[Complete uterine ruptures]. / Roturas uterinas completas.

BACKGROUND: Uterine rupture is one of the most severe Obstetric complications by high morbidity and maternal and fetal mortality. OBJECTIVES: To review cases of uterine rupture occurred for the last five years. Release the incidence, the risk factors and maternal and fetal complications, both immediate and long term. METHODS: Retrospective cohort study including all patients who completed their gestation in the University Hospital Complex of Ourense (Spain) between 2008 and March 2013. Review all medical records of patients diagnosed with uterine rupture during this period. Statistical analysis was performed using the statistical package Epidat 3.0. RESULTS: We found an overall incidence of uterine rupture of 0.078 %. In patients with a previous cesarean delivery incidence rises to 0.31%. CONCLUSION: Uterine rupture is an uncommon but with high maternal fetal morbidity. The main risk factor is a trial of labor after a previous cesarean delivery.

Complications in CO2 Laser Transoral Microsurgery for Larynx Carcinomas.

Introduction Transoral laser microsurgery (TLM) has established itself as an effective option in the management of malignant tumors of the glottis, supraglottis, and hypopharynx. Nonetheless, TLM is not a harmless technique. Complications such as bleeding, dyspnea, or ignition of the air may appear in this type of surgery. Objective The aim of this study is to describe the complications that occurred in a group of patients treated for glottic and supraglottic carcinomas in all stages by TLM. Methods This study is a retrospective analysis of patients diagnosed with squamous cell carcinoma of the glottis and supraglottis for all stages (T1, T2, T3, T4), N -/ + , M -/+ treated with TLM between January 2009 and March 2012 in a tertiary hospital. Results Ninety-eight patients met the inclusion criteria, which had undergone a total of 131 interventions. Ninety-four (95.9%) patients were male and 4 (4.1%) were female. The mean age was 64.2 years (± 10.7 years = min 45; max 88). The presence of intraoperative complications was low, affecting only 2% of patients. Immediate postoperative complications occurred in 6.1%, whereas delayed complications affected 13.2% of patients, without any of them being fatal. Conclusion TLM has shown good oncologic results and low complication rate compared with traditional open surgery during intervention, in the immediate and delayed postoperative period and in the long-term with respect to radiotherapy.

Transoral CO2 Laser Microsurgery Outcomes for Early Glottic Carcinomas T1-T2.

INTRODUCTION: Transoral laser microsurgery (TLM) has won territory in larynx oncology, establishing itself as an effective option in treatment of glottic, supraglottic, and hypopharynx tumors. Its advantages include limited resections, a reduction in number of tracheostomies, and the use of nasogastric tubes. Moreover, its oncological benefits are similar to those from open surgery in patients with early or advanced stages, when correctly selected. OBJECTIVE: The objective of this study is to review oncologic outcomes obtained with the treatment of a series of glottic tumors, treated by TLM. METHODS: Retrospective analysis of patients previously untreated, diagnosed with squamous cell carcinoma of the glottis (T1a, T1b, T2) in a tertiary university hospital. Endpoints for analysis were local control, overall and disease-specific survival, and larynx preservation rate. RESULTS: The study group included 58 patients that met the inclusion criteria: 57 (98.3%) men and 1 (1.7%) woman. Mean age was 65.5 ± 10.7 years (Min: 46/Max: 88). The tumor stages of the patients included were 30 T1a, 11 (19%) T1b, and 17 (29.3%) T2. Three-year overall survival rate was 89.7% (Fig. 1), and three-year disease-specific survival rate was 96.5%, three-year local control rate was 98.3%, and three-year organ preservation rate was 98.3%. CONCLUSION: TLM is a safe and effective option in the treatment of glottis carcinomas, associated with less morbidity and a high percentage of local control, overall survival, specific survival, and organ preservation.

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study).

BACKGROUND AND OBJECTIVES: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. RESULTS: Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. CONCLUSIONS: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.

