Significación pronóstica del volumen metabólico tumoral y de la glucólisis tumoral total en pacientes con cáncer cervical avanzado / Prognostic significance of metabolic tumor volume and total lesion glycolysis in patients with advanced cervical carcinoma

Objetivo: La tomografía por emisión de positrones con 18-flúor-2-desoxi-D-glucosa (18F-FDG PET/TC) es considerada el método de imagen más preciso para la detección de las metástasis ganglionares o a distancia en el cáncer cervical. El volumen metabólico tumoral (VMT) y la glucólisis tumoral total (GTT) de 18F-FDG PET/TC constituyen mediciones volumétricas de las células tumorales, con captación incrementada de 18F-FDG. Se evaluó el valor pronóstico de VMT y GTT en pacientes con cáncer cervical avanzado (CCA). Métodos: A 38 pacientes con CCA de un hospital universitario terciario se les realizó 18F-FDG PET/TC entre junio de 2009 y diciembre de 2015. Se analizaron diversos factores clínico-patológicos y parámetros de PET, para evaluar su relación con la supervivencia libre de progresión (SLP) y la supervivencia global (SG). Dichos parámetros fueron: valor estandarizado de captación máximo (SUVmáx), valor estandarizado de captación medio (SUVmedio), VMT y GTT del tumor primario, los ganglios pélvicos, los ganglios paraaórticos y el volumen metabólico metastásico, de existir. Resultados: Un total de 38 pacientes con CCA cumplieron los criterios de inclusión. A todos ellos se les realizó 18F-FDG PET/TC con anterioridad a la quimiorradioterapia definitiva. En los análisis univariantes el tamaño tumoral mayor, las metástasis de los ganglios pélvicos, el VMT y la GTT reflejaron una asociación significativa con la SLP y la SG (el VMT HR=1,55, p=0,011 y la GTT HR=1,43, p=0,017 para la SLP; y el VMT HR=1,82, p=0,006 y la GTT HR=1,67, p=0,007 para la SG). Conclusión: La suma de GTT y la suma de VMT pretratamiento parecen ser un factor pronóstico independiente para la SG y la SLP en pacientes con CCA tratados mediante quimiorradioterapia definitiva, y reflejan una medición mejor que la clásica de SUVmáx

Aim: 18-Fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET/CT) is considered to be the most accurate image method of detection of node or distant metastases in cervical cancer. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of 18F-FDG PET/CT are volumetric measurements of tumor cells with increased 18F-FDG uptake. The prognostic value of MTV and TLG in patients with advanced cervical cancer (ACC) were evaluated. Methods: 38 patients with ACC from one tertiary university hospital underwent 18F-FDG PET/CT between June 2009 and December 2015. Clinicopathologic factors and various PET parameters were analyzed to evaluate their relationship with recurrence-free survival (RFS) and overall survival (OS). These parameters were: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUV mean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor, of the pelvic nodes, of the paraaortic nodes and the metabolic volume of the metastases if any. Results: A total of 38 patients with ACC fulfilled the inclusion criteria. All of them underwent a 18F-FDG PET/CT before definitive chemoradiotherapy. In the univariate analyses higher tumor size, pelvic lymph node metastasis and both MTV and TLG showed a significant association with OS and with RFS (MTV HR=1.55, p=0.011 and TLG HR=1.43, p=0.017 for RFS and MTV HR=1.82, p=0.006 and TLG HR=1.67, p=0.007 for OS). Conclusion: Pretreatment TLG sum and MTV sum seem to be independent prognostic factors for OS and RFS in patients with advanced cervical cancer treated with definitive chemoradiotherapy and they are better than the classic measurement of SUVmax

Prognostic significance of metabolic tumor volume and total lesion glycolysis in patients with advanced cervical carcinoma. / Significación pronóstica del volumen metabólico tumoral y de la glucólisis tumoral total en pacientes con cáncer cervical avanzado.

