Abordaje laparoscópico mediante puerto único versus técnica convencional en el tratamiento quirúrgico del cáncer de endometrio / Single port laparoscopic approach versus conventional technique in the surgical treatment of endometrial cancer

Objetivo: El objetivo de este estudio es comparar el abordaje laparoscópico convencional con el acceso por puerto único en el tratamiento quirúrgico del cáncer de endometrio. Materiales y métodos: Estudio retrospectivo sobre 36 pacientes, 18 operadas con técnica convencional y 18 con acceso por puerto único mediante una única incisión en la piel y 3 en la fascia, para la inserción de un trócar de 10mm y 2 de 5mm. Resultados: Se obtiene menor dolor postoperatorio (22,3% vs. 83,3%, p<0,001) y un mejor resultado estético (10 vs. 8, p=0,001) en el grupo de pacientes intervenidas por puerto único. El tiempo quirúrgico fue mayor en el grupo con técnica convencional (120 vs. 180min; p=0,027). En cuanto a estancia hospitalaria (2,5 vs. 2,5 días, p=0,69), pérdida sanguínea (1,15 vs. 1,25g/dl, p=1), número de ganglios extirpados (16,5 vs. 18; p=0,78) y complicaciones intra (0% vs. 5%, p=0,19) y posquirúrgicas (16,6% vs. 11,1%, p=0,63) no hubo diferencias significativas. Conclusión: El abordaje por puerto único es una técnica factible, segura y efectiva en el tratamiento del cáncer ginecológico, presentando una menor tasa de dolor postoperatorio y un mejor resultado estético.(AU)

Objective: The objective of this study is to compare conventional laparoscopy with transumbilical single-port access for the surgical treatment of endometrial cancer. Materials and methods: A retrospective study was performed with 36 patients, of whom 18 were operated using conventional laparoscopy, and 18 using a transumbilical single-port access (laparoendoscopic single-site surgery, or LESS) by making a single incision in the umbilical skin of 2-3cm, and 3 incisions in the fascia. One 10-mm trocar and two 5-mm trocars were inserted next to each other to access the abdominal cavity. Results: There were no statistical differences between groups in postoperative changes in haemoglobin concentration (1.15 vs. 1.25g/dL, P=1), hospital stay (2.5 vs. 2.5 days, P=.69), intraoperative complication rate (0% vs. 5%, P=.19), postoperative complications (16.6% vs. 11.1%, P=.63), number of pelvic lymph nodes (16.5 vs. 18, P=.78), and number of para-aortic lymph nodes (9 vs. 10, P=.64). Patients in the LESS group experienced less postoperative pain (22.3% vs. 83.3%, P<.001), and had a higher rate of satisfaction with the cosmetic results (10 vs. 8, P=.001). The median operating time was lower in the LESS group (120-180min, P=.027). Conclusion: Laparoendoscopic single-site surgery is a feasible, safety and effective technique for the treatment of endometrial cancer, with less postoperative pain and better cosmetic results.(AU)

Clinical and subclinical cardiovascular disease in female SLE patients: Interplay between body mass index and bone mineral density.

BACKGROUND AND AIMS: Since accelerated atherosclerosis has been reported in systemic lupus erythematosus (SLE), predictive biomarkers of cardiovascular disease (CVD) are needed. Among non-traditional risk factors, bone mineral density (BMD) has been related to CVD. However, its role in SLE remains controversial. This study aims to analyze the associations of subclinical atherosclerosis with traditional and non-traditional CV risk factors. METHODS AND RESULTS: In a cross-sectional study, atherosclerosis burden was compared between 112 female SLE patients and 31 controls. Plaque number and carotid intima-media wall thickness (cIMT) were assessed by ultrasonography. In a retrospective study, BMD determinations obtained 5-years before the ultrasonography assessment were analyzed in a subgroup of 62 patients. Plaque frequency was increased in SLE, even in patients without CV events or carotid wall thickening. cIMT was increased in patients with CVD, positively correlated with body mass index (BMI). Interestingly, a paradoxical effect of BMI on carotid parameters was observed. Whereas underweight patients (BMI < 20) showed increased prevalence of carotid plaques with low cIMT, those with BMI > 30 showed higher cIMT and plaque burden. Overweight patients (25 < BMI<30) exhibited both elevated cIMT and plaque number. BMI was an independent predictor of BMD. In our retrospective study, patients with either clinical or subclinical CVD exhibited lower BMD levels than their CV-free counterparts. A low lumbar spine BMD independently predicted CVD development after adjusting for confounders. CONCLUSION: SLE was associated with a higher subclinical atherosclerosis burden, a bimodal effect being observed for BMI. Decreased BMD can be a CV risk biomarker in SLE.

