Placental MFSD2A expression in fetal growth restriction and maternal and fetal DHA status.

INTRODUCTION: Fetal growth restriction (FGR) may affect placental transfer of key nutrients to the fetus, such as the fatty acid docosahexaenoic acid (DHA). Major facilitator superfamily domain containing 2A (MFSD2A) has been described as a specific DHA carrier in placenta, but its expression has not been studied in FGR. The aim of this study was to evaluate for the first time the placental MFSD2A levels in late-FGR pregnancies and the maternal and cord plasma DHA. METHODS: 87 pregnant women from a tertial reference center were classified into late-FGR (N = 18) or control (N = 69). Fatty acid profile was determined in maternal and cord venous plasma, as well as placental levels of MFSD2A and of insulin mediators like phospho-protein kinase B (phospho-AKT) and phospho-extracellular regulated kinase (phospho-ERK). RESULTS: Maternal fatty acid profile did not differ between groups. Nevertheless, late-FGR cord vein presented higher content of saturated fatty acids than control, producing a concomitant decrease in the percentage of some unsaturated fatty acids. In the late-FGR group, a lower DHA fetal/maternal ratio was observed when using percentages, but not with concentrations. No alterations were found in the expression of MFSD2A in late-FGR placentas, nor in phospho-AKT or phospho-ERK. DISCUSSION: MFSD2A protein expression was not altered in late-FGR placentas, in line with no differences in cord DHA concentration between groups. The increase in the saturated fatty acid content of late-FGR cord might be a compensatory mechanism to ensure fetal energy supply, decreasing other fatty acids percentage. Future studies are warranted to elucidate if altered saturated fatty acid profile in late-FGR fetuses might predispose them to postnatal catch-up and to long-term health consequences.

Tratamiento con análogos de la GnRH en la endometriosis de la pared abdominal / Use of GnRH analogues in the treatment of abdominal wall endometriosi

La endometriosis de pared abdominal es inusual y prácticamente siempre se presenta adyacente a las incisiones quirúrgicas por procesos invasivos previos de la cavidad abdominal, con una incidencia máxima del 0,03-0,4% poscesárea y un intervalo de aparición después de la cirugía de 1 a 20 años en la mayoría de los casos. Se presenta como una masa o nódulo relacionado con la cicatriz, que suele asociarse a dolor cíclico. El diagnóstico definitivo es histológico, mediante ecografía, tomografía computarizada y punción-aspiración con aguja fina como métodos complementarios. El tratamiento de elección consiste en la extirpación quirúrgica de piel, tejido adiposo, músculo y peritoneo con una recuperación cercana al 100%; se considera útil el tratamiento adyuvante con análogos de la hormona liberadora de gonadotropina, ya que reducen el tamaño de la tumoración, facilitando que la exéresis de la fascia afectada no sea tan amplia y así evitar la necesidad del uso de mallas. Presentamos un caso clínico de una mujer de 34 años que, después de una segunda cesárea y con antecedente de endometriosis intrapélvica, fue diagnosticada de endometrioma sobre la incisión de Pfannestiel. Discutimos la sintomatología, el diagnóstico y el tratamiento de esta afección (AU)

Abdominal wall endometriosis is uncommon and is almost always adjacent to surgical scars at the site of previous abdominal operations. The maximum incidence is 0.03-0.4% in patients with previous cesarean section. The interval between the procedure and symptom onset is usually 1 to 20 years. The clinical presentation of the disease is a palpable mass near surgical scars, usually associated with cyclic pain. The hallmark in the diagnosis of endometriosis is histology. Ultrasonographic examination, computed tomography and fine-needle aspiration biopsy can be helpful. The treatment of choice is wide local excision with a recovery rate of nearly 100%. Adjuvant treatment with GnRH analogues is used to reduce the size of the mass, thus facilitating fascial excision to avoid synthetic mesh placement. We present a case of cutaneous scar endometriosis occurring in the site of a second cesarean section scar in a 34-year-old woman with a prior history of intrapelvic endometriosis. The clinical findings, diagnosis and treatment of this disease are discussed (AU)