Manejo con cirugía conservadora de tumor mucinoso infiltrante ovárico coexistente con tumor mucinoso borderline contralateral en gestante de 8 semanas / Conservative surgery for management of invasive mucinous ovarian tumor with concurrent borderline mucinous tumor on contralateral ovary in a woman in 8th week of pregnancy

INTRODUCCIÓN: Aproximadamente un 4% de mujeres embarazadas presentan tumoraciones anexiales en el primer trimestre de gestación, siendo la mayoría quistes anexiales simples. Solo el 1,5% persisten tras el primer trimestre y en torno al 0,9% son malignos. CASO CLÍNICO: Paciente de 31 años que consultó en urgencias por sangrado y amenorrea de 5 semanas. La ecografía transvaginal evidenció un saco gestacional intraútero y una tumoración anexial izquierda compleja de 68 mm, multilocular, sólida, de ecogenicidad mixta, con septos gruesos y un área sólida vascularizada de 40 mm, sospechosa de neoplasia de ovario. Se realizó manejo quirúrgico conservador mediante anexectomía bilateral laparoscópica en la octava semana de gestación. El diagnóstico fue de adenocarcinoma mucinoso infiltrante bien diferenciado en ovario derecho, coexistente con tumor mucinoso borderline en ovario izquierdo (etapa IC FIGO). El embarazo cursó con normalidad, a excepción de feto pequeño para la edad gestacional en la semana 39. Se finalizó la gestación en la semana 40 mediante parto vaginal. Debido al deseo de la paciente, la cirugía se realizó en el primer trimestre de embarazo en lugar de en el segundo como se recomienda. La cirugía se completó meses después del parto, con histerectomía y apendicectomía laparoscópica. DISCUSIÓN: El cáncer de ovario es el segundo tumor ginecológico más diagnosticado durante el embarazo. Suele diagnosticarse en el primer trimestre debido al cribado ecográfico gestacional. Ocurre en mujeres con baja paridad y en sus últimos años de edad reproductiva. Esto podría verse reflejado en un aumento de su incidencia debido al retraso de la edad materna al primer embarazo. Normalmente se diagnostica en etapa I, siendo entonces la supervivencia superior al 90% a los 5 años. En etapas iniciales en mujeres embarazadas, la laparoscopia es tan válida como la laparotomía.

INTRODUCTION: Approximately 4% of pregnant women present adnexal tumors in the first trimester of gestation, the majority being simple adnexal cysts. Only 1.5% persist after the first trimester and around 0.9% are malignant. CASE REPORT: 31-year-old patient who came to the emergency room because of spotting and 5-week amenorrhea. A transvaginal ultrasound revealed an intrauterine gestational sac and a 69 mm complex multiocular-solid left adnexal tumor, with thick septa and a solid vascularized area of 40 mm, with suspicion of ovarian neoplasia. Conservative surgical management was performed through laparoscopic bilateral salpingo-oophorectomy in eighth week of gestation. The diagnosis was a well-differentiated infiltrating mucinous adenocarcinoma in the right ovary, and a coexisting borderline mucinous tumor in the left ovary (FIGO stage IC). The pregnancy proceeded normally except for a small for gestational age fetus at week 39 and pregnancy was completed at week 40 by vaginal delivery. Due to the patients wishes, the surgery was performed in the 1st trimester of pregnancy instead in the 2nd as is recommended. Final surgery was completed after giving birth, with laparoscopic hysterectomy and appendectomy. DISCUSSION: Ovarian cancer is the second most diagnosed gynecological tumor during pregnancy. It is usually diagnosed during the first trimester with gestational ultrasound screening. It occurs in women with low parity and in their later years of reproductive age. This could be reflected in an increase in its incidence due to the delay in the age of first pregnancy. Normally it is diagnosed in stage I, when the survival rate is superior to 90% after 5 years. In early stages, laparoscopic surgery in pregnant women is as valid as laparotomy.

Female Genital Mutilation Consequences and Healthcare Received among Migrant Women: A Phenomenological Qualitative Study.

