Clinica e Investigacion en Ginecologia y Obstetricia最新文献

Endometriosis is a chronic, inflammatory gynecological pathology characterized by the presence of endometrial tissue outside the uterus. Clinical manifestations include chronic pelvic pain, fatigue, dysmenorrhea, dyspareunia, infertility, dysuria and dyschezia. Physical therapy can be part of the symptomatic treatment of endometriosis; therefore, this review aims to analyze the scientific literature to evaluate the effect of physical therapy in endometriosis. A bibliographic search was carried out during the first two weeks of December 2022 in the databases PubMed, Medline, Scopus, Web of Science, PEDro, CINAHL and ENFISPO. The descriptors “Endometriosis” “Physical Therapy Modalities”, “Physiotherapy”, “Physiotherapist”, “Physical therapy” and “Physical rehabilitation” were used. Results were limited to randomized clinical studies published in English or Spanish. A total of 943 results were obtained, of which 6 were selected after applying the eligibility criteria. The selected studies develop different physiotherapy interventions with techniques such as electrotherapy with TENS and high intensity pulsed laser, progressive muscle relaxation training, aerobic training, manual therapy, and therapeutic exercise through yoga. Physiotherapy appears to provide benefits in terms of reducing pelvic pain and improving quality of life in women with endometriosis.

Introduction

Metaplastic breast carcinoma (MBC) is a rare and aggressive type of breast cancer that is often diagnosed in advanced stages, with large tumors and a high histological grade. In this study, we present a case of MBC, and conduct a review and discussion of the related literature.

Main symptoms or clinical findings

A 35-year-old patient with no relevant personal or family history presents with a progressively growing 2 cm breast mass, which, over time, develops into nipple retraction and breast pain. A breast ultrasound reveals a suspicious-looking polilobulated solid mass. In summary: a BI-RADS 5 mass in the left breast.

Main diagnoses, therapeutic interventions, and outcomes

A core biopsy is performed, and the pathology report reveals an infiltrating ductal carcinoma, metaplastic variety, triple-negative with PDL1 expression > 1%. A modified radical mastectomy is performed. During follow-up, pulmonary metastasis is diagnosed, and the patient receives first and second-line systemic treatment.

Conclusions

Given the aggressive nature of this type of tumor and the limited treatment options available, participation in clinical trials may be considered to improve outcomes in these patients. A multidisciplinary approach, and review in a tumor committee are essential to guide therapeutic decisions and provide the best possible care for these patients.

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Objectives

To assess whether there is a higher rate of adverse obstetric outcomes, postpartum urinary incontinence, and sexual problems among women who give birth over 50.

Material and methods

A single-center ambispective observational study. Rate of cesarean birth, gestational diabetes, preeclampsia, intrauterine growth restriction (IUGR), prematurity, urinary incontinence (Incontinence Questionnaire Short Form [ICIQ-SF]), and sexual dysfunction (Female Sexual Function Index [FSFI-6]) were recorded.

Results

Twenty-five (0.06%) of 38,510 births occurred in women over 50 during the study period. There were 16 (64%) cesarean births. Seven (28%) women had gestational diabetes. Preeclampsia was diagnosed in 3 (12%) women. There were 5 (20%) cases of IUGR. There were 5 (20%) preterm births. The differences in the rate of cesarean birth, gestational diabetes, and IUGR between the study group and the total population were statistically significant. The results of the ICIQ-SF and FSFI-6 questionnaires were obtained from 17 women. Some degree of urinary incontinence was found in 7 (41.1%) and sexual dysfunction in 9 (52.9%) women.

Conclusions

Pregnancies in women over 50 may be associated with a higher rate of gestational diabetes, IUGR, and preeclampsia. There is a high prevalence of urinary incontinence and sexual problems among these women.

Introduction

Atypical endometriosis is considered a precursor lesion to cancer associated with endometriosis. Two types of atypical endometriosis have been proposed: an architectural type with a higher risk of malignancy and a cytological type with a lower potential for malignancy.

