RESUMO
La depresión posparto es una patología frecuente, estigmatizada, con implicaciones socio-familiares. El objetivo es revisar si existe relación entre el parto mediante cesárea comparado con la vía vaginal de parto, en el riesgo de padecer depresión posparto. En la revisión se realiza una búsqueda en PubMed; se incluyeron estudios donde se comparaba el parto vaginal vs. cesárea en relación con la depresión posparto. Tras aplicar los criterios de elegibilidad, se obtuvieron 11 artículos de interés. La literatura revisada mostró resultados heterogéneos y no concluyentes respecto a la relación directa entre la vía de parto y la depresión posparto. La asociación de la vía de parto con el riesgo de padecer este trastorno sigue siendo controversial.(AU)
Postpartum depression is a very frequent, yet stigmatized illness, and it may carry serious family and social implications. The main aim of this review is to review whether there is a link between caesarean section and the risk of postpartum depression, compared with vaginal delivery. The main search was performed on PubMed. Articles that compared vaginal delivery with caesarean section in relation to postpartum depression were included. After applying eligibility criteria, 11 relevant articles were obtained. The reviewed literature showed heterogeneous and inconclusive results regarding the direct link between delivery mode and postpartum depression. Conclusions. The relationship between mode of delivery and risk of postpartum depression remains controversial.(AU)
Assuntos
Humanos , Feminino , Depressão Pós-Parto , Período Pós-Parto , Cesárea , Nascimento Vaginal Após Cesárea , Parto , GinecologiaRESUMO
Las neoplasias hematológicas secundarias representan una complicación grave del tratamiento oncológico, aunque se desconoce su incidencia real en las pacientes con tumores ginecológicos. El diagnóstico de la leucemia mieloide aguda secundaria a platinos se basa en la sospecha clínica, las alteraciones morfológicas y el estudio citogenético. A pesar de la quimioterapia paliativa y el trasplante alogénico, que está limitado a ciertos casos, su pronóstico es desfavorable. Por ello deben optimizarse las pautas terapéuticas en los tumores ginecológicos con posibilidad de obtener largas supervivencias y mantener a los pacientes en programas de seguimiento prolongado
Secondary haematological malignancies represent severe complication of cancer treatment, although their real incidence is unknown in gynaecological tumours. The usual presentation of an acute leukaemia associated with platinum is based on clinical and cytogenetic features. Diagnosis is based on clinical suspicion, morphological alterations and cytogenetic studies. Conventional chemotherapy is mainly palliative, whereas allogenic transplantation allows the cure but just a small percentage of cases, so prognosis is dismal. Thus, potential curative therapies for solid tumours should be optimized and patients maintained in long-term surveillance programs
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamento farmacológico , Neoplasias Uterinas/diagnóstico , Segunda Neoplasia Primária/terapia , Neoplasias Uterinas/tratamento farmacológico , Segunda Neoplasia Primária/patologia , Progressão da Doença , Biópsia , Transfusão de Plaquetas , Imuno-HistoquímicaRESUMO
BACKGROUND: The appropriate selection criteria for breast-conserving surgery (BCS) or mastectomy after neoadjuvant chemotherapy (NAC) are poorly defined. The aim of this study is to analyse the incidence and prognostic factors for locoregional recurrence (LRR) in patients with breast cancer (BC) treated with NAC to develop a prognostic score to help with clinical decision-making. MATERIALS AND METHODS: Using our retrospective maintained BC database, we identified 730 patients treated with NAC (327 patients treated with BCS and 403 patients treated with mastectomy) between 1998 and 2014. To identify variables associated with an increased LRR rate, we performed firstly Kaplan-Meier curves, with comparisons among groups using log-rank test, and then, significant variables were included in a multivariate analysis using Cox proportional hazards. The prognostic index was developed by assigning score 0 (favourable) or score 1 (unfavourable) for each significant variable of multivariate analysis and was created separately for patients with BCS and mastectomy. RESULTS: At a median follow-up of 72 months, the 6-year cumulative incidence of LRR was 7.2% ( ± 3%) for BCS and 7.9% ( ± 3%) for mastectomy. By univariate analysis, variables associated with an increased LRR were for BCS: HER2 positive, grade III, ductal carcinoma in situ (DCIS), No-pCR (ypTis, ypN0), and age < 40 years; and for mastectomy, HER2-positive, DCIS, No-pCR, and LVI. By multivariate analysis, variables associated with an increased LRR were for BCS: HER2 positive (HR: 11.1, p = 0.001), DCIS (HR: 3.1, p = 0.005), and age < 40 years (HR: 2.8, p = 0.02); and for mastectomy: HER2 positive (HR: 9.5, p = 0.03), DCIS (HR: 2.7, p = 0.01), No-pCR (HR: 11.4, p = 0.01), and age < 40 years (HR: 2.8, p = 0.006). The score stratified patients into three subsets with statistically different levels of risk for LRR. For BCS, the six-year LRR rates were 3%, 13%, and 33% for the low (score 0, n = 120), intermediate (score 1, n = 95) and high (score 2-3, n = 27) risk groups, respectively (p = 0.001). For mastectomy, the six-year LRR rates were 0%, 8%, and 27% for the low (score 0, n = 20), intermediate (score 1-2, n 191), and high (score 3-4, n = 30) risk groups, respectively (p = 0.001). Of note, 21 patients that had a LRR event were HER2 positive, all of them had received trastuzumab. CONCLUSIONS: Patients with a score of 0, which made up to 19% of the study population, had very low risk of LRR. The score enabled the identification of a small group (7%) of patients with very high risk of LRR, and who may benefit from alternative treatment.