European healthcare systems are increasingly being challenged to respond to female genital mutilation (FGM). This study explores the FGM experiences of migrant women coming from FGM-practicing countries residing in a European host country. A qualitative phenomenological study was carried out and 23 participants were included. Data were collected through 18 face-to-face open-ended interviews and a focus group and were analysed using Giorgi's four-step phenomenological approach. Three main themes were derived: "FGM consequences", "healthcare received" and "tackling FGM". Participants highlighted obstetric, gynaecological and genitourinary consequences such as haemorrhages, perineal tears, caesarean delivery, risk of infection, dysmenorrhea, urinary tract infections and dysuria; consequences for sexuality, mainly, dyspareunia, loss of sexual interest and decreased quality of sexual intercourse; and psychological consequences such as loss of self-esteem, feelings of humiliation and fear of social and familial rejection. Women perceived a profound lack of knowledge about FGM from health providers and a lack of sensitive and empathetic care. Some women perceived threatening and disproportionate attitudes and reported negative experiences. Participants highlighted the importance of educating, raising awareness and improving prevention and detection strategies. The findings disclose the need to improve training and institutional plans to address structural and attitudinal barriers to health equity across migrant families in their host countries.

Predicción de riesgo de cáncer de mama en mujeres sanas de población española basado en el estudio de variantes genéticas / Prediction of cancer risk based on study of genetic variants in healthy women in the Spanish population

Objetivo: Estratificación de la población general con base en las variantes genotípicas para seleccionar a aquellas mujeres de alto riesgo a desarrollar un cáncer de mama que puedan ser candidatas a un seguimiento individualizado. Material y métodos: Se ha realizado un estudio caso-control en 856 mujeres con cáncer de mama y 839 mujeres controles de la población general pareadas por edad, analizando la asociación entre el riesgo a desarrollar cáncer de mama y un grupo de variantes basado en 76 polimorfismos de un cambio de base (SNP) de susceptibilidad. Resultados: Se han establecido 2curvas de casos y controles con base en las odds ratio (OR) genotípicas que diferencian las 2poblaciones con significación estadística (p = 2,293×10-15). Asimismo, se ha estratificado la población de casos y controles e identificado un 14% de la población que se encontraría en el grupo de alto riesgo con una OR > 2 (> 25% probabilidades de desarrollar un cáncer de mama). Este grupo sería candidato a un seguimiento individualizado. Conclusiones: El Polygenic Risk Score es un predictor del riesgo del cáncer de mama independiente que puede ayudar a seleccionar mujeres con alto riesgo para establecer medidas de seguimiento y tratamiento individualizado en función del riesgo genético

Objective: To stratify the general population based on genotypic variants in order to select women at high risk of breast cancer who could be candidates for individualized follow-up. Material and methods: We performed a case-control study in 856 women with breast cancer and 839 aged-matched control women from the general population. We analysed the association between the risk of developing breast cancer and a group of variants based on 76 susceptibility single nucleotide polymorphisms. Results: Two case-control curves were established based on genotypic odds ratios (OR) that differentiated the 2populations with statistical significance (P=2.293×10-15). Stratification of the case-control population showed that 14% of the population would be at high risk, with an OR>2 (> 25% probability of developing breast cancer). Persons in this group would be candidates for individualized follow-up. Conclusions: The Polygenic Risk Score is an independent predictor of breast cancer risk that may help to select women at high risk, with a view to establishing individualised follow-up and treatment according to genetic risk

Riesgos y complicaciones de la punción ovárica / Risks and complication of oocyte retrieval

La aspiración folicular transvaginal ecoguiada representa actualmente el método de lección para la recuperación ovocitaria, tanto por su simplicidad, seguridad como eficacia. Es una técnica que se utiliza desde el 1983 y que precisa de una curva de aprendizaje relativamente corta (1). Aunque las complicaciones asociadas a la técnica son poco frecuentes estimándose entre 0,1 -0,5 % (2) en algunos casos pueden ser graves, incluso letales (3), destacando entre ellas la hemorragia y la lesión e infección de estructuras pélvicas

Ecoguided transvaginal follicular aspiration currently represents the method of choice for ovocyte recovery, both for its simplicity, safety and efficacy. It is a technique that has been used since 1983 and requires a relatively short learning curve (1). Although complications associated with the technique are rare, estimated between 0.1 -0.5% (2)in some cases can be serious, even lethal (3), including bleeding and injury and infection of pelvic structures

