Riesgo de fracturas no vertebrales en mujeres posmenopáusicas en tratamiento antirresortivo

Objective

To determine the 5-year non-vertebral fracture risk in postmenopausal women on antiresorptive therapy.

Subjects and methods

We performed a cross-sectional multicenter study in 2,111 postmenopausal women receiving antiresorptive therapy in gynecological settings. The risk of fracture was evaluated by means of the FRACTURE Index. The influence of clinical parameters on the main variable was evaluated through linear and/or logistic regression, using the SAS v. 9.1.3 program.

Results

The mean age ± standard deviation was 61.0 ± 7.9 years. Densitometry was available in 60.5% of the women and showed a prevalence of osteopenia of 49.4% whereas that of osteoporosis was 42.4%. Biphosphonates were used in 59.3% of the women. When densitometry was available, 73.4% scored less than 6 points on the FRACTURE Index, and when densitometry was not available, 81.7% scored less than 4 points. The mean risk of non-vertebral fractures was 14.8 ± 5.3% and that of vertebral fractures was 4.0 ± 3.0%.

Conclusions

In this large group of postmenopausal women receiving antiresorptive treatment, the 5-year non-vertebral fracture risk, as assessed by the FRACTURE index, was three times higher than that of vertebral fracture.     

Actitudes,conocimiento y expectativas de las pacientes con osteoporosis posmenopáusica en España

Objective

This study describes the profile and attitudes, knowledge and expectations of patients with postmenopausal osteoporosis.

Subjects and methods

Epidemiological and cross-sectional study carried out in Spain. Participating patients were aged over 45 years and receiving treatment for postmenopausal osteoporosis. Data on personal and family medical history, diseases and concomitant medications, smoking and drinking habits, diet and physical activity, treatment and compliance were recorded. All patients completed a 17 item questionnaire on attitudes, knowledge and expectations related to their condition.

Results

A total of 1179 valid patients with postmenopausal osteoporosis were included, with a mean age of 59.89 ± 7.53 years. Only 22.6% of the patients showed acceptable knowledge of osteoporosis. A large majority (74.6%) of the patients were very/quite concerned about their condition, and 53.3% described their health status as excellent/good. However, 63.6% of the patients indicated that they need more information about osteoporosis.

Conclusions

The results of this study prove the need to provide accurate knowledge of their disease to patients with postmenopausal osteoporosis.     

Cribado del cáncer cervicouterino en colectivos de mujeres asintomáticas con factores de riesgo

Objectives

To determine the rates of cervical and vaginal disease in groups of asymptomatic women with risk factors and their degree of adhesion to the screening program.

Patients and methods

269 asimptomatic women attended during 1 year (1998) were interrogated in relation to risk practices; they underwent pap smear, colposcopy-biopsy of the cervix and determination of antibodies for VIH. A follow-up was made during 5 years.

Results

The prevalence of intaepithelial lesions was 26.8% and the accumulated incidence was 10.4%; 62.5% of the women never returned to revision more, whereas 37.6% returned at least once.

Conclusions

The women of the studied groups show high rates of cervical-vaginal pathology and high risk of developing cervical cancer. The adhesion of these women to the screening program is very low. Because of the low precision of the citology, this women must undergo a second screening test.     

Ayuno vs. dieta líquida. Estudio aleatorizado controlado para evaluar la duración de la labor de parto,tasa de cesáreas y satisfacción con la labor

Aim

To evaluate the benefits of allowing oral intake of clear liquids in terms of labor duration, the cesarean section rate, and personal satisfaction.

Methods

A randomized controlled trial was carried out to assess the effects of a clear liquid diet in a low risk population. The primary outcome was labor duration. The secondary outcome was the incidence of cesarean section. A satisfaction survey was performed within the first 2 h after delivery to evaluate the patient's perception of labor.

Results

A total of 348 patients were randomized. The mean duration of labor was 257.75 min in the liquid diet group and 288.40 min in the fasting group (p = NS). There was no statistically significant difference (per-protocol analysis and intention-to-treat analysis) in the cesarean section rate.Patients reported greater satisfaction when allowed to drink during labor than when fasting.

Conclusion

A clear liquid diet during labor did not alter the duration of labor or the cesarean section rate. Allowing a liquid diet during labor was associated with a better perception of the birth process and a higher degree of satisfaction.     

Cáncer de mama en la mujer joven

Objective

To review the characteristics of breast cancer in young women.

