[Responsiveness of the chilean version of the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF)]. / Sensibilidad al cambio de la versión español-chileno del cuestionario International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) para incontinencia urinaria femenina.

BACKGROUND: A symptom questionnaire must be able to detect minimal changes after treatment to be clinically useful. AIM: To evaluate the responsiveness of the Spanish-Chilean version of the ICIQ-SF questionnaire after medical and surgical procedures for the treatment of urinary incontinence (UI) in women consulting at a public Chilean Hospital. MATERIAL AND METHODS: Data of 124 women aged 59 ± 10 years who were treated for UI and in whom ICIQ-SF questionnaire was applied in two opportunities (before and after medical or surgical treatment), was analyzed. The sign test for paired samples was used to compare the response of each item of the questionnaire. Responsiveness of the total severity score for UI was assessed by changes of slopes estimated by Generalized Estimating Equations. Slopes of change for every type of treatment were also compared. RESULTS: Sixty two percent of the women underwent surgical treatment. The slope of the total severity score for medical treatment was -4.4 (p-value < 0.001 for change) and 12.6 (p-value < 0.001 for change) for surgical treatment. Changes in surgical treatment were significantly higher than those of medical treatment (p-value < 0.001). CONCLUSIONS: The Spanish-Chilean version of the ICIQ-SF questionnaire was able to detect changes as a result of surgical and medical treatment for urinary incontinence in the study population, fulfilling the validity of responsiveness criterion.

Age at menopause in Latin America.

OBJECTIVE: To assess the age at menopause (AM) in Latin America urban areas. DESIGN: A total of 17,150 healthy women, aged 40 to 59 years, accompanying patients to healthcare centers in 47 cities of 15 Latin American countries, were surveyed regarding their age, educational level, healthcare coverage, history of gynecological surgery, smoking habit, presence of menses, and the use of contraception or hormone therapy at menopause. The AM was calculated using logit analysis. RESULTS: The mean age of the entire sample was 49.4 +/- 5.5 years. Mean educational level was 9.9 +/- 4.5 years, and the use of hormone therapy and oral contraception was 22.1% and 7.9%, respectively. The median AM of women in all centers was 48.6 years, ranging from 43.8 years in Asuncion (Paraguay) to 53 years in Cartagena de Indias (Colombia). Logistic regression analysis determined that women aged 49 living in cities at 2,000 meters or more above sea level (OR = 2.0, 95% CI: 1.4-2.9, P < 0.001) and those with lower educational level (OR = 1.9, 95% CI: 1.3-2.8, P < 0.001) or living in countries with low gross national product (OR = 2.1, 95% CI: 1.5-2.9, P < 0.001) were more prone to an earlier onset of menopause. CONCLUSIONS: The AM varies widely in Latin America. Lower income and related poverty conditions influence the onset of menopause.

Fas ligand(+) fallopian tube epithelium induces apoptosis in both Fas receptor(+) T lymphocytes and endometrial cells.

OBJECTIVE: To establish whether human fallopian tube (FT) epithelium can induce apoptosis in T lymphocytes and endometrial cells. DESIGN: Laboratory-based study. SETTING: Hospital. PATIENT(S): Women undergoing abdominal hysterectomy for FT samples, and women volunteers with and without endometriosis for endometrial biopsies. INTERVENTION(S): FT samples obtained at time of surgery performed in reproductive-aged women with normal menstrual cycles. MAIN OUTCOME MEASURE(S): T lymphocytes or endometrial cells coincubated with FT epithelial cells and assayed for apoptosis by DNA nick-end labeling and caspase-3 activity, with the presence of Fas ligand (FasL) and Fas receptor (FasR) assessed by indirect immunostaining. RESULT(S): The epithelium of the FT-induced apoptosis in T cells as well as in human endometrial cells. The mechanism probably involves the FasL/FasR system; accordingly, we observed FasL at the apical surface of the epithelium and in the stroma of the FT at all phases of the menstrual cycle except during the early proliferative phase. The endometrial samples from patients with endometriosis did not express FasR and were resistant to apoptosis. CONCLUSION(S): In both FasR(+) T lymphocytes and endometrial cells, FasL(+) FT cells induce apoptosis. Data suggest that the FT epithelium acts as a barrier to limit the influx of lymphocytes as well as endometrial cells ascending the tube. Failure of these regulatory mechanisms may be related to the development of endometriosis.

Sensibilidad al cambio de la versión español-chileno del cuestionario International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) para incontinencia urinaria femenina / Responsiveness of the chilean version of the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF)

Background: A symptom questionnaire must be able to detect minimal changes after treatment to be clinically useful. Aim: To evaluate the responsiveness of the Spanish-Chilean version of the ICIQ-SF questionnaire after medical and surgical procedures for the treatment of urinary incontinence (UI) in women consulting at a public Chilean Hospital. Material and Methods: Data of 124 women aged 59 ± 10 years who were treated for UI and in whom ICIQ-SF questionnaire was applied in two opportunities (before and after medical or surgical treatment), was analyzed. The sign test for paired samples was used to compare the response of each item of the questionnaire. Responsiveness of the total severity score for UI was assessed by changes of slopes estimated by Generalized Estimating Equations. Slopes of change for every type of treatment were also compared. Results: Sixty two percent of the women underwent surgical treatment. The slope of the total severity score for medical treatment was -4.4 (p-value < 0.001 for change) and 12.6 (p-value < 0.001 for change) for surgical treatment. Changes in surgical treatment were significantly higher than those of medical treatment (p-value < 0.001). Conclusions: The Spanish-Chilean version of the ICIQ-SF questionnaire was able to detect changes as a result of surgical and medical treatment for urinary incontinence in the study population, fulfilling the validity of responsiveness criterion.

Estudio histeroscópico y diagnóstico de cáncer endometrial / Hysteroscopic study and diagnosis of endometrial cancer

Se analizan ocho casos en que se planteó el diagnóstico de cáncer endometrial y en quienes se efectuó histeroscopía panorámica con CO2. Cinco pacientes fueron sometidos a histeroscopía como primer examen sistemático en el estudio de metrorragia (4 casos) e hidrorrea (1 caso). Tres pacientes habían sido sometidas a raspados biópsicos que informaron cáncer endometrial. El estudio anatomopatológico se efectúo mediante la toma de biopsias dirigidas, raspados biópsicos y cirugía en todas las pacientes. La histeroscopía planteó el diagnóstico de cáncer endometrial en seis casos y descartó la presencia de neoplasia en dos casos. La histeroscopía determinó en todos los casos, el estadio clínico de diseminación, en particular, la extensión endocervical del tumor endometrial. La histeroscopía panorámica con CO2, un método de diagnóstico relativamente nuevo en nuestro medio, se perfila como altamente eficaz en la detección y diagnóstico de cáncer endometrial así como en el estudio de estadio clínico de diseminación de esta neoplasia