A Review and Follow-Up of Uterine Smooth Muscle Tumours of Uncertain Malignant Potential (STUMP): A Case Series and Literature Review.

OBJECTIVES: to analyse the clinical-pathological characteristics, treatment, and evolution of uterine smooth muscle tumours with uncertain malignant potential (STUMP) diagnosed in the Salamanca University Hospital with the implementation of the 2014 WHO criteria. MATERIALS AND METHODS: a retrospective descriptive study of patients diagnosed with STUMP from January 2015 to March 2023 at the Salamanca University Hospital. Demographic data, preoperative clinical data, treatment, complications, therapeutic results, anatomopathological findings and recurrence time were obtained. RESULTS: a total of four patients were identified and included in the study. The mean age at diagnosis was 48 years (range 36-67). The surgical indications were abnormal uterine bleeding, compressive symptoms, and the growth of a pelvic mass suspected to be a degenerated myoma from the residual cervix after a subtotal hysterectomy 6 years earlier. In all cases, a laparotomic procedure was performed. A total hysterectomy, sub-total hysterectomy, and the excision of the cervix with STUMP localization were accomplished in two, one, and one patient, respectively. The mean diameter of the tumour pieces was 13 cm (range 8-17 cm), with a mean volume of 816 cc (range 234-1467 cc). The mean follow-up was 47 months, with no recurrence to date. CONCLUSIONS: STUMPs are a heterogeneous group of tumours with a difficult-to-predict clinical evolution. In most cases, their diagnosis is histological after performing surgery for suspected leiomyoma. Due to their low incidence, there are no specific guidelines for their treatment and control. However, considering their potential risk of recurrence and metastasis, it is advisable to maintain six-monthly controls for 5 years and then annual controls for 5 years more.

Reproductive Health Practices in Spanish Women Who Underwent Voluntary Termination of Pregnancy.

Background: The incidence of Voluntary Termination of Pregnancy (VTP) is an important indicator of unplanned pregnancies and the differences in the functioning of contraceptive services and the effectiveness of their use. Its analysis is essential for monitoring the well-being of women and their partners. Our aim was to analyse the socio-demographic profile of women who request voluntary termination of pregnancy in the province of Salamanca, as well as their satisfaction with the intervention and its influence on their contraceptive methods. Methods: An intervention study (before-after) designed without a control group, including all women requesting a voluntary termination of pregnancy through the Salamanca Public Health System. Socio-demographic and reproductive health variables were used. After the termination of pregnancy, a satisfaction survey and analysis of consequences were carried out. Results: A total of 176 surveys were obtained. Women who underwent VTP in Salamanca were between 20 and 25 years old, had secondary education but were still studying or working, lived alone and had no children. The most commonly used contraceptive method was the condom (55%), followed by the pill (25%). The most frequent reason for termination of pregnancy was economic (47.7%). The abortion entailed a significant change in contraception. Whereas before the abortion only 34% used a hormonal method, 66% were willing to use one afterwards (p = 0.006). Conclusion: Reproductive health education needs to be improved so that couples use reliable contraceptive methods appropriately. Although women are generally satisfied with the care received during abortion, they would prefer better accessibility to the procedure and more comprehensive information about the process from a neutral stance.

Giant Isolated Omphalocele: Role of Prenatal Diagnosis in Prognostic Asessment and Perinatal Management.

Omphalocele is a congenital malformation of the abdominal wall consisting of a protrusion of the abdominal contents at the base of the umbilical cord. It has a high association with genetic and structural defects; however, if the latter is ruled out, its prognosis improves significantly. Prenatal diagnosis has a key role in this condition as omphalocele can be diagnosed by ultrasound in the first trimester scan, enabling a coordinated approach strategy to achieve the best perinatal results. We present a case report of a pregnant patient with a fetus having a giant omphalocele in which prenatal diagnosis played a decisive role, allowing the coordination of a multidisciplinary team, which was crucial in the immediate care of the newborn.

Penfigoide gestacional: estudio de 9 casos / Pemphigoid gestationis: a study of 9 cases

