Taiwanese Journal of Obstetrics & Gynecology, Feb 1, 2016
Objective: Bowel endometriosis is an uncommon disease that can cause serious complications and ma... more Objective: Bowel endometriosis is an uncommon disease that can cause serious complications and may require immediate medical attention. We wish to remind about bowel perforation caused by endometriosis, its diagnostic difficulty, and the need or urgent management in late pregnancy and puerperium. Case Report: We present a 38-year-old woman, which presented with bowel perforation requiring urgent surgery. A pathological exam disclosed deep ileal infiltrative endometriosis. Conclusion: Even though bowel endometriosis is a rare complication, it should be considered in the differential diagnosis of severe abdominal pain in late pregnancy or puerperium. A multidisciplinary management of these patients is needed.
Collaboration of various specialists has become essential in pediatric dental practice. In orthod... more Collaboration of various specialists has become essential in pediatric dental practice. In orthodontics, this collaboration is completely necessary when the patient presents periodontal problems. Even in healthy patients, who do not suffer from periodontal disease, periodontal complications may occur during treatment with fixed appliances. Two cases of young patients, in which periodontal procedures were used to complement the results of orthodontic treatment are presented.
Introduction/Background Realización de video de cirugia laparoscopica en que se muestra la import... more Introduction/Background Realización de video de cirugia laparoscopica en que se muestra la importancia de una adecuada identificación de estructuras en la linfadenectomia aortica y pelvica. Methodology Video production of laparoscopic surgery showing the importance of an adequate identification of structures in aortic and pelvic lymphadenectomy. In this systematic way it is possible to save unexpected structures or anatomical malformations. Results This video shows retroaortic renal vein, double obturator nerve, left ovarian vein towards vena cava, high obturator vein, crown of death vein, lateral inferior mesenteric artery... Conclusion the importance of reviewing images available preoperatively is essential, as well as performing systematic surgery step by step Disclosure Nothing to disclose
Introduction/Background LACC trial has changed the paradigm regarding the surgical treatment of c... more Introduction/Background LACC trial has changed the paradigm regarding the surgical treatment of cervical cancer. This is the first prospective study performed in this field and in which a better prognosis has been observed in patients treated by laparotomy. Methodology This is a retrospective observational cohort study without a control group. Inclusion criteria Patients with stages Ia1 (with lymphovascular invasion) to IIa1 treated by hysterectomy and trachelectomy including lymphadenectomy between January 2007 and December 2018 at the Jiménez Díaz Foundation Hospital. Exclusion criteria Patients under 18 years Pregnant patients. Older than 80 years. Surgical contraindications. ECOG ≤50% and/or ASA ≥4 Parametrial involvement All patients who met the described inclusion criteria were selected and different clinical parameters were analyzed, including age, menopausal status, physical examination for assessment of parameter involvement. Likewise, anatomopathological characteristics were studied, such as histological type, tumor size, lymphovascular invasion, parametrial infiltration, nuclear grade, stromal infiltration. The disease-free interval was also studied, as well as the overall survival. Results For all the patients recruited, a total of 84 of them were included in the inclusion criteria. The average age of the patients was 46 years (Minimum 27 and Maximum 70 years). 53 patients studied were in stage IB1 (63%), 14 stage IA1 (16.6%), 12 stage IA2 (14.3%) and 5 stage IIA1 (5.9%). The disease-free survival studied has been up to> 5 years. There have been a total of 5 recurrences (Minimum 8 and maximum 40 months). Conclusion The percentage of relapse and survival is in accordance with the current data. Laparoscopic surgery presents an acceptable complication rate. It is important to highlight the number of patients with tumors smaller than 2cm and without other associated risk factors that could have been operated on by type A radical hysterectomy and thus avoid the potential adverse effects of a more extensive surgery. Disclosure Nothing to disclose.
Hip arthroscopy is rarely associated with complications such as neurovascular and perineal injury... more Hip arthroscopy is rarely associated with complications such as neurovascular and perineal injury, both in relationship with the traction and compression exerted against the perineal support on which the patient is placed. Complications are largely transient and incidences between 0.5% and 6.4% have been reported. However, major complications can and do occur. In this paper are going to be described two cases of vulvar injury after hip arthroscopy associated with the pressure towards the perineal post of the traction table.
