Rationalisation of the caesarean section rate in a tertiary referral hospital using the Robson classification.

The aim of this study was to implement the Robson Ten Groups Classification System (RTGCS) to identify the main contributors to the caesarean section (CS) rate and to evaluate whether the introduction of a plan of obstetrical interventions reduced this rate. An observational retrospective cross-sectional study was conducted during two time periods at Alicante University General Hospital. In the pre-implementation period (2009-2012), RTGCS was applied to identify the main groups contributing to the overall CS rate. In the post-implementation period (2013-2017), RTGCS was applied again to identify changing trends in CS rates. In all, 11,034 deliveries during the pre-intervention period and 11,453 during the post-intervention period were analysed. The overall CS rate was 23.9% and 20.9%, respectively. There were no changes in perinatal outcomes. In the post-intervention period, there was a significant decrease of the CS rate in the groups of targeted interventions 1, 2, 3, 4, 5, and 8B.Impact statementWhat is already known on this subject? High CS rates are becoming a public health problem because of risks, costs, excessive medicalisation, and abuse of resources. RTGCS provides a framework for auditing and analysing CS rates.What do the results of this study add? RTGCS can identify the groups that have the greatest impact on the CS rate and monitor changes in it consequent to policy changes.What are the implications of these findings for clinical practice? The introduction of a strategic plan with evidence-based clinical interventions may have a greater effect on the CS rate than other features justifying the increase in the incidence of CS.

Can the simultaneous laparoscopic approach improve the learning of vaginal surgery with meshes in the anatomical model?

AIMS: To evaluate the usefulness of simultaneous laparoscopic assistance to improve understanding of the nonvisible surgical steps in Thiel-embalmed cadaver models for training in vaginal surgery using vaginal mesh kits and to evaluate opinions of this surgical learning procedure in comparison with other learning models. METHODS: Recording of anterior compartment prolapse repair with vaginal mesh kits using an external camera simultaneously with laparoscopic vision during the execution of the procedure at the dissection room. To measure the usefulness of this procedure, we designed an anonymous online survey that was made available to program participants via a computer application (a link to video 1 and the survey is available at encuesta@um.es). RESULTS: After watching the video, 97.2% of participants agreed that laparoscopic vision combined with the vaginal approach was useful in learning this surgical technique, and 95.8% agreed they had learned details of the surgical anatomy of the pelvis. All participants agreed that it should be mandatory to train in these techniques with cadavers before practice with live patients. In addition, 84.7% responded that the cadaveric model was superior to animal and other types of models. CONCLUSION: Laparoscopic inspection of the procedure performed with the vaginal approach allowed a better understanding of the surgical technique by making "visible" the anatomical structures that were commonly only palpated. Use of the cadaverous model was considered most efficient for training in this surgical technique.

Hamartoma perineal congénito con malformación genital y anorrectal, asociado a alteración genética: duplicidad del gen TGIF2LX / Congenital perineal hamartoma with genital and anorectal malformation associated with genetic alteraction: duplicity of the TGIF2LX gene

Se presenta el caso de una gestante de 29 años, en la que en la ecografía de la semana 20 se evidencia un varón con genitales externos ambiguos, sospecha de hipospadias y una masa perineal, con el resto de hallazgos normales. La amniocentesis informa de cariotipo 46 XY normal y microarray CGH con duplicidad del gen TGIF2LX, cuya expresión es testicular y su función parece relacionada con la espermatogénesis, y también duplicidad de su gen homólogo TGIF2LY, cuya significación es desconocida. El seguimiento prenatal es normal, con persistencia de la alteración en genitales externos. Al nacimiento se detecta hipospadias con meato en linea media, escroto bífido y masa de consistencia blanda de 4 cm con apéndice cutáneo, asociado a fístula rectoperineal. Las pruebas de imagen indican que se trata de una masa perineal exófitica de 2,2 x 4 cm, de apariencia grasa con nódulo sólido de 1,4 cm en su interior, que podría corresponder a tumor de estirpe grasa de aspecto benigno. Intervenido para resección de la masa a los 11 días de vida, anorrectoplastia posterior y localización de neoano mediante neuroestimulación. El diagnóstico anatomopatológico es hamartoma perineal congénito, con músculo liso, cartílago maduro y tejido adiposo, sin evidencia de malignidad. El postoperatorio precisa de dilataciones anales hasta conseguir defecación espontánea, pero en general es normoevolutivo. El hamartoma perineal congénito es un tumor raro y casi siempre aparece asociado a alguna malformación genital o anorrectal, pero no hay publicaciones que describan correlación con alteraciones genéticas, como podría ser nuestro caso