Cirugía oncológica ginecológica mediante puerto único y endoscopia operatoria por orificios naturales empleando equipamiento convencional / Combined laparoendoscopic single-site surgery (less) and natural orifice transluminal endoscopic surgery (NOTES) in gynaecologic oncology using conventional equipment

Objetivo: Describir y valorar la aplicabilidad de la combinación de las técnicas de puerto único y del natural orifice transluminal endoscopic surgery (NOTES) en el tratamiento quirúrgico del cáncer ginecológico empleando solo instrumental convencional. Material y métodos: Se realiza un estudio retrospectivo de 30 pacientes tratadas por cáncer ginecológico desde junio de 2012 hasta junio de 2014. Todos los procedimientos se hicieron mediante técnica de puerto único o NOTES híbrido. Se empleó equipamiento convencional, el mismo que empleamos en la laparoscopia multipuerto. Resultados: Ventiuna pacientes (70%) fueron operadas mediante puerto único umbilical; 8 casos (30%) mediante NOTES híbrido. En un caso se realizó un doble puerto único para abordaje retroperitoneal y transperitoneal simultáneo. Los procedimientos empleados fueron: histerectomía en 10 cánceres de endometrio y en 2 cánceres de cuello. En 6 casos se asoció además una linfadenectomía pélvica o una biopsia selectiva de ganglio centinela. En 3 casos, se realizó además una linfadenectomía paraaórtica. En un caso se realizó linfadenectomía pélvica y paraaórtica transperitoneal para estadificación de un cáncer de cérvix. Se realizó estadificación ovárica en 3 casos de carcinoma de ovario borderline y en 2 casos infiltrantes. Finalmente, en 3 casos se utilizó el puerto único para evaluación de resecabilidad. En 5 casos (16,66%) fue necesario utilizar algún trocar auxiliar para el abordaje paraaórtico. No fue necesaria ninguna conversión a laparotomía. No se observaron complicaciones intraoperatorias y tan solo se observaron complicaciones menores postoperatorias en 5 casos y una complicación mayor en una paciente de 72 años con un cáncer de células claras endometrial IAG3 que presentó insuficiencia cardíaca en el postoperatorio. Conclusión: Los procedimientos de puerto único y NOTES son procedimientos seguros y válidos para el manejo quirúrgico del cáncer ginecológico

Objective: To describe and assess the feasibility of combining natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery in gynaecological cancer using only conventional laparoscopic equipment. Material and methods: A retrospective review of 30 patients with gynaecological cancer, managed by either laparoendoscopic single-site surgery or hybrid natural orifice transluminal endoscopic surgery technique, from June 2012 to June 2014. Only conventional trocars, grasping forceps and sealing devices were used, similar to multiport laparoscopic surgery. Results: Twenty-one (70%) patients were managed by umbilical laparoendoscopic single-site surgery, while 8 (30%) patients underwent a hybrid natural orifice transluminal endoscopic surgery. One patient underwent a double retroperitoneal and transperitoneal single-site approach. Hysterectomy was performed in 10 cases of endometrial cancer and 2 of cervical cancer, while hysterectomy plus pelvic lymphadenectomy or sentinel node biopsy was conducted in 6 cases of endometrial cancer. Hysterectomy plus pelvic and para-aortic lymphadenectomy was performed in 3 patients with endometrial cancer. Transperitoneal pelvic and para-aortic lymphadenectomy was conducted in one case for cervical cancer staging. Staging was also performed in 3 patients with borderline ovarian cancer and in 2 cases of infiltrating cervical carcinoma. Single-port laparoscopic debulking surgery was performed in the remaining 3 cases. Additional 5-mm ports were used in 5 (16.66%) cases to perform para-aortic lymphadenectomy, but no conversion to laparotomy was needed. There were no intraoperative complications, with minor postoperative complications observed in only 5 cases. There was one postoperative major complication: Heart failure in a 72-year-old female patient with clear cell endometrial cancer stage IAG3, who needed to be referred to the cardiology department during her hospitalisation. Conclusion: Combined laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery is a safe and feasible procedure in the surgical treatment of gynaecological cancer

Combined mepacrine-hydroxychloroquine treatment in patients with systemic lupus erythematosus and refractory cutaneous and articular activity.

