Metástasis cutáneas como primer signo clínico de adenocarcinoma de ovario / Cutaneous metastasis as the first clinical sign of ovarian adenocarcinoma

Introducción. Las metástasis cutáneas de origen ovárico son raras y representan un signo de mal pronóstico. Pueden adoptar diferentes formas clínicas de presentación que obligan al diagnóstico diferencial con gran variedad de dermatosis. Caso clínico. Se presenta el caso de una paciente de 86 años que consulta por aparición de lesiones cutáneas nodulares en el abdomen inferior y la parte proximal de ambas piernas como signo inicial de una neoplasia no conocida previamente. El estudio histológico revela metástasis de adenocarcinoma de ovario. Conclusiones. Las metástasis cutáneas de origen ovárico como tumor primario constituyen una afección infrecuente y con mal pronóstico. Normalmente, aparecen a lo largo de la enfermedad, pero pueden ser el primer signo clínico de una neoplasia silente. Su manejo sigue siendo un reto clínico; por lo que son necesarios más estudios que evalúen el papel de terapias específicas para estandarizar el tratamiento (AU)

Introduction. Cutaneous metastases are rare and represent a poor prognostic sign. Clinical forms of presentation differ, requiring differential diagnosis with a variety of dermatoses. Case report. We report the case of an 86-year-old woman who presented with nodular skin lesions on the lower abdomen and proximal part of both legs as the initial sign of a previously unknown neoplasia. Histological examination revealed metastatic ovarian adenocarcinoma. Conclusions. Cutaneous metastases from a primary ovarian tumor are rare and have a poor prognosis. They typically develop during the disease, but can be the first clinical sign of a silent neoplasia. Their management remains a clinical challenge; consequently, more studies evaluating the role of specific therapies are needed to standardize treatment (AU)

Outpatient Hysteroscopic Polypectomy: Bipolar Energy System (Versapoint®) versus Mechanical Energy System (TRUCLEAR System®) - Preliminary Results.

HYPOTHESIS: The new hysteroscopic system with mechanical energy is an effective outpatient technique for diagnosis and treatment that has certain advantages over conventional hysteroscopy in the management of endometrial polyps. OBJECTIVES: Our primary objective was to assess the total duration of hysteroscopy and polypectomy performed in an outpatient setting comparing the new mechanical energy hysteroscopy to the bipolar energy system. Our secondary objective was to compare the level of safety of both hysteroscopic techniques using the procedure success rate, the need for subsequent referral to surgery, existing complications, and comfort experienced by the patient during the procedure. PATIENTS AND METHODS: This randomized controlled trial included the first 90 patients with an ultrasound diagnosis of endometrial polyp (>1 cm) who underwent an outpatient diagnostic and operative hysteroscopy at the Igualada Hospital (Barcelona) and agreed to be included in the study by signing an informed consent. RESULTS: We obtained a 91% success rate with the TRUCLEAR System® compared to a 69% success rate with the Versapoint® system. Total operating time was 6.36 min in the TRUCLEAR System group versus 10.82 min in the Versapoint system group (p < 0.05), with a polypectomy time of 3.06 and 7.91 min, respectively (p < 0.05). There were no significant differences between the two techniques when analyzing pain using the visual analogue scale. No complications were recorded for either technique. CONCLUSION: The mechanical energy system presents a significant decrease in the total duration of polypectomy and hysteroscopy when performed both by experienced staff and by staff in training, resulting in higher success rates without complications with respect to conventional hysteroscopy with bipolar energy.

A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting: preliminary results.

STUDY OBJECTIVE: To assess and compare efficacy, pain, and the learning curve associated with diagnostic therapeutic hysteroscopy using mechanical tissue removal versus bipolar electrical resection in the management of endometrial polyps in an ambulatory care setting. DESIGN: A randomized controlled clinical trial (Canadian Task Force classification I). SETTING: Hospital de Igulada, Barcelona, Spain. PATIENTS: A total of 133 patients diagnosed with endometrial polyp(s) were included and randomly assigned to 1 of the 2 hysteroscopic methods. Criteria assessed were total hysteroscopy time, full polypectomy procedure time, pain experienced by patients, and learning curve of staff in training. MEASUREMENTS AND MAIN RESULTS: The average time to perform total hysteroscopy using the mechanical tissue removal system (TRUCLEAR 5.0 System; Smith & Nephew Inc., Andover, MD) was 6 minutes 49 seconds versus 11 minutes 37 seconds required for the bipolar electrosurgery system (GYNECARE VERSAPOINT; Ethicon Inc, Somerville, NJ) (p < .01). Results for complete polypectomy time favored the TRUCLEAR System at 3 minutes 7 seconds over the VERSAPOINT System at 8 minutes 25 seconds (p < .01). If a successful procedure is predicated on access to cavity, visualization, and complete resection and excision of endometrial polyp, the mechanical TRUCLEAR Tissue Removal System shows a higher success rate than the VERSAPOINT Bipolar Electrosurgery System at 92% and 77%, respectively. Analysis of pain using the visual analog scale revealed no significant differences between the 2 techniques (p > .05). A study of the residents' learning curve showed a higher level of autonomy with hysteroscopy using the TRUCLEAR Tissue Removal System with which residents showed a higher level of confidence compared with hysteroscopy with the VERSAPOINT Bipolar Electrosurgery System. CONCLUSION: In hysteroscopic polypectomy, the mechanical tissue removal system was significantly faster, achieved a greater success rate for complete polypectomy, and required a shorter learning curve from staff being trained in the management of endometrial polyps when compared with bipolar electrical resection.

