ABSTRACT
La historia natural del carcinoma de endometrio, su epidemiología, factores de riesgo, tipos etiopatogénicos, diagnóstico, estadiaje, tratamiento quirúrgico radioterápico, hormonal y quimioterapia, etc, están llenos de nuevas adquisiciones y esperanzas (AU)
Subject(s)
Female , Humans , Adenocarcinoma , Endometrial Neoplasms , Risk Factors , Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/therapyABSTRACT
El carcinoma de endometrio es el tumor más frecuente del aparato genital femenino en los países industrializados y su incidencia es mayor en mujeres en edad geriátrica. Su relativo fácil diagnóstico hace que pueda ser un tumor de buen pronóstico si se trata precozmente. Su dependencia hormonal en la mayoría de los casos permite la identificación y el seguimiento de pacientes de alto riesgo con el fin de prevenir y detectar precozmente las lesiones precursoras (hiperplasias) y el carcinoma en sus fases iniciales. Los métodos diagnósticos actuales como la ecografía vaginal e histeroscopia han desplazado al legrado diagnóstico o microlegrado. El tratamiento es eminentemente quirúrgico (histeractomía total más doble anexectomía), realizándose linfadenectomía selectiva según la invasión miometrial, grado de diferenciación o tipo histológico del tumor, así como de la dificultad quirúrgica. La radioterapia se aplicará en casos específicos. El tratamiento adyuvante con gestágenos debe realizarse de forma protocolizada. Ultimamente, se está imponiendo la histerectomía y linfadenectomía por vía laparoscópica, lo que supone un gran beneficio para la paciente, annque precisa de ginecólogos oncólogos muy expertos en estas técnicas (AU)
Subject(s)
Aged , Female , Humans , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/therapy , Risk Factors , PrognosisABSTRACT
With the diminution of maternal and perinatal mortality, the Cesarean sections rates has increased in the world, and has produced preoccupation and restlessness in health providers and scientists. This increase of the Cesarean sections rates has been due to multiple reasons. These reasons are the increasing fetal interest, the different conception and its processing, in which it influences a lot the present preparation of obstetricians, the valuation of the fetal well-bearing, the obstetrical attitude in breech presentations and iterative cesarean sections, and of course, the social and economic pressures that carry the fear to the judicial claims, which are increasing in all developed countries. The aim of this this article is to analyze the ways to decrease this cesarean sections rates, analyzing causes of the increase, treating to describe obstetrical protocols to achieve an ideal number of cesarean sections.
Subject(s)
Cesarean Section , Cesarean Section/methods , Cesarean Section/statistics & numerical data , Female , Humans , PregnancyABSTRACT
La holoprosencefalia constituye un grupo de trastornos complejos que varían por su grado de severidad y que obedecen a la falta del desarrollo normal del cerebro anterior (prosencéfalo) durante la vida embrionaria temprana. Su etiología es heterogénea. La incidencia según las distintas series se sitúa en un 0,6/1.000 nacidos vivos. El conocimiento de la neuroanatomía evolutiva normal y anormal es esencial para identificar malformaciones específicas. Gracias al uso difundido de la ecografía prenatal cada vez se detectan más anomalías estructurales del neuroeje fetal. Una vez realizado el diagnóstico, se inicia el proceso de toma de decisiones que involucran al obstetra y a los futuros padres en elecciones difíciles en numerosas ocasiones. El manejo obstétrico dependerá de la edad gestacional en el momento del diagnóstico así como de la severidad de la anomalía. No obstante en la mayoría de los casos y ante la posibilidad de alteraciones psicomotoras en el desarrollo del recién nacido los padres suelen optar por la interrupción del embarazo. Además de realizar un repaso de los conceptos sobre la posible etiología, fisiopatología, diagnóstico, alteraciones asociadas y pronóstico fetal presentamos un caso de holoprosencefalia alobar y otro de holoprosencefalia semilobar diagnosticados en nuestro servicio durante el último año (AU)
Subject(s)
Pregnancy , Female , Humans , Holoprosencephaly , Ultrasonography, PrenatalABSTRACT
Surgery for ovarian cancer is always radical. In young patients with wish of pregnancy and in early stages, the conservative surgery can be contemplated. This type of surgery involves removing the tumoral ovary, leaving the healthy ovary and uterus. In these cases, the age, stage, histologic type, grade and biological factors must be considered. There is controversy about the surgical approach: laparoscopy or laparotomy, the indication to perform biopsy of the contralateral ovary and pelvic-paraaortic lymphadenectomy. In high-risk cases adjuvant chemotherapy must be considered. We present our experience in 330 common epithelial and germinal ovarian carcinomas. We performed conservative surgery in 13. Four patients got pregnant and 3 of them delivered a term newborn. In 13 of 52 borderline tumors a conservative surgery was performed and 3 term deliveries were obtained. All patients are alive and free of disease.
