Estanislao Beltrán

Subendometrial contractility in menstrual phase visualized by transvaginal sonography in patients with endometriosis

OBJECTIVE To describe the propagation direction of the subendometrial myometrial contractile wave in menstrual phase sonographically assessed in patients with and without endometriosis. DESIGN Prospective study. SETTING Patients and normal volunteers in a university hospital. PATIENTS Sixteen women with (study group) and 21 without (control group) endometriosis. INTERVENTIONS Patients were examined by transvaginal sonography (midsaggital plane of the uterus) and recorded on videotape for a 5-minute period. MAIN OUTCOME MEASURE Direction of propagation of contraction waves. RESULTS The endometriosis group showed a predominant retrograde pattern whereas the control group showed a normal antegrade. CONCLUSION This abnormal cervix-to-fundus myometrial activity could well increase the amount of peritoneal shedding of endometrial menstrual debris, increasing the probabilities of its heterotopic implantation.

Position of the Spanish Menopause Society regarding the management of menopausal symptoms in breast cancer patients

Breast cancer is the most common female cancer in Spain. Its high prevalence, its high survival rate, and its incidence are the reasons treatment is increasingly sought for common problems by young women who have survived it. Besides the contraception and fertility issues, many breast cancer survivors develop sexual disorders and menopausal symptoms, whether as a consequence of treatment-induced menopause or side effects of treatment. For such reasons, a panel of experts from the Spanish Menopause Society has met to develop usage recommendations for the relief of vasomotor symptoms and for sexual and reproductive health in patients with breast cancer based on the best evidence available.

Position of the Spanish Menopause Society regarding vaginal health care in postmenopausal women

Vaginal health, defined as the vaginal state in which the physiological condition remains stable, being protected from the onset of symptoms and facilitating a satisfying sex life, is one of the most common and less valued concerns in postmenopausal women. Many of the conditions that affect the vagina are related to its trophism and susceptibility to infection by unusual germs, which are phenomena strongly influenced by estrogen impregnation and the microbiota composition, ultimately affecting sexuality and the quality of life. An expert panel of the Spanish Menopause Society met to establish criteria for diagnosing and treating the processes that affect overall vaginal health and to decide the optimal timing and methods based on the best evidence available.

Posicionamiento de la Asociación Española para el Estudio de la Menopausia sobre el uso clínico de las isoflavonas en el climaterio

Resumen Objetivo Existe un interes creciente en los paises occidentales acerca de la utilidad de las isoflavonas de la soja para el tratamiento de los sintomas y enfermedades relacionadas con la menopausia y el envejecimiento, que se ha traducido en la aparicion de un importante numero de publicaciones, muchas de las cuales presentan resultados contradictorios. La Asociacion Espanola para el Estudio de la Menopausia (AEEM) ha evaluado el papel de las isoflavonas en la salud de la mujer menopausica, basandose en las mejores evidencias disponibles. Material y metodos Se reunio un panel de expertos, clinicos e investigadores en el campo de las isoflavonas. Los estudios seleccionados se obtuvieron mediante una busqueda electronica que incluyo buscadores de internet, Medline (1966- marzo de 2007) y el Registro de Ensayos Clinicos Controlados Cochrane. Resultados Las diferentes revisiones y metaanalisis sobre los efectos de las isoflavonas en la salud de la mujer son controvertidos. La diversidad de resultados puede deberse, entre otras causas, a la falta de uniformidad de los compuestos estudiados. En relacion con la dosis y el contenido en genisteina, se han demostrado efectos beneficiosos en el perfil lipidico, como antioxidantes, asi como una reduccion moderada de los sofocos. Algunos estudios sugieren un efecto positivo en la masa osea. Los datos disponibles en otros aspectos, como la mama, canceres dependientes de los estrogenos, funcion cognitiva y piel, entre otros, son escasos. Conclusiones En diversas situaciones, las isoflavonas pueden ser una alternativa terapeutica en el climaterio, si bien antes de poder proceder a la realizacion de recomendaciones generales acerca del consumo de preparados de isoflavonas, se necesitan ensayos clinicos especificos, de diseno adecuado, con preparados normalizados en cuanto al contenido en isoflavonas y sus tipos, y con suficiente numero de pacientes y tiempo de estudio.

