Real-life analysis on safety and efficacy of asciminib for ponatinib pretreated patients with chronic myeloid leukemia.

Failure of second-generation tyrosine kinase inhibitors (2GTKI) is a challenging situation in patients with chronic myeloid leukemia (CML). Asciminib, recently approved by the US Federal Drug Administration, has demonstrated in clinical trials a good efficacy and safety profile after failure of 2GTKI. However, no study has specifically addressed response rates to asciminib in ponatinib pretreated patients (PPT). Here, we present data on responses to asciminib from 52 patients in clinical practice, 20 of them (38%) with prior ponatinib exposure. We analyzed retrospectively responses and toxicities under asciminib and compared results between PPT and non-PPT patients.After a median follow-up of 30 months, 34 patients (65%) switched to asciminib due to intolerance and 18 (35%) due to resistance to prior TKIs. Forty-six patients (88%) had received at least 3 prior TKIs. Regarding responses, complete cytogenetic response was achieved or maintained in 74% and 53% for non-PPT and PPT patients, respectively. Deeper responses such as major molecular response and molecular response 4.5 were achieved in 65% and 19% in non-PPT versus 32% and 11% in PPT, respectively. Two patients (4%) harbored the T315I mutation, both PPT.In terms of toxicities, non-PPT displayed 22% grade 3-4 TEAE versus 20% in PPT. Four patients (20% of PPT) suffered from cross-intolerance with asciminib as they did under ponatinib.Our data supports asciminib as a promising alternative in resistant and intolerant non-PPT patients, as well as in intolerant PPT patients; the resistant PPT subset remains as a challenging group in need of further therapeutic options.

Rate and characteristics of urgent hospitalisation in persons with profound intellectual disabilities compared with general population.

BACKGROUND: Little is known about the hospitalisation rate of adults with severe/profound intellectual disability (PID) presenting at emergency services or about the appropriateness of hospital admissions in this population. Examining the possible differences in the patterns of hospitalisation between people with PID and those without intellectual disability (ID) may shed light on aspects of health and illness in these patients and may in turn make it possible to differentiate more clearly between mild-moderate ID and PID. METHODS: After an evaluation of the emergency visits made by adults with PID and by people without ID, patients in both groups requiring one or more hospitalisations were subsequently followed up for 18 months. The appropriateness of the decision to hospitalise was assessed using the ambulatory care-sensitive conditions index. RESULTS: There were no differences in the proportion of people with PID and controls admitted to hospital after their emergency visit. The median hospital stay was higher for PIDs: 7.5 vs. 4 days for controls. People with PID were admitted more than controls for respiratory reasons and somewhat less for other somatic causes unrelated to the nervous system. There were no admissions for psychiatric causes in the group with PID other than unspecified conduct disorders. There were no differences in other diagnostic groups. The rate of inappropriate admissions was similar in the two study groups. CONCLUSIONS: In contrast to previous results reported for the group with ID as a whole, patients with PID consulting the emergency service were not admitted to hospital more frequently than the general population nor did they present a higher rate of inappropriate admissions. These results support the utility of maintaining two distinct groups of people with ID: mild-moderate and severe-profound.

Pain underreporting associated with profound intellectual disability in emergency departments.

BACKGROUND: Little information is available regarding the visits made by persons with profound intellectual disability (PID) to general hospital emergency departments (ED). This study aims to know whether persons with PID who attend ED are given the same type of diagnoses as people with no such disability. METHODS: Over a period of 18 months, we gathered data from all non-scheduled visits to an ED by persons with PID to identify the reason for consultation (according to the classification used by the Spanish Society for Emergency Nursing) and the final diagnosis upon discharge. The results were compared with data obtained from a control group of people with no ID who attended an ED for any reason during the same period. RESULTS: Somatic complaints were the main reason for ED attendance among persons with PID (90% of consultations). These complaints were more often related to the central nervous system than was the case among non-ID patients (16 vs. 4.7%), whereas other kinds of non-central nervous system somatic complaint were less common among persons with PID (74 vs. 91%). A diagnosis implying physical pain was given less often to people with PID than to controls (3 vs. 20%). CONCLUSIONS: The results suggest that persons with PID are less able to conceptualise and communicate information about their symptoms, especially as regards pain, and that this influences the diagnosis they are given when attending an ED. Professionals working in this environment need to be aware of this possibility so as not to underestimate or overlook such symptoms and the illnesses related to them.

