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Objective: The aim of this research was to present and analyze the epidemiologic characteristics, clinical presentations, and treatment approaches to patients with diagnosed adnexal torsions. Mater...

RESUMEN Introducción y objetivos: La endometriosis es una de las principales patologías ginecológicas que afecta a mujeres en edad reproductiva. Existen muchas teorías en cuanto a su fisiopatología destacando las alteraciones genéticas y epigenéticas, los desbalances hormonales y otros factores como la inflamación crónica y el estrés oxidativo; pero en realidad, su origen continúa siendo desconocido. Estudios recientes han implicado al estrés oxidativo y la consecuente generación de radicales libres de oxígeno en la fisiopatología de la entidad mediante la generación de inflamación crónica pélvica. El objetivo de este estudio es corroborar que existen vías de estrés oxidativo que se encuentran alteradas en estas pacientes. Métodos: Se realizará un análisis de marcadores de estrés oxidativo en plasma sanguíneo, entre ellos los niveles de proteínas carboniladas y el cociente glutatión oxidado/glutatión reducido (GSSG/GSH), comparando los resultados en pacientes con endometriosis (n=19) versus un grupo control (n=11). Resultados: existe un incremento de las proteínas carboniladas en las pacientes con endometriosis (p < 0,041). No se obtuvieron diferencias estadísticamente significativas en relación al cociente GSSG/GSH o a los niveles de GSH. Conclusión: existe evidencia para relacionar al estrés oxidativo con la fisiopatología de la endometriosis, sin poder determinar a día de hoy que vías de oxidación están implicadas.

AIM We aimed to measure the effectiveness and quality of life (QoL) 10 years after transobturator suburethral tape surgery. METHODS We carried out a prospective observational study of 42 women assessed 10 years after surgical intervention with the transobturator technique. The main outcome measures were subjective and objective cure or improvement, complications, and changes in QoL. RESULTS The median abdominal leak point pressure had been 92 (82-113) mL H2 O prior to surgery. Thirty-six women (85.7%) remained cured (negative cough test) and 13 (31%) reported urine leakage during physical activity, percentages which were similar to those at a previous assessment at the 5th year. Urgency urinary incontinence was reported by 18 women (42.9%), 16 of whom required the use of anticholinergic drugs. Nineteen women had undergone some form of surgical pelvic reconstruction concomitantly with the TOT procedure, four of whom presented with relapse. The QoL tests indicated that cure and improvement persisted in 85.7% (n = 36, Urogenital Distress Inventory-6) and 92.9% (n = 39, Incontinence Impact Questionnaire-7) of the 42 evaluable women, respectively. CONCLUSION Rates of objective and subjective effectiveness remained stable after 10 years of surgery and QoL did not deteriorate significantly during that interval. The increase in urgency incontinence needs to be further investigated.

RESUMEN Introducción y objetivos: La identidad de género es la vivencia interna e individual del género tal como cada persona la siente. En algunos casos, la adquisición de los caracteres sexuales secundarios del otro género es importante en el proceso de reasignación de género, siendo importante el tratamiento endocrinológico. La cuestión es si la administración prolongada de andrógenos es segura en los casos de pacientes transexuales mujer a hombre, ya que es poca la evidencia científica a largo plazo. El objetivo de este estudio es analizar las características clínicas de los pacientes trans de nuestra unidad, y los hallazgos anatomopatológicos de las piezas quirúrgicas de histerectomía y doble anexectomía, para ver la influencia de la androgenoterapia en los genitales internos femeninos. Métodos: Se trata de un estudio descriptivo donde se analizaron datos demográficos y clínicos de los pacientes remitidos para cirugía genital, así como se analizaron los resultados del estudio anatomopatológico de las piezas de histerectomía y anexectomía. Resultados: Se incluyeron 66 pacientes, de los que 59 se intervinieron. No se halló malignidad en ninguna de las piezas quirúrgicas, sí diversos hallazgos benignos como miomas, atrofia/proliferación endometrial, actividad folicular en ovarios u ovarios tipo síndrome de ovario poliquístico. Conclusiones: La exposición a andrógenos a largo plazo no parece producir cambios malignos en la histología uterina ni ovárica, sin embargo, a menudo lleva a cambios en la actividad y la arquitectura ovárica, apreciándose en la mayoría de los casos ovarios funcionales e incluso semejantes a los observados en mujeres con ovario poliquístico. ABSTRACT Introduction and objectives: Gender identity is the internal and individual experience of the gender as each person feels it. In some cases, the acquisition of secondary sexual characteristics of the other gender is important in the process of gender reassignment, with endocrinological treatment being important. The question is whether prolonged administration of androgens is safe in cases of transsexual women to men, since there is little scientific evidence in the long term. The aim of this study is to analyze the clinical characteristics of trans patients in our unit, and the anatomopathological findings of the surgical pieces of hysterectomy and double adnexectomy, to see the influence of androgen therapy on the female internal genitalia. Methods: This is a descriptive study where demographic and clinical data of the patients referred for genital surgery were analyzed, as well as the results of the anatomopathological study of the hysterectomy and adnexectomy pieces were analyzed. Results: 66 patients were included, of which 59 were intervened. No malignancy was found in any of the surgical pieces, but several benign findings such as myomas, endometrial atrophy / proliferation, follicular activity in ovaries or ovaries like polycystic ovary syndrome. Conclusions: Long-term exposure to androgens does not seem to produce malignant changes in uterine or ovarian histology, however, it often leads to changes in ovarian activity and architecture, with functional ovaries being seen in most cases and even similar ones. those observed in women with polycystic ovary.

