Clinica e Investigacion en Ginecologia y Obstetricia最新文献

{"title":"Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre, taking into account the menopausal status of patients. Five years of experience","authors":"N. Elsner Hernández ,&nbsp;J.F. De Luis Escudero ,&nbsp;L.I. Pérez Méndez ,&nbsp;D.R. Báez Quintana ,&nbsp;E. Bruno Santana ,&nbsp;J.A. Pérez Álvarez ,&nbsp;N.R. Sierra Medina ,&nbsp;C. Chulilla Pérez ,&nbsp;A. Quesada López-Fe","doi":"10.1016/j.gine.2023.100910","DOIUrl":"https://doi.org/10.1016/j.gine.2023.100910","url":null,"abstract":"<div><h3>Objective</h3><p>The objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points.</p></div><div><h3>Results</h3><p>Out of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%).</p></div><div><h3>Conclusions</h3><p>The IOTA-ADNEX model is a reliable diagnostic tool to discard ovarian cancer. However, the accuracy of the test, at the same cut-off point, varies according to the menopausal state of the patient so it may be important to take it into account when taking decisions in clinical practice.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 1","pages":"Article 100910"},"PeriodicalIF":0.1,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49851022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Filtro de vena cava inferior ante diagnóstico de trombosis venosa profunda en gestante en trabajo de parto. A propósito de un caso clínico","authors":"M. del Mar Rubio Arroyo ,&nbsp;M. Crespo Criado ,&nbsp;J.A. Del Pozo Jiménez","doi":"10.1016/j.gine.2023.100909","DOIUrl":"https://doi.org/10.1016/j.gine.2023.100909","url":null,"abstract":"<div><h3>Introduction</h3><p>Pregnancy represents a procoagulant state that increases women's risk of thrombotic phenomena. As in the non-pregnant population, we must diagnose and treat these events as early as possible to avoid the migration of the thrombus to other locations. Anticoagulation is the first-line therapeutic measure. However, certain situations of increased bleeding such as labor may be a contraindication to initiate such anticoagulation. The following article develops a clinical case in which the deep vein thrombosis diagnosis occurred at the onset of labor.</p></div><div><h3>Main symptoms and/or clinical findings</h3><p>Increase in diameter of the left lower limb, with redness of the same and increase in local temperature. The patient described pain at the level of this limb for 15 days. He had no dyspnea and oxygen saturation was 100%.</p></div><div><h3>Main diagnoses</h3><p>Deep vein thrombosis, labor.</p></div><div><h3>Therapeutic interventions</h3><p>The contraindication of anticoagulation and the need for immediate treatment raised the inferior vena cava filter as the most reasonable option.</p></div><div><h3>Results</h3><p>After the placement of the filter, the delivery proceeded without incident. The plunger did not migrate and the filter was removed 29 days after delivery without complications.</p></div><div><h3>Conclusion</h3><p>Despite our limited clinical experience in the management of these cases, we can affirm that the inferior vena cava filter represents a reasonable and safe option in cases of thrombosis of the lower limbs in women in labor.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 1","pages":"Article 100909"},"PeriodicalIF":0.1,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49851023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost and regression analysis of preeclampsia from the perspective of the reimbursement agency","authors":"Ü. Veranyurt ,&nbsp;B. Akalin ,&nbsp;O. Veranyurt ,&nbsp;I. Şanverdi","doi":"10.1016/j.gine.2023.100858","DOIUrl":"https://doi.org/10.1016/j.gine.2023.100858","url":null,"abstract":"<div><h3>Objective</h3><p>The aim of this study is to determine the financial burden of preeclampsia (PE) from a single institution's perspective and then determine the cost of the illness from the reimbursement institution perspective and finally draw a regression model that predicts the annual cost of a patient.</p></div><div><h3>Materials and methods</h3><p>The research is a descriptive and cross-sectional type of research and a retrospective cost analysis. Patients diagnosed with PE in 2021 were included in the study. For the regression analysis of the study, a dataset with 29 parameters belonging to 65 patients was created. Regression models were built on top of it.