Insuficiencia cervical y prolapso de bolsa amniótica "en reloj de arena"en gestante pretérmino / Cervical Insufficiency and Prolapse of an "Hourglass" Amniotic Sac in Preterm Pregnant Women

RESUMEN Introducción: La insuficiencia cervical se concibe hoy día como un proceso biológico continuo con grados progresivos de insuficiencia. La expresión más extrema de la insuficiencia cervical se conoce como "bolsa en reloj de arena". La mayoría de los autores están de acuerdo en recomendar el reposo en cama y realizar cerclaje cervical de emergencia. Objetivo: Presentar el caso de una gestante en la que se logró la reversión del prolapso de las membranas amnióticas en "reloj de arena" con buenos resultados perinatales. Presentación de caso: Paciente de 31 años con antecedentes de parto anterior a las 36,5 semanas, que en los momentos actuales cursa una gestación de 20,6 semanas. Acude a la consulta por dolor en hipogastrio y al examen físico se comprueba que la bolsa amniótica protruye por el orificio cervical externo y presenta una dilatación cervical de 2 cm. Se aplica tratamiento medicamentoso y se reduce el prolapso de la bolsa. Conclusiones: Con el tratamiento conservador se logró una buena evolución de la gestación, con parto eutócico y buenos resultados perinatales(AU)

ABSTRACT Introduction: Cervical insufficiency is conceived today as a continuous biological process with progressive degrees of insufficiency. The most extreme expression of cervical insufficiency is known as "hourglass bag". Most authors agree to recommend bed rest and perform emergency cervical cerclage. Objective: To report the case of a pregnant woman in whom the prolapse reversal of the amniotic membranes in hourglass was achieved with good perinatal results. Case report: A 31-year-old patient who is currently pregnant at 20.6 weeks and has history of childbirth prior to 36.5 weeks. She comes to the consultation complaining of pain in hypogastrium. The physical examination shows that the amniotic sac protrudes through the external cervical orifice and there is 2cm cervical dilation. Drug treatment is applied and the prolapse of the sac is reduced. Conclusions: The conservative treatment achieved good evolution of the gestation, with eutócico childbirth and good perinatal results(AU)

Impact of retroperitoneal lymph node dissection in ovarian cancer - time for paradigm shift?

Ovarian cancer is the second most common malignant neoplasm of the genital tract. Staging procedures for ovarian cancer include longitudinal laparotomy, hysterectomy, bilateral salpingo-oophorectomy and infragastric omentectomy as well as systematic pelvic and para-aortic lymphadenectomy. In general, the goal of this primary procedure is to achieve the maximum cytoreduction of all abdominal diseases; a residual disease <1 cm defines optimal cytoreduction, however, a maximal effort should be made to remove all gross disease as this offers superior survival outcomes. The role of lymphadenectomy in ovarian cancer has been the focus of gynecological oncologists during recent years. The core issue of the controversy is whether the removal of lymph nodes should be performed only to stage the disease or if the removal itself improves survival. To further comprehend the issue, one must take into account that several studies have shown that systematic lymphadenectomy is associated with a risk of vascular injury, lymph cyst formation, pulmonary embolism and increased post-operative mortality even when performed by surgeons with extensive experience. We present an extensive review of the available literature on the matter, hoping to provide some insight into the true need for such a procedure.

Safety and patients' satisfaction after hysteroscopic sterilisation.

