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Resumen ANTECEDENTES: La neoplasia gestacional trofoblástica es un tumor raro, derivado de la gestación que procede de un desarrollo anormal del tejido trofoblástico. Incluye cuatro variedades, entre las que se encuentra la mola invasiva y el coriocarcinoma. Puede tener diferentes grados de proliferación; el diagnóstico diferencial es decisivo porque influye directamente en el tratamiento. Las molas premalignas suelen tratarse con legrado uterino, las malignas requieren tratamiento sistémico con mono o poliquimioterapia. CASO CLÍNICO: Paciente de 13 años, hospitalizada debido a un cuadro de vómitos y dolor abdominal. Durante el internamiento se le practicaron estudios complementarios: determinación de la fracción β de la gonadotropina coriónica humana (β-hCG) y tomografía axial computada para plantear el diagnóstico diferencial. El diagnóstico definitivo lo aportó la biopsia obtenida mediante legrado. El tratamiento se basó en la poliquimioterapia. En la actualidad está en remisión completa de la enfermedad. CONCLUSIONES: Resulta imprescindible detectar lo más temprano posible la gestación anómala, entender perfectamente su evolución e importancia de la anticoncepción mientras se trata y la enfermedad desaparece y minimizar la cantidad de pacientes que deben recibir quimioterapia.

Abstract BACKGROUND: Gestational trophoblastic neoplasia is a rare tumor that originates from pregnancy and it develop from anormal proliferation of trophoblastic tissue. It includes four varieties, including invasive mole and choriocarcinoma. They can present different degrees of proliferation, being essential differential diagnosis since it directly influences the treatment. Premalignant moles are usually treated by suction curettage while malignant forms require systemic therapy with mono or polychemotherapy. OBJECTIVE: Report the case, paying special attention to the differential diagnosis and treatment used, analyzing the reasons why polychemotherapy is established and describing the different possible options, based on current scientific evidence. CLINICAL CASE: We present the case of an invasive mola in a 13-year-old patient hospitalized by vomiting and abdominal pain. During this period, complementary techniques such as the determination of the β fraction of the human chorionic gonadotropin (β-hCG) or computed tomography (CT) are required to establish the differential diagnosis. Finally, the definitive diagnosis is provided by the biopsy obtained by curettage. Treatment is instituted with the pattern of polychemotherapy being, currently, with complete remission of the disease. CONCLUSIONS: Thus, it is essential to detect anomalous gestation early, to understand perfectly the evolution of this entity, the importance of contraception during its resolution, and to minimize patients susceptible to chemotherapy.

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Resumen ANTECEDENTES: La incidencia de plasmocitoma extramedular es baja y su localización ginecológica es excepcional. Hasta la fecha se han reportado 27 casos de plasmocitomas ginecológicos (11 correspondientes a localización cervical). CASO CLÍNICO: Paciente de 37 años, sin antecedentes médicos de interés, que acudió a consulta por sangrado uterino anormal y postcoito. En la especuloscopia se apreció el cuello uterino hipertrófico y friable. Con la biopsia cervical se estableció el diagnóstico de plasmocitoma. Posteriormente, un estudio de extensión descartó la afectación en otras localizaciones. El tratamiento consistió en histerectomía y linfadenectomía pélvica, sin tratamiento coadyuvante. Los estudios de anatomía patológica e inmunohistoquímica confirmaron el diagnóstico. En la actualidad, la paciente se encuentra en seguimiento y libre de enfermedad. CONCLUSIONES: Debido a los pocos casos reportados de plasmocitoma cervical, no existe un tratamiento de referencia. A pesar de ello, no parece haber diferencias entre las pacientes tratadas con radioterapia o cirugía. La tasa de evolución a mieloma múltiple varía de 14 a 36%. La quimioterapia no disminuye la tasa de evolución a mieloma múltiple, por lo que está contraindicada.

Abstract BACKGROUND: The incidence of extramedullary plasmacytoma is low and, specifically, the gynecological location is exceptional. To date, 27 cases of gynecological plasmacytomas have been published (11 corresponding to cervical location). CLINICAL CASE: 37-year-old patient, with no relevant medical history, who came to a consultation for abnormal uterine bleeding and bleeding. By spectroscopy, the hypertrophic and friable cervix was appreciated. Cervical biopsy verifies the diagnosis of plasmacytoma. Subsequently, an extension study ruled out involvement in other locations. Treatment consists of hysterectomy and pelvic lymphadenectomy, without adjuvant chemotherapy. The pathological and immunohistochemical studies confirmed the diagnosis. Currently, the patient is in follow-up and free of disease. CONCLUSIONS: Due to the scarcity of published cases of cervical plasmacytoma, there is no reference treatment. Despite this, there do not appear to be any differences between the patients treated with radiotherapy or surgery. The rate of progression to multiple myeloma varies from 14-36%. The adjuvant therapy does not change the rate of progression to multiple myeloma, so it is contraindicated.