Material and methods

The scientific literature was reviewed, indicating the etiological factors, diagnostic methods and treatment options, with special reference to the factors that can concur in young patients such as premature menopause, loss of fertility, pregnancy after breast cancer and breast cancer during pregnancy.

Results

Importantly, breast cancer in young women is very rare but is on the increase. Tumors are larger in young women and have positive margins, making the disease more aggressive and leading to higher mortality. Diagnosis is more difficult than in older women and the triple test (mammography, ultrasound and biopsy) is of great importance. Treatment options are the same as in older women.

Conclusions

Breast cancer in young women shows certain characteristics that differentiate it in some respects from breast cancer diagnosed in older women.     

Alteración ecográfica del endometrio en mujeres menopáusicas sin metrorragia

Objective

To determine the incidence of endometrial cancer in asymptomatic postmenopausal women with a sonographic endometrial thickness above 5 mm.

Materials and methods

We performed a retrospective study of 270 asymptomatic postmenopausal women with endometrial thickness > 5 mm on sonography. All women underwent hysteroscopy with histological evaluation if required. The incidence of endometrial cancer was evaluated.

Results

Five cases of endometrial cancer were diagnosed in the 270 women, representing an incidence of 1.85%. Of the 106 patients with a sonographic image leading to suspicion of polyp, four were diagnosed with endometrial cancer (3.77%), all of which were stage I tumors. None of the 270 women was receiving hormone replacement therapy.

Conclusions

The incidence of endometrial cancer in asymptomatic postmenopausal women with sonographic suspicion of polyp was 3.77%. Patients with this sonographic finding should undergo thorough hysteroscopy and biopsy to rule out malignancy. We believe that the cut-off value for endometrial thickness in postmenopausal women without vaginal bleeding should be determined.     

Influencia de las características tumorales del cáncer de mama en mujeres menores de 35 años en el pronóstico de la enfermedad

Background and objective

Two per cent of breast cancers develop in women aged 35 years old or younger. The aim of this study was to analyze the influence of the histological characteristics of the tumor and axillary involvement on the prognosis of the disease.

Methods

We performed a retrospective study of 71 women aged 35 years old or younger diagnosed with breast cancer in the 12 de Octubre Hospital from 1983 to 2000. A survival curve was designed using the Kaplan-Meier method.

Results

The most important prognostic factor was tumoral extension at diagnosis. A total of 66.7% of the patients in initial stage IV died within 5 years of follow-up. For stages 0 and I, 92.3% and 100% of the patients, respectively, were alive and had no evidence of disease. The most frequent histological type was infiltrating ductal carcinoma. Outcome was not influenced by tumoral type or histological grade. Recurrence was more frequent in patients with positive receptors than in those with negative receptors. One of the most important prognostic factors was axillary involvement. Recurrence occurred in 71.4% of the patients with nodal involvement compared with 31.4% of those without nodal invasion. The greater the number of affected nodes, the higher the risk of recurrence. Alteration of P53 and c-erb 2 were poor prognostic factors.

Conclusions

Tumoral size and stage, axillary involvement and the number of affected nodes were associated with a higher risk of recurrence and worse 5-year outcome. The presence of positive receptors was also related to an unfavorable outcome. Fifty percent of women lived for more than 15 years.     

Síndrome metabólico y riesgo cardiovascular en mujeres posmenopáusicas de una institución de primer nivel de Envigado (Colombia)

Objective

To compare the prevalence of metabolic syndrome in postmenopausal women by applying the IDF and the NCEP/ATPIII criteria and to assess the risk of cardiovascular disease in postmenopausal women and associated risk factors.

Material and methods

A cross-sectional study of 224 women aged ≥45 years was carried out following IDF and NCEP/ATPIII guidelines. Cardiovascular risk was estimated using Framingham projections of 10-year absolute cardiovascular disease risk and AHA cardiovascular disease risk assessment.

Results

Among evaluated women, the mean age was 59 years (SD 8.36 years). Half of the women had had their last menstrual period >10 years previously, from the FUM (RIQ: 5-18). A total of 62.9% were overweight or obese. The prevalence of metabolic syndrome was 57.1% according to the IDF criteria (IC 95%: 50.4-63.7) vs. 37.5% according to the NCEP/ATPIII criteria (IC 95%: 31.1-44.2). Framingham score was >10% in 46% of the women. According to AHA criteria, 76.8% were at risk, or at high risk, for cardiovascular disease. In the multivariate analysis, the factors most strongly associated with metabolic syndrome according to IDF criteria were obesity (OR 5.05; IC 95%: 2.18-11.69) and age >65 years (OR 2.75; IC 95% 1.34-5.64). The factors most strongly associated with cardiovascular risk were hypertension (OR 11.58; IC 95%: 4.81-27.86), low levels of high-density lipoprotein cholesterol (OR 16.63; IC 95%: 5.96-46.37), and age >55 years (OR 4.5; IC 95%: 1.90-10.67).

