Estudio piloto comparativo del test VPH con genotipado parcial en primera línea frente a otras estrategias de cribado poblacional del cáncer de cérvix. Estudio CRYGEN 16/18 / Comparative pilot study about HPV test with partial genotyping in primary screening versus other strategies for cervical cancer population screening, CRYGEN 16/18 study

Introducción: La detección precoz del cáncer de cérvix requiere la implementación de programas de cribado del virus del papiloma humano (VPH). Sin embargo, existen discrepancias en la optimización de esas estrategias. Se evalúa el rendimiento de 10 protocolos basados en técnicas moleculares, citológicas o combinadas en cribado primario. Material y métodos: Se diseña un estudio ciego, prospectivo e intervencionista en 1.977 mujeres de 35 años. La determinación molecular se realizó por la plataforma Cobas 4800HPV. Los análisis citológicos se realizaron en las mismas muestras sin conocimiento del resultado molecular. Todas las mujeres en las que se detectaba VPH-16/VPH-18 o presentaban alteración citológica y detección de otros genotipos de alto riesgo (VPHar) eran derivadas a colposcopia. Resultados: El ensayo molecular detectó presencia de VPHar en el 12,5% de las mujeres, mientras solo el 8,1% de las citologías fueron patológicas. El 19,5% de las pacientes derivadas a colposcopia revelaron lesiones de alto grado, estando VPH-16 presente en el 65,3% de ellas. En 6 de esas ocasiones (VPH-16 siempre presente) la citología había sido informada como normal. El seguimiento al año de las mujeres con citología normal y detección de VPHar identificó una lesión HSIL/CIN2+(asociada a VPH-33). En el estudio comparativo con otras estrategias el protocolo denominado CRYGEN 16/18 rindió el mejor equilibrio de sensibilidad y especificidad con la menor derivación a colposcopia. Conclusiones. La realización de detección molecular de VPH con genotipado parcial en primera línea, al menos VPH-16, con derivación directa a colposcopia, aumenta la tasa de detección de lesiones HSIL/CIN2+.(AU)

Introduction: The early detection of cervical cancer requires the implementation of molecular screening programs for human papillomavirus (HPV). However, there are discrepancies in the optimization of screening protocols. The performance of 10 primary screening strategies based on molecular, cytological or combined techniques is now evaluated. Material and methods: A blind, prospective, and interventional study was designed in 1977 35-year-old women. The molecular determination was carried out by the Cobas 4800 HPV platform. Cytological analysis was performed on the same samples without knowledge of the result of the molecular assay. All women in whom HPV-16/HPV-18 was detected or presented cytological alteration together with detection of other high-risk genotypes (HPVhr) were referred to colposcopy. Results: The molecular assay detected the presence of HPVhr genotypes in 12.5% of the women, while only 8.1% of the cytologies were pathological. Among the patients referred to colposcopy, in 19.5% high-grade lesions were observed, being HPV-16 present in 65.3% of them. In six of these high-grade lesions (associated with HPV-16 in all cases), cytology was reported as normal. The follow-up one year later, of women with normal cytology and HPVhr detection a HSIL/CIN2+ lesion was detected (associated to HPV-33). In the comparative study with other strategies, the protocol called CRYGEN 16/18 yielded the best balance of sensitivity and specificity with the least referral to colposcopy. Conclusions: Performing molecular detection of HPVhr with partial first-line genotyping of at least HPV-16, with direct referral to colposcopy, increases the detection rate of HSIL/CIN2+ lesions.(AU)

Comparative pilot study about HPV test with partial genotyping in primary screening versus other strategies for cervical cancer population screening, CRYGEN 16/18 study.

