Oral versus transdermal oestrogen delivery for endometrial preparation before embryo transfer: a prospective, comparative, randomized clinical trial.

RESEARCH QUESTION: To determine whether the transdermal route is equal or superior to the oral route, when preparing the endometrium with oestrogens for embryo transfer. DESIGN: Prospective, randomized controlled trial; 140 patients randomized; the pills group followed a protocol with oestradiol valerate pills and the patches group followed a protocol with oestradiol hemihydrate patches. The primary variable was endometrial thickness on day 10 ± 1 of treatment. Secondary variables were endometrial thickness on day 15 ± 1 of treatment, patient satisfaction, plasma levels of oestradiol, rates of pregnancy, miscarriage and delivery. Endometrial thickness was measured on day 10 ± 1 of the cycle, if the lining was 7 mm or less in thickness, another measurement was made on day 15 ± 1. Blood oestradiol levels were analysed on the day the endometrial lining was greater than 7 mm (day 10 ± 1 or day 15 ± 1). Patients completed a survey to evaluate comfort and side-effects. RESULTS: The patches group achieved significantly thicker endometrium by the first check-up on day 10 ± 1 (7.6 mm versus 7.0 mm; P = 0.026), with lower blood levels of oestradiol (159.2 pg/ml versus 237.1 pg/ml; P < 0.001) when the endometrial thickness was over 7mm. The pills group considered the treatment more comfortable, with less side-effects. No significant differences in the rates of pregnancy, miscarriage or live birth were found. CONCLUSIONS: Transdermal oestrogen treatment allows patients to reach a higher endometrial thickness after 10 days of treatment, with lower plasma levels of oestradiol, although it is not tolerated as well.

Síndrome de Turner: mosaicismo 45, X/46, XX y sus implicaciones clínicas / Turner's Syndrome: mosaicism 45, X / 46, XX and its clinical implications

El objetivo de este manuscrito es conocer cuál sería la actitud a seguir frente a un mosaico para monosomía X y sus repercusiones clínicas a partir de un caso de mosaicismo residual diagnosticado en nuestro centro. El síndrome de Turner o monosomía X es la aneuploidía más prevalente de los cromosomas sexuales, presenta gran variedad fenotípica condicionada por múltiples genotipos, entre los que destaca el mosaicismo, presente en hasta la mitad de los casos. Un correcto diagnóstico genético es fundamental para un adecuado consejo clínico y para optimizar el manejo de cada caso ya que las repercusiones clínicas y su evolución son muy variables (AU)

The aim of this article is to know what should be the attitude we should continue with a mosaic monosomy X and its clinical consequences on the basis of a case diagnosed in our hospital. Turner syndrome or monosomy X is the most common sexual chromosomes' aneuploidy, can make a lot of phenotypic variations conditioned by multiple genotypes that may occur, especially mosaicism, present in up to half of cases. Appropriate genetic diagnosis is essential for proper and appropriate genetic counseling to optimize the management of each case, as the clinical implications and evolution are highly variable (AU)

Evaluación del grado de conocimiento y satisfacción del tratamiento hormonal sustitutivo en una cohorte de mujeres menopáusicas / Evaluation of kowledge degree and satisfaction with hormonal replacement therapy among a cohort of menopausal women

