Multidisciplinary consensus on cancer management during pregnancy.

Cancer during pregnancy is a challenge for multi- and interdisciplinary collaboration due to the diagnostic, prognostic and therapeutic implications, the need for an integrated harmonization of medical action for the pregnant patient and the embryo or foetus and the characteristics of each gestational period, which will determine the protocol to be proposed and its limitations. For this reason, a group of experts appointed by participating scientific societies, which includes the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica-SEOM), the Spanish Association of Surgeons (Asociación Española de Cirujanos-AEC), the Spanish Society of Gynaecology and Obstetrics (Sociedad Española de Ginecología y Obstetricia-SEGO), the Spanish Society of Nuclear Medicine and Molecular Imaging (Sociedad Española de Medicina Nuclear e Imagen Molecular-SEMNIM), the Spanish Society of Oncological Radiotherapy (Sociedad Española de Oncología Radioterápica-SEOR) and the Spanish Society of Medical Radiology (Sociedad Española de Radiología Médica-SERAM), have worked together to establish consensus recommendations that allow the harmonization of management and ultimately the optimization of the healthcare of pregnant patients with cancer. When cancer is detected in a pregnant woman, the week of gestation in which the diagnosis is made must be considered, as well as the characteristics of the tumour. It is strongly recommended that a multidisciplinary team assesses the situation and guides the patient and her family during the informing, diagnosis and treatment process. Likewise, the foetus should be monitored and managed by specialized obstetricians who are part of a multidisciplinary cancer committee.

Optimization of surgical treatment of advanced ovarian cancer: a Spanish expert perspective.

BACKGROUND: Optimal upfront treatment of patients with advanced ovarian cancer is complex and requires the adequate function of a multidisciplinary team. Specific standard of quality of care needs to be taken into consideration. METHODS: A literature search in PubMed was performed using the following criteria: ("ovarian neoplasms"[MeSH Terms] OR ("ovarian"[All Fields] AND "neoplasms"[All Fields]) OR "ovarian neoplasms"[All Fields] OR ("ovarian"[All Fields] AND "cancer"[All Fields]) OR "ovarian cancer"[All Fields])"[Date - Publication]: "2018/01/14"[Date - Publication]). RESULTS: This article describes how to optimize the surgical management of advanced ovarian cancer, to achieve the best results in terms of survival and quality of life. For this purpose, this document will cover aspects related to pre-, intra- and postoperative care of newly diagnosed advanced ovarian cancer patients. CONCLUSION: Optimizing upfront treatment of patients with advanced ovarian cancer is complex and requires a structured quality management program including the wise judgment of a multidisciplinary team. Surgeries performed by gynecologic oncologists with formal training in cytoreductive techniques at referral centers are crucial factors to obtain better clinical and oncological outcomes. However, other factors such as the patient's clinical status, the hospital infrastructure and equipment, as well as the tumor biology of each individual patient should also be taken into account before deciding on an initial therapeutic strategy for advanced-stage ovarian cancer to offer patients the best quality of care.

Nutrient, metal contents and microbiological properties of litter and soil along a tree age gradient in Mediterranean forest ecosystems.

The link among the age of aboveground tree species, litter, soil quality and status in Mediterranean forests is not entirely comprehended (especially in Mediterranean forest sites). This study evaluates whether and by what extent tree stand composition and forest structure modify nutrient depository or alter physical, chemical and microbiological properties of soil and litter in a 120 years old pine forest chronosequence. In general, the enzymatic activity related to the phosphorous, carbon and nitrogen cycles were more developed in litter than in soil surface, while the sulphur enzymatic activity was not significantly different between the two analyzed systems. The higher dehydrogenase content measured in the litter may be an index of a higher extracellular microbial activity, compared to soil. A noticeable effect of forest age and structure on the majority of analyzed elements was detected, with nutrients and metals tending to accumulate in soil rather in the litter. Moreover, the contents of P and some metals and sulphur enzymatic activity in the litter are influenced by forest age and associated forest structure. Finally, since nutrient, metals and enzyme contents in the litter increase with forest age, forest management strategies targeted to increase the stand structure may be advisable in order to achieve higher soil functionality.

Current situation in gynecological oncology training in Spain: where we are and where we want to go.

