Abordaje laparoscópico mediante puerto único versus técnica convencional en el tratamiento quirúrgico del cáncer de endometrio / Single port laparoscopic approach versus conventional technique in the surgical treatment of endometrial cancer

Objetivo: El objetivo de este estudio es comparar el abordaje laparoscópico convencional con el acceso por puerto único en el tratamiento quirúrgico del cáncer de endometrio. Materiales y métodos: Estudio retrospectivo sobre 36 pacientes, 18 operadas con técnica convencional y 18 con acceso por puerto único mediante una única incisión en la piel y 3 en la fascia, para la inserción de un trócar de 10mm y 2 de 5mm. Resultados: Se obtiene menor dolor postoperatorio (22,3% vs. 83,3%, p<0,001) y un mejor resultado estético (10 vs. 8, p=0,001) en el grupo de pacientes intervenidas por puerto único. El tiempo quirúrgico fue mayor en el grupo con técnica convencional (120 vs. 180min; p=0,027). En cuanto a estancia hospitalaria (2,5 vs. 2,5 días, p=0,69), pérdida sanguínea (1,15 vs. 1,25g/dl, p=1), número de ganglios extirpados (16,5 vs. 18; p=0,78) y complicaciones intra (0% vs. 5%, p=0,19) y posquirúrgicas (16,6% vs. 11,1%, p=0,63) no hubo diferencias significativas. Conclusión: El abordaje por puerto único es una técnica factible, segura y efectiva en el tratamiento del cáncer ginecológico, presentando una menor tasa de dolor postoperatorio y un mejor resultado estético.(AU)

Objective: The objective of this study is to compare conventional laparoscopy with transumbilical single-port access for the surgical treatment of endometrial cancer. Materials and methods: A retrospective study was performed with 36 patients, of whom 18 were operated using conventional laparoscopy, and 18 using a transumbilical single-port access (laparoendoscopic single-site surgery, or LESS) by making a single incision in the umbilical skin of 2-3cm, and 3 incisions in the fascia. One 10-mm trocar and two 5-mm trocars were inserted next to each other to access the abdominal cavity. Results: There were no statistical differences between groups in postoperative changes in haemoglobin concentration (1.15 vs. 1.25g/dL, P=1), hospital stay (2.5 vs. 2.5 days, P=.69), intraoperative complication rate (0% vs. 5%, P=.19), postoperative complications (16.6% vs. 11.1%, P=.63), number of pelvic lymph nodes (16.5 vs. 18, P=.78), and number of para-aortic lymph nodes (9 vs. 10, P=.64). Patients in the LESS group experienced less postoperative pain (22.3% vs. 83.3%, P<.001), and had a higher rate of satisfaction with the cosmetic results (10 vs. 8, P=.001). The median operating time was lower in the LESS group (120-180min, P=.027). Conclusion: Laparoendoscopic single-site surgery is a feasible, safety and effective technique for the treatment of endometrial cancer, with less postoperative pain and better cosmetic results.(AU)

Cirugía oncológica ginecológica mediante puerto único y endoscopia operatoria por orificios naturales empleando equipamiento convencional / Combined laparoendoscopic single-site surgery (less) and natural orifice transluminal endoscopic surgery (NOTES) in gynaecologic oncology using conventional equipment

Objetivo: Describir y valorar la aplicabilidad de la combinación de las técnicas de puerto único y del natural orifice transluminal endoscopic surgery (NOTES) en el tratamiento quirúrgico del cáncer ginecológico empleando solo instrumental convencional. Material y métodos: Se realiza un estudio retrospectivo de 30 pacientes tratadas por cáncer ginecológico desde junio de 2012 hasta junio de 2014. Todos los procedimientos se hicieron mediante técnica de puerto único o NOTES híbrido. Se empleó equipamiento convencional, el mismo que empleamos en la laparoscopia multipuerto. Resultados: Ventiuna pacientes (70%) fueron operadas mediante puerto único umbilical; 8 casos (30%) mediante NOTES híbrido. En un caso se realizó un doble puerto único para abordaje retroperitoneal y transperitoneal simultáneo. Los procedimientos empleados fueron: histerectomía en 10 cánceres de endometrio y en 2 cánceres de cuello. En 6 casos se asoció además una linfadenectomía pélvica o una biopsia selectiva de ganglio centinela. En 3 casos, se realizó además una linfadenectomía paraaórtica. En un caso se realizó linfadenectomía pélvica y paraaórtica transperitoneal para estadificación de un cáncer de cérvix. Se realizó estadificación ovárica en 3 casos de carcinoma de ovario borderline y en 2 casos infiltrantes. Finalmente, en 3 casos se utilizó el puerto único para evaluación de resecabilidad. En 5 casos (16,66%) fue necesario utilizar algún trocar auxiliar para el abordaje paraaórtico. No fue necesaria ninguna conversión a laparotomía. No se observaron complicaciones intraoperatorias y tan solo se observaron complicaciones menores postoperatorias en 5 casos y una complicación mayor en una paciente de 72 años con un cáncer de células claras endometrial IAG3 que presentó insuficiencia cardíaca en el postoperatorio. Conclusión: Los procedimientos de puerto único y NOTES son procedimientos seguros y válidos para el manejo quirúrgico del cáncer ginecológico

