Método Essure: contracepción definitiva por vía histeroscópica / The Essure method: a hysteroscopic method for permanent contraception

Objetivo: Describir el procedimiento Essure de contracepción por vía histeroscópica y compararlo con los ya existentes en el armamentario actual de contracepción definitiva. Sujetos y método: Se han analizado tanto los estudios multicéntricos previos a su aprobación como la experiencia referida en trabajos posteriores de grupos expertos en histeroscopia. Resultados: Los resultados de dos estudios multicéntricos internacionales, prospectivos y aleatorizados publicados en 2003 demuestran que el método Essure presenta una elevada eficacia en la prevención del embarazo, superior al 99% con tasas de complicaciones menores inferiores al 3%. Conclusiones: La contracepción definitiva mediante el método Essure, apoyada en una curva de aprendizaje y en una adecuada experiencia en histeroscopia permiten convertirlo en una técnica factible en régimen de consulta y exitosa en el 95% de los casos

Aim: To describe hysteroscopic permanent contraception through the Essure procedure and to compare this procedure with other already available methods. Subjects and methods: We analyzed multicenter studies published before approval of the Essure method as well as the experience reported in subsequent studies by groups with expertise in hysteroscopy. Results: Data from two multicenter, international, prospective, randomized studies published in 2003 demonstrate that the Essure procedure provides high contraceptive efficacy (greater than 99%), with a minor complications rate of less than 3%. Conclusions: Permanent contraception with the Essure procedure, when performed after an adequate learning curve and by practitioners with extensive experience in diagnostic hysteroscopy, can be carried out as an outpatient technique with a 95% success rate

Essure: a new device for hysteroscopic tubal sterilization in an outpatient setting.

OBJECTIVE: To evaluate the results of hysteroscopic placement of an intratubal device for permanent birth control in 85 women in an outpatient setting. DESIGN: Prospective, observational study. SETTING: Private university hospital. PATIENT(S): Eighty-five premenopausal women who asked for tubal sterilization by hysteroscopy between July 2002 and July 2003. INTERVENTION(S): Hysteroscopic placement of titanium-dacron intratubal devices in an outpatient setting. MAIN OUTCOME MEASURE(S): Procedure feasibility without anesthesia, success rate of device implantation, patient satisfaction, and confirmation of correct placement. RESULT(S): Successful placement was achieved in 81 patients (95%). Mean time elapsed between the start of hysteroscopy, placement of devices, and removal of optics was 9 minutes (range, 1-35 minutes). No intraoperative or postoperative complications were detected. Of 81 patients, 75 (93%) had abdominal x-ray performed at the third month; bilateral correct placement was confirmed in all of them. CONCLUSION(S): Essure is a safe, effective, and minimally aggressive procedure with satisfactory patient acceptance that does not require anesthesia or hospitalization. It seems to be a good alternative to laparoscopic tubal sterilization.

Endometrial hyperplasia with secretory changes.

OBJECTIVE: Secretory changes in endometrial hyperplasia are uncommon. The aim of this study is to review the morphologic and clinical findings of 24 cases of endometrial hyperplasia with secretory changes. METHODS: In 24 patients diagnosed with endometrial hyperplasia with secretory changes during 6 years, clinical characteristics such as menopausal status and hormone treatment were correlated with morphological features. A matched age control group of 24 women with conventional endometrial hyperplasia was used to compare the hormonal effect. RESULTS: Nineteen patients were premenopausal. Nine women showed simple hyperplasia without atypia and 15 complex hyperplasia, 7 of them with atypia. Seventeen women were under hormonal treatment at the time of diagnosis, 10 of them with progestins. In 7 patients endometrial adenocarcinoma could be seen, 5 coexisting with endometrial hyperplasia with secretory changes and in 2 appearing after 1 and 4 months. In control group only 2 patients were undergoing progestin hormonal treatment. CONCLUSIONS: Secretory changes can be found in hyperplastic endometrium, particularly in premenopausal women under hormonal treatment with progestins, with the risk of misdiagnosis.

Borderline cystic tumors of the ovary: gray-scale and color Doppler sonographic findings.

PURPOSE: The aim of the study was to determine the value of gray-scale and color Doppler sonography in distinguishing borderline cystic tumors (BCTs) from benign cysts and malignant tumors of the ovary. METHODS: The gray-scale and color Doppler sonographic features of 383 ovarian lesions in 374 nonpregnant women were retrospectively studied. Sonography was performed transvaginally for all but 7 lesions, which were imaged suprapubically. All of the lesions were surgically resected via laparoscopy or laparotomy. RESULTS: The histopathologic diagnoses were 27 BCTs, 35 ovarian carcinomas, and 321 benign cysts. Sonography diagnosed 24 (89%) of 27 BCTs as malignant lesions. Patients with BCTs, were younger than those with ovarian cancer (p < 0.001). BCTs showed intracystic papillae in 17 cases (63%), diffuse internal echoes in 11 (41%), intracystic septa in 8 (30%), a heterogeneous echo pattern in 7 (26%), and a solid pattern in 4 (15%). BCTs showed blood flow in 24 cases (89%) and lower pulsatility and resistance indices (RI) compared with benign lesions (p < 0.001 for both). Multivariate analysis revealed intracystic papillae as the only independent predictor of BCTs (p < 0.001). CONCLUSIONS: When a cystic mass has papillae, this is the only abnormal finding detected by gray-scale transvaginal sonography, and color Doppler imaging shows low RI values within the mass, a BCT should be suspected.

Adenocarcinoma del cérvix / Cervix adenocarcinoma

El adenocarcinoma de cérvix es hoy día más frecuente que en el pasado y es evidente que las infecciones por el virus del papiloma humano (especialmente el VPH-18) son un factor de riesgo. El diagnóstico de adenocarcinoma de cérvix es más difícil si se compara con la variedad escamosa. Tanto los hallazgos citológicos como los colposcópicos pueden prestarse a interpretaciones equívocas, aun en manos expertas, y el diagnóstico debe confirmarse por biopsia. Los tumores glandulares malignos de cérvix presentan patrones histopatológicos diversos y están constituidos por diferentes tipos celulares, casi siempre combinados. La variedad mucinosa es la más frecuente. El tratamiento depende de la estadificación y en general es similar al utilizado para el cáncer escamoso en conjunto, los adenocarcinomas son algo más agresivos y relativamente más radiorresistentes. El pronóstico sobre todo, depende del estudio según la Federación Internacional de Ginecología y Obstetricia. El volumen tumoral es una variable pronóstica importante. En cuanto al valor de otros factores (marcadores tumorales, oncógenes y mutaciones genéticas), se requiere más estudios