</p></div><div><h3>Results</h3><p>In our study, per-patient expenses of PE patients from the perspective of the reimbursement institution were calculated and presented as average costs; severe PE patient with cesarean section 7598.5 Ł ($769.8), severe PE patient with normal vaginal delivery 8487.48 Ł (1050.43 $), mild PE patient with cesarean section 5331.67 Ł ($659.86) and mild PE patient with normal vaginal delivery was calculated as 6220.65 Ł (769.88 $). In the study, different regression formulas were created for the two groups of PE. The created regression model had an <em>R</em>² score of 91.85%.</p></div><div><h3>Conclusion</h3><p>The actors involved in the management of the disease should determine the cost-effectiveness of the disease by using the financial data of the patients and choose the right approach. Health costs in Turkey differ from the parameters in the European Union economy. Therefore, there are lower health costs. The financial findings of the disease are a guide for health policy makers, health managers and researchers.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"50 3","pages":"Article 100858"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49832926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconociendo la necesidad de abordar las causas subyacentes de la regla incapacitante: una crítica constructiva a la nueva ley de derechos sexuales y reproductivos en España","authors":"Anne-Sophie Gresle ,&nbsp;M. Ángeles Martínez-Zamora ,&nbsp;Eva Flo ,&nbsp;Joan Escarrabill ,&nbsp;Francisco Carmona ,&nbsp;en nombre del grupo ENDOMWAY","doi":"10.1016/j.gine.2023.100905","DOIUrl":"https://doi.org/10.1016/j.gine.2023.100905","url":null,"abstract":"","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"50 3","pages":"Article 100905"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49832995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of female sexual dysfunction in gynaecological cancer survivors: A case–control study","authors":"M. Arab ,&nbsp;N. Poorzad ,&nbsp;G. Noghabaei ,&nbsp;B. Ghavami ,&nbsp;B. Nouri ,&nbsp;T. Jahed Bozorgan","doi":"10.1016/j.gine.2022.100826","DOIUrl":"https://doi.org/10.1016/j.gine.2022.100826","url":null,"abstract":"<div><h3>Background</h3><p>With diagnostic and treatment advancements in cancer management, the need for improvement of survivors’ quality of life has been increasing. One of the issues affecting the quality of life in gynecologic cancer survivors is a decline in their sexual function, which is affected in many ways. In order to assess sexual dysfunction in gynecologic cancer survivors.</p></div><div><h3>Objective</h3><p>This study is designed to assess different areas of sexual function including desire, arousal, vaginal lubrication, orgasm, satisfaction, and pain.</p></div><div><h3>Materials and methods</h3><p>Patients who had completed treatment since 6 months to 6 years ago included in the case–control study starting from January 2019 to January 2020. Twenty-nine sexually active gynecologic cancer survivors with sexual dysfunction were enrolled as cases and 91 sexually active ones without sexual problems were assigned to the control group. The Female Sexual Function Index (FSFI) questionnaire consisting of 19-items and six areas was completed for each participant.</p></div><div><h3>Results</h3><p>Average sexual dysfunction score of the case group was 16.78 with cut-off point of 28 for dysfunction. The most common domain of sexual dysfunction was pain (96.55%), followed by sexual arousal (86.21%), vaginal lubrication (72.41%), orgasm (72.41%), satisfaction (65.52%) and sexual desire (55.17%).</p></div><div><h3>Conclusion</h3><p>In gynecologic cancer survivors, sexual dysfunction was directly related to employment, brachytherapy and co-existing DM and inversely related to the time elapsed since cancer diagnosis and menopause. Asking about sexual problems and referral to a specialist should be included in the patient treatment process.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"50 3","pages":"Article 100826"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49832925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sclerosing stromal tumor of the ovary: Two case reports and literature review","authors":"S. Tameish","doi":"10.1016/j.gine.2023.100881","DOIUrl":"https://doi.org/10.1016/j.gine.2023.100881","url":null,"abstract":"<div><h3>Introduction</h3><p>Sclerosing stromal tumors (SSTs) are rare benign ovarian tumors. They represent 6% of sex cord stromal tumors. Its preoperative diagnosis is often a challenge due to its similarity to malignant tumors on ultrasound imaging. We present two cases of SSTs to emphasize the consideration of this type of tumors in the differential diagnosis of solid adnexal masses in young women. A review of the literature on the typical ultrasound features, clinical presentation, and management of SSTs was performed.