Objective: To describe and assess the feasibility of combining natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery in gynaecological cancer using only conventional laparoscopic equipment. Material and methods: A retrospective review of 30 patients with gynaecological cancer, managed by either laparoendoscopic single-site surgery or hybrid natural orifice transluminal endoscopic surgery technique, from June 2012 to June 2014. Only conventional trocars, grasping forceps and sealing devices were used, similar to multiport laparoscopic surgery. Results: Twenty-one (70%) patients were managed by umbilical laparoendoscopic single-site surgery, while 8 (30%) patients underwent a hybrid natural orifice transluminal endoscopic surgery. One patient underwent a double retroperitoneal and transperitoneal single-site approach. Hysterectomy was performed in 10 cases of endometrial cancer and 2 of cervical cancer, while hysterectomy plus pelvic lymphadenectomy or sentinel node biopsy was conducted in 6 cases of endometrial cancer. Hysterectomy plus pelvic and para-aortic lymphadenectomy was performed in 3 patients with endometrial cancer. Transperitoneal pelvic and para-aortic lymphadenectomy was conducted in one case for cervical cancer staging. Staging was also performed in 3 patients with borderline ovarian cancer and in 2 cases of infiltrating cervical carcinoma. Single-port laparoscopic debulking surgery was performed in the remaining 3 cases. Additional 5-mm ports were used in 5 (16.66%) cases to perform para-aortic lymphadenectomy, but no conversion to laparotomy was needed. There were no intraoperative complications, with minor postoperative complications observed in only 5 cases. There was one postoperative major complication: Heart failure in a 72-year-old female patient with clear cell endometrial cancer stage IAG3, who needed to be referred to the cardiology department during her hospitalisation. Conclusion: Combined laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery is a safe and feasible procedure in the surgical treatment of gynaecological cancer

Pathology findings and clinical outcomes after risk reduction salpingo-oophorectomy in BRCA mutation carriers: a multicenter Spanish study

Objective: To determine the incidence of serous tubal intraepithelial carcinoma (STIC) after risk reduction salpingo-oophorectomy(RRSO), and to describe oncological outcomes after RRSO. Materials and methods: BRCA pathogenic mutation carriers who had undergone an RRSO were evaluated in this retrospective multicenter observational study. Patients were only included when fallopian tubes were analyzed following the protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Surgeries were performed between June 2010 and April 2017 at eight Spanish hospitals.Results: A total of 359 patients met the inclusion criteria. STIC was diagnosed in 3 (0.8%) patients; one of them underwent surgical staging due to positive peritoneal washing, with absence of disease at the final pathology report. None of the three patients received adjuvant chemotherapy and were free of disease at last follow-up. Fallopian tube and ovarian carcinoma were diagnosed in 5 (1.4%) and 1 (0.3%), respectively. At a median (range) follow-up time of 29 (3-92) months, five patients had a newly diagnosed breast cancer. Other types of cancer, which were diagnosed during the follow-up time, included: serous primary peritoneal carcinoma (n = 1), serous endometrial carcinoma (n = 1), colon (n = 1), pancreas (n = 1), jaw (n = 1), and lymphoma (n = 1). Seven patients died due to different types of cancer: breast (n = 4), pancreas (n = 1), jaw (n = 1), and colon (n = 1). Conclusion: The incidence of STIC after RRSO in BRCA mutation carriers is low (0.8%) and it presents an excellent oncological outcome. Patients after RRSO, however, run the risk to develop other types of cancer during follow-up and should be properly advised before the prophylactic surgery

No disponible

Pathology findings and clinical outcomes after risk reduction salpingo-oophorectomy in BRCA mutation carriers: a multicenter Spanish study.

