Environmental health knowledge and competences in Basque health workers. A comparison of different professional profiles.

Environmental exposures are responsible for a quarter of morbidity and mortality rates globally. Primary care professionals work in a privileged position to detect and intervene on environmental health matters. Nevertheless, due to lack of specific training, international literature shows that primary care health professionals have limited skills to deal with those. The objectives of this study were to assess the levels of environmental health (EH) knowledge and competence of a sample of 446 health professionals and students in the Basque Country and explore the presence that EH has on their daily practice. Only a very small proportion of participants had received training and took environmental clinical history regularly. Participants were confident to deal, and actually dealt, with tobacco, pollen and sun exposures but less able to address topics like biomarkers, pesticides and endocrine disruptors. Finally, and in accordance to previous works, we found moderate levels of EH knowledge and skills in our sample, and observed that nurses and nursing students reported higher EH skills than other professional profiles but scored lower in knowledge. Despite the manifold impacts of environmental exposures on health, interventions to strengthen health professionals' EH competence are required.

Factors involved in the persistence of stress urinary incontinence from postpartum to 12 years after first delivery.

AIMS: The aim of this study was to investigate constitutional-, pregnancy-, labor-, and delivery-related factors involved in the long-term persistence of stress urinary incontinence (SUI) from 6 months postpartum to 12 years after first delivery. We also evaluated severity and impact on quality of life of persistent SUI. METHODS: This was a longitudinal study including primigravid women who gave birth at our Public Health Hospital during 2007. Urinary symptoms were investigated at inclusion, 6 months and 12 years after delivery. Persistent SUI was defined as SUI reported both at 6 months postpartum and 12 years after first delivery. The International Consultation on Incontinence-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the Incontinence Severity Index (ISI) were used to evaluate SUI. RESULTS: During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6-month follow-up visit, and 315 formed the study group. SUI persisted in 36 out of 44 (81.8%) women. With the ISI, 52.8% of these women were categorized as having slight, 41.7% moderate, and 5.6% severe incontinence. The mean ICIQ-UI-SF score was 7.13 (SD 3.51). Pregnancy SUI (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.10-9.80) and active second stage of labor more than or equal to 1 hour (OR, 3.68; 95% CI, 1.21-11.14) were independently associated with persistent SUI. CONCLUSIONS: Women who reported SUI during pregnancy, and those who had pushed for more than or equal to 1 hour in the second stage of labor were at greater risk of SUI persisting from 6 months postpartum to long after delivery. We found this independent association after controlling for several constitutional-, pregnancy-, labor-, and delivery-related variables.

What Accounts for Physical Activity during Pregnancy? A Study on the Sociodemographic Predictors of Self-Reported and Objectively Assessed Physical Activity during the 1st and 2nd Trimesters of Pregnancy.

Physical activity (PA) during pregnancy has positive health implications for both mother and child. However, current literature indicates that not all pregnant women meet the international recommendations for PA (at least 150 min/week of moderate-to-vigorous PA). The main objective of this study was to assess PA levels among pregnant women in the city of Donostia-San Sebastian and identify their main sociodemographic predictors. We recruited 441 women in the 12th week of pregnancy from the local public obstetric health services. Women wore an accelerometer for one week during two separate time points (1st and 2nd trimesters of pregnancy) and completed a questionnaire assessing several sociodemographic variables as well as self-reported PA. With this information, we estimated women's overall PA levels during both time points. The fulfillment of PA recommendations raised up to 77% and 85% during the first and second trimesters, respectively. We found that a higher number of children and a greater preference for exercise positively predicted light-to-moderate PA, being the most consistent predictors. The availability of a greater number of cars negatively predicted moderate-to-vigorous PA.