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INTRODUCCIÓN: Hasta el momento, los resultados de distintas investigaciones sobre la exposición a Radiofrecuencias y sus consecuencias biológicas, son contradictorios. Nuestro estudio nace como un estudio de replicación, en conjunto con investigadores de la Escuela de Tecnología de la Salud de Lisboa, Lisboa, Portugal. Adoptamos el mismo diseño de estudio, para verificar si los resultados de su evaluación de la frecuencia de micronucleos (MN) en los usuarios de teléfonos móviles eran comparables a los resultados obtenidos en este estudio similar en Córdoba, Argentina. MATERIALES Y METODOS: Para estudiar el daño del ADN por la exposición a radiofrecuencia asociada con el teléfono celular se estudiaron los MN (marcadores celulares de daño genómico) en células bucales exfoliadas, extraídas de frotis de células de las mejillas internas derecha e izquierda de usuarios de teléfonos celulares en 83 voluntarios sanos de 18 a 36 años. Las frecuencias de MN fueron analizadas por la duración y el lado preferencial de uso del teléfono celular. RESULTADOS: no se observó relación entre la frecuencia de MN y la duración del uso como tampoco con el lado preferencial. CONCLUSION: nuestros resultados sugieren que la exposición a radiofrecuencia en los niveles observados no induce la formación de MN en células bucales. (AU)

INTRODUCTION: the results of various research on radiofrequency exposure and its biological consequences are contradictory. Taking into account this reasoning, our study was born as a replication study, together with researchers from the School of Health Technology of Lisbon, Lisbon, Portugal. We adopted the same study design, to verify if the results of your evaluation of the frequency of micronuclei (MN) in cell phone users were comparable to the results obtained in this similar study in Cordoba, Argentina. MATERIALS AND METHODS: To study ADN damage from radiofrequency exposure associated with cell phone, MN (cell markers of genomic damage) were studied in exfoliated buccal cells, extracted from right and left internal cheek cell smears of cell phone in 83 healthy volunteers from 18 to 36 years. RESULTS: The MN frequencies were analyzed by the duration and the preferential side of use of the cell phone. No relationship was observed between the MN frequency and the duration of use as well as the preferential side. CONCLUSION: our results suggest that exposure to radiofrequency in the observed levels does not induce the formation of MN in buccal cells. (AU)

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OBJECTIVE: to know the degree of fulfillment of the requests that women reflect in their birth plans and to determine their influence on the main obstetric and neonatal outcomes. METHOD: retrospective, descriptive and analytical study with 178 women with birth plans in third-level hospital. Inclusion criteria: low risk gestation, cephalic presentation, single childbirth, delivered at term. Scheduled and urgent cesareans without labor were excluded. A descriptive and inferential analysis of the variables was performed. RESULTS: the birth plan was mostly fulfilled in only 37% of the women. The group of women whose compliance was low (less than or equal to 50%) had a cesarean section rate of 18.8% and their children had worse outcomes in the Apgar test and umbilical cord pH; while in women with high compliance (75% or more), the percentage of cesareans fell to 6.1% and their children had better outcomes. CONCLUSION: birth plans have a low degree of compliance. The higher the compliance, the better is the maternal and neonatal outcomes. The birth plan can be an effective tool to achieve better outcomes for the mother and her child. Measures are needed to improve its compliance.

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17α-hydroxylase/17,20-lyase deficiency is a rare form of congenital adrenal hyperplasia caused by mutations in CYP17A1. Two phenotypic female sisters, aged 17 and 15 years and with 46,XY and 46,XX karyotypes, respectively, presented with primary amenorrhea and absent secondary sexual characteristics. The elder sib also presented with high blood pressure. Both patients had elevated levels of ACTH, gonadotropins, progesterone, corticosterone, and deoxycorticosterone, and reduced levels of estradiol, testosterone, androstenedione, 17-OH-P, DHEA-S, cortisol, aldosterone, and renin activity. The CYP17A1 gene was sequenced, and polymorphic haplotypes were further analyzed in the Spanish family and in Brazilian patients. The 2 sisters were compound heterozygous for p.Arg362Cys and p.Trp406Arg mutations, previously described as the most prevalent mutations in Brazilian families of Spanish (p.Trp406Arg) or Portuguese (p.Arg362Cys) origin. Analysis of polymorphisms in CYP17A1 suggested that the paternal allele with p.Arg362Cys may share a common origin with the Brazilian carriers, while the maternal allele with p.Trp406Arg did not. Hydrocortisone and sex hormone replacement therapy was initiated in both patients. In conclusion, one CYP17A1 mutation (p.Arg362Cys) may share a common ancestry in Brazilian and our present Spanish patients, while p.Trp406Arg may have arisen separately. The elder patient (46,XY) developed a more severe phenotype and a poorer response to estradiol replacement therapy.