Background: Surgery is regarded as the treatment's cornerstone for early stage and locally advanc... more Background: Surgery is regarded as the treatment's cornerstone for early stage and locally advanced nonsmall cell lung cancer (NSCLC) whenever the tumor is considered resectable. Liquid biopsy is one of the most promising research areas in oncology in the last 10 years, providing a useful non-invasive tool to detect and monitor cancer. The prognostic value of circulating tumor cells (CTCs) has been studied in different cancer types and had been related with a higher risk of relapse and worse prognosis. The aim of this study is to evaluate the prognostic value of CTC detection in patients with stage I-IIIA NSCLC treated with surgery. Methods: We conducted a prospective, single-center study of 180 consecutive patients with resected and pathological confirmed stage I to IIIA (TNM AJCC/UICC 8th edition) NSCLC. Patients' blood samples were processed and CTCs were characterized before and after the surgery. A cohort of patients had CTC determination after chemotherapy and surgery. Cut-off points were established in 1 and 5 CTCs for statistical analysis. Results: A proportion of 76.7% had at least 1 CTC before the surgery, and 30.6% had 5 or more, while 55.9% had at least 1 CTC after surgery, and 8.3% had 5 or more. We found no correlation between preoperative CTC detection for a cut-off of 5 with neither overall survival (OS) [hazard ratio (HR): 0.99, P=0.887], disease-free survival (DFS) (HR: 0.95, P=0.39) nor relapse (32.7% vs. 28.8%, P=0.596). We also did not find a correlation between postoperative CTCs detection for a cut-off of 5 with either OS (HR: 1.01, P=0.808), DFS (HR: 0.95, P=0.952) or relapse (26.7% vs. 29.5%, P=0.83). The mean change in the number of CTCs over time between preoperative and postoperative samples was 2.13, with a standard deviation of 6.78. Conclusions: Despite the large cohort of patients included in this study, CTC monitoring in the perioperative setting was not correlated with relapse, DFS or OS in our study, and therefore cannot be recommended as a reliable biomarker for minimal residual disease (MRD) after surgery.
The oral mucosa is a key player in cancer patients and during cancer treatment. The increasing pr... more The oral mucosa is a key player in cancer patients and during cancer treatment. The increasing prevalence of cancer and cancer-therapy-associated side effects are behind the major role that oral mucosa plays in oncological patients. Oral mucositis is a debilitating severe complication caused by the early toxicity of chemo and/or radiotherapy that can restrict treatment outcome possibilities, even challenging a patient’s survival. It has been referred to as the most feared cancer treatment complication. Predictive variables as to who will be affected, and to what extent, are still unclear. Additionally, oral mucositis is one of the sources of the increasing economic burden of cancer, not only for patients and their families but also for institutions and governments. All efforts should be implemented in the search for new approaches to minimize the apparently ineluctable outburst of oral mucositis during cancer treatment. New perspectives derived from different approaches to explainin...
Oral mucosa is a key player in the cancer patient and during cancer treatment. The increasing pre... more Oral mucosa is a key player in the cancer patient and during cancer treatment. The increasing prevalence of cancer and cancer therapy associated side effects are behind the major role that oral mucosa plays in the oncological patient. Oral mucositis is a debilitating severe complication caused by early toxicity of chemo and/or radiotherapy that can restrict treatment outcome possibilities, even challenging patient’s survival. It has been referred to as the most feared cancer treatment complication. Predictive variables as to who and to what extent will be affected are still unclear. Additionally, oral mucositis is one of the sources of the increasing economic burden of cancer, not only for patients and their families but also for institutions and governments. All efforts should be implemented in the search for new approaches to minimize the apparently ineluctable outburst of oral mucositis along the cancer treatment. New perspectives derived from different approaches in explaining t...
