Multidisciplinary consensus on cancer management during pregnancy

Cancer during pregnancy is a challenge for multi- and interdisciplinary collaboration due to the diagnostic, prognostic and therapeutic implications, the need for an integrated harmonization of medical action for the pregnant patient and the embryo or foetus and the characteristics of each gestational period, which will determine the protocol to be proposed and its limitations. For this reason, a group of experts appointed by participating scientific societies, which includes the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica—SEOM), the Spanish Association of Surgeons (Asociación Española de Cirujanos—AEC), the Spanish Society of Gynaecology and Obstetrics (Sociedad Española de Ginecología y Obstetricia—SEGO), the Spanish Society of Nuclear Medicine and Molecular Imaging (Sociedad Española de Medicina Nuclear e Imagen Molecular—SEMNIM), the Spanish Society of Oncological Radiotherapy (Sociedad Española de Oncología Radioterápica—SEOR) and the Spanish Society of Medical Radiology (Sociedad Española de Radiología Médica—SERAM), have worked together to establish consensus recommendations that allow the harmonization of management and ultimately the optimization of the healthcare of pregnant patients with cancer. When cancer is detected in a pregnant woman, the week of gestation in which the diagnosis is made must be considered, as well as the characteristics of the tumour. It is strongly recommended that a multidisciplinary team assesses the situation and guides the patient and her family during the informing, diagnosis and treatment process. Likewise, the foetus should be monitored and managed by specialized obstetricians who are part of a multidisciplinary cancer committee (AU)

Current situation in gynecological oncology training in Spain: where we are and where we want to go

Background. It is important to know what a young gynecologic oncologist perceives as a need to achieve a good training in gynecologic oncology. Objective. This study aims to evaluate the level of training in gynecologic oncology in Spain. Methods. A Web-based anonymous questionnaire was sent via e-mail to Spanish trainees listed in European Network of Young Gynecological Oncology (ENYGO). The survey was developed in four sections: (1) general training in gynecologic oncology, (2) distribution of current clinical activity, (3) surgical training, and (4) perspective future gynecologic oncology. It contained 51 questions, with multiple-choice answers that had to be answered by the ENYGO members. Results. The questionnaire was sent to 64 people listed in the ENYGO database. Of these, 37 members responded (response rate of 58%). Overall, more training in surgery is necessary, to perform radical oncological surgeries. It is claimed a sub-specialty recognition, to ensure an equalitarian and homogeneous training (AU)

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Anestesia subaracnoidea selectiva: Soluciones diluidas a bajas dosis / No disponible

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Anestesia subaracnoidea hipobárica a dosis bajas para cirugía anorrectal en posición de navaja: comparación entre levobupivacaína-fentanilo y lidocaína-fentanilo / Low-dose hypobaric spinal anesthesia for anorectal surgery in jackknife position: levobupivacaine-fentanyl compared to lidocaine-fentanyl

INTRODUCCIÓN: El objetivo de este estudio fue comparar el porcentaje de pacientes que evitaban su paso (bypass) por la unidad de recuperación postanestésica (URPA) después de una anestesia subaracnoidea selectiva con lidocaína- fentanilo respecto a otra de levobupivacaína-fentanilo, en cirugía anorrectal realizada en pacientes en posición de navaja. MATERIAL YMÉTODOS: Estudio aleatorizado, prospectivo y doble ciego. Se compararon dos grupos de 30 pacientes, ASA I-II. El grupo Lido recibió 18 mg de lidocaína 0,6% más 10 μg fentanilo y el grupo Levo 3 mg de levobupivacaína 0,1% más 10 μg fentanilo. Se monitorizaron las siguientes variables intraoperatorias: tiempo de inicio de la cirugía, nivel máximo de bloqueo sensitivo, necesidad de suplementación analgésica, aparición de eventos hemodinámicos. El nivel sensitivo se registró a los 5, 10 y 15 minutos y al final de la cirugía. Tras la cirugía se registró el grado de bloqueo motor, el nivel de propiocepción, el test de Romberg y si el paciente podía puentear la Unidad de recuperación postanestésica. Los tiempos de deambulación y de alta a domicilio, las complicaciones y la satisfacción postoperatoria también fueron registradas. RESULTADOS: No se observó diferencias significativas entre los grupos en cuanto a variables intraoperatorias. El 100% de los pacientes del estudio fue directamente a la unidad de adaptación al medio sin pasar por la URPA. Los tiempos para la deambulación, el alta a domicilio, así como las complicaciones y la satisfacción global postoperatoria fueron similares en ambos grupos. CONCLUSIONES: Ambas soluciones intratecales producen anestesia selectiva efectiva proporcionando un porcentaje de bypass de la URPA similar en cirugía anorrectal en posición de navaja(AU)

OBJECTIVE: To compare the percentage of patients who were able to bypass the postoperative intensive care recovery unit after selective spinal anesthesia with lidocaine-fentanyl versus levobupivacaine-fentanyl for anorectal surgery in jackknife position. MATERIAL AND METHODS: Randomized double-blind clinical trial comparing 2 groups of 30 patients classified ASA 1-2. One group received 18 mg of 0.6% lidocaine plus 10 μg of fentanyl while the other group received 3 mg of 0.1% levobupivacaine plus 10 μg of fentanyl. Intraoperative variables were time of start of surgery, maximum extension of sensory blockade, requirement for rescue analgesics, and hemodynamic events. The level of sensory blockade was recorded at 5, 10, and 15 minutes after the start of surgery and at the end of the procedure. The degrees of postoperative motor blockade and proprioception were recorded, as were the results of the Romberg test and whether or not the patient was able to bypass the postoperative recovery unit. Also noted were times of start of ambulation and discharge, complications, and postoperative satisfaction. RESULTS: Intraoperative variables did not differ significantly between groups, and all patients in both groups bypassed the postoperative recovery unit. Times until walking and discharge home, complications, and overall satisfaction after surgery were similar in the 2 groups. CONCLUSIONS: Both spinal anesthetic solutions provide effective, selective anesthesia and are associated with similar rates of recovery care unit bypass after anorectal surgery in jackknife position(AU)

Tumor de células de Leydig de ovario: una causa infrecuente de virilización en la mujer posmenopáusica / Leydig cell tumor of the ovary: an uncommon cause of virilization in postmenopausal women

El tumor de células de Leydig de ovario es un tipo de neoplasia muy raro que suele presentarse en mujeres posmenopáusicas. Presentamos el caso de una mujer de 72 años que consultó por virilización. Las determinaciones hormonales mostraron una elevación muy marcada de la testosterona (12.038 pg/ml), con valores normales del resto de hormonas sexuales. En la ecografía se observó una tumoración de 10 mm en el ovario izquierdo. Se realizó histerectomía y doble anexectomía. El estudio histológico demostró la existencia de un tumor de células de Leydig en el ovario izquierdo. Tras la intervención, los valores plasmáticos de testosterona se normalizaron, y la paciente mostró una lenta regresión de los síntomas clínicos

Leydig cell tumor of the ovary is a very rare neoplasm that usually occurs in postmenopausal women. We report the case of a 72-year-old woman with symptoms of virilization. Hormonal evaluation showed marked elevation of serum testosterone (12038 pg/ml) and no evidence of increased production of other sexual hormones. Ultrasound examination revealed a 10-mm tumor within the left ovary. Subsequently, total hysterectomy with bilateral oophorectomy was performed. Histopathological examination showed a Leydig cell tumor within the left ovary. Postoperative plasma testosterone levels returned to normal and the patient showed slow regression of clinical symptoms