Live birth in a woman without ovaries after autograft of frozen-thawed ovarian tissue combined with growth factors.

Currently, cryopreservation of oocytes, embryos and ovarian tissue is considered the basis of fertility preservation programs for women with cancer and other diseases who are rendered sterile by gonadotoxic drugs or radiation.Numerous studies have confirmed that autograft of frozen-thawed ovarian tissue can restore ovarian function and fertility. A total of twenty-two live births have been reported but we still have to consider this technique as experimental. The main problem is that the implant undergoes ischemia until neoangiogenesis is restored, resulting in significant follicular loss.At the moment, there are numerous publications in different medical fields that publish successful experiences with plasma rich in platelets (PRP) in different clinical situations promoting angiogenesis. Thus, we considered the possibility of using it in the field of ovarian autologous transplantation in order to improve the vascularization of the implant and its quality. For this, both thawed ovarian tissue as practiced pockets on the rear side of the broad ligament which have been placed, have been impregnated with PRP. We can say that the implant treated in this way has had a rapid and successful response.We report a special interesting case because this is the first time that this technique is performed successfully in a woman without ovaries combined with growth factors to promote neoangiogenesis. Obviously, the results of the hormonal response come exclusively from the implanted tissue in these special conditions.

Detección de la disfunción tiroidea en la población gestante: está justificado el cribado universal / Detection of thyroid dysfunciton in pregnant women: universal screening is justified

Existe una conocida controversia entre distintas sociedades científicas respecto a la recomendación o no de que se realice un cribado universal para la detección de disfunción tiroidea (DT) durante la gestación. Aunque varios estudios asocian el hipotiroidismo subclínico o la hipotiroxinemia con problemas obstétricos y/o con alteraciones neurocognitivas de la prole, no hay evidencia sobre los posibles efectos positivos de su tratamiento con tiroxina. Sin embargo, existe un acuerdo generalizado sobre la necesidad del tratamiento del hipotiroidismo clínico durante la gestación y los riesgos que podría ocasionar la abstención terapéutica. Por tratarse de una enfermedad frecuente, de fácil diagnóstico y para la que se dispone de un tratamiento efectivo y exento de riesgos, la Sociedad Española de Endocrinología y Nutrición (Grupo de Trabajo de Trastornos por Deficiencia de Yodo y Disfunción Tiroidea) y la Sociedad Española de Ginecología y Obstetricia recomiendan que se evalúe precozmente (antes de la semana 10) la función tiroidea a todas las mujeres embarazadas. Dada la compleja fisiología de la función tiroidea durante la gestación, la valoración de las hormonas debe realizarse utilizando valores de referencia para cada trimestre y para cada zona con las técnicas de laboratorio propias. Para el cribado, bastaría con la determinación de tirotropina y solo si esta está alterada, debería analizarse también la tiroxina libre o total. Debe recordarse también que una adecuada nutrición de yodo desde antes y durante el embarazo es fundamental para contribuir a la normalidad de la función tiroidea materno-fetal (AU)

Detection of thyroid dysfunction in pregnant women: universal screening is justified.

There is a controversy among different scientific societies in relation to the recommendations on whether universal screening for the detection of thyroid dysfunction during gestation should be performed or not. Although various studies have shown an association between subclinical hypothyroidism or hypothyroxinemia with obstetric problems and/or neurocognitive impairment in the offspring, no evidence on the possible positive effects of treatment of such conditions with thyroxin has been demonstrated so far. However, there is a general agreement about the need for treatment of clinical hypothyroidism during pregnancy and the risks of not doing so. Because it is a common, easily diagnosed and effectively treated disorder without special risk, the working Group of Iodine Deficiency Disorders and Thyroid Dysfunction of the Spanish Society of Endocrinology and Nutrition and Spanish Society of Gynaecology and Obstetrics recommends an early evaluation (before week 10) of thyroid function in all pregnant women. Given the complex physiology of thyroid function during pregnancy, hormone assessment should be performed according to reference values for each gestational trimester and generated locally in each reference laboratory. Thyrotropin determination would be sufficient for screening purposes and only if it is altered, free thyroxin or total thyroxin would be required. Adequate iodine nutrition is also highly recommended before and during pregnancy to contribute to a normal thyroid function in the pregnant women and fetus.

[Detection of thyroid dysfunction in pregnant women: universal screening is justified]. / Detección de la disfunción tiroidea en la población gestante: está justificado el cribado universal.

There is a controversy among different scientific societies in relation to the recommendations on whether universal screening for the detection of thyroid dysfunction during gestation should be performed or not. Although various studies have shown an association between subclinical hypothyroidism or hypothyroxinemia with obstetric problems and/or neurocognitive impairment in the offspring, no evidence on the possible positive effects of treatment of such conditions with thyroxin has been demonstrated so far. However, there is a general agreement about the need for treatment of clinical hypothyroidism during pregnancy and the risks of not doing so. Because it is a common, easily diagnosed and effectively treated disorder without special risk, the working Group of Iodine Deficiency Disorders and Thyroid Dysfunction of the Spanish Society of Endocrinology and Nutrition and Spanish Society of Gynaecology and Obstetrics recommends an early evaluation (before week 10) of thyroid function in all pregnant women. Given the complex physiology of thyroid function during pregnancy, hormone assessment should be performed according to reference values for each gestational trimester and generated locally in each reference laboratory. Thyrotropin determination would be sufficient for screening purposes and only if it is altered, free thyroxin or total thyroxin would be required. Adequate iodine nutrition is also highly recommended before and during pregnancy to contribute to a normal thyroid function in the pregnant women and fetus.

Hormonal environment in the induction of breast cancer in castrated rats using dimethylbenzanthracene: influence of the presence or absence of ovarian activity and of treatment with estradiol, tibolone, and raloxifene.

OBJECTIVE: The influence of hormone therapy on the induction or the promotion of breast cancer has yet to be determined. Recent studies establish a cause-effect relation between hormones and cancer, although epidemiological data and studies of tumor behavior give rise to doubts. The aim of the study was to observe and evaluate the influence of different hormonal environments on the induction of breast cancer in a well-established experimental model. DESIGN: In this experimental animal study, breast cancer was induced by using a single intragastric dose of 20 mg of dimethylbenzanthracene in prepubertal Sprague-Dawley rats randomized into five groups: group 1 (control); group 2 (castrated prepubertal animals); and groups 3, 4, and 5 (castration of prepubertal animals followed by hormonal treatment starting at puberty [11 weeks] with tibolone, raloxifene, and estradiol, respectively). Follicle-stimulating hormone and estradiol levels were measured at 6, 11, 16, and 31 weeks. RESULTS: Absence of ovarian activity was observed in groups 2, 3, 4, and 5, as well as the expected variations in hormone levels in all groups. Breast cancers were obtained in 100% of the animals in the control group, with an average of four (two to seven) tumors per animal in this group. Only one cancer appeared in groups 2, 3, and 4, and none appeared in group 5. CONCLUSIONS: In this experimental model and using the hormone treatments chosen, neither the treatments nor the absence of ovarian activity induced breast cancer.

Púrpura trombótica trombocitopénica posparto en gestante con enfermedad hipertensiva del embarazo / Postpartum thrombotic thrombocytopenic purpura in a pregnant woman with hypertension

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