[Non-surgical management of rectovaginal fistula: a case report]. / Tratamiento no quirúrgico de la fístula rectovaginal. A propósito de un caso.

BACKGROUND: The rectovaginal fistula is a rare disease whose treatment is extremely difficult. OBJECTIVE: To present the expectant management of rectovaginal fistula as an alternative to surgery for those cases in which the surgical risk is not an acceptable option. CLINICAL CASE: We report the case of a rectovaginal fistula in an 85-year-old woman with significant comorbidity that avoided the performance of any surgical technique. CONCLUSION: In patients whose surgical risk does not exceed the benefits, non-surgical management would be an option of treatment of rectovaginal fistula.

[Uterine artery embolization as palliative treatment in cervical cancer]. / Embolización de las arterias uterinas como tratamiento paliativo del cáncer de cérvix.

OBJECTIVE: To describe intractable bleeding in cases of end-stage cervical cancer that required uterine artery embolization (UAE) as a palliative treatment, evaluating the effectiveness of the technique and its success rate. MATERIAL AND METHODS: Retrospective study performed from January 2001 to May 2014, that included patients diagnosed with cervical carcinoma stage IV bleeding, who required uterine artery embolization as palliative treatment in the General Hospital of Albacete. RESULTS: Six patients had symptoms of moderate to severe bleeding and anemia. After the UAE, it was possible to offer a proper management of bleeding and successful stabilization of the patients, improving their quality of life. The success of the technique was complete (100%). CONCLUSION: Uterine artery embolization can be an effective technique in women with advanced cancers, which are not amenable to other treatments.

Analysis of perception of training in graduates of the Faculty of Medicine at Universidad de Castilla-Mancha.

INTRODUCTION: Problem-based learning has been a key component of the teaching method employed at the Faculty of Medicine at the University of Castilla La Mancha (UCLM) in Albacete, Spain since its creation. The aim of this study was to evaluate perceptions of training among residents who graduated from the first three years of the UCLM Degree in Medicine. METHODS: Using the Jefferson Medical College postgraduate rating form, residents rated their performance in four areas of clinical competency (medical knowledge, data gathering skills, clinical judgment, and professional attitudes) at the beginning of residency training in comparison with colleagues from other faculties. The construct validity of responses was evaluated using Cronbach's alpha and exploratory factor analysis. RESULTS: Over half the respondents (57.8%) considered that they had received better training than peers from other medical schools, and 98.5% felt that their general performance in the four competencies analyzed was similar or superior to that of their colleagues. Factor analysis revealed two major factors: "the physician as scientist" and "the physician as manager and communicator". CONCLUSIONS: Our study shows that graduates from the UCLM Faculty of Medicine perceive their training, which is largely based on problem-based learning, as satisfactory.

Púrpura trombótica trombocitopénica versus síndrome de HELLP: un reto diagnóstico durante la gestación / Thrombotic thrombocytopenic purpura versus hellp syndrome: a diagnostic challenge during pregnancy

La trombocitopenia es una alteración relativamente frecuente durante la gestación. Varias entidades patológicas pueden presentarse con este dato de laboratorio. Entre ellas, destacamos la púrpura trombótica trombocitopénica (PTT) y el síndrome de HELLP (hemólisis, elevación de enzimas hepáticas y trombocitopenia). Ambas entidades, en ocasiones, pueden ser muy difíciles de diferenciar cuando se producen durante el embarazo, y su manejo y tratamiento difieren enormemente. Por ello es necesario conocerlas y realizar un correcto diagnóstico diferencial, ya que el diagnóstico erróneo de cualquiera de ellas puede tener consecuencias muy graves, incluso la muerte de la paciente y del producto de la concepción (AU)

Thrombocytopenia is relatively frequent during pregnancy and can occur in a range of syndromes. Among these, particular attention should be paid to thrombotic thrombocytopenic purpura (TTP) and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). It can be difficult to differentiate between these conditions during pregnancy, and their management and complications may differ widely. It is therefore essential to recognize their causes and perform a correct differential diagnosis, particularly in light of their possible serious consequences, which include maternal and/or fetal death (AU)

[Puerperal meningitis by group B streptococcus]. / Meningitis puerperal por estreptococo del grupo B.

BACKGROUND AND OBJECTIVE: To describe an unusual clinical presentation of puerperal meningitis by Streptococcus agalactiae (S. agalactiae). PATIENT AND METHOD: We report a case of puerperal meningitis for S. agalactiae, a rare form of infection in a healthy puerperal and with an atypical presentation. RESULTS: We deeply report the clinical case, the procedures performed to exclude other diseases and management differences. It is compared with meningitis cases reported in the literature, and as in these, we opt for and early diagnosis and a rapid onset of antibiotic treatment. CONCLUSION: Meningitis caused by S. agalactiae is not a frequent complication in the postpartum period, that requires early diagnosis and treatment of which depends the patient's prognosis.

Incarceración y torsión uterina en gestante / Incarceration and uterine torsion in a pregnant woman

La torsión uterina es un evento raro, más aún cuando se produce en ausencia de embarazo. Se define como una rotación de más de 45° sobre el eje longitudinal uterino, y habitualmente tiene lugar a lo largo de la transición entre cuerpo y cérvix. En 2 tercios de los casos se produce hacia el lado derecho. Normalmente, está causada por la presencia de una condición anormal o patología que afecta al útero y/o a las estructuras adyacentes. Las manifestaciones clínicas pueden ser agudas, crónicas, o incluso un cuadro asintomático, constituyendo entonces un hallazgo intraoperatorio. La confirmación diagnóstica se realiza únicamente durante la realización de la laparotomía. La congestión de vasos en el ligamento ancho y la colocación anterior de los ovarios, hacen que la histerotomía baja realizada habitualmente en la cesárea no pueda realizarse en determinadas situaciones, optando por una histerotomía clásica en la superficie posterior del útero (AU)

Uterine torsion is a rare event, especially in the absence of pregnancy. This complication is defined as a rotation of more than 45° around the long axis of the uterus and usually occurs along the transition between the body and the cervix. In two thirds of cases, the torsion is toward the right side. This event is usually caused by the presence of an abnormal condition that affects the uterus and/or the adjacent structures. Clinical manifestations may be acute or chronic, or even entirely absent, in which case the torsion is identified as an intraoperative finding. The diagnosis can only be confirmed during laparotomy. Because of vessel congestion in the broad ligament and the anterior position of the ovaries, low hysterotomy, usually performed at cesarean section, cannot be carried out in certain situations. Instead classical hysterotomy on the posterior surface of the uterus is performed (AU)