Effects of Non-Ablative Solid-State Vaginal Laser (SSVL) for the Treatment of Vulvovaginal Atrophy in Breast Cancer Survivors after Adjuvant Aromatase Inhibitor Therapy: Preliminary Results.

BACKGROUND: One of the side effects of anti-estrogen treatments in breast cancer survivors (BCSs), especially with aromatase inhibitor (AI) treatment, is the frequent appearance of vulvo-vaginal atrophy (VVA). We aim to evaluate the efficacy, safety and feasibility of a new type of non-ablative Solid-State Vaginal Laser (SSVL) treatment in BCSs with VVA. METHODS: A total of 30 BCSs with a history of AI use and symptoms of VVA were treated with a non-ablative SSVL (LASEmaR 1500™-EUFOTON)in this non-randomized pilot study. The effects of the laser have been evaluated at baseline, 10 wk and 24 wk using a visual analogue scale (VAS), the Vaginal Health Index (VHI), the Vulvar Health Index (VuHI), the Female Sexual Function Index (FSFI), the EORTC QLQ-BR23, the Vaginal Maturation Index (VMI) and vaginal pH. RESULTS: At 10-week follow-up vs. baseline there were no statistically significant differences in FSFI, lubrication and EORTC QLQ-BR23. In all the subjective (dyspareunia, VHI, VuHI, FSFI, QLQ) and objective parameters (VMI and pH) there was a statistically significant improvement at the 6-month follow-up. Satisfaction was very high (4.7 out of 5), with 95.7% of patients being satisfied, more than or very satisfied. CONCLUSIONS: Preliminary results of SSVL treatment of VVA and dyspareunia in BCSs after AI treatment suggest clinical improvement, without relevant side effects and with a high degree of satisfaction.

Effect of a Multi-Ingredient Coriolus-versicolor-Based Vaginal Gel in Women with HPV-Dependent Cervical Lesions: The Papilobs Real-Life Prospective Study.

Human papillomavirus (HPV) is responsible for virtually all cervical cancers in women. HPV infection and persistency may lead to different-grade squamous intraepithelial lesions that can result in high-grade lesions and cancer. The objective was to prospectively evaluate the results of using a Coriolus-versicolor-based vaginal gel (Papilocare®) on HPV-dependent low-grade cervical lesion repair in a real-life scenario. HPV-positive women ≥ 25 years with ASCUS/LSIL cervical cytology results and concordant colposcopy images were included, receiving the vaginal gel one cannula/day for 21 days (first month) + one cannula/alternate days (five months). A 6-month second treatment cycle was prescribed when needed. Repair of the cervical low-grade lesions through cytology and colposcopy, HPV clearance, and level of satisfaction, and tolerability were evaluated. In total, 192 and 201 patients accounted for the total and safety analyses, respectively, and 77.1% repaired cervical lesions at 6 or 12 months (76.0% for high-risk HPV). Additionally, 71.6% achieved HPV clearance throughout the study's duration (70.6% for high-risk HPV). Satisfaction level was rated 7.9 and 7.5 out of 10 at 6 and 12 months, respectively. Only three mild-moderate product-related adverse events were reported, and all of them were resolved by the end of the study. In our study, we observed higher regression rates of low-grade cervical lesions in women treated with Papilocare® vaginal gel than spontaneous regression rates reported in the literature.

Immunogenicity and safety of a nine-valent human papillomavirus vaccine in women 27-45 years of age compared to women 16-26 years of age: An open-label phase 3 study.