OBJECTIVE: To determine the incidence of serous tubal intraepithelial carcinoma (STIC) after risk reduction salpingo-oophorectomy(RRSO), and to describe oncological outcomes after RRSO. MATERIALS AND METHODS: BRCA pathogenic mutation carriers who had undergone an RRSO were evaluated in this retrospective multicenter observational study. Patients were only included when fallopian tubes were analyzed following the protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Surgeries were performed between June 2010 and April 2017 at eight Spanish hospitals. RESULTS: A total of 359 patients met the inclusion criteria. STIC was diagnosed in 3 (0.8%) patients; one of them underwent surgical staging due to positive peritoneal washing, with absence of disease at the final pathology report. None of the three patients received adjuvant chemotherapy and were free of disease at last follow-up. Fallopian tube and ovarian carcinoma were diagnosed in 5 (1.4%) and 1 (0.3%), respectively. At a median (range) follow-up time of 29 (3-92) months, five patients had a newly diagnosed breast cancer. Other types of cancer, which were diagnosed during the follow-up time, included: serous primary peritoneal carcinoma (n = 1), serous endometrial carcinoma (n = 1), colon (n = 1), pancreas (n = 1), jaw (n = 1), and lymphoma (n = 1). Seven patients died due to different types of cancer: breast (n = 4), pancreas (n = 1), jaw (n = 1), and colon (n = 1). CONCLUSION: The incidence of STIC after RRSO in BRCA mutation carriers is low (0.8%) and it presents an excellent oncological outcome. Patients after RRSO, however, run the risk to develop other types of cancer during follow-up and should be properly advised before the prophylactic surgery.

Influence of phosphorus on Cu sorption kinetics: stirred flow chamber experiments.

A stirred flow reactor was used to study the influence of phosphorus on the adsorption and desorption kinetics of copper in two acid soils on granite and amphibolite. The presence of P was found to significantly increase Cu adsorption in both soils, albeit at different types of sites (mainly in slow adsorption sites in the soil on granite, and both in fast and slow adsorption sites in that on amphibolite). The increased Cu sorption at fast sites in the amphibolite soil was due to its high content in Fe oxyhydroxides, which bound P and released OH(-) as a result, thereby raising the pH and leading to a higher sorption capacity during fast reactions. On the other hand, the increased Cu sorption at slow adsorption sites was due to Cu(2+) acting as a bridging element between P and organic matter.

Cáncer de mama en mujeres posmenopáusicas / No disponible

Objetivo Revisar nuestra experiencia en el manejo de pacientes posmenopáusicas diagnosticadas y tratadas de cáncer de mama. Material y métodos Se ha realizado estudio descriptivo retrospectivo de 903 pacientes con cáncer de mama entre 1992 y 2008. Se seleccionó a las pacientes posmenopáusicas: 568 (62,90%). Se analizaron factores como edad, paridad, antecedentes familiares y personales, tipo de cáncer, tipo de cirugía, resultados a.p., estadio, tratamientos complementarios y seguimiento. Se ha realizado estudio estadístico mediante SPSS 15.0.ResultadosLa edad media fue 65,26±0,46 (40–95) años. Solo en 117 (20,59%) pacientes existían antecedentes familiares de cáncer de mama. En 312 casos (54,92%) existían factores de riesgo epidemiológico. Eran nuligestas 55 pacientes (9,68%). El motivo de consulta más frecuente fue la palpación de un nódulo 328 (57,7%). Se emplearon diferentes métodos diagnósticos por imagen, siendo la mamografía 420 (73,9%) el más utilizado. En 238 (41,90%) fue necesario estudio mediante biopsia intraoperatoria para confirmación histológica del diagnóstico. El tratamiento neoadyuvante fue empleado en 63 casos (11,09%). El tratamiento quirúrgico como tratamiento inicial fue realizado en 505 casos (88,90%). Pudo realizarse cirugía conservadora en 225 (39,61%) casos. El tipo histológico más frecuente fue el carcinoma ductal infiltrante en 380 (66,9%) pacientes. El número de ganglios fue 12,41±0,26(1–36). La hormonoterapia se pautó en 333 (58,62%), siendo el tamoxifeno el más empleado, en 230 (69,1%).Conclusiones El incremento de la edad conlleva un aumento de la patología oncológica mamaria. El diagnóstico en estas pacientes es mayoritariamente clínico. Los tratamientos en estas pacientes son menos conservadores debido al diagnóstico en estadios más avanzados (AU)

