Metástasis de adenocarcinoma de colon en trompa de Falopio

Fallopian tube carcinoma is a rare tumour. The reported incidence ranges from 0.14 to 1.8% of genital malignancies. The incidence of Fallopian tube carcinoma is 3.71- 4.1 per million, much lower than the incidence of ovarian carcinoma or peritoneal malignancy. Most tumours affecting the Fallopian tube are metastatic, and usually, the primary carcinoma has a gynaecological origin.An unusual case is reported on a woman whose clinical manifestations, examination and ultrasound image, simulated a pelvic inflammatory disease. However histopathological examination of the specimen confirmed a metastatic adenocarcinoma of sigmoid colon.     

Riesgo de cáncer de mama en portadoras de DIU de levonorgestrel. Revisión sistemática

IntroductionBreast cancer is the leading cause of cancer death in European women. The question arises whether the use of levonorgestrel IUD (LNG-IUD) could be associated with an increased risk of breast cancer.Material and methodsWe conducted a systematic review to identify the risk of breast cancer among LNG-IUD users.ResultsWe found 8 articles, all of them observational and concerning the Mirena® IUD. Half of the studies do not find an increased risk of breast cancer in LNG-IUD carriers and the other half do. The heterogeneity of these studies, as well as the existence of bias in them, and the absence of control for other factors prevent us from performing a meta-analysis.ConclusionsWith the current scientific evidence we cannot confirm that there is a reater risk of breast cancer in LNG-IUD carriers. Well-designed studies are required to draw clear conclusions.     

Descripción de un caso de angioedema hereditario dependiente de estrógenos

IntroductionHereditary angioedema is a rare genetic disease without any specific treatment.Main symptomsIt is characterized by recurrent episodes of skin and mucous oedema.Main diagnosesThere are three types of angioedema and type III has been related to high-level oestrogen conditions.Therapeutic interventionsWe describe the case of a patient with hereditary angioedema type III, who had an episode of angioedema associated with the periovulatory and premenstrual period.Due to this hormonal influence, we used gestagen therapy to attempt to reduce the number of ovulations.ResultsAfter several months of treatment with desogestrel, the patient reports a decrease in the number and severity of episodes.ConclusionGestagen therapy seems to be useful for controlling episodes of hereditary angioedema type III.     

Valores de referencia de hormonas tiroideas en la población de gestantes en Lugo

Background and objectiveThe complex physiology of thyroid function during pregnancy requires a hormonal evaluation according to reference values for each trimester, each area, and with the techniques of each laboratory. The objectives of this study were to analyse thyroid function in the three trimesters of pregnancy and to establish the reference values of hormones in pregnant women in this health area (Lugo).MethodsA total of 831 pregnant women were included in the study (median age: 33 years, age range: 16-47 years). Once the exclusion criteria were applied, the sample consisted of 641 pregnant women, a size that can be considered representative of the reference population.ResultsThe reference intervals were as follows: TSH first trimester, 0.10-3.74 mIU/L; second trimester, 0.45-3.77 mIU/L; and third trimester, 0.36-4.15 mIU/L. For Free T4 in the first trimester, 0.87-1.34 ng/dL; second trimester, 0.78-1.20 ng/dL; and third trimester, 0.78-1.23 ng/dL. For Free T3 in the first trimester, 2.52-3.78 pg/mL; second trimester, 2.22-3.21 pg/mL; and third trimester, 2.17-3.14 pg/mL. The presence of thyroid autoimmunity was confirmed in 109 women (13.1%), who presented with higher TSH values than pregnant women without thyroid autoimmunity.ConclusionThe reference intervals for TSH, Free T4, and Free T3 obtained in this study are below those used in the non-pregnant adult population in this laboratory. This should help to identify more accurately a possible thyroid dysfunction in pregnant women in the study area, avoiding an underdiagnosis of subclinical hypothyroidism and reducing the possible associated perinatal complications.     

