Histeroscopia en el tratamiento de los pólipos placentarios

Placental polyp is a polypoid mass due to retention of decidual or fetal placental tissue in the uterine cavity after miscarriage or parturition. The estimated incidence of retained placental tissue is approximately 1% after term delivery and is probably higher after miscarriage and preterm delivery. Clinical symptoms include heavier and longer than usual uterine bleeding and pelvic pain with or without fever, since retained products are prone to infection from the cervicovaginal flora.     

Leiomiosarcoma retroperitoneal tras tumor de músculo liso de potencial maligno incierto

Uterine smooth-muscle tumors are not easy to classify. We report a case of uterine smooth-muscle tumor of uncertain malignant potential, which metastasized to retroperitoneal leiomyosarcoma in the left obturator cavity.     

Adenocarcinoma seroso papilar sobre pólipo endometrial

We report two cases of uterine papillary serous carcinoma in endometrial polyps, which were diagnosed and treated in Donostia Hospital in San Sebastián, Spain. Although the tumors were classified as early stage, both patients suffered disease relapse and progression.     

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.     

Mioma intracervical: morcelación histeroscópica

Throughout the history of hysteroscopy, many technical changes have been made to reduce its complications, involving the distension medium, optics and image enhancement. Recently, we designed a hysteroscopic morcellator intended to facilitate hysteroscopy use and reduce the risks of the previous technique.     

Morcelador histeroscópico (Truclear System): nuestra experiencia inicial

Objective

To evaluate the efficacy and safety of the hysteroscopic morcellator.

Patients and methods

We carried out a retrospective observational study of 411 patients diagnosed with intracavitary disease, who underwent surgical hysteroscopy with the mechanical morcellation system from 2004 to 2009.

Results

We performed 327 polypectomies and 76 myomectomies. The success rate was 99.2%. The mean operative time was 9.2 minutes and 22.3 minutes, respectively.

Conclusion

The hysteroscopic morcellation technique is safe and effective, has a short learning curve, a reasonable operating time, and low rate of surgical complications.     

Tumor filodes maligno: a propósito de un caso y revisión de la literatura

Phyllodes tumor of the breast is a rare neoplasm, representing less than 1% of all breast tumors. The definitive diagnosis of these fibroepithelial tumors is histologic. Local recurrence occurs in 20% of cases. Although uncommon, these tumors can metastasize to other organs. Treatment is surgical with wide excision and disease-free margins. We present the case of a patient with phyllodes tumor who developed lung involvement.     

Metástasis en mama de melanoma maligno cutáneo

Breast metastases from extramammary primary tumors account for 2% of all malignant breast tumors (the most common being lymphoma and malignant melanoma) and can mimic primary breast carcinoma clinically and radiologically. The prognosis of patients with metastases to the breast from solid tumors is generally poor, with 80% dying in the first year. The most widely accepted treatment is simple excision. Consequently, determining the source of metastases prior to surgery avoids further surgical procedures that will not improve prognosis. We present a case of metastases from malignant cutaneous melanoma to the breast diagnosed in the right thoracic wall and surgically excised 3 years previously.     

El SeXO de los obstetras y el género de parto vaginal

Objective

To determine whether the instrumental delivery rate changes according to the number of men among thirdand fourth-year resident physicians.

Materials and methods

The proportion of instrumental deliveries was determined among 54,961 births in a single hospital from 1990 to 2006. Annual rates were calculated based on the gender of thirdand fourth-year resident physicians. For each annual rate, a 95% confidence interval was calculated and the χ² test was performed to verify the significance of differences.

Results

When the number of male physicians increased so did the rate of instrumental deliveries. Differences were significant for years in which the number of male physicians was equal to three or more.

Conclusions

The instrumental delivery rate seems to be related to the gender of third-and fourth-year resident physicians.     