Aim The aim of this study was to evaluate the clinical response to combined therapy with hydroxychloroquine and mepacrine in patients with systemic lupus erythematosus and refractory joint and/or skin disease. Methods Mepacrine was added to 46 systemic lupus erythematosus patients unresponsive to treatment with the following drug combinations: hydroxychloroquine + prednisone + immunosuppressive drugs ( n = 24), hydroxychloroquine + prednisone ( n = 16), hydroxychloroquine + prednisone + retinoids ( n = 2), hydroxychloroquine alone ( n = 1), hydroxychloroquine + one immunosuppressive drug ( n = 1), hydroxychloroquine + prednisone + one immunosuppressive drug + belimumab ( n = 1) or hydroxychloroquine + prednisone + belimumab ( n = 1). The outcome variable was the clinical response, either complete or partial, based on clinical judgement. The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score were additionally used. Results A total of 91% patients showed complete/partial response, with similar rates among those with joint or skin disease. In patients with cutaneous activity, a statistically significant decrease in the CLASI was seen. There also was a statistically significant decrease in the SLEDAI. The mean daily dose of prednisone decreased from 5.8 to 3.4 mg/d ( p = 0.001). Prednisone could be discontinued in 20% of patients. No serious adverse events were seen. Smoking was the only predictor of complete response. Conclusion In the setting of refractory skin and/or joint disease, the addition of mepacrine to previous therapy including hydroxychloroquine was safe and effective in reducing disease activity and decreasing prednisone doses. The fact that smokers responded better opens the door to further studying the combination of mepacrine-hydroxychloroquine as a first-line therapy in such patients.

The midpoint between ventilatory thresholds approaches maximal lactate steady state intensity in amateur cyclists.

The aim was to determine whether the midpoint between ventilatory thresholds (MPVT) corresponds to maximal lactate steady state (MLSS). Twelve amateur cyclists (21.0 ± 2.6 years old; 72.2 ± 9.0 kg; 179.8 ± 7.5 cm) performed an incremental test (25 W·min-1) until exhaustion and several constant load tests of 30 minutes to determine MLSS, on different occasions. Using MLSS determination as the reference method, the agreement with five other parameters (MPVT; first and second ventilatory thresholds: VT1 and VT2; respiratory exchange ratio equal to 1: RER = 1.00; and Maximum) was analysed by the Bland-Altman method. The difference between workload at MLSS and VT1, VT2, RER=1.00 and Maximum was 31.1 ± 20.0, -86.0 ± 18.3, -63.6 ± 26.3 and -192.3 ± 48.6 W, respectively. MLSS was underestimated from VT1 and overestimated from VT2, RER = 1.00 and Maximum. The smallest difference (-27.5 ± 15.1 W) between workload at MLSS and MPVT was in better agreement than other analysed parameters of intensity in cycling. The main finding is that MPVT approached the workload at MLSS in amateur cyclists, and can be used to estimate maximal steady state.

Miocarditis y enfermedad de Still del adulto / Myocarditis and adult onset still disease

No disponible

Superior vena cava syndrome due to a leiomyosarcoma of the anterior mediastinum: A case report and literature overview.

INTRODUCTION: Leiomyosarcomas are an infrequent cause of malignant superior vena cava syndrome (VCS). PRESENTATION OF CASE: A 51-year old male patient was admitted for a three-day history of dyspnoea, dysphagia and erythema of the head and neck. Computed tomography and magnetic resonance imaging showed a lesion arising on the anterior mediastinum, which was in close proximity with a thrombus in the superior vena cava. Surgical excision was performed, including open resection of the primary tumour and an atrio-innominate vein bypass with 8-mm polytetrafluoroethylene (PTFE). Histology confirmed a leiomyosarcoma and postoperative radiotherapy sessions were performed. Due to evidence of enlargement of the thrombus, a second intervention was undertaken. In this procedure, a remainder of the primary tumour was resected and the superior vena cava reconstructed with an autologous pericardium patch. The patient recovered satisfactorily and was discharged on the seventh postoperative day, with no evidence for relapse after 10 months of follow-up. DISCUSSION: Leiomyosarcomas comprise less than 2% of the tumours of the mediastinum and are a rare cause of paraneoplastic VCS. Male patients in their sixties are most commonly affected. Relapses seem to be common, and thus a careful follow-up is often recommended. CONCLUSION: In spite of the limited data on the management of thoracic leiomyosarcomas, surgery is currently considered the mainstay of treatment.

Tumoraciones mesenquimales de músculo liso de potencial maligno incierto (STUMP): revisión de un caso clínico / No disponible

Las tumoraciones mesenquimales de músculo liso uterino de potencial de malignidad incierta son hallazgos poco frecuentes en la clínica habitual. La Organización Mundial de la Salud los definió como aquellos tumores uterinos de músculo liso que no podían ser histológicamente clasificados como benignos o malignos. Presentamos un caso clínico de una mujer de 41años, que consultó por aumento del perímetro abdominal y dolor en la región abdominal. Se solicitaron pruebas de imagen, que pusieron de manifiesto la presencia de una gran masa abdominal (20cm). Ante tales hallazgos, se realizó exéresis quirúrgica de la tumoración y posterior histerectomía. El estudio anatomopatológico reveló el diagnóstico de tumoración muscular lisa de bajo grado de malignidad de potencial maligno incierto. Actualmente, la paciente se encuentra asintomática. Conclusión Las tumoraciones mesenquimales de músculo liso uterino de potencial de malignidad incierta son poco frecuentes. Su diagnóstico anatomopatológico es complicado y por ello varios estudios exponen técnicas de inmunohistoquímica que ayudan a esclarecer el diagnóstico definitivo. Algunos autores los clasifican según sus características histológicas, basándose en éstas para establecer el comportamiento y pronóstico de estos tumores. El tratamiento quirúrgico de elección no está definido y el seguimiento ha de ser estrecho por el riesgo de recurrencia existente (AU)

