No todo es lo que parece: miastenia gravis, una rara manifestación paraneoplásica del cáncer de ovario: caso clínico / Not all is what it seems: Myasthenia gravis, a rare paraneoplastic manifestation of ovarian cancer: Clinical case

Los síndromes neurológicos paraneoplásicos son un conjunto de trastornos, raramente asociados a tumores ginecológicos. Su presencia debe alertarnos sobre la posible existencia de un tumor maligno subyacente. Presentamos un caso de miastenia gravis, como manifestación paraneoplásica de un cáncer de ovario primario avanzado

Paraneoplastic neurological syndromes are an unusual diseases rarely associated with gynaecological tumours. Their presence must alert on the possible existence of an underlying malignant tumour. A rare case is presented of myasthenia gravis as a paraneoplastic manifestation of an advanced primary ovarian cancer

[Survival by surgical approach in patients with endometrial adenocarcinoma treated in Navarra in the 2001-2009]. / Supervivencia según vía de abordaje quirúrgico en pacientes con adenocarcinoma de endometrio tratadas en Navarra en el periodo 2001-2009.

BACKGROUND: Endometrial adenocarcinoma is the most frequent gynaecological neoplasia after breast cancer and represents 6% of cancers in women. The treatment for this disease is surgery. The majority of cases are diagnosed in their initial stages and surgery is curative; on other occasions it is necessary to add radiotherapy and chemotherapy. The classical treatment for endometrial adenocarcinoma is hysterectomy with double adnexectomy by laparotomy, with the addition of pelvic and para-aortic lymphadenectomy and omentectomy according to the characteristics of the case. During the last 10-15 years laparoscopy has been introduced in the surgical treatment of endometrial adenocarcinoma. The main aim of this study is to analyze the cases of endometrial adenocarcinoma treated surgically in the former Virgen de Camino Hospital (nowadays the Hospital Complex of Navarra) during 2001-2009. METHODS: Historical cohort of 444 patients with endometrial adenocarcinoma during 2001-2009 who received surgical treatment, followed four years. CONCLUSIONS: The results confirm that laparoscopy is a safe alternative to classical laparotomy as it does not affect either survival or time free of disease, in both endometrioid adenocarcinoma and non-endometrioid adenocarcinoma.

Supervivencia según vía de abordaje quirúrgico en pacientes con adenocarcinoma de endometrio tratadas en Navarra en el periodo 2001-2009 / Survival by surgical approach in patients with endometrial adenocarcinoma treated in Navarra in the 2001-2009

Fundamento: El adenocarcinoma de endometrio es la neoplasia ginecológica más frecuente tras el cáncer de mama y representa el 6% de todos los cánceres de la mujer. El tratamiento fundamental de dicha enfermedad es la cirugía. La mayoría de los casos se diagnostican en estadios iniciales y la cirugía será curativa; en otras ocasiones es necesario añadir radioterapia o quimioterapia. El tratamiento clásico del adenocarcinoma de endometrio es la histerectomía con doble anexectomía por vía laparotómica, añadiendo según las características del caso la linfadenectomía pélvica, paraaórtica y omentectomía. Durante los últimos 10-15 años se ha introducido la laparoscopia en el tratamiento quirúrgico del adenocarcinoma de endometrio. El objetivo principal de este trabajo es analizar los casos de adenocarcinoma de endometrio intervenidos quirúrgicamente en el antiguo hospital Virgen de Camino (hoy Complejo Hospitalario de Navarra) durante el periodo 2001-2009. Material y métodos: Se ha recogido una cohorte histórica de 444 pacientes con diagnóstico de adenocarcinoma de endometrio durante el periodo 2001-2009, que recibieron tratamiento quirúrgico, así como su seguimiento durante 4 años. Conclusiones: Los resultados confirman que la vía laparoscópica es una alternativa segura a la laparotomía clásica ya que no afecta a la supervivencia ni al tiempo libre de enfermedad tanto en el adenocarcinoma endometrioide como en el no endometrioide (AU)

Background: Endometrial adenocarcinoma is the most frequent gynaecological neoplasia after breast cancer and represents 6% of cancers in women. The treatment for this disease is surgery. The majority of cases are diagnosed in their initial stages and surgery is curative; on other occasions it is necessary to add radiotherapy and chemotherapy. The classical treatment for endometrial adenocarcinoma is hysterectomy with double adnexectomy by laparotomy, with the addition of pelvic and para-aortic lymphadenectomy and omentectomy according to the characteristics of the case. During the last 10-15 years laparoscopy has been introduced in the surgical treatment of endometrial adenocarcinoma. The main aim of this study is to analyze the cases of endometrial adenocarcinoma treated surgically in the former Virgen de Camino Hospital (nowadays the Hospital Complex of Navarra) during 2001-2009. Methods: Historical cohort of 444 patients with endometrial adenocarcinoma during 2001-2009 who received surgical treatment, followed four years. Conclusions: The results confirm that laparoscopy is a safe alternative to classical laparotomy as it does not affect either survival or time free of disease, in both endometrioid adenocarcinoma and non-endometrioid adenocarcinoma (AU)