Obstrucción por acúmulo de semillas: una curiosa presentación del divertículo de Meckel en adultos / Bowel obstruction caused by seeds accumulation: An unusual presentation of Meckel's diverticulum in adults

No disponible

Aborto farmacológico en el primer trimestre de la gestación: ¿dónde estamos en el año 2018? / Medical abortion in the first trimester of pregnancy. Where we are in the year 2018?

Objetivo: revisar y actualizar las pautas del aborto farmacológico. Material y método: revisión de la bibliografía. Resultados: la pauta terapéutica más utilizada en gestaciones de menos de 9 semanas (63 días) es la que combina 200 mg de mifepristona, seguidos, a las 24-48 horas, de 800 microgramos de misoprostol administrados por vía bucal o vaginal. Con esta pauta las tasas de eficacia oscilan entre el 96,12 y el 97,43% y la tasa de efectos secundarios mayores se sitúa en torno al 0,2%. Conclusiones: el aborto farmacológico es eficaz y seguro hasta las 9 semanas de gestación y, por ello, debería de ser ofrecido, como una opción válida, a todas las mujeres que consultan para interrumpir una gestación de menos de 9 semanas

Objective: To review and update the different treatment options of pharmacological abortion. Material and method: Literature search and review. Results: The most used pattern of treatment up to 63 days of gestation is that combining 200 mg of mifepristone followed by 800 micrograms of misoprostol given either vaginally or buccal. The efficacy rates varied from 96.12% to 97.43% and the incidence of severe side effects is low (0.2%). Conclusions: Medical abortion is effective and safe and should be offered to all women asking for a termination of pregnancy up to 63 days of gestation

Adherence to SEGO recommendations on heavy menstrual bleeding (SMA-UR Study) / Seguimiento de las recomendaciones SEGO sobre el Sangrado Menstrual Abundante (Estudio SMA-UR)

Objective: Heavy menstrual bleeding is one of the most common frequent gynecological disorders in women of reproductive age. It affects quality of life, and in Western countries, is one of the most frequent causes of anemia. The aim of this study was to analyze adherence to the current recommendations of the Spanish Society of Gynecology and Obstetrics on the diagnosis and treatment of heavy menstrual bleeding in patients attending the emergency department. Material and methods: Observational, retrospective, and prospective study performed in routine clinical practice. The study population comprised 98 women diagnosed with heavy menstrual bleeding in the absence of any organic cause attending a gynecological visit scheduled after an emergency department visit due to abnormal menstrual bleeding. Results: Adherence to the Spanish Society of Gynecology and Obstetrics heavy menstrual bleeding recommendations was good for most factors, such as the usual/current bleeding characteristics (80.5% and 86.6%, respectively), gynecological and family history (92.7%), physical examination (92.7%), and diagnostic tests (92.7%), although less favorable for laboratory tests (58.5%) and initiation of treatment and regimen (39.0%). Conclusions: Most of the recommendations in the guidelines were applied, except for laboratory tests, initiation of treatment, and treatment regimen, which were followed to a lesser extent

Objetivo: el sangrado menstrual abundante es una de las alteraciones ginecológicas más frecuentes en las mujeres en edad reproductiva. Afecta a la calidad de vida y es, en los países occidentales, una de las causas más frecuentes de anemia. El objetivo del presente estudio es analizar el seguimiento de las recomendaciones vigentes de la Sociedad Española de Ginecología y Obstetricia en el manejo diagnóstico y terapéutico del sangrado menstrual abundante en pacientes que acuden a urgencias. Material y metodos: estudio observacional, de seguimiento retrospectivo y prospectivo según práctica clínica habitual. Se incluyeron un total de 98 mujeres diagnosticadas de sangrado menstrual abundante sin causa orgánica visitadas en una consulta ginecológica tras haber acudido a urgencias por alteraciones del sangrado. Resultados: se siguieron las recomendaciones de la Sociedad Española de Ginecología y Obstetricia en el manejo del sangrado menstrual abundante de forma mayoritaria para las evaluaciones de las características del sangrado habitual/actual (80,5% y 86,6%, respectivamente), valoración de antecedentes ginecológicos y familiares (92,7%), exploración física (92,7%) y pruebas diagnósticas (92,7%), mientras que se realizó en menor medida en lo relativo a la evaluación de pruebas de laboratorio (58,5%) e instauración de tratamiento y pauta (39,0%) de acuerdo a las guías. Conclusiones: se siguieron las recomendaciones para la mayoría de las evaluaciones, excepto en lo relativo a las pruebas de laboratorio e instauración de tratamiento y pauta de seguimiento de acuerdo a las guías, que se realizaron en menor medida

