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1.
J Obstet Gynaecol ; 41(2): 200-206, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32172631

RESUMO

The aim of this study was to implement the Robson Ten Groups Classification System (RTGCS) to identify the main contributors to the caesarean section (CS) rate and to evaluate whether the introduction of a plan of obstetrical interventions reduced this rate. An observational retrospective cross-sectional study was conducted during two time periods at Alicante University General Hospital. In the pre-implementation period (2009-2012), RTGCS was applied to identify the main groups contributing to the overall CS rate. In the post-implementation period (2013-2017), RTGCS was applied again to identify changing trends in CS rates. In all, 11,034 deliveries during the pre-intervention period and 11,453 during the post-intervention period were analysed. The overall CS rate was 23.9% and 20.9%, respectively. There were no changes in perinatal outcomes. In the post-intervention period, there was a significant decrease of the CS rate in the groups of targeted interventions 1, 2, 3, 4, 5, and 8B.Impact statementWhat is already known on this subject? High CS rates are becoming a public health problem because of risks, costs, excessive medicalisation, and abuse of resources. RTGCS provides a framework for auditing and analysing CS rates.What do the results of this study add? RTGCS can identify the groups that have the greatest impact on the CS rate and monitor changes in it consequent to policy changes.What are the implications of these findings for clinical practice? The introduction of a strategic plan with evidence-based clinical interventions may have a greater effect on the CS rate than other features justifying the increase in the incidence of CS.


Assuntos
Cesárea , Parto Obstétrico/métodos , Trabalho de Parto Induzido/métodos , Uso Excessivo dos Serviços de Saúde , Utilização de Procedimentos e Técnicas/tendências , Prova de Trabalho de Parto , Cesárea/efeitos adversos , Cesárea/economia , Cesárea/métodos , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Uso Excessivo dos Serviços de Saúde/economia , Uso Excessivo dos Serviços de Saúde/prevenção & controle , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Saúde Pública/métodos , Estudos Retrospectivos , Risco Ajustado/métodos , Espanha/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
2.
Neurourol Urodyn ; 38(7): 1812-1817, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31274225

RESUMO

AIMS: To evaluate the usefulness of simultaneous laparoscopic assistance to improve understanding of the nonvisible surgical steps in Thiel-embalmed cadaver models for training in vaginal surgery using vaginal mesh kits and to evaluate opinions of this surgical learning procedure in comparison with other learning models. METHODS: Recording of anterior compartment prolapse repair with vaginal mesh kits using an external camera simultaneously with laparoscopic vision during the execution of the procedure at the dissection room. To measure the usefulness of this procedure, we designed an anonymous online survey that was made available to program participants via a computer application (a link to video 1 and the survey is available at encuesta@um.es). RESULTS: After watching the video, 97.2% of participants agreed that laparoscopic vision combined with the vaginal approach was useful in learning this surgical technique, and 95.8% agreed they had learned details of the surgical anatomy of the pelvis. All participants agreed that it should be mandatory to train in these techniques with cadavers before practice with live patients. In addition, 84.7% responded that the cadaveric model was superior to animal and other types of models. CONCLUSION: Laparoscopic inspection of the procedure performed with the vaginal approach allowed a better understanding of the surgical technique by making "visible" the anatomical structures that were commonly only palpated. Use of the cadaverous model was considered most efficient for training in this surgical technique.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/educação , Laparoscopia/métodos , Modelos Anatômicos , Telas Cirúrgicas , Procedimentos Cirúrgicos Urológicos/educação , Vagina/cirurgia , Cadáver , Dissecação , Feminino , Humanos , Próteses e Implantes
3.
BMC Cancer ; 17(1): 320, 2017 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-28482874

RESUMO

BACKGROUND: Breast cancer is one of the most important neoplasia among women. It was recently suggested that biological agents could be the etiological cause, particularly Human Papilloma Virus (HPV). The aim of this study was to explore the presence of HPV DNA in a case-control study. METHODS: We performed our study including 251 cases (breast cancer) and 186 controls (benign breast tumors), using three different molecular techniques with PCR (GP5/GP6, CLART® and DIRECT FLOW CHIP®). RESULTS: HPV DNA was evidenced in 51.8% of the cases and in 26.3% of the controls (p < 0.001). HPV-16 was the most prevalent serotype. The odds ratio (OR) of HPV within a multivariate model, taking into account age and breastfeeding, was 4.034. CONCLUSIONS: Our study, with methodological rigour and a sample size not previously found in the literature, demonstrate a significant presence of HPV DNA in breast cancer samples. A possible causal relationship, or mediation or not as a cofactor, remains to be established by future studies.