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ABSTRACT Objective: to know the degree of fulfillment of the requests that women reflect in their birth plans and to determine their influence on the main obstetric and neonatal outcomes. Method: retrospective, descriptive and analytical study with 178 women with birth plans in third-level hospital. Inclusion criteria: low risk gestation, cephalic presentation, single childbirth, delivered at term. Scheduled and urgent cesareans without labor were excluded. A descriptive and inferential analysis of the variables was performed. Results: the birth plan was mostly fulfilled in only 37% of the women. The group of women whose compliance was low (less than or equal to 50%) had a cesarean section rate of 18.8% and their children had worse outcomes in the Apgar test and umbilical cord pH; while in women with high compliance (75% or more), the percentage of cesareans fell to 6.1% and their children had better outcomes. Conclusion: birth plans have a low degree of compliance. The higher the compliance, the better is the maternal and neonatal outcomes. The birth plan can be an effective tool to achieve better outcomes for the mother and her child. Measures are needed to improve its compliance.

RESUMO Objetivo: conhecer o grau de cumprimento das solicitações que as mulheres registram nos seus planos de parto e determinar sua influência nos principais resultados obstétricos e neonatais. Método: estudo retrospectivo, descritivo e analítico com 178 mulheres com plano de parto em hospital de terceiro nível. Critérios de inclusão: gestação de baixo risco, apresentação cefálica, parto único a termo. Cesarianas agendadas e urgentes sem trabalho de parto foram excluídas. Foi realizada análise descritiva e inferencial das variáveis. Resultados: o plano de parto foi majoritariamente cumprido em apenas 37% das mulheres. O grupo de mulheres cujo cumprimento foi baixo (menor ou igual a 50%) teve percentagem de cesarianas de 18,8% e seus filhos tiveram resultados piores no teste de Apgar e pH do cordão, enquanto que em mulheres com alto cumprimento (75% ou mais), a porcentagem de cesáreas caiu para 6,1% e seus filhos apresentaram melhores resultados. Conclusão: o plano de parto tem um baixo grau de cumprimento. Quanto maior o cumprimento, melhores são os resultados maternos e neonatais. O plano de parto pode ser uma ferramenta eficaz para alcançar melhores resultados para a mãe e seu filho. São necessárias medidas para melhorar seu grau de cumprimento.

RESUMEN Objetivo: conocer el grado de cumplimiento de las solicitudes que las mujeres reflejan en sus planes de parto y determinar su influencia en los principales resultados obstétricos y neonatales. Método: estudio retrospectivo, descriptivo y analítico con 178 mujeres con plan de parto en hospitales de tercer nivel. Criterios de inclusión: gestación bajo riesgo, presentación cefálica, parto único a término. Se excluyeron cesáreas programadas y urgentes sin trabajo de parto. Se realizó un análisis descriptivo e inferencial de las variables. Resultados: el plan de parto se cumplió mayoritariamente solo en el 37% de las mujeres. El grupo de mujeres donde el cumplimiento fue bajo (menor o igual al 50%) tuvo un porcentaje de cesáreas del 18,8% y sus hijos tuvieron peores resultados en test de Apgar y pH de cordón; mientras que en mujeres con cumplimiento alto (75% o mayor), el porcentaje de cesáreas cayó al 6,1% y sus hijos obtuvieron mejores resultados. Conclusión: el plan de parto tiene un grado de cumplimiento bajo. A mayor cumplimiento mejores son los resultados maternos y neonatales. Puede constituir una herramienta eficaz en la consecución de mejores resultados en la madre y su hijo. Son necesarias medidas que mejoren su grado de cumplimiento.

