Factores de riesgo para carcinoma de endometrio de alto grado

Endometrial carcinoma (EC) has traditionally been divided into 2 groups: type I, considered to have a good prognosis and to be oestrogen-dependent and type II, with a poorer prognosis and oestrogen-independent. The aim of the study is to analyse the risk factors associated with high-grade EC.

Documento de consenso del Grupo de Trabajo sobre las Adherencias de la sección de endoscopia de la SEGO

Adhesions are the most frequent complication of abdominopelvic surgery. These complications have major short- and long-term consequences, including infertility, chronic pelvic pain and a lifetime risk of small bowel obstruction. Adhesions complicate future surgery, leading to high associated morbidity and expense and a considerable risk of mortality. Despite advances in surgical techniques, the burden of adhesion-related complications has remained unchanged in recent years. Adhesiolysis is still the main treatment, although adhesions reform in most patients. This consensus position provides a comprehensive overview of adhesions and their consequences and describes practical proposals for actions that gynecological surgeons in Spain should take. Developments in adhesion-reduction strategies and new agents offer a realistic possibility of reducing adhesion formation and improving patient outcomes.     

Recomendaciones de ingesta de omega-3 en los diferentes periodos de la vida de la mujer

The benefits of O3FA on cardiovascular risk factor control have been thoroughly investigated, yielding ample evidence of the benefits on cognitive and brain development in infants and anti-inflammatory actions in a number of diseases.     

Cancer de la glande de Bartholin

Bartholin gland carcinoma is a rare tumor. Treatment is not consensual due to the absence of prospective and randomized controlled trials. Bartholin gland carcinoma is actually treated similarly to primary median squamous cell carcinoma of the vulva. Here we report two cases of 42- and 67-year-old females who developed respectively an adenoid cystic carcinoma, and a squamous carcinoma of Bartholin gland.     

Carcinoma de las trompas de Falopio

Primary fallopian tube carcinoma is a rare tumor that histologically and clinically resembles epithelial ovarian cancer. The early clinical manifestations can often lead to a correct diagnosis at an early stage of the disease, leading to more favorable survival compared with epithelial ovarian cancer. However, the diagnosis of primary fallopian tube carcinoma is rarely preoperative and is usually made by the pathologist. Surgical staging and the use of chemotherapy follow the model used in epithelial ovarian cancer.     

Sistemas de clasificación y predicción de riesgo de malignidad de las lesiones anexiales

The diagnosis of an adnexal mass is a common problem in gynaecological consultation. The main objective of an adnexal mass evaluation is the diagnosis or exclusion of malignancy. This is the case because ovarian cancer is the most lethal gynaecological neoplasia and appropriate initial surgery is one of the main prognostic factors. Ultrasound scans continue to be the best method of classifying an adnexal mass. If there is any suspicion of a malignant tumour, the patient must be referred to a specialist gynaecological oncology centre. However, if there is any suspicion of a benign tumour, watchful waiting or minimally invasive surgery may be indicated.The objective of this article is to carry out a review of the most important and widely used classification systems of adnexal masses, analysing their methodology and the results of their application in the main validation studies published to date.     

Valores de referencia de la translucencia intracraneal

Objective

To determine reference ranges for intracranial translucency (ICT) in our population.

Material and methods

To assess the relationship between crown-rump length (CRL) and ICT, we performed a linear regression analysis of 471 singleton pregnancies without associated anomalies.

Results

ICT was measured in 98.9%. ICT had a normal distribution with a standard deviation of 0.4139. The mean was 2.0502 mm (0,9-3.6 mm), and the 5% and 95% percentiles corresponded to 1.4 mm and 2.7 mm. ICT had a linear correlation with CRL (ICT: 0.0125 + 1.2628 * CRL; R2: 0,055 P <.0001). The estimated ICT was calculated for the 5th percentile (1.2628 + 0.0125 * LCC) − 0.6505. The intraclass correlation coefficient was 0,816 (0606-0921 CI: 95%).

Conclusions

Measurement of the fourth ventricle during first trimester ultrasound examination is feasible and is simple to perform. An extended neurological evaluation should be carried out if measurements are above the 95th percentile or below the 9th percentile.     

Presencia de elementos de los cordones sexuales en cistoadenoma seroso de ovario

A case of ovarian serous cystadenofibroma with sex cord differentiation in a postmenopausal woman is described. The diagnosis prompted a literature search, which revealed only one previous similar case. The presence of sex cord structures can go unnoticed in histopathologic examination if the sampling is not exhaustive or the mixture of both histological types is not considered. The repercussions on prognosis are unknown.     

Conocimiento de los mecanismos de acción de los métodos de planificación familiar

Objective

To investigate women's knowledge of the mechanisms of action of birth control methods, especially those that act after fertilization, and to identify whether women want more information on this issue.

Methods

We performed a cross sectional study in a sample of 725 fertile women from primary care health centers in Pamplona (Spain) through a self-administered, anonymous, 30-item questionnaire on family planning. Univariate and multivariate logistic regression analyses were performed.

Results

Less than 5% knew all the mechanisms of action of oral contraceptives and the intrauterine device and only 7% knew those of the emergency contraception pill. Regardless of their beliefs, most women (91%) believed that they should be informed of any postfertilization effects.