</p></div><div><h3>Main symptoms and/or clinical findings</h3><p>Pelvic pain was the main symptom in both cases. In the first case, transvaginal ultrasound revealed an unilocular solid adnexal mass of 59<!--> <!-->mm<!--> <!-->×<!--> <!-->44<!--> <!-->mm<!--> <!-->×<!--> <!-->45<!--> <!-->mm with cystic areas and marked peripheral and central vascularization. MRI (magnetic resonance imaging) revealed a 50<!--> <!-->mm<!--> <!-->×<!--> <!-->50<!--> <!-->mm heterogeneous adnexal mass with a solid peripheral component and a cystic-necrotic center. In the second case, pelvic ultrasound showed a solid cystic adnexal mass of 103<!--> <!-->mm<!--> <!-->×<!--> <!-->77<!--> <!-->mm with marked peripheral vascularity.</p></div><div><h3>Main diagnoses</h3><p>Postoperative anatomopathological diagnosis in both cases was an ovarian SST.</p></div><div><h3>Therapeutic interventions and results</h3><p>Unilateral laparoscopic salpingo-oophorectomy and oophorectomy, respectively, was performed without incidents. There has been no recurrence during follow-up.</p></div><div><h3>Conclusion</h3><p>It is important to consider SSTs in the differential diagnosis of young women with a unilateral solid-cystic adnexal mass with a high degree of peripheral and central vascularization. Laparoscopic approach together with fertility-sparing techniques should be considered the treatment of choice.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"50 3","pages":"Article 100881"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49832928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversias en el tratamiento de la endometriosis en la mujer estéril","authors":"J. Gilabert-Estelles ,&nbsp;L. Rodríguez-Tabernero","doi":"10.1016/j.gine.2023.100890","DOIUrl":"https://doi.org/10.1016/j.gine.2023.100890","url":null,"abstract":"<div><p>Endometriosis is a very complex disease that limits the lives of women who suffer from it in many areas of their lives, both due to the painful symptoms it causes and the medical complications it generates. In addition, it is capable of causing sterility by different mechanisms.</p><p>In the present work we intend to review the management of the patient with endometriosis and sterility, which has important particularities with respect to the usual treatment of endometriosis. Most of the medical treatments used have an anovulatory effect, which is why they prevent pregnancy, and surgical treatments can in turn have a detrimental effect on the ovarian reserve and the time necessary to achieve pregnancy. On the other hand, assisted reproduction techniques do not always achieve the desired objective and may require associated surgeries such as in the case of the presence of hydrosalpinx or ovaries not accessible to follicular puncture.</p><p>We also carried out a critical review of the medical literature and the guidelines of the different scientific societies to try to establish general criteria for the approach to these patients with endometriosis and sterility, who as a general rule should be treated by assisted reproductive techniques. A special analysis is made of the specific situations in which a differentiated approach with previous surgery is required when the function of a pelvic organ is in danger or in deep endometriosis.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"50 3","pages":"Article 100890"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49832933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nuevo paradigma en la cirugía del mioma: reparación uterina","authors":"Maria Luisa Cañete ,&nbsp;Alicia Hernandez ,&nbsp;Violeta Romero ,&nbsp;Ignacio Lobo ,&nbsp;Juan Luis Alcazar","doi":"10.1016/j.gine.2023.100859","DOIUrl":"https://doi.org/10.1016/j.gine.2023.100859","url":null,"abstract":"<div><p>Uterine fibroids are a frequent pathology that mainly affects women in their third and fourth decade of life. Most are asymptomatic. However, some may have a significant clinical impact or on the fertility of the patient. Recently there have been relevant changes in the diagnosis and management of this entity. This paper aims to summarize these changes discussed at the 1 st National Congress of the Spanish Society for the Study of Fibroids and Endometriosis.