Extrofia vesical en el recién nacido. Diagnóstico antenatal y postnatal / Bladder exstrophy in the newborn. Antenatal and postnatal diagnosis

Entre las semanas 6ª y 7ª de amenorrea, el disco embrionario se pliega en cuatro direcciones: cefálico, caudal y laterales, izquierdo y derecho. Cada uno de los pliegues converge a nivel del ombligo con lo que se oblitera el celoma extraembrionario. Las cinco anomalías asociadas a defectos de pared abdominal son el onfalocele, la gastrosquisis, la ectopia cordis, la anomalía body stalk y la extrofia de cloaca en la que se incluye, la extrofia vesical. Presentamos el caso de una gestante con feto afecto de genitales ambiguos diminutos cuyo diagnóstico postnatal fue la extrofia vesical (AU)

Between the 6th and 7th weeks of amenorrhea, the embryonic disc folds on both longitudinal and transverse plains. The embryonic plate converges at the level of the umbilicus, thereby closing the extracelomic area. The following five anomalies are associated with abdominal wall defects: onphalocele, gastroschisis, ectopia cordis, Body stalk anomaly and cloacal exstrophy which includes bladder extrophy. We describe the case of a pregnant woman with fetus diagnosed with ambiguous genitalia during pregnancy, and postnatal diagnosis of bladder exstrophy (AU)

Robotic retroperitoneal paraaortic lymphadenectomy at Donostia University Hospital.

The purpose of this study was to describe our robotic retroperitoneal para-aortic lymphadenectomy technique and its associated outcomes as well as the advantages and disadvantages. We prospectively collected data on all retroperitoneal aortocaval lymphadenectomy procedures performed at Donostia University Hospital from December 2011 to April 2013 using the da Vinci S robotic system (Intuitive Surgical, Sunnyvale,CA). A total of 13 of these procedures were performed. The mean patient age was 60.3 years (SD, 10.18). Most patients were obese with a mean body mass index of 31.95 kg/m(2) (SD, 5), and 9 had endometrial cancer. Five individuals were restaged: 4 because of lymphovascular space invasion and 1 because of lymphovascular space invasion with G3 histology. There were 2 cases of Fédération Internationale de Gynécologie et d'Obstétrique stage IB endometrial cancer: 1 of papillary serous histology and 1 of G3. Two patients had advanced cervical cancer, and 2 had early-stage ovarian cancer. The median para-aortic lymph node yield was 12 (range, 4-21). In 3 patients, it was necessary to convert the procedure to transperitoneal access because of technical difficulties; 1 of these required laparotomy. The mean surgical time was 323 minutes (SD, 58) although this included additional complex procedures. Robotic para-aortic retroperitoneal lymphadenectomy is feasible and offers the advantages of retroperitoneal access.

¿Se puede conocer el tamaño del adenocarcinoma de endometrio con histeroscopia? / Can hysteroscopy determine the size of endometrial adenocarcinoma?

Objetivo. El objetivo de este estudio es conocer la capacidad que tiene la histeroscopia para diagnosticar el tamaño tumoral en el adenocarcinoma de endometrio. Material y métodos. Estudio prospectivo de cohortes de 34 pacientes con diagnóstico de sospecha de adenocarcinoma o de adenocarcinoma realizado en la consulta externa de histeroscopia del Hospital Donostia, en el que se analizan los hallazgos histológicos de los tumores diagnosticados histeroscópicamente como igual o menor de 2cm, como mayor de 2cm, o como difusos. Resultados. La prevalencia de tumores mayores de 2cm fue del 85,29% (intervalo de confianza del 95%, 68,1-94,4). Se diagnosticaron correctamente el 79,41% de las lesiones (IC del 95%, 61,5-90,6). La sensibilidad de la histeroscopia para detectar tumores de más de 2cm fue del 86,21% (IC del 95%, 67,4-95,4), pero su especificidad fue tan solo del 40% (IC del 95%, 7,2-82,9). La razón de probabilidades diagnósticas positivas fue del 89,29% (IC del 95%, 70,6-97,1), multiplicándose por 1,44 la posibilidad de tener un tumor mayor de 2 cm si la prueba era positiva (IC del 95%, 0,69-2,98), mientras que se multiplicaba por 0,34 si la prueba resultaba negativa (IC del 95%, 0,08-1,41). La razón de probabilidades diagnósticas negativa del 33,33% (IC del 95%, 6-75,8). Conclusiones. La histeroscopia tiene un alto valor predictivo positivo para el diagnóstico del tamaño tumoral cuando la lesión es mayor de 2 cm y cuando afecta de manera difusa a la cavidad uterina. Además, no añade coste ni complicaciones en el protocolo diagnóstico del cáncer de endometrio. La histeroscopia puede ser de utilidad en la planificación quirúrgica de la paciente (AU)

