Mioma naciente submucoso séptico. Presentación de caso clínico

Uterine myomatosis is the most frequent benign neoplasm in women, but it is also an underdiagnosed pathology because it generally does not generate symptoms, occurring in 25% of women in the reproductive stage and 70% in the postmenopausal stage. The objective of this work is to present a clinical case of a patient in the menopausal stage, who debut a large nascent submucosal fibroid with septic characteristics, its management and clinical evolution. Materials and Methods: A retrospective descriptive study was performed, presenting a clinical case. The informed consent of the patient was requested for review of clinical history and images that contributed to the development of the present research. Results :describes the case of a 48-year old nuligestal female patient who presented a large nascent submucosal fibroid, so total abdominal hysterectomy plus bilateral salpingo-oforentomia is performed, obtaining a myomatous uterus of septic characteristics that generated a complicated postoperative evolution. Conclusion: it is important to make an adequate and timely diagnosis, a correct medical history, know the genetic desires or not of the patient, the age at which she is, the size of the fibroid or fibroids, its location,take into consideration and be prepared to treat the most frequent complications.La miomatosis uterina es la neoplasia benigna más frecuente en las mujeres, pero a su vez es una patología subdiagnosticada debido a que, generalmente no genera síntomas, ocurriendo en el 25 % de mujeres en etapa reproductiva y el 70 % en etapa de menopausia.  El objetivo de este trabajo es presentar un caso clínico de una paciente en etapa menopaúsica, que presentó un gran mioma submucoso naciente con características sépticas, su manejo y evolución clínica. Materiales y Métodos: Se realizó un estudio descriptivo retrospectivo, presentación de caso clínico. Se solicitó el consentimiento informado de la paciente, para revisión de historia clínica e imágenes que contribuyeron al desarrollo de la presente investigación. Resultados : se describe  el caso  de una paciente de sexo femenino de 48 años de edad  multigesta, que presentó un gran mioma submucoso  naciente, por lo que se realiza histerectomía abdominal total más salpingo ooforectomía bilateral , obteniéndose un útero miomatosos de características sépticas que generó  una evolución posoperatoria complicada Conclusión : es importante realizar un diagnóstico adecuado y oportuno , una correcta historia clínica , conocer los deseos  genésico o no de la paciente , la edad en la que se encuentra, el tamaño del o los miomas , su localización,   tener en consideración y estar preparado para tratar las complicaciones más frecuentes

Hemorragia anteparto asociada a placenta succenturiata. Reporte de un caso.

Introduction: placenta succenturiata is a morphological abnormality of the placenta that can result in significant morbidity and mortality for both the fetus and the mother. Aim to describe a clinical case of antepartum hemorrhage associated with placenta succenturiata. Materials and methods: a retrospective descriptive study, clinical case presentation, informed consent of the patient to have access to the clinical history and use of images corresponding to the present investigation. Clinical case: the case of a pregnant woman of 33 weeks, who enters the emergency area, with hemorrhage of the third trimester, was observed in the ultrasound, presence of a lobe that reaches the level of the internal cervical orifice, being confused with placenta previa, patient was stable and under observation, with continuous fetal monitoring, until complete lung maturation was obtained, later I present pain and bleeding before delivery so it was operated surgically by cesarean operation where the presence of succenturiado lobe in the placenta is confirmed. Both developments were favourable. Discussion: The present article demonstrates, a rare variety of placental malformation that causes multiple complications and belongs to the differential of other pathologies that cause third trimester bleeding, being associated with placenta previa, so, we must keep in mind the placenta succenturiata as a cause of bleeding in the third trimester, also take into account that in the postpartum period is cause of retention of a placental portion and can cause bleeding or infection. Conclusions: The placenta succenturiata is an abnormality of rare presentation, which is part of the differential diagnosis of haemorrhages before delivery and must be diagnosed in the prenatal period, so that prenatal control and care of the birth can be performed properly, in addition to giving guidance to the patient and her family. Caesarean delivery is recommended in these cases, with surgical approach and type of incision of choice, according to comorbidities and clinical status of the patient.Introducción: La placenta succenturiata es una anomalía morfológica de la placenta que puede resultar en morbilidad y mortalidad significativas tanto para el feto como para la madre. Objetivo: describir un caso clínico de hemorragia anteparto asociado a placenta succenturiata.   Materiales y métodos: se realizó un estudio descriptivo retrospectivo, presentación de caso clínico, se obtuvo consentimiento informado  de  paciente para tener acceso a la historia clínica y uso de imágenes correspondientes a la presente investigación. Caso clínico:  se presenta el caso de una gestante de 33 semanas, que ingresa al area de emergencias, con hemorragia del tercer trimestre, en la ecografía se observó,  presencia de un  lóbulo que alcanza el  nivel del orificio cervical interno, confundiéndose con placenta previa,  paciente se encontraba  estable y en observación, con monitorización fetal continua,  hasta obtener maduración pulmonar completa, posteriormente presento dolor y sangrado ante parto por lo que fue intervenida quirúrgicamente mediante operación cesárea donde se constata la presencia de lóbulo succenturiado en placenta. La evolución de ambos fue favorable. Discusión: El presente artículo demuestra,  una rara variedad de malformación placentaria que provoca múltiples complicaciones y pertenece al diferencial de otras patologías que provocan hemorragia del tercer trimestre, pudiendo estar asociadas con placenta previa, por lo que,  hay que tener presente la placenta succenturiata como una causa de hemorragia del tercer trimestre, además tener en consideración que en el periodo postparto  es causa de retención de una porción placentaria y  puede ocasionar hemorragia o infección. Conclusiones: La placenta succenturiata es una anomalía de rara presentación, que forma parte del diagnóstico diferencial de las hemorragias ante parto y que debe ser diagnosticada en el periodo prenatal, para poder así, realizar un control prenatal y atención del parto de forma adecuada, además de dar una orientación a la paciente y su familia. Se recomienda en estos casos el parto por cesárea, con abordaje quirúrgico y tipo de incisión a elección, de acuerdo a comorbilidades y estado clínico de paciente

