Complications of HIPEC for ovarian cancer surgery: evaluation over two time periods.

OBJECTIVE: Cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) is being explored in the upfront, interval, and recurrent setting in patients with ovarian cancer. The objective of this systematic review was to assess the rate of complications associated with HIPEC in epithelial ovarian cancer surgery over two time periods. METHODS: This study was registered in PROSPERO (CRD42022328928). A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Ovid/Medline, Ovid/Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials were searched from January 2004 to April 2022. We included studies reporting on patients with advanced primary or recurrent epithelial ovarian cancer who underwent cytoreductive surgery and HIPEC. We evaluated two different time periods: 2004-2013 and 2014-2022. A random-effects meta-analysis was used to produce an overall summary. Subgroup analyses were planned according to recruited period for each specific complication type. Heterogeneity was assessed using the I2 statistic. RESULTS: A total of 4928 patients were included from 69 studies for this systematic review; 19 published from 2004-2013, and 50 published from 2014-2022. No significant differences were found between the two time periods in terms of blood transfusions (33% vs 51%; p=0.46; I2=95%) overall gastrointestinal complications (15% vs 21%; p=0.36; I2=98%), infectious diseases (16% vs 13%; p=0.62; I2=93%), overall respiratory complications (12% vs 12%; p=0.88; I2=91%), overall urinary complications (6% vs 12%; p=0.06; I2=94%), or thromboembolic events (5% vs 3%; p=0.25; I2=63%). Also, no differences were found in intensive care unit (ICU) admissions (89% vs 28%; p=0.06; I2=99%), reoperations (8% vs 7%; p=0.50; I2=37%), or deaths (3% vs 3%; p=0.77; I2=57%). CONCLUSIONS: Our review showed that overall complications have not changed over time for patients undergoing HIPEC in the setting of primary or recurrent ovarian cancer. There was no decrease in the rates of ICU admissions, reoperations, or deaths.

Protective ostomies in ovarian cancer surgery: a systematic review and meta-analysis.

OBJECTIVE: To assess the benefit of protective ostomies on anastomotic leak rate, urgent re-operations, and mortality due to anastomotic leak complications in ovarian cancer surgery. METHODS: A systematic literature search was performed in MEDLINE, Web of Science, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for all studies on anastomotic leak and ostomy formation related to ovarian cancer surgery. Non-controlled studies, case series, abstracts, case reports, study protocols, and letters to the editor were excluded. Meta-analysis was performed on the primary endpoint of anastomotic leak rate. Subgroup analysis was carried out based on type of bowel resection and bevacizumab use. Secondary endpoints were urgent re-operations and mortality associated with anastomotic leak, length of hospital stay, postoperative complications, 30-day readmission rate, adjuvant chemotherapy, survival, and reversal surgery in ostomy and non-ostomy patients. RESULTS: A total of 17 studies (2,719 patients) were included: 16 retrospective cohort studies, and 1 case-control study. Meta-analysis of 17 studies did not show a decrease in anastomotic leak rate in ostomy patients (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.60-1.70; p=0.980). Meta-analysis of ten studies (1,452 women) did not find a decrease in urgent re-operations in the ostomy group (OR=0.72; 95% CI=0.35-1.46; p=0.360). Other outcomes were not considered for meta-analysis due to the lack of data in included studies. CONCLUSION: Protective ostomies did not decrease anastomotic leak rates, and urgent re-operations in ovarian cancer surgery. This evidence supports the use of ostomies in very select cases.

Disomía uniparental-duplicación paterna de la región del cromosoma 11p15.5 como causa de displasia mesenquimatosa placentaria / Placental mesenchymal dysplasia due to uniparental disomy/paternal duplication of 11p15.5

Resumen ANTECEDENTES La displasia mesenquimatosa de la placenta es una enfermedad rara que en la ecografía se observa con vesículas en forma de racimo de uvas. Puede provocar complicaciones en el embarazo, como: restricción del crecimiento intrauterino, muerte intrauterina y parto pretérmino. CASO CLÍNICO Paciente de 31 años con displasia mesenquimatosa placentaria diagnosticada en la ecografía del primer trimestre de embarazo. Se apreció una zona con formaciones econegativas de 14 x 20 mm, con escasa captación del doppler color y que terminó de confirmarse en el segundo trimestre, con una biopsia corial. El embarazo trascurrió con normalidad hasta la semana 33, que fue cuando se detectó la restricción del crecimiento intrauterino. Debido a la alta incidencia de complicaciones obstétricas derivadas de éste se decidió la inducción del parto en la semana 37 de la gestación. CONCLUSIONES El diagnóstico de displasia mesenquimatosa placentaria requiere seguimiento estrecho del embarazo e inducir su finalización entre las semanas 37-38 para aminorar las complicaciones perinatales.

Abstract BACKGROUND Placental mesenchymal dysplasia is a rare disease of the placenta which presents with vesicles in the form of a cluster of grapes on ultrasound. It can cause pregnancy complications such as: intrauterine growth restriction, intrauterine death, and preterm birth CLINICAL CASE A 31-year-old patient with placental mesenchymal dysplacia diagnosed on the ultrasound of the first trimester of pregnancy, in which an area with 14 x 20 mm econegative formations was observed with little uptake of the color Doppler and which was confirmed in the second trimester by corial biopsy of that area. The pregnancy was normal until week 33, after which an intrauterine growth restriction was detected. Due to the high incidence of obstetric complications of this entity, an induction of labor was decided at week 37 of gestation. CONCLUSIONS Whenever this type of pathology is diagnosed, it is recommended a close follow-up of pregnancy and an induction of labor around 37-38 weeks of gestation, due to the perinatal complications presents.

