Women's knowledge about the genitourinary syndrome of menopause: adherence to its treatments in the COVID-19 era in a sample of them: COMEM-GSM study.

OBJECTIVE: To study knowledge regarding genitourinary syndrome of menopause (GSM) and the treatments for it and to analyze treatment adherence during the COVID-19 confinement. METHODS: Multi-center observational study including women between 35 and 75 years. An extension study of treatment adherence was conducted during the coronavirus pandemic between March and April 2020. RESULTS: A sample of 2355 women were included. Vaginal dryness was the most frequently identified symptom (74.3%). Lubricants were the best-known treatments (69.6%), followed by local estrogens (25.7%); 66% of the women did not speak to their gynecologist about sexuality. Comparative analyses were conducted according to age, menopausal status, type of menopause, place of residence, type of health care received and level of education. During the coronavirus confinement period, adherence to treatments for vulvovaginal atrophy was poor in 72.5% asked (n = 204). Reduced sexual activity (p > 0.001) and coronavirus diagnosis (p = 0.003) were significantly associated with poorer treatment compliance. CONCLUSIONS: There is great lack of knowledge of the treatments used for GSM. Most women do not talk to their gynecologist about sexuality. Adherence to treatments during the coronavirus confinement has been worryingly low.

Embarazo ectópico abdominal en una paciente histerectomizada / Ectopic abdominal pregnancy in a patient hysterectomized

Resumen Antecedentes: El embarazo ectópico abdominal es una alteración obstétrica poco frecuente, sobre todo en pacientes con antecedente de histerectomía. Los síntomas suelen ser inespecíficos y el diagnóstico se retrasa por la baja sospecha clínica, con el subsiguiente aumento en la morbilidad y mortalidad materna. Caso Clínico: Paciente de 33 años, con antecedentes ginecoobstétricos de tres cesáreas e histerectomía subtotal posparto por placenta acreta, que acudió al servicio médico por dolor abdominal y sangrado vaginal. En la ecografía se visualizó el saco gestacional con embrión de 12 + 4 semanas y latido cardiaco positivo. Se indicó laparotomía urgente por abdomen agudo y sospecha de embarazo ectópico abdominal; durante el procedimiento se evidenció el saco gestacional de 7 cm, adherido al colon sigmoide y al remanente cervical, con rotura sangrante hacia la cavidad abdominal que englobaba el anejo izquierdo. Se practicó resección del embarazo ectópico y anexectomía izquierda, en colaboración con el servicio de Cirugía general. El posoperatorio transcurrió sin incidentes y la paciente fue dada de alta satisfactoriamente. Conclusiones: Es importante incluir el embarazo ectópico en el diagnóstico diferencial de abdomen agudo, incluso en pacientes con antecedente de histerectomía.

Abstract Background: Abdominal ectopic pregnancy is a rare condition in obstetrics, especially if there is a history of hysterectomy. Symptoms are usually nonspecific and the diagnosis is often delayed by low clinical suspicion, with consequent increase in maternal morbi-mortality. Clinical case: 33 year-old patient with 3 previous cesareans and subtotal hysterectomy postpartum for placenta accreta, referred by abdominal pain and vaginal bleeding. In the gynecological ultrasound, a gestational sac was visualized with an embryo according to 12 + 4 weeks, with positive heartbeat. Urgent laparotomy was indicated for acute abdomen and suspicion of abdominal ectopic pregnancy, showing a gestational sac of 7 centimeters adhered to sigma and cervical stump with a bleeding broken zone to abdominal cavity that enclosed left annex, reason why resection of ectopic gestation and left annexectomy was performed in collaboration with General Surgery Service. The postoperative period was without consequences and the patient was satisfactorily discharged. Conclusions: It is important to include this entity within the differential diagnosis of acute abdomen women of childbearing age, even if a previous hysterectomy has been performed.

