Tratamiento con análogos de la GnRH en la endometriosis de la pared abdominal

Abdominal wall endometriosis is uncommon and is almost always adjacent to surgical scars at the site of previous abdominal operations. The maximum incidence is 0.03-0.4% in patients with previous cesarean section. The interval between the procedure and symptom onset is usually 1 to 20 years.     

Análisis inicial de eficiencia en la aplicación clínica de las nuevas recomendaciones para la prevención secundaria del cáncer de cuello de útero

Aim

To evaluate the efficiency of the application of the new cervical cancer screening recommendations sponsored by the Spanish Society of Obstetrics and Gynecology.

Material and methods

A total of 631 women, aged 30 years or older, who attended the Gynecology Unit of the Santa Cristina Hospital, Madrid, for cervical cancer screening underwent cervical cytology and DNA/human papilloma virus determination (Hybrid Capture 2).

Results

Analysis of the hospital's costs showed that the new prevention strategy generated an estimated saving of 198.47 € per woman undergoing cervical cancer screening.

Conclusions

The new cervical cancer screening recommendations sponsored by the Spanish Society of Gynecology and Obstetrics are highly efficient.     

Descenso de la edad al diagnóstico en el cáncer de mama

Introduction

Increasingly younger women are apparently diagnosed with breast cancer. The aim of this study was to determine whether age at diagnosis of this disease is declining.

Material and methods

We calculated incidence rates for breast cancer in Zaragoza (Spain) by age groups. The median age at diagnosis over a 20-year period was calculated. A Joinpoint regression was subsequently performed to determine the trend.

Results

The median showed a downward trend with an annual percentage change of -0.3% (95% CI -0.6, -0.1) over the 20-year period. The crude incidence rates for age groups showed that the positive trend was highest among women aged more than 85 years, PAC = 14% (95% CI 4.03; 25.9), followed by the group aged 40-44 years with a PAC of 10% (95% CI 3.4, 17.1).

Conclusions

The median age at diagnosis of breast cancer has declined over the past 20 years.     

Hiperplasia ductal atípica de mama: correlación de la biopsia percutánea y los resultados de la biopsia quirúrgica

Objetive

The purpose was to evaluate the prevalence of carcinoma found at surgical biopsy of llesions identified as atypical ductal hyperplasia by percutaneous breast biopsy.

Methods

We performed a retrospective study of all asymptomatic patients with a result of atypical ductal hyperplasia on percutaneous breast biopsy and who underwent surgical excision from January 2002 to December 2010.

Results

Sixty-eight patients were found to have atypical ductal hyperplasia at percutaneous breast biopsy and were evaluated with surgical biopsy. Seventeen patients (25%) had carcinoma at surgical excision, 10 had ductal carcinoma in situ, and 7 patients had invasive carcinoma. The mammographic characteristics associated with malignancy were analyzed.

Conclusions

A finding of atypical ductal hyperplasia at percutaneous breast biopsy frequently corresponds to cancer and is therefore an indication for surgical excision.     

Cesárea a petición de la embarazada

Objetive

: To know Spanish Obstetrics and Gynaecology Society (SEGO) members about cesarean section on request.

Method

Three questions appeared on SEGO web: 1) If a normal primigravid with a term, cephalic presentation foetus ask you for a caesarean section, would you do it?; 2) If a normal primigravid with a term, breach presentation foetus ask you for a caesarean section, would you do it?; 3) If a woman on her normal third pregnancy with two previous vaginal and with a term, breach presentation foetus ask you for a caesarean section, would you do it? Questions were asked in May 2006 and answers were collected 19^th October 2006. Data analysis was processed with web page statistic method.

Results

Among the 5300 members of SEGO, 1222 contacted the web page (23%). To question n° 1, 57.8% answered no, 24.8% yes and 17.4% had no answer. To question n° 2, 6.1% answered no, 93.8% yes and there were no abstention. To n° 3 question, 16.7% said no, 74.5% said yes and 8.8% has no opinion.Results are commented, advantages and disadvantages of caesarean are discussed as well as sanitary consequences of such an indication.     

La morbilidad de la histerectomía radical como variable de resultado combinada

Objective

To assess serious morbidity after abdominal or laparoscopic radical hysterectomy, viewed as a composite endpoint.

Subjects and methods

We reviewed 41 abdominal radical hysterectomies performed at the San Dureta Hospital, Palma de Mallorca, between 2001 and 2007. Other publications were used as comparative pattern and to establish the components of the composite endpoint. The life table method was used to calculate the proportion of surviving patients. Confidence intervals (CI) of the proportion of patients with morbidity were calculated.

Results

Six-year survival was 85%. One serious complication was observed in every 21 patients (95% CI, 1.35-16.14%).

Conclusions

Serious morbidity associated with abdominal radical hysterectomy and laparoscopic radical hysterectomy can be similar.     

Características epidemiológicas de una población de mujeres posmenopáusicas con osteopenia y osteoporosis: importancia de la dieta mediterránea

Objective

To determinate the distribution of risk factors for osteoporosis in a Spanish population of postmenopausal women.

