Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution.

OBJECTIVE: To assess the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids on fertility. MATERIAL AND METHODS: A retrospective observational study was conducted of 560 reproductive-age women with symptomatic uterine fibroids who underwent USgHIFU therapy at Mútua Terrassa University Hospital, Spain, between February 2008 and February 2018. We analyzed pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes and complications during pregnancy and delivery. RESULTS: After USgHIFU treatment, 71 pregnancies were obtained in 55 patients. Of these, 58 (82%) cases were natural pregnancies and 13 (18%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 12 (range 1-72) months. There were 43 (61%) successful deliveries, including a twin gestation, 22 (31%) spontaneous abortions and 6 (8%) therapeutic abortions. The rate of full-term deliveries was 91% (39/43) and the remaining 9% (4/43) were preterm deliveries. Of the 44 live births, 25 (57%) were born vaginally and 19 (43%) by cesarean section. The complications reported included 3 women with retained placenta (7%), 2 with placenta previa (5%) and 1 with severe preeclampsia (2%). The mean birth weight was 3.1 (range: 1.4-4.3) kg, and except for a baby born with a tetralogy of Fallot, all newborns developed well without complications during postpartum and breastfeeding. CONCLUSION: Patients undergoing USgHIFU treatment of uterine fibroids can achieve full-term pregnancies with few intrapartum or postpartum complications. More studies are required to compare fertility and perinatal outcomes between patients who underwent or not USgHIFU.

[Extracorporeal high-intensity focused ultrasound: therapeutic alternative for renal tumors]. / Ultrasonidos extracorpóreos de alta intensidad: alternativa terapéutica del tumor renal.

OBJECTIVES: High intensity focused ultrasound (HIFU) is known to be used for the treatment of solid tumors in minimally invasive procedures. Transducers allowing for application of ultrasound from an extracorporeal focus have recently been developed. A review is provided of the development, physical principles, and current status of this therapy, and our early experience with it for the treatment of renal tumors is reported. MATERIALS AND METHODS: Extracorporeal HIFU is currently being used for the treatment of tumors (mainly hepatic, gynecological, and bone tumors), and has been started to be used for renal tumors with good results. A literature review (structured search in the online MEDLINE electronic base) of the physical principles of this treatment and its biological action is provided. The therapeutic procedure used in the first few patients with renal carcinoma successfully treated with HIFU at our hospital is reported. RESULTS: This therapy has been successfully used to treat solid tumors at several centers in Europe, America, and Asia. Our center has a wide experience in treatment of gynecological tumors using extracorporeal HIFU, and has already treated renal tumors with no complications, although follow-up is still short. CONCLUSIONS: Extracorporeal use of this energy appears as a new option among non-invasive therapies for renal cancer in selected cases. A low complication rate has been noted, but much longer follow-up times are required for assessment of oncological results.

Ultrasonidos extracorpóreos de alta intensidad: alternativa terapéutica del tumor renal / Extracorporeal high-intensity focused ultrasound: Therapeutic alternative for renal tumors

Objetivos: Es conocida la aplicación de los ultrasonidos focalizados de alta intensidad (HIFU) en el tratamiento de los tumores sólidos dentro de las terapias mínimamente invasivas, habiéndose desarrollado en los últimos años transductores que permiten la aplicación de ultrasonidos desde un foco extracorpóreo. Presentamos una revisión del desarrollo, los principios físicos, el estado actual y la experiencia inicial propia de esta terapia en el tratamiento de los tumores renales. Material y métodos: Actualmente el HIFU extracorpóreo está siendo utilizado en el tratamiento de tumores, principalmente hepáticos, ginecológicos y óseos, y se ha iniciado su uso en la terapia para las neoplasias renales con buenos resultados. Presentamos una revisión bibliográfica (búsqueda estructurada en la base electrónica MEDLINE online) de los principios físicos de este tratamiento y su acción biológica. Describimos la metodología de tratamiento de los primeros casos de carcinoma renal tratados en nuestro hospital con éxito mediante HIFU. Resultados: Esta terapia ha sido empleada con éxito para tratar tumores sólidos en varios centros de Europa, América y Asia. En nuestro centro tenemos una amplia experiencia en el tratamiento mediante HIFU extracorpóreo de tumores ginecológicos, y ya hemos tratado tumores renales sin complicaciones, si bien el seguimiento es todavía corto. Conclusiones: El uso de esta energía de forma extracorpórea aparece como una nueva opción dentro de las terapias no invasivas del cáncer renal en casos seleccionados, con un escaso índice de complicaciones, aunque hace falta mucho más tiempo de seguimiento para valorar sus resultados desde el punto de vista oncológico (AU)