AIM: 18-Fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET/CT) is considered to be the most accurate image method of detection of node or distant metastases in cervical cancer. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of 18F-FDG PET/CT are volumetric measurements of tumor cells with increased 18F-FDG uptake. The prognostic value of MTV and TLG in patients with advanced cervical cancer (ACC) were evaluated. METHODS: 38 patients with ACC from one tertiary university hospital underwent 18F-FDG PET/CT between June 2009 and December 2015. Clinicopathologic factors and various PET parameters were analyzed to evaluate their relationship with recurrence-free survival (RFS) and overall survival (OS). These parameters were: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUV mean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor, of the pelvic nodes, of the paraaortic nodes and the metabolic volume of the metastases if any. RESULTS: A total of 38 patients with ACC fulfilled the inclusion criteria. All of them underwent a 18F-FDG PET/CT before definitive chemoradiotherapy. In the univariate analyses higher tumor size, pelvic lymph node metastasis and both MTV and TLG showed a significant association with OS and with RFS (MTV HR=1.55, p=0.011 and TLG HR=1.43, p=0.017 for RFS and MTV HR=1.82, p=0.006 and TLG HR=1.67, p=0.007 for OS). CONCLUSION: Pretreatment TLG sum and MTV sum seem to be independent prognostic factors for OS and RFS in patients with advanced cervical cancer treated with definitive chemoradiotherapy and they are better than the classic measurement of SUVmax.

WITHDRAWN: Response from original author: Reproducibility of first trimester three-dimensional placental measurements; a methodological issue.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, DOI of original article: http://dx.doi.org/10.1016/j.ejogrb.2016.07.485. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Correlation between the extent of intraperitoneal disease and nodal metastasis in node-positive ovarian cancer patients.

AIMS: To investigate correlations between extent of disease (ED), frequency and location of nodal metastases in node-positive EOC patients. METHODS: Data were collected from 116 consecutive patients who underwent systematic lymphadenectomy during primary surgery. Patients were grouped in ED1 (disease confined in pelvis), ED2 (disease extended to abdomen), and ED3 (distant metastases). Univariate and multivariate analysis were performed for overall survival and progression-free survival (PFS). RESULTS: Correspondence analysis revealed associations between ED1 and negative nodes, ED2 and positive aortic/pelvic nodes, and ED3 and positive external and common iliac nodes. The most representative group for nodal metastases in ED1 was aortic nodes (77.8%). The number of positive pelvic nodes increased with ED; the RR was 0.58 for ED2 and 0.25 for ED3 (p = 0.004). The RR for positive external iliac nodes was 0.66 in ED2 and 0.31 in ED3 (p = 0.002); the RR for positive common iliac nodes was 0.76 and 0.17, respectively (p = 0.001). Multivariate analysis revealed that aortic nodal metastasis was associated with PFS (p = 0.03; HR, 1.95). CONCLUSION: Distribution and percentage of nodal metastases varied with ED. The risk of pelvic nodal metastasis, increased with ED. Location of positive nodes was correlated with PFS.

Practice of endoscopic gynecologic surgery: a survey of Spanish gynecologists.

OBJECTIVE: To evaluate the implementation of endoscopic gynecologic surgery in Spanish hospitals. STUDY DESIGN: In January 2011, a questionnaire was sent to 198 gynecology departments to determine the diffusion and acceptance of specific endoscopic procedures (hysteroscopy and laparoscopy) in each hospital. RESULTS: The response rate was 52% (103/198). The practice of basic laparoscopy in Spain is high (90% of the hospitals surveyed reported that >50% of their specialists use this technique). Although advanced laparoscopic procedures are used in 83.4% of hospitals, 59.2% of these hospitals reported that <25% of gynecologists knew how to perform these techniques. In the case of adnexal masses, the approach used depends on the characteristics of the mass. Most hospitals (96.1%) reported routine use of a laparoscopic approach for benign adnexal masses measuring <10 cm, while 42% of hospitals reported routine use of a laparoscopic approach for masses that appear to be suspicious on ultrasound. Regarding hysterectomy, 38 hospitals (36.9%) reported that an abdominal approach was used in <25% of hysterectomies, 53 hospitals (51.5%) reported that a vaginal approach was used in 25-50% of hysterectomies, and 53 hospitals (52%) reported that a laparoscopic approach was used in <25% of hysterectomies. For the treatment of gynecological cancers, 53 hospitals (52%) reported that a laparoscopic approach was used in <25% of cases; this approach was reported more commonly by teaching hospitals (81.9% vs. 46.75; p<0.001) and hospitals with >200 beds (84.3% vs. 45.5%; p<0.001). In teaching hospitals, the concordance between what the respondents felt residents should be able to do, in terms of laparoscopic techniques, and what residents were actually able to do upon finishing their residency training was quite high, with the degree of concordance varying between 84.3% (adnexal mass approach) and 100% (diagnostic laparoscopy and tubal sterilization). CONCLUSIONS: More than 90% of the Spanish hospitals surveyed perform basic endoscopic techniques, and 83.4% are able to perform advanced endoscopic procedures.