Transoral CO2 Laser Microsurgery Outcomes for Early Glottic Carcinomas T1-T2

Abstract Introduction Transoral laser microsurgery (TLM) has won territory in larynx oncology, establishing itself as an effective option in treatment of glottic, supraglottic, and hypopharynx tumors. Its advantages include limited resections, a reduction in number of tracheostomies, and the use of nasogastric tubes. Moreover, its oncological benefits are similar to those from open surgery in patients with early or advanced stages, when correctly selected. Objective The objective of this study is to review oncologic outcomes obtained with the treatment of a series of glottic tumors, treated by TLM. Methods Retrospective analysis of patients previously untreated, diagnosed with squamous cell carcinoma of the glottis (T1a, T1b, T2) in a tertiary university hospital. Endpoints for analysis were local control, overall and disease-specific survival, and larynx preservation rate. Results The study group included 58 patients that met the inclusion criteria: 57 (98.3%) men and 1 (1.7%) woman. Mean age was 65.5 10.7 years (Min: 46/Max: 88). The tumor stages of the patients included were 30 T1a, 11 (19%) T1b, and 17 (29.3%) T2. Three-year overall survival rate was 89.7% (Fig. 1), and three-year disease-specific survival rate was 96.5%, three-year local control rate was 98.3%, and three-year organ preservation rate was 98.3%. Conclusion TLM is a safe and effective option in the treatment of glottis carcinomas, associated with less morbidity and a high percentage of local control, overall survival, specific survival, and organ preservation.

Complications in CO2 Laser Transoral Microsurgery for Larynx Carcinomas

Abstract Introduction Transoral laser microsurgery (TLM) has established itself as an effective option in the management of malignant tumors of the glottis, supraglottis, and hypopharynx. Nonetheless, TLM is not a harmless technique. Complications such as bleeding, dyspnea, or ignition of the air may appear in this type of surgery. Objective The aim of this study is to describe the complications that occurred in a group of patients treated for glottic and supraglottic carcinomas in all stages by TLM. Methods This study is a retrospective analysis of patients diagnosed with squamous cell carcinoma of the glottis and supraglottis for all stages (T1, T2, T3, T4), N -/ + , M -/+ treated with TLM between January 2009 and March 2012 in a tertiary hospital. Results Ninety-eight patients met the inclusion criteria, which had undergone a total of 131 interventions. Ninety-four (95.9%) patients were male and 4 (4.1%) were female. The mean age was 64.2 years ( 10.7 years =min 45; max 88). The presence of intraoperative complications was low, affecting only 2% of patients. Immediate postoperative complications occurred in 6.1%, whereas delayed complications affected 13.2% of patients, without any of them being fatal. Conclusion TLM has shown good oncologic results and low complication rate compared with traditional open surgery during intervention, in the immediate and delayed postoperative period and in the long-term with respect to radiotherapy.