The aim of this study was to understand the potential complications of the Essure® device as well as the factors influencing its onset and patient satisfaction. We present a 9-year descriptive prospective study that included 1068 patients. The device was placed in 1056 of them (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p = .00). In all, 161 of the 1064 patients who had the Essure® inserted reported having an adverse effect during the 3-months post-insertion (pelvic pain or discomfort). The mean score out of 10 attributed to this method was 9.06 (S = 1.11). We concluded that the Essure® shows a low rate of complications and users showed a high degree of satisfaction. Impact statement What is already known on this subject: There are few international publications on Essure®. When we conducted a search in PubMed for the term 'Essure', we obtained 221 publications. When we added the terms 'Essure and complications', we obtained 20 publications, and when we increased the restriction including 'satisfaction', we obtained seven; thus, the uniqueness of our study. What the results of this study add: We present a 9-year descriptive prospective study that included 1068 patients. The aim of this study was to understand the potential complications of the Essure® device (Bayer, Whippany, NJ), as well as factors that can influence its onset and the patient satisfaction. The device was placed in 1056 of the patients (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p=.00). What the implications are of these findings for clinical practice and/or further research: Our study shows a low rate of complications with Essure®, mild and transient in most cases, as well as a high degree satisfaction. Nevertheless, given the few published studies on this device, we believe that long-term follow-up is needed.

Mioma vaginal intraabdominal, masa pélvica de localización atípica / Intra-abdominal vaginal myoma, a pelvic mass of atypical location

La patología miomatosa del tracto genital inferior es uno de los motivos más frecuentes de consulta en Ginecología. Sin embargo, su localización vaginal resulta una situación infrecuente de difícil diagnóstico. En muchas ocasiones se lleva a cabo tras un hallazgo casual intraoperatorio. Las manifestaciones clínicas que producen los leiomiomas en esta localización son inespecíficas; el tratamiento quirúrgico es el de elección, generalmente mediante un abordaje por la vía vaginal(AU)

Myomatous disease of the lower genital tract is one of the most common reasons for gynecological consultation. However, vaginal location is infrequent and difficult to diagnose. On many occasions diagnosis is based on a fortuitous intraoperative finding. The clinical manifestations of vaginal leiomyomas are unspecific. Surgery is the treatment of choice, which is generally performed by vaginal approach(AU)

Adenocarcinoma mucinoso del paraovario: un tumor infrecuente / Mucinous paraovarian adenocarcinoma: a rare tumour

Se denomina tumor del paraovario a aquel que se desarrolla en los tejidos cercanos al ovario. Dado que generalmente no producen manifestaciones clínicas, su diagnóstico se suele realizar de forma incidental durante cirugías, estudios de fertilidad o post-mortem. Aunque la degeneración neoplásica de estas lesiones es altamente infrecuente, cuando ocurre puede dar lugar a tumores tanto de bajo como de alto grado. Presentamos un caso de adenocarcinoma mucinoso del paraovario intervenido en nuestro centro y revisamos la literatura disponible del tema (AU)

Paraovarian tumors are those that arise from tissues surrounding the ovaries. Given that they do not normally cause symptoms, they are usually diagnosed during surgery, fertility studies, or post-mortem. Neoplastic transformation of these lesions is highly infrequent but can give rise to low-grade (borderline) as well as high-grade tumours. We present a case of paraovarian mucinous adenocarcinoma and provide a review of the available literature on the subject (AU)

Metástasis ovárica única de angiosarcoma mamario como localización infrecuente / Single ovarian metastases of breast angiosarcoma as unusual location

Los angiosarcomas son tumores vasculares extremadamente raros con alta tasa de proliferación e invasión. Están caracterizados por células anaplásicas que se originan en las paredes de los vasos sanguíneos. Poseen mal pronóstico debido a su comportamiento altamente agresivo, el cual condiciona una elevada probabilidad de recurrencia local y extensión multiorgánica. Se presentan principalmente en: pulmón, hígado, ganglios linfáticos y huesos. Su tratamiento es controvertido debido escasa casuística disponible acerca de esta estirpe tumoral, aunque parece claro que el tratamiento principal es la cirugía y que el tratamiento posterior puede ser la quimioterapia adyuvante(AU)

Angiosarcomas are extremely rare vascular tumors with high rate of proliferation and invasion. They are characterized by anaplastic cells originating in the walls of blood vessels. They have poor prognosis because of their highly aggressive behavior, which determines a high probability of local recurrence and spreading to multiple organs. They occur mainly in lung, liver, lymph nodes and bones. Treatment is controversial due to small number of cases available about this tumor type, although it seems clear that the main treatment is surgery and subsequent treatment can be adjuvant chemotherapy(AU)