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OBJECTIVE: to evaluate the effects of labor stimulation with oxytocin on maternal and neonatal outcomes. METHOD: descriptive and analytical study with 338 women who gave birth at a tertiary hospital. Obstetric and neonatal variables were measured and compared in women submitted and non-submitted to stimulation with oxytocin. Statistics were performed using Chi-square test, Fisher exact test, Student t-test; and crude Odds Ratio with 95% confidence interval were calculated. A p < 0.05 was considered statistically significant. RESULTS: stimulation with oxytocin increases the rates of cesarean sections, epidural anesthesia and intrapartum maternal fever in primiparous and multiparous women. It has also been associated with low pH values of umbilical cord blood and with a shorter duration of the first stage of labor in primiparous women. However, it did not affect the rates of 3rd and 4th degree perineal lacerations, episiotomies, advanced neonatal resuscitation, 5-minute Apgar scores and meconium. CONCLUSION: stimulation with oxytocin should not be used systematically, but only in specific cases. These findings provide further evidence to health professionals and midwives on the use of oxytocin during labor. Under normal conditions, women should be informed of the possible effects of labor stimulation with oxytocin.

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Abstract Objective: to evaluate the effects of labor stimulation with oxytocin on maternal and neonatal outcomes. Method: descriptive and analytical study with 338 women who gave birth at a tertiary hospital. Obstetric and neonatal variables were measured and compared in women submitted and non-submitted to stimulation with oxytocin. Statistics were performed using Chi-square test, Fisher exact test, Student t-test; and crude Odds Ratio with 95% confidence interval were calculated. A p < 0.05 was considered statistically significant. Results: stimulation with oxytocin increases the rates of cesarean sections, epidural anesthesia and intrapartum maternal fever in primiparous and multiparous women. It has also been associated with low pH values of umbilical cord blood and with a shorter duration of the first stage of labor in primiparous women. However, it did not affect the rates of 3rd and 4th degree perineal lacerations, episiotomies, advanced neonatal resuscitation, 5-minute Apgar scores and meconium. Conclusion: stimulation with oxytocin should not be used systematically, but only in specific cases. These findings provide further evidence to health professionals and midwives on the use of oxytocin during labor. Under normal conditions, women should be informed of the possible effects of labor stimulation with oxytocin.

Resumo Objetivo: avaliar os efeitos da estimulação do parto com oxitocina nos resultados maternos e neonatais. Método: estudo descritivo e analítico, com 338 mulheres que deram à luz em um hospital de nível terciário. Variáveis obstétricas e neonatais foram medidas e comparadas em mulheres com e sem estimulação com oxitocina. Estatísticas foram feitas utilizando-se o teste Qui-quadrado, teste exato de Fisher e o teste t-Student; e as Odds Ratio brutas com intervalo de confiança de 95% foram calculadas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: a estimulação com oxitocina aumentou as taxas de cesarianas, anestesia peridural, febre materna intraparto em primíparas e multíparas. Ela também foi associada com baixos valores de pH do cordão umbilical e com uma menor duração da primeira fase do parto em primíparas. No entanto, ela não afetou as taxas de laceração perineal de terceiro e quarto graus, a episiotomia, a reanimação neonatal avançada, o teste de Apgar de 5 minutos e o mecônio. Conclusão: a estimulação com oxitocina não deveria ser utilizada de maneira sistemática, mas apenas em casos muito específicos. Estes resultados fornecem evidências adicionais aos profissionais de saúde e às parteiras sobre o uso de oxitocina durante o parto. Em condições normais, as mulheres deveriam ser informadas sobre os possíveis efeitos da estimulação com oxitocina.

Resumen Objetivo: valorar los efectos de la estimulación del parto con oxitocina en los resultados maternos y neonatales. Método: estudio descriptivo y analítico con 338 mujeres que parieron en un hospital de tercer nivel. Variables obstétricas y neonatales fueron medidas y comparadas en mujeres con y sin estimulación con oxitocina. Estadísticos Chi-cuadrado, test exacto de Fisher, test t-Student, Odd Ratio cruda y un intervalo de confianza del 95% fueron calculados. Un valor p < 0,05 se consideró estadísticamente significativo. Resultados: la estimulación con oxitocina incrementó el ratio de cesáreas, analgesia epidural, fiebre materna intraparto en primíparas y multíparas; también se relacionó con bajos valores de pH de cordón umbilical, y menor duración de la primera fase del parto en primíparas. Sin embargo no afectó la tasa de desgarros de 3-4 grado, episiotomías, reanimación neonatal avanzada, test de Apgar a los 5 minutos o meconio. Conclusión: la estimulación con oxitocina no debería emplearse de forma sistemática, sino solo en casos muy indicados. Estos hallazgos proporcionan mayor evidencia a los profesionales y matronas a cerca del uso de oxitocina durante el parto. En condiciones normales, las mujeres deberían estar informadas de los posibles efectos de la estimulación con oxitocina.