Evaluación físico matemática de la dinámica cardiaca arrítmica mediante la aplicación de la ley exponencial caótica / Physical mathematical evaluation of the arrhythmic cardiac dynamic by means of the application of the chaotic exponential law / Avaliação físico matemática da dinâmica cardíaca arrítmica mediante a aplicação da lei exponencial caótica

Objetivo: confirmar la aplicabilidad clínica de la ley exponencial de ayuda diagnóstica específicamente en arritmias y evaluar la concordancia diagnóstica del mismo con respecto al Gold Estándar, por medio del cálculo de la sensibilidad, especificidad y el coeficiente Kappa. Metodología: se realizó un estudio de 40 Holter, 10 corresponden a sujetos normales y 30 diagnosticados con diferentes tipos de arritmias. Se realizó una simulación teórica de todas las frecuencias cardiacas de mínimo 21 horas a partir de los valores máximos y mínimos de frecuencias registrados, para construir el atractor de la dinámica cardiaca. Seguidamente se calculó la dimensión fractal del atractor y se cuantificó la ocupación espacial de cada uno ellos en el espacio generalizado de Box-counting. Finalmente, se aplicaron los parámetros matemáticos que diferencian dinámicas cardiacas normales de enfermas y agudas, así como en evolución hacia la enfermedad. Resultados: los casos con arritmias diagnosticados matemáticamente con dinámica aguda fueron seis, se encontraron 24 casos entre los rangos de 73 y 200 de ocupación de la rejilla Kp, que corresponden a casos de evolución hacia agudización de la dinámica. El diagnóstico físico-matemático, después de ser comparado con el Gold Estándar, presentó una sensibilidad y especificidad del 100% y un coeficiente Kappa de uno. Conclusiones: la aplicación de esta metodología al estudio de la dinámica cardiaca caótica, evidencia su utilidad como herramienta de ayuda diagnóstica para la predicción y prevención de eventos arrítmicos agudos que pueden implicar situaciones con riesgo vital.

Objective: To confirm the clinical applicability of the diagnostic methodology based on the power law of cardiac dynamic systems, specifically for detecting arrhythmias, evaluating its concordance with respect to the Gold Standard, by means of the sensitivity, specificity, and Kappa coefficient. Methods: Forty Holter were studied, of which 10 corresponded to normal subjects and 30 to patients diagnosed with different types of arrhythmias. A theoretical simulation of all cardiac frequencies (of at least 21 hours) was performed from the maximum and minimum frequency values registered, to build the cardiac dynamics attractor and its fractal dimension was calculated; the spatial occupation of each one of them was quantified in the generalized Box-Counting space. Finally, the mathematical parameters to differentiate normality of acute cardiac disease and of the evolution toward disease were applied. Results: There were six cases with mathematically-diagnosed acute arrhythmias, 24 cases were between 73 and 200 occupied ranges for the Kp grid that correspond to cases of evolution toward disease. This physical-mathematical diagnosis was compared with the Gold Standard and yielded a sensitivity and specificity of 100% and a Kappa coefficient of 1. Conclusions: The application of this method to the study of chaotic cardiac dynamics evidences its usefulness as a tool of diagnostic aid for the prediction of acute arrhythmic events which may imply situations of vital risk.