Patients and methods

An observational multicenter study was carried out in 1779 postmenopausal women. The women were divided into three groups depending on the results of densitometry: 450 women with osteoporosis, 766 women with osteopenia, and 479 controls.

Results

The distribution of known risk factors for osteoporosis in our patients was similar to that in other studies. Moreover, a protective effect of a diet based on vegetables, fish, dairy products, and moderate alcohol intake against developing osteoporosis was found.

Conclusions

Our study confirms the importance of known risk factors for osteoporosis. Moreover, in our population, the beneficial effects of moderate alcohol ingestion and abundant intake of food included in the Mediterranean diet is identified.     

Impacto psicológico de la mamografía de cribado en mujeres con resultados no concluyentes

Objective

To assess the impact of mammographic screening on anxiety, depression, and quality of life in women requiring a second mammogram 6 months after an inconclusive biennial screening mammogram.

Methodology

A total of 105 women were interviewed after they had been informed of the BI-RADS results of their screening mammography. Of these women, 72 were interviewed for a second time, after they had received a negative result of the follow-up mammogram. The assessment scales used were the Hospital Anxiety and Depression Scale, and the Medical Outcomes Short-Form General Health Survey (SF-36). Anxiety and perceived physical comfort during the screening and follow-up mammograms were also evaluated through two questions specifically designed for this study.

Conclusions

Levels of anxiety and depression, quality of life and physical discomfort were satisfactory, with no differences between the two time points of measurement. Mammography screening does not cause emotional distress. These results should be emphasized by breast screening campaigns.     

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.     

Cáncer oculto de la mama. Caso clínico y revisión de la literatura

We report the case of a patient with occult cancer of the breast. A finding of metastatic adenocarcinoma to the axillary nodes with no apparent mass in the breast is rare, occurring in 0.3% to 0.8% of all breast tumors.     

Análisis de la finalización de la gestación y morbilidad materna en las gestaciones de 41 semanas

Objective

To evaluate the mode of delivery and maternal morbidity associated with pregnancies ending at 41 weeks.

Material and methods

We designed a retrospective cohort study. The mode of delivery and maternal complications of 230 pregnancies ending at 41 weeks were compared with those in 234 pregnancies ending between 37 and 40 weeks at the Miguel Servet University Hospital in 2005.

Results

Women delivering at 41 weeks had an increased risk of membrane sweep, unfavorable Bishop score at admission, induction and longer duration of labor. These increases were also seen in the rates of operative vaginal delivery (25.6 vs 17.6%, p < 0.001) and cesarean section (21.7 vs 8.5%, p < 0.001).

Conclusions

The rates of maternal peripartum complications increase as pregnancy reaches 41 weeks. Accurate investigation of these rates is important to determine the gestational age at which the risk of continuing the pregnancy outweighs the risk of labor induction.     

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.     

Actualización en linfomas primarios de mama: serie de casos y revisión de la literatura

Introduction

Primary breast lymphomas (PBL) are a rare malignant disease of the breast that can be mistaken for breast carcinoma. Knowledge of PBL allows a correct diagnostic-therapeutic approach to this uncommon malignancy (0.04- 0.5% of breast cancers).

Material and methods

This update is based on an analytic retrospective study of a series of cases recorded at the Hospital Príncipe de Asturias and a comprehensive review of the oncologic and gynecologic literature available.

Discussion

PBL are virtually indistinguishable from breast carcinomas because of their similar age distribution, clinical presentation and imaging features. Diagnosis can only be confirmed by histology. The most effective treatment is combined therapy based on chemotherapy (the most widely used being the CHOP-R regimen). Surgery and radiotherapy play a secondary role. The course of PBL varies widely, from early dissemination to complete remission. Prognostic factors play an important role in PBL. Prompt diagnosis is essential to improve outcome.

Conclusion

Because of their low prevalence, PBL are a diagnostic-therapeutic challenge. There is no agreement on treatment regimens, and outcome is highly variable. New in-depth studies are required to unify criteria and knowledge of this entity.     

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.     

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.     

Influencia de la educación maternal sobre hábitos tóxicos y uso del servicio de urgencias obstétricas

Objectives

To determine the influence of the women's exposure to maternal education on smoking and the use of obstetric emergency services.

Method

A multicenter observational study was conducted on women whose childbirth was the first in four hospitals in Andalusia (Spain) in 2011. The data were collected through an interview and medical history. The analysis estimated odds ratios and both raw and adjusted averages.

Results

A total of 520 women were studied. Participation in the maternal education program seemed to have no influence on the use of obstetric emergency services (ORa = 0.70, 95% CI = 0.47-1.04) or on changing smoking habits (ORa = 0.84, 95% CI = -0.43-1.68).

Conclusions

Attendance at a maternal education program did not modify smoking. We found no conclusive evidence of the impact of maternal education on the use of emergency obstetric services.     

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.