Hip arthroscopy is rarely associated with complications such as neurovascular and perineal injury... more Hip arthroscopy is rarely associated with complications such as neurovascular and perineal injury, both in relationship with the traction and compression exerted against the perineal support on which the patient is placed. Complications are largely transient and incidences between 0.5% and 6.4% have been reported. However, major complications can and do occur. In this paper are going to be described two cases of vulvar injury after hip arthroscopy associated with the pressure towards the perineal post of the traction table.
Background: One of the first events that can cause labor is cervical shortening. In the same way,... more Background: One of the first events that can cause labor is cervical shortening. In the same way, a decrease in cervical length during the second trimester is predictive of spontaneous preterm birth. The aim of this study is to analyze the influence of cervical length measured at the second trimester ultrasound exam in the onset of preterm birth. Material and Methods: It has been carried out a retrospective study of 2846 pregnant women with childbirth in our hospital during the period from 2016 to 2019. The selected inclusion criteria were primiparous with single and spontaneous pregnancy and nonmaternal-fetal pathology. The main variable of our study was cervical length at the 20th week of gestation. The total of patients were divided in three groups (cervical length less than 30 mm, cervical length between 30 40 mm and cervical length greater than 40 mm). Results: In relation to gestational age at the time of delivery, 5.34% of the patients had preterm birth. In the group of pregn...
espanolSe presenta el caso de una gestante de 35 semanas que acudio al servicio de urgencias con ... more espanolSe presenta el caso de una gestante de 35 semanas que acudio al servicio de urgencias con un cuadro de desorientacion, desconexion con el medio, disartria que en los siguientes minutos continuo con una crisis tonico clonica y nistagmo. Tras la estabilizacion del cuadro, se decidio realizar una cesarea urgente, obteniendose un feto varon vivo y una craneotomia electiva posterior, dado a la estabilidad neurologica de la paciente. Inicialmente se penso en una eclampsia, pero tras proteinuria negativa y una tomografia axial computarizada craneal que informo de lesion extra axial izquierda con efecto masa sobre el parenquima adyacente compatible con meningioma se descarto esta posibilidad. Los tumores cerebrales son muy infrecuentes en el embarazo y la incidencia de meningiomas en mujeres embarazadas y no embarazadas es la misma. No obstante, hoy en dia se sabe que los meningiomas aumentan su tamano durante la gestacion por el aumento de la vascularizacion y edema intracelular o e...
Introduction/Background Importance of adequate hemostasis and precision in vascular and nervous g... more Introduction/Background Importance of adequate hemostasis and precision in vascular and nervous ganglionar surgery. Methodology We present a case of a patient with adenopathies larger than 2 cm on the superior mesenteric artery, interaortocaval and adhered to the obturator nerve, which are completely resected. Results The entire disease has been removed by practicing debulking surgery. Conclusion Knowledge of the anatomy to perform better surgery. Disclosure Nothing to disclose
Aim: Telemedicine has helped to make health care more efficient. However, to date no studies have... more Aim: Telemedicine has helped to make health care more efficient. However, to date no studies have measured its impact on infertility and fertility healthcare. We assessed the potential care benefits and clinical advantages of an initiative implementing electronic patient portal (EPP) for patients scheduled to undergo assisted reproduction treatment, to reduce waiting times for medical consultation and treatment. Methods: This was designed as a retrospective cohort study. The experimental group comprised 1972 referral requests received by the assisted reproduction unit of our institution between 2015 and 2016, which were included in the group receiving telemedicine, while the control group was defined by 283 requests received in 2013, all of which were assigned face-to-face care. Results: We found a statistically significant reduction in the experimental group in terms of the days elapsed between the receipt of the assessment request and the first outpatient visit (68 days vs. 180 days, p < .001). Time to initiation of treatment was also significantly lower in this group (169 days vs. 229 days; p < .001). The experimental group contained around 7 times as many patients receiving treatment as the control group. No differences were observed in the pregnancy rate (29.9% vs. 31.1%; p = .77) or in the complication rate (3.2% vs. 0%; p = .16). Conclusions: Use of telemedicine in electronic portal patient form reduces the total waiting time involved in patient requests for infertility treatment and indirectly increases the number of patients treated, causing no negative impact on treatment outcome.