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study) / Alteraciones del metabolismo mineral, fracturas vertebrales, y calcificaciones aórticas en receptores estables de trasplante renal: papel del género (estudio EMITRAL)

Antecedentes y objetivos: La relación entre las alteraciones del metabolismo mineral, las fracturas óseas y las calcificaciones vasculares en receptores de un trasplante renal no han sido establecidas. Método: Realizamos un estudio transversal en 727 receptores estables procedentes de 28 centros de trasplante españoles. Se determinaron de manera centralizada los parámetros del metabolismo mineral; también se centralizó la semicuantificación de las fracturas vertebrales y de las calcificaciones de la aorta abdominal. Resultados: La deficiencia de vitamina D (25OHD3 < 15ng/ml) fue más frecuente en mujeres y en los estadios CKD-T I-III (29,6 vs. 44,4%; p=0,003). La relación inversa y significativa observada entre los niveles de 25OHD3 y PTH fue modificada por el género de tal manera que la pendiente fue mayor en las mujeres que en los hombres (p=0,01). Un 15% de los receptores mostró alguna fractura vertebral (VFx) con un grado de deformidad ≥2. Los factores relacionados con la VFx diferían en función del género: en los hombres, la edad (OR: 1,04; IC 95%: 1,01-1,06) y el tratamiento con CsA (OR: 3,2; IC 95: 1,6-6,3); en las mujeres la edad (OR: 1,07; IC 95%: 1,03-1,12) y los niveles de PTH (OR per 100pg/ml increase: 1,27; IC 95%: 1,043-1,542). Las calcificaciones de la aorta abdominal fueron comunes (67,2%) y se relacionaron con los factores de riesgo clásicos, pero no con los parámetros del metabolismo mineral. Conclusiones: La deficiencia de vitamina D es más frecuente en las mujeres receptoras de un trasplante renal y en los estadios más tempranos de la CKD-T, y es un factor que contribuye al desarrollo de hiperparatiroidismo secundario. Las VFx prevalentes están relacionadas con unos niveles más elevados de PTH solamente en las mujeres (AU)

Background and objectives: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. Method: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. Results: Vitamin D deficiency (25OHD3 < 15 ng/ml) was more common in female recipients at CKD-T stages I–III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100 pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. Conclusions: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients (AU)

Lactancia materna exclusiva y enfermedades prevalentes de la infancia en menores de seis meses / Exclusive breastfeeding and childhood illness in under six months infants

Objetivo: Determinar la asociación entre lactancia materna exclusiva (LME) y enfermedades prevalentes de la infancia en niños menores de seis meses en Perú el año 2012. Métodos: Análisis secundario de la Encuesta Demográfica de Salud Familiar (ENDES) 2012. Se definen variables y establece asociación de LME con enfermedad diarreica aguda (EDA), infecciones respiratorias agudas (IRA), infección inespecífica (fiebre) y problema de salud infeccioso. Análisis estad¡stico univariado, bivariado con Chi-cuadrado, OR (IC95%) y multivariado con regresión logística binaria con p<0,05 en SPSS 20, según procedimiento de ponderación del INEI. Resultados: Se incluyó a 829 niños peruanos menores de seis meses. 97,4% de niños se encontraba actualmente lactando, solo 48,7 % recib¡a LME. Se encontró un OR ajustado (ORa) de 0,37 IC95% 0,22 – 0,62) entre LME y EDA, ORa de 0,57 (IC95% 0,37 – 0,89) entre LME e infección inespecífica y ORa de 0,46 (IC95% 0.31 – 0.69) entre LME y problema de salud infeccioso en comparación a quienes no recib¡an LME. No se encontró asociación entre LME e IRA. Conclusiones: La lactancia materna exclusiva se asoció a menor probabilidad de presentar enfermedad diarreica aguda, infección inespecífica y algún problema de salud infeccioso en niños peruanos menores de seis meses.