Main symptoms and/or clinical findings

A 37-year-old Caucasian woman presented with umbilical bleeding coinciding with menstruation. On physical examination, two small, bluish lesions were observed in the umbilical scar.

Primary diagnosis

This clinical case is of interest because it describes a lesion of atypical architectural endometriosis located in the navel.

Therapeutic interventions and results

The microscopic and immunohistochemical characteristics of the lesion were examined. The presence of nuclear stratification, hyperchromatism, and pleomorphism were observed as microscopic qualities. In terms of the immunohistochemical panel, the degree of cell proliferation was analyzed using Ki 67, BAF250a was used as the surrogate marker of ARID 1A, inflammation was assessed through COX, and estrogen and progesterone receptors were examined. The results showed increased cellular activity, the presence of inflammation, and no mutation of the ARID1a gene, with moderate cell proliferation.

Conclusion

Umbilical endometriosis is rare, and while malignancy is infrequent, it is possible. For this reason, a complete anatomopathological study including an immunohistochemical panel should be performed to diagnose atypical endometriosis.

Introduction

The main objective is to study the NK markers present in circulating blood in patients with high grade intraepithelial cervical lesions compared with women without lesions or low grade lesions. The secondary objectives of the study are to understand the relationship between the NK memory like cells and the infection with HPV, as well as the persistence of the infection.

Methods and materials

It is an observational prospective study that studies women from 2019 for 2 years seen in ginecology rooms in Hospital Clínico San Carlos. The group of patients studied are: women with infection by HPV and high grade lesions, women with infection by HPV but no lesion or low grade lesion and women without lesion or infection.

Results

We have recruited 115 patients. We have found more memory like NK cells in patients infected by HPV. And when we analyze the non-smoking patients, the expression of NKp30 is lower in patients infected without lesion.

Conclusions

The results show that there could be less capacity to generate an adaptative function by NK in smoking patients than in non-smoking. A better knowledge of the NK cells biology and its role in the infection by HPV could allow us to manipulate with a therapeutic and prognostic end.

The growing commitment to gynecological health has highlighted the need to update the approach to endometriosis. Therefore, a comprehensive review of the scientific literature has been carried out to gather the latest relevant advances in its healthcare. In this regard, a gynecology congress was held on September 30 and October 1, bringing together various experts to review clinical, pharmacological, and cutting-edge aspects.

The review emphasizes the direct, indirect, and soft markers that determine the presence of endometriosis during examination, as well as the appropriate guidelines for diagnosis through imaging tests. Furthermore, it discusses the importance of conducting a complete and detailed diagnosis in patients exhibiting symptoms of the disease.

Additionally, it highlights advancements in the treatment of this condition, with a particular emphasis on the benefits of N-acetyl cysteine. Finally, it explores the role of surgery, emphasizing its advantages but pointing out that endometriosis should not always be associated with surgery since it can entail numerous complications.

Objective

To reflect from the analysis of the data of the number of laparoscopic hysterectomies that each member of a gynaecology service of a tertiary hospital can perform on the convenience of limiting this procedure to a limited number of professionals.

Material and methods

Retrospective, descriptive study on hysterectomies performed for any indication in our hospital in the period between May 1, 2014 and April 30, 2022.

Results

In this period, we have performed 1548 hysterectomies of which 760 were performed laparoscopically and of these, 289 were indicated for benign pathology. Considering the total number of professionals that make up the pool of surgeons who perform surgery for benign pathology, the average number of laparoscopic hysterectomies per surgeon per year would be 1.4 cases.

Conclusions

To ensure adequate quality of surgery, the number of professionals performing laparoscopic hysterectomies in a tertiary hospital should be limited.

Introduction

The aim of this paper is to describe and analyze the perinatal outcomes of a series of TAPS cases followed and treated in a Fetal Medicine referral center, in terms of the type of TAPS and the prenatal behavior applied.

Methods

Descriptive and inferential statistical analysis with IBM SPSS Statistics software.