Taiwanese Journal of Obstetrics and Gynecology, 2016
Objective: Bowel endometriosis is an uncommon disease that can cause serious complications and ma... more Objective: Bowel endometriosis is an uncommon disease that can cause serious complications and may require immediate medical attention. We wish to remind about bowel perforation caused by endometriosis, its diagnostic difficulty, and the need or urgent management in late pregnancy and puerperium. Case Report: We present a 38-year-old woman, which presented with bowel perforation requiring urgent surgery. A pathological exam disclosed deep ileal infiltrative endometriosis. Conclusion: Even though bowel endometriosis is a rare complication, it should be considered in the differential diagnosis of severe abdominal pain in late pregnancy or puerperium. A multidisciplinary management of these patients is needed.
Clínica e Investigación en Ginecología y Obstetricia, 2007
Subcapsular hepatic hematoma is an infrequent and severe complication of hypertension in pregnanc... more Subcapsular hepatic hematoma is an infrequent and severe complication of hypertension in pregnancy and should be suspected when there are clinical signs compatible with this diagnosis, which should be confirmed by abdominal computed tomography. Prompt diagnosis and treatment are important to avoid rupture, thus improving the high associated maternal and fetal morbidity and mortality.
Clínica e Investigación en Ginecología y Obstetricia, 2011
Gestación múltiple; Gestación yatrogénica; Embriorreducción; Estimulación ovárica; Técnicas de re... more Gestación múltiple; Gestación yatrogénica; Embriorreducción; Estimulación ovárica; Técnicas de reproducción asistida Resumen Los embarazos múltiples ocurren de forma espontánea, en una de cada 90 gestaciones en el caso de las gemelares, y en una de cada 8.100 en las triples. Sin embargo, desde el desarrollo de las unidades de reproducción humana se ha identificado un incremento del 52% de gestaciones gemelares y del 404% en las de mayor orden. Ante la elevada morbimortalidad perinatal y materna de estos embarazos y con el fin de incrementar las posibilidades de supervivencia de los fetos resultantes y minimizar la morbilidad a largo plazo en los recién nacidos, surge la embriorreducción selectiva. A pesar de ser una técnica rentable, puede implicar compromisos éticos y es un procedimiento no exento de riesgos. Por todo esto, consideramos que la actitud más eficaz ante las gestaciones múltiples es su prevención primaria.
Dyslipidemia is associated with increased low-density lipoprotein (LDL) susceptibility to oxidati... more Dyslipidemia is associated with increased low-density lipoprotein (LDL) susceptibility to oxidation, a phenomenon associated with endothelial dysfunction, atherosclerosis, cell toxicity, and intrauterine growth retardation. The present study was designed to determine if women developing gestational diabetes mellitus (GDM) have both increased plasma lipids and LDL susceptibility to oxidation throughout pregnancy. We also wanted to study the effects of obesity upon these parameters. A nested case-control study was carried out in 45 women with uncomplicated pregnancies and 62 women diagnosed with GDM following the criteria of the American Diabetes Association. In all women, blood was drawn at 15, 24, and 32 weeks of gestation. Low-density lipoprotein oxidation was initiated by the addition of CuCl 2 , and formation of conjugated dienes was monitored. Glucose, cholesterol, triglycerides, vitamin E, estradiol, and progesterone were determined. In GDM, elevated levels of glucose, cholesterol, and triglycerides were observed when compared with the control group even in the first trimester, before the detection of diabetes. In the control group, the lag phase in the LDL oxidation was 85.3, 84.4, and 95.6 minutes at 15, 24, and 32 weeks of pregnancy, compared with 63.3, 63.4, and 74.5 minutes in the GDM group (P b .001 in the 3 periods). These differences remained when adjusted for the body mass index. In a multiple linear regression analysis, a negative correlation was observed between the lag phase and the body mass index (P b .001) and cholesterol (P b .001), whereas a positive one appeared with vitamin E (P b .05) and time of gestation (P b .001). In pregnancy, GDM increases LDL susceptibility to oxidation. Obesity and hypercholesterolemia further exacerbate this effect.