BACKGROUND: Efficacy of the nine-valent human papillomavirus (9vHPV; HPV types 6/11/16/18/31/33/45/52/58) vaccine was demonstrated in a phase 3 study in women 16-26 years of age. We present a phase 3 immunogenicity and safety study of the 9vHPV vaccine in women 27-45 versus 16-26 years of age. METHODS: This international, open-label study (NCT03158220) was conducted in women 16-45 years of age. Participants (16-26 years, n = 570 and 27-45 years, n = 642) received a three-dose 9vHPV vaccination regimen (day 1, month 2, month 6). Month 7 geometric mean titers (GMTs) and seroconversion percentages to anti-HPV 6/11/16/18/31/33/45/52/58 were assessed. Participants were followed for safety throughout the study. RESULTS: At month 7, anti-HPV 6/11/16/18/31/33/45/52/58 GMTs in women 27-45 years were compared to those in women 16-26 years of age. The primary hypothesis of non-inferiority of anti-HPV 16/18/31/33/45/52/58 GMTs in older versus younger women was met. The lower bound of the GMT ratio 95% confidence interval (27-45 years to 16-26 years) was 0.60-0.67 depending on HPV type, exceeding the non-inferiority margin of 0.5 for all HPV types. Month 7 seroconversion percentages in women 27-45 years of age were >99% for all HPV types. Injection-site and vaccine-related systemic adverse events (AEs) were observed in 87.5% and 25.1% of women 16-26 years, and 85.2% and 24.1% of women 27-45 years of age, respectively; no vaccine-related serious AEs were reported and no deaths occurred during the study. CONCLUSIONS: The 9vHPV vaccine elicited non-inferior anti-HPV GMTs in women 27-45 years compared with women 16-26 years of age for HPV 16/18/31/33/45/52/58. The vaccine was generally well tolerated with a similar AE profile across the age groups. These data support bridging 9vHPV vaccine efficacy findings in women 16-26 years to women 27-45 years of age. Clinical trial registration NCT03158220.

Tumor neuroendocrino de la mama: presentación de un caso y revisión de la literatura / Neuroendocrine tumor of the breast: A case report and literature review

Los tumores neuroendocrinos de la mama constituyen una entidad poco frecuente. La existencia de marcadores neuroendocrinos ha permitido su diferenciación del resto de tumores de la mama desde hace tan solo 10 años. La mayoría son tumores de buen pronóstico que expresan receptores hormonales. Una vez descartado el origen metastásico del tumor, el tratamiento no difiere del tratamiento de otro tipo de cáncer mamario, aplicando el tratamiento adyuvante en función de los factores pronósticos y el estadio tumoral al diagnóstico. Presentamos el caso de un tumor neuroendocrino de la mama como hallazgo postoperatorio tras un tratamiento conservador de la mama por un carcinoma ductal infiltrante (AU)

Neuroendocrine tumors of the breast are uncommon. For the last 10 years, the existence of neuroendocrine markers has allowed these tumors to be differentiated from other tumors of the breast. Most are tumors with a good prognosis that express hormone receptors. Once a metastatic origin has been excluded, treatment does not differ from that of other types of breast cancer, consisting of adjuvant therapy based on prognostic factors and tumoral stage at diagnosis. We report a case of neuroendocrine tumor of the breast as a postoperative finding after conservative treatment for infiltrating ductal carcinoma of the breast (AU)

Atrapamiento de cabeza fetal en útero septo / Trapping of the fetal head in a septate uterus

El útero septo, presente en el 1% de la población en edad fértil, es la malformación uterina más frecuente, pero también la que da lugar a peores resultados reproductivos. La afección obstétrica que con más frecuencia se asocia a esta anomalía mülleriana es aquella relacionada con el mantenimiento de la gestación, como son los abortos tardíos o el parto pretérmino. Presentamos el caso de una paciente en la que la existencia de un septo en la cavidad uterina dio lugar a una microcefalia fetal como consecuencia del atrapamiento de la cabeza fetal entre el septo y una de las paredes uterinas. (AU)

Septate uterus, which occurs in approximately 1% of fertile women, is considered the most common uterine anomaly but is associated with the poorest reproductive results. Uterine anomalies are especially associated with difficulty in maintaining a pregnancy to full term, often leading to late miscarriage or preterm delivery. We present a case of fetal microcephaly in a woman with septate uterus as a consequence of trapping of the fetal head between the septum and one of the uterine walls (AU)

Carcinoma basocelular de vulva / Basal cell carcinoma of the vulva

El carcinoma basocelular de vulva es una entidad poco frecuente, con escasos estudios publicados al respecto, por lo que decidimos aportar un caso clínico y realizar una revisión bibliográfica acerca de su prevalencia, presentación clínica, tratamiento y pronóstico (AU)

Basal cell carcinoma of the vulva is a rare entity and there are few publications on this topic. We therefore decided to report a case of this tumor and to review the literature on its prevalence, clinical features, treatment, and prognosis (AU)