Defining the optimal lymphadenectomy cut-off value in epithelial ovarian cancer staging surgery utilizing a mathematical model of validation.

OBJECTIVE: Since 1985 International Federation of Gynecology and Obstetrics includes pelvic and aortic lymphadenectomy as part of the surgical staging in epithelial ovarian cancer (EOC). There is no consensus on the overall number of nodes needed in a systematic lymphadenectomy. The aim of this study is to calculate the optimal cut-off value using a mathematical modeling approach. METHODS: Data was collected retrospectively, from 1996 to 2000, of 120 consecutive Mayo Clinic patients with EOC and positive nodes. All patients was underwent pelvic and/or aortic lymphadnectomy during surgical staging. To mathematically predict the probability of a positive node in EOC patients we used a predictive mathematical model (PMM). The mathematical analysis consisted: creation of a new PMM according to our purposes, application of PMM to describe the experimental data in order to build the polynomial regression curves in each lymphatic area and determine the optimal point for each curve. RESULTS: The mean number of lymph nodes and metastatic nodes removed were 35 and 7.8, respectively; the mean percentage of positive nodes was 28.3%. The optimal point of each fitting curves were: 7 nodes for unilateral aortic nodal sampling (at least 3 infrarenal or 5 inframesenteric) and 15 nodes for unilateral pelvic lymphadenectomy (at least 5 external iliac). CONCLUSIONS: We can mathematically predict the probability to obtain a positive node in EOC surgical staging. Our results have shown the need to obtain at least 22 lymph nodes between pelvic and aortic lymphadenectomy.

Modification of the hand-held Vscan ultrasound and verification of its performance for transvaginal applications.

PURPOSE: The purpose of this work was to validate a new clinical obstetrics and gynecology (OB-GYN) application for a hand-held ultrasound (US) device. We modified the smallest hand-held device on the market and tested the system for transvaginal (TV) use. This device was originally conceived for abdominal scanning only. METHODS: The validation involved 80 successive patients examined by the same operator: 25 obstetric and 55 gynecologic cases. US examination was performed transvaginally with two US systems: the hand-held Vscan (General Electrics; GE Vingmed Ultrasound; Norway) for which an intravaginal gadget TTGP-2010® (Troyano transvaginal gadget probe) was designed, and the Voluson 730 Expert (multifrequency transvaginal ultrasound of 3-9MHz; GE Healthcare, Milwaukee, WI, USA). We performed the same measurements with both US systems in order to confirm whether or not their diagnostic capability was similar. Quantitative difference in measurements between the systems was assessed, as well as the overall diagnostic detection rate and suitability for telemedicine. RESULTS: Regarding lesion visibility with Vscan, optimal distance was 8-16cm depending on the examination type, and the total detection rate was 98.7%. The exception was an ovarian endometrioma, diagnosed as a follicular cyst using the hand-held device. Assessment of reproducibility in 180 measurements showed that the measurements obtained with Vscan were 0.3-0.4cm lower than those obtained with the high resolution US device (Voluson 730 Expert). Nevertheless, Pearson's correlation coefficient was high for biparietal diameter (0.72) and gynecological (GYN) (0.99) measurements, and for overall correlation (0.997). Image transport on USB and SD-flash cards proved convenient for telemedicine. CONCLUSIONS: A novel TV application of a hand-held US device is demonstrated for OB-GYN. Heart, abdominal and obstetrics presets of the Vscan together with color-Doppler enable a detection capability comparable to that of a high-definition US device. The lower values of the measurements obtained by the hand-held device (by 0.3-0.4cm) must be taken into account, although they have no effect on its diagnostic capability.