Objetivo: confirmar a aplicabilidade clínica da lei exponencial de ajuda diagnóstica especificamente em arritmias e avaliar a concordância diagnóstica do mesmo com respeito ao Gold Estándar, por meio do cálculo da sensibilidade, especificidade e o coeficiente Kappa. Metodologia: se realizou um estudo de 40 Holter, 10 correspondem a sujeitos normais e 30 diagnosticados com diferentes tipos de arritmias. Se realizou una simulação teórica de todas as frequências cardíacas de mínimo 21 horas a partir dos valores máximos e mínimos de frequências registrados, para construir o atractor da dinâmica cardíaca. Seguidamente se calculou a dimensão fractal do atractor e se quantificou a ocupação espacial de cada um deles no espaço generalizado de Box-counting. Finalmente, se aplicaram os parâmetros matemáticos que diferenciam dinâmicas cardíacas normais de doentes e agudas, assim como em evolução para a doença. Resultados: os casos com arritmias diagnosticados matematicamente com dinâmica aguda foram seis, se encontraram 24 casos entre as faixas de 73 e 200 de ocupação da grade Kp, que correspondem a casos de evolução para o agravamento da dinâmica. O diagnóstico físico-matemático, depois de ser comparado com o Gold Estándar, apresentou uma sensibilidade e especificidade de 100% e um coeficiente Kappa de um. Conclusões: a aplicação desta metodologia ao estudo da dinâmica cardíaca caótica, evidência sua utilidade como ferramenta de ajuda diagnóstica para a predição e prevenção de eventos arrítmicos agudos que possam implicar situações com risco vital.

Position of the Spanish Menopause Society regarding the management of perimenopause.

Perimenopause is an imprecise period in woman over 40 years of age, which comprises the time between the moment that the first changes in the menstrual cycle appear and the year following the definitive cessation of the menses. Besides irregular bleeding, many women also complain of hot flashes and other characteristic symptoms of postmenopause. Moreover, most of them are concerned about the future impact that these events may have on their health, such as needing health exams or continuing to use contraceptive methods. A panel of experts from the Spanish Menopause Society has met to establish diagnostic and therapeutic guidelines for this period based on the best available evidence.

Estrogen-related genes and postmenopausal osteoporosis risk.

BACKGROUND: To date, more than 150 candidate genes related to osteoporosis have been described, but osteoporosis has increasingly been considered a polygenic disease modulated by environmental factors. It is thought that osteoporosis predisposition, pathology, and treatment response depend on the interaction between different genes or between genes and environmental factors. OBJECTIVE: The aim of this study was to evaluate the relationship between the presence of single nucleotide polymorphisms (SNPs) in the estrogen metabolic pathway and the development of osteoporosis and to determine whether this relationship is monogenic or whether interactions between genes exist. MATERIALS AND METHODS: A multicentric study with 1980 postmenopausal Spanish women in five Spanish communities was conducted. The women completed a specific questionnaire that inquired about risk factors for osteoporosis. Data on participants' bone mineral density were obtained with dual-energy X-ray densitometers, and genetic data were obtained from frozen peripheral blood. RESULTS: The digenic protection combinations indicated involvement of the wild-type genotype (WT) of the 3'UTR marker for the CYP19A1 gene, the IVS4 marker of the same gene, and the BMP15 and FSHR genes. Among patients who carried two or more of the genotypes considered 'risky', the triple combination among markers of the ESR2 and NRIP1 genes with any of the two mutations of the analyzed markers of the BMP15 gene gave a mean T-score value of -2.32±0.91 (p = 0.02). CONCLUSION: Variants of the new candidate genes (NRIP and BMP15) can predispose patients to osteoporosis.

Factores que pueden influir en el rendimiento académico de estudiantes de Bioquímica que ingresan en el programa de Medicina de la Universidad del Rosario-Colombia / Factors that influence the academic performance in Biochemistry students who have started the Medicine program of Rosario University-Colombia