Conclusion

The joint application of the IDF criteria for metabolic syndrome and the AHA criteria for cardiovascular disease risk assessment is useful to identify a greater number of women at risk.     

Tratamiento de la endometriosis con 5 mg o 25 mg diarios de mifepristona durante 6 meses. Ensayo clínico aleatorizado,doble ciego

Objectives

To evaluate the safety and efficacy of 5 mg and 25 mg doses of mifepristone for the treatment of endometriosis.

Design

Randomized double-blind study.

Setting

Eusebio Hernández Hospital, Havana, Cuba.

Subjects

Twenty-six women laparoscopically diagnosed with endometriosis were included.

Treatment

Group I received one tablet of 25 mg mifepristone daily and group II received one tablet of 5 mg mifepristone daily for 6 months. Laparoscopy and endometrial biopsy were performed before and after treatment.

Variable to evaluate efficacy

Reduction in the intensity of dysmenorrhea measured by a visual analogue scale.

Results

In both groups reductions in the intensity of dysmenorrhea and dyspareunia were highly significant compared with initial values (P <.001). All the women were amenorrheic after 45 days of treatment.

Conclusions

At doses of 5 mg or 25 mg, mifepristone could be an alternative for the treatment of endometriosis.     

Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care—a national-based investigation into midwives’ alcohol-related education,knowledge and practice

Objective

to evaluate how much education midwives in Sweden have undertaken to help them assess alcohol intake during pregnancy, and what tools they use to identify women who may be at risk of drinking during pregnancy.

Design

a national survey was conducted in March 2006, using a questionnaire constructed by a Swedish team of researchers and clinicians.

Setting

maternity health-care centres in Sweden.

Participant

2106 midwives.

Findings

nearly all midwives stated that they had excellent or good knowledge concerning the risks associated with drinking during pregnancy. They considered themselves less knowledgeable about detecting pregnant women with risky alcohol consumption before pregnancy. The majority of the midwives had participated in some education in handling risky drinking. Almost half of the midwives assessed women's alcohol intake before pregnancy. Important facilitators for increased activity concerned recommendations and decisions at different levels (national, local and management) on how to address alcohol with expectant parents and work with risky drinkers.

Key conclusions

more education was associated with more common use of a questionnaire for assessment of women's alcohol intake before pregnancy, and more frequent counselling when identifying a pregnant woman whose pre-pregnancy consumption was risky.     

Posicionamiento de la Asociación Española para el Estudio de la Menopausia sobre el uso clínico de la Cimicífuga racemosa en el climaterio

Objective

Due to an increasing interest in the symptoms related to menopause in western countries, the Spanish Menopause Society (SMS) has assessed the role of cimicifuga racemosa in relieving those symptoms based on the most reliable evidence available.

Material and methods

A meeting was held with a panel of experts, health scientists and researchers specialised in the field of phytotherapy. The studies selected were obtained through electronic search which included INTERNET, MEDLINE (1985-May 2008), and the Cochrane Controlled Clinical Trials Register.

Results

Most studies published in recent years have been carried out using an isopropanol extract of cimicifuga racemosa. The dose most commonly studied was 40mg/day and was shown to result in a moderate decrease in hot flushes, particularly in those women with the most intense hot flushes, and an improvement in their mood. When recommended doses are used there is no significant risk to the hepatic system. Available data on the effect of cimicifuga racemosa on cardiovascular disease, bones, cognitive function or skin are scarce or non-existent.

Conclusions

Cimicifuga racemosa is an effective treatment for relief of vasomotor symptoms, at least within a suitable population of peri- and postmenopausal women. Nevertheless, more accurate clinical trials which include sufficient numbers of patients and a longer follow-up are required.     

Clasificación de cesáreas por Grupos de Robson en dos periodos comparativos en el Hospital de Manacor

Objective

To identify groups of women with changes in cesarean rates in two different periods.