Prevalence of resistance associated substitutions and efficacy of baseline resistance-guided chronic hepatitis C treatment in Spain from the GEHEP-004 cohort

Treatment guidelines differ in their recommendation to determine baseline resistance associated substitutions (RAS) before starting a first-line treatment with direct-acting antivirals (DAAs). Here we analyze the efficacy of DAA treatment with baseline RAS information. We conducted a prospective study involving 23 centers collaborating in the GEHEP-004 DAA resistance cohort. Baseline NS5A and NS3 RASs were studied by Sanger sequencing. After issuing a comprehensive resistance report, the treating physician decided the therapy, duration and ribavirin use. Sustained virological response (SVR12) data are available in 275 patients. Baseline NS5A RAS prevalence was between 4.3% and 26.8% according to genotype, and NS3 RASs prevalence (GT1a) was 6.3%. Overall, SVR12 was 97.8%. Amongst HCV-GT1a patients, 75.0% had >800,000 IU/ml and most of those that started grazoprevir/elbasvir were treated for 12 weeks. In genotype 3, NS5A Y93H was detected in 9 patients. 42.8% of the HCV-GT3 patients that started sofosbuvir/velpatasvir included ribavirin, although only 14.7% carried Y93H. The efficacy of baseline resistance-guided treatment in our cohort has been high across the most prevalent HCV genotypes in Spain. The duration of the grazoprevir/elbasvir treatment adhered mostly to AASLD/IDSA recommendations. In cirrhotic patients infected with GT-3 there has been a high use of ribavirin.This work was supported in part by grants from Fondo de Investigacion Sanitaria (www.isciii.es) (PI15/00713), Plan Nacional de I+D+I and Fondo Europeo de Desarrollo Regional-FEDER (http://www.ciencia.gob.es/portal/site/MICINN/menuitem.dbc68b34d11ccbd5d52ffeb801432ea0/?vgnextoid=e331aa27bfba7610VgnVCM1000001d04140aRCRD) (RD16/0025/0040), Fundacion Progreso y salud, Junta de Andalucia (https://www.sspa.juntadeandalucia.es/fundacionprogresoysalud/gestionconvocatorias/ugc/login.sol.jsp?id=10) (PI-0411-2014), and GEHEP-SEIMC (GEHEP-004).Peer reviewe

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

International audienceDUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

International audienceDUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

DUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

International audienceDUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

International audienceDUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

International audienceDUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals

Supernova Pointing Capabilities of DUNE

International audienceThe determination of the direction of a stellar core collapse via its neutrino emission is crucial for the identification of the progenitor for a multimessenger follow-up. A highly effective method of reconstructing supernova directions within the Deep Underground Neutrino Experiment (DUNE) is introduced. The supernova neutrino pointing resolution is studied by simulating and reconstructing electron-neutrino charged-current absorption on $^{40}$Ar and elastic scattering of neutrinos on electrons. Procedures to reconstruct individual interactions, including a newly developed technique called ``brems flipping'', as well as the burst direction from an ensemble of interactions are described. Performance of the burst direction reconstruction is evaluated for supernovae happening at a distance of 10 kpc for a specific supernova burst flux model. The pointing resolution is found to be 3.4 degrees at 68% coverage for a perfect interaction-channel classification and a fiducial mass of 40 kton, and 6.6 degrees for a 10 kton fiducial mass respectively. Assuming a 4% rate of charged-current interactions being misidentified as elastic scattering, DUNE's burst pointing resolution is found to be 4.3 degrees (8.7 degrees) at 68% coverage