[Definitive contraception with Essure device: Single institutional experience on 517 procedures]. / Anticoncepción definitiva con Essure: experiencia unicéntrica de 517 procedimientos.

OBJECTIVES: To analyse the outcomes of patients undergoing Essure sterilization in a single institution, interns of complications and technique failure. PATIENTS AND METHODS: Retrospective descriptive study of 517 patients underwent definitive contraception with Essure device in outpatient hysteroscopy office without anesthesia and controlled at 3 months with abdominal radiography, ultrasonography and hysterosalpingography in selected cases. RESULTS: The success rates of the insertion of Essure was 96.8%, similar to data reported in the literature with 3.7% of vagal reactions, as most prevalent complication. 7 (1.35%) unintended pregnancies were observed. CONCLUSIONS: Essure is a permanent birth control device, with high rate of successful insertion and a low rate of complications. Unintended pregnancies in our study are high and we must change the protocols of placement and monitoring, considering hysterosalpingography as a routine control test.

Mallas en la cirugía del prolapso genital / Meshes for genital prolapse surgery

El objetivo de esta revisión es analizar la información científica disponible sobre la utilización de las mallas en la cirugía del prolapso genital, evaluando eficacia, efectos adversos y complicaciones. La utilización de mallas en la reparación del compartimento anterior se asocia con mejores resultados anatómicos que las técnicas clásicas, mientras que no hay datos suficientes que avalen su utilización en el compartimento posterior. En el compartimento apical, la colposacropexia abdominal ha demostrado tener tasas de recurrencia menores que los procedimientos por vía vaginal, ya sea mediante técnicas clásicas o mediante el uso de mallas. Las mallas se asocian con efectos adversos a corto y a largo plazo, que pueden implicar la necesidad de nuevos procedimientos quirúrgicos. (AU)

Mallas en la cirugía del prolapso genital / Meshes for genital prolapse surgery

El objetivo de esta revisión es analizar la información científica disponible sobre la utilización de las mallas en la cirugía del prolapso genital, evaluando eficacia, efectos adversos y complicaciones. La utilización de mallas en la reparación del compartimento anterior se asocia con mejores resultados anatómicos que las técnicas clásicas, mientras que no hay datos suficientes que avalen su utilización en el compartimento posterior. En el compartimento apical, la colposacropexia abdominal ha demostrado tener tasas de recurrencia menores que los procedimientos por vía vaginal, ya sea mediante técnicas clásicas o mediante el uso de mallas. Las mallas se asocian con efectos adversos a corto y a largo plazo, que pueden implicar la necesidad de nuevos procedimientos quirúrgicos.

[Node status in 454 ductal breast cancers cases according to the association with in situ component]. / Afectación ganglionar en 454 casos con carcinoma ductal infiltrante de mama según el hallazgo de componente intraductal asociado.

BACKGROUND: Studies have shown that breast infiltrating ductal carcinoma develops from precursor lesions or pre-invasive. It is accepted that the risk of invasive ductal carcinoma increased slightly in hyperplasia, but especially in cases of atypical hyperplasia and intraductal carcinoma. OBJECTIVES: To evaluate and compare the nodal status between ductal breast cancer with in situ component (group 1) or without it (group 2). MATERIAL AND METHOD: Descriptive and retrospective study that included 454 ductal breast cancers. Data concerning clinical and pathological variables was collected. All data was compared between both groups. RESULTS: Among all cases, 176 (38.8%) showed positive lymph nodes, 136 patients (39.5%) from group 1 and 40 cases (36.4%) from group 2. Among group 1 cases, high-grade subgroup showed higher positive lymph node rate (82 cases, 55.4%) than the extensive in situ carcinomas subgroup (84 cases, 49.7%). Both of them had a significant higher rate than group 2 cases (p = 0.003 y p = 0.028, respectively). Moreover, the low-grade in situ carcinomas without cellular necrosi had positive lymph nodes just in 30 cases (24%), significantly lower (p = 0.034) than group 2. CONCLUSIONS: We did not find overall statistical differences between groups depending on in situ associated component. But when we analyzed in situ subgroups, we found differences with higher positive lymph node rate in high grade carcinomas and extensive in situ carcinomas subgroups, while lower affectation rates were observed in low grade carcinomas (without cellular necrosis), compared to the group of breast cancers without in situ component associated.

[Sonographic ovarian vascularization and volume in women with polycystic ovary syndrome treated with clomiphene citrate and metformin]. / Vascularización y volumen ovárico ecográfico en mujeres con síndrome de ovario poliquístico tratadas con citrato de clomifeno y metformina.