Embarazo ectópico intersticial tratado con metotrexato y cirugía: caso clínico / Interstitial ectopic pregnancy treated with methotrexate and surgery: clinical case

RESUMEN Antecedentes: El embarazo intersticial es muy inusual y representa <2,4% de todos las gestaciones ectópicas. Objetivo: Se presenta el caso de un embarazo ectópico intersticial tratado de forma médica y quirúrgica. Se realiza una revisión literaria sobre las opciones de manejo y tratamiento. Caso clínico: Paciente primigesta de 36 años con gestación ectópica cornual derecha tras 11 días de la transferencia de un embrión criopreservado. Se decide tratamiento con metotrexato (MTX) sin éxito y con progresión del embarazo, obligándonos por lo tanto a realizar una evacuación quirúrgica de la gestación, exponiendo a la paciente tanto a los efectos secundarios del tratamiento médico como a los del abordaje quirúrgico. Conclusión: El embarazo ectópico intersticial sigue siendo un reto para el ginecólogo. El diagnóstico muy temprano de estas patologías, aunque difícil, podría evitar la opción quirúrgica, siendo el MTX más eficaz en los casos tratados precozmente.

ABSTRACT Background: Interstitial pregnancy is very unusual, and it represents <2,4% of all ectopic pregnancies. Objective: We present the case of an interstitial ectopic pregnancy treated medically and surgically. A literary review is also made about the management and treatment options. Clinical case: A 36-year-old patient with a diagnosis of right cornual ectopic pregnancy after 11 days of a cryopreserved embryo's transfer. Methotrexate (MTX) treatment was applied as the initial step but without lasting results. Because of the progression of the pregnancy, further therapy was focused on its surgical evacuation exposing the patient to the side effects of both medical treatment and surgical approach. Conclusion: Interstitial ectopic pregnancy remains a challenge for the gynecologist. Very early diagnosis of these pathologies, although difficult, could avoid the surgical outcome, being MTX more effective in cases intervened initially.

Diagnóstico de Metástasis Ováricas de un linfoma B diseminado mediante ecografía 3D / Diagnosis of Ovarian Metastases from disseminated B lymphoma using 3D ultrasound

RESUMEN La participación del aparato genitourinario en el contexto de la enfermedad hematológica maligna es bien conocida. No obstante, la afectación ovárica por linfomas es inusual, ya sea de novo o como manifestación tardía de linfoma diseminado. El objetivo de esta comunicación es exponer la aportación diagnóstica de la ecografía tridimensional (3D) en la detección de metástasis ováricas, cuando todavía algunas de las pruebas de imagen estándar como la tomografía computarizada (TAC) son normales. En este caso presentamos una paciente con linfoma B difuso de células grandes mediastínico de crecimiento rápido y diseminación precoz a aparato gastrointestinal y genitourinario.

ABSTRACT Genitourinary participation in the context of malignant hematologic disease is well known. However, ovarian involvement by lymphoma is unusual, either de novo or as late manifestation of disseminated lymphoma. The purpose of this communication is to show the diagnostic contribution of three-dimensional ultrasound (3D) in the detection of ovarian metastases, when still some of the standard imaging tests such as computed tomography (CT) are normal. Here we present a patient with primary mediastinal large B-cell lymphoma diffuse with fast growing and early dissemination to gastrointestinal and genitourinary tract.

Knowledge, attitudes and practices of primary healthcare professionals to female genital mutilation in Valencia, Spain: are we ready for this challenge?