Objective. The aim of this study was to assess the value of hysteroscopy in determining tumoral size in endometrial adenocarcinoma. Material and methods. We carried out a prospective cohort study of 34 patients with suspected endometrial adenocarcinoma who underwent outpatient hysteroscopy in Hospital Donostia. Tumors were classified as larger or smaller than 2cm, or diffuse. These classifications were compared with subsequent histopathological results. Results. In our series, 85.29% (95% CI 68.1-94.4) of tumors were>2cm. Hysteroscopy correctly classified 79.41% of the lesions (95% CI 61.5-90.6). The sensitivity of hysteroscopy in correctly classifying tumors>2cm was 86.21% (95% CI 67.4-95.4), but specificity was only 40% (CI 95% 7.2-82.9). The positive diagnostic likelihood ratio was 89.29% (95% CI 70.6-97.1%). The chance of having a tumor>2cm was multiplied by 1.44 if hysteroscopy classified it as such (95% CI 0.62-2.98), and by 0.34 if it did not (95% CI 0.08-1.41). The negative likelihood ratio was 33.33% (95% CI 6-75.8%). Conclusion. Hysteroscopy has a high positive predictive value in diagnosing tumors larger than 2cm or with diffuse involvement of the uterine cavity. This procedure does not involve additional costs or complications to the diagnostic protocol for endometrial cancer and can be highly useful in surgical planning (AU)

Evaluación morfológica endometrial histeroscópica / Hysteroscopic evaluation of endometrial morphology

Objetivo. Evaluar la prevalencia de hiperplasia endometrial y adenocarcinoma en varios grupos de endometrios definidos por histeroscopia por las características morfológicas. Material y métodos. Estudio prospectivo de 830 histeroscopias efectuadas entre el 1 de junio del 2004 y el 31 de diciembre del 2005 en la consulta externa de patología cervical e histeroscopia del Hospital Donostia de San Sebastián. El endometrio se clasifica como atrófico, hipotrófico, activo, hipertrófico, sospecha de adenocarcinoma y adenocarcinoma según una serie de características morfológicas definidas por histeroscopia y se correlacionan con el diagnóstico histológico de la biopsia de endometrio obtenida tras la histeroscopia. Resultados. La sensibilidad, la especificidad y el valor predictivo negativo (VPN) de la morfología endometrial histeroscópica en el diagnóstico de patología premaligna y maligna son muy altos: S 87,5% (IC del 95%, 0,753-0,941), E 94,8% (IC del 95% 0,925-0,965) y VPN 98,7% (IC del 95%, 0,971-0,994). El diagnóstico morfológico de adenocarcinoma tiene una altísima especificidad (E: 99,9%, S: 74,3%, LH(+) 625,486), juntando los grupos morfológicos de sospecha de adenocarcinoma y de adenocarcinoma la sensibilidad llega al 100% (S: 100% y E: 96,3%). Conclusiones. La prevalencia de enfermedad premaligna es muy baja en los grupos histeroscópicos con morfología de atrofia, hipotrofia y endometrio activo, ligeramente superior en el endometrio hipertrófico y significativamente mayor en los casos de diagnóstico morfológico histeroscópico de sospecha de adenocarcinoma y de adenocarcinoma, donde también encontramos una prevalencia muy alta de adenocarcinoma. El diagnóstico morfológico histeroscópico exclusivamente, sin toma de biopsia, es una herramienta válida para excluir y confirmar patología endometrial(AU)