We present the case of a 29 years old patient, in which the ultrasound of week 20 shows a male with ambiguous external genitals, suspected hypospadias and a perineal mass, with the rest of normal findings. Amniocentesis reports normal 46 XY karyotype and CGH microarray with duplicity of the TGIF2LX gene, whose expression is testicular and its function seems related to spermatogenesis, and also duplicity of its homologous gene TGIF2LY, whose significance is unknown. The prenatal follow-up is normal, with persistence of the alteration in external genitals. At birth, hypospadias was detected with a midline meatus, bifid scrotum, and a soft consistency mass of 4 cm with cutaneous appendage, associated with rectoperineal fistula. The imaging tests indicate an exophytic perineal mass of 2.2 x 4 cm, with a greasy appearance and a solid nodule measuring 1.4 cm inside, which could correspond to a benign-looking fat line tumor. Intervened for resection of the mass at 11 days of life, posterior anoreplasty and neoano localization by neurostimulation. The anatomopathological diagnosis is congenital perineal hamartoma, with smooth muscle, mature cartilage and adipose tissue, without evidence of malignancy. The postoperative period requires anal dilations until spontaneous defecation, but in general it is normal. The congenital perineal hamartoma is a rare tumor and almost always appears associated with some genital or anorectal malformation, but there are not publications that describe correlation with genetic alterations, how could our case be

Presence of human papillomavirus DNA in breast cancer: a Spanish case-control study.

BACKGROUND: Breast cancer is one of the most important neoplasia among women. It was recently suggested that biological agents could be the etiological cause, particularly Human Papilloma Virus (HPV). The aim of this study was to explore the presence of HPV DNA in a case-control study. METHODS: We performed our study including 251 cases (breast cancer) and 186 controls (benign breast tumors), using three different molecular techniques with PCR (GP5/GP6, CLART® and DIRECT FLOW CHIP®). RESULTS: HPV DNA was evidenced in 51.8% of the cases and in 26.3% of the controls (p < 0.001). HPV-16 was the most prevalent serotype. The odds ratio (OR) of HPV within a multivariate model, taking into account age and breastfeeding, was 4.034. CONCLUSIONS: Our study, with methodological rigour and a sample size not previously found in the literature, demonstrate a significant presence of HPV DNA in breast cancer samples. A possible causal relationship, or mediation or not as a cofactor, remains to be established by future studies.

Does the Type of Surgical Approach and the Use of Uterine Manipulators Influence the Disease-Free Survival and Recurrence Rates in Early-Stage Endometrial Cancer?

OBJECTIVE: The purpose of this study was to compare the long-term safety, disease-free survival, and recurrence rate of total laparoscopic hysterectomy using uterine manipulator and abdominal hysterectomy in the surgical treatment in early-stage endometrial cancer. STUDY DESIGN: This was a cohort study of 147 patients with clinical endometrial cancer (laparoscopic surgery group, 77 women; laparotomy group, 70 women). Data were evaluated and analyzed by intention-to-treat principle, and survival data of stage I endometrial cancer (129 patients; 66 from laparoscopic surgery group and 60 from laparotomy group) were estimated by using the Kaplan-Meier curves. RESULTS: After a follow-up period of 60 months for both laparoscopic surgery and laparotomy groups, no significant difference in the cumulative recurrence rates (7.4% and 13.1%, P = 0.091) and overall survival (97.1% and 95.1%, P = 0.592) was detected between both groups of stage I endometrial cancer. Conversion to laparotomy occurred in 10.4% (8/77) of the laparoscopic procedures. Laparoscopic hysterectomy was associated with less use of pain medication (P = 0.001) and a shorter hospital stay (P < 0.001), but the procedure took longer than laparotomic hysterectomy (P < 0.001). The proportion of patients with intraoperative and long-term complications was not significantly different between both groups. The use of uterine manipulators did not have increased recurrence rate in patients treated with laparoscopic approach. CONCLUSIONS: The laparoscopic surgery approach to early-stage endometrial cancer using uterine manipulators is as safe and effective as the laparotomic approach.

