Descripción de un caso de angioedema hereditario dependiente de estrógenos

IntroductionHereditary angioedema is a rare genetic disease without any specific treatment.Main symptomsIt is characterized by recurrent episodes of skin and mucous oedema.Main diagnosesThere are three types of angioedema and type III has been related to high-level oestrogen conditions.Therapeutic interventionsWe describe the case of a patient with hereditary angioedema type III, who had an episode of angioedema associated with the periovulatory and premenstrual period.Due to this hormonal influence, we used gestagen therapy to attempt to reduce the number of ovulations.ResultsAfter several months of treatment with desogestrel, the patient reports a decrease in the number and severity of episodes.ConclusionGestagen therapy seems to be useful for controlling episodes of hereditary angioedema type III.     

Selección de embriones en los tratamientos de fecundación in vitro

The prevalence of infertility among the population of reproductive age continues to increase year after year in Western societies and the therapeutic resource in most cases will be assisted reproductive techniques, mainly in vitro fertilization. Although the advances made in vitro fertilization have had an undeniable impact on the chances of achieving pregnancy, the efficiency of the technique, in global terms, remains low. One of the factors with the greatest impact on in vitro fertilization results is embryo selection. That is why among the main future challenges that arise in the field of assisted human reproduction, is that of obtaining reliable embryo selection methods that allow the transfer of the embryo with greater competence to implant. In this article, the different embryo selection methods used in in vitro fertilization are reviewed.     

Etiología de la mastitis crónica: propuesta de secuencia diagnóstica

Introduction

Inflammatory breast lesions require histopathological study due to their ability to clinically and radiologically mimic malignant mammary tumours. The objective is to propose a diagnostic technique for benign chronic inflammatory processes of the breast.

Síndrome de Klippel-Trenaunay en la gestación: a propósito de un caso y revisión de literatura reciente

Klippel-Trenaunay syndrome is a rare entity with associated risks, mainly haemorrhagic and thromboembolic. Given the low incidence of this syndrome, there is little evidence on its obstetric management. We present a review of the recent literature about a case, with the aim of synthesizing the obstetric management of patients with Klippel-Trenaunay syndrome.In the case of a pregnant woman with this pathology, multidisciplinary management should be considered, which would mainly include obstetricians, haematologists, and anaesthesiologists. It is very important to perform imaging studies, especially in the third trimester, to help determine the delivery route. Given the increased risk of thrombotic events, the use of prophylactic measures during pregnancy and the puerperium is indicated. The evidence regarding the increase in bleeding complications in these patients is not so conclusive, however it is a complication that we must take into account to establish the necessary therapeutic measures.     

Resultados del programa de cribado prenatal de cromosomopatías en el área sanitaria sur de Sevilla,tras la implantación de la aplicación corporativa siPACAC

Introduction

Prenatal screening programmes for chromosomal abnormalities require software that allows the calculation of risk. The software is often commercial and linked to the biochemical reagents supplier. We present the results of the programme from the implementation of a new non-commercial, corporate software (siPACAC) and management improvements generated after its introduction.

Opinión de las parejas sobre el futuro de sus embriones pasados 5 años de congelación

ObjectivesTo contact all the couples who have embryos that have been frozen for more than 5 years at the Institut Universitari Dexeus and to know their opinion about the different options.Material And MethodsCurrently, 1,419 frozen embryos from 260 couples have remained in our center for more than 5 years. These couples were contacted by telephone and/or by a written questionnaire.ResultsAmong the legal options in our country, 24 (27%) couples prefer the self-transfer, 29 (32.5%) secondary donation and 28 (31.5%) disagreed with the legal options given. Concerning other currently illegal alternatives, 28 (31.5) would accept donation for research and 39 (43.8%) would prefer destruction of the embryos.ConclusionsThe results of this study show that it is necessary to review the current legal regulations in our country.     

Struma ovarii: presentación de 37 casos y actualización de la evidencia disponible

Objective

To determine the medical data that could behave as risk factors for poor prognosis in the struma ovarii, as well as establishing the criteria that could be of help for an early diagnosis, comparing the results obtained, with the scientific evidence that has been published to date.

