Urinary and fecal incontinence in patients with advanced ovarian cancer treated with CRS + HIPEC.

PURPOSE: The objective of this work was to analyze the long-term prevalence of urinary and fecal incontinence and their impact on quality of life in patients with advanced and recurrent ovarian cancer treated with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (CRS + HIPEC). METHODS: This cross-sectional study included a series of patients with advanced and recurrent ovarian cancer treated by CRS + HIPEC, with a disease-free period of at least 12 months after the procedure. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), fecal incontinence using the Wexner test and the Fecal Incontinence Quality of Life (FIQL) questionnaire and global quality of life using the Short Form 36 (SF-36) survey. RESULTS: A total of 64 patients were included in the study, with a median age of 55 years (range 28-78). The urinary incontinence rate was 45% and the fecal incontinence rate was 20%. Up to 14% of the patients presented both types of incontinence. The presence of urinary or fecal incontinence generated a significant negative impact on quality of life in relation to patients without incontinence. DISCUSSION: Urinary and fecal incontinence is frequent in the follow-up of ovarian cancer patients treated with CRS + HIPEC. Reconsidering the approach to the pelvis without peritoneal metastases in the peritoneum could modify the incidence of these pelvic floor dysfunctions.

Evaluation of hopelessness in patients with endometriosis / Evaluación de desesperanza en pacientes con endometriosis

Purpose: To explore the prevalence of hopelessness in patients diagnosed with endometriosis and how it may influence their relationships. Material and methods: Prospective–descriptive study among patients with a clinical and/or anatomopathological diagnosis of endometriosis. Demographic data (age, religion, educational level, marital status, occupation, etc.) and pain data have been processed. Pain associated with endometriosis has been evaluated with an analogue scale of pain. The Beck Hopelessness Scale (BHS) was used to determine the level of hopelessness. The results have been classified into 0–3 normal; 4–8 mild; 9–14 moderate and 15–20 severe. SPSS Statistics 26 has been used and the statistical significance has been stipulated at p<0.05. Results: One hundred and ten patients have been recruited with an average age of 39.8±7.09 years. The average on the Beck Hopelessness Scale is 5.08 with a SD 3.14. In our sample, we obtained that 38.2% of women experienced some level of hopelessness at the time the questionnaire was completed (mild=28.2%, moderate=9.1%, severe=0.9%). We found a significant relation between hopelessness and low income but not with regard to education, employment status or marital status. Regarding the pain experienced and its relation with hopelessness, we found that it was significantly connected to pain during urination and dyspareunia and not to chronic pelvic pain dysmenorrhea and dyschezia. Conclusion: Four out of ten patients with endometriosis experience hopelessness, mostly mildly. This hopelessness is influenced by demographic factors such as income level and also pain, specifically pain during intercourse and during urination.(AU)

Antecedentes: El objetivo es analizar la prevalencia de desesperanza en pacientes con endometriosis y cuáles pueden ser los factores relacionados con la misma. Material y método: Se ha desarrollado un estudio prospectivo descriptivo entre mujeres con diagnóstico clínico y/o anatomopatológico de endometriosis. Se recogieron datos demográficos junto al grado de dolor evaluado por la escala visual analógica. Para el estudio de la desesperanza se ha empleado la Escala de Desesperanza de Beck (BHS). Los resultados fueron clasificados en 0-3 normal; 4-8 leve; 9-14 moderado y de 15-20 como severa. El programa estadístico empleado fue Statistical Package for the Social Sciences (SPSS) 26 (IBM Corp, Armonk, NY, USA) y se estipuló la significancia estadística en p<0,05. Resultados: Un total de 110 pacientes fueron encuestadas con una edad media 39,8±7,09 años. La media obtenida en la escala es de 5,08 con una desviación estándar (DE) de 3,14. En nuestro estudio 38,2% de las participantes experimentaban desesperanza en algún grado (leve=28,2%, moderado=9,1%, severa=0,9%). Se ha encontrado una relación significativa entre la experimentación de desesperanza con usuarias con recursos económicos más bajos, pero no con la educación, situación laboral o estado civil. Con respecto al malestar experimentado, hemos observado una asociación con el provocado durante la micción o las relaciones sexuales, pero no con la disquecia, dismenorrea o el dolor pélvico crónico. Conclusión: Cuatro de cada 10 pacientes con endometriosis experimentan un grado de desesperanza, principalmente leve. Se relaciona con dispareunia y dolor en la micción, así como en mujeres con bajos recursos económicos.(AU)

Meningioma en gestante afecta de endometriosis profunda. A propósito de un caso / Meningioma in pregnant women affected by deep endometriosis. About a case

RESUMEN El siguiente caso clínico trata de una paciente, gestante tras fecundación in vitro, afecta de endometriosis profunda. Dicha paciente debutó durante el embarazo con un síndrome del seno cavernoso con cefalea e hipoestesia facial, siendo diagnosticada tras una exploración neurológica detallada y las pruebas complementarias pertinentes de un meningioma. Por este motivo, tuvo que ser sometida a una cesárea previa al abordaje terapéutico del tumor, dado el empeoramiento clínico progresivo que se estaba produciendo. Dado que en la literatura científica la asociación entre la endometriosis y la aparición de meningiomas ya ha sido descrita, con este caso clínico intentaremos acercarnos a las posibles causas de dicha asociación, como podría ser el ambiente predominantemente estrogénico de las pacientes con endometriosis. De igual modo, abordaremos el manejo del meningioma tanto dentro como fuera del embarazo, sirviéndonos para ello de la bibliografía disponible.