INTRODUCTION: The early detection of cervical cancer requires the implementation of molecular screening programmes for human papillomavirus (HPV). However, there are discrepancies in the optimization of screening protocols. The performance of 10 primary screening strategies based on molecular, cytological or combined techniques is now evaluated. MATERIAL AND METHODS: A blind, prospective, and interventional study was designed in 1.977 35-year-old women. The molecular determination was carried out by the Cobas 4800 HPV platform. Cytological analysis were performed on the same samples without knowledge of the result of the molecular assay. All women in whom HPV-16/HPV-18 was detected or presented cytological alteration together with detection of other high-risk genotypes (HPVhr) were referred to colposcopy. RESULTS: The molecular assay detected the presence of HPVhr genotypes in 12.5% of the women, while only 8.1% of the cytologies were pathological. Among the patients referred to colposcopy, in 19.5% high-grade lesions were observed, being HPV-16 present in 65.3% of them. In six of these high-grade lesions (associated with HPV-16 in all cases), cytology was reported as normal. The follow-up one year later, of women with normal cytology and HPVhr detection a HSIL/CIN2+ lesion was detected (associated to HPV-33). In the comparative study with other strategies, the protocol called CRYGEN 16/18 yielded the best balance of sensitivity and specificity with the least referral to colposcopy. CONCLUSIONS: Performing molecular detection of HPVhr with partial first-line genotyping of at least HPV-16, with direct referral to colposcopy, increases the detection rate of HSIL/CIN2+ lesions.

Comparative pilot study about HPV test with partial genotyping in primary screening versus other strategies for cervical cancer population screening, CRYGEN 16/18 study. / Estudio piloto comparativo del test VPH con genotipado parcial en primera línea frente a otras estrategias de cribado poblacional del cáncer de cérvix. Estudio CRYGEN 16/18.

INTRODUCTION: The early detection of cervical cancer requires the implementation of molecular screening programs for human papillomavirus (HPV). However, there are discrepancies in the optimization of screening protocols. The performance of 10 primary screening strategies based on molecular, cytological or combined techniques is now evaluated. MATERIAL AND METHODS: A blind, prospective, and interventional study was designed in 1977 35-year-old women. The molecular determination was carried out by the Cobas 4800 HPV platform. Cytological analysis was performed on the same samples without knowledge of the result of the molecular assay. All women in whom HPV-16/HPV-18 was detected or presented cytological alteration together with detection of other high-risk genotypes (HPVhr) were referred to colposcopy. RESULTS: The molecular assay detected the presence of HPVhr genotypes in 12.5% of the women, while only 8.1% of the cytologies were pathological. Among the patients referred to colposcopy, in 19.5% high-grade lesions were observed, being HPV-16 present in 65.3% of them. In six of these high-grade lesions (associated with HPV-16 in all cases), cytology was reported as normal. The follow-up one year later, of women with normal cytology and HPVhr detection a HSIL/CIN2+ lesion was detected (associated to HPV-33). In the comparative study with other strategies, the protocol called CRYGEN 16/18 yielded the best balance of sensitivity and specificity with the least referral to colposcopy. CONCLUSIONS: Performing molecular detection of HPVhr with partial first-line genotyping of at least HPV-16, with direct referral to colposcopy, increases the detection rate of HSIL/CIN2+ lesions.

Vascular Endothelial Growth Factor (VEGF) Polymorphisms and Serum VEGF Levels in Women With Epithelial Ovarian Cancer, Benign Tumors, and Healthy Ovaries.