BACKGROUND: It is important to know what a young gynecologic oncologist perceives as a need to achieve a good training in gynecologic oncology. OBJECTIVE: This study aims to evaluate the level of training in gynecologic oncology in Spain. METHODS: A Web-based anonymous questionnaire was sent via e-mail to Spanish trainees listed in European Network of Young Gynecological Oncology (ENYGO). The survey was developed in four sections: (1) general training in gynecologic oncology, (2) distribution of current clinical activity, (3) surgical training, and (4) perspective future gynecologic oncology. It contained 51 questions, with multiple-choice answers that had to be answered by the ENYGO members. RESULTS: The questionnaire was sent to 64 people listed in the ENYGO database. Of these, 37 members responded (response rate of 58%). Overall, more training in surgery is necessary, to perform radical oncological surgeries. It is claimed a sub-specialty recognition, to ensure an equalitarian and homogeneous training.

[Meigs' syndrome caused by bilateral ovarian fibroma mimicking ovarian cancer]. / Síndrome de Meigs por fibroma ovárico bilateral parecido al cáncer de ovario.

CASE REPORT: We report the case of a 55-year-old patient who pre- sented a pelvic mass, ascites and elevated serum CA125. Suspecting a malignant process she underwent surgery and a total hysterectomy with bilateral salpigo-oforectomy was performed. Pathologic report revealed a bilateral ovarian fibroma and non-tumoral ascites. The presence of elevated serum CA125 levels in a postmenopausal woman with a pelvic mass and ascites suggest an ovarian malignant disease. However, in case of Meigs'syndrome, all symptoms will diappear after removal of the pelvic tumor, so a fast surgical management of the patients is mandatory.

Intravascular leiomyomatosis: an exceptional entity.

Intravenous leiomyomatosis (IVL) is a rare benign condition characterized by the proliferation of smooth muscle cells originating from either the uterine venous wall or a uterine myoma. This leiomyomatosis extends most frequently to pelvic vessels, but also occasionally into the inferior vena cava and right cardiac chambers. Preoperative diagnosis is difficult and it should be suspected in the presence of cardiac or pelvic masses in women who have undergone hysterectomy or myomectomy previously. The treatment is hysterectomy, normally associated with a bilateral oophorectomy and removing the mass or metastasis if any. The post-surgical follow-up should be performed at long-term and include exploration and imaging, either ultrasound or MRI. The association of antiestrogenic drugs can be useful for disease control, especially in cases where oophorectomy is not performed and the tumor cannot be removed completely.

Carcinoma of the recto-vaginal septum. Comprehensive literature review.

Carcinoma of the recto-vaginal septum is an extremely rare entity. We performed a MEDLINE-based search on recto-vaginal septum carcinoma, focussing on its management, in order to clarify which are the best treatment options for this disease. In addition an unpublished case report has been added to the review. 34 case reports were included in our review. Surgery and adjuvant chemoradiation therapy seem to be the most common treatment option. However, since primary surgical treatment leads to mutilation by removing a large portion of the vagina and the anal sphincter with a permanent terminal colostomy, primary platinum-based chemoradiation therapy could be considered. In case of extragastrointestinal stromal tumours primary surgical treatment seems to be the best option. Due to the rarity of this entity only limited data is available. Therefore further investigation is necessary.

Granular cells tumor of the vulva: an exceptional entity.

INTRODUCTION: Granular cells tumor (GCT) is a rare tumor that develops on skin and soft tissues. Only 1-2% of these tumors present malignant behavior. MATERIAL AND METHODS: The authors report three cases of GCT and review the management of these tumors. CASE REPORT: The first case is a 73-year-old woman who was diagnosed with an atypical GCT. She was treated with local excision and then presented a local recurrence 21 months after the surgery. The other two cases are 60- and 58-year-old women diagnosed with a benign GCT. They were treated with single excision; both patients underwent second surgery due to margin affectation. CONCLUSION: Management of GCT is not clear nowadays. The careful selection of patients with poor prognostic factors is very important. Follow-up for early diagnosis of local recurrence and metastases of these tumors is of utmost importance.

Nodal involvement evaluation in advanced cervical cancer: a single institutional experience.

