Angiomixoma agresivo vulvar en mujer joven. Reporte de un caso / Aggressive vulvar angiomyxoma in a young woman. A case report

Resumen ANTECEDENTES: El angiomixoma agresivo profundo perineal es un tumor mesenquimatoso de muy limitada aparición que se origina debido a un crecimiento tumoral del tejido conjuntivo que se expande a pesar de su naturaleza benigna; se caracteriza por un comportamiento agresivo. CASO CLÍNICO: Paciente de 38 años, con un nódulo genital de 3 cm en el labio mayor izquierdo, con sospecha clínica de quiste de la glándula de Bartolino. Durante la intervención para su drenaje se objetivó una tumoración blanda, de aspecto mesenquimal, pediculado. El análisis histológico confirmó que se trataba de un angiomixoma agresivo profundo perineal. Posterior al estudio de extensión negativo, se completó la vulvectomía simple izquierda, con un posoperatorio favorable. CONCLUSIONES: La obtención de una biopsia inicial es decisiva, sobre todo en casos de tumores mesenquimales agresivos, como el angiomixoma agresivo perineal profundo. De esta manera puede establecerse un plan de tratamiento individual en función del diagnóstico histológico definitivo.

Abstract BACKGROUND: Aggressive deep perineal angiomyxoma is a mesenchymal tumor of very limited occurrence that originates due to a tumorous growth of connective tissue that expands despite its benign nature; it is characterized by an aggressive behavior. CLINICAL CASE: 38-year-old patient with a 3 cm genital nodule on the left labium majus, with clinical suspicion of Bartholin's gland cyst. During the intervention for its drainage, a soft, mesenchymal, pedunculated tumor was observed. Histological analysis confirmed that it was an aggressive deep perineal angiomyxoma. Following a negative extension study, a simple left vulvectomy was completed, with a favorable postoperative course. CONCLUSIONS: Obtaining an initial biopsy is critical, especially in cases of aggressive mesenchymal tumors, such as deep perineal aggressive angiomyxoma. In this way an individual treatment plan can be established based on the definitive histologic diagnosis.

Malformación arteriovenosa uterina como causa de hemorragia puerperal tardía / Uterine arteriovenous malformation as a cause of late puerperal hemorrhage

Resumen ANTECEDENTES: Las malformaciones arteriovenosas uterinas constituyen una causa infrecuente de hemorragia puerperal, en la bibliografía solo se encontraron 150 casos. Su conocimiento es importante porque son potencialmente mortales y porque se ha registrado un aumento en los últimos años. Suelen estar relacionadas con intervenciones en el útero: legrados, cesáreas o miomectomías o asociadas con neoplasias (enfermedad trofoblástica gestacional o adenocarcinoma endometrial), aunque otras son congénitas. CASO CLÍNICO: Paciente de 32 años, con una conización cervical y ablación de un mioma uterino mediante radiofrecuencia como únicos antecedentes de interés. A los 15 días posteriores a un parto eutócico, que fue el primero en su historial, tuvo un episodio de abundante metrorragia. En el puerperio inmediato tuvo una hemorragia abundante que requirió la transfusión de dos concentrados de hematíes. En la ecografía transvaginal el útero se observó de 22 x 44 mm, que podría corresponder a un cotiledón retenido. Ante la persistencia del sangrado se colocó un taponamiento intracavitario con una sonda de Foley con lo que se consiguió el cese del sangrado. Luego de descartar la embolización de las arterias uterinas debido al gran tamaño de la malformación arteriovenosa, se procedió a la histerectomía total simple por vía laparotómica. CONCLUSIÓN: Las malformaciones arteriovenosas uterinas, aunque son una causa infrecuente de hemorragia puerperal, deben ser sospechadas en virtud de ser potencialmente mortales.

Abstract BACKGROUND: Uterine arteriovenous malformations are a rare cause of puerperal hemorrhage, with only 150 cases reported in the literature. Their knowledge is important because they are life-threatening and because there has been an increase in recent years. They are usually related to interventions in the uterus: curettage, caesarean section or myomectomy or associated with neoplasms (gestational trophoblastic disease or endometrial adenocarcinoma), although others are congenital. CLINICAL CASE: A 32-year-old patient with a cervical conization and ablation of a uterine myoma by radiofrequency as the only history of interest. Fifteen days after a euthecological delivery, which was the first in her history, she had an episode of abundant metrorrhagia. In the immediate postpartum period, she had a heavy hemorrhage that required the transfusion of two red blood cell concentrates. Transvaginal ultrasound showed a uterus measuring 22 x 44 mm, which could correspond to a retained cotyledon. In view of the persistent bleeding, intracavitary tamponade was placed with a Foley catheter, which led to cessation of bleeding. After ruling out embolization of the uterine arteries due to the large size of the arteriovenous malformation, a simple total hysterectomy by laparotomy was performed. CONCLUSION: Uterine arteriovenous malformations, although an infrequent cause of puerperal hemorrhage, should be suspected because they are potentially fatal.