Evaluation of endometrial and subendometrial vascularization and endometrial volume by 3-D power Doppler ultrasound and its relationship with age and pregnancy in intrauterine insemination cycles.

AIMS: To measure endometrial volume and endometrial-subendometrial vascularization by 3-D power Doppler ultrasound in patients undergoing cycles of artificial insemination with ovarian stimulation, to evaluate their relationship with patients' age and pregnancy development. METHODS: We included patients with primary and secondary infertility of one year of evolution. We measured vascular indexes and endometrial volume by 3-D power Doppler ultrasound. RESULTS: Seventy-nine consecutive cycles were studied. Endometrial volume average was 4.7 ± 2.66 ml. We did not find any difference between the endometrial volumes in women who did versus did not become pregnant (9 vs. 70 women, respectively). The endometrial vascular index was significantly higher in patients aged between 31 and 33 years old. In patients between the ages of 31 and 33, both the endometrial flow index (FI; p = 0.017) and the endometrial vascular FI (p = 0.013) were higher. At the subendometrial area, the vascular FI was lower in women older than 33 years old (p = 0.024), while the FI was higher in patients that achieved pregnancy (p = 0.047). CONCLUSIONS: Endometrial volumes were independent of pregnancy development. Endometrial and subendometrial vascularization FIs were significantly higher in younger women. The subendometrial FI was significantly higher in patients who achieved pregnancy.

[Effectiveness evaluation of polypropylene mesh in the repair of urogenital prolapse in 106 patients]. / Valoración de la eficacia de la malla de polipropileno en la reparación del prolapso urogenital en 106 pacientes.

OBJECTIVE: To evaluate the efficacy and security of polypropylene meshes in the repair of urogenital prolapse. MATERIAL AND METHOD: Retrospective and non-randomized study in 106 patients which had different kinds of urogenital prolapse repaired using polypropylene meshes between April 2005 and January 2007. The follow-up was carried out by two visits to the hospital, 2 and 6 months after surgery. The variables analyzed were age, parity, menopause presence, kind of surgical technique, surgical time, time at hospital and complications. Afterwards, the information was analyzed descriptively. RESULTS: Average age was 64.4 years. The rate of multiparity and menopause women was 91.51% and 92.45% respectively. The most used surgical technique was the anterior mesh with tension-free band (34.90%), to repair the associated urinary incontinence. The rate of intraoperatory complications was 2.83%, immediate complications was 37.73% and late complications was 21.69%. The success rate after 6 months was 80-100% depending on the technique. CONCLUSIONS: There is a low rate of intraoperatory and 6 months after the repair in the reconstructive surgery of pelvic floor for the urogenital prolapses using polypropylene meshes, which makes this technique a secure and effective option for the treatment of this problem.

Valoración de la eficacia de la malla de polipropileno en la reparación del prolapso urogenital en 106 pacientes / Efectiveness evaluation of polypropylene Mesh in the repair of urogenital prolapse in 106 patients

Objetivo: evaluar la eficacia y seguridad de las mallas de polipropileno en la corrección del prolapso urogenital. Material y método: estudio retrospectivo, no randomizado sobre 106 pacientes que desde Abril de 2005 a Enero de 2007 se sometieron a corrección de diferentes tipos de prolapso urogenital mediante malla de polipropileno. El seguimiento se realizó mediante visitas en consulta a los 2 y 6 meses. Las variables a analizadas fueron: edad, paridad, presencia de menopausia, tipo de intervención, tiempos quirúrgicos y de hospitalización y complicaciones. Posteriormente se realizó un análisis descriptivo de los datos. Resultados: La edad media fue de 64,4 años. De las 106 pacientes, 97 eran multíparas (91,51%) y 98 habían pasado la menopausia (92,45%). La intervención mayoritaria fue la colocación de una malla anterior con banda libre de tensión para la corrección de la incontinencia urinaria asociada representando un 34,90% del total. Se obtuvo una tasa global de complicaciones intraoperatorias del 2,83%, inmediatas del 37,73% y tardías del 21,69%. La tasa de éxito del procedimiento a los 6 meses estuvo entre 80-100% según el tipo de intervención. Conclusiones: Existe una baja tasa de complicaciones intraoperatorias y a los 6 meses en las cirugías de reparación del suelo pélvico en los prolapsos urogenitales con la malla de polipropileno, considerando este método como una opción eficaz y muy segura para el tratamiento esta patología (AU)

