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.     

Valor de la histeroscopia en la hiperplasia endometrial con atipias

Objective

To evaluate the utility of hysteroscopy in the diagnosis of atypical hyperplasia and its ability to identify concurrent endometrial cancer.

Subjects and methods

We describe the clinical activity from January 1, 1996 to December 31, 2002, in our hospital gynecology unit. All cases of atypical hyperplasia were collected. Diagnoses made by hysteroscopy combined with different techniques of endometrial biopsy and surgical specimen analysis after hysterectomy were evaluated. All these data were correlated to analyze their diagnostic capacity.

Results

A large percentage of endometrial cancers (11/18) was previously diagnosed exclusively by hysteroscopy, based on morphological approaches. Endometrial biopsy underestimated 22.7% of cases of adenocarcinoma and overestimated 46.8% of cases of atypical hyperplasia.

Conclusions

Hysteroscopy could be a highly useful diagnostic tool to identify endometrial cancer in women with a finding of atypical endometrial hyperplasia on biopsy. Studies with a sufficiently large number of patients to show statistical significance are required.     

Tumor mülleriano mixto maligno: la experiencia de un único centro con 43 casos de 1990-2006

Objective

Malignant mixed Müllerian tumours (MMMT) patients were retrospectively evaluated in terms of epidemiology, diagnosis, treatment, follow-up, recurrent disease and survival.

Methods

Medical and histopathology records were reviewed during the 17-year period 1990-2006. Survival rates were analysed by means of the Kaplan-Meier technique. The Cox proportional hazards regression model was used in uni- and multivariate analysis.

Results

A total of 43 patients were included in this study. First-line treatment was surgery in 79% of cases. Stage I, II, III and IV were identified in 34.9%, 16.3%, 34.9% and 9.3%, respectively. A complete response was achieved in 60.4% of patients. The disease was progressive in 39.6%. Event–free survival at 2, 5 and 10 years was 50% for all, with a median time of 15 months (95% CI,6-32). There was a 42.3% recurrence-rate with a mean time to recurrence of 8.4 months. The 2, 5 and 10-years overall survival was 26% with a median time of 7 months (95% CI, 1-44). In the univariate analysis tumour size, lymphovascular infiltration, stage and pelvic radiotherapy are prognostic factors. In the multivariate analysis lymphovascular infiltration, stage and radiotherapy were found to have an independent influence on overall survival.

Conclusions

MMMT are tumours of aggressive clinical behaviour with a poor prognosis. Stage, lymphovascular infiltration and adjuvant radiotherapy are the dominant prognostic factors.     

Criterios de calidad en el manejo del cáncer de mama en Castilla y León,mejorando nuestra eficiencia

Objectives

To assess the quality of care provided to breast cancer patients in the public hospitals of Castile-Leon.

Material and methods

Data collection was carried out through a survey on quality criteria endorsed by the European Society of Breast Cancer Specialists (EUSOMA), which was sent to the public hospitals in Castile-Leon. A total of 1235 patients diagnosed with breast cancer in 2011 participated in the survey.

Results

A total of 81.81% of criteria were achieved. Ninety percent of patients received treatment within 6 weeks of diagnosis. Surgical, radiotherapeutic, and systemic treatment complied with quality criteria. However, too many surgical excisions were performed in benign disease. The cases of 87% of cancer patients were discussed by a multidisciplinary team. There was excessive follow-up in asymptomatic patients and excessive study of tumoral extension.

Conclusion

Although the healthcare provided exceeded most quality criteria, we identified areas that could be improved to achieve more efficient resource use.     

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.     

Estudio prospectivo sobre la efectividad de una minibanda suburetral en el tratamiento de la incontinencia urinaria de esfuerzo

Objectives

To assess the efficacy of the tension-free vaginal tape mini-sling (TVT-S) to treat stress urinary incontinence (SUI) in women.

Material and method

We performed a prospective study of 170 patients who underwent TVT-S insertion and who were followed-up for at least 24 months. Both the objective and subjective cure rate were evaluated using clinical examination and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).

Results

The final number of assessed women was 137. The objective cure rate was 84% and the subjective cure rate was 91.2%. There were 7 complications during the surgery and 5 cases of mesh exposure (3.6%) during the follow-up period.

Conclusions

In our experience, the TVT-S cure rate for SUI is acceptable but is lower than the published cure rate for tension-free transvaginal tape (TVT) and tension-free transvaginal tape obturator (TVT-O).     

