Sexually transmitted infections in Spain: Current status.

Sexually Transmitted Infections (STI) are a major public health problem. The problems inherent to their diagnosis, treatment and prevention have to do not only with their nature, but also with organizational issues and overlapping competencies of the different health authorities in Spain. The real situation of STI in Spain, at present, is poorly known. For this reason, the Scientific Committee on COVID and Emerging Pathogens of the Illustrious Official College of Physicians of Madrid (ICOMEM) has formulated a series of questions on this subject which were distributed, not only among the members of the Committee, but also among experts outside it. The central health authorities provide very high and increasing figures for gonococcal infection, syphilis, Chlamydia trachomatis infection and lymphogranuloma venereum (LGV). Both HIV infection and Monkeypox are two important STI caused by viruses in our environment, to which it should be added, mainly, Herpes simplex virus (HSV) and Human papillomavirus (HPV) infections. Emerging microorganisms such as Mycoplasma genitalium pose not only pathogenic challenges but also therapeutic problems, as in the case of N. gonohrroeae. The pathways that patients with suspected STI follow until they are adequately diagnosed and treated are not well known in Spain. Experts understand that this problem is fundamentally managed in public health institutions, and that Primary Care and Hospital Emergency Services, together with some institutions that deal monographically with this problem, are the recipients of most of these patients. One of the most serious difficulties of STI lies in the availability of the microbiological tests necessary for their diagnosis, particularly in this era of outsourcing of microbiology services. Added to this is the increased cost of implementing the latest generation of molecular techniques and the difficulties of transporting samples. It is clear that STI are not diseases to which the entire population is equally exposed and it is necessary to have a better knowledge of the risk groups where to focus the necessary interventions adapted to their characteristics. It should not be forgotten that STI are also a problem in the pediatric age group and that their presence can be a marker of sexual abuse with all that this implies in terms of health care and medicolegal activity. Finally, STI are infections that are associated with a high cost of care for which we have very little information. The possibility of expanding the automatic performance of laboratory tests for STI surveillance through laboratory routines is encountering ethical and legal problems that are not always easy to solve. Spain has created a ministerial area of specific attention to STI and there are plans to improve the diagnosis, treatment and prevention of these problems, but we still lack the necessary evidence on their impact. We cannot forget that these are diseases that transcend the individual and constitute a Public Health problem.

Cáncer sincrónico de carcinosarcoma uterino y carcinoma seroso tubárico. A propósito de un caso y revisión de la bibliografía / A synchronous diagnosis of uterine carcinosarcoma and serous tubal carcinoma. A case report and literature review

Exponemos el caso de una paciente de 74 años que consultó por sangrado posmenopáusico y finalmente se diagnosticó de carcinosarcoma uterino y carcinoma seroso tubárico, sincrónico.En la exploración se objetivó una formación polipoidea a través del cérvix y se visualizó en la ecografía transvaginal una imagen heterogénea intracavitaria.El resultado del estudio histológico de ambos hallazgos fue de carcinosarcoma.Tanto la resonancia magnética como la tomografía axial computarizada describieron una lesión en cuerpo uterino indicativa de mioma sin descartar degeneración sarcomatosa, además de una lesión cervical con características similares.Ante la sospecha de un carcinoma de endometrio tipo ii, se realizó, por vía laparoscópica, una histerectomía, una doble anexectomía, una omentectomía y una linfadenectomía pélvica y paraaórtica. Con el siguiente resultado anatomopatológico: carcinosarcoma uterino de 5cm con infiltración miometrial <50% y afectación del estroma cervical, con márgenes libres. Ambos anejos y tejido peritoneal presentaban infiltración por carcinoma seroso de alto grado de origen tubárico. Las linfadenectomías pélvica y paraaórtica sin evidencia de malignidad.Se concluye un estadificación de carcinosarcoma uterino estadio ii y carcinoma seroso tubárico estadio iiiB sincrónico.Se trata de una rara entidad; tenemos conocimiento de un único caso clínico similar documentado, siendo nuestro propósito presentar el manejo y tratamiento realizado.