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are rare findings in routine clinical practice. STUMP are defined by The World Health Organization astumors that cannot be histologically diagnosed as benign or malignant. We present the case of a 41-year-old woman who consulted for abdominal distension and pain. Imaging tests showed the presence of a large abdominal mass (20 cm). The mass was surgically excised followed by hysterectomy. The histopathological diagnosis was uterine STUMP of low grade malignancy. The patient is currently asymptomatic. Conclusion: STUMP are rare. Pathological diagnosis is difficult and several studies describe immunohistochemical techniques that could help to confirm the final diagnosis. Some authors classify these tumors by their histological features, which are then used to establish their behavior and prognosis. The surgical treatment of choice has not been defined and close follow-up must be performed due to the risk of recurrence (AU)

Tumor filodes de la mama. A propósito de dos casos / Phyllodes tumor of the breast: apropos of two cases

El tumor filodes de mama constituye una neoplasia de tipo fibroepitelial de mama poco frecuente, pueden ser benignas, borderline y malignas, representando un 0,3 a 0,9% de todas las tumoraciones mamarias. El diagnóstico definitivo es anatomopatológico y la resección amplia, completa y con márgenes libres de la lesión, constituye el pilar fundamental del tratamiento de estas lesiones. Presentamos dos casos de dos pacientes de 33 y 38 años, respectivamente, diagnosticadas de tumor filodes de la mama y tratadas en nuestro servicio. Hemos estudiado los métodos diagnósticos y técnicas quirúrgicas utilizadas en su tratamiento así como su posterior evolución y lo hemos comparado con lo descrito en la bibliografía (AU)

Phyllodes tumour of the breast is a highly uncommon fibro epithelial tumour, representing 0.3 to 0.9% of all breast tumours. The definitive diagnosis is histological and the goal of treatment is wide and complete surgical excision of the tumour with disease-free margins. We report two patients, aged 33 and 38 years old, with phyllodes tumour of the breast diagnosed and treated in our center. We discuss the diagnostic techniques, surgical approaches, and follow-up in these patients and compare our experience with reports in the literature (AU)

Angiofibroma celular de vulva: una entidad a investigar / No disponible

El angiofibroma celular de vulva es una tumoración bien circunscrita que aparece tanto en hombres como en mujeres. Posee unas características histológicas e inmunohistoquímicas que permiten diferenciarlo del resto de tumoraciones vulvares. Su pronóstico es bueno aunque existe cierto riesgo de recidiva. Presentamos el caso clínico de una mujer con dicho diagnóstico (AU)

Cellular angiofibroma of the vulva is a well-circumscribed tumor that occurs in men and women. This tumor has histological and immunohistochemical features that distinguish it from other vulvar tumors. The prognosis is good, although there is a risk of recurrence. Were port the case of a woman with this diagnosis (AU)

Hiperplasia endometrial atípica en biopsia preoperatoria y resultado de la pieza de histerectomía / No disponible

Objetivos: El propósito de este estudio ha sido examinar la relación entre el diagnóstico de hiperplasia atípica en el legrado o biopsia endometrial y el resultado definitivo en la pieza de histerectomía. Material y método Se encontraron 33 pacientes que cumplían las condiciones del estudio y revisamos las historias para conocer los datos clínicos, anatomopatológicos y terapéuticos relevantes. Resultados Se observó adenocarcinoma en 4 (12,12%) de las 33 piezas de histerectomía, se encontró hiperplasia en 28 de las piezas, aunque en 12 de ellas sin atipia (36,36%) y no se halló hiperplasia ni tumor en una de ellas. Conclusiones El paso siguiente a un diagnóstico de hiperplasia endometrial atípica por biopsia debe ser la histerectomía, asumiendo el sobre tratamiento que supone para algunas pacientes dado el importante riesgo de retrasar u obviar la cirugía de un cáncer coincidente operable y curable (AU)

Objectives: The purpose of this study was to examine the relationship between diagnosis of atypical endometrial hyperplasia in a curettage sample and the final pathological result after hysterectomy. Material and methods: There were 33 patients who fulfilled the criteria for inclusion in this study. Clinical records were reviewed to identify clinical, histopathological and treatment data. Results: Adenocarcinoma was found in four (12.12%) of the 33 surgical specimens from hysterectomy. Endometrial hyperplasia was found in 28 specimens, although 12 (36.3%) of these specimens showed no atypia. No endometrial hyperplasia or signs of any other tumor were found in one specimen Conclusions: After pathological findings of atypical endometrial hyperplasia, the next step should be to perform hysterectomy. Given the major risks of delaying or not performing surgery for a possible concomitant endometrial cancer, which can be treated and cured, the risk of overtreating some patients is acceptable (AU)