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"50 3","pages":"Article 100859"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49832930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Niveles de vitamina D en sangre materna y su relación con el consumo de pescado y los parámetros antropométricos de los recién nacidos en una cohorte de parejas madre/hijos de Sevilla","authors":"B. Dahiri ,&nbsp;P. Carbonero-Aguilar ,&nbsp;I. Martin-Carrasco ,&nbsp;R. Carrillo ,&nbsp;N. Florez ,&nbsp;L. Cerrillos ,&nbsp;R. Ostos ,&nbsp;J. Bautista ,&nbsp;I. Moreno","doi":"10.1016/j.gine.2023.100860","DOIUrl":"https://doi.org/10.1016/j.gine.2023.100860","url":null,"abstract":"<div><h3>Introduction</h3><p>To compare maternal vitamin D levels with the area of residence or the consumption of fish, as well as its relationship with the weight, length and cranial perimeter of babies.</p></div><div><h3>Materials and methods</h3><p>Cohort of 100 mother–child pairs (<em>n</em> <!-->=<!--> <!-->100) from the province of Seville (Virgen del Rocío University Hospital and Valme University Hospital). In maternal blood samples (gestational age<!--> <!-->≥<!--> <!-->40 weeks) 25(OH)D levels have been measured by chemiluminescence. Anthropometric measurements of the babies were made using standard methods.</p></div><div><h3>Results</h3><p>Regarding vitamin D levels, 54% had deficient values, 26% insufficient and 20% sufficient values. After a multiple regression analysis, it is observed that there is no significant difference between maternal vitamin D levels, the length and the cephalic perimeter of the babies, however, there is a difference with the birth weight (<em>P</em> <!-->&lt;<!--> <!-->.05). When applying the <em>t</em>-Student and the Wilcoxon test, there is no relationship between vitamin D levels and the area of residence or with maternal fish consumption (both <em>P</em> <!-->&gt;<!--> <!-->.05).</p></div><div><h3>Conclusions</h3><p>Eighty percent of mothers present deficient and insufficient values of vitamin D. There is no correlation between this parameter and the length and cephalic perimeter of the baby, observing a negative correlation with birth weight. No correlation was observed between the area of residence or the consumption of fish and vitamin D levels in mothers. We suggest dietary supplements for pregnant mothers and monitoring of vitamin D levels in babies.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"50 3","pages":"Article 100860"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49832927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El tratamiento hormonal es imperativo para todas las pacientes: lo antes posible y siempre","authors":"M.Á. Martínez-Zamora","doi":"10.1016/j.gine.2023.100856","DOIUrl":"https://doi.org/10.1016/j.gine.2023.100856","url":null,"abstract":"<div><p>Endometriosis is nowadays considered an inflammatory chronic benign disease that responds to hormone manipulation and affects up to 10% of women in fertile age. It seems that innate or acquired changes in the endometrium ability to implant, invade and grow in an inflammatory milieu with estrogenic dependence and progesterone resistance are the responsible for new endometriosis implants and contribute to perpetuate the illness. There is, at the moment, no optimal known treatment that achieves the four basic objectives for the treatment of endometriosis: treat the symptoms, improve fertility, eliminate endometrial implants, and avoid illness progression. As is now considered a chronic condition, the prescribed medical treatment, until the patient arrives to the physiological menopause status or gets pregnant, must be considered in the long term, and must be effective and safe. Therefore, the realistic objectives of the treatment are the reduction or abolishment of symptoms and/or improve fertility. As a consequence of the limitations and risks of endometriosis surgeries, the first-line treatment is hormonal. This must be individualized according to age, parity, pregnancy desire, associated symptoms, other illnesses and patients preferences. Globally, there are two main types of first-line hormonal treatments: estroprogestins in extended or continuous regimens and some progestins in different routes of administration (dienogest, norethisterone acetate or desogestrel orally, and levonorgestrel high-dose intrauterine device). The different hormonal treatments and their pros and cons are explained in the manuscript.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"50 3","pages":"Article 100856"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49832929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}