José Antonio Vidart Aragón

Vacunación frente al cáncer de cérvix en mujeres fuera de los programas de vacunación sistemática, con o sin infección por el virus del papiloma humano o lesión cervical. Encuesta de opinión y recomendaciones

Resumen Las vacunas frente al cancer de cervix se han implementado, en un amplio numero de paises del mundo, dentro de los programas de vacunacion sistematica. Asimismo se ha recomendado la vacunacion de rescate en adolescentes y mujeres jovenes. Desde la perspectiva de salud publica, la vacunacion rutinaria en mujeres de mayor edad no se plantea por motivos de coste-efectividad. En estos casos son el medico y la paciente los que, de forma individualizada, deben decidir sobre la vacunacion. Una encuesta de opinion dirigida a ginecologos espanoles que desarrollan su actividad asistencial en el ambito de la patologia cervical y colposcopia evidencia que, incluso en este colectivo, hay un relativo desconocimiento sobre aspectos importantes de la vacuna frente al cancer de cervix en mujeres fuera de los programas de vacunacion sistematica, con o sin infeccion por el virus del papiloma humano (VPH) o lesion cervical. Ademas se constata la demanda de mayor informacion y poder disponer de recomendaciones especificas acerca de este tema. En el presente articulo se revisan las evidencias sobre la infeccion VPH y el riesgo de cancer de cervix a lo largo de la vida, la eficacia de las vacunas en relacion con la edad o tras el tratamiento de lesiones cervicales, y la perspectiva del medico y de la mujer. Finalmente se presentan unas recomendaciones, a modo de guia clinica, sobre la vacunacion en mujeres fuera de los programas de vacunacion sistematica, con o sin infeccion o lesion cervical.

Enfermedad de Chagas y gestación

Resumen La enfermedad de Chagas puede transmitirse por via vertical y transplacentaria en areas no endemicas. Las migraciones ofrecen la oportunidad de ver enfermedades nuevas en estas zonas, que en muchas ocasiones pueden ser de gran interes desde el punto de vista diagnostico y terapeutico en la gestacion. Las principales afectaciones en el recien nacido recogidas en la bibliografia son prematuridad, bajo peso al nacimiento y baja puntuacion en la prueba de Apgar. La afectacion placentaria no implica afectacion fetal en todos los casos. El tratamiento se ha de posponer a finalizar la gestacion por los posibles efectos teratogenicos.

Multidisciplinary development of robotic surgery in a University Tertiary Hospital: Organization and outcomes

Background: Da Vinci system (Intuitive Surgical ® ) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation…) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in

Desarrollo multidisciplinario de la cirugía robótica en un hospital universitario de tercer nivel: organización y resultados

Background Da Vinci system (Intuitive Surgical®) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation…) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC.BACKGROUND Da Vinci system (Intuitive Surgical) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation...) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC. MATERIAL AND METHODS Starting from joint management and joint scrub nurses team, General and Digestive Surgery, Urology and Gynaecology Departments were progressively incorporated into the Robotic Surgery Plan, with several procedures increasing in complexity. A number of intra and extra-hospital teaching and information activities were planned to report on the Robotic Surgery Plan. RESULTS Between July 2006 and July 2008, 306 patients were operated on: 169 by General Surgery, 107 by Urology and 30 by Gynaecology teams. The outcomes showed feasibility and a short learning curve. The educational plan included residents and staff interested in robotic technology application. CONCLUSION The structured and gradual incorporation of robotic surgery throughout the PCR-HCSC has made it easier to learn, to share designed infrastructure, to coordinate information activities and multidisciplinary collaboration. This preliminary experience has shown the efficiency of an adequate organization and motivated team.

Vascular Endothelial Growth Factor (VEGF) Polymorphisms and Serum VEGF Levels in Women With Epithelial Ovarian Cancer, Benign Tumors, and Healthy Ovaries

Objective This study analyzed the relation of 5 single-nucleotide polymorphisms (SNPs) in the VEGF (vascular endothelial growth factor) gene in patients with epithelial ovarian cancer (EOC), compared with patients carrying benign tumors or healthy ovaries. We studied serum VEGF levels and the relation with SNPs and association between VEGF SNPs and haplotypes with progression-free survival (PFS) in patients with cancer. Methods The genotyping of VEGF gene polymorphisms (−2578 C/A, −1154 G/A, −460 T/C, +405 G/C, +936 C/T) was performed in DNA isolated from blood samples of 100 women. The different genotypes were evaluated by quantitative real-time polymerase chain reaction. Vascular endothelial growth factor protein concentration was assessed in serum using solid-phase sandwich enzyme-linked immunosorbent assay. Results We found statistically significant differences in the distribution of VEGF genotypes among the 3 groups of patients: −2578 C/A between those with EOC and healthy ovary (P = 0.04), −460 T/C between those with EOC and healthy ovary (P = 0.03), and −460 T/C between those with benign tumors and healthy ovary (P = 0.02). Vascular endothelial growth factor serum levels were analyzed in patients with EOC. Higher levels were found in patients with clear cell carcinoma compared with those with serous, mucinous, or endometrioid tumors (P < 0.05). No clear association was observed between VEGF SNPs and serum VEGF levels. There was no significant correlation between VEGF SNPs and PFS. In haplotype analysis, CGTCT and CGTGT showed worse prognosis without reaching the statistical significance. CGCGC and AGTGC haplotypes had statistically significant differences among patients with EOC, benign tumors, and healthy ovaries (Ps = 0.046 and 0.041, respectively). Conclusions The distribution of VEGF genotypes was different in patients with EOC, compared with those with benign tumors or women with healthy ovaries. Vascular endothelial growth factor serum levels were higher in patients with clear cell carcinoma. No correlation was found with improved PFS, but CGTCT and CGTGT haplotypes showed worse prognosis.