Objective: To determine the association between exclusive breastfeeding (EBF) and infectious diseases in infants younger than 6 months in Peru in 2012. Methods: Secondary analysis of “Encuesta Demogr fica de Salud Familiar” (ENDES) survey database of 2012. Variables were defined on the database and association established based between EBF and fever (non-specific infection), acute diarrhea (AD), respiratory tract infections (RTI) and infectious health problem. Univariate and bivariate analysis performed with Chi-squared test and Odds Ratio (IC95%); multivariate analysis with binary logistic regression, p<0.05 using SPSS 20, according to weighing procedures of INEI. Results: 829 peruvian children under 6 months were included in the study. 97,4% of infants received breastfeeding, and only 48,7% received EBF. Compared with non-EBF infants, EBF infants presented lower risks of AD (adjusted OR [aOR]= 0,38; 95%CI 0,23-0,63); non-specific infection (aOR=0,60; 95%CI 0,39-0,93) and infectious health disease (aOR=0,47; 95%CI 0,32-0,69). No association was found between RTI and EBF. Conclusion: Exclusive breastfeeding was associated with lower risk of presenting acute diarrhea, non-specific infection and infectious health problems.

La anticoncepción de larga duración tras el parto: una oportunidad infrautilizada / Long-acting contraception after delivery: an underused opportunity

Cada año, muchas mujeres sufren embarazos no deseados. Subyace tras este problema la falta de uso de algún método anticonceptivo y las incidencias/uso inadecuado de los métodos más populares: el preservativo y la anticoncepción oral. Cerca de la mitad de las mujeres que se sometieron a una interrupción voluntaria del embarazo en nuestro país tenía 1 o 2 hijos: existe un colectivo de mujeres que ha sido madre, que se plantea no serlo de nuevo a corto-medio plazo, y que no ha satisfecho sus necesidades anticonceptivas. El periodo posparto ofrece una oportunidad, infrautilizada, para abordar estas necesidades. Tras la maternidad, la mujer valora especialmente la facilidad de uso del método anticonceptivo, la protección a largo plazo y no tener que preocuparse continuamente por él, y le preocupa que afecte a la lactancia. La anticoncepción de larga duración y reversible o LARC permitiría a la mujer que ha sido madre reducir la posibilidad de un embarazo no deseado durante el tiempo que quisiera. Los más populares son los dispositivos intrauterinos de cobre (DIU-Cu) y los liberadores de levonorgestrel (DIU-LNG), ambos con índices de Pearl muy bajos. Pueden insertarse inmediatamente tras el parto en mujeres no lactantes, con tasas de expulsión bajas. En mujeres lactantes no existe consenso acerca del uso de DIU-LNG antes de las 4 semanas. Pese a sus ventajas, el uso de LARC en nuestro país es muy bajo, sobre todo debido a la falta de información

Every year, many women suffer unwanted pregnancies. Behind this problem, it is found the lack of use of contraception and the incidents / misuse of the most popular methods: condoms and oral contraception. About half of the women who underwent abortion in our country had one or two children: there is a group of women who have been mother, who not contemplate to be again in short-medium term, and who has not fulfilled their contraceptive needs. The postpartum period provides an underused opportunity to address these needs. After maternity, women particularly appreciate the ease of use of the contraceptive method, the long-term protection and not have to constantly worry about it, and are concerned about affect breastfeeding. Long-acting reversible contraception, or LARC allow the woman who has been mother reduce the possibility of an unwanted pregnancy for as long as wanted. The most popular are the copper intrauterine devices (Cu-IUD) and the releasing levonorgestrel systems (LNG-IUS), both with very low Pearl Index. They can be inserted immediately after delivery in non-lactating women, with low rates of expulsion. In lactating women there is no consensus on the use of LNG-IUD before 4 weeks. Despite its advantages, the use of LARC in our country is very low, mainly due to lack of information

Revisión: Actualización en el diagnóstico del sangrado menstrual abundante / Review: An update on the diagnosis of heavy menstrual bleeding