Taiwanese Journal of Obstetrics & Gynecology, Feb 1, 2016
Objective: Bowel endometriosis is an uncommon disease that can cause serious complications and ma... more Objective: Bowel endometriosis is an uncommon disease that can cause serious complications and may require immediate medical attention. We wish to remind about bowel perforation caused by endometriosis, its diagnostic difficulty, and the need or urgent management in late pregnancy and puerperium. Case Report: We present a 38-year-old woman, which presented with bowel perforation requiring urgent surgery. A pathological exam disclosed deep ileal infiltrative endometriosis. Conclusion: Even though bowel endometriosis is a rare complication, it should be considered in the differential diagnosis of severe abdominal pain in late pregnancy or puerperium. A multidisciplinary management of these patients is needed.
Collaboration of various specialists has become essential in pediatric dental practice. In orthod... more Collaboration of various specialists has become essential in pediatric dental practice. In orthodontics, this collaboration is completely necessary when the patient presents periodontal problems. Even in healthy patients, who do not suffer from periodontal disease, periodontal complications may occur during treatment with fixed appliances. Two cases of young patients, in which periodontal procedures were used to complement the results of orthodontic treatment are presented.
Introduction/Background Realización de video de cirugia laparoscopica en que se muestra la import... more Introduction/Background Realización de video de cirugia laparoscopica en que se muestra la importancia de una adecuada identificación de estructuras en la linfadenectomia aortica y pelvica. Methodology Video production of laparoscopic surgery showing the importance of an adequate identification of structures in aortic and pelvic lymphadenectomy. In this systematic way it is possible to save unexpected structures or anatomical malformations. Results This video shows retroaortic renal vein, double obturator nerve, left ovarian vein towards vena cava, high obturator vein, crown of death vein, lateral inferior mesenteric artery... Conclusion the importance of reviewing images available preoperatively is essential, as well as performing systematic surgery step by step Disclosure Nothing to disclose
Introduction/Background LACC trial has changed the paradigm regarding the surgical treatment of c... more Introduction/Background LACC trial has changed the paradigm regarding the surgical treatment of cervical cancer. This is the first prospective study performed in this field and in which a better prognosis has been observed in patients treated by laparotomy. Methodology This is a retrospective observational cohort study without a control group. Inclusion criteria Patients with stages Ia1 (with lymphovascular invasion) to IIa1 treated by hysterectomy and trachelectomy including lymphadenectomy between January 2007 and December 2018 at the Jiménez Díaz Foundation Hospital. Exclusion criteria Patients under 18 years Pregnant patients. Older than 80 years. Surgical contraindications. ECOG ≤50% and/or ASA ≥4 Parametrial involvement All patients who met the described inclusion criteria were selected and different clinical parameters were analyzed, including age, menopausal status, physical examination for assessment of parameter involvement. Likewise, anatomopathological characteristics were studied, such as histological type, tumor size, lymphovascular invasion, parametrial infiltration, nuclear grade, stromal infiltration. The disease-free interval was also studied, as well as the overall survival. Results For all the patients recruited, a total of 84 of them were included in the inclusion criteria. The average age of the patients was 46 years (Minimum 27 and Maximum 70 years). 53 patients studied were in stage IB1 (63%), 14 stage IA1 (16.6%), 12 stage IA2 (14.3%) and 5 stage IIA1 (5.9%). The disease-free survival studied has been up to> 5 years. There have been a total of 5 recurrences (Minimum 8 and maximum 40 months). Conclusion The percentage of relapse and survival is in accordance with the current data. Laparoscopic surgery presents an acceptable complication rate. It is important to highlight the number of patients with tumors smaller than 2cm and without other associated risk factors that could have been operated on by type A radical hysterectomy and thus avoid the potential adverse effects of a more extensive surgery. Disclosure Nothing to disclose.
Hip arthroscopy is rarely associated with complications such as neurovascular and perineal injury... more Hip arthroscopy is rarely associated with complications such as neurovascular and perineal injury, both in relationship with the traction and compression exerted against the perineal support on which the patient is placed. Complications are largely transient and incidences between 0.5% and 6.4% have been reported. However, major complications can and do occur. In this paper are going to be described two cases of vulvar injury after hip arthroscopy associated with the pressure towards the perineal post of the traction table.