BACKGROUND: The practice of Female Genital Mutilation (FGM) is a deeply-rooted tradition in 30 Sub-Saharan and Middle-East countries which affects approximately 200 million women and girls worldwide. The practice leads to devastating consequences on the health and quality of life of women and girls in both the short and long term. Globalizing processes and migration flows have recorded cases of this practice worldwide representing for healthcare professionals an emerging challenge on how to approach their healthcare in a transcultural, ethical and respectful way. No survey to assess knowledge, attitudes and practices on FGM among primary healthcare professionals has been conducted in the Valencian region of Spain to date. METHODS: The main purpose of this study is to assess the perceptions, knowledge, practices and attitudes of the primary healthcare professionals in relation to FGM in the Clínic-Malvarrosa healthcare area of Valencia. A cross-sectional descriptive study was conducted based on a self-administered questionnaire to general practitioners, paediatricians, nurses, midwives, gynaecologists, social workers and others. RESULTS: A total of 321 professionals answered the questionnaire. Less than 5% of professionals answered that they had ever found a case of FGM during their professional practice and 21.8% answered that they had ever worked with population at risk of FGM. Almost 15% of professionals answered that they had received training on FGM but of those who had received training, only 22.7% correctly identified the typology of FGM and less than 5% correctly identified the geographical area. Only 6.9% of the respondents admitted to know some protocol of action, being midwives, paediatricians and social workers the most aware professionals of such protocols. CONCLUSION: This study demonstrates that FGM is a problem present in the population attending primary healthcare services in Valencia. However, the professionals showed a profound lack of knowledge around concept, typology, countries of prevalence of FGM and existent protocols of action. It is healthcare professional duty to recognize this situation and to follow the right protocols of action, refer these women and their families to the most appropriate services and professionals that fit their needs, ensuring a multidisciplinary, positive and transcultural care for these families.

Adherence to SEGO recommendations on heavy menstrual bleeding (SMA-UR Study) / Seguimiento de las recomendaciones SEGO sobre el Sangrado Menstrual Abundante (Estudio SMA-UR)

Objective: Heavy menstrual bleeding is one of the most common frequent gynecological disorders in women of reproductive age. It affects quality of life, and in Western countries, is one of the most frequent causes of anemia. The aim of this study was to analyze adherence to the current recommendations of the Spanish Society of Gynecology and Obstetrics on the diagnosis and treatment of heavy menstrual bleeding in patients attending the emergency department. Material and methods: Observational, retrospective, and prospective study performed in routine clinical practice. The study population comprised 98 women diagnosed with heavy menstrual bleeding in the absence of any organic cause attending a gynecological visit scheduled after an emergency department visit due to abnormal menstrual bleeding. Results: Adherence to the Spanish Society of Gynecology and Obstetrics heavy menstrual bleeding recommendations was good for most factors, such as the usual/current bleeding characteristics (80.5% and 86.6%, respectively), gynecological and family history (92.7%), physical examination (92.7%), and diagnostic tests (92.7%), although less favorable for laboratory tests (58.5%) and initiation of treatment and regimen (39.0%). Conclusions: Most of the recommendations in the guidelines were applied, except for laboratory tests, initiation of treatment, and treatment regimen, which were followed to a lesser extent

Objetivo: el sangrado menstrual abundante es una de las alteraciones ginecológicas más frecuentes en las mujeres en edad reproductiva. Afecta a la calidad de vida y es, en los países occidentales, una de las causas más frecuentes de anemia. El objetivo del presente estudio es analizar el seguimiento de las recomendaciones vigentes de la Sociedad Española de Ginecología y Obstetricia en el manejo diagnóstico y terapéutico del sangrado menstrual abundante en pacientes que acuden a urgencias. Material y metodos: estudio observacional, de seguimiento retrospectivo y prospectivo según práctica clínica habitual. Se incluyeron un total de 98 mujeres diagnosticadas de sangrado menstrual abundante sin causa orgánica visitadas en una consulta ginecológica tras haber acudido a urgencias por alteraciones del sangrado. Resultados: se siguieron las recomendaciones de la Sociedad Española de Ginecología y Obstetricia en el manejo del sangrado menstrual abundante de forma mayoritaria para las evaluaciones de las características del sangrado habitual/actual (80,5% y 86,6%, respectivamente), valoración de antecedentes ginecológicos y familiares (92,7%), exploración física (92,7%) y pruebas diagnósticas (92,7%), mientras que se realizó en menor medida en lo relativo a la evaluación de pruebas de laboratorio (58,5%) e instauración de tratamiento y pauta (39,0%) de acuerdo a las guías. Conclusiones: se siguieron las recomendaciones para la mayoría de las evaluaciones, excepto en lo relativo a las pruebas de laboratorio e instauración de tratamiento y pauta de seguimiento de acuerdo a las guías, que se realizaron en menor medida

Unexpected papilledema in a young male with Type 1 diabetes.