Objective To review our experience in the management and treatment of postmenopausal women with breast cancer. Material and methods A descriptive and retrospective study was performed in 903 women with breast cancer between 1992 and 2008. A total of 568 (62.90%) menopausal women were selected. The factors studied included age, parity, familial and personal history, type of cancer, type of surgery, pathological findings, stage, complementary treatments and follow-up. Statistical analysis was performed using the SPSS statistical package version 15.0.ResultsThe mean age was 65.26±0.46 (40–95) years. Familial breast cancer was found in only 117 patients (20.59%) patients. Epidemiological risk factors were found in 312 (54.92%). Nulliparity was found in only 55 patients (9.68%). The most frequent reason for consultation was palpation of a nodule in 328 (57.7%). Distinct imaging procedures were used, the most frequent being mammography in 420 (73.9%). Intraoperative biopsy was required for histological confirmation of the diagnosis in 238 (41.90%). Neoadjuvant treatment was indicated in 63 patients (11.09%). Surgical treatment was the first step in 505 women (88.90%). Conservative surgery was feasible in 225 (39.61%) patients. The most frequent histological type was infiltrating ductal carcinoma cancer in 380 (66.9%) patients. The mean number of nodes was 12.41±0.26 (1–36). Hormono therapy was used in 333 (58.62%), the most widely used being tamoxifen in 230 (69.1%).Conclusions Increased age is associated with a greater risk of breast cancer. Diagnosis in these patients is mainly clinical. Conservative treatment is infrequent in these patients as tumors are usually diagnosed in the more advanced stages (AU)

Seasonal distributions of fungicides in soils and sediments of a small river basin partially devoted to vineyards.

The acid soils of Ourense province riverland (Galicia, NW Spain) produce about 50,000 tons of grapes for winemaking. As part of ongoing investigations into fungicide transport in Ourense vineyard soils, the occurrence of several fungicides in such soils was investigated. Soil samples were collected from the inter-row topsoil of a vineyard adjacent to the River Alongos, approximately 15 km SW of the main city of Ourense. The vines were grown in sandy loam with moderate organic carbon (OC) content (1-2%). Fungicide residues were measured in vineyard soils and river sediments by solid-liquid extraction followed by gas chromatography with mass spectrometric detection (GC-MSD). Procymidone and cyprodinil occurred at higher levels in river sediments than in the case of fludioxonil, metalaxyl and penconazole. The highest concentrations of procymidone in sediments were still low (29-57 microg/kg or ppb) suggesting that no accumulation of these compounds occur. All of them were found at higher concentrations in soil; maxima concentrations were about 1000 microg/kg for procymidone and metalaxyl, and about 400 microg/kg for cyprodinil, fludioxonil and penconazole. Folpet was never detected (detection limit lower than 2 microg/kg) in soil and sediments, suggesting that this fungicide was unstable in such samples. The frequency of fungicide detections in soils can be related to their applications in vineyards and the effect of washing off through vineyard canopy by rainfalls. The results found suggest that the vineyard soils of this region are unlikely to be prone to transport of fungicides, and therefore water supplies in this area are unlikely to be at any significant risk of contamination through viticultural use of these compounds.

Microcolpohisteroscopia / Microcolpohysteroscopy

La microcolpohisteroscopia es una técnica que combina la colposcopia, la histeroscopia y el estudio citológico “in vivo”. Su aplicación fundamental va dirigida al estudio del exocérvix, del endocervix y de la zona de transformación, permitiendo la evaluación de su epitelio tras la aplicación de tinciones supravitales a escala macro y microscópica. Describimos en este trabajo las necesidades de equipamiento, el procedimiento y una relación de procesos diagnosticables mediante esta técnica. Aunque la aplicación de la microcolpohisteroscopia es limitada a efectos de screening, sí es una técnica que permite identificar lesiones ocultas a la colposcopia convencional, permitiéndo una localización precisa de las lesiones y orientando por tanto la destrucción local de la lesión evitando el sobretratamiento y sus secuelas

Microcolpohysteroscopy combined the colposcopy, the hysteroscopy and the “in vivo” cytological evaluation. This procedure is mainly focus to endocervical, exocervical and transformation zone study. Supravital staining allows performing “in vivo” cytology. In this review we show the technical requirements and the steps of the procedure. In addition, normal and pathological microcolpohysteroscopic findings are described in detail. Microcolpohysteroscopy is useless at screening level due to technical pitfalls, however it allows to identify those lesions undetectable by conventional colposcopy. Exact topography allows a precise focal destroy and management of the lesions thus avoiding cervical overwhelming treatment