OBJECTIVE: This study analyzed the relation of 5 single-nucleotide polymorphisms (SNPs) in the VEGF (vascular endothelial growth factor) gene in patients with epithelial ovarian cancer (EOC), compared with patients carrying benign tumors or healthy ovaries. We studied serum VEGF levels and the relation with SNPs and association between VEGF SNPs and haplotypes with progression-free survival (PFS) in patients with cancer. METHODS: The genotyping of VEGF gene polymorphisms (-2578 C/A, -1154 G/A, -460 T/C, +405 G/C, +936 C/T) was performed in DNA isolated from blood samples of 100 women. The different genotypes were evaluated by quantitative real-time polymerase chain reaction. Vascular endothelial growth factor protein concentration was assessed in serum using solid-phase sandwich enzyme-linked immunosorbent assay. RESULTS: We found statistically significant differences in the distribution of VEGF genotypes among the 3 groups of patients: -2578 C/A between those with EOC and healthy ovary (P = 0.04), -460 T/C between those with EOC and healthy ovary (P = 0.03), and -460 T/C between those with benign tumors and healthy ovary (P = 0.02). Vascular endothelial growth factor serum levels were analyzed in patients with EOC. Higher levels were found in patients with clear cell carcinoma compared with those with serous, mucinous, or endometrioid tumors (P < 0.05). No clear association was observed between VEGF SNPs and serum VEGF levels. There was no significant correlation between VEGF SNPs and PFS. In haplotype analysis, CGTCT and CGTGT showed worse prognosis without reaching the statistical significance. CGCGC and AGTGC haplotypes had statistically significant differences among patients with EOC, benign tumors, and healthy ovaries (Ps = 0.046 and 0.041, respectively). CONCLUSIONS: The distribution of VEGF genotypes was different in patients with EOC, compared with those with benign tumors or women with healthy ovaries. Vascular endothelial growth factor serum levels were higher in patients with clear cell carcinoma. No correlation was found with improved PFS, but CGTCT and CGTGT haplotypes showed worse prognosis.

Eclampsia y encefalopatía posterior reversible / Eclampsia and posterior reversible encephalopathy syndrome

La eclampsia, síndrome clínico definido clásicamente por la aparición de convulsiones y/o coma en gestantes con hipertensión y proteinuria, se presenta frecuentemente como un síndrome de encefalopatía posterior reversible (PRES), entidad clínico radiólogica caracterizada por cefalea, alteraciones visuales, convulsiones y/o alteración de conciencia, junto a un patrón radiológico de edema cerebral vasogénico reversible localizado en territorio posterior. Discutimos dos casos de gestantes pretérmino que ingresaron en el Servicio de Urgencias de nuestro hospital tras debutar en su domicilio con cefalea y status epiléptico, sin antecedentes de enfermedad hipertensiva del embarazo ni proteinuria. Ambas presentaron en las pruebas de neuroimagen, criterios de síndrome de encefalopatía posterior reversible (PRES), lo que facilitó el diagnóstico diferencial y la toma de decisiones terapéuticas. Dada la estrecha asociación entre eclampsia y síndrome de encefalopatía posterior reversible (PRES), los estudios de neuroimagen constituyen una herramienta valiosa para el diagnóstico y tratamiento oportuno de estas pacientes, favoreciendo su recuperación neurológica completa sin secuelas posteriores(AU)

Eclampsia, a clinical syndrome classically defined by the occurrence of seizures and/or coma in pregnant women with hypertension and proteinuria, is often presented as a posterior reversible encephalopathy syndrome (PRES), a clinical-radiological entity characterized by headache, visual disturbances, seizures and/or alteration of consciousness, besides a radiological pattern of reversible vasogenic cerebral edema located in posterior territory. We discuss two cases of preterm pregnant women admitted to the Emergency Department of our hospital after debuting at their home with headache and status epilepticus, with no history of hypertensive disease of pregnancy or proteinuria. Both presented in neuroimaging criteria for posterior reversible encephalopathy syndrome (PRES), which facilitated the differential diagnosis and therapeutic decision making. Given the close association between eclampsia and posterior reversible encephalopathy syndrome (PRES), neuroimaging studies are a valuable tool for the diagnosis and treatment of these patients, favouring complete neurological recovery without sequelae(AU)

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)

Gestación en paciente con anemia de Cooley / Pregnancy in patients with Cooley anemia