El análisis del rendimiento académico de los estudiantes que ingresan a una institución de educación superior, así como los factores que pueden estar influyendo en él, genera respuestas a los interrogantes que corrientemente se hacen las personas involucradas en los procesos educativos y permite proponer soluciones para mejorar el desempeño de los estudiantes universitarios. Sujetos y métodos. Se determinó la asociación entre el rendimiento académico de los estudiantes en el primer nivel de Bioquímica, con los factores de tipo académico y demográfico; se utilizaron dos métodos de análisis: el primero, numérico, de acuerdo con los promedios de las notas parciales y finales; el segundo, categorizado como éxito (≥ 3,0) o fracaso (< 3,0),de acuerdo con el promedio de la nota definitiva de la asignatura. Resultados. Se encontró una asociación positiva y estadísticamente significativa entre los resultados de las pruebas de estado generales y específicas (ciencias naturales y matemáticas), el estatus de becario institucional y el ingreso directo a la carrera sin realizar cursos preuniversitarios, con el rendimiento académico en Bioquímica. Factores como el colegio en el cual realizaron la educación secundaria y la ciudad de procedencia no afectaron significativamente el rendimiento en ninguno de los análisis aplicados. Conclusiones. El rendimiento académico en Bioquímica se ve afectado directamente por factores que involucran las competencias individuales de los estudiantes, pero no por factores demográficos (AU)

Introduction. The analysis of the students’ academic achievement in a higher education institution together with the different factors that affect the student’s performance generates answers to the questions that the people involved in the teach ingprocess commonly ask themselves. This analysis is therefore, an excellent way to find and propose solutions in order to improve the student’s performance. Subjects and methods. The association between the students’ academic performance and the academic and demographic factors was determined in the first level of Biochemistry. Two methodologies were used for this purpose. The first one, a numerical analysis based on the partial and final grades, and a second categorical method based on the final success (≥ 3.0) or failure (< 3.0) on the subject. Results. A positive and statistically significant correlation was found when the academic performance in Biochemistry, the general and specific results of the state test (natural sciences and mathematics), the institutional scholarship status and entering the Medicine program without pre-university courses was analyzed. Factors, such as coming from different schools and the city of origin, do not affect significantly the performance in any of the analyses. Conclusions. Academic performance in Biochemistry is directly affected by factors involving the individual student’s skills while the demographical factors are not involved (AU)

Programa de tratamiento psicoterapéutico en un grupo de pacientes adultos con un trastorno del espectro autista de alto funcionamiento / Psychotherapeutic treatment program in a group of adults with a high-functioning autism spectrum disorder

Cada vez es mayor el número de adultos diagnosticados de un trastorno del espectro autista de alto funcionamiento que reciben el diagnóstico siendo ya adultos, lo que condiciona mucho el tratamiento aplicable, y posiblemente los resultados terapéuticos. De forma complementaria al farmacológico y psicoterapéutico individual, el tratamiento psicoterapéutico grupal es una herramienta clínica que ofrece importantes ventajas en el tratamiento de este síndrome. Métodología. En este trabajo se expone la secuencia del tratamiento grupal que hemos venido realizando en nuestro centro de trabajo, a la luz de lo que la literatura médica recoge al respecto, y según las necesidades básicas de este grupo de pacientes en su edad adulta. Conclusiones. El tratamiento psicoterapéutico grupal en pacientes adultos con un trastorno del espectro autista de alto funcionamiento es una opción de tratamiento a tener en cuenta, y cuya efectividad clínica deberá ser evaluada en futuros estudios(AU)

Introduction. An increasing number of adults diagnosed with a high-functioning autism spectrum disorder are diagnosed as being adult, so much the treatment applicable conditions, and possibly the clinical outcome. As a complement to medication and individual psychotherapy, group psychotherapy treatment is a clinical tool that offers significant advantages in the treatment of this syndrome. Metodology. This paper describes the sequence of group treatment we have been doing in our workplace, in the light of what the medical literature contains the subject, and according to the basic needs of this group of patients in adult hood. Conclusion. Group psychotherapeutic treatment in adult patients with a high-functioning autism spectrum disorder is a treatment option to consider, and whose clinical effectiveness must be evaluated in future studies (AU)

Higiene del paciente ingresado / No disponible

No disponible

Cribado del síndrome de Down en Andalucía: se precisa una estrategia más eficaz / Screening for Down syndrome in Andalusia (Spain). A more effective strategy is required