Transvaginal sonographic evaluation of subendometrial–myometrial contractility in women using a copper-releasing intrauterine device

BACKGROUND The aim of this study was to determine the effects of a copper-releasing intrauterine device (IUD) on myometrial contractility midway through the menstrual cycle. STUDY DESIGN Uterine peristalsis was studied midway through the cycle with transvaginal sonography in two groups of women, a control group and women in whom a copper-releasing IUD had been inserted. RESULTS The results showed that 12 months after insertion, no uterine motility could be detected with sonography in any of the women with an IUD, but motility did occur in all the controls. CONCLUSIONS Subendometrial-myometrial contractility midway through the menstrual cycle had been abolished in patients with a copper-releasing IUD. The loss of motility may inhibit sperm transport from the cervix to the oviduct and account for at least part of the contraceptive effect of these devices.

The Pathology of Secondary Human Yolk Sac in Spontaneous Abortion: Findings in 103 Cases

The pathology findings in 103 secondary human yolk sacs (SHYS) in spontaneous abortions (SA), from the 6th to the 20th week are reported. SHYS lesions were classified into two groups: (1) SHYS with altered expansion changes (AEC), which included 21 with marked reduction in size and 8 cystic with an increase in diameter due to active parietal growth; and (2) retrogressive and degenerative lesions (RL), frequently associated with retention that comprised 72 SHYS showing a co-agulative type of necrosis, dystrophic calcification, edema, and fibrosis. AEC with endodermal involvement seemed to be the earlier lesion since it preceded RLs by more than 2 weeks (9.0 ± 11.7 weeks of gestation; p < 0.0005). Most lesions, initial and late, could be related to low oxygen perfusion, which may be responsible for both the arrested growth with considerable reduction in size, as well as for the accelerated involution. Since the SHYS is irrigated by an end artery, this organ may be highly susceptible to ischemia, which may be caused, either by the poorly developed villous vessels associated with embryonic maldevelopment or by maternal (environmental) factors. The SHYS is an organ capable of scarring formed by actively proliferating subendodermal fibroblasts. Location of the SHYS in the chorionic cavity is altered in SA since there is premature adherence to the amnion as early as the 6th week of gestation.

Ectopic somatic endoderm in secondary human yolk sac

Three secondary human yolk sacs (SHYSs) showing heterotopic endodermal tubular structures of the gut-forming type were analyzed from a series of 180 SHYSs. These structures were similar to the early somatic endoderm involved in the formation of gut and lung. They may have arisen either as sequestrations in growth-disorganized embryos or as a phenomenon of differentiation from extraembryonal endoderm, which would indicate that extraembryonal tissues such as the SHYSs retain the capacity to differentiate somatic endoderm in developmentally altered embryos. It is possible that these structures may be the precursors of placental hepatic tissue and teratomas. Their morphologic resemblance to similar structures found in glandular, polyvesicular, and intestinal human yolk sac tumors provides yet another example of the similarity between SHYSs and yolk sac tumors.

Posicionamiento de la Asociación Española para el Estudio de la Menopausia sobre el uso clínico de la Cimicífuga racemosa en el climaterio

Objetivo: Dado el creciente interes en los paises occidentales acerca de la utilizacion de ciertas plantas para el tratamiento de los sintomas relacionados con la menopausia, la Asociacion Espanola para el Estudio de la Menopausia (AEEM) ha evaluado el papel de la Cimicifuga racemosa en el tratamiento de los sintomas climatericos sobre la base de las mejores evidencias disponibles. Material y metodos. Se reunio un panel de expertos, clinicos e investigadores, en el campo de la fitoterapia. Los estudios seleccionados se obtuvieron mediante una busqueda electronica que incluyo buscadores de Internet, MEDLINE (1985-mayo 2008) y el Registro de Ensayos Clinicos Controlados Cochrane. Resultados: La mayoria de los estudios publicados en los ultimos anos estan realizados con el extracto isopropanolico de Cimicifuga racemosa. La dosis mas estudiada ha sido 40 mg/dia y ha demostrado obtener una reduccion moderada de las sofocaciones, sobre todo en las mujeres con sofocos mas intensos, y una mejoria del estado de animo. Utilizada a las dosis recomendadas, no hay riesgo relevante desde el punto de vista hepatico. Los datos disponibles sobre su efecto en la enfermedad cardiovascular, el hueso, la funcion cognitiva y la piel son muy escasos o inexistentes. Conclusiones: La Cimicifuga racemosa es un tratamiento eficaz en el alivio de los sintomas vasomotores, al menos en una poblacion adecuada de mujeres peri y posmenopausicas, si bien se precisan mejores ensayos clinicos con suficiente numero de pacientes incluidas y mayor duracion del estudio.