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.

[The figure of the head of service (Chairman): what profile should have?]. / La figura del Jefe de Servicio: qué perfil debe de tener?

Great social-health care changes in the short term have been predicted that will seriously affect the departmental structure and care hierarchy of future hospital, universitary, public or private. The Spanish Association of Urology (AEU) wondered whether in these circumstances, in which the welfare and economic management of the hospital so-called "industrial" will dominate over other traditional aspects of the scientific hierarchy, social welfare and teaching of head Urology of service, will change his image, goals, functions, and ultimately its authority. Likewise which must be the attributes of this new generation of department heads. To this end the AEU call a roundtable requesting opinions and comments which are reflected in the enclosed text.

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)

La figura del Jefe de Servicio: ¿qué perfil debe de tener? / The figure of the head of service (chairman): what profile should have?

Se prevén grandes cambios socio sanitarios a corto plazo que afectarán seriamente la estructura departamental y jerarquía asistencial del hospital futuro, universitario público o privado. La Asociación Española de Urología se pregunta si en estas circunstancias, en la que la gestión asistencial y economicista del hospital así llamado 'industrial' dominará sobre otros aspectos tradicionales de la jerarquía científica, asistencial y docente del jefe de servicio, modificará su imagen, objetivos, funciones, y en definitiva su autoridad. Así mismo cuales han de ser los atributos de esta nueva generación de jefes de servicio. Para ello la A.E.U. convocó una mesa redonda solicitando opiniones y comentarios que se recogen en el texto adjunto (AU)

Great social-health care changes in the short term have been predicted that will seriously affect the departmental structure and care hierarchy of future hospital, universitary, public or private. The Spanish Association of Urology (AEU) wondered whether in these circumstances, in which the welfare and economic management of the hospital so-called 'industrial' will dominate over other traditional aspects of the scientific hierarchy, social welfare and teaching of head Urology of service, will change his image, goals, functions, and ultimately its authority. Likewise which must be the attributes of this new generation of department heads. To this end the AEU call a roundtable requesting opinions and comments which are reflected in the enclosed text (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)

Diagnóstico prenatal y caracterización por SKY (cariotipo espectral multicolor) de cromosomas extra estructuralmente anormales (ESAC) / Prenatal diagnosis and multicolor spectral kariotyping characterization of the extra structurally abnormal chromosomes

Los cromosomas extra estructuralmente anormales (ESAC) son pequeños cromosomas supernumerarios asociados con cierta frecuencia con el desarrollo de anormalidades. Hemos revisado 9.987 estudios citogenéticos prenatales de células de líquido amniótico, encontrando tres casos con presencia de ESAC. Cada uno de estos cromosomas fueron analizados con varias técnicas con el fin de determinar su estructura, y con las técnicas citogenéticas moleculares como el FISH (hibridización in situ por fluorescencia) y SKY (cariotipo espectral multicolor). En dos casos pudimos determinar la presencia de ESAC en otros miembros normales de la familia. Un tercer caso de ESAC de novo fue detectado, y el origen cromosómico pudo ser determinado por SKY: 47,xx,+der(22) (q12-qter). La introducción de las técnicas de citogenética molecular como el SKY tiene un importante impacto en el correcto diagnóstico y en el consejo genético de acuerdo con la necesidad del paciente

Extra structurally abnormal chromosomes (ESACs) are small supernumerary chromosomes often associated with developmental abnormalities. We have revised 9,987 prenatal cytogenetic studies of amniotic fluid cells finding 3 cases with the presence of ESACs. Each of these chromosomes was analyzed with various staining techniques in orden to determine its structure, and with molecular cytogenetics techniques such FISH (fluorescence in situ hibridization) and SKY (multicolor spectral kariotyping). In two cases we could determine the presence of ESACs in other normal members of the families. In the third case a de novo ESAC was detected, and the chromosomal origin could be identified by SKY: 47,XX,+der(22)(q12-qter). The introduction of molecular cytogenetics techniques such SKY has a great impact on the correct diagnosis and we offered the genetic counseling according with the need of the patients

Efectos del tamoxifeno en el epitelio vaginal y los ovarios / Tamoxifen effects on vaginal epithelium and ovaries