Se analiza el grado de implantación de las estrategias de cribado del síndrome de Down en Andalucía en el año 2002 y sus correspondientes resultados, a partir de las cifras y datos estadísticos publicados por agencias oficiales. La prevalencia de recién nacidos con síndrome de Down en Andalucía durante el año 2002 es una de las mayores de España y se sitúa entre las mayores de Europa. El impacto del diagnóstico prenatal del síndrome de Down en Andalucía ha sido mínimo, y la prevalencia al nacimiento es similar a la que se daba antes de la despenalización de la interrupción voluntaria del embarazo. La proporción de gestantes de 35 años o más (18,78 por ciento) hace que sea inaceptable continuar basando la estrategia de detección exclusivamente en la edad materna. Entre las estrategias en uso actualmente en Andalucía, el test combinado sería la que presentaría un mejor índice costo-eficacia. Estos datos deberían hacer tomar conciencia a las autoridades sanitarias andaluzas de la necesidad de promover la difusión de estrategias modernas de detección que permitan diagnosticar eficazmente el feto afectado de síndrome de Down (AU)

Rat glomerulosa cells in primary culture and E. coli lipopolysaccharide action.

During endotoxic shock there is a dysfunction of the adrenal gland; both corticosterone and aldosterone secretion are altered. The aim of the present study is to use glomerulosa cells in primary culture as a target of lipopolysaccharide (LPS) action. Glomerulosa cells cultured in basal conditions are able to proliferate; bFGF and ACTH have antagonic effects, bFGF increases proliferation whereas ACTH is antimitogenic. LPS has a biphasic effect, in the short term it is antimitogenic and in the long term increases the proliferation rate. LPS inhibits ACTH-induced corticosterone secretion in a dose-dependent manner in glomerulosa cells in culture similar to that in fasciculata cells, but it does not exert an important direct effect on aldosterone secretion. These results show that LPS exerts different effects in ACTH and ANG II signal transduction pathways and in the two enzymes which catalyze the late step in the steroidogenesis, 11beta-hydroxylase and aldosterone synthase, which could be in agreement with the existence of both enzymes, regulated independently, in rat zona glomerulosa cells.

Tratamiento fetoscópico del síndromede transfusión gemelo-gemelo mediantefotocoagulación con láser multidiodo / Fetoscopic treatment of twin-twin transfusion syndrome by multidiode laser photocoagulation

El síndrome de transfusión gemelo-gemelo (STGG) es una complicación frecuente y exclusiva de la gestación múltiple monocorial y se debe a la existencia de anastomosis vasculares placentarias que provocan un reparto desigual de sangre y nutrientes entre ambos gemelos. El feto transfusor desarrolla un retraso de crecimiento y oligoamnios, mientras el transfundido está hidrópico y desarrolla polihidramnios. Ante la baja eficacia de los tratamientos médicos se han propuesto diversos procedimientos invasivos para el tratamiento de la enfermedad. Los más ampliamente utilizados son el amniodrenaje o amniorreducción y la fotocoagulación láser de las anastomosis placentarias guiada por fetoscopia. Ambos procedimientos ofrecen una supervivencia similar (55 por ciento), aunque la fotocoagulación láser presenta tasas de desarrollo de secuelas neurológicas más bajas que la amniorreducción (15-30 por ciento frente a menos del 5 por ciento).Hasta la fecha el láser de neodimio es el más utilizado. Este artículo expone nuestra experiencia inicial con la fotocoagulación láser multidiodo guiada por fetoscopia para el tratamiento del STGG. Este procedimiento fue utilizado en dos gestaciones gemelares monocoriales con STGG grave. En el primero de los casos sobrevivió uno de los gemelos, mientras en el otro se produjo la muerte de ambos gemelos por rotura prematura de membranas y parto inmaduro al concluir el procedimiento. Pensamos que se trata de una alternativa de tratamiento prometedora que puede conseguir tasas de morbilidad neurológica inferiores a las que presenta el amniodrenaje. Para su aplicación se requiere que el diagnóstico se realice de una forma precoz y la centralización de los casos en Unidades de Medicina Fetal con experiencia en fetoscopia y terapia fetal intrauterina (AU)