Los síndromes talasémicos son trastornos hereditarios de la biosíntesis de la globina alfa o la beta. La disponibilidad reducida de globina disminuye la producción de tetrámeros de hemoglobina, lo que da lugar a hipocromía y microcitosis. Se produce una acumulación desequilibrada de subunidades alfa o beta porque las síntesis de las globinas no afectadas continúan a una velocidad normal. La acumulación desequilibrada de cadenas domina el fenotipo clínico. La gravedad clínica varía mucho, dependiendo del grado de trastorno de la síntesis de la globina afectada, de la síntesis alterada de otras cadenas de globina y de la herencia simultánea de otros alelos anormales de la globina. La incidencia de estos síndromes durante el embarazo en todas las razas es de uno en 300 a 500 (AU)

Thalassemia syndromes are inherited disorders of alpha- or beta-globin biosynthesis. The reduced availability of globin decreases the production of hemoglobin tetramers, giving rise to hypochromia and microcytosis. There is unbalanced accumulation of alpha or beta subunits because the synthesis of unaffected globins continues at a normal speed. This unbalanced accumulation dominates the clinical phenotype. The clinical severity varies widely, depending on the degree of disorder of the synthesis of the affected globin, the altered synthesis of other globin chains and simultaneous inheritance of other abnormal globin alleles. The incidence of these syndromes during pregnancy in all races is one in 300 to 500 (AU)

[New strategies for secondary prevention of cervical cancer]. / Nuevas estrategias para la prevención secundaria del cancer de cuello uterino.

The current incidence of cervical cancer is around 5,300,000 new cases per year worldwide and mortality 275,000 cases per year. The 80% of these cases are distributed in developing countries. Cervical cancer screening should cover to as much population as possible, for instance, through public health initiative; should be use previously validated test, and based on primary care. The efficiency is the basic criterion of this screening. The Pap smear is the best technique ever used by the Preventive Medicine; and in countries with sufficient capacity and proper application, the incidence/mortality can be decreased until 75%. The introduction of DNA-HPV testing has increased the sensitivity of detecting cervical cancer, but with lower specificity. Actually it has been incorporated into the cervical screening as proposed by the Spanish Society of Obstetrics and Gynecology. The cervical screening must be maintained even in women who have been vaccinated; because of they may be at risk of contact with other high-risk HPV types not included in the vaccine. In the future, biomarkers will be of great importance. Inactivation of the retinoblastoma suppressor gene by the oncogene HPV E7 increases levels of p16INK4a in cytoplasm. Overexpression of nuclear antigen Ki67 is a marker of cell proliferation by HPV infection.

Manejo de gestante con cistoplastia de ampliación con sigma / Management of a pregnant woman with sigmoid augmentation cystoplasty

Las cistoplastias de ampliación con segmento intestinal se emplean en el tratamiento de ciertas patologías urológicas, en pacientes con vejiga de baja capacidad y mala acomodación en los cuáles el tratamiento conservador ha fallado (mielomeningocele, lipomeningocele, lipoma intradural, quiste dermoide, agenesia sacra, lesiones traumáticas de médula espinal). El caso clínico corresponde a una gestante de 20 años con antecedentes de mielomeningocele y vejiga neurógena, tratados mediante derivación ventrículo-peritoneal y cistoplastia. La ecografía informó de feto en cefálica, con biometría fetal dentro de la normalidad y oligoamnios grave. La resonancia magnética informa de vejiga ampliada con asa de intestino grueso. Ante el oligoamnios severo y la monitorización fetal no estresante poco reactiva, se indica inducción del parto, que fracasa, realizándose cesárea con histerotomía corporal fúndica de cara anterior (AU)

Augmentation cystoplasties with intestinal section are used to treat some urological diseases in patients with low bladder capacity and deficient adaptation (myelomeningocele, lipomeningocele, intradural lipoma, dermoid cyst, sacrum agenesia, traumatic lesions of the spinal cord) in whom conservative measures have failed. We report the case of a 20-year-old pregnant woman with a history of myelomeningocele and neurogenic bladder, treated by ventriculoperitoneal shunt and cystoplasty. Ultrasonography showed a fetus in cephalic presentation, with normal biometric findings and severe oligoamnios. Magnetic resonance imaging revealed an augmented bladder with large bowel loop. Given the severe oligoamnios and unreactive fetal non-stress test, labor induction was started with unsuccessful results and cesarean section was performed (AU)