Objetivo: Realizar un análisis de los efectos que el tamoxifeno tiene en el epitelio vaginal y los ovarios de pacientes que han recibido tratamiento con este fármaco por un cáncer de mama dependiente de estrógenos. Pacientes y método: Hemos estudiado a 92 mujeres que recibieron tratamiento con tamoxifeno por cáncer de mama entre los años 2000 y 2003. Analizamos los efectos del tamoxifeno en el epitelio vaginal y la relación del tamoxifeno con la presencia de formaciones ováricas. Resultados: Hemos encontrado un efecto estrogénico en el epitelio vaginal de mujeres en estado posmenopáusico, a pesar de que recibían un fármaco cuyo efecto es antiestrogénico. El 87% de las mujeres en menopausia que recibían tamoxifeno mostraron unos frotis estrogénicos, frente al 20,9% del grupo control (mujeres en menopausia con cáncer de mama que no tomaban tamoxifeno); p < 0,001. El 13% (población joven, premenopáusica o de menos de 1 año de menopausia) de la población estudiada presentó una formación ovárica que desaparece espontáneamente. Sólo se intervino a una paciente por presentar un Doppler patológico que se correspondió con un carcinoma lúteo hemorrágico

Objective: To analyze the effects of tamoxifen on the vaginal epithelium and ovaries in patients treated with this drug for estrogen-dependent breast cancer. Patients and method: We studied 92 women who received tamoxifen therapy for breast cancer from 2000 to 2003. The effects of tamoxifen on the vaginal epithelium and the association between this drug and the presence of ovarian cysts were analyzed. Results: Although tamoxifen is an antiestrogenic drug, in postmenopausal women an estrogenic effect on the vaginal epithelium was found. Vaginal swabs showed estrogen stimulation in 87% of menopausal women receiving tamoxifen compared with 20.9% of the control group (menopausal women with breast cancer not receiving tamoxifen; p < 0.001). Ovarian cysts were found in 13% of the population studied, corresponding to women who were younger, premenopausal or with less than a year of menopause; the cysts resolved spontaneously. Only one patient underwent surgery due to abnormal Doppler findings corresponding to a hemorrhagic luteal cyst

Avances en el diagnóstico y tratamiento del cáncer de ovario / No disponible

No disponible

Normas legales en ecografía obstétrico-ginecológica / No disponible

No disponible

Fertiloscopia: una nueva técnica en el estudio de la esterilidad de origen desconocido / Fertiloscopy: a new technique in the study of infertility of unknown etiology

Objetivo: Comprobar la efectividad y la seguridad de la fertiloscopia como técnica alternativa a la laparoscopia diagnóstica en el estudio de la esterilidad de origen no filiado.Material y Métodos: Un total de 17 pacientes con diagnóstico de esterilidad de origen no filiado y candidatas a laparoscopia diagnóstica se reclutaron para el estudio. Se les realizó fertiloscopia (hidrolaparoscopia transvaginal, cromopertubación, salpingoscopia e histeroscopia en un tiempo) con anestesia general o regional.Resultados: La hidrolaparoscopia transvaginal, cromopertubación e histeroscopia se completó en 16 pacientes. En una paciente no se consiguió acceder al fondo de saco de Douglas. La salpingoscopia se realizó uni o bilateralmente en 14 pacientes (82,3 por ciento). No tuvimos ninguna complicación.Conclusiones: La fertiloscopia es un método fácil de realizar y seguro, como alternativa a la laparoscopia diagnóstica en pacientes con esterilidad de origen no filiado. (AU)

¿Cuál sería la estrategia másadecuada para el despistajeprenatal de las aneuploidías? / What is the most appropriate strategy for the prenatal screening of aneuploidies?