Tratamiento del carcinoma de cuerpo uterino mediante laparoscopia asistida por robot: nuestros primeros resultados

Objective

To present our experience from October 2009 though December 2011 and to compare outcomes and complications with a large study published in the American Journal of Obstetrics and Gynecology (AJOG) in 2011.

Material and methods

We performed a prospective study of our first 55 corpus uteri carcinomas: 50 endometrioid adenocarcinomas, two papillary serous carcinomas and three Müllerian adenosarcomas, treated with robot-assisted laparoscopy (da Vinci) in the Basurto University Hospital from October 2009 through December 2011.The variables analyzed were age, body mass index, histologic type, stages, treatment, mean operating time, mean of number of lymph nodes retrieved, the mean number and percentage of involved lymph nodes, surgical bleeding and conversion to laparotomy. We also analyzed the number and the percentage of operative, post-operative and total complications.

Results

The mean number of pelvic nodes was 14.44 vs. 13.16. Operating time was 181.1/286.5 minutes vs 196.33 minutes. Conversion to laparotomy was 5.45% vs. 2.9%. The percentage of total complications was 16.36% vs. 6.4%.

Conclusions

1) The number of pelvic nodes retrieved and the operating time were similar to those reported by the AJOG study. 2) Conversion to laparotomy and the percentage of total complications were higher than those reported in the AJOG study, possibly due to the smaller number of cases and the lesser experience (learning curve). 3) Robot-assisted laparoscopy is a viable approach with an excellent future in the treatment and staging of corpus uteri carcinomas.     

Bandas suburetrales libres de tensión transobturatriz in-out: indicación y resultados asociados

Objective

To describe the characteristics of treated patients and assess the results obtained.

Subjects and methods

All patients (n = 162) who underwent this technique between June 2005 and December 2010 at the Hospital de Fuenlabrada were included.

Results

The mean age was 51.64 years, mean body max index was 28.92 kg/m² and the mean number of vaginal deliveries was 2.31. Urodynamic diagnosis was performed in 96.3%, with findings of pure stress incontinence in 68.5%, mixed incontinence and stress incontinence in 25.9%. Intraoperative complications occurred in 3.1%. Mesh erosions were found in 1.2%. The overall objective cure rate was 92% and the subjective cure rate was 80.3%.

Conclusions

The complications rate was low and all complications were resolved. Cure rates were highly satisfactory both in pure stress urinary incontinence and in mixed urinary incontinence with a predominance of stress incontinence. Urodynamic studies before surgery allow good surgical indications and guide postsurgical prognosis.     

Diagnóstico ecográfico de la ventriculomegalia fetal. Seguimiento posnatal

Objetives

To determine the prevalence of fetal ventriculomegaly and identify the neurological outcomes of newborns with a prenatal diagnosis.

Method

Observational study of ventriculomegaly prenatally diagnosed by ultrasound in our department between 2004 and 2012.

Results

We diagnosed 61 cases of ventriculomegaly. The prevalence rate was 2.25 per 1,000. Diagnosis was made during the second trimester in 54 patients and during the third trimester in 7. Bilateral ventriculomegaly was found in 91% of the fetuses. Ventriculomegaly was mild (10-12 mm) in 79.4% and moderate (12-15 mm) in 5.6%. Severe ventriculomegaly (>15 mm) or hydrocephalus was diagnosed in 15% of the fetuses. The clinical course during pregnancy was unfavorable in 13%. Associated anomalies were diagnosed in 23 cases.

Conclusions

Mild, isolated and non-progressive ventriculomegaly has the best neurological prognosis.     

Lesiones vaginales por pesario. Estudio de casos y revisión de la literatura

Objective

We studied the adverse events occurring with the use of vaginal ring pessaries.

Material

We report a series of nine cases of adverse events involving vaginal pessaries occurring within a 4-year period with over 23719 consultations and representing an incidence of 0.03%.

Results

The mean age of the patients was 83 years (range: 70-96), and the mean parity was 3.77 (range: 2-6 children). The mean age of onset of the use of a pessary was 80 years. The mean number of years of use was 3 (range 1-5 years).The indications for pessary use were contraindication of surgery due to heart disease and, in women with prior surgery, the recurrence of prolapse or vaginal vault prolapse, and waiting for surgery.The adverse events found consisted of vaginal erosion and bleeding in 4/9 (44.44%) and vaginal discharge with vaginal infection in 5/9 (55.55%).