La inmunosupresión es un factor mayor de riesgo en la recidiva de las lesiones del tracto genital inferior asociadas al virus del papiloma humano / Immunosuppression is a major prognostic factor in recurrence of human papillomavirus-associated lesions of the lower genital track

Objetivo: Analizar las características de las lesiones preneoplásicas del tracto genital inferior (TGI) y los factores asociados a su recidiva. Material y métodos: Se estudió a 376 mujeres tratadas de algún tipo de neoplasia intraepitelial del TGI, en la década de los 90. Las lesiones se agruparon en cervicales y vulvares, y estas en lesiones de alto (CIN II-III o VIN) y de bajo grado (CIN I o atipia vulvar por virus del papiloma humano [AV-VPH]). El tratamiento de las CIN se realizó con asa diatérmica y para las lesiones vulvares fue la resección con bisturí frío y/o láser CO2.ResultadosLa edad media de las mujeres fue 32 años. La multicentricidad fue identificada en el 57% de las CIN y en el 87% de las lesiones vulvares. Un 10% de las mujeres en ambos grupos presentó algún tipo de inmunosupresión. Se identificó VPH de riesgo alto en el 25% de los casos. Con un seguimiento medio de 21 meses, la recidiva global de la CIN fue del 17% y la acumulada a 5 años del 47%. En las lesiones vulvares fue del 15 y el 54%, respectivamente. En ambos grupos lesionales la recidiva apareció en los primeros 3 años en más del 90% de los casos y se asoció a la inmunosupresión y el genotipo viral de riesgo alto, aunque el único factor de riesgo independiente en el análisis multivariante fue la inmunosupresión. Ninguna paciente progresó a cáncer invasor. Conclusiones: La inmunosupresión es el factor riesgo predictivo más importante de recurrencia. Las conductas orientadas a estimular la inmunidad podrían ser eficaces en prevención de la recurrencia de la enfermedad por el VPH (AU)

Objective: To analyze the characteristics of preneoplastic lesions of the lower genital tract (LGT) and the factors associated with their recurrence. Material and methods: A total of 376 women treated for some type of intraepithelial neoplasm of the LGT between 1990 and 1999 were studied. The lesions were classified into cervical intraepithelial neoplasms (CIN) and vulvar intraepithelial neoplasms (VIN) and were further classified into high-grade lesions (CIN 2-3 or VIN) and low-grade lesions (CIN 1 or human papillomavirus vulvar atypia [HPV-VA]). Treatment of cervical lesions consisted of CO2 laser and / or loop electrosurgical excision while that of vulvar lesions consisted of cold-knife local excision and / or CO2 laser. Results: The mean age of women was 32 years. Multicentric disease was found in 57% of CIN lesions and in 87% of vulvar lesions. Ten percent of women in both groups had some type of immunosuppression. High-risk HPV was identified in 25% of patients. With a mean follow-up of 21 months, the overall CIN recurrence was 17% and accumulated recurrence rate at 5 years was 47%. In vulvar lesions, these values were 15% and 54%, respectively. In both groups, more than 90% of recurrences occurred in the first 3 years, and relapse was associated with immunosuppression and high-risk viral genotype. In multivariate analysis, the only independent risk factor was immunosuppression. None of the lesions progressed to invasive cancer. Conclusions: The most important risk factor predictive of recurrence is immunosuppression. Measures to stimulate immunity could be effective in preventing HPV-related disease (AU)

Decidualización peritoneal y embolización de arterias uterinas en la hemorragia puerperal tras cesárea / Peritoneal deciduosis and uterine artery embolization in puerperal hemorrhage after cesarean section

