Quadrivalent Human Papillomavirus Vaccine Effectiveness after 12 Years in Madrid (Spain).

A fully government-funded human papillomavirus (HPV) vaccination program started in 2007 in Spain (only 11-14-year-old girls). The first of those vaccinated cohorts, with the quadrivalent vaccine (Gardasil), turned 25 years old in 2018, the age at which cervical cancer screening begins in Spain. The current study could provide the first evidence about the effectiveness of the quadrivalent vaccine against HPV in Spain and the influence of age of vaccination. The present ambispective cohort study, which was conducted on 790 women aged 25 and 26 years old, compares the rate of HPV prevalence and cytologic anomaly according to the vaccination status. The overall infection rate was 40.09% (vaccinated group) vs. 40.6% (non-vaccinated group). There was a significant reduction in the prevalence of HPV 6 (0% vs. 1.3%) and 16 (2.4% vs. 6.1%), and in the prevalence of cytological abnormalities linked to HPV16: Atypical Squamous Cells of Undetermined Significance (ASCUS) (2.04% vs. 14%), Low-grade Squamous Intraepithelial Lesions (LSIL) (2.94% vs. 18.7%) and High-grade Squamous Intraepithelial Lesion (HSIL) (0% vs. 40%), in the vaccinated group vs. the non-vaccinated group. Only one case of HPV11 and two cases of HPV18 were detected. The vaccine effectively reduces the prevalence of vaccine genotypes and cytological anomalies linked to these genotypes.

Papillary endothelial hyperplasia (Masson's tumor) developed in the capsule of the implant in a breast cancer patient treated with mastectomy and radiation therapy.

Papillary endothelial hyperplasia (PEH) is an uncommon benign vascular proliferation appearing in soft tissues in different body areas including the breast, which may be related to radiation therapy. A 48-year-old woman previously treated for breast cancer with mastectomy followed by radiation therapy and reconstruction with an implant presented with a newly developing mass in the implant capsule. Pathological diagnosis was PEH. Imaging features of this rare entity are described, and lesions included in differential diagnosis are discussed.

Embarazo ectópico cervical: a propósito de 3 casos. Revisión de la práctica clínica / Cervical pregnancy: three cases report. a review of current clinical practice

Se describen 3 casos de embarazos ectópicos cervicales diagnosticados y tratados conservadoramente durante el año 2008 en el hospital de la zarzuela de Madrid. El primero con embolización selectiva de las arterias uterinas y tratamiento con metotrexato a dosis única; el segundo, con embolización uterina y metotrexato a dosis múltiple y el tercero mediante instilación de CLK intramniótica con control ecográfico para reducción embrionaria, embolización de arterias uterinas y metotrexato a dosis única. Se realiza una revisión de la literatura científica sobre los distintos métodos diagnósticos y terapéuticos de esta afección, que va en aumento en los últimos años (AU)

Three cases of cervical ectopic pregnancy treated medically are described. The first case with selective uterine artery embolization and methotrexate dose single, the second case with selective uterine artery embolization and methotrexate dose multiple, and the third case intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat was necesary, before selective uterine artery and methotrexate dose unique. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. The diagnostic and therapeutic methods are discussed and the literature is reviewed (AU)

Decidualización peritoneal y embolización de arterias uterinas en la hemorragia puerperal tras cesárea / Peritoneal deciduosis and uterine artery embolization in puerperal hemorrhage after cesarean section

La decidualización peritoneal es una metaplasia de células peritoneales, que aparece en la gestación por acción de la progesterona. Anatomopatológicamente, son lesiones altamente vascularizadas, por lo que es preciso el diagnóstico definitivo mediante técnicas inmunohistoquímicas para diferenciarlo de tumores malignos. La embolización arterial selectiva es una técnica conservadora para el tratamiento de las hemorragias posparto con mínimos efectos secundarios, que permite la conservación de la fertilidad. Presentamos el hallazgo de una decidualización peritoneal severa durante la realización de una cesárea en una paciente que posteriormente precisó embolización de arterias uterinas por hemorragia puerperal (AU)

Deciduosis peritonei consists of the presence of decidua in the peritoneal surface and develops during pregnancy due to the effect of progesterone. The typical lesions are highly vascularized and immunohistochemical studies are required to exclude a diagnosis of malignancy. Selective arterial embolization is a conservative procedure to treat postpartum hemorrhages with minimal side effects and allows fertility to be preserved. We present a case of severe deciduosis peritonei identified during a cesarean section in a patient who subsequently required embolization of the uterine arteries due to a postpartum hemorrhage (AU)