Clinica e Investigacion en Ginecologia y Obstetricia最新文献_第3页

Descripción de un caso: síndrome de pseudo Meigs con leiomioma uterino 病例报告：假性梅格斯综合征伴子宫肌瘤

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-08-13 DOI: 10.1016/j.gine.2024.100984

J. Sánchez España, D.A. Sánchez Torres, F.J. Salazar Arquero

{"title":"Descripción de un caso: síndrome de pseudo Meigs con leiomioma uterino","authors":"J. Sánchez España, D.A. Sánchez Torres, F.J. Salazar Arquero","doi":"10.1016/j.gine.2024.100984","DOIUrl":"10.1016/j.gine.2024.100984","url":null,"abstract":"<div><h3>Introduction</h3><p>Meigs syndrome is an underdiagnosed pathology and should be suspected in the presence of an ovarian tumor associated with pleural and peritoneal effusion. In addition, it usually presents elevation of the tumor marker CA-125. All these clinical and analytical parameters improve after surgical removal of the tumor. Most cases are associated with benign ovarian tumors (fibroids). When it is associated with another type of ovarian/uterine tumor, whether benign or malignant, it is called «Pseudo Meigs Syndrome.» The diagnostic confirmation of the tumor will be histological.</p></div><div><h3>Main symptoms and/or clinical findings</h3><p>The clinical case of a patient is presented, in which a uterine tumor is observed that produces repetitive vasovagal syncope due to compression of pelvic organs, associated with right pleural effusion and ascites with mild-moderate elevation of CA-125.</p></div><div><h3>Main diagnoses</h3><p>The main suspected diagnosis is Pseudo-Meigs syndrome, due to the association of a uterine tumor with pleural effusion and ascites.</p></div><div><h3>Therapeutic interventions and results</h3><p>After resection of the tumor, which turned out to be a uterine leiomyoma, both effusions resolved and the tumor marker CA-125 normalized, corresponding to Pseudo Meigs Syndrome.</p></div><div><h3>Conclusion</h3><p>In the differential diagnosis of a pleural effusion associated with ascites, the presence of an ovarian/uterine tumor must be ruled out, since, if observed, we could be dealing with Meigs/Pseudo Meigs Syndrome; which will be confirmed by the disappearance of the pleural effusion, ascites and normalization of the CA-125 marker after surgical resection of the tumor and which represents its resolution.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 4","pages":"Article 100984"},"PeriodicalIF":0.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977997","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}

引用次数: 0

Preservación de la fertilidad social o no médica 社会或非医学生育力保护

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-08-12 DOI: 10.1016/j.gine.2024.100970

M. Galian , M. Díaz , C. Díaz-García

{"title":"Preservación de la fertilidad social o no médica","authors":"M. Galian , M. Díaz , C. Díaz-García","doi":"10.1016/j.gine.2024.100970","DOIUrl":"10.1016/j.gine.2024.100970","url":null,"abstract":"<div><p>Fertility preservation for social or non medical reasons is one of the reproductive treatments that has experienced the greatest increase in demand in recent years. The impact of age on a woman's ovarian reserve and oocyte quality is well known. This negatively impacts the rates of spontaneous pregnancy, risk of aneuploidy, miscarriage, and maternal and fetal complications.</p><p>Oocyte cryopreservation, carried out mainly by a healthy population, aims to mitigate the impact of age on ovarian aging and future chances of pregnancy, although it does not exempt itself from other negative consequences from the maternal and fetal health perspective, due to a delay in motherhood.</p><p>This manuscript aims to review the egg freezing treatment in terms of efficacy, safety and cost-effectiveness, since the increase in demand is an indirect reaction to a change in social trend and an increase in women who decide to postpone their motherhood, especially due to the absence of a partner.</p><p>It also emphasizes the ethical aspects of a treatment that only a minority of the population can benefit from due to its private access in most cases. This encounters certain limitations, especially for women who, despite having a good reproductive prognosis due to age, could already be in a situation of premature ovarian insufficiency.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 4","pages":"Article 100970"},"PeriodicalIF":0.1,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141953993","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}

引用次数: 0

Guideline update: Systematic fetal cardiac ultrasound during the first trimester 指南更新：妊娠头三个月系统性胎儿心脏超声检查

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-08-12 DOI: 10.1016/j.gine.2024.100987

J. Arenas Ramírez , S. Fernández García , E. Pérez Carbajo , A. Armijo Sánchez , J.A. Sainz-Bueno

引用次数: 0

Neoplasia de células epitelioides perivasculares (PEComa) del tracto genital femenino: una revisión sistemática 女性生殖道血管周围上皮样细胞瘤（PEComa）：系统综述

