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Palacios-Jaraquemada J.M.,Center for Medical Education and Clinical Research | Palacios-Jaraquemada J.M.,University of Buenos Aires
Acta Obstetricia et Gynecologica Scandinavica | Year: 2011

Objective. To analyze the efficacy of surgical techniques to stop excessive obstetric bleeding. Design. Retrospective follow up. Setting. Center for Medical Education and Clinical Research and a total of twelve hospitals in Buenos Aires. Population. Five hundred and thirty-nine consecutive patients were included: 361 had placenta accreta-percreta, 114 uterine atony, 19 cervical scar pregnancy, 21 placenta previa and 24 uterine-cervical-vaginal tears. Three hundred and forty-seven women had surgery, of whom 192 were emergencies. Methods. The surgical techniques included selective arterial ligation and compression procedures. The effectiveness of the techniques was assessed by cessation of bleeding according to source. Follow up included hysteroscopy of 100 patients and magnetic resonance imaging of 341 patients. Main outcome measures. Strong association between topographical uterine irrigation areas and surgical hemostatic technique was established. Results. Hemorrhage stopped following arterial ligation or compression sutures in 499 women, but hysterectomy was needed in 40. In cervical, lower segment and upper vaginal bleeding, Cho's compression sutures proved to be an efficient and simple procedure. Most surgical hemostatic failures that led to hysterectomy occurred in women with severe hemodynamic deterioration and coagulopathy. Two women died due to multiorgan failure. After surgery, 116 successful pregnancies were reported. Conclusions. Bilateral occlusions of the uterine artery or its branches were useful procedures to stop upper uterine bleeding. Square sutures were a simple and effective procedure to control lower genital tract bleeding. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.


Krismer F.,Innsbruck Medical University | Seppi K.,Innsbruck Medical University | Tison F.,University of Bordeaux Segalen | Zangerl A.,Innsbruck Medical University | And 15 more authors.
Movement Disorders | Year: 2012

Background:: The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. In the present study, the intrarater agreement of the motor examination part of the UMSARS was determined. Methods:: All patients were first examined face to face, while being video-recorded, by two senior and two junior investigators. The patients' videotaped examinations were reevaluated after 3 months. Intrarater reliability for each item was analyzed by kappa statistics. Results:: Overall weighted kappa (κ) values were at least substantial or excellent for all UMSARS motor examination items, except for ocular motor dysfunction, which showed only moderate intrarater agreement. Intrarater reliability was comparable between senior and junior raters, with all κ differences being ≤ 0.22. Conclusions:: The motor examination part of the UMSARS was found to have satisfactory intrarater reliability in the present cohort. © 2012 Movement Disorder Society.


D'Antonio F.,St Georges, University of London | Iacovella C.,St Georges, University of London | Palacios-Jaraquemada J.,Center for Medical Education and Clinical Research | Bruno C.H.,South Scientific Foundation | And 2 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2014

Objective To assess systematically the performance of prenatal magnetic resonance imaging (MRI) in diagnosing the presence, degree and topography of disorders of invasive placentation and to explore the role of the different MRI signs in predicting these disorders. The diagnostic accuracy of ultrasound and MRI in the detection of invasive placentation was also compared. Methods MEDLINE, EMBASE, CINAHL and The Cochrane Library, including The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and The Cochrane Central Register of Controlled Trials, were searched electronically utilizing combinations of the relevant medical subject heading terms, keywords and word variants for 'invasive placentation' and 'magnetic resonance imaging'. Only prospective studies reporting a diagnosis of invasive placentation at the time of MRI and retrospective studies in which the radiologist was blinded to the final results were included in the analysis. The MRI signs explored were: uterine bulging, heterogeneous signal intensity, dark intraplacental bands on T2 weighted sequences, focal interruption of the myometrium and tenting of the bladder. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-) and diagnostic odds ratio (DOR) were based, depending on the number of studies, upon DerSimonian-Laird random-effect or hierarchical summary receiver-operating characteristics models. Results A total of 18 studies involving 1010 pregnancies at risk for invasive placentation were included. The overall diagnostic accuracy of MRI in detecting the presence of invasive placentation was: sensitivity, 94.4% (95% CI, 86.0-97.9%); specificity, 84.0% (95% CI, 76.0-89.8%); LR+, 5.91 (95% CI, 3.73-9.39); LR-, 0.07 (95% CI, 0.02-0.18); DOR, 89.0 (95% CI, 22.8-348.1). MRI had a high predictive accuracy in assessing both the depth and topography of placental invasion. All five MRI signs showed good predictive accuracy in the diagnosis of disorders of invasive placentation. There was no difference in either the sensitivity (P = 0.24) or the specificity (P = 0.91) between ultrasound and MRI for the detection of invasive placentation. Conclusions Prenatal MRI is highly accurate in diagnosing disorders of invasive placentation. Ultrasound and MRI have comparable predictive accuracy. Large population-based studies are needed in order to assess whether ultrasound can predict the depth and topography of placental invasion as reliably as can MRI. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.


Palacios-Jaraquemada J.M.,Center for Medical Education and Clinical Research | Palacios-Jaraquemada J.M.,University of Buenos Aires
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2013

In the past decade, the incidence of placenta praevia and placenta accreta has increased and seems to be associated with induced labour, termination of pregnancy, caesarean section and pregnancy at older age. These factors imply some degree of tissue damage, which can modify the decidualisation process, and produce excessive vascular remodelling. Placenta praevia and accreta are mainly located in the lower segment, a place that predisposes to persistent uterine bleeding because of the development of new vessels and because it is a poorly contractile area of the uterus. The complexity, determined by tissue destruction, newly formed vessels, and vascular invasion of surrounding tissues, warrants multi-disciplinary management. When resective procedures are undertaken, a suitable plan to tackle surgical problems allows better control of bleeding and avoids unnecessary hysterectomies. In cases of placenta accrete, and especially when skills or institutional resources are not available, leaving the placenta in situ may be the best option until definitive treatment is undertaken. © 2012 Elsevier Ltd. All rights reserved.


Poletta F.A.,Instituto Nacional Of Genetica Medica Populacional | Poletta F.A.,Center for Medical Education and Clinical Research | Orioli I.M.,Instituto Nacional Of Genetica Medica Populacional | Orioli I.M.,Federal University of Rio de Janeiro | And 2 more authors.
Genetics and Molecular Biology | Year: 2014

This is a guide for fieldwork in Population Medical Genetics research projects. Data collection, handling, and analysis from large pedigrees require the use of specific tools and methods not widely familiar to human geneticists, unfortunately leading to ineffective graphic pedigrees. Initially, the objective of the pedigree must be decided, and the available information sources need to be identified and validated. Data collection and recording by the tabulated method is advocated, and the involved techniques are presented. Genealogical and personal information are the two main components of pedigree data. While the latter is unique to each investigation project, the former is solely represented by gametic links between persons. The triad of a given pedigree member and its two parents constitutes the building unit of a genealogy. Likewise, three ID numbers representing those three elements of the triad is the record field required for any pedigree analysis. Pedigree construction, as well as pedigree and population data analysis, varies according to the pre-established objectives, the existing information, and the available resources.

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