Objetive: to evaluate the efficacy and security of polypropylene meshes in the repair of urogenital prolapse. Material and method: retrospective and non-randomized study in 106 patients which had different kinds of urogenital prolapse repaired using polypropylene meshes between April 2005 and January 2007. The follow-up was carried out by two visits to the hospital, 2 and 6 months after surgery. The variables analyzed were age, parity, menopause presence, kind of surgical technique, surgical time, time at hospital and complications. After wards,the information was analyzed descriptively. Results: average age was 64.4 years. The rate of multiparity and menopause women was 91.51% and 92.45%respectively. The most used surgical technique was the anterior mesh with tension-free band (34.90%), to repair the associated urinary incontinence. The rate of intraoperatory complications was 2.83%, immediate complications was 37.73% and late complications was 21.69%. The success rate after 6 months was 80-100% depending on the technique. Conclusions: there is a low rate of intraoperatory and 6 months after the repair in the reconstructive surgery of pelvic floor for the urogenital prolapses using polypropylene meshes, which makes this technique a secure and effective option for the treatment of this problem (AU)

[Effectiveness evaluation of tension-free vaginal tapes in the treatment of urinary incontinence and satisfaction of 241 patients]. / Valoración de la eficacia de las mallas libres de tensión y satisfacción de 241 pacientes en la corrección de la incontinencia urinaria.

INTRODUCTION: Urinary incontinence is an extended problem between middle-aged women. There are several options for its correction with different effectiveness and complication rates. Our objective is to evaluate the effectiveness of tension-free vaginal transobturator tapes (TOT) in the repair of this incontinence. Also to evaluate the patients satisfaction rate with this kind of surgery. MATERIAL AND METHODS: Retrospective study in 241 women with a surgical repair of their urinary incontinence with TOT. We analyzed the rates of effectiveness and satisfaction of the patients with the surgical repair after 2 and 6 months. The complication rate was also analyzed. RESULTS: Urinary continence rate 2 months after surgery was around 70% and the satisfaction one around 65%. After 6 months the rates were 70% and 70% respectively with a minimal variation depending on the associated surgery. The complication rate during surgery was 3.31% and the one after surgery was 26.55%, although most of them were minor complications. COMMENT: The use of TOT for the repair of urinary incontinence is an effective and safe option with a low complication rate. Moreover the rate of patients satisfaction is high.

Valoración de la eficacia de las mallas libres de tensión y satisfacción de 241 pacientes en la corrección de la incontinencia urinaria / Effectiveness evaluation of tension-free vaginal tapes in the treatment of urinary incontinence and satisfaction of 241 patients

Introducción: La incontinencia urinaria es un problema muy extendido entre mujeres de mediana edad, para su corrección se han descrito muchas técnicas en los últimos años con diferentes tasas de éxito y complicaciones. Nuestro objetivo es valorar la eficacia de la mallas libres de tensión transobturadoras (TOT) en la corrección de este problema junto con la satisfacción de las pacientes con el procedimiento. Material y métodos: Estudio retrospectivo en 241 mujeres a las que se las corrigió su incontinencia urinaria con malla TOT. Se analizó la tasa de éxito y la tasa de satisfacción de las pacientes a los 2 y 6 meses tras la cirugía. Además se recogieron las tasas de complicaciones a corto y largo plazo. Resultados: La tasa de continencia de las pacientes a los 2 meses estuvo en torno el 70% y la de satisfacción en torno al 65%. A los 6 meses fueron del 70% y 70% respectivamente, variando ligeramente según el procedimiento asociado. Las tasa de complicaciones intraoperatorias fue del 3,31% y postoperatorias del 26,55% siendo casi todas ellas complicaciones menores. Discusión: La TOT es una opción eficaz y útil en la corrección de la incontinencia urinaria con una baja tasa de complicaciones. Además con una alta tasa de satisfacción de las pacientes (AU)