Meningioma durante el embarazo / Meningioma during pregnancy

Se presenta el caso de una gestante de 35 semanas que acudió al servicio de urgencias con un cuadro de desorientación, desconexión con el medio, disartria que en los siguientes minutos continuó con una crisis tónico clónica y nistagmo. Tras la estabilización del cuadro, se decidió realizar una cesárea urgente, obteniéndose un feto varón vivo y una craneotomía electiva posterior, dado a la estabilidad neurológica de la paciente. Inicialmente se pensó en una eclampsia, pero tras proteinuria negativa y una tomografía axial computarizada craneal que informó de lesión extra axial izquierda con efecto masa sobre el parénquima adyacente compatible con meningioma se descartó esta posibilidad. Los tumores cerebrales son muy infrecuentes en el embarazo y la incidencia de meningiomas en mujeres embarazadas y no embarazadas es la misma. No obstante, hoy en día se sabe que los meningiomas aumentan su tamaño durante la gestación por el aumento de la vascularización y edema intracelular o extracelular que ocurre durante la misma y por la expresión, de dichos tumores, de receptores de progesterona, sobre todo (AU)

We present the case of a pregnant woman of 35 weeks of pregnancy who came to the emergency room with symptoms of disorientation, disconnection with the way and aphasia which, in the next minutes, continued with a tonic- clonic seizure and nistagmo. After the stabilization of the symptoms, we decided to do an urgent caesarean, having a male new born. Firstly, we thought about an eclampsia but the proteinuria was negative and, the cranial computarized tomography was informed about an extra axial left injury with mass effect over the adjacent parenchyma compatible with meningioma, because of that we rejected the diagnosis of eclampsia. In the puerperium, an elective craneotomy was done, because of the neurological stability of the patient. Brain tumors are very infrequent in pregnancy and the incidence of meningioma in pregnant women and not pregnant women is the same. However, nowadays, it is known that meningioma grow up during pregnancy because of the increase of the vascularization and the intracellular or extracellular edema that occurs during pregnancy and because of the expression, of such tumors, of progesterone receptors (AU)

Hematoma de rectos abdominales en el embarazo. Reporte de un caso / Rectus sheath haematoma in pregnancy. A case report

Introducción: aunque el hematoma de los músculos rectos del abdomen es infrecuente durante el embarazo, debe ser considerado en el diagnóstico diferencial de pacientes que presenten abdomen agudo al fi nal del embarazo. Tanto la RM como la ecografía son útiles en el diagnóstico y tratamiento; que, inicialmente, y si el paciente se encuentra hemodinámicamente estable, debe ser conservador Caso clínico: presentamos el caso de una gestante con hematoma de músculos rectos del abdomen que, en un primer momento, se confundió con un desprendimiento prematuro de placenta (AU)

Background: Rectus sheath haematoma is infrequent during pregnancy but must be considered in the differential diagnosis of acute abdominal pain at the end of pregnancy. Both magnetic resonance imaging and ultrasound are useful for its diagnosis and treatment, which should be conservative as long as the patient is haemodynamically stable. Case report: We present the case of a pregnant woman with a rectus sheath haematoma, which was thought to be a placental abruption (AU)

Endometritis tuberculosa sin foco primario y dolor pélvico crónico / Tuberculous endometritis with no primary focus and chronic pelvic pain

Antecedentes: La tuberculosis genital y la endometritis tuberculosa es una forma de tuberculosis que continúa siendo frecuente en los países en desarrollo y habitualmente es secundaria a un foco primario pulmonar. Puede cursar de forma asintomática, o bien, producir síntomas como infertilidad primaria o secundaria, alteraciones menstruales o dolor pélvico crónico, entre otros. Caso clínico: Se presenta el caso de una paciente de 47 años en estudio por ginecología y urología por dolor pélvico crónico y sintomatología urinaria inespecífica de aproximadamente 6 meses de evolución. La ecografía transvaginal muestra contenido intracavitario escaso sugerente de piometra e imágenes trabeculares compatibles con sinequias uterinas. Mediante aspirado endometrial se extrae pus y muestra endometrial que se remite para estudio anatomopatológico. Tras el informe anatomopatológico que diagnostica inflamación crónica granulomatosa necrotizante, se solicita estudio por PCR y cultivo para micobacteriumm tuberculosis, siendo ambos positivos para el microorganismo. De este modo, se diagnosticó como endometritis tuberculosa sin existir afectación de otros órganos tras el estudio completo. Se realizó tratamiento con etambutol hidrocloruro, isoniacida, pirazinamida y rifampicina durante 2 meses y pirazinamida e isonicida durante 7 meses adicionales. Al final del tratamiento, la paciente mostraba clara mejoría de los síntomas y a la ecografía desaparición de la colección intracavitaria uterina.

Background: Genital tuberculosis and endometritis tuberculosa is a form of tuberculosis which remains prevalent in developing countries and is usually secondary to a pulmonary primary focus. It may be asymptomatic, or may produce symptoms such as primary or secondary infertility, menstrual disorders or chronic pelvic pain, among others. Clinical case: We present the case of a patient of 47-year who was studied by ginecology and urology for chronic pelvic pain and unspecific urinary symptoms since about 6 months. In transvaginal ultrasound pyometra and trabecular images compatible with uterine synechiae were observed. Endometrial samples were obtaining and sent for histopathologic examination which was informed of chronic necrotizing granulomatous inflammation. We asked for PCR and culture for tuberculosis micobacteriumm, both being positive for the microorganism. Thus, she was diagnosed of endometritis tuberculosa without involvement of other organs after complete study. She performed a treatment with ethambutol hydrochloride, isoniazid, rifampicin and pyrazinamide for 2 months and pyrazinamide and isoniazid for 7 months. At the end of treatment, the patient showed clear improvement of symptoms and disappearance of uterine intracavitary collection in the ultrasonographic study.