Background: Surgery is regarded as the treatment's cornerstone for early stage and locally advanc... more Background: Surgery is regarded as the treatment's cornerstone for early stage and locally advanced nonsmall cell lung cancer (NSCLC) whenever the tumor is considered resectable. Liquid biopsy is one of the most promising research areas in oncology in the last 10 years, providing a useful non-invasive tool to detect and monitor cancer. The prognostic value of circulating tumor cells (CTCs) has been studied in different cancer types and had been related with a higher risk of relapse and worse prognosis. The aim of this study is to evaluate the prognostic value of CTC detection in patients with stage I-IIIA NSCLC treated with surgery. Methods: We conducted a prospective, single-center study of 180 consecutive patients with resected and pathological confirmed stage I to IIIA (TNM AJCC/UICC 8th edition) NSCLC. Patients' blood samples were processed and CTCs were characterized before and after the surgery. A cohort of patients had CTC determination after chemotherapy and surgery. Cut-off points were established in 1 and 5 CTCs for statistical analysis. Results: A proportion of 76.7% had at least 1 CTC before the surgery, and 30.6% had 5 or more, while 55.9% had at least 1 CTC after surgery, and 8.3% had 5 or more. We found no correlation between preoperative CTC detection for a cut-off of 5 with neither overall survival (OS) [hazard ratio (HR): 0.99, P=0.887], disease-free survival (DFS) (HR: 0.95, P=0.39) nor relapse (32.7% vs. 28.8%, P=0.596). We also did not find a correlation between postoperative CTCs detection for a cut-off of 5 with either OS (HR: 1.01, P=0.808), DFS (HR: 0.95, P=0.952) or relapse (26.7% vs. 29.5%, P=0.83). The mean change in the number of CTCs over time between preoperative and postoperative samples was 2.13, with a standard deviation of 6.78. Conclusions: Despite the large cohort of patients included in this study, CTC monitoring in the perioperative setting was not correlated with relapse, DFS or OS in our study, and therefore cannot be recommended as a reliable biomarker for minimal residual disease (MRD) after surgery.
The oral mucosa is a key player in cancer patients and during cancer treatment. The increasing pr... more The oral mucosa is a key player in cancer patients and during cancer treatment. The increasing prevalence of cancer and cancer-therapy-associated side effects are behind the major role that oral mucosa plays in oncological patients. Oral mucositis is a debilitating severe complication caused by the early toxicity of chemo and/or radiotherapy that can restrict treatment outcome possibilities, even challenging a patient’s survival. It has been referred to as the most feared cancer treatment complication. Predictive variables as to who will be affected, and to what extent, are still unclear. Additionally, oral mucositis is one of the sources of the increasing economic burden of cancer, not only for patients and their families but also for institutions and governments. All efforts should be implemented in the search for new approaches to minimize the apparently ineluctable outburst of oral mucositis during cancer treatment. New perspectives derived from different approaches to explainin...
Oral mucosa is a key player in the cancer patient and during cancer treatment. The increasing pre... more Oral mucosa is a key player in the cancer patient and during cancer treatment. The increasing prevalence of cancer and cancer therapy associated side effects are behind the major role that oral mucosa plays in the oncological patient. Oral mucositis is a debilitating severe complication caused by early toxicity of chemo and/or radiotherapy that can restrict treatment outcome possibilities, even challenging patient’s survival. It has been referred to as the most feared cancer treatment complication. Predictive variables as to who and to what extent will be affected are still unclear. Additionally, oral mucositis is one of the sources of the increasing economic burden of cancer, not only for patients and their families but also for institutions and governments. All efforts should be implemented in the search for new approaches to minimize the apparently ineluctable outburst of oral mucositis along the cancer treatment. New perspectives derived from different approaches in explaining t...