Objective. To determine the prevalence of endometrial hyperplasia and adenocarcinoma in distinct groups of endometrial morphology defined by hysteroscopy, and to study the validity of hysteroscopic diagnosis in identifying endometrial tumors. Materials and methods. We performed a prospective study of 830 hysteroscopies carried out between June 1, 2004 and December 31, 2005 in the Gynecology Outpatient Clinic of Hospital Donostia in San Sebastian, northern Spain. Hysteroscopy was used to classify endometria into atrophic, hypotrophic, active, hypertrophic, suspicious for adenocarcinoma and adenocarcinoma, according to a series of morphological criteria. The findings were later correlated with the histopathological diagnoses obtained through endometrial biopsy. Results. The sensitivity, specificity and negative predictive value (NPV) of hysteroscopic evaluation of endometrial morphology in diagnosing malignant and premalignant disease were extremely high. Sensitivity was 87.5% (95% CI 0.753-0.941), specificity was 94.8% (95% CI 0.925-0.965) and NPV was 98.7% (95% CI 0.971-0.994). The specificity of morphological diagnosis of adenocarcinoma was 99.9%, sensitivity was 74.3%, and the likelihood ratio for a positive result was 625,486. When the groups of adenocarcinoma and suspicious for adenocarcinoma were combined, sensitivity was 100% and specificity was 96.3%. Conclusions. The prevalence of premalignant disease is very low in the hysteroscopic morphological groups of atrophic, hypotrophic and active endometria. Premalignant disease is slightly more prevalent in hypertrophic endometria and is significantly more prevalent in cases in which the hysteroscopic diagnosis is of suspicious adenocarcinoma and adenocarcinoma. In these cases, the prevalence of adenocarcinoma is very high. Hysteroscopic evaluation of endometrial morphology alone, without biopsy, is a valid tool to exclude or confirm endometrial disease in some groups(AU)

Factors involved in the persistence of stress urinary incontinence from pregnancy to 2 years post partum.

OBJECTIVE: To identify factors involved in the persistence of stress urinary incontinence (SUI) from pregnancy to 2 years post partum. METHOD: In a longitudinal study at Donostia Hospital, San Sebastián, Spain, 458 primigravid women were recruited from April to October 2007. SUI was diagnosed via the 2002 International Continence Society definition. Severity was assessed via the Incontinence Severity Index, and impact on quality of life via the International Consultation on Incontinence Questionnaire. Means (Student t test and analysis of variance) and percentages (χ(2) and Fisher exact tests) were compared, and multiple logistic regression analysis was performed with variables that were significant or close to significant in a univariate analysis (P<0.2). RESULTS: Among 272 eligible women attending follow-up at 2 years post partum, 26 (9.5%) women reported persistent SUI since pregnancy. Incontinence severity was slight or moderate in most cases and the impact on quality of life was low. A higher body mass index (BMI) in pregnant women at term was the only factor found to be associated with persistent SUI (odds ratio 1.19; 95% confidence interval 1.08-1.32). CONCLUSION: Higher BMI in pregnant women at term was an independent risk factor for the persistence of SUI from pregnancy to 2 years post partum.

Postpartum impairment of pelvic floor muscle function: factors involved and association with prolapse.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to assess factors involved in the impairment of pelvic floor muscle (PFM) function from antepartum to 6 months postpartum. We also investigated whether reduced PFM strength was associated with pelvic organ prolapse (POP) postpartum. METHODS: This was a prospective cohort study including 319 primigravid women delivered vaginally. PFM function was assessed in pregnant women at term and 6 months postpartum by digital palpation and perineometry. Prolapse was explored using the POP quantification (POP-Q) system. RESULTS: Instrumental delivery, larger newborn head circumference, and older maternal age were independent risk factors for impaired PFM function postpartum. Women with POP-Q stage ≥ II postpartum had a significant decrease in PFM strength with respect to the antepartum period, and lower PFM strength than women without such prolapse. CONCLUSIONS: Both constitutional and obstetric factors are involved in impairment of PFM function postpartum. Reduced PFM strength is associated with prolapse in the postpartum period.

Hallazgos histeroscópicos en mujeres asintomáticas con ecografía sugestiva de patología endometrial / Hysteroscopic results in asymptomatic women with ultrasonographic findings suggestive of endometrial disease

