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INTRODUCTION: Recent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy. METHODS: We performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models. RESULTS: A total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8-201.2) in the laparoscopic group and 52.6 months (range, 0.4-166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09-2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05-4.37; P=0.03). CONCLUSION: In this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.
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Histerectomia/métodos , Laparoscopia/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Adulto JovemRESUMO
Ovarian metastatic breast cancer is infrequent and usually is originating from lobular carcinomas. It was found that the risk of developing an ovarian neoplasm is approximately doubled in women with a history of breast cancer. The finding of an adnexal mass in these patients involves a particular concern and requires a study. We report a case of a 67-year-old female diagnosed of an infiltrating lobular breast carcinoma. It is done lumpectomy and an axillary dissection of lymph nodes resulting 2 of 13 lymph nodes positives. She was treated with chemotherapy and hormone treatment staying the disease in remission for years. After she was admitted with malignant pleural effusion and pathological costal fracture. The ultrasound shows an increase of size of annexes and a CA125 and CA15.3 increased in the analysis. Bilateral oophorectomy was performed. The pathology was consistent with lobular breast carcinoma. Subsequently another income was required because of disease progression. Currently after almost two years since the adnexectomy, is in close monitoring by medical oncologists. Although the diagnosis of an adnexal mass in a woman who has had breast cancer is usually a benign finding, the risk in these women to develop a malignant ovarian pathology is increased compared to the general population. Therefore, although the patient remains asymptomatic, it is important an abdominopelvic exploration from time to time. If the ultrasound image of the adnexal mass is suspect, the CA125 is increased, or estrogen receptors are negatives in the original breast tumor, should be performed surgical evaluation.
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Neoplasias da Mama/patologia , Carcinoma Lobular/secundário , Carcinoma Lobular/terapia , Neoplasias Ovarianas/secundário , Neoplasias Ovarianas/terapia , Idoso , Feminino , HumanosRESUMO
Congenital heart diseases are the most frequent abnormalities at the time of delivery. Their importance lays in the fact that they represent 46% of neonatal deaths and they are cause of a high morbidity rate. However, an early diagnosis is difficult. The aim of this revision is to give an update on the advances in the prenatal diagnosis of congenital heart diseases and their advantages compared to conventional sonography. The introduction of new technology in the detection of congenital heart diseases has improved the acquisition of better images in terms of resolution and quality. However, there is a lack of large studies to prove its benefits in non-selected population, although preliminary studies seem to give faithful results.
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Cardiopatias/congênito , Cardiopatias/diagnóstico , Diagnóstico Pré-Natal , Ecocardiografia/métodos , Cardiopatias/diagnóstico por imagem , HumanosRESUMO
BACKGROUND: Many women experience menorrhagia episodes resistant to medical treatment requiring definitive surgical treatment. OBJECTIVE: To analyze the effectiveness of hysteroscopic endometrial resection versus Novasure system. MATERIAL AND METHODS: A descriptive and retrospective study comparing 20 patients who underwent endometrial ablation with Novasure vs 20 patients who underwent hysteroscopic endometrial resection. We analyzed the indication, age, time of surgery, the incidence of complications, satisfaction at 3, 6 and 12 months and technical failure. RESULTS: No significant differences were found in terms of failure to complete the technique, and satisfaction at 3, 6 and 12 months. But significant differences regarding the mean operation time, which was reduced to 15 minutes among Novasure system patients. This could influence the total costs of the procedure. CONCLUSION: There were no significant differences between the two methods in terms of efficacy and safety; however, the final costs seem to be higher for the Novasure system.
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Eletrocirurgia , Técnicas de Ablação Endometrial/métodos , Histeroscopia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Uterine fibroids are the most frequent solid benign tumors of the female pelvis. The most frequent location is the uterine corpus; however, it has been also reported in cervical placement and broad ligament. Rarely it has been reported a case of intestinal fibroid after previous history of myomectomy. We report the case of a patient, with no surgical history of interest, who underwent a diagnostic laparoscopy due to suspicion of malignant abdominal mass. Ajejunal fibroid was found, which was removed via laparoscopy without complications. Laparoscopy may be considered in case of intestinal fibriod despite its rarity, due to the better postoperative recovery and cosmetic outcomes compared to laparotomy.