Attempted vaginal birth after cesarean: assessment of morbidity and predictors of success / Parto tras cesárea anterior: análisis de la morbimortalidad materno-fetal

Objective: Determining the appropriate approach for delivery after previous cesarean is a very controversial issue. Our objective was to establish whether pregnant women with a previous cesarean have an increased maternal and fetal morbidity and mortality after attempting vaginal delivery as well as to determine which factors may influence the achievement of a vaginal birth after cesarean. Materials and methods: A retrospective observational cohort study including 390 patients (196 cesarean group and 194 nulliparous group) was carried out. We compared neonatal and maternal outcomes between groups. Afterward, a multivariate logistic regression was applied for our second objective. Results: There were higher rates of uterine rupture (2% vs. 0%, p: 0.045) and puerperal hemorrhage (9.7% vs. 3.1%, p: 0.008) in the cesarean group and lower vaginal delivery rate (58.2% vs. 77.8%, p < 0.0005). We found that the induced onset of labor (OR = 2.9) and new born weight (OR = 1.0001) were associated with an increased risk of cesarean section. Conclusions: Our findings stress the need for further investigations in this field, which might provide a basis for a better management of patients with a previous cesarean.

Objetivo: Determinar el abordaje adecuado del tipo de parto tras una cesárea previa es un tema muy controvertido. Nuestro objetivo fue establecer si las gestantes con cesárea previa presentan mayor morbimortalidad materna y fetal tras intentar parto vaginal, así como determinar qué factores pueden influir en conseguir un parto vaginal posterior a la cesárea. Material y métodos: Estudio observacional de cohortes retrospectivo incluyendo 390 pacientes (196 con cesárea previa, 194 nulíparas). Comparamos los datos sobre los resultados neonatales y maternos. Posteriormente se aplicó un modelo de regresión logística multivariante. Resultados: Hubo mayores tasas de ruptura uterina (2% vs. 0%; p = 0.045) y hemorragia puerperal (9.7% vs. 3.1%, p: 0.008) en el grupo de cesárea anterior, así como una tasa de parto vaginal mas baja (58.2% vs. 77.8%, p < 0.0005). La inducción del parto (OR = 2,9) y el peso del recién nacido (OR = 1.0001) se asociaron a un mayor riesgo de cesárea. Conclusión: La probabilidad de parto vaginal en estas pacientes disminuye cuanto mayor sea el peso del recién nacido y con partos inducidos.

Evaluación de la efectividad y satisfacción de las pacientes tras miomectomía histeroscópica en consulta / Evaluation of effectiveness and patient satisfaction of hysteroscopic myomectomy in office

OBJETIVO: Analizar la efectividad de las miomectomías histeroscópicas en consulta realizadas con minirresector y conocer si hay factores relacionados con el grado de satisfacción de las pacientes. MÉTODO: Estudio observacional, transversal y prospectivo, de mujeres sometidas a miomectomía histeroscópica en consulta durante el año 2018. Las pacientes recibieron medicación para la preparación cervical, analgesia oral y anestesia paracervical. La miomectomía se realizó con un minirresector de 5.8 mm. Se registraron el tiempo y el dolor en una escala visual analógica (EVA) durante la entrada y la resección, así como la satisfacción de las pacientes a los 3 meses con el cuestionario validado CSQ-8. RESULTADOS: El estudio incluyó 59 pacientes. El tiempo medio de entrada fue menor de 1 minuto (47,93 segundos) y el de resección fue de 13,51 minutos. El dolor referido por las pacientes en la EVA durante la entrada y la resección puntuó en torno a 3 y 4, respectivamente. Se consiguió un 74.6% de resecciones completas de los miomas y la puntuación media de satisfacción de las pacientes fue de 27.17. La resección completa del mioma se asoció con una mayor satisfacción total de las pacientes. CONCLUSIONES: La miomectomía histeroscópica en consulta llevada a cabo con un minirresector de 5.8 mm con analgesia paracervical obtiene buenos resultados clínicos, con buena satisfacción de las pacientes. Esta última se relaciona con una resección completa del mioma, sin que influyan el tiempo necesario para su exéresis ni el dolor.