Fibroadenoma gigante de mama / Giant fibroadenoma of the breast

Los fibroadenomas son una de las tumoraciones más frecuentes de la mama. Son de características benignas y suelen presentarse en mujeres jóvenes. La forma de presentación más habitual es como una tumoración sólida, móvil e indolora que puede adquirir un gran tamaño si se produce un crecimiento rápido. El diagnóstico de estas masas se realiza con la exploración física y técnicas de imagen, principalmente la ecografía en mujeres jóvenes. La confirmación diagnóstica viene dada por el estudio histológico. El tratamiento quirúrgico debe de ser valorado individualmente; los nódulos de rápido crecimiento y gran tamaño deben de ser extirpados para analizarlos y realizar un diagnóstico diferencial con otras patologías y tumores, entre ellos, el tumor Filodes. Presentamos el caso de una mujer de 16 años que después del parto consultó por una tumoración gigante en mama, la cual fue extirpada, con diagnóstico patológico de fibroadenoma gigante. Revisamos el estudio, tratamiento y manejo de estos tumores así como la importancia de un adecuado diagnóstico diferencial (AU)

Fibroadenomas are one of the most frequent tumors of the breast. These neoplasms are benign and are most frequently diagnosed in young women. The most common form of presentation is a solid, mobile, painless mass that can become very large if there is rapid growth. Diagnosis of these breast masses is normally made by physical examination supported by imaging techniques, mainly ultrasound in young women. Confirmation of the diagnosis is provided by histological analysis. Surgical treatment should be evaluated individually; large nodules with rapid growth should be excised for analysis and for differential diagnosis with other breast diseases and tumors, especially phyllodes tumors. We present the case of a 16-year-old girl who after delivery consulted for a giant breast mass. The mass was excised and the pathological diagnosis was giant fibroadenoma. We discuss the initial approach, treatment and management of these tumors in young patients as well as the importance of a correct differential diagnosis (AU)

Cáncer de mama en mujeres posmenopáusicas / No disponible

Objetivo Revisar nuestra experiencia en el manejo de pacientes posmenopáusicas diagnosticadas y tratadas de cáncer de mama. Material y métodos Se ha realizado estudio descriptivo retrospectivo de 903 pacientes con cáncer de mama entre 1992 y 2008. Se seleccionó a las pacientes posmenopáusicas: 568 (62,90%). Se analizaron factores como edad, paridad, antecedentes familiares y personales, tipo de cáncer, tipo de cirugía, resultados a.p., estadio, tratamientos complementarios y seguimiento. Se ha realizado estudio estadístico mediante SPSS 15.0.ResultadosLa edad media fue 65,26±0,46 (40–95) años. Solo en 117 (20,59%) pacientes existían antecedentes familiares de cáncer de mama. En 312 casos (54,92%) existían factores de riesgo epidemiológico. Eran nuligestas 55 pacientes (9,68%). El motivo de consulta más frecuente fue la palpación de un nódulo 328 (57,7%). Se emplearon diferentes métodos diagnósticos por imagen, siendo la mamografía 420 (73,9%) el más utilizado. En 238 (41,90%) fue necesario estudio mediante biopsia intraoperatoria para confirmación histológica del diagnóstico. El tratamiento neoadyuvante fue empleado en 63 casos (11,09%). El tratamiento quirúrgico como tratamiento inicial fue realizado en 505 casos (88,90%). Pudo realizarse cirugía conservadora en 225 (39,61%) casos. El tipo histológico más frecuente fue el carcinoma ductal infiltrante en 380 (66,9%) pacientes. El número de ganglios fue 12,41±0,26(1–36). La hormonoterapia se pautó en 333 (58,62%), siendo el tamoxifeno el más empleado, en 230 (69,1%).Conclusiones El incremento de la edad conlleva un aumento de la patología oncológica mamaria. El diagnóstico en estas pacientes es mayoritariamente clínico. Los tratamientos en estas pacientes son menos conservadores debido al diagnóstico en estadios más avanzados (AU)