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-08-09 DOI: 10.1016/j.gine.2024.100983

I. Vieira Martins, S. Proença

{"title":"Neoplasia de células epitelioides perivasculares (PEComa) del tracto genital femenino: una revisión sistemática","authors":"I. Vieira Martins, S. Proença","doi":"10.1016/j.gine.2024.100983","DOIUrl":"10.1016/j.gine.2024.100983","url":null,"abstract":"<div><p>Perivascular epithelioid cell tumors (PEComa) are rare mesenchymal neoplasms composed by perivascular epithelioid cells that express melanocytic and smooth muscle markers. Most cases are benign, but a small group behaves malignantly. Unfortunately, as they dońt appear frequently, reliable criteria to predict malignancy have not yet been established. The PEComas of the female genital tract represent approximately 25% of the PEComas reported in the literature and the most common site of appearance is in the uterine body; less common sites include the cervix, the ovaries, the fallopian tubes, the vagina/vulva or the round or broad ligament. Uterine PEComas are not distinguishable from other uterine tumors, such as leiomyoma and leiomyosarcoma, before an anatomopathological diagnosis is made. Surgery is the most recommended primary treatment, although adjunctive therapy is generally reserved for high-risk cases. However, the best approach is not well established due to the shortage of cases described until now.</p><p>This methodical review aims to summarize, according to of current literature, what is known about the etiopathogenesis, clinical and pathological characteristics of PEComas, focusing on the approach to gynecological cases.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 4","pages":"Article 100983"},"PeriodicalIF":0.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141953369","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}

引用次数: 0

Impacto del test prenatal no invasivo en la detección de aneuploidías 无创产前检测对非整倍体检测的影响

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-08-09 DOI: 10.1016/j.gine.2024.100985

C. Valldecabres Ortiz, F. De la Fuente García, S. Górriz Pintado

{"title":"Impacto del test prenatal no invasivo en la detección de aneuploidías","authors":"C. Valldecabres Ortiz, F. De la Fuente García, S. Górriz Pintado","doi":"10.1016/j.gine.2024.100985","DOIUrl":"10.1016/j.gine.2024.100985","url":null,"abstract":"<div><h3>Background</h3><p>The non-invasive prenatal test (NIPT) is a screening test that allows for conducting a screening of major chromosomal abnormalities in the fetus during pregnancy using maternal blood. In February 2019, NIPT was included as part of the prenatal diagnosis for genetic anomalies during the first trimester of pregnancy by the Public Health System of the Valencian Community.</p><p>The objective is to assess the diagnostic and economic performance of NIPT in pregnant women within our Department since its implementation.</p></div><div><h3>Methods</h3><p>A retrospective observational study was conducted, analyzing NIPT performed since its integration into the screening for chromosomal abnormalities in pregnant women within our department. The analysis includes the number of invasive tests conducted, improvements in the detection of studied chromosomal abnormalities, and the economic feasibility in comparison to invasive testing.</p></div><div><h3>Results</h3><p>A total of 4719 combined first and second-trimester screenings were conducted with a population coverage of 98%, of which TPNI was indicated in 337 patients. Aneuploidies were detected in 4 patients: two cases of Down syndrome, one case of Patau syndrome, and one case of Turner syndrome, with the first three confirmed and the latter resulting in a false positive. The sensitivity obtained was 100%, and the specificity was 99% (95% CI). The economic savings amounted to €52,035.90.</p></div><div><h3>Conclusions</h3><p>TPNI is a highly sensitive test with high specificity. Since its incorporation into the screening for aneuploidies in pregnant women, the performance of invasive tests has been reduced, resulting in a corresponding decrease in the risk of fetal loss and significant economic savings.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 4","pages":"Article 100985"},"PeriodicalIF":0.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141953368","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}

引用次数: 0

Preeclampsia como factor de riesgo de enfermedad cardiovascular en el futuro: etiopatogenia e implicación en la práctica clínica 子痫前期是未来心血管疾病的危险因素：发病机制和对临床实践的影响

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-07-09 DOI: 10.1016/j.gine.2024.100972

M. Moreno López

引用次数: 0

Síndrome de Joubert: un reto para el diagnóstico prenatal 朱伯综合征：产前诊断的挑战

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-07-09 DOI: 10.1016/j.gine.2024.100973