OBJECTIVE: To measure the vascularization and ovarian volume with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome with stimulated ovulation treatment, and to analyse the differences between the patients treated with clomiphen citrate versus clomiphen citrate and metformin. MATERIAL AND METHOD: Therty patients were studied. Twenty ovulation cycles were obtained with clomiphen citrate and 17 with clomiphen citrate plus merformin (added in case of obesity or hyperglucemy/hyperinsulinemia). Ovarian volumes and vascular indexes were studied with 3D-sonography and results were analysed by treatment. RESULTS: There were no statistical differences of ovarian volume by treatment along the cycles, although bigger volume were found in ovulatory cycles compared to non-ovulatory ones (20,36 versus 13,89 ml, p = 0,026). No statistical differences were also found concerning vascular indexes, neither by treatment nor by the obtention of ovulation in the cycle. CONCLUSIONS: Ovarian volume and vascular indexes measured with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome do not show differents values in patients treated with clomiphen citrate alone versus clomiphen citrate plus metformin.

[Reproducibility of the fetal nasal bone measurement by means of bidimensional and three-dimensional ecography during the second trimester of the pregnancy]. / Reproducibilidad de la medición del hueso nasal fetal mediante ecografía bidimensional y tridimensional durante el segundo trimestre del embarazo.

AIMS: The utility of the valuation-measurement of the nasal bone in the prognosis of chromosomopaties during the second trimester of the pregnancy is demonstrated. OBJECTIVE: To evaluate the repeatability of nasal bone measurement during second trimester with bidimensional and three-dimensional sonography. MATERIAL AND METHOD: Nasal bone was measured in 50 single pregnancies. First observer carried out two measures of nasal bone with bidimensional sonography, and 1 measure with three-dimensional sonography. Second observer carried out just one measure with bidimensional sonography (2D) and just another one with three-dimensional sonography (3D). We studied the intraobserver variability with 2D sonography, and the interobserver variability with 2D and 3D sonography. RESULTS: 2D-sonography: nasal bone measurement showed excellent intraobserver correlation with a correlation coefficient of 0,87 (CI 95%: 0,78-0,93) and a little means difference of 0,18 (SD: 0,74). Indeed, there was a good interobserver correlation with a correlation coefficient of 0,92 (CI 95%: 0,85-0,95), and a means difference of 0,14 (SD: 0,56). 3D-sonography: there was a acceptable interobserver correlation with correlation coefficient of 0,70 (CI 95%: 0,52-0,82). CONCLUSION: Nasal bone measurement is highly reproducible by means of bidimensional sonography while using three-dimensional sonography, the results are just acceptable.

[Urogenital prolapse repair using polypropylene mesh]. / Reparación del prolapso urogenital con malla de polipropileno.

BACKGROUND: Urogenital prolapse is a condition that affects 1 to 43% of post-hysterectomized patients. Since several years some synthetic meshes have been used to repair pelvic floor, and apparently they have advantages over them predecessors. OBJECTIVE: To evaluate the efficacy and security of polypropylene meshes in the repair of urogenital prolapse. MATERIAL AND METHOD: Retrospective and non-randomized study in 106 patients that had different kinds of urogenital prolapse repaired using polypropylene meshes. The follow-up was carried out by two visits to the hospital, 2 and 6 months after surgery. The variables analyzed were age, parity, menopause presence, kind of surgical technique, surgical time, time at hospital and complications. Afterwards, the information was analyzed descriptively. RESULTS: Average age was 64.4 years. The rate of multiparity and menopause women was 91.51% and 92.45% respectively. The most used surgical technique was the anterior mesh with tension-free band (34,90%) to repair the associated urinary incontinence. The rate of intraoperatory complications was 2.8%, immediate complications was 37.7% and late complications was 21.6%. The success rate after 6 months was 80 to 100%, depending on the technique. CONCLUSIONS: There is a low rate of intraoperatory and medium-term complications in the reconstructive surgery of pelvic floor for the urogenital prolapses using polypropylene meshes, which makes this technique a secure and effective option for the treatment of this problem.

[Fetal chylothorax. Is prenatal treatment beneficial?]. / Quilotórax fetal: es benéfico su tratamiento prenatal?

We report a case of fetal chylothorax handled with intrauterine treatment, which finally died. Diagnosis, treatment and evolution are reviewed. Characteristics of the disease are described and treatment options are discussed.