Objective To review our experience in the management and treatment of postmenopausal women with breast cancer. Material and methods A descriptive and retrospective study was performed in 903 women with breast cancer between 1992 and 2008. A total of 568 (62.90%) menopausal women were selected. The factors studied included age, parity, familial and personal history, type of cancer, type of surgery, pathological findings, stage, complementary treatments and follow-up. Statistical analysis was performed using the SPSS statistical package version 15.0.ResultsThe mean age was 65.26±0.46 (40–95) years. Familial breast cancer was found in only 117 patients (20.59%) patients. Epidemiological risk factors were found in 312 (54.92%). Nulliparity was found in only 55 patients (9.68%). The most frequent reason for consultation was palpation of a nodule in 328 (57.7%). Distinct imaging procedures were used, the most frequent being mammography in 420 (73.9%). Intraoperative biopsy was required for histological confirmation of the diagnosis in 238 (41.90%). Neoadjuvant treatment was indicated in 63 patients (11.09%). Surgical treatment was the first step in 505 women (88.90%). Conservative surgery was feasible in 225 (39.61%) patients. The most frequent histological type was infiltrating ductal carcinoma cancer in 380 (66.9%) patients. The mean number of nodes was 12.41±0.26 (1–36). Hormono therapy was used in 333 (58.62%), the most widely used being tamoxifen in 230 (69.1%).Conclusions Increased age is associated with a greater risk of breast cancer. Diagnosis in these patients is mainly clinical. Conservative treatment is infrequent in these patients as tumors are usually diagnosed in the more advanced stages (AU)

Abordaje quirúrgico del cáncer de endometrio en pacientes mayores / No disponible

Objetivo: Valorar los posibles abordajes quirúrgicos del cáncer de endometrio y su morbilidad en pacientes > 65 años. Material y método: Hemos realizado un estudio descriptivo retrospectivo desde 1996 a 2006 de 70 pacientes, con edad $ 65 años, diagnosticadas de cáncer de endometrio. Se han clasificado según la vía quirúrgica en 3 grupos (vaginal, laparoscópica y laparotómica). Los factores estudiados han sido: la edad, el índice de masa corporal, las cirugías previas, el tipo de cirugía, las complicaciones peroperatorias, la tasa de conversión, la estancia media, la tasa de transfusión, el estadio FIGO, el tipo histológico y la tasa de supervivencia. Se ha realizado estudio estadístico mediante análisis informático SPSS. Resultados: La edad media fue 72,37 ± 0,68 (65-88) años y el índice de masa corporal 32,96 (17,57-52), en kg/m2, sin diferencias significativas. En 14,28% (10 pacientes) existían antecedentes de cirugías abdominales, el 68,67% (48) presentaba factores considerados de riesgo de enfermedad endometrial. La vía quirúrgica empleada fue en el 8,5% (6) vaginal, en el 50% (35) laparoscópica y en el 41,4%(29) laparotómica. La linfadenectomía se realizó en un 69% de las laparotomías y en un 97,1% de laparoscopias (tasa de conversión, 5,7%). Hubo complicaciones intraoperatorias (8,6%) y postoperatorias (28,57%) sin diferencias significativas; la estancia media fue de 6,39 ± 0,53 (2-33) días: vaginal, 5 ± 1,29 (3-10); laparoscopia, 5,32 ± 0,47 (2-14) y laparotomía, 7,93 ± 1,07 (3-33), con una p < 0,01 para la vía vaginal y la laparoscopia. La tasa de transfusión fue del 12,9%. No hubo diferencias significativas respecto a la supervivencia entre los diferentes abordajes quirúrgicos. Conclusión: El abordaje laparoscópico es una técnica viable con una escasa tasa de complicaciones y con una supervivencia similar a las pacientes intervenidas por laparotomía (AU)

Objective: To evaluate the feasibility of distinct approaches for the treatment of endometrial cancer and associated morbidity in patients over 65 years old. Material and methods: We performed a retrospective descriptive study of 70 consecutive patients diagnosed with endometrial cancer from 1996 to 2006. All the patients were 65 years old or older. The surgical approach was classified in three groups: vaginal, laparoscopy and laparotomy. The following factors were analyzed: age, body mass index, previous surgery, type of surgery, perioperative complications, laparotomy rate, mean length of hospital stay, transfusion rate, FIGO stage, histological type, and recurrence and survival rates. Statistical analysis was performed using SPPS computer analysis. Results: The mean age was 72.37 ± 0.68 years (65-88) and the mean body mass index was 32.96 (17.57-52), with no statistically significant differences. Ten patients (14.28%) had previous abdominal surgery and 48 (68.67%) had endometrial risk factors. Surgical access was vaginal in six patients (8.5%), laparoscopic in 35 (50%) and laparotomic in 29 (41.4%). Lymphadenectomy was feasible in 69% of laparotomic interventions and in 97.1% of laparoscopic procedures (conversion rate: 5.7%). The intraoperative complications rate was 8.6% and the postoperative complications rate was 28.57%, with no statistically significant differences. The mean length of hospital stay was 6.39 ± 0.53 days (2-33), 5 ± 1.29 (3-10) with the vaginal route, 5.32 ± 0.47 (2-14) with laparoscopy, and 7.93 ± 1.07 (3-33) with laparotomy; differences between the vaginal and laparoscopic routes were statistically significant (P<.01). The transfusion rate was 12.9%. The survival rate was similar among the three surgical approaches. Conclusions: The laparoscopic approach is a feasible technique, with a low complications rate and a similar survival rate to that of other approaches (AU)

Evolution of physiological and haematological parameters with training load in elite male road cyclists: a longitudinal study.

