Effectiveness and patient satisfaction with office hysteroscopic polypectomy in patients with symptomatic endometrial polyps.

Background: Endometrial polyps are a common cause of abnormal uterine bleeding. In-office hysteroscopic management is frequently performed to treat this frequently encountered pathology. Objectives: To evaluate the long-term outcome and patients' satisfaction with office hysteroscopic polypectomy in patients with symptomatic endometrial polyps. Materials and Methods: Retrospective longitudinal observational study of all hysteroscopic polypectomies performed at d'Igualada University Hospital (Barcelona, Spain) between May 2016 and December 2018. The medical records were reviewed, and a telephone interview was conducted with all the patients diagnosed with symptomatic endometrial polyps who underwent outpatient hysteroscopic polypectomy, with the purpose of evaluating the post-procedure symptomatology and satisfaction with the procedure. Main outcomes and results: A total of 848 outpatient hysteroscopies were performed, 379 of which were polypectomies. Of those, 163 procedures were performed in symptomatic patients and were included in the final analysis. The most common symptom among premenopausal patients was abnormal uterine bleeding (84.85%) and in postmenopausal women, postmenopausal bleeding (95.3%). After the procedure, the symptoms resolved or decreased considerably in 66.7% of premenopausal and 93.7% of postmenopausal patients. Additionally, 87.1% of the patients were very satisfied with the procedure. Conclusion: Office hysteroscopic polypectomy is an effective treatment for endometrial polyps with high patient satisfaction reported following the procedure.

Manejo histeroscópico de los restos ovulares con energía mecánica / Hysteroscopic management of products of conception with mechanical energy

Objetivo: Evaluar e identificar aquellas variables relacionadas con la tasa de éxito en el manejo con el histeroscopio de energía mecánica Truclear System 5.0(R) de los restos ovulares retenidos. Material y métodos: Estudio descriptivo prospectivo realizado en el Hospital de Igualada con periodo de inclusión de enero del 2015 a diciembre del 2016. Incluye a todas aquellas pacientes con diagnóstico de restos ovulares a las que se les realizó en el quirófano una histeroscopia diagnóstico-terapéutica con el histeroscopio de energía mecánica Truclear System 5.0(R). Resultados: Se incluyeron un total de 42 pacientes de las cuales se excluyeron 12 por no cumplir los criterios de inclusión. De las 30 pacientes analizadas, 21 (70%) presentaban pérdidas discontinuas en el momento del diagnóstico, mientras que 9 (30%) permanecían asintomáticas. La morcelación completa de los restos se consiguió en el 77% de las pacientes (23). No hubo ninguna complicación evidente intraoperatoria ni en el postoperatorio inmediato. Conclusiones: La resección selectiva histeroscópica con energía mecánica parece ser un buen método terapéutico para la retención de los restos ovulares, con unos porcentajes de éxito del 77%. Esta técnica nos ofrece una alternativa al tradicional legrado uterino evacuador que minimiza los riesgos y complicaciones que supone un acto quirúrgico invasivo para la paciente. Se plantea, como futura hipótesis de trabajo, la seguridad y el beneficio en la realización de la histeroscopia ambulatoria en todas aquellas pacientes con restos ovulares que cumplan unos criterios específicos

Objective: To evaluate and identify the variables related to the success rate in managing patients diagnosed with retained products of conception, by using the Truclear System 5.0(R) Hysteroscopic Morcellator, which is powered by mechanical energy. Materials and methods: A descriptive prospective study was performed at Hospital de Igualada, with the inclusion period lasting from January 2015 to December 2016. The study included all patients diagnosed with retained products of conception who underwent diagnostic and therapeutic hysteroscopy with the Truclear System 5.0(R) Hysteroscopic Morcellator, which uses mechanical energy. Results: A total of 42 patients were included, of whom 12 were excluded because they did not meet the inclusion criteria. Of the 30 patients analysed, 21 (70%) had low abnormal uterine bleeding at the time of diagnosis and 9 (30%) remained asymptomatic. The complete removal of the remains was achieved in 77% of the patients (23). There were no evident complications either during or immediately after surgery. Conclusions: Hysteroscopic selective resection with mechanical energy seems to be a good therapeutic method for retained products of conception, achieving a success rate of 77%. This technique offers an alternative to traditional dilatation and legrado, minimising the risks and complications involved in invasive surgical procedures for patients. Further studies are needed to evaluate the safety of and benefit in performing hysteroscopy on an outpatient basis in all patients with retained products of conception who meet specific criteria

