Clinica e Investigacion en Ginecologia y Obstetricia最新文献

Background

With diagnostic and treatment advancements in cancer management, the need for improvement of survivors’ quality of life has been increasing. One of the issues affecting the quality of life in gynecologic cancer survivors is a decline in their sexual function, which is affected in many ways. In order to assess sexual dysfunction in gynecologic cancer survivors.

Objective

This study is designed to assess different areas of sexual function including desire, arousal, vaginal lubrication, orgasm, satisfaction, and pain.

Materials and methods

Patients who had completed treatment since 6 months to 6 years ago included in the case–control study starting from January 2019 to January 2020. Twenty-nine sexually active gynecologic cancer survivors with sexual dysfunction were enrolled as cases and 91 sexually active ones without sexual problems were assigned to the control group. The Female Sexual Function Index (FSFI) questionnaire consisting of 19-items and six areas was completed for each participant.

Results

Average sexual dysfunction score of the case group was 16.78 with cut-off point of 28 for dysfunction. The most common domain of sexual dysfunction was pain (96.55%), followed by sexual arousal (86.21%), vaginal lubrication (72.41%), orgasm (72.41%), satisfaction (65.52%) and sexual desire (55.17%).

Conclusion

In gynecologic cancer survivors, sexual dysfunction was directly related to employment, brachytherapy and co-existing DM and inversely related to the time elapsed since cancer diagnosis and menopause. Asking about sexual problems and referral to a specialist should be included in the patient treatment process.

Introduction

Sclerosing stromal tumors (SSTs) are rare benign ovarian tumors. They represent 6% of sex cord stromal tumors. Its preoperative diagnosis is often a challenge due to its similarity to malignant tumors on ultrasound imaging. We present two cases of SSTs to emphasize the consideration of this type of tumors in the differential diagnosis of solid adnexal masses in young women. A review of the literature on the typical ultrasound features, clinical presentation, and management of SSTs was performed.

Main symptoms and/or clinical findings

Pelvic pain was the main symptom in both cases. In the first case, transvaginal ultrasound revealed an unilocular solid adnexal mass of 59 mm × 44 mm × 45 mm with cystic areas and marked peripheral and central vascularization. MRI (magnetic resonance imaging) revealed a 50 mm × 50 mm heterogeneous adnexal mass with a solid peripheral component and a cystic-necrotic center. In the second case, pelvic ultrasound showed a solid cystic adnexal mass of 103 mm × 77 mm with marked peripheral vascularity.

Main diagnoses

Postoperative anatomopathological diagnosis in both cases was an ovarian SST.

Therapeutic interventions and results

Unilateral laparoscopic salpingo-oophorectomy and oophorectomy, respectively, was performed without incidents. There has been no recurrence during follow-up.

Conclusion

It is important to consider SSTs in the differential diagnosis of young women with a unilateral solid-cystic adnexal mass with a high degree of peripheral and central vascularization. Laparoscopic approach together with fertility-sparing techniques should be considered the treatment of choice.

Endometriosis is a very complex disease that limits the lives of women who suffer from it in many areas of their lives, both due to the painful symptoms it causes and the medical complications it generates. In addition, it is capable of causing sterility by different mechanisms.

In the present work we intend to review the management of the patient with endometriosis and sterility, which has important particularities with respect to the usual treatment of endometriosis. Most of the medical treatments used have an anovulatory effect, which is why they prevent pregnancy, and surgical treatments can in turn have a detrimental effect on the ovarian reserve and the time necessary to achieve pregnancy. On the other hand, assisted reproduction techniques do not always achieve the desired objective and may require associated surgeries such as in the case of the presence of hydrosalpinx or ovaries not accessible to follicular puncture.

We also carried out a critical review of the medical literature and the guidelines of the different scientific societies to try to establish general criteria for the approach to these patients with endometriosis and sterility, who as a general rule should be treated by assisted reproductive techniques. A special analysis is made of the specific situations in which a differentiated approach with previous surgery is required when the function of a pelvic organ is in danger or in deep endometriosis.

Uterine fibroids are a frequent pathology that mainly affects women in their third and fourth decade of life. Most are asymptomatic. However, some may have a significant clinical impact or on the fertility of the patient. Recently there have been relevant changes in the diagnosis and management of this entity. This paper aims to summarize these changes discussed at the 1 st National Congress of the Spanish Society for the Study of Fibroids and Endometriosis.

Introduction

To compare maternal vitamin D levels with the area of residence or the consumption of fish, as well as its relationship with the weight, length and cranial perimeter of babies.

Materials and methods

Cohort of 100 mother–child pairs (n = 100) from the province of Seville (Virgen del Rocío University Hospital and Valme University Hospital). In maternal blood samples (gestational age ≥ 40 weeks) 25(OH)D levels have been measured by chemiluminescence. Anthropometric measurements of the babies were made using standard methods.

Results

Regarding vitamin D levels, 54% had deficient values, 26% insufficient and 20% sufficient values. After a multiple regression analysis, it is observed that there is no significant difference between maternal vitamin D levels, the length and the cephalic perimeter of the babies, however, there is a difference with the birth weight (P < .05). When applying the t-Student and the Wilcoxon test, there is no relationship between vitamin D levels and the area of residence or with maternal fish consumption (both P > .05).