Hip arthroscopy is rarely associated with complications such as neurovascular and perineal injury... more Hip arthroscopy is rarely associated with complications such as neurovascular and perineal injury, both in relationship with the traction and compression exerted against the perineal support on which the patient is placed. Complications are largely transient and incidences between 0.5% and 6.4% have been reported. However, major complications can and do occur. In this paper are going to be described two cases of vulvar injury after hip arthroscopy associated with the pressure towards the perineal post of the traction table.
Background: One of the first events that can cause labor is cervical shortening. In the same way,... more Background: One of the first events that can cause labor is cervical shortening. In the same way, a decrease in cervical length during the second trimester is predictive of spontaneous preterm birth. The aim of this study is to analyze the influence of cervical length measured at the second trimester ultrasound exam in the onset of preterm birth. Material and Methods: It has been carried out a retrospective study of 2846 pregnant women with childbirth in our hospital during the period from 2016 to 2019. The selected inclusion criteria were primiparous with single and spontaneous pregnancy and nonmaternal-fetal pathology. The main variable of our study was cervical length at the 20th week of gestation. The total of patients were divided in three groups (cervical length less than 30 mm, cervical length between 30 40 mm and cervical length greater than 40 mm). Results: In relation to gestational age at the time of delivery, 5.34% of the patients had preterm birth. In the group of pregn...
espanolSe presenta el caso de una gestante de 35 semanas que acudio al servicio de urgencias con ... more espanolSe presenta el caso de una gestante de 35 semanas que acudio al servicio de urgencias con un cuadro de desorientacion, desconexion con el medio, disartria que en los siguientes minutos continuo con una crisis tonico clonica y nistagmo. Tras la estabilizacion del cuadro, se decidio realizar una cesarea urgente, obteniendose un feto varon vivo y una craneotomia electiva posterior, dado a la estabilidad neurologica de la paciente. Inicialmente se penso en una eclampsia, pero tras proteinuria negativa y una tomografia axial computarizada craneal que informo de lesion extra axial izquierda con efecto masa sobre el parenquima adyacente compatible con meningioma se descarto esta posibilidad. Los tumores cerebrales son muy infrecuentes en el embarazo y la incidencia de meningiomas en mujeres embarazadas y no embarazadas es la misma. No obstante, hoy en dia se sabe que los meningiomas aumentan su tamano durante la gestacion por el aumento de la vascularizacion y edema intracelular o e...
Introduction/Background Importance of adequate hemostasis and precision in vascular and nervous g... more Introduction/Background Importance of adequate hemostasis and precision in vascular and nervous ganglionar surgery. Methodology We present a case of a patient with adenopathies larger than 2 cm on the superior mesenteric artery, interaortocaval and adhered to the obturator nerve, which are completely resected. Results The entire disease has been removed by practicing debulking surgery. Conclusion Knowledge of the anatomy to perform better surgery. Disclosure Nothing to disclose
Aim: Telemedicine has helped to make health care more efficient. However, to date no studies have... more Aim: Telemedicine has helped to make health care more efficient. However, to date no studies have measured its impact on infertility and fertility healthcare. We assessed the potential care benefits and clinical advantages of an initiative implementing electronic patient portal (EPP) for patients scheduled to undergo assisted reproduction treatment, to reduce waiting times for medical consultation and treatment. Methods: This was designed as a retrospective cohort study. The experimental group comprised 1972 referral requests received by the assisted reproduction unit of our institution between 2015 and 2016, which were included in the group receiving telemedicine, while the control group was defined by 283 requests received in 2013, all of which were assigned face-to-face care. Results: We found a statistically significant reduction in the experimental group in terms of the days elapsed between the receipt of the assessment request and the first outpatient visit (68 days vs. 180 days, p < .001). Time to initiation of treatment was also significantly lower in this group (169 days vs. 229 days; p < .001). The experimental group contained around 7 times as many patients receiving treatment as the control group. No differences were observed in the pregnancy rate (29.9% vs. 31.1%; p = .77) or in the complication rate (3.2% vs. 0%; p = .16). Conclusions: Use of telemedicine in electronic portal patient form reduces the total waiting time involved in patient requests for infertility treatment and indirectly increases the number of patients treated, causing no negative impact on treatment outcome.
