Francisco Machado-Linde

Fertility Preservation in Heterotopic Cervical Pregnancy: What Is the Best Procedure?

We describe a patient who underwent assisted reproduction techniques and was diagnosed with heterotopic cervical pregnancy, and then discuss the management of this entity, which is rare and has no standard protocols. Treatment consisted of intra-arterial methotrexate (50 mg/m2 body surface area) and simultaneous selective embolization of uterine arteries. The literature is also reviewed to identify other approaches and outcomes.

Uterine rupture in twin pregnancy with normal fetus and complete hydatidiform mole.

We describe a rare case of complete hydatidiform mole with twin live fetus (CHMTF) confirmed by histopathology, flow cytometry and polymerase chain reaction techniques. No malformations were observed, fetal karyotype was normal and β-human chorionic gonadotropin levels were high (>100,000 IU/ml). The patient was informed of the risks and decided to continue with the pregnancy, but at week 15, she had to undergo hysterectomy due to uterine rupture. She subsequently developed persistent trophoblastic disease (PTD) with pulmonary metastases that required treatment with polychemotherapy. Patients with CHMTF should be informed of all known risks, including the considerable risk of PTD, which is similar to or, even higher than that associated with a singleton complete mole. The risk does not appear to be increased by continuing the pregnancy. Because so few series have been published, there is a lack of evidence-based clinical management guidelines. To our knowledge, this is the first report of uterine rupture in CHMTF.

Conservative management of vesico-vaginal fistula after uterine and partial bladder necrosis due to embolization as a treatment for postpartum hemorrhage

Postpartum haemorrhage is a major cause of maternal mortality worldwide, and uterine atony its most common cause. Selective uterine artery embolization (UAE) is a safe conservative second-line treatment after uterotonics or uterine tamponade have failed and before surgical techniques are used in hemodynamically stable patients. Response rates range from 75-100 %. Complications are rare (6-9 %). Most common is postembolization syndrome (self-limited fever and pain within the first 24-48 hours). A rare (22 cases found) and severe complication is uterine necrosis, isolated or with bladder involvement (only three cases reported). All were treated with surgery (hysterectomy and partial cystectomy in cases with associated bladder necrosis). Regarding a vesicovaginal fistula after embolization, only 3 cases have been reported [1–3]. All resulted in hysterectomy (either total or subtotal).

Management of a Dichorionic Twin Pregnancy with a Normal Fetus and an Androgenetic Diploid Complete Hydatidiform Mole

We describe a rare case of complete hydatidiform mole with twin live fetus (CHMTF) confirmed by histopathology, flow cytometry, and polymerase chain reaction techniques. No malformations were observed, fetal karyotype was normal and β-human chorionic gonadotropin levels were increased (>100,000 IU/ml). Once the patient had been informed of the risks, it was decided to continue the pregnancy, but termination of pregnancy was necessary at week 13 + 5 due to maternal complications consisting of hyperthyroidism, hypertension and vaginal bleeding, followed by persistent trophoblastic disease (PTD). Patients diagnosed with CHMTF should be informed of all known risks, including the considerable risk of PTD, which is similar to - or according to some reports - even higher than that associated with a singleton complete mole and is not increased by continuing pregnancy. Due to the low number of series published, evidence-based clinical management guidelines are lacking.

Central pontine myelinolysis during pregnancy: Pathogenesis, diagnosis and management

Abstract Central pontine myelinolysis (CPM) is a rare condition usually caused by rapid sodium correction in hyponatraemia after a severe neurological syndrome. Only few cases have been reported during pregnancy, most of which were reported in patients with hyperemesis. We describe the successful management of the first case of twin pregnancy in a patient who presented with CPM after treatment for premature labour and then review the literature on CPM in pregnancy (aetiology, diagnosis and management). Our patient required emergency delivery to achieve electrolyte and fluid balance. At six months, the twins remained asymptomatic and the mother had minor sequelae. The aetiology is not clear, and there is no evidence regarding the optimal treatment or prognosis of CPM. In our patient, desmopressin-contaminated atosiban showed a certain probability in the Karch-Lasagne algorithm of a causality relationship between hyponatraemia and the drug. To our knowledge, this is the first case of myelinolysis reported in a twin pregnancy possibly related to desmopressin-contaminated atosiban.

Characterization of human peritoneal monocyte/macrophage subsets in homeostasis: Phenotype, GATA6, phagocytic/oxidative activities and cytokines expression

Peritoneal macrophages play a critical role in the control of infectious and inflammatory diseases. Although recent progress on murine peritoneal macrophages has revealed multiple aspects on their origin and mechanisms involved in their maintenance in this compartment, little is known on the characteristics of human peritoneal macrophages in homeostasis. Here, we have studied by flow cytometry several features of human peritoneal macrophages obtained from the peritoneal cavity of healthy women. Three peritoneal monocyte/macrophage subsets were established on the basis of CD14/CD16 expression (CD14++CD16−, CD14++CD16+ and CD14highCD16high), and analysis of CD11b, CD11c, CD40, CD62L, CD64, CD80, CD86, CD116, CD119, CD206, HLA-DR and Slan was carried out in each subpopulation. Intracellular expression of GATA6 and cytokines (pro-inflammatory IL-6 and TNF-α, anti-inflammatory IL-10) as well as their phagocytic/oxidative activities were also analyzed, in an attempt to identify genuine resident peritoneal macrophages. Results showed that human peritoneal macrophages are heterogeneous regarding their phenotype, cell complexity and functional abilities. A direct relationship of CD14/CD16 expression, intracellular content of GATA6, and activation/maturation markers like CD206 and HLA-DR, support that the CD14highCD16high subset represents the mature phenotype of steady-state human resident peritoneal macrophages. Furthermore, increased expression of CD14/CD16 is also related to the phagocytic activity.

Current Controversies in Stem-Cell Treatment of Urinary Incontinence in Women

Background: Urinary incontinence (UI) is a major cause of morbidity in the world and is believed to affect up to 46% of the female population Our objective was to analyze the papers that describe stem-cell treatments for UI in women. Methods: We performed a systematic review of the literature from 1946 to date that reports on clinical trials that use stem cells to treat women with urinary incontinence. Results: Nine articles (7 observational and 2 randomized studies) met the inclusion criteria. No major adverse effects were observed in any of the studies. However, the efficacy results differ widely, as the methodology used for studies was very different, as described below. Conclusion: Stem-cell therapy is promising but still experimental, and further study is needed to identify certain factors. These facts include the ideal type of patient eligible for treatment (apparently those in whom intrinsic urethral dysfunction predominates), and to determine if treatment should be isolated or combined with other cells or procedures, which are the optimal doses and if it is a cost effective procedure.