In young patients with T1D, neurological manifestations of cerebral hypertension should suggest the possibility of a cerebral venous sinus thrombosis (CVST). In these patients an inherited prothrombotic risk factor, including factor V Leiden G1691A gene mutation, should be considered during an event of thrombosis. Improving the glycemic control is the first factor that should be controlled in a patient who carries a genetic prothrombotic risk factor. Anticoagulant treatment should be started as son as CVST has been diagnosed. Long-term antithrombotic treatment with tinzaparin 175 IU/kg/day, a low-molecular weight heparin (LMWH), could be reliable and well tolerated, although an indefinite special follow-up, including neurological controls, is advisable even in asymptomatic patients.

Revisión: Actualización en el diagnóstico del sangrado menstrual abundante / Review: An update on the diagnosis of heavy menstrual bleeding

El sangrado menstrual abundante (SMA) se define como la pérdida excesiva de sangre menstrual que interfiere con una actividad física normal, emocional o social, empeorando la calidad de vida de la mujer. Factores como un bajo nivel socioeconómico, la obesidad y la alta paridad estarían asociados a una prevalencia superior de SMA. El diagnóstico del SMA se basa en la información proporcionada por la propia paciente acerca de los cambios experimentados en su sangrado, y se fundamenta en la realización de una correcta historia clínica y una exploración física y ginecológica destinada a identificar la fuente del sangrado y que incluya palpación abdominal, una visualización cervical con espéculo y una exploración pélvica con tacto bimanual. Estas técnicas se complementarían con otras como las pruebas de laboratorio, las técnicas de imagen y los análisis histológicos. Las causas posibles de SMA varían en función de la edad de la paciente. Descartada una causa orgánica, suele ser debido a alteraciones de la integridad fisiológica del eje hipófiso-gonadal que ocasionan anovulación. Siguiendo la clasificación PALMA-ÍNDICE, el diagnóstico diferencial del SMA se establecerá teniendo en cuenta en primer lugar las alteraciones estructurales (PALMA: pólipo, adenomiosis, leiomioma y malignidad) y posteriormente las no estructurales (INDICE: las causas inespecíficas, la disovulación, la iatrogenia, los trastornos de la coagulación y la inestabilidad endometrial)

Heavy menstrual bleeding (HMB) is a disorder with a major impact on the woman which is associated with a worsening of their quality of life. The objectives pursued with its treatment are correction of anemia, decrease of the amount of bleeding, prevention of recurrence and long-term consequences of anovulation, and improving the quality of life of women. The choice of treatment should be based on the decision of the woman after knowing the benefits and adverse effects of different options, taking into account their reproductive desires and personal preferences. Drug therapy should be considered when structural abnormalities have not been identified as the cause of HMB. Non-hormonal drug treatment is the first choice in patients with HMB with ovulatory cycles, with reproductive desires or limitations to hormone treatment; It includes non-steroidal anti-inflammatories and antifibrinolytics (especially tranexamic acid). The hormonal drug treatment is the best option in HMB caused by ovulation disorders. In Spain, the LNG-IUD has this specific indication, of first choice in women who may become pregnant, and an oral quadriphasic combined with estradiol valerate and dienogest (VE2-DNG). The HMB with organic cause require the surgical approach of the pathological processes that cause them. The treatment options that have proven efficacy are endometrial ablation and endometrial resection (minimally invasive but not always completely successful) and hysterectomy (major surgery). In this paper, we analyze all of them

Revisión: Actualización en el tratamiento del sangrado menstrual abundante / Review: An update on the treatment of heavy menstrual bleeding