El Síndrome de Down es uno de los defectos congénitos más frecuentes. Como consecuencia de su repercusión social se hace imprescindible un diagnóstico prenatal. Se han descrito diferentes estrategias de cribado prenatal para el diagnóstico de aneuploidías: criterios epidemiológicos, bioquímicos y ecográficos. Los criterios epidemiológicos, por sí solos; detectan un número escaso de Síndrome de Down. Este motivo ha llevado a asociarlos a otros marcadores. Han sido descritos varios marcadores bioquímicos, con mayor o menor eficacia. Clásicamente se han determinado en el segundo trimestre de gestación. Hoy en día se está comenzando a determinar los marcadores bioquímicos durante el primer trimestre. La translucencia nucal es el marcador ecográfico más estudiado para este fin. Probablemente será integrado sistemáticamente al screening de aneuploidías (AU)

[Epidemic outbreak of acute food poisoning caused by pesticides]. / Brote epidémico de intoxicación aguda alimentaria por plaguicidas.

OBJECTIVES: 1) To identify the causes of the outbreak. 2) To adopt the appropriate measures to control it. DESIGN: Observational crossover study. SETTING: San Benito Health District in Jerez de la Frontera (Cádiz). PATIENTS AND OTHER PARTICIPANTS: Diners who attended a family celebration. MEASUREMENTS AND MAIN RESULTS: On Friday 11th March 1994 there was an outbreak of acute food poisoning. The clinical notes of 9 ill diners were checked; they and 7 unaffected diners answered epidemiological questionnaires. A proportional comparison was then made between those not exposed and those exposed to each one of the foods consumed at this celebration. The clinical picture showed: high level of the Creatine phosphokinase enzyme, general myalgias, vomiting or nausea and visual problems. The average incubation period was 7 hours. The odds ratios of the foods involved was calculated. Although this reached 4 in some cases, the significance tests were not significant in any case because of the study's low statistical power. In the investigation of the trophic chain of the game-birds eaten, the presence of nitrogen or phosphorus atoms, compatible with the pattern of fonofos in the pesticide used on the hunting estate where the birds came from, was isolated. CONCLUSIONS: Epidemiological, clinical and biological evidence was found, which places us before acute organophosphorus poisoning. Coordination between the different institutions involved was decisive in finding the cause of the outbreak.

Diagnosis, treatment and follow-up of H.P.V.-C.I.N.

Between April 1989 and December 1993, eight thousand one hundred women under cytologic suspect of human papillomavirus (HPV) cervical infection underwent new cytology, colposcopy, colposcopically directed exocervical biopsy, and, eventually, endocervical curettage. HPV cervical lesions were confirmed in 300 patients (3.7%), on the basis of at least, two positive diagnostic methods. Prior to surgery, the Papanicolaou smear was negative in 50 women, cervical intraepithelial neoplasia (CIN) I in 170 cases, CIN II in 70, and CIN III in the other 10 patients. Cryosurgery was practised in CIN I, II, or III and clinical condylomata (a total of 200 patients: 66.6%). Following cryosurgery, patients were seen six weeks and one year after for repeating cytology, colposcopy and cervical biopsy (if necessary). One-year-later cytology was negative in 230 cases (76.7%); 60 (20%) of CIN I; 7 (2.3%) of CIN II; and only one case of CIN III. At the same moment, colposcopy was normal in 66.6% of these patients. The incidence of cervical HPV (3.7%) is higher than the one referred by other authors, because of the use of endocervical curettage. We conclude the cryosurgery is quite a good therapeutic method in HPV cervical lesions.

La ecografía en el control de la gestante diabética / Ultrasound for the follow up of the pregnant diabetic

Se estudia la utilidad de la ecografía en el control de 144 gestantes diabéticas desde un triple sentido: Control del crecimiento del feto, diagnóstico prenatal de malformaciones congénitas y diagnóstico del grado de bienestar fetal. En el diagnóstico prenatal de recién nacidos grandes para su edad gestacional los ultrasonidos diagnosticaron correctamente 23 de 30 casos (76.6%), con un índice de falsos negativos del 7%. En los casos de crecimiento intrauterino retardado la ecografía detectó los 4 casos existentes (100%), con un índice de falsos positivos de 33.3%, sin que existieran falsos negativos. Todos los casos de malformaciones congénitas mayores correspondientes a microcefalia, mielomeningocele occipital, nipoplasia de colon izquierdo y síndrome de Meckel-Gruber (disencefalia esplacno-quística), fueron diagnósticados prenatalmente mediante ultrasonidos