Conclusions

To ensure their right to free choice,women should be informed of all the mechanisms of action of birth control methods.     

Análisis de coste-efectividad de la prueba de citología cervicovaginal

Introduction

Cervical cancer is a major public health concern, causing approximately 10% of deaths from cancer in women worldwide.

Objective

To determine the cost-effectiveness ratio of liquid-based cytology compared with the conventional cytological smear test for the detection of precancerous lesions of the cervix.

Methods

A decision analysis model was constructed from the perspective of the public healthcare system. The alternatives compared were conventional and liquid-based cytology. The economic evaluation compared the short-term effectiveness and cost of testing. The measures of effectiveness used were the yield of the test (the proportion of correctly identified cases of cervical lesion in the population) and the «adjusted yield» (the proportion of cases identified minus false negatives). Data on diagnostic accuracy (sensitivity and specificity) and prevalence were obtained from a meta-analysis. Cost values were provided by the Virgen de las Nieves Hospital (Granada, Spain). To assess the uncertainty of the variables included in the model, several univariate and probabilistic sensitivity analyses were carried out.

Results

The incremental cost of liquid-based cytology compared with conventional cytology was €919.49 for each cervical intraepithelial neoplasia (CIN1) or higher-stage lesion found. When the adjusted yield was used as the measure of effectiveness, the incremental cost-effectiveness ratio increased to €574 per lesion identified.     

Análisis comparativo de dos protocolos de misoprostol en abortos de segundo trimestre de la gestación

Objective

To compare the mean induction-expulsion times in two regimens of vaginal misoprostol for second-trimester pregnancy termination.

Material and methods

We performed a retrospective study of 281 pregnancies between January 2000 and December 2005 (regimen A: 800 μg /24 h) and between June 2007 and December 2008 (regimen B: 400 μg /4 h). Induction-expulsion time was taken as the main outcome.

Results

The mean expulsion time was similar in both regimens (19.7 h for A and 17.7 h for B). No significant differences were found in the expulsion rate at 12, 24 and 48 h. The most commonly observed adverse effect was fever, which was more frequent in regimen B. No major adverse effects such as uterine rupture or severe hemorrhage were observed.

Conclusions

No significant differences were found between regimens A and B in the mean fetal expulsion time, although fever was more common in regimen B.     

Implantación de un sistema de gestión de riesgos en obstetricia: aprendiendo de los errores

Objective

To describe the implementation of a patient safety program in an obstetrics department and the results obtained.

Material and methods

The program was applied in all women admitted to the labor and delivery unit. To detect adverse events, a patient safety indicator system that allows monitoring over time was designed and an anonymous event reporting tool was activated.

Results

An adverse event occurred in 9.26% of hospitalized patients. Adverse events were more common in the puerperium (6.61%) and after cesarean delivery (16.04%) than in instrumental (10.63%) and vaginal delivery (7.40%). Most of the notifications concerned potential adverse events (near misses) and 72% led to improvements.

Conclusions

Our program detects adverse events and allows improvement measures to be designed. In obstetrics, safety is of great importance because of the potential effects to mother and child. Furthermore, childbirth is a frequent cause of hospitalization and litigation in obstetrics is common.     

Utilidad de la tomografía por emisión de positrones en el manejo de los cánceres de cuerpo de útero

Currently, uterine body tumors are basically surgically staged. Established consensus or defined protocols for the follow up of these neoplasms are lacking. Imaging techniques are usually requested based on the clinician’s criteria, usually suspicion of disease recurrence or progression. Structural imaging techniques, such as computed tomography or magnetic resonance imaging, present some limitations in the detection of recurrent disease. Positron emission tomography is a functional imaging technique with proven utility in neoplasms. In the last few years, interest in this technique has grown in the field of gynecologic oncology. We performed a literature review on the utility of positron emission tomography in the evaluation of endometrial cancers and uterine sarcomas, both in initial diagnosis and follow-up.     

Histología e inmunohistoquímica de los carcinomas de mama en pacientes intervenidas de más de 70 años de edad

Objective

We retrospectively analyzed tumoral characteristics (histology and immunohistochemistry) in a group of elderly patients (≥ 70 years old) after surgery between 2003 and 2005, and compared these characteristics with those of younger patients.

Material and methods

We studied the characteristics of 483 breast carcinomas diagnosed sfrom 2003 to 2005 in the Gynecology Service of the 12 de Octubre Hospital in Madrid. Of these, 153 (31.7%) corresponded to patients aged 70 years old or older. Data were analyzed using the SPSS 12.0 program, and the groups were compared using chi-square analysis (or Fisher’s test when required). Quantitative data were expressed as mean ± standard deviation and median with interquartile range.

Results

In our patients aged 70 years or older, diagnosis after mammography was less frequent. In situ and microinvasive carcinomas were less frequent and the mean size of invasive carcinomas was larger. These findings can be explained by the lack of mammographic screening. No other histological or immuno-histochemical differences were found in comparison with younger patients and no differences were found in axillary lymph node involvement in women with axillary dissection.

Conclusions

Treatment in elderly patients should be individually tailored according to the biological characteristics of the tumor, comorbidity, and life expectancy. Age per se should not be considered a predictive factor of worse outcome.