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Neoplasias do Jejuno/cirurgia , Laparoscopia , Leiomioma/cirurgia , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
BACKGROUND: During the last ten years multiple pregnancies have been increased as a result of assisted reproduction techniques, increases of even 470% are published. Multiple pregnancies are related to a higher risk of maternal and neonatal morbidity and mortality, as well as to increased use of health resources. OBJECTIVES: To review the fetal and perinatal early complications in triple pregnancies. PATIENTS AND METHOD: An observational and retrospective study of triple pregnancies followed up at the Obstetrics Department of La Paz University Hospital, Madrid, Spain, from January 2000 until May 2011. RESULTS: We reviewed the medical records of 147 triplets. The prevalence of triplets was 1 in 640 deliveries (0.15%). Among all, 79% were achieved using assisted reproductive techniques, 73% were obtained by means of in vitro fertilization. Regarding the pregnancy zigosity we found: 85% trichorionic triamniotic, 10% bichorionic triamniotic and 5% monochorionic tramniotic. Out of 402 fetuses, 35 (9%) had the following complications: 19(5%) growth retardation or oligohydramnios, nine (2%) intrauterine death, three (0.74%) postnatal death due to suspected chorioamnionitis, three (0.74%) major malformations and one case (0.24%) of twin to twin transfusion. The average duration of gestation was 33 weeks: 8% were born before 28 weeks of gestation, 30% between 28 and 32 weeks and 62% after 32 weeks. The mean birth weight was 1,906 +/- 400 g. In 29 cases (7%) arterial pH was less than 7.20. Any type of resuscitation was required by 60% of newborns and 47% were admitted to the intensive care unit. There were no significant differences in neonatal early outcomes among the first, second and third newborn. CONCLUSIONS: The risk of neonatal mortality and morbidity seems to be higher in triple pregnancies. Adverse neonatal outcomes are related to the high rate of severe prematurity.
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Doenças Fetais/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Trigêmeos , Adulto , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: Dandy-Walker syndrome is a set of abnormalities of the posterior fossa including three modalities: classic Dandy-Walker malformation, Dandy-Walker variant and mega-cisterna magna. Our objective is clarify the differential diagnosis among these entities. MATERIAL AND METHOD: Descriptive and retrospective study of Dandy-Walker cases diagnosed at our Department during the last five years plus a review of the related Medical literature. RESULTS: Three cases of Dandy-Walker modalities are reported: one case of classic Dandy-Walker malformation, one case of Dandy-Walker variant, and one case of false Dandy-Walker. In the first two cases the patients underwent legal abortion, whereas in the last one a healthy male newborn was delivered in the week 38 of gestation. CONCLUSIONS: Malformations in the posterior fossa, including Dandy-Walker syndrome, are still a challenge in prenatal diagnosis. Technical developments in imaging, such as in three-dimensional sonography and magnetic resonance, allow higher resolution and multiplanar images for an easier diagnose. There is a high rate of false positive, particularly before the 18th week of gestation. It is advisable not to establish a final diagnose before that week.
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Síndrome de Dandy-Walker/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Estudos RetrospectivosRESUMO
Ovarian steroid cell tumors represent less than 0,1% of all ovarian tumors. These tumors normally appear in adult women, producing virilization due to the secretion of testosterone. They may have occasionally a malignant behavior, but when they present during adolescence. We report the case of a 49-year-old woman with an ovarian steroid cell tumor concurrent with an ovarian fibrothecoma, which was an incidental finding, remaining the patient asymptomatic before the diagnosis. Several aspects of the symptomatology, diagnosis and treatment are discussed in this article.