Obesidad como factor pronóstico reproductivo en ciclos de fecundación in vitro-inyección espermática intracitoplasmática / Obesity as a reproductive prognostic factor in in vitro fertilization-intracytoplasmic sperm injection cycles

Objetivo. Comparar los resultados reproductivos en función del índice de masa corporal (IMC) en las pacientes sometidas a ciclos de FIV-ICSI. Sujeto y métodos. Ochocientos sesenta y tres ciclos de FIV-ICSI sometidos a estimulación ovárica controlada con protocolo de antagonistas de la GnRH. Resultados. Se encontraron diferencias en la edad media de las pacientes de los diferentes grupos, no clínicamente relevantes (± 1 año). No se encontraron diferencias significativas en la duración de la estimulación, ni en la dosis total de gonadotropinas utilizadas entre los diferentes grupos. Sin embargo, hubo menor número de folículos seleccionados, ovocitos recuperados, ovocitos maduros y de embriones disponibles para transferir al incrementarse el IMC, siendo las diferencias estadísticamente significativas. En cuanto a los resultados reproductivos; la tasa de embarazo clínico y nacido vivo se reduce progresivamente a medida que aumenta el IMC, siendo las diferencias estadísticamente significativas (grupo I: 41,4%, grupo II: 32,5%, grupo III: 29,6%; p < 0,05). Conclusiones. El sobrepeso y la obesidad empeoran los resultados reproductivos en ciclos de FIV-ICSI, reduciéndose de forma significativa la tasa de embarazo clínico y nacido vivo a medida que aumenta el IMC (AU)

Objective. To compare reproductive outcomes in our in vitro fertilization (IVF) program according to women's body mass index (BMI). Subjects and methods. We included a total of 863 IVF-intracytoplasmic sperm injection (ICSI) cycles with controlled ovarian stimulation with GnRH antagonists. Results. Patient age differed among the BMI groups but this difference was not clinically relevant (± 1 year). No significant differences were found among BMI groups in the duration of ovarian stimulation or in the total follicle-stimulating hormone dose used. However, there were significantly fewer selected follicles, retrieved oocytes, mature oocytes and transferred embryos at higher BMIs. Rates of pregnancy and live births were progressively and significantly reduced as BMI increased (group i: 41.4%, group i: 32.5%, group iii: 29.6%; P<.05). Conclusions. Female overweight and obesity impair IVF outcomes. Pregnancy and live birth rates were progressively reduced as BMI increased (AU)

Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

No disponible

Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

No disponible

Acute genital ulcers.

Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.

Prevalence of Lynch syndrome among patients with newly diagnosed endometrial cancers.

BACKGROUND: Lynch syndrome (LS) is a hereditary condition that increases the risk for endometrial and other cancers. The identification of endometrial cancer (EC) patients with LS has the potential to influence life-saving interventions. We aimed to study the prevalence of LS among EC patients in our population. METHODS: Universal screening for LS was applied for a consecutive series EC. Tumor testing using microsatellite instability (MSI), immunohistochemistry (IHC) for mismatch-repair (MMR) protein expression and MLH1-methylation analysis, when required, was used to select LS-suspicious cases. Sequencing of corresponding MMR genes was performed. RESULTS: One hundred and seventy-three EC (average age, 63 years) were screened. Sixty-one patients (35%) had abnormal IHC or MSI results. After MLH1 methylation analysis, 27 cases were considered suspicious of LS. From these, 22 were contacted and referred for genetic counseling. Nineteen pursued genetic testing and eight were diagnosed of LS. Mutations were more frequent in younger patients (<50 yrs). Three cases had either intact IHC or MSS and reinforce the need of implement the EC screening with both techniques. CONCLUSION: The prevalence of LS among EC patients was 4.6% (8/173); with a predictive frequency of 6.6% in the Spanish population. Universal screening of EC for LS is recommended.

Uterine duplicity without communication between both hemiuteri and cervicovaginal atresia: importance of a thorough diagnosis before treatment.

