HE4 might be a more useful tumor biomarker to detect malignancy in patients with ovarian endometrioma when malignancy is suspected.

OBJECTIVE: To analyze the utility of carbohydrate antigen (CA)125 and human epididymis protein 4 (HE4) to detect malignancy in women with ovarian endometriosis, when ovarian cancer is suspected and ultrasonography results are inconclusive. METHODS: Women who underwent surgery between 2015 and 2019 for ovarian endometriosis or for adnexal masses, with a final diagnosis of ovarian carcinoma (clear cell and endometrioid) were included in this retrospective study. The women were divided into three groups: ovarian endometriosis (OE), ovarian carcinoma without endometriosis (OC), and ovarian carcinoma with endometriosis (OC + E). Adnexal masses were assessed preoperatively by transvaginal ultrasonography according to the International Ovarian Tumor Analysis (IOTA) simple rules, and CA125 and HE4 blood levels were obtained. RESULTS: Of 208 women, 45 had malignancy, 16 in the OC + E group and 29 in the OC group. According to transvaginal ultrasonography, 13 were classified as undetermined risk of malignancy: OC group: 3, OE group: 3, and OC + E group: 7. When we compared the tumor biomarkers, significant differences in HE4 but not in CA125 levels were found between the groups. CONCLUSIONS: When ovarian malignancy is suspected in patients with ovarian endometriosis, HE4 is a more useful tumor biomarker to diagnose OC when ultrasonography results are inconclusive.

Multisystem inflammatory syndrome associated to COVID-19 in pediatric population. / Síndrome de respuesta inflamatoria multisistémica asociado a COVID-19 en población pediátrica.

The new SARS-CoV-2 coronavirus appears to be less aggressive in the pediatric population in comparison to the adult population. Yet, most recently, as the number of diagnosed pediatric patients with COVID-19 has increased, clinicians have observed the development of a multisystemic inflammatory response syndrome that is potentially associated with COVID-19 in the pediatric population. Our objective was to retrieve and synthesize the reports that have described the multisystemic inflammatory response syndrome potentially associated with COVID-19 in the pediatric population. We conducted a narrative review of scientific literature reported in PubMed from January 1st to June 30th, 2020, with the terms multisystem inflammatory syndrome, Kawasaki, children, COVID-19. This new syndrome has been associated with greater difficulty in treating children with COVID-19 and some deaths have been observed as a result. On the other hand, innate pediatric immunity, primarily driven by IgM, and the rapid immune response to generate germ-center dependent and non-dependent memory B cells as it has been hypothesized for other authors could largely explain the behavior and incidence of the new SARS-CoV-2 infection in the pediatric population.

El nuevo coronavirus SARS-CoV-2 parece tener una menor agresividad sobre la población pediátrica en comparación con la adulta. Sin embargo, más recientemente, al incrementar el número de pacientes pediátricos diagnosticados se ha podido observar el desarrollo de un síndrome de respuesta inflamatoria multisistémica potencialmente asociado a COVID-19 en niños. Nuestro objetivo fue recuperar y sintetizar los reportes que han descrito el síndrome de respuesta inflamatoria multisistémica potencialmente asociado a COVID-19 en niños. Se realizó un estudio de revisión de tipo narrativo de la literatura científica publicada en PubMed desde el 1 de enero 2020 al 30 de junio 2020. Los términos de búsqueda fueron síndrome inflamatorio multisistémico, Kawasaki, niños, COVID-19. El nuevo síndrome se ha asociado con una mayor dificultad para tratar a los niños con COVID-19 y se han observado algunas muertes secundarias a ello. Pero por el otro lado, la inmunidad innata pediátrica, dada por IgM, y la rápida respuesta para generar células de memoria dependientes y no dependientes del centro germinal se hipotetiza por algunos autores que podría explicar en gran parte el comportamiento y la incidencia de la nueva infección por SARS-CoV-2.

L-2-hydroxyglutaric aciduria in two female Yorkshire terriers.

Two female Yorkshire terrier puppies were presented with generalized tonic-clonic seizures and ataxia. MRI revealed bilaterally symmetrical, diffuse regions of gray matter hyperintensity on T2-weighted and fluid-attenuated inversion recovery sequences. Urinary organic acids were quantified by gas chromatography-mass spectroscopy and were consistent with a diagnosis of L-2-hydroxyglutaric aciduria (L2HGA). The L2HGDH gene encodes for the enzyme L-2-hydroxyglutarate dehydrogenase, which helps break down L-2-hydroxyglutaric acid. In both puppies described in this report, a homozygous mutation at the translation initiation codon of the homolog canine L2HGDH gene was detected (c.1A>G; p.Met1?), confirming the diagnosis of L2HGA at the DNA level. Canine L2HGA is caused by more than one mutation of L2HGDH, as reported in humans.

Does the learning curve of conservative laparoscopic surgery in women with rectovaginal endometriosis impair the recurrence rate?

OBJECTIVE: To assess the effect of surgeon's increasing experience in conservative laparoscopic surgery of women with rectovaginal endometriosis on the surgical outcome of these patients recurrence rate. DESIGN: Prospective cohort study. SETTING: University teaching hospital. PATIENT(S): The first 60 consecutive patients undergoing laparoscopic conservative surgery for symptomatic rectovaginal endometriosis at our institution during a 4- year period. INTERVENTION(S): Cases were classified into two groups according to the date of the patient's operation: the first 30 cases were defined as the early cases and the subsequent 30 cases as the late cases. MAIN OUTCOME MEASURE(S): Operating time, perioperative complications, and surgical outcome. Univariate and multivariate analyses for risk factors with recurrence of disease. RESULT(S): The two groups were similar in patient characteristics. There was a reduction in the rate of laparoconversion, operating time, estimated amount of blood loss, cases with incomplete removal, and recurrence rate with increasing surgeon's experience. Surgical completeness was significantly associated with recurrence of disease. CONCLUSION(S): A learning curve is demonstrated in the conservative laparoscopic management of patients with rectovaginal endometriosis. After gaining experience in performing 30 cases, the recurrence rate is significantly reduced.