Consejo genético en el cáncer de mama y ovario. ¿Y luego qué? / Genetic counselling in breast and ovarian cancer. And then what?

El avance en la medicina preventiva y predictiva aborda el estudio genético con el fin de identificar la presencia de genes que se asocian a patologías como el cáncer de mama y ovario, y cuya prevención y diagnóstico precoz guardan una clara relación con la supervivencia. La identificación de estos genes supone, por una parte, poder establecer medidas de prevención, pero también puede ser origen de conflictos ante las decisiones o perspectivas que plantean los resultados. En la siguiente revisión planteamos la manera en que los médicos de atención primaria y ginecólogos pueden orientar a la mujer en esta situación (AU)

The advances in preventive and predictive medicine has led to carrying out genetic studies with the purpose of identifying the presence of genes that are linked to diseases, such as breast and ovarian cancer, where prevention and early diagnosis are clearly connected to their survival. The identification of these genes means, on the one hand, that prevention measures can be established, but it also can be the origin of conflicts as regards the decisions or the future prospects arising from the results. In this review, we explain how primary care doctors and gynaecologists can guide women in this situation (AU)

Effect of a compound containing isoflavones, primrose oil and vitamin E in two different doses on climacteric symptoms.

The object of this study was to evaluate the effect of different doses of a compound containing isoflavones 60 mg, primrose oil 440 mg and vitamin E 10 mg. (IOVE) on menopausal complaints. This was an open, multicentre, randomised, group comparative, efficacy and safety trial. A total of 1,080 postmenopausal women, with climacteric symptoms, were allocated into one of two treatment groups to receive one (Group 1; n = 562) or two IOVE capsules (Group 2; n = 518) per day. The Blatt - Kupperman scale and safety parameters including weight, body mass index, blood pressure and adverse effects were assessed at the first visit before initiating the treatment, and 3 - 6 months thereafter. In addition, cholesterol, high density lipoprotein (HDL), low-density lipoprotein (LDL) and triglyceride levels were measured at baseline and at the 6th month visit. Finally, at the end of follow-up, the patient's satisfaction was assessed. No differences between groups at the beginning of the study and during the follow-up were observed. A significant reduction in Blatt - Kupperman scores were observed in the two groups. In addition, the reduction of the symptoms was more intense in the first 3 months. Increasing doses of IOVE add no beneficial effects since both studied doses were equally effective in the reduction of climacteric complaints.

Tumoración ovárica gigante de crecimiento retroperitoneal / Giant ovarian tumour, growing retroperitonealy

Se expone el caso clínico de una muchacha de 14 años que presenta una tumoración abdominal gigante, de evolución asintomática, que resultó ser un cistoadenoma seroso de ovario pero de crecimiento retroperitoneal. Se plantea como causa de esta anomalía anatómica el antecedente quirúrgico en la infancia de la corrección de una enfermedad de Hirschprung (AU)

Prophylaxis of osteoporosis with calcium, estrogens and/or eelcatonin: comparative longitudinal study of bone mass.

OBJECTIVE: To evaluate three different therapeutic regimens for the prevention of osteoporosis in natural and surgical postmenopausal women who had been found to have rapid bone loss in analytical studies. METHODS: A total of 104 naturally or surgically postmenopausal women were studied, and subsequently followed-up during 1 year for avoidance of the influence of seasonal variation on bone mass, a factor overlooked in several studies. They were randomized into four groups of 26 patients each: the untreated control group (mean age 50 +/- 5 years); the hormonal replacement treatment (HRT) group (mean age 48 +/- 6 years), which was treated for 24 days each month with transdermal 17 beta-estradiol, 50 mg/day, together with medroxiprogesterone, 10 mg during 12 days; the calcium group (mean age 50 +/- 4 years), which was treated with elemental calcium, 1 g/day; and the calcitonin group (mean age 50 +/- 5 years), which was treated for 10 days each month with eel calcitonin, 40 IU/day and with elemental calcium, 500 mg/day. Full-body bone densitometry, for measuring total body bone mineral content (TBBMC), was carried out in all the women at baseline and 1 year. TBBMC was corrected for body weight by dividing its value by body weight (TBBMC/W). RESULTS: After 1 year TBBMC/W was lower in every group: -2.14% (P < 0.001) in the control group; -0.14% (P = NS) in the HRT group (P < 0.05 vs. controls); -0.18% (P = NS) in the calcium group (P < 0.05 vs. controls); and -0.06% (P = NS) in the calcitonin group (P < 0.01 vs. controls; P < 0.05 vs. calcium and HRT). CONCLUSIONS: These findings show that all three treatments are effective in the prevention of postmenopausal loss of bone mass.

Clinical implications of natural killer (NK) cytotoxicity in patients with squamous cell carcinoma of the uterine cervix.

Natural killer (NK) activity in peripheral blood mononuclear cells (PBMC) from women with squamous cell carcinoma of the uterine cervix (SCCUC) was studied. PBMC were obtained from 26 previously untreated patients with SCCUC at different stages of disease according to the FIGO classification (5 at stage I, 4 at stage II, 5 at stage III, 6 at stage IVa, and 6 belonging to stage IVb), as well as from 23 healthy age-matched women. These cells were used as effectors against 51Cr-labeled K-562 target cells in standard 4-hr cytotoxic assays. The NK activity displayed by PBMC from patients with local stages of the neoplasm (I, II, III, and IVa) was found to be similar to that exerted by PBMC from healthy controls (P greater than 0.05). Furthermore, there were no significant differences among mean values of NK activity in PBMC from women at these different stages of the disease (P greater than 0.05). However, the NK activity detected in the PBMC of patients with distant metastatic spread of the disease (stage IVb) was significantly depressed with respect to both controls and patients at any other earlier stage (P less than 0.05). We conclude that a decrease in the NK activity present in PBMC from women with SCCUC coincides with distant tumoral dissemination of the disease.

[Immunobiology of materno-fetal relations]. / Inmunobiología de las relaciones materno-fetales.

Normal development of pregnancy requires maternal immune system tolerance towards the fetoplacental allograft. Natural Killer (NK) cells can display spontaneous lytic activity against tumoral, and poorly differentiated cells, without a prior sensitization. Moreover this cytotoxic activity is not restricted by the Major Histocompatibility Complex (MHC). We investigated the existence of modifications in the NK activity mediated by peripheral blood mononuclear cells (PBMC) from pregnant women. A significant depression was found in this activity from the first trimester to the puerperium that cannot be ascribed to a defective number of NK cells among pregnant's PBMC. However this impaired NK activity can be reconstituted in vitro by incubation of PBMC with interleukin 2 (IL 2). Pregnancy is also associated with an absence of effectors and/or precursors which mediate other cytotoxic non MHC-restricted activities after long term incubation with IL 2, the so called Lymphokine Activated Killer (LAK) cells.