The study described diagnostic and therapeutic processes for an exceptional congenital female genital anomaly involving a 15-year-old girl with progressive dysmenorrhoea and intense abdominal pain, and analyses pathogenesis of embryological anomalies associated with uterine duplicity (UD). Diagnostic methodology is analysed; treatment is described; and recommendations are provided. For the study of anomalies such as UD, we recommend the use of an ultrasound, vaginoscopy, MRI and laparoscopy imaging. Keeping in mind that hemihysterectomy should only be performed in cases with endometriosis or other unusual circumstances, surgical treatment should be avoided. A complete study based on gynaecological examination and ultrasound should be performed in adolescents with severe and progressive dysmenorrhoea. Based on the findings, imaging tests such as MRI and, if necessary, laparoscopy coinciding with menstruation, should be conducted before opting for surgical treatment.

Prenatal diagnosis of caudal dysplasia sequence associated with undiagnosed type I diabetes.

Caudal regression or caudal dysplasia sequence (CDS) is a rare congenital malformation, which includes a wide spectrum of musculoskeletal abnormalities involving the lumbosacral spine, pelvis and lower limbs. It can be associated to visceral defects in various degrees. Maternal diabetes, genetic predisposition and vascular hypoperfusion have been suggested as possible causative factors. Women with diabetes who are dependent on insulin are 200-400 times more likely to have a child with caudal regression, making CDS the most characteristic fetal abnormality of diabetic embryopathy. Prenatal diagnosis is possible by ultrasonographic examination. The sonographic findings include abrupt interruption of the lumbar spine and 'Buddha or frog position' of the lower limbs. MRI has demonstrated the level of the vertebral anomalies as well as the associated abnormalities and this is crucial because the prognosis of this condition depends on the severity of the lesion and the presence of associated disorders.

Métodos anticonceptivos ¿Cuáles se utilizan realmente? / Anticonceptive methods What are actually used?

Objetivo: Obtener información acerca de los métodos anticonceptivos utilizados por nuestras usuarias en el momento de la consulta, grado de satisfacción, conocimiento e información recibida respecto al mismo, cumplimiento, embarazos no planificados y otros datos de interés ginecológicos y socio-demográficos. Población, Material y Métodos: Estudio descriptivo, longitudinal y prospectivo basado en los resultados obtenidos de un cuestionario realizado a una muestra de las pacientes (n=87), de entre 16 y 45 años, que acudieron al Servicio de Urgencias Ginecológicas del Hospital General Universitario de Alicante durante el periodo comprendido entre junio 2010 y noviembre de 2011. Resultados: El método anticonceptivo más utilizado por las usuarias encuestadas es el preservativo (88,5%) con un nivel de satisfacción de uso de 6,3, seguido por la píldora ( 75,9% ). El 20,6% (13% ella+ 7,6% familiares y amigos) de las mujeres eligió el método anticonceptivo sin consultar previamente con un profesional sanitario. La edad de inicio de las relaciones coitales fue de 16,9 años. Un 35.6% refería haber tenido al menos un embarazo no planificado y el 70,9% de las mismas refieren haber recurrido a una interrupción legal del embarazo (ILE). El 58,6% (n=51) de las usuarias refieren haber mantenido en alguna ocasión, relaciones sexuales de riesgo. Conclusiones: Consideramos que la educación es el arma principal de la que disponemos los profesionales sanitarios para alcanzar el objetivo que, en esta materia de salud sexual y reproductiva es, evitar embarazos no deseados y que las mujeres y sus parejas puedan disfrutar de una plena y satisfactoria sexualidad a través un adecuado acceso a la planificación familiar (AU)

The aim of this study is to obtain some information about the anticonceptive methods used by our patients in terms of: type, satisfaction, knowledge or information about it, grade of compliance, not desired pregnancy and other data with gynecologist, social or demographic interest. Material and Methods:We conducted a descriptive, prospective and longitudinal study. We ask our patients to complete a questionnaire. A total of 87 women, assisted in the emergency gynecology department at the “Hospital General de Alicante”, participated. Women were aged between 16 and 45 years old, from June 2010 and November 2011. Results: The most employed anticonceptive method among our patients is the preservative (88,5%), which satisfaction level was 6,3 , followed by the contraceptive pill (75,9%). 20,6% of women selected the anticonceptive method without consulting a health worker. Sexual relationships beginning. The mean age of coital debut was 16,9 years old. A 35,6% have had an unplanned pregnancy and a 70,9% a legal abortion. A 58,6% (n = 51) of patients declared a sexual risk behaviour at least once. Conclusion: Education is the most powerful weapon of health workers to achieve the most important objective in sexual matter, to avoid unplanned pregnancies. Women and their partners must enjoy a satisfactory sex life through an adequate upon family planning (AU)

