Utilidad de la resonancia magnética abdominopélvica en el diagnóstico de abscesos tuboováricos

We present the case of a 39-year-old woman with a tubo-ovarian abscess diagnosed by pelvic magnetic resonance imaging. We highlight the importance of this imaging technique in differentiating these abscesses from other pelvic processes, especially neoplasms.     

Trombosis de la vena ovárica con extensión a la vena cava inferior en el posparto

Ovarian vein thrombosis is a complication that can appear during the postpartum period or after pelvic surgery. This complication is a rare but serious entity requiring early diagnosis and treatment and should be suspected in patients with fever and acute abdominal pain at the beginning of the postpartum. Imaging diagnosis with contrast computed tomography remains the gold standard. Administration of broad-spectrum antibiotics and heparin therapy produces immediate clinical improvement.     

Revisión de la exenteración pélvica en el cáncer de cérvix. Descripción de nuestra casuística

Total pelvic exenteration is a radical intervention, involving block resection of pelvic organs, including reproductive structures, the bladder, and the rectosigmoid colon. In gynecologic oncology, this procedure is most commonly indicated for the treatment of locally recurrent cancer or lack of response to neoadjuvant therapy.     

Quiste del conducto de Gartner asociado a carcinoma microinvasor de cérvix y presentado en una paciente como prolapso de órganos pélvicos

The incidence of vaginal cysts is estimated to be 1%. Some of these cysts, such as Gartner's duct cyst, are of embryological origin. These cysts are usually small and asymptomatic but they can sometimes grow and, due to their location, produce symptoms related to pelvic floor disease. A correct differential diagnosis is essential, in which the main complementary tests are transvaginal ultrasound and especially magnetic resonance imaging, which will establish the features and location of the cyst as well as any anomalies of the urinary system. We report a case of Gartner's duct cyst associated with invasive cervical carcinoma in a 49-year-old woman who presented with symptoms similar to pelvic organ prolapse, specifically cystocele.     

Absceso pélvico y tubo-ovárico en mujer portadora de DIU hace 16 años

We present a case of acute abdomen caused by rupture of a tubo-ovarian abscess in a 38-year-old woman who had been using an intrauterine device for 16 years. The diagnosis was made during surgery, since the intervention was performed for suspected acute appendicitis. The intervention revealed a right tubo-ovarian abscess with pelvic abscess. Culture of pelvic pus was positive for Streptococcus constellatus. The patient was treated by surgery and combined antibiotic therapy. Diagnosis was confirmed by histopathological examination.     

Tumor de células de Sertoli-Leydig ovárico

We present the rare case of a 62-year-old woman who developed an ovarian tumor associated with severe hirsutism, hypertension, renal insufficiency, and hyperparathyroidism. Hormone evaluation showed high plasma testosterone and estradiol values, with suppressed gonadotropins. Ultrasound examination and computed tomography revealed a large pelvic tumor. Differential diagnosis with a Sertoli-like endometrioid carcinoma of the ovary was contemplated, but inhibin-positive expression established the diagnosis of Sertoli-Leydig cell tumor. Postsurgical outcome was favorable, with normal plasma values of sexual steroids and an increase of gonadotropins to within the normal postmenopausal range.     

Valoración de la invasión miometrial en el carcinoma de endometrio mediante resonancia magnética

Objective

Evaluation of feability of magnetic resonance (MRI) in the assessment of the grade of myometrial invasion in endometrial carcinoma in our service.

Material and method

Retrospective study about pelvic MRI (dynamic, intravenous contrast media with gadolinium) sistematically made in the presurgical study of endometrial carcinoma in our service. 123 MRI were made in many other patients diagnosed of endometrial carcinoma between the year 2000-2004, both included. Afterwards, the results were contrasted with the histologic studies of the surgical piece.

Results

In 112 of the 123 neoplasms studied there was myometrial invasion valorated in the anatomopathologic study (paraffin sections). The MRI presented concordance with the histology in 101 cases, the positive predictive value (PPV) was 97% and although the negative predictive value (NPV) was 38.8%, the corrected negative predictive value (cNPV) was 87.5%.

Conclusions

Pelvic magnetic resonance with intravenous contrast media is a good technique to leave out deep myometrial invasion in endometrial carcinoma (cNPV: 87.5%), but its value is lower when pretending to asses superficial myometrial invasion (NPV 38,8%).When the uterine miomas are associated to endometrial carcinoma the specificity (25%) and the cNPV (14%) endure a great descent.     