La decidualización peritoneal es una metaplasia de células peritoneales, que aparece en la gestación por acción de la progesterona. Anatomopatológicamente, son lesiones altamente vascularizadas, por lo que es preciso el diagnóstico definitivo mediante técnicas inmunohistoquímicas para diferenciarlo de tumores malignos. La embolización arterial selectiva es una técnica conservadora para el tratamiento de las hemorragias posparto con mínimos efectos secundarios, que permite la conservación de la fertilidad. Presentamos el hallazgo de una decidualización peritoneal severa durante la realización de una cesárea en una paciente que posteriormente precisó embolización de arterias uterinas por hemorragia puerperal (AU)

Deciduosis peritonei consists of the presence of decidua in the peritoneal surface and develops during pregnancy due to the effect of progesterone. The typical lesions are highly vascularized and immunohistochemical studies are required to exclude a diagnosis of malignancy. Selective arterial embolization is a conservative procedure to treat postpartum hemorrhages with minimal side effects and allows fertility to be preserved. We present a case of severe deciduosis peritonei identified during a cesarean section in a patient who subsequently required embolization of the uterine arteries due to a postpartum hemorrhage (AU)

Diagnóstico diferencial entre lupus eritematoso sistémico y preeclampsia en una gestante / Differential diagnosis between systemic lupus erythematosus and preeclampsia in a pregnant woman

Presentamos el caso de una mujer de 18 años que durante el tercer trimestre de su embarazo comenzó con hipertensión arterial (HTA) y proteinuria y fue diagnosticada de preeclampsia. La gestación finalizó con éxito, habiéndose controlado satisfactoriamente con tratamiento antihipertensivo. En el plazo de una semana tras el parto desarrolló un síndrome de HELLP y una insuficiencia renal y respiratoria aguda, y fue diagnosticada entonces de lupus eritematoso sistémico y se inició tratamiento con esteroides, plasmaféresis, hemodiálisis y ciclofosfamida. La situación clínica se complicó al sufrir una neumonía por Acynetobacter. Creemos que se trató de una preeclampsia superimpuesta a una nefropatía lúpica hasta entonces silente (AU)

We report the case of an 18 year-old woman that during the third trimester of her pregnancy developed high blood pressure and proteinuria, being diagnosed of preeclampsia. The pregnancy ended successfully having being the hypertension satisfactorialy controlled with treatment. One week after delivery she developed a HELLP syndrome, an acute renal failure and respiratory insufficiency, being diagnosed then of systemic lupus erithematosus and starting a treatment with steroids, plasmapheresis, hemodyalisis and cyclophosphamide. The clinical situation got more complicated due to a pneumony by acynetobacter. We believe that it was a preeclampsia superimposed to an underlying lupus nephritis (AU)

Teratoma inmaduro de ovario en la gestación / Immature ovarian teratoma in pregnancy

La incidencia de masas anexiales en la gestación es de 1 por 1.000 embarazos; de ellos, el 3% son malignos. La mayoría de estas masas son asintomáticas y el diagnóstico se realiza frecuentemente mediante un hallazgo casual en la ecografía obstétrica; lo más común es que sea en el segundo trimestre. El manejo de los tumores ováricos depende de su naturaleza y clínica. En los casos en que se sospeche malignidad es necesaria una cirugía de estadificación e incluso asociar quimioterapia. En estos casos, debe intentarse conservar la fertilidad. Presentamos 2 casos de teratomas inmaduros de ovario en gestantes (AU)

Ovarian tumors are estimated to occur in about 1 in 1000 pregnancies; of these, 3% are malignant. Most patients are clinically asymptomatic and the masses are usually detected in a routine abdominal examination during the second trimester of pregnancy. The management of these ovarian masses depends on their etiology and clinical findings. Surgical intervention is required when malignancy is suspected. Neoadjuvant chemotherapy is also indicated. Fertility conserving surgery should be attempted. We report two cases of pregnant women with malignant immature teratomas (AU)