El sangrado menstrual abundante (SMA) se define como la pérdida excesiva de sangre menstrual que interfiere con una actividad física normal, emocional o social, empeorando la calidad de vida de la mujer. Factores como un bajo nivel socioeconómico, la obesidad y la alta paridad estarían asociados a una prevalencia superior de SMA. El diagnóstico del SMA se basa en la información proporcionada por la propia paciente acerca de los cambios experimentados en su sangrado, y se fundamenta en la realización de una correcta historia clínica y una exploración física y ginecológica destinada a identificar la fuente del sangrado y que incluya palpación abdominal, una visualización cervical con espéculo y una exploración pélvica con tacto bimanual. Estas técnicas se complementarían con otras como las pruebas de laboratorio, las técnicas de imagen y los análisis histológicos. Las causas posibles de SMA varían en función de la edad de la paciente. Descartada una causa orgánica, suele ser debido a alteraciones de la integridad fisiológica del eje hipófiso-gonadal que ocasionan anovulación. Siguiendo la clasificación PALMA-ÍNDICE, el diagnóstico diferencial del SMA se establecerá teniendo en cuenta en primer lugar las alteraciones estructurales (PALMA: pólipo, adenomiosis, leiomioma y malignidad) y posteriormente las no estructurales (INDICE: las causas inespecíficas, la disovulación, la iatrogenia, los trastornos de la coagulación y la inestabilidad endometrial)

Heavy menstrual bleeding (HMB) is a disorder with a major impact on the woman which is associated with a worsening of their quality of life. The objectives pursued with its treatment are correction of anemia, decrease of the amount of bleeding, prevention of recurrence and long-term consequences of anovulation, and improving the quality of life of women. The choice of treatment should be based on the decision of the woman after knowing the benefits and adverse effects of different options, taking into account their reproductive desires and personal preferences. Drug therapy should be considered when structural abnormalities have not been identified as the cause of HMB. Non-hormonal drug treatment is the first choice in patients with HMB with ovulatory cycles, with reproductive desires or limitations to hormone treatment; It includes non-steroidal anti-inflammatories and antifibrinolytics (especially tranexamic acid). The hormonal drug treatment is the best option in HMB caused by ovulation disorders. In Spain, the LNG-IUD has this specific indication, of first choice in women who may become pregnant, and an oral quadriphasic combined with estradiol valerate and dienogest (VE2-DNG). The HMB with organic cause require the surgical approach of the pathological processes that cause them. The treatment options that have proven efficacy are endometrial ablation and endometrial resection (minimally invasive but not always completely successful) and hysterectomy (major surgery). In this paper, we analyze all of them

Revisión: Actualización en el tratamiento del sangrado menstrual abundante / Review: An update on the treatment of heavy menstrual bleeding

El sangrado menstrual abundante (SMA) es un trastorno con un gran impacto en la mujer que conlleva un empeoramiento de su calidad de vida. Los objetivos que persigue su tratamiento incluyen la corrección de la anemia, la disminución de la cantidad de sangrado, la prevención de recurrencias y de las consecuencias a largo plazo de la anovulación, y la mejora de la calidad de vida de la mujer. La elección del tratamiento debe basarse en la decisión de la mujer tras conocer las ventajas y efectos adversos de las diferentes opciones, teniendo en cuenta sus deseos reproductivos y preferencias personales. El tratamiento farmacológico debe considerarse cuando no se hayan identificado anomalías estructurales como causa del SMA. El tratamiento farmacológico no hormonal, es de primera elección en pacientes con SMA con ciclos ovulatorios, con deseos genésicos o con limitaciones al tratamiento hormonal; incluye los aintiinflamatorios no esteroideos y los antibibrinolíticos (especialmente ácido tranexámico). El tratamiento farmacológico hormonal es la opción más adecuada ante alteraciones de la ovulación que causan SMA. En España tienen indicación específica el DIU-LNG, de primera elección en mujeres que no planean un embarazo, y un combinado cuatrifásico con valerato de estradiol y dienogest (VE2-DNG) oral. Los SMA de causa orgánica requieren el abordaje quirúrgico de los procesos patológicos que los provocan. Las opciones terapéuticas que han demostrado eficacia son la ablación endometrial y la resección endometrial (mínimamente invasivas pero no siempre completamente exitosas) y la histerectomía (cirugía mayor). En la presente revisión se analizan todas ellas

