Complications of transvaginal radiofrequency ablation of fibroids: A 5-year experience.

Introduction: Transvaginal radiofrequency ablation is a relatively noninvasive approach for the treatment of fibroids in patients who do not wish to undergo conventional surgery. Information on potential complications of this novel technique is very scarce. Methods: Retrospective, descriptive, epidemiological study of 115 patients who underwent transvaginal radiofrequency ablation of fibroids and for whom complications were recorded. Results: We performed 115 transvaginal radiofrequency ablation procedures, we recorded a total of 11 complications (9.6%; 95% CI, 3.8-14.8). Of these, 8 (7.0%) were classified as Clavien-Dindo type I, 1 (0.9%,) as type II, and 2 (1.7%) as type IIIb (severe). No other complications were recorded in a year follow-up. Conclusion: Transvaginal radiofrequency ablation is a treatment option that makes it possible to treat fibroids that are difficult to manage using other techniques. Few associated complications have been described, and most of them are mild.

Efficacy, Complications, and Factors Predictive of Response to Treatment with Transvaginal Radiofrequency Ablation for Symptomatic Uterine Myomas.

STUDY OBJECTIVE: Transvaginal radiofrequency ablation is a minimally invasive treatment for myomas in women who wish to preserve their uterus. This study aimed to evaluate the efficacy and safety of transvaginal radiofrequency to treat myomas and to identify factors predictive of the response to treatment. DESIGN: Prospective case series. SETTING: Virgen de las Nieves University Hospital, a tertiary center in Granada, Spain. PATIENTS: The participants were 59 patients with myomas. INTERVENTIONS: Transvaginal radiofrequency ablation. MEASUREMENTS AND MAIN RESULTS: The variables recorded were personal (age and type of myoma), procedure dependent (pain, need for analgesia, duration of sick leave, procedure duration, and complications), clinical (total days of menstrual bleeding and days of heavy menstrual bleeding), and score on the symptom severity scale of the Uterine Fibroid Symptom and Quality of Life Questionnaire. Myoma volume was determined by ultrasonography. Changes in clinical variables and myoma volume were analyzed 2, 6, and 12 months after the procedure. Moreover, the influence of age, initial myoma size, type of myoma, and duration of the procedure on the outcomes of treatment were analyzed. Statistically significant improvements in symptoms were seen in all variables analyzed for bleeding at 0, 2, 6, and 12 months, and a significant improvement was seen in the symptom severity scale score 12 months after the procedure. Mean myoma volume (in milliliters) was significantly lower 2, 6, and 12 months after treatment (p <.05). At 12 months, the mean reduction in myoma volume was more than 80%. Patient age and initial myoma size were identified as factors predictive of the outcomes. CONCLUSION: Transvaginal radiofrequency ablation was an effective and safe technique for the treatment of myomas. The patient's age and initial size of the myoma influenced the outcome of treatment.

Parto operatorio fallido / Failed operative vaginal delivery

La tasa de parto vaginal instrumental está disminuyendo en todos los países desarrollados a costa de un aumento generalizado de la tasa de cesáreas. El parto operatorio vaginal fallido es una situación indeseada por los obstetras, que puede conllevar en algunas ocasiones un aumento de la morbilidad materno-fetal y en casos extremos un aumento de la mortalidad fetal. Estos riesgos pueden minimizarse o evitarse mediante una evaluación individualizada de cada gestante, feto y situación clínica, aplicando los protocolos recomendados por las sociedades científicas para la realización de un parto instrumental y abandonando la vía vaginal en el momento adecuado, sin prolongar el número de intentos o sin aumentar la intensidad de la tracción realizada. La experiencia en parto operatorio vaginal es imprescindible, debiéndose abandonar dicho procedimiento ante la inseguridad del obstetra (AU)

Globally, the rate of instrumental vaginal delivery is declining in all developed countries at the expense of a general increase in the rate of cesarean sections. Failed operative vaginal delivery is an undesirable situation for all obstetricians and can sometimes lead to increased maternal and fetal morbidity and, in extreme cases, to fetal mortality. These risks can be minimized or avoided through individualized assessment of each patient, fetus, and clinical situation by using the protocols recommended by scientific societies to perform instrumental delivery and abandoning the vaginal route at the appropriate moment without extending the number of attempts or increasing the intensity of the traction performed. Experience of vaginal surgery is essential, and the procedure should be abandoned whenever the obstetrician feels uncertain (AU)

Cáncer de mama en la mujer joven / Breast cancer in young women

Objetivo: Revisar las características que tiene el cáncer de mama (CM) en la mujer joven. Material y métodos: Para ello, se hace una exhaustiva revisión bibliográfica, indicando los factores etiológicos, los métodos diagnósticos y las opciones de tratamiento existentes, con mención especial a circunstancias que pueden concurrir en estas pacientes, tales como la menopausia temprana, la pérdida de fertilidad, el embarazo tras CM y el CM durante la gestación. Resultados: Destacan que el CM en la mujer joven es muy infrecuente, aunque se está constatando un aumento en su frecuencia. Es de mayor tamaño y con márgenes positivos, lo que le confiere una mayor agresividad y una mortalidad más alta. Para su diagnóstico, más difícil que en la mujer mayor, tiene gran importancia el triple test (mamografía, ecografía y biopsia) y sus opciones de tratamiento son las mismas que en las mujeres de más edad. Conclusiones: El CM en la mujer joven tiene unas características especiales que lo diferencian, en algunos aspectos, al CM que se diagnostica en la mujer de más edad (AU)

Objective: To review the characteristics of breast cancer in young women. Material and methods: The scientific literature was reviewed, indicating the etiological factors, diagnostic methods and treatment options, with special reference to the factors that can concur in young patients such as premature menopause, loss of fertility, pregnancy after breast cancer and breast cancer during pregnancy. Results: Importantly, breast cancer in young women is very rare but is on the increase. Tumors are larger in young women and have positive margins, making the disease more aggressive and leading to higher mortality. Diagnosis is more difficult than in older women and the triple test (mammography, ultrasound and biopsy) is of great importance. Treatment options are the same as in older women. Conclusions: Breast cancer in young women shows certain characteristics that differentiate it in some respects from breast cancer diagnosed in older women (AU)