Quiste perineural simulando masa anexial en estudio de paciente infértil / Perinerural cyst simulating an adnexal mass in the study of an infertile patient

Los quistes perineurales o de Tarlov son por lo general hallazgos incidentales durante un estudio de imagen que no requieren tratamiento a menos que produzcan síntomas. Tienen una incidencia baja en la población general y esto puede deberse a un error en su diagnóstico, ya que simulan otras lesiones quísticas de la pelvis.Presentamos el caso de una paciente de 38 años en estudio por infertilidad primaria que en control ecográfico, se aprecia lesión quística pélvica de 4 cm, de situación medial, y aparentemente independiente de anejos y útero. Tras dicho hallazgo, se vitrifican los embriones y se deriva al servicio de medicina interna y de neurocirugía para completar estudio.La TC abdomino-pélvica informa de la presencia formaciones quísticas que dependen de los agujeros de conjunción sacros y que se confirman en la RMN. Dichas formaciones son compatibles con el diagnóstico de quiste meníngeo extradural.Al no presentar clínica, se decide tratamiento conservador. La paciente regresa a la unidad de reproducción para completar tratamiento de infertilidad (AU)

Perineural or Tarlov cysts are usually detected as incidental findings during an imaging study and do not require treatment unless symptomatic. The incidence of perineural cysts in the general population is low. Because these cysts simulate other cystic lesions of the pelvis, their low incidence may be due to diagnostic error.We present the case of a 38-year-old woman who was under investigation for primary infertility. An ultrasound scan revealed a 4-cm pelvic cystic lesion, situated medially and apparently independently from the annexes and uterus. Subsequently, the embryos were vitrified and were sent to the internal medicine and neurosurgery services for examination.The abdominopelvic CT scan showed the presence of cystic formations in the intervertebral foramina of sacrum, which were confirmed by magnetic resonance imaging. These formations were compatible with a diagnosis of extradural meningeal cyst.Because the patient was asymptomatic, we decided to provide conservative treatment. The patient was referred back to the fertility unit to complete the fertility treatment (AU)

Ictus paradójico asociado a histersalpingografía / Paradoxical embolism associated with hysterosalpingography

La histerosalpingografía (HSG) es un procedimiento utilizado en el estudio de la infertilidad. La embolia del medio de contraste es una complicación infrecuente y está favorecida por ciertos factores. La persistencia del foramen oval permeable (FOP) complica el pronóstico, ya que puede producir embolias paradójicas. Presentamos el caso de una mujer de 32 años, derivada de un hospital comarcal por accidente cerebrovascular isquémico tras realizarse una HSG informada como dificultosa, precisando una dosis mayor de contraste (ácido diazitroico) que la habitual. Se realizó una tomografía computarizada craneal que mostró infarto cerebral hemisférico derecho. La ecocardiografía posterior al acontecimiento reveló la existencia de un FOP. Tras 8 días de evolución, la paciente presentó mejoría progresiva del déficit, con capacidad para deambular autónomamente, por lo que se procedió al alta hospitalaria con tratamiento antiagregante domiciliario. La clínica acontecida en esta paciente y los hallazgos encontrados en las pruebas diagnósticas son altamente sugestivos de ictus isquémico de la arteria cerebral media secundario a embolismo paradójico del medio de contraste a través del FOP, por lo que resulta interesante realizar una revisión del tema (AU)

Hysterosalpingography is a procedure used in the study of infertility. Embolism of contrast dye is a rare complication and is facilitated by certain factors. Persistence of permeable foramen ovale (PFO) complicates the prognosis and may produce paradoxical embolisms. We present the case of a 32-year-old woman who was referred from a district hospital due to an ischemic stroke following a hysterosalpingography reported as difficult, requiring a higher dose of contrast medium (diatrizoic acid) than usual. A cranial computed tomography scan was performed, which showed a right hemispheric stroke. Post-event echocardiography revealed a PFO. Eight days after the event, the patient showed progressive improvement and was able to walk without assistance. Consequently, she was discharged from hospital with antiplatelet therapy. The symptomology in this patient, as well as the findings of the diagnostic tests, are highly suggestive of ischemic stroke of the middle cerebral artery secondary to paradoxical embolism of the contrast medium through the PFO. A review of the topic is provided (AU)