Torsión aislada de trompa de Falopio en paciente sometida a bloqueo tubárico bilateral / Isolated Fallopian tube torsion in a patient with bilateral tube blockage

La torsión aislada de la trompa de Falopio es un motivo infrecuente de consulta en Ginecología. La clínica que produce es sumamente inespecífica, dificultando mucho la realización de un diagnóstico de sospecha y de un tratamiento precoz (AU)

Isolated torsion of the fallopian tube is a rare reason for seeking consultation in gynaecology. Symptoms are non-specific, which hampers its presumptive diagnosis and early treatment (AU)

Diagnóstico prenatal de atresia ileal asociada a peritonitis meconial / Prenatal diagnosis of ileal atresia jounted to meconial peritonitis

La atresia ileal aislada es una situación poco frecuente que cuenta con limitados casos publicados en la bibliografía internacional. Su diagnóstico es complejo y se realiza siempre en el tercer trimestre de gestación. Puede complicarse en un 5% de los casos con peritonitis meconial, la cual empeora el pronóstico. Presentamos un caso de debut tardío de atresia ileal con perforación intestinal y peritonitis meconial en una mujer con buen control gestacional (AU)

Isolated ileal atresia is a rare situation, with few cases reported in the international literature. Its diagnosis is difficult and always occurs on the third trimester of pregnancy. It can be complicated by meconium peritonitis in 5% of the cases, worsening the prognosis. We present a late debut of a case of ileal atresia with bowel perforation and meconium peritonitis in a woman with excellent pregnancy controls (AU)

Radiation-induced breast angiosarcoma: a case report.

Radiation-induced breast angiosarcoma is a severe but rare late complication in the breast-preserving management of breast cancer through surgery and radiotherapy [1]. Often the initial diagnosis of this entity is complex given its relatively anodyne nature and usually being present in the form of typically multifocal reddish-purple papular skin lesions [2]. Because of the low incidence of this tumour, there is a limited number of studies regarding its optimal therapeutic management [3]. The preferred treatment is aggressive surgical removal and the prognosis is poor with an overall survival rate of 12-20% at five years [4].

Uso de la traquelectomía radical en cáncer de cérvix con histología infrecuente: a propósito de 2 casos / Use of radical trachelectomy in cervical cancer with rare histology: two case reports

La traquelectomía radical es una intervención que permite preservar la fertilidad en mujeres jóvenes con cáncer de cérvix en estadio precoz. Su seguridad ha sido sobradamente demostrada en el tratamiento de la estirpe escamosa, pero existen dudas sobre la conveniencia de usarla en histologías vinculadas tradicionalmente a un peor pronóstico. Presentamos aquí 2 casos atípicos de cáncer de cérvix (adenocarcinoma de células claras y carcinoma escamoso con adenocarcinoma coexistente) intervenidos mediante traquelectomía radical previa biopsia de ganglio centinela pélvico (AU)

Radical trachelectomy is a surgical technique that allows young women with early invasive cervical carcinoma to preserve their fertility. Although its safety has been demonstrated in squamous histology, doubts remain about the advisability of this intervention in histological types traditionally associated with a worse outcome. We describe two cases of rare cervical tumors (clear cell adenocarcinoma and synchronous invasive squamous cell carcinoma and invasive adenocarcinoma) treated with radical trachelectomy after pelvic sentinel node biopsy (AU)

Tumor ovárico no epitelial: tumor de Sertoli-Leydig / Non-epithelial ovarian cancer: Sertoli-Leydig cell tumor

