liquid chromatography, and mass spectrometry was performed using negative Electrospray mode in multiple reaction monitoring. Quantified free BPA values are in the range of 1.0 to 12.1 ng/mL, Detection Limit: 0,6 ng/mL.Fil: Cases, Gabriel Guillermo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad de Microanálisis y Métodos Físicos en Química Orgánica. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Unidad de Microanálisis y Métodos Físicos en Química Orgánica; Argentina. Hospital Italiano; ArgentinaFil: Calinski, Gustavo J.. Hospital Italiano; ArgentinaFil: Méndez, Mariana L.. Hospital Italiano; ArgentinaFil: Vidal, Flavia A.. Hospital Italiano; ArgentinaFil: Otaño, Lucas. Hospital Italiano; ArgentinaFil: Mariani, Gonzalo L.. Hospital Italiano; ArgentinaFil: Figar, Silvana. Hospital Italiano; ArgentinaFil: Giménez, María I.. Hospital Italiano; Argentin

Bisfenol-A: quantificação em urina de gestantes por cromatografia gasosa-espectrometria de massa

El uso de bisfenol-A (BPA) a nivel de la industria global se ha venido incrementando en los últimos años, y fueron los mercados emergentes los impulsores de esta demanda creciente. Las aplicaciones de BPA en la industria de los alimentos y bebidas representan solo del 3 al 4% del consumo global de policarbonato, pero su uso está siendo reexaminado debido a que se conocieron varios trabajos científicos que indican la existencia de una relación directa entre el BPA y los efectos adversos para la salud. La contaminación de los alimentos y bebidas se produce por migración del BPA desde los envases que los contienen (alimentos enlatados, vinos, etc.), y es la principal fuente de exposición en el humano. Para evaluar dicha exposición se desarrolló y validó un método analítico por cromatografía gaseosa acoplada a espectrometría de masa para la cuantificación de BPA total en orina de mujeres embarazadas atendidas en el Hospital Italiano de Buenos Aires en el año 2013, con un límite de cuantificación de 2,0 ng/mL y un límite de detección de 0,8 ng/mL. De las 149 muestras de orina analizadas, el 66,4% fueron cuantificables, con la mediana de BPA total de 4,8 ng/mL (4,3 ng/mg de creatinina) y la media geométrica de 4,8 ng/mL (4,7 ng/mg de creatinina).The use of bisphenol-A (BPA) at the level of the global industry has been increasing in recent years, with emerging markets being the drivers of this growing demand. BPA applications in the food and beverage industry represent only 3 to 4% of the global consumption of polycarbonate, but its use is being reexamined because several scientific works were reported indicating the existence of a direct relationship between BPA and adverse effects on health. The contamination of food and beverages is produced by the migration of BPA from the containers that hold them (canned foods, wines, etc.) and it is the main source of exposure in humans. To evaluate this exposure, an analytical method was developed by gas chromatography coupled to mass spectrometry for the quantification of total BPA in urine of pregnant women treated at the Hospital Italiano de Buenos Aires in 2013, with a limit of quantification of 2.0 ng/mL and of detection of 0.8 ng/mL. Of the 149 urine samples analyzed, 66.4% were quantifiable, with a median total BPA of 4.8 ng/mL (4.3 ng/mg creatinine) and a geometric mean of 4.8 ng/mLO uso de bisfenol-A (BPA) ao nível da indústria global foi aumentando nos últimos anos, e foram os mercados emergentes que deram impulso a essa demanda crescente. As aplicações de BPA na indústria de alimentos e bebidas representam apenas 3 a 4% do consumo global de policarbonato, mas seu uso está sendo reexaminado visto que vários trabalhos científicos indicando a existência de uma relação direta entre o BPA e os efeitos adversos na saúde foram conhecidos. A contaminação dos alimentos e bebidas é produzida pela migração de BPA das embalagens que os contêm (alimentos enlatados, vinhos, etc.) e é a principal fonte de exposição em humanos. Para avaliar esta exposição, foi desenvolvido e avaliado um método analítico por cromatografia gasosa acoplada a espectrometria de massas para a quantificação do BPA total na urina de gestantes atendidas no Hospital Italiano de Buenos Aires em 2013, com um limite de quantificação de 2,0 ng/mL e um limite de detecção de 0,8 ng/mL. Das 149 amostras de urina analisadas, 66,4% foram quantificáveis, com uma mediana de BPA total de 4,8 ng/mL (4,3 ng/mg de creatinina) e a média geométrica de 4,8 ng/mL (4,7 ng/mg de creatinina).Fil: Cases, Gabriel Guillermo. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad de Microanálisis y Métodos Físicos en Química Orgánica. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Unidad de Microanálisis y Métodos Físicos en Química Orgánica; ArgentinaFil: Uicich, Raúl Eduardo. Hospital Italiano; ArgentinaFil: Kandel Gambarte, Paula Cristina. Hospital Italiano; ArgentinaFil: Vazquez, Marcela Liliam. Hospital Italiano; ArgentinaFil: Moix, Claudio Fernando. Hospital Italiano; ArgentinaFil: Ferloni, Analía. Hospital Italiano; ArgentinaFil: Vidal, Flavia Alejandra. Hospital Italiano; ArgentinaFil: Otaño, Lucas. Hospital Italiano; ArgentinaFil: Figar, Silvana. Hospital Italiano; ArgentinaFil: Aragone, Soledad. Hospital Italiano; ArgentinaFil: Giménez, María Isabel. Hospital Italiano; Argentin

Laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy

Objective: To evaluate the feasibility and safety of laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy. Study Design: An observational study of a prospective collection of data of all pregnant women who underwent laparoscopic surgery for adnexal masses during the first trimester of pregnancy between January 1999 and November 2012 at the Obstetrics and Gynecology Department of the Italian Hospital of Buenos Aires, Buenos Aires, Argentina was performed. Results: A total of 13 women were included. The median (range) gestational age at the moment of surgical procedure was 7 weeks (range: 5-12 weeks). The main indication of surgery was cyst torsion in four cases (30.7%) and rupture of ovarian cysts in four cases (30.7%). Other indications included persistent ovarian cyst in three patients (23%) and heterotopic pregnancy in two cases (15.3%). Neither surgical complications nor spontaneous abortions occurred in any of the cases and the post-operative period was uneventful in all the cases. No cases of intrauterine growth retardation, preterm delivery, congenital defects, or neonatal complications were registered. Conclusion: The treatment of complicated adnexal masses by laparoscopic surgery during the first trimester of pregnancy appears to be a safe procedure both for the mother and for the foetus. Additional research on a larger number of cases is still needed to support these conclusions

Embarazo múltiple

La gestación múltiple o gemelar representa un embarazo de alto riesgo porque se asocia a una mayor tasa de morbi-mortalidad materna, perinatal e infantil comparado con embarazos únicos. Los embarazos múltiples tienen una prevalencia de 2 a 3 % de los nacimientos, pero producen alrededor del 25 % de los ingresos en las unidades de cuidados intensivos neonatales. El principal problema está dado por la prematuridad y sus consecuencias de corto y largo plazo, seguido por los trastornos de crecimiento y las malformaciones congénitas.Facultad de Ciencias Médica

Performance of the cervical shortening for prediction of spontaneous preterm birth in uncomplicated twins

There is a lack of consensus about the management of twins with significant cervical length (CL) shortening, especially if CL is above 25 mm. Therefore, it is important to define “abnormal” CL change over time, and to compare the performance of different strategies. The aim of this study was twofold, to describe the performance of the cervical shortening and that of an integrated strategy that includes both the cervical shortening and a fixed CL cutoff Retrospective cohort study of twins followed in our Twins Clinic at Hospital Italiano de Buenos Aires from 2013 to 2017. Inclusion criteria were dichorionic or monochorionic diamniotic twins with CL measurement between 18 and 33 + 6 weeks with available data of the delivery. Exclusion criteria included any of the following complications: iatrogenic preterm delivery velocity of shortening over time (mm/week) and as the ratio of shortening over time (%/week). ROC curves for each period were constructed and two different cutoffs were used to classify changes of the CL as positive or negative screening: a) the shortening of CL associated to the highest value of the Youden Index and b) fixing a 10% false positive rate (FPR). For the second objective, we analyzed an integrated strategy considering a fixed cutoff of 25 mm at any GA and/or a significant shortening. The screening was considered positive if any CL measurement was We included 378 patients and 1417 measurements, 284 (75%) dichorionic and 94 (25%) monochorionic. Between 20 and 28 weeks, with a change in CL cutoff = 1.6 mm/week or 4.1%/week the detection rate was 54.2% (32.8–74.4%) and the specificity 80.5% (75.1–85.1%) and 83.5% (78.5–87.8%) respectively. In the integrated strategy, the detection rate was 65.7% (47.8–80.9%) and the specificity 69 (63.7–74). All the ROC curves of the periods studied showed an AUC p = .02) and the most important change in CL was at 20–24 weeks both in the velocity and in the ratio of shortening over time. Conversely, patients that delivered at term showed a higher change in CL in the third trimester. The performance of all the strategies analyzed as a predictor of sPTB <34 weeks was moderate. The period 20–28 weeks detected half of the patients at risk with a FPR around 10–20% and the integrated strategy increased the sensitivity up to a detection of two thirds of the patients at risk but with a FPR of ∼30%. Future analyses need to explore other strategies to improve the performance and to really identify the patients at higher risk.</p