Leiomioma vaginal / Vaginal leiomyoma

Los leiomiomas son los tumores pélvicos más frecuentes en la mujer. Habitualmente se localizan en el útero siendo inusual encontrarlos en otras localizaciones como la vagina. Se presenta el caso de una paciente de 42 años que acude a consulta por una tumoración de 2 años de evolución en zona vulvovaginal izquierda sin otra sintomatología. Al examen se palpa una tumoración en el labio mayor izquierdo que se extiende hacia fosa isquiorectal de unos 4 cm y que impronta hacia el recto pero sin infiltrarlo. La RMN de pelvis muestra una tumoración de naturaleza sólida-quística vulvar y/o vaginal probablemente de naturaleza neoplásica que no involucra suelo pélvico y que llega hasta periné. Se realiza la extirpación del tumor por vía vaginal sin complicaciones. El estudio anatomopatológico confirmó el diagnóstico de leiomioma benigno. Se hace una revisión sobre el tema (AU)

Uterine leiomyomas are the most common pelvic tumors in women. These neoplasms are usually found in the uterus and their development in other locations, such as the vagina, is unusual. We report the case of a 42-year-old woman who presented with a 2-year history of a tumor in the left vulvovaginal area with no other symptomatology. On examination, a tumor of approximately 4 cm could be palpated inside the left labia majora. The tumor extended to the ischiorectal fossa with an impression in the rectum but without infiltration. Pelvic magnetic resonance imaging showed a solid-cystic vulvar and/or vaginal tumor of likely neoplastic origin which did not involve the pelvic diaphragm and which reached the perineal area. Tumoral enucleation was performed through the vaginal route, with no complications. Pathological study confirmed a benign leiomyoma. A review of the topic is provided (AU)

Lack of correlation between first trimester maternal serum 25-hydroxyvitamin D levels and ultrasound measured crown-rump length and nuchal translucency.

BACKGROUND: Vitamin D regulates the human genome and it is thought to influence the fetal growth and development, but its relation to early ultrasound fetal measures is still unknown. OBJECTIVE: To assess first trimester 25-hydroxyvitamin D [25(OH)D] maternal serum status and correlate with ultrasound crown-rump length (CRL) and nuchal translucency (NT) measurements. METHOD: In this cross-sectional study, women with singleton pregnancies undergoing the first trimester standard two-dimensional ultrasound scan for fetal anomalies were included: CRL (n = 498) and NT (n = 487). Concomitantly, maternal serum 25(OH)D levels were also measured. RESULTS: Median serum 25(OH)D levels for the entire sample (n = 498) was 27.4 ng/mL (interquartile range 20.9-32.7). Serum 25(OH)D was adequate (≥ 30 ng/mL) in only 36.1% of gravids, whereas levels were found to be insufficient (20-29.99 ng/mL) in 41.2% and deficient (< 20 ng/mL) in 22.7%. No significant correlation was found between the serum 25(OH)D levels and the measured ultrasound parameters. CONCLUSION: First trimester 25(OH)D levels did not correlate to fetal ultrasound measurements.

Embarazo heterotópico diagnosticado en una cesárea a término / Gestational sack over a previous cesarean section scar: case report and review of the literature

El embarazo heterotópico está aumentando su incidencia como consecuencia del avance de las técnicas de reproducción asistida. Es importante realizar un diagnóstico precoz pues la rotura de la gestación ectópica puede llegar a ser una urgencia potencialmente mortal. Presentamos un atípico caso clínico en el que el diagnóstico de la gestación extrauterina se realizó en el transcurso de una cesárea electiva a término (AU)

We present the case of a pregnant woman with an 8-week history of amenorrhea and insertion of a gestational sac over a previous cesarean section scar. Methotrexate treatment was unsuccessful and laparotomy was performed. We provide a literature review and update on the incidence, diagnostic methods and current treatment options of this entity (AU)

First trimester serum levels of 25-hydroxyvitamin D, free ß-human chorionic gonadotropin, and pregnancy-associated plasma protein A in Spanish women.