Objetivos: Analizar y presentar la epidemiología descriptiva de pacientes con antecedente de torsión anexial. Diseño: Estudio observacional, descriptivo y retrospectivo. Institución: Hospital Universitario Doctor Peset, Valencia, España. Participantes: Mujeres diagnosticadas de torsión anexial. Intervenciones: Diagnóstico y tratamiento de 54 mujeres de entre 11 y 64 años entre el 1/02/1997 y 30/06/2014. Resultados: En las 54 pacientes incluidas, la edad media al diagnóstico fue 31,7 años; 6 (11 ,1 %) pacientes habían sido intervenidas quirúrgicamente por patología anexial previa. El anexo más afectado fue el derecho; 34 (62,9%) pacientes presentaban masas anexiales. El síntoma de presentación en todas las pacientes fue el dolor pélvico agudo, y el tiempo medio transcurrido desde la aparición de la clínica hasta el trata miento fue de 24 a 72 horas. En 14 (25,9%) pacientes se realizó laparotomía y en 40 (74,1%) laparoscopia; 3 (5,6%) pacientes presentaron recidiva de la torsión de forma posterior. Conclusiones: El cuadro de torsión anexial debe tenerse en cuenta en toda mujer que acude a urgencias con dolor abdominal agudo. Esta patología es considerada una urgencia quirúrgica, y un retraso en el diagnóstico y tratamiento puede dar lugar a la pérdida del anexo afecto. Hoy en día, la vía laparoscópica es la de elección para su tratamiento en estas pacientes. Objectives: To present the descriptive epidemiology in a group of women with adnexal torsion. Design: Observational, descriptive and retrospective study. Setting: Hospital Universitario Doctor Peset, Valencia. Spain. Participants: Women diagnosed of adnexal torsion. Interventions: Between February 1997 and june 2014, 54 patients 11-64 years old with adnexal torsion were included. Results: The mean onset age was 31.7 years old. Previous adnexal surgerywas reported in 6 cases (11.1 %). The right adnexal region was the most affected; 34 (62.9%) patients were adnexal mass carriers. The most common presenting symptom was acute pelvic pain, and the mean lag time between onset of symptoms and confirmation of diagnosis was 24-72 hours. Fourteen (25.9%) patients were treated by laparotomy and 40 (74.1 %) by laparoscopy. Recurrence occurred in 3 patients (5.6%). Conclusions: Adnexal torsion should be considered in everywoman complaining of pelvic pain in emergency services. A prompt surgical intervention is required to avoid irreversible ovarian damage. Nowadays, conservative therapy by laparoscopy is preferred in these patients.

We aimed to measure the effectiveness and quality of life (QoL) 10 years after transobturator suburethral tape surgery.We carried out a prospective observational study of 42 women assessed 10 years after surgical intervention with the transobturator technique. The main outcome measures were subjective and objective cure or improvement, complications, and changes in QoL.The median abdominal leak point pressure had been 92 (82-113) mL HRates of objective and subjective effectiveness remained stable after 10 years of surgery and QoL did not deteriorate significantly during that interval. The increase in urgency incontinence needs to be further investigated.

Recent data suggest that hsp27, a low-molecular-weight heat shock protein, exerts important cellular actions, including the modulation of oestrogen action. We investigated whether hsp27 was differentially expressed in placental samples from small for gestational age (SGA) neonates.This study was performed in an academic hospital. Samples of villous tissue were obtained from placentae of 31 SGA (n = 16) or adequate to gestational age neonates (n = 15) delivered vaginally. The histological distribution of hsp27 in placental villi was investigated by immunohistochemistry, and the concentration of the protein was quantified by ELISA. Differences between groups were assessed by the nonparametric Mann-Whitney U test.Specific staining for hsp27 was detected in trophoblastic cells in most of the villi. The levels of hsp27 were lower in placentae from SGA neonates than from adequate to gestational age neonates.The expression of hsp27 was reduced in placentae from SGA neonates. Further work is required in order to clarify the role of hsp27 in placental physiology.

Objectives Stress urinary incontinence (SUI) is a highly prevalent dysfunction in middle-aged and elderly women. One recent technique places a sub-urethral tape passed through the transobturator foramen. Efficacy and quality of life were assessed after five years of treatment with the transobturator technique in women suffering SUI. This evaluation followed a previous control at the first year post-intervention. Study design Sixty-three women were assessed five years after operation with the transobturator technique. Additionally, twenty-nine women of these women had undergone pelvic floor reconstruction due to different forms of genital prolapse. Quality of life (QoL) was assessed by the Urogenital Distress Inventory-6 (UDI-6) and the Incontinence Impact Questionnaire-7 (IIQ-7) tests. Main outcome measures Subjective and objective cure or improvement, complications, and changes in QoL. Results Fifty women (79%) remained cured, as assessed by the cough test. Eighteen women (28%) reported urine leakage during physical activity. These objective and subjective data were worse than those reported at the one-year follow-up. De novo urge urinary incontinence was reported by 11 women or 17%. Nine of these women had undergone additional pelvic floor surgery. The QoL tests confirmed that cure or improvement was achieved in 78% (49) (UDI-6) and 79% (50) (IIQ-7) of the women. Conclusions The transobturator tape procedure resulted in acceptable rates of efficacy after five years. Moreover, QoL tests showed cure or improvement in almost four of five women. Nonetheless, women should be informed of the risk of de novo urinary urgency incontinence and the progressive loss of efficacy with time.