We report a rare case of uterine carcinosarcoma involving a 74-year-old woman. The patient complained of posmenopausal bleeding. The disease was eventually diagnosed as simultaneous uterine carcinosarcoma and high-grade serous tubal carcinoma.Clinical examination found a cervical tumour and transvaginal ultrasound showed a heterogeneous intrauterine image. The histological result of both findings was carcinosarcoma.The computed tomography scan and magnetic resonance imaging reported similar findings for intrauterine and cervical tumour, with the same features as a possible myoma or mass with sarcomatous degeneration.Given the suspicion of a high-risk variant of endometrial adenocarcinoma, the primary management of carcinosarcoma is surgery. Complete surgical staging included total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymph node dissection.The pathological findings revealed a uterine carcinosarcoma tumour, invading less than half the myometrium and the stromal connective tissue of the cervix but not extending beyond the uterus. The histopathological studies of bilateral adnexectomy and the peritoneal biopsy demonstrated the presence of high-grade serous tubal carcinoma. The lymph study was negative for malignancy.We concluded a synchronous diagnosis of uterine carcinosarcoma stage II and high-grade serous tubal carcinoma stage IIIB.A detailed literature search and management of this entity are discussed.

Neurofibroma en mama, a propósito de un caso / Breast neurofibroma: A case report

Los neurofibromas son crecimientos exuberantes del tejido nervioso periférico que aparecen en pacientes afectos de neurofibromatosis tipo 1. Los neurofibromas a nivel mamario son raros, y cuando aparecen suelen localizarse a nivel areolar. Presentamos el caso de una paciente de 31 años en la que se llevó a cabo la extirpación de un neurofibroma areolar

Neurofibromas are exuberant growths of peripheral nervous tissue that appear in patients with neurofibromatosis type 1. Neurofibromas of the breast are rare, but they are usually located in the nipple-areola complex. We present the case of a 31-year-old patient who underwent excision of a neurofibroma of the areola

Ectópico abdominal complicado con hemoperitoneo / Complicated abdominal ectopic with haemoperitoneum

El embarazo abdominal es una modalidad extremadamente rara de embarazo ectópico (EE) extratubárico, con muy pocos casos documentados en la literatura. La mortalidad materna es mayor que en los EE tubáricos por la demora en el diagnóstico y las complicaciones. Presentamos un caso de EE abdominal que se complicó con la aparición de hemoperitoneo severo en el primer trimestre de gestación. En nuestro caso, fueron necesarias 2 laparoscopias de urgencia en menos de 24 h hasta poder dar con el diagnóstico definitivo, lo cual demuestra lo dificultoso que puede llegar a ser la identificación de esta enfermedad en estadios precoces

Abdominal ectopic pregnancy is an extremely rare type of extratubal ectopic (EE) pregnancy, with very few cases documented in the literature. Maternal mortality is higher than in tubal EE because of the delay in diagnosis and complications. The case is presented of a patient with an abdominal EE that was complicated by the appearance of severe haemoperitoneum in the first trimester of pregnancy. In this case, two emergency laparoscopies were needed in less than 24 hours, until the definitive diagnosis could be found. This demonstrates how difficult it can be to identify this pathology in its early stages

Tumor de células de la granulosa del ovario de tipo adulto: revisión de 7 casos / Adult granulosa cell tumour of the ovary: A report of 7 cases

El tumor de células de la granulosa (TCG) es una neoplasia poco común que se clasifica en 2 subtipos, adulto y juvenil. Se presenta una serie de 7 casos de TCG, de tipo adulto, diagnosticados en nuestro hospital entre los años 2003 y 2017. La edad media al diagnóstico fue de 47 años, todos en estadio i. Se realizó biopsia intraoperatoria en 4 pacientes, con resultado de TCG en 3 de ellas y de cáncer de ovario en una. El estudio anatomopatológico se realizó en diferido en los otros 3 casos. El tratamiento fue siempre quirúrgico, realizándose adyuvancia con quimioterapia en un caso. Cinco pacientes presentaron hiperplasia endometrial concomitante, y una un carcinoma de mama de forma sincrónica. Durante el seguimiento se objetivaron 2 recurrencias. En nuestra serie se confirma la asociación del TCG a otras enfermedades hormonodependientes. A pesar del buen pronóstico de esta neoplasia los casos de recidiva tardía no son infrecuentes, y es necesario llevar a cabo un seguimiento a largo plazo