BACKGROUND: Vitamin D has been implicated in embryo/placental development and growth; however information in this regard is limited or unavailable. OBJECTIVE: To assess 25-hydroxyvitamin D (25(OH)D), free ß-human chorionic gonadotropin (ß-hCG) and pregnancy associated plasma protein A (PAPP-A) status during pregnancy. METHODS: Serum 25(OH)D, ß-hCG, and PAPP-A levels were measured in the first trimester of otherwise healthy Spanish pregnant women (n=488). Rho Spearman coefficients were calculated to determine correlations between analytes. RESULTS: Median serum 25(OH)D levels for the entire sample was 27.4 ng/ml (interquartile range=12.1). 25(OH)D levels were insufficient (20-29.99 ng/ml) and deficient (<20 ng/ml) in 40.6% and 23.2%, respectively, in relation to ethnics, body mass index values, tobacco use, and season/gestational age at blood sampling. ß-hCG and PAPP-A levels significantly correlated (r²=0.47) yet neither of them with 25(OH)D levels. Despite this, the three analytes significantly correlated with gestational age at sampling. CONCLUSION: First trimester 25(OH)D, ß-hCG, and PAPP-A levels increase with gestational age; however, placental peptides do not correlate with vitamin D levels, suggesting a non-placental 25(OH)D production. More research is required in this regard.

First trimester serum 25-hydroxyvitamin D status and factors related to lower levels in gravids living in the Spanish Mediterranean coast.

OBJECTIVE: To assess first trimester serum 25-hydroxyvitamin D [25(OH)D] status and factors related to deficient levels in pregnant Spanish women. METHODS: This cross-sectional study was carried out among 502 gravids (11 to 14 weeks) living in the Spanish Mediterranean sea coast (near Almería at latitude 36° N, longitude 2° W) to whom serum 25(OH)D levels were measured by electrochemiluminescence immunoassay. Logistic and multiple linear regression analysis were performed to assess the influence of ethnicity, immigration status, season of the year at blood sampling, body mass index (BMI), parity and smoking habit over 25(OH)D levels. RESULTS: The median (interquartile range, IQR) serum 25(OH)D levels for the entire sample was 27.4 ng/mL (IQR = 20.9-32.8). Only 35.9% of participants had adequate serum 25(OH)D levels (≥30 ng/mL) whereas in 41.4% and 22.7% these levels were found to be insufficient (20-29.9 ng/mL) and deficient (<20 ng/mL), respectively. Vitamin D status was found to be significantly lower in Arab women as compared to Caucasian women. 25(OH)D levels were positively correlated with gestational age at sampling and inversely with BMI values (univariate analysis). Logistic regression analysis determined that non-Caucasian ethnicity, season at sampling (autumn/winter), and nulliparity were factors related to deficient 25(OH)D levels. Multiple linear regression found a similar model yet also including maternal weight inversely correlating with 25(OH)D levels. CONCLUSION: Despite living in one of the sunniest, warmest, and driest climates of Europe, gravids displayed a high prevalence of first trimester insufficient/deficient serum 25(OH)D levels related to season at sampling, nulliparity, maternal weight, and non-Caucasian ethnicity.

Malformación arteriovenosa uterina como causa de hemorragia puerperal tardía / Uterine arteriovenous malformation as a cause of delayed postpartum hemorrhage

La malformación arteriovenosa (MAV) uterina debe incluirse en el diagnóstico diferencial de pacientes con hemorragia posparto que no cede con medidas habituales y que, incluso, empeora tras el legrado. La ecografía con Doppler color puede ayudar al diagnóstico y al manejo clínico. Aunque el tratamiento clásico ha sido la histerectomía, en la actualidad el tratamiento conservador con la embolización de la arteria uterina debería considerarse la primera opción terapéutica de estas lesiones ya que resulta seguro y efectivo. Presentamos el caso de una paciente con hemorragia puerperal tardía y MAV resuelta exitosamente con la embolización selectiva de la arteria uterina izquierda (AU)

Arteriovenous malformation (AVM) of the uterus should be included in the differential diagnosis of patients with postpartum hemorrhage that does not yield to routine measures and may even worsen after curettage. Color Doppler sonography can aid in the diagnosis and clinical management of this entity. Although the classical treatment has been hysterectomy, conservative treatment with uterine artery embolization should currently be considered the first therapeutic option for these lesions because of its safety and effectiveness. We report the case of a patient with delayed postpartum hemorrhage and AVM successfully resolved with selective embolization of the left uterine artery (AU)