Rotura prematura de membranas antes de la semana 28 de gestación y resultados neonatales / Preterm premature rupture of membranes and neonatal outcome prior to 28 weeks of gestation

Objetivo: Describir las características y el pronóstico del manejo conservador en gestantes con rotura prematura de membranas pretérmino (RPMP). Material y métodos: Estudio observacional descriptivo de 65 casos de RPMP < 28 semanas, entre 1995 y 2005. Resultados: Características principales: gestación múltiple (29,3%), exudado positivo para Estreptococcus agalactiae (Streptococcus del grupo B) (14,85%) y RPMP anterior (16%). La mediana de días de bolsa rota (BR), cuando el índice de Bishop es < 7 es de 14 para gestantes con RPMP < 24 semanas y de 5 para gestantes con RPMP ≥ 24 semanas (p = 0,01). El manejo conservador no aumenta la morbimortalidad, salvo que presenten oligoamnios moderado-severo: el 100% de las corioamnionitis y el 69% de la mortalidad perinatal ocurrieron en gestantes con oligoamnios. Conclusiones: Las gestantes con RPMP < 24 semanas e índice de Bishop < 7 presentan mayores períodos de latencia, pero la morbimortalidad maternofetal no aumenta si el índice de líquido amniótico es normal (AU)

Objective: To describe the characteristics and outcomes after conservative management of pregnancies with preterm premature rupture of membranes (PPROM). Material and methods: We performed a descriptive, observational study of 65 cases of PPROM at less than 28 weeks of pregnancy between 1995 and 2005. Results: The main characteristics were twin pregnancies, positive culture for group B Streptococcus agalactiae (14,85%) and previous PPROM (16%). The median number of days with broken membranes, when the Bishop score was < 7, was 14 for pregnancies with PROM < 24 weeks and 5 for pregnancies with PPROM ≥ 24 weeks (P=.01). Conservative management does not increase morbidity or mortality, unless there is moderatesevere oligohydramnios: 100% of chorioamnionitis and 69% of perinatal mortality occurred in pregnancies with oligohydramnios. Conclusions: Pregnancies with RPMP < 24 weeks and a Bishop¿s score of < 7 have a longer latency period and maternal-fetal morbidity and mortality are not increased if the amniotic fluid index is normal (AU)

Documento de consenso de las sociedades científicas españolas. Vacunas profilácticas frente al VPH / No disponible

No disponible

Enfermedad de Chagas y gestación / Chagas’ disease and pregnancy

La enfermedad de Chagas puede transmitirse porvía vertical y transplacentaria en áreas noendémicas. Las migraciones ofrecen la oportunidadde ver enfermedades nuevas en estas zonas, queen muchas ocasiones pueden ser de gran interésdesde el punto de vista diagnóstico y terapéuticoen la gestación. Las principales afectaciones en elrecién nacido recogidas en la bibliografía sonprematuridad, bajo peso al nacimiento y bajapuntuación en la prueba de Apgar. La afectaciónplacentaria no implica afectación fetal en todos loscasos. El tratamiento se ha de posponer a finalizarla gestación por los posibles efectos teratogénicos

Chagas’ disease can be transmitted through verticaltransmission and breast feeding in non-endemicareas. Migration is spreading new diseases in theseareas, which may have diagnostic and therapeuticimplications in pregnancy. The main effects innewborns reported in the literature are prematurity,low birth weight, and low Apgar score. Placentalinvolvement does not imply fetal disease in allcases. Treatment must be postponed until the endof pregnancy due to the possibility of teratogenic effects (AU)