Heavy menstrual bleeding (HMB) is a disorder with a major impact on the woman which is associated with a worsening of their quality of life. The objectives pursued with its treatment are correction of anemia, decrease of the amount of bleeding, prevention of recurrence and long-term consequences of anovulation, and improving the quality of life of women. The choice of treatment should be based on the decision of the woman after knowing the benefits and adverse effects of different options, taking into account their reproductive desires and personal preferences. Drug therapy should be considered when structural abnormalities have not been identified as the cause of HMB. Non-hormonal drug treatment is the first choice in patients with HMB with ovulatory cycles, with reproductive desires or limitations to hormone treatment; It includes non-steroidal anti-inflammatories and antifibrinolytics (especially tranexamic acid). The hormonal drug treatment is the best option in HMB caused by ovulation disorders. In Spain, the LNG-IUD has this specific indication, of first choice in women who may become pregnant, and an oral quadriphasic combined with estradiol valerate and dienogest (VE2-DNG). The HMB with organic cause require the surgical approach of the pathological processes that cause them. The treatment options that have proven efficacy are endometrial ablation and endometrial resection (minimally invasive but not always completely successful) and hysterectomy (major surgery). In this paper, we analyze all of them

Prevencion del dano intestinal mediante la utilizacion de un antagonista del factor de activacion plaquetaria en el trasplante intestinal / Prevention of intestinal damage through the utilization of an antagonist of the platelet activating factor in intestine transplantation

Se realiza un estudio comparativo en ratas singenicas de la cepa Wistar con objeto de valorar los efectos de preservacion del injerto al utilizar el antagonista del factor de activacion plaquetaria, WEB-2086. en la valoracion ultraestructural se ha podido comprobar los efectos de esta sustancia al nivel de las celulas epiteliales de intestino trasplantado

Utilización de métodos anticonceptivos en España por grupos de edad: resultados de 4 encuestas nacionales / Use of contraceptive methods in Spain by age groups: results of four national surveys

Objetivos: Conocer los métodos anticonceptivos utilizados según la edad de las mujeres. Material y métodos: Desde 1997 los autores venimos realizando, en España, una encuesta bienal sobre la utilización de métodos anticonceptivos en las mujeres en edad fértil (15-49 años).Resultados: En el grupo de mujeres adolescentesel método más utilizado es el condón. En el grupode 20 a 29 años, el condón sigue siendo el métodomás utilizado, seguido de la píldora. El grupo de30-39 años es el que más utiliza el dispositivo intrauterino (DIU). En el grupo de mujeres de 40-49 años los métodos quirúrgicos son utilizados hasta por el 28% de las mujeres.Conclusiones: En los últimos 6 años se ha incrementado el uso de métodos anticonceptivos en la población española. Se observan diferenciasen la elección del método anticonceptivo según la edad de las mujeres

Objectives: To determine the use of contraceptive methods according to women’s age.Material and methods: Since 1997, we have conducted a biennial national survey in Spain ofthe use of contraceptive methods among women ofchildbearing age (15-49 years).Results: Among adolescent girls, the most widelyused contraceptive method is the condom. In thegroup aged 20-29 years, the most widely used method continues to be the condom, followed by the contraceptive pill. In the group aged 30-39 years, intrauterine devices are most frequently used than in other age groups. In the group of women aged 40-49 years, surgical methods areused by up to 28% of the women.Conclusions: In the last 6 years, the use ofcontraception in Spain has increased. The choice of contraceptive method differs according to women’s age (AU)

Prevención del Daño Intestinal Mediante la Utilización de un Antagonista del Factor de Activación Plaquetaria en el Trasplante Intestinal / Prevention of intestinal damage through the utilization of an antagonist of the platelet activating factor in intestine transplantation

Se realiza un estudio comparativo en ratas singénicas de la cepa Wistar con objeto de valorar los efectos de preservación del injerto al utilizar el antagonista del factor de activación plaquetaria, WEB-2086. en la valoración ultraestructural se ha podido comprobar los efectos de esta sustancia al nivel de las células epiteliales de intestino trasplantado(AU)