AIM: The aim of this study was to describe and evaluate physiological parameters as a control tool for the monitoring of training in a group of elite cyclists during one season of training. METHODS: The study is divided into two periods (winter or ''volume'' mesocycle and spring or ''intensity'' mesocycle) between the tests that they carried out in the laboratory, consisting of a ramp test to exhaustion (work load increases 25 W X min(-1)) and a maximal lactate steady state (MLSS) test on a cycle ergometer. Macronutrients and hematological variables were recorded during the test periods as were the volume and the intensity of training sessions during the whole period of the study. RESULTS: The physiological data were similar to those previously reported for professional cyclists (approximately 450 Watts, approximately 78 mL x kg(-1) x min(-1)) and the values for the MLSS also agree with previous studies (approximately 250 Watts). Subjects improved the first ventilatory threshold (VT(1)) (approximately 52% to approximately 60% VO(2max)) and the second ventilatory threshold (VT(2)) (approximately 82% to approximately 87% VO(2max)) after the first period of training even though its low intensity focused on the performance of VT(1) (77% training in ''zone 1'', under VT(1)). The MLSS improved after the first period (approximately 225 to approximately 250 Watts) and remained high in the second (approximately 255 Watts). High levels of creatine kinase (approximately 230 U x L(-1)) and urea (37 mg x L(-1)) were found, also a decrease in hemoglobin values (approximately 15.4 to approximately 14.7g x dL(-1)). CONCLUSION: The high level reached by the subjects after the first period of training suggests that two effort tests could be enough to plan training. On the other hand, the decrease in some red blood cell and nutrition parameters suggests that there should be greater control over them during the season.

[Response of tidal volume to inspiratory time ratio during incremental exercise]. / Respuesta de la relación volumen corriente-tiempo inspiratorio durante un esfuerzo incremental.

OBJECTIVE: There is some debate about the participation of the Hering-Breuer reflex during exercise in human beings. This study aimed to investigate breathing pattern response during an incremental exercise test with a cycle ergometer. Participation of the Hering-Breuer reflex in the control of breathing was to be indirectly investigated by analyzing the ratio of tidal volume (VT) to inspiratory time (tI). SUBJECTS AND METHODS: The 9 active subjects who participated the study followed an incremental protocol on a cycle ergometer until peak criteria were reached. During exercise, VT/ti can be described in 2 phases, separated by activation of the Hering-Breuer reflex (inspiratory off-switch threshold). In phase 1, ventilation increases because VT increases, resulting in a slight decrease in tI, whereas, in phase 2, increased ventilation is due to both an increase in VT and a decrease in tI. RESULTS: The mean (SD) inspiratory off-switch threshold was 84.6% (6.3%) when expressed relative to peak VT (mean, 3065 [566.8] mL) and 48% (7.2%) relative to the forced vital capacity measured by resting spirometry. The inspiratory off-switch threshold correlated positively (r=0.93) with the second ventilatory threshold, or respiratory compensation point. CONCLUSIONS: The inspiratory off-switch threshold and VT/ti are directly related to one another. The inspiratory off-switch threshold was related to the second ventilatory threshold, suggesting that the Hering-Breuer reflex participates in control of the breathing pattern during exercise. Activation of the reflex could contribute by signaling the respiratory centers to change the breathing pattern.

Microcolpohisteroscopia / Microcolpohysteroscopy

La microcolpohisteroscopia es una técnica que combina la colposcopia, la histeroscopia y el estudio citológico “in vivo”. Su aplicación fundamental va dirigida al estudio del exocérvix, del endocervix y de la zona de transformación, permitiendo la evaluación de su epitelio tras la aplicación de tinciones supravitales a escala macro y microscópica. Describimos en este trabajo las necesidades de equipamiento, el procedimiento y una relación de procesos diagnosticables mediante esta técnica. Aunque la aplicación de la microcolpohisteroscopia es limitada a efectos de screening, sí es una técnica que permite identificar lesiones ocultas a la colposcopia convencional, permitiéndo una localización precisa de las lesiones y orientando por tanto la destrucción local de la lesión evitando el sobretratamiento y sus secuelas

Microcolpohysteroscopy combined the colposcopy, the hysteroscopy and the “in vivo” cytological evaluation. This procedure is mainly focus to endocervical, exocervical and transformation zone study. Supravital staining allows performing “in vivo” cytology. In this review we show the technical requirements and the steps of the procedure. In addition, normal and pathological microcolpohysteroscopic findings are described in detail. Microcolpohysteroscopy is useless at screening level due to technical pitfalls, however it allows to identify those lesions undetectable by conventional colposcopy. Exact topography allows a precise focal destroy and management of the lesions thus avoiding cervical overwhelming treatment