Impacto económico de la histeroscopia quirúrgica en consulta. Modelo con escenarios progresivos

Objective

To analyze the cost of outpatient versus day-case operative hysteroscopy.

Subjects and methods

The average cost of outpatient and day-case procedures were analyzed, based on the 1695 hysteroscopies performed between 2010 and 2012.A model with 10 progressive scenarios was built according to the number of outpatient procedures performed. The economic saving and the number of operating room sessions avoided were analyzed.

Results

Performing as many procedures as possible in the outpatient setting represented a saving of 177,971 € and avoided 85.16 seven-hour sessions in the operating room.

Conclusions

Outpatient operative hysteroscopy represents a safe, efficient and cost saving procedure with a high degree of patient satisfaction. This procedure should replace day-case hysteroscopy and should be widespread in the health service.     

Clasificación morfológico-histeroscópica del cancer endometrial

Objective

To assess the morphological-hysteroscopic nomenclature for endometrial cancer used by our group by evaluating the differences between distinct patterns, both morphological and those related to histological grade and stage at diagnosis.

Material and methods

We analyzed 272 patients with hysteroscopically-diagnosed endometrial cancer. Using our classification, we grouped the tumors into three patterns (pseudohyperplasial,nodular, and malignant transformation of polyps) and one subpattern (advanced). We next compared these patterns with the surgical stage and the final histological grades.

Results

When advanced signs were lacking, the patterns of pseudohyperplasia and malignant transformation of polyps were related to earlier stages and differentiated histological grades.Nodular patterns were related to scarcely differentiated histological grades. Finally, advanced subpatterns, irrespective of the basic pattern to which they belonged, were diagnosed at later stages.

Conclusions

Currently, the value of hysteroscopy in the diagnosis of endometrial cancer and intracavity involvement is widely accepted. This study demonstrates the utility and validity of our morphological-hysteroscopic classification; the nomenclature described can be used to give a name to the malignancies diagnosed and even to hazard a prognosis related to their stage and grade of histological differentiation.     

Edema agudo de pulmón como complicación de una histeroscopia quirúrgica

Surgical hysteroscopy is a minimally invasive procedure that may result in potentially serious complications. The solution most commonly used for distension is glycine because of its low viscosity, low cost, transparency and compatibility with electrosurgery. However, excessive absorption of this fluid has adverse effects, ranging from mild fluid and electrolyte alterations to severe hyponatremia, acute pulmonary edema, coma, cardiovascular collapse and death. We report a case of acute pulmonary edema due to excessive absorption of glycine during hysteroscopic myomectomy.     

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.     

Aneurismas múltiples de los vasos coriónicos

Chorionic vessels aneurysms are a rare finding in the umbilical cord and placental pathology, and its prenatal ultrasound diagnosis is exceptional. This condition means an increased fetal risk, with unknown treatment and prognosis, and it was the cause of the fetal death in the case we present, so we consider it as obstetric interest.     

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.     

Tratamiento médico del embarazo ectópico instersticial: descripción de un caso clínico

Traditional management of interstitial pregnancy involves laparotomy with cornual resection. Recent advances in transvaginal ultrasonography and sensitive beta-hCG assays have led to earlier diagnosis of these cases. We report a case of interstitial pregnancy successfully treated with parenteral methotrexate. Prompt recognition of interstitial pregnancy allows conservative approachment and systemic methotrexate presents as an effective and safe option.     

Síndrome de insensibilidad a los andrógenos familiar

Androgen insensitivity syndrome is the most frequent of the sexual development disorders with 46,XY karyotype and female phenotype. This syndrome is due to a mutation in the androgen receptor gene, which lies on the X-chromosome. Diagnosis is usually made in childhood due to inguinal hernias or during puberty due to primary amenorrhea. Gonadal extirpation is required because of the risk of malignant transformation. We present a 25-year-old patient with primary amenorrhea diagnosed with androgen insensitivity syndrome, who reported four relatives with the same diagnosis.