Assuntos
Neoplasias da Mama/virologia , Papillomavirus Humano 16 , Infecções por Papillomavirus/complicações , Adulto , Neoplasias da Mama/complicações , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Prevalência , Espanha/epidemiologia
4.
Int J Gynecol Cancer ; 26(9): 1722-1726, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27518143

RESUMO

OBJECTIVE: The purpose of this study was to compare the long-term safety, disease-free survival, and recurrence rate of total laparoscopic hysterectomy using uterine manipulator and abdominal hysterectomy in the surgical treatment in early-stage endometrial cancer. STUDY DESIGN: This was a cohort study of 147 patients with clinical endometrial cancer (laparoscopic surgery group, 77 women; laparotomy group, 70 women). Data were evaluated and analyzed by intention-to-treat principle, and survival data of stage I endometrial cancer (129 patients; 66 from laparoscopic surgery group and 60 from laparotomy group) were estimated by using the Kaplan-Meier curves. RESULTS: After a follow-up period of 60 months for both laparoscopic surgery and laparotomy groups, no significant difference in the cumulative recurrence rates (7.4% and 13.1%, P = 0.091) and overall survival (97.1% and 95.1%, P = 0.592) was detected between both groups of stage I endometrial cancer. Conversion to laparotomy occurred in 10.4% (8/77) of the laparoscopic procedures. Laparoscopic hysterectomy was associated with less use of pain medication (P = 0.001) and a shorter hospital stay (P < 0.001), but the procedure took longer than laparotomic hysterectomy (P < 0.001). The proportion of patients with intraoperative and long-term complications was not significantly different between both groups. The use of uterine manipulators did not have increased recurrence rate in patients treated with laparoscopic approach. CONCLUSIONS: The laparoscopic surgery approach to early-stage endometrial cancer using uterine manipulators is as safe and effective as the laparotomic approach.


Assuntos
Carcinoma/cirurgia , Neoplasias do Endométrio/cirurgia , Histerectomia/instrumentação , Recidiva Local de Neoplasia/epidemiologia , Idoso , Carcinoma/mortalidade , Estudos de Coortes , Intervalo Livre de Doença , Neoplasias do Endométrio/mortalidade , Feminino , Humanos , Histerectomia/métodos , Pessoa de Meia-Idade , Espanha/epidemiologia
5.
BMJ Case Rep ; 20142014 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-24473429

RESUMO

Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.


Assuntos
Úlcera/diagnóstico , Vulva/patologia , Doenças da Vulva/diagnóstico , Adolescente , Diagnóstico Diferencial , Feminino , Humanos , Hansenostáticos/uso terapêutico , Úlcera/tratamento farmacológico , Doenças da Vulva/tratamento farmacológico
6.
PLoS One ; 8(11): e79737, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24244552

RESUMO

BACKGROUND: Lynch syndrome (LS) is a hereditary condition that increases the risk for endometrial and other cancers. The identification of endometrial cancer (EC) patients with LS has the potential to influence life-saving interventions. We aimed to study the prevalence of LS among EC patients in our population. METHODS: Universal screening for LS was applied for a consecutive series EC. Tumor testing using microsatellite instability (MSI), immunohistochemistry (IHC) for mismatch-repair (MMR) protein expression and MLH1-methylation analysis, when required, was used to select LS-suspicious cases. Sequencing of corresponding MMR genes was performed. RESULTS: One hundred and seventy-three EC (average age, 63 years) were screened. Sixty-one patients (35%) had abnormal IHC or MSI results. After MLH1 methylation analysis, 27 cases were considered suspicious of LS. From these, 22 were contacted and referred for genetic counseling. Nineteen pursued genetic testing and eight were diagnosed of LS. Mutations were more frequent in younger patients (<50 yrs). Three cases had either intact IHC or MSS and reinforce the need of implement the EC screening with both techniques. CONCLUSION: The prevalence of LS among EC patients was 4.6% (8/173); with a predictive frequency of 6.6% in the Spanish population. Universal screening of EC for LS is recommended.


Assuntos
Neoplasias Colorretais Hereditárias sem Polipose/complicações , Neoplasias Colorretais Hereditárias sem Polipose/epidemiologia , Neoplasias do Endométrio/complicações , Proteínas Adaptadoras de Transdução de Sinal/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Metilação de DNA , Reparo de Erro de Pareamento de DNA , Neoplasias do Endométrio/diagnóstico , Feminino , Mutação em Linhagem Germinativa , Humanos , Imuno-Histoquímica , Instabilidade de Microssatélites , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL , Gradação de Tumores , Estadiamento de Neoplasias , Proteínas Nucleares/genética , Prevalência
7.
BMJ Case Rep ; 20132013 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-24081597

RESUMO

The study described diagnostic and therapeutic processes for an exceptional congenital female genital anomaly involving a 15-year-old girl with progressive dysmenorrhoea and intense abdominal pain, and analyses pathogenesis of embryological anomalies associated with uterine duplicity (UD). Diagnostic methodology is analysed; treatment is described; and recommendations are provided. For the study of anomalies such as UD, we recommend the use of an ultrasound, vaginoscopy, MRI and laparoscopy imaging. Keeping in mind that hemihysterectomy should only be performed in cases with endometriosis or other unusual circumstances, surgical treatment should be avoided. A complete study based on gynaecological examination and ultrasound should be performed in adolescents with severe and progressive dysmenorrhoea. Based on the findings, imaging tests such as MRI and, if necessary, laparoscopy coinciding with menstruation, should be conducted before opting for surgical treatment.