Colestasis y listeriosis en el tercer trimestre de la gestación / Cholestasis and listeriosis in the third trimester of pregnancy

La listeriosis es una infección producida por Listeria monocytogenes. Poco frecuente, afecta a personas en edades extremas de la vida, gestantes, inmunodeprimidos y, ocasionalmente, a individuos sanos. Su incidencia ha aumentado en los últimos años y presenta cierta tendencia a la estacionalidad, aumentando en verano. Puede aparecer de forma esporádica o a brotes. En gestantes, la infección se produce más frecuentemente en el tercer trimestre y la clínica suele ser leve. Sin embargo, la infección sobre el feto es severa, pudiendo producir abortos, muertes fetales, corioamnionitis y partos pretérmino con recién nacidos infectados, manifestándose en forma de granulomatosis infantiséptica con abscesos y granulomas diseminados o, tardíamente, como meningitis y sepsis. La colestasis intrahepática es una forma reversible de colestasis, de causa desconocida y específica de la gestación, siendo mas frecuente en multíparas, en el tercer trimestre y rara antes de la semana 26ª. Desaparece tras el parto y constituye la segunda causa de ictericia en la gestación, por detrás de la hepatitis. El diagnóstico de colestasis es fundamentalmente clínico. Se manifiesta por prurito palmo plantar pero también puede cursar con náuseas, vómitos y molestias abdominales localizadas en hipocondrio derecho. Dado que la listeriosis y colecistitis pueden compartir sintomatología, habrá que tener en cuenta la posibilidad de listeriosis para poner en marcha los mecanismos de confirmación diagnóstica (cultivo de fluidos o tejidos estériles: sangre, LCR neonatal, líquido amniótico o placenta)y el tratamiento específico precozmente. Se presenta un caso de colestasis y listeriosis en el tercer trimestre con buen resultado maternofetal (AU)

Listeriosis is an infection produced by Listeria monocytogenes. It is infrequent and affects people at extreme ages, pregnant women, immune compromised people and, occasionally, healthy people. Its incidence has increased in recent years and shows a certain tendency to seasonality, increasing in summer. It can appear sporadically or as outbreaks.In pregnant women the infection is most frequently produced in the third trimester and the symptoms are usually light. Nonetheless, the infection of the fetus is severe, and can produce miscarriages, fetal deaths, corioamnionitis and premature births with the newborn infected, manifested in the form of granulomatosis infantiseptica with abscesses and scattered granulomas or at a later stage , as meningitis or sepsis. Intrahepatic cholestasis is a reversible form of cholestasis, its cause is unknown, it is specific to pregnancy and is more frequent in multiparous women, in the third trimester and rarely before the 26th week. It disappears following childbirth and is the second cause of jaundice in pregnancy, after hepatitis. The diagnosis of cholestasis is basically clinical. It appears as palmoplantar pruritus but can also produce nausea, vomiting and abdominal discomfort localized in the right hypochondrium. Given that listeriosis and cholestasis can have a shared symptomology, the possibility of listeriosis must be borne in mind in order for early implementation of the mechanisms of diagnostic confirmation (cultivation of sterile fluids or tissues: blood, neonatal CSF, amniotic liquid or placenta) and specific treatment. We present a case of cholestasis and listeriosis in the third trimester with a good maternofetal result (AU)

[Cholestasis and listeriosis in the third trimester of pregnancy]. / Colestasis y listeriosis en el tercer trimestre de la gestación.

Listeriosis is an infection produced by Listeria monocytogenes. It is infrequent and affects people at extreme ages, pregnant women, immunocompromised people and, occasionally, healthy people. Its incidence has increased in recent years and shows a certain tendency to seasonality, increasing in summer. It can appear sporadically or as outbreaks. In pregnant women the infection is most frequently produced in the third trimester and the symptoms are usually light. Nonetheless, the infection of the fetus is severe, and can produce miscarriages, fetal deaths, corioamnionitis and premature births with the newborn infected, manifested in the form of granulomatosis infantiseptica with abscesses and scattered granulomas or at a later stage , as meningitis or sepsis. Intrahepatic cholestasis is a reversible form of cholestasis, its cause is unknown, it is specific to pregnancy and is more frequent in multiparous women, in the third trimester and rarely before the 26th week. It disappears following childbirth and is the second cause of jaundice in pregnancy, after hepatitis. The diagnosis of cholestasis is basically clinical. It appears as palmoplantar pruritus but can also produce nausea, vomiting and abdominal discomfort localized in the right hypochondrium. Given that listeriosis and cholestasis can have a shared symptomology, the possibility of listeriosis must be borne in mind in order for early implementation of the mechanisms of diagnostic confirmation (cultivation of sterile fluids or tissues: blood, neonatal CSF, amniotic liquid or placenta) and specific treatment. We present a case of cholestasis and listeriosis in the third trimester with a good maternofetal result.