Objetivo. El objetivo principal de este estudio es conocer la prevalencia de hiperplasia con atipias y adenocarcinoma de endometrio que se detectan al realizar una histeroscopia en mujeres posmenopáusicas asintomáticas con ecografía vaginal sugestiva de patología endometrial. El objetivo secundario es conocer la utilidad de la histeroscopia en el diagnóstico de las lesiones premalignas y malignas en dichas mujeres. Sujetos y métodos. Estudio descriptivo de 1.237 histeroscopias practicadas en un periodo de 7 años (enero de 2000 a diciembre de 2006) en la Consulta de Ginecología. Todas estaban asintomáticas y fueron enviadas a nuestra consulta por una ecografía sugestiva de patología endometrial. Resultados. El hallazgo histeroscópico más frecuente es el de pólipo endometrial (64,3%), seguido por el diagnóstico de normalidad (15,7%). Se practicaron 1.046 biopsias de endometrio. Además, 27 pacientes fueron histerectomizadas. Se diagnosticaron 14 hiperplasias con atipias (1,13%) y 20 adenocarcinomas de endometrio en estadio I (1,61%). La histeroscopia tiene una alta especificidad y VPN para el diagnóstico de patología maligna y premaligna (E: 97,5%, VPN 99,6% y LR+ de 31,25). Conclusiones. La eficiencia de la ecografía transvaginal como cribado en la mujer menopáusica asintomática en el diagnóstico de patología endometrial premaligna y maligna, según nuestros resultados, no parece ser alta. La histeroscopia permite un diagnóstico fiable en este grupo de mujeres (AU)

Objective. The main objective of this study was to determine the prevalence of atypical hyperplasia and endometrial adenocarcinoma detected by hysteroscopy in asymptomatic postmenopausal women with vaginal ultrasonographic findings suggestive of endometrial disease. The second aim was to ascertain the usefulness of hysteroscopy in the diagnosis of premalignant and malignant lesions in these patients. Subjects and methods. We performed a descriptive study of 1,237 hysteroscopies carried out over a 7-year period (January 2000 to December 2006) in the Gynecology Department of Hospital Donostia. All the women were asymptomatic and were referred to our clinic due to an ultrasound examination suggestive of endometrial disease. Results. The most frequent hysteroscopic findings were endometrial polyps (64.3%), followed by a diagnosis of normality (15.7%). A total of 1,046 endometrial biopsies were performed. In addition, 27 patients underwent hysterectomy; 14 were diagnosed with atypical hyperplasia (1.13%) and 20 with stage I endometrial adenocarcinoma (1.61%). The specificity and negative predictive value of hysteroscopy in the diagnosis of premalignant and malignant lesions were high (specificity: 97.5%, negative predictive value 99.6%, positive likelihood ratio 31.25). Conclusions. The results of our study suggest that the efficiency of transvaginal ultrasound screening in asymptomatic menopausal women in the diagnosis of premalignant and malignant endometrial disease is not high. Hysteroscopy allows a reliable diagnosis in this group of women (AU)

Stress urinary incontinence six months after first vaginal delivery.

OBJECTIVE: To determine the prevalence, severity and impact on quality of life of stress urinary incontinence (SUI) six months after the first vaginal delivery, as well as to investigate the risk factors associated with it. STUDY DESIGN: We designed a prospective study that included 396 women who had their first vaginal delivery in the Hospital Donostia. Diagnosis and identification of the type of urinary incontinence were carried out considering the 2002 ICS definitions. Women were interviewed and examined twice, at term and six months after delivery. The severity of the symptoms was evaluated with the Incontinence Severity Index (ISI) and the impact on quality of life was evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form. The statistical analysis included comparison of means (Student's t-test or analysis of variance) and proportions (Chi square and Fisher's exact tests). Multiple logistic regression analysis was performed using variables that were close to statistical significance. RESULTS: 15.1% of the women reported SUI six months after their first vaginal delivery. The ISI was slight or moderate in the majority of the cases and the impact on quality of life was low. The presence of SUI in pregnant women at term was the only independent risk factor associated with SUI after delivery (OR: 3.71; 95% IC: 1.95-7.06). The type of vaginal delivery did not influence in SUI six months after the birth, not even in women who were continent during pregnancy. CONCLUSIONS: Slight or moderate SUI was common after the first vaginal delivery and the impact on quality of life was low. Urinary incontinence during pregnancy was the only risk factor independently associated with the presence of SUI six months after the first vaginal delivery.

