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.     

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.     

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.     

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.     

Tumor de células de la granulosa de patrón difuso sarcomatoide. Presentación de un caso

Granulosa-cell tumors are rare malignant neoplasms characterized by a long natural history and a tendency to recur years after the initial diagnosis.     

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.     

Carcinoma de células pequeñas de mama

Oat cell breast cancer is a rare and aggressive form of cancer. Because only a few cases have been described in the literature, there is no standard treatment. We report the case of a 64-year-old woman who attended our unit for investigation of a node in her left breast that was diagnosed as infiltrative oat-cell breast carcinoma.     

Análisis de los factores de influencia sobre el resultado de 500 ciclos de inseminación intrauterina homóloga

Objective

To evaluate the results and analyse different factors influencing pregnancy rate using homologous intrauterine insemination.

Subjects and methods

Retrospective analysis of 500 homologous intrauterine insemination cycles in 183 infertile couples. Only one insemination per stimulated ovarian cycle was performed in patients with: mild endometriosis, ovulatory factor, male subfertility or unexplained infertility. We studied female age, duration of infertility, stimulation protocol, number of cycle, number of preovulatory follicles, motile sperm count and endometrial thickness related to pregnancy rate.

Results

Pregnancy rate per couple was 24% and per intrauterine insemination 9%, 11% was multiple pregnancies. Best outcome has been got in women younger than 37 years (P=.048) and in cycles with more than one preovulatory follicle. Other studied factors did not have influence in homologous intrauterine insemination outcome.

Conclusions

Female age is a prognostic factor for homologous intrauterine insemination with poor outcome in women older than 38 years. Cycles with more than one preovolatory follicle have better outcome. No differences in pregnancy rate have been achieved with motile sperm count over 1.5 millions/0.3 ml.     

Cribado combinado de síndrome de Down en primer trimestre: comparación de resultados de 4 años de aplicación con los 4 años precedentes

Objective

To analyze the 4-year results of first-trimester combined screening and its impact on rates of Down syndrome detection, population coverage and invasive procedures.

Subjects and methods

We performed a retrospective population-based study over 8 consecutive years (17,564 gestations with 51 cases of Down syndrome) divided in two periods: from January 31, 2002 to January 30, 2006 without combined screening (8,182 gestations and 24 cases of Down syndrome) and from January 31, 2006 to January 30, 2010 with combined screening (8,382 gestations and 27 cases of Down syndrome). Combined screening was applied in two phases: biochemical analysis was performed in the 10th week of pregnancy and ultrasound examination in the 12th week. We compared the results of screening with the previous period based on maternal age and fetal nuchal translucency measurement.

Results

Population coverage was 93%. The rate of Down syndrome detection due to the application of combined screening was 89% (91% for a single fetus) with a false-positive rate of 3.5%. There were 824 invasive procedures (34.1 to diagnose one episode). During the 4 years prior to the application of combined screening, the detection rate was 71% with 1,406 invasive procedures (87.8 to diagnose one episode).

Conclusion

Combined screening has improved the Down syndrome detection rate by 18% and has reduced the use of invasive procedures by 41%.     

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.     

Comparación de la efectividad de la pulsioximetría y el electrocardiograma fetal en las situaciones de riesgo de pérdida de bienestar fetal

Objective

To evaluate the effectiveness of pulse oximetry and fetal electrocardiogram in the management of labor with fetal heart rate patterns associated with a risk of loss of fetal well-being.

Subjects and methods

We performed an open, randomized, experimental trial with two groups: pulse oximetry was used in one group and the STAN® technique was used in the other. Each group included 40 women with single, term pregnancies in cephalic presentation and fetal heart rate patterns associated with a risk of loss of fetal well-being. The overall cesarean section rate, indications of risk of fetal distress, and neonatal acid-base balance were evaluated.

Results

No significant differences were found in the rate of cesarean section (47.5 vs 40%; P = .33), indications of risk of fetal distress (32.5 vs 37.5%; P = .41), or neonatal outcomes.

Conclusions

The use of pulse oximetry and STAN®21, as auxiliary methods to cardiotocographic recording, showed no superiority in reducing the cesarean section rate or improving neonatal outcomes.     

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.     

Metástasis atípica de un adenocarcinoma de endometrio

We report the case of a woman treated for FIGO stage IVB endometrial adenocarcinoma in our service; 3 years later the woman showed scalp and cranial bone metastases.     

Resultados obstétricos y perinatales de la implementación de un programa de versión externa cefálica

Objectives

To evaluate the effectiveness of the external cephalic version, the time required for its completion, the safety of the technique, its effectiveness in reducing the rate of caesarean sections and the perinatal outcomes.

Methods

The study included 180 pregnant women with pelvic presentation at term. Routine cardiotocographic monitoring and an ultrasound were used pre-and post-release version for foetal welfare and presentation.

Results

Success was achieved in 30% of the external cephalic version (ECV) cases during the first year, while 61.90% was successfully achieved during the fourth year. Vaginal births accounted for 61 out of the 93 successful versions, the spontaneous reversal rate was 5.37% and the spontaneous version rate following failed external version, was 3.44%. In 45 cases (25%) some kind of minor adverse effect was found and in 18 cases it was due to the use of uterine relaxants.

Conclusions

The ECV is safe and useful for reducing caesarean rates. The experience of the obstetrician who performed the technique plays a key role in ensuring success.     

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.     

Cáncer de mama tras enfermedad de Hodgkin: presentación de 2 casos clínicos

Women treated for Hodgkin’s disease have an exceptionally high risk of breast cancer as a second malignancy.     

Trombosis de senos venosos cerebrales con afectación parcial de la tórcula de Herófilo en el sexto día de puerperio

Thrombosis of the cerebral venous sinuses is rare during pregnancy and the puerperium, even though pregnancy-specially in the last trimester and puerperium-together with prothrombotic states, head trauma and oral contraceptive use are risk factors for this common condition. Thrombosis of the cerebral venous sinuses occurs in 12 out of every 100,000 births. We report a case of venous thrombosis of the sigmoid and left transverse sinuses with partial involvement of torcular Herophili in a 25-year-old patient on the sixth day of the puerperium.