Taiwanese Journal of Obstetrics and Gynecology, 2016
Objective: Bowel endometriosis is an uncommon disease that can cause serious complications and ma... more Objective: Bowel endometriosis is an uncommon disease that can cause serious complications and may require immediate medical attention. We wish to remind about bowel perforation caused by endometriosis, its diagnostic difficulty, and the need or urgent management in late pregnancy and puerperium. Case Report: We present a 38-year-old woman, which presented with bowel perforation requiring urgent surgery. A pathological exam disclosed deep ileal infiltrative endometriosis. Conclusion: Even though bowel endometriosis is a rare complication, it should be considered in the differential diagnosis of severe abdominal pain in late pregnancy or puerperium. A multidisciplinary management of these patients is needed.
Clínica e Investigación en Ginecología y Obstetricia, 2007
Subcapsular hepatic hematoma is an infrequent and severe complication of hypertension in pregnanc... more Subcapsular hepatic hematoma is an infrequent and severe complication of hypertension in pregnancy and should be suspected when there are clinical signs compatible with this diagnosis, which should be confirmed by abdominal computed tomography. Prompt diagnosis and treatment are important to avoid rupture, thus improving the high associated maternal and fetal morbidity and mortality.
Clínica e Investigación en Ginecología y Obstetricia, 2011
Gestación múltiple; Gestación yatrogénica; Embriorreducción; Estimulación ovárica; Técnicas de re... more Gestación múltiple; Gestación yatrogénica; Embriorreducción; Estimulación ovárica; Técnicas de reproducción asistida Resumen Los embarazos múltiples ocurren de forma espontánea, en una de cada 90 gestaciones en el caso de las gemelares, y en una de cada 8.100 en las triples. Sin embargo, desde el desarrollo de las unidades de reproducción humana se ha identificado un incremento del 52% de gestaciones gemelares y del 404% en las de mayor orden. Ante la elevada morbimortalidad perinatal y materna de estos embarazos y con el fin de incrementar las posibilidades de supervivencia de los fetos resultantes y minimizar la morbilidad a largo plazo en los recién nacidos, surge la embriorreducción selectiva. A pesar de ser una técnica rentable, puede implicar compromisos éticos y es un procedimiento no exento de riesgos. Por todo esto, consideramos que la actitud más eficaz ante las gestaciones múltiples es su prevención primaria.
Dyslipidemia is associated with increased low-density lipoprotein (LDL) susceptibility to oxidati... more Dyslipidemia is associated with increased low-density lipoprotein (LDL) susceptibility to oxidation, a phenomenon associated with endothelial dysfunction, atherosclerosis, cell toxicity, and intrauterine growth retardation. The present study was designed to determine if women developing gestational diabetes mellitus (GDM) have both increased plasma lipids and LDL susceptibility to oxidation throughout pregnancy. We also wanted to study the effects of obesity upon these parameters. A nested case-control study was carried out in 45 women with uncomplicated pregnancies and 62 women diagnosed with GDM following the criteria of the American Diabetes Association. In all women, blood was drawn at 15, 24, and 32 weeks of gestation. Low-density lipoprotein oxidation was initiated by the addition of CuCl 2 , and formation of conjugated dienes was monitored. Glucose, cholesterol, triglycerides, vitamin E, estradiol, and progesterone were determined. In GDM, elevated levels of glucose, cholesterol, and triglycerides were observed when compared with the control group even in the first trimester, before the detection of diabetes. In the control group, the lag phase in the LDL oxidation was 85.3, 84.4, and 95.6 minutes at 15, 24, and 32 weeks of pregnancy, compared with 63.3, 63.4, and 74.5 minutes in the GDM group (P b .001 in the 3 periods). These differences remained when adjusted for the body mass index. In a multiple linear regression analysis, a negative correlation was observed between the lag phase and the body mass index (P b .001) and cholesterol (P b .001), whereas a positive one appeared with vitamin E (P b .05) and time of gestation (P b .001). In pregnancy, GDM increases LDL susceptibility to oxidation. Obesity and hypercholesterolemia further exacerbate this effect.
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