La vulvovaginitis candidiásica recurrente / Recurrent vulvovaginal candidiasis

La vulvovaginitis candidiásica recurrente (VVCR) es una entidad presente en la práctica diaria en las consultas y en urgencias. Sus síntomas causan molestias crónicas que repercuten seriamente en la calidad de vida de la mujer, empujándola a buscar constantemente una solución que no siempre llega. El diagnóstico debe confirmarse siempre mediante cultivo y el tratamiento debe basarse en el uso de antifúngicos imidazoles, tópicos u orales, con un tratamiento inicial con triple terapia para eliminar los síntomas e intentar eliminar los reservorios; seguida de un tratamiento de mantenimiento durante 6 a 12 meses. Las opciones para la prevención de la VVCR son muy limitadas y, exceptuando la eliminación del agente causal, ninguna otra medida preventiva ha resultado eficaz. Presentamos esta actualización de la VVCR en un intento de ayudar al profesional y colaborar en mejorar la atención de la mujer afecta de VVCR(AU)

Recurrent vulvovaginal candidiasis (RVVC) is a common infection in daily clinical and emergency practice. The symptoms of this infection cause distressing chronic conditions that seriously affect women's quality of life, prompting them to seek solutions that are sometimes hard to find. Diagnosis should always be confirmed by culture and treatment should be based on the use of topical or oral antifungal imidazoles. Triple therapy focused on symptom and reservoir elimination should initially be used, followed by maintenance therapy for 6 to 12 months. The options to prevent RVVC are highly limited and, except for elimination of the causative agent, no other preventive measures have been effective. We provide an updated review of RVVC in an attempt to aid health professionals and improve the care of women with this infection(AU)

Prenatal sonographic findings of duodenal duplication: case report.

We report a rare case of duodenal duplication cyst that was suspected prenatally. Routine prenatal sonography (US) at 19 weeks' gestation showed an abdominal cystic mass on the left side of the abdomen. Follow-up US examinations showed a partial "double-wall" sign, highly suggestive of enteric duplication, and changes in cyst size and wall thickness. Postnatal US examination suggested enteric duplication cyst. A laparotomy revealed a duodenal cyst that was completely resected. The antenatal US findings associated with this condition, the accuracy of its antenatal diagnosis, and its differential diagnosis are discussed.

Vacunación frente al cáncer de cérvix en mujeres fuera de los programas de vacunación sistemática, con o sin infección por el virus del papiloma humano o lesión cervical. Encuesta de opinión y recomendaciones / Vaccination against cervical cancer in women outside of routine immunization programs, with or without infection by the human papilloma virus or cervical lesions. Opinion survey and recommendations

Las vacunas frente al cáncer de cérvix se han implementado, en un amplio número de países del mundo, dentro de los programas de vacunación sistemática. Asimismo se ha recomendado la vacunación de rescate en adolescentes y mujeres jóvenes. Desde la perspectiva de salud pública, la vacunación rutinaria en mujeres de mayor edad no se plantea por motivos de coste-efectividad. En estos casos son el médico y la paciente los que, de forma individualizada, deben decidir sobre la vacunación. Una encuesta de opinión dirigida a ginecólogos españoles que desarrollan su actividad asistencial en el ámbito de la patología cervical y colposcopia evidencia que, incluso en este colectivo, hay un relativo desconocimiento sobre aspectos importantes de la vacuna frente al cáncer de cérvix en mujeres fuera de los programas de vacunación sistemática, con o sin infección por el virus del papiloma humano (VPH) o lesión cervical. Además se constata la demanda de mayor información y poder disponer de recomendaciones específicas acerca de este tema. En el presente artículo se revisan las evidencias sobre la infección VPH y el riesgo de cáncer de cérvix a lo largo de la vida, la eficacia de las vacunas en relación con la edad o tras el tratamiento de lesiones cervicales, y la perspectiva del médico y de la mujer. Finalmente se presentan unas recomendaciones, a modo de guía clínica, sobre la vacunación en mujeres fuera de los programas de vacunación sistemática, con o sin infección o lesión cervical (AU)