PURPOSE: To assess the usefulness of different imaging techniques in the detection of nodal involvement in patients with advanced cervical carcinoma. Moreover, to analyze the correlation between the presurgical (FIGO) and postsurgical (pTNM) staging classifications. MATERIALS AND METHODS: All patients diagnosed with advanced cervical cancer (FIGO Stages IIB-IV) from 2005 to 2012 were selected. The medical charts of 51 patients that underwent presurgical assessment with posterior surgical staging by means of para-aortic lymphadenectomy, were reviewed. Nodal status assessment by computed tomography scan (CT scan), magnetic resonance imaging (MRI), positron emission tomography (PET), and sonography was compared, as well as the size given in imaging techniques compared to the final pathologic report information. RESULTS: Presurgical analysis by CT scan, MRI, PET, and sonography showed pelvic nodal involvement in 51.3% of patients, and para-aortic involvement in 30.8% of cases. CT scan showed positive pelvic nodes in 35% of cases, but pathologic confirmation was observed in just 17.6% of cases. However, MRI resulted in higher rates of up to 48.8% of cases. Concerning para-aortic nodal involvement, CT scan showed positive nodes in 25% of cases, MRI in 3.2% of cases, and the pathologic report in 15.6% of cases. The authors found significant differences between staging groups among both classifications (FIGO vs. pTNM; p < 0.001). Eight cases (15.7%) were understaged by FIGO classification. CONCLUSIONS: Despite all imaging techniques available, none has demonstrated to be efficient enough to avoid the systematic study of para-aortic nodal status by means of surgical evaluation.

[Low-dose hypobaric spinal anesthesia for anorectal surgery in jackknife position: levobupivacaine-fentanyl compared to lidocaine-fentanyl]. / Anestesia subaracnoidea hipobárica a dosis bajas para cirugía anorrectal en posición de navaja: comparación entre levobupivacaína-fentanilo y lidocaína-fentanilo.

OBJECTIVE: To compare the percentage of patients who were able to bypass the postoperative intensive care recovery unit after selective spinal anesthesia with lidocaine-fentanyl versus levobupivacaine-fentanyl for anorectal surgery in jackknife position. MATERIAL AND METHODS: Randomized double-blind clinical trial comparing 2 groups of 30 patients classified ASA 1-2. One group received 18 mg of 0.6% lidocaine plus 10 microg of fentanyl while the other group received 3 mg of 0.1% levobupivacaine plus 10 microg of fentanyl. Intraoperative variables were time of start of surgery, maximum extension of sensory blockade, requirement for rescue analgesics, and hemodynamic events. The level of sensory blockade was recorded at 5, 10, and 15 minutes after the start of surgery and at the end of the procedure. The degrees of postoperative motor blockade and proprioception were recorded, as were the results of the Romberg test and whether or not the patient was able to bypass the postoperative recovery unit. Also noted were times of start of ambulation and discharge, complications, and postoperative satisfaction. RESULTS: Intraoperative variables did not differ significantly between groups, and all patients in both groups bypassed the postoperative recovery unit. Times until walking and discharge home, complications, and overall satisfaction after surgery were similar in the 2 groups. CONCLUSIONS: Both spinal anesthetic solutions provide effective, selective anesthesia and are associated with similar rates of recovery care unit bypass after anorectal surgery in jackknife position.

Squamous cell carcinoma of the breast.

OBJECTIVE: Pure squamous cell carcinoma (SCC) of the breast is a rare tumour and its clinical behaviour is not correctly known. The aim of the study is to evaluate the prevalence, epidemiological and clinical characteristics of the cases of SCC studied in our institution. STUDY DESIGN: The breast department's database was searched for patients diagnosed with breast SCC between September 1979 and June 2006. Pathological features, outcome aspects and prognosis were studied. All specimens were reviewed by our pathologist who performed inmunohistochemistry for hormone receptors. RESULTS: Eleven patients were identified (0.19%) between 5771 cases of breast cancer. Mean age was 64 (37-76) years and mean follow-up was 46 (6-216) months. Mean disease free survival (DFS) was 92 months (S.E.=33), with a 36% DFS rate at 5 years and the mean overall survival was 93 months (S.E.=34). Mean survival from the time recurrent disease was recognized was 9 (1-16) months. Tumours were hormone receptor negative. CONCLUSIONS: SCC of the breast is aggressive and often treatment-refractory. The role of different new chemotherapy regimens need to be explored.

Permeant anions control gating of calcium-dependent chloride channels.