Telomere dysfunction and chromosome structure modulate the contribution of individual chromosomes in abnormal nuclear morphologies.

The cytokinesis-block micronucleus assay has emerged as a biomarker of chromosome damage relevant to cancer. Although it was initially developed to measure micronuclei, it is also useful for measuring nucleoplasmic bridges and nuclear buds. Abnormal nuclear morphologies are frequently observed in malignant tissues and short-term tumour cell cultures. Changes in chromosome structure and number resulting from chromosome instability are important factors in oncogenesis. Telomeres have become key players in the initiation of chromosome instability related to carcinogenesis by means of breakage-fusion-bridge cycles. To better understand the connection between telomere dysfunction and the appearance of abnormal nuclear morphologies, we have characterised the presence of micronuclei, nucleoplasmic bridges and nuclear buds in human mammary primary epithelial cells. These cells can proliferate beyond the Hayflick limit by spontaneously losing expression of the p16(INK4a) protein. Progressive telomere shortening leads to the loss of the capping function, and the appearance of end-to-end chromosome fusions that can enter into breakage-fusion-bridge cycles generating massive chromosomal instability. In human mammary epithelial cells, different types of abnormal nuclear morphologies were observed, however only nucleoplasmatic bridges and buds increased significantly with population doublings. Fluorescent in situ hybridisation using centromeric and painting specific probes for chromosomes with eroded telomeres has revealed that these chromosomes are preferentially included in the different types of abnormal nuclear morphologies observed, thus reflecting their common origin. Accordingly, real-time imaging of cell divisions enabled us to determine that anaphase bridge resolution was mainly through chromatin breakage and the formation of symmetric buds in daughter nuclei. Few micronuclei emerged in this cell system thus validating the scoring of nucleoplasmic bridges and nuclear buds for measuring chromosome instability in telomere-dysfunction cell environments.

The number of dysfunctional telomeres in a cell: one amplifies; more than one translocate.

Chromosomal instability is increasingly appreciated as a key component of tumorigenesis in humans. A combination of abnormal telomere shortening and cell-cycle checkpoint deficiency has been proposed as the initial lesions causing destabilizing chromatin bridges in proliferative cells. We examined the participation of the different types of end-to-end fusions in generating instable karyotypes in non-transformed human breast epithelial cells. We concluded that short dysfunctional telomeres represent an initiating substrate for post-replicative rejoining of sister chromatids and are likely to make an important contribution to the formation of chromosomal rearrangements and the amplification of chromosome arm segments in breast epithelial cells. We propose that there is a chronological order in the participation of the different types of end-to-end fusions in the generation of chromosomal instability. Thus, intrachromosomal post-replicative joining would proceed mainly in the early stages after overcoming growth arrest, when telomere dysfunction is limited and affects only one chromosome end in a cell. The absence of a second substrate for end joining will conduct the cell with the uncapped chromosome to replicate its DNA and fuse the uncapped sister chromatids after replication. Later, since telomeres shorten progressively with each DNA replication round, the uncapping will affect many more chromosome ends, and fusions between the uncapped ends from different chromosomes will be produced. While the fusion of sister chromatids will produce chromosome segment amplification and terminal deletions in the daughter cells, interchromosomal fusion will produce unbalanced rearrangements other than chromosome segment amplifications.