Conclusions

Eighty percent of mothers present deficient and insufficient values of vitamin D. There is no correlation between this parameter and the length and cephalic perimeter of the baby, observing a negative correlation with birth weight. No correlation was observed between the area of residence or the consumption of fish and vitamin D levels in mothers. We suggest dietary supplements for pregnant mothers and monitoring of vitamin D levels in babies.

Endometriosis is nowadays considered an inflammatory chronic benign disease that responds to hormone manipulation and affects up to 10% of women in fertile age. It seems that innate or acquired changes in the endometrium ability to implant, invade and grow in an inflammatory milieu with estrogenic dependence and progesterone resistance are the responsible for new endometriosis implants and contribute to perpetuate the illness. There is, at the moment, no optimal known treatment that achieves the four basic objectives for the treatment of endometriosis: treat the symptoms, improve fertility, eliminate endometrial implants, and avoid illness progression. As is now considered a chronic condition, the prescribed medical treatment, until the patient arrives to the physiological menopause status or gets pregnant, must be considered in the long term, and must be effective and safe. Therefore, the realistic objectives of the treatment are the reduction or abolishment of symptoms and/or improve fertility. As a consequence of the limitations and risks of endometriosis surgeries, the first-line treatment is hormonal. This must be individualized according to age, parity, pregnancy desire, associated symptoms, other illnesses and patients preferences. Globally, there are two main types of first-line hormonal treatments: estroprogestins in extended or continuous regimens and some progestins in different routes of administration (dienogest, norethisterone acetate or desogestrel orally, and levonorgestrel high-dose intrauterine device). The different hormonal treatments and their pros and cons are explained in the manuscript.

Uterine fibroids are the most common tumours in women of reproductive age, but only 25% of women will require treatment due to the presence of symptoms. There are few randomised studies that have compared the different treatment options for uterine myoma; for the moment, surgery remains the option that offers the best rates of symptomatic resolution, improved quality of life, and a lower recurrence rate. Despite the widespread use of myoma surgery, it seems reasonable to believe that by reducing surgical treatments, either with less invasive therapies or with new medical treatments, both associated morbidity and costs would be reduced. In this sense, ablative techniques for myoma treatment, UAE, HIFU, and radiofrequency, have demonstrated results in terms of symptomatic control and quality of life comparable to surgery, with a low rate of major complications. Recurrence rates and the impact on patients’ future fertility would be the main concern. Future long-term comparative studies of ablative techniques and surgical approaches are needed.

Primary ovarian failure is a condition in which women under 40 experience oligomenorrhea or amenorrhea for 4 months or longer; this early ovarian function loss may be related to a series of etiologies, including genetic disorders, autoimmune diseases, infections or iatrogenic causes; however 74%-90% are idiopathic. Despite being a less prevalent disorder, it is of great clinical importance since it affects all women in multiple aspects of life. At present, different studies are being developed in order to find new molecular targets to establish new therapies for the treatment of this pathology.

Introduction

Primary malignant cervical lymphoma is a very rare disease, which represents only 0.008% of all cervical tumors and 2% of all female extranodal lymphomas.

Main symptoms and/or clinical findings

The case of a 66-year-old woman from the Peruvian Andes is presented, with a disease period of 4 months characterized by gynaecorrhagia, with evidence of a 5 cm tumor cervix. Immunohistochemistry was performed on the biopsy of cervix to differentiate lymphoma from squamous cell carcinoma.

Primary diagnosis

Primary diffuse large B-cell lymphoma of the cervix with Ann Arbor IE IPI low-risk staging.

Therapeutic interventions and results

She being managed with immunochemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone), followed by consolidative external radiotherapy at a dose of 3,000 cGy in 15 sessions with a special IMRT technique. Resulting in satisfactory disease control and no complications from irradiation.

Conclusion

Primary diffuse large B-cell lymphoma of the cervix is very rare, therefore, in a case of primary stromal lesion of the cervix, suspicion of lymphoma should be taken into account.

Background

Ovarian cancer is the fifth deadliest cancer among women. There is no effective screening method. It has been suggested that ovarian cancer originates from precursor lesions in the fimbriae of the fallopian tubes.

Objective

The aim of this study was to determine the level of knowledge of opportunistic bilateral salpingectomy by gynecologists.

Methods

A cross-sectional study was carried out and a survey was sent electronically to gynecologists and gynecology residents. Demographic characteristics as well as questions of interest related to clinical practice and indication for surgery were included.

Results

52 subjects were included, 21 women and 31 men, with a mean age of 40.7 years. Thirty-five board certified gynecologists, as well as 17 gynecology residents, were included as part of the total survey group. Thirty-six individuals (69.2%) reported performing elective salpingectomy. The motivation they had to perform salpingectomy as a method of sterilization was: “reduction in the risk of ovarian cancer in the future” (55.6%). The indication for elective salpingectomy while performing other procedures was: “to prevent ovarian cancer” (61.1%). Certified gynecologists (42.9%) as well as residents (41.1%) considered “transvaginal ultrasound screening” as the best primary prevention method for ovarian cancer in low-risk women.

Conclusions

Opportunistic bilateral salpingectomy is safe and cost-effective. However, when gynecologists are interviewed to find out their level of knowledge, there is poor acceptance of opportunistic bilateral salpingectomy in Mexico. A training strategy should be designed in the gynecology residency in order to motivate ovarian cancer prevention.