El sangrado menstrual abundante (SMA) es un trastorno con un gran impacto en la mujer que conlleva un empeoramiento de su calidad de vida. Los objetivos que persigue su tratamiento incluyen la corrección de la anemia, la disminución de la cantidad de sangrado, la prevención de recurrencias y de las consecuencias a largo plazo de la anovulación, y la mejora de la calidad de vida de la mujer. La elección del tratamiento debe basarse en la decisión de la mujer tras conocer las ventajas y efectos adversos de las diferentes opciones, teniendo en cuenta sus deseos reproductivos y preferencias personales. El tratamiento farmacológico debe considerarse cuando no se hayan identificado anomalías estructurales como causa del SMA. El tratamiento farmacológico no hormonal, es de primera elección en pacientes con SMA con ciclos ovulatorios, con deseos genésicos o con limitaciones al tratamiento hormonal; incluye los aintiinflamatorios no esteroideos y los antibibrinolíticos (especialmente ácido tranexámico). El tratamiento farmacológico hormonal es la opción más adecuada ante alteraciones de la ovulación que causan SMA. En España tienen indicación específica el DIU-LNG, de primera elección en mujeres que no planean un embarazo, y un combinado cuatrifásico con valerato de estradiol y dienogest (VE2-DNG) oral. Los SMA de causa orgánica requieren el abordaje quirúrgico de los procesos patológicos que los provocan. Las opciones terapéuticas que han demostrado eficacia son la ablación endometrial y la resección endometrial (mínimamente invasivas pero no siempre completamente exitosas) y la histerectomía (cirugía mayor). En la presente revisión se analizan todas ellas

Heavy menstrual bleeding (HMB) is a disorder with a major impact on the woman which is associated with a worsening of their quality of life. The objectives pursued with its treatment are correction of anemia, decrease of the amount of bleeding, prevention of recurrence and long-term consequences of anovulation, and improving the quality of life of women. The choice of treatment should be based on the decision of the woman after knowing the benefits and adverse effects of different options, taking into account their reproductive desires and personal preferences. Drug therapy should be considered when structural abnormalities have not been identified as the cause of HMB. Non-hormonal drug treatment is the first choice in patients with HMB with ovulatory cycles, with reproductive desires or limitations to hormone treatment; It includes non-steroidal anti-inflammatories and antifibrinolytics (especially tranexamic acid). The hormonal drug treatment is the best option in HMB caused by ovulation disorders. In Spain, the LNG-IUD has this specific indication, of first choice in women who may become pregnant, and an oral quadriphasic combined with estradiol valerate and dienogest (VE2-DNG). The HMB with organic cause require the surgical approach of the pathological processes that cause them. The treatment options that have proven efficacy are endometrial ablation and endometrial resection (minimally invasive but not always completely successful) and hysterectomy (major surgery). In this paper, we analyze all of them

Protocolo Sociedad Española de Ginecología y Obstetricia de diagnóstico y tratamiento de las infecciones vulvovaginales. Protocolo actualizado en 2012 / The protocol of the Spanish Society of Obstetrics and Gynecology for the diagnosis and treatment of vulvovaginal infection. Update 2012

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Mielopatía compresiva como forma de presentación de una fractura transdiscal de bloque vertebral en una paciente con espondilitis anquilosante / Compressive myelopathy as the presentation form of a transdiscal fracture of the vertebrae in a patient with ankylosing spondylitis

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Riesgo de fracturasno vertebrales en mujeres posmenopáusicas en tratamiento antirresortivo / Risk of non-vertebral fractures in postmenopausal women on antiresorptive therapy

Objetivo: Determinar el riesgo de fractura a 5 años en mujeres posmenopáusicas en tratamiento antirresortivo.Sujetos y métodos: Estudio transversal multicéntrico con 2.111 mujeres posmenopáusicas tratadas con antirresortivos en consultas de ginecología. El riesgo de fractura se evaluó mediante el índice FRACTURE. La influencia de los parámetros clínicos sobre la variable principal se evaluó mediante regresión logística y/o lineal, utilizando el programa SAS v9.1.3.Resultados: La edad media ± desviación estándar fue de 61,0 ± 7,9 años y, en los casos en los que se disponía de densitometría (60,5%), la prevalencia de osteopenia fue del 49,4% y la de osteoporosis del 42,4%. El 59,3% realizaba tratamiento con bisfosfonatos. La puntuación en el índice FRACTURE fue < 6 en el 73,4% si se disponía de densitometría; cuando no constaba la densitometría, la mayoría (81,7%) puntuó < 4. El riesgo medio de (fracturas no vertebrales fue del 14,8 ± 5,3% y el de fracturas vertebrales del 4,0 ± 3,0%.Conclusiones: En mujeres posmenopáusicas en tratamiento antirresortivo, el riesgo de fractura no vertebral en los próximos 5 años es tres veces superior al de fractura vertebral (AU)