Predicción de la madurez fetal mediante la caracterización ultrasónica del pulmón / Prediction of fetal maturity through sonographic lung characterization

Objetivo: Evaluar la utilidad del examen computarizado de la textura ecográfica del pulmón fetal en la determinación de la madurez fetal.Material y métodos: Mediante ecografía realizada en 230 fetos de edades gestacionales comprendidas entre las semanas 20 y 42, se obtuvo un histograma de frecuencias de pulmón e hígado fetales, así como la relación entre ambos órganos, analizándose el nivel medio de grises, la desviación estándar y la anchura del histograma. En 20 casos, los datos ecográficos se compararon con los bioquímicos obtenidos en líquido amniótico.Resultados: El hígado no presenta cambios en el patrón de reflexión en las diferentes edades gestacionales, mientras que a partir de la semana 33-34 la ecorrefringencia pulmonar se incrementa significativamente. Estas modificaciones también se manifiestan cuando analizamos la anchura del histograma (AHP/H), e igualmente se hacen patentes al relacionarse con datos biométricos fetales o estadios de desarrollo pulmonar. Se obtienen correlaciones significativas al comparar el nivel medio de grises pulmón/hígado (NMGP/H) y AHP/H con varios parámetros bioquímicos en el líquido amniótico, particularmente con el índice L/S y DO650.Conclusiones: El pulmón fetal está maduro cuando la ecogenicidad pulmonar es mayor que la hepática, siendo el NMGP/H superior a la unidad (1,04) y la AHP/H es de 2,2 (AU)

La bahía de Minamata, la amalgama dental y las minas de oro. Exposición gestacional al mercurio y sus efectos teratogénicos / The Minamata bay, the dental amalgam and the gold mines. Gestational exposure to mercury and its teratogenic effects

Se realiza una búsqueda bibliográfica sobre la toxicidad del mercurio en la gestante y sus efectos embriofetales. Sobre la base de los acontecimientos en Japón, que dieron lugar a la denominada enfermedad de Minamata congénita, se revisan, bajo el estado de conocimientos actual, los aspectos químicos y las fuentes de exposición, la absorción materna y el paso transplacentario. Nos detenemos en la afectación fetal y las presumibles vías a través de las cuales se produce, según recientes aportaciones de la biología molecular; para concluir con los aspectos diagnósticos y preventivos. Estos últimos continúan con una vigencia total desde la intoxicación en Japón (AU)

Haploinsufficiency of the human homeobox gene ALX4 causes skull ossification defects.

Inherited defects of skull ossification often manifest as symmetric parietal foramina (PFM; MIM 168500). We previously identified mutations of MSX2 in non-syndromic PFM and demonstrated genetic heterogeneity. Deletions of 11p11-p12 (proximal 11p deletion syndrome, P11pDS; MIM 601224) are characterized by multiple exostoses, attributable to haploinsufficiency of EXT2 and PFM. Here we identify ALX4, which encodes a paired-related homeodomain transcription factor, as the PFM disease gene in P11pDS.

Binding of Escherichia coli lipopolysaccharide to fasciculata-reticularis and glomerulosa cells evaluated by flow cytometry.

Binding of Escherichia coli lipopolysaccharide (LPS) to the two cell types of the adrenal cortex: fasciculata-reticularis and glomerulosa cells has been studied by flow cytometry and using fluorescein-labeled lipopolysaccharide (FITC-LPS). The binding characteristics were different in relation to time course and number of binding sites. Both fasciculata-reticularis and glomerulosa cells bound LPS in a specific and saturable process. Fasciculata-reticularis cells showed a higher affinity for LPS binding than glomerulosa cells as deduced from Hill plots. Unlabeled LPS decreased FITC-LPS binding in both fasciculata-reticularis and glomerulosa cells, suggesting competition of both ligands for a limited number of binding sites. Lipid A seemed not to be essential for binding of LPS to fasciculata-reticularis cells. However, serum constituents inhibited FITC-LPS binding to both cell types, possibly due to cell interaction with HDL. The exposure of cells to LPS during cell culture did not modify the number of binding sites, but revealed cell size and surfaces structure changes.