OriginalDesarrollo multidisciplinario de la cirugía robótica en un hospital universitario de tercer nivel: organización y resultadosMultidisciplinary development of robotic surgery in a University Tertiary Hospital: Organization and outcomes

Background Da Vinci system (Intuitive Surgical®) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation…) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC.BACKGROUND Da Vinci system (Intuitive Surgical) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation...) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC. MATERIAL AND METHODS Starting from joint management and joint scrub nurses team, General and Digestive Surgery, Urology and Gynaecology Departments were progressively incorporated into the Robotic Surgery Plan, with several procedures increasing in complexity. A number of intra and extra-hospital teaching and information activities were planned to report on the Robotic Surgery Plan. RESULTS Between July 2006 and July 2008, 306 patients were operated on: 169 by General Surgery, 107 by Urology and 30 by Gynaecology teams. The outcomes showed feasibility and a short learning curve. The educational plan included residents and staff interested in robotic technology application. CONCLUSION The structured and gradual incorporation of robotic surgery throughout the PCR-HCSC has made it easier to learn, to share designed infrastructure, to coordinate information activities and multidisciplinary collaboration. This preliminary experience has shown the efficiency of an adequate organization and motivated team.

Rotura prematura de membranas antes de la semana 28 de gestación y resultados neonatales

Resumen Objetivo Describir las caracteristicas y el pronostico del manejo conservador en gestantes con rotura prematura de membranas pretermino (RPMP). Material y metodos Estudio observacional descriptivo de 65 casos de RPMP Resultados Caracteristicas principales: gestacion multiple (29,3%), exudado positivo para Estreptococcus agalactiae ( Streptococcus del grupo B) (14,85%) y RPMP anterior (16%). La mediana de dias de bolsa rota (BR), cuando el indice de Bishop es El manejo conservador no aumenta la morbimortalidad, salvo que presenten oligoamnios moderado-severo: el 100% de las corioamnionitis y el 69% de la mortalidad perinatal ocurrieron en gestantes con oligoamnios. Conclusiones Las gestantes con RPMP

Teratoma inmaduro de ovario en la gestación

Resumen La incidencia de masas anexiales en la gestacion es de 1 por 1.000 embarazos; de ellos, el 3% son malignos. La mayoria de estas masas son asintomaticas y el diagnostico se realiza frecuentemente mediante un hallazgo casual en la ecografia obstetrica; lo mas comun es que sea en el segundo trimestre. El manejo de los tumores ovaricos depende de su naturaleza y clinica. En los casos en que se sospeche malignidad es necesaria una cirugia de estadificacion e incluso asociar quimioterapia. En estos casos, debe intentarse conservar la fertilidad. Presentamos 2 casos de teratomas inmaduros de ovario en gestantes.

Diagnóstico diferencial entre lupus eritematoso sistémico y preeclampsia en una gestante

Presentamos el caso de una mujer de 18 anos que durante el tercer trimestre de su embarazo comenzo con hipertension arterial (HTA) y proteinuria y fue diagnosticada de preeclampsia. La gestacion finalizo con exito, habiendose controlado satisfactoriamente con tratamiento antihipertensivo. En el plazo de una semana tras el parto desarrollo un sindrome de HELLP y una insuficiencia renal y respiratoria aguda, y fue diagnosticada entonces de lupus eritematoso sistemico y se inicio tratamiento con esteroides, plasmaferesis, hemodialisis y ciclofosfamida. La situacion clinica se complico al sufrir una neumonia por Acynetobacter. Creemos que se trato de una preeclampsia superimpuesta a una nefropatia lupica hasta entonces silente.

Metástasis mamaria de melanoma

Resumen El melanoma es uno de los principales tumors que metastatizan en la mama. El problema es su diagnostico, ya que no hay imagenes radiologicas especificas, por lo que el diagnostico anatomopatologico es fundamental. Se comentan 2 casos clinicos donde la aparicion de una lesion sospechosa de malignidad en la mama esta precedida de un antecedente de melanoma. Se confirmo el diagnostico de tumor metastasico en dichas lesiones mediante inmunohistoquimica y se descarto la cirugia. Ante la sospecha de una lesion metastasica en la mama, se deberia realizar inmunohistoquimica mediante biopsia diferida o puncion-aspiracion con aguja fina, evitando asi realizar una mastectomia en caso de confirmarse el diagnostico