V. de Miguel Sánchez, S. López Casal, M. Sánchez-Andrade

{"title":"Síndrome de Joubert: un reto para el diagnóstico prenatal","authors":"V. de Miguel Sánchez, S. López Casal, M. Sánchez-Andrade","doi":"10.1016/j.gine.2024.100973","DOIUrl":"https://doi.org/10.1016/j.gine.2024.100973","url":null,"abstract":"<div><h3>Introduction</h3><p>Joubert syndrome and related disorders constitute an autosomal recessive hereditary disease, whose incidence is estimated at one case per 80,000 to 100,000 live births. It represents a developmental delay secondary to multiple congenital abnormalities, predominantly cerebellar and brainstem.</p></div><div><h3>Clinical findings</h3><p>A 37-year-old pregnant woman with an intermediate risk result in the first trimester chromosome screening. Finding in the second trimester obstetric ultrasound, absence of inferior cerebellar vermis, dysplasia of the superior vermis, vertical disposition of both cerebellar hemispheres and horizontal superior cerebellar peduncles. In the fetal resonance the presence of the «Molar tooth sign» is confirmed.</p></div><div><h3>Main diagnoses</h3><p>Cystic anomalies of the posterior fossa, specifically the Dandy-Walker malformation and Joubert syndrome.</p></div><div><h3>Therapeutic interventions and results</h3><p>Genetic study after amniocentesis, QF-PCR, Arrays CGH, without pathological findings and normal fetal karyotype of 46 XX. Confirmation was achieved by massive sequencing of 13 genes related to Joubert syndrome, evidencing the existence of 2 heterozygous pathogenic variants of the <em>CPLANE1</em> gene, each one from a parent.</p></div><div><h3>Conclusion</h3><p>Joubert Syndrome represents a challenge within prenatal diagnosis, due to its heterogeneous clinical, phenotypic and genetic presentation. This work presents the diagnostic complexity and contributes to the literature another case that allows to improve its future diagnosis.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 4","pages":"Article 100973"},"PeriodicalIF":0.1,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141582510","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}

引用次数: 0

Presentación polipoide de un carcinosarcoma primario de vagina. Un caso clinicopatológico de esta neoplasia excepcional 阴道原发性癌肉瘤的息肉状表现。这种特殊肿瘤的临床病理病例。

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-07-09 DOI: 10.1016/j.gine.2024.100971

R. Sarabia Ochoa , J.P. García de la Torre , A. Amezcua Recover

{"title":"Presentación polipoide de un carcinosarcoma primario de vagina. Un caso clinicopatológico de esta neoplasia excepcional","authors":"R. Sarabia Ochoa , J.P. García de la Torre , A. Amezcua Recover","doi":"10.1016/j.gine.2024.100971","DOIUrl":"https://doi.org/10.1016/j.gine.2024.100971","url":null,"abstract":"<div><h3>Introduction</h3><p>Gynecological carcinosarcoma, also called malignant mixed Müllerian tumor, is a rare, heterogeneous, aggressive, malignant neoplasm. The vagina as a primary site of carcinosarcoma is exceptional.</p></div><div><h3>Main symptoms and/or clinical findings</h3><p>95-year-old woman who consulted for vaginal bleeding. The gynecological examination revealed a polypoid tumor dependent on the right lateral wall of the vagina.</p><p>Main diagnoses, therapeutic interventions and results The CT radiological study identified a tumor measuring 6×3,4×3,5cm, which occupied the lower third of the vagina. The polypoid mass was excised in fragments, with resection of its base in the right medial 1/3 of the vagina. The histological study corresponded to a malignant spindle-cell neoplasm with areas of high cell density, intersecting fascicles and multiple edematous areas, with spindle-shaped or stellate-shaped cells with intense nuclear atypia and monstrous bizarre cells. Chondroid-like or myxoid appearance foci, frequent atypical multinucleated giant tumor cells, mitosis and some foci with evident epithelial differentiation in the form of poorly differentiated carcinoma were observed. The diagnosis was carcinosarcoma. Considering the patient's age, it was decided to perform follow-up without further interventions. Currently, one year after diagnosis, the patient has no evidence of recurrence.</p></div><div><h3>Conclusion</h3><p>Primary malignant neoplasms of the vagina are very rare. Vaginal carcinosarcoma is an extremely rare neoplasm that occurs in elderly women. The prognosis is poor and more studies are needed to better understand this neoplasm.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 4","pages":"Article 100971"},"PeriodicalIF":0.1,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141582511","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}

引用次数: 0

Predictors of single-dose methotrexate treatment success in ectopic pregnancies: A retrospective cohort study 宫外孕单剂量甲氨蝶呤治疗成功的预测因素：回顾性队列研究

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-07-01 DOI: 10.1016/j.gine.2024.100967