Psicofármacos y embarazo / Psychotropic drugs and pregnancy

No disponible

Calcium and reactive oxygen species as messengers in endotoxin action on adrenocortical cells.

The effect of Escherichia coli 0111:B4 endotoxin (lipopolysaccharide, LPS) on the intracellular Ca2+ and reactive oxygen metabolite content of both rat isolated fasciculata-reticularis and glomerulosa cells was evaluated by flow cytometry to know the role of these mechanisms in the initiation of cell injury produced by LPS on adrenocortical cells during endotoxic shock. A rapid increase of intracellular calcium was induced by endotoxin in both cell types. In fasciculata-reticularis cells, this [Ca2+]i increase was mainly due to an important mobilization of intracellular stores. Dose-dependent increases in [Ca2+]i were also observed when both cell types were incubated with LPS for 20 min in the presence of extracellular calcium. This treatment abolished the increase in intracellular calcium induced by ACTH and angiotensin II. On the other hand, the endotoxin produced a fast and dose-dependent increase in reactive oxygen species in both cell types, higher in glomerulosa than in fasciculata-reticularis cells. LPS-pretreated cells showed more susceptibility to the oxidative stress induced by Fe2+. These results can be related to functional alterations previously described showing the involvement of calcium and reactive oxygen species as messengers in the endotoxin action on adrenocortical cells.

Massive ovarian oedema.

Eighteen cases of massive ovarian oedema are presented. The age of patients averaged 26 years and 16 presented with an acute abdomen. Hormonal symptoms included virilism in three cases and one with precocious pseudopuberty. Ultrasonographic findings were variable and not diagnostically accurate. When performed, CA 125 levels were not raised. Seventy-two percent of cases occurred in the right ovary and none were bilateral. Torsion occurred in 14 cases. Salpingo-oophorectomy was performed in all cases. To elucidate its pathogenesis, be this either due to intermittent chronic torsion or to a proliferative phenomenon, immunohistochemistry for Ki-67 and PCNA proliferation antigens, alpha-actin and oestrogen and progesterone receptors was performed. The Ki-67 proliferation index ranged between 0% and 3%, demonstrating the low proliferative status of stromal cells. The PCNA indices, however, were unusually high (60% and above). The divergence between these findings is explained by the fact that PCNA positivity may be related to nuclear reparation subsequent to ischaemia. Alpha-actin was consistently positive in stromal cells, reflecting a myofibroblastic transformation of these cells. These findings together with the clinical evidence of torsion in the majority of cases, lead us to consider that ovarian oedema is a reactive, non-proliferative state of specific stromal cells, occurring as a response to torsion and subsequent ischaemia. The stromal cells have positive oestrogen progesterone receptors and may undergo stimulatory changes responsible for the hormonally related symptoms often found associated with massive ovarian oedema.

Subendometrial contractility in menstrual phase visualized by transvaginal sonography in patients with endometriosis.

OBJECTIVE: To describe the propagation direction of the subendometrial myometrial contractile wave in menstrual phase sonographically assessed in patients with and without endometriosis. DESIGN: Prospective study. SETTING: Patients and normal volunteers in a university hospital. PATIENTS: Sixteen women with (study group) and 21 without (control group) endometriosis. INTERVENTIONS: Patients were examined by transvaginal sonography (midsaggital plane of the uterus) and recorded on videotape for a 5-minute period. MAIN OUTCOME MEASURE: Direction of propagation of contraction waves. RESULTS: The endometriosis group showed a predominant retrograde pattern whereas the control group showed a normal antegrade. CONCLUSION: This abnormal cervix-to-fundus myometrial activity could well increase the amount of peritoneal shedding of endometrial menstrual debris, increasing the probabilities of its heterotopic implantation.