Assuntos
Doenças dos Genitais Femininos/diagnóstico , Útero/anormalidades , Vagina/anormalidades , Adolescente , Colo do Útero/anormalidades , Colo do Útero/cirurgia , Diagnóstico Diferencial , Feminino , Seguimentos , Doenças dos Genitais Femininos/congênito , Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia , Humanos , Laparoscopia , Imageamento por Ressonância Magnética , Útero/cirurgia , Vagina/cirurgia
8.
BMJ Case Rep ; 20132013 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-23737573

RESUMO

Caudal regression or caudal dysplasia sequence (CDS) is a rare congenital malformation, which includes a wide spectrum of musculoskeletal abnormalities involving the lumbosacral spine, pelvis and lower limbs. It can be associated to visceral defects in various degrees. Maternal diabetes, genetic predisposition and vascular hypoperfusion have been suggested as possible causative factors. Women with diabetes who are dependent on insulin are 200-400 times more likely to have a child with caudal regression, making CDS the most characteristic fetal abnormality of diabetic embryopathy. Prenatal diagnosis is possible by ultrasonographic examination. The sonographic findings include abrupt interruption of the lumbar spine and 'Buddha or frog position' of the lower limbs. MRI has demonstrated the level of the vertebral anomalies as well as the associated abnormalities and this is crucial because the prognosis of this condition depends on the severity of the lesion and the presence of associated disorders.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Diabetes Mellitus Tipo 1/fisiopatologia , Meningocele/diagnóstico por imagem , Gravidez em Diabéticas , Região Sacrococcígea/anormalidades , Ultrassonografia Pré-Natal , Adulto , Diabetes Mellitus Tipo 1/complicações , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Meningocele/complicações , Gravidez , Resultado da Gravidez , Região Sacrococcígea/diagnóstico por imagem , Adulto Jovem
9.
J Clin Ultrasound ; 41 Suppl 1: 1-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23124691

RESUMO

We report a rare case of duodenal duplication cyst that was suspected prenatally. Routine prenatal sonography (US) at 19 weeks' gestation showed an abdominal cystic mass on the left side of the abdomen. Follow-up US examinations showed a partial "double-wall" sign, highly suggestive of enteric duplication, and changes in cyst size and wall thickness. Postnatal US examination suggested enteric duplication cyst. A laparotomy revealed a duodenal cyst that was completely resected. The antenatal US findings associated with this condition, the accuracy of its antenatal diagnosis, and its differential diagnosis are discussed.


Assuntos
Cistos/diagnóstico por imagem , Duodenopatias/diagnóstico por imagem , Duodeno/anormalidades , Ultrassonografia Pré-Natal , Adulto , Duodeno/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Gravidez
10.
BMJ Case Rep ; 20122012 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-22684836

RESUMO

Wernicke's encephalopathy (WE) is a reversible neurological emergency caused by thiamine deficiency. Prolonged vomiting in pregnancy results in thiamine depletion. The early recognition of its clinical signs and symptoms is essential to establish the suspected diagnosis and can be confirmed by MRI. Prompt administration of thiamine is important for preventing the occurrence of sequelae in the mother and for improving the fetal prognostic. We report a case of WE induced by hyperemesis gravidarum with a good maternal and fetal outcome.


Assuntos
Hiperêmese Gravídica/complicações , Imageamento por Ressonância Magnética/métodos , Deficiência de Tiamina/complicações , Encefalopatia de Wernicke/etiologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Tiamina/sangue , Deficiência de Tiamina/sangue , Deficiência de Tiamina/diagnóstico , Encefalopatia de Wernicke/diagnóstico , Adulto Jovem
11.
Eur J Obstet Gynecol Reprod Biol ; 159(2): 472-5, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21975178

RESUMO

OBJECTIVE: To describe the diagnostic and therapeutic process for a congenital exceptional anomaly. To analyze the pathogenesis of the embryologic anomalies associated with menouria and congenital vesicovaginal fistula (VVF). STUDY DESIGN: The case of a 28-year-old female with menouria and impossibility of consummating coitus is described. The diagnostic method is analyzed. The type of treatment is described and finally we conclude with a hypothesis about embryology of congenital anomalies with VVF and menouria. RESULTS: For management of anomalies as congenital VVF, imaging tests including cystography and urography could not correctly visualize the fistulous tract. It was identified by cystoscopy, performed during the time of menouria. Surgical treatment consisted in repairing the VVF and vaginoplasty according to the McIndoe technique. CONCLUSIONS: All women with menouria need complete investigation with exhaustive exploration, analytic evaluation, ultrasound, imaging tests (principally magnetic resonance) and, very importantly, cystoscopy on the days of menouria. Surgical treatment must be careful and individualized. This case allows us to hypothesise that the blind vagina encountered reflects an anomaly of correct urogenital sinus development.


Assuntos
Hematúria/etiologia , Menstruação , Fístula Vesicovaginal/congênito , Fístula Vesicovaginal/fisiopatologia , Adulto , Cistoscopia , Feminino , Humanos , Procedimentos de Cirurgia Plástica , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Vagina/anormalidades , Vagina/cirurgia , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirurgia
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