Conclusion

The use of a pessary warrants special care and hygiene measures to ensure long-term successful use.     

Utilidad de la resonancia magnética en la estadificación prequirúrgica del cáncer de endometrio

Objective

To evaluate the usefulness of magnetic resonance imaging (MRI) for preoperative staging of endometrial carcinoma.

Materials and methods

We performed a retrospective study of 71 endometrial neoplasms diagnosed in Hospital Sant Joan de Déu. The results of preoperative MRI scans were compared with those of the definitive histological examination.

Results

The preoperative stage obtained by MRI and the final stage were concordant in 69% of cases.

Conclusion

MRI is the most useful diagnostic method for preoperative staging of endometrial carcinoma     

Evaluación de un nuevo protocolo de cribado de cáncer cervical con citología convencional y test del virus del papiloma humano

Objective

To compare the effectiveness of cervical cancer screening using cytology plus the high risk human papillomavirus (HR-HPV) DNA test in 2011 versus cytology alone in 2010.

Method

Screening was performed in primary care. The target population in the Barbastro sector consisted of 26,936 women (aged 25 to 65 years). The HPV test was performed with hybrid capture (HC2) and the PCR cobas^® system in women between the ages of 30 and 65 years. Women with negative Pap and HPV test results underwent a 5-year recheck as per the latest protocol of Spanish Society of Obstetrics and Gynecology (SEGO, 2010).

Results

A total of 4,770 Pap tests were received in 2010 and 5,241 in 2011 with coverage between 36.8 and 46.8%; 784 HPV tests were carried out in 2010 and 3,560 in 2011, with positive results in 10.58% the first year and in 7.5% the second year. Eighteen new cases of cervical intraepithelial neoplasia grades 2/3 were diagnosed in 2010 and 35 in 2011, along with 3 invasive carcinomas each year (in 2011, 3 microinvasive carcinomas).

Conclusions

The implementation of HPV testing in primary screening for cervical cancer increased the number of pre-invasive lesions detected by 98% in the year of its introduction. Primary Care involvement allows screening for cervical cancer to be performed without additional costs.     

Fractura de clavícula en recién nacidos: factores de riesgo y morbilidad asociada

Introduction

Clavicle fractures are caused by injury during the birth process. It is associated to childbirth with difficulty in the exit of shoulders and to multiple related biomedical factors.

Objective

To evaluate risk factors and associated morbidities the clavicle facture in newborn of normal childbirth.

Patients and method

Retropective study, type case control in the Hospital Herminda Martín, Chillán (Chile), January to June of 2004. The group study was constituted by 44 cases of newborn with clavicle fracture, the group control constituted itself in regard to 1:2, both corresponded to following vaginal childbirths to the case study (88 cases).

Results

The incidence was of 4.1%, were statistically significant with the time of dilatation and expulsive in primiparas, weight and size of the newborns and presence of complications in the attention of the childbirth, shoulder dystocia (9.1% versus 2.3%), maternal uncontrol (6.8% versus 1.1%) and hand-dystocia (6.8%).

Conclusions

Clavicle fracture in newborn is associated to factors of the normal labor and delivery.     

Es posible aplicar protocolos de cribado de cáncer de cérvix en la práctica diaria

Objective

To evaluate whether screening protocols for cervical cancer can be implemented without delaying the diagnosis of cancer and whether this practice is well accepted by patients.

Subjects and methods

In 2005, we developed a protocol for the early diagnosis of cervical cancer based on carrying out cervical smears every 3 years in women over the age of 30 with three previous normal smears. We studied 300 patients who had attended an appointment in 2006 and another 300 in 2008. We reviewed our records to determine whether we had performed a smear and, if one was indicated, whether we had recommended attendance at a follow-up visit 3 years later, and whether the women had returned earlier. Adherence to the protocol in cancers diagnosed from 2005 was also reviewed.

Results

The number of smears decreased by 32% in 2008 compared with 2004, the year prior to screening. In 2008, 21% of women were recommended to attend the next review 3 years later and 3% returned earlier. Of 17 cancers diagnosed since 2005, only one woman with adenocarcinoma had undergone screening.

Conclusions

The overuse of cytology/smears in daily clinical practice can be avoided.