ABSTRACT A pregnancy woman affected by deep endometriosis is presented in this clinical case. A cavernous sinus syndrome was diagnosed during her pregnancy. She started suffering from headache and facial hypoesthesia. After a detailed neurological examination and the relevant complementary tests the patient was diagnosed of a meningioma. Given the progressive clinical worsening that was taking place, she had to undergo a cesarean section prior to the therapeutic approach of the tumor. Through this clinical case we will try to approach the possible causes of the association between endometriosis and meningioma, such as the predominantly estrogenic environment of patients with endometriosis. Similarly, we will address the management of meningioma both inside and outside of pregnancy, using the related available literature.

Intrauterine growth retardation at term: association between anthropometric and endocrine parameters.

OBJECTIVE: To investigate the endocrine profile of the intrauterine growth retardation newborns and its association with anthropometric parameters at birth. STUDY DESIGN: This is a case-control study of 76 full term gestations, of which 31 were diagnosed as intrauterine growth retardation (IUGR) confirmed at birth, and 45 as normal births. Insulin, insulin-like growth factor I (IGF-I), growth hormone (GH), thyroid stimulating hormone (TSH), hydrocortisone, prolactin and 15 metabolic parameters were measured in maternal blood antepartum, amniotic fluid and umbilical cord blood at birth. RESULTS: Blood taken from the umbilical cord in the IUGR group had statistically significant lower levels of IGF-I, insulin and TSH, but higher levels of GH. In amniotic fluid and maternal blood, IUGR babies had lower levels of cortisol. The changes in GH and glucose levels in cord blood of IUGR babies were independently associated to birth weight variability (Adjusted regression coefficient-squared=0.09 and 0.17 respectively). Ponderal index (weight/length3) among IUGR babies was independently associated with metabolic changes in amniotic fluid (Adjusted regression coefficient-squared=0.35). CONCLUSIONS: The endocrine profile of IUGR fetus would be: hypoinsulinemic, hypothyrotropinemic, hypoglycemic, hypoalbuminemic, hypocholesterolemic and hypermagnesemic with lower IGF-I levels, yet higher than normal group GH levels at birth. Triglycerides in amniotic fluid; GH, Glucose and Mg changes in cord blood of IUGR babies were independently associated with birth weight variability.

¿Ingieren suficiente calcio nuestras gestantes? / Is calcium intake adequate in pregnant women in Spain?

Objetivo: Cuantificar el consumo de calcio en una población de gestantes españolas. Material y métodos: Se realizó un estudio observacional prospectivo a 115 gestantes. A través de una encuesta dietética recordatoria de 7 días en las semanas 15 y 28 de la gestación, se analizó el consumo diario de calcio, la evolución durante la gestación, así como las diferencias entre gestantes procedentes de un área urbana o rural. Resultados: El consumo medio de calcio en la semana 15 fue de 930,60 ± 300,71 mg/día (rango, 345-1.462), y en la semana 28 de 1.083,03 ± 330,59 mg/día (rango, 274-2.150). Un 76,8% de nuestras gestantes tuvieron un consumo por debajo de la ingesta diaria recomendada para la población española gestante. No hubo diferencias significativas entre el principio y el final de la gestación ni entre embarazadas procedentes de un área urbana o rural. Conclusiones: Un alto porcentaje de nuestra población tuvo un consumo de calcio deficitario

Objective: To quantify calcium intake in a group of pregnant Spanish women. Material and methods: A total of 115 pregnant women were evaluated in a prospective observational study. Dietary information was prospectively collected from pregnant women at 15 and 28 weeks' gestation using 7-day food records. Daily calcium intake throughout pregnancy, as well as differences between rural and urban populations, were analyzed. Results: The mean calcium intake was 930.60 ± 300.71 mg/day (range, 345-1,462) at 15 weeks' gestation and 1,083.03 ± 330.59 mg/day (range, 274-2,150) at 28 weeks' gestation. In 76.8% of the respondents, dietary calcium intake was below the recommended daily intake for pregnant women in Spain. No significant differences were found between early and late pregnancy or between rural and urban populations. Conclusions: Dietary calcium intake is deficient in a high percentage of pregnant women in Spain

El cáncer de endometrio en la década de los 90. Análisis de 126 casos / Endometrial cancer in the 90s. Analysis of 126 cases

Propósito: Analizar la casuística y la evolución del cáncer de endometrio en nuestra Área Sanitaria durante la década de los años 90.• Material y métodos: Se trata de un trabajo retrospectivo. Se revisaron 126 casos de cáncer de endometrio diagnosticados entre enero de 1990 y diciembre 1999 en el Hospital Universitario Príncipe de Asturias de Alcalá de Henares. Se utilizó la clasificación anatomo-clínica FIGO-2000.• Resultados: La edad media fue de 60.3 ñ 11.5 años. La histeroscopia y biopsia de endometrio fue el método diagnóstico mas frecuente (89 por ciento), sobre todo a partir del año 1994. En el 97.6 por ciento de los casos se realizó cirugía, recibieron radioterapia el 33 por ciento con un tiempo medio de seguimiento de 56 ñ 20 meses (1-100). La mayoría de los tumores eran diagnosticados en estadio I (74 por ciento). Histológicamente, el 93 por ciento correspondían al tipo endometrioide. Un 13 por ciento de las pacientes presentaban tumores coincidentes, especialmente cáncer de mama. La remisión completa tras el tratamiento inicial se ha obtenido en el 93.6 por ciento de los casos con unas tasas de supervivencia a los 10 años del 79 por ciento.• Conclusiones: La histeroscopia con biopsia de endometrio se ha impuesto como técnica diagnóstica en esta década. La cirugía se mantiene como tratamiento primario primordial, y las tasas de supervivencia, en la actualidad, son elevadas. (AU)