Comparación de costes de la cesárea mediante técnicas de Misgav Ladach y convencional con incisión de Pfannenstiel

ObjectiveTo compare the costs of the Misgav- Ladash method of cesarean delivery with those of the conventional cesarean technique.Subjects and methodsWe performed a retrospective, observational analysis of a sample of 96 cesarean operations performed from 2001–2002 at the Severo Ochoa Hospital, using the Misgav Ladach technique and conventional methods.ResultsDemographic characteristics and indications for cesarean section were similar in both groups. The costs of each technique were estimated by evaluating surgical and postsurgical data and a saving of 164.5 z.euro; was found for the Misgav Ladach group.ConclusionsThe Misgav Ladach method for cesarean delivery is cost-effective and reduces costs in comparison with the conventional method.     

Caracterización preoperatoria de las tumoraciones de ovario mediante ecografía,Doppler y determinación sérica de CA125. Estudio comparativo

ObjectiveThe aim of our study is to evaluate the usefulness of ultrasound, color and pulsed Doppler and serum CA125 in the prediction of malignancy in ovarian masses.Material And MethodsOver a one year period, 126 women diagnosed of an adnexal mass underwent a complete ultrasound color and pulsed Doppler examination and a serum determination of CA125 previously to surgical procedure. Results were correlated with histological findings. Several ultrasound and Doppler parameters were assessed by means of standard statistical analysis in terms of sensitivity, specificity, positive and negative predictive values, and odds ratio.ResultsTwenty-eight (22.2%) ovarian cancers were diagnosed. Malignant tumors showed higher levels of CA125 and were of greater volume, thicker walls and septae, with solid parts and ascites, and more abundant, and centrally located pattern of vascularity. The multicystic with solid parts type was the one most frequently was associated with malignancy, being the presence of solid parts the most powerful discrimatory variable.ConclusionsIn the preoperative evaluation of an adnexal mass, conventional ultrasound examination is more effective than vascularity evaluation by means of Doppler or serum CA125, in order to predict malignancy.     

Un caso de osificación endometrial

Endometrial ossification is a rare condition mainly associated with two factors: First, a malignant tumor, especially a mixed müllerian tumor. Second, a previous miscarriageThe pathogeny of the ossification is not totally understood. While, for some, it represents just a mere inclusion of fetal parts in endometrial stroma, it is, for others, the outcome of complete osseous metaplasiaWe present a case of endometrial ossification in a 27-year-old woman, secondary to previous curettage owing to miscarriage, seven months before     

Diagnóstico prenatal de vasa previa

ObjectivePrenatal diagnosis of vasa previa in cord insertion anomaliesMaterial and methodWe examined six cases of cord insertion anomalies or placentation anomaliesResultsThree cases were diagnosed of vessels previous the presentation and near the internal cervical orifice. Two cases of twin pregnancy with a cord velamentous insertion of the second twin on the partition membrane, the situation of the insertions showed a clinical vasa previa of the second twin after the potential birth of the first twin. The last case showed an interplacental vascular septum, in a bilobed placenta, that was previous to the presentation and near the internal cervical orificeConclusionThe bidimensional ultrasounds, the pulsed and color Doppler studies allowed the prenatal diagnosis of the vasa previa in the asymptomatic pregnancies. Its diagnosis was based in its suspect in cases with a velamentous insertion or with a bilobed placenta. In these situations, a detailed evaluation of the relation of the amniotic umbilical vessels with the inferior uterine segment or with the uterine region previous to the fetus will allow the diagnosis of the vasa previa     

Gestación ectópica ovárica con diagnóstico en segundo trimestre de embarazo en paciente portadora de DIU

Primary ovarian location is a rare form of ectopic pregnancy. According to the existing literature, the presence of an intrauterine device is its main risk factor. Its preoperative diagnosis is difficult and is usually confirmed during surgery or through subsequent histological study. Most ovarian pregnancies end in the first trimester of gestation. Those reaching the second trimester without rupture -as in the clinical case that we describe below- remain an exception. In the case of a suspected diagnosis, urgent surgical treatment is recommended to prevent rupture of the ovarian ectopic pregnancy.     

Angioleiomiosarcoma de clítoris. Presentación de caso

Vulvar carcinoma is rare, and represents 3-5% of the all gynaecological cancers. Epidermoid carcinoma accounts for 90% of them, followed by melanoma, Paget?s disease, Boweńs disease illness, basal carcinoma and sarcomas. The leiomyosarcoma is the most frequent type of sarcoma. The case is presented of a 29 year-old woman that suffered from clitoral tumour. She was treated for a benign lesion in the labia majora 3 years ago. In the current referral, she presented with pain and an ulcerated lesion, without local or regional adenopathies. The total excision was referred for a histological study, and the results showed an angio-leiomyosarcoma of the clitoris. Two years later, the patient showed no signs of residual lesion.