Granulosa cell tumour (TCG) is an uncommon neoplasia that has two subtypes, adult and juvenile. We present a report of 7 cases of adult-type TCG, that were diagnosed in our center during 2003 and 2017. The average age at diagnosis was 47 years, and all were in stage I. In four patients an intraoperative biopsy was performed, in three of which the diagnosis of TCG was obtained. Treatment was surgical in all cases, and in one case required adjuvant chemotherapy. Five patients presented with concomitant endometrial hyperplasia, and one had a synchronous breast carcinoma. During follow-up, 2 recurrences were observed. In our series, the association of TCG with other hormone-dependent pathologies was confirmed. Despite a good prognosis of this cancer, cases of late recurrence are not uncommon, and a long-term follow-up is required

Tamoxifeno y tumoraciones anexiales complejas en paciente trasplantada renal con carcinoma in situ de mama / Tamofixen and complex adnexal cysts in a renal transplant recipient with in situ carcinoma of the breast

El tamoxifeno es un modulador selectivo de los receptores estrogénicos, utilizado con la intención de reducir las tasas de recurrencia y mortalidad de pacientes con cáncer de mama y receptores hormonales positivos. A nivel de ovario y endometrio actúa como agonista estrogénico por lo que no está exento de efectos secundarios. Presentamos un caso clínico de una paciente con cáncer de mama, premenopáusica hasta el inicio del tratamiento, que desarrolló tumoraciones anexiales complejas que obligaron a indicar una laparoscopia diagnóstica y a descartar un nuevo proceso oncológico a nivel de ambos ovarios. La paciente, además, presentaba como antecedentes un trasplante renal por nefropatía y tratamiento inmunosupresor. Hemos revisado la bibliografía al respecto valorando las posibles asociaciones entre dichos procesos (AU)

Tamoxifen is a selective modulator of estrogen receptors and is used to reduce recurrence and mortality rates in breast cancer patients with positive hormone receptors. This drug acts as an estrogen receptor agonist in the ovaries and endometrium and can produce some adverse effects. We report the case of a breast cancer patient, who was premenopausal until the beginning of the treatment and who developed bilateral complex adnexal cysts, requiring a diagnostic laparoscopy to exclude a new oncologic process in the ovaries. The patient had previously received a kidney transplant for nephropathy and immunosuppressive therapy. We review the literature on the topic and evaluate the possible associations between these processes (AU)

Conceptos generales de electrocirugía en histeroscopia / Basic knowledges of electrosurgery in hysteroscopy

El cirujano endoscopista ginecológico debe estar familiarizado con los principios, aplicaciones y aspectos de seguridad de las fuentes de energía que se usan durante la cirugía. Al utilizar una fuente de energía eléctrica lo que físicamente hacemos es impulsar electrones con un voltaje dado concentrándolos en una localización específica del tejido para producir un efecto tisular deseado. Este podrá ser un efecto de corte o de coagulación. En la obtención de dicho efecto interviene el tipo de corriente , el tipo de tejido y el aplicador o terminal empleado. En este trabajo hacemos un repaso de los fundamentos de la energía eléctrica empleada en cirugía y los tipos de corrientes más frecuentemente usados, así como de sus diferentes aplicaciones clínicas

Gynaecologic endoscopist should thoroughly knows the basis, uses and security ítems related to electrosurgical energy. When using electric energy we shoot electrons to an specific tissue spot to induced a desired cutting or coagulating tissular effect. The desired tissular effect depend on the type of current, the type of tissue and the type of the instrument we use to apply the electric energy. We review the basis of electric energy, the different type of electric current and its use on surgical procedures

Trastornos menstruales en la adolescencia / Menstrual adolescence disorders

El objetivo del presente artículo es la descripción de los trastornos menstruales que acontecen en la adolescencia, con estudio de su etiología, diagnóstico y tratamiento. Se estudian las alteraciones hemorrágicas, el síndrome premenstrual y la dismenorrea

This article aim is the description of the different adolescence menstrual disorders, with the study of it aetiology, diagnosis and treatment. Bleeding disorders, premenstrual syndrome and dysmenorrhoea are studied