Recurrencia funcional tras la cirugía del prolapso. Factores de riesgo asociados

Objective

To determine the incidence of functional recurrence after surgery for pelvic organ prolapse and associated risk factors.Patients and methods: A total of 307 patients who underwent primary pelvic organ prolapse (POP) vaginal surgery between 2000 and 2004 in Donostia Hospital were interviewed. A standardized questionnaire was used that contained items on functional recurrence, prolapse riskfactors, and other disorders. The patients’ perioperative characteristics were collected retrospectively from their medical records.

Results

Functional recurrence was diagnosed in 28 patients (9.2%), of whom only five (1.6%) required reintervention during the follow-up period. Multivariate analysis showed that factors associated with an increased risk of functional recurrence were younger age (< 60 years) and body weight ≥ 65 kg. No association was found between prolapse grade prior to surgery and functional recurrence.

Conclusions

Functional recurrence after classical prolapse surgery is low. A higher risk was found in younger women and those with higher body weight.     

Utilidad de la prueba de la fibronectina fetal y de la longitud del cérvix en la predicción del parto prematuro en gestantes sintomáticas

Objective

To evaluate the usefulness of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions.

Material and methods

A prospective study was conducted at the Virgen Macarena Hospital in Seville that included 153 pregnant women with suspected preterm labor and intact membranes. Cervical length was measured by transvaginal sonography and a rapid qualitative fibronectin test was performed in the emergency consultation. Women with a negative fibronectin test and cervical length ≥ 30 mm were not hospitalized or treated with tocolytics or corticosteroids.

Results

The mean gestational age at diagnosis was 223,02 ± 19,98 days, and 267,52 ± 14,15 days at delivery. Preterm birth < 37 weeks rate was 23% and 7,4% for deliveries < 35 weeks. There is an association between cervical length < 30 mm and birth < 37 weeks (OR, 3,68; 95% CI, 1,53-8,84), and with delivery in the following 14 days (OR, 3,35; 95% CI, 1,30-21,95). With the association of both tests we gain specificity in predicting preterm birth.

Conclusion

Cervical length is the test with higher specificity (E) and negative predictive value (VPN) for the prediction of preterm birth in women with symptomatic contractions.     

Indicaciones de la resonancia magnética en el diagnóstico ginecológico

The role of magnetic resonance imaging (MRI) in gynecology has become increasingly important in the last few decades, especially in gynecologic oncology. Currently, there is strong evidence to support the use of this imaging modality in distinct pelvic diseases such as tumors, inflammations and malformations. Recent studies support a growing role for MRI in the diagnosis of breast disease. As shown in the present review, the applicability of MRI in the physiopathology of genital tract diseases seems to be progressively increasing. MRI should therefore be considered as one more option that can be employed in gynecology.     

Inicio de un síndrome de Guillain-Barré durante la gestación

We present the case of a pregnant woman who developed severe Guillain-Barré syndrome in the third trimester and who required admission to the intensive care unit of the referral hospital for suspected disease progression. No clinical improvement was observed. Because the onset of diaphragm paralysis was suspected and the fetus was in the podalic position, emergency cesarean was performed. Given the rarity of onset of Guillain-Barré syndrome in pregnancy, we review this entity to improve knowledge of maternal and fetal management.     

Análisis de dos estrategias para el manejo de la amenaza de parto pretérmino

Objective

To compare two strategies for the management of threatened preterm labor (TPL). The first strategy was based on clinical criteria alone, while the second used rapid fibronectin testing and cervical length measured by vaginal ultrasound.

Material and methods

We compared the costs and perinatal outcomes of both strategies. In the study group, both markers were used to select women at highest risk. The study group consisted of a prospective group of 122 women attending the emergency department for TPL. The control group (n = 112) was composed of a historical cohort of women admitted for TPL. Pregnant women classified as low risk for premature birth were discharged from the emergency department and were monitored on an outpatient basis. The sensitivity and specificity of both tests in predicting preterm labor were estimated. The results measured were prematurity < 37 weeks, neonatal complications, length of hospital stay and costs resulting from admission, medication and subsequent follow-up visits.

Results

Prematurity and perinatal outcomes were similar in both groups. The use of tocolytics and corticosteroids was reduced by employing the two markers. The median length of hospital stay was 0 days in the study group (2.6 days among hospitalized patients) and 5 days in the control group. The costs incurred per patient were 446.24 euros in the study group (IQR: 1,390.08) and 1,634.04 euros (IQR: 1,092.65) in the control group.

Conclusions

Based on the use of these techniques to select patients with true preterm labor and the similar perinatal results obtained in both groups, we conclude that universal treatment of all women with suspected preterm labor is not warranted. This strategy saves approximately 1,200 € per patient.     

Utilización de la resonancia magnética en la detección de los carcinomas ductales ocultos. A propósito de un caso

We present a case of ductal carcinoma in situ, as evidenced by magnetic resonance imaging with negative mammographic and ultrasound studies.