Quistes de plexos coroideos y riesgo de cromosomopatía

IntroductionSince they were first described in 1984, the presence of choroid plexus cysts during pregnancy have stimulated considerable debate concerning their possible relationship with chromosomal anomalies, mainly trisomy 18. Even today, the controversy persistsObjectiveTo identify which associated factors (cyst characteristics, associated anomalies and maternal age at diagnosis) should be considered to justify invasive karyotyping, bearing in mind that these techniques carry a risk of fetal lossMaterial and methodsWe analyzed data from one decade (January 1991-December 2000) corresponding to 26,500 fetuses who underwent ultrasound examination between weeks 14 and 22 of gestation. Choroid plexus cysts were considered as an ultrasound-negative formation of at least 3 mm in diameter located within the choroid plexusResultsChoroid plexus cysts were found in 366 fetuses (1.38%). Of these, eight fetuses presented chromosomal anomalies: six presented trisomy 18, one presented trisomy 21 and one showed chromosomal deletion at 6p. In all eight patients, choroid plexus cysts were bilateral and associated anomalies were detected. Mean maternal age was 36.5 yearsConclusionsWhen choroid plexus cysts are detected in the second trimester, detailed fetal investigation must be performed to find other possible markers of chromosomal anomalies even though some are difficult to detect ultrasonographically. Because the risk of fetal loss after amniocentesis is estimated at 1%, when other markers are absent, our results suggest that invasive karyotyping does not seem justified in pregnant women without additional risk factors     

Facteurs prédictifs de grossesses en cas de transfert de deux embryons au cours de tentatives « Top Quality »

ObjectivesTo identify IVF ± ICSI pregnancy predictive factors during “Top Quality” attempts in case of double embryo transfer.Patients and methodsThree years retrospective study (2007, 2008 and 2009) on parameters and results obtained during IVF ± ICSI defined as “Top Quality” attempts: first or second attempts on less than 35 years old women (age inferior or equal to) with one or two “Top Quality” embryo transfer.ResultsIn case of double embryo transfer, pregnancy predictive factors are (OR [IC 95%], P): average endometrial thickness on start (4.6 [2.9–5.5], P < 0.01), women smoking (4.2 [3.5–4.9], P < 0.01), average stimulation duration (3.4 [2.7–3.9], P < 0.01), average men age (2.2 [1.7–2.5], P < 0.05), gonadotrophins total dose (2.1 [1.1–3.2], P < 0.05) and first rank's attempts (1.6 [1.2–2.5], P < 0.05).Discussion and conclusionAge patient, rank attempts and quality embryo are criteria, which used to guide to a single embryo transfer. Our results incite us to consider other parameters, in particular men age and women smoking status.     

Influencia de la edad y el número de hijos previos de la madre en la proporción de sexos al nacer

The aim of this paper is to study the effects of the age and the number of previous children of the mother on the variations in the sex ratio at birth, in order to test Trivers and Willard's model which predicts that, depending on the mother's condition, there can be a biased in the sex ratio at birth. The study sample was made up of 6,994 mothers from Granada (Spain) aged from 20 to 34 who had only one child by non-assisted reproduction, and with more than 35 weeks of gestation. The results show that a significant relationship exists between the number of previous children of the mother and the sex ratio at birth. Moreover, considering that the condition of the uterus improves with the number of pregnancies, within the study range of ages, we could say that variation in the sex ratio at birth, within this study sample, follows the prediction of Trivers and Willard's model     

Tratamiento quirúrgico de la enfermedad de Paget de la mama mediante técnica Grisotti. Descripción de un caso

The involvement of the nipple-areolar complex in Paget's disease is associated in many cases with an underlying breast cancer. The rarity of the disease means that no levels of evidence or conclusive grades of recommendation have been established concerning the type of surgical treatment of this disease. Nowadays, oncoplastic surgery plus radiotherapy, in selected cases, is an alternative to the indication of mastectomy. We present the case of a patient with Paget's disease, and underlying intraductal cancer treated with Grisotti's oncoplastic surgery procedure followed by radiotherapy.     

Comparación de costes de la cesárea mediante técnicas de Misgav Ladach y convencional con incisión de Pfannenstiel

ObjectiveTo compare the costs of the Misgav- Ladash method of cesarean delivery with those of the conventional cesarean technique.Subjects and methodsWe performed a retrospective, observational analysis of a sample of 96 cesarean operations performed from 2001–2002 at the Severo Ochoa Hospital, using the Misgav Ladach technique and conventional methods.ResultsDemographic characteristics and indications for cesarean section were similar in both groups. The costs of each technique were estimated by evaluating surgical and postsurgical data and a saving of 164.5 z.euro; was found for the Misgav Ladach group.ConclusionsThe Misgav Ladach method for cesarean delivery is cost-effective and reduces costs in comparison with the conventional method.     

Conservation de la plaque aréolo-mamelonnaire en cas de mastectomie

Nipple-Sparing Mastectomy (NSM) is a procedure with skin-sparing mastectomy and nipple–areolar complex preservation in association with immediate reconstruction. The aim of this publication is to perform a review of oncological results, technical procedure, complications and indications of NSM with discussion of post-mastectomy radiotherapy indication. Local areolar recurrence is rare and treatment is performed by resection of the nipple–areolar complex. The nipple–areolar complex necrosis rate is a specific complication, observed between 1 to 30% in literature studies. Incisions and surgical procedure of dissection are discussed.