Los tumores de Sertoli-Leydig son un tipo infrecuente de tumor de ovario de estirpe no epitelial; concretamente, pertenecen al grupo de los tumores de los cordones sexuales-estroma, con una incidencia aproximada de un 2-5% de todas las neoplasias ováricas malignas. Presentamos el caso de una paciente de 42 años intervenida de un tumor de Sertoli con focos sarcomatoides. El diagnóstico de estos tumores es difícil de establecer prequirúrgicamente, y debido a la escasez de publicaciones, existe mucha controversia acerca de la estadificación quirúrgica idónea y sobre la conveniencia de realizar o no tratamiento adyuvante (AU)

Sertoli-Leydig cell tumors are a rare type of non-epithelial ovarian cancer; these tumors belong to the group of sex cord-stromal tumors and account for approximately 2-5% of all malignant ovarian tumors. We report the case of a 42-year-old woman who underwent surgery for a Sertoli tumor with sarcomatoid foci. Diagnosis of these tumors is difficult before surgery and, due to the scarcity of publications on the topic, there is controversy about the appropriate surgical staging and the role of adjuvant therapy in the management of this entity (AU)

Mola completa coexistente con feto vivo normal: caso clínico y revisión de la literatura / Complete mole coexisting with a live term fetus: a case report and literature review

La coexistencia de mola completa y feto vivo a término es una entidad raramente reportada en la literatura científica. El diagnóstico de sospecha se establece con la ecografía y la confirmación se logra a través del estudio anatomopatológico de tejidos. Las pacientes con mola completa tienen un riesgo del 12-20% de desarrollar enfermedad trofoblástica persistente, de ahí la importancia del seguimiento estrecho. Presentamos un caso de diagnóstico precoz de mola completa coexistente con gestación normal y revisamos la literatura disponible del tema (AU)

The coexistence of a complete mole and live term fetus is a rare entity seldom reported in the literature. Primary non-invasive diagnosis is usually achieved through ultrasound examination and definitive diagnosis can be achieved when molar tissue samples are available for histopathological examination. Patients with a complete mole have a 12-20% risk of developing persistent gestational trophoblastic disease, hence the importance of close follow-up. We report the early diagnosis of a complete mole coexisting with a normal fetus and also provide a review of the literature on the topic (AU)

Gestación gemelar en paciente con malformación de Arnold-Chiari tipo I asociada a siringomielia / Twin pregnancy in a patient with arnold-chiari malformation type I Associated with syringomyelia

La siringomielia es una enfermedad neurológica infrecuente, con una prevalencia aproximada de uno por cada 100.000 personas; su asociación con embarazo es aún más rara. Presentamos un caso clínico inusual en el que a una paciente con malformación de Arnold-Chiari tipo I asociada a siringomielia y gestación gemelar se le realizó a las 39 semanas una cesárea electiva con anestesia general. Debido a los pocos casos publicados de gestación en pacientes con siringomielia y malformación de Arnold-Chiari tipo I existe poca evidencia respecto al manejo de estas pacientes, por lo que se debe optar por una discusión multidisciplinar con todos los miembros del equipo médico involucrado (AU)

Syringomyelia is a rare neurological disease with a prevalence of approximately one per 100,000 people; its association with pregnancy is unusual. We present a rare case in which a patient with Arnold-Chiari type I malformation, syringomyelia, and a twin pregnancy underwent an elective cesarean section at 39 weeks under general anesthesia. Because there have been few published reports of pregnancy in patients with syringomyelia and Arnold-Chiari type I malformation, evidence is scarce on the management of these patients. Therefore, coordinated decisions involving several medical specialties is recommended (AU)

Primary neuroendocrine tumour of the breast: a case report and review of the literature.

Primary neuroendocrine tumour of the breast is a rare entity that first appeared in the 2003 World Health Organisation (WHO) classification of breast tumours. The data currently available on its prognosis are contradictory, although it seems clear that histological varieties such as small cell neuroendocrine carcinoma have a worse prognosis, due to their low degree of differentiation. The treatment of choice is surgery, and the indications for chemotherapy or radiotherapy do not differ greatly from those used for other breast tumours. It is crucial to underline the difficulty of establishing treatment protocols due to the low incidence of this histological type.