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Objetivos: En ruptura de Ligamento Cruzado Anterior (LCA), al utilizar isquiotibiales, nos preguntamos si es posible establecer algún parámetro preoperatorio que nos dé una pauta previsible del tamaño requerido de injerto en cada individuo, al considerar variables individuales como: peso, talla, índice de masa corporal (IMC). Material y Método: Estudio prospectivo, incluyo 49 individuos todos masculinos. Edad media 31,8 años, peso promedio 78,2 kg, talla media 1,74 mts e IMC promedio de 25,9. Intraoperatorio medimos longitud y diámetro del injerto total,así como su trayecto intraarticular e intratibial. Realizamos análisis estadístico múltivariable correlacionando los datos antropométricos con las mediciones obtenidas del injerto intraoperatorio. Resultado: La media de longitud total fue de 9,88 ± 0,53 cm. El diámetro promedio 8,34 ± 0,9 mm. La longitud media intraarticular de 2,12 ± 0,23 cm y la media del túnel tibial 4,7 ± 0,4 cm. En relación a longitud total del injerto, tanto talla (p=0,046), peso (p=0,01) e IMC (p=0,04) mostraron diferencias estadisticamentes significativas, al igual que la relación diametro del injerto con la variable talla (p=0,001), no así el peso (p=0,12) ni IMC (p=0,85). Conclusión: Podemos concluir que el peso no se relaciona con el diámetro de injerto y que al incrementar la talla de a 10 cm, se incrementara en 0,5 cm la longitud necesaria de injerto requerido para la reconstrucción, independientemente del incremento del IMC. Diseño del estudio: Terapéutico. Nivel de evidencia: III.(AU)

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Objetivos: En ruptura de Ligamento Cruzado Anterior (LCA), al utilizar isquiotibiales, nos preguntamos si es posible establecer algún parámetro preoperatorio que nos dé una pauta previsible del tamaño requerido de injerto en cada individuo, al considerar variables individuales como: peso, talla, índice de masa corporal (IMC). Material y Método: Estudio prospectivo, incluyo 49 individuos todos masculinos. Edad media 31,8 años, peso promedio 78,2 kg, talla media 1,74 mts e IMC promedio de 25,9. Intraoperatorio medimos longitud y diámetro del injerto total,así como su trayecto intraarticular e intratibial. Realizamos análisis estadístico múltivariable correlacionando los datos antropométricos con las mediciones obtenidas del injerto intraoperatorio. Resultado: La media de longitud total fue de 9,88 ± 0,53 cm. El diámetro promedio 8,34 ± 0,9 mm. La longitud media intraarticular de 2,12 ± 0,23 cm y la media del túnel tibial 4,7 ± 0,4 cm. En relación a longitud total del injerto, tanto talla (p=0,046), peso (p=0,01) e IMC (p=0,04) mostraron diferencias estadisticamentes significativas, al igual que la relación diametro del injerto con la variable talla (p=0,001), no así el peso (p=0,12) ni IMC (p=0,85). Conclusión: Podemos concluir que el peso no se relaciona con el diámetro de injerto y que al incrementar la talla de a 10 cm, se incrementara en 0,5 cm la longitud necesaria de injerto requerido para la reconstrucción, independientemente del incremento del IMC. Diseño del estudio: Terapéutico. Nivel de evidencia: III.

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BACKGROUND: Pilonidal disease is one of the most frequent entities in our daily surgical activity. Although it is a benign disease, malignant degeneration is likely to occur in pilonidal disease. We reviewed surgical interventions for pilonidal diseases performed from January 1, 1995 to December 31, 2008. CLINICAL CASE: We reviewed all 3729 histology reports obtained after surgical removal of pilonidal disease. There were three cases of squamous cell carcinoma and one case of basal cell carcinoma. Patients affected by squamous cell carcinoma had a mean age of 54.2 years and a mean time of evolution of the lesions of 20.6 years. We found local recurrence and lymph node recurrence. Mean follow-up period was 5 years and there was no mortality. The patient with basal cell carcinoma had 1 year of pilonidal disease evolution. There were no recurrences. CONCLUSIONS: Malignancy can arise in pilonidal diseases with a long evolution time. There is a high rate of recurrence and morbimortality in cases of squamous cell carcinomas. Adjuvant radiotherapy in addition to complete local excision has demonstrated a decrease in the rate of local recurrence.

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