La terapia hormonal sustitutiva (THS) posee un efecto antirresortivo que la convierte en la terapia más fisiológica para la prevención y tratamiento de la osteoporosis postmenopáusica. Conocer la opinión y el grado de satisfacción de las mujeres postmenopáusicas en THS es un dato importante para mejorar el tratamiento.Pacientes y método. Se realizó una encuesta con 16 preguntas a 100 mujeres en THS que acudieron de forma consecutiva a la Unidad de Densitometría de nuestro centro para realizar una exploración densitométrica. Una enfermera especializada realizó la encuesta y los datos se tabularon para su análisis. La comparación de medias se realizó mediante el análisis de la varianza (ANOVA) y se aplicó la prueba del Chi cuadrado para la comparación de frecuencias utilizando el paquete SPSS 8.0 for windows.Resultados. Se hallaron diferencias estadísticamente significativas en la edad de instauración de la menopausia en el grupo con menopausia natural 47 ñ 4 (media ñ DE) frente a quirúrgica 44 ñ 6 (media ñ DE), p < 0,01, y en el tiempo transcurrido desde la menopausia y la instauración del tratamiento 2,6 ñ 2,2 años (media ñ DE) en las mujeres con menopausia natural frente a 4,1 ñ 4,7 años (media ñ DE), p = 0,05, en las mujeres con menopausia quirúrgica. Un 72,2 por ciento sabía que el THS les era beneficioso para el hueso y las sofocaciones y solamente un 1 por ciento conocía su efecto sobre el aparato cardiovascular. El 59,8 por ciento desconocía los posibles efectos secundarios de la THS y solamente a un 8 por ciento le preocupaba el tema del cáncer de mama. La duración del tratamiento era 46 ñ 26 (media ñ DE) meses, con un intervalo de 4 a 120 meses. De las 128 mujeres que ya no realizaban tratamiento el 50 por ciento lo habían abandonado dentro del primer año. Un 73,2 por ciento reconocía no saber el tiempo que tenía que tomar el tratamiento.Conclusiones. Las mujeres en THS poseen escaso conocimiento del beneficio y de los efectos secundarios. Como autorreflexión, podríamos aconsejar una mayor comunicación con las mujeres menopáusicas explicándoles más ampliamente el THS, sus ventajas, inconvenientes y la duración prevista del mismo (AU)

[Autoplastic closure of vesicovaginal fistulae with posterosuperior bladder flap (Gil-Vernet operation)]. / Cierre autoplástico de las fístulas vésico-vaginales con colgajo vesical posterosuperior (operación de Gil-Vernet).

OBJECTIVE: To describe our experience in the treatment of vesico-vaginal fistula with autoplastic closure using a postero-superior vesical flap. Also, to discuss the technical details of the procedure. MATERIAL AND METHOD: Between 1985 and 1996, 15 patients with vesico-vaginal fistulae secondary to gynaecological surgery were operated. The fistula was considered complex in 5 patients based on previous attempts for surgical closure, number of openings or because they were located in the posterior gradient of the vesical neck. In all cases, autoplastic closure of the fistula was done with a vesical flap through an extraperitoneal abdominal approach. RESULTS: In 100% cases closure of the fistula was achieved at the first surgical attempt. There was no need to interpose vascular tissue between the bladder and the vagina to secure closure of fistula. Post-operatively, 5 patients showed decreased vesical capacity which was recovered within six months; two patients had non-obstructive post-surgical vesical instability. No patient had changes in the mechanism of urinary continence.

[Urocolpos: a cause of pseudo-incontinence in aged women]. / Urocolpos: una causa de falsa incontinencia en la mujer senil.

Presentation of our experience in three cases of urocolpos (acquired pudendal lip fusion), a series numerically equivalent to the total number of cases published until now. All patients in our series were older women and presented complete fusion of the small pudendal lips, with only a small pointed puncture in the lower part of the vulva. The main clinical signs and symptoms in our series were: urinary infection in 100%, false incontinence in 66% due to output of urine retained in the vagina, a symptom that has not been described earlier, and acute urine retention in 33%. All patients were successfully treated by means of surgical loosening of the fusioned lips and application of topical estrogens. An analysis is made of clinical and pathoanatomical features which differentiate this entity from the sclerotic and atrophic lichen. Finally, an etiopathogenic hypothesis is raised to explain the fusion acquired by the small pudendal lips in the urocolpos.

[Feminization: a paradoxical effect of stimulation with hCG/hMG in the infertile male]. / Feminización: un efecto paradójico de la estimulación con hCG/hMG en el varón infertil.

Male feminization is an uncommon and complex phenomenon which occurs as a consequence of an imbalance in the effective oestrogen/androgen relationship. One of the many approaches used in the treatment of idiopathic male infertility is hCG/hMG stimulation. This paper reports one case of an infertile male treated with hCG/hMG after surgical correction of a varicocele, which resulted in a feminization effect evidenced by gynaecomastia and severe spermatogenesis blockade. When therapy was discontinued the feminization disappeared, a rebound phenomenon with normalization of most of the seminal parameters being seen. No other fully documented cases were found in the literature. Finally, the pathoetiological mechanisms involved in the feminization are analyzed and a revision is made of the causes that may cause it.