Descripción de un caso de un leiomioma quístico gigante que simula una tumoración ovárica / A case report of giant cystic leiomyoma mimicking an ovarian tumour

Paciente de 73 años remitida por hallazgo casual de una gran masa abdominal. En la ecografía abdominal se observó una tumoración mixta de predominio quístico que ocupaba todo el abdomen, desde la pelvis hasta el apéndice xifoides. La TC abdómino-pélvico informó de una masa quística que ocupaba todo el abdomen en relación con cistoadenoma/cistoadenocarcinoma mucinoso ovárico, por lo que se indicó tratamiento quirúrgico y el diagnóstico definitivo fue un leiomioma dependiente del útero con degeneración hidrópica. Los miomas uterinos son tumoraciones frecuentes en la mujer, sin embargo si presentan cambios degenerativos, puede ser difícil su diagnóstico inicial, al simular patología anexial (AU)

A 73-year-old woman was referred to our service due to incidental discovery of a large abdominal mass. Abdominal ultrasound showed a mixed tumour, predominantly cystic, occupying the whole abdomen from the pelvis to the xyphoid process. Abdominal and pelvic computed tomography revealed a cystic mass that filled the abdomen. The preoperative diagnosis was ovarian mucinous cystadenoma/cystadenocarcinoma. Surgical treatment was indicated. The definitive diagnosis was leiomyoma with cystic degeneration. Leiomyomas are common tumours in women but if they have degenerative changes they may cause confusion in the initial diagnosis, as they can simulate a cystic adnexal mass (AU)

Dolor abdominal agudo como presentación de un linfoma ovárico / Acute abdominal pain as presentation of an ovarian lymphoma

Antecedentes: El linfoma no Hodgkin de ovario es una patología infrecuente, más aun el ovárico primario. Caso Clínico: Presentamos el caso de una paciente con antecedente de diverticulitis aguda y varios episodios posteriores de dolor abdominal agudo, fiebre y aumento de reactantes de fase aguda con pruebas de imagen no concluyentes. A pesar de la buena respuesta inicial al tratamiento antibiótico, durante uno de los episodios la paciente precisa intervención quirúrgica urgente. Durante la intervención se halla una enfermedad tumoral avanzada con diagnóstico histológico de linfoma difuso de células grandes B. Conclusión: En el diagnóstico diferencial ante una sintomatología similar a la de nuestra paciente, se debería tener presente la posibilidad de un linfoma ovárico, a pesar de su baja incidencia.

Background: Non-Hodgkin's lymphoma of the ovary is an infrequent pathology, even more primary one. Clinical case: We report a patient with a history of acute diverticulitis and several episodes of acute abdominal pain, fever and increased acute phase reactants with inconclusive imaging tests. Patient required urgent surgery during one episode despite a good initial response to antibiotic therapy. A locally advanced tumour disease was found in surgical intervention which was diagnosed as a diffuse large B-cell lymphoma. Conclusion: In the differential diagnosis in a manner similar to that of our patient symptoms, we should keep in mind the possibility of an ovarian lymphoma despite their low incidence.

Adenocarcinoma de pulmón en gestante / Lung cancer in pregnancy

El cáncer de pulmón es la neoplasia más frecuente en los países desarrollados y la primera causa de mortalidad por cáncer en el varón, con un alarmante incremento en la mujer en los últimos años. Su diagnóstico durante el embarazo es infrecuente, pero su incidencia está aumentando en los últimos años. Parece tener un comportamiento más agresivo y diagnosticarse en estadios más avanzados durante la gestación. La elección del tratamiento más apropiado es difícil y no existe suficiente información para establecer su manejo. Presentamos el caso de una gestante de 38 años diagnosticada de cáncer de pulmón estadio IIIA, a las 27 semanas. Se decidió finalizar gestación en la semana 29 y, al tratarse de una tumoración no resecable, se le realizó un tratamiento combinado con quimioterapia y radioterapia (AU)

Lung cancer is the most common neoplasm in developed countries and the first cause of cáncer related death in men, although currently there has been a significant increase in women. It remains arare condition during pregnancy, but the association of lung cancer and gestation has been increasing in recent years. It seems to be more aggressive and diagnosed mainly at advances stages during pregnancy. Choosing the most appropriate treatment is very difficult and there is not enough information to establish the management. We report a case of a 38 year-old pregnant woman with stage IIIA lung adenocarcinoma diagnosed in the 27th week. At week 29 a decision was made to terminate the pregnancy. As the tumour was unrespectable, she subsequently underwent combined chemotherapy and radiotherapy (AU)