Results

Thirteen cases of TAPS were diagnosed in a total of 510 monocorial gestations. Most of the spontaneous TAPS were diagnosed at early stages (5 cases), whereas, in post-laser TAPS, 3/6 cases were diagnosed at advanced stages.

Four fetuses (4/26; 15.4%) presented alterations in neurosonography, 3 (3/14; 21.4%) in spontaneous TAPS and one (1/12, 8.3%) in post-laser TAPS (P=0.308).

Myocardial hypertrophy was detected in 7 fetuses, 5 (71.4%) of which corresponded to advanced stage TAPS. Four were spontaneous TAPS (4/14; 28.6%) and 3 were post-laser TAPS (3/12; 25%) (P=0.797).

Eight cases (8/13; 62.5%) required some fetal therapy procedure.

There were 3 antepartum fetal deaths and one couple decided to legally terminate the pregnancy (19.23%). All 5 losses were stage IV (P=0.008).

Overall survival was 80.8% (21/26 live newborns). There were no significant differences according to the type of TAPS (P= 0.159) and the prenatal behavior adopted (P=0.746).

Conclusions

Spontaneous TAPS is therefore a clinical entity with an impact on perinatal outcomes similar to post-laser. It seems that expectant management and laser achieve higher gestational age at birth.

Many women across the world suffer from endometriosis. This disease should be staged by laparoscopy in order to know the extent of disease. Ultrasound may be a reliable diagnostic tool that could complement laparoscopy for endometriosis staging. The aim of this study is to perform a narrative review of the current status of studies comparing ultrasound findings and laparoscopic staging according to American Society Reproductive Medicine (ASRM) and ENZIAN classifications. A search in PubMed and Web of Science databases from 2004 to 2022 was performed using the following terms “endometriosis”, “ultrasound”, “laparoscopy”, “ENZIAN” and “ASRM”. We focused on the accuracy of sonography using laparoscopy as gold standard. Seven studies were ultimately included. We observed that ultrasound is accurate and correlates well with advanced stages in the case of ASRM classification, and correlates well with ENZIAN classification. However, some limitations came up. There is little scientific information out there regarding this specific topic. Some of the studies have a retrospective design and one of them has a small sample size. In addition to this, even if ultrasound could have a relevant role in staging deep endometriosis, this method is highly dependent on the operator's experience. We conclude that diagnostic performance of transvaginal ultrasound (TVS) for evaluating the extent of disease in women with pelvic endometriosis is high. However, evidence is still limited and further studies are needed.

Objective

To analyze the level of knowledge of endometriosis in primary care doctors and midwives and to identify their training needs in this area.

Design

Descriptive study conducted in the primary care services of the Health Area of Gran Canaria, through an anonymous online questionnaire.

Results

One hundred and nineteen doctors and 37 midwives completed the questionnaire; 54.6% of doctors and 67.6% of midwives considered that their knowledge about endometriosis was poor. Less than 50% of healthcare professionals knew the National System of Health's guidelines for the management of women with endometriosis. Symptoms most frequently associated to endometriosis included: moderate/severe dysmenorrhea, chronic pelvic pain and sterility. Less frequently related ones included: digestive symptoms and catamenial urinary disorders; 80% of doctors suspected endometriosis in <10 women per year; 75% of midwives suspected this condition in <20 women per year; 40% of doctors would prescribe oral contraceptives to patients with dysmenorrhea who were not planning pregnancy; 8% of doctors considered that menstruation-associated pain was common. Medical therapy was the most frequently chosen first-line treatment; 25% of doctors would choose long-term NSAIDs therapy as a first-line treatment; less than 25% of them would refer a patient to the Gynecology service only for suspected endometriosis. Most health professionals expressed their interest in improving their knowledge about endometriosis; 94.6% of midwives considered that they played a strategic role in the identification and management of patients with endometriosis.

Conclusion

Delays in the diagnosis of endometriosis are partially due to ignorance of the disease. Primary care professionals constitute the first line of health care. In this context, it is essential to develop specific training strategies, which would be welcome by health professionals.