Introduction: Urinary incontinence is an extended problem between middle-aged women. There are several options for its correction with different effectiveness and complication rates. Our objective is to evaluate the effectiveness of tension-free vaginal transobturator tapes (TOT) in the repair of this incontinence. Also to evaluate the patients satisfaction rate with this kind of surgery. Material and Methods: Retrospective study in 241 women with a surgical repair of their urinary incontinence with TOT. We analyzed the rates of effectiveness and satisfaction of the patients with the surgical repair after 2 and 6 months. The complication rate was also analyzed. Results: Urinary continence rate 2 months after surgery was around 70% and the satisfaction one around 65%. After 6 months the rates were 70% and 70% respectively with a minimal variation depending on the associated surgery. The complication rate during surgery was 3,31% and the one after surgery was 26,55%, although most of them were minor complications. Comment: The use of TOT for the repair of urinary incontinence is an effective and safe option with a low complication rate. Moreover the rate of patients satisfaction is high (AU)

The labor induction: integrated clinical and sonographic variables that predict the outcome.

OBJECTIVE: To analyze the clinical and sonographic variables that predicts the success of labor induction. STUDY DESIGN: We studied the Bishop score, cervical length and parity in 196 pregnant women in the prediction of successful vaginal delivery within 24 h of induction. Logistic regression and segmentation analysis were performed. RESULTS: Cervical length (odds ratio (OR) 1.089, P<0.001), Bishop score (OR 0.751, P=0.001) and parity (OR 4.7, P<0.001) predict the success of labor induction. In a global analysis of the variables studied, the best statistic sequence that predicts the labor induction was found when we introduced parity in the first place. The success of labor induction in nulliparous was 50.8 and 83.3% in multiparous women (P=0.0001). CONCLUSIONS: Cervical length, Bishop score and parity, integrated in a flow chart, provide independent prediction of vaginal delivery within 24 h of induction.

Pólipo endometrial. Actitud histeroscópica / Endometrial polyp. Hysteroscopic management

El pólipo endometrial es una patología de gran prevalencia en la mujer. Puede cursar asintomático, o bien producir síntomas, como sangrado o infertilidad. El mejor método para su diagnóstico de sospecha es la ecografía, y para su confirmación y valoración, la histeroscopia. Los pólipos sintomáticos deben ser extirpados. Pero existe controversia sobre qué hacer con los asintomáticos. Estos últimos, si no son extirpados deben ser cuidadosamente controlados mediante ecografía y doppler

Endometrial polyp is a great prevalence pathology in women. It may be asymptomatic or not (bleeding and infertility). The best diagnostic method to suspect it is endosonography. The hysteroscopy lets the correct confirmation and evaluation. The symptomatic polyp must be removed, but there is a question actually about what to do with asymptomatic polyp. If it is not hysteroscopic treated, should be controlled by doppler-ultrasonography

Abordaje histeroscópico de la trompa de Falopio (faloposcopia). Esterilización transcervical tubárica / Hysteroscopy of the fallopian tube (falloscopy). Transcervical tubal sterilization

El gran desarrollo de diferentes técnicas de reproducción asistida, así como la mejoría en los sistemas ópticos han permitido a muchos endoscopistas la visualización correcta de los ostium tubáricos, su cateterización y la visualización de la luz tubárica en toda su extensión. Muchos años han pasado desde los primeros intentos, obtenindo conocimientos suficientes como para eliminar oclusiones tubáricas, transferir gametos o embriones y colocar dispositivos intratubáricos como alternativa a los métodos quirúrgicos de esterilización femenina

The great improvement of many assisted reproduction techniques and the visual systems, have made possible the correct view of tubal ostia, the current catheterization and the evaluation of every tube segment. Many years have passed since initial attempts and a lot of information was obtained to make possible the elimination of tubal occlusions, the transfer of gametes and embryos, and the placement of intratubal devices as an alternative to surgical methods of female sterilization

Principios básicos en histeroscopia diagnóstica / Basic principles of diagnostic hysteroscopy