Objective: To determine the 5-year non-vertebral fracture risk in postmenopausal women on antiresorptive therapy.Subjects and methods: We performed a cross-sectional multicenter study in 2,111 postmenopausal women receiving antiresorptive therapy in gynecological settings. The risk of fracture was evaluated by means of the FRACTURE Index. The influence of clinical parameters on the main variable was evaluated through linear and/or logistic regression, using the SAS v. 9.1.3 program.Results: The mean age ± standard deviation was 61.0 ± 7.9 years. Densitometry was available in 60.5% of the women and showed a prevalence of osteopenia of 49.4% whereas that of osteoporosis was 42.4%. Biphosphonates were used in 59.3% of the women. When densitometry was available, 73.4% scored less than 6 points on the FRACTURE Index, and when densitometry was not available, 81.7% scored less than 4 points. The mean risk of non-vertebral fractures was 14.8 ± 5.3% and that of vertebral fractures was 4.0 ± 3.0%.Conclusions: In this large group of postmenopausal women receiving antiresorptive treatment, the 5-year non-vertebral fracture risk, as assessed by the FRACTURE index, was three times higher than that of vertebral fracture (AU)

Monitorización y valor pronóstico por resonancia magnética de los tratamientos biológicos en las espondiloartritis / Follow up and prognostic value using magnetic resonance imaging in patients with spondyloarthritis treated with biologic agents

El diagnóstico precoz y la respuesta al tratamiento en los pacientes con espondiloartritis han supuesto, desde siempre, un reto dada la escasez de técnicas de imagen que demostrasen, de manera cuantitativa, la inflamación en columna y articulaciones sacroilíacas. Durante los últimos 2 años se han llevado a cabo importantes avances en el uso de la resonancia magnética (RM) para el estudio de las espondiloartritis. La posibilidad de cuantificar la inflamación que ocurre en estos pacientes mediante la utilización de diferentes sistemas de puntuación permite no sólo llevar a cabo el diagnóstico de forma precoz, sino además valorar la respuesta de los pacientes con espondiloartritis a diferentes agentes terapéuticos, en especial a las nuevas terapias biológicas. Se han publicado varios ensayos controlados con dichos fármacos que muestran la disminución de las lesiones inflamatorias en RM. Esta revisión se centra, brevemente, en las técnicas y los sistemas de puntuación de RM utilizados, así como en los datos aportados por dichos estudios, que valoran la respuesta al tratamiento con terapias biológicas mediante las imágenes de RM (AU)

Early diagnosis and assessment of the response to treatment in patients suffering from spondyloarthritis have always been challenging due to the lack of imaging techniques able to demonstrate spinal and sacroiliac inflammation. The last 2 years have seen important advances in the use of magnetic resonance imaging (MRI) for the study of spondyloarthritis. The possibility of quantification of inflammatory lesions using different scoring systems allows not only an early diagnosis, but the assessment of the response to several therapeutic agents, especially those known as «biological therapies». A number of randomized controlled trials of anti-tumor necrosis factor agents have been published showing regression of inflammatory lesions in MRI. This review discusses briefly the techniques and scoring systems used and all the evidences that exist about assessing treatment in spondyloarthritis (AU)

[Follow up and prognostic value using magnetic resonance imaging in patients with spondyloarthritis treated with biologic agents]. / Monitorización y valor pronóstico por resonancia magnética de los tratamientos biológicos en las espondiloartritis.

Early diagnosis and assessment of the response to treatment in patients suffering from spondyloarthritis have always been challenging due to the lack of imaging techniques able to demonstrate spinal and sacroiliac inflammation. The last 2 years have seen important advances in the use of magnetic resonance imaging (MRI) for the study of spondyloarthritis. The possibility of quantification of inflammatory lesions using different scoring systems allows not only an early diagnosis, but the assessment of the response to several therapeutic agents, especially those known as «biological therapies¼. A number of randomized controlled trials of anti-tumor necrosis factor agents have been published showing regression of inflammatory lesions in MRI. This review discusses briefly the techniques and scoring systems used and all the evidences that exist about assessing treatment in spondyloarthritis.

Tratamiento con estrógenos, tibolona y flavonoides, ¿cuál es su papel actual en la osteoporosis posmenopáusica? / Treatment with estrogens, tibolone and flavonoids. What is their role in postmenopausal osteoporosis?

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