Estudio descriptivo del nuevo sistema morcelador de histeroscopia diagnóstica-terapéutica / Descriptive study of a new diagnostic-therapeutic hysteroscopic morcellation system

Hipótesis. El nuevo sistema de morcelación es una técnica histeroscópica diagnóstica-terapéutica eficaz y segura para el tratamiento ambulatorio de pólipos endometriales. Objetivo. Describir nuestra experiencia inicial con el nuevo sistema de morcelación histeroscópica Truclear System (Smith & Nephew) en término de polipectomías realizadas a nivel ambulatorio sin necesidad de derivación quirúrgica de la paciente. Pacientes y métodos. Estudio observacional prospectivo no aleatorizado que incluye las 100 primeras pacientes en las que se les realizó una histeroscopia con el nuevo sistema morcelador entre junio del 2011 a enero del 2012 en el Hospital de Igualada. Se diferencian 2 grupos de pacientes. Grupo 1: 55 primeras pacientes que cumplen alguno de los criterios de inclusión establecidos para la realización de una histeroscopia; Grupo 2: 45 pacientes con sospecha diagnóstica-ecográfica de pólipo endometrial. Resultados. Se realizó un total de 41 y 40 histeroscopias en el grupo 1 y 2 respectivamente, obteniendo una sospecha histeroscópica de pólipo endometrial en el 56 y 82,5% respectivamente. La tasa de éxito en la polipetomía fue del 100%, sin necesidad de derivación quirúrgica posterior en ningún caso y con una tolerancia buena o regular en el 91,3% de las pacientes. Conclusión. El nuevo sistema morcelador permite la realización de la polipectomía a nivel ambulatorio sin necesidad de derivación quirúrgica en aquellas pacientes con diagnóstico ecográfico de pólipo (AU)

Hypothesis: The new morcellation system is a safe and effective diagnostic-therapeutic technique for the outpatient management of endometrial polyps. Objective: To describe our inicial experience with the new mechanical Truclear System (Smith&Nephew) hysteroscope in a number of polypectomies performed in the outpatient setting without the need for surgical referral. Patients and methods: An observational prospective non-randomized study was performed in 100 patients who underwent hysteroscopy between June 2011 and January 2012 at the Igualada Hospital. There were two patient groups: group 1 included the first 55 patients who met the inclusion criteria for hysteroscopy and group 2 included 45 patients with endometrial polyps suspected on ultrasound. Results: We performed 41 and 40 uneventful hysteroscopies in groups 1 and 2, respectively, 56 and 82.5% were suspected endometrial polyps, respectively. Polypectomy was 100% successful in all patients. None of the patients were referred for surgery. Tolerance was moderate to good in 91.3% of the patients. Conclusion: The new morcellator system allows polypectomies to be conducted in outpatients with an ultrasound diagnosis of polyps, without the need to refer the patient for surgery (AU)

Morcelador histeroscópico (Truclear System (R)): nuestra experiencia inicial / Morcellator hysteroscopy (Truclear System(R)): preliminary experience

Objetivo. Eficacia y seguridad del sistema de morcelación histeroscópica. Pacientes y métodos. Estudio observacional retrospectivo durante el periodo 2004-2009, que incluye a un total de 411 pacientes diagnosticadas de patología intracavitaria a las que se les realizó una histeroscopia quirúrgica con un sistema de morcelación mecánica. Resultados. Se realizaron 327 polipectomías y 76 miomectomías, con una tasa de éxito del 99,2% y con un tiempo quirúrgico medio de 9,2 min y 22,3 min, respectivamente. Conclusión. La técnica de morcelación histeroscópica es segura y eficaz, presenta una corta curva de aprendizaje, unos buenos tiempos quirúrgicos y una baja tasa de complicaciones (AU)

Objective. To evaluate the efficacy and safety of the hysteroscopic morcellator. Patients and methods. We carried out a retrospective observational study of 411 patients diagnosed with intracavitary disease, who underwent surgical hysteroscopy with the mechanical morcellation system from 2004 to 2009. Results. We performed 327 polypectomies and 76 myomectomies. The success rate was 99.2%. The mean operative time was 9.2 minutes and 22.3 minutes, respectively. Conclusion. The hysteroscopic morcellation technique is safe and effective, has a short learning curve, a reasonable operating time, and low rate of surgical complications (AU)