La histeroscopia diagnóstica es una técnica sencilla, segura y que proporciona una gran cantidad de información sobre la patología endouterina. No es extraño pues que su extensión se haya producido de una manera muy rápida, arrinconando a otras técnicas más antiguas y más agresivas, como el legrado

Diagnostic hysteroscopy is a simple and safety method, which give us a very important information about endouterine diseases. So, the fast developement of this technique has made that traditional curettage, has been forgotten

Inducción del parto: variables clínicas que influyen hasta el inicio de la fase activa del parto / Induction of labor: clinical variables of influence until the onset of the active phase of labor

Objetivo: Analizar la influencia de diferentes variables clínicas en la duración de la inducción hasta llegar al período de parto activo. Sujetos y métodos: Analizamos 196 gestantes expuestas a inducción del parto. Eran gestaciones entre 37-42 semanas, únicas, en cefálica. Excluimos gestaciones con cicatrices uterinas. Definimos parto activo como cuello borrado, 2 cm y dinámica uterina regular. Dividimos el tiempo entre el comienzo de la inducción y el inicio de parto activo en 4 períodos: 0-6 h, 6-12 h, 12-24 h y más de 24 h. Utilizamos una regresión ordinal politómica. Resultados: El test de Bishop (p < 0,001), la paridad (p = 0,006) y el peso del neonato (p = 0,019) influyen en la probabilidad de llegar a parto activo en cada intervalo. No encontramos relación con la edad materna (p = 0,209), el diámetro biparietal del feto (p = 0,431) y el antecedente de aborto (p = 0,160). Conclusiones: Con el test de Bishop, la paridad y el peso del neonato se podría establecer la probabilidad de llegar a parto activo

Objective: To analyze the influence of several clinical variables on the duration of the interval between induction of labor and the active phase. Subjects and methods: We analyzed 196 pregnant women who underwent induction of labor. All the women had single, cephalic pregnancies at 37-42 weeks of gestational age. Pregnant women with uterine scars were excluded. The active period of labor was defined as cervical effacement, 2-cm dilatation and regular uterine contractions. The interval between the start of induction and the beginning of active labor was divided into four periods: 0-6 h, 6-12 h, 12-24 h and more than 24 h. Ordinal polytomic regression was applied. Results: The probability of reaching the active phase of labour in each interval was influenced by Bishop’s score (p<0.001), parity (p=0.006) and neonatal weight (p=0.019). No relationship was found with maternal age (p=0.209), fetal biparietal diameter (p=0.431) or a history of miscarriage (p=0.160). Conclusions: The probability of reaching the active phase of labor could be established using Bishop’s score, parity and neonatal weight

Creación de neovagina por laparoscopia en el síndrome de Rokitansky. Análisis de nuestros casos / Laparoscopic construction of a neovagina in Rokitansky syndrome. Analysis of our cases

Objetivo: Utilización de la laparoscopia como medio para la realización de una neovagina en pacientes con síndrome de Rokitansky aplicando los principios de Vecchietti. Pacientes y método: Dieciséis pacientes con síndrome de Rokitansky tratados mediante una modificación de la técnica de Vecchietti por vía laparoscópica. Resultados: Satisfactorio en 15 pacientes al obtener una vagina de al menos 8 cm en la revisión definitiva. Poco satisfactorio en 1 caso al disminuir la vagina de 12 a 6 cm por no seguir el tratamiento de mantenimiento. Conclusiones: La creación de una neovagina con asistencia laparoscópica es un procedimiento fácil, mínimamente invasivo y con pocos riesgos que permite un resultado temprano y satisfactorio para la paciente

Objective: Vecchieti’s principles were applied to laparoscopic construction of a neovagina in patients with Rokitansky syndrome. Patients and method: Sixteen patients with a diagnosis of Rokitansky syndrome were treated with a modified Vecchietti method by laparoscopic approach. Results: A satisfactory result was defined as a neovagina of at least 8 cm long on the final follow-up visit and was found in 15 patients. The result was much less satisfactory in the 16th patient in whom the vagina was discovered to be shortened from 12 cm to 6 cm at 2 years’ follow up as she had not followed the postoperative treatment. Conclusions: Laparoscopic creation of a neovagina is a safe, minimally invasive treatment with few risks and good functional results