Subjects and methods

Deliveries in the Manacor Hospital in 2000-2001 and 2005-2006, were analyzed through a retrospective review of clinical records and were grouped using Robsońs classification.

Results

The cesarean rate increased from 14 to 18.6% with a statistically significant increase among women with a single cephalic pregnancy at term who underwent labor induction or elective cesarean section. These two groups were the major contributors to the cesarean rate at our hospital.

Conclusion

A trend towards an increase in the rates of cesarean section was found during the study period. Robson's Classification allowed us to identify the groups of women contributing to this increase.     

Tumores malignos ginecológicos sincrónicos. Casuística del Hospital de Manacor

Objective

To alert clinicians to the possibility of synchronous tumors in patients with gynecological cancer. An important tool in diagnosis is the family history. We describe several familial syndromes involving the development of synchronous gynecological tumors.

Subjects and methods

We studied all cases of synchronous gynecological tumors in the Manacor Hospital from 1997 to 2006.

Results

Synchronous gynecologic tumors represented 0.83% of all gynecological neoplasms treated in our center in the period studied.

Conclusions

This kind of tumor is uncommon but should be considered by clinicians, especially in women with a familial history of cancer or in those with certain genetic syndromes. Examination aimed at excluding the presence of synchronous tumors is recommended.     

Estudio prospectivo,aleatorizado y controlado para evaluar la utilidad de la radiopelvimetría en la inducción de parto en primigrávidas

Introduction

There are very few studies published in the scientific literature to assess the real value of the x-ray pelvimetry (X-PM). The current recommendations on its use are based on a single meta-analysis that includes only four studies with a very low level of scientific evidence.

Objectives

To evaluate the usefulness of the X-PM in induction in primiparous women for the diagnosis of pelvic-cephalic disproportion and analysing its influence on the duration of pregnancy, neonatal mortality and the rate of caesarean sections.

Materials and methods

The observational, prospective, randomised, double-blind, study, in a population of 264 primigravid pregnant women in whom induction of labour was an indication.

Results

X-ray pelvimetry did not influence the rate of caesarean section or the perinatal results, and has a low predictive value as a prognostic factor in the method of delivery.     

Enfermedad residual después de cirugía conservadora por cáncer de mama

Objective

To evaluate which factors are related to the presence of residual tumor after lumpectomy for breast cancer with a view to determining the excisional biopsy margins that guarantee a complete excision.

Material and methods

The records of 118 women with invasive breast carcinoma who were treated with lumpectomy in our service between June 2004 and December 2006 were retrospectively reviewed. The parameters evaluated were age, palpability, diagnostic method, type of initial and definitive surgery, histologic type, tumor size, lymphovascular invasion, presence/absence of extensive intraductal component (EIC), estrogen receptors, surgical margins, reexcision, and the presence of residual tumor.

Results

Residual disease was found in 27%. In the univariate analysis, only margins (P=.015), EIC (P=.026) and size (P=.025) were significantly associated with the presence of residual tumor. With simple lineal regression analysis, only margins (P=.008) and EIC (P=.025) showed a significant association.

Conclusions

We believe that a minimum margin of 2 mm is enough to guarantee the absence of residual breast cancer if there is no EIC. In patients with margins ≤ 2 mm, the presence of EIC is an indication of high risk of residual disease.     

Absceso hepático roto en portadora de dispositivo intrauterino

Background

Although intrauterine device is safe for the most women, its association with liver abscess has been reported and can produce fatal sepsis.

Clinical case

We report a case of a patient wearing intrauterine device who arrived at the emergency department with acute abdomen due to ruptured liver abscess. The patient underwent exploratory laparotomy for surgical drainage.

Conclusion

Intrauterine device can be considered the etiology in a woman with intraabdominal infection.     

Cáncer inflamatorio de mama. Factores pronósticos relacionados con la enfermedad

Objectives

To analyze the possible prognostic value of disease-related factors in inflammatory breast carcinomas (IBC) diagnosed and treated in our hospital.

Subjects and methods

This retrospective analysis included 40 patients with non-metastatic IBC diagnosed in our service between 1991 and 2004, with both clinical and pathological criteria of IBC.

Results

Treatment response was significantly better in tumors with positive hormone receptor status. Axillary invasion, involvement of more than 4 nodes, and lack of response to neoadjuvant chemotherapy were determinants of a high risk of recurrence.

Conclusions

Our data suggest that response to neoadjuvant chemotherapy is an important prognostic factor. Further studies are required to determine the most appropriate treatment of IBC.