Metástasis mamaria de melanoma / Breast metastasis of melanoma

El melanoma es uno de los principales tumores que metastatizan en la mama. El problema es su diagnóstico, ya que no hay imágenes radiológicas específicas, por lo que el diagnóstico anatomopatológico es fundamental. Se comentan 2 casos clínicos donde la aparición de una lesión sospechosa de malignidad en la mama está precedida de un antecedente de melanoma. Se confirmó el diagnóstico de tumor metastásico en dichas lesiones mediante inmunohistoquímica y se descartó la cirugía. Ante la sospecha de una lesión metastásica en la mama, se debería realizar inmunohistoquímica mediante biopsia diferida o punción-aspiración con aguja fina, evitando así realizar una mastectomía en caso de confirmarse el diagnóstico

Melanoma is one of the main tumors metastasizing in the breast. Diagnosis is problematical since there are no specific radiological images and consequently histopathological diagnosis is essential. We report 2 cases in which the development of a breast lesion suspicious for malignancy was preceded by a melanoma. In both patients, the diagnosis of metastatic tumor was confirmed with immunohistochemical studies and surgery was avoided. When a metastatic breast lesion is suspected, immunohistochemical study with deferred or fine-needle aspiration should be performed. If the diagnosis is confirmed, mastectomy can be avoided

Evaluación de la seguridad y la eficacia de la endometrectomía histeroscópica en la menometrorragia / Safety and efficacy of hysteroscopic endometrectomy in patients with menometrorrhagia

Objetivo: Analizar la eficacia y la seguridad de la endometrectomía histeroscópica en pacientes con hemorragia uterina disfuncional. Material y métodos: Estudio retrospectivo de 119 pacientes con menometrorragias. Se evaluó la histología prequirúrgica y posquirúrgica, las complicaciones inmediatas y tardías, la recidiva de la sintomatología y la necesidad de reintervención. Resultados: La edad media de las pacientes fue de 45 años (rango, 25-72). Tras una mediana de seguimiento de 14 meses (rango, 9-54), el 92,8% de las mujeres mejoró de su metropatía. En el 30,9% persistió la amenorrea; en el 26,3%, la hipomenorrea; y en el 35,4%, la eumenorrea. Las complicaciones globales fueron del 5,9% (7 casos), 6 casos a corto plazo (3 perforaciones y 3 hemorragias intraoperatorias) y un caso de hematometra a largo plazo. Un 7,2% (8 casos) mantuvo menometrorragias tras la ablación. El fallo del tratamiento se asoció con la resección incompleta del endometrio y la presencia de complicaciones intraoperatorias. La tasa de respuesta se redujo con el tiempo: el 96% a los 6 meses y el 87% a los 3 años. Se realizó un 7,3% (8 casos) de reintervenciones, 3 de ellas histerectomías. Conclusiones: La ablación/resección endometrial o endometrectomía histeroscópica es un tratamiento seguro y efectivo en el manejo quirúrgico de la menometrorragia

Objective: To analyze the safety and efficacy of hysteroscopic endometrectomy in patients with menometrorrhagia. Material and methods: We performed a retrospective study of 119 patients with menometrorrhagia. Histology, early and late complications, symptom recurrence, and reinterventions were evaluated. Results: The mean age of the patients was 45 years (range, 25-72). With a median follow-up of 14 months (range, 9-54), menometrorrhagia was improved in 92.8%. A total of 30.9% showed amenorrhea, 26.3% hypomenorrhea, and 35.4% eumenorrhea. Complications occurred in seven patients (5.9%), early complications in six (three uterine perforations and three intraoperative hemorrhages), and there was one late complication (hematometra). Symptom recurrence was observed at the end of follow-up in eight patients (7.2%). Treatment failure was associated with incomplete endometrial resection and the presence of intraoperative complications. Treatment efficacy decreased during follow-up and was 96% at 6 months and 87% at 3 years. Reinterventions were performed in 7.3% (eight patients); of these, hysterectomy was performed in three patients. Conclusions: Hysteroscopic endometrectomy is a safe and effective surgical treatment for menometrorrhagia