Vaccines against cervical cancer have been implemented in a wide number of countries around the world as part of systematic vaccination programmes. In addition, rescue vaccination has been recommended for teenagers and young women. From a Public Health perspective, routine vaccination in older women is not proposed for reasons of cost-effectiveness. In these cases, the physician and the patient must decide about the suitability of vaccination in each individual. An opinion poll of Spanish gynaecologists rendering health-care services in the area of cervical pathologies and colposcopy has shown that, even among this group, there is relative lack of knowledge about important aspects of the vaccine against cervical cancer in women outside systematic vaccination programmes, with or without HPV infection or cervical lesions. In addition, the demand for greater information has been confirmed, as has the wish for specific recommendations on this topic. The present article reviews the evidence on HPV infection and the lifelong risk of cervical cancer, the efficacy of vaccines with respect to age or after the treatment of cervical lesions and the perspectives of physicians and women. Finally, some recommendations are made by way of clinical guidance for the vaccination of women outside systematic vaccination programmes, with or without infection or cervical lesion (AU)

Wernicke's encephalopathy induced by hyperemesis gravidarum.

Wernicke's encephalopathy (WE) is a reversible neurological emergency caused by thiamine deficiency. Prolonged vomiting in pregnancy results in thiamine depletion. The early recognition of its clinical signs and symptoms is essential to establish the suspected diagnosis and can be confirmed by MRI. Prompt administration of thiamine is important for preventing the occurrence of sequelae in the mother and for improving the fetal prognostic. We report a case of WE induced by hyperemesis gravidarum with a good maternal and fetal outcome.

Encuesta sobre el uso en España de la prueba para la determinación del virus del papiloma humano / Survey on the use of tests for the detection of human papilloma virus in Spain

Objetivo. Conocer el conocimiento de las recomendaciones españolas para el cribado del cáncer de cuello uterino (CCU) y evaluar la utilización por los ginecólogos en España de las pruebas de detección del virus del papiloma humano (VPH). Sujetos y métodos. Encuesta dirigida a ginecólogos de la Sociedad Española de Ginecología y Obstetricia y la Asociación Española de Patología Cervical y Colposcopia. Se recogieron los datos aportados por 141 especialistas. Resultados. Participó el 30% de la población objeto de estudio. El 95,6% conocía las recomendaciones. El 93,5% utilizaba habitualmente la técnica de detección del VPH (el 77,7% como cribado de CCU). Los criterios de uso variaron considerablemente entre participantes. El principal motivo para no usar la técnica fue su falta de disponibilidad. Conclusiones. Es necesario reforzar la formación e información sobre las recomendaciones disponibles acerca de las nuevas estrategias de cribado y, en particular, del uso clínico de la determinación del VPH (AU)

Objective. To determine knowledge of the Spanish guidelines for cervical cancer screening, and to evaluate the use of tests for the detection of human papilloma virus (HPV) by Spanish gynecologists. Subjects and methods. The survey focused on gynecologists who were members of the Spanish Society of Gynecology and Obstetrics and the Spanish Association of Cervical Pathology and Colposcopy. One hundred forty-one specialists completed the questionnaire. Results. Thirty percent of the target population participated. A total of 95.6% were aware of the recommendations and 93.5% routinely used the test for the detection of the HPV (77.7% for cervical cancer screening). The criteria for the use of the test varied considerably among participants. The main reason for not using the technique was its unavailability. Conclusions. Training and information on the available recommendations for the new screening strategies and, particularly, on the clinical use of HPV determination should be reinforced (AU)

Mastitis granulomatosa crónica idiopática / Chronic idiopathic granulomatous mastitis

La mastitis granulomatosa crónica idiopática (MGCI) es una enfermedad inflamatoria benigna con una baja incidencia. Se ha asociado a una respuesta inmunológica anormal, la utilización de anticonceptivos orales, así como la existencia de algún organismo infeccioso, como posible causante de una reacción alérgica de tipo cuerpo extraño. Afecta principalmente a mujeres en edad fértil. Generalmente es unilateral y se manifiesta por una o más masas inflamatorias. El aspecto mamográfico puede simular el desarrollo de un carcinoma intraductal, enfermedad de Paget o procesos inflamatorios mamarios de origen benigno de diferentes etiologías. Histopatológicamente se caracteriza por una lobulitis crónica, necrotizante, no caseificante, que presenta formación de granulomas. El diagnóstico de MGCI debe fundamentarse en este patrón histológico combinado con la exclusión de otras lesiones granulomatosas de la mama. Aunque se han planteado varias alternativas terapéuticas, tanto quirúrgicas como médicas, el tratamiento ideal de la MGCI no ha sido aún establecido. Las resecciones quirúrgicas del tejido afectado asociado o no con corticoides orales es la terapia más utilizada (AU)