OBJECTIVE: To analyze the effectiveness of hysteroscopic myomectomy in office performed with mini-resectoscope, and to know if there is any variable related with patient satisfaction. METHOD: Observational and prospective transversal study, which included all women who underwent a hysteroscopic myomectomy in office in 2018. Patients received drugs for cervical preparation and pain management, as well as paracervical block. We used the 5.8 mm mini-resectoscope. We kept record of time and AVS pain during entrance and resection, as well as patient satisfaction 3 months after the procedure using the CSQ-8. RESULTS: The study included 59 patients. Mean entrance time was less than 1 minute (47.93 seconds), while mean resection time was 13.51 minutes. AVS pain during entrance and resection was around 3 and 4, respectively. We achieved 74.6% rate of complete resection. Mean patient satisfaction rate was 27.17 points. We found that a complete myoma resection is related to higher patient satisfaction. CONCLUSIONS: Hysteroscopic myomectomy in office performed with the 5.8 mm mini-resectoscope, using cervical block, achieves good clinical results and a good patient satisfaction. Patient satisfaction is associated with a complete resection of the myoma, without any influence of pain experienced or time required.

Relationship Between Paraoxonase-1 and Butyrylcholinesterase Activities and Nutritional Status in Mexican Children.

BACKGROUND: The enzymes butyrylcholinesterase (BuChE) and paraoxonase-1 (PON1) are the primary bioscavenging enzymes in serum and exhibit antioxidant and anti-inflammatory activities. PON1 has been associated with diseases caused by high oxidative stress, whereas BuChE appears to be involved in the pathophysiology of the metabolic syndrome and related disorders. It has been suggested that children from rural communities in Mexico may have a predisposition to develop obesity or type 2 diabetes during adolescence or adulthood. The objective of this study was to determine whether associations exist between the paraoxonase (PONase)/arylesterase (AREase) activity of PON1, its PON1-Q192R and PON1-L55M polymorphisms, and BuChE activity with the nutritional status and lipid profiles in a group of children from rural communities in Mexico. METHODS: A group of 97 boys and girls from a rural community in Mexico were assessed for body mass index, the enzymatic activities of BuChE, PONase, and AREase were measured in serum, and their lipid profiles were determined. Genetic polymorphisms of PON1-L55M and PON1-Q192R were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The children were classified into four groups: thinness, normal weight, overweight, and obese. Of the children studied, 34.4% were overweight and obese. The mean age of the participants was 9.5 years (standard deviation = 1.8). The L allele of the PON1-L55M genotype was the most frequent (83.3%), and the R allele of the PON1-Q192R genotype was the most frequent (61.8%). Overweight and obese children had higher values of BuChE, total cholesterol, triglycerides (TG), and lower high-density lipoprotein (HDL-C) values than children with thinness or normal weight (P = 0.028, P = 0.019, P = 0.004, P = 0.069 and P = 0.021, respectively). The levels of AREase and PONase and the prevalence of PON1-L55M and PON1-Q192R genotypes were similar between groups (P = 0.484 and P = 0.380, respectively). CONCLUSIONS: This study establishes a positive association of BuChE activity with nutritional status and serum TG.

Factores socioculturales determinantes de los hábitos alimentarios de niños de una escuela- jardín en Perú: / Sociocultural factors determinants of eating habits of kindergarten schoolchildren in Peru:

RESUMEN Con el objetivo de explorar los factores socioculturales que determinan los hábitos alimentarios de niños menores de cinco años de una escuela inicial de Chachapoyas en Perú, realizamos un estudio cualitativo mediante entrevistas semiestructuradas a 18 padres y madres. Los factores determinantes de los hábitos alimenticios fueron: la disponibilidad y facilidad de preparación de los alimentos; horario y trabajo desempeñado por los padres; ingesta de café en niños como práctica común; falta de recursos e incertidumbre económica para la planificación alimenticia, y la falta de conocimientos nutricionales. Asimismo, se identificaron creencias que pueden explicar algunos hábitos alimenticios, como los efectos beneficiosos de la comida en familia, la lactancia materna y otros alimentos, o el papel de la alimentación para el buen desarrollo intelectual y físico de los niños. Los resultados aportan evidencia sobre el modo en que los padres afrontan y entienden la alimentación de sus hijos, determinando, a su vez, la calidad de la misma.