V. Chegini , H. Pakniat , M. Shora , M. Mirzadeh , F. Lalooha , V. Chegini , M.D. Griffiths , Z. Alimoradi

{"title":"Predictors of single-dose methotrexate treatment success in ectopic pregnancies: A retrospective cohort study","authors":"V. Chegini , H. Pakniat , M. Shora , M. Mirzadeh , F. Lalooha , V. Chegini , M.D. Griffiths , Z. Alimoradi","doi":"10.1016/j.gine.2024.100967","DOIUrl":"https://doi.org/10.1016/j.gine.2024.100967","url":null,"abstract":"<div><h3>Objective</h3><p>The present study investigated the predictors of single-dose (50mg/m<sup>2</sup>) methotrexate (MTX) treatment success in ectopic pregnancies.</p></div><div><h3>Method</h3><p>A retrospective cohort study was conducted using information databases from a single academic tertiary care hospital among 396 participants referred for treatment of ectopic pregnancy (EP). Data were collected on age, history of EP, basal level of β-hCG, features of vaginal ultrasound (left or right), mass size, presence of hematoma around the mass and free pelvic fluid, and demand of subsequent doses of MTX or surgery. The patients were divided into success and failure groups based on whether they were treated with a single-dose of methotrexate (single dose MTX), or required subsequent doses of MTX or surgery.</p></div><div><h3>Results</h3><p>The success rate of single-dose MTX treatment was approximately 74%. The failure chance was significantly higher in right adnexal masses (OR: 3.45), history of EP (OR: 28.19), presence of hematoma on ultrasound (OR: 26.69), and serum β-hCG>719mIu/ml (OR: 5.19). A mass size>19mm was associated with a 79% increased chance of failure (<em>p</em>   <!-->mIu/ml was the best cutoff for patients with EP (with a sensitivity of 82% and specificity of 63%).</p></div><div><h3>Conclusion</h3><p>The treatment outcome of single dose MTX can be successfully predicted based on the previous history of EP, the presence of hematoma on ultrasound, mass location, and measurement of β-hCG levels before treatment.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 4","pages":"Article 100967"},"PeriodicalIF":0.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480881","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}

引用次数: 0

Malaria grave en gestante con trombocitopenia severa y afectación placentaria: manejo en zona no endémica. A propósito de un caso 一名患有严重血小板减少症和胎盘受累的孕妇患重症疟疾：非流行区的处理方法。病例报告

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Clinica e Investigacion en Ginecologia y Obstetricia Pub Date : 2024-06-26 DOI: 10.1016/j.gine.2024.100969

A. Llamazares de la Moral , M.J. Cuerva , J.L. Bartha

{"title":"Malaria grave en gestante con trombocitopenia severa y afectación placentaria: manejo en zona no endémica. A propósito de un caso","authors":"A. Llamazares de la Moral , M.J. Cuerva , J.L. Bartha","doi":"10.1016/j.gine.2024.100969","DOIUrl":"https://doi.org/10.1016/j.gine.2024.100969","url":null,"abstract":"<div><h3>Introduction</h3><p>Malaria presents a significant challenge during pregnancy, even in non-endemic environments like Spain. Pregnant women face severe complications due to placental parasite accumulation, leading to conditions such as severe anemia, miscarriage, intrauterine growth restriction, and perinatal death. In this article, we present a clinical case illustrating the complexities and successful management strategies of malaria during pregnancy in a non-endemic setting.</p></div><div><h3>Major symptoms and clinical findings</h3><p>A 37-week pregnant woman from Equatorial Guinea presents with fever and hemoptoic sputum. Laboratory analysis reveals severe thrombocytopenia, anemia, and hyperbilirubinemia, prompting suspicion of malaria.</p></div><div><h3>Major diagnoses, therapeutic interventions and outcomes</h3><p><em>P.falciparum</em> antigen is detected in the blood, meeting criteria for severe malaria based on clinical and analytical findings. Treatment with intravenous artesunate results in rapid parasitemia reduction. On the second day, the patient enters labor and undergoes a eutocic delivery, giving birth to a healthy baby girl with negative <em>P.falciparum</em> antigen. Parasites are found in the placental intervillous space upon analysis. Postpartum oral therapy with dihydroartemisinin-piperaquine proceeds without incident. Discharge occurs three days later.</p></div><div><h3>Conclusions</h3><p>Effective management of malaria during pregnancy requires early suspicion, a multidisciplinary approach, and targeted treatment to optimize maternal-fetal outcomes. Vaginal birth at term is recommended to mitigate perinatal complications and promote maternal recovery. Oral dihydroartemisinin-piperaquine therapy emerges as a promising option for postpartum preventive treatment, yielding favorable short- and long-term results.</p></div>","PeriodicalId":41294,"journal":{"name":"Clinica e Investigacion en Ginecologia y Obstetricia","volume":"51 4","pages":"Article 100969"},"PeriodicalIF":0.1,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480882","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}

引用次数: 0