Factors involved in stress urinary incontinence 1 year after first delivery.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to investigate the risk factors involved in stress urinary incontinence (SUI) 1 year after first delivery. METHODS: This was a longitudinal study of 352 primigravid women who gave birth at Donostia Hospital during 2007. Urinary symptoms were investigated (Abrams et al., Neurourol Urodyn 21:167-178, 2002) on inclusion and 1 year after delivery, and the incontinence severity index (ISI) was calculated. Incontinent women answered the International Consultation on Incontinence short form questionnaire. Pelvic floor muscle strength and joint hypermobility were evaluated. RESULTS: SUI affected 40 (11.4%) women 1 year after first delivery. The ISI distribution was: 62.5% slight, 32.5% moderate, 2.5% severe and 2.5% very severe. The only factor independently associated with SUI after delivery was the development of SUI during pregnancy (OR, 5.79; 95% CI, 2.79-12.00). CONCLUSIONS: The new onset of SUI during pregnancy is an independent risk factor for SUI in the postpartum period.

Síndrome de Youssef y fístulas vesicouterinas / Youssef´s syndrome and vesicouterine fistulas

El síndrome de Youssef es una complicación infrecuente, habitualmente secundaria a una cesárea con incisión en el segmento inferior. Consiste en una fístula vesicouterina en la zona supraístmica del útero. Se analizan su sintomatología, la clásica tríada de cesárea, amenorrea y hematurias cíclicas o menurias con continencia urinaria conservada, su diagnóstico y su tratamiento, habitualmente quirúrgico, mediante la resección del trayecto fistuloso e interponiendo un parche de epiplón (AU)

Youssef´s syndrome is a rare complication commonly secondary to lower segment caesare an section. It consists of a vesicouterine fistula situated above the isthmus of the uterus. Its symptomatology is analysed, which includes the classical triad of caesarean section, amenorrhoe a and cyclic haematuria or menurias in the absence of urinary incontinence, together with its diagnosis and treatment, usually surgical, with excision of its fistulous tract and interposition of an omentalpedicle (AU)

Influence of maternal weight on the new onset of stress urinary incontinence in pregnant women.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to investigate the incidence and severity of stress urinary incontinence (SUI) in primigravid women at term and its association with maternal body weight. METHODS: This was an observational study of 458 primigravid women who came to give birth at Donostia Hospital during 2007. Urinary symptoms were investigated (2002 ICS definitions), and a physical examination including height, weight, pelvic floor muscle strength, and fetal presentation was performed. We calculated the incontinence severity index (ISI) and the women answered the International Consultation on Incontinence short form questionnaire. RESULTS: SUI affected 139 (30.3%) primigravid women. The ISI distribution was 40.3% slight, 54.7% moderate, 4.3% severe, and 0.7% very severe. Pregnant women at term with body weight >or=75 kg appear to have more than doubled the risk of presenting SUI. CONCLUSIONS: The incidence of SUI is high in pregnancy. Increased maternal body weight at term is an independent risk factor for incontinence.

Implantes peritoneales de tejido glial maduro (gliomatosis peritoneal) y de otros tejidos maduros asociados a teratoma ovárico inmaduro / Peritoneal implants of mature glial tissue (gliomatosis peritonei) and other mature tissues associated with ovarian teratoma

La gliomatosis peritoneal es una forma de extensión muy poco frecuente de los teratomas ováricos. Se caracteriza por la implantación miliar de tejido glial dentro de la cavidad peritoneal en pacientes con teratomas ováricos, generalmente inmaduros. Puede semejar un cuadro de carcinomatosis peritoneal. A pesar de su extensión intraperitoneal, la gliomatosis peritoneal no afecta adversamente al pronóstico del teratoma ovárico primario si los implantes de tejido glial se componen de tejido maduro y, por tanto, justifica tratamientos conservadores. El grado histológico del teratoma es el factor pronóstico que debe indicar el tratamiento complementario necesario. Su pronóstico es bueno, aunque se han descrito casos de malignización

Peritoneal gliomatosis is a very rare metastatic form of ovarian teratoma, characterized by miliary dissemination of glial tissue inside the peritoneal cavity in patients with an ovarian ­ usually immature ­ teratoma. Peritoneal gliomatosis may resemble peritoneal carcinomatosis. Despite peritoneal dissemination, if the glial tissue implants are composed of mature tissue, peritoneal gliomatosis does not adversely affect the prognosis of the primary ovarian teratoma. Consequently, conservative treatment is warranted. The main prognostic factor is the histological grade of the teratoma, which indicates the required complementary treatment. The prognosis of peritoneal gliomatosis is favorable, although cases of malignant transformation have been reporte (AU)