Respuesta de la relación volumen corriente-tiempo inspiratorio durante un esfuerzo incremental / Response of tidal volume to inspiratory time ratio during incremental exercise

Objetivo: La participación del reflejo de Hering-Breuer durante el ejercicio en seres humanos es objeto de discusión. El propósito del presente trabajo ha sido estudiar la respuesta del patrón respiratorio durante un esfuerzo incremental en cicloergómetro para comprobar, de forma indirecta, mediante el análisis de la relación volumen corriente-tiempo inspiratorio (VT/tI), la participación del reflejo de Hering-Breuer en el control de la respiración. Sujetos y métodos: Han participado en el estudio 9 sujetos activos que han llevado a cabo un protocolo incremental en cicloergómetro hasta alcanzar criterios máximos. Se ha comprobado que la relación VT/tI durante el ejercicio presenta 2 fases con un punto de ruptura, denominado punto de ruptura Hering-Breuer (PHB): fase I, donde el incremento de la ventilación se produce a expensas del aumento del VT con ligero descenso del tI, y fase II, durante la cual el incremento ventilatorio se produce tanto por el aumento del VT como por el descenso del tI. Resultados: En el estudio, el PHB se alcanzaba a un valor medio (± desviación estándar) del 84,6 ± 6,3% respecto al máximo valor de VT (3.065 ± 566,8 ml) y de un 48 ± 7,2% respecto al valor de la capacidad vital forzada medida en la espirometría de reposo. El PHB se relacionó de forma positiva (r = 0,93) con el umbral ventilatorio 2 o umbral de compensación respiratoria. Conclusiones: Existe relación directa entre el PHB y VT/tI. El PHB se relaciona con el umbral ventilatorio 2, de manera que intervendría en el control del patrón ventilatorio durante el ejercicio. La entrada en funcionamiento del reflejo podría contribuir informando a los centros respiratorios para llevar a cabo el cambio de patrón ventilatorio

Objective: There is some debate about the participation of the Hering-Breuer reflex during exercise in human beings. This study aimed to investigate breathing pattern response during an incremental exercise test with a cycle ergometer. Participation of the Hering-Breuer reflex in the control of breathing was to be indirectly investigated by analyzing the ratio of tidal volume (VT) to inspiratory time (tI). Subjects and methods: The 9 active subjects who participated the study followed an incremental protocol on a cycle ergometer until peak criteria were reached. During exercise, VT/ti can be described in 2 phases, separated by activation of the Hering-Breuer reflex (inspiratory off-switch threshold). In phase 1, ventilation increases because VT increases, resulting in a slight decrease in tI, whereas, in phase 2, increased ventilation is due to both an increase in VT and a decrease in tI. Results: The mean (SD) inspiratory off-switch threshold was 84.6% (6.3%) when expressed relative to peak VT (mean, 3065 [566.8] mL) and 48% (7.2%) relative to the forced vital capacity measured by resting spirometry. The inspiratory off-switch threshold correlated positively (r=0.93) with the second ventilatory threshold, or respiratory compensation point. Conclusions: The inspiratory off-switch threshold and VT/ti are directly related to one another. The inspiratory off-switch threshold was related to the second ventilatory threshold, suggesting that the Hering-Breuer reflex participates in control of the breathing pattern during exercise. Activation of the reflex could contribute by signaling the respiratory centers to change the breathing pattern

Tumor del seno endodérmico en la tercera década de la vida: a propósito de un caso / Yolk sac tumor in the third decade of life: apropos of a case

Se presenta el caso de una paciente con un tumor del seno endodérmico en la tercera década de la vida. El tumor del seno endodérmico es el segundo tumor ovárico maligno más frecuente dentro de los tumores de células germinales. A pesar de ser tumores raros (representan < 1% de los tumores malignos de ovario), su importancia radica en la rapidez de crecimiento y de diseminación intraabdominal y en las consecuencias que conlleva el tratamiento de estas neoplasias para la fertilidad posterior de la paciente. Gracias a la quimiosensibilidad de estos tumores y a los nuevos regímenes de poliquimioterapia, el pronóstico ha mejorado y ha permitido realizar cirugía conservadora incluso en estadios avanzados

We report a case of yolk sac tumor in a patient in the third decade of life. Yolk sac tumors are is the second most common form of malignant germ cell tumor. Although these tumors are rare (< 1% of all malignant ovarian tumors), their importance lies in their rapid growth and intra-abdominal dissemination and in the repercussions of treatment on patients' future fertility. Due to the chemosensitivity of these tumors and effective new polychemotherapy regimens, the prognosis of affected patients has improved and conservative surgery can be performed even in advanced stage tumors