Objectives: High intensity focused ultrasound (HIFU) is known to be used for the treatment of solid tumors in minimally invasive procedures. Transducers allowing for application of ultrasound from an extracorporeal focus have recently been developed. A review is provided of the development, physical principles, and current status of this therapy, and our early experience with it for the treatment of renal tumors is reported. Materials and methods: Extracorporeal HIFU is currently being used for the treatment of tumors (mainly hepatic, gynecological, and bone tumors), and has been started to be used for renal tumors with good results. A literature review (structured search in the online MEDLINE electronic base) of the physical principles of this treatment and its biological action is provided. The therapeutic procedure used in the first few patients with renal carcinoma successfully treated with HIFU at our hospital is reported. Results: This therapy has been successfully used to treat solid tumors at several centers in Europe, America, and Asia. Our center has a wide experience in treatment of gynecological tumors using extracorporeal HIFU, and has already treated renal tumors with no complications, although follow-up is still short. Conclusions: Extracorporeal use of this energy appears as a new option among non-invasive therapies for renal cancer in selected cases. A low complication rate has been noted, but much longer follow-up times are required for assessment of oncological results (AU)

Hiperplasia ductal esclerosante subareolar de la mama: presentación de ocho casos / Subareolar sclerosing ductal hyperplasia of the breast: report of eight cases

La hiperplasia ductal esclerosante subareolar es una entidad clinicopatológica con características similares a las del adenoma del pezón pero localizada en la región subareolar sin afectarlo. Se revisan las características clínicas, radiológicas, anatomopatológicas y citológicas de ocho casos de hiperplasia ductal esclerosante subareolar.La forma clínica de presentación más frecuente cursó con derrame hemático por el pezón o retracción de la piel. Dos casos presentaron sospecha radiológica, ecográfica o citológica de malignidad. En ningún caso se constató afectación del pezón. El patrón anatomopatológico habitual fue el de papilomatosis, siendo los patrónes esclerosante o adenósico los que se prestaron a una interpretación erronea de malignidad antes del tratamineto quirúrgico. La hiperplasia ductal esclerosante es una entidad clinicopatológica benigna diferenciable del adenoma del pezón que en ocasiones puede ser confundida clínica, radiológica o citológicamente con una lesión maligna de la mama (AU)

Lymphadenectomy in ovarian cancer.

Current guidelines for the surgical staging of ovarian cancer include the removal of retroperitoneal lymph nodes (pelvic and aortic). In most centres this is achieved by means of laparotomy, but advanced laparoscopic techniques have also been performed and still further prospective controlled studies with long-term follow-up are necessary to validate the efficacy. Lymph node sampling, short of complete dissection, should be avoided because it may be insufficient to detect metastasis. In any case, laparoscopic lymphadenectomy as well as open surgery, should be in the hands of properly trained subspecialists in gynaecologic oncology. Of 97 patients with ovarian carcinoma studied in our hospital, 68% were treated by means of complete staging laparotomy (FIGO). Lymphadenectomy was spared in 14 cases with stage I tumours (mainly serous) without changes in overall survival. In 15% metastases in pelvic lymph nodes were present. In the same proportion aortic lymph nodes were positive. In 5.5%, aortic metastases were present in the absence of pelvic involvement.

Clinical and magnetic resonance imaging correlation in acute spinal cord injury.

The aim of this study was to correlate traumatic spinal cord injury (SCI) patient's outcome with magnetic resonance imaging (MRI) performed within the first 15 days following trauma. We retrospectively analyzed 55 SCI patients. Upon admission, 28 were diagnosed as having a complete SCI (51%), versus 27 with an incomplete SCI (49%). All of the patients with a normal pattern on MRI (four cases), had an incomplete SCI, whereas all patients (15 cases) presenting with a hemorrhage pattern (Type 1) had a complete SCI (P = 0.0001). Fourteen of the 15 individuals (93.4%) with the edema pattern (Type II) had an incomplete SCI (P = 0.001), while the other patient had neurological deterioration, and a syrinx was noted 2 years later (6.6%). Among the 10 individuals showing a contusion pattern (Type III), seven were admitted with an incomplete SCI (70%) and three with a complete SCI (30%). The compression pattern tends to be associated with a complete SCI in 77.8% (seven of nine patients). All patients with a transection pattern on MRI (two cases) were clinically diagnosed as having a complete SCI. Early functional prognosis may be established on the basis of clinical presentation of SCI and associated MRI. Cord hemorrhage and transection are irreversible, while edema has a potential for neurological recovery. Cord contusion tends to be associated with an incomplete SCI, unlike the compression pattern, in which the prognosis depends on the degree of the initial neurological damage.