El penfigoide gestacional es una dermatosis bullosa subepidérmica rara, que aparece generalmente en multíparas en el curso del segundo o tercer trimestre de la gestación o, eventualmente, en el posparto. El objetivo de este trabajo es determinar el perfil epidemiológico, clínico, terapéutico y evolutivo de esta afección a través de una serie hospitalaria. El estudio es retrospectivo, realizado en 9 pacientes que presentaron un penfigoide gestacional, confirmado por inmunofluorescencia directa y controladas por el servicio de dermatología. La edad de aparición de la enfermedad estaba comprendida entre 18 y 35 años, con una media ñ de 27,33 ñ 5,68 años. El primer acceso de penfigoide gestacional afectó, sobre todo, a las multíparas (77,77 por ciento de los casos) y había aparecido en el curso del tercer trimestre en 6 pacientes (66,66 por ciento).En todas las enfermas, el primer síntoma fue prurito intenso, seguido de una erupción eritematosa maculopapulosa. En el acmé del proceso, todas las mujeres presentaron máculas eritematosas confluyentes y policíclicas, rematadas por vesículas con disposición herpética, con predominio en la región umbilical. La inmunofluorescencia directa confirmó el diagnóstico en todos los casos, objetivando un depósito lineal de la fracción C3 del complemento a lo largo de la unión dermoepidérmica. La corticoterapia general (0,5-1 mg/kg/día) se utilizó en el 77,77 por ciento de los casos (7 de 9 mujeres). La dapsona fue eficaz en 2 pacientes (22,22 por ciento); 3 pacientes (33,33 por ciento) mejoraron con antihistamínicos asociados a los dermocorticoides. La evolución reflejó una recidiva de las lesiones en el posparto inmediato en 5 mujeres (55,55 por ciento); 3 mujeres presentaron recidivas en el curso de gestaciones ulteriores. El penfigoide gestacional es una dermatosis rara en el curso del embarazo. Nuestra serie se ajusta a lo reflejado en la bibliografía, con predominio de aparición en el tercer trimestre, un mayor porcentaje de multíparas y ausencia de afección en los neonatos. No obstante, es de destacar la afección relativamente alta de la cara y la eficacia de la dapsona cuando ésta fue prescrita (AU)

Embolias gaseosas y terapia por oxigenación hiperbárica durante la gestación / Uterine rupture secondary to dinoprostone in association with epidural analgesia

Aportamos el caso de una mujer embarazada que presentó una embolia paradójica gaseosa subsiguiente a la desconexión del catéter de una vía venosa central. La instalación secundaria de una hemiplejía derecha asociada con un síndrome confusional justificó el tratamiento de urgencia por oxigenoterapia hiperbárica, lo que permitió la remisión completa del cuadro neurológico inicial. La presentación de este caso clínico pone en primer plano la discusión de los riesgos de embolia gaseosa durante el embarazo y el posparto, las indicaciones y los efectos de la oxigenoterapia hiperbárica sobre el feto (AU)

Embolias gaseosas y terapia por oxigenación hiperbárica durante la gestación / Air embolism and hyperbaric oxygen therapy during pregnancy

Aportamos el caso de una mujer embarazada que presentó una embolia paradójica gaseosa subsiguiente a la desconexión del catéter de una vía venosa central. La instalación secundaria de una hemiplejía derecha asociada con un síndrome confusional justificó el tratamiento de urgencia por oxigenoterapia hiperbárica, lo que permitió la remisión completa del cuadro neurológico inicial. La presentación de este caso clínico pone en primer plano la discusión de los riesgos de embolia gaseosa durante el embarazo y el posparto, las indicaciones y los efectos de la oxigenoterapia hiperbárica sobre el feto (AU)

Oclusión intestinal y pelviperitonitis: dos complicaciones atípicas de la conización por bisturí frío / Intestinal occlusion and pelviperitonitis: two atypical complications of cold knife conization

Las complicaciones asociadas con las conizaciones por bisturí frío son, con mayor frecuencia, las hemorragias o las infecciones genitourinarias. Presentamos un caso de colpotomía posterior accidental con lesión del fondo de saco de Douglas, que pasó inicialmente inadvertida, en el curso de una conización con bisturí frío, y secundariamente complicado con incarceración de un asa intestinal en la herida vaginal y una pelviperitonitis. (AU)

[Clinico-epidemiologic study of accidental poisoning with Robinia pseudoacacia L. in school children]. / Estudio clinicoepidemiológico de un envenenamiento accidental por Robinia pseudoacacia L. en escolares.

A clinical-epidemiological study of an accidental poisoning by Robinia pseudoacacia L. (lucust tree) in six school children has been made. The case had sucked and/or chewed the bark of this plant. The clinical symptoms were abdominal pain, thirst, nausea, vomiting, dry throat, muscle weakness, mydriasis, headache, dizziness and diarrhea. The treatment was activated charcoal in 5 cases and subsequent gastric lavage in 3 cases. The results was favorable. The poisoning took place in the school yard during the mid-morning recreation period. Only girls were affected (average age 6.5 +/- 2.1 years old). The attack rate was 31.6% for the school children who tasted the bark, and chewing it constituted the highest factor of risk (p = 0.03). Recommendations have been made to prevent childhood accidents.