Subject(s)
Ovarian Neoplasms/surgery , Adult , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Laparoscopy , Laparotomy , Neoplasm Staging , Ovarian Neoplasms/pathology , PrognosisSubject(s)
Hysterectomy/methods , Female , History, 19th Century , History, 20th Century , Humans , Hysterectomy/history , Lymph Node ExcisionSubject(s)
Adenocarcinoma/prevention & control , Endometrial Neoplasms/prevention & control , Postmenopause , Adenocarcinoma/chemically induced , Adenocarcinoma/epidemiology , Adult , Aged , Aged, 80 and over , Contraindications , Endometrial Hyperplasia/etiology , Endometrial Neoplasms/chemically induced , Endometrial Neoplasms/epidemiology , Estrogens/adverse effects , Estrogens/biosynthesis , Estrogens/therapeutic use , Female , Genital Neoplasms, Female/epidemiology , Humans , Incidence , Middle Aged , Ovary/physiology , Progestins/therapeutic use , Risk , Spain/epidemiologySubject(s)
Adenocarcinoma/diagnostic imaging , Endometrial Neoplasms/diagnostic imaging , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Endometrial Neoplasms/pathology , Endometrial Neoplasms/surgery , Endometrium/diagnostic imaging , Endometrium/pathology , Endometrium/surgery , Evaluation Studies as Topic , Female , Humans , Lymph Node Excision , Lymphatic Metastasis , Middle Aged , Neoplasm Staging , Ultrasonography , VaginaSubject(s)
Hernia, Umbilical/pathology , Umbilical Cord/pathology , Amniocentesis , Female , Fetal Distress/diagnosis , Fetal Distress/etiology , Fetal Distress/pathology , Fetus/abnormalities , Hematoma/pathology , Hemorrhage/pathology , Humans , Infant, Newborn , Magnetic Resonance Imaging , Pregnancy , Thrombosis/pathology , Ultrasonography, Prenatal , Umbilical Arteries/abnormalities , Umbilical Arteries/pathology , Umbilical Cord/abnormalities , Umbilical Veins/pathologyABSTRACT
PIP: On the basis of available data, the most likely action of IUDs is that of an endometrial polymorphonuclear infiltration, affecting both the upward movement of spermatozoa and the series of steps that precede implantation, although other actions may play a subsidiary role to a greater or lesser extent. With respect to IUDs of the Cu-T type, it appears that basically they act through metabolic endometrial changes initiated by actions affecting enzyme systems, which prevent the endometrium from becoming receptive to nidation. It is also highly probable that they have a harmful effect on the spermatozoa moving through the uterine cavity, and it is possible that cervical mucus, under the action of Cu-T IUDs, may alter its function as sperm filter, rendering sperm penetration more difficult, although the latter action is still being researched. Blastocysts appear to remain unaffected by all the actions of Cu-T IUDs.^ieng
Subject(s)
Cervix Uteri , Contraception , Embryo Implantation , Endometrium , Enzymes , Intrauterine Devices, Copper , Biology , Family Planning Services , Genitalia , Genitalia, Female , Intrauterine Devices , Physiology , Urogenital System , UterusABSTRACT
The occurrence of oestrogenic smears in postmenopausal women has been reported by several authors. Oestrogenic activity has been examined in 962 smears from postmenopausal women ; these results have been compared with those obtained in 214 cases of surgical menopause. Does the senescent ovary continue to produce oestrogens ? Or are the mucous membranes of the female genital apparatus, and in particular the vaginal mucous membranes, capable of transforming certain 17-CS type suprarenal catabolites into oestrogens. or at least of reactivating these catabolites "oestrogenically".