Chronic idiopathic granulomatous mastitis (CIGM) is a benign inflammatory disease with a low incidence. This entity has been associated with an abnormal immune response, oral contraceptive use and the existence of an infectious organism as a possible cause of an allergic reaction to a foreign body. CIGM mainly affects women of childbearing age, is usually unilateral and is manifested by one or more inflammatory masses. The mammographic appearance may mimic the development of intraductal carcinoma, Paget's disease or benign inflammatory processes of the breast of various etiologies. Histopathologically, CIGM is characterized by chronic, necrotizing, non-caseating lobulitis, which shows formation of granulomas. The diagnosis of CIGM should be established on the basis of this pattern, combined with exclusion of other granulomatous lesions of the breast. Although various medical and surgical therapeutic options have been proposed, the optimal treatment of CIGM has not yet been established. The most commonly used treatment is surgical resection of affected tissue with or without oral corticosteroid therapy (AU)

Evaluación de dos guías de valoración de riesgos laborales en el embarazo / Assessment of two guideliness for occupatinal risks in pregnacy

Objetivos: El reconocimiento en España de la prestación derivada de contingencia profesional por exposición a riesgoslaborales en el embarazo originó que diversas instituciones elaboraran guías para orientar la actuación de los profesionales.El objetivo de este trabajo es evaluar la calidad de los métodos utilizados en la elaboración de las guías de la Asociación deMutuas de Accidentes de Trabajo (AMAT) y de la Sociedad Española de Ginecología y Obstetricia (SEGO), así como elcontenido de sus recomendaciones.Métodos: Estrategia de consenso formal en dos fases: valoración individual y reunión presencial. Para evaluar la calidadse utilizó el instrumento AGREE II estructurado en seis áreas generales (alcance y objetivos, rigor, participación, claridad,aplicabilidad e independencia). Se calcularon las puntuaciones estandarizadas por áreas (% sobre la máxima puntuaciónposible en cada área) y las medianas de respuesta por ítem. También se analizó la concordancia en las respuestas de los cincoevaluadores. Se evaluaron las similitudes y diferencias en las recomendaciones de ambas guías y la adecuación de las recomendacionesatendiendo a la experiencia profesional de cada evaluador y a la documentación científica disponible.Resultados: Las dos guías obtuvieron una evaluación global similar de calidad (<50%). La aplicabilidad fue el área peorevaluada en ambas guías (7%). El porcentaje de acuerdo general entre evaluadores fue superior al 75%. Los evaluadores semostraron más heterogéneos en la valoración de la adecuación de las recomendaciones presentes en las guías.Conclusiones: Ambas guías deberían ser modificadas, especialmente para mejorar su calidad general y las recomendacionesincluidas(AU)

Objectives: As a consequence of new legislation in Spain establishing particular conditions for the control of occupationalexposures during pregnancy, different Spanish associations have developed guides for professional practice. This paper evaluates the methodological quality and content of the guidelines of the Asociación de Mutuas de Accidentes de Trabajo(AMAT), an association of occupational health insurance companies, and the Sociedad Española de Ginecología y Obstetricia(SEGO), the Spanish professional society of obstetrics and gynecology.Methods: Formal consensus strategy in two phases: individual assessment and face-to-face meeting. To assess the quality,the AGREE II instrument was used, divided into six general areas (goals and objectives, rigor, participation, clarity,applicability, and independence). Standardized scores were calculated by area (as a percent of maximum score in each area),together with the medians of response to each item. Concordance among the five reviewers was also analyzed. Similaritiesand differences were also assessed, as was the adequacy of the recommendations in both guides according to the reviewers’own experience and the available scientific literature.Results: Both guides obtained similar overall quality scores (<50%). Applicability showed the lowest scores in bothguides (7%). The percentage of agreement between raters was greater than 75%. The experts showed greater heterogeneityregarding the adequacy of the recommendations in the guidelines.Conclusions: Both guides should be modified, mostly to improve their overall quality and recommendations(AU)