ABSTRACT To examine the sociocultural factors that determine the eating habits of children aged less than 5 years who attend kindergarten school in Chachapoyas in Peru, we carried out a qualitative study by means of semi-structured interviews of 18 fathers and mothers. The key factors related to eating habits were as follows: availability and easiness to prepare foods, schedule and work done by parents, intake of coffee in children as a common practice, lack of resources and economic uncertainty for food planning, and the lack of nutritional knowledge. Similarly, beliefs that might explain some eating habits, such as the beneficial effects of eating food as a family, maternal breastfeeding, and others, or the role of nutrition for the appropriate intellectual and physical development of children were identified. Our results provide evidence about the ways parents tackle and understand their children's nutrition while, in turn, determining its quality.

Factores socioculturales determinantes de los hábitos alimentarios de niños de una escuela-jardín en Perú: estudio cualitativo / Sociocultural factors determinants of eating habits of kindergarten schoolchildren in Peru: a qualitative study

Con el objetivo de explorar los factores socioculturales que determinan los hábitos alimentarios de niños menores de cinco años de una escuela inicial de Chachapoyas en Perú, realizamos un estudio cualitativo mediante entrevistas semiestructuradas a 18 padres y madres. Los factores determinantes de los hábitos alimenticios fueron: la disponibilidad y facilidad de preparación de los alimentos; horario y trabajo desempeñado por los padres; ingesta de café en niños como práctica común; falta de recursos e incertidumbre económica para la planificación alimenticia, y la falta de conocimientos nutricionales. Asimismo, se identificaron creencias que pueden explicar algunos hábitos alimenticios, como los efectos beneficiosos de la comida en familia, la lactancia materna y otros alimentos, o el papel de la alimentación para el buen desarrollo intelectual y físico de los niños. Los resultados aportan evidencia sobre el modo en que los padres afrontan y entienden la alimentación de sus hijos, determinando, a su vez, la calidad de la misma.

To examine the sociocultural factors that determine the eating habits of children aged less than 5 years who attendkindergarten school in Chachapoyas in Peru, we carried out a qualitative study by means of semi-structured interviewsof 18 fathers and mothers. The key factors related to eating habits were as follows: availability and easiness to prepare foods, schedule and work done by parents, intake of coffee in children as a common practice, lack of resources and economic uncertainty for food planning, and the lack of nutritional knowledge. Similarly, beliefs that might explain some eating habits, such as the beneficial effects of eating food as a family, maternal breastfeeding, and others, or the role of nutrition for the appropriate intellectual and physical development of children were identified. Our results provide evidence about the ways parents tackle and understand their children’s nutrition while, in turn, determining its quality.

[Sociocultural factors determinants of eating habits of kindergarten schoolchildren in Peru]. / Factores socioculturales determinantes de los hábitos alimentarios de niños de una escuela- jardín en Perú.

To examine the sociocultural factors that determine the eating habits of children aged less than 5 years who attend kindergarten school in Chachapoyas in Peru, we carried out a qualitative study by means of semi-structured interviews of 18 fathers and mothers. The key factors related to eating habits were as follows: availability and easiness to prepare foods, schedule and work done by parents, intake of coffee in children as a common practice, lack of resources and economic uncertainty for food planning, and the lack of nutritional knowledge. Similarly, beliefs that might explain some eating habits, such as the beneficial effects of eating food as a family, maternal breastfeeding, and others, or the role of nutrition for the appropriate intellectual and physical development of children were identified. Our results provide evidence about the ways parents tackle and understand their children's nutrition while, in turn, determining its quality.

Small GTP-binding proteins are associated with chitosomes and vesicles carrying glucose oxidase from Mucor circinelloides.

Fractions enriched with chitosomes and vesicles carrying glucose oxidase (GOX) activity from the dimorphic zygomycete Mucor circinelloides were obtained using two successive sucrose gradients, the first a linear-log and the second an isopycnic gradient. Using an [alpha-(32)P]GTP-binding assay, we detected the association of small GTP-binding proteins (21 and 17 kDa) with both types of vesicles. In addition, by ADP-ribosylation with C3 exotoxin, and Western blot analysis with specific antibodies, we identified the small GTPases RhoA (Rho1p) and Rab8, and a 17 kDa protein, with pI values of 6.0, 6.1, and 6.2 and molecular masses of 21, 21 and 17 kDa, respectively, associated with those vesicles carrying GOX activity. Rab and Cdc42 proteins with pI values of 6.1 and 6.2 and molecular masses of 21 and 17 kDa, respectively, were found associated with chitosomes. These data indicate the presence in M. circinelloides of low molecular mass G-proteins in chitosomes and in vesicles carrying GOX activity. The difference in association of Rho1 and Cdc42, with vesicles carrying GOX activity and chitosomes, respectively, indicates that each of these proteins probably controls formation, transport and specific plasma membrane site docking of the respective vesicles.