The effects of external anions (SCN(-), NO3-, I(-), Br(-), F(-), glutamate, and aspartate) on gating of Ca(2+)-dependent Cl(-) channels from rat parotid acinar cells were studied using the whole-cell configuration of the patch-clamp technique. Shifts in the reversal potential of the current induced by replacement of external Cl(-) with foreign anions, gave the following selectivity sequence based on permeability ratios ( P(x)/ P(Cl)): SCN(-)>I(-)>NO3->Br(-)>Cl(-)>F(-)>aspartate>glutamate. Using a continuum electrostatic model we calculated that this lyotropic sequence resulted from the interaction between anions and a polarizable tunnel with an effective dielectric constant of approximately 23. Our data revealed that anions with P(x)/P(Cl) > 1 accelerated activation kinetics in a voltage-independent manner and slowed deactivation kinetics. Moreover, permeant anions enhanced whole-cell conductance ( g, an index of the apparent open probability) in a voltage-dependent manner, and shifted leftward the membrane potential- g curves. All of these effects were produced by the anions with an effectiveness that followed the selectivity sequence. To explain the effects of permeant anions on activation kinetics and g(Cl) we propose that there are 2 different anion-binding sites in the channel. One site is located outside the electrical field and controls channel activation kinetics, while a second site is located within the pore and controls whole-cell conductance. Thus, interactions of permeant anions with these two sites hinder the closing mechanism and stabilize the channel in the open state.

A nursing approach: towards the integral health care of renal patients.

In February 1993, after several multicentre meetings held together with nephrologists, the decision was taken to create the Peritoneal Dialysis Nursing Group for the Central Area; having as its primary purpose the provision of integrated medical care to renal patients.

[Seven-year experience with microsurgery]. / Experiencia de siete años de microcirugía.

From 700 laparoscopies performed, in 600 of them (85.7%) the tuboperitoneal factor was altered. Surgery included: termino-terminal plastia 70 cases (36%), (3 patients had previous plastia); adhensiolysis 62 (31%), salpingostomy 48 (24%), neoimplantation 10 (5%), and mixed surgery 9 (4%). After surgery, desertion was present in 78 patients. Of the 121 remaining, 34 (28.1%) had primary sterility and 87 (71.9%) secondary sterility. 74 patients (61.2%) obtained pregnancy, 62 (83.8%) reached term, seven were abortions of first trimester (9.5%) and were five ectopic pregnancies (6.7%). The interval between surgery and pregnancy achievement was 1 to 48 months, 12.8 months average. We emphasize the 47 patients analysis who didn't has pregnancy, through: remark time after surgery, histerosalpingography, new laparoscopy and reevaluation of sterility factors; the results were: 19 cases (40.5%) have a 5 to 60 months time after surgery, 19.5 months average, 18 (38.3%) had new tubary obstruction, three (6.4%) with endometriosis treatment, three (6.4%) have tuberculosis genital treatment, two (4.2%) with falling again endocrine-ovarian factor, and two (4.2%) with masculine relapse. A decease was present because anesthetic complication. We underline selection surgery criterion and a strictly evaluation, such as an antiadhesion pre, trans and postoperative regime, ligamentopexya of rounds ligaments and a conscious education of the patients in their strictly pursuit.

[The combined colposcopic index as a diagnostic method in human papillomavirus infection and cervical intraepithelial neoplasia]. / El índice colposcópico combinado (ICC) como método diagnóstico en la infección por papilomavirus humano y la neoplasia intraepitelial cervical.

This is a prospective, comparative study of 142 patients of combined colposcopic index according to Reid's criterium and the index used at the Clinics of Colposcopy, Gyn-Ob Hospital "Luis Castelazo Ayala", IMSS. Seventy two patients were studied with the Hospital Index, and 70 with the CCI. This constituted by neatness of peripheral edges, the color, characteristics of vessels and iodine tinction; a score of 0, 1, 2 was given, the sum of which gave a final qualification, and it was traspolated to a colposcopic diagnosis. The CCI correlated with the histological diagnosis in 64 patients (91.42%); while for the Hospital Index it was in 61 cases (84.7%). The indexes showed a good sensitivity (0.95), a high positive predictive value (0.95 vs 0.88), and adequate accuracy (0.91 vs 0.84), as well as a good prevalence (0.90 vs 0.85). It is concluded that the CCI is reliable for the colposcopic diagnosis of human papillomavirus and for CIN.